RigiScan勃起功能障碍诊治临床应用中国专家共识

阴茎勃起功能障碍(erectile dysfunction,ED)是成年男性的常见病和多发病,不仅影响患者及其伴侣的生活质量,也是心血管疾病的早期症状和危险指标。RigiScan问世以来,夜间阴茎勃起硬度检测和视听性性刺激检测在泌尿外科及男科学领域中得到了广泛的应用。然而,临床上仍存在RigiScan的使用适应证不明确、使用方法不规范、判断标准不统一等问题。因此,需要更权威的指导性文件来规范其在ED诊治领域及司法鉴定中的应用,以使更多的ED患者受益。因此,中国性学会组织相关临床专家根据现有的循证医学证据共同研究并制定本共识,旨在为临床医生提供规范的ED诊治指导和参考。     

女性不孕患者的心理干预疗法

女性生殖系统的功能主要受神经内分泌系统调控，心理因素可以影响神经内分泌系统和生殖系统的正常运行。我们在积极治疗女性不孕疾病的同时，一定要关注不孕女性在就诊、检查和治疗各个时期的心理变化，及时进行心理干预治疗，以增强对不孕女性患者临床治疗效果。     

他达拉非联合复方玄驹胶囊对56例早泄合并ED患者的临床观察

目的:观察他达拉非联合复方玄驹胶囊对早泄合并ED患者的临床疗效。方法:将来我院男科门诊就诊的106例被确诊为早泄合并ED的患者,分成治疗组和对照组两组。治疗组56例患者给予每晚口服他达拉非5mg,同时联合复方玄驹胶囊3粒/次,3次/d,连续1个月;对照组50例患者仅给予口服复方玄驹胶囊3粒/次,3次/d,连续1个月。结果:106例患者均完成了本次临床研究,所有患者治疗1个月后,治疗组患者的阴道内射精潜伏时间(IELT)平均可延长至2.01min;对照组患者的IELT也可平均延长1.07min,两组患者经治后,IELT与治疗前相比较均有显著性的差异(P0.01),且治疗组与对照组相比较差异也有统计学意义(P0.05);两组无论是患者本人还是其伴侣性生活满意度均较治疗前显著提高(P0.01),治疗组与对照组之间差异有统计学意义(P0.05)。结论:他达拉非联合复方玄驹胶囊能提高早泄合并ED患者及其性伴侣的性生活满意度,延长患者的阴道射精潜伏时间,对早泄合并ED患者有较好的疗效。     

负压吸引结合中药浸泡治疗合并ED的早泄患者

目的:评价负压吸引结合中药浸泡对合并勃起功能障碍(erectiledysfunction,ED)的早泄患者的临床疗效。方法:对31例诊断为合并ED的早泄患者用负压吸引结合中药浸泡治疗4周,以阴道内射精潜伏期及配偶性交满意度来评价早泄治疗效果,并评估ED的总体疗效和治疗满意度。结果:早泄改善者共19例,有效率为61.29%。勃起功能改善者共21例,改善率为67.74%。19例早泄有效者17例(占89.47%)为负压吸引改善了勃起功能的病人,且ED治疗满意率89.47%;12例早泄无效者中ED治疗满意率仅为8.33%。在早泄有效者和无效者间比较其治疗前、后ED的疗效,差异有显著性(P<0.01),未发现不良反应。结论:对合并ED的早泄病人,负压吸引结合中药浸泡既能安全有效地改善其勃起功能,也改善了其控制射精的能力,因此不失为一条安全有效治疗合并有ED的早泄患者的途径。     

