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Objective To investigate the clinical features of cutaneous adverse reactions to tyrosine kinase inhibitors.Methods Thirty patients with cutaneous adverse reactions to tyrosine kinase inhibitors were enrolled from the First Affiliated Hospital of Guangzhou Medical University between January 2015 and December 2016,and their laboratory test results,histopathological findings and treatment response data were collected and analyzed retrospectively.Results Of the 30 patients,15 presented with acneiform eruptions,10 with eczematoid eruptions,2 with morbilliform rashes,1 with telangiectasia,1 with hand-foot skin reaction,9 with xerosis,7 with nail changes and 4 with hair changes.A patient with grade 4 acneiform eruptions showed a markedly elevated alanine transaminase (ALT) level (315 U/L).Mild ALT abnormalities (48.5-88.1 U/L) were found in 3 patients with grade 3 acneiform eruptions,1 with grade 2 acneiform eruptions,1 with grade 1 acneiform eruptions and 1 with eczematoid eruptions complicated by fever.Two patients with eczematoid eruptions and 1 with morbilliform rashes showed elevated proportions of peripheral blood eosinophils (0.057-0.303).Pathological changes of the acneiform eruptions included hyperkeratosis and dilation of hair follicles and neutrophilic infiltration.Pathological manifestations of eczematoid eruptions included different degrees of spongiosis,thickened spinous layer,irregular elongation of rete ridges and liquefaction degeneration of basal cells in the epidermis,and perivascular infiltration of lymphocytes and eosinophils in the superficial dermis.Patients with grade 1-3 acneiform eruptions received oral minocycline for 6 weeks,skin lesions gradually regressed,but relapse occurred after the withdrawal.After withdrawal of targeted antineoplastic agents and 2-week treatment with systemic glucocorticoids,skin lesions gradually regressed in patients with grade 4 acneiform eruptions,those with eczematoid eruptions complicated by fever,and those with morbilliform rashes.Skin rashes also resolved in patients with mild morbilliform rashes and those with mild eczematoid eruptions after 2 weeks of treatment with antianaphylactic agents and topical glucocorticoids.Oral antibiotics were effective for the treatment of periungual erythematous swelling or granulomas.Conclusion Tyrosine kinase inhibitor-related cutaneous adverse reactions include a constellation of disorders,and hepatic function can be impaired.
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Objective To analyze the clinical and histopathological features,immunophenotypes,treatment and prognosis of subcutaneous panniculitis-like T cell lymphoma (SPTL).Methods Clinical and experimental data were collected from 9 cases of SPTL,and retrospectively analyzed.Related pathological and immunohistochemical markers were examined by Envision method.Eight patients were followed up.Results Of the 9 patients,8 had multiple subcutaneous nodules and plaques,which mainly involved the lower limbs in 8 patients and the trunk in 6 patients.Seven patients had fever.Three patients were subjected to the whole-body positron emission tomography-computed tomography (PET-CT),and 7 to bone marrow aspiration.No visceral tumors and hemophagocytic syndrome were found.Histopathological examination of skin lesions showed atypical mononuclear cells with large nuclei and deep staining,which mainly infiltrated the subcutaneous adipose tissue and were arranged in a circular pattern.Among 9 patients,infiltration of tumor cells was observed around skin appendages and blood vessels in the dermis in 5 patients.Immunohistochemical examination showed positive staining for βF1,CD3 and CD8 in tumor cells in 9 cases,positive staining for granzyme B and T-cell-restricted intracellular antigen-1 (TIA-1) in 8 cases,and negative staining for CD4,CD20,CD30 and CD56 in all the patients.Five patients received chemotherapy,including a child and a postpartum woman.One child received methylprednisoloue pulse therapy.During the follow-up,8 patients achieved a complete clinical remission after treatment.Conclusion SPTL is derived from α/β T cells,and histopathological and immunohistochemical examinations can be helpful for its diagnosis and differential diagnosis.
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Small scale restricted online course (SPOCs)+flipped classroomteaching is expected to become an important complement to the traditional teaching of dermatology. In this teaching mode, first of all knowledge nodes are divided separately according to the syllabus and for each node, 7 to 10 minutes of micro video or micro-lecture is made, which enables students to make best use of fragmented time through the network to master relevant knowledge independently before the trainee. In the flipped classroom, based on the difficulties and misunderstandings of learning reflected from the network monitor data, teacher can make full use of time on demonstrating typical cases, organizing discussion, grouping students to take diag-nostic and therapeutic exercise, answering targeted questions, teaching clinical thinking, experience and doctor-patient communication skills. Through this teaching mode, the new teaching idea can be imple-mented that students are in dominant position while teachers are in leading position, which contributes to deepening the understanding , absorption and application of knowledge and improving students' ability of communication, cooperation, diagnosis and treatment.
