1病历资料<br>　　患者，男，70岁，因“全身反复红斑、丘疹、斑丘疹伴痒10月余”入院。10月前暴晒后于双手及前臂出现环形丘疹、斑丘疹，自觉瘙痒，当地医院诊断为“光化性皮炎”，给予“地氯雷他定片”等治疗无明显好转。皮损逐渐增多并蔓延至上臂，躯干及下肢。至外院治疗，诊断为“环状肉芽肿”，给予“复方甘草酸苷片、糖皮质激素”等药物治疗，皮损好转。近3个月来，患者全身出现相似皮损。患者阑尾切除术后12年，胆囊切除术后3年，有“青霉素”过敏史。无高血压、糖尿病、肝炎、<br>　　结核等病史。查体：一般情况可，浅表淋巴结未触及。皮肤科情况：躯干及四肢皮肤见粟粒至黄豆大小的扁平环状、圆形或类圆形红斑、丘疹，表面光滑，对称分布（图1，2）。实验室检查：血尿大便常规、血生化均正常，HP（＋），其余检查无异常。左下肢、背部组织病理检查示：表皮大致正常，真皮浅中层局部胶原纤维排列紊乱，周围见淋巴组织，上皮样细胞呈栅栏状排列，弹力纤维染色：弹力纤维减少（图3，4）。诊断：泛发型环状肉芽肿。

Selectins is a member of the family of cell adhesion molecules, and widely expressed on the surface of leukocyte, endothelial cell and platelet, closely related to inflammation, leukocyte homing, tumor migration and more other processes.In recent years, more research on selectins of dermatosis increased.This article is a brief review on dermatosis inflammation, immune response and tumor metastasis of the expression and change of selectins.

Objective To investigate the risk factors of delayed female acne and develop targeted prevention and intervention programs.Methods A case-control study has been carried out.There have many potential risk factors have been analyzed which include age, marriage, culture degree, time of computer-using, sunexposure, smoking, drinking, eating sweet, high fat diet, vegetables, animal oil.The independent samples t test, Chi square test of sin-gle factors and multivariate Logistic regression method were used to analyze the risk factors of female delayed acne. Results There were 71 patients in the case group and 251 persons in the control group.The results have shown that u-sing computer( OR=1.95,P<0.05) , and drinking( OR=2.335,P<0.05) are the main risk factors in related to fe-male delayed acne.Conclusion Using computer and drinking are risk factors of late-onset acne.Oil skin people are susceptible population.Therefore keeping health lifestyle is an important measure to prevent female delayed acne.

Objective To analyze the current clinic application of severe acne treatment, and to provide evidences to improve its treatment. Methods Using sampling survey, a total of 3 012 severe acne patients who visited the dermato-logical department of 35 hospitals over the country for the first time were selected for this study. Each patient filled a ques-tionnaire about their acknowledgement, history of medical intervention and drug therapy of severe acne. Results Among all 3 012 patients with severe acne, 76.6%believed acne is a kind of skin disease, but only 35.2%of the patients went to see doctors at early stage of disease, while others choose interventions such as self-extrudation , topical medication or skin care products, herbal tea/folk recipes, beauty salons and application of coverture cosmetics. Among all severe acne patients, 2 388 cases (79.3%)had taken oral medications, which included 1 161(48.6%) patients who took anti-biotics. 394 cases (33.9%) took roxithromycine and 173 cases(14.9%) took other kinds of anti-biotics. 55.5%of all these patients who took oral medication less than 4 weeks in duration. 2 081 cases (69.1%) applied external drugs, in which includes 90 cases (4.3%) of using glucocorticoid, and 437 cases (21.0%) of using other kinds of external products. The adverse effects of topical treat-ments were commonly observed, such as erythema (512 cases, 24.6%), desquamation (683 cases, 32.8%), scab (73 cases, 3.5%) and hypersensitive (281 cases, 13.5%). Conclusion Severe acne is a disease need systematic treatment. but only mi-nority of the patients went to see doctors at early stage of disease. The current problems in treatment of severe acne include lack of target in choosing drugs, not long enough treatment course, and adverse effects of cutaneous administration.Early , safe and targeted medical attention with sufficient treatment course is encouraged.

