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Vitiligo is a common, psychologically devastating pigmentary disorder. Surgical graftings are used to treat stable vitiligo when medical treatment fails. An automated epidermal micrograft harvesting (AEMH) system was first designated to treat wounds, and very few studies investigated the application of AEMH in vitiligo. In this study, we investigated the efficacy and safety of the AEMH system in patients with stable segmental and nonsegmental vitiligo. The rate of repigmentation and adverse events was recorded bimonthly for at least 12 months. We analyzed the efficacy based on patient characteristics, vitiligo subtypes, and different anatomical locations. A total of 56 depigmented lesions from 34 patients were included. 95.50% of the automated epidermal micrografts were successfully grafted at the recipient sites. There was a significant improvement in Vitiligo Area Scoring Index (VASI) and Dermatologic Life Quality Index (DLQI) in patients treated with AEMH (p < 0.001). The rate of repigmentation by VASI score improves from 96.25 ± 8.59 to 48.30 ± 28.16 after the treatment (p < 0.001). Treatment outcomes were comparable between the patients of segmental and stable nonsegmental vitiligo. The face and neck region achieved a better outcome, followed by the trunk (chest, abdomen, back, and axilla), limbs, and the worse outcome was found in the acral region (p < 0.014). Conclusively, AEMH is an effective treatment procedure with limited adverse events in patients with stable vitiligo. This harvesting method may be a feasible option for vitiligo surgical treatment.

A man in his 60s presented with painful erythematous plaques and vesicles on the right side of his nose and palate that had appeared three days earlier. Before he noticed the skin lesions, he had a stinging and itchy sensation for two days on the external aspect of his nose. Cutaneous examination showed scattered erythematous plaques and crusted blisters on the right side of his nose, midface (fig 1a), upper eyelid, and forehead (fig 1b), extending to the anterior scalp. Intraoral inspection showed multiple ulcerations overlying whitish slough on the right side of the hard palate, gingiva, and oral mucosa (fig 1c). Fig 1 Cutaneous and mucosal lesions Nasopharyngoscopy to evaluate the intranasal lesions showed a pre-existing perforation of the nasal septum. Lesions were present …

Background Patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) have high mortality rates. Disseminated intravascular coagulation has been reported in SJS/TEN patients. The influence of this lethal complication in patients with SJS/TEN is not well known. Objective This study aimed to investigate the risk and outcomes of disseminated intravascular coagulation in patients with SJS/TEN. Methods We analyzed the disseminated intravascular coagulation profiles of patients receiving a diagnosis of SJS/TEN between 2010 and 2019. Results We analyzed 150 patients with SJS/TEN (75 with SJS, 22 with overlapping SJS/TEN, and 53 with TEN) and their complete disseminated intravascular coagulation profiles. Disseminated intravascular coagulation was diagnosed in 32 patients (21.3%), primarily those with TEN. It was significantly associated with systemic complications, including gastrointestinal bleeding, respiratory failure, renal failure, liver failure, infection, and bacteremia. Additionally, SJS/TEN patients with disseminated intravascular coagulation had elevated procalcitonin levels. Among patients with SJS/TEN, disseminated intravascular coagulation was associated with a greater than 10-fold increase in mortality (78.1% vs 7%). Limitations The study limitations include small sample size and a single hospital system. Conclusion Disseminated intravascular coagulation is a potential complication of SJS/TEN and associated with higher mortality. Early recognition and appropriate management of this critical complication are important for patients with SJS/TEN.

Background Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations. Periorbital involvement, however, is a relatively rare clinical presentation of CLE. Objectives This clinical study aimed to investigate the characteristics of this unique presentation of CLE in tertiary medical centers. Methods We enrolled patients with periorbital erythema and swelling as the presenting sign of lupus erythematosus, from January 2003 to November 2017, using the data of 553 pathologically proven CLE cases from the registration database of the Chang Gung Memorial Hospitals in Taiwan. Results We enrolled a total of 25 patients. The mean age was 46.7 years and 68% of the patients were female. Most of the patients (84.0%) presented with unilateral involvement, with the left orbit involved in 15 patients (60%); the upper eyelid was the most frequently involved (72%). Mean duration between the onset of clinical manifestations and the diagnosis of CLE was approximately 59 weeks. Nineteen patients had been previously misdiagnosed. All patients had features compatible with CLE on histopathological examination. In contrast, laboratory analysis of the autoimmune profile often revealed negative results, including those for antinuclear antibodies (25%). Notably, anti-SSA/SSB (45.5%) showed the highest positive rate. During follow-up, six patients developed systemic lupus erythematosus (SLE) and two patients developed Sjögren syndrome. Conclusions The diagnosis of CLE presenting as periorbital erythema and swelling is often delayed because of clinical mimicry and the high proportion of negative results on autoantibody tests. Increased clinical suspicion and prompt histopathological examination are crucial for early diagnosis. Moreover, one-fourth of the patients ultimately developed SLE, which highlights the importance of clinical awareness.

