Angiokeratoma presenting as plantar verruca: a case study

One of the more frequent pathologic conditions that podiatric physicians are confronted with is plantar verrucae. Plantar verrucae have been studied extensively in terms of morphological features and incidence in the population at large and in patients with human immunodeficiency virus infection. Solitary angiokeratomas can be morphologically similar to plantar verrucae, presenting as hyperkeratotic pedunculated lesions. We present a unique case study of a 40-year-old man with human immunodeficiency virus with a painful solitary angiokeratoma masquerading as plantar verrucae. The lesion demonstrated clinical signs consistent with those highlighted in the literature for verrucae, namely, showing as red and black lacunae, punctuated hyperkeratotic epidermis. We propose that solitary angiokeratomas should be an important part of a podiatric physician's differential diagnosis in the lower extremity owing to the similarity of morphological features with plantar verrucae.     

Clinical study of bismuth-based quadruple therapy as first-line therapy for the eradication of Helicobacter

目的 评价含铋剂的四联10d疗法作为一线方案治疗幽门螺杆菌感染的有效性和安全性.方法 将140例幽门螺杆菌感染的初治患者随机分为三联治疗组和四联治疗组各70例.三联治疗组给予埃索美拉唑20 mg bid+克拉霉素500 mg bid+阿莫西林1.0 g bid治疗7d,四联治疗组给予埃索美拉唑20 mg bid+克拉霉素500 mg bid+阿莫西林1.0 g,bid+果胶铋150 mg tid治疗10d.疗程结束6周后复查13C-尿素呼气试验,判断幽门螺杆菌根除情况,同时观察治疗过程中的不良反应.结果 三联治疗组按方案(PP)分析和按意向治疗(ITT)分析H.pylori的根除率分别为76.5％、74.3％,四联治疗组按PP和按ITT分析根除率分别为92.5％、88.6％,四联治疗组按PP和ITT分析H.pylori的根除率均高于三联治疗组(P值分别为0.010、0.030).两组不良反应发生率相似,无严重的不良反应病例.结论 含铋剂的四联10d疗法用于幽门螺杆菌感染的初治,疗效高于标准三联7d疗法,是一种可供选择的一线治疗方案.     

含铋剂四联一线治疗方案根除幽门螺杆菌疗效观察

目的:评价含铋剂四联方案(耐信+克拉霉素+阿莫西林+丽珠得乐)治疗消化性溃疡或慢性胃炎Hp感染患者的疗效,寻找高效、经济的一线Hp根除方案.方法:①136例消化性渍疡或慢性胃炎Hp感染初治患者,随机分为四联组(67例)和三联组(69例);四联组采用埃索美拉唑20 mg+克拉霉素缓释0.5 g+阿莫西林1.0 g+枸橼酸铋钾胶囊220 mg/d,三联组采用埃索美拉唑20 mg+克拉霉素缓释片0.5 g+阿莫西林1.0 g/d,7 d为1疗程.②采用14C-UBT检测Hp根除率.③按ITT和PP分析,计算成本-效果比(C/E)及增量成本-效果比(△C/AE).结果:四联组Hp根除率为88.71%,三联组Hp根除率为73.02%,两组比较差异有统计学意义(P<0.05).四联组和三联组成本.效果比分别为4.15和4.82,含铋荆四联相对于标准三联方案增量成本-效果比为1.02.结论:Hp根除率含铋荆四联方案较标准三联方案高,可推荐为经济、高效的一线治疗方案.     

