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Is the development of liquid biopsy for the early detection and the monitoring of breast cancers on its way of overtaking mammography? 用于早期检测和监测乳腺癌的液体活检技术是否正在超越乳房 X 线照相术?
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1415940
Hicham Mansour, Chakib Nejjari, Roberto Incitti, Naima Anouar, A. Ouhajjou
Mammography, as of today, is used as a gold standard for screening, diagnosing, and monitoring breast cancer (BC). While overall beneficial, it presents several downsides, such as limitations in accuracy, relatively high costs, and dependence on heavy infrastructure, greatly limiting accessibility for the entire global target population. There is currently no established alternative to mammography, and overcoming this major challenge is a hot topic in research and technology. One avenue for tackling this issue is the development of highly sensitive and specific non-invasive blood tests for the early diagnosis and follow-up of breast cancer. This paper discusses the limitations of mammography and recapitulates the blood tests already available, those under development, and future developments in this field.
目前,乳腺 X 射线照相术已成为筛查、诊断和监测乳腺癌(BC)的黄金标准。虽然乳腺 X 射线照相术总体上是有益的,但它也存在一些缺点,如准确性有限、成本相对较高、依赖于繁重的基础设施等,极大地限制了全球目标人群的可及性。目前还没有成熟的乳腺 X 射线照相术替代方法,克服这一重大挑战是研究和技术领域的热门话题。解决这一问题的途径之一是开发高灵敏度和特异性的无创血液检测,用于乳腺癌的早期诊断和随访。本文讨论了乳房 X 射线照相术的局限性,并概述了已有的血液检测方法、正在开发的检测方法以及该领域的未来发展。
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引用次数: 0
Mycobacterium marinum hand infection: a case report and literature review 马氏分枝杆菌手部感染:病例报告和文献综述
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1433153
Chunping Liu, Jiahao Hao, Minghui Song, Jiaqing Ye, Cuiying Zheng, Yinqi Huang, Zhongjun Feng, Ruiping Jiang, Yan Shi, Weili Gao, Huifen Zuo, Zhenjun Zhao, Lijie Zhang
Mycobacterium marinum, a photochromogenic, slow-growing mycobacterium, thrives in both marine and freshwater environments. Optimal growth occurs between 25°C and 35°C, with survival becoming challenging above 37°C. Typically, M. marinum enters the body via skin abrasions, often leading to infections of the upper extremities. Diagnosis of M. marinum infection is frequently challenging and delayed due to the difficult pathogen identification. At present, a standardized treatment protocol has yet to be established. Presented herein is a case study detailing an infection of the right hand's middle finger caused by M. marinum. Notably, his occupation as a chef, handling fish and seafood post-injury, was a significant factor. Histological examination of the skin biopsy and positive acid-fast staining were consistent with a diagnosis of mycobacterial infection. Pathological examination confirmed a skin infection with infectious granuloma, and tissue section acid-fast staining revealed acid-fast bacill. Cultures on Columbia blood agar yielded rough, flattened, yellow-fleshy colonies after 10 days, which was identified as M. marinum through 16S rRNA sequencing. The patient responded well to a 3-month regimen of oral moxifloxacin (0.4 qd) and linezolid (0.6 qd), resulting in rash resolution and pain relief, with no recurrence observed for 1-year follow-up. This report presents the first documented acid-fast staining images of M. marinum tissue sections and colony morphology photographs, offering an in-depth view of M. marinum's morphological characteristics. It aims to enhance awareness of M. marinum infections, underscore the necessity for clinicians to delve into patient histories, and provide a review of the clinical manifestations, diagnostic techniques, therapeutic approaches, and pathogenic mechanisms associated with M. marinum.
