Opacification of refractive bifocal intraocular lens in one month: Three case reports

Rationale:Multifocal intraocular lenses (IOLs) are used widely. However, the discovery of LS-313 MF15/30 (Oculentis B.V.) opacity during surgery has not yet been reported. This article reports 3 cases of LS-313 MF15/30 (Oculentis B.V.) IOL opacity found during cataract surgery implantation within 1 month.Patient concerns:Three patients underwent cataract surgery, and opacification of their IOL (LS-313 MF15/30, Oculentis B.V.) was found intraoperatively.Diagnosis:The patient was diagnosed with a postoperative intraocular opacity.Interventions:In case 1, the surgeon scrubbed the IOL with intraocular perfusion fluid and a gelatin sponge swab to reduce opacity in the central optical area of the IOL and then implanted it into the capsule bag. In case 2, the surgeon used the infusion-aspiration polishing mode for cleaning. To avoid IOL wear and bag damage, washing was stopped when turbidity in the center of the optical area was reduced. In case 3, we learned from our previous experience that the surgeon cut the IOL into 2 pieces and moved it out at the main incision, which was replaced and implanted with a brand new IOL, after the implanted IOL was again found cloudy.Outcomes:In case 1, more than 10 months after the surgery, the IOL was restored to transparency, no obvious eye discomfort was noted, and uncorrected visual acuity was 20/25. In case 2, the patient''s IOL surrounding area was still partially turbid after more than 10 months of follow-up. In case 3, the patient''s uncorrected visual acuity on postoperative day 1 was 20/20, and the best-corrected visual acuity was 20/20.Lesson:There are many reasons for the opacification of the IOL. In addition to the patient''s own factors, the material, production, and packaging of the IOL, as well as the influence of external environmental temperature, the influence of the IOL implant instrument should not be ignored and needs to be considered.     

红皮病性银屑病198例临床回顾性分析

目的分析红皮病性银屑病的诱发因素、临床特点、治疗方法和疗效。方法回顾性分析2010年1月—2013年12月收治的红皮病性银屑病患者的临床资料。结果 198例中男女之比为3∶1,平均发病年龄为45岁,从其他类型银屑病转化为红皮病性银屑病176例(88.8%),平均病程14.63年;其余22例患者的平均病程为5.6年。主要诱发因素为感染、滥用糖皮质激素和突然停药。174例(87.9%)并发甲损害,14例(7.1%)并发脓疱,16例(8.1%)关节受累,30例(15.1%)伴发热。根据病情和治疗史选择联合治疗方案,163例患者分5组治疗:复方甘草酸二铵联合阿奇霉素药物(14例)、病情严重的患者在此治疗基础上分别加用雷公藤多苷(15例)、阿维A(61例)、雷公藤多苷+阿维A(63例)、雷公藤多苷+阿维A+甲氨蝶呤(10例),各治疗组有效率分别为85.7%、86.7%、90.1%、92%和90%。结论红皮病性银屑病主要由其他类型银屑病转化而来,控制诱因和规范化治疗有助于减少红皮病性银屑病的发病率。联合治疗可以提高病情严重患者的疗效。     

TOX 与 Notch1在MF中的表达

目的：检测TOX蛋白及活化型Notch1蛋白在MF中的表达情况,探讨TOX及Notch1蛋白作为MF分子标记物的可行性。方法：采用免疫组化方法检测35例MF（15例斑片期,10例斑块期,10例肿瘤期）和45例对照组（15例淋巴瘤样丘疹病、15例扁平苔藓、15例银屑病）的病理组织标本中TOX蛋白及活化型Notch1蛋白的表达。结果：TOX蛋白染色结果：MF阳性率约94.3%,且阴性标本全部为斑片期,对照组阳性率75.6%。MF组TOX蛋白表达强度高于对照组比较,差异有统计学意义(P<0.05)。 MF组与对照组所有病例肿瘤细胞Notch1阴性。 结论： MF组与对照组TOX蛋白表达水平有显著差异性,但还不足以证明TOX可作为诊断MF的分子标记物,需进一步验证。Notch1蛋白不在皮肤T细胞淋巴瘤中表达 ,故无法作为MF的分子标记物。     

An improved membrane-filtration enzyme immunoassay for the rapid serological diagnosis of viral infections

A one-step modification of the membrane-filtration enzyme immunoassay (MF EIA) (Barnett et al. J. Clin. Microbiol., 23:385–399, 1987), for estimation of virus-specific antibody is described. The modified MF EIA allowed serum, antigen and enzyme-conjugated anti-globulin to be incubated together in membrane-based 96-well plates to enable the formation of immune complexes in solution at 37°C. The assay required only 45 min for completion and polyethylene glycol was shown to be an essential component in reaction mixtures for IgG assays to enhance immune complex formation. The modified MF EIA was as sensitive as the previous two-step method for monitoring responses to influenza vaccin, and control antigen backgrounds were significantly reduced. The one-step procedure was also shown to be suitable for the rapid serodiagnosis of naturally acquired influenza A and B infections. However, MF EIA detected cross-reactive H1N1 responses in 57.7% of naturally-acquired H3N2 infections, suggesting that responses to common internal antigens were being measured. Cross-reactive responses to influenza A viruses could not be detected in volunteers receiving subunit vaccines.     

