桂西北女性生殖道感染病原体的分布及危险因素分析

目的 了解桂西北地区女性下生殖道感染病原体的分布及危险因素,为制定预防和治疗措施提供依据.方法 采用多阶段分层随机抽样的方法,抽取桂城市人群、农村人群和流动人群有性经历的女性2 212例,其中包括未婚女性.结果 本次调查共检出女性下生殖道的感染774例,检出率为35.0％,感染率较高的为HPV、加德纳菌、解脲支原体和真菌.不同年龄段人群感染病原体的类型有差异.Logisitic回归分析结果显示受教育程度、洗浴方式、性伴侣个数、性交是否使用安全套、经期性交和阴道冲洗也是影响女性下生殖道感染的独立影响因素.结论 不同年龄段人群生殖道感染病原体的类型有差异,应根据不同人群的特点采取有针对性的预防和治疗措施.     

Comparative analysis of skin surface lipids of the labia majora, inner thigh, and forearm

The purpose of this study was to develop a procedure for the collection of skin surface corneocyte lipids from the semioccluded and intimate regions of the labia majora and inner thigh of women, to evaluate the polar and nonpolar composition, and to compare the distribution of the lipid classes relative to a collection of lipids from the forearm. The solvent system of ethanol-cyclohexane was well tolerated across all sites. While the yield of polar lipids was similar across all 3 sites, there were only marginal differences in the relative abundance of ceramides, a class of lipids closely associated with skin barrier activity. The yield of neutral lipids was significantly less for the labia majora and was associated with a reduced yield of wax esters, triglycerides and free fatty acids, likely associated with reduced sebaceous gland activity. Factors that may contribute to an inferior skin barrier activity for the labia majora are discussed and suggest a possible deficiency of ω-6 fatty acid linked to the sphingosine base of ceramide EOS.     

An investigator blinded cross-over study to characterize the cutaneous effects and suitability of modern sanitary pads for menstrual protection for women residing in the USA

Background: The cutaneous and sensory effects of the practical usage of sanitary pads have been studied globally. However, clinical studies in the United States were conducted only quite a long time ago, and the results of these studies were not published.

Methods: Fifty-four women residing in the United States were asked to use commercially available sanitary pads with a nonwoven unique surface sheet and pads with a perforated film. This was a cross-over study design conducted over the course of two menstrual periods. A board certified dermatologist evaluated the levels of erythema and fissuring, burning, stinging and itching sensations based on clinical observations and interviews. Measurement of pH and swabs for bacteria counting of vulvar skin were also performed. Data from the first clinical evaluation conducted prior to the first menstrual cycle were used as the baseline. At the end of the study, the subjects were asked to complete self-assessment questionnaires about product suitability.

Results: Forty-two women (age: 18–50, mean: 37.5) completed the study. No signs of irritation or meaningful differences from the baseline were found in the clinical observations or in the interviews by the dermatologist for either product. No significant difference from baseline was found in the vulvar skin surface pH or in the number of total bacteria for either product. The results of the suitability indicated that the majority of subjects were highly satisfied with both types, but they especially preferred the sanitary pad with a nonwoven unique surface top sheet.

Conclusion: These results revalidate the results of a previous clinical study in the United States and are consistent with recent reports of worldwide clinical trials of high performance sanitary pads.     

Assessing the dermal compatibility of a new female incontinence product line

Context: We have developed a line of products designed to better meet the overall needs of women suffering from urinary incontinence. The products are more discrete and contain a unique odor neutralizing technology (ONT).

Objective: This paper describes the overall skin compatibility program for this product line in which the new products were compared to negative controls and/or commercially marketed reference products with an established history of safe use.

