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Rapamycin is a mammalian target of rapamycin(mTOR) receptor inhibitor. Advances in the understanding of the mTOR signaling pathway and its downstream effects on tumorigenesis and vascular proliferation have broadened the clinical applications of mTOR receptor inhibitors in treating many challenging diseases. Rapamycin is used orally for the treatment of kidney transplantation, lymphatic leiomyomatosis of lung, tuberous sclerosis complex(TSC), and etc. But systemic therapy using the rapamycin has significant side effects. To mitigate the side effects of systemic rapamycin for dermatologic applications, clinicians have used topical therapy. In recent years, research publications on the topical rapamycin in the treatment of a variety of diseases have increased, as on such diseases of facial angiofibroma of tuberous sclerosis complex, lymphatic malformation, Kaposi hemangioendothelioma, tufted angiomas, and etc. Topical rapamycin can be used as an effective long-term therapy while avoiding systemic side effects, providing a new treatment method for dermatologists. This paper discusses the progress in the treatment of topical rapamycin preparations.
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Objective:To compare the efficacy and safety of biologics versus methotrexate in the treatment of severe pediatric plaque psoriasis.Methods:A retrospective matched case-control study was carried out. Twenty children with severe plaque psoriasis from Beijing Children′s Hospital, Capital Medical University from June 2016 to November 2021 were included in this study, and the patients treated with biologics (adalimumab or secukinumab) were matched with those treated with methotrexate at a ratio of 1∶1 according to the psoriasis area and severity index (PASI) score and age. PASI, physician′s global assessment (PGA) , and body surface area (BSA) scores were assessed at weeks 4, 8 and 12 after the start of treatment, and adverse drug reactions were recorded. Statistical analysis was mainly carried out by using Mann-Whitney U test, Fisher′s exact test and generalized estimating equations. Results:At weeks 4 and 8, the proportions of patients achieving PASI75 and PASI90 were significantly higher in the biologics group (PASI75: 7/10, 10/10, PASI90: 5/10, 9/10, respectively) than in the methotrexate group (PASI75: 1/10, 5/10, PASI90: 0, 1/10, respectively; all P < 0.05) , while there was no significant difference between the biologics group and methotrexate group at week 12 (PASI75: 10/10 vs. 8/10, PASI90: 9/10 vs. 4/10, both P > 0.05) . There were no significant differences in the PASI, BSA or PGA scores between the two groups at baseline (all P > 0.05) , while the biologics group showed significantly decreased PASI and BSA scores at weeks 4, 8 and 12, and significantly decreased PGA score at week 8 compared with the methotrexate group (PASI: Z = 2.50, 3.56, 2.63, respectively; BSA: Z = 2.87, 3.57, 2.40, respectively; PGA: Z = 2.81; all P<0.05) . Analysis of changes over time showed that the PASI, PGA and BSA scores in the biologics group significantly decreased at weeks 4, 8 and 12 compared with those at baseline (all P<0.01) ; the PASI and PGA scores significantly decreased at weeks 8 and 12 compared with the corresponding scores at week 4 (all P<0.05) ; however, there were no significant differences in the PASI, PGA or BSA scores between week 12 and 8 (all P>0.05) . In the methotrexate group, the PASI, PGA and BSA scores at weeks 4, 8 and 12 were all significantly lower than the corresponding scores at the previous adjacent time points (all P<0.05) . There was no significant difference in the incidence of adverse reactions between the two groups ( P = 0.650) , and no serious adverse reactions occurred in either group. The main adverse reaction was infection in the biologics group, while infection and elevation of transaminase levels were common in the methotrexate group. Conclusion:Biologics and methotrexate were both effective and safe for the treatment of severe pediatricplaque psoriasis, and biologics facilitated rapider achievement of PASI75 and PASI90 compared with methotrexate.
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A 26-month-old male child was admitted for hair abnormality after birth. There was no hair growth on the scalp of the child after birth, rough skin and scattered rice-grain-sized follicular papules were observed all over the body, and erythema was seen in the perianal region. Fifteen days after birth, the patient was found to be photophobic. Skin examination showed diffusely distributed rice-grain-sized follicular papules all over the body, no growth of hair, eyelashes or eyebrows, and well-circumscribed perianal erythema with scaling at the edges. Genetic testing revealed a c.661T>A mutation in the MBTPS2 gene on the X chromosome of the child, which caused a substitution of phenylalanine by isoleucine at amino acid position 221 (p. Phe221Ile) . A heterozygous mutation at the same locus was identified in the patient′s mother. The patient was diagnosed with ichthyosis follicularis, alopecia, and photophobia syndrome.
