595 nm染料激光联合外用0.5%马来酸噻吗洛尔溶液治疗浅表型婴儿血管瘤的疗效评价

The combination treatment for mix infantile hemangiomas (IHs) using oral propranolol with topical timolol maleate was not well documented in the literature. The aim of this study was to evaluate the therapeutic effects and safety of oral propranolol along with topical timolol maleate or oral propranolol alone for treating mixed IHs in the oral and maxillofacial regions. Between March 2013 and June 2014, a total of 31 patients with mixed IHs in the oral and maxillofacial regions were recruited to the study and randomly divided into experimental and control groups. Fourteen patients in the experimental group (A) were treated with oral proranolol in combination with topical timolol maleate, and 17 patients in the control group (B) underwent orally proranolol treatment alone. The maximal treatment duration was planned for 8 months. Ultrasonography and serial photographs based on Visual Analogue Scale (VAS) were used to assess the effects of treatment before and after treatment, as well as adverse effects after medication were evaluated and managed accordingly. All patients completed treatment. Among the most patients, there was obvious fading of color or decrease in size of the IHs when compared with pretreatment. There was significant reduction of color fading in A (mean VAS score: 8.36 ± 1.39) than that in B (7.18 ± 1.71) (P = 0.043) after the end of treatment, whereas the reduction of sizes in A (8.00 ± 1.75) had no significant difference than that in B (7.59 ± 1.80) (P= .51). The treatment duration of A (5.64 ± 1.45) was shorter than that of B (6.71 ± 1.10) (P= .037). No major collateral effects were observed in both the groups throughout the course of treatment. Oral proranolol combined with topical timolol maleate was well tolerated and effective treatment, mild side effects, and especially gave rise to better clinical response in the treatment of mixed IHs than oral propranolol alone.

Topical imiquimod in the treatment of infantile hemangiomas: A retrospective study

Objective To investigate whether topical mucopolysaccharide polysulfate (MPS) cream can reduce the incidence of eczema and skin atrophy in patients with moderate- or low-risk infantile hemangioma after the treatment with topical beta-blockers or 595-nm pulsed dye laser (PDL) , and to analyze factors influencing the occurrence of eczema and skin atrophy. Methods A total of 722 patients aged 0- 1 years with moderate- or low-risk infantile hemangioma were enrolled from 5 Children′s Hospitals in China. According to the disease condition and therapy acceptability, these patients were divided into 6 groups to be treated with topical beta-blockers and MPS cream (blocker+ MPS group) , topical beta-blockers (blocker group) , 595-nm PDL and topical MPS cream (PDL+ MPS group) , 595-nm PDL (PDL group) , 595-nm PDL combined with topical beta-blockers and MPS cream (PDL+ blocker+ MPS group) , and 595-nm PDL and topical beta-blockers (PDL+ blocker group) , respectively. All the externally applied agents were applied twice a day, and PDL was performed once every 4 weeks. Efficacy and adverse reactions were evaluated after 3-month treatment. Univariate and multivariate Logistic regression analyses were carried out to analyze factors influencing the incidence of eczema and skin atrophy in patients with infantile hemangioma after treatment, and chi-square test was carried out to compare efficacy among the groups. Results After 3-month treatment, multivariate Logistic regression analysis for comparing the blocker+ MPS group with blocker group showed that the risk factor for eczema on the surface of hemangiomas was no topical treatment with MPS cream (P= 0.007, OR= 3.887, 95% CI: 1.439-10.493) , while no correlations were observed between the occurrence of skin atrophy on the surface of hemangiomas and analyzed factors. Multivariate Logistic regression analysis for comparing the PDL+MPS group with PDL group showed that no topical treatment with MPS cream (P 0.05) . Conclusion During the treatment of moderate- or low-risk infantile hemangioma with topical beta-blockers or 595-nm PDL, the combination with topical MPS cream can reduce the occurrence of eczema and skin atrophy without affecting the therapeutic effect. Key words: Hemangioma; Infant; Eczema; Mucopolysaccharide polysulfate; Skin atrophy; Adverse reaction

Clinical observations on the treatment of infantile hemangiomas with topical imiquimod 5% cream

Infantile hemangioma. Part 2: Management

A randomized double-blind, positive-control trial of topical thalidomide in erosive oral lichen planus

