Value of serum IgG4 and IgG4/IgG ratio in differential diagnosis of autoimmune diseases / 中国基层医药

Objective:To investigate the value of immunoglobulin G4 (IgG4) and IgG4/ immunoglobulin G (IgG) ratio in the differential diagnosis of IgG4-related diseases (IgG4-RD) and other autoimmune diseases.Methods:A total of 35 patients with IgG4-RD and 937 patients with autoimmune diseases who received treatment in Beijing Hospital from January 2021 to July 2022, and 200 subjects who concurrently underwent health checkups in the same hospital were included in this study. The IMMAGE 800 and BN II automatic special protein analyzers were used to detect IgG and IgG4. The receiver operating characteristic (ROC) curve of IgG4 and IgG4/IgG ratio was plotted.Results:Serum IgG4 level and IgG4/IgG ratio in the IgG4-RD group were 2.83 (2.01, 5.07) g/L and 25% (18%, 43%) respectively, which were higher than 0.35 (0.16, 0.72) g/L, 3% (1%, 6%) in the autoimmune disease group and 0.27 (0.14, 0.49) g/L, 2% (1%, 4%) in the healthy control group ( U = 795.50, 82.50, 1 744.50, 205.50, all P < 0.001). Taking IgG4 ≥ 1.35 g/L as the standard, patients with IgG4 ≥ 1.35 g/L in the three groups were screened out. There was a statistically significant difference in IgG4/IgG ratio between the IgG4-RD group and the non-IgG4-RD group ( U = 453.50, P < 0.001). The ROC curve of IgG4 and IgG4/IgG ratio showed that when IgG4 was 1.47 g/L, the sensitivity was 91.7%, the specificity was 83.5%, and the area under the ROC curve was 0.96. When IgG4/IgG was 12.5%, the sensitivity was 91.4%, the specificity was 85%, and the area under the ROC curve was 0.96. Taking IgG4 ≥ 1.47 g/L and IgG4/IgG ≥ 12.5% as the diagnostic criteria of IgG4-RD, the sensitivity was 94.3%, the specificity was 85.9%, and the area under the ROC curve was 0.96, which were higher than the sensitivity (87.2%) and diagnostic specificity (82.6%) provided by IgG4 alone. Conclusion:Because non-IgG4-RD diseases can also have the phenomenon of increased IgG4, when IgG4 ≥ 1.47 g/L is taken as the diagnostic criteria, its diagnostic sensitivity and specificity are the highest. Combined detection of IgG4 and IgG4/IgG ratio can increase the diagnostic efficacy of IgG4-RD.

Clinical analysis of 21 cases of IgG4-related diseases / 口腔疾病防治

Objective@# To summarize the clinical manifestations of IgG4-related diseases in the head and neck, explore treatment methods.@*Methods @#The clinical data of 21 patients diagnosed with IgG4-related diseases were retrospectively analyzed. The clinical data and the results of glucocorticoid and immunosuppressive therapy were studied retrospectively.@* Results@#All patients had swollen sclerotic masses, and CT showed irregular high-density masses with uniform enhancement in the enlarged glands. Some patients had mucosal thickening and mass-like changes in theoral cavity, nose, sinuses, throat and other tissues, and most of the patients had cervical lymphadenopathy and elevated serum IgG4 levels (≥ 1.35 g/L). Histopathological examination of affected exosine glands and affected mucosa and lymph nodes in all patients showed infiltration of lymphocytes, plasma cells and IgG4+ plasma cells. In 21 patients, the mass in the affected glands and mucosa (including head, neck and other tissues) disappeared, and the clinical symptoms were relieved after the application of glucocorticoids. However, with a reduction in glucocorticoids, the mass recurred or even worsened.@*Conclusion @#For patients with a single mass in the submandibular gland, parotid gland and other salivary glands, as well as lymph node enlargement, CT is the first choice to identify the nature of gland neoplasms. Combined with pathological examination, related auxiliary examination and peripheral blood examination are also needed to obtain a definitive diagnosis. Glucocorticoid therapy is used to achieve a good prognosis, and long-term follow-up and timely adjustment of medication regimens are required.

