Diplomate in Medical Laboratory Immunology Certification Examination: A New Chapter for Medical Laboratory Immunology.

It is indeed a privilege to be an immunologist in what is arguably the golden age of immunology. From astounding advances in fundamental knowledge to groundbreaking immunotherapeutic offerings, immunology has carved out an enviable niche for itself in basic science and clinical medicine. The need and the vital importance of appropriate education, training, and certification in clinical immunology was recognized by the World Health Organization as far back as 1972. In the United States, Ph.D. scientists with board certification in medical laboratory immunology have served as directors of high-complexity Clinical Laboratory Improvement Amendments- and College of American Pathologists-certified clinical immunology laboratories since 1977. From 1977 to 2017, board certification for medical laboratory immunology was administered by the American Society for Microbiology through the American Board of Medical Laboratory Immunology examination. The American Board of Medical Laboratory Immunology examination was phased out in 2017, and in the fall of 2019, the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) examination committee took on the responsibility of developing a new doctoral-level certification examination for medical laboratory immunology. This transition to the ASCP BOC represents a well-deserved and much-needed recognition of the rapid advances in and the highly specialized nature of medical laboratory immunology and its ever-increasing relevance to patient care. This new ASCP BOC certification is called the Diplomate in Medical Laboratory Immunology, and, as of April 1, 2023, it is now available to potential examinees. In this report, we describe the examination, eligibility routes, and potential career pathways for successful diplomates.

Guided Imagery for Total Knee Replacement: A Randomized, Placebo-Controlled Pilot Study.

OBJECTIVES: To determine the effect of guided imagery (GI) on functional outcomes of total knee replacement (TKR), explore psychological and neuroimmune mediators, and assess feasibility of study implementation. DESIGN: Investigator-blinded, randomized, placebo-controlled pilot study. SETTINGS: Hospital, surgeon's office, participant's home. PARTICIPANTS: 82 persons undergoing TKR. INTERVENTIONS: Audiorecordings of TKR-specific GI scripts or placebo-control audiorecordings of audiobook segments. OUTCOME MEASURES: Gait velocity and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Function scale. RESULTS: Outcomes for 58 participants (29 receiving GI and 29 controls) were analyzed at 6 months after surgery. The most frequent reason for noncompletion was protocol-driven exclusion at 6 months for having the contralateral knee replaced before the study endpoint (n = 15). With imaging ability as a moderator, gait velocity, but not WOMAC Function score, was significantly improved at 6 months in the GI group. Participants in the GI group, but not the control group, had lower WOMAC Pain scores at 3 weeks after surgery than at baseline. Hair cortisol concentration was significantly lower at 6 months after surgery than at baseline in the GI group but not the control group. GI group participants had lower treatment adherence but greater treatment credibility than the control group. CONCLUSION: Randomized controlled trials of GI in the TKR population are feasible, but inclusion/exclusion criteria influence attrition. Further studies are needed to elaborate this study's findings, which suggest that guided imagery improves objective, but not patient-reported, outcomes of TKR. Hair cortisol concentration results suggest that engagement in a time-limited guided imagery intervention may contribute to stress reduction even after the intervention is terminated. Further investigation into optimal content and dosing of GI is needed.

Human Immunodeficiency Virus Diagnostic Testing: 30 Years of Evolution.

A concern during the early AIDS epidemic was the lack of a test to identify individuals who carried the virus. The first HIV antibody test, developed in 1985, was designed to screen blood products, not to diagnose AIDS. The first-generation assays detected IgG antibody and became positive 6 to 12 weeks postinfection. False-positive results occurred; thus, a two-test algorithm was developed using a Western blot or immunofluorescence test as a confirmatory procedure. The second-generation HIV test added recombinant antigens, and the third-generation HIV tests included IgM detection, reducing the test-negative window to approximately 3 weeks postinfection. Fourth- and fifth-generation HIV assays added p24 antigen detection to the screening assay, reducing the test-negative window to 11 to 14 days. A new algorithm addressed the fourth-generation assay's ability to detect both antibody and antigen and yet not differentiate between them. The fifth-generation HIV assay provides separate antigen and antibody results and will require yet another algorithm. HIV infection may now be detected approximately 2 weeks postexposure, with a reduced number of false-positive results.

Genistein-modified poly(ethylene oxide)/poly(D,L-lactic acid) electrospun mats with improved antioxidant and anti-inflammatory properties.

Genistein is a phytochemical with a broad range of desirable biological activity for wound healing. However, its poor bioavailability requires developing a new method for fabricating an appropriate carrier vehicle to deliver genistein in a sustained manner. Based on the guidance afforded by the ternary phase diagram of poly(D,L-lactic acid) (PDLLA), poly(ethylene oxide) (PEO), and genistein blends, certain selective compositions were electrospun. We obtained a uniformly smooth surface morphology in unmodified and genistein-modified PEO/PDLLA fibers, documented by scanning electron microscopy. Moreover, wide-angle X-ray diffraction and 1H NMR studies revealed that the genistein molecules, successfully incorporated in the blends, remained chemically stable after electrospinning. Besides surface wettability and dimensional stability of the electrospun mats, the released genistein amount has been evaluated as a function of PEO concentration. Our biocompatibility investigations suggest that genistein-modified PEO/PDLLA electrospun mats exhibit strong antioxidant and anti-inflammatory activities which indicate they have potential applications for wound dressings.

