Hematopoietic cell activation in the subventricular zone after Theiler's virus infection

Background

The long latent stage seen in syphilis, followed by chronic central nervous system infection and inflammation, can be explained by the persistence of atypical cystic and granular forms of Treponema pallidum. We investigated whether a similar situation may occur in Lyme neuroborreliosis.

Method

Atypical forms of Borrelia burgdorferi spirochetes were induced exposing cultures of Borrelia burgdorferi (strains B31 and ADB1) to such unfavorable conditions as osmotic and heat shock, and exposure to the binding agents Thioflavin S and Congo red. We also analyzed whether these forms may be induced in vitro, following infection of primary chicken and rat neurons, as well as rat and human astrocytes. We further analyzed whether atypical forms similar to those induced in vitro may also occur in vivo, in brains of three patients with Lyme neuroborreliosis. We used immunohistochemical methods to detect evidence of neuroinflammation in the form of reactive microglia and astrocytes.

Results

Under these conditions we observed atypical cystic, rolled and granular forms of these spirochetes. We characterized these abnormal forms by histochemical, immunohistochemical, dark field and atomic force microscopy (AFM) methods. The atypical and cystic forms found in the brains of three patients with neuropathologically confirmed Lyme neuroborreliosis were identical to those induced in vitro. We also observed nuclear fragmentation of the infected astrocytes using the TUNEL method. Abundant HLA-DR positive microglia and GFAP positive reactive astrocytes were present in the cerebral cortex.

Conclusion

The results indicate that atypical extra- and intracellular pleomorphic and cystic forms of Borrelia burgdorferi and local neuroinflammation occur in the brain in chronic Lyme neuroborreliosis. The persistence of these more resistant spirochete forms, and their intracellular location in neurons and glial cells, may explain the long latent stage and persistence of Borrelia infection. The results also suggest that Borrelia burgdorferi may induce cellular dysfunction and apoptosis. The detection and recognition of atypical, cystic and granular forms in infected tissues is essential for the diagnosis and the treatment as they can occur in the absence of the typical spiral Borrelia form.     

诺卡式菌性角膜炎表现为盘状角膜炎1例

目的:报告诺卡式菌属感染引起的盘状角膜炎病例1例。方法:病例报告。结果:患者,男,13岁,无角膜接触镜使用史,在小溪里游泳后,右眼疼痛伴视力下降2wk。最佳矫正视力:右眼6/30(0.2)。检查发现角膜基质存在形态规则的旁中心盘状浸润伴炎症反应。角膜敏感度下降。最初角膜刮片镜检行革兰氏染色阴性,棘阿米巴角膜刮片和培养阴性。诊断为病毒性盘状角膜炎,给予口服阿昔洛韦和局部使用激素眼药水。2wk后患者视力恶化伴角膜损伤加重,再次角膜取材刮片行革兰氏染色提示诺卡式菌属感染,按经验局部给予3g/L加替沙星眼药水后,临床效果明显。治疗6mo后,视力达到6/6仅在角膜中心留有少量角膜混浊。结论:诺卡式菌属感染延误诊断可以导致病情恶化。如果采用正确的治疗,诺卡式菌属感染引起的角膜炎可以恢复良好,仅留少量瘢痕,获得较好的视力。     

纤维胆道镜临床应用160例

0　引言　纤维胆道镜 (下称胆道镜 )在肝内外胆道疾病中的应用 ,其诊治价值已得到充分肯定 .我院 1996 - 0 1/ 1999- 12 ,术中、术后使用胆道镜诊治胆道肿瘤及结石 16 0例 ,取得了较满意的效果 .1　对象和方法1.1　对象　术中应用胆道镜行胆道探查共 38(男 2 3,女 15 )例 ,其中胆总管结石 2 9例 ,肝内胆管多发结石 5例 ,胆管肿瘤4例 .术后经 T管瘘道取石或活检 12 2 (男 78,女 44 )例 ,年龄18～ 77岁 ,其中肝外胆管残余结石 114例 ,多发性肝内胆管残余结石 5例 ,胆总管下端肿瘤活检 2例 ,置管造影 1例 .1.2　方法　日本 Olympus CHP2 OQ…     

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre-eclampsia

Objective  To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia.
Design  This was a prospective screening study.
Setting  The Homerton University Hospital, a London teaching hospital.
Population  Two hundred and ten low-risk women with a singleton pregnancy were analysed.
Methods  Radial artery pulse waveforms were measured between the 11⁺⁰ and 13⁺⁶ weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve.
Main outcome measures  Prediction of pre-eclampsia by AIx-75.
Results  Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia.
Conclusion  First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.