Comparison of a fractional 2940-nm Er:YAG laser and 5% amorolfine lacquer combination therapy versus a 5% amorolfine lacquer monotherapy for the treatment of onychomycosis: a randomized controlled trial

Lasers in Medical Science - Onychomycosis is a fungal infection of the nail. The aim of this randomized controlled clinical trial was to compare the efficacy of 2940-nm Er:YAG laser treatment...     

老年皮肤性病患者诊疗过程中的伦理探讨

探讨了目前临床上诊疗老年皮肤性病患者时存在的伦理道德问题,主要有（1）询问病史时道德责任感不强,问诊不讲究技巧;（2）检查时不细致,伤害患者的人格;（3）临床检验态度不严谨,操作不规范;（4）治疗方案不规范,未考虑老年人的特点,提出了解方案,包括(1)询问病只时要有高度的道德责任感,结合老年人的特点问疹;（2）体格检查时全面系统、认真负责,尊重和关心老年患者;（3）临床检验要态度严谨、操作规范,方便老年患者;（4）治疗时尽可能考虑老年人的特点,合理治疗;（5）尊重和爱护生命,重视老年皮肤病患者的生活质量。     

经支气管镜大容量灌洗治疗支气管扩张症并感染患者的前瞻性研究

目的评价经支气管镜大容量灌洗治疗支气管扩张症并感染的安全性和有效性。方法采用随机、对照的临床试验设计,对2009年8月至2014年1月收治的支气管扩张症并感染患者进行研究。入选病例在合理内科药物治疗前提下,65例患者随机分为大容量灌洗组（A组,n=21）、小容量灌洗组（B组,n=22）及对照组（C组,n=22）。灌洗组均接受一次治疗,大容量灌洗组灌洗量为500~2 000 m L,小容量灌洗组灌洗量为100~200 m L。观察记录患者的一般情况,记录并比较治疗前、后各组简化的临床肺部感染评分（CPIS）、C反应蛋白（CRP）水平、抗生素使用时间、住院时间及治疗有效率。结果 A组灌洗量为（1 250.0±403.3）m L,B组灌洗量为（141.0±41.2）m L。A组的住院时间和抗生素使用时间分别为（8.4±1.0）d和（7.9±1.1）d,短于B组[（13.5±1.6）d、（11.6±2.4）d]和对照组[（15.3±3.2）d、（13.3±2.6）d]（P〈0.05）;总有效率为95.23%,高于B组（81.82%）和C组（68.19%）;第7 d A组的CPIS评分为（1.9±1.4）分,低于B组[（2.7±0.8）分]和C组[（3.7±0.9）分]（P〈0.05）;A组CRP下降更为显著,差异均有统计学意义（P〈0.05）。A组和B组不良反应分别为一过性低氧血症（23.81%、9.09%）、窦性心动过速（100%、68.18%）、气道黏膜损伤（38.09%、13.64%）、血压升高（19.05%、13.64%）。结论经支气管镜选择性大容量支气管灌洗治疗支气管扩张并感染安全、有效,值得临床推广。     

Patients with breath test positive are necessary to be identified from irritable bowel syndrome: a clinical trial based on microbiomics and rifaximin sensitivity

Background:As a non-invasive and effective diagnostic method for small intestinal bacterial overgrowth (SIBO), wild-use of breath test (BT) has demonstrated a high comorbidity rate in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) and SIBO. Patients overlapping with SIBO respond better to rifaximin therapy than those with IBS-D only. Gut microbiota plays a critical role in both of these two diseases. We aimed to determine the microbial difference between IBS-D overlapping with/without SIBO, and to study the underlying mechanism of its sensitivity to rifaximin.Methods:Patients with IBS-D were categorized as BT-negative (IBSN) and BT-positive (IBSP). Healthy volunteers (BT-negative) were enrolled as healthy control. The patients were clinically evaluated before and after rifaximin treatment (0.4 g bid, 4 weeks). Blood, intestine, and stool samples were collected for cytokine assessment and gut microbial analyses.Results:Clinical complaints and microbial abundance were significantly higher in IBSP than in IBSN. In contrast, severe systemic inflammation and more active bacterial invasion function that were associated with enrichment of opportunistic pathogens were seen in IBSN. The symptoms of IBSP patients were relieved in different degrees after therapy, but the symptoms of IBSN rarely changed. We also found that the presence of IBSN-enriched genera (Enterobacter and Enterococcus) are unaffected by rifaximin therapy.Conclusions:IBS-D patients overlapping with SIBO showed noticeably different fecal microbial composition and function compared with IBS-D only. The better response to rifaximin in those comorbid patients might associate with their different gut microbiota, which suggests that BT is necessary before IBS-D diagnosis and use of rifaximin.Registration:Chinese Clinical Trial Registry, ChiCTR1800017911.     

Pneumonia,pleurisy, mediastinitis,and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration: A case report

Introduction:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen).Patient concerns:A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed.Diagnosis:The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid.Interventions:Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed.Outcomes:Seven days after the treatments, the patient''s symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic.Conclusions:EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.     

特殊人群性病规范化诊疗的伦理学因素探讨

分析探讨了以老年人、孕产妇、儿童为代表的特殊人群性病规范化诊疗的伦理学影响因素.老年性病患者由于生理机能减退、可能存在基础疾病,部分老年人尚存在言语不清、记忆模糊、自尊心较强等心理特点,加上生活质量下降,因此在老年人性病规范化诊疗过程中的主要伦理学措施应包括考虑老年人的病理生理和心理特点,采取个性化诊疗,有技巧的问诊与体格检查,并重视提高其生活质量.孕产妇患者的性病规范化诊疗过程中主要应采取伦理学措施原则包括重视婚检与产检,及早发现可能存在的性病,并应权衡可能存在的医疗风险.儿童性病的规范化诊疗中主要应注意家庭成员是否感染或是否受到性侵犯等,做好保护性医疗,并且做好宣传教育,让儿童远离性病.     

类天疱疮样扁平苔藓1例

目的：报告和分析一例少见的类天疱疮样扁平苔藓病例。方法：取患背部皮损活检组织部分行组织病理和免疫病理检查。结果：活检组织切片,HE染色示：表皮角化过度伴角化不全,颗粒层不规则增厚,基底细胞液化严重已融合成表皮下大疱,无大疱区域表皮和真皮分界不清。有较多淋巴细胞在此区域以及血管周浸润,可见“色素失禁”现象。直接免疫荧光显示基底膜有IgG、C3、IgM呈线状沉积。符合类天疱疮样扁平苔藓。经治疗后痊愈,随访一年未见复发。结论：类天疱疮样扁平苔藓临床表现和病理结果不同于大疱性扁平苔藓和大疱性类天疱疮,是一个独立的疾病。可采用灰黄霉素、四环素和烟酰胺治疗。     

丁酸氢化可的松软膏治疗儿童异位性皮炎临床疗效观察

目的:评价丁酸氢化可的松软膏治疗儿童异位性皮炎的临床疗效。方法:采用自身对照,治疗侧用丁酸氢化可的松软膏;对照侧用0.1％糠酸莫米松霜。结果:共观察了46例异位性皮炎患儿,丁酸氢化可的松软膏的有效率为84.78%,0.1％糠酸莫米松霜的有效率为91.30％,二者差异无显著性(x2=0.93,P>0.05)。二组均未观察到明显的不良反应。结论:丁酸氢化可的松软膏是一种高效、安全的外用皮质类固醇激素制剂,可以应用于治疗儿童异位性皮炎。