Family intervention after stroke: does counseling or education help?

Two interventions for improving stroke caregiver knowledge, stabilizing family function, promoting patient adjustment, and enlisting the use of social resources after stroke were compared with routine medical and nursing care of stroke patients (n = 61) at a 440-bed Veterans Administration Medical Center. The education intervention (n = 64) consisted of classroom instruction for caregivers about basic stroke care principles. The counseling condition (n = 63) consisted of education plus seven follow-up problem-solving sessions with a social worker (for the caregiver). Six months and 1 year after the stroke, both interventions significantly improved caregiver knowledge and stabilized some aspects of family function better than routine care. Counseling was consistently more effective than education alone and resulted in better patient adjustment at 1 year. Neither intervention influenced the use of social resources.

Tentacle contraction in Heliophrya erhardi (Suctoria): the role of inositol phospholipid metabolites and cyclic nucleotides in stimulus-response coupling

Extracellular stimulation of Heliophrya erhardi with 15 V, 100 ms induces tentacle contraction. The effects of a number of pharmacological agents on response latency (time from stimulus to start of contraction) and contraction time (time for tentacles to reach 20% of their original length) were recorded. Contraction was enhanced in the presence of phorbol ester TPA and R59022, both of which increase activation of diacylglycerol-dependent protein kinase C. Lithium ions, which are known to inhibit dephosphorylation of inositol 1-phosphate, also affected the response, causing a decrease in latency and increase in contraction time. These results strongly implicate products of inositol phospholipid metabolism in stimulus-contraction coupling. The latency of contraction was reduced in the presence of IBMX, a nonspecific inhibitor of cyclic nucleotide phosphodiesterases. Application of membrane-permeable cyclic nucleotide analogs led to an increase in latency and contraction time for cAMP analog, but a decrease in both parameters for cGMP. This suggests that the two cyclic nucleotides have opposing roles in modulating the response. The possible roles and interactions of membrane phospholipid metabolites and cyclic nucleotides in the control of tentacle contraction of H. erhardi are discussed.

In vitro interferon-gamma production by cultured T-cells in severe aplastic anaemia: correlation with granulomonopoietic inhibition in patients who respond to anti-thymocyte globulin

T-cell-mediated inhibition of granulomonopoietic progenitors (CFU-GM) was studied in vitro in 27 patients with severe aplastic anaemia (AA). In nine out of 13 responders to anti-thymocyte globulin (ATG), cultured T-cells obtained prior to therapy, as well as their conditioned medium strongly suppressed both normal allogeneic and autologous CFU-GM (the latter obtained after marrow recovery). Addition of anti-interferon-gamma to the cultures abolished the suppressive effect on CFU-GM. After ATG therapy, no similar inhibitory effect was detected. Employing the panning method with monoclonal antibodies (CD4+ for inducer/helper and CD8+ for cytotoxic/suppressor T-cells) we were able to show that the cells responsible for in vitro CFU-GM inhibition were included in the cytotoxic/suppressor T-cell subpopulation. Cultured T-cells and their conditioned medium obtained from 14 non-responders to ATG did not show CFU-GM suppression. The mean interferon (IFN) levels in the T-cell conditioned media of ATG-responders was 625 +/- 125 mu/ml while in non-responders the level was 45 +/- 15 mu/ml (normal control levels 43 +/- 24 mu/ml). Freshly isolated peripheral blood lymphocytes from either group did not show any in vitro inhibitory effect. The response rate to ATG was statistically significant when the generation in culture of high versus low IFN production was compared (P = 0.0001). Experiments with T-cells obtained from heavily transfused thalassaemia major, and myelodysplastic syndrome patients, as well as normal volunteers, also did not demonstrate any suppression of CFU-GM. Our results indicate that the response rate to ATG is significantly higher in patients with AA who have an abnormal regulation of interferon-gamma (g-IFN) production.

Using personal and family variates to predict patients' adjustment after stroke

Forty patients diagnosed with strokes were evaluated to examine the contribution of typical stroke-outcome correlates toward personal adjustment. Multiple regression analyses indicated that significant variance in personal adjustment was accounted for by caregivers' anxiety. Compared to community norms, stroke patients were significantly more confused and depressed, but they were no different on interpersonal adjustment. Results may help in developing methods to identify stroke patients at risk for poor adjustment.

Effects of apomorphine on punished and unpunished responding in the rat

Apomorphine has been reported to increase shock-suppressed drinking, which suggests that it might have antianxiety activity. Because some drugs that increase shock-suppressed drinking are not active in other punishment procedures, the effects of apomorphine on punished and unpunished responding maintained by a multiple fixed-interval, fixed-interval schedule of food presentation were studied in rats. At doses from 3.125 to 100 micrograms/kg, apomorphine failed to increase punished or unpunished responding. In contrast, pentobarbital produced large increases in punished responding maintained by a fixed-interval schedule of food presentation.

