Objective To investigate the efficacy of laboratory tests in the renal damage early diagnosis of children with Henoch-Schoalein purpura (HSP) and clinical effect of early intervention.Methods For the 143 HSP patients with normal repeated urine routine test findings,renal function biomarkers including urinary proteins ( immunoglobulin G (IgG),micro-albumin ( MA ),transferrin (TRF),a1 -microglobulin ( α1 -MG),β2-Microglobulin (β2-MG) ) and urinary enzymes ( N-acetyl-beta-D-glucosaminidase ( NAG ),γ-glutamyltransferase (y-GT) ) were detected to investigate the details of renal function changes.One hundred and thirty-one HSP patients,who had abnormal laboratory test findings of renal function biomarkers mentioned above,were randomly divided into control group ( n =65 ) and intervention group ( n =66 ),and both groups received comprehensive treatment including cimetidine,loratadine and calcium agents.However,66 patients in intervention group received low-dose heparin via micropump-based continuous intravenous infusion and regular oral diammonium glycyrrhizinate treatment.Sixty-five patients were enrolled in control group,without further treatment.Results Among the 143 patients with normal urine routine examination,131 cases (91.61％ ) had abnormal findings of renal function biomarkers.After therapy either for 2 months or 4 months,urine protein and urine enzymes were lower than before treatment,and the difference was significant (P ＜ 0.01 ).In the control group only β2-MG,NAG,γ-GT3 indexes significantly lowered at the end of 2 months ( P ＜0.01 ),and all parameters were significantly decreased at the end of 4 months ( P ＜0.01 ).Furthermore,Intervention group had lower levels of renal function biomarkers at the end of 2 months or 4 months,as compared with the control group,showing significant difference ( P ＜0.05 or P ＜0.01 ).Urinary IgG,MA,TRF,NAG recovered rapidly in the intervention group after 4 months and almost returned to the normal,but urinary α1-MG,β2-MG,γ-GT recovered slowly and still remained abnormal after 4 months due to the varying severity.After treatment for 4 months,the rate of urine testing abnormalities was higher in the control group than in the intervention group (36.92％ vs 6.10％ ),and the difference was significant (P ＜0.05).Conclusion Combined detection of renal function biomarkers is helpful for early diagnosis of renal damage in HSP patients.Early intervention with heparin and diammonium glycyrrhizinate can prevent kidney damage,delay disease progress.Early diagnosis and early intervention should be emphasized for the treatment strategy of the renal damage of children with HSP.

Objective To explore the efficacy and safety of low-dose heparin in the treament of children with primary nephrotic syndrome (PNS). Methods It was an open and comparative trial. Eightyeight children with PNS in the hypercoagulable state,on the basis of administrating with glucocorticosteroid,were administrated with low-dose heparin that infused by micro pump oriented to time ( group A). Eighty patients only treated with glucocorticosteroid were chosen as control (group B). Results Serum-albumin and activated partial thromboplastin time (APTT) increased,but fibrinogen (Fib) decreased after therapy in the group A,and they all showed significant differences (P ＜ 0. 01 ). Serum-albumin increased after therapy in the group B and there was significant difference (P＜0. 01 ). However,APTT and Fib in the group B showed no significant difference( P ＞ 0. 05 ) between post-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A were significantly higher than those in group B, and Fib was significantly lower than that in group B ( P ＜ 0. 01 ). The rate of urine protein remission in group A (82/88) was significantly higher than that in group B (63/80). Urine protein remission time and edema disappearance time were significantly shorter in group A than group B ( P ＜ 0. 01 ). APTT of group A at the peak concentration of heparin after therapy was significantly higher than that of pretherapy ( P ＜ 0. 01 ), and the ratio was 2. 38. However, there was no significant difference in APTT at the valley concentration of heparin between post-treatment and pretherapy ( P ＞ 0.05 ). Conclusion Low dose-heparin infused by micro pump oriented to time in the treatment of children with PNS has an obvious anticoagulative effect. It can improve the rate of urine protein remission and shorten edema disappearance time. Meanwhile it is safety ,requires no laboratory monitor and has few drug side effects,thus it deserves further clinical application.

