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Background: To our knowledge, an international consensus is lacking regarding the development of an adequate informed consent form for a patch test (PT) and the information that should be included in such document. Objectives: The aim of the study was to reach a consensus on the specific points that need to be addressed in a PT consent form. Methods: A Delphi survey, comprising 2 rounds and 1 final discussion, was used to gather and analyse data, which was conducted over the Internet. Each statement that reached a consensus with the respondents (9 expert dermatologists from Europe) was defined as a median consensus score (MED) of ≥7 and agreement among panelists as an interquartile range (IQR) of ≤3. All study participants were members of the EADV task force on contact dermatitis. Results: The expert panel addressed several topics that should be included in an informed consent form for a PT: introduction, preparation for PT, testing procedure, allowed activities, adverse events and additional authorizations. Conclusions: Our results assess recommendations regarding points to be contained in an informed consent form for a PR. Future actions towards standardization and harmonization of this specific consent form are needed.

Cankers and diebacks of European hop hornbeam (Ostrya carpinifolia) have been observed in the Italian Alps since 2001. In 2013, and 2014, field and laboratory investigations were performed in the provinces of Trento, Padua and Verona (northern Italy) to assess the presence and spread of disease affecting O. carpinifolia. Environmental and dendrometric data were recorded and analyzed, and samples were collected for the laboratory assays. Disease was observed in 106 of the 270 plots surveyed. In the majority of these, there were a small number of infections, but in some areas, severe attacks and multiple infections were recorded. Symptoms of decline, undoubtedly connected to cankers spreading across small surfaces, were observed in 31 plots. The presence of disease was positively correlated with sites predisposed to drought and correlated with lower altitudes. The fungus Botryosphaeria dothidea was found to be the primary agent involved in the disease, although Dothiorella parva was also isolated from the same infected tissues. However, both fungi were also obtained from healthy tissues, confirming their role as endophytes and/or latent pathogens. In inoculation tests, both species proved to be weakly pathogenic, but under laboratory conditions, they differed in their growth behaviors in relation to temperature. The annual growth of natural infection in the field is greater with higher autumn temperatures. The results indicate that the disease affecting O. carpinifolia occurred as a consequence of drought-related factors and high temperatures, and under changing climatic conditions, the disease is spreading in the surveyed areas of northeastern Italy. This study confirms field observations that revealed a higher incidence of new diseases in forests as a result of new climatic conditions with frequent extreme phenomena.

To cite this article: Pfiffner P Stadler BM Rasi C Scala E Mari A. Cross reactions vs co sensitization evaluated by in silico motifs and in vitro IgE microarray testing. Allergy 2012; 67: 210 216. ABSTRACT: Background and objective: Using an in silico allergen clustering method we have recently shown that allergen extracts are highly cross reactive. Here we used serological data from a multi array IgE test based on recombinant or highly purified natural allergens to evaluate whether co reactions are true cross reactions or co sensitizations by allergens with the same motifs. Methods: The serum database consisted of 3142 samples each tested against 103 highly purified natural or recombinant allergens. Cross reactivity was predicted by an iterative motif finding algorithm through sequence motifs identified in 2708 known allergens. Results: Allergen proteins containing the same motifs cross reacted as predicted. However proteins with identical motifs revealed a hierarchy in the degree of cross reaction: The more frequent an allergen was positive in the allergic population the less frequently it was cross reacting and vice versa. Co sensitization was analyzed by splitting the dataset into patient groups that were most likely sensitized through geographical occurrence of allergens. Interestingly most co reactions are cross reactions but not co sensitizations. Conclusions: The observed hierarchy of cross reactivity may play an important role for the future management of allergic diseases.

