Changes of CD3+CD56+ γδ T cell number and apoptosis during hospital admission are related to mortality in septic patients.

Immunoparalysis and apoptosis of T cells are serious problems for the evolution of septic patients. We aimed to relate changes in the number of αß and γδ T cells during hospital stay to the poor evolution of sepsis. In this prospective study, we recruited a total of 92 septic patients from the Emergency and Intensive Care Departments of two Hospitals, according to the latest criteria for the definition and management of sepsis. According to the severity of the septic process, there was a progressive decrease in T cells, being much more intense in γδ T cells. This decrease recovered in surviving patients, but CD3+CD56+ γδ T cells continued to decreased during hospital stay in non-surviving patients. Apoptosis increased in sepsis. Cell death of CD3+CD56+ γδ T cells progressively increased according to the severity of sepsis, especially in non-surviving patients.

Gammadelta T cells as a predictor of surgical relapse of Crohn's disease.

BACKGROUND: We recently demonstrated a decrease in the overall lymphocyte population in the peripheral blood of patients with CD compared to healthy controls and this decrease is more evident in γδ T lymphocytes. The percentages of T cell subsets could reflect the risk of surgical relapse in CD patients. The aim of this study is to study the correlation between αß and γδ T cell subsets in the peripheral blood of patients with CD and the risk for surgery during follow up. METHODS: A prospective study of 102 patients with CD compared with 102 healthy subjects (control group) matched by age and sex was conducted. Lymphocytic populations of CD3+, CD4+, CD8+, CD56+, and αß and γδ T cell subsets were measured in the peripheral blood of all participants. RESULTS: We found evidence of a relationship between lower γδ T cell levels and risk of surgical relapse in CD. The lowest subsets observed in CD patients with surgical relapse were CD3+γδ, CD3+CD8+γδ and CD3+CD56+γδT cells. We observed a relationship between a decrease in γδ T cells and the most severe forms of the disease. The lowest levels of CD3+γδ and CD3+CD8+γδT cells were observed in the fistulizing phenotype. CONCLUSIONS: The deficit of γδ T cells was related with the severity and the risk for surgical relapse in CD patients. Patients with CD3+γδ deficit were more prone to surgery than patients without this deficit. These results suggest that γδ T cells could be used as markers of poor prognosis of CD following the diagnosis of the disease.

Determination of Anti-Anisakis Simplex Antibodies and Relationship with αß and γδ Lymphocyte Subpopulations in Patients with Crohn's Disease.

BACKGROUND: The etiology of Crohn's disease (CD) is still unknown although new theories are based on defects in innate immunity. We have previously shown a decrease in γδ T cells in CD patients. Previous studies have shown a high prevalence of anti-A. simplex immunoglobulins in CD patients. The diminution of γδ T cells in the peripheral blood and intestinal mucosa of CD patients may create a state of immunosuppression that would facilitate A. simplex infection. AIMS: To study the antibody responses to Anisakis antigens in Crohn's disease patients and its relationship with αß and γδ T cell subsets. METHODS: We recruited 81 CD patients and 81 healthy controls. αß and γδ T cell subsets and anti-A. simplex antibodies were measured. RESULTS: Levels of anti-A. simplex IgG and IgM were significantly increased in CD patients. Almost 20% of CD patients were positive for IgG and IgM anti-A. simplex versus only 3.7 and 2.5%, respectively, in normal subjects. However, lower specific IgA levels were observed in the group of CD patients versus healthy subjects. We found an association between CD3 + CD8 + Î³Î´ subset and IgM anti-A. simplex levels. In ileal cases and stricturing behavior of CD, we observed the highest levels of specific antibodies with the exception of anti-A. simplex IgA. CONCLUSIONS: The relationship of specific antibodies with a γδ T cell deficiency makes these cell candidates to play a role in the immune response against Anisakis. In addition, anti-Anisakis antibodies could be considered as markers of risk of progression in CD.

Values for αß and γδ T-lymphocytes and CD4+, CD8+, and CD56+ subsets in healthy adult subjects: assessment by age and gender.

