首页 > 最新文献

European journal of rheumatology最新文献

英文 中文
Minimal Change Disease and Primary Sjogren Syndrome Concurrence: Case-Based review. 微小变化疾病和原发性干燥综合征并发:基于病例的回顾。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.20246
Nazife Şule Yaşar Bilge, Sultan Özkurt, Mustafa Fuat Açıkalın, Timuçin Kaşifoğlu

Primary Sjogren's syndrome is a chronic autoimmune disease with glandular and extraglandular features. Renal involvement is less frequent when compared with other systemic manifestations. Glomerulonephritis is a relatively rare manifestation of primary Sjogren's syndrome. Among all types of glomerular manifestations, minimal change disease is rarely identified, and there are only a few cases in the literature. Herein, we present a 53-year-old male patient who was diagnosed with primary Sjogren's syndrome and minimal change disease while searching for the etiopathogenesis of nephrotic syndrome. The patient had edema, dyspnea, hypertension, and 12 g/day proteinuria at admission. Serum albumin level was 1.82 g/dL, and renal function tests were within normal ranges. Renal biopsy findings were consistent with minimal change disease. At the same time, he was diagnosed with primary Sjogren's syndrome based on dry eyes demonstrated with Schirmer's test, positive antinuclear antibody, anti-SS-A, and anti-SS-B antibodies. Hydroxychloroquine with methylprednisolone 1 mg/kg (64 mg/day) was started, and methylprednisolone was slowly tapered. His proteinuria regressed to 79.2 mg/day, creatinine level was 0.83 mg/dL, and serum albumin level increased to 3.88 g/dL on the second week of the glucocorticoid treatment. In this case-based review, we present our case with 5 other reports of minimal change disease associated with primary Sjogren's syndrome. Our aim was to increase the awareness of this rare concurrence both among rheumatologists and nephrologists in light of the literature review.

原发性干燥综合征是一种具有腺和腺外特征的慢性自身免疫性疾病。与其他全身性表现相比,肾脏受累较少见。肾小球肾炎是原发性干燥综合征的一种相对罕见的表现。在所有类型的肾小球表现中,微小改变疾病很少被发现,文献中也只有少数病例。在此,我们报告一位53岁男性患者,在寻找肾病综合征的发病机制时,被诊断为原发性干燥综合征和微小病变。患者入院时有水肿、呼吸困难、高血压和12g /d蛋白尿。血清白蛋白1.82 g/dL,肾功能在正常范围内。肾活检结果与微小病变一致。同时,根据Schirmer试验、抗核抗体、抗ss - a、抗ss - b抗体阳性,诊断为原发性干燥综合征。羟氯喹联合甲基强的松龙1 mg/kg (64 mg/天)开始治疗,甲基强的松龙逐渐减少剂量。在糖皮质激素治疗的第二周,他的蛋白尿下降到79.2 mg/d,肌酐水平为0.83 mg/dL,血清白蛋白水平上升到3.88 g/dL。在这个以病例为基础的回顾中,我们将我们的病例与其他5例与原发性干燥综合征相关的微小变化疾病的报告一起呈现。我们的目的是根据文献综述,提高风湿病学家和肾病学家对这种罕见并发的认识。
{"title":"Minimal Change Disease and Primary Sjogren Syndrome Concurrence: Case-Based review.","authors":"Nazife Şule Yaşar Bilge,&nbsp;Sultan Özkurt,&nbsp;Mustafa Fuat Açıkalın,&nbsp;Timuçin Kaşifoğlu","doi":"10.5152/eurjrheum.2022.20246","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.20246","url":null,"abstract":"<p><p>Primary Sjogren's syndrome is a chronic autoimmune disease with glandular and extraglandular features. Renal involvement is less frequent when compared with other systemic manifestations. Glomerulonephritis is a relatively rare manifestation of primary Sjogren's syndrome. Among all types of glomerular manifestations, minimal change disease is rarely identified, and there are only a few cases in the literature. Herein, we present a 53-year-old male patient who was diagnosed with primary Sjogren's syndrome and minimal change disease while searching for the etiopathogenesis of nephrotic syndrome. The patient had edema, dyspnea, hypertension, and 12 g/day proteinuria at admission. Serum albumin level was 1.82 g/dL, and renal function tests were within normal ranges. Renal biopsy findings were consistent with minimal change disease. At the same time, he was diagnosed with primary Sjogren's syndrome based on dry eyes demonstrated with Schirmer's test, positive antinuclear antibody, anti-SS-A, and anti-SS-B antibodies. Hydroxychloroquine with methylprednisolone 1 mg/kg (64 mg/day) was started, and methylprednisolone was slowly tapered. His proteinuria regressed to 79.2 mg/day, creatinine level was 0.83 mg/dL, and serum albumin level increased to 3.88 g/dL on the second week of the glucocorticoid treatment. In this case-based review, we present our case with 5 other reports of minimal change disease associated with primary Sjogren's syndrome. Our aim was to increase the awareness of this rare concurrence both among rheumatologists and nephrologists in light of the literature review.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"221-224"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/b8/ejr-9-4-221.PMC10089134.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9286588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Multidisciplinary models for pregnancy care in patients with rheumatic diseases: Clinical experiences and experts opinion. 风湿病患者妊娠护理的多学科模式:临床经验和专家意见。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eujrheum.2022.20012
Andrea Pluma, Laia Alsina, Ofelia Baniandres, Rafael Caliz, Manel Casellas, Dolors Grados, Juan Antonio Martınez Lopez, Erika Padron Perez, Ana Polo, Jose Maria Pego Reigosa, Elisa Trujillo, Paloma Vela

