Investigation of clinical factors influencing the response to systemic glucocorticoid treatment in patients with progressive non-segmental vitiligo / 中华皮肤科杂志

Objective:To compare the clinical data and peripheral blood levels of CXC chemokine ligand (CXCL) 9 and CXCL10 between patients with progressive non-segmental vitiligo who were sensitive to systemic glucocorticoid treatment and those who were resistant, and to clarify key clinical factors influencing the sensitivity to systemic glucocorticoid treatment.Methods:From May 2021 to May 2023, a cohort of patients with progressive non-segmental vitiligo receiving systemic glucocorticoid treatment was established in Huashan Hospital, Fudan University. Clinical data and peripheral blood samples were prospectively collected from all enrolled patients. Standard treatment, i.e., intramuscular injections of 1 ml of compound betamethasone once a month, was administered. After 3-month treatment, the improvement of patients′ skin lesions was estimated, and the vitiligo area and severity index (VASI) score and the Vitiligo European Task Force assessment tool (VETFa) were used to evaluate the efficacy. Patients with VASI changes ≥ 0 and VETFa progression scores ≤ 0 point were included in the glucocorticoid-sensitive group (i.e., the patients′ condition was stable or improved), otherwise those with VASI changes < 0 and VETFa progression scores of 1 point were included in the glucocorticoid-resistant group. Associations of lesion locations, specific clinical markers (trichrome lesions, confetti-like depigmentation, and Koebner phenomenon), previous medication history, family history of vitiligo, etc. with the response to systemic glucocorticoid treatment were analyzed. At baseline and after 3-month treatment, peripheral blood samples were collected from the patients, and enzyme-linked immunosorbent assay was performed to detect the plasma levels of CXCL9 and CXCL10. Statistical analysis was carried out by using the chi-square test, Fisher′s exact test, binary logistic regression analysis, Mann-Whitney U test, and Wilcoxon signed-rank test. Results:A total of 142 patients with vitiligo were enrolled, and 127 completed 3-month treatment, including 77 males and 50 females. Their age at diagnosis was 18 to 65 (36.6 ± 11.4) years, and the disease duration ranged from 2 months to 58 (13.5 ± 10.7) years; 25 (19.7%) had a family history of vitiligo; the percentage of lesion area to total body surface area before treatment ranged from 1% to 70% (11.5% ± 12.7%), and the VASI score was 1% to 70% (10.8% ± 11.6%). Multivariate logistic regression analysis showed that the absence of specific clinical markers (odds ratio [ OR] = 6.900, 95% confidence interval [ CI]: 1.228, 38.757, P = 0.028), carrying a single specific clinical marker ( OR = 2.579, 95% CI: 1.012, 6.574, P = 0.047), having a history of topical glucocorticoid treatment ( OR = 2.643, 95% CI: 1.019, 6.850, P = 0.041), the absence of family history of vitiligo ( OR = 5.090, 95% CI: 1.070, 24.215, P = 0.030), and lesions on the proximal extremities ( OR = 3.767, 95% CI: 1.315, 10.793, P = 0.037) were risk factors for the resistance to systemic glucocorticoid treatment in the patients with vitiligo. After 3-month treatment, the glucocorticoid-sensitive group showed a significant decrease in plasma CXCL10 levels compared with those before treatment ( W = 571.00, P < 0.001), while there was no significant difference between the pre- and post-treatment CXCL10 levels in the glucocorticoid-resistant group ( W = 48.00, P = 0.524). Additionally, no significant difference was observed in changes of the plasma CXCL9 level before and after treatment between the glucocorticoid-sensitive and glucocorticoid-resistant groups ( P > 0.05) . Conclusions:Carrying no or a single specific clinical marker, having a history of topical glucocorticoid treatment, the absence of family history of vitiligo, and lesions on the proximal extremities appeared to be risk factors for the resistance to systemic glucocorticoid treatment in patients with progressive non-segmental vitiligo. Changes in CXCL10 levels after treatment may be used as an important evaluation indicator for determining whether patients with progressive vitiligo were resistant to systemic glucocorticoid treatment.

The application of spectral CT multiparametric myocardial imaging in preoperative non-invasive assessment for percutaneous coronary intervention / 中华放射学杂志

Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.