BACKGROUND: Normal reference values in healthy subjects for T-lymphocytes for both types of receptors, αß and γδ, and their subsets are yet to be defined. The aim of this study was to measure peripheral blood αß and γδ total T-lymphocytes and their subsets in a population of healthy subjects, in order to obtain valid reference values for studies in human pathology. METHODS: We studied a total of 157 healthy subjects, 78 men and 79 women, establishing their levels of CD3+, CD4+, CD8+, CD56+, αßCD3+, αßCD3+CD4+, αßCD3+CD8+, αßCD3+CD56+, γδCD3+, γδCD3+CD4-CD8-, γδCD3+CD8+, and γδCD3+CD56+ T-cells by flow cytometry. The T-cell subsets were compared for different age and gender groups. RESULTS: A significant decrease in CD3+, CD3+CD4+, CD3+CD4+ αß, and CD3+ γδ T-cells was observed in elderly subjects. CD3+, CD3+ αß, and CD3+CD4+ αß T-cells increased in women, while CD3+CD56+ αß T-cells increased in men. CONCLUSIONS.: These reference values could be useful in further research studies for assessing changes that occur in the different αß and γδ T subsets in human pathology.

The effect of anti-Anisakis simplex antibody levels on C3 and C4 complement components in human sera.

Previously, an in vitro effect was observed on the complement system not only of the excretory-secretory products but also of somatic antigens from L3 Anisakis simplex larvae. In the present work the effect of anti-A. simplex specific antibodies on C3 and C4 levels in human sera was investigated. Up to 309 samples of sera were tested to determine levels of C3 and C4 and anti-A. simplex antibodies, including immunoglobulins IgG, IgM, IgA and IgE. Significant differences were observed between levels of C3 and C4 and all immunoglobulins except for IgE. In the case of immunoglobulins, the probability that an anti-A. simplex positive subject has a C3 deficiency was 3.8 times higher than a subject without specific antibodies. In conclusion, an association between elevated levels of anti-A. simplex antibodies and C3 and C4 deficiency was demonstrated.

Use of non-invasive positive pressure ventilation in emergency departments of hospitals in Spain.

A survey was undertaken of the use of non-invasive ventilation (NIV) in Spain. 45.7% of emergency departments use NIV. The average time it has been in use is 4 years. Public hospitals use NIV more frequently (89.5%) as well as teaching hospitals (78.1%). Emergency physicians are the professionals who most frequently use NIV (68.8%). High flux continuous positive airway pressure (58.4%) and facial masks (63.5%) are most commonly used. Only 18.9% of hospitals have quality registration in NIV and 35.6% have protocols for using NIV. The method is underused by technicians working in hospital emergency services and there is a lack of uniform protocols with other departments involved.

Epidemiology of appendectomy and appendicitis in the Valencian community (Spain), 1998-2007.

BACKGROUND/AIMS: Our purpose was to study the incidence of appendectomy and appendicitis in the Valencian community (Spain) during a period of 10 years (1998-2007). METHODS: Data on discharge diagnoses of appendectomy and appendicitis were downloaded from all public hospitals in the Valencian community. RESULTS: We identified 44,683 cases of appendectomies and 42,742 cases of appendicitis (95.7%) during the study period. The age-standardized incidence rates among men ranked between 132.1 cases per 100,000 population in 2003 and 117.46 cases per 100,000 population in 2000 without a clear trend through the study period. The appendiceal perforation rate was 12.1% and the negative appendectomy rate 4.3%. The global mortality was 0.38%. CONCLUSIONS: The incidence of appendectomy in our community presents a slight descending trend. This decline is more intense in females. The appendix perforation rate is lower than in other studies. The death rate is similar to other studies; however, it is very low in patients of younger age.

Differential effect of appendectomy and tonsillectomy on anti-Kudoa sp. antibodies in patients with MALTectomy.

