Skin diseases in the Da Qing Diabetes Study: a cross-sectional study.

BACKGROUND: The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM. METHODS: We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated. RESULTS: In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in "disturbances of pigmentation" and "neurological and psychogenic dermatoses". The duration of T2DM also significantly associated with the prevalence of "disturbances of pigmentation" and "neurological and psychogenic dermatoses". Subsequently, the prevalence of "disturbances of pigmentation" was higher in males than females in NGT (P < 0.01) and T2DM (P < 0.01) groups. In addition, the difference in the prevalence of "disturbances of pigmentation" was also significant in NGT and T2DM groups (P < 0.01). CONCLUSIONS: There was a high prevalence of skin diseases in the Da Qing Diabetes Study. To address the skin diseases in the Da Qing Diabetes Study, increased awareness and intervention measures should be implemented.

Diagnostic capacity of skin tumor artificial intelligence-assisted decision-making software in real-world clinical settings.

BACKGROUND: Youzhi artificial intelligence (AI) software is the AI-assisted decision-making system for diagnosing skin tumors. The high diagnostic accuracy of Youzhi AI software was previously validated in specific datasets. The objective of this study was to compare the performance of diagnostic capacity between Youzhi AI software and dermatologists in real-world clinical settings. METHODS: A total of 106 patients who underwent skin tumor resection in the Dermatology Department of China-Japan Friendship Hospital from July 2017 to June 2019 and were confirmed as skin tumors by pathological biopsy were selected. Dermoscopy and clinical images of 106 patients were diagnosed by Youzhi AI software and dermatologists at different dermoscopy diagnostic levels. The primary outcome was to compare the diagnostic accuracy of the Youzhi AI software with that of dermatologists and that measured in the laboratory using specific data sets. The secondary results included the sensitivity, specificity, positive predictive value, negative predictive value, F-measure, and Matthews correlation coefficient of Youzhi AI software in the real-world. RESULTS: The diagnostic accuracy of Youzhi AI software in real-world clinical settings was lower than that of the laboratory data (P < 0.001). The output result of Youzhi AI software has good stability after several tests. Youzhi AI software diagnosed benign and malignant diseases by recognizing dermoscopic images and diagnosed disease types with higher diagnostic accuracy than by recognizing clinical images (P = 0.008, P = 0.016, respectively). Compared with dermatologists, Youzhi AI software was more accurate in the diagnosis of skin tumor types through the recognition of dermoscopic images (P = 0.01). By evaluating the diagnostic performance of dermatologists under different modes, the diagnostic accuracy of dermatologists in diagnosing disease types by matching dermoscopic and clinical images was significantly higher than that by identifying dermoscopic and clinical images in random sequence (P = 0.022). The diagnostic accuracy of dermatologists in the diagnosis of benign and malignant diseases by recognizing dermoscopic images was significantly higher than that by recognizing clinical images (P = 0.010). CONCLUSION: The diagnostic accuracy of Youzhi AI software for skin tumors in real-world clinical settings was not as high as that of using special data sets in the laboratory. However, there was no significant difference between the diagnostic capacity of Youzhi AI software and the average diagnostic capacity of dermatologists. It can provide assistant diagnostic decisions for dermatologists in the current state.

Effect of polymer microneedle pre-treatment on drug distributions in the skin in vivo.

Solid microneedles (MNs) represent a useful tool for enhancing skin permeability by creating microchannels that provide a drug delivery route. To achieve the solid polymer MNs to become a clinical reality and to be commercialised, it is much essential to understand the skin penetration process. In this work, the effect of polymer MN height and density, drug molecular weight, as well as drug diffusion time on the drug permeability distribution was systemically investigated in vivo. MN with a height of 800 µm was most conductive to enhance the vertical distribution of drug permeation into the skin, while 11 × 11 MN array was most beneficial to promote the horizontal distribution of drug permeation into the skin. In addition, the increasing of drug molecular weight could reduce the drug permeability distribution and Fluorescein isothiocyanate most likely to penetrate into the skin after MNs pre-treatment. With the increase of drug diffusion time, the drug distribution in the subcutaneous gradually weakened until the drug was absorbed by the subcutaneous tissue at 8 h. These results suggest that the solid polymer MNs can penetrate the stratum corneum of the skin for enhancing drug delivery, especially small molecule drugs.

