浅述性病中医辩证中的若干问题

中医学认为,性病的发病过程是处于运动着的发展、变化的状态,每个病种的不同发展阶段都有其固有的属性与特质,如属明属阳,偏虚偏实等。性病发病又与外界致病因素及机体正气强弱密切相关,处个病种之间     

关于麻风预防法

麻风被认为是由麻风菌引起的传染病,但其感染和发病的过程并不明确,要能发病还必需体内体外的各项条件齐备;它也是传染性很小的传染病之一。今日之医学,已可在其初期阶段将其治愈,使传染源近于消灭,完全没有天花或斑疹伤寒那种引起威胁社会的流行的危     

麻风病基本消灭阶段的流行病学特征

目的：分析麻风病基本消灭阶段流行病学特征,以指导麻风防治工作。方法：根据山东省历年的麻风病人登记表,分析比较麻风基本消灭阶段与防治初期的流行学特征。结果：麻风基本消灭阶段的流行病学特征与防治初期比较有显著变化;新病例呈散在分布;发病年龄显著升高;少年儿童发病显著减少;多菌型病例所占比升高。复发病例在新发病例中占比升高。结论：麻风病中、高流行区达到基本消灭麻风病后,应根据其流行病学特征采取相应防治对     

银屑病免疫信号通路及靶向治疗的研究进展

银屑病是一种免疫介导的慢性炎症性皮肤病,其确切的发病机制尚不清楚,多种免疫信号通路在银屑病的起始和加重阶段发挥重要的作用。近年来,针对发病过程中不同靶点的靶向药物在银屑病治疗方面的研究取得了重大突破,新型靶向生物制剂已经成为银屑病治疗的重要手段。本文对近几年银屑病免疫信号通路及靶向治疗的研究进展进行综述。     

太田痣的发病机制及激光治疗进展

太田痣又可称眼上腭部褐青色痣、眼真皮黑素细胞增多症,是临床较常见的一种色素性疾病,严重影响患者的心理健康。虽然目前对其发病机制的研究仍处于初始阶段,但调Q激光治疗太田痣的疗效被大众所认可。本文对太田痣的发病机制和激光治疗太田痣的新进展以及影响疗效的一些因素进行总结,为提高治愈率和减少副作用提供借鉴。     

脂溢性皮炎研究进展

脂溢性皮炎(SD)或头皮屑临床常见,过去被认为是发病机制不同的两种疾病,目前多数学者认为二者是同一疾病的不同阶段,头皮屑属轻型脂溢性皮炎。其确切的发病机制至今不清,一般认为是众多因素综合作用的结果,研究发现,SD的发病与免疫功能紊乱及糠秕马拉色菌(M.furfur)感染密切相关。本病的治疗以去脂、消炎、杀菌、止痒为主,近几年有作者提出局部用免疫抑制剂及紫外线治疗取得较好效果。     

细胞因子在斑秃发病机制中的作用研究进展

斑秃可能是一个由细胞介导的针对生长期毛囊致毛发脱落的自身免疫相关性疾病。细胞因子在其发病过程中发挥了重要作用。在发病最初阶段以Th1细胞因子和IL-1浸润为主,尤以IFN-γ的作用为关键。IL-10和IL-1Ra是具有抗炎症和免疫抑制作用的细胞因子,在治愈斑秃皮损中表达增强,提示可能在治疗斑秃过程中发挥一定作用。     

T淋巴细胞与银屑病发病机制的关系

银屑病是一种以角质形成细胞(KC)增生分化异常为主要表现的皮肤病,随着研究的进展,人们逐渐认识到T细胞在银屑病发病中的重要作用,银屑病发病原因在于T淋巴细胞的异常,其中参与银屑病发病的T细胞大致经历3个阶段的变化:T细胞活化;T细胞迁移至病变皮肤;活化T细胞释放细胞因子发挥促增殖功能;整个过程中T细胞可促发了银屑病的细胞及分子生物的链式反应加重银屑病皮损.文中总结了这几阶段发生发展的过程,以供参考.     

骨髓,银屑病的发病“中枢”?