Research progress on DNA damage in aging-related diseases / 中华老年医学杂志

DNA damage is one of the research hotspots in the field of aging and related diseases, because it can cause cell cycle arrest and apoptosis, accelerate the body's rate of aging and increase the risk of aging-related diseases.This review will summarize the mechanisms of DNA damage in cells, animal models and individuals and its associations with aging and aging-related diseases, including cancer, cardiovascular disease, Alzheimer's disease and premature aging syndromes.We aim to provide a theoretical framework for anti-aging research and clinical intervention in the treatment of aging-related diseases.

Clinical characteristics of retroperitoneal fibrosis:an analysis of 28 cases / 中华全科医师杂志

Clinical data of 28 patients diagnosed with retroperitoneal fibrosis (RPF) in Shanxi Bethune Hospital from September 2014 to September 2020 were retrospectively analyzed. There were 16 males and 12 female with a mean onset age of (56±11) years. The clinical manifestations were lumbago (16/28, 57.14%), abdominal pain (9/28, 32.14%) and back pain (8/28, 28.57%). Inflammatory indexes were elevated in 25 cases (89.29%), and 3 cases had renal insufficiency. Serum IgG4 was elevated in 3 cases (10.71%). Scheel imaging evaluation showed that proportion of type Ⅰ combined with type Ⅲ (abdominal aorta and/or iliac vascular involvement combined with unilateral or bilateral ureteral involvement) was the highest(50.00%, 14/28). followed by. Twenty-seven patients (96.43%) were treated with glucocorticoids and immunosuppressants; 14 patients (50.00%) underwent surgical intervention for ureteral obstruction or hydronephrosis; 6 patients (21.43%) relapsed during hormone withdrawal; 6 patients (21.43%) recovered from the disease and terminated medication; and 13 patients (46.43%) successfully removed the double J tube after lifting ureteral obstruction and hydronephrosis. It is suggested that RPF is more likely to occur in middle-aged and elderly men, with low back pain as the main clinical feature, and ureteral involvement as the main imaging feature. Glucocorticoid combined with immunosuppressive therapy is the conventional treatment. Surgical intervention can relieve acute obstruction and effectively improve the prognosis of patients.

IgG4 related disease involving the adrenal glands: a case report / 中华泌尿外科杂志

IgG4-related diseases have a low incidence and are easily misdiagnosed as tumors in clinical treatments. A 26-year-old male patient was admitted to the hospital because of a left adrenal tumor found in health examination for more than 5 months. The tumor in the left adrenal region could be seen from abdominal CT, and the retroperitoneal laparoscopic resection of the left adrenal tumor was performed. Postoperative pathology was consistent with IgG4-related diseases, and serum IgG4 was abnormally high. After 2 months’ follow-up, serum IgG4 returned to normal, and no special discomfort.

Occupational safety, best practices, and legislative review on small-scale mining in the Philippines

Introduction@#Small-scale mining (SSM) has been in the Philippines since the early 1900s and significant contributor to the local economy. SSM has contributed 14% of the country's total Gross Domestic Product and has a revenue share of about 19 billion pesos (380 million USD). @*Objectives@#This study aims to document mining occupational safety and health in SSM in the Philippines and identify best practices among miners and communities to reduce toxic chemical use in mining. It also aims to evolve laws and legislative measures on mining in the country as the basis for more aggressive policies and programs for SSM in the Philippines. @*Methods@#The data were based on gray literature, peer-reviewed journals, databases, government statistics, and secondary literature. Data were analyzed through critical appraisal on the impacts of mining in terms of occupational safety, mining issues, hazards, and disasters, environmental and health impact, as well as documentation of best practices in mining to reduce the use of toxic chemicals, and the current laws and legislations on mining in the Philippines. @*Results@#SSM or artisanal mining is categorized as part of the informal sector of the market economy. In the Philippines, the leading types of accidents in the mines are being hit by falling objects, suffocation from chemical fumes, and crushing injuries, exposure to intense heat, poor ventilation, vibration, dust, fumes, repetitive stress injury, intense noise, manual handling (e.g., lifting) of heavy machinery, and biological and chemical hazard. Occupational illnesses include skin diseases, emphysema, chronic obstructive lung disease, and hearing loss. Due to these risks, the Philippines has adopted mercury-free mining, cyanide reduction, and green and climate-smart mining. The use of borax in recovering gold from ore instead of mercury originated in the Philippines, which is now widely known as the mercury-free gravity-borax method adopted in Africa and Asia. The Philippines also has a plethora of laws covering mining as a whole. Developmental directives include enacting specific SSM laws and regulations, including a separate set of safety rules, and decentralizing the issue and control of SSM permits and licenses through local government units. Some noted legislative measures, Presidential Decrees, and Administrative Orders have been crafted to cover the safety net, equity, safety, and health for small-scale miners, among the most vulnerable working populations. @*Discussion@#Hazards and risks have been documented in SSM in the Philippines. However, the policies, legislation, and protective measures on SSM warrant more comprehensive coverage, implementation, and provision of social safety nets. @*Conclusion@#The study concludes that mining in the Philippines continues to be a problem as it produces adverse effects on workers' health, the community, and the environment. It is crucial to ensure the health and safety of mining workers, and all players and stakeholders must fulfill their respective roles. Governments and communities need to perform their regulatory and monitoring functions dutifully to build up their capacities to benefit mining communities that contribute much to the local economy.

