text:
Ihe njedebe nke ọmụmụ ahụ gụnyere eziokwu ndị a: ọ bụghị ọtụtụ ndị ọrịa na-enweta ọgwụgwọ ezubere iche n'ihi ọnụ ahịa ọgwụgwọ dị elu; Ọ dịghị nghazi nke oncologists kwupụta mgbazi nke dermatological ọjọọ omume na mmalite nkebi nke omume ha na-ntụgharị na dermatovenereologists maka oge ọgwụgwọ. N'ihe gbasara ihe ndị a dị n'elu, otu ndị a na-ewe ọrụ adịghị ọtụtụ.
0,9800
9 (64%)
0.72
Usoro ọgwụgwọ Sorafenib, n ndị ọrịa (%)
0,5597
Emere ọmụmụ ihe ahụ na ngalaba nke Dermatovenereology na Cosmetology nke Central State Medical Academy of the Administration of the President of the Russian Federation, na Department of Antitumor Drug Therapy na Consultative na Diagnostic Center nke Polyclinic nke Federal. State Budgetary Institution of Education and Science "Central Clinical Hospital with a Polyclinic" nke nchịkwa nke Onye isi ala nke Russian Federation, na-ezigakwa ndị ọrịa site na Federal State Budgetary Institution "National Medical Research Center of Endocrinology" nke Ministry of Health. Russian Federation.
Ọrịa ahụ enwechaghị mmetụta na ndụ onye ọrịa
1.64
Tebụl 1. Njirimara nke otu
3.85
A kwadoro ọmụmụ ihe ahụ site na kọmitii ụkpụrụ sayensị mpaghara nke Central State Medical Academy nke nchịkwa nke President nke Russian Federation (nkeji nke nzukọ nke kọmitii ụkpụrụ omume obodo No. 2 nke Jenụwarị 12, 2017).
Nkọwa nke enyemaka ahụike
0
Ebe nyocha
Mkparịta ụka
26.21
0,0087
R
Mgbu
0.92
0,7935
N'ime otu njikwa, ebe a na-eme ọgwụgwọ dị ka ndụmọdụ ọkọlọtọ si dị, LPS ji nwayọọ nwayọọ na-alaghachi n'izu nke abụọ ma ọ bụ nke atọ nke ọgwụgwọ, mana n'ime otu a desquamation belatara ngwa ngwa - n'ime izu mbụ site na 53% (n'ime ndị isi - site na 33%), nke nwere ike ijikọ na iji ude nwere 10% urea. Ntughari nke erythema na fissures n'ime izu mbụ bụ 43 na 39%, n'otu n'otu (na otu 1st - 53 na 54%, n'otu n'otu).
Achọpụtara njikọ kpọmkwem n'etiti dermatological index nke ịdị mma ndụ na ngosipụta ụlọ ọgwụ nke LPs. Enwere nso nso dị elu nke njikọ nke DIQ na erythema, mgbu, ọkụ, paresthesia, na desquamation (Table 4).
A na-ekpebi mmetụta na-egbu egbu nke ọgwụ ọjọọ site na usoro nke ime ihe, metabolism ọgwụ, dose na ogologo oge iji ya. LPS n'oge ọgwụgwọ ezubere iche na-egosipụta onwe ya na mpaghara akpụkpọ ahụ n'ebe esemokwu ma ọ bụ nrụgide na-abawanye, ọtụtụ mgbe ndị a bụ ntule nke akụkụ ọkpụkpụ na-apụta (calcaneus, amụma nke isi metatarsal na mpaghara nrụgide nke akpụkpọ ụkwụ na uwe). Mgbaàmà na-eme na ọnwa mbụ nke ọgwụgwọ, enwere mkpesa nke paresthesia, nhụjuanya, itching, mgbu; A na-ahụ oke, erythematous, edematous foci na ụlọ ọgwụ, yana ihe na-aga n'ihu na-etolite, mgbawa na-egbu mgbu na-etolite. Dịka nhazi ọkwa CTCAE NCI v.5.0 (dị ka ọ dị na ụdị nke gara aga - CTCAE NCI v.4.03), enwere ogo atọ nke ogo LPs:
0,8258
Otu isi
(n = 14)
Parathyroid cancer, n ndị ọrịa (%)
Ọrịa ahụ nwere mmetụta siri ike na ndụ onye ọrịa.
0,0017
Osikapa. 2. Ọrịa Palmar-plantar, mmebi ụkwụ nke ogo II.
<0.0001
0.31
0,6674
2.21
0,0033
Usoro ọgwụgwọ ngwakọta ahọpụtara nke ọgwụ sistemu na mpaghara dị mma ma na-emetụta akụkụ niile nke mmeghachi omume nsi nke multikinase inhibitors.
Index Ogo Ndụ nke Dermatological (DLQI, 0-30) (Nkọkọ ọnụ ọnụ ọkwa Spearman)
0.0120
0,5018
2
2.77
0,5917
Ọrịa ahụ nwere mmetụta siri ike na ndụ onye ọrịa.
0,8576
Uru ndeksi
2 (14.5%)
0,0047
0–1
0,0432
Ihe kpatara ya
Nsonaazụ ndị ọzọ nke ọmụmụ ahụ bụ nyocha nke mmetụta nke ọgwụgwọ ahụ na njirisi ụlọ ọgwụ maka ịdị njọ nke usoro akpụkpọ anụ pathological - erythema, peeling, blisters na cracks na-agbanwe n'okpuru mmetụta ọgwụgwọ; yana ike nke paresthesia, mgbu na ọkụ.
Ndị na-egbochi Multikinase nwere ọnụ ọgụgụ dị iche iche nke nsị anụ ahụ, ma enwere ike ịdebe na ọrịa aka-ụkwụ bụ mmetụta kachasị emetụta, dị ka isi mmalite dị iche iche si kwuo, ugboro ugboro ya na-erute 20% na sunitinib, 26% na axitinib, 32% na axitinib. lenvatinib, cabozantinib - 42%, sorafenib - 76% [9, 10].
1 (7.5%)
Isiokwu 2. Nkọwa nke ụkpụrụ nke ndeksi DIQI
Usoro maka iwepụ na ọmụmụ ihe: nsonye na-ezighi ezi; ajọ omume ọjọọ; ihe omume nke njirisi mwepụ na onye ọrịa n'oge ọmụmụ ihe; onye ọrịa jụrụ isonye na ọmụmụ ihe.
1.46
N'ozuzu, ndị ọrịa nke ndị isi na-egosipụta mmetụta kachasị mma nke ọgwụgwọ dermatological na ọganihu ngwa ngwa na ndụ ndụ, nke nwere ike jikọta ya na enyemaka nke mgbaàmà dịka mgbu, ọkụ, na-egosipụtakwa na njikọ dị n'etiti DIVC na ụlọ ọgwụ. ngosipụta, ọ bụ ezie na a na-ahụ mmekọrịta kacha nso na erythema, nke na-egosipụta ịdị njọ nke usoro akpụkpọ ahụ (lee Isiokwu 3). Ọ dịghị ihe dị iche iche dị iche iche dị iche iche na-enyocha ike nke blisters na cracks, nke a na-ejikọta ya na oge nke epithelialization nke ọnya anụ ahụ dị omimi, Otú ọ dị, ekwesịrị iburu n'uche na mgbawa ahụ nọ na ọkwa ọgwụgwọ na-arụ ọrụ. A na-adọta nlebara anya na mwepu ngwa ngwa nke paresthesias n'ime izu nke abụọ nke ọgwụgwọ n'ime ndị ọrịa nke otu ọmụmụ ihe, nke, o doro anya, jikọtara ya na iji ọnụ na-ekwu nkwadebe nke lipoic acid.
1.71
0,0004
Otu njikwa*
p
Oke
0.0107
3.43
Rịba ama : * - etiti (min-max).
Ya mere, ntinye ọgwụ nwere ọrụ antioxidant (alfa-lipoic acid) na usoro ọgwụgwọ yana mmetụta ọgwụ jikọtara ya na calcipotriol na betamethasone na ndị ọrịa na-anata ọgwụgwọ na multikinase inhibitors na inwe mgbaàmà nke ọrịa ụkwụ ụkwụ na-enye aka ngwa ngwa. na enyemaka dị irè nke ọnọdụ onye ọrịa, na-ebelata mkpesa, jikọtara ya na ihe ọjọọ nke ọgwụgwọ anticancer n'ụdị LPS, na mkpebi nke ngosipụta ụlọ ọgwụ ya.
Ụzọ ndebanye aha nsonaazụ
Usoro nsonye: ọrịa aka-ụkwụ I-II siri ike (CTCAE NCI v.4.03) megide ndabere nke ọgwụgwọ ezubere iche na multikinase inhibitors; afọ site na 20 ruo 75 afọ; nkwenye mara ọkwa isonye na ọmụmụ ihe.
0,7558
Paresthesia
Isi nsonaazụ ọmụmụ
Nchacha
afụ
0.93
Ọgwụgwọ ọrịa palmoplantar, ma ọ bụ palmar-plantar erythrodysesthesia, gosipụtara site na mgbaàmà nke ọnya anụ ahụ na dysesthesia, nke na-egosipụta na nkọwa nke ihe omume dermatological na-adịghị mma, kwesịrị ịgụnye ọgwụ ndị ezubere iji wepụ ihe mgbaàmà nke ịmalite neuropathy na-egbu egbu. Ọmụmụ ihe a na-eji alfa-lipoic (thioctic) acid, antioxidant lipophilic eke. Ntinye ya na usoro ọgwụgwọ ahụ bụ ihe ziri ezi n'ụzọ ziri ezi, ebe ọ bụ na ọgwụ ahụ egosila na ọ dị irè n'ịgwọ ọrịa polyneuropathies dị iche iche [14], nke butere mbelata ngwa ngwa na mgbaàmà nke dysesthesia na mgbu na, ya mere, mmụba nke ogo ndụ ndị ọrịa.
Nyocha ụkpụrụ omume
Ọgwụ Lenvatinib, n ndị ọrịa (%)
29%
1.85
0,4323
12 (85.5%)
0,9196
2.71
2–5
A tụlere nsonaazụ ya dị ka usoro ike siri dị:
Ọmụmụ ihe ọzọ gbasara ihe ọjọọ dermatological nke ọgwụgwọ ọgwụ mgbochi a na-atụ anya ga-enyere aka ịmepụta mmezi na mgbochi dị irè nke ga-eme ka ọ dị mma iji ọgwụ mgbochi ọrịa cancer mee ihe iji nweta mmetụta ọgwụgwọ na-azọpụta ndụ.
Ntụle nke obere otu
1.31
0,8496
Ihe (ndị sonyere) nke ọmụmụ ihe
Afọ*, afọ
11.62
Nsonaazụ ọmụmụ ihe ndị ọzọ
0.94
Osikapa. 1. Ọrịa Palmar-plantar, mmebi n'ọbụ aka nke ogo 1st.
Multikinase inhibitors nke na-elekwasị anya ọtụtụ ndị na-anabata ya n'otu oge: VEGFR (vasoendothelial growth factor receptor), PDGFR (platelet growth factor receptor), bFGFR (fibroblast growth factor receptor), RET na Flt-3 kinases na ndị ọzọ na-etinye aka na angiogenesis tumor, na-emekarị ka ọ dị njọ. Ụdị nke LPS [1-5]. Usoro pathogenetic nke LPS, yana ngosipụta ndị ọzọ nke ihe ọjọọ dermatological, na-amụsi ike ugbu a. Enwere njikọ doro anya na nkwụsị nke ọrụ nke ihe ndị na-eto eto (VEGF, TGF-B1, EGF, PDGF, FGF2), mmetụta inhibitory na uto na ọdịiche nke fibroblasts akpụkpọ anụ, nke na-eduga ná mbelata mmepụta nke collagen, fibronectin na akụkụ ndị ọzọ nke intercellular matrix, na-akpaghasị usoro nke ọdịiche, sel mmụba na nrụzi akpụkpọ ahụ [7].
Ndị isi bụ ndị ọrịa 14 na-ewere alfa-lipoic (thioctic) acid 600 mg kwa ụbọchị ọnụ maka izu 4 n'otu oge na tyrosine kinase inhibitor (sorafenib ma ọ bụ lenvatinib) ma jiri onye na-ahụ maka ihe - mmanụ nwere 0.005% synthetic analog nke ọgwụ ahụ. vitamin D metabolite - calcipotriol na 0.05% glucocorticosteroid - betamethasone dipropionate, ugboro 2 n'ụbọchị maka izu 4. A na-enye ude ahụ ugboro 2 n'ụbọchị na akpụkpọ ahụ dị n'akụkụ nkwụ na ihe ọkụkụ nke ụkwụ.
0,8752
- I ogo - ntakịrị mgbanwe akpụkpọ ahụ na-enweghị mgbu: erythema, edema, hyperkeratosis (Fig 1);
3.14
0.71
0,6063
Otu njikwa
(n = 13)
0,9109
10 (77%)
21–30
Ntinye aka nke ndị edemede: Shatokhina E.A. - echiche na imewe, nchịkọta data, nyochaa ike nke ndị ọrịa, na-ede akụkọ; Kruglova L.S. - Isonye na ide edemede; Shukhov O.A. - nchịkọta data nyocha. Ndị edemede niile nyere aka dị ukwuu na ọmụmụ ihe na nkwadebe nke isiokwu ahụ, gụọ ma kwado nsụgharị ikpeazụ tupu e bipụta ya.
- Edekọkwara mmetụta ọgwụgwọ na-adịghị mma dị ka nyocha ụlọ ọgwụ na ajụjụ ajụjụ si dị.
