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Sensitivität und Spezifität verschiedener prognostischer Systeme zur Lenkung der Überwachung auf Metastasen beim Aderhautmelanom 一些预测系统在指导静脉黑瘤的扩散监测时的敏感性和特殊性
Pub Date : 2023-10-27 DOI: 10.1159/000534139
Ira Seibel
Uveal melanoma (UM) metastasises in ∼50% of patients, most frequently to the liver. Surveillance imaging can provide early detection of hepatic metastases; however, guidance regarding UM patient risk stratification for surveillance is unclear. This study compared sensitivity and specificity of four current prognostic systems, when used for risk stratification for surveillance, on patients treated at the Liverpool Ocular Oncology Centre (LOOC) between 2007–2016 (n = 1047). It found that the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) or Liverpool Parsimonious Model (LPM) offered greater specificity at equal levels of sensitivity than the American Joint Committee on Cancer (AJCC) system or monosomy 3 alone, and suggests guidance to achieve 95% sensitivity and 51% specificity (i.e., how to detect the same number of patients with metastases, while reducing the number of negative scans). For example, 180 scans could be safely avoided over 5 years in 200 patients using the most specific approach. LUMPOIII also offered high sensitivity and improved specificity over the AJCC in the absence of genetic information, making the result relevant to centres that do not perform genetic testing, or where such testing is inappropriate or fails. This study provides valuable information for clinical guidelines for risk stratification for surveillance in UM.
葡萄膜黑色素瘤(UM)在50%的患者中转移,最常转移到肝脏。监测影像可以早期发现肝转移;然而,关于UM患者风险分层监测的指导尚不清楚。本研究比较了2007-2016年在利物浦眼科肿瘤中心(LOOC)治疗的患者(n = 1047)中,四种当前预后系统用于风险分层监测时的敏感性和特异性。研究发现,利物浦葡萄膜黑色素瘤预测在线III (LUMPOIII)或利物浦简约模型(LPM)在同等敏感性水平下比美国癌症联合委员会(AJCC)系统或单独使用单体3提供更高的特异性,并建议指导达到95%的敏感性和51%的特异性(即如何检测到相同数量的转移患者,同时减少阴性扫描次数)。例如,使用最具体的方法,200名患者在5年内可以安全地避免180次扫描。在缺乏遗传信息的情况下,LUMPOIII还提供了比AJCC更高的灵敏度和更高的特异性,使结果与不进行基因检测或此类检测不适当或失败的中心相关。本研究提供了有价值的信息,为临床指导风险分层监测在UM。
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引用次数: 0
Uveamelanom: Neue Therapieoption zugelassen 治疗被接纳
Pub Date : 2023-10-27 DOI: 10.1159/000534265
Kai-Christian Klespe
In der IMCgp100-202 Studie wurden zuvor unbehandelte HLA-A*02:01-positive Patienten mit metastasiertem Aderhautmelanom im Verhältnis 2:1 nach dem Zufallsprinzip entweder mit Tebentafusp (Tebentafusp-Gruppe) oder einer Therapie nach Wahl des Prüfarztes mit Pembrolizumab, Ipilimumab oder Dacarbazin (Kontrollgruppe) behandelt, stratifiziert nach dem Laktatdehydrogenase-Spiegel. Der primäre Endpunkt war das Gesamtüberleben.Die Gesamtüberlebensrate nach einem Jahr betrug 73% in der Tebentafusp-Gruppe und 59 %in der Kontrollgruppe (Hazard Ratio für Tod 0,51; 95% Konfidenzintervall [CI] 0,37 bis 0,71; P<0,001) in der Intention-to-Treat-Population. Das progressionsfreie Überleben war in der Tebentafusp-Gruppe ebenfalls signifikant höher als in der Kontrollgruppe (31% gegenüber 19% nach 6 Monaten; Hazard Ratio für Krankheitsprogression oder Tod, 0,73; 95% CI, 0,58 bis 0,94; P = 0,01). Die häufigsten behandlungsbedingten unerwünschten Ereignisse in der Tebentafusp-Gruppe waren zytokinvermittelte Ereignisse (aufgrund von T-Zell-Aktivierung) und hautbezogene Ereignisse (aufgrund von Glykoprotein-100-positiven Melanozyten), einschließlich Hautausschlag (83%), Pyrexie (76%) und Pruritus (69%). Die Häufigkeit und der Schweregrad dieser unerwünschten Ereignisse nahmen nach den ersten 3 oder 4 Dosen ab und führten nur in seltenen Fällen zum Abbruch der Studienbehandlung (2%). Es wurden keine behandlungsbedingten Todesfälle gemeldet.
