Low dose oral glucocorticoid therapy in lichen planus: A retrospective cohort study

Background: There are various topical and systemic treatment options for the management of lichen planus. However, it is often difficult to achieve long-term disease control and many of the common therapies may be associated with unwanted side effects. Aims: To evaluate the effectiveness of 8 mg oral methylprednisolone administered daily in lichen planus by the analysis of medical records. Methods: In this retrospective cohort study, we compared the rates of improvement between two groups of patients. The first group received 8 mg oral methylprednisolone daily for at least one month. In the second group, patients with similar parameters to the first group (age, sex, disease manifestation) but without systemic glucocorticoid therapy were included. Fisher’s exact test was used to compare the rates of remission in the two groups. Results: In the daily oral methylprednisolone (n = 24) and no systemic corticosteroids (n = 16) groups, 23 (95.8%) and 6 (37.5%) patients achieved partial or complete remission, respectively. The frequency of improvement was significantly higher in patients who received oral methylprednisolone (P < 0.0001). Limitations: Limitations of this study include its retrospective design and the relatively small sample size. Conclusion: Low dose oral glucocorticoid therapy may be an effective option for the systemic treatment of lichen planus. Based on our results and previous studies, instead of higher doses, longer therapy duration with low doses should be considered.

Advances in surgical treatment of hilar cholangiocarcinoma / 中华肝胆外科杂志

Hilar cholangiocarcinoma (HCCA) is the most common type of cholangiocarcinoma, with in sidious onset and a high degree of malignancy, and there are often lymph node metastasis and vascular invasion. R 0 resection by surgery is still the main treatment for cure. This article reviews the hot issues and their related advances in surgical treatment of hilar cholangiocarcinoma, including preoperative evaluation, surgical treatment and systematic treatment.

Chinese expert guidance on overall application of lenvatinib in hepatocellular carcinoma / 中华消化外科杂志

Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4,2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.

Efficacy and safety of anti-PD-1 monoclonal antibody in advanced hepatocellular carcinoma after TACE combined with TKI therapy / 中华内科杂志

Objective:To evaluate the efficacy and safety of anti-programmed cell death 1 (PD-1) receptor monoclonal antibody (MoAb) in patients with advanced hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemoembolization (TACE) combined with tyrosine kinase inhibitor (TKI).Methods:From February 2019 to February 2020, 56 HCC patients who relapsed after TACE-TKI treatment in Department of Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University were enrolled. All patients received anti-PD-1 MoAb (sintilimab injection) and followed up every 6 weeks. According to mRECIST, the curative effect was evaluated as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). Objective response rate (ORR) and disease control rate (DCR), progression-free survival (PFS) and treatment-related adverse events (TRAEs) were recorded. Univariate analysis by Chi-square test and binary logistic regression model was used to determine the influencing factors of DCR. The Kaplan-Meier method and Cox proportional hazard regression model were used to analyze the survival data.Results:A total of 48 patients were enrolled in this study including 42 males and 6 females, with a median age of 55 years (29-71 years). ECOG scores comprised of 0 in 24 cases, 1-2 in 24 cases. Thirty-six patients were in Child-Pugh grade A of liver function and 12 cases were grade B. The median follow-up time was 4.5 months. There were 2 patients achieved CR, 12 patients with PR and 16 with SD. ORR was 29.2%, DCR was 62.5%. The independent influencing factors of DCR was ECOG score and AFP level ( P=0.031, P=0.012). Median PFS was 4.1 months (95% CI 2.7-5.4 months), and ECOG score was the independent influencing factor of PFS ( P=0.042). Treatment-related adverse events were reported in 70.8% (34/48) patients. Incidence of grade Ⅲ-Ⅳ TRAEs was 22.9% (11/48). Conclusion:In patients with HCC who relapse from TACE and TKI treatment, anti-PD-1 monoclonal antibody is efficacious safe especially in those with ECOG 0 score.

Psoriasis severa en paciente con infeccion latente por tuberculosis (ltbi). estrategia terapeutica / Severe psoriasis in a patient with latent tuberculosis infection (ltbi). therapeutic strategy

RESUMEN La psoriasis es una enfermedad inflamatoria sistémica crónica, de base genética y mediada inmunológicamente. En esta oportunidad, se reporta un caso en paciente mujer de 66 años con diagnóstico de psoriasis en placa moderada a severa sin respuesta clínica favorable a diversos tratamientos tópicos y sistémicos, cursando de manera concomitante con infección latente por tuberculosis (LTBI). Se decide como estrategia terapéutica tratamiento sistémico con biológico (Secukinumab). Teniendo en cuenta la importancia de la correcta evaluación respecto a la posibilidad de Tuberculosis (TBC) debido a que representa un desafío mundial actual en la prescripción de biológicos.

