Anti-inflammatory effects of an inflammatory chemokine: CCL2 inhibits lymphocyte homing by modulation of CCL21-triggered integrin-mediated adhesions

Our studies focus on the pathways that restrict homing of specific subsets of immune cells, and thereby fine-tune the immune response at specific lymphoid and peripheral tissues. Here, we report that CCL2 (at picomolar [pM] levels) renders both murine and human T cells defective in their ability to develop CCR7-triggered activation of LFA-1- and LFA-1-mediated adhesion strengthening to endothelial ICAM-1 both in vitro and in vivo. CCL2 also attenuated lymphocyte chemotaxis toward lymph node chemokines. Consequently, low-dose CCL2 inhibited lymphocyte homing to peripheral lymph nodes but did not affect lymphocyte trafficking through the spleen. Impaired homing of lymphocytes to peripheral lymph nodes resulted in attenuated progression of both asthma and adjuvant arthritis. Thus, pM levels of circulating CCL2 can exert global suppressive effects on T-cell trafficking and differentiation within peripheral lymph nodes, and may be clinically beneficial as an anti-inflammatory agent.     

Clinical Features,Etiology, and Outcomes of Community-Acquired Pneumonia in Patients With Diabetes Mellitus

We performed an observational analysis of a prospective cohort of immunocompetent hospitalized adults with community-acquired pneumonia (CAP) to determine the epidemiology, clinical features, and outcomes of pneumonia in patients with diabetes mellitus (DM). We also analyzed the risk factors for mortality and the impact of statins and other cardiovascular drugs on outcomes. Of 2407 CAP episodes, 516 (21.4%) occurred in patients with DM; 483 (97%) had type 2 diabetes, 197 (40%) were on insulin treatment, and 119 (23.9%) had end-organ damage related to DM. Patients with DM had different clinical features compared to the other patients. They were less likely to have acute onset, cough, purulent sputum, and pleural chest pain. No differences in etiology were found between study groups. Patients with DM had more inhospital acute metabolic complications, although the case-fatality rate was similar between the groups. Independent risk factors for mortality in patients with DM were advanced age, bacteremia, septic shock, and gram-negative pneumonia. Patients with end-organ damage related to DM had more inhospital cardiac events and a higher early case-fatality rate than did the overall population. The use of statins and other cardiovascular drugs was not associated with better CAP outcomes in patients with DM. In conclusion, CAP in patients with DM presents different clinical features compared to the features of patients without DM.     

Thrombophilia in children with venous thromboembolic disease

Venous thromboembolic events (VTEs) in children are usually associated with underlying clinical conditions such as central venous line, cancer and cardiac diseases. The objective of this review is to present the importance of thrombophilia to the occurrence of childhood VTE. The reported prevalence of thrombophilia in children with VTE varies extremely between 10% and 78% in different registries. The variation in the reported prevalence most probably reflects differences in the clinical characteristics of the children studied and differences in study designs. The initial management of children with thrombophilia and VTE is similar to those individuals who do not have a specific inherited thrombophilic risk factor, except in the rare events of homozygous deficiencies of prothrombotic coagulation proteins. The impact of thrombophilic markers on long-term therapy and outcome of children with VTE has not been completely clarified. According to the current guidelines for thrombophilia, all children with VTE should be tested for a full panel of genetic and acquired prothrombotic traits. However, re-evaluation of co-morbid risk factors other than thrombophilic markers and careful consideration of the prognostic value of thrombophilic markers might help to change future attitude from the rigidity of current guidelines to more rational schemes.     

Outcomes for treated anxious children: a critical review of Long‐Term‐Follow‐Up studies

Background: Anxiety disorders are the most common psychiatric disorders of childhood, generating significant distress in the individual and an economic burden to society. They are precursors to diverse psychiatric illnesses and have an impact on development. Childhood anxiety's reach into the future accentuates the importance of studying the long‐term effect of treatment. The purpose of this paper is to examine existing Long‐Term‐Follow‐Up (LTFU) studies' capacity to inform us on the impact of anxiety treatment on development. Method: Medline, PsycInfo, SciSearch, SocScisearch, Cinhal, Embase, and the Cochrane library were searched. Bibliographies of relevant book chapters and review articles and information from colleagues with expertise in anxiety were also a source of information. The search produced more than a thousand citations. Only eight studies met inclusion criteria: follow‐up of a cohort of treated anxious youth for more than 2 years. Results: follow‐up ranged from 2 to 7.4 years. The studies were methodologically rigorous and, in general, showed maintenance of or improvement in acute treatment gains. The studies reviewed could not outline course of recovery or control for pivotal confounding variables such as maturation. Seven of the eight studies employed a Cognitive Behavioral intervention and one employed a manualized, time‐limited, psychodynamic intervention. No LTFU trial for medication was found. Conclusion: ample evidence exists for the short‐term benefit of pediatric anxiety treatment, but evidence is still lacking for the understanding of treatment's role in the facilitation of healthy development into adulthood. Recommendations for future research are proposed. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Nasal sinus metastasis of renal carcinoma. A case report

Renal cell carcinoma is the primary neoplasm which most frequently metastasizes in the nasosinusal region. We present a case of a 51-year-old man who was nephrectomized for a renal cell carcinoma. A year later, he presented a left nasosinusal lesion. The biopsy was conclusive for renal cell metastasis. A paralateronasal and bicoronal approach was used. Currently, 6 years later the patient is free of local disease, but he presents cutaneous metastasis. Renal cell nasosinusal metastasis is found in a context of disseminated disease. Symptoms are unspecific, but the epistaxis constitutes the most common sign due to the significant vascularizations of the tumor. Definitive diagnosis is obtained from the biopsy of the tumor. TC and RM illustrated the lesion's extension and involvement of adjacent structures. Prognosis is poor. The survival rate fluctuates between 15-30% at 5 years. Surgery is the elective treatment but should be considered on an individual basis.