Acral Fibrokeratoma of the Foot Treated with Excision and Trap Door Flap Closure: A Case Report

Acral fibrokeratoma is a relatively rare, benign lesion that is typically found on the fingers and toes but can also be found on the palms and soles. Several case reports have been published of this rare lesion, with only a few investigators describing lesions of the feet. The techniques of using skin from a portion of the mass to close the defect left from mass excision have been poorly reported. Our technique, which we have termed the “trap door flap,” has design similarities to the appearance and mechanics of a trap door. We present the case of a patient with a 7-year history of a slow-growing, soft tissue mass on the plantar and medial aspect of his left hallux. The mass was subsequently excised and closed with a local flap. The flap had healed uneventfully by 2 weeks postoperatively, and the patient denied any evidence of recurrence or pain at 12 months of follow-up.     

老年恶性肿瘤患者并发医院获得性肺炎的临床分析

目的：探讨老年肿瘤患者并发医院获得性肺炎的危险因素。方法：选择南通市老年康复医院并发医院获得性肺炎的老年肿瘤患者50例为观察组,随机选择同时段住院治疗未并发医院获得性肺炎的老年肿瘤患者50例为对照组。从住院时间、肿瘤分期、功能状态评分（PS评分）、糖皮质激素的使用、应用广谱抗菌药物、侵入性操作、手术、放疗/化疗、贫血、中性粒细胞缺乏、血清白蛋白水平、是否合并糖尿病、慢性阻塞性肺病（COPD）、长期吸烟等方面比较两组的差异。结果：住院时间≥30d、肿瘤分期（Ⅲ＋Ⅳ期）、贫血、中性粒细胞缺乏、PS评分、血清白蛋白水平〈30g/L、COPD病史方面两组比较差异有统计学意义（P〈0.01）,糖皮质激素的使用、应用广谱抗菌药物、侵入性操作、手术、放疗/化疗、是否合并糖尿病、长期吸烟方面两组比较差异有统计学意义（P〈0.05）。结论：多种危险因素可以导致老年肿瘤患者并发医院获得性肺炎感染,应该采取积极有效的预防措施,并进行规范治疗。     

Community‐acquired infections associated with increased risk of lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia

Emerging evidence supports the role of immune stimulation in the development of lymphoplasmacytic lymphoma/Waldenström Macroglobulinaemia (LPL/WM). Using the population‐based Surveillance, Epidemiology End Results‐Medicare database we investigated the exposure to 14 common community‐acquired infections and subsequent risk of LPL/WM in 693 LPL/WM cases and 200 000 controls. Respiratory tract infections, bronchitis [odds ratio (OR) 1·56], pharyngitis (OR 1·43), pneumonia (OR 1·42) and sinusitis (OR 1·33) and skin infection, herpes zoster (OR 1·51) were all significantly associated with subsequent increased risk of LPL/WM. For each of these infections, the findings remained significantly elevated following the exclusion of more than 6 years of Medicare claims data prior to LPL/WM diagnosis. Our findings may support a role for infections in the development of LPL/WM or could reflect an underlying immune disturbance that is present several years prior to diagnosis and thereby part of the natural history of disease progression.     

Insights into the Structures and Multimeric Status of APOBEC Proteins Involved in Viral Restriction and Other Cellular Functions

Apolipoprotein B mRNA editing catalytic polypeptide-like (APOBEC) proteins belong to a family of deaminase proteins that can catalyze the deamination of cytosine to uracil on single-stranded DNA or/and RNA. APOBEC proteins are involved in diverse biological functions, including adaptive and innate immunity, which are critical for restricting viral infection and endogenous retroelements. Dysregulation of their functions can cause undesired genomic mutations and RNA modification, leading to various associated diseases, such as hyper-IgM syndrome and cancer. This review focuses on the structural and biochemical data on the multimerization status of individual APOBECs and the associated functional implications. Many APOBECs form various multimeric complexes, and multimerization is an important way to regulate functions for some of these proteins at several levels, such as deaminase activity, protein stability, subcellular localization, protein storage and activation, virion packaging, and antiviral activity. The multimerization of some APOBECs is more complicated than others, due to the associated complex RNA binding modes.     

替加环素对比左氧氟沙星治疗社区获得性肺炎疗效与安全性的Meta分析

摘 要 目的:系统评价替加环素与左氧氟沙星治疗社区获得性肺炎的疗效与安全性。方法：计算机检索 The Cochrane library, PubMed, Web of science,中国知网、万方数据库、维普期刊数据库,搜索替加环素对比左氧氟沙星治疗社区获得性肺炎的随机对照试验, 并对获得的研究进行质量评价,综合纳入符合条件的文献用Rev Man 5.0统计学软件进行Meta 分析。结果：共纳入3项RCT,合计1 275例患者,Meta分析结果显示,基于临床有效（CE）人群,替加环素对比左氧氟沙星治疗社区获得性肺炎(CAP）临床治疗有效率的差异无统计学意义(OR_合并=1.40,95%CI[0.92,2.15],P=0.12);基于临床意向性分析（c-mITT）人群, 两组临床治疗有效率的差异无统计学意义(OR_合并=1.11, 95%CI[0.82,1.49], P=0.5）,因此替加环素与左氧氟沙星相比治疗CAP效果相当。两组总不良反应发生率的差异有统计学意义(OR_合并=1.57, 95%CI[1.25,1.97], P＜0.000 1）, 两组消化系统不良反应发生率的差异无统计学意义(OR_合并=2.29, 95%CI[1.75,3.01], P＜0.000 01）。结论：本研究证据表明替加环素可以作为社区获得性肺炎的替代治疗药物,但与左氧氟沙星相比其不良反应风险会增加,治疗费用也会大大增加,不作为社区获得性肺炎的首选。本研究纳入的随机对照试验（RCT）质量高,但是数量较少,随着更多RCT的开展,结论将被进一步论证。     

狼疮性肾炎并发社区获得性肺炎患者的抗感染用药监护

目的:分析临床药师参与狼疮性肾炎并发社区获得性肺炎患者抗感染用药监护。方法:对1例狼疮性肾炎并发社区获得性肺炎(重症)患者进行全程药学监护,协助医师制定抗感染药物治疗方案,并随病情变化作修正或调整。结果:莫西沙星和哌拉西林钠/他唑巴坦钠的联合用药,使患者的肺部感染得到及时有效控制,避免了潜在狼疮性肾炎复发或加重的危险。结论:特殊人群抗菌药物的选择,不仅要考虑抗菌谱、抗菌活性,还应结合患者的个体特征和药动学特性来做综合选择,可提高患者用药的安全性和有效性。     

血清PCT和CRP检测在社区获得性肺炎诊断中的临床意义

目的 探讨血清降钙素原(PCT)和C反应蛋白(CRP)在社区获得性肺炎(CAP)实验室诊断中的应用价值.方法 分析我院2014年1月至2015年1月社区获得性肺炎患者150例.并选取同期健康体检者150例做为正常对照组.所有各组均进行血清PCT和CRP含量的测定.结果 社区获得性肺炎患者组的血清PCT和CRP含量明显高于正常对照组,相比较有统计学意义(P＜0.05);PCT和CRP的敏感性分别为87.3％和83.3％,二者敏感性比较差异无统计学意义(P＞0.05);但二者的特异度相比较,PCT为95.3％,较CRP的70.7％高,相比较有统计学意义(P＜0.05).结论 血清PCT和CRP的测定在诊断CAP中都有一定的应用价值,特别是PCT在敏感性和特异性方面都优于CRP,是一个较好的诊断与鉴别诊断的指标,更值得临床推广应用.