2019年 · 第132卷第17期

Artificial intelligence (AI) had been first coined at a famous Dartmouth College conference in 1956. AI is gradually interrelated with all disciplines, and also permeates all aspects of the medical field. In the early 1970s, medical researchers discovered the applicability of AI in life sciences.^[1]AI can play a role in many aspects, such as medical image recognition and auxiliary diagnosis,^[2]biotechnology,^[3]drug research and development,^[4]etc. Currently, medical image recognition is the most widely used.

Due to advances in high-frequency ultrasound technology, it is easier to detect fine structures of skin lesions. The aim of this study was to examine the ultrasonographic features and use recurrence risk stratification to assess the diagnostic performance of pre-operative ultrasound examination of basal cell carcinoma (BCC).

This was a retrospective study. Forty-six BCC lesions underwent pre-operative ultrasound examination using 50- and 20- MHz probes. Ultrasonographic shape, margin, internal echoes, hyper-echoic spots, posterior echoes, and depth of the lesion were evaluated and correlated with the risk of recurrence based on histological features.

Forty-two patients had 46 skin lesions in total. The high-risk (n = 6) and low-risk (n = 40) groups exhibited considerable overlap in the ultrasonographic manifestations and no significant difference in margin (χ² = 3.231, P = 0.072), internal echo (χ² = 1.592, P = 0.207), or posterior echo (P = 0.169). However, high-risk BCCs tended to be irregular in shape than low-risk lesions (χ² = 4.313, P = 0.038). Both types presented hyper-echoic spots (χ² = 1.850, P = 0.174). Additionally, 78% of low-risk lesions were confined to the dermis (31/40), and 100% of high-risk lesions infiltrated into the sub-cutaneous tissue, resulting in a significant difference between the two groups (χ² = 10.951, P = 0.001). Ultrasound detected sub-clinical lesions in five patients.

High-frequency ultrasound can provide important information for pre-operative evaluation of risk in BCC foci and reveal hidden lesions. The technique may play a crucial role in guiding therapeutic options for BCC.

Compared with Caucasians, unique demographic and clinical features have been reported in Chinese patients with malignant melanoma, but similar comparative studies of melanocytic nevi (MN) are lacking. This study examined the clinical and dermoscopic features of MN in surgically treated Chinese cases.

Clinical data and dermoscopic findings from 1046 cases of MN were collected and analyzed. Cases were treated from January 1 to December 31, 2014 at the Department of Dermatology and Venerology, Peking University First Hospital. The association between nevi location and histologic subtypes was examined with Chi-squared test and univariate logistic regression. Chi-squared test was also used to analyze the proportion of globular patterns across different body sites, and proportion of parallel furrow patterns across different histologic subtypes.

The majority of the nevi were from female patients, irrespective of location. The range of age at the time of nevi onset was from 0 (birth) to 79 years. There were 381 (36.4%, 381/1046) congenital nevi; of these 81.6% (311/381) were present at birth. Nevi appeared before 30 years of age in 83.2% (870/1046) of the cases. Median values of length growth rate in congenital and acquired MN were 2.0 and 1.6, respectively. Median values of length growth rates in four age groups (0–9, 10–19, 20–29, and ≥30 years) of congenital nevi were 2.2, 2.0, 2.4, and 2.0, respectively. In acral nevi, which often need to be differentiated from acral lentiginous melanoma, 50.2% (109/217) were junctional (odds ratio [OR]; 95% confidence interval [CI]: 91.572 [52.210–160.959], P < 0.05). Acral location was also associated with a higher likelihood of compound nevi subtype (OR [95% CI]: 14.468 [8.981–23.306], P < 0.05). The globular (59.4%, 354/596) and pseudonetwork (48.8%, 291/596) dermoscopic patterns were often seen in the head and neck region. In areas other than head and neck and acral regions, the globular pattern was the commonest pattern (34.8%, 71/204) regardless of age. Parallel furrow pattern occurred in 46.0% (87/189) of acral MN, followed by fibrillar pattern (21.7%, 41/189).

Unique clinical and dermoscopic features exist in Chinese patients with MN compared with observations reported in other population.

