3例着色芽生菌病的临床分析及病原菌鉴定

目的对着色芽生菌病进行临床分析及病原菌鉴定。方法分析3例患者的临床特点。取患者皮损及分泌物行组织病理及真菌学检查。提取病原菌DNA,利用引物ITS4和ITS5进行rDNA ITS区序列的PCR扩增,扩增产物测序后在Genbank核酸数据库中进行同源性比对。按照CLSI制定的M38-A方案对菌株进行体外药敏实验。结果结合3例患者组织病理、真菌学特征及rDNA ITS区序列分析将病原菌鉴定为Fonsecaea monophora,其引起的着色芽生菌病病程迁延。体外药敏试验显示该菌对伊曲康唑、特比萘芬、伏立康唑、硝酸异康唑均敏感。临床上伊曲康唑和（或）特比萘芬治疗有效。结论 Fonsecaea monophora与裴氏着色霉相似,可通过分子生物学方法鉴别,其引起的着色芽生菌病需长期治疗。     

长脉冲1064nm Nd:YAG激光治疗甲真菌病有效性和安全性的研究

目的:探讨长脉冲1064 nm Nd∶YAG激光治疗甲真菌病的有效性和安全性。方法:选取2014年1月-2015年1月本院收治的80例甲真菌病患者作为研究对象,按照随机数字表法分为观察组和对照组,观察组患者45例,对照组患者35例。观察组患者采用长脉冲1064 nm Nd∶YAG治疗,每个靶甲重复照射3次,每周进行以上治疗1次,共治疗6次,即6周。对照组患者给予常规伊曲康唑间歇冲击口服。治疗后,比较两组患者的真菌学评价、临床疗效及不良反应。结果:治疗后,观察组第3、6个月临床有效率分别为80.0%(36/45)和80.0%(36/45),对照组第3、6个月临床有效率分别为54.3%(19/35)和74.3%(26/35),两组患者第3个月临床疗效比较,差异有统计学意义(P0.05),第6个月临床疗效比较,差异无统计学意义(P0.05)。治疗后3、6个月两组患者真菌学评价比较,差异均无统计学意义(P0.05)。后期随访中,两组患者均未发现任何不良反应。结论:脉冲1064 nm Nd∶YAG激光用于治疗甲真菌病疗效显著,且安全性好,具有临床推广价值。     

长脉冲1064nm Nd:YAG激光联合胶原修复贴治疗中度痤疮的疗效

目的:探讨长脉冲1064nm Nd:YAG激光联合胶原修复贴治疗中度痤疮的疗效及安全性。方法:128例中度痤疮患者,随机分为激光组44例、激光联合胶原修复贴组(简称联合组)44例和药物组40例,激光组使用长脉冲Nd:YAG激光,设定治疗参数(波长1064 nm,光斑4 mm,脉宽35 ms,能量密度35~40 J/cm2,频率1.5 Hz)进行激光治疗,共进行4疗程治疗,每次间隔1周,同时配合基础药物治疗;激光联合胶原修复组先进行与激光组相同的激光照射治疗,治疗完毕立即使用胶原修复贴外敷于面部30 min/次,并于每次治疗后3 d再次外贴,同时配合基础药物治疗;药物组为基础药物治疗,即口服罗红霉素胶囊,外用2%莫匹罗星软膏;治疗4周后评价疗效。结果:治疗4周后激光组有效率为90.1%,联合组有效率为93.1%,与药物组相比差异均有统计学意义(P0.05)。治疗结束2月后随访,联合组未发生炎症后色素沉着与激光组、药物组比较差异均有统计学意义(P0.05)。结论:长脉冲1064nm Nd:YAG激光联合胶原修复贴是治疗中度痤疮的有效方法,近期疗效明确,副作用小。     

595nm脉冲染料激光结合1064nm ND:YAG激光治疗草莓状血管瘤

目的探讨595nm脉冲染料激光结合1064nm ND:YAG激光治疗草莓状血管瘤的临床疗效.方法用595nm脉冲染料激光结合1064nm ND:YAG激光治疗草莓状血管瘤108例;根据皮损的深浅、面积、颜色选择参数,并根据即刻反应来调整参数;治疗间隔4周.结果 108例皮损痊愈率为84%,显效率为91%;不良反应及副作用:术后水泡发生率为50%,萎缩性瘢痕发生率为3%.结论应用595nm脉冲染料激光结合1064nm ND:YAG激光治疗婴儿草莓状血管瘤效果好,不良反应低,可在临床上推广使用.     

