Group-based acceptance and commitment therapy to enhance graduate student psychological flexibility: Treatment development and preliminary implementation evaluation

Objective: Graduate student mental health is a growing concern and the need for interventions is well-documented. This manuscript outlines an Acceptance and Commitment Therapy group treatment for graduate students intended to promote psychological flexibility through the cultivation of six processes: contact with the present moment (mindfulness), freely chosen life direction (values), distance from thoughts (defusion), nonjudgmental acknowledgement of one's internal experiences (acceptance), meta-awareness of one's own experiences (self-as-context), and ongoing patterns of behavior in the service of values (committed action). Participants: The treatment was delivered to graduate students across academic disciplines with variable psychological concerns over several semesters. Method: Graduate students completed measures of preliminary acceptability. Results: Clients perceived the intervention positively and believed they benefited from participating. Conclusion: Treatment evaluation information support the social validity and acceptability of the treatment and justify future studies assessing treatment efficacy and effectiveness.

Critical Care of Patients With Cardiopulmonary Complications of Sarcoidosis

Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.

Reversible Cerebral Vasoconstriction Syndrome Associated with Coronary Artery Vasospasm

Reversible cerebral vasoconstriction syndrome is a rare disorder associated with neurologic symptoms secondary to diffuse cerebral vasospasm. Cardiac involvement in this disease is exceedingly rare. A 50-year-old woman was admitted to our hospital for evaluation of chest pain. During a 3-year period, she had been admitted multiple times because of chest pain and elevated serum cardiac enzymes. Transthoracic echocardiograms showed transient wall-motion abnormalities; however, coronary angiograms revealed no coronary artery disease. At the current admission, she had a thunderclap headache, and cerebral angiograms revealed diffuse cerebral vasoconstriction that improved after verapamil infusion, confirming the diagnosis of reversible cerebral vasoconstriction syndrome. The patient was treated successfully with oral diltiazem and had no recurrence of symptoms. We describe what we think is the first reported case of coronary artery spasm in association with reversible cerebral vasoconstriction syndrome. Future research should be focused on identifying treatment options and defining the mechanisms by which the cerebral and coronary vasculature are affected.

Are psychotherapies with more dropouts less effective?

Psychotherapy dropout is often regarded as an indicator of treatment failure; however, evidence of a relationship between dropout and outcome has not been well established. The current research consisted of three meta-analytic studies, the results of which found (a) individuals who dropped out began treatment more distressed than those who completed therapy, (b) individuals who dropped out of therapy were more distressed at posttreatment than individuals who completed therapy, and (c) treatments with higher rates of dropout were also less effective for the treatment completers. Dropout may particularly signal poor outcomes for shorter treatments. The continued ambiguity in the meaning of dropout is discussed as well as the promising potential for future research in the area of dropout as it relates to outcome.

Event Centrality and Bereavement Symptomatology: The Moderating Role of Meaning Made

The centrality of a loss to a bereaved individual’s identity is associated with greater symptomatology, whereas meaning made of a loss is associated with positive outcomes. This article examines meaning made as a moderator of the relationship between event centrality and symptomatology. Our sample consisted of 204 bereaved undergraduate university students. Centrality was assessed using the Centrality of Events Scale, meaning made was assessed using the Integration of Stressful Life Experiences Scale, and symptomatology was assessed using the posttraumatic stress disorder Checklist-Civilian and Inventory of Complicated Grief-Revised. Meaning made had a significant moderating effect on the relationship between centrality and both measures of symptomatology. At lower levels of meaning made, centrality had a strong and positive association with symptomatology; at higher levels of meaning made, this association became weaker. These results suggest that meaning made is the key to understanding how centrality affects bereavement outcomes.

Defining the nasal transcriptome in granulomatosis with polyangiitis (Wegener's)

OBJECTIVE

To determine whether disease processes related to granulomatosis with polyangiitis (Wegener's) (GPA) are reflected in gene expression profiles of the nasal mucosa.

