Segurança da vacinação contra a COVID-19 em doentes referenciados dos cuidados de saúde primários por alergia ao veneno de himenópteros / COVID-19 vaccination safety in patients with hymenoptera venom allergy referred by primary health care

Introdução: As reações de hipersensibilidade após vacinação contra a COVID-19 têm vindo a ser descritas, embora a anafilaxia seja rara. A hipersensibilidade ao veneno de himenópteros constitui a terceira causa mais frequente de anafilaxia em Portugal, embora não pareça aumentar o risco de anafilaxia à vacinação contra a COVID-19. Objetivos: Avaliar a segurança da vacinação contra a COVID-19 em doentes com história de alergia ao veneno de himenópteros referenciados dos Cuidados de Saúde Primários (CSP). Métodos: Estudo observacional retrospectivo com inclusão dos doentes com alergia ao veneno de himenópteros referenciados pelos CSP ao serviço de Imunoalergologia, para estratificação do risco de reações de hipersensibilidade à vacina contra o SARS-CoV-2, entre janeiro e dezembro de 2021. Resultados: No total, incluíram-se 18 doentes, 72% do sexo feminino, média de idades de 61±18 [21-89] anos. Na caracterização do tipo da reação ao veneno de himenópteros, as reações locais exuberantes corresponderam a 33% de todas as reações referidas. Quanto a sintomas sistêmicos de anafilaxia, foram referidos sintomas mucocutâneos (33%), respiratórios (28%), cardiovasculares (33%) e gastrointestinais (11%). A abelha foi o inseto mais frequentemente implicado (61%). Relativamente aos valores de triptase basal, 3 doentes apresentaram níveis acima do cut-off estabelecido de 11,4 ng/mL, tendo indicação formal para iniciar esquema de vacinação em meio hospitalar. Durante o processo vacinal registrou-se um total de 46 administrações em 18 doentes, todas sem intercorrências. Apenas 5 doentes foram vacinados em meio hospitalar, tendo sido os restantes encaminhados para os CSP. Os doentes com mastocitose confirmada ou suspeita foram submetidos à pré-medicação com anti-histamínico anti-H1 e anti- H2, bem como montelucaste, na véspera e no dia da vacinação. Conclusões: A vacinação contra a COVID-19 é segura em doentes com reação de hipersensibilidade ao veneno de himenópteros. O protocolo utilizado mostrou ser eficaz na segregação de doentes entre CSP e cuidados secundários/terciários.

Introduction: Despite numerous reports of hypersensitivity reactions to COVID-19 vaccination, anaphylaxis is rare. Although hypersensitivity reactions to hymenoptera venom are the third most common cause of anaphylaxis in Portugal, they don't appear to enhance the risk of anaphylactic reaction to COVID-19 vaccination. Objectives: To assess the safety of COVID-19 vaccination in patients with a history of hymenoptera venom allergy. Methods: This retrospective observational study included patients with hymenoptera venom allergy referred by primary health care to the Immunoallergology Outpatient Clinic of a tertiary hospital between January and December 2021 to stratify the risk of hypersensitivity reactions to the SARSCoV- 2 vaccine. Results: A total of 18 patients were included: 72% women; mean age 61 (SD, 18 [range 21-89]) years. One-third of all reported reactions to hymenoptera venom were large and local. Topical systemic symptoms of anaphylaxis were mucocutaneous (33%), respiratory (28%), cardiovascular (33%) and gastrointestinal (11%). The honeybee was the most frequently involved hymenoptera species (61%). The basal tryptase levels of 3 patients were above the established cut-off (11.4 ng/mL) and they were formally indicated for vaccination in a hospital setting. Concerning the vaccination process, 46 doses were administered to the 18 patients and no reactions were recorded. Only 5 patients were vaccinated in a hospital environment; the rest were referred to primary health care centers. Patients with confirmed or suspected mastocytosis were premedicated with anti-H1 and anti-H2 antihistamines, as well as montelukast, the day before and on the day of vaccination. Conclusions: COVID-19 vaccination is safe for patients with hypersensitivity to hymenoptera venom. The risk assessment protocol effectively designated patients to primary or secondary/tertiary health care.

