autoimmune

自身免疫
  • 文章类型: Case Reports
    抗甘氨酸受体(抗GlyR)抗体介导多种免疫相关疾病。本研究旨在总结抗GlyR抗体相关疾病的临床特征,以提高我们对其的认识。
    通过收集甘氨酸受体(GlyR)抗体阳性的住院患者的临床信息,本研究报道了一名新的GlyR抗体阳性患者的临床特征.为了获得关于抗GlyR抗体相关疾病的更多信息,本研究中新报道的病例和以前发表的病例的临床数据和结果被合并和分析.
    在这项研究中发现了一个新的抗GlyR抗体相关的进行性脑脊髓炎,伴有僵硬和肌阵挛症(PERM)。一名20岁的男性,脑脊液抗GlyR抗体仅阳性,一线免疫疗法预后良好。文献回顾表明,抗GlyR抗体相关疾病的常见临床表现包括PERM或僵人综合征(SPS)(n=179,50.1%)。癫痫发作(n=94,26.3%),和其他神经系统疾病(n=84,24.5%)。其他神经系统问题包括脱髓鞘,炎症,小脑共济失调和运动障碍,脑炎,急性精神病,认知障碍或痴呆,乳糜泻,帕金森病,神经性疼痛和异常性疼痛,类固醇反应性耳聋,hemibalism/tic,喉肌张力障碍,全身无力包括呼吸肌。PERM/SPS组对免疫疗法的反应优于其他组。
    研究结果表明在抗GlyR抗体相关疾病中存在多种临床表型。常见的临床表型包括PERM,SPS,癫痫发作,和副肿瘤疾病。患有RERM/SPS的患者对免疫疗法反应良好。
    UNASSIGNED: Antiglycine receptor (anti-GlyR) antibody mediates multiple immune-related diseases. This study aimed to summarize the clinical features to enhance our understanding of anti-GlyR antibody-related disease.
    UNASSIGNED: By collecting clinical information from admitted patients positive for glycine receptor (GlyR) antibody, the clinical characteristics of a new patient positive for GlyR antibody were reported in this study. To obtain additional information regarding anti-GlyR antibody-linked illness, clinical data and findings on both newly reported instances in this study and previously published cases were merged and analyzed.
    UNASSIGNED: A new case of anti-GlyR antibody-related progressive encephalomyelitis with rigidity and myoclonus (PERM) was identified in this study. A 20-year-old man with only positive cerebrospinal fluid anti-GlyR antibody had a good prognosis with first-line immunotherapy. The literature review indicated that the common clinical manifestations of anti-GlyR antibody-related disease included PERM or stiff-person syndrome (SPS) (n = 179, 50.1%), epileptic seizure (n = 94, 26.3%), and other neurological disorders (n = 84, 24.5%). Other neurological issues included demyelination, inflammation, cerebellar ataxia and movement disorders, encephalitis, acute psychosis, cognitive impairment or dementia, celiac disease, Parkinson\'s disease, neuropathic pain and allodynia, steroid-responsive deafness, hemiballism/tics, laryngeal dystonia, and generalized weakness included respiratory muscles. The group of PERM/SPS exhibited a better response to immunotherapy than others.
    UNASSIGNED: The findings suggest the presence of multiple clinical phenotypes in anti-GlyR antibody-related disease. Common clinical phenotypes include PERM, SPS, epileptic seizure, and paraneoplastic disease. Patients with RERM/SPS respond well to immunotherapy.
