Atopic dermatitis (AD) is an inflammatory skin disease closely related to impairment of skin barrier function.Hereditary factors,life style and exposure to the environment all contribute to the occurrence of AD.Even though AD occurs mostly in infants,sometimes it may initially occur in adults,which is called adult-onset AD (AOAD).There are evident differences in types,immunological mechanisms and association with other diseases between childhood AD and AOAD.The lesional distribution of AOAD is similar to that of childhood AD,while AOAD is characterized by subacute and chronic dermatitis,and mainly manifests as dry hypertrophic lesions rarely complicated with exudation.Th1/Th2 imbalance and hyperfunction of antigen-presenting cells are immunological basis of AD occurrence.Moreover,FLG gene mutations are associated with the occurrence of AD.Acquired expression defect in the FLG gene induced by elevated levels of interleukin-13 (IL-13) only occurs in adults,suggesting that AOAD is different from AD that initially occurs during infancy and continues into adulthood.Infection,changes of bacterial flora in the skin and intestinal tract,and smoking are all important causative factors of AOAD,thus enquiries about histories of related diseases and smoking are helpful for the diagnosis of AOAD.

Objective To investigate the prevalence of psoriatic arthritis (PsA) in patients with psoriasis and its clinical features.Methods A cross-sectional study was conducted among patients diagnosed with psoriasis from January 2014 to January 2015.Through a questionnaire survey,the diagnosis of PsA was confirmed according to the Classification Criteria for Psoriatic Arthritis (CASPAR) in patients with suspected PsA.Clinical data were collected from patients with newly and previously diagnosed PsA.Statistical analysis was carried out by t test for two-group comparisons,one-way analysis of variance (ANOVA) for multi-group comparisons,and chi-square test for comparisons of rates.All the statistical tests were two-sided.Results Totally,1 062 outpatients with psoriasis were enrolled into this study,and 125 were suspected to have PsA.According to the CASPAR,70 (6.59％) patients were finally diagnosed with PsA,with the ratio of male to female being 2.1 ∶ 1,and 45 of them (64.29％) were newly diagnosed.Psoriasis vulgaris lesions were observed in 50 (71.43％) patients with PsA,and were the most common type of skin lesions in patients with PsA.There were 5 clinical types of PsA in these patients,including asymmetrical oligoarthritis (23 cases,32.86％),symmetric polyarthritis (19 cases,27.14％),distal interphalangeal predominant arthritis (10 cases,14.29％),vertebral or sacroiliac arthropathy (7 cases,10.00％),and arthritis mutilans (11 cases,15.71％),with some overlap among these clinical types.As relatively distinctive manifestations of PsA,dactylitis and enthesitis were observed in 14 (20.00％) and 8 cases (11.43％) respectively.In addition,43 (61.43％) cases had nail involvements.Conclusion To master clinical features of PsA and to diagnose it early are of great significance for long-term prognosis of PsA patients.

Objective To investigate the clinical features of and GJB2 gene mutations in a Chinese Han patient with keratitis-ichthyosis-deafness syndrome (KID syndrome),in hope to offer evidence for the clinical and genetic diagnosis of KID syndrome.Methods Clinical data were collected from a patient with KID syndrome.DNA was extracted from peripheral blood of the patient and his two family members (mother and brother).PCR was performed to amplify the exon 2 and its flanking splicing sites of GJB2 gene followed by bidirectional direct DNA sequencing. Results The patient presented with the typical triad of vascularizing keratitis,ichthyosis and congenital deafness.A G148A mutation in the exon 2 of GJB2 gene,resulting in the substitution of aspartic acid by asparagine at position 50 of the junction protein connexin 26 (Cx26),was identified in the patient,but not in either of his family members.Conclusion The G148A mutation in GJB2 gene may be responsible for the clinical phenotype of KID syndrome in this Chinese patient.

Objective To assess the clinical efficacy and safety of fire needling therapy for vitiligo. Method A self-control study was carried out. Fifty-six vitiligo patients with 124 skin lesions were allocated by long-axis random to two groups. The treatment group received fire needling therapy weekly for 12 times or until cure and the control group, no treatment as a blank control. The clinical efficacy and safety were assessed after the completion of treatment. Result The total efficacy rate of local fire needling therapy for vitiligo skin lesions was 79.8% and there was a statistically significant difference as compared with the control group (P<0.05). The therapeutic effect was better in patients with faciocervical skin lesions or short course of disease. The therapeutic effect increased with an increase in the course of treatment at the early stage of treatment but did not significantly increase after 8 weeks of treatment. Main adverse reactions were mild pain and skin infection. Conclusion Local fire needling has a definite therapeutic effect on vitiligo with high safety.

