Assessment of stigma related to visible skin diseases: a systematic review and evaluation of patient-reported outcome measures.

Misconceptions about visible skin diseases are widespread, and patients often face discrimination and stigmatization due to their condition. The associated negative health and psychosocial consequences of stigmatization in skin diseases have prompted an increase in research activity in recent times, resulting in a wide variety of assessment measures. This study aimed at aggregating and evaluating evidence of psychometric properties and methodological quality of published measures to assess stigma in visible skin diseases. Studies assessing stigmatization in visible skin diseases were searched in four databases (Medline, PsycINFO, Web of Science and Embase) until February 2021. The review followed PRISMA guidelines. Papers regarding development and/or validation of measures were identified by two independent researchers. Inclusion criteria were defined as follows: (i) quantitative studies in (ii) populations with skin diseases using (iii) questionnaires explicitly assessing (iv) perceived or public stigmatization or discrimination available in (iv) English or German language. The COnsensus-based Standards of health Measurement INstruments (COSMIN) checklist was used to evaluate their psychometric properties and risk of bias. 35 studies using 21 instruments were identified. Twenty instruments focused on assessing the perceived reality of those affected by visible skin diseases, while public stigma was only assessed by two instruments. Twelve scales could be recommended for use, while nine instruments had the potential to be recommended after further studies have assessed their quality. Some limitations are to be noted. Only studies in English and German were included. Research on self-constructed instruments can lead to new validated instruments, but they were not included in the review at this point. Several validated instruments could be recommended for use. Future research is needed regarding the assessment of stigma across different visible skin diseases, in children and adolescents, and in the general public.

Oral administration of Parabacteroides distasonis antigens attenuates experimental murine colitis through modulation of immunity and microbiota composition.

Commensal bacteria have been shown to modulate the host mucosal immune system. Here, we report that oral treatment of BALB/c mice with components from the commensal, Parabacteroides distasonis, significantly reduces the severity of intestinal inflammation in murine models of acute and chronic colitis induced by dextran sulphate sodium (DSS). The membranous fraction of P. distasonis (mPd) prevented DSS-induced increases in several proinflammatory cytokines, increased mPd-specific serum antibodies and stabilized the intestinal microbial ecology. The anti-colitic effect of oral mPd was not observed in severe combined immunodeficient mice and probably involved induction of specific antibody responses and stabilization of the intestinal microbiota. Our results suggest that specific bacterial components derived from the commensal bacterium, P. distasonis, may be useful in the development of new therapeutic strategies for chronic inflammatory disorders such as inflammatory bowel disease.

Surface modification of polyimide sheets for regenerative medicine applications.

In the present work, two strategies were elaborated to surface-functionalize implantable polyimide sheets. In the first methodology, cross-linkable vinyl groups were introduced on the polyimide surface using aminopropylmethacrylamide. In the second approach, a reactive succinimidyl ester was introduced on the surface of PI. Using the former approach, the aim is to apply a vinyl functionalized biopolymer coating. In the latter approach, any amine containing biopolymer can be immobilized. The foils developed were characterized in depth using a variety of characterization techniques including atomic force microscopy, static contact angle measurements, and X-ray photoelectron spectroscopy. The results indicated that both modification strategies were successful. The subcutaneous implantation in mice indicated that both modification strategies resulted in biocompatible materials, inducing only limited cellular infiltration to the surrounding tissue.

Oral administration of probiotic bacteria (E. coli Nissle, E. coli O83, Lactobacillus casei) influences the severity of dextran sodium sulfate-induced colitis in BALB/c mice.

Our study examined whether repeated preventive oral administration of live probiotic bacterial strains Escherichia coli O83:K24:H31 (Ec O83), Escherichia coli Nissle 1917 O6:K5:H1 (Ec Nis) and Lactobacillus casei DN 114001 (Lc) can protect mice against dextran sodium sulfate (DSS)-induced colitis. A significant decrease in average symptom score was observed in Ec O83-, Ec Nis- and Lc-pretreated group (p < 0.05). Significant differences in body mass loss between Lc pretreated mice with DSS-induced colitis were found when compared with nontreated mice (p < 0.05). PBS pretreated mice had a significantly shorter colon than Ec O83-, Ec Nis- and Lc-pretreated mice (p < 0.05). Administration of Lc significantly decreased the severity of DSS induced histological marks of inflammation (p < 0.05). A significant difference (p < 0.05) was also found in specific IgA level against given probiotic in enteral fluid between colitic mice and healthy mice pretreated with Ec 083 and Ec Nis.

