Volume 132 · Issue 17 · 2019

人工智能（AI）最早是在1956年达特茅斯学院的一次著名会议上提出的。AI逐渐与所有学科相互关联，也渗透到医疗领域的方方面面。20世纪70年代初，医学研究人员发现了AI在生命科学中的适用性。^[1]AI可以在医学影像识别和辅助诊断等多个方面发挥作用，^[2]生物技术、^[3]药物研发、^[4]等，目前医学图像识别应用最为广泛。

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.

皮肤肿瘤始于正常的皮肤细胞，它们的某些部分可能会发生转化，并有可能以失控的方式繁殖。^[1]皮肤肿瘤非常常见，并且发病率在全球范围内以惊人的速度增加。对于许多国家来说，皮肤肿瘤的护理存在显著的成本负担，并且随着发病率的增加，其健康支出将继续增长。^[2]皮肤肿瘤诊断的常见过程包括初始临床筛查、放射学图像和组织病理学检查。^[3]在皮肤科领域，皮肤病种类繁多，中国皮肤病患者数量庞大。然而，我国皮肤科医生只有2.4万人左右，平均每6万人只有一名皮肤科医生；即使在欠发达地区，每10万人中也只有一名皮肤科医生。^[4]正如张医生在《中国皮肤科医生的一天》中所描述的那样，中国皮肤科医生的患者量很大。^[5]我国皮肤科医生对皮肤肿瘤的影像诊断能力在不同地区、不同医院之间并不一致。

致编辑：皮肤纤维瘤是一种非常常见的由纤维组织细胞组成的皮肤良性肿瘤，可发生于体表任何部位，成人患者好发于四肢。临床上，皮肤纤维瘤表现为坚挺、单个或多发硬丘疹、斑块或结节，表面光滑，通常颜色为浅棕色至深棕色、紫红色或黄色。典型地，这些肿瘤的侧向压迫可能在上覆皮肤中产生酒窝样凹陷，这一特征称为酒窝征。^[1]皮肤镜检查是一种用于诊断和治疗色素性皮肤肿瘤的非侵入性方法。^[1,2,3,4]

致编辑：一名57岁女性因左脚色素斑到我们诊所就诊，5个月前出现并逐渐增大。她没有感到疼痛或任何其他感觉。查体发现左脚10mm × 8mm，形状不规则，多色浅棕色斑块[图1A].

致编辑：单侧痣样毛细血管扩张症(UNT)是一种罕见的血管性皮肤病，其特征是毛细血管扩张呈线性、单侧模式分布。这种情况的病因尚未完全了解，尽管高雌激素水平被认为与其发展有关。^[1]受影响的患者经常因为美容困扰而求助于治疗。脉冲染料激光（PDL）疗法已被用于治疗各种血管病变，如鲜红斑痣（PWS）、血管瘤、蜘蛛血管瘤和血管角化瘤。PDL模式具有实现选择性光热分解的优点，导致选择性血管损伤，而不会对周围组织造成不必要的热损伤。^[2]Sharma和Khandpur之前用PDL治疗了6例UNT病例，并报告在2至5次治疗后，其中5例病例达到了良好至极好的照明。^[3]

致编辑：扁平苔藓是一种以多边形、离散和紫色丘疹为特征的炎性疾病。^[1]在此，我们报告了两例诊断为急性广泛性扁平苔藓患者的皮肤镜特征。

致编辑：加德纳纤维瘤(GAF)^[1]通常伴有家族性腺瘤性息肉病(FAP)，这与结肠腺瘤性息肉病的突变有关（APC).^[2,3,4]GAF和FAP均表现为Gardner综合征(GS)、肠息肉病三联征、软组织肿瘤(包括GAF和硬纤维瘤)和骨瘤。^[2,3,4]在这里，我们介绍了一名被诊断为散发性GAF的男子APC基因突变。此外，在他的乙状结肠发现了一个管状腺瘤。我们证实了GAF作为有或没有APC突变的胃肠器官和骨骼问题的强大前哨元素的重要性。^[3]