在前一IMCgp100-202研究被积怨HLA-A * 02:01-positive患者metastasiertem Aderhautmelanom相对2:1漫无计划要么与Tebentafusp (Tebentafusp-Gruppe)或治疗后的选择Prüfarztes和Pembrolizumab Ipilimumab或治疗Dacarbazin(对照组)、stratifiziert后Laktatdehydrogenase-Spiegel .他们的首要的终点是总体的生存在一年后,tebentafp组有73%,对照组中有59%,控制组中有59%95%果酱—0.37—0.71;接下来在特班夫夫治疗法组中,进攻性存活的情况也明显高于控制组(6个月后为31%);暴力犯罪或死亡比例? 0.7395%的印度教徒P = 01)提特本夫夫§§一组最受伤害的事件是细胞金骚事(因t细胞激活而引起)、与皮肤有关的事件(通过血糖素—100种发霉素引起),包括皮疹(83%)、晒伤(76%)和69%谎言(69%)。这些有害事件的发生率和严重性在最初3或4剂量后降下来,极少数情况下只能导致休克治疗(2%)。我们没发现任何与治疗有关的死亡
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引用次数: 0
Empfehlungen für die interdisziplinäre Betreuung von Patienten mit Riesenzellarteriitis: «Giant Cell Arteritis Hospital Quality Standards» (GHOST) 建议的护理的患者Riesenzellarteriitis:«用力Cell Arteritis医院加强质量标准»(幽灵)
Pub Date : 2023-10-27 DOI: 10.1159/000534264
Christoph Tappeiner
Objective: GCA is the commonest primary systemic vasculitis in adults, with significant health economic costs and societal burden. There is wide variation in access to secondary care GCA services, with 34% of hospitals in England not having any formal clinical pathway. Quality standards provide levers for change to improve services. Methods: The multidisciplinary steering committee were asked to anonymously put forward up to five aspects of service essential for best practice. Responses were qualitatively analysed to identify common themes, subsequently condensed into domain headings, and ranked in order of importance. Quality standards and metrics for each domain were drafted, requiring a minimum 75% agreement. Results: 13 themes were identified from the initial suggestions. Nine quality standards with auditable metrics were developed from the top 10 themes. Patient Access, glucocorticoid use, pathways, ultrasonography, temporal artery biopsy, PET scan access, rheumatology/ophthalmology expertise, education, multidisciplinary working have all been covered in these quality standards. Access to care is a strand that has run through each of the developed standards. An audit tool was developed as part of this exercise.