海洋分枝杆菌是一种光致变色、生长缓慢的分枝杆菌,在海洋和淡水环境中都能生长。其最佳生长温度为 25°C 至 35°C,超过 37°C 则难以存活。通常,M. marinum 通过皮肤擦伤进入人体,通常会导致上肢感染。由于病原体难以识别,马林菌感染的诊断往往具有挑战性,并且会被延迟。目前,标准化治疗方案尚未建立。本文介绍的病例详细说明了马氏菌引起的右手中指感染。值得注意的是,他的职业是厨师,受伤后要处理鱼类和海鲜,这是一个重要因素。皮肤活检组织学检查和酸性染色阳性结果与分枝杆菌感染的诊断一致。病理检查证实皮肤感染并伴有感染性肉芽肿,组织切片酸性染色显示为耐酸杆菌。在哥伦比亚血琼脂上进行培养,10 天后得到粗糙、扁平、黄色肉质菌落,通过 16S rRNA 测序确定为 M. marinum。患者口服莫西沙星(0.4 qd)和利奈唑胺(0.6 qd)3 个月后反应良好,皮疹消退,疼痛减轻,随访 1 年未见复发。本报告首次记录了马林菌组织切片的耐酸染色图像和菌落形态照片,深入展示了马林菌的形态特征。报告旨在提高人们对马林镑菌感染的认识,强调临床医生深入了解患者病史的必要性,并对与马林镑菌相关的临床表现、诊断技术、治疗方法和致病机制进行回顾。
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引用次数: 0
Efficacy of percutaneous microwave ablation guided by contrast-enhanced and two-dimensional ultrasound for in hepatic alveolar echinococcosis in difficult/dangerous locations 造影剂增强和二维超声引导下的经皮微波消融术对疑难/危险部位肝泡棘球蚴病的疗效
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1436753
Wangxing Huang, Zhipeng Hu, Lina Qi, Xiaoyan Zhang, Min Li, Mingan Yu, Guoyong Hua
Ultrasound-guided microwave ablation (MWA) has become a popular method for treating malignant liver tumors. However, few studies have investigated its use in the treatment of hepatoalveolar echinococcosis (HAE). This study aimed to explore the effectiveness and safety of contrast-enhanced ultrasound combined with two-dimensional ultrasound-guided MWA for the treatment of HAE in difficult/dangerous locations.Data from 81 patients, who were diagnosed with hepatic alveolar hydatid disease in difficult/dangerous locations between January 2018 and January 2023, and underwent contrast-enhanced ultrasonography combined with two-dimensional ultrasound-guided MWA, were analyzed. After undergoing MWA, patients were followed up to determine whether the lesions recurred and to evaluate the therapeutic effect of MWA. Preoperatively, individualized strategies were designed for lesions in different locations, and different auxiliary ablation technologies were used for contrast-enhanced ultrasound combined with two-dimensional ultrasound-guided MWA to achieve complete inactivation of lesions in difficult/dangerous locations.MWA was performed on 89 HAE lesions in 81 patients. The median diameter of the lesions was 2.86 cm (interquartile range [IQR] 2.36–3.49 cm). The complete ablation rate after surgery was 100%, with a recurrence rate of 11.11%, and median follow-up of 24 months (IQR 12–48 months). The incidence of minor complications was 14.81%; no serious complications or deaths occurred. Compared with before surgery, TB, DB, alanine aminotransferase, and aspartate aminotransferase levels increased (p < 0.001), albumin platelets and activated partial thromboplastin time decreased (p < 0.05), with no statistical difference in prothrombin time (p > 0.05).MWA may be a safe and effective method for treating HAE in difficult/dangerous locations, and may represent a new and alternative option for this patient population.
超声引导下的微波消融术(MWA)已成为治疗恶性肝肿瘤的常用方法。然而,很少有研究调查其在治疗肝泡棘球蚴病(HAE)中的应用。本研究旨在探讨造影剂增强超声联合二维超声引导的MWA治疗疑难/危险部位HAE的有效性和安全性。研究人员对2018年1月至2023年1月期间确诊为疑难/危险部位肝泡水包虫病并接受造影剂增强超声联合二维超声引导的MWA治疗的81例患者的数据进行了分析。接受 MWA 后,对患者进行随访,以确定病变是否复发,并评估 MWA 的治疗效果。术前,针对不同位置的病灶设计了个性化的策略,造影剂增强超声联合二维超声引导下的MWA采用了不同的辅助消融技术,以实现困难/危险位置病灶的完全灭活。81名患者的89个HAE病灶接受了MWA手术,病灶的中位直径为2.86厘米(四分位距[IQR]为2.36-3.49厘米)。术后完全消融率为100%,复发率为11.11%,中位随访时间为24个月(IQR为12-48个月)。轻微并发症发生率为 14.81%,无严重并发症或死亡病例。与手术前相比,TB、DB、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶水平均有所升高(P 0.05)。MWA可能是治疗疑难/危险部位HAE的一种安全有效的方法,可能是这类患者的一种新的替代选择。
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引用次数: 0
The role of methylprednisolone in severe COVID-19 patients: a meta-analysis 甲基强的松龙在重症 COVID-19 患者中的作用:一项荟萃分析
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1428581
Wanru Xu, Yujun Zeng, Hedong Han, Tangfeng Lv, Dang Lin
