Background:Organophosphate pesticides (OPPs) are widely used environmental chemicals with potential health impacts, but their relationship with atopic dermatitis (AD) remains unclear. Methods:Using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2007, we investigated associations between urinary OPP metabolites and AD in 4,258 adults. Six dialkyl phosphate (DAP) metabolites were measured, and weighted quantile sum (WQS) regression was used to assess mixture effects. Results:Both DMP (odds ratio [OR] = 1.17, 95% confidence interval [CI]: 1.05-1.31) and DMDTP (OR = 2.23, 95%CI: 1.08-4.60) showed significant positive associations with AD in fully adjusted models. WQS regression revealed significant associations between mixed OPP exposure and AD (OR = 1.25, 95%CI: 1.04-1.50), with DMP contributing most (45.8%) to the mixture effect. Stratified analyses indicated stronger associations in males, younger adults (<60 years), and smokers. Conclusion:Our findings suggest that OPP exposure, particularly DMP, may be associated with increased AD risk in adults. These results provide new insights into environmental risk factors for AD.

加强医学生医德教育是人类医学卫生健康更好发展、医学院培养医学生职业道德及医德精神与医德实践相融入的需要.通过深入探讨医德教育与医德实践融入的新模式、激发医学生自身修养融入实践的新动力以及新时代下培养医学生成长的新途径等方面,提出了精选医德教育队伍,学习伦理学与人文教育,以医学生为中心,营造适合学生学习环境等具体措施,从而创设适合每个学生发展的教育,以期培养医学生成长为能应对突发公共卫生事件挑战的卫士.

Objective To study the therapeutic effect of berberine tannin in atopic dermatitis（AD）.Methods Thirty male,pathogen-free BALB/c mice were randomly divided into 5 groups:the model group,1%berberine tannate group,5% berberine tannate group,and 0.03% tacrolimus group were treated on the 1st,3rd,and 5th day of the first week on the outer skin of the bilateral auricles of mice respectively apply 20 μL each of 1% DNCB（2,4-dinitrochlorobenzene）in acetone-olive oil for initial sensitization. From the 2nd to the 3rd week,20 μL of acetone-olive oil solution of 0.5% DNCB was applied to the sensitized parts of the bilateral auricles of the mice every 3 days for resensitization,and the mice were treated with drugs every day.The control group applied the same amount of acetone-olive oil base at the same time. Bilateral ear thickness of mice was measured twice a week at the same time interval. After the experiment,the mice were sacrificed,and the ears of the mice were excised for histopathological examination. Results After DNCB sensitization,compared with the control group,the ear thickness of the model group was significantly increased,and there was a statistically significant difference（P＜0.01）. After the treatment of 1%,5% berberine tannate and 0.03% tacrolimus,the ear thickness of mice was significantly improved,and compared with the model group,there were significant statistical differences（P＜0.01）. Compared with the 0.03% tacrolimus group,there was no significant difference in the ear thickness of mice between the berberine tannate groups at different concentrations（P＞0.05）. Histopathological results showed that compared with the control group,the model group had obvious edema and inflammatory cell infiltration in the ear dermis,and the thickness of the epidermis increased,and the difference in thickness was statistically significant（P＜0.01）. After treatment with 1%,5% berberine tannin and 0.03% tacrolimus,the thickness of the epidermis was reduced,and there was a significant statistical difference（P＜0.01）,indicating that the disease condition was improved. There was no statistical difference between the 0.03% tacrolimus group and the 0.03% tacrolimus group（P＞0.05）. Conclusion Berberine tannate has a good therapeutic effect on atopic dermatitis,and it is expected to develop new uses for the treatment of atopic dermatitis,providing new ideas for clinical treatment of AD.

Allergen-specific Th2 cells refer to a subset of Th2 cells that undergo substantial expansion following allergen stimulation. They play a crucial role in allergic diseases, and an increasing amount of research has revealed a close relationship between surface molecules on allergen-specific Th2 cells and allergic diseases. In comparison to other CD4+T cells or Th2 cells, allergen-specific Th2 cells exhibit low expression of CD27 but high expression of CD154, CD69, CRTH2, CD161, ST2, hPGDs, CD49d, and COX-2. They can be used for the identification of allergen-specific Th2 cells and serve as potential targets for the prevention and treatment of specific diseases. They hold significant value in preventing the onset and exacerbation of allergic diseases.

