1. 病史与临床病灶
〔1〕 疥疮潜伏期的长短因人而异,一般而言,初次感染的潜伏期约为2-6个星期;剧痒,是疥疮临床上最重要的特征,在视觉性类比评分〔visual analogue scale, VAS score, 0-10〕通常高达8-10分,在夜深人静时会更形显著。
在临床病灶方面,受孕的雌虫钻入人体表皮待产,形成数厘米长、匍匐状或波浪状的线形突起病灶,即为典型的隧道〔burrow〕病灶,此原发性〔primary〕病灶是疥虫感染时特有的〔pathognomonic〕徵候,常在手指指蹼、手腕屈侧、腋下、手肘、腰际、阴茎、阴囊或女性的乳晕可以看到。
皮疹的面积与位置与疥虫的分布没有关联,而与被感染者的免疫状态有关。疥虫感染后,人体的免疫系统对疥虫的虫体或排泄物产生致敏化〔sensitization〕,呈现与其他过敏性疾病类似的Th2〔T helper 2〕的体液型〔humoral〕免疫反应,经由间白素〔interleukin, IL〕-4, 5, 10& 13等作用,患者被感染的皮肤产生过敏性的发炎反应,而出现红色丘疹、脓疱、结节、斑块、水疱或表皮剥伤〔excoriation〕等,都属于次发性〔secondary〕病灶;在某些曾受过疥虫感染的患者身上,再次感染疥虫时,临床症状出现的时间会大幅缩短,甚至在数小时到一天内就出现。因此若没有经由致敏化即主诉的痒感,通常以心理性因素居多。
〔2〕 婴儿与幼童的疥疮
常见在躯干有广泛性湿疹病灶,手掌和脚掌有隧道病灶,与成人的疥疮有所不同,也会侵犯脸部与头皮。
〔3〕 结痂型〔或挪威型〕〔crusted or Norwegian〕疥疮。
1847年,挪威的Boeck报告了两位 疯患者身上不寻常的一种疥疮型态〔5〕,四年后Hebra参访挪威,也发现类似的案例,因此将这种型态的疥疮命名为scabies norvegica Boeckii。挪威型疥疮在挪威以外的国家,也可看到,以欧洲最多,美国和英国的报告较少,因此”挪威型”这个名称较不恰当,应改称”结痂型”疥疮较为适当。
此类患者身上病灶众多、分布广泛,主要感染手和脚,也经常出现在头皮、脸部、膝盖或指甲下侧,因渗出液多、角化过度〔hyperkeratosis〕,呈现出结痂厚皮的外貌,而非传统典型的隧道样病灶,这些痂皮中都布满了虫体。
结痂型疥疮经常出现在免疫机能不全〔如:AIDS, 疯病〕、游民、营养缺乏、中风、感觉性神经疾病、恶性肿瘤、失智症、精神病患、接受强效外用皮质类固醇或口服皮质类固醇治疗的患者身上,免疫系统的异常和对痒的感受出现问题,会导致患者身上的疥虫大量繁殖,结痂型疥疮患者身上的疥虫数量常常成千上百,甚至多达百万;这种疥虫与传统型疥疮中的疥虫不同,对环境的忍受度较好,以脱落在寝具和衣物上的皮屑维生,离开宿主可以存活长达1个星期。另外也有健康的孕妇感染结痂型疥疮的案例报告,可能与怀孕时期细胞免疫与免疫耐受的改变有关〔6〕。
〔4〕 以人以外的哺乳动物为宿主的疥虫感染。
疥虫〔S scabiei〕感染动物的案例曾在猪〔pig scabies〕、马〔equine scabies〕、狗〔canine scabies〕、猫〔feline scabies〕和狐狸报告过,统称为兽疥癣〔mange〕。疥虫对哺乳类动物的感染具物种特异性〔species-specific〕,偶而会有误入他种哺乳类动物的情形,人类从驯养的动物身上得到疥疮,并非不常见,但这些病灶与传统人疥癣〔疥疮〕的分布不同,没有典型的隧道病灶,潜伏期与症状持续时间较短,通常在数天内会自行缓解,很少有持续性的症状或症候〔7〕。
2. 皮肤刮屑氢氧化钾〔skin scraping KOH〕显微镜检查。
皮肤刮屑氢氧化钾显微镜检查,是诊断疥疮的重要方法。以裸眼或放大镜检视,选取临床上可疑的疥疮病灶,以指缝、手腕或腋下之原发性隧道病灶或没抓破的丘疹病灶为佳〔老人可以选择肩膀、背部或腹部病灶〕,若病灶某一端有黑点,可能代表有疥虫存在。以涂有薄层矿物油的解剖刀片,刮取病灶与周围皮肤,刮取时最好刮到上部真皮,出现轻微点状出血为佳,代表整层表皮已被完全刮下,吸附於刀片上。将刮下来的组织置於载玻片上,不加10% KOH〔potassium hydroxide〕,先在显微镜下寻找疥虫的排泄物〔scybala〕;之后加入10% KOH,稍微隔火加热促进反应后〔可溶解皮肤角质与其他杂质〕,在显微镜下寻找虫体、虫卵或虫体断肢。但在实际经验中,皮肤刮屑氢氧化钾显微镜检查的敏感度〔sensitivity〕较低,因此即使没有找到疥虫相关证据,并无法排除疥疮诊断的可能。
3. 墨水染色检查
以墨水涂抹可疑的隧道病灶,墨水会渗透进入隧道,以酒精擦去多馀墨水,可以明显地分别出隧道与周围的组织。
4. 四环酶素〔tetracycline〕染色检查。
以四环酶素水溶液涂抹可疑的隧道病灶后,用酒精擦去多馀的药水,以伍式灯〔Wood’s light,波长360nm〕照射,可见隧道中有绿色萤光。
5. 皮肤切片检查
皮肤切片检查并不是常规地使用於疥疮的诊断,当临床上遇到不典型的病灶表现时,会辅以皮肤切片检查来做鉴别诊断,有时候可以看到疥虫虫体与发炎细胞的浸润。
6. 多重 链锁反应〔polymerase chain reaction, PCR〕
某些病灶分布与表现为不典型湿疹,但临床上怀疑为疥疮的患者,可以取其皮肤的脱屑或组织,经由PCR放大疥虫的DNA后,利用ELISA侦测以辅助诊断。
