Ocular syphilis:a case series of four patients and a review of the literature

Background:The incidence of syphilis has been increasing in the United States over the last two decades,with a more recent increase among women.Ocular syphilis is an uncommon but important complication of syphilis,most often presenting as posterior or panuveitis in late or latent syphilis of unknown duration.Untreated ocular syphilis may lead to permanent vision loss,underscoring the importance of appropriate evaluation and treatment of ocular syphilis.Case Description:In a retrospective,non-contiguous case series,we highlight four patients diagnosed and treated with ocular syphilis at a single institution.Four presentations of ocular syphilis are illustrated:anterior and intermediate uveitis,optic neuritis,posterior uveitis,and panuveitis.All patients initially presented with a decreased visual acuity(VA).One patient had a previous diagnosis of human immunodeficiency virus(HIV).Three patients were treated with intravenous(IV)penicillin and one patient with IV ceftriaxone.All had a return to their baseline VA after their course of treatment.Conclusions:Syphilis may go undetected without a high index of clinical suspicion due to its nonspecific presentations.All patients with ocular inflammation should have syphilis testing as a part of their infectious workup with both treponemal and non-treponemal testing.Patients diagnosed with syphilis and are not known to be HIV-negative should undergo testing for HIV due to the high rate of co-infection.Early diagnosis and prompt treatment after onset of symptoms may contribute to a more favorable prognosis for ocular syphilis.

Syphilis and HIV Infection among Pregnant Women Previously Screened Negative during Their First Antenetal Care Visit (ANC) at Some Selected Health Facilities in the Buea Health District, Cameroon

Syphilis and HIV are amongst the world’s most widespread diseases, particularly in low-income countries. Syphilis and HIV infections during pregnancy have been associated with numerous adverse pregnancy outcomes. Of concern now are the rising rates of congenital syphilis and HIV in Cameroon. Cameroon only mandates testing pregnant women for syphilis and HIV during their first ANC visit. This study was aimed at determining the incidence of new syphilis and HIV infections and factors associated with pregnant women who previously tested negative during their first ANC visit. A cohort design was used, where 335 pregnant women were followed up for a period from December 2019 to August 2020. A blood sample was drawn and the serum was analyzed using the WANTAI ELISA and AIDTM HIV 1 + 2 Ag/Ab ELISAPlus test methods for syphilis and HIV respectively at three intervals. A questionnaire was used to identify risk factors. Data was analyzed using SPSS 23.0. Out of the 335 pregnant women who were followed up during this study, 49 (14.6%) were later diagnosed with syphilis (32 in 2nd trimester and 17 in 3rd trimester). 54 (16.1%) were diagnosed with HIV infection (13 at two months post-1st-trimester visit, 23 in the 2nd trimester and 18 in the 3rd trimester). Lastly, 10 (2%) were co-infected with syphilis and HIV of which 8 occurred during 2nd trimester and 2 in the 3rd trimester. The factors associated with contracting new syphilis infections include;younger age group aOR (1.302, 95% CI), leaving in an urban area aOR (3.158, 95% CI), lower level of education (Primary and no formal) with aOR of (9.055, 95% CI) (P = 0.001) and (6.764, 95% CI) (P = 0.006) respectively, inadequate knowledge on the diseases aOR (2.176, 95% CI), women unaware of their partner status aOR (3.190, 95% CI). Most factors associated with contracting new HIV infections were similar to the factors associated with contracting new syphilis infections post 1st ANC visit aOR (1.174, 95% CI) and pregnant women with more than one sexual partner aOR (7.342, 95% CI) were observed for HIV infection.. There is an increased incidence of new infection of syphilis and HIV post first ANC screening in the Buea Health District, Cameroon. The need for constant education on the identifiable factors and these diseases, and screening during every ANC visit irrespective of their previous laboratory results is warranted.

