人工股骨头置换术结合快速康复理念治疗高龄不稳定型股骨转子间骨折的临床效果

目的探讨人工股骨头置换术结合快速康复理念治疗高龄不稳定型股骨转子间骨折的疗效。 方法选取赤峰市医院骨关节科2016年4月至2017年9月股骨转子间骨折患者90例,按随机数字表法分为两组,快速康复组46例,遵循围手术期循证医学证据,严格执行快速康复程序;对照组44例,沿袭传统手术管理模式。比较两组患者术后早期疼痛数字分级评分法(NRS)评分,术后输血率,恶心、呕吐发生率,口渴、饥饿、腹胀发生率,住院时间,术后2周的满意度评分,术后3个月髋关节功能Harris评分,术后并发症发生率等。对数据比较采用t检验和χ²检验。 结果术后12、24、48 h,快速康复组患者早期疼痛NRS评分分别为(3.23±1.32)、(2.42±1.51)、(1.53±1.12)分,低于对照组[ (4.40±1.52)、(3.62±1.41)、(2.43±1.22)分],差异均有统计学意义(t＝ 3.9039、3.8924、3.6481,P＝ 0.0002、0.0002、0.0004);快速康复组患者术后输血率15.2%(5/46),低于对照组[47.7%(21/44)],差异有统计学意义(χ²＝9.6251,P＝0.0019);快速康复组患者术后恶心、呕吐发生率为10.9%(5/46),低于对照组[34.1%(15/44)],差异有统计学意义(χ²＝5.7370,P＝0.0166);快速康复组术后口渴、饥饿、腹胀发生率为13.0%(6/46),低于对照组[40.9%(18/44)],差异有统计学意义(χ²＝7.5616,P＝0.0060);快速康复组患者住院时间为(4.3±1.1) d,少于对照组[(6.8±1.7) d],差异有统计学意义(t＝8.3191,P<0.05);快速康复组患者术后2周的满意度评分为(9.6±1.2)分,高于对照组[(8.8±1.6)分],差异有统计学意义(t＝2.6912,P＝0.0085);快速康复组、对照组患者术后3个月髋关节功能Harris评分分别为(89.2±12.3)、(88.5±11.6)分,两组比较差异无统计学意义(t＝0.2775,P＝0.7821);快速康复组患者术后并发症发生率2.2%(1/46),低于对照组[18.2%(8/44)],差异有统计学意义(χ²＝4.7480,P＝0.0293)。 结论采用人工股骨头置换术结合快速康复理念治疗高龄股骨转子间骨折,可缩短患者住院时间,使患者快速恢复日常活动,提高患者满意度,是一种安全可靠的选择。     

糖尿病足神经性溃疡患者中Charcot足高危人群的识别

目的从糖尿病足神经性溃疡患者中识别可能发展为Charcot足的高危人群。方法回顾性分析比较解放军空军总医院2008年6月至2013年6月期间诊断的20例糖尿病Charcot足患者(CN组)与2010年1月至2011年12月住院诊断糖尿病足单发神经性溃疡且随访至2014年6月无足部畸形改变的58例患者(NU组)的一般情况、检查和化验指标、糖尿病慢性合并症、并发症情况、糖尿病足溃疡分布、足部放射线平片特点。结果 (1)2组患者平均年龄、性别比例、吸烟者比例、BMI、Hb A1c、血脂4项、足背动脉直径以及糖尿病肾病(Ⅲ~Ⅳ期)、慢性肾脏疾病3期以上、糖尿病视网膜增殖期病变、冠心病的患病率之间比较,差异无统计学意义(P0.05)。2组足部创面均环绕胼胝。(2)CN组单身多,与NU组相比:糖尿病病程短、双足出现麻木感时间长、血管无明显狭窄和硬化、反复糖尿病足溃疡患病率多,更多患者合并糖尿病自主神经病变,合并高血压者较少,差异有统计学意义(P0.05)。CN组创面以中足为多(89.48%),足放射线平片示骨质疏松,关节破坏、紊乱、脱位或半脱位,截肢率较NU组高(P0.05);NU组创面以前足为主,足放射线平片多表现为跖趾关节周围局部骨质溶骨性破坏。NU足平片更多见软组织内血管钙化影,与CN组比较差异有统计学意义(P0.05)。结论糖尿病NU患者中血糖升高后较早出现足部感觉减退的中年患者,没有足部缺血表现,合并糖尿病自主神经病变和反复足部溃疡病史者,为出现糖尿病Charcot足的高危人群。进行足底压力缓解相关治疗,预防糖尿病Charcot足出现。     

