Assessment of New Culture Method for Detection of Borrelia Species from Serum of Lyme Disease Patients

A novel method of culturing spirochetes from the serum of U.S. Lyme disease patients was recently reported by Sapi and colleagues to have 94% sensitivity and 100% specificity for Borrelia species as assessed by microscopy and DNA sequence analysis of the pyrG gene (E. Sapi, N. Pabbati, A. Datar, E. M. Davies, A. Rattelle, and B. A. Kuo, Int. J. Med. Sci. 10:362–376, 2013). The majority of the spirochetes described were related by pyrG sequences to species of Borrelia previously undetected in North American patients without a reported history of travel to Europe or Asia. To better understand these unexpected findings, we determined pyrG sequences of the laboratory reference strains used by the investigators for method development and testing of culture medium. Eighty percent (41/51) of the reported patient-derived pyrG sequences were identical to one of the laboratory strains, and an additional 12% (6/51) differed by only a single nucleotide across a 603-bp region of the pyrG gene. Thus, false positivity due to laboratory contamination of patient samples cannot be ruled out, and further validation of the proposed novel culture method is required.     

Effects of Pretreating Serum Samples on the Performance of a Latex Agglutination Test for Serodiagnosis of Paracoccidioidomycosis

Paracoccidioidomycosis (PCM) is a fungal disease caused by Paracoccidioides brasiliensis, and Brazil is one of the principal countries where it is endemic. Diagnosis is based on the observation of budding P. brasiliensis yeast in clinical specimens from patients; however, the sensitivity of the visualization of fungi is low, indicating that serological tests are used for early diagnosis. The double-immunodiffusion test (ID) is the “gold standard” test for serology in PCM, although the execution of this test requires the availability of laboratorial infrastructure. We report the improved performance of a latex agglutination test (LAT) by pretreating 30 serum samples from PCM patients and 71 controls (histoplasmosis and aspergillosis patients, patients with bacterial infections, and normal human sera) with a dilution buffer incubated at 37°C for 30 min. The sensitivity and specificity of the LAT test in the nonpretreated samples were 73% and 79%, respectively. However, when samples were pretreated, the sensitivity and specificity of the test increased to 90%. In this study, we did not observe cross-reactivity with histoplasmosis patient sera, but some reactions to sera from patients with aspergillosis and bacterial infections were noted. Normal human sera were not reactive in our tests. These results indicate the need for the elimination of heterologous reactions so that we can adequately use this method for screening cases of PCM.     

Immunological Responses to Candida albicans I. Mouse-Thigh Lesion as a Model for Experimental Candidiasis

A mouse-thigh lesion model for experimental candidiasis is described. A standard inoculum of 5 x 10(8) yeast cells of Candida albicans, injected into the thigh muscle of C57BL/Ks mice, produced an easily measured thigh lesion that was self-limiting by 4 to 6 weeks, permitting a study of immunological responses to the infection. Examination of the histopathology of the lesion reveals that the cellular infiltrate is predominately granulocytic, and gives little evidence for an active, specific, cell-mediated immune response.     

Performance of Purified Antigens for Serodiagnosis of Pulmonary Tuberculosis: a Meta-Analysis

