点阵激光的临床应用进展

由于点阵激光具有疗效肯定,安全性高和停工期短等优点,已成功用于治疗痤疮瘢痕和光老化等.与传统的剥脱性和非剥脱性激光不同,点阵激光仅作用部分皮肤,保留周围正常皮肤,从而有利于快速愈合和减少停工期.点阵激光通过微治疗孔传递高能量到达真皮层,从而保证疗效,而避免传统剥脱性激光容易出现的风险为持续性色素减退和瘢痕.概述近几年剥脱性和非剥脱性点阵激光在瘢痕、光老化、萎缩纹、色素性疾病、脱发和点阵激光经皮给药等的临床应用、机制和疗效.     

点阵激光治疗黄褐斑进展

点阵激光是皮肤激光美容领域的一种新技术,近年来在黄褐斑的治疗中显示出良好的前景.点阵激光的作用原理是局灶性光热作用,是选择性光热作用的一个重要拓展和延伸.点阵激光可分为非剥脱性点阵激光和剥脱性点阵激光,对黄褐斑有一定的疗效,改善程度不一,有的甚至加重,其疗效与治疗参数的选择、皮肤类型、术后护理、黄褐斑类型等有关.不良反应主要为短暂性红斑、水肿、灼热和疼痛感等,患者可耐受,但炎症后色素沉着发生率相对较高.     

点阵激光在皮肤科的临床应用及进展

点阵激光第一次报道于2004年,是为得到明显美容效果和最低风险美容技术而引进市场的。与传统的剥脱和非剥脱激光不同的是,剥脱点阵激光和非剥脱点阵激光治疗的仅仅是皮肤的一小部分,最多可有约95%的皮肤不受累,未受损害的周围组织包绕受损组织可使表皮迅速修复。2006年FDA批准非剥脱性点阵激光可用于治疗色素损害、眶周皱纹、皮肤重塑、黄褐斑、软组织凝结、痤疮瘢痕、外科瘢痕和光化性角化症。2007年这个概念被进一步发展到剥脱性点阵激光(Er:YAG或CO2激光),这些设备由FDA明确指出用于治疗各种皱纹、组织结构不平整、色素损伤和血管皮肤变色。本文就剥脱和非剥脱点阵激光这两个概念及其技术细节和临床指征进行了综述。     

点阵激光治疗痤疮性瘢痕进展

痤疮后凹陷性瘢痕是痤疮愈合后常见的后遗症,给患者的生活和心理带来很多困扰。传统的治疗方法很多,如化学剥脱、外科切除、磨削、组织填充等,但这些方法疗效不甚理想,常常伴有术后感染、瘢痕加重及色素变化等严重的不良反应。点阵激光是以局灶性光热作用原理作为理论指导的一种新型激光治疗模式,可分为剥脱性点阵激光和非剥脱性点阵激光,在痤疮瘢痕的治疗中取得了显著的疗效。     

强脉冲光及非剥脱点阵激光治疗痤疮瘢痕研究进展

随着强脉冲光与非剥脱点阵激光的问世,痤疮凹陷性瘢痕的治疗相对变得容易许多。而且治疗效果好,不良反应小。强脉冲光在皮肤美容界应用广泛,在治疗早期痤疮痘痕及浅表凹陷性瘢痕方面有较为明显的疗效。另外,在维持皮肤年轻化方面更容易被广大求美者接受。非剥脱点阵激光在治疗痤疮凹陷性瘢痕上疗效更加显著,它以独特的点阵微孔、选择性光热作用占据领先地位。强脉冲光和非剥脱点阵激光联合治疗,会更好的发挥激光设备的优势,起到更好的治疗作用。     

激光辅助透皮给药技术应用于皮肤科的进展

激光具备精准、可控性高和技术成熟的优点广泛应用于临床,在辅助透皮给药技术时激光能通过改变皮肤屏障来提高药物的渗透量和作用深度,其中剥脱性点阵激光因创伤小、不良反应少,能有效增加渗透率而作为首选.影响疗效的主要因素可分为点阵激光的覆盖率、能量及药物的封包时间和相对分子质量.在皮肤科临床,剥脱性点阵激光辅助透皮给药技术能有效提高皮肤基底细胞癌、光线性角化病和增生性瘢痕的疗效,降低甲氨蝶呤治疗银屑病的药物浓度,不论是动物实验还是临床试验均证明其应用于一些皮肤病治疗的可行性.     

