What is already known about this topic?:Brucellosis, mainly caused by Brucella melitensis (B. melitensis), is regarded as a significant zoonotic disease in China. In Weihai, located at the eastern end of the Shandong Peninsula, brucellosis has been in a low epidemic phase for the past five years.What is added by this report?:This was the initial report of a brucellosis outbreak in the last five years. Strains of B. melitensis bv. 3 from Weihai and other cities showed a close genetic relationship, suggesting a potential common ancestry.What are the implications for public health practice?:Epidemiological investigations depend on standardized and effective molecular typing methods and analysis tools for public health laboratories to identify and trace outbreaks. Understanding the circulation patterns of livestock in free-range households in heavily affected areas is essential for controlling the spread of brucellosis.

BACKGROUND:The aim of this study was to investigate the serum level of uric acid (UA) in male patients with androgenetic alopecia (AGA) and to compare the level with that of men without AGA. In addition, the comparison of the serum level of uric acid (UA) before and after treatment with finasteride was performed. METHOD:A total of 120 male patients with AGA and 120 males without AGA were enrolled in this prospective study. Patients with AGA were randomized into two groups: 60 patients were given 1 mg finasteride orally every day for 6 months, and 60 patients were given placebo. Serum UA level was detected at the first visit and after the 6-month treatment by colorimetric analysis. RESULTS:Before treatment, the mean serum UA level in patients with AGA was higher than that in the control group (401.52±83.27 umol/L vs 362.67±60.88 umol/L, P<0.050), and a higher proportion of hyperuricemia was found in patients with AGA (2 9.17% vs 15.00%, P<0.050). After treatment, the mean serum UA level in the finasteride group decreased significantly, from 405.87±87.12 umol/L to 381.84±82.50 umol/L (P<0.050), and from 397.17±79.73 to 394.18±78.09 umol/L in the placebo group (P = 0.370). Patients with AGA with hyperuricemia had a higher BMI (25.38±3.43 kg/m2) when compared to the patients without hyperuricemia (23.88±2.64 kg/m2). For every unit of BMI increase in patients with AGA, the risk of hyperuricemia increased by 30.5% (P = 0.030). Furthermore, the levels of UA were different in the finasteride group before and after treatment (P = 0.049, 95%CI, 0.080, 47.970). CONCLUSIONS:We found that AGA has a relationship with hyperuricemia, and the level of serum UA can decrease with the treatment of finasteride.

OBJECTIVE:The aim of this meta-analysis is to investigate the relationship between interleukin (IL)-10 levels and its polymorphism and Takayasu arteritis (TAK).METHODS:Five databases including PubMed, Web of Science, Ovid, Sinomed and China National Knowledge Infrastructure (CNKI) were gone through from inception to March 31, 2022. Studies were screened according to the inclusion and exclusion criteria. Newcastle-Ottawa Scale (NOS) was applied to assess study quality. Strengths of association were evaluated by odds ratio (OR) and 95% CI. The T v. t (allele contrast), TT v. tt (homozygous contrast), Tt vs tt (heterozygous contrast), TT + Tt vs tt (dominant contrast) and TT vs Tt + tt (recessive contrast) models were adopted.RESULTS:Seven studies were included. No significant relationship between IL-10 and TAK was detected in the included patients (P > 0.05). The levels of IL-10 were lower in the active group than those in the stable group, which was -0.47 (95% CI: -0.93, 0.00) (P = 0.05). No significant relationships between IL-10 and TAK were found under all contrasts for polymorphisms rs1800871, rs1800872 and rs1800896 (P > 0.05).CONCLUSIONS:There was no significant difference in IL-10 levels between TAK patients and control subjects. The levels of IL-10 were lower in TAK patients in the active stage. There was no significant association between IL-10 gene polymorphisms and TAK. Further well-designed studies with larger sample sizes in patients with different stages are needed.

