Bullous pemphigoid (BP) can be comorbid with a variety of immune diseases, such as immune skin diseases (psoriasis, vitiligo, alopecia areata and various other immune bullous diseases) , immune digestive diseases (inflammatory bowel disease, primary biliary cirrhosis) , autoimmune thyroid diseases, autoimmune rheumatic diseases (rheumatoid arthritis, dermatomyositis, scleroderma and systemic lupus erythematosus) , immune renal diseases (immune nephropathy, renal allograft rejection) and acquired hemophilia A. The above comorbidities markedly affect the quality of life of and treatment options for patients. This review elaborates on currently reported immune diseases associated with BP and their concomitant mechanisms.

目的 分析医院初治的食管癌住院费用影响因素,为医疗费用控制、医疗资源配置、癌症防控政策制定提供决策参考.方法 回顾性分析北京某三甲肿瘤专科医院2015年1月1日-2019年12月31日食管癌初治患者的病案资料共计4485份,对研究指标进行描述性统计分析、单因素统计分析、逐步回归多因素分析.结果 共纳入食管癌患者4485例,平均住院费用为8.96万元.影响住院费用的独立影响因素包括:年龄(P=0.05)、收入情况(P=0.04)、付费方式(P＜0.01)、治疗方式(P＜0.01)、住院天数(P＜0.01)等.肿瘤分期与治疗方式有明显相关性(P＜0.01).结论 食管癌住院费用影响因素众多、直接医疗负担较重,北京市综合医疗改革,对食管癌患者住院费用控制和结构调整有积极作用.我们既要规范诊疗,又要推行早诊早治,积极推行医疗改革,从而有效降低群众医疗负担、合理配置医疗资源.

痛风是由于嘌呤代谢紊乱致血尿酸增高引起的一组疾病，其临床特点多为非对称性单关节炎反复发作，特征性受累关节为第一跖趾足关节。当病例受累关节不典型，又存在易混淆的临床症状、检验及影像学结果时，易误诊。报道1例以反复膝关节肿痛为主要临床表现的痛风患者，因类风湿因子升高且关节超声提示滑膜炎而误诊为类风湿关节炎。

Skin is the largest organ of human, which can reflect host's health condition. Dermatovenereology is an important clinical discipline which focus on the profile of morphology. The challenge of learning is too much content but limited teaching hours. As to medical students, they may often feel dull and lose learning interest. How to arouse the enthusiasm and autonomy of medical students, and improve teaching effectiveness is one of difficulties in clinical teaching of dermatovenereology so draw attention by faculty as a potential orientation of education remodeling This paper aims for exploring a new teaching method, ‘diagnosis-initiated mode’, which may stimulate their interest in the learning of dermatovenereology.

China has a large number of hepatocellular carcinoma patients, and more than half of the new cases and deaths of hepatocellular carcinoma in the world occur in China every year. The chemosensitivity of hepatocellular carcinoma is relatively low. Targeted therapy with antiangio-genic drugs are main treatment options for advanced hepatocellular carcinoma, but the effective rate and survival prolonging effect are very limited. Recently immune checkpoint inhibitors have exhibited promising efficacy in hepatocellular carcinoma, which is changing the pattern of hepatocellular carcinoma treatment. However, challenges still exit. Biomarkers commonly used in clinical practice including programmed death ligand-1, tumor mutational burden and mismatch repair proteins have limited clinical value in hepatocellular carcinoma. Compared with other etiology related liver cancer, hepatitis B related hepatocellular carcinoma in China harbors unique gene mutation map, but the individualized treatment strategy based on molecular typing has not yet been established. More effective and diversified systematic treatment methods can promote the comprehensive treatment of hepatocellular carcinoma into a new era, and the relevant diagnosis and treatments need to be further explored and established. Based on relevant literatures and combined with clinical practices, the authors investigate the progress and consideration of immunotherapy strategy for hepatocellular carcinoma.