Serum human chorionic gonadotrophin (hCG) is higher in twin than that in singleton pregnancies. As hCG stimulates the thyroid to produce more free thyroxine (FT4), which may lead to decreased thyroid-stimulating hormone (TSH) levels, the reference ranges of thyroid-related indicators may differ between singleton and twin pregnancies in the first trimester. This study aimed to establish reference ranges for thyroid-related indicators in early twin pregnancies and to compare them with singleton pregnancies.

Data of 820 twin-pregnant women were extracted from the established database of all pregnant women who delivered at Peking University First Hospital from October 2013 to May 2018; 160 who met National Academy of Clinical Biochemistry criteria were included to establish TSH and FT4 reference ranges. We screened 480 (3:1 paired) women with singleton pregnancies from the same database as controls. The Mann-Whitney test for TSH and FT4 levels was applied for comparisons between singleton and twin pregnancies.

First-trimester reference ranges (4–12 gestational weeks) for twin pregnancies were: TSH 0.69 (0.01–3.35) mIU/L and FT4 16.38 (12.45–23.34) pmol/L. Median TSH was significantly lower at 7 to 12 gestational weeks than that at 4 to 6 gestational weeks (0.62 vs. 0.96 mIU/L, Z = -1.964, P = 0.049); FT4 was not significantly different between the two groups. Compared to singleton pregnancies, median TSH was significantly lower (0.69 vs. 1.27 mIU/L, Z = -6.538, P = 0.000), and FT4 was significantly higher (16.38 vs. 14.85 pmol/L, Z = -7.399, P = 0.000) in twin pregnancies in the first trimester.

Specific reference ranges for thyroid-related indicators for twin pregnancies are needed to avoid a misdiagnosis of thyroid dysfunction. Moreover, establishment of separate reference ranges for 4 to 6 and 7 to 12 gestational weeks in twin pregnancies may be considered.

With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China.

The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution.

Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001)

This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China.

NCT02285257, https://clinicaltrials.gov/ct2/show/record/NCT02285257.

Deceleration capacity (DC) is a non-invasive marker for cardiac autonomic dysfunction; however, few studies have shown that the influence factors of cardiac autonomic dysfunction and the correlations between DC and stroke risk in paroxysmal atrial fibrillation (AF). We aimed to explore the influencing factors of abnormal DC and the relationships between DC and stroke risk in patients with paroxysmal AF.

The study included hospitalized paroxysmal AF patients with DC measurements derived from 24-h Holter electrocardiography recordings taken between August 2015 and June 2016. Multivariable regression analysis was performed to evaluate the associations between correlated variables and abnormal DC values. The relationship between DC and ischemic stroke risk scores in patients with paroxysmal AF was analyzed.

We studied 259 hospitalized patients with paroxysmal AF (143 [55.2%] male, mean age 66.4 ± 12.0 years); 38 patients of them showed abnormal DC values. In the univariate analysis, age, hypertension, heart failure, and previous stroke/transient ischemic attack (TIA) were significantly associated with abnormal DC values. Among these factors, a history of previous stroke/TIA (odds ratio = 2.861, 95% confidence interval: 1.356–6.039) were independently associated with abnormal DC values in patients with paroxysmal AF. The abnormal DC group showed a higher stroke risk with the score of congestive heart failure, hypertension, age >75 years, diabetes mellitus, previous stroke and TIA (CHADS₂) (2.25 ± 1.48 vs. 1.40 ± 1.34, t = -4.907, P = 0.001) and CHA₂DS₂-vascular disease, age 65–74 years and female category (VASc) (3.76 ± 1.95 vs. 2.71 ± 1.87, t = -4.847, P = 0.001) scores. Correlation analysis showed that DC was negatively correlated with CHADS₂ scores (r = -0.290, P < 0.001) and CHA₂DS₂-VASc scores (r = -0.263, P > 0.001).

Lower DC is closely associated with previous stroke/TIA, and is also correlated negatively with higher stroke risk scores in patients with paroxysmal AF. It could be a potential indicator of stroke risk in paroxysmal AF patients.