The relation between vitamin D receptor (VDR) gene polymorphisms and ankylosing spondylitis (AS) remains unclear. A systematic review and meta-analysis were conducted using six databases, including PubMed, Web of Science, EMBASE, CNKI, Wanfang and Cochrane Library. The selection of each study was based on inclusion and exclusion criteria. The Newcastle–Ottawa Scale was applied to assess the quality of the included studies, while the strength was evaluated by odds ratios and 95

Objective To provide evidence of the association between CLTA-4 gene polymorphisms and alopecia areata (AA).Methods PubMed, EMBASE, Web of Science, Cochrane, Wanfang, and CNKI databases were searched until 30 April 2021. The selection was completed according to the inclusion and exclusion criteria. The study quality assessment was based on Newcastle-Ottawa Scale. The assessment of the association was measured by ORs and 95%CIs.Results Nine studies, containing 2858 AA cases and 5444 disease-free control subjects were included. For rs231775 polymorphism, no significant association with AA was found, which was A vs. a, OR = 1.02 [0.81, 1.30], p = 0.85; AA vs. aa, OR = 1.26 [0.81, 1.97], p = 0.31; Aa vs. aa, OR = 1.04 [0.54, 2.01], p = 0.91; AA + Aa vs. aa, OR = 1.04 [0.71, 1.53], p = 0.82; AA vs. Aa + aa, OR = 1.31 [0.97, 1.78], p = 0.08. For rs3087243 polymorphism, also no significant association was found, which was A vs. a, OR = 0.93 [0.78, 1.11]; p = 0.40, AA vs. aa, OR = 0.68 [0.44, 1.06]; p = 0.09; Aa vs. aa, OR = 0.87 [0.45, 1.68], p = 0.68; AA + Aa vs. aa, OR = 0.93 [0.68, 1.28], p = 0.66; AA vs. Aa + aa, OR = 0.78 [0.34, 1.81], p = 0.57. For rs231726 polymorphism, a significant correlation was found, which was A vs. a, OR = 0.76 [0.70, 0.82], p < 0.05.Conclusions A significant correlation between CTLA-4 rs231726 polymorphism and AA susceptibility was found, but no significant association of CTLA-4 gene rs231775 and rs3087243 polymorphisms and AA susceptibility was found.

目的 分析脊柱关节病型银屑病关节炎关节受累的影响因素,寻找早期发现该病的可能指标.方法 回顾性选取2016年9月至2022年2月就诊于首都医科大学附属北京友谊医院风湿内科及皮肤科的358例银屑病关节炎的患者作为研究对象,根据受累部位不同将患者分为脊柱关节病型银屑病关节炎组(n=117)和外周关节病银屑病关节炎组(n=241).根据强直性脊柱炎疾病活动(ASDAS)评分对脊柱关节病型银屑病关节炎患者进行疾病活动度分组,疾病轻度活动组(ASDAS<2.1,n=47),重度活动组(ASDAS≥2.1,n=70).分析影像学分级、银屑病面积与严重性指数(PASI)评分、格拉斯哥超声附着点评分系统(GUESS)评分、自身抗体、炎症指标等与脊柱关节病型银屑病关节炎疾病活动度之间的相关性.结果 脊柱关节病型银屑病关节炎组患者的眼部受累的比率、HLA-B27阳性率、红细胞沉降率(ESR)、GUESS评分分别为14.5％、20.1％、(21.8±16.6)mm/h、(23.0±12.1)分,高于外周关节病变型银屑病关节炎组[6.2％、10.4％、(34.6±21.3)mm/h、(9.5±10.3)分],差异均有统计学意义(P<0.05).在脊柱关节病型银屑病关节炎患者中,轻度活动组与重度活动组骶髂关节CT分级差异无统计学意义(P>0.05);重度活动组患者PASI评分、GUESS评分为(14.5±9.1)、(12.8±9.6)分,均高于轻度活动组[(10.6±6.1)、(2.2±3.4)分],差异均有统计学意义(P<0.05);轻度活动组与重度活动组组间HLA-B27阳性率、抗环瓜氨酸肽(CCP)抗体阳性率比较(14.7％vs.22.9％、8.8％vs.12.0％),差异无统计学意义(P>0.05);重度活动组患者的平均ESR和C反应蛋白(CRP)值为9.4 mm/h、4.8 mg/L,均显著高于轻度活动组(1.6 mm/h、1.0 mg/L),差异均有统计学意义(P<0.05).多因素Logistic回归发现PASI评分(OR=1.075,95％CI=0.930～1.243,P<0.05)与GUESS评分(OR=0.476,95％CI=1.057～2.453,P<0.05)是脊柱关节病型银屑病重度疾病活动度的独立影响因素.结论 临床医师在早期评估银屑病关节炎患者时,应将PASI评分及GUESS评分作为整体评估脊柱关节病型银屑病关节炎的重要手段.