Materials and methods: Test products consisted of several product forms (light pads/pantiliners, moderate pads, briefs and taped diapers) with ONT and having various degrees of protection. Studies were conducted using standard protocols for 4-day and 21-day cumulative irritation, the Human Repeat Insult Patch Test (HRIPT), and the Behind-the-Knee (BTK) test for mechanical and chemical irritation. In one 4-day irritation study and one HRIPT, test subjects consisted of individuals with self-assessed sensitive skin. In addition, one 4-day study was conducted using normal skin sites, and sites compromised by tape stripping. Nonirritant controls were physiologic saline and/or current, commercially marketed incontinence products. All responses were evaluated by visual scoring of erythema. In addition, in the BTK, transepidermal water loss (TEWL) and adverse sensory effects collected from panelists’ daily diaries were also evaluated.

Results and discussion: Two 4-day cumulative irritation studies and one 21-day study demonstrated that a wide range of product forms (liners, light and moderate pads, briefs and adult diapers) produced skin reactions similar to the nonirritant controls. The 4-day study conducted using sensitive skin subjects showed good skin compatibility, and the test products were comparable to the nonirritant controls. In the 4-day study with both normal and compromised skin sites, test products produced mean erythema scores similar to the nonirritant controls. Three HRIPT separate studies confirm that the products do not induce contact sensitization, including one study conducted on individuals with self-assessed sensitive skin. In the BTK, test and control products produced similar irritation, as assessed by erythema, TEWL and sensory effects.

Conclusion: The results from the patch tests and mechanical irritation test demonstrate good skin compatibility of the new line of products with the unique ONT. In addition, the forms of the product (i.e. liner, pad or brief), were equally compatible with skin.     

Assessing the skin irritation potential of facial tissues

Our primary objective was to develop a short-term test system for evaluating differences in the irritant effects of facial tissues that could be used as a screening tool for product improvements with regard to skin mildness. The strongest evidence for product superiority is based on a combination of data: 1) subjective (i.e., panelist or consumer preference with regard to the attributes important to skin effects) and 2) expert clinical evaluation (i.e., a quantitative measure of product superiority by a third party, such as erythema and dryness scores). In this assay, both measures were evaluated. Methods: In three separate studies, facial tissue products were compared with a currently marketed product with a lotion coating (product A). Test materials included products B and C (each without a lotion coating) and product G (a facial tissue product coated with a developmental lotion). Panelists (15-16 per study) were assigned one tissue product to use on one side of the nose and the other product on the alternate side. They were asked to wipe the tissue from the nasal bridge to the upper lip for 10 wipes every 20 minutes for a total of 170 wipes (17 series) daily on Monday through Thursday. Prior to the first test product application, the integrity of the skin on the nasolabial folds was compromised by tape stripping using successive applications of occlusive tape. Erythema and dryness were scored by a trained grader every morning and afternoon. Panelists were asked specific questions about product preference at the end of each day. Results: Based on the statistical analysis, the reported sensory effects were the most reliable measure of product differences, with panelists showing a clear preference for the lotioned product (A) over the nonlotioned products (B and C), and slight preference for product A over the other lotioned product (G). The clinical evaluation measures of irritation (erythema and dryness) were less consistent in detecting product differences. Those differences that were detected were generally consistent with the sensory effects data. Conclusions: This assay detects significant panelists' preferences and, therefore, forms a useful part of the arsenal for evaluating skin effects and claims support. However, without further modification, the assay is not sufficiently robust to reliably detect differences in the clinical measures of irritant effects (erythema and dryness).     

Polyhexamethylene biguanide for treatment of external genital warts: a prospective, double-blind, randomized study

Genital human papillomavirus infection is one of the most common sexually transmitted diseases. Polyhexamethylene biguanide is a new agent, that has been demonstrated to have potent in vivo antiviral effects in animal and in human models. The present prospective, double-blind, randomized, placebo (vehicle-controlled) trial evaluated the efficacy and safety of daily patient-applied polyhexamethylene biguanide for up to 16-weeks for the treatment of external genital warts. Wart recurrence was investigated during a 12-week treatment-free follow-up period. In the intent-to-treat analysis, baseline warts cleared from 49 of 94 (52%) patients treated with polyhexamethylene biguanide cream versus and 3 of 95 (4%) placebo patients; the differences between the groups treated with placebo and polyhexamethylene biguanide were significant (P < 0.0001). For subjects who completed the follow-up period, recurrence rates after a complete response were 19% (9 of 48 patients) in the polyhexamethylene biguanide cream group, 17% cream group, and 0% (0 of 3) in the placebo group. There were no systemic reactions, although local skin reactions (generally of mild or moderate severity) were common in the polyhexamethylene biguanide cream group. Local reactions caused two patients to discontinue treatment. The most frequently reported local skin reactions were erythema, excoriation or flaking, and erosion. Patient-applied polyhexamethylene biguanide cream is effective for the treatment of external genital warts and has a favorable safety profile.     