Acne vulgaris (commonly called acne) is a skin disease caused by changes in the pilosebaceous units (skin structures consisting of a hair follicle and its associated sebaceous gland). Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.[1] Acne lesions are commonly referred to as pimples, spots, zits, or bacne.。
Acne is most common during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood. [2] For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches his or her early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will continue to suffer well into their thirties, forties and beyond.[3]。
The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules. Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne. [4]。
Aside from scarring, its main effects are psychological, such as reduced self-esteem[5] and, according to at least one study, depression or suicide.[6] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.[5]。
The root cause of why some people get acne and some do not is not fully known. It is known to be partly hereditary. Several factors are known to be linked to acne:。
Family/Genetic history. The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions. [11] 。
Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the glands to get larger and make more sebum. [12] 。
Inflammation, skin irritation or scratching of any sort will activate inflammation. Anti-inflammatories are known to improve acne[citation needed]. 。
Stress, through increased output of hormones from the adrenal (stress) glands, although modern tests have said otherwise and point to this not being a cause[citation needed]. 。
Hyperactive sebaceous glands, secondary to the three hormone sources above. 。
Accumulation of dead skin cells[citation needed]. 。
Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing. [13] 。
Use of anabolic steroids[citation needed]. 。
Any medication containing lithium, barbiturates or androgens.[citation needed] 。
Exposure to certain chemical compounds. Chloracne is particularly linked to toxic exposure to dioxins, namely Chlorinated dioxins[citation needed]. 。
Exposure to halogens. Halogen acne is linked to exposure to halogens (e.g. iodides, chlorides, bromides, fluorides)[citation needed]. 。
