Dalian Dermatosis Hospital

Existing phototherapies are ineffective for treating patients with vitiligo with complete leukotrichia. We compared the efficacy of reverse perilesional irradiation, during which only the lesional areas are covered, with conventional narrowband ultraviolet B (NB-UVB) home phototherapy for repigmentation of non-segmental vitiligo in patients with complete leukotrichia. This was a 12-week, open-label, double-arm, multicenter clinical trial, with a total of 121 patients with non-segmental vitiligo who were randomly divided into two groups (both received topical tacrolimus): the conventional NB-UVB irradiation (CI) and reverse perilesional NB-UVB irradiation (RI) groups. A statistically significant difference in improvement from baseline was observed in the RI group compared with the findings in the CI group (-30.8% ± 11.8% vs. -25.5% ± 11.05%, respectively [p = .010]; pair-wise comparison p = .900 at week 4, p = .104 at week 8, and p = .010 at week 12). At week 12, the average percentage change from baseline of leukotrichia in the irradiation area significantly decreased from 100% to 82.2% ± 13.65% in the RI group, and from 100% to 88.7% ± 9.64% in the CI group (p = .027). Adverse events were minor, including desquamation, dryness, erythema, and blisters. No severe or lasting side effects were observed during the study. RI mediated better repigmentation of vitiligo with complete leukotrichia than CI.

IntroductionThe treatment options for moderate to severe psoriasis (msPsO) in China have been greatly increased with the approvals of biologics. However, the unmet needs and treatment preferences of systemic treatments for msPsO in China remain unclarified.MethodsFifty dermatologists and 300 patients with msPsO (41% with severe psoriasis) were surveyed for effectiveness, safety, treatment convenience, and treatment preferences (using a choice-based conjoint questionnaire). Descriptive statistics and conjoint simulation analyses were employed to summarize survey information and assess treatment preferences.ResultsBoth patients and dermatologists reported shorter treatment duration for oral drugs (2.7–6.2 months) than that for biologics (9.5–17.0 months). The most frequently reported treatment discontinuation reasons by the surveyed patients and dermatologists were unsatisfactory effectiveness (average 84.5%) for oral drugs and loss of efficacy over time (average 68.5%) for biologics. Commonly reported treatment inconveniences included regular lab tests for traditional oral drugs (average 71.5%) and administration assistance for biologics (average 58.0%). Injection site reactions (average 51.5%) and needle fear (average 35.5%) were frequently reported for biologics among the surveyed patients and dermatologists. Once-daily oral treatment was preferred over biweekly subcutaneous injection treatment when the two had comparable attributes (average in patients 87.1% vs. 12.9%; average in dermatologists 93.4% vs. 6.6%).ConclusionsUnmet needs of systemic treatments remain for msPsO in China. Once-daily oral treatment is preferred over biweekly subcutaneous injections to treat msPsO when other treatment attributes are comparable.

