Simultaneous improvement and worsening of vitiligo lesions during the course of NB‐UVB phototherapy; vitiligo may not act as one unit

Re‐pigmentation and stabilization are the two ultimate goals of any re‐pigmenting plan designed for vitiligo management. Furthermore, whether the improvement of some vitiligo lesions could be considered a guarantee for a similar response and/or stabilization of the rest of the lesions or not, remains to be clarified. To evaluate the behavior of non‐segmental vitiligo (NSV), while on narrow band‐ultraviolet B (NB‐UVB) phototherapy. 25 patients with stable generalized NSV were included and received NB‐UVB twice weekly. For the sake of ensuring accuracy of follow up, up to four lesions were randomly chosen in each patient and regularly measured using the point counting technique. The over‐all point counting technique of all included patients showed a significant reduction (18.5 ± 8.4 cm² to 8.2± 3.1 cm²) after 6 months of therapy (p < .001). Nine patients (36%), showed mixed response in the different lesions. Improvement was documented in some lesions, while other lesions showed no response or even worsening. No significant correlations were detected between the behavior of vitiligo during NB‐UVB and any of the demographic or clinical data of the patients. NB‐UVB is a pillar in the management of vitiligo, however close follow‐up of the patient as a whole and his lesions, by both subjective and objective measures are mandatory to detect activity as early as possible, as vitiligo at many times may not act as one unit. This early detection of activity and the subsequent change in the treatment policy may ultimately change the final outcome of treatment.     

自身免疫性肝炎的现代处理观点

自身免疫性肝炎（AIH）常见于女性,表现为肝酶异常（转氨酶升高）、血清自身抗体如抗核抗体（ANA）、抗平滑肌抗体（SMA）、抗可溶性肝抗原抗体／肝胰抗原（SLA／LP）、抗肝肾做粒体抗体（LKM）1阳性和γ-免疫球蛋白升高,但并非所有AIH患者均出现上述特征。AIH的组织学特点为界面性肝炎,以浆细胞和淋巴细胞浸润为主,但无特征性组织学表现。AIH的确诊较为困难,目前的流行病学资料中报道的AIH实际发病率和患病率可能偏低。     

Circulating red cells usually remain of host origin after bone marrow transplantation for severe combined immunodeficiency

Background: Patients with severe combined immunodeficiency (SCID) treated with allogeneic bone marrow transplantation often receive a milder conditioning regimen than patients who undergo transplantation for hematologic malignancy, and they regularly retain circulating white cells of host origin. The origin of circulating red cells following successful bone marrow transplantation to treat SCID is not known. Study Design and Methods: Review of the medical records identified all patients with SCID who underwent ABO-mismatched bone marrow transplantation at the University of California, San Francisco, between 1982 and 1994. The ABO and Rh phenotype at>6 months after transplantation was determined for all successful transplants by review of the medical record or the taking of a fresh blood sample for analysis. Patient-conditioning and donor bone marrow-preparative regimens were reviewed to assess their possible influence on the red cell phenotype after successful bone marrow transplantation. Results: Nine of 35 SCID patients who underwent successful transplantation received marrow from ABO-mismatched donors. Eight of the nine patients had only host red cells circulating at 6 to 84 months after transplantation, while one patient had only donor red cells circulating at 48 months after transplantation. None of the patients had circulating red cells of both host and donor origin. Conditioning regimens included cyclophosphamide and antithymocyte globulin for all nine patients; only three patients also received total body irradiation. Seven of the nine patients received related-donor, HLA- mismatched bone marrow, and two patients received HLA-identical bone marrow; eight patients received T-cell-depleted bone marrow. The one patient whose red cell phenotype converted to that of the donor received T-cell-depleted, haploidentical marrow, and the preparative regimen included chemotherapy and total body irradiation. Conclusion: SCID patients successfully treated with allogeneic bone marrow transplantation typically fail to show circulating red cells of donor phenotype; this finding is in contrast to the universal presence of circulating donor red cells following successful bone marrow transplantation to treat hematologic malignancies and other diseases. The milder conditioning regimens typically given to patients with SCID, along with T-cell depletion and HLA mismatching, may play a role in this different outcome. It is not known whether the inability to find circulating red cells of donor origin is due to a failure to engraft donor pluripotent stem cells or a failure of engrafted donor stem cells to differentiate along the erythroid lineage.     

