SerpinB2 deficiency modulates Th1/Th2 responses after schistosome infection.

SerpinB2, also known as plasminogen activator inhibitor type-2, is a major product of macrophages and is upregulated during many infections. Although SerpinB2 inhibits urokinase plasminogen activator in vitro, evidence that this represents its physiological role in vivo is not compelling. We have recently shown that SerpinB2-/-mice generate enhanced Th1 responses after immunization with a Th1 immunogen. Herein,we show that Schistosoma japonicum granulomas induced liver SerpinB2 mRNA expression by >600-fold in wild-type mice. In SerpinB2-/- mice, worm and egg burden, and granuloma number and volume were unaffected. However, granulomas in these mice were associated with reduced fibrosis (as determined by Sirius red staining and image analysis) and increased iNOS, IL-6, IL-10 and TNFa and decreased Arg 1 and IL-13 mRNA expression. SerpinB2-/- mice immunized with soluble egg antigen (SEA) also showed reduced levels of SEA-specific IgG1. SerpinB2 deficiency thus promoted certain Th1 and reduced certain Th2 responses in response to this Th2 immunogen.

Immunopathogenesis of human schistosomiasis.

Schistosomiasis continues to be a significant cause of parasitic morbidity and mortality worldwide. This review considers the basic features of the pathology and clinical outcomes of hepatointestinal and genitourinary schistosomiasis, presents an overview of the numerous studies on animal models that have clarified many of the immunopathological features, and provides insight into our current understanding of the immunopathogenesis and genetic control of human schistosomiasis. In murine schistosomiasis, pathology is induced by a CD4(+) Th2 driven granulomatous response directed against schistosome eggs lodged in the host liver. The Th2 cytokines IL-4 and IL-13 drive this response, whereas IL-10, IL13Ralpha2, IFN-gamma and a subset of regulatory T-cells act to limit schistosome induced pathology. A variety of cell types including hepatic stellate cells, alternatively activated macrophages and regulatory T-cells have also been implicated in the pathogenesis of schistosomiasis. Current knowledge suggests the immunopathogenic mechanisms underlying human schistosomiasis are likely to be similar. The review also considers the future development of anti-pathology schistosome vaccines. As fibrosis is an important feature of many other diseases such as Crohn's disease and sarcoidosis, a comprehensive understanding of the cellular and molecular mechanisms involved in schistosomiasis may also ultimately contribute to the development an effective disease intervention strategy for other granulofibrotic diseases.

Parathyroid cysts.

Parathyroid cysts are a rare cause of primary hyperparathyroidism. A case is presented of a 25-year-old black man who presented with hyperparathyroidism and at operation was found to have a 2.5 cm parathyroid cyst at the left inferior position. The cyst contained clear fluid, and the wall was thickened and composed of hyperplastic parathyroid tissue. The remaining glands were smaller but also hyperplastic. Subtotal parathyroidectomy was performed. This case presents many of the typical features of parathyroid cysts. The pertinent literature is reviewed. Parathyroid cysts present as two distinct groups, functioning and nonfunctioning. The former are more common in men, and the cyst is more likely to be secondary to degenerative changes in a hyperplastic gland. In contrast, nonfunctioning parathyroid cysts are more common in women and present as neck masses or incidental findings at operation. The different proposed etiologies for parathyroid cysts are discussed. Preoperative diagnosis is rare but important as it may prevent an unnecessary neck exploration or thyroidectomy. The diagnosis should be suspected with any cystic neck mass that yields clear fluid on aspiration, especially if it is in the inferior position. The fluid should be submitted for parathormone evaluation. Aspiration alone has been curative in some cases.

Spontaneous abdominal aortic infections. Essentials of diagnosis and management.

