Use of antiplatelet agents in sepsis: A glimpse into the future

As mechanisms of sepsis pathophysiology have been elucidated with time, sepsis may be considered nowadays, as an uncontrolled inflammatory and pro-coagulant response to a pathogen. In this cascade of events, platelets play a key role, via interaction with endothelial cells and modulation of both innate and adaptive immune system. In that manner, inhibition of platelet function could represent a useful tool for attenuating inflammatory response and improving outcomes. Data on current antiplatelet agents, including acetylsalicylic acid, P2Y12 inhibitors and GPIIb/IIIa antagonists, in animal models are promising. Clinical data in patients hospitalized for pneumonia, at risk for acute lung injury, and/or critically ill revealed an association between antiplatelet therapy and reduction in both short-term mortality and prevalence of acute lung injury, as well as, the need for intensive care unit admission, without a concomitant increased bleeding risk. In need of innovative approach in the treatment of sepsis, further prospective, interventional, randomized trials are pivotal to establish potential use of antiplatelet agents in this context.     

Clinical and Laboratory Features of Adult T-cell Leukaemia Lymphoma in Barbados

We describe the clinical and pathological features of 23 Afro-Caribbean patients with adult T-cell leukaemia/lymphoma admitted to the Queen Elizabeth Hospital, Barbados over a 5 year period. There were 9 males and 14 females, with a median age of 38 years (range 14-84). Twelve had acute leukaemia, 10 lymphoma (including 4 with solitary extra nodal lesions) and 1 smouldering subtype. Two patients had a past history of tropical spastic paraparesis/HTLV 1 associated myelopathy (TSP/HAM). The prognosis was poor, with only 3 complete responses to chemotherapy (CHOP) lasting from 9 to 36 months. We conclude that ATLL in Barbados is similar to the disease in the other Caribbean islands and Japan, except that in Barbados the age of onset is over a decade younger than in Japan.     

Follicular mucinosis - Case report

Follicular mucinosis, also known as alopecia mucinosa, is a cutaneous mucinosis histologically characterized by accumulation of dermal type mucin in the pilosebaceous follicle and sebaceous glands. It presents in two forms, a primary or idiopathic form and a secondary form associated with various benign or malignant processes. Among the malignant processes, the main association is with mycosis fungoides. The frequent overlap of clinical, histopathological, immunohistochemical and molecular biology characteristics makes the correct classification of these conditions difficult, therefore a long follow-up of all cases is recommended. We report the case of an adolescent with disseminated lesions and discuss the difficulty of early identification of secondary follicular mucinosis associated with cutaneous lymphoma.     

Mycosis fungoides and Sézary syndrome: clinical,histopathological and immunohistochemical review and update

This paper reviews the diagnostic and classificatory concepts of mycosis fungoidesand Sézary syndrome in light of the latest normative publications. Itdescribes the great variability of the clinical expression of mycosis fungoides inits early stages as well as the histopathological and immunohistochemical aspectsthat help with diagnosis. The diagnostic criteria required for characterizingSézary syndrome and the staging system used for both mycosis fungoides andSézary syndrome are described.     

Cyclosporin a and tacrolimus (FK506) differentially alter T-cell receptor expression in vivo

Cyclosporin A (CSA) and tacrolimus (FK506) are two common immunosuppressive agents used post blood and marrow transplantation. Despite similarity in their accepted modes of action, we observed polarized effects of CSA and FK506 on the in vivo human T cell repertoire. To determine the possible mechanism for this difference, the effects of CSA and FK506 on cell viability, cell proliferation, interleukin-2 production, and calcineurin inhibition were determined in vitro. Our data suggest that a secondary mechanism of action exists for the different T-cell repertoire induced by exposure to CSA and FK506.     

