A model of human immunodeficiency virus encephalitis in scid mice

Human immunodeficiency virus (HIV)-associated dementia complex is a common and devastating manifestation of the late phases of HIV infection. The pathogenesis of dementia complex is poorly understood and effective treatments have not been developed, in part because of the lack of an appropriate animal model. Mice with severe combined immunodeficiency (scid mice), which accept xenografts without rejection, were intracerebrally inoculated with human peripheral blood mononuclear cells and HIV. One to 4 weeks after inoculation, the brains of these mice contained human macrophages (some of which were HIV p24 antigen positive), occasional multinucleated cells, and striking gliosis by immunocytochemical staining. Human macrophages also were frequently positive for tumor necrosis factor type alpha and occasionally for interleukin 1 and VLA-4. Cultures of these brains for HIV were positive. Generally, human macrophages were not present in the brains of control mice, nor was significant gliosis, and HIV was not recovered from mice that received HIV only intracerebrally. Pathologically, this model of HIV encephalitis in scid mice resembles HIV encephalitis in humans and the data suggest that the activation of macrophages by infection with HIV results in their accumulation and persistence in brain and in the development of gliosis. This model of HIV encephalitis should provide insights into the pathogenesis and treatment of this disorder.

Cerebral white matter changes in acquired immunodeficiency syndrome dementia: alterations of the blood-brain barrier

The cause of acquired immunodeficiency syndrome (AIDS) dementia, which is a frequent late manifestation of human immunodeficiency virus (HIV) infection, is unknown but radiological and pathological studies have implicated alterations in subcortical white matter. To investigate the pathological basis of these white matter abnormalities, we performed an immunocytochemical and histological analysis of subcortical white matter from AIDS patients with and without dementia, from pre-AIDS patients (asymptomatic HIV-seropositive patients), and from HIV-seronegative control subjects. Reduced intensity of Luxol fast blue staining, designated "diffuse myelin pallor," was detected in 8 of 15 AIDS dementia patients, 3 of 13 AIDS nondemented patients, and none of the pre-AIDS patients (n = 2) or control subjects (n = 9). In contrast to Luxol fast blue staining, sections stained immunocytochemically for myelin proteins did not show decreased staining intensities in regions of diffuse myelin pallor. In addition, neither demyelinated axons nor active demyelination were detected in light and electron micrographs of subcortical white matter from brains of patients with AIDS dementia. An increase in the number of perivascular macrophages and hypertrophy of astrocytes and microglia occurred in brain sections from HIV-infected patients. These changes were not specific to dementia or regions of diffuse myelin pallor and they occurred in both gray and white matter. In contrast to the lack of myelin pathology in AIDS dementia brains, significant accumulations of serum proteins in white matter glia were detected in the brains of 12 of 12 patients with AIDS dementia and 6 of 12 AIDS patients without dementia. Serum protein-immunopositive cortical neurons were detected in the frontal cortex of 11 of 12 patients with AIDS dementia and 3 of 12 nondemented AIDS patients. Seronegative control subjects showed minimal serum protein immunoreactivity in both cortex and white matter. We conclude therefore that alterations in the blood-brain barrier and not demyelination contribute to the development of AIDS dementia.

Intracerebral cytokine messenger RNA expression in acquired immunodeficiency syndrome dementia

The pathogenesis of the dementia associated with human immunodeficiency virus (HIV) infection is unclear, but has been postulated to be due to indirect effects of HIV infection including the local production of cytokines. To determine which cytokines are produced in the nervous system and to identify any correlations with dementia, cytokine and HIV messenger RNA expression was analyzed by reverse transcriptase-polymerase chain reaction in the brains from 24 HIV-infected patients with and without dementia and 9 HIV-uninfected control subjects. Levels of tumor necrosis factor-alpha messenger RNA were significantly higher and levels of interleukin (IL)-4 messenger RNA were significantly lower in demented compared to nondemented HIV-infected patients. Demented patients also had lower IL-1 beta levels than did nondemented patients. No significant differences were detected in the amounts of leukemia inhibitory factor, IL-6, transforming growth factor-beta 1 and -beta 2, monokine induced by gamma interferon-2 (MIG-2), or interferon-gamma messenger RNAs. IL-10 and IL-2 messenger RNAs were undetectable in all brains examined. Cytokine messenger RNA levels in nondemented HIV-positive patients were similar to those in HIV-negative control subjects. HIV transcripts were more abundant in subcortical white matter than in the basal ganglia, cortex, or deep white matter. Our findings suggest a possible role for tumor necrosis factor-alpha in the development of neurological dysfunction. Increased levels of tumor necrosis factor-alpha messenger RNA were not associated with increased levels of IL-1 beta messenger RNA, suggesting differential regulation of these monokines in acquired immunodeficiency syndrome dementia.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term psychosocial sequelae of chronic physical disorders in childhood

OBJECTIVE

This study was designed to examine the long-term psychosocial sequelae of chronic physical disorders that begin during childhood.

DESIGN

We analyzed data from a national birth cohort. 12,537 children were followed until age 23 years--76% of all born in Britain during one week in 1958. Of these, 1667 had a chronic disorder before age 16 and 1279 were included in the 23-year follow-up.

