他达拉非治疗ED的进展

他达拉非是治疗ED的有效药物,大量的研究已经证实了其在ED患者中的临床疗效。相对于西地那非和伐地那非,他达拉非最为显著的特点是它的长效性,接受治疗的ED患者可以在长达36 h的时间窗内自然地达到有效的勃起。他达拉非对患有内科合并症的ED患者具有良好的疗效,它还能有效地改善患者的心理以及晨勃现象,使患者恢复生活的自信。他达拉非的长效性使患者性生活符合“自然、愉快、正常的性生活”这一治疗要求,从而成为越来越多患者的首选药物。     

他达拉非治疗ED疗效和安全性新进展

他达拉非——长效5型磷酸二酯酶(PDE5)抑制剂是治疗勃起功能障碍(ED)的首选药物之一。许多临床研究证实其在普通ED患者、老年患者以及伴有糖尿病、脊髓损伤或前列腺癌术后患者中有较好的疗效和良好的安全性及耐受性,而且其独特的长达36 h的时间窗不仅增强了患者的自信心,更改善了患者及其伴侣的生活质量。     

Clinical Rheumatology: A Book Review

This concise book on ‘Clinical Rheumatology’ has described all the important Rheumatology conditions and their management in adequate detail and lucid manner. It is likely to serve multiple goals by catering to a multitarget audience comprising undergraduate and postgraduate medical students, residents, and clinicians who wanted to gain practical knowledge. In addition, the book caters to orthopaedic surgeons, internists, physiatrists, physiotherapists, occupational therapists, and rheumatologists. Day-to-day questions are answered in a knowledge format that can be applied straight away. Senior clinicians will find it as a ready reckoner to refresh their knowledge and teach. ‘Clinical Rheumatology’ book has come out as a reader-friendly, value for time book that I would highly recommend to all orthopaedic surgeons to have the insight and skill to manage rheumatology patients in their clinical practice.

Title of Book: Clinical RheumatologyAuthor: Prof. Rohini HandaPublisher: SpringerISSN: 978-981-33-4884-4Edition: FirstDate of publication: 2021Price: 145.59 Euros (Hardcover), 117.69 (E-Book)Rheumatic diseases are common in the community, yet the teaching of Rheumatology is primarily marginalized in the undergraduate and postgraduate medical curricula in India and many other developing countries. This leaves the young doctors inadequately trained and poorly prepared for the avalanche of cases with musculoskeletal (MSK) problems that they encounter in real life. In the same vein, there is a substantial unmet need for concise Rheumatology textbooks. The undergraduate books offer incomplete information, while the voluminous reference books are daunting for non-rheumatologists seeking to find practical, evidence-based information that will equip them to handle everyday clinical situations.‘Clinical Rheumatology’ aims to fill this gap. The author, Prof. Rohini Handa, is a clinician with vast and varied experience and has served on the faculty of the All India Institute of Medical Sciences (AIIMS), New Delhi, for over 2 decades. He is currently a Senior Consultant Rheumatologist at the Indraprastha Apollo Hospitals. He has held several distinguished appointments in a career spanning four decades, as Dean Indian College of Physicians, Chair of the International League of Associations for Rheumatology, President of Asia Pacific League of Associations for Rheumatology, and the Indian Rheumatology Association. A clinician has lucidly written this book, who has vast and varied experience. The entire gamut of Rheumatology is discussed in 35 chapters. The introductory chapters deal with the bedside approach to a patient with MSK complaints and the commonly ordered laboratory investigations. Arthritides, connective disease diseases, vasculitides, and soft tissue rheumatism are discussed seamlessly. Common dilemmas and conundrums, like seronegative arthritis, undifferentiated connective tissue disease, and mixed connective tissue diseases have attracted separate chapters. The approach to connective tissue diseases is expounded in a fashion that is likely to appeal to all orthopedic surgeons. The author has pruned unnecessary detail. Some of the novel chapters include emergencies in rheumatology practice, pregnancy and fatherhood issues, and the contemporary problem of COVID. Tropical rheumatic diseases like chikungunya and dengue are adequately discussed. The last chapter listing reliable web resources is quite handy.The emphasis of ‘Clinical Rheumatology’ is on concept building, where it seems to have admirably succeeded. The layout of the book is visually attractive, and the contents are intellectually satisfying. The liberal sprinkling of tables, flow charts, and boxes breaks the monotony of the text and makes for an easy read. Being a single-author text, the style consistency is maintained throughout. Clinical Rheumatology is available both in hardcover version and as E-Book.The book is not without its shortcomings. A detailed reference list is not provided, and the chapters contain only a couple of essential references as suggested reading. While the table of contents is exhaustive, the index is conspicuous by its absence. I would have loved it more if its fonts were up by one or two sizes to avoid stress on the elderly eyes. Trial data is discussed shorn of full details. The author at places has embraced brevity over verbosity. While keeping with the international benchmarks in mind, the cost of the book is high for the Indian students, but a discounted price is available on Amazon as compared to the publisher’s website.‘Clinical Rheumatology’ is likely to serve multiple goals by catering to a multitarget audience comprising undergraduate and postgraduate medical students, residents, and clinicians who wanted to gain practical knowledge. In addition, the book caters to orthopaedic surgeons, internists, physiatrists, physiotherapists, occupational therapists, and rheumatologists. Day-to-day questions are answered in a knowledge format that can be applied straight away. Senior clinicians will find it as a ready reckoner to refresh their knowledge and teach.On the whole, ‘Clinical Rheumatology’ comes across as a reader-friendly, value for time book that I would highly recommend to all libraries and all orthopaedic surgeons individually to have the insight and skill to manage rheumatology patients in their clinical practice (see Fig. ​Fig.11).Open in a separate windowFig. 1Cover page of the book     

