《EAU(2015年版)早泄诊治指南》解读

早泄是一种常见的男性性功能障碍,欧洲泌尿外科学会于2015年3月颁布了《2015版早泄诊治指南》。新《指南》在早泄的定义、发病机制、基于循证医学的流行病、诊断标准、安全而有效的治疗等方面做了论述。通过本《指南》的解读,旨在帮助不熟悉性功能障碍治疗的医生更加正确的诊断和治疗早泄。     

中国痤疮治疗指南(2014修订版)

<正>痤疮是一种毛囊皮脂腺的慢性炎症性皮肤病,发病率为70%~87%,对青少年的心理和社交影响超过了哮喘和癫痫。临床医师对痤疮的治疗选择存在很大差异,有些治疗方法疗效不肯定,缺乏循证医学证据支持,个别方法甚至会对患者造成损害。因此,制定一套行之有效的治疗痤疮的指南来规范其治疗是非常必要的。当然,指南不是一成不变的,随着新的循证医学证据和新药的研发,痤疮的治疗指南还需与时俱进,定期更新。本指南是在2008年出版的痤疮指南基     

梅毒的流行、检测与治疗现状(二)

<正>(接上期)梅毒的广泛流行和传播已成为世界各国的公共卫生问题,因此梅毒的规范化治疗也受到高度重视。2003年世界卫生组织推荐的梅毒治疗方案和2006年美国疾病控制中心梅毒治疗指南是我国在制定梅毒     

周少虎教授辨治早泄经验

早泄是一种常见的男性性功能障碍疾病,随着诊断标准的逐渐明朗,诊断率呈现逐年上升的趋势。然而迄今为止,虽然有一些治疗早泄的药物在临床广泛使用,甚至被纳入数个指南作为可选方案,但均缺乏可靠的研究支持,且易出现不同程度的不良反应,而中医药治疗早泄副作用较少。周少虎教授根据数十年的男科疾病治疗经验,总结出早泄的根本病因为肾气亏虚、精关不固,夹杂有血瘀,临床常在益肾固精的同时佐以少量活血化瘀之品,疗效满意。     

早泄宁帖(延射宁帖)治疗早泄1000例临床观察

早泄属男性性功能障碍疾病之一,常可导致夫妻感情不和、不育、甚至离婚。据笔者在男科门诊统计,早泄约占20%-30%,已超过阳痿(ED)患者。现临床报道资料不多,历代医家对此也有专论。"未交即泄"或"乍交     

日本《ED诊治指南(2008版)》解读

日本医学性学会(Japanese Society for Sexual Medicine,JSSM),按照循证医学的原则,制定了《日本性医学学会ED诊治指南》(以下简称《指南》),并已发表。该指南分为制定背景,流行病学,危险因子,诊断和治疗等几个方面;该《指南》存有很多亮点,如提出了三种ED是可以治愈的;ED治疗失败后的策略;诊室的具体要求等。通过本《指南》的解读,旨在帮助全科医生和不熟悉性功能障碍治疗的医生更加正确的诊断和治疗ED。     

《早泄诊断与治疗》第2版出版

正由郭军、张春影、吕伯东主编,全国30余位泌尿男科专家编写的《早泄诊断与治疗》(第2版)2016年1月由人民军医出版社出版。全书22.8万字,274页,价格28元。全书共14章,包括:射精的解剖、生理与调控,早泄的概念、病因、发病机制、诊断与治疗方法;中医对早泄的认识和古代房中术简介;前列腺炎、勃起功能障碍与早泄;早泄的医患沟通技巧与健康教育等。并增加了甲状腺功能亢进对早泄的影响、诊断与治疗,     

于庆成雕塑艺术(续四)

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于庆成雕塑艺术(续六)

