Thymic stromal lymphopoietin (TSLP) was initially demonstrated to be critical in regulating inflammatory responses among various allergic disorders (such as atopic dermatitis, food allergy, and asthma). Although two isoforms (short form and long form) of TSLP have been demonstrated in human tissues, the long form of TSLP (lfTSLP) is strongly implicated in the pathogenesis of allergies and cutaneous immune-mediated diseases. The immunomodulatory activity of lfTSLP varies widely, driving T helper (Th) cells polarizing Th2 and Th17 immune responses and inducing itch. Moreover, lfTSLP is closely associated with skin fibrosis, epidermal hyperplasia, angiogenesis, and homeostatic tolerogenic regulations. This review highlights significant progress from experimental and clinical studies on lfTSLP in cutaneous immune-mediated diseases (atopic dermatitis, psoriasis, bullous pemphigoid, systemic sclerosis, chronic spontaneous urticaria, Behçet’s disease, vitiligo, rosacea, systemic lupus erythematosus, and alopecia areata). We also offer original insights into the pleiotropic properties of the cytokine TSLP in various pathophysiological conditions, with significant clinical implications of TSLP-targeted therapies for immune-mediated skin diseases in the future.
Background: As the more application of high-resolution computed tomography (HRCT), a great number of ground glass opacity (GGO) is identified. Video-assisted thoracoscopic surgery (VATS) segmentectomy is technically more difficult than lobectomy because of the anatomical complexity. Three-dimensional computed tomography bronchography angiography (3D-CTBA) is a powerful tool for thoracic surgeons to analyze pulmonary anatomy, allowing a better understanding of the pulmonary anatomy in each patient.Here we encountered seven cases of bifurcated right upper bronchus (B1 defective). The variation in vascular pattern of these patients is analyzed. Methods: Between October 2018 and December 2018, a consecutive 162 patients with pulmonary lesions were admitted and underwent 3D-CTB prior to surgery. A total of seven cases of bifurcated right upper bronchus (B1 Defective) were identified. Then 3D-CTBA reconstruction was performed by Syngo MultiModality Workplace (Software: Syngo MMWP, Version: VF40A). Radiology colleagues processed all 3D images and thoracic surgeons confirmed the validity of all reconstructions.Results: The mean age of the seven patients (3 females and 4 males) is 54 years. According to the branches of artery, they are divided into two types: "Tr. sup + A. asc" (2/7, 28.6%) and "Tr. sup + Tr. inf + A. asc" (5/7, 71.4%). According to the branches of A2 asc, another two types can be divided: type A, two branches of A2a asc + A2b asc (4/7, 57.1%) and type B, only one branch of A2b asc (3/7, 42.9%). Types can also be divided according to the branches of A2 rec: A, no A2 rec (4/7, 57.1%); B, one branch of A2a rec (2/7, 28.6%); C, two branches of A2a rec + A2b rec (1/7, 14.3%). According to the origins of A3, three types can be divided: A, A3 origins from Tr. inf (1/7, 14.3%); B, A3 origins from Tr. sup (2/7, 28.6%); C, A3 origins from both Tr. sup and Tr. inf (4/7, 57.1%). Conclusions:The "defective B1" type of bifurcated right upper lobe (RUL) bronchus is relatively rare.A pre-operative understanding of its anatomical features, especially the vascular variation patterns, may be helpful for completing a satisfactory segmentectomy. 3D-CTBA is a powerful tool, allowing a better understanding of the pulmonary anatomy in each patient before and during surgical procedures.
BackgroundA close association between psoriasis and anti-p200 pemphigoid has been demonstrated by numerous studies. However, the clinical characteristics of patients suffering from these two entities have not yet been well-elucidated.ObjectiveThis study aimed to review the case reports and case series, summarizing clinical features and therapeutic strategies in patients suffering from anti-p200 pemphigoid and psoriasis.MethodsA systematic review was conducted by searching PubMed, EMBASE, and Web of Science databases for studies published in English involving patients with psoriasis and anti-p200 pemphigoid on 6 September 2021. All case reports and case series reporting patients diagnosed with anti-p200 pemphigoid and psoriasis were included in this systematic review.ResultsA total of 21 eligible studies comprising 26 anti-p200 pemphigoid patients with preceding psoriasis were included in the qualitative synthesis. The average age at blisters eruption was 62.5 years, and the mean duration between the two entities was 15.6 years. Twenty-four percent of patients developed bullous lesions during UV therapy. Clinical manifestation of bullae and/or vesicles was recorded in all patients, and the trunk (94.7%) was most frequently involved, with only 15.8% reporting mucosal involvement. Epitope spreading was detected by immunoblotting in 33.3% of patients. All the patients reached completed remission during the course of disease, with 36.8% experiencing at least one relapse. Monotherapy of prednisolone was the leading therapeutic approach (n=6, 31.6%) required for disease control, but 5 (83.3%) of them suffered from blister recurrence after tapering or ceasing corticosteroid.ConclusionMost of the clinical aspects of patients with anti-p200 pemphigoid and psoriasis were similar to what was demonstrated in previous articles on anti-p200 pemphigoid. Nevertheless, compared with other anti-p200 pemphigoid cases without psoriasis, a clinical manifestation pattern with more frequent involvement of the trunk and less mucosal involvement was illustrated in those with psoriasis. Generally, monotherapy is sufficient for a complete remission for such patients. However, one or more relapses have been recorded in a considerable portion of patients, especially those prescribed with prednisolone. It reminded us to be more cautious during a tapering of medication.
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