扬州市传染病院2016年至2018年HIV/AIDS患者的临床特征调查分析

目的调查和分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者的临床特征。方法选择2016~2018年扬州市第三人民医院诊治的186例HIV/AIDS患者的临床资料进行回顾性分析,统计其临床特征,包括流行病学特征、临床症状和体征、机会性感染情况和实验室指标检查结果。结果 186例患者中,男性,31岁~50岁、51岁~70岁,有同性性接触史,城镇,III期、IV期占比均较高,分别为89.2%,43.5%、39.2%,51.6%,56.5%,31.2%、26.9%,2016年、2017年和2018年占比基本持平;咳嗽、咳痰、口腔白色腐状物覆盖、淋巴结肿大、发热、呼吸困难、腹泻、皮疹、恶心、胸痛、头痛、夜间盗汗、呕吐、视力下降者的占比依次降低,分别为65.1%、62.9%、62.4%、54.8%、52.2%、52.2%、24.7%、19.9%、10.8%、10.8%、9.1%、8.6%、6.5%、4.8%;真菌感染、肺孢子菌肺炎、鹅口疮、巨细胞病毒感染、持续腹泻、皮肤损害、结核感染、机会性感染肿瘤占比依次下降,分别为61.3%、59.7%、58.1%、36.6%、19.4%、8.6%、5.4%、1.6%;不同临床分期患者体质量指数(BMI)、白细胞计数、血红蛋白、总淋巴细胞计数、CD4、CD8比较,其差异均具有统计学意义(均P<0.05),IV期者相似文献   

Skin penetration of antimicrobial agents in rats

Skin penetration of various antimicrobial agents was studied in rats. Skin concentration/serum concentration ratios were classified into three groups, i.e. group I with ratio greater than or equal to 0.7, group II with the ratio 0.7-0.4 and group III with the ratio less than or equal to 0.4. The drugs of group I were OFLX, CPFX, LFLX, FLRX, SPFX, AMK, EM, RXM, CAM, CLDM. The drugs of group II were ABPC, CVA/AMPC, CVA/TIPC, CEX, CED, CXD, CTM-HE, CXM-AX, CPZ, CBPZ, TFLX, ASTM, MINO. The drugs of group III were AMPC, CCL, CDX, CPDX-PR, CFTM-PI, CTZ, CEC, CEZ, CTM, CMZ, CZON, MCR, IPM/CS. Factors which may influence the skin penetration were discussed, but no definite conclusion has not been obtained.     

Drugs causing fixed eruptions: a study of 450 cases

Background Drug eruptions are among the most common cutaneous disorders encountered by the dermatologist. Some drug eruptions, although trivial, may cause cosmetic embarrassment and fixed drug eruption (FDE) is one of them. The diagnostic hallmark is its recurrence at previously affected sites. Objective We evaluated 450 FDE patients to determine the causative drugs. Results The ratio of men to women was 1:1.1. The main presentation of FDE was circular hyperpigmented lesion. Less commonly FDE presented as: nonpigmenting erythema, urticaria, dermatitis, periorbital or generalized hypermelanosis. Occasionally FDE mimicked lichen planus, erythema multiforme, Stevens–Johnson syndrome, paronychia, cheilitis, psoriasis, housewife’s dermatitis, melasma, lichen planus actinicus, discoid lupus erythematosus, erythema annulare centrifugum, pemphigus vulgaris, chilblains, pityriasis rosea and vulval or perianal hypermelanosis. Cotrimoxazole was the most common cause of FDE. Other drugs incriminated were tetracycline, metamizole, phenylbutazone, paracetamol, acetylsalicylic acid, mefenamic acid, metronidazole, tinidazole, chlormezanone, amoxycillin, ampicillin, erythromycin, belladonna, griseofulvin, phenobarbitone, diclofenac sodium, indomethacin, ibuprofen, diflunisal, pyrantel pamoate, clindamycin, allopurinol, orphenadrine, and albendazole. Conclusions Cotrimoxazole was the most common cause of FDE, whereas FDE with diclofenac sodium, pyrantel pamoate, clindamycin, and albendazole were reported for the first time. FDE may have multiform presentations.     

Benign skin changes associated with chronic sunlight exposure

Chronic and heavy sun exposure will insidiously induce changes in human skin during the course of many years. These changes include wrinkles, atrophy, cutis rhomboidalis nuchae, yellow papules and plaques of the face, colloid milium, telangiectasis, diffuse erythema, diffuse brown pigmentation, ecchymoses, freckles, actinic lentigo, nevi, Favre-Racouchot syndrome, poikiloderma of Civatte, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, melanoma, actinic lichen planus, actinic reticuloid, porphyria cutanea tarda, and erythropoietic protoporphyria. In particular, we describe the clinical appearance of the benign changes caused by chronic sunlight exposure.     