Objectives: To describe different models of multidisciplinary pregnancy care for patients with inflammatory and autoimmune rheumatic diseases, and the steps to follow concerning their implementation.

Methods: A qualitative study was conducted including: (1) a comprehensive literature search in PUBMED focused on multidisciplinary care models; (2) structured interviews with seven rheumatologists from multidisciplinary pregnancy clinics for patients with inflammatory and autoimmune rheumatic diseases. Data were collected related to the hospitals, medical departments, populations cared for, and multidisciplinary care models (type, material, and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision-making, research and educational activities, multidisciplinary clinical sessions, initiation/start, planning, advantages/disadvantages, and barriers/facilitators for implementation); (3) a nominal meeting group in which the results of searches and interviews were analyzed and the recommendations for the implementation of the multidisciplinary care models defined.

Results: We analyzed seven models of multidisciplinary care in pregnancy, implemented 3-10 years ago, which can all be summarized by two different subtypes: parallel (patients are assessed the same day in the involved medical services) and preferential (patients are assessed on different days in the involved medical services) circuits. The implementation of a specific model results rather from an adaptation to the hospital's and professionals' circumstances. Correct planning and good harmony among professionals are key points to implementing a model.

Conclusion: Different multidisciplinary care models have been implemented for patients with inflammatory and autoimmune rheumatic diseases during pregnancy. They pretend to improve care, system efficiency, and collaboration among specialists and should be carefully implemented.

目的:探讨不同的多学科妊娠护理模式对炎症性和自身免疫性风湿病患者的影响及其实施步骤。方法:进行定性研究,包括:(1)在PUBMED中进行以多学科护理模式为重点的综合文献检索;(2)对来自多学科妊娠诊所的7名风湿病学家进行结构化访谈,以治疗炎症性和自身免疫性风湿病患者。收集了与医院、医疗部门、护理人群和多学科护理模式(类型、材料和人力资源、专业要求、目标、转诊标准、议程、协议、职责、决策、研究和教育活动、多学科临床会议、启动/开始、规划、优势/劣势和实施障碍/促进因素)相关的数据;(3)一个名义上的会议小组,在这个小组中,对搜索和访谈的结果进行分析,并确定实施多学科护理模式的建议。结果:我们分析了3-10年前实施的7种妊娠多学科护理模式,它们都可以归纳为两种不同的亚型:平行回路(患者在涉及的医疗服务中同一天接受评估)和优先回路(患者在涉及的医疗服务中在不同的日期接受评估)。具体模式的实施结果,而不是适应医院和专业人员的情况。正确的规划和专业人员之间的良好协调是实施模式的关键。结论:对妊娠期炎性和自身免疫性风湿病患者实施不同的多学科护理模式。他们假装改善护理,系统效率和专家之间的合作,应该仔细实施。
{"title":"Multidisciplinary models for pregnancy care in patients with rheumatic diseases: Clinical experiences and experts opinion.","authors":"Andrea Pluma,&nbsp;Laia Alsina,&nbsp;Ofelia Baniandres,&nbsp;Rafael Caliz,&nbsp;Manel Casellas,&nbsp;Dolors Grados,&nbsp;Juan Antonio Martınez Lopez,&nbsp;Erika Padron Perez,&nbsp;Ana Polo,&nbsp;Jose Maria Pego Reigosa,&nbsp;Elisa Trujillo,&nbsp;Paloma Vela","doi":"10.5152/eujrheum.2022.20012","DOIUrl":"https://doi.org/10.5152/eujrheum.2022.20012","url":null,"abstract":"<p><strong>Objectives: </strong>To describe different models of multidisciplinary pregnancy care for patients with inflammatory and autoimmune rheumatic diseases, and the steps to follow concerning their implementation.</p><p><strong>Methods: </strong>A qualitative study was conducted including: (1) a comprehensive literature search in PUBMED focused on multidisciplinary care models; (2) structured interviews with seven rheumatologists from multidisciplinary pregnancy clinics for patients with inflammatory and autoimmune rheumatic diseases. Data were collected related to the hospitals, medical departments, populations cared for, and multidisciplinary care models (type, material, and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision-making, research and educational activities, multidisciplinary clinical sessions, initiation/start, planning, advantages/disadvantages, and barriers/facilitators for implementation); (3) a nominal meeting group in which the results of searches and interviews were analyzed and the recommendations for the implementation of the multidisciplinary care models defined.</p><p><strong>Results: </strong>We analyzed seven models of multidisciplinary care in pregnancy, implemented 3-10 years ago, which can all be summarized by two different subtypes: parallel (patients are assessed the same day in the involved medical services) and preferential (patients are assessed on different days in the involved medical services) circuits. The implementation of a specific model results rather from an adaptation to the hospital's and professionals' circumstances. Correct planning and good harmony among professionals are key points to implementing a model.</p><p><strong>Conclusion: </strong>Different multidisciplinary care models have been implemented for patients with inflammatory and autoimmune rheumatic diseases during pregnancy. They pretend to improve care, system efficiency, and collaboration among specialists and should be carefully implemented.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"191-196"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9101323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Ruxolitinib for Refractory Macrophage Activation Syndrome Complicating Adult-Onset Still's Disease. 鲁索利替尼治疗难治性巨噬细胞激活综合征并发成人发病斯蒂尔氏病。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21064
Ofer Levy, Arie Apel, Hossam Alhdor, Avraham Mizrachi, Nancy Agmon-Levin, Maya Koren-Michowitz, Mirit Amit-Vazina