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  • 文章类型: Journal Article
    背景:Graves病(GD)的病理生理学涉及滤泡辅助性T(Tfh)和滤泡调节性T(Tfr)细胞之间的失衡,以及氧化应激(OS)。夏枯草(夏酷曹,XKC)及其主要生物活性化合物,木犀草素,因其治疗GD的潜力而得到认可。然而,解释XKC的免疫调节和抗氧化作用的机制仍然难以捉摸。
    目的:本研究旨在评估XKC和木犀草素在重组TSH受体A亚基(Ad-hTSHR-289)腺病毒诱导的GD小鼠模型中的药理作用并阐明其潜在机制。
    方法:采用高效液相色谱-四极杆飞行时间质谱(HPLC-QTOFMS)检测XKC的成分。通过三次肌肉注射Ad-TSHR-289诱导雌性BALB/c小鼠建立GD模型。甲状腺功能,通过ELISA测量自身抗体和OS参数。流式细胞术检测Tfh细胞和Tfr细胞的变更。RT-qPCR,西方印迹,用免疫组织化学方法探讨相关的分子机制。
    结果:通过HPLC-QTOFMS鉴定了XKC中的37种化学成分,以类黄酮为代表,类固醇,萜类化合物,和木犀草素.XKC和木犀草素降低了GD小鼠的T4、TRAb水平,促进了甲状腺损伤的恢复。同时,XKC和木犀草素通过降低MDA水平有效缓解OS,NOX2,4-HNE,8-OHdG,同时提高GSH水平。流式细胞仪检测显示,XKC和木犀草素恢复了Tfh/Tfr和Tfh/Treg的异常比例,GD小鼠IL-21、Bcl-6和Foxp3的mRNA水平。此外,XKC和木犀草素抑制PI3K,Akt,p-PI3K和p-Akt,但激活了Nrf2和HO-1。
    结论:XKC和木犀草素可通过重新平衡Tfh/Tfr细胞和减轻OS来抑制GD的发展。这种治疗机制可能涉及Nrf2/HO-1和PI3K/Akt信号通路。木犀草素是XKC对抗GD的主要功效物质基础。第一次,我们从自身免疫和OS的角度揭示了XKC和木犀草素治疗GD的机制。
    BACKGROUND: The pathophysiology of Graves\' disease (GD) involves imbalances between follicular helper T (Tfh) and follicular regulatory T (Tfr) cells, as well as oxidative stress (OS). Prunella vulgaris L. (Xia Ku Cao, XKC) and its primary bioactive compound, luteolin, are recognized for their potential in treating GD. Yet, the mechanism accounting for the immune-modulatory and antioxidant effects of XKC remains elusive.
    OBJECTIVE: This study aims to evaluate the pharmacological effects and elucidate the underlying mechanism of XKC and luteolin in a GD mouse model induced by recombinant adenovirus of TSH receptor A subunit (Ad-hTSHR-289).
    METHODS: High-Performance Liquid Chromatography-Quadrupole Time-of-Flight Mass Spectrometry (HPLC-QTOF MS) was used to detect the constituents of XKC. The GD model was established through inducing female BALB/c mice with three intramuscular injections of Ad-TSHR-289. Thyroid function, autoantibody and OS parameters were measured by ELISA. Changes of Tfh cells and Tfr cells were detected by flow cytometry. RT-qPCR, Western Blotting, immunohistochemistry were used to explore the related molecular mechanisms.
    RESULTS: A total of 37 chemical components from XKC were identified by HPLC-QTOF MS, represented by flavonoids, steroids, terpenoids, and luteolin. XKC and luteolin reduced T4, TRAb levels and facilitated the recovery from thyroid damage in GD mice. Meanwhile, XKC and luteolin effectively alleviated OS by decreasing the levels of MDA, NOX2, 4-HNE, 8-OHdG, while increasing GSH level. Flow cytometry showed that XKC and luteolin restored the abnormal proportions of Tfh/Tfr and Tfh/Treg, and the mRNA levels of IL-21, Bcl-6 and Foxp3 in GD mice. In addition, XKC and luteolin inhibited PI3K, Akt, p-PI3K and p-Akt, but activated Nrf2 and HO-1.
    CONCLUSIONS: XKC and luteolin could inhibit the development of GD in vivo by rebalancing Tfh/Tfr cells and alleviating OS. This therapeutic mechanism may involve the Nrf2/HO-1 and PI3K/Akt signaling pathways. Luteolin is the main efficacy material basis of XKC in countering GD. For the first time, we revealed the mechanism of XKC and luteolin in the treatment of GD from the perspective of autoimmune and OS.