Abnormal differentiation of thymocytes induced by free cyclosporine is avoided when cyclosporine bound to N-(2-hydroxypropyl)methacrylamide copolymer carrier is used.

BACKGROUND: The side effects of cyclosporine (CsA)-including nephrotoxicity and abnormal differentiation of thymocytes developing in the thymus-can be decreased or even avoided using targeted conjugates of CsA, where both targeting moiety and drug are bound to water-soluble polymeric carrier based on N-(2-hydroxypropyl) methacrylamide (HPMA). METHODS: Irradiated, syngeneic bone marrow transplanted-mice (BALB/c and A/Ph) were treated intraperitoneally for 4 weeks with 20 mg/kg of free CsA, HPMA-conjugated CsA, or antibody-targeted HPMA-bound CsA. Immunohistology of the thymus was performed together with two-color flow cytometry to detect the effect of different forms of CsA on individual thymocyte subpopulations. RESULTS: . We have shown that free CsA strongly abrogated T-cell development. The appearance of mature thymocytes expressing CD3(high) is almost completely inhibited (1.8%) after free CsA treatment, whereas these cells are well detectable in controls (22%) and HPMA polymer-bound CsA-treated animals (19%). Immunohistological studies have shown acellular rests of the medulla after free CsA treatment, whereas well-stained medullary thymocytes were detected in controls and after exposure to antibody-targeted HPMA. conjugated CsA. CONCLUSIONS: HPMA-conjugates of CsA are generally more specific in their targeting to T lymphocytes. It was found that nonspecific binding of CsA to erythrocytes and plasma lipoproteins is significantly reduced using anti-CD3 targeted, HPMA polymer-bound CsA In addition, the entry of these macromolecules into the thymus is limited-probably due to the blood-thymus barrier-and HPMA conjugates of CsA, unlike free drug, do not abrogate T-cell development in bone marrow transplanted mice.

Failure to detect the presence of pluripotential haemopoietic stem cells in the mouse brain.

Single cell suspensions prepared from adult mouse brains were tested for the presence of pluripotential haemopoietic stem cells (colony-forming units, CFU) by transfer into an irradiated recipient and enumeration of the CFU in the recipient's spleen. In contrast to the findings of others (Bartlett, 1982), we did not detect CFU after injection of brain cell suspensions, although they were detectable after inoculation with bone marrow cells. The number of CFU in recipients after transfer of increasing numbers of brain cells was the same as that detected in the irradiated controls which had not received any transferred cells. Finally, cells from the brain, in contrast to bone marrow cells, were not able to protect recipient animals from the effects of lethal irradiation.

Cellular expression of the cytolytic factor in earthworms Eisenia foetida.

Coelomic fluid of earthworms contains a 42 kDa protein designated CCF-1 (coelomic cytolytic factor 1), which accounts for approximately 40% of cytolytic activity of the entire coelomic fluid. CCF-1 was documented to be present on cells of the mesenchymal lining of the coelomic cavity as well as on free coelomocytes. Both cellular and humoral levels of CCF-1 were significantly increased after parenteral injection of endotoxin. Moreover, CCF-1 seems to be involved in cell mediated cytotoxicity, because cytotoxic activity is blocked in the presence of anti-CCF-1 monoclonal antibody (mAb).

Detection of antigen in the coelomocytes of the earthworm, Eisenia foetida (Annelida).

