<h3>2020鼠年臺(tái)歷，比往年來得晚些。封面的兩只老鼠是世界上獨(dú)有：先原創(chuàng)勾畫草圖，然后在科瑪嘉培養(yǎng)基上接種5種念珠菌，在30℃孵箱內(nèi)培養(yǎng)5天，長(zhǎng)出來天然顏色的“實(shí)驗(yàn)鼠”：鼠小伙穿著粉紅色實(shí)驗(yàn)服，鼠姑娘圍著綠色圍巾，手握三角瓶，仰頭思考實(shí)驗(yàn)方案，要分離鑒定菌種、做出好的結(jié)果、解決患者疾苦、完成SCI論文書寫和投稿，預(yù)示著充實(shí)、忙碌和多產(chǎn)的鼠年。</h3> <h3>2020 caslendar of the Rat Year, comes later than usual. The two mice on the cover are unique in the world: first they sketch the original, then they are inoculated with five candida species on the CHROMagar and incubated at 30 °C for 5 days, “Lab rats” of natural color grow out: The boy mouse wears a pink lab coat, the girl mouse wears a green scarf, holds a triangle bottle, look up to think about the experiment, to isolate and identify strains, make good results, solve the patient suffering, complete SCI paper writing and submission, foreshadowing a full, busy and productive year of the rat.</h3> <h3>頭癬是真菌累及毛發(fā)的病變，在放大200倍的皮膚鏡下螺旋樣發(fā)一目了然，快速而精準(zhǔn)確定病發(fā)；標(biāo)本中真菌經(jīng)熒光染色能即刻顯示分隔的鏈狀菌絲，熒光亮度越強(qiáng)反映幾丁質(zhì)代謝越活躍，真菌生長(zhǎng)旺盛，致病力強(qiáng)，舞蹈的菌絲體動(dòng)感十足。</h3> <h3>Tinea capitis is a fungal hair lesion that can be identified rapidly and accurately by a 200-fold magnification of a dermoscope. Fluorescent staining of the fungus in the specimen can immediately reveal the separated streptomyces, the stronger the fluorescence intensity, the more active the chitin metabolism, the vigorous growth of the fungus, the stronger the pathogenicity, the dance of the mycelium is full of motion.</h3> <h3>毛囊蠕形螨是人體面部毛囊內(nèi)及表面的常駐寄生蟲，與玫瑰色皮炎和痤瘡等有關(guān)。左側(cè)是掃描電鏡下所見毛囊蠕形螨，經(jīng)偽色處理后表面結(jié)構(gòu)清晰可見；右側(cè)是熒光染色在熒光顯微鏡下觀察，表面及4對(duì)足熒光強(qiáng)度高、腹腔內(nèi)集中熒光亮團(tuán)，提示這些部位幾丁質(zhì)合成活躍、消化道有未消化的幾丁質(zhì)成分。</h3> <h3>Demodex folliculorum is a resident parasite on human face, which is related to rose dermatitis and acne. On the left side, 4 pairs of feet and trunk of Demodex folliculorum can be seen clearly by pseudo-color processing, on the right side, 4 pairs of feet and body surface of D. folliculorum can be seen by fluorescent staining, and on the bright blue side, 4 pairs of feet and body surface of D. folliculorum can be seen chitin. The uniform bright blue structure in the abdominal cavity suggests that the digestive tract contains synthetic or undigested chitin.</h3> <h3>皮膚鏡下?？吹揭恍┨厥饨Y(jié)構(gòu)：左側(cè)是痤瘡皮損，像初春綻開的玫瑰；右側(cè)初看像兩片“樹葉”和一個(gè)“蘋果”，“樹葉”乃接受冷凍治療后的色素沉著、“蘋果”是傳染性軟疣皮損的表現(xiàn)，微觀世界令人驚嘆！</h3> <h3>Special structures are often seen under the dermoscope: Acne lesions on the left, like a rose in early spring; on the right, two "leaves" and an "apple" at first glance, "Leaf" is treated by cryotherapy after pigmentation, "apple" is the performance of Molluscum contagiosum skin lesions, the microscopic world is amazing!</h3> <h3>4月有華西皮膚真菌講習(xí)班（第21期），還有中西醫(yī)結(jié)合皮膚年會(huì)。白念珠菌是條件性致病真菌，在人體皮膚黏膜表面、消化道、呼吸道、泌尿生殖道可定植，局部屏障受損或免疫功能下降可致病，掃描電鏡下白念珠菌表面光滑飽滿為酵母細(xì)胞，一般不具致病性，當(dāng)出芽產(chǎn)生假菌絲往往提示為致病態(tài)；右側(cè)為球形馬拉色菌熒光染色所見，為皮膚表面常駐菌，可引起花斑糠疹、馬拉色菌毛囊炎、脂溢性皮炎（頭皮屑），Nature報(bào)道可引起胰腺癌，值得關(guān)注和深入研究。