Myalgia and Arthralgia Immune-related Adverse Events (irAEs) in Patients With Genitourinary Malignancies Treated With Immune Checkpoint Inhibitors

BackgroundMyalgia and arthralgia immune-related adverse events (irAEs) in patients treated with checkpoint inhibitors (CPIs) present a clinical challenge. We describe the clinical characteristics and treatment of myalgia and arthralgia irAEs in CPI-treated patients with genitourinary (GU) malignancies.Patients and MethodsPatients with GU malignancies who were treated with CPIs and developed myalgia and arthralgia irAEs that resulted in interruption or discontinuation of CPI therapy were reviewed. Patient-, disease-, and irAE-related data were collected and analyzed.ResultsTwenty-one patients were identified. Eighteen (86%) had renal cell carcinoma; 3 (14%) had urothelial carcinoma. The majority (71%) were male; the median age at diagnosis was 56 years (range, 36-78 years). CPI therapy included anti-programmed death-ligand 1 (29%), anti-programmed cell death protein 1 (48%), and combined programmed cell death protein 1/cytotoxic T-lymphocyte-associated protein 4 antibodies (24%). The median time from CPI initiation to myalgia and arthralgia irAE was 5.1 months (range, 0.23-50.5 months). All patients were treated with prednisone with a median initial dose of 40 mg/d (range, 10-90 mg/d) for a median duration of 64 weeks (range, 3-242 weeks). Treatment with methotrexate (14%), infliximab (14%), tocilizumab (10%), gabapentin (10%), and etanercept (5%) was also required in some patients. Six (29%) patients restarted CPI therapy following symptom improvement, 3 (15%) switched to a subsequent therapy, and 12 (55%) patients had an ongoing sustained response to therapy (median, 14.5 months; range, 3-55 months) despite no subsequent anti-cancer therapy.ConclusionMyalgia and arthralgia irAEs in CPI-treated patients with GU malignancies vary in timing of presentation, severity, and treatment. Multidisciplinary teams that include a rheumatologist are critical for optimal management. Durable response to CPIs can be maintained even after therapy discontinuation.     

多功能温灸器治疗痹症的临床观察

目的 :观察多功能温灸器治疗痹症的临床疗效。方法 :运用多功能温灸器治疗为治疗组 ,并与温针灸组比较。结果 :温灸器组与温针灸组疗效相比 ,组间差异经统计学分析有极显著性意义 (P<0 0 1) ,提示治疗组疗效优于对照组。结论 :多功能温灸器除可替代传统温针灸外 ,还有磁疗、按摩作用 ,且操作方便、安全 ,易于掌握。     

关节痛巧问诊

关节痛是关节疾病最常见的症状，也是风湿类疾病的主要症状之一．问诊在关节疾病的诊断中占有重要作用，大部分关节痛的患者可以通过认真仔细的问诊获得对疾病诊断的主要信息并据此作出临床初步诊断．总结出5个针对关节痛患者的问诊要点：（1）问起病的时间、缓急和诱因；（2）问关节受累的部位及多寡；（3）问关节局部表现及关节功能情况；（4）问伴随症状；（5）问继往诊疗情况．     

艾灸治疗关节痛的疗效与神经组织内p-物质和脑啡肽的关系

艾灸对福氏佐剂引起的关节炎大鼠的关节痛有显著疗效。艾灸也有助于患鼠坐骨神经内异常P-物质含量的恢复;并能使腰髓内亮-脑啡肽和P-物质保持较高的水平。结果表明,艾灸能加强脊髓内脑啡肽系统的功能,并可能激活下行的P-物质能神经元,它们在调制一级传入神经元的功能方面起重要的作用,因此艾灸的上述作用可能与其治疗关节痛的疗效有关。     

Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed.     

Survivin improves the early recognition of rheumatoid arthritis among patients with arthralgia: A population-based study within two university cities of Sweden

ObjectivesThe aim of this study was to validate the use of survivin for preclinical recognition of rheumatoid arthritis (RA) among patients with unexplained arthralgia.MethodsSerum levels of survivin and the arthritis-specific autoantibodies RF and ACPA were measured in total of 5046 patients with musculoskeletal complains during 12 consecutive months in Gothenburg and in Umeå. Among them, 303 arthralgia patients were identified and prospectively followed.ResultsAfter 48 months, 12.2% of the arthralgia patients developed RA. Most of RA cases had high serum survivin, which increased the relative risk for RA (RR = 5.90, p = 3 × 10⁻⁷). Combination of survivin with autoantibodies was present in only 4.6% of the arthralgia patients and increased further the risk of RA and shortened time to RA development. Presence of any single autoantibody in the survivin-negative patients was associated with a minor risk for RA and had RA-free survival similar to the reference group.ConclusionThis study shows that measurement of survivin in serum improves estimation of RA risk and prospectively predicts RA development in patients with arthralgia. Survivin may indicate a phase preceding autoantibody production.     

