重症手足口病患者并发神经源性肺水肿的影响因素分析

 目的:分析重症手足口病(HFMD)患者并发神经源性肺水肿(NPE)的影响因素。方法：选取2014年1月-2019年1月本院收治的101例重症HFMD患儿，根据是否并发NPE分为并发NPE组（50例）、未并发NPE组（51例）。收集两组患儿一般资料，记录两组患儿入院时的症状、体征、血压、血糖、白细胞计数（WBC）、C反应蛋白（CRP）、cTnI、病原学检测结果，应用单因素分析和Logistic多元回归分析影响重症HFMD并发NPE的因素，ROC曲线分析WBC及cTnI对HFMD并发NPE的预测价值。结果：单因素分析结果显示，两组患儿在EV71感染（ X²=7.50，P=0.006）、最高体温超过39 ℃（ X²=11.25，P=0.001）、肢体麻（ X² =12.20，P=0.001）、心动过速（X²=22.12，P＜0.01）、血压升高（ X²=19.47，P＜0.01）、血糖水平（t=5.93，P＜0.01）、WBC水平（t=6.35，P＜0.01）、CRP水平（t=5.21，P＜0.01）、cTnI水平（t=8.52，P＜0.01）方面有明显差异；多因素Logistic回归分析结果显示，心动过速（OR=6.74，P=0.015）、血压上升（OR=4.40，P=0.049）、血糖升高（OR=12.09，P=0.039）、WBC升高（OR=14.15，P=0.032）、cTnI升高（OR=12.23，P=0.043）是并发NPE的独立危险因素。WBC及cTnI预测重症HFMD并发NPE的AUC值分别为0.80、0.89，cTnI的AUC值明显高于WBC的AUC值（P＜0.05）。结论：心动过速、血压上升、血糖升高、WBC升高、cTnI升高是HFMD并NPE发生的高危因素，检测cTnI对于预测HFMD并发NPE具有积极意义。     

乌司他丁对外伤性脓毒症脏器保护及全身炎症反应的抑制作用

目的 探讨乌司他丁（Ulinastatin,UTI）对严重外伤后脓毒症的重要脏器功能保护及全身炎症反应的抑制作用.方法 选择42例严重外伤后脓毒症患者,随机分为对照组和UTI治疗组.对照组常规给予抗炎、抗休克补液治疗,UTI组则在对照组的基础上加用UTI治疗,连续3 d.各组分别于入院第0天,入院第1、2、3天测定动脉血气分析、血常规及临床生化指标,结果与对照组的组间比较,UTI治疗组的外周血中C反应蛋白、白细胞总数显著下降（P〈0.05或P〈0.01）,患者的心率、呼吸频率显著改善（P〈0.05）,严重外伤后经过UTI治疗3d,患者的心肌酶学、肝功能及肾功能指标显著改善,其中AST、ALT、BUN、Cr、LDH及CK指标,与入院0天比较均有显著性差异（P〈0.05或P〈0.01）.与对照组比较,UTI治疗组的心肌酶谱CK、肾功能的Cr与BUN、肝功能的ALT、AST指标均有显著性差异（P〈0.05或P〈0.01）,而LDH、CK-MB则没有显著性差异（P〉0.05）.结论 UTI能有效降低严重外伤后脓毒症患者的脏器功能受损及抑制全身炎症反应综合征.     

Silver deposits in cutaneous burn scar tissue is a common phenomenon following application of a silver dressing

Background:  Silver dressings have been widely and successfully used to prevent cutaneous wounds, including burns, chronic ulcers, dermatitis and other cutaneous conditions, from infection. However, in a few cases, skin discolouration or argyria-like appearances have been reported. This study investigated the level of silver in scar tissue post-burn injury following application of Acticoat™, a silver dressing.
Methods:  A porcine deep dermal partial thickness burn model was used. Burn wounds were treated with this silver dressing until completion of re-epithelialization, and silver levels were measured in a total of 160 scars and normal tissues.
Results:  The mean level of silver in scar tissue covered with silver dressings was 136 μg/g, while the silver level in normal skin was less than 0.747 μg/g. A number of wounds had a slate-grey appearance, and dissection of the scars revealed brown-black pigment mostly in the middle and deep dermis within the scar. The level of silver and the severity of the slate-grey discolouration were correlated with the length of time of the silver dressing application.
Conclusions:  These results show that silver deposition in cutaneous scar tissue is a common phenomenon, and higher levels of silver deposits and severe skin discolouration are correlated with an increase in the duration of this silver dressing application.     

