盐酸舍曲林联合中药伊木萨克治疗原发性早泄的临床研究

目的:探讨盐酸舍曲林联合中成药伊木萨克治疗原发性早泄的临床疗效。方法:2013年6月至2015年10月门诊收集无器质性疾病的原发性早泄患者192例,年龄22~48岁,平均(27.63±6.78)岁,随机分成两组:A组患者单用盐酸舍曲林50mg/d,性生活前4~6h服用;B组患者服用盐酸舍曲林50mg/d,同时给予中成药伊木萨克,3片/d,睡前口服;连续服用4周,比较两组之间治疗有效率、治疗前后平均阴道内射精潜伏时间(IELT)和配偶性交满意度以及治疗期间的不良反应。结果:两组患者IELT在治疗后均显著延长,配偶性交满意度显著提高,而B组较A组增加更显著,存在明显的统计学差异(P0.05)。结论:盐酸舍曲林联合中成药伊木萨克治疗原发性早泄疗效显著优于单用盐酸舍曲林,但长期效果亟待进一步观察。     

中西医结合治疗继发性早泄的疗效观察

目的:观察辨证论治联合盐酸舍曲林片治疗继发性早泄的疗效观察。方法:选取2013年1月至2014年6月于我院泌尿男科就诊的早泄患者156例,将其随机分为治疗组、中药组及西药组,各52例。中药组单纯中药辨证论治,分别给予肝经湿热证、阴虚火旺证、肾气不固证、心脾两虚证患者不同方药,1剂/d,水煎400 m L分早、晚2次温服;西药组给予盐酸舍曲林片50mg,1次/d;治疗组给予盐酸舍曲林片联合中药辨证治疗,连续用药4周。观察三组治疗前后及随访1个月射精潜伏期变化。结果:三组患者治疗后及随访1个月的IELF有明显提高,差异具有统计学意义(P0.01);治疗组在治疗后及随访1个月时的IELF均高于中药组和西药组,差异具有统计学意义(P0.01)。结论:中药辨证论治联合盐酸舍曲林片治疗继发性早泄能够明显提高患者的IELF,临床疗效良好,值得进一步研究推广。     

盐酸舍曲林联合复方玄驹胶囊并配合早泄训练治疗早泄的临床疗效

目的:观察盐酸舍曲林、复方玄驹胶囊配合早泄训练疗法治疗早泄的临床疗效。方法:将55例符合诊断标准的早泄患者给予盐酸舍曲林联合复方玄驹胶囊口服治疗,同时进行早泄训练,疗程为1个月,治疗前后进行CIPE、IELT和双方性满意度的评估,并进行统计学分析。结果:实际治疗了50例,脱落5例,在CIPE评分、IELT评分、双方的性生活满意度评分中,治疗前后比较,P0.01,差异均有统计学意义。结论:盐酸舍曲林联合复方玄驹胶囊治疗并配合早泄训练能明显改善早泄患者的性生活质量。     

盐酸舍曲林药物联合心理辅导治疗早泄及对患者性生活满意度影响的临床研究

目的:探讨盐酸舍曲林联合心理辅导治疗早泄及对患者性生活满意度的影响。方法:选自我院于2014年9月至2016年9月期间收治的早泄患者76例,按照随机数字表法分为观察组38例与对照组38例。对照组口服盐酸坦索罗辛,观察组在对照组基础上口服盐酸舍曲林片。两组疗程均为8周。两组同时进行心理辅导。比较两组治疗疗效,治疗前后性生活满意度、阴道内射精潜伏期、CIPE-5评分及不良反应情况。结果:观察组治疗总有效率(94.74%)高于对照组(73.69%),且有统计学差异(P0.05);两组治疗后患者性生活满意度和配偶性生活满意度评分增加,且有统计学差异(P0.05);观察组治疗后患者性生活满意度和配偶性生活满意度评分高于对照组,且有统计学差异(P0.05);两组治疗后阴道内射精潜伏期和CIPE-5评分增加,且有统计学差异(P0.05);观察组治疗后阴道内射精潜伏期和CIPE-5评分高于对照组,且有统计学差异(P0.05);两组不良反应发生率比较无统计学差异(P0.05)。结论:盐酸舍曲林联合心理辅导治疗早泄疗效明显,且可明显改善患者性生活满意度。     

疏肝益阳胶囊对早泄患者的疗效与不良反应的影响

目的:探讨疏肝益阳胶囊用于治疗早泄患者的效果与不良反应发生情况。方法:将120例早泄患者随机分为A、B、C三组。A组采取单纯行为治疗,B组口服盐酸舍曲林片,C组在B组的基础上联用疏肝益阳胶囊,比较三组患者的射精潜伏期、早泄症状、勃起功能障碍、性生活满意度及不良反应率。结果:治疗后C组的IELT指标高于A组和B组,差异有统计学意义(P0.05)。B组、C组的CIPE指标高于A组,且C组CIPE指标高于B组,差异有统计学意义(P0.05)。治疗后,C组HAMD和IIEF-5指标均低于A组和B组,差异有统计学意义(P0.05)。治疗后,C组患者性生活满意度优于A组和B组,差异均有统计学意义(P0.05)。结论:疏肝益阳胶囊可用于早泄患者的治疗,在舍曲林的基础应用疏肝益阳胶囊可以改善患者早泄症状、勃起功能障碍和抑郁情绪,增加性生活满意度,且不良反应更少。     