METHODS

Nasal brushings of the inferior turbinate were obtained from 32 patients with GPA (10 with active nasal disease, 13 with prior nasal disease, and 9 with no history of nasal disease) and a composite comparator group with and without inflammatory nasal disease (12 healthy people, 15 with sarcoidosis, and 8 with allergic rhinitis). Differential gene expression was assessed between subgroups of GPA and comparators.

RESULTS

A total of 339 genes were differentially expressed between the GPA and comparator groups (absolute fold change >1.5; false discovery rate <0.05). Top canonical pathways up-regulated in nasal brushings from patients with GPA included granulocyte adhesion and diapedesis (P = 8.6(-22) ), agranulocyte adhesion and diapedesis (P = 1.3(-14) ), IL10 signaling (P = 3.0(-11) ), LXR/RXR activation (P = 4.3(-11) ), and TREM1 signaling (P = 9.0(-11) ). A set of genes differentially expressed in GPA independently of nasal disease activity status included genes related to epithelial barrier integrity (fibronectin 1, desmosomal proteins) and several matricellular proteins (e.g., osteonectin, osteopontin). Significant overlap of differentially expressed genes was observed between active and prior nasal disease GPA subgroups. Peripheral blood neutrophil and mononuclear gene expression levels associated with GPA were similarly altered in the nasal gene expression profiles of patients with active or prior nasal disease.

CONCLUSION

Profiling the nasal transcriptome in GPA reveals gene expression signatures related to innate immunity, inflammatory cell chemotaxis, extracellular matrix composition, and epithelial barrier integrity. Thus, airway-based expression profiling is feasible and informative in GPA.

Obesity and weight gain in relation to incidence of sarcoidosis in US black women: data from the Black Women's Health Study

BACKGROUND

Sarcoidosis, a systemic disorder characterized by chronic granulomatous inflammation, occurs more frequently among US black women, as do overweight and obesity. Little is known about the relation of overweight and obesity, which induce chronic inflammation, to incidence of sarcoidosis.

METHODS

We assessed the relation of obesity and weight gain to the incidence of sarcoidosis in the Black Women's Health Study, a follow-up study of 59,000 US black women aged 21 to 69 years at baseline in 1995. Information on weight at age 18 years, height, current weight, incident sarcoidosis, and covariates was collected at baseline and on biennial follow-up questionnaires. Cox regression models adjusted for age, education, geographic region, smoking, alcohol consumption, and physical activity were used to estimate incidence rate ratios (IRRs) and 95% CIs.

RESULTS

From 1995 through 2011, 454 incident cases of sarcoidosis occurred during 707,557 person-years of follow-up. The incidence of sarcoidosis increased with increasing BMI and weight gain. The IRR was 1.40 (95% CI, 0.88-2.25) for BMI ≥ 30 kg/m2 at age 18 years relative to 20 to 24 kg/m2 (P trend = .18), 1.42 (95% CI, 1.07-1.89) for BMI ≥ 35 kg/m2 at baseline relative to 20 to 24 kg/m2 (P trend = .01), and 1.47 (95% CI, 1.10-1.97) for a weight gain between age 18 years and baseline of ≥ 30 kg relative to 0 to 9 kg (P trend = .16). In stratified analyses, there were significant trends of sarcoidosis incidence with increasing BMI and weight gain in women aged ≥ 45 years and ever smokers.

CONCLUSIONS

The present study provides evidence that weight gain and obesity during adulthood are associated with increased sarcoidosis incidence.

Mortality among African American women with sarcoidosis: data from the Black Women's Health Study

BACKGROUND

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology that disproportionately affects black females.  Few studies have specifically addressed causes of death in this population.

OBJECTIVES

To assess rates and causes of death among women with sarcoidosis in a prospective cohort study of U.S. black women.

DESIGN

The Black Women's Health Study is a follow-up study of 59,000 U.S. black women aged 21-69 (median age 38) at entry in 1995.  Data on demographic and lifestyle factors and medical conditions, including sarcoidosis, were obtained through biennial questionnaires.  Deaths and causes of death from 1995 through 2009 among study subjects were identified from National Death Index data. We assessed mortality rates among women with and without a history of sarcoidosis.  Poisson regression models were used to estimate age-adjusted mortality rates. Cox proportional-hazards models were used to estimate hazard ratios for mortality and 95% confidence intervals.