Erythrodermic psoriasis in a dialyzed patient successfully treated with Secukinumab

Erythrodermic psoriasis is a severe, life‐threatening condition with additional complications, when occurring in hemodialyzed patients, as the majority of treatments are contraindicated. A 44‐years‐old man, of Philippine origins, with a 15‐years‐history of psoriasis treated with cyclosporine developed progressive hypertension and renal insufficiency. Despite drug dismission, renal function worsen to end‐stage, and hemodialysis was necessary three times a week. Phototherapy was not able to control the skin condition, progressing to erythroderma, and after nephrology consultation, the patient consent to the off‐label secukinumab treatment, at the standard regimen (300 mg subcutaneously once weekly at weeks 0‐4 followed by 300 mg every 4 weeks). Seven days after the first injection, a rapid improvement was noted, with the psoriasis area severity index (PASI) score passing from 31.5 to 17.6. At the 52‐week‐follow‐up visit, the patient was completely clarified, without any side effects. The case supports secukinumab effectiveness and safety in difficult patients, including erythrodermic psoriasis with end‐stage renal failure, as drug plasma levels seem not to be affected by hemodialysis. Results are rapidly achieved, and long term maintained, with the additional advantage of a very comfortable monthly administration.     

A case of erythrodermic psoriasis successfully treated with guselkumab

Erythrodermic psoriasis (EP) is the most severe form of psoriasis, resulting in significant morbidity and mortality. EP treatment with biologics is not well ruled by international guidelines, so most biological drugs are used basing on case reports or small case series. Guselkumab, a fully human anti‐interleukin (IL)‐23 monoclonal antibody, is approved for moderate to severe plaque psoriasis while its use in EP is off label. To date, no case reports on Caucasian patients have been described in the literature. We report the case of 38‐year‐old Caucasian male with EP successfully treated with guselkumab, reaching PASI 100 after 20 weeks of therapy and still maintaining this response at Week 48. Our case report suggests guselkumab as an efficacious and well‐tolerated treatment in EP, presenting a long‐term efficacy in the prevention of recurrences. Further studies are warrant to confirm our data, with controlled trials specifically dedicated to EP being strictly needed in order to verify the role and efficacy of anti‐IL23 in EP.     

禽流感H5N1灭活疫苗与不同纳米化佐剂联合免疫研究

目的 观察禽流感H5N1灭活疫苗加不同佐剂以及纳米化佐剂免疫小鼠后产生的免疫应答的差异,同时观察免疫对异亚型病毒攻击后的保护情况.   方法 用H5N1灭活疫苗分别联合佐剂氢氧化铝、纳米化氢氧化铝、MF59和纳米化MF59通过腹腔注射方式免疫雌性BALB/c小鼠,同时分别以H5N1灭活疫苗免疫小鼠以及PBS腹腔注射处理小鼠作对照.采用ELISA方法分别对各组小鼠免疫后血清特异性IgG及其亚类IgG1、IgG2a水平进行检测,以PR8病毒鼻腔攻击后观察小鼠体重变化情况和生存率.采用t检验作组间比较.    结果 与PBS处理组相比,无论以何种方式免疫H5N1疫苗,免疫后特异性IgG及其亚类水平均明显升高(t=7.4004,P<0.01),以联合MF59后诱导的特异性抗体水平最高.其中疫苗单独免疫组和联合M59免疫组IgG2a水平升高明显,联合纳米化MF59免疫小鼠后IgG2a水平有所下降,IgG1水平有所升高;联合铝佐剂组以IgG1升高为主.攻毒后各组小鼠体重均出现下降,但疫苗单独免疫小鼠以及疫苗与佐剂联合免疫小鼠于攻毒后期体重恢复接近正常或者正常.PBS处理组小鼠攻毒后全部死亡,佐剂联合免疫组小鼠存活率100%,而疫苗单独免疫小鼠存活率为70%.   结论 H5N1疫苗无论是单独免疫或是联合不同佐剂免疫均可诱导较高水平的特异性抗体产生,有非常好的免疫原性.H5N1灭活疫苗诱导的抗体亚类以IgG2a为主,MF59以及纳米化MF59也以诱导IgG2a亚类为主,但纳米化MF59可诱导更均衡的免疫应答.联合铝佐剂或纳米化铝佐剂免疫小鼠后均可诱导以IgG1亚类为主的抗体应答.联合两种佐剂均可对小鼠产生很好的异亚型保护.     

Sézary syndrome without erythroderma: A case report and review of published work

Sézary syndrome (SS) is defined by erythroderma and circulating atypical T cells, with or without lymphadenopathy. Recently, Thompson et al. identified a distinct population of SS patients with an atypical presentation: a high blood tumor burden of Sézary cells fulfilling criteria for SS but without fulfilling the criteria for erythroderma at the diagnosis. Here, we report a case of a 49‐year‐old Japanese man with SS who did not present with erythroderma initially, but exhibited erythematous itchy papules symmetrically located on the legs and arms. We also reviewed reported cases of SS without initial erythroderma. The skin manifestations at diagnosis varied from patches to tumors often seen in mycosis fungoides, and other rarer findings such as excoriation, palmoplantar keratoderma and alopecia. Pruritus was reported in most patients (86%), unlike early mycosis fungoides, and could be the main clue to the diagnosis of SS. Notably, three patients were reported to have presented with papular lesions, similar to our case. Little is known about why skin lesions in SS without erythroderma vary and why these cases did not exhibit erythroderma initially. Attenuated stimulation by colonized Staphylococcus aureus, impairment in recruitment of malignant T cells and suppression of inflammatory response induced by malignant T cells with regulatory phenotype may be associated with skin manifestations. Further studies are necessary to elucidate the etiology of this entity.