Anti-FcαRI Monoclonal Antibodies Resolve IgA Autoantibody-Mediated Disease.

Immunoglobulin A (IgA) is generally considered as a non-inflammatory regulator of mucosal immunity, and its importance in diversifying the gut microbiota is increasingly appreciated. IgA autoantibodies have been found in several autoimmune or chronic inflammatory diseases, but their role in pathophysiology is ill-understood. IgA can interact with the Fc receptor FcαRI on immune cells. We now established a novel IgA autoimmune blistering model, which closely resembles the human disease linear IgA bullous disease (LABD) by using genetically modified mice that produce human IgA and express human FcαRI. Intravital microscopy demonstrated that presence of IgA anti-collagen XVII, - the auto-antigen in LABD-, resulted in neutrophil activation and extravasation from blood vessels into skin tissue. Continued exposure to anti-collagen XVII IgA led to massive neutrophil accumulation, severe tissue damage and blister formation. Importantly, treatment with anti-FcαRI monoclonal antibodies not only prevented disease, but was also able to resolve existing inflammation and tissue damage. Collectively, our data reveal a novel role of neutrophil FcαRI in IgA autoantibody-mediated disease and identify FcαRI as promising new therapeutic target to resolve chronic inflammation and tissue damage.

Inadequacy of iridium implant as sole radiation treatment for operable breast cancer.

In order to avoid a prolonged course of external irradiation as part of breast conservation therapy, 27 patients received an iridium implant to the primary tumour bed as sole radiation treatment. Surgery was standardised comprising tumourectomy and axillary clearance. Using a rigid implant afterloading with iridium192 wires, 55 Gy was delivered on a continuous basis over 5 days. After 6 years median follow-up, relapse of cancer within the treated breast has occurred in 10 of the 27 patients (37%). Compared with historical controls treated by similar surgery and iridium192 implant (20 Gy) with external radiotherapy (46 Gy), there was a significantly increased breast relapse rate in those treated by iridium implant alone. However, the incidence of distant metastases and overall survival was similar. Thus, a continuous iridium192 implant delivering 55 Gy in 5 days is not an effective means of achieving local control in patients with operable breast cancer.

Iridium implant treatment without external radiotherapy for operable breast cancer: a pilot study.

A pilot study has been conducted to examine a new approach to the treatment of operable breast carcinoma. 27 patients with tumours measuring up to 4 cm in diameter have been treated by tumourectomy, axillary clearance and high dose iridium-192 implant (55 Gy) without any external beam radiotherapy. This enabled the entire local primary treatment of the breast carcinoma to be given in five days. The technique was compatible with adjuvant chemotherapy for those with involved axillary nodes. Local complications have been few and locoregional control has to date been satisfactory. With a relatively short median follow-up of 27 months, cosmesis was objectively rated as good or excellent in over 80% of cases and subjectively rated good/excellent in 96%. High dose brachytherapy now requires testing in a prospective clinical trial to determine whether it is as effective as standard breast conservation techniques for management of early breast cancer.

Assessment of skin dose and its relation to cosmesis in the conservative treatment of early breast cancer.

A conservation technique has been developed for the treatment of early breast cancer which involved removal of the tumor, axillary clearance, tumor site implantation with Iridium-192 wires for a boost dose and subsequent treatment of the breast with radical megavoltage external beam therapy. Although the cosmetic results were satisfactory in the majority of the patients, for some it was rated as fair or poor. One variable factor which could have carried some morbidity was the dose of radiation received by the skin. In 51 patients, doses were measured at several points over the treated breast using Thermoluminescent Dosimetry (TLD) at the time of the iridium implant and during the subsequent external beam therapy. Development of skin pigmentation, oedema, and fibrosis were unrelated to the dose received by the skin but the findings suggested that doses greater than 50 Gy to the skin increased the possibility of late (greater than 24 months) telangiectasia over the boosted area. Treatment of tumors in the lower half of the breast, or in large breasts, was associated with a higher incidence of poor cosmesis. This may have been the result of varying posture on the interstitial dose distribution from the Iridium-192 wires and comparison of dose distribution in both supine and erect positions was carried out.

A new combined approach to the conservative treatment of early breast cancer.

A combined surgical and radiotherapeutic technique is described that aims to: (1) achieve permanent local control of disease; (2) give full information on the histology and biochemistry of the tumor; (3) detail axillary node status; and (4) be compatible with adjuvant endocrine therapy or chemotherapy. This treatment is accomplished with minimal cosmetic defect and, in the majority of patients, with almost total conservation of the breast form. The surgical procedures are carried out during one hospital admission and performed with one anesthetic. No prosthetic replacement or augmentation of the breast is involved.

