紫癜消胶囊治疗过敏性紫癜的临床观察及其作用机制研究

目的 探讨紫癜消胶囊治疗过敏性紫癜的疗效和机制.方法 选择82例过敏性紫癜患者,随机分为治疗组和抗组胺对照组,观察其各种症状体征.进行小鼠耳廓肿胀、毛细血管通透性等实验.结果 治疗组在紫癜消退及症状缓解时间等方面优于对照组(P＜0.01).紫癜消胶囊对二甲苯所至耳郭肿胀有显著抑制作用,对HAC所致毛细血管通透性增高有显著抑制作用.结论 紫癜消胶囊对过敏性紫癜有良好的治疗作用.     

活血消银片对银屑病患者VEGF水平和PASI指数的影响以及其临床疗效分析

目的观察活血消银片对银屑病患者血管内皮生长因子(VEGF)和银屑病皮损面积和严重程度指数(PASI)的影响以及其临床治疗作用。方法选取2012年7月—2015年6月我院皮肤科收治的寻常型银屑病患者78例,使用数字法随机分为对照组和活血消银片观察组,每组39例。对照组口服阿维A胶囊,观察组口服阿维A胶囊和活血消银片。比较2组治疗前后VEGF水平和PASI指数,以及临床疗效和不良反应。结果治疗前2组VEGF水平和PASI指数差异无统计学意义(P0.05),治疗后两组VEGF水平和PASI指数显著减低(P0.05和P0.01),但观察组对VEGF水平和PASI指数的减低作用优于对照组(P0.05)。观察组临床治疗有效率为92.3%(36/39),显著优于对照组的79.5%(31/39)(P0.05)。观察组不良反应发生率为12.8%(5/39),对照组不良反应发生率为10.3%(4/39),2组间差异无统计学意义(P0.05)。结论活血消银片可以显著减低银屑病患者VEGF水平和PASI指数,临床疗效显著、使用安全,值得临床推广使用。     

芩珠凉血方配合NB-UVB治疗寻常型银屑病血热证疗效及对其T淋巴细胞亚群和MCP-1、M-CSF水平的影响

目的观察芩珠凉血方配合窄谱中波紫外线(NB-UVB)治疗寻常型银屑病血热证疗效及对其T淋巴细胞亚群和单核细胞趋化蛋白-1(MCP-1)、巨噬细胞集落刺激因子(M-CSF)水平的影响。方法将106例寻常型银屑病血热证患者按照随机数字表法分为2组,各53例,对照组给予NB-UVB治疗,研究组在对照组基础上配合芩珠凉血方治疗。观察2组中医症候积分、银屑病皮损面积和严重程度指数(PASI)评分、临床疗效,检测T淋巴细胞亚群和MCP-1、M-CSF水平。结果治疗后2组中医症候积分显著低于治疗前(P0.05),且研究组显著低于对照组(P0.05);治疗后2组皮损面积及PASI评分(鳞屑、红斑、浸润)显著低于治疗前(P0.05),且研究组显著低于对照组(P0.05);研究组总有效率90.57%显著高于对照组73.58%(P0.05);治疗后2组CD3~+、CD4~+、CD4~+/CD8~+显著高于治疗前(P0.05),且研究组显著高于对照组(P0.05),2组CD8~+、MCP-1、M-CSF水平显著低于治疗前(P0.05),且研究组显著低于对照组(P0.05)。结论芩珠凉血方配合NB-UVB可有效改善寻常型银屑病血热证患者MCP-1、M-CSF水平和T淋巴细胞亚群水平,提高临床疗效。     

羚黄凉血颗粒口服联合甲基强的松龙冲击治疗儿童过敏性紫癜疗效观察

目的观察羚黄凉血颗粒口服联合甲基强的松龙冲击治疗儿童过敏性紫癜的临床效果。方法选取2016年12月至2018年12月我院过敏性紫癜患儿84例,按照随机数字表法分为联合组和对照组,每组各42例。对照组采用甲基强的松龙冲击治疗,联合组采用羚黄凉血颗粒口服联合甲基强的松龙冲击治疗。比较两组疗效、治疗后皮疹、紫癜消退时间及关节疼痛、消化症状改善时间。结果两组治疗后总有效率比较,联合组95.24%(40/42)高于对照组61.90%(26/42),差异具有统计学意义(P 0.05);治疗后联合组皮疹、紫癜消退时间短于对照组,关节疼痛、消化症状改善时间短于对照组,差异具有统计学意义(P 0.05)。结论羚黄凉血颗粒口服联合甲基强的松龙冲击治疗儿童过敏性紫癜的效果确切,能有效缩短病程时间。     

