Recent advances in myeloid-derived suppressor cell biology / 医学前沿

In recent years, studying the role of myeloid-derived suppressor cells (MDSCs) in many pathological inflammatory conditions has become a very active research area. Although the role of MDSCs in cancer is relatively well established, their role in non-cancerous pathological conditions remains in its infancy resulting in much confusion. Our objectives in this review are to address some recent advances in MDSC research in order to minimize such confusion and to provide an insight into their function in the context of other diseases. The following topics will be specifically focused upon: (1) definition and characterization of MDSCs; (2) whether all MDSC populations consist of immature cells; (3) technical issues in MDSC isolation, estimation and characterization; (4) the origin of MDSCs and their anatomical distribution in health and disease; (5) mediators of MDSC expansion and accumulation; (6) factors that determine the expansion of one MDSC population over the other; (7) the Yin and Yang roles of MDSCs. Moreover, the functions of MDSCs will be addressed throughout the text.

Assessment of wet age-related macular degeneration by optical coherence tomography angiography

Background: to date, fundus fluorescein angiography [FFA], remains the gold standard for the diagnosis of choroidal neovascular membrane [CNV]. Optical coherence tomography angiography [OCTA] is a new imaging modality that allows a clear, depth-resolved visualization of the retinal vascular structures

Aim of the Work: to evaluate the role of OCTA in diagnosis of CNV in patients with age-related macular degeneration [AMD]

Patients and Methods: this study enrolled 32 patients [40 eyes], including 20 patients [20 eyes] with wet AMD and 12 patients [20 eyes] with dry AMD. All patients underwent swept-source optical coherence tomography [SS-OCT], swept-source OCTA, and fundus fluorescein angiography [FFA]. OCTA was used to evaluate neovascular networks in terms of their type, location and extent of visualization. Sensitivity and specificity of the method were assessed separately in a group of 20 CNV eyes and 20 dry AMD based on FFA diagnosis as the gold standard

Results: sensitivity and specificity of en face OCTA were 95% and 100% respectively. Both Sensitivity and specificity of structural OCT were 100%

Conclusion: OCTA enables diagnosis of both classic and occult choroidal neovascularization in patients with AMD. The method has high sensitivity and specificity

Motor evoked potentials as a predictor for upper limb function following acute stroke

To record the MEPs in the affected upper limb of hemiplegic patients in order to study its role in the prediction of functional and motor recovery of the upper limb in cases of acute stroke. This study included 30 patients suffering from acute stroke, all of them were subjected to history taking, clinical and neurological examination and clinical assessment scales [initially and after three months of conventional physiotherapy] including Medical Research Council [MRC] scale, Nine Hole Peg test [NHPT] and action research arm test [ARAT]. Also, all patients and controls were subjected to MEPs recording in order to evaluate resting motor threshold, MEP amplitude and central motor conduction Time [CMCT]. The mean of initial MRC scale, NHPT and ARAT was 1.73 +/- 1.17, 4.23 +/- 2.34 and 21.53 +/- 14.42 respectively. As regards MEPs, the mean of resting motor threshold [mamp], MEP amplitude [microv] and CMCT [msec] were 109.57, 0.56 and 11.28 respectively showing a highly significant difference from the control group whose mean values were 73.4, 2.98 and 7 respectively. Patients were divided according to initial CMCT into three groups: group I and II [patients with normal and delayed CMCT respectively] and Group III [patients with absent MEP]. On comparing the initial and follow up motor and functional recovery according to the clinical scales [MRC, NHPT and ARAT] in the three patient groups, group I and II exhibited highly significant [P<0.01] higher scores than group III. Correlation study showed a significant negative correlation between CMCT and MRC scale and ARAT, also there was a significant positive correlation between CMCT and NHPT while no significant correlation was found between resting motor threshold or amplitude of MEPs and the follow up clinical scales. Predictive value of CMCT for improvement of different scores [MRC, NHPT and ARAT] was 22, 38 and 36.6% respectively. CMCT of MEPs was the parameter with the highest predictive value to functional improvement of affected upper limb in stroke patients. These data can be helpful for clinicians to plan the program of rehabilitation according to the expected recovery of motor function

