2014年 · 第94卷第44期

Dermatoscopy is a non-invasive examination technique, which can observe the microstructure of the epidermis, the junction between epidermis and dermis, and the dermal papilla, thus closely linking macroscopic dermatology with microscopic dermatopathology. Dermoscopy has been widely used in the diagnosis and differential diagnosis of pigmented and non-pigmented skin diseases because of its convenience, non-invasiveness and high diagnostic accuracy. The application and research of dermatoscope reached a climax in the 2000 Internet Dermatoscopy Conference and the first World Dermatoscopy Conference held in Rome in 2001, and it was rapidly spread all over the world. The clinical application of dermatoscope increases the correct diagnosis rate of skin diseases by 30% compared with the simple naked observation^[1]Combined with the clinical manifestations visible to the naked eye and the histopathology of the skin lesions, it provides intuitive, objective and accurate clues for the diagnosis of dermatology, which is of great significance to the development of dermatology field. Because of the particularity of the nail anatomy and the inconvenience of histopathological materials, dermoscopy provides a good prospect for non-invasive diagnosis of nail diseases. Dermoscope can not only observe the nail plate, but also observe the micro-structure and blood vessels of the proximal nail fold, nail matrix, nail bed and free nail edge. According to this, the diagnosis and differential diagnosis can be confirmed, and the activity degree of disease and the therapeutic effect can be evaluated.

China's clinical research scale is large, the level is low, and the influence in international academic circles is small. This situation needs to be changed urgently. The "Twelfth Five-Year Plan" support plan of the Ministry of Science and Technology has arranged the "Demonstration Application Research on the Construction of Collaborative Network for Clinical Medical Research" project, in which the first batch of 13 national clinical medical research centers in 6 subject fields has passed the evaluation and started, and the second batch of 9 national clinical medical research centers in 3 subject fields has passed the selection and is being announced. The core of this project is to establish a collaborative network for clinical medical research (hereinafter referred to as the collaborative network). Collaborative network will change the clinical research model and lay the foundation for the leap-forward development of clinical research in China and better participation in international academic competition^[1]。 The author participated in the whole process of project evaluation, and realized that collaborative network has many important characteristics and advantages, which are necessary to discuss and summarize. Therefore, this paper expounds the scientific basis of collaborative network to promote the development of clinical research from five dimensions, so as to lay a good foundation for better organization and implementation of collaborative network construction.

Skin surgery is an inherent sub-specialty of dermatology. At present, it is not only widely carried out in dermatology departments and dermatology hospitals of Class III A hospitals, but also involved in dermatology business in some hospitals below Class II. Due to the rapid development of dermatological surgery technology and the rapid increase of practitioners in recent years, some problems have been exposed in the development of dermatological surgery, such as large cognitive differences in subject categories, mixed qualifications of practitioners, insufficient standardization of talent training, etc. In order to promote the scientific and sustainable development of dermatology, promote the standardization of related medical behaviors, and fulfill the purpose of "service, coordination, self-discipline, rights protection, supervision and management" of industry organizations, the Dermatology Subspecialty Committee of Dermatology Branch of Chinese Medical Doctors Association took the lead in drawing up the expert consensus on the discipline system and standard construction of dermatology in China as follows.

Since 2012, a novel coronavirus infection has emerged in the Middle East region, which has now been named Middle East respiratory syndrome coronavirus (MERS – CoV), which is the sixth coronavirus found to infect humans and belongs to the C-line beta coronavirus^[1]。 The virus can cause symptoms similar to those of severe acute respiratory syndrome (SARS), with patients ranging from asymptomatic to severe pneumonia with acute respiratory distress syndrome and multiple organ failure. All patients with symptoms have respiratory symptoms, and another 1/3 of patients have gastrointestinal symptoms^[2]。 As of 23 July 2014, there were 837 laboratory-confirmed cases, including 291 deaths, involving 21 countries in the Middle East, Europe, Africa, North America and Asia. Although there are no imported cases in China at present, because MERS-CoV infection often leads to serious diseases, the mortality rate is higher than that of SARS, and a large number of people travel between China and the Middle East every year due to travel and Hajj, it still deserves clinical vigilance and attention. From March to April, 2014, a large number of medical staff infections in the Middle East sounded the alarm for disease prevention and control. Therefore, the latest progress and implications of MERS research are summarized as follows.