Macrophage activation syndrome is the most frequent life-threatening complication of adult-onset Still's disease. This is a nearly fatal case of a young patient, which has been refractory to corticoste- roids, anakinra, tocilizumab, cyclosporine A, and etoposide, but eventually responded miraculously to salvage therapy with ruxolitinib. We review recent pertinent data related to the therapeutic value of ruxolitinib for macrophage activation syndrome triggered by adult-onset Still's disease.

巨噬细胞激活综合征是成人发病的斯蒂尔氏病最常见的危及生命的并发症。这是一位几乎致命的年轻患者,他对皮质酮类药物、阿那那、托珠单抗、环孢素a和依托泊苷难以治愈,但最终对鲁索利替尼的补救性治疗产生了奇迹般的反应。我们回顾了最近有关鲁索利替尼治疗成人发病斯蒂尔氏病引发的巨噬细胞激活综合征的相关数据。
{"title":"Ruxolitinib for Refractory Macrophage Activation Syndrome Complicating Adult-Onset Still's Disease.","authors":"Ofer Levy,&nbsp;Arie Apel,&nbsp;Hossam Alhdor,&nbsp;Avraham Mizrachi,&nbsp;Nancy Agmon-Levin,&nbsp;Maya Koren-Michowitz,&nbsp;Mirit Amit-Vazina","doi":"10.5152/eurjrheum.2022.21064","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21064","url":null,"abstract":"<p><p>Macrophage activation syndrome is the most frequent life-threatening complication of adult-onset Still's disease. This is a nearly fatal case of a young patient, which has been refractory to corticoste- roids, anakinra, tocilizumab, cyclosporine A, and etoposide, but eventually responded miraculously to salvage therapy with ruxolitinib. We review recent pertinent data related to the therapeutic value of ruxolitinib for macrophage activation syndrome triggered by adult-onset Still's disease.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"217-220"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/52/ejr-9-4-217.PMC10089131.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9285011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Takayasu arteritis early diagnosis by noninvasive imaging. 高须动脉炎的无创影像学早期诊断。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21119
Joaquin J Barjau-Vallet, Pedro Del Valle Rodriguez-Flores, Yeison Arias Morales
{"title":"Takayasu arteritis early diagnosis by noninvasive imaging.","authors":"Joaquin J Barjau-Vallet,&nbsp;Pedro Del Valle Rodriguez-Flores,&nbsp;Yeison Arias Morales","doi":"10.5152/eurjrheum.2022.21119","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21119","url":null,"abstract":"","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"225-226"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10591688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Concurrent use of tumor necrosis factor inhibitor and tyrosine kinase inhibitor in ankylosing spondylitis and myeloid neoplasm. 肿瘤坏死因子抑制剂和酪氨酸激酶抑制剂在强直性脊柱炎和髓系肿瘤中的同时应用。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21097
Akash Gupta, Yuliya Afinogenova, Nikolai A Podoltsev, Abhijeet Danve

