Normal ICOS, ICOSL and AID Alleles in Danish Patients with Common Variable Immunodeficiency

Common variable immunodeficiency, CVID, is a primary antibody deficiency characterized by decreased levels of serum immunoglobulin G (IgG), decreased IgA and/or IgM and recurrent infections. It is assumed to be heterogeneous group of disorders caused by different genetic defects. Some patients have decreased levels of class switched memory B cells and/or decreased levels of somatic hypermutation which points to defects in the germinal centre (GC) reactions as cause of the disease in these patients. The inducible costimulator, ICOS, and its' ligand, ICOSL, are both involved in and necessary for the GC reaction and so is activation-induced cytidine deaminase, AID. Therefore, we sequenced the ICOS, ICOSL and AID genes in a cohort of 34 Danish CVID patients. We found 13 new single nucleotide polymorphisms (SNP) in the intron regions of the ICOSL gene as well as one SNP in exon 3. However, none of these polymorphisms were associated with CVID. We did not find a previously reported CVID-causing ICOS gene deletion or any other unique mutations in the ICOS or AID genes.

Mouse antibody production test: can we do without it?

Introduction of microbiologically contaminated materials into mice can cause infections of the recipients and jeopardize experimental protocols. As such, the methods used to screen biological materials should be sensitive, reliable and suitable for routine diagnostic work. In this report, the sensitivity of the viral plaque assay, mouse antibody production test and polymerase chain reaction (PCR) for detection of MHV-A59 and MMVp, two of the most prevalent pathogenic viruses in experimental mouse facilities, was compared. Analysis of serial tenfold dilutions of virus stocks revealed that the sensitivity of the mouse antibody production test on day 28 (10(-10) dilution) was at least 10 times higher than that of the viral plaque assay (10(-9) dilution) and 10(4) times more than that of the RT-PCR (10(-6) dilution) for detection of MHV-A59. For detection of MMVp, the PCR (10(-10) dilution) proved to be 10(6) times more sensitive than the viral plaque assay (10(-4) dilution) and the mouse antibody production test on day 28 (10(-4) dilution) which were equally sensitive. Based on the present study, it was shown that the method for diagnosis of viruses in biological materials should be employed only after the sensitivity has been determined for the viruses of interest implying that the most sensitive method needs to be determined independently for each virus.

Receptor heteromerization in adenosine A2A receptor signaling: relevance for striatal function and Parkinson's disease

Recently evidence has been presented that adenosine A2A and dopamine D2 receptors form functional heteromeric receptor complexes as demonstrated in human neuroblastoma cells and mouse fibroblast Ltk- cells. These A2A/D2 heteromeric receptor complexes undergo coaggregation, cointernalization, and codesensitization on D2 or A2A receptor agonist treatments and especially after combined agonist treatment. It is hypothesized that the A2A/D2 receptor heteromer represents the molecular basis for the antagonistic A2A/D2 receptor interactions demonstrated at the biochemical and behavioral levels. Functional heteromeric complexes between A2A and metabotropic glutamate 5 receptors (mGluR5) have also recently been demonstrated in HEK-293 cells and rat striatal membrane preparations. The A2A/mGluR5 receptor heteromer may account for the synergism found after combined agonist treatments demonstrated in different in vitro and in vivo models. D2, A2A, and mGluR5 receptors are found together in the dendritic spines of the striatopallidal GABA neurons. Therefore, possible D2/A2A/mGluR5 multimeric receptor complexes and the receptor interactions within them may have a major role in controlling the dorsal and ventral striatopallidal GABA neurons involved in Parkinson's disease and in schizophrenia and drug addiction, respectively.

Delay of diagnosis in pancreatic cancer due to suspected symptomatic cholelithiasis

BACKGROUND

A single centre study was conducted to examine the frequency of cholecystectomies, both open and laparoscopic, up to 2 years prior to the diagnosis of pancreatic cancer. In particular, it was of interest to investigate whether there is a diagnostic delay in a significant number of pancreatic cancer patients and if these patients already have symptoms or findings at the time of cholecystectomy that might have been indicative of the underlying malignant disease.

METHODS

It is demonstrated that 17 out of 186 pancreatic cancer patients (9%) underwent a cholecystectomy within the 2 years prior to cancer diagnosis.

RESULTS

A significant number of these patients showed a considerable weight loss at the time of the cholecystectomy. It is hypothesized that symptoms which led to cholecystectomies in these patients were most likely related to the pancreatic cancer. Owing to the resulting delay of pancreatic cancer diagnosis the resection rate with curative intent decreases to 35% from 44% in the whole series.

