Management of resistant halo nevi

Background: Halo nevus (HN) is a rare dermatologic disorder characterized by typical whitish rim surrounding an existing melanocytic nevus resembling halo. It is a cosmetic problem that may be linked to vitiligo, and it is advised to remove these nevi in order to avoid development of vitiligo.

Objectives: The aim of the present study is to evaluate the cosmetic outcome after nevus removal and leukoderma dermabrasion with epithelial graft followed by narrow-band ultraviolet B (NB-UVB) phototherapy as management of resistant halo nevi and avoidance of development of vitiligo.

Patients and Methods: Ten patients with persisting halo nevi were selected as candidates in this study. Superficial dermabrasion was carried out using proper diamond fraises on depigmented rim and then punch biopsy probes with suitable size were used to harvest the nevus. Thiersch graft was prepared and applied on the dermabraded depigmented area. After 1 week of the procedure, patients were exposed to NB-UVB twice weekly and were followed up for 3 months.

Results: Repigmentation was noticed in 2 weeks and was nearly fully accomplished in all 10 patients within the 3-month period. No other vitiligo lesions developed during this period in all patients except for one case.

Conclusion: Excision of Sutton’s nevus with combined dermabrasion and Thiersch grafting followed by phototherapy is a good aesthetic maneuver in treating halo nevi and helps in avoiding further vitiligo depigmentation.     

T-cell receptor gene rearrangement in T-cell large granular leukocyte leukemia: preferential V alpha but diverse J alpha usage in one of five patients

T-gamma lymphoproliferative disease (T-gamma LPD) is a chronic disorder of mature T cells that is associated with neutropenia and autoimmune phenomena. Although the progression of the lymphoproliferation is indolent, it is often associated with a monoclonal proliferation of T- cell-type large granular lymphocytes (LGL) that manifest multiple in vitro suppressor and cytotoxic activities. We considered the possibility that the granulocytopenia or anemia might represent an autoimmune disorder mediated by the monoclonal LGL via T-cell receptor (TCR) recognition of an antigen involved in hematopoiesis. Therefore, in an effort to characterize the usage of the TCR alpha- and beta-chain genes in patients with T-gamma LPD, we cloned and sequenced TCR alpha- and beta-chain mRNAs derived from the T-cell type LGL of five patients. The five patients studied did not use a common V alpha nor a common J alpha segment. However, an unusual finding was observed in one of the patients where the occurrence of a single variable-diversity-junctional (VDJ) rearrangement of the beta chain confirmed the monoclonal origin of the LGL proliferation. In accord with this evidence for monoclonality, many of the cells studied used a common V alpha (V alpha 19.1). In contrast to this common V alpha usage, there was a marked diversity of the J alpha segments and N-region addition that were associated with the V alpha 19.1 segment. This pattern of common V alpha usage associated with different N and J alpha segments suggests an immune-mediated selection process affecting the TCR alpha chain occurring after the transformation event that established the clone. We suggest that the T-cell-type LGL malignant clone might have developed autoreactivity conferred by the selected TCR alpha chain and that this autoreactivity might be implicated in this patient's anemia.     

睡眠个人信念与态度的调查分析

目的:分析失眠者与非失眠者关于睡眠的信念与态度看法的差异,识别失眠者错误的睡眠认知.方法:对35名失眠患者(失眠组)进行睡眠个人信念与态度量表(DBAS)及匹兹堡睡眠质量指数(PSQI)测评,对39名健康受试者(非失眠组)进行睡眠个人信念与态度量表测评.结果:非失眠组DBAS总分(87.97±7.88)分高于失眠组(85.06±11.19)分,但差异没有显著性(t=-1.419,P>0.05);对量表的5个组成部分进行两组之间的比较.差异均有显著性(P<0.05),其中失眠组在对控制和预测睡眠的能力评价和对失眠后果的估计比非失眠组差:从各个条目的均数来看,失眠组比非失眠组存在更多的错误认知;失眠组DBAS总分与PSQI等因素的相关分析均无统计学意义(P>0.05).结论:失眠组比非失眠组存在更多的错误信念与态度,这些错误的信念与态度主要为对控制和预测睡眠的能力评价和对失眠后果的评估两方面.     

异补骨脂素对小鼠胚胎前成骨细胞TGF-β受体影响的实验研究

目的:探讨经不同浓度异补骨脂素干预对小鼠胚胎前成骨细胞(MC3T3-E1)增殖、Ⅰ型骨胶原的表达、TGF-βⅠ、Ⅱ型受体的影响以及与原发性骨质疏松症的关系。方法:细胞分为正常对照组与不同浓度异补骨脂素组。各组细胞采用MTT方法检测MC3T3-E1细胞增殖情况,天狼星红染色法测定Ⅰ型骨胶原的表达,荧光素酶报告基因检测TGF-β1通路活性以及Western-Blot法检测TGF-βⅠ、Ⅱ型受体的表达。结果:经不同浓度异补骨脂素刺激,可明显促进MC3T3-E1细胞增殖(P<0.05);Ⅰ型胶原表达逐渐增强;荧光素酶报告基因检测显示TGF-β1通路活性明显增强;Western-Blot结果显示TGF-βⅠ、Ⅱ型受体表达明显增强。结论:异补骨脂素可促进小鼠胚胎前成骨细胞的增殖及Ⅰ型骨胶原表达,对原发性骨质疏松症具有治疗作用。其作用机制可能是通过激活TGF-β信号通路而发挥抗骨质疏松作用。     

生活方式改善对预防糖尿病的重要作用

营养过剩、肥胖．缺少运动是糖尿病发病的重要原因。本文针对这些原因阐述了防止肥胖、控制饮食和增加运动等生活方式的改善对预防糖尿病的重要作用。     

脑卒中患者医院感染的临床分析及预防对策

在我国大规模人群调查显示，脑卒中年发病率为109．7～217/10万，且随年龄而增长，脑卒中患者为医院感染的高危人群，其感染发生率明显高于其他疾病。为了解脑卒中患者的医院感染危险因素，预防和控制医院感染的发生，现对海安肿瘤医院院收治的396例脑卒中患者病历资料进行调查，分析脑卒中患者医院感染的危险因素和特点，为有效控制院内感染提供依据。     

急性阑尾炎多层螺旋CT扫描征象与血清炎性标志物的相关性研究

目的探讨急性阑尾炎多层螺旋CT征象与血清炎性标志物的关系。方法收集2012年1月至2013年12月于同济大学附属杨浦医院经手术病理证实的具有完整临床及影像资料的急性阑尾炎患者66例,对所有患者的急性阑尾病变程度行CT分级,分析其与患者白细胞(WBC)计数、中性粒细胞百分比(NEUT%)及血清C反应蛋白(CRP)水平的相关性。结果急性阑尾炎CT分级与患者WBC计数与CRP水平呈正相关(P0.05),穿孔性阑尾炎患者NEUT%及CRP水平明显高于其他患者。CRP水平与阑尾直径、阑尾积液、回盲部变化、阑尾周围炎性条纹、小肠积液呈正相关(P0.05),WBC计数与回盲部变化及阑尾周围炎性条纹呈正相关(P0.05)。结论WBC计数及CRP水平与急性阑尾炎CT分级有关,CRP对急性阑尾炎的诊断及其严重程度的判断更有优势;CRP、NEUT%是穿孔性阑尾炎的重要预测因子,WBC可以更好地发现早期阑尾周围的炎性反应,综合分析CT表现与血清炎性标志物能更准确地诊断急性阑尾炎。