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Objective To investigate differences in Rab protein expressions in McCoy cells with acute versus persistent Chlamydia trachomatis (Ct) infection.Methods Cultured McCoy cells were infected with different amounts (400,500,550 μl/well) of Ct strain D suspensions,then cultured with the medium containing 100 U/ml penicillin G (persistent Ct infection groups) or that without penicillin G (acute Ct infection groups).Ct-uninfected McCoy cells receiving no penicillin G treatment served as the blank control group,and those receiving penicillin G treatment as the penicillin group.Mter 48-hour culture,McCoy cells were lysed,proteins were collected,and total RNA was extracted from the cells.Enzyme-linked immunosorbent assay (ELISA) was conducted to measure protein levels of Rab4A,Rab6A,Rab10,Rab11A and Rab14,and fluorescence-based quantitative PCR to quantify mRNA expressions of Rab4A and Rab14 (expressed as 2-ΔΔα).Results Protein levels of Rab4A,Rab6A,Rab10,Rab11A and Rab14 were all significantly lower in the acute than in the persistent Ct infection groups (all Z =3.621,P ＜ 0.001),and lower in the persistent and acute Ct infection groups than in the blank control group (all P ＜ 0.008 3),but insignificantly different between the blank control group and penicillin group (all P ＞ 0.05).In addition,the expressions of Rab4A and Rab14 mRNAs were consistent with those of their proteins in these groups.Conclusion The transcriptional and expression levels of Rab proteins are higher in McCoy cells persistently infected with Ct than in those acutely infected with Ct.
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Objective To investigate clinical and pathological features of pseudoepitheliomatous keratotic and micaceous balanitis (PKMB).Methods The clinical and pathological features as well as treatment of PKMB were retrospectively analyzed in 5 male patients collected from Janumy 2008 to December 2013.Results The age at onset of PKMB varied from 56 to 67 years in these 5 patients,and none of the patients had received prepucectomy.Indurated keratotic plaques were observed in the glans of penis and inner lamina of the prepuce with no tenderness on palpation,whose surfaces were covered with grayish yellow,adherent and hard micaceous crusts.Histopathological study revealed obvious hyperkeratosis complicated by parakeratosis,epidermal pseudoepitheliomatous hyperplasia,thickened spinous layer,and normal cell polarity in the epidermis,as well as telangiectasis and mild to moderate lymphocytic infiltration in the upper dermis.Immunohistochemical examination showed positive nuclear staining of epidermal cells for human papillomavirus (HPV) in 2 cases.Two patients took small doses of prednisone,but achieved no obvious improvement.Oral isotretinoin had resulted in a favorable outcome in another two cases,but relapse occurred after dose reduction,and thick crusts still appeared after topical application of glucocorticoid cream and tacrolimus cream,or carbon dioxide laser treatment and photodynamic therapy.Conclusions PKMB is a chronic and obstinate disease,and should be diagnosed based on pathological findings.Its treatment is difficult,and tretinoin has some effects,but relapse often occurs after drug withdrawal and maintenance treatment is needed.