CONCLUSION

Patients suffering from cholecystolithiasis and showing atypical symptoms or other notable findings such as considerable weight loss might be assessed in more detail pre- as well as postoperatively in order to minimize the diagnostic delay in pancreatic cancer and to avoid unnecessary operations.

Assessment of visual acuity in relation to central nervous system activation in children with mental retardation

Assessment of visual acuity was combined with observations of behavioral state indicating CNS activation in 24 individuals with mental retardation. Visual acuity was assessed by presentations of Teller Acuity Cards on two occasions. Behavioral state was classified along a scale with four categories during visual acuity testing. Results showed good test-retest reliability for the Teller Acuity Cards. Six participants had different behavioral state scores on the two test occasions, but displayed similar visual acuity on both tests. No participant rated as "drowsy" displayed responses on the acuity test. Results indicate that forced-choice preferential-looking technique can be used to test visual acuity in this population unless the participant is drowsy.

Rett syndrome and ageing: a case study

PURPOSE

This case study of an elderly women with Rett syndrome is used to consider whether observed changes may be related to physiological processes involved in ageing or environmental adaptations, which is important for delivery of rehabilitation.

METHOD

The life story of a woman with Rett syndrome who lived to the age of 60 is presented. It is based on medical records, older and more recent videotapes, and interviews with her sister and care staff.

RESULTS

After 21 years without walking, following intensive physiotherapy, she regained the ability to walk without support. She also showed improvement in hand use a few years before she died. During the early regression she appeared to lose social interest. The interest improved after some time, but she remained wary of people she did not know.

CONCLUSION

The walking and hand use indicate that these functions may have been present to a greater extent than assumed by people in the environment and that her poor function reflects dyspraxia and lack of opportunity and training rather than lack of ability. Although more studies of elderly women with Rett syndrome is needed to answer whether the observed changes were due to physiological processes involved in ageing or environmental adaptations, the present case story demonstrates that identification of females with Rett syndrome is important at all age levels.

[Chronic Monteggia injury in a child]

The case of a Monteggia fracture neglected from two years of age and seen at the age of fourteen, is described. A shortening of the affected ulna by three cm and a relative elongation of the radius was found. The function of the arm and elbow joint was remarkably unaffected with nearly full extension and flexion, supination and pronation. The carrying angle was ten degrees on both sides. Based on the literature, it is stressed that diagnosis and treatment of Monteggia lesions should be immediate. Complications in non-treated cases and at late treatment are many, and the results of such treatment dubious. It is thus of great importance that, when dealing with ulnar fracture a radiograph is also taken of the elbow joint to secure immediate diagnosis.

Hidden visual capabilities in mentally retarded subjects diagnosed as deaf-blind

The visual acuity of twelve multi-handicapped, mentally retarded subjects, diagnosed as deaf-blind, was measured on two occasions with the Teller Acuity Cards (TAC). Eight subjects scored above the criterion for legally blind and the results of six of these indicated various degrees of poor to approaching-normal eyesight. To evaluate high-level vision four subjects were tested with the Fagan Test, assessing visual recognition memory for faces subsequent to familiarization with the preferential looking technique. The results for three subjects showed evidence for perceptual recognition. It is concluded that TAC combined with the Fagan Test may detect perceptual capacities unnoticed by clinical observation.

Factors influencing the policy responses of host governments to mass refugee influxes

"The policy responses of asylum governments to mass influxes of refugees have varied considerably. Focusing on less developed countries, this article explores why some host governments respond in relatively generous ways, while other governments act more restrictively. The policy alternatives available to receiving governments are classified, and a set of factors influencing refugee policy formation is explored. These factors include: the costs and benefits of accepting international assistance, relations with the sending country, political calculations about the local community's absorption capacity, and national security considerations."

Adhesion receptors on bone marrow stromal cells: in vivo expression of vascular cell adhesion molecule-1 by reticular cells and sinusoidal endothelium in normal and gamma-irradiated mice

