Psychological stress-induced modulation of interleukin 2 receptor gene expression and interleukin 2 production in peripheral blood leukocytes.

We explored the expression of the interleukin 2 receptor (IL-2R) and the synthesis of IL-2R messenger RNA by peripheral blood leukocytes obtained from medical students experiencing examination stress in three independent studies. The peripheral blood leukocytes obtained at low-stress baseline periods had significantly higher percentages of IL-2R-positive cells when compared with cells obtained from the same individuals during examinations. In addition, IL2-R messenger RNA in peripheral blood leukocytes decreased significantly during examination periods in a subset of 13 subjects. In one study, we found an increase in the accumulation of interleukin 2 in cultures of cells showing down regulation of IL-2R expression and IL-2R messenger RNA levels. While there are ample data demonstrating stress-associated decrements in the immune response in humans and animals, these data provide the first evidence that this interaction may be observed at the level of gene expression. The data suggest one mechanism whereby the central nervous system modulates the immune response during psychological stress.

The activated plasma recalcification time. A Measurement encompassing the activated partial thromboplastin time and platelet function, with improved detection of bleeders.

A study of 300 patients is presented to demonstrate the effectiveness of the activated plasma recalcification time (APRT) as a measure of the intrinsic pathway and platelet function in the detection of bleeders. The activated partial thromboplastin time (APTT) and platelet count were determined in all patients having both normal and abnormal APRT's and the results correlated with overt bleeding tendencies. Abnormality of the APTT is closely paralleled by abnormality of the APRT, independent of the platelet count. When the APTT is normal, an abnormal APRT will characterize clinical bleeders with greater frequency than will the platelet count. The value of the APRT is greatest when done in concert with other standard coagulation measurements, as it both reinforces and expands their diagnostic capability.

An evaluation of the overestimation of serum albumin by bromcresol green.

Repeated observations have shown that the bromcresol green method overestimates serum albumin. Random patient serum samples were analyzed by a bromcresol green method using the Technicon AutoAnalyzer and by serum protein electrophoresis using cellulose acetate. The mean AutoAnalyzer value was 4.29 g/dl and the mean protein electrophoresis value was 3.68 g/dl (r = 0.915, slope = 0.869, y intercept = 1.090 g/dl where bromcresol green is on the Y axis, n = 166). Studies of the interference of proteins other than albumin in the bromcresol green method using the Technicon AutoAnalyzer showed that alpha globulins produce approximately a third, beta globulins a ninth, fibrinogen a fifth and hemoglobin equal the color intensity with the bromcresol green reagent that a comparable weight of albumin produced. In the bromcresol green method using the Du Pont ACA the interferences were even greater. At present, serum protein electrophresis is the most reliable method generally available to measure serum albumin. A modified bromcresol green method or immunoassay may eventually prove to be the method of choice.

Stress depresses interferon production by leukocytes concomitant with a decrease in natural killer cell activity.

This study addressed the effects of a commonplace stressful event on interferon production and natural killer (NK) cell activity and numbers. The quantity of interferons (IFN) produced by concanavalin A stimulated leukocytes obtained from 40 medical students during examinations was significantly lower when compared with IFN levels produced by peripheral blood leukocytes (PBLs) taken 6 weeks earlier (baseline). In addition, three different assays measuring NK cells also showed significant decrements during examinations when compared with baseline samples. These assays included lysis of MOLT-4 target cells, percentage of anti-Leu-7+ (NK) cells, and percentage of large granular lymphocytes. Self-report data documented the significantly greater distress associated with examinations in comparison with baseline samples. The data have implications for immunosuppressive disorders and stress-associated illnesses.

Decision-oriented test request forms. A system for implementing practice parameters in laboratory medicine.

The implementation of practice parameters in laboratory medicine by changing physicians' behavior represents a major challenge. Education, restriction of tests, financial incentives, and concurrent chart reviews have not been effective in persuading physicians to improve their use of laboratory tests. The use of decision-oriented test request forms is suggested as an approach to this problem.

Helping physicians use laboratory tests.

We have described a paradigm for viewing the use of the clinical laboratory in terms of solutions to clinical problems instead of as endless lists of tests. In this regard, we have categorized many of the clinical problems that rely heavily on laboratory testing for their solutions and have suggested ways for readers to develop their own lists for their facilities. We believe that conceptualizing laboratory services in this way can help physicians to use the clinical laboratory in more effective and cost-efficient ways.

Interpretive reporting.

Recent growth in the number and complexity of laboratory tests requires more widespread and more sophisticated interpretive reporting. The author examines the state of the art and how pathologists can effectively manage the laboratory data portion of the medical data base.

Stress-related impairments in cellular immunity.

The percentages of total T-lymphocytes (OKT-3+), helper T-cells (OKT-4+), and suppressor T-cells (OKT-8+) were significantly lower in blood samples obtained from 40 medical students during examinations, compared to baseline values obtained 6 weeks earlier. In addition, the response of T-lymphocytes to stimulation by phytohemagglutinin and concanavilin A was also significantly lower during examinations, compared to baseline. Self-report data documented significantly greater distress associated with examinations. The data have implications for immunosuppressive disorders and stress-related illnesses.