Background The efficacy of topical minoxidil (MX) alone on female pattern hair loss (FPHL) is limited. Combination therapy based on topical MX is currently expected to provide better outcomes. Objectives This study aimed to assess whether the combined therapies including MX plus oral spironolactone (SPT) and MX plus microneedling (MN) have advantages in efficacy and safety over topical MX alone on mild-to-moderate FPHL with normal hormone levels in the blood and regular menstrual cycle. Methods A prospective, single-center, parallel-group, evaluator blinded, randomized trial including 120 non-menopause women with proven FPHL (Sinclair class II-III) was performed in China. Patients were randomly assigned to three groups, namely, the MX group (5% topical MX alone, once daily), the MX + SPT group (MX plus SPT 80–100 mg daily), and the MX+MN group (MX plus MN every 2 weeks, 12 sessions). The change from the baseline to week 24 was assessed in hair growth (hair density and diameter under dermoscope), scalp tissue structure (epidermal thickness, dermis thickness, and average hair follicle diameter under ultrasound biomicroscopy), physician's global assessment (using a 7-point global-assessment scale and Sinclair's stage change), patient evaluation (Women's Androgenetic Alopecia Quality of Life Questionnaire and Sinclair's hair-shedding score) and side effects. Results In total, 115 participants completed the trial. At week 24, the hair density increased most in MX + MN group and increased least in MX group ( p < 0.001 for MX + MN group vs. MX + SPT group; p = 0.009 for MX + SPT group vs. MX group). The hair shaft diameter significantly increased in all groups ( p < 0.001, respectively), but there were no significant differences among the three groups ( p = 0.905). The epidermal thickness and average hair follicle diameter only increased in MX + MN group. Dermis thickness increased in all groups, but there were no significant differences among the three groups. Both physician's and patient assessments showed improvement in all three groups. Scalp pruritus was the most common side effect. The MX + SPT group had the most reported adverse effects. Limitations The main limitations of this study are the relatively small sample size, the exclusion of severe FPHL patients, and the potential bias from unblinded treatments among the 3 groups. Conclusion Topical MX combined with MN is a better choice than either MX plus oral SPT or MX alone for the treatment of mild-to-moderate FPHL patients.

To the Editor: Acne vulgaris is a chronic, inflammatory, and disfiguring skin disease with lesions, post-inflammatory hyperpigmentation, and scarring. Chemical peeling is a simple and well-tolerated procedure for mild-to-moderate acne. Glycolic acid (GA) is water-soluble and has the smallest molecular weight among all the alpha-hydroxy acids. High-concentration GA (20%–70%), applied at 2 to 4-week intervals in the hospital or cosmetology clinic, have proved effective for acne.[1] Low-concentration GA (≤10%) is safe and convenient, and can be used at home.[2] Up to now, differences in efficiency between low and high concentrations of GA for acne vulgaris have not been reported. This study compared the efficacy and safety of 5% GA complex and 20% GA for acne patients, to guide GA selection at different concentrations. The Ethics Committee of Beijing Friendship Hospital approved the study protocol (No. 2019-P2-007-01). All patients provided written informed consent. The trial identification number is ChiCTR2000031393 in the Chinese Clinical Trail Register of the World Health Organization. This randomized controlled clinical trial was performed with 80 acne patients, from March 1 to May 31, 2019. The inclusion criteria were as follows: mild or moderate acne (Pillsbury grade I–III, Fitzpatrick skin types IV–VI); aged ≥18 years; and no topical or systemic treatment within 1 month. The exclusion criteria were as follows: active or recurrent herpes infection; history of hypertrophic scarring or keloid; use of oral isotretinoin, steroid, or immunosuppressive