低强度脉冲超声在脊髓损伤神经修复中的研究进展

脊髓损伤在临床医疗中倍受关注.作为一种致残率极高的中枢神经系统创伤性疾病,脊髓损伤可以导致严重的运动、感觉和自主功能障碍.目前仍未发现令人满意的治疗方法.低强度脉冲超声(LIPUS)作为物理治疗的一种方式,可非侵入性地传输能量,被应用于骨折愈合、肌肉损伤及组织修复等过程中.实验研究发现LIPUS可在脊髓损伤中发挥重要作用,有研究在细胞学和分子生物学等层面对其作用机制进行了探索,本文就此进行综述.     

Luz pulsada intensa: resultados en ojo seco crónico tras LASIK

A report is presented on the visual and clinical results from a retrospective case series of patients with chronic, evaporative, dry eye syndrome (DES), after refractive surgery, and treated with intense pulsed light treatment (IPL). Four sessions were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was completed before initiating treatment and after the last session. Pre- and post-treatment data included: visual acuity (VA), refraction, clinical evaluation (DEWS severity grading, and Oxford corneal staining), and Orbscan topography. Twenty eyes were treated and the following data recorded: Schirmer I 14.7 ± 5.6; 15.6 ± 3.4 mm, tear breakup time (TBUT) 3.4 ± 1.6; 5.1 ± 1.2 s (P > .003), DEWS 3.4 ± 0.5; 1.6 ± 0.7 (P < .003), Oxford grade 0.8 ± 0.77; 0.4 ± 0.75 (P > .003), VA 0.67 ± 0.26; 0.90 ± 0.15 (P < .0001), best corrected VA 0.83 ± 0.18; 0.92 ± 0.14 (P > .003), spherical equivalent −0.31 ± 0.6; −0.08 ± 0.38 D (P > .003), OSDI 34 ± 16; 28 ± 11.0 points (P > .003), frequency artificial tear use 3.4 ± 2.0; 2.5 ± 1.9 times/day (P > .03). A significant clinical and visual improvement was observed, together with a decreased frequency in artificial tear use, in LASIK patients with chronic DES after IPL treatment.     

Randomised double-masked placebo-controlled trial of the cumulative treatment efficacy profile of intense pulsed light therapy for meibomian gland dysfunction

PurposeTo assess long-term cumulative treatment effects of intense pulsed light (IPL) therapy in meibomian gland dysfunction (MGD).MethodsEighty-seven symptomatic participants (58 female, mean ± SD age, 53 ± 16 years) with clinical signs of MGD were enrolled in a prospective, double-masked, parallel-group, randomised, placebo-controlled trial. Participants were randomised to receive either four or five homogeneously sequenced light pulses or placebo treatment to both eyes, (E-Eye Intense Regulated Pulsed Light, E-Swin, France). Visual acuity, dry eye symptomology, tear film parameters, and ocular surface characteristics were assessed immediately before treatment on days 0, 15, 45, 75, and four weeks after treatment course completion on day 105. Inflammatory and goblet cell function marker expression, and eyelid swab microbiology cultures were evaluated at baseline and day 105.ResultsSignificant decreases in OSDI, SPEED, and SANDE symptomology scores, and meibomian gland capping, accompanied by increased tear film lipid layer thickness, and inhibited Corynebacterium macginleyi growth were observed in both treatment groups (all p < 0.05). Sustained clinical improvements occurred in both treatment groups from day 75, although significant changes from day 45, in lipid layer quality, meibomian gland capping, OSDI and SANDE symptomology, were limited to the five-flash group (all p < 0.05).ConclusionsIPL therapy effected significant improvements in dry eye symptomology, tear film lipid layer thickness, and meibomian gland capping in MGD patients. Five-flash IPL treatment showed superior clinical efficacy to four-flash, and an initial course of at least four treatments is suggested to allow for establishment of sustained cumulative therapeutic benefits prior to evaluation of overall treatment efficacy.Trial registration numberACTRN12616000667415.     

强脉冲光防治瘢痕156例疗效分析

目的:探讨强脉冲光技术在瘢痕防治中的应用价值。方法:采用由两名固定医师及患者共同评价疗效的方式,对2008年7月~2011年9月应用强脉冲光(波长560~1200nm,脉宽3.2~3.6ms,脉冲延时10~30ms,双脉冲模式,能量密度19~26J/cm2)治疗的156例不同病程、部位、色泽以及治疗次数的门诊瘢痕患者进行临床疗效评价。结果:瘢痕病程在1个月内的与大于1个月的疗效比较,差异有统计学意义(P0.05),病程越短,效果越显著。面部瘢痕疗效明显优于其他部位,红色和色素沉着性瘢痕治疗效果好于近肤色的瘢痕。整体疗效随着治疗次数增加而提高,治疗2次与3~5次疗效比较,差异有统计学意义,且治疗3~5次效果最满意,但组间疗效比较无统计学意义(P0.05)。治疗6次后的效果不如4~5次明显。结论:强脉冲光技术无创安全、操作便捷,疗效满意,不失为防治瘢痕的理想选择。     

强脉冲光治疗面部毛细血管扩张症108例疗效分析

目的:探讨强脉冲光治疗后,面部不同程度毛细血管扩张症患者的治疗效果和最终满意度。方法:采用Lumenis One激光与强脉冲光操作系统对不同程度毛细血管扩张症患者进行治疗,观察局部毛细血管和总体皮肤改善情况,并在疗程结束后1个月进行满意度回访。结果:经5次治疗(1个疗程)后,轻、中度毛细血管扩张症有效率达100%,重度有效率88.9%,总有效率98.1%,患者满意度为99.1%。结论:强脉冲光治疗面部毛细血管扩张症疗效明显,同时改善皮肤衰老状态,患者满意度高。     