Earthworms, Eisenia foetida, are able to respond to antigenic stimulation by the formation of the antigen-binding molecules by coelomocytes--the effector cells of annelids' defence reactions. The ability to react with gold-labelled antigen was detected in agranular coelomocytes by electron microscopy. Furthermore, flow cytometry analysis used for quantitative evaluation of antigen binding showed significant increase of both antigen-binding cells and the amount of antigen bound per cell after stimulation. The antigen binding was inhibited by preincubation of cells with several similar proteins, although the most potent inhibitor was the immunizing antigen.

A new approach to in vitro studies of antigenic response in earthworms.

A method for in vitro cultivation of earthworm gut wall tissue explants is described. Tissue explants are able to respond to protein antigen by secretion of antigen-binding protein into the culture medium. Large irregular cells and round-shaped cells are released from tissue explants during the cultivation. This method represents an advantageous tool for in vitro studies providing the possibility of parallel assays from the same donor.

The influence of a colonic microbiota on HPMA copolymer lectin conjugates binding in rodent intestine.

Germ-free (GF) animals lack a colonic microflora like that seen in conventional (CV) animals. Bacterial presence plays a role in the development of glycoproteins in the gastrointestinal (GI) tract; the absence of a microbiota has been seen to suppress the production of certain glycoproteins and glycolipids. Binding patterns of lectins are modified when glycoprotein structures are altered (e.g., during development or disease). Little information on lectin binding patterns in mature GF animals is available. We examined the binding of free and N-(2-hydroxypropyl)methacrylamide (HPMA) copolymer-conjugated fluorescein isothiocyanate (FITC)-labeled wheat germ agglutinin (WGA) [P(HPMA)-(WGA-FITC)] and FITC-labeled peanut agglutinin (PNA) [P(HPMA)-(PNA-FITC)] in CV and GF mouse colon with and without neuraminidase pretreatment. Anti-Thomsen-Friedenreich (TF) antigen (a development and disease-related glycoprotein) antibody binding was also examined in these tissues. Subtle differences were seen in the binding patterns between CV and GF animals. CV animals showed strong P(HPMA)-(WGA-FITC) binding in goblet cells, but minimal P(HPMA)-(PNA-FITC) binding was visible. In GF animals, luminal surface binding of P(HPMA)-(WGA-FITC) was visible, and goblet cell binding of P(HPMA)-(PNA-FITC) was seen. These subtle changes suggest that altered glycoprotein expression occurred under GF conditions.

Experimental ablation nephropathy. Fine structure, morphometry, cell membrane epitopes, glomerular polyanion and effect of subsequent transplantation.

The subtotal (5/6) nephrectomy performed in 23 adult female rats induced severe hypertrophy of residual parenchyma with interstitial fibrosis, tubular dilatation, and focal and segmental glomerulosclerosis (FSG). This ablation nephropathy (AbN) caused proteinuria, progressive renal failure, and hypertension. The extent of FSG was assessed by semiquantitative scoring. The ultrastructure revealed widespread foot process fusion, many dense cytoplasmic inclusions in podocytes, and degenerative changes or disruption of mesangium with glomerular "microcysts". Numerous granular deposits of rat Ig were seen in the glomeruli but a short praeterminal i.v. load by heat-aggregated human Ig did not alter the morphology of AbN and produced discrete and inconstant glomerular deposits. Similarly an i.v. injection of protamine and heparin generated protamine-heparin complexes seen in various layers of glomerular capillary wall, similar to those found previously in normal rats. AbN displayed a partial irregular depletion of polyanion sites reactive with polyethylenimine in lamina rara externa. A significant increase in both glomerular and interstitial Ia+ cells and a marked predominance of W3/25+ cells in the interstitial infiltrates were documented by immunohistochemistry in the remnant kidneys. Both AbN and FSG could be largely corrected (or prevented?) by subsequent syngeneic renal transplantation (TPL; 6 animals). On the other hand a severe AbN was found in two post-ablation residues after unsuccessful TPL with graft necrosis or sclerosis.--AbN has some analogies to various chronic human nephropathies (e.g. FSG) and may explain their progression to the terminal failure. Degenerative and finally destructive mesangial lesion seems to be of prime importance in AbN.

Ultrastructural immunohistochemistry of glomerulonephritis in needle biopsy.