反应性穿通性胶原病是一种罕见的皮肤病,其特征是变性胶原纤维通过表皮排出.该病具体发病机制尚不明确,目前根据病因可分为遗传性和获得性,遗传性相对少见,而获得性则通常见于成年人,常合并其他系统疾病.该病目前没有标准的治疗方案.本文报道度普利尤单抗治疗获得性反应性穿通性胶原病合并特应性皮炎 1 例,为临床医师在治疗方面提供更多的思路.

目的 评估临床实践中度普利尤单抗(dupilumab)治疗老年顽固性重度特应性皮炎(AD)的疗效及安全性.方法 回顾2020年8月-2021年10月在北京大学第三医院皮肤科接受度普利尤单抗规律治疗至少16周,并联合丙酸氟替卡松乳膏治疗4周的老年顽固性重度AD患者的多方面疗效评估数据,包括治疗前后AD病情控制(ADCT)、瘙痒数值评分量表(NRS)、湿疹面积和严重程度指数(EASI)、皮肤病生活质量指数(DLQI)评分变化,以及药物安全性.结果 共30例符合标准的老年顽固性重度AD患者纳入研究.治疗后第2周,23.33％的患者达病情控制(ADCT＜7分);瘙痒NRS评分下降45.52％,73.33％的患者瘙痒NRS评分下降≥4分;EASI评分下降42.37％,46.67％的患者达EASI-50;DLQI评分下降≥4分的患者达73.33％.治疗后第16周,所有患者(100％)均达到病情控制(ADCT＜7分);瘙痒NRS评分下降87.92％,所有患者瘙痒NRS下降幅度均≥4分;EASI评分下降93.83％,达到EASI-50、EASI-75和EASI-90的患者分别为100％、96.67％和86.67％;DLQI评分下降≥4分的患者达100％.1例患者出现多发性细菌性毛囊炎,其余患者均未出现不良反应.结论 度普利尤单抗能显著改善并持续控制老年顽固性重度AD患者的病情.

特应性皮炎(atopic dermatitis,AD)是一种常见的儿童过敏性皮肤病,具有明显的遗传倾向,常伴有剧烈瘙痒,易并发哮喘和过敏性鼻炎,严重影响患者的生活质量.大量的研究表明,皮肤屏障、皮肤微生态和皮肤免疫微环境的相互作用共同促进了AD的炎症进程,这些研究为治疗这种难治性皮肤病提供了多种新靶标和新思路.因此,本文综述了特应性皮炎发病机制的研究进展.

Background: Pancreatic cancer is common in elderly persons, and less than 20% of patients present with localized, potentially curable tumors. Methods: We compared the methylated sites and genes in pericarcinous tissues compared to cancer tissue, and blood compared to pericarcinous tissues in order to harvest methylation markers for putative diagnostic and therapy monitoring purposes. Results: Of 15,397 CpG sites detected in 7,440 genes, 5,605 (36.4%, 5,605 of 15,397) CpG sites were hypomethylated and 5,870 (38.12%, 5,870 of 15,397) CpG sites were hypermethylated. We then performed Gene Ontology (GO) and KEGG analysis to systematically characterize the ten significantly differentially methylated genes: PTPRN2, MAD1L1, TNXB, PRDM16, GNAS, KCNQ1, TSNARE1, HDAC4, TBCD, and DIP2C. Meanwhile, function analysis of genes with differentially methylated sites located in promoter regions of overlap group was also performed. According to previous studies, we further screened 22 pancreatic cancer related key genes. The results suggested that these key genes can influence methylation. GO and KEGG analysis indicated that these genes are involved in a wide range of functions. Conclusions: The identification of differentially methylated genes in this study provides valuable information for liquid biopsy methylation markers in pancreatic cancer.

