Cutaneous actinomycosis presenting as chronic mastitis

Actinomycosis is a chronic granulomatous suppurative infection caused by anaerobic actinomyces. Primary cutaneous involvement is uncommon because of the exclusively endogenous habitat of the organism. We describe a very unusual presentation mimicking chronic mastitis. A 35‐year‐old woman presented 7 months post‐partum with tenderness and induration in the right breast. She was pyrexial and felt systemically unwell. An initial diagnosis of mastitis was made. Treatment with penicillin, imipenem, co‐amoxiclav and metronidazole had no effect. Skin biopsy revealed the characteristic ‘sulphur granules’ of actinomycoses in the deep dermis. Long term oral clindamycin (> 12 months) has produced a very good response clinically, with a concomitant decrease in inflammatory markers. Cutaneous actinomycosis has been described by haematogenous spread from visceral organs or after trauma. The organism is difficult to culture and is often diagnosed histologically by the presence of ‘sulphur granules’. It is very sensitive to penicillin but prolonged treatment is needed.     

Bcl-2蛋白表达与乳癌预后病理参数

0　引言　 bcl- 2基因是一种抑制凋亡基因 [1 ] ,通过基因突变或易位 ,使表达增强 .近期研究发现 Bcl- 2蛋白在非淋巴造血系统肿瘤中 ,也有异常表达 .如 :乳腺癌、前列腺癌、肺癌、鼻咽癌、胃癌、神经胶质瘤等 [2 ] ,且认为 Bcl- 2蛋白表达与预后因素有关 [3,4] .目前 ,国内有关实体瘤中 Bcl- 2表达、调节及功能与预后关系研究报道较少 .我们主要观察 Bcl- 2蛋白在乳腺癌中的表达及预后因素间的相关性 .1　材料和方法1 .1　材料　收集我院 1 995 / 1 998原发乳腺癌手术切除标本6 9例 ,均为女性 ,年龄 2 9～ 72岁 ,平均 45岁 .术前未做过任…     

Does Choose &; Book fail to deliver the expected choice to patients? A survey of patients' experience of outpatient appointment booking

Background  

Choose and Book is a central part of the UK Government patient choice agenda that seeks to provide patients with a choice over the time, date and place of their first outpatient appointment. This is done through the use of a computerised booking system. After a 2004 pilot study, Choose and Book was formally launched in January 2006. This is the first study of patient experience of Choose and Book since then.     

EphrinB2 Regulation by PTH and PTHrP Revealed by Molecular Profiling in Differentiating Osteoblasts

With the aim of identifying new pathways and genes regulated by PTH(1–34) and PTH‐related protein 1–141 [PTHrP(1–141)] in osteoblasts, this study was carried out using a mouse marrow stromal cell line, Kusa 4b10, that acquires features of the osteoblastic phenotype in long‐term culture conditions. After the appearance of functional PTH receptor 1 (PTHR1) in Kusa 4b10 cells, they were treated with either PTH(1–34) or PTHrP(1–141), and RNA was subjected to Affymetrix whole mouse genome array. The microarray data were validated using quantitative real‐time RT‐PCR on independently prepared RNA samples from differentiated Kusa 4b10, UMR106 osteosarcoma cells, and primary mouse calvarial osteoblasts, as well as in vivo using RNA from metaphyseal bone after a single PTH injection to 3‐wk‐old and 6‐mo‐old ovariectomized rats. Of the 45,101 probes used on the microarray, 4675 were differentially expressed by ≥1.5 fold, with a false discovery rate <0.1. Among the regulated genes, ephrinB2 mRNA was upregulated in response to both PTH and PTHrP. This was confirmed by quantitative real‐time PCR in vitro and in vivo. Increased ephrinB2 protein was also shown in vitro by Western blotting, and immunostaining of femur sections showed ephrinB2 in both osteoclasts and osteoblasts. Production of ephrinB2, as well as other ephrins or Eph family members, did not change during differentiation of Kusa 4b10 cells. Blockade of ephrinB2/EphB4 interaction resulted in inhibition of mineralization of Kusa 4b10 cells. Together with the shown effect of ephrinB2 promoting osteoblast differentiation and bone formation through action on EphB4, the data raise the possibility that PTH or PTHrP might regulate ephrinB2 to act in a paracrine or autocrine manner on EphB4 or EphB2 in the osteoblast, contributing as a local event to the anabolic action of PTH or PTHrP.     

