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Patch testing and cross sensitivity study of adverse cutaneous drug reactions due to anticonvulsants: A preliminary report

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World Journal of Methodology 2017年第1期7卷 25-32页

作者： TN Shiny Vikram K Mahajan Karaninder S Mehta Pushpinder S Chauhan Ritu Rawat Rajni Sharma department of der-matology Venereology and LeprosyDr.R.P.Govt. Medical College

AIM To evaluate the utility of patch test and cross-sensitivity patterns in patients with adverse cutaneous drug reactions(ACDR) from common anticonvulsants. METHODS Twenty-four(M:F = 13:11) patients aged 18-75 years with ACDR from anticonvulsants were patch tested 3-27 mo after complete recovery using carbamazepine, phenytoin, phenobarbitone, lamotrigine, and sodium valproate in 10%, 20% and 30% conc. in pet. after informed consent. Positive reactions persisting on D3 and D4 were considered significant. RESULTS Clinical patterns were exanthematous drug rash with or without systemic involvement(DRESS) in 18(75%), Stevens-Johnsons syndrome/toxic epidermal necrolysis(SJS/TEN) overlap and TEN in 2(8.3%) patients each, SJS and lichenoid drug eruption in 1(4.2%) patient each, respectively. The implicated drugs were phenytoin in 14(58.3%), carbamazepine in 9(37.5%), phenobarbitone in 2(8.3%), and lamotrigine in 1(4.7%) patients,respectively. Twelve(50%) patients elicited positive reactions to implicated drugs; carbamazepine in 6(50%), phenytoin alone in 4(33.3%), phenobarbitone alone in 1(8.3%), and both phenytoin and phenobarbitone in 1(8.33%) patients, respectively. Cross-reactions occurred in 11(92%) patients. Six patients with carbamazepine positive patch test reaction showed cross sensitivity with phenobarbitone, sodium valproate and/or lamotrigine. Three(75%) patients among positive phenytoin patch test reactions had cross reactions with phenobarbitone, lamotrigine, and/or valproate. CONCLUSION Carbamazepine remains the commonest anticonvulsant causing ACDRs and cross-reactions with other anticonvulsants are possible. Drug patch testing appears useful in DRESS for drug imputability and cross-reactions established clinically.

关键词： Anticonvulsant hypersensitivity syndrome Carbamazepine Sodium valproate Drug rash with eosinophilia with or without systemic involvement Drug patch test Lamotrigine Phenobarbitone Phenytoin Stevens-Johnsons syndrome Toxic epidermal necrolysis

Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

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World Journal of Clinical Cases 2016年第7期4卷 181-186页

作者： Mehtap Evran Murat Sert Tamer Tetiker Gamze Akku? ?mer Sunkar Bi?er department of Internal Medicine Division of Endocrinology Cukurova University Medical Faculty University of Cukurova in Adana department of Orthopedics and Trau-matology Cukurova University Medical Faculty University of Cukurova in Adana

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients(one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.

关键词： Diabetes mellitus Foot ulcer Calcaneal fracture

“En bloc ” caudate lobe and inferior vena cava resection following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal and liver metastasis of colorectal cancer

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World Journal of Gastroenterology 2016年第46期22卷 10249-10253页

作者： Patricia Sánchez-Velázquez Nicolas Moosmann Ingolf T?pel Pompiliu Piso department of Surgery Barmherzige Brüder Krankenhaus Regensburg department of Oncology and Hematology Barmherzige Brüder Krankenhaus Regensburg department of Vascular Surgery Barmherzige Brüder Krankenhaus Regensburg

There are diverse protocols to manage patients with recurrent disease after primary cytoreductive surgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) for peritoneal carcinomatosis. We describe a case of metachronous liver metastasis after CRS and HIPEC for colorectal cancer, successfully treated with a selective metastectomy and partial graft of the inferior vena cava. A 35-year-old female presented with a large tumour in the cecum and consequent colonic stenosis. After an emergency right colectomy, the patient received adjuvant chemotherapy. One year later she was diagnosed with peritoneal carcinomatosis, and it was decided to carry out a CRS/HIPEC. After 2 years of total remission, an isolated metachronous liver metastasis was detected by magnetic resonance imaging surveillance. The patient underwent a third procedure including a caudate lobe and partial inferior vena cava resection with a prosthetic graft interposition, achieving an R0 situation. The postoperative course was uneventful and the patient was discharged on postoperative day 17 after the liver resection. At 18-mo follow-up after the liver resection the patient remained free of recurrence. In selected patients, the option of re-operation due to recurrent disease should be discussed. Even liver resection of a metachronous metastasis and an extended vascular resection are acceptable after CRS/HIPEC and can be considered as a potential treatment option to remove all macroscopic lesions.