目的 比较医护人员使用某皮肤清洗液洗手后使用芙汭皮肤膏对手部细菌菌落计数、皮肤屏障功能的影响以及使用者的主观评价,探讨更适用于医务工作者的手消毒、手护理方法.方法 选择2020年3-6月北京大学第三医院门诊医护人员作为监测对象,并随机分为试验组和对照组,每组60人次,其中医生和护士分别为29人次和31人次.监测对象均按七步洗手法洗手1 min,用无菌擦手纸擦干双手.试验组洗手后使用芙汭皮肤膏1g均匀涂抹双手背与手掌,对照组不使用任何护手霜.采集两组洗手后即刻、洗手后30 min的手部样本,进行细菌培养及菌落计数.分别在洗手前、洗手后30 min对手部行皮肤屏障功能检测,同时收集监测对象洗手后30 min手部舒适度的主观评价.结果 试验组与对照组医护人员洗手后即刻菌落计数比较差异无统计学意义,洗手后30 min试验组菌落计数显著低于对照组(P=0.001);试验组与对照组洗手前角质层含水量(Stratum corneum hydration,SCH)及经皮肤水分丢失(transepidermalwater loss,TEWL)值比较差异无统计学意义,洗手后30min试验组SCH高于对照组,TEWL低于对照组(P＜0.05);洗手后30 min试验组手部舒适度评分优于对照组(P＜0.05).结论 洗手后使用芙汭皮肤膏可增强洗手后的抑菌效果,并可以帮助维护皮肤屏障功能,且在皮肤舒适度方面较好,可以作为手护理的一部分,在临床中推广应用.