Chronic use of amphetamines. [14] 。
Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). In addition, acne-prone skin has been shown to be insulin resistant[citation needed].。
Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).。
AK:Acesulfame-k 安赛蜜(乙酰磺胺酸钾又称AK糖)
AK:Alkyd Resin 醇酸树脂。
ak:account,account current 帐目,往来帐户。
AK:Acknowledgment =acknowledgement。
AK:Armeekorps (German Army corps) Armeekorps(德国军)
AK:Atomic Kitten (band) “原子猫”(带)
ak:amikacin 丁胺卡那霉素,氨羟丁酰卡那霉素。
AK:Actinic Keratosis 光化性角化病。
扩展资料
AK:Acesulfame-k 安赛蜜。
安赛蜜是一种食品添加剂,化学名称为乙酰磺胺酸钾,又称AK糖,外观为白色结晶性粉末,它是一种有机合成盐,其口味与甘蔗相似,易溶于水,微溶于酒精。安赛蜜化学性质稳定,不易出现分解失效现象;
不参与机体代谢,不提供能量;甜度较高,价格便宜;无致龋齿性;对热和酸稳定性好,是当前世界上第四代合成甜味剂。它和其他甜味剂混合使用能产生很强的协同效应,一般浓度下可增加甜度20%~40%。
1990年代末我国就对其制定了产品的行业标准,随着国内安赛蜜生产水平的不断提高,在食品加工上的应用范围越来越广,并有较大比例的出口。
1. If a test under the same conditions can be duplicated, and the likely outcome of each test more than one, but in a test before it can claim it arises which results claimed that the random test pilot.。
2. If the results of randomized trials unlimited uncountable results and the likelihood of each uniform, in the sample space every incident can use a basic one to describe bounded region, said the random tests for the geometric probability.。
3. The positive integer k, that the random variable X k-th power of mathematical expectation for the k-X Origin moments, recorded as vk.。
4. A full set (as σ (X) | X ∈ Rn) a range range of σ.。
5. Determinant row start out by the formula.。
6. The V linear transformation can keratosis A necessary and sufficient condition is a group of the V A component of the vector -。
7. Distribution methods will be used quadratic linear through non-replacement of degraded into standard.。
8. From equations eliminated some unknown function and its derivative, are contained only one unknown function with constant coefficient of linear differential equations.。
9. The function has been obtained into the original equation, in general, can be obtained without going through the remaining points of unknown function.。
10. If f (x) in [a, b] continuous, then f (x) [a, b] integrable.If f (x) in [a, b] has profession, and only a limited interruption, then f (x) [a, b] integrable.。
1. 病史与临床病灶