本文结合国内外银屑病研究的最新报道 ,分析了银屑病的免疫学发病特点 ,提出骨髓可能是银屑病发病“中枢” ,并预见了在这一发病模式下银屑病的研究前景 ,这一理论旨在探讨将银屑病研究带向一个新的阶段。     

麻风病基本消灭阶段的流行病学分析及防治策略探讨

目的:分析麻风病基本消灭阶段的流行病学特征,研究探讨新时期的麻风病防治新策略。方法:对肇庆市1996年～2001年麻风病疫情和新发现病例进行流行病学分析。结果:麻风病基本消灭阶段的流行病学特征与流行时期比较有了明显变化:发现率、发病率、患病率相对稳定,病例呈离散型分布,发病年龄逐年升高,儿童发病很低,多菌型(MB)型比较显著升高,病例家庭分布下降。病例特征:病人中复发病例较少,Ⅱ级以上畸残率下降,病人发现方式以被动发现为主。结论:麻风病基本消灭阶段的防治策略必须根据相关的变化而作出相应调整。     

Structural correlations between dermoscopic and histopathological features of juvenile xanthogranuloma

Juvenile xanthogranuloma(JXG) is the variant of non‐Langerhans’ cell histiocytosis. The orange‐yellow background coloration with clouds of paler yellow deposits is the most characteristic dermoscopic finding of JXG. Other dermoscopic features include erythematous border, subtle pigment network and white linear streak. The objective of this study was to present the structural correlation between dermoscopic features and histopathological findings of JXG and to find the different dermoscopic features in various stages of JXG. Eleven patients with histologically proven JXG were examined with polarized light dermoscopy. Histopathological findings were assessed and dermoscopic features including setting sun appearance, clouds of paler yellow globules, whitish streak, and branched and linear vessels were evaluated. Among 11 patients, five patients were in early evolutionary stage, four patients in fully developed stage and two in late regressive stage. The setting sun appearance was found in all patients in different stages except one in late regressive stage (90.9%). The clouds of paler yellow globules were present in nine patients (81.8%) and were constant features in fully developed stage and late regressive stage. The whitish streak was present in four patients (36.4%) and telangiectasia in 10 patients (81.8%). The setting sun appearance may hold diagnostic value in early evolutionary stage to fully developed stage, but not in late regressive stage. The clouds of paler yellow globules are more predominant in fully developed stage and late regressive stage. In addition to the use of dermoscopy as an accurate diagnostic tool for differential diagnosis, it could be applied in evaluation of histopathological maturation of JXG.     

Mycosis fungoides--analysis of the duration of disease stages in patients who progress and the time point of high-grade transformation

BACKGROUND: Mycosis fungoides (MF) is a low-grade malignant primary cutaneous T-cell lymphoma which, in its evolution, passes through five distinct stages (patch, plaque, and tumor stages, lymph node infiltration, and, finally, multiple organ infiltration). Furthermore, a blast transformation into a high-grade malignant lymphoma can occur. In order to better understand the dynamics of the disease and the prognostic implications in patients who progress, we studied the duration of each stage and the time at which blast transformation occurred. METHODS: We reviewed the records of 48 MF patients who had been followed in the lymphoma clinic of the Department of Dermatology, University Hospital Zurich, Zurich, Switzerland for a median of 10 years. Forty-two cases were eligible for evaluation. RESULTS: Our study showed that MF in patients who progress is a disease which, after an initial patch stage with an average duration of 7.2 years, a plaque stage lasting for an average of 2.3 years, and a tumor stage with an average duration of 1.8 years, leads to a stage of lymph node infiltration with an average duration of 0.6 years, internal organ infiltration lasting for an average of 0.5 years and, finally, a fatal outcome. Consequently, the overall average disease duration in progressing patients is 12.4 years. Blast transformation occurs in 85% of all cases in the tumor stage. CONCLUSIONS: The course of progressing MF is chronic and advancing. The progression is initially slow and later accelerates. Important prognostic factors are the stage of disease and the presence of blast transformation. The prognosis is better in the early stage and when blast transformation is absent.     

miR‐155 is involved in tumor progression of mycosis fungoides

Biopsy specimens from 23 early stage and 19 tumor‐stage mycosis fungoides (MF) patients were evaluated for miR‐155 expression by real‐time qualitative PCR and compared with 15 biopsy specimens from patients with T‐cell‐rich inflammatory skin diseases. Significant upregulation of miR‐155 was found in MF tumors compared with both early‐stage MF lesions and controls. There was no difference in miR‐155 expression between early‐stage and inflammatory dermatoses. Using laser capture microdissection, it was found that miR‐155 was significantly higher in the lymphoma cells in tumor stage compared with the intraepidermal lymphocytes in early stage. In contrast, there was no difference in miR‐155 expression between the intraepidermal lymphocytes and the dermal lymphocytes in early‐stage MF. These findings suggest that although miR‐155 expression cannot serve to discriminate early‐stage MF from inflammatory dermatoses; however, it is involved in the switch from the indolent early stage into the aggressive tumor stage of the disease.     

