银屑病瘙痒发病机制的研究现况

瘙痒是多数原发性皮肤疾病及某些系统性疾病常见的临床症状。银屑病患者瘙痒发生率较高,但其具体发病机制复杂且尚不清楚。银屑病皮肤瘙痒的发生、发展源于神经、免疫、内分泌和血管系统等的共同参与。本文对银屑病瘙痒发病机制中涉及的相关介质进行综述,旨在提高对瘙痒症状的认识以及进一步研究缓解瘙痒的治疗方案。     

早期颅骨修补治疗颅脑损伤大骨瓣减压术后顽固性硬膜下积液

目的分析早期颅骨修补治疗颅脑损伤大骨瓣减压术后顽固性硬膜下积液的效果及机制。 方法选取解放军第二五一医院神经外科自2014年1月至2019年1月收治的因颅脑损伤术后行去骨瓣减压并发硬膜下积液患者20例，给予皮下或颅骨钻孔引流、局部加压、腰大池引流及大脑外侧裂池开放等方法后效果不明显，4~6周后行颅骨修补后观察硬膜下积液变化。 结果2例患者术后出现局部伤口感染，经过积极换药抗生素治疗后甚至痊愈；5例患者术后1个月复查CT硬膜下积液减少不明显，术后3、6个月后随访发现积液逐渐减少消失；其余患者均取得良好的效果，神经功能障碍不同程度恢复，随访硬膜下积液未再复发。 结论早期颅骨修补术能有效治疗顽固性性硬膜下积液。     

Current and emerging systemic treatments targeting the neural system for chronic pruritus

ABSTRACT

Introduction

Pruritus is a debilitating symptom that significantly affects the quality of life of patients who suffer from it. Many current and emerging systemic treatments targeting the neural system have been successful in treating itch of various underlying etiologies.     

套管式长针深层软组织松解术的临床特点与应用

套管式长针属古代“九针”中“长针”的范畴,可祛深邪久痹,通过松解神经根,刺激相应区域的肌肉,以调节机体生理功能。套管式长针深层软组织松解术依据中医学经筋理论和以痛为腧理论,属于古代针刺中的“经刺”“报刺”“恢刺”及“合谷刺”等范畴。通过针刺疏散瘀滞之气血,以通治痛。套管式长针弥补普通毫针刺激量小及松解类针具风险较大的不足,兼具针刺调衡、提插松解的双重作用。套管式长针深层软组织松解术对深层肌纤维紧张所导致的各类难治性疼痛类疾病疗效明显,为临床医生提供了新的治疗方式,具有较高的推广及应用价值。     

Effect of topical vitamin D on chronic kidney disease‐associated pruritus: An open‐label pilot study

Chronic kidney disease‐associated pruritus (CKD‐aP) is a troublesome symptom in patients with end‐stage renal disease (ESRD). Recently, vitamin D deficiency has been known to be one of the possible etiologic factors in CKD‐aP. However, limited data is available on whether topical vitamin D treatment is effective for relieving CKD‐aP. Therefore, the purpose of this study is to evaluate the effectiveness of topically vitamin D for CKD‐aP. Twenty‐three patients with CKD‐aP were enrolled in a single center, open‐label study. Patients were instructed to apply a topical vitamin D (calcipotriol) agent (Daivonex solution; LEO Pharma) or vehicle solution twice daily for a month. We assessed the efficacy and safety of topical vitamin D on CKD‐aP using clinical and dermoscopic photographs, and questionnaires including the validated modified pruritus assessment score (VMPAS) and visual analog scale (VAS) every 2 weeks. Dry dermoscopic findings showed significant improvement of scale (dryness) on the skin of topical vitamin D‐treated patients compared with those of the vehicle group. Both VMPAS and VAS were significantly decreased after 2 and 4 weeks of the topical vitamin D treatment compared with the vehicle, respectively (P < 0.05). No significant side‐effects were observed. Topical vitamin D may be one of the safe and effective therapeutic candidates for CKD‐aP.     