In two patients with glomerulonephritis (GN) IgG and C 3 were visualized in ultrastructure by means of HRP-conjugated antisera. The first patient had an acute postinfectious extra-intracapillary GN lasting for about two months with granular fluorescence of anti-IgG, -C 3, and -C 1q. Electron microscopy revealed widespread endothelial defects, a well-pronounced polymorphonuclear stasis, and typical perimembranous "humps". These deposits reacted with HRP-anti-C 3 but the ultrastructural proof of IgG was negative. A weak and sporadic reaction of both these conjugates was seen in the swollen mesangial matrix while intraluminal plugs of coagulated plasma and extracapillary exudates yielded a dense coarse reaction product. In the second patient (allograft, three years after transplantation) the membranous and proliferative probably recurrent GN with nephrotic syndrome showed massive perimembranous deposits in the late involution stage. Granular fluorescence of the main Ig classes and of C 3 was sporadic or absent. In the ultrastructural immunoenzyme assay, too, the residues of deposits failed to react with HRP-anti-IgG or -C 3 and the mesangial matrix harboured only sporadic foci of faint positivity; however, dense product was again seen in capillary plasmatic "microthrombi". The discrepancy between immunofluorescence microscopy and immunoenzyme histochemistry, noted also by others in experimental glomerulopathies, may reflect the instability and dynamic properties of immune deposits with an early loss of antibody reactivity and a more protracted though not persistent local activation of complement. In light microscopy, fluorescent granules may correspond not only to the sites of immune deposition but also to accidental intracapillary plasma precipitates.

Protein aggregates in extracorporally perfused rabbit kidneys.

Eighteen rabbit kidneys were perfused ex vivo for 1 h with allogeneic blood, and in 16 a solution of xenogeneic aggregate-free, aggregated or antibody-complexed protein was added to the perfusate 5 min after the start (human immunoglobulins or serum albumin, partly cationized, were used). The kidneys were examined by light and electron microscopy and the human and rabbit immunoglobulin (or albumin) precipitates were detected by direct immunofluorescence and ultrastructural immunohistochemistry. In 13 kidneys the perfusion produced small segmental glomerular endocapillary aggregates of platelets, leukocytes, and granular precipitates reactive with both anti-rabbit and anti-human antibodies. No typical deposits were seen in mesangium or in periphery of glomerular capillaries but rabbit Ig penetrated to the inter- and subepithelial spaces of proximal convoluted tubules. Three kidneys perfused by cationized aggregated human Ig (or by cationized albumin-antialbumin complexes) exhibited a destructive lesion with rapid breakdown of blood flow and massive global endocapillary plugs of similar ultrastructure but with focal endothelial sloughing. Pericapillary granular precipitates of human and rabbit Ig were seen in these kidneys. When the blood with cationized Ig aggregates was used for perfusion of two further kidneys extensive endocapillary aggregates with endothelial damage reappeared but the extracapillary penetration and precipitation were lacking and the blood flow largely improved. Membrane polyanion of podocytes stained by colloidal iron was preserved even in close proximity of cationized complex precipitates. Thus, in the ex-vivo perfusion model the preformed neutral aggregates did not penetrate through the glomerular capillary wall and were not phagocytized by mesangial cells. The cationized aggregates induced rapid circulatory failure with massive platelet clumping and granular pericapillary "humps" ultrastructurally different from the deposits of human and experimental immune complex glomerulonephritis.

Wegener's granulomatosis with bilateral necrotizing scleritis, polyarthritis and renal failure efficiently treated with immunosuppressive therapy.

A case report of a female patient with Wegener's granulomatosis is presented. After an initial involvement of the upper respiratory tract in the form of a sinusitis, there followed a severe necrotizing bilateral scleritis necessitating the enucleation of the left eye ball. Renal involvement developed as late as 24 months after the onset of the disease and led to renal failure within three months. Throughout the duration of her disease, the patient had joint symptoms in the form of episodes of migratory nondeforming polyarthritis. The administration of corticosteroids alone in daily doses up to 60 mg prednisone failed to control the progression of the disease, while immunosuppressive therapy with cyclophosphamide combined with methylprednisolone pulse therapy and haemodialysis resulted in a marked improvement of renal function and in the subsidence of the ocular and articular symptoms.

