Atopic dermatitis (AD) is a chronic inflammatory cutaneous disorder in which the skin is affected by microbial dysbiosis. The role of commensal skin microbiota in AD is of great interest. Extracellular vesicles (EVs) are important regulators of skin homeostasis and pathology. The mechanism of preventing AD pathogenesis through commensal skin microbiota-derived EVs remains poorly understood. In this study, we investigated the role of commensal skin bacterium Staphylococcus epidermidis-derived EVs (SE-EVs). We showed that SE-EVs significantly decreased the expression of proinflammatory genes (TNFa, IL1b, IL6, IL8, and iNOS) through lipoteichoic acid and increased the proliferation and migration of calcipotriene (MC903)-treated HaCaT keratinocytes. Furthermore, SE-EVs increased the expression of human b-defensins 2 and 3 in MC903-treated HaCaT cells through toll-like receptor 2, enhancing resistance to S. aureus growth. In addition, topical SE-EV application remarkably attenuated inflammatory cell infiltration (CD4 & thorn; T cells and Gr1 & thorn; cells), T helper 2 cytokine gene expression (Il4, Il13, and Tlsp), and IgE levels in MC903-induced AD-like dermatitis mice. Intriguingly, SEEVs induced IL-17A & thorn; CD8 & thorn;T-cell accumulation in the epidermis, which may represent heterologous protection. Taken together, our findings showed that SE-EVs reduced AD-like skin inflammation in mice and may potentially be a bioactive nanocarrier for the treatment of AD.

Due to the difficulty of overcoming the abnormal epidermal barriers and addressing S. aureus infections without disrupting indigenous skin microbiota, effective treatment of bacterial infection atopic dermatitis (AD) remains a significant clinical challenge. Skin microbiota-derived extracellular vesicles (EVs) shows protentional for skin disease treatment, but the lack of antimicrobial activity and limited skin penetration hamper their application in bacterial infection AD treatment. Here, we developed novel nanoantibiotics by loading Lev into S. epidermidis-derived EVs (Lev@SE-EVs), with supreme antimicrobial activity, regulating epidermal immune responses and enhanced epidermal barrier functionality. The nanoantibiotics were further integrated into hyaluronic acid-based microneedle (MN) for efficient transdermal delivery of therapeutic agents and effectively treating bacterial infection in AD. Upon insertion into the skin, the rapidly released Lev@SE-EVs from MN are uptake by S. aureus in a selective manner, fibroblasts, and surrounding immune cells to exert therapeutic effects in the infected dermal layer, resulting in mitigated skin inflammation, reduced S. aureus burden and increased dermis repair. Notably, Lev@SE-EVs induce IL-17A+ CD8+ T-cell accumulation in the skin in an unrelated inflammation manner, which may represent heterologous protection. This EVs-integrated MN assisted Lev@SE-EVs to alleviate skin inflammation, repair skin, and provide an effective and safe therapeutic approach for bacterial infection AD treatment.

There is a potential correlation between vitiligo and gut microbiota, although research in this area is currently limited. The research employed high-throughput sequencing of 16S rRNA to examine the gut microbiome in the stool samples of 49 individuals with vitiligo and 49 without the condition. The study encompassed four comparison groups: (1) DI (disease) group vs. HC (healthy control) group; (2) DI_m group (disease group of minors) vs. HC_m group (healthy control group of minors); (3) DI_a group (adult disease group) vs. HC_a group (adult healthy control group); (4) DI_m group vs. DI_a group. Research findings have indicated the presence of spatial heterogeneity in the gut microbiota composition between individuals with vitiligo and healthy controls. A significant reduction in gut microbiota diversity has been observed in vitiligo patients across both minors and adult groups. However, variations have been noted in the composition of disease-related differential microbial markers among different age groups. Specifically, Bacteroides and Parabacteroides have been identified as specific markers of the intestinal microbiota of vitiligo patients in both minor and adult groups. Correlative analyses have revealed a positive correlation of these two genera with the Vitiligo Area Scoring Index (VASI) and disease duration. It is noteworthy that there are no significant differences in diversity between the DI_m group and the DI_a group, with similarities in microbiota composition and functional characteristics. Nevertheless, correlative analyses suggest a declining trend in Bacteroides and Parabacteroides with increasing age. Individuals with vitiligo exhibit distinct features in their gut microbiome when contrasted with those in the healthy control group. Additionally, the microbial marker genera that show variances between patients and healthy controls vary among different age groups. Disease-specific microbial marker genera (Bacteroides and Parabacteroides) are associated with VASI, duration of the condition, and age. These findings are essential for improving early diagnosis and developing potential treatment strategies for individuals with vitiligo.

