[Objective] To evaluate the efficacy of autologous whole blood injections in patients with chronic spontaneous urticaria and positive autologous serum skin test (ASST).[[Methods]] After assessment of clinical history,patients with chronic spontaneous urticaria underwent skin prick test (SPT) and ASST.Then,100 patients with positive ASST but negative SPT for common allergens were randomly classified into treatment group (n =60) and control group (n =40).Oral loratadine was given to all the patients with a gradual tapering to the least maintenance dose.Patients in the treatment group were also injected with autologous whole blood once a week for 12 times.Patients were evaluated by urticaria activity score (UAS) and dermatology life quality index (DLQI) at the baseline,the end of the 3rd and 6th month after the initial treatment.The total amount of antihistamines required for the control of urticaria every month was calculated.The UAS,DLQI,accumulative amount of administrated antihistamines,and the diameter of wheal/flush induced by autologous serum were compared by t test before and after the treatment,and the efficacy was compared by rank sum test between the two groups.[Results] No significant difference was observed between the control and treatment group in UAS at the baseline (5.73 ± 0.51 vs.5.32 ± 0.79,P＞ 0.05).The UAS reached 1.57 ± 1.42 and 0.69± 0.92 with a decrease rate of 69％ and 81％ in the treatment group,and 3.65 ± 1.53 and 2.65 ± 1.61 with a decrease rate of 35％ and 53％ in the control group,respectively at the end of the 3rd and 6th month,and statistical difference was observed for the decrease in both groups at the two time points (all P ＜ 0.05).The total amount of antihistamines required for the control of urticaria per month averaged 8.63 pills and 3.83 pills respectively in the treatment group after 3 and 6 months of treatment,significantly less than that in the control group (16.85 and 15.27 pills,respectively).[Conclusion]s The combination of oral antihistamine and autologous whole blood injections can not only reduce disease activity and improve patients' quality of life,but also decrease the total amount of antihistamines required for the control of urticaria.

1 病历摘要 患者男,34岁.因全身丘疹30年伴额部斑块1年余,于2011年5月21日至我院就诊.患者于30年前无明显诱因,全身出现散在的红色斑丘疹,并逐渐扩大,不能自行消退.近一年来额面部出现结节,并逐渐增大,破溃结痂不能愈合.患者未正规就诊及治疗,外用各种药物(具体不详)治疗效果不佳.有乙肝病史,职业为农民,经常日晒.父母非近亲结婚,患者系足月顺产,家族中无类似疾病.

Objective To investigate clinical epidemiological charateristics of chronic urticaria(CU).Methods A survey was conducted to clinically diagnosed CU patients in our hospitals from January to September 2010.All these subjects received physical examination by dermatologists and were required to fulfill the self-report questionnaires.EpiData and SPSS 13.0 were utilized for statistical analysis.Results Totally,there were 535 valid questionnaires returned in this survey.Of them,204 were male and 331 were female with a mean age of 34.4±14.0.The average age of these subjects at first onset was 30.6±14.8.The prevalence of CU peaked in patients aging from 20 to 40 years.The self-reported eliciting factors of urticaria were as follows: physical stimuli 94(approximately 17.6%),drugs 23(4.3%),foods 29(5.4%),mental factor 39(7.3%),working pressure 9(1.7%),mosquito 24(4.5%),and others 54(10.0%),whereas 263(49.2%) of the participants could not identify any trigger.The most common type was chronic spontaneous urticaria(CSU),accounting for 294(55.0%),followed by dermographic urticaria factitia 120(22.4%).While the rarest type was delayed pressure urticaria,vibratory urticaria and exercise induced urticaria type.Angioedema in CU accounted for 105(19.6%),70(21.1%) were female,and 76(25.9%) were CSU with it.Positive autologous serum skin test(ASST) was accounted for 49.6%.Conclusion The high prevalence of CU is in the young populations,with various clinical manifestations.Coexisting with angioedema is not uncommon.Investigating CU clinical epidemiological characteristics is helpful to guide the therapy strategies.