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  • 文章类型: Journal Article
    OBJECTIVE: Both schizophrenia and type 1 diabetes mellitus (T1D) are known as immune-related disorders. We systematically reviewed observational studies to explore the relationship between schizophrenia or schizoaffective disorder and T1D.
    METHODS: A preliminary search of articles was completed using the following databases: Airiti Library, CINAHL Complete (via EBSCOhost), OVID MEDLINE, Embase, and PubMed. Two researchers independently assessed each study\'s quality based on Joanna Briggs Institute (JBI). A narrative review summarized the potential relationship between the two diseases.
    RESULTS: Eleven studies were included in the final analysis. Six observational studies investigated the risk of schizophrenia and schizoaffective disorder in patients with T1D. Two studies showed negative correlations, one showed no correlation, and three showed positive correlations. On the other hand, five studies reported the prevalence of T1D in patients with schizophrenia. Two of them showed positive associations, and three others showed no association. Although the majority of the included studies suggested a positive association between the two medical conditions, these studies were still too heterogeneous to draw consistent results.
    CONCLUSIONS: We found conflicting results regarding the bidirectional relationship between schizophrenia or schizoaffective disorder and T1D. These may stem from differences in study design, sampling methods, or definition of diagnoses, which are essential aspects to consider in future research.
    UNASSIGNED: ZIELSETZUNG: Sowohl Schizophrenie als auch Typ-1-Diabetes mellitus (T1D) sind als immunbezogene Störungen bekannt. Wir haben systematisch Beobachtungsstudien überprüft, um die Beziehung zwischen Schizophrenie oder schizoaffektiver Störung und T1D zu untersuchen.
    METHODS: Eine vorläufige Suche nach Artikeln wurde in den folgenden Datenbanken durchgeführt: Airiti Library, CINAHL Complete (über EBSCOhost), OVID MEDLINE, Embase und PubMed. Zwei Forscher bewerteten unabhängig voneinander die Qualität jeder Studie anhand des Joanna Briggs Institute (JBI). Eine narrative Übersicht fasste die potenzielle Beziehung zwischen den beiden Krankheiten zusammen.
    UNASSIGNED: Elf Studien wurden in die abschließende Analyse einbezogen. Sechs Beobachtungsstudien untersuchten das Risiko von Schizophrenie und schizoaffektiver Störung bei Patienten mit T1D. Zwei Studien zeigten negative orrelationen, eine zeigte keine Korrelation und drei zeigten positive Korrelationen. Andererseits berichteten fünf Studien über die Prävalenz von T1D bei Patienten mit Schizophrenie. Zwei von ihnen zeigten positive Assoziationen, und drei andere zeigten keine Assoziation. Obwohl die Mehrheit der eingeschlossenen Studien eine positive Assoziation zwischen den beiden medizinischen Zuständen nahelegte, waren diese Studien immer noch zu heterogen, um konsistente Ergebnisse zu erzielen.
    UNASSIGNED: Wir fanden widersprüchliche Ergebnisse hinsichtlich der bidirektionalen Beziehung zwischen Schizophrenie oder schizoaffektiver Störung und T1D. Diese könnten auf Unterschiede im Studiendesign, den Stichprobenmethoden oder der Definition der Diagnosen zurückzuführen sein, was wesentliche Aspekte sind, die in zukünftigen Forschungen berücksichtigt werden müssen.
