Effect of polymorphism of the HLA-DPA1 chain on presentation of antigenic peptides

Human T-cell clones that recognize a peptide from mycobacterial heat shock protein 60 in the context of HLA-DP were found to be sensitive to changes in the DPA1 chain of the restricting element, optimal responses being seen with the combination HLA-DPA1*0201 and HLA-DPB*0301. HLA-DP dimers containing HLA-DPA1*01 were only able to present antigenic peptides to T-cell clones when peptides were present throughout the period of coculture of T cells with antigen presenting cells. In contrast the optimal HLA-DP dimer could also stimulate T-cell clones maximally when incubated with peptides for 1 h and then thoroughly washed. This suggests that the DPA1 polymorphism influenced the strength of binding of antigenic peptides to the HLA-DP dimer. Modeling studies identified amino acid 31 of DPA1 as the polymorphic residue most likely to account for this effect. This is the first demonstration that the relatively limited polymorphism displayed by DPA1 has functional consequences.

Subjective, laryngoscopic, and acoustic measurements of laryngeal reflux before and after treatment with omeprazole

Laryngeal manifestation of gastroesophageal reflux is felt to be prevalent in our society. In general, diagnosis has been based primarily on symptoms. Historically, additional testing included laryngoscopy, barium swallow, manometry, and more recently, single- and double-probe pH monitoring. We evaluated 68 patients who were symptomatically suggestive of having reflux laryngitis. We administered surveys grading their symptoms. All patients underwent standardized videolaryngostroboscopic evaluation and computerized acoustic analysis. Patients then underwent a uniform therapy of dietary restrictions and omeprazole, a hydrogen ion inhibitor, for 12 weeks. Patients were then retested. This regimen demonstrated an 85% success of relieving symptoms. Utilizing the new laryngoscopic grading system, improvement was found to be statistically significant in improvement of all findings except granulomas. In patients with the pretherapy complaint of hoarseness, acoustic measures of jitter, shimmer, habitual frequency, and frequency range all showed significant improvement. The authors conclude that in patients with symptomatic reflux laryngitis, standardized videolaryngoscopy and, if hoarse, acoustic analysis are useful exam techniques to aide diagnosis and monitor therapy. Anti-reflux therapy with omeprazole is effective and improvement can be objectively demonstrated with the techniques described.

Recurrent self-injurious behavior in forensic patients

A high prevalence of self-injurious behavior has been reported in the forensic psychiatric population and the correctional psychiatric population. Severely and recurrently self-destructive patients pose great therapeutic challenges. The present study examined forensic patients who engaged in multiple acts of self-injury while hospitalized and compared them to forensic patients who engaged in a single act of self-injury. The groups did not differ on demographic or diagnostic measures, but the recurringly self-injurious patients were more frequently and more severely aggressive against others (verbally as well as physically), and required longer hospitalization. The results are interpreted to suggest that the high cost of recurring self-injury in human and financial terms may be reduced by a strategy of early and vigorous intervention.

The influence of the spine on the shoulder in the throwing athlete

Analysis of shoulder dysfunction in throwing and overhead athletes can no longer be restricted to evaluation of the glenohumeral joint alone. The isolated shoulder is incapable of generating the force necessary to hurl a baseball at velocities of 90-100 miles per hour or serve a tennis ball in excess of 120 miles per hour. The purpose of this paper is to provide a literature based theoretical framework for the role of the spine during these activities. The spine is a pivotal component of the kinematic chain which functions as a transfer link between the lower and upper limbs, a force generator capable of accelerating the arm, and a force attenuator which dampens shear forces at the glenohumeral joint during the deceleration phase of the pitching motion. Side bending and rotation of the cervical spine facilitates visual acquisition of the intended target. Inflexibility of the hip musculature and weakness of the muscles which attach to the thoracolumbar fascia have profound effects upon spine function which secondarily places greater stress upon the glenohumeral joint and rotator cuff. Shoulder rehabilitation and injury prevention programs should include evaluation of and exercise regimens for the lumbar, thoracic and cervical spine.

