失去亲人的 CTCL 患者的家庭照护者经历Orlowska, D.; Selman, L.E.; Beynon, T.; Radcliffe, E.; Whittaker, S.; Child, F.; Harding, R.
doi: 10.1111/bjd.17172pmid: N/A
Summary皮肤 T‐细胞淋巴瘤 (CTCL) 是一种罕见的皮肤癌类型。皮肤可能会发生肿瘤或溃疡。有时这些肿瘤或溃疡可能会覆盖相当大的区域并让人感到发痒或不舒服。在更晚期的疾病中, 内部身体部位可能会受到影响。每年只有少数人得到诊断(每百万人中有 8 人), 因此大多数全科医生 (GP) 都不会遇到患有这种疾病的人。这项来自英国的研究旨在了解因此疾病死亡者的家人或亲密朋友的经历(并非所有患有这种疾病的人都死于此疾病)。11 例死亡的 CTCL 患者的亲属接受了访谈, 访谈是在患者死亡后 4 个月或更长时间以后进行的。对他们所说的主题进行了叙述。家庭成员生动地描述了疾病如何改变了他们亲属的外表。他们谈到了照顾皮肤受损的人是多么困难。他们描述了他们在医院和家中照顾亲人时必须做的许多不同的事情。一些患者经常进出医院。有的照护者期望他们每次都能回家,所以当他们的亲戚去世时他们感到毫无准备。一些照护者描述, 看到他们的亲属去世前疾病对其造成的影响是多么令人沮丧。作者认为,应该将家庭照护者视为照顾病人的护理团队的一部分。他们建议, 在每位患者患病期间, 应考虑照护者对实际和情感支持以及信息的需求。在亲属去世后也应提供对照护者的支持。
Experiences of bereaved family caregivers of patients with CTCLOrlowska, D.; Selman, L.E.; Beynon, T.; Radcliffe, E.; Whittaker, S.; Child, F.; Harding, R.
doi: 10.1111/bjd.17161pmid: N/A
SummaryCutaneous T‐cell lymphomas (CTCL) are rare types of skin cancer. Skin may develop tumours or ulcers. Sometimes these may cover quite large areas and feel itchy or uncomfortable. Internal body parts may be affected in more advanced disease. Only a few people are diagnosed each year (8 per million), so most GPs do not meet people with this disease. This study from the U.K. aimed to find out about the experiences of family or close friends of people who had died because of the disease (not all people with this disease die of it). Relatives of 11 patients with CTCL who had died were interviewed, four months or more after the death. The themes from what they said are described. Family members gave vivid descriptions of how the illness changed the appearance of their relative. They spoke of how difficult it was to look after someone with very damaged skin. They described the many different things they had to do to care for their relative both in hospital and at home. Some patients had frequently been in and out of hospital. Some caregivers expected them to come home each time and so had not felt prepared when their relative died. Several caregivers described how upsetting it was to see how illness affected their relative before they died. The authors say that family caregivers should be seen as part of the care team looking after the patient. They recommend that carers’ needs for practical and emotional support and information should be considered during each patient's illness. Support for carers should also be offered following the death of their relative.
Methotrexate activated Tregs via the CD73/AMPK/mTOR pathwayYan, K.; Xu, W.; Huang, Y.; Zhang, Z.; Huang, Q.; Xin, K.Z.; Ma, Y.; Han, L.
doi: 10.1111/bjd.17165pmid: N/A
SummaryPsoriasis is a common skin disease that affects about 2% to 3% of people. The cause is unknown and believed to involve the genes and immune system, and the treatments we use now can control psoriasis but do not cure it. This study, from China, aimed to find out the effect and mechanism (way of working) of a drug called methotrexate on cells called regulatory T cells, which have the power to fight back and calm down the skin, as well as its relationship with the pathway of a chemical in the body called adenosine, which is a target in psoriasis therapy. Regulatory T cells (and effector T cells, which can trigger psoriasis) were isolated from the blood of healthy people and patients with psoriasis. Various laboratory tests were used to examine the effect of methotrexate on the adenosine pathway. The authors found that psoriasis patients have regulatory T cells with decreased function, meaning they do not work so well, and reduced CD73 level, which was the starting section of adenosine pathway. Furthermore, methotrexate could restore the immunosuppressive function of regulatory T cells by affecting part of the adenosine pathway, including increasing CD73 expression and regulating its related signal pathway. In conclusion, the study deepens doctors’ and patients’ understanding of methotrexate in the treatment of psoriasis, and contributes to our understanding of psoriasis.
