Objective To investigate the application and challenge of reflectance confocal microscopy (RCM) in the diagnosis of pigmented nevus. Method A total of 997 patients with clinical diagnosis of pigmented nevus were included in the study, and RCM imaging was performed on the lesion of each patient. A biopsy was performed in 78 of these patients for histological diagnosis. We retrospectively analyzed the results of RCM diagnosis and histological diagnosis and then found the RCM characteristics of the histologically confirmed lesion. Results According to the RCM images, 823 of the 997 (82.55%) patients were diagnosed with pigmented nevus, while 113 (11.33%) were not diagnosed by dermatologists using RCM. Of the 78 biopsy lesions, 36 of the 46 (78.26%) cases diagnosed with pigmented nevus were consistent with histological diagnosis, while three were rediagnosed with dermatofibromas, four were seborrheic keratosis, one was malignant melanoma in situ, and two were lentigo. Conclusion RCM exhibits a high diagnostic accuracy for patients with clinical diagnosis of pigmented nevus. However, due to the limitation of RCM scanning depth and the commonality of the microscopic characteristics of related diseases, RCM still faces certain challenges in the diagnosis of pigmented nevus.

Background and ObjectivesPort wine stain (PWS) is a congenital vascular malformation of the human skin. Laser is the treatment of choice for PWS. Laser‐resistant PWS is one crucial factor accounting for inadequate treatment outcome, which needs to be fully characterized. This study aims to quantitatively characterize the morphology of laser‐resistant PWS blood vessels in the upper papillary dermis using in vivo reflectance confocal microscopy (RCM).Study Design/Materials and MethodsA total of 42 PWS subjects receiving laser treatment from August 2016 through July 2018 were enrolled into this study. Thirty‐three subjects had facial PWS; nine had extremity PWS. All subject's PWS received multiplex 585/1,064 nm laser treatment. RCM images were taken before and after treatment. The density, diameter, blood flow, and depth of PWS blood vessels were analyzed.ResultsWe found 44.4% PWS on the extremities (four out of nine subjects) were laser‐resistant, which was significantly higher (P < 0.001) when compared with those PWS on the face (15.2%, 5 out of 33 subjects). The laser‐resistant facial PWS blood vessels had significantly higher blood flow (1.35 ± 0.26 U vs. 0.89 ± 0.22 U, P < 0.001), larger blood vessel diameters (109.60 ± 18.24 µm vs. 84.36 ± 24.04 µm, P = 0.033) and were located deeper in the skin (106.01 ± 13.87 µm vs. 87.82 ± 12.57 µm, P < 0.001) in the skin when compared with laser‐responsive PWS on the face. The average PWS blood vessel density (17.01 ± 4.63/mm2 vs. 16.61 ± 4.44/mm2, P = 0.857) was not correlated to the laser resistance.ConclusionsLaser‐resistant PWS blood vessels had significantly higher blood flow, larger diameters, and were located deeper in the skin. RCM can be a valuable tool for a prognostic evaluation on laser‐resistant lesions before treatment, thereby providing guidance for tailored laser treatment protocols, which may improve the therapeutic outcome. The limitations for this study include relative small sample size and acquisitions of different blood vessels before and after 2 months of treatment. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Arteriovenous malformations (AVMs) are characterized by a snarled tangle of arteries and veins that are connected to each other through a bypass in the capillary bed.1,2 AVMs can occur anywhere on the body but are most commonly in the brain, lungs, pelvis, and extremities.1,2 AVMs can be either asymptomatic or cause intense pain or bleeding and can lead to serious medical problems.3,4 The diagnosis of an AVM involves a combination of vascular imaging studies, such as Doppler ultrasound, computerized axial tomography, magnetic resonance angiography, and histologic examination of tissue biopsies.

Nevus depigmentosus (ND) is a rare, congenital, nonprogressive depigmented lesion with irregular outline. To date, the few therapeutic approaches that have been developed to treat ND have yielded unsatisfactory results. We reported on a 6-month-old girl who presented with a ND on the right side of her face for 5 months. Treatment with a 308-nm excimer laser was started once a week at 300 mJ/cm2 and then was increased by 50-100 mJ/cm2 in each subsequent session until post-treatment erythema occurred. After 10 treatments, repigmentation in the lesion was evident and remained stable 1 month later at follow up. This case supports that the 308-nm excimer laser may be a good choice for the treatment of ND.

Human embryonic stem cell (hESC) line chHES-480 was derived from abnormal blastocyst diagnosed with adrenoleukodystrophy (ALD) after preimplantation genetic diagnosis (PGD) treatment. DNA sequencing analysis confirmed that chHES-480 cell line carried a hemizygous missense mutation c.1825G>A(p.Glu609Lys) of ABCD1 gene. Characteristic tests proved that the chHES-480 cell line presented typical markers of pluripotency and had the capability to form the three germ layers both in vitro and in vivo.

