RESUMO
Magnesium plays a critical role in athlete health and performance. It is involved in numerous physiological mechanisms that support energy production, immune function, pain modulation, muscle function and bone health. Athletes may be susceptible to magnesium deficiency due to an increased utilization during exercise.Objective: This study reports on the magnesium status of 192 Olympic and Paralympic athletes over the course of eight years.Methods: Athletes on the British Athletics world class performance plan undertook blood testing for Red Cell Magnesium status. Their history of tendon pain, muscle and bone injury, ethnicity, sporting event and gender were also recorded. 510 samples from 192 athletes were included in the study.Results: On at least one blood test during the study time, 22% of athletes were identified as clinically deficient (<1.19 mmol/L). The average red cell magnesium concentration was 1.34 nmol/L. Magnesium was significantly lower in female athletes and those with Black or Mixed-Race ethnicity and was higher in Throws athletes and Paralympians with Cerebral Palsy. Athletes with a history of achilles or patella tendon pain had significantly lower magnesium levels than average.Conclusions: This study highlights the importance of investigating magnesium within this population to identify deficiency and support athlete health. Several areas for future work are identified to explore the relationship between magnesium and gender, ethnicity and tendon pain and muscle injury in athletes. Furthermore, new guidelines for magnesium status within athletics populations are proposed.
Assuntos
Atletas/estatística & dados numéricos , Deficiência de Magnésio/epidemiologia , Magnésio/sangue , Estado Nutricional , Atletismo/estatística & dados numéricos , Adolescente , Adulto , Desempenho Atlético/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atletismo/fisiologia , Adulto JovemRESUMO
AIM: To implement and validate the newly proposed British athletics muscle injury classification in the assessment of hamstring injuries in track and field athletes and to analyse the nature and frequency of the discrepancies. MATERIALS AND METHODS: This was a retrospective study analysing hamstring injuries in elite British athletes using the proposed classification system. Classification of 65 hamstring injuries in 45 high-level athletes by two radiologists at two time points 4 months apart to determine interrater variability, intrarater variability, and feasibility of the classification system was undertaken. RESULTS: Interrater Kappa values of 0.80 (95% confidence interval [CI]: 0.67-0.92; p<0.0001) for Round 1 and 0.88 (95% CI: 0.76-1.00; p<0.0001) for Round 2 of the review were observed. Percentages of agreement were 85% for Round 1 and 91% for Round 2. The intrarater Kappa value for the two reviewers were 0.76 (95% CI: 0.63-0.88; p<0.0001) and 0.65 (95% CI: 0.53-0.76; p<0.0001) and the average was 0.71 suggesting substantial overall agreement. The percentages of agreement were 82% and 72%, respectively. CONCLUSIONS: This classification system is straightforward to use and produces both reproducible and consistent results based on interrater and intrarater Kappa values with at least substantial agreement in all groups. Further work is ongoing to investigate whether individual grades within this classification system provide prognostic information and could guide clinical management.
Assuntos
Traumatismos em Atletas/classificação , Traumatismos em Atletas/diagnóstico , Imageamento por Ressonância Magnética , Músculo Esquelético/lesões , Doenças Musculares/classificação , Doenças Musculares/diagnóstico , Traumatismos em Atletas/patologia , Estudos de Viabilidade , Humanos , Músculo Esquelético/patologia , Doenças Musculares/patologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Esportes/estatística & dados numéricos , Atletismo/estatística & dados numéricos , Reino UnidoRESUMO
Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.
