Objective To investigate the clinical efficacy and safety of 308-nm excimer laser combined with tazarotene gel for the treatment of plaque psoriasis.Methods Seventy-two patients with plaque psoriasis were randomly and equally divided into three groups according to a random number table:tazarotene group topically applying tazarotene gel once per night,308-nm excimer laser group treated with 308-nm excimer laser,combination group treated with both tazarotene gel and 308-nm excimer laser.Clinical efficacy was evaluated according to psoriasis area and severity index (PASI) score and response rate,and safety according to adverse reactions at week 2,4 and 8 after starting treatment.Results PASI score was significantly lower in the combination group at week 4 and 8 (4.75 ± 0.44 and 2.35 ± 0.37 respectively) than in the 308-nm excimer laser group (6.75 ± 0.57 and 4.67 ± 0.36 respectively,both P ＜ 0.05) and tazarotene group (8.75 ± 0.48 and 6.48 ± 0.45 respectively,both P ＜ 0.05),and significantly lower in the combination group at week 8 than at week 2 and 4 (both P ＜ 0.05).A significant increase was observed in the response rate at week 2,4,and 8 in the combination group (29.1％ (7/24),66.7％ (16/24) and 87.5％ (21/24) respectively) compared with the tazarotene group (12.5％ (3/24),41.7％ (10/24) and 62.5％ (15/24) respectively,all P＜ 0.05) and 308-nm excimer laser group (20.8％ (5/24),50.0％ (12/24) and 75.0％ (18/24) respectively,all P＜ 0.05).No systemic adverse reactions were observed in any of the 3 groups during the study,and there was no significant difference in the incidence of local adverse reactions between the combination group,tazarotene group and 308-nm excimer laser group (16.7％ (4/24) vs.12.5％ (3/24) vs.12.5％ (3/24),P ＞ 0.05).Conclusion The efficacy of 308-nm excimer laser combined with tazarotene gel is superior to that of tazarotene gel or 308-nm excimer laser alone in the treatment of plaque psoriasis.

Objective To evaluate the efficacy of Xuebijing injection plus oral acitretin for the treatment of erythrodermic psoriasis.Methods Forty-eight patients with erythrodermic psoriasis were equally and randomly divided into two groups by a random number table:test group treated with Xuebijing injection once a day plus oral acitretin,and control group treated with oral acitretin.The dose of acitretin began at 0.5 mg per kilogram per day,and was modified according to the tolerance in and response of patients.After 8 weeks of treatment,clinical efficacy was evaluated by psoriasis area and severity index (PASI) score,response rate and recurrence rate.Adverse reactions were also recorded and evaluated.Results The difference in PASI score between pre-and post-treatment was significantly higher in the test group than in the control group (34.9 ± 2.2 vs.27.3 ± 1.7,t =3.37,P ＜ 0.05).The total response rate was 87.5％ in the test group and 62.5％ in the control group (x2 =4.87,P ＜ 0.05).There was a statistical decrease in the average onset time ((13.5 ± 2.4) d vs.(20.7 ± 3.1) d,t =3.67,P ＜ 0.05),daily dose and total dose of acitretin ((26.4 ± 3.3) mg vs.(34.7 ± 3.5) mg,(1854.5 ± 85.2) mg vs.(2768.8 ± 88.7) mg,t =3.07,4.32,respectively,both P ＜ 0.05) in the test group compared with the control group.The recurrence rate was 9.5％ (2/21) in the test group and 26.6％ (4/15) in the control group (x2 =5.23,P ＜ 0.05).Conclusion In the case of erythroderma psoriaticum,Xuebijing injection combined with oral acitretin is superior to oral acitretin alone in clinical efficacy,onset time and reducing recurrence.

Objective: To investigate the clinical and genetic character of Chinese children with the aarF domain containing kinase 4 (ADCK4)-associated glomerulopathy. Methods: Applying next generation sequencing to detect possible gene mutation(renal disease associated monogene was pooled as one panel) in 69 children with steroid-resistant nephrotic syndrome (SRNS) or persistent proteinuria of unknown origin. Sanger sequencing was used to confirm the significant mutations found in the children and to validate these mutation sites in their patients. Using online software (PolyPhen2, SIFT, Mutation Taster) to predict whether the detected missense mutations were disease causing or not. Collecting and analyzing clinical data of children with ADCK4-associated glomerulopathy, which included onset age, clinical manifestation, and renal pathology. Results: The ADCK4 gene mutation was detected in 8 children with a positive rate of 11.6% (8 out of 69), among which 3 patients carried homozygous c.748G>C mutation, 3 patients carried homologous c.737G>A mutation, 1 patient carried compound heterozygous mutation(c.748G>C and c.737G>A), and 1 patient carried compound heterologous mutation(c.551A>G and c.737G>A). Collectively, there were only 3 mutation sites found in total 8 patients, in which the mutation sites of c.748G>C and c.737G>A had high detection frequency in these 8 patients. These 3 mutation sites were all missense mutation which were predicted to be disease causing by online software and not reported before. The average onset age was 6.5 years (2 years-11.75 years). Four patients presented with SRNS and the other 4 presented with persistent proteinuria. All 8 patients had no extrarenal manifestation, renal biopsy revealed focal segmental glomerulosclerosis (FSGS) in most patients, among which 3 cases had gone to end-stage renal disease (ESRD) at disease onset, and 2 cases progressed to ESRD 2 and 5 years after onset respectively. Seven patients had received glucocorticoid and/or immunosuppressive drug while only one patient getting partial response. All 8 patients were treated with large amount of coenzyme Q₁₀ (15 mg·kg^-1·d^-1) after definite diagnosis of ADCK4 mutation-some patients had acquired encouraging curative effect. Conclusions ADCK4-associated glomerulopathy is not rare especially in the children with SRNS. The onset age is relatively old and the extrarenal manifestation is less common. FSGS is a main pathology type. Patients usually have no response to immunosuppressive therapy, but may benefit from addition of large amount of coenzyme Q₁₀. Some patients may only manifest with insidious proteinuria, causing the early diagnosis to be difficult, which deserves more attention. Three new missense mutations expand disease causing mutation repertoire of ADCK4 gene, among which the two sites of c.748G>C and c.737G>A may be mutation hotspot of ADCK4-associated glomerulopathy in Chinese population, and need further study.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.