An 81-year-old male presented with an 8-year history of recurrent ulcer on the left dorsal foot which gradually spread to involve both lower limbs. Physical examination revealed no abnormality of any organ systems and no palpable superficial lymph nodes. Skin examination showed erythematous swelling of the left dorsal foot with an ulcer sized 7 cm × 10 cm on the surface. Tendon was visible at the base of the ulcer, and the ulcer margin was elevated giving a dyke-like appearance. The perilesional skin was purple-brown. There were several millet-like papuloid lesions circularly arranged at the inner side of the right foot as well as dark erythematous or brown nodules and pigmented patches with tenderness on both lower limbs. Histopathology of the ulcer of the left dorsal foot and papuloid lesions on the right foot revealed a visible epidermotropic infiltrate in the epidermis as well as an infiltration throughout the entire dermis with medium-sized atypical lymphoid cells with obvious mitoses. Immunohistochemical examination showed the coexpression of both T cell markers (including CD3, CD45RO, CD43) and B cell marker (CD20), with scatted positive staining for PAX-5and negative staining for CD79α or CD1 9. PCR confirmed the rearrangement of T cell receptor (TCR)-γgene. A diagnosis of peripheral T cell lymphoma unspecified was made in view of the rearrangement of TCR-γgene and above findings. The patient was treated with the following modified CHOP regimen: intravenous cyclophosphamide 0.8 g, leurocristine 2 mg and epirubicin hydrochloride 60 mg, as well as oral prednisone 15 mg twice daily for 5 days every 3 weeks (one treatment session). After 3 treatment sessions, the lesions improved markedly.

A 37-year-old female was admitted to the hospital for an itching and painful subcutaneous nodule with ulceration on the extensor aspect of her left forearm for more than 6 months.The pain was severe,continuous and localized.Systemic and local treatment with antibiotics resulted in no obvious improvement.The lesion had gradually increased in size over the past 6 months and the ulcer had enlarged for 1 month.On examination,a hard infiltrative plaque measuring about 5.5 cm × 4.0 cm with a well-defined margin was seen on the extensor aspect of her left forearm,along with ulceration and some dirty discharge on the surface.The diagnosis of fibrosarcoma,grade Ⅱ was eventually made by a biopsy of the lesion,which revealed increased pigmentation in the basal layer,and tumor tissue was tightly adherent to the epidermis.Dermis and subcutaneous fat layer were infiltrated with various sizes of spindle cells with fine collagen fiber bundles between the cells.Obvious atypia and mitotic figures were easily observed in some of the cells.Immunohistochemical analysis showed moderately positive staining for fibronectin,but negative staining for human melanoma black-45 (HMB45),S100,smooth muscle actin (SMA),Melan-a,high molecular weight cytokeratin (HCK),CD34,CD68 or cytokeratin.Some diseases should be differentiated from this case,including dermatofibrosarcoma protuberans,cutaneous spindle cell squamous carcinoma,atypical fibroxanthoma,malignant fibrous histiocytoma,and so on.

Objective To evaluate the clinical value of multi-locus polymerase chain reaction (PCR) for identifying Mycobacterium tuberculosis complex isolated in children. Methods The isolates were collected and were first determined by PNB/TCH medium. 7-point PCR sites including 16SrRNA, Rv0577, IS1561, Rv1510, Rv1970, Rv3877/8 and Rv3120, and 4-point PCR sites including ropB, RD1, RD8 (present), RD8 (deleted) were used to amplify them by PCR. Results Total of 204 isolates were collected, in which 199 were Mycobacterium tuberculosis, 3 were Mycobacterium bovis, and 2 were non-tuberculous mycobacteria by the PNB/TCH method. 4-point PCR analysis showed that 196 were Mycobacterium tuberculosis, 2 were Mycobacterium bovis, 3 were BCG species and 3 were non-tuberculous mycobacteria. 7-point PCR analysis showed that 191 were Mycobacterium tuberculosis, 2 were Mycobacterium bovis, 3 were BCG species, 4 were African Mycobacterium type I, 1 was Mycobacterium caprae, 1 was Mycobacterium microti and 2 were non-tuberculous mycobacteria. Conclusion Compared with the conventional method, the PCR identification in 4-point PCR method and 7-point PCR method could rapidly identify the BCG among the complex group in children tuberculosis. 7-point PCR method was able to identify all the subspecies of Mycobacterium, except Africa Mycobacterium. 4-point PCR method would be more rapid and easier in the identification of BCG strains.