致编辑：男，62岁，来我科就诊，诉面部多发性红色结节进行性增大出血20天。患者既往有乙肝病史，未接受任何治疗20年。3个月前，他被诊断为肝细胞癌（HCC）和多处转移（包括肺和下腔静脉）。随后，他接受了经导管动脉化疗栓塞和抗病毒药物治疗。体格检查示面部有6个直径1~10mm的微红硬结节。部分病变伴有毛细血管扩张、破裂和出血[图1A和图1B].皮肤镜检查显示均匀、模糊的乳红色区域，多条蛇形和树枝状血管，以及乳红色区域上一些不规则的红色腔隙[图1C].出血结节的皮肤活检显示真皮中有大量肿瘤细胞。肿瘤由有丝分裂增加的多形性细胞组成，观察到细胞间出血[图1D].此外，通过免疫组织化学染色证实了HCC的皮肤转移[图1E和图1F]，其显示肝细胞(+)、精氨酸酶-1(+)、细胞角蛋白(+)、Ki-67(30%+)、细胞角蛋白19(-)、甲胎蛋白(-)、癌胚抗原(-)和上皮膜抗原(-)。

致编辑：一名43岁男性被诊断为急性T细胞淋巴细胞白血病。他接受了6/6人类白细胞抗原（HLA）匹配的同种异体干细胞移植；捐赠者是他的妹妹。环孢素A作为移植物预防剂使用5个月vs宿主疾病。停用环孢素A三个月后，他的脸上出现丘疹。体格检查时，在面部中央区域观察到多个小圆顶形红褐色丘疹，延伸至双颊、下眼睑和下巴[图1A].无面外病变。丘疹的皮肤镜检查显示点状血管和线状血管水平和垂直排列，形成多边形图案，未观察到靶样毛囊塞的结构。皮肤镜观察方式为偏振光、非润湿[图1E].Diascopic检查显示苹果果冻外观。组织病理学分析显示上皮样细胞肉芽肿，中心区域干酪化坏死，朗汉斯巨细胞围绕中度淋巴组织细胞浸润[图1C和图1D].对病理片进行抗酸染色，未发现分枝杆菌。实验室分析，包括全血细胞计数、红细胞沉降率、血清钙血症、血清血管紧张素I转换酶水平、血液化学、结核感染T细胞斑点试验（T-SPOT）和胸部X线检查正常或阴性。他被诊断为面部播散性粟粒性狼疮（LMDF）。患者和供体之前都有酒渣鼻和LMDF。前3个月肌注复方倍他米松1ml，每月1次。患者还接受了异维a酸10mg/天和局部他克莫司每日两次的处方，临床反应良好。治疗6个月后病灶好转[图1B].

致编辑：使用化妆品（非处方护肤品）引起的不良事件可能表现为皮肤红斑、丘疹、瘙痒、干燥、脱皮和异常变色。化妆品的非药物使用在中国越来越普遍，但对化妆品相关不良事件的特点知之甚少。在本研究中，我们评估了中国南方化妆品相关不良事件的临床特征、涉及产品、路径测试率和患者教育水平分布。

致编辑：听觉言语幻觉（AVH）被定义为在没有任何外部听觉刺激的情况下听到声音。^[1,2,3]大多数AVH内容与体验者有关，这些事件通常会引起严重的苦恼。AVHs可发生在患有多种精神障碍和神经疾病的患者中，如精神分裂症、双相情感障碍(BP)、重度抑郁障碍(MDD)、创伤后应激障碍(PTSD)、边缘型人格障碍(BPD)，以及健康个体中。^[2,3,4]它们在精神分裂症患者中最为普遍，影响该人群的70%以上。除精神分裂症外，一般人群中高达46%的BPD患者、11.3%至62.8%的BP患者、5.4%至40.6%的MDD患者和4.2%的个体经历AVHs。^[1,2,3,4]

致编辑：线粒体疾病是一组常见的人类遗传疾病，可发生在生命的任何十年。线粒体DNA（mtDNA）突变是大多数成人发病的线粒体疾病的原因。^[1]在mtDNA中有超过260种已知的致病突变。^[2]在过去的二十年中，已经报道了大量mtDNA的致病突变，这些突变与广泛的临床特征相关。^[3]