RESULTS

A total of 121 deaths occurred among 1,192 women with a history of sarcoidosis and 2813 deaths among women without sarcoidosis.  Mortality was greater at every age among women with sarcoidosis and the overall multivariable-adjusted hazard ratio was 2.44 (95% CI 2.03-2.93, p&lt;0.0001). Of the deaths among women with sarcoidosis, 24.7% were directly attributable to sarcoidosis.

CONCLUSIONS

In the Black Women's Health Study, women with sarcoidosis were more than twice as likely to die as women without the disease, with many of the deaths directly attributable to sarcoidosis.  Sarcoidosis is an important cause of premature death among black women with the disease.

Reproductive and hormonal factors in relation to incidence of sarcoidosis in US Black women: The Black Women's Health Study

The authors assessed the relation of hormonal and pregnancy-related factors to the incidence of sarcoidosis in the Black Women's Health Study. On biennial questionnaires, participants (US black women aged 21-69 years at baseline) reported data on diagnoses of sarcoidosis, reproductive history, and medication use. Cox regression models, adjusted for age, education, geographic region, smoking, and body mass index, were used to estimate incidence rate ratios and 95% confidence intervals. During 694,818 person-years of follow-up from 1995 through 2009, 452 incident cases of sarcoidosis were identified. The incidence of sarcoidosis decreased as age at menopause increased (P-trend = 0.03). Both later age at first full-term birth and having a more recent birth were associated with a reduced incidence of sarcoidosis. In models that included both factors, the incidence rate ratios were 0.60 (95% confidence interval: 0.37, 0.97) for age at first birth ≥30 years versus <20 years (P-trend = 0.05) and 0.73 (95% confidence interval: 0.43, 1.24) for <5 years since last birth versus ≥15 years (P-trend = 0.15). No significant associations were observed with age at menarche, parity, lactation, oral contraceptive use, or female hormone use. These results suggest that later full-term pregnancy and longer exposure to endogenous female hormones may be related to a reduced risk of sarcoidosis.

The impact of conversational acknowledgers on perceptions of psychotherapists

During conversations, individuals often signal that they are paying attention by the use of verbal and nonverbal cues. This study examined these conversational acknowledgers in psychotherapy and evaluated the effects of therapists varying levels of two specific actions-short utterances and nodding-on perceptions of the therapist. A series of brief psychotherapy videos with therapists displaying different levels of the two types of acknowledgers were presented to 320 participants recruited both online and from a university campus. Analysis indicated that when therapists used high levels of both verbal acknowledgers and nodding or when they refrained from using both types of acknowledgers, therapist empathy and therapeutic alliance were perceived as greater than when therapists engaged in one type of acknowledger but not the other.

Correlating sterics parameters and diastereomeric ratio values for a multicomponent assembly to predict exciton-coupled circular dichroism intensity and thereby enantiomeric excess of chiral secondary alcohols

Linear free energy relationship (LFER) substituent parameters are commonly employed for exploring reaction mechanisms and very recently have been used to guide the design of asymmetric catalysts, but their usage in dynamic covalent chemistry is rare. Herein, the properties of an in situ-generated dynamic multicomponent covalent assembly that creates tris(pyridine) metal complexes incorporating chiral secondary alcohols were explored using LFER-based steric parameters. The diastereomeric ratio (dr) of the assembly was correlated with the magnitude of the exciton-coupled circular dichroism (ECCD) induced by chiral alcohols. Charton steric parameters were successfully correlated with the dr values. Through the combination of these correlations, both the dr and CD intensity were predicted for test alcohols. These correlations were also employed to measure a few new Charton parameters. Finally, the prediction of enantiomeric excess (ee) of test samples with various alcohol structures was also successfully achieved. The prediction of spectral properties in advance by using well-established steric parameters is shown to be useful for rapid ee screening because the need for calibration curves and enantiomerically enriched samples is avoided.