& lt; b>目的:& lt; / b>GCA是成人中最常见的原发性系统性血管炎,具有显著的健康经济成本和社会负担。在获得二级保健GCA服务方面存在很大差异,英格兰34%的医院没有任何正式的临床途径。质量标准提供了改进服务的杠杆。& lt; b>方法:& lt; / b>多学科指导委员会被要求匿名提出服务的五个方面,这些方面对于最佳实践至关重要。对回答进行定性分析,以确定共同主题,随后浓缩成领域标题,并按重要性排序。起草了每个领域的质量标准和指标,要求至少75%的同意。& lt; b>结果:& lt; / b>从最初的建议中确定了13个主题。从前10个主题中开发了9个具有可审计指标的质量标准。患者访问、糖皮质激素使用、路径、超声检查、颞动脉活检、PET扫描访问、风湿病学/眼科专业知识、教育、多学科工作都涵盖在这些质量标准中。获得医疗服务是贯穿每一项已制定标准的一个环节。作为该练习的一部分,开发了一个审计工具。
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引用次数: 0
Akne vulgaris: Neue Studie bestätigt Wirksamkeit und Sicherheit der Lasertherapie 粉刺野性:新研究证明了激光疗法的有效性和安全性
Pub Date : 2023-10-26 DOI: 10.1159/000534625
Andrea Schulz
Background: Selective photothermolysis on sebaceous glands is an effective method for treating acne vulgaris (AV); however, safety, efficacy, and discomfort hinder its utilization in clinical settings. Aims: The primary objective is to evaluate the safety and efficacy of a novel 1726 nm laser with contact cooling to treat AV. Methods: Seventeen patients aged 18 to 36 were enrolled and treated in this IRB-approved, single-center, open-label study. Patients received up to three facial laser sessions up to seven weeks apart. Follow-up visits happened ten days post-session and at the 4 and 12 weeks following the final session. The investigator assessed the severity of device-related adverse events (AEs). Investigator Global Assessment (IGA) and inflammatory lesion counts (ILC) were used as metrics to evaluate acne resolution and skin condition enhancement. Patients&apos; perspectives on satisfaction and comfort using this technology were assessed using Subject Experience Questionnaires (SEQ). Results: Safety assessment showed mild and transient AEs. All subjects tolerated anesthetics-free treatments well, with a mean treatment discomfort score of 4.9 ± 1.5. Compared to baseline, a statistically significant reduction in ILC (p = 0.003) of 52% to 56% is achieved four to twelve weeks following treatment. Long-term follow-ups showed progressive improvement 24 months post-treatment with a 97% reduction in ILC. SEQs revealed high subject satisfaction (71%) with psychosocial improvement three months post-treatment.
& lt; b>背景:& lt; / b>皮脂腺选择性光热疗法是治疗寻常痤疮(AV)的有效方法。然而,安全性、有效性和不适阻碍了其在临床环境中的应用。& lt; b>目标:& lt; / b>主要目的是评估一种新型的1726 nm激光接触冷却治疗AV的安全性和有效性。17名年龄在18至36岁之间的患者入组并在这项经irb批准的单中心开放标签研究中接受治疗。患者每隔七周接受三次面部激光治疗。随访在治疗后10天以及最后一次治疗后的第4周和第12周进行。研究者评估了器械相关不良事件(ae)的严重程度。研究者总体评估(IGA)和炎性病变计数(ILC)作为评估痤疮消退和皮肤状况改善的指标。Patients& apo;使用受试者体验问卷(SEQ)对使用该技术的满意度和舒适度进行评估。& lt; b>结果:& lt; / b>安全性评价为轻度和短暂性不良反应。所有受试者对无麻醉治疗耐受良好,平均治疗不适评分为4.9±1.5。与基线相比,在治疗后4至12周,ILC (p = 0.003)降低了52%至56%,具有统计学意义。长期随访显示治疗后24个月逐渐改善,ILC降低97%。SEQs显示治疗后三个月心理社会改善的受试者满意度很高(71%)。
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引用次数: 0
NSCLC: Tumorzellen in den Luftwegen jenseits vom Tumorrand haben prognostische Bedeutung NSCLC:癌症外围空气路径上的肿瘤细胞有预测意义
Pub Date : 2023-10-26 DOI: 10.1159/000534558
Thomas Lesser
Background: The current accuracy of frozen section diagnosis of tumor spread through air spaces (STAS) in non-small cell lung cancer (NSCLC) is poor. However, the accuracy and prognostic value of STAS assessment on frozen sections in small-sized NSCLC (diameter ≤2 cm) is unknown. Methods: Three hundred fifty-two patients with clinical stage I NSCLC (≤2 cm) were included, of which the parafin sections and frozen sections were reviewed. The accuracy of STAS diagnosis in frozen sections was assessed using parafin sections as the gold standard. The relationship between STAS on frozen sections and prognosis was assessed by the Kaplan–Meier method and log-rank tests. Results: STAS on frozen sections in 58 of 352 patients could not be evaluated. In the other 294 patients, 36.39% (107/294) was STAS-positive on parafin sections and 29.59% (87/294) on frozen sections. The accuracy of frozen section diagnosis of STAS was 74.14% (218/294), sensitivity was 55.14% (59/107), specifcity was 85.02% (159/187) and agreement was moderate (K = 0.418). In subgroup analysis, the Kappa values for frozen section diagnosis of STAS in the consolidation-to-tumor ratio (CTR) ≤0.5 group and CTR &#x3e; 0.5 group were 0.368, 0.415, respectively. In survival analysis, STAS-positive frozen sections were associated with worse recurrence-free survival in the CTR &#x3e;0.5 group (P &#x3e; 0.5) suggests that frozen section assessment of STAS can be applied to the treatment strategy of small-sized NSCLC with CTR &#x3e; 0.5.
