Stevens-Johnson syndrome/toxic epidermal necrolysis successfully treated with Chinese herbal medicine Pi-Yan-Ning: A case report.

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare adverse cutaneous reaction with a low incidence and high mortality. Despite posing a serious threat to patients' health and lives, there is no high-quality evidence for a standard treatment regimen. Here we report the case of a 62-year-old man with stage IV pancreatic cancer who experienced immunotherapy-induced SJS/TEN. After consensus-based regular treatments at a local hospital, his symptoms became worse. Thus, he consented to receive Chinese herbal medicine (CHM) therapy. The affected parts of the patient were treated with the CHM Pi-Yan-Ning which was applied externally for 20 min twice a day. After 7 days of treatment, the dead skin began peeling away from the former lesions that had covered his hands, feet, and lips, indicating that skin had regenerated. After 12 days of treatment, the patient's skin was completely recovered. In this case, SJS/TEN was successfully treated with Pi-Yan-Ning, suggesting that there might be tremendous potential for the use of Pi-Yan-Ning in the treatment of severe skin reactions to drug treatments. Further basic investigations and clinical trials to explore the mechanism and efficacy are needed.

[Determination of ascitic bacterial 16S rRNA by quantitative PCR-microarray in the diagnosis of spontaneous bacterial peritonitis].

OBJECTIVE: To evaluate the significance of determining ascitic bacterial 16S rRNA by quantitative PCR combined with microarray (PCR-microarray) in the diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: Ascitic bacterial 16SrRNA was determined by real time fluorescent quantitative PCR-microarray in 76 cases of suspected SBP and 6 cases of non-infectious ascites with chronic liver diseases. The results were compared with ascitic bacterial culture simultaneously. RESULTS: Of 76 ascitic samples, 17 were detected bacteria positive by PCR-microarray, including 8 Grams positive(G+) and 9 Grams negative(G-), which was higher than that by bacterial culture which had only 6 ascitic samples detected positive (all G-); the positive rates were 22.4% vs 7.9%, respectively (P < 0.01). The bacterial strains detected by both methods in 6 cases had a consistency with each other. No bacteria were detected in another 6 cases of non-infectious ascites with chronic liver diseases. CONCLUSIONS: Determination of ascitic bacteria 16S rRNA by PCR-microarray has a higher specificity and sensitivity in the diagnosis of SBP as compared with the bacteria culture. Application of this novel method can not only accelerate SBP diagnosis but also stratify the different pathogens.

[Determination of ascitic bacterial 16S rRNA gene in the rapid diagnosis of spontaneous bacterial peritonitis].

OBJECTIVE: To evaluate the value of ascitic bacterial 16S rRNA gene determination in the rapid diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: 16S rRNA gene from bacterial DNA in ascites was determined by quantitative fluorescent polymerase chain reaction (PCR) in 76 patients with suspected SBP and 6 patients with non-infectious ascites. The results were compared with those obtained from bacterial culture. RESULTS: The positive rate of SBP was 22.4% among patients detected with ascitic bacterial 16S rRNA gene determination-based quantitative fluorescent PCR, which was significantly higher than that (7.9%) in patients only received bacterial culture (P<0.05). In addition,in 6 patients with non-infectious ascites,both the 16S rRNA gene determination-based quantitative fluorescent PCR and bacterial culture showed negative results. CONCLUSIONS: 16S rRNA gene determination-based quantitative fluorescent PCR can be an effective tool for the rapid diagnosis of SBP. It is more sensitive than the bacterial culture.

[Level of serum and liver tissue TGF-beta1 in patients with liver fibrosis due to chronic hepatitis B].

OBJECTIVE: To detect the level of serum and liver tissue TGF-beta1 in patients with chronic hepatitis B, to study their relation to liver fibrosis and gain the evidence for diagnosis of liver fibrosis. METHODS: The liver fibrosis grades (S0-S4) of 131 cases with chronic HBV infection were diagnosed after liver biopsy. Serum TGF-beta1 was detected by enzyme-linked immunosorbent assay, and the semiquantitative analysis was applied after detecting the expression of TGF-beta1 in liver tissue with immunohistochemistry. Their relations to liver fibrosis were analyzed. RESULTS: Serum and tissue level of TGF-beta1 increased significantly with the development of fibrosis, and the same result was obtained between themselves (P < 0.01). There was very significant difference for serum level of TGF-beta1 among the groups with different fibrosis grades (P < 0.01). Serum levels of TGF-beta1 were decreased significantly comparing the Group S0 or S1 to S4 (P < 0.005). There were significant difference for serum level of TGF-beta1 among S0 and the others (P < 0.005). And there was significant difference between S1 and S3 (P < 0.005). The expression level of TGF-beta1 in liver tissue has no significant difference between group S3 and S4 (P > 0.05). However, the differences were significantly among the other comparisons (P < 0.01). CONCLUSION: There is close relation between the level of TGF-beta1 and the different liver fibrosis grades due to chronic hepatitis B. The serum level of TGF-beta1 is a potential noninvasive maker for diagnosis of liver fibrosis.

[Expression of Bcl-2 and Bax proteins in rat liver fibrosis model and the role of IFN-gamma].

OBJECTIVE: To study the expression of Bcl-2 and Bax in rat liver fibrosis model induced by CCl4 and the role of IFN-gamma. METHODS: Liver fibrosis was induced in rats by subcutaneous injection of CCl4. The rats were divided into fibrosis model group, Bie-Jia-Ruan-Gan-Tablet treatment group and IFN-gamma treatment group (0.2 MU.kg.d, i. m. for 12 weeks), and another 10 rats without any treatment were used as normal control. Bcl-2 and Bax proteins expression were detected by immunohistochemistry. RESULTS: Bcl-2 was expressed weakly in the homogenate of hepatocytes and hepatic sinusoid in normal control rats, and it was expressed stronger in fibrous septae, portal area, hepatic sinusoid, the homogenate and membrane of hepatocytes and central vein in fibrosis model rats (3.87%+/-2.37% vs 9.46%+/-4.29%, t=2.83, P<0.05). Bax was expressed slightly in central vein and the hepatic sinusoid around, and it was expressed stronger in the homogenate of hepatocytes, hepatic sinusoid, fibrous septae, membrane of hepatocytes and epithelial cells of bile duct (3.50%+/-1.88% vs 9.80%+/-3.75%, t=3.72, P<0.01). Compared with that in fibrosis model rats, the expression of Bax was significantly lower in rats treated with IFN-gamma (9.80%+/-3.75% vs 5.85%+/-2.35%, t=2.98, P<0.01), but the expression of Bcl-2 was not significantly different (t=1.49, P>0.05), however it was significantly lower in fibrous septae in IFN-gamma-treated group than in model group (6.58%+/-4.13% vs 9.46%+/-4.29%, t=2.80, P<0.05). CONCLUSION: The expression of Bcl-2 and Bax increases in liver fibrosis model rats, and IFN-gamma can promote myofibroblasts apoptosis