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Objective To determine the prevalent herpes simplex virus (HSV) strain in patients with genital herpes (GH),and to evaluate the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of anti-herpes simplex virus type 2 (HSV2) IgG and IgM antibodies in the diagnosis of genital herpes (GH) before in vitro fertilization (IVF).Methods Totally,193 HSV2 clinical strains isolated in cell culture from the lesions of patients with GH in the Department of Dermatology,First Affiliated Hospital,Sun Yat-sen University between 2009 and 2011 were typed by using type-specific fluorescein isothiocyanate (FITC)-labelled anti-HSV monoclonal antibodies.Serum samples were obtained from 57 anti-HSV2 IgM/IgG antibody-positive females with suspected GH as well as their husbands (clinical observation group),68 HSV culture-positive patients diagnosed with GH (positive control group),and 120 children aged 8-12 years (negative control group).Enzyme-linked immunosorbent assay (ELISA) was performed to detect anti-HSV1/HSV2 IgG/IgM antibodies in these serum samples.Statistical analysis was carried out using chi-square test.Results There was a significant difference between the positive control group and negative control group in the positivity rate of anti-HSV1 IgG (89.71％ (61/68) vs.40.80％ (49/120),P ＜ 0.01) and anti-HSV2 IgG (91.18％ (62/68) vs.0,P ＜ 0.01),but not in that of anti-HSV1 IgM (20.59％ (14/68) vs.21.70％ (26/120),P ＞ 0.05) or anti-HSV2 lgM (13.24％ (9/68)vs.13.30％ (16/120),P ＞ 0.05).In the clinical observation group,the positivity rate of anti-HSV1 and anti-HSV2 IgM antibodies,anti-HSV1 and anti-HSV2 IgG antibodies was 80.70％ (46/57),91.23％ (52/57),84.21％ (48/57) and 14.04％ (8/57) respectively in the females,19.30％ (11/57),8.77％ (5/57),87.71％ (50/57),12.28％ (7/57)respectively in the males,with significant differences in the positivity rate of anti-HSV1 and-HSV2 IgM antibodies (both P ＜ 0.01),but not in that of anti-HSV 1 or-HSV2 IgG antibodies (both P ＞ 0.05).The sensitivity,specificity,PPV and NPV were 13.24％ (9/68),86.67％ (104/120),36.00％ (9/25) and 63.80％ (104/163) respectively for anti-HSV2 IgM antibody in the diagnosis of GH,91.18％ (62/68),100.00％ (120/120),100.00％ (62/62),and 95.24％ (120/126) respectively for anti-HSV2 IgG antibody.Conclusions HSV2 prevails in the patients with GH in this region,while HSV1 only amounts to 5.18％.The type-specific anti-HSV2 IgG antibody shows a higher specificity,sensitivity,PPV and NPV in the diagnosis of GH than anti-HSV2 IgM antibody,hence,the type-specific anti-HSV2 IgG antibody is superior to anti-HSV2 IgM antibody in diagnosing GH before assisted reproduction.
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A 22-year-old patient was admitted to the hospital with a solitary,gradually growing and painless mass in the left shoulder for 2 years.Physical examination revealed no abnormality except for the skin lesion.Skin examination showed an elevated lesion measuring about 3.5 cm× 2.0 cm × 1.5 cm with smooth surface and normal color,which was located in the subcutaeous tissue,indurated and movable.Resection of the tumor was performed under local anesthesia.On visual observation during operation,the tumor was sited in the subcutaneous fat tissue,nodular-like and surrounded locally by fibrous pseudocapsules with a grey incisal surface and mild texture.Microscopicalty,the tumor was extremely similar to breast fibroadenoma with multiple lobuli,and each of the lobuli was composed of tubiform structures,basal cell-like epithelial cell trabs and fibromyxoid stroma abundant in fibroblast-like spindle cells.No hair bulb or primitive dermal papillae were observed in the lobuli,which were separated by compact collagen fibers infiltrated by a few scattered inflammatory cells.Fibromyxoid strotma was surrounded by basal cell-like epithelial cell strabs in most lobuli,and some tubiform structures were filled with a little thin lightly eosinophilic material in a concentric arrangement.Immunohistochemistry showed that intralobular epithelial cells were strongly positive for cytokeratin 5/6,but negative for CAM5.2 or carcinoembryonic antigen (CEA).In addition,the lightly eosinophilic material in lumens was negative for periodic acid-Schiff (PAS) staining.These results suggested that the tubiform structures were immature follicles,but not sweat ducts.The patient was diagnosed with nodular fibrofolliculoma (NFF) based on the clinical manifestations,morphological features,immunohistochemical and PAS staining results.No relapse was observed in more than 3 months of postoperative follow-up.As a benign trichogenic adnexal neoplasm with unique clinicopathological manifestations,NFF may be a new entity of cutaneous adnexal neoplasm.
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ObjectiveTo observe the ultrastructural changes of Chlamydia trachomatis after treatment with azithromycin.Methods The Chlamydia trachomatis laboratory strain (D/UW-3/Cx) was cultured in McCoy cells with or without the presence of azithromycin of 0.0667,0.1340,0.1900,0.2680 and 0.3330 mg/L for 48 hours.The ultrastructural changes of host cells andChlamydia trachomatis were observed by transmission electron microscopy.ResultsAfter 48-hour culture,vesicles increased in number both inside and outside of the inclusion bodies with the rise in azithromycin concentration; there were abnormally large reticulate bodies,some of which experienced abnormal division and even necrosis or breakdown; the number of elementary bodies was decreased,while their size was enlarged,with a more wrinkled outer membrane.No inclusionbodieswereseenwhentheconcentrationofazithromycinwas0.333mg/L. Conclusions Azithromycin can induce an increment in the outer membrane of Chlamydia trachomatis,formation of vesicles,abnormal enlargement or breakdown of reticulate bodies,and a decrease in elementary bodies.