Biologic disease-modifying agents (bDMARDs) are highly effective in controlling the symptoms of autoimmune rheumatic diseases. The decision on whether to continue bDMARDs following a cancer diagnosis can be challenging for patients and physicians. Here, we describe a case of a middle-aged male with ankylosing spondylitis who was controlled on infliximab (IFX) and found to have a myeloid neoplasm with Platelet-Derived Growth Factor Receptor Beta rearrangement. The patient was started on a tyrosine kinase inhibitor imatinib. Given its significant positive effect on patient's quality of life, IFX was continued with a favorable outcome. This case highlights the importance of shared decisionmaking in balancing risks and benefits of immunosuppressants in appropriate cases of hematologic malignancy.

生物疾病调节剂(bDMARDs)在控制自身免疫性风湿病症状方面非常有效。癌症诊断后是否继续使用bdmard对患者和医生来说都是一个挑战。在这里,我们描述了一个中年男性强直性脊柱炎的病例,他被控制在英夫利昔单抗(IFX),发现有一个髓系肿瘤与血小板衍生生长因子受体β重排。患者开始使用酪氨酸激酶抑制剂伊马替尼。鉴于其对患者生活质量的显著积极影响,IFX继续治疗并取得了良好的结果。本病例强调了在适当的血液恶性肿瘤病例中,在平衡免疫抑制剂的风险和益处方面共同决策的重要性。
{"title":"Concurrent use of tumor necrosis factor inhibitor and tyrosine kinase inhibitor in ankylosing spondylitis and myeloid neoplasm.","authors":"Akash Gupta,&nbsp;Yuliya Afinogenova,&nbsp;Nikolai A Podoltsev,&nbsp;Abhijeet Danve","doi":"10.5152/eurjrheum.2022.21097","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21097","url":null,"abstract":"<p><p>Biologic disease-modifying agents (bDMARDs) are highly effective in controlling the symptoms of autoimmune rheumatic diseases. The decision on whether to continue bDMARDs following a cancer diagnosis can be challenging for patients and physicians. Here, we describe a case of a middle-aged male with ankylosing spondylitis who was controlled on infliximab (IFX) and found to have a myeloid neoplasm with Platelet-Derived Growth Factor Receptor Beta rearrangement. The patient was started on a tyrosine kinase inhibitor imatinib. Given its significant positive effect on patient's quality of life, IFX was continued with a favorable outcome. This case highlights the importance of shared decisionmaking in balancing risks and benefits of immunosuppressants in appropriate cases of hematologic malignancy.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"215-216"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9101321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Unusual Case of Extrapulmonary Tuberculosis in Rheumatology Consultation. 风湿病会诊一例罕见的肺外结核。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21207
Kayra Somay, İlker Eren, Mahir Kapmaz, Benan Çağlayan, Afak Durur Karakaya, Nilüfer Alpay Kanıtez
{"title":"An Unusual Case of Extrapulmonary Tuberculosis in Rheumatology Consultation.","authors":"Kayra Somay,&nbsp;İlker Eren,&nbsp;Mahir Kapmaz,&nbsp;Benan Çağlayan,&nbsp;Afak Durur Karakaya,&nbsp;Nilüfer Alpay Kanıtez","doi":"10.5152/eurjrheum.2022.21207","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21207","url":null,"abstract":"","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"227-228"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/a5/ejr-9-4-227.PMC10089129.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What are the main factors affecting the outcome of tocilizumab therapy in COVID-19-induced cytokine release syndrome? 在COVID-19诱导的细胞因子释放综合征中,影响tocilizumab治疗结果的主要因素是什么?
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-07-01 DOI: 10.5152/eurjrheum.2022.21010
Cansu Akleylek, Seray Gizem Gür, İbrahim Halil Sever, Safiye Koçulu Demir, Esin Çevik, Egemen Eken, Zafer Gökkaya, Yonca Çağatay, Neslihan Yılmaz

Objective: Recommendations for the treatment of cytokine release syndrome/macrophage activation syndrome (MAS) associated with coronavirus disease-2019 (COVID-19) are still of poor quality. IL-6 is an important therapeutic target as a main mediator of cytokine storm. The aim of our study was to evaluate the tocilizumab (TCZ) efficacy and factors affecting the therapy outcome.