MEASURES

Outcome measures included self-reported psychological disturbances between ages 16 and 23, scores on the Malaise Inventory, social class, educational qualifications, unemployment, and social activities.

RESULTS

The total cumulative incidence rate before 16 years was 109.5 per 1000. Demographic comparisons showed that the group with chronic physical disorders was similar to those free of chronic disorders in all respects except the sex ratio. Men with chronic physical disorders had significantly higher relative risks for abnormal scores on the Malaise Inventory (1.52, confidence interval [CI] 1.13, 2.05); specialist psychological care (1.43, CI 1.00, 2.03); poor educational qualifications (1.26, CI 1.08, 1.47); periods of unemployment (1.20, CI 1.03, 1.41); and less social drinking (1.36, CI 1.15, 1.60). In contrast, women only had a significantly elevated risk for having seen a mental health specialist (1.32, CI 1.02, 1.71). Among the men some of the risks were further elevated for those in specific diagnostic groups. These findings are examined in the light of postulates about the impact of chronic physical disorders as a whole and in an attempt to explain the striking sex differences. For clinicians they provide further reason to justify concern about the psychosocial aspects of care for children with chronic disorders.

Explaining social class differences in psychological health among young adults: a longitudinal perspective

The relationship between psychological health and occupational class was investigated in the large British sample of 23-year-old subjects from the 1958 birth cohort study. Odds of poor psychological health indicated by (1) the Malaise Inventory and (2) seeking help for a psychological problem between ages 16 and 23] were significantly greater in classes IV and V than in classes I and II: odds ratios were (1) 3.90 and 5.84, (2) 2.32 and 2.33 for men and women, respectively. Explanations for these differences were examined using longitudinal data representing 'inheritance' at birth, socio-economic background, educational achievement, earlier health and behaviour. The analyses suggested that each of these contributes to class differences in psychological health. Behaviour at age 16 (identified from the Rutter Behaviour Scale) was particularly notable for both psychological measures, as were educational achievement (for Malaise) and unemployment (for psychological morbidity needing specialist help). Mechanisms by which such factors might operate are discussed. Having accounted for earlier circumstances, class differences were no longer significant, except for Malaise in women. In this case an odds ratio of more than twofold remained after adjusting for earlier circumstances.

T-cell dominated inflammatory reactions in the bronchi of asthmatics are not reflected in matched bronchoalveolar lavage specimens

Samples of bronchoalveolar lavage (BAL) and endobronchial biopsies were obtained from five patients with clinically diagnosed asthma (ATS criteria). A comparison was made of the presence and distribution of immunocompetent lymphocytes and macrophages within each sample. Significantly raised numbers of T lymphocytes, CD45RO+ lymphocytes, RFD1+ macrophage-like cells and RFD7+ macrophages were seen in the bronchial biopsies. In contrast four out of five of the BAL specimens showed a normal differential cell count, the one exception being a patient exhibiting a degree of lymphocytosis. Further, immunocytological investigation demonstrated a normal distribution of T-cell subsets and macrophage subsets in asthmatic BAL with the exception that in four out of five of these patients a raised number of macrophage-like cells exhibiting phenotypic markers of monocytes was observed. Correlation between BAL and biopsy data was seen in the number of CD45RO+ T-cells present. No other parameters exhibited a significant correlation. Raised expression of HLA-DR was recorded in all asthmatic biopsies, yet lavage cells from the same patients failed to exhibit any increase of HLA-DR density over normal. It is concluded that the immune-associated inflammation present in endobronchial biopsies of clinically stable asthmatics is not reflected in bronchoalveolar lavage samples taken from the same patients.

T-cell dominated inflammatory reactions in the bronchi of asthmatics are not reflected in matched bronchoalveolar lavage specimens

Samples of bronchoalveolar lavage (BAL) and endobronchial biopsies were obtained from five patients with clinically diagnosed asthma (ATS criteria). A comparison was made of the presence and distribution of immunocompetent lymphocytes and macrophages within each sample. Significantly raised numbers of T lymphocytes, CD45RO+ lymphocytes, RFD1+ macrophage-like cells and RFD7+ macrophages were seen in the bronchial biopsies. In contrast four out of five of the BAL specimens showed a normal differential cell count, the one exception being a patient exhibiting a degree of lymphocytosis. Further, immunocytological investigation demonstrated a normal distribution of T-cell subsets and macrophage subsets in asthmatic BAL with the exception that in four out of five of these patients a raised number of macrophage-like cells exhibiting phenotypic markers of monocytes was observed. Correlation between BAL and biopsy data was seen in the number of CD45RO+ T-cells present. No other parameters exhibited a significant correlation. Raised expression of HLA-DR was recorded in all asthmatic biopsies, yet lavage cells from the same patients failed to exhibit any increase of HLA-DR density over normal. It is concluded that the immune-associated inflammation present in endobronchial biopsies of clinically stable asthmatics is not reflected in bronchoalveolar lavage samples taken from the same patients.

