Hypereosinophilia, mastectomy, and nephrotic syndrome in a male patient: A case report

BACKGROUND Hypereosinophilia(HE)is a heterogeneous disease of unknown etiology in which tissue and organ injury is inflicted by excess numbers of circulating or infiltrating eosinophils.Herein,we describe a patient with rare organ damage due to HE and review the pertinent literature.CASE SUMMARY A 43 year-old Chinese man with a 13-year history of eosinophilia and shortness of breath for 7 d presented to our hospital.During the course of his illness,the patient variably presented with gastrointestinal symptoms,eczema,vitiligo,mastitis,joint symptoms,nephrotic syndrome,and interstitial pneumonia.The chronic mastitis proved burdensome,necessitating bilateral mastectomy.HE was diagnosed by repeat bone marrow biopsy,and a kidney biopsy showed focal segmental glomerulosclerosis.Intermittent steroidal therapy is typically initiated to relieve such symptoms,although relapse and organ involvement often ensue once treatment is withdrawn.We administered methylprednisolone sodium succinate(40 mg/d)intravenously for 3 d,followed by oral tablets at the same dose.Subsequent computed tomography(CT)of the chest CT showed relative improvement of the interstitial pneumonia.The patient is currently on a continuous regimen of oral steroid,and his condition is stable.CONCLUSION HE is heterogeneous condition.This is the first reported case of bilateral mastectomy in a male patient with longstanding HE.

Neurothekeoma located in the hallux and axilla:Two case reports

BACKGROUND Neurothekeomas(NTKs)are rare benign soft tissue tumours that typically occur in the head,trunk,and upper limbs and are rare in other parts of the body.CASE SUMMARY Herein,we present two rare cases in which primary NTKs were located in the hallux and axilla.A 47-year-old woman complained of a verrucous bulge on the plantar side of the left hallux.The surface skin of the tumour was abraded due to poor wound healing.A 6-year-old boy complained of a gradually growing subcutaneous mass in the axilla.The tumours of both patients were completely resected,and the diagnosis of NTK was confirmed by histopathology.At the oneyear follow-up,both patients had a good prognosis without local recurrence.CONCLUSION To date,NTKs located in the hallux and axilla have rarely been reported in the literature.We describe NTKs that occurred in unconventional areas and summarize the challenges in their diagnosis and differential diagnosis.

Expert consensus on the use of human serum albumin in critically ill patients

Introduction Human serum albumin(HSA)is a non-glycosylated,negatively charged,single-chain polypeptide composed of 585 amino acid residues with a relative molecular mass of 66.438 kD.It is synthesized by the liver at a rate of approximately 200 mg·kg^(-1)·day^(-1),with a half-life of 21 days,and subjected to catabolism in the muscles,liver,and kidneys at a rate of 4%per day.[1]Albumin,accounting for 60%of the total plasma protein,has various physiological functions,[2]such as maintaining 70%to 80%of effective plasma colloid osmotic pressure,coordinating vascular endothelial integrity,anti-oxidant and anti-inflammatory activities,maintaining the acidbase balance,and participating in the transport,distribution,and metabolism of a variety of endogenous and exogenous substances.

Expert recommendations on blood purification treatment protocol for patients with severe COVID-19

Coronavirus disease(COVID-19)was first diagnosed in Wuhan in December 2019.The World Health Organization defined the subsequent outbreak of COVID-19 worldwide as a public health emergency of international concern.Epidemiological data indicate that at least 20%of COVID-19 patients have severe disease.In addition to impairment of the respiratory system,acute kidney injury(AKI)is a major complication.Immune damage mediated by cytokine storms and concomitant AKI is a key factor for poor prognosis.Based on previous experience of blood purification for patients with severe acute respiratory syndrome and Middle East respiratory syndrome combined with clinical front-line practice,we developed a blood purification protocol for patients with severe COVID-19.This protocol is divided into four major steps.The first step is to assess whether patients with severe COVID-19 require blood purification.The second step is to prescribe a blood purification treatment for patients with COVID-19.The third step is to monitor and adjust parameters of blood purification.The fourth step is to evaluate the timing of discontinuation of blood purification.It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implemenlation of the present protocol.

Expert consensus on management of analgesia and sedation for patients with severe coronavirus disease 2019

The coronavirus disease 2019(COVID-19)has been declared a global pandemic and is a major public health issue worldwide.COVID-19 is a systemic disease damaging multiple organs,including the lung as the main target organ.

Focus on coronavirus disease 2019 associated coagulopathy

The coronavirus disease 2019(COVID-19)has caused a global outbreak and became a major public health issue globally.It has been found that COVID-19 patients are commonly complicated with coagulation abnormities,which are closely associated with the severity and prognosis of patients.A thorough understanding of the prevalence of coagulopathy and potential causes of abnormities of coagulation parameters in COVID-19 patients is crucial for clinicians to standardize the diagnosis and management of COVID-19 associated coagulopathy.

Expert consensus on blood pressure management in critically ill patients

Introduction For critically ill patients with unstable hemodynamics,goal‑directed therapy for arterial blood pressure is needed with continuous daily bedside monitoring.The prevalence of hypertension in Chinese adults is 25.2%,of which 1–2%of patients may experience a hypertensive emergency,with a mortality rate of 6.9%in the acute phase.The mortality and readmission rates within 90 days of onset are as high as 11%.[1]Furthermore,the mortality rate for patients who experience hypertensive emergencies can reach 50%within 12 months of the incident.[2]The incidence of perioperative hypertension in patients undergoing cardiac surgery is approximately 50%,with this figure dropping to 25%for non-cardiac surgery.Surgery may increase the incidence of perioperative cardio-cerebrovascular adverse events by 3–5%.[3]