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Chronic Obstructive Pulmonary Disease (COPD) and Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS) are Risk Factors for Cryptococcosis 慢性阻塞性肺疾病(COPD)和哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)是隐球菌病的危险因素
Pub Date : 2020-06-04 DOI: 10.2174/1874838402011010001
Aline Beatriz Mahler Pereira, A. P. Rogerio
Cryptococcosis is a fungal infection of global importance affecting the central nervous system and other organs such as the lungs. The severity of cryptococcosis is largely dependent on the integrity of the host immune system. The protection to cryptococcosis is associated with Th1 immune response while Th2 results in susceptibility to Cryptococcus infection. Asthma is a chronic inflammatory disease commonly coordinated by Th2 immune response. The airway inflammation in Chronic Obstructive Pulmonary Disease (COPD) patients is characterized by increased neutrophils, macrophages, proteases, IL-6, IL-8, and Th1 cytokines. Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS) patients present phenotype that shares Th1 (COPD) and Th2 (asthma). There are several risk factors associated with Cryptococcus infection, including smoking, that cause airway remodeling and dysregulated and damaging airway inflammation.
隐球菌病是一种全球性的真菌感染,影响中枢神经系统和其他器官,如肺。隐球菌病的严重程度很大程度上取决于宿主免疫系统的完整性。对隐球菌病的保护与Th1免疫应答有关,而Th2导致对隐球菌感染的易感性。哮喘是一种慢性炎症性疾病,通常由Th2免疫反应协调。慢性阻塞性肺疾病(COPD)患者气道炎症的特征是中性粒细胞、巨噬细胞、蛋白酶、IL-6、IL-8和Th1细胞因子增加。哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)患者的表型共享Th1 (COPD)和Th2(哮喘)。有几个与隐球菌感染相关的危险因素,包括吸烟,会导致气道重塑和失调和破坏性气道炎症。
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引用次数: 2
Association Between Endoscopic, Radiologic and Patient-reported Chronic Rhinosinusitis with Nasal Polyps 内镜、放射学和患者报告的慢性鼻窦炎伴鼻息肉之间的关系
Pub Date : 2019-05-31 DOI: 10.2174/1874838401910010001
A. Luukkainen, J. Numminen, M. Rautiainen, Anna Julkunen, H. Huhtala, J. Lampi, A. Markkola, J. Myller, A. Andiappan, D. Wang, S. Toppila-Salmi
Chronic Rhinosinusitis without Nasal Polyps (CRSsNP) and with Nasal Polyps (CRSwNP) affect 10% and 1-4% of the general population respectively. Early detection and treatment of CRSwNP might prevent recalcitrant disease forms. The aim of this prospective controlled study was to evaluate association between endoscopic, radiologic, and self-reported CRSwNP, and a family history in defining CRSwNP. This study involved 73 CRS patients aged 18 years or over undergoing CRS-surgical consultation at the Tampere University Hospital. Data of sinus Computed Tomography (CT) scans and nasal endoscopy was obtained from patient records. Sixty controls ±allergic rhinitis underwent clinical examination. All subjects filled a questionnaire. Associations were analyzed by Chi square and adjusted regression models. The predictive performance of various parameters was assessed using the Area Under the Receiver Operating Characteristic curve (AUROC). A total of 33% of CRSwNP patients reported not having Nasal Polyps (NPs), while 18% of CRSsNP patients reported having NPs (p < 0.001). Radiologic Nasal Polyp (NP) score differentiated CRSwNP from CRSsNP with an AUROC of 0.95 (95% CI 0.91-1.00). The AUROC value for Lund-Mackay (LM) score was 0.84 (0.75-0.94). Positive family history of NP did not differ significantly between CRS and control groups. Family history of allergy or asthma was given with certainty, whereas CRS patients had uncertainty of reporting NPs in family compared to controls (adjusted OR=6.02, 95% CI 1.98-18.30, p = 0.002). Our findings suggest that in situations where nasal endoscopy cannot be performed, early detection of CRSwNP could result from information obtained from sinus CT scans and patients, in comparison to family history which has lower predictive value. However validation studies with larger sample sizes are still needed.