中线T细胞淋巴瘤的TCR-γ基因重排研究

目的:对中线T细胞淋巴瘤的克隆性进行研究。方法:用一组针对T细胞受体γ链基因V区片段的家族特异性引物和PCR方法,对11例(22个标本)中线T细胞淋巴瘤病例进行了T细胞受体丁基因重排的检测。结果:22个标本中21个有T细胞受体γ链基因的克隆性重排(94.45％)。在9例原发灶的连续活检和1例原发灶及其转移灶的标本中均未发现增生的克隆家族的改变。结论:中线T细胞淋巴瘤的病变组织中存在T细胞的单克隆性增生,为该肿瘤的T细胞起源提供了分子生物学的证据。在中线T细胞淋巴瘤的疾病过程中(包括转移灶)增生T细胞的家族未发生变化,支持肿瘤的单克隆起源学说。     

Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology

Several distinct clinical forms of mycosis fungoides have been described. Hypopigmented mycosis fungoides should be regarded as a subtype of mycosis fungoides, insofar as it presents some peculiar characteristics that contrast with the clinical features of the classical form. Most patients with hypopigmented mycosis fungoides are younger than patients typically diagnosed with classical mycosis fungoides. In addition to typical dark-skinned individuals impairment, hypopigmented mycosis fungoides has also been described in Asian patients. The prognosis for hypopigmented mycosis fungoides is much better than for classical mycosis fungoides: hypopigmented mycosis fungoides is diagnosed when there are only patches of affected skin, and lesions usually will not progress beyond terminal stages, although they can persist for many years. Diagnosis should involve clinicopathologic correlation: skin biopsy analysis often reveals intense epidermotropism, characterized by haloed, large, and atypical CD8+ lymphocytes with convoluted nuclei, in contrast to mild to moderate dermal lymphocytic infiltrate. These CD8+ cells, which participate in T helper 1-mediated immune responses, prevent evolution to mycosis fungoides plaques and tumors and could be considered the main cause of the inhibition of melanogenesis. Therefore, hypopigmentation could be considered a marker of good prognosis for mycosis fungoides.     

T细胞亚群及Ki67在宫颈人乳头状瘤病毒感染进程中的变化及意义

目的 研究人乳头状瘤病毒(HPV)感染进程中,患者CD4+、CD8+T细胞亚群和Ki67的水平变化并探讨其临床意义.方法 2009年3月-2010年12月医院妇科进行宫颈活检的120例患者纳入研究,其中宫颈上皮肉瘤样病变(CIN)Ⅰ、Ⅱ、Ⅲ级以及宫颈鳞癌患者各30例,均为HPV阳性,此外选择同期就诊的30例慢性宫颈炎、HPV阴性患者作为对照组;采用流式细胞仪检测患者外周血的CD4+和CD8+T细胞,采用免疫组化的方法检测病变组织中Ki67的表达.结果 宫颈上皮肉瘤样病变CIN Ⅰ级外周血的CD4+T细胞水平为(562.8±74.5)、CINⅡ级为(446.1±73.5)、CINⅢ级为(315.7±62.4)、宫颈癌组为(235.2±39.9)个/μl,均显著低于对照组的(621.3±87.4)个/μl;并且随着HPV感染的进展,CD4+T细胞水平逐渐降低;CIN Ⅰ级外周血的CD8+T细胞水平为(578.3±77.9)、CINⅡ级为(642.8±82.9)、CINⅢ级为(712.3±85.5)和宫颈癌组(768.4±86.6)个/μl,均显著高于对照组;并且随着HPV感染的进展,CD8+T细胞水平逐渐升高;CIN Ⅰ级病变组织Ki67表达阳性率为20.0％、CINⅡ级为46.7％、CINⅢ级为73.3％和宫颈癌组93.3％,均显著高于对照组的3.3％;并且随着HPV感染的进展,Ki67表达阳性率逐渐升高.结论 HPV感染进程中伴随CD4+T细胞降低、CD8+T细胞以及Ki67升高,免疫功能的降低以及Ki67表达的上调,在宫颈HPV感染进程中起重要作用.     

共刺激受体:肿瘤免疫疗法的潜在靶点

免疫细胞表面的共刺激受体对免疫细胞的活化、增殖及效应功能的发挥具有重要作用。在肿瘤中,共刺激受体经特异性激动性单克隆抗体激活后能增强免疫细胞的效应功能,促进对肿瘤细胞的杀伤,抑制肿瘤的生长,可作为抗肿瘤免疫疗法的靶点。本文就几种共刺激受体在生理条件下、肿瘤免疫及抗肿瘤免疫治疗中的作用进行了综述。