KOUNIS SYNDROME (ALLERGIC ANGINA): AN ELUSIVE DIAGNOSIS

We studied case series of 6 patients admitted with hypersensitivity and acute coronary syndrome. Kounis syndrome is local manifestation of generalised hypersensitivity reaction. Kounis syndrome (allergic angina) is not rare but rarely recognized and under-diagnosed. Serum tryptase is diagnostic biomarker of diagnose KS. Patients were treated with antihistaminic, adrenaline, steroid. In all patient having hypersensitivity reaction due to various triggers kounis syndrome should be suspected with high index of suspicion

Abordagem das reações de hipersensibilidade perioperatória: Orientações da Sociedade Brasileira de Anestesiologia e da Associação Brasileira de Alergia e Imunologia - Parte II: etiologia e diagnóstico / Approach to perioperative hypersensitivity reactions: Guidelines from the Brazilian Society of Anesthesiology and the Brazilian Association of Allergy and Immunology - Part II: etiology and diagnosis

A anafilaxia perioperatória é manifestação importante no contexto de eventos adversos relacionados à cirurgia. Embora frequentemente relacionada à indução anestésica, pode ocorrer por outros agentes administrados por outras vias. A anafilaxia pode se apresentar como colapso cardiovascular, obstrução da via aérea e/ou insuficiência respiratória com ou sem manifestação cutânea, com consequências fatais em muito casos. Apesar de considerada inevitável em alguns casos, a sua incidência poderia (e deveria) ser reduzida através da busca por fármacos mais seguros. A avaliação abrangente de um episódio é um dos elementos primordiais para tornar a exposição subsequente mais segura, com orientações derivadas dessa investigação. Entretanto, representa um desafio estatístico por ser reação rara, randômica e muitas vezes independente de exposições sucessivas dos pacientes a procedimentos de baixo risco. Neste documento são revisados os mecanismos fisiopatológicos, agentes desencadeantes (adultos e crianças), assim como a abordagem diagnóstica durante a crise e após o episódio. Uma avaliação abrangente, a identificação das medicações, antissépticos e outras substâncias usadas em cada região, registros detalhados e nomenclatura padronizada são pontos fundamentais para a obtenção de dados epidemiológicos mais fidedignos sobre a anafilaxia perioperatória.

Perioperative anaphylaxis is an important manifestation in the context of surgery-related adverse events. Although often related to anesthetic induction, it may be caused by other agents administered by other routes. Anaphylaxis may manifest as cardiovascular collapse, airway obstruction and/or respiratory failure with or without skin manifestation, resulting often in death. Although this reaction is considered inevitable in some cases, its incidence could (and should) be reduced by the search for safer drugs. Comprehensive assessment of an allergic reaction is a key element to make subsequent exposure safer, with guidance derived from this investigation. However, surveillance of perioperative anaphylaxis represents a statistical challenge because this is a rare, random reaction and often independent of successive patient exposures to low-risk procedures. This paper reviews pathophysiological mechanisms, triggering agents (adults and children), as well as therapeutic and diagnostic approach during and after an allergic reaction. Comprehensive assessment, identification of medications/antiseptics used in each region and detailed records with standardized terminology are key points for obtaining more reliable epidemiological data on perioperative anaphylaxis.

Atualização sobre reações de hipersensibilidade perioperatória: Documento conjunto da Sociedade Brasileira de Anestesiologia e Associação Brasileira de Alergia e Imunologia ­ Parte II: etiologia e diagnóstico / Update on perioperative hypersensitivity reactions: Joint document from the Brazilian Society of Anesthesiology and Brazilian Association of Allergy and Immunology ­ Part II: Etiology and diagnosis

A anafilaxia perioperatória é manifestação importante no contexto de eventos adversos relacionados à cirurgia. Embora frequentemente relacionada à indução anestésica, pode ocorrer por outros agentes administrados por outras vias. A anafilaxia pode se apresentar como colapso cardiovascular, obstrução da via aérea e/ou insuficiência respiratória com ou sem manifestação cutânea, com consequências fatais em muito casos. Apesar de considerada inevitável em alguns casos, a sua incidência poderia (e deveria) ser reduzida através da busca por fármacos mais seguros. A avaliação abrangente de um episódio é um dos elementos primordiais para tornar a exposição subsequente mais segura, com orientações derivadas dessa investigação. Entretanto, representa um desafio estatístico por ser reação rara, randômica e muitas vezes independente de exposições sucessivas dos pacientes a procedimentos de baixo risco. Neste documento são revisados os mecanismos fisiopatológicos, agentes desencadeantes (adultos e crianças), assim como a abordagem diagnóstica durante a crise e após o episódio. Uma avaliação abrangente, a identificação das medicações, antissépticos e outras substâncias usadas em cada região, registros detalhados e nomenclatura padronizada são pontos fundamentais para a obtenção de dados epidemiológicos mais fidedignos sobre a anafilaxia perioperatória.