ABSTRACT Psoriasis is a chronic systemic inflammatory disease, genetically based and immunologically mediated. This time, a case is reported in a 66-year-old female patient with a diagnosis of moderate to severe plaque psoriasis with no favorable clinical response to various topical and systemic treatments, concurrently presenting with latent tuberculosis infection (LTBI). Biological systemic treatment (Secukinumab) was decided as a therapeutic strategy. Taking into account the importance of the correct evaluation regarding the possibility of Tuberculosis (TBC) because it represents a current global challenge in prescribing biologicals.

El tratamiento intralesional de Leishmaniasis cutánea es seguro frente al riesgo de complicaciones mucosas? / Is the intralesional treatment of cutaneous Leishmaniasis safe against the risk of mucosal complications?

OBJETIVO: evaluar la seguridad a largo plazo frente al riesgo de complicaciones mucosas del uso intralesional de antimoniales pentavalentes en pacientes con leishmaniasis cutánea comparado con el uso sistémico de los mismos. MÉTODOS: estudio observacional, cuantitativo de tipo longitudinal retrospectivo. Se analizó un total de 66 registros clínicos de pacientes, con diagnóstico de Leishmaniasis cutánea del parque Isiboro Secure durante el periodo 2012 a 2016. Se evaluó un total de 46 tratamientos sistémicos y 20 intralesionales. RESULTADOS: la evaluación clínica realizada entre 4 y 7 años posteriores a la cicatrización de las lesiones cutáneas de Leishmaniasis mostró la ausencia de desarrollo de lesiones mucosas. Así mismo no se reportó fallas terapéuticas, recidivas ni efectos adversos a corto plazo. CONCLUSIONES: el tratamiento intralesional fue seguro y eficaz a largo plazo y es una opción confiable para el tratamiento de leishmaniasis cutánea evitando las complicaciones futuras de la enfermedad.

OBJECTIVE: to assess the long-term safety against the risk of mucosal complications of intralesional pentavalent antimonials (PA) in patients with cutaneous Leishmaniasis compared to the systemic use of PA. METHODS: retrospective longitudinal quantitative observational study. A total of 66 clinical records of patients diagnosed with cutaneous Leishmaniasis in Isiboro Secure Park were analyzed between 2012 and 2016. A total of 46 systemic and 20 intralesional treatments were evaluated. RESULTS: clinical evaluation 4-7 years after healing of Leishmaniasis skin lesions showed no development of mucosal lesions. Likewise, no therapeutic failures, relapses or short-term adverse effects were reported. CONCLUSIONS: intralesional treatment was safe and effective in the long term and is a reliable option for the treatment of cutaneous Leishmaniasis avoiding the future complications of the disease.

Diagnosis and treatment experience of granulomatous cheilitis: case report and literature review / 口腔疾病防治

Objective@#To investigate the etiology, diagnosis and treatment of granulomatous cheilitis（GC）.@*Methods@# For a patient with recurrent granulomatous cheilitis for more than 1 year in whom no medical treatment was used, only systemic treatment of the teeth was performed, and its efficacy was observed. We also reviewed the relevant literature. @*Results@#The vermilion of the right lower lip of the patient was obviously swollen and soft. There was rebound and no pitting edema with palpation. A large dark red rash with local desquamation was observed on the skin over the right mandible. There were residual roots in tooth 35, 46, and 47, a porcelain bridge on 11-24, deep caries in 15, 16, 26, and 36, and many calculi in the whole mouth, and the gingival margin was obviously congested and swollen. Histopathological examination showed many lymphocytes infiltrated the superficial dermis, and granulation tissue, plasma cells and eosinophils infiltrated locally. The diagnosis was as follows: ① GC; ② 35, 46, and 47 residual roots; ③ 15, 16, 26, and 36 deep caries; ④ gingivitis. The treatment included extraction of 35, 46, and 47 residual roots, periodontal basic treatment, and fillings for 15, 16, 26, and 36. No drugs were administered except for 3 days after tooth extraction. After 5 weeks of treatment, the swelling of the lower lip and the skin rash completely disappeared. There was no recurrence in the follow-up observation at six months. Through a literature review and analysis, we found that GC may be related to various factors such as immunity, infection, and genetics. Local oral infections may be closely related to the incidence of GC.@*Conclusion @#Resolution of local oral infections is effective for the treatment of granulomatous cheilitis, and local oral infections may be closely related to the onset of granulomatous cheilitis. In the treatment of granulomatous cheilitis, attention should be paid to the systematic examination of the oral condition, and the treatment of suspected lesions in the oral cavity should begin in the early stages of treatment.