Assessing the Skin Irritation Potential of Facial Tissues

ABSTRACT

Our primary objective was to develop a short-term test system for evaluating differences in the irritant effects of facial tissues that could be used as a screening tool for product improvements with regard to skin mildness. The strongest evidence for product superiority is based on a combination of data: 1) subjective (i.e., panelist or consumer preference with regard to the attributes important to skin effects) and 2) expert clinical evaluation (i.e., a quantitative measure of product superiority by a third party, such as erythema and dryness scores). In this assay, both measures were evaluated. Methods: In three separate studies, facial tissue products were compared with a currently marketed product with a lotion coating (product A). Test materials included products B and C (each without a lotion coating) and product G (a facial tissue product coated with a developmental lotion). Panelists (15–16 per study) were assigned one tissue product to use on one side of the nose and the other product on the alternate side. They were asked to wipe the tissue from the nasal bridge to the upper lip for 10 wipes every 20 minutes for a total of 170 wipes (17 series) daily on Monday through Thursday. Prior to the first test product application, the integrity of the skin on the nasolabial folds was compromised by tape stripping using successive applications of occlusive tape. Erythema and dryness were scored by a trained grader every morning and afternoon. Panelists were asked specific questions about product preference at the end of each day. Results: Based on the statistical analysis, the reported sensory effects were the most reliable measure of product differences, with panelists showing a clear preference for the lotioned product (A) over the nonlotioned products (B and C), and slight preference for product A over the other lotioned product (G). The clinical evaluation measures of irritation (erythema and dryness) were less consistent in detecting product differences. Those differences that were detected were generally consistent with the sensory effects data. Conclusions: This assay detects significant panelists' preferences and, therefore, forms a useful part of the arsenal for evaluating skin effects and claims support. However, without further modification, the assay is not sufficiently robust to reliably detect differences in the clinical measures of irritant effects (erythema and dryness).     

An investigator-blind, single-center, controlled, parallel group study to confirm the suitability of sanitary pads for menstrual protection in an ethnic nigerian population

This study assessed the suitability of a widely used brand of sanitary pad with a formed film top sheet (study pad) for comfort, protection from soiling, and fit to underwear in a local female Nigerian population compared to a leading nonwoven product (reference pad) marketed in Nigeria. Two hundred eighty-nine healthy Nigerian women 18-45 years of age were randomized to wear one of the brands over two menstrual cycles. Both groups reported comparable (yet few) sensations of itching, rubbing/chafing, redness/rash, and burning/stinging. Participants rated menstrual protection of the study pad statistically significantly better for 88% of questions on a rating form. The percentage of negative comments regarding leakage and pad slip was statistically significantly lower for the study pad than for the reference product. There were no pad-related adverse events. These results show that the study pad was preferred in terms of comfort, protection from soiling, and fit to underwear. Further, top sheet technologies do not differ from nonwoven products in terms of compatibility to skin during use.     

