Clinical and laboratory features of neurosyphilis: A single-center, retrospective study of 402 patients

Neurosyphilis is a serious global health issue and a big challenge in developing countries, related risk factors should be taken seriously. Although there are a certain number of studies describing the clinical and laboratory features and risk factors for symptomatic neurosyphilis (SNS), but some risk factors are still controversial. The aim of this research is to investigate the association between asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS) and identify risk factors for SNS. This was a single-center retrospective study in a tertiary hospital in Hangzhou, China. The clinical and laboratory features of neurosyphilis patients from January 1, 2011 to July 31, 2020 were retrospectively reviewed. After detailed assessments based on diagnostic criteria, 402 patients with neurosyphilis were enrolled in this study. There were 299 male and 103 female patients. The median age was 53.5 (45, 61) years. Multivariable logistic regression displayed that SNS were correlated with the following factors: male, without anti-syphilis treatment, high pretreatment serum RPR titer and positive CSF RPR. Our findings suggest a potential association between SNS and specific factors, including male gender, elevated pretreatment serum and CSF RPR titers. Moreover, our observations indicate that individuals without anti-syphilis treatment may be at a higher likelihood of manifesting the symptomatic form. This underscores the importance of considering gender, RPR titers, and treatment status as significant contributors to the risk profile for SNS.

Efficacy and safety of CM310 in moderate-to-severe atopic dermatitis: A multicenter, randomized, double-blind, placebo-controlled phase 2b trial

BACKGROUND

Atopic dermatitis (AD) affects approximately 10% of adults worldwide. CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling. This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD.

METHODS

This multicenter, randomized, double-blind, placebo-controlled, phase 2b trial was conducted in 21 medical institutions in China from February to November 2021. Totally 120 eligible patients were enrolled and randomized (1:1:1) to receive subcutaneous injections of 300 mg CM310, 150 mg CM310, or placebo every 2 weeks for 16 weeks, followed by an 8-week follow-up period. The primary endpoint was the proportion of patients achieving ≥75% improvement in the Eczema Area and Severity Index (EASI-75) score from baseline at week 16. Safety and pharmacodynamics were also studied.

RESULTS

At week 16, the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups (70% [28/40] for high-dose and 65% [26/40] for low-dose) than that in the placebo group (20%[8/40]). The differences in EASI-75 response rate were 50% (high vs . placebo, 95% CI 31%-69%) and 45% (low vs . placebo, 95% CI 26%-64%), with both P values <0.0001. CM310 at both doses also significantly improved the EASI score, Investigator's Global Assessment score, daily peak pruritus Numerical Rating Scale, AD-affected body surface area, and Dermatology Life Quality Index compared with placebo. CM310 treatment reduced levels of thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase, and blood eosinophils. The incidence of treatment-emergent adverse events (TEAEs) was similar among all three groups, with the most common TEAEs reported being upper respiratory tract infection, atopic dermatitis, hyperlipidemia, and hyperuricemia. No severe adverse events were deemed to be attributed to CM310.

CONCLUSION

CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.

Clinical practice Guidelines for 5-Aminolevulinic acid photodynamic therapy for acne vulgaris in China

