Volume 133 · Issue 17 · 2020

最近的冠状病毒疾病2019（新冠肺炎）疫情完全扰乱了医院和门诊活动。^[1,2]它已经进行了重组，以减少患者流入，减少非紧急门诊就诊，并集中公共卫生力量抗击新冠肺炎疫情。在这次重组中，皮肤科也调整了他们的活动，暂停常规患者就诊，只提供紧急手术切除、紧急就诊、咨询和肿瘤检查。

Youzhi artificial intelligence (AI) software is the AI-assisted decision-making system for diagnosing skin tumors. The high diagnostic accuracy of Youzhi AI software was previously validated in specific datasets. The objective of this study was to compare the performance of diagnostic capacity between Youzhi AI software and dermatologists in real-world clinical settings.

A total of 106 patients who underwent skin tumor resection in the Dermatology Department of China-Japan Friendship Hospital from July 2017 to June 2019 and were confirmed as skin tumors by pathological biopsy were selected. Dermoscopy and clinical images of 106 patients were diagnosed by Youzhi AI software and dermatologists at different dermoscopy diagnostic levels. The primary outcome was to compare the diagnostic accuracy of the Youzhi AI software with that of dermatologists and that measured in the laboratory using specific data sets. The secondary results included the sensitivity, specificity, positive predictive value, negative predictive value, F-measure, and Matthews correlation coefficient of Youzhi AI software in the real-world.

The diagnostic accuracy of Youzhi AI software in real-world clinical settings was lower than that of the laboratory data (P < 0.001). The output result of Youzhi AI software has good stability after several tests. Youzhi AI software diagnosed benign and malignant diseases by recognizing dermoscopic images and diagnosed disease types with higher diagnostic accuracy than by recognizing clinical images (P = 0.008, P = 0.016, respectively). Compared with dermatologists, Youzhi AI software was more accurate in the diagnosis of skin tumor types through the recognition of dermoscopic images (P = 0.01). By evaluating the diagnostic performance of dermatologists under different modes, the diagnostic accuracy of dermatologists in diagnosing disease types by matching dermoscopic and clinical images was significantly higher than that by identifying dermoscopic and clinical images in random sequence (P = 0.022). The diagnostic accuracy of dermatologists in the diagnosis of benign and malignant diseases by recognizing dermoscopic images was significantly higher than that by recognizing clinical images (P = 0.010).

The diagnostic accuracy of Youzhi AI software for skin tumors in real-world clinical settings was not as high as that of using special data sets in the laboratory. However, there was no significant difference between the diagnostic capacity of Youzhi AI software and the average diagnostic capacity of dermatologists. It can provide assistant diagnostic decisions for dermatologists in the current state.

Diagnoses of Skin diseases are frequently delayed in China due to lack of dermatologists. A deep learning-based diagnosis supporting system can facilitate pre-screening patients to prioritize dermatologists’ efforts. We aimed to evaluate the classification sensitivity and specificity of deep learning models to classify skin tumors and psoriasis for Chinese population with a modest number of dermoscopic images.

We developed a convolutional neural network (CNN) based on two datasets from a consecutive series of patients who underwent the dermoscopy in the clinic of the Department of Dermatology, Peking Union Medical College Hospital, between 2016 and 2018, prospectively. In order to evaluate the feasibility of the algorithm, we used two datasets. Dataset I consisted of 7192 dermoscopic images for a multi-class model to differentiate three most common skin tumors and other diseases. Dataset II consisted of 3115 dermoscopic images for a two-class model to classify psoriasis from other inflammatory diseases. We compared the performance of CNN with 164 dermatologists in a reader study with 130 dermoscopic images. The experts’ consensus was used as the reference standard except for the cases of basal cell carcinoma (BCC), which were all confirmed by histopathology.

