BACKGROUND Vedolizumab, a newer class of integrin antagonist biological agents, has been applied to treat patients with moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), especially for patients who are refractory to traditional therapies and tumor necrosis factor antagonists. However, some rare but life-threatening adverse effects warrant pharmacovigilance. We describe the first fatal case of vedolizumab-associated severe diffuse interstitial lung disease in China. CASE SUMMARY We present a case of new-onset diffuse parenchymal lung disease developing under treatment with vedolizumab in a patient with UC. After two doses of vedolizumab, he developed persistent fever and progressively worsening dyspnea. Extensive workups, including bronchoalveolar lavage, transbronchial lung biopsy and metagenomic next-generation sequencing, identified no infectious causes, and other potential causes (such as tumors and cardiogenic pulmonary edema) were also excluded. As a result, a diagnosis of vedolizumab-related interstitial lung disease was established. Unfortunately, although corticosteroids and empiric antibiotics were administered, the patient eventually died of respiratory failure. CONCLUSION Vedolizumab-related interstitial lung disease in patients with UC is rare but potentially lethal. Gastroenterologists and pulmonologists should be aware of vedolizumab-related adverse drug reactions.
ObjectiveExtracorporeal membrane oxygenation (ECMO) is increasingly used in critically ill patients with respiratory and/or cardiac failure. This study aimed to investigate the epidemiology and risk factors of nosocomial infection (NI) in pediatric patients who underwent ECMO for respiratory and/or circulatory failure.MethodsMedical records for patients that were administered underwent ECMO support at Xiangya Second Hospital of Central South University, The Sixth Medical Center of PLA General Hospital, and Children's Hospital Affiliation of Zhengzhou University, from September 2012 to December 2019 were retrospectively reviewed. Clinical data of the patients who developed NI were collected and analyzed. Univariate and multivariate logistic regressions were performed to identify the independent predictive factors of NI during ECMO.ResultsA total of 54 first episodes of NI were identified in the 190 patients on ECMO, including 32 cases of respiratory tract infections, 20 cases of bloodstream infections, and 2 cases of surgical site wound infections. Gram-negative pathogens were the dominant pathogens isolated, accounting for 92.6% of the NI. The incidence of ECMO-related NI was 47.6 cases per 1,000 ECMO days. In the univariate logistic regression, ECMO mode, ECMO duration, ICU duration, and peritoneal dialysis were associated with the development of NI in patients with ECMO support. However, in the multivariate analysis, only ECMO duration (OR = 2.46, 95%CI: 1.10, 5.51; P = 0.029), ICU duration (OR = 1.35, 95%CI: 1.05, 1.59; P = 0.017) and peritoneal dialysis (OR = 2.69, 95%CI: 1.08, 5.73; P = 0.031) were the independent predictive factors for NI during ECMO support.ConclusionThis study identified the significant correlation between ECMO-related NI and ECMO duration, ICU duration, and peritoneal dialysis. Appropriate preventive measures are needed for hospitals to reduce the incidence of ECMO in pediatric patients.
Acid-suppressive medication use in acute stroke patients: is it time to change practice? Dear editor, Previous studies have shown that use of acid-suppressive medications may be associated with an increased risk of both community-and hospital-acquired pneumonia (HAP) (1). Stroke patients are particularly at high risk for HAP because of stroke-associated deficits such as somnolence and dysphagia. Two studies from China reported an increased risk of HAP in stroke patients who were given protonpump inhibitors (2) and histamine-2 receptor antagonists (3). Recently, Herzig et al. showed an increased risk for nosocomial pneumonia in hospitalized stroke patients who were treated with acid-suppressive medications (4). Significantly, after adjusting for 30 covariates, the odds ratio of HAP in the exposed group was 2•3 [95% confidence interval (CI) = 1•2-4•6]. The authors concluded that acid-suppressive medication use was associated with more than double the odds of HAP in patients presenting with acute stroke and recommended more restrictive use of these medications.
Despite of the fact that the traffic control zone for maintenance work (work zone) has been recognized as one of major priorities to guarantee the traffic safety, only one conventional posted speed limit (PSL) strategy is applied into the organization and management. This article presents the strategy of the variable speed limit (VSL) on highway work zones that brings about gradual deceleration and low speed variance. To evaluate the safety of the proposed VSL strategy, this study uses the microscopic simulation software VISSM to estimate the traffic flow and adopt transversal and longitudinal coefficients of safety (MSDE and cv) to compare the different speed limit strategies. The results of simulation and analysis confirm that VSL yield a substantial decrease the traffic turbulence caused by speed limit and increase the traffic safety throughout work zones.
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