无鼻息肉的慢性鼻窦炎(CRSsNP)和有鼻息肉的慢性鼻窦炎(CRSwNP)分别占总人口的10%和1-4%。早期发现和治疗CRSwNP可能会预防顽固性疾病的形成。这项前瞻性对照研究的目的是评估内镜、放射学和自我报告的CRSwNP与CRSwNP定义的家族史之间的关系。本研究涉及73名18岁或以上的CRS患者,他们在坦佩雷大学医院接受CRS手术会诊。鼻窦计算机断层扫描(CT)和鼻内窥镜检查数据从患者记录中获得。对照组±变应性鼻炎60例进行临床检查。所有的研究对象都填写了一份问卷。通过卡方和调整后的回归模型分析相关性。使用受试者工作特征曲线下面积(AUROC)评估各参数的预测性能。共有33%的CRSwNP患者报告没有鼻息肉(NPs),而18%的CRSsNP患者报告有鼻息肉(p < 0.001)。鼻息肉(NP)评分区分CRSwNP和CRSsNP的AUROC为0.95 (95% CI 0.91-1.00)。LM评分的AUROC值为0.84(0.75 ~ 0.94)。阳性NP家族史在CRS组和对照组之间无显著差异。过敏或哮喘家族史是确定的,而与对照组相比,CRS患者报告NPs的家族史是不确定的(调整后or =6.02, 95% CI 1.98-18.30, p = 0.002)。我们的研究结果表明,在不能进行鼻内窥镜检查的情况下,可以从鼻窦CT扫描和患者获得的信息中早期发现CRSwNP,而家族史的预测价值较低。然而,仍然需要更大样本量的验证研究。
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引用次数: 1
Food Allergy Knowledge and Attitudes Among School Teachers in Jazan, Saudi Arabia 沙特阿拉伯吉赞地区学校教师的食物过敏知识和态度
Pub Date : 2018-08-29 DOI: 10.2174/1874838401809010001
Gassem Gohal
Food allergy topic has become more widely discussed in developed countries, but with less interest in Middle Eastern Arabian Countries. The main objective of this paper is to assess the knowledge and perception of schoolteachers about food allergy. A cross sectional study was conducted among a sample of 360 school teachers between May 2013 and February 2014 in province of Jazan in Saudi Arabia, using a validated web-based self-administered survey. The results revealed that almost (59.7%) of the schoolteachers had a medium insufficient knowledge about food allergy; only 17.3% had good knowledge about food allergy. Female teachers had higher knowledge scores (58.5 ± 17.2) as compared to male (51.8 ± 16.0) with statistically significant difference (p = 0.017). The majority of schoolteachers have a significantly poor knowledge in most of food allergy domains. More than half of responders either do not know or they disagree that the food allergy is a serious problem and can lead to death. Regression analysis revealed that participant’s level of knowledge is significantly associated with school teacher’s attitudes towards food allergy (OR = 0.06, 95% CI: 0.39 - 0.92, p = 0.01), practice (OR = 1.68, 95% CI: 1.11 - 2.56, p = 0.01), and years of experiences (OR = 1.8, 95% CI; 1.15 - 2.98, p = 0.011). Knowledge of food allergy among schoolteachers is not adequate, failing to recognize and treat fatal food allergy reactions necessitate an urgent need to set a school policy to improve the food allergy situation.
