Novel intense pulsed light-photodynamic therapy strategy in the treatment of facial actinic keratoses concomitant with rosacea

Rosacea presents as transient or persistent erythema,papules,pustules,fAushing,and telangi-ectasia on the middle of the face,which has some clinical similarity with act inic keratosis(AK).These two conditions can coexist in the same patient.Dermoscopy and reflect ance confocal microscopy(RCM)could be useful methods for diagnosis and monitoring treatment efficacy.Novel intense pulsed light-photodynamic therapy(IPL-PDT)may have better tolerance and curative effect than traditional red-light 5-aminolevulinic acid photodynamic therapy(ALA-PDT).Herein,we present a case of facial AKs concomitant with rosacea where combination therapy of novel IPL-PDT and oral minocycline was effective in that AK lesions were eliminated and the patient's facial erythema and telangiectasia were significantly improved.

Does Low-Dose Intravenous Methylprednisolone Pulse Therapy Produce Unacceptable Adverse Effects in Children?

Background: Intravenous methylprednisolone pulse therapy has been used since the late 1960s for acute transplant rejection or severe renal involvement in systemic lupus erythematosus and primary glomerulonephritis. However, reports of serious adverse effects such as life-threatening cardiac arrhythmias and sudden death raise questions about its safety. Objective: To investigate the incidence of significant adverse effects associated with low-dose methylprednisolone pulse therapy (LDMPT) in pediatric patients. Methods: We retrospectively analyzed adverse effects during and after LDMPT in 68 patients (median age: 11.4 years;43% male) with various glomerular diseases who were admitted to Saitama Children’s Medical Center between April 2007 and December 2010. LDMPT consisted of pulse methylprednisolone (15-20 mg/kg;maximum 600 mg/d) for 3 consecutive days weekly for 2-3 weeks. Results: Although adverse effects occurred in 54 of 68 patients (79%), most were mild and transient. Transient glycosuria was noted in 46 patients (68%), hypertension in 6 (9%), elevated intraocular pressure in 6 (9%), hypokalemia in 5 (7%), and liver damage in 2 (3%). No late-onset adverse effects such as osteoporotic fractures, steroid diabetes mellitus, or short stature were observed. Conclusion: LDMPT appears to be relatively safe and well tolerated in children with various glomerular diseases.

Methylprednisolone Pulse Therapy in COVID-19 as the First Choice for Public Health: When Right Timing Breaks Controversies—Emergency Guide

Based on Russian and the Middle East corticosteroids trials in MERS-CoV, we performed methylprednisolone pulse therapy (MPT), resulting in a clinical trial still without result. Our previous cohort (not compared n = 18) showed 76% of MPT patients did not progress to orotracheal intubation as MTP blocked the cytokine storm, a lower result compared to Tehran’s study explained by performing MPT in any lung phase. The Middle East study had been carried out during the initial lung phase. We are in an international emergency. Considering previous protocols and clinical practice, we understand that MPT must be used in COVID-19, and the indication to avoid going to the hospital when the first symptoms appear should be changed urgently for the population with inflammatory comorbidities. This article aims to: 1) show the Iranian protocol to reduce deaths and intubations by COVID-19;2) present a possible approach to the patient COVID-19 with methylprednisolone pulse and strict criteria for orotracheal intubation to avoid hypoxemia;3) highlight that there is already a protocol that can be an international guideline-based on the Iranian work for the treatment of COVID-19;and 4) argue that corticosteroids are not controversial, but their use in a period outside the best timing period makes it controversial;and 5) emphasise the urgency of modifying the current protocol that postpones the visit of patients to the hospital in case of symptoms, since late hospital evaluation has been catastrophic for a world population.

Preliminary Colorimetric Assessment of Progressive Nonsegmental Vitiligo under Short-Term Intravenous Methylprednisolone Pulse Therapy

Although the administration of systemic steroid for nonsegmental vitiligo in the progressive stage is a recommended treatment according to guidelines, the clinical efficacy of this regimen has not been fully established. In this study, we evaluated the clinical efficacy of half-dose steroid treatment and stratified the evidence regarding its usefulness in progressive vitiligo patients. Half-dose steroid pulse therapy (500 mg/day of methylprednisolone for three sequential days) was administered intravenously three times monthly in five vitiligo patients. The visual changes in vitiligo lesions were evaluated on photographs and quantified using a spectrophotometer. As results, all patients completed three cycles of treatment without severe adverse events. Three of the five patients achieved disease arrest with decrease in white contrast. Therefore, short-term and halfdose steroid therapy is well tolerated and effective for achieving disease arrest in progressive nonsegmental vitiligo. The whiteness assessed by a spectrophotometer is possibly associated with therapeutic response to steroid therapy.

Effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures

Objective:To study the effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures.Methods: A total of 72 patients with osteoporotic distal radial fractures who were treated in the hospital between September 2015 and January 2017 were collected and divided into control group (n=36) and observation group (n=36) according to the random number table method. Control group received routine external fixation, and observation group received mid-frequency pulse therapy combined with external fixation. The differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were not statistically significant between the two groups. After 1 month of treatment, serum BGP, TAC and SOD levels of both groups of patients were higher than those before treatment whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those before treatment, and serum BGP, TAC and SOD levels of observation group were higher than those of control group whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those of control group.Conclusion: Mid-frequency pulse therapy combined with external fixation can promote fracture healing and reduce postoperative inflammatory response and oxidative stress response in patients with osteoporotic distal radial fracture.

Fifty Cases of Chloasma Treated by Acupuncture plus Intensive Pulse Light Irradiation

Objective: To observe the clinical therapeutic effect of acupuncture plus intensive pulse light irradiation on chloasma. Methods: Ninety-six cases of chloasma were randomly divided into two groups, the control group of 46 cases treated by simple acupuncture and the treatment group of 50 cases treated by acupuncture and intensive pulse light irradiation. Results: The total effective rate was 89.1% and 98.0% in the control group and treatment group respectively, with a significant difference between the two groups (P<0.05). Conclusion: For chloasma, the effect of treatment with acupuncture plus intensive pulse light irradiation is superior to that with simple acupuncture.

ACUPUNCTURE AT NEIGUAN POINT FOR TREATMENT OF 106 CASES OF LOW PULSE PRESSURE SYNDROME

In spite of normal mean aterlal pressure,decrease of pulse pressure can induce a seriesof clinical symptoms,which is termed as low pulse pressure syndrorne.Acupuncture at bilateralNeiguan（PC 6）is Capable of raising systolic pressure, lowering diastolic pressure, increasing pulsepressure difference and eliminating corresponding symptoms.The effective rate was more than 92％in this observation.

Effects of pulse width and repetition rate of pulsed laser on kinetics and production of singlet oxygen luminescence

Pulsed and continuous-wave(CW)lasers have been widely used as the light sources for photodynamic therapy(PDT)treatment.Singlet oxygen(^(1)O_(2))is known to be a major cytotoxic agent in type-II PDT and can be directly detected by its near-infrared luminescence at 1270 nm.As compared to CW laser excitation,the effiects of pulse width and repetition rate of pulsed laser on the kinetics and production of^(1)O_(2)luminescence were quantitatively studied during photosensitization of Rose Bengal.Significant di®erence in kinetics of^(1)O_(2)luminescence was found under the excitation with various pulse widths of nanosecond,microsecond and CW irradiation with power of 20mW.The peak intensity and duration of^(1)O_(2)production varied with the pulse widths for pulsed laser excitation,while the^(1)O_(2)was generated continuously and its production reached a steady state with CW excitation.However,no significant di®erence(P>0:05)in integral^(1)O_(2)production was observed.The results suggest that the PDT efficacy using pulsed laser may be identical to the CW laser with the same wavelength and the same average°uence rate below a threshold in solution.

