目的 检测尖锐湿疣(condyloma acuminate,CA)患者血清中辅助性T淋巴细胞(helper T cell,Th细胞)相关细胞因子的表达水平,探讨其在CA发病机制中可能的作用,揭示CA患者全身的免疫状态.方法 分别采集 40 例CA患者和 20 名健康对照者外周血,采用高通量抗体芯片技术检测CA患者及健康对照者外周血血清中Th细胞相关细胞因子表达水平.结果 CA患者外周血血清中Th1型细胞因子干扰素(IFN)-γ、白细胞介素(IL)-2、肿瘤坏死因子(TNF)-α表达水平分别为(5.11±3.44)pg/ml、(4.44±2.53)pg/ml、(30.16±7.38)pg/ml,较健康对照组(9.5±3.77)pg/ml、(8.26±3.26)pg/ml、(37.06±12.16)pg/ml降低;Th2 型细胞因子IL-4 表达水平为(4.18±2.29)pg/ml,较健康对照组(2.07±1.10)pg/ml升高;Treg型细胞因子IL-10、转化生长因子(TGF)-β表达水平分别为(2.03±1.01)pg/ml、(904.67±317.91)pg/ml,较健康对照组(1.26±0.71)pg/ml、(648.96±180.34)pg/ml升高;Th17型细胞因子IL-17 及IL-23 表达水平分别为(1.39±0.23)pg/ml、(172.98±42.56)pg/ml,较健康对照组(1.62±0.44)pg/ml、(204.23±48.88)pg/ml降低;以上差异均有统计学意义(均P＜0.05).结论 Th1/Th2、Th17/Treg型细胞因子交互作用失衡很可能是CA重要的免疫学发病机制之一.CA患者存在全身性的细胞免疫功能紊乱.

目的:分析超脉冲CO2激光和Q开关倍频Nd:YAG 532 nm激光治疗脂溢性角化病(Seborrheic keratosis,SK)的有效性及安全性.方法:连续纳入2019年8月-2020年6月笔者医院收治的脂溢性角化病患者60例(皮损174处),根据皮损形态选择超脉冲CO2激光或Q开关倍频Nd:YAG 532 nm激光进行治疗.治疗后随访3个月,观察治疗效果及不良反应情况.结果:超脉冲CO2激光治疗患者32例(皮损92处),创面愈合时间为(7.78±2.19)d,总有效率为96.88％(31/82),疼痛发生率为56.25％(18/32),不良反应发生率为9.38％(3/32);Q开关倍频Nd:YAG 532 nm激光治疗患者28例(皮损82处),创面愈合时间为(7.15±2.04)d,总有效率为96.43％(27/28),疼痛发生率为53.57％(15/28),不良反应发生率为7.14％(2/28).结论:超脉冲CO2激光和Q开关倍频Nd:YAG 532 nm激光治疗SK患者均安全有效,需根据皮损形态选择合适的治疗方式.

目的:探讨Q开关Nd:YAG激光治疗交界痣的临床疗效及对术后复发的影响.方法:选择2019年1月-2020年7月于笔者医院行CO2激光治疗交界痣的338例患者为研究对象,采用随机数字表法将其分为对照组(169例)及观察组(169例).对照组给予CO2激光治疗,观察组给予Q开关Nd:YAG激光治疗.比较两组治疗效果、结痂时间、创面愈合时间及红斑持续时间;观察两组患者术后即刻及术后24h的视觉模拟评分法(VAS)及治疗后1周、1个月的温哥华瘢痕量表(VSS)评分变化情况,比较两组治疗后3个月、6个月的复发率及对美观、治疗效果的满意度;统计两组患者增生性或凹陷性瘢痕、色素沉着及皮肤萎缩等不良反应发生率.结果:观察组总有效率高于对照组(P<0.05);观察组结痂时间短于对照组(P<0.05),两组创面愈合时间及红斑持续时间对比差异无统计学意义(P>0.05);观察组治疗后1周、1个月的VSS评分低于对照组(P<0.05);观察组治疗后3个月及6个月的复发率均低于对照组,对美观、治疗效果的满意度高于对照组(P<0.05),两组对舒适的满意度比较差异无统计学意义(P>0.05);观察组不良反应发生率低于对照组(P<0.05).结论:Q开关Nd:YAG激光治疗交界痣,可提高治疗效果,缩短结痂时间,减轻瘢痕严重程度,并能降低复发率.

患者男,62岁.右侧腹股沟斑疹1年余,加重伴瘙痒1个月.患者1年余前健步走后发现右侧腹股沟轻微红斑,偶伴瘙痒,间断涂抹酮康唑乳膏,每日2次,皮损无明显好转.1个月前患者自觉瘙痒加重,伴异味,并发现阴囊右侧出现黑色线状丘疹,遂于2017年12月13日来我科就诊.既往史及家族史:2型糖尿病史10余年,血糖控制欠佳.家族中无类似疾病患者.