Perioperative anaphylaxis is an important manifestation in the context of surgery-related adverse events. Although often related to anesthetic induction, it may be caused by other agents administered by other routes. Anaphylaxis may manifest as cardiovascular collapse, airway obstruction and/or respiratory failure with or without skin manifestation, resulting often in death. Although this reaction is considered inevitable in some cases, its incidence could (and should) be reduced by the search for safer drugs. Comprehensive assessment of an allergic reaction is a key element to make subsequent exposure safer, with guidance derived from this investigation. However, surveillance of perioperative anaphylaxis represents a statistical challenge because this is a rare, random reaction and often independent of successive patient exposures to low-risk procedures. This paper reviews pathophysiological mechanisms, triggering agents (adults and children), as well as therapeutic and diagnostic approach during and after an allergic reaction. Comprehensive assessment, identification of medications/antiseptics used in each region and detailed records with standardized terminology are key points for obtaining more reliable epidemiological data on perioperative anaphylaxis.

Análise de células dendríticas, mastócitos e vascularização na doença periodontal biofilme induzida em idosos / Analysis of dendritic cells, mast cells and vasculature in biofilm-induced periodontal disease in the elderly

A microbiota e o sistema imune do idoso apresentam algumas alterações, favorecendo ao aparecimento de infecções e doenças inflamatórias. A doença periodontal é um exemplo, permeando entre fase imediata e tardia, pode ter alterações em sua evolução com o envelhecimento humano. Compreender a doença periodontal e sua relação com o ciclo da vida é importante para a prevenção, tratamento e cura. Este estudo tem como objetivo avaliar a quantidade de mastócitos (triptase), células dendríticas imaturas (CD1a), células dendríticas maduras (CD83) e vasos sanguíneos (CD34) em 154 tecidos periodontais saudáveis e doentes (27 idosos e 127 adultos). Foi utilizada a técnica de imunoistoquímica através da imunomarcação do CD1a, CD83, triptase e CD34, sendo contabilizados em 5 campos de maior número de células positivas, no aumento de 1000x. Para o CD34, ainda foram calculadas a área e o perímetro microvascular para todos os vasos sanguíneos presentes, e dos vasos com presença do endotélio vascular alto. Não houve diferença na imunomarcação das células dendríticas, dos mastócitos e na quantidade de vasos sanguíneos nos tecidos gengivais, entre os casos de gengiva clinicamente saudável, gengivite induzida por biofilme e periodontite estágios II, III e IV, avaliando isoladamente os grupos etários: adultos e idosos. As células dendríticas imaturas são mais numerosas no idoso com o quadro clínico de gengivite e periodontite. Os adultos com gengivite induzida por biofilme possuem maior quantidade de vasos sanguíneos que o grupo idoso. A área microvascular e o perímetro microvascular dos vasos sanguíneos com o endotélio vascular alto apresentaram maiores nos idosos nos casos de gengivite. Este estudo concluiu que nesta amostra não houve diferença na quantidade de células dendríticas imaturas e maduras, mastócitos na doença periodontal dentro dos grupos etário, porém as células dendríticas imaturas estão mais presentes no idoso podendo estar relacionado a algum decréscimo funcional. Em relação aos vasos sanguíneos, há presença de HEVs em adultos e idosos, não havendo diferença entre os diagnósticos. Nos idosos com gengivite há um aumento da área microvascular e perímetro microvascular, necessitando de estudos que justifiquem esta diferença (AU).

The elderly's microbiota and immune system show some changes, favoring the onset of infections and inflammatory diseases. Periodontal disease is an example, permeating between immediate and adaptative stages, it can have changes in its evolution with human aging. Understanding periodontal disease and its relationship with the life cycle is important for prevention, treatment and cure. This study aims to assess the amount of mast cells (tryptase), immature dendritic cells (CD1a), mature dendritic cells (CD83) and blood vessels (CD34) in 154 healthy and sick periodontal tissues (27 elderly and 127 adults). The immunohistochemistry technique was used through the immunostaining of CD1a, CD83, tryptase and CD34, being counted in 5 fields with a greater number of positive cells, in the 1000x increase. For CD34, the microvascular area and perimeter were also calculated for all blood vessels present, and for vessels with the presence of high vascular endothelium. There was no difference in the immunostaining of dendritic cells, mast cells and the amount of blood vessels in the gingival tissues, between cases of clinically healthy gingiva, biofilm-induced gingivitis and stages II, III and IV periodontitis, evaluating the age groups: adults and elderly. Immature dendritic cells are more numerous in the elderly with the clinical picture of gingivitis and periodontitis. Adults with biofilm-induced gingivitis have a greater amount of blood vessels than the elderly group. The microvascular area and the microvascular perimeter of the blood vessels with the high vascular endothelium were larger in the elderly in cases of gingivitis. This study concluded that in this sample there was no difference in the amount of immature and mature dendritic cells, mast cells in periodontal disease within the age groups, however, immature dendritic cells are more present in the elderly and may be related to some functional decrease. Regarding blood vessels, there are HEVs in adults and the elderly, with no difference between diagnoses. In the elderly with gingivitis there is an increase in the microvascular area and microvascular perimeter, requiring studies that justify this difference (AU).