目的 探讨肿瘤患者外周插入中心导管(peripherally inserted central catheters,PICC)继发皮肤损害处的菌群组成.方法 选择2019年12月至2021年6月我院收治并接受PICC置管的肿瘤患者62例.其中31例患者PICC置管处继发皮肤损害,纳入PICC组;31例患者PICC置管处未发生并发症,纳入对照组.采集两组患者PICC置管处的皮肤微生物并进行16SrRNA基因测序和分析.采用Mann-Whitney U检验分析两组对象皮肤微生物的丰度差异.采用随机森林分类模型对最佳PICC组分类单元集进行变量重要性分析,并且分析皮肤微生物群对PICC置管处继发皮肤损害的鉴别价值.结果 共鉴定出15 243个可操作分类单元(operational taxonomic units,OTUs),鉴定水平为99.3％.移除罕见OTU后,保留1 958个OTU.分析表明PICC组和对照组之间皮肤微生物丰度存在显著差异,其中有7个菌群变化最显著.Staphylococcus aure-us 在PICC组中的丰度显著增加,而代表严格厌氧菌的Burkholderia sp.、Finegoldia sp.、Staphylococcus sp.、Lactobacillus sp.、Pelomonas sp.、Propionibacterium acnes 在 PICC 组中的丰度显著降低.此外,PICC 组患者菌群多样性减少.随机森林特征选择和分类分析鉴定出26种可区分PICC组和对照组的微生物,其中最具鉴别性的分类群是葡萄球菌属,包括 Staphylococcus aureus(Z=16.03,AUC=0.99)、Staphylococcus epider-midi(Z=4.14,AUC=0.98)、Staphylococcus sp.(Z=-7.21,AUC=0.98)、Burkholderia sp.(Z=-8.59,AUC=0.98).结论 PICC置管处继发皮肤损害的肿瘤患者其皮肤菌群失调,其中Staphylococcus aureus的丰度增加最多.

患者男,64岁,右侧乳头破溃,反复渗出流血3年余.皮肤科情况:右侧乳头呈灰蓝色,中央溃疡凹陷,表面少量渗出、流血,部分上覆棕色结痂.左侧乳头及乳晕正常.双侧腋窝未触及肿大的淋巴结.皮损组织病理示:真皮内可见嗜碱性基底样细胞构成的大小不等的肿瘤细胞团块,团块周边排列成栅栏状,可见收缩间隙.诊断:结节/溃疡型基底细胞癌.治疗:行手术治疗,患者术后恢复较好,目前仍在随访中.

Background: The newly described ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area [BSA]) is a 5-item mortality prediction model for patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). It was developed in the United States, has at present been externally tested only in the United States, Spain, and Singapore, and remains to be validated in resource-restricted settings. We sought to compare the accuracy of ABCD-10 and Score of Toxic Epidermal Necrolysis (SCORTEN) in predicting in-hospital mortality in a cohort from central China. Due to disease progression affecting the accuracy of the prediction model during hospitalization, for example, higher predictive accuracy of SCORTEN based on parameters collected on day 3 of hospitalization, we also assessed the overall predictive value of ABCD-10 on days 1 and 3, respectively. Methods: A retrospective study was performed over a 10-year period (2010-2020) from 3 medical institutions in Wuhan. The performance of predictive models was assessed by both discrimination and calibration. Receiver-operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit tests and calibration plots were used to evaluate the model discrimination and calibration. Results: Of 84 included patients, 11 (13.1%) did not survive. The discrimination power of ABCD-10 was not significantly different from that of SCORTEN (area under the curve: day 1, p > 0.05; day 3, p > 0.05). Although the calibration of ABCD-10 was good, it was inferior to SCORTEN as it underestimated total mortality (Hosmer-Lemeshow goodness-of-fit test: day 1, p = 0.17 vs. p = 0.63; day 3, p = 0.35 vs. p = 0.93). Besides, the performance of ABCD-10 was slightly better on day 3 relative to day 1. During hospitalization, bacteremia developed in 21 (25.0%) patients, which was associated with a higher risk of death in our cohort (odds ratio, 22.88; 95% CI, 4.38-119.40; p < 0.001). Conclusion: ABCD-10 showed acceptable overall performance, but revealed mortality underestimation and was inferior to the performance of SCORTEN. In consistence with SCORTEN, ABCD-10 was a better model when using values collected at day 3 of hospitalization relative to day 1.

