Objective To evaluate the efficacy and safety of butyl flufenamate ointment for the treatment of solar dermatitis.Methods Sixty-four patients with solar dermatitis were randomly divided into the observation group (n =32) and control group (n =32) to topically apply butyl flufenamate ointment and diclofenac sodium cream,respectively,for 3 weeks.The efficacy was evaluated by lesion scores and a visual analog scale for pruritus.Results At the end of the treatment,4 patients in the observation group were clinically cured,19 markedly improved,17 improved,and 2 showed no improvement; meanwhile,2 patients in the control group were clinically cured,11 markedly improved,14 improved,and 5 showed no improvement.The total response rate was significantly higher (93.8％ vs.84.4％,P ＜ 0.05),while the pruritus score was significantly lower (P ＜ 0.05) in the observation group than in the control group.Conclusion Butyl flufenamate ointment is superior to dicofenac sodium cream in terms of both efficacy and anti-pruritic effect.

Objective To estimate the efficacy and safety of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) in the treatment of lichen sclerosus et atrophicus of the vulva.Methods An open and noncontrolled clinical study was performed.Forty-two patients were enrolled in this study and received ALA-PDT once every two weeks for 2 to 4 times.Follow-up visits were arranged at 2,4 and 8 weeks after initiation of treatment,and patients were evaluated at the baseline (before treatment) and all the follow-up time points for the efficacy and safety of treatment.Results Finally,38 patients completed the trial and 4 patients were lost to follow up.The total response rate was 81.6％ (31/38) at the end of the treatment.The average symptom and sign score in these patients was significantly lower at 2,4 and 8 weeks after initiation of treatment than that before treatment (17.6 ± 10.18,11.6 ± 8.35 and 7.6 ± 5.93 vs.29.3 ± 9.17,t =5.26,8.80,12.22,respectively,all P ＜ 0.01).A significant improvement was also observed in the other aspects,such as skin lesion area,hypopigmentation,erosion/rhagades and itching score at 2,4 and 8 weeks,as well as in skin atrophy at 8 weeks after initiation of treatment compared with those before treatment (all P ＜ 0.05).Local burning sensation was the main adverse reaction to ALA-PDT,and 16％ (6/38) of these patients complained of severe pain during the first treatment.Conclusion ALA-PDT shows favorable efficacy in patients with lichen sclerosus et atrophicus of the vulva with a rapid onset of action.

Objective To investigate the prevalence of and risk factors for glucocorticoid-induced diabetes mellitus (GDM) in patients with pemphigus or pemphigoid receiving glucocorticoid therapy.Methods This study included 68 hospitalized patients with pemphigus or pemphigoid receiving glucocorticoid therapy in the Institute of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College from December 2011 to January 2013.Comparisons were carried out between patients with GDM and those without regarding multiple parameters,including age,sex,body mass index (BMI),pathological type,initial dose and maximum daily dose of glucocorticoids,family history of diabetes mellitus,immunosuppressive treatment,etc.Independent samples t test was used for intergroup comparisons,Chi-square test and Fisher exact probability test for the analysis of count data,and a logistic regression model for the determination of risk factors.Results Among the 68 patients,26 (38.2％) developed GDM during glucocorticoid therapy.Univariate logistic regression analysis showed that the initial dose of glucocorticoids (P ＜ 0.05,OR 1.023,95％ CI 1.002-1.044),maximum daily dose of glucocorticoids(P ＜ 0.01,OR 1.037,95％ CI 1.013-1.062),duration of glucocorticoid treatment (P ＜ 0.05,OR 1.143,95％ CI 1.028-1.271),BMI (P ＜ 0.01,OR 1.265,95％ CI 1.080-1.481) and dexamethasone use (P ＜ 0.01,OR 6.0,95％ CI 1.887-19.076) were risk factors for GDM in these patients.Multivariate logistic regression analysis showed that BMI (P ＜ 0.05,OR 1.223,95％ CI 1.017-1.471) and maximum daily dose of glucocorticoids (P ＜ 0.05,OR 1.037,95％ CI 1.009-1.065) were independent risk factors for GDM.Conclusions In this study,38.2％ of the patients with pemphigus or pemphigoid developed GDM during glucocorticoid therapy.BMI and maximum daily dose of glucocorticoids seem to be independent risk factors for GDM.

