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Objective:To investigate prognostic factors for acral lentiginous melanoma (ALM) , and to construct a nomogram to verify the predictive value of these factors.Methods:Clinical data on 1 573 patients with ALM were collected from the Surveillance, Epidemiology, and End Results (SEER) database of National Cancer Institute in United States between 2004 and 2015. Data about patients′ age, gender, ulcer status, SEER staging, surgical protocols, T-, N- and M-staging, overall survival rates and disease-specific survival rates were extracted. Chi-square test was used to analyze the correlation of clinical characteristics with overall survival rates and melanoma-specific survival rates, and univariate and multivariate Cox proportional hazards regression models were used to investigate prognostic factors and establish predictive models.Results:Among the 1 537 patients with ALM, 714 were males, 823 were females, 818 were under 64 years of age, and 1 363 were Caucasian. Skin lesions occurred on the lower limbs and buttocks in 1 205 cases, and 974 cases had ulcers; according to the SEER staging, non-spread localized skin lesions were observed in 1 048 cases. There were significant differences in the mortality rate among patients of different ages at diagnosis, different gender, with different ulcer status, surgical status, and at different SEER stages, T-stages, N-stages and M-stages (all P < 0.001) . Univariate and multivariate Cox regression analysis showed that age ≥ 65 years, male, ulcers and distant lymph node metastasis in the SEER staging were associated with increased risk of death in the patients (all P < 0.05) , and the mortality rate was significantly higher in the patients with T2-, T3- or T4-stage ALM than in those with T1-stage ALM (all P < 0.05) , and higher in the patients with N1-, N2- and N3-stage ALM than in those with N0-stage ALM (all P < 0.05) . Conclusion:Age, gender, ulcer status, SEER stage, T-stage and N-stage are independent prognostic factors for overall survival rates and disease-specific survival rates of ALM.
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Objective To adopt the network meta analysis method to compare the incidence difference of cutaneous squamous-cell carcinoma(SCC)and rash in 5 kinds of targeted drugs regimen for treating malignant melanoma.Methods PubMed and Cochrane Library databases were retrieved by computer.The retrieval range was from their establishment to November 2015.The network meta analysis pooled the evidences of direct and indirect comparison for evaluating the pooled odds ratio(OR)and cumulative probability of cutaneous complications occurrence difference in 5 kinds of targeted drugs regimen for treating malignant melanoma.Results Six randomized controlled trials(RCTs)conforming to the inclusion criteria were included.The meta analysis results revealed that compared with Dabrafenib+Trametinib,the cutaneous SCC occurrence rate of Vemurafenib was higher(OR=9.20,95％CI=1.26-52.53),while the rash occurrence rate of Vemurafenib+Cobimetinib was higher(OR=6.81,95％CI=1.01-41.87).The surface under the cumulative ranking curves(SUCRA)value showed that adopting Trametinib had the lowest occurrence rate for SCC,and adopting Dabrafenib+Trametinib had the lowest occurrence rate of rash.Conclusion Dabrafenib+Trametinibis generate the lowest complication incidence rate of malignant melanoma.
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Objective To evaluate the effects of problem-based learning (PBL) teaching mode and lecture-based learning (LBL) teaching mode applied in clinical teaching of dermatology in China.Methods All studies on PBL teaching mode and LBL teaching mode applied in clinical teaching of dermatology in China published from 1990 to 2015 were identified by searching in CNKI,VIP database,Wanfang data and so on.Meta-analysis was performed by RevMan 5.3 software.Results Six random controlled trials on 710 clinical students qualified for the meta-analysis according to our criteria.The students in PBL group got significant higher scores than those of the students in LBL group in theoretical scores [WMD=3.75,95％CI=2.58-4.92,P＜0.05],clinical skills tests [WMD=5.27,95％CI=4.60-5.94,P＜0.05] and total scores [WMD=7.93,95％CI=6.49-9.37,P＜0.05].Conclusion PBL teaching mode is an effective mode on teaching of dermatology in China,particularly for theoretical scores and clinical skills,compared with LBL mode.
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We learn the advanced philosophy and methods in dermatology residency standardized training program by introducing the residents matching system,periodical training programs and evaluation mechanisms in Taiwan.With the knowledge of current dermatology residency training system in mainland China,we give some recommendations to how to improve dermatology residency standardized training system in mainland China:standardizing and improving dermatology residence recruiting metrics,preparing effective training plan,and implementing better candidate evaluation processes as well as providing a strong faculty team.