Evidence for the elaboration of multiple axons by developing dentate granule cells

A sample of 185 Neurobiotin-filled dentate granule cells has been collected from rats aged P14 to P120 in a study of the effects of serotonin (5-hydroxytryptamine, 5-HT) depletion on granule cell development. A small number (5.9%) of these neurons exhibit more than one axon. These neurons have morphologies consistent with that described for dentate granule cells. One axon typically arises from the soma while additional axons take origin from either dendrites or the soma. Both axons may be mossy fibers or one axon may be a mossy fiber and the second assume a morphology and distribution similar to that described for interneurons. These latter neurons therefore exhibit a mixed phenotype by having a granule cell morphology and an interneuronal axon type. These data suggest that some granule cells give rise to multiple mossy fibers or express a mixed axonal phenotype during maturation.

In vitro proliferative responses of human peripheral blood mononuclear cells to non-recall antigens

Primary in vitro proliferative responses of naive T cells to antigens other than superantigens and alloantigens have been little studied. Two tissue culture techniques have been reported which support in vitro antigen priming of T cells. These methods require various degrees of cellular manipulation and culture vessels other than standard microtitre plates. We report here that primary proliferative responses to non-recall antigens can be readily obtained using unselected human PBMC prepared from either adult or cord blood. Cells proliferate whether cultured in 2 ml volumes, 200 microliters microcultures or 20 microliters hanging drops. The variation in the proliferative responses increases as the culture volume is decreased such that considerable errors are apparent when Terasaki culture plates are used. The lowest stimulation indices are also observed in the 20 microliters microcultures. Nevertheless, similar response patterns are noted for the differing culture vessels; generally, proliferative responses reach peak magnitude only after 7 days of culture. The initial concentration of PBMC in culture influences the magnitude of the reactions such that halving the cell numbers frequently leads to greater than 50% reduction in the measured responses. The results of this study indicate that neither a specialised culture vessel nor complex cellular manipulation are required for in vitro priming of T cell immunity. Consequently, this area of immunology should be readily amenable to further study.

A national quality improvement effort: cancer registry data

Cancer registries are sources of epidemiological, patterns-of-care, and outcome data for local, regional, state, and national studies of patients with cancer. Since 1976, these registries have formed a voluntary network of contributors to annual patient care studies under the aegis of the National Cancer Data Committee of the Commission on Cancer. These annual studies provide timely clinical information that is widely disseminated to physicians, allied health personnel, administrators, health care planners, and public and private agencies. The use of the data has grown exponentially and has been the basis for more than 90 publications. Merging this activity with the National Cancer Data Base has further expanded the demand and use of registry data. This study was undertaken to respond to inquiries as to the validity of the data and the qualifications and competency of cancer registrars. It provides the baseline for cancer registry data quality and serves as a quality management tool to identify opportunities to enhance data quality.

Cancer. Introduction

This supplement presents the study of various histologic types of cancers diagnosed in the populations covered by the Surveillance, Epidemiology, and End Results (SEER) Program. It describes the SEER program and the coding of histologic type by the International Classification of Diseases for Oncology. Each of the 19 articles deals with the histologic types of cancer found in major sites or with specific histologic types, such as lymphomas or melanomas. Histologic types have been grouped based on those developed by Dr. John Berg. Data presented in this supplement are based on more than one million microscopically proven invasive cancers and 98,000 in situ cancers diagnosed during the period 1973-1987 in areas covered by the SEER Program.

Overload injuries in the lower extremity in runners

This article will discuss some of the common overload injuries that occur in runners. An approach to accurate diagnosis will be described in terms of tissue injuries, clinical symptoms, specific tissues overloaded, functional biomechanical deficits, and functional adaptations that occur. With this background, specific principles of rehabilitation of these disorders will be described.

Childhood cancer

BACKGROUND

Cancers of individual organs generally are composed of various histologic types, each with its own frequency and demographic patterns. For childhood cancers in particular, a classification of cancers by histologic type is important for understanding the etiology and progression of the disease.

METHODS

Data from the Surveillance, Epidemiology, and End Results (SEER) Program on 9308 microscopically confirmed malignant neoplasms in children younger than age 15, newly diagnosed during 1973-1987, were made available for analysis. Tumors were grouped histologically according to a classification previously utilized in an international volume of childhood cancer incidence.