复方甘草酸苷胶囊联合红光治疗面部糖皮质激素依赖性皮炎疗效观察

目的:观察复方甘草酸苷胶囊联合红光治疗糖皮质激素依赖性皮炎的疗效。方法:66例患者,随机分为两组:治疗组43例,口服复方甘草酸苷胶囊20mg,每日3次,联合红光面部照射,使用波长(633±3)nm,能量密度128 J/cm2,每次照射20min,每周治疗2次;对照组23倒,口服咪唑斯汀缓释片10mg,每日1次。所有患者外涂硅油霜,两组疗程均为8周。结果:治疗组有效率为90%,对照组为65%,两组比较差异具有显著性(P0.05)。结论:复方甘草酸苷胶囊联合红光治疗面部糖皮质激素依赖性皮炎疗效好,无不良反应。     

LED蓝光照射治疗MRSA感染创面的临床研究

目的:探讨使用LED蓝光照射治疗MRSA感染创面的临床疗效。方法:2012年12月~2014年1月,笔者科室共收治11例MASA感染的难治创面患者,创面大小20cm×20cm~40cm×40cm。通过每日洗澡,双氧水冲洗,LED蓝光照射及碘伏换药治疗。结果:复查细菌培养均未检测出MRSA,创面均完全愈合。结论:LED蓝光照射治疗对MRSA感染创面有较好的临床效果。     

强脉冲光联合点阵铒激光治疗痤疮瘢痕的临床效果分析

目的:联合运用强脉冲光和点阵铒激光治疗痤疮瘢痕,研究分析其临床疗效及对患者生活质量的影响。方法:采用简单化随机分组方法将我院2011年1月到2013年6月期间收治的126例痤疮瘢痕患者随机分为强脉冲组、点阵组、联合治疗组,每组各42例。接受相应治疗后评价其ECCA权重评分、有效率、不良反应及生活质量。结果:联合治疗组治疗前后ECCA权重评分下降较强脉冲组和点阵组多(P0.05);联合治疗组总有效率95.24%,强脉冲组总有效率76.19%,点阵组总有效率80.9%,联合治疗组高于其他两组(P0.05);联合治疗组不良反应发生率14.29%,强脉冲组为40.48%,点阵组为35.71%,联合治疗组不良反应低于其他两组(P0.05);治疗后联合治疗组在自我感知、社会功能、情感功能、痤疮症状等评分均高于强脉冲组和点阵组(P0.05)。结论:联合运用强脉冲光和点阵铒激光治疗痤疮瘢痕能提高疗效,减少不良反应的发生,同时能提高患者的生活质量,值得推广。     

茵栀黄颗粒联合蓝光治疗黄疸疗效及对新生儿肝功能、胆红素、脑功能的影响

目的:研究茵栀黄颗粒口服联合蓝光治疗对新生儿黄疸肝功能、胆红素水平及脑功能的影响。方法:选择120例新生儿黄疸患儿并随机分为观察组和对照组各60例。对照组患儿采用蓝光治疗; 观察组患者在对照组基础上联合茵栀黄颗粒治疗,两组均治疗7 d。比较两组患儿治疗前后肝功能、胆红素水平、炎症反应水平及治疗后脑功能损伤情况和疗效。结果:治疗后观察组谷草转氨酶(AST)和谷丙转氨酶(ALT)水平显著低于对照组(P<0.05); 总胆红素(TBIL)、间接胆红素(IBIL)水平显著低于对照组(P<0.05); 白介素-6(IL-6)、C反应蛋白(CRP)水平显著低于对照组(P<0.05); 脑功能正常率显著高于对照组(P<0.05); 总有效率明显高于对照组(P<0.05)。结论:新生儿黄疸患儿通过茵栀黄颗粒口服联合蓝光治疗对改善肝功能、调节胆红素水平和炎症反应、改善脑功能有积极意义,整体疗效较理想。     

The influence of body size on the pharmacodynamic and pharmacokinetic response to clopidogrel and prasugrel: A retrospective analysis of the FEATHER study

Introduction

Patients treated with clopidogrel who have higher body size exhibit greater platelet reactivity than patients with lower body size. In a retrospective analysis of the FEATHER trial, we examined the relationship between platelet response to thienopyridines clopidogrel 75 mg (Clop-75), prasugrel 5 mg (Pras-5), and prasugrel 10 mg (Pras-10) using 3 body size indices: body weight (BW), body mass index (BMI), and body surface area (BSA). Relationships were assessed as continuous variables and as 4 incremental body size groups.

Materials and Methods

Aspirin-treated patients with stable coronary artery disease (N = 72) and a BW range of 45-134 kg received Clop-75, Pras-5, and Pras-10 in a 3-period, blinded, cross-over study. Platelet assays included maximum platelet aggregation (MPA) to 20 μM ADP by light transmission aggregometry, VerifyNow-P2Y12 reaction units (PRU), and vasodilator-associated stimulated phosphoprotein (VASP) phosphorylation platelet reactivity index (PRI). Exposure to active metabolites (AMs) was also assessed.

Results

Body size was a determinant of AM exposure and residual platelet reactivity regardless of type and dose of thienopyridine. BW and BSA demonstrated marginally stronger correlations with platelet reactivity; VASP-PRI demonstrated a stronger correlation with the body size than the other tests. Correlation coefficients ranged from a high of 0.64 (BW vs. PRI on Pras-5) to a low of 0.34 (BMI vs. MPA on Pras-10), but all were statistically significant (p < 0.01).

Conclusions

Using a comprehensive selection of body size indices, AM exposures, platelet function tests, and thienopyridine doses, we demonstrated a consistent inverse relationship between body size and response to clopidogrel and prasugrel.