High risk factors for severe hand, foot and mouth disease: a multicenter retrospective survey in Anhui Province China, 2008-2009

Objectives:

This study sought to determine the high risk factors for severe hand, foot, and mouth disease (HFMD).

Materials and Methods:

Retrospective 229 severe HFMD cases from four hospitals in FuYang, HeFei, and BoZhou (Anhui Provincial Hospital, Fuyang City People''s Hospital, No. 2 People''s Hospital of Fuyang and Bozhou city People''s Hospital) in 2008-2009 were studied, with 140 mild HFMD cases in the same area. Using univariate and multivariate logistic regression analyses, the high risk factors of HFMD were identified by comparing clinical and laboratory findings between severe cases and mild cases.

Results:

There was a significant difference in age, total duration of fever, rate of respiratory and heart, shake of limbs, white blood cell count, blood sugar, and CK-MB between the two groups. Univariate logistic regression analysis showed that severe cases were associated with age (<3 years), withdrawnness and lethargy, shake of limbs, tachycardia, total leukocyte count (≥17×10⁹/l), blood sugar (≥7 mmol/l), and CK-MB (≥16 mmol/l). Furthermore, age (<3 years), withdrawnness, and lethargy, shake of limbs, WBC (≥17×10⁹/l), and CK-MB (≥16 mmol/l) were found to be high risk factors for severe cases after multivariate logistic regression analysis.

Conclusions:

Clinicians should give importance to these risk factors. Early recognition of children at risk and timely intervention is the key to reduce acute mortality and morbidity.     

Elevation of circulating neutrophil extracellular traps,interleukin (IL)-8, IL-22, and vascular endothelial growth factor in patients with venomous snake mamushi (Gloydius blomhoffii) bites

Mamushi bites cause swelling and pain that extend from the bitten site. The coagulopathic, anti-coagulopathic, and vasculopathic actions of mamushi venom result in various laboratory abnormalities, occasionally with muscular, renal, and other organ damage. We investigated the serum biomarkers that were associated with the pathogenesis of mamushi bites, focusing on markers related to tissue-damage and neutrophil activation. Twenty patients (one case of grade 2, 13 cases of grade 3, and six cases of grade 4 of severity) seen by us in one summer season were enrolled. Peripheral blood samples were taken from the patients on day 0, day 2, and day 7 after mamushi bites. In addition to routine blood examination, serum samples were subjected to enzyme-linked immunosorbent assay for citrullinated histone H3 (CitH3), interleukin (IL)-8, IL-17A, IL-22, vascular endothelial growth factor (VEGF), high mobility group box protein 1 (HMGB1), tumor necrosis factor (TNF)-α, and IL-33. Creatinine kinase (CK) values significantly correlated with prothrombin time (PT) levels, suggesting that muscular damage is associated with exaggerated coagulation and fibrinolysis. In the vast majority of patients, HMGB1, TNF-α, and IL-33 were under detection levels. Neutrophil counts did not correlate with PT or CK, indicating that the coagulation disorder and muscular damage were virtually independent of the neutrophil activation. The neutrophil number significantly correlated with CitH3, a representative marker of neutrophil extracellular traps. Moreover, there were significant correlations between neutrophil number, CitH3, IL-8, IL-22, and VEGF. Our study suggests that there are two major cascades in mamushi bites. One is an already characterized venom effect on coagulation, vessels, and muscles. In the other novel cascade, we propose that neutrophil activation with IL-8 leads to the production of IL-22 and VEGF. This sequential event may contribute to both vascular damage and repair.     

Coombs-positive hemolytic anemia secondary to brown recluse spider bite: a review of the literature and discussion of treatment

The bite of the brown recluse spider (Loxosceles reclusa) typically results in local, dermonecrotic skin lesions. Rarely, these bites may precipitate systemic disturbances of varying severity collectively known as systemic loxoscelism. The more severe systemic alterations attributed to the venom of this arachnid include hemolytic anemia, multiorgan failure, disseminated intravascular coagulation, or even death. Coombs-positive hemolysis associated with brown recluse spider bites has rarely been documented in the literature. We report 2 cases of systemic loxoscelism in young women associated with severe Coombs-positive hemolytic anemia and systemic symptoms requiring hospitalization. Both patients were treated with aggressive wound care, hematologic monitoring with blood transfusion, and intravenous fluid replacement. Recovery was excellent in both cases. We review the literature and discuss the controversies surrounding the treatment of more severe brown recluse bite reactions.     

