Objective To treat a group of patients with port wine stains (PWS) using a variable pulse width (VPW) frequency doubled Nd:YAG 532nm with high energy long pulse green (HELP G) laser and to evaluate the clinical efficacy, side effects and different histological changes between VPW and HELP G. Methods Thirty two patients with PWS were treated in order to study the clinical improvement by transforming from 11～16 J/cm 2 at 3 mm spot size (VPW,7～10 ms) gradually to 16～24 J/cm 2 at 4～5 mm spot size (HELP G,15～50 ms). Two patients were biopsied before and after the laser treatment.Results After treatment of 1～8 times(3.19 average), very good results were achieved in 7 PWS, and excellent results were achieved in 15 PWS.Improvement was found in 68.75 % of the patients.Conclusion VPW with HELP G laser at 532 nm appears to be an effective treatment for PWS.

Objective To analyse the possible risk factors associated with the progression of vitiligo.Methods A questionnaire survey was carried out to collect the clinical data on 1088 patients with vitiligo.The relationship between possible inducements to the progression of vitiligo and lesion area was statistically analyzed in patients with the same clinical course of vitiligo. Paired t test was performed to compare the mean area index of involvement between patients with inducements and those without Results A significant difference was observed in the mean area index of involvement between patients with isomorphic response and those without (t = 6.770, P ＜ 0.01 ) as well as between patients negatively affected by psychiatric factors and those unaffected (t = 6.704, P ＜ 0.01 ), but not between patients with family history and those without (t = 1.499,P ＞ 0.05). Conclusion A rapid progression of vitiligo is more likely to be observed in patients negatively affected by psychiatric factors and patients with isomorphic response.

Objective To investigate the relationship between the efficacy of autologous epidermal grafting and the levels of epidermal cytokines in vitiligo. Methods A total of 57 patients with stable vitiligo receiving autologous epidermal grafting were included in this study. Before grafting, 17 patients were irradiated with narrow-band UVB on vitiliginous sites. Suction blister fluid was collected from the recipient site (vitiligous lesions) and donor site (normal skin) in these patients (including the 17 patients irradiated with NB-UVB). ELISA was used to detect the levels of endothelin-1 (ET-1 ) and stem cell factors (SCF) in suction blister fluid. Clinical efficacy was evaluated through a 3-month follow-up. Resttlts Among these 57 patients, 45 successfully responded to autologous epidermal grafting. In these 45 patients, the levels of ET-1 and SCF in vitiligous lesions were 728.97±286.12 ng/L and 329.97±114.13 ng/L respectively, significantly higher than those in nomal skin (503.16±251.44 ng/L, 224.73±107.91 ng/L, t = 5.443, 5.897, respectively, both P < 0.05 ). In those who responded poorly, significant difference was also observed in the level of SCF between the normal skin and vitiligous lesions (309.00±163.89 ng/L vs 204.22±83.25 ng/L, t = 3.03, P < 0.05), but not in the level of ET-1. Increased level of ET-1 was observed in both vitiligous lesions and normal skin of patients who responded well compared to those who responded poorly, while no difference was noticed in the level of SCF between these two groups of patients. The level of ET-1 was statistically higher in vitiligous lesions in patients exposed to NB-UVB than in those without exposure (t = 1.44, P > 0.05). In those patients who responded successfully, the level of ET-1 was lower in the 15 patients exposed to NB-UVB compared to the other 30 patients without exposure (548.48±230.22 ng/L vs 794.60±278.72 ng/L, P<0.05); no significant difference in the level of SCF was noted. Conclusions ET-1 and SCF may both play important roles in the repigmentation of vitiligo, with ET-1 exerting a more important role.

