Local infiltration of tissue-resident memory CD4 + T cells in lesions of patients with pemphigus and its clinical implications / 中华皮肤科杂志

Objective:To investigate the local infiltration of tissue-resident memory CD4 + T (CD4 + T RM) cells in lesions of patients with pemphigus and its clinical implications. Methods:From September 2017 to December 2018, 20 patients with pemphigus and 15 healthy human controls were collected from Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Flow cytometry was performed to determine the proportion of CD4 + T RM cells in skin lesions of pemphigus patients and normal skin of healthy controls. The degree of CD4 + T RM cell infiltration in skin lesions was compared among different body sites of the patients with pemphigus, and the correlation between the proportion of CD4 + T RM cells and the time to disease control was analyzed. Normally distributed data were analyzed by using t test, and non-normally distributed data by using non-parametric test; the Pearson correlation coefficient was used to analyze correlations of the proportion of CD4 + T RM cells with pemphigus disease area index (PDAI) scores and circulating anti-desmoglein (Dsg) antibody titers. Results:Among the 20 patients, there were 16 with pemphigus vulgaris and 4 with pemphigus foliaceus. All the patients had skin involvement, 14 lesional tissue samples were taken from the trunk, and 6 from the limbs. There was no significant difference between the healthy control group and pemphigus group in terms of age, gender or biopsy sites (all P > 0.05) . The proportions of CD3 + T cells (72.75% ± 8.22%) and CD4 + T RM cells (44.05% ± 14.27%) in the skin lesions of patients with pemphigus were significantly higher than those in the skin tissues of the healthy controls (31.33% ± 8.72%, 12.60% ± 5.12%, t = 14.24, 9.10, respectively, both P < 0.001) . Among the patients with pemphigus, the proportion of CD4 + T RM cells was significantly higher in the skin lesions on the trunk (49.57% ± 12.32%) than in those on the limbs (31.17% ± 9.75%, t = 3.23, P < 0.05) . The proportion of CD4 + T RM cells in the skin lesions was positively correlated with the PDAI scores ( r2 = 0.246, P = 0.026) , but not correlated with serum titers of circulating anti-Dsg1 ( r2 = 0.137, P > 0.05) or anti-Dsg3 ( r2 = 0.162, P > 0.05) antibodies in the patients. During the treatment with systemic glucocorticoids, the proportion of CD4 + T RM cells in the skin lesions was significantly higher in the patients whose lesions could not be controlled within 4 weeks than in those whose lesions could be controlled within 4 weeks ( t = 3.22, P < 0.05) . Conclusion:The proportion of CD4 + T RM cells markedly increased in the skin lesions of patients with pemphigus, which may be related to the severity of the disease and response to treatment.

Research progress of nanomedicine in pediatric lung diseases / 中国药科大学学报

@#Nanomedicine is charactered with a high specific surface area, diversified structure and function, and charged surface. It can realize the targeted therap by functional modification of surface or introducing the stimuli-responsive unit. Therefore, nanomedicine is increasingly being concerned. Because nanomedicine can accumulate efficiently in the lungs, drug delivery systems based on nanotechnology have broad prospects in the field of the diagnosis, prevention, and treatment in pediatric lung diseases. Herein, we reviewed the research progress of nanomedicine in pediatric lung diseases, especially in respiratory syncytial virus infection and cystic fibrosis.

Pathological features of ectopic lymphoid structure in skin lesions of patients with pemphigus / 中华皮肤科杂志

