Intestinal CD103(+)CD11b(-) dendritic cells restrain colitis via IFN-γ-induced anti-inflammatory response in epithelial cells.

A crosstalk between commensals, gut immune cells, and colonic epithelia is required for a proper function of intestinal mucosal barrier. Here we investigated the importance of two distinct intestinal dendritic cell (DC) subsets in controlling intestinal inflammation. We show that Clec9A-diphtheria toxin receptor (DTR) mice after depletion of CD103(+)CD11b(-) DCs developed severe, low-dose dextran sodium sulfate (DSS)-induced colitis, whereas the lack of CD103(+)CD11b(+) DCs in Clec4a4-DTR mice did not exacerbate intestinal inflammation. The CD103(+)CD11b(-) DC subset has gained a functional specialization that able them to repress inflammation via several epithelial interferon-γ (IFN-γ)-induced proteins. Among others, we identified that epithelial IDO1 and interleukin-18-binding protein (IL-18bp) were strongly modulated by CD103(+)CD11b(-) DCs. Through its preferential property to express IL-12 and IL-15, this particular DC subset can induce lymphocytes in colonic lamina propria and in epithelia to secrete IFN-γ that then can trigger a reversible early anti-inflammatory response in intestinal epithelial cells.

Endotoxin shock and tumour necrosis factor release in mannoheptulose-treated mice.

Administration of mannoheptulose partially protected mice infected with Listeria monocytogenes against the lethal effect of a subsequent endotoxin challenge. The ability of these animals to produce tumour necrosis factor was however unaffected. Mannoheptulose was observed to reverse the hypoglycaemic effect of endotoxin, possibly through inhibition of insulin secretion. The therapeutic significance of these observations is discussed.

Effect of combined treatment of anti-inflammatory drug and mannoheptulose on the production of tumour necrosis factor and endotoxin shock in mice.

The endotoxin shock induced in mice by injection of viable Listeria monocytogenes and challenged with endotoxin can be alleviated by combined administration of mannoheptulose with acetylsalicylate or sulindac. The ability of animals to secrete tumour necrosis factor into the blood was, however, not affected. The significance of these observations are discussed.

Metastatic renal cell carcinoma of the spine: surgical treatment and results.

OBJECT: Renal cell carcinoma (RCC) is an aggressive malignancy that frequently metastasizes. When RCC metastasizes to the spine, significant pain and neurological dysfunction often follow. Because systemic therapy and radiotherapy have a limited effect in controlling spinal disease, surgery is frequently required; however, there are very few published series specifically addressing the role and benefits of the surgical treatment for this disease. The authors conducted a retrospective study to review their experience with the surgical treatment of metastatic RCC of the spine, paying particular attention to methodology and patient neurological status, pain relief, and survival. METHODS: Between January 1993 and April 1999, 79 patients (63 men and 16 women patients; average age 55 years, range 16-82 years) underwent 107 spinal operations for metastatic RCC. Indications for surgery included disabling pain (94 [88%] of 107 procedures) and/or neurological dysfunction (55 [51%] of 107 procedures). The anatomical location and extent of tumor determined the choice of an anterior, posterior, or combined surgical approach. Internal fixation was performed in all but three patients. Preoperative embolization was required in approximately one half of the patients. Radiotherapy was performed in 40 patients prior to surgery, and immuno- and chemotherapy were administered in 70 patients either pre- or postoperatively. After an average follow-up duration of 15 months, 57 patients had died. Kaplan-Meier analysis revealed a median postoperative survival of 12.3 months. Significant pain reduction, as indicated by a visual analog pain scale, was achieved in 84 (89%) of the 94 cases presenting with disabling pain. Neurological improvement was seen in 36 (65%) of the 55 patients. The major morbidity and 30-day mortality rates were 15% (16 of 107 procedures) and 2% (two of 107 procedures), respectively. CONCLUSIONS: In selected patients with metastatic RCC of the spine, resection followed by stabilization can provide pain relief and neurological preservation or improvement.

Neuroradiology imaging database: using picture archive and communication systems for brain tumour research.

INTRODUCTION: Disease registries and databases form an important component of research in clinical medicine, and can be useful to support retrospective studies and prospective clinical trials. However, analysis of radiological imaging databases has not been explored: imaging and clinical data often exist as separate silos of information, even in modern digital-enabled hospitals in Singapore. We describe a computerised method for creating a radiological research database using data from the picture archive and communication system (PACS) and hospital information system (HIS). METHODS: Using a relational database and Java programming language, we created the neuroradiology imaging database (NRID). A web-interface for keyword searches were tested with the clinical data from PACS of a tertiary referral hospital for neurological diseases. Keyword and wildcard searches were conducted for various brain neoplasms and compared to HIS discharge diagnosis. RESULTS: The NRID was deployed successfully and keyword search could be completed in real time. Lists of patients with meningioma, oligodendroglial tumour, neurocytomas, cerebral abscess, and neurocysticercosis could be exported and compared with the HIS discharge diagnosis. Patients with neurological diseases could be obtained by manually combining lists. CONCLUSION: An imaging database can be created using clinical PACS data, which can enable keyword search functions to support brain tumour research. Radiological databases can help support clinical research, but further work needs to be done in order to take full advantage of the potential of digital health information.

Improvements in the performance of local public health agencies.

Local health agencies in Iowa were surveyed in 1995 and 1997 to ascertain their performance in the areas of assessment, policy development, and assurance. Some improvements were noted in the assessment function. However, development of health plans and a policy agenda as well as evaluation of programs remain weak. Structural changes may be needed to increase the effectiveness of small, rural, public health agencies. Options discussed in this article include increases in funding, consolidation into districts, specialized training, a shift of responsibilities to the state level, and a merger with local hospitals.