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To explore the rule of acupuncture and moxibustion in treating insomnia, and to use the Ancient and ModernMedical Cloud Platform (V1.4), a data mining technology, as a basis for interdisciplinary research ideas to providereference for clinical. Searching for acupuncture therapy insomnia clinical research literature in the past 30 years (January 1, 1987-December 31, 2017 in Chinese Knowledge Resource Base (CNKI), Chinese Science and TechnologyJournal Database (Chongqing Weipu), Chinese Academic Journal Database (Wanfang Data), and China BiomedicalDocumentation Database (CBM) for) by computer, using Excel to establish a database and enter the Ancient and ModernMedical Case Cloud Platform (V1.4), data mining methods such as frequency analysis, association rule analysis, hole pairanalysis, community analysis, and complex network analysis are used to analyze the data from the perspectives of singlehole frequency, cave Association, core prescriptions, and clinical syndrome differentiation prescriptions. The data arevisually displayed using novel and colorful charts to enhance visibility. After screening, a total of 191 articles wereincluded in the literature, involving a total of 149 acupoints and a total of 2139 points. Among them, the top fiveacupoints in the point frequency were Sanyinjiao (143 times), Shenmen (139 times), Baihui (120 times), Neiguan (115 times), and Taichong (107 times) . The first five points are Shenmen-Sanyinjiao (120 times), Neiguan-Sanyinjiao (98 times), Neiguan-Shenmen (96 times), Baihuo-Sanyinjiao (96 times), Baihui-Shenmen (91 times) and so on. The maincore prescriptions are Sanyinjiao, Shenmen, Baihui, Neiguan, Taichong, Xinshu, Taixi, Zusanli, Si shencong, Pi shu, andAn mian. The secondary core prescriptions are Fenglong, Shen shu, Yin tang, Gan shu, Dan shu, Fengchi, Zhong wan, Shenting, Zhaohai, Da ling, and others. Using the Ancient and Modern Medical Cloud Platform (V1.4) to analyze thedata, the clinical study of acupuncture and moxibustion for insomnia is illustrated with charts, thus visibility is enhanced, and it is easier to understand. It can guide clinical practice, but remember to consider specific clinical conditions.
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Objective This paper explores the application effects of the teaching mode of"Problem-based Learning (PBL)" in Chinese internal medicine teaching. Methods 73 students from the major of traditional Chinese medicine from the First Clinical Medical College of Shandong University of Traditional Chinese Medicine are divided into observation group(36)and control group(37)with the random number table. Two different teaching methods, i.e., PBL and LBL (Lecture Based Learning), are employed to carry out prospective and randomized controlled study at parallel level, and then questionnaire are used to evaluate the teaching effects. Results The average scores of the observation group are high than those of the controlled group in the following aspects:the active classroom atmosphere(3.5 ± 0.6 vs.3.2 ± 0.6,t=2.275),improving classroom attention(3.6 ± 0.6 vs.3.2 ± 0.7,t=2.778),benefiting to the grasping of knowledge(3.5 ± 0.6 vs.3.0 ± 0.6,t=2.818), improving the self-taught ability(3.6 ± 0.6 vs.3.0 ± 1.1,t=2.935),improving the ability of analyzing problems(3.7 ± 0.5 vs. 3.1 ± 1.0, t=3.072), improving TCM thinking ability (3.5 ± 0.6 vs. 3.1 ± 0.9, t=2.431), enhancing the cooperative ability(3.6 ± 0.6 vs.3.0 ± 1.0,t=3.049),improving the communication ability(3.7 ± 0.5 vs.3.0 ± 1.0, t=3.864)and improving the innovation consciousness(3.2 ± 0.7 vs.2.7 ± 0.9,t=2.423)(P<0.05 or P<0.01).The score of the comprehensive evaluation of the questionnaire in the observation group are higher than that in the controlled group (P<0.01). Conclusions PBL teaching method has remarkable advantages over LBL teaching method in training the knowledge, ability and quality of students, as well as the overall teaching effect.
