The systematic significance of surface features of theBalanophora tuber (Balanophoraceae)

The surface ofBalanophora tubers consists of a nonepidermal layer made up of two distinctive types of cells, armature cells and stellate wart cells. Both cell types are provided with a heavy wall, and are dead at maturity. Stellate warts in the three species investigated,B. elongata, B. fungosa, andB. hansenii, séem to be uniform in appearance, but armature cells are extremely distinctive for each species. They are present in large, agglomerate masses in the first, singly or in very small clusters in the second, and as completely free, individual, acicular cells in the third species. Such differences are believed to be significant systematically, and the separation ofB. hansenii is thus probably justified. Notwithstanding superficial similarities, stellate warts do not seem to be comparable to the lenticels of other plants.     

MORTALITY RATE FROM SKIN CANCER

Cancer of the glabrous skin (exclusive of cancer of the superficial mucous membranes, melanoma, sarcoma and other rare skin tumors) is a highly curable disease. However, the mortality rate based on United States Public Health Service statistics for the State of California and an analysis of 35 fatalities occurring in 2,122 cases as observed over a 20-year period in the Visible Tumor Clinic at the University of California, is approximately 1.65 per cent to 1.75 per cent.Skin cancer could theoretically approach a 100 per cent cure rate with two simple rules: Firstly, the patient should seek proper medical advice early for all suspicious growths, moles or warts. Secondly, after an exact diagnosis is made by biopsy, the first treatment given by the physician, whether surgical, chemosurgical, electrosurgical or x-ray, should be complete and adequate, for the first time is the “golden opportunity” for cure.     

Cost of Preventing,Managing, and Treating Human Papillomavirus (HPV)-Related Diseases in Sweden before the Introduction of Quadrivalent HPV Vaccination

Objective

Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented.

Methods and Materials

Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts.

Results

From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million.

Conclusion

Prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts are substantial. Defining these costs is important for future cost-effectiveness analyses of the quadrivalent HPV vaccination program in Sweden.     

CO_2激光联合胸腺五肽治疗尖锐湿疣的临床效果分析

目的：探讨CO2激光联合胸腺五肽治疗尖锐湿疣的临床疗效。方法：将我院2010年2月-2011年8月期间收治的82例尖锐湿疣患者随机分为两组,治疗组50例采用CO2激光器治疗联合胸腺五肽肌注;对照组32例单纯采用CO2激光器治疗;两组治疗疗程结束后观察临床疗效。结果：治疗组50例,一次治愈者46例,占92%;二次治愈者4例,占8%。对照组32例,一次治愈者19例,占59.4%;二次治愈者13例,占40.6%。两组一次治愈率比较差异明显,具有统计学意义（P〈0.05）。两组术后局部轻度水肿和疼痛,无需处理1~3天缓解或痊愈。结论：CO2激光联合胸腺五肽治疗尖锐湿疣临床疗效好,并具有治疗简便,术后不良反应少,治愈率高等特点。     

CO2 激光联合胸腺五肽治疗尖锐湿疣的临床效果分析

目的:探讨CO2激光联合胸腺五肽治疗尖锐湿疣的临床疗效。方法:将我院2010年2月-2011年8月期间收治的82例尖锐湿疣患者随机分为两组,治疗组50例采用CO2激光器治疗联合胸腺五肽肌注;对照组32例单纯采用CO2激光器治疗;两组治疗疗程结束后观察临床疗效。结果:治疗组50例,一次治愈者46例,占92%;二次治愈者4例,占8%。对照组32例,一次治愈者19例,占59.4%;二次治愈者13例,占40.6%。两组一次治愈率比较差异明显,具有统计学意义(P<0.05)。两组术后局部轻度水肿和疼痛,无需处理1~3天缓解或痊愈。结论:CO2激光联合胸腺五肽治疗尖锐湿疣临床疗效好,并具有治疗简便,术后不良反应少,治愈率高等特点。     

The interaction of high and low-risk human papillomavirus genotypes increases the risk of developing genital warts: A population-based cohort study

Cervical cancer is among the most common type of cancers in women and is associated with human papillomavirus (HPV) infection. Genital warts are also reported to be linked with HPV infection types 11 and 6. In turn, clinical characteristics and morphological features of warts may be useful in the prediction of prognosis and in making treatment decisions. Thus, we have investigated the association of high and low-risk HPVs genotype with genital wart risk, as well as pathological and cytological information in cases recruited from a population-based cohort study of 1380 patients. Patients infected with HPV genotype 6 or 11 had an increased risk of having warts, with OR of 2.34 (95% CI: 0.955-5.737, P = 0.06). Also, this association was enhanced in the presence of high plus low-risk HPV for having genital wart (OR: 2.814; 95%: 1.208-6.55, P = 0.017) and cases having high-risk HPV (OR: 2.329; 95% CI: 1.029-5.269, P = 0.042). Moreover, we observed patients with genital warts having CIN2/3, indicating the importance of informing the physician to the patient to prevent more severe lesions. Our data demonstrated that patients with both low/high-risk HPV types had an increased risk of developing genital warts and persistent infection with HPV was a necessary precursor for the increase in cervical lesions.     