BACKGROUND:Several studies have shown that hair follicle bugle cells can differentiate into hair follicles and contribute to the formation of the epidermis and sebaceous gland. Although many lines of evidence have suggested that the renewal and maintenance of the sebaceous gland depends on hair follicle bulge cells, direct evidence supporting the in vitro differentiation of follicle bulge cells into sebaceous gland cells has not been found.METHODS:Rat vibrissa follicle bulge cells were isolated, cultured, and transfected with green fluorescent protein (GFPC1) plasmids carrying the peroxisome proliferator-activated receptor gamma2 (PPARgamma2 ) gene. The transfected cells were cultured in modified medium, and the morphologic changes of the cells were observed. Moreover, the expression of epithelial membrane antigens (EMAs) by the cells was detected by immunocytochemistry, and adipogenesis of the cells was evaluated.RESULTS:After induction culture, the cell body enlarged gradually and contained abundant cytoplasm; lipid droplets appeared in the cytoplasm of some cells, and the cells resembled sebocytes of the sebaceous gland. The cells were positive on oil red O and EMA staining. The expression of PPARgamma2 mRNA and protein was significantly upregulated in PPARgamma2-transfected cells. The rate of oil red O-stained and EMA-positive cells was higher in PPARgamma2-transfected cells after induction than in bulge-PPARgamma2 cells and non-transfected bulge cells.CONCLUSIONS:Rat vibrissa hair follicle bulge cells may differentiate into sebocytes in vitro, and the PPARgamma2 gene plays a crucial role.

1 病历摘要 患儿女,2岁.左侧面部红色丘疹渐增多2年.患儿出生时家属发现其左耳前有2个粟粒大的红色丘疹,无破溃,未予特殊注意.皮损逐渐增大、增多,呈群集分布且逐渐向面颊部延伸,患儿偶搔抓患处,曾给予丁酸氢化可的松软膏(尤卓尔)外用,无明显效果.

As an important member of the cyclooxygenase isoenzymes, cyclooxygenase-2 (COX-2) mainly catalyzes the first two steps in prostanoid synthesis. In mammalian animals, although COX-2 was thought to be rarely expressed in most normal tissues and was usually upregulated in a variety of epithelial tumors and inflammatory reactions, recently it was reported that COX-2 could localize in the epidermis as well as the pilosebaceous unit of the normal human and mouse skin. Until now, the function of COX-2 in normal skin has remained unknown. To investigate the possible roles of COX-2 in normal skin by RT-PCR and immunochemistry, we studied the expression pattern of COX-2 in hair cycle of the normal rat skin. The expression of COX-2 mRNA was detected in normal rat skin sample and was related to the hair follicle cycle. When the hair cycle entered catagen and telogen, COX-2 mRNA transcription in skin increased significantly. Furthermore, the location of COX-2 immunoreactivity showed that COX-2 protein is mainly concentrated in the epidermis and pilosebaceous unit. In the stratified epidermis, the strong COX-2 protein expression was detected in the suprabasal layers of epidermis in anagen and declined in catagen and telogen. In hair follicle, COX-2 protein was obviously expressed in the outer root sheath of the anagen hair follicle, and was barely detectable in catagen as well as telogen. In the sebaceous gland, the COX-2 protein expression became more intense in catagen and telogen, with an increase in sebaceous gland size. Our results suggested that COX-2 was not specific to some abnormal tissues and was indeed involved in the normal physiology of rat skin, such as the differentiation of epidermis, the morphogenesis of the hair follicle, the transformation of hair cycle stages, and the lipid production of the sebaceous gland.

<正>患儿女,14岁。左耳后丘疹1年,无自觉症状,于2006年7月28日来本院门诊就诊。患儿1年前左耳后出现2个针头大黄白色丘疹,不痛不痒,未予治疗,后皮损逐渐增多。既往体健,否认局部有刺激及外伤史。家族中无类似疾病患者。体格检查:

Objective: To detect the expression of trappin-2 in psoriasis. Methods: The expression of trappin-2 in the serum from 50 patients with psoriasis vulgaris and 16 patients with psoriasis pustulosa,and in suction blister fluids from 32 patients with psoriasis vulgaris and 10 patients with circumscribed psoriasis pustulosa,was measured with double-sandwich ELISA. Results: The levels of trappin-2 expression in the sera and lesions from patients with psoriasis vulgaris were significantly higher than those from the controls (all P 0.01). There was also significant difference in trappin-2 expression in sera between progressive stage and stationary stage(P 0.05). These were also positively correlated with the corresponding PASI scores. The levels of trappin-2 expression in the sera and lesions from circumscribed and generalized psoriasis pustulosa were significantly higher than those from the controls(P 0.05). There was no statistical difference between the levels of trappin-2 expression from psoriasis pustulosa and those from psoriasis vulgaris,and no correlation was found with the severity scores. Conclusion: Trappin-2 might play an important role in the pathogenesis of psoriasis vulgaris and psoriasis pustulosa.

