化疗联合超声电导经皮透药治疗复治空洞性肺结核的疗效评价

目的 探讨超声电导经皮透药治疗复治空洞性肺结核的临床疗效.方法 选择西安市结核病胸部肿瘤医院2011年12月至2012年8月,经痰涂片或痰结核分枝杆菌培养确诊为复治继发性涂阳肺结核且合并空洞者183例,按照完全随机法(抽签法)分为化疗联合超声电导组(92例)、单纯化疗组(91例),两组化疗方案均为2 HRZES/6 HRE,超声电导组在全身化疗的基础上加用超声电导经皮透药治疗(采用超声电导仪及超声电导凝胶贴片进行药物靶位透入,凝胶贴片含有异烟肼注射液0.1g),观察治疗后1、3、6个月3个时间点各组患者的症状改善情况、痰菌阴转率、结核病灶治疗有效率、结核空洞治疗有效率、并发症及不良反应.结果 超声电导组2例患者因经济原因未完成疗程退组,单纯化疗组1例患者因出现严重肝损伤退组,共计3例患者观察期未满1个月.超声电导组治疗后1、3和6个月时痰菌阴转率分别为50.00％(45/90)、66.67％(60/90)和83.33％(75/90),显著高于单纯化疗组(31.11％,28/90;40.00％,36/90;52.22％,47/90),差异有统计学意义(x2值分别为6.660、12.857、19.943,P值均≤0.01);结核空洞超声电导组治疗有效率为40.00％(36/90)、50.00％(45/90)和83.33％(75/90),显著高于单纯化疗组(15.56％,14/90; 31.11％,28/90;50.00％,45/90),两组差异有统计学意义(x2值分别为13.460、8.149、22.540,P值均＜0.01);超声电导组与单纯化疗组不良反应发生率(分别为10.00％,9/90;14.44％,13/90),差异无统计学意义(x2=0.829,P=0.363).结论 超声电导经皮透药治疗复治空洞性肺结核可以提高患者的痰菌阴转率及空洞治疗有效率,是一种结核病治疗的新型给药途径.     

Phonophoresis of Phyllanthus amarus nanoparticle gel improves functional capacity in individuals with knee osteoarthritis: A randomized controlled trial

ObjectiveThis study examined the effects of treatment with Phyllanthus amarus nanoparticle gel applied by phonophoresis (PP) and ultrasound therapy (UT) in patients with symptomatic knee osteoarthritis (OA) using a randomized, double-blind, controlled trial.MethodsPatients with knee OA (n = 40; mean age ± SD, 64.30 ± 9.71 years), who had visual analogue scale (VAS) scores for knee pain intensity of 68.00 ± 9.58 (UT group) and 71.00 ± 8.74 (PP group, respectively) before treatment, were randomly allocated into two groups. Both groups were treated with an ultrasound program in continuous mode, 1.0 W/cm², 10 min per session, for 10 sessions. Nanoparticles of P. amarus were used in the PP group, whereas a nondrug coupling gel was used in the UT group. The 6-min walk test (6-MWT) was performed to evaluate functional capacity. The VAS and the 6-MWT were evaluated before and after 10 treatment sessions in both groups using a double-blind procedure.ResultsVAS and 6-MWT showed significant improvement after treatment in both groups (p < 0.05). The PP group showed more significant effects than the UT group, in terms of both reducing the VAS pain score (p < 0.05) and improving 6-MWT (p < 0.05).ConclusionsPP is suggested as an effective method for the treatment of symptomatic knee OA for reducing pain and improving functional capacity.     

景天祛斑胶囊联合超声透入氢醌霜治疗黄褐斑的临床研究

目的：观察景天祛斑胶囊联合超声透入氢醌霜治疗黄褐斑的临床疗效。方法本研究为随机对照研究。将符合纳入标准的180例黄褐斑患者采用随机数字表法分为2组,对照组80例给予超声波透入2%氢醌乳膏;治疗组100例在对照组基础上加服景天祛斑胶囊,均连续治疗2个月。评价治疗结束时和2个月后随访时症状和皮肤损伤总积分。结果治疗结束时,治疗组治愈率为81.0%(81/100),对照组为67.5%(54/80),2组比较差异有统计学意义(χ2＝4.320,P＝0.038)。2个月后随访时,治疗组治愈率为92.0%(92/100),对照组为76.3%(61/80),2组比较差异有统计学意义(χ2＝5.538,P＝0.019)。治疗组治疗结束时、2个月后随访时皮损总积分[(1.61±0.84)分、(1.30±0.85)分比(3.48±1.02)分,t＝14.152、16.419]均较治疗前降低(P＜0.01);对照组治疗结束时、2个月后随访时皮损总积分[(2.04±0.61)分、(2.03±0.51)分比(3.45±1.09)分,t＝10.097、10.554]均较治疗前降低(P＜0.01)。治疗组治疗结束、2个月后随访时皮损总积分下降程度较对照组显著(t值分别为3.839、6.767,P＜0.01)。结论景天祛斑胶囊联合超声波透入氢醌乳膏可有效治疗黄褐斑。     

Relative Acoustic Transmission of Topical Preparations Used With Therapeutic Ultrasound

Objective

To determine the relative acoustic transmission allowed by various preparations at 1MHz and 3MHz ultrasound (US) frequencies.