Objective To evaluate the activation patterns in the cortexes of expressive aphasics after stroke so as to explore the pathogenic mechanism of expressive aphasia.Methods Blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) was the method of choice.It was administered to 9 subjects with expressive aphasia at 1 to 3 months post-stroke onset and to 10 healthy controls.Active areas in the patients' brains were observed using a block-designed picture-naming task,and language function was tested with the China Rehabilitation Research Center's aphasia examination (CRRCAE).The control group received BOLD-fMRI only.SPM8 software was used to process the fMRI data.Results Differences were observed in the mapping of activated areas between the two groups,but many activated areas showed no difference.Significant differences in activation were observed in areas associated with vision,language and cognition,including the bilateral inferior frontal gyrus,the bilateral superior temporal gyrus,the bilateral insula,the bilateral basal ganglia,the left superior frontal gyrus,the left middle frontal gyrus,the left precentral gyrus,the left thalamus,and the left middle temporal gyrus.All the patients had activated cortex regions associated with visual processing in the left and/or right hemisphere,such as the middle frontal gyrus,the middle temporal gyrus,the lingual gyrus and the fusiform gyrus.The activation volumes in the left hemisphere were significantly smaller than those in normal adults.Regions related to language such as the left inferior frontal gyrus (Broca's area),the left middle frontal gyrus,and the right inferior frontal gyrus (the mirror region of Broca's area) were activated in some of them.While the activation frequency,activated volume and activation intensity generally were all less in the patients than in the controls,the activation intensity in the right superior temporal gyrus,the bilateral superior parietal lobule and the left inferior temporal gyrus were stronger.Conclusions Language production may be associated with multiple,interconnected regions.The right hemisphere participates in natural language processing.Aphasia damages both linguistic and cognitive areas,reducing activation in Broca's aphasia.Activation areas in the left hemisphere and the right inferior frontal gyrus decrease significantly,while some regions in the right hemisphere are relatively more activated.The right inferior frontal gyrus may play a different role in language recovery at different periods of aphasia after stroke.

Objective To screen the factors that affect severity of language disorder in subcortex aphasia, and analyze its characteristics and therapeutic effect. Methods 10 moderate degree and 12 severe degree subcortex aphasics were evaluated with Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE) and the Boston Diagnostic Aphasia Examination (BDAE) before and 4 weeks after language training. The factors affecting severity of subcortex aphasia and characteristics were analyzed before training, and effect of language training was examined before and after training. Results Severity of subcortex aphasia was related to age and the complication of apraxia of speech. There was a relatively high level in listening comprehension, reading, repeating and reading aloud abilities. After training, all kinds of language abilities improved significantly in moderate degree subcortex aphasics. Whereas, comprehension and verbal communication capabilities increased obviously, but written communication abilities advanced rarely in severe degree subcortex aphasics. Conclusion Age and the complication of aphasia of speech may be important factors influencing severity of language disorder in subcortex aphasia. There are specific clinical features in subcortex aphasia. Almost all language abilities can be improved by language training, but therapeutic effect is differrent between moderate degree and severe degree subcortex aphasics.

Ohjective To explore the impact of constraint-induced aphasia therapy (CIAT) on language function and neural activity in patients with chronic Broca's aphasia.Methods Two chronic aphasics whose use of language was recovering after standard language therapy were selected to receive 1.5 h of CIAT twice daily for two weeks (30 hours in total).Before and after the CIAT they were tested using a block-designed picture-naming task,fMRIs were taken and their use of language was examined.Results The language function assessments showed relatively large improvements in the subjects' use of language after 4 weeks of conventional language training,but not much further change after 8 and 12 weeks.After the two weeks of CIAT,their language function improved further to a certain extent.fMRI showed increased activation in the left inferior frontal gyrus with or without enhanced activation in the left hemisphere,and reduced activation in the right inferior frontal gyrus.Conclusions Functional reorganization induced in the brain by CIAT was associated with up-regulation of the left inferior frontal gyrus or down-regulation of the right inferior frontal gyrus.Even the whole language network may have been modified.