长脉冲1064nm Nd：YAG激光治疗儿童化脓性肉芽肿的疗效观察

目的 探索长脉冲1064 nm Nd：YAG激光治疗儿童化脓性肉芽肿的疗效及安全性.方法 分别使用长脉冲1064 nm Nd：YAG激光和电离子对儿童化脓性肉芽肿进行治疗,对术中出血、术后色素沉着和瘢痕的形成等情况进行对比分析.结果 激光组除1例皮损较大(直径超过1 cm)经二次治疗痊愈,其余均一次治愈,一次治愈率为98.38％;电离组45例一次治愈,13例经二次治疗痊愈,3例经三次治疗痊愈,一次治愈率为73.8％.两组一次治愈率差异有统计学意义(P＜0.05).两组患者均有不良反应出现.激光组色素沉着12例,多在半年内消退,浅表瘢痕2例;电离组色素沉着5例,浅表瘢痕25例,增生瘢痕1例.两组色素改变发生率差异无统计学意义(P＞ 0.01),两组瘢痕发生率差异有统计学意义(P＜0.01).两组患者皮损去除后随访半年,均未见复发病例.结论 长脉冲1064nm Nd：YAG激光治疗儿童化脓性肉芽肿在术中、术后不良反应少于电离子.     

长脉冲1064nm Nd:YAG激光治疗儿童蜘蛛痣58例临床观察

目的:研究长脉冲1064nm Nd:YAG激光治疗儿童蜘蛛痣的疗效和不良反应。方法:对本院58名蜘蛛痣患儿使用长脉冲1064nm Nd:YAG激光治疗头进行治疗,间隔2个月复诊,治疗结束后于2个月和6个月分别进行一次随访。结果:58例患儿均痊愈,治愈率100%。21例患儿出现红斑、水肿,均在1周内消退。2例患儿出现了不同程度的色素沉着,大约于治疗1周后出现,2~3周时较明显,2个月后消退。无一例有瘢痕形成。所有病例随访半年无复发。所有患儿对治疗结果均表示满意。结论:长脉冲1064nm Nd:YAG激光治疗儿童蜘蛛痣是一种治疗蜘蛛痣值得推广的方法。     

调Q1064nmNd:YAG激光联合穴位埋线治疗黄褐斑78例

目的探讨调Q1064nmd:YAG激光联合穴位埋线治疗黄褐斑的临床疗效。方法搜集2014年10月~2015年11月于我科就诊的黄褐斑患者78例,随机分为治疗组和对照组,每组各39例。治疗组:予以调Q1064nm Nd:YAG激光联合穴位埋线治疗;对照组:予以单纯调Q1064nm Nd:YAG激光治疗,激光和穴位埋线均为每2周治疗一次,10次为1个疗程,1个疗程即评定临床疗效及不良反应,治疗期间及1个疗程之后3个月评价疗效及不良反应。结果治疗组的总有效率为:94.87%,对照组为:76.92%,两组比较,差异有显著性意义(P0.05)。结论调Q1064nm Nd:YAG激光联合穴位埋线治疗黄褐斑疗效满意,值得临床推广。     

