目的:探讨不同剂量异维A酸联合脉冲染料激光治疗酒渣鼻的疗效及安全性.方法:纳入2016年10月-2019年1月海军军医大学附属长征医院皮肤科收治的Ⅱ、Ⅲ期酒渣鼻患者150例,按照随机数字表法分为观察组、对照组和激光组,每组50例.三组患者均给予脉冲染料激光照射治疗,观察组:给予起始剂量20mg/d的异维A酸治疗,每周按每天5mg进行减量,3周后减至5mg/d口服,维持;对照组:给予15mg/d异维A酸治疗,维持;激光组:单纯给予脉冲染料激光治疗.三组患者均连续治疗8周,观察三组的临床疗效、治疗前后皮损评分及不良反应发生情况.结果:观察组临床总有效率为90.00％,对照组总有效率为92.00％,两组比较差异无统计学意义(Z=0.122,P=0.727);但观察组、对照组总有效率均高于激光组(Z=4.336,5.741,P<0.05);三组患者治疗后丘疹/脓疱、毛细血管扩张及鼻赘评分均低于治疗前(P<0.05);治疗后,观察组和对照组比较差异无统计学意义(P>0.05);治疗后,观察组和对照组丘疹/脓疱、毛细血管扩张及鼻赘评分均低于激光组,差异具有统计学意义(P<0.05);治疗期间,观察组不良反应发生率低于对照组和激光组,差异具有统计学意义(χ2=5.655,P=0.019).结论:与常规剂量相比,极低剂量的异维A酸联合脉冲染料激光治疗中重度酒渣鼻也能获得较好的疗效,能够明显改善面部皮损评分,且安全性高,值得临床医生借鉴应用.

教学评价就是依据一定的教学目标和标准,对教学活动是否达到既定标准,是否满足学生、教师的发展需求的价值判断.本文主要通过对教学质量评价工作在皮肤性病学专业的实践探索,为本专业建立和完善有效的教学质量评价机制提供参考.

为进一步深化军队院校建设的教学改革,探索新型教学模式和方法,结合皮肤性病学的学科特点和专业特色,将PBL案例教学和微视频建设进行有机结合,体现“面向全军、服务基层、能力导向、专科特长”的军队特色.

Chronic urticaria (CU) is characterized by repeated occurrence of wheals or itching for more than 6 weeks. When urticaria symptoms repeatedly occur despite taking Western medicines such as antihistamines, Chinese medicine (CM) has been shown to relieve symptoms and prevent recurrence. However, the lack of robust evidence from the evidence-based medicine perspective is hindering acceptance of CM by the Western medicine community. In recent years, more and more evidence-based studies of CU treatment by CM were report in English literatures, including acupuncture, herbs, and food, although some of evidence is still with low quality. These progress in CM treatment of CU will inspire high quality evidences via randomized, controlled trials assessing effificacy and safety of CM treatment of CU.

近年来,随着真菌感染发病率的不断提高,有关医学真菌学的教学显得尤为重要。该文以《头癣》为例,在科学取向教学论的指导下,就教学任务、教学目标、教学策略和教学评价等方面展开教学设计,对医学真菌学的教学具有重要的参考意义。

Combined with previous literatures being reviewed, this paper analyzed various teaching indicators according the theory of scientiifc instruction/teaching in Dermatology, such as teaching objectives, which has a certain theoretical and practical signiifcance for the daily teaching of Dermatology and Venereology.

为进一步深化军队医学院校的教学改革,探索新型教学模式和方法,本文在全面了解微视频建设现状的基础上,分析其优势和不足.同时,结合皮肤性病学的学科特点和专业特色,对微视频的建设工作开展可行性设计与开发,并努力构建成一系列微视频作品,旨在丰富传统教学模式的前提下实现高效学习,体现“面向全军、服务基层”的军队特色.

随着社会老龄化的加剧,老年相关的许多疾病开始引起社会的广泛关注,其中皮肤瘙痒症严重影响了老年人的生活质量.皮肤瘙痒症是由各种原因引起的皮肤瘙痒症状,秋冬季节尤其严重. 针对老年人皮肤的特殊性,采用相关的预防措施,积极进行针对性治疗,配合生活规律,劳逸结合,可以达到有效治疗和预防的目的.

