The skin is the largest organ of the human body, covering an area of approximately 2 m 2 in adult. The skin functions as multiple barriers, such as permeability barrier, microbial barrier, and immune barrier, protecting the skin against various insults. Among these barriers, epidermal permeability barrier prevents substances in and out the body through the skin, while melanin serves as epidermal pigment barrier, protecting the skin from excessive ultraviolet (UV) radiation. 1 Recent studies demonstrated that epidermal permeability barrier and pigment barrier co-regulated each other. Disruption of permeability
Patients with metachronous metastatic nasopharyngeal carcinoma (NPC) differ significantly in survival outcomes. The aim of this study is to build a clinically practical nomogram incorporating known tumor prognostic factors to predict survival for metastatic NPC patients in epidemic areas.A total of 860 patients with metachronous metastatic nasopharyngeal carcinoma were analyzed retrospectively. Variables assessed were age, gender, body mass index, Karnofsky Performance Status (KPS), Union for International Cancer Control (UICC) T and N stages, World Health Organization (WHO) histology type, serum lactate dehydrogenase (sLDH) level, serum Epstein–Barr virus (EBV) level, treatment modality, specific metastatic location (lung/liver/bone), number of metastatic location(s) (isolated vs multiple), and number of metastatic lesion(s) in metastatic location(s) (single vs multiple). The independent prognostic factors for overall survival (OS) by Cox-regression model were utilized to build the nomogram.Independent prognostic factors for OS of metastatic NPC patients included age, UICC N stage, KPS, sLDH, number of metastatic locations, number of metastatic lesions, involvement of liver metastasis, and involvement of bone metastasis. Calibration of the final model suggested a c-index of 0.68 (95% confidence interval [CI], 0.65–0.69). Based on the total point (TP) by nomogram, we further subdivided the study cohort into 4 groups. Group 1 (TP < 320, 208 patients) had the lowest risk of dying. Discrimination was visualized by the differences in survival between these 4 groups (group 2/group 1: hazard ratio [HR] = 1.61, 95%CI: 1.24–2.09; group 3/group 1: HR = 2.20, 95%CI: 1.69–2.86; and group 4/group 1: HR = 3.66, 95%CI: 2.82–4.75).The developed nomogram can help guide the prognostication of patients with metachronous metastatic NPC in epidemic areas.
Atopy may be a facilitating factor in some alopecia areata (AA) patients with early disease onset and more severe/extensive AA. The underlying immune mechanisms are unknown, but allergen responses may support a pro‐inflammatory environment that indirectly promotes AA. To investigate the long‐term effect of allergen immunotherapy (AIT) against house dust mite (HDM) allergy on disease severity and prognosis for AA patients. An observational comparative effectiveness study was conducted on 69 AA patients with HDM allergy. 34 patients received conventional/traditional AA treatment (TrAA) plus AIT (AIT‐TrAA), and 35 patients received TrAA alone. Serum total immunoglobulin E (tIgE), HDM specific IgE (sIgE), HDM specific IgG4 (sIgG4) and cytokines (IL‐4, IL‐5, IL‐10, IL‐12, IL‐13, IL‐33, IFNγ) were quantified in these patients, together with 58 non‐allergic AA patients and 40 healthy controls. At the end of the 3‐year desensitization course, the AIT‐TrAA group presented with lower SALT scores than the TrAA group, especially in non‐alopecia totalis/universalis (AT/U) patients and pre‐adolescent AT/U patients (age ≤ 14). In patients with elevated tIgE levels before AIT, a decrease in tIgE was correlated to reduced extent of AA on completion of the AIT course. After desensitization, elevation of IL‐5 and decrease of IL‐33 were observed in HDM allergic‐AA patients. Desensitization to HDM in allergic AA patients reduces the severity of relapse‐related hair loss over the 3‐year AIT treatment course, possibly via opposing Th2 dominance. This adjunctive treatment may help reduce disease severity and curtail the disease process in allergic patients with AA.
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