不同剂量20%氨基酮戊酸光动力治疗外阴尖锐湿疣患者疗效比较

目的:探讨不同剂量20%氨基酮戊酸光动力治疗外阴尖锐湿疣患者的疗效。方法:将2013年5月至2015年10月我院收治的76例外阴尖锐湿疣患者随机分为观察组(40例)和对照组(36例),观察组采用0.5m L 20%氨基酮戊酸光动力治疗,对照组采用0.25m L 20%氨基酮戊酸光动力治疗,比较两组临床疗效、疣体清除、治疗后复发及不良反应发生情况。结果:观察组1、2、3次治疗后总有效率分别为75.0%、95.0%及97.5%,明显高于对照组的47.2%、69.4%及77.8%,差异均有统计学意义(P0.05);观察组治疗1、2、3周疣体清除率分别为76.9%、94.2%及96.2%,明显高于对照组的45.7%、73.9%及82.6%,差异有统计学意义(P0.05);观察组治疗后12周及24周复发率均为10.0%,明显低于对照组的30.6%、33.3%,差异有统计学意义(P0.05);观察组不良反应发生率为27.5%,对照组为33.3%,比较差异无统计学意义(P0.05)。结论:0.5m L 20%氨基酮戊酸光动力较0.25m L20%氨基酮戊酸光动力治疗外阴尖锐湿疣更有助于清除疣体,降低复发,且未增加不良反应,疗效显著,值得在临床上推广应用。     

不同剂量20%盐酸氨基酮戊酸光动力治疗外阴尖锐湿疣患者有效性和安全性比较

目的探讨不同剂量20%盐酸氨基酮戊酸光动力(ALA-PDT)治疗外阴尖锐湿疣的有效性和安全性。方法选取2014年6月至2017年6月遂宁市中心医院诊治的86例外阴尖锐湿疣患者作为研究对象。将其简单随机分组为观察组和对照组,每组各43例。观察组采用0.5mL20%盐酸氨基酮戊酸光动力治疗,对照组采用0.25mL20%盐酸氨基酮戊酸光动力治疗,比较两组患者的治疗效果和不良反应。结果观察组1次治疗、2次治疗、3次治疗后的总有效率分别为74.4%、95.3%和97.7,均明显高于对照组同期总有效率,差异比较均具有统计学意义(均P0.05);观察组患者1次治疗、2次治疗、3次治疗后的疣体清除率分别为76.8%、92.9%及96.4%,均明显高于对照组同期疣体清除率,差异比较均具有统计学意义(均P0.05);治疗8周、12周及24周后,观察组患者的复发率明显低于对照组,差异比较具有统计学意义(P0.05);观察组共出现不良反应6例(14.0%),对照组出现7例(16.3%),两组不良反应发生率差异无统计学意义(P0.05)。结论采用0.5mL20%盐酸氨基酮戊酸光动力治疗外阴尖锐湿疣的临床疗效更佳,疣体清除率高、复发率低,且未见不良反应增多,值得在临床上推广应用。     

液氮冷冻联合5-氨基酮戊酸光动力疗法治疗巨大尖锐湿疣疗效分析

目的观察液氮冷冻联合5-氨基酮戊酸光动力疗法(ALA-PDT)治疗巨大尖锐湿疣的疗效。方法回顾性分析液氮冷冻联合5-氨基酮戊酸光动力疗法(ALA-PDT)治疗巨大尖锐湿疣和单纯液氮冷冻治疗的资料,比较两组患者疣体祛除后第4,8及12周时的复发率。结果治疗组治疗后第4,8和12周时的复发率分别为9.10%,18.20%和22.70%,对照组分别为35.00%,50.00%和60.00%,两组复发率差异有统计学意义(P<0.05)。结论冷冻联合ALA-PDT治疗巨大尖锐湿疣有很好的疗效,能显著降低复发率。     

5-氨基酮戊酸光动力治疗联合干扰素局部注射治疗尿道尖锐湿疣的临床效果分析

目的:观察5-氨基酮戊酸光动力联合干扰素局部注射治疗尿道尖锐湿疣的临床效果,为临床治疗提供参考依据。方法:收集来我科就诊的临床诊断为尖锐湿疣的患者70例,将其随机分为观察组与对照组,比较两组患者的临床疗效及不良反应发生情况,随访6个月后比较两组的HPV清除及复发率。结果:观察组的临床恢复率为94.3%,而对照组的恢复率为71.4%,两组的差异具有统计学意义(χ2=6.437,P=0.011);随访6个月后,观察组的HPV转阴率为80.0%,而对照组的为57.1%,观察组的复发率为10.3%,而对照组的复发率为30.0%,两组HPV转阴率及复发率之间的差异具有统计学意义(P<0.05);两组患者的不良反应发生率无统计学意义(P>0.05)。结论:5-氨基酮戊酸光动力联合干扰素局部注射治疗尿道尖锐湿疣的临床效果显著,复发率低,不良反应发生率较低。     

