Biomedical subjects
Publications and source records attributed to R A Lawrence.
There has been much debate as to whether the media have a direct influence on the incidence of interpersonal violence and violent behaviour. The producers of cinema and television programmers and newspaper editors deny this influence and maintain that they merely reflect the current existence of violence in society.
OBJECTIVE: To determine how police surgeons in the United Kingdom performed examinations of child abuse victims because wide variations in protocols and procedures have been reported. METHOD: Practising members of the Association of Police Surgeons were requested to complete an enquiry form. Replies were anonymous and subjects covered included gender, work area, training, procedures and protocols for joint examinations with paediatricians and the use of digital or instrument examinations in alleged penetrative sexual abuse. RESULTS: Of all those eligible, 47.7% had responded. Males made up 74.7% of respondents. Published guidelines were followed by 85.3% and 69.8% used purpose-built examination suites while 8.8% still used police station facilities. Procedures for joint examinations were working satisfactorily, according to 79.2% of respondents who also considered that the forensic physician should take the lead role in examinations. Clinical findings were recorded on a prepared aide memoire by 35.2%. Colposcopes were used by 3.4% while 23.3% of respondents considered that a colposcope should be used but cost was an inhibiting factor. CONCLUSIONS: Reported variations in procedures and protocols in examining child abuse victims were confirmed. More discussion and liaison between agencies concerned is required and a firm commitment to the paramountcy of the child's interests is needed.
BACKGROUND: Little information is available about the degree to which obstetricians promote breastfeeding through patient care practices and educational activities. The purpose of this study was to determine the attitudes, practices, and recommendations of obstetricians regarding infant feeding selection. METHODS: A written survey was mailed to 148 obstetrician/gynecologists in Monroe County, New York (78% response rate, n = 116). RESULTS: Of the 104 physicians in active obstetric practice, 86 percent conducted prenatal discussions about infant feeding with patients, 80 percent recommended breastfeeding, and 68 percent were commonly contacted postpartum by patients to address breastfeeding questions. Overall, 57 percent routinely incorporated these breastfeeding supportive practices into their prenatal and postpartum patient care. Attitudes about obstetric responsibility for infant feeding counselings and about the importance of counseling independently predicted the provision of these services. Infant feeding information was given to patients by 98 percent of obstetricians; 75 percent used written and 39 percent used videotaped materials. Formula company-produced infant feeding literature (41%), pregnancy literature (57%), and free formula offers (61%) were commonly used. Of those surveyed, 58 percent lacked training and 22 percent reported inadequate training in infant nutrition. CONCLUSIONS: Although most obstetricians in Monroe County provide infant feeding education and recommend breastfeeding, most report that their training about infant nutrition is inadequate, and they distribute infant formula company materials and offers to patients. Such discrepancies in patient care are inconsistent with promoting breastfeeding as optimal infant nutrition.
Plant toxic to humans abound in home and yard as well as open fields and woods. Only experienced botanists and serious students of edible vegetation can distinguish safely what is edible, inedible, or simply toxic. Parents should be instructed to protect their children from truly toxic household plants and train their children never to eat a plant not provided to them by someone trustworthy as edible. If a child or an adult consumes a possibly toxic plant, the regional poison center should be contacted for identification and management instructions. As with all potential poisonings, the sooner the management is initiated, the better the outcome. Adults have been seriously poisoned by confusing a toxic plant with something that they thought was edible (eg, pokeweed root for horseradish). The pediatrician's office should be a model, with only nontoxic plants on display-no dieffenbachia, peace lily, pothos, or philodendron, for example.
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Infection with the nematode, Nippostrongylus brasiliensis, results in a Th2-dominated immune response. We describe the dynamics of this response in both local and systemic environments. Th2-type responses were evident first in the mesenteric lymph node, with parasite antigen-specific proliferation and IL-4/IL-5 release peaking at Days 7-9 postinfection, shortly before expulsion of the adult worms from the gut. IFN-gamma responses were not observed in the mesenteric lymph node. Responses in the spleen generally followed those in the mesenteric lymph nodes by 2-3 days and showed a greater degree of Th1-type cytokine production. N. brasiliensis was shown to be a powerful inducer of IL-4 responses with as few as six infective N. brasiliensis larvae eliciting IL-4 production in the mesenteric lymph node, but only high doses of larvae (600) elicited IL-4 secretion in the spleen. Similar levels of IL-4 production by lymph node cells stimulated with Con A or parasite antigen postinfection indicated the extent of polyclonal Th2 stimulation by this parasite. Infection of IL-4-deficient mice showed that despite the absence of IL-4-dependent Th2 responses, these mice were able to curtail egg production and expel adult N. brasiliensis in a time frame similar to that of fully immunocompetent animals. These results emphasize the magnitude of the Th2 response to N. brasiliensis and also show that IL-4 is not a prerequisite for the development of immunity to N. brasiliensis.