Design

Bench-top laboratory study.

Setting

Laboratory.

Participants

No human or animal participants were used.

Interventions

We administered continuous US through various over-the-counter preparations at 1.2W/cm² at both 1MHz and 3MHz frequencies for 30 seconds and measured the acoustic output.

Main Outcome Measures

Percentage of transmission of energy relative to commercial US gel. Planned observational comparisons were made at both 1MHz and 3MHz frequencies. Topical agents were categorized as either gel-based or cream-based preparations.

Results

Transmission of gel-based preparations (1MHz and 3MHz): Arnica gel (97% and 110%), Biofreeze (60% and 79%), Capzasin (70% and 93%), Cobroxin (76% and 91%), and Solarcaine (70% and 101%). Cream-based preparations (1MHz and 3MHz): Arnica cream (67% and 74%), Australian Dream (54% and 80%), Bengay (37% and 55%), MediPeds Footcare (126% and 101%), Neuragen PN (76% and 90%), Octogen (38% and 47%), and Thera-Gesic (52% and 73%).

Conclusions

Topical agents suspended in aqueous gels are generally more effective in transmitting US energy, while many cream-based agents are less effective, particularly at 1MHz frequency. Many agents that are commonly used to provide a sensory effect, such as topical analgesic creams, may block US transmission. Agents that reduce US transmission may lead to poor phonophoresis results and are likely to minimize the therapeutic effects of US.     

局部超声透入利多卡因治疗对全膝关节置换术后患者镇痛效果的影响

目的：观察超声药物透入利多卡因对全膝关节置换术（ TKA ）后患者疼痛的影响。方法采用随机数字表法将112例TKA患者分为观察组及对照组,每组各56例。观察组患者局部超声透入利多卡因治疗,对照组给予超声透入安慰剂治疗。采用NRS评估量表对两组患者静息状态及功能锻炼后局部疼痛情况进行评价,比较两组患者膝关节活动度,并评估治疗安全性。结果观察组患者术后48,72,96 h静息状态下NRS得分分别为（3．96±0．53）,（3．25±0．51）,（2．62±0．38）分,均优于对照组的（5．25±0．48）,（4．32±0．41）,（3．43±0．31）分,两组比较差异有统计学意义（t值分别为120．758,98．763,89．224;P＜0．05）。48,72,96 h功能锻炼后,观察组NRS得分为（4．90±0．59）,（4．17±0．72）,（3．28±0．36）,明显优于对照组（5．965±0．58）,（4．97±0．62）,（3．86±0．36）分,两组比较差异有统计学意义（t值分别为88．152,86．375,79．249;P＜0．05）;观察组患者术后2,3,7 d膝关节活动度分别为（45．8±7．6）°,（63．2±8．7）°,（95．6±8．2）°,明显优于对照组的（41．1±6．9）°,（55．3±5．8）°,（88．9±6．3）°,两组比较差异有统计学意义（ t值分别为78．024,87．018,89．472;P＜0．05）,治疗期间未出现不良反应,安全纪录均为Ⅰ级。结论超声药物透入可有效缓解TKA后疼痛,改善膝关节活动度。     

超声散血净透入对家兔玻璃体积血的实验研究

目的探讨超声散血净对家兔实验性玻璃体积血的作用。方法用家兔自体动脉血造成玻璃体积血模型,随机分成散血净治疗组、尿激酶治疗组、不作治疗的对照组。30 d后观察各组眼底可见度、玻璃体蛋白浓度、超氧化物歧化酶(SOD)活性和巨噬细胞计数及吞噬率。结果散血净治疗组眼底可见度的恢复较其它组快,蛋白浓度明显下降,SOD活性增强,巨噬细胞计数高于其它组。结论超声散血净能促进玻璃体积血的吸收。     