Objective To evaluate the cumulative irritative effect of topical retinoic acid preparations on normal skin.Methods A randomlized,doubled blind,placebo-controlled clinical trial was carried out with7groups for6tested preparations.All subjects were patch tested with each preparation for24hours on Monday to Thursday,and for72hours on Friday.The patch tests were performed for3consecutive weeks.Results The minimal cumulative irritative effects were found in Group G treated with0.1%adapalene gel,with a cumulative irritative index of0.09?0.11in20days.The cumulative irritative index was significantly lower in Group G than that in Group B treated with0.1%retinoic acid(Diweishuang誖)(0.59?0.24),or in0.025%retinoic acid(Diweishuang誖)(0.41?0.22),or in0.05%retinoic acid(VITAMIN誖Cream)(0.25?0.22).Conclusion Adapalene,the third generation of retinoic acid,is characterized by lower irritative ef-fects in comparison to the first generation of topical retinoic acid agents.

Objective To assess the expression pattern of protease-activated receptor 2 (PAR2) in human keratinocytes and to characterize its biological functions in the regulation of skin barrier.Methods Primary human keratinocytes and human N/TERT keratinocytes were used as the subject of this study.The expression and distribution of PAR2 in the keratinocytes were analyzed by using immunoflorescence staining and Western blot.Two different PAR2 agonists,trypsin and a PAR2-activating peptide (AP),as well as a PAR2-antagonistic peptide (H2N-FSLLRY-COOH) and a control peptide were used to induce the activation of PAR2 in the keratinocytes.Then,a fluorescence-based calcium mobilization assay was performed to evaluate the biological function of PAR2.Data were statistically analyzed by one-factor analysis of variance.Results Under normal culture conditions,PAR2 was weakly expressed in keratinocytes,and the expression was unaffected by culture medium composition or culture duration.Calcium mobilization was induced by trypsin of 50-250 nmol/L and the PAR2-activating peptide in a dose-and time-dependent pattern.The maximal activation of PAR2 was observed in keratinocytes treated with the PAR2 agonist HAN-SLIGKV-COOH of 75-250 μmol/L.The PAR2-antagonistic peptide (H2N-FSLLRY-COOH) obviously suppressed the increase in calcium mobilization induced by trypsin,while the control peptide PAR-RAP showed no inductive effect on the PAR2 activation based on the absence of calcium mobilization.The substrate-induced calcium release was complete within 250 seconds,and peaked at 50 seconds after the initial trypsin or PAR-AP stimulation.Moreover,the activation of PAR2 was accompanied by an increase in ERK phosphorylation and elicitation of MAPK signaling pathway in keratinocytes.Conclusions Human keratinocytes positively express PAR2,which can be activated by trypsin and PAR2-activating peptides,and the activation of PAR2 may influence the physiological function of keratinocytes by inducing intracellular calcium release.

A case of cytomegalovirus infection with skin lesions as the primary manifestation is reported.A 46-year-old female patient presented with a 3-month history of painful perioral blisters and erosions,and a 6-week history of erythema,blisters and erosions on the left ann.The patient was ever diagnosed with systemic lupus erythematosus and lupus nephritis 12 years prior to the presentation.Systemic lupus erythematosus was exacerbated 5 months prior to this presentation,and glucocorticoids and mycophenolate mofetil were administered.Skin examination revealed irregularly shaped perioral blisters with erosions and crusts,localized patchy erythema with erosion in the center on the flexor aspect of the left forearm,erythema and blisters on the left upper arm,and multiple petechiae and ecchymoses on the abdomen.Histopathological examination of the skin lesion on the left upper limb showed epidermal necrolysis with scattered viral inclusion bodies.Immunohistochemical examination revealed positive staining for cytomegalovirus antigen in giant cells in the necrolytic epidermis.Cytomegalovirus DNA was detected in exudates from lesions.However,cytomegalovirus DNA was not detected in the serum in the initial test,but became positive (8.04 × 103 copies/ml) 1 week later.In addition,anti-cytomegalovirus IgG antibodies were detected in the serum.The patient was diagnosed with cutaneous cytomegalovirus infection.Affter the treatment with both oral and topical ganciclovir,the lesions were improved gradually,followed by severe pulmonary infection,and the patient was finally died of multiple organ failure.

