Treatment-related Skin Toxicity Caused by Programmed Death-1 Inhibitor Nivolumab: A Case Report / 中国肺癌杂志

BACKGROUND@#Nivolumab is an checkpoint inhibitor combining with programmed death-1 (PD-1) receptor on T cells, which can block the interactions between PD-1 and programmed death ligands (PD-L), including PD-L1 and PD-L2. And then block the immunosuppression mediated by the PD-1 pathway. The aim of the study is to investigate the clinical manifestations, diagnosis, treatment and prognosis of treatment-related skin toxicity caused by PD-1 inhibitor Nivolumab.@*METHODS@#The clinical data of treatment-related skin toxicity caused by PD-1 inhibitor Nivolumab in a patient with advanced lung adenocarcinoma admitted to the Shanghai Chest Hospital was retrospectively analyzed. The diagnosis, treatment and prognosis of the patient were discussed.@*RESULTS@#The patient was a 60-year-old male presented with relapse after surgery and adjuvant postoperative chemotherapy for his lung carcinoma. The patient's condition still progressed after multiple chemotherapy, targeted therapy and local radiotherapy of bone metastasis. Then Nivolumab, a kind of PD-1 inhibitors, was given intravenously every 3 weeks with the average dosage 3 mg/kg. After one cycle of Nivolumab, the patient began to have skin rashes, which aggravated gradually. The patient's skin toxicity was alleviated after enough steroids and was controlled with tapering steroids slowly. Now the patient was still given oral steroids treatment. And the lung disease remained stable.@*CONCLUSIONS@#Immune-related skin toxicity associated with PD-1 inhibitor should be aware of; early detection, early treatment and the prognosis could be better. It is necessary to improve the understanding of Immune-related skin toxicity associated with PD-1 inhibitor, to diagnose and treat it early, and the prognosis could be better.

Advances on bacteria-associated hemophagocytic syndrome / 中国小儿急救医学

Bacteria-associated hemophagocytic syndrome( BAHS) is a rare and life-threatening he-matological system disease. Various bacteria can cause BAHS,but the prognosis is better than other types of hemophagocytic syndrome. This article described the etiology,pathogenies,diagnostic criteria,treatment and prognosis of BAHS,in order to raise awareness of the disease.

Preliminary study on elderly patients with ulcerative colitis in Shanghai / 中华消化杂志

Objective To investigate the clinical characteristics between elderly and non-elderly patients with ulcerative colitis (UC) in Shanghai, so as to improve the diagnosis and management of the disease. Methods The clinical and endoscopic data from 214 patients with UC,who were admitted to Shanghai Ruijin Hospital between 1998 and 2009,were retrospectively analyzed. The database was established and according to onset age,the patients were divided into elderly group (n= 28, ≥60 years of age) and non-elderly group (n = 128, ＜60 years of age), The comparisons between two groups were performed using Chi square test for non-quantitative variables, and student's t test and nonparametric tests for quantitative variables. Logistic regression was used to analyze the risk factor.Results Onset peak of UC was found in patients ranged from 40 to 49 years of age, and elderly patients were accounted for 13.08 % in Shanghai. There was no significant difference between two groups with respect to clinical manifestation, complications, Truelove and Witts criteria index, or endoscopic score. In active phase, elevated peripheral platelet counts were seen in more elderly patients than those in non-elderly patients (75% vs 29%, F= 4. 4, P= 0. 043). However, high level of peripheral platelet was found in non-elderly patients (Z= -2.6, P=0. 008). Endoscopic examination revealed that the colonic lesion in elderly patients was limited and was more common in left-sided colon and protosigmoid (F=5. 8, P = 0. 012). More non-elderly patients were treated with steroid in comparison to elderly patients with mild or severe UC (28. 6% vs 55.7%, F=7.7,P=0. 007). In addition, the high mortality was found in elderly patients when compared with non-elderly patients (20.8 % vs 2.84%, F= 12. 8, P = 0. 008). Conclusion The differences existed between elderly and non-elderly UC patients with respect to clinical manifestation, lab investigation, involved extent of colon, medication and prognosis.

The relation between classes and prognosis of the brainstem hemorrhage / 中国基层医药

Objective - To analyze the relation between classes and prognosis of the brain.stem hemorrhage.Methods 37 patients with spontaneous brainstem hemorrhage were divided into three groups according to con-sciousness and breathing function: Ⅰ group 13 cases with consciousness; Ⅱ group 11 cases without consciousness; Ⅲgroup 13 cases without consciousness and respiration, according to the classes, using different ways and means. Re-suits Ⅰ group 13 cases survival in 13 cases; Ⅱ group 10 cases survival and 1 case death in 11 cases; Ⅲ group 1 case survival and 12 cases death in 13 eases. Conclusion The classes of the brain.stem hemorrhage is propitious to select therapeutic measure and prognostic estimate. The intensive care and the surgery can reduce mortality rate.