The purpose of this study is to assess the effectiveness of methylprednisolone in severe COVID-19.PubMed, the Cochrane Library and Web of Science were searched for literatures comparing methylprednisolone and control treatment in severe COVID-19 patients. Statistical pooling was reported as risk ratio (RR) with corresponding 95% confidence interval (CI). The outcomes of interest in the literature survey were mortality and adverse events.A total of 13 studies were included, including 3,138 patients with severe COVID-19, of which 1,634 patients were treated with methylprednisolone and 1,504 patients were treated with control treatment. Five of the 13 studies reported severe adverse events. Our meta-analysis indicates that methylprednisolone treatment in COVID-19 patients is associated with a significant reduction in mortality (RR 0.62, 95% CI 0.46–0.85, p = 0.003) compared to control treatment, without an increased risk of adverse events (RR 1.20, 95% CI 0.92–1.56, p = 0.17). Moreover, high-dose methylprednisolone treatment (RR 0.57; 95% CI 0.40–0.82, p = 0.003) and short-course methylprednisolone treatment (RR 0.54; 95% CI 0.38–0.89, p = 0.01) found to significantly reduce mortality. Additionally, it was found that younger severe COVID-19 patients (RR 0.40; 95% CI 0.20–0.80, p = 0.01) had better outcomes to methylprednisolone than older patients.Methylprednisolone was correlated with lower mortality compared with control treatment in severe COVID-19 patients without increasing serious adverse reactions. Furthermore, high-doses and short-term of methylprednisolone treatment were linked with better younger COVID-19 reported higher benefit from methylprednisolone than older COVID-19 patients.
本研究旨在评估甲基强的松龙对重症 COVID-19 的疗效。研究人员在 PubMed、Cochrane 图书馆和 Web of Science 上检索了对重症 COVID-19 患者进行甲基强的松龙和对照治疗进行比较的文献。统计汇总结果以风险比(RR)和相应的 95% 置信区间(CI)进行报告。共纳入了 13 项研究,包括 3,138 名重症 COVID-19 患者,其中 1,634 名患者接受了甲基强的松龙治疗,1,504 名患者接受了对照治疗。13 项研究中有 5 项报告了严重的不良事件。我们的荟萃分析表明,与对照组治疗相比,COVID-19 患者接受甲基强的松龙治疗可显著降低死亡率(RR 0.62,95% CI 0.46-0.85,p = 0.003),同时不会增加不良事件风险(RR 1.20,95% CI 0.92-1.56,p = 0.17)。此外,大剂量甲基强的松龙治疗(RR 0.57;95% CI 0.40-0.82,p = 0.003)和短疗程甲基强的松龙治疗(RR 0.54;95% CI 0.38-0.89,p = 0.01)可显著降低死亡率。此外,研究还发现,较年轻的严重 COVID-19 患者(RR 0.40;95% CI 0.20-0.80,p = 0.01)对甲基强的松龙的疗效优于较年长的患者。与对照治疗相比,甲基强的松龙可降低严重 COVID-19 患者的死亡率,但不会增加严重不良反应。此外,大剂量和短期甲基强的松龙治疗与较年轻的 COVID-19 患者从甲基强的松龙中获得的益处高于较年长的 COVID-19 患者有关。
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引用次数: 0
Xanthogranulomatous pyelonephritis in a patient with polycystic kidney disease without underlying risk factors: a case report 无潜在危险因素的多囊肾患者黄疽性肾盂肾炎:病例报告
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1419965
Yoomee Kang, T. W. Lee, Eunjin Bae, H. Jang, Sehyun Jung, Seunghye Lee, Se‐Ho Chang, Dong Jun Park
Xanthogranulomatous pyelonephritis (XGP) is an extremely rare, chronic granulomatous inflammatory condition thought to arise secondary to a combination of obstruction, recurrent bacterial infection and an incomplete immune response although the etiology of XGP is more complex. We would like to report a case of XGP occurring in a patient with polycystic kidney disease (PCKD), which has not been previously documented in etiology. A 29-year-old woman presented to our hospital with right upper quadrant pain for 5 days. She had experienced a low-grade fever, generalized weakness, and myalgia throughout her body for 2 weeks. She had no history of renal stones or recurrent UTIs. Contrast-enhanced CT revealed a well-enhancing large septated cystic mass in the right kidney and numerous cysts in the liver and both kidneys. Open right radical nephrectomy was performed due to the suspicion of renal cell carcinoma, as there was no response to antibiotics over 7 days. Gross specimen demonstrated architectural distortion due to xanthomatous nodules and a dilated pelvico-calyceal system filled with pus and blood. Microscopic examination revealed infiltration of neutrophils and lipid-laden macrophages. The patient is currently being followed up in the outpatient clinic without recurrence of XGP. This is the first reported case of XGP in a patient with underlying PCKD. Physicians should consider PCKD as a potential underlying cause of XGP.
