Cell-free CD5 in patients with rheumatic diseases.

Since an increased frequency of CD5+ B cells has been reported in rheumatoid arthritis (RA) and primary Sj?gren's syndrome (SS), and the expression of the molecule was reduced on the T cells of some SS patients, we hypothesised that there would be an accelerated turnover of CD5 in these disorders. We describe a novel enzyme-linked immunosorbent assay for measuring cell-free (CF) CD5, using rabbit F(ab')2 anti-CD5 antibody as capture agent and monoclonal anti-CD5 antibody as revealing agent. It was established that CF-CD5 was detectable in RA and SS sera, as opposed to sera from patients with ankylosing spondylitis and normal controls. The level of CF-CD5 did not correlate with rheumatoid factor in RA patients but was significantly higher (P less than 0.05) in SS patients with extraglandular manifestations than in those with glandular disease. Three of the latter patients with significantly increased levels of CD5-negative T cells did not have a particularly high proportion of CF-CD5 in these sera.     

Antimitochondrial (pyruvate dehydrogenase) autoantibodies in autoimmune rheumatic diseases

Anti-pyruvate dehydrogenase (PDH) antibodies were determined in 1451 sera of patients with primary biliary cirrhosis (PBC) and several autoimmune rheumatic conditions by ELISA and immunoblotting. They were detected in sera of 93% of the patients with PBC (179 of 192 patients) in 60 of 277 (22%) patients with Sjogren's syndrome (SjS), 34 of 437 (8%) patients with scleroderma, 33 of 191 patients with SLE (17%), and 5 of 55 (10%) patients with rheumatoid arthritis (RA) but in none of the patients with polymyositis or the antiphospholipid syndrome. The ELISA studies were confirmed by immunoblots showing binding of autoimmune rheumatic sera to the same epitope (74 kd) of mitochondria that the PBC sera reacted with. The identical binding characteristics were also confirmed by protein competition assays with purified PDH. In 4 of 53 patients with SjS who were positive for anti-PDH, high titers as in PBC were detected. The anti-PDH antibodies in Sjogren's patients were associated with deranged liver function tests and extraglandular features but did not correlate with any other non-organ-specific antibody. Follow-up studies confirmed the association of the emergence of anti-PDH antibodies with defects in liver function tests. The antibodies were more prevalent in SLE and RA when they were associated with Sjogren's syndrome (30 and 18.8%, respectively). Among patients with different forms of scleroderma, anti-PDH antibodies were noted in subjects with systemic sclerosis, morphea, and Raynaud's phenomenon. The incidence was much more significant among patients with calcinosis, Raynaud's, esophageal dysmotility, sclerosis, and telangiectasia (CREST) (8/34), in whom antibodies were detected in 5 who had already developed PBC. The relationship among anti-PDH antibodies, PBC, and development of other autoimmune rheumatic conditions is discussed. It is proposed that the early detection of anti-PDH antibodies in patients with rheumatic conditions may predict the future development of PBC. This observation may have therapeutic implications.     

Functional heterogeneity of anti-endothelial cell antibodies

While it has been claimed that some anti-endothelial cell antibodies (AECA) activate EC, there is also evidence that others trigger apoptosis. To address the issue of whether activation is a prerequisite for AECA-mediated apoptosis of EC, 23 AECA-positive sera were evaluated for their ability to induce activation and/or apoptosis. Activation was defined as an over-expression of E-selectin and intercellular adhesion molecule 1. Optical microscopy, annexin V binding, hypoploid cell enumeration, and determination of poly (ADP-ribose) polymerase cleavage-related products were used to assess apoptosis. Four functional profiles were defined: 10 sera promoted activation and apoptosis (act+/apo+), one was act+/apo-, six act-/apo+, and the remaining six act-/apo-. The reduced membrane expression of thrombomodulin was associated with apoptosis, rather than activation. Caspase-3 was implicated in the two models of apoptosis, the ratios of several survival proteins to Bax decreased, regardless of the ability of apo+ AECA to activate the cells, while radical oxygen species did not appear to be involved. Furthermore, it occurred that macrophages engulfed EC treated with apoptosis-promoting AECA, but not those incubated with AECA that did not induce apoptosis. Hence, AECA represent an extremely heterogeneous family of autoantibodies, not only because of the variety of their target antigens, but also the subsequent diversity of their effects.     