Methods: This retrospective study included 27 patients treated with TCZ for COVID-19-MAS. All patients in this study were treated with TCZ (intravenously, at a dose of 8 mg kg1 ) in addition to standard therapy. Clinical improvement (survival and decreased oxygen demand) on the 10-14th days and secondary infection rate were assessed.

Results: In our 27 treated patients, 14 (51.8%) received TCZ in the intensive care unit (ICU) and seven (25.9%) were need to invasive mechanical ventilation (IMV). Fifteen (55.6%) of these patients revealed a good clinical response (four patients discharge from the ICU and 11 patients who followed-up in nonICU beds showed a decrease in oxygen demand). TCZ was significantly less effective in patients having high Murray lung injury score, low PO2/FiO2 ratio, IMV, and ICU admission (P < .05). Severity of hypoxemia was found as a single independent risk factor in the multivariable analysis (P < .05). Secondary bacterial infections rate was significantly higher in intubated patients (P < .01) or treated in the ICU (P ¼ .01).

Conclusion: TCZ was showed limited efficacy for COVID-19-related MAS. The most important predictive indicator for therapy outcome was found as the severity of hypoxemia. In addition, IMV and/or ICU was associated with the poor outcome and high side effect. So, controlled trials are still needed to confirm the indications and timing of TCZ therapy.

目的:新冠病毒病-2019 (COVID-19)相关细胞因子释放综合征/巨噬细胞激活综合征(MAS)的治疗建议质量仍然较差。IL-6作为细胞因子风暴的主要介质是重要的治疗靶点。本研究的目的是评估托珠单抗(TCZ)的疗效和影响治疗结果的因素。方法:回顾性研究27例经中西医结合治疗的新冠肺炎患者。本研究中的所有患者在标准治疗的基础上接受TCZ(静脉注射,剂量为8mg kg1)治疗。观察10 ~ 14天的临床改善情况(生存和耗氧量下降)及继发感染率。结果:27例患者中,重症监护病房(ICU)接受TCZ治疗的14例(51.8%),需要有创机械通气(IMV)治疗的7例(25.9%)。15例(55.6%)患者表现出良好的临床反应(4例从ICU出院,11例在非ICU床位随访的患者出现需氧量下降)。在Murray肺损伤评分高、PO2/FiO2比低、IMV低、入住ICU的患者中,TCZ的疗效明显较差(P < 0.05)。在多变量分析中发现低氧血症的严重程度是一个独立的危险因素(P < 0.05)。继发细菌感染率明显高于插管组(P < 0.01)和ICU组(P < 0.01)。结论:TCZ对新型冠状病毒相关MAS疗效有限。治疗结果最重要的预测指标是低氧血症的严重程度。此外,IMV和/或ICU与预后差和高副作用相关。因此,还需要进行对照试验来确定TCZ的适应症和治疗时机。
{"title":"What are the main factors affecting the outcome of tocilizumab therapy in COVID-19-induced cytokine release syndrome?","authors":"Cansu Akleylek,&nbsp;Seray Gizem Gür,&nbsp;İbrahim Halil Sever,&nbsp;Safiye Koçulu Demir,&nbsp;Esin Çevik,&nbsp;Egemen Eken,&nbsp;Zafer Gökkaya,&nbsp;Yonca Çağatay,&nbsp;Neslihan Yılmaz","doi":"10.5152/eurjrheum.2022.21010","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21010","url":null,"abstract":"<p><strong>Objective: </strong>Recommendations for the treatment of cytokine release syndrome/macrophage activation syndrome (MAS) associated with coronavirus disease-2019 (COVID-19) are still of poor quality. IL-6 is an important therapeutic target as a main mediator of cytokine storm. The aim of our study was to evaluate the tocilizumab (TCZ) efficacy and factors affecting the therapy outcome.</p><p><strong>Methods: </strong>This retrospective study included 27 patients treated with TCZ for COVID-19-MAS. All patients in this study were treated with TCZ (intravenously, at a dose of 8 mg kg1 ) in addition to standard therapy. Clinical improvement (survival and decreased oxygen demand) on the 10-14th days and secondary infection rate were assessed.</p><p><strong>Results: </strong>In our 27 treated patients, 14 (51.8%) received TCZ in the intensive care unit (ICU) and seven (25.9%) were need to invasive mechanical ventilation (IMV). Fifteen (55.6%) of these patients revealed a good clinical response (four patients discharge from the ICU and 11 patients who followed-up in nonICU beds showed a decrease in oxygen demand). TCZ was significantly less effective in patients having high Murray lung injury score, low PO2/FiO2 ratio, IMV, and ICU admission (P < .05). Severity of hypoxemia was found as a single independent risk factor in the multivariable analysis (P < .05). Secondary bacterial infections rate was significantly higher in intubated patients (P < .01) or treated in the ICU (P ¼ .01).</p><p><strong>Conclusion: </strong>TCZ was showed limited efficacy for COVID-19-related MAS. The most important predictive indicator for therapy outcome was found as the severity of hypoxemia. In addition, IMV and/or ICU was associated with the poor outcome and high side effect. So, controlled trials are still needed to confirm the indications and timing of TCZ therapy.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 3","pages":"126-131"},"PeriodicalIF":1.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Identifying physician-perceived barriers to a pragmatic treatment trial in rheumatoid arthritis. 确定医生感知的障碍,以实际治疗类风湿关节炎试验。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-07-01 DOI: 10.5152/eujrheum.2022.21038
Haiyan Qu, Shamly Austin, Jasvinder A Singh

