Cohort study of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis in China:evaluation of risk models and new predictor of pulmonary consolidation on computed tomography

Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)are rare but severe diseases.This study aimed to validate the predictive ability of risk models in patients with SJS/TEN and propose possible refinement in China.Patients in the Department of Dermatology of Huashan Hospital from January 2008 to January 2019 were included.Results showed that the severity-of-illness score for TEN(SCORTEN)had a good discrimination(area under the receiver operating characteristic curve(AUC),0.78),and it was superior to auxiliary score(AS)and ABCD-10,which indicates age,bicarbonate level,cancer,dialysis,and 10%involved body surface area(AUC,0.69 and 0.68,respectively).The calibration of SCORTEN(Hosmer-Lemeshow goodness-of-fit test,P=0.69)was also better than that of AS(P=0.25)and ABCD-10(P=0.55).SCORTEN and ABCD-10 were similar(Brier score(BS),0.04 and 0.04)in terms of accuracy of predictions.In addition,the imaging appearance of pulmonary consolidation on computed tomography was associated with high mortality.Refined models were formed using the variables and this imaging appearance.The refined AS and ABCD-10 models were similar in discrimination compared with the original SCORTEN(0.74 vs.0.78,P=0.23;0.74 vs.0.78,P=0.30,respectively).Therefore,SCORTEN showed good discrimination performance,calibration,and accuracy,and refined AS or ABCD-10 model may be an option when SCORTEN variables are not available.

Versatile nanocomposite augments high-intensity focused ultrasound for high-efficacy sonodynamic therapy of glioma

High-intensity focused ultrasound(HIFU),with inherent advantages of improved ultrasonic depth and low off-target damage,holds the promising capability for glioma treatment,but the relatively long therapeutic time and potential physical complications may hamper its clinical application.Herein,a bovine serum albumin(BSA)-based nanoplatform with in situ growth of MnO_(2) was synthesized,and Protoporphyrin IX(PpIX)was further anchored to obtain a versatile PpIX@MnO_(2)@BSA nanoplatform(denoted as BMP).By employing HIFU as the exogenous irradiation source,a high-efficacy sonodynamic therapy(SDT)is developed,in which the excited BMP enables the production of tumoricidal reactive oxygen species(ROS).The inherent tumor microenvironment(TME)-responsive property of MnO_(2) endows BMP with specific T1-weighted magnetic resonance imaging(MRI)by releasing Mn2+,and the simultaneously generated O_(2) facilitates hypoxia alleviation as well as ^(1)O_(2) generation.Compared with HIFU therapy alone,suppression of glioma growth and improved survival benefits are achieved through the designed TMEresponsive nanocomposite under HIFU exposure.The high-efficacy SDT strategy combining BMP and HIFU demonstrated favorable TME-responsive T1-weighted MRI,hypoxic environment alleviation,and anti-tumor capability,providing a perspective paradigm for MRI-guided glioma treatment.