CHARGE syndrome: a review of the immunological aspects

CHARGE syndrome is caused by a dominant variant in the CHD7 gene. Multiple organ systems can be affected because of haploinsufficiency of CHD7 during embryonic development. CHARGE syndrome shares many clinical features with the 22q11.2 deletion syndrome. Immunological abnormalities have been described, but are generally given little attention in studies on CHARGE syndrome. However, structured information on immunological abnormalities in CHARGE patients is necessary to develop optimal guidelines for diagnosis, treatment and follow-up in these patients. Here, we provide an overview of the current literature on immunological abnormalities in CHARGE syndrome. We also explore immunological abnormalities in comparable multiple congenital anomaly syndromes to identify common immunological phenotypes and genetic pathways that might regulate the immune system. Finally, we aim to identify gaps in our knowledge on the immunological aspects in CHARGE syndrome that need further study.     

高效液相色谱法同时测定红药胶囊中6种有效成分含量

目的:建立高效液相色谱测定红药胶囊中6种成分三七皂苷R1、人参皂苷Rg1、人参皂苷Rb1、欧前胡素、异欧前胡素和羟基红花黄色素A的含量。方法:采用Waster XTerra C18色谱柱(250×4.6 mm,5μm),流动相为乙腈-0.1%磷酸水溶液,流速1.0 m L/min,检测波长为203 nm、300 nm和403 nm,柱温30℃。结果:三七皂苷R1、人参皂苷Rg1、人参皂苷Rb1、欧前胡素、异欧前胡素和羟基红花黄色素A的进样量分别在0.310~5.425μg(0.9997),0.404~7.070μg(0.9998),0.420~7.350μg(0.9997),0.008~0.140μg(0.9996),0.002~0.034μg(0.9996),0.012~0.217μg(0.9997)范围内与峰面积线性关系良好,平均加样回收率(n=6)分别为98.23%、99.15%、100.32%、99.91%,98.67%,99.27%。结论:含量测定方法可作为红药胶囊的质量控制的有效方法。     

Laparoscopic Cardiomyotomy for Achalasia: A Single Unit study

Aims

Achalasia is a rare incurable neuromuscular disorder of the oesophagus. A number of treatment options are available. We reviewed our results of laparoscopic cardiomyotomy over a 30 month period.

Methods

18 patients with manometric features of achalasia underwent surgery between 2004 and 2006. Pre and postoperative weight and dysphagia scores were recorded (maximum score 45=normal, 0=complete dysphagia). Change in the Body Mass Index (BMI) was measured. Other symptoms (heartburn, epigastric pain, regurgitation, odynophagia and sleep disturbance) were scored on a 0–4 scale of increasing severity.

Results

At mean follow up of 16.2 months the mean dysphagia score was significantly improved from 7.5 to 33.9 (p<0.005). BMI was significantly increased from 22.3 to 25.8 kg/m² (p<0.05). Scores for heartburn, epigastric pain, regurgitation, odynophagia and sleep disturbance were also significantly improved. The average inpatient stay was 3.1 days and average operating time 111 minutes. One mucosal perforation occurred which was repaired intraoperatively. No patients required secondary operative intervention.

Conclusions

Laparoscopic cardiomyotomy is a safe, highly effective, minimally invasive treatment for achalasia.     

人血清脱金属铁传递蛋白裂解焦磷酸键的研究

目的:测定人血清脱金属铁传递蛋白裂解焦磷酸键的反应速率常数.方法:应用31P NMR技术,在不同pH值及不同浓度MgCl2存在条件下,测定了脱金属铁传递蛋白与焦磷酸二钠反应的核磁共振图谱,根据焦磷酸盐的摩尔浓度(对应于其谱峰强度)随时间的变化情况,应用动力学公式对数据进行拟合.结果:当人血清脱金属铁传递蛋白(0.5～1.0 mmol/L)与焦磷酸盐的反应摩尔浓度比为15时,在312 K条件下,反应速率常数分别为:8.83×10-4 L·mmol-1·h-1(pH 6.85)、9.59×10-4 L·mmol-1·h-1(pH 7.40)和1.38×10-3 L·mmol-1·h-1(pH 8.15).在2 mmol/L MgCl2存在时,pH 7.40、312 K条件下,反应速率常数为1.21×10-3L·mmol-1·h-1.结论:人血清脱金属铁传递蛋白能缓慢地将焦磷酸根裂解为磷酸根,反应具有二级反应动力学性质,Mg2 对该裂解反应有弱催化作用.     