agent in the past 6 months; sensitive or photosensitive skin; pregnant or lactating; menstrual disorders; polycystic ovary syndrome; hirsutism; or refusal to give consent. Patients were randomly divided into two groups. In group A, 5% GA complex (Cosmocos, Korea) consisting of alpha-hydroxy acid peel and essence repairing factors such as sodium hydroxide, allantoin, trehalose, and Portulaca oleracea extract was applied once daily. In group B, the patients underwent four treatment sessions with 20% GA (NeoStrata, NJ, USA), biweekly. All the participants were followed up 2 weeks after the last treatment (day 70). The skin lesion scores, patient satisfaction, and adverse effects for each patient were recorded before treatment (baseline) and after treatment (day 70) by the same two dermatologists. The severity of active acne was evaluated according to the Michaëlsson grading system, in which comedones were non-inflammatory lesions, and papules, pustules, and infiltrates were inflammatory lesions.[3] Satisfaction was graded from 1 to 4 by visual analog scale. Skin rejuvenation parameters (wrinkles, pores, red area, and brown area) and skin physiological parameters (transepidermal water loss [TEWL] and skin hydration) were recorded using the VISIA system (Canfield Imaging Systems, NJ, USA) and CK Multi-Probe Adapter (MPA580, Courega-Khazaka, Cologne, Germany) before and after treatment. The lactic acid stinging test (LAST) was performed to assess skin sensitivity. Categorical data were assessed using the chi-squared test. For continuous data with normal distribution, paired and unpaired t tests were used within and between groups. For data that were not normally distributed, the non-parametric test was used. Statistical analyses were performed using SPSS 23.0 (IBM Corp, Armonk, NY, USA). P values <0.05 were considered statistically significant. All patients completed this trial. At baseline, the basic data between the two groups were comparable [Supplementary Table 1, https://links.lww.com/CM9/B261]. After treatment, in both groups, the clinical efficacy, number of lesions, and lesion severity index improved significantly compared to the baseline, with an additional significant decrease in the brown area score, and a significant increase in TEWL (P < 0.05, each; Supplementary Table 2, https://links.lww.com/CM9/B261). However, a statistically significant increase in skin hydration was observed only in the 5% GA complex group A [Table 1 and Supplementary Figure 1, https://links.lww.com/CM9/B261]. Regarding LAST, after treatment, the time to highest sting intensity was significantly later relative to the baseline in both groups (P < 0.05, each; Supplementary Table 2, https://links.lww.com/CM9/B261). Five patients in the 5% GA complex group and eight patients in 20% GA group reported adverse effects, which amounts to a non-significant difference. Table 1 - Comparison of mean changes between 5% GA complex and 20% GA groups before and after treatment. Items 5% GA complex 20% GA t or z † P-value Basic information Lesions (n) 27.60 ± 15.93 18.80 ± 12.14 2.78 <0.01 Non-inflammatory lesions (n) 16.20 ± 12.07 11.80 ± 11.93 1.64 0.11 Inflammatory lesions (n) 11.28 ± 10.50 7.00 ± 6.22 2.22 0.03 Lesion severity index 26.13 ± 16.32 18.55 ± 11.17 2.42 0.02 Satisfaction score 3.25 ± 0.87 2.78 ± 0.80 2.54 0.01 Visia test Score of wrinkles 40.50 (−37.00, 188.25) 39.5 (−67.75, 39.50) z = 0.077 0.94 Score of pores −56.00 (−212.75, 104.50) 146.50 (44.75, 265.75) z = 4.403 <0.01 Score of red area −3.75 ± 49.58 8.95 ± 43.09 1.22 0.23 Score of brown area 53.10 ± 61.42 45.00 ± 65.00 0.57 0.57 Skin biophysical properties∗ TEWL (g·m−2·h−1) 2.43 ± 5.68 6.52 ± 4.91 3.45 <0.01 Skin hydration 11.91 ± 17.86 2.08 ± 13.82 2.75 <0.01 LAST Decrease of the highest intensity score 0.15 ± 1.00 0.15 ± 0.92 0.00 1.00 Increase in moment of the highest intensity (s) 83.25 ± 162.83 71.25 ± 166.78 0.33 0.75 Increase in moment of sting (s) 19.50 ± 222.73 32.63 ± 174.83 0.29 0.77 Decrease of total scores 0.35 ± 2.58 0.65 ± 2.13 0.57 0.57 GA: Glycolic acid; LAST: Lactic acid stinging test.