Highlights in pathogenesis of vitiligo

Vitiligo is a common pigmentary disorder. Many studies across decades and all over the world have attempted to illustrate the pathogenesis behind it; however, the pathogenesis of vitiligo remains elusive. This review article, we present the findings behind the most and updated theories behind this psychologically debilitating and disfiguring disease. The discussion begun with the role of genetic predisposition followed by neural theory first proposed in the 1950 s. Wehighlight the autoimmune hypothesis, followed by the reactive oxygen species model, zinc-α2-glycoprotein deficiency hypothesis, viral theory, intrinsic theory and biochemical, molecular and cellular alterations accounting for loss of functioning melanocytes in vitiligo. Many theories were elaborated to clarify vitiligo pathogenesis. It is a multifactorial disease involving the interplay of several factors. Future research is needed to clarify the interaction of these factors for better understanding of vitiligo pathogenesis and subsequent successful treatment.     

Combination immunotherapy of B16 melanoma using anti-cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and granulocyte/macrophage colony-stimulating factor (GM-CSF)-producing vaccines induces rejection of subcutaneous and metastatic tumors accompanied by autoimmune depigmentation.

We examined the effectiveness of cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) blockade, alone or in combination with a granulocyte/macrophage colony-stimulating factor (GM-CSF)-expressing tumor cell vaccine, on rejection of the highly tumorigenic, poorly immunogenic murine melanoma B16-BL6. Recently established tumors could be eradicated in 80% (68/85) of the cases using combination treatment, whereas each treatment by itself showed little or no effect. Tumor rejection was dependent on CD8(+) and NK1.1(+) cells but occurred irrespective of the presence of CD4(+) T cells. Mice surviving a primary challenge rejected a secondary challenge with B16-BL6 or the parental B16-F0 line. The same treatment regimen was found to be therapeutically effective against outgrowth of preestablished B16-F10 lung metastases, inducing long-term survival. Of all mice surviving B16-BL6 or B16-F10 tumors after combination treatment, 56% (38/68) developed depigmentation, starting at the site of vaccination or challenge and in most cases progressing to distant locations. Depigmentation was found to occur in CD4-depleted mice, strongly suggesting that the effect was mediated by CTLs. This study shows that CTLA-4 blockade provides a powerful tool to enhance T cell activation and memory against a poorly immunogenic spontaneous murine tumor and that this may involve recruitment of autoreactive T cells.     

白癜风与甲状腺疾病的相关性研究

目的研究白癜风与甲状腺疾病的相关性。方法采用化学发光法检测289例白癜风患者和128例健康者血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、抗甲状腺过氧化物酶抗体(TPO-Ab)、抗甲状腺球蛋白抗体(TG-Ab)水平。对检测结果进行统计学分析。结果白癜风患者FT3、TG-Ab、TPO-Ab异常率高于健康者(P0.05)。白癜风合并甲状腺疾病发病率与白癜风患者年龄、性别有关(P0.05)。结论白癜风患者存在不同程度的甲状腺功能指标及自身抗体水平的异常,男性和青少年白癜风患者更为明显。因此有必要对白癜风患者进行甲状腺疾病指标检测。     

直肠癌术后局部复发再治疗的诊治分析

目的:探讨直肠癌术后局部复发的原因、预防及治疗方法。方法:回顾性分析43例直肠癌术后局部复发患者的临床资料。结果:行根治性切除21例,其1、3、5年的生存率分别为100%、52.4%、33.3%。根治术组和姑息术组中位生存期分别为34.5(12-84)个月和12(3-21)个月。结论:局部复发性直肠癌积极手术治疗并行以手术为主的综合治疗可以延长患者生存期,提高生存质量。     

132例白癜风患者自身抗体的检测分析

目的通过分析白癜风患者血清中相关自身抗体的水平,以探讨自身免疫在白癜风患者发病中的作用及其临床意义。方法分别用电化学发光免疫分析法、间接免疫荧光法、乳胶凝集法检测132例白癜风患者与50名正常对照组血清中甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、抗核抗体(ANA)和类风湿因子(RF)的水平,比较白癜风患者与正常对照组间各种自身抗体的阳性率。结果白癜风患者TPO、TGAb及RF阳性率高于正常对照组,两组相比差异有统计学意义(P0.05),而ANA阳性率两组相比差异无统计学意义(P0.05)。结论白癜风患者部分自身抗体水平明显高于正常人群,自身免疫与白癜风的发病密切相关,对白癜风患者进行相关自身抗体的检测将有助于预测某些自身免疫性疾病的发生。     