黄疽性肾盂肾炎(XGP)是一种极为罕见的慢性肉芽肿性炎症,被认为是继发于梗阻、反复细菌感染和不完全免疫反应的综合病症,但其病因较为复杂。我们想报告一例发生在多囊肾(PCKD)患者身上的 XGP 病例,该病因以前从未有过记录。一名 29 岁女性因右上腹疼痛 5 天来我院就诊。她曾连续两周出现低烧、全身无力和肌痛。她没有肾结石或复发性尿毒症病史。对比增强 CT 显示,她的右肾有一个强化良好的巨大隔膜囊性肿块,肝脏和双肾也有许多囊肿。由于抗生素治疗 7 天仍无反应,医生怀疑是肾细胞癌,于是对患者进行了开放性右肾根治术。大体标本显示,黄瘤结节导致结构扭曲,扩张的肾盂-肾盏系统充满脓血。显微镜检查发现中性粒细胞和脂质巨噬细胞浸润。目前,患者正在门诊接受随访,XGP 没有复发。这是首例在有基础 PCKD 的患者中报告的 XGP 病例。医生应将 PCKD 视为 XGP 的潜在病因。
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引用次数: 0
Strengthening surgical healthcare research capacity in sub-Saharan Africa: impact of a research training programme in Nigeria 加强撒哈拉以南非洲地区的外科医疗保健研究能力:尼日利亚研究培训计划的影响
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1429168
E. A. Ameh, J. Seyi-Olajide, Nkeiruka Ameh, Afieharo Michael, Mohammed AS Abdullahi, Oti N. Aria, Nkeiruka Obi, Isaac Chukwu
Limited research capacity has contributed to the lack of high-quality research from low-and middle-income countries. This is compounded by limited research training opportunities. Research capacity scale-up training was deployed as part of the implementation of the National Surgical, Obstetrics, Anaesthesia, and Nursing Plan for Nigeria. We report the impact of this locally contextualized efforts to scale up research capacity in sub-Saharan Africa.This is an evaluation of the training of 65 participants in research, grant writing and manuscript writing and publication. Pre- and post-training surveys using a 5-point Likert scale and open-ended questions were administered to evaluate the impact of the programme.There were 39 (60%) males and 26 (40%) females aged 26–62 years (median 42 years). Thirty-nine (60%) participants had previous training in research, but only 12 (18.5%) had previously received grant writing training, and 17 (26.2%) had previously received manuscript writing and publishing training. Following training, 45 (70.3%) participants agreed that the training was relevant. The research, grant writing and manuscript writing, and publication components of the training were rated high by the participants (45–59, 70.3–92.2%). However, 41.2% felt that there was not enough time, and 32.4% felt that the training was too comprehensive. Nearly all the participants agreed that the training had improved their skills in research, grant writing and manuscript writing and publication, and more than two-thirds subsequently engaged in informal mentoring of others. Overall, participants achieved success in designing their own research projects and publishing manuscripts and grants. Three (4.6%) of the participants had gone on to become faculty for the research training programme. The three top barriers encountered following training were time constraints (67.3%), lack of funding (36.5%) and not being able to find research collaborators (25%).Outcome of this training programme is encouraging and highlights the feasibility and potential impact of deploying such programmes in low and middle income countries (LMICs). Despite the positive outcomes, barriers including time constraints, funding limitations, and difficulties in finding research collaborators remain to be addressed. Such training programmes need to be supported to strengthen the research capacity in this and similar settings.