23%
A na-arụ ọrụ nke ndị ọrịa na nhazi nke otu site na Jenụwarị 2017 ruo August 2018. A na-eme nnyocha ahụ n'ime otu ọnwa mgbe nyochachara na nchịkọta. A na-eme nyocha, mkpebi nke indices na ajụjụ ọ bụla ụbọchị 7, 4 akara akara. Ma tupu mmalite nke ọgwụgwọ dermatological na na nleta ọ bụla, onye nyocha ahụ kpebiri IGA index (Investigator's Global Assessment), onye ọrịa ahụ kpebiri akara mgbaàmà dị na Visual Analogue Scale (VAS) na àgwà ndụ ndụ dermatological (DIQI, Dermatology). Ndụ Ogo Index). , DLQI). Edekọrọ ihe ngosi na-adịghị mma nke ọgwụgwọ dermatological na-aga n'ihu.
Ebumnuche
anọ
1.07
otu
11–20
A na-ekewa ndị ọrịa n'ime ìgwè abụọ dabere na usoro ọgwụgwọ. Ojiji nke usoro randomization mere ka o kwe omume iji hụ na nkesa nke ndị ọrịa site na afọ, mmekọahụ, na oke ọrịa ahụ (Table 1). Maka randomization, a na-eji tebụl ọnụọgụgụ enweghị usoro.
Ụzọ
Oke ọmụmụ
Mkparịta ụka nke isi ihe si na ọmụmụ ihe
Mmebi nke akpụkpọ ahụ mgbe ị na-eji ọgwụ ọgwụgwọ ezubere iche maka ọgwụgwọ ọrịa kansa na-aghọ otu n'ime ihe ndị na-ebute nsogbu na-edugakarị na mbelata dose nke ọgwụ na ọbụna kagbuo zuru oke. Ọgwụgwọ na ọgwụ ezubere iche na-esonyere ya na mmeghachi omume ọjọọ dermatological n'ụdị akpụkpọ akọrọ, ihe ọkụ ọkụ maculopapular, ihe otutu dị ka rashes dị iche iche, mana ihe kpatara ịkwụsị ọgwụ ahụ bụ palmar-plantar erythrodysesthesia, ma ọ bụ ọrịa aka ụkwụ ( LPS, ọrịa aka-ụkwụ, HFS, mmeghachi omume akpụkpọ ụkwụ ụkwụ, HFSR). Iji chọpụta mmetụta na-adịghị mma na akpụkpọ ọbụ aka na ọbụbụ ọgwụ ezubere iche, a na-ejikarị okwu ahụ bụ "mmeghachi omume akpụkpọ anụ ụkwụ" (HFSR) na nso nso a, ebe ọ bụ na, n'adịghị ka ọrịa aka-ụkwụ nke na-eme n'oge ọgwụgwọ na ọgwụ chemotherapy omenala, nzaghachi nke ọgwụgwọ ezubere iche nwere ọdịiche dị n'ụlọ ọgwụ jikọtara ya na usoro omume nke ọgwụ. Na nhazi ọkwa kachasị ọhụrụ nke ihe ọjọọ nke na-ekpebi ụdị na oke mmetụta dị n'akụkụ ọgwụgwọ anticancer nke US National Cancer Institute (CTCAE NCI v.5.0) chọrọ, a na-eji okwu ahụ bụ "palmar-plantar erythrodysesthesia" (palmar-plantar erythrodysesthesia) mee ihe. , nke na-agụnye mmetụta ọ bụla na-egbu egbu nke akpụkpọ ahụ dị na n'ọbụ aka na ọbụ aka, na-egosipụta mmebi nke uche na mpaghara ndị a. Otú ọ dị, na akwụkwọ na n'etiti oncologists, okwu LPS bụ ihe nkịtị na-eji n'agbanyeghị na ọgwụ na-akpalite mmepe ya, ya mere, e jikwa ya na ọmụmụ a. Ọrịa Palmar-plantar na-amalite na akpụkpọ akọrọ, ọdịdị dysesthesia nke nkwụ na ụkwụ, peeling, cracks, na n'ụdị siri ike, ngwa ngwa na-eto eto, ọnya na erosions na-eme. Ugboro ugboro nke ọrịa ahụ na-erute 50%, na mgbe ejikọtara ya na ọgwụ ndị ọzọ antitumor - 80% [1], nke nwere ike ibido na njedebe nke ọrụ kwa ụbọchị, na n'ihu mmepe na enweghị nlekọta dermatological, na njedebe. nke ọrụ onwe. Mgbasawanye nke ihe ngosi maka iji ọgwụ ọhụrụ ezubere iche maka ọgwụgwọ na ihe ịga nke ọma nke ojiji ha na ọrịa cancer colorectal, ọrịa cancer akpa ume na-abụghị obere cell, ọrịa ara ara, ọrịa hepatocellular cancer, renal cell carcinoma, na thyroid cancer na-ekpebi mkpa ọgwụgwọ nke LPS. na ụzọ maka mgbochi ya [2-5]. mgbawa, na n'ụdị siri ike, na-etolite ngwa ngwa, afụ na mbuze na-eme. Ugboro ugboro nke ọrịa ahụ na-erute 50%, na mgbe ejikọtara ya na ọgwụ ndị ọzọ antitumor - 80% [1], nke nwere ike ibido na njedebe nke ọrụ kwa ụbọchị, na n'ihu mmepe na enweghị nlekọta dermatological, na njedebe. nke ọrụ onwe. Mgbasawanye nke ihe ngosi maka iji ọgwụ ọhụrụ ezubere iche maka ọgwụgwọ na ihe ịga nke ọma nke ojiji ha na ọrịa cancer colorectal, ọrịa cancer akpa ume na-abụghị obere cell, ọrịa ara ara, ọrịa hepatocellular cancer, renal cell carcinoma, na thyroid cancer na-ekpebi mkpa ọgwụgwọ nke LPS. na ụzọ maka mgbochi ya [2-5]. mgbawa, na n'ụdị siri ike, na-etolite ngwa ngwa, afụ na mbuze na-eme. Ugboro ugboro nke ọrịa ahụ na-erute 50%, na mgbe ejikọtara ya na ọgwụ ndị ọzọ antitumor - 80% [1], nke nwere ike ibido na njedebe nke ọrụ kwa ụbọchị, na n'ihu mmepe na enweghị nlekọta dermatological, na njedebe. nke ọrụ onwe. Mgbasawanye nke ihe ngosi maka iji ọgwụ ọhụrụ ezubere iche maka ọgwụgwọ na ihe ịga nke ọma nke ojiji ha na ọrịa cancer colorectal, ọrịa cancer akpa ume na-abụghị obere cell, ọrịa ara ara, ọrịa hepatocellular cancer, renal cell carcinoma, na thyroid cancer na-ekpebi mkpa ọgwụgwọ nke LPS. na ụzọ maka mgbochi ya [2-5]. na mgbe ejikọtara ya na ọgwụ mgbochi ọrịa cancer ndị ọzọ - 80% [1]. Mgbasawanye nke ihe ngosi maka iji ọgwụ ọhụrụ ezubere iche maka ọgwụgwọ na ihe ịga nke ọma nke ojiji ha na ọrịa cancer colorectal, ọrịa cancer akpa ume na-abụghị obere cell, ọrịa ara ara, ọrịa hepatocellular cancer, renal cell carcinoma, na thyroid cancer na-ekpebi mkpa ọgwụgwọ nke LPS. na ụzọ maka mgbochi ya [2-5]. na mgbe ejikọtara ya na ọgwụ mgbochi ọrịa cancer ndị ọzọ - 80% [1]. Mgbasawanye nke ihe ngosi maka iji ọgwụ ọhụrụ ezubere iche maka ọgwụgwọ na ihe ịga nke ọma nke ojiji ha na ọrịa cancer colorectal, ọrịa cancer akpa ume na-abụghị obere cell, ọrịa ara ara, ọrịa hepatocellular cancer, renal cell carcinoma, na thyroid cancer na-ekpebi mkpa ọgwụgwọ nke LPS. na ụzọ maka mgbochi ya [2-5].
Isi nsonaazụ ọmụmụ
2.62
Ọrịa akpụkpọ ahụ anaghị emetụta ndụ onye ọrịa
Ngụkọta ndị ọrịa 27 nwere ọrịa aka-ụkwụ I-II siri ike (ụmụ nwanyị 15 na ndị nwoke 12 gbara afọ 31 ruo 63) nọ na-elele. Site na njedebe nke ọmụmụ (izu 4 nke ọgwụgwọ), ndị niile sonyere na-enweta enyemaka ụfọdụ site na ngosipụta nke ọrịa aka-ụkwụ.
0,8392
17.43
Onye na-ahụ maka ọgwụgwọ n'èzí, mmanu nwere calcipotriol na betamethasone, egosila ịdị irè ya na usoro ọgwụgwọ a jikọtara ọnụ. Betamethasone dị ka glucocorticosteroid dị n'elu nwere mgbochi mkpali, vasoconstrictor, immunosuppressive mmetụta; A na-etinyekarị glucocorticoids mpaghara na ndụmọdụ maka mgbazi nke ihe ọjọọ dermatological, n'adịghị ka calcipotriol, ihe analog nke vitamin D. Ọ na-akpali morphological dị iche iche nke keratinocytes ma na-akpata nkwụsị nke na-adabere na dose nke mmụba ha, bụ ihe mgbochi siri ike nke ịmalite ọrụ. nke T-lymphocytes sitere na interleukin-1, na-enweghị mmetụta ọ bụla na mgbanwe calcium. A na-eji ọgwụ a na-arụsi ọrụ ike na-agwọ ụdị psoriasis dị iche iche, gụnyere palmoplantar psoriasis, foto ụlọ ọgwụ nke nwere ụfọdụ njirimara na-emekarị na LPS (ọkụ, peeling, ọzịza, erythema). N'iburu n'uche usoro ihe omume nke onyinye a na arụmọrụ egosipụtara na usoro akpụkpọ anụ dyskeratotic, ntinye nke ude na calcipotriol na usoro ọgwụgwọ ziri ezi. Dị ka ọtụtụ ọmụmụ si kwuo, mmetụta ọgwụgwọ nke calcipotriol na-etolite n'ime izu 2, nke a na-akwadokwa site na nsonaazụ ọmụmụ anyị - peeling, erythema, na cracks na-arụsi ọrụ ike na njedebe nke izu nke abụọ, nke kpatara nnukwu ọdịiche dị n'etiti DICL. na isi otu na njikwa.
Usoro akwadoro maka ọgwụgwọ ọrịa ụkwụ aka, gụnyere lipoic acid 600 mg kwa ụbọchị ọnụ na ude nwere calcipotriol na betamethasone propionate, nke a na-eji na mpụga ndị ọrịa na-anata multikinase inhibitors maka ọgwụgwọ antitumor, ngwa ngwa na nke ọma na-ebelata mgbaàmà nke PPS. A na-egosipụta nke a na mmụba dị ịrịba ama na dermatological index nke ndụ ndụ dị ka n'oge izu nke abụọ nke ọgwụgwọ na n'ihu mbelata ya, n'ụzọ dị iche na DIQI na njikwa ( p <0.0001).
11.79
0.0147
Nyocha ndekọ ọnụ ọgụgụ
0,5334
Esemokwu nke mmasị. Ndị na-ede akwụkwọ na-ekwupụta enweghị nke doro anya na esemokwu nke mmasị metụtara mbipụta nke isiokwu a.
Kpochapụ ọrịa kansa akụrụ, n ndị ọrịa (%)
2.38
Ogologo oge ọmụmụ
- mgbanwe na ntule nke àgwà ndụ na ndabere nke a ajụjụ n'ụdị eluigwe na ala nke Russified ọkọlọtọ ajụjụ na-ekpebi DIQOL.
0.54
N'oge mmalite (ebe efu), otu dị iche iche na-emekọ ihe n'ihe gbasara foto ahụike, nke gosipụtara site na indices (Table 2). Mgbe otu izu nke ọgwụgwọ gasịrị, a na-ahụ nlọghachi nke usoro akpụkpọ ahụ n'òtù abụọ ahụ, ma n'ime ìgwè ndị bụ isi ọ dị ịrịba ama, ọ bụ ezie na ọ bụghị na ihe niile na-egosi: a na-enweta ọdịiche dị ịrịba ama mgbe a na-enyocha erythema, paresthesia ( p <0.0003), mgbu na mgbu. mmetụta na-ere ọkụ, DICL dịkwa iche iche ugbua na usoro ọgwụgwọ a ( p <0.05); peeling belatara ruo n'ókè dị ukwuu na otu njikwa ( p<0.0004), nke enwere ike ịsị na iji ude nwere urea, nke nwere ihe keratolytic. Mgbe izu 2 nke ọgwụgwọ gasịrị, mmetụta dị mma nọgidere na-adị n'ìgwè abụọ ahụ, ma n'ime ìgwè ndị bụ isi, a na-akọwapụta ya: ndị na-egosi erythema, paresthesia na ọkụ dị iche iche, ma ihe dị iche iche dị ịrịba ama bụ DIQOL - 17.4 na isi otu na 22.8 n'ime otu njikwa ( p <0,0001). Ihe nchịkwa na-esote bụ 3 izu ọgwụgwọ, n'oge a, ọdịiche dị ịrịba ama na uru dị na isi otu na-egosi ihe ngosi nke erythema, desquamation na ndị ọzọ pụtara ọdịiche dị na paresthesia ( p <0.0008) na mgbu ( p <0.0001) indices; DICF na-ejigide nnukwu uru na otu isi ( p0.0001). Na njedebe nke ọmụmụ (mgbe 4 izu ọgwụgwọ gasịrị), a chọtara ọdịiche dị ukwuu na enyemaka nke erythema, paresthesia, mgbu na isi ihe maka nyochaa ịdị irè nke ọgwụgwọ DICV na ndị ọrịa nke otu ọmụmụ ihe dị mkpa. nke p <0.0001 (Table 3).