On 26 February 2013 the new "Law on Patients' Rights" (hereinafter also the "Law") became effective. This Law strengthens patients' rights vis-à-vis the insurdnce company and also regulates patients' rights regarding their relation to the doctor. This has consequences for the laws on medical liability all doctors must consider. The doctor's performance is and remains a service and such service does not hold any guarantee of success. Nevertheless, this Law primarily reads as a "law on the duties of physicians". To duly take into account these duties and to avoid mistakes and misinterpretation of the Law, the Ethics Committee of the Consortium of Osteosynthesis Trauma Germany (AOTRAUMA-D) has drafted comments on the Law. Brief summaries of its effects are to be found at the end of the respective comment under the heading "Consequences for Practice". The text of the law was influenced particularly by case law, as continuously developed by the German Federal Court of Justice ("BGH"). The implementation of the Law on Patients' Rights was effected by the newly inserted sections 630a to 630h of the German Civil Code (the "BGB"), which are analysed below. The following comments are addressed to physicians only and do not deal with the specific requirements and particularities of the other medical professions such as physiotherapy, midwifery and others so on. Special attention should be paid to the comments on the newly inserted Duty to inform, which has to be fullfilled prior to any diagnostic or therapeutic procedure (sec. 630c para 2 sentence 1 BGB). Under certain conditions the doctor also has to inform the patient about the circumstances that lead to the presumed occurance of a therapeutic or diagnostic malpractice (sec. 630c para. 2 sentence 2 BGB), based on the manifestation of an undesired event or an undesired outcome. As before, the patient's valid consent to any procedure (sec. 630d BGB) is directly linked to the comprehensive and timely provision of information (sec. 630e BGB). Comprehensive documentation obligations regarding all procedures are stipulated in sec. 630f BGB. As before, the burden of proof still rests with the patient, unless a severe malpractice has been established (sec. 630h BGB). The definition of "severe malpractice" remains unchanged and is based on the case law of the Federal Court of Justice (BGH). The patient's obligations to preserve his or her health and to actively support the process of recovery and securing a positive outcome of the treatment are not explicitly mentioned in the Law. Nevertheless, the patient and the physician need to work closely together to achieve a successful result of the treatment. In case the patient does not give his or her cooperation, the physician should consider terminating the treatment relationship.

Background Methods for comparing local mental health service systems are needed to allow identification of different patterns of service provision and of inequities within and between countries. Aim The aim of this study was to describe and compare mental health service systems in 13 catchment areas in Spain and Italy. Within each country, a range of area characteristics was represented. Method The European Service Mapping Schedule (ESMS) and European Socio-Demographic Schedule (ESDS) were used to describe: (i) socio-demographic and geographical area characteristics; (ii) services provided; and (iii) service utilisation in each area. Results Great differences emerged in patterns of service provision and use between and within countries. In contrast to Northern Europe, high unemployment rates were not associated with high service utilisation rates, but areas with large numbers of single-person households tended to have high service use. Most service utilisation rates were substantially below those reported from Northern European studies. Spanish centres tended to have low rates of hospital service utilisation despite limited development of community-based services. Trieste, where there has been a strong emphasis on developing innovative community services, showed a distinctive pattern with low hospital bed use and high rates of day service use and of contacts in the community. Conclusion This methodology yielded useful data, which raise significant questions regarding equity and the implementation of mental health policy. The very large variations indicate that underlying local patterns of service provision must be investigated and taken into account in the interpretation of research evaluations of interventions.

Bullous pemphigoid (BP) is an autoimmune skin disease in which patient autoantibodies react with BP180 and BP230 proteins. In addition to IgG, IgE has been shown to play a role in the disease.To evaluate the feasibility of detecting IgE and IgG against the immunodominant BP180 NC16A domain (BP180) using a microarray system.BP180 was immobilized on an experimental version of the ISAC(®) microarray (Exp96). The BP study group and the controls were all tested on the commercial ISAC 103 version and on the Exp96. IgG and IgE were measured in a single run. BP180 IgG and IgE results were compared with those using an enzyme-linked immunosorbent assay (ELISA).All results obtained using the IgG ELISA on the 31 patients with BP were replicated with the ISAC IgG. Five of eight BP sera tested by ELISA showed similar results with ISAC IgE. Twenty-nine (94%) and 19 (61%) of the 31 patients with BP were IgG and IgE positive to BP180, respectively, whereas four (3%) and six (4%) of 138 normal donors were IgG and IgE positive, respectively. Interestingly, the levels of IgG against BP180 detected using the ISAC system were related to the disease severity. Patients with BP showed a peculiar profile of IgE recognition toward some groups of allergens, which was absent in a group of allergic individuals. A significant, higher prevalence of hen's egg recognition was observed in patients with BP who had specific IgE to BP180.The present preliminary study indicates that the ISAC microarray system is suitable for detecting IgG and IgE autoantibodies in patients with BP. Notably, this system allows the assessment of IgE and IgG autoantibodies at the same time, could be employed for the detection of autoantibodies to other autoantigens, and allows profiling for specific IgE to allergens.