Objective To explore the effects of local anesthetics with different temperatures on labor analgesia and adverse reactions of labor. Methods A total of 102 primiparae were selected from January 30, 2017 to January 10, 2018 in Shenzhen Baoan Maternal and Child Health Hospital. The 120 primiparae were randomly divided into two groups: observation group (n=52) and control group (n=50) by digits table method. The two groups were treated with continuous epidural anesthesia for labor analgesia, and the local anesthetics used in the two groups were the same, but the temperature of local anethetics were different. The local anesthetics in the control group were at room temperature (24 ℃), while the local anesthetics in the observation group were preheated to human body temperature (37 ℃). The analgesic effects and adverse reactions were observed in the two groups. The body temperatures and visual analogue scale (VAS) scores were compared at different time points before and after analgesia between the two groups by the variance analysis of repeated measurement data. Incidences of fever, chills, hypotension, nausea and vomiting, pruritus and total adverse reactions were compared by chi-square test or continuity correction of chi-square test. The procedures followed in this study was in accordance with the ethical standards established by the Human Beings Test Committee of Shenzhen Baoan District Maternal and Child Health Hospital, and was approved by the committee (Approval No. QKTLL-2017-04-11). And the clinical research informed consent form was signed with each primipara. Results ①There were no significant differences between two groups in the age, body weight, length of dilatation of cervix before analgesia and body temperature at admission (P>0.05). ②The onset time of analgesia in observation group was (11.0±1.3) min, which was obviously shorter than (13.1±2.0) min of control group, and the difference was statistically significant (t=6.559, P 0.05), while 15 and 30 min after analgesia, the VAS scores in the observation group both were significantly lower than those in the control group, and the differences were statistically significant (t=20.415, 40.281; P<0.001). And the results of further analysis by fixing the treatment measures factor showed that there were significant differences in VAS scores before and after analgesia both in the observation group and the control group (F=16.324, 12.338; P<0.001). ④ The compared results of body temperatures before and after analgesia showed that there was no interaction between the treatment measures and the time factor (Ftreatment×time=0.699, P=0.307). There was no significant difference in body temperature at the time of 5 min before analgesia, 1 h and 2 h after analgesia (F time=0.287, P=0.715). There was no significant difference in the body temperature between the two groups (Ftreatment=0.365, P=0.644). ⑤The incidences of chill, hypotension and total adverse reactions in observation group were 1.9% (1/52), 3.8% (2/52), 15.4% (8/52) respectively, which were significantly lower than those in control group 16.0% (8/50), 18.0% (9/50), 50.0% (25/50), and all the differences were statistically significant (χ2=4.651, P=0.031; χ2=5.307, P=0.021; χ2=13.956, P<0.001). Conclusions Preheating local anesthetics to human body temperature during labor can shorten the onset time of analgesia, improve the analgesic effect, and reduce the risk of adverse reactions. Key words: Analgesia, epidural; Anesthetics, local; Hot temperature; Labor pain; Analgesic effect; Primiparae

Objective: To investigate the curative effect of remifentanil on analgesia in newborns.Patients and methods: One hundred and twenty full-term puerperae from January 2013 to December 2013 were selected and randomly divided into three groups: remifentanil patient-controlled intravenous labor analgesia group (Group A, n = 40), patient-controlled epidural analgesia (PCEA) group (Group B, n = 40), and spontaneous labor group (Group C, n = 40). General conditions, visual analogue scale (VAS) score, labor stage, bleeding, delivery mode, neonatal asphyxia rate, oxyhemoglobin saturation in puerpera, and umbilical arterial blood gas analysis indexes of the fetus were measured. In addition, complications and adverse reactions were recorded.Results: VAS scores in Group A and B were significantly lower than that in Group C at each time point after analgesic intervention (p < .05), without differences at 30 min and 1 h after analgesia between Group A and B (p > .05). However, VAS scores in Group A were significantly higher than those in Group B at the full opening of the uterine orifice and fetal delivery (p < .05). The active phases in the first stage of labor in Group A and B were significantly shorter than that in Group C (p <.05). There were no significant differences in general conditions, VAS score before analgesia, the second and third stages of labor, delivery mode, bleeding, neonatal asphyxia rate, oxyhemoglobin saturation, pH value, partial pressure of oxygen (PO2), and partial pressure of carbon dioxide (PCO2) among three groups (p > .05).Conclusions: Remifentanil intravenous labor analgesia is not superior to PCEA, but does not increase adverse effects, suggesting it might be a supplementary method of PCEA.