研究能力有限导致中低收入国家缺乏高质量的研究。而研究培训机会有限则加剧了这一问题。作为尼日利亚国家外科、产科、麻醉和护理计划实施工作的一部分,开展了科研能力提升培训。我们报告了这一因地制宜的努力对撒哈拉以南非洲地区科研能力提升的影响。这是对 65 名参加者在科研、基金撰写、手稿撰写和出版方面的培训情况进行的评估。培训前和培训后的调查使用了 5 分李克特量表和开放式问题,以评估该计划的影响。参加者中有 39 名男性(60%)和 26 名女性(40%),年龄在 26-62 岁之间(中位数为 42 岁)。39名参与者(60%)曾接受过研究培训,但只有12名(18.5%)曾接受过撰写研究基金的培训,17名(26.2%)曾接受过撰写和出版手稿的培训。培训结束后,45 名学员(70.3%)认为培训很有意义。学员们对培训中的研究、资助金撰写、稿件撰写和出版部分给予了较高的评价(45-59 人,70.3-92.2%)。但是,41.2% 的学员认为培训时间不够,32.4% 的学员认为培训内容过于全面。几乎所有学员都认为,培训提高了他们在研究、基金撰写、稿件撰写和出版方面的技能,三分之二以上的学员随后参与了对他人的非正式指导。总体而言,学员们在设计自己的研究项目、发表手稿和获得资助方面取得了成功。三位学员(4.6%)成为研究培训计划的教师。培训后遇到的三大障碍是时间限制(67.3%)、缺乏资金(36.5%)和找不到研究合作者(25%)。尽管取得了积极成果,但包括时间限制、资金限制和难以找到研究合作者在内的障碍仍有待解决。此类培训计划需要得到支持,以加强该地区及类似地区的研究能力。
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引用次数: 0
Maternal puerperal infection caused by Parabacteroides goldsteinii: a case report 由 Parabacteroides goldsteinii 引起的产妇产褥感染:一份病例报告
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1450931
Liwei Peng, Xiaomin Chen, Zhenhui Wang, Lu Yi, Zhengjiang Jin
Parabacteroides goldsteinii, a member of the Parabacteroides genus, was initially discovered in the feces and abdominal tissue of patients with appendicitis, peritonitis, and abdominal abscesses. In recent years, P. goldsteinii has been widely regarded as a gut probiotic, and human infections have been extremely rare. In 2010, P. goldsteinii was first isolated from the blood culture of a patient with abdominal infection, confirming its ability to cause bacteremia. In this study, we report a rare case of puerperal infection with septic shock caused by P. goldsteinii infection in a pregnant woman.A 31-year-old female experienced perineal lacerations, cervical lacerations, and postpartum hemorrhage during childbirth. Nine days postpartum, the patient developed septic shock, and P. goldsteinii infection was identified through blood culture and mass spectrometry. We administered broad-spectrum antibiotics, including meropenem/nalidixic acid and piperacillin tazobactam, intravenously, but the antimicrobial effect was not satisfactory. Upon ultrasound examination, we identified a focus of infection in the patient’s uterus. Subsequently, uterine curettage was performed, followed by uterine cavity irrigation with metronidazole and intramuscular injection of gentamicin and dexamethasone. Following treatment, the patient’s physiological parameters gradually returned to normal, and she was discharged 30 days after admission.Parabacteroides goldsteinii bacteraemia is extremely rare, and clinically, the postinfection toxicity of this bacterium appears to be significant. In this report, we review the research history of P. goldsteinii and relevant infection cases, aiming to enhance awareness among clinical practitioners, particularly obstetricians and gynecologists, regarding P. goldsteinii bloodstream infections, facilitating early diagnosis and timely treatment.