A sporadic case of apocrine hidrocystoma is reported.A 20-year-old Chinese woman had small round-oval papules,gradually inerescent,asymptomatie,localized to the outboard of left eye for about 1 year.Histological examination showed multiple enlarged intradermal cyst.The cyst wall consisted of 1 to 2 layers flat or columnar cells.Decapitation se eretion was seen in inner layer cells.The out layer of cysts was formed by flat or cubic myoepithelial cells.Papillary pro- trusion was observed on part of the cyst wall.There was a few eosinophilic substance contained in the cysts.

Objective To detect β-nerve growth factor(βNGF) secreted by hair follicle bulge cells cultured in vitro qualitatively and quantitively and search the relationship between β-NGF and bulge cells growth condition.Methods The primary tissues from the labial part and around the barbell in inbred Wistar rats aged 6-8 d were stripped by micromanipulative technique and cultured.The ultrastructure of primary bulge cells was observed under transmission electron microscope(TEM).The secretion of β-NGF was determined by ELISA and immunocytochemistry.Results Primary bulge cells were cultured in vitro successfully.β-NGF was strongly expressed in the plasma of cultured bulge cells detected by ICC.The secretion of NGF detected by ELISA was regularly correlated with the characteristic of primary cultured bulge cells.Conclusion Primary bulge cells secreted the highest β-NGF when bulge cells grew into peak phase.The expression of β-NGF must have some necessary relationships with hair follicle bulge cells.

The bulge region of hair follicle has been reported as a putative reservoir of hair follicle stem cell (HFSC) for years; however, few studies were done about the characteristics of bulge-originated cells in vitro up to now. In this experiment, the bulge cells isolated from human hair follicles by enzymatic digestion and microdissection were cultured and passaged, and the morphological and biological features of cultured bulge cells were investigated by microscopy and immunocytochemistry. The result showed that new-proliferated cells could be observed on the second day after inoculation, and the quantity of the cells with a greater proliferation potential, reached a peak at the 6th day and maintained this higher level for several days. The mitotic figures of bulge cells were seen and these cells showed undifferentiated morphologic features. The bulge cells strongly expressed K19 and β1-integrin, which are the markers of HFSC, in a descensive way with the culture time. The result indicates that the cultured bulge cell from human hair follicle possesses the properties of primitive cells and supports the hypothesis that HFSC resides in the bulge area.

We attempted to characterize the genes expression of CD4+ T lymphocytes for the pathogenesis of systemic lupus erythematosus (SLE). Genomewide gene expression profiles of CD4+ T cells, which were isolated from the disease severe activity (T4-1s) and nonactivity (T4-2s) with an SLE patient by using long serial analysis of gene expression (LongSAGE). We picked out 289 genes matching to Unigene cluster with different expression more than four copies between T4-1s and T4-2s libraries and analyzed their roles from the collectedly published articles of PubMed by genes functional clustering. The genes functions were related to a diverse cellular process including: (1) most of these genes were associated with CD4+ T cells functions, particularly related to cellular developments; (2) Ras pathway genes as RANBP10, GMIP, RASGRP2 and ARL5 might be responsible for the abnormal development of CD4+ T cells of SLE; (3) HIG2, TCF7, KHSRP, WWP1, SMAD3, TLK2, AES, CCNI and PIM2 belong to Wnt/beta-catenin way, they could play roles in modulating proliferation and differentiation of T lymphocytes; (4) uncertain viral infections may initiate autoimmunity because high levels expression genes were detected in T4-1s such as TRIM22, IER2, ABCE1, DUT, G1P2, G1P3, HNRPUL1, EVER2, IFNAR1, TNFSF14, TMP21 and PVRL2; and (5) apoptosis relating genes as EIF3S8, SH3BGRL3, GPX4, TOSO, PFDN5, BIN1, XIAPAF1, TEGT and CUGBP2 may contribute to over uploading of selfantigens in SLE cells. Abnormalities findings of multiple genes expression involving with a variety of CD4+ T cells process might be meaningful to understanding the pathogenesis of SLE, and immature CD4+ T cells may be responsible for SLE.