Serological antibody detection tests for tuberculosis may offer the potential to improve diagnosis. Recent meta-analyses have shown that commercially available tests have variable accuracies and a limited clinical role. We reviewed the immunodiagnostic potential of antigens evaluated in research laboratories (in-house) for the serodiagnosis of pulmonary tuberculosis and conducted a meta-analysis to evaluate the performance of comparable antigens. Selection criteria included the participation of at least 25 pulmonary tuberculosis patients and the use of purified antigens. Studies evaluating 38 kDa, MPT51, malate synthase, culture filtrate protein 10, TbF6, antigen 85B, α-crystallin, 2,3-diacyltrehalose, 2,3,6-triacyltrehalose, 2,3,6,6′-tetraacyltrehalose 2′-sulfate, cord factor, and TbF6 plus DPEP (multiple antigen) were included in the meta-analysis. The results demonstrated that (i) in sputum smear-positive patients, sensitivities significantly ≥50% were provided for recombinant malate synthase (73%; 95% confidence interval [CI], 58 to 85) and TbF6 plus DPEP (75%; 95% CI, 50 to 91); (ii) protein antigens achieved high specificities; (iii) among the lipid antigens, cord factor had the best overall performance (sensitivity, 69% [95% CI, 28 to 94]; specificity, 91% [95% CI, 78 to 97]); (iv) compared with the sensitivities achieved with single antigens (median sensitivity, 53%; range, 2% to 100%), multiple antigens yielded higher sensitivities (median sensitivity, 76%; range, 16% to 96%); (v) in human immunodeficiency virus (HIV)-infected patients who are sputum smear positive, antibodies to several single and multiple antigens were detected; and (vi) data on seroreactivity to antigens in sputum smear-negative or pediatric patients were insufficient. Potential candidate antigens for an antibody detection test for pulmonary tuberculosis in HIV-infected and -uninfected patients have been identified, although no antigen achieves sufficient sensitivity to replace sputum smear microscopy. Combinations of select antigens provide higher sensitivities than single antigens. The use of a case-control design with healthy controls for the majority of studies was a limitation of the review. Efforts are needed to improve the methodological quality of tuberculosis diagnostic studies.The failure to diagnose tuberculosis (TB) accurately and rapidly is a key challenge in curbing the epidemic (45, 88, 116). Sputum microscopy, currently the sole diagnostic test in most areas where TB is endemic, has several limitations; in particular, the sensitivity compared with that of culture is variable (80, 97, 104, 116), multiple patient visits are required (56, 93, 114), considerable technical training is necessary, and the procedure is labor-intensive (45, 65). Antibody detection tests (serological tests) are used for the diagnosis of many infectious diseases and could potentially improve the means of diagnosis of TB. These tests measure the presence of specific antibodies (most often immunoglobulin G [IgG]) directed against immunodominant antigens of the pathogen in question. Compared with microscopy, antibody detection methods may enable the rapid diagnosis of TB, as these tests have the advantages of speed (results can be available within hours), technological simplicity, and minimal training requirements. In addition, these tests can be adapted to point-of-care formats that can be implemented at lower levels of health services in low- and middle-income countries (21, 22, 57, 65).Efforts to develop antibody detection tests for the diagnosis of TB have been under way for decades, and the performance of these tests has been well described (13, 17, 22, 32, 40, 47, 48, 52, 60, 64, 100, 107). Several systematic reviews of these tests have been published (discussed below) (28, 94, 95).First-generation antibody detection tests were based on crude mixtures of constituents and products of Mycobacterium tuberculosis, for example, culture filtrate proteins and purified protein derivative, the preparation used in the tuberculin skin test. Several of these early tests had low specificities, as the tests contained antigens shared among different bacterial species (1, 22, 48, 57). During the past two decades, an increased understanding of humoral immune responses to M. tuberculosis and the new tools of genomics and proteomics have led to the discovery of new antigens reported to provide improved sensitivities and specificities for the diagnosis of TB compared with those achieved with the antigens in the first-generation tests (48).We reviewed the immunodiagnostic potential of different antigens evaluated in research laboratories (in-house) for the serodiagnosis of pulmonary TB and carried out a meta-analysis to evaluate the performance of various antigens singly and in combination. Previous meta-analyses have shown that commercially available serological tests for both pulmonary TB (94) and extrapulmonary TB (95) have variable accuracies and, consequently, a limited clinical role. Another systematic review (searches through 2003) limited studies to the cohort or case series type of design and included only nine studies relating to in-house anti-TB antibody serological tests (28). A recently published expert review (1) did not include a meta-analysis. We are unaware of other systematic reviews on this topic.The current review addresses the following questions. (i) What is the performance of different antigens in the serodiagnosis of pulmonary TB in sputum smear-positive and smear-negative patients? (ii) What is the performance of these antigens in the serodiagnosis of pulmonary TB in patients with human immunodeficiency virus (HIV) infection?     

