Inflammatory cues enhance TGFβ activation by distinct subsets of human intestinal dendritic cells via integrin αvβ8

Regulation of intestinal T-cell responses is crucial for immune homeostasis and prevention of inflammatory bowel disease (IBD). A vital cytokine in regulating intestinal T cells is transforming growth factor-β (TGFβ), which is secreted by cells as a latent complex that requires activation to function. However, how TGFβ activation is regulated in the human intestine, and how such pathways are altered in IBD is completely unknown. Here we show that a key activator of TGFβ, integrin αvβ8, is highly expressed on human intestinal dendritic cells (DCs), specifically on the CD1c⁺ but not the CD141⁺ intestinal DC subset. Expression was significantly upregulated on intestinal DC from IBD patients, indicating that inflammatory signals may upregulate expression of this key TGFβ-activating molecule. Indeed, we found that the Toll-like receptor 4 ligand lipopolysaccharide upregulates integrin αvβ8 expression and TGFβ activation by human DC. We also show that DC expression of integrin αvβ8 enhanced induction of FOXP3 in CD4⁺ T cells, suggesting functional importance of integrin αvβ8 expression by human DC. These results show that microbial signals enhance the TGFβ-activating ability of human DC via regulation of integrin αvβ8 expression, and that intestinal inflammation may drive this pathway in patients with IBD.

Size of testes, ovaries, uterus and breast buds by ultrasound in healthy full-term neonates ages 0-3 days

BACKGROUND

Hormonally sensitive organs in the neonate can change size within days of birth as circulating maternal estrogen wanes. Although several reports document the size of these organs through infancy, few focus attention on the near-birth period. Clinical and research evaluation of hormonal and genitourinary disorders would benefit from reference size standards.

OBJECTIVE

We describe the size of the uterus, ovaries, testes and breast buds in healthy term neonates.

MATERIALS AND METHODS

As part of the Infant Feeding and Early Development (IFED) study, we sonographically measured the largest diameter of these organs in sagittal, transverse and anterior-posterior planes for 194 female and 204 male newborns up to 3 days old. We calculated mean, median and percentiles for longest axis length and for volume calculated from measured diameters. We evaluated size differences by laterality, gender and race and compared our observations against published values.

RESULTS

Mean length and mean volume were as follows: uterus, 4.2 cm and 10.0 cm³; ovary, 1.0 cm and 0.2 cm³; testis, 1.1 cm and 0.3 cm³ (0.4 cm³ Lambert volume); female breast bud, 1.2 cm and 0.7 cm³; male breast bud, 1.1 cm and 0.6 cm³. Breast buds were larger in females than males. Laterality differences were typically below the precision of clinical measurement. No significant race differences were detected.

CONCLUSION

Using data from our large cohort together with published values, we provide guidelines for evaluating the size of reproductive organs within the first 3 days of age. Discrepancies between our results and published values are likely attributable to technique.

Treatment outcome for adolescents abusing alcohol and cannabis: how many 'reliably improve'?

Alcohol and cannabis are the primary substances contributing to referrals of adolescents to substance abuse treatment services. Their outcome has not been examined in Ireland. A three month follow-up was conducted in an outpatient adolescent treatment program. We followed up 35 high risk users of alcohol and 55 high risk users of cannabis. Although the high risk drinkers achieved a significant reduction in median number of days drinking (p = 0.004), only four (11 %) were abstinent at follow up. A further five (14%) achieved a reliable reduction in days of drinking. The high risk cannabis users demonstrated a significant drop in median days of use (p < 0.001), although only six (11%) were abstinent at follow up. A further 20 (36%) achieved a reliable reduction in days of use. Calculation of reliable change allows examination of outcomes which fall short of the elusive goal of abstinence.