Objective: To analyze and evaluate the value of the anti-epidermal intercellular desmosome antibodies, anti-desmoglein (Dsg) 1, and anti-Dsg3, as well as the anti-epidermal basement membrane hemidesmosomes antibodies, anti-BP180, and anti-BP230 in the diagnosis of pemphigus and bullous pemphigoid. Methods: Patients with pemphigus or bullous pemphigoid treated in the Department of Dermatology of Dalian Dermatosis Hospital from July 2019 to July 2021 were selected. They were clinically diagnosed with histopathological and indirect immunofluorescence methods. They were divided into the pemphigus group (n = 102) and the bullous pemphigoid group (n = 175). Additionally, 120 patients who were ruled out of pemphigus and bullous pemphigoid during the same period were selected as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect anti-Dsg1, anti-Dsg3, anti-BP180, and anti-BP230 antibodies. Indirect immunofluorescence (IIF) was used to detect the IgG levels of the anti-epidermal intercellular desmosome antibodies and anti-epidermal basement membrane hemidesmosomes antibodies. The positive rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic rate of each antibody were evaluated and analyzed comprehensively. Results: In the pemphigus group, bullous pemphigoid group, and control group, the positive rates of anti-Dsg1 are respectively 83.3% (85/102), 0 (0/175), and 1.7% (2/120); the positive rates of anti-Dsg3 are 41.1% (42/102), 0 (0/175), and 0 (0/120), respectively; the positive rates of BP180 are 5.9% (6/102), 85.7% (150/175), and 5% (6/120), respectively; the positive rates of BP230 are 1.9% (2/102), 57.7% (101/175), and 1.7% (1/120), respectively. Meanwhile, the positive rates of anti-epidermal intercellular desmosome antibodies are 69.6% (71/102), 0 (0/175), and 0 (0/120), respectively; the positive rates of anti-epidermal basement membrane hemidesmosome antibodies are 0% (0/102), 51.4% (90/175), and 0 (0/120), respectively. Among the patients with pemphigus, the sensitivity, specificity, PPV, NPV, and diagnostic rates of the anti-epidermal intercellular desmosome antibody test were 65.1%, 100%, 100%, 85.2%, and 92.2%; for anti-Dsg1, respectively, 83.3%, 99.3%, 97.7%, 88.7%, and 95.2%; for anti-Dsg3, respectively, 41.1%, 100%, 100%, 83.1%, and 84.9%. Among the patients with bullous pemphigoid, the sensitivity, specificity, PPV, NPV, and diagnostic rates of the anti-epidermal basement membrane hemidesmosomes antibody test were 51.4%, 100%, 100%, 72.3%, and 78.6%; for anti-BP180, respectively, 85.7%, 94.6%, 92.6%, 89.4%, and 90.7%; for anti-BP230, respectively, 57.7%, 98.2%, 96.2%, 74.7%, and 80.1%. Conclusion: The detection of autoantibodies in serum and the confirmation of the specific target antigens could complement each other to reduce clinical missed diagnosis and increase the positive diagnostic rate if the two tests were conducted simultaneously. The positive result of the anti-epidermal intercellular desmosome antibody and the anti-epidermal basement membrane hemidesmosomes antibody has better accuracy in diagnosing pemphigus and bullous pemphigoid. In contrast, the negative result is of great value in ruling out pemphigus and bullous pemphigoid.

Scholars have recently used various methods to study the human body’s characteristics, propose improvements, and rely on medical data. This research introduces a new real−time data collection and analysis system comprising two components: a smart mask for data collection and a processing unit for analysis and storage. The medical mask incorporates four sensors: three heat sensors to measure the nose tip and exhaled air temperature from the nostrils and mouth, along with a microphone for audio data. Collected data is instantly transmitted to the processing unit. Temperature readings are labeled and stored for analysis, while audio data is classified into breathing, coughing, and speaking categories using the Support Vector Machine (SVM) algorithm. The SVM’s performance is further optimized using the Lion Algorithm. Evaluation results indicate satisfactory accuracy for temperature data collected from the mask. The SVM achieved 84.3% accuracy for sound data classification, while the Lion algorithm−optimized SVM achieved an even higher accuracy of 93.6%. Future work aims to establish a reliable data collection tool that will serve as the foundation for developing an intelligent human body analysis model called the real human body neural network (rhBNN+).

AIM: To report an atypical Adams-Oliver syndrome (AOS) family with typical ocular signs of familial exudative vitreoretinopathy (FEVR). METHODS: A patient with visible avascular area and obvious non-perfusion zone in the peripheral retina with systemic signs of AOS was reported. Familial and personal characteristics were collected for the patient and his sister. Gene sequencing and ophthalmic examinations including fluorescein angiography were all performed for the whole family. RESULTS: Two novel mutations of DOCK6 (c.1396C>T and c.4796G>A) were identified in the proband and his family, and two compound heterozygous mutations were revealed in the proband and his sister. The patient and his sister showed physical deformities and mental abnormalities while FEVR mimicking retinal disorder can also be defined. No remarkable ocular or systemic abnormality can be observed for their parents. Peripheral retinal non-perfusion area, obvious abnormal vascularization or even retinal fold were observed in the proband and his sister, while only small avascular zone was identified for their parents. CONCLUSION: This is the first genetic authenticated AOS case mimicked as FEVR with genetic sequencing of a family. For the patients with ocular phenotype of FEVR, further examination should be performed if the systemic or mental abnormalities exist.