Effect of dexmedetomidine on proliferation, migration and invasion ability of renal carcinoma cells and relationship with ferroptosis / 中华麻醉学杂志

Objective:To evaluate the effect of dexmedetomidine (Dex) on the proliferation, migration and invasion ability of renal carcinoma cells and the relationship with ferroptosis.Methods:Experiment Ⅰ GRC-1 cells at the logarithmic growth phase were selected and divided into 5 groups ( n=6 each) using a random number table method: control group (group C) and different concentrations of dexmedetomidine groups(D1, D2, D3, and D4 groups). Group C was routinely incubated for 24 h. D1, D2, D3, and D4 groups were incubated with dexmedetomidine at 0.1, 1.0, 10.0 and 100.0 μmol/L respectively, for 24 h. The cell proliferation ability was assessed by CCK-8 assay.The cell migration and invasion ability was was evaluated by Transwell chamber assay. Experiment Ⅱ GRC-1 cells at the logarithmic growth phasewere selected and divided into 3 groups ( n=6 each) using a random number table method: control group (group C), dexmedetomidine group (group D), and dexmedetomidine+ Ferrostatin-1 group (group D+ F). Group C was routinely cultured for 24 h. Dexmedetomidine 10 μmol/L was added and cells were incubated for 24 h in group D. Dexmedetomidine 10 μmol/L was added, Ferrostatin-1 1 μmol/L was simultaneously added, and then cells were incubated for 24 h in group D+ F. The proliferation ability of the cells was tested by CCK-8 assay, and the migration and invasion ability of the cells was detected by Transwell assay. The contents of glutathione (GSH), malondialdehyde (MDA) and Fe 2+ were measured by the colorimetric method. The expression of glutathione peroxidase 4(GPX4) and ATF4-induced solute carrier family 7a member 11 (SLC7A11) was detected by Western blot. Results:Experiment I Compared with group C, the cell proliferation and the number of migrating and invading cells were significantly decreased in D3 and D4 groups ( P<0.05), and no significant change was found in aforementioned indexes in D1 and D2 groups ( P>0.05). Experiment Ⅱ Compared with group C, the cell proliferation and the number of migrating and invading cells were significantly decreased, the content of Fe 2+ was increased, the content of GSH was decreased, the expression of GPX4 and SLC7A11 was down-regulated ( P<0.05), and no significant change was found in MDA content in group D( P>0.05). Compared with group D, the cell proliferation and the number of migrating and invading cells were significantly increased, the content of Fe 2+ was decreased, the content of GSH was increased, the expression of GPX4 and SLC7A11 was up-regulated ( P<0.05), and no significant change was found in the MDA content in group D+ F( P>0.05). Conclusions:Dexmedetomidine can inhibit the proliferation, migration and invision ability of renal carcinoma cells, and the mechanism is related to promotion of ferroptosis.

Severe Cutaneous Adverse Reactions: A Single-Center Retrospective Study of 173 Patients in China

BACKGROUND: Severe cutaneous adverse reactions (SCAR) to drugs are a crucial public health issue and the use of systemic corticosteroids in SCAR has been controversial. OBJECTIVE: To analyze clinical features, causative drugs, treatment, outcomes, and prognostic factors of SCAR in the case-series of 173 patients, and add more information to the debate of using systemic corticosteroids in SCAR management. METHODS: A retrospective study of 173 SCAR patients diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) or acute generalized exanthematous pustulosis (AGEP) at a tertiary care institution in China between January 2014 and December 2017 was conducted. RESULTS: Of 173 patients, allopurinol, carbamazepine, and antibiotics are the most frequently implicated drugs for DRESS (40.4%), SJS/TEN (26.0%), and AGEP (40.0%) respectively. Moreover, there is a strongly negative correlation between early corticosteroids use and the progression (p=0.000) and severity (p=0.01) of skin lesions. However, there is no association between early corticosteroids use and the mortality of SCAR (odds ratio: 1.01, 95% confidence interval: 0.95~1.08). In addition, lymphadenopathy, eosinophilia, and interval from onset to corticosteroids treatment were correlated with SCAR prognosis. CONCLUSION: Prompt short-course systemic corticosteroids use is associated with early-stage skin lesions remission without influencing the disease mortality. Lymphadenopathy and eosinophilia were the independent poor prognostic factors of SCAR.

