ABSTRACT
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research. Critical to its real-world success will be consideration for practice workflow and logistics, and sustainability through novel reimbursement mechanisms.
Subject(s)
Ambulatory Care , Delivery of Health Care, Integrated , Depression, Postpartum , Depression , Pregnancy Complications , Depression/diagnosis , Depression/therapy , Depression, Postpartum/diagnosis , Depression, Postpartum/therapy , Female , Humans , Mass Screening , Patient Satisfaction , Perinatal Care , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Self Efficacy , Surveys and QuestionnairesABSTRACT
T cells are activated by antigen (Ag)-bearing dendritic cells (DCs) in lymph nodes in three phases. The duration of the initial phase of transient, serial DC-T cell interactions is inversely correlated with Ag dose. The second phase, characterized by stable DC-T cell contacts, is believed to be necessary for full-fledged T cell activation. Here we have shown that this is not the case. CD8⺠T cells interacting with DCs presenting low-dose, short-lived Ag did not transition to phase 2, whereas higher Ag dose yielded phase 2 transition. Both antigenic constellations promoted T cell proliferation and effector differentiation but yielded different transcriptome signatures at 12 hr and 24 hr. T cells that experienced phase 2 developed long-lived memory, whereas conditions without stable contacts yielded immunological amnesia. Thus, T cells make fate decisions within hours after Ag exposure, resulting in long-term memory or abortive effector responses, correlating with T cell-DCs interaction kinetics.
Subject(s)
Antigen Presentation , CD8-Positive T-Lymphocytes/immunology , Dendritic Cells/immunology , Immunologic Memory/immunology , Adoptive Transfer , Animals , Antigen-Presenting Cells/immunology , CD8-Positive T-Lymphocytes/metabolism , Cell Communication , Cell Differentiation , Dendritic Cells/metabolism , Lymph Nodes/immunology , Lymphocyte Activation , Lymphocytic choriomeningitis virus/immunology , Mice , Mice, Inbred C57BL , Mice, Knockout , Transcriptome/immunologyABSTRACT
Hepatic natural killer (NK) cells mediate antigen-specific contact hypersensitivity (CHS) in mice deficient in T cells and B cells. We report here that hepatic NK cells, but not splenic or naive NK cells, also developed specific memory of vaccines containing antigens from influenza, vesicular stomatitis virus (VSV) or human immunodeficiency virus type 1 (HIV-1). Adoptive transfer of virus-sensitized NK cells into naive recipient mice enhanced the survival of the mice after lethal challenge with the sensitizing virus but not after lethal challenge with a different virus. NK cell memory of haptens and viruses depended on CXCR6, a chemokine receptor on hepatic NK cells that was required for the persistence of memory NK cells but not for antigen recognition. Thus, hepatic NK cells can develop adaptive immunity to structurally diverse antigens, an activity that requires NK cell-expressed CXCR6.
Subject(s)
Haptens/immunology , Immunologic Memory/immunology , Killer Cells, Natural/immunology , Lymphocyte Subsets/immunology , Receptors, CXCR/immunology , Viruses/immunology , Adaptive Immunity/immunology , Adoptive Transfer , Animals , Cell Separation , Chemotaxis, Leukocyte/immunology , Cytotoxicity, Immunologic/immunology , Flow Cytometry , Killer Cells, Natural/metabolism , Liver/cytology , Liver/immunology , Lymphocyte Subsets/metabolism , Mice , Mice, Inbred C57BL , Mice, Knockout , Mice, Transgenic , Receptors, CXCR/metabolism , Receptors, CXCR6 , Virus Diseases/immunologyABSTRACT
After homing to lymph nodes, CD8+ T cells are primed by dendritic cells (DCs) in three phases. During phase one, T cells undergo brief serial contacts with DCs for several hours, whereas phase two is characterized by stable T cell-DC interactions. We show here that the duration of phase one and T cell activation kinetics correlated inversely with the number of complexes of cognate peptide and major histocompatibility complex (pMHC) per DC and with the density of antigen-presenting DCs per lymph node. Very few pMHC complexes were necessary for the induction of full-fledged T cell activation and effector differentiation. However, neither T cell activation nor transition to phase two occurred below a threshold antigen dose determined in part by pMHC stability. Thus, phase one permits T cells to make integrated 'measurements' of antigen dose that determine subsequent T cell participation in immune responses.