Toxic epidermal necrolysis complicated with primary cutaneous aspergillosis: A report of four cases.

Primary cutaneous aspergillosis (PCA) is a rare opportunistic infection caused by Aspergillus that can be life-threatening. PCA is mainly reported in immunocompromised hosts such as patients with AIDS, those with hematologic malignancy, or infants with occlusive dressings. However, no study has previously reported PCA associated with toxic epidermal necrolysis (TEN). This study reports four cases of TEN complicated with PCA, presenting with discrete gray or black spots over newly formed epithelia. Risk factors of PCA in patients with TEN include host factors, iatrogenic factors, indoor environment, and wound care. Two of the four cases eventually died, highlighting the importance of further exploring PCA in patients with TEN.

Anti-immunoglobulin E provides an additional therapy to conventional steroids for Kimura's disease.

Kimura's disease (KD) is a chronic inflammatory disease characterized by painless subcutaneous head and neck swelling, eosinophilia, and elevated serum immunoglobulin (Ig) E levels. There are various therapies, including surgery, radiation, systemic steroids, and immune suppressants, but their efficacy remains moderate due to the high recurrence rate. Biologics, like monoclonal antibodies, have shown tremendous effectiveness for chronic inflammatory diseases. Omalizumab is a monoclonal antibody against IgE and has not been approved for KD so far. We describe two refractory KD cases that responded to a small dose of steroids plus omalizumab. Additionally, we reviewed another 13 KD cases that were treated with biologics, including omalizumab, rituximab, dupilumab, and mepolizumab. The results indicate that biologics provide an alternative treatment strategy for KD.

Mycobacterium haemophilum infection with cutaneous involvement: two case reports and an updated literature review: Mycobacterium haemophilum skin infection.

Mycobacterium haemophilum (MH) is a slow-growing, non-tuberculous Mycobacterium that most commonly causes infections in immunocompromised patients. The skin is the most prevalent site of infection and can be an isolated presentation or part of a disseminated disease. Herein, we reported a case of isolated MH infection of the hand and a case of disseminated MH infection with multiple skin lesions. In addition, other MH cases with cutaneous involvement over the last 10 years, from 2011-2022, were reviewed and analyzed. Among the 79 included cases, the common skin findings in MH infections included nodules, ulcers, abscesses, swelling, and pustules. Middle-aged patients with iatrogenic immunosuppression from glucocorticoids, mycophenolate mofetil, cyclosporine, and cyclophosphamide are the most susceptible to MH infection, with a higher risk of dissemination to internal organs. Disseminated MH infections commonly present as tenosynovitis, arthritis/arthralgia, or osteomyelitis. There is a lack of strong evidence for treatment; however, triple therapy of quinolone, macrolides, and rifampicin is most often used in clinical practice. The overall prognosis is good. The presence of iatrogenic immunocompromised diseases, lesions involving the proximal limbs, and dissemination of MH infections are associated with worse clinical outcomes.

Identification of umami peptides based on virtual screening and molecular docking from Atlantic cod (Gadus morhua).

Umami peptides have currently become the research focus in the food umami science field and the key direction for umami agent development. This is because umami peptides have good processing characteristics, umami and nutritional values. We here used virtual screening (including online enzymolysis through ExPASy PeptideCutter, bioactivity screening using the PeptideRanker, toxicity and physicochemical property prediction using Innovagen and ToxinPred software), molecular docking, and electronic tongue analysis to identify umami peptides generated from Atlantic cod myosin. Twenty-three putative umami peptides were screened from the myosin. Molecular docking results suggested that these 23 peptides could enter the binding pocket in the T1R3 cavity, wherein Glu128 and Asp196 were the main amino acid residues, and that hydrogen bonding and electrostatic interactions were the main binding forces. Twelve synthetic peptides tested on the electronic tongue exhibited umami taste and a synergistic effect with monosodium glutamate (MSG). Among them, GGR, AGCD, and SGDAW had higher umami intensities than the other peptides, while SGDAW and NDDGW exhibited stronger umami-enhancing capabilities in 0.1% MSG solution. This study offers a method for the rapid screening of umami peptides from marine protein resources and places the foundation for their application in the food industry.

Predictive Value of the HEART Score Combined with Hypersensitive C-Reactive Protein for 30 d Adverse Cardiovascular Events in Patients with Acute Chest Pain.

