BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor an...BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor and lenvatinib is safe and effective.However,we report a case of toxic epidermal necrolysis(TEN),a grade 4 toxicity,after this combination therapy.CASE SUMMARY A 39-year-old male presented with erythema,blisters and erosions on the face,neck,trunk and limbs 1 wk after receiving combination therapy with lenvatinib and toripalimab,a PD-1 inhibitor.The skin injury covered more than 70%of the body surface area.He was previously diagnosed with liver cancer with cervical vertebra metastasis.Histologically,prominent necrotic keratinocytes,hyperkeratosis,liquefaction of basal cells and acantholytic bullae were observed in the epidermis.Blood vessels in the dermis were infiltrated by lymphocytes and eosinophils.Direct immunofluorescence staining was negative.Thus,the diagnosis was confirmed to be TEN(associated with combination therapy with toripalimab and lenvatinib).Full-dose and long-term corticosteroids,high-dose intravenous immunoglobulin and targeted antibiotic drugs were administered.The rashes gradually faded;however,as expected,the tumor progressed.Therefore, sorafenib and regorafenib were given in succession, and the patient was still alive at the10-mo follow-up.CONCLUSIONCautious attention should be given to rashes that develop after combination therapy with PD-1inhibitors and lenvatinib. Large-dose and long-course glucocorticoids may be crucial for thetreatment of TEN associated with this combination treatment.展开更多
An induction levitation melting （ILM） refining process is performed to remove most microsized inclusions in ultra-low carbon steel （UCS）. Nanosized, spheroid shaped sulfide precipitates remain dispersed in the UCS...An induction levitation melting （ILM） refining process is performed to remove most microsized inclusions in ultra-low carbon steel （UCS）. Nanosized, spheroid shaped sulfide precipitates remain dispersed in the UCS. During the ILM process, the UCS is molten and is rotated under an upward magnetic field. With the addition of Ti additives, the spinning molten steel under the upward magnetic field ejects particles because of resultant centrifugal, floating, and magnetic forces. Magnetic force plays a key role in removing sub-micrometer-sized particles, composed of porous aluminum titanate enwrapping alumina nuclei. Consequently, sulfide precipitates with sizes less than 50 nan remain dispersed in the steel matrix. These findings open a path to the fabrication of clean steel or steel bearing only a nanosized strengthen- ing phase.展开更多
基金Supported by Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases,No. 2018B030322012
文摘BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor and lenvatinib is safe and effective.However,we report a case of toxic epidermal necrolysis(TEN),a grade 4 toxicity,after this combination therapy.CASE SUMMARY A 39-year-old male presented with erythema,blisters and erosions on the face,neck,trunk and limbs 1 wk after receiving combination therapy with lenvatinib and toripalimab,a PD-1 inhibitor.The skin injury covered more than 70%of the body surface area.He was previously diagnosed with liver cancer with cervical vertebra metastasis.Histologically,prominent necrotic keratinocytes,hyperkeratosis,liquefaction of basal cells and acantholytic bullae were observed in the epidermis.Blood vessels in the dermis were infiltrated by lymphocytes and eosinophils.Direct immunofluorescence staining was negative.Thus,the diagnosis was confirmed to be TEN(associated with combination therapy with toripalimab and lenvatinib).Full-dose and long-term corticosteroids,high-dose intravenous immunoglobulin and targeted antibiotic drugs were administered.The rashes gradually faded;however,as expected,the tumor progressed.Therefore, sorafenib and regorafenib were given in succession, and the patient was still alive at the10-mo follow-up.CONCLUSIONCautious attention should be given to rashes that develop after combination therapy with PD-1inhibitors and lenvatinib. Large-dose and long-course glucocorticoids may be crucial for thetreatment of TEN associated with this combination treatment.
基金supported partly by the National Natural Science Foundation of China (No. 51472170)the Major State Basic Research Development Program of China (No. 2011CB932700)
文摘An induction levitation melting （ILM） refining process is performed to remove most microsized inclusions in ultra-low carbon steel （UCS）. Nanosized, spheroid shaped sulfide precipitates remain dispersed in the UCS. During the ILM process, the UCS is molten and is rotated under an upward magnetic field. With the addition of Ti additives, the spinning molten steel under the upward magnetic field ejects particles because of resultant centrifugal, floating, and magnetic forces. Magnetic force plays a key role in removing sub-micrometer-sized particles, composed of porous aluminum titanate enwrapping alumina nuclei. Consequently, sulfide precipitates with sizes less than 50 nan remain dispersed in the steel matrix. These findings open a path to the fabrication of clean steel or steel bearing only a nanosized strengthen- ing phase.