目的 分析肺微小结节(直径≤10 mm)的CT影像学表现,并探讨CT对其定性诊断的价值.方法 回顾性分析2017年3月至2018年11月行手术后经病理检查证实的87例肺微小结节患者共102个肺微小结节的多层螺旋CT征象.结果 102个肺微小结节中,良性组25个、癌前病变组27个、恶性组50个,3组结节的密度、毛刺征、分叶征、血管集束征、胸膜凹陷征发生率差异有统计学意义(P＜0.05).血管集束征在良性组和癌前病变组主要表现为贴边走形或穿行,无增粗扭曲,而恶性组主要表现为穿行并增粗扭曲,3组血管增厚和走形表现差异有统计学意义(x2=19.103,P＜0.001).3组的结节位置、瘤一肺界面情况、空泡征发生情况差异无统计学意义(P＞0.05).结论 肺微小结节CT影像学表现有一定特征性,CT在肺微小结节的诊断中有较高的价值.

Objective To investigate the teaching demands and practical effects of rotation in department of dermatology as well as demands for case database on eight-year medical students at Peking Union Medical College (PUMC). Methods From January 2017 to January 2019,the questionnaire survey was issued to the eight-year medical students of the 2011 to 2014 grade,which investigated the demands of the rotation,the difficulty in learning, the degree of mastery and demands for case database. Results A total of 101 valid questionnaires were received,which showed that the eight-year medical students at PUMC had a strong interest in the diagnosis and treatment of common and uncommon skin diseases as well as medical cosmetology. Autoimmune bullous disease was the most difficult chapter to learn. The eight-year medical students at PUMC had a strong demand for dermatology case database. They hoped to share it electronically. The most interesting content in the database was allergic skin disease. Conclusions The difficulties and weakness in dermatology teaching for eight-year medical students at PUMC and students' demands for dermatology case database are initially clarified,which may support is the improvement of learning outcome in dermatology.

嵌合抗原受体T(chimeric antigen receptor-T,CAR-T)细胞是一种通过基因编辑表达跨膜嵌合抗原受体并具有特异性导向的T细胞.CAR-T作为一种新兴的免疫治疗,已在肿瘤治疗方面取得较大突破.近年来,基于当前自身免疫性疾病治疗的局限性,研究者们正在不断探索CAR-T及其衍生疗法在自身免疫性疾病中的潜在治疗价值.本文重点阐述CAR-T在自身免疫性疾病领域的研究进展及现阶段所面临的挑战,为自身免疫性疾病的精准治疗提供理论依据.

自收自支事业单位是国家不拨款,经费完全自主筹集的事业单位.自收自支事业单位作为一个特殊的存在,经费几乎靠自主管理.新形势下,随着事业单位改革深化和市场经济不断发展,为加强自收自支事业单位预算管理,提高资金使用效率,对自收自支自事业单位预算管理进行探讨以期对改善管理提供些许建议.

目的 探讨伴t(11;19)(q23;p13)白血病临床实验室特点.方法 回顾性分析21例初诊t(11;19)(q23;p13)患者的临床实验室资料,包括核型分析、荧光原位杂交、融合基因、细胞免疫表型等.结果 21例患者中,16例为t(11;19)(q23;p13.1),核型表现为(11q+,19p–),伴有融合基因MLL-ELL阳性.男7例,女9例.分型诊断:1例AML-M2,3例AML-M4,10例AML-M5,另2例为CMML;5例为t(11;19)(q23;p13.3),核型表现为(11q–,19p+),伴有融合基因MLL-ENL阳性.1例男性,4例女性.分型诊断:3例proB-ALL,1例preB-ALL,1例T-ALL.结论 t(11;19)(q23;p13)为少见的非随机染色体易位,t(11;19)(q23;p13.1)主要在成人急性髓系白血病(AML)出现,且与单核系相关,而t(11;19)(q23;p13.3)主要在婴幼儿及儿童急性淋巴细胞白血病(ALL)中出现.

