Summary. Background: Immune thrombocytopenia (ITP) is a common autoimmune bleeding disorder, in which platelet glycoprotein (GP)IIb-IIIa and GPIb-IX are the two most frequently targeted autoantigens. Our previous studies in animal models of ITP demonstrated that intravenous immunoglobulin G (IVIG) could protect against antiGPIIb-IIIa autoantibody-mediated thrombocytopenia but failed to ameliorate ITP induced by most anti-GPIb-IX autoantibodies. Objectives: The objective of this human study was to evaluate the association between the specificity of antiplatelet autoantibodies and response to IVIG treatment. Patients/Methods: In this retrospective study, a cohort of 156 previously untreated adults with severe ITP who underwent IVIG therapy (0.4 g kg À1 day À1 for 5 days) was analyzed. The primary outcome was response defined as platelet counts of ≥ 30 9 10 9 L À1 and a doubling of baseline counts within 7 days of dosing, and an absence of bleeding. Results and Conclusions: Among the 66 patients with anti-GPIb-IX autoantibodies, only 24 (36.4%) achieved a response, as compared with 72 of 90 patients (80.0%) who were negative for anti-GPIb-IX autoantibodies (relative risk 2.2; 95% confidence interval 1.6-3.1). This study found no difference in response between patients with anti-GPIIb-IIIa autoantibodies (61.7%) and those without anti-GPIIb-IIIa autoantibodies (61.3%). Logistic regressions, including main effects and the interaction between these two autoantibodies, showed no influence of anti-GPIIb-IIIa autoantibodies on the effects of anti-GPIb-IX autoantibodies with regard to their association with IVIG response. Thus, in adults with ITP, the presence of anti-GPIb-IX autoantibodies is a predictive factor for poor response to IVIG treatment. Trial registration: ClinicalTrials.gov NCT01666795.
Haemorrhagic fever with renal syndrome (HFRS) is a type of vector-borne zoonosis sensitive to climate change. To explore the short-term effect of air temperature and amount of precipitation on HFRS incidence, a total of 13 722 clinically confirmed HFRS cases from January 1977 to December 2001 in Junan County, China were included in this study. According to symmetric bidirectional case-crossover design, the hazard period (the three calendar months preceding the month when the case was diagnosed) and the control period (the same calendar month of the year before and the year after the hazard period) matched and conditional logistic regression was used to examine the effect of monthly mean temperature and precipitation on the risk of HFRS. The results showed the facilitating climatic conditions for HFRS included: condition with moderate mean air temperature (10-25 °C) and abundant precipitation (>120 mm) 3 months before [odds ratio (OR) 1·346, 95% confidence interval (CI) 1·191-1·522] and 2 months before (OR 1·193, 95% CI 1·063-1·339); and condition with temperature >25 °C and abundant precipitation (>120 mm) 3 months before (OR 1·17, 95% CI 1·004-1·363). Temperature of 10-25 °C and moderate precipitation (10-120 mm) in the current month was the most favourable condition for HFRS incidence.
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