An association between posttransplant antibody production and renal transplant rejection.
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Biomedical subjects
Publications and source records attributed to S Martin.
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BACKGROUND: We report a case of keratosis lichenoides chronica and prolonged exposure to a source of heat (infrared radiation). CASE REPORT: A 35 year-old man was examined for a symmetric and reticulate dermatosis on the abdomen, the interior of arms and lower extremities. The lesions had progressed over several months. They were characterized by hyperpigmentation, erythematous, bullous and squamous papules. These lesions were associated with those of the scalp, evoking seborrheic dermatitis. The patient was exposed to a source of heat with an electric radiator on his bare chest everyday. The skin biopsy showed a lichenoid reaction. All these elements allowed to put the diagnosis of keratosis lichenoides chronica, probably actived by the infrared light. DISCUSSION: Keratosis lichenoides chronica is a rare acquired dermatosis of the young adult. Its physiopathology remains elusive. This dermatosis is characterized by keratosic violaceous lichenoid papules distributed symmetrically. The eruption is usually asymptomatic. The histological examination indicates a lichenoid reaction. The progression is chronic and the disease is very resistant to therapy. Keratosis lichenoides chronica has never been described as being able to be induced by Koebner's phenomenon. In the literature, two cases of erythema ab igne were associated with lichen planus. For some authors, keratosis lichenoides chronica is an entity itself, for others it would be related to lichen planus. These arguments enabled us to diagnose keratosis lichenoides chronica probably activated by the infrared light.
Stickler syndrome (hereditary arthro-ophthalmopathy) is a dominantly inherited connective tissue disorder with ocular, oro-facial, auditory and skeletal manifestations. It is genetically and phenotypically heterogeneous with the majority of families having mutations in the gene encoding type II collagen (COL2A1) and exhibiting a characteristic 'membranous' or type 1 vitreous phenotype. More recently a novel mutation in the gene encoding the alpha1 chain of type XI collagen (COL11A1) was reported in a Stickler syndrome pedigree with a different 'beaded' or type 2 vitreous phenotype. In the present study five more families with the type 2 vitreous phenotype were examined for linkage to four candidate genes: COL2A1, COL5A2, COL11A1 and COL11A2. Two families were linked to COL11A1 and sequencing identified mutations resulting in shortened alphal(XI) collagen chains, one via exon skipping and the other via a multiexon deletion. One of the families showed weak linkage to COL5A2 but sequencing the open reading frame failed to identify a mutation. In the remaining two families all four loci were excluded by linkage analysis. These data confirm that mutations in COL11A1 cause Stickler syndrome with the type2 vitreous phenotype and also reveal further locus heterogeneity.
BACKGROUND AND OBJECTIVES: A study using scanning electron microscopy showed that although the laminas forming the dura mater are concentric and parallel to the surface of the medulla, the fiber layers' orientations are different in each sub-lamina, dispelling the conventional knowledge that all the fibers of the dura are arranged in a parallel direction. Thus, this study evaluated the dural lesions produced by Whitacre and Quincke spinal needles in the external and internal surface of the dura mater of the lower spine area in an attempt to gain more insight into the pathophysiology of postdural puncture headaches (PDPH). METHODS: The T11-L4 dural membranes from 5 fresh (immediately after extraction of organs for transplantation), male patients declared brain dead, ages 23, 46, 48, 55, and 60 years, were excised by anterior laminectomy. Morphologic orientation of the membrane and normal pH were maintained with an apparatus designed for this purpose. One hundred punctures (20 on each sample) at 90-degree angles were done with a new needle each time, 50 with 25-gauge Whitacre and 50 with 25-gauge Quincke needles. Half of the punctures with the Quincke needles were done with the bevel in parallel direction to the axis of the spinal cord, and the rest with the bevel perpendicular to it. Fixation in solutions of 2.5% glutaraldehyde phosphate buffer, followed by dehydration with acetone, was done 15 minutes after the punctures. After acetone was removed at ideal conditions of temperature and pressure, the specimens were then metallized with carbon followed by gold and inspected under a scanning electron