Prediction of Hypotension During Neuraxial Anesthesia in Patients with Pregnancy-Induced Hypertension Through Subclavian Vein Collapsibility Index

Objective:To explore and evaluate the predictive value of subclavian vein collapsibility index(SCV-CI)on hypotension during neuraxial anesthesia in patients with pregnancy-induced hypertension(PIH).Methods:Pregnant women with PIH who underwent elective cesarean section in our hospital from January to July 2021 were selected as the research subjects.Patients who experienced hypotension during anesthesia were included into the hypotension group,whereas patients who had a normal blood pressure during anesthesia were included in the normotensive group.The SCV-CI was then calculated for three respiratory cycles,the average value was taken as the base value,and the patient was monitored for another 20 minutes.The blood pressure,heart rate,blood oxygen saturation,and SCV-CI of the patients were measured,and the incidence of maternal nausea and vomiting and cord blood gas were recorded.Then,a correlation analysis was conducted on the relationship between subclavian vein collapsibility index and hypotension.A receiver operating characteristic curve was drawn to seek the threshold value of subclavian vein collapsibility index for post-anesthesia hypotension.Results:There was no significant difference in systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)between the two groups before anesthesia(P>0.05).After anesthesia,the above indexes(SBP,103.25±12.48 mmHg;DBP,58.94±7.46 mmHg;and HR,52.96±6.48 beats/min)were significantly lower than those of the normal blood pressure group,and the difference was statistically significant(P<0.05).In comparison,the SCV-CI in the hypotension group was 35.82±4.93%greater than that in the normal blood pressure group(23.85±5.27%),and the incidence of nausea and vomiting in the hypotension group(40.0%)was significantly higher than that in the normotensive group(10.53%),and the difference was statistically significant(P<0.05).The area under the curve of SCV-CI prediction against hypotension in patients with PIH under neuraxial anesthesia was 0.825(95%CI:0.762-0.893,P<0.001),the cut-off value was 25.68%,the predictive sensitivity was 92.68%,and the specificity was 81.24%.Conclusion:SCV-CI has a good predictive value for the occurrence of hypotension in patients with PIH during neuraxial anesthesia.

Community-based Survey of Prevalence and Risk Factors of Syphilis among Injection Drug Users in Sichuan Province, China

Objectives: To investigate prevalence and risk fac-tors of syphilis infection among injection drug users(IDUs) in Lianshan Yizu Autonomous Region ofSichuan province, China.Methods: From November 8th 2002 to November29th 2002, a community-based cross-sectional surveywas conducted to investigate the demographic charac-teristics and sexual behaviors of a population of IDUs.Blood samples were collected to test for syphilisinfection. A total of 379 subjects were recruitedfor the study through community outreach and peerrecruiting methods.Results: Of 379 IDUs, the syphilis prevalence amongIDUs was 15.3% (58/379). Gender, years of education,history of unprotected sex with non-steady sex part-ner in the last month, number of sex partners in thelast 6 months, frequency of sex with non-steady sexpartner in the last 6 months, and number of any newsex partner(s) in the last 6 months were associatedwith syphilis infection after univariate analysis usingthe chi-squared test. Multivariate logistic regressionanalysis showed that ethnicity (OR, 2.85; 95% CI,1.55-5.25), marriage (OR, 1.94; 95% CI, 1.04-3.62)and receiving money for sex in the last 6 months (OR, ,5.60; 95% CI, 2.65-11.85) were significantly associ-ated with syphilis infection among IDUs.Conclusions: This study found that receiving moneyfor sex in the last 6 months was significantly associ-ated with syphilis prevalence among IDUs. It isrecommended that further health education andintervention campaigns be focused on IDUs to promotesafe sexual practices.