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Objective To explore the rule of acupoints selection of acupuncture and moxibustion in treating Alzheimer disease based on TCM Knowledge Service and Sharing System (V1.2.8); To provide references for the clinic. Methods Literature about acupuncture and moxibustion for the treatment of Alzheimer disease in CNKI, Choingqing Weipu, Wanfang database, and CBM from 1st January, 1996 to 1st January, 2016 was searched. Excel2007 was used to establish database and enter into TCM Knowledge Service and Sharing System (V1.2.8). The data were analyzed by data mining method such as frequency analysis, association rule analysis, point-to-pair analysis and core prescription analysis. Results After screening, 125 acupuncture prescriptions were included, involving 108 acupoints and 998 total acupoints selection frequency. Baihui had the highest frequency (78 times, 62.40％). The core acupoint combinations were Zusanli-Baihui, Zusanli-Sanyinjiao, and Baihui-Sishencong. The main core prescription was Bauhui, Zusanli, Sishencong, Shenmen, Taixi, Sanyinjiao, Neiguan, Taichong, Fenglong, Dazhui, Fengchi, Shenshu, Shenting, Xuanzhong. The second core prescription was Hegu, Yintang, Tanzhong, Xuehai, Geshu, Ganshu, Pishu, Qihai, Yanglingyuan, and Shangxing. Conclusion The rules of acupoints selection analyzed by TCM Knowledge Service and Sharing System (V1.2.8) for Alzheimer disease can be used to guide clinical application, but with modification according to symptoms.
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Objective To investigate the efficacy and safety of sirolimus 0.1% ointment in the treatment of facial angiofibromas in children with tuberous sclerosis complex. Methods Sirolimus 0.1% ointment was prepared. Twenty children with tuberous sclerosis complex who had facial angiofibromas were enrolled in this study. Facial angiofibromas were topically treated with the self?prepared sirolimus 0.1% ointment twice a day for 12 weeks. The facial angiofibroma severity index(FASI)was calculated, the degree of satisfaction with the treatment was evaluated, and adverse reactions were analyzed at weeks 4 and 12. Plasma sirolimus concentrations as well as blood biochemical and immunological parameters were measured, blood coagulation activity was evaluated, and routine blood tests as well as urine tests were performed at baseline and week 12. Results The FASI of patients significantly decreased at weeks 4(4.400 ± 1.284)and 12(2.975 ± 1.543)compared with that at baseline(5.750 ± 1.175, both P<0.000 1), and was significantly lower at week 12 than at week 4(P < 0.000 1). The efficacy index was 49.87% ± 22.08% at week 12, significantly higher than that at week 4(24.43%± 10.18%, t=7.338, P<0.01). The color, size and number of lesions significantly decreased in all the patients, and facial angiofibromas completely disappeared in 2 patients at week 12. At week 4, 10 parents were satisfied with the improvement of erythema, 3 parents with that of lesion volume, and 3 parents with that of lesion area. The degree of parent satisfaction increased at week 12 in all the cases. The blood concentration of sirolimus was lower than 1.0μg/L both before and after the treatment. No severe systemic or local adverse reactions were noted in these patients. Conclusion Sirolimus 0.1%ointment is markedly effective and safe for the treatment of facial angiofibromas in patients with tuberous sclerosis complex.
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A 13-year-old girl presented with multiple recurrent cutaneous plaques for more than six months,which had been aggravated with intermittent fever for five months.No obvious systemic abnormality was found.Dermatological examination revealed multiple,non-ulcerative,painless,infiltrative,indurated,poorly marginated,purple subcutaneous plaques measuring 3-1 1 cm in diameter with slight squamation in bilateral buttocks and lower limbs.Laboratory investigations showed bicytopenia with the white blood cell count being (0.03-3.7) × 109/L and red blood cell count being (2.8-4.4) × 1012/L,a normal platelet count,hypofibrinogenemia (1.79 g/L) and low proportion of natural killer cells (4.6％).Bone marrow smear showed active proliferation of cells,decreased proportion of granulocytes,presence of a few indefinitely classified cells,and phagocytosis.Reticulocytes were easily seen in the bone marrow smear.Pathologically,no obvious abnormality was observed in the epidermis or dermis,while the subcutaneous adipose tissue,especially fat lobules and some interlobular septa,was extensively infiltrated by large-to medium-sized lymphoid cells with pleomorphic and twisted nuclei as well as a small amount of cytoplasm; necrosis and phagocytosis of nuclear debris and lymphocytes were visible.The atypical lymphoid cells stained positive for CD3,T-cell intracellular antigen-1,granzyme B and TCRγδ with partial loss of CD5 and CD7,but negative for CD56,CD4,CD8 and TCRαβ.No Epstein-Barr virus-encoded RNA (EBER) was detected by in situ hybridization.Based on these findings,a diagnosis of primary cutaneous γδ-T cell lymphoma with hemophagocytic syndrome was made.