A review of child health in the 1958 birth cohort: National Child Development Study

In the week 3-9 March 1958, 98% of all births in England, Scotland and Wales (approximately 17,000) were studied in the Perinatal Mortality Survey. The follow-up of surviving children, known as the National Child Development Study, comprises four major sweeps at ages 7, 11, 16 and 23. Medical examinations were conducted at each age, except at 23 when health was self-reported. Details of the child's family background and socio-economic circumstances were recorded, together with assessments of their social development and educational attainment. Seventy-six per cent of the target population were interviewed at age 23. The health of subjects in the 1958 cohort has been described in over 200 publications but there is no comprehensive account of findings from birth to age 23. This overview attempts to redress this. As new data are gathered from the study subjects at age 33, opportunities will exist to investigate associations between childhood factors and health in midlife. Data on their partners and children will be included, allowing studies of inter-generational and family health. Further indications of changing illness patterns will be possible from comparisons with data collected on earlier and later born cohorts.

Secular trends in social class and sex differences in adult height

Trends in social class and sex differences in adult mean height in Great Britain since the turn of the century were investigated using data from parents and offspring in the 1946 and 1958 British birth cohort studies (n = 50,000). There has been an increase of 1.09 cm per decade in the mean height of men but only 0.36 cm per decade in the mean height of women. On average men from non-manual origins were 1.97 cm taller than men from manual origins and the figure for women was 1.61 cm. Trends in class differences in height for those born between the beginning of the century and 1958 have been small; fluctuations have occurred over the period but were unsynchronized for men and women.

T cell dominated inflammatory reactions in the bronchioles of asymptomatic asthmatics are also present in the nasal mucosa

Endobronchial and nasal mucosa biopsies were obtained from 5 patients with clinically-stable, diagnosed asthma (ATS criteria). A comparison was made of the presence and distribution of immunocompetent lymphocytes and macrophages within each sample. The distribution of immunocompetent cells within the nasal biopsies of the asthmatic patients reflected a very similar inflammatory infiltrate to that seen in the bronchial biopsies. Significantly raised numbers of T lymphocytes, CD45RO + lymphocytes, RFD1 + macrophage-like cells and RFD7 + macrophages were seen in both the nasal mucosa and the bronchial biopsies. Increases in HLA-DR expression were also seen in the nasal mucosa biopsies from asthmatics although the increases over normal did not reach statistical significance. It is concluded that inflammation present in the nasal mucosa of asymptomatic asthmatics exhibits cellular characteristics also seen in endobronchial biopsies. This observation offers the possibility that mucosal biopsy may be an alternative and less invasive approach for studying the cells involved in the bronchial inflammatory reaction that possibly predisposes asthmatics to bronchial hyper-responsiveness.

Pathological and molecular biological features of a myelopathy associated with HTLV-1 infection

We report the pathological and molecular biological findings of human T-cell lymphotropic virus type 1 (HTLV-1) infection of the spinal cord in a patient with a chronic progressive myelopathy. Light microscopy disclosed loss of myelin and axons, thickening of blood vessels and a lymphocytic cell infiltrate in the spinal cord especially at the cervical and thoracic levels. Electron microscopy confirmed the vascular appearance seen with light microscopy but virus particles were not observed. The HTLV-1 gag gene could be amplified (by polymerase chain reaction) from cervical spinal cord tissue while not from elsewhere in the neuroaxis. The presence of HTLV-1 genomic material in spinal cord tissue has not been previously reported.

Structural and functional studies of the endothelial activation antigen endothelial leucocyte adhesion molecule-1 using a panel of monoclonal antibodies

We have produced a panel of mAb to the endothelial activation Ag endothelial leucocyte adhesion molecule-1 (ELAM-1), using both a conventional immunization protocol and one involving immunosuppression. By constructing ELAM-1 mutants we have demonstrated that seven of these antibodies recognize epitopes within the lectin domain of ELAM-1 and that one binds within the complement regulatory protein domains. These studies also suggest that the EGF-like domain is important in maintaining the conformation of the neighbouring lectin domain. In functional studies, U937 cells bound to Cos cells expressing either ELAM-1 or ELAM-1 with the complement regulatory protein domains deleted. No adhesion was observed to Cos cells expressing ELAM-1 mutants lacking either the lectin or EGF-like domains. The fact that antibodies directed against the lectin domain can inhibit adhesion suggest that this domain is directly involved in cell binding.

Structural and functional studies of the endothelial activation antigen endothelial leucocyte adhesion molecule-1 using a panel of monoclonal antibodies

We have produced a panel of mAb to the endothelial activation Ag endothelial leucocyte adhesion molecule-1 (ELAM-1), using both a conventional immunization protocol and one involving immunosuppression. By constructing ELAM-1 mutants we have demonstrated that seven of these antibodies recognize epitopes within the lectin domain of ELAM-1 and that one binds within the complement regulatory protein domains. These studies also suggest that the EGF-like domain is important in maintaining the conformation of the neighbouring lectin domain. In functional studies, U937 cells bound to Cos cells expressing either ELAM-1 or ELAM-1 with the complement regulatory protein domains deleted. No adhesion was observed to Cos cells expressing ELAM-1 mutants lacking either the lectin or EGF-like domains. The fact that antibodies directed against the lectin domain can inhibit adhesion suggest that this domain is directly involved in cell binding.