Water-sealed spirometer for measurements in newborns and infants.

Details are given of two spirometers for use in neonates and infants < 12 mo old. The minimum volumes are 520 and 670 ml, respectively. The maximum volume changes that can be recorded are 250 and 450 ml, respectively. The minimal detectable volume changes are 0.4 and 0.6 ml, respectively. Rebreathing of dead space gas is prevented by a fan producing a flow of 6.2 and 10.2 l/min, respectively; 100% gas mixing after injecting a gas bolus in the two spirometers is achieved in 5.7 and 6.6 s, respectively. Resistance to airflow is 0.2 kPa.l-1.s (2 cmH2O.l-1.s) at 150 ml/s in both spirometers. The frequency response of both instruments is flat to 6 cycles/s. The instruments can be easily cleaned and are suitable for bedside measurements.

Measurement in vitro of enamel abrasion by dentifrice.

An in vitro method of measuring the abrasivities of dentifrices and abrasive powders on human dental enamel has been developed. The method, based on a proven dentin abrasivity method, records, in absolute terms, the abrasive effects of brushing flat, nonirradiated, enamel specimens beneath an aqueous slurry of the test material with the use of a surface profile meter.

Restriction endonuclease analysis of Leptospira interrogans serovar hardjo isolates from cattle.

The genomes of 253 strains of Leptospira interrogans serovar hardjo were examined by restriction endonuclease analysis of their DNA. The strains had been isolated from cattle at an abattoir (190), milk of agalactic cows (seven) and from aborted bovine fetuses (56). Two distinct genome types, Hardjoprajitno and Hardjobovis, were detected. The majority (91 per cent) of isolates from abattoir cattle were of the Hardjobovis type while most (76 per cent) of the isolates from clinical/pathological material were similar to Hardjoprajitno.

Differentiation of reference strains of leptospires of the Pomona serogroup by cross-agglutination absorption and restriction endonuclease analysis.

The serological classification of all reference strains that have been described as representing separate serovars of Leptospira interrogans within the Pomona serogroup was investigated using cross-agglutination absorption and bacterial restriction endonuclease analysis (BRENDA). Comparative cross-agglutination absorption studies indicated that cornelli CB, monjakov Monjakov and kennewicki LT1026 were homologous with pomona Pomona, and dania K1 and tsaratsova B81/7 were homologous with mozdok 5621. BRENDA confirmed these results, except that pomona Pomona and monjakov Monjakov showed a difference in the high molecular weight region. It is proposed that four serovars be currently recognised within the Pomona serogroup: pomona, mozdok, proechimys and tropica. The relative merits of the use of cross-agglutination absorption and BRENDA with respect to identification of Pomona serogroup isolates are discussed.

Identification by cross-agglutination absorption and restriction endonuclease analysis of leptospires of the Pomona serogroup isolated in the United Kingdom.

Five strains of Leptospira interrogans isolated in the United Kingdom and belonging to the Pomona serogroup were subjected to cross-agglutination absorption and bacterial restriction endonuclease DNA analysis (BRENDA) for their identification. British isolates were compared with reference strains representing the known serovars in the Pomona serogroup and also with isolates of the Pomona serogroup obtained from other countries. Three strains isolated from wildlife in England produced equivocal results when the cross-agglutination absorption and BRENDA results were compared. According to the World Health Organisation definition of a serovar the three English strains represented two new serovars, whereas by BRENDA all three had DNA electrophoresis patterns indistinguishable from serovar mozdok. Serovar pomona has not as yet been isolated in Great Britain and the epidemiology of the Pomona serogroup infections that have been detected by serology suggests that a serovar such as mozdok, maintained by wildlife, may be the causal agent. Two strains isolated in Northern Ireland were identified as pomona by the cross-agglutination absorption test. Further studies are needed to investigate the homogeneity of field and reference strains that are designated as pomona using the cross-agglutination absorption test.

Replication of human occlusal tooth attrition surfaces for scanning electron microscopic study.

Silicone negative replicas of dentine islands exposed by occlusal attrition were examined on extracted human teeth using the scanning electron microscope. Because the details of the dentinal tubules were reproducible on the silicone impression, the replication technique was applied in vivo to occlusal attrition to demonstrate patent dentinal tubules in cases with symptomatic exposed dentine islands. using this replication technique, it should be possible to monitor the effect of the therapeutic management of symptomatic tooth attrition on dentinal tubule closure.

The relationship between intestinal Campylobacter species isolated from animals and humans as determined by BRENDA.