Serum Treponema lgM Antibody Test for Syphilis Diagnoss

Objective: To evaluate the clinical utility of testingserum anti-treponema pallidum IgM antibody in thediagnosis of syphilis patients. Methods: Seventy-two cases of syphilis were testedfor specific IgM antibody with ELISA, and the resultswere compared with RPR and TPPA. Results: The sensitivity of IgM antibody was 73.3%(11/15) in primary syphilis, 88.9% (16/18) in sec-ondary syphilis, and there was no significant differ-ence between these values (x^2=1.6363, P>0.10). Thesensitivity of IgM antibody in diagnosing latent syphi-lis was only 26.1% (6/23), much lower than the detec-tion rate in symptomatic early syphilis (x^2=17.6189, P<0.005). RPR and TPPA were both 100% sensitive inlatent and early symptomatic syphilis. Two were posi-tive for IgM in the 16 cases who had received regulartreatments 2 to 24 months before enrolled. Conclusions: Specific IgM antibody detection doesnot appear superior to RPR and TPPA in diagnosingprimary syphilis. The diagnosis of latent syphilisshould mainly rely on RPR and TPPA, since there arelow titers of IgM antibody at that stage. IgM antibodytesting alone should not be recommended for monitor-ing syphilis development or treatment efficacy. Fur-ther studies should be concerned.

Analysis of Th1/Th2 and Tc1/Tc2 Balance from Peripheral Blood in Patients with Secondary Early Syphilis

Objective: To understand the change of Th1/Th2 and Tc1/Tc2 balance in patients with secondary early syphilis. Methods: Peripheral blood Th and Tc cell subpopu-lations were examined by three-color flow cytometry in 30 patients with secondary early syphilis and 20 healthy subjects. Results: Percentages of CD3+ CD4+ T cells and the ratio of CD4+CD8+ and NK cells in syphilitic patients were significantly lower than in the control group (P<0.001), but no statistical difference was found in percentages of CD8+ and CD19+ cells between the two groups (P > 0.05). The percentage of Th1 cells and ratios of Th1/Th2 and Tc1/Tc2 in syphilitic patients were clearly decreased as compared to those in controls (P<0.001-0.01), whereas percentages of Tc0 and Tc2 cells in syphilitics was higher than those in controls(P<0.001). Conclusion: There could be a disturbance of cellular immunity and the relatively intact function of humoral immunity in secondary syphilis. It is postulated that the polarization toward development of Th2 and Tc2 cells and their associated cytokines might be involved in the incomplete clearance of treponemes and the development of chronic infection.

Serum Levels of Interleukin-2 and -10 in Patients with Early Syphilis

Objective: To investigate the roles of interleukin-2(IL-2) and interleukin-10 (IL-10) in pathogenesis ofearly syphilis. Methods: The serum levels of IL-2 and IL-10 in 48patients with early syphilis were detected by ABC-ELISA. Results: (1) The level of IL-2 in the patients withearly syphilis was significantly higher than that inhealthy controls, while that of IL-10 was lower(P<0.001 and P<0.001). (2) The levels of IL-2 and IL-10 were almost identical in patients with primary andsecondary syphilis (P>0.05), as well as between dif-ferent RPR titers (P>0.05). (3) After therapy, the levelof IL-2 decreased markedly (P<0.05), while that of IL-10 increase (p>0.05). (4) A significant correlation wasfound between the serum levels of IL-2 and IL-10 (r=0.5385 P<0.05). Conclusions: Th1 up-regulation occurs in patientswith early syphilis, and plays an active role in fightingagainst TP infection.

Analysis of the Current situation of Syphilis in a Sexually Transmitted Disease Clinic

