重症监护病房患者深部真菌感染分析

目的探讨笔者所在医院重症监护病房（ICU）患者深部真菌感染的发病特点,并了解院内深部真菌感染常见致病菌的耐药情况。初步探讨院内深部真菌感染高危因素,对相关因素进行分析,为有效控制真菌感染及合理用药提供参考依据。方法采用前瞻性对照研究,对2011年1月～2012年6月入住ICU经筛选符合条件的231例患者作为研究对象,随访和调查患者的性别、年龄、住院时间、基础疾病,是否有侵入性操作、使用抗真菌药物情况,以及部分血生化检查指标,同时记录真菌感染者致病菌种及药敏试验结果。结果231例患者中真菌感染者37例,深部真菌的发病率为16．02％。真菌感染部位以下呼吸道感染最为常见。从血液、尿液、痰液、胸腔积液、腹水、脑脊液等标本中共分离出菌株45株,其中酵母菌42株,霉菌3株,酵母菌中以白念珠菌（18株）最为多见。真菌培养药敏试验结果显示抗真菌药物对深部真菌的敏感性分布有明显的种问差异。结论①深部真菌感染以白念珠菌最为常见,其次是热带念珠菌、光滑念珠菌、曲霉。真菌感染部位以下呼吸道感染最为常见。药敏试验结果显示,抗真菌药物对深部真菌的敏感性分布有明显的种间差异。②高龄、住院时间长、抗菌药物的广泛应用、各种侵入性操作的使用、高血糖、低蛋白血症、贫血是ICU患者深部真菌感染的高危因素。     

Annular infectious dermatoses

Annular configuration is conspicuous in the clinical manifestation of many skin diseases and can be helpful for the diagnosis and differential diagnosis. Variations may include arciform, ring-form, annular, circinate, serpiginous, gyrated, polycyclic, targeted or figurate forms, in different colors, sizes, and numbers, with various textures and surfaces. In infectious dermatoses, the annular reactions can be specific or nonspecific, while the underlying mechanisms remain largely unknown. In the specific reactions caused by direct invasion of the pathogens, the contest between the centrifugal outspread of the infectious agents and the centripetal impedance of the host immune response is supposed to determine the final conformation. Examples include erythema infectiosum, orf, erythema multiforme, and pityriasis rosea of viral origin. Bacterial infections that may display annular lesions include erythrasma, erythema (chronicum) migrans of Lyme borreliosis, secondary syphilis, cutaneous tuberculosis, and leprosy. Superficial mycosis, such as dermatophytosis, candida intertrigo, tinea imbricata, and subcutaneous mycosis, such as chromoblastomycosis, and algae infection protothecosis, are characterized by annular progression of the skin lesions. The creeping serpiginous extension is an alarming sign for the diagnosis of cutaneous larva migrans. A better understanding of the virulence and pathogenicity of the pathogens and the way and type of immune response will help to clarify the pathogenesis.     

The basement membrane zone of the nail

The anatomy of the epidermis, dermis and subcutaneous tissues of the nail apparatus is distinct from that of non-appendageal skin. Apart from the demonstration of the longitudinal configuration of the dermal-epidermal junction of the nail bed, there have been no studies of the composition of the basement membrane zone of the nail apparatus. We obtained three human accessory digits, including one thumb, all of which had been amputated for cosmetic reasons, and were without known pathology. Specimens were stained with a battery of monoclonal and polyclonal antibodies which target normal basement membrane zone antigens, and studied by indirect immunoflourescence. This study demonstrated that the four distinct regions of the nail, namely the proximal nail fold, the nail matrix, the nail bed and the hyponychium expressed all the target antigens found in the normal non-appendageal basement membrane. In particular, there was normal expression of the epidermal-associated antigens, the 220-and 180-kDa bullous pemphigoid antigens, and the α6β4 integrin. There was also normal expression of the lamina lucida antigens LH39, GB3 and laminin. It is of interest that the dermal-associated components, namely the 285-kDa linear IgA antigen, the extracellular matrix glycoproteins chondroitin sulphate, type VII collagen and its closely associated proteins, and the poorly characterized antigen for LH24 and LH39 were all normally expressed.Fibronectin, which is not a normal basement membrane zone component, was diffusely expressed in the extracellular matrix, but did not accentuate the basement membrane zone. LHF2, an antibody raised against tenascin, which shows weak positive staining at the tips of dermal papillae in normal skin (unpublished data) diffusely stained the extracellular matrix and the tips of the dermal papillae of the nail matrix and hyponychium, but did not stain the basement membrane of the nail bed. These findings show that despite the numerous distinct features of epidermis, dermis and subcutis of the nail apparatus, the basement membrane zone has virtually identical antigen expression to that of the dermal-epidermal junction elsewhere. The difference in LHF2 expression in the nail bed most likely reflects the different shape of the nail bed basement membrane, which is arranged in longitudinal folds.     