Effect of papain on the interaction between human monocytes, erythrocytes, and IgG

The mechanism by which papain detaches IgG-sensitized erythrocytes from the monocyte surface has been explored in an in vitro assay for the monocyte IgG receptor using red cells quantitatively sensitized with IgG anti-Rh D immunoglobulin. Papain treatment of IgG-sensitized erythrocytes diminished the ability of these cells to bind to the monocyte surface; however, treatment of erythrocytes with papain prior to sensitization with IgG did not inhibit binding, and at papain concentrations is greater than or equal to 38 mug/ml binding was enhanced. IgG receptor activity was not diminished by prior treatment of monolayer cells with papain and was enhanced with high concentrations of papain. These studies suggest that papain detaches erythrocytes from the monocyte surface by virtue of its proteolytic effect on IgG and not by an effect of papain on the D antigen of red cells or the IgG receptor on monocytes.     

A proof-of-principle gel-free proteomics strategy for the identification of predictive biomarkers for the onset of pre-eclampsia

Objective  Progress in the prevention and treatment of women at risk of pre-eclampsia (PE) still remains hindered by the lack of clinical screening tools that can accurately predict which mothers are at risk. The identification and validation of predictive biomarkers is therefore seen as a critical milestone towards improved healthcare provision and the clinical testing of new therapeutic strategies. Gel-free proteomic technologies offer the capability of analysing hundreds of plasma proteins simultaneously, but as yet these methods have not been applied to pregnancy complications. To assess the feasibility of such an approach to plasma biomarker research in pregnancy we have applied the technique to samples from women with PE to gestation-matched controls.
Sample  Pooled plasma samples taken at time of disease from women with PE ( n  = 23) and gestation-matched controls ( n  = 23).
Methods  Proteomics strategy for relative quantification of proteins using mass spectrometry.
Results  We identified several differences, including elevated levels of endoglin, PAPP-A and PSG1 in PE plasma. Increased levels of endoglin were validated using immunoassay analysis of individual plasma samples.
Conclusions  Although at a relatively early stage, this mass spectrometry-based approach shows promise as a tool to identify global protein changes in plasma. The application of these methods to pre-disease samples is the next step in the identification of clinically useful biomarkers.     

INCREASING CAESAREAN SECTION AND PERINATAL OUTCOME

An analysis of births by caesarean sections for ten years at a service hospital was carried out to identify the benefit in terms of reduction in perinatal mortality over the period without increase in maternal mortality and morbidity. An increase of 43.25 per cent in caesarean section rate was observed. Since 1986 there had been no significant change in the indications for caesarean sections or obstetrical care in terms of man and machine modernisation at this hospital. New born''s care in this hospital is supervised by obstetrician and medical specialist. However, a definite reduction in perinatal mortality rate by 59.68 per cent was noted with no maternal mortality in caesarean cases. This retrospective study showed that the judicious increase of caesarean sections could improve perinatal outcome.KEY WORDS: Perinatal mortality in caesarean section, Perinatal outcome with increased caesarean section rate     

Effects of natural menopause, hysterectomy, and oophorectomy on lumbar spine and femoral neck bone densities

Lumbar spine and femoral neck bone densities of women, aged 35-65, were measured by dual photon bone densitometry. After exclusion of women with spinal and other abnormalities, this study included 233 subjects: 60 menstruant, 91 who underwent natural menopause (56 more than 2 years post-menopause), 45 bilaterally oophorectomized, and 37 hysterectomized without bilateral oophorectomy. No significant differences were found between the age-normalized average bone densities of the menstruant, early postmenopausal, and late postmenopausal women; nor was there a difference between the rates of their bone loss. The bone densities of the hysterectomized women were significantly lower than those of the normals. The bone densities of the oophorectomized women were significantly lower than those of the hysterectomized patients. The rates of bone loss, however, were comparable in all groups studied. The use of estrogen without progestin was associated with significantly higher lumbar spine densities in the oophorectomized women, but showed no significant effect in any of the other groups.