Combination therapy(toripalimab and lenvatinib)-associated toxic epidermal necrolysis in a patient with metastatic liver cancer:A case report

BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor and lenvatinib is safe and effective.However,we report a case of toxic epidermal necrolysis(TEN),a grade 4 toxicity,after this combination therapy.CASE SUMMARY A 39-year-old male presented with erythema,blisters and erosions on the face,neck,trunk and limbs 1 wk after receiving combination therapy with lenvatinib and toripalimab,a PD-1 inhibitor.The skin injury covered more than 70%of the body surface area.He was previously diagnosed with liver cancer with cervical vertebra metastasis.Histologically,prominent necrotic keratinocytes,hyperkeratosis,liquefaction of basal cells and acantholytic bullae were observed in the epidermis.Blood vessels in the dermis were infiltrated by lymphocytes and eosinophils.Direct immunofluorescence staining was negative.Thus,the diagnosis was confirmed to be TEN(associated with combination therapy with toripalimab and lenvatinib).Full-dose and long-term corticosteroids,high-dose intravenous immunoglobulin and targeted antibiotic drugs were administered.The rashes gradually faded;however,as expected,the tumor progressed.Therefore, sorafenib and regorafenib were given in succession, and the patient was still alive at the10-mo follow-up.CONCLUSIONCautious attention should be given to rashes that develop after combination therapy with PD-1inhibitors and lenvatinib. Large-dose and long-course glucocorticoids may be crucial for thetreatment of TEN associated with this combination treatment.

A study of acupoint selection rules of moxibustion and auricular point therapy in the treatment of urinary retention after anorectal surgery based on data mining

Based on the Traditional Chinese Medicine Inheritance Support System(V2.5),we explored the compatibility rules of moxibustion and auricular point prescriptions in the treatment of urinary retention after anorectal surgery,and further to obtain new prescriptions.Methods:We searched CNKI,Wanfang,VIP and CBM databases for the literature of moxibustion and auricular point therapy for urinary retention after anorectal surgery,collecting complete prescriptions and entering them into the Traditional Chinese Medicine Inheritance Support System(V2.5).The acupoint frequency,association rules,and combination rules were analyzed by data mining method of software integration.Results:126 moxibustion prescriptions were selected,and the acupoints for urinary retention after anorectal surgery in the literature were analyzed,including 10 acupoints with frequency≥6,9 acupoint combinations with frequency≥26,5 acupoints with association rules,6 core acupoint combinations and 3 new prescription.124 auricular point prescriptions were selected,and the relevant acupoints in the literature were analyzed,including 10 acupoints with frequency of use≥18,15 acupoint combinations with frequency≥40,12 acupoint combinations with association rules,6 core acupoint combinations,and 3 new prescriptions.The core points include Qihai(RN6),Sanyinjiao(SP6),Zhongji(RN3),Guanyuan(RN4).The auricular point therapy is more to select the tenderness points and acupoints that have an impact on the urinary system,mainly including“Pangguang”(CO9),“Shenmen”(TF4),“Shen”(CO10),“Sanjiao”(CO17),“Pizhixia”(AT4),“Niaodao”(HX3),“Fei”(CO14),“Jiaogan”(AH6a).Conclusion:Moxibustion for the treatment of urinary retention is mainly based on invigorating“Primordial Qi”and regulating the functions of“Middle Jiao”(refers to the area of the body just below the diaphragm and above the navel that helps produce delicate nutrients).The entropic clustering of complex systems excavated new prescriptions for the treatment of urinary retention after anorectal surgery,providing new ideas for future research and treatment.

Deep Learning-Assisted Visualized Fluorometric Sensor Array for Biogenic Amines Detection

Biogenic amines(BAs)are important biomarkers for monitoring food quality and assisting in the diagnosis of disease.Facial,portable,accurate and high-throughput BAs detection is still challenging by the specific sensor compounds development or the complicated instrument operation.Deep learning(DL)algorithms are blooming for their superiority on the nonlinear and multidimensional data analysis,which endow the great advantage for the artificial intelligence assisted large sample analysis of the environmental or daily health monitoring.In this work,we developed a deep learning-assisted visualized fluorometric array-based sensing method.Two commercial fluorescent dyes were selected and combined into sensor arrays.Variation in the alkalinity of BAs causes significant and distinct fluorescence changes of the dyes.In conjunction with pattern recognition by the pretrained CNN models,the sensor array clearly differentiates seven BAs with 99.29%prediction accuracy and allows rapid single and multi-component quantification with a volume fraction range from 200 cm^(3)/m^(3)to 2500 cm^(3)/m^(3).This method also provides a new way for meat freshness monitoring.We envision that this novel analytical method for BAs can be used as an alternative and promising tool for the detection of a wider variety of analytes.