Characterization of AFMP1: a Novel Target for Serodiagnosis of Aspergillosis

We cloned the AFMP1 gene, which encodes the first antigenic cell wall galactomannoprotein in Aspergillus fumigatus. AFMP1 codes for a protein, Afmp1p, of 284 amino acid residues, with a few sequence features that are present in Mp1p, the antigenic cell wall mannoprotein in Penicillium marneffei that we described previously, as well as several other cell wall proteins of Saccharomyces cerevisiae and Candida albicans. It contains a serine- and threonine-rich region for O glycosylation, a signal peptide, and a putative glycosylphosphatidyl inositol attachment signal sequence. Specific anti-Afmp1p antibody was generated with recombinant Afmp1p protein purified from Escherichia coli to allow further characterization of Afmp1p. Afmp1p has a high affinity for Galanthus nivalis agglutinin, a characteristic indicative of a mannoprotein. Furthermore, it was recognized by a rat monoclonal antibody against the galactofuran side chain of galactomannan, indicating that it is a galactomannoprotein. Ultrastructural analysis by immunogold staining indicated that Afmp1p is present in the cell walls of the hyphae and conidia of A. fumigatus. Finally, it was observed that patients with aspergilloma and invasive aspergillosis due to A. fumigatus develop a specific antibody response against Afmp1p. This suggested that the recombinant protein and its antibody may be useful for serodiagnosis in patients with aspergilloma or invasive aspergillosis, and the protein may represent a good cell surface target for host humoral immunity.     

Effect of Boundary Absorption in Dispersion in Casson Fluid Flow in a Tube

The combined effect of yield stress and irreversible boundary reaction on dispersion process in a Casson fluid flowing in a conduit (pipe/channel) is studied using the generalized dispersion model proposed by Sankarasubramanian and Gill (Sankarasubramanian, R., and W. N. Gill. Proc. R. Soc. London, Ser. A 333:115-132, 1973). The study describes the development of dispersive transport following the injection of a tracer in terms of the three effective transport coefficients, viz., exchange, convection, and dispersion coefficients. The exchange coefficient does not depend on yield stress but the convection and dispersion coefficients depend on yield stress or equivalently plug flow region. For large times, when the plug flow radius is one-tenth of pipe radius, the convective coefficient is reduced by 0.41 times of the corresponding value for a Newtonian fluid at equivalent wall absorption parameter; in channel case the reduction is by 39%. It is seen that the asymptotic dispersion coefficient decreases with increase in wall absorption parameter and yield stress of the fluid. When the plug radius in pipe (channel) is 0.1, depending upon the values of wall absorption parameter, say (0.01-100) the reduction factor in dispersion coefficient is in the range (0.1-0.3) in comparison to the values of the Newtonian case. The results reduce to those of Sankarasubramanian and Gill (Sankarasubramanian, R., and W. N. Gill. Proc. R. Soc. London, Ser. A 333:115-132, 1973) when there is no yield stress for the pipe flow analysis and to those of Dash et al. (Dash, R. K., G. Jayaraman, and K. N. Mehta. Ann. Biomed. Eng. 28:373-385, 2000) when there is no interphase mass transfer. The study can be used as a starting first approximation solution for studying the dispersion in the cardiovascular system.     

Laboratory Evaluation of Serological Tests for Systemic Candidiasis: a Cooperative Study