Phase I trial of recombinant human macrophage colony-stimulating factor in patients with invasive fungal infections

A phase I dose escalation trial of recombinant human macrophage colony- stimulating factor (rhM-CSF) in combination with conventional antifungal therapy was conducted in 24 marrow transplant recipients with invasive fungal infection. Daily doses ranged from 100 to 2,000 micrograms/m2/d. Toxicity, such as constitutional symptoms, directly ascribed to rhM-CSF was not observed; however, transient, dose-related thrombocytopenia was observed. Patients who received 2,000 micrograms/m2/d of rhM-CSF had a mean reduction in platelet count of 61,000/mm3 during the rhM-CSF infusion period, which was significant when compared with patients who received lower doses of rhM-CSF (P = .008). Fourteen of the 16 patients who received rhM-CSF after undergoing allogeneic bone marrow transplantation had no change in the severity of graft-versus-host disease (GVHD) while receiving rhM-CSF. One had an increase in the severity of GVHD and one had a decrease. There were no effects on neutrophil, monocyte, or lymphocyte counts. Six patients had resolution of their infections, 12 were not evaluable for response, and six did not respond. Ten patients survived 100 days after initiation of rhM-CSF and 14 died. Further trials with rhM-CSF to assess antifungal activity are indicated.     

B-cell reconstitution after autologous bone marrow transplantation: increase in serum CD23 ("IgE-binding factor") precedes IgE and B-cell regeneration

The serum levels of IgE and the soluble cleavage product of CD23 (sCD23) were prospectively monitored for up to 1 year after transplantation in 34 patients who underwent autologous (n = 33) or syngeneic (n = 1) bone marrow transplantation (BMT). In 25 patients (74%), a transient IgE peak (two- to 2,750-fold increase) appeared in the serum 3 to 4 weeks after BMT. In 18 patients (51%), a two- to 125- fold increase in sCD23 coincided with the IgE peak. In only three patients was a sCD23 peak observed without a concomitant increase in IgE. The sCD23 increment preceded the IgE peak in each individual case. During the period of increased sCD23 serum levels, the absolute numbers of circulating B cells and other cell types expressing surface CD23 were extremely low. The biologic significance of these findings is discussed in light of present knowledge of regulation of B-cell growth and differentiation with special reference to the role of sCD23 as a multifunctional cytokine.     

Expression of the alloantigen Zwa (or P1A1) on human vascular smooth muscle cells and foreskin fibroblasts: a study on normal individuals and a patient with Glanzmann's thrombasthenia

The cytoadhesin family consists of platelet glycoprotein (GP) IIb-IIIa and the endothelial vitronectin receptor. The beta subunit (GP IIIa) of these complexes expresses the alloantigen Zwa (or PIA1). This alloantigen is not expressed by members of other integrin subfamilies. By using immunoprecipitation and immunoblot techniques, we found that the beta subunit of a heterodimer, expressed by cultured human arterial smooth muscle cells and cultured foreskin fibroblasts, carries the Zwa antigenic determinant. Furthermore, the mobilities of the alpha and beta subunits of these two heterodimers are indistinguishable from those of the alpha and beta subunits of the endothelial vitronectin receptor. Therefore, we propose that the smooth muscle cell and fibroblast heterodimer are members of the cytoadhesin family. In Glanzmann's thrombasthenia, platelet GP IIb-IIIa is absent or severely reduced. Previously, we showed that endothelial cells from a thrombasthenic patient normally synthesize and express a GP IIb-IIIa- related molecule (the vitronectin receptor). Here we show that arterial smooth muscle cells, obtained from the same patient, express a surface molecule indistinguishable from the endothelial vitronectin receptor. We also demonstrate that both the endothelial and the smooth muscle cell GP IIIa-related molecule in this Glanzmann patient express Zwa. Our data indicate that (a) GP IIb-IIIa-related molecules on cell types other than platelets and endothelial cells can express Zwa in vitro, and (b) patients with Glanzmann's disease can express the Zwa antigen. This study substantiates our view that the defect in Glanzmann's disease is restricted to the megakaryocytes/platelets.