Challenge of New Norms: Obesity amid COVID-19 Pandemic

@#COVID-19 pandemic aggravated the global public health system, which is already overwhelmed by the increasing statistics of comorbidities and burden due to obesity. The number of individuals with obesity and obesity-associated diseases are rising in many regions that could attribute to the growing obesogenic environment and the lockdown implemented to curb COVID-19. This review focuses on the aspects of the obesity epidemic, chronic inflammatory effects of obesity, positive outcomes of obesity interventions and the worsening effects observed in obese COVID-19 patients. The chronic inflammatory effects of obesity are apparent by the increase of pro-inflammatory signals by immune cells in the adipose tissue and reactive species populations. The reduction of antioxidants exacerbates the effects of oxidative stress on genomic and tissue levels. The public must be made aware of the importance of practising a healthier lifestyle, even more now as we are fighting the COVID-19 pandemic.

Advances in diagnosis and treatment of IgG4-related hepatobiliary and pancreatic diseases / 临床肝胆病杂志

IgG4-related hepatobiliary and pancreatic diseases are a part of the IgG4-related disease multiorgan fibroinflammatory disorder, including IgG4-related autoimmune pancreatitis, IgG4-related sclerosing cholangitis, and IgG4-related hepatic involvement. The main pathological features include IgG4 + plasma cell/lymphocyte infiltration, storiform fibrosis, obliterative phlebitis, and eosinophil infiltration. The diagnosis of this disease is often based on the comprehensive diagnostic criteria for IgG4-related diseases and organ-specific diagnostic criteria. However, it is difficult to differentiate IgG4-related hepatobiliary and pancreatic diseases from neoplastic diseases, and novel diagnostic biomarkers are expected to improve the sensitivity and specificity of diagnosis. To date, glucocorticoids remain the first-line drug for this disease, and biological agents, especially anti-CD20 monoclonal antibody, may be an alternative therapy for patients with corticosteroid contraindication/intolerance or recurrent/refractory disease.

Factores relacionados con osteoartritis en trabajadores informales del centro de Medellín, Colombia / Related factors with Osteoarthritis in informal workers in Medellin downtown, Colombia

Resumen Introducción: Se hace una correlación entre la osteoatrosis y las condiciones laborales, hábitos y estilos de vida de los trabajadores informales del centro de Medellín, Colombia. Objetivo: Identificar la relación de la osteoartritis y la prevalencia de enfermedades crónicas y degenerativas con las condiciones sociodemográficas, laborales, hábitos y estilos de vida en un grupo de trabajadores informales de Medellín, Colombia. Materiales y métodos: Estudio transversal, con fuente primaria de información de 686 trabajadores informales. Se realizó una encuesta asistida, previa toma de consentimiento. Se seleccionaron 289 trabajadores con diagnóstico de enfermedad crónica o degenerativa, ≥18 años, con ≥5 años en su oficio. Se realizaron análisis exploratorios y de asociación con prueba Chi2, y cálculo de RP con IC del 95%. Resultados: el 79,9% de la población padecía alguna enfermedad crónica. El 3,46% presentaba diagnóstico de osteoartritis, siendo significativamente mayor (p<0,05) en quienes tenían entre 21 y 30 años en su oficio (RP=5,62. IC:1,20;26,34). También fue mayor la prevalencia de osteoartritis en; >45 años (RP=2,26), mujeres (RP:4,44), trabajadores sedentarios (RP=1,71), obesos (RP=3,40), así como en quienes habían sido obreros (RP=1,30), en aquellos que tenían puestos de venta semiestacionaria (RP=2,21), vendían productos de cosecha y perecederos (RP=1,78), en quienes trabajaban >8 horas diarias (RP:2,77), ≤5días a la semana (RP=3,10), no tenían espacio suficiente para moverse (RP=2,08), y en quienes tenían posturas o movimientos forzados (RP=2,72). Conclusión: En la población de vendedores informales del centro de Medellín, los factores sociodemográficos, laborales, hábitos y estilos de vida modificables se relacionan con una mayor prevalencia de osteoartritis.

