[Late onset immunodeficiency with hypo-IgG and hyper-IgM, T CD4+ lymphocytopenia and vitiligo]. / Immunodeficienza ad insorgenza tardiva con ipo-IgG e iper-IgM, linfocitopenia T CD4+ e vitiligo.

The Authors report the clinical case of a patient with a deficit of humoral immunity who developed infections since puberty. The serum levels of IgG and IgA decreased progressively in the fourth decade of life, while serum IgM increased. Moreover, the patient developed a marked CD4+ T lymphocytopenia and a meager B lymphocytopenia, vitiligo, positivity for anti-SSA/Ro autoantibodies and granulomatous phlogosis of the knee. The heterogeneity of the clinical and laboratory data suggests that this patient might present an overlap immunodeficiency syndrome with some of the clinical and immunological features typical of the hyper-IgM syndrome (in the X-linked or autosomal forms) and others that can be referred to a nosologically distinct humoral immunodeficiency such as the common variable immunodeficiency.

A contemporary reexamination of revenue ruling 69-545 and the promotion of health rationale for exemption.

In recent years, Revenue Ruling 69-545 has generated considerable discussion about what is necessary to satisfy the "promotion of health" standard of charitable exemption under Section 501(c)(3). This Article reviews the development of the standards of exemption applicable to nonprofit hospitals, including Revenue Ruling 56-185 and Revenue Ruling 83-157. It then provides a detailed discussion of Revenue Ruling 69-545 and sets forth the author's view on how the Ruling's factual elements should be interpreted. The author concludes that the promotion of health rationale should not be limited by treating the fact patterns of Revenue Ruling 69-545 as prescriptive of a multifaceted test of exemption, or by seeking to impose a mandatory charity care requirement as a precondition of exemption. Rather, a flexible approach to promotion of health should be embraced by the Internal Revenue Service (IRS), practitioners, and the courts.

Chemiluminescence activity in whole blood phagocytes of dogs naturally infected with Leishmania infantum.

Dogs are the domestic reservoir of Leishmania infantum, a vector-borne intracellular protozoan agent of human visceral leishmaniasis. The role of polymorphonuclear leukocytes (PMNs) in the immune defence against this parasite has been poorly studied. We have investigated the function of peripheral blood PMNs in naive beagle dogs that have been naturally exposed to phlebotomine vectors in an area highly endemic for canine leishmaniasis, and found infected by Leishmania at the end of the transmission season. Whole blood phagocyte oxidative metabolism was assessed by a rapid method that determines a luminol-amplified chemiluminescence (CL) emission. This was evaluated using either a soluble stimulant, phorbol mirystate acetate (PMA), or phagocytic stimuli, such as zymosan unopsonized (ZYM) or opsonized with autologous serum (OPZ). In blood samples taken 2 months after exposure to Leishmania transmission, data on CL emission revealed a significant decrease of reactive oxygen intermediates (ROI) production in the presence of both PMA and ZYM, compared with blood samples obtained from dogs before exposure. On the contrary, no variations in CL emission were detected in presence of OPZ. Our data indicate that immunological changes occur early in canine leishmaniasis and confirm that the role of PMNs and their products need to be clarified.

Early suppression of lymphoproliferative response in dogs with natural infection by Leishmania infantum.

Dogs are the domestic reservoirs of zoonotic visceral leishmaniasis caused by Leishmania infantum. Early detection of canine infections evolving to clinically patent disease may be important to leishmaniasis control. In this study we firstly investigated the peripheral blood mononuclear cell (PBMC) response to leishmanial antigens and to polyclonal activators concanavalin A, phytohemagglutinin and pokeweed mitogen, of mixed-breed dogs with natural L. infantum infection, either in presymptomatic or in patent disease condition, compared to healthy animals. Leishmania antigens did not induce a clear proliferative response in any of the animals examined. Furthermore, mitogen-induced lymphocyte proliferation was found strongly reduced not only in symptomatic, but also in presymptomatic dogs suggesting that the cell-mediated immunity is suppressed in progressive canine leishmaniasis. To test this finding, naive Beagle dogs were exposed to natural L. infantum infection in a highly endemic area of southern Italy. Two to 10 months after exposure all dogs were found to be infected by Leishmania, and on month 2 of exposure they all showed a significant reduction in PBMC activation by mitogens. Our results indicate that suppression of the lymphoproliferative response is a common occurrence in dogs already at the beginning of an established leishmanial infection.