Objective To explore the efficacy and safety of low dose dopamine combined with phentolamine in the treatment of primary nephrotic syndrome (PNS) with edema. Methods Retrospective control studies were performed in 155 patients of PNS with edema, who received comprehensive treatment with small dose dopamine combined with phentolamine (group A). Patients treated with furosemide infusion were recruited as control (group B). Results The urinary output, urinary sodium increased after therapy in group A, showing significant differences (P ＜ 0. 01). But urinary potassium excretion, serum sodium and potassium showed no significant difference after therapy in group A. The urinary output, urinary sodium and potassium excretion increased and the serum sodium and potassium decreased after therapy in group B, all showing significant differences between before and after treatment (P ＜0. 01). The edema relief rate,urinary output, urinary sodium excretion, serum sodium and potassium in group A was significantly higher whereas urinary potassium excretion were significantly lower than those of group B(P ＜0. 01). The rate of drug adverse reaction in group A was significantly lower than that of group B. Conclusion Low dose dopamine combined with phentolamine in PNS with edema is safe and effective,which may be a substitute of diuretic like furosemide in the treatment of edema of patients with different blood volume.

Objective:To compare the clinical efficacy of oxycodone hydrochloride controlled-release tablets (OHCT) and pa-tient-controlled intravenous analgesia (PCIA) in the treatment of intractable cancer pain. Methods:Retrospective analysis was conduct-ed to evaluate the intractable cancer pain of 89 elderly patients who were admitted to the medical oncology departments of The Second Affiliated Hospital of Fujian Medical University and the Fuzhou General Hospital of Nanjing Military Command between September 2012 and March 2014. Among the 89 patients, 47 were treated with OHCT, and 42 received PCIA. The total dosage ranged from 60 mg/d to 400 mg/d PO q12h for patients in the OHCT group, whereas abackground dose+patient-controlled dosemode was adopted for patients in the PCIA group. The therapeutic efficacy, presence of adverse reactions, cost of treatment, and degree of patient satisfaction were compared between the two groups. Results:The average dosages of analgesics in the two groups were almost the same (P>0.05). Visual analogue scale (VAS) values and daily average VAS values were both lower in the PCIA group than in the OHCT group at 24 h after analgesia (P<0.05). The incidence of adverse reactions, such as nausea and vomiting, was also lower in the PCIA group than in the OHCT group (P<0.05). The cost of treatment and degree of patient satisfaction were the same in both groups (P>0.05). Conclusion:Pa-tients who received PCIA attained better analgesia and exhibited less adverse reactions than those who received OHCT whereas the treatment cost and patient satisfaction did not differ in both groups.

Objective To investigate UV- or heat-inactivated Epstein-Barr virus(EBV)stimulating the production of anti-keratin autoantibody(AK auto Ab)in cultured human umbilical cord blood B cells. Methods Mononuclear cells were isolated routinely from umbilical cord blood, in which monocytes, NK cells and cytotoxicity T cells were eliminated by L-leucine methyl ester method, and T cells were removed by sheep red blood cells(SRBCs)treated with 2-amino ethyl-isothiouronium bromide (AET). The purified B cells were treated with UV- or heat-inactivated EBV respectively and then cultured in complete IMDM. CD5, CD3, CD4 and CD8 cells were detected by flow cytometry. IgG and IgM of AK auto Ab were measured by ELISA in the supernatant which came from the B cells treated by UV-inactivated EBV or EBV-transformed B cells respectively. Results In UV-inactivated EBV group CD5+B cells accounted for 43% and 47% of all cells detected on the 14th and 28th day, respectively. No CD3, CD4 and CD8 cells were detected during this period. In UV-inactivated EBV group the AK auto Ab of IgG and IgM increased significantly on the 18th and 26th day, respectively (P 0.05). On the 40th day the AK auto Ab of IgG and IgM were significantly higher in EBV-transformed B cell group than those in UV-inactivated EBV group. Conclusions UV-inactivated EBV is able to induce AK auto Ab production but heat-inactivated EBV does not, which suggests that EBV protein might be the effective agent in inducing the production of AK auto Ab.