Abstract Introduction: A correlation is made regarding osteoarthrosis and working conditions and lifestyles of informal workers in Medellin downtown. Objective: To identify the prevalence of chronic and degenerative diseases, and the relationship of osteoarthritis with sociodemographic and work conditions, habits and lifestyles, in a group of informal workers from Medellín, Colombia. Materials and methods: Cross-sectional study, with a primary source of information, with 686 workers. An assisted survey was applied, after obtaining consent. 289 workers with a diagnosis of chronic or degenerative disease, ≥18 years old, with ≥5 years in their profession were included. Exploratory and association analysis with Chi2 test, and calculation of PR with 95% CI. Results: 79.9% of them suffered from a chronic disease. 3.46% had a diagnosis of osteoarthrosis, being significantly higher (p <0.05) in those who had spent between 21 and 30 years performing their profession (PR=5,62.CI:1,20;26,34). The prevalence of osteoarthrosis was also higher in; >45 years (PR=2.26), women (PR=4,44), sedentary workers (PR=1,71), obese (PR=3,40), as well as those who had been brick-layers (PR=1,30), in those who had semi-stationary sales positions (PR=2,21), they sold harvest and perishable products (PR=1,78), in those who worked> 8 hours a day (PR:2,77), ≤ 5 days a week (PR=3,10), they did not have enough space to move (PR = 2.08), and in those who had forced postures or movements (PR=2,72). Conclusion: sociodemographic and work factors, habits and modifiable lifestyles are related to a higher prevalence of osteoarthrosis in this working population.

Investigação epidemiológica de Covid-19 relacionada ao trabalho em trabalhadores de Saúde: experiência do Cerest Salvador / Epidemiological investigation of work- related Covid-19 cases among health workers: Salvador Cerest's experience / Investigacion epidemiologica del Covid-19 relacionado con el trabajo en trabajadores de la salud: la experiencia del Cerest Salvador

A pandemia da Covid-19 trouxe um cenário inédito para a saúde pública. Considerando o crescente número de trabalhadores de saúde infectados no município de Salvador, Bahia, o Centro de Referência em Saúde do Trabalhador de Salvador desenvolveu uma metodologia para investigação epidemiológica da relação de casos de Covid-19 com o trabalho. Este relato apresenta estratégias e métodos desenvolvidos para a investigação dos casos de trabalhadores positivos para Covid-19, com o objetivo de conhecer as condições de trabalho, possibilidades de contaminação e cronologia da doença, a fim de estabelecer sua relação com o trabalho. Foram realizadas entrevistas semiestruturadas por telefone, com coleta de informações em instrumento padronizado, sobre questões relacionadas à ocupação, hábitos, medidas de controle e prevenção, cronologia da doença e impressões sobre o adoecimento do trabalhador. As entrevistas foram realizadas com trabalhadores da saúde que constavam no banco de dados fornecido pelo Centro de Informações Estratégicas em Vigilância em Saúde de Salvador como positivos para Covid-19. Foram analisadas 2.102 investigações epidemiológicas, concluídas entre abril e agosto de 2020; dessas, 81,4% apresentaram-se como casos de Covid-19 relacionada ao trabalho. Dos casos investigados, 35,2% são trabalhadores da categoria de técnico/auxiliar de enfermagem, seguidos por enfermeiros, com 14,0%, e médicos, com 7,0%. A pandemia da Covid-19 demonstra a vulnerabilidade do trabalhador em saúde, seja pelas más condições de trabalho, carência de equipamentos de proteção coletiva e individual, ou pela precariedade dos vínculos trabalhistas. Identificar a relação com o trabalho e como este atua na disseminação da Covid-19 é importante para a intervenção e enfrentamento da pandemia nos ambientes de trabalho.