Markers for seedling and adult plant crown rot resistance in four partially resistant bread wheat sources

QTL identified for seedling and adult plant crown rot resistance in four partially resistant hexaploid wheat sources. PCR-based markers identified for use in marker-assisted selection. Crown rot, caused by Fusarium pseudograminearum, is an important disease of wheat in many wheat-growing regions globally. Complete resistance to infection by F. pseudograminearum has not been observed in a wheat host, but germplasm with partial resistance to this pathogen has been identified. The partially resistant wheat hexaploid germplasm sources 2-49, Sunco, IRN497 and CPI133817 were investigated in both seedling and adult plant field trials to identify markers associated with the resistance which could be used in marker-assisted selection programs. Thirteen different quantitative trait loci (QTL) conditioning crown rot resistance were identified in the four different sources. Some QTL were only observed in seedling trials whereas others appeared to be adult plant specific. For example while the QTL on chromosomes 1AS, 1BS, and 4BS contributed by 2-49 and on 2BS contributed by Sunco were detected in both seedling and field trials, the QTL on 1DL present in 2-49 and the QTL on 3BL in IRN497 were only detected in seedling trials. Genetic correlations between field trials of the same population were strong, as were correlations between seedling trials of the same population. Low to moderate correlations were observed between seedling and field trials. Flanking markers, most of which are less than 10 cM apart, have now been identified for each of the regions associated with crown rot resistance.

Crusted scabies is associated with increased IL-17 secretion by skin T cells

Scabies is an ectoparasitic infestation by the mite Sarcoptes scabiei. Although commonly self-limiting, a fraction of patients develop severely debilitating crusted scabies. The immune mechanisms underlying the development of crusted scabies are unclear, and undertaking longitudinal infection studies in humans is difficult. We utilized a porcine model to compare cellular immune responses in peripheral blood and skin of pigs with different clinical manifestations of scabies (n = 12), and in uninfected controls (n = 6). Although clinical symptoms were not evident until at least 4 weeks post-infestation, the numbers of peripheral IFNγ-secreting CD4(+) T cells and γδ T cells increased in infected pigs from week 1 post-infestation. γδ T cells remained increased in the blood at week 15 post-infestation. At week 15, skin cell infiltrates from pigs with crusted scabies had significantly higher CD8(+) T cell, γδ T cell and IL-17(+) cell numbers than those with ordinary scabies. Peripheral IL-17 levels were not increased, suggesting that localized skin IL-17-secreting T cells may play a critical role in the pathogenesis of crusted scabies development. Given the potential of anti-IL-17 immunotherapy demonstrated for other inflammatory skin diseases, this study may provide a novel therapeutic avenue for patients with recurrent crusted scabies.

Socio-economic gradients in self-reported health in Ireland and Northern Ireland

BACKGROUND

Research and policy related to reducing health inequalities has progressed separately within Ireland and Northern Ireland. This paper describes the first exploration of the socio-economic influences on health on the island of Ireland since 1922.

METHODS

Postal survey.

RESULTS

The response rate was 52%; 11,870 respondents. Men reported more long-standing illness (LLTI) or poor general health (PGH); depression was more common amongst women. Socio-economic gradients in health were evident in both jurisdictions, with the effects of household income being particularly marked. Overall, morbidity levels were significantly better in Ireland than in Northern Ireland: adjusted odds ratio of 0.79 (95% CI 0.71 - 0.88) for LLTI; 0.64 (0.57 - 0.72) for PGH; 0.90 (0.82 - 0.99) for depression.

CONCLUSIONS

There is evidence of strong and similar socio-economic gradients in health throughout the island of Ireland. This would suggest joint policy approaches or at least further comparative evaluation of the initiatives in each jurisdiction.

Alcohol consumption in pregnancy: results from the general practice setting

BACKGROUND

There is no established safe level of alcohol consumption in pregnancy. Studies from Ireland have consistently shown lower abstention and higher binge drinking rates in pregnancy than other countries, indicating a high potential for foetal alcohol-related disorders. There has been little research on alcohol in pregnancy in primary care.

AIMS

To determine the prevalence of alcohol consumption amongst pregnant women attending their GP for antenatal care, and to compare this to use in the year prior to conception.

METHODS

Prospective cross-sectional study was carried out in fifteen teaching practices in the greater Dublin area. Women were recruited at their antenatal visits. Data were gathered by self-completed questionnaire in the practice, or researcher-administered telephone questionnaire. The questionnaire was based on the AUDIT, a WHO-validated data collection instrument designed for use in primary care.

