[Analysis of long-term prognosis and risk factors in patients with dilated cardiomyopathy]

Objective: To investigate the risk factors and long-term prognosis of major adverse cardiovascular events(MACEs) in patients with dilated cardiomyopathy (DCM). Methods: This study was a single-center retrospective cohort study. Clinical information from 300 patients with DCM hospitalized in Peking Union Medical College Hospital from April 2013 to April 2023 was collected. Based on echocardiography results, the patients were divided into two groups: isolated DCM and DCM with left ventricular non-compaction cardiomyopathy (LVNC). The MACEs, including major heart failure events, severe ventricular arrhythmias, and cardiovascular death, were recorded by outpatient or telephone follow-up. Univariate and multivariate Cox proportional hazard regression models were used to analyze the risk factors affecting the prognosis of patients with DCM. Kaplan-Meier curve and log-rank were used for survival analysis to compare the difference in the incidence of cardiovascular events between the two groups. Results: The included 300 DCM patients were (47.8±16.8) years old, with 197 males (65.7%), of which 237 (79.0%) were isolated DCM and 63 (21.0%) were DCM with LVNC. The follow-up time was 4.0 (1.9, 6.2) years. A total of 142 (47.3%) MACEs occurred, including 117 (39.0%) major heart failure events, 20 (6.7%) severe ventricular arrhythmia events, and 53 (17.7%) cardiovascular death events. Multivariate Cox proportional hazard regression analysis showed that increased left ventricular end-diastolic diameter (HR=1.21, 95%CI: 1.01-1.44, P=0.042), moderate or severe mitral regurgitation (HR=1.71, 95%CI: 1.19-2.47, P=0.004), increased ln (N-terminal pro-B-type natriuretic peptide) (HR=1.30, 95%CI: 1.10-1.54, P=0.002) were independent risk factors for dverse cardiovascular events in DCM patients, and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI) treatment (HR=0.45, 95%CI: 0.26-0.78, P=0.004) was independent protective factor. Kaplan-Meier survival analysis found no significant difference in the risk of MACEs between isolated DCM and DCM with LVNC (P=0.22). Similarly, there were no significant differences in the incidence of major heart failure, severe ventricular arrhythmia, and cardiovascular death between the two groups (all P>0.05). Conclusion: An increase in left ventricular end-diastolic diameter, moderate or severe mitral regurgitation, elevated N-terminal pro-B-type natriuretic peptide, and non use of ACEI/ARB/ARNI are independent predictors of cardiovascular events in DCM patients. There was no significant risk of MACEs in patients with isolated DCM and DCM with LVNC, and suggested that LVNC may be a unique phenotype and should be accurately managed in combination with genetic background.

Dynamics of the Deformable Fluid Interface Interacting with an Approaching Solid under the Electrostatic Field

A theoretical model was developed to describe the dynamics of a deformable fluid interface interacting with an approaching solid without contact by both the attractive electrostatic and van der Waals (i.e., vdW) interaction, analogous to the situation in the experiments by electric force microscopy (i.e., EFM) or electric-surface force apparatus (i.e., E-SFA) involved in the soft fluid interface. On the basis of this model, a numerical study of the deformation of the fluid interface, the force-vs-separation behavior, and the critical limiting conditions of contact has systematically been carried out. Our results show that the surface pressure induced by the electrostatic interaction plays a more prominent role in the deformation of the fluid interface than the vdW interaction does, and there exists a principal length scale associated with the relative strength of the electrostatic field to the surface tension, affecting the fluid interface shape under the electrostatic field. It was also shown that both the force-distance curves and the corresponding curves of fluid interface deformation peak versus distance for various electrostatic fields satisfy the universal scaling power law. Moreover, an analytical solution to the Euler-Lagrange differential equation governing the deformation of the fluid interface under the external electric field is obtained, and two extended formulas for explicitly describing the principal length scales that respectively characterize the lateral and longitudinal deformations of the fluid interface were determined.

