不同置换液量血液透析滤过治疗尿毒症皮肤瘙痒疗效观察

目的：观察不同置换液量血液透析滤过(HDF)对尿毒症皮肤瘙痒的治疗作用。方法：将30例并发皮肤瘙痒的维持性血液透析尿毒症患随机分为三个组，分别接受高置换液量后稀释HDF(置换液20L)、低置换液量后稀释HDF(置换液10L)和高通量血液透析治疗。均使用F60透析器，隔日1次，连续3次，其余治疗条件相同。对皮肤瘙痒症状定量计分，比较三组病人治疗前后皮肤瘙痒症状积分的改变以及血磷和甲状旁腺激素(PTH)的变化。结果：高置换液量HDF组治疗后皮肤瘙痒积分明显下降，有统计学意义。其余两组无差异。以皮肤瘙痒积分下降50％为有效计算，高置换液量HDF组7例有效，有效率70％；低置换液量HDF组3例有效。有效率30％；透析组1例有效，有效率10％。三组间比较有统计学差异。三组透析后血磷均明显下降，有统计学意义；PTH亦有下降，HDF组有统计学差异，HD组无统计学差异。结论：增加置换液量可以提高HDF治疗尿毒症皮肤瘙痒的疗效；HDF治疗尿毒症皮肤瘙痒疗效优于高通量血液透析；HDF清除PTH的效果高于HD。     

A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae

Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.     

Case for diagnosis

Pemphigoid gestationis is a rare, autoimmune blistering dermatosis of pregnancy. No increase in fetal or maternal mortality has been demonstrated, but a greater prevalence of premature and small-for-gestationalage babies has been reported. Topical and systemic corticosteroids and antihistamines are the manstay of treatment. The authors report a case of a 27-year-old woman at 28-weeks gestation with sudden onset of pruriginous vesicles and blisters in the abdomen and limbs. Systemic corticosteroids were introduced and maintained throughout gestation to prevent flares and tapered after the birth of a healthy child.     

老年性瘙痒症小鼠模型的研制

目的 探讨一种建立老年性皮肤瘙痒症实验动物模型的方法.方法 随机挑选昆明小鼠,尾静脉取血后测全血RBC、Hb、WBC、嗜酸性粒细胞值,同时取腹部和前腿皮肤检测皮脂腺.剩余昆明小鼠控制饲料和饮水量饲养10 d后,用冷风、碱水和化纤布料连续刺激14d,录像10 min,观察和记录搔抓次数.于第27天随机抽取样本进行血液取样和皮肤取样,检测内容同前.结果 与实验前相比,动物搔抓次数明显增加,嗜酸性粒细胞数目升高,HCT值升高；RGB、HGB值升高、皮脂腺分泌较前旺盛.结论 在中医理论指导下,模拟临床发病原因采用综合因素初步制造出一种老年性皮肤瘙痒症实验动物模型.     

内源性大麻素系统调节瘙痒的研究进展

背景 很多药物和疾病都能引起瘙痒,但目前有关瘙痒的病理生理学还不完全清楚.研究发现,内源性大麻素系统在调节瘙痒中起着重要的作用,影响着瘙痒的发生与发展.目的 就近年来国内外有关内源性大麻素系统调节瘙痒的文献作一综述. 内容 大麻素受体1 (cannabinoid receptor 1,CB1)激动剂缓解瘙痒,拮抗剂诱发瘙痒.大麻素受体2(cannabinoid receptor 2,CB2)拮抗剂、内源性大麻素类化合物和脂肪酰胺水解酶(fatty acid amide hydrolase,FAAH)间接抑制瘙痒.此外,内源性大麻素的止痒作用可能部分是通过瞬时受体电位香草类受体(transient receptor potential vanilloid type,TRPV)介导的.趋向 内源性大麻素系统可能成为将来各种病因学全身性瘙痒的止痒靶点,但其调节瘙痒的机制还不十分清楚,需要进一步的研究和探讨.     

养老机构老年人皮肤健康状况调查及影响因素分析

目的调查洛阳市养老机构老年人皮肤健康现状并分析影响因素,为构建老年人皮肤健康状况监测及干预体系提供依据。方法本研究为横断面研究。采用分层随机抽样法,选取2019年11—12月在洛阳市7家养老机构居住的489名老年人为研究对象,使用自行编制的老年人皮肤健康状况调查问卷、简易智力状态检查量表(MMSE)、一般情况及疾病状况调查问卷进行调查。采用单因素分析和二元Logistic回归分析探讨发生率前3位皮肤问题的影响因素。结果共调查489名老年人,不符合纳入标准163名,实际完成调查问卷326名,收回有效问卷321份。321名养老机构老年人皮肤问题发生率为89.1%(286/321),其中发生率占前3位的皮肤问题依次为皮肤干燥症(58.3%,187/321)、瘙痒症(24.3%,78/321)、浅部真菌感染(14.3%,46/321),其余依次为皮肤撕裂伤、压力性损伤、皮下淤血、失禁性皮炎,发生率分别为9.3%(30/321)、6.5%(21/321)、4.4%(14/321)、2.2%(7/321)。Logistic回归分析显示,年龄、文化程度、BMI、护肤频率为养老机构老年人发生皮肤干燥症的影响因素(OR值分别为0.474、1.904、0.426、2.026;P<0.01);年龄、基础疾病、护肤频率为养老机构老年人发生皮肤瘙痒症的影响因素(OR值分别为0.645、0.575、1.659;P<0.05);年龄、用药种类、MMSE得分为养老机构老年人发生浅部真菌感染的影响因素(OR值分别为1.646、0.248、4.539;P<0.05)。发生各类皮肤问题后,大多数老年人未做处理或自行处理。结论洛阳市养老机构老年人存在较多皮肤健康问题,皮肤疾病发生的影响因素复杂,且相关处理措施不规范。养老机构医护人员应需重视老年人皮肤问题的评估与管理,提高护理员皮肤护理水平,加强老年人护肤宣教。     

触液核在大鼠慢性瘙痒维持中的作用

目的 探讨触液核在大鼠慢性瘙痒维持中的作用.方法 雄性SD大鼠,3月龄,体重240～ 280 g.第一部分采用随机数字表法,将42只大鼠分为3组(n=14):生理盐水组(C组)、丙酮组(A组)和恶唑酮组(O组).O组于颈背部涂抹0.5％恶唑酮15μl,C组和A组分别涂抹等容量生理盐水和丙酮,分别于给药后7、9、13、16、17、18、21、23 d重复上述处理,记录每次给药后30 min内搔抓次数,每组取6只动物,在最后1次涂抹恶唑酮后2h取脑组织,测定触液核c-Fos表达.第二部分 采用随机数字表法,将24只大鼠分为3组(n=8):正常对照组(C1组)、慢性瘙痒组(CI组)和慢性瘙痒+触液核毁损术组(CI+ KA组),CI组和CI+ KA组采用上述方法制备慢性瘙痒模型,触液核毁损术于第8次给药后6h实施,并记录第9次给药后30 min内搔抓次数.结果 第一部分 与C组比较,A组T4-8时搔抓次数增多,O组T1-8时搔抓次数增多,A组和O组触液核c-Fos表达上调(P＜0.05);与A组比较,O组T1-8时搔抓次数增多,触液核c-Fos表达上调(P＜0.05).第二部分 与C1组比较,CI组和CI+ KA组搔抓次数增多(P＜0.05),而CI+ KA组搔抓次数少于CI组(P＜0.05).结论 触液核参与了大鼠慢性瘙痒的维持.