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特应性皮炎的诊断与健康教育

<正>0052中国特应性皮炎诊疗指南(2014版)中华医学会皮肤性病学分会免疫学组、特应性皮炎协作研究中心//全科医学临床与教育.-2014,12(6).-603~606,615为了规范特应性皮炎的诊断和治疗,中华医学会皮肤性病学分会免疫学组于2008年制定了我国第1版特应性皮炎诊疗指南,指南发表6年     

李曰庆教授从心肝肾论治早泄的经验

早泄是男性性功能障碍的常见病、多发病,对男性性心理的危害极大,而目前在治疗早泄方面,李曰庆教授应用中医药从心、肝、肾进行论治取得较好效果。总结李曰庆教授治疗早泄的经验,有利于我们进一步对早泄疾病有更全面的认知,更好地指导临床。     

Unexpected enlightening of a “female world”. Male medical students’ experiences of learning and performing the first pelvic examination

ObjectiveTo gain a deeper understanding of how undergraduate male medical students experience a pelvic examination learning concept and performing the first pelvic examination (PE) on a professional patient.Study designA qualitative study. In-depth interviews with 12 male medical students’ after their involvement in a learning session about the PE, with professional patients and a supervising gynecologist as instructors. The interviews were analyzed according to the constant comparative method, a variety of content analysis, to acquire a deeper understanding of the students’ experiences and the ongoing social processes.ResultsThe essence of the entire analysis was “Unexpected enlightening of a ‘female world’” and was identified from the three categories; “Not just any exam”, “Professional supportive interaction” and “Humble awareness”. The male students’ most prominent concern was how to establish a professional rapport with the patient in the PE situation. Beneficial active support from the professional patient and the gynecologist assisted the students to overcome inherent barriers and facilitated the examination procedure. The informants gained “inside information” from the patients’ perspective of being examined leading to a new awareness about an earlier unknown “female world” that is what women might go through before and during a PE and an humble understanding of how vulnerable it is to be placed in the examination position.ConclusionThe beneficial PE learning concept promoted an unexpected insight in what a woman might experience during a PE, creating a humble awareness of this vulnerable intimate situation and ideas for how to establish professional rapport.     

Gynecological patients learning to perform the pelvic examination: A win–win concept

ObjectiveThis study explored gynecological patient perceptions of previous pelvic examinations (PE), a learning session about PE prior to a scheduled PE consultation, and the impact of the learning session on the PE during the consultation.Study designTwelve informants were purposefully sampled from women with scheduled gynecologist appointments at a Swedish University Hospital. The learning session preceded the consultation and provided information on female genital anatomy and the PE, and the informant performed a PE on a mannequin. Individual qualitative interviews followed the consultation. The interviews were transcribed verbatim and analyzed using a constant comparative analysis to acquire a deeper understanding of the women’s experiences of the learning session and the subsequent PE.ResultsThree categories were identified in the analysis: ‘Harmonizing the bad with the good’ category, which primarily concerned the informants’ previous experiences of the PE. ‘Gaining self-confidence through knowledge’, which depicted the informants’ experiences of the learning session. ‘Mental preparation enables bodily recapture’, which was the summarizing category of informant experiences of the scheduled PE. The core category, ‘active involvement triggers empowerment’, was created from the categories, and constitutes the core of the empirical material.ConclusionThe informants’ active participation during the learning session increased their knowledge, generated self-confidence, triggered an empowering process, and promoted interaction with the examiner during their subsequent PE.     

Current Diagnosis and Management of Premature Ejaculation

Premature ejaculation (PE) is a common sexual dysfunction characterized by reduced intravaginal ejaculatory latency time (IELT), inability to delay ejaculation, and personal distress. Increasing understanding of pathophysiologic mechanisms has yielded diverse and effective therapies. The current review discusses contemporary evaluation and management of PE, with a review of all randomized, controlled trials (RCT) performed. Therapies with RCT data include behavioral modification/psychotherapy, topical anesthetics, narcotic-like pain relievers, phosphodiesterase-5 (PDE-5) inhibitors, selective serotonin/norepinephrine reuptake inhibitors and receptor antagonists, tricyclic antidepressants, and surgery. As data are insufficient to define optimal therapies, treatment decisions are based on clinical factors (comorbid conditions, PE mechanism and patient preference), trial outcomes, and adverse event profiles. Combination therapies demonstrate superior efficacy to single agents, with concomitant use of behavioral/psychosexual modifications with pharmacotherapy recommended. The role of surgery in PE remains undefined, with additional data required. Further comparative RCTs are required to define optimal treatment algorithms.     