Nonspecific lipid transfer proteins (nsLTPs) are important food allergens. Often, patients allergic to the nsLTP in peach suffer from allergy to hazelnuts. We aimed to analyse the T-cell response to Cor a 8, the nsLTP in hazelnut and its immunological cross-reactivity with the nsLTP in peach, Pru p 3. METHODS: Cor a 8-reactive T-cell lines (TCL) established from patients allergic to hazelnut and peach were stimulated with 12-mer peptides representing the complete amino acid sequence of Cor a 8 to identify its T-cell-activating regions and with Pru p 3 to investigate cellular cross-reactivity. T-cell clones specific for different major T-cell-activating regions of Pru p 3 were stimulated with Cor a 8. Both nsLTPs were subjected to endolysosomal degradation assays. Immunoglobulin E (IgE) cross-reactivity between Cor a 8 and Pru p 3 was assessed in inhibition enzyme-linked immunosorbent assay. RESULTS: No major T-cell-activating region was found among 26 T-cell-reactive peptides identified in Cor a 8. Although generated with Cor a 8, 62% of the TCL responded more strongly to Pru p 3. This cross-reactivity was mediated by T cells specific for the immunodominant region Pru p 3(61-75) . Peptide clusters encompassing this region were generated during lysosomal degradation of both nsLTPs. Cor a 8 was more rapidly degraded by lysosomal proteases than Pru p 3. Pre-incubation of sera with Pru p 3 completely abolished IgE binding to Cor a 8, which was not the case vice versa. CONCLUSIONS: T-cell reactivity to Cor a 8 is predominantly based on cross-reactivity with Pru p 3, indicating that the latter initiates sensitisation to its homolog in hazelnut. The limited allergenic potential of Cor a 8 seems to be associated with rapid lysosomal degradation during allergen processing and the lack of major T-cell-activating regions

The availability of allergenic molecules and high-throughput microtechnologies allow the collection of a large number of IgE results at the same time in a single test. This can be carried out applying the test in the routine diagnostic work-up.The aim of this study was to make a cross-sectional evaluation of the raw prevalence of IgE reactivity to allergenic molecules in serum samples from a cohort of Italian patients using an innovative tool.The ISAC, a microarray system, has been used for specific IgE detection using 75 different allergenic molecules. Sera were collected from 23,077 unselected consecutive individuals complaining about any allergic disease.Sixteen thousand four hundred and eight of 23,077 patients had IgE to at least one of 75 allergenic molecules. The top-ranked molecules in this cohort were Cup a 1 (42.7%), Der f 2 (38.7%), and Phl p 1 (37.9%), whereas all the other allergens tested scored in a range between 36.8% and 0.04%, including the first food allergen, Pru p 3, ranked 15th (9.79%). Prevalence varied quite markedly depending on the age range considered, and showing a different behaviour in the lifetime sensitization process. Unsupervised two-way hierarchical clustering analysis generated distinctive patterns of reactivity as the result of IgE recognition of either homologous allergens belonging to different biological sources or non-homologous belonging to the same biological source.Allergen-based microarray is a tool for the detection of IgE-related sensitization to panels of allergens and gives a more precise and comprehensive evaluation for an IgE-based epidemiology. This insight brings data for better understanding of the sensitization process.

The CHAT classification separates various current and historical presentations of cerebrovascular disease in an effort to determine important prognostic clues for management and prognosis. To evaluate known risk factors for late stroke and death, we followed up for an average of 44 months 633 patients who had undergone 714 carotid operations. We analyzed the indication for surgery (by CHAT) and the effect of preoperative risk factors (age, hypertension, cardiac disease, tobacco use, diabetes, hyperlipidemia, renal disease, pulmonary disease, and total risk factor score) on the end points of late stroke and death. Ipsilateral stroke was uncommon after carotid endarterectomy: with life-table analysis, the probability of late stroke at 5 years after carotid endarterectomy was 3%. Among the 127 patients with amaurosis fugax, the incidence of late stroke and of mortality was a combined total of 1% per year, and the 17 patients who had been first seen with permanent ocular stroke (blindness) fared equally well. The 28 patients who were first seen with vertebrobasilar symptoms and were treated by carotid endarterectomy also fared particularly well, with no late strokes or deaths within the first 5 years. Logistic regression analyses revealed that the various indications for carotid endarterectomy were associated with differing patterns of risk factors as significant predictors of late stroke or death. For patients first seen with asymptomatic lesions, only diabetes was an important predictor for late stroke ( p = 0.05) and renal disease was the only marker for early death ( p = 0.05). On the other hand, those factors were not significant risk factors for patients first seen with amaurosis fugax, for whom tobacco use was a negative predictor for stroke ( p = 0.06) and male gender a negative predictor for early death ( p = 0.03). After cortical transient ischemic attacks and carotid endarterectomy, there were no risk factors predictive of late stroke or of death. For patients with prior stroke, age was a very strong predictor of stroke ( p = 0.01) and both age and a history of cardiac disease were significant risk factors for early death ( p = 0.007). In contrast to the results in reports of patients treated medically for transient ischemic attacks and stroke, we found that several risk factors appeared to play relatively minor roles. In conclusion, stroke after carotid endarterectomy was uncommon, least common after ocular symptoms, and most likely after permanent cortical stroke. Specific risk factors were less important for patients after carotid endarterectomy than for the medically treated stroke patient. (J Vasc Surg 1992;16:575–87.)