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  • 文章类型: Journal Article
    背景:由于自身免疫性疾病和风湿性疾病(AIRD)患者的潜在病情,大流行给他们带来了独特的挑战,免疫抑制治疗的效果,增加疫苗的犹豫。
    目的:自身免疫性疾病(COVAD)中的COVID-19疫苗接种研究,一系列正在进行的,患者自我报告调查的设想是作为收集患者对AIRD观点的独特工具.它涉及一家跨国公司,在全球封锁中的多中心协作努力。
    方法:利用社交媒体作为研究工具,COVAD使用经过验证的患者报告结果(PRO)收集数据。这项研究,由一个核心团队组成,指导委员会,和全球合作者,促进数据收集和分析。经过飞行员测试,经过验证的调查,关于COVID-19感染的问题,疫苗接种和结果,患者人口统计学,并将PROs分发给患有AIRDs和健康对照(HCs)的患者。
    结论:我们提出了在这个国际合作项目中遇到的挑战,包括协调,数据管理,资金紧张,语言障碍,和作者的担忧,同时强调为解决这些问题而采取的措施。
    结论:协作虚拟模型为医学研究提供了一个动态的新前沿,对研究罕见疾病至关重要。COVAD研究证明了在线平台进行大规模、以患者为中心的研究,强调了将患者观点纳入临床护理的重要性。照顾病人是我们的核心动机,在研究影响他们的条件时,必须承认他们的声音是平等的利益相关者和有价值的伙伴。
    The pandemic presented unique challenges for individuals with autoimmune and rheumatic diseases (AIRDs) due to their underlying condition, the effects of immunosuppressive treatments, and increased vaccine hesitancy.
    The COVID-19 vaccination in autoimmune diseases (COVAD) study, a series of ongoing, patient self-reported surveys were conceived with the vision of being a unique tool to gather patient perspectives on AIRDs. It involved a multinational, multicenter collaborative effort amidst a global lockdown.
    Leveraging social media as a research tool, COVAD collected data using validated patient-reported outcomes (PROs). The study, comprising a core team, steering committee, and global collaborators, facilitated data collection and analysis. A pilot-tested, validated survey, featuring questions regarding COVID-19 infection, vaccination and outcomes, patient demographics, and PROs was circulated to patients with AIRDs and healthy controls (HCs).
    We present the challenges encountered during this international collaborative project, including coordination, data management, funding constraints, language barriers, and authorship concerns, while highlighting the measures taken to address them.
    Collaborative virtual models offer a dynamic new frontier in medical research and are vital to studying rare diseases. The COVAD study demonstrates the potential of online platforms for conducting large-scale, patient-focused research and underscores the importance of integrating patient perspective into clinical care. Care of patients is our central motivation, and it is essential to recognize their voices as equal stakeholders and valued partners in the study of the conditions that affect them.
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  • 文章类型: Journal Article
    NLRP炎性体是一组胞质多蛋白寡聚体模式识别受体(PRR),参与识别由感染细胞产生的病原体相关分子模式(PAMP)和危险相关分子模式(DAMP)。它们通过触发保护性炎症反应来调节先天免疫。然而,尽管有保护作用,NLRP传感蛋白中的异常NLPR炎性体激活和功能获得突变参与非通信自身免疫的发生和增强,自身炎症,和神经退行性疾病。在过去的几年里,在理解NLRP炎性体生理功能及其激活的分子机制方面取得了重大进展,以及针对炎症性疾病中NLRP炎性体活性的疗法。这里,我们提供了NLRP炎性体的最新研究进展,包括NLRP1、CARD8、NLRP3、NLRP6、NLRP7、NLRP2、NLRP9、NLRP10和NLRP12关于它们的结构和组装特征,信号转导和分子激活机制。重要的是,我们强调了与许多人类自身炎症相关的NLRP炎性体失调的机制,自身免疫,和神经退行性疾病。总的来说,我们总结了NLRP生物学的最新发现,它们形成的炎性体,以及它们在健康和疾病中的作用,并为NLRP炎性体的未来研究提供治疗策略和观点。
    NLRP inflammasomes are a group of cytosolic multiprotein oligomer pattern recognition receptors (PRRs) involved in the recognition of pathogen-associated molecular patterns (PAMPs) and danger-associated molecular patterns (DAMPs) produced by infected cells. They regulate innate immunity by triggering a protective inflammatory response. However, despite their protective role, aberrant NLPR inflammasome activation and gain-of-function mutations in NLRP sensor proteins are involved in occurrence and enhancement of non-communicating autoimmune, auto-inflammatory, and neurodegenerative diseases. In the last few years, significant advances have been achieved in the understanding of the NLRP inflammasome physiological functions and their molecular mechanisms of activation, as well as therapeutics that target NLRP inflammasome activity in inflammatory diseases. Here, we provide the latest research progress on NLRP inflammasomes, including NLRP1, CARD8, NLRP3, NLRP6, NLRP7, NLRP2, NLRP9, NLRP10, and NLRP12 regarding their structural and assembling features, signaling transduction and molecular activation mechanisms. Importantly, we highlight the mechanisms associated with NLRP inflammasome dysregulation involved in numerous human auto-inflammatory, autoimmune, and neurodegenerative diseases. Overall, we summarize the latest discoveries in NLRP biology, their forming inflammasomes, and their role in health and diseases, and provide therapeutic strategies and perspectives for future studies about NLRP inflammasomes.