Mycosis fungoides--a review of the management of 28 patients and of the recent literature

BACKGROUND: Mycosis fungoides is an uncommon cutaneous T-cell lymphoma characterized by malignant monoclonal proliferation of T-helper lymphocytes. Its course is variable with a potential for lymphatic and hematogenous involvement. We report the investigations, staging, treatment, follow-up, and outcome of 28 patients. This is the first such study reported from Ireland. METHODS: Twenty-eight patients with mycosis fungoides (14 women, 14 men; average age, 52.5 years) were reviewed over 12 years in the dermatology clinic which assesses an average of 4500 patients per year. All mycosis fungoides patients were referred from their family physicians. The diagnosis was made in all cases from a combination of clinical findings, histology, and immunohistochemistry. TNM staging revealed 11 patients at diagnosis stage IA (T1), 12 at stage IB (T2), four at stage IIB (T3), and one at stage III (T4). RESULTS: The usual male preponderance was not found. Eight patients needed multiple biopsies to establish the diagnosis. Detailed investigations were not useful in the early stages. Patients were followed up over a 12-year period. Thirteen patients died as a result of cutaneous lymphoma. Two patients with stage IA disease progressed rapidly and died, a feature reported in only 10% of patients at this stage. Five patients showed unusual features, including a long history prior to presentation, the development of the rarely reported bullous mycosis fungoides, and aggressive disease beginning at a young age. CONCLUSIONS: Mycosis fungoides is rare; we reviewed 28 patients over 12 years. The prognosis is poor at the later stages; 13 patients died. Two patients who died were unusual in that they rapidly progressed from stage IA disease; however, in the majority of patients with this stage, the prognosis is excellent. Detailed investigations were unhelpful in early stage disease. Close clinical follow-up is essential to identify disease progression.     

蕈样肉芽肿的端粒酶研究

目的 检测各期蕈样肉芽肿(MF)的端粒酶活性,探讨端粒酶在MF肿瘤发生机制中的作用.方法 采用端粒酶聚合酶链反应-酶联免疫吸附测定法(PCR-ELISA),对35例MF患者进行端粒酶的定性和定量分析.结果 92.3%的肿瘤期MF、78.6%的斑块期MF和75.0%的斑片期MF显示端粒酶阳性;肿瘤期MF的端粒酶活性水平高于斑块期和斑片期,且差异有显着性;而斑块期与斑片期之间差异无显着性.对照组的端粒酶均为阴性.讨论 MF患者存在高水平的端粒酶活性,提示端粒酶可能在MF的肿瘤发生中起重要作用,对MF的诊断有一定的临床意义.     

Subungual melanoma: Histological examination of 50 cases from early stage to bone invasion

Subungual melanoma is a rare form of malignant melanoma. It is extremely difficult to differentiate it histologically from benign melanonychia striata or melanocytic nevus, especially in the early stage. We divided 50 cases of subungual melanoma into four groups according to clinical progress, and examined their histological findings in each respective stage. In the early stage (19 cases), atypical melanocytes were polygonal showing slight nuclear atypia with no mitoses at all. In six out of 19 cases (31.6%), the atypical melanocytes proliferated more in the hyponychium than in the nail matrix, and only very few in the nail bed. Periungual pigmentation (Hutchinson's sign) appeared from the early stage in almost all cases. With stage progression (middle stage, 13 cases; progressive stage, 13 cases; and bone invasive stage, five cases) the number of atypical melanocytes and their degree of nuclear atypia increased, and the ascent of atypical melanocytes and pagetoid spread became conspicuous. Mitoses became apparent only from the progressive stage. From these observations, we would like to propose three new pathological clues of early stage subungual melanoma: (i) “skip lesion”, proliferation of the tumor cells are more prominent in the hyponychium than in the nail bed or nail matrix; (ii) histological confirmation of Hutchinson's sign; and (iii) epithelial thickening and/or compact arrangement of the elongated basal cells.     

Rising levels of serum S100 protein precede other evidence of disease progression in patients with malignant melanoma