食物过敏话题在发达国家已被广泛讨论,但在中东阿拉伯国家却鲜有人关注。本文的主要目的是评估学校教师对食物过敏的知识和认知。2013年5月至2014年2月,在沙特阿拉伯吉赞省的360名学校教师样本中进行了一项横断面研究,使用了一项经过验证的基于网络的自我管理调查。结果显示,近59.7%的学校教师对食物过敏知识存在中等程度的不足;只有17.3%的人对食物过敏有良好的了解。女教师知识得分(58.5±17.2)高于男教师(51.8±16.0),差异有统计学意义(p = 0.017)。大多数学校教师在大多数食物过敏领域的知识明显贫乏。超过一半的应答者要么不知道,要么不同意食物过敏是一个严重的问题,可能导致死亡。回归分析显示,参与者的知识水平与学校教师对食物过敏的态度(OR = 0.06, 95% CI: 0.39 ~ 0.92, p = 0.01)、实践(OR = 1.68, 95% CI: 1.11 ~ 2.56, p = 0.01)和经验年数(OR = 1.8, 95% CI;1.15 - 2.98, p = 0.011)。学校教师的食物过敏知识不足,无法识别和治疗致命的食物过敏反应,迫切需要制定学校政策来改善食物过敏状况。
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引用次数: 7
Anaphylaxis to Glatiramer Acetate 醋酸格拉替默过敏反应
Pub Date : 2015-08-17 DOI: 10.2174/1874838401508010023
S. Wöhrl, F. Wantke, W. Hemmer
Glatiramer acetate (Copaxone, Teva Pharma) and interferon beta are the two only disease-modifying therapies for multiple sclerosis. Glatiramer acetate is known for frequently simulating mild, anaphylactoid reactions while true, IgE- mediated allergic reactions have been hardly reported so far. Herein, we report two females suffering from multiple scle- rosis who experienced rapidly aggravating hypersensitivity-reactions upon treatment with glatiramer acetate. Patient one experienced an asthma attack, patient two an exacerbation of her urticaria and angioedema. An IgE-mediated mechanism could be demonstrated by a positive intradermal test to a 1:1000 dilution in the first 31-year old and by a positive skin prick test to a 1:10 diluted skin prick test in the second 32-year old second woman.
醋酸格拉替默(Copaxone, Teva Pharma)和干扰素是多发性硬化症仅有的两种改善疾病的疗法。众所周知,醋酸格拉替雷默经常引起轻微的类过敏反应,而IgE介导的过敏反应迄今几乎没有报道。在此,我们报告了两名患有多发性鳞片硬化的女性,她们在服用醋酸格拉替雷默治疗后迅速加重了超敏反应。患者1哮喘发作,患者2荨麻疹和血管性水肿加重。在第一个31岁女性中,1:100稀释皮内试验呈阳性,在第二个32岁女性中,1:10稀释皮刺试验呈阳性,ige介导的机制可以得到证实。
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引用次数: 1
Dynamics of Plasma and Granule Membrane in Murine Bone Marrow- Derived Mast Cells after Re-stimulation 小鼠骨髓源肥大细胞再刺激后血浆和颗粒膜的动态变化
Pub Date : 2015-05-15 DOI: 10.2174/1874838401508010014
M. Kaneko, Arisa Yamada
Mast cells are derived from hematopoietic stem cells and play important roles in allergic responses. Mast cells are long-lived compared with other granular cell types. Since the response of the individual mast cell after Fc RI-induced degranulation is unclear, the aim of this study was to analyze morphological changes in individual mast cells after re- stimulation. To observe plasma and granule membrane dynamics, AcGFP-actb ( -actin) and DsRed-monomer (DRM)- CD63 fusion constructs were introduced into bone marrow-derived mast cells (BMMCs). Furthermore, AcGFP-CD63 and DRM-Cma1 (mMCP-5) were introduced into BMMCs. Re-stimulation resulted in increased  -hexosaminidase release and cytokine mRNA expression similar to those observed during initial stimulation. Moreover, expression of Fc RI on BMMCs 24 h after initial stimulation was similar to that measured before initial stimulation. Changes in morphology of the plasma membrane and colocalization of granules and plasma membrane were observed after initial stimulation. BMMCs returned to normal 120 min after the initial stimulation. These phenomena were also observed in BMMCs after re-stimulation. BMMC chymase content decreased 20 min after stimulation but returned to near normal 24 h after stimula- tion. These findings suggest that mast cell functions can be maintained and that these cells can be repeatedly degranulated after Fc RI-mediated stimulation.