环丙沙星超声透入的效果观察

目的 研究药物超声透入治疗对药物的促渗作用,以改善传统给药途径,为超声在实际中的广泛应用提供参考依据。方法 选用与人皮肤渗透性接近的豚鼠皮肤和喹喏酮类药物环丙沙星（CPFX）,利用本所自制的药物渗透治疗仪进行选择性治疗。实验分组：I组（对照组）样品池中为0．2％CPFX,不使用药物渗透治疗仪。Ⅱ组（促渗剂组）样品池中为0．2％CPFX＋3％氮酮（Az),不使用药物渗透治疗仪。Ⅲ组（药物超声透入组）样品池中为0．2％CPFX,并使用药物渗透治疗仪30min。Ⅳ组（综合组）样品池中为0．2％CPFX＋3％ Az,并使用药物渗透治疗仪30min。采用HPLC法对离体实验和在体实验的样品进行检测,以峰面积对药物浓度作直线回归。结果 最低检测浓度0．010μg/ml,离体实验中药物浓度随时间的进行而增加,综合组的浓度最高（P＜0．01）,超声组和促渗剂组无差别（P＞0．05）;在体实验中综合组的浓度最高（P＜0．01）,超声组和促渗剂组无差别（P＞0．05）,CPFX浓度从低到高的顺序是血、心、肝、肾。结论 超声波和Az均可提高皮肤的通透性,且二者有很好的协同作用,可使CPFX在体内达到有效浓度且分布符合药代动力学特点。     

Low frequency sonophoresis mediated transdermal and intradermal delivery of ketoprofen

The objective of this study was to test low frequency sonophoresis at 20 kHz for delivery of ketoprofen into and across the skin. Permeation studies were carried out in vitro on excised hairless rat skin over a period of 24 h using Franz diffusion cells after which, skin samples were subjected to skin extraction to quantify the amount of drug present in skin. Parameters like ultrasound application time, duty cycle coupling medium and distance of ultrasound horn from skin were optimized. Transepidermal water loss (TEWL) was measured to indicate the extent of barrier disruption following sonophoresis. Confocal microscopy was used to visualize dye penetration through sonophoresis treated skin. Application of ultrasound significantly enhanced permeation of ketoprofen from 74.87 ± 5.27 μg/cm² for passive delivery to 491.37 ± 48.78 μg/cm² for sonophoresis. Drug levels in skin layers increased from 34.69 ± 7.25 μg following passive permeation to 212.62 ± 45.69 μg following sonophoresis. TEWL increased from 31.6 ± 0.02 (passive) to 69.5 ± 12.60 (sonophoresis) indicating disruption of barrier properties. Confocal microscopy images depicted enhanced dye penetration through sonophoresis treated skin confirming barrier disruption. Low frequency sonophoresis with optimized ultrasound parameters can be effectively used to actively enhance transdermal and topical delivery of ketoprofen.     

Ultrasound-mediated transdermal drug delivery: Mechanisms, scope, and emerging trends

The use of ultrasound for the delivery of drugs to, or through, the skin is commonly known as sonophoresis or phonophoresis. The use of therapeutic and high frequencies of ultrasound (≥ 0.7 MHz) for sonophoresis (HFS) dates back to as early as the 1950s, while low-frequency sonophoresis (LFS, 20-100 kHz) has only been investigated significantly during the past two decades. Although HFS and LFS are similar because they both utilize ultrasound to increase the skin penetration of permeants, the mechanisms associated with each physical enhancer are different. Specifically, the location of cavitation and the extent to which each process can increase skin permeability are quite dissimilar. Although the applications of both technologies are different, they each have strengths that could allow them to improve current methods of local, regional, and systemic drug delivery. In this review, we will discuss the mechanisms associated with both HFS and LFS, specifically concentrating on the key mechanistic differences between these two skin treatment methods. Background on the relevant physics associated with ultrasound transmitted through aqueous media will also be discussed, along with implications of these phenomena on sonophoresis. Finally, a thorough review of the literature is included, dating back to the first published reports of sonophoresis, including a discussion of emerging trends in the field.     

超声治疗裸鼠移植癌的实验研究

目的观察高强度聚焦超声（ＨＩＦＵ）治疗裸鼠移植癌的疗效，探讨局部肿瘤非手术“切除”的可能性。方法将ＢＡＬＢ／Ｃ裸鼠背部接种Ｈ２２肿瘤细胞造模后，分为ＨＩＦＵ组２０只，对照组１０只。ＨＩＦＵ组采用频率为３．５ＭＨｚ超声，声头直径４ｃｍ，聚焦深度３．１ｃｍ，声强３００Ｗ／ｃｍ２，聚焦直径０．３５ｃｍ，纵深度０．５ｃｍ，连续波每次作用于病变局部３０秒，热电偶电极测得靶区温度为８５℃，每周５次，共４周累计１０分钟。检测作用前后肿瘤直径，观察肿瘤抑制率及病理组织变化。结果ＨＩＦＵ作用４周后，ＨＩＦＵ组与对照组肿瘤直径分别为（１．１０±０．４８）ｃｍ和（２．４５±０．８７）ｃｍ，Ｐ＜０．０５，肿瘤抑制率为９５％。其中５只裸鼠肿瘤完全脱落，而周围正常组织完好，未发现转移病灶。病理切片可见癌组织大片坏死，及癌巢间大片空泡变性；对照组裸鼠全部死亡。结论ＨＩＦＵ疗法是一种治疗局部肿瘤无创性的有效治疗方法。