Purpose: This study aimed to explore the predictive value of the HEART score combined with hypersensitive C-reactive protein (hs-CRP) for 30 d major adverse cardiovascular events (MACEs) in patients with acute chest pain. Methods: 103 patients with acute chest pain admitted to the emergency department of our hospital from May 2020 to May 2022 were selected as the study subjects. The patients' HEART score and plasma hs-CRP level were recorded. The patients were followed up for 30 d to observe whether MACE occurred. Results: Among 103 patients with acute chest pain, MACE occurred in 8 cases within 30 d of follow-up, and the probability of MACE was 7.76%. There was a statistically significant difference in 30 d MACE risk among patients with different HEART score stratification (P < 0.05). The age, HEART score, and hs-CRP levels of patients in the MACE group were higher than those in the non-MACE group (P < 0.05). The HEART score and the hs-CRP level were independent risk factors for 30 d MACE in patients with acute chest pain (P < 0.05). The AUC of the HEART score combined with hs-CRP in the occurrence of 30 d MACE in patients with acute chest pain was 0.901, which was significantly higher than 0.720 and 0.758 of single detection. Conclusion: The HEART score combined with hs-CRP can better predict the occurrence of 30 d MACE in patients with acute chest pain.

The Value of Neutrophil/Lymphocyte Ratio Combined with Red Blood Cell Distribution Width in Evaluating the Prognosis of Emergency Patients with Sepsis.

Sepsis is a dysfunction of various organs caused by a dysfunctional host response induced by infection. In recent years, the mortality rate of sepsis patients, especially the mortality rate of septic shock patients still remains high. Due to the complexity and heterogeneity of sepsis, there is currently a lack of clinical biomarkers that can be widely used for the early assessment of sepsis. In order to find more concise and accurate biomarkers for timely and adequate intervention in sepsis, we explored the value of neutrophil/lymphocyte ratio (NLR) combined with red blood cell distribution width (RDW) in assessing the prognosis of emergency sepsis patients. The results showed that NLR and RDW were closely related to the prognosis of emergency sepsis patients. The combination of the two can evaluate the prognosis of patients with emergency sepsis, which deserves close attention from clinicians.

Effects of ultrasound pretreatment at different powers on flavor characteristics of enzymatic hydrolysates of cod (Gadus macrocephalus) head.

To make better use of cod head (Gadus macrocephalus), a by-product of fish processing, the effects of ultrasound pretreatment on the enzymatic properties and volatile compounds of cod head enzymatic hydrolysates were investigated. The results demonstrated that ultrasound pretreatment at 150-600 W had a positive effect cod head enzymatic hydrolysates. The soluble peptides content of the enzymatic hydrolysates reached the highest value of 5.31 ± 0.16 mg/mL at the ultrasound power level of 450 W, and the content of peptide molecules < 3-kDa was up to 93.96%. The type and relative content of volatile compounds, especially aldehydes, alcohols, and ketones, also increased with the increase the ultrasound power. The electronic tongue results indicated that ultrasound pretreatment reduced bitterness and astringency. The electronic nose results indicated that the hydrogen- and alkane-containing odor components in the hydrolyzed liquid after ultrasound pretreatment differed significantly from conventional enzymatic hydrolysates. In conclusion, ultrasound pretreatment may be applicable as a suitable technology to assist enzymatic hydrolysis of the cod head, and as such, promote the utilization of fish by-products.

Correlation between Coagulation Fibrinolysis Function and Outcomes during Hospitalization in Patients with Severe Traumatic Hemorrhagic Shock.

Objective: To analyze the correlation between coagulation fibrinolysis function and outcomes during hospitalization in patients with severe traumatic hemorrhagic shock. Methods: A retrospective collection was performed on the clinical data of 106 patients with severe traumatic shock admitted to the hospital between January 2020 and January 2022. According to the injury severity score (ISS), they were divided into the S1 group (ISS <25 points, n = 70) and the S2 group (ISS ≥25 points, n = 36). The prothrombin time (PT), fibrinogen (Fib), thrombin time (TT), and activated partial thromboplastin time (APTT) were detected by the coagulation assay. The aD-dimer (D-D) was detected by an enzyme-linked immunosorbent assay. Antithrombin activity (AT : A) and plasminogen activity (PLG : A) were detected by the chromogenic substrate method. The relationship between coagulation fibrinolysis indexes and injury severity was analyzed by Spearman's correlation analysis. The predictive value of coagulation fibrinolysis indexes for outcomes of patients with severe traumatic hemorrhagic shock was evaluated by receiver operating characteristic (ROC) curves. Results: The levels of PT, APTT, D-D, TT, AT : A and PLG : A in the S2 group were higher than those in S1 group, while the Fib level was lower than that in the S1 group (P < 0.05). A Spearman's analysis showed that PT, APTT, TT, D-D, AT : A, and PLG : A were positively correlated with injury severity (P < 0.05), while Fib was negatively correlated with it (P < 0.05). Among the 106 patients, there were 89 survived cases and 17 died cases. The levels of PT, APTT, D-D, AT : A and PLG : A in the death group were lower than those in the survival group, while the Fib level was higher than that in the survival group. The results of ROC curve analysis showed that serum PT, APTT, Fib, TT and D-D were of predictive value for outcomes (AUC = 0.713, AUC = 0.683, AUC = 0.712, AUC = 0.761, AUC = 0.730, AUC = 0.765, AUC = 0.673, P < 0.05), and cutoff values were 20.29 s, 34.79 s, 3.54 g/L, 20.97 s, 1.42 µg/L, 73.53% and 63.97%, respectively. Conclusion: There is coagulation and fibrinolysis dysfunction in patients with severe traumatic hemorrhagic shock, which is related to injury severity. The coagulation fibrinolysis indexes have a certain predictive value for outcomes of patients.

