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 analyze clinical and histopathological characteristics of infantile congenital melanocytic nevi (ICMN) .Methods:Clinical and pathological data were collected from 126 infants with confirmedly diagnosed congenital melanocytic nevi in Department of Dermatology, Xijing Hospital from January 2015 to January 2020, and were retrospectively analyzed. Chi-square test was used for comparisons of enumeration data.Results:Among the 126 patients with ICMN, 68 were males and 58 were females; 109 (86.5%) presented with skin lesions at birth; 73 (57.9%) were 2 - 3 years old at the first clinic visit. The skin lesions occurred on the head and face (76 cases, 60.3%) , trunk (24 cases, 19.1%) or extremities (26 cases, 20.6%) . There were 36 (28.6%) patients with small congenital nevi, 68 (54.0%) with M1-type medium-sized nevi, 13 (10.3%) with M2-type medium-sized nevi and 9 (7.1%) with giant nevi. Of 126 cases of ICMN, 121 (96.0%) had solitary lesions, 5 (4.0%) had multiple lesions, 44 (34.9%) had nevi with coarse hairs, 15 (11.9%) had nevi complicated by papules or hyperplastic nodules, and 6 (4.8%) had satellite lesions. Pathological subtypes included compound nevus (120 cases, 95.2%) , intradermal nevus (4 cases, 3.2%) , and junctional nevus (2 cases, 1.6%) . Under the microscope, the depth of the skin lesions was < 1 mm in 38 (30.1%) cases, 1 - 2 mm in 61 (48.4%) and > 2 mm in 25 (19.8%) , and 45 (35.7%) cases showed nevus cells infiltrating the subcutaneous fat layer or deeper tissues. Among the 126 ICMN lesions, common pathological features included nevus tissue maturation (100%, 2 cases of junctional nevi were excluded) , pigment granules in the stratum corneum (53 cases, 42.1%) , disordered/asymmetric distribution of nevus cells (80 cases, 63.5%) , scattered epidermal nevus cells (91 cases, 72.2%) , pagetoid spread of epidermal nevus cells (67 cases, 53.2%) , melanophages in the dermis (71 cases, 56.4%) , and nevus cells distributed along hair follicles/sebaceous glands (82 cases, 65.1%) . Special pathological features included nevus cells embedded in the vascular/lymphatic vessels (42 cases, 33.3%) , nevus cell lysis (45 cases, 35.7%) , fibromatous changes (25 cases, 19.8%) , involvement of the arrector pilli muscles (31 cases, 24.6%) , and mast cell infiltration (30 cases, 23.8%) . Pathological patterns of ICMN with different clinical features: the incidences of infiltration depth > 2 mm, pigment granules and columnar pigment granules in the stratum corneum were significantly higher in the giant nevi than in the small and medium-sized nevi ( χ2 = 7.93, 10.76, 5.89 respectively, all P < 0.05) ; the incidences of infiltration depth > 2 mm, epidermal spongiosis with scattered nevus cells, nevus cell nests distributed along the hair follicles/sebaceous glands, fibromatous changes and mast cell infiltration were significantly higher in the skin lesions with coarse hairs than in those without ( χ2 = 28.29, 8.11, 6.22, 7.92, 8.19 respectively, all P < 0.01) ; the incidences of pagetoid spread of epidermal nevus cells and atypical nevus cells were significantly higher in the skin lesions with papules/hyperplastic nodules than in those without papules/hyperplastic nodules ( χ2 = 4.92, 6.30 respectively, both P < 0.05) . Conclusions:The clinical and histopathological characteristics of ICMN are unique, and atypical nevus cells are common in ICMN. The diagnosis and treatment of ICMN need to be based on the combination of clinical and pathological characteristics.