心理治疗联合盐酸舍曲林治疗早泄效果及对患者性生活满意度的影响

目的:探讨心理治疗联合盐酸舍曲林治疗早泄效果及对患者性生活满意度的影响。方法:选取2015年1月至2016年1月间于我院泌尿科治疗的早泄患者80例作为研究对象,随机分为观察组和对照组,对照组患者接受盐酸舍曲林药物治疗方式,而观察组在此基础上辅以小组心理干预,治疗周期结束后,比较两组患者的早泄症状改善情况以及CIPE-5、CIPE-7满意程度评分。结果:治疗周期结束后,观察组患者早泄轻度、中度、重度程度分布分别由治疗前的13例、17例、10例分别改善为35例、5例、0例,其改善程度明显优于对照组(P0.05),而性满意程度评分也有治疗前的(3.21±0.51)分、(2.79±0.43)分提高为(4.21±0.78)分、(3.88±0.64)分,明显优于对照组(P0.05)。结论:心理治疗联合盐酸舍曲林治疗早泄临床效果较优,可以明显提高患者以及配偶性满意度,可以适当临床推广。     

慢性前列腺炎所致的早泄的三组药物治疗比较

目的:比较联合应用西地那非+舍曲林、他达拉非+舍曲林、脱水淫羊藿素同系物+舍曲林与单用西地那非、他达拉非、舍曲林、脱水淫羊藿素同系物治疗早泄的临床效果。方法:280例患者随机分成七组:(单纯口服西地那非、他达拉非、舍曲林、脱水淫羊藿素同系物)和西地那非+舍曲林、他达拉非+舍曲林、脱水淫羊藿素同系物+舍曲林。记录患者治疗前后阴道内射精潜伏期、患者性生活满意度、患者配偶性生活满意度、每月性交频率以及治疗期间的药物不良反应。结果:(1)联合用药脱水淫羊藿素同系物+舍曲林治疗早泄的效果与西地那非+舍曲林、他达拉非+舍曲林比较无显著性差异,但不良反应有显著性差异;(2)联合用药脱水淫羊藿素同系物+舍曲林、西地那非+舍曲林、他达拉非+舍曲林治疗早泄的效果与单用西地那非、他达拉非、舍曲林、脱水淫羊藿素同系物比较有显著性差异。结论:在治疗早泄方面,联合用药脱水淫羊藿素同系物+舍曲林优于西地那非+舍曲林、他达拉非+舍曲林及单用西地那非、他达拉非、舍曲林、脱水淫羊藿素同系物。     

天麻钩藤饮加减联合舍曲林治疗早泄的临床观察

目的:观察天麻钩藤饮加减联合舍曲林治疗早泄的临床疗效。方法:将100例早泄患者随机分为单用组和联合组,各50例。单用组予口服舍曲林,每日睡前服用50mg,1次/d;若预计当日发生性生活,则在性生活前4~6h服用50mg。联合组:在上述治疗的同时,给予口服天麻钩藤饮(天麻、钩藤、石决明、栀子等)加减方药,1剂/d,早晚服用。上述两组均治疗4周。对比观察两组治疗前、治疗后的阴道内射精潜伏时间(intravaginal ejaculationg latency time,IELT)、配偶性生活满意度评分及临床总有效率。结果:单用组有效率为59.18%,联合组总有效率79.07%,两组总疗效比较,有统计学差异(P0.05),联合组射精潜伏期时间,改善患者及性伴侣的性生活满意度方面优于单用组(P0.05)。结论:天麻钩藤饮加减联合舍曲林治疗早泄疗效明确,为治疗早泄的一种可行性治疗方法。     

舍曲林联合伐地那非与单用舍曲林治疗早泄的疗效及安全性比较

目的：探讨舍曲林联合伐地那非与单用舍曲林治疗早泄的疗效及安全性比较。方法：选择80例早泄患者随机分为对照组和联合组。对照组患者口服舍曲林50rag,1次／d,性生活前4—6h服用;联合组患者除了同样服用舍曲林外,在性生活前O．5b左右加用伐地那非10mg。两组的疗程均为4周。观察两组患者治疗前后平均阴道内射精潜伏期、性交满意度及治疗期间的不良反应。结果：治疗4周后,两组患者的阴道内平均射精潜伏期时间均较治疗前明显延长（P〈0．05或P〈0．01）,且联合组延长的时间明显长于对照组（P〈0．05）;同时联合组的性交总满意率明显高于对照组（x2=6．27,P〈0．05）;对照组和联合组治疗期间分别出现不良反应5例和8例,症状均较轻,未发生严重的药物不良反应。两组患者治疗期间不良反应发生率比较无明显统计学差异（x2=0．83,P〉0．05）。结论：舍曲林联合伐地那非治疗早泄的疗效确切,安全性较好,可明显延长患者阴道内平均射精潜伏期时间,提高夫妻双方的性交满意度。     

盐酸达泊西汀对继发性早泄的临床治疗价值

目的分析盐酸达泊西汀对继发性早泄的临床治疗价值。方法选取2018年10月至2020年1月秦皇岛市第一医院诊治的170例继发性早泄患者作为研究对象。根据治疗方法的不同分为常规组(n=85)和盐酸达泊西汀组(n=85)。常规组给予左洛复片进行治疗,盐酸达泊西汀组在常规组的基础上给予盐酸达泊西汀片进行治疗,比较两组治疗效果。结果治疗8周后,盐酸达泊西汀组射精潜伏期、控制射精能力、性生活满意度均高于常规组,早泄诊断工具(PEDT)评分低于常规组,差异具有统计学意义(P0.05);盐酸达泊西汀组的总有效率高于常规组,差异具有统计学意义(P0.05)。结论盐酸达泊西汀治疗继发性早泄的效果较好,可延长患者的射精潜伏期,增强患者控制射精的能力,提高患者的性生活满意度,减轻继发性早泄的严重程度。     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Occupational allergic contact dermatitis caused by decorative plants

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria ), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

[Translated article] Pruritus in Dermatology: Part 1—General Concepts and Pruritogens

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.