Paradoxical phenomena of bullous pemphigoid induced and treated by identical biologics

ObjectiveThis study aimed to investigate the clinical features of biologics-induced bullous pemphigoid (BP) and the therapeutic effects of those agents for BP, exploring the underlying pathophysiological mechanisms.MethodsWe searched PubMed, Web of Science, and Elsevier for studies involving pemphigoid patients treated with or induced by identical biologics published in English from January 2009 to April 2022.ResultsSeventeen cases of drug-induced BP associated with anti-tumor necrosis factor (aTNF)-α therapies, one with interleukin (IL)-17 inhibitors, and seven with IL-12/IL-23 or IL-23 inhibitors were enrolled. Time to cutaneous toxicity varied among different types of agents, and the characteristics of clinical examinations were similar to idiopathic BP. Discontinuation of the culprit drugs and initiation of topical or systemic corticosteroids were adequate in most cases. Several monoclonal antibodies above have also been reported for the treatment of refractory or recurrent BP, especially concurrent with psoriasis.ConclusionBiologics for immune-related diseases, including TNF-α, IL-17, and IL-12/IL-23 or IL-23 inhibitors, can both induce and treat BP, which might be associated with a helper T cells Th1/Th2 imbalance, complicated inflammatory networks, and a specific individual microenvironment, suggestive of a new perspective on the therapeutic algorithms of BP. There have been numerous reports about biologics inducing or treating BP. We have taken note of this phenomenon and focused on biologics with both pathogenetic and therapeutic effects on BP. Our review summarized the clinical characteristics of associated cases, trying to figure out the underlying mechanisms of this paradoxical phenomenon and to provide an integrated perspective and new therapeutic alternatives for BP

Case report: Successful treatment of non-bullous lichen planus pemphigoides with dupilumab

Lichen planus pemphigoides (LPP) is a rare autoimmune bullous disease, characterized by the coexistence of lichen planus and subepidermal bullae. However, the minority of LPP patients present with papules rather than vesicles or blisters, which is defined as non-bullous LPP. The diagnosis of LPP relies on manifestations, histopathology, serological assay, and direct immunofluorescence of linear disposition of IgG and/or C3 at the basement membrane zone. Up to now, no standard therapeutic strategies have been proposed for the treatment of LPP. Herein, we describe an uncommon non-bullous LPP patient with widespread papules and erythema, probably induced by vaccination. During hospitalization, he had a poor response to the conventional treatment of topical and systemic corticosteroids, and his condition was finally alleviated by the addition of dupilumab. For LPP patients with a traditional medication failure, or who were not suitable for a higher dose of corticosteroids, a combination with dupilumab could be an alternative option

Successful treatment of alopecia universalis with abrocitinib: a case report

Abrocitinib, a highly selective inhibitor of Janus kinase 1 (JAK1), has been approved for the treatment of moderate-to-severe atopic dermatitis (AD). Patients with alopecia universalis (AU) co-morbid with AD receiving abrocitinib achieved clinical remission for both diseases. We report a case of a patient with AU after drug reaction with eosinophilia and systemic symptoms (DRESS) who responded well to abrocitinib therapy at a dose of 100 and 200 mg once daily. In addition, we reviewed cases of alopecia after DRESS and explored the underlying mechanisms for alopecia areata (AA) being an autoimmune sequela. The therapeutic effects of JAK inhibitors for AA may involve downstream cytokines, such as IFN-γ and IL-15. Abrocitinib may be a promising therapeutic option for recalcitrant AU

Thymic Stromal Lymphopoietin Is Implicated in the Pathogenesis of Bullous Pemphigoid by Dendritic Cells

Objectives. Both thymic stromal lymphopoietin (TSLP) and dendritic cells (DCs) are involved in many autoimmune diseases, but the potential roles of TSLP and DCs in bullous pemphigoid (BP) have not been clarified. We sought to explore the contributions of TSLP and DCs in patients with BP. Methods. TSLP levels in sera and blister fluids were measured by enzyme-linked immunosorbent assay. The TSLP expression in the BP lesional skin was detected by immunohistochemical staining. Infiltration of DCs, marked by DC-specific intercellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN), and its relationship with TSLP and TSLP receptors was evaluated by immunofluorescence staining. Results. We found that TSLP levels in sera and in blister fluids of patients with BP were higher compared to the control groups. In patients with BP, TSLP levels in sera correlated with TSLP levels in blisters. The expression of TSLP in the BP lesional skin was higher compared to the healthy controls’ skin. Greater numbers of TSLP-positive cells were observed in the epidermis of patients with BP compared to the healthy controls. Greater numbers of DC-SIGN-positive cells were present in the BP lesional skin compared to the skin of controls. The expression of TSLP was highly upregulated in DC-SIGN-positive cells, and most DC-SIGN-positive cells expressed TSLP receptors. Conclusions. We conclude that TSLP may activate DC-SIGN-positive DCs directly, which may be involved in the pathogenesis of BP

Clinical features and in vivo confocal microscopy assessment in 12 patients with ocular cicatricial pemphigoid

