Effect of low-molecular-weight heparins on anti-Xa peak levels and adverse reactions in Chinese patients with recurrent spontaneous abortion: a single-center, observational study

Objective To compare three commonly used low-molecular-weight heparins (LWMHs) in the treatment of recurrent spontaneous abortion (RSA) by evaluating the anti-Xa peak levels and adverse reactions. Methods In this single-center, observational study, we enrolled 310 patients with RSA in whom anti-Xa levels were measured during pregnancy. Patients were divided into three groups according to the LMWH they used: the nadroparin group, enoxaparin group and dalteparin group. We compared the peak anti-Xa levels and the coagulation status of each group, and analyzed the incidence of adverse reactions, including local allergy, liver and renal dysfunction, and the impact on platelet. Results Patients in the enoxaparin group had a higher anti-Xa peak level than those in the nadroparin group (0.80 ± 0.22 IU/ml vs. 0.61 ± 0.24 IU/ml; P < 0.0001), although most patients in the three groups reached the target concentration of anti-Xa. Furthermore, patients in the enoxaparin group had a more stable anti-Xa levels during pregnancy. In addition, patients in the nadroparin group had a higher rate of local allergy than those in the enoxaparin group (60.5% vs. 42.5%; P = 0.004) and those in the dalteparin group (60.5% vs. 33.3%; P = 0.002). Further examination by the type of local allergy indicated a dramatic difference in pruritus and induration between the nadroparin group and the other two groups. No difference was found in the incidence of liver and renal dysfunction and thrombocytopenia. Conclusion Compared with nadroparin and daltepatin, enoxaparin showed a better performance regarding anti-Xa levels and the incidence of adverse reactions in the treatment of RSA.

Eosinophilic peritonitis in a patient with liver cirrhosis: A case report

Eosinophilic gastroenteritis (EG) is a gastrointestinal disease characterized by abnormal infiltration of eosinophilic cells in the gastrointestinal tract, excluding known causes of eosinophilia. Eosinophilic peritonitis (EP) is rare and is considered by most scholars to be a systemic or local allergy to exogenous or endogenous allergens. It is a clinical manifestation of eosinophilic gastroenteritis involving the serosal layer. Hereby, we report a case of EP in a patient with liver cirrhosis. A 32-year-old man was admitted to our hospital for intermittent fatigue, abdominal distension and abdominal pain. On account of clinical feature and pathological results of peritoneal puncture biopsy, excluding other causes of peripheral eosinophilia, the diagnosis of EP with hepatic cirrhosis was established. The possibility of EP should be paid great attention to patients with cirrhosis with peritonitis. Gastrointestinal endoscope biopsy, laparoscopy or peritoneal puncture biopsy are conducive to the diagnosis and differential diagnosis. Therefore, once the disease is suspected, gastrointestinal endoscope biopsy should be performed actively, and multiple pathological samples should be taken to contribute to diagnosis and treatment. Laparoscopy or peritoneal puncture biopsy is of vital significance for definitive diagnosis.

Role of local allergic inflammation and Staphylococcus aureus enterotoxins in Chinese patients with chronic rhinosinusitis with nasal polyps

Objective:To investigate the role of local allergic inflammation and Staphylococcus aureus enterotoxins in chronic rhinosinusitis with nasal polyps.Methods:This study included 36 patients with chronic rhinosinusitis with nasal polyps and 18 controls. Total immunoglobulin E, eosinophil cationic protein, staphylococcal enterotoxin types A and B specific immunoglobulin E, staphylococcal enterotoxin types A and B, and myeloperoxidase levels were determined.Results:Four patients with chronic rhinosinusitis with nasal polyps had a local allergy. All chronic rhinosinusitis with nasal polyps patients tested negative for staphylococcal enterotoxin types A and B specific immunoglobulin E. The chronic rhinosinusitis with nasal polyps group had significantly elevated staphylococcal enterotoxin types A and B levels in the supernatant. Fourteen patients belonged to the eosinophilic chronic rhinosinusitis with nasal polyps group and the others were characterised as having non-eosinophilic chronic rhinosinusitis with nasal polyps.Conclusion:Local allergy may play a role in chronic rhinosinusitis with nasal polyps, independent of staphylococcal enterotoxin superantigens. Staphylococcal enterotoxins may be important in the pathogenesis of chronic rhinosinusitis with nasal polyps; however, their roles as superantigens were not confirmed in this study. In Chinese subjects, chronic rhinosinusitis with nasal polyps usually manifests as a neutrophilic inflammation.

Individualized versus fixed dosing of L-asparaginase during intensification therapy in children treated on Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocol 00–001

20000 Background: Asparaginase (ASP) is an important agent in the treatment of ALL, but is associated with multiple toxicities. In an attempt to reduce toxicity and improve ASP tolerability, we investigated individualizing the dose to maintain nadir serum ASP levels at the minimum concentration (0.01 - 0.014 IU/ml) required to achieve asparagine depletion. Methods: 399 children (1–18 years) with newly diagnosed ALL were randomized to receive intramuscular E.coli ASP either as fixed dose (FD) (N=201; 25,000 IU/m2/week) or individualized dose (ID) (N=198; 12,500 IU/m2/week starting dose, adjusted up or down every 3 weeks based upon nadir serum ASP level) for 30 weeks during post-induction intensification. We report here on 365 randomized patients (pts) who had 7-day nadir ASP levels measured (185 FD and 180 ID). Serum ASP levels were measured prior to ASP doses 2, 4 and every third subsequent dose. ASP-antibodies (ab) were measured every six weeks. Results: The median dose for ID pts was17,500 IU/m2 (range 6,000–28,000 IU/m2). The median ASP concentration was 0.11 IU/ml (range < 0.025- 2.16 IU/ml) for FD (N=1190 samples) and 0.08 IU/ml (range < 0.025–0.74 IU/ml) for ID (N= 1238 samples) (p<0.01). The interpatient variability in ASP concentration was smaller for ID vs. FD at all 10 time points measured. The proportion of pts who had detectable E.coli-ASP antibodies did not differ between the two arms (35% FD vs. 40% ID) (p= 0.33). The median ASP concentration was lower for ab-positive pts (0.08 IU/ml vs. 0.1 IU/ml, (p<0.01). Toxicity was similar in the two arms: local allergy: 6% FD vs. 8% ID (p= 0.55); systemic allergy: 12% FD vs. 14% ID (p= 0.54); pancreatitis: 5% FD vs. 7% ID (p= 0.66); thrombosis: 8% FD vs. 7% ID (p= 0.84). No association was observed between nadir ASP levels and either pancreatitis or thrombosis. Conclusions: Individualized dosing of E.coli ASP during intensification therapy reduced peak nadir ASP levels and interpatient variability but did not significantly decrease the incidence of ASP-related toxicity. Longer follow-up is necessary to determine event-free survival of the randomized pts. No significant financial relationships to disclose.