金氏副乳菌(Parabacteroides goldsteinii)是副乳菌属的一员,最初是在阑尾炎、腹膜炎和腹腔脓肿患者的粪便和腹部组织中发现的。近年来,P. goldsteinii 被广泛认为是一种肠道益生菌,人类感染极为罕见。2010 年,首次从一名腹部感染患者的血液培养物中分离出金孢子菌,证实了其导致菌血症的能力。在本研究中,我们报告了一例罕见的产褥期感染病例,该病例是由孕妇感染金黄色葡萄球菌引起的脓毒性休克。一名 31 岁的女性在分娩过程中经历了会阴撕裂伤、宫颈撕裂伤和产后出血。产后九天,患者出现脓毒性休克,通过血液培养和质谱分析确定为金孢子菌感染。我们静脉注射了广谱抗生素,包括美罗培南/纳利昔酸和哌拉西林他唑巴坦,但抗菌效果并不理想。经超声波检查,我们在患者的子宫内发现了一个感染灶。随后,我们对患者进行了子宫刮宫术,用甲硝唑冲洗宫腔,并肌肉注射庆大霉素和地塞米松。治疗后,患者的生理指标逐渐恢复正常,入院 30 天后出院。金丝桃副杆菌菌血症极为罕见,临床上,这种细菌感染后的毒性似乎很大。在本报告中,我们回顾了金黄色葡萄球菌的研究历史和相关感染病例,旨在提高临床医师,尤其是妇产科医师对金黄色葡萄球菌血流感染的认识,促进早期诊断和及时治疗。
{"title":"Maternal puerperal infection caused by Parabacteroides goldsteinii: a case report","authors":"Liwei Peng, Xiaomin Chen, Zhenhui Wang, Lu Yi, Zhengjiang Jin","doi":"10.3389/fmed.2024.1450931","DOIUrl":"https://doi.org/10.3389/fmed.2024.1450931","url":null,"abstract":"Parabacteroides goldsteinii, a member of the Parabacteroides genus, was initially discovered in the feces and abdominal tissue of patients with appendicitis, peritonitis, and abdominal abscesses. In recent years, P. goldsteinii has been widely regarded as a gut probiotic, and human infections have been extremely rare. In 2010, P. goldsteinii was first isolated from the blood culture of a patient with abdominal infection, confirming its ability to cause bacteremia. In this study, we report a rare case of puerperal infection with septic shock caused by P. goldsteinii infection in a pregnant woman.A 31-year-old female experienced perineal lacerations, cervical lacerations, and postpartum hemorrhage during childbirth. Nine days postpartum, the patient developed septic shock, and P. goldsteinii infection was identified through blood culture and mass spectrometry. We administered broad-spectrum antibiotics, including meropenem/nalidixic acid and piperacillin tazobactam, intravenously, but the antimicrobial effect was not satisfactory. Upon ultrasound examination, we identified a focus of infection in the patient’s uterus. Subsequently, uterine curettage was performed, followed by uterine cavity irrigation with metronidazole and intramuscular injection of gentamicin and dexamethasone. Following treatment, the patient’s physiological parameters gradually returned to normal, and she was discharged 30 days after admission.Parabacteroides goldsteinii bacteraemia is extremely rare, and clinically, the postinfection toxicity of this bacterium appears to be significant. In this report, we review the research history of P. goldsteinii and relevant infection cases, aiming to enhance awareness among clinical practitioners, particularly obstetricians and gynecologists, regarding P. goldsteinii bloodstream infections, facilitating early diagnosis and timely treatment.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"93 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922022","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
Clinical efficacy and safety of secukinumab in the treatment of generalized pustular psoriasis in the pediatric population: a systematic review of the literature 赛库单抗治疗儿童泛发性脓疱型银屑病的临床疗效和安全性:系统性文献综述
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1377381
Kebo Wei, Ping Li, Xin He, Dongyue Yang, Jing Lang, Lingyao Lai, Min Xiao
Generalized pustular psoriasis (GPP) is a severe type of psoriasis. The current treatment primarily relies on corticosteroids and immunosuppressants. In recent years, biologics have been increasingly utilized in the treatment of this disease, and have demonstrated good clinical efficacy. However, children and adolescents are primarily treated with immunosuppressants, which have limited clinical application due to the serious side effects they may cause. At the same time, the effectiveness of current treatments is unsatisfactory. Secukinumab has been widely reported to be effective and safe in treating this disease. However, there are still insufficient data on its use in treating GPP in children.To conduct a systematic review of the existing literature on the use of secukinumab for treating generalized pustular psoriasis in children and adolescents, and to evaluate its clinical effectiveness and safety.We conducted a systematic review of all the literature reporting on the treatment of GPP in children and adolescents with secukinumab.A total of 7 papers (46 patients) were included in this study. After 12 weeks of treatment, all 46 participants were able to achieve a GPPASI score of 90 or higher, with approximately 96% of patients achieving complete clearing of the lesions (GPPASI 100 or JDA0). Adverse events were reported in 8 patients, the rate of adverse reactions was approximately 17%.The treatment of GPP in children and adolescents with secukinumab has a rapid onset of action and a high safety profile. However, the results of the literature may be influenced by publication bias.
