Randomized controlled trial comparing photodynamic therapy based on methylene blue dye and fluconazole for toenail onychomycosis

Photodynamic therapy (PDT) is a medical modality that uses a combination of visible light and a photosensitive compound in the presence of oxygen. It is widely used to treat non‐melanoma skin cancer; other indications are being investigated, especially onychomycosis. Eighty patients with toenail onychomycosis were enrolled and completed this randomized, parallel, placebo‐controlled study. For 24 weeks, 40 patients (Group A) were treated with one placebo capsule per week and sessions of 2% methylene blue aqueous solution irradiated with light emission diode device (MBLED/PDT) with 18 J/cm²; and another 40 patients (Group B) were treated with 300 mg oral fluconazole per week and sessions of placebo PDT (haematoxylin‐diluted 1 : 10). The use of MBLED/PDT consisted of sessions with an interval of 15 days between each session for 6 months. Microbiological and clinical cure was assessed at 1 and 12 months posttreatment. Group A (MBLED/PDT) patients showed a significant response (p < 0.002) compared with Group B (fluconazole), especially in patients who required nail abrasion (p < 0.001). The MBLED/PDT is safe, effective, and well tolerated; it promotes a favorable outcome with good patient adherence and may be considered as a practical and feasible treatment option for toenail onychomycosis.     

Modulation of ultraviolet (UV) transmission by emollients: relevance to narrowband UVB phototherapy and psoralen plus UVA photochemotherapy

BACKGROUND: Patients with psoriasis undergoing or about to undergo ultraviolet (UV) phototherapy and photochemotherapy often have thick scale on their plaques which can prevent the penetration of UV radiation. Emollients are used to moisturize the skin and to prevent or reduce some of the milder side-effects ('dryness', itching) sometimes experienced during UV therapy. However, emollients can alter the UV transmission of skin and thus may alter the clinical effects of phototherapy and photochemotherapy. OBJECTIVES: We tested 30 of the topical emollients in the British National Formulary (BNF) using a standard in vitro technique used to test sunscreens. We also surveyed U.K. phototherapy units to establish routine practice for emollient use in phototherapy and photochemotherapy. METHODS: We used a standard in vitro technique to measure the monochromatic protection factors (MPFs) of 30 non-bath emollients from the BNF. An application rate of 2 mg cm-2 was used. For the assessment of effects during narrowband UVB (TL-01) phototherapy, the mean of the protection factors at 310 and 315 nm was calculated; for psoralen plus UVA photochemotherapy the mean UVA protection factor was used. A questionnaire survey was used to assess routine practice concerning emollient use prior to phototherapies in phototherapy units throughout the U.K. RESULTS: In the UVA range, 17 of the 30 emollients gave protection factors of 1.2 or above. In the UVB range, 23 of 30 had an MPF of 1.2 or above. Yellow soft paraffin had the highest protection factor in the UVB range. Of 78 centres surveyed, 57 returned completed questionnaires (73%). Seventeen of 57 (30%) centres routinely used emollients immediately prior to administering phototherapy treatments. The remaining 40 of 57 (70%) did not. Forty-five (79%) responding centres recommended the use of emollients after phototherapy. CONCLUSIONS: This study has revealed considerable variability in the practice of emollient use before phototherapy treatments. Although the majority of centres included in this study did not routinely use emollients, almost one third did. Our in vitro measurement of 30 emollients revealed marked variation in UV transmission, with many emollients blocking sufficient UV to affect the response to therapy.     

5-氨基酮戊酸光动力作用对白念珠菌超微结构的影响

目的：观察5‐氨基酮戊酸光动力对白念珠菌细胞超微结构的影响,为研究5‐氨基酮戊酸光动力抗菌的作用机制提供理论基础。方法设置实验组（5‐氨基酮戊酸光动力作用后的白念珠菌组）及对照组,分别在透射电镜下观察2组菌株细胞的超微结构。结果透射电镜下,5‐氨基酮戊酸光动力作用后的白念珠菌细胞肿胀变形,细胞壁、细胞膜结构不完整,细胞壁疏松,细胞膜与细胞壁之间间隙大小不一,部分细胞可见细胞壁棉絮状致密外层或细胞膜局灶性缺失的现象。结论5‐氨基酮戊酸光动力对白念珠菌的细胞壁结构具有一定的影响。     

反相高效液相色谱法测定人血浆中痂囊腔菌素A的含量

目的建立反相高效液相色谱法测定人血浆中痂囊腔菌素A含量。方法血浆样品经处理后,采用RP-HPLC测定。色谱柱为Kromasil C18(250 mm×4.6 mm,5μm),流动相为乙腈∶水(70∶30,V/V),流速1 mL.min-1,柱温27℃,检测波长470 nm。结果痂囊腔菌素A在0.300～10.000 mg.L-1范围内线性关系良好(r=0.999 3),定量限为0.300 mg.L-1。低、中、高浓度(0.500,3.000,8.000 mg.L-1)的日内及日间RSD≤7.37%,平均提取回收率分别为(93.97±6.32)%,(91.71±5.79)%和(88.95±3.26)%。结论本法简便、快捷、灵敏、准确,可满足临床试验中痂囊腔菌素A药动学研究的需要。     