The accuracies of multi-class and two-class models were 81.49% ± 0.88% and 77.02% ± 1.81%, respectively. In the reader study, for the multi-class tasks, the diagnosis sensitivity and specificity of 164 dermatologists were 0.770 and 0.962 for BCC, 0.807 and 0.897 for melanocytic nevus, 0.624 and 0.976 for seborrheic keratosis, 0.939 and 0.875 for the "others" group, respectively; the diagnosis sensitivity and specificity of multi-class CNN were 0.800 and 1.000 for BCC, 0.800 and 0.840 for melanocytic nevus, 0.850 and 0.940 for seborrheic keratosis, 0.750 and 0.940 for the "others" group, respectively. For the two-class tasks, the sensitivity and specificity of dermatologists and CNN for classifying psoriasis were 0.872 and 0.838, 1.000 and 0.605, respectively. Both the dermatologists and CNN achieved at least moderate consistency with the reference standard, and there was no significant difference in Kappa coefficients between them (P > 0.05).

The performance of CNN developed with relatively modest number of dermoscopic images of skin tumors and psoriasis for Chinese population is comparable with 164 dermatologists. These two models could be used for screening in patients suspected with skin tumors and psoriasis respectively in primary care hospital.

Long non-coding RNAs (lncRNAs) play key roles in human cancers. In our previous study, we demonstrated that lncRNA FKBP prolyl isomerase 9 pseudogene 1 (FKBP9P1) was highly expressed in head and neck squamous cell cancer (HNSCC) tissues. However, its functional significance remains poorly understood. In the present study, we identify the role and potential molecular biologic mechanisms of FKBP9P1 in HNSCC.

Quantitative real-time polymerase chain reaction was used to detect the expression of FKBP9P1 in HNSCC tissues, matched adjacent normal tissues, human HNSCC cells (FaDu, Cal-27, SCC4, and SCC9), and human immortalized keratinocytes cell HaCaT (normal control). Cal-27 and SCC9 cells were transfected with sh-FKBP9P1-1, sh-FKBP9P1-2, and normal control (sh-NC) lentivirus. Cell counting kit-8 assay, colony formation assay, wound healing assay, and trans-well assay were used to explore the biologic function of FKBP9P1 in HNSCC cells. Furthermore, western blotting was used to determine the mechanism of FKBP9P1 in HNSCC progression. Chi-squared test was performed to assess the clinical significance among FKBP9P1 high-expression and low-expression groups. Survival analyses were performed using the Kaplan-Meier method and assessed using the log-rank test. The comparison between two groups was analyzed by Student t test, and comparisons among multiple samples were performed by one-way analysis of variance and a Bonferroni post hoc test.

FKBP9P1 expression was significantly up-regulated in HNSCC tissues (tumor vs. normal, 1.914 vs. 0.957, t = 7.746, P < 0.001) and cell lines (P < 0.01 in all HNSCC cell lines). Besides, the median FKBP9P1 expression of HNSCC tissues (1.677) was considered as the threshold. High FKBP9P1 level was correlated with advanced T stage (P = 0.022), advanced N stage (P = 0.036), advanced clinical stage (P = 0.018), and poor prognosis of HNSCC patients (overall survival, P = 0.002 and disease-free survival, P < 0.001). Knockdown of FKBP9P1 led to marked repression in proliferation, migration, and invasion of HNSCC cells in vitro (P all < 0.01). Mechanistically, silencing FKBP9P1 was observed to restrain the PI3K/AKT signaling pathway.

Silencing lncRNA FKBP9P1 represses HNSCC progression and inhibits PI3K/AKT (phosphatidylinositol 3 kinase/AKT Serine/Threonine Kinase) signaling in vitro. Therefore, FKBP9P1 could be a potential new target for the diagnosis and treatment of HNSCC patients.

The classification criteria and staging groups for nasopharyngeal carcinoma described in the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) staging system have been revised over time. This study assessed the proportion of patients whose staging and treatment strategy have changed due to revisions of the UICC/AJCC staging system over the past 10 years (ie, from the sixth edition to the eighth edition), to provide information for further refinement.

