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Objective:To investigate the distribution of pathogenic fungi in patients with tinea capitis diagnosed in Xijing Hospital, Air Force Medical University in the past 10 years.Methods:A total of 871 outpatients or inpatients with tinea capitis were collected from the Department of Dermatology, Xijing Hospital from January 2011 to December 2020, and their clinical data and pathogen distribution were retrospectively analyzed. Pearson chi-square test was used to analyze differences in the pathogen distribution between children and adult patients with tinea capitis.Results:Of 871 patients with tinea capitis, 588 (67.5%) were males and 283 (33.5%) were females; 21 (2.40%) were aged less than 1 year, 266 (30.50%) aged 1 - 3 years, 352 (40.40%) aged 4 - 6 years, 187 (21.50%) aged 7 - 12 years, 4 (0.50%) aged 12 - 18 years, and 41 (4.70%) were aged 18 - 74 years. A total of 705 pathogenic strains were isolated from these patients, including 599 strains of Microsporum canis (85.0%) , 52 strains of Trichophyton mentagrophytes complex (7.4%) , 27 strains of Trichophyton tonsurans (3.8%) , and 18 strains of Trichophyton violaceum (2.6%) . Among the pathogenic fungi of tinea capitis, the proportion of Trichophyton violaceum was significantly higher in adults (8.8%) than in children (2.2%, P = 0.048) . Conclusions:In the past 10 years, the patients with tinea capitis in the Department of Dermatology, Xijing Hospital were mainly children aged 1 - 6 yearswhile adults, and adult patients with tinea capitis were uncommon. The main pathogen of tinea capitis was Microsporum canis, followed by Trichophyton mentagrophytes complex.
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Objective:To establish a melanoma cell line derived from a Chinese female patient of Han nationality with metastatic melanoma, and to study its basic biological characteristics.Methods:Metastatic melanoma cells were isolated from axillary lymph nodes of a 17-year-old female patient with malignant melanoma, and subjected to culture in vitro to establish a cell line. Short tandem repeat (STR) genotyping was performed to compare the information about the cell line and its derived tissue, and to detect gene mutations; cell counting kit-8 (CCK8) assay was conducted to assess the cellular proliferative activity, and soft agar cloning assay to assess the anchorage-independent proliferation; karyotype analysis was performed to determine the number and structure of chromosomes; with the highly aggressive melanoma cell line A2058 and keratinocyte line HaCaT serving as controls, Transwell assay was conducted to detect differences in cell migratory and invasive abilities, cell immunofluorescence assay and Western blot analysis were performed to determine the protein expression of melanoma-specific markers HMB45, S100 and Melan-A; the tumorigenicity was evaluated in vivo in a tumor-bearing mouse model. Results:A melanoma cell line was successfully established and named ZJMM-45, which was cultured for more than 70 passages over a 1-year period, and showed a stable shape and proliferative activity. The cells were spindle-shaped or polygonal, and could produce melanin. STR matching analysis showed that the ZJMM-45 sample was 96% matched with the cryopreserved lymph node tissue of the patient, suggesting that they were from the same source. A tumor-related gene BRAF V600E mutation (c.1799T>A) was identified in the ZJMM-45 cell line; karyotype analysis revealed that ZJMM-45 cells had triploid chromosomes and abnormal structures. ZJMM-45 cells grew exponentially in vitro and reached a plateau-phase in growth on day 5; the cells grew clonally and formed colonies in agar, showing anchorage-independent and malignant proliferative activity. Cell immunofluorescence assay and Western blot analysis showed that both ZJMM-45 and A2058 cells expressed HMB45, S100 and Melan-A; Transwell assay revealed that the numbers of invasive and migratory ZJMM-45 cells (300 ± 14, 260 ± 14, respectively) were significantly higher than those of invasive and migratory A2058 cells (150 ± 6, 160 ± 19, t = 13.25, 11.76, respectively, both P < 0.001) . The tumor-bearing mouse experiment showed that all 5 nude mice developed tumors with an inner diameter of 1.0 cm after 4 weeks, and the tumors were histopathologically characterized by proliferating hyperchromatic melanoma cell nuclei and formation of small nests, which were similar to primary solid tumors. Conclusion:The metastatic melanoma cell line ZJMM-45 derived from a Chinese patient with melanoma was successfully constructed, which carried the BRAF V600E mutation and expressed melanoma-specific markers, and was characterized by rapid proliferation, invasion and metastasis in both in vivo and in vitro culture, as well as obvious tumorigenicity in the in vivo experiment.