The Covid-19 pandemic caused by the new coronavirus (SARS-CoV-2) has brought an unprecedented scenario to public health. Due to the growing number of infected workers in the city of Salvador, the Salvador Worker´s Health Reference Center developed a strategy to conduct an epidemiological investigation of work-related cases of Covid-19 among health workers that tested positive for Covid-19. This report presents the strategy and methods developed to investigate cases of workers positive for Covid-19, with the purpose of knowing working conditions, contamination possibilities, and disease chronology to establish the relationship between disease and work. Semi-structured telephone interviews were conducted, recording information in a data collection tool, focusing on issues related to occupation, habits, preventive measures and control, disease chronology and worker's impressions about their illness. The interviews were applied to health workers registered as positive for Covid-19 at the database provided by Salvador Center for Strategic Information on Health Surveillance. From April to August 2020, 2,102 epidemiological investigations were completed, of which 81.39% were work-related cases of Covid-19. Of the investigated cases, 35.2% are nursing assistants, followed by nurses (14.0%) and medical physicians (7.0%). The Covid-19 pandemic shows the vulnerability of health work, whether due to poor working conditions, lack of collective and individual protective equipment, or even due to precarious nature of employment bonds. Knowing the relationship between work conditions and Covid-19 cases, will certainly contribute to implement preventive and protective measures to control pandemics in workplaces.

La pandemia del Covid-19 ha ocasionado un escenario sin precedentes para la salud pública. Debido al creciente número de trabajadores infectados en el municipio de Salvador (Brasil), el Centro de Referencia en Salud del Trabajador de Salvador desarrolló una estrategia de investigación epidemiológica respecto a la relación de los casos de Covid-19 con el trabajo. Este informe presenta la estrategia y los métodos desarrollados para investigar los casos de trabajadores positivos para el Covid-19, con el propósito de conocer las condiciones laborales, posibilidades de contaminación, cronología de la enfermedad, así como establecer su relación con el trabajo. Se realizaron entrevistas semiestructuradas por teléfono, con recopilación de información en instrumento estandarizado, enfocándose en cuestiones relacionadas con ocupación, hábitos, medidas de control y prevención, cronología de la enfermedad e impresiones sobre la enfermedad del trabajador. Las entrevistas se realizaron con los trabajadores de la salud que estaban identificados en la base de datos del Centro de Información Estratégica en Vigilancia en Salud de Salvador entre los positivos para Covid-19. De abril a agosto 2020, se analizaron 2.102 investigaciones epidemiológicas, de estas el 81,4% se presentaron como casos de Covid-19 relacionados con el trabajo. De los casos investigados, el 35,2% fueron de trabajadores en la categoría de técnico/auxiliar de enfermería, seguidos de enfermeros (14,0%) y médicos (7,0%). La pandemia del Covid-19 demuestra la vulnerabilidad del trabajo en salud, ya sea por las malas condiciones de trabajo, falta de equipos de protección colectiva e individual, o por la precariedad de los vínculos laborales. Se considera importante identificar la relación entre Covid-19 y trabajo, así como las condiciones de trabajo que contribuyen con su diseminación, a fin de establecer medidas de protección y enfrentamiento de la pandemia en los ambientes laborales.

Tracing origin and development of "Fenglong (ST 40) for phlegm": examination and verification / 中国针灸

From the perspective of academic history, the background and evolution of "Fenglong (ST 40) for phlegm" were systematically summarized. As a result, it was found that in the early period, Fenglong (ST 40) was used for "tangible phlegm" of respiratory tract, but in the later generations, due to the comprehensive effects of various factors, the phlegm treated by Fenglong (ST 40) was generalized. In modern clinical practice of acupuncture and moxibustion, Fenglong (ST 40) is widely used for phlegm-related diseases. In addition, the knowledge content represented by "Fenglong (ST 40) for phlegm" showed evolution and change in academic heritage of previous dynasties. It is necessary for modern acupuncture researchers to systematically sort out, test and discriminate the habitual knowledge in combination with the background of traditional Chinese medicine, so as to promote the contemporary inheritance and application of traditional acupuncture theory and knowledge.

Progress in research on autophagy in vascular aging-related diseases / 中华老年医学杂志

Aging begins in the early stages of life and is an irreversible process in which wide-ranging and gradual functional declines occur with age in various organs of the body.Vascular aging, as a part of the overall aging process, plays an important role in the occurrence and development of vascular senescence-related diseases.Autophagy maintains homeostasis of the intracellular environment via degradation of damaged, denatured, or senescent proteins and organelles.Studies have found that basal autophagy is critical in regulating normal vascular function.However, abnormal autophagy may contribute to vascular aging and diseases associated with it.The purpose of this paper is to review recent progress on autophagy in vascular aging and its related diseases.

