Toe Absence Related to Verrucous Carcinoma

Introduction:Verrucous carcinoma is a rare variant of squamous cell carcinoma.It generally grows exogenously and bone erosion is rare.Here we present a case of verrucous carcinoma on the foot with toe absence.Case presentation:A 64-year-old man presented with a 6-year history of a slowly growing exogenous hyperkeratotic verrucous lesion on the right fifth toe,which had been absent for 1year.Before the lesion appeared,he had undergone nail extraction on this toe.The culture of fungi and mycobacteria were negative.Three-dimensional computed tomography showed that the fifth toe of the right foot was absent.Histopathological examination showed that the lesion was exogenous and verrucous and exhibited moderate keratinocyte hyperplasia.Combined with clinical manifestation and histopathological examination,verrucous carcinoma is suggested.The lesion was surgically excised,and the patient was followed up for more than 6months without recurrence.Discussion:Verrucous carcinoma is an exophytic tumor with verrucous growth at the beginning,which can invade deep tissues and even cause limb mutilation.When encountering a patient with a wart-like plaque on the foot that responds poorly to conventional treatments,clinicians should maintain a high degree of clinical vigilance and a low threshold for biopsy.Conclusion:We observed a rare outcome of toe absence associated with verrucous carcinoma.Therefore,early diagnosis of verrucous carcinoma is very important.Surgical excision is an effective treatment at present.Extensive resection is usually required to avoid recurrence.

Itraconazole Promotes Macrophage M1 Polarization and Phagocytic Capacity of Macrophage to Candida Albicans

Objective: The present study was designed to evaluate whether and how itraconazole affects the macrophage polarization and its reactivity to Candida albicans. Methods: Cell toxicity of itraconazole was measured using cell counting kit-8 assay in RAW264.7 cells. The cell models were induced by lipopolysaccharide (LPS), interleukin (IL)-4, or Candida albicans. Levels of cytokines secreted by RAW246.7 treated with itraconazole were detected by Luminex or Cytometric Bead Array compared to the controls without itraconazole treatment, and the expressions of inducible nitric oxide synthase and arginase (Arg) were determined by Western blot. Phagocytosis ability was measured by both flow cytometry and fluorescence microscope. The Student's t test and one-way analysis of variance were used to calculate the differences between groups. Results: In comparison to the control, itraconazole inhibited the growth of the cells in both a time- and a dosedependent manner. Increased secretion of IL-6 (0.25μmol/L ITZ [538.03±60.23pg/mL, P<0.05], 0.5μmol/L [550.32 ±47.87 pg/mL, P<0.05] and 1 μmol/L [626.95±75.24pg/mL, P<0.01] vs. control [370.43±33.98pg/mL]) and tumor necrosis factor-alpha (TNF-α) (1μmol/L ITZ vs. control: 2521.51±444.06pg/mL vs. 1617.85±94.57 pg/mL, P<0.05) were detected in the LPS-induced cell model with itraconazole treatment. In the cells induced by IL-4, itraconazole increased the secretion of IL-6 (1μmol/L ITZ vs. control: 528.33±11.60pg/mL vs. 466.99±28.32 pg/mL, P<0.05), TNF-α (1μmol/L ITZ vs. control: 4.85±0.32pg/mL vs. 4.30±0.19 pg/mL, P<0.05), and IL-1β (0.25μmol/L [325.95±13.97pg/mL, P<0.05], 0.5μmol/L [332.38±11.97pg/mL, P<0.05] and 1μmol/L [334.35±16.23 pg/mL, P<0.05] vs. control [291.62±17.03pg/mL]), and reduced the secretion of IL-10 (1μmol/L ITZ vs. control: 7.21±0.68 pg/mL vs. 9.11±0.14pg/mL, P<0.05). The secretion of IL-6 (1μmol/L ITZ vs. control: 38.34±1.36pg/mL vs. 32.32± 0.84pg/mL, P<0.05) and TNF-α (1μmol/L ITZ vs. control: 1060.17±80.16pg/mL vs. 890.84±52.82 pg/mL, P<0.01) was improved in Candida albicans-stimulated RAW264.7 cells under the treatment of itraconazole, while the secretion of IL-4 (0.5μmol/L [2.86±0.20 pg/mL, P<0.05] and 1μmol/L [2.24±0.33 pg/mL, P<0.001] vs. control [3.91±0.23 pg/mL]) and IL-10 (1μmol/L ITZ vs. control: 19.46±2.05pg/mL vs. 25.67±1.95pg/mL, P<0.05) decreased. In all three activated patterns, itraconazole enhanced the expression of inducible nitric oxide synthase (P<0.01) and slightly inhibited the Arg-1 expression (P<0.05). Phagocytosis ability of RAW264.7 cells at 1μmol/L ITZ treatment was increased by 7.53%±2.21% (P<0.01) and 9.73%±2.03% (P<0.01) at the ratio of cells: yeast of 1:4 and 1:8, respectively, in comparison to the control group.Itraconazole improved M1 polarization of RAW264.7 cells and enhanced the phagocytic capacity of RAW264.7 to Candida albicans, indicating a significant immunological enhancement. The study improves the understanding of undergoing mechanisms related to the anti-tumor and anti-infection effects of itraconazole.

Trichorrhexis nodosa examined by scanning electron microscopy

Introduction Trichorrhexis nodosa (TN), one of the most common hair shaft anomalies, was first identified by Samuel Wilks in 1852(1)As either a congenital or acquired hair shaft disorder, TN is characterized by fragile and easily broken hair accompanied by frayed cortical fibers and loss of the cuticle(2)Complete fracture of the hair shaft subsequently occurs. Moreover, hair shaft fragility may increase the risk of developing TN. Congenital TN, including trichothiodystrophy[3], argininosuccinic aciduria[4], Menkes syndrome[5] and trichohepatoenteric syndrome[6], is rare in the clinical setting. Acquired TN, which is provoked by hair injury secondary to physical or chemical trauma (usually physical trauma), is often overlooked in daily life. We herein reported a case of TN in a woman with androgenetic alopecia.