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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 analyze risk factors for diabetes mellitus in patients with vitiligo, and to construct and validate a prediction model.Methods:A total of 110 vitiligo patients with diabetes mellitus (comorbidity group) and 4 505 vitiligo patients without diabetes mellitus (control group) were collected from the medical record database in Xijing Hospital, the Fourth Military Medical University from January 2010 to October 2021, and matched for gender and age at a ratio of 1∶4 by using a propensity score method. After matching, the matched pairs were randomly divided into a training set and a test set at a ratio of 4∶1. Univariate and multivariate logistic regression analyses were used to assess demographic and clinical characteristics of patients in the training set, screen differential factors, and construct a prediction model. A five-fold cross-validation method was used for internal validation after construction of the prediction model. The discrimination (area under the curve [AUC]) , calibration (Hosmer-Lemeshow test) and accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of the prediction model were evaluated in the test set.Results:A total of 107 cases in the comorbidity group and 428 cases in the control group were successfully matched. The training set included 430 cases, and the test set included 105 cases. Based on multivariate logistic regression results, a total of 6 factors were included in the prediction model, including course of vitiligo (odds ratio [ OR] = 1.04, 95% confidence interval [ CI]: 1.02 - 1.07, P<0.001) , high-sugar/high-fat/high-salt diet ( OR = 3.19, 95% CI: 1.38 - 7.38, P = 0.007) , family history of diabetes ( OR = 23.23, 95% CI: 9.72 - 55.50, P<0.001) , metabolic comorbidities ( OR = 12.53, 95% CI: 5.60 - 28.07, P<0.001) , autoimmune comorbidities ( OR = 5.89, 95% CI: 2.52 - 13.76, P<0.001) , and acral vitiligo ( OR = 3.84, 95% CI: 1.45 - 10.19, P = 0.007) . Five-fold cross-validation results showed a good predictive performance of the prediction model, with the AUC being 0.902 (95% CI: 0.864 - 0.940) in the training set and 0.895 (95% CI: 0.815 - 0.974) in the test set. The prediction model also showed favourable discrimination (AUC =0.814, 95% CI: 0.715 - 0.913) , calibration (Hosmer-Lemeshow test, P = 0.068) , and accuracy (sensitivity = 0.810, 95% CI: 0.574 - 0.937; specificity = 0.786, 95% CI: 0.680 - 0.865; positive predictive value = 0.486, 95% CI: 0.317 - 0.657; negative predictive value = 0.943, 95% CI: 0.853 - 0.982) in the test set. Conclusion:A risk prediction model was constructed for diabetes mellitus in patients with vitiligo based on 6 factors (course of vitiligo, high-sugar/high-fat/high-salt diet, family history of diabetes, metabolic comorbidities, autoimmune comorbidities, and acral vitiligo) , which showed favourable discrimination, calibration and accuracy, and might provide a reference for screening the high-risk diabetic population in vitiligo patients.