microscope. RESULTS: Twenty-five of the Whitacre and 23 of the Quincke punctures were found for evaluation. There were no differences in the cross-sectional area of the punctures produced by the Whitacre or Quincke needles on the dura. The area of the dural lesions produced by 25-gauge Quincke needles, 15 minutes after they have been withdrawn, was 0.023 mm2 (confidence interval [CI] 95%, 0.015 to 0.027) in the external aspect (epidural surface) and 0.034 mm2 (CI 95%, 0.018 to 0.051) in the internal aspect (arachnoid surface) of the dural sac. The area of the lesions produced by the 25-gauge Whitacre needles was 0.026 mm2 (CI 95%, 0.019 to 0.032) and 0.030 mm2 (CI 95%, 0.025 to 0.036) in the external and internal surfaces of the dural sac, respectively. There were no significant differences in the cross-sectional areas of the punctures produced by the 25-gauge Whitacre or 25-gauge Quincke needles. Moreover, with Quincke needles the dural lesions closed in an 88.3% (CI 95%, 86.3 to 92.4) and 82.7% (CI 95%, 74.1 to 90.9) of their original sizes in the epidural and arachnoid surfaces, respectively. With Whitacre needles, the closure occurred in an 86.8% (CI 95%, 83.8 to 90.3) and 84.8% (CI 95% 81.7 to 87.3) in the dural and arachnoid surfaces, respectively. However, there were differences in the morphology of the lesions. The Whitacre needles produced coarse lesions with significant destruction in the dura's fibers while the Quincke needles produced a 'U'-shaped lesion (flap) that mimics the opened lid of a tin can, regardless of the tip's direction. CONCLUSIONS: The needles produced lesions in the dura with different morphology and characteristics. Lesions with the Quincke needles resulted in a clean-cut opening in the dural membrane while the Whitacre needle produced a more traumatic opening with tearing and severe disruption of the collagen fibers. Thus, we hypothesized that the lower incidence of PDPH seen with the Whitacre needles may be explained, in part, by the inflammatory reaction produced by the tearing of the collagen fibers after dural penetration. This inflammatory reaction may result in a significant edema which may act as a plug limiting the leakage of cerebrospinal fluid.
BACKGROUND: The second to fourth digit ratio (2D:4D) is lower in men than in women. 2D:4D may be established in utero and is negatively correlated with sperm counts and testosterone in men and positively correlated with oestrogen in men and women. Negative associations between male 2D:4D and family size and positive associations between female 2D:4D and family size have been found in some European populations. AIM: The study seeks to investigate the relationship between 2D:4D and family size in samples from Europe, Asia and Africa. SUBJECTS AND METHODS: Measurements of right hand 2D:4D were made in English (Merseyside, n = 403), Indian (Sugali and Yanadi, n= 160) and South African (Zulu,n = 258) populations. RESULTS: 2D:4D was weakly sexually dimorphic and showed strong ethnic differences. There were significant associations between 2D:4D and family size. For males these included negative associations in English and South African samples, and in the total sample. In females there was a positive association in the English sample, a negative association in the South African sample, and the total female sample showed a positive relationship between 2D:4D and family size. CONCLUSIONS: 2D:4D showed weak sex and strong ethnic differences. Low values of 2D:4D were associated with large family size in men. The situation was less clear in women but on balance there was evidence to support a relationship between high values of 2D:4D and large family size.
In developing vaccines to counteract viral infections, it is important to produce reagents that engender the type of immune response best suited to provide protection and avoid immunopathology. Recovery from infection is the principal role of T cell immunity, and cells that recognize virus-infected cells (cytotoxic T lymphocytes) and kill them--often before new virus is replicated--represent a crucial component of the recovery process. The cytotoxic T lymphocytes are particularly important in situations where the load of infection is high. In this review the cells and mediators, as well as the viral and host cell antigens involved in antiviral induction of cytotoxic T lymphocytes, are discussed. Particular attention is paid to the importance of the intracellular pathway of processing taken by viral antigens and the outcome in terms of the recognition of cytotoxic T lymphocytes. The new types of vaccines--especially subunits, antiidiotypes, and recombinant viral vectors--are discussed in terms of their likely effectiveness at inducing cytotoxic T lymphocytes.