Both cortical and cortical-subcortical (cortex-involved) lesions are typically associated with embolic stroke, of which atrial fibrillation (AF) is the common cause. The aim of this study was to find out the associations between cortex-involved stroke, vascular risk factors, and the subtypes (discovery time and duration) of AF.

This was an imaging study of the China Atrial Fibrillation Screening in Acute Ischemic Stroke Patients (CRIST) trial. Between October 2013 and June 2015, 1511 acute ischemic stroke or transient ischemic attack (TIA) patients within 7 days after stroke onset at 20 Chinese hospitals were enrolled in this prospective, multicenter cohort, cross-sectional study. The final analysis of this sub-study included 243 patients with AF with required magnetic resonance imaging (MRI) sequences. AF was diagnosed by 6-day Holter monitoring and classified by duration of 24 h. Two stroke specialists blinded to the clinical information reviewed MRI (diffusion-weighted MRI). The third stroke specialists, also blinded to the clinical information, assessed the conflicts. Adjusted large artery atherosclerosis as confounding factor, the associations between cortex-involved lesions, vascular risk factors, and the subtype of AF were evaluated by univariate and multivariate regression analyses.

Of 243 acute ischemic stroke patients with AF, 190 were known AF and 53 were newly detected AF. There were 28 patients with AF persistent >24 h and 25 persistent ≤24 h in newly detected AF. Patients with newly detected AF were likely to have a fewer history of stroke or TIA (16.98% vs. 36.31%, P = 0.008) and lower fasting blood glucose (5.91 ± 1.83 mmol/L vs. 6.75 ± 3.83 mmol/L, P = 0.030) than patients with known AF. Among these 243 patients, 102 (41.98%) patients were with cortex-involved lesions. Cortex-involved lesions were significantly related to newly detected AF persistent >24 h (odds ratio [OR]: 4.517, 95% confidence interval [CI]: 1.490–13.696, P = 0.008), proteinuria (OR: 3.431, 95% CI: 1.530–7.692, P = 0.021), and glycosylated hemoglobin (OR: 0.632, 95% CI: 0.464–0.861, P = 0.004).

Compared to previously known AF, newly detected AF persistent >24 h was associated with cortex-involved ischemic stroke.

NCT02156765, https://clinicaltrials.gov/ct2/show/record/NCT02156765

The pathogenesis of obstructive sleep apnea (OSA) remains not fully understood. This study aimed to explore the mechanism of OSA by assessing the association between the human tandem of P domains in a weak inwardly rectifying K⁺ channel (TWIK)-related acid-sensitive K⁺ channel-1 (TASK-1) gene and OSA.

A total of 164 patients with severe OSA and 171 patients without OSA were recruited from the Center for Hypertension of People’s Hospital of Xinjiang Uygur Autonomous Region (China) from April to December in 2016. Two single nucleotide polymorphisms (rs1275988 and rs2586886) in the TASK-1 gene were selected and genotyped using a kompetitive allele specific polymerase chain reaction genotyping system. Clinical-pathological characteristics and genotype data were compared between the severe and non-OSA groups to explore the association between TASK-1 gene polymorphism and severe OSA.

There were no significant differences in genotype distribution, allele frequency, and the recessive and dominant model of the two selected single nucleotide polymorphisms (rs1275988 and rs2586886) between the severe and non-OSA groups in the total population (P < 0.05). However, for patients with a body mass index (BMI) ≥28 kg/m², the distribution of genotypes and alleles, and the recessive model (GG + GA vs. AA) exhibited significant differences between the severe and non-OSA group (for genotypes: P = 0.014 and P = 0.026; for alleles: P = 0.006 and P = 0.011; for the recessive model: P = 0.005 and P = 0.009, respectively). The simple logistic regression analysis revealed that the GG genotype was a risk factor for OSA. The odds ratio (OR) and 95% confidence intervals (CI) were 4.902 (1.582–15.186, P = 0.006) for rs1275988 and 4.420 (1.422–13.734, P = 0.010) for rs2586886, respectively. In multivariate logistic regression analysis, the combination of GG genotypes of rs1275988 with BMI ≥28 kg/m² increased the risk of severe OSA (OR = 8.916, 95% CI 4.506–17.645, P < 0.001).

