Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East

ObjectiveThe purpose of this paper is to review the efficacy and safety profile in children treated with topical 0.03% Tacrolimus ointment for vernal keratoconjunctivitis in Middle East and to propose a treatment posology. According to recent studies, a complex non-IgE dependent mechanism plays a relevant role in the pathogenesis of vernal keratoconjunctivitis. Numerous cells and mediators have been found in the serum, conjunctiva and tears of patients with Vernal keratoconjunctivitis.DesignThis case series included 10 patients from a single centre, pediatric department of a tertiary hospital with active symptomatic vernal keratoconjunctivitis. All the patients had proliferative lesions and corneal involvement despite conventional medications, including topical steroids. All other medications, systemic and topical: steroids, antihistamines and cyclosporine, were unsuccessful. Patients were treated with topical 0.03% Tacrolimus ointment twice daily for 8 weeks and then once a day for the next two month followed by thrice a week for two months. The changes in symptoms and signs after treatment were evaluated, also the development of possible complications was assessed.ResultsThe results showed a significant reduction in signs and symptoms after 4 weeks of the treatment. Clinical resolution of giant papillae and corneal lesions were seen within eight weeks and no additional drug was required during that period, except tear substitutes. Treatment was continued for period of two months and then slowly reduced.ConclusionThe use of 0.03% Tacrolimus ointment is safe and effective in children refractory to conventional treatment of vernal keratoconjunctivitis even in high temperature climate as Middle East. Due to the effectiveness of the treatment, the dosage used may be proposed for conventional use.     

Role and value of laparoscopic training devices in assessing nondominant and two-handed dexterity

Background and objectives: To determine improvement in hand dexterity with targeted laparoscopic skill exercises desirable for use in the operating rooms among in-training laparoscopic gynaecological surgeons and medical students. Design: Cross-sectional study with paired analysis. Setting: Kiel School of Gynaecological Endoscopy and Reproductive Medicine, Germany, between February and April 2005. Subjects: Twenty third-year medical students and 20 in-training gynaecological endoscopic surgeons from various parts of the world. Interventions: Demonstration and explanation of a set of five laparoscopic skill exercises desirable for use in the operating rooms before administering a pretest. This was followed by voluntary practice of these exercises for at least 10 times over 1 day. The posttest was performed the next day once the participant was comfortable performing the skill. Pre- and posttest assessments were conducted by independent supervisors. Main outcome measures: Time to completion of tasks with minimal errors. Results: There was significant reduction in mean time for all the laparoscopic skill exercises performed with dominant, nondominant, and both hands, before and after the training and practice (p-value <0.01; paired t-test). Moderate to high correlation (0.617–0.901) was seen with the intermediate and complex/difficult tasks, whereas low correlation was seen with the simple/easy task (0.200–0.336). Medical students and gynaecologists both showed improvement in performance from pretest to posttest in terms of reduction in mean time taken to perform all the tasks with minimal errors. Conclusions: Simple laparoscopic training devices can substantially help an individual hand’s improvement and acquisition of laparoscopic skills. Simple laparoscopic training devices along with animal models will continue to provide an efficient and effective environment for learning and teaching laparoscopic surgical skills. With this training, performance improves progressively with practice.     

Fabricating fixed partial dentures using existing restorations

A technique has been described for utilizing an existing fixed splint in the fabrication of a fixed partial denture to replace splinted teeth that are extracted.     

急性坏死性胰腺炎大鼠胰腺高迁移率族蛋白-1的表达及意义

目的探讨急性坏死性胰腺炎(ANP)大鼠模型胰腺组织高迁移率族蛋白-1(HMGB1)的表达及其意义。方法72只大鼠随机分成3组,即对照组、ANP组和正丁酸钠治疗组(治疗组)。逆行性胰胆管注射5%牛磺胆酸钠建立ANP模型。ELISA法检测血清TNF-α和IL-1β水平;RT-PCR法检测胰腺组织HMGB1 mRNA的表达,并观察其病理变化。结果ANP组血清TNF-α和IL-1β水平在ANP建模后6h达高峰,12h下降。ANP组大鼠胰腺组织HMGB1 mRNA表达水平在ANP后12h明显升高,至24h仍维持在较高水平。治疗组胰腺组织HMGB1 mRNA表达水平在ANP后12,24h明显低于ANP组(P<0.05),且同期胰腺损伤比ANP组轻(P<0.05)。建模后24h血清TNF-α和IL-1β水平ANP组与治疗组间差异无显著性。结论HMGB1作为晚期炎症因子参与了ANP的全身炎症反应。HMGB1抑制剂正丁酸钠能降低ANP大鼠胰腺组织HMGB1基因表达水平,减轻ANP胰腺组织的损伤。     

An improved method for the isolation of the major protein of the gonococcal outer membrane in an antigenically reactive form

The major outer membrane protein (protein I) has been isolated from Neisseria gonorrhoeae strain P9 in an immunologically reactive form. Membranes were sequentially extracted with the detergents sodium cholate and Empigen BB. Protein I was enriched in the Empigen-soluble fraction and was separated from other proteins and lipopolysaccharide by gel filtration chromatography on Sephadex G-200. The purified protein retained its antigenic activity with antiserum raised against the unfractionated outer membrane complex.     

The morphogenesis of testicular degeneration induced in rats by orally administered 2,5-hexanedione

The neurotoxic hexacarbon 2,5-hexanedione (2,5-HD) produces testicular atrophy in experimental animals. To examine the morphogenesis of the testicular lesion, 1.0% 2,5-HD was provided in the drinking water of adult F-344 rats for up to 6 weeks. After 3 weeks of administration, there were occasional large vacuoles in the basal region of the germinal epithelium. At 4 weeks, these vacuoles were much larger and more numerous; electron microscopy demonstrated that they were derived from the smooth endoplasmic reticulum. The vacuoles were preferentially associated with stages 12, 13, 14, and 1 of the spermatogenic cycle. Additionally, at 4 weeks there was a significant decrease in the number of tubules in stages 7 and 13, and a concomitant increase in the percentage of tubules in stages 3, 5, and 6. By Week 5, most Golgi-phase and cap-phase spermatids were visibly affected, showing margination of nuclear chromatin, and were becoming dissociated from Sertoli cells. Frequent multinucleated giant cells were seen and electron microscopy of these cells suggested that they were derived from fused spermatocytes or spermatids. After 6 weeks, fewer giant cells were present, most tubules contained cellular debris, and many showed empty lumina encircled by a thin ring of cytoplasm near the basement membrane. Interstitial tissue appeared unaffected. These studies indicate that the Sertoli cell is probably an initial target for 2,5-HD action in the testis.