挪威疥1例

<正>患者女,75岁。因全身痒性红色皮疹、结痂2月余来诊。2月前患者躯干四肢出现红色斑疹、丘疹,伴明显瘙痒,夜间为重。患者因脑梗死、老年痴呆平素住在养老院,当地医院按     

浅谈临床医学院医学教育研究的开展

随着中国教育的改革和发展，临床医学教育研究越来越受到医学院校和临床教师的重视，本文阐述了开展医学教育研究的重要性，对如何开展和实施医学教育研究进行探讨，最后分析了影响医学教育研究成果产生的一些因素。     

芳维A酸氨丁三醇对HaCaT细胞环氧化酶-2 mRNA表达的影响

目的:观察第三代维A酸药物芳维A酸氨丁三醇(代号FY-10)对人角质形成细胞环氧化酶-2表达的影响。方法:通过体外培养HaCaT细胞,脂多糖(LPS)诱导环氧化酶-2(COX-2)mRNA表达,再以芳维A酸氨丁三醇处理细胞后,采用RT-PCR的方法检测COX-2表达水平的变化。结果:(1)以10μg/L终浓度LPS作用细胞2h后,细胞COX-2 mRNA表达明显高于作用前(x-±s分别为0.779±0.099和1.033±0.207,t值为6.083,P=0.00012)。(2)在加入LPS的同时加入芳维A酸氨丁三醇可以明显降低COX-2 mRNA的表达,二者的x-±s分别为1.161±0.130和0.849±0.056,(t值为5.398,P<0.01)。(3)芳维A酸氨丁三醇的作用呈浓度依赖性,以1×10-6mol/L作用最强。结论:芳维A酸氨丁三醇对人角质形成细胞的环氧化酶-2有肯定的抑制作用,为其治疗以炎症细胞浸润为表现的银屑病提供了理论基础。     

维A酸对角质形成细胞的细胞周期及CDK_4表达的影响

目的观察维A酸对角质形成细胞的细胞周期及周期蛋白依赖激酶4(CDK4)表达的影响。方法将体外培养的角质形成细胞在不同浓度芳维A酸氨丁三醇及依曲替酸下作用4天后,倒置显微镜下观察细胞生长状况,流式细胞仪检测细胞周期,Western blot法检测CDK4蛋白表达水平。结果药物作用后的细胞生长受到阻滞,G1期细胞所占比率随药物浓度升高而增加,芳维A酸氨丁三醇G1期周期阻滞作用强于依曲替酸,CDK4表达水平随药物浓度升高而降低。结论维A酸可通过影响角质形成细胞的细胞周期来降低细胞增殖,过程中伴随着CDK4表达水平的改变,这种作用的强弱与药物结构及浓度相关。     

Effects of α-melanocyte-stimulating hormone on the production of TNF-α and IL-10 by peripheral blood mononuclear cells from patients with psoriasis

Objective To investigate the effects of alpha-melanocyte-stimulating hormone (alpha-MSH) on the production of tumor necrosis factor-alpha (TNF-alpha) and intedeukin-10 (IL-10) by peri-pheral blood monohuclear cells (PBMCs) from patients with psoriasis vulgaris. Methods Heparinized peri-pheral blood was obtained from 20 patients with psoriasis vulgaris and 10 healthy human controls. PBMCs were isolated, cultured in complete medium, and stimulated with phytohemagglutinin (PHA) alone, the com-bination of PHA and various concentrations of alpha-MSH, or nothing. After another 48-hour culture, ELISA and real-time PCR were performed to measure the secretion levels of TNF-alpha and IL-10 in the super-natants of cultured PBMCs as well as the mRNA expression levels of TNF-alpha and IL-10 in PBMCs. Results The secretion level of TNF-alpha in the supematants of patient-derived PBMCs stimulated by nothing or PHA alone was significantly higher than that from normal control-derived PBMCs (329.87 ± 99.33 ng/L vs 116.95 ± 37.15 ng/L, 1756.01 ± 183.60 ng/L vs 1287.30 ± 152.36 ng/L, both P<0.01). alpha-MSH of all tested concentrations (10-13, 10-11, 10-7,mol/L) could inhibit the secretion of TNF-alpha by PBMCs com-pared with PHA alone (all P < 0.01), and the maximum effective concentration was 10-13 mol/L. On the con-Wary, a significant decrease was observed in the secretion level of IL-10 in the supematants of patient-derived PBMCs stimulated by nothing or PHA alone compared with normal control-derived PBMCs (P <0.05 or 0.01). Moreover, the secretion of IL-10 by PBMCs was promoted by alpha-MSH of all tested con-centrations (P < 0.01 or 0.05), with the maximum effective concentration being 10-13 mol/L (P < 0.01). The alpha-MSH of 10-13 mol/L down-regulated the mRNA expression of TNF-alpha (P < 0.001), but up-regnlated that of IL-10 (P < 0.001) in PHA-stimulated PBMCs from patients. Conclusion alpha-MSH can regulate the production of TNF-alpha and IL-10 by PHA-stimulated PBMCs from patients with psoriasis vulgaris.     

以痤疮样疹为表现的药物反应1例

患者男,59岁。因胆管肿瘤术后2个月,而部、颈部红色丘疹10d,于2006年4月来我科就诊。患者2个月前因“胆总管下段占位”行手术治疗,随后曾应用吉西他滨、表阿霉素、伊立替康（喜树碱）等化疗。发疹前10d开始应用．与西他滨、阿瓦斯汀埃罗替尼（avastin）和口服埃罗替尼（erlotinib,tarceva）150mg/d联合化疗方案：服用埃罗替尼3d后上胸部、颈部及面部出现丘疹。逐渐增多．第10d时头而部皮损明显加重,有刺痛,鼻翼两侧有暗红色液体渗出,遂停用化疗药而就诊。既往体健,否认有药物、食物过敏史．[第一段]     

Sweet综合征伴鞘膜积液及附睾炎

报告1例Sweet综合征伴鞘膜积液、附睾炎。患者男,52岁。1周前头部、颈部、胸部出现红色丘疹、斑块,部分损害表面呈水疱样,左侧阴囊肿大,伴发热5d。皮损组织病理检查示：真皮浅层及乳头高度水肿,密集中性粒细胞浸润。阴囊B超示：双侧鞘膜腔积液,左侧附睾增大。给予泼尼松治疗2周后皮损消退,鞘膜积液明显改善。     

卡瑞利珠单抗治疗肺癌引起反应性毛细血管瘤1例

<正>患者男，58岁。因躯干散在红色丘疹5个月，右眉结节2周，于2019年5月12日来海军军医大学第一附属医院皮肤科就诊。患者5个月前因肺癌输注卡瑞利珠单抗后出现躯干红色丘疹，4个月前再次使用，丘疹逐渐增多，泛发至面部、躯干、四肢、手掌和臀部等，2周前右眉部出现结节，易出血，无痛痒。既往史：患者2018年诊断为左肺鳞癌Ⅳa期。家族史：父母体健，家族中无类似疾病患者。     

银屑病常用生物制剂诱导的矛盾性反应研究进展

目前治疗银屑病生物制剂主要包括TNF-α抑制剂、IL-12/23抑制剂、IL-23抑制剂和IL-17抑制剂等，在治疗银屑病、类风湿性关节炎、炎症性肠病等适应症的过程中可能出现或者加重其他适应症的表现，即矛盾性反应。本文对国内外银屑病常用生物制剂诱导的主要矛盾性反应进行了归纳总结，为临床医生更合理应用生物制剂、规范处理诱导的矛盾性反应提供依据。