Estimation of conditional and marginal odds ratios using the prognostic score.

Introduced by Hansen in 2008, the prognostic score (PGS) has been presented as 'the prognostic analogue of the propensity score' (PPS). PPS-based methods are intended to estimate marginal effects. Most previous studies evaluated the performance of existing PGS-based methods (adjustment, stratification and matching using the PGS) in situations in which the theoretical conditional and marginal effects are equal (i.e., collapsible situations). To support the use of PGS framework as an alternative to the PPS framework, applied researchers must have reliable information about the type of treatment effect estimated by each method. We propose four new PGS-based methods, each developed to estimate a specific type of treatment effect. We evaluated the ability of existing and new PGS-based methods to estimate the conditional treatment effect (CTE), the (marginal) average treatment effect on the whole population (ATE), and the (marginal) average treatment effect on the treated population (ATT), when the odds ratio (a non-collapsible estimator) is the measure of interest. The performance of PGS-based methods was assessed by Monte Carlo simulations and compared with PPS-based methods and multivariate regression analysis. Existing PGS-based methods did not allow for estimating the ATE and showed unacceptable performance when the proportion of exposed subjects was large. When estimating marginal effects, PPS-based methods were too conservative, whereas the new PGS-based methods performed better with low prevalence of exposure, and had coverages closer to the nominal value. When estimating CTE, the new PGS-based methods performed as well as traditional multivariate regression. Copyright © 2016 John Wiley & Sons, Ltd.

Correlation Between the Lauge-Hansen Classification and Ligament Injuries in Ankle Fractures.

OBJECTIVE: To evaluate the ability of the Lauge-Hansen classification to predict ligament injuries in ankle fractures using magnetic resonance imaging (MRI) and intraoperative findings. DESIGN: Prospective evaluation in consecutive patients. SETTING: Academic level 1 trauma center. PATIENTS: Three-hundred patients with an operatively treated ankle fracture who met the inclusion and exclusion criteria. INTERVENTION: Injury ankle radiographs were assigned to a Lauge-Hansen classification. MRI scans were obtained to evaluate the syndesmotic and deltoid ligaments. A Lauge-Hansen classification for each patient was recorded based on intraoperative findings. MAIN OUTCOME MEASUREMENTS: Comparisons were made between the predicted ankle ligamentous injuries based on radiographic Lauge-Hansen classifications, preoperative MRI analyses, and intraoperative findings. RESULTS: On the basis of the Lauge-Hansen system and injury radiographs, 77% (231/300) were classified as supination external rotation, 13% (40/300) were pronation external rotation, 4% (11/300) were supination adduction, <1% (1/300) was pronation abduction, and 6% (17/300) were not classifiable. Of the 283 fractures that were classified into Lauge-Hansen classes, 266 (94%) had MRI readings of ligamentous injuries consistent with the Lauge-Hansen predictions. Intraoperative findings also highly correlated with the Lauge-Hansen class of ankle fractures, with nearly complete agreement. Comparing MRI and intraoperative findings revealed discrepancies in 6% (16/283) of ankle fracture classifications. CONCLUSIONS: In our large cohort of patients, comparisons between injury radiographs, preoperative MRI, and intraoperative findings suggest that the Lauge-Hansen system is an accurate predictor of ligamentous injuries. The predictions based on the Lauge-Hansen system can be useful for fracture reduction maneuvers and operative planning. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation.

AIMS: To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei(®) X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%. CONCLUSION: Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures.

An international multicenter study on quality of life and family quality of life in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) has severe impact on the quality of life (QoL) of children suffering from the disease and their families. The infant's dermatitis quality of life index (IDQoL) and the dermatitis family impact questionnaire (DFI) were designed to study this impact. AIMS: To compare the impact of AD on children and their families in different countries. METHODS: 419 children with AD from six countries representing three continents under the age of 4 years were included into the study. English, Ukrainian, Czech, Portuguese, and Korean versions of the IDQoL and the DFI and Dutch version of the IDQoL questionnaires were used. RESULTS: The highest scored items for the IDQoL and the DFI were rather similar. The IDQoL and the DFI results were well correlated with parental assessment of disease severity and between each other in all countries. Some differences mostly in the IDQoL assessment were found. CONCLUSION: Despite some reported peculiarities, parents in different counties assessed QoL and family QoL of their AD children in a similar way. The IDQoL and the DFI may be reliable initial measures for international studies. International study on the influence of the same treatment methods on the IDQoL and the DFI assessments is important.

