Lymphocyte CC chemokine receptor 9 and epithelial thymus-expressed chemokine (TECK) expression distinguish the small intestinal immune compartment: Epithelial expression of tissue-specific chemokines as an organizing principle in regional immunity.

The immune system has evolved specialized cellular and molecular mechanisms for targeting and regulating immune responses at epithelial surfaces. Here we show that small intestinal intraepithelial lymphocytes and lamina propria lymphocytes migrate to thymus-expressed chemokine (TECK). This attraction is mediated by CC chemokine receptor (CCR)9, a chemoattractant receptor expressed at high levels by essentially all CD4(+) and CD8(+) T lymphocytes in the small intestine. Only a small subset of lymphocytes in the colon are CCR9(+), and lymphocytes from other tissues including tonsils, lung, inflamed liver, normal or inflamed skin, inflamed synovium and synovial fluid, breast milk, and seminal fluid are universally CCR9(-). TECK expression is also restricted to the small intestine: immunohistochemistry reveals that intense anti-TECK reactivity characterizes crypt epithelium in the jejunum and ileum, but not in other epithelia of the digestive tract (including stomach and colon), skin, lung, or salivary gland. These results imply a restricted role for lymphocyte CCR9 and its ligand TECK in the small intestine, and provide the first evidence for distinctive mechanisms of lymphocyte recruitment that may permit functional specialization of immune responses in different segments of the gastrointestinal tract. Selective expression of chemokines by differentiated epithelium may represent an important mechanism for targeting and specialization of immune responses.

Measurements of DIII-D poloidal field by fiber-optic pulsed polarimetry.

A new technique for measuring the spatial and temporal structure of the poloidal field is presented, whereby the magnetic field causes the polarization of light traveling through an optical fiber to rotate via the Faraday effect by an amount proportional to the strength of the field oriented along the fiber. In fiber optic pulsed polarimetry, changes in the polarization of the backscatter light from the fiber are detected, thereby permitting measurement of the field as a function of position along the fiber. In this proof-of-principle experiment, specially prepared single-mode fibers with weak fiber Bragg gratings were installed in the poloidal direction on the outside of the thermal blanket on DIII-D. Light at 532 nm from a mode-locked Nd:YAG laser was injected into the optical fibers. The laser repetition rate was 895 kHz with a pulse length of <10 ps, resulting in ∼1 µs temporal resolution. A photodetector system measured the Stokes polarization components necessary to determine the amount of polarization rotation. For this experiment, bandwidth limitations of the detectors resulted in a spatial resolution of ≈2 cm. The measured temporal and spatial distributions of the poloidal field are consistent with inductive probe measurements and Elastodynamic Finite Integration Technique reconstructions of the spatial distribution. This demonstrates the ability of this technique to provide real-time detection of the temporal and spatial variations of the poloidal field. Besides revealing more detailed information about the plasma, this new diagnostic capability can also help in detecting instabilities in real time, thereby enabling enhanced machine protection.

Bonzo/CXCR6 expression defines type 1-polarized T-cell subsets with extralymphoid tissue homing potential.

Chemokine receptor expression is finely controlled during T-cell development. We show that newly identified chemokine receptor Bonzo/CXCR6 is expressed by subsets of Th1 or T-cytotoxic 1 (Tc1) cells, but not by Th2 or Tc2 cells, establishing Bonzo as a differential marker of polarized type 1 T cells in vitro and in vivo. Priming of naive T cells by dendritic cells induces expression of Bonzo on T cells. IL-12 enhances this dendritic cell-dependent upregulation, while IL-4 inhibits it. In blood, 35-56% of Bonzo+ CD4 T cells are Th1 cells, and 60-65% of Bonzo+ CD8 T cells are Tc1 cells, while few Bonzo+ cells are type 2 T cells. Almost all Bonzo+ Tc1 cells contain preformed granzyme A and display cytotoxic effector phenotype. Most Bonzo+ T cells lack L-selectin and/or CCR7, homing receptors for lymphoid tissues. Instead, Bonzo+ T cells are dramatically enriched among T cells in tissue sites of inflammation, such as rheumatoid joints and inflamed livers. Bonzo may be important in trafficking of effector T cells that mediate type 1 inflammation, making it a potential target for therapeutic modulation of inflammatory diseases.