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  • 文章类型: Journal Article
    SARS-CoV-2导致2019年冠状病毒病(COVID-19),一种没有或没有一种或多种症状的传染病:发烧,咳嗽,头痛,喉咙痛,失去味道和气味,疼痛,疲劳和肌肉骨骼疼痛。为了预防COVID-19,有可用的疫苗,包括辉瑞公司开发的疫苗,Moderna,Sinovac,Janssen,和阿斯利康。最近的证据表明,一些接种COVID-19的个体偶尔会发展为格林-巴利综合征(GBS)的潜在副作用,一种严重的神经系统自身免疫性疾病,其中针对周围神经系统(PNS)的免疫反应可导致显著的发病率。GBS以前与几种病毒或细菌感染有关,接种某些COVID-19后发现GBS,虽然罕见,应提醒医生早期诊断和有针对性的治疗。在这里,我们回顾了5例在不同国家接种COVID-19疫苗后出现的GBS病例。
    SARS-CoV-2 causes Coronavirus Disease 2019 (COVID-19), an infectious condition that can present none or one or more of these symptoms: fever, cough, headache, sore throat, loss of taste and smell, aches, fatigue and musculoskeletal pain. For the prevention of COVID-19, there are vaccines available including those developed by Pfizer, Moderna, Sinovac, Janssen, and AstraZeneca. Recent evidence has shown that some COVID-19-vaccinated individuals can occasionally develop as a potential side effect Guillain-Barre syndrome (GBS), a severe neurological autoimmune condition in which the immune response against the peripheral nerve system (PNS) can result in significant morbidity. GBS had been linked previously to several viral or bacterial infections, and the finding of GBS after vaccination with certain COVID-19, while rare, should alert medical practitioners for an early diagnosis and targeted treatment. Here we review five cases of GBS that developed in different countries after COVID-19 vaccination.
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  • 文章类型: Case Reports
    在患有严重自身免疫性神经胶质纤维酸性蛋白(GFAP)星形细胞病的患者中没有器官捐赠的报道。
    一名27岁的男性患者出现发烧和头痛,一周后,他四肢无力和不稳定。他去了当地的医院,但没有找到原因.十三天后,他失去知觉,被迅速转移到重症监护室接受对症支持治疗,没有改进。然后他被转移到我们医院,他在同一天心脏骤停.这个家庭放弃了治疗,选择了器官捐赠,出于财务原因。基于细胞的测定证明了脑脊液中的GFAP抗体。接受器官移植15个月后,两名肾脏受体和一名肝脏受体均未出现异常反应。
    我们报告了一例脑死亡后器官捐献的病例,患者诊断为GFAP星形细胞病,强调需要警惕这种情况的患者可能发生心脏骤停。考虑到GFAP星形细胞病的潜力在观察恶化的症状时至关重要,癫痫发作,以及疑似病毒感染后的意识障碍。考虑到排除全身感染和没有外周器官受累,从GFAP星形细胞病变患者中成功捐献器官可能是可行的。
    UNASSIGNED: No reports of organ donation have been documented in patients suffering from severe autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.