Objective To analyze the clinical features of severe acne patients of different genders,ages to provide a basis for more targeted treatments. Methods From 2009 to 2011,by a sampling survey,1 944 severe acne patients from 35 third-class a hospitals in 24 cities and used" Acne Vulgaris Genetic Epidemiology questionnaires". Two experienced dermato-logical clinicians assessed the types,quantity,locations of patientsˊ skin damages and guided them to complete the question-naires. ResUlts In 1 944 severe acne patients,there were 1 000 males,944 females;1 433 had adolescent acnes〔842 males (58. 8%),591 females(41. 2%)〕,591 had adult acne〔158 males(30. 9%),353 females(69. 1%)〕. There was sig-nificant difference in distribution of varying types of acnes between males and females(χ2 =116. 60,P<0. 001). Totally 377 patients had adult persistent acnes lasting from adolescent onset until after the age of 25 ( 73. 5%),134 had late-onset acnes after the age of 25(26. 5%). In 353 females patients with adult acnes,238 had persistent(67. 4%),115 had late-onset (32. 6%). In 158 males with adult acnes,139 had persistent(88. 0%),19 had late-onset(12. 0%). Adult acnes were mainly persistent both in males and females,but the proportion of late-onset acnes was higher in females than in males,the difference was significant〔χ2 =23. 36,OR=2. 71,95%CI(1. 73,4. 23),P<0. 001〕. A total of 716 patients had acne family histories(36. 8%),including 349 males,367 females;569 had adolescent acnes(79. 5%),130 had persistent (18. 1%),17 had late-onset(2. 4%). The proportion of adolescent acnes was the highest in males and females who had acne family histories. The proportion of adolescent acnes was higher in males than in females,while that of persistent,late-onset ac-nes higher in females than in males(P<0. 05). In females severe acne patients,adolescent acne pimples/pustules were more than persistent(Z =2. 39,P =0. 017),similar to late -onset(Z =1. 25,P =0. 210);the atrophic acars were more in groups adolescent(Z= -3. 87,P<0. 001)and persistent acne(Z= -3. 68,P<0. 001)than in late-onset group;there was no significant difference in number of acnes(χ2 =2. 48,P=0. 290),nodules/cysts(χ2 =1. 94,P =0. 379),hyper-trophic scars(χ2 =4. 40,P=0. 106)between different types of acnes. In skin damage distribution,the incidences of pimples/pustules on forehead or cheeks were lower,those of nodules/cysts on back,those of atrophic scars on lower mandibles higher in persistent acne patients than in adolescent acne patients,the difference was significant(P<0. 05). The incidence of atrophic scars on noses was high in late-onset acne patients(P<0. 05). In male severe acne patients,there was no significant differ-ence in number of acnes(χ2 =0. 07,P=0. 966),pimples/pustules(χ2 =1. 02,P=0. 600),nodules/cysts(χ2 =0. 31,P=0. 857),hypertrophic scars(χ2 =3. 37,P =0. 186),atrophic scars(χ2 =5. 03,P =0. 081)between different types of acnes. In skin damage distribution,the incidence of atrophic scars of adolescent acnes on cheeks was 48. 0%(404/842), higher that of late-onset(36. 8%,7/19),the difference was significant〔χ2 =5. 00,OR=1. 60,95%CI(1. 06,2. 41), P=0. 025〕. ConclUsion The proportion of adolescent acnes is the highest in severe acnes. Adult acnes are mainly postpuberal persistent ones. The risks of adult acnes,especially those of late-onset,were higher in females than in males. The impacts of family history of acnes are great on adolescent,female adult acnes.

Objective Human enterovirus 71(EV71)and coxsakievirus A16(CoxA16)are two major causes of hand-foot-and-mouth disease(HFMD).Since poliovirus has been eradicated,EV71 has come to medical attention as the most important enterovirus related to severe complications and sequelae.This study was conducted to investigate the casual causes of HFMD in children during an epidemic from April to June of 2008 in Kunming.Methods 58 specimens that include vesicle fluid,urine and throat swabs,were collected from 25 patients with HFMD.Those suspected people were diagnosed through RT-PCR.Results 13 patients were identified as positive for CoxA16 and 5 patients were identified as positive for EV71,the rate of CoxA16 and EV71 was 52% and 20% respectively.Conclusions The major causes of HFMD in this epidemic CoxA16 and EV71,and clinicians can hardly distinguish these two viruses through clinical manifestations. Vesicle swabs give a high diagnostic yield in this study.

人类偏肺病毒(human meta pneumo virus,hMPV)是2001年由荷兰学者报告从呼吸道感染患儿标本中分离到的一种新病毒.自该病毒发现至今,hMPV所致相关疾病及其流行病学特征已基本明确,然而hMPV的发病机理、免疫机制、与喘息相关等问题仍在探讨中.本文就人类偏肺病毒的研究新进展及其相关免疫机理等问题作一综述.