Haloperidol decanoate: a depot antipsychotic

This article reviews the role of a new depot antipsychotic dosage form, haloperidol decanoate (HD), in relationship to other comparable pharmacotherapies (oral and injectable). The chemistry, indications, contraindications, and pharmacokinetics of HD are discussed. The available clinical research in humans is presented and evaluated with respect to efficacy, adverse effects, and dosing. HD is clearly an effective antipsychotic dosage form. Certainly, HD can improve compliance and possibly outcome for selected patients. HD should be reserved for chronic relapsing schizophrenic patients who have responded to oral haloperidol. Considering the pharmacokinetics, potential risks, and cost of HD, the clinician needs to be prepared with recommendations to effect optimal use of HD (guidelines are presented).

Effect of mental disorders on hospital readmission for medical/surgical patients

To estimate the relationship between mental health problems and use of medical resources, this study compared readmission rates of medical/surgical patients who had a comorbid psychiatric disorder with those who did not. Patients with mental disorders were no more likely to be readmitted for medical problems after their index hospitalization than patients without psychiatric comorbidity. Results may assist in determining whether to include psychiatric variables as risk factors that might predict poor outcome after medical care.

Elevations in thyroid-stimulating hormone in normal subjects after receiving short-term lithium carbonate

Nine normal, healthy male subjects had significantly elevated thyroid-stimulating hormone (TSH) concentrations while receiving oral lithium carbonate for two weeks. The mean minimum lithium serum concentration was 0.765 mEq/L. The TSH concentrations after 15 days on lithium were significantly correlated to the TSH concentration at baseline. No correlation was found between mean minimum lithium steady-state concentration and TSH concentration after 15 days on lithium. Further research is necessary to determine if a high baseline TSH concentration or an early rise in TSH will predict those patients who will eventually develop hypothyroidism after long-term lithium therapy.

Identifying factors associated with health care use: a hospital-based risk screening index

The purpose of the current study was to identify variables near hospital admission that could effectively discriminate patients at risk for nursing home placement, long hospital stay, or readmission. Risk factors reported in the literature were used to predict hospital outcome for 532 admissions. Factors that discriminated type of outcome included: two or more chronic medical conditions, living alone or being admitted from a nursing home, dependent ambulation, poor mental status, psychiatric comorbidity, prior admission, age over 75, and being unmarried. Using these criteria, an index was developed to determine risk for placement, readmission, or lengthy stay. Use of cumulative risk scores can result in accurate prediction of outcome and may be useful in targeting patients for intervention. Performance characteristics of the risk index are discussed.

Interleukin 2-activated killer cells in patients following transplants of soybean lectin-separated and E rosette-depleted bone marrow

During the early period following bone marrow transplantation before the immune system has reached full functional maturity, unprimed, nonspecific lytic systems may play a critical role as antiviral or antitumor effectors. The reconstitution of cells with this potential is of particular importance in recipients of bone marrow that has been depleted of mature T lymphocytes to prevent graft v host disease (GVHD). We examined the recovery of natural killer (NK) cells and interleukin 2 (IL 2)-augmented lymphokine-activated killer cells (LAK) in 48 patients at various intervals following transplantation of bone marrow depleted of mature cellular elements by treatment with soybean agglutinin and sheep RBCs (SBA-E- BMT). We found normal levels of both NK and LAK activity as early as 3 weeks following SBA-E- BMT. When compared with cells from controls, NK and LAK precursors from transplant recipients appeared to be activated in vivo in that freshly isolated peripheral blood mononuclear cells (PBMCs) from patients had an elevated cytolytic activity toward NK-insensitive targets and a more rapid response to activation by IL 2. In patients as well as controls, both LAK precursors and LAK effectors lacked antigens present on mature T lymphocytes (CD3, CD4, or CD8) but expressed antigens present on NK cells (CD2, CD16, and NKH1A). The LAK cells did not lyse either donor or host peripheral blood T cell targets. The activity of NK effectors but not LAK precursors survived the in vivo total body irradiation used for pretransplant conditioning in three patients studied. LAK precursors could be demonstrated as early as 18 days following transplant at a time when the bone marrow contained primarily donor-derived cells. Little or no LAK activity could be generated from cells of the SBA-E- BM graft itself, suggesting that LAK precursors differentiate rapidly from more primitive progenitors in the marrow graft. Thus, our data indicate that the NK and LAK lytic systems are among the earliest activities to recover during immune reconstitution following T cell-depleted BMTs.

An evaluation of population pharmacokinetics in therapeutic trials. Part II. Detection of a drug-drug interaction

The use of observational data, collected during the routine clinical care of patients, has been advocated as a means to obtain clinically relevant information regarding the pharmacokinetic parameters of drugs. However, the validity of this approach and its proper role in new drug development is unclear. This study was performed to evaluate the ability of three approaches to estimate population pharmacokinetic parameters: the traditional approach, mixed-effect modeling, and a simple pharmacokinetic screen. The evaluation was performed with data collected during a multicenter, open-label study evaluating the efficacy, safety, and pharmacokinetics of imipramine and alprazolam in combination. The traditional pharmacokinetic study demonstrated a 20% decrease in the clearance of imipramine in the presence of 4 mg/day alprazolam. Mixed-effect modeling extends these findings by suggesting that the interaction is dependent on the simultaneous concentration of alprazolam, a finding that was not possible under the study design typically used for traditional pharmacokinetic studies. Although the simple screen suggests the presence of the drug-drug interaction, limited information regarding pharmacokinetic parameters is available and those parameters that can be estimated are biased.