Increased level of serum Homocysteine in vitiligo

Background: Vitiligo is an acquired depigmenting disorder caused by the destruction of melanocytes. The exact etiopathogenesis and mechanisms of vitiligo are not fully understood. Vitamin B12 and folic acid levels are decreased in vitiligo, which are the important cofactors required in the metabolism of Homocysteine (Hcy). Consequently, Hcy level increases in the circulation. Therefore, it is possible that increased Hcy plays a role in melanocytes destruction. The aim was to study for any association of vitiligo with serum Hcy level. Method: A total of 30 vitiligo patients of both sexes and 30 control subjects were enrolled in this study. Sera from patients and controls were assayed for Hcy by Enzyme immunoassay. The collected data were analyzed by SPSS version‐16. Results: The mean serum level of Hcy was significantly higher in patients with vitiligo as compared with healthy controls and its level was high in male patients as compared with female patients. The Hcy level in vegetarian patients was significantly higher as compared with nonvegetarian patients. The Hcy level was also significantly higher in active vitiligo patients as compared with stable vitiligo patients. Conclusion: An increased serum Hcy may be a precipitating factor for vitiligo in the predisposed individuals. Serum Hcy is related to the gender of patients, activity of disease, and dietary habits of vitiligo patients. J. Clin. Lab. Anal. 25:110–112, 2011. © 2011 Wiley‐Liss, Inc.     

Development of metastatic Merkel cell carcinoma following the excision of same‐sided recurrent auricular melanoma

Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin that is highly aggressive and often metastasizes early. MCC is diagnosed based on histopathological findings and is most commonly treated with surgical resection, which may be accompanied by chemotherapy and/or radiation. This report describes a 55‐year‐old male patient with the history of recurrent malignant melanoma of the right pinna and subsequent excision. Three years following the excision of melanoma, he presented with a lesion to the right forehead as well as a right‐sided neck mass that were found to be metastatic Merkel cell carcinoma.     

基于两种蛋白质组学技术筛选不同分期白癜风的差异表达蛋白

目的:采用两种蛋白质组学技术鉴定和筛选不同分期白癜风的血清标志物,并研究其网络关系.方法:收集白癜风稳定期和进展期以及健康人各15例的血清样本,采用双向凝胶电泳技术(2-DE)和核素标记相对和绝对定量技术(iTRAQ)对所有样本进行检测,筛选出差异表达蛋白,并用软件分析其可能作用的主要通路.结果:通过2-DE鉴定出稳定...     

白癜风人群戊型肝炎感染状况调查

目的调查研究白癜风人群戊型肝炎的感染状况。方法对434例白癜风患者进行现况调查。收集患者血清并采用酶联免疫吸附测定(ELISA)方法进行抗戊型肝炎病毒(HEV)-IgG及抗HEV-IgM的检测,分析抗HEV-IgG阳性率与性别、年龄、病程及各免疫学指标之间的相关性。结果白癜风人群抗HEV-IgG阳性率为26.26%。成年及进展期白癜风患者抗HEVIgG阳性率远高于青少年和稳定期白癜风患者,差异有统计学意义(P0.05)。IgG、IgA、C4检测水平异常患者抗HEV-IgG阳性率远高于这3项指标的正常水平者,差异有统计学意义(P0.05)。抗HEV-IgM阳性者10人且均伴有抗HEV-IgG阳性。结论白癜风人群HEV感染率较高,有必要对该人群进行相应的HEV预防措施,从而降低此人群HEV的发病率。     

miR-182受TEAD1转录调控参与黑素瘤细胞转移

目的:探讨黑素瘤中microRNA(miRNA)-183/96/182同源簇的表达丰度及可能的调控机制。方法:采用荧光定量聚合酶链反应(qPCR)检测黑素瘤细胞系(A375、WM35)与黑素瘤样本中miR-183/96/182的表达丰度与差异。JASPAR数据库分析miR-183/96/182启动子区域可能存在的转录因子结合位点。采用荧光素酶报告基因实验与染色质免疫沉淀法(ChIP)分析转录因子对miR-183/96/182表达的调控机制。分析转录因子与miR-183/96/182对黑素瘤细胞迁移的影响。结果:miR-183/96/182同源簇中,miR-182在黑素瘤细胞系与肿瘤样本中的表达较其他两种miR升高(P0.05)。黑素瘤细胞系过表达TEAD1后,miR-182的表达升高(P0.05);抑制miR-182后,TEAD1诱导的黑素瘤细胞转移的作用降低(P0.01)。结论:miR-182在黑素瘤中高表达,其可能通过TEAD1的转录调控参与黑素瘤细胞转移。     

Co‐occurrence of progressive hemifacial atrophy due to morphea with homolateral segmental vitiligo: A case report

Simultaneous occurrence of progressive hemifacial atrophy due to morphea and homolateral segmental vitiligo, younger onset, rapid progression followed by stabilization and dermatomal distribution suggests a possible relationship between them.     