Immune checkpoint receptors with co-stimulatory and co-inhibitory signals are important modulators for the immune system. However, unrestricted co-stimulation and/or inadequate co-inhibition may cause breakdown of self-tolerance, leading to autoimmunity. Systemic lupus erythematosus (SLE) is a complex multi-organ disease with skewed and dysregulated immune responses interacting with genetics and the environment. The close connections between co-signaling pathways and SLE have gradually been established in past research. Also, the recent success of immune checkpoint blockade in cancer therapy illustrates the importance of the co-inhibitory receptors in cancer immunotherapy. Moreover, immune checkpoint blockade could result in substantial immune-related adverse events that mimic autoimmune diseases, including lupus. Together, immune checkpoint regulators represent viable immunotherapeutic targets for the treatment of both autoimmunity and cancer. Therefore, it appears reasonable to treat SLE by restoring the out-of-order co-signaling axis or by manipulating collateral pathways to control the pathogenic immune responses. Here, we review the current state of knowledge regarding the relationships between SLE and the co-signaling pathways of T cells, B cells, dendritic cells, and neutrophils, and highlight their potential clinical implications. Current clinical trials targeting the specific co-signaling axes involved in SLE help to advance such knowledge, but further in-depth exploration is still warranted.

A 47-year-old man presented with multiple tender, erythematous-to-violaceous macules and pustules on his palms and lower legs (Fig [1][1]). Spike fever, malaise and arthralgia in wrists and right ankle were noted for 3 days. There was no history of urogenital symptoms. Laboratory surveillance showed

Aim: Acute appendicitis is the most common disease in pregnant women. Based on the premise of the protection of fetus, diagnosis sometimes would be difficult. The purpose of this study is to evaluate the risk and benefit of magnetic resonance imaging for suspected acute appendicitis in Pregnancy. Method: From Oct 2015 to Apr 2017, 10 pregnant women came to our emergency department because of suspected acute appendicitis. We bring MRI to participate the diagnosis in case ultrasound is insufficient to make accurate detection. Result: 5 cases with nonvisualization of appendicitis and 5 cases were confirmed acute appendicitis. Ultrasound of these women couldn't clearly show the abnormal anatomy. But with non-radiation MRI acute appendicitis with presence of appendicoliths were identified. Conclusion: The use of MRI in pregnant women with suspected acute appendicitis is meaningful, not only in confirmation or exclusion of appendicitis but also alternative non-radiation diagnosis tool for further treatment.

A Blu-ray Disc (BD) player, back-end SoC supporting multiple protection, video and display formats is fabricated in a 90nm 1P7M CMOS process with a core area of 62.95mm2. This SoC adopts a general copy protection (GCP) unit to integrate various kinds of protection algorithms (e.g. AES, CSS, CPPM/CPRM, DES, SHA-1/MD5), designs a dedicated memory management unit (MMU) for realizing multiple video standards (e.g. MPEG-1/2/4, H.264, VC-1), and exploits a reduced display path so as to provide two display outputs simultaneously. Moreover, a 3.7Gb/s/ch HDMI TX circuit is proposed to support different color depths and display resolutions. For BD player applications, AACS decryption, 60fps H.264 decode, 1080pHD with 480pSD picture overlay (PIP), and HDMI-1.3 12b deep color-mode output is achieved at 200MHz, 200MHz, 148.5MHz and 222.5MHz clock frequency, respectively. It dissipates about 1.605W at 1.0V core and 1.2/3.3V HDMI macro. The chip features are summarized in Fig. 8.4.1.

A fully-compliant high-definition video decoder LSI for Blu-ray Disc (BD) player is presented. It supports MPEC-2 MP@HL, H.264 HP@L4.1, and VC-1 AP@L3 video decoding in a single chip and features resource sharing and memory management unit to achieve area/throughput efficiency. A test chip is fabricated and integrates 515 K logic gates with 522 Kbits of embedded SRAM in 90nm single-poly seven-metal CMOS process with area of 5.06 mm2. For Blu-ray player requirements, video decoding of full 1920times1080 high-definition sequences at 60 frames per second requires 125 Mpixels/sec of processing throughput which is two times higher than comparable designs [5][6] and is achieved at 200 MHz clock frequency with power dissipation of 317 mW at 1.0 V supply voltage.