Three serological tests for candidiasis, agar gel diffusion (AGD-1), whole cell agglutination (AGGL-1), and latex agglutination (LAT), were evaluated by six laboratories with 100 coded sera. In addition, each of six laboratories performed a test of its choice, either the AGD-2, the AGD-3, the AGGL-2, or one of three counterimmunoelectrophoresis (CEP) methods (CEP-1, CEP-2, and CEP-3). Results are presented by laboratory for a group of 53 "candida-involved" cases (33 proven, 14 presumptive, and 6 probable) and 47 negative controls (41 normal and 6 other disease states). The AGD-1 test produced an overall average of 85.1% positive results in the candida-involved group and 5.0% positives in the control group. The LAT produced an overall average of 89.0% positives in the candida-involved group and 17.4% positives in the controls. The AGGL-1 test produced an overall average of 63.8% positives in the candida-involved group, with 12.3% positives in the controls. In the individual tests, the best performance was shown by the CEP-3 test (92.5% positives in the candida-involved group and 2.1% positives in controls) and the CEP-1 test (88.7% positive in the candida-involved group and no positives in the controls). The tests with the highest sensitivity were the AGGL-2 and CEP-2 (94.3 and 96.2%, respectively). These tests were also the least specific (80.9 and 76.6%, respectively). In the three common tests, the AGD-1 was the most reproducible, whereas the AGGL-1 produced considerable laboratory-to-laboratory variation. Since cell-free extracts of mechanically disrupted C. albicans were used for the LAT and all the AGD and CEP tests, the difference in performance was considered to be mainly due to antigenic composition and the conditions of the test. The results of this study confirm the value of serological tests for the diagnosis of systemic candidiasis, but point out the need for standardized reagents.     

Efficient Diagnosis of Vulvovaginal Candidiasis by Use of a New Rapid Immunochromatography Test

The clinical symptoms of vulvovaginal candidiasis (VVC) are nonspecific, and misdiagnosis is common, leading to a delay in the initiation of antifungal treatment. We evaluated a new immunochromatography test (ICT), the CandiVagi assay (SR2B, Avrille, France), for the rapid diagnosis of VVC. This test, which employs an immunoglobulin M antibody directed against the β-1,2-mannopyranosyl epitopes found in the yeast cell wall, was compared with direct microscopic examination and culture of vaginal swabs. Two-hundred five women were investigated, including 130 women with symptomatic vaginitis and 75 asymptomatic controls. Two vaginal swabs were obtained from each woman: one was used to prepare a wet mount and Gram-stained preparations for direct microscopic examination and was also cultured on Sabouraud dextrose agar for the isolation of Candida spp., and the second swab was used for ICT. The sensitivities of microscopic examination, culture, and ICT for the diagnosis of VVC were 61%, 100%, and 96.6%, respectively, while the specificities of the three methods were 100%, 82%, and 98.6%, respectively. ICT had a negative predictive value of 98.6%, a positive predictive value of 96.6%, and an efficiency of 98%. ICT provided a rapid result and a better compromise between sensitivity and specificity than conventional microscopy and culture for the diagnosis of VVC. This easy-to-perform diagnostic test will be useful to practitioners treating women with symptoms of vaginitis.Vaginitis is the commonest reason for gynecological consultation in women of childbearing age. Anaerobic bacteria are the most prevalent cause of vaginal infection in the United States and Europe, followed closely by Candida spp. (34, 37). It is estimated that at least 75% of healthy adult women will suffer one episode of Candida vulvovaginitis during their reproductive lives and that 5% will have recurrent infectious episodes (20, 30). Candida albicans is responsible for infection in 80 to 90% of cases, although the incidence of vulvovaginal candidiasis (VVC) due to non-C. albicans species such as C. glabrata has increased steadily over the past few decades (21, 36).The main symptoms of VVC have been widely described and include vulvar and vaginal pruritus, pain or a burning sensation, and external dysuria (8). Physical examination may reveal perineal edema, vulvar and vaginal erythema, fissures, and a thick curdy discharge (8). However, these symptoms are nonspecific and do not enable clinicians to distinguish confidently between VVC, bacterial vaginosis, and Trichomonas vaginalis infection (2, 22, 23, 31), leading to subsequent suboptimal care. The accurate diagnosis of VVC currently depends on the demonstration of a Candida sp. in vaginal swabs by direct microscopic examination and/or culture. A positive Gram stain, the absence of a watery discharge, and patient self-diagnosis of “another yeast infection” have been identified as the best predictors of a positive culture for patients with VVC (1).Several rapid diagnostic tests have been developed over the past 25 years in an attempt to speed up the diagnosis of VVC (17, 29). Latex particle agglutination (LPA) was found to be more sensitive than KOH microscopy (19, 28, 29) and was more specific than other diagnostic criteria (10). However, a few studies reported false-positive reactions with this test (39) or a sensitivity that was lower than that of KOH microscopic examination carried out by experienced clinical practitioners (38).We have developed a sensitive immunochromatography test (ICT), the CandiVagi assay (SR2B, Avrille, France), for the rapid diagnosis of VVC using an immunoglobulin M (IgM) monoclonal antibody (MAb) directed against the Candida mannan (18, 40). Here, we present the results of a preliminary evaluation of this test and a comparison of the results obtained by ICT with those obtained by conventional microscopy and culture. Specific attention was focused on the ability of ICT to discriminate between Candida carriage and Candida infection and its specificity for women with bacterial/trichomonal vaginitis.     