Nineteen documented cases of Loxosceles reclusa envenomation

OBJECTIVE: Our purpose was to review documented Loxosceles reclusa (brown recluse spider) envenomations and to describe the natural history. METHODS: This article is a retrospective review of 19 documented cases seen in a university dermatology clinic. The study included the cases of 11 female and 8 male patients between the ages of 15 and 54 years with documented cases of brown recluse spider bite between 1987 and 1993. Rest, ice compresses, elevation, and prophylactic antibiotics were used in all cases. Fourteen patients received dapsone and 11 received nonsteroidal anti-inflammatory drugs. Two patients were hospitalized. A 3-point scale of cutaneous lesion severity was developed. Analysis of the association between maximum lesion severity (mild, moderate, severe) and time to complete healing or final evaluation was statistically significant (P < .001). RESULTS: All patients presented with localized erythema. Most bites were on the extremities (18/19; 95%). The most common presenting symptom was pain at the bite site (10/19; 53%). Eleven patients (58%) had skin necrosis; 32% of them had areas of necrosis larger than 1 cm(2). Time to healing ranged from 5 days to more than 17 weeks (mean, 5.6 weeks). Average time to healing for grade 3 (severe) lesions was 74 days, for grade 2 (moderate) lesions 22 days, and for grade 1 (mild) lesions 8 days (in patients seen more than once). CONCLUSIONS: Brown recluse spider bites frequently induce necrotic, slowly healing lesions. Maximum lesion severity is a predictor of time to complete healing.     

Serum antidiuretic hormone is elevated in relation to the increase in average total body transepidermal water loss in severe atopic dermatitis

BACKGROUND: While elevation of antidiuretic hormone (ADH) (arginine vasopressin) levels in the serum has been reported in severe atopic dermatitis (AD), the cause is as yet unexplained. On the other hand, transepidermal water loss (TEWL) is known to increase in the damaged skin due to AD. OBJECTIVES: As ADH increases as a result of dehydration of the body, this study examined whether the high ADH level in severe AD is a reaction to the increased water loss through the entire body skin surface area. METHODS: Forty-eight patients of different ages and with various degrees of AD along with six age- and sex-matched control persons were the study subjects. Using a quick responsive evaporimeter, an average total body TEWL (ATEWL) value was obtained for each subject. Laboratory tests including ADH, serum lactate dehydrogenase (LDH) and peripheral blood eosinophil count (EOS) were also performed. Clinical severity grading was made globally. The relevancy of this grading was empirically demonstrated by its statistically significant relation to LDH and EOS which are commonly known as appropriate gauges for AD severity. Results ATEWL was observed to be significantly greater in patients with AD of at least moderate severity than in normal controls, and ADH was significantly greater in patients with severe and very severe AD. Both ATEWL and ADH showed a significant relation to AD severity. Finally, a significant correlation was found between ADH and ATEWL. CONCLUSIONS: It is possible that elevated ADH is at least in part a reaction to increased ATEWL.     

Wells’ syndrome triggered by centipede bite

A 68-year-old African–American woman was awoken from her sleep by a centipede bite on the dorsum of her left hand. Several days later, the patient presented to the emergency room complaining of fevers, severe itching, swelling, and blistering ( Fig. 1 ) of both hands. The past history was unremarkable. There was no history of asthma or use of medications. Physical examination at that time was consistent with a bullous cellulitis of the hands. Laboratory investigations revealed: white blood cell count (WBC), 10.3 (normal, 4 1 , 2 , 3 - 9 , 10 .5); differential: 54 neutrophils, 15 lymphocytes, and 31 eosinophils. The platelet count was 225,000/mm³. A blood chemistry profile was within normal limits. Blood cultures and stool examination for ova and parasites were negative. The patient was treated with oral cephalexin and diphenhydramine.