Identification and characterization of circRNAs in maize seedlings under deficient nitrogen

Here, deep sequencing results of the maize transcriptome in leaves and roots were compared under high-nitrogen (HN) and low-nitrogen (LN) conditions to identify differentially expressed circRNAs (DECs). Circular RNAs (circRNAs) are covalently closed non-coding RNA with widely regulatory potency that has been identified in animals and plants. However, the understanding of circRNAs involved in responsive nitrogen deficiency remains to be elucidated. A total of 24 and 22 DECs were obtained from the leaves and roots, respectively. Ten circRNAs were validated by divergent and convergent primers, and 6 DECs showed the same expression tendency validated by reverse transcriptase-quantitative PCR. Integrating the identified differentially expressed miRNAs, 34 circRNAs could act as miRNA decoys, which might play important roles in multiple biological processes, including organonitrogen compound biosynthesis and regulation of the metabolic process. A total of 51 circRNA-parent genes located in the genome-wide association study identified loci were assessed between HN and LN conditions and were associated with root growth and development. In summary, our results provide valuable information regarding further study of maize circRNAs under nitrogen deficiency and provide new insights into screening of candidate genes as well as the improvement of maize regarding nitrogen deficiency resistance. CircRNA-miRNA-mRNA co-expression networks were constructed to explore the circRNAs that participated in biological development and nitrogen metabolism.

[Epidemiological study of bone and joint injury based on urban medical insurance database]

OBJECTIVE

To estimate the prevalence rate of bone and joint injury in China and to describe the three-dimension distribution of the disease (area, time and people).

METHODS

Based on a cross-sectional design, a retrospective study was conducted by using Chinese basic medical insurance database from January 1, 2013 to December 31, 2017 to analyze the epidemiological characteristics of bone and joint injury. The prevalence rate of bone and joint injury in each city was calculated, and then using meta-analyses to estimate the pooled prevalence of each area and the whole country. The pooled prevalence rates were compared among the different groups of populations, in terms of geographical area, time and population characteristics (age and gender).

RESULTS

A total of 28 419 264 subjects were included in this study, including 705 793 patients with bone and joint injury. From 2013 to 2017, in Chinese basic medical insurance database, the overall prevalence rate of bone and joint injury was 141.5(95%CI: 90.4－203.7) per 10 000 population, and the prevalence rates of non-specific or polyarticular disease, knee disease, and shoulder disease were 101.6 (95%CI: 63.5－148.4)per 10 000 population, 22.5(95%CI:15.1－31.4)per 10 000 population and 10.9 (95%CI: 6.4－16.4)per 10 000 population. The prevalence rates varied across the areas, the highest rate was observed in North China, with the prevalence of 310.6 (95%CI: 12.6－989.7) per 10 000 population, and the lowest rate was observed in Southwest China, with the prevalence of 59.0 (95%CI: 37.5－85.2) per 10 000 population. The prevalence rate of bone and joint injury increased over the study period, from 111.1 (95%CI: 56.0－182.5)per 10 000 population in 2013 to 175.5 (95%CI: 116.8－245.5)per 10 000 population in 2017. The prevalence of bone and joint injury in the female population was 149.1 (95%CI: 94.2－215.9) per 10 000 population, which was higher than that of men [133.6(95%CI: 86.2－190.9) per 10 000 population]. The higher prevalence of knee disease, unspecified or polyarticular disease, and bone and joint injury were observed in people aged 60 years and older, while the prevalence of shoulder disease peaked in 40－59 years old people [20.6 (95%CI: 12.5－30.5) per 10 000 population].

CONCLUSION

This study reported a relative low prevalence of bone and joint injury in China from 2013 to 2017. The prevalence increased over the study period, and the highest prevalence rate was observed in North China. The prevalence rate showed differences among different groups of populations, and higher rates were observed in females and people aged 60 years and older.