抗核抗体、免疫球蛋白及补体在儿童白癜风疾病中的价值探讨

目的探讨白癜风患儿抗核抗体、免疫球蛋白(IgG、IgM和IgA)和补体(C3和C4)在本病中的临床价值。方法以调查表形式收集145例白癜风患儿的临床资料,应用统计学软件对数据进行统计学分析。采用间接免疫荧光法和免疫印迹法检测患儿血清抗核抗体及12种自身抗体谱,免疫透射比浊法检测IgG、IgM、IgA和C3、C4。结果调查发现,145例患儿的病程为1个月至5年,白斑的初发部位以头面部最为多见,以轻度和散发型白斑类型居多;大部分患儿病情处于进展期,30.35%患儿有白癜风或者自身免疫性疾病的家族史。对其血清抗核抗体检测结果发现,共有13例为阳性,其中8例存在特定自身抗体阳性。白癜风组IgG、IgA水平明显低于对照组,差异有统计学意义(P0.01),而IgM水平差异无统计学意义(P0.05)。白癜风组患儿C4血清水平明显低于对照组,差异有统计学意义(P=0.035),但C3水平差异无统计学意义(P0.05)。结论白癜风患儿的抗核抗体水平与健康儿童几乎无异,但存在较为明显的体液免疫功能异常。     

The effectiveness of therapeutic interventions on quality of life for vitiligo patients: A systematic review

This paper reviews the effectiveness of therapeutic interventions on quality of life for adult patients with vitiligo. We systematically searched nine databases from 1990 to February 2010 and reviewed randomized controlled trials and quasi-experimental studies of current therapeutic interventions for vitiligo, including oral, topical, combination, camouflage, cognitive-behavioural therapy and grafting. Quality of life outcomes were collected. The Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument was used for quality assessment. Nine studies were included for this review, and all treatments were found to improve quality of life for vitiligo patients. Disease-altering interventions were effective in improving quality of life. Lifestyle-altering interventions were found to be selectively effective for patients with more severe quality of life impairment. Current interventions for vitiligo are effective in improving quality of life either by enhancing physical appearance of the patient or by addressing the psychological distress directly. Less effectiveness was achieved for the functional and social dimensions, which are more dependent on social and cultural norms. This suggests that current interventions alone are inadequate to address the holistic quality of life challenges associated with vitiligo.     

超声介入无水乙醇量化治疗肝包膜下复发性肝癌的研究

目的评价超声介入注射无水乙醇量化治疗肝包膜下复发性肝癌的临床应用价值。方法临床病理证实的生长于肝包膜下的复发性肝癌患者136例，行超声介入无水乙醇量化注射治疗，注射量按回归方程Y=2．885X（当肿瘤直径≤5cm时），Y=1．805X（当肿瘤直径〉5cm时）计算（X为肿瘤最大直径，单位为cm;Y为注射乙醇量，单位为ml），每2～3d注射1次。直径≤5cm的肿瘤结节4～10次为一疗程，〉5cm的肿瘤结节10-20次为一疗程。所有病例随访12～60个月。观察临床症状与体征，并结合相关检查结果。统计1，2，3，4，5年生存率。结果超声引导无水乙醇量化注射治疗2～8周后肿瘤平均直径从3．4cm降为2．6cm。治疗后活检结果显示92．1％（126／136）未检出癌细胞，仅7．9％（10／136）可见变性癌细胞，均为肿瘤直径〉4．5cm者。治疗前AFP升高112例，治疗后转阴者占88．2％（99／112）。经超声引导无水乙醇注射治疗后1，2，3，4，5年生存率分别为93．4％，83．1％，72．8％，63．1％和51．9％，中数生存期为47．7月。均无严重并发症发生。结论超声介入注射无水乙醇量化治疗肝包膜下复发性肝癌有较高的临床应用价值，值得深入研究。     