</h3> <h3>There's the 21st Medical Mycology Course in West China Hospital in April, and the annual Chinese-Western Dermatology Conference. Candida albicans is a conditional pathogenic fungus, which can be colonized on the surface of human skin and mucous membrane, digestive tract, respiratory tract and genitourinary tract, under the scanning electron microscope, the surface of Candida albicans is smooth and full with yeast cells, but it is not pathogenic. When it sprouts and produces false hyphae, it is usually indicated as pathogenic. On the right-hand side, Malassezia globosa, a resident on the skin, can cause pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis (Dandruff). Nature reports that Malassezia can cause pancreatic cancer, which deserves attention and further study.</h3> <h3>人體皮膚小宇宙：皮膚是維持人體內(nèi)環(huán)境和外界的界面，對(duì)維持內(nèi)環(huán)境穩(wěn)定和代謝極端重要；一個(gè)小小的毛囊口堵塞儲(chǔ)留可以看到令人驚訝的微觀宇宙，需要了解、探索的“黑洞”還有太多太多；利用最新的皮膚鏡、紫外光皮膚鏡觀察到的超微結(jié)構(gòu)只是滄海一粟；還有很多未知領(lǐng)域需要科學(xué)家不斷探索和發(fā)現(xiàn)。</h3> <h3>Human Skin Microcosm: The skin is the interface between the internal and external environment of the human body and is vital for maintaining the stability and metabolism of the internal environment; a tiny hair follicle that clogs up the reservoir can reveal surprising microcosm, there are so many black holes to learn and explore; the ultrastructure observed with the latest dermoscopes and UV dermoscopes are just a drop in the ocean; and there are still many unexplored areas to be explored and discovered.</h3> <h3>嬰兒血管瘤常出生后出現(xiàn)，不斷生長(zhǎng)和隆起，左側(cè)示皮膚鏡下清晰看到血管蜿蜒增粗，是判斷生長(zhǎng)狀態(tài)、治療決策和療效的客觀指標(biāo)；右側(cè)是紫外光皮膚鏡所觀察到的面部毛囊皮脂腺開口的情況，紅色和亮藍(lán)色分別提示痤瘡桿菌和馬拉色菌，對(duì)初步判斷毛囊-皮脂腺單位內(nèi)的微生物群提供了直觀的信息。</h3> <h3>Infantile hemangioma often appears after birth, constantly growing and bulging. On the left side of the dermoscope clearly see winding thickening of blood vessels, is to judge the growth state, treatment decision-making and efficacy of objective indicators; On the right is an opening of the sebaceous gland of the hair follicle as observed by the UV-dermoscope. The Red and bright blue colors indicate Propionibacterium acnes and Malassezia, respectively, and provide visual information for the preliminary determination of microflora in the sebaceous gland of the hair follicle unit.</h3> <h3>卡氏枝孢瓶霉引起著色芽生菌病，臨床表現(xiàn)為皮膚結(jié)節(jié)潰瘍和增生，容易誤診為孢子絲菌病、皮膚腫瘤或其它病原菌感染。本例曾經(jīng)依據(jù)病理診斷為孢子絲菌病抗真菌治療有效，但停藥后有復(fù)發(fā)，經(jīng)培養(yǎng)的菌落特點(diǎn)、小培養(yǎng)觀察鏈狀菌絲及分子測(cè)序最終鑒定菌種，連續(xù)內(nèi)服抗真菌和局部抗真菌及加熱治療治愈，論文發(fā)表在印度皮膚性病和麻風(fēng)學(xué)雜志上。</h3> <h3>Cladophialophora carrionii causes chromoblastomycosis, which is characterized by ulceration and hyperplasia of cutaneous nodules and is easily misdiagnosed as Sporotrichosis, skin tumors or other pathogenic bacterial infections. In this case, the pathological diagnosis was that Sporotrichosis and antifungal treatment was effective, but there was a recurrence after discontinuation of the drug. The pathogen was later identified by culture, slide culture, observation of chain-mycelium and molecular sequencing, cured with continuous oral and topical antifungal therapy and thermotherapy, the paper be published in the Indian Journal of Dermatology Venereology & Leprology.