Parent-adolescent conflict and adolescent injuries

Several studies have linked cumulative measures of stress to injuries, however none have examined the relationship between a prevalent stressor in adolescence, conflict between the parent and adolescent, and injuries. Data for this study came from 8231 British adolescents born one week in 1958 who had information on injuries between ages 15 and 17 available. A conflict scale was devised by summing mothers' assessments of the frequency of arguments with their 16-year-old offspring about eight problem areas. This scale had a linear association with injury rates for both boys and girls. Adolescent boys with high levels of conflict (greater than 90th percentile on conflict scale) had 2.9 times the rate of injuries resulting in hospitalization compared with boys from low conflict families (less than 25th percentile), and 1.6 times the number of injuries resulting in outpatient care. Girls with high levels of conflict had 2.9 times the hospitalized injuries and 1.8 times the rate of less severe injuries compared with girls with low conflict. These findings suggest that conflictual parent-adolescent relationships may be an indicator of increased injuries in adolescents.

Social and economic background and class inequalities in health among young adults

This paper considers which socio-economic factors in childhood and early adulthood are most strongly associated with social class differences in health at age 23. Longitudinal data from the 1958 (NCDS) cohort were used for this purpose. By age 23 class gradients were evident for several health measures, including self-rated health, 'malaise', psychological morbidity and height. The contribution of earlier socio-economic background was established by assessing how far class differences in the health indicators were reduced by controlling for earlier circumstances. While class differentials were not eliminated after taking account of earlier circumstances, substantial reductions were associated with a number of factors in childhood, in particular social class, housing tenure, crowding, family size and receipt of free school meals. More recent experiences of unemployment and family formation were also important.

Family disruption in early life and drinking in young adulthood

The relationship between family disruption early in life and subsequent drinking in young adulthood was examined in a large representative British sample. Contrary to popular belief, parental loss was not an antecedent to heavy drinking in young adults. This finding was observed within social class of origin groups and when the nature and timing of the disruption were considered separately.

Women's lung cancer mortality, socio-economic status and changing smoking patterns

Mortality data from the OPCS Longitudinal Study were used to determine whether the conventional classification of married women by their husband's occupation under-estimates the extent of social differences in lung cancer among this group. Differences existed for social class measures but alternatives based on housing tenure and car access defined socio-economic differences wider than any other previously recorded for England and Wales: married women living in rented housing and without a car were two and a half times as likely to die from lung cancer than those in owner occupied housing with access to a car. In 1957 and 1974 mothers of children included in the 1958 cohort study showed parallel socio-economic differences in smoking patterns as well as in uptake and cessation rates. Data from the General Household Survey for 1982 similarly suggest that cigarette smoking is more sharply differentiated using household rather than occupational measures of class. This suggests that wide differences in mortality are likely to persist through the eighties and beyond.

Expression of intercellular adhesion molecule 1 (ICAM-1) on human articular cartilage chondrocytes

Monoclonal antibodies have been used to demonstrate the induction of intercellular adhesion molecule 1 (ICAM-1) on chondrocytes in human articular cartilage. ICAM-1 was found not to be constitutively expressed but could be induced by exogenous interleukin 1 alpha(IL1- alpha) at concentrations ranging from 0.01 to 20 ng/ml during in vitro culture. Maximum expression was observed with 2-5ng/ml. In time-course experiments ICAM-1 was not expressed after 4h in culture with IL1 alpha. Expression was induced by 16h and was sustained for a minimum of 6 days in the continued presence of the cytokine. The endothelial leukocyte adhesion molecule (ELAM-1) was not expressed on chondrocytes and was not induced by IL1-alpha.

Cytomegalovirus and Rasmussen's encephalitis

In-situ hybridisation with a biotinylated cytomegalovirus (CMV) DNA probe was done on brain biopsy specimens from 10 patients with Rasmussen's encephalitis (RE) and 46 age-matched control patients with other neurological diseases. All 10 patients with RE had intractable epilepsy and focal neurological deficits, and there was perivascular cuffing, microglial nodules, astrogliosis, and neuronal loss. CMV genomic material was demonstrated in 7 of the 10 patients with RE (in neurons, astrocytes, oligodendrocytes, and endothelial cells) and in 2 of the 46 control patients. Probes for herpes simplex virus and hepatitis B virus were negative in all patients and in fibroblast controls. The results suggest that CMV is a likely cause of Rasmussen's encephalitis.

Encephalopathy in liver transplantation: neuropathology and CMV infection

The clinical histories and pathological findings of 27 autopsied cases of orthotopic liver transplantation (OLT) were reviewed. Fatal OLT was complicated in 93% of cases by neurological dysfunction, usually manifested by encephalopathy, with or without seizures. The etiology of the encephalopathy was largely multifactorial (44%) or undetermined (20%). Subarachnoid hemorrhage, central pontine myelinolysis, meningitis, brain infarction, polyclonal B cell lymphoma and spinal cord necrosis were common neuropathological findings. These diagnoses were often masked by other systemic illnesses. The role of cytomegalovirus (CMV) in neurologic dysfunction was explored with in situ hybridization and immunohistochemical techniques. OLT cases showed a significantly higher (89%) frequency of CMV genomic material in brain tissue compared to age-matched non immunocompromised (NIC) patients (23%). All OLT cases with encephalopathy of undetermined cause demonstrated usually prominent hybridization to the CMV probe. CMV may be an important cause of encephalopathy in such patients.