Figure 1 Open in figure viewer PowerPoint Left hand reveals a bulla and several vesicles at the site of the centipede bite     

Vitamin D Level in Children Is Correlated with Severity of Atopic Dermatitis but Only in Patients with Allergic Sensitizations

Vitamin D is believed to affect the progression and severity of atopic dermatitis (AD). Allergic sensitization may cause this effect to vary. Individuals who fulfilled the Hanifin and Rajka criteria for AD underwent epidermal prick tests and blood tests for specific immunoglobulin E(IgE), serum total IgE, 25‐hydroxy vitamin D, and peripheral blood eosinophil count and percentage. Disease severity was determined according to the Scoring Atopic Dermatitis (SCORAD) index. Patients were grouped according to allergic sensitization. Seventy‐three children with AD (median age 33.0 mos, interquartile range 19.0–61.5 mos) were enrolled in the study; 33 (45.2%) were found to have allergic sensitization. In this group there was a negative correlation between SCORAD score and serum vitamin D level (p = 0.047, correlation coefficient [r] = ?0.349), whereas there was no correlation in the group without sensitization (p = 0.30, r = ?0.168). Vitamin D was not correlated with total IgE and eosinophil percentage in either AD group (p = 0.77, r = 0.054 and p = 0.73, r = ?0.062, respectively). Vitamin D may affect the severity of AD, especially in children with allergic sensitization.     

抗反转录病毒药物不良反应患者人类免疫缺陷病毒相关疲乏症的影响因素分析

目的分析服用抗反转录病毒(ARV)药物不良反应患者人类免疫缺陷病毒(HIV)相关疲乏症发生的频率及影响因素,为采取相应措施提供依据。方法回顾性分析纳入某课题河南分中心的科研病例的基本临床特征,计算HIV相关疲乏及常见症状发生率;同时使用SPSS19.0软件从疲乏组患者中随机抽取约20%样本组成疲乏组与非疲乏组进行比较分析。结果共收集研究病例483例,剔除病例145例,疲乏发生率90.24%(305/338)。疲乏组发生率明显高于非疲乏组者的症状有面色异常、气短、胸闷、头晕、食欲不振、腹胀及腰酸,差异均有统计学意义(P均<0.05)。疲乏组与非疲乏组WBC计数差异有统计学意义(P<0.05),CD4+T细胞计数,RBC,Hb及Plt差异无统计学意义(P均>0.05)。多因素Logistic回归分析结果提示,面色异常(OR=6.650)、食欲不振(OR=6.094)、气短(OR=16.392)、WBC计数(OR=0.227)和CD4+T淋巴细胞计数(OR=0.194)与HIV相关疲乏有关。结论 ARV药物不良反应患者HIV相关疲乏症是常见症状。面色异常、食欲不振、气短是影响疲乏发生的危险性因素,异常WBC计数和高CD4+T淋巴细胞计数是HIV相关疲乏的保护性因素。     

Sweet's syndrome in a woman with a prothrombin gene (G20210A) mutation

A 46‐year‐old woman was admitted to our hospital with tender, erythematous plaques on her palms of 1‐year duration ( Fig. 1 ). She had a history of fever and upper respiratory tract infection. On dermatological examination, there were found to be tender erythematous papules and plaques on the palms. Physical examination was normal. Ophthalmologic examination revealed bilateral episcleritis. Laboratory tests showed the following values: white blood cell count, 15,600 cells/µL with 3% band forms, 74% segmented neutrophils, 3% monocytes, and 20% lymphocytes; red blood cell count, 4.53 × 10⁶ cells/µL; hemoglobin, 13.2 g/dL; hematocrit value, 40.9%, and platelet count, 241 × 10⁹ platelets/µL. The erythrocyte sedimentation rate was 52 mm/ h, and the C‐reactive protein level was 38.8 mg/dL. Cultures from blood and throat swabs for bacteria revealed no pathogenic growths. Urinanalysis, liver and kidney function tests were within normal limits. Antinuclear, anti‐DNA, and antiphospholipid antibodies were negative, and total C3 and C4 complement levels were normal. In histopathological examination, large infiltrates of neutrophils and nuclear dust were seen in a diffuse pattern within the edematous dermis. There were scattered neutrophils within the epidermis. The vascular endothelial cells were plump, but there was no fibrin in the wall of the venules ( Figs 2 and 3 ). In addition, there was a heterozygous prothrombin (G20210A) gene mutation in rapid polymerase chain reaction (PCR) analysis. She had no history of venous thrombosis or hematologic disorders. The following coagulation and thrombophilic tests were normal: activated protein C ratio (2.6; normal > 2), protein C (84%; normal: 78–106%), prothrombin time (9.8 s; normal: 7–13 s), activated partial thromboplastin time (29.6 s; normal: 22.6–35.0 s), fibrinogen (312 mg/dL; normal: 146–400 mg/dL), bleeding time (30 s, Duke method), and clotting time (5 min, Lee‐White method). Chest X‐ray, abdominal ultrasound findings and tumor marker levels were normal. Based on clinical, laboratory and histopathological findings a diagnosis of Sweet's syndrome associated with prothrombin gene mutation was made. The skin lesions resolved rapidly on treatment with wet compresses of Burrow's solution and oral prednisolone (1 mg/kg). The dose of prednisolone was gradually reduced, and was discontinued after 4 weeks.

