Urine screening practices in methadone maintenance clinics. A survey of how the results are used

The urinalysis practices of 324 methadone maintenance clinics were surveyed using a brief self-report questionnaire. Results indicate that there is wide variability in collection practices and clinic responses to positive findings. Virtually all clinics provide counseling and revocation of take-home methadone doses as a response to positive urinalysis results. However, increase in urine screening frequency, methadone dose adjustments, contingency contracting, group therapy, and eventual discharge are interventions also used. The implementation of different interventions varied as a function of clinic size, city size, region of the country, and program funding source.     

Proximal femoral focal deficiency: radiologic analysis of 49 cases

Proximal femoral focal deficiency, an uncommon congenital anomaly, necessitates early radiologic classification for surgical planning and treatment. Objective radiographic criteria, including femoral length index, acetabular depth index, acetabular angle index, and shape of the proximal femur were determined in 49 patients before cartilaginous ossification of the femoral capital epiphysis; final classification was based on follow-up radiographs or findings at arthrography or surgery. These parameters were analyzed to determine the accuracy and contributions of each in classification. Correct classification into one of three groups was possible in 86% of cases with use of three of the parameters: femoral length index, acetabular depth index, and shape of the proximal femur. The acetabular angle was found to contribute insignificantly to classification. Magnetic resonance imaging, used in only one case, depicted the nonossified cartilaginous femoral capital epiphysis, thus obviating the need for invasive diagnostic procedures and facilitating early classification.     

Production of pemphigus antibodyin vitro and analysis of T-cell subsets

T cells from nine patients in the active stage of pemphigus vulgaris and five in the inactive stage of the disease were studied with Leu-1, Leu-2, and Leu-3 monoclonal antibodies. No significant differences were observed in the proportions of total T cells or T cells expressing either helper or suppressor phenotype in peripheral blood leukocytes of patients compared to normal subjects. Immunoregulatory mechanisms were functionally studied using an assay measuring total IgG synthesizedin vitro. Peripheral blood leukocytes were separated into T- and B-cell fractions and cultured in various combinations. In nine experiments, the T cells were irradiated prior to culturing with B cells to remove their suppressor function. No statistically significant differences were observed in the total IgG synthesized by B cells obtained from patients and normal subjects when cultured with untreated T cells or irradiated T cells obtained from patients or normal controls. These results indicated that there was no loss of suppressor-cell function or increased helper-cell function when assessed by measuring the total IgG synthesized. The addition of serum from pemphigus patients to peripheral blood leukocyte cultures of pemphigus patients and normal controls had no statistically significant effect on the synthesis of total protein or on the amount of Ig synthesized and secreted. Peripheral blood leukocytes from six untreated patients with pemphigus vulgaris were stimulatedin vitro with pokeweed mitogen (PWM) to produce immunoglobulin. The IgG produced selectively bound to the intercellular cement substance of the epidermis of patients' perilesional skin, normal human skin, and monkey esophagus. The IgG was biosynthetically labeled by culturing the leukocytes in medium supplemented with [³H]leucine, and the binding of the radiolabeled IgG was visualized by autoradiography. The IgG nature of the protein was demonstrated by precipitation withStaphylococcus protein A and removal with rabbit anti-human IgG antisera. Peripheral blood leukocytes obtained from normal volunteers and control patients did not produce this antibody. Our studies indicate that there was no general functional or phenotypic alteration of suppressor or helper T cells in the peripheral blood. The peripheral blood leukocytes of pemphigus patients under PWM stimulation can produce an anti-intercellular cement substance antibodyin vitro. These results indicate that the abnormality of immunoregulation which resulted in the production of a pathogenetic autoantibody in pemphigus is highly specific.     