Both the GG genotype of rs1275988 and GG genotype of rs2586886 in the TASK-1 gene may play as potential risk factors in obese patients with OSA.

Unpredictable difficult laryngoscopy (DL) remains a challenge for anesthesiologists, especially when difficult ventilation occurs during standard laryngoscopy. Accurate airway assessment should always be performed, but the common airway assessment methods only perform superficial screening. Thus, the deep laryngopharyngeal anatomy may not be evaluated. Ultrasound-based airway assessment has been recently proposed as a useful, simple, and non-invasive bedside tool as an adjunct to clinical methods, which may facilitate identification of DL. The present study aimed to determine the correlation between ultrasound-measured indicators and DL.

Patients undergoing elective surgery under general anesthesia with tracheal intubation were enrolled. Ultrasonic airway assessments were performed before anesthesia induction. Ultrasound diagnostic indicators included the thickness and width of the base of the tongue, the angle between the epiglottis and glottis, the length of the thyrohyoid membrane, and the thickness of the lateral pharyngeal wall. A score of ≥3 in the Modified Cormack-Lehane Scoring System was used as a standard of DL and was also applied to divide patients into DL and non-DL groups. The area under the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic ability of various diagnostic indicators.

A total of 499 patients were enrolled into non-DL and DL groups comprising 452 (452/499, 90.6%) and 47 (47/499, 9.4%) patients, respectively. One ultrasonic diagnoses indicator correlated with DL, namely, the angle between the epiglottis and glottis. When the angle between the epiglottis and glottis was 50°, the area under the ROC curve was maximum (0.902), and the best sensitivity (81%) and specificity (89%) were achieved.

Airway ultrasounds should be considered to identify DL. The ultrasonic angle measured between the epiglottis and glottis is highly associated with DL, which may occur when the angle is less than 50°.

ChiCTR-DDT-13004102, http://www.chictr.org.cn/showproj.aspx?proj=5465

Rapid visual acuity (VA) decline was a common complaint in patients with sellar/suprasellar germinoma. In our hospital, 3.4 Gy/2f of emergency irradiation was applied to save patient VA and enable subsequent chemoradiotherapy. This study aimed to investigate the efficacy of emergency irradiation with 3.4 Gy/2f in patients with sellar/suprasellar germinoma who had rapid VA decline.

From January 2014 to December 2017, 33 patients with sellar/suprasellar germinoma who complained of VA decline within 3 months received 3.4 Gy/2f of emergency irradiation in Beijing Tiantan Hospital. The best-corrected VA (BCVA) and mean deviation (MD) were measured. Correlations between visual function change and clinical factors, including age at diagnosis, duration of VA decline, extent of tumor regression, serum level of tumor markers, were analyzed.

Among 33 patients with sellar/suprasellar germinoma, the median diameter and volume of sellar/suprasellar lesions were 32 mm (range: 5–55 mm) and 12.9 cm³ (range 0.6–58.5 cm³), respectively. Data on pre- and post-emergency-irradiation BCVA were obtained in 32 patients. For the right eyes, BCVA was improved in 23 patients (71.9%), unchanged in 7 (21.9%), and worsened in 2 (6.2%); and for the left eyes, these numbers were 27 (84.4%), 4 (12.5%), and 1 (3.1%), respectively. In terms of the logarithm of the minimum angle of resolution (logarithm of the minimum angle of resolution = Log (1/BCVA) score, the improvement was significant in both eyes (P < 0.001). In terms of MD, six patients had paired data and the improvement was marginal in the right eyes (P = 0.068) and significant in the left eyes (P = 0.043). However, no clinical factor was found to have correlation with visual function improvement.

In sellar/suprasellar germinoma patients with VA decline, 3.4 Gy/2f of emergency irradiation was effective in improving visual function.

Acitretin and matrine have been used in the treatment of psoriasis in China. This study was designed to investigate the role and related mechanisms of matrine alone and in combination with acitretin in the treatment of psoriasis in vitro and in vivo.