血清HWP1检测在儿童皮肤念珠菌病诊断中应用研究

目的 分析讨论血清白色念珠菌菌丝壁蛋白1 (hyphal wall protein 1,HWP1)检测在儿童皮肤念珠菌病诊断中的灵敏度和特异性等诊断效力.方法 选取本院2014年1月至2016年12月期间收治的86例儿童皮肤病患者进行研究,所有患儿均接受血清HWP1检测,将检测结果与金标准诊断结果对比,分析血清HWP1检测诊断儿童皮肤病念珠菌感染的灵敏度、特异性、阳性诊断价值和阴性诊断价值.结果 本研究中86例患几经组织培养确诊为念珠菌感染的患儿41例,非念珠菌感染患儿45例,两性间血清HWP1抗体阳性率相比,差异无统计学意义(P＞0.05);念珠菌感染患儿血清HWP1抗体阳性率(85.37％)显著高于非念珠菌感染患儿(6.67％),差异有统计学意义(P＜0.05);血清HWP1检测诊断灵敏度85.37％,特异性93.33％,阳性预测值92.11％,阴性预测值87.50％,ROC曲线下面积为0.896.结论 血清HWP1能够为儿童皮肤病念珠菌感染筛查和鉴别诊断提供高价值信息,其灵敏度优良,特异性非常高,值得临床推荐.     

Kinetic Patterns of Candida albicans Germ Tube Antibody in Critically Ill Patients: Influence on Mortality