肠道微生态在维持人体健康以及疾病发生发展过程中有着重要的作用,其可以通过细菌种群及其代谢物影响全身免疫系统.在皮肤组织中,肠道微生态能够调控皮肤细胞的分化和局部免疫反应,并且建立、维持皮肤稳态.笔者从肠道微生态的组成及作用出发,叙述其与皮肤稳态的相互影响,并以痤疮、特应性皮炎和银屑病等常见炎症性皮肤疾病为例,探讨肠道微生物群及其代谢产物对肠-皮肤轴和免疫通路、稳态的影响以及如何在这些皮肤疾病的发生和防治中发挥重要作用;并结合部分使用益生菌治疗皮肤病的临床和基础研究,为这些皮肤病的治疗提供新思路,强调进一步探索肠-皮肤轴、开发更全面可靠的长期微生物菌群干预措施的重要意义.

银屑病是一种慢性反复发作的炎症性皮肤病,发病机制与遗传因素、免疫异常及环境因素密切相关.银屑病的诊断通常依据典型的临床表现,但对于位于特殊部位或者治疗后皮疹出现不典型表现的情况,需要依赖皮肤组织病理明确诊断.此为有创检查,存在的风险使得患者的接受度有限.因此,随着皮肤影像技术的发展,皮肤镜、反射共聚焦显微镜、高频超声、光学相干断层扫描、光声成像等技术逐渐应用于皮肤疾病的诊断及治疗.本文对各种无创成像技术在对银屑病的诊断及治疗监测的作用进行了综述.

Infection with Helicobacter pylori (Hp) can result in imbalance in the immune system in humans. The long-term interaction of immunity between host and bacteria leads to loss of the skin au-toantigen tolerance, leading some immunological dermatoses. The eradication of Hp has been shown to relieve symptoms in some chronic immune skin diseases, such as urticaria, rosacea, psoriasis and auto-immune bullous disease,. However the relationship between Hp infection and Behcet's disease, sclero-derma, alopecia areata and allergic purpura is still controversial. This review focuses on the relationship between Hp infection and common immune skin diseases.

山东近十年为实现金刚石找矿新突破,针对鲁西金刚石原生矿"攻深扫盲",开展了基于不同技术方法的深部成矿预测,主要包括:金刚石资源量定量预测(1600 m以浅),可控源大地电磁测深法(CSAMT)反演预测(1000 m以浅),基于重力、大地电磁测深、反射地震综合物理方法反演预测(4 km以浅),基于断裂构造特征分析对已知矿体深边部三维定位定量预测.本文系统阐述各深部预测的技术方法、参数选择、技术路线等,评价各预测方法的实际效果,提出将地球物理、地质钻孔、地质剖面等多元地质信息有效融合进行三维综合信息成矿预测的思路,以进一步提高深部成矿预测的有效性和可靠性,总结了鲁西金刚石矿田由浅至深关于岩性、金刚石粒度及规模形态的变化规律,为今后金刚石找矿及预测工作中有效判别金伯利岩筒的"相带"部位、规模形态及含矿性提供经验积累,助力金刚石找矿及预测实现新突破.

目的观察microRNA-125b（miR-125b）和信号传导转录激活因子3（STAT3）在皮肤鳞状细胞癌（CSCC）中的表达,并探讨miR-125b靶向STAT3进而调控CSCC发生发展的分子机制。方法采用qRT-PCR法和Western Blot检测32例CSCC组织及其周围正常皮肤组织中以及CSCC细胞系（A431、SCC13和SCL-1）和正常皮肤细胞系HaCaT中miR-125b和STAT3的表达。荧光素酶报告基因实验被用于验证miR-125b对STAT3的靶向作用。采用MTT法和流式细胞术检测miR-125b mimic或STAT3 shRNA对CSCC细胞系（A431、SCC13和SCL-1）细胞增殖、细胞周期和细胞凋亡的影响。采用克隆形成实验、细胞转移和侵袭实验观察miR-125b mimic对CSCC细胞系A431细胞的增殖、转移和侵袭能力的影响。结果与正常皮肤组织和细胞相比,CSCC组织和细胞中miR-125b表达显著下降,而STAT3的表达则显著上调。miR-125b靶向STAT3的3’-UTR发挥对其表达的调控作用。miR-125b mimic或STAT3 shRNA转染后,A431、SCC13和SCL-1细胞的增殖明显受抑制,G0/G1期细胞比例明显增加,并且促进了细胞凋亡。miR-125b mimic能明显抑制A431细胞的克隆形成、细胞转移和侵袭的能力。结论 miR-125b/STAT3的表达异常通过影响细胞的增殖、凋亡和侵袭参与了CSCC的发生发展。二者可成为CSCC新的诊断和治疗靶点。

2019年12月以来新型冠状病毒感染肺炎发生于武汉并迅速蔓延至全国.皮肤作为人体的第一道防线,在抗击疫情工作中皮肤科医务人员责无旁贷.为进一步做好新型冠状病毒感染肺炎预防与控制工作,有效降低新型冠状病毒肺炎在皮肤科病房的传播风险,规范医务人员的诊治程序,我们根据皮肤科病房收治的1例疑似新型冠状病毒肺炎患者的诊治经验和新型冠状病毒感染肺炎的医院感染相关制度,特整理出皮肤科病房防控新型冠状病毒感染肺炎的应急策略.

