Analysis of publication trends in two internationally renowned ophthalmology journals

International journals represent a forum for exchange of current information with contributions from all over the world. High standards are essential. In this report, we compared the publishing trends of two internationally renowned ophthalmology journals--the British Journal of Ophthalmology (BJO) and the American Journal of Ophthalmology (AJO).     

固定衬垫式和活动衬垫式全膝人工关节置换术后随访4．5年以上的对比性研究

背景：低接触应力旋转平台（活动衬垫式）和Insall Burstein-Ⅱ型（固定衬垫式）全膝人工关节假体各自独立的长期稳定性已有报道，但我们尚未见有关这两种假体的中长期随访及对比性研究。 方法：对32例双侧膝关节畸形和术前活动范围均相似的膝关节炎患者进行了前瞻性评估，患者同意一侧膝关节行活动衬垫全膝关节置换，另一侧膝关节行固定衬垫全膝关节置换。术后平均随访6年，使患者、医生和观测者的相关干扰降至最小，对两种假体进行对比分析，项目包括临床和X线片结果、生存率和并发症发生率。 结果：术后骨关节炎患者的功能评分和活动范围好于类风湿性关节炎患者。然而，对患者在膝关节协会评分、屈曲范围、主观表现或髌股并发症发生率等方面进行评估，没有发现活动衬垫式假体比固定衬垫式假体更好。X线片显示两者在假体排列上没有差异。两例使用活动衬垫式假体的膝关节需要再次手术，其中1例因衬垫脱位而需要早期翻修，另1例因深部感染而进行关节融合。 结论：我们发现中期随访患者的临床表现显示，活动衬垫式全膝关节置换术并不比固定衬垫式全膝人工关节置换术具有更多的优点。活动衬垫式假体发生假体脱位和半脱位的危险性应给予重视，在发生脱位后要早期进行翻修。 可信水平：治疗性研究，Ⅱ级，进一步可信度参见作者介绍。     

T cell subsets and Langerhans cells in lichen planus: in situ characterization using monoclonal antibodies

Skin biopsies from four patients with lichen planus were studied using monoclonal antibodies directed against T lymphocytes. Anti-T1 and anti-T3 antibodies, which react with all peripheral T cells, stained most cells in the dermal infiltrates. The majority of infiltrating cells also stained with anti-T4 and anti-T4b antibodies, which react with helper/inducer cells, whereas a minority of cells stained with anti-T8 antibody, which reacts with cytotoxic/suppres-sor cells. Surface IgM was not identified on any infiltrating cells, providing evidence against B cell participation. Intraepidermal and dermal cells with long cytoplasmic extensions stained with anti-T6 antibody in all cases, defining them as Langerhans cells or their precursors. T6-positive cells were seen in greater number than in normal control epidermis and dermis. The results indicate that well-developed lesions of lichen planus are characterized by an influx of helper/inducer T lymphocytes and increased numbers of Langerhans cells. These observations support the contention that cellular immunity is important in the pathogenesis of this disorder.     

A Study to Assess the Efficacy of Chemoprophylaxis in the Prevention of Endoscopy-related Bacteraemia in Patients Aged 60 and Over

Five hundred and fifteen patients aged 60 and over (mean age74.7; 278 men and 237 women) underwent routine endoscopic procedures(gastroscopy, bronchoscopy and cystoscopy). Alternate patientswere given antibiotics before the procedure, as currently recommended,and blood was taken for culture from all patients within fiveminutes of completion of the procedure. Of 74 patients who underwent bronchoscopy, only one culture,from one of 37 controls was positive. Of 262 who underwent gastroscopy,cultures were negative in the 130 who received antibiotics butpositive in 13 of the 132 controls (9.8 per cent p<0.001).Cystoscopy was performed in 179; one culture was positive inthe 88 given antibiotics (1.1 per cent) compared to 25 in the91 controls (27.5 per cent; p<0.001). Bacteraemia rates appear to be low following bronchoscopy (<5per cent) but higher with gastroscopy (10 per cent) and cystoscopy(28 per cent). Chemoprophylaxis was effective in reducing theserates in this patient group.     

In situ identification of T6-positive cells in normal human dermis by immunoelectron microscopy*

Monoclonal anti-T6 antibody, which reacts with the majority of cortical thymocytes but not peripheral T cells, also reacts with human epidermal Langerhans cells, as shown by a four-step immunoperoxidase method and immunoelectron microscopy. To define whether T6-positive cells are also present in normal human dermis, we used these techniques to demonstrate two immunologically distinct populations of histiocyte-like cells in normal human dermis. The first population contains cells devoid of phagolysosomes or Birbeck granules. These cells react with anti-T6 antibody, but not with monoclonal anti-T3 antibody which defines peripheral T cells, and are found predominantly in and around dermal lymphatic vessels. The second is composed of phagolysosome-containing cells which do not react with anti-T6 antibody or anti-T3 antibody. Because to date, Langerhans cells are the only cells in normal human epidermis that react with anti-T6 antibody, these data provide immunological evidence for a specific link between Langerhans cells and a T6-positive dermal mononuclear cell, possibly the so-called indeterminate cell. In addition, application of these techniques should, for the first time, permit the immunological distinction of these T6-positive mononuclear cells from other cells bearing la antigens, such as dermal histiocytes and certain lymphocytes, in normal and diseased skin.     