Human lymphatic filariasis is a major tropical disease in which clinical manifestations range from asymptomatic microfilaraemia to chronic pathology. Investigative immunological research into this disease is hampered by the fact that mice are refractory to the full developmental cycle of this parasitic nematode. However, studies using either single-stage infections or immunocompromised mice have greatly added to our knowledge of the filarial-induced immune pathways leading to protective immunity, pathology and immunological tolerance. In this review, Rachel Lawrence discusses the recent advances in our understanding of the immunology of lymphatic filariasis using the mouse model.
Specific T cell hyporesponsiveness and depressed antibody production is a key feature of human infection with the filarial nematodes, Brugia malayi and Wuchereria bancrofti. Despite this immune suppression, responses indicative of Th2 subset activation are present, including unusually high levels of specific IgG4. We tested the possibility that infection with filarial nematodes causes a reduction in the co-stimulatory or antigen-presenting capacity of macrophages resulting in a failure to activate specific T cells. Adherent peritoneal exudate cells (PEC) from mice implanted with adult B. Malayi were used to present antigen to the conalbumin-specific T cell clone, D10.G4. Proliferation of the D10 cells at even background levels was completely blocked by the presence of implant-derived adherent PEC. However, cytokine production by these cells in response to antigen was intact, and thus PEC from implanted mice are capable of functionally processing and presenting antigen. The elicitation of a suppressive cell population was specific for live adults as cells from mice implanted with dead adult parasites effectively stimulated D10 proliferation. The block in cellular proliferation is not due to the production of factors typically associated with macrophage suppression such as nitric oxide, prostaglandins or catalase. These observations are consistent with the T cell hyporesponsiveness seen in human cases of patent Brugia infection and may provide a murine model for the immune suppression seen in lymphatic filariasis.
Recent data have indicated that CD8+ T cells suppress rodent IgE responses. In this study we investigated the effect of CD8+ T cells on primary and established IgE responses in euthymic and athymic nude rats. Euthymic PVG rats were depleted of CD8+ T cells by intraperitoneal injection of a CD8-specific monoclonal antibody (OX8), which resulted in an apparent loss of 92% of splenic and 98% of peripheral blood CD8+ T cells. The CD8+ T-cell depleted animals failed to mount a significant IgE response compared with control animals given an irrelevant monoclonal antibody (OX21). Furthermore, PVG nude rats reconstituted with purified CD4+ thoracic duct lymphocytes (TDL) alone failed to mount a significant IgE response, while animals given unfractionated TDL (containing CD4+ and CD8+ T cells) did. Depletion of CD8+ T cells 7 days prior to immunization and subsequent reconstitution at the time of immunization restored the IgE response. In contrast, removal of CD8+ T cells 1 month after induction of IgE by immunization with ovalbumin (OVA) and ricin prolonged the IgE response. In all cases IgG antibody responses were unaffected by the presence or absence of CD8+ T cells. This study shows that some CD8+ T cells are required for IgE, but not IgG, production to soluble antigen in a primary immune response. However, later in the immune response CD8+ T cells were shown to inhibit IgE production. These effects were apparently restricted to the immune response to soluble antigen, as Hooded Lister rats infected with 9000 larvae of the nematode Nippostrongylus brasiliensis produced high sustained levels of circulating IgE, in excess of 10 micrograms/ml, regardless of whether CD8+ T cells were depleted before or 1 month after infection.
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Resistance of intact mice to infection with the filarial nematode, Brugia malayi is dependent on the presence of T cells. To investigate the role of Th2 cells in this protection, mice with a targeted disruption of the IL-4 gene were infected with different developmental stages of B. malayi. We examined the phenotypic changes in the immune response and the survival of each stage in these mice. In wild-type mice, adult female worms induce Th2 responses, characterized by antigen-specific IgG1 production, elevated IgE, and marked IL-4 secretion by splenocytes stimulated in vitro with Brugia extract. However, first stage larvae (microfilariae), induce Th1 responses with the appearance of antigen-specific IgG2a, IgG2b, and IgG3 and IFN-gamma secretion by splenocytes. Infection of IL-4-deficient mice revealed a dramatic change in the response to adult worms, with a severe reduction in IgG1 production and a corresponding increase in the production of IgG2a, IgG2b, IgG3, and IFN-gamma release. The switch to Th1-type responses was particularly marked in IL-4-deficient recipients of female worms, which continually release live microfilariae. In the absence of IL-4, down-regulation of the microfilarial-induced Th1 response does not occur. Despite these profound alterations to the immune response in IL-4-deficient mice, survival of infective larvae, adult worms, or microfilariae in the peritoneal cavity was unaffected. In mice, therefore, the prominent Th2-type response elicited by filarial parasites may not be an essential component of the host protective immune response.