Anti-inflammatory and skin-hydrating properties of a dietary supplement and topical formulations containing oligomeric proanthocyanidins

BACKGROUND: Anti-inflammatory and skin hydration properties of a dietary supplement and 2 topical formulations (Anthogenol) with oligomeric proanthocyanidins were investigated. METHODS: Forty-two subjects were randomized into 2 groups: one taking the dietary supplement (100 mg/day) and the other without supplement. After 4 weeks, erythema was induced using UV radiation followed by treatment with topical cream or lotion. Erythema was measured for up to 72 h after irradiation. Skin hydration after 1 and 2 weeks of application of the cream and lotion was also measured in separate test fields. RESULTS: Both topical formulations led to a significant suppression of erythema formation and the dietary supplement led to an additional slightly stronger suppression. Thus 72 h after UV exposure and compared to the control fields of patients that had not taken a dietary supplement, erythema was slightly (13.2%) lower in the subjects that had taken a dietary supplement. The cream resulted in a maximal reduction of erythema of 45.9% (p = 0.0015), while the lotion resulted in a maximal reduction of 53.1% (p = 0.0002). Both topical formulations also increased skin hydration (by nearly 20%; p < 0.002 for all combinations of dietary supplementation and topical treatment) and the hydration was higher in the group taking the dietary supplement. CONCLUSION: The regular use of Anthogenol products may help to protect from free-radical-mediated skin inflammation and to increase skin hydration.     

妇洁洗液的研制及临床疗效观察

目的:妇洁洗液(粤药制字Z20070127)是梅州市第三人民医院的自制产品。医院药剂科为进一步提高产品质量,组织科研人员对妇洁洗液的研制及质量控制方法进行提高。妇洁洗液主要用于治疗妇女外阴炎、阴道炎、宫颈炎、外阴瘙痒、皮肤瘙痒、局部感染。观察该药的临床疗效。方法:采用煎煮、浓缩等制剂工艺制成符合本院制剂标准的中药洗剂并应用于临床,对380例妇女外阴炎、阴道炎、宫颈炎、外阴瘙痒、皮肤瘙痒、局部感染等病症患者随机分为治疗组和对照组各190例,治疗组使用妇洁洗液,对照组使用洁尔阴(成都恩威药业,规格100ml,批号120623,100230,110325,101020),治疗15天,观察比较两组疗效。结果:治疗组总有效率达95.75%,对照组总有效率达57.33%,两组比较,差异有统计学意义(P<0.05)。结论:质量标准提高后的妇洁洗液质量可控,治疗妇女外阴炎、阴道炎、宫颈炎、外阴瘙痒、皮肤瘙痒、局部感染疗效更加显著,值得推广应用。     

Editorial chiaroscuro

Background: The term “sensitive skin” is being used with increasing frequency in the scientific literature. The general perception is that sensitive skin is more of a complaint for women, with very little emphasis on what sensitive skin means to men.

Hypothesis/Aims: An epidemiologic approach was used to compare gender difference with regard to perceptions about sensitive skin.

Methods: The population consisted of 163 men with a mean (standard deviation [SD]) age of 38.6 (9.7) years and 869 women with a mean (SD) age of 35.1 (9.6) years. Participants filled out a questionnaire that was designed to evaluate perceptions of sensitive skin in general and at specific body sites and asked about perceived underlying causes (environmental factors and household and personal products) of their skin sensitivity. Comparisons were made between all men and women who responded, and between men and women of specific age groups. Comparisons were also conducted for different ethnic groups.

Results: The perceived severity of sensitive skin was comparable for men and women when asked about sensitive skin in general and sensitive skin of the body. For sensitive skin of the face and genital area, the perception of skin sensitivity appeared to shift toward less severe perceived reactions for the men. A significantly lower proportion of men ≥50 years of age perceived general sensitivity (52.9%) vs. women (78.6%), with no significant differences in the ≤30-year, 31–39-year, and 40–49-year age groups. A significantly lower proportion of men in the ≤30- and the 31–39-year age groups perceived that they had sensitive genital skin. The reasons men and women thought they had sensitive skin differed, with a significantly lower proportion of men citing visual evidence of skin irritation due to the use of products (11% of all men and 18% of all women) and a significantly higher proportion citing rubbing or friction from contact (9% of all men and 4% of all women).     

