Tissue-resident macrophages: then and now

Macrophages have been at the heart of immune research for over a century and are an integral component of innate immunity. Macrophages are often viewed as terminally differentiated monocytic phagocytes. They infiltrate tissues during inflammation, and form polarized populations that perform pro-inflammatory or anti-inflammatory functions. Tissue-resident macrophages were regarded as differentiated monocytes, which seed the tissues to perform immune sentinel and homeostatic functions. However, tissue-resident macrophages are not a homogeneous population, but are in fact a grouping of cells with similar functions and phenotypes. In the last decade, it has been revealed that many of these cells are not terminally differentiated and, in most cases, are not derived from haematopoiesis in the adult. Recent research has highlighted that tissue-resident macrophages cannot be grouped into simple polarized categories, especially in vivo, when they are exposed to complex signalling events. It has now been demonstrated that the tissue environment itself is a major controller of macrophage phenotype, and can influence the expression of many genes regardless of origin. This is consistent with the concept that cells within different tissues have diverse responses in inflammation. There is still a mountain to climb in the field, as it evolves to encompass not only tissue-resident macrophage diversity, but also categorization of specific tissue environments and the plasticity of macrophages themselves. This knowledge provides a new perspective on therapeutic strategies, as macrophage subsets can potentially be manipulated to control the inflammatory environment in a tissue-specific manner.     

Histology safety: now and then

Histology safety usually focuses on general laboratory issues, but this article concentrates on the hazards affecting the individual histotech and their evolution in the last half a century. Using the information from a survey especially designed for the occasion, the hazards were divided into 4 groups, and their prevalence was expressed as percentages for national and foreign laboratories. All the laboratories received a "safety index" (SI) with an average value of 0.77 +/- 0.11 for 63 national laboratories and 0.69 +/- 0.13 for 22 foreign laboratories, these 2 averages being statistically different (P < .02). The historical evolution of the SI required answering the same questionnaire retrospectively, and so it was done for 17 laboratories with an SI average of 0.27 +/- 0.12 for 1955/1989 and 0.77 +/- 0.13, almost 3 times larger for 1990/2007, with improvement of all safety issues. The technological, organizational, and regulatory advances before 1989 showed an unremarkable effect on the SI, and the only circumstance considered as the driving force behind the almost triple increment of the SI during 1990/2007 was the awareness that the AIDS epidemic instilled in the minds and consciences of the medical laboratory personnel in general. Even after almost tripling the average SI value in 2007, national histology laboratories obtained a grade average of "C+" only, leaving room for improvement.     

Birth then and now

Halfway through the 20^th century, views on pain in labour encompassed almost everything from women's self-blame to blaming nurses, midwives, doctors or partners for 'bad experiences'. Soon after that, giving birth came to be seen – in some settings and by some caregivers – as a 'natural' and thus benign event which women could 'master'. In their recent systematic review of women's expectations and experiences of pain relief in labour, Joanne Lally, Madeleine Murtagh, Sheila Macphail, and Richard Thomson show that there is wide variation in women's expectations and knowledge about the first birth. This systematic review provides us with a strong basis for reflection and action.     

Medullary carcinoma, provocative now as then

The recent observation that studies of BRCA1-associated tumors contain a high proportion of medullary carcinomas and ductal carcinomas with medullary features has re-introduced pathologists to an old diagnostic problem. The term "medullary carcinoma" dates to the 19th century, but the modern entity was introduced in 1949 by Moore and Foote, who described a carcinoma with a lymphoid infiltrate, a favorable prognosis, and low frequency of metastasis. Almost three decades later, Ridolfi et al proposed specific criteria for diagnosis, resulting in an entity with an even more favorable prognosis and a lower incidence. The reproducibility and clinical relevance of the diagnosis have been questioned recently, and new criteria have been proposed and compared. The tumors typically express cytokeratin 7, often vimentin and S100-protein, but not cytokeratin 20. The usual ones are positive for p53 and negative for estrogen receptor, Her2/neu, and bcl-2. Medullary carcinomas express e-cadherin and beta-catenin more often than ordinary high-grade ductal carcinomas, and the former have genetic differences from the latter. The lymphoid infiltrate of medullary carcinomas is related to beta-actin fragments exposed by apoptotic cells. The present review discusses historical and recent developments and emphasizes diagnostic criteria.     