An electron microscope study of gametangia in the green seaweed Halimeda tuna

Abstract

The gametangia of the green seaweed Halimeda tuna are spherical bodies of diameter up to 250–300 μm. They are clustered in groups of 8–10 on hundreds of threads sprouting from all pale white segments of the fertile individuals. In addition to gametes, starch-containing chloroplasts, naked starch grains and two types of spherical bodies different in size and ultrastructure are the main corpuscular components. A layer of amorphous material of irregular thickness underlies the walls which are finely and evenly rough, structureless, electron translucent and 1–1.5 μm thick. Gametangia with superficial wall warts were found also.     

Photothermal therapy enhanced the effectiveness of imiquimod against refractory cutaneous warts through boosting immune responses

Refractory cutaneous warts are difficult to eliminate. In situ photo‐immunotherapy (ISPI) is an innovative treatment concept combining local photothermal therapy (PTT) and topical immunotherapy using imiquimod. To compare the efficacy of ISPI vs topical imiquimod alone, a prospective randomized controlled trial was performed with patients suffering from refractory cutaneous warts. In both groups, approximately 50% of the skin surface containing warts was treated for 6 weeks. On the basis of topical imiquimod, ISPI includes an additional 808 nm laser irradiation. Treatment response, temperatures during irradiation and histopathologic examination were evaluated. The complete response rate in the ISPI‐group (22/36, 61.1%) was significantly higher than in the imiquimod alone group (11/34, 32.4%). In the ISPI‐group, the mean maximum temperature was 44.5 ± 5.1°C, and obvious lymphocytic infiltration was found in the perivasculature of the dermis. There was no recurrence or worsening in both groups during the 12‐month follow‐up. No obvious adverse reaction was observed. This study demonstrates that ISPI can be used as an effective and safe treatment modality for refractory cutaneous warts.      

Oxidative stress in patients with nongenital warts

Comparison of oxidative stress status between subjects with or without warts is absent in the literature. In this study, we evaluated 31 consecutive patients with warts (15 female, 16 male) and 36 control cases with no evidence of disease to determine the effects of oxidative stress in patients with warts. The patients were classified according to the wart type, duration, number, and location of lesions. We measured the indicators of oxidative stress such as catalase (CAT), glucose-6-phosphate dehydrogenase (G6PD), superoxide dismutase (SOD), and malondialdehyde (MDA) in the venous blood by spectrophotometry. There was a statistically significant increase in levels of CAT, G6PD, SOD activities and MDA in the patients with warts compared to the control group (P< .05). However, we could not define a statistically significant correlation between these increased enzyme activities and MDA levels and the type, the duration, the number, and the location of lesions. We determined possible suppression of T cells during oxidative stress that might have a negative effect on the prognosis of the disease. Therefore, we propose an argument for the appropriateness to give priority to immunomodulatory treatment alternatives instead of destructive methods in patients with demonstrated oxidative stress.     

PULMONARY HYALINE MEMBRANE DISEASE—A Panel Discussion: Internist's Point of View

Seventy-six digital and periungual warts in 40 patients were treated topically with cantharidin, a potent blistering agent. The material, dissolved in equal parts of acetone and collodion, was applied directly to the warts. Occlusion facilitated blistering. No pretreatment was required. The warts were re-treated at weekly intervals until clinically cured.Fifty-six per cent of digital warts and 33 per cent of periungual warts cleared after a single application of cantharidin. Few required more than three treatments. Observation was continued for more than six months in more than half of the cases. Cure was lasting in about 70 per cent of the cases in which the long term result was known.Cantharidin ranks with liquid nitrogen in effectiveness, but it is painless to apply and does not cause scarring. For these reasons it is especially useful in children.The main disadvantage is pain and tenderness at the treated site for two to four days in some patients. This can be avoided by careful application of the drug. Occasionally new warts appear at the edge of the cantharidin blister. They are best treated by curettage and desiccation.     