</h3> <h3>孢子絲菌病病理切片上不易發(fā)現(xiàn)真菌，應(yīng)用真菌熒光染色技術(shù)即使一個(gè)真菌孢子也能被發(fā)現(xiàn)，像黑暗的星空中的啟明星，大大提高檢測(cè)的敏感性；皮脂腺內(nèi)的毛囊蟲又叫皮脂螨，比毛囊螨要短，但熒光染色下能夠看到4對(duì)足和口器，亮綠的熒光提示這些部位幾丁質(zhì)合成活躍。</h3> <h3>It is not easy to find fungi on a Sporotrichosis. With the fluorescent staining techniques, even a single fungal yeast can be detected, like a Venus in the dark sky, greatly increasing the sensitivity of detection; The mites inside the sebaceous glands, called Demondex brevis, are shorter than Demodex folliculorum, but four pairs of feet and mouth parts can be seen under fluorescent staining. The bright green fluorescence indicates that these areas are active in chitin synthesis.</h3> <h3>傳染性軟疣是由傳染性軟疣病毒所致的皮膚病，常累及兒童，由與患者直接或間接接觸而傳播，早起皮損難以辨認(rèn)。皮膚鏡下看到兩個(gè)皮損連接起來，很像游泳用護(hù)目鏡，透射電鏡下見無數(shù)的傳染性軟疣病毒顆粒，提示其傳染性極強(qiáng)。本例患兒是通過公共游泳池游泳而染病，皮膚鏡下確認(rèn)后切除病灶，透射電鏡圖像證實(shí)病毒。此論文發(fā)表在英國(guó)皮膚病雜志上。</h3> <h3>Molluscum contagiosum is a skin disease caused by Molluscum contagiosum virus, often affecting children, spread by direct or indirect contact with the patient, making it difficult to identify early onset lesions. Under the dermoscope, the lesions are joined together, much like swimming goggles, and under the transmission electron microscope, numerous Molluscum contagiosum virus particles are visible, suggesting that they are highly contagious. In this case, the patient was infected by swimming in public swimming pool. After dermoscopy, the lesion was removed and the virus was confirmed by transmission electron microscopy. The paper was published in the British Journal of Dermatology.</h3> <h3>皮脂腺痣常出生后發(fā)生，局部皮脂腺增生，表面毛發(fā)稀少，此例用真菌熒光染色發(fā)現(xiàn)大量馬拉色菌，有出芽和菌絲，含油培養(yǎng)基分離出球形馬拉色菌，掃描電鏡下看到特征性的出芽和芽頸結(jié)構(gòu)，局部的毛干也發(fā)現(xiàn)被馬拉色菌破壞，提示嗜脂性的馬拉色菌在皮脂腺豐富的部位容易繁殖而過度生長(zhǎng)，破壞毛干。此論文發(fā)表在英國(guó)皮膚病雜志封面上。</h3> <h3>Nevus sebaceous often occurs after birth, local hyperplasia of sebaceous glands and sparse hair on the surface. In this case, a large number of Malassezia was found by fluorescent staining of fungi, including budding and Hyphae, and Malassezia globose was isolated from oil-containing medium, under scanning electron microscope, we found the characteristic budding and budding neck structure, and the partial hair shaft was destroyed by Malassezia yeasts, which suggested that the lipophilic Malassezia was easy to multiply and overgrow in the area rich in sebaceous glands, and destroyed the hair shaft. The paper appears as Cover Image on the British Journal of Dermatology.</h3> <h3>疥瘡是非常容易傳染的由疥蟲傳播的寄生蟲皮膚病，早期診斷很難，我們首次采用皮膚鏡+墨水染色+顯微鏡，快速確認(rèn)了患者皮下隧道末端疥螨成蟲及所產(chǎn)蟲卵，是之得到及時(shí)診治。論文發(fā)表在美國(guó)皮膚病學(xué)雜志上。