Catastrophic gastrointestinal complication of systemic immunosuppression

We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone.The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis.Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus(HSV)and cytomegalovirus(CMV)respectively.Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens.CMV on the other hand most commonly causes a colitis or less commonly oesophagitis.CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only.Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate.The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.

Role of cytokines and other factors involved in the Mycobacterium tuberculosis infection

Mycobacterium tuberculosis （Mtb） is a pathogen that is widely distributed geographically and continues to be a major threat to world health. Bacterial virulence factors, nutritional state, host genetic condition and immune response play an important role in the evolution of the infection. The genetically diverse Mtb strains from different lineages have been shown to induce variable immune system response. The modern and ancient lineages strains induce different cytokines patterns. The immunity to Mtb depends on Th1-cell activity [interferon- γ （IFN- γ ）, interleukin-12 （IL-12） and tumor necrosis factor-α （TNF-α）]. IL-1β directly kills Mtb in murine and human macrophages. IL-6 is a requirement in host resistance to Mtb infection. IFN- γ , TNF-α, IL-12 and IL-17 are participants in Mycobacterium-induced granuloma formation. Other regulating proteins as IL-27 and IL-10 can prevent extensive immunopathology. CXCL 8 enhances the capacity of the neutrophil to kill Mtb . CXCL13 and CCL19 have been identified as participants in the formation of granuloma and control the Mtb infection. Treg cells are increased in patients with active tuberculosis （TB） but decrease with anti-TB treatment. The increment of these cells causes down- regulation of adaptive immune response facilitating the persistence of the bacterial infection. Predominance of Th2 phenotype cytokines increases the severity of TB. The evolution of the Mtb infection will depend of the cytokines network and of the infuence of other factors aforementioned.

Management of ischemic proctitis with severe rectal haemorrhage: A case report

Acute ischemic proctitis is a rare pathological condition. We report here a patient presented with massive rectal haemorrhage from a bleeding vessel superimposed on an underlying pathology of ischemic proctitis. This case report illustrates the difficulties in making the clinical distinction between ischemic proctitis and other pathological entities. We also discussed the beneficial role of arteriogram with embolotherapy as an effective therapeutic measure in the management of lower gastrointestinal bleeding. The literature on the subject is reviewed.

Comparison of Perfusion Weighted Magnetic Resonance Imaging and Single Photon Emission Computed Tomography for Assessment of Cerebrovascular Reserve in Symptomatic Carotid Territory Stenosis

Background: Perfusion Weighted Magnetic Resonance Imaging (PW-MRI) and HMPAO Single Photon Emission Computed Tomography (SPECT) are both cerebral perfusion measurement techniques. Imaging before and after acetazolamide administration can assess cerebrovascular reserve in symptomatic haemodynamic cerebrovascular disease. We compared SPECT and PW-MRI parameters in this patient group. Methods: We identified 10 patients with haemody-namically induced symptoms and intra- or extra-cranial arterial stenoses with back-to-back acetazolamide challenge SPECT and PW-MRI, 4 of whom had resting studies. Regions of interest (ROIs) were applied to parameter maps using an ASPECTS template and perfusion parameters expressed relative to contralateral ROIs, giving 118 challenge and 48 resting ROIs. Results: SPECT relative cerebral blood flow (rCBF) correlated with PW-MRI time to peak (TTP) (r = ?0.568), mean transit time (MTT) (r = ?0.317), regional cerebral blood flow (rCBF) (r = 0.299) and cerebral blood volume (CBV) (r = 0.224). Bias between SPECT and PW-MRI rCBF was small (?0.018) with wide limits of agreement and a systematic measurement error. Pre- to post-acetazolamide PW-MRI rCBF change showed poor sensitivity and specificity for detecting change in SPECT rCBF. SPECT and PW-MRI rCBF had stronger correlation and smaller bias in unilateral stenosis than with bilateral stenosis. Conclusion: Systematic bias between techniques limits interchange- ability in cerebrovascular reserve measurement in patients with cerebrovascular stenosis.

多发性硬化症损害与外观正常白质早发与迟发HHV-6的基因转录

Multiple sclerosis is an inflammatory demyelinating disease of the CNS, the ae tiology of which is believed to have both genetic and environmental components. We have investigated one of the candidate viruses for the environmental componen t of multiple sclerosis, the neurotropic human herpesvirus 6 (HHV-6).Utilizing fluorescent in situ hybridization (FISH) techniques,we have examined human post -mortem tissues for the presence of immediate early and late viral gene express ion in multiple sclerosis patient normal appearing white matter (NAWM), lesional tissue and normal control brain samples. HHV-6 gene transcription was detected in all tissue samples and was restricted to oligodendrocytes, as determined by double mRNA FISH analysis. Quantitative analysis of viral mRNA expression indica ted that both NAWM and lesional multiple sclerosis samples exhibited significant ly higher levels of HHV-6 expression compared with the normal control samples. Lesional samples exhibited the highest levels of viral gene expression,with NAWM exhibiting an intermediate level between lesional and control tissues. Immunofl uorescence against early and late HHV-6 proteins verified active translation of HHV-6 viral mRNA in oligodendrocytes. Southern blot analysis of nested polymer ase chain reactions using extracted genomic DNA and cDNA confirmed the presence of the HHV-6 genome in all individuals,with the active expression profile mirro ring the FISH results. The frequent high level of HHV-6 infection in multiple s clerosis samples suggests a possible role in pathogenesis.