Objective To compare three methods for the extraction of mycobacterial DNA.Methods Two commercial DNA extraction kits and an ordinary freeze-thawing method were used to extract DNA from the pure suspensions of three species of Mycobacteria (M.tuberculosis,M.leprae and M.smegmatis) at different densities (1 × 10 to 1 × 105 cells/ml),simulated clinical specimens containing different concentrations of mycobacterial cells (1 × 10 to 1 × 104 cells/ml).The purity and concentration of the extracted DNA were evaluated.Then,PCR was performed to amplify the 16S rRNA region of Mycobacteria.The performance of the three methods was compared by the purity and concentration of extracted DNA as well as the results of PCR.Further more,76 clinical skin specimens suspected to be infected with Mycobacteria were used to further validate the performance of these methods.Results All the extracted DNA samples could be detected by PCR.The highest purity of DNA was obtained by the kit A,followed sequentially by the freeze-thawing method and the kit B.When pure suspensions were used,the detection limit was consistently 1 × 102 cells/ml for all the three methods.With simulated specimens,the detection rate was consistently 100％ for all the three methods at the concentration of 1 × 103 cells/ml,60％ (12/20),55％ (11/20) and 55％ (11/20) for the kit A,kit B and freeze-thawing method respectively at the concentration of 1 × 102 cells/ml.The analysis of clinical specimens showed that the kit B could be used to extract DNA from paraffin-embedded specimens,with the detection rate similar to that of kit A and freeze-thawing method.Conclusions The kit A could rapidly yield high-quality genomic DNA of Mycobacteria by repeated cleaning of columns,and may serve as the optimal method for scientific and clinical studies,and the kit B is suitable for extracting mycobacterial DNA from fresh tissue specimens besides paraffin-embedded specimens.

Objective To evaluate the clinical efficacy and safety of two glycolic acid-containing liquid preparations for the treatment of facial acne vulgaris.Methods Sixty patients with mild to moderate acne vulgaris were included in a randomized,single-blinded,split-face,controlled study.The left and right sides of each patient's face were randomly assigned to the test group (treated with one hydroxy acid-containing liquid preparation) and control group (treated with the other hydroxy acid-containing liquid preparation).In total,all the patients were given four times of treatment at week 0,2,6 and 10 with the concentration of hydroxy acid in both preparations being 20％,35％,50％ and 70％,respectively.The number of inflammatory and noninflammatory acne lesions was counted,and the improvement in acne mark,scar and pores was evaluated by a 6-point grading scale before every treatment and 4 weeks after the last treatment.Results At 2,6,10,and 14 weeks after initiation of treatment,the clearance rate for inflammatory lesions was 20.4％,43.3％,66.9％ and 80.2％ respectively in the test group,21.6％,44.2％,68.1％ and 79.8％ respectively in the control group,while that for noninflammatory lesions was 18.5％,34.0％,41.3％ and 59.6％ respectively in the test group,17.8％,31.2％,44.9％ and 57.1％ respectively in the control group.The response rate was 80.0％ in the test group and 78.3％ in the control group at the end of the study.Adverse effects were observed in both groups,including temporary pain,erythema and formation of hoar frost,all of which well responded to symptomatic treatment.There were no significant differences in clinical efficacy or adverse effects between the two groups (both P ＞ 0.05).Conclusion Both of the hydroxy acid-containing preparations are effective and safe for mild to moderate acne vulgaris.

Objective To investigate the dermoscopic and confocal microscopic features of Riehl's melanosis,as well as their association with histopathological findings.Methods Ten patients with a previously established diagnosis of Riehl's melanosis were recruited.The lesions of the patients were observed using dermoscopy and in vivo confocal laser scanning microscopy (CLSM),followed by histopathologic analysis.Results On dermoscopy and CLSM,all the lesions showed the following features:pseudonetwork,liquefaction degeneration of the basal cell layer,and incontinence of pigment.Conclusion Both dermoscopy and in vivo CLSM can serve as noninvasive auxiliary diagnostic tools for Riehl's melanosis.

Objective To analyze causative factors for and therapeutic effect of total glucosides of paeony (TGP) on palmoplantar pustulosis (PPP).Methods Ninety patients with PPP were recruited in this study.A questionnaire survey was carried out to collect clinical data from these patients,and a patch test to identify contact allergens for these patients.All the patients were randomly divided into two groups:observation group treated with TGP capsule 0.6 g thrice a day,and control group treated with tripterygium glycosides tablets 20 mg thrice a day.Both groups topically applied mometasone furoate cream once a day.The efficacy and side effects were evaluated 4 and 8 weeks after initiation of treatment.Results Of the 90 patients,the ratio of male to female was 1 ∶ 1.64,smokers amounted to 42.22％,and 23 (26.67％) reported a history of infection before the onset of PPP.As the patch test showed,potassium dichromate and nickel sulfate were the most common contact allergens in these patients.The response rate was significantly higher in the observation group than in the control group after 4 weeks of treatment (64.44％ vs.40.00％,x2 =5.388,P ＜ 0.05),but similar between the two groups after 8 weeks of treatment (88.89％ vs.80.00％,x2 =1.353,P ＞ 0.05).No significant difference was observed in the occurrence of adverse reactions between the two groups (17.78％ vs.11.11％,x2 =0.809,P ＞ 0.05).Conclusions Smoking may play a certain role in the development of PPP,and infection seems to be a primary inducing factor.TGP combined with mometasone furoate cream is effective for the treatment of PPP.

