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1.
Rev Med Interne ; 38(2): 113-124, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27020403

RESUMO

Systemic sclerosis (SSc) is an orphan disease characterized by progressive fibrosis of the skin and internal organs. Aside from vasculopathy and fibrotic processes, its pathogenesis involves an aberrant activation of immune cells, among which B cells seem to play a significant role. Indeed, B cell homeostasis is disturbed during SSc: the memory subset is activated and displays an increased susceptibility to apoptosis, which is responsible for their decreased number. This chronic loss of B cells enhances bone marrow production of the naïve subset that accounts for their increased number in peripheral blood. This permanent activation state can be explained mainly by two mechanisms: a dysregulation of B cell receptor (BCR) signaling, and an overproduction of B cell survival signals, B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL). These disturbances of B cell homeostasis induce several functional anomalies that participate in the inflammatory and fibrotic events observed during SSc: autoantibody production (some being directly pathogenic); secretion of pro-inflammatory and pro-fibrotic cytokines (interleukin-6); direct cooperation with other SSc-involved cells [fibroblasts, through transforming growth factor-ß (TGF-ß) signaling, and T cells]. These data justify the evaluation of anti-B cell strategies as therapeutic options for SSc, such as B cell depletion or blockage of B cell survival signaling.


Assuntos
Linfócitos B/fisiologia , Escleroderma Sistêmico/imunologia , Animais , Autoanticorpos/fisiologia , Comunicação Celular/imunologia , Humanos , Imunoterapia/métodos , Terapia de Alvo Molecular , Escleroderma Sistêmico/patologia , Escleroderma Sistêmico/terapia , Linfócitos T/imunologia
4.
Artigo em Francês | MEDLINE | ID: mdl-2081866

RESUMO

Two protocols for prophylaxis by antibiotics in labour were compared to see how effective they were in preventing materno-fetal infection in patients who had signs of chorio-amnionitis. There was in increase in E. coli infections in 40% of liquor which were resistant to amoxycillin which had been used right up to now. 135 cases of patients who had received antibiotic treatment in labour were studied. 61 of these were treated with amoxycillin and 74 with piperacillin. The results show that there was a drop of 11.05% in the number of newborns who were infected in the group of patients who were treated with piperacillin. It was not possible using piperacillin to avoid all infections of the mother and fetus. The severity of the infection in the fetus, as judged by the Apgar score and the opinion of the paediatricians, was less serious in the group that was treated with piperacillin. The death rate for both groups was identical: one in each group. Both were caused by E. coli infections. A drop of 11% in post partum maternal infections was noted. Its was shown that piperacillin was more efficacious, but this way of preventing of infections in the mother and fetus lay in finding as early as possible the situation that could increase the risk of infection.


Assuntos
Amoxicilina/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Protocolos Clínicos/normas , Complicações do Trabalho de Parto/tratamento farmacológico , Piperacilina/uso terapêutico , Amoxicilina/administração & dosagem , Índice de Apgar , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/prevenção & controle , Peso ao Nascer , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/prevenção & controle , Piperacilina/administração & dosagem , Gravidez
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