来曲唑改善多囊卵巢综合征不孕患者激素水平和排卵情况的疗效分析

目的:探讨来曲唑改善多囊卵巢综合征不孕患者激素水平和排卵情况。方法:将2012年9月至2014年12月我院收治的96例多囊卵巢综合征不孕患者随机分为观察组和对照组,对照组采用氯米芬治疗,观察组采用来曲唑治疗,比较两组排卵情况及治疗前后激素水平。结果:观察组排卵数及优势卵泡数明显多于对照组,排卵率、妊娠率高于对照组,OHSS发生及早期流产发生率低于对照组,差异有统计学意义(P<0.05);观察组HCG注射日子宫内膜厚度大于对照组,Insler评分高于对照组,差异有统计学意义(P<0.05);观察组治疗后LH、FSH、E_2水平明显高于对照组,T低于对照组,差异有统计学意义(P<0.05)。结论:来曲唑有助于多囊卵巢综合征不孕患者排卵,改善激素水平,可在临床上推广。     

滋阴补阳中药对子宫内膜异位症合并不孕患者血清性激素水平与妊娠结局的影响研究

目的:探讨滋阴补阳中药对子宫内膜异位症合并不孕患者血清性激素水平与妊娠结局的影响。方法:选取我院妇科住院部子宫内膜异位症合并不孕症腹腔镜术后患者98例,采用随机数字表法将患者分为两组,对照组48例,采用常规促排卵治疗,研究组50例,在对照组基础上采用滋阴补阳中药治疗,比较两组临床疗效、血清性激素水平和妊娠结局的差异。结果:研究组治疗有效率明显高于对照组,两组比较差异具有统计学意义(P0.05),h CG注射日,研究组血清性激素(雌二醇、总睾酮、促黄体生成素)水平、子宫内膜厚度、成熟卵泡数目和优势卵泡数目均明显高于对照组,两组比较差异具有统计学意义(P0.05);研究组排卵率和妊娠率明显高于对照组(P0.05);研究组不良妊娠率明显低于对照组(P0.05)。结论:滋阴补阳中药有助于改善子宫内膜异位症合并不孕症患者血清性激素水平,改善子宫内膜厚度与排卵情况,改善妊娠结局,值得临床推广应用。     

枸橼酸氯米芬联合来曲唑对排卵障碍不孕症患者卵泡成熟时间、生殖激素水平的影响

目的研究枸橼酸氯米芬联合来曲唑对排卵障碍不孕症患者卵泡成熟时间、生殖激素水平的影响。方法选取2018年7月至2019年7月衡水市第二人民医院诊治的146例排卵障碍不孕症患者作为研究对象。按照完全随机法分为联合治疗组(n=73)和来曲唑治疗组(n=73)。对来曲唑治疗组患者使用来曲唑进行治疗,对联合治疗组使用枸橼酸氯米芬联合来曲唑进行治疗。对两组患者雌二醇(E_2)、孕酮(P)、子宫膜厚度、卵泡成熟时间、脂肪因子[内脂素(VF)、脂联素(APN)及瘦素(LP)]水平进行检测并作出比较;统计患者不良反应发生率、排卵率以及妊娠率。结果治疗后联合治疗组患者生殖激素E_2、P水平高于来曲唑治疗组患者,差异具有统计学意义(P0.05);治疗后联合治疗组患者子宫内膜厚度高于来曲唑治疗组患者,差异具有统计学意义(P0.05),联合治疗组患者卵泡成熟时间低于来曲唑治疗组患者,差异具有统计学意义(P0.05);治疗后联合治疗组患者不良发生率高于来曲唑治疗组患者,差异具有统计学意义(P0.05);治疗后联合治疗组患者脂肪因子VF、LP低于来曲唑治疗组患者,差异具有统计学意义(P0.05),联合治疗组患者脂肪因子APN高于来曲唑治疗组患者,差异具有统计学意义(P0.05);治疗后联合治疗组患者排卵率、妊娠率均高于来曲唑治疗组患者,差异均具有统计学意义(均P0.05)。结论枸橼酸氯米芬联合来曲唑治疗排卵障碍不孕症患者可以提高生殖激素E_2、P水平,降低卵泡成熟时间,增加子宫膜厚度,提高排卵率和妊娠率。     

来曲唑与氯米芬应用于多囊卵巢综合征不孕患者临床疗效分析研究

目的:比较来曲唑与氯米芬应用于多囊卵巢综合征不孕患者临床疗效分析。方法:选择2010年1月至2012年10月就诊于我院不孕门诊的PCOS不孕患者70例,随机分为两组,氯米芬组34例和来曲唑组36例,70例患者共进行129个促排卵周期,分析两组的临床治疗效果。结果:来曲唑组临床妊娠率为38.89%,明显优于氯米芬组17.65%的妊娠率,二者比较差异有统计学意义(P<0.05)。来曲唑组在优势卵泡率、排卵率及临床妊娠率方面均优于氯米芬组,二者比较差异有统计学意义(P<0.05)。结论:来曲唑应用于多囊卵巢综合征不孕患者,可以明显提高患者的临床妊娠率,值得在一定范围内临床推广应用。     

