A minimally invasive tool to study immune response and skin barrier in children with atopic dermatitis

Atopic dermatitis (AD, atopic eczema) is a very common skin condition affecting 10-20% of children. It affects children of all skin colours and seems to occur more often in Asian children and children with dark skin types. However, most research is performed on children with light skin types. This study, performed in Amsterdam, the Netherlands, aimed to investigate differences between AD in children with dark and light skin types. To study this, the investigators took tape strips from 53 AD children aged 0-12 years and 50 healthy children as control (comparison). Tape stripping is a painless procedure which is ideal to perform in children, in which a small round sticker is attached to the skin. When removing this special sticker, a thin layer of skin cells remains attached to the sticker, allowing the investigators to study several aspects of skin inflammation and skin barrier. The authors found that AD skin from children with light and dark skin have similar levels and types of skin inflammation. However, they found differences in skin barrier markers between these two groups. In light skinned children, markers of good skin barrier were lower in AD skin when compared to healthy children's skin, while in dark AD skin these skin barrier markers were not significantly different from healthy dark skin. This study showed that dark-skinned and light-skinned AD children are similar when it concerns skin inflammation, but in light skinned AD children the skin barrier dysfunction may play an additional role in the development of AD. This suggests that AD in light and dark skin has different mechanisms of development.     

Cardiac Denervation for Arrhythmia Treatment with Transesophageal Ultrasonic Strategy in Canine Models

Stellate ganglion (SG) modification has been investigated for arrhythmia treatment. In this study, transesophageal SG imaging and intervention were explored using a homemade 30F integrated focused ultrasonic catheter in healthy mongrel canines in vivo. Anatomic details of SGs were ultrasonically imaged and evaluated. SG had a heterogeneous echoic structure and characteristic profiles sketched by hyper-echoic outlines in an ultrasonogram. Left SGs in the experimental group were successfully ablated through the esophagus under ultrasonic guidance provided by the catheter itself. Two weeks after the ablation, the QT and QTc of the experimental group decreased compared with those of the sham group and at baseline (both p values < 0.001). Histologic examination revealed that left SGs were destroyed. No major complications were observed. This approach may be further explored as a method for ganglia remodeling evaluation and as a strategy of ganglia modification for arrhythmia and for other diseases.     

＊ 补充基金信息（立项部门，项目类型，课题名称，负责人信息）

病机是认识疾病病变的关键，抓住核心病机演变发展的规律，是中医临床诊疗的主旨和核心。病机兼化理论由中国中医科学院胡镜清研究员提出，用以从病机层面理解疑难复杂疾病病证关系和把握其演变规律，在明确疾病基本矛盾的同时，兼顾疾病的复杂性和多变性。文章通过构建新型冠状病毒肺炎病机兼化框架，揭示其病机演化规律，认为新冠肺炎属于“湿毒疫”范畴，湿毒始终是本病的病变核心，初期寒化，进展期热化，恢复期虚化是本病病机的传变方式。知本病之机，可未病先防，知病机传变，可截断扭转，有利于临床上增强对疾病发生发展趋势的预见性。     

A case of nodal marginal zone lymphoma with hypersensitivity to mosquito bites as initial symptom

Hypersensitivity to mosquito bites (HMB) refers to skin reactions such as bullae and necrosis, which occurs after being bitten by mosquitoes and can present with multiple systemic reactions such as fever, lymphadenopathy, hepatosplenomegaly simultaneously or subsequently. A 48‐year‐old male patient presented with recurrent erythema, nodules, papules, vesicles and bullae over upper body and bilateral limbs with itching over the sites of mosquito bite for more than 1 year with low‐grade fever and superficial lymph nodes enlargement. The patient's symptoms failed to improve from conventional anti allergic treatment although skin biopsy showed changes of HMB reaction. Subsequently, the lymph node was biopsied and was reported to be nodal marginal zone lymphoma (NMZL), and then the patient was eventually diagnosed with nodal marginal zone lymphoma with HMB. To date only one case of nodal marginal zone lymphoma with HMB has been reported from Korea, and this is the first case to be reported in China.     

一种预测子宫内膜病变患者内膜病理类型的临床模型＊

目的 开发并评估一种用于预测子宫内膜病变患者内膜病理类型的临床模型；方法 选取2019年11月至2021年11月因妇科B超发现子宫内膜病变并于山东中医药大学附属医院行宫腔镜下内膜活检的患者，结合其病史与最小绝对收缩和选择算子法（Least absolute shrinkage and selection operator，LASSO）筛选影响内膜病变的独立危险因素，列线图（nomogram）函数建立列线图模型，采用ROC曲线下方的面积大小（Area Under Curve， AUC）、C指数（C-index）、拟合优度（Hosmer-Lemeshow）检验、自举法（bootstrap）评估及验证模型，依据列线图对纳入患者进行风险赋分，绘制ROC曲线获取风险评分的截断值，从而划分高低风险的人群；结果 阴道流血、绝经、无流产史、并发高血压、B超内膜厚度增厚、内膜回声不正常，中医证型为虚实夹杂证是发生子宫内膜癌及癌前病变的独立危险因素，评估模型所得AUC值与C-index均>0.9，Hosmer-Lemeshow检验显示P>0.05，bootstrap内部验证法所得C-index亦高于0.9，均说明模型准确度、区分度及可信度良好，当患者的风险评分总和≥177分时，属于高风险人群；结论 本模型可以预测B超提示子宫内膜病变患者的内膜病理类型为癌前或恶变型的概率并识别高风险人群。     