泛发性脓疱型银屑病(GPP)是一种严重的银屑病类型。目前的治疗主要依靠皮质类固醇激素和免疫抑制剂。近年来,生物制剂被越来越多地用于治疗这种疾病,并取得了良好的临床疗效。然而,儿童和青少年主要使用免疫抑制剂进行治疗,而免疫抑制剂可能会导致严重的副作用,因此临床应用有限。同时,目前的治疗效果也不尽如人意。塞库单抗(Secukinumab)被广泛报道为治疗这种疾病的有效且安全的药物。我们对所有报道使用赛库单抗治疗儿童和青少年 GPP 的文献进行了系统性回顾,共纳入了 7 篇论文(46 名患者)。经过12周的治疗后,所有46名参与者的GPPASI评分都达到了90分或更高,其中约96%的患者实现了病灶的完全清除(GPPASI 100或JDA0)。8名患者出现了不良反应,不良反应发生率约为17%。"secukinumab治疗儿童和青少年GPP起效快,安全性高。然而,文献结果可能会受到发表偏倚的影响。
{"title":"Clinical efficacy and safety of secukinumab in the treatment of generalized pustular psoriasis in the pediatric population: a systematic review of the literature","authors":"Kebo Wei, Ping Li, Xin He, Dongyue Yang, Jing Lang, Lingyao Lai, Min Xiao","doi":"10.3389/fmed.2024.1377381","DOIUrl":"https://doi.org/10.3389/fmed.2024.1377381","url":null,"abstract":"Generalized pustular psoriasis (GPP) is a severe type of psoriasis. The current treatment primarily relies on corticosteroids and immunosuppressants. In recent years, biologics have been increasingly utilized in the treatment of this disease, and have demonstrated good clinical efficacy. However, children and adolescents are primarily treated with immunosuppressants, which have limited clinical application due to the serious side effects they may cause. At the same time, the effectiveness of current treatments is unsatisfactory. Secukinumab has been widely reported to be effective and safe in treating this disease. However, there are still insufficient data on its use in treating GPP in children.To conduct a systematic review of the existing literature on the use of secukinumab for treating generalized pustular psoriasis in children and adolescents, and to evaluate its clinical effectiveness and safety.We conducted a systematic review of all the literature reporting on the treatment of GPP in children and adolescents with secukinumab.A total of 7 papers (46 patients) were included in this study. After 12 weeks of treatment, all 46 participants were able to achieve a GPPASI score of 90 or higher, with approximately 96% of patients achieving complete clearing of the lesions (GPPASI 100 or JDA0). Adverse events were reported in 8 patients, the rate of adverse reactions was approximately 17%.The treatment of GPP in children and adolescents with secukinumab has a rapid onset of action and a high safety profile. However, the results of the literature may be influenced by publication bias.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"59 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141923475","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
Case report: Abscesses in children caused by invasive group A Streptococcus 病例报告:由侵袭性 A 组链球菌引起的儿童脓肿
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1438624
D. Guo, Shuting Zhuang, Qinghua Lu, Yunsheng Chen, Qing Meng, Lifang Sun, Yuejie Zheng, Wenjian Wang, Dingle Yu
Streptococcus is one of the common pathogens of suppurative infections. Invasive group A Streptococcus (iGAS) infections often develop from skin or soft tissue infections, and streptococcal toxic shock syndrome is considered the main cause of death in Chinese children with iGAS infectious disease. However, soft tissue infections caused by iGAS infections, especially the formation of abscesses, are relatively rare. A retrospective study was conducted, and pediatric in-patients who were diagnosed with an iGAS infection identified by cultures from normally sterile sites and treated in a tertiary hospital during 2016–2018 were included. A total of 14 patients were identified, which included 10 boys and four girls. The patients had an age range from 3 months to 10 years and were diagnosed with soft tissue infections and a formation of abscesses caused by iGAS infections. The most common sites of infections were the lower limbs. In five patients, the abscess was accompanied by fever, and the local soft tissue showed redness, swelling, tenderness, and an elevated skin temperature. Laboratory findings included an increased white blood cell (WBC) count in 12 patients, an increased C reactive protein (CRP) level in seven patients, and an increased erythrocyte sedimentation rate (ESR) in 10 patients. No patients had an elevated procalcitonin level. For all 14 patients, we performed puncture and drainage of abscesses, and cultured GAS from the drainage fluid. All children also received antibiotic treatment. During 2 months of follow-up, the patients' condition remained stable and no evidence of kidney or heart damage was observed. For pediatric patients with abscesses, early diagnosis, prompt treatment with incision and drainage, and immediate culture of the drainage fluid are important. Upon confirmation of an iGAS infection, β-lactam antibiotics should be given to provide effective treatment, and in some patients with poor therapeutic outcomes, the use of vancomycin as an alternative can achieve the desired results.