Multicultural genetic counseling: then, now, and in the 21st century.

Scholars, educators, and practitioners have argued that racial-cultural issues are obstacles for those seeking genetic counseling. When available, cross-cultural genetic counseling has focused on simplistic knowledge of client health beliefs and cultural customs, professional cultures, and biased theoretical models as reasons for failure to create realistic knowledge of members of racial-cultural groups in the United States. Recognizing the importance of meeting the needs for all who seek genetic counseling services, genetic counselors have been providing direction in cross-cultural genetic counseling research, practice, training, and developing competency, ethical, and professional guidelines. However, emanating from a cultural pluralism perspective, cross-cultural genetic counseling has often resulted in homogenized group stereotypes without attention to intragroup variation and individual differences. A transition from cross-cultural towards multicultural genetics shifts from culture-specific group norms to an integrated social, historical, psychological, and political perspective. By valuing the process of personal and professional racial-cultural identity development, the evolution from cross-cultural to multicultural genetic counseling that has occurred within the past quarter century is discussed.     

The 30th anniversary of the American Board of Allergy and Immunology: then and now

Thirty years ago the Allergy Subspecialty Boards of the American Board of Pediatrics (ABP) and the American Board of Internal Medicine (ABIM) merged to form the American Board of Allergy and Immunology (ABAI). The ABAI mission was to: establish qualifications and examine physician candidates for certification as specialists in allergy and immunology; serve the public, physicians, hospitals, and medical schools by providing the names of physicians certified by the Board; assist educational and professional organizations to improve the quality of care and availability of allergists to deliver such care, to establish and improve standards for the teaching of allergy and immunology, to establish standards for training programs, and to encourage development of increased opportunities for training of physicians interested in allergy and immunology. This mission statement has guided the activities of the Board ever since by providing a strong focus on the 2 major responsibilities: examining and certifying candidates in a fair objective way, and setting standards for the content and conduct of training programs.     

Visions of clinical assessment: then, now, and a brief history of the future

Perspectives on the discipline of psychological assessment are provided through reflections on a classic article by Hunt (1946), review of current issues, and a projection of changes likely to occur over the next fifty years. Topics covered include the place of idiosyncratic qualitative responses, test design, clinical judgment, managed care, financial efficacy, over emphasis on pathology, treatment planning, status of projectives, ecological validity, relationship between theory and tests, innovations in scale construction, and computer-assisted assessment. Future predictions relate to innovations in computer-assisted assessment, practitioner roles in an increasingly automated environment, the future of traditional tests, and human-rights issues.     

Maude Abbott Lecture--1991. The capillary then and now: an overview of capillary pathology.

The concept of capillary is traced through its historical development, beginning with the pathologic "synanastomoses" between arteries and veins as proposed by the ancient Greeks. Harvey assumed that arteriovenous connections existed but never saw them. Malpighi and van Leeuwenhoek were the first to observe the capillary circulation in vivo. In the 1800s, pathologists contributed two advances: a method for proving that capillaries have a structured wall (von Recklinghausen) and the notion of "capillary leakage" in inflammation (Cohnheim). Then physiologists took over for half a century (Starling, Krogh, Pappenheimer) until electron microscopy created a new viewpoint (Palade). Several topics of capillary pathophysiology are discussed: vascular labeling and the capillary as a privileged vessel; capillary versus venular leakage in inflammation; endothelial tone. The overview concludes with a summary of 15 pathologic events that may occur in capillaries.     

Posters: Angiogenesis

Inflammation Research -     

Psychotherapy: Then and now

Some of the important and interesting developments in psychotherapy that have occurred over the past 50 years are discussed. Included are the increased number and variety of individuals engaged inn psychotherapy, the prominent role and contribution of psychologists with reference to psychotherapy research, the proliferation of the forms of psychotherapy as well as the more recent movement for integration, the current popularity of brief forms of psychotherapy, and some practical future issues.