羊胚素对小鼠黑色素瘤生长抑制作用的研究

目的 研究羊胚素对黑色素瘤生长的影响.方法 选择C57BL/ 6小鼠20只,皮下接种小鼠黑色素瘤细胞B16,随机均分成2组：给药组（接种当天开始每天腹腔注射羊胚素0.15 mg连续17 d）和对照组（不作处理）.试验期间2次/d观察肿瘤生长情况,1次/3 d称量体重、测量肿瘤大小.结果 接种后第4 d、7d、10 d、13 d,给药组分别有2、7、9、10只动物有肿瘤长出,对照组分别有1、4、8、和10只大鼠有肿瘤长出.首次给药0～7 d,给药组动物平均瘤体积增长略快;首次给药后7～16 d,给药组除肿瘤形成较晚的两只大鼠瘤体积增长较快以外,其余大鼠瘤体积均增长缓慢.试验期间,对照组于接种后16 d、17 d、19 d分别发现2（2/10）、1（1/8）、1（1/7）只动物死亡,给药组于接种后16 d、19 d各有一只大鼠死亡.结论 腹腔注射羊胚素,在有肿瘤细胞存在条件下能够刺激形成肿瘤;在肿瘤生长期间能够抑制肿瘤的生长,并延长动物存活期.     

The red face: art, history and medical representations

For millennia, a red face has been a handicap in social relations, mainly because of the associated bias against alcoholics. The color red is also the color of emotion, betrayal of the person who blushes. Since the color red is one of the main characteristics of rosacea, it contributes to the bad reputation this disorder has, which is therefore the subject of a pressing therapeutic demand, principally in women. Nineteenth-century French novelists such as Balzac and later Proust, admirably described blotchy, red, or sanguine faces, which always announced a difficult, violent temperament, or was simply the mark of the laboring class. The color red remains ambivalent today, on the one hand denoting blood and life and on the other suffering, shame, and death. The history of dermatology shows that the semiology of rosacea was very well described in the earliest reports, notably those written in the Middle Ages. The term "acne rosacea" appeared in Bateman's writings, who made it a clinical form of acne. This confusion lasted throughout the nineteenth century. It was not until Hebra in Austria and Darier in France that the differential diagnosis was clearly made between acne and rosacea. A "couperosis" previously referred to the entire range of the disease, particularly the papules and pustules, and it was not until the twentieth century that the current meaning of rosacea progressively gained ground: this term today designates facial telangiectasia, whether or not it is associated with a characteristic redness. Rosacea is a conspicuous disease, since the lesions involve the central portion of the face.Among the many manifestations of rosacea, redness is the most characteristic [1].     

