A new proposal for phenotypic classification and outcome assessment of dermatomyositis based on clinical manifestations and serological testing

Abstract Background Dermatomyositis (DM) is an infrequent disease subgroup of idiopathic inflammatory myopathies characterized by distinct skin lesions. However, high heterogeneity makes clinical diagnosis and treatment of DM very challenging. Objectives Unsupervised classification in DM patients and analysis of key factors related to clinical outcomes. Methods This retrospective study was conducted between 2017 and 2022 at the Department of Rheumatology, Xiangya Hospital, Central South University. 162 DM patients were enrolled for unsupervised hierarchical cluster analysis. In addition, we divided the clinical outcomes of DM patients into four subgroups: withdrawal, stabilization, aggravation, and death, and compared the clinical profiles amongst the subgroups. Results Out of 162 DM patients, three clusters were defined. Cluster 1 (n = 40) was mainly grouped by patients with prominent muscular involvement and mild Interstitial Lung Disease (ILD). Cluster 2 (n = 72) grouped patients with skin rash, anti-Melanoma Differentiation Associated protein 5 positive (anti-MDA5+), and Rapid Progressive Interstitial Lung Disease (RP-ILD). Cluster 3 (n = 50) grouped patients with the mildest symptoms. The proportion of death increased across the three clusters (cluster 3 < cluster 1 < cluster 2). Study limitations The number of cases was limited for the subsequent construction and validation of predictive models. We did not review all skin symptoms or pathological changes in detail. Conclusions We reclassified DM into three clusters with different risks for poor outcome based on diverse clinical profiles. Clinical serological testing and cluster analysis are necessary to help clinicians evaluate patients during follow-up and conduct phenotype-based personalized care in DM.

Expression of Tspan29 in breast cancer tissues and its effect on malignant biological behaviors of MCF-7 and MDA-MB-231 cells / 中国肿瘤生物治疗杂志

@#Objective: To investigate the expression of tetraspanins-29 (Tspan29) in breast cancer tissues and cell lines and to explore the effect of Tspan29 knockdown on proliferation, invasion, migration and epithelial-mesenchymal transition (EMT) of breast cancer MCF-7 and MDA-MB-231 cells. Methods:Atotal of20pairsofbreast cancer tissues and corresponding para-cancerous tissues resected in Minhang Branch of Cancer HospitalAffiliated to Fudan University from June 2017 to February 2018 were collected for this study; in addition, breast cancer celllinesMCF-7,MDA-MB-231andhumanbreastepithelialMDA-kb2cellswerealsocollected.ThemRNAand protein expressions of Tspan29 in above mentioned tissues and cell lines were detected by Real-time quantitative (qPCR) and Western blotting. The expression of Tspan29 in MCF-7 and MDA-MB-231 cells was interfered by siRNA. qPCR was used to detect the mRNA and protein expressions of Tspan29. PCR microarray was used to examine the expressions of EMT-related genes in MCF-7 cells. CCK-8 assayandTranswellwereusedtodetectcellproliferation, migration and invasion of MCF-7 and MDA-MB-231 cells. Results: The mRNA and protein expressions of Tspan29 in breast cancer tissues were significantly higher than that in para-cancerous tissues (all P<0.01); and the mRNA and protein expressions of Tspan29 in MCF-7 and MDA-MB-231 cells were significantly higher than that in MDA-kb2 cells (P<0.01). After being interfered with siTspan29, the mRNA and protein expressions of Tspan29 were significantly down-regulated in MCF-7 cells (all P<0.05); the proliferation, invasion and migration of MCF-7 and MDA-MB-231 cells were significantly inhibited (all P<0.05); and among the EMT-related genes, two were significantly up-regulated while 7 were down-regulated. Conclusion: Tspan29 is significantly up-regulated in breast cancer tissues and cell lines, and knockdown of Tspan29 significantly inhibits the proliferation, invasion and migration of breast cancer cells. ··

Different jaw positions and condylar positions in oral therapy / 口腔疾病防治

@#In the stomatognathic system, a stable jaw position is influenced by occlusion, the temporomandibular joint and neuromuscular stability. The condylar position in the glenoid fossa is closely related to the jaw position, while no consensus has been reached on the optimum jaw position and its corresponding condylar position in oral therapy. This paper summarizes the controversial opinions regarding the selection of jaw position and the corresponding condylar position in prosthetics and orthodontics, including antero-superior, antero-inferior, and therapeutic positions. Their indications, theoretical bases and clinical applications are also included. The literature review results suggest that, the antero-superior position, in other words, centric relation, should be chosen when the patient has a stable jaw position without TMD. In cases where finding an ideal antero-superior position is difficult due to hyperplasia or deformation or disarrangement of the articular disc, the antero-inferior position is recommended to alleviate symptoms and facilitate reconstruction of the TMJ to obtain good stability. Moreover, for high-angle patients with Class Ⅱ malocclusion or for patients with mild skeletal malocclusion, camouflaged orthodontic treatment combined with antero-inferior jaw repositioning through the potential of condyle remodeling can be an alternative to orthognathic surgery and can simplify the treatment plan. While the therapeutic position is specifically proposed for coping with complicated situations related to cranio-mandibular dysfunction, such as maximal intercuspal position abnormalities or deflection, muscle and TMJ dysfunction, unstable jaw position, in which changes in the original occlusion or abnormal TMJ guidance are induced, and a new intercuspal position can be established and stabilized on the basis of occlusal support and modified guidance. The therapeutic position put aside the debate regarding condylar position, however, the specific position of the condyle has not been reported in this case. This review suggests that different jaw positions and condylar positions have different scopes of application, and their clinical selection should be based on based on whether the patient′s joints have organic changes and the stability of the jaw positions should be comprehensively considered. However, the long-term effects of oral therapy based on different jaw positions need to be further verified by controlled clinical trials in the future.

Horn shaped perforator flap pedicled with the angular artery: anatomy basis and clinical application / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.</p><p><b>METHODS</b>(1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.</p><p><b>RESULTS</b>The facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.</p><p><b>CONCLUSIONS</b>The flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.</p>