Incidental seminal vesicle amyloidosis observed in diagnostic prostate biopsies--are routine investigations for systemic amyloidosis warranted？

Seminal vesicle （SV） amyloidosis is a well-documented histological entity, but it is observed infrequently. Its incidence is on the rise, which is probably related to the increasing use of prostate biopsies to investigate patients with elevated serum prostate-specific antigen levels. Here, we report seven cases of incidental SV amyloidosis over a 3-year period and consider their relationship to the previously suggested aetiological factors. Based on our series, we conclude that incidental localized SV amyloidosis observed in diagnostic prostate biopsies does not warrant formal investigations for systemic amyloidosis.

A Review of Endocrine Disorders in Thalassaemia

Endocrine dysfunction in thalassaemia is amongst the most common complication and is principally attributed to excessive iron overload and suboptimal chelation. The prevalence is quite high particularly in multiethnic populations but determining the prevalence is often difficult due to the widespread heterogeneity of the population and timing of exposure to chelation therapy. Disturbances in growth, pubertal development, abnormal gonadal functions, impaired thyroid, parathyroid and adrenal functions, diabetes and disorderly bone growth are commonly encountered. Early detection and institution of appropriate transfusion regimen and chelation therapy and treatment of complications are the keys to managing this population including regular follow. In this article, we review the literature in relation to the various endocrine complications encountered in thalassaemia.

Antimonene Nanosheets - mediated Photoacoustic Imaging for Tumor Detection in vivo

Photoacoustic imaging(PAI)is a new non-invasive and non-ionizing biomedical imaging method developed in recent years.PAI exhibits the high resolution of optical imaging and the deep tissue penetration of acoustic imaging,breaking through the soft limit of traditional biomedical imaging.However,most early tumors exhibit non-obvious photoacoustic imaging,so it is important to develop effective extrinsic photoacoustic imaging agents.On this basis,antimonene nanosheets(AMNSs)was designed.As a new two-dimensional(2D)material,AMNSs has good light absorption,excellent photothermal conversion efficiency and photoacoustic performance in the band range of 300-900 nm.So,the AMNSs are expected to be used as a contrast agent to achieve high quality photoacoustic imaging of ultra-small tumors in vivo.

Myofiber Permeability and Force Production of Rat Muscles Following Eccentric Contractions: The Repeated Bout Effect Depends on the Interval

Past eccentric contraction (ECC)-induced muscle injury reduces the severity of symptoms of subsequent muscle injury;this phenomenon is known as a repeated bout effect (RBE). It has been reported that increases in the duration of the interval between the first and second bouts are linked to weakening of the RBE. However, the histology following the attenuation of the RBE remains unclear. We examined the sustained effects of the second bout with regard to myofiber permeability and muscle force. Sixty-four male rats were randomly assigned to eight groups that varied in the number of exercise sessions and the duration of the interval between the first and second bouts: the non-ECC (Control);the single-injury (Post 1st bout);groups that were allowed to recover for 1, 2, and 4 weeks after a single injury (Pre 2nd bout_1w, Pre 2nd bout_2w, and Pre 2nd bout_4w);and groups that were subjected to second injuries 1, 2, and 4 weeks after the first (Post 2nd bout_1w, Post 2nd bout_2w, and Post 2nd bout_4w). The tibialis anterior was electrically stimulated in each ECC group. Twenty-four hours before muscle sampling, Evans blue dye (EBD) (a marker of myofiber damage) was administered. The maximal isometric contraction tension was measured immediately before sampling. The number of EBD-positive (+) fibers was determined via histological analysis. An RBE was revealed by functional examination at the 1- and 2-week and histological examination at the 1-, 2-, and 4-week time points (P < 0.05). In terms of myofiber permeability, prolongation of the interval before the second bout weakened this effect (P < 0.05). Experiments with 1-, 2-, and 4-week intervals indicated that prolongation of the interval before the second bout weakened the RBE with regard to myofiber permeability.

儿童窄波紫外线B(UVB)光疗法

Background. While narrowband ultraviolet B (UVB) phototherapy is a well-established treatment for a range of skin conditions in adults, there is little in the literature about its use in children and data regarding its long-term carcinogenic potential are lacking. Aim. We undertook a retrospective review of the use of narrowband UVB phototherapy in a paediatric population attending two Glasgow Hospitals. Methods. Phototherapy case notes for all children aged 16 years and under at time of treatment were reviewed at two hospital sites between 1996 and 2002. Results. In total, 77 children had been treated (median age 12 years, range 4-16). The conditions treated most frequently were psoriasis (45% ) and atopic eczema (32% ). Other dermatoses treated included alopecia areata, acne, hydroa vacciniforme and polymorphic light eruption. Treatment courses for atopic conditions were longer than those required for psoriatic conditions: median number of treatments 24 for atopic eczema (range 3-46), and 17.5 for psoriasis (range 9-35). By the end of treatment, 68% of the atopic patients and 63% of the patients with psoriasis had cleared. The adverse event profile was similar to that in adults, with erythema, herpes simplex reactivation and PLE all recorded. Anxiety was a problem for five patients. Conclusion. We conclude that narrowband UVB phototherapy is a useful and well-tolerated treatment for children with severe or intractable inflammatory skin disease, but concerns remain regarding long-term side-effects.