Family interaction and treatment adherence after stroke

Caregivers of 60 stroke patients were assessed five months after patient discharge from a stroke care unit to determine the relationship between family function and poststroke treatment adherence. Areas of family interaction which were significantly related to ratings of treatment adherence included problem solving, communication, and affective involvement. Better functioning families were consistently high on signs of treatment adherence. Findings suggest that families with specific dysfunction may not be as capable of helping patients comply with rehabilitation efforts as families who function more effectively. Thorough family assessment to identify which areas of family interaction are most problematic in relation to adherence issues is recommended.

Prestroke family interaction as a predictor of stroke outcome

The Family of Assessment Device and clinical data for 60 stroke patients were used to predict outcome at six months and one year poststroke. Ratings of behavior control and affective responsiveness of the family predicted number of days of rehospitalization during the study. Problem solving scores, family communication skills, and patient self-care ability predicted family-rated patient adjustment. Family function was a better predictor of hospital stay than baseline ratings of typical predictors of stroke outcome. Family function represents an area for potential stroke intervention that may have more relevance to efficient health care delivery and the clinical status of stroke patients than has previously been noted.

Predicting poststroke family function: a continuing dilemma

To determine what effect stroke might have on family interaction, common stroke outcome variables were used to predict family function for a sample of 78 families in which one member had recent onset of stroke. Traditional stroke-outcome predictors were not useful in accounting for variance in family function. The nature of family dynamics after disability may require additional research because the relationship is complex.

A monoclonal antibody that induces T cell aggregation reacts with vascular endothelial cells and placental trophoblasts

We have found that a mouse monoclonal antibody (alpha Leu-13) to a 16 kilodalton human lymphocyte surface antigen reacts with vascular endothelial cells as determined by immunoperoxidase staining of frozen tissue sections. In earlier studies, alpha Leu-13 was found to induce purified T cells to aggregate when added to cultures in nanogram concentrations. In the studies reported here, alpha Leu-13 stained vascular endothelial cells of arteries, capillaries, and veins in all organs examined from adults. It also reacted weakly with epithelial cells of proximal tubules of the kidney and with nonkeratinized basal epithelial cells of the cervix and esophagus. When a panel of tissues from a 14-wk-old fetus was examined, alpha Leu-13 was not found to react with endothelial cells of any specimen. However, it did stain medullary thymocytes and placental trophoblasts of this fetus. The implications of these findings to the possible function of the Leu-13 antigen in immune ontogeny are discussed.

A monoclonal antibody that induces T cell aggregation reacts with vascular endothelial cells and placental trophoblasts

We have found that a mouse monoclonal antibody (alpha Leu-13) to a 16 kilodalton human lymphocyte surface antigen reacts with vascular endothelial cells as determined by immunoperoxidase staining of frozen tissue sections. In earlier studies, alpha Leu-13 was found to induce purified T cells to aggregate when added to cultures in nanogram concentrations. In the studies reported here, alpha Leu-13 stained vascular endothelial cells of arteries, capillaries, and veins in all organs examined from adults. It also reacted weakly with epithelial cells of proximal tubules of the kidney and with nonkeratinized basal epithelial cells of the cervix and esophagus. When a panel of tissues from a 14-wk-old fetus was examined, alpha Leu-13 was not found to react with endothelial cells of any specimen. However, it did stain medullary thymocytes and placental trophoblasts of this fetus. The implications of these findings to the possible function of the Leu-13 antigen in immune ontogeny are discussed.

Identification with the monoclonal antibody 26.163 of a determinant shared by the beta chains of the gene products of the HLA-DR, DQ, and DP loci

Immunochemical studies (sequential immunoprecipitation followed by SDS-PAGE and two-dimensional gel electrophoresis) have shown that the monoclonal antibody (MoAb) 26.163 reacts with HLA-DR, DQ, and DP antigens. Testing with isolated alpha and beta chains of HLA class II antigens and immunoblot analysis also demonstrated that the determinant defined by the MoAb 26.163 is localized on beta chains and does not require their association with alpha chains for its expression. The MoAb 26.163 appears to be the first example of a monoclonal antibody with specificity for the gene products of HLA-DR, DQ, and DP loci.

Effect of expectation and level of adjustment on treatment outcome

This analysis assessed the hypothesis that a relation between adjustment prior to treatment and client outcome, based on documented theoretical observations about similar relationships between clients' expectations and subsequent adjustment after therapeutic counseling, is curvilinear. A sample of 77 outpatients at a University-affiliated hospital completed self-assessments using standardized adjustment scales. There was no curvilinear relationship between prior adjustment and outcome, but a linear relationship between expectation and self-assessed outcome was observed.

Cognitive therapy to achieve personal goals: results of telephone group counseling with disabled adults

Physical disability alters a person's lifestyle and can be detrimental in its effects on mood and activity. We describe a counseling program for severely disabled persons who participated in cognitive therapy by telephone. Therapy involved solving problems related to personal dissatisfaction, loneliness, or depression. The treated group reported significantly less loneliness after treatment and were observed by their families to demonstrate more social role skills than the control group. High goal attainment reported by the treated groups was significantly correlated with decreased loneliness, positive changes in social role skills, and family expectations. Treating affective problems with scheduled telephone contact should be further evaluated because of the observed effectiveness and potential for reaching homebound clientele.