An Integrative Approach to the Treatment of Premature Ejaculation

Introduction

Approaches to the diagnosis and treatment of premature ejaculation (PE) have evolved over the past 50 years. In this paper, we briefly review significant historical and conceptual changes in the understanding of PE, with the aim of suggesting a contemporary integrative treatment plan.

Methods

A review of PE diagnostic nosology, risk factors, and classical and contemporary treatment strategies suggests the need for an integrative approach so as to ensure both increased ejaculatory latency and relationship satisfaction.

Results

A multi-faceted integrative treatment process is offered, emphasizing brevity and relying on a modified PLISSIT model. This model, summarized in a flow chart, progresses through sequentially deeper levels of engagement and includes attention to physiological, behavioral, cognitive-affective, and relationship factors, addressing each on an as needed basis.

Conclusion

Important to any treatment model is consideration of time, cost, and access. The proposed model attempts to remove potential barriers for seeking treatment by addressing all three concerns.     

Pressure ulcer/injury classification today: An international perspective

There has been an ongoing debate in the healthcare community about what pressure ulcers/injuries are, and how to name, define and classify them. The aim of this discussion paper is to provide a brief theoretical background about pressure ulcer/injury classification, to explain the approach the Guideline Governance Group has taken during the 2019 update of the International Guideline for ‘Prevention and Treatment of Pressure Ulcers/Injuries’ and to share views on how to best implement pressure ulcer/injury classification. First formal pressure ulcer/injury classifications were introduced in the 1950s and today various pressure ulcer/injury classification systems are used worldwide. Dissimilarities between commonly used classification systems may be considered a limitation that impedes clinical and scientific communication. However, the conceptual meaning of pressure ulcer/injury categories described within the various classification systems is comparable and the current evidence does not indicate that one classification is superior to another. Therefore, the Guideline Governance Group created a crosswalk of the major pressure ulcer/injury classifications in common use across different geographic regions. Clinicians are encouraged to use the classification system adopted by their healthcare setting in the most consistent way. The validity of pressure ulcer/injury classification is closely linked to its intended purpose. Studying measurement properties of pressure ulcer/injury classification systems must follow state-of-the-art methods. Structured educational interventions are helpful for improving diagnostic accuracy and reducing misclassification of pressure ulcers/injuries. Implementation of innovative skin and soft tissue assessments and revised pressure ulcer/injury classifications are only worth implementing, when the diagnostic information improves clinical care.     

《EAU慢性盆腔疼痛指南(2012年版)》前列腺疼痛综合征解读

欧洲泌尿外科学会(The European Association of Urology,EAU)2012年发表了新的《EAU慢性盆腔疼痛指南(2012年版)》(以下简称《指南》)。在前列腺疼痛综合征(Prostate pain syndrome,PPS)的定义、发病机制、流行病学、诊断标准、安全有效的治疗等方面做了论述。本文通过对《指南》中PPS的解读,旨在帮助全科医生和不熟悉PPS治疗的医生正确诊断和治疗该病。     

《EAU男性不育症指南(2012年版)》解读

欧洲泌尿外科学会(The European Association of Urology,EAU)2012年发表了新的《EAU男性不育症指南(2012年版)》(以下简称《指南》)。在男性不育症(Male Infertility,MI)的定义、流行病学、引起不育各种疾病的定义、诊断、治疗等方面做了论述。本文通过对《指南》的解读,旨在帮助全科医生和不熟悉MI治疗的医生正确诊断和治疗该病。     