类天疱疮群是一组由自身抗体攻击基底膜带抗原蛋白,导致真表皮分离、表皮下水疱的自身免疫性疱病。该群组包含大疱性类天疱疮、黏膜类天疱疮等多个疾病,其中大疱性类天疱疮最为常见。不同国家和地区的类天疱疮发病特点不同,有些类天疱疮的病因和发病机制尚不明确。本文对几种较常见类天疱疮的流行病学特征及可能致病因素进行综述,为疾病的干预提供新视角。

Objective To investigate the clinical features of bullous systemic lupus erythematosus (BSLE),so as to improve the physicians' understanding of this condition.Methods The clinical date of 8 BSLE patients who were hospitalized in Peking Union Medical College Hospital from January 2014 to December 2016 were analyzed.Numerical data and categorical data were analyzed using t-test and chi-square test,respectively.Results These 8 subjects accounted for 0.3％ of the 2 965 hospitalized systemic lupus erythematosus (SLE) patients,including 2 males and 6 females with the mean age of (25±10) years old and median duration of 17 (3～43) months.Skin lesions,as the initial symptom at onset were shown in 3 cases.Blisters or bullae occurred on the face in 6 patients (6/8),trunk in 5 patients (5/8),extremities in 5 patients (5/8).All of them arose on normal-appearing skin.BSLE often occurred in active SLE with the average SLE disease activity index (SLEDAI) score of (12±8).Renal damage (8/8) was the most common complication followed by hematological abnormality (6/8),serositis (4/8),arthritis (3/8),neurological involvement (2/8).Compare with SLE patients without BSLE,the incidence of hematuria (6 cases,75％) and hemolytic anemia(4 cases,50％) were statistically higher in BSLE patients.Treated by corticosteroid and immunosuppressants,6 patients achieved clinical improvements,Conchusion The incidence of SLE is relatively rare.It tends to occur in patients with active lupus,especially in lupus nephritis and hematologic involvement.Glucocorticoids combined with immunosuppressants,as well as local treatment,could improve the prognosis.

Objective Relying on the molecular pathology group of Guangdong province clinical quality control center to carry out the external quality control for HER-2 gene detection by fluorescence in situ hybridization (FISH) methods in Guangdong province hospitals, in order to understand the standard operating procedure(SOP)key node of HER-2 gene detection entirely and better guide the targeted therapy of breast can-cer. M ethods The paraffin sections with different positive patterns of HER-2 were selected as the quality control tablets,and the cases of the same expression pattern were performed consecutively,and the first and last 2 pieces were tested to ensure the consistency of quality control tablets.Each participating laboratories adopted the FISH methods of their own work and selected the corresponding probes and digestive enzymes according to the actual situation. The quality control results were interpreted by quality control team members in a double-blind manner. R esults From the results of 26 laboratories participating in the quality control of HER-2 gene detection,all reagents used in the laboratories were approved by China Food and Drug Administration,and had no significant effect of these 3 probes on the quality control results. There were still some details of operation and interpretation in some individual laboratories. As a unit mistaken for cluster amplification, the self-agree-ment results of specimen①was 96.15%,specimen②was 84.62%,and the consistency of specimen③was up to 100%.The specimens were digested with Pepsin and proteinase K,and there were no obvious difference be-tween the 2 kinds of enzyme digestion.Meanwhile,microscopic examinations showed that DAPI staining were unclear in 2 units, it suggested the existence of excessive digestion. C onclusion Each laboratory should strictly follow the operating procedures of each laboratory to ensure that the temperature, buffer and cleaning liquid concentration and pH value,and probe configuration are accurate in the dyeing process.Only by constant-ly improving the external quality control system, the scientific design basis and clinical experiment process steps and evaluation standards,cooperating with the inspection team who knows the content,and regularly mon-itoring activities,the accuracy and consistency of HER-2 detection can be ensured in our province.

Bullous pemphigoid (BP) is an autoimmune skin disease characterized by the binding of autoantibodies to components of the hemidesmosome structure (BP230 and BP180),resulting in an inflammatory response and subepidermal blister formation.Binding of pathogenic autoantibodies activate complement cascade,neutrophils,mast cells,macrophages and other inflammatory cells.In this study,we summarized the role of neutrophils in the immunopathogenesis of BP mouse model,and will throw light on the new direction for disease intervention.