二氧化碳激光联合干扰素对尖锐湿疣的治疗效果及对患者免疫功能的影响

目的探讨二氧化碳激光联合干扰素对尖锐湿疣的治疗效果及对患者免疫功能的影响。方法选取2016年2月至2019年2月台州市第二人民医院诊治的120例尖锐湿疣患者作为研究对象。采用随机数字法将其分为观察组(n=60)及对照组(n=60)。观察组采取用二氧化碳激光联合干扰素α-2b治疗,对照组采取用二氧化碳激光治疗。治疗3个月后,评估两组患者临床效果;采用流式细胞仪测定两组患者外周血T淋巴细胞亚群含量;通过为期6个月的随访记录两组患者复发情况。结果治疗3个月后,观察组患者临床有效率高于对照组患者,差异具有统计学意义(P0.05)。治疗3个月后,两组患者CD4~+、CD4~+/CD8~+均高于治疗前,差异具有统计学意义(P0.05),CD8~+低于治疗前,差异具有统计学意义(P0.05);且观察组患者CD4~+、CD4~+/CD8~+均高于对照组患者,差异均具有统计学意义(均P0.05),CD8~+低于对照组,差异具有统计学意义(P0.05)。为期6个月的随访结果显示,观察组患者复发率及复发时间均低于对照组患者,差异具有统计学意义(P0.05)。结论二氧化碳激光联合干扰素α-2b可有效提升尖锐湿疣患者免疫功能、降低复发率、延长复发时间,临床效果优于单独采取二氧化碳激光治疗。     

过敏性紫癜病情与免疫球蛋白及T淋巴细胞亚群水平的相关性研究

目的探讨过敏性紫癜患儿病情与免疫球蛋白及T淋巴细胞亚群水平的相关性。方法收集2017年11月至2019年2月来我院进行治疗的90例过敏性紫癜(HSP)患儿的临床资料,作为观察组。选取同时期来我院进行健康体检的健康志愿儿童90例为对照组。观察免疫球蛋白水平、各组T淋巴细胞亚群及NK细胞阳性百分率、相关性。结果重度组IgA、IgG、IgM水平最高,中度组次之,轻度组最低,但都高于对照组,组间对比,差异显著(P <0.05);重度组CD3+T、CD4+T、CD4+T/CD8+T、NK细胞阳性百分率水平最低,CD8+T水平最高,组间对比,差异显著(P <0.05);血清IgA水平、CD8+T水平,和HSP症状表现为正相关,r=0.618、0.591,P <0.05;CD3+T、CD4+T、CD4+T/CD8+T、NK细胞阳性百分率水平,和HSP症状表现为负相关,r=-0.612、-0.588、-0.579、-0.599,P <0.05。结论过敏性紫癜患儿病情与免疫球蛋白及T淋巴细胞亚群水平有相关性,临床可根据这些指标的变化,辅助临床诊断。     

脾氨肽联合激光对尖锐湿疣患者淋巴细胞和细胞因子水平的影响

目的探讨脾氨肽联合激光对尖锐湿疣患者的临床效果及对患因子水平的影响者淋巴细胞和细胞因子水平的影响。方法选择2012年1月—2015年1月本院皮肤性病门诊收治的98例尖锐湿疣患者进行研究,采用随机数字表法分为联合组和对照组各49例,联合组采用脾氨肽联合激光治疗,对照组仅采取激光治疗,对比2组患者的临床效果、T淋巴细胞亚群及细胞因子水平差异。结果治疗前,联合组和对照组的T淋巴细胞亚群值、白介素细胞(IL)-2、IL-10水平差异均无统计学意义(P0.05);治疗后,联合组患者的CD3~+、CD4~+、CD4~+/CD8~+值、IL-2水平均显著的高于对照组患者(P0.05),联合组的CD8~+值、IL-10水平显著的低于对照组患者(P0.05);治疗后2组患者的CD3~+、CD4~+、CD4~+/CD8~+值、IL-2水平较治疗前均显著的提高(P0.05),CD8~+、IL-10水平较治疗前均显著的降低(P0.05);联合组的痊愈率89.80%显著的高于对照组的73.47%(P0.05);联合组的远期复发率6.12%显著的低于对照组的20.41%(P0.05)。结论脾氨肽联合激光对尖锐湿疣患者具有较好的临床效果,其作用机制与改善患者的免疫水平有关。     

