[The role of CTLA-4 in the pathogenesis of chronic tonsillitis].

Objective:The purposes of the present study were to explore the role of CTLA-4 in the pathogenesis on development of chronic tonsillitis, and to provide new possibilities and theoretical basis for the drug therapy of chronic tonsillitis and, from soft regulation of the inflammatory immune response point of view. Method:Tonsil tissues were obtained by tonsillectomy and classified into two groups according to clinical forms of tonsillitis, CT (chronic tonsillitis) group (n=21) and TH (hypertrophy of tonsil) group (n=15). We used HE staining to observe the pathological changes in the structure of tonsil tissue in different groups. We used immunofluorescence (IF) method to determine the differences in expression of CTLA-4 between two groups and their distribution characteristics , and used Real-time fluorescent quantitative PCR technique (qRT-PCR) to detect CTLA-4 mRNA expression in the two groups. Result:①HE staining showed the pathogeny structure mainly characterized as the follicular hyperplasia and germinal center in CT group, and obvious "star" phenomenons in TH group. ②Immunofluorescence results showed that the average fluorescence intensity and density of CTLA-4 protein in CT group was significantly higher than in TH group (P<0.05), the difference was statistically significant. ③The qRT-PCR experiment results showed that the expression level of CTLA-4 mRNA in CT group were obviously higher than in HT group (t=6.294, P<0.01), and the differences were statistically significant too. Conclusion:We found CTLA-4 played an important role in the development of chronic tonsillitis disease, suggesting that the mechanism of immunosuppression may exist in the process of chronic tonsil inflammation. Tonsil lymphoid tissue immune suppression provided a new explanation for recurrent tonsillitis, and provides a possibility for the development of new drugs for the treatment of chronic tonsillitis with the exception of surgery recurrent tonsillitis, at the same time for the clinical treatment of chronic tonsillitis in addition to surgery, but the possibility of researching new drugs from the perspective of immunology.

Association between painful physical symptoms and clinical outcomes in East Asian patients with major depressive disorder: a 3-month prospective observational study.

AIMS: Reports from non-Asian populations indicate that painful physical symptoms (PPS) are associated with poorer clinical and functional outcomes in major depressive disorder (MDD). The purpose of this study is to report comparative changes in disease severity, treatment patterns and quality of life observed in East Asian patients with MDD, with and without PPS, as assessed prospectively over a 3-month observation period. METHODS: This observational study enrolled 909 patients with MDD in psychiatric care settings in China, Hong Kong, Korea, Malaysia, Singapore and Taiwan. Patients were classified as PPS positive (PPS+) or negative (PPS-) based on mean modified Somatic Symptom Inventory scores of >or= 2 or < 2 respectively. The Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD(17)) determined depression severity; a visual analogue scale (VAS) determined pain severity; and the EuroQoL (EQ-5D) assessed well-being after 3 months observation. RESULTS: Of the 909 enrollees, 355/471 (75.4%) of PPS+ patients and 363/438 (82.9%) of PPS- patients completed the study (p = 0.006). PPS+ patients improved less than PPS- patients on depression, pain and quality of life measures during the study (HAMD(17) p < 0.001, CGI-S p < 0.001, VAS p = 0.008 and EQ-5D p = 0.004). Fewer PPS+ patients (46.5%) achieved remission compared with PPS- patients (69.4%, p < 0.001). CONCLUSION: As the presence of PPS is associated with poorer outcomes in East Asian MDD patients, clinical management should aim to address both the mental and PPS associated with MDD.