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Objective:To investigate dermoscopic manifestations and features of melanonychia.Methods:A retrospective analysis was carried out on dermoscopic images of 4 common types of melanonychia collected in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2016 to July 2020.Results:A total of 266 cases of melanonychia were collected, including 64 (24.1%) of subungual melanoma, 52 (19.5%) of nail matrix nevi, 89 (33.5%) of subungual hemorrhage, and 61 (22.9%) of onychomycosis. Subungual melanoma and nail matrix nevi mostly occurred in the fingernails. To be specific, subungual melanoma most frequently occurred in the thumbnails (62.8%) , while nail matrix nevi mostly involved the 2 nd - 5 th fingernails (73.9%) . Subungual hemorrhage and onychomycosis mostly occurred in the toenails, and there were 51 (57.3%) cases of subungual hemorrhage of the toenails and 46 (75.4%) cases of onychomycosis of the toenails. Subungual melanoma mostly occurred in patients aged over 40 years (49 cases, 76.8%) , while the other 3 types of melanonychia mostly affected patients aged under 40 years. Dermoscopic manifestations of subungual melanoma mainly included regular longitudinal bands (35 cases, 54.7%) or irregular bands (25 cases, 39.0%) whose width was greater than 3 mm in 87.5% cases, Hutchinson sign (36 cases, 56.3%) , and ruptures (15 cases, 23.4%) which mainly were black-brown in color; dermoscopic manifestations of nail matrix nevi mainly were a single regular pigmented band (52 cases, 100%) whose width was less than 3 mm in 36 (69.2%) cases, and Hutchinson sign (26 cases, 50%) , while no ruptures were observed in nail matrix nevus lesions; subungual hemorrhage dermoscopically manifested as diffuse macules (74 cases, 83.1%) , and globular dark red or black hemorrhagic structures were observed in 85 (95.5%) cases; fungal melanonychia was dermoscopically characterized by irregular dark brown longitudinal bands (54 cases, 88.5%) . Conclusions:Subungual melanoma was dermoscopically characterized by regular longitudinal bands with a width of greater than 3 mm, nail matrix nevi by regular longitudinal bands, subungual hemorrhage by diffuse macules, and onychomycosis by irregular longitudinal bands. Dermatoscopy can be used to identify melanonychia lesions and provide a basis for auxiliary diagnosis of subungual melanoma.
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Objective:To investigate Chinese dermatologists′ perceptions of the correlation between diet and psoriasis, and to analyze factors influencing their perceptions.Methods:An exploratory survey study was conducted among Chinese dermatologists via the WeChat and Umer doctor platforms. The questionnaire consisted of 3 sections including career background characteristics (11 items) , dietary suggestions (3 items) and perceptions of effects of diet on psoriasis (19 items) . The results were expressed in frequency, assessed by chi-square test, and variables with significant differences were subjected to binary logistic regression analysis.Results:A total of 3 905 valid questionnaires were received. Among these responders, 91% believed psoriasis could be affected by dietary factors, and most believed certain diets could aggravate the severity of psoriasis; most dermatologists (80.1%) suggested patients avoid some foods or drinks, and the top 5 foods or drinks suggested to be avoided were seafood (2 950, 94.34%) , spicy food (2 599, 83.11%) , wine (2 588, 82.76%) , mutton (1 995, 63.8%) and beef (1 979, 63.29%) . Logistic regression analysis revealed that doctors with a college degree, practitioners of traditional Chinese medicine or integrated traditional Chinese and Western medicine, and those from hospitals of traditional Chinese medicine were more likely to suggest food or drink avoidance (all P < 0.001) ; practitioners of Western medicine ( P < 0.001) and those specializing in psoriasis ( P < 0.001) were more likely to inform that there was no need for food or drink avoidance, while those from municipal or county hospitals were less likely to inform that ( P = 0.025, 0.042, respectively) . Practitioners of traditional Chinese medicine ( P < 0.001) or integrated traditional Chinese and Western medicine ( P = 0.004) were more likely to believe that foods could aggravate the disease condition, while clinicians with working experience of more than 20 years ( P < 0.01) and those with a doctor degree ( P = 0.008) were less likely to think so; doctors with a college degree, and those from traditional Chinese medicine hospitals were more likely to believe that drinks could aggravate the disease condition (both P < 0.05) ; practitioners of traditional Chinese medicine or integrated traditional Chinese and Western medicine, those with intermediate and senior professional titles, those working at psoriasis specialty clinics and those engaged in psoriasis basic research were more likely to believe that foods could relieve the disease condition (all P < 0.05) ; doctors from traditional Chinese medicine hospitals, those with working experience of > 5 years, those with a college degree, and those engaged in psoriasis basic research were more likely to believe that drinks could relieve the condition (all P < 0.05) . Conclusion:A relatively high proportion of Chinese dermatologists had the viewpoints that diets were correlated with the severity of psoriasis and there was a need for food or drink avoidance, and this perception was related to academic degree, practicing category of clinicians, as well as the type and location of the hospital.