Figure 1 Open in figure viewer PowerPoint Erythematous plaques on the palmar aspect of the hand     

Isolation of α-toxin-producing Staphylococcus aureus from the skin of highly sensitized adult patients with severe atopic dermatitis

Background  Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, α-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion.
Objectives  To investigate the association between sensitization to inhalant allergens and skin colonization with α-toxin-producing S. aureus in AD.
Patients and methods  We investigated 127 patients with AD, aged 14–65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens.
Results  Forty-eight of 127 patients were colonized with S. aureus , suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced α-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen.
Conclusions  Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with α-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with α-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards α-toxin-producing S. aureus .     

Relation between patients' and physicians' severity assessment of occupational hand eczema

BACKGROUND: Severity assessment of occupational hand eczema (OHE) is important not only in clinical settings but also in research. Questionnaires with self-rated assessment of severity may be an attractive tool for assessing severity because of their cost efficiency in comparison with expensive clinical examinations. OBJECTIVES: To evaluate the relation between self-rated severity and severity assessment based on standardized medical certificates issued by dermatologists in a population of patients with OHE. METHODS: Between October 2001 and November 2002 (58 weeks) we identified all new cases of recognized OHE from the Danish National Board of Industrial Injuries (DNBII) registry. Each patient was examined by a dermatologist, who issued a standardized medical certificate. The severity assessment in the DNBII registry was based on this medical certificate, which comprised information on morphology and extent of eczema, and frequency of eruptions. All participants received a self-administered questionnaire and were asked to classify severity of their OHE on a visual analogue scale from 0 to 10. The relation between DNBII-assessed and self-rated severity was illustrated by a receiver operating characteristic analysis. RESULTS: Of 758 patients included in the study, 621 returned the questionnaire and 602 (79%) provided information on self-rated severity. The proportion of severe cases was significantly higher among patients' assessments compared with the rating by the DNBII. Almost 18% were categorized as severe cases by the DNBII while 40% of patients had assessed themselves as having severe eczema. The optimal cut-off point had a sensitivity and specificity of self-rated severity according to the DNBII assessment of 65% and 66%, respectively. The positive predictive value was 29% and the negative predictive value was 90%. CONCLUSIONS: The low positive predictive value suggests major differences in the criteria for self-rated severity vs. DNBII-rated severity. We recommend researchers to include ratings from both patients and physicians in future investigations of severity. The methods may address different aspects of OHE.     

伴白细胞升高的荨麻疹性血管炎患者36例临床分析

目的探讨伴白细胞升高的严重性荨麻疹性血管炎患者临床表现特点。方法回顾性分析本科2017年12月-2019年4月36例严重荨麻疹性血管炎患者临床特点和化验结果。采用Fisher确切概率法(n<40)进行统计学处理。结果女20例,男16例,男女之比约4∶5;平均发病年龄为35岁;外周血WBC≥15.0×10^9/L的患者比WBC<15.0×10^9/L的患者出现发热(60.00%vs.12.50%)、胸闷(70.00%vs.18.78%)、腹痛(80.00%vs.25.00%)、关节痛(65.00%vs.12.50%)、色素沉着(65.00%vs.18.78%)的几率均高,差异有统计学意义(P均<0.01);而外周血WBC≥15.0×10^9/L患者与WBC<15.0×10^9/L患者出现尿检异常和补体降低几率比较差异无统计学意义(P均>0.05)。外周血WBC≥15.0×10^9/L患者中85.00%需使用抗生素治疗。结论白细胞升高达≥15.0×10^9/L患者可能存在未被发现或潜在的感染,往往有更多临床症状并且病情较重。     