</h3> <h3>Scabies is a highly contagious skin disease spread by the sarcoptes Scabiei parasite. Early diagnosis is difficult. For the first time, we confirmed the Sarcoptes Scabiei with eggs at the end of the subcutaneous tunnel by dermoscope + ink staining + microscope. The patient is to get timely diagnosis and treatment. This paper was published in Journal of American Academy of Dermatology.</h3> <h3>不規(guī)則毛霉所致面部皮下感染常常由外傷或手術(shù)傷口所致，需要用兩性霉素B才能治愈。本例曾誤診為腫瘤，所幸及時(shí)培養(yǎng)分離出真菌，特點(diǎn)是生長(zhǎng)迅速的毛樣菌落，掃描電鏡下觀察到菌絲頂端孢子囊孢子。患者最終治愈。論文發(fā)表在真菌病理學(xué)雜志上。</h3> <h3>Subcutaneous facial infections caused by Mucor irregular are often caused by trauma or surgical wounds and require Amphotericin B to Cure. This case was misdiagnosed as a tumor, fortunately, fungi were isolated in time, characterized by rapid growth of mold-like colonies. Sporangium & sporangiospore on the top of mycelium under scanning electron microscope. This patient is finally cured. The paper is published in Mycopathologia.</h3> <h3>眼瞼紅腫和眼睫毛病變疑似麥粒腫而抗生素治療無效，皮膚鏡下發(fā)現(xiàn)睫毛根部有螺旋狀縮窄而提供線索，小心取下睫毛顯微鏡下找到元兇，培養(yǎng)和鑒定為趾間毛癬菌，系患兒玩寵物兔接觸感染所致，針對(duì)性抗真菌治愈。發(fā)表英國(guó)皮膚病雜志封面。</h3> <h3>Eyelid redness and eyelash lesions suspected hordeolum and antibiotic treatment was ineffective. Dermoscopy found eyelash root spiral narrowing and provide a clue. We carefully removed the eyelash, by microscope to find the culprit, culture and identification indicates Trichophyton interdigital. This fungus is infected due to the child playing a pet rabbit. We switched to targeted antifungal therapy and the patient was cured. This is published as Cover Image on British Journal of Dermatology.</h3> <h3>梅毒是萬能的模仿者，常常有意想不到的臨床表現(xiàn)，本例常規(guī)篩查發(fā)現(xiàn)血清陽(yáng)性，免疫組化和掃描電鏡均證實(shí)病變組織內(nèi)的梅毒螺旋體，因同時(shí)感染HIV病毒，臨床表現(xiàn)為惡性梅毒，肌注芐星青霉素治愈患者。此論文發(fā)表在英國(guó)皮膚病雜志上。</h3> <h3>Syphilis is a universal imitator, often with unexpected clinical manifestations. In this case the routine screening was sero-positive, and both immunohistochemistry and scanning electron microscopy confirmed the presence of Treponema pallidum in tissue, as a result of co-infection with HIV, the patient was diagnosed as malignant syphilis, and be cured by intramuscular injection of Benzathine Penicillin. The paper was published in the British Journal of Dermatology.</h3> <h3>對(duì)每一例皮膚患者皮損做皮膚鏡觀察拍照分析, 對(duì)真菌性、病毒性、細(xì)菌性、寄生蟲性病原體做顯微鏡觀察、培養(yǎng)及分子、掃描電鏡、透射電鏡觀察等多維度研究，每位碩士和博士研究生都接受皮膚鏡為主的操作技術(shù)培訓(xùn)和發(fā)表論文?！岸嗑S攻堅(jiān)”疑難病、“降維打擊”常見病，這就是我們的“精準(zhǔn)皮膚診療室” 團(tuán)隊(duì)，專注創(chuàng)新、樂在其中！</h3> <h3>The skin lesions of each patient were observed and photographed by dermoscope, and the fungal, viral, bacterial and parasitic pathogens were observed by microscope, culture and molecular, SEM and TEM, every MD and PhD Students received training of dermoscopy and publish papers. "Multi-dimensional attack" for complicated diseases, and "dimensional reduction blow" for common diseases, this is our "Precision Dermatology Clinic" team, on innovation and enjoy scientific research!</h3>