The spectrum, pathogenesis, and changing bacteriology of spontaneous abdominal aortic infections is presented. The classic presentation includes fever, positive blood cultures, and a pulsatile abdominal mass. However, most essential in the preoperative diagnosis is having a high index of suspicion. The bacteriologic spectrum is changing, with Salmonella now being the most common organism cultured. Principles of management include aggressive antibiotic therapy, excision of infected tissue, and extra-anatomic bypass. Long-term follow-up for late complications is important. With early recognition and aggressive combined medical and surgical management, increasing numbers of survivors are being reported.

Epidemiologic study of pulmonary obstruction in workers occupationally exposed to ethyl and methyl cyanoacrylate.

The association between pulmonary obstruction (e.g., asthma) and occupational exposure to methyl cyanoacrylate (MCA) and ethyl cyanoacrylate (ECA) was examined in an occupational cohort of 450 persons at an adhesive production facility in Puerto Rico. Employee medical records containing information on physical examinations and pulmonary function tests (PFTs), as well as occupational histories, on each employee over a period of about 17 yr and industrial hygiene measurements were evaluated. The cohort analysis was based on a Cox proportional hazards model. Workers exposed to ECA or MCA were compared to workers unexposed to these chemicals with respect to their risk of becoming an "incident case." An "incident case" was defined as any person whose PFTs were normal at the time of employment, but later demonstrated an obstructive pattern, which was defined as a decline in the ratio of forced expiratory volume exhaled in 1 s to forced vital capacity (FEV1/FVC) below 70%. A separate case-control analysis was also conducted that compared "suspected cases," defined as all those whose PFTs ever demonstrated an obstructive pattern (e.g., asthma), to persons whose PFTs remained within normal limits throughout their employment with respect to their past peak and cumulative exposures to cyanoacrylates. All of these analyses showed no evidence that exposure to average short-term concentrations of ECA or MCA of less than 0.5 ppm and occasional daily peak exposures of at least 1.5 ppm (usually 10 min or less), with occasional higher concentrations during spills, were associated with an increased risk of pulmonary obstruction. However, the study suggested that persons occupationally exposed to cyanoacrylates were more likely to have some reversible eye or upper airway irritation than persons who were unexposed.

Chronic sorrow in multiple sclerosis. A case study.

Multiple sclerosis, one of the most common chronic disabilities among young adults, may potentiate the occurrence of chronic sorrow. Chronic sorrow differs from acute grief because it is permanent, periodic, and progressive in nature; it may be a normal component of chronic illness and disability. This study describes one woman's experience with multiple sclerosis, her chronic sorrow about the trajectory of her disability, her progressive loss of bodily function, and the stigma of chronic illness. It also reports some of the feelings experienced by her husband, the primary caregiver.

Coping with chronic sorrow.

This qualitative study was designed to examine the presence of chronic sorrow in diverse populations of individuals with chronic or life threatening conditions and to identify strategies for coping with feelings of chronic sorrow. Chronic sorrow was defined as a pervasive sadness that is permanent, periodic, and progressive in nature. The sample comprised 5 infertile couples, 10 individuals with long-term cancer, 10 individuals with multiple sclerosis, 6 individuals with Parkinson's disease, and 4 spouse caregivers. Data were collected through audiotaped face-to-face or telephone interviews using the Burke/NCRCS Chronic Sorrow Questionnaire. The audiotapes were transcribed, entered into a computer analysis program, and collaboratively analyzed by the researchers. The findings indicate that 83% of the subjects experienced chronic sorrow. The four coping strategies that were identified by the subjects as being helpful to their situation were categorized by the researchers as interpersonal, emotional, cognitive, and action.

Middle-range theory of chronic sorrow.

PURPOSE: To introduce a middle-range nursing theory of chronic sorrow that presents this sorrow as a normal response to ongoing disparity due to loss. Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss. The theory provides a framework for understanding and working with people following a single or ongoing loss. ORGANIZING FRAMEWORK: The model of chronic sorrow includes antecedents, trigger events, and internal and external management methods. SCOPE: Theory is useful for analyzing individual responses of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of the "perfect" child, or bereavement. SOURCES: The theory was developed using concept analysis, critical review of research, and validation in 10 qualitative studies of various loss situations. CONCLUSIONS: Chronic sorrow has been shown to explain the experience of people across the lifespan who encounter ongoing disparity because of significant loss. Nurses need to view chronic sorrow as a normal response to loss and, when it is triggered, provide support by fostering positive coping strategies and assuming roles that increase comfort.

