结核疫苗的研究进展

结核病是由结核分枝杆菌引发的一种传染病。1882年，结核分枝杆菌(mycobacterium tuberculosis， Mtb)由Robert Koch发现，至今仍是致人类死亡主要病原体之一。更可怕是，多重耐药(MDR)和广泛耐药(XDR) Mtb患病率的明显增加。上世纪90年代，世界卫生组织(World Health Organization， WHO)宣布结核病处于全球性紧急状态。结核病的最佳预防措施是接种疫苗，但是卡介苗(bacille Calmette-Guérin，BCG)对成人的保护效力不完全。随着Mtb基因序列的检测成功，疫苗的研究取得了重大的进展，已经有十几种候选疫苗准备或已进人体临床试验阶段。当前热门的候选疫苗包括重组BCG疫苗、减毒Mtb活疫苗和亚单位疫苗等。本文将从这些方面进行综述。     

Reduced dose of Bacillus Calmette-Guérin versus full dose of Bacillus Calmette-Guérin for non-muscle-invasive bladder cancer after transurethral resection bladder tumor： a meta-analysis of randomized controlled trials

Background Bladder cancer is widely known as the most common malignant tumor in the urinary tract,with 75％-85％ of patients suffering from nonmuscle invasive bladder cancer （NMIBC）.However,the optimal dose of Bacillus Calmette-Guérin （BCG） remains controversial.The aim of this study was to compare the therapeutic efficacy of full dose （FD） with the reduced dose （RD） of BCG.Methods Randomized controlled trials （RCTs） were selected through the Cochrane Library,PubMed and Embase and were supplemented by hand searching of bibliographies.The end points include overall survival rate,recurrence rate,progression rate and side effects.Results Five RCTs that included a total of 1 473 patients （727 in the reduced dose group vs 746 in the full dose group）,with a median follow-up period from 33.5 month to 7.1 year.Disease in 80 of 687 （11.6％） patients assigned to the RD group progress to the muscular layer or distant metastasis,compared with 81 of 698 （11.6％） patients assigned to the FD group （RR=1.02; 95％ CI,0.77-1.36; P=0.89）.The incidence of recurrence at three year was reported in all five studies to be 41.1％ （299 of 727） and 36.1％ （269 of 746） in the RD and FD groups,respectively （RR=1.13; 95％ CI,1.00-1.29; P=0.05）.The 5-year survival rate was 75.9％ （502 of 662） in the RD group,and 75.8％ （510 of 673） in the FD group.In the RD group 41 of 655 （6.3％） patients and 56 of 663 （8.7％） patients in the FD group did not complete the treatment due to systemic or local side effects （RR=0.75; 95％ CI,0.51-1.10; P=0.14） Conclusions In general,the results of our study demonstrate a trend towards a reduction of the toxicity in reduced dose group without affecting the efficacy of treatment when compared with full dose.More trials with large sample size are still necessary to explore the prognosis of the patients with high risk of tumor in different dose group.     

卡介苗中PE和PPE家族蛋白B细胞抗原表位多态性研究

目的 了解13株卡介苗(bacille calmette-gurin, BCG)基因组中由PE/PPE基因家族编码的B细胞抗原表位分布情况, 分析其对BCG免疫保护力的潜在影响。方法 从国际免疫表位数据库(Immune Epitope Data base, IEDB)中检索结核分枝杆菌B细胞抗原表位, 与结核分枝杆菌参考菌株H37Rv的蛋白质组进行序列比对, 确定PE/PPE基因家族编码B细胞抗原表位序列;并与13株BCG基因组进行序列比对, 提取表位编码序列, 分析其在BCG中的分布与变异。结果 6个PE/PPE基因家族的基因编码28个B细胞抗原表位, 21个B细胞抗原表位在13株BCG中高度保守, 7个B细胞抗原表位在BCG中发生基因变异, 变异表位分别产生于BCG的不同形成期。结论 PE/PPE基因家族所表达的蛋白大多为细菌表面蛋白, PE/PPE蛋白家族中B细胞抗原表位的变化可能对BCG的保护力产生影响, 应继续开展基于B细胞表位的BCG遗传特征研究。     

Pathological Examination: Features of Ocular Tumors<br/>Examen Anatomopathologique: Particularités des Tumeurs Oculaires

The pathological examination of ocular tumors has specificities in terms of macroscopic management, microscopic analysis, and molecular examinations requiring special attention. We discuss here the difficulties encountered in the reception in the pathological anatomy laboratory of conjunctival samples, enucleation and orbital exenteration pieces, then detail the diagnostic and theranostic, microscopic and molecular characteristics of ocular tumor pathologies. Conjunctival tumors (epithelial, melanocytic and lymphoid), choroidal tumors (including uveal melanoma) and retinoblastoma are treated. Because of their low frequency and their features, these tumors should be the subject of anatomo-clinical discussions.

