淋病是目前全球最常见、对生活质量及生殖能力危害最大的性传播疾病之一.近年来,淋球菌对抗生素的耐药性日趋严峻,严重影响对淋病的有效治疗及传播的控制.应对日益严重的淋球菌耐药问题,除了研究病原菌的遗传特征及基因变异之外,如何加强药物的科学应用,提高治疗效能,尽量减少耐药菌株的产生及控制其传播一直是研究的热点.尤其在治疗淋病药物使用的策略方面,如何既能提高治疗效能加强疗效,又可抑制耐药菌株的产生与传播进行了有益的研究,通过监测菌株对常用抗生素的最小抑菌浓度(MIC)制定有效的治疗方案,适度增大用药剂量、多种药物联合治疗等综合措施有效预防及控制淋球菌耐药菌株的形成与传播.

1 临床资料 患者男,20岁,学生.褶皱舌15年,上唇肿胀1年.患者15年前,发现舌部出现皱褶、萎缩,无伴不适.1年前无明显诱因上唇出现肿胀、肥厚,无伴瘙痒、疼痛,食用海鲜或饮酒后加重,伴脱屑.日晒后,病情无明显加重.患者曾至外院诊治,行唇部皮损病理活检术,考虑肉芽肿性唇炎,予抗组胺、糖皮质激素等治疗后,病情无明显改善.患者既往3年前曾出现单侧面瘫,鼓腮难,吹气偏移,予中药治疗1个月后恢复,具体不详.患者无药物、接触物、食物过敏史,无其他系统性疾病,其弟有皱襞舌病史5年.

儿童银屑病是一种常见的炎症性皮肤病, 而儿童脓疱型银屑病 (Childhood pustular psoriasis, CPP) 较为少见, 是一种发生于儿童的全身性炎症性伴皮肤功能障碍的银屑病类型.CPP顽固且易复发, 对患儿及其父母生活质量及发展都影响颇大.对于CPP, 皮肤的局部治疗是必不可少的基础, 维甲酸类、甲氨蝶呤、环孢素、生物制剂等为系统治疗中的常用药物, 脓疱型银屑病儿童通常对光疗有较好的反应.此文介绍了目前针对于儿童脓疱型银屑病的治疗共识与经验, 为现在的治疗进展进行了概括.

Background: Vitiligo is an acquired depigmentation skin disorder mainly caused by the destruction of melanocytes. There are many therapeutic options available for vitiligo, but the options are not uniformly effective. Objectives: This study aimed to explore the clinical effect of the autologous non-cultured epidermal cell suspension (NCES) technique in the treatment of patients with stable vitiligo. Methods: A retrospective study of before-after comparisons was undertaken with 41 patients with stable vitiligo who received treatment with the NCES technique. The percentage of repigmentation area was evaluated using image analysis of the appearance before and 6-9 months after operation. Results: A total of 41 patients (18 males and 23 females) with a duration of clinical stability for ranging from 1 to 10 years (mean 1.6 +/- 1.9) were included. The mean age was 20.2 years (range, 8-50) and 4 (9.8%) were children under the age of 14 years. After 6-9 months of follow-up, 80.5% (33/41) of the patients showed good response; among these patients, 17.1% (7/41) showed complete or almost complete repigmentation. Interestingly, all 4 children showed very good response (more than 76% repigmentation). There were no significant differences in the efficacy of treatment between the different transplantation areas of the facial neck, trunk, and distal limbs and there were no adverse effects such as infection or scar formation. Limitation: This study included only a single center with a small sample size. Conclusions: Our study shows that the NCES technique has a high therapeutic effect, is safe for patients with stable vitiligo, and may be a very promising potential option for treating children.

目的 分析26例白色萎缩患者的临床、组织病理表现,以提高早期诊治水平.方法 通过临床资料回顾性分析,将广州医科大学皮肤病研究所诊治的26例白色萎缩患者的临床表现、实验室及组织病理检查、治疗情况进行总结.结果 患病具有青年女性倾向,皮损好发于双小腿及远端部位,主要表现为红斑、紫癜、瘀斑、痛性溃疡,遗留白色萎缩和色素沉着,易反复发作.皮肤组织病理检查发现大多数皮损真皮内血管壁纤维蛋白样坏死、透明血栓形成.小剂量阿司匹林、双嘧达莫及糖皮质激素治疗效果较好.结论 根据典型病史、临床表现及组织病理学检查即可诊断白色萎缩,临床上应提高对白色萎缩的早期诊断、早期治疗.

Objective: To investigate the effect of all-trans retinoic acid (ATRA) on Cx43 protein expression and GJIC function in IL-22-treated HaCaT cells, and whether it is related to the JNK pathway to further elaborate molecular mechanism of ATRA on GJIC function. Methods: The optimal pretreated time affected by ATRA on HaCaT cells was screened in IL-22 treatment group.Scrape-loading dye-transfer assay was applied to observe the variation of GJIC function.The expression value of Cx43, p-JNK, JNK in ATRA and/or IL-22 treatment group were detected by immunofluorescence. Results: ATRA caused time-dependent increasing of GJIC function in HaCaT cells. After treatment of ATRA on IL-22 induced HaCaT cells, Cx43 protein expression level increased, GJIC function up-regulated, and p-JNK expression had not significant change. Conclusions: ATRA inhibited the decrease of Cx43 expression by IL-22-mediated and down-regulation of GJIC, and this process was not related to the JNK pathway.

