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Objective:To analyze clinical manifestations, histopathological and pathogenic fungus characteristics as well as treatment of 3 cases of disseminated cutaneous alternariosis caused by Alternaria. Methods:Clinical data were collected from 3 cases of disseminated cutaneous alternariosis caused by Alternaria, who were diagnosed in Department of Dermatology, Xijing Hospital from 2019 to 2021, and clinical and histopathological features, fungal culture, strain identification and treatment results were retrospectively analyzed. Results:The 3 patients were aged 55, 41 and 46 years respectively, including 1 male and 2 females. Two patients were previously diagnosed with nephrotic syndrome and 1 with systemic lupus erythematosus. All the patients had a history of taking glucocorticoids and tacrolimus for different durations, and experienced chronic infections. Histopathological examination with hematoxylin and eosin (HE) staining showed double-contour thick-walled spores and knot-shaped thick-walled septal hyphae, but no melanin in skin lesions. Sequencing of the fungal internal transcribed spacer region confirmed that 2 cases were infected with Alternaria alternate, and 1 with Alternaria infectoria. Fungal culture at different temperatures showed that the growth ability of Alternaria markedly decreased at the temperature over 35 ℃. To treat these patients, the dose of tacrolimus was reduced to less than 1/3 of the standard dose, or tacrolimus was switched to other immunosuppressants, and systemic antifungal therapy was also given at the same time. After 7-month treatment, good clinical outcomes were achieved in the 3 patients. Conclusion:Disseminated cutaneous alternariosis is characterized by bilateral hematogenous dissemination and lymphatic distribution in unilateral limbs, and the skin lesions are characterized by verrucous plaques covered with scabs, nodules and/or sinuses.
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Objective:To explore surgical treatment strategies and prognosis of early-stage nail apparatus melanoma.Methods:A total of 115 patients with early-stage nail apparatus melanoma receiving surgical treatment were collected from Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from July 2011 to December 2019, and surgical treatment strategies and outcomes were analyzed retrospectively.Results:According to the modified ABCDEF criteria and clinical manifestations (such as deformation of the nail plate, ulcers, nodules) , 73 patients with early-stage nail apparatus melanoma received extended surgical resection based on the resection principles of melanoma in situ, 22 based on the resection principles of stage I and II melanoma, 20 based on the resection principles of stage I and II melanoma with invasion risks. During the follow-up period of 6 months to 9 years, there was no recurrence of the primary tumors in any patients; no abnormalities were observed by the ultrasound examination of lymph nodes in 101 patients; metastases occurred in 2 patients receiving finger amputation, 1 of whom died; 12 patients were lost to follow-up. Conclusion:To select extended surgical resection strategies for early-stage nail apparatus melanoma based on clinical manifestations, can ensure adequate treatment and preserve the normal function of the extremities to the greatest extent without recurrence of the primary tumors.
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Objective:To analyze clinicopathological characteristics of trauma-related melanoma and their relationship with the prognosis of patients.Methods:Clinical data were collected from 87 cases of trauma-related melanomas in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from 2009 to 2020, and their clinicopathological characteristics were retrospectively analyzed. Mann-Whitney test was used to analyze the difference in Breslow thickness of tumors between patients of different ages or genders; Spearman rank correlation analysis was used to analyze the correlation between the time from trauma to the notice of melanoma and Breslow thickness, Kaplan-Meier survival analysis and Log-Rank test were employed to analyze the relationship between clinicopathological characteristics of melanoma and the prognosis of patients; Cox regression model was used to analyze risk factors for survival duration of patients with trauma-related melanoma.Results:Among the 87 patients with trauma-related melanoma, 47 (54.02%) were males and 40 (45.98%) were females. Among them, melanoma occurred in 50 (57.47%) cases after sharp injuries, and in 37 (42.53%) after blunt injuries. In addition, 31 (35.63%) cases presented with primary lesions on the hands, and 48 (55.17%) on the feet. The Breslow thickness of the primary tumors was significantly higher in the group aged > 55 years than in the group aged ≤ 55 years ( U= 623.500, P= 0.010) , but there was no significant difference between patients of different genders ( P= 0.138) . The time from trauma to the notice of melanoma was negatively correlated with the Breslow thickness of tumors ( r=-0.203, P= 0.037) . The age of patients, Breslow thickness of tumors, Ki67 proliferation index and genetic background of tumor significantly affect the survival duration of patients with trauma-related melanoma ( P= 0.011, 0.031, 0.002 and 0.031, respectively) ; the gender, type of trauma and ulceration of tumor mass did not significantly affect the survival duration of patients ( P= 0.618, 0.114 and 0.379, respectively) . Cox regression model analysis showed that the Ki67 proliferation index and Breslow thickness were independent risk factors affecting the prognosis of trauma-related melanoma (risk ratio [ RR] and 95% confidence interval [ CI] were 1.946 (1.234, 4.217) and 1.839 (1.014, 3.332) , P= 0.039 and 0.045, respectively) . Conclusion:The Breslow thickness of trauma-related melanoma is related to the age of patients and time from trauma to the notice of melanoma; the age, Breslow thickness of tumors, Ki67 proliferation index and genetic background of tumor all affect the survival duration of patients with melanoma, and Ki67 proliferation index and Breslow thickness are independent risk factors affecting prognosis.