Classification and rising medication therapy in stiff skin syndrome: A case report and literature review.

Stiff skin syndrome (SSS) is a rare disorder characterized by skin induration and limited joint mobility in the absence of visceral, musculoskeletal, vascular, or immunologic abnormalities. Distinctive subsets of SSS could be distinguished by various manifestation and mechanism, which accounts for the high heterogeneity in SSS cases. Although rehabilitation training remains the mainstay of management, rising medications has drawn awareness in recent years, owing to the potential efficacy. Nevertheless, experience was limited, especially in widespread SSS. We report on a 5-year-old girl with widespread SSS, whose lesion stopped progressing after combination therapy by mycophenolic acid (MPA) and losartan (LST) in addition to rehabilitation exercise. Despite limited experience, a combined therapy of MPA and LST seems to be effective in retarding progression of widespread SSS.

Inhibition of tumor necrosis factor improves conventional steroid therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis in a cohort of patients.

BACKGROUND: Systemic steroid therapies for Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) have been challenged because of their limited benefits. Whether additional tumor necrosis factor (TNF) α inhibition provides an optimized approach remains unexplored. OBJECTIVE: To investigate the efficacy of TNF-α inhibition combined with a steroid to treat SJS/TEN and to identify potential biomarkers. METHODS: Twenty-five patients with SJS/TEN were recruited and divided into 2 groups: 10 patients received methylprednisolone and 15 patients received etanercept plus methylprednisolone. Serum levels of granzyme B, perforin, interferon-γ, interleukin (IL) 6, IL-15, IL-18, macrophage inflammatory protein 1α, macrophage inflammatory protein 1ß, and TNF-α were measured by multiplex cytokine analysis kits during the acute and resolution phases. RESULTS: Compared with the steroid monotherapy, the combination therapy significantly shortened the course of the initial steroid treatment and the duration of the acute stage, hospitalization stay, and skin re-epithelialization. Although both therapies significantly reduced IL-15 levels; the combination therapy also decreased IL-6 and IL-18 levels. While the level of IL-15 was positively correlated with skin re-epithelialization time in both groups, the level of IL-6 served as an additional marker for the course of the disease in the combination therapy group. LIMITATIONS: The cohort size is relatively small. CONCLUSION: Additional TNF-α inhibition to steroid treatment appeared to improve outcomes for SJS/TEN.

Association Between Daily Dietary Eicosatetraenoic Acid Intake and the Lower Risk of Psoriasis in American Adults.

PURPOSE: Unlike eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the relationship between eicosatetraenoic acid (ETA) and psoriasis remains unclear. Therefore, We performed a cross-sectional study in the general American population to investigate the association between daily dietary ETA, EPA, and DHA intake and the risk of psoriasis. PARTICIPANTS AND METHODS: This study applied data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 and 2009-2014. Dietary n3 polyunsaturated fatty acids (PUFA) were calculated based on two 24-hour dietary recall interviews. We defined psoriasis by responding to the question "Have you ever been told by a doctor or other health care professional that you had psoriasis?". Multivariable logistic regression analysis, trend tests, subgroup analysis, and interaction tests were used to evaluate the associations of ETA, EPA, and DHA intake with the risk of psoriasis, respectively. RESULTS: A total of 15,733 participants were included in this study. In our optimal multivariate-adjusted model, the odds ratio (OR) with 95% confidence interval (CI) of psoriasis were 0.30 (0.12, 0.88), 1.92 (0.78, 4.74), 1.28 (0.72, 2.27) for daily dietary ETA, EPA, and DHA intake, respectively. Trend tests showed a dose-effect relationship between daily dietary ETA intake and the lower risk of psoriasis. Subgroup analysis and tests for interaction showed that the association was stable in different subgroups. CONCLUSION: Our study revealed that there might be a dose-effect association of daily dietary ETA intake with the lower risk of psoriasis in American adults.

Vacuum-Assisted Closure and Skin Grafting Combined with Amphotericin B for Successful Treatment of an Immunocompromised Patient with Cutaneous Mucormycosis Caused by Mucor irregularis: A Case Report and Literature Review.

