支气管哮喘防治全球创议(GINA)将哮喘的严重程度分为三度四级，其中三级和四级属于中度和重度哮喘。在整个哮喘人群当中，中重度哮喘大约只占1／3，但在临床上轻度哮喘患者很少就诊，中重度哮喘大约占就诊患者的2／3甚至更多。中重度哮喘患者由于症状明显，频繁就诊，因为哮喘控制不良，经常出现急性发作，需要住院治疗，虽然人数不是很多，但占用了大部分的医疗资源。无论是从提高哮喘防治的整体水平的角度，还是从减少哮喘疾病负担的角度，都应当将中重度哮喘作为哮喘长期管理的主要的目标人群。
Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.
目的:比较4种选药方案治疗复治后耐多药结核病的治疗疗效。方法:回顾性分析152例复治后耐多药结核病例,按治疗方案分为4组。Ⅰ组采用标准化疗方案HSRZE;Ⅱ组根据过去的治疗史组成个体化方案;Ⅲ组根据药敏试验组成个体化方案;Ⅳ组采用力克肺疾、左氧氟沙星、卷曲霉素、阿奇霉素、阿莫西林克拉维酸方案。结果:4组病灶吸收有效率分别为20.00%、47.37%、52.38%、81.48%;4组12个月疾菌阴转率分别为22.22%、57.89%、50.00%、81.48%。结论:对于所有复治肺结核患者均采用统一的标准复治方案有效率低,由力克肺疾、左氧氟沙星、卷曲霉素、阿奇霉素、阿莫西林克拉维酸联合组成的化疗方案是治疗复治后耐多药结核病的有效方案。
ObjectiveTo discuss the practical methods of clinical drug therapy with clinical pharmacists' participation. MethodThe patient was male and at the age of 88. Because of "exertional heart tiredness for 4 years, coughing sputum for 10 days, and sudden inarticulate condition", he was admitted into the hospital on November 22nd, 2013. The diagnosis was cerebral infarction with pulmonary infection. Clinical pharmacists participated in the consultation on February 19th, 2014 because the uncontrollable repeated pulmonary infection. By analyzing the therapeutic scheme, clinical pharmacists made and adjusted the treatment scheme for one patient with refractory infections. ResultsAfter the treatment scheme was adjusted, several laboratory test results of the patient returned to normal, including respiratory rate, body temperature, white blood cell count and neutrophils. Sputum volume decreased obviously and sputum culture was negative. Lung signs and image were significantly improved. ConclusionsClinical pharmacists should pay more attention to the analysis of the clinical therapeutic scheme to improve therapeutic efficacy for patients with refractory infections.
ObjectiveTo compare the clinical characteristics,high-resolution computed tomography (HRCT) manifestations,pulmonary function results,serum autoantibodies and treatment modality of connective tissue diseases related interstitial lung diseases (CTD-ILDs) and idiopathic interstitial pneumonias (ⅡPs). MethodsPatients explicitly diagnosed with CTD-ILDs and ⅡPs were retrospectively selected from Nanjing Drum Tower Hospital between January 2004 and December 2012.The clinical features were abstracted,including age,gender,symptoms,signs,serum autoantibody results,HRCT findings,and treatment.Patient characteristics were compared between CTD-ILDs and ⅡPs using a Pearson's χ2 test for categorical variables,and a Student's t test for continuous variables. ResultsA total of 692 patients with complete data were included in this study,with 240 CTD-ILDs cases and 452 ⅡP cases.CTD-ILDs could exist in different types of CTDs,which were mainly shown in Sjogren's syndrome,rheumatoid arthritis,and dermatomyositis/polymyositis.Age,gender,connective tissue diseases related characteristics such as dry eyes,dry mouth,and arthralgia,and several autoantibodies such as ANA,SSA,SSB all showed significantly difference between CTD-ILDs and ⅡPs (P<0.05).However there were no significant differences in cough,dyspnea after exertion,velcro crackles on auscultation,or finger clubbing between two groups (P>0.05). The HRCT manifestations of CTD-ILDs were reticular opacities,patchy consolidation,band-like shadows,and pleural thickening.Pulmonary function tests commonly showed restrictive lung function and decreased diffusing capacity.The histopathologic findings of lung biopsies of CTD-ILDs were mostly chronic inflammatory cell infiltration,as well as hyperplasia of fibrous tissue and septal thickness.The finding of chronic inflammatory cell infiltration showed significant difference between CTD-ILDs and ⅡPs (P<0.05),while the HRCT manifestations,pulmonary function results or other histopathologic findings did not(P>0.05).The current treatment modality was corticosteroids plus immunosuppressants. ConclusionDespite the similarities,CTD-ILDs show distinct clinical,laboratory and imaging features from from ⅡPs in clinical practice.