A review of bundle theory and the strength of yarns compared to single filaments has been made for several high strength filament materials. The dielectric properties and the statistical distribution of tensile strength have been compared for filaments of glass (Types E and S), graphites, and the high modulus PRD-49 (organic). The review was made in conjunction with the development of a new type of a high modulus line using PRD-49 filaments. The lines were to be used as guys for the antennae system at the Arecibo Observatory in Puerto Rico, the National Astronomy and Ionosphere Center which is operated by Cornell University for the National Science Foundation. The unique requirement for these cables was not only the high modulus for a low total elongation of 20 to 90 ft lengths with low loss tangent and dielectric properties, but the need for rigidity at comparatively low prestrain loads. Varying sizes and designs were produced experimentally, ranging from 15 to 19 000 1b ultimate strengths. The testing of lines involved both precision optical strain measurements on 1 ft gage lengths as well as 10 ft test lengths for elongation, modulus, and strength measurements. The final design involved 1800 ends of 380 denier Type III, PRD-49 duPont fibers. The finished cable has a nominal modulus of 16. 5 x 10 6 psi capable of supporting a 19 000-1b load with a cable weight 0.04 1b/ft of length. For optimum resistance to weathering, moisture, and ultraviolet effects, outer sheathing with extruded black PVC had been used. Epoxy bonded end fittings were employed to permit tension adjustments at the comparatively low leads.

Analytical models are presented for: (1) monolayer composite fabrication, (2) consolidation of monolayer composites into plates, and (3) composite deformation under transverse compression. Upper-bound solutions of the models are developed by using the limit analysis of plastic theory. These solutions depend on (1) the flow stress of the matrix material, and (2) frictional coefficients for the fiber-matrix and for the matrix-die interfaces. They were determined experimentally from compression ring tests. The analytical predictions of the average consolidation pressure are in good agreement with experimental results for an aluminum matrix from room temperature to 750°F (399°C). Transverse compression deformations were examined by several methods including scanning electron microscopy for aluminum-steel wire, aluminum-Borsic, and aluminum-nickel unidirectionally solidified composites. The analytical predictions for flow line directions from a proposed strip compression model agree with the experimentally determined angles.

The clinical relevance of immunoglobulin E (IgE) to plant glycans is a longstanding debate. We sought to evaluate their clinical reactivity using the human glycoprotein lactoferrin expressed in rice.Allergic patients with IgE antibodies against plant glycans were analyzed for the presence of IgE against rice-produced lactoferrin. The potency of IgE to induce mediator release was assessed by basophil histamine release and skin prick tests (SPTs). Clinical relevance was evaluated by double-blind placebo-controlled oral challenge (DBPCOC).Twenty-four of 29 sera (82.7%) with IgE antibodies against plant glycans demonstrated IgE binding to transgenic lactoferrin. In three of five cases transgenic lactoferrin induced histamine release. Compared to a control major grass pollen allergen lactoferrin concentrations needed for biological activity of IgE were 5-6 orders of magnitude higher. Skin prick test and DBPCOC were negative in five patients with potential clinical reactivity that volunteered to undergo these in vivo challenges.Poor or no biological activity and lack of clinical relevance of IgE-binding plant glycans (five out of five) was demonstrated using human lactoferrin expressed in rice as a model.

Alport syndrome (ATS) is a clinically and genetically heterogeneous progressive nephropathy often associated with deafness and/or ocular lesions. The histological aspect is characterized by thinning, thickening and splitting of the glomerular basement membrane (GBM). Alport syndrome is caused by mutations in COL4A3 gene (type IV collagen, alfa-3 chain), or COL4A4 gene (type IV collagen, alfa-4 chain) or COL4A5 gene (type IV collagen, alfa-5 chain) genes. Alport syndrome accounts for 1-2% of renal failure cases in Europe, and for 2-3% of transplanted patients in United States. This review focuses on the three types of Alport syndrome which differ in the clinical progression and in the mode of inheritance. The common X-linked form is caused by mutations in the COL4A5 gene and it accounts for 85% of cases. The autosomal dominant and the autosomal recessive forms are caused by mutations in either COL4A3 or COL4A4 genes. The autosomal recessive form which is responsible for the 10-15% of Alport cases, has been known since several years. On the contrary, the autosomal dominant form has only recently been identified in some families. Furthermore, this review will focus on the difficulties encountered during the genetic counselling related to the differential diagnosis between Alport syndrome and Thin Basement Membrane Disease (TBMD). We will report direct experiences of our group showing the difficulties to give an exact prognosis and a correct recurrence risk to the family.