To the Editor: Psoriasis is a chronic, recurrent, systemic, immune-mediated inflammatory disease that mainly affects the skin, nails, and joints. Plaque psoriasis is the most common type of psoriasis, accounting for more than 80% to 90% of all cases. Secukinumab, a human IgG monoclonal antibody that antagonizes interleukin 17A (IL-17A), was approved by the US Food and Drug Administration in 2015 to treat moderate-to-severe plaque psoriasis. A Chinese multicenter, double-blind, placebo-controlled phase III randomized clinical trial (RCT) demonstrated excellent efficacy and safety.[1] Secukinumab has been available on the Chinese market since May 2019, with a recommended dose of 300 mg. It is well-known that RCTs, due to their rigorous, normalized design schemes, cannot fully reflect what happens in clinical practice settings. The concept of the “efficacy-effectiveness gap” was also introduced,[2] which supports the importance of real-world study. Here, we retrospectively summarized all the inpatients with plaque psoriasis who were treated with secukinumab at Peking University Third Hospital from June to December 2019. General information (sex, age, weight, body mass index, etc.) and clinical features (disease duration, family history, comorbidities, laboratory tests, previous treatments, concomitant treatments, etc.) were collected from clinical records. The psoriasis area severity index (PASI), body surface area (BSA), dermatology life quality index (DLQI), psoriasis scalp severity index (PSSI), nail psoriasis severity index (NAPSI), and palmoplantar psoriasis area and severity index (ppPASI) were also recorded. Safety was assessed by adverse events, and special cases that met the exclusion criteria of clinical trials were monitored accordingly. Statistical analysis was performed with SPSS 26.0 software (IBM Corp, Armonk, NY, USA). This study was approved by the Ethical Committee of Peking University Third Hospital (No. 329-01). Twenty inpatients started secukinumab treatment during the half-year study period. Twelve (60.0%) did not meet the eligibility criteria for the phase III RCT: ten patients (10/20) did not meet the inclusion criteria, one patient had concurrent hepatitis B virus (HBV)/hepatitis C virus (HCV) infection, and one patient had pre-existing idiopathic thrombocytopenia. General patient characteristics were summarized and compared with those in the phase III RCT,[1] and a lower severity was noted in our patients [Supplementary Table 1, https://links.lww.com/CM9/A403]. All patients followed the standard regimen with secukinumab (300 mg) administered subcutaneously once weekly for four weeks and then once every four weeks. During the treatment, four patients used concomitant topical treatments intermittently; two used calcipotriol, and two used calcipotriol betamethasone ointment. The percentages of PASI 75/90/100 responders, BSA involvement ≤ 3%, and BSA involvement ≤ 1% responders, and DLQI <5 and DLQI 0/1 responders are shown in Figure 1A–C. The PASI scores were 8.40 (3.25–11.85), 3.65 (1.38–5.75), and 0.50 (0–1.50) at weeks 2, 4, and 12, respectively. All reached statistical significance compared with the baseline PASI of 11.10 (6.00–17.03) (Zweek 2 = −3.622, P < 0.001; Zweek 4 = −2.803, P = 0.005; Zweek 12 = −3.464, P = 0.001). At week 2, the PASI 75/90/100 responses were 11.8%/5.9%/0%. At week 12, they reached 87.5%, 68.8%, and 43.8%, respectively. The median time to achieve a PASI 75 response was 8 weeks. Considering all patients, 87.5% achieved an absolute PASI ≤ 3, and the PASI score improvement was 95.74% (84.63–100.00%) at week 12.Figure 1: Percentages of PASI 75/90/100 responders (A), BSA 3% and BSA 1% responders (B), DLQI <5 and DLQI 0/1 responders (C) and PSSI 75/90/100 responders (D). Fingernail NAPSI change in patients with fingernail psoriasis (E). Platelet counts of the patient with idiopathic thrombocytopenia (F). Representative pictures of psoriasis on scalp (G) and fingernails (H). PASI: Psoriasis area severity index; BSA: Body surface area; DLQI: Dermatology life quality index; NAPSI: Nail psoriasis severity index; PSSI: Psoriasis scalp severity index.There was no data available concerning BSA or DLQI in the Chinese phase III RCT. An acceptable response of BSA ≤ 3% or a target response of BSA ≤ 1% was considered to be a more practical instrument for real-world application. In our study, the BSA values were 21.5% (6.3%–32.8%), 10.3% (6.1%–17.1%), and 1.0% (0.0%–2.8%) at weeks 2, 4, and 12, respectively. BSA slightly improved at week 2 but did not reach statistical significance (Zweek 2 = −1.663, P = 0.096); however, at weeks 4 and 12, BSA was significantly reduced compared with the baseline BSA of 20.3% (7.6–31.3%) (Zweek 4 = −2.810, P = 0.005; Zweek 12 = −3.408, P = 0.001). At week 2, the BSA ≤ 3%/BSA ≤ 1% responses were 11.8%/5.9%. At week 12, they reached 81.3%, and 62.5%, respectively. Achieving an improvement of 4 points or more in the DLQI was proposed as an assessment