激光疗法在雄激素性脱发中的应用

近年来,国内外研究表明光疗法治疗雄激素性脱发效果良好。波长650~785 nm的低能量光、波长1550 nm和1927 nm的非剥脱性点阵激光以及剥脱性二氧化碳点阵激光治疗雄激素性脱发有效,其中,655 nm激光的疗效证据最充分。本文对不同波长的低能量激光和高能量点阵激光在雄激素性脱发治疗中的应用进行综述。     

1540nm非剥脱点阵激光联合氨甲环酸治疗黄褐斑的临床观察

目的评价1 540 nm非剥脱点阵激光联合氨甲环酸治疗黄褐斑的疗效性和安全性。方法将入选的105例黄褐斑患者随机分为3组,各35例,联合治疗组接受1 540 nm非剥脱点阵激光联合氨甲环酸治疗,激光组仅接受1 540 nm非剥脱点阵激光治疗,药物组仅接受氨甲环酸治疗。1 540 nm非剥脱点阵激光治疗1次/月,6次为1个疗程,氨甲环酸片口服,250 mg/次,2次/d,疗程6个月。疗程结束后比较3组患者的临床疗效及安全性。结果联合治疗组、激光组和药物组有效率分别为80.00%,47.06%,51.52%,联合治疗组与对照组间疗效差异有统计学意义(P0.05)。结论 1 540 nm非剥脱点阵激光联合氨甲环酸治疗黄褐斑可获得较好的疗效性和安全性,疗效优于单用1 540 nm非剥脱点阵激光或单用氨甲环酸治疗。     

非剥脱1565nm铒玻璃点阵激光治疗妊娠纹的临床观察

目的探讨非剥脱1565nm铒玻璃点阵激光对妊娠纹治疗效果及不良反应的影响。方法随机抽样法选取2017年12月—2018年12月本院皮肤科医美、妊娠纹门诊收治的60例妊娠纹患者。所有患者均行非剥脱1565nm铒玻璃点阵激光治疗。比较治疗前后皮肤弹性、表皮厚度、妊娠纹宽度变化,并统计临床疗效、不良反应。结果治疗后3个月,本组患者皮肤弹性、表皮厚度均高于治疗前,妊娠纹宽度小于治疗前(P0.05);本组患者总有效率为96.67%:显效22例,好转36例,无效2例;本组患者视觉模拟评分法(VAS)评分(2.95±0.75)分,不良反应发生率为6.67%。结论妊娠纹治疗中应用非剥脱1565nm铒玻璃点阵激光可改善皮肤弹性、表皮厚度、妊娠纹宽度,效果理想,且不良反应少,值得临床推广。     

A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效

目的:探讨A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效。方法:选择年龄30~60岁有眶周皱纹患者60例,随机分为3组,A组给予A型肉毒毒素注射,B组给予Lux1540 nm非剥脱点阵激光治疗,C组给予A型肉毒毒素注射联合Lux1540 nm非剥脱点阵激光治疗。每例患者在治疗前,治疗后14 d、1、3、6个月随访并行疗效评估。结果治疗1个月后,三组患者眶周皱纹、纹理、弹性、水分均有所改善,与治疗前比较,差异均有统计学意义(P值均<0.05)。肉毒毒素注射联合Lux1540 nm非剥脱点阵激光的C组患者,其皱纹、纹理、弹性、水分的远期效果改善更加明显。结论 A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗可同时改善眶周的皱纹和纹理,同时具有紧致眶周皮肤的作用,是眶周皮肤年轻化治疗的理想治疗方案。     

Lumps and bumps in neonates and infants

There are many developmental abnormalities that may appear in the neonate and in infants when critical steps in embryogenesis fail. These steps are often not fatal but can lead to significant morbidity for those patients affected. A logical approach is needed in addressing both the diagnostic and therapeutic issues that arise when caring for these patients, as various lesions will warrant an observational approach, and others may require imaging studies or definitive surgical intervention. Additionally, there are other "lumps and bumps" that are seen in the neonatal and infantile age groups that include malignancies and cutaneous neoplasms with associated systemic sequelae.     

Understanding and Evaluating Systematic Reviews and Meta-analyses

A systematic review is a summary of existing evidence that answers a specific clinical question, contains a thorough, unbiased search of the relevant literature, explicit criteria for assessing studies and structured presentation of the results. A systematic review that incorporates quantitative pooling of similar studies to produce an overall summary of treatment effects is a meta-analysis. A systematic review should have clear, focused clinical objectives containing four elements expressed through the acronym PICO (Patient, group of patients, or problem, an Intervention, a Comparison intervention and specific Outcomes). Explicit and thorough search of the literature is a pre-requisite of any good systematic review. Reviews should have pre-defined explicit criteria for what studies would be included and the analysis should include only those studies that fit the inclusion criteria. The quality (risk of bias) of the primary studies should be critically appraised. Particularly the role of publication and language bias should be acknowledged and addressed by the review, whenever possible. Structured reporting of the results with quantitative pooling of the data must be attempted, whenever appropriate. The review should include interpretation of the data, including implications for clinical practice and further research. Overall, the current quality of reporting of systematic reviews remains highly variable.     

