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Objective:To investigate distribution characteristics of Treponema pallidum (Tp) in secondary syphilis lesions, and to analyze its correlation with histopathological findings. Methods:Totally, 41 patients were collected from Department of Dermatology and Venereology, Peking Union Medical College Hospital from January 2008 to December 2018, who were confirmedly diagnosed with secondary syphilis according to clinical manifestations and serological examinations, and had undergone histopathological examinations. Immunohistochemical results of skin tissue sections were analyzed, and differences in clinical and histopathological characteristics were analyzed between immunohistochemically Tp-positive and Tp-negative sections. Continuous data were compared by using t test or Kruskal-Wallis test, and categorical data were compared by using Chi-square test or Fisher′s exact test. Results:Immunohistochemical examination showed that Tp was detected in 68.3% of the 42 secondary syphilis tissue sections, and Tp was mainly distributed in the lower epidermis and superficial and middle dermis. The positive rate of Tp was significantly higher in secondary syphilis lesions mainly manifesting as maculae (80% [16/20]) than in those mainly manifesting as papules (50% [11/22], P < 0.05) . Among 10 pathological characteristics, extended rete ridges, basal cell liquefaction degeneration, neutrophil infiltration in the stratum corneum, lichenoid pattern of infiltration and punctate keratinocyte necrosis were observed more frequently in immunohistochemically Tp-positive sections than in Tp-negative sections (all P < 0.05) . Immunohistochemical study revealed that tissue sections with a larger number of Tp showed more pathological features ( H = 17.914, P < 0.001) . Immunohistochemical staining showed that there were 8, 7 and 6 syphilis-specific histopathological characteristics on average in 8 tissue sections with a larger number of Tp, 14 with a medium number of Tp and 5 with a small number of Tp, respectively; while only 4 syphilis-specific histopathological characteristics were observed on average in 15 immunohistochemically Tp-negative tissue sections. Conclusion:Immunohistochemical staining could show the distribution of Tp in secondary syphilis lesions, and it seems that tissue sections with a larger number of Tp present with more syphilis-specific histopathological characteristics.
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Objective To report a pedigree with X?linked dominant protoporphyria(XLDPP), and to detect 5?aminolevulinic acid synthetase 2(ALAS2)gene mutations in this pedigree. Methods A clinical investigation was performed in a pedigree with XLDPP, and relevant data were collected from family members. A next?generation sequencing method was applied to screen possible mutation sites, and Sanger sequencing was performed to determine pathogenic gene mutations. Dermoscopy was conducted to observe skin lesions in the patients with XLDPP, and the Fotofinder system and very high frequency (VHF) ultrasound system were utilized to assess the severity of photodamage. Liver and gallbladder ultrasonography as well as blood examination were performed for all the family members. Results A deletion mutation, c.1706?1709ΔAGTG, was detected in the ALAS2 gene on the X chromosomes of all the patients in this family, which led to replacement or loss of 19-20 C?terminal residues through transcriptional frameshifting, and eventually caused an increase in ALAS2 activity. In the patients with XLDPP, skin photodamage was relatively severe;protoporphyrin?induced hepatobiliary damage was observed and aggravated with age;anemia and iron deficiency occurred sometimes. Conclusion The deletion mutation c.1706?1709ΔAGTG of the ALAS2 gene may be the underlying cause of XLDPP in this pedigree.