    UNASSIGNED: A 27-year-old male patient developed a fever and headache, followed a week later by weakness and unsteadiness in his limbs. He attended his local hospital, but no cause was found. Thirteen days later, he became unconscious and was promptly moved to the intensive care unit for symptomatic support treatment, with no improvement. He was then transferred to our hospital, where he suffered a cardiac arrest on the same day. The family abandoned treatment and opted for organ donation, for financial reasons. Cell-based assays demonstrated GFAP antibodies in the cerebrospinal fluid. Two kidney recipients and one liver recipient showed no abnormal reactions 15 months after receiving organ transplants.
    UNASSIGNED: We report a case of organ donation following brain death in a patient diagnosed with GFAP astrocytopathy, highlighting the need for vigilance regarding the potential occurrence of cardiac arrest in patients with this condition. Considering the potential of GFAP astrocytopathy is crucial when observing deteriorating symptoms, seizures, and consciousness disturbances subsequent to a suspected viral infection. Successful organ donation from patients with GFAP astrocytopathy may be feasible given the exclusion of systemic infection and the absence of peripheral organ involvement.
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  • 文章类型: Journal Article
    特发性肉芽肿性乳腺炎(IGM)是非癌性的,原因不明的慢性乳房炎性疾病,由于其高难治性和局部侵略性,对生活质量构成重大挑战。这种疾病的典型症状包括皮肤发红,坚实而柔软的乳房肿块和乳房疼痛;其他可能包括肿胀,瘘管,脓肿(通常不发烧),乳头收缩,和橙色外观。IGM通常模仿乳房脓肿或恶性肿瘤,尤其是炎性乳腺癌,其特点是缺乏标准化的治疗方案,不一致的患者反应和未知的机制。这种疾病的明确诊断依赖于核心针活检和组织病理学检查。流行的病因学理论表明,IGM是一种自身免疫性疾病,因为一些患者对类固醇治疗反应良好。此外,并发结节性红斑或其他自身免疫疾病的存在支持该疾病的自身免疫性质。根据现有知识,这篇综述旨在阐明IGM的自身免疫优势特征,并探讨其潜在的病因.此外,我们利用现有研究讨论了IGM的免疫介导的发病机制,并提出了治疗这种疾病的免疫治疗策略.
    Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d\'orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.
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  • 文章类型: Systematic Review
    背景:白癜风,与荷尔蒙和遗传因素有关的自身免疫性皮肤病,由于黑素细胞活性逐渐下降,导致色素沉着减少。本系统综述探讨了饮食干预和营养在白癜风管理中的作用。
    方法:在PubMed上进行全面搜索,谷歌学者,欧洲PMC确定了214项研究,筛选后有14人符合纳入标准。选定的研究主要探讨了膳食补充剂对疾病活动的影响。
    结果:重金属暴露,特别是Cd,Pb,汞,表明潜在的联系增加的活性氧和白癜风的发展。关于微量矿物质(锌和铜)的作用,出现了相互矛盾的证据,一些研究表明白癜风患者存在缺陷,另一些研究表明白癜风患者存在过度缺陷。具有抗炎特性的维生素,如维生素C,D,和B12,以及抗氧化剂,研究了它们在色素沉着策略中的潜力。此外,多不饱和脂肪酸(PUFA),尤其是在不同类型的脂肪消耗中,有牵连。强调需要减少对药物和光疗干预的依赖,该综述揭示了膳食补充剂作为添加剂或耀斑减少剂的新作用。
    结论:虽然饮食干预不能被认为是一种独立的治疗方法,他们仍然有理由被用作辅助手段。大规模的临床试验有必要建立强有力的证据和协议,也可能有助于减少对药理学方法的依赖,伴随着它们的不良反应。
    BACKGROUND: Vitiligo, an autoimmune skin disorder linked to hormonal and genetic factors, results in reduced pigmentation due to a gradual decline in melanocyte activity. This systematic review delves into the role of dietary intervention and nutrition in managing vitiligo.
    METHODS: A comprehensive search on PubMed, Google Scholar, and European PMC identified 214 studies, with 14 meeting inclusion criteria post-screening. The selected studies primarily explored the impact of dietary supplements on disease activity.
