皮肤鳞状细胞癌诊疗专家共识（2021）

【摘要】 皮肤鳞状细胞癌是非黑素瘤皮肤癌中最常见的肿瘤之一。近年来随着对其发病机制研究的深入以及诊断技术、Mohs显微描记手术、靶向治疗、免疫治疗的发展,皮肤鳞状细胞癌的诊疗取得了较大进展。该共识在国内外近期文献及诊疗指南的基础上,结合我国的诊疗现状,重点阐述皮肤鳞状细胞癌的临床表现及分型、病理活检及报告规范、风险等级评估、分级分期以及规范化治疗等,为临床医生的诊疗工作提供参考依据。     

Retrospective study investigating the prevalence and clinical significance of hepatitis B virus precore and basal core promoter variants

BACKGROUND:

Hepatitis B virus (HBV) precore (PC) and basal core promoter (BCP) variants are well known; however, their prevalence in North America is unclear, especially among hepatitis B e antigen-negative patients.

OBJECTIVE:

To investigate the prevalence of PC/BCP mutations and their clinical significance.

METHODS:

One hundred twenty-eight patients positive for both hepatitis B surface antigen and hepatitis B e antibody were selected, and PC/BCP mutations were identified using a line probe assay. The subjects’ charts were reviewed for race/ethnicity, HBV genotype, HBV viral load, sex, liver enzyme levels, imaging and biopsy results up to 10 years before the study.

RESULTS:

The prevalence of PC and BCP variants were 47.6% and 62.5%, respectively. Older age was associated with aspartate aminotransferase-to-platelet index ratio (APRI) ≥0.7 (P=0.011) and abnormal imaging/biopsy results (P=0.0008). Although the presence of BCP variant(s) was associated with APRI ≥0.7 (P=0.029), it was not associated with abnormal imaging/biopsy results. The combination of age ≥50 years and the presence of BCP variant(s) was associated with abnormal imaging/biopsy results, suggestive of either cirrhosis or hepatocellular carcinoma (not observed with PC mutation). Neither sex or genotype, or median HBV viral load showed significant influence on any of these outcomes.

CONCLUSIONS:

The present study suggests that the prevalence of PC and BCP mutations are higher than what has been previously reported. One potential explanation would be increased immigration in the past decade. Considering the potential public health and clinical implications of these variants, long-term multicentre and prospective studies could further unravel the uncertainty around these variants.     

Effects of Pentoxifylline on Non-Alcoholic Steatohepatitis: A Randomized,Double-Blind,Placebo-Controlled Trial in Iran

Background:

Non-alcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease. Several studies suggest that pentoxifylline (PTX) can improve the disease outcome.

Objectives:

We aimed to compare the effect of pentoxifylline with placebo on liver aminotransferases and cytokines, including interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin 8 (IL-8) in patients with NASH.

Patients and Methods:

Thirty patients with NASH were included in the study, based on ultrasonography and 1.5-fold mean change from baseline serum levels of liver aminotransferases. Patients with NASH were randomized to receive 1200 mg PTX (the intervention group) or placebo (the placebo group) for 6 months. The serum levels of liver aminotransferases and cytokines were compared between the intervention and placebo groups, at various time points.

Results:

The serum levels of liver aminotransferases were significantly reduced at 3 months and at 6 months, compared with baseline, in both groups. The serum levels of IL-6 were significantly decreased, in both groups, only at 6 months, compared with baseline. Compared to the placebo group, the serum level of TNF-α was significantly decreased in the intervention group, at 6 months. The serum level of IL-8 was increased, in both groups, after 6 months, without reaching clinical significance. There was no significant difference in serum levels of liver aminotransferases and cytokines, between intervention and placebo groups.

Conclusions:

Decreases in the serum levels of liver aminotransferases and cytokines, in both groups, are related to low-calorie diets and exercise, rather than PTX.     