Inhibition of thiazide photohemolysis in vitro by antioxidants and a nitrogen atmosphere

The diuretics acetazolamide, bemetizide, bendroflumethiazide, benzthiazide, benzylhydrochlorothiazide, bumetanide, butizide, chlorazanile, chlorothiazide, chlortalidone, clopamide, cyclopenthiazide, cyclothiazide, diazoxide, etozoline, furosemide, hydrochlorothiazide, hydroflumethiazide, indapamide, mefruside, metolazone, piretanide, polythiazide, trichlormethiazide, and xipamide were screened in vitro for phototoxic effects by means of a photohemolysis test. In all, 19 out of the 25 test substances revealed phototoxic hemolytic properties after irradiation with either solar simulating irradiation, UVA and/or visible light. Addition of the antioxidants ascorbic acid, alpha-tocopherole or superoxide dismutase significantly inhibited the phototoxic hemolysis, as well as did investigations carried out in a nitrogen rich atmosphere, findings which indicate the involvement of reactive oxygen species in the phototoxic process.     

Current therapy: immunopharmaceuticals

Immunopharmarca are classified as follows: thymus factors and hormones, lymphokines and cytokines, microbial products, drugs with potential effects on the immune system, and external immunomodulators. We discuss new drugs and substances such as Timunox, Tp-1 Serono, delimmun, Isoprenosine, recombinant interleukin 2, Immuneron, tumor necrosis factor, Sandimmun, and diphencyprone, as well as drugs already known like Levamisole, Bestatin, gold, sulfones, and sulfopyridines.     

生殖道分泌物支原体培养、半定量与耐药率调查

近年来,泌尿生殖道支原体感染,越发引起重视。检出手段也不断创新,新药不断开发,而支原体的耐药谱也不断发生变化,为此,要了解目前北京地区泌尿生殖道支原体中解脲支原体(Uu)和人型支原体(Mh)的感染率和耐药性,笔者选用了IST与DM培养试剂盒,对170例生殖道标本进行了培养检测,又将前次培养阳性结果与耐药率一并统计,临床分析另文报道,现就实验部分报告如下:     

Obesity and the skin: skin physiology and skin manifestations of obesity

Obesity is widely recognized as an epidemic in the Western world; however, the impact of obesity on the skin has received minimal attention. The purpose of this article is to highlight the association between obesity and dermatologic conditions. We review the impact of obesity on the skin, including skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity. Obesity is responsible for changes in skin barrier function, sebaceous glands and sebum production, sweat glands, lymphatics, collagen structure and function, wound healing, microcirculation and macrocirculation, and subcutaneous fat. Moreover, obesity is implicated in a wide spectrum of dermatologic diseases, including acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, and fat redistribution, lymphedema, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, psoriasis, insulin resistance syndrome, and tophaceous gout. We review the clinical features, evidence for association with obesity, and management of these various dermatoses and highlight the profound impact of obesity in clinical dermatology. LEARNING OBJECTIVE: After completing this learning activity, participants should be aware of obesity-associated changes in skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity, and be able to formulate a pathophysiology-based treatment strategy for obesity-associated dermatoses.     

Prevalence of dermatological disorders in Japan: a nationwide, cross-sectional, seasonal, multicenter, hospital-based study

To clarify the prevalence of skin disorders among dermatology patients in Japan, a nationwide, cross-sectional, seasonal, multicenter study was conducted in 69 university hospitals, 45 district-based pivotal hospitals, and 56 private clinics (170 clinics in total). In each clinic, information was collected on the diagnosis, age, and gender of all outpatients and inpatients who visited the clinic on any one day of the second week in each of May, August, and November 2007 and February 2008. Among 67,448 cases, the top twenty skin disorders were, in descending order of incidence, miscellaneous eczema, atopic dermatitis, tinea pedis, urticaria/angioedema, tinea unguium, viral warts, psoriasis, contact dermatitis, acne, seborrheic dermatitis, hand eczema, miscellaneous benign skin tumors, alopecia areata, herpes zoster/postherpetic neuralgia, skin ulcers (nondiabetic), prurigo, epidermal cysts, vitiligo vulgaris, seborrheic keratosis, and drug eruption/toxicoderma. Atopic dermatitis, impetigo, molluscum, warts, acne, and miscellaneous eczema shared their top-ranking position in the pediatric population, whereas the most common disorders among the geriatric population were tinea pedis, tinea unguium, psoriasis, seborrheic dermatitis, and miscellaneous eczema. For some disorders, such as atopic dermatitis, contact dermatitis, urticaria/angioedema, prurigo, insect bites, and tinea pedis, the number of patients correlated with the average high and low monthly temperatures. Males showed a greater susceptibility to some diseases (psoriasis, erythroderma, diabetic dermatoses, inter alia), whereas females were more susceptible to others (erythema nodosum, collagen diseases, livedo reticularis/racemosa, hand eczema, inter alia). In conclusion, this hospital-based study highlights the present situation regarding dermatological patients in the early 21st century in Japan.     