Microvascular abnormalities in juvenile onset systemic lupus erythematosus

To assess the microvascular abnormalities in patients with juvenile onset systemic lupus erythematosus [SLE] using the nailfold capillaroscopy [NFC] and to measure the levels of anti-annexin V antibody [a-AXV Ab] titer to correlate them with each other and with renal affection. This study was conducted on twenty patients with juvenile onset SLE and ten healthy controls. All the patients and controls were subjected to history taking and clinical examination, laboratory investigations especially kidney function tests, ANA and anti-ds-DNA and quantitative assay of a-AXV Ab titer. SLE disease activity index and NFC were also performed. The mean capillary number and length in the patients was 7.05 +/- 1.76 and 477.1 +/- 157.01 respectively, showing a significant difference from the controls [10 +/- 1.05 and 315 +/- 105.01 respectively], while there was no significant difference regarding capiliary width. Tortuous capillaries were found in 13 patients showing a significant difference from the controls having hairpin capillaries. Organized capillaries were found in 3 patients and all the controls. The mean a-AXV Ab titer in patients was 226.45 +/- 117.66 AU/ml showing a significant difference from the controls [5.6 +/- 1.71 AU/ml]. Proteinuria showed a positive significant correlation with a-AXV Ab titer, capillary width and length [r=0.530, 0.457 and 0.447 respectively] while it was negatively correlated with capillary number [r=-0.459]. Anti-AXV Ab titer was positively correlated with capillary length [r= 0.509]. At cut-off value 160 AU/ml, a-AXV Ab titer showed sensitivity [Sn] and specificity [Sp] 100% in discriminating lupus nephritis [LN] from negative LN while capillary length showed Sn and Sp 100 and 70% at cut-off 370 and capillary width had 70% Sn and 80% Sp at cut-off 20 NEC is of value in detecting micro vascular abnormalities in juvenile onset SLE and its analysis especially capillary length in combination with a-AXV Ab titer may be helpful in raising suspicion for lupus nephritis

Vestibular dysfunction in systemic sclerosis

Systemic sclerosis is a chronic connective tissue disease characterized by multisystem affection. Nervous system involvement in the form of peripheral and cranial nerve affection has been reported in systemic sclerosis [SSc] patients. To study the possible occurrence of vestibular dysfunction in SSc and to determine its nature [peripheral or central]. Also, we aimed to correlate any vestibular involvement with clinical and laboratory data of the patients. Fifteen female patients suffering from SSc were included in this study. All patients were subjected to careful history taking, clinical examination, basic audiological examination, vestibular test battery in the form of Vestibular Evoked Myogenic Potentials [VEMP] and Videonystagmography [VNG]. VNG included bithermal caloric test to assess the semicircular canal and superior vestibular nerve while the oculomotor test battery was used to assess the central pathway. Out of the 15 female patients included in this study, nine patients was suffering from limited SSc [60%] while six patients had diffuse SSc [40%]. The mean age was 37.56 +/- 11.89 years with mean disease duration 8.43 +/- 7.3 years. The results of our study showed a high incidence of vestibular dysfunction in SSc patients where 13 patients [86.66%] showed abnormality in one or more of vestibular tests, 12 patients [80%] having abnormal VEMP results and 3 patients [19.99%] having abnormal caloric test. Our study showed that Systemic sclerosis has definite vestibular involvement. The results of VEMP and VNG showed definite peripheral vestibular pattern of dysfunction. Our results revealed peripheral vestibular dysfunction which is suspected to be due to vascular or inflammatory vestibular neuropathy

Comparison between repetitive peripheral magnetic stimulation [RPMS] and botulinum toxin -A injection in management of spasticity