OBJECTIVE: This study examined the 7-year outcome of speech/language (S/L) impaired and control children selected from a community sample at age 5 years. METHOD: Two hundred fifteen children completed a variety of speech and language tests at age 12 years. Children with S/L impairment were further classified as "speech only," "language only," or "speech and language impaired." RESULTS: More than 72% of children who had S/L impairment at age 5 remained impaired at age 12. Children with both speech and language problems were most likely to remain S/L impaired; 81% had some kind of S/L impairment at follow-up. Similarly, children with both expressive and receptive language impairment were more likely to show expressive or receptive impairment at follow-up than children with expressive impairment alone. One third of time 1 controls had S/L problems at follow-up, and of these 82% had speech impairment only. CONCLUSIONS: S/L impairment identified at age 5 has long-lasting effects. More pervasive problems were associated with poorer outcomes. Screening at age 5 may be useful, as most serious S/L problems that emerged by middle childhood could be identified at age 5. The effects of S/L treatment require further study.
A common 137Cs brachytherapy source has a 2-cm physical length and 1.38-cm active length. The active length is not symmetric with respect to the source center because one source end contains an eyelet. Current dose rate tables assume a symmetric source loading with respect to the source center. A computer program was written to calculate an asymmetric distribution using the manufacturers' source specifications. Corrections were made for attenuation and obliquity through the source materials. Dose rate values in cGy/h for a 137Cs source equivalent to 1 mg of 226Ra are shown as a function of the radius from the source center and angle from the source end containing the eyelet. Dose rate values in the table were confirmed by ferrous sulfate measurements using small volumes. The table values agree with published values at points more distant than a few cm and lying at an angle such that the asymmetry of the source loading has its minimum influence.
It is well established that low-dose UVB radiation inhibits the antigen-presenting cell (APC) function of murine Langerhans cells in vivo and converts them from immunogenic to tolerogenic APC. Recently, we have shown that UVB-irradiated murine bone marrow-derived dendritic cells (UVB-DC) suppressed proliferation of naive and primed T cells, but tolerized primed T cells only. To examine the underlying mechanism for these differences, naive OVA(323-339)-peptide-specific, TCR-transgenic T cells from DO11.10 mice were analyzed following coculture with unirradiated DC or UVB-DC. First, we found that UVB-DC inhibit OVA-specific T cell proliferation UVB dose and antigen dose dependently. Analysis of T cells cocultured with both, unirradiated and UVB-DC, revealed an activated T cell phenotype with increased expression of CD25 and CD69 by FACS. Supernatants harvested from cocultures with UVB-DC showed reduced levels of IFN-gamma, IL-2 and IL-4, but not TGF-beta, compared with unirradiated DC as determined by ELISA. Furthermore, these T cells did not proliferate upon restimulation. Interestingly, addition of these nonproliferating T cells to cocultures of naive T cells and freshly prepared unirradiated DC inhibited T cell proliferation depending on the number of added nonproliferating T cells. Also, in supernatants, increased levels of TGF-beta were found. Therefore, our data indicate that UVB-DC propagate T cells with a regulatory function. Since regulatory T cells are characterized by enhanced TGF-beta secretion and increased CTLA-4 expression, we currently investigate the role of CTLA-4 phenotypically and functionally. In conclusion, we have shown that UVB-DC inhibit proliferation of naive OVA-specific T cells. These T cells, exhibiting an activated phenotype and increased TGF-beta production, suppress proliferation of naive T cells cocultured with unirradiated DC. These results suggest that UVB-DC induce nonproliferating, regulatory type T cells.
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The number of contact lens wearers has steadily increased over the past 10 years. Convenience, efficiency and availability of different types of lenses have made them popular. The rise in the use of contact lenses has increased the number of people at risk of contact lens-related complications. Studies have highlighted the consequences of poor contact lens care. Acanthamoeba keratitis is one of the most devastating complications of contact lens wear and can be avoided by adhering to the recommended contact lens regimen. This article reviews the literature on the complications of contact lens wear and stresses the need to educate the wearer. It examines the nurse's role in relation to health promotion and the basic principles for successful long-term contact lens wear. This information is relevant to all nurses caring for people with contact lenses and will be of particular interest to the nurse who wears contact lenses.