人工全膝关节置换术结合加速康复外科理念治疗膝关节骨关节炎的临床效果

探讨人工全膝关节置换术(TKA)结合加速康复外科(ERAS)理念治疗膝关节骨关节炎(KOA)的疗效。 方法选取赤峰市医院骨关节科2018年1月至11月收治的KOA患者220例,按随机数字表法分为2组,加速康复组(n＝108),遵循围手术期应用ERAS理念,严格执行加速康复程序;对照组(n＝112),沿袭传统手术管理模式。制定相同的出院标准,比较2组患者术后早期疼痛数字评分法(NRS)评分,术后输血率,恶心、呕吐发生率,口渴、饥饿发生率,达到出院标准的时间,术后2周的满意度评分,术后3个月美国特种外科医院(HSS)膝关节评分,术后并发症发生率等。数据比较采用t检验和χ²检验。 结果术后12、24、48 h,加速康复组术后早期疼痛NRS评分分别为(2.13±1.21)、(2.42±1.11)、(2.83±1.18)分,低于对照组[(3.24±1.45)、(3.35±1.23)、(3.78±1.25)分],差异均有统计学意义(t＝3.9498、3.7689、3.7088,P＝0.0002、0.0003、0.0004);加速康复组术后输血率6.5%(7/108),低于对照组[27.7%(31/112)],差异有统计学意义(χ²＝17.2887,P<0.05);加速康复组术后恶心、呕吐发生率为14.8%(16/108),低于对照组[38.4%(43/112)],差异有统计学意义(χ²＝15.5741,P<0.05);加速康复组术后口渴、饥饿发生率为12.0%(13/108),低于对照组[41.1%(46/112)],差异有统计学意义(χ²＝23.6163,P<0.05);加速康复组达到出院标准的时间平均为(2.9±1.3) d,少于对照组[(5.7±1.6) d],差异有统计学意义(t＝9.1301,P<0.05);加速康复组术后2周的满意度评分为(9.8±1.2)分,高于对照组[(8.9±1.1)分],差异有统计学意义(t＝3.7042,P<0.05);加速康复组、对照组术后3个月HSS膝关节评分分别为(88.2±13.2)、(87.7±16.6)分,2组比较差异无统计学意义(t＝0.1585,P＝0.8744);加速康复组并发症发生率为2.7%(3/108),低于对照组[9.8%(10/112)],差异有统计学意义(t＝4.5779,P＝0.0324)。 结论采用人工TKA结合ERAS理念治疗KOA,可以减轻术后应激反应,加速患者康复进程,减少手术并发症,缩短住院时间,提高患者满意度,是一种安全、可靠的选择,值得临床推广应用。     

护理质量敏感性指标在糖尿病足创面患者护理中的应用

目的探讨护理质量敏感性指标在糖尿病足创面患者护理中的应用。 方法选择2016年6月至2020年12月北京市职业病防治研究院(北京市化工职业病防治院)收治的糖尿病足创面患者108例，按照随机数字表法将患者分为观察组和对照组，每组各54例。对照组进行常规护理，即监测生命体征、根据医嘱监测血糖、用药指导及健康教育等。观察组在常规护理的基础上，成立护理干预小组，于入院时、术前、术中、术后对患者进行身体及心理评估，根据评估结果制定护理质量敏感性指标和个体护理方案。术前根据对患者的评估结果，告知患者及家属治疗、护理的相关内容，及时发现并纠正其错误认知，消除紧张情绪，使其积极配合手术。术中严密观察患者各项指标变化及足部末端出血情况，及时告知手术医师，采取相应的治疗措施。术后评估患者创面疼痛、术后出血情况及自理程度；根据病情给予患者正确体位，指导患者进行足部屈伸运动；严密监测患者各项指标，并详细记录；观察患者患肢远端血运情况；根据患者的心理状态，给予心理干预措施，消除其恐惧心理，观察下肢足创面恢复情况，给予预防护理措施。出院时对患者进行用药指导，交待其出院后注意事项，定期进行电话随访。采用护理质量敏感性指标中的结果性指标进行评价，统计2组患者的创面愈合时间、入院时及出院时的空腹血糖值、满意的患者例数、护理不良事件发生率、日常生活活动能力评估量表评分。数据比较采用t检验和χ²检验。 结果观察组平均创面愈合时间为(21.4±1.8) d，明显少于对照组[(29.1±1.8) d]，2组比较差异有统计学意义(t＝20.234，P<0.05)；观察组出院时空腹血糖为(6.73±0.32) mmol/L，较入院时[(11.47±0.61) mmol/L]明显降低，且低于对照组[(7.96±0.82) mmol/L]，差异均有统计学意义(t＝10.14、108.02，P<0.05)；观察组满意患者比例为96.3%(52/54)，明显优于对照组[77.8%(42/52)]，差异有统计学意义(χ²＝14.63，P<0.05)；观察组护理不良事件发生率为7.40%(4/54)，低于对照组[18.51%(10/54)]，2组比较差异无统计学意义(P>0.05)。入院时观察组和对照组患者日常生活活动能力评估量表评分分别为(92.13±2.50)、(91.25±2.19)分，2组比较差异无统计学意义(P>0.05)，出院时2组日常生活活动能力评估量表评分分别为(98.63±1.21)、(92.75±2.91)分，较入院时均有所提高，差异均有统计学意义(t＝14.581、4.088，P<0.05)，且观察组评分高于对照组，差异有统计学意义(t＝9.945，P<0.05)。 结论基于护理质量敏感性指标的护理干预可以明显优化护理效果，提高患者满意度，减少护理不良事件发生率。     