Pulmonary disease progress in sarcoid patients with and without bronchoalveolar lavage collagenase

To assess the usefulness of bronchoalveolar lavage (BAL) collagenase measurement in gauging disease severity and outcome in sarcoidosis, we analyzed BAL fluids from 84 patients with sarcoidosis for collagenase and monitored disease progress in these patients for a minimum of 12 months. Twenty patients (24%) were found to have BAL collagenase activity on initial evaluation (collagenase-positive group). Compared with patients without BAL collagenase (collagenase-negative group), the collagenase-positive group had (1) a higher proportion of BAL suppressor T cells (p less than 0.03); (2) a lower helper-suppressor T-cell ratio (p less than 0.002); (3) lower mean percent predicted FEV1, FVC, and DLCO levels (p less than 0.05); and (4) a higher proportion of patients with advanced (Stage 4) disease on chest roentgenogram (p less than 0.001). Significant differences were also observed between the collagenase-positive and collagenase-negative groups during follow-up. A higher proportion (55%, n = 11) of collagenase-positive patients required corticosteroid therapy than did collagenase-negative patients (26%; n = 17; p less than 0.025). Of those who remained untreated, pulmonary function tended to decrease in the collagenase-positive group, whereas mean pulmonary function levels actually improved in the collagenase negative group (p less than 0.05). Of those who required therapy, mean percent predicted FVC and DLCO levels improved significantly after treatment in the collagenase-negative group (p less than 0.01 and p less than 0.05, respectively), whereas an improvement in percent predicted FVC levels only (p less than 0.01) was observed in the collagenase-positive group.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between bronchial immunopathology and hyperresponsiveness in asthma

Physiological and Immunopathological parameters were investigated in 15 patients with diagnosed asthma, and 6 non-asthmatics presenting with other chest symptoms. The 15 symptom-free asthmatics expressed bronchohyperresponsiveness with a mean provocative dose producing a 20% fall in forced expiratory volume in one second (PD20FEV1) of 1 mg histamine. None of the non-asthmatics responded to 16 mg histamine. Twenty four hours later bronchoscopy was performed and endobronchial biopsies were obtained. Histological staining of frozen biopsy sections revealed a mononuclear cell infiltrate in all 15 asthmatics, while only 1 of the 6 non-asthmatics showed mild inflammation. Monoclonal antibodies were used to identify subsets of lymphocytes, activation markers, macrophages, and HLA-DR expression within the peribronchial infiltrates. In all samples, activated T-cells and macrophages were identified and HLA-DR expression was found to be raised, but the CD4: CD8 ratio was highly variable. No clear relationship was found between cellular distribution and measured lung function parameters. A highly significant correlation was found between the level of HLA-DR expression on the infiltrating cells (quantified microdensitometrically) and bronchial hyperresponsiveness. These results show for the first time that a chronic T-cell-mediated immune response is present in the bronchial tissue of asymptomatic asthmatics, and that the HLA-DR expression promoted correlates with the hyperresponsive status. These data promote the hypothesis that a T-cell-mediated response contributes to a predisposition to bronchial hyperresponsiveness in asthmatics.

The relationship between bronchial immunopathology and hyperresponsiveness in asthma

Physiological and Immunopathological parameters were investigated in 15 patients with diagnosed asthma, and 6 non-asthmatics presenting with other chest symptoms. The 15 symptom-free asthmatics expressed bronchohyperresponsiveness with a mean provocative dose producing a 20% fall in forced expiratory volume in one second (PD20FEV1) of 1 mg histamine. None of the non-asthmatics responded to 16 mg histamine. Twenty four hours later bronchoscopy was performed and endobronchial biopsies were obtained. Histological staining of frozen biopsy sections revealed a mononuclear cell infiltrate in all 15 asthmatics, while only 1 of the 6 non-asthmatics showed mild inflammation. Monoclonal antibodies were used to identify subsets of lymphocytes, activation markers, macrophages, and HLA-DR expression within the peribronchial infiltrates. In all samples, activated T-cells and macrophages were identified and HLA-DR expression was found to be raised, but the CD4: CD8 ratio was highly variable. No clear relationship was found between cellular distribution and measured lung function parameters. A highly significant correlation was found between the level of HLA-DR expression on the infiltrating cells (quantified microdensitometrically) and bronchial hyperresponsiveness. These results show for the first time that a chronic T-cell-mediated immune response is present in the bronchial tissue of asymptomatic asthmatics, and that the HLA-DR expression promoted correlates with the hyperresponsive status. These data promote the hypothesis that a T-cell-mediated response contributes to a predisposition to bronchial hyperresponsiveness in asthmatics.