Objective： To analyze the current situation of syphilis in the sexually transmitted diseases （STDs） clinic, from January 1994 to December 2002 was studied. Methods： All syphilis patients were confirmed by history, physical examination, dark-field microscopy of samples taken from the chancre or satellite lymph nodes,or positive serological tests. Results： From 1994 to 2002, there were 2067 cases of early syphilis, accounting for 20.01% （2067/10330） of all STD cases. The annual proportion of syphilis cases among all STD cases from 1994 to 2002 was 0.57%, 0.53%, 3.54%, 16.20%, 31.29%, 27.88%, 25.63%, 17.11%, 10.48%, respectively. Of 2067 syphilis patients,49.64% （1026/2067） were male and 50.36% （1041/2067） were female. 44.75% （925/2067） of all cases presented with primary syphilis, 44.90% （928/2067） with secondary syphilis, 9.77% （202/2067） with latent syphilis （without any conspicuous clinical signs or symptoms）, and 0.58% （12/2067） with congenital syphilis. The 30-39 year old cohort accounted for the largest proportion, at 37.68% （779/2067） of all syphilis cases. The 20-29 year old cohort also accounted for a large proportion, at 37.20% （769/2067） of all cases,followed by the 40-49 year old cohort, at 17.95% （371/2067）. Syphilis was most prevalent among the unemployed,self-employed laborers, and office workers in decreasing order. The majority of cases were graduates of either primary school, high school, or college. Of all syphilis cases, 87.86% （1816/2067） were married, and 12.14%（251/2067, including children） were unmarried. 76.78% （1587/2067） of all cases were acquired through extramarital intercourse. 14.03% （290/2067） of cases were infected by their spouses. 0.58% （12/2067） of cases were due to vertical transmission. 8.61% （178） of cases were acquired through indirect contact. Conclusion： The proportion of syphilis infection among all STDs remained stable from 1994 to 1995,quickly and dramatically increased from 1996 to 1999,and then gradually tapered down from 2000 to 2002. The incidence of congenital syphilis infections increased throughout the study period.

Hepatitis C virus infection and biological falsepositive syphilis test:a single-center experience

BACKGROUND:Rapid plasma regain positive and/or treponema pallidum hemagglutination negative [RPR(+)/TPHA(-)] results were designated as biologic false-positive (BFP).There are limited data about BFP reactions against syphilis in patients with hepatitis C virus (HCV) infection.This study aimed to determine the prevalence of BFP reactions for syphilis in patients with HCV infection in a large sample and assess the relationship between BFP reactions and HCV infection.METHODS:A total of 2656 patients with positive anti-HCV and 5600 healthy control subjects were enrolled in this study.Hepatitis C serology was determined by a second generation ELISA test for HCV antibody.Syphilis serology was determined by the RPR test.Those subjects with reactive RPR positive underwent the TPHA test.Demographics and laboratory data were collected by trained clinicians.RESULTS:Among 2656 patients,111 (4.2%) had a reactive RPR test.Of the 111 patients who were subjected to reactive RPR test,30 (27.0%) showed HCV(+)/RPR(+).Of 5600 healthy controls,80 (1.4%) had a reactive RPR test.Fourteen (17.5%) controls with HCV(-)/RPR(+) had a non-reactive TPHA test.These represented 1.1% of all HCV-positive and 0.3% of all HCV-negative subjects (P<0.001).A significantly increased prevalence shown by false-positive tests for syphilis was observed in elderly HCV-seropositive patients.BFP-HCV positive group had a higher prevalence of eosinophilia.The eosinophil abnormality was compared between the patients and controls (66.7% vs 21.4%,P=0.0043).No significant results were observed in antinuclear antibodies,antiphospholipid and complement (C3,C4) (P>0.05).CONCLUSIONS:The data of this study demonstrate that HCV infection is associated with a false-positive RPR test.In this study BFPs were significantly more common in HCV positive patients compared to HCV-negative ones.Eosinophil abnormality can be considered as a predictor for BFP.Excessive BFPs must be considered in assessing the frequency of syphilis in a HCV-positive population and the importance of the treponemal specific serologic test should be emphasized for a diagnosis of syphilis in such population.

Tertiary syphilis mimicking hepatic metastases of underlying primary peritoneal serous carcinoma

Tertiary syphilis,especially in cases involving visceral gummatous disease,can be confused with cancer of the solid organs.We report a case of tertiary hepatic syphilis that manifested with intrahepatic masses in a patient who had an underlying primary peritoneal serous carcinoma (PPSC).The patient was diagnosed with PPSC and achieved a complete remission of PPSC following six cycles of platinum-based chemotherapy.Two hepatic nodules developed during the follow-up period and were initially labeled as hepatic metastases from the underlying PPSC,based on radiological findings.A resection of hepatic nodules was performed for therapeutic and diagnostic purposes,because there were no other metastatic foci except in the liver.Unex-pectedly,serology and histology confirmed tertiary sy philis.This rare case emphasizes the importance of including tertiary syphilis in the differential diagnosis of a space-occupying lesion,even with an existing diagn osis of underlying cancer.