Direct functional analysis of epitope-specific CD8+ T cells in peripheral blood.

The functional status of virus-specific CD8+ T cells is important for the outcome and the immunopathogenesis of viral infections. We have developed an assay for the direct functional analysis of antigen-specific CD8+ T cells, which does not require prolonged in vitro cultivation and amplification of T cells. Whole blood samples were incubated with peptide antigens for <5 h, followed by staining with peptide-MHC tetramers to identify epitope-specific T cells. The cells were also stained for the activation marker CD69 or for the production of cytokines such as interferon-gamma (IFNgamma) or tumor necrosis factor-alpha (TNFalpha). With the combined staining with tetramer and antibodies to CD69 or cytokines the number of antigen-specific CD8+ T cells as well as the functional response of each individual cell to the cognate antigen can be determined in a single experiment. Virus-specific CD8+ T cells that are nonfunctional, as well as those that are functional under the same stimulating conditions can be simultaneously detected with this assay, which is not possible by using other T-cell functional assays including cytotoxicity assay, intracellular cytokine staining, and enzyme-linked immunospot (ELISPOT) assay.

Cognitive and behavioral treatment of pathological gambling: a controlled study.

This study evaluated the efficacy of a cognitive-behavioral treatment package for pathological gambling. Twenty-nine men who met criteria for pathological gambling in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; DSM-III-R; American Psychiatric Association, 1987) were randomly assigned to treatment or wait-list control. The treatment included 4 components: (a) cognitive correction of erroneous perceptions about gambling, (b) problem-solving training, (c) social skills training, and (d) relapse prevention. The dependent variables were the South Oaks Gambling Screen, perception of control, frequency of gambling, perceived self-efficacy, desire to gamble, and number of DSM-III-R criteria met by participants. Posttest results indicated highly significant changes in the treatment group on all outcome measures, and analysis of data from 6- and 12-month follow-ups revealed maintenance of therapeutic gains. Recommendations for clinical interventions are discussed and focus on the cognitive correction of erroneous perceptions of gambling.

Worry themes in primary GAD, secondary GAD, and other anxiety disorders.

This study examines worry themes among 87 anxiety disorder patients divided into three groups: (a) 24 primary generalized anxiety disorder (GAD) patients, (b) 25 secondary GAD patients, and (c) 38 other anxiety disorder patients (primarily obsessive-compulsive disorder, social phobia and panic disorder with agoraphobia). Structured and free-recall measures were used to measure five worry themes: relationships, work, finances, physical threat, and the future. Both types of measures revealed that GAD patients worry more about the future than non-GAD patients. Further, post hoc analyses testing for linear relationships indicated that primary GAD patients worry more about the future than secondary GAD patients who in turn worry more about the future than other anxiety disorder patients. The results suggest that although worry about immediate problems may not differentiate GAD patients from other anxiety disorder patients, high levels of worry about future events may be a distinguishing feature of GAD.

Anomalies on capture nets of Hydropsyche slossonae larvae (Trichoptera; Hydropsychidae) following a sublethal chronic exposure to cadmium.

A laboratory study on the sublethal effects of cadmium (Cd) on the net-spinning process of the larvae of Hydropsyche slossonae was conducted in order to assess the potential of net anomalies as an indicator of chronic exposure to Cd. Two major anomalies with different frequency levels were identified after chronic exposure to 0.37, 1.2, 11.6, 21.4 and 43.3 microg l(-1) of Cd. The first was a distortion of the midline meshes where the diamond-shape structure is disrupted and the meshes are separated by extra strands (called 'midline' anomaly). The second aberration consisted of a distortion of the rectilinear structure of net opening by strands being fused or added over the meshes (called 'crossover' anomaly). The midline distortion may be linked to a physiological stress caused by Cd, which can affect the control of the net-spinning process. It was not possible to relate the crossover aberrations to a specific toxic action of Cd, but data indicated that both anomalies are independent from each other and that two modes of action could be implicated. Protein analyses of capture nets have revealed silk polypeptide modifications at the highest Cd concentration tested, indicating a possible effect of Cd interaction with silk proteins. However, neither a gradient-concentration nor a time-dependent response could be established with both aberration frequencies. Silk protein modifications would rather play a secondary role in the appearance of both net anomalies, and mostly at a high concentration level. Finally, the toxicity curves (EC(50)) show that the sensitivity threshold for both types of aberration ranged from 1 to 5 microg l(-1) which is highly sensitive compared with other sublethal effects of Cd on other macroinvertebrate species. Hence, the use of capture-net anomalies of hydropsychid larvae would represent a valuable indicator of sublethal toxicity induced by Cd and possibly by other metals in running waters.

