原发性多汗症治疗进展

原发性多汗症是一种不符合人体正常体温调节、出汗过多,并影响患者生活质量的慢性疾病.普通人群中患病率为2.8％～16.3％.原发性多汗症的治疗分为保守治疗和手术治疗.保守治疗包括局部止汗剂、抗胆碱能药物、电离子渗透疗法、肉毒素局部注射和激光、射频等.手术治疗主要包括腋窝汗腺的切除术、腋下吸脂术和交感神经切除术等.治疗应根据患者的自身情况,采用个体化治疗,其要点应按照保守治疗到手术治疗的原则进行.     

Effect of Iontophoretic Patterns on in Vivo Antidiuretic Response to Desmopressin Acetate Administered Transdermally

Abstract

The effects of concentration, amperage and duration on the antidiuretic response induced by iontophoretic delivery of desmopressin acetate (DDAVP) were examined using a diabetes insipidus model in rats. A higher current density brought about a larger and longer antidiuretic response. Prolonged iontophoretic duration caused an overdose. Repeated short iontophoretic treatments with lower current density maintained a constant response with a short lag time and a rapid disappearance of pharmacological response immediately after cessation of the final treatment. This type of iontophoresis substantially reduced the inter-subject variability of response as compared to the response using an intranasal route of administration.     

Indirect treatment comparison of two non-invasive patient-controlled analgesia treatments for acute post-operative pain management

Objectives: To evaluate the relative clinical efficacy, safety, and tolerability associated with two non-invasive patient-controlled analgesia (PCA) treatments, sufentanil sublingual tablet system (SSTS) and fentanyl iontophoretic patient-controlled transdermal system (PCTS). These two treatments have recently been approved in the EU for the management of acute moderate-to-severe post-operative pain in adult patients.

Methods: As no head-to-head trials comparing SSTS and PCTS currently exist, indirect treatment comparison (ITC) analyses were conducted to evaluate SSTS or PCTS versus intravenous (IV) morphine PCA.

Results: Five studies, four assessing PCTS and one assessing SSTS, were included in this analysis. SSTS had statistical or numerical advantages over PCTS for both patient global assessment (PGA) and healthcare professional global assessment (HPGA) outcomes at all time points investigated. SSTS was also associated with greater patient ease of use (weighted mean difference [WMD]: 0.13; 95% confidence interval [CI]: ?0.02–0.28) and a higher patient satisfaction score (WMD: 0.31; 95% CI: 0.05–0.57; p?=?.019) compared with PCTS. In terms of tolerability, all-cause withdrawals from treatment were reported to be less likely with SSTS (risk ratio: 0.65; 95% CI: 0.42–1.02). No significant differences were observed between SSTS and PCTS in terms of safety and adverse events.

Conclusions: In the absence of direct head-to-head data, the combination of promising phase III trial results compared to IV morphine PCA, a SLR comparison against other opioid treatments, and the results of this exploratory analysis present a strong rationale in support of SSTS as a key option for management of post-operative pain.     

清肺方离子导入治疗痰热壅肺型社区获得性肺炎疗效观察

目的 观察清肺方离子导入治疗痰热壅肺型社区获得性肺炎（community acquired pneumonia,CAP）的疗效。方法 将60例患者随机分为治疗组和对照组,每组30例,对照组采用常规抗感染、化痰治疗,治疗组在对照组治疗的基础上加清肺方离子导入治疗12 d;治疗前、治疗6 d后、治疗12 d后,分别观察两组患者中医证候积分、白细胞（white blood cell,WBC）计数、中性粒细胞百分比（neutrophil percentage,N%）、超敏C反应蛋白（high sensitivity C-reactive protein,hs-CRP）及胸部CT的变化情况。结果 与治疗前比较,两组患者治疗6、12 d后,中医证候积分、WBC计数、N%、hs-CRP水平均显著下降（P＜0.05）;治疗6、12 d后,治疗组患者中医证候积分、WBC计数均显著低于对照组（P＜0.05）。两组患者治疗后肺部炎症吸收情况比较,差异有统计学意义（P＜0.05）。结论 清肺方离子导入治疗痰热壅肺型CAP能够较快缓解患者咳嗽、咳痰、胸痛、发热等症状,促进肺部炎症吸收。     