The influence of kinetic patterns of Candida albicans germ tube antibodies (CAGTA) on mortality was analyzed in six intensive care units. Statistically significant lower mortality rates were found in patients with patterns of increasing CAGTA titers who had been treated with antifungal agents. Thus, antifungal treatment should be considered when CAGTA titers are increasing in critically ill patients.Invasive candidiasis (IC) in critically ill patients represents a diagnostic challenge. The mortality rate of patients with IC remains excessively high (10) and is associated with difficulty in making a prompt microbiological diagnosis (11) and a delay in antifungal treatment (2, 7). Until now, no single serological test has found widespread clinical acceptance (8). Recently, an immunofluorescence test for Candida albicans germ tube antibody (CAGTA) detection has been marketed to help with the IC diagnosis. A recently published mortality analysis by our group showed a significant diminution of mortality in those patients with a CAGTA-positive result (12), although the significance of a CAGTA-positive result without other evidence of IC (serological candidiasis) remained unknown. For these reasons, the aims of the present study of critically ill patients with risk factors of developing IC were to describe the kinetic patterns of CAGTA-positive patients and to analyze the outcome of these patients according to CAGTA detection, dynamic profiles of patients, and the administration of antifungal therapy.(This work was partially presented at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, 25 to 28 October 2008.)A retrospective subanalysis of mortality extracted from a prospective observational multicenter study was conducted at six Spanish university hospitals over a period of 2 years (2005 to 2006) (12). Inclusion criteria were as follows: (i) acute pancreatitis of >7 days of evolution, (ii) a prolonged intensive care unit (ICU) stay (>14 days) and three or more risk factors (diabetes mellitus, extrarenal depuration, parenteral nutrition, more than 7 days of broad-spectrum antibiotic therapy, and major abdominal surgery), (iii) liver transplant, (iv) neutropenia or bone marrow transplant, and (v) a high level of Candida colonization. Exclusion criteria were as follows: (i) pregnancy, (ii) an age of <18 years, (iii) previous IC, or (iv) a life expectancy of <7 days. A CAGTA detection assay (Candida albicans immunofluorescence assay immunoglobulin G; Vircell, Spain) was performed twice a week, and a positive result was determined to be a serum titer of ≥1/160 in at least one sample. Blood cultures were processed with automated systems (BACTEC [Becton Dickinson] or BacT/Alert [bioMérieux, Spain]). Identification of yeasts was made with the API 32C or Vitek system (bioMérieux). At each institution, the decision to add antifungal therapy for patients with suspected IC was at the discretion of the prescribing physician based on clinical criteria, but it was not influenced by CAGTA results. The chi-square or Fisher''s exact test was used to compare categorical variables. For patients who had at least one positive result, the increase or decrease of CAGTA titers was also described. A P value of ≤0.05 was considered statistically significant.Fifty-three critically ill nonneutropenic patients (37.7% postsurgery) were included. Twenty-two patients (10 patients had one positive sample, 8 patients had two, and 4 patients had three or more) had CAGTA-positive results, none of them with positive blood cultures for Candida isolates. There were no differences in the antifungal treatment rates between the CAGTA-positive and CAGTA-negative groups. Two patients determined to be CAGTA positive on the basis of only one determination were excluded since it was impossible to determine any change in their titers. Three patterns in CAGTA-positive patients were detected: increasing titers (31.8%), decreasing titers (36.4%), and no change in titer kinetics (22.8%) (Table ​(Table1).1). The intra-ICU mortality rate was significantly lower (P = 0.004) in CAGTA-positive patients (22.7% versus 61.2% in CAGTA-negative patients), as had been previously described by our group (12).

TABLE 1.

Mortality of CAGTA-positive patients according to their dynamic patterns and the administration of antifungal treatment

Evaluation of a Rapid Immunochromatographic Test for Serodiagnosis of Visceral Leishmaniasis

The purpose of this study was to compare the performance of a rapid immunochromatographic dipstick test for the qualitative detection of circulating antibodies to the leishmanial recombinant antigen K39 with that of a classical immunofluorescent antibody test for serodiagnosis of visceral leishmaniasis. Sera from 143 Italian subjects, including 69 patients with clinically suspected visceral leishmaniasis, 23 patients with hypergammaglobulinemia and 51 healthy controls, were tested. The immunochromatographic test was performed according to the manufacturer's instructions, using antigen-impregnated nitrocellulose paper strips. The immunofluorescent antibody test was performed according to an established method, using promastigotes of Leishmania infantum zymodeme Montpellier 1 as antigen. In 11 patients, diagnosis of active Leishmania infection was established by microscopic examination of biopsy samples and/or clinical response to meglumine antimoniate. Results of the two tests correlated for all but two sera examined. In two patients, one with proven infectious mononucleosis and one with bacterial pneumonia, the immunofluorescent antibody test was positive and the dipstick test was negative. In the restricted sample of patients in whom a definitive diagnosis was established, the immunochromatographic test was positive in 11 of 11 patients with confirmed Leishmania infection and negative in 103 of 103 subjects who either had other documented diseases or were healthy controls, showing 100% sensitivity and 100% specificity. Electronic Publication     

Serodiagnosis of ocular toxocariasis: a comparison of two antigens.

This study was designed to compare the sensitivity and specificity of enzyme linked immunosorbent assay (ELISA) for the serodiagnosis of ocular toxocariasis using Toxocara canis embryonated egg antigen (TEE) and toxocara excretory-secretory or exoantigen (TEX) produced in vitro. TEE and TEX ELISA were comparably sensitive, but TEX ELISA was better able to discriminate between serum samples from patients with ocular toxocariasis and those from patients with retinoblastoma. In addition, preabsorption of sera with Ascaris suum embryonated egg antigen seemed to be essential to prevent false positive results with TEE ELISA but was not so critical for TEX-ELISA. Further studies are still required to standardise TEX for serodiagnosis.     