Management of thyroid nodules in children: a 20-year experience.

The medical records and surgical slides of 58 patients with the diagnosis of thyroid nodules (solitary nodule in 50 patients) are reviewed. The most common cause of thyroid nodules in this series is follicular adenoma (27 patients or 46%). A nuclear scan (technetium or radioactive iodine) was performed in 55 patients, of which 40 showed a cold nodule. Twelve of the 40 cold nodules were malignant (30%). However, for solitary nodules the incidence of cancer is 27%. This last figure is significantly greater than the one recently reported by Hung et al (18.5%). Available diagnostic methods are reviewed and the clinical management as derived from our experience is presented.

Treatment of pathological gamblers: an experimental study.

The efficacy of a behavioral treatment for pathological gamblers, including cognitive interventions, problem solving and relapse prevention is examined. Three pathological gamblers meeting DSM-III-R criteria were studied in an experimental multiple baseline design. By the end of treatment the subjects ceased all gambling behaviors, increased their perception of self-control of gambling, and evaluated their problems as less severe. Therapeutic gains were maintained at 6- and 9-month follow-ups. The importance of problem solving and the modification of erroneous perceptions in treatment programs for pathological gambling is discussed.

Cognitive-behavioral treatment for adolescent pathological gamblers.

This study evaluated the effectiveness of a cognitive-behavioral treatment for adolescent pathological gamblers. Perception of control and severity of the problem served as dependent variables. Four adolescent pathological gamblers meeting DSM-III-R criteria were treated in a multiple baseline design across individuals. Results showed clinically significant changes for all subjects; they remained abstinent at 1-, 4-, and 6-month follow-ups. The clinical implications of these results are discussed.

Larvicidal activity of the entomopathogenic fungus Tolypocladium cylindrosporum (Deuteromycotina: Hyphomycetes) on the mosquito Aedes triseriatus and the black fly Simulium vittatum (Diptera: Simuliidae).

Laboratory bioassays evaluated the pathogenicity of the entomopathogenic fungus Tolypocladium cylindrosporum against Aedes triseriatus. All larval instars were found to be susceptible at temperatures from 18 to 25 degrees C. Blastoconidia were more virulent than conidia. Mortality was proportional to exposure time in assays using blastoconidia. Blastoconidia and exposure time appear to be a more adequate method for bioassay of T. cylindrosporum virulence than the standard procedure of using conidia and continuous exposure. Tolypocladium cylindrosporum was also active against Simulium vittatum black fly larvae, but the mortality recorded was much lower than with mosquito larvae.

Reduction of mortality rates of Bacillus thuringiensis var. israelensis aqueous suspensions due to freezing and thawing.

When studying the behavior (carry, dispersion, persistence) of Bacillus thuringiensis var. israelensis (B.t.i.) formulations used in the treatment of rivers or streams for black fly control, a large number of samples containing small quantities of B.t.i. are required for proper analysis. Freezing is a useful procedure to prevent enzymatic alteration or bacterial growth in samples before bioassays are to be performed. Using Aedes atropalpus neonate larvae, we studied the effect of freezing and thawing of B.t.i. aqueous suspensions by looking at mortality response parameters such as the slope and the LC50 of the probit regression. Initial concentration values of 1, 5, 10 and 20 mg/liter at the moment of freezing of the B.t.i. suspensions did not significantly affect toxicity. The number of freeze-thaw cycles greatly increased the LC50 values without much change to the slope of the log-probit regressions. We derived an equation that allowed us to compensate for the loss of toxicity of a given B.t.i. sample, knowing the number of freeze-thaw cycles.