We retrospectively reviewed 1901 patients with non-metastatic nasopharyngeal carcinoma treated in our cancer center between November 2009 and June 2012. The Akaike information criterion and Harrell concordance index were applied to evaluate the performance of the staging system.

In total, 25 (1.3%) of the 1901 patients who were staged as T2a according to the sixth edition system were downgraded to T1 in the eighth edition; 430 (22.6%) staged as N0 in the sixth edition were upgraded to N1 in the eighth edition; 106 (5.6%) staged as N1/2 in the sixth edition were upgraded to N3 in the eighth edition. In addition, 51 (2.7%) and 25 (1.3%) of the study population were upstaged from stage I to stage II and stage II to stage IVa, respectively; 10 (0.5%) was downgraded from stage II to stage I. The survival curves of adjacent N categories and staging groups defined by eighth classification system were well-separated. However, there was no significant difference in the locoregional failure-free survival (P = 0.730) and disease-free survival (P = 0.690) rates between the T2 and T3 categories in the eighth edition classification system.

Modifications to the tumor-node-metastasis staging system over the past 10 years have resulted in N classification changes in numerous cases. Although the eighth edition tumor-node-metastasis staging system better predicts survival outcomes, the T classification could be simplified in future revisions.

Ectopic pregnancy (EP) is a common complication in women undergoing assisted reproductive treatment, but the underlying causes for this remain unclear. This study aimed to explore factors affecting the incidence of EP in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1, 2013 and December 31, 2017. Patient age, infertility diagnosis (tubal factor or not), primary or secondary infertility, type of cycle (frozen-thawed or fresh), type of embryo(s) transferred (cleavage embryo or blastocyst), number of embryos transferred (one, two, or three), previous history of EP, and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP. Based on clinical typing results, the patients were divided into an EP group or a non-EP group. Categorical variables were analyzed using Chi-squared test or Fisher exact test. Logistic regression analysis was performed to explore their associations with the incidence of EP.

The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group (31.3% vs. 46.7%, χ² = 26.032, P < 0.001). The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group (89.2% vs. 63.6%, χ² = 77.410, P < 0.001). The percentages of patients with transfer of cleavage-stage embryo or blastocyst (91.4% vs. 84.4%, χ² = 10.132, P = 0.001) and different endometrial combined thickness (ECT) (χ² = 18.373, P < 0.001) differed significantly between EP and non-EP groups. For patients who had a previous history of one to four EPs, the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group (92.2% vs. 77.6%, χ² = 13.737, P < 0.001). In multivariate logistic regression analysis, tubal infertility was strongly associated with EP (adjusted odds ratio: 3.995, 95% confidence interval: 2.706-5.897, P < 0.001).

In IVF/ICSI cycles, transfer of a blastocyst-stage embryo, especially for patients with a previous history of EP, reduced the rate of EP. Tubal infertility was strongly associated with EP.

The effects of oral contrast agents (OCAs) on dosimetry have not been studied in detail. Therefore, this study aimed to examine the influence of OCAs on dose calculation in volumetric-modulated arc therapy plans for rectal cancer.

From 2008 to 2016, computed tomography (CT) images were obtained from 33 rectal cancer patients administered OCA with or without intravenous contrast agent (ICA) and 14 patients who received no contrast agent. CT numbers of organs at risk were recorded and converted to electronic densities. Volumetric-modulated arc therapy plans were designed before and after the original densities were replaced with non-enhanced densities. Doses to the planned target volume (PTV) and organs at risk were compared between the plans.

OCA significantly increased the mean and maximum densities of the bowels, while the effects of ICA on these parameters depended on the blood supply of the organs. With OCA, the actual doses for PTV were significantly higher than planned and doses to the bowel increased significantly although moderately. However, the increase in the volume receiving a high-range doses was substantial (the absolute change of intestine volume receiving ≥52 Gy: 1.46 [0.05-3.99, cubic centimeter range: -6.74 to 128.12], the absolute change of colon volume receiving ≥50 Gy: 0.34 [0.01-1.53 cc, range: -0.08 to 3.80 cc]. Dose changes due to ICA were insignificant. Pearson correlation showed that dose changes were significantly correlated with a high intestinal volume within or near the PTV (ρ > 0.5, P < 0.05) and with the density of enhanced intestine (ρ > 0.3, P < 0.05).