5-氨基酮戊酸光动力联合Nd:YAG激光治疗男性尿道口尖锐湿疣疗效观察

目的观察对比5-氨基酮戊酸光动力疗法(ALA-PDT)联合Nd:YAG激光及单纯Nd:YAG激光2种方法治疗男性尿道口尖锐湿疣的疗效及复发率,探索一种疗效好和复发率低的治疗男性尿道口尖锐湿疣的方法。方法将入选的64例尖锐湿疣患者随机分为A组和B组(各32例),A组单纯Nd:YAG激光治疗,B组采用(ALA-PDT)联合Nd:YAG激光治疗,对比2组患者的临床疗效及复发率。结果 A组治愈18例(56.2%),复发14例(43.8%);B组治愈26例(81.3%),复发6例(18.7%),A、B 2组治愈率与复发率比较,差异有统计学意义(χ2=4.66,P0.05)。结论 5-氨基酮戊酸光动力疗法(ALA-PDT)联合Nd:YAG激光治疗男性尿道口尖锐湿疣(CA)既对尖锐湿疣疣体具有清除作用外,还对疣体周围的潜伏病灶有治疗作用,是一种疗效好和复发率低的治疗方法。     

CO_2激光联合5-氨基酮戊酸光动力疗法治疗难治性尖锐湿疣的临床研究

目的研究CO2激光联合5-氨基酮戊酸光动力疗法治疗难治性尖锐湿疣的价值,为临床治疗提供参考依据。方法选取2016年10月至2017年10月南通市第三人民医院诊治的80例尖锐湿疣患者作为研究对象。按照随机数表法平均分成两组。其中对照组40例采用CO2激光治疗,试验组40例在对照组的基础上联合氨基酮戊酸-光动力治疗。对比治疗后两组患者的不良反应+复发率、临床疗效及伤口愈合、伤口结痂、HPV清除时间。结果治疗后,对照组患者的复发率为22.5%,高于试验组的5.0%,差异具有统计学意义(P0.05),且对照组的不良反应发生率为12.5%,观察组为15%,差异无统计学意义(P0.05)。治疗后,试验组患者的总有效率为95.0%,高于对照组的77.5%,差异具有统计学意义(P0.05);且试验组患者的HPV清除、伤口愈合、伤口结痂的时间分别为(32.4±12.4)d、(7.2±1.2)d、(3.1±1.1)d,均小于对照组,差异具有统计学意义(P0.05)。结论 CO2激光联合5-氨基酮戊酸光动力疗法治疗难治性尖锐湿疣,可有效降低复发及不良反应发生率,临床疗效显著,有利于患者的伤口愈合、结痂及HPV清除,值得在临床上推广。     

光动力疗法联合咪喹莫特对尖锐湿疣复发的影响

目的研究5-氨基酮戊酸光动力疗法联合咪喹莫特治疗尖锐湿疣的临床效果。方法选择2016年1月—2017年10月在我院皮肤科进行诊治的61例尖锐湿疣患者,随机分为2组。对照组单纯给予5-氨基酮戊酸光动力疗法,观察组联合于皮损部位涂抹5%咪喹莫特软膏。治疗3周后,比较2组的临床治愈率、复发率以及免疫功能。结果观察组的复发率为明显低于对照组(P0.05),观察组的治愈率明显高于对照组(P0.05);治疗后,2组的CD~+4、CD~+3以及CD~+4/CD~+8均明显升高,且观察组更为明显(P0.05)。结论 5-氨基酮戊酸光动力疗法联合咪喹莫特治疗尖锐湿疣的临床效果明显优于单纯使用5-氨基酮戊酸光动力疗法,可以有效降低复发率,改善免疫功能,并具有较高的安全性。     

中药联合5-氨基酮戊酸光动力疗法和CO2激光治疗女性尖锐湿疣的疗效观察

目的：观察中药联合5-氨基酮戊酸光动力疗法和CO2激光术治疗女性尖锐湿疣患者的临床疗效。方法：80例女性尖锐湿疣患者随机分为两组,对照组行CO2激光术和5-氨基酮戊酸光动力治疗,治疗组在对照组的基础上再联合中药汤剂内服外用治疗。治疗结束后3个月观察疗效和复发率。结果：对照组痊愈率75％,复发率25％;治疗组治愈率92．5％,复发率7．5％,两组痊愈率比较有统计学意义（P〈0．05）,复发率比较差异亦有统计学意义（P〈0．05）。结论：中药联合5-氨基酮戊酸光动力和CO2激光术治疗可提高女性尖锐湿疣患者的临床治愈率,降低其复发率。     