Family Resource Questionnaire: reliability and validity of a social support measure for families of stroke patients

This article describes the development of an instrument, the Family Resource Questionnaire, designed to measure dimensions of social support after stroke. Interrater reliability and concurrent validity was established with 48 consecutive stroke admissions onto a rehabilitation service. Effects of socially desirable responses were minimized with an interview protocol. Moderate validity and high reliability were found.

Family stroke education

To increase families' involvement in rehabilitation, an informational session called Family Stroke Education Class was implemented at a 305 bed medical center serving disabled veterans and their families. After a year, a study of questionnaires completed by family and patients at the meetings showed that anxiety level about their illness had decreased significantly. Twenty-six (86.7 percent) of thirty participants felt more comfortable about approaching team members with questions in the future, and 76.7 percent felt more informed as a result of taking the class. Knowledge scores improved significantly on the post tests. Thus it appears that the educational format is a practical way of including the needs and soliciting participation of families as well as a means for providing basic information to patients on stroke rehabilitation.

Induction of T cell aggregation by antibody to a 16kd human leukocyte surface antigen

We describe studies of a human leukocyte antigen, termed Leu-13, that is defined by a mouse monoclonal antibody that reacts with T and B lymphocytes. Optimal staining of T cells requires a much higher concentration of alpha Leu-13 (greater than or equal to 200 micrograms/ml) than alpha Leu-4 (6 micrograms/ml). However, the fluorescence intensity of T cells labeled with alpha Leu-13, washed and kept at 4 degrees C for different periods, does not diminish more rapidly than the fluorescence of T cells stained with alpha Leu-4 and treated the same way. These results indicate that the novel binding pattern of alpha Leu-13 is not due to weak affinity. Immunoprecipitation and SDS-PAGE analysis indicates that alpha Leu-13 precipitates a major 16-kilodalton (16kd) band and a minor 26kd component from Nonidet P-40-solubilized membrane of normal T cells that are surface-labeled with 125I. The similar sizes of the 16kd to 26kd (Leu-13) and 22kd to 28kd (Leu-4) molecules prompted us to compare the capacity of alpha Leu-13 and alpha Leu-4 to trigger T cell functions, and to co-modulate and co-precipitate the T cell antigen receptor. Unlike alpha Leu-4, alpha Leu-13 does not trigger T cell proliferation or augment NK activity, but inhibits the mitogenic effect of alpha Leu-4/T3 antibodies. alpha Leu-13 also induces T cells to clump into large aggregates after 16 hr of culture at 37 degrees C, but not at 4 degrees C. T cell aggregation is triggered by concentrations of alpha Leu-13 as low as 12.5 ng/ml. At this concentration, alpha Leu-13 is not detectable on the surface of T cells by indirect immunofluorescence analysis in a FACS. On leukemic T cells, alpha Leu-4 was found to co-modulate and co-precipitate a 38kd to 44kd dimer having apparent idiotypic determinants, whereas alpha Leu-13 did not. The possible significance of these findings to immune regulation by T cells is discussed.

Induction of T cell aggregation by antibody to a 16kd human leukocyte surface antigen

We describe studies of a human leukocyte antigen, termed Leu-13, that is defined by a mouse monoclonal antibody that reacts with T and B lymphocytes. Optimal staining of T cells requires a much higher concentration of alpha Leu-13 (greater than or equal to 200 micrograms/ml) than alpha Leu-4 (6 micrograms/ml). However, the fluorescence intensity of T cells labeled with alpha Leu-13, washed and kept at 4 degrees C for different periods, does not diminish more rapidly than the fluorescence of T cells stained with alpha Leu-4 and treated the same way. These results indicate that the novel binding pattern of alpha Leu-13 is not due to weak affinity. Immunoprecipitation and SDS-PAGE analysis indicates that alpha Leu-13 precipitates a major 16-kilodalton (16kd) band and a minor 26kd component from Nonidet P-40-solubilized membrane of normal T cells that are surface-labeled with 125I. The similar sizes of the 16kd to 26kd (Leu-13) and 22kd to 28kd (Leu-4) molecules prompted us to compare the capacity of alpha Leu-13 and alpha Leu-4 to trigger T cell functions, and to co-modulate and co-precipitate the T cell antigen receptor. Unlike alpha Leu-4, alpha Leu-13 does not trigger T cell proliferation or augment NK activity, but inhibits the mitogenic effect of alpha Leu-4/T3 antibodies. alpha Leu-13 also induces T cells to clump into large aggregates after 16 hr of culture at 37 degrees C, but not at 4 degrees C. T cell aggregation is triggered by concentrations of alpha Leu-13 as low as 12.5 ng/ml. At this concentration, alpha Leu-13 is not detectable on the surface of T cells by indirect immunofluorescence analysis in a FACS. On leukemic T cells, alpha Leu-4 was found to co-modulate and co-precipitate a 38kd to 44kd dimer having apparent idiotypic determinants, whereas alpha Leu-13 did not. The possible significance of these findings to immune regulation by T cells is discussed.