链球菌是化脓性感染的常见病原体之一。侵袭性 A 组链球菌(iGAS)感染通常由皮肤或软组织感染引起,链球菌中毒性休克综合征被认为是中国儿童 iGAS 感染性疾病死亡的主要原因。然而,由 iGAS 感染引起的软组织感染,尤其是脓肿的形成却相对罕见。研究人员开展了一项回顾性研究,纳入了2016-2018年期间在一家三甲医院接受治疗、经正常无菌部位培养鉴定确诊为iGAS感染的儿科住院患者。共确定了 14 名患者,其中包括 10 名男孩和 4 名女孩。患者年龄从3个月到10岁不等,被诊断为由iGAS感染引起的软组织感染和脓肿形成。最常见的感染部位是下肢。五名患者的脓肿伴有发热,局部软组织出现红肿、触痛和皮温升高。实验室检查结果包括:12 名患者的白细胞(WBC)计数升高,7 名患者的 C 反应蛋白(CRP)水平升高,10 名患者的红细胞沉降率(ESR)升高。没有患者出现降钙素原水平升高。我们对所有 14 名患者进行了脓肿穿刺和引流,并从引流液中培养出了 GAS。所有患儿都接受了抗生素治疗。在两个月的随访中,患者的病情保持稳定,没有发现肾脏或心脏受损的迹象。对于患有脓肿的儿童患者来说,早期诊断、及时切开引流治疗和立即培养引流液非常重要。在确诊为 iGAS 感染后,应使用β-内酰胺类抗生素进行有效治疗,对于一些治疗效果不佳的患者,使用万古霉素作为替代药物也能达到预期效果。
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引用次数: 0
Association between serum vitamin D and the risk of diabetic kidney disease in patients with type 2 diabetes 2 型糖尿病患者血清维生素 D 与糖尿病肾病风险之间的关系
Pub Date : 2024-08-09 DOI: 10.3389/fmed.2024.1445487
Yujie Wang, Chenggang Hu, Ying Li, Qi Liu, Lichao Gao, Dongmei Zhang, Ling Cao
This investigation explored the potential correlation between serum vitamin D concentration and diabetic kidney disease (DKD) among patients with type 2 diabetes mellitus (T2DM).This cross-sectional study assessed 4,570 patients with T2DM drawn from the National Health and Nutrition Examination Survey (NHANES) dataset. Restricted cubic splines were utilized to examine the dose–response relationship between serum vitamin D levels and the risk of DKD in patients with T2DM. Serum vitamin D concentrations were divided into quartiles for multivariable logistic regression analysis to evaluate the association between varying serum vitamin D levels and DKD risk in patients with T2DM. Additionally, sex-stratified analyses were conducted to determine consistency of the results. The influence of vitamin D concentrations on mortality risk was assessed using a Cox regression model.Of the patients with T2DM, 33% were diagnosed with DKD. Restricted cubic spline plots revealed a U-shaped relationship between vitamin D levels and DKD risk, with a protective effect noted in the mid-range, indicating optimal serum vitamin D concentrations between 59.6 nmol/L and 84.3 nmol/L. The multivariate Cox regression analysis suggested that higher VID levels were associated with a reduced mortality risk, particularly in male patients.The regulation and monitoring of serum vitamin D levels within an optimal range may play a pivotal role in the prevention of DKD in patients with T2DM. Public health strategies should emphasize the regular monitoring of vitamin D levels, especially among populations at elevated risk, to mitigate the progression of DKD and decrease the associated mortality rates.
这项横断面研究评估了来自美国国家健康与营养调查(NHANES)数据集的4570名T2DM患者。这项横断面研究对来自美国国家健康与营养调查(NHANES)数据集的 4570 名 T2DM 患者进行了评估,并利用限制性三次样条来检验 T2DM 患者血清维生素 D 水平与 DKD 风险之间的剂量-反应关系。血清维生素 D 浓度被分为四等分,用于多变量逻辑回归分析,以评估不同血清维生素 D 水平与 T2DM 患者 DKD 风险之间的关系。此外,还进行了性别分层分析,以确定结果的一致性。采用 Cox 回归模型评估了维生素 D 浓度对死亡风险的影响。限制立方样条图显示,维生素 D 水平与 DKD 风险之间呈 U 型关系,在中间范围具有保护作用,表明最佳血清维生素 D 浓度在 59.6 nmol/L 至 84.3 nmol/L 之间。多变量 Cox 回归分析表明,VID 水平越高,死亡风险越低,尤其是男性患者。公共卫生战略应强调定期监测维生素 D 水平,尤其是在高危人群中,以缓解 DKD 的进展并降低相关死亡率。
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Frontiers in Medicine
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