Résumé:
L’examen anatomopathologique des tumeurs oculaires comporte des spécificités en termes de prise en charge macroscopique, d’analyse microscopique, et d’examens moléculaires nécessitant une attention toute particulière. Nous discutons ici les difficultés rencontrées à la réception au laboratoire d’anatomie pathologique des prélèvements conjonctivaux, des pièces d’énucléation et d’exentération orbitaire, puis détaillons les caractéristiques diagnostiques et théranostiques, microscopiques et moléculaires, des pathologies tumorales oculaires. Sont traités les tumeurs conjonctivales (épithéliales, mélanocytaires et lymphoïdes), choroïdiennes (dont le mélanome uvéal) et le rétinoblastome. De par leur faible fréquence et leurs particularités, ces tumeurs doivent faire l’objet de discussions anatomo-cliniques.     

Uveal Melanoma Management for Medical Oncologists in 2020<br/>Prise en charge du mélanome uvéal en oncologie médicale en 2020

Uveal melanoma is a rare subtype of melanoma, intrinsically different from cutaneous melanoma. Despite optimal therapeutic management allowing local control of the primary ocular tumor, 20 to 50% of patients develop metastases, mainly localized to the liver, with a poor prognosis and a 12-month median survival from the diagnosis of the metastatic disease. There is a lack of effective treatments in the metastatic setting, and dedicated strategies and trials for uveal melanoma patients are needed, based on identification of new targets and specific preclinical findings.


Résumé:
Le mélanome de l’uvée est un cancer rare, en tous points différent du mélanome cutané. Malgré un excellent contrôle local grâce aux traitements ophtalmologiques, 20 à 50% des patients développent des métastases, hépatiques le plus souvent, dont le pronostic est sombre et la survie médiane de 12 mois, en l’absence de traitement systémique efficace et en dehors des rares cas relevant de la chirurgie. Une meilleure connaissance de la biologie et une recherche préclinique dédiée sont les éléments indispensables à une recherche clinique basée sur l’identification de cibles thérapeutiques spécifiques du mélanome uvéal.     

Skin expansion in cicatricial alopecia of the scalp: 18 cases

INTRODUCTION: Skin expansion technique used to increase the hair surface available at the scalp level was a major breakthrough in the surgical treatment of important cicatricial alopecia. This article had for aim to define the importance and limits of this technique in the treatment of alopecia and to highlight its relevance compared to other methods. PATIENTS AND METHODS: Between November 1998 and April 2006, 18 patients (7 women and 11 men) presenting with one or many cicatricial alopecia areas were treated by skin expansion. The age of patients ranged between 14 and 68 years, with an average of 33 years. The indications were related to burn sequels in 44% of all cases. The average area of alopecia was 167 cm2. This technique combines two operating phases. In the first phase, the expansion balloon is inserted and then gradually filled. In the second phase, it is removed and the alopecic area is covered by the expanded flaps. RESULTS: Thirty-nine expansion prostheses were used, with an average volume of 292 cc. Their number varied between 1 and 6 (two on average) for each patient. The average duration of expansion was 77 days. The tissue gained with this technique allowed the use of 38 flaps. The transposition flaps was the most frequently used (39.4%). The rate of major complications leading to total failure of the process reached 5.5%. The final result was considered good in 90% of the cases. DISCUSSION: The results demonstrate that skin expansion technique is a simple, reliable, and efficient method in the healing of important cicatricial alopecia of scalp. It enables a wider use of the classical local flap technique, by expanding the surface and vascularization allowing for a direct suturing of the donor site. Skin expansion holds an important place in the treatment of significant skin cicatricial alopecia, since it represents the only surgical solution when the alopecia area exceeds 50 cm2.     

Autotransplantation of an immature tooth

Autogenous tooth transplantation is indicated in young people treated by orthodontology, especially when they present with damaged first molars requiring extraction. This therapeutic alternative with a favourable prognosis is an elegant solution after a single tooth loss.