& lt; b>背景:& lt; / b>目前非小细胞肺癌(NSCLC)经气腔扩散(STAS)的冰冻切片诊断准确性较差。然而,STAS评估小尺寸NSCLC(直径≤2 cm)冷冻切片的准确性和预后价值尚不清楚。& lt; b>方法:& lt; / b>纳入临床I期(≤2 cm) NSCLC患者352例,回顾石蜡切片和冷冻切片。以石蜡切片为金标准,评估冷冻切片STAS诊断的准确性。采用Kaplan-Meier法和log-rank检验评估冷冻切片STAS与预后的关系。& lt; b>结果:& lt; / b>352例患者中有58例冷冻切片的STAS无法评估。其余294例患者中,石蜡切片stas阳性36.39%(107/294),冷冻切片29.59%(87/294)。冷冻切片诊断STAS的准确性为74.14%(218/294),敏感性为55.14%(59/107),特异性为85.02%(159/187),一致性为中等(<i>K</i>= 0.418)。在亚群分析中,Kappa</i>凝固切片诊断STAS在实变与肿瘤比(CTR)≤0.5组和CTR >0.5组分别为0.368、0.415。在生存分析中,CTR >0.5组stas阳性冷冻切片与较差的无复发生存率相关(<i>P</i>, # x3e;0.5)提示冷冻切片STAS评估可应用于CTR治疗小细胞NSCLC的治疗策略>0.5.
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引用次数: 0
Nicht kleinzellige Lungentumoren: Frühzeitige Diagnose, vollständige Resektion und individualisierte Therapien als Schlüssel für kontinuierliche Behandlungsverbesserung 并非单细胞无眠:早期诊断、完整康复、个性化疗法作为确保连续改进的关键
Pub Date : 2023-10-23 DOI: 10.1159/000534546
Katrin Welcker
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引用次数: 0
Pleuraergüsse: Serum-Erguss-Albumin-Gradient ermöglicht die schnelle Erkennung von Transsudaten 昴:血清蛋白被用于快速检测流发数据
Pub Date : 2023-10-19 DOI: 10.1159/000534462
Franz Stanzel
Introduction: While Light’s criteria exhibit high sensitivity (98%) in detecting exudative pleural effusions, the capacity to rule out transudates is relatively limited. A previous study showed that approximately one-fifth of patients with congestive cardiac failure on diuretics also met the criteria for exudate. This study compares the diagnostic value of Light’s criteria, the serum-effusion albumin gradient (SEAG) method, and pleural effusion glucose levels for accurately categorizing pleural effusion as transudate or exudate. Methodology: We conducted this cross-sectional observational study in a tertiary care hospital in Ahmedabad, India. Two hundred patients with pleural effusion undergoing thoracentesis were included. Laboratory parameters measured in pleural fluid analysis included pleural fluid protein, pleural fluid lactate dehydrogenase (LDH), pleural fluid albumin, and pleural fluid glucose. Serum protein, serum LDH, and serum albumin were also collected. Mean values and standard deviations (SDs) were calculated for analysis. Results: A significant difference was observed in the mean value of exudative and transudative effusions for each parameter (pleural fluid protein/serum fluid protein ratio, pleural fluid LDH/serum fluid LDH ratio, pleural fluid LDH, SEAG, and pleural fluid glucose) (P &#x3c; 0.001). Light’s criteria demonstrated the highest efficacy in diagnosing exudates (accuracy = 97.50%), while SEAG demonstrated the highest efficacy in diagnosing transudates (accuracy = 97.50%).