Hyperthermia was combined with bleomycin, melphalan and cis-platinum in order to examine cell lethality and oncogenic transformation in C3H10T1/2 cells from the adjuvant use of heat with chemotherapy agents. When cells were exposed concurrently to 42.5 degrees C and each of the three chemotherapy agents, heat enhanced both the cytotoxic and oncogenic potential of the drugs. Hyperthermia-enhanced ratios were largest for bleomycin-treated cells. Examination of transformation incidences expressed as a function of surviving fraction, i.e. the cytotoxicity of treatment and therefore drug-heat efficacy, showed that for a given level of cell killing the combination of heat and cis-platinum resulted in fewer transformants per surviving cell than for cis-platinum alone. Hyperthermia appears to reduce the oncogenic potential of low concentrations of melphalan but has no effect on bleomycin-induced oncogenic transformation.
Glutaraldehyde-preserved bovine pericardium (GPBP) is evaluated as a bioprosthesis for the reconstruction of surgical defects in the thoracoabdominal wall. The mechanical properties of bovine pericardium preserved at different concentrations of glutaraldehyde were studied. Samples preserved in 0.5% glutaraldehyde showed a significantly higher tensile strength (11.7 +/- 0.8 N/mm2) than samples preserved in 2.5, 5, or 10% (similar to pericardium preserved in normal saline). The percentage of elongation was significantly lower than samples preserved in 1, 2.5, and 5% glutaraldehyde. GPBP at 0.5% was used to repair experimentally induced defects of the abdominal wall (n = 9), chest wall (n = 6), diaphragm (n = 6), and sternum (n = 7). All animals presented adequate tolerance to the material used and no case of infection or rejection of the material was seen in any of the animals. Finally, 0.5% GPBP was used clinically in a series of 40 patients: postincisional abdominal hernia (n = 30), inguinal hernia (n = 8), diaphragmatic hernia (n = 1), and congenital pelvic defect with prolapse of abdominal organs (n = 1). Surgical use showed that GPBP was a very manageable material and long-term results were good in 37 patients with a mean follow up of 18 months (range 5-35 months). Six patients presented seroma formation (all abdominal hernia patients), three of which eventually developed infection and had the GPBP patch removed at 3, 5, and 7 months postoperatively. The rest of the patients presented good scar formation with adequate resistance at the area of implantation. GPBP is a biological material with sufficient resistance to be used surgically in the repair of thoracoabdominal defects. Ideal concentration of glutaraldehyde to be used in the preparation-preservation of the material is 0.5% since higher concentration negatively affect its tensile rupture strength and elongation.
In most patients who undergo coronary angioplasty (PTCA), coronary bypass surgery (CABG) is an alternative. Patients with severe symptoms secondary to coronary disease, amenable to PTCA, but who are poor CABG candidates are commonly seen. From April 1988 to December 1989 PTCA was performed in 751 patients. Patients with evolving infarction (47) were excluded. Of the remaining 704, 605 were considered candidates for CABG and they were compared to the 99 patients not felt to be candidates for CABG. The objective of this report was to compare these 2 patient groups. These salvage PTCA patients were older, had a higher incidence of heart failure, more prior CABG, higher left ventricular end-diastolic pressure and lower ejection fraction (all p less than 0.01). PTCA had a high success rate per lesion in both groups (96% CABG candidates vs. 95% salvage patients), but there were more patients whose culprit lesion could not be dilated in the salvage group (14% vs. 7%, p less than 0.02). Severe complications including Q wave infarction (2% vs. .3%) and in-hospital death (7% vs. 0.2%) were more common in salvage patients. As planned, emergency CABG was not performed on any salvage PTCA patient but on 2.6% of the other patients. Patients who may benefit from PTCA but were not felt to be operable made up 13% of our PTCA experience. PTCA can be performed in these patients but risks were increased.