Local accumulation of FOXP3+ regulatory T cells: evidence for an immune evasion mechanism in patients with large condylomata acuminata

Condylomata acuminata derived from the infection of human papillomavirus is a common sexually transmitted disease. Although T cell-mediated cellular immunity is considered as the main arm against such infection, the regulation of T cell immune responses in genital condylomata is unclear to date. In this study, we analyzed FOXP3(+) regulatory T cells in genital condylomata of patients. The results show that FOXP3(+) regulatory T cells with suppressive function accumulated in large warts. Consistently, the immunosuppressive milieu in large warts was characterized by high expression of IL-10 and TGF-beta1 and low expression of IL-2 and IFN-gamma. The responsiveness of wart-infiltrating T cells both in vitro and in vivo can be increased by depleting FOXP3(+) T cells. The accumulation of FOXP3(+) regulatory T cells in large warts can be partly ascribed to the chemotaxis of CCL17 and CCL22, derived from Langerhans cells and macrophages in wart. Although such accumulation favors the local immunosuppression, it seems not to influence the systemic immunity. In conclusion, these findings demonstrate that FOXP3(+) regulatory T cells play an important role in genital condylomata, which has multiple implications in the comprehensive treatment of condylomata acuminata.     

Human papillomavirus type 29 (HPV-29), an HPV type cross-hybridizing with HPV-2 and with HPV-3-related types.

The cloning and partial characterization of human papillomavirus (HPV) type 29 is presented. By hybridization analyses, this virus appears to be related to HPV types associated with common warts and HPV types associated with flat warts.     

Immunolocalization of lactoferrin in surgically resected pigmented skin lesions

Lactoferrin (Lf) expression was determined immunohistochemically in 57 formalin-fixed paraffin-embedded bioptic samples obtained from an equal number of patients treated by surgery to remove pigmented skin lesions (nevi = 23; melanoma = 12; vulgaris and seborrhoeic warts = 12; basal cell carcinoma = 10); in addition, 10 specimens of normal skin were studied as control. On 3 mm thick sections, depigmentation and antigen retrieval procedures were performed. The Lf immunoreactivity was revealed by a rabbit anti-human Lf. Quantification of Lf immunoreactivity was performed using an intensity-distribution (ID) score. Melanocytic cells, regardless of their benign or malignant nature, were consistently stained, with no significant differences in the Lf ID-score between melanomas or nevi. A different intensity of Lf immunoreactivity was encountered in superficial portions of warts, exclusively inside squamous epithelial cells arranged in sheets or whorls of keratin. On the contrary, basal cell carcinomas were always unstained, while a slight Lf positivity was found in focal keratinized areas present in two tumours showing baso-squamous differentiation. The Lf immunoreactivity was localized in the cytoplasm and only occasionally in the nucleus. The biological meaning of Lf in these cases of human skin specimens remains unexplained, although it cannot be ruled out that Lf might be involved in the defense system against tumours, or alternatively, may be used by cells requiring iron availability for their turnover. Moreover, the immunohistochemical expression of Lf in melanocytic lesions might be also related to a Lf-melanin interaction. Finally, the involvement of Lf in skin squamous non-neoplastic elements could be related to its role as one of the molecules modulating an unspecific inflammatory or anti-oxidant response.     

Determining oxidant and antioxidant status in patients with genital warts

Abstract

Objectives

Warts are abnormal skin growths caused by human papilloma virus (HPV) infections within the skin of patients. Genital warts usually appear in the perianal and perigenital regions. Asymptomatic warts may be activated after years and may damage natural immunity. The inflammation that occurs during this process may lead to an imbalance between the prooxidant and the antioxidant systems. The aim of this study was to investigate erythrocyte glutathione peroxidase (GSH-Px) activity, serum paraoxonase enzyme levels, and oxidative stress levels in patients with genital warts.

Patients and Methods

In total, 32 patients with genital warts and 35 healthy subjects were included in this study. Erythrocyte GSH-Px activity, serum catalase activity, and paraoxonase enzyme, and malondialdehyde (MDA) levels were determined.

Results

Erythrocyte GSH-Px activity, serum MDA levels, and catalase activity were significantly higher in patients with genital warts than in controls (P < 0.01, P < 0.05, and P < 0.05, respectively). However, serum paraoxonase enzyme levels were not significantly different between groups (P > 0.05). Serum triglyceride levels were significantly lower in patients with genital warts than in controls (P < 0.01). However, there were no statistically signi?cant differences between groups with respect to total cholesterol, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol levels (all P > 0.05).