To compare between the use of repetitive peripheral magnetic stimulation and botulinum toxin-A injection in management of spasticity in patients with paraparesis. Twenty three patients suffering from spastic paraparesis due to traumatic spinal cord injury were included in this study. Assessment included spasm frequency scale [SFS], adductor tone scale, Modified Ashworth scale [MMAS], clonus score, Medical research council scale for muscle power testing. Patients were divided into two groups, group A [10 patients]: received botulinum toxin type A injection and group B [13 patients]: received repetitive peripheral magnetic stimulation [RPMS] one session daily for 3 successive days. All patients were reassessed at 4, 7 and 30 days from the start of therapy. There was no significant difference in the neurological baseline data after 4 and 7 days in group A patients. However, after 30 days, there was a statistically significant decrease in the spasticity scales. After four days therapy, there was highly significant difference [p<0.01] in the neurological scales with decreased spasticity scales in group B compared to group A. After seven days, there was highly significant difference [p<0.01] between group A and B with decreased spasm frequency and clonus score scales in group A. After 30 days, there was a highly significant difference [p<0.01] between group A and B with decreased adductor tone, modified ashworth, spasm frequency scales, clonus and functional independence measure scores in group A. RPMS and botulinum toxin A injection can be used complementary to each other as RPMS has immediate and short term effects on spasticity while botulinum toxin A has delayed and long term effects on muscle tone

Relation between homocysteine, folate, vitamin B12 and MTHFR C677T polymorphism and bone turnover markers in postmenopausal women

To investigate the association between total Homocysteine [tHcy] levels with bone turnover markers and lumbar spine BMD, and to study the influences of MTHFR genotypes and B-vitamins on tHcy and BMD in a group of Egyptian postmenopausal women. 66 Egyptian postmenopausal women were subjected to clinical assessment and lumbar spine BMD measurement. Venous blood samples were collected to measure the levels of plasma tHcy, plasma folate, vitamin B12, osteocalcin, serum cross-linking telopeptide of type I collagen [S-CTX] and the MTHFR C677T genotyping. According to the T-score, the participants were divided into three groups: normal [N], osteopenic [OPN] and osteoporotic [OPR]. tHcy levels were statistically significantly higher, and serum folate levels statistically significantly lower in the OPR group compared to the other two groups. Nonsignificant differences between the three groups regarding vitamin B12 levels and percentage of the 3 MTHFR genotypes were found. Osteocalcin and the S-CTX levels were statistically significantly higher in the OPR group than the other two groups. BMD was statistically significantly positively correlated with folate and negatively correlated with tHcy, Osteocalcin and S-CTX, while was nonsignificantly correlated with vitamin B12 levels. tHcy was statistically significantly negatively correlated with folate and positively correlated with Osteocalcin and S-CTX, while was nonsignificantly correlated with vitamin B12. The MTHFR genotype groups were not associated with the BMD, tHcy, folate or vitamin B12 levels. In postmenopausal women, tHcy and folate could be related to lumbar spine BMD while vitamin B12 and the MTHFR genotypes seem not to have relation to BMD

Sympathetic skin response in carpal tunnel syndrome

Sympathetic skin response [SSR] is most frequently used in diagnosing functional impairment of non-myelinated postganglionic sympathetic fibers. Early diagnosis of autonomic dysfunction is important in patients with carpal tunnel syndrome [CTS] as the earlier the diagnosis the more effective the treatment. Aim of this work was to measure the SSR in patients with CTS to detect its relation with possible autonomic dysfunction. This study included 18 patients [23 hands] with CTS, graded according to Bland [2000]. SSR measurement was done, and the latency and amplitude were measured. Clinical manifestations of autonomic dysfunction were present in 6 hands [26%]. There was statistically high significant longer disease duration among patients with autonomic dysfunction in comparison to those without. Among our patients, 3 hands [13%] had no elicited SSR. This was associated with very severe carpal tunnel syndrome, female sex, and long disease duration. There was a statistically high significant difference between patients and controls as regards the latency of SSR with no significant difference as regards the amplitude. There was a statistically high significant positive correlation between the SSR latency and the grading of CTS, and statistically high significant negative correlation between the amplitude of SSR and the grading of CTS. SSR can be used in the electrodiagnostic workup for patients with carpal tunnel syndrome where it can be used as a method for detection of autonomic dysfunction in these patients