耳穴贴压、针刺联合丹参离子导入治疗玻璃体积血50例临床护理

目的:探讨耳穴贴压、针刺联合丹参离子导入治疗玻璃体积血的临床治疗意义.方法:将103例玻璃体积血患者随机分为两组,治疗组50例采用耳穴贴压、针刺联合丹参离子导入治疗,对照组53例采用常规治疗及对症处理,评价并对比分析治疗后患者的视功能恢复与眼底改善情况.结果:治疗组患者视力提高有效率达86%,对照组为69.8%,两组比较有显著性差异(P<0.05).结论:耳穴贴压、针刺联合丹参离子导入治疗玻璃体积血有改善症状、促进积血吸收、提高视力的良好治疗效果.     

Lidocaine transport through living rat skin using alternating current

The purpose of the study was to determine whether lidocaine could be transported through living rat skin using alternating current and to determine whether lidocaine transport depends on voltage. The drug delivery cell was originally constructed for the application of an electric field. Hairless rats were anaesthetised using sevoflurane, and a tracheotomy was performed. The drug delivery cell, with lidocaine solution in the donor cell, was placed on the abdominal skin. Samples were collected from the subcutaneous tissue using a microdialysis probe inserted into the abdominal subcutaneous tissue, and the lidocaine concentrations in the samples were determined using high-performance liquid chromatography. The lidocaine concentration in the rat skin increased in time, and voltage-dependency was approximately linear. The lidocaine concentration after the application of 20 V for 21 min was about ten-fold higher than that observed after 21 min of passive diffusion. Lidocaine was successfully transported through living rat skin in a voltage- and time-dependent manner. This drug delivery cell may contribute to local anaesthesia and pain management of human skin.     

创伤性面瘫物理疗法的临床研究

目的 比较超短波加离子导入疗法（A组）与电刺激加离子导入疗法（B组）治疗创伤性面瘫的效果。方法 对39例创伤性面神经损伤患者进行临床对照研究，通过量化面神经功能评价、神经电图检查及面神经功能的主观评价比较面神经损伤的治疗效果。结果 创伤性面瘫以青年男性多见，损伤程度以中、重度为主；对于神经损伤轻、中度患者,A组与B组均能促进神经恢复，B组神经功能开始恢复时间早于A组。对于神经损伤重度患者，A组与B组神经恢复率高于对照组，两组均不能减少并发症出现率。结论 超短波加离子导入疗法与电刺激加离子导入疗法均能促进面神经损伤的恢复，但对于减少并发症发生率并无帮助。     

Laser Doppler imaging in the detection of peripheral neuropathy

Small fiber neuropathy is common in a number of systemic diseases and is often challenging to diagnose. Laser Doppler imaging (LDI) is a test of small fiber neurovascular function that can quantify the integrity of the vasomotor C-fiber mediated axon-reflex, but no standardized method of analysis exists. We developed a novel LDI analysis technique and tested it in a human model of small fiber neuropathy. Eighteen healthy subjects (age 24 ± 3 years) underwent LDI testing to assess the axon-mediated flare area in response to 10% acetylcholine iontophoresis. LDI measurements were taken before and longitudinally after a 48-hour application of 0.1% capsaicin (to cause a transient small fiber neuropathy) on the skin of the thigh; placebo cream was placed on the contralateral thigh as a control. We compared our new LDI image analysis technique to two previously published methods. The new LDI analysis technique was the only method to show a consistent difference in axon-reflex area between capsaicin treated and placebo treated skin on all testing days (p < 0.05) with maximum attenuation of the flare area immediately post-application (438 ± 298 mm² vs. 824 ± 375 mm², p < 0.05). In conclusion, this study demonstrates that our novel flare area method for LDI analysis can detect neurovascular dysfunction in a model of small fiber neuropathy, is an improvement over existing methods, and may supplement clinical assessment of small fiber neuropathy.