Neurological disability in leprosy: incidence and gender association in Sergipe, Brazil.

The environmental impact assessment process is over 40 years old and has dramatically expanded. Topics, such as social, health and human rights impact are now included. The main body of an impact analysis is generally hundreds of pages long and supported by countless technical appendices. For large, oil/gas, mining and water resources projects both the volume and technical sophistication of the reports has far exceeded the processing ability of host communities. Instead of informing and empowering, the reports are abstruse and overwhelming. Reinvention is required. The development of a visual integrated impact assessment strategy that utilizes remote sensing and spatial analyses is described.

Optimization of cold-adapted lysozyme production from the psychrophilic yeast Debaryomyces hansenii using statistical experimental methods.

UNLABELLED: Statistical experimental designs were employed to optimize culture conditions for cold-adapted lysozyme production of a psychrophilic yeast Debaryomyces hansenii. In the first step of optimization using Plackett-Burman design (PBD), peptone, glucose, temperature, and NaCl were identified as significant variables that affected lysozyme production, the formula was further optimized using a four factor central composite design (CCD) to understand their interaction and to determine their optimal levels. A quadratic model was developed and validated. Compared to the initial level (18.8 U/mL), the maximum lysozyme production (65.8 U/mL) observed was approximately increased by 3.5-fold under the optimized conditions. PRACTICAL APPLICATION: Cold-adapted lysozymes production was first optimized using statistical experimental methods. A 3.5-fold enhancement of microbial lysozyme was gained after optimization. Such an improved production will facilitate the application of microbial lysozyme. Thus, D. hansenii lysozyme may be a good and new resource for the industrial production of cold-adapted lysozymes.

Statistical optimization of medium composition for bacterial cellulose production by Gluconacetobacter hansenii UAC09 using coffee cherry husk extract--an agro-industry waste.

During the production of grape wine, the formation of thick leathery pellicle/bacterial cellulose (BC) at the airliquid interface was due to the bacterium, which was isolated and identified as Gluconacetobacter hansenii UAC09. Cultural conditions for bacterial cellulose production from G. hansenii UAC09 were optimized by central composite rotatable experimental design. To economize the BC production, coffee cherry husk (CCH) extract and corn steep liquor (CSL) were used as less expensive sources of carbon and nitrogen, respectively. CCH and CSL are byproducts from the coffee processing and starch processing industry, respectively. The interactions between pH (4.5- 8.5), CSL (2-10%), alcohol (0.5-2%), acetic acid (0.5- 2%), and water dilution rate to CCH ratio (1:1 to 1:5) were studied using response surface methodology. The optimum conditions for maximum BC production were pH (6.64), CSL (10%), alcohol (0.5%), acetic acid (1.13%), and water to CCH ratio (1:1). After 2 weeks of fermentation, the amount of BC produced was 6.24 g/l. This yield was comparable to the predicted value of 6.09 g/l. This is the first report on the optimization of the fermentation medium by RSM using CCH extract as the carbon source for BC production by G. hansenii UAC09.

[Supination external rotation lesions of the ankle joint in osteoporotic lower leg specimens. Experimental induction and review of the literature]. / Die Supinations-Eversions-Verletzung des OSG in osteoporotischen Unterschenkelpräparaten. Experimentelle Induktion und Literaturübersicht.

BACKGROUND: Knowledge of the pathomechanism and the detailed extent of ankle joint lesions determines adequate therapy and success of treatment. MATERIAL AND METHODS: Supination external rotation lesions were induced in 29 human cadavera with a testing apparatus; 27 of these specimens were from elderly women. Bone mineral density was measured. The literature review includes experimental studies of this fracture entity. RESULTS: We induced stage II in 42%; applying an additional lateral force on the fibula raised the incidence. The syndesmosis stayed intact in 50% although the fibula fractured at the level of the tibial plafond. Stage IV lesions were registered in 25%. The overall low bone mineral density showed a positive correlation to the angle at which the fibula fracture occurred. CONCLUSIONS: We reproduced supination external rotation lesions according to Lauge-Hansen in osteoporotic ankles. There is a certain discrepancy between the obligatory lesion of the inferior anterior tibiofibular syndesmosis at stage II according to Lauge-Hansen, as we observed an intact syndesmosis in 50% at stage II. Stage IV defining medial malleolar fractures were reproduced after Lauge-Hansen and Michelson et al.

