Serum IgA and IgG functional antibodies and their subclasses to Streptococcus pneumoniae capsular antigen found in two aged‐matched cohorts of children with and without otitis media with effusion

Serum IgA and IgG functional antibodies and their subclasses to Streptococcus pneumoniae capsular antigen found in two aged‐matched cohorts of children with and without otitis media with effusion The relationship between acute otitis media and otitis media with effusion (OME) is uncertain and the aetiology of OME is multifactorial. Otitis media with effusion may be an inflammatory condition; both bacteria and viral infections could play a part in this inflammation. The four bacteria Streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aureus and Branhamella catarrhalis cause 60% of the infections whereas S. pneumoniae accounts for up to 35%. IgA provides the dominant surface response to polysaccharide and lipopolysaccharide antigens, of which IgA₂ is the main subclass. Once the mucosa has been breached, most protection is provided by IgG. IgG₂ acts mainly against bacterial capsular antigens. This study looked at two groups of 50 children with and without OME who were aged between 3 and 10 years. The aims were to determine if, firstly, the levels of the serum immunoglobulins were different in the two groups, secondly whether these children made the appropriate antibody response to the capsular antigen to S. pneumoniae (PCP), and finally if there was a delay in the maturity of the IgA response. The total IgG, IgA and all subclass levels were measured using radial immunodiffusion. Levels of functional IgA and IgG were measured using ELISAs (25 patients in each group). The results were analysed with non‐parametric tests. The immunoglobulin levels were within the normal levels for both groups. There were very good correlations between the IgG total anti‐PCP and the IgG₂ anti‐PCP (R > 0.9, p = 0.001). There was a good correlation between the levels of both IgG total and IgG₂ anti‐PCP against IgA total anti‐PCP in both groups (R > 0.85, p > 0.01). This confirms a normal antibody response between both groups of patients. The ages of the controls and patients (50 samples) were correlated with increasing titres of circulating functional antibodies (P = 0.001). This is highly suggestive of a normal age‐related response. In conclusion, the findings were contradictory to our original hypothesis that there is a subtle difference in surface protection between children with and without OME. We believe that a previous history of recurrent acute otitis media is unrelated to the development of OME after 3 years of age.     

Slipped upper femoral epiphysis with hemophilia A

A 13-year-old boy who had hemophilia A was reported with pain in the left thigh and hip on walking. He had no history of trauma. Severe hemophilia A is diagnosed with a Factor VIII level of <1 iu/dl. The presumptive diagnosis was that of a spontaneous bleed into the hip joint. Factor VIII mutational analysis revealed a C to G substitution at nucleotide 6683 which results in a cystine change at codon 2194. However, the symptoms persisted and an X-ray demonstrated the presence of an acute on chronic slip of the upper femoral epiphysis. The patient was transferred to the center treating his hemophilia where the hip was pinned in situ under cover with Factor VIII. This case demonstrates the need to be aware of a possible traumatic diagnosis of hip pain in a hemophiliac child with a longstanding history of spontaneous bleeding into joints.     

雷帕霉素对炎性反应状态下肾小球系膜细胞内脂质稳态的影响

Objective To investigate the effect of rapamycin on cholesterol homeostasis of glomerular mesangial cells and the underlying mechanism. Methods Glomerular mesangial cell line (HMCL) cells were cultured and divided into control group, IL-1β group and different concentration rapamycin groups. Intracellular cholesterol accumulation was observed and measured by oil O staining and HPLC. Real-time quantitative PCR and Western blot were used to detect the mRNA and protein expression of LDLR, PPARγ, LXRα, ABCA1 in HMCL after the treatment with IL-1β and rapamycin. Results Rapamycin had no significant influence on intracellular cholesterol concentration under normal condition. IL-1β significantly increased the intracellular cholesterol concentration by 143％ of control (P<0.05), and 10, 50, 100 ?滋g/L rapamycin could significantly inhibit the effect of IL-1β (87％, 116％, 96％ of control respectively, all P<0.05). Rapamycin could suppress the increased expression of LDLR caused by IL-1β on both mRNA and protein level in a dose-dependent manner（P<0.01）. Rapamycin dose-dependently up-regulated the reduced mRNA and protein expression of ABCA1, the decreased mRNA expression of PPARγ and LXRα induced by IL-1β as well (P<0.01）. Conclusion Rapamycin may contribute to the maintenance of intracellular cholesterol homeostasis in glomerular mesangial cells under inflammatory state by both reducing cholesterol uptake and promoting cholesterol efflux.     

Epidemiological considerations following long-term surveillance of invasive group A streptococcal disease in The Netherlands, 1992–2003

A nationwide laboratory-based surveillance system for invasive group A streptococcal (GAS) infections was conducted in The Netherlands from March 1992 until December 2003. Until 1996, all isolates submitted were evaluated clinically and demographically. During this period there was a transition from passive to active surveillance for some of the participating laboratories, corresponding to a national coverage of 50%. During active surveillance, participating laboratories submitted twice as many isolates from invasive GAS disease, whereas the relative submission of isolates representing very severe manifestations (toxic shock-like syndrome, fatality) did not increase. From 1997 onwards, invasiveness was defined solely on the basis of source of isolation (without clinical evaluation). During the period of microbiological and clinical evaluation, microbiological evaluation alone was found to be specific (> 99%), but had limited sensitivity (66%). Estimation of the true rate of invasive GAS disease should be based on an active surveillance system with inclusion of both microbiological and clinical data.     

