Emphysema is the predominant component of COPD in AAT deficiency, but the prevalence and impact of airway disease are greater than currently recognized. Consequently, future therapeutic strategies in AAT deficiency should also target this component of COPD.

Liver homing of clinical grade Tregs after therapeutic infusion in patients with autoimmune hepatitis Tregs suppress proliferation and cytokine production of T effector cells & prevent autoimmunity Autologous Tregs home to inflamed autoimmune livers after infusion without side effects Autoimmune hepatitis patients Tregs express CXCR3 chemokine receptor and are functional Highlights • Tregs from patients with autoimmune hepatitis are suppressive, possess functional markers CD39 and CTLA-4, and express CXCR3. • Treg infusion in autoimmune liver disease is safe without any side effects. • 22-44% of infused Tregs home to and were retained in the livers of patients with autoimmune hepatitis for up to 72 hours.

Asymmetrical bilateral masseteric hypertrophy or unilateral masseteric hypertrophy may present a diagnostic dilemma. While the history and clinical examination are important in differentiating this benign condition from parotid and dental pathology, they cannot necessarily exclude rarer malignant lesions of or within the muscle itself. We present a case where MRI provided clear and elegant confirmation of our provisional clinical diagnosis by illustrating both the soft tissue features and the logical corresponding bony features of this condition, thus obviating the need for further invasive investigations.

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Aim-Controversy exists regarding the evidence base of medicine. Estimates range from 20% to 80% in various specialties, but there have been no studies in paediatrics. The aim of this study was to ascertain the evidence base for community paediatrics. Methods-Twelve community paediatricians working in clinics and schools in Yorkshire, Manchester, Teesside, and Cheshire carried out a prospective review of consecutive clinical contacts. Evidence for diagnostic processes, prescribing, referrals, counselling/advice, and child health promotion was found by searching electronic databases. This information was critically appraised and a consensus was obtained regarding quality and whether it supported actions taken. Results-Two hundred and forty seven consultations and 1149 clinical actions were performed. Good evidence was found from a randomised controlled trial or other appropriate study for 39.9% of the 629 actions studied; convincing nonexperimental evidence for 7%; inconclusive evidence for 25.4%; evidence of ineVectiveness for 0.2%; and no evidence for 27.5%. Prescribing and child health promotion activities had the highest levels of quality evidence, and counselling/ advice had the lowest. Conclusions-An encouraging amount of evidence was found to support much of community paediatric practice. This study improved on previous research in other specialties because actions other than medications and surgery were included. (Arch Dis Child 1999;80:257-261)