Methotrexate (MTX) is the first-line treatment for psoriasis in China. The metabolic processes of MTX include various proteins and genes. Previous studies have shown that gene polymorphisms had significant impacts on the efficacy of MTX. However, the influence of gene polymorphisms has not been reported in the Chinese psoriatic patients. The aim of this study was to verify the impacts of candidate genes polymorphisms on the effectiveness of MTX in a Chinese psoriatic population. In this study, we enrolled 259 psoriasis patients from two clinical centres. Each of them received MTX treatment at 7.5-15mg/week for at least 8weeks. Patients were stratified as responders and non-responders according to whether the Psoriasis Area and Severity Index score declined more than 75% (PASI75). According to previous reports, 16 single nucleotide polymorphisms (SNPs) were selected and genotyped for each patient using the Sequenom platform. Fisher's exact test, the chi-square test, Mann-Whitney tests and ANOVA analyses were used for statistical analysis. Among 259 patients, there were 182 males and 77 females, 63 patients with psoriatic arthritis and 196 patients without arthritis phenotype, and the age of all patients ranged from 19 to 70years (49.7±13.6). The baseline PASI value of patients was 13.8±8.5, and 33.2% of patients achieved a PASI75 response after MTX treatment. Patients carrying the ATP-binding cassette subfamily B member 1 gene (ABCB1) rs1045642 TT genotype were associated with more severe psoriasis skin lesion (P=0.032). Furthermore, the ABCB1 rs1045642 TT genotype was found to be more frequent in non-responders (P=0.017), especially in moderate-to-severe patients (P=0.002) and patients without psoriatic arthritis (P=0.026) after MTX treatment. We have demonstrated for the first time that polymorphism of the ABCB1 rs1045642 TT genotype is predictive of a worse clinical response of skin lesions to MTX therapy in a Chinese psoriatic population.

In medical outpatient services, due to patients’ imbalanced selection for doctors of different levels and for different visiting periods, inefficiency of resource utilization and dissatisfaction of patients have become the main problems faced by hospital managers. For the first time, this research has considered patients’ preference between high-ranking professional titles of general doctor and expert doctor. Through analyzing real data of the outpatient clinic at Dalian City Dermatology Hospital, the behavioral pattern of patients’ patience limit adjusted with expected waiting time was obtained. This research also established a data-driven discrete event simulation model that takes into account walk-in patients’ time preferences, appointment patients’ no-shows and cancellations, and considers complex patient flow caused by unbalanced selection of doctor resources and patience limit of waiting time. To optimize scheduling for appointment patients with two types of doctors, this research put forward a simulation optimization framework that maximized hospital benefit and minimized patients’ dissatisfaction. At the same time, simulation budget allocation based on multi-objective optimization and genetic algorithm were combined to obtain the approximate Pareto joint capacity plan of multi-servers and a patient scheduling scheme. The simulation model was validated through a case study based on real data of outpatient service for the whole year, and the proposed optimization method can comprehensively improve performance of outpatient service scheduling system. The simulation optimization framework can provide an effective scheduling scheme for all multi-server service systems involving consumer selection and impatient behavior.

Objective To investigate the susceptibility of Neisseria gonorrhoeae to gentamicin in Dalian. Methods A total of 120 isolates were collected from patients with gonococcal infections in Dalian CDC from 2016 to 2018. Minimum inhibitory concentrations (MICs) of gentamicin in Neisseria gonorrhoeae were determined by the agar dilution method. Results No gentamicin-resistant isolates were found in 120 strains, of which 103 strains (85.8%) were susceptible to gentamicin (MIC≤ 4 mg/L) , and 17 strains (14.2%) were intermediate susceptible (MIC=8 mg/L) . Conclusions The gonococcal isolates in Dalian have high antimicrobial susceptibility to gentamicin. Key words: Neisseria gonorrhoeae; Gentamicin; Agar dilution method