The human embryonic stem cell (hESC) line chHES-458 was derived from a abnormal blastocyst carrying the expanded CAG repeat mutation of the HTT gene that would lead to Huntington disease. This cell line maintained a normal karyotype 46, XX during long-term culture and displayed pluripotent characteristics, including expression of pluripotency-related transcription factors and capacity of forming well-differentiated three germ layers after being injected into the SCID mice.

Spinocerebellar ataxia type3 (SCA3) is an autosomal dominant neurodegenerative disorder. Human embryonic stem cell line chHES-472 was derived from abnormal embryo donated by SCA3 patient after preimplantation genetic diagnosis (PGD) treatment. This cell line had a normal karyotype and retained the disease-causing mutant in ATXN3 gene. Characteristic tests proved that the embryonic stem cell line presented typical markers of pluripotency and had the capability to form the three germlayers in vivo.

Objective:To explore the application value of confocal laser scanning microscopy（CLSM） for detection of facial Demodex mites. Methods:One hundred and twenty patients without basic diseases visiting the Department of Dermatology of the Third Xiangya Hospital for papules, pustules, erythema, and scales and suspected to have facial demodicosis were selected. Basic information and types of facial lesion were recorded. CLSM was performed to examine Demodex infection. Twenty patients with positive infection as indicated by CLSM were randomly selected for further verification with microscopy. Results:Among the 120 patients, 59 were positive for facial demodicosis as indicated by CLSM, with a detection rate of 49.2%, 61.1% of males and 39.4% of females. The 20 patients with further microscopic examination were all diagnosed as Demodex folliculorum infection. Among the 120 patients, the Demodex detection rate showed a trend of increase with age, with the highest rate （72.7%, 16/22） in the group of 40-49 years［P<0.05 versus the 21.1% （4/19） in the group of 10-19 years and the 37.8% （14/37） in 20-29］. In addition, there was a significant difference in the percentage of patients with ＜5 mites and ≥5 mites in area of 4 mm×4 mm between type I （mainly erythema and scales）（80.6%, 29/36; 19.4%, 7/36, respectively; P<0.01） and type II lesions （mainly papules and pustules） （52.2%, 12/23; 47.8%, 11/23, respectively; P>0.05）（P<0.05）. Conclusion:CLSM is an efficient technique for detecting facial Demodex, and is advantageous as it offers in-situ, noninvasive, painless, real-time and dynamic detection.

The aim of this study was to investigate the effectiveness of CO2 laser vaporation and topical PDT combination on condylomata acuminate (CA) located in the perianal and external genital area. A total of 119 patients (perianal CA=52 cases and external genital CA=67 cases) with at least one CA lesion >2mm were treated with monopulse CO2 laser followed by topical ALA-PDT. PDT was repeated till complete response was achieved. Approximately half of the patients only needed one session of PDT treatment and another half needed multiple PDT treatments to achieve complete response. During the 6-month follow-up 7.1% of patients relapsed. In terms of complete response rate and recurrence rate there were no statistical differences between perianal and genital groups. No severe adverse effects were observed. CO2 laser vaporation plus ALA-PDT is a highly effective modality for treating CA.

In this study, we established a Wistar rat model of right middle cerebral artery occlusion and observed pathological imaging changes (T2-weighted imaging [T2WI], T(2)FLAIR, and diffusion-weighted imaging [DWI]) following cerebral infarction. The pathological changes were divided into three phases: early cerebral infarction, middle cerebral infarction, and late cerebral infarction. In the early cerebral infarction phase (less than 2 hours post-infarction), there was evidence of intracellular edema, which improved after reperfusion. This improvement was defined as the ischemic penumbra. In this phase, a high DWI signal and a low apparent diffusion coefficient were observed in the right basal ganglia region. By contrast, there were no abnormal T2WI and T(2)FLAIR signals. For the middle cerebral infarction phase (2-4 hours post-infarction), a mixed edema was observed. After reperfusion, there was a mild improvement in cell edema, while the angioedema became more serious. A high DWI signal and a low apparent diffusion coefficient signal were observed, and some rats showed high T2WI and T(2)FLAIR signals. For the late cerebral infarction phase (4-6 hours post-infarction), significant angioedema was visible in the infarction site. After reperfusion, there was a significant increase in angioedema, while there was evidence of hemorrhage and necrosis. A mixed signal was observed on DWI, while a high apparent diffusion coefficient signal, a high T2WI signal, and a high T(2)FLAIR signal were also observed. All 86 cerebral infarction patients were subjected to T2WI, T(2)FLAIR, and DWI. MRI results of clinic data similar to the early infarction phase of animal experiments were found in 51 patients, for which 10 patients (10/51) had an onset time greater than 6 hours. A total of 35 patients had MRI results similar to the middle and late infarction phase of animal experiments, of which eight patients (8/35) had an onset time less than 6 hours. These data suggest that defining the "therapeutic time window" as the time 6 hours after infarction may not be suitable for all patients. Integrated application of MRI sequences including T2WI, T(2)FLAIR, DW-MRI, and apparent diffusion coefficient mapping should be used to examine the ischemic penumbra, which may provide valuable information for identifying the "therapeutic time window".