Change of hs-CRP,sVCAM-1,NT-proBNP levels in patients with pregnancy-induced hypertension after therapy with magnesium sulfate and nifudipine

Objective:To investigate the change of the hs-CRP,sVC AM-1,NT-proBNP levels of the patients with pregnancy-induced hypertension(PIH) syndrome.Methods:A total of 200 patients with PIH were divided into mild,moderate and severe group,and 50 healthy pregnancy patients served as the control group.The serum sVCAM-1 levels were detected by enzyme-linked immunosorbent assay,hs-CRP were detected by immunity transmission turbidity,and NT-proBNP levels were determined by the colloidal gold method.Patients were treated with magnesium sulfate and nifudipine and the contrastive analysis was performed before and after treatment.And the pathological changes in placental of PIH patients were delected by hematoxylin-eosin staining at the same time.Results:The hs-CRP,sVCAM-l,NT-proBNP levels of patients in the mild, moderate and severe PHI group were significantly higher than that in the control group(P<0.05). The hs-CKP,sVCAM-l,NT-proBNP levels in the severe group were significantly higher than the mild group and the moderate group,the difference was statistically significant(P<0.05).The hsCRP,sVCAM-l,NT-proBNP of the moderate group were significantly higher than the mild group(P<0.05).There was a positive correlation between hs-CRP,sVCAM-1,NT-proBNP expression levels and the degree of the PIH.The expression of hs-CRP,sVCAM-1,NT-proBNP levels of the moderate and the severe group were significantly decreased(P<0.05).The number of placental villi and interstitial blood vessel in the moderate and severe PIH group were significantly less than the control group(P<0.05).Conclusions:The increased levels of serum hs-CRP,sVCAM-1, NT-proBNP may be involved in the process of vascular endothelial cell injury of the PIH,and the hs-CRP,sVCAM-1,NT-proBNP can be used as the auxiliary index for diagnosis of PIH and determination of PIH severity.

Malignant syphilis accompanied with neurosyphilis in a malnourished patient: A case report

BACKGROUND Syphilis is a common sexually transmitted disease caused by the Treponema pallidum (T.pallidum).Malignant syphilis is a rare presentation of secondary syphilis.Here,we present a case diagnosed with malignant syphilis accompanied with neurosyphilis.CASE SUMMARY A 56-year-old man present with a 2-mo history of spreading ulcerous and necrotic papules and nodules covered with thick crusts over the face,trunk,extremities,and genitalia.The patient was diagnosed with malignant syphilis accompanied by neurosyphilis based on the characteristic morphology of the lesions,positive serological and cerebrospinal fluid tests for syphilis,brain magnetic resonance imaging,and histopathology,along with resolution of the lesions following the institution of penicillin therapy.The lesions and neurological condition successfully resolved after a course of treatment with penicillin.CONCLUSION We suggest that neurosyphilis should be considered whenever people have psychiatric symptoms without cutaneous lesions or human immunodeficiency virus.

Increased Oxidative Stress in Women With Pregnancy-induced Hypertension

Objective To investigate whether pregnancy-induced hypertension （PIH） may increase oxidative stress in women with PIH, and to explore the mechanisms by which PIH may increase oxidative stress and potential free radical damage. Methods Seventy women with PIH and seventy women with uncomplicated normotensive pregnancy （UNP） whose age, nutritional conditions, levels of hemoglobin and albumin were all matched, were enrolled in a randomized controlled trial. Their plasma concentrations of nitric oxide （NO）, vitamin C （VC）, vitamin E （VE）, and β-carotene （β-CAR） as well as their erythrocyte malondialdehyde （MDA）, and activities of superoxide dismutase （SOD）, catalase （CAT） and glutathione peroxidase （GPX） were determined by spcctrophotometry. Results Compared with average values of the above experimental parameters in the women with UNP, the average value of erythrocyte MDA in the women with PIH significantly increased （P〈0.0001）, while the average values of plasma NO, VC, VE, and β-CAR as well as those of erythrocyte SOD, CAT, and GPX in the women with PIH significantly decreased （P〈0.0005-0.0001）. The findings from partial correlation analysis （controlling for age） for 70 women with PIH showed that with elevated systolic blood pressure （SBP） and diastolic blood pressure （DBP）, MDA value gradually increased （P〈0.001）, and NO, VC, VE, β-CAR, SOD, CAT, and GPX values gradually decreased （P〈0.02-0.001）. The findings from reliability analysis for NO, VC, VE, β-CAR, SOD, CAT, GPX, and MDA values used to reflect increased oxidative stress and potential free radical damage in women with PIH showed that the reliability coefficients （alpha, 8 items） = 0.7062, P〈 0.0001, and the standardized item alpha = 0.9116, P〈 0.0001. Conclusion The findings in the present research suggest that pregnancy-induced hypertension can increase oxidative stress and potential free radical damage in women with pregnancy-induced hypertension.