纯合子BIGH3R124H基因突变的角膜临床及免疫病理学表型研究

A family was previously reported as suffering from severe granular dystrophy. The phenotypic picture suggested a mix of homozygous and heterozygous family members. Genetic analysis confirms the homozygousity in the patients most severely affected, but shows the disease state to be one of Avellino corneal dystrophy. The previous case reports are extended immunohistological staining using polyclonal antibodies raised against keratofepithelin. This genotype/phenotype correlation study is consistent with incomplete dominance.

对急性卒中进行灌注CT视觉评估可精确判断梗死大小和组织存活情况

Objective: To establish the validity of visual interpretation of immediately processed perfusion computed tomography (CT)maps in acute stroke for prediction of final infarction. Methods: Perfusion CT studies acquired prospectively were reprocessed within six hours of stroke onset using standard CT console software. Four contiguous 5 mm thick images were obtained and maps of time to peak (TTP) and cerebral blood volume (CBV) generated. Volumes of lesions identified only by visual inspection were measured from manually drawn regions of interest. Volumes of tissue with prolonged TTP or reduced CBV were compared with independently calculated volume of infarction on non-contrast CT (NCCT) at 24-48 hours, and with clinical severity using the NIHSS score. Arterial patency at 24-48 h was included in analyses. Results: Studies were analysed from 17 patients 150 minutes (median) after stroke onset. Volume of tissue with prolonged TTP correlated with initial NIHSS (r = 0.62, p = 0.009), and with NCCT final infarct volume when arterial occlusion persisted (r = 0.953, p = 0.012). Volume of tissue with reduced CBV correlated with final infarct volume if recanalisation occurred (r = 0.835, p = 0.001). Recanalisation was associated with lower 24 h NIHSS score (6 (IQR, 5 to 9.5) v 19 (18 to 26), p = 0.027), and in 10 patients given rtPA for MCA M1 oc clusion, with lower infarct volume (73 v 431 ml, p = 0.002). Conclusions: Visual evaluation of TTP and CBV maps generated by standard perfusion CT software corr elated with 24-48 hour CT infarct volumes. Comparison of TTP and CBV maps yield s information on tissue viability. Perfusion CT represents a practical technique to aid acute clinical decision making. Recanalisation was a crucial determinant of clinical and radiological outcome.

Effects of Clarithromycin at Sub-Minimum Inhibitory Concentrations on Early <i>erm</i>B Gene Expression, Metabolic Activity and Growth of an <i>erm</i>(B)-Expressing Macrolide-Resistant Strain of <i>Streptococcus pneumoniae</i>

Aim: To investigate the effects of exposure of a macrolide-resistant [erm (B)-expressing] strain of Streptococcus pneumoniae (strain 2507) to clarithromycin (0.5 and 5 mg/L) added at the outset and 6 hours after initiation of culture on early gene expression, energy metabolism, and growth. Methods: Bacterial growth was determined by turbidometric and colony counting procedures, energy metabolism by measurement of ATP, while analysis of gene expression was performed using reverse transcription-PCR and sequencing. Results: Addition of clarithromycin, at either concentration, at the outset of culture, caused transient suppression of growth of 10 - 12 hours duration, while delayed addition of antibiotic (during the logarithmic phase) resulted in an abrupt halt in growth followed by recovery. These inhibitory effects of clarithromycin on bacterial growth were associated with up-regulation of expression of erm(B), decreased ATP and protein synthesis, and were unaffected by inclusion of either catalase (500 and 1000 kunits/L), or competence-stimulating peptide (CSP-1, 0.5 mg/L). The inhibitory effects could, however, be overcome by pre-exposure of the bacteria to the antibiotic. Moreover, clarithromycin appeared to potentiate the antimicrobial actions of ceftriaxone, at sub-MIC concentrations, for strain 2507. Conclusions: Unlike several other common bacterial pathogens, the full expression of erm(B)-mediated macrolide resistance by the pneumococcus has a slow onset, which is associated with transient susceptibility to macrolides and inhibition of growth.

帕金森病的诊断与药物治疗：苏格兰院际指南概要

阅读本概要的目的 帕金森病是一种常见的神经变性病，65岁以上老年人中有1％诊断为此病。此病对患者和家属，以及医疗保健和社会保健系统都有相当大的影响。随着人口老化，在未来25年内，苏格兰的病例数可能会增加30％。本病难以准确诊断，尤其是在初次就诊时。随着病情的发展，规范的治疗通常是多种药物的组合治疗。本文总结了苏格兰院际指南（SIGN）关于帕金森病的诊断和药物治疗的建议。