紫杉醇联合卡铂新辅助化疗对局部晚期宫颈癌患者的疗效及其对免疫功能和远期预后的影响

目的探讨紫杉醇联合卡铂新辅助化疗对局部晚期宫颈癌患者的疗效及其对免疫功能和远期预后的影响。方法选取2015年3月至2018年12月首都医科大学附属北京妇产医院收治的74例局部晚期宫颈癌患者作为研究对象。随机分为观察组和对照组,每组37例。在行广泛性子宫切除术及盆腔淋巴结清扫术前,观察组采用紫杉醇联合卡铂新辅助化疗,对照组采用卡铂新辅助化疗。治疗后,比较两组的疗效。比较两组治疗前后CD3~+、CD4~+、CD8~+水平并计算CD4~+/CD8~+。比较两组不良反应发生情况。采用Kaplan-Meier生存曲线分析预后。结果观察组总有效率(81.08%)高于对照组(59.46%),差异具有统计学意义(P0.05);治疗后,两组CD3~+、CD4~+、CD4~+/CD8~+均高于同组治疗前,CD8~+低于同组治疗前,且观察组CD3~+、CD4~+、CD4~+/CD8~+均高于对照组,CD8~+低于对照组,差异具有统计学意义(P0.05);两组骨髓抑制、贫血、胃肠道反应、肝肾功能损害等不良反应发生率比较,差异无统计学意义(P0.05);观察组总体生存率(64.86%)高于对照组(40.54%),差异具有统计学意义(P0.05);观察组中位生存时间(38个月)大于对照组(30个月),差异具有统计学意义(P0.05)。结论紫杉醇联合卡铂新辅助化疗用于局部晚期宫颈癌患者能够提高疗效,恢复免疫功能并改善远期预后。     

基于皮腠神气变生理论指导的综合疗法治疗带状疱疹相关性疼痛的临床研究

目的探讨基于皮腠神气变生理论指导下的中医综合疗法治疗带状疱疹相关性疼痛的临床疗效。方法利用随机数字表法将我院收治的208例带状疱疹相关性疼痛患者分为观察组和对照组各104例,2组在心理治疗基础上对照组给予普瑞巴林,观察组给予中医综合疗法,14 d为1个疗程,治疗1个疗程后评价2组患者临床疗效。分别与治疗前后采用视觉模拟评分(VAS)、疼痛分级指数(PRI)及现有疼痛强度(PPI)评价疼痛;采用入睡时间评分、睡眠质量评分、睡眠时间评分、睡眠障碍评分及睡眠效率评分评价睡眠质量;观察治疗后血清白细胞介素(IL)-6、干扰素(IFN)-γ、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子(TNF)-α炎性因子表达及CD4~+/CD8~+、CD8~+、CD3~+免疫指标。结果治疗后,观察组有效率显著高于对照组(P0.05);观察组VAS、PRI及PPI评分均显著低于对照组(P0.05);入睡时间评分、睡眠质量评分、睡眠时间评分、睡眠障碍评分及睡眠效率评分均显著低于对照组(P0.05)。观察组治疗后IL-6、IFN-γ、hs-CRP及TNF-α均明显低于对照组,且CD4~+/CD8~+、CD8~+、CD4~+及CD3~+改善程度均明显优于对照组(P0.05)。结论基于皮腠神气变生理论指导下的中医综合疗法治疗带状疱疹相关性疼痛疗效较好,值得开展进一步研究。     

舒适护理对小儿过敏性紫癜症状消退及复发的影响

目的观察过敏性紫癜患儿应用舒适护理对症状消退及复发的影响。方法选取2017年1月～2017年9月我院行常规护理的过敏性紫癜患儿42例为对照组,并选取2017年10月～2018年6月予以舒适护理的过敏性紫癜患儿42例为观察组。比较两组症状消退时间、住院时间与疾病复发情况。结果观察组症状消退与住院时间均短于对照组,疾病复发率低于对照组,差异有统计学意义(P 0.05)。结论针对过敏性紫癜患儿,应用舒适护理利于加快症状消退,降低疾病复发率,改善预后。     

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.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.