晚期妊娠合并潜伏期梅毒对母婴的影响及防治对策

目的:探究与分析晚期妊娠合并潜伏期梅毒对母婴的影响及防治对策。方法:选取我院自2010年10月至2014年10月收治的晚期妊娠合并梅毒患者30例作为观察组,另选择同时期入院的30例晚期妊娠孕妇作为对照组,对比两组孕妇的妊娠结局、新生儿预后情况及孕妇血RPR滴度与先天性梅毒儿并发症的关系。结果:观察组与对照组孕妇妊娠结局为足月产、早产、死胎死产及产褥感染相比组间均具有明显差异(χ2=4.34,P0.05;χ2=4.19,P0.05;χ2=3.91,P0.05;χ2=3.96,P0.05)。观察组与对照组新生儿预后为正常新生儿、窒息儿、低体重儿、先天性梅毒儿、潜伏期梅毒儿及新生儿死亡相比组间均具有明显差异(χ2=9.67,P0.05;χ2=5.25,P0.05;χ2=5.11,P0.05;χ2=5.28,P0.05;χ2=4.56,P0.05;χ2=4.56,P0.05)。观察组孕妇血RPR1∶8与观察组孕妇血RPR1∶8发生肝功能异常与骨损害相比组间有明显差异(χ2=5.66,P0.05;χ2=5.47,P0.05)。结论:晚期妊娠合并潜伏期梅毒可对母婴健康造成影响,对梅毒行早期诊断与治疗至关重要,可降低先天性梅毒儿的发病率。     

晚期妊娠合并性传播疾病临床分析

目的分析和探讨晚期妊娠合并性传播疾病的特点。方法从2015年1月~2016年12月在我院住院分娩的晚期妊娠孕妇2 073例中49例合并性传播疾病的孕妇设为观察组。随机选择同期在我院住院正常分娩的50例妊娠孕妇设为对照组,比较两组的妊娠结局。结果 2 073例孕妇中49例合并性传播疾病,发生率为23.94‰。观察组胎膜早破、产褥感染、新生儿感染的发生率显著高于对照组,差异具有统计学意义(P0.05);观察组正常分娩率显著低于对照组,助产率及剖宫产率显著高于对照组,差异均具有统计学意义(P0.05)。结论晚期妊娠的分娩方式及妊娠结局会受到性传播疾病的影响,应给予及时的有效处理,维护母婴安全。     

探究妊娠晚期合并性传播疾病对妊娠结局及新生儿的影响

目的:探究与分析妊娠晚期合并性传播疾病对妊娠结局及新生儿的影响。方法:选取我院自2012年5月至2014年5月收治的456例性病孕产妇作为试验组,对其宫颈分泌物进行检测,主要检测指标包括解脲支原体、淋病、尖锐湿疣、霉菌、滴虫、HIV、梅毒。另选择同时期的正常分娩孕产妇419例作为对照组,观察两组孕产妇妊娠结局及新生儿情况。结果:试验组孕产妇共456例,经检查可见其中霉菌性阴道炎278例(60.96%),滴虫性阴道炎58例(12.72%),解脲支原体阴道炎45例(9.87%),沙眼衣原体阴道炎39例(8.55%),淋病23例(5.04%),尖锐湿疣10例(2.19%),梅毒3例(0.66%),本组中未检测出艾滋病患者。对照组出现胎膜早破率、早产率、产褥感染率、新生儿感染率及低体重儿率分别为13.60%、5.49%、5.01%、1.19%及1.43%,试验组出现胎膜早破率、早产率、产褥感染率、新生儿感染率及低体重儿率分别为19.96%、6.80%、12.06%、1.97%及2.19%,组间比较差异显著(χ2=4.59,P0.05;χ2=4.28,P0.05;χ2=4.02,P0.05;χ2=4.55,P0.05;χ2=3.91,P0.05)。对照组阴道分娩率为71.27%,剖宫产率为28.73%,试验组阴道分娩率为70.64%,剖宫产率为29.36%,组间比较无明显差异(χ2=3.53,P0.05;χ2=3.48,P0.05)。结论:孕妇产妇感染性病的发病率较高,且多伴有两种及以上的混合感染,对其妊娠结局造成了不小的影响,甚至对新生儿的生命健康造成威胁。     

