Assessing recovery after cold challenge and thumb involvement can help to rule out systemic sclerosis in patients presenting with Raynaud?s phenomenon

Objective: Our aim was to study whether recovery from a Raynaud?s attack and involvement of the thumb are differentiators for systemic sclerosis (SSc) in patients with Raynaud?s phenomenon (RP). Method: A stepwise cooling and recovery procedure was performed, provoking an RP attack, in patients with primary Raynaud?s phenomenon (PRP, n =?68) and SSc (n?=?18). During the procedure, the perfusion of all five fingers during cooling and recovery was assessed by photoelectric plethysmography. Results: In SSc patients, perfusion after 10?min in one or more fingers was more frequently not restored than in PRP patients (p?=?0.001), with a negative predictive value of 98%. The thumb was more frequently involved in SSc patients (p?=?0.036), with a negative predictive value of 95%. Positive predictive values were low. Conclusions: In patients with RP, when there is restoration of perfusion in all fingers after 10?min or when the thumb is spared, the presence of an underlying SSc is very unlikely. Although these results need to be validated in a clinical setting in a larger prospective study, these signs can help physicians to select additional testing for SSc in RP patients

Characterization of BIS20x3, a bi-specific antibody activating and retargeting T-cells to CD20-positive B-cells

This paper describes a bi-specific antibody, which was called BIS20x3. It retargets CD3ɛ-positive cells (T-cells) to CD20-positive cells and was obtained by hybrid–hybridoma fusion. BIS20x3 could be isolated readily from quadroma culture supernatant and retained all the signalling characteristics associated with both of its chains. Cross-linking of BIS20x3 on Ramos cells leads to DNA fragmentation percentages similar to those obtained after Rituximab-cross-linking. Cross-linking of BIS20x3 on T-cells using cross-linking F(ab′)2-fragments induced T-cell activation. Indirect cross-linking of T-cell-bound BIS20x3 via Ramos cells hyper-activated the T-cells. Furthermore, it was demonstrated that BIS20x3 effectively re-targets T-cells to B-cells, leading to high B-cell cytotoxicity. The results presented in this paper show that BIS20x3 is fully functional in retargeting T-cells to B-cells and suggest that B-cell lymphomas may represent ideal targets for T-cell retargeting bi-specific antibodies, because the retargeted T-cell is maximally stimulated in the presence of B-cells. Additionally, since B-cells may up-regulate CD95/ Fas expression upon binding of CD20-directed antibodies, B-cells will become even more sensitive for T-cell mediated killing via CD95L/ Fas L, and therefore supports the intention to use T-cell retargeting bi-specific antibodies recognizing CD20 on B-cell malignancies as a treatment modality for these diseases. © 2001 Cancer Research Campaign http://www.bjcancer.co

Health claims databases used for kidney research around the world

Health claims databases offer opportunities for studies on large populations of patients with kidney disease and health outcomes in a non-experimental setting. Among others, their unique features enable studies on healthcare costs or on longitudinal, epidemiological data with nationwide coverage. However, health claims databases also have several limitations. Because clinical data and information on renal function are often lacking, the identification of patients with kidney disease depends on the actual presence of diagnosis codes only. Investigating the validity of these data is therefore crucial to assess whether outcomes derived from health claims data are truly meaningful. Also, one should take into account the coverage and content of a health claims database, especially when making international comparisons. In this article, an overview is provided of international health claims databases and their main publications in the area of nephrology. The structure and contents of the Dutch health claims database will be described, as well as an initiative to use the outcomes for research and the development of the Dutch Kidney Atlas. Finally, we will discuss to what extent one might be able to identify patients with kidney disease using health claims databases, as well as their strengths and limitations

Pet-related bacterial zoonotic infections:Three cases of severe infections in the immunocompromised host

Pets can have many positive effects on their owners. However, close contact with pets offers optimal conditions for transmission of micro-organisms. Especially immunocompromised patients are at risk for zoonotic infections. Here we describe the diagnosis, microbiology and treatment of three patients with severe zoonotic infections with Helicobacter canis, Pasteurella multocida and Capnocytophaga canimorsus. With this case report we would like to emphasize the importance of awareness for pet-related zoonotic infections in immunocompromised patients