Dermoscopy in China: current status and future prospective.

OBJECTIVE: Dermoscopy is a useful technique for improving the diagnostic accuracy of various types of skin disorders. In China, dermoscopy has been widely accepted, and domestic researchers have made tremendous progress in the field of dermoscopy. The main purpose of this review is to summarize the current status of dermoscopy in China and identify its future directions. DATA SOURCES: Articles included in this review were obtained by searching the following databases: Wanfang, China National Knowledge Infrastructure, PubMed, and the Web of Science. We focused on research published before 2019 with keywords including dermoscopy, dermoscopic, dermoscope and trichoscopy. STUDY SELECTION: A total of 50 studies were selected. Of these studies, 20 studies were in Chinese and 30 in English, research samples of all the studies were collected from Chinese populations. RESULTS: Since 2000, more than 380 articles about dermoscopy have been published in domestic or foreign journals. Dermoscopy can improve the diagnostic accuracy of neoplastic diseases, evaluating the therapeutic effect of treatment, and determining the treatment endpoint, and it can also assist in the differential diagnosis of inflammatory diseases and in the assessment of the severity of the disease. In addition, researches about the applications of dermoscopy during surgical treatment have been published. Training courses aiming to improve the diagnostic ability of dermatologists, either face-to-face or online, have been offered. The Chinese Skin Image Database, launched in 2017 as a work platform for dermatologists, has promoted the development of dermoscopy in China. Computer-aided diagnostic systems based on the Chinese population are ready for use. In the future, cooperation, resource sharing, talent development, image management, and computer-aided diagnosis will be important directions for the development of dermoscopy in China. CONCLUSION: Dermoscopy has been widely used and developed in China, however, it still needs to address more challenges in the future.

The maximum possible amount of drug in rapidly separating microneedles.

There is an increasing concern on the drug loading capacity of microneedles (MNs) to meet higher drug dosage requirement. The present study describes the fabrication of modified rapidly separating polyvinyl alcohol (PVA)-based MNs (RS-P-MNs) with high drug loading using a mechanical agitation process. The drugs encapsulated within the PVA polymer gel by mechanical agitation served as an encapsulating agent for drugs that provide a high drug loading capacity and also release of drugs in a controlled manner. The various parameters such as microscopic analysis, atomic force microscopy (AFM), drug loading, drug delivery efficiency, mechanical test, skin penetration ability, and in vitro and in vivo analyses indicate the great potential of the RS-P-MNs. The maximum drug loading capacity of RS-P-MNs was measured to be approximately 900 ng per microneedle, which was almost a hundred times than the traditional drug encapsulating mode. The in vitro and in vivo results suggested that the controlled release of drugs is due to the encapsulating mode (mechanical agitation) of drugs. The prepared RS-P-MNs with high drug loading in this study provided a gentle and controlled release of drugs instead of the robust release of drugs from traditional MNs. Graphical abstract.

Kinetic stability studies of HBV vaccine in a microneedle patch.

