Most studies reported that high plasma endothelin-1 (ET-1), big ET-1, and C-terminal proET-1 (CT-proET-1) were correlated with poor prognosis of heart failure (HF). However, available evidence remains controversial. To help solve the debate, we collected all the available studies and performed a meta-analysis. We searched the databases covering Embase, PubMed, Ovid, and Web of Science on June 28, 2017. The hazard ratio (HR) or risk ratio (RR) and its 95% confidence intervals (CIs) were collected and calculated by use of a random-effect model. Heterogeneity was assessed by Cochran's Q test, and publication bias was assessed by funnel plots with Egger's and Begg's linear regression test. Thirty-two studies with 18,497 patients were included in the analysis. Results showed that circulating ET-1, big ET-1, and CT-proET-1 were positively correlated with high risk of adverse outcomes, with pooled RRs (95% CIs) of 2.22 (1.82–2.71, P < .001), 2.47 (1.93–3.17, P < .001), and 2.27 (1.57–3.29, P < .001), respectively. In the subgroup of death as primary outcome, the pooled RRs (95% CIs) were 2.13 (1.68–2.70, P < .001), 2.55 (1.82–3.57, P < .001), and 2.02 (1.39–2.92, P < .001) for ET-1, big ET-1, and CT-proET-1, respectively. No significant publication bias was observed in this study. Our meta-analysis provided evidence that increased plasma levels of ET-1, big ET-1, and CT-proET-1 were associated with poor prognosis or mortality for HF populations.

Rationale: This study aimed to address the diagnostic challenges associated with MYH9-related disorders (MYH9-RDs) and highlight the importance of recognizing Döhle body-like inclusions as crucial diagnostic markers for this condition. Patient concerns: Patients with MYH9-RDs often present with mild and diverse clinical characteristics, leading to misdiagnosis, delayed diagnosis, and inappropriate treatments, such as hormonal therapy and splenectomy. This section highlights the significance of understanding atypical clinical presentations and their impact on patients’ well-being. Diagnoses: This section emphasizes the misdiagnosis of MYH9-RDs as immune thrombocytopenia due to overlapping clinical features. This highlights the need for a comprehensive approach, including detailed personal and family history, careful review of peripheral blood smears, and identification of Döhle body-like inclusions to differentiate MYH9-RDs from other conditions. Intervention: This study advocates for a shift in the diagnostic approach, urging physicians to pay closer attention to the morphological features observed in peripheral blood smears, particularly the presence of Döhle body-like inclusions and large platelets. This emphasizes the importance of avoiding unnecessary diagnostic studies through effective utilization of this simple and reliable method. Outcomes: By adopting a comprehensive approach that combines gene sequencing with morphological analysis, an accurate diagnosis of MYH9-RDs can be achieved. Early identification of MYH9-RDs allows for appropriate management strategies, genetic counseling, and prevention of complications associated with the condition. Lessons: This section highlights the lessons learned from this study, emphasizing the need for increased awareness among healthcare professionals about MYH9-RDs and the importance of incorporating peripheral blood smear evaluations into the diagnostic process. This emphasizes the significance of accurate diagnosis to prevent unnecessary treatments and ensure appropriate patient care.

Rationale: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonotic disease characterized by a high fatality rate of 12% to 15%. Despite hematologic abnormalities being frequently reported in SFTS patients, detailed characterization of peripheral blood cells, especially in severe cases, is scarce. This case report aims to fill this gap by describing the unique morphological features of blood cells in a patient with a severe outcome. Patient concerns: A male patient presented with severe symptoms of SFTS, including high fever and thrombocytopenia, and was subsequently infected with a highly virulent strain of the SFTS virus. Diagnoses: The patient was diagnosed with virus-associated hemophagocytic syndrome related to SFTS based on clinical presentation and laboratory findings. Interventions: The interventions included comprehensive supportive care and treatment aimed at managing the severe symptoms and complications associated with SFTS. Outcomes: Despite the interventions, the patient experienced significant morphological changes in white blood cells and ultimately succumbed to the illness. Lessons: The detailed description of abnormal cell morphology in this case provides valuable insights into the pathophysiology of SFTS. Recognizing these morphological abnormalities can aid in early detection and may have implications for assessing disease severity and guiding treatment strategies.

Rationale: Norwegian scabies (crusted scabies) is an extreme manifestation of Sarcoptes scabiei infestation, primarily affecting immunocompromised populations such as HIV-positive individuals. This condition is characterized by a severe mite burden and high transmissibility, often accompanied by pathognomonic hyperkeratotic plaques. Patient concerns: A 46-year-old male patient diagnosed with HIV presented with persistent fever and progressive cutaneous desquamation, along with lymphadenopathy and worsening rash, initially misdiagnosed as atopic dermatitis. Diagnoses: Microscopic examination of skin scrapings confirmed a diagnosis of Norwegian scabies. Blood cultures and lymph node puncture revealed disseminated Talaromyces marneffei infection. The patient’s cluster of differentiation 4 cell count was extremely low, and immunoglobulin E levels were significantly elevated. Interventions: The patient received a comprehensive treatment regimen including topical sulfur ointment, oral ivermectin, and voriconazole, in addition to antiretroviral therapy. Supportive care included methylprednisolone and immunoglobulin therapy. Outcomes: After 1 month of treatment, the patient’s skin symptoms completely resolved, and he was discharged. Lessons: For immunocompromised HIV patients, routine microscopic examination of skin scrapings is recommended to promptly identify Norwegian scabies, preventing misdiagnosis and potential infectious complications.

Introduction. Talaromyces marneffei (TM) is a common opportunistic infection among patients with AIDS, characterized by rapid systemic dissemination and a high mortality rate. Early identification of patients at risk of death is critical to improving clinical outcomes. Hypothesis/Gap Statement. Despite the severity of disseminated TM infection (DPSM), few predictive tools exist to assess mortality risk in affected AIDS patients. A clinical prediction model incorporating novel inflammatory markers may help guide timely intervention. Aim. This study aimed to identify independent risk factors for mortality in AIDS patients with DPSM and to develop and validate a nomogram for individualized risk prediction. Methodology. A retrospective study was conducted on 174 AIDS patients with DPSM and complete clinical data admitted to Hangzhou Xixi Hospital between January 2013 and June 2024. A training cohort of 104 patients was used to identify mortality-related risk factors via logistic regression and to construct a predictive nomogram. The remaining 70 patients constituted a validation cohort to evaluate the model using area under the curve (AUC), decision curve analysis (DCA) and calibration curves. Results. The overall mortality rate was 18.97% (33/174). Effusion, bone marrow suppression, systemic inflammation and malnutrition were significantly associated with fatal outcomes (P<0.05). Multivariate logistic regression identified white blood cell count, C-reactive protein-to-prealbumin ratio and procalcitonin-to-albumin ratio as independent risk factors for mortality. The nomogram based on these predictors showed strong discriminative power in both training and validation cohorts (AUC=0.89 and 0.78, respectively). DCA demonstrated the clinical utility and net benefit of the model. Conclusion. This study identified key predictors of mortality in AIDS patients with DPSM and developed a validated nomogram incorporating novel inflammatory markers. The tool offers potential value for individualized risk assessment and clinical decision-making.