BACKGROUND: Several serum markers may be useful in the detection of metastatic melanoma, but none is in routine clinical use. OBJECTIVE: To assess the validity of S100 protein as a serum marker of melanoma progression. METHODS: Serum S100 protein levels were measured in 496 serum samples from 214 melanoma patients, using the Sangtec luminescence immunoassay. There were 75 patients with stage 1 melanoma, 66 initially with stage 2 melanoma, 49 initially with stage 3 melanoma and 24 with stage 4 melanoma. RESULTS: Serum S100 protein levels were < 0.2 microg L-1 in 71 of 75 (95%) stage 1 patients. One patient who had a normal level developed local recurrence. Fifty-eight of 66 (88%) stage 2 patients also had normal serum S100 protein levels. One with elevated levels progressed to stage 3 melanoma and five with elevated levels progressed to stage 4 disease. The remaining two with elevated serum S100 protein remained well. Thirty-five of 49 (71%) stage 3 patients had normal levels and, of these, two have progressed to stage 4 disease. Three patients with stage 3 disease had an elevated serum S100 protein level on one occasion but remained well. Eleven of 13 patients who developed stage 4 melanoma during the study had rising levels of serum S100 protein > 0.2 microg L-1 5-23 weeks before detection of melanoma progression by conventional means. Twenty-two of 24 patients with stage 4 disease throughout the study had consistently elevated serum S100 protein levels, and the two patients with normal levels were clinically disease free after surgery and chemotherapy. None of 14 control subjects with atypical naevi had elevated S100 protein levels, and only one of 11 healthy normal controls had an elevated level. CONCLUSIONS: Thus, rising levels of serum S100 protein are a specific and sensitive clinically relevant marker of tumour progression in melanoma patients, which precedes other evidence of melanoma recurrence.     

Prevalence and severity of pruritus in cutaneous T cell lymphoma

Background The most common types of cutaneous T cell lymphoma (CTCL) are mycosis fungoides (MF) and its leukemic variant, Sézary syndrome (SS). One of the hallmarks of MF and SS is pruritus that rarely responds to treatment. Little is known about the prevalence and severity of pruritus in MF and SS. Objectives A retrospective analysis was performed to assess the prevalence and severity of pruritus in MF and SS. Methods This study compared self‐reported pruritus in early‐stage (stage Ia–IIa) and late‐stage (stage IIb–IVb) disease, and in MF and SS, in patients presenting at our CTCL clinic between January 1, 2006, and June 30, 2010. Results Of the 551 eligible patients, 486 reported baseline pruritus values. Overall, 373 patients had early‐stage disease, 113 had late‐stage disease, and 72 had SS. The prevalence of pruritus was 66% in all patients, 62% in patients with early‐stage disease, 83% in those with late‐stage disease, 61% in those with MF, and 94% in those with SS. Mean pruritus values out of 10 were: 4.2 [standard error of the mean (SEM) = 0.18] in all patients; 3.4 (SEM = 0.19) in patients with early‐stage disease; 6.6 (SEM = 0.36) in those with late‐stage disease; 3.6 (SEM = 0.18) in MF patients, and 7.7 (SEM = 0.37) in SS patients. Differences between early‐ and late‐stage disease, and MF and SS, were statistically significant (P < 0.001). Conclusions Pruritus affects a large proportion of patients with CTCL and is significantly more severe in late‐ than in early‐stage disease and in SS than in MF. Little information exists on the full range of the symptom burden on the patient. This aspect of patient care requires further exploration.     

流式细胞分析法测定外周血皮肤淋巴细胞相关抗原阳性T细胞在寻常性银屑病中的表达

目的探讨T细胞亚群和皮肤淋巴细胞相关抗原（CLA）在寻常性银屑病外周血中的表达情况。方法采用免疫荧光双标记流式细胞分析法检测不同病期的寻常性银屑病患者外周血中T细胞亚群及CLA的表达情况。结果银屑病进展期患者外周血CD4^＋T细胞降低，CD8^＋T细胞显著升高，CD4／CD8的比值降低，与静止期和正常人相比差异均有显著性。静止期患者T细胞亚群的变化与正常人之间无明显差异。进展期患者表达CLA的T细胞亚群明显高于正常人，同时对比静止期也明显增高。而静止期与正常人比较只有CLA^＋CD8^＋T细胞显著升高。结论银屑病患者存在细胞免疫功能的异常．CLA在T细胞上的表达对银屑痛的病情进展起一定作用．     

Urgent call for reconsideration of chronic kidney disease

Circulating toxins namely: free radicals, cytokines and metabolic products induce glomerular endothelial dysfunction, hemodynamic maladjustment and chronic ischemic state;this leads to tubulointerstitial fibrosis in chronic kidney disease (CKD). Altered vascular homeostasis observed in late stage CKD revealed defective angiogenesis and impaired nitric oxide production explaining therapeutic resistance to vasodilator treatment in late stage CKD. Under current practice, CKD patients are diagnosed and treated at a rather late stage due to the lack of sensitivity of the diagnostic markers available. This suggests the need for an alternative therapeutic strategy implementing the therapeutic approach at an early stage. This view is supported by the normal or mildly impaired vascular homeostasis observed in early stage CKD. Treatment at this early stage can potentially enhance renal perfusion, correct the renal ischemic state and restore renal function. Thus, this alternative therapeutic approach would effectively prevent end-stage renal disease.