Contrast agents applied in simulation cause underestimation of doses in actual treatment. The overdose due to ICA was slight, while that due to OCA was moderate. The bowel volume receiving ≥50Gy was dramatically increased when OCA within the bowel was absent. Physicians should be aware of these issues if the original plan is barely within clinical tolerance or if a considerable volume of enhanced intestine is within or near the PTV.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Genome-wide association studies in non-Asian population revealed a link between COPD and mutations in the PTCH1 gene encoding Patched1, a receptor in the Hedgehog signaling pathway important for lung morphogenesis and pulmonary function. The aim of this study was to investigate the association between PTCH1 polymorphisms and the COPD risk in the Chinese Han population.

We performed a case-control study including 296 patients with COPD and 300 healthy individuals. Single-nucleotide polymorphisms in the PTCH1 gene were identified and genotyped based on the linkage disequilibrium analysis in all participants. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis after adjustment for age, gender, and smoking.

In total, 28 single-nucleotide polymorphisms were identified in patients with COPD. Among them, "A" allele of rs28491365 (OR: 1.388, 95% CI: 1.055-1.827, P = 0.018), and "G" alleles of rs10512248 (OR: 1.299, 95% CI: 1.021-1.653, P = 0.033) and rs28705285 (OR: 1.359, 95% CI: 1.024-1.803, P = 0.033; respectively) were significantly associated with an increased COPD risk. Genetic model analysis revealed that the "T/T" genotype of rs34695652 was associated with a decreased COPD risk under the recessive model (OR: 0.490, 95% CI: 0.270-0.880, P = 0.010), whereas rs28504650/rs10512248 haplotype CG was significantly associated with an increased COPD risk after adjustment for age, gender, and smoking status (OR: 6.364, 95% CI: 1.220-33.292, P = 0.028).

The study provides a new insight into the role of PTCH1 polymorphisms in the susceptibility to COPD in the Chinese Han population.

Renal cell carcinoma (RCC) has the propensity to lead to venous tumor thrombus (VTT). Nephrectomy with tumor thrombectomy is an effective treatment option but is a technically challenging surgical procedure that is accompanied by a high rate of complications. The aims of this study were to investigate pre-operative imaging parameters for the assessment of inferior vena cava (IVC) wall invasion due to a tumor thrombus in patients with RCC and to identify predictors from the intra-operative findings.

Clinical and imaging data were collected from 110 patients who underwent nephrectomy with IVC tumor thrombectomy (levels I-IV) for RCC and IVC tumor thrombus at the Peking University Third Hospital between May 2015 and March 2018. Univariable and multivariable logistic regression and receiver operating characteristic curves were used to assess the correlations between pre-operative imaging features and intra-operative macroscopic invasions of the IVC wall by tumor thrombus.

Among the 110 patients, 41 underwent partial or segmental resection of IVC. There were univariate associations of pre-operative imaging parameters that could be used to predict the need for IVC resection, including those of the Mayo classification, maximum anterior-posterior (AP) diameter of the renal vein at the renal vein ostium (RVo), maximum AP diameter of the VTT at the RVo and IVC occlusion. For the multivariable analysis, the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of invasion of the IVC wall by tumor thrombus. The optimum imaging thresholds included an AP diameter of the VTT at the RVo larger than 17.0 mm and the presence of IVC occlusion, with which we predicted invasions of the IVC wall requiring IVC resection. The probabilities of intra-operative IVC resection for patients without both independent factors, with an AP diameter of the VTT at the RVo larger than 17.0 mm, with IVC occlusion, and with both concurrent factors were 5%, 23%, 56%, and 66%, respectively.