Q开关Nd：YAG1064nm激光治疗外伤性文身疗效分析

目的观察长脉宽Q开关Nd：YAG激光在外伤性文身治疗中的疗效。方法自2006年1月～2007年12月,利用调Q开关Nd：YAG1064nm激光对13例外伤性文身患者治疗,间隔6～8周以首次相同的脉冲形式重复治疗．并进行疗效观察。结果外伤性文身男性多于女性,交通事故为第一原因,经过Q-开关Nd：YAG激光治疗一次后,皮损均有明显消退,并随治疗次数增多,治愈率明显增高,经过5次治疗,75％的患者治愈,有效率100％．均有很好的疗效。结论Q-开关Nd：YAG激光是治疗外伤性文身安全、有效的方法．不良反应常见的是色素沉着为可逆性,未见有新的疤痕形成。     

长脉宽1064 nm Nd：YAG激光治疗趾甲真菌病的疗效及安全性

目的：探讨长脉宽1064 nm Nd：YAG激光治疗趾甲真菌病的疗效及安全性。方法对确诊的104例（461个趾甲）趾甲真菌病患者,根据年龄段分为Ⅰ组（≥60岁）和Ⅱ组（<60岁）,按照SCIO评分及病甲位置的差异分为不同亚组;所有患者病甲均使用长脉宽1064 nm Nd：YAG激光进行每周1次、共10~12次的治疗,随访至初次治疗后的48周,观察疗效及不良反应。结果所有病人随访至48周,总体临床有效率为72.5%。Ⅱ组的临床有效率和真菌学治愈率均高于Ⅰ组,差异有统计学意义（P<0.05）。不同SCIO亚组之间的临床有效率无统计学差异（P>0.05）。第2~4趾甲亚组的临床有效率优于第1、第5趾甲亚组,差异有统计学意义（P<0.05）;所有患者无明显不良反应。结论长脉宽1064 nm Nd：YAG激光是一种安全微创有效的治疗甲真菌病的方法,可在临床推广使用。     

激光和强脉冲光对小型猪皮肤光老化的改善性治疗研究

目的建立可模拟临床皮肤激光研究的光老化实验动物模型,观察不同类型的非剥脱激光和强脉冲光对模型动物皮肤光老化的改善性治疗作用。方法分别应用强脉冲光,长脉宽1064 nm Nd:YAG激光,1320 nm Nd:YAG激光对光老化区域皮肤进行照射治疗2次,分别在激光治疗前、第一次激光治疗后2周、第二次激光治疗后4周,检测皮肤生理功能并行组织活检,观察皮肤真皮胶原的改变和皮肤羟脯氨酸含量的变化。结果与正常皮肤比较,紫外线照射区皮肤含水量和皮肤弹性下降,黑色素指数增加,均有统计学差异(P0.05);经激光和强脉冲光治疗后,与未经治疗的光老化皮肤区相比较,皮肤含水量和血红素含量无明显变化(P0.05),而皮肤弹性和羟脯氨酸含量均有明显改善,差异有统计学意义(P0.05);病理显示:激光和强脉冲光治疗后,真皮内胶原纤维增加。结论强脉冲光和非剥脱激光能够较快速地改善紫外线造成的皮肤光老化的一些表现,对表皮的损伤很小。     

Effects of laser irradiation on Trichophyton rubrum growth and ultrastructure

Background  Trichophyton rubrum (T. rubrum) is the most common causative agent of dermatophytosis worldwide. In this study, we examined the effect of laser irradiation on the growth and morphology of T. rubrum.

Methods  Colonies of T. rubrum were isolated (one colony per plate), and randomly assigned to 5 treatment groups: Q-switched  694 nm ruby laser treatment, long-pulsed Nd:YAG 1064 nm laser treatment, intense pulsed light (IPL) treatment, 308 nm excimer laser treatment and the blank control group without treatment. Standardized photographs were obtained from grown-up fungal plates prior to treatment. Colonies were then exposed to various wavelengths and fluences of laser light. To compare the growth of colonies, they were re-photographed under identical conditions three and six days post-treatment. To investigate the morphology of T. rubrum, scanning electron microscope (SEM) and transmission electron microscope (TEM) images were obtained from specimens exposed to 24 hours of laser treatment.