Oral manifestations of COVID‐19 disease: A review article

Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID‐19). In this review article, we described oral lesions of COVID‐19 patients. We searched PubMed library and Google Scholar for published literature since December 2019 until September 2020. Finally, we selected 35 articles including case reports, case series and letters to editor. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki‐like, EM‐like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa‐like, angular cheilitis, atypical Sweet syndrome, and Melkerson‐Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID‐19 disease had more widespread and sever oral lesions. Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper‐inflammatory response secondary to COVID‐19 are the most important predisposing factors for onset of oral lesions in COVID‐19 patients.     

使用化妆品导致激素依赖性皮炎124例临床分析

目的 探讨在使用化妆品过程中产生的激素依赖性皮炎的临床特点。方法 对124例皮肤科门诊确诊的激素依赖性皮炎患者进行回顾总结。结果 所有患者均为使用含有皮质类固醇激素的化妆品后发生,以美容为主要目的,表现为激素依赖症状和激素后遗症状。结论 化妆品所致的激素依赖性皮炎有其特殊性,可产生严重的不良反应,对患者身心造成损害。     

Nail changes and disorders among the elderly

Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.     

Sexually acquired hepatitis

OBJECTIVES: To assess current knowledge of sexually transmitted viral hepatitis in relation to epidemiology, clinical presentation, management, and diagnosis with particular reference to resource-poor settings. METHOD: A search of published literature identified through Medline from 1966 to October 2001, the Cochrane Library, and reference lists taken from each article obtained. Textword and MeSH searches for hepatitis A, B, C, D, E, G, delta, GB virus, GBV-C, and TT virus were linked to searches under the textword terms sex$, prevent$, and MeSH subheadings, microbiology, complications, drug therapy, therapy, diagnosis, epidemiology, transmission, and prevention and control. CONCLUSIONS: In heterosexual relationships, hepatitis B is readily transmitted sexually and hepatitis C and D less so, with no evidence for sexual transmission of hepatitis A. Hepatitis types A-D are all transmissible sexually in male homosexual relationships under certain conditions. In resource-poor countries sexual transmission is generally only a significant route of transmission for hepatitis B.     

Novel approaches in herbal cosmetics

Nutracosmetics are an emerging class of health and beauty aid products that combine the benefits of nutracosmetical ingredients with the elegance, skin feel, and delivery systems of cosmetics. Herbs and spices have been used in maintaining and enhancing human beauty because herbs have many beneficial properties, such as sunscreen, antiaging, moisturizing, antioxidant, anticellulite, and antimicrobial effects. As compared with synthetic cosmetic products, herbal products are mild, biodegradable, and have low toxicity profile. To enhance these properties, research is being done in the development of newer approaches, which could improve both the aesthetic appeal and performance of a cosmetic product. In this respect, the approaches studied and discussed include liposomes, phytosomes, transferosomes, nanoemulsions, nanoparticles, microemulsions, nanocrystals, and cubosomes.     

Melanoma prognostic factors found in the dermatopathology report

Significant prognostic information is available in a routine melanoma dermatopathology report. Features that are enumerated in the pathology report and that portend a potentially poorer prognosis are older age, site (acral, head, neck), male sex, increasing Breslow tumor thickness, increasing Clark's level, ulceration, increasing number of mitoses, vertical growth phase, regression, absence of a host inflammatory response, increased tumor vascularity, angiotropism, vascular invasion, neurotropism, marked atypia, and satellite metastasis.     

Nutlin-3对人A375黑素瘤细胞生物学行为的影响及可能机制

目的 观察顺式咪唑啉衍生物nutlin-3对人A375黑素瘤细胞生物学行为的影响,研究其机制。 方法 将A375细胞分为实验组和对照组,实验组细胞接受2.5、5、10 μmol/L nutlin-3处理,对照组细胞采用二甲基亚砜处理。分别于作用24、48、72 h后,噻唑蓝（MTT）法检测细胞增殖情况;Western印迹检测p53蛋白表达的改变;流式细胞仪检测细胞周期分布以及细胞凋亡;Transwell法检测迁移性变化。采用重复测量的方差分析进行统计学检验。 结果 2.5、5、10 μmol/L nutlin-3处理A375细胞24、48、72 h后,MTT法显示不同时间点间的增殖抑制率差异有统计学意义（F = 67.43,P < 0.01）,不同浓度间的抑制率差异有统计学意义（F = 135.58,P < 0.01）,浓度越高抑制率越高;时间和浓度之间有交互作用（F = 26.95,P < 0.01）。Western印迹 、流式细胞仪、Transwell法检测显示,不同时间点之间A375细胞的p53表达、G2期细胞百分率、凋亡率、迁移抑制率差异均有统计学意义（F值分别为1255.00、831.38、809.45、1100.00,均P < 0.01）,除p53外,时间越长各项指标值越高;不同浓度间各项指标值差异均有统计学意义（F值分别为9196.00、267.99、723.83、1667.00,均P < 0.01）,浓度越高各项指标值越高;时间与浓度之间交互作用有统计学意义（F值分别为826.79、21.602、44.48、313.09,均P < 0.01）。 结论 nutlin-3可能通过p53蛋白积累途径抑制人A375细胞的增殖和迁移,促进细胞周期停滞和细胞凋亡。     