关键词： Cytoreductive surgery Liver resection Hyperthermic intraperitoneal chemotherapy Colorectal cancer Liver metastasis

Serum procalcitonin and interleukin-6 levels may help to differentiate systemic inflammatory response of infectious and non-infectious origin

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Chinese Medical Journal 2003年第4期116卷 538-542页

作者：杜斌潘家绮陈德昌李毅 department of Critical Care Medicine Peking Union Medical College Hospital department of He matology Peking Union Medical College Hospital

To evaluate the efficacy of using procalcitonin (PCT) and interleukin-6 (IL-6) to differentiate sepsis from non-infectious systemic inflammatory response syndrome (SIRS) Methods We made a prospective study in a general intensive care unit at Peking Union Medical College Hospital Twenty patients with sepsis and 31 patients with non-infectious SIRS were enrolled in this study Serum concentrations of PCT, IL-6 and C-reactive protein (CRP) were determined within 24 h after clinical onset of sepsis or non-infectious SIRS Leukocyte count, percentage of neutrophils, and absolute neutrophil count, as well as maximal body temperature were also recorded Results Serum concentrations of PCT, IL-6, and CRP, as well as maximal body temperature, were significantly higher in septic patients [3 6 (1 8, 27 5) μg/L, 810±516 ng/L, 180±108 g/L, 38 6±1 2℃] than non-infectious SIRS patients [0 5 (0 2, 1 8) μg/L, 235±177 ng/L, 109±70 g/L, 37 9±0 9℃] IL-6 and PCT exhibited the best discriminative power between sepsis and non-infectious SIRS, with sensitivity above 80% and specificity above 70% A sepsis score with combination of IL-6 and PCT showed the best discriminative power with the area under the receiver operating characteristic curve of 0 923 Conclusions Assessing IL-6 and PCT levels are more reliable ways to differentiate sepsis from non-infectious SIRS, compared with conventional inflammatory parameters

关键词： sepsis systemic inflammatory response s yndrome procalcitonin interleukin-6 C-reactive protein

Cerebral venous sinus thrombosis after ChAdOx1 nCov- 19 vaccination with a misleading first cerebral MRI scan

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Stroke & Vascular Neurology 2021年第4期6卷 668-670页

作者： Benno Ikenberg Antonia Franziska Demleitner Thomas Thiele Benedikt Wiestler Katharina Götze Georg Mößmer Paul Lingor department of Neurology Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany Institut für Immunologie und Transfusionsmedizin Universitätsmedizin GreifswaldGreifswaldGermany department of Diagnostic und Interventional Neuroradiology Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany department of Medicine III Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany Institute for Clinical Chemistry and Pathobiochemistry Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany

SUMMARY Vaccine-induced immune thrombotic thrombocytopenia(VITT)and cerebral venous sinus thrombosis(CVST)have been recently described as rare complications following vaccination against SARS-CoV-2 with vector *** report a case of a young woman who presented with VITT and cerebral CVST 7 days following vaccination with ChAdOx1 nCov-19(AstraZeneca).While the initial MRI was considered void of pathological findings,MRI 3 days later revealed extensive CVST of the transversal and sigmoidal sinus with intracerebral *** tests including a platelet-factor-4-induced platelet activation assay confirmed the diagnosis of *** with intravenous immunoglobulins and argatroban resulted in a normalisation of platelet counts and remission of CVST.

关键词： vaccination cerebral venous

Beta-blocker treatment in heart failure patients with atrial fibrillation:challenges and perspectives

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Journal of Geriatric Cardiology 2021年第5期18卷 362-375页

作者： Emmanouil Chourdakis Ioanna Koniari Dimitrios Velissaris Grigorios Tsigkas Nikolaos G Kounis Neriman Osman Krankenhaus der Barmherzigen Brüder Trier Germany Manchester Heart Institute Manchester University Foundation TrustManchesterUnited Kingdom department of Internal Medicine University Hospital of PatrasPatrasGreece Cardiology department University Hospital of PatrasPatrasGreece

Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently *** classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midrange reduced EF(40%−49%,HFmrEF)and reduced EF(<40%,HFrEF)are crucial for optimising the therapeutic approach,as each subgroup responds *** constitute an important component of our pharmacological regimen for chronic *** administration is reccomended in patients with HF with reduced ejection fraction in stable sinus rhythm,due to improvement of symptoms,the better long termoutcome and *** beneficial role of betablocker use in patients with preserved EF still remain unclear,as no treatment showed a positive impact,regarding morbidity or mortality *** presence of AF in HF patients increases as the disease severity evolves and is associated with a higher rate of cardiovascular morbidity and *** more question is the use of betablocker in HF patients irrespective of EF and concomitant *** are many conflicting data and publications,regarding the beta blocker benefit in this ***,it is supported an attenuation of betablockers beneficial effect in HF patients with AF.A design of more randomised trials/studies with HF patients and concomitant AF may improve our clinical approach of betablockers use and identify the patients with HF,who mostly profit from an invasive approach.