criterion in the British guidelines. A DLQI score of less than 5 (DLQI < 5) was one of the parameters in the decision algorithms for treatment in the French guidelines, and a DLQI of 0/1 was considered to indicate that there was no impact of psoriasis on quality of life. In our study, the DLQI scores were 7.0 (4.3–10.8), 4.0 (2.0–9.0), and 0 (0–4.0) at weeks 2, 4, and 12, respectively. All improved significantly compared with the baseline DLQI of 11.0 (8.0–21.0) (Zweek2 = −2.425, P = 0.015, Zweek4 = −2.197, P = 0.028, Zweek12 = −3.063, P = 0.002). At week 2, 50% of patients had a reduction of ≥ 4 points compared to the baseline DLQI scores, and 25% and 12.5% of patients achieved a DLQI < 5 and DLQI of 0/1, respectively. At week 12, a reduction of ≥ 4 points, DLQI < 5, and DLQI 0/1 were achieved in 60%, 80%, and 66.7% of patients, respectively. The results were comparable to those of the phase III RCT in China.[1] In addition, in line with the superior efficacy demonstrated in Chinese patients in clinical trials, our data also supported superior effectiveness in a real-life clinical setting (PASI 75/90/100: 87.5%/68.8%/43.8% vs. 72%/50%/36%, DLQI 0/1: 66.7% vs. 57%, compared with the results of a meta-analysis including 43 studies conducted in other countries and regions[3]). In the Chinese results, the lower proportion of overweight or obese patients and the higher proportion of biologic-naïve patients might be the reasons for the superior efficacy and effectiveness. The efficacy of secukinumab in difficult-to-treat locations, such as the scalp, nail, and palmoplantar regions, was not reported in the Chinese phase III RCT. In our study, 13 patients had scalp psoriasis. The PSSI scores were 1.5 (0–8.0), 2.0 (0–21.0), and 0(0–3.3) at weeks 2, 4, and 12, respectively. All reached statistical significance compared with the baseline PSSI of 5.0 (3.0, 12.5) (Zweek 2 = −2.692, P = 0.007; Zweek 4 = −2.032, P = 0.042; Zweek 12 = −2.913, P = 0.004). At week 12, the PSSI 75/90/100 responses were 83.3%, 75.0%, and 66.7%, respectively [Figure 1D and 1G]. In three patients with fingernail psoriasis, NAPSI improved by 100.0%, 53.3%, and 28.6% [Figure 1E and 1H]. Only one patient had toenail psoriasis, and achieved a 45.0% improvement in NAPSI. Only one patient had hyperkeratotic palmoplantar psoriasis, with a baseline ppPASI of 16.6, and this was completely cleared at week 8 (ppPASI 100). During the 12-week secukinumab treatment schedule, nine patients (45.0%) had at least one adverse event. The most common adverse events were upper respiratory tract infections (four cases), tinea pedis (two cases), and facial dermatitis (two cases). No serious adverse events occurred, and no patient had to discontinue drug treatment due to adverse events. One special case was a patient with a concurrent HBV/HCV infection. He was positive for hepatitis C virus antibody (HCV-IgM) and hepatitis B virus core antibody (HBcAb) at baseline, and HBsAg, HBV-DNA, and HCV-RNA were negative. He did not show virus reactivation during the 48 weeks of secukinumab treatment without antiviral prophylaxis. Although virus reactivation was not found in our patient, it has been reported that without antiviral prophylaxis, 1 of 11 HBsAg-negative/HBcAb-positive/HBsAb-negative patients, and one of nine patients with HCV infection developed HBV reactivation and enhanced replication of HCV with hepatitis after three months of secukinumab therapy, and both were clinically asymptomatic at the time of reactivation.[4] The viral load and transaminase should be closely monitored. Another special case was a patient with idiopathic thrombocytopenia. The platelet counts increased from 52 × 109/L at baseline to 84 × 109/L at week 12, and remained at 82 × 109/L at week 32 [Figure 1F]. To our knowledge, there have been no previous reports concerning secukinumab (or any other biologic) treatment in patients with psoriasis and pre-existing idiopathic thrombocytopenia. Other occurrences of transient thrombocytopenia during biologic treatment with normal platelet count at baseline were reported,[5] with adalimumab as the probable cause. In this case, considering that the face and nails were affected, and taking into account obesity (body mass index = 30 kg/m2), hypertension, and the patient's intentions and expectations, the decision to initiate secukinumab treatment was made after discussion with the patient and consultation with hematologists. PASI 100 was achieved at week 8 and was sustained during the 32-week follow-up. A slightly increasing platelet count over time even suggested a possible co-benefit. Fully understanding the effect of secukinumab on platelet count in patients with idiopathic thrombocytopenia requires long-term follow-up studies with larger sample sizes. Funding This work was supported by grants from the National Natural Science Foundation of China (No. 81972560) and Beijing Municipal Natural Science Foundation (No. 7202231). Conflicts of interest None.