Polyprotein allergens are a family of structurally homologous molecules from parasitic nematodes which induce specific immunoglobulin E in infected individuals. We show here that both H-2 and non-H-2 factors determine the ability of mice to generate T- and B-cell responses to the filarial polyprotein allergen (Brugia malayi gp15/400). Further, H-2 and non-H-2 genes can complement one another to overcome nonresponsiveness to this molecule. However, these genetic restrictions govern only responses to the native glycoprotein and all strains of mice respond equivalently when immunized with a recombinant polypeptide. Overlapping fragments of gp15/400 were constructed to compare the T-cell and antibody responses to native versus recombinant gp15/400 in responder (BALB/c H-2d) and nonresponder (B10.D2 H-2d, CBA H-2k, and BALB.K H-2k) strains. BALB/c mice generated T-cell responses to the same fragment (positions 89 to 133 and 1 to 21) whether immunized with native or recombinant material, although the antibody responses differed in fine specificity, H-2k mice, unresponsive to the native molecule, generated T cells responsive to the centrally located peptide (positions 57 to 100) only when immunized with the recombinant. Antibody responses in H-2k mice were directed at the peptide (positions 11 to 67) which is glycosylated in the native molecule. Our findings suggest that recognition of gp15/400 is affected by modifications that occur in the parasite but are absent when the molecule is produced in bacteria. This study provides a detailed evaluation of the immune response to an important nematode antigen as a start to the unraveling of the complex interaction of these multicellular parasites with mammalian hosts.
Type II lung epithelial cells are different from other lung cell types in their means of processing and regulating intracellular glutathione (GSH) levels. In lung cell types, including endothelial cells, fibroblasts, smooth muscle cells, and macrophages, oxidants, sulfhydryl reagents, and electrophilic agents have been shown to induce cystine uptake and concomitantly increase GSH levels, suggesting that cysteine, formed by intracellular reduction of cystine, is a rate-limiting substrate for GSH synthesis. The cystine transport increase was reportedly due to increase in activity of a sodium-independent transport system designated xc-. We have now examined cultures of rat lung type II cells exposed to diethylmaleic acid and arsenite. Although a rise in cellular GSH occurred, cystine transport was not induced. Cystine transport in type II cells was found to differ from the xc- system previously described. Type II cell cystine transport is primarily sodium dependent and is inhibitable by aspartate as well as glutamate and homocysteate. We conclude that the type II cell differs from other lung cell types in both its cystine transport mechanism and method of GSH regulation.
Cells in most culture media use cystine as the primary source of the cysteine precursor needed for glutathione (GSH) synthesis. As a result, GSH levels in many cultured cells may be limited by the rate of uptake of cystine into cells. We have shown that incubation with extracellular GSH can result in the reaction of GSH with cystine to generate cysteine, and that bovine pulmonary artery endothelial cells and lung type II epithelial cells transported cysteine more efficiently than cysteine. Cysteine transport was not affected by the presence of GSH. In cells incubated with GSH in RPMI-1640 there was a cystine-dependent increase in intracellular GSH levels. The increases in GSH were not prevented by the presence of acivicin, an inhibitor of the gamma-glutamyl transpeptidase reaction. Incubation with oxidized glutathione (GSSG) did not result in significant increases in intracellular GSH levels. We conclude that a primary mechanism by which extracellular GSH may increase intracellular GSH levels in cultured cells is by reducing cystine to cysteine, which is then rapidly transported and used as a substrate for intracellular GSH synthesis.