Airborne concentrations of ethyl and methyl cyanoacrylate in the workplace.

A survey was conducted of persons who manufacture, mix, bottle, and package methyl 2-cyanoacrylate (MCA) and ethyl 2-cyanoacrylate (ECA). Airborne concentrations of these cyanoacrylates also were measured during waste-handling operations. During a 1-week period, 162 personal and area samples were collected. About 90% of the samples were analyzed for ECA (the predominant adhesive being manufactured at the facility). About 50% of the samples were collected during periods of 15 min or less, the remainder for 15 to 240 min. Some 8-hour time-weighted average (TWA) samples also were collected. Samples were collected using Tenax tubes with subsequent analysis by high-performance liquid chromatography. Most samples were collected where highest exposure was likely (e.g., during mixing, bottling, and packaging). Peak concentrations of exposure (duration of 15 min or less), measured during a variety of tasks, ranged from 0.003 to 1.5 ppm. In particular, personal mean short-term airborne concentrations of ECA for the mixing operators ranged from 0.039 ppm to 0.650 ppm, while various 10-min to 1-hour activities were performed, with a TWA concentration of 0.07 ppm. Personal short-term airborne concentrations of ECA for bottling and packaging workers (n = 60) were 0.040 ppm +/- 0.016 ppm (mean +/- standard deviation), with similar 8-hour TWA concentrations due to the continuous nature of bottling and packaging. Other personal samples were not significantly different. The area samples were normally within a factor of 2 of the peak personal sampling results. These data indicate that, when handled at room temperature and relative humidity ranging from 40-69%, both MCA and ECA produce airborne concentrations that are nearly always less than about 0.1 ppm, which is less than the threshold of irritation.

Establishing a long-distance research consortium.

With the increased emphasis on the generation of nursing knowledge through research, collaboration has been identified as an effective way of maximizing both personal and financial resources. There are few articles that specifically describe the process for initiating such a collaborative effort, especially when interested persons are far removed, geographically, from one another. This paper outlines the steps involved in establishing a research consortium and chronicles the development of the Nursing Consortium for Research on Chronic Sorrow. Lancaster's (1985) criteria for effective research collaboration are used to evaluate this developmental process.

Splenic salvage techniques in the management of pseudocysts of the spleen.

Nonparasitic splenic pseudocysts are an uncommon late sequela of splenic trauma. These cysts presumably develop from previously unrecognized subcapsular splenic hematomas. Classical therapy for splenic pseudocysts has been splenectomy. However, the recent recognition of the postsplenectomy sepsis syndrome has led to methods of surgical management that salvage the remainder of the spleen.

Chronic sorrow: a lifespan concept.

Losses are an integral part of chronic illness and disability. The term chronic sorrow, has been used to describe the long-term periodic sadness the chronically ill and their caregivers experience in reaction to continual losses. In this conceptual analysis of chronic sorrow, identified critical attributes are: cyclic sadness over time in a situation with no predictable end; external and internal stimuli triggering the feelings of loss, disappointment, and fear; and, progression and intensification of the sadness or sorrow years after the initial disappointment or loss. Model, borderline, related, contrary, and illegitimate cases illustrate what the concept is and what it is not. The meaning of chronic sorrow is compared to the meaning of unresolvable grief and depression. Chronic sorrow in various stages of life is illustrated in descriptions of: the situation and feelings of parents of handicapped children; multiple sclerosis patients in the middle, productive years; and elderly caregivers of spouses with dementia. Implications for research include the need to study the concept in various populations to determine its prevalence and operation. Through research, the meaning of the concept can be further clarified. This is a beginning step toward developing nursing theory that will give direction for providing care to persons encountering sadness over long periods of time.