Anti-Nucleosome antibodies as a diagnostic tool in systemic lupus erythematosus and marker of lupus nephritis

To evaluate the prevalence of anti-nucleosome antibodies [anti-NCS Abs] in systemic lupus erythematosus [SLE], their role in diagnosis, disease activity and lupus nephritis [LN]. The study was conducted on 23 SLE female patients. They were divided into two groups according to the presence or absence of LN. Ten apparently healthy individuals served as a control group. Clinical assessment was done to all patients especially for renal affection. Disease activity was scored with SLEDAI. Anti-NCS and anti-dsDNA antibodies were measured with ELISA. Renal biopsy was performed for patients with LN. The prevalence of anti-NCS Abs was [78.3%] and anti-dsDNA Abs was [56.5%] in SLE. Seventeen patients presented with LN and 6patients without. Among these patients, the prevalence of anti-NCS Abs and anti-dsDNA Abs were [88%-64.7%] and [50%-33.3%] respectively. Anti-NCS Abs were found to be positive in 21.7% of SLE patients lacking anti-dsDNA Abs. The mean anti-NCS and anti-dsDNA Abs tiler in SLE was 250.60 +/- 207.00 and 443.3 +/- 714.3 respectively, showing a highly significant increase compared with healthy controls [12.3 +/- 4.54 and 31.0 +/- 20.11] [p<0.001]. Moreover, in LN and those without LN, the mean anti-NCS Abs showed a highly significant increase [331.41 +/- 179. 73 and 21.67 +/- 8.36] [p<0.001], while there was a significant increase in the mean of anti-ds DNA Abs [574.71 +/- 794.07 and 71.17 +/- 46.99] [p<0.05] respectively. The sensitivity and specificity of anti-NCS Abs in SLE were 82.6% and 100% and in LN were 88.2% and 100% respectively. Anti-NCS Abs showed a positive significant correlation with ESR [r=0.900], SLEDAI [r=0.761] and anti-dsDNA Abs [r=0.681] in LN, but showed a negative significant correlation with disease duration [r=-0.511] and C4 [r=-0.650] in patients without LN. In LN 7 patients hadproliferative glomerular lesion [WHO class III], 6 patients class IV and 4 patients class II on renal biopsy. They were associated with a statistically significant proteinuria, anti-ds DNA and anti-NCS especially in classes II and IV, Anti-NCS Abs could be a useful parameter for diagnosis and assessment of disease activity and LN in SLE, It seems to be a more sensitive marker of SLE than anti-ds DNA especially in patients who are anti-dsDNA antibody negative

Effect of modifiable and non-modifiable risk factors as predictors of functional outcome of stroke rehabilitation

The old myth that the survival of patients with complete stroke is not sufficiently long enough to justify the great expenses and efforts of rehabilitation has been disproved by recent studies which show that at least 50 percent of the survivors lived for 7.5 years or longer. The risk factors may act as stroke outcome predictors and hence determine the intensity and type of rehabilitation program. To investigate the stroke outcome predictors that will define groups of patients with maximal or minimal benefit from rehabilitation of stroke. This prospective study included 115 Ischemic stroke patients attending the Department of Rheumatology and Rehabilitation, Zagazig University Hospitals, Zagazig Health Insurance Hospital and Zagazig Rehabilitation Centre, Ministry of Social Affairs, Egypt during 2005-2006. All the patients were subjected to full history and clinical examination and routine investigations. We analyzed the influence of modifiable risk factors: diabetes mellitus [DM], hypertension [HTN], ischemic heart disease [IHD] and the duration before rehabilitation and non modifiable factors; age, sex and side of lesion on stroke outcome. All patients received regular rehabilitation and an evaluation at enrolling and discharge, using the modified Barthel Index. The study lasted for 9 months duration. Our results after statistical analysis showed that patients with ischemic heart disease [IHD] showed the greatest improvement after 4 months of rehabilitation. The group of patients without risk co-morbid factor followed and then patients with hypertension [HTN], patients with diabetes mellitus, patients with combined DM and HTN and patients with combined HTN and ischemic heart disease IHD. The group of patients known to have HTN, DM and IHD combined did not show significant improvement. The non modifiable risk factors age, sex and site of cerebrovascular lesion did not show any significant difference although younger patients showed better improvement without significant difference. Modifiable risk factors have a strong effect as predictors of functional outcome at rehabilitation. Patients with more than 2 risk factors as well as late entry for rehabilitation may have bad prognosis

