A Case Report of Paraneoplastic Pemphigus Associated With Retroperitoneal Inflammatory Myofibroblastic Tumor

Paraneoplastic pemphigus (PNP) is an autoimmune bullous disease associated with underlying neoplasms, both malignant and benign. The most constant clinical presentation of PNP is the presence of intractable stomatitis. Herein we present a 25-year-old male with a 3-month history of refractory stomatitis especially involving the lips and widespread vesiculobullous eruption on his trunk and extremities. The diagnosis of PNP was confirmed based on histological and serological results. Investigation for the underlying neoplasm revealed a retroperitoneal tumorous mass which was biopsied and diagnosed as the inflammatory myofibroblastic tumor (IMT). The tumor was surgically excised, and different treatment regimens were used to treat the mucocutaneous lesions. Skin lesions responded favorably to treatment, but oral stomatitis still persists which is the case in most PNP patients. This combination of PNP and IMT has rarely been reported in the literature. Treatment started with corticosteroid and rituximab then tumor excised

Rituximab therapy improves recalcitrant Pemphigus vulgaris

Pemphigus is a severe life-threatening blistering disease associated with autoantibodies against cell adhesion proteins desmogleins 1 and 3. Patients with severe pemphigus commonly show high rates of relapse after conventional immunosuppressive therapy. The newly developed drug Rituximab showed impressing promises in the treatment of refractory pemphigus vulgaris (PV). In the present study the efficacy of a single course rituximab therapy in the treatment of PV was investigated. Eighteen patients with severe recalcitrant PV were recruited to this study. Pemphigus disease activity index (PDAI), anti-desmoglein 1 and anti-desmoglein 3 antibody titers, and percent of CD20 positive cells were measured at baseline, 10 ± 1, and 22 ± 2 weeks after rituximab therapy. Rituximab was given intravenously at dose 375 mg/m2 once weekly for 4 weeks. Rituximab therapy caused a dramatic reduction in the PDAI, accompanied by decreases in anti-desmoglein 1 and anti-desmoglein 3 antibody titers over the follow-up course. The B-cell population decreased at the first follow-up, but returned to its baseline levels at the second follow-up. Rituximab therapy decreased the dose of immunosuppressive drugs required to control the disease. It seems that the rituximab may be effective and safe for treatment of refractory PV

Carrier effect in development of rifampin loaded proliposome for pulmonary delivery: a quality by design study

Purpose: Pulmonary tuberculosis (TB) is a worldwide life-threatening infection. The recommended anti-TB regimen contains oral administration of classical first-line drugs such as rifampin for 6-24 months which often leads to low patient compliance due to high adverse effects; therefore, lung localized pulmonary delivery of anti-TB agents may be a suitable alternative. Proliposomes free-flowing powders are well-known carriers for lung delivery since they can form liposomes by hydration. Liposomes are safe and useful carriers for lung delivery due to their phospholipid structure. Methods: Porous lactose and mannitol as proliposome carriers were prepared by spray drying technique using sucrose and citric acid as templating agents. Design Expert® software was used to develop forty formulations based on the porous and non-porous carriers, which were characterized with respect to their weight yield, density, and flowability. Rifampin-loaded hydrated liposomes were produced and evaluated for size, morphology, loading capacity and encapsulation efficiency. The optimized proliposomes in vitro release and aerosolization properties were evaluated. Solid-state analysis was confirmed by differential scanning calorimetry (DSC). Results: Porous lactose surface area was 80 folds higher than non-porous one, respectively. Optimized porous-based proliposome indicated the acceptable aerosolization properties, including mass median aerodynamic diameter (MMAD) of 6.21 ± 0.36 μm and fine particle fraction (FPF) of 9.17 ± 0.18% with a fast rifampin release (80%) within one hour. DSC results proved that there was no change in the solid-state of rifampin during the production process. Conclusion: Hence, it seems; rifampin loaded inhalable proliposomes may be a suitable system for delivering liposomal rifampin into the lungs

Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris

Background: Twenty percent azelaic acid gel is recommended as a topical treatment for acne due to its favorable profile. Aim: Our objective in this study was to evaluate the efficacy of 20% azelaic acid gel in the treatment of mild to moderate acne vulgaris. Methods: This was a double blind, randomized clinical trial. Sixty patients with mild to moderate acne vulgaris were selected randomly to receive either azelaic acid gel or the vehicle gel alone. Patients were followed up every 15 days for a period of 45 days. The number of lesions and the acne severity index (ASI) were recorded and compared using Student's t-test. Results: Total lesion count was reduced by 60.6% and 19.9% by azelaic acid gel and the placebo respectively (P =0.002). ASI was reduced by 65.2% and 21.3% by azelaic acid gel and the placebo respectively (P =0.001), i.e., azelaic acid gel was 3.06 times more effective than the placebo in reducing ASI. Conclusion: Azelaic acid gel can be used as an effective treatment in mild to moderate acne vulgaris

The expression of Cysteine-Rich Secretory Protein 2 (CRISP2) and miR-582-5p in seminal plasma fluid and spermatozoa of infertile men

Cysteine-Rich Secretory Protein 2 (CRISP2) plays an important role in the morphology and motion of male ejaculated spermatozoa. The association of its expression with some miRNAs is also well known. The aim of this study was to determine the expression of CRISP2 and mir-582 in the seminal plasma fluid and spermatozoa of three groups of infertile men and the possible association of their expressions. In this experimental study, the expression of CRISP2 in seminal plasma fluid and spermatozoa of 17 men with asthenozoospermia, 15 men with teratozoospermia, 17 men with teratoasthenozoospermia, and 18 infertile individuals with normozoospermia were measured using western blotting. Then by using bioinformatics studies, miR-582-5p was nominated as a CRISP2-associated miRNA, and its expression was evaluated by means of Real-Time PCR. Comparison of expression of CRISP2 and miRNA-582 in the studied groups was analyzed by t-test and Mann-Whitney U test. The expression of CRISP2 showed a significant reduction in the spermatozoa and seminal plasma fluid of all three groups, (p < 0.05). MiR-582-5p expression significantly increased in teratozoospermia patients (<0.05), and significantly decreased in teratoasthenozoospermia patients (p < 0.05). Meanwhile, changes in the expression of miR-582-5p in teratoasthenozoospermia individuals was associated with a decrease in the expression of CRISP2, which could represent the potential role of miR-582-5p in regulation of CRISP2 expression in teratoasthenozoospermia individuals

Grazing intensity alters the plant diversity‐ecosystem carbon storage relationship in rangelands across topographic and climatic gradients

1. Plant diversity supports multiple ecosystem functions, including carbon sequestration. Recent shifts in plant diversity in rangelands due to increased grazing pressure and climate changes have the potential to impact the sequestration of carbon in arid to semi-humid regions worldwide. However, plant diversity, grazing intensity and carbon storage are also influenced by environmental factors such as nutrient availability, climate, and topography. The complexity of these interactions limits our ability to fully assess the impacts of grazing on biodiversity-ecosystem function (BEF) relationships. Read the free Plain Language Summary for this article on the Journal blog. 2. We assessed how grazing intensity modifies BEF relationships by determining the links between plant diversity and ecosystem carbon stocks (plant and soil carbon) across broad environmental gradients and different plant growth forms. To achieve this, we surveyed 1493 quadrats across 10 rangelands, covering an area of 23,756 ha in northern Iran. 3. We show that aboveground carbon stocks increased with plant diversity across topographic, climatic and soil fertility gradients. The relationship between aboveground carbon stocks and plant diversity was strongest for forbs, followed by shrubs and grasses. Soil carbon stocks increased strongly with soil fertility across sites, but aridity, grazing, plant diversity and topography were also important in explaining variation in soil carbon stocks. 4. Importantly, aboveground and soil carbon stocks declined at high grazing intensity, and grazing modified the relationship between plant diversity and carbon stocks regardless of differences in abiotic conditions across sites. 4. Our study demonstrates that relationships between plant diversity and ecosystem carbon stocks persist across gradients of aridity, topography, and soil fertility, but the relationships are modified by grazing intensity. Our findings suggest that potential losses in plant diversity under grazing intensification could reduce ecosystem carbon storage across wide areas of arid to semi-humid rangelands. We discuss the potential mechanisms underpinning rangeland BEF relationships to stimulate future research