Core-shell nanowires of NiCo2O4@α-Co(OH)2 on Ni foam with enhanced performances for supercapacitors

The composites of NiCo₂O₄ with unique structures are extensively explored as promising electrodes. In this work, core-shell structured nanowires anchored on nickel foam are synthesized by the hydrothermal synthesis of NiCo₂O₄ as core and subsequent electrodeposition of α-Co(OH)₂ as shell. The core-shell composites exhibit enhanced electrochemical performances ascribing to the synergistic reactions from both materials, showing higher specific capacitance than any single component. By changing the deposition time, the mass loading of α-Co(OH)₂ can be easily controlled. The electrochemical performances of the hybrid electrodes are diverse with the mass loading of Co(OH)₂. The optimized hybrid electrode with 3 mins electrodeposition exhibits the highest specific capacitance (1298 F g^-1 at 1 A g^-1) among all electrodes. The redox reaction is a main contributor to the total specific capacitance through electrochemical kinetics analysis. An asymmetric supercapacitor assembled by the optimized material as positive electrode and activated carbon as negative electrode can achieve a relatively high energy density of 39.7 Wh kg^-1 at a power density of 387.5 W kg^-1 (at 0.5 A g^-1) in a voltage of 1.55 V.

Synthesis of single-phase CuCo2-xNixS4 for high-performance supercapacitors

Developing safe, efficient and environment-friendly energy storage systems continues to inspire researchers to synthesize new electrode materials. Doping or substituting host material by some guest elements has been regarded as an effective way to improve the performance of supercapacitors. In this work, single-phase CuCo_2-xNi_xS₄ materials were synthesized by a facile two-step hydrothermal method, where Co in CuCo₂S₄ was substituted by Ni. Cobalt could be easily substituted with Ni in a rational range to keep its constant phase. But, a high content of Ni resulted in a multi-phase composite. Among a series of CuCo_2-xNi_xS₄ materials with different Ni/Co mole ratios, CuCo_1.25Ni_0.75S₄ material presented a significantly high specific capacitance (647 F g^-1 or 272 C g^-1 at 1 A g^-1) and the best cycling stability (∼98% specific capacitance retention after 10,000 charge-discharge cycles), which was mainly due to the modified composition, specific single phase, higher electroconductivity, more electroactive sites and the synergistic effect between Ni and Co. Moreover, the assembled asymmetric capacitor using CuCo_1.25Ni_0.75S₄ as a positive electrode and activated carbon as a negative electrode delivered a high energy density of 31.8 Wh kg^-1 at the power density of 412.5 W kg^-1. These results demonstrated that ternary metal sulfides of CuCo_2-xNi_xS₄ are promising electrode materials for high-performance supercapacitors.

[Comorbidities and concomitant medication use in adult patients with chronic hepatitis C: a descriptive epidemiological analysis]

Objective: To analyze the comorbidity and concomitant medications use in adult patients with chronic hepatitis C. Methods: A descriptive epidemiological methods was carried out in adult patients with chronic hepatitis C and data from 2013 to 2015 were accessed through the China Medical Insurance database. Results: Among a chronic HCV cohort of 2 958 cases, the top five comorbidities were diabetes, hypertension, ischemic heart disease, gastroduodenitis, and co-infection with HBV and HCV. The three most common concomitant medications prescribed for mentioned comorbidities were acarbose, metformin and repaglinide (Diabetes), nifedipine, amlodipine and metoprolol (Hypertension), aspirin, nifedipine and amlodipine (Ischemic heart disease), omeprazole, pantoprazole and levolfoxacin (Gastroduodenitis), ribavirin, pegylated interferon alpha-2a and alpha-2b ( Co- infected with hepatitis B and C virus). Conclusion: The five most frequent comorbidities in adult patients with chronic hepatitis C are diabetes, hypertension, ischemic heart disease, gastroduodenitis, and co-infection with HBV and HCV. A concomitant medication use in those patients with comorbidities causes potential drug-drug interactions.

[Association between statins use and liver injury based on prescription sequence symmetry analysis]

OBJECTIVE

To study the association between statins use and liver-injury through prescription sequence symmetry analysis(PSSA)and evaluate the feasibility of the method to be used in Chinese Medical Insurance Database.