女性生殖道沙眼衣原体感染对自然流产的影响

目的 探讨女性生殖道沙眼衣原体感染对自然流产的影响.方法 选取自然流产并做荧光聚合酶链反应（PCR）检测生殖道沙眼衣原体孕妇85例作为研究组,另选取人工流产并做荧光PCR检测生殖道沙眼衣原体孕妇85例为对照组,比较2组衣原体感染情况.结果 研究组检出率15.29%明显高于对照组的4.70%,差异有统计学意义（P＜0.05）.结论 女性生殖道衣原体感染与自然流产密切相关,是引起自然流产的重要原因.     

Pharmacokinetics and safety of continuously applied lidocaine patches 5%.

The pharmacokinetics, safety, and tolerability of four topical lidocaine patches 5% continuously applied for 72 hours and changed every 12 or 24 hours were examined. In this randomized, prospective, multiple-dose, open-label pharmacokinetic study, lidocaine patches were applied to healthy men and women for three consecutive days. Ten subjects received four lidocaine patches every 24 hours (group 1), and 10 subjects received four patches every 12 hours (group 2). Serial samples of venous blood were obtained to determine pharmacokinetic data. Overall tolerability and safety were assessed, and skin sensory testing was conducted to determine whether local anesthetic activity was produced. The mean maximum plasma lidocaine concentrations at steady state with lidocaine patches applied in groups 1 and 2 were 186 and 225 ng/mL, respectively, compared with the reported mean maximum plasma concentration of 130 ng/ml. with the labeled dosage (12 hr/day). The area under the concentration-time curve for one dosage interval at steady state was 3550 and 4506 ng.hr/mL for groups 1 and 2, respectively. No loss in sensation at the application site was reported. No patient had edema, and most cases of erythema were very slight. No systemic adverse events were judged to be related to the patches. Continuous application for 72 hours of four lidocaine patches 5%, changed every 12 or 24 hours, produced plasma lidocaine concentrations that remained well below those that typically produce antiarrhythmic effects or toxicity. Mild application-site erythema occurred in most patients, but no systemic adverse reactions were judged to be related to the patches. No loss in sensation at the application site was reported.     

乳腺癌改良根治术中保留肋间臂神经的临床价值

目的探讨早期（Ⅰ、Ⅱ期）乳腺癌改良根治术中保留肋间臂神经的临床价值。方法回顾性分析62例行早期乳腺癌改良根治术患者的临床资料,以术中完整保留肋间臂神经46例患者作为观察组,术中切除肋间臂神经16例患者作为对照组,对比分析两组术后上臂内侧及腋部皮肤感觉异常发生情况及乳腺癌复发情况。结果62例均行乳腺癌改良根治术,均临床治愈出院。观察组上臂内侧及腋窝皮肤感觉异常5例（10．9％）,明显低于对照组的16例（100．0％）（χ2=19．27,P〈0．05）。平均随访1年,观察组中上臂皮肤感党异常患者5例,在术后1-3个月内恢复;对照组感觉异常均未恢复正常;两组均未发现肿瘤局部复发或远处转移。结论在乳腺癌改良根治术中保留肋间臂神经是可行的,可明显减少术后患侧上臂内侧及腋部皮肤感觉异常发生率,改善患者术后生活质量。     

5α-Reductase Inhibition Prevents the Luteal Phase Increase in Plasma Allopregnanolone Levels and Mitigates Symptoms in Women with Premenstrual Dysphoric Disorder

