Secretion from Human Apocrine Glands: An Electron Microscopic Study

Electron microscopic examination of apocrine glands revealed three types of secretion: merocrine, apocrine, and possibly holocrine. In the merocrine type of secretion numerous vesicles originating in the Golgi area discharged their granular contents into the lumen of the gland. In the apocrine type of secretion three stages were observed: (1) formation of an apical cap; (2) formation of a dividing membrane at the base of the apical cap; and (3) formation of tubules above the dividing membrane that extended parallel to the membrane and led to a separation of the apical cap from the underlying cell. In the holocrine type of secretion individual secretory cells or even strands of secretory cells were discharged into the lumen of the gland

Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic non-inferiority randomised controlled trial

Background: Bullous pemphigoid (BP) is a blistering skin disorder with increased mortality. We tested whether a strategy of starting treatment with doxycycline conveys acceptable short-term blister control whilst conferring long-term safety advantages over starting treatment with oral corticosteroids. Methods: Pragmatic multi-centre parallel-group randomised controlled trial of adults with BP (≥3 blisters ≥2 sites and linear basement membrane IgG/C3) plus economic evaluation. Participants were randomised to doxycycline (200 mg/day) or prednisolone (0·5 mg/kg/day). Localised adjuvant potent topical corticosteroids (<30 g/week) was permitted weeks 1-3. The non-inferiority primary effectiveness outcome was the proportion of participants with ≤3 blisters at 6 weeks. We assumed that doxycycline would be 25% less effective than corticosteroids with a 37% acceptable margin of noninferiority. The primary safety outcome was the proportion with severe, life-threatening or fatal treatment-related adverse events by 52 weeks. Analysis used a regression model adjusting for baseline disease severity, age and Karnofsky score, with missing data imputed. Results: 132 patients were randomised to doxycycline and 121 to prednisolone from 54 UK and 7 German dermatology centres. Mean age was 77·7 years and 68.4% had moderate to severe baseline disease. For those starting doxycycline, 83/112 (74·1%) had ≤3 blisters at 6 weeks compared with 92/101 (91·1%) for prednisolone, a difference of 18·6% favouring prednisolone (upper limit of 90% CI, 26·1%, within the predefined 37% margin). Related severe, life-threatening and fatal events at 52 weeks were 18·5% for those starting doxycycline and 36·6% for prednisolone (mITT analysis), an adjusted difference of 19·0% (95% CI, 7·9%, 30·1%, p=0·001). Conclusions: A strategy of starting BP patients on doxycycline is non-inferior to standard treatment with oral prednisolone for short-term blister control and significantly safer long-term

Urban Systems Between National and Global: Recent Reconfiguration Through Transnational Networks

Because the whole book’s issue assumes the uneven integrations of national/continental urban systems inside the global economy, this chapter evaluates the rates and qualitative modes of integration of the national urban systems by the economic networks that are dominated by multinational firms. The empirical study encompasses the largest 1250 cities of the world delineated in a comparative way according to common definitions of large urban regions (LURs). The position of LURs in multinational firms’ ownership networks in 2 years, 2010 and 2013, corresponds to the deepest period of the crisis and the following recovery, respectively. Thus, we checked that the fast reorganization of multinational firms facing this crisis between 2010 and 2013 did not fundamentally transform their strong urban organization but rather introduced some minor changes, particularly due to the simultaneous breakthrough of emergent countries’ companies (especially the Chinese ones). Synthetic network clustering methods partitioning cities of the world offer clear visions of the structure of the multipolar urban networks. They reveal “regions” of integration of cities for all kinds of multinational companies but also distinguishing companies according to their skill levels either in industry or in services. A special attention is given to some highly integrated cities appearing with properties of “city-states,” i.e., without a strong national urban system