RESULTS

Two hundred and forty valid questionnaires were returned (80 % recruitment rate). Alcohol intake and binge drinking levels were much lower during pregnancy compared to the year prior to pregnancy (p < 0.001). There was a marked reduction in the prevalence of alcohol use in pregnancy compared to previous research. Over 97 % drink no more than once a week, including almost two-thirds of women who abstain totally from alcohol in pregnancy. Non-pregnant Irish women drink alcohol more frequently, and with higher rates of binge drinking, than women of other nationalities.

CONCLUSIONS

Primary care is a suitable setting to research alcohol use in pregnancy. Alcohol use in pregnancy in Ireland has decreased markedly compared to previous research from this jurisdiction.

Getting a handle on the general practice workforce in Ireland

BACKGROUND

General practice makes a critical contribution to healthcare in Ireland. However, there is a weak understanding of the general practice workforce in Ireland.

AIMS

The aim of this study is to estimate the number of general practitioners (GPs) and practice nurses in Ireland.

METHODS

A variety of data sources was used to corroborate counts of general practitioners and practice nurses. Capture-recapture methods were used to estimate the hidden population of GPs not identified by the databases included.

RESULTS

There are 2,954 general practitioners in Ireland, equivalent to 64.4 per 100,000 population. There are 1,700 practice nurses nationally, equivalent to 37.1 per 100,000 persons. There is substantial regional variation in the number of general practitioners and practice nurses per 100,000. To some extent, deficits in one discipline may be counterbalanced by a surplus in the other.

CONCLUSIONS

In the absence of a centralised register, it is not possible to track the number of GPs or practice nurses working in Ireland at present. This is despite the fact that there are twice as many general practice visits per annum compared to hospital visits.

A review of RSPCA research into wildlife rehabilitation

Wildlife rehabilitation is defined as 'the treatment and temporary care of injured, diseased, and displaced indigenous animals, and the subsequent release of healthy animals to appropriate habitats in the wild' (Miller 2012). Vets are frequently presented with wildlife casualties and although there are a number of texts available to help vets with the treatment of wild animals, such as the BSAVA Manual of Wildlife Casualties (Mullineaux and others 2003) and papers produced by experienced wildlife vets (eg, Bexton and Couper 2010, Couper and Bexton 2012), there still remains questions regarding which individual animals can, or should, be treated, which animals will survive treatment and which animals will survive after they have been released back to the wild. The RSPCA believes that the welfare of wildlife casualties can be improved by investigating which injuries or illnesses are most likely to result in a successful release for each species, and by collecting data on postrelease survivorship. As a result, there have been a number of papers published based on the work of the RSPCA's four wildlife centres: East Winch in Norfolk, Mallydams Wood in East Sussex, Stapeley Grange in Cheshire and West Hatch in Somerset. This paper summarises this research, to guide those in the profession with an interest in this subject to papers that may prove useful to them.

Anti-depressants in primary care: analysis of treatment discontinuations

It is well known that adherence to anti-depressant therapy is often poor, but the literature describes little in the way of systematic analyses to determine co-relation between treatment discontinuation and possible contributing factors. We used a community dispensing database to review anti-depressant prescribing patterns and continuity of therapy over a period of 10 months among a population of community-based general practice patients. Some 109,228 anti-depressant prescriptions were dispensed to 24,073 patients, of whom 37.5% collected a single prescription only. Tricyclic anti-depressant prescribing declined significantly during the observation period (from 70% of prescriptions in month 1 to 66% in month 10) while that of selective serotonin reuptake inhibitors (SSRIs) increased (23% in month 1, 28% in month 10) ( p < 0.0001). Some 27% of those on tricyclics were prescribed <50% of the defined daily dose (DDD) compared with 2% of those on SSRIs. Among patients new to therapy who collected >1 prescription, adherence was poor and declined over time. The factors that influenced the extent to which patients failed to adhere to therapy included dosage level (% DDD) and age ( p <0.0001 for both), but not drug class or sex. The findings suggest that low dosage is a contributory factor in treatment discontinuation, and that contrary to common perception, SSRIs are not necessarily associated with better adherence to therapy than tricyclics. Copyright (c) 2000 John Wiley & Sons, Ltd.