A variety of evidence suggest that 5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) is clinically effective in management of acne vulgaris. Several clinical guidelines for acne recommend PDT as an alternative treatment modality for severe acne. However, there is a lack of detailed clinical guideline for PDT in acne treatment. To propose up-to-date, evidence-based and practical recommendations on application of ALA-PDT for acne vulgaris, dermatologists and PDT experts from the Photodynamic Therapy Research Center of the CMA and Photodynamic Therapy Rehabilitation Training Center of CARD achieved consensus and guidelines based on careful evaluation of published literature, expert opinions and experience. ALA-PDT plays a therapeutic role in all four major pathogenesis of acne, and is suitable for moderate to severe acne and scar-prone acne, especially for patients who cannot tolerate or refused systemic antibiotics and isotretinoin. The efficacy and adverse reactions of ALA-PDT are closely related to therapeutic parameters including ALA concentration, incubation time, light source and dosage. Proper pretreatment helps to improve transdermal absorption of ALA and enhances its efficacy. We reviewed and proposed recommended protocols for four PDT procedures including conventional PDT (C-PDT), modified painless PDT (M-PDT), intense pulsed light PDT (IPL-PDT) and daylight PDT (DL-PDT). M-PDT with lower ALA concentration (3-5%), shorter incubation time (30 mins), and lower dose but prolonged illumination (630nm, 40-60 mW/cm², 150 J/cm²) can improve lesions of moderate to severe acne vulgaris effectively with minimal pain and easier manipulation, and thus was recommended by Chinese dermatologists. Lastly, management of adverse reactions were addressed.

An 18-Year-Old Woman With Recurrent Skin, Nail, and Oral Mucosal Abnormalities

An 18-year-old woman had a 14-year history of recurrent skin, nail, and oral mucosal abnormalities, treated with 3- to 6-month courses of itraconazole; the abnormalities typically recurred within 6 to 12 months of discontinuing itraconazole. Skin scrapings from the lower extremities demonstrated fungal elements; fungal culture of the skin scrapings grew Candida albicans. What is the diagnosis and what would you do next?

Gout-like hands

A 65-year-old man presented to our hospital with a 1-year history of multiple nodules on his arms and hands without itching or pain.

Emergency management of 2019 novel coronavirus: implications for the dermatology department

Since cases first emerged in December 2019, COVID‐19 (a type of coronavirus) has rapidly become pandemic. This fast‐tracked paper (published quickly) from China on COVID‐19 is written by dermatologists at the epicentre of the outbreak in Wuhan.

Dermatology clinic staff may be at risk because protective equipment is not routinely available, and skin lesions might possibly transmit the virus indirectly. These authors suggest preventive measures based on experience in this and previous coronavirus outbreaks.

Online consultation for non‐urgent patients reduces the numbers of patients attending clinics. Nurse‐led triage, to identify patients with possible COVID‐19, at the entrances of hospital and skin clinics directs patients with a cough or fever to a specific COVID‐19 area and a dermatologist is consulted if the fever might be related to skin disease.

Clinic staff wear N95 masks and observe hand hygiene during consultations. Patients are admitted to a ward only if routine blood tests and chest CT scans exclude COVID‐19. Triage will not detect patients who are showing no symptoms but who are developing the disease, so the hospital should provide an on‐call expert team to discuss inpatients suspected or diagnosed with COVID‐19 and refer them to radiology, respiratory or intensive care colleagues as required.

Confirmed cases are managed following local policies. Skin disorders in COVID‐19 inpatients can usually be managed remotely using photographs, email and teleconferencing. If necessary a multidisciplinary team (a team of medical staff from different specialties) can meet in the clean area of the isolation ward. If the dermatologist must see the patient, all records should be provided in advance to minimise exposure time.

With these precautions, as of 20th February 2020 no infected patients were detected in the Wuhan Dermatology Department.

This is a summary of the study: Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department

Linked Article: Tao et al. Br J Dermatol 2020; 182:1477–1478

Emergency management for preventing and controlling nosocomial infection of the 2019 novel coronavirus: implications for the dermatology department

Plain language summary available online

Downregulation of 14-3-3β and 14-3-3ζ in lesions of psoriasis vulgaris

BACKGROUND

The 14-3-3 proteins are a family of conserved regulatory molecules expressed in all eukaryotic cells, which play essential roles in a wide range of vital regulatory processes, including differentiation, proliferation and transformation. In mammalian cells, seven 14-3-3 isoforms (β, γ, ε, η, θ/τ, σ and ζ) have been identified, and each of these seems to have distinct tissue localizations and isoform-specific functions. 14-3-3β and 14-3-3ζ are two important members of the 14-3-3 family.