Results  Growth of T. rubrum colonies was significantly inhibited following irradiation by 694 nm Q-switched and 1064 nm long-pulsed Nd:YAG lasers. Other treatments exerted little or no effect. Q-switched laser irradiation exerted a stronger growth inhibitory effect than long-pulsed Nd:YAG laser irradiation. Following treatment by the Q-switched ruby laser system, T. rubrum hyphae became shrunken and deflated, and SEM images revealed rough, fractured hyphal surfaces, punctured with small destructive holes. TEM images showed that the hyphae were degenerating, as evidenced by the irregular shape of hyphae, rough and loose cell wall, and obscure cytoplasmic texture. Initially high electron density structure was visible in the cell; later, low-density structure appeared as a result of cytoplasmic dissolution. In contrast, the blank control group showed no obvious changes in morphology.

Conclusion  The Q-switched 694 nm ruby laser treatment significantly inhibits the growth and changes the morphology of T. rubrum.

     

Clinical Evaluation of Color Doppler Ultrasound in Selecting the Optimal Treatment Modality for Infantile Hemangioma

Objective We investigated the efficacy and safety of 1064 nm Nd: YAG laser, intense pulsed light (IPL), and lauromacrogol injection in the treatment of hemangioma, in order to evaluate the value of color Doppler ultrasound guidance in choosing the optimal treatment modality. Methods Infantile patients who were clinical diagnosed as hemangiomas were randomly divided into group A, who had color Doppler ultrasound examinations before the treatment, and group B who had the treatment without ultrasound evaluation. Patients in the group A were assigned into subgroups according to the depth of lesion by sonography: group A-1 for those who had a lesion depth <1.2 mm, and took intense pulsed light therapy; group A-2 for those who had a lesion depth≥1.2mm and < 3 mm, and took long pulse 1064 nm Nd:YAG laser therapy; group A-3 for those who had a lesion depth≥3mm and <5 mm, and were treated by IPL combined with long pulse 1064 nm Nd:YAG laser treatment; Group A-4 for those who had a lesion depth≥5 mm, and took lauromacrogol injection therapy. Patients in the group B took long pulse 1064 nm Nd:YAG laser treatment without preoperative ultrasound evaluation. The efficacy and adverse reactions of the treatments between the groups were evaluated and compared statistically. Results Totally 113 patients with 128 skin lesions were enrolled in this study, 85 in the group A (mean age 6.8±7.9 months) and 28 in the group B (mean age 6.9±9.9 months). The mean depth of hemangioma was 3.3±1.1 mm in the group A, ranging from 0.5-7.8 mm, with 0.8±0.4 mm, 2.2±0.4 mm,4.2±0.6 mm and 6.2±0.7 mm in group A1, A2, A3 and A4, respectively. The cure rates and effective rates in the group A were significantly higher than those in the group B (cure rates: 64.5%vs 56.3%,U=3.378, P=0.045; effective rates: 89.5%vs 78.1%,U=4.163,P=0.041). The adverse effect rates of the group A (vesicle 20.0%, pigmentation 46.9%, scarring 17.7%) were lower than those of the group B (vesicle 21.9%, pigmentation 60.4%, scarring 25.0%). Incidences of pigmentation and scarring were statistically significantly different (U=3.884,P=0.034, andU=4.016,P=0.032 respectively) between the two groups. Conclusion With the guidance of color Doppler ultrasound, the efficacy and safety of long pulse 1064 nmNd:YAG laser, intense pulsed light, and lauromacrogol injection in the treatment of infantile hemangioma have better outcomes compared to laser treatment alone without preoperative ultrasound examination.     