The long-term effect of repetitive transcranial magnetic stimulation in the treatment of intractable insomnia

ObjectiveTo explore the differences in clinical efficacy of different courses of repetitive transcranial magnetic stimulation (rTMS) in the treatment of intractable insomnia and the duration of clinical efficacy after cessation of treatment.Method70 patients with intractable insomnia were randomly divided into 1 treatment course group and 2 treatment courses group. The rTMS course consisted of daily sessions of 1200 stimuli for the r-DLPFC at a frequency of 1 Hz and 800 stimuli for parietal lobe (CPZ) at a frequency of 1 Hz. The pitchburg sleep index (PSQI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and cardiopulmonary coupled sleep (CPC) were assessed for 35 patients in each group at baseline, at 2 weeks, and at 1 and 3 months after treatment.ResultThe scores of PSQI, HAMD and HAMA in the 2 groups were significantly improved after 1 month of follow-up after rTMS treatment (p < 0.01). The long-term effect of different treatment courses is different. After 2 consecutive courses of treatment, there was still a significant difference between the 3-month follow-up and the pre-treatment period (p < 0.05). However, there was no statistical difference between the 3-month follow-up of one course of treatment and the pre-treatment period. The results of CPC test showed that the improvement of total sleep time (TST), and deep sleep time (DST) was basically consistent with the assessment of PSQI, HAMD and HAMA that the clinical efficacy of the 3-month follow-up was better than that of one course of treatment after 2 consecutive courses of treatment.ConclusionThe treatment of refractory insomnia by rTMS is effective, and the duration of the curative effect is related to the course of treatment. 2 consecutive courses of treatment still have a certain effect after 3 months, which is worthy of clinical promotion.     

血液透析治疗尿毒症顽固性高血压的疗效比较

〔摘 要〕 目的：分析在尿毒症顽固性高血压患者治疗过程中使用血液透析所取得的临床效果。方法：选取 2019 年 1 月 至 2020 年 3 月期间江门市人民医院血透室在透的 80 例尿毒症顽固性高血压患者作为研究对象，采用随机列表将 其分为对照组和观察组，各 40 例。观察组患者选取血液透析的方式进行治疗，对照组患者选取血液灌流的方式进 行治疗，对两组患者临床治疗效果进行分析。结果：观察组患者治疗总有效率高于对照组，差异具有统计学意义 （P ＜ 0.05）。治疗前，两组患者血压比较，差异无统计学意义（P ＞ 0.05）；治疗后，两组患者收缩压与舒张压均降低， 且观察组低于对照组，差异具有统计学意义（P ＜ 0.05）。两组患者均未出现严重不良反应，组间比较，差异无统计学意义 （P ＞ 0.05）。结论：在尿毒症顽固性高血压患者治疗过程中，通过血液透析疗法的应用，有利于提升患者治疗质量，对 于患者健康具有积极作用。     

Effects of ruxolitinib cream on pruritus and quality of life in atopic dermatitis: Results from a phase 2, randomized,dose-ranging,vehicle- and active-controlled study

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Is there an association between otologic symptoms and temporomandibular disorders?: An evidence-based review

BackgroundThe aim of this article is to discuss the scientific evidence available on the pathophysiology and management of otologic complaints in patients with temporomandibular disorders (TMDs).Types of Studies ReviewedThe authors conducted an electronic search in MEDLINE, Web of Science and ScienceDirect and retrieved all the relevant peer-reviewed journal articles available in English on the topic. No time restriction was applied.ResultsNo consensus exists on the management of otologic symptoms in patients with concomitant TMD. The scientific evidence suggests that conservative or reversible TMD therapy might provide relief. However, this evidence is scarce and low, thus further studies with larger sample sizes and better designed methodological frameworks are needed. Until such evidence is available, dentists and orofacial pain specialists should treat TMD patients using current guidelines and refer those with otologic symptoms to an otolaryngologist.Practical ImplicationsGiven the wide range of potential pathophysiologies and treatments for each otologic symptom described in the TMD patient, close collaboration with otolaryngologists is essential to achieve the best patient care.