Monocyte major histocompatibility complex class II expression in term and preterm labor

OBJECTIVE: To investigate how term and preterm labor (PTL) influence the balance between maternal proinflammatory and antiinflammatory responses as measured by expression of major histocompatibility complex (MHC) Class II on maternal monocytes and tumor necrosis factor-alpha (TNF-alpha) production by in vitro stimulation of whole blood by lipopolysaccharide (LPS). METHODS: Blood was taken from the following women (n=118): term elective cesarean delivery or in spontaneous labor, in premature labor, or with preterm premature rupture of the membranes (PROM) at less than 32 weeks, and gestation-matched reference group. Monocyte MHC Class II expression was measured by flow cytometry using a dual-staining technique. Plasma cytokine levels were assayed using a cytometric bead array system. In vitro whole blood stimulation with LPS was also performed, and cytokine production was measured. RESULTS: Term labor was associated with a fall in the percentage of monocytes expressing MHC Class II, compared with third trimester of pregnancy, P<.05 and a reduction in LPS-stimulated TNF-alpha production. This fall in MHC Class II was even more pronounced in PTL and preterm PROM groups compared with the reference group, P<.01. CONCLUSION: There was evidence of reduced expression of monocyte MHC Class II and LPS-stimulated TNF-alpha in term and preterm labor. This pattern of reduced MHC Class II expression and reduced TNF-alpha production is known as monocyte hyporesponsiveness or immune paresis. Detection of this state may provide insights into the maternal inflammatory status and be of use in the management of women with threatened PTL or preterm PROM. LEVEL OF EVIDENCE: II.     

Peripancreatic Fat Invasion Is an Independent Predictor of Poor Outcome Following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Background  

Following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), identification of peripancreatic fat tumor invasion promotes a tumor to stage T3. We sought to understand better the impact of histological peripancreatic fat invasion on prognosis and site of recurrence in a cohort of patients with PDAC.     

PREDICTORS OF WOMEN'S INTERNET ACCESS AND INTERNET HEALTH SEEKING

A random, population-based sample of 431 women aged 18–74 in King County, Washington, USA, completed a survey module on Internet use and access. Level of mental health, level of general health perceptions, older age, and higher income predicted women's health-related Internet use. Participants without access reported various barriers to obtaining access; perceived lack of usefulness of the Internet as an information source and unfamiliarity with using this technology appear equally important reasons as financial cost for not adopting the Internet. Internet use motivators are complex; these findings have relevance to the design of Internet-based interventions.     

Addressing Environmental Health Concerns near Trecatti Landfill Site,United Kingdom

Residents near the Trecatti landfill site located in South Wales, United Kingdom, expressed concern about odors and health effects they attributed to site emissions. The authors compared routinely collected, population-based, health data from potentially exposed electoral wards (i.e., United Kingdom electoral tracts) with data from both wards nearby, matched for socioeconomic deprivation scores, and with wards where residents were likely to attend the same hospital. Mortality rates were higher for all causes and neoplastic diseases (but not respiratory disease) in the exposed wards, but there was no change in rates after the site opened. Hospital data revealed a transient increase in admissions for asthma during the 3 yr that preceded the peak in odor complaints. The birth prevalence of congenital malformations was raised in the exposed wards, but the authors could not exclude a possible artifact resulting from differences in reporting practices between hospitals. The absence of environmental monitoring in the community during the period of public concern was a significant weakness of this study.     

Plasma glutathione S-transferase measurements after paracetamol overdose: evidence for early hepatocellular damage.

Plasma glutathione S-transferase (GST) measurements have been used to study early changes in hepatocellular integrity after paracetamol overdose and treatment with N-acetylcysteine (NAC). Patients admitted within seven hours and successfully treated had raised or equivocal GST on admission and each showed a transient peak in GST approximately 12 hours after the overdose. Similar, though smaller changes in GST, were seen in untreated patients whose paracetamol level fell below the treatment line. The plasma GST concentrations in successfully treated patients were small compared with values found in patients who subsequently developed severe liver damage. The changes in GST concentration observed in patients who developed severe liver damage indicated that distinct early and late phases of paracetamol-induced hepatotoxicity occurred. Although the mechanism by which paracetamol exerts its early toxic effect is unclear, our data suggest that prompt treatment with NAC can successfully prevent both clinical and subclinical hepatotoxicity in this early period.     

The development of new density gradient media for purifying human islets and islet-quality assessments

Successful islet transplantation is dependent on the quality and quantity of islets infused. Islets are purified on density gradients, but procedures currently used have limited capacity for pancreatic digests, islet yield, and viability. We aimed to improve islet purification with a modified gradient medium. Biocoll was diluted in University of Wisconsin solution to create linear density gradients of 1.065 to 1.095 g/mL. Properties of islets purified from 22 human pancreas digests with modified medium were compared with 15 preparations using standard medium. The modification increased the capacity of gradients for pancreatic digests from 20 to 60 mL, islet yield increased from 218,000 to 435,318 per isolation, and viability increased from 65.4% to 92.1%. Islet fractions contained greater than 95% of recovered insulin. Islets showed good physiologic responses to secretagogues and restored normoglycemia in streptozotocin-induced diabetic severe combined immunodeficiency disease mice. The new medium enhances yield, purity, and viability of human islet preparations for clinical islet transplantation.