多元化护理干预对游离皮瓣移植修复皮肤缺损围手术期临床效果的影响

目的探讨多元化护理干预对游离皮瓣移植修复皮肤缺损围手术期临床效果的影响。 方法回顾性分析2018年5月至2019年4月在空军军医大学西京医院烧伤与皮肤外科实施游离皮瓣移植修复皮肤缺损的60例符合入选标准的患者的病例资料。根据当时的医疗模式，将2018年5月至10月收治的30例接受常规护理的患者设为常规护理组，将2018年11月至2019年4月收治的30例实施多元化护理干预措施的患者设为多元化护理干预组。常规护理组术前调控手术室内温度在22～25 ℃，术中使用保温箱预热液体，设置温度40 ℃，待皮瓣切下后用温的0.9%氯化钠溶液冲洗皮瓣，术中及时加盖无菌中单，术后观察皮瓣血运。多元化护理干预组主要通过围手术期有计划地对患者加强心理干预、术前温度的控制、术中保温、规范术后观察皮瓣血运时间，规范观察皮瓣血运及皮瓣弹性指标、皮瓣温度监测6个方面并进行干预。比较2组患者术后10 d皮瓣血管危象总发生率、皮瓣成活率及术后患者满意度，对数据行χ²检验。 结果术后10 d，多元化护理干预组血管危象总发生率6%(2/30)，低于常规护理组的血管危象总发生率16.6%(5/30)，2组比较差异有统计学意义(χ²＝0.647，P＝0.042)。多元化护理干预组皮瓣成活率96.6%(29/30)，常规护理组皮瓣成活率86.6%(26/30)，2组比较差异有统计学意义(χ²＝0.837，P＝0.035)。多元化护理干预组患者满意度96.6%(29/30)，常规护理组患者满意度76.6%(23/30)，2组比较差异有统计学意义(χ²＝4.482，P＝0.047)。 结论多元化护理干预游离皮瓣移植修复皮肤缺损围手术期效果显著，可有效减少血管危象发生，大幅度提升皮瓣成活率，值得临床大力推广。     

上皮膜蛋白1在浆液性卵巢癌中的表达及临床意义

目的 探讨上皮膜蛋白1(EMP1)在浆液性卵巢癌(SOC)中的表达及其临床意义。方法 采用免疫组化法检测EMP1蛋白在306例SOC组织和85例正常卵巢组织中的表达情况，利用χ²检验比较不同EMP1蛋白表达水平的SOC患者临床病理特征的差异，应用Kaplan-Meier法分析EMP1蛋白表达水平与患者预后的关系。结果 SOC组织EMP1蛋白高表达率为42.8%显著高于正常卵巢组织的12.9%(χ²=25.661,P<0.001)。EMP1蛋白高表达与淋巴结转移(χ²=14.251,P<0.001)和高FIGO分期(χ²=6.954,P=0.008)呈正相关。EMP1蛋白高表达的SOC患者总生存率(χ²=14.574,P<0.001)和无进展生存率(χ²=4.683,P=0.031)均较低表达者降低。结论 EMP1蛋白在SOC组织中呈高表达，其表达水平上调与淋巴结转移和高FIGO分期相关，且可预测SOC患者预后不良。提示EMP1可能成为一个...     

吉林省双胎先天性心脏病发生情况及临床特征分析

目的 分析2017—2021年吉林省单胎儿与双胎儿先天性心脏病(CHD)的发生情况，为更深层次了解双胎CHD问题提供参考。方法 回顾性分析2017—2021年吉林省出生缺陷上报系统发现的CHD患儿，分析单胎与双胎CHD的发生情况及临床特征。采用SPSS软件进行统计学分析，组间比较采用χ²检验。结果 2017—2021年吉林省CHD发生率为3.33‰，单胎和双胎CHD发生率分别为3.04‰和27.04‰，单胎与双胎CHD发生率差异有统计学意义(χ²=1236.06,P=0.000)。CHD类型中单纯心血管间交通发生率最高(2.49‰)，其次依次为合并畸形(0.52‰)、复杂畸形(0.13‰)、心脏瓣膜畸形(0.10‰)等。双胎CHD早产发生率和低出生体质量发生率均高于单胎，产前确诊率低于单胎(χ²=69.36,P=0.000；χ²=71.05,P=0.000；χ²=21.89,P=0.000)。结论 应重视双胎孕产妇的产前筛查、产前诊断管理，加强对双胎CHD胎儿孕产妇产期及胎儿发...     