Changes in neurosteroid levels during the luteal phase of the menstrual cycle may precipitate affective symptoms. To test this hypothesis, we stabilized neurosteroid levels by administering the 5α-reductase inhibitor dutasteride to block conversion of progesterone to its neurosteroid metabolite allopregnanolone in women with premenstrual dysphoric disorder (PMDD) and in asymptomatic control women. Sixteen women with prospectively confirmed PMDD and 16 control women participated in one of two separate randomized, double-blind, placebo-controlled, cross-over trials, each lasting three menstrual cycles. After one menstrual cycle of single-blind placebo, participants were randomized to receive, for the next two menstrual cycles, either double-blind placebo or dutasteride (low-dose 0.5 mg/day in the first eight PMDD and eight control women or high-dose 2.5 mg/day in the second group of women). All women completed the daily rating form (DRF) and were evaluated in clinic during the follicular and luteal phases of each menstrual cycle. Main outcome measures were the DRF symptoms of irritability, sadness, and anxiety. Analyses were performed with SAS PROC MIXED. In the low-dose group, no significant effect of dutasteride on PMDD symptoms was observed compared with placebo (ie, symptom cyclicity maintained), and plasma allopregnanolone levels increased in women with PMDD from follicular to the luteal phases, suggesting the absence of effect of the low-dose dutasteride on 5α-reductase. In contrast, the high-dose group experienced a statistically significant reduction in several core PMDD symptoms (ie, irritability, sadness, anxiety, food cravings, and bloating) on dutasteride compared with placebo. Dutasteride had no effect on mood in controls. Stabilization of allopregnanolone levels from the follicular to the luteal phase of the menstrual cycle by blocking the conversion of progesterone to its 5α-reduced neurosteroid metabolite mitigates symptoms in PMDD. These data provide preliminary support for the pathophysiologic relevance of neurosteroids in this condition.     

Autoimmune estrogen dermatitis in an infertile female

Autoimmune estrogen dermatitis is a cyclical cutaneous eruption that occurs premenstrually and goes to the rapid resolution within a few days of menstrual cycles. The disorder has variable clinical manifestations consisting of macules, papules, vesicles, urticarial lesions, bullae, eczematous plaques, and erythema multiforme-like lesions. Herein, we present a case of a 30-year-old woman with attacks of edema and erosions involving the oral and genital mucosal sites on every first day of her menstruation period. She had also multiple endocrinological problems such as hypotroidism and infertility. To determine the sex hormon sensitivity, intradermal skin tests were performed. Based on her personal history and skin test findings, a diagnosis of autoimmune estrogen dermatitis was made. After the oophorectomy, she was free from the skin and mucosal symptoms. We propose that it is important to suspect the diagnosis of autoimmune estrogen dermatitis in patients who present with recurrent cylic eruptions and it must be kept in mind that these patients might have a concomitant infertility.     

Sexually Transmitted Diseases and Reproductive History in Women with Experience of Casual Travel Sex Abroad

Background: The objective of this study was to determine whether the frequency of sexually transmitted diseases (STDs) and some reproductive events in women with experience of casual travel sex (CTS) abroad with previously unknown male partners differed when compared to women lacking such experience.
Methods: Nine hundred and ninety-six women seeking contraceptive advice from two family planning clinics and a youth clinic were studied. Two hundred and seventy-six of these women (27.7%) admitted experience of CTS.
Results: Among current STDs, only the prevalence of cervical human papilloma virus infection was significantly higher in women with a history of CTS when compared to the comparison (COMP) group (11.2% vs. 0.7%). A history of gonorrhea, genital chlamydial infection, and genital warts was reported significantly more often in women with, rather than without, CTS ( p =0-.005). Women who had experienced CTS had a lower rate of childbirth, but higher rates of legal abortion and pelvic inflammatory disease than did females in the COMP group.
Conclusion: The study shows that women with experience of CTS belong to a group at high risk for acquisition of STDs. This increased risk, with the exception of genital warts, was attributed to sexual risk taking in general, not merely to traveling abroad.     

Thalidomide as elective treatment in persistent erythema multiforme; report of two cases

Recurrent erythema multiforme is a rare disorder, clinically characterized by symmetrically distributed, erythematous, and bullous skin and mucous lesions, mainly precipitated by a preceding herpes simplex infection. In rare cases, EM presents continuous or persistent relapses, and has been related to an Epstein-Barr virus infection. We report 2 cases of severe, persistent erythema multiforme, treated with thalidomide, with complete disease suppression in both cases. Thalidomide induces immunomodulator, anti-inflammatory, and anti-angiogenic effects, and may be considered as the elective treatment of this rare variety of erythema multiforme. However, in order to avoid neuropathic side effects, patients under thalidomide therapy should be monitored every 6 months with nerve conduction studies while taking the drug.