Abstract Background: There is a few evidence-based information regarding the efficacy and safety of acitretin treatment in children with pustular psoriasis (PP). Objective: This study aimed to provide an additional evidence for this field. Methods: A retrospective study was undertaken for 15 children with PP who received acitretin in doses of 0.6–1.0 mg/kg/day for 4–6 weeks, the transition dose of 0.2–0.4 mg/kg/day for 4–6 weeks and maintenance dose of 0.2–0.3 mg/kg/day. Additionally, a literature review on this topic is conducted. Results: Of 15 children with generalized PP (GPP, n = 10), palmoplantar psoriasis (PPP, n = 3), and acrodermatitis continua of Hallopeau (ACH, n = 2), 93.3% (14/15) showed good response, only one case with ACH exhibited moderate response. During the 10–32 months of follow-up, acitrerin monotherapy for children cases with PP overall showed good efficacy and safety. In the literature review, a total of 107 childhood PP cases treated with acitretin in 21 studies were included in the analysis. The clinical effectiveness was obtained in 88.8% (95/107) patients treated with acitretin as monotherapy or combination therapy, and most of cases (92.6%, 100/107) treated by acitretin did not report side effects during the treatment and follow-up of acitretin. Limitation: This study is just included a small sample sizes and no standardized studies were used in the literature. Conclusion: Acitretin therapy for children with PP (monotherapy or combination therapy), all showed a satisfactory therapeutic effect and safety, independent of the short or long-tern therapeutic procedures.

目的 监测2017年广州地区淋球菌临床分离株对7种抗生素的耐药情况,为科学、有效地选择抗生素治疗淋病提供理论依据.方法 对广州地区临床分离培养的101株淋球菌,用琼脂稀释法测定青霉素、四环素、环丙沙星、大观霉素、阿奇霉素、头孢曲松、头孢克肟的最低抑菌浓度(MIC),根据世界卫生组织(WHO)的标准判定其敏感性.结果 检出产青霉素酶淋球菌(PPNG)达21.43％ (21/98),质粒介导的高度耐四环素淋球菌(TRNG)达24.49％(24/98),环丙沙星耐药率高达100％ (98/98),阿奇霉素耐药率达6.12％ (6/98),大观霉素未发现耐药菌,头孢曲松中度敏感率达6.93％ (7/101),头孢克肟中度敏感率达15.84％(16/101).结论 持续进行淋球菌耐药性监测为制定合理抗菌治疗方案提供科学指导,是降低淋球菌对抗生素的耐药率的有效办法.

甲氨蝶呤(MTX)是一种具有抗炎、抗细胞增殖作用的免疫抑制剂,应用于银屑病的一线治疗已取得良好疗效.本文从MTX对银屑病的适应症、给药途径、用法用量、药物间的相互作用、不良反应、对生育的影响、禁忌症、毒副作用的预防、监测与随访,以及补充叶酸是否有益等方面进行概述.

目的:评价细胞自体体外再生(ReCell(?))技术治疗稳定期白癜风的临床疗效.方法:利用ReCell(?)技术治疗稳定期白癜风患者,观察患者的复色程度.结果:共15例患者接收治疗,男8例,女7例;年龄8～46岁,平均23.3岁.随访9个月,有13例患者皮损色素恢复为显效,有效率为86.67％.所有患者手术区域术后随访未出现感染与疤痕形成.结论:ReCell(?)技术对稳定期白癜风患者有较好的疗效.

Long-term systemic treatment with acitretin for severe hyperkeratotic disorders is needed to maintain quality of life of afflicted patients, but treatment has been limited owing to its potential side-effects including skeletal malformations, particularly for children during their growth and development. A retrospective investigation was conducted with three children afflicted with a severe hyperkeratotic disorder, namely Darier's disease, bullous ichthyosiform erythroderma or lamellar ichthyosis, who were continuously maintained on 0.2-0.3 mg/kg per day acitretin for more than 12 years after an initial period at a larger acitretin dose to bring each disease under control. The patients had good responses to acitretin treatment, which was assessed for safety, skeletal abnormalities, growth retardation and other potential side-effects. Acitretin monotherapy was an effective treatment for these children, and maintenance doses were well tolerated with no skeletal or other observable side-effects during the course of the study.