We studied the expression of adhesion molecules affecting recirculation and homing on peripheral blood CD4(+) T cells of patients with systemic sclerosis (SSc), in order to evaluate whether the distribution of tissue targeted subsets could reflect the participation of internal organs or the extent of cutaneous involvement [i.e. limited cutaneous (lc) and diffuse cutaneous (dc)]. Peripheral blood mononuclear cells (PBMC) from 51 patients with SSc and 19 sex- and age-matched controls were investigated by cytofluorimetric analysis for lymphocyte subpopulations carrying the following surface molecules: CD3, CD4, CLA, alpha4beta7 and alpha4beta1. Standard routine biochemistry and clinical examinations were also performed in all patients. We found that both alpha4beta1(+) and alpha4beta7(+) cells within the CD4(+) T cell population were significantly increased, while CLA(+) CD4(+) T cells were significantly reduced in SSc, compared to healthy donors. Significantly lower absolute numbers of alpha4beta7(+) cells were found in lc- compared to dc-SSc. Patients with oesophageal involvement had high numbers of alpha4beta7(+) cells, while those with nephritis also showed low levels of CLA(+) cells. Lung involvement was related directly to alpha4beta1(+) cell numbers and inversely to alpha4beta7(+) CD4 cell numbers. Taken together, our findings demonstrate that distinct CD4(+) T cell populations with selective homing properties show changes from normal distribution in SSc, and such changes are related to clinical expression and organ involvement in the course of the disease.

To determine the efficacy of percutaneous needle aspiration (PNA) with antibiotic therapy in treatment for pyogenic liver abscess (PLA).One hundred fifteen patients (59 male; 56 female; age range, 16-86 years; mean age, 45.3 years) with 147 PLAs (mean diameter, 6.8 cm; range, 3-16 cm) underwent PNA with ultrasound (US) guidance and antibiotic therapy. Needle caliber (22-16 gauge) was tailored to PLA volume. If necessary, PNA was repeated every 3-7 days.Three hundred one PNAs were performed (range, 1-4 per patient; mean, 2.2 per patient). A single puncture was sufficient in 57 patients. Cure (normalization of clinical and laboratory parameters and resolution of hepatic lesions) was achieved in 113 patients (98.3%). Two patients with large PLAs required surgery. Patients were hospitalized 7-24 days (mean, 9 days). In the last eight patients, all abscesses were evacuated in one session. Neither complications nor deaths ensued. Recurrence of PLA was not observed in any patient during follow-up (6-36 months).US-guided PNA with antibiotic therapy in treatment for PLA is a valid alternative to prolonged catheter drainage.

Anisakis simplex (AS), a fish and cephalopodes parasite, may cause allergic reactions in humans on eating and/or handling contaminated fish. We present a case of occupational hypersensitivity to AS in a woman employed in a frozen-fish factory. She showed both generalised urticarial rash and asthmatic symptoms after work place exposure. All these symptoms immediately disappeared after work place exposure was ceased. The presence of a positive skin prick test and high specific IgE values confirmed a hypersensitivity to anisakis. This is the first case reported of both occupational generalised urticaria and allergic airborne asthma due to AS in the same patient. We suggest that AS could be an important cause of occupational asthma and/or urticaria in the fish industry.

In the Northwestern region of Piedmont (Fig.1), with a total population of about 4,300,000, the discrepancies between actual status of psychiatric assistance and requirements of the current Italian regulation are not particularly conspicuous.1,2 The number of patients treated in the four psychiatric hospitals of the region has decreased from 6,250 in 1975 to 472, and 22 psychiatric services for diagnosis and treatment have been opened in general hospitals (with a total availability of 263 beds). While the 70 regional psychiatric outpatient services are evenly spread over the whole region, the distribution of day services (residential and semi-residential) seems less homogeneous. On the whole, such agencies are staffed by 350 doctors, 79 psychologists, 52 social workers, 808 nurses, 74 educators, and 375 employees classified as “other professionals”. Today, psychiatric hospitals have a total staff of 147 professionals.3,4,5,6

We evaluated the relationship between cytokine profile and the expression of the lymphocyte activation gene-3 (LAG-3) in both T cell clones and polyclonal T cell lines; LAG-3 is a CD4-like protein whose expression is reportedly restricted to Th1/0 cells and dependent upon IFN-gamma. We found that, while LAG-3 was expressed only by CD4+ T cell clones producing IFN-gamma, most CD8+ clones producing IL-4 but not IFN-gamma (i.e., with a T cytotoxic-2-like profile) were LAG-3+. The intensity of LAG-3 expression by CD8+ clones correlated with the amount of released IFN-gamma, suggesting that this cytokine is not required for expression but rather for the up-regulation of LAG-3. Flow cytometric analyses of polyclonal T cell lines confirmed that LAG-3 could be expressed by both CD4+ and CD8+ cells that did not contain cytoplasmic IFN-gamma. In these cell lines, large proportions of CD4+ and CD8+ cells coexpressed LAG-3 and CD30, a putative marker of Th2-like cells. Overall, our data do not support the earlier suggestion that LAG-3 and CD30 are selective markers of T cells with type-1 and type-2 cytokine profiles, respectively.