0,5956
- ihe mgbaàmà nke onwe, kpebisiri ike site na ndị ọrịa na-enyocha mmetụta ha (paresthesia, ọkụ, mgbu) dị ka VAS si kwuo - ihe ngosi ihe ngosi 5-point nke ihe mgbaàmà;
okike (nwoke)
0,1622
55 (32–62)
0.23
7 (54%)
22.85
0,0434
0,9659
6–10
Ntughari ngwa ngwa na enyemaka mbụ nke isi ihe mgbaàmà na-emetụta ogo ndụ na-enweta n'ime otu ndị isi n'oge ọgwụgwọ mgbagwoju anya na alfa-lipoic acid na ojiji mpaghara nke ọgwụ ngwakọta nwere calcipotriol na betamethasone.
A na-eme nnwale ụlọ ọgwụ n'ọtụtụ ebe mepere emepe nke metụtara ndị ọrịa nwere ọrịa aka na ụkwụ.
Nchacha
0,0008
mgbawa
24.08
Ọrịa thyroid, n ndị ọrịa (%)
26.08
Erythema
12 (92.5%)
Tebụl 4. Mmekọrịta dị n'etiti njirimara dermatological nke ndụ ndụ na ngosipụta ụlọ ọgwụ nke LPs
- ogo III - ọnya akpụkpọ ahụ na-egbu mgbu (scaling, blisters, erythema, edema, hyperkeratosis, hemorrhages), na-egbochi nlekọta onwe onye [7-9].
0,3446
- ebumnobi mgbaàmà nke ọrịa ahụ, kpebisiri ike site na onye nchọpụta na-eji IGA index, ihe mgbaàmà (erythema, peeling, blisters, cracks) na-enyocha site na 0 ruo 5 isi n'ihe banyere ịdị njọ, ebe 0 - enweghị ihe ngosi, 1 - ntakịrị, 2 - nwayọọ. , 3 - agafeghị oke, 4 - akpọpụta, 5 - ngosipụta dị oke egwu nke mmeghachi omume palmar-plantar na ọgwụgwọ ezubere iche maka mgbochi tumor;
Mara : * - nkezi akara. A na-eme ka ụkpụrụ p pụta ìhè n'atụghị egwu , na-akwado ihe ndekọ ọnụ ọgụgụ dị iche iche dị n'etiti otu ndị atụnyere.
4.08
0.0291
Mgbu
Ihe ọjọọ
0,9527
0,8741
4.29
Isi mmalite nke ego. Emere ọmụmụ ihe ahụ na ụgwọ onwe onye nke otu ndị edemede.
Usoro na ọnọdụ
Ndepụta Ogo Ndụ Dermatological (DLQI, 0-30)
2.69
Otu isi*
6 (46%)
0,0003
0.46
Usoro mgbochi akwadoro maka ndị ọrịa na-ewere ọgwụgwọ ezubere iche bụ iji gbochie nkụ na mgbakasị ahụ nke akpụkpọ ahụ: iji mmiri ọkụ, uwe dị mma, mmanụ ịsa ahụ, ude mmiri na-ekpo ọkụ, izere akwa ịsa ahụ siri ike, na-eyi akpụkpọ ụkwụ dị mma na silicone soft insoles. Ma, ọ dị mwute ikwu, ọbụna na-arụsi ọrụ ike na mmejuputa iwu ndị dị otú ahụ mgbochi, mmepe nke LPs na-emekarị hụrụ. Ekwesiri iburu n'uche na, n'otu oge ahụ, mmepe nke mmeghachi omume na-egbu egbu bụ ihe ịrịba ama dị mma nke nzaghachi anụ ahụ na ọgwụgwọ antitumor. N'akụkụ a, mmepe nke ụzọ maka ọgwụgwọ na mgbochi nke ọrịa aka-ụkwụ bụ akụkụ dị mkpa interdisciplinary nke dermatology na oncology.
1.38
Ihe njirisi na-abụghị nsonye: ọnụnọ nke ọrịa ọrịa na-adịghị ala ala decompensated; mmanya na-egbu egbu; riri ahụ; ndị ọrịa nwere nnukwu ọrịa anụ ahụ ma ọ bụ nke uche na-achịkwaghị achịkwa nke, n'echiche nke onye nyocha, nwere ike imetụta nsonaazụ ọmụmụ ma ọ bụ gbochie onye ọrịa imezu ihe niile achọrọ n'ọmụmụ ihe; ihe ngosi na anamnesis nke mmeghachi omume ọjọọ na ọgwụ na ihe mejupụtara ọgwụ ndị edepụtara.
Usoro nnabata
0.69
Agbakọbeghị nha nlele ahụ na mbụ. Ndị ọrịa niile zutere njirisi nsonye na bịanyere aka na nkwenye ama ama n'oge oge ndebanye aha gụnyere. Emere nhazi ndekọ aha nke nsonaazụ ọmụmụ site na iji ngwanrọ XLSTAT (ụdị 2014.5.03, Addinsoft, USA). A na-eme nhazi data ndekọ ọnụ ọgụgụ site na iji usoro nkọwa na ọnụ ọgụgụ na-abụghị parametric: a na-ekpebi ihe dị iche iche dị na ụkpụrụ dị iche iche site na iji ule Mann-Whitney, a na-eji ọnụ ọgụgụ mmekọrịta nke Spearman mee ihe iji chọpụta njikọ (a na-ewere ọdịiche dị iche iche dị mkpa na p <0.05).
Isi ihe na-egosi ịdị irè nke ọgwụgwọ na ìgwè ndị a tụnyere ya bụ dermatological index nke ndụ ndụ mgbe 4 izu ọgwụgwọ gasịrị.
- ogo II - ọnya anụ ahụ na-egbu mgbu (scaling, blisters, erythema, edema, hyperkeratosis, hemorrhages), na-egbochi ọrụ kwa ụbọchị (Fig 2);
Na-ere ọkụ
0.38
22.43
1.15
Ọrịa ahụ nwere mmetụta agafeghị oke na ndụ onye ọrịa
Nhazi ọmụmụ
I ogo LPS, n ndị ọrịa (%)
Ndị na-egbochi Tyrosine kinase bụ ọgwụ ọgwụgwọ ezubere iche, usoro ha na-eme ihe na-emetụta mmetụta mgbochi na tyrosine kinases na-anabata ya, ebe ọ bụ ndị na-anabata ya n'elu sel dị iche iche na-arụ ọrụ na-eduga na nzaghachi na mmụba nke mkpokọta uto. ihe. Ndị na-anabata ya bụ tyrosine kinases nke na-anabata transmembrane nke bụ phosphorylated mgbe ejikọtara ya na ligand [6].
p
Paresthesia
3.15
5 (36%)
0.85
Tebụl 3. Ntụle nyocha nke ike nke ngosipụta ụlọ ọgwụ nke LP na otu
2 (15.5%)
<0.0001
Nchịkọta nke isi nsonaazụ ọmụmụ
N'oge ọmụmụ ihe, ọ dịghị ihe ọjọọ metụtara iji usoro ọgwụgwọ dermatological jikọtara ọnụ ka edebanye aha.
II ogo LPS, n ndị ọrịa (%)
0.56
2.46
1.36
Na-ere ọkụ
3.23
mgbawa
Onye ọrịa ọ bụla nwetara ozi zuru ezu gbasara ọmụmụ ihe ahụ ma nye nkwenye doro anya isonye.
54 (31–63)
N'ime otu isi, ebe ndị ọrịa, na mgbakwunye na lipoic acid, na-eji ude na calcipotriol na betamethasone mee ihe, ngosipụta ụlọ ọgwụ n'ụdị erythema, infiltration na desquamation kpamkpam, a hụrụ nhụsianya kachasị ngwa ngwa n'izu mbụ. N'ịtụle nyocha nke mmetụta uche nke ndị ọrịa, a pụkwara ịmara na ọganihu dị ịrịba ama na-eme n'izu mbụ nke ọgwụgwọ.
3
Nyochaa ịdị irè nke usoro ọhụrụ maka ọgwụgwọ ọrịa aka na ụkwụ na ndị ọrịa na-anata multikinase inhibitors.
0,1482
1.69
21.69
10 (71%)
0,8169
Nkọwa
Otu njikwa ahụ gụnyere ndị ọrịa 13 bụ ndị na-eji ude nwere 10% urea, ugboro abụọ n'ụbọchị, na ude nwere 0.05% betamethasone dipropionate, maka iji mpụga, ugboro abụọ n'ụbọchị. Ngwakọta a nke ndị na-ahụ maka mpụga na-agbaso ndụmọdụ ndị bara uru maka ọgwụgwọ ọgwụ nke nsogbu dermatological nke ọgwụgwọ ọgwụ mgbochi ọrịa cancer n'ihe gbasara ọgwụgwọ ọgwụ maka ọrịa aka ụkwụ [13].
Tụkwasị na nke ahụ, ndị ọrịa natara ọgwụgwọ dermatological ọzọ n'ìgwè bụ isi kwuru na ọganihu dị ịrịba ama na ọrụ na ndụ kwa ụbọchị, ọdịmma n'ozuzu, na ọnọdụ ọnọdụ, bụ nke mere ka ndụ dịkwuo mma. Ekwesiri iburu n'uche na ọ dịghị onye ọ bụla n'ime ndị ọrịa a na-ahụ anya sitere na otu abụọ ahụ chọrọ mbelata dose nke multikinase inhibitor na nkwụsị nke usoro ọgwụgwọ antitumor.
0,8642
0.59
0.86
afụ
Erythema
0,5969
Mkpa:
- moisturizer CeraVe ® SA.
- Tinye aka na ụkwụ n'ime mmiri ọkụ ma ọ bụ ebe ịsa ahụ dị ọkụ.
- Jiri ude ma ọ bụ ude na-adịghị esi ísì ụtọ nke nwere ngwaahịa mmanụ ala, dị ka:
- ọnya;
- Regorafenib ( Stivarga® )
- ọgwụ ndị na-ewepụ oke akpụkpọ anụ;
- ọgwụ antimicrobial (ọgwụ ndị na-egbu microorganisms);
-
-
- salicylic acid (na-egbu egbu);
- na-abawanye mgbu ma ọ bụ ahụ erughị ala;
- Vemurafenib ( Zelboraf® )
- Doxorubicin (Adriamycin® )
Ọrịa aka-ụkwụ na mmeghachi omume akpụkpọ ụkwụ aka
-
- na-abawanye ọbara ọbara ma ọ bụ ọzịza;
-
- isi na-adịghị mma site n'aka na ụkwụ;
-
- Pazopanib (Votrient® )
-
- Sorafenib (Nexavar® )
- akpukpọ-okpukpu nke-ọka;
- Cabozantinib ( Cometriq® )
- ọ bụrụ na ị karịrị afọ 18, ị nwekwara ike iji ụzọ ndị dị n'okpuru ebe a; ejila ha ma ọ bụrụ na ị nọ n'okpuru afọ 18:
- Yiri akwa sọks owu dị nro na akpụkpọ ụkwụ niile. A na-atụ aro ka iji insoles ụfụfụ na-amị amị na ihe nkpuchi iji belata nrụgide akpụkpọ ụkwụ na ụkwụ.
Mgbaàmà nke mmeghachi omume akpụkpọ anụ palmoplantar na-apụtakarị n'akụkụ ahụ a na-enwe nrụgide siri ike, dị ka bọọlụ nke mkpịsị ụkwụ, n'etiti mkpịsị ụkwụ, na n'akụkụ ụkwụ.
- Udderly Smooth® ;
- Cytarabine ( Cytosar- U® )
-
- akpụkpọ ahụ siri ike, na-ekpo ọkụ, ma ọ bụ na-ekpo ọkụ na-emetụ aka;
- Yiri sọks, tights, ma ọ bụ akpụkpọ ụkwụ nke siri ike nke ukwuu, Mgbaàmà nke ọrịa ụkwụ aka na mmeghachi omume akpụkpọ ụkwụ nwere ike ịpụta 3 ruo 6 izu mgbe ịmalitere chemotherapy. Dabere na ọgwụ ị na-aṅụ, aka gị na ọbụ ụkwụ gị nwere ike igosi nke ọ bụla n'ime mgbaàmà ndị a:
Palmar-plantar syndrome
-
- mgbu dị nkọ ma ọ bụ na-ere ọkụ, karịsịa n'ọnụ mkpịsị aka na mkpịsị ụkwụ;
Ndị a bụ ọgwụ a na-etinye ozugbo na akpụkpọ ahụ. Ndị a gụnyere:
-
- Mepee ọnya. Tinye mmanụ mmanụ dị ka Vaseline® ma were bandeeji kpuchie ya (Band-Aid® ) .
A machibidoro ya iwu:
Ọgwụ ndị edepụtara n'okpuru nwere ike ibute ọrịa aka na ụkwụ.
- Sunitinib ( Sutent® )
- urea ude;
- ntakịrị ma ọ bụ akpọ ọbara ọbara;
- Ozi a na-akọwa ihe mgbaàmà nke ọrịa aka-ụkwụ na mmeghachi omume akpụkpọ ụkwụ na otu esi ejikwa ha.
- Ime ihe ọ bụla gụnyere ịcha aka ma ọ bụ ụkwụ gị, karịa itinye obere ude ma ọ bụ ude.
- mwepu nke agba odo na-egbuke egbuke ma ọ bụ akwụkwọ ndụ akwụkwọ ndụ;
- Dọkịta gị nwere ike ịnye ọgwụ ọgwụ n'elu iji gwọọ mpaghara nsogbu.Kpọọ onye na-ahụ maka ahụike gị ma ọ bụrụ na ị nweta ihe ọ bụla n'ime ihe ndị a.