Molecular cloning of CD31, a putative intercellular adhesion molecule closely related to carcinoembryonic antigen

cDNA clones encoding CD31 have been isolated by transient expression. The sequence of CD31 expressed on human umbilical vein endothelial cells (HUVEC) is identical to that expressed on the monocyte-like cell line HL60. In HUVEC. CD31 is concentrated in regions of cell-cell contacts. CD31 is a member of the Ig superfamily and is most closely related to the carcinoembryonic antigen CEA, consisting of four contiguous C2 domains. The localization of CD31 to regions of cell-cell contacts, and the sequence similarity to CEA, a known intercellular adhesion molecule (ICAM), strongly suggest that CD31 may function as an ICAM, possibly mediating endothelial cell-cell contacts and also promoting interactions between leukocytes and endothelial cells.

Employment and drinking in early adulthood: a longitudinal perspective

The relationship between drinking and employment was examined in a large, national representative longitudinal sample of young adults in Britain. Teenage drinking did not emerge as a strong influence upon subsequent employment experience: few associations were significant for either sex. However, early employment experiences did appear to be relevant to drinking in young adults, since unemployment of six months or more in total was significantly associated with heavier drinking in men (odds ratio = 1.38, CI 1.14-1.64). Respondents ratings of overall job satisfaction were not generally associated with either previous drinking or with that in early adulthood.

The role of family formation and dissolution in shaping drinking behaviour in early adulthood

The role of family formation and dissolution was examined in relation to alcohol consumption in early adulthood, using longitudinal data from a large representative British sample (the 1958 cohort). In comparison with other potential influences upon drinking, including employment and financial circumstances, social position and psychological wellbeing, the family formation patterns of young adults were most strongly associated with their current drinking. Stability and change in drinking between adolescence and early adulthood were also examined. Results were generally consistent with stable partnerships and family formation exerting a moderating influence on drinking since marriage and parenthood were most prevalent among groups reducing consumption or maintaining the lighter drinking of their teens. Most importantly, partnership breakdown was associated with heavier drinking established at age 16 and increasing consumption between adolescence and early adulthood.

Childhood morbidity and adulthood ill health

STUDY OBJECTIVE

The aim of the study was to investigate the relationship between the state of health in childhood and ill health in early adult life.

DESIGN

The study used data collected as part of the National Child Development Study and related health at 7 years of age to that at 23. A wide range of information on child health in the cohort was available, which was used to construct a broader measure of health status than selected diagnostic categories.

SETTING

The survey population was nationwide.

PARTICIPANTS

The study population included all children born in the week 3-9 March 1958. They were followed up at 7, 11, 16, and 23 years. Of the target population of 17,733 births, 12,537 (76%) were retraced and interviewed at 23.

MEASUREMENTS AND MAIN RESULTS

Children at age 7 were allocated to 13 morbidity groups; 20% of children had reported no ill-health apart from the common infectious diseases, but 10% were included in four or more of the morbidity groups. Children with no reported morbidity retained their health advantage into early adulthood: ratios of observed to expected ill health for four of the five indices examined at age 23 were all significantly below one (self rated health 0.81, asthma and/or wheezy bronchitis 0.63, allergies 0.79, emotional health 0.75). Children with more morbidity at age 7 had higher ratios of ill health in adulthood. A chronic condition in childhood was associated not only with excess morbidity in the short term but also with a poor health rating in early adult life (ratio = 1.38). Morbidity was significantly increased for most of the adulthood indices among children with asthma and/or wheezy bronchitis. However most ill health in young adulthood occurred in study members with a relatively healthy childhood.

CONCLUSIONS

Although the state of health in childhood has long term implications, it does not form a substantial contribution to ill health in early adult life.

Predicting traffic injuries in childhood: a cohort analysis

Data from a sample of more than 16,000 children born in the United Kingdom in 1958 were studied to identify factors that may affect the risk of having a traffic injury. Five sets of risk factors were examined: physical, developmental, educational, behavioral, and family. Information about these factors were obtained systematically from parents, teachers, and physicians when the children were 7 and 11 years of age. The results were related to traffic injuries occurring for the first time during each subsequent 4-year period. Between 8 and 11 years of age, 431 children had a traffic injury requiring medical attention, and between 12 and 16 years the number was 590. Logistic regression analyses identified a small number of factors associated with injuries, which varied according to the age and gender of the child. When all these factors were entered into a final model, only five remained: fidgety, abnormal behavior, and three measures of family disruption or disadvantage--crowding, family problems, and being removed from the family and placed in the care of the local authority. These findings suggest that it may be unwise to place much reliance on "high risk" preventive strategies by measures of this kind. Instead, more emphasis should be placed on community-based passive and environmental strategies.

