Differential expression of alpha-smooth muscle actin and vascular endothelial growth factor in skin biopsy of patients with systemic sclerosis: a histological and immunohistochemical study

Vasculopathy is a hallmark of systemic sclerosis [SSc]. It contributes to many of its clinical manifestations and precedes fibrosis. The aim of this study was to investigate the expression of alpha-smooth muscle actin [alpha-SMA] in skin biopsy of patients with SSc and correlate it with other manifestations of vasculopathy, including those seen on fundus fluorescein angiography and tissue vascular endothelial growth factor [VEGF] expression. This study included 25 patients with SSc and 10 healthy individuals. Patients underwent full history taking and a clinical examination. All participants underwent fundus fluorescein angiography. Skin biopsy was examined by H and E staining, Mallory triple staining, and immunohistochemical staining for alpha-SMA and VEGF. Histological examination showed loss of dermal papillae, hypovascularity of the dermis, and subepidermal fibrosis. Immunohistochemical staining of the vessel wall in skin biopsy samples showed a statistically highly significant increase in VEGF and a highly significant decrease in alpha-SMA in patients as compared with controls. There was a highly significant positive correlation between VEGF and duration of illness, Raynaud's phenomenon, digital ulcers, disease activity score, and modified Rodnan Skin Score. As regards alpha-SMA, there was a highly significant negative correlation with Raynaud's phenomenon, disease activity score, modified Rodnan Skin Score, and VEGF, whereas there was a significant negative correlation with digital ulcers. The strongest correlation [r] for the duration of illness was found with alpha-SMA, followed by VEGF. alpha-SMA was found to be correlated to different manifestations of vasculopathy in SSc. It was found to be one of the early markers of vasculopathy among the other studied variables. Besides its diagnostic role in SSc vasculopathy, it could play a role in impaired vasculogenesis, making it a potential therapeutic target in the management of SSc

Immunohistochemical and light and electron microscopic study of the basement membrane in photoaged skin

The basement membrane plays an important role in maintaining a healthy epidermis and dermis, and repeated damage destabilizes the skin and accelerates the aging process. This study was carried out to detect the changes in human skin basement membrane in sun-exposed skin compared with sun-protected skin. Skin biopsies were taken from sun-exposed and sun-protected skin of 10 male individuals aged between 50 and 60 years and processed for light and electron microscopic examination of the changes of the basement membrane. Immunohistochemical assessment of laminin and matrix metalloproteinase-1 [MMP-1] expression in skin biopsies was also carried out. Histological examination of sections of sun-exposed skin revealed that the basement membrane was discontinuous and the collagenous fibers of the underlying connective tissue were discrete in comparison with sun-protected skin. Immunoreactivity for laminin was decreased, whereas that for MMP-1 was markedly increased in sun-exposed skin as compared with sun-protected skin. The results of the current study revealed that the structure of the basement membrane was affected in sun-exposed skin as regards thickness, continuity, and structure. Increased activity of MMP-1 accounts at least in part for the disruption of the basal lamina and degradation of collagenous fibers of the dermis

Serum levels of IL-10, TNF-alpha and neopterin in chronic hepatitis c virus infection and their relation to viral load

Hepatitis C virus [HCV] has been shown to be an etioligic agent responsible for chronic liver disease with eventual progress to cirrhosis in 20% of patients. While the immunologic mechanisms in chronic HCV infection have not been clearly defined, it is believed that cytokines are involved. In this study, the serum levels of IL-10 [by ELISA], TNF-alpha [by ELISA] and neopterin [by RIA] in patients with chronic hepatitis C [n = 40] were measured. They were compared with biochemical [ALT, AST, GGT] and viral [serum levels of HCV-RNA] indicators of infection. In addition, serum autoantibodies [anti-LKM, ANA, ASMA and APCA] were done by the indirect immunofluorescence technique. Also, twenty healthy subjects were enrolled as a control group. Serum levels of IL-10, TNF-alpha and neopterin were significantly increased in HCV infected patients versus normal control group [P<0.001]. There was significant positive correlation between serum level of IL-10 and serum level of HCV-RNA [P < 0.001]. There was also a significant negative correlation between serum level of TNF-alpha and both of serum level of HCV-RNA [P < 0.05] and IL-10 [P < 0.001]. ANA was detected in 7.5%, ASMA in 37.5% and APCA in 2.5% in these patients. In summary HCV patients have an altered immune reactivity that may play a role in the pathogenesis of chronic HCV. An activated T cell response is present in these patients as manifested by increased circulating cytokine levels and presence of serum autoantibodies. Proper understanding of the immune response in HCV patients should make it possible to design future treatment strategies for HCV infection

role of oxidative stress in Egyptian patients with zoonotic cutaneous leishmaniasis

Zoonotic cutaneous leishmaniasis [ZCL] is endemic in North Sinai Governorate. It is a parasitic disease in which the immune system is implicated in its pathogenesis. The erythrocyte lipid peroxidation [ELPO], erythrocyte reduced glutathione [ERGT], glutathione peroxidase [GTPo] and serum vitamin C [SVC] were estimated in 19 patients with ZCL and 16 controls. The ELPO and ERGT were significantly higher in the patient group, while the GTPo and SVC were relatively lower. These results showed that the oxidative stress has a role in active ZCL, probably induces the endogen anti-oxidant system. That is to say, the oxidant-anti-oxidant balance system changes to the oxidative side with marked increase of erythrocyte lipid peroxidation and erythrocyte reduced glutathione

Clinical study for the use of torps and porps in ossicular chain recon struction

Plasti-pore ossicular replacement prosthesis are widely used now. This paper is presented to evaluate the results of 190 cases in whom either plasti-pore TORP or PORP had been used. Patients, were divided into groups depending on whether total or partial replacement prosthesis was used and also whether open or closed technique was done during surgery. Follow up carried out for a period of minimum of one year and a maximum of three years. Our results were evaluated both anatomically and functionally. Anatomically, the rate of extrusion of TORPs was 20%, while that for PORPs was 52.1%. PORPS were not applied when wide access was used, so the percentage of extrusion of PORPs in cases associated with cholesteatoma where posterior tympanotomy was done was 66.6%, this high rate of extrusion was attributed to the eustachian tube dysfunction which is usually prisentin in these cases. The rate of rejection of TORPs in wide access tympanoplasty was almost 0%, although functional results were not gratifying. For central perforations the rate of extrusion of both PORPs and TORPs was 50%, Hearing was improved only in 50% of the non-rejected cases. This paper is presented in order to evaluate the results of this widely used material in relation to the technique of surgery

Ossicular reconstruction after open technique tympanoplasty

16 cases of chronic suppurative otitis media with cholesteatoma were treated by open technique tympanoplasty. Ossicular reconstruction was done using tragal cartilage and perichondrium presenting a new technique for its fashioning and application. This was done either as one stage or two stages procedure. Follow up was done for 15 months both clinically and audiologically. Results were assessed both anatomically and functionally. Good anatomical results i. e. grajr take was obtained in 81.25% of cases. As for functional results; post-operative air bone gap equal or less than 20 dB was obtained in 37.5% of cases, while air bone gap equal or less than 25 dB was obtained in 75% of cases. This method is presented as an alternative to autograft ossicles whenever they can not be used