不同置换液量血液透析滤过治疗尿毒症皮肤瘙痒疗效观察

目的：观察不同置换液量血液透析滤过(HDF)对尿毒症皮肤瘙痒的治疗作用。方法：将30例并发皮肤瘙痒的维持性血液透析尿毒症患随机分为三个组，分别接受高置换液量后稀释HDF(置换液20L)、低置换液量后稀释HDF(置换液10L)和高通量血液透析治疗。均使用F60透析器，隔日1次，连续3次，其余治疗条件相同。对皮肤瘙痒症状定量计分，比较三组病人治疗前后皮肤瘙痒症状积分的改变以及血磷和甲状旁腺激素(PTH)的变化。结果：高置换液量HDF组治疗后皮肤瘙痒积分明显下降，有统计学意义。其余两组无差异。以皮肤瘙痒积分下降50％为有效计算，高置换液量HDF组7例有效，有效率70％；低置换液量HDF组3例有效。有效率30％；透析组1例有效，有效率10％。三组间比较有统计学差异。三组透析后血磷均明显下降，有统计学意义；PTH亦有下降，HDF组有统计学差异，HD组无统计学差异。结论：增加置换液量可以提高HDF治疗尿毒症皮肤瘙痒的疗效；HDF治疗尿毒症皮肤瘙痒疗效优于高通量血液透析；HDF清除PTH的效果高于HD。     

A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae

Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.     

不同溶媒预冲管路改善血液透析患者皮肤瘙痒的临床观察

目的 观察两种常用的溶媒预冲体外血液循环管路(包括一次性透析器)对改善血液透析患者皮肤瘙痒的临床治疗效果.方法 对22例患者,分为治疗组(11例),采用5%葡萄糖预冲血液透析管路,后进行维持性血液透析;对照组(11例),常规采用0.9%生理盐水预冲血液透析管路,后进行维持性血液透析;每位患者连续观察15次,治疗过程使用的药物包括促红素、透析参数如血流量、透析器及透析机的型号均相同,对两组患者进行瘙痒程度、糖化血红蛋白、血脂、空腹血糖、血补体C3及嗜酸粒细胞计数的比较.结果 5%葡萄糖预冲(治疗组),其透析器显示出较好的相容性,表现在瘙痒程度方面有明显减轻.与0.9%生理盐水预冲(对照组)有显著性差异(P<0.05);但在反应过敏的指标血C3及嗜酸粒细胞计数、糖化血红蛋白、血脂、空腹血糖等方面无显著差异(P>0.05).结论 5%葡萄糖预冲血液透析管路和透析器,能明显减轻血液透析过程中因为使用一次性透析器,导致皮肤瘙痒增高的机率,在短期内对人体血糖和脂代谢影响不明显,相对安全、有效.     

48例尿毒症患者皮肤瘙痒症的透析模式分析及护理

目的探讨在规范的护理措施基础上选择血液透析（Hemodialysis,HD）＋血液透析滤过（Hemodiafiltration,HDF）模式相比单纯HD模式对改善尿毒症患者顽固性皮肤瘙痒的优势。方法选择尿毒症伴皮肤瘙痒患者48例,随机将其分为观察组和对照组,每组24例,观察组患者采取血液透析HD＋血液透析滤过HDF,对照组实施单纯HD,同时规范护理措施。治疗3个月后检测甲状旁腺激素和血β2-微球蛋白,并采用皮肤瘙痒临床症状评分法评估瘙痒程度。结果观察组患者治疗3个月后血β2-微球蛋白（β2-microglobulin,β2-MG）、甲状旁腺激素（Parathyroidhormone,PTH）水平均明显低于对照组（P〈0．01）,皮肤瘙痒程度明显轻于对照组（P〈0．01）。结论采用血液透析＋血液透析滤过模式,并重视临床护理干预,能更有效地缓解尿毒症患者顽固性皮肤瘙痒症状。     