Chemotherapy for advanced malignant melanoma

Summary Systemic chemotherapy for the treatment of metastatic melanoma remains disappointing. Nor new single agent has demonstrated promising results. The combination of cisplatin, decarbazine, carmustine, and tamoxifen appears to be one of the most active regimens with an overall response rate approaching 50%. In some patients, responses have been durable and exceed 3 years. Sequential small phase II trials suggest that tamoxifen is an important component in this combination. The efficacy of the combination of hormonal and chemotherapy, however, needs to be corroborated in a large multicenter phase II trial. In addition, further laboratory and clinical studies are needed to evaluate the role of tamoxifen. Biological response modifiers, such as interleukin-2 and α-interferon, have limited activity as single agents, but in combination with cytotoxic agents show some promise and merit further evaluation. Future research should focus on the development of more effective agents, and on the use of aggressive adjuvant and neoadjuvant chemotherapy in high-risk patients with locally advanced disease.     

动态对比增强MRI在鉴别胶质瘤复发及放射性脑损伤中的应用

目的分析动态对比增强MRI（DCE-MRI）在鉴别胶质瘤复发与放射性脑损伤中的作用。材料与方法应用Philips 3.0 T TX MR扫描机,对28例脑胶质瘤术后放疗后患者（随访中出现异常强化灶）行头部DCE扫描,采用FFE序列行多层采集,28例患者被二次手术病理或临床及影像随访证实为胶质瘤术后复发17例,放射性脑损伤11例。采用渗透分析软件,在对比剂强化区域及对侧正常脑组织回顾性画出感兴趣区,获得T1加权信号强度-时间曲线,基于双室血流动力学模型,产生三个脑血流动力学参数Ktrans、Ve和Kep。测量时参考增强图像,手动勾画感兴趣区,为了减少误差反复测量8～10次,取其平均值。采用秩和检验比较胶质瘤复发和放射性损伤两组间的DCE灌注参数,并作ROC曲线分析,明确各项指标在临床上对于胶质瘤复发诊断的优越性。结果 Ktrans、Ve、Kep在胶质瘤复发组和放射性损伤组及对侧脑组织间有统计学意义,Ktrans在胶质瘤复发组高于放射性坏死组（P〈0.01）,且Ktrans界值高于0.12对胶质瘤复发的诊断显示出100%的敏感度和87%的特异度,ROC曲线下面积为0.974。Ve值在胶质瘤复发组高于放射性坏死组（P〈0.01）,ROC曲线下面积为0.872。Kep值在鉴别胶质瘤复发组与放射性坏死组不具有统计学意义（P〈0.05）。结论 DCE-MRI可以用于鉴别胶质瘤复发与放射性脑损伤,Ktrans值及Ve值对二者鉴别具有重要的临床意义。     

Primary malignant melanoma of the esophagus

We report a case of primary malignant melanoma of the esophagus.     

Nevoid melanoma

This article discusses the key features of nevoid melanoma. Gross features, microscopic features, immunohistochemistry, differential diagnosis, diagnosis, prognosis, and treatment are also discussed.     

超声结合增强CT对甲状腺癌术后局部复发/残留的诊断价值

目的 对比分析甲状腺癌术后局部复发/残留的高频彩色多普勒超声与增强CT表现,探讨超声、增强CT及二者结合对甲状腺癌术后局部复发/残留的诊断符合率.方法 回顾性分析46例经手术病理证实的甲状腺癌术后局部复发/残留患者同期高频彩色多普勒超声与增强CT影像学资料及诊断符合率.结果 甲状腺癌术后复发/残留时间7 d～10年,平均(14.6±12.1)月.局部复发/残留结节20例,大小0.5～4.6 cm,平均2.1 cm,超声声像图以低回声实性结节为主(60％),砂粒样钙化占40％.颈部淋巴结转移40例,以Ⅵ区为主(75％),超声检出最小转移性淋巴结3 mm;40例中12例(30％)伴液化囊性变,10例(25％)伴点状钙化,5例(12.5％)同时合并钙化及囊性变,结内微钙化、囊性变及高回声等为特异性表现.超声及增强CT对局部复发/残留结节检出率均为90％,颈部淋巴结转移检出率分别为80％和72.5％.超声与增强CT对局部复发/残留结节、颈部淋巴结及总诊断率分别为65％、67.5％和65.2％对75％、55％和65.2％,二者联合诊断率为86.4％、77.5％和91.3％,与单纯高频彩色多普勒超声及增强CT相比,差异有统计学意义(P＜0.05).结论 高频彩色多普勒超声可作为甲状腺癌术后随访的首选影像学检查方法之一,联合增强CT可进一步提高诊断符合率.