Clinical characteristics of central nervous system involvement in IgG4 related diseases / 北京大学学报(医学版)

OBJECTIVE@#To improve the understanding of the clinical characteristics of immunoglobulin G4-related disease (IgG4-RD) with central nervous system (CNS) involvement, so as to contribute to the early diagnosis and treatment.@*METHODS@#In this study, 10 patients with IgG4-RD with CNS involvement were selected. Clinical data including demographic features, clinical manifestations, organ involvement, laboratory findings, radiological results, pathology, treatments and outcomes were collected retrospectively.@*RESULTS@#Among the 10 IgG4-RD patients complicated with CNS involvement, 6 cases manifested as pituitary involvement and 4 cases manifested as dural involvement. Only 2 patients had nervous system involvement alone, while the left patients were complicated with other organ involvement besides nervous system. Half of the patients presented nervous system involvement as the initial manifestation, and the main symptoms of nervous system included polydipsia, polyuria, headache, decreased vision and so on. In the laboratory examination, the serum IgG4 level was increased in 9 cases (90.0%), and the total serum IgE was increased in 7 cases (87.5%). At the same time, their IgG, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were increased, while complement (C) 3 and C4 were decreased in some patients. Eight patients underwent tissue biopsies in different parts, the pathological examination showed a large number of lymphocyte and plasma cell infiltration, accompanied by fibrous tissue proliferation in part. All the patients were treated with glucocorticoids, and 8 cases (80%) were given immunosuppressants at the same time, and 3 cases were treated with rituximab when they expe-rienced disease relapse. As a result, 2 cases (20%) achieved complete remission (CR), and 8 cases (80%) achieved partial remission (PR). The median follow-up time was 13.5 months, and 4 cases relapsed.@*CONCLUSION@#Pituitary and dura are common affected organs of IgG4-RD with CNS involvement. Most IgG4-RD patients with CNS involvement are combined with other organ involvement, but half of them presented nervous system involvement as the initial manifestation, and the symptoms are not typical. In order to make an early diagnosis, laboratory, imaging examination and tissue biopsy should be taken into consideration in combination if necessary.

Superexploração da força de trabalho e saúde do trabalhador: o trabalho precário na confecção / Overexploitation of the workforce and workers' health: precarious work in clothing making

Resumo É essencial o entendimento das mudanças ocorridas no mundo do trabalho e de como estas se relacionam com o processo saúde-doença. Objetivou-se analisar as expressões da superexploração da força de trabalho e sua repercussão na saúde dos trabalhadores de facções instaladas em dois municípios do arranjo produtivo local de confecções do Agreste pernambucano. A pesquisa foi orientada por uma perspectiva que considera a totalidade e a historicidade das relações sociais e sua articulação com os processos sociais particulares. Foram aplicados questionários e entrevistas semiestruturadas para trabalhadores da confecção dos municípios de Toritama e Santa Cruz do Capibaribe, no ano de 2017. Os resultados foram analisados com base no método dialético. A superexploração da força de trabalho se expressou nas relações de trabalho por meio da articulação da remuneração da força de trabalho abaixo de seu valor, do aumento do valor histórico moral da força de trabalho sem seu pagamento correspondente, da extensão das jornadas de trabalho e da intensificação do trabalho exercido nas facções. Tais características tendem a violar o fundo de consumo e de vida dos trabalhadores, que poderão apresentar um desgaste precoce de sua força de trabalho, podendo ser evidenciado pelo adoecimento e/ou perda precoce da capacidade para o trabalho.

Abstract Understanding the changes in the world of work and how they relate to the health-disease process is essential. This study aimed to analyze the expressions of the overexploitation of the workforce and its impact on the health of workers from facções in two municipalities in the local production arrangement of the Agreste in Pernambuco state, Brazil. The research was guided by a perspective that considers the totality and historicity of social relations and their articulation with particular social processes. Questionnaires and semi-structured interviews were applied to confection workers in the municipalities of Toritama and Santa Cruz do Capibaribe, in 2017. The results were analyzed based on the dialectic method. The overexploitation of the workforce was expressed in labor relations through the articulation of the workforce's remuneration below its value, the increase in the historical moral value of the workforce without its corresponding payment, the extension of working hours and the intensification of the work carried out in the facções. Such characteristics tend to violate the consumption and life fund of workers, who may present an early strain on their workforce, which can be evidenced by illness and / or early loss of ability to work.