Intellectual disability: definition, etiological factors, classification, diagnosis, treatment and prognosis

Etiology and classification: Causal factors related with cognitive disability are multiples and can be classified as follows: Genetic, acquired (congenital and developmental), environmental and sociocultural. Likewise, in relation to the classification, cognitive disability has as a common denominator a subnormal intellectual functioning level; nevertheless, the extent to which an individual is unable to face the demands established by society for the individual’s age group has brought about four degrees of severity: Mild, moderate, severe and profound. Diagnostic: The clinical history must put an emphasis on healthcare during the prenatal, perinatal and postnatal period and include the results of all previous studies, including a genealogical tree for at least three generations and an intentional search for family antecedents of mental delay, psychiatric illnesses and congenital abnormalities. The physical exam should focus on secondary abnormalities and congenital malformations, somatometric measurements and neurological and behavioral phenotype evaluations. If it is not feasible to establish a clinical diagnosis, it is necessary to conduct high-resolution cytogenetic studies in addition to metabolic clinical evaluations. In the next step, if no abnormal data are identified, submicroscopic chromosomal disorders are evaluated. Prognosis: Intellectual disability is not curable; and yet, the prognostic in general terms is good when using the emotional wellbeing of the individual as a parameter. Conclusions: Intellectual disability should be treated in a comprehensive manner. Nevertheless, currently, the fundamental task and perhaps the only one that applies is the detection of the limitation and abilities as a function of subjects’ age and expectations for the future, with the only goal being to provide the support necessary for each one of the dimensions or areas in which the person’s life is expressed and exposed.

Etiología y clasificación: múltiples factores causales están relacionados con la discapacidad cognoscitiva y pueden clasificarse de la siguiente manera: genéticos, adquiridos, (congénitos y de desarrollo), ambientales y socioculturales. Del mismo modo, en cuanto a la clasificación, la discapacidad cognoscitiva tiene como común denominador un nivel de funcionamiento intelectual por debajo de lo normal; sin embargo, la medida en que una persona es incapaz de afrontar las demandas establecidas por la sociedad para su grupo de edad ha dado origen a cuatro grados de severidad: ligera, moderada, severa y profunda. Diagnóstico: el historial clínico debe hacer énfasis en el cuidado de la salud durante el periodo prenatal, perinatal y postnatal e incluir los resultados de todos los estudios previos, incluyendo un árbol genealógico de al menos tres generaciones y una búsqueda intencional de antecedentes familiares de retraso mental, enfermedades psiquiátricas y anomalías congénitas. El examen físico debe concentrarse en anomalías secundarias y en malformaciones congénitas, mediciones somatométricas, y evaluaciones del fenotipo neurológico y conductual. Si no es posible establecer un diagnóstico clínico, se deben hacer estudios citogenéticos de alta resolución en adición a las evaluaciones clínicas metabólicas. Si no se identifican datos anormales, el siguiente paso consiste en la evaluación de trastornos cromosómicos submicroscópicos. Prognosis: la discapacidad intelectual no es curable, sin embargo el prognóstico es bueno en términos generales cuando se usa como parámetro el bienestar emocional del individuo. Conclusiones: el tratamiento para discapacidad intelectual requiere de un enfoque amplio. Sin embargo, la tarea principal y quizás la única que tiene aplicación es la detección de las limitaciones y habilidades en función de la edad y expectativas para el futuro de la persona, con el único fin de proporcionar el apoyo necesario para cada...

Collective Review of Cases of Spinal Metastases / 대한정형외과학회잡지

The authors have reviewed and analysed 238 cases of the apinal metastases. Those cases were treated from January, 1980 to December, 1986 at the department of orthopaedic surgery of Kosin medical center. Among these cases, 37 were received radiotherapy alone ; 10, surgery alone ; 9, combined treatment and the rest of 137 cases were treated symptomatically. In doing the surgical decompression, it was performed in an emergent basis, designed to minimize the progression of the neurologic dificit and to prevent the serious consequences. The effectiveness of the treatment was discussed. And our review concludes the followings : 1. The most frequent primary tumor is breast cancer in woman and lung cancer in man. A sex ratio is more frequent in woman, and peak age is 6th decade. An average survival time is longest in nasopharyngeal cancer(16.6 mos.). 2. The most frequent metastatic deposit is the thoracolumbar spine(28.57%). 3. The prognosis is best in the breast cancer(83.3%), and cervical involvement(66.7%). 4. The prognosis is good for cases with incomplete paraplegia, intact sphincter control, a long duration of pain and neurologic deficit, and the cases with cord compression of gradual onset. 5. The radiotheraphy is the most effective method of treatment.

Clinical Observation in the Primary Malignant Bone Tumors / 대한정형외과학회잡지

A total 73 cases of primary malignant bone tumors was reviewed and analysed clinically at the department of orthopaedic surgery, Kosin medicsl center, Pusan, Kores for 11 years from January, 1975 to December, 1985. The results were obtained as follows ; l. In the 73 cases of primsry malignant bone tumors, osteogenic sarcoma was the most common primary malignant bone tumor (57%) and followed by chondrossrcoma (10%), multiple myeloma (8%). 2. Average survival times according to each primary malignant bone tumors was more than 3 years in chondrosarcoma, reticulum cell sarcoma, and synovial sarcoma, 28 months in osteogenic sarcoma, and 7 months in Ewings sarcoma. Ewings sarcoma had the worse prognosis and the slowly progressing tumors-chondrosarcoma, reticulum cell sarcoma and synovial sarcoma are needed long term follow up. 3. In osteogenic sarcoma, the prognosis was better when developed in their 3rd decsde than when developed in their 2nd decade. 4. There is a slight difference in average survival time on the location of the site, for example when tumor is located in the distal femur, the prognosis was worst. 5. There is no difference in the prognosis. The mode of treatment did not effect to their prognosis. 6. It was clear that the tumors which had not been responded to chemotherapy or radiation therapy had poorer prognosis. Chondrosarcoma, fibrosarcoma and synovisl sarcoma were considered as slowly progressed tumors, and so it may be benefit to the patients that chemotherapy and/or radiotherapy were prescribed.