Major histocompatibility complex class II (DRB1*, DQA1*, and DQB1*) and DRB1*04 subtypes' associations of Hashimoto's thyroiditis in a Greek population

Hashimoto's thyroiditis (HT) is an autoimmune disease resulting from complex interactions between genetic and environmental factors. The disease is associated with certain human leukocyte antigen (HLA) class II alleles in various populations. We aimed to determine in this study, for the first time in a Greek population, the association of HLA-DRB1*, -DQA1*, and -DQB1* alleles with HT. HLA-DRB1*, -DQA1*, and -DQB1* alleles' and -DRB1*04 subtypes' distribution was evaluated in 125 patients with HT and in 500 healthy control individuals by using a DNA-based sequence-specific primer method. Chi^_squared tests and Bonferroni correction method were applied in the statistical analysis of the data. Significantly higher frequency of DRB1*04 (24.8% vs 7.7%, P  < 0.0001) was observed in HT patients, while HLA-DRB1*07 was significantly decreased (2.8% vs 7.9%, P  < 0.05). HLA-DRB1*04 subtyping showed a significant increase of DRB1*0405 (21% vs 7.8%, P  < 0.0001) in HT patients. Also significant high frequencies of DQB1*0201 (14.8% vs 8.2%, P  < 0.001), DQB1*0302 (18.8% vs 7.0%, P  < 0.0001), and DQA1*0301 (25.6% vs 7.8%, P  < 0.0001) were recorded in the patient group. Conducting the first research of this kind in a Greek population, our study tries to provide an evaluation of the prevalence of HT relating to HLA-DRB1*0405, and we report a relative risk of 2.7 for HT in a Greek population.     

CK19、RET、Survivin在甲状腺乳头状癌及淋巴细胞性甲状腺炎中表达的意义

目的:探讨淋巴细胞性甲状腺炎(LT)与甲状腺乳头状癌(PTC)之间的关系。方法:选取手术切除并经病理证实的26例LT、26例PTC及28例LT合并PTC组织,应用免疫组织化学法检测细胞角蛋白19、RET、Sur-vivin蛋白的表达。结果:CK19、RET、Survivin在LT合并PTC中的癌组织与癌周淋巴细胞性甲状腺炎组织中的表达均无统计学差异(P>0.05)。在单纯PTC及LT合并PTC两组淋巴结转移状况的比较中,Survivin的阳性率在周围淋巴结转移组均高于无淋巴结转移组,差异有统计学意义(P<0.05)。结论:(1)LT与PTC的关系密切,LT可被认为是一种癌前病变。(2)Survivin蛋白的表达与PTC及LT合并PTC的淋巴结转移呈正相关,可以作为判断其转移倾向的参考指标。     

Bcl-2,Caspase-3在甲状腺癌和桥本甲状腺炎中的表达及意义

目的探讨Bcl-2,Caspase-3在甲状腺癌和桥本甲状腺炎中的表达及意义。方法采用TUNEL法检测37例甲状腺癌和14例桥本甲状腺炎组织中的细胞凋亡率,并采用免疫组织化学方法检测Bcl-2和Caspase-3的表达及分布。结果桥本甲状腺炎组中细胞凋亡率(28.6%)比甲状腺癌组(5.4%)显著增高(P<0.05),桥本甲状腺炎淋巴细胞浸润区的甲状腺滤泡Bcl-2蛋白表达阳性率(64.3%)比甲状腺癌组(91.9%)中明显降低(P<0.05)。桥本甲状腺炎甲状腺滤泡中Caspase-3表达阳性率(85.7%)比甲状腺癌组中(56.8%)明显增高(P<0.05)。甲状腺组织中凋亡细胞和Caspase-3阳性细胞主要分布于淋巴滤泡浸润附近,Bcl-2阳性细胞则多分布于远离淋巴滤泡浸润区域。结论Bcl-2,Caspase-3在甲状腺癌和桥本甲状腺炎中的表达有差异,可能是导致甲状腺癌凋亡水平相对低下,桥本甲状腺凋亡水平增高的重要因素。     

Complications of childhood Sjögren syndrome

Sjögren syndrome (SS) is a common disorder in adults and involves both glandular and extraglandular systems. We report here four cases of childhood SS complicated by chronic thyroiditis, interstitial nephritis or sweat gland inflammation. Additionally, in one of these cases, the central nervous system was involved. All of these complications are common in adult cases.     

Increased serum creatinine associated with severe primary hypothyroidism

A case of myxoedema due to Hashimoto's thyroiditis associated with a significant increase in serum creatinine is reported. Thyroid hormone replacement therapy resulted in normalization of the serum biochemistry within 1 month.     