Distribution of major histocompatibility antigens in normal skin

The distribution of major histocompatibility antigens HLA-A,B,C (HLA), beta 2-microglobulin (beta 2m), and Ia-like antigens (HLA-DR; Ia) in normal skin was studied in frozen tissue sections by a four-step immunoperoxidase method and an avidin-biotin method employing monoclonal antibodies. HLA and beta 2m were present on the basal and spinous keratinocytes of the epidermis, on the outer root sheath epithelium in the infundibulum of the hair follicle, and on the excretory sebaceous duct epithelium. Ia-positive dendritic cells were found in the epidermis and hair follicles, but they were more frequent in the infundibulum and isthmus of the hair follicle than in its inferior portion or in the epidermis. In the straight eccrine duct, HLA and beta 2m-positivity was most striking in its lower portion. In the superficial duct, there was a less intense staining using the four-step procedure, but when an avidin-biotin method was used, the difference was less apparent. In contrast, the acrosyringial epithelium was markedly Ia-positive with decreasing intensity of staining as the duct penetrated the dermis. No HLA or Ia antigens were identified in eccrine glands and apocrine glands. Eccrine glands were slightly beta 2m-positive. HLA and beta 2m were uniformly present in non-dilated and dilated intradermal apocrine ducts.     

Leucocyte Migration Inhibition in Cow's Milk Protein Intolerance

ABSTRACT. The leucocyte migration inhibition (LMI) was determined in an assay after in vitro challenge with beta-lactoglobulin. The assay was considered positive when migration inhibition index was greater than 20 % (mean +3 SD of healthy infants). Ninety-eight infants with protracted diarrhoea and failure to thrive, 16 healthy, 12 malnourished, and 16 infants suffering from acute gastroenteritis were studied. Of the 98 patients with protracted diarrhoea, 12 fulfilled Goldman's criteria for cow's milk protein intolerance, 63 had lactose malabsorption, and in 15 no associated causative factor was identified. The mean index of migration inhibition in the cow's milk allergic group (58.83 ± 11.98) was higher than in healthy controls (8.25 ± 3.91), the difference being statistically significant ( p < 0.05). The test was positive in all patients with caw's milk protein intolerance. The assay was also positive in four other patients suffering from protracted diarrhoea, two of whom had lactose malabsorption. All the infants with acute gastroenteritis and malnutrition had values within the normal range. The migration inhibition index in five patients with cow's milk intolerance had declined to 24.74 ± 4.87 in assays performed 1-6 weeks after return of clinical tolerance to cow's milk ( p < 0.05) but the test was still within the postive range in three of the five infants. These results suggest that this cell mediated immune assay is a sensitive test for the diagnosis of cow's milk protein intolerance in infants. The specificity needs to be reassessed in the light of more objective criteria for the diagnosis of cow's milk protein intolerance.     

Novel screening strategies for early ovarian cancer by transabdominal ultrasonography

Summary. Data collected during a prospective study to assess the efficacy of detecting early ovarian cancer by transabdominal ultrasonography have been used to refine and extend the screening procedure. The analysis was based on results from 5479 self-referred asymptomatic women, who were scheduled to undergo three annual screens consisting of one or more ultrasound scans. A positive result (based mainly on the presence of abnormal morphology) was obtained at 338 screens (326 women). Five patients with primary ovarian cancer (four stage la, one stage 1b; two at screen 1, three at screen 2) were identified (prevalence 0.09%). The apparent detection rate was 100% and the false-positive rate (FPR) was 3.5% at screen 1 and 2.3% overall. The use of abnormal morphology, or the maximum ovarian volume (MOV) >96th centile as alternative criteria for a positive screen result, together with a defined volume change at rescan (VC) would give a FPR of 3.1% at screen 1 and 2.0% overall. The use of abnormal morphology alone at scan 1 and VC at rescan would give an overall FPR of 1.6%. The odds that a positive screen result would indicate the presence of an ovarian mass, a benign tumour, any ovarian cancer or primary ovarian cancer would be about 4 to 1, 2 to 1, 1 to 26, and 1 to 50 respectively. The results provide a more rational basis for the application and development of screening procedures for early ovarian cancer in both pre and postmenopausal women.     

Ovarian size in postmenopausal women

Summary. Ovarian volumes have been determined by pelvic ultrasonography in 2246 apparently healthy postmenopausal women of whom 2221 were included in the statistical analysis. Factors associated with gonadal size have been identified, and reference ranges for derived indices have been determined for use (in association with criteria for abnormal morphology) in a screening programme for ovarian carcinoma. The right ovary was present in 98·9% of subjects and the left in 99 · 1 %. The mean (SD; range) of right and left ovarian volumes were 3·58 (1·40; 1·00–14.01) and 3·57 (1·37; 0·88–10·9) ml respectively. Significant predictors of ovarian volume were years since the menopause, weight, parity, age at menopause, a history of hormone replacement therapy, and previously diagnosed breast cancer. Abnormal ovarian volumes were assessed from a score equal to the (observed mean log volume (MLV) minus the predicted MLV)/0·327. A simplified nomogram has been prepared for routine clinical use. The relative abnormality of one ovary was assessed from a ratio score equal to log_e (larger ovarian volume/smaller ovarian volume)/0·211 compared with the 99th centile for the Gaussian distribution.