关键词： treatment evolve mostly

Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation

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World Journal of Hepatology 2015年第11期7卷 1494-1508页

作者： Arno Kornberg department of Surgery Klinikum rechts der Isar Technical University

Shortage of appropriate donor grafts is the foremost current problem in organ transplantation. As a logical consequence, waiting times have extended and pretransplant mortality rates were significantly increasing. The implementation of a priority-based liver allocation system using the model of end-stage liverdisease(MELD) score helped to reduce waiting list mortality in liver transplantation(LT). However, due to an escalating organ scarcity, pre-LT MELD scores have significantly increased and liver recipients became more complex in recent years. This has finally led to posttransplant decreasing survival rates, attributed mainly to elevated rates of infectious and immunologic complications. To meet this challenging development, an increasing number of extended criteria donor grafts are currently accepted, which may, however, aggravate the patients' infectious and immunologic risk profiles. The administration of intravenous immunoglobulins(IVIg) is an established treatment in patients with immune deficiencies and other antibody-mediated diseases. In addition, IVIg was shown to be useful in treatment of several disorders caused by deterioration of the cellular immune system. It proved to be effective in preventing hyperacute rejection in highly sensitized kidney and heart transplants. In the liver transplant setting, the administration of specific Ig against hepatitis B virus is current standard in post-LT antiviral prophylaxis. The mechanisms of action of IVIg are complex and not fully understood. However, there is increasing experimental and clinical evidence that IVIg has an immuno-balancing impact by a combination of immuno-supporting and immuno-suppressive properties. It may be suggested that, especially in the context of a worsening organ shortage with all resulting clinical implications, liver transplant patients should benefit from immuno-regulatory capabilities of IVIg. In this review, perspectives of immune modulation by IVIg and impact on outcome in liver t

关键词： Intravenous immunoglobulins Immunemodulation Hyperimmunoglobulin Model of end-stageliver disease Liver transplantation

Monitoring machine learning models:a categorization of challenges and methods

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Data Science and Management 2022年第3期5卷 105-116页

作者： Tim Schröder Michael Schulz department of Computer Science Nordakademie Hochschule der WirtschaftVan-der-Smissen-Straße 9Hamburg22767Germany

The importance of software based on machine learning is growing rapidly,but the potential of prototypes may not be realized in *** study identified six categories of challenges for verification and validation of machine learning applications during ***,monitoring was analyzed as a possible solution to mitigate those *** relevant data and model metrics may reveal problems at an early stage,allowing for targeted *** study presents a taxonomy of methods and metrics currently addressed in scientific literature and compares these categories with case studies from practice.

关键词： Machine learning Monitoring Operations Taxonomy

Sequence architecture of a Jurassic ramp succession from Gebel Maghara(North Sinai,Egypt):Implications for eustasy

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Journal of Palaeogeography 2015年第3期4卷 305-330页

作者： Ahmed Awad Abdelhady Franz Theodor Fürsich Geology department Faculty of ScienceMinia University FG Pal?oumwelt Geozentrum Nordbayern der Universit?t Erlangen

The Jurassic succession at Gebet Maghara, North Sinai, Egypt, represents a mixed carbonate-siticictastic sequence. Combining information from both fossits and rocks attowed a ptausibte reconstruction of the depositionat environments and of the basin evotution. The Ju- rassic succession of Gebel Maghara was deposited on a ramp, and the architecture of the ramp facies was strongty controtted not onty by sea-revel changes but atso by extensionat tectonics in connection with rifting of the Tethys, North Gondwana. Seven tectonicalty modified thirdorder sequences （DS 1-DS 7） have been recognized. The first three sequences （DS 1-DS 3）, ranging from the Toarcian to the Bajocian, record sea invasion （intertidat to shattow subtida[lconditions） across an intracratonic area as a resutt of eustatic sea-fever changes during a quiescent rift stage. The remaining sequences （DS 4-DS 7） reflect open marine mid to outer ramp settings. Non-marine conditions around the Bajocian-Bathonian boundary, documented by catiche, represent the maximum regression of the sea. During an active extensionat stage, horsts, which formerty acted as barriers separating the Maghara sub-basin from the main ocean, subsided. Subsequent rejuvenation and reactivation of fautts shifted the homoctinat physiography of the ramp to a distatty steepened ramp during the earty Bathonian, creating a 200-m-thick dettaic wedge. SimiLar processes during the earty Kimmeridgian created a catcirudite-catcarenite succession of stope origin. The diversity and the epifaunat/infaunat percentage of the macrofauna disptay a cyctic pattern which coincides more or tess with the sequence stratigraphic architecture.

关键词： facies sequence stratigraphy ramp extensional basin Jurassic Gebel Maghara Egypt