Sarcoidosis in black women in the United States: data from the Black Women's Health Study

BACKGROUND

Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs among men and women of all races. In the United States, black women are most frequently and most severely affected. There have been few epidemiologic studies of sarcoidosis focusing on black women.

METHODS

In this article, we present data on incidence, prevalence, and clinical characteristics of sarcoidosis among participants in the Black Women's Health Study, a cohort study of 59,000 black women from across the United States. Data on incident disease and potential risk factors are obtained through biennial questionnaires. Follow-up has been > 80% through six completed cycles.

RESULTS

There were 685 prevalent cases of sarcoidosis at baseline in 1995 and 435 incident cases reported during 611,585 person-years of follow-up through 2007, for an average annual incidence rate of 71/100,000 and a current prevalence of 2.0%. The sarcoid diagnosis was confirmed in 96% of self-reported cases for whom medical records or physician checklists were obtained. The most frequently affected site was the lung. Most patients also had extrapulmonary involvement, with the most common sites being lymph nodes, skin, and eyes. Prednisone had the highest prevalence of use, followed by inhaled corticosteroids.

CONCLUSIONS

This study confirms previous reports of high incidence and prevalence of sarcoidosis among black women, as well as the extent of extrapulmonary disease, frequent need for steroid therapy, and comorbid conditions in this population. The prospective identification of sarcoidosis cases from a defined population will enable a valid assessment of risk factors for incident disease as follow-up continues.

Affective synchrony in dual- and single-smoker couples: further evidence of "symptom-system fit"?

Couples in which one or both partners smoked despite one of them having a heart or lung problem discussed a health-related disagreement before and during a period of laboratory smoking. Immediately afterwards, the partners in these 25 couples used independent joysticks to recall their continuous emotional experience during the interaction while watching themselves on video. A couple-level index of affective synchrony, reflecting correlated moment-to-moment change in the two partners' joystick ratings, tended to increase from baseline to smoking for 9 dual-smoker couples but decrease for 16 single-smoker couples. Results suggest that coregulation of shared emotional experience could be a factor in smoking persistence, particularly when both partners in a couple smoke. Relationship-focused interventions addressing this fit between symptom and system may help smokers achieve stable cessation.

Health consequences of partner distress in couples coping with heart failure

BACKGROUND

Chronic heart failure (HF) is associated with psychologic distress for patients and their spouses. Although research indicates that a patient's distress can influence the course of illness, less is known about possible effects of a spouse's distress on the patient or of a patient's distress on the health of the spouse.

METHODS AND RESULTS

Baseline home interviews of 60 patients with HF (43 men, 17 women) and their spouses included assessments of each partner's psychologic distress (Hopkins Symptom Checklist-25) and perceived general health (Short Form-36 Questionnaire), as well as severity of patients' HF symptoms. We repeated the health and HF-symptom assessments in follow-up interviews 6 months later. As hypothesized, the spouse's distress at baseline predicted an unfavorable course of patients' HF symptoms and general health over the next 6 months, independently of the patient's own baseline distress. There were no prospective effects of the patient's distress on the spouse's health, however, suggesting that partner distress had asymmetric health consequences for patients and spouses.

CONCLUSION

The results complement other evidence linking marital quality to the course of HF and highlight the importance of looking beyond the patient to improve prediction of health outcomes.

The effectiveness of psychotherapeutic interventions for bereaved persons: a comprehensive quantitative review

Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined (a) the absolute effectiveness of bereavement interventions immediately following intervention and at follow-up assessments, (b) several of the clinically and theoretically relevant moderators of outcome, and (c) change over time among recipients of the interventions and individuals in no-intervention control groups. Overall, analyses showed that interventions had a small effect at posttreatment but no statistically significant benefit at follow-up. However, interventions that exclusively targeted grievers displaying marked difficulties adapting to loss had outcomes that compare favorably with psychotherapies for other difficulties. Other evidence suggested that the discouraging results for studies failing to screen for indications of distress could be attributed to a tendency among controls to improve naturally over time. The findings of the review underscore the importance of attending to the targeted population in the practice and study of psychotherapeutic interventions for bereaved persons.