肥大细胞来源于造血干细胞,在过敏反应中起重要作用。与其他颗粒细胞类型相比,肥大细胞寿命较长。由于Fcri诱导的肥大细胞脱颗粒后个体肥大细胞的反应尚不清楚,因此本研究的目的是分析再刺激后个体肥大细胞的形态学变化。为了观察血浆和颗粒膜动力学,将AcGFP-actb(-actin)和dsred -单体(DRM)- CD63融合构建物引入骨髓源性肥大细胞(BMMCs)。在BMMCs中引入AcGFP-CD63和DRM-Cma1 (mMCP-5)。再次刺激导致-己糖氨酸酶释放和细胞因子mRNA表达增加,与初始刺激时观察到的相似。此外,初始刺激后24 h BMMCs上FcRI的表达与初始刺激前相似。在初始刺激后,观察到质膜形态的变化以及颗粒和质膜的共定位。初始刺激后120分钟bmcs恢复正常。这些现象在再刺激后的bmcs中也观察到了。刺激后20 min BMMC酶含量下降,24 h后恢复到接近正常水平。这些发现表明,肥大细胞功能可以维持,这些细胞可以在Fcri介导的刺激后反复脱颗粒。
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引用次数: 0
Sputum Induction in Children and Adolescents with Problematic Severe Asthma: Success Rate, Safety and Tolerability 诱导痰治疗儿童和青少年严重哮喘:成功率、安全性和耐受性
Pub Date : 2015-03-31 DOI: 10.2174/1874838401508010007
C. Ricci, L. Lasmar, P. Pitrez, R.F. Mascarenhas, P. Camargos
Background: In problematic severe asthma (PSA), inflammatory phenotypes can by identified by assessing cel- lularity in induced sputum (IS) samples. However, there have been few studies employing sputum induction (SI) in pedi- atric patients. Objective: To assess the success rate, safety and tolerability of SI, as well as IS sample cellularity, in pediatric PSA pa- tients. Methods: We conducted a cross-sectional study involving 44 pediatric PSA patients. We collected IS samples using inha- lations of nebulized saline solution. On the basis of the post-bronchodilator forced expiratory volume in one second (FEV1, % of predicted), we administered nebulization with 4.5% hypertonic saline (for patients with an FEV1 � 60%) or 0.9% isotonic saline (for those with an FEV1 50%. Results: The observed success rate was 75% (95% CI: 60-86). Most of the patients provided satisfactory samples, al- though multiple SI sessions were required in some cases (27%). In comparison with the IS samples containing > 20% squamous cells, those containing � 20% showed significantly more neutrophils (P = 0.02) and eosinophils (P = 0.03). The most common adverse events were mild wheezing (in 14%) and salty taste (in 9%). In 8% of the sessions, there was a � 20% decrease in FEV1. Conclusion: In our sample of pediatric patients with PSA, sputum induction was safe and generally well tolerated, sug- gesting that it could be useful in the assessment of inflammatory processes in such patients.