RESULTS

The most frequent histologic types were acute lymphocytic leukemia (23.6%), astrocytoma (9.6%), neuroblastoma (6.6%), and Wilms' tumor (6.4%). Acute lymphocytic leukemia accounted for 75% of childhood leukemia. The most common form of Hodgkin's disease was the nodular sclerosing subtype, which was diagnosed in 56% of all cases. Burkitt's and Burkitt-like disease accounted for approximately one third of non-Hodgkin's lymphoma, the sex ratio (male to female) being unusually high (5.7). Among the brain tumors, glioma was of interest because 198 cases (excluded from this analysis) were diagnosed without histologic confirmation--due, no doubt, to their inaccessibility for biopsy because they were located in the brain stem. The most common histologic type of soft tissue sarcoma was rhabdomyosarcoma, which accounted for 51% of the total, more than half of which were of the embryonal type. To the authors' knowledge, this report offers for the first time the relative frequencies of rare types of leukemias, such as megakaryoblastic leukemia, in childhood. This report also includes the frequencies of 21 rarer forms of soft tissue sarcoma. Five forms of childhood cancer had a 5-year relative survival rate of 85% or better. Of the cancers with the poorest outcome, three had relative survival rates of 46.5-49%; the relative survival rate of acute myelogenous leukemia was only 26.4%. The trends in survival over time for 21 types of childhood cancer also are included in this report.

CONCLUSIONS

Further refinements in classification now are available through laboratory techniques utilizing molecular biology, immunology, and cytogenetics, which are of importance in etiologic studies, diagnosis, treatment, and prognosis. It would be important in the future for cancer registries to record the results of relevant laboratory tests for further analysis by subtype.

Athletic performance - must it decline with age?

Many individuals continue to exercise train and experience athletic success well into the eighth and ninth decades of their lives. This paper examines the interaction between aging and athletic performance with specific reference to how regular exercise training attenuates the decrements in performance typically attributed to the aging process. The importance of rehabilitation of musculoskeletal injuries to facilitate continued participation in athletics is also addressed.

Thigh injuries in athletes

The thigh, which consists of the heavily muscled region around the femur, is vulnerable to many types of athletic injury. This review addresses the assessment, prevention, and rehabilitation of both the common thigh injuries associated with participation in sports, such as contusions and myositis ossificans traumatica, and a few relatively uncommon but diagnostically important entities that sports physicians must recognize when an athlete has pain or dysfunction attributable to the thigh. Dividing the thigh into anatomic compartments aids in both differential diagnosis and understanding of the pathomechanics that lead to injury. Rehabilitation is especially emphasized because improper selection of modalities or misuse of exercise can seriously impede or worsen recovery. Conversely, the use of appropriate rehabilitation principles and new concepts in exercise prescription can decrease morbidity and lead to rapid resumption of sports.

Characterization of autoreactive helper T cells in a murine model of autoimmune haemolytic disease

Repeated immunization of mice with rat red blood cells (RRBC) results in the production of both erythrocyte autoantibodies and anti-RRBC antibodies. The manner in which erythrocyte self-tolerance is broken has been little studied. It has been assumed that help for autoreactive B cells is provided by Th cells specific for the foreign RRBC. We show here that autoreactive Th cells can be recovered from RRBC-immunized mice. The Th cells proliferate in vitro whether stimulated by self or rat erythrocytes. Analysis of the specificity of the proliferating cells revealed extensive cross-reactivity for the two types of erythrocytes. It is therefore surprising that, in initial cultures, a slower response is evident when mouse erythrocytes are used as the antigen. From cytotoxic depletion of T-cell subsets, the phenotype of the proliferating cells was identified as Thy-1.2+, Lyt-1.1+, Lyt-2.1-, L3T4+. During in vitro stimulation of the T cells, growth factors characteristic of Th cells are secreted. Finally, we demonstrate that the responding T cells are able to help primary in vitro antibody responses to self and rat erythrocytes. We conclude that autoreactive Th cells are likely to be involved in the experimental induction of autoimmune haemolytic disease in mice.

Memory and the lifespan of human T lymphocytes

The properties of human CD45RA and CD45R0 T cells are described. CD45R0 cells respond to recall antigens and provide help for B lymphocytes. They produce a wide variety of cytokines including IL-2, IL-4 and IFN-gamma. CD45RA T cells respond poorly to recall antigens and produce mainly IL-2. The phenotype of CD45R0 cells suggests that they may be in cycle and in vivo data shows that they have a short lifespan while CD45RA cells are long lived. The lineage relationship of the two subsets is not clear but in vivo and in vitro evidence suggests bidirectional conversion between CD45RA and CD45R0 phenotypes.