Impact of COVID-19 on Clinicopathological Spectrum of Pityriasis Rosea in Korea

BackgroundPityriasis rosea (PR) is a papulosquamous eruption with generally unknown origin but suspected to be related to viral etiologies. The clinicopathological spectrum of several disorders with viral etiologies has been altered after the coronavirus disease 2019 (COVID-19) pandemic. The author group could experience coherent histological alterations in PR after the COVID-19 pandemic. This study aimed to investigate how the clinicopathological findings of PR were changed after the COVID-19 pandemic.MethodsPatients (n = 11) diagnosed with PR based on the clinical manifestations and skin biopsies between February 2018 and October 2019 and 11 patients in February 2020 and October 2021 were retrospectively analyzed by investigating the medical records.ResultsThe patients with PR during the COVID-19 pandemic demonstrated statistically significant histopathological alterations from classic brisk and dense infiltration pattern to dormant and sparse infiltration and psoriasiform-dominant patterns (P = 0.019). PR was associated with more frequent pruritus during the pandemic period (P = 0.027).ConclusionIn conclusion, PR demonstrated a significant histopathological alteration with more frequent pruritus during the COVID-19 pandemic. The comparative results about clinicopathological findings of PR will provide a useful reference for dermatologists in the diagnostic process of PR in the COVID-19 pandemic.     

养老机构老年人皮肤健康状况调查及影响因素分析

目的:调查洛阳市养老机构老年人皮肤健康现状并分析影响因素,为构建老年人皮肤健康状况监测及干预体系提供依据。方法:本研究为横断面研究。采用分层随机抽样法,选取2019年11—12月在洛阳市7家养老机构居住的489名老年人为研究对象,使用自行编制的老年人皮肤健康状况调查问卷、简易智力状态检查量表（MMSE）、一般情况及疾病...     

血液灌流串联血液透析对钙磷代谢及甲状旁腺素影响的临床观察

目的探讨血液灌流器与透析器串联对钙磷代谢及甲状旁腺素的影响。方法将在我院长期维持性血液透析患者64例,随机分为两组。联合组为血液灌流串联血液透析,共33例。对照组为单纯血液透析,共31例。6个月后检测血甲状旁腺素、血钙及血磷,并观察皮肤瘙痒的改善情况。结果联合组血磷、甲状旁腺素均明显下降,血钙明显上升,差异有统计学意义（P〈0．05）。对照组血磷、甲状旁腺素均明显下降,差异有统计学意义（P〈0．05）。联合组治疗后血甲状旁腺素、血磷均较对照组治疗后下降明显,差异有统计学意义（P〈0．05）。联合组皮肤瘙痒较对照组明显减轻。结论血液灌流串联血液透析能有效调节钙磷代谢,降低甲状旁腺素水平,改善皮肤瘙痒症状,提高患者生活质量。     

Case for diagnosis

Pemphigoid gestationis is a rare, autoimmune blistering dermatosis of pregnancy. No increase in fetal or maternal mortality has been demonstrated, but a greater prevalence of premature and small-for-gestationalage babies has been reported. Topical and systemic corticosteroids and antihistamines are the manstay of treatment. The authors report a case of a 27-year-old woman at 28-weeks gestation with sudden onset of pruriginous vesicles and blisters in the abdomen and limbs. Systemic corticosteroids were introduced and maintained throughout gestation to prevent flares and tapered after the birth of a healthy child.     

老年性瘙痒症小鼠模型的研制

目的 探讨一种建立老年性皮肤瘙痒症实验动物模型的方法.方法 随机挑选昆明小鼠,尾静脉取血后测全血RBC、Hb、WBC、嗜酸性粒细胞值,同时取腹部和前腿皮肤检测皮脂腺.剩余昆明小鼠控制饲料和饮水量饲养10 d后,用冷风、碱水和化纤布料连续刺激14d,录像10 min,观察和记录搔抓次数.于第27天随机抽取样本进行血液取样和皮肤取样,检测内容同前.结果 与实验前相比,动物搔抓次数明显增加,嗜酸性粒细胞数目升高,HCT值升高；RGB、HGB值升高、皮脂腺分泌较前旺盛.结论 在中医理论指导下,模拟临床发病原因采用综合因素初步制造出一种老年性皮肤瘙痒症实验动物模型.