Strategies for selling and consolidating physician practices.

The changing dynamics of healthcare service delivery is forcing many physicians to consider selling their practices to hospitals or health plans or consolidating them with other practices. Besides being subject to the corporate and tax requirements that apply to the sale of any business, the sale of physician practices is also subject to Federal fraud and abuse and self-referral laws. Several sale strategies are available to physicians who desire to sell or consolidate their practices, including asset sales, stock sales, forward mergers, drop down consolidations, spinoffs, and statutory mergers. Each strategy has advantages and disadvantages, but whichever strategy is chosen, both sellers and buyers must ensure that tax issues are addressed and that the transaction complies with the requirements of Federal anti-kickback and self-referral laws.

Functional characteristics of cord blood T lymphocytes after lectin and anti-CD3 stimulation. Differences in the way T cells express activation molecules and proliferate.

Newborns are more susceptible than adults to infections, which suggests a relative immaturity of the immune system early after birth. Cord blood T cells differ significantly both in surface phenotype and function from adult T cells. We examined the proliferation and expression of activation molecules by lymphocytes isolated from umbilical cord blood or peripheral blood of adults. The lymphocytes were cultured for 5 days in the presence of phytohemagglutinin, concanavalin A, or anti-CD3 monoclonal antibody. Cord blood T cells expressed the CD45RA molecule, while a low proportion expressed the RO isoform, a marker of primed or activated lymphocytes. Furthermore, more than 95% of neonatal lymphocytes bear the CD38 molecule, but do not express the CD57 molecule. After stimulation by phytohemagglutinin or concanavalin A, the lymphocytes from newborns were activated and proliferated as efficiently as adult T cells. Anti-CD3 did not cause neonatal lymphocytes to proliferate, but these cells expressed activation molecules, such as HLA-DR antigens and the receptor for interleukin-2 and transferrin. The relevance of these findings to tolerance induction in immature cord blood T cells is discussed.

Inhibition of interleukin-1 release and activity by the rat seminal vesicle protein SV-IV.

SV-IV, a 9.8-kd protein isolated from rat seminal vesicle secretion, has been shown to have strong non-species-specific immunosuppressive, anti-inflammatory, antithrombotic, and antiphospholipase A2 properties. The present investigation was undertaken to determine the mechanism of action of its immunosuppressive effects. It was found that SV-IV is a potent inhibitor of interleukin-1 (IL-1) release from lipopolysaccharide (LPS)-activated human adherent monocytes and an effective inhibitor of IL-1-induced thymocyte proliferation. The ability of SV-IV to form a noncovalent dimeric association with IL-1 alpha but not with IL-1 beta, its ability to induce a marked decrease of IL-1 binding to its own receptors on the thymocyte surface, and its capacity to bind specifically to the macrophage plasma membrane might play an important role in the molecular mechanism of these inhibitory effects.

On the record, off the hook. Paperwork protects tax status.

Meeting minutes of Section 501(c)(3) organizations are one of the first places the Internal Revenue Service, the state attorney general, and others will look in trying to determine whether the board of directors is governing the corporation's operations and activities in conformance with tax-exemption rules and whether board members are properly fulfilling their corporate fiduciary duties. Because such minutes reflect deliberations and actions that took place at board meetings, minutes provide a record of circumstances surrounding significant corporate decisions--decisions the IRS and others may choose to question. An organization trying to maintain its tax-exempt status can further its cause by making sure that meeting discussions (and minutes), as well as backup documentation, include all pertinent information. The tax-exempt organization should take special care when drafting minutes regarding deliberations and actions pertaining to transactions that prompt close IRS scrutiny. For example, with joint ventures, corporate minutes should reflect that the exempt organization's board based its decision to enter into the joint venture primarily on the venture's investment value and/or its value in achieving exempt purposes--not the venture's benefit to the non-exempt party.