METHODS

The data of the patients who prescribed both statins and liver-proactive drugs in Chinese Basic Medical Insurance Database in 2013 were selected as study subjects to calculate the adjusted sequence ratio(ASR)with signal detection methods to determine the study parameters and investigate the potential association between statins use and liver-injury.

RESULTS

In 5 649 individuals which met the inclusion criteria, the washout period was set as one month and interval period was set as 60 days. The overall ASR of statins was 1.471(95%CI: 1.395-1.550), the ASR of atorvastatin was 1.419(95% CI: 1.335-1.508), the ASR of simvastatin was 1.307(95%CI: 1.164-1.467). The positive signal was strong in 30 days interval period.

CONCLUSIONS

PSSA indicated that there might be potential association between statins use and liver-injury, especially the uses of atorvastatin and simvastatin. This signal detection method may be a fast and effective method in drug safety evaluation and can be used in Chinese Medical Insurance Database.

[Determination of trace bismuth by atomic fluorescence spectrometry in blood]

Objective: To establish a method for determination trace bismuth in blood by atomic fluorescence spectrometry (AFS) . Methods: 4.0 ml nitric acid and 1.0 ml perchloric acid was added into 1.0 ml blood sample then through automation graphite digestion instrument digested, after that 1.0 ml thiocarbamide-vitamin (10%) was injected, 8% HCl constant volume to 10.0 ml, the bismuth was detected by atomic fluorescence spectrometry with 5.0 ml digestive sample. Results: The method showed a linear relationship within the range of 0.4-50.0 μg/L (r=0.999 7) . The within-run and between-run relative standard deviations (RSD) of repetitive measurement at 10.0, 20.0, 40.0 μg/L concentration levels were 2.2%-4.9% and 3.0%-4.0%. The detection limit was 0.032 μg/L. The recoveries of bismuth were 93.0%-103.9%. Conclusion: This method is low detection limit, good accurate and high sensitivity. It has been applied for determination of trace bismuth in blood samples those who need occupation health examination or poisoning diagnosis.

Thermosetting Polyimides with Improved Impact Toughness and Excellent Thermal and Thermo-Oxidative Stability

Thermoset polyimides were prepared by thermally curing B-staged endcapped polyimide resins that were obtained by thermally baking PMR polyimide matrix resins. The polyimide matrix resins were prepared by incorporating flexible ether-bridged aromatic segments [–Ar–O–Ar–] into PMR polyimide backbone to improve their processability and impact toughness. Experimental results indicated that the B-staged polyimide resins possessed adjustable and easily controllable thermal processability which ensure that thermoset polyimides are produced with improved impact strength and high glass transition temperature compared with PMR-15. Thermal and thermo-oxidative stability as well as hygrothermal resistance of the thermoset polyimides were also systemically investigated.

Processable Polyimides with High Glass Transition Temperature and High Storage Modulus Retention at 400°C

End-capped polyimide precursor solutions in ethyl alcohol were prepared by incorporating carbonyl groups into the polymer backbone of a second-generation PMR ( in situ polymerization of monomer reactants) polyimide, PMR-II-50, which exhibited good features as a matrix resin for carbon-fibrereinforced composites. Cured polyimides were prepared in an analogous process as the PMR-II polyimides. The thermal and thermo-oxidative stability of the cured polyimides was systemically investigated. It was found that the cured polyimide containing a 1:1 mole ratio of the carbonyl group [–C(O)–] to the hexafluoroisopropyl group [–C(CF3)2–] in the polymer backbone possessed a very high glass transition temperature (440 °C) and an excellent thermal decomposition temperature (576 °C). The onset temperature of the storage modulus curve was measured at about 400 °C with high retention ( >55%) of the storage modulus at 400 °C, compared to 10–15% of the corresponding PMR-II polyimide. Carbon-fibre-reinforced composites also showed a high onset temperature of the storage modulus (420 °C) and high storage modulus retention ( >85%) at 400 °C. Preliminary results indicated that the composite laminate exhibited excellent mechanical strength retention at 371 °C, which was superior to that of CF/PMR-II composites.

