Assessment of nail fold capillary changes by hand-held dermoscopy in adult dermatomyositis: A single-centre prospective study.

BACKGROUND: Hand-held dermoscopy is a valuable tool for dermatologists, but it has been rarely used to assess the nail fold capillary (NFC) in patients with dermatomyositis (DM). METHODS: Patients were collected from the Department of Dermatology and Venereology from July 2020 to July 2021, and the follow-up was conducted until January 2022. Demographic features, disease activity and NFC changes were analysed using a hand-held dermoscopy. RESULTS: The most common NFC finding in our study was bushy capillary (87.0%). There was no significant improvement in scleroderma-dermatomyositis (SD)-like nail fold changes or enlarged capillaries from baseline to 12 weeks of treatment (p > 0.05) or from 12 weeks to 24 weeks of treatment (p > 0.05), but there was a significant improvement from baseline to 24 weeks of treatment (p < 0.05). The avascular area did not improve from baseline to 12 weeks of follow-up, but the changes were significant from 12 weeks to 24 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05). Periungual erythema improved significantly from baseline to 12 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05), but it did not improve significantly from 12 weeks to 24 weeks of treatment (p > 0.05). There was no significant difference in disease activity between patients with or without specific NFC changes. However, some NFC features improved as disease activity decreased. CONCLUSION: Dermoscopy of NFC is a cost-effective option for the preliminary diagnosis of DM. Further, long-term follow-up is necessary to study the relationship between disease activity and NFC changes.

JAK-inhibitors for dermatomyositis: A concise literature review.

Refractory dermatomyositis (DM) is defined as cases that do not show improvement after initial treatment with two different immunosuppressives combined with corticosteroids with or without intravenous immunoglobulins. In recent years, few studies have reported a positive response to the use of Janus kinase inhibitors (JAK-inhibitors) for the treatment of refractory DM. A systematic literature review was performed for articles studying the use of JAK-inhibitors for the treatment of refractory DM. We identified 38 females and 15 males treated with JAK-inhibitors without serious side effects. Tofacitinib was the most frequently used JAK-inhibitor followed by ruxolitinib. Significant improvement in CDASI score, muscle strength, body weight, and skin lesions were reported in most of the studies. The duration of follow-up ranged from 1 to 15 months without relapse. Therefore, the use of JAK-inhibitors looks promising in the treatment of refractory DM and further high volume research may be required to validate the current concept. As only case reports and series were identified without direct comparison for review, there is a potential risk of bias. Despite these limitations, we believe that the result of this analysis allows a better understanding of treatment options for refractory DM and will help generate a hypothesis that can be further tested.

Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume center: a single-center experience in China.

BACKGROUND: Surgical treatment is still the most effective treatment for gallbladder cancer. For the patients with stage T1b and above, the current guidelines recommend the extended radical operation, and oncologic extended resection can benefit the survival of the patients. The laparoscopic approach is still in the early phase, and its safety and oncological outcomes are not well known. OBJECTIVE: To evaluate the technical feasibility and oncological outcomes of laparoscopic surgery for oncologic extended resection of early-stage incidental gallbladder carcinoma. RESULTS: This study included 18 male and 32 female patients. Twenty patients underwent laparoscopic oncologic extended resection and 30 patients underwent open oncologic extended resection. All of the patients had R0 resection. A laparoscopic approach was associated with less intraoperative blood loss (242 ± 108.5 vs 401 ± 130.3; p < 0.01) and shorter duration of postoperative hospital stay (6.2 ± 2.4 vs 8.6 ± 2.3; p < 0.01). There was no statistically significant difference between two groups for lymph nodes yield (5.4 ± 3.5 vs 5.8 ± 2.1; p > 0.05), incidence of lymphatic metastasis (15% vs 16.67%; p > 0.05), residual disease (20% vs 23.3%; p > 0.05), and postoperative morbidity (15% vs 20%; p > 0.05). During follow-up time of median 20.95 (12-29.5) months, no significant difference was found between the two groups for early tumor recurrence (10% vs 13.33%; p > 0.05) and disease-free survival (p > 0.05). CONCLUSION: Laparoscopic surgery may offer similar intraoperative, perioperative, and short-term oncological outcomes as an open oncologic extended resection for incidental gallbladder carcinoma.

Primary Palmar Hyperhidrosis (PPH) Accompanied With Nevus Flammeus: A Case Report.

Palmar hyperhidrosis (PH) is a medical condition characterized by excessive sweating in the palms of the hands, which can result in significant distress and impairment in daily activities. Flammeus nevus, on the other hand, is a benign vascular lesion that appears as a red or purplish discoloration on the skin, commonly found on the face, neck, or trunk. In some cases, flammeus nevus can co-occur with PH, leading to increased sweating in the affected area. This condition can cause significant psychosocial impact, affecting an individual's quality of life (QoL) and self-esteem. We present a case report of a patient presenting with PPH with flammeus nevus. There is currently limited information available on the relationship between PH and flammeus nevus, and more research is needed to better understand this phenomenon; here we have reported the presentation of a patient. In conclusion, PH accompanied with flammeus nevus is a condition that requires prompt attention and management to mitigate its adverse effects. We have used ChatGPT to aid in structuring and writing this case report.

