Case Report: sintilimab-induced Stevens-Johnson Syndrome in a patient with advanced lung adenocarcinoma.

Immune checkpoint inhibitors (ICIs) have been widely applicated in clinical therapy in recent years. Skin-related adverse reaction is one of the most common adverse events for ICIs. Stevens-Johnson syndrome (SJS) is one of the serious cutaneous reactions threatening the life. Here, we reported a case of 76-year-old male patient with poorly differentiated metastatic lung adenocarcinoma, after 9 weeks exposure of sintilimab (3 doses) combined with paclitaxel liposome after concurrent chemotherapy/radiotherapy, experienced Stevens-Johnson syndrome involving limbs, trunk, lip and the oral mucosa. Biopsy of the skin tissue showed infiltration of CD4 and CD8 positive T lymphocytes. We also found PD-L1 expression in the glands and the basal layer of the skin. This finding is distinct from the previously reported expression of PD-L1 on the surface of epidermal keratinocytes in patients with SJS due to immunotherapy.

In vitro and in vivo Evaluation of the Bioactive Nanofibers-Encapsulated Benzalkonium Bromide for Accelerating Wound Repair with MRSA Skin Infection.

Purpose: Developing the ideal drug or dressing is a serious challenge to controlling the occurrence of antibacterial infection during wound healing. Thus, it is important to prepare novel nanofibers for a wound dressing that can control bacterial infections. In our study, the novel self-assembled nanofibers of benzalkonium bromide with bioactive peptide materials of IKVAV and RGD were designed and fabricated. Methods: Different drug concentration effects of encapsulation efficacy, swelling ratio and strength were determined. Its release profile in simulated wound fluid and its cytotoxicity were studied in vitro. Importantly, the antibacterial efficacy, inhibition of biofilm formation effect and wound healing against MRSA infections in vitro and in vivo were performed after observing the tissue toxicity in vivo. Results: It was found that the optimized drug load (0.8%) was affected by the encapsulation efficacy, swelling ratio, and strength. In addition, the novel nanofibers with average diameter (222.0 nm) and stabile zeta potential (-11.2 mV) have good morphology and characteristics. It has a delayed released profile in the simulated wound fluid and good biocompatibility with L929 cells and most tissues. Importantly, the nanofibers were shown to improve antibacterial efficacy, inhibit biofilm formation, and lead to accelerated wound healing following infection with methicillin-resistant Staphylococcus aureus. Conclusion: These data suggest that novel nanofibers could effectively shorten the wound-healing time by inhibiting biofilm formation, which make it promising candidates for treatment of MRSA-induced wound infections.

A novel non­contact communication between human keratinocytes and T cells: Exosomes derived from keratinocytes support superantigen­induced proliferation of resting T cells.

It is widely accepted that keratinocytes act as non­professional antigen­presenting cells and support superantigen­induced proliferation of resting T cells; however, it remains unknown whether keratinocytes function in situ with T cells via a non­contact mechanism. The current study used a transwell co­culture system and demonstrated, for the first time to the best of the authors' knowledge, that HaCaT cells (the human keratinocyte cell line) did induce T cell proliferation via indirect contact. The data further indicated that exosomes, small membrane vesicles that transfer antigens to recipient cells, are also involved in the superantigen­associated immunity of keratinocytes. The current study provided experimental evidence that HaCaT­exosomes contained MHC I and II, and could interact with T cells. In addition, following interferon γ stimulation, Staphylococcal aureus enterotoxin B­loaded HaCaT cells secreted exosomes to induce the proliferation of CD4+ and CD8+ T cells in vitro. This novel biological function of exosomes reveals a new mechanism of how keratinocytes participate in bacterial superantigen­induced immune responses.

Etanercept in the treatment of intestinal Behcet's disease.