Establishment of new evaluation standards for systemic anaphylactoid reactions using mouse model / 中国中药杂志

The detection of drug-induced anaphylactoid reactions remains a global challenge,still lacking mature and reliable animal models or test methods. Therefore,the purpose of this paper is to explore and establish the test methods and evaluation standards for anaphylactoid reactions that apply to injection drugs. Based on the anaphylactoid reaction symptoms of mice induced by intravenous injection drugs C48/40 and Tween 80,a list of systemic anaphylactoid reaction symptoms in mice was sorted out and an evaluation standard of anaphylactoid reactions symptoms was established by applying symptom intensity coefficient K( that can represent these verity of anaphylactoid reaction symptoms) and its calculation formula Accordingly,histamine,tryptase,and Ig E were selected as blood indicators of anaphylactoid reactions,so that a test method combining symptoms evaluation and blood makers detection was established.This test method could be used to evaluate the characteristics of anaphylactoid reactions: coefficient K,blood histamine levels were highly and positively correlated with C48/80 and Tween 80 dose; The log value of histamine was highly and positively correlated with K; tryptase level may rise,or remain steady,or drop,possibly associated with the characteristics of the tested object and time for blood taking; and Ig E level would drop or remain steady,but it would not rise,which can be clearly distinguished from type I allergic reactions. On this basis,tiohexol,iopromide,paclitaxel,Xuesaitong Injection,Shuanghuanglian Injection and Shengmai Injection were used to investigate the applicability. The testing results showed a high degree of consistency with the actual clinical situation. The results suggest that the method of systemic anaphylaxis test in mice has high sensitivity,specificity and good consistency with clinical practice.It is suggested to be further validated and popularized.

Changes and significance of serum TPS and ILG6 after TACE treatment of hepatocellular carcinoma / 实用放射学杂志

Objective To explore the changes of serum tryptase(TPS)and interleuk-6 (IL-6)levels before and after TACE treatment in patients with hepatocellular carcinoma (HCC).Methods ELISA was used to detect the serum TPS and IL-6 levels in 5 1 patients with HCC 1 day before and 1 day,1 week and 1 month after TACE.30 healthy people were enrolled as a control group.Results Serum TPS and IL-6 levels in observation group before TACE were higher than those in control group (P＜0.05),and serum TPS level in the observation group was positively correlated with serum IL-6 level (P＜0.05)before TACE.Serum TPS and IL-6 levels in the response group one month after TACE were lower than those one day before TACE (P＜0.05),while compared with those one day before TACE ,the non-response group increased slightly and non significance was showed(P＞0.05).Conclusion Serum TPS and IL-6 levels are closely related to the response of HCC to TACE treatment,thus these may be used to evaluate the efficacy of TACE in treatment of HCC.

Hypersensitivity Reaction to Perioperative Drug Mistaken for Local Anesthetic Systemic Toxicity in a Patient under Brachial Plexus Block / 고신대학교의과대학학술지

Perioperative anaphylaxis, although rare, is a severe, life-threatening unexpected systemic hypersensitivity reaction. Simultaneous administration of various drugs during anesthesia, the difficulty of communicate with patients in sedation and anesthesia, and coverage of the patient with surgical drapes are considered to be factors that impede early recognition of anaphylactic reactions. It is very important to perform an intradermal skin test because antibiotics are the most common cause of perioperative anaphylaxis. We report a case of negative-intradermal skin test antibiotic anaphylaxis mistaken for local aesthetic systemic toxicity without increase of serum tryptase for confirmative diagnostic biomaker during surgery under brachial plexus block. It is not possible to exclude the danger of anaphylaxis completely, even if it is negative-intradermal skin test and normal tryptase level. Therefore, anesthesiologists should be closely monitored and treated early for antibiotics related hypersensitive reaction, like other medicines during anesthesia.