Human T lymphocytes and mast cells differentially express and regulate extra- and intracellular CXCR1 and CXCR2

CXCL8 plays a major role in cell recruitment to sites of inflammation. Apart from neutrophils, little is known, however, about the cellular distribution and regulation of CXCL8 receptors in cells involved in acquired and adaptive immune responses. In previous studies, we have demonstrated the extracellular expression and function of CXCR1/2 on mast cells and also detected an intracellular pool of CXCR1/2. Here, we have addressed the question of receptor regulation during stimulation of human mast cells (HMC-1 cell line) and have studied T cells in comparison. Cell permeabilization was performed to detect both surface and possible intracellular receptor pools. HMC-1 cells stained positive for both receptors on the cell surface (CXCR1, 50%; CXCR2, 51%) and also after cell permeabilization (CXCR1, 86%; CXCR2, 74%). Similarly, T cells exhibited both cell-surface receptor expression (CXCR1, 30%; CXCR2, 23%) and higher total receptor expression (CXCR1, 50%; CXCR2, 36%), although overall values were lower than that in HMC-1 cells. On immunoblot, molecular weights of extra- and intracellular receptors on mast cells were the same, excluding altered receptor glycosylation. On stimulation with phorbol 12-myristate 13-acetate plus calcium ionophore, a time-dependent decrease of surface-membrane receptors was observed in both cell types, while total receptor remained the same, suggesting that receptor shedding is not involved. The kinetics of membrane receptor internalization and replenishment differed for the two cell types. Furthermore, receptor internalization was associated with decreased F-actin polymerization, a basic prerequisite for cell migration. These findings demonstrate for the first time the expression of extra- and intracellular CXCR1/2 receptors on T cells and delineate the dynamics of CXCR1/2 receptors on mast cells and T cells. Furthermore, they suggest a cell-type-specific and finely tuned regulation of chemokine responses at the receptor level in the context of inflammation.     

噬菌体疗法及其在皮肤和泌尿生殖道感染中的应用与展望

【摘要】 随着耐药菌的大量出现,给临床抗感染治疗带来严峻挑战。噬菌体疗法被认为是能够应对这种困境非常有希望的方法,已在很多学科得到探索和应用,在清除皮肤黏膜感染方面的疗效也得到证实,成为目前国际研究的热点。应用多种噬菌体混合的鸡尾酒疗法、噬菌体内溶酶以及噬菌体蛋白治疗耐药的金黄色葡萄球菌、铜绿假单胞菌、大肠杆菌、克雷伯菌、变形杆菌等获得良好的效果。本文综述噬菌体疗法的背景、特征、发展特点及其在皮肤和泌尿生殖道感染中的应用和前景。     

BRAF、NRAS癌基因与恶性黑素瘤的研究

近年来,世界范围内黑素瘤的发生率正逐渐升高,发病年龄也愈来愈早,其死亡率也随之增加.环境因素和遗传易感因素是恶性黑素瘤发病的主要机制.遗传易感性的研究发现,与散发性恶性黑素瘤发病密切相关的两个遗传易感基因是位于RAS-RAF-MEK-ERK途径的BRAF、NRAS基因.其中BRAF基因是黑素瘤中突变率最高的基因,也是目前黑素瘤特异性靶向治疗研究的热点基因.概述BRAF、NRAS基因突变在恶性黑素瘤形成、发生、发展中所起的重要作用,并评述BRAF基因突变在黑素瘤临床诊治上的应用价值.     

血管瘤与脉管畸形诊疗现状与展望

【摘要】 随着血管瘤和脉管畸形分类的不断更新,其诊断和治疗也逐步发展。婴儿血管瘤预后良好,但治疗时机和方法选择对预后至关重要,β受体阻滞剂是一线药物。而脉管畸形尤其一些发病率较低的脉管畸形相关综合征的正确诊断及鉴别诊断仍是现代医学领域面临的挑战。近年研究显示,脉管畸形致病与相关基因突变相关,这些发现为靶向药物治疗提供了理论依据。本文阐述常见的血管瘤及脉管畸形的诊断和治疗现状、存在问题及未来研究方向。