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Objective:To explore predictive factors for the efficacy of omalizumab in the treatment of refractory chronic spontaneous urticaria (CSU) .Methods:Totally, 40 patients with refractory CSU treated with omalizumab were enrolled from Department of Dermatology, the Second Affiliated Hospital of Soochow University from 2019 to 2021. Before treatment, clinical data including the urticaria activity score over 7 days (UAS7) and dermatology life quality index (DLQI) were collected; venous blood samples were collected for the detection of total immunoglobulin E (IgE) antibodies, eosinophil counts and basophil counts, anti-thyroid peroxidase (TPO) IgG antibody levels, mean platelet volume, as well as C-reactive protein (CRP) , D-dimer, complements C3 and C4, interleukin (IL) -2, IL-4, IL-6, IL-10, IL-17A, tumor necrosis factor (TNF) -α and interferon (IFN) -γ levels, and percentages of CD4 + T cells and CD8 + T cells; meanwhile, the autologous serum skin test (ASST) was performed. After 12-week treatment with omalizumab, 40 CSU patients were divided into well-responding group and poorly-responding group according to the UAS7 score, and the above laboratory indicators were compared between the two groups. For continuous variable indicators with significant differences, the accuracy of prediction and optimal cut-off values were determined by using the receiver operating characteristic (ROC) curve; for categorical variable indicators with significant differences, the sensitivity and specificity for the prediction of poor clinical response to omalizumab were calculated; correlations among the above indicators were analyzed by Pearson correlation analysis. Results:After 12-week treatment with omalizumab, 28 CSU patients responded well to omalizumab, and 12 responded poorly. Before treatment, the poorly-responding group showed significantly increased proportions of patients with eosinopenia (6/12) , basopenia (7/12) , decreased C3 (6/12) , decreased C4 (6/12) , positive anti-TPO IgG antibodies (5/12) and low total IgE levels (8/12) , increased proportion of CD4 + T cells (71.13% ± 3.26%) , and increased IL-17A levels (27.16 ± 9.75 pg/ml) compared with the well-responding group (14.3%, 10.7%, 14.3%, 7.1%, 10.7%, 14.3%, 60.33% ± 5.12%, 19.24 ± 10.84 pg/ml, respectively; all P < 0.05) , but decreased IL-6 levels compared with the well-responding group ( t = 5.75, P < 0.05) . According to the ROC analysis and calculation of sensitivity, specificity and accuracy, the above indicators showed high accuracy in predicting therapeutic effect of omalizumab, and the optimal cut-off values of IL-6, IL-17A, and CD4 + T cell proportion were 8.672 pg/ml, 23.415 pg/ml, and 67.95%, respectively. In addition, the IL-6 level was significantly positively correlated with the total IgE level in CSU patients at baseline ( r = 0.43, P = 0.006) . Conclusion:Before the selection of omalizumab for the treatment of refractory CSU, there is a need to detect the eosinophil and basophil counts, levels of complements C3, C4, anti-TPO IgG antibodies, total IgE, IL-17A and IL-6, and CD4 + T cell proportions to predict therapeutic effect of omalizumab, so as to determine whether omalizumab is suitable for the patients.
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The interleukin (IL) -23/IL-17 axis is the main pathway in the pathogenesis of plaque-type psoriasis vulgaris, and IL-17A plays a key role in the relevant immune pathways. IL-17A mediates overlapping inflammatory pathways in atherosclerosis and psoriasis, promotes inflammation, coagulation and thrombosis, and plays an important role in the occurrence and development of cardiovascular comorbidities in patients with psoriasis. Inhibiting the inflammatory effect of IL-17A can reduce the incidence and mortality of cardiovascular comorbidities in patients with severe psoriasis. This review summarizes recent research progress in IL-17A-mediated systemic inflammation and cardiovascular comorbidities in patients with psoriasis, and provides a reference for prevention and reduction of cardiovascular comorbidities in patients with psoriasis in clinical practice.