CLINICAL EVALUATION OF FOUR RECOMBINANT TREPONEMA PALLIDUM ANTIGEN-BASED RAPID TESTS IN THE DIAGNOSIS OF SYPHILIS

Objective To assess the sensitivity, specificity, and feasibility of 4 recombinant Treponema pallidum antigenbased rapid tests in the diagnosis of syphilis. Methods A total of 970 outpatients were selected from the Sexually Transmitted Diseases Centre of Peking Union Medical College Hospital. Venous blood was collected and serum was extracted. T. paUidum antibodies in whole blood, anticoagulant whole blood, and serum were detected using 4 recombinant T. pallidum antigen-based rapid tests. T. pallidum haemagglutination test （TPHA） was considered as the gold standard for the detection of T. pallidum specific antibodies in serum. The sensitivities and specificities of four methods were analyzed. Results The sensitivities and specificities of Abbott Determine Syphilis TP test, SD-BIOLINE Syphilis 3.0 test, VISITECT-SYPHILIS test, and Syphicheck-WB test for serum specimens were 100% and 98. 9%, 95.7% and 98.0%, 94.6% and 98.2%, 68.1% and 98.9% ; for whole blood were 74. 1% and 99. 5%, 87.9% and 99.4% , 73.2% and 99.7%, 64. 7% and 99.7%. The observed sensitivities of the 4 rapid diagnosis tests were not significantly different with TPHA （ P 〉 0.05 ）. Conclusions The 4 rapid tests show good performance and characteristics in the diagnosis of syphilis. Furthermore, they are more sensitive for serum specimens than whole blood.

Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

Objective:To report our experience with two tests,anti-cardiolipin antibody test[venereal disease reasearch laboratory(VDRL) test]and specific treponemal test(Treponema pallidum hemagglutination assay),used for screening antenatal,high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008.Methods:A total of 14639 samples received from various patient groups including antenatal cases,patients attending sexually transmitted disease(STD) clinic,blood donors and HIV positive patients were screened.Results:Among the 14639 samples collected,103 were positive by VDRL test.Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay.The cumulative seroprevalence over two years was found to be 0.61%in this study.The syphilis seroprevalence reduced from 0.88%in 2006 to 0.40%in 2008.Among the various sub-populations studied,patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%.The seroprevalence decreased significantly from 4.00%in 2006 to1.39%in 2008.Conclusions:Our study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence.These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.

Eliminating Mother-to-Child Transmission of Syphilis: Chinese Practice before and during COVID-19 Pandemics

Mother-to-child transmission(MTCT)of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries.In 2007,World Health Orgernization launched the global elimination of MTCT(EMTCT)of syphilis.Given the high burden of congenital syphilis,China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis.The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019.However,due to the global pandemic of COVID-19,the current measures for eliminating MTCT of syphilis are greatly challenged.In this article,we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years,the remarkable achievements by the policy support under the leadership of the government.In the context of COVID-19 pandemics,strengthening emergency response to the regional outbreaks of COVID-19,adopting safe,rapid,early and high-quality clinical care for 100%of pregnant women to receive prenatal syphilis testing services,ensuring the availability of Benzathine penicillin for the treatment,and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis.Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.