& lt; b>介绍:& lt; / b>虽然Light的标准在检测渗出性胸腔积液方面表现出很高的灵敏度(98%),但排除渗出物的能力相对有限。先前的一项研究表明,大约五分之一的使用利尿剂的充血性心力衰竭患者也符合渗出物的标准。本研究比较了Light标准、血清积液白蛋白梯度(SEAG)法和胸腔积液葡萄糖水平对准确分类胸腔积液为渗出液或渗出液的诊断价值。& lt; b>方法:& lt; / b>我们在印度艾哈迈达巴德的一家三级保健医院进行了这项横断面观察研究。200例胸腔积液患者接受胸腔穿刺。在胸腔液分析中测量的实验室参数包括胸腔液蛋白、胸腔液乳酸脱氢酶(LDH)、胸腔液白蛋白和胸腔液葡萄糖。同时采集血清蛋白、LDH、白蛋白。计算平均值和标准差(sd)进行分析。& lt; b>结果:& lt; / b>各参数(胸液蛋白/血清蛋白比、胸液LDH/血清LDH比、胸液LDH、SEAG和胸液葡萄糖)的渗出液和转诊液的平均值有显著差异(<i>P</i>, # x3c;0.001)。Light的诊断标准对渗出液的诊断效率最高(准确率为97.50%),SEAG对渗出液的诊断效率最高(准确率为97.50%)。
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引用次数: 0
MPA-ILD: Eine seltene Manifestation mit schwieriger Diagnose 一种难诊断的罕见现象
Pub Date : 2023-10-12 DOI: 10.1159/000534239
Fotios Drakopanagiotakis, Andreas Günther
Background: Interstitial lung disease (ILD) is a significant complication associated with microscopic polyangiitis (MPA) that has a poor prognosis. However, the longterm clinical course, outcomes, and prognostic factors of MPA-ILD are not well defined. Hence, this study aimed to investigate the long-term clinical course, outcomes, and prognostic factors in patients with MPA-ILD. Methods: Clinical data of 39 patients with MPA-ILD (biopsy proven cases, n = 6) were retrospectively analyzed. High resolution computed tomography (HRCT) patterns were assessed based on the 2018 idiopathic pulmonary fibrosis diagnostic criteria. Acute exacerbation (AE) was defined as the worsening of dyspnea within 30 days, with new bilateral lung infiltration that is not fully explained by heart failure or fluid overload and that does not have identified extra-parenchymal causes (pneumothorax, pleural effusion, or pulmonary embolism). Results: The median follow-up period was 72.0 months (interquartile range: 44–117 months). The mean age of the patients was 62.7 years and 59.0% were male. Usual interstitial pneumonia (UIP) and probable usual interstitial pneumonia patterns on high resolution computed tomography were identified in 61.5 and 17.9% of the patients, respectively. During the follow-up, 51.3% of patients died, and the 5- and 10-year overall survival rates were 73.5% and 42.0%, respectively. Acute exacerbation occurred in 17.9% of the patients. The non-survivors had higher neutrophil counts in bronchoalveolar lavage (BAL) fluid and more frequent acute exacerbation than the survivors. In the multivariable Cox analysis, older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01–1.14; p = 0.028) and higher BAL counts (HR, 1.09; 95% CI, 1.01–1.17; p = 0.015) were found to be the independent prognostic factors associated with mortality in patients with MPA-ILD. Conclusion: During the 6 years-follow-up, about half of patients with MPA-ILD died and approximately one-fifth experienced acute exacerbation. Our results suggest that older age and higher BAL neutrophil counts mean poor prognosis in patients with MPA-ILD. © 2023 Kim, Lee, Choe and Song