Objective: The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a rheumatoid arthritis (RA) pragmatic trial of anti-tumor necrosis factor (TNF) biologic versus non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate.

Methods: Semistructured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data.

Results: Physician perceived patient barriers to the implementation of an RA pragmatic trial. This theme covers three subthemes: (1) patients' personal barriers, (2) patients' treatment-related factors, and (3) trial-related factors (eg, patient recruitment, side effects, mode of use, etc). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four subthemes: (1) clinic-related factors, (2) patient-related factors, (3) research personnel, and (4) facilitators (positive factors of the clinic).

Conclusion: Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (eg, coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patientcentered strategies to implement a pragmatic RA trial.

目的:本定性研究的目的是确定在对甲氨蝶呤反应不充分后,抗肿瘤坏死因子(TNF)生物制剂与非TNF生物制剂/ janus -激酶抑制剂启动的类风湿性关节炎(RA)实用试验中,医生感知的患者和临床招募患者的障碍。方法:于2019年3月对26名风湿病专家进行半结构化电话访谈。采用探索性专题分析方法对访谈数据进行分析。结果:医生认为患者对实施RA实用试验存在障碍。该主题包括三个子主题:(1)患者的个人障碍;(2)患者的治疗相关因素;(3)试验相关因素(如患者招募、副作用、使用方式等)。从临床或医疗系统的角度来看,医生认为临床障碍干扰了实用的试验登记。该主题包括四个子主题:(1)临床相关因素,(2)患者相关因素,(3)研究人员,(4)促进者(临床积极因素)。结论:我们的归纳专题分析结果将有助于研究人员了解可能影响实际RA试验实施的关键患者和临床/系统因素/障碍。这些主题表明,有一些因素可以修改(例如,需要协调员的努力,在诊所就诊期间有效的患者招募,提供者的参与)和需要克服的挑战(患者保险状况,繁忙的诊所流量和空间问题,包括有限的病房数量)。总之,这些主题为我们和其他研究团队制定以临床为中心和以患者为中心的策略来实施实用的RA试验提供了基础。
{"title":"Identifying physician-perceived barriers to a pragmatic treatment trial in rheumatoid arthritis.","authors":"Haiyan Qu,&nbsp;Shamly Austin,&nbsp;Jasvinder A Singh","doi":"10.5152/eujrheum.2022.21038","DOIUrl":"https://doi.org/10.5152/eujrheum.2022.21038","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a rheumatoid arthritis (RA) pragmatic trial of anti-tumor necrosis factor (TNF) biologic versus non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate.</p><p><strong>Methods: </strong>Semistructured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data.</p><p><strong>Results: </strong>Physician perceived patient barriers to the implementation of an RA pragmatic trial. This theme covers three subthemes: (1) patients' personal barriers, (2) patients' treatment-related factors, and (3) trial-related factors (eg, patient recruitment, side effects, mode of use, etc). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four subthemes: (1) clinic-related factors, (2) patient-related factors, (3) research personnel, and (4) facilitators (positive factors of the clinic).</p><p><strong>Conclusion: </strong>Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (eg, coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patientcentered strategies to implement a pragmatic RA trial.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 3","pages":"132-138"},"PeriodicalIF":1.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39792798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physical activity and psychosomatic status in patients with Behçet's disease during coronavirus disease pandem. 冠状病毒大流行期间behaperet病患者的身体活动和心身状况
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-07-01 DOI: 10.5152/eurjrheum.2021.20166
Songül Bağlan Yentür, Furkan Bilek, Süleyman Serdar Koca

Objective: The aim of this study is to examine the changes in physical activity level, fatigue, depression, and sleep quality in patients with Behçet's disease during the COVID-19 pandemic.