Cutaneous and visceral sarcoidosis. Apropos of an exceptional form

We present here an exceptional case of cutaneous and vascular sarcoidosis associated with lesions of the liver, spleen and lymph nodes. The disease began when this male patient was 27 years' old and gradually extended over 35 years, despite long-term systemic corticosteroid therapy. Clinically, the initial cutaneous lesions were atrophic, erythematous and squamous, resembling those of erythroderma; they were located on the skin of the right popliteal fossa, the left arm, the neck, the upper part of the chest and around the waist. Subsequently, they spread slowly to involve almost the entire skin, except for the face, right upper limb, left lower limb, hands and feet. The most ancient of these lesions were distinctly black. The skin was paper thin due to complete disappearance of the subcutaneous tissue. Left temporo-parietal alopecia of the cicatricial type developed towards the end of the patient's life. The nails remained normal throughout, and there were no other cutaneous signs of sarcoidosis. Initially, the venous network was clearly visible beneath the atrophic skin, but later on, the veins became grossly dilated and sacculated in those areas which had first been invaded by skin atrophy. Phlebography of the left upper limb confirmed the venous dilatation, while arteriography of the upper limbs showed multiple sacciform aneurysms of the subclavian, axillary and brachial arteries, with distal thrombosis of the latter vessel. Histology showed typical lesions of sarcoidosis in a vein; no arterial biopsy was performed. The muscles had a nodular and sclerous appearance; amyotrophy developed in the last stages of the disease; tendons and joints were normal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Disseminated histoplasmosis presenting as pyoderma gangrenosum-like lesions in a patient with acquired immunodeficiency syndrome

A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (HIV) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. Sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including Histoplasma antibodies, toxoplasmosis immunoglobulin M (IgM), rapid plasma reagin (RPR), hepatitis C virus (HCV), and hepatitis B virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and Penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms residing extracellularly. Methenamine silver stain confirmed the presence of 2-4 microm fungal spores suggestive of Histoplasma capsulatum (Fig. 2). Because of the patient's deteriorating condition, intravenous amphotericin B was initiated after tissue culture was obtained. Within the first week of treatment, the skin lesions started to resolve. Histoplasma capsulatum was later isolated by culture, confirming the diagnosis. The patient was continued on amphotericin B for a total of 10 weeks, and was started on lamivudine, stavudine, and nelfinavir for her HIV infection during hospitalization. After amphotericin B therapy, the patient was placed on life-long suppressive therapy with itraconazole. Follow-up at 9 months after the initial presentation revealed no evidence of relapse of histoplasmosis.     

PHACE syndrome: clinical manifestations,diagnostic criteria,and management

Infantile hemangioma can be linked to other organ malformations. In 1996, PHACE syndrome was first defined as the association of large and segmental infantile hemangioma, usually on the face, head, or cervical region, with malformations of the posterior fossa of the brain, arterial anomalies of the central nervous system, coarctation of the aorta, cardiac defects, and ocular abnormalities. Over 300 cases of PHACE syndrome have been reported, and it is cconsidered one of the most common neurocutaneous vascular disorders in childhood. Knowledge of the features and locations of lesions that imply a greater risk of systemic involvement is crucial for the diagnosis and proper management of PHACE syndrome patients. This review highlights the diagnostic criteria for PHACE syndrome, the imaging workup for extracutaneous involvement, the treatment of infantile hemangioma, and the importance of a multidisciplinary approach in the management of these patients.     

Inmunohistoquímica en dermatopatología: revisión de los anticuerpos utilizados con mayor frecuencia (parte ii)

Dermatopathology includes a long list of disorders, some of which have very similar histopathology. Immunohistochemistry is an important auxiliary tool for diagnosis and differential diagnosis, and for predicting the outcome of many skin tumors. It is also the main technique for determining the origin of a tissue or the differentiation of neoplastic cells. In many cases, immunohistochemistry provides a more accurate diagnosis of the different processes that infiltrate the skin. This review examines the role of immunohistochemistry in studying the differentiation and biological behavior of the majority of tumors that can involve the skin. We review immunoperoxidase techniques, discuss the utility of the most commonly used antibodies, and highlight a number of diagnostic problems in which immunohistochemistry may be very useful. In each case, the goal is to reach a specific and definitive diagnosis. In the second part of our review, we examine the most useful and specific antibodies in the study of skin infections and of epithelial, muscular, lymphatic and hematologic, neural, neuroendocrine, and melanocytic neoplasms that affect the skin. Finally, we include a brief review of the immunohistochemical profile of skin metastases of malignant visceral tumors.     

Ocular manifestations of pigmentary disorders.