Behcet's disease (BD) accompanied by intestinal involvement is called intestinal BD. Although recent studies have attained positive feedback with the administration of anti-TNF-α agents in patients with BD, only a few reports on the study of etanercept in intestinal BD have been found. In this study, 35 cases of intestinal BD were treated with conventional therapy (prednisone or methotrexate) for a minimum period of 3 months (group 1). Another 19 patients who failed to respond to conventional therapy were then treated with etanercept (25 mg twice a week for 3 months). During each subsequent relapse, the patients were given the same treatment. The main outcome measures were the four criteria for diagnosis of BD (buccal ulcers, genital ulcers, ocular lesions, and skin lesions), the manifestation of intestinal involvement (abdominal symptoms, double-balloon enteroscopy), laboratory examinations of the acute phase reactants (erythrocyte sedimentation rate) and C-reactive protein, and relapses. As a result of the administered therapy, the healing rate of buccal and genital ulcers, the remission rate of ocular lesions, skin lesions, and abdominal symptoms, the healing rate of intestinal ulcers, and the recovery rate of ESR and CRP were significantly higher in group 2 than those of group 1. The relapse rate in the etanercept therapy was reduced significantly when compared with conventional therapy group. In conclusion, etanercept treatment, in contrast to the conventional therapy, can result in better curative effect and less adverse reactions in intestinal BD.

[Experimental study on the antibacterial effects of zirconium phosphate gauze loaded with silver on the common bacteria on rat burn wound].

OBJECTIVE: To investigate the antibacterial effects of zirconium phosphate gauze loaded with silver on rat burn wounds seeded with commonly seen bacteria. METHODS: Wistar rats were employed in the study and were scalded and infected. The minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC) of zirconium phosphate loaded with silver were determined by double dilution in tubes. The effect on wound healing and the subeschar bacterial count of the rat burn wounds were observed after the wounds had been covered by gauze loaded with zirconium phosphate and silver, and also with the gauze which has been rinsed for 20 times. RESULTS: The MIC of silver loaded zirconium phosphate on Staphylococcus aureus, Pseudomonas aeruginosa and E. coli were 8, 8 and 16 mg/L, respectively, while the MBC were 16, 8 and 32 mg/L, respectively. The subeschar bacterial count in the burn wounds with the gauze with silver loaded zirconium phosphate was ten times lower than that in those which were treated with gauze with SD-Ag and 100 times lower than that with ordinary gauze. But there was no difference in the bacterial count between the wounds which were treated with fresh gauze with silver loaded zirconium phosphate and that with the gauze which has been rinsed for 20 times (P > 0.05). Furthermore, wound healing seemed to be better with the gauze with silver loaded zirconium phosphate when compared with those by the other two kinds of gauze. CONCLUSION: The silver loaded zirconium phosphate was found to be bacteriocidal against bacteria commonly seen in the burn wounds.

[An experimental study on the role of indirect antigen presentation pathway on the immunogenetic of epidermal cells].

OBJECTIVE: To explore the role of indirect antigen presentation pathway on the immunogenecity of epidermal cells. METHODS: Human epidermal cells (HEC), allogeneic human peripheral blood lymphocytes (PBL) and mononuclear cells (PBM, including monocytes) were isolated and cultured in vitro. HECs were transfected by human-originated CTLA4Ig-adenovirus vector. The CTLA4Ig expression was observed. Allogeneic PBLs or PBMs were added to the transfected and non-transfected HECs with simple cultured PBLs and PBMs as the control. The proliferation of PBL and PBM was determined by (3)H-TdR incooperation. RESULTS: HECs could be successfully transfected by CTLA4Ig-adenovirus vector and expressed corresponding proteins. The non-transfected HECs could stimulate slight proliferation of allogeneic PBLs (P < 0.05) and stimulate remarkable proliferation of PBMs (including monocytes) (P < 0.05). The proliferation reaction of PBLs and PBMs decreased significantly (P < 0.05) after being stimulated by HEC which was modulated by CTLA4Ig genes. CONCLUSION: Indirect antigen presentation pathway might play important roles in the HEC immunogenicity which could be evidently inhibited by CTLA4Ig.