Clinical characteristics and outcome of southern Chinese males with systemic lupus erythematosus.

The aims were to study the gender differences in clinical manifestations, disease course and organ damage in systemic lupus erythematosus (SLE). Clinical manifestations, autoantibody profile, relapses and damage scores were obtained from 51 Chinese males with SLE and compared with 201 consecutive female SLE controls. Fifty-one males were identified among 630 SLE patients who attended our clinics, giving a male prevalence of 8% and a female to male ratio of 11.4-1. Both the male SLE patients and the female controls had similar age and SLEDAI score at disease onset. Male SLE patients had less alopecia (P = 0.03), Raynaud's phenomenon (P = 0.01) and anti-Ro (P = 0.049) during the course of the disease but none of the differences were statistically significant after correction for multiple observations. The prevalence of major organ involvement in either sex was not different. Both groups of patients had a comparable mean duration of follow-up (104 vs. 102 months, P = 0.87). Males had a significantly lower rate of relapses (total No. of flares/patient-year: 0.23 in men vs. 0.33 in women, P = 0.04), but the frequency of severe flares (No. of severe flares/patient-year in men 0.08 vs. 0.12 in women, P = 0.16) was not significantly different from the females. Male patients with positive anti-Ro had significantly less overall flares than their female counterparts who were anti-Ro positive (0.16 vs. 0.34, P = 0.006). However, the use of immunosuppressive agents for disease control in patients of both sexes was similar. 22 (43%) of the males and 78 (39%) of the females had organ damage. A higher percentage of male patients had impairment of renal function (P = 0.006) but the proportion of patients who required dialysis was not different (4% in men vs. 2% in females. P = 0.92). There was also a trend of more cardiovascular damage in the males but the difference was not statistically significant (P = 0.09). The mean SLICC/ACR scores were not significantly higher in the males than the females (0.71 vs. 0.60, P = 0.47). Males tend to differ from females in clinical manifestations, immunological profile and disease course in SLE. However, there was no gender difference in the involvement of major organs/systems. Males had less overall disease flares than the females but the rate of severe flares was not significantly lower. For patients who were anti-Ro positive, males had significantly less total number of flares/patient-year than their female counterparts. More renal impairment and cardiovascular damage was present in our male lupus patients but the overall damage scores were not significantly higher.     

Randomised controlled trial comparing cisatracurium and vecuronium infusions in a paediatric intensive care unit

Objective To evaluate and compare the efficacy, infusion rate and recovery profile of vecuronium and cisatracurium continuous infusion in critically ill children requiring mechanical ventilation.Design and setting Prospective, randomised, double-blind, single-centre study in critically ill children in a paediatric intensive care unit in a tertiary childrens hospital.Methods Thirty-seven children from 3 months to 16 years old (median 4.1 year) were randomised to receive either drug; those already receiving more than 6 h of neuromuscular blocking drugs were excluded. The Train-of-Four (TOF) Watch maintained neuromuscular blockade to at least one twitch in the TOF response. Recovery time was measured from cessation of infusion until spontaneous TOF ratio recovery of 70%.Results The cisatracurium infusion rate in nineteen children averaged 3.9±1.3 µg kg^–1 min^–1 with a median duration of 63 h (IQR 23–88). The vecuronium infusion rate in 18 children averaged mean 2.6±1.3 µg kg^–1 min^–1 with a median duration of 40 h (IQR 27–72). Median time to recovery was significantly shorter with cisatracurium (52 min, 35–73) than with vecuronium (123 min, 80–480). Prolonged recovery of neuromuscular function (>24 h) occurred in one child (6%) on vecuronium.Conclusions Recovery of neuromuscular function after discontinuation of neuromuscular blocking drug infusion in children is significantly faster with cisatracurium than vecuronium. Neuromuscular monitoring was not sufficient to eliminate prolonged recovery in children on vecuronium infusions.     

HDV/HBV感染树鼩肝组织ICE表达及肝细胞凋亡

目的 探讨HDV/HBV感染树鼩肝组织中ICE表达与HDV感染之间的关系,以及ICE在丁型肝炎肝细胞凋亡中的作用。 方法 采用免疫组化技术对45份HDV感染树鼩肝组织中HDVAg,ICE的表达进行了检测;应用原位末端标记技术对肝组织凋亡进行检测;并应用免疫组化双重染色对HDVAg,ICE的表达以及肝细胞凋亡进行了检测。 结果 肝组织45份中有43份可检出ICE(阳性率96％),有41份可检出凋亡细胞(阳性率91％),ICE在肝细胞浆和(或)膜上表达,以肝细胞浆内表达为主,HDVAg表达与ICE表达之间有显著相关性X~2=36.2(P<0.05),HDVAg表达越强,ICE表达越强,凋亡阳性细胞在肝细胞索多呈散在分布,在坏死灶中也可检出,凋亡在HDVAg阳性和阴性细胞中均可发生,以在HDVAg阳性细胞内发生为主,ICE表达与肝细胞凋亡之间有显著相关性X~2=35.6(P<0.05),ICE表达越强,凋亡阳性细胞越多。 结论 丁型肝炎病毒感染和未感染的肝细胞均可发生凋亡,但凋亡只在少数细胞内发生;HDV可诱导ICE表达,ICE在肝细胞凋亡中起重要作用。     

Parathyroid hormone-related protein relaxes rat gastric smooth muscle and shows cross-desensitization with parathyroid hormone

Previously, we reported that parathyroid hormone (PTH) is a potent and effective relaxant of rat gastrointestinal smooth muscle. Since the recently discovered PTH-related protein (PTHrP) has amino-terminal homology with PTH and acts like PTH on bone and kidney, we decided to study the effects of synthetic PTHrP analogs on the isometric tension of rat fundic strips. Rat (r) PTH-(1-34), human (h) PTHrP-(1-34), and [Tyr0]hPTHrP-(1-34) relaxed acetylcholine-stimulated fundic strips in a dose-dependent manner, with an IC50 of 6, 10, and 31 nM, respectively. However, maximal doses of [Tyr0]hPTHrP-(1-34) were considerably less effective than the other two peptides. Addition of rPTH-(1-34) or hPTHrP-(1-34) to a maximally effective dose of [Tyr0]hPTHrP-(1-34) produced no further relaxation, indicating that [Tyr0]hPTHrP-(1-34) also has antagonistic properties. Bovine PTH-(3-34) an established in vitro antagonist of PTH, partially inhibited the relaxant effect of PTHrP. Fundic strips that had been desensitized by preincubation for 30-45 minutes with either rPTH-(1-34) or hPTHrP-(1-34) (330-500 nM) were also insensitive to the relaxant action of either peptide, but in the same preparations, the relaxation produced by vasoactive intestinal peptide was unaffected. These studies indicate that PTHrP and PTH can interact with the same receptor. Whether PTHrP influences gastrointestinal motility in normal or tumor-bearing persons remains to be investigated.     

Brief Report: A Case of Autism with Interstitial Deletion of Chromosome 13

A case of an 18-year-old male who meets the DSM-IV criteria for autistic disorder and borderline intelligence is described. Cytogenetic evaluation revealed a karyotype of 46, XY, del(13)(q14q22). The relevance of this case to the etiology of autism is discussed.