Dupilumab for treatment of severe atopic dermatitis accompanied by lichenoid amyloidosis in adults:Two case reports

BACKGROUND Lichenoid amyloidosis(LA)is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules,usually on the lower leg,back,forearm,or thigh.LA may be associated with several skin diseases,including atopic dermatitis(AD).The treatment of LA is considered to be difficult.However,as there is some overlap in the etiopathogenesis of LA and AD,AD treatment may also be effective for LA.CASE SUMMARY Case 1:A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs.He had a long history of the disease(8 years),with repeated and polymorphic skin lesions.Given the poor efficacy of traditional treatments,this patient was recommended to receive dupilumab treatment.At the initial stage,300 mg was injected subcutaneously every 2 wk.After 28 wk,the drug interval was extended to 1 mo due to the pandemic.Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90(skin lesions improved by 90%compared with the baseline)by the end of the study.Moreover,Investigator's Global Assessment score was 1,and scoring atopic dermatitis index and numeric rating scale improved by 97.7%and 87.5%compared with the baseline,respectively,with LA skin lesions having largely subsided.Case 2:A 30-year-old woman was diagnosed with severe AD with LA,due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis,and erythema and papules scattered on limbs and trunk with pruritus,present for 25 years.After 16 wk of dupilumab treatment,she stopped,and skin lesions completely subsided,without recurrence since the last follow-up.CONCLUSION Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA,in addition to benefits in the quality of life of the patients.

The role of pineal microRNA-325 in regulating circadian rhythms after neonatal hypoxic-ischemic brain damage

Circadian rhythm disorder is a common,but often neglected,consequence of neonatal hypoxic-ischemic brain damage(HIBD).However,the underlying molecular mechanisms remain largely unknown.We previously showed that,in a rat model of HIBD,up-regulation of microRNA-325(miR-325)in the pineal gland is responsible for the suppression of Aanat,a key enzyme involved in melatonin synthesis and circadian rhythm regulation.To better understand the mechanism by which miR-325 affects circadian rhythms in neonates with HIBD,we compared clinical samples from neonates with HIBD and samples from healthy neonates recruited from the First Affiliated Hospital of Soochow University(Dushuhu Branch)in 2019.We found that circulating miR-325 levels correlated positively with the severity of sleep and circadian rhythm disorders in neonates with HIBD.Furthermore,a luciferase reporter gene assay revealed that LIM homeobox 3(LHX3)is a novel downstream target of miR-325.In addition,in miR-325 knock-down mice,the transcription factor LHX3 exhibited an miR-325-dependent circadian pattern of expression in the pineal gland.We established a neonatal mouse model of HIBD by performing doublelayer ligation of the left common carotid artery and exposing the pups to a low-oxygen environment for 2 hours.Lhx3 mRNA expression was significantly down-regulated in these mice and partially rescued in miR-325 knockout mice subjected to the same conditions.Finally,we showed that improvement in circadian rhythm-related behaviors in animals with HIBD was dependent on both miR-325 and LHX3.Taken together,our findings suggest that the miR-325-LHX3 axis is responsible for regulating circadian rhythms and provide novel insights into the identification of potential therapeutic targets for circadian rhythm disorders in patients with neonatal HIBD.The clinical trial was approved by Institutional Review Board of Children’s Hospital of Soochow University(approval No.2015028)on July 20,2015.Animal experiments were approved by Animal Care and Use Committee,School of Medicine,Soochow University,China(approval No.XD-2016-1)on January 15,2016.

Unilateral lichen planus with Blaschko line distribution: A case report

BACKGROUND Lichen planus(LP)with distribution of lesions along Blaschko’s lines is a rare entity,accounting for 0.24%-0.62%of all patients.Unilateral distribution of lesions in arm,leg,trunk,and waist is even less common.Approximately 10%of patients with LP manifest nail lesions.CASE SUMMARY A 20-year-old woman presented to our department with polygonal,purpuric,flattopped papules over the right arm,right leg,and right side of trunk and waist for the last 5 mo.The patient initially developed nail deformation in the left middle finger with no obvious cause,followed by development of blue-purple and red maculopapular rash with pruritus.During the disease course,the skin lesions aggravated and spread to several segments due to scratching.The lesions showed unilateral distribution along the Blaschko’s lines.The diagnosis of LP along Blaschko’s lines was established based on dermoscopy and skin biopsy.Her cutaneous lesions considerably improved after 4-wk treatment with intramuscular glucocorticoid,oral acitretin,topical glucocorticoid,and retinoids.CONCLUSION Cases of LP involving multiple segments of the body along the Blaschko’s lines with nail damage are rare.

