Corin is a cardiac protease that regulates BP (blood pressure) by activating natriuretic peptides. Recent animal studies identified corin expression in the kidney where it may regulate renal function. In the present study, we tested the hypothesis that corin may be present in human urine and that urinary corin levels may be altered in patients with kidney disease. We obtained urine and kidney tissue samples from normal individuals and CKD (chronic kidney disease) patients. Using ELISA, we detected corin protein in human urine. In normal individuals, urinary corin levels did not correlate with that of plasma, indicating that urinary corin is probably of kidney origin. Compared with normal controls, CKD patients had markedly reduced urinary corin levels and this reduction correlated with disease severity. By immunostaining, human corin protein was identified on the epithelial cell surface in renal tubules. The renal corin mRNA and protein levels were significantly lower in CKD patients than non-CKD controls. The results indicate that renal tubular corin may be shed into urine and that urinary and renal corin levels were reduced in CKD patients. These data suggest that reduced corin levels in the kidney may reflect the underlying pathology in CKD.

BACKGROUNDAllergic transfusion reactions (ATRs) are a common adverse reaction to transfusion therapy and can be potentially fatal. Washing blood products is the most effective strategy for preventing ATRs; however, washed products, especially platelets, are not available at many blood centers.STUDY DESIGN AND METHODSA 29‐year‐old female patient with an advanced myelodysplastic/myeloproliferative neoplasm, unclassifiable, developed severe ATRs after four platelet transfusions in a week. She showed no response to premedication with histamines and steroids and still had severe ATRs with the next three platelet transfusions. A laboratory workup revealed that her IgA level was slightly decreased, while her haptoglobin level was normal. Anti‐IgA testing was not available. The patient decided to undergo allogeneic peripheral blood stem cell (PBSC) transplantation. As the onset of symptoms ATR, which were similar to Type 1 hypersensitivity reactions mediated by IgE antibodies, occurred immediately after transfusion and omalizumab is a humanized monoclonal anti‐IgE, we elected to offer off‐label use of omalizumab before administering the conditioning regimen.RESULTSOmalizumab was injected subcutaneously at a dose of 150 mg. Surprisingly, transfusion reactions fully resolved within 24 hours. No serious side effects were noticed. Another 150 mg of omalizumab was administered 1 day before PBSC infusion. The patient remained asymptomatic without any signs of ATRs throughout the whole period of transplantation. Seven months after transplantation, the patient was in complete remission without overt complications.CONCLUSIONThis case suggests that omalizumab is a promising new alternative treatment for the prevention of severe ATRs.

Severe Pneumocystis pneumonia (PCP) has a poor prognosis, and its early and precise diagnosis is difficult in immunocompromised individuals. Therefore, this study explored the diagnostic value of metagenomic next-generation sequencing (mNGS) of peripheral blood in diagnosing severe PCP in patients with hematological diseases. This prospective study analyzed the clinical manifestations, mNGS results (from the peripheral blood), traditional pathogen detection results, laboratory test results, chest computed tomography (CT) images, treatments, and outcomes of severe PCP in hematological patients who were hospitalized in the 2 centers of the Affiliated Hospital of Soochow University between September 2019 and October 2021. A total of 31 cases of hematological diseases complicated with pulmonary infections, including 7 cases of severe PCP diagnosed by mNGS performed on peripheral blood samples, were analyzed. Traditional pathogen detection methods for PCP cannot be used. In contrast, the laboratory readings for Pneumocystis jirovecii (Pj ) detected within 48 hours of symptom onset by mNGS on the 7 blood samples ranged from 12 to 5873, with a median value of 43. Under the guidance of the mNGS results, preemptive antimicrobial therapy with trimethoprim/sulfamethoxazole alone or in combination with caspofungin was administered to treat Pj . After treatment, 4 patients recovered, and 3 patients died of acute respiratory failure and acute respiratory distress syndrome (ARDS). MNGS performed on peripheral blood samples is optional but can provide early recognition of severe PCP and help guide empirical treatment in critical hematological patients.

Objectives This study aimed to explore useful clinical indexes for management of severe/critically ill patients with COVID-19, Influenza A H7N9 and H1N1 pneumonia by comparing hematological and radiological characteristics between them. Methods Severe/critically ill patients with confirmed diagnosis of COVID-19, Influenza A H7N9 and H1N1 pneumonia were retrospectively enrolled. The demographic data, clinical manifestations, hematological parameters, and radiological characteristics of three groups were compared. The influenza A was divided into two groups with/without patient death. Results In this study, 16 cases of COVID-19, 10 cases of influenza A (H7N9), and 13 cases of influenza A (H1N1) who met severe/critically ill criteria were included. Compared with COVID-19, the Influenza A (H7N9 and H1N1) groups had relatively more chronic diseases (80% and 92.3% vs 25%, P༜0.05), higher APACHE Ⅱ scores (16.00 ± 8.63 and 15.08 ± 6.24, vs 5.50 ± 2.58, P༜0.05) and higher mortality rates (40% and 46.2% vs 0%, P༜0.05). The hematological finding indicated that Influenza A H7N9 and H1N1 patients had more significant lymphocytopenia (0.59 ± 0.31 × 109/L and 0.56 ± 0.35 × 109/L vs 0.97 ± 0.33 × 109/L, P < 0.05), elevated neutrophil to lymphocyte ratio (NLR; 14.67 ± 6.10 and 14.64 ± 10.36 vs 6.29 ± 3.72, P < 0.05) compared to COVID-19. Especially in influenza A patients, NLR was significant different between the patients with or without death. Compared with the H7N9 group, ground glass opacity (GGO) on chest CT was more common in the COVID-19 group (P = 0.028), while pleural effusion was relatively rare (P = 0.001). Conclusion Compared to COVID-19, patients with Influenza A (H7N9 and H1N1) had more underlying chronic diseases and higher mortality rates. The NLR can be used as a clinical parameter for the predication of risk stratification and outcome in COVID-19 and Influenza A pneumonia. Manifestations of pleural effusion or GGO in chest CT may be helpful for the identification of different viral pneumonia.