Juvenile Form der subakuten nekrotisierenden Encephalomyelopathie (Leigh) mit ungewöhnlicher ZNS-Lokalisation

Summary The case of an adolescent girl aged 16 with subacute necrotizing encephalomyelopathy (Leigh) is reported. The chronic course of illness lasting for 7.5 years was characterized by visual and gait disorders progressing to blindness, incomplete spastic tetraparesis, and fatal respiratory insufficiency. Neuropathology, in addition to CNS lesions with typical pattern, revealed involvement of Ammon's horn, fornix, corpora mammillaria, tractus mammillothalamicus, and corpus callosum. The massive damage to the total Ammon's horn formation, the distribution of which correlates to none of the established patterns of lesion, is related to the primary disease given, and an additional secondary transneuronal degeneration of associated systems is suggested.

     

Changes in the sensitivity to cholinomimetic drugs of smooth and cardiac muscle in the rat induced by subacute administration of di-isopropyl phosphorofluoridate

The effect of subacute administration to rats of di-isopropyl phosphorofluoridate (DFP) on the sensitivity of the cardiovascular system to carbachol and on the sensitivity of various isolated tissues to acetylcholine, methacholine and carbachol was investigated. Cholinesterase inhibition produced by DFP in the isolated tissues was also determined.In the cardiovascular experiments both the magnitude of responses and the slope of the dose-response curves for hypotension and bradycardia produced by carbachol in the anaesthetized rat were reduced in the DFP-treated group.In experiments with isolated tissuesfrom DFP-treated animals it was found that sensitivity to methacholine and acetylcholine increased in the bladder to a greater extent that in the atria or ileum. The sensitivity to carbachol decreased to a similar extent in all 3 tissues. Acetylcholinesterase and butyrylcholinesterase levels in the bladder were inhibited to a greater extent than in the other 2 tissues.The results show that the degree of enzyme inhibition produced by DFP in the tissues after subacute administration for 10 days does not correlate with the decrease in the sensitivity of the tissues to carbachol. It is suggested that the association between accumulation of transmitter and enzyme inhibition is a more important factor than the degree of enzyme inhibition itself in the development of subsensitivity to carbachol.The release of cholinergic transmitter from the electrically stimulated isolated rat bladder may also be impaired following subacute administration of DFP.     

Post-acute intermediate care in nursing-led units: a systematic review of effectiveness

OBJECTIVE: In order to determine whether post-acute intermediate care in nursing-led inpatient units (NLUs) is effective in preparing patients for discharge from hospital we conducted a systematic review of the evidence. REVIEW METHODS: The Cochrane Library, Effective Practice and Organisation of Care specialist register, Medline, Cinahl, Embase, British Nursing Index and the HMIC databases were searched for all available dates up to mid-2003. The science and social science citation indices were searched for papers that cited key works. Authors of papers were asked to identify additional research. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time-series designs that compared the NLU to usual post-acute inpatient care for adults were included in the review. Studies were assessed for quality. Statistical meta-analysis on the results of controlled trials was performed. Sensitivity analyses were conducted to determine the impact of methodological quality on conclusions. OUTCOMES: Outcomes considered were mortality, institutionalisation after discharge, functional status early readmission, length of inpatient stay and cost. RESULTS: Nine random or quasi-random controlled trials involving 1669 patients were reviewed. Quality was variable. The mean age of patients in all studies was over 70 years. There was no statistically significant difference in inpatient mortality between NLU and usual inpatient care (OR 1.10, 95% CI 0.56-2.16). The NLU was associated with reduced odds of discharge to institutional care (OR 0.44 95% CI 0.22-0.89), better functional status at discharge (SMD 0.37, 95% CI 0.20-0.54) and reduced odds of early readmission (OR 0.52 95% CI 0.34-0.80). Length of stay until discharge home was increased by 5.13 days (WMD) (95% CI-0.5-10.76 days). At longest follow up (3-6 months) there was no statistically significant difference in the proportion of patients in institutional care (OR 0.97, 95% CI 0.60-1.58). The results were not generally sensitive to study quality. CONCLUSIONS: The NLU successfully functions as a form of intermediate care, so far there is no evidence of adverse outcome from the lower level of routine medical care. However, more research is required to confirm safety. Patients discharged from NLUs have higher levels of function although it is unclear if the benefit is simply a product of an increased stay. There is no evidence of benefit over the longer term.     

Different virus antibodies in serum and cerebrospinal fluid of patients suffering from subacute sclerosing panencephalitis

Complement fixing (CF) antibody titers to measles, parainfluenza (PI) types I and 3, mumps, herpes type 1, and cytomegalovirus (CMV) in serum and cerebrospinal fluid (CSF) of 33 patients with subacute sclerosing panencephalitis (SSPE) were evaluated. Results were analyzed in comparison to 11 patients with neurological diseases other than SSPE and 7 normal subjects. All SSPE patients had elevated serum and CSF measles antibody titers. The number of SSPE patients manifesting elevated titers other than measles did not reach statistical significance when compared to controls, except for PI type 1. This suggests a possible dual infection with measles and PI in SSPE. The anticomplementary effect detected in the serum and CSF of some patients indirectly suggests the presence of immune complexes.