Evolutionary Lifestyle and Mental Health

Some have suggested that psychological distress may be lower if individuals adopt a lifestyle more similar to our evolutionary past. In this study, we assessed relationships between distress and six lifestyle elements (sleep, omega-3 consumption, exercise, rumination, sunlight exposure, and socialization). A large sample ( N = 495) of college undergraduates reported levels of each lifestyle element and their distress on the Beck Depression Inventory and Hopkins Symptom Checklist. Analysis revealed a positive relationship for rumination and a curvilinear relationship for sleep. In contrast, none of the other elements correlated reliably with distress. The findings raise the possibility that relationships between these lifestyle elements and distress may not be critical for the range of exposure typically experienced in a normal, nonclinical population.

Sarcoidosis-Associated Pulmonary Hypertension

RATIONALE

Pulmonary hypertension is a known complication of sarcoidosis and is associated with increased mortality. Little is known about the outcome of sarcoidosis-associated pulmonary hypertension, including response to treatment.

OBJECTIVE

To determine the characteristics and outcome of patients with sarcoidosis-associated pulmonary hypertension treated with IV epoprostenol.

DESIGN

Retrospective chart review of all cases of pulmonary hypertension with a concomitant diagnosis of sarcoidosis evaluated in the Boston University Pulmonary Hypertension Center from 2000 to 2004.

MEASUREMENTS

Data collected included patient demographics, sarcoidosis stage, pulmonary function, echocardiography results, treatment, baseline and posttreatment hemodynamic measurements, and clinical outcome.

RESULTS

Eight patients were identified; four of the patients had stage IV pulmonary sarcoidosis. Pulmonary function test results were notable for severe diffusion impairment (mean diffusion capacity of the lung for carbon monoxide, 30% of predicted), with only mild-to-moderate restrictive physiology (mean FVC, 59% of predicted). Seventy-five percent of patients required supplemental oxygen at the time of presentation. All patients had moderate or severe pulmonary hypertension and were New York Heart Association (NYHA)/World Health Organization (WHO) class III or IV. A vasodilator trial with epoprostenol was performed in seven of the eight patients; six of the seven patients had a significant hemodynamic response (> 25% reduction in pulmonary vascular resistance). All but one of the responders (five of six patients) continued on therapy. Average clinical improvement was one to two NYHA/WHO classes at a mean follow-up of 29 months (range, 15 to 49 months).

CONCLUSIONS

In patients with sarcoidosis-associated pulmonary hypertension, the severity of pulmonary vascular disease occurs out of proportion to lung function abnormalities. The majority of our patients responded to epoprostenol; survival may be improved in this group.

Interleukin-1beta induces osteopontin expression in pulmonary fibroblasts

Osteopontin is a multifunctional matricellular protein identified as one of the most upregulated genes in pulmonary fibrosis. Experimental animal models have identified early pro-fibrotic cytokines as essential to the pathogenesis of inflammation-induced pulmonary fibrosis. However, the principal sources of osteopontin in the fibroproliferative lung, and the factors responsible for its induction, have not been fully defined. We isolated primary rat lung fibroblasts in culture to examine the expression and regulation of lung fibroblast-derived osteopontin. Our results demonstrate a potent and dramatic increase in osteopontin expression induced by interleukin-1beta (IL-1beta), whereas tumor necrosis factor-alpha, transforming growth factor-beta, and angiotensin II had minimal effect. Stimulation with IL-1beta resulted in the secretion of soluble osteopontin protein. We found that osteopontin expression by IL-1beta was regulated via signaling primarily through the mitogen-activated protein kinase member ERK1/2, partially by p38 MAPK, but not at all by JNK. Finally, the mechanism of IL-1beta increase in osteopontin mRNA requires de novo transcription and translation. In conclusion, we find that osteopontin is expressed by primary lung fibroblasts and is potently upregulated by the early inflammatory and pro-fibrotic cytokine IL-1beta. Activated fibroblasts may be a significant source of osteopontin production during lung fibrogenesis.