CFTR gene and male fertility

Secretion of electrolytes and water by the epididymal epithelium is important in the formation an optimal fluid environment for sperm maturation and transport. This process is disrupted in the genetic disease cystic fibrosis caused by mutation of the cystic fibrosis transmemebrane conductance regulator (CFTR) gene. Recent findings of CFTR gene mutations in healthy men with congenital bilateral absence of the vas deferens or poor sperm quality may indicate that CFTR gene mutations have a far-reaching effect on human reproduction.      

综合疗法配合医疗体操治疗肩关节周围炎55例

临床资料 肩关节周围炎(肩周炎)患55例．分为综合组28例(30个肩关节)，男17例(18个肩关节)，女11例(12个肩关节)，年龄48～70(平均54)岁，病程2～36(平均6)mo．对照组27例(30个肩关节)，男15例(17个肩关节)，女12例(13个肩关节)，年龄47～70(平均52)岁，病程1．5～36(平均7)mo，两组病情基本一致．综合组采用：①局部药物封闭：20g／L利多卡因注射液5mL，654．2注射液10mg，     

The control chart: an epidemiological tool for public health monitoring

The objective of the authors is to apply the control chart, a statistical method for quality control used in industry, to public health surveillance. A pilot study was conducted during the 1998 World Football Cup (WFC) by 553 sentinel general practitioners (GPs) throughout France. The average number of cases of communicable, environmental and societal diseases relating to mass gatherings, and the total number of referrals to hospital reported daily by a GP, were plotted on a u-chart for each condition monitored. This average was beyond the statistical control limits if it fell outside the 99.7% confidence interval of the baseline incidences estimated before the WFC. Seven hundred and forty data points representing 262 279 medical encounters were plotted. Nineteen points exceeded the statistical control limits. None of these alerts was confirmed for two consecutive days. Control charts ensured that the level of the items chosen for general community health surveillance remained under control.     

Evaluation of activatory and inhibitory natural killer cell receptors in non-segmental vitiligo: a flow cytometric study

Background Recent observations established the role of altered cellular immunity and autoimmune hypothesis in the pathogenesis of vitiligo. There have been several reports discussing T‐cell and natural killer (NK) cell populations, but NK cell receptors were not evaluated in vitiligo. Objective The purpose of this investigation was to assess the role of T and NK cells as well as activatory and inhibitory NK cell receptor alterations in the pathogenesis of vitiligo and whether any aberrations were correlated with clinical findings of the disease. Patients/methods Fifty‐three patients with non‐segmental vitiligo and 45 age‐ and sex‐matched healthy controls were enrolled in the study. The percentages of lymphocytes, granulocytes, monocytes and CD3, CD4, CD8, CD14, CD16, CD56, CD45, CD45RA, CD54RO, CD28, CD80, CD94, CD158a, KIR3DL‐1 receptors as well as CD94, CD158a, KIR3DL‐1 receptors on CD16⁺ cells were detected by using flow cytometry. The patient and control groups were compared in terms of the results of flow cytometric analysis, and the results were assessed regarding the type and activity of vitiligo. Results The percentages of CD16⁺CD56⁺, CD3⁺CD16⁺CD56⁺, CD8⁺ and CD45RO⁺ cells were significantly increased in vitiligo group compared with the controls. No difference was detected between the patients and control groups in percentages of CD3⁺, CD4⁺, CD3^?CD16⁺CD56⁺, CD28⁺, CD45⁺, CD45RA⁺, CD94⁺, CD158a⁺ and KIR3DL‐1⁺ cells. The percentage of CD16⁺CD158a⁺ cells was significantly decreased in a randomized selected group of vitiligo patients. There were no differences in percentage expression of studied cell surface antigens between patients in the active or stable period. CD3⁺ cells were significantly increased in generalized form, and CD45RO⁺ cells were significantly increased in acral/acrofacial form when compared with the other types of vitiligo. Conclusions These results indicate further evidence for T and NK cell abnormalities in non‐segmental vitiligo. The present data show that NK cell activation may be responsible in the pathogenesis of vitiligo in conformity with decreased inhibitory and increased activatory NK cell receptors.