Nested PCR for diagnosing scabies infestationHahm, J.E.; Kim, C.W.; Kim, S.S.
doi: 10.1111/bjd.17164pmid: N/A
SummaryScabies is a highly contagious, very itchy infestation on the skin of mites called Sarcoptes scabiei. Although it is more prevalent in developing countries, outbreaks in elderly care facilities are a growing problem for developed countries. Mineral oil examination, which involves gently scraping the patient's skin with mineral oil, transferring scales to a glass slide, and then identifying the mites or eggs with a microscope, is regarded as the gold standard in diagnosing scabies, but it is not always accurate. This study, from South Korea, aimed to enhance the accuracy of laboratory diagnosis of scabies. The authors tested a different way of detecting scabies, called nested polymerase chain reaction (PCR) and compared nested PCR results with those of conventional diagnostic method, to see which is more accurate. Nested PCR is a way of making many copies of a specific DNA region in a test tube, making it possible to look for DNA from the mites that cause scabies. Clinically suspected scabies patients underwent mineral oil examination. The diagnosis was positive for scabies when mites or eggs were found under the microscope, and patients were then designated as ‘microscopy‐positive’. Patients in the ‘microscopy‐negative’ group presented with negative microscopic results, meaning that mites or eggs had not been seen under a microscope. Skin scrapings were collected from both groups for PCR. Of the total 63 samples, 28 were microscopy‐positive and 35 were negative. All microscopically proven scabies cases were positive with nested PCR. Among microscopy‐negative ones, S. scabiei DNA was detected in 9 samples. This means that in 9 of the 35 cases where mites or eggs were not found under a microscope using the normal testing method, mites' DNA was indeed found using nested PCR. If sensitivity (accuracy) of nested PCR is considered 100%, then sensitivity of microscopy is 75.68%. Therefore, nested PCR can be successfully used as an alternative method for diagnosing suspected scabies cases. Furthermore, infection‐control measures and treatments can be initiated before it spreads too widely, minimizing the risk of outbreaks.
New 8th edition of TNM staging and implications for skin cancerKeohane, S.G.; Proby, C.M.; Newlands, C.; Motley, R.J.; Nasr, I.; Mohd Mustapa, M.F.; , ; Slater, D.N.; ,
doi: 10.1111/bjd.17170pmid: N/A
SummaryAccurate staging of a skin cancer is essential in order to properly plan its management. Staging takes account of the tumour itself (T), whether it has spread to lymph glands (nodes – N) and whether it has spread to distant organs (metastases – M). The TNM classification system is constantly being revised in the light of new research. The latest edition for skin cancer (TNM8) was published in 2016 by the Union for International Cancer Control, and has now been adopted by the relevant bodies in the U.K. TNM8 displays significant changes from TNM7 in the staging of skin cancers including the commoner basal cell carcinoma and squamous cell carcinoma (non‐melanoma skin cancers ‐ NMSC), melanoma, as well as rarer skin tumours. These changes impose additional responsibilities on the clinicians seeing the patient. These include measuring the maximum diameter of every potential NMSC and writing this on the form to accompany the excised tumour to the laboratory. In addition, the form must state whether it is possible to manually feel enlarged glands or visualise them on a scan. Patients with thin melanomas less than 0.8mm whose lymph nodes have been shown to be free of cancer by a technique known as sentinel lymph node biopsy now have a lower TNM stage. Their hospital follow‐up is reduced from 5 years to 1 year which is an important advance. Some microscopic features previously thought to indicate the aggressiveness of a tumour, have been dropped from the TNM8 classification. For example the differentiation (deviation from normal tissue appearance) of a squamous carcinoma and the number of visibly dividing cells in a melanoma are no longer considered important.