Assuntos
Atletas , Medicina Esportiva/métodos , Esportes , Desempenho Atlético/fisiologia , Atenção à Saúde/métodos , Registros Eletrônicos de Saúde , Humanos , Modelos Biológicos , Folhetos , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/métodos , Assistência Centrada no Paciente , Educação Física e Treinamento/métodos , Papel do Médico , Relações Médico-Paciente , Responsabilidade SocialRESUMO
Deletion of the Saccharomyces cerevisiae TOP3 gene, encoding Top3p, leads to a slow-growth phenotype characterized by an accumulation of cells with a late S/G2 content of DNA (S. Gangloff, J. P. McDonald, C. Bendixen, L. Arthur, and R. Rothstein, Mol. Cell. Biol. 14:8391-8398, 1994). We have investigated the function of TOP3 during cell cycle progression and the molecular basis for the cell cycle delay seen in top3Delta strains. We show that top3Delta mutants exhibit a RAD24-dependent delay in the G2 phase, suggesting a possible role for Top3p in the resolution of abnormal DNA structures or DNA damage arising during S phase. Consistent with this notion, top3Delta strains are sensitive to killing by a variety of DNA-damaging agents, including UV light and the alkylating agent methyl methanesulfonate, and are partially defective in the intra-S-phase checkpoint that slows the rate of S-phase progression following exposure to DNA-damaging agents. This S-phase checkpoint defect is associated with a defect in phosphorylation of Rad53p, indicating that, in the absence of Top3p, the efficiency of sensing the existence of DNA damage or signaling to the Rad53 kinase is impaired. Consistent with a role for Top3p specifically during S phase, top3Delta mutants are sensitive to the replication inhibitor hydroxyurea, expression of the TOP3 mRNA is activated in late G1 phase, and DNA damage checkpoints operating outside of S phase are unaffected by deletion of TOP3. All of these phenotypic consequences of loss of Top3p function are at least partially suppressed by deletion of SGS1, the yeast homologue of the human Bloom's and Werner's syndrome genes. These data implicate Top3p and, by inference, Sgs1p in an S-phase-specific role in the cellular response to DNA damage. A model proposing a role for these proteins in S phase is presented.
Assuntos
Proteínas de Ciclo Celular , Dano ao DNA , DNA Topoisomerases Tipo I/metabolismo , DNA Topoisomerases Tipo I/fisiologia , Proteínas Serina-Treonina Quinases/metabolismo , Fase S , Proteínas de Saccharomyces cerevisiae , Saccharomyces cerevisiae/genética , Alquilantes/farmacologia , Northern Blotting , Western Blotting , Ciclo Celular , Quinase do Ponto de Checagem 2 , Relação Dose-Resposta a Droga , Citometria de Fluxo , Fase G2 , Deleção de Genes , Hidroxiureia/farmacologia , Metanossulfonato de Metila/farmacologia , Mitose , Modelos Biológicos , Mutação , Fenótipo , Fosforilação , Saccharomyces cerevisiae/enzimologia , Fatores de Tempo , Raios UltravioletaRESUMO
Pre-clinical studies of allogeneic stem cell transplantation suggest that depletion of naive T cells from donor lymphocytes will reduce the risk of GvHD but preserve immunity to infectious pathogens. In this study, we have established a clinical-grade protocol under good manufacturing practice conditions for purging CD62L(+) naive T cells from steady-state leukapheresis products using the CliniMACS system. The efficacy of immunomagnetic CD62L depletion was assessed by analysis of cell composition and functional immune responses. A median 2.9 log CD62L depletion was achieved with no evidence of CD62L shedding during the procedure and a mean T-cell yield of 47%. CD62L(-) cells comprised an equal mix of CD4(+) and CD8(+) T cells, with elimination of B cells but maintenance of regulatory T cells and natural killer cell populations. CD62L-depleted T cells were predominantly CD45RA(-) and CD45RA(+) effector memory (>90%) and contained the bulk of pentamer-staining antivirus-specific T cells. Functional assessment of CD62L(-) cells revealed the maintenance of antiviral T-cell reactivity and a reduction in the alloreactive immune response compared with unmanipulated cells. Clinical-grade depletion of naive T cells using immunomagnetic CD62L beads from steady-state leukapheresis products is highly efficient and generates cells suitable for adoptive transfer in the context of clinical trials.
Assuntos
Transferência Adotiva/métodos , Linfócitos T CD8-Positivos/imunologia , Memória Imunológica/imunologia , Separação Imunomagnética/métodos , Voluntários Saudáveis , HumanosRESUMO
A patient with chronic ITP relapsed after conventional therapy but following an infusion with low dose anti D (Rho) immunoglobulin, she entered a remission which has now lasted 10 months. This is difficult to explain on the basis of long term macrophage Fc receptor blockade and suggests an alternative mechanism of action.