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Four male cases of hidradenitis suppurativa (Hurley stage Ⅱ/Ⅲ) aged 20 - 45 years were collected from Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from August 2017 to December 2019. All the patients presented with sinuses, abscesses and scars on the buttocks, axillary and inguinal regions, and showed a poor response to previous treatment with antibiotics, glucocorticoids, retinoids, traditional Chinese medicine, etc. The patients were treated with intravenous drips of infliximab at a dose of 5 mg/kg at weeks 0, 2 and 6, followed by an every-9-week treatment regimen, or with subcutaneous injection of adalimumab at a dose of 80 mg at weeks 0 and 2, followed by an every-3-week regimen at a dose of 40 mg. Two patients experienced infusion reactions after intravenous drips of infliximab, and then were switched to adalimumab. Three of these patients achieved hidradenitis suppurativa clinical response, whereas 1 showed no response.
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Objective@#To analyze the prevalence of and risk factors for infections in patients with pemphigus, and to evaluate their effect on prognosis.@*Methods@#Clinical data were collected from 182 inpatients with pemphigus in Department of Dermatology, Xijing Hospital, Fourth Military Medical University from May 2011 to May 2017, and retrospectively analyzed. Associations of infection rates with age, disease severity, comorbidities, maximum dose of glucocorticoids, hospitalization duration and costs were analyzed. Statistical analysis was carried out with SPSS 22.0 software by using Logistic regression analysis for analyzing risk factors for concurrent infections in pemphigus patients who were hospitalized for the first time.@*Results@#Among the 182 patients, 82 (45.05%) experienced infections. Additionally, 107 pathogenic strains were cultured from secretions from skin lesions of 77 patients, including 60 strains of Staphylococcus aureus (56.07%) , and 58 Staphylococcus aureus strains were resistant to penicillin (96.67%) . Among the 182 patients, infections were observed in 11 of 14 patients with hypoproteinemia, 69 (41.07%) of 168 patients without hypoproteinemia, 4 (4.81%) of 27 patients with mild pemphigus, 34 (37.7%) of 90 patients with moderate pemphigus and 44 (67.69%) of 65 patients with severe pemphigus. Logistic regression analysis showed that the prevalence rate of infections was significantly higher in the patients with hypoproteinemia than in those without hypoproteinemia (OR = 5.559, 95% CI 1.053-29.347, P = 0.043) . Compared with the patients with mild pemphigus, the prevalence rate of infections significantly increased in the patients with moderate (OR = 4.676, 95% CI 1.276-17.123, P < 0.05) or severe pemphigus (OR = 16.529, 95% CI 4.183-65.314, P < 0.001) . The prevalence of infections in patients with pemphigus was unaffected by gender, types of pemphigus, or the presence of hypertension or diabetes (all P > 0.05) . Among the 145 patients who were followed up, 33 were completely cured, 67 were cured clinically, 23 received improvement, 10 experienced relapse or exacerbation, and 12 died. Of the 12 dead patients, 3 died of pneumonia, 2 died of exacerbated pemphigus and skin infections, and 1 died of sepsis.@*Conclusions@#High disease severity and hypoproteinemia are risk factors for infections in patients with pemphigus. Bacterial infection is a common complication in patients with pemphigus, and severe infections are one of the causes of death in patients with pemphigus.
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In the last 10 years, emerging evidence from basic researches and clinical trials has revealed and confirmed the critical role of Th17/interleukin-17A (IL-17A) in the occurrence of psoriasis. Besides affecting the proliferative activity and functions of keratinocytes, IL-17A also plays an important role in the regulation of immune cells and related cytokines in the immune microenvironment in psoriasis. In recent years, monoclonal antibodies targeting the IL-17A pathway, such as secukinumab, ixekizumab and brodalumab, have been successively marketed in China and other countries, and have exhibited marked efficacy in clinical practice. This review summarizes latest advances in the role of IL-17A in the pathogenesis of psoriasis as well as in biotherapies targeting IL-17A and its receptor IL-17RA.