ObjectiveTo summarize research progress of comprehensive treatment based on gene therapy, immunotherapy, and targeted therapy in recent years in order to improve understanding and treatment level of triple negative breast cancer (TNBC).MethodThe literatures about TNBC treatment in recent 5 years were reviewed and summarized.ResultsTNBC was more invasive than other types of breast cancer due to its lack of targeted receptors, and its recurrence and metastasis were earlier. The treatment plan was still mainly surgical treatment, supplemented by the chemotherapy and radiotherapy.ConclusionsAlthough recent studies of TNBC in surgical treatment, chemoradiotherapy, targeted therapy and other aspects have shown a good clinical application prospect, more evidences of clinical trials with large samples are still needed. With the deepening of molecular mechanism research, endocrine therapy and targeted drug therapy, including androgen-receptor-positive, have provided some new ideas for treatment of TNBC.
ObjectiveTo examine the characteristics of Rhodococcus equi (R. equi) infection for better awareness of this disease.MethodsThe clinical data of a patient with pulmonary abscess caused by R. equi after renal transplantation were reported. We also reviewed the reports of infections caused by R. equi.ResultsThe clinical manifestations and laboratory examination of the patient were consistent with the characteristics of R. equi infection. The growth of R. equi was found in sputum and blood culture. The follow-up data showed that the treatment was effective. Literature search identified 23 similar patients. In all the 24 patients (containing this one), the time of infection after renal transplantation ranged from 4 months to 11 years. There were 21 patients with cumulative pulmonary infection, and 10 patients had a clear epidemiological history of direct or indirect contact with horses. Eighteen patients improved after regular antibacterial treatment or surgical treatment.ConclusionsOpportunistic infections caused by R. equi mainly affect transplant recipients and other patients with lower immunity. Infections caused by R. equi may affect many organ systems with various manifestations. The optimal therapy is not established due to the rarity of this infection. Clinicians should select antibiotic agents rationally based on antimicrobial susceptibility testing and treatment response of patients.
Ciliary body tumor is a rare intraocular tumor. Due to its unique anatomical location, its correct diagnosis and reasonable treatment are very difficult problems. In terms of diagnosis and differential diagnosis, ophthalmologists need to fully utilize the role of slit lamp microscope and transillumination experiment to capture secondary changes in the anterior segment caused by hidden ciliary body tumors, such as monocular localized cataract, lens indentation, and pigment dissemination, etc. Ophthalmological imaging methods, especially ultrasound biomicroscopy, can achieve the purpose of early detection and early diagnosis. According to the size, location and morphological characteristics of the tumor, a reasonable treatment plan is formulated. Since ciliary body tumors are mostly benign, the recurrence rate of local resection is low, which can satisfy the pathological diagnosis and preserve part of the patient's vision. Therefore, eye-preserving treatment should be advocated. However, enucleation remains the treatment of choice for tumors that are too large to be treated with local excision or radiation, eyes with refractory glaucoma, and tumors that do not respond to radiation therapy.
ObjectiveTo summarize current widely-used therapies for cutaneous neurofibroma (cNF) and related research progress. MethodsBased on extensive investigation of domestic and foreign research, the existing treatment of cNF, including the indications, effectiveness and trials of targeted drugs were reviewed. ResultscNF is a hallmark feature of neurofibromatosis type 1 and has a dramatic negative impact on patient appearance and quality of life. At present, there is no standard management of cNF. Invasive treatment is a commonly-used treatment. Surgical removal gives excellent cosmetic results, but it is difficult for multiple tumors; CO2 laser ablation, laser photocoagulation, electro-drying, and radiofrequency ablation are effective in treating lots of cNF at one time. Although fast and effective, these therapies can lead to depigmentation, hyperpigmentation, or extensive scarring. There is no targeted drug approval for cNF, and a series of studies have been carried out on the Ras-MEK pathway, Ras-mTOR pathway, receptor tyrosine kinase, et al. ConclusionThe treatment of cNF has developed rapidly in recent years and has broad prospects, but the individualization and precision of the treatment still needs further clinical research.