Disorders of pigmentation can result from either an abnormal number of melanocytes, as in nevus of Ota and vitiligo, or an abnormal amount of melanin production, as in albinism. Melanin-producing cells are found in the skin, mucous membranes, uveal tract, and retinal pigment epithelium of the eye and the stria vascularis of the inner ear. Thus, many of the hereditary or congenital pigmentary disorders of the skin are associated with similar pigmentary abnormalities in the eye, such as iris heterochromia or changes in pigmentation of the fundus; however, more commonly, the associated eye finding is a defect in ocular motility, i.e., strabismus and nystagmus, suggesting a concomitant defect in neurologic development. In albinos, the observed neurologic abnormality in the visual pathway and foveal hypoplasia are hypothesized to be related directly to the lack of melanin in the pigment epithelium during development. In acquired disorders of pigmentation, in particular, vitiligo, Vogt-Koyanagi-Harada syndrome, and onchocerciasis, there is a frequent association with uveitis, suggesting an inflammatory cause for the cutaneous pigmentary changes.     

A syndrome of hemimaxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings (HATS)

Hemimaxillofacial dysplasia and segmental odontomaxillary dysplasia appear to be the same syndrome, having the common features of unilateral abnormalities of bone, teeth, gums, and skin. Oral manifestations are the hallmark of this condition. Those affected are generally recognized in childhood and may have partial anodontia, abnormal spacing of the teeth, delayed eruption, and gingival thickening of the affected segment. Reported cutaneous manifestations include facial asymmetry, Becker's nevus, "hairy nevus," lip hypopigmentation, discontinuity of the vermilion border, depression of the cheek, and erythema. The oral lesions do not appear to be progressive. We describe a child with features consistent with hemimaxillofacial dysplasia/segmental odontomaxillary dysplasia. Findings of a biopsy specimen from the cheek confirmed the presence of a Becker's nevus. Cutaneous findings reported in the previous 31 cases are reviewed and summarized. The acronym HATS (hemimaxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings) is introduced to reflect the spectrum of abnormalities in bone, teeth, and skin that may be seen in this developmental disorder.     

改良连续皮内缝合在皮肤外科手术中的临床应用

目的 介绍改良连续皮内缝合闭合手术切口的方法及临床效果。 方法 选取82例手术患者,其中色素痣37例,基底细胞癌10例,皮脂腺囊肿16例,脂肪瘤6例,脂溢性角化8例,皮肤纤维瘤3例,凹陷性瘢痕2例。所有皮损均采用单纯手术切除,术后切口长度最短0.8 cm,最长12 cm。术后切口采用改良连续缝合,即将两端带有小三角针的可吸收线,分别按从一侧皮缘真皮内进、出针,然后再从对侧皮缘真皮内进、出针的顺序缝合切口。 结果 82例手术患者,术后均采用改良连续皮内缝合法闭合手术切口,80例Ι期愈合,2例术后2 d开始红肿,疼痛,经对症处理5 d后红肿消失。术后随访3 ~ 6个月,78例切口对合平整、光滑,4例出现瘢痕增生,给予糖皮质激素局部封闭后明显缓解好转。无切口裂开。 结论 改良连续皮内缝合法用于面颈、躯干、四肢皮肤缺损,术后切口对合好,美容效果满意。     

Primary skeletal muscle lymphoma presenting as refractory cellulitis

The right torso of a 55-year-old woman showed diffuse skin and soft-tissue changes suggestive of cellulitis. However, several clinical and radiologic features, including the subacute and non-toxic nature of the illness and the patient's lack of response to antibiotic therapy, indicated a noninfectious etiology. Malignancy was suggested by striking changes seen on computed tomographic scanning--including extensive infiltration and enlargement of the musculature of the right shoulder girdle, the intercostal musculature, the latissimus dorsi, and the rhomboids; focal enlargement of the right paraspinal muscles; and enlargement of the psoas and the iliacus muscles and of the musculature around the hip joint. The mediastinal, hilar, and paraaortic regions showed no adenopathy. A large hypodense lesion of approximately 4.5 cm, which was seen in the caudate lobe of the liver, raised the concern of a metastatic focus of malignancy. Because of these findings, an immediate muscle biopsy was performed. Results showed a non-Hodgkin's lymphoma with a B-cell phenotype. Although primary skeletal muscle lymphoma is very uncommon in patients without human immunodeficiency virus infection, clinical presentation of refractory cellulitis, as seen in the current case, is extremely rare.     