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Objective To analyze the prevalence of and risk factors for infections in patients with pemphigus,and to evaluate their effect on prognosis.Methods Clinical data were collected from 182 inpatients with pemphigus in Department of Dermatology,Xijing Hospital,Fourth Military Medical University from May 2011 to May 2017,and retrospectively analyzed.Associations of infection rates with age,disease severity,comorbidities,maximum dose of glucocorticoids,hospitalization duration and costs were analyzed.Statistical analysis was carried out with SPSS 22.0 software by using Logistic regression analysis for analyzing risk factors for concurrent infections in pemphigus patients who were hospitalized for the first time.Results Among the 182 patients,82 (45.05％) experienced infections.Additionally,107 pathogenic strains were cultured from secretions from skin lesions of 77 patients,including 60 strains of Staphylococcus aureus (56.07％),and 58 Staphylococcus aureus strains were resistant to penicillin (96.67％).Among the 182 patients,infections were observed in 11 of 14 patients with hypoproteinemia,69 (41.07％) of 168 patients without hypoproteinemia,4 (4.81％) of 27 patients with mild pemphigus,34 (37.7％) of 90 patients with moderate pemphigus and 44 (67.69％)of 65 patients with severe pemphigus.Logistic regression analysis showed that the prevalence rate of infections was significantly higher in the patients with hypoproteinemia than in those without hypoproteinemia (OR =5.559,95％ CI 1.053-29.347,P =0.043).Compared with the patients with mild pemphigus,the prevalence rate of infections significantly increased in the patients with moderate (OR =4.676,95％ CI 1.276-17.123,P ＜ 0.05) or severe pemphigus (OR =16.529,95％ CI 4.183-65.314,P ＜ 0.001).The prevalence of infections in patients with pemphigus was unaffected by gender,types of pemphigus,or the presence of hypertension or diabetes (all P ＞ 0.05).Among the 145 patients who were followed up,33 were completely cured,67 were cured clinically,23 received improvement,10 experienced relapse or exacerbation,and 12 died.Of the 12 dead patients,3 died of pneumonia,2 died of exacerbated pemphigus and skin infections,and 1 died of sepsis.Conclusions High disease severity and hypoproteinemia are risk factors for infections in patients with pemphigus.Bacterial infection is a common complication in patients with pemphigus,and severe infections are one of the causes of death in patients with pemphigus.
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Objective To investigate the effect of Shenfu injection on the expressions of endoplasmic reticulum stress-related factors oxygen-regulated protein 150 (ORP150),X-box binding protein 1 (XBP1),and C/EBP homologous protein (CHOP) mRNAs in cerebral cortical neurons after hypoxic-ischemic brain damage (HIBD) in neonatal rats.Methods The 7 day-newborn Sprague-Dawley rats were randomly divided into sham operation,normal saline and Shenfu treatment (Shenfu injection,10 ml/kg per day,peritoneal injection,for 3 days) groups.They were redivided into 3 h,6 h,12 h,24 h,3 d and 7 d subgroups at different time points after modeling (n =8 in each group).A HIBD model of the neonatal rats was induced.Reverse transcription-polymerase chain reaction was used to detect the expressions of ORP150,XBP1,and CHOP mRNAs in rat cerebral cortex.Results The expressions of ORP150,XBP1 and CHOP mRNAs of the sham operation group was very week.The expressions of ORP150,XBP1 and CHOP mRNAs in the normal saline group and the Shenfu treatment group were significantly upregulated compared to those in the sham operation group at 3 h after modeling (all P ＜0.05); the expressions of XBP1 and CHOP mRNAs reached the peak at 6 and 12 h,respectively.Then they decreased mildly and closed to the level in the sham operation group at day 7.The expressions of XBP1 and CHOP mRNAs in the Shenfu treatment group at 12,24 h and day 3 after modeling were significantly lower than those in the normal saline group (all P ＜0.05).The XBP1 mRNA expression was significantly positively correlated with the CHOP mRNA expression in the normal saline group (r =0.649,P ＜0.05).Conclusions HIBD in neonatal rats induces endoplasmic reticulum stress response.ORP150,XBP1 and CHOP may be involved in the delayed neuronal damage process after HIBD in neonatal rats.Shenfu injection downregulates the expression of XBP1 and CHOP mRNAs and inhibits endoplasmic reticulum stress response.