Adolescent decision-making: the development of competence

This article reviews evidence relating to the development of competence in decision-making during adolescence. The review focuses on cognitive aspects of decision-making and discusses nine indicators of competence: choice; comprehension; creativity; compromise; consequentiality; correctness; credibility; consistency; and commitment. The evidence suggests that by the age of 15 years many adolescents show a reliable level of competence in metacognitive understanding of decision-making, creative problem-solving, correctness of choice, and commitment to a course of action. Young adolescents (12-14 years) are less able to create options, identify a wide range of risks and benefits, foresee the consequences of alternatives, and gauge the credibility of information from sources with vested interests. No evidence is available relating to age differences in willingness to make choices, devise compromises, and show consistency of choices. Barriers to achieving competence in decision-making during adolescence include attitudinal constraints (e.g. beliefs about the proper age for making decisions), peer group pressures to conformity, breakdowns in family structure and functioning, and restricted legal rights to make important personal decisions (e.g. to donate blood or body tissue).

HTLV-1 associated myelopathy in Canada

We report the clinical and laboratory findings of six Canadian patients with progressive myelopathy associated with HTLV-1 infection. The diagnosis was suspected on clinical grounds and supported by serological studies and positive gene amplification. Only five had emigrated from an area endemic for HTLV-1 infection. Tropical spastic paraparesis should be considered in all patients with myelopathy, even those without standard serological markers of HTLV-1 infection. The pathogenesis of this condition and the serological and molecular biological means by which this diagnosis can be made are reviewed.

Collagenase and fibronectin in bronchoalveolar lavage fluid in patients with sarcoidosis

Bronchoalveolar lavage fluid from 43 patients with biopsy proved sarcoidosis and 10 control subjects were assayed for fibronectin and collagenase activity. Fibronectin was significantly increased in the group with sarcoidosis and was found to be positively correlated with angiotensin converting enzyme activity, protein concentration, percentage of T cells and helper:suppressor ratios in the lavage fluid. Increased fibronectin in the bronchoalveolar lavage fluid was not related to functional or radiographic indices of interstitial disease and did not identify patients subsequently requiring treatment. Latent collagenase was present in bronchoalveolar lavage fluid from 16 patients with sarcoidosis but not in any control sample. There was no association between the collagenase activity and the cell profiles of the lavage fluid. Yet carbon monoxide transfer factor was decreased in patients with bronchoalveolar lavage fluid collagenase. Ten of 16 patients with bronchoalveolar lavage fluid collagenase had radiographic class III or IV disease and a disease duration of more than two years. On follow up 62% of patients with bronchoalveolar lavage fluid collagenase required subsequent treatment, compared with only 23% of patients without collagenase. These results indicate an association between bronchoalveolar lavage fluid collagenase and progressive, prolonged disease in sarcoidosis, whereas increased bronchoalveolar lavage fluid fibronectin is associated with indices of disease activity.

Social class and changes in weight-for-height between childhood and early adulthood

The changes in weight-for-height of those from different social class backgrounds have been examined in the 1958 longitudinal study. Social class differences in the prevalence of overweight and obesity were found to be negligible in childhood but marked by early adulthood, with a greater percentage of overweight and obesity in lower social classes. This different was three-fold among obese men and two-fold among obese women when respondents were classified on the basis of their own occupation. However, a longer term effect of early class backgrounds also emerged. Children from manual backgrounds were more likely to become overweight and obese young adults (7 per cent of those with average weight-for-height at age 7) compared with their non-manual contemporaries (3 per cent). Interestingly, they were also more likely to remain overweight or obese through to early adulthood. Methods preventing weight gain in early life, whilst poorly developed at present, need to ensure that approaches are relevant to young people with lower social class backgrounds.

Autotransfusion: quality of blood prepared with a red cell processing device

The quality of blood salvaged at operation and prepared with the Dideco Autotrans BT 795 autotransfusion device was compared with that of donor blood in 41 patients having cardiac surgery involving cardiopulmonary bypass. Saved blood had a higher haemoglobin concentration (17.3 v. 13.1 g dl-1; P less than 0.001), a higher 2,3-diphosphoglycerate concentration (5.3 v. 1.1 mmol litre-1; P less than 0.00001), higher white cell count (17.1 X 10(9) litre-1 v. 4.1; P less than 0.00001), higher pH (7.5 v. 6.6; P less than 0.00001) and a more physiological potassium concentration (5.4 v. 8.8 mmol litre-1; P less than 0.00001) than donor blood. Saved blood platelet count was 34.5 X 10(9) litre-1 compared with 146.24 X 10(9) litre-1 (P less than 0.00001) and its heparin concentration was 0.64 u. ml-1. We conclude that this autotransfusor is a useful aid to blood conservation, producing good quality red cells with relatively normal pH and potassium values. However, modification of the centrifugation and washing is required to lessen the high white cell count and heparin concentrations found in the saved blood.