〔1〕 疥疮潜伏期的长短因人而异,一般而言,初次感染的潜伏期约为2-6个星期;剧痒,是疥疮临床上最重要的特征,在视觉性类比评分〔visual analogue scale, VAS score, 0-10〕通常高达8-10分,在夜深人静时会更形显著。
在临床病灶方面,受孕的雌虫钻入人体表皮待产,形成数厘米长、匍匐状或波浪状的线形突起病灶,即为典型的隧道〔burrow〕病灶,此原发性〔primary〕病灶是疥虫感染时特有的〔pathognomonic〕徵候,常在手指指蹼、手腕屈侧、腋下、手肘、腰际、阴茎、阴囊或女性的乳晕可以看到。
皮疹的面积与位置与疥虫的分布没有关联,而与被感染者的免疫状态有关。疥虫感染后,人体的免疫系统对疥虫的虫体或排泄物产生致敏化〔sensitization〕,呈现与其他过敏性疾病类似的Th2〔T helper 2〕的体液型〔humoral〕免疫反应,经由间白素〔interleukin, IL〕-4, 5, 10& 13等作用,患者被感染的皮肤产生过敏性的发炎反应,而出现红色丘疹、脓疱、结节、斑块、水疱或表皮剥伤〔excoriation〕等,都属于次发性〔secondary〕病灶;在某些曾受过疥虫感染的患者身上,再次感染疥虫时,临床症状出现的时间会大幅缩短,甚至在数小时到一天内就出现。因此若没有经由致敏化即主诉的痒感,通常以心理性因素居多。
〔2〕 婴儿与幼童的疥疮
常见在躯干有广泛性湿疹病灶,手掌和脚掌有隧道病灶,与成人的疥疮有所不同,也会侵犯脸部与头皮。
〔3〕 结痂型〔或挪威型〕〔crusted or Norwegian〕疥疮。
1847年,挪威的Boeck报告了两位 疯患者身上不寻常的一种疥疮型态〔5〕,四年后Hebra参访挪威,也发现类似的案例,因此将这种型态的疥疮命名为scabies norvegica Boeckii。挪威型疥疮在挪威以外的国家,也可看到,以欧洲最多,美国和英国的报告较少,因此”挪威型”这个名称较不恰当,应改称”结痂型”疥疮较为适当。
此类患者身上病灶众多、分布广泛,主要感染手和脚,也经常出现在头皮、脸部、膝盖或指甲下侧,因渗出液多、角化过度〔hyperkeratosis〕,呈现出结痂厚皮的外貌,而非传统典型的隧道样病灶,这些痂皮中都布满了虫体。
结痂型疥疮经常出现在免疫机能不全〔如:AIDS, 疯病〕、游民、营养缺乏、中风、感觉性神经疾病、恶性肿瘤、失智症、精神病患、接受强效外用皮质类固醇或口服皮质类固醇治疗的患者身上,免疫系统的异常和对痒的感受出现问题,会导致患者身上的疥虫大量繁殖,结痂型疥疮患者身上的疥虫数量常常成千上百,甚至多达百万;这种疥虫与传统型疥疮中的疥虫不同,对环境的忍受度较好,以脱落在寝具和衣物上的皮屑维生,离开宿主可以存活长达1个星期。另外也有健康的孕妇感染结痂型疥疮的案例报告,可能与怀孕时期细胞免疫与免疫耐受的改变有关〔6〕。
〔4〕 以人以外的哺乳动物为宿主的疥虫感染。
疥虫〔S scabiei〕感染动物的案例曾在猪〔pig scabies〕、马〔equine scabies〕、狗〔canine scabies〕、猫〔feline scabies〕和狐狸报告过,统称为兽疥癣〔mange〕。疥虫对哺乳类动物的感染具物种特异性〔species-specific〕,偶而会有误入他种哺乳类动物的情形,人类从驯养的动物身上得到疥疮,并非不常见,但这些病灶与传统人疥癣〔疥疮〕的分布不同,没有典型的隧道病灶,潜伏期与症状持续时间较短,通常在数天内会自行缓解,很少有持续性的症状或症候〔7〕。
2. 皮肤刮屑氢氧化钾〔skin scraping KOH〕显微镜检查。
皮肤刮屑氢氧化钾显微镜检查,是诊断疥疮的重要方法。以裸眼或放大镜检视,选取临床上可疑的疥疮病灶,以指缝、手腕或腋下之原发性隧道病灶或没抓破的丘疹病灶为佳〔老人可以选择肩膀、背部或腹部病灶〕,若病灶某一端有黑点,可能代表有疥虫存在。以涂有薄层矿物油的解剖刀片,刮取病灶与周围皮肤,刮取时最好刮到上部真皮,出现轻微点状出血为佳,代表整层表皮已被完全刮下,吸附於刀片上。将刮下来的组织置於载玻片上,不加10% KOH〔potassium hydroxide〕,先在显微镜下寻找疥虫的排泄物〔scybala〕;之后加入10% KOH,稍微隔火加热促进反应后〔可溶解皮肤角质与其他杂质〕,在显微镜下寻找虫体、虫卵或虫体断肢。但在实际经验中,皮肤刮屑氢氧化钾显微镜检查的敏感度〔sensitivity〕较低,因此即使没有找到疥虫相关证据,并无法排除疥疮诊断的可能。
3. 墨水染色检查
以墨水涂抹可疑的隧道病灶,墨水会渗透进入隧道,以酒精擦去多馀墨水,可以明显地分别出隧道与周围的组织。
4. 四环酶素〔tetracycline〕染色检查。
以四环酶素水溶液涂抹可疑的隧道病灶后,用酒精擦去多馀的药水,以伍式灯〔Wood’s light,波长360nm〕照射,可见隧道中有绿色萤光。
5. 皮肤切片检查
皮肤切片检查并不是常规地使用於疥疮的诊断,当临床上遇到不典型的病灶表现时,会辅以皮肤切片检查来做鉴别诊断,有时候可以看到疥虫虫体与发炎细胞的浸润。
6. 多重 链锁反应〔polymerase chain reaction, PCR〕
某些病灶分布与表现为不典型湿疹,但临床上怀疑为疥疮的患者,可以取其皮肤的脱屑或组织,经由PCR放大疥虫的DNA后,利用ELISA侦测以辅助诊断。