糖尿病肾病患者认知功能障碍与血清β淀粉样蛋白的关系

目的 探讨糖尿病肾病(diabetic kidney disease,DKD)患者认知功能障碍与人β淀粉样蛋白1-42(human β Amyloid 1-42,Aβ1-42)的关系。方法 选取2020年5月至2021年5月在徐州医科大学附属医院内分泌科治疗的2型糖尿病(type 2 diabetes mellitus,T2DM)患者161例,根据尿白蛋白/肌酐比值(urine albumin creatine ratio,UACR)水平分为正常白蛋白尿(DM)组(n=60)、微量白蛋白尿(DKD1)组(n=58)和大量白蛋白尿(DKD2)组(n=43)。采用蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表评估患者认知功能。检测患者Aβ1-42、UACR、胱抑素C(Cystatin C,CysC)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR),并分析上述指标与MoCA评分的关系。结果 与DM组比较,DKD1和DKD2组CysC、Aβ1-42均升高(P<0.05),eGFR降低(P<0.05)。与DKD1组比较,DKD2组CysC升高(P<0.05),eGFR降低(P<0.05)。与DM组相比,DKD1组、DKD2组MoCA评分均降低(P<0.05)。与DKD1组比较,DKD2组MoCA评分降低(P<0.05)。3组MoCA评分与Aβ1-42、UACR、CysC呈负相关(均P<0.01),与eGFR呈正相关(P<0.01)。3组Aβ1-42与UACR、CysC呈正相关(均P<0.01),与eGFR呈负相关(P<0.01)。多因素线性回归分析结果显示,Aβ1-42、UACR是影响DKD患者MoCA评分的影响因素,Aβ1-42、UACR水平越高,MoCA评分越低,患者认知功能越差。结论 DKD患者存在认知功能障碍,与Aβ1-42水平及肾损害严重程度密切相关。     

药物涂层球囊治疗膝下动脉硬化性狭窄或闭塞致严重下肢缺血

目的 观察药物涂层球囊(DCB)治疗膝下动脉硬化性狭窄或闭塞致严重下肢缺血(CLI)的效果。方法 回顾性分析96例膝下动脉硬化性狭窄或闭塞致CLI患者,其中50例接受DCB治疗(DCB组)、46例接受普通球囊治疗(对照组),比较2组治疗效果、安全性及预后。结果 96例球囊均到达病变部位并成功完成扩张,未植入补救性支架。组间术前及术后即刻踝肱指数(ABI)、Rutherford分级及Wagner分级差异均无统计学意义(P均＞0.05);术后6、12个月DCB组ABI高于、Rutherford分级及Wagner分级均低于对照组(P均＜0.05)。术后6、12个月,DCB组一期通畅率均高于、管腔丢失均少于对照组(P均＜0.05),组间截肢率差异均无统计学意义(P均＞0.05)。Kaplan-Meier分析结果显示,术后12个月,DCB组免于临床驱动的靶病变血运重建率(CD-TLR)为89.81%,高于对照组的67.39%(P=0.008 8)。结论 DCB治疗膝下动脉硬化性狭窄或闭塞致CLI效果较好。     

当归饮子对血虚风燥型湿疹模型幼鼠的影响及作用机制＊

目的 研究当归饮子对血虚风燥型湿疹模型幼鼠的影响并探讨其作用机制。方法 采用2，4-二硝基氯苯（DNCB）、乙酰苯肼（APH）结合物理刺激制备血虚风燥湿疹模型，50只SD大鼠随机分为空白组、模型组、当归饮子高剂量组（30 g·kg^-1）、当归饮子低剂量组（15 g·kg^-1）、地氯雷他定组（0.8 mg·kg^-1），连续灌胃15天。观察幼鼠体重、脾脏指数、胸腺指数；通过湿疹皮损评分、HE染色组织病理学改变评价当归饮子对血虚风燥湿疹的治疗效果；采用酶联免疫吸附法（ELISA）检测血清γ-干扰素（IFN-γ）、白介素-4（IL-4）、免疫球蛋白E（IgE）、白三烯B4（LTB4）、白三烯C4（LTC4）含量；采用逆转录聚合酶链式反应（RT-PCR）检测皮肤组织半胱氨酰白三烯受体1（CysLTR1）和半胱氨酰白三烯受体2（CysLTR2）表达水平，以探索当归饮子治疗血虚风燥湿疹的作用机制。结果 与正常组相比，模型组幼鼠体重明显减轻（P<0.05），脾脏指数增大、胸腺指数减小（P<0.05）；幼鼠背部出现红斑、糜烂、渗出、水肿、鳞屑等皮损；病理学呈现大量中性粒细胞浸润、表皮海绵水肿、角化过度伴角化不全；IFN-γ水平下降（P<0.05），IL-4、IgE、LTB4、LTC4水平及皮肤CysLTR1和CysLTR2受体表达水平上调（P<0.01）。与模型组相比，当归饮子高、低剂量组及地氯雷他定组体重均明显上升（P<0.05），脾脏指数减小、胸腺指数增大（P<0.05）；皮损均明显改善（P<0.05），病理改变呈表皮炎症消失，真皮乳头水肿消失；IFN-γ水平显著上升（P<0.05），IL-4、IgE、LTB4、LTC4水平明显下降（P<0.05）；皮肤CysLTR1和CysLTR2受体表达水平均明显下降（P<0.05），其中以当归饮子高剂量组最为明显（P<0.05）。结论 当归饮子治疗血虚风燥型湿疹模型幼鼠疗效明显，机制可能与其调控湿疹幼鼠Thl／Th2失衡、下调血清LTB4、LTC4水平及皮肤CysLTR1、CysLTR2受体表达水平有关。