We found an association between tonsillectomized patients and subsequent appendicitis. We also observed that MALTectomy significantly decreased secretory IgA levels in serum of patients, being this decrease more pronounced when both operations (tonsillectomy and appendectomy) had been performed. The elevated humoral responses detected previously by us in BALB/c mice immunized with Kudoa sp. pseudocyst extracts and the high IgG1 and IgE levels induced by the oral administration of Kudoa sp. pseudocysts to BALB/c mice showed the possible immunopathological effects in man from the ingestion of Kudoa sp. infected fish. We use the ELISA method to investigate the possible relationship between MALTectomy (tonsillectomy and appendectomy) and specific antibody levels to Kudoa sp. Both anti-Kudoa sp. specific antibody levels and the number of patients that recognized Kudoa sp. antigens were greater in tonsillectomy patients when compared to the control and the other studied groups (appendectomized and appendectomized+tonsillectomies patients). Tonsillectomy was associated to a switch in the class of immunoglobulins involved in these responses and these responses may be abrogated by appendectomy. Tonsils and appendix may respond in different ways to Kudoa sp. antigens and these different reactions may be involved in some immunopathological reactions.

Anisakis simplex and Kudoa sp.: evaluation of specific antibodies in appendectomized patients.

High prevalence and intensity of infection with anisakid larvae has been reported in commercially important fish in Spain. Likewise, Kudoa-infected fish have lately been detected in both fresh and frozen fish. In the present study the possible relation between appendectomy and specific antibodies to these fish parasites was investigated. One hundred and sixty patients were enrolled in this study. They were divided into two groups of eighty patients each and matched for sex and age: Group 1 (appendectomized) and Group 2 (control group). Total immunoglobulins (Ig's), IgG, IgM, IgA and IgE against Anisakis simplex or Kudoa sp. antigens were analysed by ELISA. The mean values of the specific antibodies were lower in the appendectomy group, although significant differences were not observed in the case of IgG, IgA and IgE anti-A. simplex and IgE anti-Kudoa sp. In summary, appendectomy significantly decreased serum specific immunoglobulin levels against these food borne parasite antigens. This decrease was detectable from three months to three years post-appendectomy. It is necessary to study the influence of the surgical removal of other important parts of the GALT on these anti-parasite humoral immune responses.

Association between tonsillectomy, adenoidectomy, and appendicitis.

INTRODUCTION: Tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. OBJECTIVE: To examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. MATERIAL AND METHOD: A cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy) was tested. RESULTS: The 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28) than in men (OR: 1.74; 95% CI: 0.90-3.39). CONCLUSIONS: A clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.

Asociación entre amigdalectomía, adenoidectomía y apendicitis / Association between tonsillectomy, adenoidectomy, and appendicitis

Introduction: tonsillectomy, with or without adenoidectomy,is one of the most frequent surgical procedures generally performed,especially in young patients. Several studies suggest thatthere is a relationship between tonsillectomy and altered MALTimmune system.Objective: to examine the possible association between tonsillectomyor adenoidectomy and the risk of subsequent appendicitis.Material and method: a cross-sectional study was performedin 650 patients admitted to the emergency department of a generalhospital in Valencia, Spain. Previous history of tonsillectomyand/or adenoidectomy was related to a history of appendectomy.A descriptive study and an analysis of the relationship betweenprevious operations and appendicitis was performed. A multivariableanalysis controlled for age and sex was also performed, includingthe possible interaction of the gender variable. The independenteffect of each of the procedures (tonsillectomy,adenoidectomy) was tested.Results: the 25.5% of patients had undergone tonsillectomyand 11.5% adenoidectomy; 17.5% had had an appendectomy.On average, women were operated on more frequently than men.In the bivariate analysis, both tonsillectomy and adenoidectomywere significantly associated with subsequent appendectomy. Inthe multivariate analysis, this association was only maintained fortonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysiscontrolling for sex showed a modification of this effect, with ahigher association in women (OR: 5.20; 95% CI: 2.91-9.28) thanin men (OR: 1.74; 95% CI: 0.90-3.39).Conclusions: a clear association has been found, especially inwomen, between previous tonsillectomy and subsequent acute appendicitis.Due to a lack of data on acute appendicitis there shouldbe further studies to explain the findings of this study, as this couldbe the first described risk factor of acute appendicitis