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Objective To compare clinical efficacy and safety of microwave therapy versus suction -curettage through small incisions in the treatment of axillary osmidrosis.Methods Totally,60 patients with axillary osmidrosis were enrolled from Department of Dermatology,Xijing Hospital,Fourth Military Medical University from January 2017 to February 2018.Every patient received miraDry microwave therapy on the left axillary (microwave therapy group) and suction-curettage through small incisions on the right axillary (suction-curettage group),and operation duration was recorded.After follow-up of half a year,clinical efficacy and complications were compared between the two groups.Results After 6-month follow-up,no significant differences were observed in the response rate or recurrence rate between the microwave therapy group (93.33％[56/60],6.67％[4/60] respectively) and suction-curettage group (96.67％ [58/60],3.33％ [2/60] respectively;both P ＞ 0.05).However,the incidence rate of postoperative complications was significantly lower in the microwave therapy group (0) than in the suction-curettage group (6.67％ [4/60],x2 =4.138,P =0.042).Conclusion Compared with suction-curettage through small incisions,microwave therapy has advantages of being non-invasive and less postoperative complications.
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Objective@#To compare clinical efficacy and safety of microwave therapy versus suction-curettage through small incisions in the treatment of axillary osmidrosis.@*Methods@#Totally, 60 patients with axillary osmidrosis were enrolled from Department of Dermatology, Xijing Hospital, Fourth Military Medical University from January 2017 to February 2018. Every patient received miraDry microwave therapy on the left axillary (microwave therapy group) and suction-curettage through small incisions on the right axillary (suction-curettage group) , and operation duration was recorded. After follow-up of half a year, clinical efficacy and complications were compared between the two groups.@*Results@#After 6-month follow-up, no significant differences were observed in the response rate or recurrence rate between the microwave therapy group (93.33%[56/60], 6.67%[4/60] respectively) and suction-curettage group (96.67% [58/60], 3.33% [2/60] respectively; both P > 0.05) . However, the incidence rate of postoperative complications was significantly lower in the microwave therapy group (0) than in the suction-curettage group (6.67% [4/60], χ2 = 4.138, P = 0.042) .@*Conclusion@#Compared with suction-curettage through small incisions, microwave therapy has advantages of being non-invasive and less postoperative complications.
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Objective To explore the application of radiofrequency lipolysis combined with line-ar lifting in fine lipolysis ,facial rejuvenation and treatment of common complications .Methods From February 2016 to October 2018 ,237 patients were treated by radiofrequency lipolysis combined with linear lifting .According to the patient's face shape ,skin laxity and fat accumulation ,the thickness of fat was measured by B-mode ultrasonography before operation ,and the operative plan was formulated after sufficient communication with the patients .Then ,we marked the range of lipolysis ,the orienta-tion of serrated line and the position of puncture point ,followed by the adjustment of the treatment parameters .Subsequently ,we placed FaceTite handle after swelling anesthesia ,moving slowly and fixing the treatment point ,as well as monitoring the temperature and swelling status of the skin .Im-mediately after the completion of lipolysis ,the treatment area of skin was ice compressed ,with the trocar needles inserted and serrated lines introduced for linear lifting operation .Neck-jaw sleeves were put on after operation .Results 237 patients had different degrees of post-operative edema ,of which the period ranged from 2 to 7 days .168 patients were followed up for 6 to 24 months ,and 8 patients had subcutaneous sclerosis that then gradually disappeared within 2 months after operation .Folliculitis occurred in 5 cases of scalp puncture ,and recovered after topical antibiotics .Facial skin relaxation and sagging ,fat accumulation ,facial shape ,pouch and wrinkles of 160 patients were improved in varying degrees ,and the outcomes of facial rejuvenation were obvious .However ,the self-reported treatment outcomes of 7 patients were not obvious .One patient was reported that the sagging of the skin after sacrificial lipolysis was worse than before ;48 patients underwent autologous fat transplantation ,botu-linum toxin injection ,hot pull ,E-light ,and water-light injection during the follow-up period ,and were not included in the evaluation of efficacy ;21 patients were lost to follow-up .Conclusions Radio-frequency lipolysis combined with linear lifting is an effective method for facial rejuvenation ,and it has obvious effect in fining lipolysis and facial rejuvenation by avoiding the disadvantage of single approach . Post-operative edema should be controlled and avoided to improve patients'satisfaction .