Objective To evaluate the efficacy and safety of acitretin combined with methotrexate in treatment of refractory moderate to severe psoriasis vulgaris. Methods Twelve patients with moderate to severe psoriasis who were resistant to acitretin or methotrexate monotherapy were treated with acitretin combined with methotrexate for 24 weeks. The therapeutic effect was observed and adverse reactions of the multitherapy were monitored during the 24 weeks of treatment. Results The PASI score decreased in all patients during 24-week treatment (P<0.05). Specifically,50％ achieved PASI 75 and 83.3％ achieved PASI 50 after 16 weeks of treatment. All patients showed remarkable curative response (100％ patients with PASI 50,vs. 91.67％ with PASI 75),at 24 weeks of treatment,and no adverse reactions were reported. Conclusion Acitretin combined with methotrexate is effective in the treatment of refractory moderate to severe psoriasis vulgaris and the adverse reactions of the multitherapy are not noted.

Background: Interleukin 4 (IL-4) -590C/T polymorphism has been reported to influence atopic dermatitis (AD) susceptibility, but the results are controversial.Objective: This meta-analysis was performed to study the association between IL-4 -590C/T polymorphism and AD susceptibility.Methods: The PubMed, Embase, and China National Knowledge Infrastructure databases were searched. Odds ratios (ORs) with 95% confidence intervals (CIs) were performed to estimate the strength of the association.Results: Ten studies comprising 923 cases and 1215 controls were included. The overall population revealed significant associations between IL-4 -590C/T polymorphism and AD susceptibility under the allele (OR, 1.19; 95% CI, 1.03Y1.38; I-2 = 0.0%), recessive (OR, 1.27; 95% CI, 1.002Y1.61; I-2 = 0.0%), and dominant (OR, 1.33; 95% CI, 1.003Y1.76; I-2 = 0.0%) models; similar results were found under the allele (OR, 1.19; 95% CI,1.01Y1.39; I-2 = 0.0%) and recessive (OR, 1.27; 95% CI, 1.001Y1.62; I-2 = 0.0%) models after excluding not-inYHardy-Weinberg equilibrium studies. However, subgroup analyses by ethnicity showed no significant associationin Asians or whites. Subgroup analyses by age indicateda significant association inchildren under the allele(OR, 1.30; 95% CI, 1.06Y1.60; I-2 = 0.0%) and dominant (OR, 1.42; 95% CI, 1.02Y1.97; I-2 = 0.0%) models, children in articles with Hardy-Weinberg equilibriumunder the allelemodel (OR, 1.33; 95% CI, 1.05Y1.69; I-2 = 0.0%), and Asian children under the allele model (OR, 1.41; 95% CI, 1.02Y1.95; I-2 = 0.0%) but not in white children.Conclusions: The IL-4 -590C/T polymorphism may contribute to AD susceptibility in the overall population and children, especially for Asian children, but large well-designed studies are warranted to confirm this conclusion.

目的:对阿维A治疗儿童脓疱型银屑病的疗效及安全性进行观察、评估.方法:对10例儿童泛发性脓疱型银屑病进行回顾性研究,起始剂量使用0.6～1.0 mg/(kg·d)阿维A持续治疗4～6周,过渡期减量为0.2 ～0.4 mg/(kg·d)治疗4～6周,维持剂量为0.2～0.3 mg/(kg·d),持续6～12周,随访7～ 32个月,观察患者疗效及不良反应.结果:9例儿童脓疱型银屑病PASI评分下降率均≥90％,1例为60％～＜90％.最常见的不良反应有皮肤干燥(60％,6/10)、瘙痒(40％,4/10)、唇炎(10％,1/10),其他副作用如骨骼发育迟缓、肝功能异常等均未发现.结论:低剂量使用阿维A治疗儿童脓疱型银屑病安全且疗效佳.

A 43-year-old male had asymptomatic perianal papules and plaques for over 19 years.He had been misdiagnosed as "deep mycosis","mycosis fungoides" and "malacoplakia".The histopathologic features included epidermal hyperkeratosis and parakeratosis,pseudo-epitheliomatous hyperplasia.Dermal granulomas were composed of lymphocytes,plasmocytes,neutrophils,histocytes,and few muhinucleated giant cells.Tumor tissue was negative for both PAS and Acid-fast staining.But patient was positive for PPD test (3 +) and PPD-IgG (+).Diagnosis:tuberculosis verrucosa cutis.The lesions improved after 6 months of treatment.

Hyper-immunoglobulin E syndrome (HIES) is a rare primary immunodeficiency characterized by immune and connective tissue abnormalities. With the primary manifestations of eczematous dermatitis, elevated serum levels of IgE and eosinophilia, HIES and atopic dermatitis(AD) which were commonly seen in children, have many similarities of skin symptoms. HIES patients also suffer from problems more than those of the immune system such as significant recurrent bacteria or virus infections, skeletal dysplasia, and the malignancies are also likely to be found in some of the patients. Due to the numerous resemblances on clinical manifestations and lab experimental results between HIES and AD, and the fact that HIES is an uncommon disease with low morbidity, as well as clinicians lack sufifcient understanding on this disease, clinicians are likely to omit or mistaken it for AD in clinical practice. This article aims to help the clinicians deepen the understanding of the disease, through the comprehensive comparison and analysis of the characteristics of the manifestations of HIES and its similarities and differences with the AD, so as to minimize the risks of omission or misdiagnose.