HaCaT cells were treated with matrine at different concentrations of 0 (blank control), 0.2, 0.4, 0.8, and 1.6 mg/mL for 24, 48, 72 h, respectively. 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium cell viability assay was used to assess the growth and proliferation of HaCaT cells. Cell cycle and apoptosis were detected by flow cytometry. Expression of protein was detected by Western blotting. Autophagy was observed by transmission electron microscopy. Then HaCaT cells were assigned to normal saline (NS) control group, matrine (0.4 mg/mL) group, acitretin (10 μmol/L) group, and matrine plus acitretin group, and the above methods were repeated. In animal experiments, the cumulative score (erythema, scaling, thickening) as a measure of the severity of inflammation was used to measure the skin performance of mice after treated with matrine 50 mg/kg, acitretin 4.5 mg/kg or combination of the two drugs on the psoriasis-like mouse models, respectively. Pathological findings of the lesions were observed, and the protein expressions in the lesions were detected by immunohistochemistry.

Cell proliferation inhibition was seen in HaCaT cells with treatment of matrine in a dose- and time-dependent manner (P < 0.01, respectively). Cell cycle G0/G1 phase arrest was observed in a dose-dependent way (P < 0.01). The expression of p21 (P < 0.05), LC3II/I (P < 0.01), and Beclin 1 (P < 0.01) increased and the expression of cyclin D1 (P < 0.05) decreased with increasing doses of matrine. Compared with the blank control, more autophagosomes were seen in HaCaT cells treated with matrine at 0.4 mg/mL by transmission electron microscopy (2.667 ± 1.202 vs. 21.33 ± 1.453, t = 9.899, P < 0.01). Cell proliferation inhibition and degree of the G0/G1 phase arrest was significantly higher in matrine plus acitretin group than those in matrine, acitretin, or the NS control group (P < 0.01, respectively). Compared with matrine or acitretin group, the expression of p21 (P < 0.05, P < 0.05) and LC3II/I (P < 0.01, P < 0.05) in matrine plus acitretin group increased significantly and the expression of cyclin D1 (P < 0.01, P < 0.05) and p62 (P < 0.05, P < 0.05) was reduced significantly. Compared with matrine or acitretin, matrine plus acitretin significantly down-regulated the phosphorylation of phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway (P < 0.05) and its downstream p-p70S6K (P < 0.05). In addition, the cumulative score of mice in the matrine plus acitretin group was significantly better than that in the matrine or acitretin group (1.480 ± 0.230 vs. 2.370 ± 0.241, P < 0.01; 1.480 ± 0.230 vs. 2.888 ± 0.341, P < 0.01). The expression of LC3 protein in the matrine plus acitretin group was also higher than that in the matrine, acitretin, or the NS control group (P < 0.05, respectively).

Matrine has therapeutic potentials for psoriasis. Matrine and acitretin show synergistic effect via cell cycle arrest and autophagy induction by PI3K/Akt/mTOR pathway.

Dermoscopy is a useful technique for improving the diagnostic accuracy of various types of skin disorders. In China, dermoscopy has been widely accepted, and domestic researchers have made tremendous progress in the field of dermoscopy. The main purpose of this review is to summarize the current status of dermoscopy in China and identify its future directions.

Articles included in this review were obtained by searching the following databases: Wanfang, China National Knowledge Infrastructure, PubMed, and the Web of Science. We focused on research published before 2019 with keywords including dermoscopy, dermoscopic, dermoscope and trichoscopy.

A total of 50 studies were selected. Of these studies, 20 studies were in Chinese and 30 in English, research samples of all the studies were collected from Chinese populations.