AIM

To explore the role of 14-3-3β and 14-3-3ζ in normal skin and psoriasis vulgaris (PV) skin.

METHODS

Using immunohistochemistry and western blotting, we measured expression of 14-3-3β and 14-3-3ζ in 30 PV lesions and 15 normal skin samples. The average optical density (OD) of immunostaining and the relative grey scale of immunoblotting for 4-3-3β and 14-3-3ζ were analysed by the t-test.

RESULTS

The average OD of immunostaining for 14-3-3β and 14-3-3ζ was 0.17 ± 0.00 and 0.24 ± 0.01, respectively, in psoriatic lesions, which was significantly lower than in normal controls (0.22 ± 0.01 and 0.37 ± 0.02, respectively; P < 0.01 for both). There was also a significant difference in the relative grey scale of 14-3-3β and 14-3-3ζ (0.52 ± 0.03 and 1.44 ± 0.06, respectively) in psoriatic lesions compared with normal control tissue (3.32 ± 0.15 and 2.76 ± 0.11, respectively; P < 0.01 for both).

CONCLUSIONS

Expression of 14-3-3β and 14-3-3ζ were lower in psoriatic lesions than in normal human skin tissue. We speculate that 14-3-3β and 14-3-3ζ may be involved in the regulation of normal skin function, thus decreased expression of 14-3-3β and 14-3-3ζ might precipitate the disturbance in proliferation and differentiation of keratinocytes seen in psoriasis.

Dyspepsia and irritable bowel syndrome in China: a population-based endoscopy study of prevalence and impact

BACKGROUND

Dyspepsia and irritable bowel syndrome (IBS) are common in Western populations.

AIM

To determine the epidemiology of dyspepsia and IBS in China.

METHODS

A representative sample of 18 000 adults from five regions of China were asked to complete the modified Rome II questionnaire; 20% were asked to complete the 36-item Short Form Health Survey (SF-36). Participants from Shanghai were invited to provide blood samples and undergo oesophago-gastroduodenoscopy. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined using a multivariate logistic regression model.

RESULTS

The survey was completed by 16 091 individuals (response rate: 89.4%). Overall, 387 participants (2.4%) had dyspepsia and 735 (4.6%) had IBS. All SF-36 dimension scores were at least five points lower in individuals with than without dyspepsia or IBS (P < or = 0.001). In Shanghai, 1030 (32.7%) of the 3153 respondents agreed to endoscopy; neither dyspepsia nor IBS was found to be associated with reflux oesophagitis, peptic ulcer disease or Helicobacter pylori infection.

CONCLUSIONS

Prevalence estimates for dyspepsia and IBS in China are lower than in Western populations. In China, dyspepsia or IBS symptoms are generally not associated with underlying organic disease.

[Research on fibrotic effect of Ni-Ti and 317L alloys in esophagus]

This study was conducted to examiune the fibrotic effect of Ni-Ti and 317L alloys in esophagus. The extract fluid from Ni-Ti, 317L alloys was made according to the ASTM standards of U.S.A. The Fb of esophageal scar was cultured primarily, then incubated with alloy abstract fluid. The proliferating activity of Fb was measured by MTT at 4, 24, 48, 72 hours in the course of culturing. The esophagus embedding test of Ni-Ti, 317L alloys was made according to ASTM standards of U.S.A. The tissue around the alloys was taken at weeks 2 and 12, and the pathologic changes were analysed. The results showed that Ni-Ti, 317L extract could depress the proliferating function of Fb gently, and the depressing action increased gradually with the culturing time. The result of embedding test was in accord with the ASTM standards of U.S.A. completely; the fibrotic membrane around the NiTi, 317L alloys became thinner with embedding time. These findings suggested that the scattering composition of Ni-Ti, 317L in body fluid might not activate the proliferating and secreting function of Fb, and the two alloys could not lead to fibrosis of esophagus aroun them.