& lt; b>背景:& lt; / b>间质性肺疾病(ILD)是与显微多血管炎(MPA)相关的重要并发症,预后较差。然而,MPA-ILD的长期临床病程、预后和预后因素尚未明确。因此,本研究旨在探讨MPA-ILD患者的长期临床病程、预后和预后因素。& lt; b>方法:& lt; / b>39例MPA-ILD(活检证实病例)临床资料<i>n<= 6)进行回顾性分析。根据2018年特发性肺纤维化诊断标准评估高分辨率计算机断层扫描(HRCT)模式。急性加重(AE)定义为30天内呼吸困难加重,伴有新的双侧肺浸润,不能完全由心力衰竭或体液超载解释,也不能确定肺实质外原因(气胸、胸腔积液或肺栓塞)。& lt; b>结果:& lt; / b>中位随访时间为72.0个月(四分位数间距:44-117个月)。患者平均年龄62.7岁,男性占59.0%。在高分辨率计算机断层扫描中,分别有61.5%和17.9%的患者发现了常见性间质性肺炎(UIP)和可能的常见性间质性肺炎。随访期间,51.3%的患者死亡,5年和10年总生存率分别为73.5%和42.0%。17.9%的患者出现急性加重。非幸存者在支气管肺泡灌洗液(BAL)中有较高的中性粒细胞计数,并且比幸存者更频繁的急性加重。在多变量Cox分析中,年龄较大(风险比[HR], 1.07;95%置信区间[CI], 1.01-1.14;& lt; i>术中;/ i>= 0.028), BAL计数较高(HR, 1.09;95% ci, 1.01-1.17;& lt; i>术中;/ i>= 0.015)是与MPA-ILD患者死亡率相关的独立预后因素。& lt; b>结论:& lt; / b>在6年的随访中,大约一半的MPA-ILD患者死亡,大约五分之一的患者急性加重。我们的研究结果表明,年龄较大和BAL中性粒细胞计数较高意味着MPA-ILD患者预后较差。©2023 Kim, Lee, Choe and Song
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引用次数: 0
Update Immunglobulin-A Vaskulitis 免疫球蛋白 A 血管炎的最新进展
Pub Date : 2023-10-12 DOI: 10.1159/000534383
Sabine Adler
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引用次数: 0
Nivolumab-induzierte Pneumonie bei nicht kleinzelligem Lungenkarzinom: Ein Fallbericht 测量体积用非体外肺部癌症释放空气寄生虫:测量图
Pub Date : 2023-10-12 DOI: 10.1159/000533781
Tehmina Habib, Mohammad Abu-Abaa, Diana Kolman-Taddeo
Nivolumab ist ein Immuncheckpoint-Inhibitor (ICI), der sich bei der Behandlung bestimmter bösartiger Erkrankungen, einschließlich des nicht kleinzelligen Lungenkarzinoms, als wirksam erwiesen hat. In diesem Fallbericht stellen wir eine 53-jährige Patientin vor, bei der ein metastasierendes nichtkleinzelliges Lungenkarzinom dia­gnostiziert wurde. Nach Bestrahlung (sowohl extern als auch mit Brachytherapie) und Entfernung des Tumors durch bronchoskopische Kryotherapie entwickelte sie unter Nivolumab und Ipilimumab eine initiale Pneumonitis. Diese wurde erfolgreich mit einer Steroidtherapie behandelt, sodass die Monotherapie mit Nivolumab wiederaufgenommen werden konnte. Einige Monate später entwickelte die Patientin jedoch eine organisierende Pneumonie, die zum Abbruch der Immuntherapie und zum Beginn einer Kortikosteroidtherapie führte. Dieser Fall sollte Kliniker daran erinnern, dass ICI zwar eine neue und wirksame Therapie für bestimmte maligne Erkrankungen darstellen, dass aber immunologische Nebenwirkungen kräftezehrend sein und eine Fortsetzung der Immuntherapie verhindern können. Anhand dieses Falles soll hier die Literatur zu dieser seltenen Nebenwirkung der Nivolumab-induzierten Pneumonitis sowie zu den Risikofaktoren, der Diagnose und der Behandlung gesichtet werden.
尼革美是一种免疫测量器(住在这里),它已证明有效治疗某些恶性疾病,包括非体外肺癌。在这些案例报告中,我们介绍了一名53岁的患者一种非显性心肺衰变手术在对外服疗法和休克疗法的放射后,通过支气肿切除术切除肿瘤在尼革默氏病和伊皮拉默病症下引发了轻微的肺炎。他们成功地使用类固醇治疗,使尼革恢复了单细胞治疗的作用。但几个月后,病人却发展出一种器官肺炎,导致免疫治疗停止并开始皮质醇治疗。这种现象应当提醒住院医生,虽然这里对某些恶性病例是有效的新疗法,但免疫的副作用…可以减轻负担,妨碍继续治疗。根据这一案例,我们要查看测量发光管的这一罕见的副作用以及相关风险因素、诊断和治疗。
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引用次数: 0
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