Different handling of antigen by macrophages of low-responder C57BL/10ScSn strain and high-responder A/J strain of mice. II. Antigen uptake.

The uptake of 51Cr-SRBC and 125I-ARS-BG6 in the liver and spleen of non-immune low IgG responder C57BL/10ScSn mice is higher than in the high-responder A/J strain. After immunization with SRBC, the uptake in the spleen of A/J mice is ten times higher and that in the liver three times higher than in C57BL/10ScSn mice. The higher uptake of the well responding A/J strain, which is antigen specific, is due not only to a higher level of opsonizing antibodies. Endotoxin stimulation, which increases the IgG formation of the low-responding strain, does not increase the uptake in this strain. In the low-responder strain there is a considerable level of free 51Cr in the serum and kidney within 5 min after antigen injection, suggesting a high catabolic rate of the antigen. In contrast, at that time in the A/J strain virtually all of the radioactivity is still bound to the erythrocyte fraction. Ultrastructural observations suggest that in the low-responding strain the antigen residues survived in macrophages for a long period of time. The results provide evidence of differences between the metabolic activity of macrophage populations of both strains which could be related to the low IgG response of the strain C57BL/10ScSn.

Detection of thymosin 5 in calf and mouse thymus and in nude mouse dysgenetic thymus.

Thymosin 5 was traced in calf and mouse thymuses by fluorochrome-labelled rabbit anti-calf thymosin. The presence of thymosin 5 or its individual components was found 1. in groups of cortical epithelial cells in calf thymuses and in single cortical epithelial cells in mouse thymuses. 2. In some marginal (blastema) cells of the thymus cortex of calves and 14-day-old mice. 3. In perivascular epithelial cells of the calf thymus. 4. In occasional medullary epithelial cells of the calf and mouse thymus. In all cases there was a marked alternation of entirely negative and positive cell-containing thymic lobuli. In 4 of 13 cases comparatively strong positivity was found in tightyly arranged epithelial cells in an individual acinus in the dysgenetic thymus of nude mice, the positive cases being concentrated among the youngest mice studied.

Evaluation of community dental health curricula by baccalaureate dental hygiene graduates.

Three groups of University of Iowa dental hygiene graduates, designed as the Traditional, Transitional, and Experimental Groups, who experienced three types of curricula with increasingly greater emphasis on community dental health were surveyed. The purpose of the study was to determine the correlation between curricular emphasis in community dental health and graduate's perceptions of the adequacy of their educational preparation for public health employment, the percentage employed in public health programs, and their interest in pursuing public health employment in the future. 1. The results of the survey indicated that curricular emphasis was associated with graduates' perceptions of adequacy for public health roles. Specific findings of the study included: a. a greater percentage of the Experimental Group perceived that their education prepared them for state, county, and local public health employment. b. a greater percentage of the Transitional and Experimental Groups perceived and that their education prepared them for employment in elementary and secondary schools. 2. Curricular emphasis did not appear to affect employment patterns of this group of graduates. Public health employment experiences were not significantly different among groups. 3. Interest in future public health employment was affected by curricular emphasis. Findings indicated that a significantly greater percentage of Experimental subjects were interested in future employment positions in state, county, and local public health systems, hospitals, and dental hygiene programs.

Ultrastructure of rat aortic grafts.

This study compares the ultrastructure of three syngeneic and three allogeneic grafts of rat abdominal aorta (Lewis to Lewis and BN to Lewis, respectively); the tissue was sampled three months after transplantation (TPL). The endothelial plate was preserved and mononuclear cell adherence was absent. In syngeneic grafts the intima and media remained close to normal with well-preserved smooth muscle cells (SMC). The thickened allograft neointima consisted of elongated spindle cells and rich intercellular matrix. The cells were typical SMC without apparent signs of dystrophy or degeneration. On the other hand, most SMC of the media showed complete disruption and disorganization of membrane and organelles suggestive of accomplished necrosis. However, the framework of elastic lamellae was preserved, without apparent ruptures or lytic changes. Intraintimal migration of medial SMC was not recorded while some cytoplasmic strips were seen to extend across the outer elastic lamella (possible rudimentary outgrowth of SMC?). Lymphocytes and histiomonocytic cells (macrophages) were found in the adventitia but not in the destroyed media. Thus electron microscopy elucidated the histological picture of "anuclear allograft media" and confirmed the predominance of SMC in the thickened neointima. However, signs of the mediointimal SMC invasion were not apparent three months post TPL.