3种不同剂量来曲唑分别联合枸橼酸氯米芬对PCOS不孕患者性激素和内膜的影响

目的探讨3种剂量来曲唑分别联合枸橼酸氯米芬对多囊卵巢综合征(polycystic ovary syndrome,PCOS)不孕患者性激素和内膜的影响。方法选取2015年1月至2017年12月成都市送子鸟不孕不育医院诊治的129例PCOS不孕患者作为研究对象。按照随机数表法将其平均分为A组、B组和C组,每组43例患者,选择同期月经正常的40例育龄妇女为参照组。A、B和C组患者在月经周期均给予来曲唑联合枸橼酸氯米芬治疗,其中A组患者来曲唑剂量为2.5mg/d,B组患者来曲唑剂量为5mg/d,C组患者来曲唑剂量为7.5mg/d,三组患者最大卵泡直径不小于20mm时通过人绒毛膜促性腺激素(hCG)进行诱发排卵。比较四组成员hCG期间相关激素和血清性激素结合球蛋白(SHBG)水平、子宫内膜厚度及分型、排卵和妊娠情况。结果 A组、B组和C组患者的卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)和SHBG水平均明显低于参照组成员,睾酮(T)水平均明显高于参照组成员(均P0.05);A组和B组患者的FSH、LH、E_2和SHBG水平均明显低于C组患者,T水平均明显高于C组患者,其差异均具有统计学意义(均P0.05);A组患者的FSH、LH、E_2和SHBG水平均明显低于B组患者,T水平均明显高于B组患者,其差异均具有统计学意义(均P0.05)。在优势卵泡发育至10mm～12mm、14mm～16mm和18mm～20mm时间节点时:A组、B组和C组患者的雌激素水平和子宫内膜厚度均明显低于参照组成员(均P0.05);C组患者的雌激素水平和子宫内膜厚度均明显低于A组和B组患者,其差异均具有统计学意义(均P0.05);B组患者的雌激素水平和子宫内膜厚度均明显低于A组患者,其差异军具有统计学意义(均P0.05)。四组成员hCG日均未见C型子宫内膜,且四组成员A型、B型占比比较,其差异均无统计学意义(均P0.05)。四组成员排卵率相比,其无差异均无统计学意义(均P0.05);A组、B组和C组患者的妊娠率均明显低于参照组成员,且A组和B组患者的妊娠率低于C组患者,A组患者的妊娠率低于B组患者,其差异均具有统计学意义(均P0.05)。结论来曲唑联合枸橼酸氯米芬可以促进PCOS不孕患者性激素和SHBG的分泌,对雌激素和子宫内膜有一定的抑制作用,但达到胚胎着床的要求,能够提高患者的妊娠率,以7.5mg/d来曲唑剂量的作用效果最为明显。     

氯米芬对多囊卵巢综合征患者卵巢血流的影响

目的:探讨氯米芬对多囊卵巢综合征患者卵巢血流的影响,为促进多囊卵巢综合征患者的康复提供科学依据。方法:选取2014年10月至2015年10月于我院就诊的多囊卵巢综合征不孕患者60例作为研究对象,随机分成对照组和观察组。观察组患者采用氯米芬治疗。监测两组对象的排卵情况及卵巢血流动力学参数、黄体生成素、血清睾酮、雌二醇水平和卵泡刺激素。结果:两组患者PI和RI均呈现周期性变化,且治疗后围排卵期、黄体中期PI、RI指标优于治疗前,差异有统计学意义(P0.01)。观察组患者治疗后围排卵期、黄体中期PI、RI指标优于对照组,差异有统计学意义(P0.01)。观察组排卵率高于对照组,差异有统计学意义(P0.05)。两组患者治疗后FSH、LH、E2水平与治疗前相比均有改善,差异具有统计学意义(P0.01)。观察组治疗后FSH、LH、E2水平优于对照组,差异具有统计学意义(P0.01)。结论:氯米芬可在一定程度上改善多囊卵巢综合征患者的卵巢血流,但其虽排卵率高,妊娠率却不理想,尚需结合其他药物做进一步研究。     