Genetically engineered negative signaling molecules in the immunomodulation of allergic diseases

PURPOSE OF REVIEW: This review summarizes current knowledge regarding the control of human mast cell and basophil signaling and recent developments using a new therapeutic platform consisting of a human bifunctional gamma and epsilon heavy chain (Fc gamma-Fc epsilon) protein to inhibit allergic reactivity. RECENT FINDINGS: Crosslinking of Fc gamma RIIb to Fc epsilon RI on human mast cells and basophils by a genetically engineered Fc gamma-Fc epsilon protein (GE2) leads to the inhibition of mediator release upon Fc epsilon RI challenge. GE2 protein was shown to inhibit cord blood-derived mast cell and peripheral blood basophil mediator release in vitro in a dose-dependent fashion, including inhibition of human IgE reactivity to cat. IgE-driven mediator release from lung tissue was also inhibited by GE2. The mechanism of inhibition in mast cells included alterations in IgE-mediated Ca mobilization, spleen tyrosine kinase phosphorylation and the formation of downstream of kinase-growth factor receptor-bound protein 2-SH2 domain-containing inositol 5-phosphatase (dok-grb2-SHIP) complexes. Proallergic effects of Langerhan's like dendritic cells and B-cell IgE switching were also inhibited by GE2. In vivo, GE2 was shown to block passive cutaneous anaphylaxis driven by human IgE in mice expressing the human Fc epsilon RI and inhibit skin test reactivity to dust mite antigen in a dose-dependent manner in rhesus monkeys. SUMMARY: The balance between positive and negative signaling controls mast cell and basophil reactivity, which is critical in the expression of human allergic diseases. This approach using a human Fc gamma-Fc epsilon fusion protein to co-aggregate Fc epsilon RI with the Fc gamma RII holds promise as a new therapeutic platform for the immunomodulation of allergic diseases and potentially other mast cell/basophil-dependent disease states.     

Chemical constituents of diesel exhaust particles induce IL-4 production and histamine release by human basophils

BACKGROUND: An epidemiologic relationship between airway allergic diseases and exposure to atmospheric pollutants has been demonstrated and suggested to be one factor in the increasing prevalence of asthma. Diesel exhaust particles (DEPs) have been shown to participate in the development of allergic airway inflammation, in which the targets include macrophages, B and T cells, epithelial cells, and mast cells. In addition to the adjuvant effect of DEPs on total and allergen-specific IgE production, DEPs also act to induce chemokines and cytokines and may play a key role in primary sensitization. OBJECTIVE: DEPs have been shown to increase local IL-4-containing Kit(+) cells soon after in vivo nasal challenge. The aim of this study was to examine the effects of DEPs on human basophils, a key source of IL-4. METHODS: Peripheral blood leukocytes from allergic and control subjects were cultured in the presence of organic extracts of DEP (DEPex) with or without allergen. The cultures were analyzed for IL-4-containing cells by using multiparameter flow cytometry, IL-4 secretion with ELISA, and histamine release. RESULTS: Basophils, when exposed in vitro to DEPex, expressed IL-4 and released histamine significantly (P <.01) more than with antigen activation. DEPex did not synergize with allergen in cytokine production and histamine release. DEPex-induced basophil IL-4 expression peaked at 2 hours and persisted through 20 hours, in contrast to allergen-induced IL-4, which was transient. The effect of DEPex on basophil cytokine expression and histamine release was dose dependent and occurred with cells from both allergic and nonallergic subjects. DEPex induced IL-4 expression and histamine release in highly enriched basophil populations, suggesting it acts directly on basophils. Other peripheral blood leukocytes, including T cells, did not contribute to this cytokine expression. Preincubation with N-acetylcysteine completely abrogated DEPex-driven basophil IL-4 expression. CONCLUSIONS: Basophils are a direct target for DEPex, inducing IL-4 expression and histamine release in an IgE-allergen independent fashion. N-acetylcysteine inhibition of DEPex-driven IL-4 expression provides evidence that generation of reactive oxygen species is required for the effects observed. The capability of DEPex to activate basophils in both allergic and nonallergic subjects suggests a potential role of this pollutant in the increasing prevalence of allergic diseases.