Objective:To analyze clinical and pathological features of 320 cases of Spitzoid tumors.Methods:Clinical and pathological data were collected from 320 patients with Spitzoid tumors in Department of Dermatology, Xijing Hospital from January 2005 to January 2020, and retrospectively analyzed.Results:The 320 patients included 141 males and 179 females, aged 0 - 65 (12.5 ± 11.7) years, and their course of disease ranged from 1 month to 30 years. Among them, there were 307 patients with Spitz nevi, 8 with atypical Spitz tumors and 5 with Spitzoid melanoma. Most skin lesions were solitary, and occurred on the head, face, trunk and limbs, with clear boundaries. Among the 307 patients with Spitz nevi, the skin lesions were mainly black (132 cases, 43.0%) and red (108 cases, 35.1%) in color, most of which were uniformly pigmented (262 cases, 85.3%) with smooth surfaces (272 cases, 88.6%) . There were several special clinical subtypes of Spitz nevi, including Spitz nevus arising in a nevus spilus (11 cases, 3.6%) , agminated Spitz nevus (11 cases, 3.6%) , disseminated Spitz nevus (6 cases, 2.0%) , nodular Spitz nevus (7 cases, 2.3%) and keloid-like Spitz nevus (1 case, 0.3%) . Characteristic histopathological manifestations of Spitz nevi included pagetoid spread of epidermal nevus cells (123 cases, 40.1%) , Kamino bodies at the dermo-epidermal junction (74 cases, 24.1%) , horizontal band-like distribution of nevus cells (177 cases, 57.8) , wedge-shaped distribution of nevus cells (118 cases, 38.4%) , fissures around nevus cell nests (177 cases, 57.8%) , physiological mitotic figures (117 cases, 38.1%) , and fine nuclear chromatin (307 cases, 100%) . According to the special histopathological manifestations, Spitz nevi were divided into pigmented epithelioid Spitz nevus (9 cases, 2.9%) , desmoplastic Spitz nevus (13 cases, 4.2%) , hemangiomatous Spitz nevus (8 cases, 2.6%) , verrucous Spitz nevus (12 cases, 3.9%) , mucoid Spitz nevus (10 cases, 3.3%) , halo-like Spitz nevus (4 cases, 1.3%) , etc. Among the 8 cases of atypical Spitz tumors, 4 skin lesions were black, 7 were uniformly pigmented, and 3 had rough surfaces; the characteristic pathological manifestations included mild to moderate atypia of cells, mitotic figures (2 - 6 cells/mm 2 in 7 cases) , and coarse nuclear chromatin (5 cases) . Among the 5 cases of Spitzoid melanoma, 3 had red skin lesions, 4 were non-uniformly pigmented, and 3 had rough surfaces; the characteristic pathological manifestations included pagetoid spread of melanocytes (3 cases) , non-polar infiltrating growth of immature tumor cells, pathological mitotic figures (3 cases, > 6 cells/mm 2) , coarse nuclear chromatin and obviously stained nuclear membrane. Conclusions:Spitzoid tumors are characterized by unique clinical and histopathological features. There are various clinical and pathological subtypes of Spitz nevi, and atypical Spitz tumors have clinical and pathological characteristics of both Spitz nevi and melanoma.

Objective To detect the proliferation of and production of interferon-γ by drug-specific peripheral T cells from patients with severe drug eruption.Methods Peripheral blood mononuclear cells (PBMCs) were isolated from 10 patients with severe drug eruption,10 patients with mild or moderate drug eruption and 10 normal human controls,stimulated with causative drugs to obtain drug-specific T cells.Then,both PBMCs and drug-specific T cells were stimulated with causative drugs or unrelated drugs followed by the detection of secretion levels of IFN-γ with ex vivo enzyme-linked immunodotting (ELISpot) assay and cultured ELlSpot assav respectively.Results After stimulation with causative drugs,a higher level of IFN-γ was secreted by PBMCs and drug-specific T cells from patients with severe drug eruption compared with those from normal human controls (both P<0.01).and by drug-specific T cells than by PBMCs (P<0.01).The culture with unrelated drugs could neither induce the generation of drug-specific T cells nor promote the secretion of IFN-γ by PBMCs from the patients.Drug-specific T cells still existed in the peripheral blood of 3 patients within 1 to 3 years after recovery of drug eruption.Conclusions There are drug-specific T cells in peripheral blood of patients with severe drug eruption,and they may persist for a certain period of time after recovery of drug eruption.Ex vivo ELISpot combined with cultured ELISpot may be applied to the identification of causative drugs in vivo.

