Clinical presentation of hemophagocytic lymphohistiocytosis in adults is less typical than in children

OBJECTIVE: Hemophagocytic lymphohistiocytosis in adults is largely underdiagnosed. To improve the rate and accuracy of diagnosis in adults, the clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis were analyzed in and compared between adults and children in a Chinese cohort. METHOD: Data from 50 hemophagocytic lymphohistiocytosis patients, including 34 adults and 16 children who fulfilled the 2004 hemophagocytic lymphohistiocytosis diagnostic criteria, were collected and analyzed. RESULTS: 1. Etiological factors: The proportion of Epstein-Barr virus infection was lower in adults compared with children, whereas fungal infection and natural killer/T cell lymphoma were more frequent in adults (

Brain-Heart Modulation of the Autonomic Nervous System in Older Adults ‘at-risk’ of Dementia: a Study of Heart Rate Variability During Sleep

Dementia is a devastating disease that currently cannot be effectively cured. A better understanding of the early physiologic processes in people ‘at-risk’ of developing dementia could improve our ability to differentiate various pathophysiological processes contributing to dementia pathology. Research examining the integrity of the autonomic nervous system is mixed for various types of dementia, as well as people who are ‘at-risk’ of dementia. Studying autonomic activities, especially parasympathetic activities during sleep - via heart rate variability can potentially shed light on the mixed findings of studies that have been conducted during the daytime. Furthermore, proper autonomic regulation is dependent on both the functional and structural integrity of the brain. It is therefore crucial to understand how the central nervous system interacts with the autonomic nervous system. The overarching aim of the current thesis is to examine autonomic function during sleep, specifically parasympathetic function via high-frequency heart rate variability in older adults ‘at-risk’ of dementia, and how such parasympathetic dysfunction during sleep is linked to cognition, and the morphological and functional integrity of the brain. In a series of three studies, the work of this thesis has revealed that reduced nocturnal high-frequency heart rate variability is: a) present in older adults with amnestic mild cognitive impairment, who are at high risk of developing dementia, especially dementia due to Alzheimer’s disease; b) associated with reduced verbal episodic memory performance and hippocampal atrophy; and c) associated with reduced brain functional connectivity in key regions modulating autonomic responses including the insula, cingulate cortex, thalamus and amygdala. The combined evidence has highlighted the potential of nocturnal heart rate variability as a marker of early neurogenerative disease in older adults ‘at-risk’ of cognitive decline

Efficacy and safety of umbilical cord mesenchymal stem cells for the treatment of patients with COVID-19

OBJECTIVES: The coronavirus disease (COVID-19) outbreak has catastrophically threatened public health worldwide and presented great challenges for clinicians. To date, no specific drugs are available against severe acute respiratory syndrome coronavirus 2. Mesenchymal stem cells (MSCs) appear to be a promising cell therapy owing to their potent modulatory effects on reducing and healing inflammation-induced lung and other tissue injuries. The present pilot study aimed to explore the therapeutic potential and safety of MSCs isolated from healthy cord tissues in the treatment of patients with COVID-19. METHODS: Twelve patients with COVID-19 treated with MSCs plus conventional therapy and 13 treated with conventional therapy alone (control) were included. The efficacy of MSC infusion was evaluated by changes in oxygenation index, clinical chemistry and hematology tests, immunoglobulin (Ig) levels, and pulmonary computerized tomography (CT) imaging. The safety of MSC infusion was evaluated based on the occurrence of allergic reactions and serious adverse events. RESULTS: The MSC-treated group demonstrated significantly improved oxygenation index. The area of pulmonary inflammation decreased significantly, and the CT number in the inflammatory area tended to be restored. Decreased IgM levels were also observed after MSC therapy. Laboratory biomarker levels at baseline and after therapy showed no significant changes in either the MSC-treated or control group. CONCLUSION: Intravenous infusion of MSCs in patients with COVID-19 was effective and well tolerated. Further studies involving a large cohort or randomized controlled trials are warranted

Clinical presentation of hemophagocytic lymphohistiocytosis in adults is less typical than in children

OBJECTIVE: Hemophagocytic lymphohistiocytosis in adults is largely underdiagnosed. To improve the rate and accuracy of diagnosis in adults, the clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis were analyzed in and compared between adults and children in a Chinese cohort. METHOD: Data from 50 hemophagocytic lymphohistiocytosis patients, including 34 adults and 16 children who fulfilled the 2004 hemophagocytic lymphohistiocytosis diagnostic criteria, were collected and analyzed. RESULTS: 1. Etiological factors: The proportion of Epstein-Barr virus infection was lower in adults compared with children, whereas fungal infection and natural killer/T cell lymphoma were more frequent in adults (P19 mmol/L and lactate dehydrogenase >500 U/L compared with adults (P<0.05). 3. The time interval from the onset of symptoms to clinical diagnosis was significantly shorter in pediatric patients than in adults (P<0.05). CONCLUSIONS: Certain clinical features were different between the two groups. The less characteristic clinical presentation of hemophagocytic lymphohistiocytosis in adults may make the disease more difficult to diagnose. Our findings suggest that hemophagocytic lymphohistiocytosis should be considered when an adult patient presents with the above-mentioned symptoms