体外光化学疗法对皮肤移植小鼠产生调节性T细胞的影响

目的  探讨输注体外光化学法处理的脾淋巴细胞对皮肤移植受体小鼠产生调节性T细胞(Treg)及移植物存活时间的影响。方法  以C57BL/6小鼠为供体,BALB/c小鼠为受体,建立小鼠皮肤移植模型。分离C57BL/6和BALB/c小鼠脾淋巴细胞(CSP、BSP),制备经8-甲氧基补骨脂素联合长波紫外线(PUVA)处理的小鼠脾淋巴细胞(PUVA-SP)。根据受者静脉输注的成分将实验动物随机分为5组(每组12只)：PUVA-BSP组、PUVA-CSP组、BSP组、CSP组及磷酸盐缓冲液(PBS)对照组,每组受体分别于术前7 d、手术当日和术后7 d按组别从尾静脉注入PUVA-BSP、PUVA-CSP、BSP、CSP或PBS。观察受体移植物的存活时间,检测受体外周血中CD4⁺CD25⁺Foxp3⁺Treg表达情况。结果  皮肤移植术后,PUVA-BSP组和PUVA-CSP组的受体小鼠外周细胞CD4⁺CD25⁺Foxp3⁺Treg的比例明显高于输注BSP组、CSP组和PBS对照组;PUVA-CSP组高于PUVA-BSP,BSP组和CSP组低于PBS对照组。PUVA-BSP组和PUVA-CSP组的受者小鼠移植皮片存活时间明显长于BSP组、CSP组和PBS对照组(均为P＜0.05)。结论  输注足够数量的PUVA-SP可诱导受体体内产生较多的CD4⁺CD25⁺Foxp3⁺Treg,可以显著延长移植物的存活时间。     

锌酞菁－LDL复合物光敏作用诱导小鼠肿瘤细胞程序性死亡

电镜观察表明，锌酞菁人血清低密度脂蛋白（ＬＤＬ）复合物对小鼠ＭＳ－２纤维肉瘤细胞有很强的直接光敏杀伤作用，瘤细胞出现一系列结构改变：核染色质凝聚、局部核膜孔消失、核固缩、核破裂、凝聚的染色质流散、胞质内吞噬现象、胞膜表面肿胀粗钝的胞突形成、细胞碎裂等。提示该复合物光敏作用可诱导肿瘤细胞的程序性死亡，为解释其光敏杀伤机理提供了新的论据。     

Extracorporeal Photochemotherapy for the Treatment of Graft‐Versus‐Host Disease

Abstract: Photopheresis (extracorporeal photochemotherapy, ECP) is a new type of photochemotherapy used for the treatment of oncological and autoimmune diseases. Additionally, recent reports indicate that this therapy is promising in both pediatric and adult patients who develop graft versus host disease (GVHD) resistant to conventional protocols after bone marrow transplantation (BMT). In this paper, we review 31 studies where ECP was used in the treatment of acute and chronic GVHD. A total of 76 (32% female) acute GVHD patients have been considered in 11 series. Fifty‐nine patients presented with skin involvement; 47 had liver involvement, and 28 had gastrointestinal manifestations. Treatment duration ranged from 1 to 24 months. A regression of skin manifestations was observed in 83% of the patients with a complete response in 67%. A complete regression of liver and gut manifestations was reported in 38% and 54% of the patients, respectively. The overall patient survival was 53%. Of the 43 patients alive, 8 developed chronic GVHD manifestations. The immunosuppressive therapy was discontinued in 28% of cases and reduced in 46%. A total of 204 (45% female) chronic GVHD patients treated with ECP 1 to 110 months from transplantation have been considered in 20 series. One hundred twenty‐eight patients presented with skin involvement, 84 with liver, 31 with lung, and 59 with oral manifestations. Treatment duration ranged from 3 to 40 months. A regression of skin manifestations was observed in 76% of patients with a complete response in 38%. An improvement of liver and lung involvement was reported in 48% and 39% of the patients, respectively. Of the 59 patients with oral manifestations, an improvement was obtained in 63% of cases. The overall patient survival was 79%. ECP is a nonaggressive treatment that may benefit patients with both acute and chronic GVHD who do not respond to standard immunosuppressive therapy.     

妊娠合并卵巢恶性肿瘤的研究进展

卵巢恶性肿瘤是严重威胁女性生命的恶性肿瘤之一,随着卵巢恶性肿瘤的年轻化、女性妊娠期 年龄的增大,妊娠期合并卵巢恶性肿瘤的发病率逐渐增加。而目前临床尚缺乏关于妊娠期合并卵巢恶性肿瘤 的规范化诊疗标准。但关于妊娠期合并卵巢肿瘤的发生、发展及诊疗的研究已有了进一步的进展,该文拟对 妊娠期合并卵巢恶性肿瘤的研究进展进行综述,以期为临床应用提供指导。