Mechanisms of repigmentation induced by photobiomodulation therapy in vitiligo

Photobiomodulation (PBM) therapy is based on the exposure of biological tissues to low‐level laser light (coherent light) or light‐emitting diodes (LEDs; noncoherent light), leading to the modulation of cellular functions, such as proliferation and migration, which result in tissue regeneration. PBM therapy has important clinical applications in regenerative medicine. Vitiligo is an acquired depigmentary disorder resulting from disappearance of functional melanocytes in the involved skin. Vitiligo repigmentation depends on available melanocytes derived from (a) melanocyte stem cells located in the bulge area of hair follicles and (b) the epidermis at the lesional borders, which contains a pool of functional melanocytes. Since follicular melanoblasts (MBs) are derived from the melanocyte stem cells residing at the bulge area of hair follicle, the process of vitiligo repigmentation presents a research model for studying the regenerative effect of PBM therapy. Previous reports have shown favourable response for treatment of vitiligo with a low‐energy helium‐neon (He‐Ne) laser. This review focuses on the molecular events that took place during the repigmentation process of vitiligo triggered by He‐Ne laser (632.8 nm, red light). Monochromatic radiation in the visible and infrared A (IRA) range sustains matrix metalloproteinase (MMP), improves mitochondrial function, and increases adenosine triphosphate (ATP) synthesis and O₂ consumption, which lead to cellular regenerative pathways. Cytochrome c oxidase in the mitochondria was reported to be the photoacceptor upon which He‐Ne laser exerts its effects. Mitochondrial retrograde signalling is responsible for the cellular events by red light. This review shows that He‐Ne laser initiated mitochondrial retrograde signalling via a Ca²⁺‐dependent cascade. The impact on cytochrome c oxidase within the mitochondria, an event that results in activation of CREB (cyclic‐AMP response element binding protein)‐related cascade, is responsible for the He‐Ne laser promoting functional development at different stages of MBs and boosting functional melanocytes. He‐Ne laser irradiation induced (a) melanocyte stem cell differentiation; (b) immature outer root sheath MB migration; (c) differentiated outer root sheath MB melanogenesis and migration; and (d) perilesional melanocyte migration and proliferation. These photobiomodulation effects result in perifollocular and marginal repigmentation in vitiligo.     

An Evidence-Based Review of Total Body Irradiation

The purpose of this literature review is to investigate clinical treatment methods of total body irradiation within the context of a clinical department adopting a paediatric cohort with no existing technique. An extensive review of the literature was conducted using PubMed, Science Direct, Google Scholar, and Clinicians Knowledge Network. Articles were limited to nonhelical tomotherapy, nonparticle therapies, and those using hyperfractionated regimes. Total marrow irradiation was excluded because of national treatment and trial limitations. Of the numerous patient positioning methods present within the literature, the most comfortable and reproducible positioning methods for total body irradiation include both supine and the supine and/or prone combination. These positions increased stability and patient comfort during treatment, while also facilitating computed tomography data acquisition at the simulation stage. Ideally, dose calculations should be performed using a three-dimensional treatment planning system and quality assurance procedures that include in vivo dosimetry measurements. The available literature also suggests inhomogeneity correction factors and intensity modulation are superior to conventional open field techniques and should be implemented within developing protocols. Dynamic machine dose modulation is suggested to reduce department impact, removing the need for tissue compensators and accessory shielding devices, while providing significant improvements to treatment time and dose accuracy. Further long-term survival and intensity modulation studies are warranted, including direct comparisons of both dose modulation and treatment efficiency.     

不可切除胃癌转化治疗的研究进展

胃癌在全国范围内是发病率最高的恶性肿瘤之一，在癌症相关死亡原因中排名第三。目前外科手术仍然是胃癌获得根治性治疗的主要手段，但是其中有30%~40%的进展期胃癌患者在初诊时就失去了根治手术的机会，因此不可切除胃癌转化为可切除胃癌是患者获得"治愈"的最佳选择。随着近些年来新型药物的出现、治疗手段的多样化及多学科诊治模式的发展，"转化治疗"的理念应运而生，从而延长患者生存时间并提高其生活质量。本文就不可切除胃癌的治疗现状与进展、"转化治疗"的应用等进行综述。     

中医药治疗慢性前列腺炎研究概况

综述近年中医药治疗慢性前列腺炎的临床研究,认为本病病因病机之核心在于脾肾亏虚为本,湿热、痰浊、瘀毒为标,病久则伤及脾肾,由实转虚。中医内治法主要以辨证论治、辨病论治或单方验方为主,外治法以中药洗浴、中药灌肠、肛门给药、针灸为主。中医药治疗本病优势明显。应继续完善对中医药作用机制的认识,制订统一的辨证论治及疗效评价标准,针对效果显著的名方开展研究。     

