Keratinocyte expression of intercellular adhesion molecule 1 (ICAM-1) correlated with infiltration of lymphocyte function associated antigen 1 (LFA-1) positive cells in evolving allergic contact dermatitis reactions

Adhesion molecules are considered to have an important role in inflammatory reactions. We investigated the kinetics of ICAM-1 expression on keratinocytes and correlated this with the numbers of lymphocytes expressing LFA-1 in the dermis and epidermis of evolving allergic contact dermatitis reactions. In nickel-sensitive individuals, after application of a nickel patch, increased expression of ICAM-1 on keratinocytes was observed as early as 3 h and reached a maximum at 48 h. The number of lymphocytes expressing LFA-1 in the dermis and epidermis was greatest at 48 h. The LFA-1 cells were observed to be in close proximity to keratinocytes expressing ICAM-1, thus supporting the hypothesis that T-lymphocytes attach to keratinocytes via LFA-1/ICAM-1 molecules.     

A short scale for predicting drug misuse using selected items from the MMPI

The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 210 young people who either used no drugs, used non-opioids, used opioids but did not inject and drug injectors. From the data collected a short scale of 37 items was derived which distinguished between non-users and drug users. Validation was then attempted using 214 subjects who were either in drug treatment programmes or alcohol treatment programmes as well as appropriate control groups. The Drug Misuse Scale was able to distinguish between these groups. The MacAndrew Scale proved better at distinguishing subjects in alcohol treatment programmes. However, the Drug Misuse Scale proved to be significantly better at distinguishing the drug misusers. It is suggested that the Drug Misuse Scale may prove a valuable clinical tool.     

Periventricular Leukomalacia:

ABSTRACT. The ultrasonographic findings and neurological development of 15 preterm infants, born between August 1981 and July 1984, who developed periventricular leukomalacia (P.V.L.) are described. The incidence of P.V.L. in infants with a birth weight less than 1500 g was 2.3 %. Nine of the 15 infants demonstrated areas of increased echogenicity in the periventricular regions prior to the development of cystic changes. The mean age for the appearance of cysts was 26 days. At follow-up 14 infants showed evidence of abnormal motor development and 8 infants had visual defects. All infants appear to have normal hearing, but 3 infants show signs of delayed speech. To date, only 2 infants demonstrate signs of mental retardation, but many of the infants are too young to assess intelligence accurately.     

The criminality of new drug users in Glasgow

The drug use and crime of 210 teenage licit and illict drug users were examined. Over 90% of the sample, including non-users, soft drug users, opioid users and injectors, were obtained via the same ‘snowball’ of friends and acquaintances. None had been injecting for more than 2 years. It was found that the frequency of use of all licit and illict drugs and the frequency of all crimes were intercorrelated. However, even many of the opioid injectors in this sample were not near-daily users and ‘addiction’ did not explain the results of regression equations predicting crime and drug use; crime explained drug use more than drug use explained crime and drug use was not a major unique predictor of theft. The criminal drug-using teenagers in this sample were better regarded as ‘delinquents’ than as ‘drug-abusers’ or ‘drug addicts’. Delinquent behaviour of all kinds appeared to be increased by prior criminal experience, having delinquent friends and lack of conventional social support (notably including having spent time in care). Implications of these findings for theories of delinquency and the practice of treatment and prevention are discussed.     

Plasma fibronectin levels in extremely preterm infants in the first 8 weeks of life

Abstract Fibronectin has in the past been considered to function simply as a non-specific plasma opsonin. However, recent studies have demonstrated that this molecule plays an important role in fundamental components of the immune response, for example, neutrophil adhesion, T cell activation and endothelial function. Additionally, fibronectin is important in lung homeostasis where it contributes to alveolar epithelial integrity. In this study plasma fibronectin levels were measured longitudinally in a group of extremely preterm infants, mean gestational age 27 weeks.
Plasma fibronectin levels at birth were significantly lower in the preterm study group than in term controls (mean 91±33 μg/mL compared with 214±62 μg/mL in the term controls, P <0.0001). The preterm cohort demonstrated a more than two-fold rise in plasma fibronectin on days one and two; levels fell almost to baseline values by day three with a subsequent slow rise to a plateau by day 28. No further increase was seen by day 56. This sequence of early changes in fibronectin levels mirrored closely the time course of respiratory distress syndrome. Infants of mothers with pre-eclampsia had significantly lower peak fibronectin levels than in those without ( P = 0.016), and those infants with bronchopulmonary dysplasia showed a trend towards lower basal fibronectin levels ( P = 0.07) and a greater difference between peak and basal levels ( P = 0.05).
Neonates, particularly those born preterm, have blunted immunological responses to infection. Fibronectin plays a key role in immunological responsiveness. The significant changes in fibronectin levels after birth in the preterm neonate are likely to have important pathophysiological consequences. The relationship between alterations in fibronectin after birth, endothelial and epithelial cell function, and respiratory distress syndrome (RDS) remain to be explored.     

How we treat: considerations for physiotherapy in the patient with haemophilia and inhibitors undergoing elective orthopaedic surgery

Ten weeks prior to a scheduled left total knee arthroplasty, a 25‐year‐old man with severe haemophilia A and a high‐titre inhibitor presented to the physical therapist for a preoperative assessment at the haemophilia treatment centre (HTC). Prior to the recommendation to proceed to surgery, the therapist and other members of the multidisciplinary care team had surmised that, despite two previous radiosynovectomies, an arthroscopic synovectomy, and most recently at the age of 18 years, an arthroscopic debridement, the patient continued to have a progression of joint disease manifested by pain, restricted range of motion and reduced strength. Based on these findings and the patient’s history of consistent adherence to and follow‐through with recommended treatments, the HTC staff and orthopaedic surgeon determined that he was a good candidate for total knee replacement. The patient’s pain and joint disease severely limited his mobility and participation in functional activities. The most recent radiographs were notable for severe tricompartmental arthropathy of the left knee with joint deformity, flexion contracture, and osteoporosis. When queried about current haemostatic therapy during the initial preoperative visit with the physical therapist, the patient explained that he was self‐infusing a bypassing agent to treat active bleeds and as prophylactic treatment before participating in vigorous physical activity, as advised by his haematologist. He had previously managed his joint pain with cyclooxygenase‐2 inhibitors and both short‐ and long‐acting opioids, in addition to physical therapy. His current personal inventory of mobility and rehabilitative aids consisted of crutches, compressive wraps, and a cold‐compression unit. Further assessment of relevant environmental and psychosocial factors revealed that the patient was living with his girlfriend and 3‐year‐old daughter, for whom he was the primary caregiver, in a two‐story home with five steps to enter. He was also working part‐time from home as a computer consultant. The visit concluded with a formal physical assessment and discussion of next steps, including plans for additional preoperative physical therapy sessions. The therapist also informed the patient about what to expect postoperatively in terms of rehabilitation and recovery.