Macrophages in innate and acquired immunity

Alveolar macrophages play a central role in pulmonary host defense. When foreign particles or pathogens enter the respiratory tract, constitutively present innate host defenses attempt to clear the challenge. Alveolar macrophage phagocytosis of foreign material is a critical component of this response, as is secretion of inflammatory mediators designed to combat invading pathogens. If the pathogenic burden is too large and overwhelms innate immunity, then acquired immune responses are initiated resulting in the generation of antigen-specific cellular and humoral immunity. In response to evolutionary pressures to minimize unnecessary inflammation in the lower respiratory tract, alveolar macrophages are generally poor accessory cells in the initiation of specific immunity. However, in many circumstances, especially those associated with cellular activation, alveolar macrophages can play an important role in the generation and expansion of pulmonary immune responses. This review discusses the role of alveolar macrophages in innate and acquired pulmonary host defense.     

Factors favoring the onset and continuation of rheumatic fever

Rheumatic fever is one of the most important of diseases economically, not only because of its acute manifestations, but also because of its rôle in the production of between 30 and 40 per cent of chronic cardiac disease in the latitude of the North Atlantic States. Microscopic findings indicate it to be a widespread disease involving by preference mesenchymal structures or mesenchymal protions of parenchymatous organs. Physiological stress and strain appear to favor localization of its manifestations, although it may be locally active without giving rise to symptoms; and various vulnerable organs may be either simultaneously or independently involved.A number of factors appear to have causative relationships. Climatic conditions such as exist in temperate zones in winter favor its development; while sunny dry summers and tropical weather inhibit or prevent its evolution. Among the poorer classes it is from fifteen to twenty times more prevalent than in persons better housed and fed. Malnutrition and mild toxic states are frequent precursors of characteristic attacks. Most patients, both children and adults, give a history of repeated nonspecific infections of the respiratory tract, tonsils, sinuses, or middle ear, extending over several years, before a typical attack of rheumatic fever is ushered in by a severe focal infection. Persons in intimate contact with patients during acute outbursts of rheumatic fever not infrequently suffer simultaneously from upper respiratory infections, or from typical rheumatic fever; hence there seems to be a distinct communicable factor favoring its spread. Because chronicity and relapses are so frequent, and crippling cardiac damage is of such gradual evolution, and finally because laboratory tests often reveal activity in periods between attacks, it seems justifiable to consider the infection to be characterized by long periods of preparation or sensitization of the tissues, the result of repeated mild infection before a more intense focal infection sets off the violent explosion recognized as acute rheumatic fever. Similar mild infections, more-over, apparently favor the continuation of true rheumatic activity in viscera already involved. It seems logical, therefore, to regard these preparatory periods and mild chronic infections between acute out-breaks as essential parts of the morbid process; hence our therapeutic and prophylactic efforts should be directed against them as well as against the more acute manifestations of the disease.     

REACTION OF RABBITS TO STREPTOCOCCI: COMPARATIVE SENSITIZING EFFECT OF INTRACUTANEOUS AND INTRAVENOUS INOCULA IN MINUTE DOSES

1. Rabbits were rendered very hypersensitive by relatively small doses of green streptococci given intracutaneously, and somewhat less hypersensitive by similar doses of heat-killed vaccine prepared from hemolytic streptococci. 2. Animals receiving the same doses intravenously gave, upon subsequent testing, lesions slightly more marked than normal controls; but these lesions were qualitatively hard and nodular compared with the large edematous lesions in the cutaneously sensitized group. 3. There was no parallelism between the degree of cutaneous or ophthalmic hypersensitivity and agglutinin titer in the blood serum. 4. Bacterial hypersensitivity to whole streptococci appears to depend more upon previously induced focal infection than upon circulating antibodies.     

The inter‐rater reliability between nurse‐assessors clinically assessing infection of chronic wounds using the WUWHS criteria

The aim of this study was to determine the inter‐rater reliability between one expert‐nurse and four clinical‐nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria. A quasi‐experimental design was used to collect the data. In comparison to phase 1 in which ‘open questions’ were asked, in phase 2 a pre‐printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter‐rater reliability of signs and symptoms was expressed by Cohens Kappa (κ). A substantial agreement (κ ≥ 0·6) was considered as adequate. In both phases pocketing (p < 0·02), and erythema (p < 0·004) scored statistically significant results. Phase 2 showed higher inter‐rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect‐ and a perfect agreement for malodour and pain, respectively. According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre‐printed form than making use of an ‘open questions’ form. To provide this with a higher level of evidence, there is need for more well conducted studies.     

Hypoxia in head and neck cancer

A high level of hypoxia in solid tumours is an adverse prognostic factor for the poor outcome of cancer patients following treatment. This review describes the status of research into finding a practical method for measuring hypoxia and treating hypoxic tumours. The application of such methodology would enable the selection of head and neck cancer treatment based on an individual's tumour oxygenation status. This individualization would include the selection not only of surgery or radiotherapy, but also of novel hypoxia-modification strategies.     

Integrated CT-PET imaging of esophageal cancer: unexpected and unusual distribution of distant organ metastases

CT-PET imaging is being increasingly used for the initial staging, assessment of treatment response, and follow-up of patients with esophageal carcinoma, primarily because of its superior detection of distant metastases compared to conventional methods. Our recent experience has shown that metastases from esophageal cancer can occur in unusual locations and have an unexpected presentation. Recognition of the distribution and appearance of esophageal metastases is important for optimal image interpretation in order to avoid confusion with more benign disease. This article reviews the location and appearance of metastases detected by CT-PET imaging in patients with esophageal cancer either at presentation or after preoperative or definitive chemoradiation therapy.     

用气相色谱-同位素比值质谱法测定体外肠道细菌发酵产生的短链脂肪酸

目的：了解肠道细菌发酵产生短链脂肪酸的情况，为乳糖不耐症状的发生提供依据。方法：在体外进行细菌培养，用稳定性同位素标记的葡萄糖作底物，用气相色谱－同位素比值质谱法测定短链脂肪酸。结果：细菌纯培养显示不同菌株产生的短链脂肪酸不同。人体粪便培养表明不同人体产生的短链脂肪酸的种类相同，而各种类数量不同。结论：所测定的人体肠道发酵产生短链脂肪酸的能力不同，可能与乳糖不耐症状的发生有关。