Support following total laryngectomy: Exploring the concept from different perspectives.

Adjustment after total laryngectomy is complex, and the resultant support needs are extensive. Current practice is often guided by health-related quality of life measures. While useful, many of these tools were developed without considering the perspectives of people who have experienced the surgery. To improve understanding of the support needs after total laryngectomy, multiple viewpoints were examined, for example individuals with a laryngectomy (IWL), significant others (SO) and health professionals (HP). A qualitative study explored the perspectives of 28 individuals (IWL-seven men and five women, nine SO and seven HP). Data were collected through in-depth, semi-structured interviews and analysed using constructivist grounded theory and symbolic interactionism. The data suggested that the construct "being supported to develop competence and resilience" is a multidimensional and nonlinear phenomenon underpinned by the interactive processes "perceiving influencing factors," "building trusting relationships" and "sharing and balancing the care." The findings highlight the significant contribution the care triad (i.e., IWL, SO and HP) plays and the factors influencing care, safety and dignity for IWL. Furthermore, support is optimised when all stakeholders are competent with the care. In turn, reduced competence increases the burden for one or all in the triad.

Chronic genital herpes and disclosure.... The influence of stigma.

The objectives of this study were to assess the nature and effect of stigma on disclosure of diagnosis to sexual partners among those with problematic disease. Data from questionnaires and semistructured interviews were collected and analysed. Data regarding anxiety were also collected using a validated tool. Ethical approval was received from the Chelsea and Westminster Healthcare National Health Service (NHS) Trust. Disclosure of diagnosis tended to occur in the context of established relationships. Herpes-related stigma was associated with non-disclosure of diagnosis to sexual partners. The point prevalence of moderate to severe anxiety in this sample was 32%. The use of suppressive medication did not affect anxiety scores. In conclusion, the reaction to a diagnosis of genital herpes is influenced by a socially constructed understanding and the decision to disclose or not is influenced by this. Stigma is a barrier to disclosure of genital herpes diagnosis. Management strategies aimed at encouraging disclosure to partners must address perceived stigma.

WW- and SH3-domain interactions with Epstein-Barr virus LMP2A.

Epstein-Barr virus (EBV) is a human herpesvirus which establishes a lifelong latent infection in B lymphocytes. Latent membrane protein 2A (LMP2A) is expressed in both humans with EBV latent infection and EBV immortalized cell lines grown in culture. Previous studies have shown that the amino terminal domain of LMP2A, which contains eight tyrosines, associates with a variety of cellular proteins via SH2-phosphotyrosine interactions. Also contained within the LMP2A amino terminal domain are five proline-rich regions, three of which possess the PxxP core consensus sequence required for interacting with SH3 domains and two of which possess the PPxY core consensus sequence (PY motif) required for interacting with class I type WW domains. In the current study, the ability of LMP2A to interact with either modular SH3 or WW domains was investigated. The results of these studies indicate that the two LMP2A PY motifs interact strongly with representative class I WW domains, but not with representative class II WW domains. In contrast, no interactions were detected between LMP2A and any of the five different SH3 domains tested. These data demonstrate that a subset of the conserved proline-rich motifs within the amino terminus of LMP2A can potentially mediate interactions with cellular proteins and may play a role in EBV-mediated latency and/or transformation.

The domain structure of ICAM-1 and the kinetics of binding to rhinovirus.

Fragments of intercellular adhesion molecule 1 (ICAM- 1) containing only the two most N terminal of its five immunoglobulin SF domains bind to rhinovirus 3 with the same affinity and kinetics as a fragment with the entire extracellular domain. The fully active two-domain fragments contain 5 or 14 more residues than a previously described fragment that is only partially active. Comparison of X-ray crystal structures show differences at the bottom of domain 2. Four different glycoforms of ICAM- 1 bind with identical kinetics.

Characterization of murine intercellular adhesion molecule-2.

Rat mAbs were raised against murine intercellular adhesion molecule-2 (ICAM-2). Immune precipitation and purification reveal that the murine ICAM-2 glycoprotein is 55 kDa and is similar in size to human ICAM-2. ICAM-2 is expressed on a variety of leukocyte cell lines, including T and B lymphoma, mastocytoma, and macrophage lines. ICAM-2 is well expressed on endothelioma cell lines, and in contrast to ICAM-1, expression is not increased by inflammatory cytokines. One of the mAb to ICAM-2 partially or completely inhibits binding of cells expressing LFA-1 to purified ICAM-2, and binding of cells expressing ICAM-2 to purified LFA-1. The findings in the mouse are congruent with those in the human, suggesting functional conservation of ICAM-2 across species.

The I domain is a major recognition site on the leukocyte integrin Mac-1 (CD11b/CD18) for four distinct adhesion ligands.

Despite the identification and characterization of several distinct ligands for the leukocyte integrin (CD11/CD18) family of adhesion receptors, little is known about the structural regions on these molecules that mediate ligand recognition. In this report, we use alpha subunit chimeras of Mac-1 (CD11b/CD18) and p150,95 (CD11c/CD18), and an extended panel of newly generated and previously characterized mAbs specific to the alpha chain of Mac-1 to map the binding sites for four distinct ligands for Mac-1: iC3b, fibrinogen, ICAM-1, and the as-yet uncharacterized counter-receptor responsible for neutrophil homotypic adhesion. Epitopes of mAbs that blocked ligand binding were mapped with the chimeras and used to localize the ligand recognition sites because the data obtained from functional assays with the Mac-1/p150,95 chimeras were not easily interpreted. Results show that the I domain on the alpha chain of Mac-1 is an important recognition site for all four ligands, and that the NH2-terminal and perhaps divalent cation binding regions but not the COOH-terminal segment may contribute. The recognition sites in the I domain appear overlapping but not identical as individual Mac-1-ligand interactions are distinguished by the discrete patterns of inhibitory mAbs. Additionally, we find that the alpha subunit NH2-terminal region and divalent cation binding region, despite being separated by over 200 amino acids of the I domain, appear structurally apposed because three mAbs require the presence of both of these regions for antigenic reactivity, and chimeras that contain the NH2 terminus of p150,95 require the divalent cation binding region of p150,95 to associate firmly with the beta subunit.

Respiratory poliomyelitis: a follow-up study.

Data from the medical records of 113 patients living in Manitoba who had contracted respiratory poliomyelitis between 1952 and 1959 were compared with information obtained from interviews with these patients in 1980. The study was designed to determine whether the patients' respiratory function, mobility, ability to perform daily tasks, and employment, residential and marital status had changed between 1 year after the onset of polio and 1980. The patients' dependence on mechanical aids and other people was also studied. More than half (56%) of the patients perceived their respiratory impairment to be the same as it was 1 year after the onset of polio, 27% perceived the impairment to be increased, and 17% perceived it to be decreased. There was an association between level of respiratory function, mobility and ability to perform daily tasks. The 69 patients who lived at home had better respiratory function, mobility and ability to perform daily tasks than the 24 patients who were assisted by a home care program and the 20 who lived in hospital. The latter group had the lowest levels of respiratory and functional ability.