∗Mean change of skin biophysical properties represents the results of post-treatment data minus pre-treatment data; mean change of the remaining parameters was calculated from the difference in the results of pre-treatment data and post-treatment data.†The normality of distribution was first analyzed. For normal distribution data, the form of mean ± standard deviation was applied, and t-tests were used; for non-normal distribution data, the form of median with interquartile range was applied, and a non-parametric test was used. The intergroup comparisons showed that patients given 5% GA complex showed better results in terms of total and inflammatory lesions, lesion severity index, skin hydration, and satisfaction scores than did the patients administered 20% GA (P < 0.05). Also, patients treated with 20% GA showed a lower score for pores and higher TEWL compared with patients given 5% GA (P < 0.05, respectively). Similar effects were shown in the improvement of wrinkles, red area, brown area, and LAST [Supplementary Figures 1–3, https://links.lww.com/CM9/B261]. Previous studies in mice showed that GA at high concentrations (≥3%) caused epidermal separation, resulting in skin irritation or chemical burns. GA at low concentrations (≤2%) might have an anti-inflammatory effect via epigenetic modifications, and decreased corneocyte cohesion and epidermal thickness.[3,4] Human skin has better tolerance than mouse skin; ≤5% GA was usually considered the low-concentration group in clinical application, while ≥20% GA group was defined as high. After treatment, each group experienced a significant decrease in skin lesions. Two obvious differences between two groups were found in our study. First, the decrease of pores in 20% GA group was better than that in 5% GA group. Pore improvement may be attributed to collagen remodeling in the group with higher concentration. This indicates that 20% GA acts as both a superficial and medium-depth peel, while the 5% GA complex was associated with superficial peels. Second, the epidermal barrier function was evaluated by TEWL and skin hydration in this study. After treatment, the TEWL of each group had increased significantly relative to the baseline, and a greater increase of TEWL was observed in the 20% GA group than in the 5% group. Skin hydration was significantly higher in the 5% GA complex group compared with the baseline, but did not change significantly in the 20% group. On the one hand, the higher concentration may be an irritant to the skin barrier, but on the other, the 5% GA complex contains repairing factors which may help improve the skin barrier signs. Moreover, the anti-inflammatory effects of the 5% GA complex may have contributed to the significant decrease in the inflammatory lesions of the patients. LAST is a skin sensitivity assessment that was used to confirm whether skin sensitivity changed after treatment. In our study, the patients were able to tolerate LA stimulation for a longer time after treatment. The differences in other LAST indicators between the groups were not significant, indicating that skin sensitivity of patients after either 5% GA or 20% GA treatment was improved. There were some limitations in our study. The study design would be more convincing by the addition of an age- and gender-matched control group, who used the same facial cleanser or vitamin E moisturizing cream as the 80 participants in this study who had acne. Besides, since this is a single-center study, the source of patients may be limited. Thus, the generalization of the results may not be universal. In conclusion, 20% GA and 5% GA complex were both effective on mild-to-moderate acne. Twenty percent GA is more suitable for acne patients presenting with large pores, whereas 5% GA complex, which could repair the skin barrier, is appropriate for acne patients with inflammatory lesions. Funding This work was supported by grants from the National Natural Science Foundation of China (No. 82273555) and Beijing Natural Science Foundation (No. 722240). Conflicts of interest None.