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Objective To investigate the role of cHSP60 in the pathogenesis of murine cervicitis.Methods Fifty female C3H/HeN mice were randomly and equally classified into 5 groups, including the control group receiving no treatment and 4 groups receiving intravaginal inoculation of cHSP60 (cHSP60 group),live elementary bodies of Chlamydia trachomatis mouse pneumonitis (MoPn group), inactive elementary bodies of MoPn (inactive MoPn group) and growth medium (medium group), respectively. Five days after the inoculation,cervical tissue was resected from these mice and subjected to pathological examination. Results There were varying degrees of inflammatory reaction characterized by neutrophil infiltration, necrosis and shedding of mucosal cells in the cervices of mice in cGSP60 and MoPn groups. No statistical difference was observed in the incidence of cervicitis (90% vs. 80%, P ＞ 0.05), neutrophile count [76.00 (25.0 - 80.0) vs. 25.00 (8.75 -32.5), P＞ 0.05] or inflammation score [12.5 (11.5 - 14.25) vs. 9.00 (8.00 - 11.5), P ＞ 0.05] between the cHSP60 and MoPn group. The inflammatory reaction was weak with decreased incidence of cervicitis (40%),inflammation score [0.00 (0.00- 12.50)] and neutrophile count [0.00 (0.00- 15.50)] in inactive MoPn group compared with the cHSP60 and MoPn groups (all P ＜ 0.05). A small number of neutrophils migrated into the superficial layer of cervical mucosa in only 2 mice in the medium group. Conclusion cHSP60 may be a primary pathogenic factor in chlamydial genital tract infection.
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Objective To clone and express Chlamydia trachomatis (Ct) heat shock protein 60 (hsp60) gene. Methods The hsp60 gene fragment was amplified from Ct chromosomal DNA by PCR. After purification and digestion with enzymes Sal I and Not I , the hsp60 gene fragment was inserted into the compatible site of prokaryotic expression vector pET-28a. The constructed recombinant plasmid was identified by PCR, restriction enzyme cleavage and sequencing, then, it was transfected into an expression strain Escherichia coli BL21 (DE3). The expression of fusion protein was induced by isopropy-β-D- thiogalactoside (IPTG) in the host bacteria, and the expressed product was identified by sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE) and Western-blot. Results PCR and restriction enzymes cleavage analysis confirmed that the hsp60 gene was successfully cloned into the recombinant plasmid. DNA sequencing showed that the sequence of cloned gene was fully consistent with the published sequence in Genebank. As revealed by SDS-PAGE, the size of expressed fusion protein approximated 60 kilodaltons, and Western-blot confirmed the expressed product to be the expected protein. The final concentration of fusion protein was 17.85 mg/L with a purity of more than 90%. Conclusions A recombinant expression plasmid pET-28a-hsp60 is successfully constructed in this study, and soluble hsp60 protein is expressed by the recombinant plasmid-transfected E. coli.
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20%ALA cream were applied topically to condylomata acuminata.The cream was kept in place for 4 h.He-Ne laser light at 630nm was used,and the dose of light was 100 J/cm2 for all of the patients.After three treatment,the complete removal rate(CRR)of urethral and other genital mucossa were 93.4%and 88.9%,significantly higher than genital skin 39.1%(P＜0.05).The adverse reactions of ALA-PDT are mainly local minor erosion,short-term pain,but no scar.It showed that ALA-PDT is an effective,minimally invasive treatment for condylomata acuminata,especially for the lesions on urethral and genital mucosa.
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Objective To explore the effect of residual UDG on all dU-DNA PCR products. Methods The hybridization percentage of dU-DNA PCR products, which were stored at 37℃ for 20 hours as well as at -20℃,4℃,room temperature and 37℃,respectively, were detected by employing microplate hybridization technique. The effect of inactivating the products at 94 ℃ for 10 minutes on the activity of Taq polymerase was also analysed. Results Compared with the control, A value decreased by 13.281% and 20.557%, respectively after adding 0.2u and 10u UDG (P