单中心前瞻性研究囊性变对早期股骨头坏死微创保髋手术后疗效的影响

目的观察囊性变是否影响早期股骨头坏死(ONFH)保髋手术后的疗效。 方法前瞻性临床随访观察2017年6月至2020年11月航空总医院收治的早期ONFH的患者病历资料。根据术前影像学(CT与MRI)评估结果分组,其中股骨头内有囊性变的患者设为囊性变组,共32例患者37髋;股骨头内不存在囊性变的患者设为非囊性变组,共50例患者59髋。所有患者均采用经大粗隆单一入路双孔道减压植骨+结构性骨支撑微创保髋手术,通过内下通道对股骨头坏死内下区域进行减压植骨,经外上通道对股骨头坏死外上区域进行减压植骨+结构性骨支撑。术后3、6、12个月及之后每年进行1次随访,以最终行髋关节置换术即认为手术失败随访终止,术前和末次随访数据纳入研究进行数据分析。采用Harris髋关节评分对髋关节的功能进行评估;比较2组患者髋关节功能评分、优良率以及不同分型患者(C+L1型、L2+L3型)髋关节功能评分;比较2组患者影像学进展率、失败率。所有纳入研究的患者术前与随访时均行髋关节正侧位X线、CT检查,术后影像学评估如股骨头无塌陷或原有塌陷无加重即认为影像学稳定,如发生软骨下骨折或塌陷加重即认为影像学进展。以最终行髋关节置换即认为手术失败。数据行Wilcoxon符号秩检验、χ²检验,采用Kaplan-Meier方法进行生存分析。 结果所有患者均纳入研究,平均随访(30.6±8.6)个月。囊性变组患者末次随访时的Harris髋关节评分为(82.43±16.36)分,较术前[(75.67±13.43)分]明显提高,差异有统计学意义(P＝0.022);优良率由术前的37.84%(14/37)提高到62.16%(23/37),差异有统计学意义(χ²＝4.378,P<0.05)。非囊性变组患者末次随访时的Harris髋关节评分为(81.76±17.68)分,较术前[(82.90±12.77)分]无明显变化,差异无统计学意义(P＝0.965);优良率由术前的55.93%(33/59)提高到62.71%(37/59),差异无统计学意义(χ²＝0.562,P>0.05)。术前囊性变组患者Harris髋关节评分明显低于非囊性变组,差异有统计学意义(P＝0.021),末次随访时,囊性变组与非囊性变组的Harris髋关节评分比较,差异无统计学意义(P＝0.778)。囊性变组C+L1型患者Harris髋关节评分术前与末次随访时比较差异无统计学意义(P＝0.417);L2+L3型患者Harris髋关节评分术前明显低于末次随访时,差异有统计学意义(P＝0.040)。非囊性变组C+L1型患者Harris髋关节评分术前与末次随访时比较差异无统计学意义(P＝0.088);L2+L3型患者Harris髋关节评分术前与末次随访时比较差异无统计学意义(P＝0.189)。术前,囊性变组C+L1型患者Harris髋关节评分明显低于非囊性变组C+L1型患者,差异有统计学意义(P＝0.022);末次随访时,2组中C+L1型患者Harris髋关节评分比较差异无统计学意义(P＝0.335)。术前,囊性变组L2+L3型患者Harris髋关节评分与非囊性变组L2+L3型患者比较差异无统计学意义(P＝0.261),末次随访时2组中L2+L3型患者Harris髋关节评分比较差异无统计学意义(P＝0.323)。末次随访时,囊性变组患者的影像学进展率为27.03%(10/37),非囊性变组为22.03%(13/59),比较差异无统计学意义(χ²＝0.311,P＝0.577);囊性变组C+L1型患者影像学进展率38.46%(5/13)高于非囊性变组C+L1型患者[4.76%(1/21)],差异有统计学意义(χ²＝4.170,P＝0.019),而囊性变组、非囊性变组L2+L3型患者影像学进展率分别为20.83%(5/24)、32.43%(12/37),比较差异无统计学意义(χ²＝0.974,P＝0.324)。末次随访时囊性变组失败率为13.51%(5/37),非囊性变组失败率为11.86%(7/59),比较差异无统计学意义(χ²＝0.000,P>0.05)。Kaplan-Meier生存曲线示,2组总体生存曲线进展平缓,未表现出明显的与临床失败相关的时间界。 结论股骨头囊性变区域可能对ARCOII期或C+L1型的ONFH患者的髋关节功能和影像学进展有一定影响,但是不建议作为影响早期ONFH保髋手术预后的危险因素。     