Objective To determine the clinical features of childhood vitiligo in Han nationality.Methods A standardized questionnaire was used to clinically investigate 396 cases of vitiligo in patients aged less than 12 years;825 adult patients with vitiligo served as controls.Data analysis was done by SPSS 10.0.Results In child patients with vitiligo,46.2% were males,and 53.8%females;there was no statistically significant difference in gender ratio between the childhood and adult groups(P＜0.05).The incidence of segmental vitiligo was 33.3%in children,significantly higher than that in adult patients(13.5%).On the contrary,the incidence of generalized vitiligo was significantly lower in children han in adult patients(4.3%vs 11.6%).A family history of vitiligo was observed in 12.4%of children,and in 12.7% of adults,withoutsignificant difference between the two groups.For both childhood and adult vitiligo patients,the incidence of vitiligo was significantly higher in firSt-degree relatives than in second-degree relatives.The most common precipitating factor of childhood vitiligo was trauma.The incidence of halo nevi was higher in patients with childhood vitiligo compared to patients with adult vitiligo,while thyroid disease was seen more frequently in adult patients.Conclusion There are some differences in clinical characteristics of vitiligo between children and adults.

Objective To observe the curative effect of narrow-band ultraviolet(NB-UVB)on stable vitiligo with autologous epidermis grafting.Methods A total of 82 patients with stable vitiligo were recruited and randomly divided into a control group and a treatment group.The patients in the treatment group were pretreated with NB-UVB before autologous epidermis grafting,while those in the control group were not.The pretreatment with NB-UVB was implemented twice a week for at least 4 weeks before the autologous epidermis grafting. A 3-month follow-up observation was conducted with regard to the effectiveness. Results Pretreatment with NB-UVB could significantly increase the survival rate of skin grafts and rate of repigment of leukoplakia,when compared with autologous epidermises transplantation alone.The rate of complete repigment raised significantly(P＜0.05),and so did the curative effect for vulgaris generalized vitiligo(P＜0.029).It was found that the curative effect on vitiligo was closely related to the frequency of NB-UVB radiation,location of leukoplakia,color of skin,and the time of repigment appearance. ConclusiOn Pretreatment with NB-UVB can significantly improve curative effect of autologous epidermis grafting on vitiligo.

Objective To assess the efficacy and safety of 308-nm excimer laser combined with topical tacrolimus 0.03％ cream for the treatment of childhood vitiligo on the face or neck.Methods Sixty-eight children aged ＜ or =14 years with vitiligo on the face or neck were enrolled in this study,and divided into two groups based on lesional sites,i.e.,skin group with lesions on the forehead,cheek,lower mandible,neck or in the periortic region and mucosa group with lesions in the perioral or periorbital region.All the patients received 308-nm excimer laser irradiation once or twice weekly and topical tacrolimus 0.03％ cream twice daily.Twenty sessions of irradiation served as a treatment course.Efficacy was evaluated at the end of the treatment course.The effects of erythema reaction and cumulative irradiation dose on efficacy were assessed.Results After 20 times of laser therapy,an excellent response was achieved in 78.4％ of the patients in the skin group,and 54.8％ in the mucosa group (P ＜ 0.05).During the treatment,the average frequency of erythema reaction lasting 48 hours or longer was significantly lower in the skin group than in the mucosa group (5.84 vs.9.12,P ＜ 0.01).After 10 and 20 times of laser therapy,the cumulative radiation dose was 4215 mJ/cm2 and 10 453 mJ/cm2 in the skin group,respectively,compared to 3364 mJ/cm2 and 7430 mJ/cm2 in the mucosa group,respectively (both P ＜ 0.01).Conclusions The 308-nm excimer laser combined with topical tacrolimus cream is effective and safe for the treatment of childhood vitiligo on the face or neck.Vitiligo on the forehead,cheek,lower mandible,neck and in the periortic region appears to respond better to this therapy with a weaker erythema reaction than that in the perioral or periorbital region.

Objective To evaluate the performance of the hypersensitive C-reactive protein(hs-CRP) rapid quantitative chemilu-minescent detection kit .Methods According to National Committee for Clinical Laboratory Standards (NCCLS) EP10-A2 docu-ment ,hs-CRP rapid quantitative chemiluminescent detection kit was employed to measure the CRP at low ,medium and high con-centration levels of quality control serum .Bias ,total imprecision and their slope rates ,intercepts ,carryover ,non-linearity and drift were calculated ,and its clinical acceptability was evaluated .Results Bias and total imprecision of hs-CRP rapid quantitative chemi-luminescent detection kit were within the allowable ranges ,the average values of slope rates ,intercepts ,carryover ,non-linearity and drift were 1 .005 7 ,0 .537 8 ,0 .789 6% ,0 .019 2 ,0 .036 0 ,respectively ,the differences showed no statistically significance ( P>0 .05) .Conclusion hs-CRP rapid quantitative chemiluminescent detection kit has good accuracy and precision ,stable perform-ance ,and consistent with the clinical testing requirements .