Intestinal thermophilic Campylobacter species produce stable patterns when subjected to bacterial restriction endonuclease DNA analysis (BRENDA); this technique is therefore of considerable value in epidemiological studies. BRENDA was used to examine thermophilic Campylobacter species from humans, wild and domestic animals. One hundred and ninety-four (61%) of 316 isolates of Campylobacter jejuni from humans had BRENDA patterns which could be matched to those of animal isolates. Poultry appear to be a major source of infection for C. jejuni in humans with nearly half (49.7%) of the human isolates giving patterns which were indistinguishable from those isolated from poultry. A total of 60 BRENDA types were identified from 316 human isolates and 11 of these had the same pattern as those isolated from poultry. One of the three Campylobacter coli BRENDA types recovered from poultry was indistinguishable from a human isolate type. Pigs appear to be only a minor source of C. coli infection for humans in New Zealand. Rats were found to be infected with strains of C. jejuni with BRENDA patterns indistinguishable from those infecting humans, poultry and a horse. None of the 102 isolates of Campylobacter species from wild birds gave BRENDA patterns similar to those of isolates from humans.

Dual infections of red deer (Cervus elaphus) by Leptospira interrogans serovars copenhageni and hardjo.

On a property in the Nelson District, blood and urine samples were taken from red deer (Cervus elaphus) from which low (<1:100) antibody titres to serovar copenhageni and suspected leptospiral abortions had previously been reported. A total of 27 hinds were sampled. Microscopic agglutination test (MAT) titres in sera ranging from 1:32 to 1:128 were found in six animals. Thirteen leptospiral isolations were made from nine of the 27 urine samples. Four of these were typed as copenhageni and nine as hardjo. Two cultures were prepared from each urine sample and hardjo and copenhageni were both isolated from single urine samples from two animals. None of the 27 deer had serum MAT titres at 1:32 or above to copenhageni.

Restriction endonuclease DNA analysis of Leptospira interrogans serovars icterohaemorrhagiae and hebdomadis.

Antigenic variants of Leptospira interrogans serovars copenhageni and hebdomadis were examined by bacterial restriction endonuclease DNA analysis with EcoRI, XhoI, SalI, BstEII, and HindIII as the digesting enzymes. The antigenic variants were stable cloned strains which had been cultivated in media containing homologous immune serum. One of the strains examined has been reported elsewhere (R. Yanagawa and J. Takashima, Infect. Immun. 10:1439-1442) as having an antigenic makeup which more closely resembles serovar kremastos than the serovar hebdomadis parent. The closely antigenically related but naturally occurring serovars icterhaemorrhagiae strain RGA and copenhageni strain M20 were examined in parallel. No differences could be shown between the hebdomadis parent and any of its mutants. Serovars copenhageni and icterohaemorrhagiae produced patterns which differed in the high-molecular-weight bands only. The Shibaura parent strain did not differ from copenhageni M20, but the Shibaura M1 strain differed from the other mutants and from icterohaemorrhagiae RGA in its high-molecular-weight bands.

Identification of Campylobacter coli isolates from animals and humans by bacterial restriction endonuclease DNA analysis.

Ninety-nine Campylobacter coli isolates were examined by bacterial restriction endonuclease DNA analysis (BRENDA) with HindIII. Isolates from poultry from the same environment had identical patterns, patterns of isolates carried by suckling piglets were generally the same as those of isolates recovered from their dams, and one human patient yielded the same BRENDA type when sampled 6 weeks later. The 14 human isolates examined produced 11 distinct BRENDA types. Forty-three C. coli isolates from pigs were represented by 20 BRENDA types. Ten C. coli isolates from the feces of gulls yielded five different BRENDA types. Thirty-two C. coli isolates from live chickens and processed chicken yielded five different BRENDA types. Three human isolates had identical DNA patterns; two were from brothers living in the same house, and the third was from a human with no apparent relationship to the brothers. Another human isolate was identical to a poultry isolate. None of the pig strains had DNA patterns resembling those of human strains, nor were the DNA patterns like those of any strains recovered from poultry or gulls. Four C. coli isolates were subcultured onto agar 23 times over a period of 45 days, and their BRENDA patterns were preserved. BRENDA shows great promise for use in epidemiological studies of C. coli.

Prognostic factors in oral squamous carcinoma and their relation to clinical staging.

One hundred and three patients with an oral squamous carcinoma were studied in an attempt to determine the clinical factors which affect survival. The 5 yr actuarial survival of the whole group of patients was 55%. Although survival depended on clinical staging, in those patients with no palpable nodes on presentation the tumour size did not affect survival. The most significant factor determining survival was the presence of palpable lymph nodes on presentation. Palpable nodes were more likely in patients with large tumours than those with small tumours. On the basis of these findings a modification of the TNM classification is suggested giving more weight to the presence of cervical nodes than in the present staging system.