Periorbital (eyelid) dermatides

Physicians in various specialties—and dermatologists in particular—frequently encounter various forms of inflammation of the eyelids and of the anterior surface of the eye. Distinguishing the cause of itchy, painful, red, edematous eyelids is often difficult. Because the uppermost layer of the eyelids is part of the skin that wraps the entire body, almost every skin disease in the textbook can affect the periorbital area as well. In this contribution, we focused on the most common such disorders that require special consideration, as a result of their special appearance, their challenging diagnosis, or the nature of their treatment. We reviewed the key features of several common dermatides that affect the eyelids, such as atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, airborne contact dermatitis, rosacea, psoriasis, and others. We focused on the special clinical features, causes, and treatments specific to the delicate skin of the eyelids. Because structures of the eye itself (ie, the conjunctiva, the cornea, the lens, and the retina) may be involved in some of the discussed periorbital skin diseases, we found it useful to add a brief summary of the eyelid complications of those diseases. We then briefly reviewed some acute sight-threatening and even life-threatening infections of the eyelids, although dermatologists are not likely to be the primary care physicians responsible for treating them.     

Healing of Ulcers due to Cryofibrinogenemia with Colchicine and High-Dose Pentoxifylline

Cryofibrinogenemia is due to the presence of reversibly cold-precipitating plasma proteins and material, consisting mostly of fibrinogen, fibronectin, and fibrin. This condition can be idiopathic or secondary to infection, thromboembolic states, neoplasm, or connective tissue disease. The characteristic lesions of cryofibrinogenemia include purpura and ulcerations. Histologically, the lesions of cryofibrinogenemia demonstrate fibrin thrombi within vessels, with no evidence of vasculitis. Treatment of cryofibrinogenemia should be directed at the underlying disease process, if one can be found. Other treatments have included the anabolic steroid stanozolol, which is presently unavailable, anticoagulants, immunosuppressive agents, plasmapheresis, and the combination of streptokinase and streptodornase. We report a case of a 61-year-old male smoker with a 10-year history of intermittent ulcerations of both legs and feet. Two separate biopsies showed epidermal ulceration and thrombi within superficial dermal vessels without evidence of vasculitis. These findings, together with the presence of elevated plasma cryofibrinogen, led to the diagnosis of cryofibrinogenemia. The patient continued to have ulcerations despite efforts to control his high blood pressure, cold avoidance, local wound care, and treatment with pentoxifylline 800 mg three times daily. However, when colchicine 0.6 mg twice daily was added to the patient’s care, this led to rapid healing of his ulcerations. He has remained ulcer free for 2 years taking the combination of colchicine and high-dose pentoxifylline. Efforts to reduce the dose of these agents have repeatedly led to recurrences, and remission has promptly followed re-establishment of the combination. To our knowledge, this is the first report documenting use of the combination of colchicine and high-dose pentoxifylline to successfully treat ulcers due to cryofibrinogenemia.     