Medullary thyroid carcinoma - Adverse events during systemic treatment: risk-benefit ratio

ABSTRACT Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from parafollicular C cells of the thyroid and associated with mutations in the proto-oncogene REarranged during Transfection (RET). The prognosis of MTC depends on clinical stage, with a 95.6% 10-year survival rate among patients with localized disease and 40% among patients with advanced disease. Standard chemotherapy and radiotherapy have no significant impact on the overall survival of these patients and two tyrosine kinase receptor inhibitors (TKIs), vandetanib and cabozantinib, have been recently approved for the systemic treatment of locally advanced or metastatic MTC. However, since patients with MTC and residual or recurrent disease may have an indolent course with no need for systemic treatment, and since these drugs are highly toxic, it is extremely important to select the patients who will receive these drugs in a correct manner. It is also essential to carefully monitor patients using TKI regarding possible adverse effects, which should be properly managed when occurring.

Challenges and strategies in the diagnosis and treatment of pancreatic cancer / 中华消化外科杂志

Pancreatic cancer is an aggressive malignant gastrointestinal tumor,surgical resection offers the only chance of cure. Due to its anatomic and biological characters,early stage pancreatic cancer is usually clinically silent,80％-85％ of patients present with advanced unresectable disease. Furthermore,pancreatic cancer responds poorly to most radiochemotherapeutic agents.In this article,we discuss some clinical aspects including early diagnosis,preoperative systemic assessment,surgery and perioperartive adjuvant therapy,and we hope to find the challenges as well as strategies for pancreatic cancer in order to further improve the current level of diagnosis and treatment in China.

The Clinical Characteristics of Facial Herpes Zoster in Korean Patients

PURPOSE: To investigate the clinical characteristics of Korean patients with facial herpes zoster. METHODS: The present study enrolled patients with facial involvement among the patients with herpes zoster. The percentage of involved branches of the trigeminal nerve, types and frequency of ocular complications, and changes in visual acuity depending on systemic treatment were analyzed. RESULTS: A total of 146 patients (15.9%) out of 916 patients with herpes zoster were diagnosed with facial herpes zoster. The ophthalmic branch was the most frequently involved (55.5%), and coinfection with the ophthalmic and maxillary branch was also common (31.5%). Ocular complications developed in 82 eyes (56.2%) and were most common in the group of coinfection with the ophthalmic and maxillary branch (Fisher's exact test, p=0.003). Conjunctivitis (72.0%) was the most commonly observed ocular complication, while punctate keratitis and endothelitis were also frequent. After treatment with a systemic antiviral agent, visual acuity was significantly improved (paired t test, p=0.001). CONCLUSIONS: A higher incidence of ophthalmic complications was observed in facial herpes zoster patients with a wider area of involvement, including the ophthalmic branch. There was significant improvement of visual acuity and ocular complications after systemic treatment. Therefore, systemic antiviral treatment should be considered when a broad herpes zoster skin lesion is observed.

Terapia anti-angiogénica en el manejo del cáncer renal de células claras metastásico / Antiangiogenic therapy in metastatic clear cell renal cancer

Con la aparición de la terapia anti-angiogénica hace algunos años y dado a sus promisorios resultados en el manejo del cáncer renal metastático, nuestra intención es presentar una puesta al día sobre este tema, realizando para tal efecto una revisión bibliográfica completa de los trabajos mas relevantes usando como fuente la base de datos PUBMED (1996-2007) sobre la terapia antiangiogenica en el manejo del cáncer renal metastásico. El siguiente artículo hace hincapié sobre la fisiopatología de la génesis del cáncer renal y de la acción de los agentes anti-angiogénicos, los resultados de las series clínicas publicadas, las características de los agentes anti-angiogénicos y algunos enfoques terapéuticos en los cuales podrían tener un rol en el futuro.

We present an update of the molecular targeted therapy in advanced renal cell carcinoma due to their promising results. We make a complete revision in PUBMED database (1996-2007) of the most relevant studies in molecular targeted therapy for the management of metastasis renal cell carcinoma. The emphasis was done in the physiopathology of renal cell carcinoma and molecular targeted therapy, the results of clinical trials, the characteristics of these drugs and their role in future directions.

Pharmacologic Treatment of Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory pruritic skin disease that affects a large number of children and adults in Korea. The treatment of AD requires a comprehensive approach that includes evaluation of potential triggers and education of the patients and family members regarding proper avoidance measures. Because existing remedies for AD do not cure the disorder itself, a program of disease control and management should be pursued. Topical corticosteroids are the effective and relatively safe therapy for patients with AD, but prolonged usage can result in skin atrophy and other side-effects. The topical calcineurin inhibitors such as pimecrolimus and tacrolimus allow a steroid-free, anti-inflammatory topical therapy of AD. Occasionally, however, children afflicted with severe AD require more intensive therapies (e.g., ultraviolet light exposure systemic corticosteroids, and cyclosporine) that need close monitoring. This review focuses on the current guidelines of managing AD regarding the efficacy and safety of several pharmacologic options. Management strategies discussed include topical corticosteroids, topical calcineurin inhibitors, antihistamines and anti-infectives. A management algorithm is also presented.