Methods: The study was designed as an online questionnaire applied to individuals who are being followed up with the diagnosis of Behçet's disease in the rheumatology department. Data were collected using multiple scales including International Physical Activity Questionnaire (IPAQ), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Pittsburg Sleep Quality Index (PSQI), and Visual Analogue Scale (VAS) to evaluate physical activity level, fatigue, depression, sleep quality, and pain, respectively.

Results: Sixteen patients diagnosed with Behçet's disease were included in the study. No statistically significant difference was observed between the IPAQ, FSS, BDI, PSQI, and VAS assessment scores before COVID-19 and during COVID-19 period (P > .05 for all).

Conclusion: Thinking of the negative effects of aggressive clinical symptoms, Behçet's disease patients should be supported in physical activity and psychosocial status.

目的:探讨2019冠状病毒病(COVID-19)大流行期间behaperet病患者身体活动水平、疲劳、抑郁和睡眠质量的变化。方法:本研究设计为一份在线问卷,适用于风湿病科随访诊断为behaperet病的个体。采用国际体力活动问卷(IPAQ)、疲劳严重程度量表(FSS)、贝克抑郁量表(BDI)、匹兹堡睡眠质量指数(PSQI)和视觉模拟量表(VAS)等量表,分别评价受试者的体力活动水平、疲劳程度、抑郁程度、睡眠质量和疼痛程度。结果:16例诊断为behaperet病的患者纳入研究。IPAQ、FSS、BDI、PSQI、VAS评分在新冠肺炎前与新冠肺炎期间比较,差异均无统计学意义(P > 0.05)。结论:考虑到侵袭性临床症状对患者的负面影响,应在身体活动和心理社会状况方面给予支持。
{"title":"Physical activity and psychosomatic status in patients with Behçet's disease during coronavirus disease pandem.","authors":"Songül Bağlan Yentür,&nbsp;Furkan Bilek,&nbsp;Süleyman Serdar Koca","doi":"10.5152/eurjrheum.2021.20166","DOIUrl":"https://doi.org/10.5152/eurjrheum.2021.20166","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to examine the changes in physical activity level, fatigue, depression, and sleep quality in patients with Behçet's disease during the COVID-19 pandemic.</p><p><strong>Methods: </strong>The study was designed as an online questionnaire applied to individuals who are being followed up with the diagnosis of Behçet's disease in the rheumatology department. Data were collected using multiple scales including International Physical Activity Questionnaire (IPAQ), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Pittsburg Sleep Quality Index (PSQI), and Visual Analogue Scale (VAS) to evaluate physical activity level, fatigue, depression, sleep quality, and pain, respectively.</p><p><strong>Results: </strong>Sixteen patients diagnosed with Behçet's disease were included in the study. No statistically significant difference was observed between the IPAQ, FSS, BDI, PSQI, and VAS assessment scores before COVID-19 and during COVID-19 period (P > .05 for all).</p><p><strong>Conclusion: </strong>Thinking of the negative effects of aggressive clinical symptoms, Behçet's disease patients should be supported in physical activity and psychosocial status.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 3","pages":"144-147"},"PeriodicalIF":1.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Updates in ANCA-associated vasculitis. anca相关血管炎的最新进展。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-07-01 DOI: 10.5152/eujrheum.2022.20248
Carolyn Ross, Jean-Paul Makhzoum, Christian Pagnoux

Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) are small-vessel vasculitides that include granulomatosis with polyangiitis (formerly Wegener's granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (Churg - Strauss syndrome). Renal-limited AAV can be considered a fourth entity. Despite their rarity and still unknown cause(s), research into AAV has been very active over the past decades and has allowed for the development of new therapeutic regimens. The pathogenesis is a complex process of immune dysregulations with genetic and environmental influences. Recent genome-wide association studies have identified multiple genetic predisposing variants, especially at the major histocompatibility complex region. The pathogenic role of antimyeloperoxidase ANCA (MPO-ANCA) is well supported by several animal models, but that of antiproteinase 3 ANCA (PR3-ANCA) is not as strongly demonstrated. B cells likely play a major role in the pathogenesis because they produce ANCAs, as do neutrophil abnormalities, imbalances in T-cell subtypes, and/or cytokine - chemokine networks. The role of the alternative complement pathway was established more recently, and studies of the antagonist of human C5a receptor (avacopan) in AAV have just been completed, with promising results. The current standard management of severe AAV still consists of remission induction therapy with glucocorticoids combined with rituximab or, less often now, cyclophosphamide. Several studies showed that reduced-dose regimens of glucocorticoids are noninferior to the previously used heavier regimens, for therefore less cumulative exposure to glucocorticoids. Avacopan use may even lead to new steroid-free therapeutic approaches, at least for some selected patients. Several trials and studies have now shown the superiority of rituximab over azathioprine or methotrexate as maintenance therapy. However, the optimal dosing regimen and duration for maintenance remain to be better defined, at the individual patient level. Many changes have occurred in the standard of care for AAV over the past decades, and more are expected soon, including with use of avacopan, but also, likely, a few other agents under investigation or development.