Urinary glycosaminoglycan excretion as a laboratory marker in the diagnosis of interstitial cystitis

Urinary macromolecular uronate and glycosaminoglycan uronate concentrations were determined in 209 urine specimens obtained from 192 interstitial cystitis patients, 47 asymptomatic normal individuals and 32 spinal cord injury patients. As a group the concentration of macromolecular uronate or glycosaminoglycan uronate was significantly less in the interstitial cystitis patients than in the normal controls. Some interstitial cystitis patients showed low values of macromolecular uronate and glycosaminoglycan uronate. Analysis of the population distributions suggested that macromolecular uronate may have significant value in diagnosis of interstitial cystitis.

Molecular comparison of the negative-acting nitrogen control gene, nmr, in Neurospora crassa and other Neurospora and fungal species

In Neurospora crassa, the expression of unlinked structural genes which encode nitrogen catabolic enzymes is subject to genetic and metabolic regulation. The negative-acting nmr regulatory gene appears to play a role in nitrogen catabolite repression. Using the N. crassa nmr gene as a probe, homologous sequences were identified in a variety of other filamentous fungi. The polymerase chain reaction was used to isolate the nmr-like gene from the exotic Mauriceville strain of N. crassa and from the two related species, N. intermedia and N. sitophila. Sequence comparisons were carried out with a 1.7-kb DNA segment which includes the entire coding region of nmr plus 5' and 3' noncoding sequences. The size of the nmr coding region was identical in all three Neurospora species. Approximately 30 nucleotide base substitutions were found in the coding region of the nmr gene of each of the sister species when compared to the standard N. crassa sequence. However, most of the base changes occurred in third codon positions and were silent. The NMR proteins of N. sitophila and of N. intermedia display only three and four amino acid substitutions, respectively, from the N. crassa protein. Two regions of high variability, which include deletions and insertions of bases, were found in the 5' and 3' noncoding regions of the gene.

Oxygen transport and peripheral microcirculation in long-term diabetes

The purpose of this investigation was to evaluate the impact of long-term diabetes on muscle blood flow (MBF) and oxygen transport (vO2) during exercise. Twelve male patients (58 +/- 8 years, mean +/- SD), with at least a 10-year history of diabetes controlled by insulin, and seven age-matched controls (56 +/- 5 years, mean +/- SD) participated in this study. No patient had been clinically diagnosed as having peripheral vascular disease, and on the average resting ankle/arm systolic blood pressure ratios were normal. Following a baseline period, 5 min of cycle ergometer exercises at 75 W were performed in the upright position and, after 1-hr recovery, in the supine position. Continuous vO2 was determined via breath-by-breath analysis. MBF was measured in the vastus lateralis (VL) and tibialis anterior (TA) by 133Xe clearance. In the erect position, the diabetic group (compared with the control group, respectively) exhibited significantly (P less than 0.05) lower exercise MBF [ml. (100 g.min)-1] in both VL (19 +/- 2.5 vs 30.9 +/- 2) and TA (13.7 +/- 2 vs 22.0 +/- 4), a lower steady-state VO2 (1.3 +/- 0.3 vs 1.7 +/- 0.2 liters.min-1) during exercise including the values in the last 15 sec of exercise, and greater accumulation of blood lactate (35 +/- 2 vs 22.0 +/- 2 mg/100 ml). The same trends in the data were observed during supine exercise; however, the blood pressure of the diabetics was significantly elevated during exercise when compared with that of controls. The reduced exercise MBF in the TA and VL demonstrated that impaired microvascular flow, without clinically overt peripheral vascular disease, in long-term diabetics leads to reduced oxygen delivery and exercise tolerance.

Induction of callus from axillary buds of taro (Colocasia esculenta var. esculenta, Araceae) and subsequent plantlet regeneration

Axillary buds of taro (Colocasia esculenta var. esculenta, Araceae) cultured on half strength Murashige-Skoog medium (HMS) containing taro extract (HMSTE) and 2, 4, 5-trichlorophenoxyacetic acid produce a compact, hard, slow growing callus which is not very active morphogenetically and produces only a few plantlets. When cultured on HMSTE plus 5 mg 1(-1) each of naphthaleneacetic acid and benzyl adenine (HMSNB) the buds produce a fast growing, friable and morphogenetically active callus. Meristematic regions form on the friable callus after 30 days on HMSNB. If transferred to HMSTE at this point the callus gives rise to plantlets. Addition of taro extract to the media is required for the culture of buds, induction of callus and plantlet regeneration.