Cell adhesion molecules (CAMs) play a key role in interactions between stromal and hematopoietic cells in bone marrow (BM) and in cell traffic through vascular endothelium. To examine the identity of CAMs involved in these processes in mouse BM, we have investigated the in vivo expression of vascular cell adhesion molecule-1 (VCAM-1) and its counter-receptor, very late antigen-4 (VLA-4). Radioiodinated monoclonal antibodies (MoAbs) detecting VLA-4 and VCAM-1 were injected intravenously. Antibody binding was detected in BM by light and electron microscope radioautography. VCAM-1 labeling was restricted to stromal reticular cells and endothelial cells lining BM sinusoids. VCAM-1+ reticular cells formed patchy concentrations, especially in subosteal regions, associated with lymphoid, granulocytic, and erythroid cells. After gamma-irradiation to deplete hematopoietic cells, reticular cells and endothelial cells all showed VCAM-1 labeling in apparently increased intensity. VLA-4 labeling was shown by undifferentiated blast cells and lymphohematopoietic cells both in BM cell suspensions and in vivo, especially at reticular cell contact points. The results demonstrate that VCAM-1 is expressed in vivo by certain BM reticular cells, suggesting that the molecule mediates adhesion to multiple lineages of lymphohematopoietic cells. The finding that VCAM-1 is also expressed constitutively by BM sinusoidal endothelium, unlike its inductive expression by endothelia elsewhere, suggests that VCAM-1 and VLA-4 may be involved in regulating the normal cell traffic between BM and the blood stream.

Federal block grants and state spending: the Alcohol, Drug Abuse, and Mental Health block grant and state agency behavior

With renewed interest in block grants as a way to channel federal funds to states, several questions arise about the effect of block grants on state spending. A central question about the block grant form of intergovernmental aid is whether states spend the funds on the intended services or use budgetary strategies to appear to be in compliance with maintenance-of-effort provisions but then reallocate block grant funds from the targeted program. We studied the effect of the Alcohol, Drug Abuse and Mental Health block grant program on state substance abuse expenditures by analyzing spending data from the fifty states between fiscal years 1987 and 1992. Our findings suggest that this block grant has stimulated state spending, but this effect may be relevant only since 1990, and differs among states.

Preferential looking: a sudden shift in visual fixation pattern at 32 months of age

Observations of eye movements of young children in a modified preferential looking task suggest a change in the visual looking pattern taking place during a very brief time between 32 and 33 months of age. In the younger children, a grating stimulus elicited eye movements towards the target followed by a few seconds of focused attention; in the older children a visual avoidance behavior was observed where subjects looked consistently in the opposite direction of the target. An analysis of video recordings suggests that this avoidance pattern was a composite of a very brief initial target-directed eye movement which was quickly arrested, and followed by eye movements in the opposite direction, initiating a search of the visual scene.

Apoptosis and macrophage-mediated cell deletion in the regulation of B lymphopoiesis in mouse bone marrow

Studies of cell population dynamics and microenvironmental organization of B lymphopoiesis in the bone marrow of normal mice and in various genetically modified states have shown that cell loss, involving processes of apoptosis and macrophage-mediated cell deletion, is a prominent feature of the primary genesis of B lymphocytes. Balanced against the influence of proliferative stimulants, the programmed death of precursor B cells provides a quantitative control, determining the magnitude of the final output of functional B lymphocytes to the peripheral immune system. The cell loss mechanisms can be readily set in motion by external or systemic influences, making the B-cell output particularly vulnerable to suppression by ionizing irradiation, stress or other systemic mediators. In addition, however, cell loss exerts an important quality control in the formation of the primary B-cell repertoire. The combination of apoptosis and macrophage-mediated deletion, acting at successive stages of B-cell differentiation, efficiently eliminates many precursors having non-productive Ig gene rearrangements, cell cycle dysregulations, and certain autoreactive Ig specificities. Outstanding areas of further work abound. Important questions concern the nature of mechanisms which underlie the processes of B-cell apoptosis and macrophage deletion in bone marrow, the microenvironmental signals involved in B-cell life or death decisions and genetic factors which may override these B-cell culling mechanisms. The answers will be relevant to problems of autoimmune disease, humoral immunodeficiency and B-cell neoplasia.

[Pneumonia among patients admitted to intensive care units. An epidemiological multicenter study of APACHE II score, incidence and course]

Pneumonia in patients in intensive care units (ICU) is associated with several diagnostic difficulties and high mortality. This study was conducted to describe the diagnostic procedures and clinical characteristics of the pneumonic and critically ill patient in relation to APACHE II score. The material consisted of 193 patients admitted to seven Danish ICUs and is also included in a European epidemiologic survey (EURO.NIS). Twenty-eight (14.5%) developed pneumonia and 18 (9.3%) of these were nosocomial (> 48h after admission). Patients with pneumonia had a significantly higher APACHE II score, duration of stay and mortality. The techniques used to diagnose pneumonia were mainly conventional and did not or only seldom include protected brush, bronchoalveolar lavage or pulmonary biosy. The predominant pathogens isolated in tracheal aspirate were Gram-negative bacilli (50%). The APACHE II scoring system was found to stratify patients with respect to mortality, duration of stay and pneumonia diagnosed in ICU.