Perfil clínico-epidemiológico dos casos de hanseníase notificados no município de Assis Brasil, Acre, no período de 2003 a 2010 / Clinical and epidemiological profile of leprosy cases reported in Assis Brazil, Acre, in the period 2003 to 2010

A hanseníase é considerada um problema de saúde pública nos países em desenvolvimento. No período de 2001 a 2007, o Acre foi o 8o Estado com os maiores coeficientes de prevalência e incidência de hanseníase em todo o Brasil. Este é um estudo retrospectivo que utilizou os dados das fichas de notificação de casos de hanseníase do Sistema de Informação de Agravos de Notificação do município de Assis Brasil, Acre, entre 2003 e 2010. Os dados foram digitados e analisados no programa SPSS, sendo que médias e proporções foram comparadas com o Teste de Anova e o Teste do Qui-Quadrado. Foram notificados 25 casos novos, com coeficiente de detecção de 98,7/100.000 habitantes em 2010, sendo 56% casos índices e 44% contatos; oito (32%) casos de hanseníase paucibacilar e 17 (68%) de hanseníase multibacilar. Predominou a forma dimorfa (52%), seguido da forma tuberculóide (32%) e forma virchowiana (16%). A bacilos-copia foi negativa em 75% dos testes. Nove pacientes foram considerados curados no tempo preconizado, um paciente necessitou de maior tempo de tratamento, oito pacientes ainda estavam em tratamento e seis casos ti-veram evolução desconhecida. A alta frequência de ca-sos de hanseníase multibacilar reforça a ideia da demora no diagnóstico e da dificuldade em detectar formas mais leves da doença, contribuindo para manter a transmis-são, necessitando de maior ação do sistema de saúde.

Leprosy is a public health problem in the developing world. Between 2001 and 2007, Acre state presented the 8th highest incidence and prevalence coefficients in the whole country. This is a retrospective study that used the notification data from the local health system, between 2003 and 2010. Data was analyzed in SPSS; av-erages and proportions were compared using Anova and Chi-square test. There were 25 new cases notified, with a new case detection coefficient of 98,7/100.000 inhabitants in 2010, being 56% index cases, 44% con-tacts; eight (32%) paucibacillary cases and 17 (68%) multibacillary cases. The predominant clinical form was dimorphous (52%), followed by tuberculoid (32%) and virchow ́s forms (16%). The baciloscopy was negative in 75% of cases. Nine patients were considered cured in the allotted time, one patient needed longer treatment time, eight patients were still under treatment and six patients had unknown follow-up. The high frequency of multibacillary cases reinforces the idea that the diag-nosis is taking long to be performed and it is difficult to detect mild forms of the disease, contributing for main-taining the transmission, therefore a more effective ac-tion must be taken by the health system.

Functional connectivity metrics during stroke recovery.

We explore functional connectivity in nine subjects measured with 1.5T fMRI-BOLD in a longitudinal study of recovery from unilateral stroke affecting the motor area (Small et al., 2002). We found that several measures of complexity of covariance matrices show strong correlations with behavioral measures of recovery. In Schmah et al. (2010), we applied Linear and Quadratic Discriminants (LD and QD) computed on a principal components (PC) subspace to classify the fMRI volumes into "early" and "late" sessions. We demonstrated excellent classification accuracy with QD but not LD, indicating that potentially important differences in functional connectivity exist between the early and late sessions. Motivated by Mclntosh et al. (2008), who showed that EEG brain-signal variability and behavioral performance both increased with age during development, we investigated complexity of the covariance matrix for this longitudinal stroke recovery data set. We used three complexity measures: the sphericity index described by Abdi (2010); "unsupervised dimensionality", which is the number of PCs that minimizes unsupervised generalization error of a covariance matrix (Hansen et al., 1999); and "QD dimensionality", which is the number of PCs that minimizes the classification accuracy of QD. Although these approaches measure different kinds of complexity, all showed strong correlations with one or more behavioral tests: nine-hole peg test, hand grip test and pinch test. We could not demonstrate that either sphericity or unsupervised dimensionality were significantly different for the "early" and "late" sessions using a paired Wilcoxon test. However, the amount of relative behavioral improvement was correlated with sphericity of the overall covariance matrix (pooled across all sessions), as well as with the divergence of the eigenspectra between the "early" and "late" covariance matrices. Complexity measures that use the number of PCs (which optimize QD classification or unsupervised generalization) were correlated with the behavioral performance of the final session, but not with the relative improvement. These are suggestive, but limited, results given the sample size, restricted behavioral measurements and older 1.5T BOLD data sets. Nevertheless, they indicate one potentially fruitful direction for future data-driven fMRI studies of stroke recovery in larger, better-characterized longitudinal stroke data sets recorded at higher field strength. Finally, we produced sensitivity maps (Kjems et al., 2002) corresponding to both linear and quadratic discriminants for the "early" vs. "late" classification. These maps measure the influence of each voxel on the class assignments for a given classifier. Differences between the scaled sensitivity maps for the linear and quadratic discriminants indicate brain regions involved in changes in functional connectivity. These regions are highly variable across subjects, but include the cerebellum and the motor area contralateral to the lesion.

