T cells in patients with chronic Tγ lymphocytosis: Morphology,cytochemistry, ultrastructure and immunological characteristics

Summary We have studied the morphology and cytochemistry in relation to the immunological phenotyping and functional properties of T cells from eight patients with chronic T lymphocytosis. At the light microscopic level the morphology of the patients' lymphocytes was similar to that described for large granular lymphocytes. Ultrastructurally, a division into two groups could be made on differences in the amount of cytoplasm and the location and the more irregular form of the nuclei. The lymphocytes of one group (five patients) had in common the phenotype Fc+, T3+, T4–, T8+, Ia–, M1– and demonstrated (with the exception of one patient) the same functions: presence of K-cell activity, absence of NK, helper and suppressor cell activities. In the other group (three patients), the lymphocytes of one patient showed the same phenotype and functions as those indicated above. The other two patients both lacked the T8 antigen on their lymphocytes but were different with regard to other surface markers. In addition, their cells were functionally identical: both demonstrated NK- and K-cell activity. Thus in this group of eight patients with chronic T lymphocytosis, the immunological and functional subdivision paralleled in part a morphological division at the ultrastructural level.     

Excessive apoptosis of bone marrow erythroblasts in a patient with autoimmune haemolytic anaemia with reticulocytopenia

We report a patient with autoimmune haemolytic anaemia (AIHA) with reticulocytopenia, who showed excessive apoptosis of erythroblasts. Ultrastructural analysis of bone marrow cells showed that 50% of erythroblasts had characteristic features of apoptosis, which was confirmed by staining with Annexin-V. In addition, in contrast to normal erythroblasts, Ig staining of the entire erythroblast population could be shown. These data show that apoptosis may contribute to the mechanism of reticulocytopenia in AIHA.     

Inverse relation between iodine intake and thyroid blood flow: color Doppler flow imaging in euthyroid humans

High intake of iodine inhibits iodide trapping, iodide organification, and hormone release from the human thyroid. We investigated whether iodine intake also affects thyroid blood flow, as was suggested by a recent study in euthyroid rats. With a Color Doppler device we made 14 consecutive Duplex-Doppler registrations of both superior thyroid arteries in 10 euthyroid volunteers during baseline iodine intake (1 week), iodine restriction (2 weeks), return to baseline (1 week), and iodine excess (1 week; 80 mumol sodium iodide/day). Vessel diameters and mean flow velocity were measured on videotape recordings by a "blinded" observer. Baseline iodide excretion was 0.88 +/- 0.38 (+/- SD) mumol/day. Mean flow velocity was 13.9 +/- 4.1 cm/s, and vessel diameter was 1.07 +/- 0.22 mm. Blood flow was 7.7 +/- 3.8 mL/min.superior thyroid artery. During the low iodine diet, excretion dropped to 0.49 +/- 0.16 mumol/day, and blood flow increased to 11.0 +/- 5.0 mL/min (P less than 0.001), remaining elevated (10.3 +/- 4.4 mL/min) during the second baseline diet. During high iodide intake, blood flow averaged 5.8 +/- 3.4 mL/min (P less than 0.001), and the expected decrease in thyroid hormone levels and increase in TSH were seen. We conclude that thyroid blood flow responds inversely, and independently from TSH, to changes in iodine intake in euthyroid humans.     

ADVANCED GLYCATION END PRODUCTS IN RENAL FAILURE: AN OVERVIEW

The article aims to present an overview of the existing knowledge on advanced glycation end products (AGE). They are moieties that bind to proteins, but also lipids and nuclear acids. AGE are formed during glycation and oxidative stress. Accumulation of AGE occurs especially in diabetes and chronic renal failure and plays a major pathogenetic role. The deleterious effects of AGE result from cross‐linking of proteins and activation of the receptor for advanced glycation end products. AGE accumulation can be noninvasively assessed by the skin autofluorescence reader. In diabetics, the skin autofluorescence predicts cardiac mortality and the occurrence of macro‐ and microvascular complications. In patients on haemodialysis, skin autofluorescence is highly elevated and predicts mortality. After renal transplantation AGE accumulation is lower than during haemodialysis, but still remains elevated and is a strong risk factor for chronic renal transplant dysfunction. Some of the potential methods to intervene with AGE accumulation are discussed in this article.     

1 + 1 = 3? The systematic development of a theoretical and evidence-based tailored multimedia intervention to improve medication adherence

Objective

To describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically.

Methods

The development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients.

Results

The components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention.

Conclusion

By applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior.

Practice implications

This study could serve as a guide for the development of other health interventions.