Lymphocytosis of large granular lymphocytes associated with anemia and neutropenia: Proof of monoclonality of the LGL-population,but benign clinical course

Summary A 37-year-old man with severe transfusion-requiring anemia and neutropenia associated with lymphocytosis of large granular lymphocytes (LGLs) has been followed over a period of 3.5 years. Detailed phenotyping of the LGL has been performed, revealing a phenotype of CD3⁺, CD8⁺, CD16⁺, HLA-DR⁺, and Leu-7⁺. Southern-blot analysis of the T-cell receptor beta-chain locus detected a gene rearrangement, thus providing proof of monoclonality of the peripheral blood LGLs.Abbreviations CD Cluster of differentiation - LGLs Large granular lymphocytes - PBMCs Peripheral blood mononuclear cells     

Bowling Together: Promoting the Identity,Brand, and Value of the Society of Clinical Psychology

The declining trends in membership within the American Psychological Association (APA) and APA divisions reviewed by Robiner, Fossum, and Hong (2015) are startling and provide a wake‐up call to professional psychology. In this commentary, Karlin (the President‐Elect of APA Division 12, the Society of Clinical Psychology [SCP]) identifies important issues associated with membership needs and declines within SCP and critical areas of focus for ensuring its future success. In identifying current needs and providing a vision for the future of SCP, Karlin stresses the importance of and future plans for promoting the identity, brand, and value of SCP.     

National Priority Setting of Clinical Practice Guidelines Development for Chronic Disease Management

By November 2013, a total of 125 clinical practice guidelines (CPGs) have been developed in Korea. However, despite the high burden of diseases and the clinical importance of CPGs, most chronic diseases do not have available CPGs. Merely 83 CPGs are related to chronic diseases, and only 40 guidelines had been developed in the last 5 yr. Considering the rate of the production of new evidence in medicine and the worsening burden from chronic diseases, the need for developing CPGs for more chronic diseases is becoming increasingly pressing. Since 2011, the Korean Academy of Medical Sciences and the Korea Centers for Disease Control and Prevention have been jointly developing CPGs for chronic diseases. However, priorities have to be set and resources need to be allocated within the constraint of a limited funding. This study identifies the chronic diseases that should be prioritized for the development of CPGs in Korea. Through an objective assessment by using the analytic hierarchy process and a subjective assessment with a survey of expert opinion, high priorities were placed on ischemic heart disease, cerebrovascular diseases, Alzheimer''s disease and other dementias, osteoarthritis, neck pain, chronic kidney disease, and cirrhosis of the liver.     

Feasibility,acceptability, and effectiveness of a decision aid versus an informational website to promote clinical trial decision-making among cancer patients: A pilot randomized controlled trial

ObjectiveTo assess intervention feasibility and acceptability, and compare the effectiveness of the CHOICES Decision Aid (DA) versus the National Cancer Institute (NCI) Cancer Clinical Trials (CCT) website to improve knowledge about CCTs and preparedness to make an informed decision.MethodsOncology patients (n = 101) with a scheduled clinic visit were enrolled and randomized. Decision-making variables were collected at two timepoints. Post-intervention scores were examined via paired t-tests and multivariate regression analyses. Predictors of the magnitudes of the change in scores were examined in multivariable regression analyses.ResultsThe interventions were feasible to implement and acceptable to participants. Both interventions increased objective and subjective knowledge, improved clarity of opinions, and reduced decisional conflict (p-values < 0.01). Improvements in the belief that one could find out about CCTs were observed in the CHOICES DA arm (p < 0.001). Multivariable analyses controlling for educational attainment showed no significant differences in the magnitude of change in outcome variables between intervention arms, but did find that improvements in some variables in the NCI arm – but not CHOICES DA arm – were associated with previous educational attainment.ConclusionsInterventions were feasible to implement and acceptable. Improvements in knowledge and decision-making outcomes were observed in both arms, supporting the view that interventions to improve CCT decision making are effective and feasible. Our results suggest that the CHOICES DA may be more effective than an informational website in improving decision-making outcomes regardless of participants’ educational attainment.Practice implicationsCCT resources should support informed decision-making among all cancer survivors, regardless of educational attainment.     

精制Vero细胞狂犬病疫苗的临床观察及免疫学效果 …

目的 目前我国使用的人用狂犬病疫苗生产工艺较落后,致使用后副反应较严重,而国际上Ｖｅｒｏ细胞狂犬病疫苗已研制成功和使用近２０年,不仅免疫效果良好而且副反应很轻。为了改变我国狂犬病疫苗生产工艺的落后和质量较差的状况,而开展此项研究。方法 海南省生物制品研究所和河南省生物技术研究所联合研制的Ｖｅｒｏ细胞狂犬病疫苗获得卫生部批准进行临床观察,该疫苗以ａＧ株适应Ｖｅｒｏ细胞后为生产毒种,转瓶培养、并浓缩适