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Chinese Expert Proposal on the Diagnosis and Management of Pemphigus Vulgaris (2020)

International Journal of Dermatology and Venereology 2020年第3期3卷 148-155页

作者： Ya-Gang Zuo Li Li Jin-Bo Chen Liu-Qing Chen Su-Ying Feng Wei Li Xiao-Qun Luo Meng Pan Gang Wang Ting Xiao Bao-Qi Yang Kang Zeng Gui-Ying Zhang Hong-Zhong Jin Dermatology Branch of China,International Exchange and Promotion Association for Medical and Healthcare Department of Dermatology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Dermatology Wuhan No.1 HospitalWuhanHubei 430022China Department of Dermatology Hospital for Skin Diseases(Institute of Dermatology)Chinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingJiangsu 210042China Department of Dermatology West China Hospital of Sichuan UniversityChengduSichuan 610041China Department of Dermatology Huashan Hospital Affiliated to Fudan UniversityShanghai 200040China Department of Dermatology Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical CollegeShanghai 310000China Department of Dermatology Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Dermatology The First Hospital of China Medical UniversityShenyangLiaoning 110001China Department of Dermatology Shandong Provincial Dermatology HospitalJinanShandong 250022China Department of Dermatology Southern Hospital of Southern Medical UniversityGuangzhouGuangdong 510515China Department of Dermatology Xiangya Second Hospital of Central South UniversityChangshaHunan 410011China 不详

Pemphigus vulgaris(PV)is a life-threatening autoimmune bullous disease that causes blisters and erosions on the skin and mucous membranes to standardize the diagnosis and treatment of PV,Chinese experts in this field were invited to make recommendations which are presented in this *** vulgaris can be divided into cutaneous mucous type,cutaneous type and mucous mucous dominant type according to the different clinical *** pathological manifestations of PV are acantholysis above the basal *** diagnosis of PV and the assessment of the severity of the disease are made in accordance with the clinical manifestations,histopathological features,immunofluorescence assay results,and detection of pathogenic serum *** first-line treatment of PV comprises systemic *** combination with immunosuppressive agents or rituximab is recommended for moderate and severe *** immunoglobulin administration is recommended for patients being treated with *** exchange and stem cell transplantation can be performed if *** the course of therapy,the disease activity should be closely monitored,and actions should be taken to prevent adverse reactions.

关键词： pemphigus proposal diagnosis management

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Management of autoimmune hepatitis:Focus on pharmacologic treatments beyond corticosteroids

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World Journal of Hepatology 2014年第6期6卷 410-418页

作者： Marta Casal Moura Rodrigo Liberal Hélder Cardoso Ana Maria Horta e Vale Guilherme Macedo Servico de Medicina Interna Centro Hospitalar de Sao JoaoE.P.E.Porto 4200-319Portugal Faculdade de Medicina da Universidade do Porto Hernani MonteiroPorto 4200-319Portugal Paediatric Liver Centre and institute of Liver Studies King’s College London School of Medicine at King’s College HospitalLondon SE5 9RSUnited Kingdom Guilherme Macedo Servico de GastrenterologiaCentro Hospitalar de Sao JoaoE.P.E.Porto 4202-451Portugal

In autoimmune hepatitis, patients who are intolerant or with toxicity experience, non-responders, relapsers or refractory are challenging. Non-standard drugs are being tried to preemptively avoid corticosteroid-related side effects. Prognosis and quality of life of life rely on treatment optimization. Recently, emergence of powerful immunosuppressive agents, mainly from liver transplantation, challenged the supremacy of the corticosteroid regime and promise greater immunosuppression than conventional medications, offer site-specific actions and satisfactory patient tolerance. Successes in experimental models of related diseases have primed these molecular interventions. We performed a literature review on alternative treatments. Azatioprine intolerance is the principal indication for mycophenolate use butit can be used as a front-line therapy. Cyclosporine A and tacrolimus have been tested for non-responders or relapsers. Rituximab may be used as salvage therapy. Anti-tumor necrosis factor-alpha agents may be used for incomplete responses or non-responders. Methotrexate is possibly an alternative for induction of remission and maintenance in refractory patients. Cyclophosphamide has been included in the induction regimen with corticosteroids. Ursodeoxycholic acid action is mainly immunomodulatory. Non-standard treatments are coming slowly to the attention, but its use should be cautious performed by experienced centers.