Electroacupuncture of "Tianshu" (ST 25) Suppresses Visceral Pain Possibly by Down-regulating Mast Cell Activation, and Tryptase and SP Expression in Rats with Post-infectious Irritable Bowel Syndrome / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Tianshu" (ST 25) on visceral pain and colonic mast cell (MCs) number and tryptase and SP expression in post-infectious irritable bowel syndrome (PI-IBS) rats, so as to reveal its mechanisms underlying improvement of PI-IBS. METHODS: Forty-five female Wistar rats were randomly divided into control, model and EA groups (15 rats/ group, 3 rats/group used for H. E. staining, and 12 rats/group for immunohistochemistry). The PI-IBS model was established by intra-anal injection of mixed liquor of 50% ethyl alcohol and trinitro-benzene-sulfonic acid (TNBS). EA (2 Hz/15 Hz, 0.5-1.0 mA) was applied to bilateral "Tianshu" (ST 25) for 30 min, once every day for 14 days. The visceral pain was measured by abdominal withdrawal reflex (AWR), for which the rectal implanted air balloon was dilated by infusion of normal saline. The histopathological changes of the colon tissue were observed after H. E. staining, and the colonic MCs were displayed by Toluidine blue staining. The expression of tryptase and SP proteins in the colon specimens were detected by immunohistochemistry. RESULTS: The AWR threshold was significantly lowered in the model group relevant to the control group (P<0.05) and considerably increased after EA intervention in comparison with the model group (P<0.05). The number of MCs and the expression levels of colonic tryptase and SP proteins in the colon tissues were significantly higher in the model group than in the control group (P<0.05), and obviously lower after EA intervention in the EA group than in the model group (P<0.05). CONCLUSION: EA of "Tianshu" (ST 25) can inhibit visceral pain in PI-IBS rats, which may be associated with its effects in activating MCs and down-regulating the expression of tryptase and SP proteins in the colonic tissues.

Evaluation of the left venticular systolic function with the measurement of global longitudinal strain by Speckle tracking echocardiography in anaphylaxis

BACKGROUND: It is not known how cardiac functions are affected during anaphylaxis. OBJECTIVE: Our aim was to measure the cardiac functions shortly after an anaphylaxis attack using a new technique that detects subclinical left ventricular dysfunction. METHODS: Patients in our hospital who experienced anaphylaxis and urticaria (control group) due to any cause were included in the study. Tryptase levels were measured on the third hour of the reaction and 6 weeks later. Left ventricular systolic functions were evaluated with global strain measurement using echocardiography, approximately 4 hours and 6-week post reaction. RESULTS: Twelve patients were included in the anaphylaxis group (83.3% female; mean age, 43.25 ± 9.9 years). The causes of anaphylaxis were drug ingestion (n = 11) and venom immunotherapy. Eight of the anaphylactic reactions (66.7%) were severe and in 9 reactions (75%) tryptase levels increased. In the anaphylaxis group, strain values measured shortly after anaphylaxis were significantly lower than those calculated 6 weeks later (p < 0.001) and tryptase levels significantly increased (p = 0.002). The strain values measured both shortly after anaphylaxis and 6 weeks later did not differ according to severity of anaphylaxis. In severe anaphylaxis, tryptase levels during anaphylaxis and 6 weeks later were significantly higher (p = 0.019, p = 0.035). The control group evidenced no differences regarding strain and tryptase levels measured at reaction and 6 weeks later. At reaction, in the anaphylaxis group, the tryptase levels were higher and the strain values were lower than those in the urticaria group (p = 0.007, p = 0.003). CONCLUSION: Cardiac dysfunction may develop during an anaphylaxis independent of severity of reaction.

Clinical efficacy of Sini decoction adjustment combined rabeprazole enteric capsules in gastroesophageal reflux cough and its effect on IL-8, SP, MCT levels / 中国生化药物杂志

Objective To research the clinical efficacy of Sini decoction adjustment combined rabeprazole enteric capsules in treatment of gastroesophageal reflux cough and its effect on interleukin 8 (IL-8) and substance P (SP), the mast cell tryptase (MCT) levels.Methods 92 cases of gastroesophageal reflux cough were divided into control group and experimental group by drawing method , each had 46 cases.Control group were treated by rabeprazole enteric capsules, experimental group were treated with rabeprazole enteric capsules based on the control group.The curative effect, cough symptoms integral, IL-8, SP, MCT, gastric dynamic element (MOT) and the gastrin-releasing (GAS), pulmonary function and safety were compared between two groups.Results The total effective rate of experimental group(93.47%) was higher than the control group(76.08%), the difference was statistically significant (P<0.05).After treatment, the symptoms of experimental group(1.53 ±0.19) points was higher than the control groupthe difference was statistically significant(1.96 ±0.24)points,P<0.05.The IL-8, SP, MCT levels of experimental group were all lower than the control group ( P<0.05 ) .The MOT, GAS, and lung function of experimental group improved more significantly than the control group ( P <0.05 ) .The security between two groups has no significant difference .Conclusion The curative effect of Sini decoction adjustment combined Rabeprazole enteric capsules in treatment gastroesophageal reflux cough is obvious, can decrease IL-8, SP, MCT levels.