Since 2000, more than 380 articles about dermoscopy have been published in domestic or foreign journals. Dermoscopy can improve the diagnostic accuracy of neoplastic diseases, evaluating the therapeutic effect of treatment, and determining the treatment endpoint, and it can also assist in the differential diagnosis of inflammatory diseases and in the assessment of the severity of the disease. In addition, researches about the applications of dermoscopy during surgical treatment have been published. Training courses aiming to improve the diagnostic ability of dermatologists, either face-to-face or online, have been offered. The Chinese Skin Image Database, launched in 2017 as a work platform for dermatologists, has promoted the development of dermoscopy in China. Computer-aided diagnostic systems based on the Chinese population are ready for use. In the future, cooperation, resource sharing, talent development, image management, and computer-aided diagnosis will be important directions for the development of dermoscopy in China.

Dermoscopy has been widely used and developed in China, however, it still needs to address more challenges in the future.

In recent years, attempting the biventricular pathway or biventricular conversions in patients with borderline ventricle has become a hot topic. However, inappropriate pursuit of biventricular repair in borderline candidates will lead to adverse clinical outcomes. Therefore, it is important to accurately assess the degree of ventricular development before operation and whether it can tolerate biventricular repair. This review evaluated ventricular development using echocardiography for a better prediction of biventricular repair in borderline ventricle.

Articles from January 1, 1990 to April 1, 2019 on biventricular repair in borderline ventricle were accessed from PubMed, using keywords including "borderline ventricle," "congenital heart disease," "CHD," "echocardiography," and "biventricular repair."

Original articles and critical reviews relevant to the review’s theme were selected.

Borderline left ventricle (LV): (1) Critical aortic stenosis: the Rhodes score, Congenital Heart Surgeons Society regression equation and another new scoring system was proposed to predict the feasibility of biventricular repair. (2) Aortic arch hypoplasia: the LV size and the diameter of aortic and mitral valve (MV) annulus should be taken into considerations for biventricular repair. (3) Right-dominant unbalanced atrioventricular septal defect (AVSD): atrioventricular valve index (AVVI), left ventricular inflow index (LVII), and right ventricle (RV)/LV inflow angle were the echocardiographic indices for biventricular repair. Borderline RV: (1) pulmonary atresia/intact ventricular septum (PA/IVS): the diameter z-score of tricuspid valve (TV) annulus, ratio of TV to MV diameter, RV inlet length z-score, RV area z-score, RV development index, and RV-TV index, etc. Less objective but more practical description is to classify the RV as tripartite, bipartite, and unipartite. The presence or absence of RV sinusoids, RV dependent coronary circulation, and the degree of tricuspid regurgitation should also be noted. (2) Left-dominant unbalanced AVSD: AVVI, LV, and RV volumes, whether apex forming ventricles were the echocardiographic indices for biventricular repair.

Although the evaluation of echocardiography cannot guarantee the success of biventricular repair surgery, echocardiography can still provide relatively valuable basis for surgical decision making.

This review aimed to summarize research progress regarding congenital cytomegalovirus (cCMV) infection-related nervous system diseases and their mechanisms.

All literature quoted in this review was retrieved from PubMed and Web of Science using the keywords "Cytomegalovirus" and "Neurologic disease" in English. To identify more important information, we did not set time limits.

Relevant articles were selected by carefully reading the titles and abstracts. Then, different diagnosis and clinical treatment methods for human CMV infection-related neurologic diseases were compared, and the main mechanism and pathogenesis of neurologic damage caused by CMV were summarized from the selected published articles.

cCMV infection is a major cause of neonatal malformation. cCMV can infect the fetal encephalon during early gestation and compromise neurodevelopment, resulting in varying degrees of neurologic damage, mainly including hearing impairment, central nervous system (CNS) infection, neurodevelopmental disorders, ophthalmic complications, cerebral neoplasms, infantile autism, epilepsy, and other neurologic abnormalities.

cCMV infection-induced neurodevelopmental abnormalities, which were directly caused by fetal encephalon infection, thus inducing neuroimmune responses to damage nerve cells. Such abnormalities were also caused by suppression of the proliferation and differentiation of neural progenitor cells by CMV’s gene products. cCMV infection in the fetal encephalon can also inhibit neuronal migration and synapse formation and indirectly trigger placental inflammation and thus disrupt the oxygen supply to the fetus.