    RESULTS: Heavy metal exposure, specifically Cd, Pb, and Hg, indicated potential links to heightened reactive oxygen species and vitiligo development. Conflicting evidence emerged regarding the role of trace minerals (Zn and Cu), with some studies suggesting deficiencies and others proposing excesses in vitiligo patients. Vitamins with anti-inflammatory properties like vitamin C, D, and B12, along with antioxidants, were investigated for their potential in repigmentation strategies. Additionally, polyunsaturated fatty acids (PUFAs), especially in varying types of fat consumption, were implicated. Emphasizing the need to reduce reliance on pharmacological and phototherapy interventions, the review uncovers novel roles for dietary supplements as adjuncts or flare reducers.
    CONCLUSIONS: While dietary interventions cannot be thought of as a standalone therapy, they still make a case for being used as adjuncts. Large scale clinical trials are warranted to establish strong evidence and protocols, and might also help reduce the dependency on pharmacological methods, which come with their adverse effect profiles.
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  • 文章类型: Journal Article
    肿瘤坏死因子α(TNFα)参与不良妊娠结局的发生。该研究旨在评估免疫抑制TNFα抑制剂(TNFαi)在COVID-19大流行背景下治疗有复发性生殖衰竭史的患者的安全性和有效性。我们回顾了在中国大陆第一波COVID-19大流行期间接受TNFαi(赛托珠单抗)的85例患者,从2022年11月21日至2023年1月11日。我们还从从未使用TNFαi的130名怀孕患者中收集了相应的数据进行比较。既往流产史无显著差异,流产,胚胎植入失败,COVID-19疫苗的合并症和剂量。在TNFαi组和非TNFαi组中,有82.2%和87.7%的孕妇感染有症状的原发性COVID-19。TNFαi组症状持续时间明显延长,咳嗽和嗜睡的发生率明显高于TNFαi组。两组报告同龄密切接触者的严重程度相似,其他症状和住院率相似。没有死亡报告。在体外受精(IVF)亚组中,我们实现了17.4%的生化妊娠损失率,流产率为21.7%,持续妊娠率和活产率为34.2%。COVID-19不影响活产率。我们得出的结论是,妊娠期TNFαi的给药与COVID-19的易感性和严重程度的增加无关。然而,TNFαi使用者表现出更突出的症状和更长的恢复时间。在妊娠丢失的高危人群中,使用TNFαi的妊娠结局令人满意。
    Tumor necrosis factor alpha (TNFα) is involved in the occurrence of negative pregnancy outcomes. The study aimed to evaluate the safety and efficacy of the immunosuppressive TNFα inhibitors (TNFαi) in the treatment of patients with a history of recurrent reproductive failure in the context of COVID-19 pandemics. We reviewed 85 patients who received TNFαi (certolizumab pegol) during Mainland China\'s first wave of COVID-19 pandemic, from 21st Nov 2022-11 th Jan 2023. We also collected corresponding data from 130 pregnant patients who never used TNFαi for comparison. There were no significant differences in the history of previous pregnancy loss, miscarriage, embryo implantation failure, comorbidities and doses of COVID-19 vaccination. 82.2% and 87.7% pregnant patients contracted primary COVID-19 with symptoms in TNFαi group and no-TNFαi group. Duration of symptoms was significantly longer in TNFαi group and the incidences of cough and lethargy was significantly higher in TNFαi group. Both groups reported similar severity to same-aged close contacts, similar rates of other symptoms and hospitalization. No deaths were reported. In the in vitro fertilization (IVF) subgroup, we achieved a biochemical pregnancy loss rate of 17.4%, miscarriage rate of 21.7%, ongoing pregnancy rate and live birth rate of 34.2%. COVID-19 did not influence the live birth rate. We concluded that TNFαi administration in pregnancy was not associated with increased susceptivity to and severity of COVID-19. However, TNFαi users showed more prominent symptoms and longer recovery time. The pregnancy outcomes with TNFαi in such high-risk group for pregnancy loss was satisfactory.
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