Terminal deoxynucleotidyl transferase-containing cells in peripheral blood: implications for the surveillance of patients with lymphoblastic leukemia or lymphoma in remission

An indirect immunofluorescence assay was used to quantitate TdT- containing (TdT+) cells in the mononuclear leukocyte fraction of peripheral blood from normal subjects and patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL). In normal children (10) and adults (10), 0.036% +/- 0.014% (mean +/- SD) and 0.030% +/- 0.015% TdT+ cells were found. In peripheral bloods from 10 children receiving chemotherapy for tumors other than ALL or LL, 0.040% +/- 0.039% TdT+ cells were found. Serial determinations were performed on 15 patients with ALL or LL who were in clinical remission. Eight of these patients remained in continuous remission and always had fewer than 0.11% TdT+ cells in their peripheral blood. Three patients who developed systemic relapse were found to have progressively rising numbers of TdT+ cells in their peripheral blood prior to clinical evidence of relapse. All 3 of these patients had greater than 0.1% TdT+ cells in their peripheral blood from 3 to 8 wk prior to clinical relapse. In 3 other patients, localized extramedullary relapse developed, but no trend was found on serial TdT determinations. Thus, the indirect immunofluorescence assay for TdT detects a small population of cells in normal peripheral blood. In patients with ALL, progressive increases above this normal level were associated with subsequent bone marrow relapse.     

Tissue inhibitor of metalloproteinase-2 inhibits T-cell infiltration and preserves pancreatic beta-cell function in an in vitro type 1 diabetes mellitus model

Type 1 diabetes mellitus (T1DM) results from autoreactive T-cells that attack and destroy insulin producing pancreatic beta-cells. This knowledge has provided a framework for numerous efforts to prevent or mitigate T1DM at various stages of the disease. In this study, we utilized an organ culture model of type 1 diabetes to determine whether tissue inhibitors of metalloproteinases (TIMPs) could block T-cell migration into the pancreas and ultimately preserve beta-cell function. We measured T-cell repertoires, insulin secretion, and performed immunohistochemistry and confocal laser microscopy in order to evaluate the effect of TIMP-1, TIMP-2, and TIMP-3 on our in vitro T1DM organ culture model. TIMP-2 decreased T-cell transmigration and preserved insulin production in our T1DM organ culture model. Moreover, TIMP-2 inhibited transmigration of diabetogenic T-cells across an islet microvascular endothelial cell layer. Our findings suggest that TIMP-2 is effective at blocking infiltration of autoreactive T-cells into target pancreas tissue thereby preserving pancreatic beta-cell mass.     

COMPLIANCE WITH PRESCRIBED MEDICINES IN GENERAL MEDICAL AND SURGICAL WARDS

SUMMARY A total of 6833 doses of medication were prescribed to 753 hospital inpatients in general wards over a 24-hour period (excluding medicines prescribed on an as-required basis and medicines prescribed for the first time during the 24-hour period). Of these, 574 (8.4%) doses were omitted, representing at least one omitted dose in 242 (32.1%) patients. Many of the omitted doses were of symptomatic treatments and in 43% of instances omission was deemed, retrospectively, to have been beneficial. Some omissions, however, were of a potentially life-threatening nature. The most common reasons for omission were that the patient refused the drug or that the nurse thought the drug unnecessary, the patient was on ‘nil by mouth’ or was too ill or unable to take the medicine. Thus, omission of prescribed medicines in general wards is common, often of little consequence or even beneficial, but of a potentially serious nature.     

Dose-range and dose-frequency study of recombinant human interleukin-1 receptor antagonist in patients with rheumatoid arthritis

Objective. To preliminarily evaluate the safety and efficacy of different dose levels and dosing frequencies of recombinant human interleukin-1 receptor antagonist (rHuIL-1Ra) in the treatment of patients with rheumatoid arthritis (RA). Methods. One hundred seventy-five patients with active RA were enrolled in a randomized, double-blind trial of rHuIL-1Ra administered by subcutaneous injection. There were 9 treatment groups in the trial. During the initial 3-week treatment phase, patients were treated with 20, 70, or 200 mg rHuIL-1Ra, administered either once, 3 times, or 7 times per week, followed by a 4-week maintenance phase, during which all patients received the treatment-phase dose once per week. To maintain the blindness of the study, patients received daily injections of either rHuIL-1Ra or placebo on the days rHuIL-1Ra was not administered. Results. Recombinant HuIL-1Ra was well tolerated. The most frequent adverse event was injection-site reactions, which were reported in 62% of patients and caused 8 patients (5%) to withdraw prematurely from the study. Five patients (3%) developed serious adverse reactions unrelated to dose or dosing frequency. Due to the lack of a placebo arm and to the multiple small treatment groups, a definitive statement regarding efficacy could not be made. However, by the end of the 3-week treatment phase, daily dosing appeared more effective than weekly dosing when assessed by the number of swollen joints, the investigator and patient assessments of disease activity, pain score, and C-reactive protein levels. Conclusion. These preliminary data suggest that rHuIL-1Ra may be safely administered by subcutaneous injection to RA patients. The frequency of dosing appears to be important in determining clinical response, with daily administration providing the most benefit. A placebo-controlled trial is in progress to further assess the clinical usefulness and to better define appropriate doses of rHuIL-1Ra in patients with RA.