Cutaneous T-cell lymphoma (CTCL) represents a rare group of extranodal T-cell lymphoproliferative diseases. Due to poor clinical outcome of CTCL, there is an urgent need for new and improved therapies. A small molecule, IPA-3, which inhibits p21-activated kinase 1 (PAK1), has shown therapeutic potential in various types of malignancies. In the present study, the anti-tumor effect of IPA-3 and its underlying molecular mechanism was evaluated. High expression of phosphorylated-PAK1 (pho-PAK1) was seen in CTCL lesional skin compared to benign inflammatory dermatoses. IPA-3 could significantly inhibit the proliferation of 3 CTCL lines in a dose- and time-dependent manner. The percentage of apoptotic cells was higher in the treatment group. Further, IPA-3 treatment caused increased EGR1 protein levels and decreased apoptosis-related BCL-2 and pho-BAD protein levels. In summary, inhibition of pho-PAK1 has significant anti-tumor effects in CTCL cells and it can be explored as a future therapeutic option.

Objective To explore and establish a method for quantitative evaluation of facial skin pores based on dermoscopy, and to evaluate the scientificity and practicability of this method. Methods Totally, 30 patients with enlarged facial skin pores were enrolled from Department of Dermatology, Peking University Third Hospital between June 2017 and December 2017, and treated with 2 940 nm Er pixel laser. Photographs were taken, and dermoscopic images were collected before and after treatment. According to the standard photographs of facial pores, the improvement of enlarged facial pores was evaluated by comparing the photos before and after the treatment. A dermoscope-based pore detection system was established, and quantified indices for pore area and color difference before and after the treatment were evaluated by using this system. A pre-post self-contrast study was conducted, and statistical analysis was carried out by using paired t test for the comparison of measurement data and paired non-parametric test (Wilcoxon signed-rank test) for the comparison of ranked data. Results After the treatment, the standard photograph method for the assessment of facial pores showed score reduction by 3 grades in 1 of the 30 patients (3.3%) , by 2 grades in 7 (23.3%) , by 1 grade in 21 (70%) , and no changes of grades in 1 (3.3%) . Additionally, the differences between pre- and post-treatment grades were significant (Z = -4.94, P < 0.01) . The detection rate of skin pores by using the detection system was (70.59 ± 3) %. After the treatment, the quantified values of pore area and color difference both significantly decreased compared with those before the treatment (pore area: 712.95 ± 87.45 vs. 831.45 ± 88.92, t = 5.70, P < 0.05; color difference: 23.82 ± 9.43 vs. 28.92 ± 9.91, t = 2.76, P < 0.05) . Conclusion The dermoscopy-based method for quantitative evaluation of skin pores after the treatment with 2 940 nm Er pixel laser showed highly consistent results with the standard photograph method, which can be further verified and popularized in the evaluation of enlarged skin pores. Key words: Dermoscopy; Image processing, computer-assisted; Laser therapy; Skin pore widening

Medical ethics education in clinical practice stage is especially critical to improve medical students' humanistic, medical ethics and professional accomplishment. Compared with other clinical disciplines, dermatology and venereology has many characteristics. To strengthen medical ethics education in dermatology and venereology clinical practice, we should persist in promoting and cultivating core values of Chinese socialism, accurately grasp the characteristics of various skin diseases, educate and guide students to flexibly apply the basic principles of ethics and improve their ethical decision-making ability. In the process of teaching implementation, we should pay attention to the coordination of education, enrich teaching means and strengthen practical teaching, so as to improve the quality of education.

Objective To explore and establish a method for quantitative evaluation of facial skin pores based on dermoscopy,and to evaluate the scientificity and practicability of this method.Methods Totally,30 patients with enlarged facial skin pores were enrolled from Department of Dermatology,Peking University Third Hospital between June 2017 and December 2017,and treated with 2 940 nm Er pixel laser.Photographs were taken,and dermoscopic images were collected before and after treatment.According to the standard photographs of facial pores,the improvement of enlarged facial pores was evaluated by comparing the photos before and after the treatment.A dermoscope-based pore detection system was established,and quantified indices for pore area and color difference before and after the treatment were evaluated by using this system.A pre-post self-contrast study was conducted,and statistical analysis was carried out by using paired t test for the comparison of measurement data and paired non-parametric test (Wilcoxon signed-rank test) for the comparison of ranked data.Results After the treatment,the standard photograph method for the assessment of facial pores showed score reduction by 3 grades in 1 of the 30 patients (3.3％),by 2 grades in 7(23.3％),by 1 grade in 21(70％),and no changes of grades in 1 (3.3％).Additionally,the differences between pre-and post-treatment grades were significant (Z =-4.94,P ＜ 0.01).The detection rate of skin pores by using the detection system was (70.59 ± 3)％.After the treatment,the quantified values of pore area and color difference both significantly decreased compared with those before the treatment (pore area:712.95 ± 87.45 vs.831.45 ± 88.92,t =5.70,P ＜ 0.05;color difference:23.82 ± 9.43 vs.28.92 ± 9.91,t =2.76,P ＜ 0.05).Conclusion The dermoscopy-based method for quantitative evaluation of skin pores after the treatment with 2 940 nm Er pixel laser showed highly consistent results with the standard photograph method,which can be further verified and popularized in the evaluation of enlarged skin pores.