Objective To explore the experience in nursing breast cancer patients with simple mastectomy and sentinel lymph node biopsy.Methods Indocyanine green combined with methylene blue was used for sentinel lymph node biopsy.114 breast cancer patients with negative frozen biopsy of sentinel lymph node were treated with mastectomy plus sentinel lymph node biopsy.Before the operation,psychological nursing and preoperative guidance were carried out,and after the operative,pain nursing and wound care were done. Results The operation time of 114 patients was 1~2h, and the amount of bleeding was 50~100mL. After the operation, subcutaneous effusion occurred in 5 patients.After the treatment and intensive care,all the patients were cured. Conclusions Simple mastectomy and sentinel lymph node biopsy can avoid unnecessary lymph node dissection and reduce the injury to the body.Active and effective nursing measures and techniques play a dual role,which can ensure the desired effect.

A 69-year-old male presented with keratotic plaques on his palms and soles, as well as papules and macules on his whole body with itching for 40 days. He has taken metoprolol tartrate for 2 years intermit-tently. The biopsy featrues were accordance with lichenoid drug eruption. Betaloc was discontinued and the patient was treated with oral acitretin 30mg, once a day for one month combined with topical tacrolimus oint-ment and the lesions subsided.

目的 了解乳腺癌患者对治疗诱导的围绝经期症状的应对方法,为围绝经期症状管理提供依据.方法 对124例术后辅助化疗和/或抗雌激素治疗并伴中重度围绝经期综合征的乳腺癌门诊随诊患者进行访谈,了解治疗诱导的围绝经期症状对患者生活的影响及患者的应对方法.结果 93.5％的患者认为围绝经期症状对其生活有影响,自诉影响生活的4个主要症状依次为体力及精力感觉非常疲乏、关节肌肉不适、潮热、睡眠障碍;59.7％的患者曾采取措施来缓解症状,但仅38.8％认为有效;服用中药是患者采用最多的方式(43.2％);71.8％的患者表示应对围绝经期症状存在困难,其中不知道如何寻求帮助是最大的困难(57.3％).结论 乳腺癌患者认为治疗诱导的围绝经期症状严重影响其生活质量,应对措施整体有效率较低;乳腺癌患者围绝经期症状需要规范管理.

青年人卒中后需要家庭及社会长期提供支持,这都给卒中患者带来了一定程度的羞耻体验,被称为病耻感.病耻感在很大程度对患者的生活质量和心理健康产生影响.本综述通过了解青年脑卒中患者病耻感的研究现状,为有效降低青年脑卒中患者病耻感的干预方法提供更正确的策略,促使青年脑卒中患者提高生存品质.

嗜中性皮肤病包括一组以中性粒细胞浸润为组织病理特征的皮肤病,常见类型包括Sweet综合征、坏疽性脓皮病、白塞病等.嗜中性皮肤病大多合并多系统表现,其受累系统广泛,包括肺、骨、关节、中枢神经系统、肝、脾、肾、肌肉和心血管等.本文总结了该病常见的系统表现,旨在拓宽临床思维,促进疾病的系统诊断与治疗.

Synovitis,acne,pustulosis,hyperostosis and osteitis (SAPHO) syndrome is a rare disease with chronic inflammatory osteoarticular symptoms and various dermatologic lesions,manifesting as synovitis,acne,pustulosis,hyperostosis and osteitis.Various skin manifestations of SAPHO syndrome mainly include palmoplantar pustulosis,severe acne,psoriasis vulgaris and follicular occlusion triad.However,the causes of skin manifestations of SAPHO syndrome remain uncertain.Recent studies have found that it may be related to the activation of Toll-like receptor 2 (TLR-2) pathway and dysregulation of P2X7-interleukin (IL)-1 β axis.It is hard to control the symptoms of SAHPO syndrome.Non-steroidal anti inflammatory drugs (NSAIDs) usually serve as traditional first-line drugs,and second-line drugs usually include glucocorticoids,bisphosphonates and antirheumatic drugs.Current studies also suggest that tumor necrosis factor-α (TNF-oα) antagonists can relieve the symptoms of SAPHO syndrome,but their therapeutic effect is also controversial.Recent studies have found that secukinumab,an IL-17A antagonist,is rather effective for palmoplantar pustulosis.Correct understanding of the skin manifestations is meaningful for early diagnosis,treatment and pathological exploration of SAPHO syndrome.