T-Cell receptor αβ and γδ T cells in rat and human skin — are they equivalent?

In the not-so-distant past the skin was generally viewed as a passive target for immune-mediated injury. Over the last decade, however, concepts of a previously unrecognized role for the skin have unfolded, whereby resident bone marrow-derived leukocytes (e.g. Langerhans cells and T cells) initiate and regulate the immune responses that protect it. Their combination with other immunomodulatory resident cells (e.g. keratinocytes, melanocytes, endothelial cells, fibroblasts) led to the idea that the skin may function as a self-sustaining lymphoid tissue. Although T lymphocytes or, at least, certain subpopulations thereof have the general propensity to populate epithelial tissues, there exist major species differences regarding the phenotype of intraepidermal T cells. The purpose of this review is to fill gaps in our understanding of the relationship of rodent skin T cells to T cells identified in human skin and the normal physiologic and pathologic role(s) of these cells.     

Epidermal T lymphocytes--ontogeny, features and function.

Conclusions The murine epidermis contains a network of Thy-1⁺ dendritic T cells. These T cells arise from early fetal stem cells and differentiate in the fetal or neonatal thymic or epidermal microenvironment. Their lack of expression of CD5, CD4, and CD8 antigens, as well as their virtually exclusive expression of a CD3/TCR V3/V1 complex, distinguishes DETC from the bulk of peripheral T cells.The early appearance of TCR / cells in ontogeny, the lack of expression of CD4 and CD8 antigens, and the relative paucity of and genes compared to and genes, indicates that / T cells provide a phylogenetically primitive, broadly acting, and poorly discriminating immunologic defense system. In this system, recognition of antigen is not restricted by classical MHC class I and class II antigens, but may occur in the context of relatively nonpolymorphic restricting elements, such as Qa [82], Tla [10] or CD1 [62]. This rather primitive immune system provided by DETC may serve to protect the epidermal integrity. Upon recognition of self proteins released following epidermal injury, DETC may become activated and assist in the removal of altered cells. In this limited fashion, the epidermis may be an independently competent immunologic system. However, the fact that the TCR repertoire of DETC does not allow for the recognition of antigenic peptides in conjunction with MHC moieties excludes the possibility that the diverse immune response elicited by topical contact with foreign antigens is mediated by DETC.Whether this statement also applies to the human epidermis cannot be answered at the present time. Let us consider a few plausible concepts concerning derivation and function of human epidermal T cells. First, one could postulate that in early ontogeny, the human epidermis harbors a small, indigenous population of naive T lymphocytes with monomorphic TCR representing an analogue to murine DETC. These cells could function in a manner similar to that proposed for murine DETC. They may even persist into adult life, so far undetected because they would be outnumbered by immigrating polymorphic T cells from peripheral lymphoid organs. Second, it is conceivable that the human epidermis contains an indigenous population of naive T lymphocytes with a polymorphic TCR repertoire representing a phylogenetically advanced analogue to murine DETC. Although equipped with TCR allowing antigen recognition in the context of MHC, their density is probably too low to make them an effective host defense system against the multitude of environmental antigens presented by Langerhans cells. One could rather assume that they proliferate upon recognition of self antigens occurring in a perturbed epidermis. The autoreactivity of these cells may not necessarily be beneficial. Finally, the fact that the entry of circulating HECA-452⁺ memory cells into the skin is dependent upon the injury-induced ELAM-1 expression by endothelial cells of the dermal microvasculature could indicate that all T cells present in adult human epidermis are recruited upon alteration of the skin. Following this reasoning, the human epidermis should not be regarded as a complete, self-sustaining immunologic organ but rather as a homing site for and a target of lymphocytes antigenically sensitized in peripheral lymphoid organs.     

Reevaluation of the periodic acid-Schiff stain in acute leukemia with immunophenotypic analyses.