Giant intracranial aneurysm of the anterior communicating artery treated by direct surgery using A3–A3 side-to-side anastomosis and A3-RA graft-STA anastomosis

Summary We describe a giant aneurysm of the anterior communicating artery (ACoA) which was treated with a STA-RA graft-A3 bonnet bypass and A3–A3 side-to-side anastomosis. A giant and partially thrombosed ACoA aneurysm was partially coated 3 years before his current presentation, its gradual increase producing visual field disturbances. An A3–A3 side-to-side anastomosis and STA-RA graft-A3 bonnet bypass were performed. The aneurysm was dissected, and the thrombus removed under transient parent-artery occlusion. The aneurysmal neck was successfully clipped without encountering ischemic changes. This strategy may be useful for treating giant or thrombosed aneurysms in the region of the ACoA.     

肾母细胞瘤RASSF1A基因启动子区甲基化研究

目的了解肾母细胞瘤RASSF1A基因启动子区甲基化情况。方法手术获取9例肾母细胞瘤及瘤旁残留肾组织,提取DNA后用亚硫酸氢钠处理,巢式PCR扩增RASSF1A基因启动子区DNA片段,测序,检测启动子区甲基化情况。结果发现1例16个CpG岛位点中有10个存在甲基化(10/16),相应瘤旁残留肾组织无甲基化(0/16);在另1例瘤组织中检测到12个CpG岛位点存在甲基化(12/16),但仅有8个CpG岛位点与上例相同,另外4个位点不同。结论肾母细胞瘤中RASSF1A基因启动子区存在甲基化,与瘤旁残留肾组织甲基化情况有差别。     

脊髓血管畸形血管内皮生长因子在脑脊液的表达

目的探讨脊髓血管畸形是否存在血管内皮生长因子(VEGF)表达,及其表达与临床特征之间是否存在相关性。方法在手术中留取56例脊髓血管畸形的脑脊液标本,其中动静脉畸形(SCAVM)23例,硬脊膜动静脉瘘(SDAVF)19例,海绵状血管瘤(CM)14例;以我院12例蛛网膜下腔阻滞病人脑脊液作为对照组,分别通过酶联免疫吸附方法(ELISA)测定脊髓血管畸形脑脊液中VEGF含量。结果SCAVM脑脊液中VEGF浓度为(277±66)pg/ml、SDAVF为(318±54)pg/ml、CM为(146±32)pg/ml均高于正常对照组(123±27)pg/ml。术前栓塞和出血均可导致脑脊液VEGF升高。结论VEGF与脊髓血管畸形的发生、发展存在一定关系,出血和栓塞均可影响VEGF的表达。     

Treatment of cremaster synkinesias with botulinum toxin A: a video case report.

Synkinesias secondary to nerve lesions and aberrant re-innervation are well-known phenomena especially after lesions of the facial nerve. Synkinesias can successfully be treated with botulinum toxin A (BTx A). Synkinesias of the cremaster muscle have not been described or treated to date. We present the case of a 62-year-old man who developed synkinesias of both cremaster muscles after extensive laparatomy for esophageal cancer. Treatment of synkinesias with various oral medications had been unsuccessful. Electromyography-guided injections of BTx A in both cremaster muscles (15 MU on the right and 10 on the left) led to significant symptom relief for an average of 8 weeks. We present the case including pre- and posttreatment video clips.     

No association of C-1019G promoter polymorphism of 5-HT1A receptor gene with migraine

It is well known that migraine has a strong genetic component, although the type and number of genes involved remains unclear. There is evidence to suggest that serotonin-related genes may be involved in the pathogenesis of migraine. To investigate whether the 5-HT1A receptor gene contributes to the risk of migraine we performed an association study of C-1019G promoter polymorphism of the gene in 102 migraineurs and 93 controls. Subjects were of Han Chinese origin. No significant differences in allele (P=0.82) or genotype frequencies (P=0.71) were seen in migraineurs compared with the controls. When migraine with aura, without aura, with family history, without family history were analyzed separately, the frequencies did not vary significantly. Our results suggest that C-1019G in 5-HT1A is not a major genetic risk factor for migraine.     

转移相关基因nm23和P53及S100A4在晚期胃癌中的表达及与侵袭转移的相关性研究

目的探讨转移相关蛋白（nm23和P53及S100A4）在晚期胃癌转移发展过程中的意义。方法应用组织芯片和免疫组织化学方法研究nm23、P53和S100A4在74例胃癌患者的癌、癌旁、淋巴结转移、远处转移（肝脏、胰腺、卵巢等）组织中的表达。结果同癌旁组织相比，癌组织中P53和S100A4表达明显升高（P〈0．01），而nm23的表达明显降低（P〈0．05）；同癌组织相比，淋巴结中nm23的表达明显降低（P〈0．05）。远处转移组织S100A4表达明显升高（P〈0．01）。3者的阳性表达与胃癌的部分恶性生物学行为有关。癌组织中nm23^＋／P53^＋、P53^＋／S100A4^＋和nm23^＋／S100A4^＋的基因表型比例分别为48例（64．9％）、50例（67．6％）和39例（52．7％），其中P53^＋／S100A4^＋、nm23^＋／S100A4^＋和nm23^＋／P53^＋／S100A4^＋均与胃癌的高转移潜能相关。结论nm23和S100A4在肿瘤转移中发挥了重要作用；联合检测nm23、P53和S100A4的表达可用于评定胃癌的转移潜能。