背景:在有问题的严重哮喘(PSA)中,炎症表型可以通过评估诱导痰(IS)样本中的细胞清晰度来识别。然而,在儿科患者中应用诱导痰的研究很少。目的:评估SI在儿童PSA患者中的成功率、安全性和耐受性,以及IS样本的细胞含量。方法:我们对44例儿童PSA患者进行了横断面研究。我们用吸入的雾化盐水溶液来收集IS样本。根据支气管扩张剂后一秒用力呼气量(FEV1,预测的%),我们给予4.5%高渗生理盐水(FEV1 - 60%)或0.9%等渗生理盐水(FEV1 50%)雾化。结果:观察成功率为75% (95% CI: 60-86)。大多数患者提供了满意的样本,尽管在某些情况下需要多次SI(27%)。与含有> 20%鳞状细胞的IS样品相比,含有- 20%鳞状细胞的IS样品中中性粒细胞(P = 0.02)和嗜酸性粒细胞(P = 0.03)显著增加。最常见的不良事件是轻度喘息(14%)和咸味(9%)。在8%的疗程中,FEV1下降了20%。结论:在我们的儿童PSA患者样本中,痰诱导是安全的,并且通常耐受性良好,这表明它可以用于评估此类患者的炎症过程。
{"title":"Sputum Induction in Children and Adolescents with Problematic Severe Asthma: Success Rate, Safety and Tolerability","authors":"C. Ricci, L. Lasmar, P. Pitrez, R.F. Mascarenhas, P. Camargos","doi":"10.2174/1874838401508010007","DOIUrl":"https://doi.org/10.2174/1874838401508010007","url":null,"abstract":"Background: In problematic severe asthma (PSA), inflammatory phenotypes can by identified by assessing cel- lularity in induced sputum (IS) samples. However, there have been few studies employing sputum induction (SI) in pedi- atric patients. Objective: To assess the success rate, safety and tolerability of SI, as well as IS sample cellularity, in pediatric PSA pa- tients. Methods: We conducted a cross-sectional study involving 44 pediatric PSA patients. We collected IS samples using inha- lations of nebulized saline solution. On the basis of the post-bronchodilator forced expiratory volume in one second (FEV1, % of predicted), we administered nebulization with 4.5% hypertonic saline (for patients with an FEV1 � 60%) or 0.9% isotonic saline (for those with an FEV1 50%. Results: The observed success rate was 75% (95% CI: 60-86). Most of the patients provided satisfactory samples, al- though multiple SI sessions were required in some cases (27%). In comparison with the IS samples containing > 20% squamous cells, those containing � 20% showed significantly more neutrophils (P = 0.02) and eosinophils (P = 0.03). The most common adverse events were mild wheezing (in 14%) and salty taste (in 9%). In 8% of the sessions, there was a � 20% decrease in FEV1. Conclusion: In our sample of pediatric patients with PSA, sputum induction was safe and generally well tolerated, sug- gesting that it could be useful in the assessment of inflammatory processes in such patients.","PeriodicalId":22835,"journal":{"name":"The Open Allergy Journal","volume":"2011 1","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2015-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82573046","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
Role of Antibiotics and Infection-Host Interactions in the Prevalence ofRespiratory Atopy: Experience and Perspective 抗生素和感染-宿主相互作用在呼吸道特应性患病率中的作用:经验和观点
Pub Date : 2015-03-31 DOI: 10.2174/1874838401508010001
A. Bakiri, E. Mingomataj, Alkerta Ibranji
We have witnessed a dramatic increase in the prevalence of respiratory allergies during the last decades. The role of infections in the prevalence of respiratory allergic diseases is attributed to the antagonism between: a) induction of T helper (Th) 1 immune response by human organism; and b) manipulation of the human immune response toward Th2 profile by common infective agents in order to increase their surviving opportunity. This review proposes an important role of massive antibiotics exposure during neonatal and early childhood on the increasing epidemiological trend. It is be- lieved that the antibiotics exposure during early childhood has also provided better surviving opportunity for atopic indi- viduals with an inadequate immune defense against common infections, deviating therefore the genetic background of general population toward Th2 profile. Taking this into account, we suggest that Th2 profile frequency (and consequently atopic phenotype prevalence) can be increased along an individual lifespan after initial massive antibiotic introduction, until the entire population is exposed to them during childhood. This hypothesis may explain findings on epidemiological surveys, which report a prevalent increase among adults in industrialized countries between 1970s and 2000s, while in re- cently-developed countries this trend begun only at the end of 1980s. These arguments may lead to the conclusion that in- fections will manipulate the human immunity along generations, whereas actual antibiotics can increase the prevalence of respiratory allergies among a population only along an individual longevity. These findings may be beneficial in the de- velopment of future strategies for management of respiratory allergic or infective pathologies.