三种方法综合治疗肛管尖锐湿疣的疗效观察

目的分析三种方法综合治疗肛管尖锐湿疣的治疗效果。方法选取本院2016年8月至2018年7月间收治的80例肛管尖锐湿疣患者,随机分为观察组和对照组,每组各40例。对照组采用CO_2激光联合5-氨基酮戊酸光动力治疗,观察组在对照组治疗基础上再给予卡介菌多糖核酸注射液肌注治疗。记录两组在光动力治疗后第4周、第12周及第24周的疣体复发情况,并于第24周比较两组疗效及不良反应。结果在光动力治疗后第24周观察组患者复发率小于对照组,差异具有统计学意义(P 0.05)。结论肛管尖锐湿疣患者采取CO_2激光联合5-氨基酮戊酸光动力及肌注卡介菌多糖核酸注射液治疗临床效果良好,复发率较低且安全性良好,具有一定临床价值,值得推广应用。     

电离子联合ALA-PDT治疗尖锐湿疣临床效果分析

目的:探讨高频电子灼烧联合5-氨基酮戊酸光动力疗法(ALA-PDT)治疗尖锐湿疣的临床效果。方法:选取2015年6月至2016年6月在我院确诊治疗的尖锐湿疣患者80例为观察对象,随机分为两组,每组40人,一组使用高频电子灼烧联合5-氨基酮戊酸光动力(ALA-PDT)治疗方案(联合组),另一组采用单纯高频电离子灼烧治疗方案(电离子组),并对两组患者临床治疗效果进行分析。结果:治疗半年后,联合组PCR阴性率为62.50%,高于电离子组(χ~2=8.498,P=0.004);两组患者治疗前症状积分无差别,治疗半年后,联合组患者症状较电离子组明显改善;两组患者治疗前的炎症细胞因子水平无明显差别,治疗半年后,联合组IL-6、hs-CRP和TNF-α等水平低于电离子组(P0.05)。结论:电离子联合ALAPDT治疗尖锐湿疣效果优于单纯使用高频电子灼烧治疗尖锐湿疣。     

Combination effect of photodynamic and sonodynamic therapy on experimental skin squamous cell carcinoma in C3H/HeN mice

We studied a combination of photodynamic therapy (PDT) and sonodynamic therapy (SDT) for improving tumoricidal effects in a transplantable mouse squamous cell carcinoma (SCC) model. Two sensitizers were utilized: the pheophorbide-a derivative PH-1126, which is a newly developed photosensitizer, and the gallium porphyrin analogue ATX-70, a commonly used sonosensitizer. Mice were injected with either PH-1126 or ATX-70 i.p. at doses of 5 or 10 mg/kg.bw. At 24 (ATX-70) or 36 hr (PH-1126) (time of optimum drug concentration in the tumor) after injection, SCCs underwent laser light irradiation (88 J/cm2 of 575 nm for ATX-70; 44J/cm2 of 650 nm for PH-1126) (PDT), ultrasound irradiation (0.51 W/cm2 at 1.0 MHz for 10 minutes) (SDT), or a combination of the two treatments. The combination of PDT and SDT using either PH-1126 or ATX-70 as a sensitizer resulted in significantly improved inhibition of tumor growth (92-98%) (additive effect) as compared to either single treatment (27-77%). The combination using PH-1126 resulted in 25% of the treated mice being tumor free at 20 days after treatment. Moreover, the median survival period (from irradiation to death) of PDT + SDT-treated mice (> 120 days) was significantly greater than that in single treatment groups (77-95 days). Histological changes revealed that combination therapy could induce tumor necrosis 2-3 times as deep as in either of the single modalities. The combination of PDT and SDT could be very useful for treatment of non-superficial or nodular tumors.     

Which adjuvant treatment for patients with BRAFV600-mutant cutaneous melanoma?