动态超声观察血管性勃起功能障碍患者阴茎血流动力学的应用

目的:探究动态超声在观察血管性勃起功能障碍(ED)患者阴茎血流动力学上的临床应用效果。方法:将我院2013年1月至2016年1月接治的220例疑似血管性ED患者纳入研究,并选取100例心理性ED患者进行对照。应用阴茎海绵体注射血管活性药物试验(ICI)及多普勒超声对所有入选患者的阴茎海绵体进行血流动力学检测,分析不同类型ED患者在ICI前后阴茎长度、周长的变化以及收缩期峰值流速、舒张末期峰值流速、血流阻力指数的变化。结果:在220例疑似血管性ED患者中,动脉性ED患者74例,静脉性ED患者65例,混合血管性ED患者81例。动脉性ED、混合血管性ED患者的阴茎海绵体内径、PSV和EDV上均小于静脉性ED和心理性ED患者,而动脉性ED和心理性ED在RI上明显高于静脉性ED和混合血管性ED,差异具有统计学意义(P0.05)。ICI试验之前,动脉性ED、静脉性ED、混合血管性ED、心理性ED四组患者在阴茎周长、长度上比较并无显著性差异(P0.05);ICI试验后,动脉性ED患者的阴茎周长、阴茎长度明显短于静脉性ED、混合血管性ED、心理性ED患者,差异具有统计学意义(P0.05)。结论:彩色多普勒超声能够极为清晰地反映出血管性ED患者的阴茎血流动力学状态,为准确有效地判断血管性ED分型提供有力的诊断依据,在临床鉴别上值得推广使用。     

浅谈白癜风与心理因素相关性及其对中医辨证治疗的指导意义

白癜风为临床常见的色素障碍性皮肤病，临床资料显示有相当数量的白癜风患者其发病和皮损加重与心理因素有着一定的关系，近10余年来国内外多篇文献证实白癜风与心理因素关系密切，在白癜风的临床治疗中应重视对患者的心理疏导并重视心理因素对机体的影响，可采用补益、疏理气机、清热凉血、活血化瘀等多种辨证方法和药物。在治疗中灵活应用。     

雀斑患者个性特征对强脉冲光疗效评价的影响

医学美容科学的飞速发展为治疗雀斑提供了良好的技术,但医患双方对治疗效果的评价却常常出现很大的差异.美容治疗通过美化容貌来满足患者追求美的心理需要,对疗效的评价与心理因素密切相关.因此,有必要在进一步提高临床疗效的同时,探索患者个性因素对疗效评价的影响.     

女性性唤起的影响因素

目的:研究影响女性性唤起的因素。方法:对国内外相关文献进行综述。结果:生理周期作为特有的生理特征和情绪唤醒、注意力分散、性刺激与认为重要性等社会心理因素都对女性的性唤起有重要影响。结论:社会心理因素是影响女性性唤起的主要因素,对女性性唤起障碍的治疗应该从其根源入手。重视对社会心理因素的调节和控制,对提高其性唤起水平有重要意义。     

勃起功能障碍与糖尿病及冠心病关系的研究进展

糖尿病(DM)患者勃起功能障碍(ED)的发生率明显增高,ED与冠心病(CHD)也有着密切的关系。DM患者伴发ED时,对CHD的预警作用更强。因此,重视ED的早期检出,对ED患者检查相应的危险因素及动脉硬化的其他表现,将防治关口前移,会取得更好的防治效果。     

低强度体外冲击波/脉冲式超声波治疗勃起功能障碍中国专家共识

勃起功能障碍(ED)是成年男性的常见病和多发病,目前国内外ED诊疗指南推荐的口服药物、阴茎海绵体内血管活性药物注射和阴茎假体植入等治疗方案均不能针对ED病因,故无法从纠正发病机制方面彻底治愈ED。低强度体外冲击波疗法(Li-ESWT)和低强度脉冲式超声波(LIPUS)治疗ED,因其独特的作用机制和生物学效应,不仅能够改善患者的勃起功能,亦能针对病因治疗,促进阴茎功能康复。然而,目前临床上存在Li-ESWT和LIPUS治疗ED适应证不明确、治疗方案不统一、疗效差异大等问题,限制了该类疗法的进一步应用。据此,中国性学会组织本领域内多位临床专家,根据现有的Li-ESWT和LIPUS治疗ED的国内外循证医学证据,经共同研究、讨论达成一致,制定了本共识,旨在为从事Li-ESWT及LIPUS治疗ED领域的临床医生、设备研发人员提供规范的治疗方法和参考。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.