The efficacy of personal construct therapy: A comprehensive review

Prior narrative and quantitative reviews have suggested that personal construct therapy (PCT) is an efficacious and viable form of treatment. However, these reviews failed to include all published, controlled PCT outcome studies and did not account for all measures of outcome. The present quantitative review, therefore, offers a comprehensive integration of the 22 published studies that compare PCT to a control group, examining its overall efficacy at posttest and follow-up as well as its effects for different types of outcome measures. Overall, the efficacy of PCT was found to be somewhat weaker than that reported in previous reviews. It was also found that traditional self-report and behavioral observation measures tended to yield larger effects compared to measures that focused on personal meanings and scored content supplied by the client.

Is Psychotherapy Good for Your Health?

This is a dedicated review of the evidence for the relation of having a period of psychotherapy and then comparing it with a measure of improved physical health. We aimed to make it the first intended-to-be-complete review of this type. Three inter-related types of studies were examined: Type 1: reduction in physical illnesses through psychotherapy, especially for the patient's survival time during the interval between diagnosis and an end point, Type 2: reduction in pain in relation to receiving psychotherapy, and Type 3: reduction in costs of treatment in relation to receiving psychotherapy. To find the relevant studies on these topics, we performed a literature search using both Psychinfo and Medline databases. An average of the effect sizes under each type was taken to calculate the mean effect size along with its confidence interval. Our results (1) on survival time for the combined severe patients, did not reach even the lowest significant level of effect size, although the low severity patients seemed to fit the hypothesis better, but the other two reduction topics, (2) and (3), clearly did achieve it.

Altered bleomycin-induced lung fibrosis in osteopontin-deficient mice

Osteopontin is a multifunctional matricellular protein abundantly expressed during inflammation and repair. Osteopontin deficiency is associated with abnormal wound repair characterized by aberrant collagen fibrillogenesis in the heart and skin. Recent gene microarray studies found that osteopontin is abundantly expressed in both human and mouse lung fibrosis. Macrophages and T cells are known to be major sources of osteopontin. During lung fibrosis, however, osteopontin expression continues to increase when inflammation has receded, suggesting alternative sources of ostepontin during this response. In this study, we demonstrate immunoreactivity for osteopontin in lung epithelial and inflammatory cells in human usual interstitial pneumonitis and murine bleomycin-induced lung fibrosis. After treatment with bleomycin, osteopontin-null mice develop lung fibrosis characterized by dilated distal air spaces and reduced type I collagen expression compared with wild-type controls. There is also a significant decrease in levels of active transforming growth factor-beta(1) and matrix metalloproteinase-2 in osteopontin null mice. Type III collagen expression and total collagenase activity are similar in both groups. These results demonstrate that osteopontin expression is associated with important fibrogenic signals in the lung and that the epithelium may be an important source of osteopontin during lung fibrosis.

IFN-gamma induction of osteopontin expression in human monocytoid cells

Osteopontin (OPN) is an arginine-glycine-aspartate (RGD)-containing cytokine that increases macrophage expression of the Th1 cytokines interferon-gamma (IFN-gamma) and interleukin-12 (IL-12), and downregulates macrophage expression of IL-10. OPN has been implicated in the clearance of mycobacterial infection and in granuloma formation. We previously showed decreased OPN expression in the granulomas of patients with disseminated mycobacterial infection in the setting of mutation of the IFN-gamma receptor-1 (IFNGR-1). These data suggested that IFN-gamma critically regulates OPN expression during mycobacterial infection. Herein, we characterize the effect of IFN-gamma stimulation on OPN expression by human monocytoid cells. By Western blot, ELISA, and Northern blot analysis, IFN-gamma treatment of THP-1 cells was shown to induce OPN mRNA and protein expression in a time-dependent and dose-dependent manner. The human OPN promoter was amplified by PCR using human genomic DNA as a template and transfected into THP-1 cells. Compared with control, OPN promoter activity increased by 15-fold after treatment with IFN-gamma. Similar induction of OPN was seen in IFN-gamma-stimulated primary human blood monocytes. These data show that IFN-gamma stimulates OPN expression from monocytoid cells and suggest that OPN may function in a positive feedback loop in Th1 inflammation, increasing expression of IFN-gamma, which itself upregulates the OPN gene.