-
- ndị steroid;
- ihe na-eme ka ọkpụkpụ na-egbuke egbuke Kerasal ® Otu Nzọụkwụ Na-ekpochapụ Ụkwụ Moisturizer Therapy ™ ;
- Vandetanib ( Carelsa® )
- mgbaàmà na-adịgide ma ọ bụ na-akawanye njọ;
- Fluorouracil (5-FU® )
- Ọ bụrụ na mgbaàmà na-akawanye njọ, dọkịta gị nwere ike ịnye ọgwụ ọnụ (nke a na-aṅụ) iji belata mgbu ma ọ bụ ọzịza.
- Liposomal doxorubicin (Doxil® )
Ọrịa aka ụkwụ na mmeghachi omume akpụkpọ ụkwụ bụ ọnọdụ na-emetụta akpụkpọ ahụ n'ọbụ aka na ọbụ ụkwụ. Enwere ike ịkpata ọnọdụ a site na ọgwụ ụfọdụ ejiri n'oge chemotherapy.
Mgbaàmà
-
- okpomọkụ 100.4°F (38°C) ma ọ bụ karịa;
Mwepụ nke mgbaàmà
-
- ọbara ọgbụgba.
-
- ihe mgbochi mmiri, dị ka Dermabond® , maka imechi ọnya na aka ma ọ bụ ụkwụ.
-
- Axitinib ( Inlyta® )
-
-
- capecitabine (Xeloda® );
- ihe mgbu;
- Mee ka aka na ụkwụ gị mmiri nke ọma. Iji mee nke a, gbanye ha na mmiri dị jụụ maka nkeji 20-30, kpoo ya na akwa nhicha ahụ, wee tinye ihe na-esi ísì ụtọ na-enweghị isi dị ka Eucerin ® . A ghaghị ime nke a ọbụlagodi otu ugboro n'ụbọchị.
Ọgwụ ndị edepụtara n'okpuru nwere ike ibute mmeghachi omume ụkwụ.
- nke ọ bụla n'ime ihe mgbaàmà ndị a na-apụta na akpụkpọ aka ma ọ bụ ụkwụ: Mgbaàmà nke ọrịa aka-ụkwụ na mmeghachi omume akpụkpọ ụkwụ nwere ike ịdịgasị iche n'ịdị njọ, site na ahụ erughị ala ruo nrịanrịa nke nwere ike igbochi gị ime ihe omume ị na-emebu. O nwere ike isiri gị ike iburu obere ihe dị ka mkpịsị akwụkwọ ma ọ bụ ndụdụ. Ọ nwere ike isi ike ịgbanye bọtịnụ na uwe. Ọ na-esiri ụfọdụ ndị ike ịga ije.
- moisturizers;
- Were saa ahụ dị ọkụ.
-
Ọgwụ ndị nwere ike ịkpata mmeghachi omume
Soro ndụmọdụ ndị dị n'okpuru iji nyere gị aka imeri mgbaàmà ndị a.
- ajụjụ ọ bụla ma ọ bụ nsogbu a na-atụghị anya ya.
- Yiri uwe elu owu dị arọ mgbe ị na-arụ ọrụ n'ime ụlọ ma ọ bụ n'èzí ụlọ, dị ka ihicha ụlọ, ịkọ ugbo, ma ọ bụ ịzụ ahịa ihe oriri.
-
Kedu mgbe ị ga-akpọtụrụ onye na-ahụ maka ahụike gị?
Mgbaàmà na-akwụsịkarị mgbe ọgwụ chemotherapy belatara ma ọ bụ kwụsịchaa usoro ọgwụgwọ. Akpụkpọ ahụ na-amalite ịgbake mgbe izu ole na ole gasịrị.
- Dabrafenib ( Tafinlar® )
- akpụkpọ ahụ kpọrọ nkụ, gbawara agbawa, gbawara agbawa, ma ọ bụ nke gbajiri agbaji;
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Palmar-plantar mmeghachi omume akpụkpọ anụ
Gwa onye nlekọta ahụike gị ozugbo ị nwere mgbaàmà. Jide n'aka na ị ga-agwa dọkịta gị ma ọ bụrụ na ị nwere ọrịa shuga, ọrịa vaskụla, ma ọ bụ neuropathy peripheral. Ọrịa ndị a na-ebute mbibi nke akpụkpọ ahụ, gbochie ọnya ọnya ma nwee ike ibute ọrịa.
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N'ọrụ nke R. Mössner et al. [36] gbaghaara njikọ nke DILI na mmụgharị na mkpụrụ ndụ IL 36 RN , ebe njikọ nke DILI nwere mgbanwe na mkpụrụ ndụ CARD 14 na 8 n'ime ndị ọrịa 251 nwere DILI.
Enwere akụkọ ole na ole maka DILI n'ihi nfụkasị metal [45-47].
Achọpụtara na usoro mkpali dị iche na "n'oge" na ọnya psoriatic tozuru okè. Ya mere, na "n'oge" foci, mkpụrụ ndụ nke ihe mgbochi ebumpụta ụwa (neutrophils, sel mast na-arụ ọrụ, wdg) na interferon-a na-emepụta plasmacytoid dendritic sel (pDC) na-ebutekarị, ebe T-lymphocytes na macrophages bụ ihe e ji mara ihe n'oge [16]. (Fig 2).
Agbanyeghị, na ọmụmụ German nke P. Weisensel et al. [56] ahụghị njikọ dị n'etiti DILI na enweghị ndidi gluten.
ọrịa celiac Mmụba na mmụba nke nnabata gluten na ọmụmụ Swedish nke M. Eriksson et al. Achọpụtara [39] na 10 n'ime ndị ọrịa 39 nyochara. Ekwenyere data ndị a site na nyocha nke G. Michaëlsson et al. [55], onye chọpụtara ọgwụ mgbochi IgA na gliadin na 17.9% nke ndị ọrịa 123 nwere DILI. N'ime ndị ọrịa a, a na-ahụta ọganihu ma ọ bụ mgbaghara nke usoro akpụkpọ ahụ na ndị mmadụ na-agbaso nri na-enweghị gluten ruo ọtụtụ ọnwa.
Pustules nwere ike ịgbakọta wee kwụsị mgbe ụbọchị ole na ole gachara, na-ahapụ ntụpọ aja aja. Erythema na-akpachapụ anya nke ọma na-agbakọkarị ihe gbasara pustulation [2, 3, 6].
Focal ọrịa . Ọrịa tonsillitis na-adịghị ala ala na nke na-adịghị ala ala, sinusitis na-adịghị ala ala, ọrịa eze nwere ike jikọta ya na ọnya pustular nke ọbụ aka na ọbụ ụkwụ. Ọnụ ọgụgụ dị ukwuu nke ọrụ na-akwado mmụba ma ọ bụ mmepe nke DILI mgbe ọrịa ma ọ bụ mmụba na foto ahụike nke DILI mgbe ọgwụgwọ nke foci nke ọrịa na-adịghị ala ala nke tonsils bụ ndị ọkà mmụta sayensị Japan bipụtara [42-44].
Nke mbụ na-egosipụta echiche nke akụkọ ihe mere eme na ọnya pustular nke nkwụ na ọkpụkpụ na-agụnye n'ụdị ọnya akpụkpọ anụ psoriatic ma na-akpọ ya "psoriasis pustular nke nkwụ na ụkwụ", ma ọ bụ "Pustular psoriasis nke ụdị Barber". A nabatara usoro a ogologo oge ma kwado ya site na myirịta nke ọtụtụ njirimara: ngosi ụlọ ọgwụ nke dermatosis, afọ mmalite nke ọrịa ahụ, ọnụnọ nke akụkọ ihe mere eme ezinụlọ nke psoriasis na 10-43% nke ikpe, ihe omume nke ọrịa. ntu na nkwonkwo ọnya, ọnụnọ nke ọnya psoriatic n'èzí n'ọbụ aka na ọbụ ụkwụ na ụfọdụ ndị ọrịa nwere DILI [2].
Dị ka usoro nhazi ọkwa nke atọ si dị, a na-ekewa psoriasis pustular mpaghara n'ime akụkụ atọ nke nosological: acrodermatitis na-adịgide adịgide pustular Hallopeau, DILI, na pustular psoriasis nke ọbụ aka na ọbụ ụkwụ.
Ndị ọrịa nwere DILI nwere ike ịmalite ngosipụta ụlọ ọgwụ ndị ọzọ, gụnyere ọnya na-abụghị pustular nke akpụkpọ ahụ dị nro, onychodystrophy, na ogbu na nkwonkwo.
Na mgbakwunye, IL-17A, nke na-eme ihe n'ụzọ autocrine, nwere ike ịmepụta neutrophils n'onwe ha [22, 23].
N'ime nnyocha R. Bissonnette et al. [27] chọtara mmụba 89 na 190 ugboro na okwu IL-17A na ihe nlele anụ ahụ sitere na ndị ọrịa nwere palmoplantar pustular psoriasis na DILI, n'otu n'otu, ma e jiri ya tụnyere njikwa ahụike. N'otu oge ahụ, achọpụtaghị mmụba nke okwu IL-12 / IL-23, bụ nke dị iche na foto dị na psoriasis vulgaris, ebe mmụba 72 na-abawanye na okwu IL-17A na 22- A na-ahụta mmụba nke mpịaji na IL-23.
Enwere njikọ dị n'etiti njikọ nke IFN-a na TNF-a (Fig 3): nkwụsị nke otu n'ime cytokines na-eduga n'ịbawanye mmepụta na, ya mere, mmetụta nke ọzọ, na ntụgharị. Ihe omume a nwere ike ịkọwa okwu gbasara mmụba ma ọ bụ ntinye nke psoriasis na ndị ọrịa na-anata usoro ọgwụgwọ usoro ndu na ndị na-emechi TNF-a. N'ime 40-60% nke ikpe ndị dị otú ahụ, DILI na-anọchi anya rashes [12, 25].
Mgbanwe osteoarticular na-ebutekarị ngosipụta akpụkpọ ahụ, mana enwere ike ịpụta n'otu oge ma ọ bụ soro ọnya anụ ahụ [52]. Na mgbakwunye na DILI, rashes na SAPHO syndrome nwere ike ịnọchite anya psoriasis, conglobate na acne zuru oke, na-emebi Hoffmann folliculitis, na suppurative hidradenitis.
Palmar-plantar pustulosis (PPP) bụ ọrịa akpụkpọ anụ ahụ na-adịghị ala ala nke a na-eji na-emepụta pustules na-adịghị mma na ọbụ aka na ọbụ ụkwụ yana usoro nlọghachi azụ na-adịgide adịgide. N'otu oge ahụ na pustules na-elekwasị anya, a na-ahụ ntụpọ na-acha odo odo-agba aja aja na-acha odo odo n'ọnọdụ ebe a na-edozi pustules na cracks. Ọtụtụ mgbe usoro a na-aga n'ihu megide ndabere nke erythema na desquamation (Fig 1).
Dị ka a na-achị, DILI na-emetụta ndị mmadụ n'ime afọ iri nke ise ma ọ bụ isii nke ndụ. Dika nyocha nlegharị anya nke ndị ọrịa 39 nwere DILI, nkezi afọ ndị ọrịa nwere mmalite nke ọrịa ahụ bụ afọ 48 [2]. Ụmụ nwanyị nwere ike ịrịa ọrịa: dịka data dị iche iche [2] si kwuo, oke nke ndị ọrịa nwanyị bụ 58-94%.
Ihe ndabere maka nke a bụ data na ọdịiche dị n'etiti DILI na psoriasis. Ya mere, DILI adịghị ejikọta ya na isi ihe na-achọpụta mkpụrụ ndụ ihe nketa nke psoriasis vulgaris - HLA-cw6, HCR * wwcc, CD SN nke mpaghara PSORS-1 [9]. Ebumnuche bụ isi nke mbufụt na DILI bụ acrosyringium, akụkụ epidermal nke eriri afọ nke ọsụsọ, nke na-etinye aka na nhazi nke pustule. Dị ka ọtụtụ ọmụmụ [10] si kwuo, a naghị achọpụta nke ikpeazụ n'oge ọmụmụ histological na immunohistochemical nke akpụkpọ anụ nke ndị ọrịa na-eme ka DILI dịkwuo njọ. N'otu oge ahụ, na akpụkpọ anụ nke ndị ọrịa, a na-ekpebi immunostaining na-adịghị ike nke tumor necrosis factor-a (TNF-a), bụ nke a na-akpọ nke ọma karịa na akpụkpọ ahụ dị mma, na ọbụna karịa na akpụkpọ ahụ nke ndị ọrịa nwere psoriasis [11] ]. N'ikpeazụ, DILI na-etolitekarị n'oge ọgwụgwọ psoriasis na ndị ọrụ ndụ [12].
Achọpụtala njikọ nke DILI nwere ọtụtụ ọrịa sistemu.
Na nyocha nke N. Setta-Kaffetzi et al. [30], a chọtara mmụgharị IL36RN na 7 n'ime ndị ọrịa 84 nwere psoriasis pustular zuru oke, na 3 n'ime ndị ọrịa 139 nwere DILI, yana na 2 n'ime ndị ọrịa 9 nwere Hallopeau acrodermatitis.
Ọdịdị Th 17 gụnyere IL-1B, IL-23 zoro ezo site na mDC, yana pDC site na ọtụtụ chemokines [16, 21] (lee Fig. 2).
2017;16 (3): 4-12 .
Clinical dermatology na venereology. 2017;16 (3): 4-12
Otu echiche nke pathogenesis nke DILI adịghị adị taa.