Characterization and expression of the HLA-DC antigens defined by anti-Leu 10

The expression of HLA-DC antigens on peripheral blood mononuclear cells, in tonsil and lymph node tissue sections, on tumor cell lines, and on activated T cells was studied using monoclonal antibody, anti-Leu 10. Anti-Leu 10 reacts with HLA-DC molecules on homozygous B cell lines expressing HLA-DR 1,2,4,5,6,8, and 9. It reacts with heterozygous B lymphocytes expressing DR7 and DRw10, suggesting it also recognizes HLA-DC molecules linked to DRw10. The HLA-DC molecules detected by anti-Leu 10 are expressed on all Ig-positive and DR-positive peripheral B lymphocytes and an apparent subpopulation of DR-positive peripheral blood monocytes. Two-color immunofluorescence experiments using phycoerythrin-anti-HLA-DR (L243) and FITC-anti-Leu 10 demonstrated a correlation of the amounts of HLA-DR and DC antigens expressed on B lymphocytes. Cells expressing relatively low, or high amounts of one Class II molecule express respectively low or high amounts of the other Class II molecule. Anti-Leu 10 reacted with all B lymphocyte derived tumor cell lines not with lines of myeloid or erythroid origin, and with only one T cell derived line, HUT-78 which has an activated T cell phenotype. Consistent with this result, anti-Leu 10 binding suggested the presence of HLA-DC on activated T cells in lymphoid tissue, in addition to staining B cells. HLA-DC was also detected on mitogen and MLC activated T cells by anti-Leu 10 binding. Anti-Leu 10 is, therefore, a useful reagent for further studies of the role of HLA-DC in T cell activation and in normal B cell and monocyte functions.

Predicting change in life satisfaction as a function of group counseling

Clients' characteristics associated with outcome of group counseling were identified in a sample of physically disabled persons using standardized self-report inventories. 60 subjects were tested before and after an 8-wk. treatment interval for signs of emotional disorder, inactivity, and social problems related to being severely disabled. Treatment consisted of group conference phone calls using self-determined task assignments as a focus for discussion. Loneliness accounted for 68% of the variance in post-treatment life-satisfaction scores. Signs of depression and available social support were also significant predictors. Remarkably lonely persons showed significant decreases in signs of loneliness after treatment. Using regression analysis, persons with adjustment problems could be identified and prognosis for treatment predicted with acceptable reliability.

Antimalarial psychosis revisited

Drug-induced psychosis resulted from the administration of quinacrine hydrochloride at a dosage of 100 mg twice daily for the treatment of discoid lupus. After two weeks of drug treatment, the patient exhibited symptoms similar to those seen in the manic phase of bipolar affective disorder. Although the incidence of antimalarial psychosis is unclear and perhaps small, we recommend close observation of patients for behavioral changes suggesting the development of antimalarial psychosis. Astute observation, leading to the early detection of behavioral changes, may help avert the development of a costly and disabling complication of drug therapy.

Clonal expression of differentiation and Ia-like antigens on alloreactive human T lymphocytes

A series of human T lymphocyte clones showing specific responses for major histocompatibility complex-encoded alloantigens were isolated from a single culture. They were classified into distinct functional groups based on measurement of alloantigen-specific proliferation and cytotoxicity. Surface antigen expression on these clones was analyzed using a panel of monoclonal antibodies specific for T cell differentiation antigens and for Ia-like antigens. Four distinct groups were identified based on the Leu series of differentiation antigens: (a) Leu1+,2+,3+,4+; (b) Leu1+,3+,4+; (c) Leu1+,2+,4+; and (d) Leu2+,4+. Functionally distinct clones showed not only differential expression of Leu2 and Leu3 , antigens which had previously been shown to distinguish helper/inducer and cytotoxic/suppressor cells, but also of Leu1, an antigen classified as a common T cell marker. All of the clones were found to express Ia antigens as detected by three framework monoclonal antibodies, but none were found to express a determinant associated with the DR3 allospecificity , although it was found on normal B lymphocytes and a B cell line established from the HLA-DR3 individual from whom these clones were derived.

Evaluation of family stroke education

To increase families' involvement in rehabilitation, a series of informational sessions called the Family Stroke Education Class was implemented at a 305 bed medical center serving disabled veterans and their families. Questionnaires completed by family and patients at the meetings showed that anxiety level decreased significantly. More than 90% of participants felt more comfortable about approaching team members with questions in the future, and 77% felt more informed as a result of taking the class. Knowledge scores improved significantly and sustained over a 3 month time period. The educational format was a practical way of including the needs and soliciting participation of the family as well as a means for providing basic information on stroke rehabilitation.

Group treatment of physically disabled adults by telephone

Physical disability threatens a person's life style and can be detrimental in its effects on mood and activity. We describe a counseling program for severely disabled persons who were involved in telephone support groups in order to solve problems related to feeling discouraged, lonely, or being too inactive to remain healthy. A majority of the participants reported being less anxious and more socially involved as a result of the intervention. Ease with which groups were conducted and positive feedback from participants suggests that research should evaluate the cost effectiveness of phone intervention and explore potential of treating affective problems with scheduled phone contact.