An increase in the AP VTT diameter at the RVo and the presence of complete occlusion of the IVC are independent risk factors for a high probability of IVC wall invasion by tumor thrombus.

Circular RNA ciRS-7 has been reported to be involved in the progression of various cancers. However, ciRS-7 expression and its role in clear cell renal cell carcinoma (ccRCC) progression remains unclear. This study aimed to investigate the effect of ciRS-7 expression on ccRCC and the related signaling pathway.

ciRS-7 expression was analyzed using quantitative reverse transcription polymerase chain reaction in 87 pairs of ccRCC and matched adjacent normal tissues. The role of ciRS-7 in ccRCC cell proliferation and invasion was determined using the cell counting kit-8 and invasion assays, respectively. Potential mechanisms underlying the role of ciRS-7 in promoting ccRCC progression were explored by Western blotting. The relationship between the expression of ciRS-7 and features of ccRCC was analyzed by the Chi-square test and progression-free survival was determined using a Kaplan-Meier plot.

ciRS-7 was overexpressed in ccRCC tissues compared with that in matched adjacent normal tissues. In addition, ciRS-7 up-regulation was closely associated with tumor diameter (P = 0.050), clinical stage (P = 0.009), and distant metastasis (P = 0.007). ciRS-7 knockdown in 786O and 769P cells markedly inhibited their proliferative and invasive abilities. In addition, ciRS-7 inhibition reduced phosphorylated epidermal growth factor receptor (p-EGFR) and phosphorylated serine/threonine kinase (p-Akt) levels.

ciRS-7 up-regulation could promote ccRCC cell proliferation and invasion, which may be related with the EGFR/Akt signaling pathway. ciRS-7 might be a potential ccRCC therapeutic target.

TOSO, also named Fas inhibitory molecule 3 (FAIM3), has recently been identified as an immunoglobulin M (IgM) Fc receptor (FcμR). Previous studies have shown that TOSO is specifically over-expressed in chronic lymphocytic leukemia (CLL). However, the functions of TOSO in CLL remain unknown. The B-cell receptor (BCR) signaling pathway has been reported to be constitutively activated in CLL. Here, we aimed to investigate the functions of TOSO in the BCR signaling pathway and the pathogenesis of CLL.

We over-expressed TOSO in B-cell lymphoma cell lines (Granta-519 and Z138) by lentiviral transduction and knocked down TOSO by siRNA in primary CLL cells. The over-expression and knockdown of TOSO were confirmed at the RNA level by polymerase chain reaction and protein level by Western blotting. Co-immunoprecipitation with TOSO antibody followed by liquid chromatography coupled with tandem mass spectrometry (IP/LCMS) was used to identify TOSO interacting proteins. Western blotting was performed to detect the activation status of BCR signaling pathways as well as B-cell lymphoma 2 (BCL-2). Flow cytometry was used to examine the apoptosis of TOSO-over-expressing B lymphoma cell lines and TOSO-down-regulated CLL cells via the staining of Annexin V and 7-AAD. One-way analyses of variance were used for intergroup comparisons, while independent samples t tests were used for two-sample comparisons.

From IP/LCMS, we identified spleen tyrosine kinase (SYK) as a crucial candidate of TOSO-interacting protein and confirmed it by co-immunoprecipitation. After stimulation with anti-IgM, TOSO over-expression increased the phosphorylation of SYK, and subsequently activated the BCR signaling pathway, which could be reversed by a SYK inhibitor. TOSO knockdown in primary CLL cells resulted in reduced SYK phosphorylation as well as attenuated BCR signaling pathway. The apoptosis rates of the Granta-519 and Z138 cells expressing TOSO were (8.46 ± 2.90)% and (4.20 ± 1.21)%, respectively, significantly lower than the rates of the control groups, which were (25.20 ± 4.60)% and (19.72 ± 1.10)%, respectively (P < 0.05 for both). The apoptosis rate was reduced after knocking down TOSO in the primary CLL cells. In addition, we also found that TOSO down-regulation in primary cells from CLL patients led to decreased expression of BCL-2 as well as lower apoptosis, and vice versa in the cell line.