Telangiectasia macular eruptiva perstans: reporte de caso y revisión de la literatura / Telangiectasia macularis eruptiva perstans: case report and literature review

La Telangiectasia Macular Eruptiva Perstans (TMEP), forma infrecuente de mastocitosis cutánea consiste en la proliferación anormal de mastocitos en dermis papilar sin participación de otros órganos. Afecta mayormente a adultos, con algunos informes en niños. Típicamente, las lesiones de TMEP son máculas eritematosas con finas telangiectasias, distribuidas principalmente en tronco y extremidades superiores con un patrón simétrico, puede presentar afectación sistémica o asociarse con neoplasias linfoproliferativas. Se presentan dos casos de TMEP en una mujer de 32 años cuyo inicio coincidió con su primera gestación y el de una mujer de 55 años, ambas sin síntomas sistémicos, se discute la presentación clínica, histopatología y tratamiento.

Macular telangiectasia eruptiva perstans (TMEP), an uncommon form of cutaneous mastocytosis, consists in the abnormal proliferation of mast cells in the papillary dermis without the participation of other organs. It affects almost exclusively adults, with some reports in children. Typically, TMEP lesions are erythematous macules with fine telangiectasias, distributed mainly in the trunk and upper limbs with a symmetrical pattern, may present systemic involvement or be associated with lymphoproliferative neoplasms. We present two cases of TMEP in a 32-year-old woman whose onset coincided with her first pregnancy and that of a 55-yearold woman, both without systemic symptoms, whose clinical presentation, histopathology and treatment are discussed.

Telangiectasia macularis eruptiva perstans: A report of five cases / A propósito de cinco casos / Macularis eruptive telangiectasia perstans

Se comunican cinco pacientes con mastocitosis cutánea, en la forma clínica de "telangiectasia macularis eruptiva perstans" (TMEP), con hallazgos clínicos asociados. En la mayoría de los pacientes, la enfermedad se presenta en adultos con manifestaciones clínicas limitadas a la piel, con buen pronóstico. Destacamos la importancia de su conocimiento por el dermatólogo, la necesidad de su estudio y seguimiento multidisciplinario.

Five patients with cutaneous mastocytosis are presented with the clinical variant of "macularis eruptive telangiectasia perstans" (METP), with associated clinical findings. In most cases the disease occurs in adults with clinical manifestations limited to the skin with a good prognosis. We emphasize the importance of studying by a dermatologist and the necessity of interdisciplinary consideration and a proper follow-up.

The expression of the tryptase in the plasma of the brain traumatic patients / 中国基层医药

Objective To detect the expression of the tryptase in the plasma,and study the meaning in brain traumatic patients.Methods There were two groups:the brain traumatic group(40 patients)and the control group (20 health people).The content of plasma tryptase was determined by fluorescence enzyme immunoassay..Results The level of plasma tryptase had no statistical significance in control group(2.97 ±1.05)μg/L compared with the brain traumatic group(3.03 ±1.39)μg/L,however there had statistical significance comparing with sever brain traumatic patients(3.84 ±0.52μg/L)(t =3.32,P <0.05).4 cases of death in patients with severe head injury group content of tryptase (5.85 ±1.05)μg/L,which was significantly higher than the group of 16 cases of injury in severe head injury after 2 months still alive with the content of serum tryptase (2.49 ±0.52)μg/L,the difference was statistically significant (t =8.13,P <0.01).Conclusion The plasma tryptase level in sever brain traumatic patients increased significantly,and might be of importance for treatment strategies and prognosis.

Refractory intraoperative hypotension with elevated serum tryptase

Severe intraoperative hypotension has been reported in patients on angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists. We describe a patient on lisinopril who developed refractory intraoperative hypotension associated with increased serum tryptase level suggesting mast cell activation (allergic reaction). However, allergology workup ruled out an allergic etiology as well as mastocytosis, and hypotension recalcitrant to treatment was attributed to uninterrupted lisinopril therapy. Elevated serum tryptase was attributed to our patient's chronic renal insufficiency.