曲普瑞林联合腹腔镜保守手术治疗子宫内膜异位症的疗效观察

目的：探讨曲普瑞林联合腹腔镜保守手术治疗子宫内膜异位症的疗效观察。方法：82例子宫内膜异位症患者分为联合组与对照组。两组患者均予以腹腔镜保守手术治疗,联合组术后予以曲普瑞林3.75mg肌注,每月1次,连用6个月。观察并比较两组患者治疗前后性激素水平的变化、治疗结束后随访6个月的治疗效果、1年内怀孕情况及不良反应情况。结果：治疗6个月后,两组患者性激素FSH、LH、E2水平均较治疗前下降（P〈0.05或P〈0.01）,且联合组下降幅度明显优于对照组（P〈0.05）;治疗结束后随访6个月,联合组患者的临床疗效明显优于对照组,复发率明显低于对照组（χ^2=5.14,P〈0.05）;停药1年后,联合组患者的成功怀孕率明显高于对照组（χ^2=4.02,P〈0.05）,两组患者治疗期间不良反应发生率比较无明显统计学差异（P〉0.05）。结论：曲普瑞林联合腹腔镜保守手术治疗子宫内膜异位症可以取得较单纯手术治疗更好的疗效,降低术后复发率,提高怀孕率,不良反应少。     

氨基酮戊酸光动力疗法与冷冻治疗尖锐湿疣合并外阴阴道念珠菌病的疗效对比研究

目的：分析氨基酮戊酸光动力联合抗真菌治疗尖锐湿疣合并外阴阴道念珠菌病临床疗效及安全性。方法：选择在本院接受治疗的尖锐湿疣合并外阴道念珠菌病患者86例为研究对象,分别接受冷冻联合抗真菌治疗及氨基酮戊酸光动力联合抗真菌治疗,比较两组治疗效果及临床安全性差异。结果：观察组患者尖锐湿疣治疗有效率、真菌感染治疗有效率明显高于对照组[93.8%VS 76.08%,95.65%VS80.43%]（χ^2=3.842、3.748,P=0.028、0.032〈0.05）;观察组不良反应发生率、尖锐湿疣复发率、外阴阴道念珠菌病复发率均明显低于对照组[4.34%VS 19.56%、9.38%VS23.81%、5.88%VS 17.39%]（χ^2=5.324、5.854、4.356,P=0.022、0.018、0.036〈0.05）。结论：氨基酮戊酸光动力联合抗真菌治疗可以显著提高尖锐湿疣合并外阴阴道念珠菌病患者的治疗效果,具有良好的治疗安全性。     

母婴规范诊治对先天性梅毒患儿RPR转变影响的临床研究

目的：研究母婴规范诊治对于先天性梅毒患儿RPR转变的影响。方法：对我院收治的72例梅毒孕妇及所产新生儿的临床资料进行分析,按照孕妇梅毒诊治是否规范将新生儿分为A组（规范诊治组）和B组（非规范诊治组）,比较两组孕妇的妊娠结局及新生儿快速血浆反应素环状卡片试验（RPR）阳性率,比较两组新生儿的临床表现,观察两组患儿的RPR的转变情况。结果：A组孕妇的足月分娩率（92.5%）、新生儿的RPR阳性率（55.0%）与B组相比,差异有统计学意义（P〈0.05）;B组新生儿,出现皮肤损伤、病理性黄疸等临床症状的比率明显高于A组,差异具有统计学意义（P〈0.05）;经治疗后A组患儿的转阴时间更短,治疗到12个月,两组患儿全部转阴。结论：梅毒孕妇进行规范化诊治后,所产先天性梅毒患儿几率下降,且先天性梅毒患儿RPR转阴更快。     

药疹患者外周血单一核细胞中巨细胞病毒的检测

目的 探讨人巨细胞病毒（CMV）感染在药疹发病中的作用。 方法 收集44例药疹患者（其中重型药疹13例）及50例健康对照外周血,Taqman实时荧光定量PCR（RT-PCR）检测外周血单一核细胞中CMV DNA阳性率及载量;酶联免疫吸附试验（ELISA）检测血清CMV IgM阳性率。 结果 44例药疹患者CMV DNA阳性率（65.91%,29/44例）高于健康对照组（28.00%,14/50例）,差异有统计学意义（χ2 = 13.552,P < 0.05）;重型药疹患者（11/13例）、轻型药疹患者（58.06%,18/31例）及健康对照组CMV DNA阳性率不完全相等（χ2 = 16.153,P < 0.05）,其中重型组高于轻型组（χ2 = 13.817,P < 0.05）及对照组（χ2 = 7.237,P < 0.05）;药疹患者CMV DNA载量（28 183.829 ± 19 527.654）拷贝高于健康对照组（3 019.952 ± 1 760.952）拷贝,差异有统计学意义（t′ = 8.517,P < 0.05）,重型药疹患者（554 813.389 ± 722 642.498）拷贝、轻型药疹患者（13 290.558 ± 14 082.356）拷贝与对照组间CMV DNA载量差异无统计学意义（P > 0.05）。药疹患者CMV IgM阳性率（13.64%,6/44例）与健康对照组（6.00%,3/50例）差异无统计学意义（P > 0.05）;轻型药疹（6.45%,2/31例）、重型药疹（4/13例）及健康对照组各组均数不完全相等（χ2 = 7.832,P < 0.05）,其中重型组高于对照组（χ2 = 6.409,P < 0.05）。 结论 药疹患者存在CMV感染,CMV感染可能是药疹发病或加重的因素之一。     