Effect of rice bran oil on hypercholesterolemia and tibial calcium in rat

The data from the epidemiological study indicate that increases in serum cholesterol levels are associated with increased risk of death from coronary heart disease. A number - of studies in humans and animals have shown that rice bran oil [RBO] is as effective as other vegetable oils in lowering plasma cholesterol levels. The present study was undertaken to compare the effects of two concentrations [6%] and [3%] of Egyptian-RBO on hypercholesterolaemia and calcium content of tibia in rats. Four groups of six rats were used, the first group was fed on basal diet [control], while the second group was fed on basal diet plus 1% cholesterol The groups 3 and 4 were fed on basal diet +1% cholesterol + RBO [3 and 6% respectively]. Non significant differences were noticed in the mean value of body weight, organ weight and relative organ weights [organ wt/body wt] between different experimental groups. The results obtained showed no significant change in transaminase [AST and ALT] activities between different treated groups. No significant effect was observed in plasma urea and creatinine or hemoglobin in different treated groups compared to control group. Significant decrease in malodialdehyde [MDA] value was observed in group 4 [6%, rice bran oil] compared to control. Total cholesterol and low density lipoprotein cholesterol showed significant increase in hypercholesterolemic group [52% and 169%] compared to control. Supplementation of rice bran oil in groups 4 decreased its level compared to cholesterol group 2. The data obtained revealed that triacylglycerol was significantly decreased due to supplementatjon with rice bran oil of groups 3 [by 17.26%] and 4 [by 16.07%] compared to hypercholesterolemia in rats of group 2. The results showed that the rats fed on the rice oil [6%] diet had significantly higher bone calcium [by 17.48% of control] of right tibia. tibial Phosphorus, magnesium and zinc in all treated groups were not significantly changed compared to control

Conclusion: Rice bran oil seems to be a very promising phytochemical alternative to classic lipid-lowering agents and increasing tibial calcium

Adrenocortical function relation to inflammatory markers in early untreated rheumatoid arthritis

To study adrenocortical function alterations in patients with early rheumatoid arthritis [RA]. 25 untreated patients with new onset RA were studied and compared with 25 age and sex-matched healthy subjects [controls]. All subjects were studied for plasma ACTH, cortisol, dehyroepiandrosterone sulfate [DHEAS], free and total testosterone, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor. No significant differences in the basal levels of ACTH, Cortisol, DHEAS, and total testosterone when comparing RA patients with controls were found, while there were statistically significant elevations in the inflammatory indices [ESR and CRP] and lower basal morning levels of free testosterone [Lower in males age >/= 45 years] in RA patients when compared with controls. From this study we concluded that adrenocortical function seem to be unaltered in early untreated RA patients

Evaluation of different guide methods for the selection of artificial maxillary anterior teeth

The selection and arangement of maxillary anterior teeth for edentulous patient have long been recognized as a clinical problem in prosthodontic practice. So this study was directed to evaluate some different guide methods used for the selection of maxillary anterior teeth and to find the correlation between anatomical landmarks with the maxillary anterior teeth in dentulous subject. A specially designed tool was used to represent the Frankfort horizontal plane and the orbital plane on both sides of the face. A lateral right and anterposterior cephalometric radiographs were taken for each subject with the teeth in centric occlusion and the lip in repose. The Frankfort and orbital planes, the long axis of the maxillary canine and the most protruding central incisor were drawn. The Bizygomatic width was measured cilnically and cephalometrically. The results showed that there were significant correlations between the width of the 6 anterior teeth with both Bizygomatic width clinically and interorbital plan distance at Orbitale clinically and cephalometrically