A 27-year-old man presented with a 3-year history of persistent asymptomatic papules on the left chest and axirlary fossa. Multiple skin biopsies were performed and histopathology revealed mild acanthosis, extension of the dermal papilla, lichenoid lymphoid infiltrates in upper dermis. Some lymphoid cells migrated into the epidermis and formed Pautrier's microabscesses. Immunohistochemistry revealed that the infiltrating cells were positive for LCA, CD45RO, CD3, CD4 and CD8 (scattered), but negative for CD68 or CD30. Cutaneous laser confocal microscopy showed the shadow of scattered, oval or round, slightly refractive cells measuring 4-8 pm in diameter. A diagnosis of papular mycosis fungoides was made. The papules were softened with the lightening of lesional color after treatment with narrow-band ultraviolet B, topical fluticasone propionate cream and isotretinoin gel.

Objective To explore the effect of doctor-patient interaction based on information platform on hypertensive patients' self-efficacy and treatment compliance in community. Methods A convenience sampling method was used, and 280 patients with hypertension in Huaxin community health service centre were included. Patients were divided into interactive group (89 cases) and control group (191 cases) according to their wishes. Control group received a regular follow-up at community clinics, while interactive group participated in the doctor-patient interaction based on information platform at the same time of regular community clinic visit for 3 months. All patients were investigated using Self-efficacy Assessment Scale for Hypertensives and Treatment Compliance Questionnaire before and after intervention, which was used for effectiveness analysis. Results Before intervention, two groups showed no significant difference in self-efficacy (t=1.635,P>0.05), but there was significant difference in treatment compliance [interactive group:8.00(5.00) vs. control group:10.00(3.00)] (Z=4.409,P<0.05). After the intervention, two groups showed no significant difference in treatment compliance (Z=0.784,P>0.05), but there was significant difference in self-efficacy (interactive group:34.42 ± 4.49 vs. control group:32.63 ± 5.53) (t=2.867, P<0.01), which in interactive group was higher. Before and after the intervention, self-efficacy and the treatment compliance had significantly increased in interactive group (P<0.05). while not significantlyincreased in control group (P>0.05). Before intervention, there was a significant positive correlation between the total score of self-efficacy and treatment compliance(r=0.500, P<0.001), drug therapy compliance (r=0.327, P<0.001) and Non-drug treatment compliance (r=0.469, P<0.001) in two groups, while there was lower positive correlation after intervention. Conclusion The doctor-patient interaction project of community hypertension supervision based on informatization platform is effective on the improvement of self-efficacy and the treatment compliance through the enhanced doctor-patient communication, particularly in promoting the role of self-efficacy to accelerate the improvement of health behaviors, compliance behavior and treatment compliance.

ObjectiveTo evaluate the effect of large-spot and low-energy Q switched Nd:YAG laser on melasma,and to observe the changes of melasma lesions with confocal laser scanning microscopy (CLSM) before and after the laser treatment.MethodsTotally,45 patients aged from 24 to 48 years and diagnosed with facial melasma were included in this study,and treated with large-spot and low-energy Q switched Nd:YAG once a week for 10 or more sessions.CLSM was used to estimate the melanin content in melasma lesions before each irradiation and after the last irradiation.ResultsAmong the 45 patients,8 ( 17.78％ ) were nearly cured,25 (55.56％) markedly improved,11 (24.44％) improved,and only 1 (2.22％) unimproved after the laser irradiation.The total response rate was 73.33％.As CLSM showed,there was an increment in melanin granules in melasma lesions compared with the normal skin surrounding melasma lesions,but a reduction in melanin granules was induced by the laser treatment in melasma lesions.ConclusionsLarge-spot and lowenergy Q switched Nd∶YAG laser is substantially effective and highly safe for the treatment of melasma,and CLSM can be used to evaluate the therapeutic effect of laser on melasma.