TOSO might be involved in the pathogenesis of CLL by interacting with SYK, enhancing the BCR signaling pathway, and inducing apoptosis resistance.

黄褐斑是一种常见的、慢性的、获得性的、难治性的色素沉着过度，其发病机制是多因素的。^[1,2]目前的治疗包括局部或全身药物、化学换肤、基于激光和光的疗法以及传统中药。^[3]目前，黄褐斑的治疗评价主要可归纳为四类：（1）患者自我评价^[4];（2）皮肤科医生使用的评分系统^[5];（三）非侵入性检测技术^[6,7];(4)组织病理学和免疫组织化学评估。^[8]提供一种非侵入性、客观和可重复的方法来评估黄褐斑的治疗效果已经成为许多研究人员的焦点。在目前的综述中，讨论了近年来应用于黄褐斑治疗评估的常用和最新的非侵入性检测技术。

小汗腺囊瘤（EH）是由小汗腺分泌物潴留引起的小汗腺导管囊性扩张而衍生的良性肿瘤。EH很少见，多见于中年女性，尤其是长期在炎热潮湿环境中工作或停留的女性。病变通常累及眼周及颧骨区，表现为多发性半透明肤色至发蓝的囊肿。病变的大小和数目可随季节而波动，温暖天气加重，寒冷天气减轻。EH的组织病理学特征为单房真皮囊肿，内衬两层立方形至扁平上皮细胞。

Morphea和生殖器外硬化性苔藓（ELS）是临床上相似的慢性炎症性皮肤病。睡眠的典型特征是红斑斑块、中枢性色素减退硬化和萎缩斑块的连续发展。ELS表现为蓝白色丘疹，合并或扩大为有光泽、硬化、瘢痕样斑块。睡眠和ELS之间的鉴别可能是困难的，尤其是在早期或非典型病例中。此外，可以观察到这两种情况的共存，并且经常需要活检来区分它们。皮肤镜检查作为一种非侵入性技术，在辅助诊断皮肤肿瘤和非肿瘤性皮肤病方面是有效的。报道使用皮肤镜检查诊断高加索患者睡眠和ELS的研究已陆续发表。^[1,2,3,4,5]我们设计了这项前瞻性研究来分析和比较中国患者睡眠障碍和ELS的皮肤镜特征。

关于保留十二指肠的胰头切除术（DPPHR）和胰十二指肠切除术（PD）的围手术期并发症、安全性和长期生活质量存在争议。我们对DPPHR和PD治疗胰头良性和低度恶性疾病进行了对比分析。本研究经新疆医科大学第一附属医院伦理委员会机构审查委员会批准（编号：K202001-14），符合赫尔辛基宣言由于这是一项回顾性研究，数据分析是匿名进行的，因此本研究免于患者的知情同意。

结直肠癌（CRC）是世界上第三大最常诊断的恶性肿瘤。在过去的几年里，在中国等发展中国家，CRC的发病率和死亡率都显著增加，对人类健康构成了严重威胁。目前认为，约70%的结肠直肠癌来源于常规腺瘤，30%来源于锯齿状腺瘤。^[1]据报道，晚期腺瘤的CRC发病率为20.0/10,000人-年，非晚期腺瘤为9.1/10,000人-年。^[2]结肠镜检查作为CRC筛查和随访的重要工具，可以通过发现和切除癌前病变来预防CRC的发展，从而有效降低发病率和死亡率。目前息肉切除术后监测指南大多建议根据基线风险分层间隔3至10年。^[3]然而，中国还没有这样的指南，医生倾向于在1年内进行下一次结肠镜检查，这比目前的国际建议要短得多。