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Objective To investigate the expression and significance of TGF‐β receptor Ⅰ /TGF‐β receptor Ⅱ (TGF‐β Ⅰ /TGF‐β Ⅱ) in human skin malignant melanoma A375 cell line .Methods The reverse transcription‐real time polymerase chain reac‐tion (RT‐PCR) and Western blot were utilized to assess the expressions of TGF‐βR Ⅰ /TGF‐‐βR Ⅱ in A375 cell line and human normal melanocytes .Results The expressions of TGF‐βR Ⅰ /TGF‐‐βR Ⅱ mRNA and protein of A375 cells line were significantly lower than those of human normal melanocytes .Conclusion The down‐regulated expression of TGF‐βR in the TGF‐β/Smad signal pathway of human skin malignant melanoma may be one of the pathogenesis of skin malignant melanoma .
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Objective To investigate the role of human herpesvirus type 7 (HHV-7) in the development of drug eruptions.Methods Venous blood samples were collected from 35 patients with mild drug eruptions at acute stage,15 patients with severe drug eruptions at both acute stage and remission stage,as well as 50 healthy human controls.PCR was performed to detect HHV-7 DNA in peripheral blood mononuclear cells (PBMCs),and enzymelinked immunosorbent assay (ELISA) to determine the titer of anti-HHV-7 IgM antibody in serum.Statistical analysis was carried out by t test,one way analysis of variance,Chi-square test and q test.Results The detection rate of HHV-7 DNA was significantly higher in these patients with drug eruptions than in the healthy controls (82.00％ (41/50) vs.62.00％ (31/50),x2 =4.96,P ＜ 0.05),different among patients with severe drug eruptions (93.33％ (14/15)),patients with mild drug eruptions (77.14％ (27/35)) and the healthy controls (x2 =6.32,P ＜ 0.05),higher in the patients with severe drug eruptions than in the healthy controls (q =3.50,P ＜ 0.05),but not significantly different between the patients with severe drug eruptions at acute stage and those at remission stage (73.33％(11/15),P ＞ 0.05).The anti-HHV-7 IgM antibody titer was significantly increased in the patients with drug eruptions compared with the healthy controls ((69.319 0 ± 25.289 7) ng/L vs.(59.785 3 ± 22.438 2) ng/L,t =1.99,P ＜ 0.05),but no significant difference was observed among the patients with severe drug eruptions (74.340 7 ±31.411 2) ng/L),patients with mild drug eruptions ((65.479 1 ± 21.326 1) ng/L) and healthy controls (P ＞ 0.05) or between HHV-7 DNA-positive patients ((63.748 1 ± 27.239 1) ng/L) and-negative patients ((65.580 2 ± 36.258 4) ng/L,P ＞ 0.05).Conclusions Active HHV-7 infection exists in patients with drug eruptions,and may be associated with the development and aggravation of this entity.
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Objective To investigate the relationship between anti-Helicobacter pylori (Hp) antibodies and development of chronic urticaria (CU).Methods Fifty CU patients with positive 13C-urea breath test and anti-Hp antibodies,as well as 50 healthy human controls were recruited in this study.Serum samples were collected from all the subjects.The samples from the patients were subjected to tests for anti-high affinity IgE receptor (anti-FcεRI) and-IgE antibodies.Human mast cells (HMCs) were classified into several parts to be incubated with the sera of patients with CU,the sera of healthy controls with anti-IgE and-FcεRI antibodies respectively for 20 minutes.Those incubated with the sera of healthy controls without these antibodies served as the control.Subsequently,the levels of histamine released by HMCs were measured by enzyme-linked immunosorbent assay (ELISA).Results The sera of CU patients showed a stronger ability to activate HMCs to release histamine than those of healthy controls ((3.13 ± 0.93) μg/L vs (2.92 ± 0.75) μg/L,t =2.39,P ＜ 0.05).Anti-FcεRI antibodies were detected in 4 patients,and antiIgE antibodies in 3 patients.A significant increase was observed in the levels of histamine released by HMCs incubated with anti-FcεRI antibody-positive and anti-IgE antibody-positive patient-derived sera (t =4.82,6.34,respectively,both P ＜ 0.01),but not in those incubated with patient-derived sera only positive for anti-Hp antibodies (t =1.74,P ＞ 0.05) compared with those incubated with healthy control-derived sera.In comparison with the antibody-free healthy control-derived sera,those with anti-Hp IgG antibodies showed no significant effect on the release of histamines by HMCs (t =1.95,P ＞ 0.05),whereas those with anti-FcεRI antibodies and anti-IgE antibodies exhibited an obvious promoting effect (t =3.72,3.02,respectively,both P ＜ 0.01).Conclusions The anti-Hp antibodies appears to have no role in the pathogenesis of CU,but the presence of anti-FcεRI and anti-IgE antibodies may contribute to the initiation of CU in patients with Hp infection.