A role for Th17 cells in the regulation of tertiary lymphoid follicles

Immune responses propagate in secondary lymphoid organs (SLOs), such as the spleen and lymph nodes. These highly organized structures are typified by distinct B-cell follicles and T-cell zones, and are orchestrated by interactions between the TNF superfamily molecules expressed on hematopoietic cells and their receptors on mesenchymal cells and the subsequent cytokines and chemokines that are elicited. During chronic immune responses, cellular effectors of the immune response can infiltrate target tissue and organize anatomically into de novo B-cell follicles and T-cell areas, a phenomenon called lymphoid neogenesis or the formation of tertiary lymphoid organs (TLOs). Critical to the development of SLOs are lymphoid-tissue inducer (LTi) cells, that is innate lymphoid cells that arise from common precursor cells within the fetal liver. Of interest, Th17 cells, a subset of CD4(+) T cells most associated with autoimmune pathogenesis, share many developmental and effector markers with LTi cells. Here, we compare and contrast LTi and Th17 cells, and review recent evidence that Th17 cells and Th17 cytokines, such as IL-17 and IL-22, contribute to the development of ectopic lymphoid structures in chronic-ally inflamed tissue.     

Who transitions from private to public health insurance?: Lessons from expansions of the State Children's Health Insurance Program

This paper examines families of children who transition from private to public health insurance. These transitions include, but are not limited to, transitions that constitute crowd-out. We pool longitudinal panels from the Survey of Income and Program Participation (SIPP) covering 1990 to 2005. The annual rate of children who transition from private to public coverage more than doubled over this period, although it remains small. Transitioning children in recent years are typically in working families with median incomes of around 200% of poverty. Children who transition from private to public coverage are more likely to belong to minority groups, to have lower incomes, and to be in poorer health than children remaining privately insured. Public coverage now provides important protections for low-income working families, especially those with children in poor health. These findings underscore the need to implement post-health-reform policies with an eye towards possible adverse selection into public programs.     

Do protective lead garments harbor harmful bacteria?

This study attempted to identify and characterize bacteria present on shared-use protective lead shielding garments worn in the operating room. Those worn at the authors' institution were collected and swabbed in designated 5×5-cm areas. Swabs were sent to the clinical laboratory for bacterial isolation and identification. All isolates were identified using standard microbiological methods. Isolates then underwent antimicrobial susceptibility testing as per standard hospital procedures. Of 182 total collected swabs, bacteria were isolated on only 5 (2.7%) samples. Coagulase-negative Staphylococci was identified on 3 samples and the remaining 2 grew coagulase-negative Staphylococci and gram-positive rods. The collection sites for these isolates were the lead apron, midline, bottom outer surface (n=3), thyroid shield midline, inner surface (n=1), and skirt midline, bottom inner surface (n=1). Of the collected samples, 98.3% were negative for bacterial growth. The remaining isolates were consistent with common skin flora. No multi-drug resistant organisms were identified on any garments. Standard cleaning procedures at the institution are an effective way to prevent growth of bacteria on shared-use protective lead shielding garments worn in the operating room.     

Update of the GEFPICS' recommendations for HER2 status determination in breast cancers in France

In Europe, patients who may benefit from an HER2 targeted drug are currently selected by immunohistochemistry (IHC). In situ hybridization (ISH) techniques should be used for complementary assessment of ambiguous 2+ IHC cases and for the calibration of the IHC technique. Eligibility to an HER2 target treatment is defined by an HER2 positive status being IHC test 3+ or 2+ amplified. Reliable detection of HER2 status is essential to the appropriate usage of HER2 targeted drugs because its specificity is limited to tumors overexpressing HER2. It is essential that the IHC evaluation of the HER2 status of a mammary carcinoma is optimized and reliable. This GEFPICS' guidelines look over the different steps of the IHC technique, the controls and, the rules for interpretation. Once acquired, this knowledge must be perpetuated by the observation of rules of good technical practice (internal and external controls, quality assurance programs).     

Breast Cancer Sentinel Lymph Node Identification Rates: The Influence of Radiocolloid Mapping,Case Volume,and the Place of the Procedure

Background We hypothesized that high-volume surgeons performing sentinel lymph node (SLN) biopsy at an academic medical center (AMC) would have the same identification rates at suburban surgical centers (SSCs). Methods Twenty-one surgeons performed 1199 SLN biopsies in 1187 clinically node-negative patients with an intraoperative gamma probe (IOGP) plus blue dye (at AMC) or blue dye alone (at SSCs). Demographic, radiologic, and pathological data were analyzed by generalized estimating equations logistic regression models. Results Four surgeons (group 1) performed 877 procedures (361, 247, 152, and 117 cases each), 426 with and 451 without IOGP. Seventeen surgeons (group 2) performed 322 procedures (2–92 cases each), 173 with and 149 without IOGP. Group 1 found 411 SLNs (96.5%) with and 419 (92.9%) without IOGP (P = .024). Group 2 found 163 (94.2%) with and 117 (78.5%) without IOGP (P < .0001). The odds of finding the SLN was 2.9 times higher with IOGP (95% confidence interval [95% CI], 1.8, 4.7; P < .001) and 2.7 times higher by group 1 than group 2 surgeons (95% CI, 1.7, 4.3; P < .001), controlling for tumor size and surgery type. Conclusions High-volume surgeons identified more SLNs with IOGP (at the AMC) than without (at the SSCs). They also were more efficient than low-volume surgeons when blue dye alone was used. Low-volume surgeons were almost as efficient as high-volume surgeons when they used IOGP. Optimal identification of SLNs requires nuclear medicine facilities. Presented in part at the 59th Annual Cancer Symposium of the Society of Surgical Oncology, San Diego, CA, March 25, 2006.     

Plastic surgical delivery systems for targeted gene therapy

The expansion of gene therapy applications from inherited disorders to acquired conditions has been mirrored by an exponential rise in both experimental work and clinical trials. This review highlights current plastic surgical delivery systems and clinical applications for targeted gene therapy. We revisit some of the vectors used both experimentally and in clinical gene therapy trials, with an emphasis on developments in plastic surgical delivery systems resulting in improved targeting of therapeutic genes. In addition, we discuss a novel technique for the delivery of gene therapy using the ex vivo transduction of free flaps, developed in our laboratory. This delivery system achieves targeted high-level transgene expression with minimal demonstrable systemic toxicity. Advances in delivery systems are essential for translating basic research into clinical therapeutics.