在过去的几十年里,我们目睹了呼吸道过敏的发病率急剧上升。感染在呼吸道变应性疾病流行中的作用归因于:a)人体机体诱导辅助性T (Th) 1免疫应答;b)通过常见感染因子操纵人体对Th2谱的免疫反应,以增加其生存机会。这篇综述提出了新生儿和幼儿时期大量抗生素暴露在日益增加的流行病学趋势中的重要作用。我们认为,幼儿时期的抗生素暴露也为对常见感染免疫防御不足的特应性个体提供了更好的生存机会,从而偏离了一般人群的遗传背景,倾向于Th2谱。考虑到这一点,我们建议Th2基因谱频率(以及由此导致的特应性表型患病率)可以在初始大规模抗生素引入后随着个体寿命的增加而增加,直到整个人群在童年时期暴露于抗生素。这一假设可以解释流行病学调查的结果,这些调查报告说,在20世纪70年代至21世纪头十年期间,工业化国家的成年人普遍增加,而在最近的发达国家,这一趋势直到20世纪80年代末才开始。这些论点可能会得出这样的结论:感染会在几代人的时间内操纵人体免疫力,而实际的抗生素只会在个体寿命期间增加人群中呼吸道过敏的患病率。这些发现可能有助于未来呼吸道过敏或感染性病理管理策略的发展。
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引用次数: 2
Distinct Reactivity of Transient Receptor Potential Vanilloid Subtype 1 in a Murine Model of Atopic Dermatitis with Serious Scratching 瞬时受体电位香草蛋白亚型1在严重抓挠性特应性皮炎小鼠模型中的明显反应性
Pub Date : 2014-11-19 DOI: 10.2174/1874838401407010010
Yan Xia, A. Tanaka, K. Oida, A. Matsuda, H. Jang, Y. Amagai, S. Ishizaka, H. Matsuda
Background: Abnormality in skin sensitivity may be responsible for unbearable itch in patients with atopic dermatitis (AD). Objectives: We evaluated reactivity of NC/Tnd mice, a model for human AD, against various experimental stimulations. Methods: Several behavioral tests were performed after external stimuli were applied to NC/Tnd mice. Transient receptor potential vanilloid subtype 1 (TRPV1) reactivity of neuronal cells collected from the dorsal root ganglions (DRG) was analyzed with a Ca ++ influx test. Finally, we evaluated suppressive effect of capsaicin on atopic itch of NC/Tnd mice. Results: Pain responses to heat, acidic stimulation, and capsaicin injection, which are transduced through TRPV1, were decreased in NC/Tnd mice, when compared to two standard strains BALB/c and C57BL/6 mice. The reactivity of the primary neurons isolated from DRG to capsaicin was markedly reduced in NC/Tnd mice. Topical application of histamine evoked scratching in NC/Tnd mice as well as other two strains; however, the scratching intensities induced by non- histamine pruritogens were significantly lower in NC/Tnd mice comparing to the two strains. In conventional NC/Tnd mice with AD, topical application of capsaicin reduced the scratching behavior. Conclusion: TRPV1 is associated with both pain and itch sensation; however, abnormalities in TRPV1 reactivity may in- volve in severe itch in NC/Tnd mice.
背景:皮肤敏感性异常可能导致特应性皮炎(AD)患者难以忍受的瘙痒。目的:研究人类AD模型NC/Tnd小鼠对各种实验刺激的反应性。方法:对NC/Tnd小鼠施加外部刺激后,进行多项行为测试。用钙离子内流试验分析了从背根神经节(DRG)采集的神经细胞的瞬时受体电位香草样蛋白亚型1 (TRPV1)的反应性。最后,我们评价了辣椒素对NC/Tnd小鼠特应性瘙痒的抑制作用。结果:与两种标准菌株BALB/c和C57BL/6小鼠相比,NC/Tnd小鼠对TRPV1介导的热、酸刺激和辣椒素注射的疼痛反应降低。在NC/Tnd小鼠中,DRG分离的原代神经元对辣椒素的反应性明显降低。局部应用组胺引起NC/Tnd小鼠及其他两种品系的抓伤;而非组胺类瘙痒剂对NC/Tnd小鼠的抓痕强度明显低于两种毒株。在常规NC/Tnd AD小鼠中,局部应用辣椒素可减少抓挠行为。结论:TRPV1与疼痛和瘙痒感觉均相关;然而,TRPV1反应性异常可能与NC/Tnd小鼠严重瘙痒有关。
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引用次数: 0
Evidence-based Medicine and Clinical Study Designs: Examples of Applications for Allergy Research 循证医学和临床研究设计:过敏研究应用实例
Pub Date : 2014-09-08 DOI: 10.2174/1874838401407010001
S. Thomsen
Evidence of the effect of clinical interventions in allergology, and in medicine as a whole, can be hierarchically grouped based on the research design producing the evidence. The most weight is given to systematic reviews and meta- analyses, and to randomised controlled trials. These trial designs are superior to non-randomised controlled trials and co- hort studies, which in turn are superior to case-control studies. The least weight is given to case-studies and anecdotal evi- dence. Herein, the principles of evidence-based medicine and clinical study designs are reviewed in the context of exam- ples from the allergology literature.