N7-Methylguanosine Genes Related Prognostic Biomarker in Hepatocellular Carcinoma.

Background: About 90% of liver cancer-related deaths are caused by hepatocellular carcinoma (HCC). N7-methylguanosine (m7G) modification is associated with the biological process and regulation of various diseases. To the best of our knowledge, its role in the pathogenesis and prognosis of HCC has not been thoroughly investigated. Aim: To identify N7-methylguanosine (m7G) related prognostic biomarkers in HCC. Furthermore, we also studied the association of m7G-related prognostic gene signature with immune infiltration in HCC. Methods: The TCGA datasets were used as a training and GEO dataset "GSE76427" for validation of the results. Statistical analyses were performed using the R statistical software version 4.1.2. Results: Functional enrichment analysis identified some pathogenesis related to HCC. We identified 3 m7G-related genes (CDK1, ANO1, and PDGFRA) as prognostic biomarkers for HCC. A risk score was calculated from these 3 prognostic m7G-related genes which showed the high-risk group had a significantly poorer prognosis than the low-risk group in both training and validation datasets. The 3- and 5-years overall survival was predicted better with the risk score than the ideal model in the entire cohort in the predictive nomogram. Furthermore, immune checkpoint genes like CTLA4, HAVCR2, LAG3, and TIGT were expressed significantly higher in the high-risk group and the chemotherapy sensitivity analysis showed that the high-risk groups were responsive to sorafenib treatment. Conclusion: These 3 m7G genes related signature model can be used as prognostic biomarkers in HCC and a guide for immunotherapy and chemotherapy response. Future clinical study on this biomarker model is required to verify its clinical implications.

Prognostic significance of tumor budding in biliary tract cancer.

BACKGROUND: Tumor budding is a significant prognostic indicator for poor survival of several solid tumors. However, due to the lack of a standard scoring system, its clinical application for biliary tract cancer (BTC) is limited. OBJECTIVE: To identify the prognostic significance of tumor budding in BTC. RESULTS: Tumor budding was associated with poor histologic differentiation, lymphovascular invasion, perineural invasion, lymph node metastasis, positive surgical margin, etc. Tumor budding was a predictor of poor OS in univariate (HR: 4.36; 95% CI 3.15 to 6.02; P < 0.001) and multivariate (HR: 2.95; 95% CI 2.28 to 3.80; P < 0.001) analysis. Similarly, it was also a predictor of poor DFS in univariate (HR: 3.26; 95% CI 2.12 to 4.99; P < 0.001) and multivariate (HR: 3.21; 95% CI 1.90 to 5.40; P < 0.001) analysis. In addition, tumor budding was also associated with advanced T-stage, poor histologic differentiation, lymph node metastasis, positive resection margin, lymphatic invasion, vascular invasion, and perineural invasion. CONCLUSION: Results of our study have shown that tumor budding is a strong predictor of poor survival for BTC. The clinical utility of tumor budding as a prognostic marker for BTC should be considered after developing a standard international consensus based on the current evidence.

Efficacy and safety of sorafenib plus hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma.

BACKGROUND: Sorafenib is the standard treatment for patients with advanced HCC with improvement in survival and radiologic progression of the disease. Recently, few studies have advocated the Sorafenib + HAIC combination therapy results in better overall survival and progression-free survival than Sorafenib monotherapy in patients with advanced HCC. Herein, we aim to identify the best possible treatment option among the above two lines of therapy for patients with advanced HCC. METHODS: The fixed effects and a random-effects model were used to perform a meta-analysis for overall response rate overall survival, and adverse events. Subgroup analysis of the data of univariate analysis in each included trial was performed to identify the specific patient population who could be benefitted from the combination therapy. RESULTS: Four RCTs containing 609 patients were included in the final analysis. The overall response rate (OR: 3.81; 95% CI 1.01 to 14.42; P = 0.05) and overall survival (HR: 0.70; 95% CI 0.40 to 1.24; P > 0.05) were comparable. Subgroup analysis of OS showed that patients with Child-Pugh score B (HR: 0.30; 95% CI 0.13 to 0.72; P < 0.05) and AFP <400 ng/ml (HR: 0.72; 95% CI 0.52 to 0.99; P < 0.05) were associated with significantly improved survival in the Sorafenib + HAIC group. Bone marrow suppression (OR: 3.76; 95% CI 2.58 to 5.48; P < 0.001) was significantly higher in the Sorafenib + HAIC group, but hepatic function impairment, constitutional symptoms, gastrointestinal events, and dermatological events were comparable (p > 0.05). CONCLUSIONS: Patients with Child-Pugh score B and AFP <400 ng/ml may be benefited most from Sorafenib + HAIC combination therapy.