Expression of TGF-β1 in Placenta of the Patients with Pregnancy-induced Hypertension and Its relationship with Serum VCAM-1

The expression of transforming growth factor-β1 (TGF-β1) in placental tissue of pregnancy-induced hypertension (PIH) and the relationship between the level of expression of TGF-β1 and the amount of vascular cell adhesion molecule-1 (VCAM-1) in serum was studied. Immunohistochemistry ABC was used to detect the expression and distribution of TGF-β1 in placental tissues in 40 PIH women and 20 normal pregnancy women. High resolution pathological image analysis system was used to determine the quality of TGF-β1. The VCAM-1 in serum was examined by enzyme linked immunoabsorbent assay (ELISA). The results showed that TGF-β1 could be express in syncytiotrophoblast. The levels of TGF-β1 expression in placental tissues of the patients with moderate and severe PIH were significantly higher (P<0.05), while the serum VCAM-1 was significantly lower than in normal group (P<0.01). There was a significant positive correlation between the expression of TGF-β1 in placental tissues and the serum VCAM-1 (r=0.969, P<0.01). It was concluded that the level of TGF-β1 expression in PIH was increased and was positively correlated with the amount of serum VCAM-1, indicating that they might be involved in the pathogenesis of PIH.

Peliosis and gummatous syphilis of the liver: A case report

Peliosis hepatis is a rare benign vascular disorder of the liver that may be associated with malignancy, infection and drugs. The imaging manifestation of this disorder is often variable and nonspecific making its diagnosis difficult. We describe a rare case of peliosis hepatis and gummatous syphilis of the liver with emphasis on CT findings. Image characteristics of our patient included pseudotumoral appearance of peliosis hepatis, isodensity to the adjacent liver parenchyma on unenhanced and dual-phase scanning. To our knowledge, peliosis hepatis associated with syphilis and unique enhancement pattern has not been reported. Considering the imaging features of peliosis hepatis, it should be considered in the differential diagnosis of atypical focal hepatic lesion.

Ocular syphilis: resurgence of an old disease in modern Malaysian society

Dear Editor,Syphilis is a spirochaetal bacterial sexually transmitted disease（STD） caused by Treponema pallidum. Outbreaks of syphilis have been described in Western communities, especially in men who have sex with men（MSM） and people infected with human immunodeficiency virus（HIV）^（[1]）. Reports of the condition from Asian countries remains limited.

Second-trimester maternal β-human chorionic gonadotropin level associated with subsequent development of pregnancy-induced hypertension

Objective:To determine whether maternal β-human chorionic gonadotropin(β-hCG) level in second-trimester may be associated with subsequent development of pregnancy-induced hypertension(PIH).Methods:Seven hundred and sixty-two women in mid-trimester were to have maternal urine β-hCG standardized concentrations and maternal serum β-hCG measurements.Their case histories were recorded and reviewed from mid-trimester to delivery.The relation was observed between maternal urine,serum markers and subsequent development of PIH.Results:Among 762 women,504 cases were normal pregnancies,42 cases had PIH,94 cases had premature rupture of membrane (PROM),69 cases had preterm delivery (PD),53 other cases were excluded by various reasons.The levels of maternal urine,serum β-hCG in PIH were (61.75±9.78) IU/L and (304.56±54.17) ng/mg respectively,which were higher significantly than normal pregnancy group ([20.65±7.61] IU/L and [146.34±47.81] ng/mg,P<0.05).When maternal serum,urine β-hCG levels ≥2 MOM(multiple of mean),the incidences of developing PIH were increased significantly as compared with those of β-hCG <2 MOM women.The incidence of PIH increased from 5.1% in pregnancies with urine β-hCG ≥2 MOM to 11.7% in cases with urine β-hCG ≥4 MOM.Conclusion:The elevation of maternal mid-trimester urine,serum β-hCG levels is not only an early signal for dysfunction of placenta but also a dangerous signal for development of PIH.Second-trimester maternal urine β-hCG measurement proves to be superior to serum marker in clinical prediction.