Tumor targeting with surface-shielded ligand--polycation DNA complexes.

Incorporation of the receptor binding ligands transferrin (Tf) or epidermal growth factor (EGF) into DNA/polyethylenimine (PEI) complexes was found to enhance gene transfer into tumor cell lines in a receptor-dependent manner. In systemic applications, the surface charge of DNA complexes dominated the in vivo characteristics of gene transfer. Administration of surface-shielded Tf-polycation/DNA complexes into the tail vein of A/J mice resulted in preferential gene delivery into distantly growing subcutaneous Neuro2a tumors. In contrast, application of positively charged DNA/PEI complexes directed gene transfer primarily to the lung. Two alternatives of masking the surface charge of complexes were accomplished. In the first case, shielding was obtained by covalently coating of DNA/Tf-PEI complexes with polyethylene glycol (PEG). Alternatively, incorporation of sufficient Tf protein into the DNA complexes resulted in charge shielding even without PEGylation. In the latter case lower-molecular weight polycations (25 kDa PEI for Tf-PEI complexes, or 32 kDa polylysine for AVET complexes) were used.     

Infant-feeding Practices among HIV-infected Mothers in an HIV-treatment Programme

The transmission of HIV via breastmilk has led to various recommendations for HIV-infected mothers. In this study, the feeding practices of HIV-infected mothers in the first six months of their infants’ lives were evaluated. In total, 103 consecutive mothers of children, aged 6-24 months, were evaluated for their feeding practices in the first six months of their infants’ lives. The mothers were recruited in two cohorts based on their entry (PMTCT cohort) or non-entry (non-PMTCT cohort) to an HIV MTCT-prevention programme. Information obtained included maternal age, socioeconomic class, and the educational level attained. All the babies in the non-PMTCT cohort were breastfed compared to none in the PMTCT cohort. Infant formula was inadequately prepared for 77.42% of babies in the non-PMTCT cohort compared to 18.64% in the PMTCT cohort. The mixed-feeding rate was high (70.45 %) in the non-PMTCT cohort. Over 70% of babies in both the cohorts were bottle-fed. Voluntary counselling and testing services in the healthcare system should be strengthened. All mothers should receive infant-feeding counselling, with exclusive breastfeeding being encouraged in those with unknown HIV status.Key words: Antiretroviral therapy, Breastfeeding, Counselling, HIV, Infant-feeding practices, Infant food, PMTCT, Nigeria     

Phase II trial of weekly paclitaxel (80 mg/m2) in platinum and paclitaxel-resistant ovarian and primary peritoneal cancers: a Gynecologic Oncology Group study

OBJECTIVE: To evaluate the activity of single agent weekly paclitaxel in patients with both platinum and paclitaxel (delivered every 3 weeks)-resistant ovarian cancer. METHODS: Forty-eight patients with platinum and paclitaxel-resistant ovarian cancer (defined as progression during, or recurrence < 6 months following, their prior treatment with both agents) received single agent weekly paclitaxel (80 mg/m2/week) until disease progression (assuming acceptable toxicity). Following the initial 12 weekly doses, treatment could be given for 3 weeks, with a 1 week break. RESULTS: In this chemoresistant population, the objective response rate was 20.9%. Serious adverse events were relatively uncommon (neuropathy-grade 2: 21%; grade 3: 4%; and grade 3 fatigue: 8%). CONCLUSION: The weekly administration of paclitaxel can be a useful management approach in women with both platinum and paclitaxel (given every 3 weeks)-resistant ovarian cancer. It would be appropriate to directly compare weekly to every 3-week paclitaxel delivery in the setting of primary chemotherapy of advanced ovarian cancer.