Transformation related expression of glutathione-S-transferase P in rat liver cells

A neutral isoenzyme of glutathione transferase designated glutathione-S-transferase 7-7, but also referred to as glutathione-S-transferase P (GST-P) is absent from adult rat liver hepatocytes, but expressed at a very early stage in chemically induced in vivo hepatocarcinogenesis. The expression of this enzyme in a range of aflatoxin B1 (AFB1) associated hepatocarcinogenic systems has been examined, including in vivo induced preneoplastic and neoplastic liver tissue, cell lines derived from hepatomas, primary hepatocytes in culture and an immortalized rat liver cell line before and after transformation in vitro either by transfection with ras oncogenes or by treatment with metabolically activated AFB1. Analyses of total cytosol proteins using a polyclonal antibody to GST-P did not detect the presence of GST-P protein in cytosols from control or regenerating liver. A low level of expression was detected in the immortalized, non-transformed epithelial cell line, but a greatly induced level occurred subsequent to transformation of these cells by either of the two techniques used. High levels of the protein were detected in in vivo induced preneoplastic and neoplastic tissues, and in the cell lines derived from them. Total RNA fractions isolated from the various cells or tissues, when examined with a cDNA probe for GST-P mRNA, showed it to be absent from control and regenerating rat liver. It was present at low levels in the untransformed cell line and primary hepatocytes after 48 h in culture, but present at greatest abundance in the in vivo and in vitro transformed cells. The results indicate that the highest elevation in expression of this protein is associated with the stage of definitive malignant transformation in in vitro carcinogenesis, and this could have relevance in defining comparable events in the in vivo multistage sequence.

Incidence of renal stones in 18 British towns. A collaborative study

The geographical distribution of renal stones in England and Wales was investigated by selecting 18 towns which encompassed a range of social and economic conditions. Case registers of stone patients were maintained in the hospitals for 2 years; they included out-patients and in-patients. The annual registration rate was 22/100,000 population. Additional information was available for 1980 from Hospital Activity Analysis and the annual rate was 28/100,000. It is suggested that this is the best estimate of the incidence of renal stones in England and Wales. The rate ranged from 56/100,000 in Canterbury to 15/100,000 in Burton-on-Trent. The incidence of renal stones was higher in towns with better social and economic conditions. In comparison, climatic factors, latitude and water hardness were not important determinants of the distribution of renal stones.

Diet and renal stones: a case-control study

The diets of 51 men with renal stones were compared with those of 94 age-matched controls, using a measured record of all food and drink consumed during 4 days. The mean intakes of three nutrients suspected in the aetiology of renal stones, animal protein, refined carbohydrate (sugar) and dietary fibre, were similar for both cases and controls. However, the cases had a higher intake of ascorbic acid. A greater proportion of cases had low fluid intakes or took no exercise in their leisure time.

Long latency spinal cord dorsum potential; suppression by intrathecal morphine and enkephalin analog

We have developed a new method which combines intrathecal recordings of spinal cord dorsum potentials (CDPs) with application of drugs to the spinal cord via an intrathecal catheter. With this technique we have discovered a late component (LC) in the CDP which has not been previously described. The LC is evoked by high intensity electrical stimulation of the rat tail. Whereas previous reports describe early components in the CDP evoked by low intensity A-fiber stimulation, ours is the first to describe a late evoked potential implicating C-fiber activation of the cord. Moreover, we show that the LC is blocked by intrathecal application of morphine sulphate or D-Ala-Met-enkephalinamide in a naloxone reversible manner. We postulate that this LC represents, at least in part, the spinal cord evoked response to C-polymodal nociceptive afferent inputs.

Incidence of diabetes amongst people aged 18-50 years in nine British towns: a collaborative study

The incidence of diabetes among people aged 18-50 years has been studied prospectively in nine towns, chosen to encompass the range of socio-economic conditions and spread of latitude in England and Wales. The incidence of Type 1 (insulin-dependent) diabetes in this age group varied little between the towns. However, the incidence of Type 2 (non-insulin-dependent) diabetes was markedly higher in the towns with 'worse' socio-economic conditions. The mean incidences were 23 per 100 000 for the three 'worse' towns and 10 per 100 000 for the three 'better' towns. This was not explicable by an association between the disease and social class. This finding has to be reconciled with known and hypothesised influences in the aetiology of Type 2 diabetes.

The prevalence of gout in three English towns

The prevalence of gout has been measured in three English towns by means of a postal questionnaire. The three towns were selected to give a range of socio-economic conditions. In each town questionnaires were sent to a sample of approximately 5000 men aged 45 to 74 years. The questionnaire elicited a history of gout and a history of an attack of severe pain in the great toe. There was a progressive increase in prevalence of gout from Ipswich, the town with the most favourable socio-economic status, through Wakefield to Preston, the town with the least favourable socio-economic status. Within each town there was no difference between the social class distribution of cases and age-matched controls

Moral reasoning in alcoholics and addicts: structure vs content

19 alcoholics and 20 addicts were selected from the detoxified inpatient population of a VA hospital. 17 socioeconomically matched controls were drawn from the nonprofessional staff. Kohlberg's Moral Maturity scores were not significantly different for the three groups. However, the content variables involved in choosing between the value of life and law differentiated these groups. The value of reporting both structure and content was examined.

Prevalence of gall stones at necropsy in nine British towns: a collaborative study

A prospective study of the prevalence of gall stones at necropsy in nine towns in England and Wales showed considerable geographical variations. The age- and sex-standardised prevalence ranged from 20.6% in Ipswich to 9.2% in Wakefield. The distribution of gall stones differed from that of all-cause mortality and was negatively correlated with that of mortality from ischaemic heart disease. Socioeconomic influences related to affluence do not appear to be major determinants of the distribution of gall stones.