基于家庭的心理治疗对强迫障碍治疗的研究进展

强迫障碍(obsessive-compulsive disorder,OCD)是常见的难治性精神疾病,经过心理治疗和药物治疗仅有40%~60%患者获得缓解,患者残留各种症状和功能障碍。心理治疗是OCD治疗的重要组成部分,家庭因素在疾病的发生、维持和预后中起重要作用,以家庭为基础的心理治疗越来越受到重视。文章就对OCD采用基于家庭的心理治疗的必要性和进展进行综述,研究显示患者家属的精神心理状态和家庭顺应性等因素与OCD治疗效果密切相关,而家庭成员高度参与,针对家庭因素干预的基于家庭的心理治疗策略可以增强治疗效果,改善患者家庭功能。文章为强迫障碍的临床优化治疗提供了实践依据。     

Successful Use of Surgically Placed Impella 5.0 and Central Extracorporeal Membrane Oxygenation Circuit in a Patient with Postcardiotomy Shock

The Impella 5.0, a percutaneously inserted left ventricular assist device, has been used to support patients who have severe heart failure or who are undergoing high-risk percutaneous coronary intervention. We report our surgical placement of the Impella 5.0, through a graft sewn to the aorta, to unload the left ventricle of a 59-year-old man who was undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy shock. The patient underwent successful placement of a long-term left ventricular assist device before his discharge from the hospital. The versatility of the Impella 5.0 is exemplified in this patient who was successfully bridged to long-term support.     

探究培美曲塞与多西他赛在晚期非小细胞肺癌靶向治疗失败后挽救化疗中的临床疗效

目的 研究培美曲塞与多西他赛在晚期非小细胞肺癌靶向治疗失败后挽救化疗中的应用效果。方法 筛选2018 年1 月～2020 年1 月本院的60 例晚期非小细胞肺癌靶向治疗失败后挽救化疗的患者作为研究对象，依据患者选择的药物种类分为观察组和对照组，每组各30 例，对照组采用多西他赛治疗，观察组予以培美曲塞治疗，对比分析两组的近期治疗效果、生存质量评分和毒副反应发生情况。结果 观察组病症控制率为66.67%，对照组病症控制率为36.67%，观察组病症控制效果更好；观察组生存质量评分为（65.2±3.4）分，对照组生存质量评分为（51.7±4.6）分，两组比较差异有统计学意义（t=12.926，P=0.000）；观察组各项毒副反应发生率均低于对照组，差异有统计学意义（P＜0.05）。结论 在晚期非小细胞肺癌靶向治疗失败后进行挽救化疗中选用培美曲塞有更好的治疗效果，可以较好的进行临床治疗，改善患者的生活质量，且产生的毒副反应较少，在实际临床中的应用价值较高。     

奥拉西坦联合肌电生物反馈疗法治疗血管性痴呆疗效观察

目的:探讨奥拉西坦联合肌电生物反馈疗法治疗血管性痴呆(VD)的临床效果。方法:随机将2017年1月~2017年6月某院收治的104例VD患者随机分为A、B两组(A=52,B=52)。两组患者均给予奥拉西坦治疗,B组加用肌电生物反馈疗法,对比两组患者治疗前后MMSE、ADL和SF-36评分。结果:治疗后B组患者MMS、ADL和SF-36评分均高于A组(P<0.05)。结论:奥拉西坦联合肌电生物反馈疗法治疗可有效改善VD智力水平、自主生活能力和生活质量,具有较高的临床推广价值。     

完全型雄激素不敏感综合征2例临床特点及处理

雄激素不敏感综合征(androgen insensitivity syndrome,AIS)又称为睾丸女性化综合征(testicular feminization syndrome,TFS),是一种X连锁遗传病,是男性假两性畸形中较常见的类型,可分为完全型AIS和不完全型AIS,其原因主要是雄激素受体(androgen receptor,AR)基因的突变导致其对雄激素产生抵抗和不应答。本文回顾南京医科大学附属妇产医院2例CAIS患者的临床资料及诊疗过程,以期能进一步提高对该病的认知及诊治水平。     

胰十二指肠切除术后胃排空障碍的诊疗进展

目的总结胰十二指肠切除术(PD)后胃排空障碍诊疗的现状与进展。方法检索近年来国内外有关PD后胃排空障碍的相关研究文献并进行综述。结果目前胃排空障碍的病因及发病机制尚未完全阐明,与手术创伤、患者高龄、合并糖尿病、伴有其他腹部并发症等多种高危因素有关。保留幽门PD并不增加术后胃排空障碍的风险,而幽门环切除、结肠前吻合、Braun吻合、微创手术对降低其发生是有利的。胃排空障碍的治疗目前国内外仍无明显进展,但绝大多数患者可通过对症保守治疗获得痊愈。结论 PD后胃排空障碍应以预防为主,围术期应用术后加速康复策略可能是目前临床解决术后胃排空障碍的关键所在,但需进一步研究。