Role of PAR-2 in tryptase mediated IEC-6 cell injury / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate the role of protease activated receptor-2 ( PAR-2 ) in the process of tryptase mediated IEC-6 cell injury.METHODS:The rat intestinal epithelial cell line IEC-6 was treated with tryptase at different concentrations (1 μg/L, 10 μg/L, 100μg/L and 1 000μg/L) in the presence or absence of PAR-2 antagonist FSLLRY-NH2 for 12 h respectively.The cell survival rate was detected by MTT assay.The protein levels of PAR-2 and cleaved-caspase 3 were determined by Western blotting.The LDH activity was also measured.RESULTS:Compared with control group, the cell survival rates were significantly decreased in 100 μg/L and 1 000 μg/L tryptase treated groups, the LDH activities were significantly increased in 10 μg/L to 1 000 μg/L tryptase treated groups, and the protein levels of PAR-2 and cleaved caspase 3 were significantly increased in 100μg/L and 1 000μg/L tryptase treated groups (P<0.05).Com-pared with 1 000 μg/L tryptase treated group, the LDH activity and cleaved caspase 3 protein level were dramatically de-creased while the survival rate was significantly increased in the presence of PAR-2 antagonist FSLLRY-NH2 (P<0.05). CONCLUSION:Tryptase induces IEC-6 cell injury in a dose-dependent manner by activating PAR-2.

Effect of 1, 25-dihydroxyvitamin D3 on mast cells tryptase in asthmatic guinea pigs

Objective:To explore the effect of 1,25-dihydroxyvitamin D3 on the mast cell tryptase (MCT) in asthmatic guinea pigs. Methods:A total of 60 male or female healthy guinea pigs were randomly divided into control group (group A), asthmatic group(group B), and 1,25-dihydroxyvitamin D3 group(group C), with 20 cases in each group. To establish asthmatic guinea pig models, 1ml peanut oil was filled into stomach in the morning in group A and group B , and 1ml peanut oil with 1,25-dihydroxyvitamin D3 was filled into stomach in group C. Airway resistance (Re) of asthmatic guinea pigs was detected, and the bronchoalveolar lavage fluid (BALF) cells were counted. Lung tissue with HE and MCT immunohistochemical staining were used to observe the pathological changes in lung tissue and the distribution of MCT. Results:After injection of different concentration of acetylcholine chloride, the Re in group B and group C were increased significantly compared with group A (P<0.05);compared with group B, the Re in group C were decreased significantly (t=-5.385, -5.761, -6.184,-13.574, P<0.05);the total number of BALF cells and eosinophils were increased significantly in group B and C (t=19.618, 9.598, 10.854, 5.388, P<0.05);compared with group B, the total number of BALF cells and eosinophils in group C was decreased significantly (t=-5.555,-5.392, P<0.05);the number of tryptase positive cells in group B was increased significantly than that in group A (t=21.312, P<0.05), and in addition to the alveolar septum and submucosa, the cells were also distributed around blood vessels and outside the cells; the number of tryptase positive cells in group C was decreased significantly compared with group B, and the difference was statistically significant (t=5.043, P<0.05). Conclusions:After the asthmatic guinea pigs are treated with 1,25-dihydroxyvitamin D3, their BALF, Re, infiltration degree of inflammatory cells in the trachea and lung tissue and airway inflammatory reaction are reduced significantly. 1,25-dihydroxyvitamin D3has a certain inhibiting effect on the activation of mast cells and the release of MCT granules.

Effect of 1,25-dihydroxyvitamin D3 on mast cells tryptase in asthmatic guinea pigs