Objective:To investigate the efficacy of drug combined moisturizerand sunscreen with Prinsepia utilis oil and purslane in the treatment of chronic actinic dermatitis.Methods:From May 2017 to August 2018, 216 cases of chronic actinic dermatitis admitted to the Department of Dermatology, the First Affiliated Hospital of Kunming Medical University were divided into 4 groups. The 54 cases of control group was treated by oral administration of ebaxtin discontinued and hydroxychloroquine sulfate tablets for 4 weeks. The external use of desonide cream for 2 weeks. On this basis, the 56 cases of first treatment group used topical moisturizer twice a day, and topical sunscreen once a day; only topical moisturizer was used in 54 cases of second treatment group, twice a day; the 52 cases of third treatment group only used topical sunscreen once a day. Patients were followed up at 2, 4 and 6 weeks after treatment, respectively. The eczema area and severity index were detected to evaluate curative effect, and skin lesions water, trans epidermal water loss and content of lipid in the four groups of patients; reflective confocal microscope was used to observe the inflammatory reaction, blood vessels in skin lesions and so on.Results:After 6 weeks treatment, the efficacy rate of 54 cases in the first treatment group (85.2%) was significantly higher than that of 56 cases in the second treatment group (62.5%), 54 cases in the third treatment group (64.8%), 52 cases in the control group (50.0%), and the difference was statistically significant ( P<0.05). Non-invasive skin test results showed that the transepidermal water loss of the three groups was 16.42±8.64, 21.59±12.34 and 19.79±11.79, respectively, which was significantly lower than that before treatment (38.76±12.59, 38.37±14.48, 39.2±13.93). and the skin water content (42.15±10.25, 35.5±12.91, 33.42±12.83) and lipid content (37.96±11.16, 31.5±8.31, 34.09±12.51), compared with the pre-treatment skin water content (21.30±11.04, 16.86±10.88, 14.73±12.00) and lipid content (13.64±10.10, 15.67±12.60, 9.42±7.75) significantly increased, the difference was statistically significant ( P<0.05). The improvement of spongiosis (0.97±0.68), disruption of honycomb pattern and (0.82±0.77) and vascular dilatation (1.03±0.73) under reflective confocal microscope was better in first treatment than that in the second treatment (1.51±0.56, 1.0±0.77, 1.31±0.68). and the third treatment (1.35±0.85, 1.35±0.85, 0.97±0.80), and the control group (1.85±0.74, 1.85±0.74, 1.53±0.61). The difference was statistically significant ( P<0.05). Compared with the second treatment, the third treatment and control group, transepidermal water loss in the first treatment was significantly decreased, and epidermal water content and lipid content were significantly increased, with statistically significant difference ( P<0.05). Conclusions:The efficacy of drugs combined with moisturizer and sunscreen in the treatment of chronic actinic dermatitis is significantly better than that of simple drug therapy and drugs with topical moisturizer or sunscreen. It suggests that in the treatment of chronic actinic dermatitis, it is not only necessary to be anti-inflammatory, anti-photosensitive treatment, but also need to pay attention to moisturize and sun protection.

Objective To explore the methods for quality management and continuous improvement of nursing care quality in the orthopedic demonstration ward by taking the hospital accreditation as an opportunity. Methods From July 2012 to June 2013, the continuous care quality improvement in the ward was carried out to find out the problems with PDCA (plan, do, check, action) cycle method, including enhancing the function of orthopedic nursing quality management groups, conducting all-staff training and improving the knowing rate by referring to the standards of hospital assessment standards. Results After the performance of whole-process quality management, the percentage of indexes assessed at level A, B and C was increased from 42.2%to 50.0%, 17.2%to 14.7%and 40.2%to 35.3%, respectively. The score of nurses' responsibility accreditation was increased from 92 to 95. The rates of patient and nursing staff satisfaction were increased from 91.8%to 98.9%and 92.57%to 97.7%, respectively. Conclusion In accordance with the standards for hospital accreditation, the continuous improvement of nursing quality in the orthopedic demonstration wards can improve the specialist care of orthopedic care, improve patients' and nurses' satisfaction, thus making the daily work more scientific and standardized.