伊立替康与奥沙利铂一线治疗晚期结直肠癌的临床疗效评价

Background To compare clinical efficacy and toxicity of irinotecan combined with 5-fluorouracil and leucovorin with those of oxatiplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer. Methods Literature search was performed by keywords ＂irinotecan＂, ＂oxaliplatin＂ and ＂colorectal cancer＂ on all randomized controlled trails reported on irinotecan versus oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer in MEDLINE, OVID, Springer, Cochrane Controlled Trials Register （CCTR） and CBMdisc （Chinese Biology and Medicine disc） before January 2010. Two authors drew the details of trial design, characteristics of patients, outcomes, and toxicity from the studies included. Data analysis was performed by RevMan 4.2. Results According to the screening criteria, 7 clinical studies with 2095 participants of advanced colorectal cancer were included in this meta analysis. The baseline characteristics of irinotecan group were similar to those of oxaliplatin group. The response rate of oxaliplatin group was higher than that of irinotecan group （relative risk （RR）=0.82, 95% confidence interval （95%C/） （0.70, 0.96）, P=0.01）, and the median overall survival of oxaliplatin group was longer by 2.04 months than that of irinotecan group （95%C/（-3.54, -0.54）, P=0.008）. In the comparison of grade 3-4 toxicity between the two groups, the incidences of nausea, emesis, diarrhoea and alopecia in irinotecan group were higher than those in oxaliplatin group （RR=1.94, 95%C/（1.22, 3.09）, P=0.005; 1.71, 95%C/（1.34, 2.18）, P 〈0.001; 14.56, 95%C/（4.11, 51.66）, P 〈0.0001）, respectively. However, the incidence of neurotoxicity, neutropenia and thrombocytopenia in irinotecan group were lower than those in oxaliplatin group （RR=0.06, 95%CI（0.03, 0.14）, P 〈0.00001; 0.70, 95%CI （0.55, 0.91）, P=0.006; 0.18, 95%CI（0.05, 0.61）, P=0.006）, respectively. Conclusions Both irinotecan and oxaliplatin combined with 5-fluorouracil and leucovorin were effective in the first-line therapy of advanced colorectal cancer. However, the combined regimen of oxaliplatin plus 5-fluorouracil and leucovorin is more excellent. Irinotecan trended to result in more gastrointestinal tract reactions than oxaliplatin did, but the mvelosuppression and neurotoxicity were more frequent in oxaliplatin regimen than irinotecan regimen.     

恶性梗阻性黄疸介入综合治疗

目的 探讨介入综合治疗恶性梗阻性黄疸的效果及价值.方法 回顾性分析恶性梗阻性黄疸病例109例,其中男54例、女55例,平均年龄(71±12)岁.所有患者经CT和(或)MRI检查结合临床表现诊断为恶性胆道梗阻.先进行经皮肝胆道穿刺,随后置入引流管胆道引流(PTCD)或胆道内支架.术后1周.38病例行肝动脉化疗栓塞(TACE).结果 109例病例均成功穿刺并置入引流管(55例)或植入支架(54例),成功率100%.PTCD及支架引流后血清丙氨酸转氨酶、总胆红素,直接胆红素水平及Child-Pugh分级评分的独立样本t检验,P值分别为0.019、0.002、0.002及0.396.TACE后组间血清丙氨酸转氨酶、总胆红素,直接胆红素水平及Child-Pugh分级评分的独立样本t检验,P值分别为0.834、0.000、0.002及0.002.全组平均生存期26.45(标准误,SE,4.07)周,PTCD及支架治疗的平均生存期分别为28.19(SE,6.54)和21.38(SE,2.51)周(P=0.713);38例行TACE治疗及71例未进一步治疗的平均生存期分别为43.71(SE,8.32)和14.38(SE,2.66)周(P=0.000).不同引流方法在减轻黄疸,改善肝功能,延长生存期方面差异无统计学意义.引流术后,接受了TACE治疗的患者其生存期明显超过未治疗组.结论 胆道支架减轻黄疸的幅度优于PTCD,但黄疸缓解的比例组间无差异;两者短期内对肝功能的改善均无明显作用.在胆道引流术后短期,无论是否行TACE治疗,整体的总体胆红素水平都有继续下降,但行TACE治疗可明显加大胆红素水平下降的幅度,同时能改善整体的肝功能水平.     

含铋剂四联疗法作为一线方案根除幽门螺杆菌的临床研究

目的评价含铋剂的四联10d疗法作为一线方案治疗幽门螺杆菌感染的有效性和安全性。方法将140例幽门螺杆菌感染的初治患者随机分为三联治疗组和四联治疗组各70例。三联治疗组给予埃索美拉唑20mgbid+克拉霉素500mgbid+阿莫西林1.0gbid治疗7d,四联治疗组给予埃索美拉唑20mg bid+克拉霉素500mg bid+阿莫西林1.0g,bid+果胶铋150mgtid治疗10d。疗程结束6周后复查13C-尿素呼气试验,判断幽门螺杆菌根除情况,同时观察治疗过程中的不良反应。结果三联治疗组按方案(PP)分析和按意向治疗(ITT)分析H.pylori的根除率分别为76.5%、74.3%,四联治疗组按PP和按ITT分析根除率分别为92.5%、88.6%,四联治疗组按PP和ITT分析H.pylori的根除率均高于三联治疗组(P值分别为0.010、0.030)。两组不良反应发生率相似,无严重的不良反应病例。结论含铋剂的四联10d疗法用于幽门螺杆菌感染的初治,疗效高于标准三联7d疗法,是一种可供选择的一线治疗方案。     