目的 构建具有不同医学背景的分层学生标准化患者(SSP)体系,应用于医学生沟通技能培训,并对其进行评价.方法 分别在大学通识教育阶段(A组)、基础医学学习阶段(B组)、临床见习实习阶段(C组)的八年制临床医学专业中遴选医学生作为SSP进行培训.在进入临床实习的医学生中随机抽取36名,分为试验组(n=18)和对照组(n=18).每阶段培训安排3次教学,时长约90分钟,间隔3～4天进行,总时长180分钟,共培训2个阶段.试验组分为3个小组,每阶段培训在A、B、C三组SSP中轮转.对照组分为3个小组,固定由A(B、C)组SSP配合完成,不进行轮换.通过专家考核、SSP印象评分、问卷调查评价教学效果.结果 专家考核中,试验组在语言表达、副语言信息、沟通效果评价方面优于对照组.试验组SSP印象评分优于对照组.问卷调查显示86.1％的学生认为分层SSP培训对提高沟通技能更为有效.结论在沟通技能培训中应用分层SSP可显著提高培训效果,值得进一步研究和推广.

Objective To compare differences of gut microbiome between patients with severe acne vulgaris and healthy individuals by using high-throughput sequencing technology.Methods Stool samples were collected from 10 outpatients with severe acne vulgaris and 10 age-and sex-matched healthy controls.Then,the bacterial DNA was extracted and subjected to 16S rRNA sequencing for the identification of microbial species,and the differences of gut microbiome were compared between the patients and controls.Results There were no significant differences in the diversity of intestinal microflora,but only the relative abundance of a few bacteria differed significantly between the two groups.Gut microbiome in the two groups mainly consisted of Bacteroidetes,Firmicutes,Proteobacteria and Actinobacteria.There were no significant differences in the relative abundance of bacteria at the phylum and genus levels between the two groups.However,the relative abundance of Blautia producta and Coprococcus eutactus at the species level differed remarkably between the two groups.Conclusion No significant differences in the bacterial diversity indices are found,but some bacterial species significantly differ between the patients with severe acne vulgaris and healthy controls.

目的 评价染料脉冲光(Dye pulse light,Dye-PL)治疗以面部潮红为主要表现的敏感性皮肤的有效性及安全性.方法 对伴有面部潮红的敏感性皮肤患者12例实施全面部Dye-PL治疗,治疗能量密度8～14 J/cm2,每4周1次,共治疗3次.分别在治疗前(T0)、治疗3次结束后28 d(T1)两个时间点,采集患者面部照片,行面部皮肤镜、无创皮肤生理功能检查,同时随访患者主观症状改善情况及不良反应.结果 时间点T1与T0相比,患者主观症状、皮疹改善明显,皮肤镜下增生血管明显减少变细,皮肤颜色相关指标黑素指数(melanin index,MI)及红斑指数(erythemaindex,EI)显著降低(P＜0.05).整个治疗过程中无严重不良反应出现.结论 Dye-PL治疗以面部潮红为主要表现的敏感性皮肤安全而有效.