The rat colon and Swiss 3T3 cells have been proposed as FP receptor preparations. However, the rank orders of potency for contraction of the rat colon and Ca++ signaling in Swiss 3T3 cells were found to be disparate. Although both appeared to be FP receptor preparations in that PGF2 alpha and FP receptor selective analogs were the most potent agonists, the potency ranking for other PGs and their analogs differed markedly. This presented two alternative major hypotheses for interpreting these data: (1) Swiss 3T3 cells and the rat colon possess different FP receptor subtypes and (2) the rat colon contains a heterogeneous population of prostanoid receptors. To further characterize prostanoid receptor populations in these two preparations, radioligand binding studies were performed with 3H-PGE2 and 3H-17-phenyl-PGF2 alpha. The rank order of potency for inhibition of 3H-PGE2 binding in the rat colon was consistent with EP3 receptor pharmacology. Thus, MB 28767, sulprostone and PGE2 were potent inhibitors, whereas PGF2 alpha, PGD2 and other analogs were substantially less potent. The rank order of potency for inhibition of 3H-17-phenyl-PGF2 alpha binding in the rat colon was consistent with the presence of an FP receptor. Thus, the potency rank order for the natural PGs was PGF2 alpha > PGD2 > PGE2 and among the synthetic analogs only PGF2 alpha analogs were potent competitors. In Swiss 3T3 cells an identical rank order of potency for eliciting a Ca++ transient signal and inhibition of 3H-17-phenyl-PGF2 alpha binding was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
Natural infection with filarial nematode parasites shows many characteristics of a Th2 immune response. In these infections, long-lived adult worms inhabit the lymphatics, releasing laval microfilariae (Mf) into the blood stream. To compare the effect of these different developmental stages on the mammalian immune system, Mf and adult worms of either sex were implanted into BALB/c mice, in which they survive for at least 28 days. Serum Ab responses showed that whereas Mf stimulated specific Abs of all IgG subclasses, but little total IgE, adult worms stimulated only IgG1 and IgE responses. Splenocytes from implanted mice were stimulated in vitro with specific Ag or Con A and assayed for proliferation and profiles of cytokine secretion. Cells from Mf-infected mice secreted high levels of IFN-gamma (30 U/ml) throughout infection, but very little IL-4 at the early time points. By day 28 postinfection, however, splenocytes from Mf-infected mice showed some IL-4 secretion in response to specific Ag (40 U/ml). The IFN-gamma response to Mf was found to be independent of the inoculum dose in the range of 10(2) to 10(6) organisms. In contrast, splenocytes taken from adult worm-implanted mice on days 14, 21, and 28 postinfection produced high levels of IL-4 (up to 435 U/ml) and negligible amounts of IFN-gamma despite the production of large numbers of Mf by adult female worms. CD4+ cells were primarily responsible for this IL-4 production. These results demonstrate that adult filarial parasites, and females in particular, exert a rapid polarization of the immune response in a Th2-like direction, but that this effect may be modulated by the Mf stage.
Thus far, the prostanoid FP-receptor has been characterized only on the basis of agonist studies. It is currently classified as a receptor having particular sensitivity to prostaglandin F2 alpha (PGF2 alpha) but with the ability to recognize prostaglandins D2 and E2 (PGD2 and PGE2). We have re-examined this concept by studying second messenger Ca2+ signals to PGF2 alpha, PGD2 and PGE2, and performing radioligand binding studies in Swiss 3T3 cells. The same rank order of potency was obtained for both the Ca2+ transient signal and competition for PGF2 alpha binding sites. The potency rank order, PGF2 alpha > PGD2 > PGE2, was identical to that obtained from functional studies in isolated tissues, such as the cat iris. Additional support for the concept that PGF2 alpha, PGD2, and PGE2 interact with a single receptor to elicit a Ca2+ signal was provided by successive addition studies. Thus, cells pretreated with a supramaximal concentration of PGF2 alpha exhibited little or no response to subsequent administration of PGD2 or PGE2. Likewise, cells pretreated with a large concentration of PGD2 or PGE2 exhibited minimal responsiveness to successive addition of the corresponding alternative prostaglandins. Pretreatment with a maximally effective concentration of PGF2 alpha, PGD2, or PGE2 rendered the cells refractory to the FP-receptor selective agonist fluprostenol, which further supports the hypothesis that Ca2+ transient signals in response to prostanoids in Swiss 3T3 cells are mediated by the FP-receptor. The Ca2+ transient responses to PGF2 alpha, PGD2, and PGE2 also exhibited a similar modest reduction when extracellular Ca2+ was removed. Finally, the DP-receptor antagonist BW A868C did not block the Ca2+ transient response to PGD2, indicating an absence of DP-receptor involvement. Moreover, Ca2+ responses to the thromboxane A2 mimetic U-46619 were unaffected by the TP-antagonist BM 13505, which indicates no involvement of the TP-receptor. These results support the contention that the FP-receptor has particular sensitivity to PGF2 alpha but will also recognize PGD2 and PGE2.