AIM: To describe the clinical features and microstructural characteristics assessed by in vivo confocal microscopy (IVCM) in patients with ocular cicatricial pemphigoid (OCP). METHODS: A descriptive, uncontrolled case series study. Patients diagnosed with OCP were examined by clinical history, slit-lamp biomicroscopy features and IVCM images. The results of direct immunofluorescence (DIF) biopsies and indirect immunofluorescence (IIF) were also recorded. Local and systemic immunosuppressive therapy were administered and adjusted according to response. RESULTS: A total of 12 consecutive OCP patients (7 male, 5 female; mean age 60.42±10.39y) were recruited. All patients exhibited bilateral progressive conjunctival scarring and recurrent chronic conjunctivitis was the most frequent clinical pattern. The mean duration of symptoms prior to diagnosis of OCP was 2.95±2.85y (range: 5mo to 10y). The Foster classification varied from stage I to IV and 20 eyes (83%) were within or greater than Foster stage Ⅲ on presentation. Two of the 12 patients (17%) demonstrated positive DIF; 3 of the 12 (25%) patients reported positive IIF. The mean duration of the follow-up period was 20.17±11.88mo (range: 6 to 48mo). IVCM showed variable degrees of abnormality in the conjuctiva-cornea and conjuctival scarring was detected in all the involved eyes. Corneal stromal cell activation and dendritic cell infiltration presented as ocular surface inflammation, ocular surface keratinization along with the destroyed Vogt palisades was noted in eyes with potential limbal stem cell deficiency. After treatment, remission of ocular surface inflammation was achieved in all the patients, 18 eyes (75%) remained stable, 6 eyes (25%) had recurrent conjunctivitis and cicatrization in 2 eyes (8%) was progressing.  CONCLUSION: As an autoimmune disease, OCP manifests as variable degrees of clinical and laboratory abnormalities with both local and systemic immunosuppressive treatment playing important roles in disease therapy. IVCM can be as a valuable non-invasive technique to assess ocular surface changes in a cellular level with a potential value for providing diagnostic evidence and monitoring therapeutic effects during follow-up

Number of trials necessary to achieve reliable change-of-direction measurement in amateur basketball players

This study examined the inter-day reliability and repeatability of change-of-direction (COD) performance to determine the minimum number of measurement trials required to represent a stable athlete’s performance. Twenty-three university basketball players performed seven COD trials. Identical tests were performed two weeks later to evaluate inter-day reliability. Intra-class correlation coefficients were utilised to examine inter-day reliability for all data input methods. Separated ANOVA with repeated measures was performed to examine the trial effect. The ICC analysis indicated that data from the first trial exhibited the lowest reliability and that the fastest trial generally had higher reliability than the mean performance trial. The trial effect results revealed slower COD performance time in the first three trials than in later trials (p < 0.05), with no significant differences amongst later trials. These results suggested that at least four change-of-direction trials are required with respect to improving measurement reliability

Comparison of image quality, diagnostic accuracy and radiation dose between flash model and retrospective ECG-triggered protocols in dual source computed tomography (DSCT) in congenital heart diseases

BACKGROUND: Dual source computed tomography (DSCT) plays an important role in the diagnosis of congenital heart diseases (CHD). However, the issue of radiation-related side effects constitutes a wide public concern. The aim of the study was to explore the differences in diagnostic accuracy, radiation dose and image quality between a prospectively ECG - triggered high - pitch spiral acquisition (flash model) and a retrospective ECG-gated protocol of DSCT used for the detection of CHD. MATERIAL AND METHODS: The study included 58 patients with CHD who underwent a DSCT examination, including two groups of 29 patients in each protocol. Then, both subjective and objective image quality, diagnostic accuracy and radiation dose were compared between the two protocols. RESULTS: The image quality and the total as well as partial diagnostic accuracy did not differ significantly between the protocols. The radiation dose in the flash model was obviously lower than that in the retrospective model (P<0.05). CONCLUSIONS: Compared to the retrospective protocol, the flash model can significantly reduce the dose of radiation, while maintaining both diagnostic accuracy and image quality

Hybrid System Combining Two-Dimensional Materials and Ferroelectrics and Its Application in Photodetection

Photodetectors are one of the most important components for a future "Internet-of-Things" information society. Compared to the mainstream semiconductor-based photodetectors, emerging devices based on two-dimensional (2D) materials and ferroelectrics as well as their hybrid systems have been extensively studied in recent decades due to their outstanding performances and related interesting physical, electrical, and optoelectronic phenomena. In this paper, we review the photodetection based on 2D materials and ferroelectric hybrid systems. The fundamentals of 2D and ferroelectric materials as well as the interaction in the hybrid system will be introduced. Ferroelectricity modulated optoelectronic properties in the hybrid system will be discussed in detail. After the basics and figures of merit of photodetectors are summarized, the 2D-ferroelectrics devices with different structures including p-n diodes, Schottky diodes, and field-effect transistors will be reviewed and compared. The polarization of ferroelectrics offers the possibility of the modulation and enhancement of the photodetection in the hybrid detectors, which will be discussed in depth. Finally, the challenges and perspectives of the photodetectors based on 2D ferroelectrics will be proposed. This Review outlines the important aspects of the recent development of the hybrid system of 2D and ferroelectric materials, which could interact with each other and thus lead to photodetectors with higher performances. Such a Review will be helpful for the research of emerging physical phenomena and for the design of multifunctional nanoscale electronic and optoelectronic devices

Phase Change Random Access Memory for Neuro‐Inspired Computing

Abstract: Neuro‐inspired computing using emerging memristors plays an increasingly significant role for the realization of artificial intelligence and thus has attracted widespread interest in the era of big data. Thanks to the maturity of technology and the superiority of device performance, phase change random access memory (PCRAM) is a promising candidate for both nonvolatile memories and neuro‐inspired computing. Recently many efforts have been carried out to achieve the biological behavior using PCRAM and to clarify the related working mechanism. In order to further improve device performances, it is helpful and urgent to summarize and discuss the PCRAM solution for neuro‐inspired computing. In this paper, fundamentals, principles, recent progresses, existing challenges, and mainstream solutions are reviewed, and a brief outlook is highlighted and introduced, with the expectation to expound future directions