This study systematically demonstrated the antigenicity kinetics of HBV vaccine microneedles (MNs) during the fabrication, application and storage. To improve the stability of HBsAg in a microneedle patch, several selected saccharides were added to the MN formulations as stabilizers. According to the experimental data, no significant decrease of the bio-activity of HBsAg antigen was found during the microneedle fabrication process. And then immune effects of HBsAg added with different sugars were tested. Chitosan and trehalose loaded HBsAg MNs enhanced the antibody levels to approximately 1.5-fold and 2-fold of the plain HBsAg MNs respectively while sucrose and glucose were not obviously beneficial. During the short-term storage under 60 °C, the antigenicity of HBsAg MNs encapsulated with glucose and chitosan declined sharply in 24 h and hardly left after 7 days. As for the groups of HBsAg MNs added with sucrose and trehalose, approximately 90% of HBsAg initial antigenicity maintained, which could be attributed to the protective function of non-reductive disaccharides. As for the long-term storage experiments, the pharmacological activity of HBsAg antigen protected by sucrose and trehalose slightly reduced in 3 months except for the samples under 60 °C. In extreme condition, trehalose performed even better protection function than sucrose, of which the antigenicity of HBsAg in MNs left approximately 81% and 63% of its initial, respectively. These results confirmed that trehalose loaded HBsAg MNs enabled stable encapsulation and storage of HBsAg antigen and realized reasonable enhancement of immune effect in a relatively painless, safe, and convenient manner.

Safety Evaluation of Solid Polymer Microneedles in Human Volunteers at Different Application Sites.

The focus of solid microneedles technology to date has largely been on cosmetology, vaccination, and insulin delivery, etc. However, limited information is available about the safety of solid polymer microneedles applied in different parts of the human body. In consideration of the different application sites of cosmetology, vaccination, and insulin delivery involved with microneedles technique, factors influencing user acceptance to microneedles including the length and density as well as the size of microneedle patches were systematically investigated by applying different microneedle patches on the forehead, forearm, and abdomen skins of 18 healthy human participants. Multiple insertion tests demonstrated that solid microneedles with a length of 400 µm, a density of 100 MN/cm2, and an array size of 10 × 10 were optimal for forehead pretreatment. Microneedles with lengths of 400 and 600 µm, densities of 49 and 100 MN/cm2, and an array size of 10 × 10 caused less pain and slight skin irritation in the forearm, whereas 400 µm height, 49 and 100 MNs/cm2 densities, and 5 × 5, 10 × 10, and 10 × 20 arrays of the solid microneedles were not considered painful and were well-tolerated in abdomen insertion. In conclusion, the optimization of the dimensions of microneedles according to application sites could improve medication compliance and the safety of clinical use of solid microneedles.

Up-regulation of Tight-Junction Proteins by p38 Mitogen-Activated Protein Kinase/p53 Inhibition Leads to a Reduction of Injury to the Intestinal Mucosal Barrier in Severe Acute Pancreatitis.

OBJECTIVES: The aim of this study was to explore the role of the p38 mitogen-activated protein kinase (p38MAPK)/p53 signaling pathway in injury to the intestinal mucosal barrier during severe acute pancreatitis (SAP). METHODS: Both sham operation and SAP groups had 3 subgroups analyzed 3, 6, or 12 hours after the SAP induction. The concentrations of amylase, endotoxin, diamine oxidase, tumor necrosis factor α, and phospho-p38MAPK, p53, and caspase-3 and the messenger RNA levels of zonula occludens protein-1 and occludin in the intestine were measured. Immunohistochemical staining was used to determine the expression of zonula occludens protein-1 and occludin. Pathological changes of the pancreas and intestine were also assessed. Then, rats were randomly assigned to 5 groups-sham operation group, SAP group, 3 groups treated with different concentrations of p38MAPK-inhibitor SB203580-and the abovementioned experiment was repeated and analyzed 6 hours after the SAP induction. RESULTS: The phospho-p38MAPK reached a peak value at 6 hours after the SAP induction with obvious pathological injury to the pancreas and intestine. Treatment with SB203580 led to a less damage to the pancreatic and intestinal tissues. CONCLUSIONS: These results suggest that SAP activates the p38MAPK/p53 signaling pathway and induces injury to the intestinal mucosal barrier, which can be alleviated by inhibiting the p38MAPK/p53 pathway.