Introduction. Infantile hemangiomas (IHs) occur 3 to 4 times more frequently in preterm infants than in those born at term. Yet, data about efficacy and safety of topical therapy for IHs in preterm infants, especially in those born with very low gestational age (less than 33 gestational weeks) is very scarce. Case report. We reported five very preterm girls treated with topical timolol maleate 0.5% gel for superficial cutaneous IHs. In four infants topical timolol was applied on a single IH each, and in one infant two IHs were treated. Out of six treated IHs, one was located on the face, four on the trunk and one on the leg. They were regularly monitored for IH involution and potential adverse effects of timolol for 6?13 months of local treatment. Good therapeutic effect was achieved in all the presented infants, with no adverse effects related to topical administration of timolol-maleate. Conclusion. Topical timolol is an effective and safe therapy for superficial cutaneous infantile hemangiomas in very preterm infants. The treatment should be discussed in detail with parents and individualized management plan should be tailored for each infant in order to maximize the chances of a successful outcome, while avoiding adverse effects.

To investigate the correlation of nasal obstruction symptom score (NOSE) and visual analogue scale (VAS) score with standardized computed tomography cross-sectional areas (CT-CSA). In this cross-sectional study, candidates for functional septo(-rhino)plasty due to chronic nasal obstruction, with a preoperative CT scan were eligible. Subjects filled out a NOSE (0-100) score and a VAS (0-4) score. Nine CT-CSA were segmented. We measured the absolute difference of the right from the left nose as a measure of asymmetry. We examined the correlation of NOSE and VAS score with the mean value of asymmetry of these CT-CSA and with the largest asymmetry among these CT-CSA. In 40 subjects, the median value (minimum-maximum) of NOSE and VAS score was 75.0 (20-95) and 3.0 (1-4), respectively. NOSE score correlated significantly with VAS score (r = 0.74; P < .001). The median value of the mean asymmetry and largest asymmetry was 0.37 (0.18-1.11) and 0.83 (0.33-1.94) cm2, respectively. NOSE score correlated neither with the mean asymmetry (r = 0.28; P = .085) nor with the largest asymmetry (r = 0.22; P = .18). VAS score correlated significantly, still poorly, with the mean asymmetry (r = 0.51; P < .001) and lesser with the largest asymmetry (r = 0.39; P = .012). Despite the limited sample size, VAS score correlated significantly, but poorly, with CT-CSA in candidates for functional nasal surgery. On the contrary, NOSE score did not correlate with CT-CSA preoperatively.

Objectives: The aim of the study was to assess the self-perception of dental aesthetics and orthodontic treatment need in a group of young adults. Materials and methods: Perception of dental aesthetics and orthodontic treatment need was assessed among 189 first year university undergraduates using the Oral Aesthetic Subjective Impact Scale (OASIS), a visual analogue scale (VAS), and the Aesthetic component (AC) scale of the Index of Orthodontic treatment Need (IOTN). Data analysis was done using SPSS version 11.0. Descriptive statistics and Chi-square tests were used. One way analysis of variance (ANOVA) was used to identify differences in the mean VAS and OASIS scores according to perceived orthodontic treatment need on the AC scale of IOTN. The relationship between the various scales was examined using correlation tests. Statistical significance was set as p < 0.05. Results: The mean OASIS and VAS scores were 13.61 ± 5.98 and 75.64 ± 18.40 respectively. According to the AC scale of IOTN, 86.8% of participants rated themselves as having no need for treatment, 7.4% borderline need and 5.8% great need for orthodontic treatment. Comparison of mean OASIS and VAS scores according to the AC category showed a trend towards higher mean OASIS scores and lower VAS scores with greater treatment need. ANOVA showed there were significant differences between the AC groups in mean OASIS and VAS scores. Spearman‘s correlation tests between the 3 scales gave low results. Conclusion: There was a low correlation between the OASIS, VAS and AC scale of IOTN in evaluating self-perception of dental aesthetics and orthodontic treatment need. The OASIS and VAS were able to discriminate between participants with different degrees of treatment need.