Assuntos
Imunoglobulinas/administração & dosagem , Púrpura Trombocitopênica/terapia , Plaquetas/imunologia , Criança , Feminino , Humanos , Macrófagos/imunologia , Púrpura Trombocitopênica/sangue , Púrpura Trombocitopênica/imunologia , Receptores Fc , Sistema do Grupo Sanguíneo Rh-Hr , Imunoglobulina rho(D)RESUMO
We report the case of a 46-year-old male who developed dermatomyositis and a sarcoid-like reaction in association with testicular relapse of multiple myeloma. The myositis progressed despite chemotherapy directed at the underlying malignant disorder and immunosuppressive treatment. There was, however, a dramatic and sustained response to high-dose chemotherapy and autologous peripheral blood stem cell transplantation which resulted in resolution of the myopathy and partial resolution of the sarcoid-like reaction. This case report highlights the potential of autologous stem cell transplantation as treatment for para-neoplastic disorders associated with haematological malignancies.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Dermatomiosite/terapia , Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/complicações , Sarcoidose/terapia , Terapia Combinada , Dermatomiosite/diagnóstico , Dermatomiosite/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Recidiva , Sarcoidose/diagnóstico , Sarcoidose/etiologia , Neoplasias Testiculares/terapia , Resultado do TratamentoRESUMO
In common with other plasma cell dyscrasias in which a small tumour burden is associated with severe clinical symptoms (notably systemic AL amyloidosis) the possible benefits of dose intensification are yet to be fully explored in POEMS syndrome. One important issue is whether the toxicity of the procedure is significantly increased in this group. We report two cases of POEMS syndrome with solitary asymptomatic bone lesions treated with high-dose melphalan (200 mg/m(2)) and peripheral blood stem cell (PBSC) rescue. In both cases there was minimal peri-transplant morbidity and a subsequent substantial and maintained improvement in the peripheral neuropathy.
Assuntos
Síndrome POEMS/terapia , Transplante de Células-Tronco de Sangue Periférico , Adulto , Feminino , Humanos , Masculino , Melfalan/administração & dosagem , Melfalan/toxicidade , Pessoa de Meia-Idade , Síndrome POEMS/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report a 45-year-old female with AML who underwent a T cell-depleted sibling allograft and relapsed a year later with extramedullary disease involving the lung parenchyma and presenting with the clinical and radiological features of interstitial pneumonitis. The patient was treated with donor lymphocyte infusion (DLI) resulting in complete resolution of the radiological signs. The unusual presentation and the management options are discussed.
Assuntos
Transplante de Medula Óssea , Leucemia Mieloide/diagnóstico , Leucemia Mieloide/terapia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/terapia , Transfusão de Linfócitos , Transplante de Medula Óssea/patologia , Diagnóstico Diferencial , Feminino , Humanos , Leucemia Mieloide/patologia , Doenças Pulmonares Intersticiais/patologia , Transfusão de Linfócitos/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de NeoplasiaRESUMO
We evaluated the outcome of two modes of T cell depletion for HLA-identical sibling stem cell transplants in 34 consecutive adult patients: group A (n = 11) received PBSC post CliniMACs immuno-magnetic enrichment of CD34(+) cells and group B (n = 23) received bone marrow following in vitro incubation with CAMPATH-1M and complement. All patients received an identical conditioning regimen which consisted of in vivoCAMPATH-1H 20 mg over 5 days, thiotepa 10 mg/kg, cyclophosphamide 120 mg/kg and 14.4 Gy TBI. No additional graft-versus-host disease prophylaxis was given. The mean T cell dose administered was 0.02 +/- 0.05 x 10(6)/kg for group A and 2.8 +/- 2.8 10(6)/kg for group B (P < 0.001). With a median follow-up of 28 months overall survival was 36.4% for group A at 12 months compared to 78.3% for group B (P = 0.001). Transplant-related mortality in group A at 12 months was 63.6% as compared to 18.0% in group B (P = 0.003). Most of the procedure-related deaths in group A occurred secondary to infection. These results suggest that extensive in vitro T cell depletion of peripheral blood stem cells in combination with in vivo T cell depletion may have profound effects upon the incidence of infections following allogeneic stem cell transplantation and this may adversely effect transplant-related mortality.
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Depleção Linfocítica/efeitos adversos , Linfócitos T , Adulto , Alemtuzumab , Anticorpos Monoclonais , Anticorpos Monoclonais Humanizados , Anticorpos Antineoplásicos , Feminino , Seguimentos , Doença Enxerto-Hospedeiro/prevenção & controle , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/mortalidade , Humanos , Separação Imunomagnética , Incidência , Infecções/etiologia , Infecções/mortalidade , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/terapia , Indução de Remissão , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Linfócitos T/imunologia , Linfócitos T/transplante , Transplante Homólogo , Resultado do TratamentoRESUMO
Culex quinquefasciatus have been found to breed in about 29 per cent of the wells in semi-urban area and 14 per cent of the wells in rural areas of Varanasi at one time or other. Majority of such wells are used-ones. Effectiveness of Poecillia reticulata, Esomus danrica and Trichogaster fasciatus in controlling well breeding is evaluated in the present study with successful results.