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<p><b>OBJECTIVE</b>Only a few clinical reports in the treatment of early mycosis fungoides (MF)(IA, IB, IIA stage) are available in the literature. The purpose of this study was to compare the efficacy and safety of narrow-band UVB and psoralen plus ultraviolet A (PUVA) photochemoterapy in 24 patients with early-stage MF, and explore a new approach for the treatment of early mycosis fungoides.</p><p><b>METHODS</b>A total of 24 identified early mycosis fungoides patients received PUVA, NB-UVB and a combined therapy of PUVA followed by NB-UVB (n = 9/6/9) irradiation. A retrospective study was carried out to analyze the sex, age of onset, TNM stage, treatment, and duration of treatment, and times of treatment, duration of maintenance treatment, effective and recurrence in these patients. The data were analyzed using SPSS 17.0 and a two-sided test at the α = 0.05 level of significance was conducted.</p><p><b>RESULTS</b>Of the 24 patients studied, the average treatment was 104.5 (95% CI, 75.71-133.29) times. The average duration of treatment was 12.88 (95% CI, 9.90-15.85) months. The average maintenance treatment time was 11.08 (95% CI, 2.13-20.04) months. The effective rate (CR+PR) of PUVA treatment was 88.9%, recurrence rate was 11.1% (n = 9). In the NB-UVB treatment group, the effective rate was 100.0%, and the recurrence rate was 33.3% (n = 6). In the PUVA followed by NB-UVB (combination therapy) treatment group, the effective rate was 77.8% and the recurrence rate was 55.6% (n = 9). There were no significant differences among the three groups in terms of number of treatments, treatment duration, maintenance treatment duration, effective rate and recurrence rate (P > 0.05).</p><p><b>CONCLUSIONS</b>PUVA and NB-UVB are effective and safe in the targeted therapy of early stage mycosis fungoides. The combined therapy of PUVA followed by NB-UVB can reduce the total PUVA dose and risk of developing skin cancer.</p>
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Humans , Combined Modality Therapy , Methods , Ficusin , Mycosis Fungoides , Therapeutics , Neoplasm Recurrence, Local , PUVA Therapy , Photochemotherapy , Physical Examination , Retrospective Studies , Treatment Outcome , Ultraviolet TherapyABSTRACT
Objectives To study the incidence of Trichomonas vaginalis(TV)infection in Chinese male patients with nongonococcal urethritis(NGU),to evaluate the sensitivity and specificity of urine-based and urethral swab polymerase chain reaction(PCR)detection,and to set up a method of non-invasive detection for male TV infection.Methods One hundred and five male NGU patients were collected from the STD clinic.Two urethral swabs were obtained from each patient,one for InPouch TV culture system,the other for PCR;one urine specimen(first-void urine or first-catch urine)was also collected for PCR detection.Culture was considered as the"gold standard".Compared with the culture,the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of two PCR detection were calculated.Results The positive rate of InPouch TV system detection was4.76%(5/105);the positive rate of urine-based PCR and urethral swab PCR detection was3.81%(4/105)and4.76%(5/105),respectively.In comparison with the culture,the sensitivity,specificity,PPV and NPV were80%,100%,100%and99%for urine-based PCR and80%,99%,80%and99%for urethral swab PCR.Conclusions TV is one of the etiological agent for male NGU,the positive rate of TV is4.76%in our study.The urine-based PCR detection has a higher sensitivity and specificity and provides a noninvasive method which is feasible in practice.
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Objective To evaluate the performance of ligase chain reaction(LCR) in the detection of Chlamydia trachomatis(Ct) from urethral or cervical samples in STD patients. Methods Ct was detected by LCR in urethral or cervical swabs from 276 cases with urethritis or cervicitis attending our STD clinic. All 276 urethral or cervical swab specimens were pooled by 4 into 69 pools for detection. Chlamydial cell culture was performed in 56 cases with nongonococal urethritis or cervicitis. Discrepant results were analyzed by PCR with primers targeting Ct major outer membrane protein gene. Results The sensitivity and specificity of LCR assay were 96.7% and 100% respectively. Two LCR approaches, pooling or individual testing, yielded 100% of consistency in the detection of Ct in urethral or cervical specimens. Conclusions LCR provides a highly sensitive and specific assay for detection of Ct from urethral and cervical samples, and could be recommended for the diagnosis of genital chlamydial infection. Pooling LCR is suitable for screening of urethral or cervical Ct infection in population study.