Discharge planning for children with heart disease.

Almost all children with heart disease are successfully cared for at home by their parents. Pediatric cardiovascular nurses play a major role in preparing parents to meet their child's medical needs, in aiding families to cope with a chronic condition, and in encouraging normal growth and development for their young patients. Through assessment, collaboration with other members of the health care team, planning with the family, teaching, counseling and supportive interventions, and evaluating care, nurses assist in a smooth transition to home and appropriate use of community resources.

[The role of echography in splenic injuries in children]. / Le rôle de l'échographie dans le traumatisme splénique chez l'enfant.

We have reviewed 39 cases of ruptured spleen in children from 1979 to march 1983 at Ste-Justine Hospital in Montreal. We were mainly interested in the role of ultrasonography, its value and limitations. The practical management is exposed. To the best of our knowledge, it is the first report of this kind in pediatrics.

Overview of pediatric arrhythmias.

Cardiac arrhythmias are being depressed with increased frequency in the pediatric population. Causes of pediatric arrhythmias in the general population include severe metabolic or electrolyte disturbances, drug toxicity, and chest trauma. Repairs of complex congenital heart disease have frequently left this population with persistent or recurrent postoperative arrhythmias. The diagnosis, evaluation, and management of pediatric arrhythmias requires nurses to be skilled in hemodynamic assessment and arrhythmia detection. The registered nurse's grasp of developmental issues and family education is vital in providing quality care to families dealing with these diagnoses.

Hypoplastic left heart syndrome repair. Preventing complications.

Hypoplastic left heart syndrome presents a special challenge for the neonatal/pediatric critical care nurse. The nurse plays a vital role in preventing the complications that may arise from the syndrome itself or the surgical repair. Here, the authors describe how to prevent complications following first stage palliation of hypoplastic left heart syndrome.

[The marriage therapist is a Trojan horse: reflections inspired by the results of research on interventions with couples]. / Le thérapeute conjugal est un cheval de Troie: Réflexions inspirées des résultats de recherches sur l'intervention auprès des couples.

Communication training and positive exchange training are the two methods for improving marital relations that research has established as being the most effective. However, even after conducting therapy involving both partners based on these methods, too few couples (35%) succeed in reaching the same level of satisfaction as couples who are already satisfied with their relationship. The efforts that have been undertaken to increase this rate have focused mainly on developing new therapeutic techniques that include cognitive, emotional and systemic approaches. However, the results of experimental studies to date do not prove the superiority of these new approaches. Given this situation, it is time to pay more attention to particular characteristics of the therapeutic relation in marital therapy and to the means of obtaining the collaboration of the two spouses. As is the opinion of certain authors, the most difficult clinical task does not consist of finding what the clients must do to solve their problems, but rather to determine how to motivate them and help them achieve their goal. An analysis of this task, based on clinical observations and results of recent research in this area, has allowed the authors to present a number of hypotheses about ways to reinforce the therapeutic alliance and eventually reduce the failure rate of marital therapy.

Geometric variability of the scoliotic spine using statistics on articulated shape models.

This paper introduces a method to analyze the variability of the spine shape and of the spine shape deformations using articulated shape models. The spine shape was expressed as a vector of relative poses between local coordinate systems of neighboring vertebrae. Spine shape deformations were then modeled by a vector of rigid transformations that transforms one spine shape into another. Because rigid transformations do not naturally belong to a vector space, conventional mean and covariance could not be applied. The Fréchet mean and a generalized covariance were used instead. The spine shapes of a group of 295 scoliotic patients were quantitatively analyzed as well as the spine shape deformations associated with the Cotrel-Dubousset corrective surgery (33 patients), the Boston brace (39 patients), and the scoliosis progression without treatment (26 patients). The variability of intervertebral poses was found to be inhomogeneous (lumbar vertebrae were more variable than the thoracic ones) and anisotropic (with maximal rotational variability around the coronal axis and maximal translational variability along the axial direction). Finally, brace and surgery were found to have a significant effect on the Fréchet mean and on the generalized covariance in specific spine regions where treatments modified the spine shape.