Allocytotoxic T cell clones: both Leu 2+3- and Leu 2-3+ T cells recognize class I histocompatibility antigens

T cell clones were selected which were cytotoxic for human class I major histocompatibility target antigens. Specificity was based on target cell panel studies and inhibition by monoclonal antibodies to class I determinants. Eight clones were Leu 2+3-. The cytotoxicity of these clones was inhibited by antibody to the Leu 2 antigen. Two clones expressed the Leu 2-3+ phenotype and were not inhibited by anti-Leu 2a or anti-Leu 3a antibodies. These studies indicate that class I-specific cytotoxic T cells are distributed in both T cell subsets, though predominantly in the Leu 2+3- group. In addition, these studies suggest that the Leu 3 molecule may not function in identical fashion in Leu 3+ cytotoxic T cells, which recognize class I target antigens, as in those which recognize class II targets.

Noncovalently bonded subunits of 22 and 28 kd are rapidly internalized by T cells reacted with anti-Leu-4 antibody

Using immunofluorescence analysis in a FACS or cytofluorograph, we monitored the density of four different human T cell surface molecules (Leu-1/OKT1, Leu-2/OKT5,8, Leu-3/OKT4, and Leu-4/OKT3) at different intervals of incubation at 37 degrees C with monoclonal antibodies that react with these structures. Leu-1 and Leu-2 are probable human homologues of the murine Lyt-1 and Lyt-2,3 antigens, respectively. Leu-3 is a 55 kd antigen that is restricted to Leu-2- (helper) T cells. Leu-4 is expressed by all peripheral T cells and has at least two components of 22 and 28 kd that have an undefined structural relationship. The ultimate degree of modulation of each antigen varied considerably. Modulation of Leu-4 was particularly striking, because this antigen disappeared completely from the cell membrane within 7 hr of culture with saturating concentrations of alpha Leu-4. After modulation of surface 125I-labeled T cells, Leu-4 was found in the detergent-solubilized cell lysate, but not in the cellfree supernatant, indicating that it was internalized. Our results also indicated that the internalized antigen-antibody complex existed in at least two forms: a) as an antigen-antibody complex having only the lower m.w. (22 kd) component bound to antibody, or b) as free antigen having the 28 kd chain in noncovalent association with the 22 kd moiety. These studies indicate that the Leu-4 structure is composed of at least two distinct chains that are noncovalently associated. The rapid modulation and structural properties of the Leu-4 complex are discussed in the context of its possible functions in T cell immunity.

Noncovalently bonded subunits of 22 and 28 kd are rapidly internalized by T cells reacted with anti-Leu-4 antibody

Using immunofluorescence analysis in a FACS or cytofluorograph, we monitored the density of four different human T cell surface molecules (Leu-1/OKT1, Leu-2/OKT5,8, Leu-3/OKT4, and Leu-4/OKT3) at different intervals of incubation at 37 degrees C with monoclonal antibodies that react with these structures. Leu-1 and Leu-2 are probable human homologues of the murine Lyt-1 and Lyt-2,3 antigens, respectively. Leu-3 is a 55 kd antigen that is restricted to Leu-2- (helper) T cells. Leu-4 is expressed by all peripheral T cells and has at least two components of 22 and 28 kd that have an undefined structural relationship. The ultimate degree of modulation of each antigen varied considerably. Modulation of Leu-4 was particularly striking, because this antigen disappeared completely from the cell membrane within 7 hr of culture with saturating concentrations of alpha Leu-4. After modulation of surface 125I-labeled T cells, Leu-4 was found in the detergent-solubilized cell lysate, but not in the cellfree supernatant, indicating that it was internalized. Our results also indicated that the internalized antigen-antibody complex existed in at least two forms: a) as an antigen-antibody complex having only the lower m.w. (22 kd) component bound to antibody, or b) as free antigen having the 28 kd chain in noncovalent association with the 22 kd moiety. These studies indicate that the Leu-4 structure is composed of at least two distinct chains that are noncovalently associated. The rapid modulation and structural properties of the Leu-4 complex are discussed in the context of its possible functions in T cell immunity.

Blocking of human T lymphocyte functions by anti-Leu-2 and anti-Leu-3 antibodies: differential inhibition of proliferation and suppression

We have shown previously that monoclonal antibodies to the Leu-2 and Leu-3 T cell antigens block the response of their respective subsets in allogeneic MLR. The present study was an effort to explore the mechanism of inhibition and to determine if anti-Leu-2 and anti-Leu-3 antibodies affect the responses to stimuli in addition to alloantigens. Our results indicate that antibodies to Leu-2 and Leu-3 have profound inhibitory effects on proliferation by their respective T cell subsets responding to a variety of stimuli, including specific soluble antigens and alloantigen. This effect was characterized by the following features: a) For optimal inhibition of proliferation, antibody must be present at the onset of antigenic stimulation. b) Inhibition is augmented by increasing the concentration of antibody or decreasing the concentration of antigen. c) Fab fragments of both anti-Leu-2a and anti-Leu-3a antibodies also block proliferation. In addition to their effects on T cell proliferation, anti-Leu-3 antibody blocked T cell-dependent lg synthesis induced in MLR, and anti-Leu-2 antibody prevented the induction, in vitro, of Leu-2+3- suppressor cells of lg synthesis. Taken together, these results suggest that antibodies to antigenic determinants on the Leu-2 and Leu-3 molecules competitively block segments of these structures that bind to alloantigen or nominal antigen. On the other hand, anti-Leu-2a antibody failed to block suppression of the MLR by in vivo activated, antigen-specific Leu-2+3- suppressor cells, which suggests that the Leu-2a epitope does not transmit antigen-specific signals from these differentiated suppressor T cells.