蓝痣（BN）是一种良性的获得性色素性病变，其特征是蓝色或深蓝色色素沉着。大多数病变是良性的，随着时间的推移是稳定的，有时会发展成恶性蓝痣（MBN），这是恶性黑色素瘤的一种变体。MBN的预后至少与常规黑色素瘤一样严重。^[1]此外，包括结节性黑色素瘤、色素性基底细胞癌和黑色素瘤皮肤转移的BN的鉴别诊断可能导致过度手术切除。

致编辑：患者男，50岁，躯干和四肢出现瘙痒性丘疹和结节1个月。患者有20年酒精中毒史，10年梅尼埃病史。2个月前因梅尼埃病静脉注射七叶皂苷钠治疗5天。其他慢性病或特殊家族史均被否定。经体格检查，在其四肢、肩部和背部发现红色或棕色丘疹和直径3至5毫米的结节，伴有中央脐状坏死或角蛋白栓，伴有Kobner现象[图1A].超声检查、外周血细胞计数、生化检查基本正常。皮肤镜检查显示一个红棕色无结构区域，中心覆盖有结痂和鳞片，周围有白色边缘，周围有红色炎性圈，周围有偏振模式的环状和点状血管[图1B].组织病理学显示中央杯状坏死表皮中有中性粒细胞和变性角蛋白成分，坏死表皮下有变性胶原纤维，真皮血管周围有淋巴细胞片和散在的嗜酸性粒细胞[图1C].马森染色[图1D]和Verhoeff-van Gieson染色[图1E]证实了坏死表皮中胶原纤维和碎裂的弹性纤维的穿透。诊断为获得性反应性穿孔性胶原病，对口服抗组胺药、局部类固醇和窄带紫外线B治疗5周反应良好。患者报告病灶清除4个月，但在电话随访中再次饮酒后复发。

致编辑：皮脂腺癌（Sebaceous carcinoma，SC）是一种罕见的皮肤恶性肿瘤，由上皮衬里分化而来，起源于皮脂腺。^[1]因此，皮脂腺痣（NS）倾向于发展成良性或恶性肿瘤。^[2]在此，我们报告了一例罕见的SC病例的皮肤镜检查结果，该病例起源于NS，在糜烂性红斑表面出现突起结节，迅速由黄色色素斑块引起，未导致复发。皮肤镜检查是产生术前诊断的强有力的诊断工具。

致编辑：程序性死亡-1（PD-1）抑制剂是新型有效的抗肿瘤药物，但可能引起严重的免疫相关不良事件，如中毒性表皮坏死松解症和银屑病等。^[1]首个重组人源抗PD-1单克隆抗体信迪利单抗（信达生物，Inc.，中国苏州）于2018年底在中国获批上市。在此，我们报告了抗PD-1诱导肺癌急性加重斑块型银屑病的皮肤镜特征，以指导临床医生对这一潜在不良反应的关注。

致编辑：局限性淋巴管瘤（LC）是一种罕见的良性皮肤病，涉及真皮深层和皮下淋巴通道的错构瘤性淋巴畸形。皮肤LC（CLC）是最常见的淋巴管瘤。很少发生在阴囊。在以前的研究中已经研究了皮肤镜检查帮助临床医生做出CLC正确诊断的能力。

致编辑：影像学科学技术的不断发展和成熟，使皮肤影像学成为皮肤科必不可少的亚专科之一。这对改变皮肤科诊断模式产生了客观而全面的影响。由此可见，皮肤影像学已经成为所有皮肤科医生必须掌握的诊断技能之一。皮肤成像设备在临床和科学研究中起着至关重要的作用。它不仅是正确诊断皮肤病的必要辅助手段，也是皮肤成像能力强化的关键环节和硬件基础。皮肤镜检查、反射共聚焦显微镜（RCM）和甚高频（VHF）皮肤超声成像诊断系统（VHF skin ultra-sound）已成为中国皮肤科临床常用的皮肤成像设备。近年来，随着各级医院对皮肤科的日益重视，医疗设备投入不断增加，皮肤影像设备不断优化。据我们所知，目前尚无关于中国公立医院皮肤影像设备现状的文献报道。本研究拟调查分析全国皮肤影像设备现状，为进一步规范和加强皮肤影像设备发展和皮肤科建设提供客观依据。这样，有望为满足临床需求、实现医疗资源优化配置奠定基础。