Ọrịa na-efe efe
N'agbanyeghị oke akụkụ nke ọnya akpụkpọ ahụ, DILI nwere ike inwe mmetụta dị njọ na ndụ ndụ. Ndị ọrịa na-enwekarị nchegbu banyere itching, ọkụ ọkụ na mgbu na mpaghara mgbawa. N'ọnọdụ ndị siri ike, na ọnya ụkwụ, ihe isi ike ịga ije nwere ike ime, na mmebi aka ọrụ na-akpaghasị mmekọrịta ọha na eze nke ndị ọrịa [1].
Clinical foto na N'ezie
Ịṅụ sịga. A maara njikọ dị elu nke DILI na ise siga. Ndị na-ese anwụrụ bụ 42-100% nke ndị ọrịa nwere DILI [2]. Otu esi enweta mmekọrịta a emebeghị. Eleghị anya, nicotine, na-eme dị ka agonist nke nicotinic acetylcholine receptors, na-emetụta ọrụ nke sweat glands na keratinocytes [38, 39]. A makwaara na nicotine in vitro na -akpali neutrophils imepụta IL-8 [14].
Na 2011, Marrakchi et al. Achọpụtara na nke mbụ mgbanwe na-adịghị arụ ọrụ na IL-36 antagonist gene (IL36RN) n'ime ezinụlọ itoolu Tunisia nwere ụdị nkwụghachi azụ nke autosomal nke psoriasis pustular. Akpọrọ ọrịa a IL-36 antagonist deficiency (DITRA) [13]. Mgbe e mesịrị, a chọpụtara na ọ bụghị nanị ụdị ezinụlọ nke pustular psoriasis, kamakwa Hallopeau acrodermatitis nwere ike ịbụ ngosipụta ahụike nke DITRA [29].
Enweghị ụbara mmepụta nke IL-12 (otu n'ime isi ihe na-akpali akpali nke Th1 dị iche iche ) na-egosi na ịgbalite ụzọ autoimmune a abụghịkwa isi na DILI [27].
Ihe data mkpụrụ ndụ ihe nketa enwetara na-agba akaebe na etiological na pathogenetic heterogeneity (ya na otu ụdị foto ụlọ ọgwụ nke rashes) n'ime otu ọrịa ndị ekwuru na mbụ n'ụdị psoriasis pustular. Ozi a na-enye ohere ịme mgbanwe dị iche iche nke nosological na ọkwa ọhụrụ na mmepe nke nhazi ọhụrụ nke dermatosis pustular na-egbuke egbuke, gụnyere mpaghara palmoplantar.
Ọgwụ. Enwere ọtụtụ akụkọ banyere mmepe nke DILI n'oge ọgwụgwọ na ndị na-emechi TNF-a [11, 12, 25, 48, 49]. Pustular ọnya nke ọbụ aka na ọbụ ụkwụ bụ ihe dị ka ọkara nke ikpe psoriasis niile metụtara ọgwụgwọ na TNF-a blockers [12,25]. A na-eche na mbelata mmepụta nke TNF-a na-eduga na hyperproduction nke IFN-a site na pDC precursors, nke na-eduga ná ntinye nke nzaghachi mkpali na DILI [12].
N'ime ọmụmụ ihe a, e guzobere ngalaba-localization nke IL-17A na neutrophil elastase, nke, dị ka e kwuru n'elu, nwere ike igosi mkpa mmepụta autocrine nke IL-17A site na neutrophils [27].
Osikapa. 5. Mmebi nke mbọ na LPP. Pustule subungual nwere oke onycholysis (n'aka ekpe) yana akara thimble nwere oke onycholysis (n'aka nri) N'oge mbụ a, histopathology nke psoriasis nwere njirimara niile nke ọrịa autoinflammatory na-ebute IL-1 [16].
Dermatosis na-emetụta tumadi ụmụ nwanyị dị etiti.
Agbanyeghị, data ewepụtara na-ejedebe site na ọnụ ọgụgụ dị nta nke nyocha na ọmụmụ ihe ma chọọ nkọwa ọzọ.
N'akụkụ a, data na-adịbeghị anya na-egosi mmụba nke anụ ahụ na ọkwa serum nke IL-17A na ndị ọrịa na-aṅụ sịga na-eme ka periodontitis na-akpali mmasị. Nyere njikọ dị elu nke DILI na ise siga, a pụrụ iwere ihe a dị ka ihe nwere ike ime ka mmepụta IL-17A dịkwuo elu na akpụkpọ nkwụ na ụkwụ na DILI [27].
IFN-a na-eme ka mmejuputa usoro ndị na-esote nke nzaghachi mkpali na-enwe ike igbochi mmepụta nke IL-1 na ntinye nke inflammasomes na sel immunocompetent [16] (lee Fig. 2).
A na-ekwenyekwa n'echiche bimodal n'ọtụtụ nyocha ụlọ ọgwụ. Ya mere, a kọwawo mkpebi zuru oke nke psoriasis na iatrogenic agranulocytosis nke ọgwụ na-akpata, na, n'aka nke ọzọ, ọgwụ Th1 na- emepụta, dị ka IFN-a ma ọ bụ imiquimod, na-eme ka psoriasis dịkwuo njọ [26].
Ihe na-akpasu iwe
Ọchịchị nke nzaghachi autoinflammatory na-eme ka ọtụtụ ndị edemede [13] tụlee DILI dị ka autoinflammatory pustular neutrophilic dermatosis tinyere DIRA, DITRA, SAPHO syndrome, wdg.
Palmar-plantar pustulosis: pathogenetic, ụlọ ọgwụ na epidemiological atụmatụ. Clinical dermatology na venereology.
Ọnụnọ nke psoriasiform ọnya n'èzí n'ọbụ aka na ụkwụ, mgbe ụfọdụ a na-ahụ na ndị ọrịa nwere DILI, a na-atụ aro ka a na-ewere ya dị ka ihe ọkụ ọkụ nke DILI n'èzí n'ọbụ aka na ụkwụ ( extra - palmoplantar lesions ) , ma ọ bụghị dị ka psoriatic foci, nke bụ ụlọ ọgwụ na ụlọ ọgwụ. akwadoro n'akụkọ ihe mere eme (ihe na-esighi ike pụta n'elu anụ ahụ).
A na-ahụkarị okwu ahụ bụ "palmoplantar pustulosis" n'akwụkwọ ọgbara ọhụrụ, Otú ọ dị, ọtụtụ ndị na-ede akwụkwọ na-arụrịta ụka na nsonazụ Council, na okwu ahụ bụ "pustular psoriasis nke nkwụ na ọbụ ụkwụ" ka na-eji n'akwụkwọ.
Petersburg State University, St. Petersburg, Russia, 199034
N'iburu n'uche ịdị n'otu nke mmalite nke DILI na psoriasis, ọ bụ ihe amamihe dị na ya ileba anya na data kachasị ọhụrụ na pathogenesis nke psoriasis vulgaris.
Osikapa. 1. Foto ụlọ ọgwụ nke palmar-plantar pustulosis. Tụkwasị na nke ahụ, ọdịdị ahụike nke ọrịa psoriatic na-egosipụta ọdịdị dị iche iche na ụdị mbufụt. Neutrophilic infiltrate dị na pustular psoriasis, ebe T-lymphocytes na-abụkarị na plaques tozuru okè nke psoriasis vulgaris.
Ọtụtụ ọmụmụ [10, 14] chọtara nchịkọta nke mkpụrụ ndụ pro-inflammatory na cytokines gburugburu acrosyringium, nke a na-ewere dị ka isi ihe mgbaru ọsọ nke nzaghachi mkpali.
Ya mere, psoriasis na-amalite site na mmeghachi omume mkparị IL-1-Th 17 , nke na-esote "mgbanwe" na usoro autoimmune nke mbufụt n'okpuru mmetụta nke pDC-emepụta IFN-a, nke na-eduga na ntinye nke IFN-Y-emepụta. Th 1 banye ọnya dị ogologo.
Nke mbụ "ọkụ" nke mbufụt na-esote mpụta nke sel CD4+, na mmalite mmalite tumadi Th17 , nke bụ ụdị "akwa" n'etiti ihe mgbochi ebumpụta ụwa na mgbanwe [20].
Ihe e ji mara foto ụlọ ọgwụ nke pustulosis n'ọbụ aka na ọbụ ụkwụ bụ n'ichepụta pustules na-adịghị ahụkebe 1-10 mm n'ogo [2, 3, 6]. Akpụkpọ anụ nke aka na-emetụta tumadi na mpaghara nke oke tenor na hypotenor na akụkụ etiti nke nkwụ. N'elu ọbụ ụkwụ, ebe instep, etiti na akụkụ akụkụ nke ụkwụ, na elu mpụta na / ma ọ bụ azụ nke ikiri ụkwụ na-etinyekarị aka na usoro ahụ [7] (lee Fig. 1).
Likhonos LM, Smirnova IO. Pustulosis palmaris et plantaris: pathogenetic, Clinical, na epidemiological atụmatụ. Clinical Dermatology na Venerologiya. 2017;16 (3): 4-12 . (Na Russia).
Ahụhụ akpụkpọ ahụ n'èzí n'ọbụ aka na ọbụ ụkwụ. Mmepe nke psoriasis na-abụghị pustular dị ka ọnya akpụkpọ anụ nke mpaghara ndị ọzọ, dị ka ogwe aka, nku aka, akụkụ azụ azụ nke ụkwụ, shins, ikpere, buttocks, obere oge ICH na-apụta n'ọtụtụ ndị ọrịa [5]. Ngosipụta ndị a na-ahụkarị maka ndị ọrịa nwere ọrịa siri ike [5]. Ọnya n'èzí n'ọbụ aka na ọbụ ụkwụ bụ nke a na-akọwapụta nke ọma nke ọma na ọ na-adịchaghịkwa etinye n'ime ya karịa na psoriasis vulgaris kpochapụwo. Obere oge, pustules n'otu n'otu nwere ike ịpụta [5] (Fig 4).
Ọrịa shuga mellitus ụdị 2. Achọpụtara ọkwa dị elu nke calcium serum na mbelata ọkwa nke hormone parathyroid n'etiti ụmụ nwanyị nwere DILI ma e jiri ya tụnyere otu njikwa nke ndị nwere ahụike na ọmụmụ E. Hagforsen et al. [57]. Otu nnyocha ahụ kwuru na mmụba nke ụdị ọrịa shuga 2 dị n'etiti ndị ọrịa nwere DILI.
Ụzọ na nhazi ọkwa
Ọrịa ogbu na nkwonkwo . Ọtụtụ ndị ọrịa nwere DILI na-ebute ọrịa ogbu na nkwonkwo ma ọ bụ arthralgia. N'ime nyocha azụ azụ nke A. Brunasso et al. [2] n'ime ndị ọrịa 39 nwere DILI, 10 (26%) ndị ọrịa nwere ọrịa ogbu na nkwonkwo, nke kwekọrọ na data akwụkwọ ndị ọzọ.
Ọnya n'èzí n'ọbụ aka na ọbụ ụkwụ, dị na ụfọdụ ndị ọrịa nwere DILI, bụ ọnya psoriasis, nke na-adịkarịghị abanye n'ime ya karịa plaques "classic" nke psoriasis vulgaris.
Likhonos L.M.
N'ime nnyocha nke ndị ọrịa 21 nwere DILI na otu njikwa ( n = 21), dị ka afọ na mmekọahụ, a chọtara nsogbu nchekasị dị elu n'etiti ndị ọrịa nwere DILI (61 na 19%, n'otu n'otu) [41].
Ọrịa nke thyroid gland. N'ime ọmụmụ ihe Swedish nke K. Rosén et al. [53], onye gụnyere ndị ọrịa 50 nwere DILI, hụrụ mmụba nke ọrịa thyroid. M. Eriksson et al. [39] kpughere ndịiche site na uru ntụaka nke ihe ngosi nke opekata mpe otu homonụ thyroid na 17 (43.59%) nke 39 nyochara ndị ọrịa nwere DILI. N'ime ọmụmụ asụsụ Spanish nke R. Giménez-Garcia et al. [54] na 3 nke ndị ọrịa 12 nwere DILI ahọpụtara maka nyocha ụlọ nyocha n'ihi ihe ize ndụ nke onye ọ bụla ma ọ bụ ezinụlọ nwere ike ịkpata ọrịa ọrịa thyroid, achọpụtara ọrịa.
Na nyocha nke K. Sugiura et al. [34] tụnyere ugboro nke mmụgharị na IL 36 RN gene n'ime otu abụọ: ndị ọrịa nwere psoriasis pustular zuru oke na foci nke psoriasis vulgaris na enweghị ha. Achọpụtara mmụgharị na mmadụ 9 n'ime ndị ọrịa 11 na-enweghị psoriasis vulgaris rashes na naanị n'ime 2 n'ime 20 ebe a na-ejikọta ya na psoriasis vulgaris rashes.
Petersburg State University, St. Petersburg, Russia, 199106
Ihe nlereanya a na-akọwa ihe kpatara glucocorticosteroids dị n'elu na-arụ ọrụ nke ọma na ọnya "ochie" na mononuclear cell infiltrate, ebe nnukwu ọnya nwere nnukwu neutrophils na-eguzogide ọgwụ steroid [16]. Ọgwụgwọ na TNF-a-blockers, nke na-arụ ọrụ megide autoinflammatory cytokine TNF-a, na-enye nsonaazụ naanị na 75% nke ikpe [16].
Th 17 na- emepụtakwa ọtụtụ cytokines (IL-17A, IL-17 ° F, IL-21, IL-22, IL-26, GM-CSF, TNF-a, wdg) na-etinye aka na mmepe nke mbufụt na poriasis. Na nzaghachi na mkpali nke ndị na-anabata IL-17, leukocytes, mkpụrụ ndụ endothelial, keratinocytes, na fibroblasts na-emepụta ihe na-akpali akpali nke granulocyte colony (G-CSF), IL-6, na IL-8 na mgbasa ozi neutrophil activation na chemotaxis, na-amalite nke abụọ ife efe. ọrịa neutrophilia [20].