Objective To investigate pathological features of infiltrating lymphocytes in skin lesions of patients with pemphigus,and to analyze their correlation with titers of anti-desmoglein (Dsg) 1 and anti-Dsg3 antibodies in peripheral blood.Methods A retrospective pathological analysis was performed in 93 patients with pemphigus vulgaris or pemphigus foliaceus,who visited the Department of Dermatology of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine between 2014 and 2016.For each HE-stained section,the total number of lymphocytes per × 50 microscopic field was counted,and defined as lymphocyte density index.Enzyme-linked immunosorbent assay (ELISA) was conducted to determine the serum titers of anti-Dsg1 and anti-Dsg3 antibodies in the patients with pemphigus.The correlations between the lymphocyte density index and titers of anti-Dsg1 and anti-Dsg3 antibodies were analyzed.Immunohistochemical staining was performed in lesional skin samples from 8 patients with pemphigus vulgaris and 8 patients with pemphigus foliaceus,so as to analyze the distribution of CD3+ T cells,CD20+ B cells and CD138+ plasma cells.Results Of the 93 pathological sections,93 (100.00％) showed Grade1 lymphocyte aggregates,64 (68.09％) showed Grade 2 lymphocyte aggregates,and 10 (10.64％) showed Grade 3 lymphocyte aggregates,and the 56 cases of pemphigus vulgaris and 37 of pemphigus foliaceus showed the similar proportion of grade 1,2 and 3 lymphocyte aggregates.There was also no significant difference in the lymphocyte density index between patients with pemphigus vulgaris and pemphigus foliaceus (P ＞ 0.05),and the lymphocyte density index was uncorrelated with the serum titers of anti-Dsg1 and anti-Dsg3 antibodies in patients with pemphigus.Of the 16 cases of pemphigus,CD3+ T cells were found in all cases,CD20+ B cells in 15,and CD138+ plasma cells in 12.Of 16 sections,all showed a large amount of CD3+ T cells in Grade 1-3 lymphocyte aggregates,while lymphocyte aggregates containing CD20+ B cells and CD138+ plasma cells were found in 52.80％ ± 5.78％ and 34.59％ ± 7.42％ of sections respectively.No significant differences in the distribution of CD3+ T cells,CD20+ B cells,CD138+ plasma cells were found between the 8 cases of pemphigus vulgaris and 8 cases of pemphigus foliaceus.Conclusion Different degrees of lymphocyte infiltration generally exist in skin lesions of patients with pemphigus,which may form ectopic lymphoid structures and contribute to the development and aggravation of pemphigus skin lesions.

Three cases of trauma-triggered autoimmune bullous skin diseases / 中华皮肤科杂志

Objective To summarize clinical and histopathological features of trauma-triggered autoimmune bullous skin diseases,and to explore its possible pathogenesis.Methods Clinical manifestations,histopathological features and treatment of 3 cases of trauma-triggered pemphigus or pemphigoid were analyzed,and summarized according to related domestic and overseas literature.Results Of the 3 cases,1 was a female aged 62 years,and 2 were males aged 60 and 71 years respectively.They all had a history of skin trauma or surgery before the onset of the diseases,and time intervals from trauma to diseases were 5,5 weeks and 3 days respectively.The 3 cases were diagnosed as bullous pemphigoid (anti -BP180 antibody 109 U/ml,anti-BP230 antibody negative),pemphigus vulgaris (anti-Dsg1 antibody 68.8 U/ml,anti-Dsg3 antibody 219 U/ml) and pemphigus foliaceus (anti-Dsg1 antibody 143 U/ml,anti-Dsg3 antibody negative) respectively.Their lesions were relieved dramatically after oral and (or) topical glucocorticoid treatment.Conclusions Trauma may be a triggering factor for autoimmune bullous skin diseases.For patients with post-traumatic poor wound healing or skin erythema,blisters and erosion,which can hardly be attributed to trauma or surgery itself,autoimmune bullous skin diseases should be considered,and histopathological or immunopathological examinations should be performed timely.

Predictive value of plasma N-terminal-pro-brain natriuretic peptide in weaning patients from mechanical ventilation / 中华急诊医学杂志

Objective To evaluate the predictive value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) in weaning patients from mechanical ventilation (MV).Methods Data of 42 patients supported with MV in intensive care unit (ICU) admitted to the Rui Jin Hospital from January through December in 2014 were retrospectively analyzed,and the causes for MV were recorded.According to the outcomes of weaning from MV after 48 hours,the patients were divided into two groups namely success group and failure group.Comparisons of fluid balance in 72 hours before spontaneous breathing trial (SBT),and comparisons of NT-proBNP1 levels at admission,NT-proBNP2 levels before SBT,NT-proBNP3 levels after 48 hours after SBT between two groups were carried out.And the receiver operating characteristic (ROC) curve for predicting weaning rate was plotted to find the optimal cut-off point of NT-proBNP2.Results In the total of 42 patients,there were 27 cases in success group and 15 cases in failure group.There were not statistically differences of NT-proBNP1 levels between success group and failure group (P =0.121).However,the NT-proBNP2 levels and NT-proBNP3 levels in failure group were significantly higher than those in success group (P =0.01,0.003).The area under curve (AUC) of the ROC curve of NT-proBNP2 levels to predict the failure of weaning was 0.862 (95％ CI:0.753-0.971).When the optimal cut-off point of NT-proBNP2 was 715.5 pg/mL,the sensitivity and specificity were 93.3％ and 74.1％,respectively.Conclusion The NT-proBNP2 levels before SBT have predictive value in weaning rate,and it can be used as one of the screening indicators for weaning.