原因不明不育患者减数分裂同源染色体重组的研究

在第一次减数分裂前期,同源染色体之间的重组对同源染色体正确分离起着重要作用。重组异常是染色体不分离的重要风险因子,并可能进一步导致不育。而不育症作为一个重要的健康问题,影响着10%～20%夫妇,其中含有男方因素引起的不育占50%。尽管男性不育的发病率高,但目前关于因减数分裂导致精子发生过程失败的机制仍知之甚少。近年来发展的免疫荧光技术使我们可以直视减数分裂重组事件,为研究人类精子形成的过程提供了新的手段。     

An Updated Review of the Therapeutic Management of Keratoacanthomas

ObjectiveKeratoacanthomas are fast-growing cutaneous neoplasms that can be difficult to distinguish from squamous cell carcinoma, both clinically and histologically. The uncertain behavior of these neoplasms creates a challenge in management, and treatment choice often varies significantly between cases. The objective of this review is to discuss the most common and up-to-date treatment modalities used in the management of keratoacanthomas.MethodsA literature search was performed using PubMed to access and review relevant keratoacanthoma treatment modalities published within the last 40 years. Keywords searched included "keratoacanthoma," "Grzybowski syndrome," "Ferguson-Smith syndrome," "Witten-Zac syndrome," and "Muir-Torre" syndrome.ResultsOur search resulted in 3,408 articles, of which 67 articles were ultimately included in this review.ConclusionAlthough surgical removal with excision or Mohs micrographic surgery remains the standard of therapy, there are many alternative therapeutic modalities that can be utilized.     

Biologic Therapies for the Treatment of Knee Osteoarthritis: An Updated Systematic Review

BackgroundUse of “orthobiologics” continues to expand for patients who have knee osteoarthritis (OA). We sought to perform a systemic review of biologic therapies relative to comparative groups, including the following: (1) platelet-rich plasma (PRP); (2) bone marrow–derived mesenchymal stem cells (BMSCs); (3) adipose-derived mesenchymal stem cells (ADSCs); and (4) amniotic-derived mesenchymal stem cells (AMSCs). We assessed the following: (1) study methodologies; (2) cell preparations and formulations; (3) patient-reported outcome scores (PROMs); and (4) structural changes.MethodsPubMed, Cochrane Library, and Embase databases were queried (2013-2021) to conduct a systematic review of biologic therapies for knee OA, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighty-two studies were included: PRP (51); BMSC (15); ADSC (11); and AMSC (5). Study evaluations were made using the Modified Coleman Methodology Score. PROMs included the Western Ontario and McMaster Universities Arthritis Index and the Visual Analog Scale. Structural change evaluations included ultrasounds, radiographs, or magnetic resonance imaging.ResultsPRP comprised a majority of the studies (n = 51), most with “fair” to “good” Modified Coleman Methodology Score. Studies had variable cell preparations and formulations, with comparison study results leading to inconsistent PROMs, and structural changes. A limited number of studies were included for BMSC, ADSC, and AMSC, all with similar findings to PRP.ConclusionAvailable literature evaluating “orthobiologics” for knee OA remain nonsuperior to comparison cohorts. Higher level studies with larger sample sizes and improved methodologies are warranted to suggest differences. Despite a growth of “orthobiologics” in clinics, this updated systematic review highlights the uncertain efficacy for use in knee OA.     

Infected Cardiac Myxoma: an Updated Review

OBJECTIVE

This study aims to present an updated clinical picture of the infected cardiac myxoma. Revankar & Clark made a systematic review of infected cardiac myxoma based on the literature before 1998. Since then, there has not been any updated information describing its recent changing trends.

