Epstein-Barr virus: Biology and disease

Epstein—Barr virus is a human herpes virus which, whilst found as a widespread asymptomatic infection, is also associated with certain tumours of lymphoid and epithelial origin including Burkitt's lymphoma (BL), immunoblastic lymphoma (IBL), Hodgkin's Disease (HD) and nasopharyngeal carcinoma (NPC). A unique characteristic of EBV is its ability to infect and transform primary resting B lymphocytes in vitro into permanently growing lymphoblastoid cell lines (LCLs); this effect is associated with constitutive expression of a limited set of viral genes. Interestingly, the pattern of EBV gene expression observed in LCLs in vitro is also a feature of IBLs, a tumour associated with immunosuppression. The other EBV associated tumours display a more restricted pattern of EBV latent protein expression. B cell lines can be activated in vitro into the virus replicative cycle, where a large number of viral genes associated with EBV DNA replication and virus assembly are synthesised. Whilst EBV can be detected in throat washings from seropositive individuals, the only in vivo situation where full virus replication can be reliably observed is hairy leukoplakia (HL), a benign lesion of lingual epithelium frequently found in AIDS patients. Thus, the relative contribution of lymphoid cells and epithelial cells to latent EBV infection/persistence vs replication in vivo remains controversial. Recent studies suggest that HL represents a focus of EBV replication in the absence of a truly latent infection and this supports the contention that EBV persistence resides in the lymphoid compartment. These aspects together with the role of EBV in oral diseases and the effect of certain EBV genes on the control of epithelial cell growth and differentiation will be discussed.     

Acupuncture for osteoarthritis of the knee

Miller E, Maimon Y, Rosenblatt Y et al. Delayed effect of acupuncture treatment in OA of the knee: a blinded, randomized, controlled trial. Evid Based Complement Altern Med 2011; Article ID 792975. doi:10.1093/ecam/nen080     

The use of a guide catheter extension system as an aid during transradial percutaneous coronary intervention of coronary artery bypass grafts

Aims : Prior coronary artery bypass graft (CABG) surgery is one of the main predictors of failure of transradial PCI. Frequently this is due to difficulty in graft cannulation and/or poor backup support. In addition to Proxis's? embolic protection role, the Proxis?, Heartrail?, and GuideLiner? guide catheter extension devices have all been shown to facilitate coronary intervention by increasing backup support and aiding stent delivery. We describe our institution's experiences using these devices to aid transradial graft intervention. Methods : Between October 2007 and March 2010, the utility and safety of these devices were assessed in consecutive transradial graft intervention procedures. Proxis? cases used for proximal protection alone were excluded. Deep intubation was defined as an intubation depth of ≥2cm. Results : Guide catheter extensions were used in 33 of 41 transradial graft interventions identified. Proxis? was used for proximal protection alone in 3 cases, leaving 30 cases as the study group (Heartrail? n = 18, GuideLiner? n = 3, Proxis? n = 9). In all study cases procedural success with final TIMI‐3 flow was achieved. Guide catheter extensions were used to aid during graft cannulation (n = 11), to improve backup support via deep intubation (n = 26) and as an adjunctive aspiration device (n = 11). Filter‐based distal embolic protection devices were used in 11/21 Heartrail? and GuideLiner? cases. Deep intubation depths ranged from 30 to 138 mm (mean 61 mm) with no complications related to deep intubation seen. Conclusions : The use of guide catheter extension systems facilitated transradial graft intervention via several mechanisms including aid to graft cannulation, increasing backup support, and as an adjunctive aspiration device. © 2011 Wiley Periodicals, Inc.     

Tinea capitis in south-western Ethiopia: a study of risk factors for infection and carriage

Background Tinea capitis is a common dermatophyte infection which constitutes an important public health problem among children worldwide. The endemic nature of scalp ringworm in Africa is perpetuated mainly by the lack of knowledge about the prevalence and carrier status, and the absence of control measures. Methods Two hundred and nineteen schoolchildren from urban and rural communities of the Illubabor district, south-western Ethiopia, were examined, and scalp samples were taken. Children were classified according to clinical signs and mycologic findings. Results Physical examination revealed that 29% of the children had clinical lesions compatible with tinea capitis. Dermatophytes were isolated from 33% of the children's scalp samples; of these, 16% had clinical lesions and 17% were identified as carriers. Trichophyton violaceum was responsible for 97% of infections. Conclusions Tinea capitis was the second most prevalent cutaneous finding in these children, with a higher prevalence in the urban community; the predictive value of the clinical diagnosis was low and a high proportion of children were identified as carriers in these communities. No relationship between household overcrowding and scalp infection was found.     

FS02.2CD4+ CCR10+ effector T cells reside at former allergic contact dermatitis sites

Local skin memory (LSM) describes the clinical phenomenon of an accelerated and increased inflammatory allergic contact dermatitis (ACD) response upon renewed allergen exposure. This has been ascribed to the local persistence of few, but allergen‐specific, T cells. Here, firstly, we characterized effector T cells, and, subsequently, studied which of these cell populations are present at former challenge sites and might contribute to LSM. Peripheral blood T cells were stimulated with nickel sulphate. Cellular phenotypes and chemokine receptor expression profiles were analysed by FACS‐staining: CLA together with CD4/CD8, CD45R0/RA, CXCR3, CCR4, CCR6 and CCR10. Skin biopsies were taken at 0, 3 and 21 days after allergen application and analysed for the same markers. Upon nickel‐stimulation, amount of CD4+ CLA+ CD45R0+ T cells was increased. Together with CLA, CXCR3, CCR4 and, mainly, CCR10 expression was augmented. CCR6 expression was negative on CLA+ cells. In biopsies from patch tests, cellular infiltrates were present at 3 and 21 days after allergen application. Interestingly at day 21, residing cells were localized at the perivascularity and were characterized as CD4+ CD8− CCR10+ T cells. In conclusion, nickel‐activated effector T cells can be characterised as CD4+ CD8− CLA+ memory T cells. They express CXCR3, CCR4 and, in particular, CCR10. After clinical recovery from an ACD reaction, CD4+ CCR10+ memory T cells apparently reside locally. The persistence of these CCR10+ T cells, expressing the appropriate receptor of the skin specific chemokine CCL27, can explain clinically important phenomena such as LSM and flare up reactions.