To determine the sensitivity and specificity of the periodic acid-Schiff (PAS) stain in the diagnosis of acute leukemia in light of the finer characterization of this disorder now available through immunophenotyping, we examined the blasts from 51 patients with newly diagnosed acute leukemia by morphological, cytochemical, and immunophenotypic analyses. The 51 patients represented every new case of acute leukemia subjected to cytochemical stains and flow cytometry between July 1987 and February 1989. By cell-surface marker analysis, 29 exhibited lymphocytic lineage, while 21 were myelocytic. One was mixed lineage. The PAS positivity, defined by the presence of blocks or coarse granules in 5% or more of the blasts, was found in 15 of 29 lymphoblastic leukemias and in four of the myeloblastic leukemias. However, PAS-positive lymphoblastic leukemias were negative with the other cytochemical stains: myeloperoxidase, Sudan black B, and alpha-naphthyl butyrate esterase. The PAS-positive myeloblastic leukemias were positive with at least one other stain. Three cases of myeloblastic leukemia exhibited greater than 10% PAS-positive blasts, with all three being acute monoblastic leukemia. Thus, the sensitivity and specificity of the PAS stain alone for lymphoblastic leukemia was 52% (15 true positives of 29) and 81% (four false positives), respectively. The sensitivity of a cytochemical-staining combination of PAS positivity and myeloperoxidase, Sudan black B, and alpha-naphthyl butyrate esterase negativity in defining cases of lymphoblastic leukemia remained at 52%; however, the specificity of this combination for lymphoblastic leukemia was 100% (no false positives). Thus, a positive PAS stain, in combination with negative myeloperoxidase, Sudan black B, and alpha-naphthyl butyrate esterase stains, continues to have a diagnostic role in the distinction between lymphoblastic and myeloblastic leukemia, and greater immunologic sophistication serves to support this position.     

Sentinel-Node-Biopsie beim Mammakarzinom

Die Sentinel-Lymphknotenbiopsie (Sentinel-Node-Biopsie, SNB) ist ein diagnostisches Verfahren beim Mammakarzinom, mit dem der Nodalstatus durch selektive Entnahme und Untersuchung des (der) Lymphknoten mit der höchsten Wahrscheinlichkeit für eine Metastasierung bestimmt wird. Hauptziel der Methode ist eine vollständige Erfassung der Patientinnen mit Lymphknotenmetastasen sowie die Vermeidung von Morbidität durch eine Axilladissektion bei nodalnegativen Frauen. Aufgrund der hohen Übereinstimmung zwischen dem histologischem Status des Sentinel-Nodes und dem definitiven Nodalstatus (ermittelt durch konventionelle Axilladissektion) stellt sich immer mehr die Frage, ob und unter welchen Bedingungen die SNB als Routineverfahren für das axilläre Staging gelten kann.     

Are Better Sleepers More Engaged Workers? A Self‐regulatory Approach to Sleep Hygiene and Work Engagement

Previous research has emphasized facets of both the organizational environment and individual differences as predictors of work engagement. This study explored sleep hygiene as another important behavioural factor that may be related to work engagement. With a sample of 328 adult workers, we tested a multiple mediator model in which sleep hygiene predicts work engagement through one's appraisals of resource depletion stemming from demands (psychological strain) and general self‐regulatory capacity (self‐control). Results indicated that individuals who frequently engaged in poor sleep hygiene behaviours had lower self‐regulatory capacity, experienced higher subjective depletion and were less engaged at work. Additionally, the path from poor sleep hygiene to decreased work engagement was attributed to perceptions of personal resources that are needed to exert self‐regulatory energy at work. This is consistent with current self‐regulatory theories suggesting that individuals have a limited amount of resources to allocate to demands and that the depletion of these resources can lead to stress and lower self‐regulatory functioning in response to other demands. Specifically, poor sleep hygiene results in the loss of self‐regulatory resources needed to be engaged in work tasks by impairing the after‐work recovery process. Practical and research implications regarding sleep hygiene interventions for well‐being and productivity improvement are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

Recurrent oral squamous cell carcinoma‐incorporating advance care planning in education and practice

This reflection describes a life‐limiting case of oral squamous cell carcinoma (SCC) that required thoughtful management facilitated by an advance care plan (ACP). A 70‐year‐old female was diagnosed with a T4aN2bM0 biopsy‐proven invasive, well‐differentiated keratinizing SCC. Surgical wide‐local excision included teeth #11‐16 with left unilateral neck dissection, levels I‐V. She was rehabilitated with maxillary obturator prosthesis and underwent chemoradiation therapy. Her course was complicated by dysphagia and trismus. She experienced multiple recurrences. At a certain point, negative margins could not be achieved without facial disfigurement. The patient, her husband, and providers decided together that further management would be palliative. Before the additional surgical procedures, she communicated a thorough ACP with her husband and providers who were prepared to facilitate difficult care decisions on her behalf. The patient passed away at home with hospice care at the age of 74. This motivated patient with oral SCC and impactful postmanagement complications appreciated the clarity of an ACP. Her values and goals of care were incorporated with ongoing communication and documentation of this plan, which was instrumental in facilitating her person‐centered care. The providers apply lessons learned here in future practice and education of residents and students.