Primary cutaneous cryptococcosis (PCC) has been confirmed as a distinct clinical entity with secondary cutaneous cryptococcosis from systematic infection since 2003. Although it has been confirmed as a distinct clinical entity, little has progressed on PCC in immunocompetent hosts compared to their immunocompromised counterpart. We reviewed the literature on cases of PCC in immunocompetent patients from 2004 to 2014, and 21 cases from 16 reports were identified. Males are more likely to develop PCC infections, with a ratio of 17:4 male to female. These patients were found to be almost all senior population except for patients from Asia. Asymptomatic or moderate itching manifesting in a painful nodule is the most common presentation, although there is no typical clinical manifestation recorded. Upper limbs are the most common site of infection, accounting for 71.4 % of all patients. Of the 12 identified isolates, 6 strains are identified as C. neoformans, 5 as C. gattii, and 1 as C.laurentii. Fluconazole was used in 10 cases; however, only 80 % of the 10 cases could confirm that fluconazole was effective in clearing the infections. Interestingly although not approved as a treatment option, Itraconazole was effective in the seven cases it was used to treat cryptococcosis, with a dosage range of 100-400 mg/d and duration from 3 to 6 months. Even though the prognosis of these patients was generally good, more data are need to determine which antifungal azole is the better treatment option and whether primary skin infections could disseminate to systematic infection.

在八年制的皮肤性病学教学实践中,教师通过心理学角度进行的先行组织者策略,对应学生原有认知结构,进行真正的意义学习,并结合具体课程的教学设计进行说明.

To summarize the epidemiology, clinical features, treatment, and outcome of cryptococcal meningitis (CM) in autoimmune hemolytic anemia (AIHA) patients and to provide a reference for the prevention and control of AIHA complicated with CM, we evaluated five cases of CM in patients with AIHA treated in our hospital from 2003 to 2013 and eight related foreign cases. All of the clinical isolates were Cryptococcus neoformans var. grubii and grouped into the VNI genotype and serotype A. The clinical features exhibit significant features. Headache, nausea, and fever are common symptoms of AIHA complicated with CM. The early clinical manifestations lack specificity, which may lead to delayed diagnosis and treatment. Long-term use of prednisone (≥15 mg day−1), poor control of anemia, and splenectomy are risk factors for AIHA complicated with cryptococcal infection. The combination of intravenous amphotericin B and oral 5-fluorocytosine remains the preferred treatment for AIHA complicated with CM.

在皮肤性病学教学实践中,教员在微视频建设中,力争将授课的难点或重点转变成短而精的微片段,后串联成一个有意义的联结体,引导学员进行真正意义的学习.并结合带状疱疹临床表现这一知识点,进行微视频的合理构建.

This article analyzes the problems exist in the current curriculum evaluation system and explores the construction of a reasonable evaluation system which combining formative evaluation and summative evaluation of Dermatology.It provides a useful reference and credible evidence for improving teaching evaluation approach and teaching quality of this course.

Objective To analysis the clinical features of renal transplant patients with cryptococcal meningitis,and the difficulties of the diagnosis and treatment.Methods Four patients with cryptococcal meningitis after renal transplantation were involved in this study.The clinical manifestations,laboratory data,treatment and prognosis were analyzed.Results Four patients,2 male and 2 female,were underwent renal transplantation for the first time.The clinical manifestations included headache and fever.Three patients were confirmed cryptococcal meningitis by CSF culture and means of India ink.All patients were given antifungal treatment of amphotericin B liposome,voriconazole,and 5-flucytosine,while 1 patient was given amphotericin B intrathecal injection.After 2-4 months treatment,the results of cryptococcus smear turned negative,and clinical symptoms disappeared in 4 patients.Now all the 4 patients are still in follow-up,and there are no relapse.Conclusions Renal transplant patients with cryptococcal meningitis presented atypical clinical manifestations,which made it extremely difficult to diagnosis.Early diagnosis,timely treatment,and cooperation between different departments are the key to improve outcomes.

Medical teaching for foreign medical students has been carried out in our university.Combining the teaching experience of dermatology,analyzing relative teaching problems and proposing corresponding countermeasures,this paper tries to explore more efficient English teaching metllods for foreign medical students in dermatology.