Treatment of patients with melanoma has considerably improved over the past decade and more recently with adjuvant therapies for patients with American Joint Committee on Cancer (AJCC) stage III (loco-regional metastases) or IV (distant metastases) totally resected melanoma, in order to prevent recurrence. In the adjuvant setting, two options are available to patients with BRAF^V600-mutant AJCC stage III totally resected melanoma: anti-PD-1 blockers (nivolumab or pembrolizumab) or BRAF plus MEK inhibitors (dabrafenib plus trametinib). In the absence of comparative studies, it is difficult to determine which of these options is best. Our aim was to review published studies focusing on the management of patients with BRAF^V600-mutant melanoma in the adjuvant setting. We also reviewed the main clinical trials of BRAF plus MEK inhibitors and immunotherapy in advanced (i.e. unresectable metastatic) BRAF-mutant melanoma in an attempt to identify results potentially affecting the management of patients on adjuvants. More adverse events are observed with targeted therapy, but all resolve rapidly upon drug discontinuation, whereas with immune checkpoint blockers some adverse events may persist. New therapeutic strategies are emerging, notably neoadjuvant therapies for stage III patients and adjuvant therapies for stage II patients; the place of the adjuvant strategy amidst all these options will soon be re-evaluated. The choice of adjuvant treatment could influence the choice of subsequent treatments in neo-adjuvant or metastatic settings. This review will lead clinicians to a better understanding of the different adjuvant treatments available for patients with totally resected AJCC stage III and IV BRAF^V600-mutant melanoma before considering subsequent treatment strategies.     

Phototherapy

Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.     

Therapeutic principles in vulvovaginal dermatology

The diagnosis and management of chronic vulvovaginal disease requires attention to several issues. Psychological factors are usually important, because women worry about malignancy, impaired sexuality and self-image, fertility, and sexually transmitted diseases. Multifactorial processes are common due to the risk of secondary candidiasis, contact dermatitis, effects of low estrogen in postmenopausal women and women on oral contraceptives, and so forth. Undertreatment of inflammatory dermatoses is common, because clinicians use topical corticosteroids that are of inadequate potency and for insufficient duration. All of these issues must be considered for optimal benefit in the therapy of chronic vulvovaginal diseases.     

生物共振治疗慢性荨麻疹疗效分析

目的探讨生物共振治疗系统治疗慢性荨麻疹的临床疗效及安全性。方法将患者随机分为3组,治疗组61例,采用生物共振治疗系统进行脱敏治疗;对照组59例口服咪唑斯汀(皿治林)10mg,qd,连续用3周;联合治疗组32例,采用生物共振治疗系统脱敏治疗同时加口服咪唑斯汀(皿治林)10mg,qd,连用3周。结果3组治疗有效率比较差异有显著性(P<0.05),其中联合治疗组与治疗组及对照组比较均有显著差异(P<0.05),治疗组与对照组比较无显著性差异(P>0.05)。3组复发率比较差异有显著性(P<0.001)。结论生物共振技术治疗慢性荨麻疹有一定的疗效和安全性,且复发率低,尤其联合治疗可提高疗效。     

生物制剂在系统性红斑狼疮和银屑病的应用

自第一个生物制剂用于治疗类风湿关节以来已14年。生物制剂同传统的皮质类固醇激素及免疫抑制剂相比,最大的优点在于它们能够选择性地抑制自身反应的淋巴细胞,对机体正常免疫功能没有明显损害,副作用明显降低,具有广阔的临床应用前景。生物制剂目前在风湿免疫科应用较广泛,近年在皮肤科也逐步开始应用,本文就以下几类生物制剂：1.细胞因子相关生物制剂;2.针对B细胞的生物制剂; 3. 改变T、B 细胞相互作用的生物制剂; 4.与免疫耐受相关的生物制剂; 5.补体抑制剂等的特点,治疗有关疾病的情况,存在的问题进行综述。     

“性瘾”治疗的评述

本文对西方的＂性瘾＂的治疗进行了全面的评述,介绍了性瘾治疗中的个体疗法、团体疗法、婚姻家庭疗法以及其它疗法。这是国内第一次全面、详尽地介绍西方性瘾的治疗,将有助于推进国内的性瘾研究与治疗。     

New treatment options for onychomycosis

Abstract

Onychomycosis is the most common nail disorder. The causative pathogens are not only dermatophytes in the majority of cases (Trichophyton rubrum and T. mentagrophytes), but also yeasts of the genus Candida and molds. A wide variety of topical antifungal agents are proposed for first-line treatment of superficial onychomycosis, when the matrix is not involved. New treatment options using light were recently introduced, such as thermal lasers, non-thermal lasers, and photodynamic therapy. For thermal lasers, a temperature increase in the nail of around 50°C seems to be a prerequisite for success. For non-thermal lasers, the clinical data are very debatable and their mechanism of action still remains mysterious. For photodynamic therapy, 5-aminolevulinic acid is used. The therapy consists of exciting protoporphyrin IX with red light that penetrates relatively deeply. Further clinical studies of larger series of patients and with longer follow-up are still needed to reach a definitive conclusion on the value of these devices.