染色体核型分析与单核苷酸多态性微阵列检测在高危孕妇产前诊断的应用

目的探讨染色体核型分析及单核苷酸多态性微阵列(single nucleotide polymorphism array,SNP-array)技术对于高危因素孕妇产前诊断的价值。方法选取2018年1月至2019年12月于本院产前诊断中心就诊的高危孕妇1660例,于孕中期行羊水穿刺,对羊水细胞同时行染色体核型分析及SNP-array检测。比较高危因素(高龄、超声异常、不良孕史、夫妇染色体异常、血清学筛查高风险、无创产前基因检测)两种方法的检出情况。结果所有标本均成功检测。染色体核型分析发现致病性核型135例,检出率为8.13%(135/1660),SNP-array致病性拷贝数变异(copy number variations,CNVs)检出率为9.04%(150/1660),两种方法异常染色体检出率差异有统计学意义(χ²=9.33,P<0.01)。比较合并两项及以上高危因素和单项高危因素的致病性CNVs检出率差异有统计学意义(P<0.05)。当合并两项及以上高危因素时SNP-array致病性CNVs高于传统染色体核型分析的异常核型检出率(χ²=5.14,P<0.05)。结论SNP-array可增加高危孕妇染色体致病性CNVs检出率,结合染色体核型分析可互补检出平衡易位及低比例嵌合体等,以减少遗传病患儿的漏诊,降低出生缺陷。     

北京市某三甲医院创面修复专科病区5年间糖尿病足住院病例回顾性分析

目的回顾性调查解放军总医院第四医学中心烧伤整形三科暨创面修复中心糖尿病足住院病例的相关诊疗信息,分析其临床特点,为临床治疗提供一定参考。 方法回顾性分析2014年1月1日至2018年12月31日解放军总医院第四医学中心烧伤整形三科暨创面修复中心收治的糖尿病足住院患者资料。统计患者基本资料、病程、创面信息、治疗方式和结局。描述糖尿病足住院患者流行病学特征,比较性别、病程、治疗方式等因素对创面细菌感染、治疗效果的影响。 结果最终纳入研究505例患者,男321例,女184例。(1)患者平均年龄(64.112.9)岁,61~70岁年龄段患者最多(157例,31.1%),女性患者年龄高于男性患者(F＝22.532,P<0.001)。(2)入组患者均合并慢性基础性疾病。其中,下肢动脉粥样硬化381例(75.45%),高血压病318例(62.97%),冠状动脉粥样硬化性心脏病168例(33.27%),陈旧性脑梗死150例(29.70%)。(3)急性创面119例,慢性创面386例。(4)患者溃疡最常见的发病部位依次为足趾(48.9%)、足底(16.2%)、足背(14.7%)、足踝(11.1%)、足跟(9.1%)。(5)160例糖尿病足溃疡患者行创面微生物学检查,其中135例(84.38%)为阳性,急性创面多以革兰氏阳性菌感染为主,慢性创面多以革兰氏阴性菌感染为主(χ²＝7.860,P<0.05)。(6)301例患者行外科手术治疗,67例患者行单纯负压吸引治疗,137例患者行单纯换药治疗,165例(32.67%)患者治愈,268例(53.07%)患者好转,71例(14.06%)患者未愈,1例(0.198%)患者死亡,手术治疗的治愈率显著高于单纯负压吸引、单纯换药治疗(χ²＝135.614,P<0.001)。 结论患病群体主要为中老年,年龄集中在51~70岁,男性患者居多,女性患者年龄高于男性患者。患者多合并慢性基础性疾病,需重视基础疾病的治疗。创面常见发病部位为足趾、足底、足背、足踝、足跟。创面合并微生物感染率非常高,抗感染治疗要及时、合理。相比单纯负压吸引、单纯换药治疗,手术治疗的治愈率更高。     

Prevalence and patient's consciousness of tinea pedis and onychomycosis]

Epidemiological studies on tinea pedis and onychomycosis have been performed across Europe and East Asia. The prevalence of these conditions was 20%, respectively, and it increased with advancing age, more men than women had fungal infection of the feet. The prevalent predisposing factors were sports participation, average temperature, and family history of tinea pedis. The predisposing diseases were hypercholesterolemia, cardiovascular disease, diabetes mellitus, and osteoarticular disease. We conducted an epidemiological investigation to determine the prevalence and circumstances of untreated and unsuspected tinea pedis and onychomycosis. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as past history of tinea pedis and/or onychomycosis, age, disposition of toes, and predisposing disease, as well as the type of shoes worn daily. We suspected that a patient's local and systemic conditions affected each other, creating good conditions for tinea pedis and onychomycosis so that the prevalence has increased. More understanding of occult athlete's foot will lead to prevention and improvement in treatment and diagnosis.     

Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain

This study prospectively evaluated the prevalence and risk factors of tinea unguium and tinea pedis in the general adult population in Madrid, Spain. One thousand subjects were clinically examined, and samples of nails and scales from the interdigital spaces of the feet were taken from those patients presenting with signs or symptoms of onychomycosis and/or tinea pedis, respectively. In addition, a sample from the fourth interdigital space of both feet was collected from all individuals with a piece of sterilized wool carpet. Tinea unguium was defined as a positive direct examination with potassium hydroxide and culture of the etiological agent from subjects with clinically abnormal nails. Patients with positive dermatophyte cultures of foot specimens were considered to have tinea pedis. The prevalence of tinea unguium was 2.8% (4.0% for men and 1.7% for women), and the prevalence of tinea pedis was 2.9% (4.2% for men and 1.7% for women). The etiological agents of tinea unguium were identified as Trichopyton rubrum (82.1%), followed by Trichopyton mentagrophytes var. interdigitale (14.3%) and Trichopyton tonsurans (3.5%). Trichophyton rubrum (44.8%) and Trichophyton mentagrophytes (44.8%), followed by Epidermophyton floccosum (7%) and T. tonsurans (3.4%), were the organisms isolated from patients with tinea pedis. The percentage of subjects who suffered simultaneously from both diseases was 1.1% (1.7% for men and 0.6% for women). In a multivariate logistic regression analysis, age (relative risk [RR], 1.03) and gender (RR, 2.50) were independent risk factors for tinea unguium, while only gender (RR, 2.65) was predictive for the occurrence of tinea pedis. In both analyses, the presence of one of the two conditions was associated with a higher risk for the appearance of the other disease (RR, >25).     

1997 Epidemiological survey of dermatophytoses in Japan]

An epidemiological investigation on dermatophytoses in Japan for the year 1997 was carried out with the following results. The number of dermatomycoses patients visiting the fourteen cooperating institutes that year was 8,284. New outpatients with this condition accounted for 13.3% of all new outpatients in these institutes. Dermatophytoses patients numbered 7,314 and were composed of: tinea pedis 4,901 (63.8%), tinea unguium 1,592 (20.7%), tinea corporis 557 (7.2%), tinea cruris 395 (5.1%), tinea manuum 215 (2.8%), tinea capitis 12, kerion celsi 3, tinea barbae 1 and granuloma trichophyticum 1. Of these, 117 were children under 15 years of age. Species and incidences of the 2,273 strains isolated from the patients with dermatophytoses were as follows: Trichophyton (T.) rubrum 1,628 (71.6%), T. mentagrophytes 617 (27.2%), Epidermophyton floccosum 9 (0.4%), Microsporum (M.) canis 2, M. gypseum 2, T. glabrum 1, and 15 undetermined strains. Candidiasis was found in 714 individuals: intertrigo 302, erosio interdigitalis 108, erythema infantum 85, oral candidiasis 51, paronychia et onychia 51, genital candidiasis 50, onychomycosis 15 and other atypical forms of candidiasis 39. Patients with tinea versicolor numbered 242 and those with malassezia folliculitis 15. There were nine cases of deep dermal mycoses. The results of superficial dermatophytoses for the year 1997 differed from those of 1991-92 in the following points: tinea corporis and tinea cruris were lower in number, while tinea unguium had increased in ratio and number continuously. M. canis infection tended to decrease. In the age distribution of tinea, in every clinical form the peak of distribution curve gradually shifted to a more elderly age group.     

Superficial fungal infections seen at the National Skin Centre, Singapore.

Cutaneous fungal infections are common in Singapore. The National Skin Centre is a tertiary referral centre for dermatological diseases in the country, and sees more than 2,500 cases of superficial fungal infections annually. AIM: This study analyses data collated from the centre's medical record office as well as fungal culture results from the mycology laboratory. RESULTS: From 1999 to 2003, there were a total of 12,903 cases of superficial fungal infections seen at the centre. The majority of patients (n=9335) (72.3%) were males. The most common infection was tinea pedis (n=3516) (27.3%), followed by pityriasis versicolor (n=3249) (25.2%) and tinea cruris (n=1745) (13.5%). Candidal infections were also common (n=1430), the majority of which were cases of candidal intertrigo. There were very few cases of tinea capitis, which is uncommon in Singapore. The number of cases of onychomycosis has shown a rising trend over the past 5 years. Trichophyton rubrum was the most prevalent fungal pathogen isolated from all cases of superficial fungal infections of the skin, except for tinea pedis, where Trichophyton interdigitale was the most frequently isolated organism. Dermatophytes remain the most commonly isolated fungal pathogens isolated in toenail onychomycosis, whilst Candida species accounted for the majority of isolates in fingernail onychomycosis. CONCLUSION: Current epidemiologic trends of superficial fungal infections in Singapore show some similarities to recent studies from the United Kingdom and United States.     