Blocking of human T lymphocyte functions by anti-Leu-2 and anti-Leu-3 antibodies: differential inhibition of proliferation and suppression

We have shown previously that monoclonal antibodies to the Leu-2 and Leu-3 T cell antigens block the response of their respective subsets in allogeneic MLR. The present study was an effort to explore the mechanism of inhibition and to determine if anti-Leu-2 and anti-Leu-3 antibodies affect the responses to stimuli in addition to alloantigens. Our results indicate that antibodies to Leu-2 and Leu-3 have profound inhibitory effects on proliferation by their respective T cell subsets responding to a variety of stimuli, including specific soluble antigens and alloantigen. This effect was characterized by the following features: a) For optimal inhibition of proliferation, antibody must be present at the onset of antigenic stimulation. b) Inhibition is augmented by increasing the concentration of antibody or decreasing the concentration of antigen. c) Fab fragments of both anti-Leu-2a and anti-Leu-3a antibodies also block proliferation. In addition to their effects on T cell proliferation, anti-Leu-3 antibody blocked T cell-dependent lg synthesis induced in MLR, and anti-Leu-2 antibody prevented the induction, in vitro, of Leu-2+3- suppressor cells of lg synthesis. Taken together, these results suggest that antibodies to antigenic determinants on the Leu-2 and Leu-3 molecules competitively block segments of these structures that bind to alloantigen or nominal antigen. On the other hand, anti-Leu-2a antibody failed to block suppression of the MLR by in vivo activated, antigen-specific Leu-2+3- suppressor cells, which suggests that the Leu-2a epitope does not transmit antigen-specific signals from these differentiated suppressor T cells.

Loneliness, depression, and social activity after determination of legal blindness

In 84 blind clients, incidence of depression was 6% (5 subjects), and symptoms changed markedly as a function of time since determination of legal blindness. Self-reports of feelings of loneliness were evident in 20% (17 subjects). Report of loneliness was correlated with social inactivity. Depression and loneliness were unrelated to gender, marital or cognitive status, diagnostic category, or type of onset (sudden or progressive). Situational reactions were common after determination of blindness, but presence of vegetative signs of depression seemed atypical. Since affective disorders are associated with failure to return to prior social activities and cannot be predicted by commonly used patients' characteristics, the health care team should be prepared to identify, monitor, and manage affective symptoms in patients with significant visual loss.

Social support needs in adjustment to stroke

Persons experiencing recent onset of stroke show wide variation in their adjustment process. This study evaluates how much these individual differences are a function of interpersonal needs for social contact after the rehabilitation process. Subjective needs for social relations are measured and compared with adjustment to stroke. Variation in the expression of and desire for social support appears to be related to outcome of rehabilitation and adjustment to chronic physical limitations.

Characterization of B-cell type chronic lymphocytic leukemia cells by surface markers and a monoclonal antibody

This study was carried out to determine the reactivity of the Leu-1 mouse monoclonal antibody with B-chronic lymphocytic leukemia and other B-cell leukemias. This antibody has been previously reported to recognize a surface antigen expressed by almost all human thymocytes and peripheral T cells. It was also detected on surface immunoglobulin-bearing cells of most patients with chronic lymphocytic leukemia but was not detectable in normal B-cells and B-cell lines. In the present series, the neoplastic lymphocytes in 33 cases of B-chronic lymphocytic leukemia expressed surface immunoglobulin, Ia antigen, and receptors for Fc, C3, and mouse erythrocytes. All but one case expressed the Leu-1 antigen as detected by indirect immunofluorescence using flow cytometry. In three other cases, the leukemic cells in the peripheral blood reacted with anti-Leu-1, whereas the bone marrow lymphocytes did not. Moreover, quantitative differences in the surface density of Leu-1 were apparent by flow cytometry. The peripheral blood and bone marrow lymphocytes in other B-cell leukemias, including 15 cases of leukemic B-cell lymphomas and three cases of hairy-cell leukemia, failed to stain positively with the anti-Leu-1 antibody. The recognition of the Leu-1 antigen adds to the phenotypic characterization of b-chronic lymphocytic leukemia and may contribute to a better understanding of the pathogenesis of the disease and its expression in different tissues.