tions excluded a diagnosis of basal cell naevus syndrome. After multidisciplinary evaluation, including input by a dermatology surgeon, dermatologist and oncologist, vismodegib 150 mg/day was started, and the patient was closely followed up. Most of the BCC lesions regressed within 1 month of treatment, but a well-defined, red, vegetating nodular lesion developed at the same time, evolving from a small pre-existing ulcerated plaque located on the medial nasal sidewall (Fig. 1a,b). Under the suspicion that this was an SCC, the association of which with vismodegib treatment is still unclear, the patient underwent surgical excision with a deferred reconstruction (Fig. 1c). Histological examination of the tumour identified a grossly nodular, outgrowing lesion within the dermis, which was ulcerating the epidermis. It lacked features of epithelial atypia. The proliferation was composed of a highly pleomorphic population of predominantly large spindle-shaped cells, with a highmitotic rate and a component of unusual giant cells (Fig. 2a–c). Those features, associated with specific immunostaining results (diffuse strong CD10 positivity, partial expression of CD68R/ PGM1, and negativity for MelanA, broad-spectrum cytokeratins, p63, p40, desmin, HHF35, h-Caldesmon and CD34) (Fig. 2d–h), supported the diagnosis of atypical fibroxanthoma, completely excised. Computed tomography of the head and neck gave negative results, and the patient underwent secondary reconstruction by skin graft. Six months later, the patient was tolerating ongoing vismodegib therapy with only dysgeusia. This is consistent with other reports of the long-term tolerability of this treatment. Currently, he has reported no other relevant adverse effects. As suggested by Mohan and colleagues for SCC, the high mutational load of the epidermis induced by ultraviolet radiation and other insults may lead to its being ‘spring-loaded’ to produce SCC once the hedgehog pathway is inhibited by vismodegib. The exact mechanism by which hedgehog inhibition may increase the risk of other nonmelanoma skin cancers is unknown, but recent data obtained from medulloblastoma models show that Hedgehog pathway inhibition can activate the RAS– mitogen-activated protein kinase (MAPK) pathway, thereby circumventing Hedgehog pathway dependency for tumour growth. Because of the association between RAS pathway dysregulation and multiple human cancers (including atypical fibroxanthoma), Hedgehog pathway inhibition, such as through vismodegib therapy, could promote the development of other secondary cancers. However, a recent study by Bhutani and et al. concluded that vismodegib was not associated with an increased risk of subsequent SCC compared with standard surgical treatment of BCC, therefore further large-scale, placebocontrolled trials are needed to definitively assess this risk. In our case, the association between the enhancement of the growth of this rare skin tumour and the therapy with vismodegib is suggested by the rapid development of the lesion from a pre-existing papule, concomitantly with the beginning of therapy (30 days). To our knowledge, this is the first reported case of atypical fibroxathoma promoted by vismodegib.

Objective To investigate the effects of closed working environment in submarine on human skin barrier function. Methods Thirty cases of young men were simply randomly selected. Indicators of skin barrier functions including stratum corneum hydration (SCH), melanin index (MI), erythema index (EI) and transepidermal water loss (TEWL) were noninvasively detected and compared on three sites of skin (forehead, back of hand, and abdomen) of every subject at two different time point of before (T0) and 48 hours after (T1) submarine commission respectively. Results MI and EI of the subjects' forehead and back at T1 decreased significantly compared with those at T0. There was no significant change in MI and EI of abdominal skin. SCH and TEWL of all three sites of skins varied little between T0 and T1 after tape strips. TEWL increased significantly on skins of forehead, back of hand, and abdomen at T1 comparing with those at T0 (P < 0.05), and the recovery rate decreased (P < 0.05). Conclusion A long term ( >2 months) work in a closed environment as submarine will impair human stratum corneum integrity and pigment barrier, but impact little on SCH and TEWL as observed.

孤立皮损是皮肤科患者的常见就诊原因，且常为单发性皮肤肿瘤的首发表现。目前我国皮肤肿瘤流行病学的研究还很滞后，关于皮肤肿瘤临床与组织病理联系的资料也较少［1－4］。本研究选择以孤立皮损就诊，组织病理检查确诊为良、恶性单发性皮肤肿瘤的病例为研究对象，总结其临床与组织病理资料，以期对皮肤肿瘤的流行病学研究及诊治提供有意义的思路和线索。