Abnormal pulmonary granuloma formation in osteopontin-deficient mice

Osteopontin is a novel cytokine that is expressed in pulmonary granulomatous disease such as sarcoidosis and tuberculosis. It can regulate macrophage and T cell migration, activation, and cytokine expression, yet its role in granuloma formation and evolution is unknown. We induced hypersensitivity pulmonary granulomas by embolizing Schistosoma mansoni eggs to the lungs of osteopontin-deficient (null mutant) mice and osteopontin-sufficient (wild-type control) mice. Granulomas from osteopontin-null animals were smaller at early time points and contained remarkably few macrophages and macrophage-derived epithelioid cells and giant cells. T cell accumulation was unaffected by osteopontin deficiency. These results demonstrate that osteopontin regulates macrophage accumulation during pulmonary granuloma formation, and may explain the impaired ability of osteopontin-deficient hosts to control mycobacterial disease.

Is psychotherapy more effective when therapists disclose information about themselves?

Theorists have long debated the wisdom of therapists disclosing personal information during psychotherapy. Some observers have argued that such therapist self-disclosure impedes treatment, whereas others have suggested that it enhances the effectiveness of therapy. To test these competing positions, therapists at a university counseling center were instructed to increase the number of self-disclosures they made during treatment of one client and refrain from making self-disclosures during treatment of another client. Analyses revealed that clients receiving psychotherapy under conditions of heightened therapist disclosure not only reported lower levels of symptom distress but also liked their therapist more. Such findings suggest that self-disclosure by the therapist may improve both the quality of the therapeutic relationship and the outcome of treatment.

Osteopontin: a key cytokine in cell-mediated and granulomatous inflammation

Osteopontin (Opn) is a secreted adhesive, glycosylated phosphoprotein that contains the arginine-glycine-aspartic acid (RGD) cell-binding sequence that is found in many extracellular matrix (ECM) proteins (for a review of Opn see References Denhardt & Guo 1993; Patarca et al. 1993; Rittling & Denhardt 1999). Since its initial description in 1979 as a secreted protein associated with malignant transformation, Opn has been independently discovered by investigators from diverse scientific disciplines, and has been associated with a remarkable range of pathologic responses. Opn is an important bone matrix protein, where it is thought to mediate adhesion of osteoclasts to resorbing bone. However, studies from the past decade have identified an alternative role for Opn as a key cytokine regulating tissue repair and inflammation. Recent work by our laboratory and that of others has underlined the importance of Opn as a pivotal cytokine in the cellular immune response. Despite this Opn is not well known to the immunologist. In this review we will focus on studies that pertain to the role of Opn in cell-mediated and granulomatous inflammation.

Osteopontin augments CD3-mediated interferon-gamma and CD40 ligand expression by T cells, which results in IL-12 production from peripheral blood mononuclear cells

Osteopontin is an RGD-containing bone matrix protein with cytokine-like functions that is associated with early stages of Th1-mediated diseases. Although the function of osteopontin in these responses is unknown, it is expressed by activated T cells and macrophages and can costimulate T cell proliferation. Studies have demonstrated that early IL-12 and IFN-gamma expression is required to induce a protective response to many intracellular pathogens. Herein, we demonstrate that osteopontin stimulation augments the ability of anti-CD3 monoclonal antibody to induce CD40 ligand (CD40L) and IFN-gamma expression on human T cells, resulting in CD40L- and IFN-gamma-dependent IL-12 production in vitro. These findings suggest a functional role for osteopontin in early Th1 responses, namely regulation of T cell-dependent IL-12 production. Further, osteopontin up-regulation of CD40L provides mechanistic support for the association of osteopontin with polyclonal B cell proliferation and humoral autoimmune disease.