Preoperative CT staging in sigmoid diverticulitis--does it correlate with intraoperative and histological findings?

PURPOSE: This study was designed to evaluate whether the computed tomography (CT) reflects the extent of the inflammation in sigmoid diverticulitis (SD) in order to draw conclusions for selecting the appropriate treatment. METHODS: Two hundred four patients who underwent resection for SD from January 2003 to December 2008 were included. The preoperative CT stage was compared with intraoperative and histological findings. Patients were classified into phlegmonous (Hansen-Stock IIa), abscess-forming (HS IIb), and free perforated (HS IIc) forms of SD. Patients with a recurrent type of diverticulitis were excluded. RESULTS: In the phlegmonous type (HS IIa; n = 75), we found a correlation with the preoperative stage in 52% (intraoperative) and 56% (histological), an understaging in 12% (intraoperative) and 11% (histological), and an overstaging in 36% (intraoperative) and 33% (histological). In the abscess-forming type (HS IIb, Hinchey I/II; n = 87), we found conformity in 92% (intraoperative) and 90% (histological), understaging in 3% (intraoperative) and 0% (histological), and overstaging in 5% (intraoperative) and 10% (histological). In the presence of a free perforation (HS IIc, Hinchey III/IV; n = 42), we saw conformity in 100% (intraoperative and histological). The positive predictive value for correctly diagnosing of phlegmonous type (HS IIa), abscess-forming type (HS IIb), and free perforation (HS IIc) by CT was intraoperatively (histologically) 52% (56), 92% (90), and 100% (100), respectively. CONCLUSIONS: The CT is one of the most accurate methods for staging in SD. However, in the phlegmonous type (HS IIa), it leads to an overestimation of the findings in every third patient. It must be clarified whether this pronounced low inflammation should really be regarded as a complicated form of SD. In contrast, the abscess-forming (HS IIb) and free perforated (HS IIc) type of complicated SD is very well reflected by CT.

Limitations of clinico-histopathological correlation of skin biopsies in leprosy.

BACKGROUND: Skin biopsies play an important role in diagnosing and classifying different types of leprosy. The aim of this study was to analyse different histologic types of leprosy, to correlate histopathological diagnosis with clinical diagnosis, to study the uniformity of clinical and histological findings in the diagnosis of leprosy and to evaluate difficulties faced during clinicopathological correlation according to Ridley- Jopling classification due to inadequacy of data provided. METHODS: This is a retrospective study of all skin biopsies reported from Department of Pathology of Tribhuvan University Teaching Hospital from 14 April 2007 to 13 April 2009, for which leprosy was the diagnosis or was strongly suspected on histopathology. RESULTS: Out of 40 cases included, 33 were males and seven were females. Tuberculoid leprosy was the most common type comprising 23 /40 cases (57.5%). In 18/ 40 cases (45%), clinical diagnosis was leprosy. Only in three, leprosy was classified according to Ridley-Jopling criteria clinically. Thus clinicopathological correlation according to Ridley-Jopling criteria could not be done. Histopathological reporting lacked uniformity too. In 13/40 reports (32.5%), exact location of granuloma, presence or absence of Grenz zone and enroachment of epidermis by granuloma was not mentioned. None mentioned the number and distribution of lymphocytes or relative proportion of epithelioid cells and foamy histiocytes. Results: Out of 40 cases included, 33 were males and seven were females. Tuberculoid leprosy was the most common type comprising 23 /40 cases (57.5%). In 18/ 40 cases (45%), clinical diagnosis was leprosy. Only in three, leprosy was classified according to Ridley-Jopling criteria clinically. Thus clinicopathological correlation according to Ridley-Jopling criteria could not be done. Histopathological reporting lacked uniformity too. In 13/40 reports (32.5%), exact location of granuloma, presence or absence of Grenz zone and enroachment of epidermis by granuloma was not mentioned. None mentioned the number and distribution of lymphocytes or relative proportion of epithelioid cells and foamy histiocytes. CONCLUSIONS: Histopathological diagnosis of leprosy did not correlated with clinical diagnosis significantly. Uniformity was not seen in the clinical or histopathological informations provided making it difficult to conduct retrospective clinico pathological correlation.

