Objective:To investigate the efficacy and safety of transdermal triamcinolone acetonide delivery assisted by carbon dioxide dot matrix laser combined with narrow spectrum intense pulse laser in the treatment of keloid.Methods:A total of 82 patients with keloid in the Fifth Hospital of Huangshi City from March 2019 to March 2023 were retrospectively included and divided into two groups according to treatment methods. Combination group: 43 cases, including 20 males and 23 females, aged 20-55 (38.3±7.3) years, with a course of 3-8 (6.2±0.8) months, were treated with carbon dioxide dot matrix laser combined with narrow-spectrum intense pulse laser assisted transdermal administration of triamcinolone. Control group: 39 cases, including 23 males and 16 females, were treated with transdermal administration of triamcinolone acetonide alone, aged 21-54 (37.9±6.5) years, and the course of disease was 3-8 (6.2±0.7) months. Both groups were treated once a month for 9 months. The total effective rate, Vancouver scar scale score, bilateral scar assessment scale score, itching degree of scar, and incidence of adverse reactions were compared between the two groups after 9 months of treatment, and the cumulative recurrence rate of 12 and 24 months after treatment was assessed.Results:The total effective rate of the combined group was 93.0% (40/43), which was higher than that of the control group (76.9%) (30/39, P=0.014). After treatment, the color, vascular distribution, thickness, softness, total score and bidirectional scar assessment scale score of the combined group were lower than those of the control group, and the degree of scar itch was less than that of the control group (all P<0.05). The incidence of adverse reactions was 14.0% (6/43) in the combined group and 17.9% (7/39) in the control group, the difference was not statistically significant ( P=0.621). At 12 months after treatment, the recurrence rate was 4.7% (2/43) in the combination group and 5.1% (2/39) in the control group, with no statistical significance ( P=0.920). At 24 months after treatment, the recurrence rate in the combination group was 7.0% (3/43), lower than that in the control group (23.1%) (9/39, P=0.039). Conclusion:Carbon dioxide dot matrix laser combined with narrow spectrum intense pulse laser assisted transdermal triamcinolone acetonide in the treatment of keloid has a good effect, which can reduce the degree of scar itching, reduce recurrence, and do not increase adverse reactions.

Objective:To investigate the efficacy and safety of transdermal triamcinolone acetonide delivery assisted by carbon dioxide dot matrix laser combined with narrow spectrum intense pulse laser in the treatment of keloid.Methods:A total of 82 patients with keloid in the Fifth Hospital of Huangshi City from March 2019 to March 2023 were retrospectively included and divided into two groups according to treatment methods. Combination group: 43 cases, including 20 males and 23 females, aged 20-55 (38.3±7.3) years, with a course of 3-8 (6.2±0.8) months, were treated with carbon dioxide dot matrix laser combined with narrow-spectrum intense pulse laser assisted transdermal administration of triamcinolone. Control group: 39 cases, including 23 males and 16 females, were treated with transdermal administration of triamcinolone acetonide alone, aged 21-54 (37.9±6.5) years, and the course of disease was 3-8 (6.2±0.7) months. Both groups were treated once a month for 9 months. The total effective rate, Vancouver scar scale score, bilateral scar assessment scale score, itching degree of scar, and incidence of adverse reactions were compared between the two groups after 9 months of treatment, and the cumulative recurrence rate of 12 and 24 months after treatment was assessed.Results:The total effective rate of the combined group was 93.0% (40/43), which was higher than that of the control group (76.9%) (30/39, P=0.014). After treatment, the color, vascular distribution, thickness, softness, total score and bidirectional scar assessment scale score of the combined group were lower than those of the control group, and the degree of scar itch was less than that of the control group (all P<0.05). The incidence of adverse reactions was 14.0% (6/43) in the combined group and 17.9% (7/39) in the control group, the difference was not statistically significant ( P=0.621). At 12 months after treatment, the recurrence rate was 4.7% (2/43) in the combination group and 5.1% (2/39) in the control group, with no statistical significance ( P=0.920). At 24 months after treatment, the recurrence rate in the combination group was 7.0% (3/43), lower than that in the control group (23.1%) (9/39, P=0.039). Conclusion:Carbon dioxide dot matrix laser combined with narrow spectrum intense pulse laser assisted transdermal triamcinolone acetonide in the treatment of keloid has a good effect, which can reduce the degree of scar itching, reduce recurrence, and do not increase adverse reactions.

Objective:The purpose of this study was to explore the critical values of monitored indexes of perioperative major adverse cardiac events(MACE), so as to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function to further improve the perioperative safety of elderly patients with biliary diseases.Methods:The clinical data of 246 elderly patients with biliary diseases in our hospital from May 2016 to February 2022 were collected.According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.The differences of clinical data, the monitoring indexes of postoperative cardiac function, and the coagulation function between the two groups were compared and analyzed.Logistic regression was used to analyze the independent risk factors of perioperative MACE, the cut-off value of the receiver operating characteristic(ROC)curve was calculated, and the Logistic multivariate prediction model was established.Results:In the MACE compared with the non-MACE group, age, postoperative complications and mortality, postoperative hospital stay, and the levels of postoperative high sensitivity troponin-I(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and D-dimer(D-D)were significantly increased(all P<0.05). Multivariate Logistic regression showed that postoperative BNP and D-D were two independent risk factors for perioperative MACE, and their cut-off values in the ROC curve were 382.65 pg/mL and 0.975mg/L respectively.The Logistic multivariate prediction model established by the Logistic regression equation was P= ex/(1+ ex), X=-5.710+ 0.003X 1+ 0.811X 2, where X 1 was the postoperative BNP level and X 2 was the postoperative D-D level.The accuracy, specificity and sensitivity of this prediction model for predicting perioperative MACE were 96.3%(237/246), 100.0%(235/235), and 18.2%(2/11). Conclusions:The Logistic multivariate prediction model established in this study can effectively predict the occurrence of perioperative MACE in elderly patients.Postoperative BNP and D-D were two independent risk factors for perioperative MACE.The cut-off values of BNP and D-D in the ROC curve could be used as critical values for monitoring perioperative MACE.Therefore, it is of great clinical significance to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function, and further improve the perioperative safety of elderly patients with biliary diseases.