Preparation and Properties of PMR-II Polyimide/Chopped Quartz Fibre Composites

High-temperature polyimide composites with low and stable dielectric properties were produced by thermally curing prepolyimide moulding compounds which were prepared by the wet impregnation of chopped short quartz fibres with a PMR-II polyimide matrix resin solution, followed by the evaporation of the solvent with vigorous stirring. The mechanical properties, thermo-oxidative stability as well as the dielectric and electric properties of the composites were studied. The experimental results showed that the composites exhibit outstanding mechanical properties and excellent thermal and thermo-oxidative stability at temperatures as high as 371 °C. It was revealed that both the dielectric constant (∼3.0) and loss tangent (∼10−3) of the composites were not obviously changed with a frequency in the broadband wavelength (1 kHz–20 GHz).

Chemotherapeutic effect of Zerumbone on melanoma cells through mitochondria-mediated pathways

BACKGROUND

Zerumbone (ZER) is a phytochemical that appears to regulate cell proliferation and apoptosis. It has been reported to have an anti-tumour effect in various malignant cells; however, the effect and the mechanism of ZER on melanoma cells needs to be clarified.

AIM

To explore whether ZER has an effect on human melanoma cells and to identify the mechanisms involved.

METHODS

We determined the chemotherapeutic action of ZER on the human malignant melanoma (MM) A375 cell line by CCK-8 immunohistochemistry, Hoechst 33342 staining and flow cytometry analysis. We also investigated the signalling pathways by which ZER induces apoptosis in A375 cells, using western blotting, reverse transcription PCR and caspase-3 activity analysis.

RESULTS

ZER induced significant cytotoxic action in A375 cells. Hoechst 33342 staining and flow cytometry apoptosis analysis further demonstrated that ZER induced apoptosis in A375 cells. Treatment with ZER downregulated Bcl-2 gene and protein levels, upregulated Bax and Cytochrome c gene and protein levels, and activated Caspase-3.

CONCLUSIONS

ZER might have a chemotherapeutic effect on human melanoma cells through mitochondria-mediated pathways.

Processable PMR Poly(Pyrrolone-Imide)s Matrix Resins and their Short Carbon Fiber-Reinforced Composites

Processable poly(pyrrolone-imide)s (PPI) were prepared via PMR process from diethyl ester of 4,4′-(hexafluoroisopropylidene)diphthalic acid (6FDE), 3,3′, 4,4′-tetraaminodiphenyl ether (TADPE), p-phenylenediamine ( p-PDA) and monoethyl ester of cis-5-norbornene- endo-2,3-dicarboxylic acid (NE) using methyl alcohol as solvent. The homogenous PPI matrix resin solutions with 32 wt.% solid content had the low absolute viscosities in the range of 80-90 mPa s at 25 °C. The matrix resin solutions were stable for a period of > 2 months at the refrigerator temperature (4 °C) and showed good adhesion on carbon fibers. The matrix resin solutions could be thermally converted to B-stage end-capped prepolymer, which was then thermally processed to yield the fully-cured PPI. Experimental results demonstrated that the fully-cured PPI exhibited good thermal stability with glass transition temperatures of >400 °C and the thermal decomposition temperature of 525-537 °C. The onset temperatures of the DMA storage modulus curve for PPI-20 was as high as 395 °C and the storage modulus retention was 71% at 370 °C. The short carbon fiber-reinforced PPI composites (CF/PPI) were also fabricated. The CF/PPI composites showed excellent thermal stabilities and good mechanical properties, with glass transition temperature in the range of 413-421 °C and the storage modulus retention of 76-87% at 370 °C.

[Determination of trace gallium by graphite furnace atomic absorption spectrometry in urine]

OBJECTIVE

To establish a method for determination trace gallium in urine by graphite furnace atomic absorption spectrometry (GFAAS).

METHODS

The ammonium dihydrogen phosphate was matrix modifier. The temperature effect about pyrolysis (Tpyr) and atomization temperature were optimized for determination of trace gallium. The method of technical standard about within-run, between-run and recoveries of standard were optimized.