Enfermedades transmitidas por el agua en Argentina y Brasil a principios del siglo XXI / Waterborne diseases in Argentina and Brazil at the beginning of the 21st century

Resumen Este artículo pretende analizar la evolución de la mortalidad por enfermedades transmitidas por el agua durante el primer decenio del siglo XXI, por grupos de edades, comparando dos países del cono sur: Argentina y Brasil. Se estiman Años de Esperanza de Vida Perdidos (AEVP) por causa de muerte en base a la técnica descripta por Eduardo Arriaga. Para todas las estimaciones de defunción se utilizan promedios móviles para establecer dos períodos: 2000-2002 y 2009-2011. Se observa una tendencia general a la disminución de la mortalidad por enfermedades relacionadas con el agua, tanto en Argentina como en Brasil, con una velocidad de reducción promedio de los años de vida perdidos cercana al 1% anual. Esta reducción no es uniforme para todas las enfermedades relacionadas a este grupo de causas; de hecho existen causas que aumentan su mortalidad en el período estudiado, aunque en su mayoría se trata de brotes epidémicos. Por otro lado, el grupo de causas analizado impacta más en las edades más vulnerables: los menores de 1 año y los mayores de 50 años. Las intervenciones aisladas que se hacen sobre la higiene del agua, no logran por sí solas alcanzar los niveles de éxito deseado frente a este tipo de afecciones, que dependen de otros factores asociados a las condiciones de salud, la calidad de vida y la educación sanitaria.

Abstract This article aims at analyzing the evolution of mortality from waterborne diseases during the first decade of the 21st century, by age groups, comparing two countries of the southern cone: Argentina and Brazil. The method of years of potential life lost (YPLL) due to death, based on the technique described by Eduardo Arriaga, was used. For all death estimates, moving averages are used to establish two periods: 2000-2002 and 2009-2011. There is a general trend towards a reduction in mortality because of water-related diseases, both in Argentina and Brazil, with an average reduction rate of years of life lost close to 1% per year. This reduction is not uniform for all diseases related to this group of causes; in fact, there are causes that increase their mortality in the period studied, although most are epidemic outbreaks. On the other hand, the group of causes analyzed impacts more on the most vulnerable ages: those under 1 year old and those over 50 years old. The isolated interventions made on the hygiene of the water do not reach the levels of desired success by themselves considering this type of affections, that depend on other factors associated to the health conditions, the quality of life and the health education.

Violências contra trabalhadores adoecidos e instrumentos de gestão: uma relação a explorar / Violences against sick workers and management tools: a relationship to explore

Trata-se de estudo realizado por demanda de um sindicato de trabalhadores metalúrgicos à Fundacentro, objetivando analisar as situações de violências vividas por trabalhadores adoecidos pelo trabalho em uma montadora de automóveis. Foram realizadas entrevistas com sindicalistas, visita à montadora, entrevistas individuais e coletivas com trabalhadores, validação dos dados. À luz da discussão sobre violências relacionadas ao trabalho e intensificação do trabalho, analisou-se sua relação com instrumentos de gestão. Com base na compreensão de gestão de Gaulejac e na perspectiva das evoluções conceituais sobre violência no trabalho, expressada por Soboll, entre outros, confirmaram-se práticas de exclusão e isolamento de trabalhadores adoecidos, humilhações e descaracterização das doenças relacionadas ao trabalho, deslegitimando e colocando os adoecidos sob suspeita. Instrumentos de gestão e elementos da cultura organizacional eram utilizados nestas práticas violentas caracterizando um modo de agir sistêmico que contribui para a cronificação de doenças e a geração de incapacidade, além de prejudicarem ações preventivas, tanto da própria empresa, como do Estado, pela ocultação de riscos e danos. Demandas dessa natureza são frequentes, evidenciando que a violência contra adoecidos pelo trabalho e o ocultamento de doenças do trabalho constituem sério problema social com impacto dramático nas vidas de trabalhadores e no sistema de saúde pública

This study was carried out by Fundacentro at the request of a metalworkers' union, aiming to characterize and analyze the situations of violence experienced by workers who had work-related injuries or illnesses, in an automobile assembly plant. Interviews with trade unionists, a visit to the automaker, individual and collective interviews with workers and validation of the data were carried out. It was based on the Gaulejac's management concept and the Soboll's violence at work concept. The exclusion and isolation of sick workers, humiliation, denial and de-characterization of work-related illnesses were confirmed, delegitimizing and placing the workers under suspicion. Management tools and elements of organizational culture were used in these violent practices, characterizing a systemic way of acting, which contributes to these diseases becoming chronic and generating incapacity, as well as impairing preventive actions, of both the company itself and the State, by concealment of risks and damages. Demands of this nature are frequent, evidencing that the violence against people with work-related illnesses and the concealment of such illnesses constitute an important social problem, with a dramatic impacts on the lives of workers and the public health system.