METHODS

A comprehensive literature search of infected cardiac myxoma was conducted on MEDLINE, Highwire Press and Google between 1998 and 2014.

RESULTS

In comparison with Revankar & Clark''s series, the present series disclosed a significantly decreased overall mortality. It is believed that refinement of the prompt diagnosis and timely management (use of sensitive antibiotics and surgical resection of the infected myxoma) have resulted in better outcomes of such patients.

CONCLUSION

The present series of infected cardiac myxoma illustrated some aggravated clinical manifestations (relative more occasions of high-grade fever, multiple embolic events and the presence of refractory microorganisms), which should draw enough attention to careful diagnosis and treatment. In general, the prognosis of infected cardiac myxoma is relatively benign and the long-term survival is always promising.     

Risk of Skin Cancer with Phototherapy in Moderate-to-Severe Psoriasis: An Updated Systematic Review

Phototherapy is a standard treatment for moderate-to-severe psoriasis. However, concern remains regarding the associated cutaneous carcinogenic risk. Our objective is to conduct a systematic review of skin cancer risk for psoriasis patients treated with phototherapy. To achieve our goal, we searched Cochrane, PubMed, and Embase databases. We aimed to evaluate existing literature (from July 1, 2010, to December 31, 2020) on phototherapy for all Fitzpatrick skin phototypes (FSP) which includes 71 articles, and eight articles being categorized in this review. Five studies did not report an increased skin cancer risk with narrowband-ultraviolet blue (UVB) and unspecified UVB for FSP II through VI, with one study not reporting FSP. Three studies did report an increased risk of skin cancer with narrowband-UVB and broadband-UVB for FSP I-VI, with one study also not specifying skin phototypes or UVB phototherapy type. Additionally, a study with psoralen and ultraviolet A with and without narrowband-UVB demonstrated an increased risk of skin cancer in phototypes III and IV. The most commonly reported secondary outcomes with phototherapy were actinic keratosis (123) and solar lentigines (10). Numerous patients were also on additional therapies including methotrexate, acitretin, and biologics. Study limitations include publication bias due to limited number of studies published on this topic in the last ten years along with heterogeneity in reporting. The relationship between phototherapy, psoriasis, and cutaneous oncogenic risk remains contradictory. While phototherapy for psoriasis is an efficacious therapy, further studies are needed to understand the cutaneous oncogenic risk based on FSP to help clinicals tailor treatment recommendations based on skin phototypes.     

Synchronous Carotid Endarterectomy and Off-pump Coronary Bypass: An Updated,Systematic Review of Early Outcomes

ObjectivesTo update our previous systematic review of outcomes following synchronous carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OFF-CABG).DesignA systematic review of operative risks reported in published studies of synchronous CEA plus OFF-CABG procedures.ResultsWe identified 12 eligible studies, including data on 324 synchronous CEA plus OFF-CABG procedures. Operative mortality was 1.5% (95% confidence interval (CI): 0.3–2.8), the risk of death or ipsilateral stroke was 1.6% (0.4–2.8%), risk of death or any stroke was 2.2% (95% CI: 0.7–3.7) and the risk of death, stroke or myocardial infarction was 3.6% (95% CI: 1.6–5.5).ConclusionsLimited published data on 324 patients suggest that early outcomes after synchronous CEA plus OFFCABG are better than those following staged or synchronous CEA plus CABG where the cardiac procedure was performed on-pump. This may, however, be attributed to publication bias, case selection or the fact that the aorta was not manipulated or cannulated, rather than CEA being primarily responsible for the lower stroke risk. Colleagues with unpublished experience of CEA plus OFF-CABG are encouraged to submit their data to further inform the debate.     

Hyperbaric Oxygen Therapy for Malignancy: A Review

One unique feature of tumors is the presence of hypoxic regions, which occur predominantly at the tumor center. Hypoxia has a major impact on various aspects of tumor cell function and proliferation. Hypoxic tumor cells are relatively insensitive to conventional therapy owing to cellular adaptations effected by the hypoxic microenvironment. Recent efforts have aimed to alter the hypoxic state and to reverse these adaptations to improve treatment outcome. One way to increase tumor oxygen tensions is by hyperbaric oxygen (HBO) therapy. HBO therapy can influence the tumor microenvironment at several levels. It can alter tumor hypoxia, a potent stimulus that drives angiogenesis. Hyperoxia as a result of HBO also produces reactive oxygen species, which can damage tumors by inducing excessive oxidative stress. This review outlines the importance of oxygen to tumors and the mechanisms by which tumors survive under hypoxic conditions. It also presents data from both experimental and clinical studies for the effect of HBO on malignancy.