临床干预对过敏学和整个医学的影响的证据可以根据产生证据的研究设计进行分层分组。最重要的是系统评价和荟萃分析,以及随机对照试验。这些试验设计优于非随机对照试验和队列研究,而后者又优于病例对照研究。对个案研究和轶事证据的重视程度最低。在此,循证医学的原则和临床研究的设计是在检查的背景下,从过敏学文献的例子进行审查。
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引用次数: 1
Erlotinib-induced Adverse Skin Reactions 厄洛替尼诱发的皮肤不良反应
Pub Date : 2013-09-20 DOI: 10.2174/1874838420130904002
Toshiyuki Yamamoto
Erlotinib is low molecular-weight quinazolin derivatives which selectively inhibit the epidermal growth factor receptor (EGF-R) tyrosine kinase activity of the intracellular domain, block autophosphorylation and the subsequent sig- naling cascades. EGF-R is expressed on basal keratinocytes, sebocytes, the outer root sheath of hairs, and endothelial cells in the skin, and plays important roles in the regulation of differentiation, proliferation, apoptosis, attachment and migra- tion of keratinocytes, inflammation, and wound healing. Therefore, inhibition of EGF-R causes a number of cutaneous adverse reactions. Among them, severe skin lesions are very stressful, and impair quality of life of patients. Moreover, they even bring disadvantages such as drug withdrawal or interruption. Several review papers describe representative or common skin lesions which appear either during the first a few weeks or at later phases. Common skin manifestations in- clude papular and pustular follicular eruptions (acneiform eruption), xerosis, paronychia, pruritus, and abnormalities of hairs; however, other than those eruptions, several unusual lesions are also induced. Early intervention of dermatologists and management of skin lesions are quite important, because discontinuance of the drug is unfavorable for patients with clinical benefits for cancers. In this brief review, various cutaneous manifestations seen in Japanese patients treated with erlotinib (Tarceva) are shown, and current management of representative severe conditions is also described.
厄洛替尼是低分子量喹唑啉衍生物,选择性抑制细胞内表皮生长因子受体(EGF-R)酪氨酸激酶活性,阻断自磷酸化和随后的信号级联反应。EGF-R在皮肤基底角化细胞、皮脂细胞、毛发外根鞘和内皮细胞中表达,在角化细胞的分化、增殖、凋亡、附着和迁移、炎症和伤口愈合等过程中发挥重要作用。因此,抑制EGF-R会引起许多皮肤不良反应。其中,严重的皮肤病变压力很大,影响患者的生活质量。此外,它们甚至带来诸如停药或中断等缺点。几篇综述文章描述了在最初几周或后期出现的典型或常见的皮肤病变。常见的皮肤表现包括丘疹和脓疱性毛囊疹(针状疹)、干裂、甲沟炎、瘙痒和毛发异常;然而,除了这些爆发,一些不寻常的病变也会引起。皮肤科医生的早期干预和皮肤病变的管理是非常重要的,因为停药对癌症患者的临床益处是不利的。在这篇简短的综述中,显示了使用厄洛替尼(特罗凯)治疗的日本患者的各种皮肤表现,并描述了目前具有代表性的严重疾病的管理。
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引用次数: 2
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The Open Allergy Journal
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