To investigate the clinical joints manifestations under musculoskeletal ultrasound (MSUS) and hematological findings in patients with psoriatic arthritis (PsA), which may provide a basis for improving the early diagnosis of PsA. From September 2016 to February 2021, 328 patients with psoriasis visited the dermatological and rheumatic outpatient of the Beijing Friendship Hospital were enrolled in this retrospective study. Patients were enrolled according to a paired-design method. The PsA group included 164 patients diagnosed with PsA, and the control group included 164 patients diagnosed with psoriasis without PsA. Both groups of patients were evaluated by a rheumatoid immunologist, a dermatologist, and a sonographer. Demographic data, course of disease, severity of skin lesions, combined diseases, and previous treatment were all collected. All patients received MSUS and blood examinations. Lower extremity enthsis diseases were evaluated by Glasgow ultrasound enthesitis scoring system (GUESS). In the comparison of baseline clinical characteristics, the PsA group has longer course of psoriasis (P = 0.005), longer course of joints pain (P = 0.035), higher incidence of peripheral joints pain (P = 0.001), higher GUESS score (P < 0.001), and higher incidence of involved nails or toenails (P = 0.036) The most common joints involved were proximal interphalangeal joint (33.5%), knee (27.4%), and metacarpophalangeal joint (25.0%). Differences in clinical manifestations at different lower limb enthesitis on MSUS have also been proved. The positive incidences of rheumatoid factor (RF) (P = 0.002) and anti-cyclic citrullinated peptide (CCP) antibody (P < 0.001) in the PsA group were significantly higher than those in the control group. Binary Logistic regression showed that patients with anti-CCP antibody positive had a higher risk of active PsA compared to patients with negative antibodies in PsA group (OR: 0.626, 95%CI: 0.361–0.792, P < 0.05). In conclusion, the most common joints involved were proximal interphalangeal joint, knee, and metacarpophalangeal joint in patients with PsA, and the common types of diseased joints manifestations on MSUS were synovial thickening, fluid accumulation, bone destruction, increased blood flow signals, and attachment site inflammation. GUESS scoring systems can be used to identify PsA in patients with psoriasis. Psoriasis patients with RF and anti-CCP antibody positive were more likely to develop PsA, and anti-CCP antibody positive was a risk factor for active PsA. • GUESS scoring systems can be used to identify PsA in patients with psoriasis. • Psoriasis patients with RF and anti-CCP antibody positive were more likely to develop PsA, and anti-CCP antibody positive was a risk factor for active PsA.

Aims: The aim of this study was to summarize the currently available evidence on the associations between the IL-10-1082G/A, IL-10-592A/C, and IL-10-819G/A polymorphisms and susceptibility to atopic dermatitis (AD). Materials and Methods: Five electronic databases including PubMed, the Web of Science, Excerpta Medica dataBASE, the Cochrane Library, and the China National Knowledge Infrastructure were searched for potential studies. Studies illustrating the association of the IL-10-1082G/A, IL-10-592A/C, and IL-10-819G/A polymorphisms and AD susceptibility were included in this meta-analysis. For a study to be included, it had to have been published before September 20, 2018. Study quality was assessed using the Newcastle-Ottawa scale. Summary odds ratios and 95% confidence intervals were calculated to evaluate potential associations under five genetic models. Results: A total of 15 case-control studies comprising of 1647 AD patients and 2031 controls were included in this meta-analysis. Their methodological qualities were generally high. We confirmed an association between the IL-10-819G/A polymorphism and AD, but there was an insignificant association identified between the IL-10-1082G/A and the IL-10-592A/C polymorphisms and AD when all ethnic groups were considered together. The subgroup analyses revealed some ethnic-specific effects. For the IL-10-819G/A polymorphism, individuals with the GG-genotype seemed to have an increased risk of AD among Caucasian populations, but less so in the Asian populations. However, for the IL-10-1082G/A polymorphism, the GG-genotype carriers seemed to be more susceptible to AD in the Asian populations than in the Caucasian populations. Conclusions: This meta-analysis suggests that the IL-10-819G/A polymorphism seems to be associated with increased risk of AD among Caucasian populations, and that the IL-10-1082G/A polymorphism seems to be correlated with AD among Asian populations.