张炳厚教授的临床经验和学术思想

理论上张教授强调要全面认识中医,气和气化是关键。欲深入探究中医气的内涵和气化的本质,就必须结合中国传统文化。临床上四诊合参,尤重问诊舌诊,融合古今,力求创新。他打破内伤外感头痛的界限,创立了治疗头痛的系列验方;主张肾功能不全属于虚损,辨治应当谨察二便,食补重在适度;他善治痹症皮疹疑难杂症,在坚守原则的同时探索中医的变通和创新。     

The Clinical Expression of Hemochromatosis in Oslo,Norway: Excessive Oral Iron Intake May Lead to Secondary Hemochromatosis Even in HFE C282Y Mutation Negative Subjects

Background: The prevalence of hereditary hemochromatosis in Norway is one of the highest reported in the world. However, the clinical presentation in patients with hemochromatosis in Norway seems to be different compared with recent studies elsewhere. The aim of this study was to investigate patients with hemochromatosis in one community hospital in Norway and to study the prevalence of the C282Y mutation. Methods: One hundred and twenty patients were consecutively admitted to one medical department in Oslo. Serum transferrin and ferritin concentrations were measured in all patients, and a percutaneous liver biopsy was obtained in 108 of 120 (90%) patients. Stainable iron (Perls stain) in hepatocytes was graded from 0 to 4⁺ and fibrosis from 1 to 4. Genotyping for the C282Y and H63D mutation in the HFE gene was performed by PCR-RFLP. Results: Forty-eight (40%) of the patients suffered from tiredness and astenia and 29 (24%) had typical arthropathy. Only 5 of 105 (4.5%) had biopsy confirmed cirrhosis and 5 had diabetes mellitus. Patients referred from a blood bank had significantly less symptoms and signs compared with other patients. Twenty-one of 120 (17.5%) patients were C282Y mutation negative. Seventeen (81%) of these patients (16 women and 1 man) had a history of extensive oral iron intake lasting from 5 to 50 years. When excluding those with extensive oral iron intake (n = 17), 92 of 103 (89%) were homozygous for the C282Y mutation, 7 (7%) were heterozygous including 3 compound heterozygous and 4 (4%) were mutation negative. Conclusions: Only a minority of our patients with hemochromatosis had a far advanced disease at the time of diagnosis (less than 5% had cirrhosis) and hemochromatosis in a majority of the C282Y mutation negative patients was associated with excessive oral iron intake for several years.     

基于Lucene.net痹证医药文献全文检索系统的研制

选取对比了几种常用全文检索技术,在深入研究全文检索引擎Lucene.net架构的基础上提出了基于Lucene.net痹证医药文献全文检索系统流程,并具体介绍了系统实现过程以及测试结果。     

一期双膝关节置换与选择性单膝关节置换术早期临床疗效观察

目的 评价双膝关节疾病患者一期双侧人工全膝关节置换术(TKA)与选择性单侧TKA后早期临床疗效及简明健康状况调查表(SF-36)健康问卷调查的差异.方法 2008年2月-2009年8月纳入新疆医科大学第四附属医院骨科中心初次行TKA的患者144例(190膝),假体均采用施乐辉公司假体(GenesisTM‖Smith & Nephew).46例(92膝)行一期双膝TKA(双膝组):男8例(16膝),女38例(76膝);年龄(66.7±8.9)岁;其中骨性关节炎(OA)44例(88膝),类风湿性关节炎(RA)2例(4膝);同期对98例(98膝)行一期选择性单侧TKA(单膝组):男30例(30膝),女68例(68膝);年龄(68.0±4.5)岁;其中OA患者78例(78膝),RA患者20例(20膝).结果 术后双膝组1例发生一过性腓总神经麻痹,1例急性呼吸窘迫综合征(ARDS),1例术后切口愈合不良;单膝组发生2例切口愈合不良.双膝组44例(88膝)获随访,随访时间11～19个月,平均16个月.单膝组91例(91膝)获随访,随访时间12～23个月,平均18个月;术后1年SF-36量表调查显示,除两组除生理职能比较差异有统计学意义(P＜0.05)外,其余7方面比较差异均无统计学意义(P＞0.05).术后1年双膝组及单膝组关节活动范围(ROM)分别为(123.7±16.5)°和(123.7±16.5)°,差异无统计学意义(P＞0.05);美国特种外科医院(HSS)评分分别为(91.5±8.5)分和(91.2±9.6)分,差异无统计学意义(P＞0.05).视觉模拟疼痛评分(VAS)分别为(1.4±0.9)分和(2.6±1.6)分,差异有统计学意义(P＜0.05).结论 双膝组术后早期在疼痛评分方面优于单膝组,但SF-36量表评价、HSS膝关节功能评分及ROM等方面较单膝组无明显优势.