甲泼尼龙冲击治疗儿童肾脏风湿性疾病导致窦性心动过缓11例病例系列报告

背景国内缺乏甲泼尼龙冲击治疗儿童肾脏风湿性疾病导致窦性心动过缓(SB)的报道,发生SB后是否停止冲击治疗尚无定论。目的 总结甲泼尼龙冲击治疗儿童肾脏风湿性疾病时导致SB的临床特征。设计病例系列报告。方法 纳入2018年1月1日至2024年4月1日在苏州大学附属儿童医院肾脏免疫科住院、使用甲泼尼龙冲击治疗,治疗期间任意一次测量心率<60次/分且经心电图证实为SB的连续病例。截取患儿的临床表现、辅助检查以及转归情况。主要结局指标甲泼尼龙冲击治疗后发生SB的临床特征。结果 11例患儿纳入本文分析,女7例,男4例,平均年龄(11.3±2.5)岁,其中系统性红斑狼疮合并巨噬细胞活化综合征(MAS)3例,IgA血管炎相关性肾炎、幼年特发性关节炎合并MAS、皮肌炎合并MAS各2例,ANCA相关性血管炎和C3肾小球肾炎各1例。平均基础心率(88±4)次/分。甲泼尼龙冲击治疗的平均剂量为(10.7±3.0) mg·kg~(-1)·d~(-1),冲击治疗时间3~5(4.3±0.9)d。SB发生时间为第1剂甲泼尼龙冲击治疗后1~3(1.8±0.8)d,最低心率48~58(53±4)次/分,心率下降幅度32.6%~44.6%(40.0%±3.7%)。出现SB时血气分析、电解质检查、心脏超声和甲状腺功能均未见异常。均未予抗心律失常治疗,最后1剂甲泼尼龙冲击治疗至恢复到基础心率的时间为4~8(6.1±1.1)d。治疗期间均未出现头晕、胸闷、心悸等心血管系统症状,随访(2.4±2.1)年,均未发现心血管系统异常。结论 甲泼尼龙冲击治疗引起SB时患儿无不适症状,易被忽视,一般无需特殊治疗,可在密切监测下继续完成冲击疗程,心率多在冲击治疗结束后1周左右恢复正常。

低频脉冲电疗配合无痛运动疗法在PVP治疗OVCF中的应用

目的:探究低频脉冲电疗配合无痛运动疗法在经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCF)患者中的应用价值。方法:收集在医院骨科接受PVP治疗的70例OVCF患者,据随机信封法划分为观察组(35例)与对照组(35例)。对照组患者实施常规围术期康复干预方案,观察组患者基于对照组常规干预方案上实施低频脉冲电疗配合无痛运动疗法。持续干预4周,比较两组干预后腰椎活动度,干预前后疼痛NRS评分、腰椎功能ODI评分、日常生活活动能力ADL评分、生活质量评分;比较两组干预总体优良率。结果:干预后,观察组患者左右弯曲、前屈及后伸、左右旋转的腰椎活动度均高于对照组(P<0.05),两组患者NRS评分及ODI评分均较治疗前降低,但观察组降低幅度大于对照组(P<0.05);两组患者ADL评分及生活质量评分均较治疗前升高,但观察组改善幅度大于对照组(P<0.05);观察组患者干预总体优良率明显高于对照组(P<0.05)。结论:骨质疏松压缩骨折患者在PVP治疗的术后采用低频脉冲电疗配合无痛运动疗法进行康复干预的效果显著,且能明显减轻腰椎疼痛感,改善腰椎功能,提升日常生活活动能力,辅助改善患者预后生活质量,值得推广。

中医定向透药疗法和中频脉冲电刺激治疗偏瘫肩痛的疗效差异分析

目的 分析偏瘫肩痛患者实施中医定向透药与中频脉冲电刺激治疗的效果。方法 随机选取潍坊市中医院于2022年11月—2023年11月收治的60例偏瘫肩痛患者为研究对象,掷骰子分组为透药组与刺激组,各30例。透药组行中医定向透药治疗,刺激组行中频脉冲电刺激治疗。比较两组疼痛情况、肩关节活动度、肢体功能情况及有效率。结果 治疗后,透药组疼痛评分低于刺激组,肩关节活动度高于刺激组,上肢功能及上肢自理能力优于刺激组,差异有统计学意义(P均<0.05)。透药组治疗总有效率为96.67%,高于刺激组的76.67%,差异有统计学意义(χ^(2)=5.192,P<0.05)。结论 中医定向透药疗法可大幅减轻肩痛问题,拓展肩关节活动度,提升肩关节功能,有效率高,相比中频脉冲电刺激疗效更好。

不同剂量糖皮质激素冲击治疗风湿病患者的临床疗效分析

目的分析不同剂量糖皮质激素冲击治疗风湿病的临床疗效。方法80例风湿病患者,采取随机形式分为对照组和研究组,每组40例。对照组接受小剂量甲泼尼龙琥珀酸钠治疗,研究组接受大剂量甲泼尼龙琥珀酸钠治疗。比较两组患者治疗效果、不良反应发生情况。结果研究组疾病治疗总有效率90.0%高于对照组的60.0%,对比存在显著差异(P<0.05)。研究组治疗期间不良反应发生率为37.5%,与对照组的25.0%对比不存在显著差异(P>0.05)。结论临床中为风湿病患者提供大剂量糖皮质激素进行冲击治疗,能够提高疾病临床疗效,且不会引发严重不良反应。