自2019年12月以来,一场新型冠状病毒肺炎(novel coronavirus disease,COVID-2019)疫情从我国湖北武汉爆发并迅速蔓延到世界各地.在这场疫情中,一方面,医务人员需要长时间穿戴防护设备,极易发生一些职业相关的次生皮肤病或使原有皮肤病加重.另一方面,居家隔离的慢性皮肤病患者可能因无法及时就医而发生病情加重或反复.此外,疫情期间因恐慌焦虑出现的心理问题也会引发一系列皮肤疾病.积极探讨如何去正确处理这些疫情期间可能发生的皮肤问题,既可为临床皮肤科医生抗疫工作提供参考,也为未来可能发生的其他公共卫生事件提供借鉴.

Recently, the 2019 novel coronavirus has rapidly spread throughout China. The medical staff at dermatology departments of some hospitals in Hubei province also participated in the fight against coronavirus disease 2019. However, many problems emerged during this period. Some medical staff at dermatology departments lacked abilities to deal with emergencies, self-protect, and to conduct surveys on skin diseases occurring in this period. In this article, the authors highlight common problems in and give advice on dermatology teaching about national public health emergencies to healthcare workers, undergraduate students, graduate students and senior residents, hoping that healthcare workers at dermatology departments will calmly deal with public health emergencies in the future.

To the Editor: Recently, the number of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in China has been decreasing. At manuscript preparation, new cases had not been reported in Wuhan since March 18, 2020.1The Novel Coronavirus Pneumonia Emergency Response Epidemiology TeamThe epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) — China, 2020.China CDC Weekly. 2020; 2: 113-122Crossref Scopus (1278) Google Scholar As health care systems resume routine clinical activities, implementation of robust infection control measures to prevent nosocomial transmission of SARS-CoV-2 remains a top priority.2Bowdle A. Munoz-Price L.S. Preventing infection of patients and healthcare workers should be the new normal in the era of novel coronavirus epidemics.Anesthesiology. 2020; 132: 1292-1295Crossref PubMed Scopus (46) Google Scholar Our dermatology department is in Wuhan, the area first and worst affected by coronavirus disease 2019 in China. We aim to share our experiences in this unique position by outlining our infection control plan. We hope that it can serve as guidance for dermatology departments and the health agencies overseeing them. In the early days of the outbreak, high rates of nosocomial SARS-CoV-2 infections were observed in health care workers. More than two-thirds of infected health care workers had contracted the virus in units without known coronavirus disease 2019 patients.3Wang D. Hu B. Hu C. et al.Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China.JAMA. 2020; 323: 1061-1069Crossref PubMed Scopus (16038) Google Scholar We suspect that covert carriers of the virus may have contributed to this unchecked nosocomial spread; Qiu4Qiu J. Covert coronavirus infections could be seeding new outbreaks.Nature. 2020 Mar 20; (Online ahead of print)https://doi.org/10.1038/d41586-020-00822-xCrossref Scopus (157) Google Scholar reported that 60% of infections may be asymptomatic. By remaining cognizant of this risk, even in departments not directly involved in treatment of coronavirus disease 2019, we devised the following infection control plan for our dermatology clinic: First, an experienced infection control expert team was established. This team took responsibility for training and managing health care workers, including hand hygiene and the proper use of personal protective equipment (Supplemental Material 1 available via Mendeley at https://data.mendeley.com/datasets/s3ncfct2z8/1), as well as monitoring their state of health. We also held emergency simulations outlining protocols for inpatient dermatology admissions and consultations, as well as contingency plans for exposure to SARS-CoV-2–infected patients or health care workers in dermatology clinics. Next, the department was divided into clean, potentially contaminated, and contaminated zones. The potentially contaminated and contaminated zones were separated by 2 buffer zones (Fig 1). Patients and staff were to use separate passageways. Before entering the designated patient care area (contaminated zone), staff would don personal protective equipment in the clean zone. On exiting the contaminated zone, they would follow a series of transitions before returning to the clean zone. In the first buffer zone, they doffed personal protective equipment (except working clothes, N95 masks, goggles, and caps). Then they entered the potentially contaminated zone to remove the remaining items. Next, they transitioned to the second buffer zone, where they donned a new surgical mask. Only then did they enter the clean zone. This functional and geographic division of the clinics and wards was designed to minimize the risk of cross contamination. By sanitizing and washing hands in each zone and using adequate personal protective equipment for all patient encounters, we lessened the risk of nosocomial transmission. Finally, all employees were required to achieve 100% on a written examination (Supplemental Material 2). Thirty-five staff members completed the test (response rate 100%). Because of the relatively low accuracy rate of personal protective skills (82.04%) and division of work area (84.28%) (Fig 2), some dermatology staff received additional training. In the fight against future outbreaks, infection-prevention strategies take precedence.2Bowdle A. Munoz-Price L.S. Preventing infection of patients and healthcare workers should be the new normal in the era of novel coronavirus epidemics.Anesthesiology. 2020; 132: 1292-1295Crossref PubMed Scopus (46) Google Scholar Dermatologists should be trained in these measures, and clinics should be modified to minimize the risk of nosocomial transmission. We want to express our deep respect for all the first-line health care workers for their dedication in the fight against SARS-CoV-2 and thank the health care workers who participated in this study.