FOLFIRI一线治疗晚期胃癌50例临床观察

目的观察伊立替康联合亚叶酸钙及氟尿嘧啶（FOLFIRI）一线治疗晚期胃癌的疗效、中位无进展生存时间（PFS）、总的生存时间（OS）及毒副作用。方法50例经过组织学证实的晚期胃癌患者接受FOLFIRI方案治疗,主要终点是：客观有效率（RR）、PFS、总生存时间（oS）及毒副反应。结果50例患者均可以接受疗效及生存评价,其中部分缓解（PR）23例（46．0％）,稳定（SD）13例（26．0％）,进展（PD）14例（28％）,无CR病例。RR为46．0％,中位PFS时间为6．4个月,中住OS为10．6个月。结论FOLFIRI方案一线治疗局部晚期和转移性晚期胃癌能够提高RR、PFS及0S,副作用轻,耐受性好,可在临床推广应用。     

替吉奥联合奥沙利铂一线治疗晚期食管癌的研究

目的 探讨奥沙利铂（OXA）联合替吉奥胶囊一线治疗晚期食管癌的疗效及不良反应。方法 将35 例采用OXA联合替吉奥胶囊（SOX 方案）化疗的晚期食管癌患者设为治疗组,32 例行顺铂（DDP）联合氟尿嘧啶（DF 方案）化疗的患者设为对照组。观察及随访两组患者的近、远期疗效及不良反应。结果 治疗组及对照组的近期有效率分别为62.9%和37.5%,比较有统计学差异（P＜0.05）,疾病控制率分别为85.7%和65.6%,组间比较无统计学差异（P＞0.05）。治疗组的中位生存期（12.4 个月）与对照组（10.4 个月）相比有统计学差异（P＜0.05）,两组患者1年生存率分别为54.3%和34.4%,2 年生存率分别为5.7%和0.0%,两组间均无统计学差异（字2=2.680、2.654,均P＞0.05）。在不良反应方面,两组患者的血液学、消化道不良反应及肝功能损害比较无统计学差异（均P＞0.05）,治疗组神经系统不良反应发生率高于对照组（P＜0.05）。结论 OXA 联合替吉奥（SOX 方案）治疗晚期食管癌疗效较为肯定,患者耐受良好。     

晚期肺腺癌患者维持治疗中EGFR-TKI联合贝伐珠单抗的回顾性分析

目的 对比分析EGFR突变阳性的晚期肺腺癌患者经EGFR-TKI治疗达疾病稳定后联合贝伐珠单抗维持治疗与EGFR-TKI单药治疗的疗效与安全性.方法 收集2013-2019年就诊于本院的192例晚期肺腺癌患者,其中联合组30例,单药组162例.联合组患者经一线EGFR-TKI诱导治疗后联合贝伐珠单抗维持治疗,单药组患者...     

Capsule endoscopy for 663 patients: a retrospective analysis

[目的]探讨胶囊内镜对消化道疾病的临床诊断价值.[方法]回顾性分析663例(其中健康体检者176例)采用国产OMOM胶囊内镜行消化道检查的临床资料,观察其病变检出情况、图像质量及检查安全性、耐受性.[结果]663例受检者中,658例顺利完成检查,成功率99.2％,528例发现阳性病变,检出率为79.6％;共检出病变1121处(403例同时存在2种或2种以上病变).487例患者中,小肠病变检出率为61.8％,诊断率为55.0％.所检出的病变包括糜烂、溃疡、息肉、血管发育异常、憩室、寄生虫、淋巴管扩张、肿瘤等.胶囊在食道内运行时间(28.2±11.8)(3～58)s,在胃内运行时间(57.4±48.4)(2～204)min,在小肠内运行时间(268.7±96.9)(54～525)min.4例患者发生胶囊内镜滞留.[结论]胶囊内镜检查安全、有效,耐受性好,诊断率较高,对消化道疾病特别是小肠疾病具有重要的诊断价值.     