“乎井术”针刺疗法治疗慢性非萎缩性胃炎临床研究

目的:观察长桑君脉法“乎井术”针刺疗法对缓解慢性非萎缩性胃炎临床症状的临床疗效。方法:回顾分析2020年6月—2022年10月到广州中医药大学顺德医院顺峰山门诊和三门诊就诊,且治疗方案采用了长桑君脉法“乎井术”针刺疗法的慢性非萎缩性胃炎患者资料。比较患者治疗前后的中医证候积分,并统计临床疗效、症状缓解时间及不良反应。结果:治疗后患者腹痛、腹胀、胸胁胀痛、烧心、呃逆、恶心等中医证候积分均降低(P<0.05)。临床治疗总有效率91.71%。不良反应发生率0.55%。治疗后患者各不适症状均在2~4 min左右可得到缓解。结论:“乎井术”针刺治疗能迅速缓解患者临床症状,解除患者痛苦,操作简便,安全有效。

中药膏摩联合脉冲超短波治疗慢性踝关节扭伤的临床研究

目的:研究中药膏摩联合脉冲超短波治疗慢性踝关节扭伤的临床效果。方法:选取2020年1月—2022年8月北京市昌平区中西医结合医院门诊慢性踝关节扭伤患者80例,随机分为治疗组和对照组,每组40例。治疗组采用中药膏摩联合脉冲超短波治疗,对照组采用双氯芬酸二乙胺乳剂外用配合脉冲超短波治疗。在治疗前及治疗后第3、7、14、28、42天进行视觉模拟评分量表(VAS)评分、Kofoed踝关节功能评分,并测量患踝软组织周径(四点定位法),对两组临床疗效进行比较。结果:治疗第3、7、14、28、42天,治疗组患者踝关节VAS评分降低值均大于对照组,Kofoed踝关节功能评分升高值均大于对照组,踝关节周径减小值均大于对照组,差异有统计学意义(P<0.05);治疗14d后,治疗组临床疗效优于对照组,差异有统计学意义(P<0.05)。结论:中药膏摩联合脉冲超短波治疗慢性踝关节扭伤,具备较好的疗效,能够有效减轻患者关节疼痛、缓解关节肿胀、改善关节功能。

光动力疗法辅助治疗海分枝杆菌感染一例

海分枝杆菌感染的典型特征为皮肤感染性肉芽肿。抗生素是治疗海分枝杆菌皮肤感染的首选药物。本文报道了一例海分枝杆菌感染的中年女性,由于抗生素不耐受,给予光动力治疗和点阵激光辅助加速治疗后成功治愈。

用于皮肤病激光治疗的脉冲光热辐射模型

针对皮肤病激光治疗过程中生物组织内部温度分布与形态测量困难、医生凭借经验选取治疗参数导致疗效不佳等问题,建立了利用脉冲光热辐射法(PPTR)重建皮肤结构,并智能化选取激光参数开展辅助治疗的理论模型。采用基于自定义截断参数选取方法的截断奇异值分解法、基于L曲线法选取正则化参数的Tikhonov正则化法和给定迭代次数的共轭梯度法这3种逆算法进行仿真计算,建立误差评估函数,分析对比了不同表皮层厚度、患病层厚度及深度的重建效果,同时制作皮肤仿体进行离体实验,并以此为依据开展了鲜红斑痣临床治疗的应用研究。结果表明:3种逆算法的综合性能评价指数由高到低依次为0.066、0.082、0.126,验证了其在鲜红斑痣血管层常见深度范围内的重建效果均能保持较高精度;体外实验结果和临床应用验证了所提出的PPTR模型可用于求解表皮、病变层等组织的温升分布、厚度、位置等信息,且重建结果的精度能够满足治疗需求。该模型及研究结果可为激光治疗过程中参数的选取提供定量化指导。