Objective:To investigate the influencing factors of hospitalization for pregnant women with influenza A.Methods:From December 2018 to February 2019, 261 pregnant women with influenza A were admitted to Beijing Ditan Hospital, Capital Medical University. The clinical data of age, gestational period, underlying diseases, time from onset to treatment, white blood cell count and lymphocyte count of these patients were collected. Data of out-patients were compared with those of inpatients. Chi-square test and multivariate logistic regression were used to analyze the influencing factors of hospitalization in pregnant women with influenza A.Results:Among the 261 cases of pregnancy with influenza A, 36 cases (13.79%) were hospitalized, of which 10 (27.78%) were hospitalized due to severe influenza complications, the other 26 cases (72.22%) were hospitalized due to pregnancy related adverse events. The proportions of hospitalized patients with age ≥30 years old, gestational period ≥28 weeks, combined with underlying diseases and lymphocyte count <1×10 9/L were 75.00%(27/36), 83.33%(30/36), 16.67%(6/36) and 50.00%(18/36), respectively, which were significantly higher than those of out-patients (47.11%(106/225), 35.56%(80/225), 0.89%(2/225) and 13.22%(16/121), respectively; χ2=9.66, 29.05, 26.00 and 22.12, respectively, all P<0.05). The proportions of inpatients and out-patients with white blood cell count ≥4×10 9/L were 97.22%(35/36) and 97.52%(118/121), respectively, and there was no significant difference ( χ2=0.01, P=0.921). Multivariate logistic regression analysis showed that age ≥30 years (odds ratio ( OR)=5.181, 95% confidence interval ( CI) 1.628-16.489, P=0.005), gestational period ≥28 weeks ( OR=11.054, 95% CI 3.233-37.796, P<0.01), lymphocyte count <1×10 9/L ( OR=6.864, 95% CI 2.237-20.729, P=0.001), and time from onset to treatment <24 h ( OR=0.076, 95% CI 0.012-0.468, P=0.005) were the influencing factors for hospitalization of pregnant women with influenza A. Conclusion:Age ≥30 years old, gestational period ≥28 weeks, lymphocyte count <1×10 9/L and time from onset to treatment <24 h are the influencing factors for hospitalization of pregnant women with influenza A.

Objective To investigate clinical and histopathological features of lichen planopilaris (LPP).Methods The clinical and histopathological findings in 3 cases of LPP were analyzed.Results All the 3 patients were female,and their average age was 49 years.One patient presented with large-area patchy hair loss on the frontal,parietal and occipital region,and 2 patients presented with irregular patchy hair loss on the scalp and skin atrophy.Besides the hair loss,the eyebrows and axillary hairs also lost in 1 patient.Histopathological examination showed liquefaction degeneration of basal cells in the walls of hair follicles and infiltration of lymphocytes.Infiltration of a small number of lymphocytes was also observed around blood vessels and appendages.Conclusions LPP may only affect the scalp,or involve the other sites all over the body.LPP commonly manifests as patchy hair loss on the scalp and skin atrophy,and is pathologically characterized by liquefaction degeneration of basal cells in hair follicles and infiltration of lymphocytes.

Objective To explore the value and the influencing factors of the modified spu-tum-sucking method on in prevention and treatment of ventilator-associated pneumonia in pa-tients with mechanical ventilation.Methods The clinical data of 512 patients with mechanical ven-tilation were retrospectively analyzed,the control group with 200 cases was applied the open endo-tracheal sputum suction while the study group with 312 cases was carried out closed endotracheal sputum suction,the pulse oxygen saturation,peak airway pressure,and the incidence of ventilator-associated pneumonia were analyzed.Results Compared with the control group,the incidence and mortality of ventilator-associated pneumonia of study group were lower than that in the control group (P <0.05).The time of SpO2 back to basis level of study group was better than that in the control group(P <0.05).Conclusion The modified sputum-sucking method can reduce respira-tory tract damage and decrease the incidence of ventilator-associated pneumonia,so it is worthy of spreading.