报告1例骨膜增生厚皮症.患者男,25岁.头面部皮肤及四肢末端进行性增生肥厚10年余.皮肤科检查:颜面部皮肤肥厚增生,折叠,呈沟回状,皮脂溢出明显,面容为痛苦绝望表情,眼距宽、鼻梁低、鼻端大,呈狮面,枕部头皮呈脑回样,皱襞粗大,沟嵴明显,前臂和小腿呈圆柱状,似象皮腿,手指和足趾呈杵状,小鱼际肥厚明显,呈铲样手,余检查未见异常.

Amphotericin B deoxycholate (AmB), a classic antifungal drug, remains the initial treatment of choice for deep fungal infections, but it is not appropriate for treatment of cryptococcal meningitis due to its inability to pass through the blood–brain barrier (BBB). We examined the efficacy of amphotericin B-polybutylcyanoacrylate nanoparticles (AmB-PBCA-NPs) modified with polysorbate 80 that had a mean particle diameter less than 100 nanometers (69.0 ± 28.6 nm). AmB-PBCA-NPs were detected in the brain 30 minutes after systemic administration into BALB/c mice and had a higher concentration than systemically administered AmB liposome (AmB-L, P < 0.05); AmB was not detected in the brain. Following infection for 24 hours and then 7 days of treatment, the survival rate of mice in the AmB-PBCA-NP group (80%) was significantly higher than that of the AmB (0%) or AmB-L (60%) treatment groups. Fungal load was also lower when assessed by colony-forming unit counts obtained after plating infected brain tissue (P < 0.05). Our study indicates that AmB-PBCA-NPs with polysorbate 80 coating have the capacity to transport AmB across the BBB and is an efficient treatment against cryptococcal meningitis in a mouse model.

Objective To study the epidemiology and clinical features of primary cutaneous cryptococcosis from 2000 to 2008.Methods Cases of primary cutaneous cryptococcosis from 2000 to 2008 were retrospectively analysed and the differences with those between 1985 and 2000 were compared.Results PCC occurred more commonly in the older and the male in the recent 8 years.There was no difference in the onset between immunocompetent and immunocompromised hosts,while HIV positive patients had the lower probability to get PCC,xternal injury might be the important causative factors,erythra still happened majorly in extremities or other exposure sites,the erythra had changed from whitlow or cellulitis to ulcer,nodus,erythema,and so on,the oral antifungal drugs combined with surgery were most acceptable treatment and fluconazole was still the first choice for PCC,and the prognosis was good.Conclusions In recent years,PCC obtained some new characteristics.We considered that the immune state affected less or had no effect on incidence of PCC,while majorly affected the final outcome of Cryptococcus infection.

Objective To investigate the effect of Cryptococcus neoformans on the viability of keratinocytes.Methods Strains of Cryptococcus neoformans B3501 and its acapsule mutant cap64 were cocultured with keratinocytes and the viability of the keratinocytes was measured by flow cytometry after 0.5 h,1 h and 2 h.Results were compared with those of negative control,hear-killed fungi,and the fungi indirectly contacted with keratinocytes.Results Viability of keratinocytes decreased significantly cocultured with Cryptococcus neoformans by time prolonging,while more significantly after 1 h and 2 h's coculture with B3501.There was no difference in the viability of keratinocytes between coculture with killed B3501 and indirect coculture with B3501.Conclusions Capsule of Cryptococcus neoformans plays an important role in viability of keratinocytes.Indirect contact with Cryptococcus neoformans is necessary for viability decreasing.

SummaryCryptococcus neoformans is a medically important fungus and can infect all the organs of the body. As vascular endothelial cell is an important target for C. neoformans to penetrate any organs, the differential protein expression of human umbilical vascular endothelial cell (HUVEC) after incubating with C. neoformans may be the key to penetration. The proteins of HUVECs incubated with C. neoformans and normal HUVECs were collected and purified. After two‐dimensional electrophoresis, the differential protein expression was identified by matrix‐assisted laser desorption/ionisation mass spectrometry. The mRNA levels of some proteins were measured by real‐time PCR. Three proteins were found significantly overexpressed in HUVECs incubated with C. neoformans, and nine other proteins were downregulated. The mRNA levels of S100A10 and peroxiredoxin I fluctuated with the protein levels. These results suggested that the expressions of peroxiredoxin I and S100A10 were regulated during the process of invasion of HUVECs by C. neoformans. We hypothesise that these proteins take part in the modifications of HUVEC cytoskeleton and the tolerance to oxidative stress, which may affect the process of invasion by C. neoformans.