脉冲CO_(2)激光结合牙周基础治疗对青春期龈炎前瞻性半口自身对照研究

目的基于半口自身对照研究观察脉冲CO_(2)激光结合牙周基础治疗对青春期龈炎的疗效。方法选择200例符合标准的青春期龈炎患者,采用左右半口自身对照研究,一侧行牙周基础治疗,为对照组;另一侧行脉冲CO_(2)激光结合牙周基础治疗,为治疗组。对比分析2组患者牙龈红肿、出血好转时间,治疗后7 d和6周时探诊深度(PD)>3 mm的位点数、探诊出血(BOP)阳性位点数、BOP百分率、牙龈指数(GI)、出血指数(BI)、菌斑指数(PLI)的变化以及龈沟液白细胞介素1β(IL-1β)、C-反应蛋白(CRP)、前列腺素E_(2)(PGE_(2))、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平的改变。结果治疗组牙龈红肿、出血好转时间均早于对照组(均P<0.05)。治疗后7 d和6周时,2组PD>3 mm的位点数、BOP阳性位点数和BOP百分率均降低(P<0.05),且治疗组较对照组更低(P<0.05)。治疗后7 d和6周时,2组PLI、GI、BI均降低(均P<0.05),且治疗组PLI、GI、BI均低于对照组(P<0.05)。治疗后6周时2组龈沟液IL-1β、CRP、PGE_(2)、TNF-α、IL-6水平均下降(均P<0.05),且治疗组低于对照组(均P<0.05)。结论相对于单纯牙周基础治疗,脉冲CO_(2)激光结合牙周基础治疗对青春期龈炎的临床疗效更佳,且能较快改善患者临床症状,降低局部炎性反应。

一种用于尿道瘢痕防治动物实验的超声探头设计

目的 尿道瘢痕是患者尿道手术后常见的并发症之一,并且难以通过手术治疗方法清除。低强度脉冲超声(low intensity pulse ultrasound,LIPUS)在抑制纤维化,抑制炎症方面有十分突出的表现,为超声防治尿道瘢痕提供了理论的可能性。尽管如此,目前并没有对超声用于尿道瘢痕的防治作用的报道,另外有关超声抑制纤维化、抑制炎症的作用机制也仍需要进一步的研究。本文针对新西兰雄兔尿道重建模型设计了一种超声探头,用于LIPUS抑制尿道瘢痕疗效和作用机制的动物实验研究。方法 根据兔阴茎的尺寸与形状设计探头结构,通过有限元仿真预测探头声场,用3D打印技术制造原型机。最后对探头声场进行测试,并且用于动物实验验证其实用性。结果 探头超声频率为2 MHz,治疗腔长度44 mm,直径8 mm。治疗腔沿长度方向上有3个紧邻的治疗区,每个治疗区的半功率长度约6 mm,治疗区内的I_(sata)(时间平均空间平均声强)可通过前端驱动器电源电压进行调节,当电源电压为30 V时,I_(sata)大于0.87 W/cm^(2)。结论 本文设计的超声探头体积小、重量轻、声场均匀,可以对动物尿道实施稳定有效的超声照射,为超声治疗尿道瘢痕动物实验提供了一种有用的工具。

非标准状态下脉压变异率评估患者容量反应性的研究进展

容量反应性是目标导向液体治疗(GDFT)的核心,脉压变异率(PPV)反映每搏输出量随呼吸的变化,能够准确评估患者的容量反应性。然而,PPV监测依赖于心肺相互作用,测量时有严格的条件限制。PPV测量的标准状态要求患者接受机械通气,潮气量至少为预测体重(PBW)8 ml/kg,同时不合并自主呼吸、低肺顺应性、心律失常、胸腔开放、腹内高压和高呼吸频率等,不完全满足上述测量条件时测得的PPV则为非标准状态下PPV。临床上多数患者不满足PPV测量的标准状态,因此如何保证非标准状态下PPV应用的有效性成为当前临床研究的热点。本文综述了PPV的原理以及非标准状态下PPV的临床应用等内容,为临床合理使用PPV监测提供参考。

低频脉冲电刺激治疗运动发育迟缓患儿的疗效分析

目的:观察低频脉冲电刺激辅助治疗运动发育迟缓患儿的临床疗效。方法:回顾性选取2021年6月至2023年5月本院收治的运动发育障碍的患儿202例作为研究对象。根据治疗方式的不同将患儿分为对照组(98例,采用常规运动训练治疗)与观察组(104例,采用低频脉冲电刺激辅助常规运动训练治疗)。分析比较两组的运动能力(Peabody运动发育量表)、治疗效果、日常生活活动能力[日常生活活动能力量表(Activity of Daily Living Scale,ADL)]及并发症。结果:治疗后,两组的精细运动商(Fine Motor Quotient,FMQ)、总运动商(Total motor quotient,TMQ)及粗大运动商(Gross motor quotient,GMQ)评分均升高,且观察组的各项评分均明显高于对照组(P<0.05)。观察组治疗总有效率明显高于对照组(P<0.05)。治疗后,两组的ADL评分均显著升高,且观察组治疗后1m、3m、5mADL评分均明显高于对照组(P<0.05)。观察组的并发症发生率明显低于对照组(P<0.05)。结论:对运动发育迟缓的患儿辅以低频脉冲电刺激治疗,能提高治疗效果,改善运动能力和日常生活活动能力,减少并发症。