RESULTS

The method showed a linear relationship within the range of 0.20~80.00 μg/L (r=0.998). The within-run and between-run relative standard deviations (RSD) of repetitive measurement at 5.0, 10.0, 20.0 μg/L concentration levels were 2.1%~5.5% and 2.3%~3.0%. The detection limit was 0.06 μg/L. The recoveries of gallium were 98.2%~101.1%.

CONCLUSION

This method is simple, low detection limit, accurate, reliable and reproducible. It has been applied for determination of trace gallium in urine samples those who need occupation health examination or poisoning diagnosis.

Genomic full-length sequence of two HLA-A*11 alleles, identified by cloning and sequencing

Genomic full length sequences of HLA-A*11:01:01 and A*11:02:01 were identified by cloning and sequencing from two different Chinese donors.

Full-length coding sequences of two MICA alleles, MICA*002:01 and MICA*012:01, identified by sequence-based typing in Chinese individuals

Full-length coding sequences of MICA*002:01 and MICA*012:01, were identified by sequence-based typing in Chinese individuals.

Modification of cyclosporin A and conjugation of its derivative to HPMA copolymers

Cyclosporin A (CsA) was epoxidized with m-chloroperoxybenzoic acid in the presence of sodium carbonate or with tert-butyl hydroperoxide in the presence of dioxomolybdenum iminodiethanoxide. The CsA epoxide was not stable and rearranged into a compound with a more stable five-member ring structure. An amino group containing cyclosporin A derivative (CsA amine) was obtained by the reaction of CsA epoxide with excess ethylenediamine. The yield of the CsA amine was 30--40% based on the CsA. An HPMA copolymer--CsA conjugate was prepared by the reaction of the CsA amine with an HPMA and MA-Gly-Phe-Leu-Gly-ONp copolymer. The content of CsA amine in the conjugate was 8.7 wt %. The CsA amine was released from the copolymer by enzymatic hydrolysis with papain.

Synthesis of bioadhesive lectin-HPMA copolymer-cyclosporin conjugates

An amino group containing cyclosporin A (CsA) derivative has been synthesized and conjugated to N-(2-hydroxypropyl)methacrylamide (HPMA) copolymer via an aromatic azo bond, which can be specifically cleaved by azoreductase activity in colon to release the drug for the treatment of colon diseases. Lectins, peanut (Arachis hypogea) agglutinin (PNA) and wheat germ agglutinin (WGA), have been conjugated to HPMA copolymer-CsA derivative conjugates (PCsA), respectively, to give bioadhesive conjugates. The PNA and WGA are the targeting proteins that can bind to diseased colon tissue and healthy tissue, respectively. There were on average four P(CsA) copolymer chains attached on one WGA molecule with a drug content of 16.0 wt % and five P(CsA) copolymer chains attached on one PNA molecule with a drug content of 11.5 wt %. The incubation of a P(CsA) copolymer with the rat cecal contents resulted in the cleavage of the azo bond and release of the cyclosporin derivative. The biological evaluation of the conjugates is under way.

A novel bullous pemphigoid antigen (BP125) located in the deeper layers of the basement membrane zone

BACKGROUND AND DESIGN

Bullous pemphigoid (BP) is associated with autoantibodies to 230-kd and 160- to 180-kd hemidesmosomal antigens located in the most superficial layers of the basement membrane zone (BMZ). In this study, conducted to characterize BMZ antigens in different extracts of the skin, we unexpectedly found that some patients with BP also have antibodies to a 125-kd antigen present in the deep layers of the BMZ.