Skin tumors begin from normal skin cells, and some parts of them may transform with the potential to reproduce in an out-of-control manner.^[1]Skin tumors are exceedingly common and the incidence is increasing at an alarming rate across the globe. There is a significant cost burden in the care of skin tumors for many countries and health expenditure for which will continue to grow as the incidence increases.^[2]The common processes for skin tumors diagnosis include an initial clinical screening, radiological image, and histopathological examination.^[3]In the field of dermatology, there are various kinds of skin diseases and there is a vast amount of patients with skin diseases in China. However, there are only around 24,000 dermatologists in China, and on average, there is only one dermatologist for every 60,000 people; even in the underdeveloped areas, there is only one dermatologist for every 100,000 people.^[4]Dermatologists in China have a large patient volume, as Dr. Zhang described in "A Day in the Life of a Chinese Dermatologist."^[5]The imaging diagnosis ability of skin tumors is inconsistent among different regions and hospitals by Chinese dermatologists.

To the Editor:Dermatofibroma is a very common benign tumor of the skin composed of fibrohistiocytic cells, which may occur anywhere on the body surface with a predilection for the extremities in adult patients. Clinically, dermatofibromas appear as firm, single or multiple hard papules, plaques or nodules, with a smooth surface, the usual color varying from light brown to dark brown, purple red or yellow. Characteristically, the lateral compression of these tumors may produce a dimple-like depression in the overlying skin, a feature known as the dimple sign.^[1]Dermoscopy is a non-invasive method used in the diagnosis and management of pigmented skin tumors.^[1,2,3,4]

To the Editor:A 57-year-old woman presented to our clinic for a pigmented patch on the left foot, which appeared 5 months earlier and progressively enlarged. She felt no pain or any other feelings. Physical examination revealed a light brown patch with an irregular shape and multiple colors, sized 10 mm × 8 mm on the left foot [Figure 1A].

To the Editor:Unilateral nevoid telangiectasia (UNT) is a rare vascular dermatosis characterized by telangiectasia that is distributed in a linear, unilateral pattern. The etiology of this condition is not yet fully understood, although high estrogen levels are thought to be related to its development.^[1]Affected patients often resort to treatment because of cosmetic distress. Pulsed dye laser (PDL) therapies have been employed to treat various vascular lesions, such as port-wine stains (PWS), hemangioma, spider angioma, and angiokeratoma. PDL modalities have the advantage of achieving selective photothermolysis, leading to selective vascular injury without unwanted thermal damage to surrounding tissue.^[2]Sharma and Khandpur have previously treated six UNT cases with PDL and reported that good to excellent lighting was achieved in five of these cases after 2 to 5 sessions.^[3]

To the Editor:Lichen planus is an inflammatory condition characterized by polygonal, discrete, and violaceous papules.^[1]Here, we report the dermoscopic features of two patients diagnosed with acute widespread lichen planus.

To the Editor:Gardner fibroma (GAF)^[1]is usually companied by familial adenomatous polyposis (FAP), which is related to mutations in adenomatous polyposis coli (APC).^[2,3,4]Both GAF and FAP present with signs of Gardner syndrome (GS), triad of intestinal polyposis, soft tissue tumor (including GAF and desmoid), and osteomas.^[2,3,4]Here, we presented a man who was diagnosed with sporadic GAF withoutAPCgene mutations. In addition, a tubular adenoma was revealed in his sigmoid. We confirmed the significance of GAF as a powerful sentinel element for gastrointestinal organ and bone problems with or without APC mutations.^[3]