A New Method for Quantification and Assessment of Epileptiform Activity in EEG with Special Reference to Focal Nocturnal Epileptiform Activity

Quantification of epileptiform activity in EEG has been applied for decades. This has mainly been done by visual inspection of the recorded EEG. There have been many attempts using computers to quantify the activity, usually with moderate success. In a row of contexts, including Landau-Kleffner syndrome and the syndrome of epilepsy with continuous spike wave during slow sleep, the spike index (SI) has been applied to quantify ‹interictal nocturnal focal epileptiform activity’, which is suggested as a general term for the epileptiform activity enhanced by sleep. However, the SI has been implemented differently by different authors and has usually not been well described and never properly defined. This study suggests a definition of SI that gives a semiautomatic and relatively robust algorithm for assessment. The method employs spike detection by means of template matching of the current source density estimate. The percentage of time within an epoch with interspike interval (ISI) below a given limit, usually 3 s, is returned as the SI. This is calculated during daytime and in non-REM sleep. The standard epoch length is 10 min. The parameter selection is discussed in the context of the influence of spikes and bursts on cognition. The described method gives reproducible results in routine use, gives clinical valuable information, and is easily implemented in a clinical setting. There is only a minor added workload for the electroencephalographer.     

Cardiovascular Reactivity to a Naturally Occurring Stressor: Development and Psychometric Evaluation of a Psychophysiological Assessment Procedure

Three studies were conducted to examine the feasibility, reactive effects of assessment, stability, sampling parameters, and sensitivity of an assessment procedure designed to measure cardiovascular responses to a discrete, naturally occurring, and replicatable stressor—university course examinations. Undergraduate students monitored their blood pressure and heart rate several times during one or two classroom examinations and for several class sessions preceding each examination. Classroom examinations were generally associated with significant increases in subjective measures of distress and cardiovascular measures. Reactive effects of assessment and other sources of error were minimized and responses were reasonably stable over time. These results support the potential utility, validity, and cost-efficiency of this methodology for assessing cardiovascular reactivity to naturally occurring stressors.     

Deficiency of Interleukin2 Inhibitor Activity in Serum from Autoimmune-Prone Mice

To study the mechanisms that regulate the activity of Interleukin 2 (IL 2) and possibly limit its activity, we have examined normal mouse serum for their ability to Inhibit IL 2-mediated proliferation of a cloned IL 2-dependent cytotoxic T lymphocyte line (CTLL). Normal mouse serum contains a factor capable of inhibiting IL2 dependent proliferation of CTLL cells. This factor is absorbed with IL 2-dependent cells, but not with IL 2 molecules. Decreased activity of the inhibitor is observed in serum from autoimmune-prone mice such as NZB and NZBWF1 hybrid mice. The results suggest that the serum IL 2 inhibitor may play an important role In the in vivo regulatory mechanism of IL 2 activity and that lack of the Inhibitor may be associated with aberrant immune functions.     

The Child-Adult Medical Procedure Interaction Scale-Revised: An Assessment of Validity

Investigated the validity of the Child–Adult Medical ProcedureInteraction Scale-Revised (CAMPIS-R) using multiple concurrentobjective and subjective measures of child distress, approach–avoidancebehavior, fear, pain, child cooperation, and parents' perceivedability to help their preschool children during routine immunizations.Partents', staffs', and children's behaviors in the treatmentroom were videotaped and coded. Results indicate that the validityof the CAMPIS–R codes of Child Coping and Distress, ParentDistress Promoting and Coping Promoting, and Staff DistressPromoting and Coping Promoting behavior were supported, withall significant correlations being in the predicted direction.An unanticipated finding was that the child, parent, and staffNeutral behaviors were inversely related to some measures ofdistress and positively related to some measures of coping.Interobserver reliability was high for each CAMPIS–R code.