Achọkwu ọmụmụ ihe iji kwado njikọ nke DILI na ọrịa ndị a.
Likhonos L.M., Smirnova I.O.
Ọnya ntu . Ntinye aka ntu bụ ụdị DILI. Enwere ike ịmepụta pustules subundual, onycholysis, akara thimble, onychodystrophy, ma ọ bụ ngbanwe nke mbọ [51] (Fig 5).
Osikapa. 2. Nlereanya nke mmepe nke nzaghachi mkpali na mmalite na ntozu foci nke psoriasis. https://i2.wp.com/doi.org/10.17116/klinderma20171634-12
Dị ka echiche a si dị, nzaghachi autoinflammatory na-achịkwa na guttate na pustular psoriasis, na ọnya psoriatic n'oge. Nzaghachi nke autoimmune Th 1 -mediated bụ njirimara nke plaques tozuru okè, nke neutrophils dị naanị na Munro microabscesses.
Nyochaa akwụkwọ banyere ọnya pustular nke mpaghara palmoplantar ekweghị ka ịmepụta nkwenye na mmalite, pathogenesis na mmekọrịta nke ọrịa ndị dị ka DILI na-adịghị ala ala, pustular psoriasis nke ọbụ aka na ụkwụ, Andrews' pustular bacterids na pustular Hallopeau acrodermatitis na-adịgide adịgide. . N'akwụkwọ ọgbara ọhụrụ, ọtụtụ dermatoses (ma e wezụga Hallopeau acrodermatitis), nke na-egosipụta site na pustules na-adịghị mma na n'ọbụ aka, na-ejikọta ya site na okwu ahụ bụ "palmar-plantar pustulosis", nke dịpụrụ adịpụ site na ngalaba nosological dị iche iche. Otú ọ dị, ọ bụ ezie na ụfọdụ ndị edemede anabatala ụzọ ọhụrụ ma tụlee DILI dị ka ọrịa onwe ya [2-5], ndị ọzọ [6-8] na-ewere DILI ka ọ bụrụ ụdị ọgwụgwọ psoriasis.
Ozi gbasara ọrịa gbasara DILI nwere oke. Dị ka ọmụmụ Swedish si L. Hellgren et al. [37], n'ime akwụkwọ ndekọ ahụike 1971 nke ngalaba ụlọ ọgwụ na-ahụ maka ndị ọrịa, ọnụ ọgụgụ ndị ọrịa chọpụtara na ha nwere pustulosis palmoplantar bụ 0.37%. Ewepụrụ ndị ọrịa nwere psoriasis n'èzí n'ọbụ aka na ọbụbụ na ọmụmụ a.
Nchegbu. Ụfọdụ ndị ọrịa na-akọ na ọrịa ahụ na-akawanye njọ na nzaghachi nke nrụgide, nke mere ka a nyochaa ọnọdụ nke eriri akwara na mpaghara akpụkpọ ahụ metụtara. Achọpụtala njikọ dị n'etiti akwara na mkpụrụ ndụ mast. Tụkwasị na nke ahụ, neutrophils na gburugburu ebe obibi nke pustule na-eme ka ihe dị mma maka ihe P. N'ihi ya, ndị na-ahụ maka ụbụrụ nwere ike ịrụ ọrụ na mmepe nke mbufụt na DILI [40].
Smirnova I.O.
N'aka nke ya, TNF-a na-akpali sel endothelial iji gosipụta polymorphonuclear leukocyte adhesion molecules. Nke a na-eme ka ntugharị nke neutrophils si na capillaries nke oyi akwa papillary banye n'ime dermis na gaba n'ihu na mpaghara subcorneal, na-esote nguzobe nke Munro microabscesses [16]. Ya mere, n'oge a, neutrophils bụ mkpụrụ ndụ mkpali kachasị na-akwaga n'ime epidermis [16].
Na oge nke m, mkpụrụ ndụ dendritic plasmacytoid (pDC) na-apụta na dermis na-elekwasị anya na mbufụt, nke chemerin na ndị ọzọ chemoattractants dọtara na nzaghachi DNA mebiri na IL-1 secretion. Ndị PDC na-etinyekwa aka na-adọta neutrophils na saịtị mbufụt. Otú ọ dị, isi ọrụ ha bụ mmepụta nke IFN-a [16].
Otu ọrịa autoinflammatory, nke na mbụ gụnyere monogenic periodic febrile syndromes ( periodic syndrome fevers ), na-agụnye ọrịa na mmepe nke akụkụ nke mgbochi ebumpụta ụwa na-ekere òkè na-enweghị autoantibodies ma ọ bụ antigen-kpọmkwem T-lymphocytes. N'adịghị ka psoriasis, ọrịa ndị a na-emekarị site na ngbanwe nke otu mkpụrụ ndụ ihe nketa, ya bụ, ọ nwere ụdị ihe nketa monoogenic [28].
Palmar-plantar pustulosis: pathogenetic, ụlọ ọgwụ na epidemiological atụmatụ
N'ime nyocha nke ndị ọrịa 50 nwere DILI, ọnya ntu ntu mere na 15 (30%) n'ime ha. Pustulization nke subunual bụ ọnya ntu a na-ahụkarị [51].
Petersburg State University, St. Petersburg, Russia, 199034
Na usoro nke mbụ, n'okpuru ọrụ nke ndị na-akpata (nje virus, ọgwụ ọjọọ, mmebi cell), ndị na-anabata ihe dị ka (TLR) 7/8, 9 na-arụ ọrụ na cytokines nke ezinụlọ IL-1 (IL-1a, IL-1B). IL-36) na-ahapụ ya na keratinocytes mebiri emebi [17]. IL-1 na-adọta neutrophils na-elekwasị anya, na-eche na ọ na-ebute TNF-a secretion site keratinocytes na neutrophils [18] (Fig. 2).
Ọnụ ọgụgụ nke ndị ọrịa nwere DILI na ọnya na-abụghị ebe palmoplantar siri ike ịkọ, n'ihi na ọtụtụ ọmụmụ [2] kpachapụrụ anya wepụ ndị ọrịa dị otú ahụ. Data e bipụtara na-adịgasị iche iche (site na 4 ruo 73%).
Fig.4. Psoriasiform ọnya na ala ụkwụ na onye ọrịa nwere pustular ọnya nke ụkwụ A maara na IL-17A na DILI na-agbakọba na acrosyringium na nwere ike mepụta ma Th17 na ndị na-adịghị mkpali mkpụrụ ndụ nke acrosyringium [14].
N'ụzọ dị ịtụnanya, n'ime ìgwè ndị ọrịa nwere DILI, ọkwa ngosipụta nke IL-8, otu n'ime ndị chemattractants neutrophil bụ isi, dị iche: enwere mmụba ya n'etiti ndị ọrịa nwere palmoplantar pustular psoriasis na enweghị ọdịiche dị na nkwupụta na DILI ma e jiri ya tụnyere ya. njikwa ahụike. Esemokwu dị otú ahụ nwere ike igosi heterogeneity pathogenetic n'ime ìgwè ọnya pustular na-adịghị ala ala nke n'ọbụ aka na ọbụ ụkwụ.
Isi ihe dị mkpa, dị ka nke a na-ekewa rashes na DILI na pustular psoriasis nke ọbụ aka na ụkwụ, bụ ọnụnọ nke psoriasiform foci na mpaghara ndị ọzọ nke akpụkpọ anụ. N'otu oge ahụ, a na-ekwusi ike na myirịta dị na foto histological na profaịlụ cytokine nke ọrịa abụọ ahụ na-egosi otu ụzọ pathogenetic maka mmepe nke dermatoses, n'agbanyeghị ọdịiche mkpụrụ ndụ ihe nketa [4, 7, 13].
Otú ọ dị, nzuzo nzuzo nke IFN-a na-aga n'ihu na-enye ọrụ T-cell na ịgbanye na njikọ nke autoimmune nke na-egbuke egbuke, na-esote IFN-Y-producing Th 1 . Ka usoro ahụ na-aghọwanye nke na-adịghị ala ala, TNF-a zoro ezo na nnukwu mDC, yana Th17 na Th1 , na-enye nkwụsị nke IFN-a nzuzo na foci tozuru okè site na mkpali nke pDC maturation [12, 24], ọnụ ọgụgụ nke ikpeazụ. na-ebelatakwa na mwepu nke chemerin na ndị ọzọ chemoattractants [16] (lee fig. 2).
Otú ọ dị, mgbe ị na-atụle pathogenesis nke DILI n'ime usoro nke echiche dị n'elu, ihe kpatara ọdịdị doro anya nke mmeghachi omume autoinflammatory n'elu autoimmune na-anọgide na-edoghị anya.
Osikapa. 3. Ụdị mmetụta mmetụta nke INF-a na TNF-a.
Mmechi
DILI bụ ọrịa akpụkpọ anụ ahụ na-adịghị ala ala nke na-enwekarị pustules na-adịghị mma n'ọbụ aka na/ma ọ bụ ọbụ ụkwụ.
Nyere na IL-36 bụ nke ezinụlọ IL-1 nke cytokines, data ndị a na-adọrọ mmasị. Karịsịa n'ihi akụkọ banyere ịdị irè dị elu na ọgwụgwọ ụfọdụ nke psoriasis pustular na IL-1 antagonist antagonist anakinra (anakinra) [31-33].
Ihe e kwuru n'elu nwere ike igosi ọnụnọ nke ụfọdụ ngọngọ na mmepe nke mmeghachi omume autoimmune na DILI na ọkwa mDC ma ọ bụ na ọkwa gara aga.
N'ihi ya, e nwere ụzọ atọ bụ isi maka nhazi nke DILI na-adịghị ala ala.
Ọtụtụ mgbe, a na-emetụta aka na ụkwụ n'otu oge, mana ọ bụ naanị akpụkpọ ọbụ aka ma ọ bụ naanị ụkwụ nwere ike imetụta [2, 39]. Usoro a na-abụkarị akụkụ abụọ, mana ọ nwere ike ịbụ otu akụkụ, ọkachasị n'oge ọrịa ahụ [37].
N'ime ọnụ ọgụgụ dị ịrịba ama nke ndị ọrịa, a na-emetụta efere ntu, na ọrịa ogbu na nkwonkwo nwere ike ịmalite. Pustulosis nke ọbụ aka na ọbụ ụkwụ nwere ike ịbụ otu n'ime ngosipụta akpụkpọ ahụ nke ọrịa SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis). A chọrọ nyocha ndị ọzọ iji kọwaa njikọ nke DILI na ọrịa thyroid, ụkọ gluten, na ụdị ọrịa shuga 2. Data na pathogenesis nke DILI dị ụkọ na njedebe site na ọnụ ọgụgụ dị nta nke nlele. A kọwo njikọ dị elu nke ọrịa na ise siga. Mgbe ị na-atụle DILI dị ka ụdị ọnya psoriatic, ihe kpatara ịkpọpụta ikike mgbochi ebumpụta ụwa n'elu nke enwetara ka bụ ihe omimi. N'afọ ndị na-adịbeghị anya, ekele maka nchọpụta nke ọrụ mmụgharị na IL 36 RN geneỌtụtụ ọrịa ndị a na-ewerebu na ha metụtara DILI (ụdị ụfọdụ nke psoriasis pustular (DITRA), Hallopeau acrodermatitis) malitere ịsị na ọ bụ monoogenic autoinflammatory pustular dermatoses.
Achọpụtara usoro nke abụọ n'ikpeazụ na 2007, mgbe n'oge ọrụ nke International Council na nsogbu psoriasis (The International Psoriasis Council, nke a na-akpọ ya Council), pustular psoriasis nke n'ọbụ aka na ọbụ ụkwụ na-apụtara dị ka nosological nọọrọ onwe ya. unit, nke a tụrụ aro maka okwu ahụ bụ " palmar " .
Ruo n'oge na-adịbeghị anya, a na-ewere psoriasis vulgaris dị ka ọrịa nwere akụkụ autoimmune, nke na-egosi ikere òkè na mmepe nke usoro ọgwụgwọ ọrịa nke enwetara, nke na-ebute usoro mkpali na profaịlụ Th1 cytokine [15]. N'oge a, a na-anabatakarị tiori nke bimodal immune activation na psoriasis, nke pụtara itinye aka na njikọ nke ebumpụta ụwa na nke enwetara na mmepe nke ma autoinflammatory na autoimmune mmeghachi omume, n'otu n'otu [16].
Echiche nke oge a nke pathogenesis
Antimicrobial peptides (AMPs), gụnyere CAMP (LL37), kpaliri site na mmebi cell, na-etinye aka na ntinye nke IFN-a synthesis site na plasmacytoid dendritic cell. Ihe mgbagwoju LL37/RNA na ụdị 1 interferon nwekwara ike ịgbalite mkpụrụ ndụ dendritic myeloid (mDC) [19]. Chemokine CCL20 zoro ezo site na keratinocytes na nzaghachi mmebi na n'okpuru mmetụta nke TNF-a na-ekerekwa òkè n'ịgba CD11c + mDC na CCR6 + IL-17 na-emepụta mkpụrụ ndụ T (lee Fig. 2) [19].
Epidemiology
Ihe data ndị a na-egosi ụdị dị iche iche nke pathogenetic n'ime ìgwè ndị ọrịa nwere ọnya pustular na-adịghị ala ala, gụnyere mpaghara palmoplantar, nke chọrọ nyocha ọzọ iji mepụta nhazi mkpụrụ ndụ ihe nketa ọhụrụ nke dermatoses pustular na-adịghị ala ala.