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Objective To evaluate the performance of surgical approaches in the treatment of linear scleroderma of the head and face. Methods Forty-three patients with stable linear scleroderma of the head and face were included in this study. Surgical approaches, which included direct suture,skin flap translocation, soft-tissue augmentation and filling operation with dermal tissues, were selected and utilized alone or in combination according to the size, location and degree of atrophy and depression of lesions. Results After surgical treatment, wound dehiscence developed in one of these patients, but the wound healed after two sessions of suture. During one year of follow up, all the patients achieved favorite color, feeling and blood supply in the filling areas as well as good facial profile and visual appearance with no obvious convexity and concavity. Skin flaps matched well with surrounding tissues, incision lines were inconspicuous, and hairline looked naturally with well-distributed hairs in these patients after treatment. Patients were satisfied with treatment results. Conclusion Satisfied cosmetic outcomes can be achieved by using surgical approaches in patients with stable linear scleroderma of the head and face.
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Objective To detect beta-human papilloma virus (HPV) and determine its genotype in actinic keratosis (AK) lesions.Methods Tissue specimens were collected from the lesions of 39 patients with AK and normal skin of 40 healthy controls.A nested PCR was performed to detect alpha-HPV and beta-HPV DNA in these specimens.The genotype of beta-HPV was determined in beta-HPV DNA-positive specimens by a common PCR using specific primers targeting 12 HPV genotypes,including HPV 5,8,15,17,19,20,21,23,36,38,49 and 80.Results The detection rate of beta-HPV DNA was 84.6％ (30/39) in the patients with AK,and 30.0％ (12/40) in the healthy controls (x2 =6.76,P ＜ 0.05),while no significant difference was observed in the detection rate of alpha-HPV DNA between the two groups (12.8％ vs.7.5％,x2 =0.91,P ＞ 0.05).HPV 38 was the predominant genotype of beta-HPV in these patients with a detection rate of 36％ (12/33),followed by HPV36.The prevalence of all the 12 genotypes of HPV was consistently low in the healthy controls.Mixed HPV infections were observed in 10 AK lesions,but in none of the healthy controls.No statistical difference was noted in the positivity rate of beta-HPV among patients at different ages,of different genders,with different occupations or clinical courses (x2 =0.53,0.94,0.81,0.73,respectively,all P ＞ 0.05).Conclusions Compared with healthy controls,the patients with AK showed a higher beta-HPV infection rate,with HPV38 as the predominant genotype.
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Carotid atherosclerosis is an important pathogenesis of ischemic stroke.Inflammation plays a crucial role in the artery atherosclerotic genesis and development as well as its caused complications.Human CXC chemokine ligand 16 (CXCL16),as a novel chemokine,involves in the formation and development of atherosclerotic plaques.It may be associated with atherosclerotic stroke.
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Objective To investigate the influence of different nutritional support ways on intestinal dysbacteriosis in patients with severe acute pancreatitis (SAP).Methods Sixty-six patients with SAP from January 2003 to June 2010 were divided into study group and control group according to random digits table,33 cases in each group,they were treated with enteral nutrition and total parenteral alimentation support treatment respectively and the incidence of intestinal dysbacteriosis was observed and compared.Results In 7 - 10 d after the onset of SAP,the number of escherichia coli and enterococci in study group were significantly lower than those in control group,the difference was statistically significant (P ＜ 0.05 );the number of bifidobacterium and lactobacillus were significantly higher than those in control group (P ＜ 0.05 ).A total of 25 patients in both groups occurred intestinal dysbacteriosis,the total incidence was 37.9%,the incidence in study group was 24.2% (8/33) and which was significantly lower than that in control group [51.5%( 17/33 )](P ＜ 0.05 ).Conclusion Enteral nutrition support treatment can reduce the incidence of intestinal dysbacteriosis in patients with SAP,its efficacy is better than parenteral nutrition.
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Objective To study the expression of double-stranded RNA-dependent protein kinase (PKR) in malignant melanoma and ordinary nevi. Methods The expression of PKR and proliferating cell nuclear antigen was examined in 42 cases of malignant melanoma and 25 ordinary nevi by an immunohistochemical method. Results The positive rate of PKR expression was higher in the patients with malignant melanoma than that in the patients with ordinary nevi (P