Association of programmed cell death 1 (PDCD1) gene polymorphisms with colorectal cancer among Han Chinese population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the association of programmed cell death 1 (PDCD1) gene polymorphisms with the susceptibility and/or progression of colorectal cancer.</p><p><b>METHODS</b>A hospital-based case-control study was carried out, which recruited 426 colorectal cancer patients and 500 healthy individuals. Five single nucleotide polymorphisms, namely rs36084323, rs11568821, rs2227981, rs2227982 and rs10204525, were selected for the study and genotyped with a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay.</p><p><b>RESULTS</b>The G allele of rs36084323 under a dominant model was associated with increased risk of advanced TNM staging of colorectal cancer progression (OR=1.59, 95%CI=1.02-2.48). Haplotypes G-G-C-T-A and A-G-C-C-G of the rs36084323, rs11568821, rs2227981, rs2227982, and rs10204525 were negatively associated with the occurrence of colorectal cancer.</p><p><b>CONCLUSION</b>The G allele of rs36084323 is associated with increased risk of advanced TNM staging of colorectal cancer. Conversely, the incidence of colorectal cancer is negatively associated with the haplotypes G-G-C-T-A and A-G-C-C-G of rs36084323, rs11568821, rs2227981, rs2227982, and rs10204525.</p>

The analysis of the psychosocial factors which influence the family burden of the caregivers of the psychosis patients in community / 中华行为医学与脑科学杂志

Objective To analyze the family burden of the caregivers of the psychosis patients in community, and the psychosocial factors which influence the family burden.Methods Conducted some questionnaires to survey the requirement and attitude on mental health knowledge,social support,family burden and coping style of the caregivers of the psychosis patients from the twelve communities which served as the stations for the psychosis of the twelve prefectures organized uniformly by Guangdong provincial disabled federation.Results 360 questionnaire was provided,and 308 replied to our questionnaire effectively.The mean score of each single item of the family burden questionnaire was beyond the moderate.The factor score of the economy burden was the highest among the factots of the economy burden(2.33±0.52),the daily activity of the family(2.17±0.53),the recreation activity of the family(2.00±0.58),the family relationship(2.10±0.54),the body health of the family members (2.03±0.65),and the mental health of the family members(2.09±0.68).The bad emotion and experience with the patients aggravated some factors of the family burden(P<0.05～0.01).According to correlation analysis and regression analysis,there were significant relation and impact between family burden with the requirement and attitude on mental health knowledge,subject support,coping style,age,economy,culture and so on(P<0.05～0.01). Conclusion Negative assumption to mental health will aggravate the family burden,transfering the positive message and changing passive coping style will help to reduce the family burden.

Requirement and Attitude to Mental Health Knowledge among Psychosis Patients, Caregivers and Healthy Pepople in Community / 中国康复理论与实践

@#ObjectiveTo analyse the requirement and attitude to mental health knowledge and the influence factors among the psychosis patients, the caregivers and the healthy pepople.MethodsThe questionnaire survey conducted among the psychosis patients, the caregivers and the healthy pepople from 12 communities which served as the stations for the psychosis where 12 prefectures were organized uniformly by Guangdong Provincial Federation of Disabled Persons.Results1080 sheets of questionnaire were provided, and 986 replied to meet the requirements. The caregivers showed significant difference in requirment and attitude to mental health knowledge compared to the psychosis patients and the healthy pepople(P＜0.05-0.001). The main influence factors were cultural education, regional economic, the frequency of inpatient, the anxiety emotion of the caregivers, which were statistical significance(P＜0.05-0.001).ConclusionIt is lack in the requirement and cognition to mental health knowledge among the psychosis patients, the caregivers and the healthy pepople. Cultural education and economic development are the effective measures to improve the level of the mental health knowledge.