Role of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation. METHODS: Twenty-one consecutive patients with leprosy (12 men and 9 women; mean age +/- SD, 47.7 +/- 17.2 years) and 20 control participants (14 men and 6 women; mean age, 46.5 +/- 16.2 years) were evaluated with sonography. Leprosy diagnosis was established on the basis of clinical, bacteriologic, and histopathologic criteria. The reference standard for ulnar neuropathy in this study was clinical symptoms in patients with proven leprosy. The sonographic cross-sectional areas (CSAs) of the ulnar nerve in 3 different regions were obtained. Statistical analyses included Student t tests and receiver operating characteristic curve analysis. RESULTS: The CSAs of the ulnar nerve were significantly larger in the leprosy group than the control group for all regions (P < .01). Sonographic abnormalities in leprosy nerves included focal thickening (90.5%), hypoechoic areas (81%), loss of the fascicular pattern (33.3%), and focal hyperechoic areas (4.7%). Receiver operating characteristic curve analysis showed that a maximum CSA cutoff value of 9.8 mm(2) was the best discriminator (sensitivity, 0.91; specificity, 0.90). Three patients with normal electrophysiologic findings had abnormal sonographic findings. Two patients had normal sonographic findings, of which 1 had abnormal electrophysiologic findings, and the other refused electrophysiologic testing. CONCLUSIONS: Sonography and electrophysiology were complementary for identifying ulnar nerve neuropathy in patients with leprosy, with clinical symptoms as the reference standard. This reinforces the role of sonography in the investigation of leprosy ulnar neuropathy.

Development and evaluation of a novel multiple-primer PCR amplification refractory mutation system for the rapid detection of mutations conferring rifampicin resistance in codon 425 of the rpoB gene of Mycobacterium leprae.

Rifampicin-resistant Mycobacterium leprae is regularly reported and drug resistance is a major threat for the elimination of leprosy. There is an urgent need for a simple method that can detect rifampicin resistance in clinical isolates. This study developed a multiple-primer PCR amplification refractory mutation system, a simple, reliable and economical method for clinical specimens that allowed the rapid detection of mutations in the nucleotides of the codon for Ser425 of the M. leprae rpoB gene, mutation of which to Leu, Met or Phe is associated with rifampicin resistance. The approach involved a multiple-primer PCR in which both mutant-specific and normal sets of primers were included in the reaction. The mutant-specific primer was complementary to the corresponding sequence of the wild-type gene except for one additional deliberate mismatch at the fourth nucleotide from the 3'-OH terminus. A single mismatch has little influence on the yield of PCR products, but if there are two mismatches as a result of mutation at the position being tested, the mutant-specific primer will not function in PCR under appropriate conditions, leading to no yield of PCR product from the mutant allele. The assay was evaluated successfully using a panel of plasmids and M. leprae reference strains carrying the wild-type or known rpoB mutations. The assay was subsequently applied to M. leprae DNA extracts from skin biopsies taken from patients. In all biopsy samples, the wild-type allele was detected for Ser425. The PCR results correlated with rifampicin susceptibility, as also measured by the traditional in vivo mouse footpad technique.

Mycobacterium leprae in neurons of the medulla oblongata and spinal cord in leprosy.