OBJECTIVE@#To explore the effect of 1,25-dihydroxyvitamin D3 on the mast cell tryptase (MCT) in asthmatic guinea pigs.@*METHODS@#A total of 60 male or female healthy guinea pigs were randomly divided into control group (group A), asthmatic group (group B), and 1,25-dihydroxyvitamin D3 group (group C), with 20 cases in each group. To establish asthmatic guinea pig models, 1 mL peanut oil was filled into stomach in the morning in group A and group B, and 1 mL peanut oil with 1,25-dihydroxyvitamin D3 was filled into stomach in group C. Airway resistance (Re) of asthmatic guinea pigs was detected, and the bronchoalveolar lavage fluid (BALF) cells were counted. Lung tissue with HE and MCT immunohistochemical staining were used to observe the pathological changes in lung tissue and the distribution of MCT.@*RESULTS@#After injection of different concentration of acetylcholine chloride, the Re in group B and group C were increased significantly compared with group A (P < 0.05); compared with group B, the Re in group C were decreased significantly (t = -5.385, -5.761, -6.184, -13.574, P < 0.05); the total number of BALF cells and eosinophils were increased significantly in group B and C (t = 19.618, 9.598, 10.854, 5.388, P < 0.05); compared with group B, the total number of BALF cells and eosinophils in group C was decreased significantly (t = -5.555, -5.392, P < 0.05); the number of tryptase positive cells in group B was increased significantly than that in group A (t = 21.312, P < 0.05), and in addition to the alveolar septum and submucosa, the cells were also distributed around blood vessels and outside the cells; the number of tryptase positive cells in group C was decreased significantly compared with group B, and the difference was statistically significant (t = 5.043, P < 0.05).@*CONCLUSIONS@#After the asthmatic guinea pigs are treated with 1,25-dihydroxyvitamin D3, their BALF, Re, infiltration degree of inflammatory cells in the trachea and lung tissue and airway inflammatory reaction are reduced significantly. 1,25-dihydroxyvitamin D3 has a certain inhibiting effect on the activation of mast cells and the release of MCT granules.

Expression of transforming growth factor-βon mast cells in human chro-nic periapical diseases / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate the distribution of mast cells ( MCs) and the expression of transforming growth factor-β(TGF-β) on tryptase positive MCs in different types of human periapical diseases.METHODS:Total 78 cases of specimens were involved in this study, including healthy control, periapical cyst and periapical granuloma.The tissue sam-ples were fixed in 10% formalin for at least 48 h, stained with hematoxylin and eosin for histopathological examination, stained with toluidine blue staining for identifying MCs and MCs degranulation, and stained with double immunofluores-cence for identification of tryptase-TGF-βdouble positive MCs.RESULTS:The density of tryptase-TGF-βdouble positive MCs in the periapical lesions was significantly higher than that in the healthy controls ( P<0.01) .The number of TGF-βpositive MCs in the periapical cyst was significantly higher than that in the periapical granuloma ( P<0.01 ) .Compared with toluidine blue staining, the number of MCs with double immunofluorescence staining significantly increased ( P <0.01).CONCLUSION:The TGF-βpositive MCs may play an important role in the pathogenesis of human chronic peria-pical diseases, particularly in the formation of fibrous tissue in periapical cyst.Double immunofluorescence staining is more sensitive than the traditional toluidine blue staining for identifying MCs.

Effect of 1,25-dihydroxyvitamin D3 on mast cells tryptase in asthmatic guinea pigs

Objective: To explore the effect of 1,25-dihydroxyvitamin D3 on the mast cell tryptase (MCT) in asthmatic guinea pigs. Methods: A total of 60 male or female healthy guinea pigs were randomly divided into control group (group A), asthmatic group (group B), and 1,25-dihydroxyvitamin D3 group (group C), with 20 cases in each group. To establish asthmatic guinea pig models, 1mL peanut oil was filled into stomach in the morning in group A and group B, and 1mL peanut oil with 1,25-dihydroxyvitamin D3 was filled into stomach in group C. Airway resistance (Re) of asthmatic guinea pigs was detected, and the bronchoalveolar lavage fluid (BALF) cells were counted. Lung tissue with HE and MCT immunohistochemical staining were used to observe the pathological changes in lung tissue and the distribution of MCT. Results: After injection of different concentration of acetylcholine chloride, the Re in group B and group C were increased significantly compared with group A (P<0.05); compared with group B, the Re in group C were decreased significantly (t=-5.385,-5.761,-6.184,-13.574, P<0.05); the total number of BALF cells and eosinophils were increased significantly in group B and C (t=19.618, 9.598, 10.854, 5.388, P<0.05); compared with group B, the total number of BALF cells and eosinophils in group C was decreased significantly (t=-5.555,-5.392, P<0.05); the number of tryptase positive cells in group B was increased significantly than that in group A (t=21.312, P<0.05), and in addition to the alveolar septum and submucosa, the cells were also distributed around blood vessels and outside the cells; the number of tryptase positive cells in group C was decreased significantly compared with group B, and the difference was statistically significant (t=5.043, P<0.05). Conclusions: After the asthmatic guinea pigs are treated with 1,25-dihydroxyvitamin D3, their BALF, Re, infiltration degree of inflammatory cells in the trachea and lung tissue and airway inflammatory reaction are reduced significantly. 1,25-dihydroxyvitamin D3 has a certain inhibiting effect on the activation of mast cells and the release of MCT granules.