Patient, male, 71 years old. He was admitted to hospital on October 29, 2012 due to cough, sputum, chills and fever for 2 days. Before the illness, he had a history of cold, yellow phlegm, and the highest body temperature was 38 ℃, accompanied by shortness of breath and persistent right chest swelling and pain. Admission physical examination: A little wet rales was smelled in the right lung. Blood routine: white blood cells 25.13×10⁹/L, neutrophils 92.1%, platelets 74×10⁹/L, hemoglobin 143 g/L. Blood sodium 130 mmol/L, potassium 3.0 mmol/L, chlorine 97 mmol/L; Blood myocardial enzymes and troponin T were normal. Arterial blood gas analysis (without oxygen): pH 7.54, PaO₂76 mmHg (1 mmHg =0.133 kPa), PaCO₂25 mmHg, Oxygen saturation 96.2%. Electrocardiogram showed atrial fibrillation. Liver function was normal. Total blood protein was 63.1 g/L, albumin was 36.7 g/L, white globule ratio was 1.4, total bilirubin was 42.5 μ mol/L, and direct bilirubin was 12.4 μ mol/L. Blood glucose 7.24 mmol/L. Procalcitonin 5.37 μ g/L. Chest CT at admission: large ground glass shadow in the middle lobe of the right lung, thickening of the right pleura (Figure 1) Cardiac color Doppler ultrasound showed a small amount of tricuspid regurgitation and normal left ventricular systolic function. Venous color ultrasound of both lower limbs: no obvious abnormality.

The 63-year-old female was seen on November 14, 2013 10 days later because the liver occupied space was found by B-ultrasound during health examination. He was in good health and had no symptoms such as abdominal pain, distension, fever, nausea, vomiting and yellowing of the skin and sclera. No obvious abnormal signs were found on physical examination, and no obvious abnormalities were found in blood routine, biochemistry, hepatitis B, coagulation spectrum and complete set of tumors after admission. CT showed that a 33 mm ×25 mm ×28 mm occupied space was seen in the VI segment of the right liver; MRI showed that the parenchyma of the right liver segment VI mass showed a slightly high signal on T2WI and DWI, a low signal on the same phase of T1WI, and an isosignal on the opposite phase; The parenchyma of the arterial mass began to strengthen in the early stage of enhancement scan, significantly strengthened in the late stage, and continued to strengthen in the delayed stage of portal vein. On November 19th, liver tumor resection was performed under general anesthesia. Intraoperatively, a 40 mm ×30 mm nodule was seen in segment VI of the liver near the liver capsule, which was slightly hard in texture and had no adhesion to the surrounding tissues. Intraoperative rapid freezing pathological diagnosis predisposes to benign bile duct adenomas. Gross examination: The partial liver resection specimen showed a nodule with a size of 25 mm ×20 mm ×10 mm. The section surface was pale yellow and medium, and the boundary with the surrounding liver tissue was clear. HE morphological characteristics: The tumor is composed of mature, benign-appearing small bile ducts, with a relatively clear boundary with the surrounding normal liver tissues. It is densely proliferated by the surrounding small bile ducts, with a round lumen, a diameter close to the interlobular bile ducts, and chronic inflammatory cell infiltration can be seen in the interstitium (FIG. 1A)； The interstitial fibrous tissue near the central region proliferates and collagenizes, and the density of the small bile duct decreases. It is separated by fibrous tissue and squeezed into a fissure or irregular shape (FIG. 1B), and even the small bile duct disappears where collagenization is obvious; The bile duct cells were dwarf cubic, the nucleus was round, the cell morphology was mild, no atypia, mitotic image and necrosis were observed; There was no obvious dilated cystic bile duct in the tumor, and there was no bile in the bile duct. Immunohistochemistry showed that CK19, CK7, CD56 and CD10 were all (+), while AFP, P53, CDX2, CK20, TTF-1 and Syn were all (-); The proliferation index of Ki – 67 was 5%. Pathological diagnosis: (right liver) intrahepatic bile duct adenoma (BDA). No treatment was given postoperatively. Follow-up for 6 months showed good condition and no tumor recurrence was observed.