Dissection of immunoregulatory subpopulations of T lymphocytes within the helper and suppressor sublineages in man

The helper/inducer (Leu-3) and suppressor/cytotoxic (Leu-2) sublineages of human peripheral blood T cells can both the subdivided into functionally distinct subsets with anti-Leu-8, a new monoclonal antibody that identifies 75 +/- 10% of the Leu-3 cells and 60 +/- 10% of the Leu-2 cells. Using the autologous MLR as a T cell-dependent stimulus for immunoglobulin synthesis, we have shown that the major helper effect for antibody formation lies within the numerically minor Leu-3,8- subset. In addition, neither Leu-2,8- cells alone suppress Leu-3-induced immunoglobulin synthesis, but in combination these subsets are markedly inhibitory. These results indicate that at least two phenotypically distinct cell types of suppressor lineage interact to produce suppression of an immune response in man.

Dissection of immunoregulatory subpopulations of T lymphocytes within the helper and suppressor sublineages in man

The helper/inducer (Leu-3) and suppressor/cytotoxic (Leu-2) sublineages of human peripheral blood T cells can both the subdivided into functionally distinct subsets with anti-Leu-8, a new monoclonal antibody that identifies 75 +/- 10% of the Leu-3 cells and 60 +/- 10% of the Leu-2 cells. Using the autologous MLR as a T cell-dependent stimulus for immunoglobulin synthesis, we have shown that the major helper effect for antibody formation lies within the numerically minor Leu-3,8- subset. In addition, neither Leu-2,8- cells alone suppress Leu-3-induced immunoglobulin synthesis, but in combination these subsets are markedly inhibitory. These results indicate that at least two phenotypically distinct cell types of suppressor lineage interact to produce suppression of an immune response in man.

Analysis of T-cell differentiation antigens in acute lymphatic leukemia using monoclonal antibodies

Leukemic cells in 134 patients with ALL were analyzed by a panel of mouse monoclonal antibodies. Two antibodies are reactive with all peripheral blood T cells but define different surface antigens (Leu-1 and Leu-4). Two other antibodies react with antigens that are restricted to suppressor/cytotoxic T cells (Leu-2) and to helper T cells (Leu-3). We also used antibodies to the receptor for sheep red blood cells (SRBC) (Leu-5) and to a human "TL-like" antigen that is found on most thymocytes but not in peripheral T cells (Leu-6). An antibody to the human p29.34 "Ia-like" molecule was also tested. Of the 134 ALL patients, 17 had a predominance of SRBC-rosetting (Leu-5+) lymphoblasts ("T" ALL), expressing different surface phenotypes defined by this panel of monoclonal antibodies. These phenotypes were not readily classifiable according to a scheme of sequential stages of normal differentiation proposed. Moreover, the lymphoblasts in 8 of 113 patients not expressing conventional B- to T-cell markers ("null" ALL) reacted with the monoclonal anti-T-cell antibodies. This study suggests that the classification of lymphoblasts in ALL based on the reactivities observed with this panel of mouse monoclonal antibodies is not easily reconciled with current models of normal T-cell differentiation. However, it should be emphasized that the precise sequence of antigenic expression by cells undergoing thymic differentiation is still not fully known, and further phenotypic analysis of ALL cells might contribute to an improved understanding of this malignancy.

Evaluation of amoxapine

The pharmacology, pharmacokinetics, clinical trials, side effects, and dosage of amoxapine are reviewed. Amoxapine is a tricyclic dibenzoxazepine antidepressant that is chemically similar to the antipsychotic agent loxapine. In animal tests, amoxapine and its metabolites block reuptake of the neurotransmitter norepinephrine, with little effect on serotonin. It is rapidly and virtually completely absorbed when administered orally; peak serum concentrations occur one to two hours after ingestion. Amoxapine is widely distributed throughout body tissues and is 90% bound to serum proteins. Aromatic hydroxylation in the liver produces two major metabolites, which are excreted in the urine primarily but also in the feces. Amoxapine's elimination half-life is eight hours; one of the metabolites has a long half-life (30 hours). In clinical trials, amoxapine has been compared with amitriptyline and imipramine in several types of depressed patients. In some studies, amoxapine's therapeutic effects were measurable earlier (at one or two weeks after initiation of therapy) than those of the amitriptyline or imipramine, but generally only a portion of the depression-rating scales yielded statistically significant differences. Side effects noted during amoxapine therapy include hypotension (42%), drowsiness (14%), xerostomia (14%), constipation (12%), blurred vision (7%), fatigue (5%), and vertigo (5%). Amoxapine is approved by FDA for use in patients with neurotic or reactive depressive disorders, endogenous or psychotic depression, and depression accompanied by anxiety or agitation. The usual adult dosage is 200-300 mg daily, either in divided doses or a single bedtime dose. Amoxapine is a safe and effective antidepressant with no striking advantages over other available agents.

Treatment of social isolation and loneliness in a sample of visually impaired elderly persons

An experimental study was conducted to evaluate the effectiveness of an outreach program for 84 isolated elderly persons who had been legally blind for many years. Visual impairment and restriction of environment is reported to contribute to varying degrees of loneliness, depression, and social isolation. Group therapy by telephone was provided to a sample of 42 elderly blind veterans to provide a format for problem solving and treatment for affective disorder related to isolation. Significant decreases in loneliness and increase in activity level were attributed to therapeutic intervention by telephone.