The treatment of striae distensae has recently been reported with various lasers such as the 585-nm pulsed dye laser. At lower fluences (2.0 to 4.0 J/cm2), this laser has been purported to increase the amount of collagen in the extracellular matrix. To determine whether the 585-nm pulsed dye laser is effective in both striae rubra and striae alba after two treatments and, in addition, to determine whether there is a net effect on collagen density in treated samples. Twenty patients (skin types II to VI) with either striae rubra (9) or striae alba (11) were treated at baseline and at week 6. The total length of the study was 12 weeks. Untreated striae on the same patient were used as control subjects. Striae clinical parameters such as color and area were measured before the first and after the last treatment by an independent examiner using a visual analog scale. A hydroxyproline assay was used to measure collagen changes in two of the striae quantitatively. The 585 nm had a moderate beneficial effect in reducing the degree of erythema in striae rubra. There was no apparent clinical change on striae alba. Total collagen per gram of dry weight of sampled tissue increased in striae treated with pulsed dye laser versus control subjects. We recommend the use of the 585-nm pulsed dye laser for striae rubra in patients skin types II to IV. Extreme caution or avoidance should be observed in pulsed dye laser treatments for patients with phototypes V to VI even with the use of low fluences. Tissue collagen changes measured may be an early change, which precedes significant clinical improvement.

To discuss the safety and effectiveness of the improved technique by comparing the effects of low temperature bone cement infusion before and after the improvement in the percutaneous vertebroplasty (PVP). The clinical data of 170 patients (184 vertebrae) with osteoporotic vertebral compression fracture who met the selection criteria between January 2016 and January 2018 were retrospectively analyzed. All patients were treated with PVP by low-temperature bone cement perfusion technology. According to the technical improvement or not, the patients were divided into two groups: the group before the technical improvement (group A, 95 cases) and the group after the technical improvement (group B, 75 cases). In group A, the patients were treated by keeping the temperature of bone cement at 0℃ and parallel puncture; in group B, the patients were treated by increasing the temperature of bone cement or reducing the time of bone cement in ice salt water and cross puncture. There was no significant difference in gender, age, disease duration, T value of bone mineral density, operative segment, and preoperative vertebral compression rate, visual analogue scale (VAS) score between the two groups ( P>0.05). CT examination was performed immediately after operation, and the leakage rate of bone cement was calculated. The amount of bone cement perfusion and the proportion of bone cement in contact with the upper and lower endplates at the same time were compared between the two groups. The vertebral compression rate was calculated and the VAS score was used to evaluate the pain before operation, at immediate after operation, and last follow-up. There was no complication such as incision infection, spinal nerve injury, or pulmonary embolism in both groups. There was no significant difference in the amount of bone cement perfusion between groups A and B ( t=0.175, P=0.861). There were 38 vertebral bodies (36.89%) in group A and 49 vertebral bodies (60.49%) in group B exposed to bone cement contacting with the upper and lower endplates at the same time, showing significant difference ( χ 2=10.132, P=0.001). Bone cement leakage occurred in 19 vertebral bodies (18.45%) in group A and 6 vertebral bodies (7.41%) in group B, also showing significant difference ( χ 2=4.706, P=0.030). The patients in group A and group B were followed up (13.3±1.2) months and (11.5±1.1) months, respectively. The vertebral compression rates of the two groups at immediate after operation were significantly lower than those before operation ( P<0.05), but the vertebral compression rate of group A at last follow-up was significantly higher than that at immediate after operation ( P<0.05), and there was no significant difference in group B between at immediate after operation and at last follow-up ( P>0.05). The VAS scores of the two groups at immediate after operation were significantly lower than those before operation ( P<0.05); but the VAS scores of group A at last follow-up were significantly higher than those at immediate after operation ( P<0.05) and there was no siginificant difference in group B ( P>0.05). There was no significant difference in VAS scores between the two groups at immediate after operation ( t=0.380, P=0.705); but at last follow-up, VAS score in group B was significantly lower than that in group A ( t=3.627, P=0.000). The improved advanced low-temperature bone cement perfusion technology during PVP by increasing the viscosity of bone cement combined with cross-puncture technology, can reduce bone cement leakage, improve the distribution of bone cement in the vertebral body, and reduce the risk of vertebral collapse, and achieve better effectiveness.