致编辑：酒渣鼻是一种常见的面部中央皮肤慢性炎症性皮肤病，典型表现为潮红、红斑、丘疹、脓疱、phymatous改变等。^[1]红斑是所有类型酒渣鼻中最常见的表现。敏感性皮肤(SS)通常被定义为在暴露于某些物理、热或化学刺激时发生不愉快的感觉(瘙痒、烧灼感、疼痛和刺痛)，这些刺激通常不会在健康皮肤上引起此类感觉。据报道，74%的SS患者也可能出现红斑。^[2]酒渣鼻和SS的发病机制、用药、预后有较大差异，因此需要寻找可靠的非侵入性方法来鉴别两者。

致编辑：穿孔性皮肤病是一组以丘疹结节性皮疹为特征的疾病，内源性或外源性物质通过表皮消除。原发性穿孔性疾病包括反应性穿孔性胶原病、穿孔性弹性增生症、Kyrle病、穿孔性毛囊炎和获得性穿孔性皮肤病。穿孔现象也可能继发于一些其他皮肤病，如皮肤钙质沉着症、环状肉芽肿、嗜铬细胞真菌病、扁平苔藓、纹状苔藓和罕见的两面针苔藓。在此，我们报告了一例中国患者的广泛穿孔性两面针苔藓。

致编辑：Livedoid vasculopathy(LV)是一种涉及真皮浅层和中层血管的血栓闭塞性疾病，其特征是疼痛的红斑或紫癜性斑或丘疹、小结痂性溃疡和数月后残留的瓷白色萎缩性瘢痕。^[1,2]皮肤镜检查是一种无创、有效的图像分析技术^[3]这可以帮助皮肤科医生可视化色素沉着模式和血管结构，以及表皮和真皮的其他形态特征。本研究旨在确定2017年10月至2018年8月在我院接受治疗的LV患者的LV临床和皮肤镜特征。该研究由郑州大学第一附属医院伦理委员会批准（编号：2018-YB-05）。本研究按照既定指南和法规进行。我们已获得所有适当的患者同意书。在表格中，患者已经同意在杂志上报道他们的图像和其他临床信息。

致编辑：脂溢性角化病（Seborrheic keratosis，SK）是临床上最常见的皮肤良性肿瘤之一。然而，由于其临床特征的广泛变化，特别是当其病变的表现和皮肤镜发现都不典型时，将SK病变与其他良性或恶性皮肤肿瘤区分可能是具有挑战性的。^[1,2]我们在此报告一例腺样体型SK，在皮肤镜检查时最初模拟色素性基底细胞癌（BCC）。

致编辑：应激引起的胃溃疡是应激诱导的器官损伤的一个例子。应激性溃疡常见于危重患者，可导致与死亡率高度增加相关的显著上消化道出血。水浸泡和束缚应激（WIRS）是一种身体和心理应激源的复合体，其引起的损害类似于脓毒症、创伤或手术引起的胃部病变。^[1]值得注意的是，充分的粘膜血流在保护胃粘膜免受损伤中起着重要作用。无机硝酸盐存在于日常饮食中，尤其是一些蔬菜中。饮食中的硝酸盐可以被口腔细菌迅速转化为亚硝酸盐，并在酸性胃中进一步还原为一氧化氮（NO）。据报道，硝酸盐在缺氧或酸性条件下充当NO的生物储库。^[2]膳食硝酸盐作为NO供体，有可能在动物模型和人类中预防心血管疾病、血管损伤和高血压。^[3,4]我们之前的研究表明，膳食硝酸盐可以增强缺血皮瓣的血流量。^[5]在这里，我们探讨了硝酸盐治疗在应激诱导的蒙古沙鼠胃粘膜损伤中的作用。