1996 epidemiological survey of dermatophytoses in Japan. Epidemiological Investigation Committee for Human Mycoses in the Japanese Society for Medical Mycology]

An epidemiological investigation on dermatophytoses in Japan for the year 1996 was carried out with the following results. The number of dermatomycoses patients visiting the fifteen cooperating institutes that year was 8,402. New outpatients with this condition accounted for 13.1% of all new outpatients in these institutes. Dermatophytoses patients numbered 7,395 and were composed of: tinea pedis 4,764 (64.4%), tinea unguium 1,487 (20.1%), tinea corporis 558 (7.5%), tinea cruris 369 (5.0%), tinea manuum 195 (2.6%), tinea capitis 11, kerion Celsi 7, tinea barbae 1 and other forms 3. Of these, 113 were children under 15 years of age. Species and incidences of the 2,615 strains isolated from the patients with dermatophytoses were as follows: Trichophyton (T.) rubrum 1,828 (69. 9%), T. mentagrophytes 743 (28.4%) Epidermophyton floccosum 20 (0. 8%), Microsporum (M.) canis 13 (0.5%), M. gypseum 5, T. violaceum 2, and 4 undetermined strains. Candidiasis was found in 722 individuals: intertrigo 299, erosio interdigitalis 95, erythema infantum 89, oral candidiasis 63, paronychia et onychia 56, genital candidiasis 56, onychomycosis 24, chronic mucocutaneous candidiasis 1 and other atypical forms of candidiasis 39. Patients with tinea versicolor numbered 265 and those with Malassezia folliculitis 15. There were five cases of deep dermal mycoses: three of sporotrichosis, one of chromomycosis and one of aspergillosis. The results of superficial dermatophytoses for the year 1996 differed from those of 1991-92 in the following points: Tinea corporis and tinea cruris were lower in number, while tinea unguium had increased in ratio and number. M. canis infection tended to decrease gradually. In the age-distribution of tinea, in every clinical form the peak of distribution curve shifted to a more elderly age group.     

电流感觉阈值对糖尿病足风险的预测研究

目的应用感觉神经定量检测仪检测糖尿病足患者周围感觉神经,探讨电流感觉阈值(CPT)在糖尿病足发生风险的预测价值。方法测定48例糖尿病足(糖尿病足组)及212例未合并足病的糖尿病患者(非糖尿病足组)的正中神经、腓肠神经于2000Hz、250Hz、5Hz的CPT,并检测患者踝肱指数(ABI)及血糖等代谢指标,记录高血压、冠心病等病史及糖尿病并发症情况。结果与非糖尿病足组患者比较,糖尿病足组患者CPT明显升高,其中5Hz(P<0.01)最为明显;糖尿病足组合并高血压、冠心病、脑梗死、糖尿病肾病、糖尿病视网膜病变的发生率均高于非糖尿病足组(P<0.01);糖尿病足组较非糖尿病足组ABI明显降低,在各分度组差异均有统计学意义(P<0.01)。ABI与5HzCPT及250HzCPT均呈负相关(r=-0.454,P<0.01;r=-0.342,P<0.05)。结论糖尿病神经病变的发生与血管病变有关,ABI低、CPT高的患者糖尿病足较单独ABI低的患者糖尿病足发生风险增加,CPT联合ABI较单独检测ABI对于糖尿病足的发生更加有预测价值。     

Seven days of intermittent terbinafine 250 mg treatment in Tinea pedis]

Tinea pedis responds well to topical antifungal therapy, however, relapse of the disease is not uncommon. Long-term application of antifungals is usually necessary to control relapse. We conducted an open trial of a 7 day intermittent course of oral terbinafine treatment at 250 mg/day for plantar type and interdigital type of tinea pedis. Seventy-five patients of plantar type and 49 patients of interdigital tinea pedis were treated with a 7 day course of terbinafine 250 mg/day. Clinical assessments were made at baseline and every 4 weeks. Another 7 day course of the same amount of terbinafine were given depending on the clinical and the mycological response. Of the 75 plantar type tinea pedis with 8 patients excluded, 66 of the remaining 67 (98.5%) were evaluated as cured. Of the 49 interdigital tinea pedis (3 excluded), 43 of 46 patients (93.5%) cured. Relapse of the disease was observed in 4 of 51 patients at 1 year after treatment, 4 of 25 at 2 years, and 2 of 9 at 3 years in the plantar type, and in 4 of 30 at 1 year, 0 of 14 at 2 years, and 0 of 6 at 3 years in the interdigital tinea pedis group. Intermittent terbinafine therapy is thus effective in the treatment of tinea pedis.     