Late-onset Rothmund-Thomson syndrome

A 43-year-old woman presented with complaints of exfoliation of the skin and mottled pigmentation all over the body, intolerance to sunlight for the last 14 years, and swelling on the lower one-third of the neck for 15 years. She was apparently well until the age of 29 years when she noticed redness on her shins which later progressed to involve the upper limbs, chest, and face. Three months later, she observed multiple, small, brownish plaques over the erythematous areas, which gradually spread to the sun-exposed areas, namely the face, forearms, hands, and nape of the neck. The erythema disappeared within 5 months of onset. The patient experienced redness of the face, intolerance to the sun, and reduced sweating, particularly during the summer. There was no history of bullous eruption, difficulty during deglutition, tremors, or pedal edema. She suffered five miscarriages and, ultimately, was successful in delivering a normal boy who is now 16 years of age. She had menarche at the age of 14 years and her menstrual cycle was regular. There was no history of similar illness in the family. On cutaneous examination, the skin on the face, neck, trunk, buttocks, and limbs was found to be dry, lusterless, thin, and covered with fine scales. Mottled hyperpigmentation was observed all over the body. Atrophy and telangiectasia were seen over the neck (Fig. 1), face (Fig. 2), nape of the neck, upper and lower limbs, back, and chest. Mild erythema was observed over the face, nose, ears, and forearms. The hair on the scalp, eyebrows, axillae, and pubic area was sparse and thin. The teeth were loose and discolored due to caries, and a foul odor emanated from the mouth. The nails were lusterless and centrally depressed. The thyroid gland was enlarged, smooth, nontender, and moved with deglutition. No bruit was heard over it. No ocular abnormality was detected. The patient had a haemoglobin level of 7.6 g%, total serum iron binding capacity of 70 micromol/L (normal, 45-66 micromol/L), and serum ferritin level of 10 microg/L (normal, 15-200 microg/L). Peripheral blood smear showed hypochromic microcytic red blood cells. Total and differential leukocyte counts, erythrocyte sedimentation rate (ESR), blood glucose, serum electrolytes, total and differential serum proteins, liver function tests, blood urea, and microscopic examination of urine and stools were within normal limits. The thyroid profile and complement C3 and C4 levels were within normal limits. Rheumatoid factor, antinuclear factor and LE cells were absent. Abdominal ultrasonogram was normal. Fine needle aspiration cytology from the thyroid gland showed features suggestive of colloid goiter. Skin biopsy revealed thinning of the epidermis, flattening of the rete ridges, and hydropic degeneration of the basal cell layer. The dermis was edematous with dilated capillaries, melanophages, and a band-like mononuclear infiltrate. The sweat glands were reduced in number.     

Geographic tongue: an SEM study

In this study, scanning electron microscopy (SEM) was used to describe in detail the surface structure of geographic tongue. Tissue samples from the anterior part of the tongue were removed from 15 patients with geographic tongue and from 15 control subjects. Normally, the surface mucosa of the tongue was covered by filiform papillae, which consisted of the body and hairs. The mucosal surface of the body was smooth with some desquamating cells, but hairs were covered by an extensive plaque of microorganism. With SEM, the surface of geographic tongue contained 3 different types of mucosa: atrophic area, white margin, and area of normal appearance. On the atrophic area, the mucosa formed low elevations, and hairs were lacking. At high magnification, the superficial cells of the low elevations were polygonal, and they had parallel or branching microplicae. The white margin contained many desquamating cells, which had broken microplicae or no surface structures. Here the inflammatory infiltrate of the epithelium and that of the subepithelial connective tissue was moderate. On the normal-appearing area, desquamation of the mucosa on the papillar bodies was more pronounced than normally. On every specimen was a fissure, on the walls of which the superficial cells had broken microplicae and knob-like structures. The adherence of candidal hyphae within the superficial cells was seen in the area of the fissure. On the geographic tongue some fungiform papillae with taste pores were seen.     

世博安保＂三防＂医学救援应急机动组的组建

2010年,中国人民解放军第八五医院参与了上海世博会的＂三防＂医学救援工作,组成＂三防＂医学救援应急机动组,成员包括军医、护士和司机.医务人员来自烧伤外科、骨科、普外科、呼吸科、神经内科等科室,均具有中高级技术职称,参加过＂四川汶川抗震救灾＂、＂奥运安保＂和军区、分部组织的军事演习等重大军事行动,具有扎实的军事素质、卫勤保障能力和专业技术能力.他们接受了有关核辐射突发事件、化学事故、生物恐怖袭击的理论知识,个人防护基本技能、急救技术、快速反应和协同训练等五个方面的培训.做到了＂一专多能＂.科学制定预案,确定了多条机动路线,以能够根据具体情况确定最佳路线,及时到达现场.在备勤期间,执行任务人员保持24 h在院待命,听令后18 min内出发.在近8个月的世博安保备勤期间,＂三防＂医学救援应急机动组不但圆满完成了此次世博安保任务,为今后平战时各种＂核、生、化＂突发事件的医学应急救援做好了人员和技术的储备.