RESULTS

By Western immunoblot analysis, antibodies that reacted strongly to a 125-kd antigen (BP125) in 4% sodium dodecyl sulfate plus 2 mol/L of urea extract of the dermal side of 1 mol/L of sodium chloride-split human skin were present in the serum samples of eight (21%) of 38 patients with BP, but in none of 55 control individuals (17 BMZ antibody-positive patients without BP and 38 BMZ antibody-negative patients). Immunofluorescence studies with affinity-purified antibody localized BP125 to the BMZ on the dermal side of the salt-split skin. BP125 was not detected in the epidermal portion of the salt-split skin, either by Western blot analysis of epidermal extracts or by indirect immunofluorescence with affinity-purified antibody, indicating it is not an epidermal antigen that contaminates the dermis during the salt-splitting procedure, and which argues against it being a breakdown product of the 230-kd or 160- to 180-kd BP antigens.

CONCLUSIONS

These results indicate that autoantibodies in BP can be directed to different antigens present in different strata within the BMZ and suggest that different immune mechanisms may be involved in the pathogenesis of this disease.

Identification of a novel basement membrane antigen (p84) defined by sera with antibodies to both the epidermal and dermal side of split skin

The diagnosis of autoimmune blistering skin disease is increasingly based on the skin antigen(s) that is the target of the autoimmune process. Some patients with bullous diseases have unusual basement membrane autoantibodies that react to antigens present in both the epidermal and dermal sides of skin split with 1 M NaCl. This combined staining pattern is due to antibodies directed in part to a 160-kilodalton (kD) basement membrane antigen present on the epidermal side of the split skin and to different antigen(s) present on the dermal side. The identity of the current antigen(s), and the significance of this unusual type of combined staining antibody response is not known. Sera of five patients with combined staining antibodies, 19 patients with other types of basement membrane antibodies (15 directed only to the epidermal and four only to the dermal side of split skin), and 23 patients without basement membrane antibodies were tested by Western immunoblot for reactivity to 4% sodium dodecyl sulfate+2 M urea extracts of dermal and epidermal side of salt-split skin. Three (60%) of the combined staining sera had antibodies to an 82-84-kD antigen (p84) reproducibly present in dermal, but not epidermal, extracts of normal human skin. Antibodies to this antigen were absent in the 42 control sera. Western blot affinity-purified antibody to p84 bound only to the basement membrane, on the dermal side of 1 molar salt-split skin. By co-migration experiments, p84 differed from other basement membrane antigens including the major and minor bullous pemphigoid, cicatrizing pemphigoid, and epidermolysis bullosa acquisita antigens, types III and IV collagen, laminin, and epiligrin. Thus, combined staining antibodies are directed in part to an 82-84-kD antigen (p84), a normal but previously underscribed component of the basement membrane of human skin. This antigen differs from the basement membrane antigens recognized by autoantibodies in other subepidermal bullous diseases. The antibody response to p84 provides a specific marker for a novel autoimmune subepidermal blistering skin disease.

A paraneoplastic mixed bullous skin disease associated with anti-skin antibodies and a B-cell lymphoma

BACKGROUND

The full spectrum of bullous diseases associated with underlying cancers remains to be fully defined.

OBSERVATION

We describe a patient with a mixed bullous disease exhibiting combined features of cicatricial pemphigoid and pemphigus and associated with a B-cell lymphoma producing an IgM paraprotein to intercellular antigens in human skin. The patient had the clinical features of cicatricial pemphigoid and the histologic and immunofluorescence abnormalities of both cicatricial pemphigoid and pemphigus. These included oral and cutaneous erosions; ocular scarring; subbasal and acantholytic intraepidermal bullae; and circulating and tissue-fixed basement membrane zone and intercellular antibodies. The antibodies were directed to a 140-kd antigen in dermal extracts of skin split with 1 mol/L of sodium chloride and to antigens with approximate molecular weights of 150, 180, 230, and 285 kd in the dermal extract. In contrast to paraneoplastic pemphigus, the intercellular antibodies did not react to mammalian bladder. The intercellular antibodies were of the IgM class and were associated with the paraprotein produced by the malignant B cells.

CONCLUSIONS

We believe that this condition represents a novel bullous disease, which we refer to as paraneoplastic mixed bullous disease. This condition illustrates that distinct bullous diseases are associated with paraneoplastic syndromes and that at least one possible mechanism for such eruptions is the production of anti-skin antibodies by malignant B cells.