定坤丹联合达英-35、来曲唑治疗多囊卵巢综合征不孕对子宫内膜容受性、卵巢储备功能的影响

目的研究定坤丹联合达英-35、来曲唑治疗多囊卵巢综合征不孕对子宫内膜容受性、卵巢储备功能的影响。方法选取2018年1月至2019年12月兵器工业五二一医院诊治的173例多囊卵巢综合征不孕患者作为研究对象。按照治疗方法的不同分为对照组(n=86)和联合组(n=87),对照组给予达英-35联合来曲唑治疗,联合组在对照组基础上给予定坤丹治疗。检测两组子宫内膜容受性[血流阻力指数(RI)、血流搏动指数(PI)、子宫内膜厚度、卵巢体积]、卵巢储备功能指标[黄体生成激素(LH)、雌二醇(E_2)、卵泡刺激素(FSH)、抗苗勒氏管激素(AMH)]。结果治疗后2个月、3个月,联合组RI、PI、卵巢体积、LH、E_2、AMH水平低于对照组,子宫内膜厚度、FSH水平高于对照组,差异具有统计学意义(P0.05);联合组足月分娩率、排卵率、月经正常率高于对照组,差异具有统计学意义(P0.05)。结论定坤丹联合达英-35、来曲唑可改善多囊卵巢综合征不孕患者子宫内膜容受性、卵巢储备功能。     

复方阿胶浆联合克罗米芬治疗排卵障碍性不孕患者临床研究

目的:探讨复方阿胶浆联合克罗米芬治疗排卵障碍性不孕患者的临床疗效。方法:选取2014年1月至2015年12月就诊于我院的排卵障碍性不孕患者80例,随机均分为观察组和对照组(各40例),其中对照组患者给予克罗米芬治疗,观察组患者给予复方阿胶浆和克罗米芬治疗,比较两组治疗前后子宫内膜厚度及形态、排卵率、妊娠率、妊娠结局及卵泡发育情况。结果:观察组的子宫内膜厚度及形态、排卵率、妊娠率、单卵泡发育周期率明显优于对照组,差异具有统计学意义(P0.05)。结论:复方阿胶浆联合克罗米芬可增加子宫内膜厚度、改善子宫内膜形态,提高排卵率、妊娠率,较单纯应用克罗米芬的疗效更为显著,可广泛应用于临床。     

糖皮质激素联合氯米芬治疗多囊卵巢综合征对患者血清孕酮、雌二醇的影响分析

目的:分析糖皮质激素与氯米芬合用治疗多囊卵巢综合征对患者血清孕酮、雌二醇的影响。方法:选取2015年1月至2016年3月在我院生殖科诊断为多囊卵巢综合征的患者共120例,随机均分为两组,每组60例。对照组仅给予氯米芬治疗,观察组加服糖皮质激素治疗。比较两组治疗效果;检测两组患者成熟卵泡数、子宫内膜厚度、注射HCG日血清E_2值,对宫颈粘液进行评分;检测两组患者治疗前后的生殖内分泌指标水平,包括卵泡刺激素(FSH)、黄体生成素(LH)、孕酮(P)、雌二醇(E_2)、睾酮(T)、泌乳素(PRL)、性激素结合蛋白(SHBG)。结果:观察组总有效率96.67%,显著大于对照组的81.67%(P0.05);观察组HCG日血清E_2水平、子宫内膜厚度、成熟卵泡数、宫颈粘液评分均显著优于对照组(P0.05);观察组FSH、LH、E_2、T、PRL水平明显降低(P0.05),P、SHBG水平明显升高;两组比较有统计学差异(P0.05)。结论:糖皮质激素与氯米芬合用治疗多囊卵巢综合征可有效改善患者激素水平。     

芬吗通在克罗米芬促排卵患者中改善子宫内膜厚度提高临床妊娠率的研究

目的:探讨芬吗通在克罗米芬(CC)促排卵患者中改善子宫内膜厚度提高临床妊娠率的作用。方法:选取我院2014年5月至2016年5月收治的不明原因排卵障碍的不孕患者200例,随机将这些患者分为芬吗通联合CC治疗组(芬吗通组,n=100)和补佳乐联合CC治疗组(补佳乐组,n=100)两组,芬吗通组患者接受芬吗通联合CC治疗,补佳乐组患者接受补佳乐联合CC治疗,然后对两组患者HCG日与排卵后1周的子宫内膜发育情况、排卵情况、排卵后1周P水平值、生化妊娠及临床妊娠情况进行统计分析。结果:芬吗通组患者HCG日A型内膜比例显著低于补佳乐组(P0.05),临床妊娠率显著高于补佳乐组(P0.05)。结论:芬吗通较补佳乐更能有效改善CC促排卵患者的子宫内膜发育,提高患者的临床妊娠率。     

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.     

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.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

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.     

Medición del impacto psicológico en pacientes con psoriasis en tratamiento sistémico

Background and objectives

The negative impact of psoriasis on patient quality of life can be as important as the physical consequences of the disease. We could assume that clearance of the disease would also lead to an improvement in its psychosocial impact. The present study assesses the psychological state of patients with psoriasis receiving systemic treatment in a psoriasis unit, especially those with mild or no disease involvement.