Immunoglobulin Class and Subclass Distribution of Dextran-Reactive Antibodies in Human Reactors and Non Reactors to Clinical Dextran

The red cell-linked antigen-antiglobulin reaction (RCLAAR) with stearoyldextran-coated erythrocytes was used to characterize the immunoglobulin (Ig) classes and IgG subclasses of dextran reactive antibodies (DRA) in 27 dextran reactors (DR) and 96 on reactors (DNR). High titres of dextran reactive IgG were regularly found in sera of patients with severe dextran-induced anaphylactoid/anaphylactic reactions (DIAR) prior to the infusion. In four lethal cases IgG antibodies were found to be in the highest titre range of 16,384 to 32,768. In addition, high IgA and IgM titres were also in severe DIAR. DNR had much lower titres of dextran reactive antibodies of IgG, IgM and IgA classes and IgD antibody was absent in both groups. Dextran reactive IgE antibodies were not demonstrable in DR. Dextran reactive IgG2, IgG3, IgG4 and IgG1 (indirect measurement) were demonstrated in both DR and FNR. Dextran infusion caused variable neutralization in all Ig classes and IgG subclasses, but the contribution of IgG2 was considered most important because of its high titres and most pronounced neutralization in severe DIAR. It is concluded that DRA mainly of the IgG class, play a critical pathogenic role in the induction of severe DIAR, which accordingly is classified as immune complex (Type III) anaphylaxis. The method of RCLAAR allows to delineate a risk group of about 2% of potential reactors.     

Osteoarthritis and other long-term health conditions in former elite cricketers

Objectives

This study aimed to describe the prevalence and risk of chronic conditions in former elite cricketers compared to a normal population, and describe wellbeing in former elite cricketers.

Reorganisation of human step initiation during acute experimental muscle pain

The effects of experimentally induced pain in tibialis anterior on step initiation were studied in six healthy male volunteers by kinematics, kinetics and electromyography (EMG). We observed longer reaction times, lower joint moments and decreased EMG activity in the painful leading leg’s tibialis anterior and gastrocnemius muscles. Peripheral nociceptive input appeared to alter the internal representation used in the step initiation motor program.     

Transcultural Nursing Society position statement on human rights.

In 2006, the Transcultural Nursing Society created a business plan with a firm commitment to social change and the support of human rights. One of the primary goals of the plan was to seek recognition from the United Nations as a Human Rights Organization. As a first step in articulating this goal, the board of trustees of TCNS tasked a small group of Transcultural Nursing Scholars to develop a position statement. This article is the culmination of the collaborative task force's efforts to define how TCNS seeks the fulfillment of human rights for people of all cultures worldwide.     

Abnormal expression of interleukin-23 in mycosis fungoides/Sézary syndrome lesions

Progression of mycosis fungoides (MF) to Sézary syndrome (SS) is accompanied by a shift from a T(H)1 to a T(H)2 cytokine profile. Interleukin (IL)-23 is a novel cytokine that shares a common p40 subunit with the T(H)1 inducer, IL-12. IL-23 induces a third profile, T(H)IL-17, that is dominant in inflammation and autoimmunity. Although IL-23 induces an eczematous-like skin reaction in mice, and is expressed in T(H)1-mediated skin disorders such as psoriasis, it has not been evaluated in MF/SS. To study the role of IL-23 in MF/SS development, 40 MF/SS lesions of all stages were immunohistochemically analyzed with a novel anti-human IL-23 antibody raised against full-length human IL-23. IL-23 was detected with the catalyzed signal amplification system. The intensity and frequency of IL-23 staining were semi-quantitatively graded in both the dermal infiltrate and the epidermis. Increased expression of IL-23 was observed throughout the epidermal keratinocytes and in dermal lymphocytes compared to normal skin. IL-23 intensity did not differ significantly among the stages of MF/SS; however, in stage IVB patients, we observed lower frequency of IL-23 expression in dermal lymphocytes than in other stage patients [P = 0.13, analysis of variance (ANOVA)]. Interestingly, clusters of atypical lymphocytes, especially the epidermotropic tumor cells, demonstrated weak or absent IL-23 staining in 18 of 40 (45%) lesions. This finding was present in 4 of 5 (80%) of the stage IVB lesions and 7 of 11 (64%) of the lesions from Sézary patients. These findings indicate that abnormal IL-23 expression may play a role in the pathogenesis and progression of MF/SS.     

Osnabrueck hand eczema severity index--a study of the interobserver reliability of a scoring system assessing skin diseases of the hands

An easy-to-use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index (OHSI) was developed for this purpose and the interobserver reliability investigated. The clinical severity was evaluated on the basis of the extension or clinical characteristics of six morphological characteristics. For the validation of the OHSI, hand eczema in 28 patients was investigated independently by one dermatologist and 2 occupational physicians. The agreement between the observers was determined by using kappa values, Kendall's coefficient of concordance, the intraclass correlation coefficient (ICC) and the 95% limits of agreement. The ICC for the total OHSI was 0.80 and the estimated limits of agreement (-3.6 and 3.0) were sufficiently small to expect that ratings according to OHSI performed by independent observers of different medical specialities should produce similar results. It could be demonstrated that the use of the OHSI is simple and practicable. The interobserver reliability for the summary score is good. OHSI seems a reliable tool for assessing the severity of occupational hand eczema.