To the Editor:A 62-year-old man came to our department and complained with progressively enlarging and bleeding multiple reddish nodules on his face for 20 days. The patient had a previous history of hepatitis B without any treatment for 20 years. Three months ago, he was diagnosed as hepatocellular carcinoma (HCC) and multiple metastases (including lung and inferior vena cava). Then, he was treated with transcatheter arterial chemoembolization and antivirus drugs. The physical examination showed six reddish, firm, and nodules with diameters of 1 to 10 mm on his face. Some lesions accompanied with capillaries dilatation, rupture, and bleeding [Figure 1AandFigure 1B]. Dermoscopic examination revealed homogenous, blurry milky-red area, multiple serpentine and arborizing vessels, and some irregular red lacunas over a milky-red areas [Figure 1C]. The skin biopsy from a bleeding nodule revealed a large number of mass tumor cells in dermis. The tumors were composed of pleomorphic cells with increased mitosis, and inter-cellular bleeding was noted [Figure 1D]. Furthermore, cutaneous metastases from HCC was confirmed by immunohistochemical staining [Figure 1EandFigure 1F], which showed hepatocyte (+), arginase-1 (+), cytokeratin (+), Ki-67 (30%+), cytokeratin 19 (–), α-fetoprotein (–), carcinoembryonic antigen (–), and epithelial membrane antigen (–).

To the Editor:A 43-year-old man was diagnosed with acute T-cell lymphoblastic leukemia. He underwent allogeneic stem cell transplantation with a 6/6 human leukocyte antigen (HLA)-match; the donor was his sister. Cyclosporine A was used for 5 months as a prophylactic for graftvs. host disease. Three months after discontinuation of cyclosporine A, he developed papules on his face. Upon physical examination, multiple small dome-shaped, reddish-brown papules were observed on the central area of the face that extended to both cheeks, lower eyelids, and chin [Figure 1A]. Extra-facial lesions were absent. Dermoscopy examination of the papules demonstrated dotted vessels and linear vessels arranged both horizontally and vertically, forming a polygonal pattern, and the structure of targetoid follicule plugs was not observed. The mode of dermoscopy for observation was polarized light, non-wetting [Figure 1E]. Diascopic examination revealed an apple-jelly appearance. Histopathological analysis demonstrated epithelioid cell granulomas, with central areas of caseation necrosis and Langhans giant cells surrounding a moderate lymphohistiocytic infiltrate [Figure 1CandFigure 1D]. An acidfast stain was performed on the pathology tablets, and no mycobacteria were found. Laboratory analyses, including full blood count, erythrocyte sedimentation rate, serum calcemia, serum angiotensin-I-converting enzyme level, blood chemistry, tuberculosis infection T cell spot test (T-SPOT), and a chest X-ray were normal or negative. He was diagnosed with lupus miliaris disseminatus faciei (LMDF). The patient and the donor both had rosacea and LMDF before. In the first 3 months, intra-muscular injection of 1 mL of the compound betamethasone was given once a month. The patient was also prescribed isotretinoin at a dose of 10 mg/day and topical tacrolimus twice a day and had a good clinical response. After 6 months of treatment, the lesions improved [Figure 1B].

To the Editor: Cosmetics (non-prescription skin care products) use-induced adverse events could present as skin erythema, papules, pruritus, dryness, desquamation, and abnormal discoloration. Non-medicated cosmetics use is more and more common in the China, but little is known about the characteristics of cosmetic-related adverse events. In this study, we assessed the clinical features, involved products, path-testing rate, and patient’s education level distributions in cosmetic-related adverse events in southern China.

To the Editor:Auditory verbal hallucination (AVH) is defined as the hearing of voices in the absence of any external auditory stimulus.^[1,2,3]Most AVH content is related to the experiencer, and these events usually cause serious distress. AVHs can occur in patients with a broad range of mental disorders and neurological diseases, such as schizophrenia, bipolar disorder (BP), major depressive disorder (MDD), post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), and in healthy individuals.^[2,3,4]They are most prevalent in schizophrenic patients, affecting more than 70% of this population. Beyond schizophrenia, up to 46% of patients with BPD, 11.3% to 62.8% of persons with BP, 5.4% to 40.6% of those with MDD, and 4.2% of individuals in the general population experience AVHs.^[1,2,3,4]

To the Editor:Mitochondrial diseases are a common group of human genetic diseases that can occur at any decade of life. Mitochondrial DNA (mtDNA) mutations are responsible for most adult-onset mitochondrial diseases.^[1]There are over 260 known pathogenic mutations in mtDNA.^[2]In the last two decades, a large number of pathogenic mutations of mtDNA have been reported, which associate with a wide spectrum of clinical features.^[3]