DILI nwere ike ịdị ndụ ruo ọtụtụ afọ na iri afọ, na-enwe oge ọgbaghara na obere mgbaghara [50]. Ọrịa a na-ebelata ịdịmma ndụ nke ọma, na-ebute ahụ erughị ala ma na-ebute nsogbu arụ ọrụ [3].
Nchịkọta dị otú ahụ na-enweghị mmụba na IL-23 bụ ihe na-adọrọ mmasị ma na-atụ aro na IL-23 nwere ike ọ gaghị abụ isi ihe mkpali maka ntinye nke okwu IL-17A na DILI, n'ụzọ dị iche na psoriasis.
Na nyocha na nso nso a [35] nke IL 36 RN mutation ọnụego n'etiti ndị ọrịa China, a chọtara mmụgharị na 75% nke ndị ọrịa 32 nwere psoriasis pustular zuru oke, na ọnụ ọgụgụ kachasị elu (93.8%) na ndị nwere Hallopeau acrodermatitis aka ọnya. Ọzọkwa, a chọtara mmụgharị na mkpụrụ ndụ IL 36 RN n'ime mmadụ 2 n'ime ndị ọrịa 14 nwere DILI. Mgbanwe c.115+6T > C bụ nke a na-ahụkarị.
E. Christophers et al. [16] tụrụ aro na ọdịdị dị iche iche nke foto ahụike na akụkọ ihe mere eme nke psoriasis nwere ike igosipụta ụdị "mgbanwe" site na oge autoinflammatory gaa na autoimmune [16].
Ọrịa SAPHO , aha ya bụ akwụkwọ ozi mbụ nke isi ihe mgbaàmà (synovitis - synovitis, acne - acne, pustulosis - pustulosis, hyperostosis - hyperostosis na osteitis - osteitis), bụ ọrịa ogbu na nkwonkwo na-adịghị ahụkebe nke e ji ọtụtụ mmeghachi omume akpụkpọ anụ neutrophilic, otu n'ime ngosipụta nke ya bụ DILI [13, 52]. Ọrịa ogbu na nkwonkwo na ọrịa SAPHO na-agụnyekarị obi azụ ma nwee ike ịpụta na mgbu, fragility, na ọzịza na sternum na nkwupụta ya.
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Gọvanọ Soludo Ekwenwòólá Nkwa Ịkwàlite Ọkụ Latirik n'Anambra
Izunna Okafor dere akụkọ a
Aka na-achị steeti Anambra bụ Gọvanọ Chukwuma Soludo ekwunwòólá na ọchịchị ya nwere ezi mmasị n'ịkwàlite ọdịmma steeti ahụ na ụmụafọ ya, site n'ịhụ na ihe dị icheiche e ji enyere ndụ aka na ihe na-akwàlite mmepe na ọdịmma obodo akọghị ụkọ na steeti ahụ.
Gọvanọ Soludo kwupụtàrà nke a ụbọchị Wenezdee n'okwu ya na mmemme ịtọ okwute ntọala maka ịrụ ogige ọkụ latirik bụ ‘power station’ ike ya ruru 132KV n'Aguleri, dị n'okpuruọchịchị ime obodo Anambra East.
N'okwu ya na mmemme ahụ, nke weere ọnọdụ n'Umuekete Igboezulu Aguleri, Gọvanọ Soludo, nke ọ bụ Kọmishọna na-ahụ maka ọkụ na mmiri na steeti ahụ, bụ Injinia Julius Chukwuemeka nochitèrè anya ya n'ebe ahụ mèrè ka a mara na ogige ahụ ga-enye obodo dịgasị na mpaghara ọgbọ nta nkwàdó ‘Anambra North’ ọkụ n'ùjú.
O mere ka a mara na nke ahụ bụ mmezupụ̀ta otu n'ime nkwà o kwèrè banyere ịkwàlite ọkụ latirik na steeti ahụ, bụkwa nke pụtabagoro ìhè na nsonso a. O kwuru na ọ nweghị Mega Waatị ọkụ latirik ọbụla a na-emepụta n'ime steeti ahụ ugbua, ma kọwaa na steeti ahụ ga-ebido imepụta ọkụ, site n'aka ndị nnọrọonwe.
Ọ dụkwazịrị ndị obodo ahụ ọdụ ka ha chekwaba ma lekọta akụrụngwa ahụ na ihe ndị ọzọ dị icheiche gọọmenti rụrụ na mpaghara ha anya nke ọma, iji hụ na ndị omekome ebibighị ya maọbụ zukọsịa ihe dị na ya.
Ụfọdụ ndị ọzọ dị icheiche sonyere nà mmemme ahụ gụnyèrè eze ọdịnala Aguleri, bụ Igwe Micheal Idigo; onyeisi ‘Enugwu-Otu Aguleri Development Union’, Maazị Nnamdi Adimora; onyeisioche Umuekete Igboezunu Aguleri, Maazị Chinedu Mmadubueze; onye ji ọkwa dịka ‘Senior Manager’ n'okpuru ngalaba ‘Protection, Control and Maintenance’ nke ụlọọrụ ‘Transmission Company of Nigeria’ bụ Injinia Chinedu Ifeatu; tinyéré Injinia Chinwendu Anyanwu bụ onye Kọntraktọ̀ ụlọọrụ ‘Cinnac Ventures Limited’ ji ọrụ ngo ahụ.

robotstxt: allowed

filter: keep


text:
G ISN IS B 5 XNUMX-AXIS CNC igwe?
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5-axis machining (ise axis machining a, a mode nke CNC igwe ngwá ọrụ machining.
5 anyụike, nke na-ezo aka anyụike atọ nke x, y, na z tinyere anyụike abụọ na-agbagharị.
Ọ bụrụ na e jiri ya tụnyere axis (3 nke nnwere onwe nke x, y, na z), 5-axis machining na-ezo aka igwe cnc nke ngwá ọrụ nwere ike idozi ma jikọta ya na ogo 5 nke nnwere onwe mgbe ị na-arụ akụkụ dị iche iche na jiometrị dị mgbagwoju anya.
A na-ejikarị arụ ọrụ 5-axis arụ ọrụ na mbara igwe na-arụ ọrụ akụkụ ahụ, akụkụ turbine, na ndị na-etinye ihe na-enweghị ụdị. Ihe akụrụngwa 5-axis nwere ike ịhazi akụkụ dị iche iche nke arụ ọrụ na-enweghị ịgbanwe ọnọdụ nke mpempe akwụkwọ na akụrụngwa akụrụngwa, nke nwere ike imeziwanye arụmọrụ nke akụkụ nke akụkụ prismatic.
Uru nke PTJ Ise AXIS CNC igwe?
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Ihe ndị ụlọ ọrụ ahụ rụpụtara gụnyere ọkachasị ebu ebu ise, akụkụ, na mbipụta izizi.
A na-ejikarị arụ ọrụ 5-axis arụ ọrụ na mbara igwe na-arụ ọrụ akụkụ ahụ, akụkụ turbine, na ndị na-etinye ihe na-enweghị ụdị.
- ▶ Ọsọ Mbelata Mbido
- ▶ Mgbanwe nke mmekpa igwe
- ▶ Ọdịdị dị elu dị elu
- ▶ Ngwa ngwa ihe Cutcha
- ▶ Mma Mma Emechara
nleba
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PTJ anọwo na-ejere ndị ahịa ụwa niile ozi kemgbe 2007. Anyị na-anọgide na-akpụzi nkà anyị ma melite akụrụngwa anyị iji hụ na ndị ahịa anyị nwere afọ ojuju. Anyị nwere ọtụtụ ndị ahịa na-eguzosi ike n'ihe ndị soro anyị rụọ ọrụ karịa 10 Afọ.
Ka anyị lelee videos na-amụta ihe calture banyere Ngwaọrụ PTJ.
● CNC machining ugbo elu Parts
● Cnc machining Medical Parts
● CNC machining Automotive Parts
● CNC machining Electronics Parts
● Mụtakwuo maka Ugbo igwe


text:
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Ụzọ ịkpụzi seramiiki ụlọ ọrụ mmepụta ihe
Mechanical ngwa mere nke oge a ulo oru ceramics na-ọtụtụ-eji agha ceramics, textile ceramics, electronic na eletriki seramiki, wdg Ya mere, ị maara otú ulo oru ceramik na-guzobere? Kedu usoro ndị a? Kezhong Ceramics ga-agwa gị.
2022-05-20
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Ntụaka maka Akaụntụ ọnụ ahịa nkedo ụfụfụ efu
Ntụle ọnụ ahịa dị nfe ma nwee ike ịgụnye akụkụ abụọ, ya bụ ihe na -abawanye ọnụ ahịa yana ihe mbelata ọnụ ahịa. Ọdịiche dị n'etiti ihe abụọ a bụ ọnụọgụ mmụba ma ọ bụ ibelata ego mgbe emechara usoro nkedo ụfụfụ furu efu.
2021-11-27
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Ngwa nke mmepụta ọgụgụ isi na ụfụfụ efu
Anyị ụlọ ọrụ malitere na-amụ nwere ọgụgụ isi mmepụta na 2014, na ọtụtụ nnyocha e mere na-etinyere na ngwaahịa anyị. Karịsịa na Disemba 2020, ụlọ ọrụ anyị bịanyere aka n'ahịrị mmepụta ụfụfụ nke nwere ọgụgụ isi na Maanshan Haitian Heavy Industry, nke ga-etinye ngwaahịa anyị nwere ọgụgụ isi n'ụzọ zuru ezu n'afọ ndị na-adịbeghị anya n'ahịrị mmepụta a.
2021-11-13
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Ọrụ nke mkpuchi mkpuchi na usoro mmepụta nkedo ụfụfụ efu
A na-eji ụlọ ihicha pụrụ iche na-abawanye ma na-echekwa okpomọkụ nke ụlọ ihicha site na ọkụ ọkụ, gas, ọkụ eletrik, geothermal, steam, wdg, na ngwá ọrụ pụrụ iche na-eme ka mmiri na-emepụta mmiri iji nweta mmetụta nke akpịrị ịkpọ nkụ, nkwụsịtụ na ihicha. .
2021-11-20
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Mpaghara Ngwa dị iche iche nke Shrapnel zoro ezo
Nkenke nkenke akụrụngwa bụ akụkụ stampụ ọla, nke bụ ụdị akụkụ mmiri igwe na -arụ ọrụ na -agbanwe. Ọ bụ nke ụdị nke akụrụngwa akụrụngwa elektrọnik. A na -eji igwe anaghị agba nchara ma ọ bụ manganese eme ihe nkenke ngwaike mgbe ọgwụgwọ okpomọkụ gasịrị
2021-09-24
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Methodzọ nhicha nke onye nrụpụta ụlọ ọrụ
China bụ nnukwu mba na -emepụta ihe, na nkewa mmepụta ọdịnala na -eji nwayọ na -apụ n'anya. Dochie igwe eji eme akwụkwọ ntuziaka aghọọla ihe a na -apụghị izere ezere na mmepe mmekọrịta mmadụ na ibe ya, na robots ụlọ ọrụ na -arụkwa ọrụ dị mkpa. Iji hụ na arụmọrụ robot a na -arụkarị, onye ọrụ ga na -edozigharị ma na -ehicha onye na -eme ihe. Yabụ, kedu usoro nhicha nke onye aghụghọ?
2021-08-14
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Nhọrọ na Nhazi nke Usoro Njikere Manipulator
N'ime usoro nhazi nke onye na -eme ihe, enwere ọtụtụ nhọrọ maka ụzọ njide. Kedu ụdị usoro njide ịhọrọ, na mgbakwunye na ntụle nhazi, bụ maka ọnụ ahịa iji ya na ịdị mma nke mmezi. Tụlee, ka emechara, ọ dị mkpa ka a tụlee ihe dị ọnụ ala.
2021-08-14
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Nnyocha na teknụzụ Ni-Si Alloy Slender Shaft na-atụgharị teknụzụ
Ọ bụ ihe siri ike nhazi ma na-ejikarị ya eme ihe na mbara igwe, ụgbọ elu na mpaghara ndị ọzọ. Mbipụ ya bụ ebe siri ike na teknụzụ igwe ọgbara ọhụrụ. Ijikọta njirimara nke ihe nickel-silicon alloy ihe, were kọntaktị ụlọ ọrụ nickel-silicon alloy dị ka ihe atụ, a mụọla teknụzụ nhazi ntụgharị, yana echekwara teknụzụ nhazi ihe dị elu maka ụlọ ọrụ, nke nwere ụfọdụ uru ngwa.
2021-08-14
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Ngwa nke sistemụ AC Servo na ahịrị oyi na -akpụ akpụ oyi akwa
Iwebata usoro tupu ịkụ ọkpọ na teknụzụ ịkwọ ụgbọ mmiri hydraulic na ahịrị mmepụta oyi nke kọlụm ọkwado ọ bụghị naanị na-agbasawanye ụdị imewe yana izizi nrụpụta nke akụkụ akụkụ nke kọlụm akwa, kamakwa na-emezu ihe ndị achọrọ. nhazi na mgbakọ nke usoro nhazi ígwè ígwè, na -ebuli elu
2021-08-21
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Nhọrọ oge nhazi nke ụgbọ elu flange flange
N'ime usoro nrụnye nnukwu kreenu, ịdị larịị nke flange crane ga -agbanwe. Omume a na -emebu bụ igwe igwe flange crane mgbe emechara mgbakọ na ịgbado ọkụ nke mgbakọ ntọala crane, iji hụ na ịdị larịị nke flange crane na -emezu ihe achọrọ nke eserese.