复方甲硝唑栓联合倍美力软膏治疗老年性阴道炎的临床研究

目的：探讨复方甲硝唑栓联合倍美力软膏治疗老年性阴道炎的临床疗效和安全性。方法：选取2011年1月至2012年12月来本院妇科就诊的老年性阴道炎患者共130例作为研究对象。根据入院时间将患者随机分为观察组和对照组,每组各65人。对照组采用甲硝唑栓进行治疗,观察组加用倍美力软膏进行联合治疗。对比两组临床表现改善情况、血清激素水平和临床疗效。结果：治疗后,与对照组相比,观察组白带增多、阴道瘙痒和阴道壁红肿充血症状明显缓解（χ^2=4.33、4.01、6.39,P均〈0.05）;治疗后,与对照组相比,观察组血清FSH水平升高幅度较大（U=8.43,P〈0.05）,E2降低幅度较大（U=5.59,P〈0.05）;观察组治愈率和总有效率分别为63.08%和95.38%,均高于对照组（44.62%,81.54%）（χ^2=4.46、6.10,P均〈0.05）。结论：复方甲硝唑栓联合倍美力软膏治疗老年性阴道炎较单纯应用复方甲硝唑栓具有明显的优势,给药方便,安全可靠,值得在临床上进一步推广。     

孕早期抗梅毒治疗对妊娠期梅毒孕妇妊娠结局及新生儿预后的影响

目的探讨孕早期抗梅毒治疗对妊娠期梅毒孕妇妊娠结局及新生儿预后的影响。方法选取2016年6月至2018年6月深圳市龙华区人民医院诊治的妊娠期梅毒孕妇150例作为研究对象。根据抗梅毒治疗时机不同分为观察组(n=75)、对照组(n=75),两组均予以苄星青霉素治疗,观察组孕早期(孕周13周)行抗梅毒治疗,对照组孕中晚期(孕周≥13周)行抗梅毒治疗,对两组孕妇妊娠结局、新生儿娩出时情况、新生儿预后情况、不同RPR滴度下新生儿梅毒感染情况进行观察。结果不良妊娠结局发生率观察组为6.67%,低于对照组(17.33%),差异具有统计学意义(P0.05);观察组新生儿Apgar评分及出生体重均高于对照组,差异具有统计学意义(P0.05),两组呼吸和心率比较,差异无统计学意义(P0.05);观察组低体重儿、新生儿死亡、新生儿窒息、新生儿梅毒感染占比与对照组比均较低,差异具有统计学意义(P0.05);两组孕妇RPR滴度≤1∶8时,新生儿梅毒感染率差异无统计学意义(P0.05),当孕妇RPR滴度1∶8时,观察组新生儿梅毒感染率低于对照组且差异具有统计学意义(P0.05)。结论孕早期抗梅毒治疗可减少妊娠期梅毒孕妇不良妊娠结局,阻断梅毒垂直传播,改善新生儿预后,值得推广。     

妊娠期HPV感染对孕产妇阴道炎及妊娠结局的影响

目的观察妊娠期人乳头瘤病毒(HPV)感染对孕产妇阴道炎及妊娠结局的影响。方法以2017年12月至2018年12月期间我院收治的50例妊娠期HPV感染孕产妇作为观察组,选择同期健康孕妇50例为对照组,分别检测患者阴道和宫颈分泌物,比较阴道炎发生率和妊娠结局的影响。结果两组孕产妇在细菌性阴道炎、pH值 4.5的检出率比较,观察组明显高于对照组,差异有统计学意义(P 0.05);但其他菌群及清洁度Ⅱ度方面比较,差异无统计学意义(P 0.05);分娩方式、妊娠结局以及观察组不同分娩方式的新生儿HPV阳性检出率等方面比较均无明显差异(P 0.05),不具统计学意义。结论孕产妇在妊娠期阴道内酸性环境被破坏,因而容易感染HPV,容易引起细菌性阴道炎,虽然对妊娠结局和新生儿的影响较小,但也应引起重视,防止新生儿发生感染。     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Medición del impacto psicológico en pacientes con psoriasis en tratamiento sistémico

Background and objectives

The negative impact of psoriasis on patient quality of life can be as important as the physical consequences of the disease. We could assume that clearance of the disease would also lead to an improvement in its psychosocial impact. The present study assesses the psychological state of patients with psoriasis receiving systemic treatment in a psoriasis unit, especially those with mild or no disease involvement.

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.