维持性血液透析终末期肾病患者皮肤病变调查分析

目的　调查进行维持性血液透析（maintenance hemodialysis, MHD）的终末期肾脏病患者皮肤病变的发病情况和病变特点，探讨其危险因素。方法　对181例MHD的终末期肾病患者进行皮肤体检；收集其临床和生化资料，分析皮肤病变的患病率，病变类型及其危险因素。结果　 ①181例患者中161例（88.95％）存在不同种类的皮肤病变，其中38例（23.60％）存在1种皮肤病变，52例（32.30％）有2种，40例（24.84％）有3种、26例（16.15％）有4种、5例（3.11％）有5种。②最常见是皮肤干燥（128/181， 77.72％），其次是瘙痒（101/181，55.80％）、脱屑（73/181，40.33％）和色素沉着（70/181，38.67％）。其他有皮肤苍白（6/181，3.31％）、瘀斑（4/181，2.21％）、指（趾）干性坏疽（3/181，1.66％）、足部溃疡（2/181，1.10％）、甲纵裂（1/181，0.55％）。③皮肤病变组患者的透析龄、超滤量、血磷、钙磷乘积、甲状旁腺激素、超敏C-反应蛋白（Hs-CRP）水平，乙肝、丙肝病毒标志物阳性率明显高于无皮肤病变组；而血红蛋白、血清尿素清除指数（Kt/V）明显低于无皮肤病变组。④Logistic回归分析结果显示，透析龄、KT/V、血钙磷乘积、血甲状旁腺激素、高敏C反应蛋白（Hs-CRP）和丙肝病毒标志物阳性是MHD患者发生皮肤病变的独立危险因素。结论MHD的终末期肾病患者皮肤病变的患病率高，以皮肤干燥症和皮肤瘙痒最常见。透析龄、KT/V、血钙磷乘积、血甲状旁腺激素、Hs-CRP和丙肝病毒标志物阳性是MHD终末期肾病患者发生皮肤病变的独立危险因素。     

Evidenzbasierte Beurteilung der Auswirkung von Typ-IV-Allergien bei der Minderung der Erwerbsfähigkeit

Evidence-based guidelines about the distribution of type IV allergens of the European standard series in different professions and its occupational relevance are missing. Based on published data, epidemiological investigations, work related knowledge about industrial processes, and allergen specific properties, recommendations are given about the clinical impact in the working environment for the following allergens: acrylates/methacrylates, epoxy resins, dichromate, cobalt, nickel, formaldehyde, (chlor-)methylisothiazolone, p-phenylendiamine, colophony, thiurame, mercaptobenzothiazole, dithiocarbamate, n-isopropyl-n'-phenyl-p-phenylendiamine, fragrance mix, composite mix, and neomycinsulfate. These recommendations might improve the clearance rate and allergological evaluation of the occupational relevance of different delayed type sensitizations or allergens.     

过敏性紫癜病因及发病机制研究进展

过敏性紫癜(anaphylactoid purpura,AP)是一种急性、自限性,主要侵犯全身毛细血管的疾病,多发生儿童及成人。病因复杂,其确切病因尚不清楚,目前发现可能与感染、药物、遗传等因素相关。本病发病机制尚未完全阐明,研究发现体液免疫、细胞免疫、内皮素-1、Toll-like受体2、Toll-like受体4、基质金属蛋白酶、白三烯和脂氧素A4、血管内皮生长因子、胰岛素样生长因子等均在发病中起一定作用。     

Complications of lasers and light treatments

Cutaneous lasers and lights, and also more novel cutaneous energy modalities like radiofrequency and ultrasound, are in general very safe interventions with an associated rapid healing time. Posttreatment sequelae are usually mild and spontaneously resolving, with erythema and edema lasting hours to days. More troublesome, less common short-term adverse events include urticaria, erosions, crusting, ecchymoses, blistering, and infection. Medium-term adverse events include hyperpigmentation, hypopigmentation, a line of demarcation, burns, textural imperfections, and delayed reepithelialization. Long-term to permanent adverse events, which are fortunately rare, include indentation, scar, and ocular damage. With few exceptions, there are management strategies for avoiding laser adverse events, and, if they do occur, for mitigating their impact.