Objective To evaluate the relationship between spectinomycin resistance in Neisseria gonorrhoeae and mutations in the rpsE gene.Methods Genomic DNA was extracted from 4 clinical isolates of Neisseria gonorrhoeae with different levels of spectinomycin resistance.Then,PCR was performed to amplify the entire rpsE gene and the spectinomycin resistance-determining region (SRDR) in the 16S rRNA gene followed by direct sequencing.Two spectinomycin-sensitive Neisseria gonorrhoeae strains were transformed with the genomic DNA containing the mutant rpsE gene.Subsequently,the susceptibility of the transformants to spectinomycin was determined,and PCR was performed to amplify the rpsE and 16S rRNA genes in the transformants followed by sequencing.Results All the 4 spectinomycin-resistant Neisseria gonorrhoeae strains harbored an A70C transversion in the rpsE gene,but no abnormality in the SRDR of the 16S rRNA gene.No mutations were detected in the spectinomycin-sensitive Neisseria gonorrhoeae strains.The A70C transversion in the rpsE gene was also detected in the two Neisseria gonorrhoeae transformants with spectinomycin resistance.Conclusion The A70C point mutation within the rpsE gene is associated with spectinomycin resistance in Neisseria gonorrhoeae.

Objective To measure the expression of hypoxia-inducible factor (HIF)-1α in acral malignant melanoma (MM) tissue and to investigate its relationship with the stem cell factor (SCF)/c-kit pathway.Methods Immunohistochemical staining was performed to measure the expression of HIF-1α in tissue specimens from lesions of 93 patients with acral MM,21 with non-acral MM,39 with acral melanocytic nevi,and from the normal acral skin of 15 healthy human controls.Meanwhile,the expression of c-kit was detected by immunohistochemical staining in the 93 acral MM tissue specimens.Statistical comparisons were carried out by chi-square test and Mann-Whitney U test.The relationship of HIF-1α expression with c-kit expression as well as tumor progression and staging was assessed by Spearman correlation analysis.Results Immunohistochemistry showed that the expression rate of HIF-1α was 87.10％ (81/93) in acral MM specimens,90.48％ (19/21) in non-acral MM specimens,15.38％ (6/39) in acral melanocytic nevus specimens,but 0 (0/15) in the normal acral skin specimens.The expression of HIF-1α was significantly higher in acral MM lesions than in normal acral skin and acral melanocytic nevus lesions (both P ＜ 0.01),and significantly different between acral MM and non-acral MM lesions (P ＜ 0.01).Moreover,HIF-1α expression was positively correlated with Clark level and Breslow depth of melanoma (rs =0.442,0.368,respectively,both P ＜ 0.01),with the progression of acral MM (from in situ to aggressive and metastatic MM) (rs =0.420,P ＜ 0.01),and with the expression of c-kit (rs =0.307,P ＜ 0.01).Conclusions HIF-1α is highly expressed in acral MM,positively correlated with the staging,progression and aggression of MM,and co-expressed with c-kit in acral MM tissue,suggesting that both HIF-1α and c-kit take part in the pathogenesis of acral MM.

Objective To evaluate the effects of tumor-associated macrophages on the proliferation,invasion and migration of human cutaneous malignant melanoma cells.Methods Cultured U937 human monocytic cells at logarithmic phase were classified into three groups to be pretreated with phorbol ester for 48 hours followed by 48-hour activation by phorbol ester (M polarization),lipopolysaccharide (LPS) at 25 mg/L (M1 polarization),and interleukin (IL)-4 at 15 μg/L (M2 polarization) respectively.Then,enzyme-linked immunosorbent assay (ELISA) was performed to determine the levels of IL-12p70 and IL-10 in the supernatant of these activated cells.A375 human malignant melanoma cells were divided into four groups to be cultured alone or with M-,M1-and M2-polarized macrophages respectively.After additional culture for different durations (24,48 and 72 hours),methyl thiazolyl tetrazolium (MTT) assay was conducted to estimate the proliferative activity,and Transwell assay to evaluate the invasion and migration activity,of the A375 cells.Results The proliferation of A375 cells was accelerated by coculture with M-and M2-polarized macrophages,but inhibited by that with M1-polarized macrophages,with significant differences among the four groups in the proliferative activity at 48 and 72 hours (all P ＜ 0.05),but not at 24 hours (P ＞ 0.05).Invasion assay showed that the number of A375 cells that migrated through Transwell chambers was significantly larger in M2 and M groups (147.00 ± 7.92 and 113.22 ± 8.15 respectively),but smaller in the M1 group (56.44 ± 7.55),than in the control group (84.11 ± 6.07,all P ＜ 0.05).Similarly,migration assay revealed a significant increase in the number of A375 cells that migrated through Transwell chambers in the M2 and M(p) groups (198.33 ± 8.22 and 156.00 ± 8.83 respectively),but a significant decrease in the M1 group (97.11 ± 6.75) as compared with the control group (123.89 ± 7.01,all P＜ 0.05).Conclusions The proliferation,invasion and migration of A375 cells can be accelerated by IL-4-activated M2-polarized macrophages,but decelerated by LPS-activated M1-polarized macrophages.Phorbol ester tends to induce monocytic cells to differentiate into M2-polarized macrophages.