1M3S护理管理模式联合优化个体护理对ICU重症肺炎患者的临床疗效、APACHEⅡ评分及不良并发症的影响

目的探讨1M3S护理管理模式联合优化个体护理对ICU重症肺炎患者的临床疗效、APACHEⅡ评分及不良并发症的影响。方法选取中南大学湘雅医学院附属海口医院2018年10月—2020年12月收治的148例ICU重症肺炎患者,按照随机数字表法分为对照组和观察组,每组74例。对照组采用优化个体护理,观察组在此基础上实施1M3S护理管理模式,对比两组患者临床疗效、退热时间、止咳时间、白细胞计数恢复正常时间、IL-6、IL-8表达水平、APACHEⅡ评分及不良并发症情况。结果观察组临床总有效率高于对照组(P<0.05);观察组退热时间、止咳时间、白细胞计数恢复正常时间短于对照组(P<0.05);护理后两组外周血IL-6、IL-8表达水平均低于护理前,且观察组外周血IL-6、IL-8表达水平低于对照组(P<0.05);护理后APACHEⅡ评分水平均低于护理前,且观察组APACHEⅡ评分低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论1M3S护理管理模式联合优化个体护理有助于改善ICU重症肺炎患者的临床疗效,降低其APACHEⅡ评分和并发症发生率,临床上值得继续推广。     

Brown recluse spider bites

The bite of the brown recluse spider (BRS) is the most severe arthropod cause of necrotic skin lesions. The severity of cutaneous injury due to BRS bites vary from mild erythema to severe necrosis. Rarely, severe systemic reactions occur. Diagnosis may be difficult, since the victim may not feel the bite or see the spider. Treatment must be individually tailored. Proper treatment, reassurance, and rapid followup are helpful in reducing the cutaneous and psychologic discomfort associated with BRS bites.     

寻常型银屑病患者治疗前后外周血中单个核细胞Foxp3 mRNA水平的检测分析

目的观察寻常型银屑病患者外周血单个核细胞中Fopx3 mRNA转录水平,并分析其治疗前后的变化特点,为探讨CD4+CD25+调节性T细胞(CD4+CD25+Treg)与寻常型银屑病免疫学发病机制的关系打下一定基础。方法采用巢式-聚合酶链式反应(Nested-PCR)的方法,检测25例寻常型银屑病患者和10例正常对照组的外周血单个核细胞中Foxp3 mRNA的转录水平,并对其中15例患者进行治疗前后的比较。以银屑病面积和严重度指数(psoriasis area andseverity index,PASI)评价疗效,并分析疗效与Foxp3 mRNA的转录水平的特点。结果25例寻常型银屑病患者外周血单个核细胞中Foxp3 mRNA水平(1.87±0.90)显著低于10例正常对照组(3.83±1.04)(P<0.05)。进一步分析显示:其中15例患者采用三联法治疗后,外周血单个核细胞中Foxp3mRNA转录水平显著升高,当PASI的评分为(3.2±2.97)时尤其明显(2.5 4±1.02)。结论寻常型银屑病患者外周血单个核细胞Foxp3 mRNA转录水平显著低于正常人,治疗后外周血单个核细胞中Foxp3mRNA水平显著升高,提示:CD4+CD25+Treg与寻常型银屑病免疫学发病机制密切相关。     

A histopathologic study of arthropod bite reactions in 20 patients highlights relevant adnexal involvement

Background:  Insect bites produce diverse skin reactions. Although quite common, the histopathologic features of arthropod assaults have not ever been studied systemically.
Materials and methods:  Twenty biopsies from cases, clinically diagnosed as arthropod bite reactions between January 2003 and June 2007 were reviewed retrospectively. The aim of the study was to verify as to whether reliable histopathologic criteria could be established based on the frequency of findings observed.
Results:  Epidermal spongiosis (present in 16 of 20 cases), in particular spongiosis of the infundibular epithelium and acrosyringia as well as eosinophilic spongiosis, emerge as relevant diagnostic clues. A moderately dense, superficial and deep infiltrate consisting mainly of lymphocytes and eosinophils was prevalent in the dermis, with eosinophils tending to interstitial and periadnexal distribution. Of note, 19 of 20 (95%) cases revealed periadnexal involvement, whereas 16 of 20 (80%) had the infiltrate extending particularly along the sweat ducts and the coiled glands. In three biopsies, concomitant involvement of sweat glands, hair follicles and sebaceous glands was noted.
Conclusion:  A practical histopathologic algorithm of arthropod bite recognition is proposed. The involvement of the sweat glands in the pattern of arthropod bite reaction is suggested as a new reliable diagnostic clue.