Evidence indicates that, at least in the early stage, Kaposi's sarcoma (KS) is a cytokine-mediated disease and that it is consistently associated with a novel herpesvirus termed human herpesvirus-8 (HHV-8). To gain insights into the mechanisms by which cytokines and HHV-8 may cooperate in disease pathogenesis, we examined the phenotype, the Th1 (gamma-interferon [gamma IFN]) and Th2 (interleukin-4 [IL-4] cytokine profile and the presence of HHV-8 in peripheral blood mononuclear cells (PBMC), tumor-infiltrating lymphocytes (TIL), and spindle cell cultures derived from skin lesions of patients affected by classical KS (C-KS) and acquired immunodeficiency syndrome (AIDS)-associated KS (AIDS-KS). TIL and spindle cell cultures were examined at day 0 or after culture in conditioned media from activated T cells (TCM) that contain the same cytokines increased in KS tissues. No differences were found in the immunophenotype of PBMC from C-KS patients versus controls, except for AIDS-KS patients who showed a T-CD8+ expansion. However, a preferential infiltration of T-CD8+ cells was found in all KS lesions examined, which was maintained after culture of TIL in TCM. gamma IFN production was found in both PBMC and cultures derived from all KS examined; some IL-4 positive supernatants were found only in three AIDS-KS cases. Uninvolved skin did not show appreciable lymphocyte infiltration or cytokine production. The culture conditions of the lesional skin allowed also the appearance of adherent, spindle-like cells bearing markers of tissue macrophages. Finally, most or all of the PBMC, lesions, and macrophagic cell cultures from the skin lesions were found to be positive for HHV-8 infection by nested polymerase chain reaction (PCR). These findings indicate that patients with KS express a Th1 phenotype with a prevalent gamma IFN production, likely accounted for by the local T-CD8+ infiltration. By analogy with other viral infections (i.e., Epstein-Barr virus), this suggests that in loco recruitment of lymphoid cells and the subsequent gamma IFN production may be in response to or elicited by HHV-8 that was found in both PBMC and macrophagic cell cultures from the lesions of the same patients.

A combination of three beta, or C-C, chemokines, as well as IL-16, have been shown to inhibit HIV replication in vitro. Cellular antiviral factor is a more potent agent, and acts on all HIV strains. All are mainly, but not exclusively, produced by CD8+ T cells, both in HIV+ and healthy subjects. We studied the production of these HIV-suppressive factors in patients with HIV infection at different stages of disease. No difference in production by PBMC stimulated with PHA has been observed in asymptomatic HIV+, long-term nonprogressors (LTnP), and AIDS patients. When T cell line supernatants from these three groups were studied, no significant difference was found for C-C chemokines or IL-16 production, and viral suppression. However, T cell clones from LTnP secreted higher levels of all three chemokines, IL-16, and exerted a stronger inhibition on HIV replication. CD8+ clones showed a higher production than CD4+ clones. These clones were able to produce all antiviral factors irrespective of the secretion of type 1 or type 2 cytokines. The antiviral activities were not correlated, implying that viral suppression did not depend solely on C-C chemokines or IL-16. We postulate that all factors are needed to prevent HIV disease progression.

Common variable immunodeficiency (CVI), also known as acquired hypogammaglobulinemia, affects both males and females and may occur at any age (WHO Scientific Group 1992). Infections in patients with CVI are similar to those observed in X-linked agammaglobulinemia. Recurrent pyogenic infections, chronic progressive bronchiectasis, sprue-like syndrome with protein loss, and intestinal giardiasis are frequent. Occasionally a diagnosis of CVI is suggested by radiographic findings; because of the common occurrence of pulmonary disease in CVI, chronic changes occur with time and the radiological and clinical picture varies according to the stage of the pathology. After many years, the radiographic picture of the lungs in patients with CVI is similar to that of patients with cystic fibrosis. An important differentiating characteristic is the lack of hilar adenopathy either on the plain film or the lack of bronchial deviation usually observed by nodal enlargement in tomograms or bronchograms. The pulmonary changes include bronchial thickening, emphysema, cystic changes, bronchial dilation, and pulmonary fibrosis. Important associations are chronic sinusitis and otitis, diarrhoea, and splenomegaly (Aiuti and Luzi 1987; Cunningham-Rundles 1989).