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Objective To explore the predictive value of modified version Essen stroke risk score (ESRS) for recurrent cerebral infarction in 1 year. Methods Factors ofcerebrovascular stenosisand≥ 2 lesions in diffusion weighted imaging (DWI) which reflected large vascular stenosis and unstable plaques to the ESRS were added, and the 2 factors of other cardiovascular diseases and“peripheral vascular disease”which were difficult to operate clinically and had a lower incidence compared with the European and American people were got rid of. Thus, the total score of the modified version ESRS was still 9 scores. The risk of recurrent cerebral infarction in 1 year in 263 patients with cerebral infarction were evaluated by ESRS and modified version ESRS, and the predictive value was evaluated by area under receiver-operating characteristics (ROC) curve. Results The incidence of recurrent cerebral infarction in 1 year in 263 patients with cerebral infarction was 15.59% (41/263). There were statistical differences in the incidences of recurrent cerebral infarction in 1 year for different risk stratification patients by 2 methods (P<0.01). Multiple factor Logistic regression analysis results showed that thecerebrovascular stenosisand≥2 lesions in DWIwere the independent risk factors in predicting recurrent cerebral infarction in 1 year (OR=12.48 and 18.72, 95%CI 5.083-30.641 and 7.718-43.242, P=0.000 and 0.000). The area under ROC of predicting recurrent cerebral infarction in 1 year by ESRS and modified version ESRS was 0.68 (95% CI 0.58- 0.79) and 0.70 (95% CI 0.60-0.79), and there was statistical difference (P<0.01). Conclusions The predictive value of modified version ESRS in recurrent cerebral infarction in 1 year is higher than that of ESRS, and it is an effective method.
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Objective To investigate the efficacy of dermabrasion combined with aminolevulinic acid-based photodynamic therapy (ALA-PDT) for the treatment of nasal nodular basal cell carcinoma (nBCC).Methods Twentyfive patients who were pathologically diagnosed as nasal nBCC with lesion area ＞ 1 cm2 but no bone or cartilage involvement,were included in this study and treated with dermabrasion combined with ALA-PDT.At first,the part of tumor protruding outside the skin was removed by artherectomy,then dermabrasion was carried out.The wound surface was topically treated with 20％ aminolevulinic acid solution for 3-4 hours away from light immediately after surgery,then irradiated with LED light at a mean dose of 100 J/cm2 for 20 minutes.ALA-PDT was performed once a week for 3 consecutive weeks.The degree of and time required for wound healing were assessed,and tumor recurrence,cicatrization and appearance outcomes were observed during 1 year after surgery.Efficacy was assessed comprehensively.Results No postoperative wound infection occurred in these patients,and the average time for wound healing was (11.2 ± 1.3) days.During 1 year after the treatment,no recurrence was found,while cicatricial contracture developed in 1 case,mild proliferative scar in 3 cases,and depressed scar in 4 cases.All the patients were satisfied with the treatment outcomes,except 1 patient who was basically satisfied.Conclusions Dermabrasion combined with ALA-PDT is easy to operate with rapid wound healing,low postoperative recurrence rate and high degree of patient satisfaction,and is worthy of clinical promotion.
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ObjectiveTo investigate the difference in cell apoptosis between keratoacanthoma and squamous cell carcinoma.Methods Ninety specimens were obtained from the lesions of 30 patients with regressing keratoacanthoma (rKA) and 30 patients with well-differentiated squamous cell carcinoma (wdSCC) as well as from the normal skin of 30 human controls.Immunohistochemistry was carried out to measure the expressions of B-cell leukemia/lymphoma 2(Bcl-2),cysteine-aspartic acid protease(Caspase)-3,second mitochondria-derived activator of caspase/direct inhibitor of apoptosis-binding protein with low pl (Smac/DIABLO) and inhibitor of apoptosis protein Livin.ResultsThe Bcl-2 protein expression was significantly lower in rKA specimens than in normal control specimens(t =3.1572,P ＜ 0.05).A lower expression of Caspase-3 protein was observed in rKA specimens compared with wdSCC specimens (t =2.1364,P ＜ 0.05).The expression of Smac/DIABLO protein was significantly increased in normal control specimens than in rKA and wdSCC specimens(t =7.6141,9.5666,respectively,both P ＜ 0.05).Livin was absent in normal skin,but highly expressed in rKA and wdSCC specimens,and the difference was significant between the normal skin and lesional (rKA and wdSCC) specimens ( t =4.7913,12.7737,respectively,both P ＜ 0.05).The expression of Livin protein was significantly reduced in rKA specimens than in wdSCC specimens(t =7.9824,P ＜ 0.05).Conclusions Cell apoptosis plays a certain role in the natural regression process of KA.The detection of apoptosis-regulating proteins Caspase-3 and Livin are beneficial for the differentiation between rKA and wdSCC.