Objective To detect the expression of CD1 a,CD83,CD80 and CD86 in dendritic cells (DCs)in condyloma acuminatum(CA) lesions,in order to investigate the possible roles of the molecular phenotype of DCs in the progression of CA and the relationship with human papillomavirus (HPV) subtypes.Methods HPV genotyping kit was used to detect the HPV subtypes in the patients with CA.The expression of C D1 a,CD83,CD80 and CD86 in DCs of 41 CA lesions and 32 normal foreskins were detected by EnVision immunohistochemical method.Results The number of CD1 a positive DCs was greater in CA lesions than that in normal foreskin tissue of the healthy control group.Among the CA patients,the number of CD1 a positive DCs was significantly higher in the long course CA group than in the short course CA group,and it was higher in high-risk HPV CA group than low-risk HPV CA group.It was slightly higher in the relapsed CA group compared with that in the first onset CA group,but no statistical significance was found.The number of CD83 positive DCs was greater in CA lesions than that in normal foreskin tissue of the healthy control group.In CA lesions,the number of CD83 positive DCs was correlated with the number of CD1 a positive DCs,but it is significantly lower than the latter.No significant difference was found in the number of CD80/CD86 positive DCs between the CA group and the healthy control group.Conclusion Most of the DCs in CA lesions were immature and short of expression of co-stimulatory molecules (CD80 and CD86),especially in CA cases with high-risk HPV subtypes,which may be one of the immunological mechanisms leading to the disability of presentation of HPV antigens,resulting in CA relapse and prolonged course of disease.

Objective To characterize the morphology and structure of hair surtaces and cross sections in children of different ages,and to understand the development and maturation processes and status of hairs in terms of ultrastructure in healthy children after birth.Methods Ninety healthy child volunteers were equally classified into 3 groups:infancy group (aged less than 1 year),toddler group (aged 1-2 years),and preschool-age group (aged 3-5 years).Hair samples were collected from the vertex,tempus,and occiput of each child.Field emission scanning electron microscopy was performed to obtain morphological data on surfaces and cross sections of hairs,including minimal and maximal hair diameters,hair index (the ratio of minimal to maximal diameter of hairs),hair cuticle thickness (measured on hair cross sections,each hair has 5-10 layers of cuticles),hair cuticle count (the number of cuticles per 100 μm length of hair shaft) and pattern (flat waveform or irregular shape).Statistical analysis was carried out by using analysis of variance,t test,chi-square test,and least significant difference (LSD) test with SPSS19.0 software.Results The minimal and maximal cross-sectional diameters of hairs significantly differed between the three age groups at the same anatomic site (vertex:F =39.67,28.32,respectively,both P ＜ 0.01;tempus:F =13.12,11.91,respectively,both P ＜ 0.01;occiput:F =18.41,16.43,respectively,both P ＜ 0.01),and increased with age,while no significant changes occurred in hair index with age.Meanwhile,significant differences were observed between the three age groups in the thickness of hair cuticles on the vertex (F =6.15,P ＜ 0.01),and in the number of hair cuticles on the vertex,tempus,and occiput (F=3.29,3.36 and 3.48 respectively,all P＜ 0.05).LSD test showed a significant difference in minimal and maximal hair diameters between the infancy group and toddler group and between the infancy group and preschool-age group (all P ＜ 0.001),an elevation in the thickness of hair cuticles on the vertex in the preschool-age group compared with the infancy group (0.59 ± 0.09 vs.0.49 ± 0.08 μm,P =0.003),but a decrease in the number of hair cuticles on the vertex,tempus and occiput in the preschool-age group compared with the infancy group (all P ＜ 0.05).No significant differences were observed between male and female volunteers in minimal and maximal hair diameters,hair index or hair cuticle thickness and number at the same anatomic site.In addition,there were no significant differences in the distribution of the two hair cuticle patterns between the three age groups.Conclusions Hair diameter and cuticle thickness both increase,while hair cuticle number decreases,with the development of children.

目的 检测尖锐湿疣(Condyloma Acuminatum,CA)患者皮损中FOXP3的表达情况,并探讨其在CA免疫学发病机制中的作用及其与HPV亚型的相关性.方法 采用免疫组织化学EnVision法检测FOXP3在CA皮损及正常包皮中的表达,同时应用基因芯片技术检测CA患者疣体脱落细胞中的HPV基因型.结果 CA患者皮损中FOXP3阳性率高于正常对照组(P＜0.01),且复发组高于初发组(P＜0.01)、长病程组高于短病程组(P＜0.01),但在低危型与高危型HPV感染组间差异无统计学意义(P＞0.05). 结论 CA患者皮损中FOXP3阳性率增高与CA的发生、发展关系密切,这种细胞免疫功能失调可能与其免疫学发病机制有关但与HPV亚型无关.