Peripheral neuropathy has been extensively studied in leprosy, a chronic disease caused by Mycobacterium leprae, but the central nervous system (CNS) is thought to be free from bacilli. Involvement of the CNS was explored in autopsy cases of clinically cured lepromatous leprosy (n = 67) and in non-leprosy cases (n = 15). Paraffin sections of the medulla oblongata and spinal cord were subjected to hematoxylin and eosin staining, Fite acid-fast staining, and anti-phenolic glycolipid-I (PGL-I) immunostaining. PGL-I-positive areas were microdissected from selected cases and nested polymerase chain reaction (PCR) targeting the M. leprae-specific repetitive sequence was performed. Of the 67 cases of leprosy, 44 (67%) had vacuolar changes of motor neurons either in medulla oblongata (nucleus ambiguous or hypoglossal nucleus) or spinal cord. Fite staining was negative, but PGL-I was positive in vacuolated areas. PCR revealed M. leprae-specific genomic DNA in 18 of 19 cases (95%) with vacuolated changes and 5 of 8 (63%) without vacuolated changes. All of above findings were negative in control cases. Terminal deoxynucleotidyl transferase dUTP nick-end labeling staining did not show a significant increase of apoptosis in the neurons. The PCR positivity had a significant correlation with PGL-I immunostaining (p < 0.05). The presence of vacuolar changes in the spinal cord was correlated with hand and feet deformity grades (p = 0.04). This study provides significant additional evidence to indicate that M. leprae is present in the CNS in a subset of patients. Further investigation is required to correlate this finding to motor dysfunction and silent neuropathy in leprosy.

Decreased expression of CD3zeta and nuclear transcription factor kappa B in patients with pulmonary tuberculosis: potential mechanisms and reversibility with treatment.

BACKGROUND: The protective immune response against Mycobacterium tuberculosis relies both on antigen-presenting cells and on T lymphocytes. In patients with different forms of tuberculosis, varying degrees of T cell function--ranging from positive delayed-type hypersensitivity, in asymptomatic infected healthy individuals, to the absence of the response, in patients with miliary or pulmonary tuberculosis (PTB)--have been reported. The decreased expression of CD3zeta reported in T cells from patients with either cancer or leprosy has provided possible explanations for the altered immune response observed in these diseases. METHODS: The present study aimed to compare the expression of CD3zeta , nuclear transcription factor- kappa B (NF- kappa B), arginase activity, and cytokine production in 20 patients with PTB, in 20 tuberculin-positive asymptomatic subjects, and in 14 tuberculin-negative control subjects. RESULTS: Compared with those in tuberculin (purified protein derivative)-negative control subjects, peripheral-blood T lymphocytes from patients with active PTB had significantly (P < .001) decreased expression of CD3zeta and absence of the p65/p50 heterodimer of NF- kappa B. These alterations were reversed only in patients who responded to treatment. Also reported here for the first time is that the presence of arginase activity in peripheral-blood mononuclear-cell lysates of patients with PTB parallels high production of interleukin-10. CONCLUSIONS: The presence of arginase could, in part, explain the decreased expression of CD3zeta . These findings provide a novel mechanism that may explain the T cell dysfunction observed in patients with PTB.

[Hansen's disease in the laboratory]. / A hanseniase no laboratório.

A physical doctor with a PhD in Pathology, Euzenir Nunes Sarno studies the immunology factors of Hansen's disease, one of the oldest chronic infections and that is an exclusively human disease. Staff member of an ambulatory that has become a reference on the disease in Brazil with 220 to 250 new patients per year, Euzenir emphasizes that the fact one cannot cultivate Mycobacterium leprae brings about some everlasting questions in relation to the transmission of and the sensitivity to the disease. There are also many epidemiology questions that remain unanswered. Estimates show that, among those who have contact with multi-bacilli patients, 90% are infected but only about 8% get sick. The high infection rate of those who live with multi-bacilli patients but never fall sick shows that just a small number of individuals are sensitive to Mycobacterium leprae. This is one of the questions immunology has not been able to answer. Why do some people resist to it and some don't? The figures are even lower when compared to those who are in contact with patients that are paucibacillus-infected, i.e. a manifestation of the disease with few bacilli. Hansen's disease is known as a skin malady. But, according to the specialist, its first damage is to the nerve, when the area becomes insensitive. Besides damaging the sensitive skin nerves, the disease can lead to motor disability and irreversible deformities, which sometimes lead to the amputation of limbs and protruded parts of the body. Mycobacterium leprae was one of the first pathogenic bacteria whose genome sequence has been entirely mapped. Only now we have the capacity to have more precise assessments. The disease is not inherited, and only in 1986 health services in Brazil began to take the responsibility for both the disease and its patients. During the twenty-year military dictatorship the country underwent, the health system was dismantled. In 1991, the one-year treatment with three drugs - Dapsone, Rifanpicine and Clofazimine- was introduced in our country. Just 30% of the cases get to negative results after the treatment. according to the interviewee, whereas tuberculosis is a highly virulent multi-bacilli disease, leprosy bacillus is not virulent, is a 'lazy' germ at the end of its evolutional process. One third of its genome does not work.