Should interferon gamma release assays become the standard method for screening patients for Mycobacterium tuberculosis infections in the United States?

The Centers for Disease Control and Prevention recently published updated guidelines for the use of interferon gamma release assays (IGRAs) to detect Mycobacterium tuberculosis. This document gives a balanced analysis of the strengths and weaknesses of IGRAs. To date, these assays have not been widely adopted in the United States by clinical laboratories. We have asked two experts, Thomas Alexander of Summa Health Care, who has adopted an IGRA for M. tuberculosis detection in his laboratory, and Melissa Miller of UNC Hospitals, who has evaluated one but has not chosen to adopt it, to explain how each reached this decision based on their experience with the test and the data that have been published concerning IGRA.

Immunologic function in the elderly after injury--the neutrophil and innate immunity.

BACKGROUND: Aging is associated with a decline in immune function. This may contribute to decreased ability of an elderly patient to mount an appropriate innate inflammatory response when injured. This study examined elderly trauma patients to determine whether there was a difference in neutrophil response to injury when compared with controls. METHODS: This prospective, observational, cohort study compared neutrophil function in 24 injured elderly (older than 65 years) patients admitted to our trauma center to control groups of noninjured individuals (11 elderly and 17 young). Blood samples were also taken from the injured elderly group within 48 hours of trauma and subsequently at two periods during their hospital stay. A single blood sample was obtained from the noninjured control groups. Neutrophils were analyzed for CD18 expression, stimulated oxidative burst, apoptosis, and IL-10. Results were compared using one-way analysis of variance (alpha 0.05). This study was approved by the Institutional Review Board. RESULTS: Twenty-four injured elderly subjects were enrolled: mean injury severity score 15.3, average age 74.6 years, 92% survival, 100% blunt trauma. CD18 levels in the elderly injured subjects for all three time periods were significantly higher than both control groups. When evaluated between controls, CD18 for the noninjured elderly (NIE) was also significantly higher than the noninjured young (NIY). The neutrophil stimulated oxidative burst in the injured elderly subjects at time periods 1, 2, and 3 was not significantly different from the NIY controls. However, the injured elderly had a significantly higher oxidative burst at time period 3 than the NIE controls. Apoptosis in the injured elderly subjects was significantly lower in all three time periods than the NIY. There was no difference in apoptosis between the injured elderly subjects when compared with the NIE controls. There was no significant difference in IL-10 expression among groups. CONCLUSION: Injury results in differences in innate immune function in the elderly when compared with controls. The clinical significance of this is uncertain and warrants further investigation.

The incidence of celiac disease antibodies in plasma specimens with low hemoglobin levels.

Antibodies to gliadin and tissue transglutaminase (TTG) are associated with celiac disease. Celiac patients often present with low hemoglobin levels; however, the incidence of celiac disease in patients with low hemoglobin levels is unknown. We investigated the incidence of celiac disease-associated antibodies in plasma obtained from individuals with low and normal hemoglobin levels. Our objective was to determine if antigliadin and anti-TTG antibodies are more prevalent in individuals with low hemoglobin levels than in control subjects with normal hemoglobin levels. Following IRB approval, we obtained 86 plasma specimens with hemoglobin levels less than or equal to 10 g/dL and 88 plasma specimens from individuals with hemoglobin levels greater than or equal to 13 g/dL. IgA and IgG antibodies to gliadin and TTG were determined by ELISA assays provided by BioRad, Inc. IgG antigliadin Ab was present in 6 out of 86 low hemoglobin specimens and in two of the normal hemoglobin specimens. The IgA antigliadin ELISA assay was positive in 19 out of 86 low hemoglobin specimens and in 21 out of 88 normal hemoglobin specimens. IgA anti-TTG was detected in 9 out of 86 low hemoglobin specimens and in 3 out of 88 normal hemoglobin specimens. IgG anti-TTG was not present in any of the specimens. IgA antibodies to TTG were more prevalent in individuals with low hemoglobin levels. The incidence of IgG anti-TTG and IgG and IgA antibodies to gliadin was not related to plasma hemoglobin levels in our sample.

Predicting immune status in women from PTSD and childhood and adult violence.

This study uses a predictive exploratory design to test the relationships between and among childhood maltreatment, intimate partner violence (IPV), posttraumatic stress disorder (PTSD) symptoms, and immune status in abused women. A convenience sample of 126 abused women and 12 nonabused women matched for age and race/ethnicity were recruited. The woman's current smoking habit, history of childhood maltreatment, experience of IPV, and PTSD symptoms predicted immune status. This prediction occurs through both direct and indirect pathways from IPV to immune status and from IPV to immune status through PTSD.