Structure and function of B-cell linker and its role in the development of B cell-related diseases / 南方医科大学学报

B cell linker (BLNK) is a key linker protein of B cell receptor (BCR) signaling pathway. BLNK participates in the regulation of PLC-γactivity and the activation of Ras pathway through its typical structure and interaction network with other proteins, and is thus widely involved in the regulation of B cell proliferation, differentiation, apoptosis and signal transduction. Furthermore, it is closely related to anaphylactic diseases, multiple sclerosis, chromosomal aneuploidy, aneuglobulinemia, B lymphocytic leukemia and lymphoma. Herein we review the structure and biological function of BLNK and its role in B cell-related diseases. BLNK can cooperate with a series of effective proteins to activate BCR signaling pathway, thereby regulating the development, maturation and function of B cells. The functional mutation of BLNK can destroy the homeostasis of B cells and affect the development and maturation of B cells, which leads to the occurrence of B cell related diseases. A comprehensive understanding of the biological functions of BLNK not only provides insights into the pathogenesis of B cell-related diseases, but also inspires new ideas and helps to find breakthroughs for the treatment of these diseases with BLNK as the therapeutic target.

The 471st case: duodenal ulcer, mucor infection, and elevated IgG4 / 中华内科杂志

Mucor infection is rarely reported in non-immunocompromised population, especially in isolated gastrointestinal tracts. IgG4-related diseases (IgG4-RD) have been recognized in recent years, but secondary causes of IgG4 elevation should be differentiated. We reported a young man with duodenal mass and ulcer and high serum IgG4 level. Histological biopsy of the mass revealed positive mucor mycelium and infiltration of IgG4 positive plasma cells. Serum IgG4 decreased to normal range after surgical resection and systemic antifungal treatment. This case suggests that isolated mucor mycosis infection can develop in the digestive tract and mimics as IgG4-related disease.

Clinical significance and pathological features of ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis / 中华肾脏病杂志

Objective@#To investigate the clinical significance and pathological features of lymphocytes and plasma cells infiltration and related ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis (IgG4-TIN).@*Methods@#Complete data was collected from 24 patients with IgG4-TIN confirmed by pathology in the Peking University First Hospital. The renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy examination. In addition, immunohistochemistry was used to detect the distribution of CD20+ B lymphocytes, CD3+ T lymphocytes and CD138+ plasma cells.@*Results@#A total of 24 patients were enrolled in the study, including 21 males (87.5%), 3 females (12.5%). The age was (58.0±10.8) years (38-75 years). Pathology analysis showed ectopic lymphoid-like structures were located in 16 (66.7%) cases and Russell bodies were detected in infiltrative plasma cells of 19(79.2%) cases with IgG4-TIN. Compared with cases without Russell body formation, cases with Russell body formation in renal interstitial plasma cells were more prone to show ectopic germinal center-like structure formation (P=0.001), tubular basement membrane (TBM) electron dense deposits (P=0.040) and reduced blood C3 levels (P=0.028).@*Conclusions@#Abnormal tubulointerstitial infiltration of ectopic lymphoid-like structures and plasma cells with prominent Russell body exist in IgG4-TIN patients, which suggests the persistent activation of lymphocytes and plasma cells in renal interstitium may contribute to the pathogenesis of IgG4-TIN.

Epstein-Barr virus infection and respiratory-related diseases in children / 中华实用儿科临床杂志

Epstein-Barr virus (EBV) is a common viral pathogen in children.EBV infection can cause childhood tumors, immune-related diseases and respiratory-related diseases.The proportion of EBV infection in Chinese children is high and the age of primary infection is early.Its pathogenesis is closely related to B lymphocytes, natural killer cells and gene defects.Clinical EBV infection is not only associated with childhood tumors and immune-related diseases, but also causes respiratory-related diseases that deserve more attention.