Volume 20, issue 4

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1148/thumbnail.jp

Aspects of human papillomavirus (HPV) disease in human immunodeficiency virus (HIV) infection

Cutaneous and genital human papillomavirus (HPV) infection in HIV patients, on suppressive anti-retroviral therapy (ART), poses under-investigated clinical challenges. HPV in HIV may represent a form of immune reconstitution associated disease (IRAD). HPV disease and IRADs have been separately correlated with human leucocyte antigen (HLA) genotype. HLA might also influence HPV in HIV. Comprehensive HPV typing of persistent warts obtained from HIV infected and healthy subjects was performed. Cutaneous HPV types were detected using nested PCR/sequencing and newly developed (Luminex based) HSLPCR/ MPG; genital and beta HPV types were identified using a reverse hybridisation line probe assay. Real time PCR was employed to determine HPV DNA viral loads. HLA alleles were defined in HIV infected and healthy patients by Luminex-based molecular typing using DNA derived from blood. The HPV profile of cutaneous and genital HIV warts differs significantly from warts from healthy individuals. In HIV, HPV 7 has been confirmed to be an important HPV type in cutaneous warts (p=0.001). In genital warts in HIV, HPV 11 is the predominant HPV type (p=0.15) and HPV 6 is less common (p=0.002), contrasting with the usual finding that HPV 6 is the principal type in the general population. Cross-over of HPV types between cutaneous and genital sites suggests that HPV tropism is less important than previously thought. An excess of beta HPV types, predominantly as mixed infections, is seen in cutaneous warts in HIV (p<0.0005). The HLA class I allele group HLA-B*44 (as the allele HLA-B*44:02 and the haplotype HLA-B*44, -C*05) has been identified more frequently in HIV than in controls (p=0.004, allele group; p=0.0006, allele; p=0.001, haplotype). The class II allele HLA-DQB1*06 may also be of interest (p=0.03). However, the differences are reduced after correction for multiple testing. Further work is required to ascertain if these HPV types and alleles are of importance

Studies on allergy and inflammation

The enclosed papers have been classified into five major sections whose content is as follows:SECTION A - The eosinophil leucocyte The first works are studies on the mechanisms of eosinophil accumulation following antigen-antibody (1,2 ) reactions in guinea pig skin. ' y These were extended to observations on eosinophil chemotaxis in vitro in relation to the complement system. (3,4)The eosinophil chemotactic factor of anaphylaxis (ECF-A) was first described in 1971.(5,6) Interactions between ECF-A and complement-derived eosinophilotactic factors were reported later(7) as were investigations on the chemical characterisation of ECF-A.(8) Inhibition of eosinophil chemotaxis by an agent related to disodium cromoglycate is also described.(9) Other eosinophil chemotactic agents thought to participate in eosinophil accumulation in vivo include material derived from Hodgkin's lymph node cells,histamine and one of its major catabolites, imidazole acetic acid.(11) The interactions of these agents both in vitro and in vivo were extensively studied(12,13) and extended to investigations on the response of eosinophils to an ECF-A tetrapeptide and histamine in various disease states(14) as well as the capacity of these agents to mobilise eosinophils in the skin of atopic and non-atopic human volunteers.(15)Evidence was provided that one of the functions of the eosinophil in allergic tissue reactions may be its capacity to inhibit mast cell 'regranulation'.(16)Membrane receptors for IgG and complement (C4, C3b and C3d) on human eosinophils and neutrophils and their relation to eosinophilia were described(17) and this work led to the observation that the ECF-A tetrapeptides and histamine both selectively enhance human eosinophil complement receptors.(18)This work, and those of others, was reviewed in several articles.(19-26)SECTION B - Mediators of hypersensitivityIn 1974 it was shown that both slow reacting substance of anaphylaxis (SRS-A) and ECF-A were released from passively sensitized skin following interaction with specific antigen.(27) The inactivation of SRS-A by the arylsulphatase contained in various tissues was described(28`) and later it was shown that appreciable amounts of human SRS-A were present in lung as a preformed mediator.(29)A number of miscellaneous papers relating to mediators are contained in this section: these include an observation on complement activation by Corynebacterium parvum;(30) some chemical and physical properties of synthetic human fibrinopeptides(31) and the description of a primate macrophage-cytophilic antibody(32)A review of the various biological pathways associated with the inflammatory response as they relate to complications of blood transfusion were described in a review article.(33)SECTION C - Studies on chemotaxisThis section contains papers on chemotaxis of (34) neutrophils, monocytes and basophils. Particular attention was given to the identification of chemotactic agents associated with Hageman factor-dependent path¬ ways(35), fibrin, formation(36,37) and fibrinolysis.(38,39)There is a study on the relation between neutrophil accumulation in vivo and agents that are chemotactic in vitro.(40)Alterations in monocyte chemotaxis in bronchial carcinoma were described.(41)Much of this work, especially the relation between chemotaxis and haemostasis, was reviewed in 1975.(42)SECTION D - Clinical studiesThis section contains reports on alterations in the complement systems in bronchial asthma(43-45) and the significance of immunoglobulins and complement in pleural effusions associated with bronchial carcinoma.(46) Studies on mediators of hypersensitivity in chronic bronchitis and asthma and their modulation by pharmacological agents are also described.(47,48)Detailed immunological investigations of two clinical cases, one of chronic benign neutropenia(49) and the other on the effect of transfer factor in chronic mucocutaneous candidiasis,(50) are described.A consideration of how coagulation and other biological systems may interrelate in the context of 'Stroke' was discussed in a review article.(51)SECTION E - MethodologyThis section contains two articles on methodology, one on the preparation of transfer factor( 52) and the other on tests of immune function.(53

Medical-Data-Models.org:A collection of freely available forms (September 2016)

MDM-Portal (Medical Data-Models) is a meta-data repository for creating, analysing, sharing and reusing medical forms, developed by the Institute of Medical Informatics, University of Muenster in Germany. Electronic forms for documentation of patient data are an integral part within the workflow of physicians. A huge amount of data is collected either through routine documentation forms (EHRs) for electronic health records or as case report forms (CRFs) for clinical trials. This raises major scientific challenges for health care, since different health information systems are not necessarily compatible with each other and thus information exchange of structured data is hampered. Software vendors provide a variety of individual documentation forms according to their standard contracts, which function as isolated applications. Furthermore, free availability of those forms is rarely the case. Currently less than 5 % of medical forms are freely accessible. Based on this lack of transparency harmonization of data models in health care is extremely cumbersome, thus work and know-how of completed clinical trials and routine documentation in hospitals are hard to be re-used. The MDM-Portal serves as an infrastructure for academic (non-commercial) medical research to contribute a solution to this problem. It already contains more than 4,000 system-independent forms (CDISC ODM Format, www.cdisc.org, Operational Data Model) with more than 380,000 dataelements. This enables researchers to view, discuss, download and export forms in most common technical formats such as PDF, CSV, Excel, SQL, SPSS, R, etc. A growing user community will lead to a growing database of medical forms. In this matter, we would like to encourage all medical researchers to register and add forms and discuss existing forms