Objective:To investigate clinical features and preventive measures of misdiagnosed cutaneous melanoma, as well as causes of its misdiagnosis.Methods:Clinical data were collected from patients with pathologically confirmed cutaneous melanoma which was initially clinically misdiagnosed as other diseases in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2005 to December 2019, and clinical manifestations and causes of its misdiagnosis were analyzed.Results:A total of 118 patients with clinically misdiagnosed cutaneous melanoma were collected, including 38 males and 80 females. The median age at misdiagnosis was 48 years, the median age at onset was 40.5 years, and the median disease duration was 54 months. The main skin lesions were black maculae and papules. The initial clinical diagnoses were pigmented nevi (53 cases, 44.92%) , nail matrix nevi (12 cases, 10.17%) , seborrheic keratosis (14 cases, 11.86%) , vascular tumors (10 cases, 8.47%) , squamous cell carcinoma (5 cases, 4.24%) , basal cell carcinoma (4 cases, 3.39%) and other diseases (20 cases, 16.95%) . As far as the ABCDE (asymmetry, border irregularity, color variegation, diameter > 6 mm, evolving) rule for melanoma was concerned, 78 (66.10%) , 64 (54.24%) , 57 (48.31%) , 66 (55.93%) and 39 (33.05%) cases conformed to hte A, B, C, D and E rules respectively, 14 conformed to the ABCDE rule, 13 conformed to the ABCD rule, and 13 did not conform to any of them. Among the 53 cases of melanoma in situ, 28 (52.83%) were misdiagnosed as pigmented nevi, 11 (20.75%) as nail matrix nevi; among the 66 cases of invasive melanoma, 25 (37.88%) were misdiagnosed as pigmented nevi, 9 (13.64%) as vascular tumors, and 5 (7.58%) as squamous cell carcinoma. The information of physicians of 67 misdiagnosed patients was available, and those of 42 out of the 67 patients had clincial experience of ≤ 5 years; among 27 misdiagnosed patients conforming to the ABCD or ABCDE rule, the information of physicians of 9 patients was available, and those of 7 out of the 9 patients had clinical experience of ≤ 5 years. Conclusion:Cutaneous melanoma has a variety of lesion patterns and is easily misdiagnosed, and physicians′ clinical experience and the ABCDE rule-based evaluation are important for diagnosis.

Objective:To investigate clinical and histopathological features of congenital melanocytic nevi (CMN) complicated by proliferative nodules (PN) .Methods:Ten patients with clinically and pathologically confirmed CMN complicated by PN were collected from Department of Dermatology, the Fourth Military Medical University from 2015 to 2019, and their clinical and pathological data were analyzed retrospectively.Results:The 10 patients were aged from 2 to 45 years, with an average age of 15 years. Nine patients developed PN in infancy, and 1 in adulthood. The skin lesions were located on the extremities in 4 cases, on the head and face in 3 cases, and on the trunk in 2 cases, and the trunk and extremities were both involved in 1 case. Skin lesions clinically manifested as 1 or more nodules arising in black patches or plaques. Six patients presented with multiple PN, 4 with solitary PN, with the diameter of a single nodule being 0.2-1.5 cm, and only 1 case presented with ulcers. Histopathological examination showed mature melanocytes in the PN, with few mitotic figures, no obvious cytological atypia, and no necrosis. Immunohistochemical study showed that nevus cells diffusely expressed Melan-A, but did not express or partially expressed HMB45, and the Ki67 proliferation index was below 5%.Conclusion:CMN complicated by PN can occur on the extremities, head, face, and trunk, clinically manifesting as solitary or multiple nodules on pre-existing CMN; histopathologically, mature melanocytes can be observed in PN, immunohistochemical staining for HMB45 and Ki67 can facilitate the diagnosis, and its prognosis needs long-term follow-up.

Objective:To investigate clinical and histopathological features of Meyerson nevus.Methods:Clinical and histopathological data were collected from 6 patients with confirmed Meyerson nevi in Department of Dermatology, the Fourth Military Medical University from January 2015 to January 2019, and retrospectively analyzed.Results:Among the 6 patients, 3 were males and 3 were females, with a median age of 10.5 years (range, 7 months to 28 years). Skin lesions were located on the extremities of 3 cases, as well as on the trunk of 3 cases. Meyerson nevi arose from congenital pigmented nevi in 4 cases, as well as from acquired pigmented nevi in 2 cases. The duration of pigmented nevi varied from 7 months to 18 years. Four patients felt itching in the past 2 months, and 2 had no concomitant symptoms such as itching. Central pigmented nevi manifested as papules in 5 cases and a plaque in 1 case, which were brown or black in color, with regular shapes, uniform pigmentation and clear borders. Pigmented nevi were surrounded by a halo of erythema in 6 cases, and skin lesions were covered with scales or crusts in 4 cases. Histopathological examination of Meyerson nevi revealed characteristics of both pigmented nevus and eczema. Histopathologically, pigmented nevi manifested as junctional nevi or compound nevi, and eczema manifested as serous exudation, irregular epidermal hyperplasia, spongiosis and perivascular infiltration of lymphocytes in the superficial dermis.Conclusions:Meyerson nevus is rare, and mostly occurs on the trunk and extremities. When itching occurs or erythema appears around the pigmented nevus, the diagnosis of Meyerson nevus should be considered.