Outcome of refractory to conventional and/or biologic treatment adult Still's disease following canakinumab treatment: Countrywide data in 50 patients

ObjectiveTo assess the efficacy and safety of the IL-1b inhibitor canakinumab in all adults with refractory Still's disease identified from the National Organization For Medicines for off-label drug use.Methods: In a retrospective longitudinal multicenter cohort of 50 patients (median age 39 years) with active Still's disease despite treatment with corticosteroids (n = 11), conventional and synthetic (n = 34) and/or biologic disease modifying anti-rheumatic drugs (n = 30), we assessed the efficacy of canakinumab 150–300 mg administered every 4 (n = 47) or 8 weeks (n = 3) as combination therapy or monotherapy (n = 7) during a median follow-up of 27 (3–84) months.ResultsΑ complete response was initially observed in 78% of patients within 3 months (median), irrespective of age at disease onset. A partial response was evident in 20%. One patient had resistant disease. Treatment de-escalation was attempted in 15 of 39 complete responders and a complete drug discontinuation in 21 patients for 8 months (median). Eleven patients (22%) relapsed during treatment, one during de-escalation process, and 11 after treatment discontinuation. Overall, 9 of 11 relapses were successfully treated with canakinumab treatment intensification or re-introduction. At last visit, 18% of patients were off treatment due to remission and 26% due to disease activity. Canakinumab had a significant corticosteroid sparing effect allowing weaning in 21 of 41 cases. Infections (20%, severe 4%) and leucopenia (6%) led to treatment cessation in one patient.ConclusionHigh rates of sustained remission were observed in this, largest so far, real-life cohort of adult patients with refractory Still's disease treated with canakinumab.     

组织细胞坏死性淋巴结炎

目的提高对少见病组织细胞坏死性淋巴结炎的认识。方法对我科诊治的患者进行分析，并结合文献复习。结果组织细胞坏死性淋巴结炎是一种具有特殊临床病理过程的自限性淋巴结疾病，病因及发病机制不明，以顽固性发热、区域性淋巴结肿大和一过性白细胞减少为特征。结论临床表现具有非特异性，组织学形态较复杂，容易误诊。抗生素治疗对本病无效，而糖皮质激素是最有效的治疗药物。     

关节镜下单束重建后交叉韧带临床疗效分析

目的探讨、分析关节镜下利用自体腘绳肌及同种异体肌腱单束重建后交叉韧带的中期临床疗效。方法关节镜下利用自体肌腱或异体胫前肌腱及跟腱辅以endo-button系统及生物型可吸收界面螺钉治疗50例膝关节后交叉韧带损伤患者。结果所有患者平均随访2.45年,按Lysholm膝关节功能评分与Tegner膝关节运动评分标准,术前患者术前平均56.4分（Ly-sholm）,3.0分（Tegner）,术后80.3分（Lysholm）,6.2分（Tegner）。结论自体半腱肌、股薄肌与同种异体肌腱重建膝关节后交叉韧带强度好,植入后固定牢靠,术后并发症少。     

瞬时弹性成像评价慢性乙型肝炎患者抗病毒治疗的效果

目的对比分析应用瞬时弹性成像动态检测慢性乙型肝炎患者抗病毒治疗前后肝硬度值的变化,评价抗病毒药物对慢性乙型肝炎患者肝纤维化的临床治疗效果。 方法选取2015年1月至2019年10月在安徽医科大学第一附属医院和联勤保障部队第901医院就诊的125例使用拉米夫定（LAM组）、阿德福韦（ADV组）和二者联合（LAM+ADV组）治疗的慢性乙型肝炎患者,分别检测其抗病毒治疗前、后（6~24个月）的肝硬度值、谷丙转氨酶（ALT）和血清肝纤维化指标的变化情况,采用单因素重复测量方差分析抗病毒治疗前后患者肝硬度值、ALT值、肝纤维化指标值的差异,并采用Pearson相关分析肝硬度值与ALT值和肝纤维化指标的相关性。 结果抗病毒治疗后患者的肝硬度值明显下降,从治疗前的（15.25±2.28）kPa下降至24个月后的（6.79±1.76）kPa,差异具有统计学意义（F=330.784,P＜0.001）,LAM组、ADV组和LAM+ADV组中治疗后6个月与治疗前（t=5.597、6.399、6.721,P均＜0.001）、12个月与6个月（t=4.779、5.284、6.006,P＜0.001、=0.001、＜0.001）、18个月与12个月（t=3.109、3.456、3.638,P=0.003、=0.001、＜0.001）、24个月与12个月（t=2.801、3.160、3.173,P=0.007、0.002、0.002）肝硬度值比较,差异均具有统计学意义。治疗24个月后患者ALT恢复率为84.8%（106/125）,其中LAM组为83.78%（31/37）,ADV组为84.45%（38/45）,LAM+ADV组为86.05%（37/43）。24个月后患者血清中的透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PC Ⅲ）及Ⅳ型胶原（Ⅳ C）等指标值均明显降低,差异具有统计学意义（LAM组：t=20.184、5.312、7.740、18.267,P均＜0.001;ADV组：t=21.315、3.361、9.064、20.428,P均＜0.001;LAM+ADV组：t=21.492、7.158、10.687、21.543,P均＜0.001）。肝硬度值与ALT值、肝纤维化指标（HA、LN、PC Ⅲ and Ⅳ C）值的变化相一致,均呈正相关性（r=0.745、0.689、0.695、0.687、0.697,P均＜0.05）。 结论瞬时弹性成像可动态检测慢性乙型肝炎患者的肝纤维化,观察和评价抗病毒药物的治疗效果,具有良好的临床应用价值。     