Palmar Erythema

Palmar erythema (PE), an often overlooked physical finding, is due to several physiologic or systemic pathologic states. PE can exist as a primary physiologic finding or as a secondary marker of systemic pathology. Primary or physiologic PE can be due to heredity, occurs in at least 30% of pregnant women as a result of associated alterations in the function of the skin and its microvasculature, or may be a diagnosis of exclusion (i.e. idiopathic PE). Secondary PE from systemic pathology encompasses a wide range of disease states. Twenty-three percent of patients with liver cirrhosis, from varying causes, can manifest PE as a result of abnormal serum estradiol levels. Patients with a rare neonatal liver disease such as Wilson disease and hereditary hemochromatosis may exhibit PE along with the other systemic manifestations of the genodermatoses. PE has been reported to occur in >60% of patients with rheumatoid arthritis and is associated with a favorable prognosis. Up to 18% of patients with thyrotoxicosis and 4.1% of patients with diabetes mellitus can have PE. This cutaneous manifestation of diabetes occurs more often than the more classic diseases such as necrobiosis lipoidica diabeticorum (0.6%). PE can be seen in early gestational syphilis and among patients with human T-lymphotrophic virus-1-associated myelopathy. Drug-induced PE with hepatic damage has been documented with use of amiodarone, gemfibrozil, and cholestyramine, while topiramate and albuterol (salbutamol) have been reported to cause PE in the setting of normal liver function. Fifteen percent of patients with both metastatic and primary brain neoplasms may have PE. Increased levels of angiogenic factors and estrogens from solid tumors have been postulated as the cause of PE in such cases. Erythema ab igne can mimic PE, and patients with atopic diathesis are more likely to have PE than matched control subjects. Smoking and chronic mercury poisoning are environmental causes of PE.No treatment of primary PE is indicated. If medication is the cause of PE, the drug responsible should be discontinued if possible. Identification of PE related to underlying disorders should be followed by treatment of the underlying condition. In light of the numerous etiologies of PE, this article reviews the current literature and provides a framework to help guide the clinician in determining the cause of PE in patients presenting with this finding.     

Cisplatin encapsulated in phosphatidylethanolamine liposomes enhances the in vitro cytotoxicity and in vivo intratumor drug accumulation against melanomas

BACKGROUND: Cisplatin is a potent anticancer drug for treating melanoma. OBJECTIVE: The aim of this study was to evaluate the possibility of using liposomes, for intratumoral distribution in a melanoma, composed of phosphatidylethanolamine (PE), for its cytotoxicity. METHOD: The in vitro drug release, in vitro cytotoxicity against melanoma, and in vivo residence time in the tumor of liposome-encapsulated cisplatin were investigated. The liposomes were prepared and characterized in terms of their morphology, size, zeta potential, and drug loading. RESULT: The size of the PE liposomes attained a level of approximately 100 nm. The concentration of cisplatin encapsulated in PE liposomes was 50-70% dependent on the presence or absence of polyethylene glycol (PEG) derivatives. On the other hand, no or negligible cisplatin molecules were encapsulated in egg phosphatidylcholine (EPC) liposomes. PE liposomes had higher cytotoxicity than classic liposomes or free cisplatin. Images of confocal laser scanning microscopy confirmed the great potency of PE liposomes to deliver cisplatin into cells. The incorporation of PEG derivatives completely inhibited the proliferation of melanoma cells. With in vivo intratumoral administration, the cisplatin concentration in the tumor tissue was maintained at a high level for 72 h after application of the PE liposomes. The PE liposomes delivered cisplatin into the tumor approximately 3.6 times more efficiently than the free drug. CONCLUSION: These results demonstrate that PE liposomes represent a potentially useful strategy for targeting cisplatin delivery into melanomas.