Prevalence and Treatment of Children＇s Asthma in Rura Areas Compared with Urban Areas in Beijing

The prevalence of childhood asthma has been increasing in China. This study aimed to compare the prevalence, diagnosis, and treatment of asthmatic children from urban and rural areas in Beijing, China. Methods： Schools, communities, and kindergartens were randomly selected by cluster random sampling from urban and rural areas in Beijing. Parents were surveyed by the same screening questionnaires. On-the-spot inquiries, physical examinations, medical records, and previous test results were used to diagnose asthmatic children. Information on previous diagnoses, treatments, and control of symptoms was obtained. Results： From 7209 children in rural areas and 13,513 children in urban areas who completed screening questionnaires, 587 children were diagnosed as asthma. The prevalence of asthma in rural areas was lower than in urban areas （1.25% vs. 3.68%, χ^2 = 100.80, P 〈 0.001）. The diagnosis of asthma in rural areas was lower than in urban areas （48.9% vs. 73.9%, χ^2 = 34.6, P 〈 0.001）. Compared with urban asthmatic children （56.5%）, only 35.6% of rural asthmatic children received inhaled corticosteroids （P 〈 0.05）. The use ofbronchodilators was also lower in rural areas than in urban areas （56.5% vs. 66.4%, χ^2 = 14.2, P 〈 0.01）. Conclusion： The prevalence of asthma in children was lower in rural areas compared with children in the urban area of Bcijing. A considerable number of children were not diagnosed and inadequately treated in rural areas,

Association of Different Human Rhinovirus Species with Asthma in Children： A Preliminary Study

Background： Human rhinoviruses （HRVs） are divided into three genetic species： HRV-A, HRV-B, and HRV-C. The association of different HRV species with asthma in children in China has not yet been evaluated. This preliminary study aimed to assess the associations between different HRV species, particularly HRV-C, and asthma in young children in China. Methods： A total of 702 nasopharyngeal aspirates were obtained from 155 children with asthma （asthma group）, 461 children with acute respiratory infection （ARI） without asthma （nonasthma ARI group）, and 86 children from the control group. Semi-nested polymerase chain reaction （PCR） was used to detect HRVs, and PCR products were sequenced for species identification. Epidemiological characteristics of HRV-positive cases were analyzed. Results： HRVs were the most common pathogen （ 15.4%; 108/702） in the patients in this study. The prevalence of HRV was significantly different （F = 20.633, P = 0.000） between tile asthma （25.8%） and nonasthma ARI groups （11.1%）. Phylogenetic analysis indicated that in the 108 cases positive for HRVs, 41 were identified as HRV-A, 8 as HRV-B, and 56 as HRV-C, Comparing the asthma with the nonasthlna ARI group, Spearman＇s rank correlation analysis revealed an association between HRV-A （P 〈 0.05） and C （P 〈 0.01） and asthma, confirmed by regression analysis, with odds ratios of 2.2 （HRV-A） and 4.2 （HRV-C）. Conclusions： Our data revealed a high prevalence of HRVs in children in China, regardless of clinical status. HRV-C was the dominant species and may be one of the key factors in the association of HRVs with asthma.

Molecularly imprinted open porous membranes made from Pickering W/O HIPEs for selective adsorption and separation of methyl 4-hydroxybenzoate

In this study, novel molecularly imprinted open porous membranes（MIOPMs） were prepared using the Pickering HIPEs template method and molecular imprinting technology for selective adsorption and separation of methyl 4-hydroxybenzoate（M4HB）. The template M4 HB, functional monomers,crosslinker and plastifier 2-ethylhexyl acrylate（2-EHA） were contained in the oil phase. Hydrophobic silica nanoparticles（HNP-SiO2） were employed as a stabilizer to establish stable W/O Pickering HIPEs with nonionic surfactant sorbitantrioleate（Span 85）. The results of SEM and FTIR indicated that the optimal MIOPMs were prepared successfully and possessed open and interconnecting pores. Then, the MIOPMs were used as sorbents for M4 HB. The correlation coefficient（R^2） values for the Langmuir–Freundlich isotherm model and pseudo-second-order kinetic model fitting to the adsorption equilibrium and kinetic data respectively were all higher than 0.95. The maximum adsorption capacity and the time of rapid adsorption for MIOPM4 were 4.146 mg g^-1 and 100 min, respectively. In addition, the permeability separation factor of MIOPMs for M4 HB compared to a structurally related analog methyl2-hydroxybenzoate（M2HB） could reach 3.122.