Clinical Evaluation of Color Doppler Ultrasound in Selecting the Optimal Treatment Modality for Infantile Hemangioma△

Objective We investigated the efficacy and safety of 1064 nm Nd: YAG laser, intense pulsed light (IPL), and lauromacrogol injection in the treatment of hemangioma, in order to evaluate the value of color Doppler ultrasound guidance in choosing the optimal treatment modality. Methods Infantile patients who were clinical diagnosed as hemangiomas were randomly divided into group A, who had color Doppler ultrasound examinations before the treatment, and group B who had the treatment without ultrasound evaluation. Patients in the group A were assigned into subgroups according to the depth of lesion by sonography: group A-1 for those who had a lesion depth <1.2 mm, and took intense pulsed light therapy; group A-2 for those who had a lesion depth ≥1.2mm and < 3 mm, and took long pulse 1064 nm Nd:YAG laser therapy; group A-3 for those who had a lesion depth ≥3mm and <5 mm, and were treated by IPL combined with long pulse 1064 nm Nd:YAG laser treatment; Group A-4 for those who had a lesion depth ≥5 mm, and took lauromacrogol injection therapy. Patients in the group B took long pulse 1064 nm Nd:YAG laser treatment without preoperative ultrasound evaluation. The efficacy and adverse reactions of the treatments between the groups were evaluated and compared statistically.Results Totally 113 patients with 128 skin lesions were enrolled in this study, 85 in the group A (mean age 6.8±7.9 months) and 28 in the group B (mean age 6.9±9.9 months). The mean depth of hemangioma was 3.3±1.1 mm in the group A, ranging from 0.5-7.8 mm, with 0.8±0.4 mm, 2.2±0.4 mm, 4.2±0.6 mm and 6.2±0.7 mm in group A1, A2, A3 and A4, respectively. The cure rates and effective rates in the group A were significantly higher than those in the group B (cure rates: 64.5% vs 56.3%, U=3.378, P=0.045; effective rates: 89.5% vs 78.1%, U=4.163, P=0.041). The adverse effect rates of the group A (vesicle 20.0%, pigmentation 46.9%, scarring 17.7%) were lower than those of the group B (vesicle 21.9%, pigmentation 60.4%, scarring 25.0%). Incidences of pigmentation and scarring were statistically significantly different (U=3.884, P=0.034, and U=4.016, P=0.032 respectively) between the two groups.Conclusion With the guidance of color Doppler ultrasound, the efficacy and safety of long pulse 1064 nmNd:YAG laser, intense pulsed light, and lauromacrogol injection in the treatment of infantile hemangioma have better outcomes compared to laser treatment alone without preoperative ultrasound examination.     

1064nmNd:YAG激光治疗甲真菌病疗效观察

目的探讨1 064nm Nd:YAG激光治疗甲真菌病的可行性,疗效及安全性。方法 64例甲真菌患者随机分为2组,激光组及药物组各32例;激光组使用长脉冲1 064nmNd:YAG激光,设定参数(波长1 064nm,光斑4mm,脉宽35ms,能量密度30~40J/cm2,频率1.0~2.0HZ),对病甲进行激光照射,共进行6疗程治疗,每次间隔1周。对照组患者服用伊曲康唑胶囊。使用治疗后3月及治疗后6月根据病甲受累面积及真菌学检查评价疗效。结果治疗第3月末激光组显效率为78.13%(25/32),与药物组相比差异有统计学意义(χ2=4.43,P0.05);治疗第6月末,再次评估疗效,激光组显效率与药物组相比差异无统计学意义(P0.05)。随访3~6月,未出现严重不良反应。结论长脉冲1 064nm Nd:YAG激光治疗甲真菌病可行、安全,与口服抗真菌药疗效相当,进行大样本、长期的临床研究可进一步评价该法的临床应用价值。     