Conclusions

Our data suggest that oxidative stress is increased in genital warts. Increased oxidative stress levels may contribute to the pathogenesis of genital warts, and prolonged HPV infection due to chronic inflammation could also affect oxidative stress.     

Warts and wart virus antibodies in patients with systemic lupus erythematosus.

Warts were found in 25 out of 56 patients with definite or probable systemic lupus erythematosus (SLE) but in only 19 out of 160 control patients. Warts were particularly prevalent in elderly patients with SLE. The corticosteroid and antimalarial drugs used to treat SLE did not influence the frequency of warts. Wart-virus antibodies were found significantly less often in patients with SLE than in controls: antibodies were detected in 23 out of 51 patients and in 40 out of 54 controls. Ihe findings suggest that some deficiency in the immune mechanisms of patients with SLE predisposes them to develop warts. There was an inverse correlation among the patients with SLE between the occurrence of warts and rheumatoid factor activity. This suggests that rheumatoid factor may interfere with resistance to warts.     

新疆5种丛藓科植物的解剖学研究

运用石蜡切片和电镜扫描技术,对5种丛藓科植物的茎、叶进行了解剖学研究。结果表明:短叶对齿藓Didymodon tectorus(C.Müll.)Saito.整个茎细胞的细胞壁均加厚,叶细胞壁凹陷呈网状,角质层纹饰条状、鳞片状和颗粒状;卷叶丛本藓Anoectangium thomsonii Mitt.茎表皮及中轴细胞壁厚,叶表面的粗疣粗糙、密集,疣上还有小孔和鳞片状纹饰;山赤藓Syntrichia ruralis(Hedw.)Web.Mohr.茎皮部细胞质浓,叶片背腹两面均密被鹿角状疣,疣上有层层叠加状纹饰和乳突;无疣墙藓Tortula mucronifolia Schweagr.茎横切面呈长圆形,叶细胞壁薄,无疣,叶背面细胞表皮较粗糙,叶腹面细胞表皮较光滑,角质层纹饰稀疏且短;长叶纽藓Tortella tortuosa(Hedw.)Limpr.茎表皮细胞壁强烈凹陷,叶细胞表面密被粗疣,疣上的角质层纹饰呈不规则鳞片状。丛藓科植物茎及叶的微观特征,为该科植物属、种的鉴定提供了重要的分类依据。     

The A.M.A. Session

The use of liquid nitrogen for the removal of warts has advantages over electrocautery in certain circumstances. Although the incidence of recurrences after liquid nitrogen is higher than after cautery, it causes considerably less scarring. It is most useful in dealing with peri-ungual and multiple warts. The technique is simple and a supply of liquid nitrogen can be kept on hand in the office at relatively low cost.     

The A.M.A. Session

The use of liquid nitrogen for the removal of warts has advantages over electrocautery in certain circumstances. Although the incidence of recurrences after liquid nitrogen is higher than after cautery, it causes considerably less scarring. It is most useful in dealing with peri-ungual and multiple warts.The technique is simple and a supply of liquid nitrogen can be kept on hand in the office at relatively low cost.     

Follow up of women with a history of mildly abnormal cervical smears which have returned to normal without treatment

The progress of 124 women with at least two negative cervical smears following a history of mildly abnormal smears for which no treatment had been given was compared with 106 women with negative smears and a clinical history of genital warts or herpes virus infection and 460 age-matched controls. After 4 years, excluding those for whom there was no follow up, 5.8% of those with a history of abnormal smears, none of those with a clinical history of genital warts or herpes virus and 1.1% of controls had developed histological evidence of at least cervical intraepithelial neoplasia grade III (CINIII) when referred for investigation of subsequent abnormal smears; one woman, from the control group, had developed invasive cervical cancer. Women with two negative smears after a history of abnormal smears who subsequently developed CINIII were more likely to have had a previous smear reported as moderate or mild-moderate dyskaryosis (2/6) compared with those whose follow up was negative (2/89). the results suggest that two negative cervical smears may not necessarily indicate that a lesion has regressed, but that a clinical history of genital warts or herpes virus infection should not be an indication for increased surveillance.     

Treatment of recurrent common warts with one low dose of intralesional natural human leukocyte interferon alpha

Nine patients with recurrent and long lasting common warts were treated with intralesional Hu-IFN-alpha. The schedule was a single dose per wart, ranged between 10(5) and 2 x 10(5) IU. Placebo was also administered in 3 of these patients. Complete remission was observed in 7 of the 9 patients. The pattern of warts involution and the possible interferon mechanism of action are discussed. A significant pain relief, produced by interferon injection was observed in the patients with plantar warts and in one patient with subungueal wart.