Assuntos
Culex , Ciprinodontiformes , Peixes , Controle de Mosquitos , Poecilia , Abastecimento de Água , Animais , Índia , LarvaRESUMO
From January 1984 to March 1987, eleven cases of multiple myeloma were registered in the Department of Radiotherapy, Safdarjang Hospital, New Delhi, giving an incidence of more than three cases per year. The cases had age distribution ranging 40-90 years, the youngest being 40 years and oldest 85 years. The majority were in their sixties. Majority were males. Moderate aches and pain either all over the body or confined to a region along with lethargy and weakness were the commonest presenting symptoms. Lytic bone lesions was the commonest complication. One case had cranial nerve involvement.
Assuntos
Mieloma Múltiplo/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
EBV-associated post-transplant lymphoproliferative disease (PTLD) following Alemtuzumab-based allo-SCT is a relatively uncommon and challenging clinical problem but has not received detailed study in a large cohort. Quantitative-PCR (qPCR) monitoring for EBV reactivation post allo-SCT is now commonplace but its diagnostic and predictive value remains unclear. Sixty-nine patients with PTLD following Alemtuzumab-based allo-SCT were studied. Marked clinicopathological heterogeneity was evident; lymphadenopathy was frequently absent, whereas advanced extranodal disease was common. The median viral load at clinical presentation was 49 300 copies/mL (50-65 200 000 copies/mL) and, notably, 23% and 45% of cases, respectively, had îº10 000 and îº40 000 copies/mL. The overall response rate to rituximab as first-line therapy was 70%. For rituximab failures, chemotherapy was ineffectual but DLIs were successful. A four-parameter prognostic index predicted response to therapy (OR 0.30 (0.12-0.74); P=0.009] and PTLD mortality (hazard ratio (HR) 1.81 (1.12-2.93) P=0.02) on multivariate analysis. This is the largest detailed series of EBV-associated PTLD after allo-SCT. At clinical presentation, EBV-qPCR values are frequently below customary thresholds for pre-emptive therapy, challenging current paradigms for monitoring and intervention. A four-point score identifies a proportion of patients at risk of rituximab-refractory disease for whom alternative therapy is needed.
Assuntos
Anticorpos Monoclonais Murinos/uso terapêutico , Antineoplásicos/uso terapêutico , Infecções por Vírus Epstein-Barr/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transtornos Linfoproliferativos/virologia , Condicionamento Pré-Transplante/efeitos adversos , Adulto , Anticorpos Monoclonais Murinos/administração & dosagem , Anticorpos Monoclonais Murinos/farmacologia , Antineoplásicos/administração & dosagem , Antineoplásicos/farmacologia , Estudos de Coortes , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imunoterapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Rituximab , Análise de Sobrevida , Condicionamento Pré-Transplante/métodos , Carga ViralAssuntos
Transplante de Células-Tronco Hematopoéticas , Transfusão de Linfócitos , Transtornos Linfoproliferativos/terapia , Púrpura Trombocitopênica Idiopática/terapia , Condicionamento Pré-Transplante/métodos , Adulto , Humanos , Transtornos Linfoproliferativos/imunologia , Masculino , Púrpura Trombocitopênica Idiopática/imunologiaRESUMO
The healing process in guinea pig skin following surgical incisions was evaluated at the molecular level, in vivo, by the use of Raman spectroscopy. After the incisions were closed either by suturing or by laser tissue welding (LTW), differences in the respective Raman spectra were identified. The study determined that the ratio of the Raman peaks of the amide III (1247 cm(-1)) band to a peak at 1326 cm(-1) (the superposition of elastin and keratin bands) can be used to evaluate the progression of wound healing. Conformational changes in the amide I band (1633-1682 cm(-1)) and spectrum changes in the range of 1450-1520 cm(-1) were observed in LTW and sutured skin. The stages of the healing process of the guinea pig skin following LTW and suturing were evaluated by Raman spectroscopy, using histopathology as the gold standard. LTW skin demonstrated better healing than sutured skin, exhibiting minimal hyperkeratosis, minimal collagen deposition, near-normal surface contour, and minimal loss of dermal appendages. A wavelet decomposition-reconstruction baseline correction algorithm was employed to remove the fluorescence wing from the Raman spectra.