Phagocytosis of protamine-heparin aggregates by mouse peritoneal exudate cells.

Protamine--heparin aggregates (PHAg's) were injected intraperitoneally into thioglycollate-prestimulated mice, peritoneal exudate cells, chiefly macrophages (M phi's) being collected after 2, 15 and 60 min, 6 h, and 30 h for electron microscopy and histochemistry. An intensive phagocytosis of PHAg's was seen even after 5 min and extracellular spaces were cleared of them after 60 min. The less rapid intracellular digestion and breakdown of PHAg's were accompanied by a gradual disappearance of their outer mucopolysaccharide layer. In vitro phagocytosis (60 min in MEM) proceeded in a similar way but more slowly. Coating of PHAg's with immunoglobulin was documented in vitro by ultrastructural enzyme immunocytochemistry. Thus the exudate M phi's are capable of rapid and efficient ingestion of PHAg's which is probably supported in vivo by the interaction of PHAg surface with some exudate components. On the other hand, the intracellular digestion of PHAg's, especially of their mucopolysaccharide shell, is far more protracted.

Morphology and immunohistochemistry of rat aortic grafts.

Allotransplantation (TPL) of the abdominal aortic segments of BN donors was performed in 32 Lewis recipients with or without cyclosporin A (CyA) immunosuppression, and the vascular changes were compared to those of 10 syngeneic grafts (Lewis-->Lewis) and to the autologous rat aortae. The vessels were examined 2, 3, 4 and 5 months post TPL by light microscopy, the thickness of intima and media was measured morphometrically and the cell infiltration of adventitia and intima was assessed semiquantitatively. Thirty-six aortae were examined by three-step enzyme immunohistochemistry (proof of selected differentiation, proliferation, cytoskeletal and connective tissue matrix antigens). The adventitia displayed an intense focal and scattered mononuclear cell infiltration; it was more discrete and focal in the intima. This cellularity persisted in the allografts but disappeared from the intima and was reduced in the adventitia of the isografts after four and five months. Disseminated ED1+ activated macrophages were the most prominent population of infiltrates whereas modest numbers of adventitial ED2+ tissue macrophages remained constant throughout the intervals examined. CD4+ cells (focal and scattered) outnumbered (roughly twice) the scattered CD8+ lymphocytes; both these types were rare in the intima. Leukocyte invasion of the media was lacking (except for scarce isolated CD8+ cells in some allografts). In syngeneic grafts the smooth muscle cells (SMC) of media remained intact and the intimal thickening was slight to absent (about 5 microns) four and five months post TPL. On the other hand, the allograft media underwent severe destructive changes (karyolysis, depletion of alpha-SMC actin, focal calcification and general thinning without rupture or aneurysm). The prominent allograft intimal thickening (70-80 microns) was due to the proliferation of longitudinally oriented myointimal cells (alpha-SMC actin, FD2, PCNA and Ki67+) and an increase in matrix substance (strong metachromasia and positivity of chondroitin-sulfate proteoglycan). The deposition of lipids remained discrete, without atheromatous plaques and mural thrombosis. All changes were comparable in CyA-treated and untreated animals. Thus the main lesions of the allografts were (i) persistent mononuclear infiltration chiefly in adventitia, (ii) destruction of medial SMC, and (iii) intimal thickening by proliferation of myointimal cells. At the postTPL intervals examined the proliferation and intimal migration of medial SMC were not apparent and a morphological correlate of significant anti-medial-SMC cytotoxic attack was lacking.