抗中性粒细胞细胞质抗体(ANCA)相关血管炎(AAV)是小血管血管炎,包括肉芽肿病合并多血管炎(原Wegener肉芽肿病)、显微镜下的多血管炎和嗜酸性肉芽肿病合并多血管炎(Churg - Strauss综合征)。肾受限型AAV可被视为第四个实体。尽管AAV罕见且病因不明,但在过去的几十年里,对AAV的研究一直非常活跃,并为新的治疗方案的开发提供了条件。其发病机制是一个复杂的免疫失调过程,受遗传和环境的影响。最近的全基因组关联研究已经确定了多种遗传易感变异,特别是在主要组织相容性复合体区域。抗髓过氧化物酶ANCA (MPO-ANCA)的致病作用已得到多种动物模型的支持,但抗蛋白酶3 ANCA (PR3-ANCA)的致病作用尚未得到充分证实。B细胞可能在发病机制中起主要作用,因为它们产生anca,中性粒细胞异常、t细胞亚型失衡和/或细胞因子-趋化因子网络也会产生anca。替代补体途径的作用是最近才确立的,而人类C5a受体拮抗剂(avacopan)在AAV中的研究刚刚完成,结果很有希望。目前严重AAV的标准治疗仍然包括糖皮质激素联合利妥昔单抗或环磷酰胺(现在较少使用)的缓解诱导治疗。几项研究表明,减少糖皮质激素剂量的方案并不逊于以前使用的更大剂量方案,因此减少了糖皮质激素的累积暴露。Avacopan的使用甚至可能导致新的无类固醇治疗方法,至少对于一些选定的患者。一些试验和研究表明,作为维持治疗,利妥昔单抗优于硫唑嘌呤或甲氨蝶呤。然而,在个体患者水平上,最佳给药方案和维持时间仍有待更好地确定。在过去的几十年里,AAV的治疗标准发生了许多变化,预计很快会有更多的变化,包括使用avacopan,但也可能有其他一些正在研究或开发的药物。
{"title":"Updates in ANCA-associated vasculitis.","authors":"Carolyn Ross,&nbsp;Jean-Paul Makhzoum,&nbsp;Christian Pagnoux","doi":"10.5152/eujrheum.2022.20248","DOIUrl":"https://doi.org/10.5152/eujrheum.2022.20248","url":null,"abstract":"<p><p>Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) are small-vessel vasculitides that include granulomatosis with polyangiitis (formerly Wegener's granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (Churg - Strauss syndrome). Renal-limited AAV can be considered a fourth entity. Despite their rarity and still unknown cause(s), research into AAV has been very active over the past decades and has allowed for the development of new therapeutic regimens. The pathogenesis is a complex process of immune dysregulations with genetic and environmental influences. Recent genome-wide association studies have identified multiple genetic predisposing variants, especially at the major histocompatibility complex region. The pathogenic role of antimyeloperoxidase ANCA (MPO-ANCA) is well supported by several animal models, but that of antiproteinase 3 ANCA (PR3-ANCA) is not as strongly demonstrated. B cells likely play a major role in the pathogenesis because they produce ANCAs, as do neutrophil abnormalities, imbalances in T-cell subtypes, and/or cytokine - chemokine networks. The role of the alternative complement pathway was established more recently, and studies of the antagonist of human C5a receptor (avacopan) in AAV have just been completed, with promising results. The current standard management of severe AAV still consists of remission induction therapy with glucocorticoids combined with rituximab or, less often now, cyclophosphamide. Several studies showed that reduced-dose regimens of glucocorticoids are noninferior to the previously used heavier regimens, for therefore less cumulative exposure to glucocorticoids. Avacopan use may even lead to new steroid-free therapeutic approaches, at least for some selected patients. Several trials and studies have now shown the superiority of rituximab over azathioprine or methotrexate as maintenance therapy. However, the optimal dosing regimen and duration for maintenance remain to be better defined, at the individual patient level. Many changes have occurred in the standard of care for AAV over the past decades, and more are expected soon, including with use of avacopan, but also, likely, a few other agents under investigation or development.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 3","pages":"153-166"},"PeriodicalIF":1.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39792801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
期刊
European journal of rheumatology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1