Assuntos
Terapia a Laser/métodos , Fenômenos Fisiológicos da Pele , Análise Espectral Raman/métodos , Cicatrização/efeitos da radiação , Amidas/química , Animais , Colágeno/análise , Procedimentos Cirúrgicos Dermatológicos , Elastina/química , Cobaias , Queratinas/química , Pele/patologia , Técnicas de SuturaRESUMO
Disease relapse following an allogeneic transplant remains a major cause of treatment failure, often with a poor outcome. Second allogeneic transplant procedures have been associated with high TRM, especially with myeloablative conditioning. We hypothesized that the use of reduced-intensity conditioning (RIC) would decrease the TRM. We performed a retrospective national multicentre analysis of 71 patients receiving a second allogeneic transplant using RIC after disease relapse following an initial allogeneic transplant. The majority of patients had leukaemia/myelodysplasia (MDS) (N=57), nine had lymphoproliferative disorders, two had myeloma and three had myeloproliferative diseases. A total of 25% of patients had unrelated donors. The median follow-up was 906 days from the second allograft. The predicted overall survival (OS) and TRM at 2 years were 28 and 27%, respectively. TRM was significantly lower in those who relapsed late (>11 months) following the first transplant (2 years: 17 vs 38% in early relapses; P=0.03). Two factors were significantly associated with a better survival: late relapse (P=0.014) and chronic GVHD following the second transplant (P=0.014). These data support our hypothesis that the second RIC allograft results in a lower TRM than using MA. A proportion of patients achieved a sustained remission even when relapsing after a previous MA transplant.
Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Recidiva Local de Neoplasia/terapia , Sistema de Registros , Condicionamento Pré-Transplante/métodos , Adolescente , Adulto , Idoso , Criança , Doença Enxerto-Hospedeiro , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Transplante Homólogo , Adulto JovemRESUMO
This study aimed to assess the accuracy and agreement between examiners when attempting to identify a single lumbar spinal level using passive intersegmental motion testing, a technique commonly used by physical therapists. Thirty-five adults were examined independently by an experienced and a novice clinician. Each examiner was asked to identify and note the interspace between the fifth lumbar vertebra and the first sacral vertebra, and to mark it. The mark was invisible to the second clinician asked to identify the same lumbar interspace. The true level was then identified by fluoroscopic imaging and was correct in 54-57% of cases. Interobserver agreement was poor. A significant learning effect was found for the experienced examiner, with proportionately more correct levels identified during the second part of the study (79%) when compared to the first (31%). The results show that intersegmental motion testing is a relatively unreliable method of identifying the correct spinal level.
Assuntos
Injeções Espinhais/métodos , Dor Lombar/terapia , Vértebras Lombares/fisiologia , Amplitude de Movimento Articular , Adulto , Idoso , Feminino , Fluoroscopia , Humanos , Injeções Intra-Articulares/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Palpação/métodos , Reprodutibilidade dos TestesAssuntos
Ciática/economia , Ciática/terapia , Analgésicos/economia , Analgésicos/uso terapêutico , Ensaios Clínicos como Assunto , Análise Custo-Benefício , Glucocorticoides/economia , Glucocorticoides/uso terapêutico , Humanos , Injeções Epidurais , Modelos Econômicos , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/métodosRESUMO
Ageing is associated with evidence of immune deficiency and dysregulation. Key changes in the immune system with ageing include a progressive reduction in naive T cell output associated with thymic involution and peripheral expansion of oligoclonal memory T cells. These features are associated with evidence of impaired immune responsiveness both in vitro and in vivo, termed immune senescence. CD4+ CD25+ T cells have recently been recognized as mediators of peripheral immune regulation and play a role in the control of autoimmune and pathogen-specific immune responses. The significance of CD4+ CD25+ regulatory T cells in the context of immunosenescence is not known. We have investigated the number, phenotype and function of CD4+ CD25+ T cells in healthy volunteers over a wide age range. We demonstrate that the number of CD4+ CD25+ and CD4+ CD25high T cells in healthy volunteers increases with age. In both age groups CD4+ CD25+ T cells showed a phenotype consistent with that described for regulatory T cells. Further analysis of CD4+ CD25high T cells in young and elderly donors showed equivalent expression of intracellular CTLA-4 and surface expression of activation markers. In vitro, functional titration assays of CD4+ CD25high T cells demonstrated equivalent regulatory function in both young and elderly donors, with suppression of proliferation and cytokine production in response to polyclonal T cell stimulation. These observations demonstrate an increase in peripheral blood CD4+ CD25high regulatory T cells associated with ageing. The relevance of these expanded cells in relation to the immune senescence seen in the elderly as yet remains unclear.