关键词： Autoimmune hepatitis Pharmacologic nonstandard treatment Immunosuppression Azathioprine intolerance Difficult-to-treat patients Salvage therapy

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Management of adult Langerhans cell histiocytosis based on the characteristic clinical features

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World Journal of Hematology 2013年第3期2卷 89-98页

作者： Shinsaku Imashuku Chihiro Shimazaki Arinobu Tojo Toshihiko Imamura Akira Morimoto Division of Hematology Takasago-seibu HospitalTakasago 676-0812Japan the NPO for Japan Langerhans Cell Histiocytosis Study Group Kyoto 602-8566Japan Division of Hematology Social Insurance Kyoto HospitalKyoto 603-8151Japan Division of Stem Cell Therapy Center for Stem Cell Biology and Regenerative Medicinethe Institute of Medical Sciencethe University of TokyoTokyo 108-8639Japan Department of Pediatrics Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyoto 602-8566Japan Department of Pediatrics Jichi Medical University School of MedicineShimotsuke 329-0498Japan

To find out the most appropriate management,clinical features of 18 cases of adult multisystem langerhans cell histiocytosis(LCH) have been analyzed. The patients comprising of 9 males and 9 females were median age of 36 years,ranging from 18-53 years at diagnosis. Regarding the initial symptoms,7 patients(2 males and 5 females) showed central diabetes insipidus(CDI) and other endocrine symptoms with thickened pituitary stalk or a mass at the hypothalamic region. Additional 2 patients initiated the disease with CDI with no immediate diagnosis. In the remaining patients,the diseasebegun with single(n = 3) or multiple(n = 1) spinal bone lesion(s) in 4 patients(all males),with multiple bone lesions in 3 patients(1 male and 2 females),with single skull lesion in one female patient and with ambiguous symptoms including hypothyroidism in the remaining one male patient. We also recognized the correlation between pregnancy/childbirth and LCH in 4 patients. In terms of treatment,9 patients received systemic immuno-chemotherapy alone,of which the majority received vinblastine-based chemotherapy while 4 received 2-chlorodeoxyadenosine. Five had a combination of immuno-chemotherapy with surgical resection or radiotherapy,2 had immunotherapy alone,2 had surgical resection followed by observation alone to date. Three patients received hematopoietic stem cell transplantation after extensive chemotherapy. In terms of outcome,15 patients are alive(9 with active disease,6 without active disease),with a median of 66 mo(range 17-166 mo),two died of disease while the remaining 1 lost to follow-up. Based on these results,we think that early diagnosis and rapid introduction of appropriate treatment are essential,in order to overcome the problems relevant to adult LCH.

关键词： Langerhans cell histiocytosis Adult Immuno-chemotherapy 2-chlorodeoxyadenosine Childbirth

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Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review

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Chinese Journal of Traumatology 2019年第1期22卷 1-11页

作者： Yang Li Pei-Yuan Li Shi-Jing Sun Yuan-Zhang Yao Zhan-Fei Li Tao Liu Fan Yang Lian-Yang Zhang Xiang-Jun Bai Jing-Shan Huo Wu-Bing He Jun Ouyang Lei Peng Ping Hu Yan-An Zhu Ping Jin Qi-Feng Shao Yan-Feng Wang Rui-Wu Dai Pei-Yang Hu Hai-Ming Chen Ge-Fei Wang Yong-Gao Wang Hong-Xu Jin Chang-Ju Zhu Qi-Yong Zhang Biao Shao Xi-Guang Sang Chang-Lin Yin Trauma Center of PLA State Key Laboratory of Trauma Bums and Combined Injury Institute of Surgery Research Doping Hospital Third Military Medical University Chongqing China Ninth People's Hospital of Zhengzhou Zhengzhou China Zhongnan Hospital of Wuhan University Wuhan China Chengdu Military General Hospital ChengduChina Tiantai County People's Hospital Tiantai Zhejiang China The First Affiliated Hospital of Nanchang University Nanchang China Department of Surgery Jinling Hospital Medical School of Nanjing University Nanjing China Department of Surgery The First Affiliated Hospital of Zhejiang Chinese Medical University Hangzhou China Shenyang Military General Hospital Shenyang China The First Affiliated Hospital of Zhengzhou University Zhengzhou China The Affiliated Hospital of Guizhou Medical University Guiyang China Trauma Center/Department of Emergency and Trauma Surgery Tongji Hospital of Tongji Medical College Huazhong University of Science & Technology Wuhan China The First People's Hospital of Kunming Kunming China Qilu Hospital of Shandong University Jinan China The First Affiliated Hospital of Third Military Medical University Chongqing China Foshan Hospital of Traditional Chinese Medicine Foshan Guangzhou Province China Fujian Provincial Hospital Fuzhou China Emergency Surgery of the First Affiliated Hospital Shihezi University School of Medicine Shihezi Xinjiang Autonomous Region China The First Affiliated Hospital of Hainan Medical University Haikou China Chongqing Emergency Medical Center Chongqing China Taizhou Hospital of Zhejiang Province Taizhou Zhejiang Province China Yuyao People's Hospital of Zhejiang Province Yuyao Zhejiang Province China

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chin ese Trauma Surge on Associati on orga nized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal *** questions regarding the use of VSD in abdominal surgeries were addressed:(1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions?(2) Can VSD be preventively used for a high-risk abdominal incision w让h primary suture?(3) Can VSD be used in severely contaminated/infected abdominal surgical sites?(4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome?(5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage?(6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula?(7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess?(8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects?(9) Does VSD in crease the risk of bleeding?(10) Does VSD increase the risk of intestinal wail injury?(11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

关键词： Guideline Vacuum sealing drainage Abdominal surgery

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