乳腺癌治疗新方向—乳腺癌微环境

乳腺癌是女性发病率最高的恶性肿瘤,严重威胁女性健康,为探究新的治疗方法,研究人员将肿瘤微环境作为潜在的抗癌靶标。肿瘤微环境由几种关键的细胞类型组成,包括成纤维细胞、血管和淋巴内皮细胞、破骨细胞、脂肪细胞和免疫细胞,这些细胞有利于肿瘤的发生、发展和转移,因此,这些宿主细胞有望成为抗肿瘤和抗转移治疗中的潜在靶标。突变和耐药是抗肿瘤治疗失败的重要原因,靶向肿瘤相关宿主细胞的优势是这些细胞较少发生突变和耐药性。本文讨论了宿主细胞在肿瘤发生、发展和转移过程中的作用,以及靶向这些细胞群治疗肿瘤的新发展。     

蛋白激酶Cδ亚型抑制剂对脂多糖诱导肺微血管内皮细胞损伤的影响

目的研究蛋白激酶C(PKC)的亚型PKCδ在大鼠肺微血管内皮细胞(RPMVEC)中的表达及其抑制剂Rottlerin对脂多糖(LPS)导致RPMVEC单层通透性增高的影响。方法取体外培养的RPMVEC进行PKCδ的W estern b lot和免疫组化检测,用针头式滤器检测LPS及LPS+Rottlerin干预后RPMVEC单层滤过系数(K f)的变化。结果PKCδ在RPMVEC中有广泛的表达,其表达部位主要位于胞质。Rot-tlerin能减低LPS导致的RPMVEC单层通透性增高。结论LPS导致RPMVEC损伤的机制与PKC的激活有关,PKCδ亚型抑制剂可减轻LPS诱导的RPMVEC单层通透性增高。     

Acquisition and retention of surgical skills taught during intern surgical boot camp

BackgroundSurgical residencies have implemented boot-camps for early acquisition of basic technical skills for interns. However, educators worry that retention is poor. We hypothesized that a structured boot-camp curriculum would improve skills.MethodsInterns underwent eight boot-camp sessions at the beginning of residency. Interns completed pre-, post-boot-camp, and end-of-year skills assessments, as well as post-boot camp and end-of-year porcine procedure labs. Proficiency was measured on a 5-point scale and by completion time.ResultsAfter boot-camp, interns improved all domains of knot-tying. Median time decreased for skin-closure (8.3 vs 9.9 min, p < 0.01), peg transfer (57 vs 87 s, p < 0.01), intracorporeal (178 vs 300 s, p < 0.01), and extracorporeal knot-tying (140 vs 259 s, p < 0.01). At the end-of-year assessment, interns exhibited retention of all skills and improved in knot-tying and central line skills. During the retention porcine lab, interns progressed basic but not complex skills.ConclusionsAn eight-week boot-camp effectively improved technical skills among surgery interns. Interns retained all skills and improved upon techniques frequently practiced during intern year.     

烧伤回吸期持续性高钠高氯与侵袭性感染

目的：探讨大面积烧伤患持续性高钠高氯产生的原因及防治措施,动态监测大面积烧伤后血清Ｎａ＾＋高Ｃｌ＾－和６１例严重务后非持续性ａ＾＋,高Ｃｌ＾－患的临床特点。结果：７例严重烧伤后持续高Ｎａ＾＋,高Ｃｌ＾－患的临床特点。结果;７例严重烧伤后持续高Ｎａ＾＋,高Ｃｌ＾－１患均有严重分割生感染。且高ＮＡ＾＋出现止升愈快,则感染愈重,愈后愈差。结论：１．烧伤后持续性高Ｎａ＾＋,高Ｃｌ产生的原因是严重侵