1 病例介绍 患者,男性,29岁,因排尿疼痛、尿道溢脓4天于2012年3月6日就诊.患者4天前发现尿道有脓性分泌物排出并伴有尿频、尿痛,同时发现尿道口右侧有针尖大小孔,挤压后有脓性分泌物自小孔溢出.患者发病前10天有非婚性生活史. 体格检查:系统检查未见异常,全身浅表淋巴结未触及.皮肤科检查:尿道口局部轻度红肿,尿道口右侧见一针尖大小孔,挤压后有黄白色分泌物溢出,无外阴溃疡或赘生物.实验室检查:HIV及梅毒筛查均为阴性.取小孔分泌物涂片镜检见多型核白细胞内革兰氏阴性双球菌,脓液淋球菌PCR为阳性.

Objective: To investigate the clinical efficacy and safety of combined topical therapy with 0.1% tacrolimus ointment and selenium sulfide lotion in the patients with seborrheic dermatitis of the scalp. Methods: Sixty-two patients were randomly divided into either 0.1% tacrolimus ointment group or halcinonide solution group, all the patients were topically applied twice daily with selenium sulfide lotion twice a week simultaneously. The course of treatment was 4 weeks, and the scores for clinical symptoms and signs were evaluated and recorded before and after treatment. Meanwhile the adverse events were also observed. Results: The effective rates of the two groups were 90.00% and 90.62% respectively, without significant difference(χ 2=0.12, P>0.05). One month after treatment, the relapse rate of tacrolimus group was 16.67%, whereas halcinonide group 40.62%(χ 2=4.31, P<0.05). Conclusion: Combined topical therapy of 0.1% tacrolimus ointment with selenium sulfide lotion is a safe and effective treatment for the seborreheic dermatitis of the scalp.

<正>曲霉(Aspergillus)是广泛存在于自然界一种腐生菌及正常人体皮肤黏膜的常驻真菌。曲霉孢子较小,直径2~3μm,可以在空气中漂浮,并且通过呼吸道进入人体。由于曲霉主要通过呼吸道进入人体,所以曲霉感染主要发生在肺部。根据发病部位、菌落定植或侵袭,以及宿主的免疫状态可以将曲霉感染分为以下3类:①过敏性支气管肺曲霉病(ABPA);②曲霉瘤;③侵袭性曲霉病(IA)。IA是一种严重危及患者生命

内分泌特别是各种性激素对毛发具有重要的调节作用,女性在妊娠期雌、孕激素大量增加,本文对这一时期女性头发的各个生长指标进行调查研究,为研究激素对头发特征的影响提供依据.

OBJECTIVE To study the distribution of Candida spp. in the patients with high-risk of fungal infection and the risk factors of deep candidiasis. METHODS A prospective cohort study was performed among 440 consecutive hospitalized patients admitted to the hematology wards, geriatric wards, and ICUs from May 2004 to April 2005. Stool, urine, and saliva were cultured during the period 72 - 96 h after hospitalization for the first time and then once a week till the patient was discharged or by the end of the sixth week. If deep fungal infection was suspected culture of blood, sputum, bacterium-free body fluid, and/or biopsy specimens were cultured. Medical records were reviewed to analyze the possible risk factors. RESULTS 426 strains of Candida spp. were isolated from 152 patients, with Candida albicans accounting for 67.4% and other Candida spp for 32.6%. 61 patients were discovered to express Candida colonization. The major species isolated from patients with Candida colonization was Candida albicans. The risk factors identified included two or more broad-spectrum antibiotic administration (odds ratio 16.204; 95% confidence interval, 2.005 to 130.980), Candida colonization (10.636; 3.743 to 30.222), and urinary canal administration (4.285; 1.399 to 13.127). CONCLUSION Candida albicans is still the major organism isolated from the high risk fungal infection patients. Two or more broad-spectrum antibiotic administration, Candida colonization, and urinary canal administration are proved to be the risk factors, with the broad-spectrum antibiotic administration exhibiting more influence than Candida colonization and urinary canal administration.

近年来,随着免疫抑制人群的逐渐增多和侵入性诊疗方法的应用,侵袭性曲霉病(invasive aspergillosis,IA)的发病率和病死率均明显升高.早期诊断IA是提高患者生存率和改善患者预后的关键.本研究应用曲霉抗原酶联免疫吸附试验(ELISA)检测试剂盒对48例临床可疑IA患者的血清进行曲霉抗原检测,以评价其在IA早期诊断方面的应用价值.

念珠菌感染是医院内最常见的真菌感染,它占到了整个真菌感染的80%以上,但由于传统诊断方法的缺陷,目前仍无法做到早期诊断并及时应用抗真菌药物,在这种情况下深入了解其流行病学资料就显得尤为重要.