We have determined the percentages and absolute numbers of lymphocyte subpopulations in 49 patients with common variable immunodeficiency (CVI). In vitro production of IL-6 by PHA-stimulated PBMC of 28 patients was also evaluated. Our data indicate profound alterations in the lymphocyte subpopulations evaluated, including increased CD8 cells (these cells outnumbered CD4 cells in 26 cases), severe defect of CD4 cells (400/mm3) in 10 cases and reduction of CD19 cells (50/mm3) in 11/41 cases. Increased production in vitro of IL-6 by PBMC of CVI patients does not correlate with the absolute numbers of lymphocytes, lymphocyte subpopulations, or monocytes. In addition, IL-6 was unable to significantly modify the amount of PWM-driven IgM production by CVI cells.

The CHAT classification separates various current and historical presentations of cerebrovascular disease in an effort to determine important prognostic clues for management and prognosis. To evaluate known risk factors for late stroke and death, we followed up for an average of 44 months 633 patients who had undergone 714 carotid operations. We analyzed the indication for surgery (by CHAT) and the effect of preoperative risk factors (age, hypertension, cardiac disease, tobacco use, diabetes, hyperlipidemia, renal disease, pulmonary disease, and total risk factor score) on the end points of late stroke and death. Ipsilateral stroke was uncommon after carotid endarterectomy: with life-table analysis, the probability of late stroke at 5 years after carotid endarterectomy was 3%. Among the 127 patients with amaurosis fugax, the incidence of late stroke and of mortality was a combined total of 1% per year, and the 17 patients who had been first seen with permanent ocular stroke (blindness) fared equally well. The 28 patients who were first seen with vertebrobasilar symptoms and were treated by carotid endarterectomy also fared particularly well, with no late strokes or deaths within the first 5 years. Logistic regression analyses revealed that the various indications for carotid endarterectomy were associated with differing patterns of risk factors as significant predictors of late stroke or death. For patients first seen with asymptomatic lesions, only diabetes was an important predictor for late stroke (p = 0.05) and renal disease was the only marker for early death (p = 0.05). On the other hand, those factors were not significant risk factors for patients first seen with amaurosis fugax, for whom tobacco use was a negative predictor for stroke (p = 0.06) and male gender a negative predictor for early death (p = 0.03). After cortical transient ischemic attacks and carotid endarterectomy, there were no risk factors predictive of late stroke or of death. For patients with prior stroke, age was a very strong predictor of stroke (p = 0.01) and both age and a history of cardiac disease were significant risk factors for early death (p = 0.007). In contrast to the results in reports of patients treated medically for transient ischemic attacks and stroke, we found that several risk factors appeared to play relatively minor roles. In conclusion, stroke after carotid endarterectomy was uncommon, least common after ocular symptoms, and most likely after permanent cortical stroke. Specific risk factors were less important for patients after carotid endarterectomy than for the medically treated stroke patient.

We studied the clinical and immunological effects of three months' treatment with intranasal flunisolide (100 micrograms daily) in 18 allergic patients with perennial rhinitis. 17 were hypersensitive to house dust mite and one to Parietaria pollen only. We found no significant changes in white blood cell count, serum levels of IgE and nasal IgA. However the treatment induced a marked improvement of clinical symptoms in all cases, and we observed a significant reduction of total IgE in nasal secretion. Flunisolide seems to exert this effect through its antiinflammatory action on the nasal mucosa.

We measured the in vitro production of interferon-gamma (IFN-gamma) in five cases of hyper-IgE syndrome (HIgE), induced by mitogens, calcium ionophores and phorbol ester. The biosynthesis of IFN-gamma was severely reduced or undetectable in HIgE, while it was near normal in most atopic patients. The in vitro spontaneous production of IgE was increased overall in HIgE patients, although no correlation was found with serum IgE levels. Recombinant interleukin-4 (IL-4) induced a further increase in IgE synthesis, and its effect was totally antagonized by recombinant IFN-gamma; the same pattern of response was also observed in atopic subjects with high production of IgE. IFN-alpha synergized with IL-4 on IgE synthesis, whereas recombinant IL-6 gave opposite changes in individual cases tested. We propose that IFN-gamma deficiency may be responsible for some of the features of HIgE patients, including IgE levels and infections.

We evaluated the clinical response to oligoallergenic dietary treatment and the intestinal absorption of a protein antigen, cow milk beta-lactoglobulin (BLG) in 24 patients with chronic urticaria/angioedema syndrome 13 of whom also suffered from joint symptoms. Sixteen patients (77% of those with arthralgia) responded to diet (RD) with marked reduction of symptoms; the others did not respond (NR). Ten (all but one RD with arthralgia) had increased permeability to BLG after oral administration of cow milk. Four with high titers of IgG to BLG showed the highest absorption of BLG and the groups with arthralgia showed higher BLG levels than those without arthralgia. In all cases, specific IgE to cow milk was absent. These data suggest that the symptoms of a subgroup of patients with chronic urticaria, and especially patients with joint complaints that subside with diet, are related to excess intestinal permeability. The measurement of gut permeability to food proteins may be useful to define those who may benefit from dietary restriction.