2021-08-14
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Ọrụ nke onye nbipute 3D na ịme ụdịdị
N'ozuzu, enweghị ike imepụta ngwaahịa emepụtara nke ọma. Ozugbo ha nwere nkwarụ, a ga -ewepụ ha, nke na -emebi ike mmadụ, akụrụngwa na oge. Ihe ngosi a bụ nzọụkwụ dị mkpa iji nyochaa ike nke imewe na usoro mmepe ngwaahịa. Ọ bụ ụzọ kwụ ọtọ ma dị irè iji chọpụta ntụpọ, adịghị ike, na adịghị ike nke ngwaahịa a haziri, iji wee mezie ndọtị na ntụpọ. Ngwa nhazi ihe eji eme ihe maka ụdị prototype gụnyere ngwaọrụ igwe njikwa akara ọnụọgụ CNC, ndị na -ebi akwụkwọ 3D, na igwe na -akpụzi silicone.
2021-08-21
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Mmepe na ntinye nke teknụzụ na -atụgharị eriri igwe
Na mmepe na itinye teknụzụ na -atụgharị eriri, a na -eji uru nke izizi igwe dị elu, ịdị mma kwụsiri ike, na arụmọrụ dị elu nke teknụzụ a na mmepe na ngwa. A na -ahụta na ọ nwere ntụkwasị obi dị elu na akụrụngwa igwe na -arụ ọrụ pụrụ iche. Igwe ọkụ dị n'ime ime na-eme ka onye otu ahụ na-arụ ọrụ na-arụ ọrụ njikọ na akụrụngwa.
2020-09-18
- 5 Axis igwe
- Mkpo Cnc
- CNC agbanye
- Ụlọ ọrụ igwe
- Usoro Machining
- Ọgwụgwọ Ọgwụ
- Igwe igwe
- Plastic igwe
- Ntụ ntụ Metallurgy akpụzi
- Nkedo nke Anwụ
- Akụkụ osisi
- Akụkụ igwe akpaaka
- Akụkụ Mpịakọta
- Heatsink LED
- Ihe owuwu
- Akụkụ mkpanaka
- Akụkụ Ahụike
- Elektrik Parts
- Ejiri Machining
- Akụkụ Bicycle
- Aluminium igwe
- Nhazi Titanium
- Igwe anaghị agba nchara machining
- Ọla kọpa
- Ngwongwo ọla
- Ngwunye Super Alloy
- Peek igwe
- Ụlọ ọrụ UHMW
- Ịrụ Ọrụ Pụrụ iche
- PA6 igwe
- Nhazi PPS
- Ngwongwo Teflon
- Inconel igwe
- Ngwá Ọrụ Ngwá Ọrụ Ngwá Ọrụ
- Ihe ndi ozo


text:
Azụ nile nke na-erughị centimita iri bụ obere ụdị. Ọ bụ ihe azụ dị jụụ ma zuru oke ọnụ iji weghachite a obere biotope Amazon.
Maka ụdị a, a kwadoro ha aquariums wider karịa miri emi, Lita 60. Karịa ihe ọ bụla n'ihi na n'oge oge ọmụmụ, ha ga-ewere nke a akụkụ nke akwarium nke ha ga-agbachitere n'ụzọ ike, ọ bụrụ na ọ dị mkpa.
Obere Amazon Biotope Aquarium
Cheta na biotope bu iji weghachite ala ala na onodu onodu gburugburu ebe obibi maka azụ na mmepe osisi, na nke a Amazonia na obere ụdị.
Ndị a bụ azụ kesara n'akụkụ efere nke Osimiri Amazon na ndi ozo. Ha nwere otutu ahihia. Kporo ka azu nwere ike zoo ya na ezigbo udo mmiri. Mmiri dị nro na nke acidic, na nkezi okpomọkụ nke ihe 26ºC.
Yabụ, iji megharịa ya, naanị ị ga - emepụta ya Ọnọdụ ndị Amazon dị ka a ga-asị na ọ bụ ebe obibi ya. N'ịbụ obere aquariums, anaghị atụ aro ka ị tinye azụ atọ ma ọ bụ azụ anọ. Ihe ndozi ga-abụ ndekọ, osisi ụfọdụ nwere ihe ọkụ ọkụ dị ala na okwute.
A na-atụ aro nzacha carbon dị ike ma ọ bụrụhaala na ị naghị emegharị nnukwu ihe na akwarium, ha bụ azụ mmiri dị jụụ. Enwere ike ịgụnye ya ficus doo ka akwarium dị ka mma.
Speciesdị egosipụtara
Na obere akwarium Amazon, ị gaghị echefu ya azụ tetras, ebe ọ bụ na ha dị egwu. Na discus azụ ha dakọtara nke ọma ma ọ bụrụhaala na akwarium ahụ nwere ike ịnabata obere ógbè nke ụdị atọ. Angelfish bụkwa nhọrọ ebe ha bi na mpaghara ndị dị elu na kọlụm mmiri ma agaghị asọpụrụ ókèala nke azụ ndị ọzọ.
Banyere osisi maka ụdị biotope a nke Amazon, ha bụ ndị sitere na ụdị genus Echinodorus.


text: 7 “Mgbe Jehova bụ́ Chineke unu ga-akpọbata unu n’ala ahụ unu ga-abanye ma biri na ya,+ ọ ga-ekpochapụrụ unu mba ndị dị ọtụtụ,+ ya bụ, ndị Het, ndị Gegash, ndị Amọraịt,+ ndị Kenan, ndị Perizaịt, ndị Haịvaịt, na ndị Jebus,+ mba asaa ndị dị ọtụtụ ma dị ike karịa unu.+2 Jehova bụ́ Chineke unu ga-enyefe ha n’aka unu, unu ga-emerikwa ha.+ Hụnụ na unu bibiri ha.+ Unu na ha agbala ndụ. Unu emekwarala ha ebere ọ bụla.+3 Unu na ha agọla ọgọ. Unu akpọrọla ụmụ unu ndị nwaanyị kpọnye ụmụ ha ndị nwoke. Unu alụtakwarala ụmụ unu ndị nwoke ụmụ ha ndị nwaanyị.+4 N’ihi na ha ga-eme ka ụmụ unu kwụsị ife m wee fewe chi ọzọ dị iche iche.+ Jehova ga-ewesazi unu oké iwe, ọ ga-ebibikwa unu n’egbughị oge.+5 “Kama, ihe a ka unu ga-eme ha: Kwatusịanụ ebe ịchụàjà ha, kụtusịanụ ogidi arụsị ha,+ gbutusịanụ ogwe osisi arụsị* ha,+ kpọọkwanụ arụsị ha a pịrị apị ọkụ.+6 N’ihi na unu bụụrụ Jehova bụ́ Chineke unu ndị dị nsọ, Jehova bụ́ Chineke unu ahọrọkwala unu ka unu bụrụ ndị ya, ndị pụrụ iche n’ime ndị niile nọ n’ụwa.+7 “Ihe mere Jehova ji hụ unu n’anya ma họrọ unu abụghị maka na unu dị ọtụtụ karịa ndị ọzọ niile,+ n’ihi na ọ bụ unu kacha nta ná ndị niile.+8 Kama, ọ bụ maka na Jehova hụrụ unu n’anya nakwa maka na ọ na-emezu iyi ọ ṅụụrụ nna nna unu hà+ mere Jehova ji jiri aka ya dị ike kpọpụta unu, ka o wee napụta unu n’ebe unu nọ na-agba ohu,*+ n’aka Fero eze Ijipt.9 O dokwara unu anya na Jehova bụ́ Chineke unu bụ ezi Chineke, Chineke e kwesịrị ịtụkwasị obi, onye na-anaghị emebi ọgbụgba ndụ ya na ndị hụrụ ya n’anya na ndị na-edebe iwu ya gbara, na-ahụkwa ha n’anya* ruo otu puku ọgbọ.+10 Ma ọ na-ebibi ndị kpọrọ ya asị, si otú ahụ kwụọ ha ụgwọ ihe ha metara.+ Ọ gaghị egbu oge ịta ndị kpọrọ ya asị ahụhụ. Ọ ga-akwụ ha ụgwọ ihe ha metara.11 N’ihi ya, lezienụ anya ka unu na-edebe iwu ya, na-eso ntụziaka ya, na-emekwa ihe ndị o kpebiri ka unu na-eme, bụ́ ihe ndị m na-enye unu n’iwu taa.12 “Ọ bụrụ na unu ana-erube isi n’ihe ndị Jehova bụ́ Chineke unu kpebiri ka unu na-eme, na-emekwa ha, ọ ga-emezu ọgbụgba ndụ ya ma hụ unu n’anya* otú ọ ṅụụrụ nna nna unu hà n’iyi.13 Ọ ga-ahụ unu n’anya, gọzie unu ma mee ka unu mụbaa. Ọ ga-eme ka unu mụta ọtụtụ ụmụ.*+ Ọ ga-agọzikwa ihe unu kụrụ n’ala unu, ọka* unu, mmanya ọhụrụ unu, mmanụ unu,+ ụmụ ehi unu na ụmụ ìgwè ewu na atụrụ unu, n’ala ahụ ọ ṅụụrụ nna nna unu hà iyi na ọ ga-enye unu.+14 Unu ga-abụ ndị a kacha gọzie agọzie n’ime ndị ọzọ niile.+ A gaghị enwe nwoke ma ọ bụ nwaanyị n’ime unu na-agaghị amụta nwa. A gaghịkwa enwe anụ ụlọ unu na-agaghị amụta nwa.+15 Jehova ga-ewepụrụ unu ọrịa niile. Ọ gaghị eme ka unu rịa ọrịa ọjọọ ọ bụla unu hụrụ n’Ijipt.+ Kama, ọ ga-eme ka ndị niile kpọrọ unu asị rịa ha.16 Unu ga-ebibi ndị niile Jehova bụ́ Chineke unu na-enyefe n’aka unu.+ Unu* emerela ha ebere.+ Unu efekwala chi ha dị iche iche ofufe,+ n’ihi na ọ ga-abụrụ unu ọnyà.+17 “Ọ bụrụ na unu ekwuo n’obi unu, sị, ‘Mba ndị a dị ọtụtụ karịa anyị. Olee otú anyị ga-esi achụpụ ha?’+18 unu atụla ha egwu.+ Chetaranụ onwe unu ihe Jehova bụ́ Chineke unu mere Fero na Ijipt niile,+19 nnukwu ahụhụ a tara ha nke unu ji anya unu hụ na ihe àmà na ọrụ ebube+ na aka siri ike na ike Jehova bụ́ Chineke unu ji kpọpụta unu.+ Ọ bụ ihe Jehova bụ́ Chineke unu ga-eme ndị niile unu na-atụ egwu.+20 Jehova bụ́ Chineke unu ga-eme ka egwu jide ha ruo mgbe ndị fọrọ afọ+ na ndị na-ezoro unu onwe ha nwụchara.21 Unu atụla ha ụjọ n’ihi na Jehova bụ́ Chineke unu nọnyeere unu.+ Ọ bụ onye ukwu na Chineke e kwesịrị ịtụ egwu.+22 “Jehova bụ́ Chineke unu ga-eji nke nta nke nta chụpụrụ unu mba ndị a.+ A gaghị ekwe ka unu bibie ha ọsọ ọsọ, ka anụ ọhịa ghara ịmụba tagbusiwe unu.23 Jehova bụ́ Chineke unu ga-enyefe ha n’aka unu ma merie ha kpamkpam ruo mgbe e bibichara ha.+24 Ọ ga-enyefe ndị eze ha n’aka unu.+ Unu ga-ehichapụkwa aha ha n’ụwa.*+ E nweghị onye ga-anọchiri unu ụzọ+ ruo mgbe unu kpochapụrụ ha.+25 Unu ga-akpọ arụsị ha a pịrị apị, bụ́ ndị ha ji mere chi, ọkụ.+ Agụụ ọlaọcha na ọlaedo dị n’arụsị ndị ahụ agụla unu.+ Unu ewerekwala ha, ka ha ghara ịbụrụ unu ọnyà, n’ihi na ọ bụ arụ n’anya Jehova bụ́ Chineke unu.+26 Unu ewebatala ihe Chineke kpọrọ asị n’ụlọ unu wee si otú ahụ bụrụ ndị a ga-ebibi ebibi otú a ga-ebibi ihe ahụ. Unu ga-asọ ihe ahụ oyi, kpọọkwa ya asị n’ihi na ọ bụ ihe a ga-ebibi ebibi.


text:
Umu aka niile kwesiri igba BCG (Bacille Calmette-Guerin) nke na enye mgbochi n’aka ukwara nta na leprosy.
Umuaka niile kwesiri inweta ogwu mgbochi n’aka diphtheria, tetanus, pertussis ya na DTP vaccine. Diphtheria na ebute infekshon ebe isi ekume, nke oge ufodu na ebute agha iku ume ma o bu onwu. Tetanus na ebute akwara ikwuru otu ebe na afu ajo ufu. Pertussis ma o bu whooping cough na emetuta ebe e si eku ume. O nwere ike ibute ukwara ga anoru izu ano we ruo izi asato. Oria ndi a jogburu onwe ya n’ahu uma aka.
Umu nwanyi niile di ime kwesiri igba ogwu mgbochi tetanus
Umu aka nile kwesiri igba ogwi mgbochi polio. Ihe ngosi polio bu aka na ukwu na ete ete ma o bu nwata na agaghi agaghari agaghari. N’ime umuaka iri abuo butere polio, otu n’ime ha agaghi aga ije na uwa niile.
Ogwu mgbochi ndi ozo a ga agbanwu umuaka bu nke a na agba n’ihi ebe ha bi. O di mkpa na isonyere usoro eweputara na mba unu. Ekwesiri igba umuaka ogwu mgbochi naani na afo ha kwesiri, na mgbe ha kwesiri.
Sources
Burns, A. A., Niemann, S., Lovich, R., Maxwell, J., & Shapiro, K. (2014). Where women have no doctor: A health guide for women. Hesperian Foundation.