住院医师规范培训是医学生毕业后教育的重要组成部分,对培训临床高层次医师极为重要,它承担了医学终生教育的承前(医学院校基本教育)和启后(继续医学教育)的重要地位,是临床医生成长过程的关键所在.而皮肤科作为临床医学中的一门基础学科,因其临床实用性强,且对医师基本功要求高,因此如何做好皮肤科住院医师临床诊断的思维能力训练,就成为规范化培训教学研究的重点.文章借武汉华中科技大学同济医学院附属协和医院皮肤科开展住院医师全新模式的教学查房,对此种创新性的临床规范化培训方法进行了初步的探讨及研究,为更好的培养皮肤科合格的住院医师总结了经验.

过敏性紫癜(HSP)是一种以皮肤紫癜、瘀点、瘀斑为主要表现的变态反应性小血管炎,好发于儿童,发病原因至今不明.近年来认为各种感染,包括细菌、病毒、支原体/衣原体、真菌等微生物以及寄生虫感染是过敏性紫癜的主要诱因,由感染因素引发的过敏性紫癜发生肾损害的概率较高,严重影响患者的预后.大量研究显示,对HSP患者进行抗感染治疗后患者病情缓解.临床医师在治疗HSP时除了要积极治疗原发病外,还要评估患者有无其他脏器(尤其是肾脏)受累,及早进行干预以改善预后.

1病历摘要 患者女,37岁.因腹壁斑疹8年,明显增大半年于2015年3月21日来我科门诊就诊.患者8年前行剖宫产手术,切口愈合后即发现其下缘有一黄豆大暗红色斑疹,不突出于皮面,因无自觉症状而未予诊治.半年前无明显诱因斑疹突然增大,并逐渐隆起至鸽蛋大,偶有局部不适及轻度痒感,无明显疼痛.既往体健,无慢性疾病及类似疾病家族史.

目的 观察白芍总苷(total glucosides of paeony,TGP)对人肥大细胞组胺释放的影响,探讨TGP治疗慢性荨麻疹等变态反应性疾病的机制.方法 取正常成人包皮,采用酶消化法分离肥大细胞,甲苯胺蓝染色鉴定肥大细胞.不同浓度TGP(100、200、400、800、1600μg/ml)作用肥大细胞24 h后,采用细胞计数试剂盒(cell counting kit 8,CCK-8)检测TGP对肥大细胞毒性的影响.在抗IgE抗体激活肥大细胞后,采用酶联免疫吸附试验(enzyme linked immunosor-bent assay,ELISA)检测不同TGP浓度(200、400、600、800μg/ml)对肥大细胞组胺释放的影响.结果 经甲苯胺蓝染色法鉴定后培养出来的细胞为肥大细胞.TGP的浓度在100、200、400、600、800、1600μg/ml时,对正常肥大细胞均无明显毒性.抗IgE抗体激活肥大细胞后,200、400、600、800μg/ml TGP可抑制肥大细胞组胺的释放.结论 采用此法成功分离出人肥大细胞,TGP在一定浓度范围内对人正常肥大细胞无明显细胞毒性,但能显著抑制人肥大细胞组胺的释放.

人人都希望拥有健康,不愿意疾病缠身.可有些人过分害怕疾病,由此产生不正常的恐惧心理,没有病也认为自己病入膏盲.这就成了一种妄想症. 皮肤寄生虫妄想症 一位50多岁的中年妇女来门诊看病,她说自己得了一种怪病.