Negative Emotion and Relative Factors in Caregivers of Patients with Schizophrenia in Community / 中国康复理论与实践

@#ObjectiveTo investigate the negative emoion and the relative factors in the caregivers of the schizophrenia patients in community. Methods212 caregivers from 12 communities psychotic service stations in 12 prefectures in Guangdong were investigated with the Zung Self-rate of Depression, the experience and attitude of the psychosis, the requirement and attitude on mental health knowledge, the social support scale, the family burden scale and the simply coping style questionaire. ResultsThere were 112 caregivers with no depression (52.8%), 57 with mild depression (26.9%), 30 with middle depression (14.2%), 13 with severe depression (6.1%). More than 50% caregivers worry about unsafty, getting into trouble, worse reputation, genetics, felt scare, strained relationship with the patients. There were significant differences in the hopelessness, the strained relaionship, treatment in other cities, superstition, hospitalization longer between the depression and no depression group, as well as in the economy burden, the interference in the family living, the amusement of family, the family relaionship, the body health and the mental health of the other family members, but no significant in the factors of the requirement and attitude on mental healh knowledge. The caregivers with depression reported less social support than the caregivers with no depression, but there was no difference between these groups in utilization of support. ConclusionThe caregivers of the schizophrenia patients experience negative emotion in community, who need mental and material assistance and the education of the knowledge about diseases.

Negative Emotion and Relative Factors in Caregivers of Patients with Schizophrenia in Community / 中国康复理论与实践

@#ObjectiveTo investigate the negative emoion and the relative factors in the caregivers of the schizophrenia patients in community. Methods212 caregivers from 12 communities psychotic service stations in 12 prefectures in Guangdong were investigated with the Zung Self-rate of Depression, the experience and attitude of the psychosis, the requirement and attitude on mental health knowledge, the social support scale, the family burden scale and the simply coping style questionaire. ResultsThere were 112 caregivers with no depression (52.8%), 57 with mild depression (26.9%), 30 with middle depression (14.2%), 13 with severe depression (6.1%). More than 50% caregivers worry about unsafty, getting into trouble, worse reputation, genetics, felt scare, strained relationship with the patients. There were significant differences in the hopelessness, the strained relaionship, treatment in other cities, superstition, hospitalization longer between the depression and no depression group, as well as in the economy burden, the interference in the family living, the amusement of family, the family relaionship, the body health and the mental health of the other family members, but no significant in the factors of the requirement and attitude on mental healh knowledge. The caregivers with depression reported less social support than the caregivers with no depression, but there was no difference between these groups in utilization of support. ConclusionThe caregivers of the schizophrenia patients experience negative emotion in community, who need mental and material assistance and the education of the knowledge about diseases.

Experimental study of Eupolyphaga Sinensis Walker on red blood cell immunity in mice with blood-deficiency / 中国免疫学杂志

Objective:To study the effect of Eupolyphaga Sinensis Walker (ESW) on red blood cell immune adherence (RCIA) in mice model with blood-deficiency by Cyclophosphamide , aimingatfurther research on the mechanism of blood stasis syndrome and promoting blood circulation and removing blood stasis.Methods:This model was made in mice by i.p. cyclophosphamide (0.01 g/kg).It has been observed that how the influence of ESW on the function of red cell immune adherence. The serum anticardiolipin antibodies (ACA),ACA-IgG?ACA-IgA and ACA-IgM levels were measured by using enzymelinked immunosorbent assay (ELISA). The mice body weight were weighted before model and after model and glandular weight were weighted. The serum levels of trace element zinc calcium were determined in healthy mice.Results:The results showed there is a decline in garland rate of red blood cell C3b receptors (RBC-C3bRR) in mice when animal model of Blood - deficiency by cyclophosphamide (0.01 g/kg) form, the serum ACA-IgG and ACA-IgA levels were markedly elevated,while mice body weight and spleen thymus weight markedly depressed. ESW (25 g/kg) increased RBC-C3bRR in the mice model with Blood-deficiency,restified the mice model body weight loss by cyclophosphamide, increased spleen thymus weight .ESW (25 g/kg) increased serum zinc calcium level in the normal mice.Conclusion:ESW increases activity of CR 1 of red blood cells and RCIA, inhibits serum ACA-IgG and ACA-IgA.ESW enhances serum zinc calcium level, that can be a good biological pharmacodynamics.