OBJECTIVE To evaluate the short-term efficacy and safety of propranolol for problematic infantile hemangiomas. METHODS Oral propranolol was administered to 68 infants with heamngiomas diagnosed by clinical evaluation and adjuvant examination at 1.0~2.0 mg per kilogram of body weight per day, divided to 2 or 3 times. The patients revisited once a month. The changes of the tumor size, texture, and color were monitored and recorded at a regular interval.The adverse effects after medication were observed and managed accordingly.The short-term results were evaluated using a 4-grade system. RESULTS All the 68 infants were followed up for 3-13 months, except that 1 infants combined with other diseases and 4 withdrew.The overall response was Scale 1 in 8 infants, Scale II in 13, Scale III in 29, and Scale IV in 13. No serious adverse effects were seen, but none cured entirely as well. CONCLUSION Oral propranolol is safe and effective for infantile heamngioma with good short-term result. It could be used as the primary drug for problematic infantile hemangiomas at the rapid growth stage of hemangiomas.

Objectives: To study the influence of 5-ALA-IPL-PDT on the MAPK pathway and the secretion of MMP-1, TGF-β1 in fibroblasts. Methods: The fibroblasts were inoculated onto the culture plates. Two hours before IPL radiation dif ferent doses of 5-aminolevulinic acid (5-ALA) were added to the plate. The level of MAPK phosphorylation was examined by Western blotting. The levels of TGF-β1 and MMP-1 were assessed with enzyme-linked immunosorbent assay (ELISA). Results: Circled digit oneCompared with control groups, the expressions of MMP-1 in IPL(10 J/cm 2)+ALA(0.5 mmol/L) groups and IPL(10 J/cm 2)+ALA(1.0 mmol/L) groups were markedly enhanced by 94.7% and 111.4%, While the expressions of TGF-β1 dropped by 34.8% and 39.1%, respectively(P < 0.05). Circled digit twoCompared with IPL groups, IPL(10 J/cm 2)+ALA(0.5 mmol/L) increased the phosphorylation of MAPK(ERK,P38 and JNK), up to 113.1%, 36.1% and 67.3%, respectively. Conclusions: 5-ALA-IPL-PDT stimulates MAPK (ERK, P38 and JNK) phosphorylation in fibroblasts, a potential mechanism involved in downregulating the expression of TGF-β1 proteins,and upregulating the expression of MMP-1 proteins.

OBJECTIVE:To explore the effect of intense pulsed laser (IPL) on anti-aging and its mechanism.METHODS:Rat skin was continuously irradiated ex vivo by IPL at certain wavelengths with different energy densities. The rats were irradiated twice with an interval of 2 weeks. We measured superoxide dismutase (SOD) activity, malondialdehyde (MDA) content, hydroproline (Hyp) content, and the level of apoptosis-related gene B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X protein (Bax) in the IPL treatment groups, and then compared with those in the model groups and the control group.RESULTS:SOD activity and Hyp content in the IPL treatment groups were higher than those in the model groups, and MDA content in the IPL treatment group was lower than that in the model group (P<0.05). IPL irradiation increased Bcl-2 protein content in rat skin cells, but had no effect on Bax protein expression.CONCLUSION:IPL is effective to improve the appearance of aging skin. Its mechanism may relate to maintaining the balance of oxidation and anti-oxidation, restoring oxidase activity, and regulating the death of skin cells by increasing Bcl-2 expression.

Dyschromatosis symmetrica hereditaria (DSH) is a hereditary skin disease characterized by the presence of hyperpigmented and hypopigmented macules on face and dorsal aspects of the extremities that appear in infancy or early childhood. Genetic studies have identified mutations in the double-stranded RNA-specific adenosine deaminase (DSRAD) gene, encoding double-stranded RNA-specific adenosine deaminase, to be responsible for this disorder. Here, we report two novel mutations c.2116 G > A (E706K) and c.2848 C > T (Q950X) in the DSRAD gene identified in two Chinese pedigrees with DSH. This study should be useful for genetic counseling and prenatal diagnosis for affected families and in expanding the database on DSRAD gene mutations in DSH.