To evaluate the levels of leukotrienes (LTs), interleukin-2 (IL-2), interleukin-4 (IL-4), interferon-γ (IFN-γ) in patients with eczema and observe the effects inversed by mizolastine. Serum LTB4, LTC4, IL-2, IL-4, IFN-γ and urinary LTE4 levels were detected by enzyme-linked immunosorbent assay (ELISA) and LTB4, LTC4, LTE4 concentrations of cutis tissue were measured by reverse-phase high-pressure liquid chromatography (RP-HPLC) in 10 eczema patients and 10 healthy volunteers. Eczema patients received mizolastine 10mg once a day for 5 days, respectively, for comparison between before and after treatment. The above markers were assayed again after treatment. Serum LTB4, LTC4, IL-2, IFN-γ and urinary LTE4 and skin tissue LTB4, LTC4, LTE4 levels in patients are higher than those in healthy volunteers significantly (P<0.05). But serum IL-4 level did not show significant difference between patients and normal controls (P>0.05). Mizolastine significantly reduced serum LTB4 and IFN-γ levels as well as skin lesion LTB4, LTC4, LTE4 concentrations. LTs are involved in the pathogenesis of eczema. Mizolastine clearly reduces LTs levels in skin lesion.

Objective To investigate the expression and significance of androgen receptor(AR) of rat vibrissa follicle stem cells in culture and vibrissa follicle stem cells in vivo at three different phases of a hair follicle cycle,including anagen,catagen and telogen.Methods AR was detected using immunohistochemistry.The expression of AR mRNA was examined by total RNA extraction and RT-PCR.Results In vivo the vibrissa follicle stem cells expressed AR in the whole hair follicle cycle.AR mRNA was strongly expressed in anagen,weakly in catagen and telogen.AR expressed in the cultured vibrissa follicle stem cells.Conclusion The expression of AR mRNA was altered regularly in rat vibrissa follicle stem cells in vivo throughout the hair follicle cycle,which suggested that the interaction between androgen and AR may facilitate the differentiation of vibrissa follicle stem cells.

A 50-year-old female presented with painful oral ulcers for five years and the painful erosion at vulval region for two years.She was diagnosed as oral lichen planus for many times and had no effect with corresponding treatment.Physical examination found the erosions in right buccal mucosa,on the upper and lower gingiva,the aditus vaginae,and the lower part of labium minus.Histopathologic examination supported the diagnosis lichen planus.This condition is a variant of erosive lichen planus.

Objective To investigate the expression pattern of COX-2 in adult rat pilosebaceous unit.Methods The expression pattern of COX-2 was detected by RT-PCT,immunohistochemical staining and stem cell primary culture.Results COX-2 expression in pilosebaceous unit of adult rat showed strongly positive at sebaceous gland,positive in bulge region and negative in hair matrix.Conclusion COX-2 in adult rat sebaceous gland was strongly and specifically expressed.Based on the theory that the hair follicle stem cells can migrate and differentiate from bulge region to sebaceous gland,the expression patterns of COX-2 indicates that it may play an important role on orienting differentiation of hair follicle stem cells to sebocytes.

Objective To study the change of growth property of rat hair follicle stem cells cultured in serum-free K-SFM in vitro. Methods Rat hair follicle bulge cells were isolated and cultured in two different conditions, serum-free K-SFM and DMEM/F12 with 10% fetal calf serum. Growth property, colony-forming efficiency (CFE), and K19 expression were analyzed. Results The CFE and positive expression of K19 were significantly higher in bulge cells cultured in serum-free K-SFM than that of DMEM/F12 with 10% fetal calf serum (P0.05). Conclusion Rat hair follicle bulge cells cultured in serum-free K-SFM has more advantages of high proliferation and stable phenotype than in DMEM/F12 with 10% fetal calf serum.

A case of giant Fournier's gangrene is reported. A 50-year-old man presented with painful erythema, swelling and vesicles with rapidly progressing ulceration on the external genitalia, which involved perianal, perineal and scrotal regions. The ulcer covered about 3% of the body surface. Escherichia coli were repeatedly isolated in purulent secretions and anaerobic culture was negative. Pathological changes showed chronic inflammation of the skin and local tissue necrosis.