The correlation of structural anisotropy with normal spectral emissivity has been investigated experimentally and theoretically. Measurements include data on the two major crystallographic faces of pyrolytic graphite, pyrolytic boron nitride and single crystal beryllium. The results were obtained at temperatures near 800°C over a wavelength range from visible to near i.r. (0.60 to 11 μ) in both purified hydrogen and argon atmospheres. Pyrolytic graphite C -faces deposited at higher temperatures exhibit generally lower normal spectral emissivity (0.60 to 11 μ) corresponding to an increase in basal plane absorption as the deposition temperature increases. A further increase in basal plane absorption upon extreme annealing results in the lowest normal spectral emissivity of C -face pyrolytic graphite. This highly annealed C -face pyrolytic graphite exhibits a normal spectral emissivity dispersion which is close to the theoretically predicted curve of C -face single crystal graphite. Pyrolytic boron nitride in its lattice absorption region ( λ ≳ 2.60 μ ) exhibits a normal spectral emissivity of the A -face which is greater than that of the C -face. This corresponds to the greater absorption in the basal plane than in the prismatic plane. Single crystal beryllium in its free-carrier intraband absorption region ( λ ≳ 2.50 μ ) exhibits a normal spectral emissivity of the A -face, (1010), which is greater than that of the C -face, (0001). Thus, absorption is greater in the basal plane ( E → ⊥ c- axis ) than in the prismatic plane ( E → ⊥ c- axis ) corresponding to an inverse relationship of normal spectral emissivity to absorption in the intraband region.

The correlation of structural anisotropy with the normal spectral emissivity of pyrolytic graphite is discussed relative to polycrystalline graphite and to isotropic single crystal nickel. Results reported include data in the near infrared (1.5–13μ) at temperatures between 800 and 1200°C in a hydrogen atmosphere. Photomicrographs (up to 1000×), interference photographs, and X-ray orientation patterns were taken of all surfaces before and after the experiments to insure that no surface changes had taken place. The pyrolytic graphite C -face ( c -axis perpendicular to the surface) exhibits a spectral dispersion similar to that predicted theoretically for the same orientation of single crystal graphite. The normal spectral emissivity of the C -face is on the average a factor of 2 to 3 lower than the A -face ( c -axis parallel to the surface) and similar to a metal in its variation with wavelength. The Hagen-Rubens relation developed for metals in the infrared appears to hold qualitatively for pyrolytic graphite in that the lower emissivity face corresponds to the lower electrical resistivity direction. Normal spectral measurements on a series of cross-sections between the two major orientations of pyrolytic graphite have been made and shown to have similar trends as calculated and observed from visible reflectivity data for single crystal graphite. High purity and dense polycrystalline graphite shows a spectral dispersion similar to the A -face pyrolytic graphite, but with generally higher emissivity values due to the effect of the pores invariably present. The emissivity of pyrolytic and polycrystalline graphites are essentially temperature independent in contrast to the observed orientation dependence of the former.

Mass spectrographic, combustion-chromatographic, inert-gas fusion, and colorimetric techniques of analysis have been applied to the determination of impurities in zone-melted tungsten. The mass spectrograph, in sampling only small quantities of the specimen, revealed that the impurity distribution was in general inhomogeneous. The results indicated that only the most refractory impurities were redistributed by zone-refining action and that the primary mechanism of removal is generally by volatilization.

A comparison has been made of high strength filament materials having low dielectric and loss-tangent properties for use in antennae cables; lines and guys. The availability of type S glass fibers of higher strength than type E and the more recent production of high-modulus carbon filaments, and high-modulus organic type polymeric fibers offer several materials to choose from for optimum design. Since frequently both the mechanical and electrical properties are important for cables, a brief review is given of properties considered for final design and production. A specific problem and solution is analyzed with supporting data. At the Cornell University National Astronomy and Ionosphere Center in Puerto Rico, cables used in the antennas ,system had to meet the following unique combination of requirements: 1) high modulus for a low total elongation, 2) assurance of rigidity at comparatively low prestrain loads, and 3) low loss-tangent and dielectric properties. The final lines involved use of a recently developed PRD-49 organic fiber exhibiting higher polymer strength and modulus than previously obtainable. A modulus of 16.5x106psi was obtained for a line capable of supporting a 19, 000 Ib load and weighing approximately 0.04 Ib/ft of length. The implications of this work in other antennae and related design problems are also discussed.

Chromium‐doped α‐Al2O3 (ruby) whiskers have been grown by a vapor phase reaction. The ruby whisker growth morphologies were studied by means of optical and x‐ray microscopy. Neutron activation analysis was employed to determine the chromium concentrations. Several unusual whisker shapes and surface configurations were observed and are discussed.