Cutaneous mucormycosis caused by Mucor irregularis (M. irregularis) is a rare condition that typically occurs in immunocompetent patients. Herein, we describe an immunocompromised patient with cutaneous M. irregularis infection who was successfully treated with debridement combined with vacuum assisted closure (VAC) negative pressure technique and split-thickness skin grafting. We present this case owing to its complexity and rarity and the successful treatment with surgical therapy. A 58-year-old man presented to our hospital with a history of skin ulcers and eschar on the right lower leg since two months. He had been receiving methylprednisolone therapy for bullous pemphigoid that occurred five months prior to the present lesions. Histopathological examination of a right leg lesion showed broad, branching hyphae in the dermis. Fungal culture and subsequent molecular cytogenetic analysis identified the pathogen as M. irregularis. After admission, methylprednisolone was gradually tapered and systemic treatment with amphotericin B (total dose 615 mg) initiated along with others supportive therapies. However, the ulcers showed no improvement, and amphotericin B had to be discontinued owing to development of renal dysfunction. After extensive surgical debridement combined with VAC and skin grafting, his skin ulcers were healed; subsequent fungal cultures of the lesions were negative. The patient exhibited no signs of recurrence at 36-month follow-up. Twenty-six cases with M. irregularis-associated cutaneous mucormycosis in literature were reviewed.

The efficacy and safety of low-molecular-weight heparin calcium combined with Xueshuantong injections in the treatment of elderly acute deep venous thrombosis patients.

OBJECTIVE: To explore the therapeutic effect of low-molecular-weight heparin calcium (LMWH-Ca) combined with Xueshuantong injections in treating elderly acute deep venous thrombosis (ADVT) patients, and to analyze the effect of this combination on the coagulation function, hemorheology, and safety. METHODS: A total of 122 elderly patients with ADVT who were treated in our hospital were recruited as the study cohort. The patients were randomly divided into a control group (n=61) and an observation group (n=61). The patients in the control group were given abdominal subcutaneous injections of low-molecular-weight heparin calcium (LMWH-Ca). The patients in the observation group were given intravenous drips of LMWH-Ca (low-molecular-weight heparin calcium) and Xueshuantong injections. After the treatment, comparisons of the detumescence times of the affected limb, the differences in the circumferences of the lower limbs, the coagulation parameters, the overall response rates, the incidences of complications, and the hemorheological parameters were conducted between both groups. RESULTS: After the treatment, the detumescence times and the average differences in the circumferences of the lower limbs were significantly reduced (P<0.001; all P<0.001), the prothrombin times (PT) and the activated partial thromboplastin times (APTT) were significantly extended (all P<0.01), the overall response rate was higher (all P<0.05), and the three hemorheological parameters (high shear viscosity, low shear viscosity, and plasma viscosity) were lower in the observation group than they were in the control group (all P<0.001), there were no statistical differences in the fibrinogen (FIB) levels, the incidences of complications, or the incidences of adverse drug reactions between the two groups (P>0.05; P=0.343; P=0.298). CONCLUSION: To sum up, low-molecular-weight heparin combined with Xueshuantong injections can effectively treat elderly ADVT patients, reduce the differences in the circumferences of the lower limbs, regulate the coagulation function, and improve the blood viscosity, so it is worthy of clinical promotion.

Acute pancreatic injuries: A complication of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with cytotoxic immunocell activation.

BACKGROUND: Complications involving internal organs are usually present in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, pancreatic complications are rarely reported and studied. OBJECTIVE: To summarize clinical characteristics of SJS/TEN-associated acute pancreatic injuries and to investigate underlying inflammatory mechanisms. METHODS: Clinical records of 124 inpatients with SJS/TEN were reviewed. Serum levels of tumor necrosis factor α, interleukin (IL) 6, IL-18, IL-15, IL-12p70, and soluble CD56 were determined in 18 healthy donors and 17 patients with SJS/TEN, including 3 with acute pancreatic injuries. RESULTS: Acute pancreatic injury was diagnosed in 7.3% of patients (9/124) in the SJS/TEN cohort. Elevation of serum transaminase level and hypoalbuminemia occurred more frequently in patients with acute pancreatic injuries compared with those without pancreatic symptoms (P = .004 and <.001, respectively). Although acute pancreatic injury did not alter mortality rate of SJS/TEN, it was associated with longer hospitalization stays (P = .008). Within the serum cytokines whose levels were elevated in SJS/TEN, only IL-18 was found to be selectively increased in patients with acute pancreatic injuries compared with those without them (P = .03). LIMITATIONS: Cohort was small. CONCLUSION: Acute pancreatic injury is a gastrointestinal complication of SJS/TEN in which hepatotoxicity is more likely to occur. Overexpression of IL-18 might be involved in this unique entity.