Analysis of dermatophyte flora at a private clinic in Sapporo during the period 1992 to 2001]

Statistical analysis was made of a total of 5530 patients (6798 cases) of dermatophytoses presenting at our private clinic during the period 1992 to 2001. The number of patients and cases represents 8.0% and 9.8% of the entire outpatient population during that time, respectively. Sex ratio (male/female) was 1.5. Among the 6798 dermatophytoses cases, tinea pedis was most frequent (65.8%), followed by tinea unguium (20.7%), tinea cruris (7.2%), tinea corporis (3.9%), tinea manuum (2.4%) and tinea barbae (0.04%). The incidence of tinea unguium increased, whereas that of tinea pedis, tinea cruris, and tinea corporis decreased during this ten year period, and 35.8% of dermatophytoses patients had more than two clinical subtypes simultaneously. Three thousand seven hundred ninety-five dermatophytes were isolated during the survey. : Trichophyton rubrum (TR)(79.4%), Trichophyton mentagrophytes (TM)(19.5%), Microsporum canis (MC)(0.7%), Epidermophyton floccosum (EF) (0.3%), and Microsporum gypseum (MG) (0.1%). Compared with our previous analysis reported for the period 1982 to 1991, the frequency of dermatophytoses increased, especially among aged individuals. Of the clinical subtypes, tinea pedis and tinea unguium were higher, but tinea cruris and tinea corporis were lower, and tinea capitis was not seen in the current survey. Among dermatophytes, TR was increased and other types of fungi were decreased. TR was 4.08 times more common than TM; this ratio is higher than our previous report.     

Dermatophyte flora at the dermatology clinic of Kimitsu Chuo Hospital from 1994 through 1999]

Kimitsu Chuo Hospital is located in the middle of Chiba Prefecture along Tokyo Bay. An epidemiological survey of dermatophytosis was made at the dermatology clinic of the hospital from January 1994 through December 1999. Dermatophytosis patients numbered 2,580 and disease types were composed of: tinea pedis 1,656 (64.2%), tinea unguium 377 (14.6%), tinea corporis 308 (11.9%), tinea cruris 139 (5.4%), tinea manuum 92 (3.6%), tinea capitis 6 (0.2%) and tinea profunda 2 (0.1%). Species frequencies in the 1,610 strains isolated from these patients were as follows: 929 (57.7%) of Trichophyton rubrum, 651 (40.4%) of T. mentagrophytes, 9 (0.6%) of Microsporum gypseum, 8 (0.5%) of M. canis, 8 (0.5%) of Epidermophyton floccosum and 5 (0.3%) of T. violaceum. The ratio of T.R/T.M was 1.43 in all the isolates, and 0.81 in the isolates from tinea pedis. These ratios were lower than those of the epidemiological survey of dermatomycoses in Japan in 1997. T. mentagrophytes was characteristically dominant in this hospital and resulted from a drastic increase in tinea pedis caused by this species in the summer season.     

The diabetic foot in Cameroon

A five-month long study has been conducted in the unit of Endocrinal and Metabolic diseases of the Yaounde Central Hospital, at the National Centre for Diabetes and Hypertension and at the Baptiste d'Eloug-ébé Health Centre. After giving their consent, all diabetic patients were included whether or not they presented with diabetic foot 300 patients were included, 278 suffering from a type 2 diabetes, MIF sex-ratio: 1.2 mean age: 55 +/- 12 years. The global prevalence of the diabetic foot was found to be as high as 13% (n=39), ranging from 25.6% (inpatient) to 11.1 % (outpatients). The mean age for patients presenting with a diabetic foot was 57 +/- 9 years. A type 2 diabetes was diagnosed in 38 of those patients. Most patients had grade 0 (43.6%) or grade 1 (30.8%) lesions, according to the Wagner classification. None presented with grade 5 lesions. A strong correlation between the following risk factors and the evidence of a diabetic foot was noticed, with regard to: an history of foot ulcer (p < 0.0001), a neuropathy revealed by the graduated tuning fork (p < 0.005), foot deformations (p < 0.05), a neuropathy revealed by the monofilament 10-g (p < 0.03). Few patients ever had a foot examination: 14% (n=42). Diabetes mellitus, a non transmissible disease, is a world-wide epidemic, especially in developing countries (Africa, Asia), the diabetic foot being one of the most severe and frequent complication. Its cost is among the highest of the diabetes chronic complications. The struggle against that burden relies upon the prevention (education of patients and care givers, early detection of the lesions) and upon a multidisciplinary approach and treatment. In sub-Saharan Africa and especially in Cameroon, emphasis must be put on education of both patients and care givers.