Objective To observe the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in elderly patients ≥70 years old undergoing inguinal hernia repair. Methods Sixty American Society of AnesthesiologistsⅠ orⅡ patients, aged ≥70 years old, scheduled for elective unilateral inguinal hernia repair under spinal-epidural anesthesia were randomly divided into two groups (n=30 each) using a random number table: control group and test group. Ultrasound-guided TAP block was performed at the end of surgery in the test group. Adverse reactions such as nausea, vomiting, palpitation, dyspnea, dizziness, and sleepiness in the two groups were observed during and after operation. In the test group, the occurrence of adverse events such as blood vessel, nerve, and abdominal organ injury, local anesthetic toxicity, and puncture site infection related to nerve block during and after operation were recorded. Visual analog scale (VAS) scores at rest and cough were recorded at 4, 6, 8, 12, and 24 hours after operation in both groups. Time to ambulation after operation, days of hospitalization after operation, total days of hospitalization, cost of anesthesia, and total cost of hospitalization were recorded. The use of non-steroidal analgesics in the two groups after operation was also recorded. Results There were no adverse reactions such as nausea, vomiting, palpitation, dyspnea, dizziness, or sleepiness during and after operation in both groups. All patients in the test group had no injuries of blood vessels, nerves, and abdominal organs, local anesthetic toxicity, or puncture site infection during and after operation. VAS scores at resting state [4 h: (3.8±1.2) points vs (1.6±0.5) points; 6 h: (4.2±1.5) points vs (1.8±0.8) points; 8 h: (4.8±1.5) points vs (2.0±0.7) points; 12 h: (5.2±1.4) points vs (2.2±0.6) points; 24 h: (3.2±١.١) points vs (1.6±0.6) points] and cough [4 h: (3.9±1.3) points vs (1.8±0.8) points; 6 h: (4.6±1.5) points vs (2.0±0.8) points; 8 h: (5.5±1.6) points vs (2.2±0.9) points; 12 h: (5.8±1.8) points vs (2.4±0.8) points; 24 h: (4.6±1.4) points vs (1.8±0.7) points] at different time points were significantly higher in the control group than in the test group (P<0.01). The cost of anesthesia in the test group was significantly higher [(780.06±63.10) yuan vs (566.69±93.23) yuan] than that in control group (P<0.01). There was no significant difference in the total cost of hospitalization between the two groups. The time to ambulation in the test group was earlier [(5.26±1.43) days vs (8.62±1.62) days] than that in the control group (P<0.01), and the number of non-steroidal drugs used in the test group was significantly less (2 vs 28) than that in the control group (P<0.01). Conclusion Ultrasound-guided TAP block is a safe and effective method for postoperative analgesia in elderly patients ≥70 years old after open inguinal hernia repair. Key words: Ultrasound-guided; Transversus abdominis plane block; Elderly patients; Hemiorrhaphy; Postoperative analgesia

To prospective study the effectiveness and safety of multimodal analgesia (MA) in treatment of avascular necrosis of the femoral head with free vascularized fibular grafting (FVFG). Sixty patients with avascular necrosis of the femoral head, who were scheduled to unilateral primary FVFG between February 2016 and December 2016 and met the selection criteria, were included in the study. All patients were allocated to two groups according to the method of random number table: MA group ( n=30) and control group ( n=30). There was no significant difference in gender, age, body mass index, side, duration and stage of avascular necrosis of the femoral head, preoperative visual analogue scale (VAS) scores under quiescent and active states, and range of motion (ROM) of hip flexion and abduction before operation ( P>0.05). The patients in the MA group were treated with MA therapy, including oral administration of celecoxib before operation, local anesthetic wound infiltration during operation, and ice compression and oral administration of celecoxib after operation. The patients in control group were only treated with patient-controlled intravenous analgesia pump. The postoperative VAS scores under quiescent and active states, ROM of hip flexion and abduction, prescription of Tramadol and adverse reaction were recorded and compared. The operations were completed successfully in both groups without obvious complications and adverse reaction. The Tramadol was used in 4 cases (13.3%) of MA group and in 11 cases (36.7%) of control group, but no significant difference was found between the two groups ( χ 2=4.356, P=0.072). The VAS scores under quiescent state at 6 and 24 hours postoperatively were significantly lower in MA group than in control group ( P<0.05), while VAS scores under active state at 48 hours postoperatively and on the day of discharge were significantly lower in MA group than in control group ( P<0.05). There was no significant difference in VAS score between two groups at other time points ( P>0.05). The ROM of hip flexion in MA group was better than that in control group at 1 day postoperatively and the day of discharge ( P<0.05), while no significant difference was found at 2 and 3 days postoperatively ( P>0.05). The ROM of hip abduction in MA group was superior to the control group at 1, 2, and 3 days postoperatively and the day of discharge ( P<0.05). The MA can effectively relieve the pain following FVFG and facilitate early functional exercises of the hip. The usage of opioids was also relatively fewer for MA protocol.