Induction of natural IgE by glucocorticoids

IgE mediates allergic responses by coating mast cell or basophil surfaces and inducing degranulation upon binding a specific allergen. IgE can also be spontaneously produced in the absence of foreign allergens; yet the origin, regulation, and functions of such “natural” IgE still remain largely unknown. Here, we find that glucocorticoids enhance the production of IgE in B cells both in vivo and ex vivo without antigenic challenge. Such IgE production is promoted by B cell–intrinsic glucocorticoid receptor signaling that reinforces CD40 signaling and synergizes with the IL-4/STAT6 pathway. In addition, we found that rare B cells in the mesenteric lymph nodes are responsible for the production of glucocorticoid-inducible IgE. Furthermore, locally produced glucocorticoids in the gut may induce natural IgE during perturbations of gut homeostasis, such as dysbiosis. Notably, mice preemptively treated with glucocorticoids were protected from subsequent pathogenic anaphylaxis. Together, our results suggest that glucocorticoids, classically considered to be broadly immunosuppressive, have a selective immunostimulatory role in B cells.     

美国教学医院教师专业发展的全国性调查

在当前医学教育持续变革的背景中,医学教师的专业发展成为广泛关注的焦点.为了解目前美国以提高教师的教学技能为目标的教师专业发展(faculty development,FD)活动的参与率、课程设计、教学方法和评估策略等情况,美国约翰·霍普金斯大学预防、流行病学和临床研究中心采取邮件调查的方式,对美国277家教学医院进行了调查.     

Evaluation of Nutritional Status and Eating Pattern in First and Second-Time Denture Wearers: A Prospective 60 Days (2 Months) Pilot Study

Elderly individuals with extensive tooth loss preferentially consume soft, easier to chew foods which have a low nutrient density. The purpose of this study was to suggest that every complete denture wearer has to be periodically counseled by a registered Dietician and Dentist for check up to avoid malnutrition and disease. Fourteen patients were selected for this study. Seven of them with four or five teeth remaining without any functional units and seven patients who were known cases of complete denture wearers with ill-fitting or worn out dentures. The results of the study analyzed the change in eating pattern and hence the nutritional status of two groups of edentulous subjects; Group I (patients who underwent a recent transition from partially edentulous state to a completely edentulous state), and Group II (known complete denture wearers for five to ten years). Clinical examination of Group I showed an improvement, by, the decrease in percentages in both the paleness of the conjunctiva and nails of the selected patients. In Group II, there was a significant change in anthropometry and iron intake and the clinical examination showed positive changes in the patient's normal appearance, eyes and nails. Paired sample statistics between both the groups evaluated significant changes in energy, iron and vitamin C intakes in the dietary assessment chart. The general questionnaire assessment showed an improvement in the eating pattern of both the groups, which, may definitely account for a positive change in the nutritional status of the participants later. This study emphasizes that every complete denture wearer needs to be periodically counseled by a registered dietician and dentist for checkup to avoid malnutrition and disease.     

Ureterovaginal fistula: summary of 18 years' experience

Ureterovaginal fistula is an uncommon complication of pelvic operations. We report 31 such cases seen over an 18-year period, all of which followed surgery for benign gynaecological conditions. Most patients had no urinary symptoms until the sudden onset of incontinence 1 to 4 weeks post-operatively. Diagnosis was established by a combination of intravenous urography, cystography, cystoscopy, retrograde ureteropyelography and dye studies. Twenty-nine patients underwent ureteroneocystostomy, 10 with a Boari flap and 19 by a direct method; fistulas healed in 2 patients following conservative treatment. Renal salvage was achieved in all cases.     

Gerota versus Zuckerkandl: the renal fascia revisited

In the medical literature, Gerota fascia is frequently used as a general term to describe both the anterior and posterior pararenal fascia. However, Zuckerkandl's name is also often used to describe either the anterior or posterior fascia. To resolve this confusion, the authors reviewed the original works by Gerota and Zuckerkandl. In 1883, Zuckerkandl described the posterior renal fascia but did not recognize the presence of the anterior renal fascia. In 1895, Gerota documented the presence of the anterior renal fascia and clearly assigned Zuckerkandl's name to the posterior renal fascia. Thus, the terms Zuckerkandl fascia and posterior renal fascia are synonymous, as are Gerota fascia and anterior renal fascia.     

Acquired C1-esterase inhibitor deficiency: Three case reports and commentary on the syndrome

Acquired C1-esterase inhibitor deficiency is a rare syndrome which usually presents with episodes of angioedema. Most patients have an underlying lymphoproliferative disorder. It is important to gastroenterologists, haematologists, immunologists and dermatologists, as these are the more likely specialties to which the patient will present. Recognition of the syndrome is important not only for diagnostic purposes but for investigating and treating any associated underlying lymphoproliferative disorders. In some instances the angioedema may precede the lymphoma by many years. Optimal patient management requires that both angioedema and the underlying lymphoma be recognized and treated.