Nd：YAG激光治疗文刺的最佳时机及最适治疗间隔时间的研究

目的 观察文刺及Nd：YAG激光治疗后,不同时期文刺动物模型文刺色素颗粒位置及形状的变化,为选择激光治疗的最佳时机和最佳治疗间隔时间提供实验依据.方法 用40只昆明种小白鼠复制文刺动物模型,在光镜下分别观察文刺后不同时间色素颗粒的变化.3个月后,用Nd：YAG 1064nm激光治疗文刺,在治疗后1天、1周、1个月、3个月,在光镜下观察文刺色素颗粒位置的变化及未治疗部位文刺色素颗粒位置的变化.结果 （1）文刺动物模型复制后文刺色素颗粒的位置及形状：第1天散在分布于表皮和真皮,呈毛刺状;1周时主要位于真皮深层和毛囊周围;3个月主要灶状分布于皮下组织;6个月呈狭窄的带状分布于皮下组织内.（2）激光治疗后文刺色素颗粒的位置及形状：第1天,大部分被击碎成大小一致的颗粒,呈毛刺状;第1周,边缘开始变得整齐光滑;第3个月,数量更少,边缘更清楚,并在皮下组织中呈狭窄的带状分布.结论 Nd：YAG激光能有效击碎文刺色素颗粒,最佳治疗时间为文刺后6个月,最佳治疗间隔时间为3个月.     

口服氨甲环酸片联合Q开关1064 nm Nd:YAG激光治疗黄褐斑临床疗效观察

目的 观察口服氨甲环酸片联合Q开关1064 nm Nd:YAG激光对面部黄褐斑的临床疗效及应用价值。方法选取在本院确诊的黄褐斑患者200例为研究对象,采用回顾性分析的方法将其分为治疗组和对照组,每组各100例。治疗组采用口服氨甲环酸片加Q开关1064 nm Nd:YAG激光联合治疗,对照组仅予以Q开关1064 nm Nd:YAG激光治疗。每次激光治疗间隔周期为4周,共治疗6个周期,并随访6个月,观察治疗后临床疗效、复发及不良反应等情况,并对结果进行统计分析。结果治疗组总有效率为81%,对照组为52%,治疗组对黄褐斑的治疗疗效较对照组占明显优势(P<0.05),且无明显不良反应。治疗组复发率为4%,对照组复发率为12%,治疗组的远期疗效优于对照组。结论口服氨甲环酸片联合Q开关Nd:YAG激光治疗面部黄褐斑疗效佳,值得临床推广应用。     

0.9 ms 1064 nm Nd：YAG激光联合伊曲康唑治疗趾甲真菌病

目的探究0.9 ms 1064 nm Nd：YAG激光联合伊曲康唑治疗趾甲真菌病的临床疗效及安全性。方法对37例（178个甲） 趾甲真菌病患者随机分为甲乙两组,再按甲真菌病临床评分指数（SCIO）和甲真菌病严重度指数（OSI）分值高低各分为不同亚 组。所有患者均使用激光治疗（1次/周,共8次）。乙组第1周口服伊曲康唑0.2 g,2/日。比较治疗前后的疗效、临床评分、外观变 化以及不良反应,并进行患者满意度调查。结果随访12个月,临床有效率甲组31.33%、乙组35.79%;真菌清除率甲组30.00%、 乙组41.18%;两组临床有效率、真菌清除率差异均无统计学意义（P>0.05）。SCIO/OSI变化,甲组均无统计学意义（P>0.05）、乙 组均有统计学意义（P<0.05）;SCIO<12、OSI<16时,不同亚组之间临床有效率无明显差异（P>0.05）;SCIO≥12、OSI≥16时,不同 亚组之间临床有效率有差异性（P<0.05）。分别有33.71%、74.72%、70.79%的病甲在面积、形状、颜色方面得到改善。62.16%患 者对治疗效果满意。所有患者无明显不良反应。结论0.9 ms 1064 nm Nd：YAG激光1年内有效改善甲真菌病病甲的外观,对 于较为严重的甲真菌病,联合伊曲康唑治疗是个更好的选择。     

应用MEDLITE脉部激光脱毛100例临床观察

目的　观察激光脱毛的临床效果。方法　应用Q开关Nd :YAG固体脉冲对 1 0 0例面部、躯干、四肢多毛患者进行治疗 ,波长选择 1 0 6 4nm ,光斑选择 8～ 6nm ,对应能量为 2 2～ 3 8J/cm2 。每 3～ 4周脱毛 1次。结果　 1 0 0例患者分别脱毛 3～ 7次 ,均达到理想的脱毛效果 ,无任何副作用。结论　MEDLITE四波长激光脱毛效果可靠 ,是目前较好的一种脱毛方法