663例胶囊内镜检查回顾性研究分析

目的探讨胶囊内镜对消化道疾病的临床诊断价值。方法回顾性分析663例(其中健康体检者176例)采用国产OMOM胶囊内镜行消化道检查的临床资料,观察其病变检出情况、图像质量及检查安全性、耐受性。结果 663例受检者中,658例顺利完成检查,成功率99.2%,528例发现阳性病变,检出率为79.6%;共检出病变1 121处(403例同时存在2种或2种以上病变)。487例患者中,小肠病变检出率为61.8%,诊断率为55.0%。所检出的病变包括糜烂、溃疡、息肉、血管发育异常、憩室、寄生虫、淋巴管扩张、肿瘤等。胶囊在食道内运行时间(28.2±11.8)(3～58)s,在胃内运行时间(57.4±48.4)(2～204)min,在小肠内运行时间(268.7±96.9)(54～525)min。4例患者发生胶囊内镜滞留。结论胶囊内镜检查安全、有效,耐受性好,诊断率较高,对消化道疾病特别是小肠疾病具有重要的诊断价值。     

导管消融作为心房颤动一线治疗方案:进展与思考

心房颤动是临床上常见的心律失常,严重危害人类健康,早期有效控制房颤发作并减少并发症是治疗重点。鉴于导管消融是有创治疗手段,既往指南均推荐导管消融作为二线治疗策略。近年来随着导管消融技术的进步和优化,导管消融有望取代抗心律失常药物,成为心房颤动一线治疗方案。本文系统介绍了导管消融作为房颤一线治疗方案的探索,并探讨了有望成为房颤一线治疗的一些新技术。     

Substrate reduction therapy with miglustat for type 1 Gaucher disease: A retrospective analysis from a single institution

Introduction.

Gaucher disease (GD) is an infrequent progressive multisystem lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme, glucocerebrosidase. A retrospective, single-center analysis of the clinical experience concerning the use of miglustat (N-butyldeoxynojirimycin), an oral inhibitor of glucosylceramide synthase, in type 1 Gaucher disease (GD1) was conducted to evaluate the efficacy, adverse events (AE), and outcome of miglustat therapy.

Patients and methods.

Six adult Caucasian patients with GD1 (two women and four men), aged 21–81 years (median age 59 years), were treated with miglustat between October 2005 and April 2011. All but one patient (83%) carried at least one allele with c.1226A>G (N370S) mutation in the GBA1 gene.

Results.

Weight loss, diarrhea, poor appetite, and tremor were frequently reported AE by the patients. All of them experienced at least 2 AE, and three patients (50%) experienced at least 4 AE. Only two out of six patients (33%) have used miglustat longer than 12 months, of which only one used it longer than 15 months.

Conclusions.

The major obstacle to successful miglustat therapy in GD1 was the high proportion of patients discontinuing their treatment due to the AE and the worsened quality of life. Further efforts are needed to improve tolerability of miglustat and, in consequence, compliance of patients treated with this orphan drug.     

Substrate reduction therapy with miglustat for type 1 Gaucher disease: A retrospective analysis from a single institution

Abstract

Introduction. Gaucher disease (GD) is an infrequent progressive multisystem lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme, glucocerebrosidase. A retrospective, single-center analysis of the clinical experience concerning the use of miglustat (N-butyldeoxynojirimycin), an oral inhibitor of glucosylceramide synthase, in type 1 Gaucher disease (GD1) was conducted to evaluate the efficacy, adverse events (AE), and outcome of miglustat therapy.

Patients and methods. Six adult Caucasian patients with GD1 (two women and four men), aged 21–81 years (median age 59 years), were treated with miglustat between October 2005 and April 2011. All but one patient (83%) carried at least one allele with c.1226A>G (N370S) mutation in the GBA1 gene.

Results. Weight loss, diarrhea, poor appetite, and tremor were frequently reported AE by the patients. All of them experienced at least 2 AE, and three patients (50%) experienced at least 4 AE. Only two out of six patients (33%) have used miglustat longer than 12 months, of which only one used it longer than 15 months.

Conclusions. The major obstacle to successful miglustat therapy in GD1 was the high proportion of patients discontinuing their treatment due to the AE and the worsened quality of life. Further efforts are needed to improve tolerability of miglustat and, in consequence, compliance of patients treated with this orphan drug.