BACKGROUND & AIMS: :Four cases of intradural extramedullary tuberculous spinal granulomas without bony involvement are presented. Both, the rarity of the disease, as well as the successful microsurgical resection with good recovery prompted this report. The pathogenesis with the controversies therein, is discussed and pertinent literature is reviewed.

背景与目标： ：介绍了4例无骨累及的硬膜内髓外结核性肉芽肿病例。该疾病的稀有性以及成功进行了良好康复的显微外科切除术均促使了这一报道。讨论了其中存在争议的发病机理，并复习了相关文献。

BACKGROUND & AIMS: :Tuberculosis is a common infection in Taiwan, and it is probably a cause of reactive hemophagocytic syndrome. We report the case of a 63-year-old man with initial presentation of fever and progressive jaundice. Hemophagocytic syndrome was documented by the findings of peripheral blood smear and bone marrow biopsy. Although chemotherapy and antituberculous therapy were administered early, he passed away. Sputum and bone marrow cultures confirmed the presence of Mycobacterium tuberculosis 3 weeks later. Bone marrow biopsy revealed noncaseating granuloma. Patients with hemophagocytic syndrome should be rigorously screened for tuberculosis and antituberculous therapy should be initiated early to improve prognosis.

背景与目标： ：结核病是台湾常见的感染，可能是反应性噬血细胞综合征的病因。我们报告了最初发烧和进行性黄疸的63岁男性病例。通过外周血涂片检查和骨髓活检发现有吞噬细胞综合征。尽管尽早进行了化学疗法和抗结核治疗，但他去世了。 3周后，痰液和骨髓培养物证实存在结核分枝杆菌。骨髓活检显示无干酪性肉芽肿。应严格筛查有吞噬细胞综合征的患者是否患有结核病，并应尽早开始抗结核治疗以改善预后。

BACKGROUND & AIMS: :Tuberculosis (TB), caused by Mycobacterium tuberculosis, continues to be a major global health problem. Lung granulomas are organized structures of host immune cells that function to contain the bacteria. Cytokine expression is a critical component of the protective immune response, but inappropriate cytokine expression can exacerbate TB. Although the importance of proinflammatory cytokines in controlling M. tuberculosis infection has been established, the effects of anti-inflammatory cytokines, such as IL-10, in TB are less well understood. To investigate the role of IL-10, we used an Ab to neutralize IL-10 in cynomolgus macaques during M. tuberculosis infection. Anti-IL-10-treated nonhuman primates had similar overall disease outcomes compared with untreated control nonhuman primates, but there were immunological changes in granulomas and lymph nodes from anti-IL-10-treated animals. There was less thoracic inflammation and increased cytokine production in lung granulomas and lymph nodes from IL-10-neutralized animals at 3-4 wk postinfection compared with control animals. At 8 wk postinfection, lung granulomas from IL-10-neutralized animals had reduced cytokine production but increased fibrosis relative to control animals. Although these immunological changes did not affect the overall disease burden during the first 8 wk of infection, we paired computational modeling to explore late infection dynamics. Our findings support that early changes occurring in the absence of IL-10 may lead to better bacterial control later during infection. These unique datasets provide insight into the contribution of IL-10 to the immunological balance necessary for granulomas to control bacterial burden and disease pathology in M. tuberculosis infection.

背景与目标： 结核分枝杆菌引起的结核病（TB）仍然是全球主要的健康问题。肺肉芽肿是宿主免疫细胞的组织结构，其功能是遏制细菌。细胞因子的表达是保护性免疫反应的关键组成部分，但是不适当的细胞因子表达会加剧结核病。尽管已经确定了促炎细胞因子在控制结核分枝杆菌感染中的重要性，但人们对抗炎细胞因子（如IL-10）在结核病中的作用还知之甚少。为了研究IL-10的作用，我们在结核分枝杆菌感染期间使用了Ab中和猕猴猕猴中的IL-10。与未经治疗的对照非人类灵长类动物相比，抗IL-10-处理的非人类灵长类动物具有相似的总体疾病结局，但抗IL-10处理的动物的肉芽肿和淋巴结免疫学改变。与对照动物相比，在感染后3-4周，IL-10中和动物的肺肉芽肿和淋巴结中的胸腔炎症减少，细胞因子产生增加。感染后第8周，来自IL-10中和动物的肺肉芽肿与对照动物相比，细胞因子产生减少，但纤维化增加。尽管这些免疫学变化在感染的前8周内并未影响总体疾病负担，但我们将计算模型配对以探讨晚期感染动态。我们的发现支持在缺乏IL-10的情况下发生早期变化可能会在感染后期导致更好的细菌控制。这些独特的数据集可洞察IL-10对肉芽肿控制结核分枝杆菌感染中细菌负担和疾病病理所必需的免疫平衡的贡献。

BACKGROUND & AIMS: BACKGROUND:The determinants for recurrence of Crohn's disease remain controversial. Eight factors that might predict recurrence were studied in 130 patients operated on for Crohn's disease over a 24-year period.

METHODS:Separate survival curves were estimated for each variable. A multivariate analysis was then carried out in which several selected explanatory variables were included simultaneously in a proportional hazards regression model.

RESULTS:Operation for recurrent disease was necessary in 36 patients. Univariate analysis revealed a highly significant relationship between the presence of granulomas and subsequent recurrence (P = 0.003). There was a trend towards increased recurrence in patients with ileocolonic disease and segmental colectomy (P = 0.11 and P = 0.1 respectively). Age, sex, length of history, indication for operation and affected lines of transection were not associated with recurrence. After multivariate analysis, the association of granulomas with recurrence remained significant (P = 0.03). This association persisted when death was regarded as a treatment failure (P = 0.02).

CONCLUSION:The presence of granulomas in patients with Crohn's disease is significantly associated with recurrence.

背景与目标： 背景：克罗恩氏病复发的决定因素仍有争议。在24年的时间里，对130位接受克罗恩病手术的患者进行了八项可能预测复发的因素的研究。

方法：估计每个变量的独立生存曲线。然后进行了多变量分析，其中在比例风险回归模型中同时包含了几个选定的解释变量。

结果：36例患者必须进行复发性疾病手术。单因素分析显示肉芽肿的存在与随后的复发之间存在高度显着的相关性（P = 0.003）。回肠结肠疾病和节段性结肠切除术的患者有增加复发的趋势（分别为P = 0.11和P = 0.1）。年龄，性别，病史长度，手术指征和横断线均与复发无关。经过多变量分析，肉芽肿与复发的关联仍然很显着（P = 0.03）。当死亡被视为治疗失败时，这种关联仍然存在（P = 0.02）。

结论：克罗恩病患者肉芽肿的存在与复发密切相关。