Pulmonary inflammation promoted by type-2 dendritic cells is a feature of human and murine schistosomiasis.

Schistosomiasis is a parasitic disease affecting over 200 million people in multiple organs, including the lungs. Despite this, there is little understanding of pulmonary immune responses during schistosomiasis. Here, we show type-2 dominated lung immune responses in both patent (egg producing) and pre-patent (larval lung migration) murine Schistosoma mansoni (S. mansoni) infection. Human pre-patent S. mansoni infection pulmonary (sputum) samples revealed a mixed type-1/type-2 inflammatory cytokine profile, whilst a case-control study showed no significant pulmonary cytokine changes in endemic patent infection. However, schistosomiasis induced expansion of pulmonary type-2 conventional dendritic cells (cDC2s) in human and murine hosts, at both infection stages. Further, cDC2s were required for type-2 pulmonary inflammation in murine pre-patent or patent infection. These data elevate our fundamental understanding of pulmonary immune responses during schistosomiasis, which may be important for future vaccine design, as well as for understanding links between schistosomiasis and other lung diseases.

Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability.

The Severin classification system frequently is used to evaluate the radiographic results of operations performed for the treatment of congenital dislocation of the hip. However, the reliability of this classification scheme has not been established, to our knowledge. Ideally, a classification system should be validated before it is used to promote therapeutic guidelines or to compare results of treatment; the purpose of the present study was to establish the intraobserver and interobserver reliability of the Severin classification system. Four blinded raters and the operating surgeon independently used the Severin system to evaluate the most recent radiographs of thirty-seven children (fifty-six hips) who had been managed, an average of nine years previously, with a medial open reduction for congenital dislocation of the hip. Three of the raters evaluated the same radiographs again under similar testing circumstances eight weeks later. Ten paired interobserver and three intraobserver comparisons then were analyzed with use of the Cohen kappa coefficient (kappa). The average kappa coefficient for the six pairwise comparisons between the four blinded raters was 0.15 (range, -0.05 to 0.42) when all Severin classes were analyzed independently. The average kappa coefficient for the four pairwise comparisons between the blinded raters and the operating surgeon was even lower (0.02). The kappa coefficients for the three intraobserver comparisons were 0.20, 0.38, and 0.44 (average, 0.34). Kappa analysis demonstrated variable and low levels of agreement when the Severin system was used to rate the results of operations performed for the treatment of congenital dislocation of the hip. We believe that the unadjusted kappa coefficient should indicate excellent agreement (kappa > 0.75) for all comparisons if this system is to be used for the evaluation of clinical results. The unacceptably low levels of intraobserver and interobserver reliability call into question the clinical conclusions of reports in which the Severin system has been used as the basis of proof.

Transfer of human adenine deaminase gene into murine hematopoietic stem cells: sequential study of spleen colony-forming units from bone marrow of living mice and the requirement of the microenvironment.

Irradiated female mice were reconstituted with male hematopoietic stem cells (HSCs) retrovirally marked with human adenine deaminase (hADA) complimentary DNA. HSCs were incubated with interleukin-6 and stem cell factor before coculture with GP+E86-producing cells. Bone marrow HSCs were infused intravenously to irradiated mice and spleen colony-forming units (CFU-S) were evaluated for hADA marked clones by Southern blot analysis. 45 of 54 CFU-S were marked by the hADA gene sequence with multiple copies integrated per genome. Oligoclonal hematopoiesis evolved over time with 1-2 clones demonstrated 5-11 months after reconstitution. Comparable results were obtained with embryonic fetal liver HSCs. Incubation of bone marrow HSCs with adherent stromal cells rather than growth factors produced less efficient gene transfer, and polyclonal hematopoiesis was not observed. Donor origin was established by the Y chromosome probe. These results support the clonal succession model of hematopoiesis.

Adductor and psoas release for subluxation of the hip in children with spastic cerebral palsy.

Forty-four hips in 22 children between the ages of 2.0 and 6.0 years (mean, 4.0 years) with cerebral palsy were followed-up prospectively for a minimum of 5 years. Of the 44 hips studied preoperatively, 20 were radiologically normal, 24 were subluxed, and one was dislocated. Five years postoperatively, 39 hips were normal, five were subluxed, and none was dislocated. None of the 27 hips that were normal preoperatively either subluxed or dislocated during the study period. Nineteen of the subluxed hips became normal, and five remained subluxed. Adductor and psoas releases prevent hip subluxation and provide a measure of protection to the opposite hip.

Issues in the pediatric athlete.

Owing to an increase in children participating in competitive organized sports, there is a real concern for the health and well-being of the individual pediatric athlete. A knowledge of several aspects of the care of these children will not only make sports participation more enjoyable but also help to minimize injury. It should be remembered that children are not small adults. They not only have a different physiologic response to exercise but also have many cartilaginous growth areas that are susceptible to injury. Appropriate training in the pediatric athlete will help prevent injury. Conservative training programs, completed in a well-ventilated and air-conditioned area are important. In the prepubescent, efforts should be made to make training fun, with emphasis placed on skills important to the sport rather than monotonous repetitions and intensive conditioning. Because early detection and treatment of overuse injury and spondylolisthesis will help decrease morbidity and may prevent permanent injury, it is important to maintain a high index of suspicion for the development of early symptoms and signs. Knee injuries are very common and require appropriate evaluation that often includes stress radiographs and arthroscopy. Although isolated ligamentous injury usually has a good prognosis, injury to the ACL seems to cause significant morbidity in the long run. Reconstruction in the adolescent with significant symptoms and instability is reasonable. More research into ACL insufficiency in the child athlete, however, is required before the natural history and best method of management is established. Sport participation is to be enjoyed. Certainly, sports are much more fun when one is healthy. A knowledge of issues in the pediatric athlete will help maintain the health and happiness of these children.

Educational outcomes in teenage pregnancy and parenting programs: results from a demonstration.

A comparison of five in-school educational and service approaches offered at seven sites in Arizona to 789 pregnant and parenting teenagers shows that except for those who enroll in a program in their third trimester, pregnant and parenting teenagers who attend a comprehensive, school-based, community-linked program are significantly more likely to continue in school than are those who have no access to a special program. The comprehensive program's impact is greatest among Hispanic students, younger students, those in grades 9-10, those who are living with their partner and those who enter the program in the first trimester. Two of the program components--strong outreach efforts and case management-are believed to have an especially favorable impact on continuation in school.

PIP: Hispanic adolescents, and particularly Mexican Americans adolescents, have a very high rate of pregnancy and dropping out of school. The aim of this article was to provide the results of an evaluation of a school- based demonstration project (Teenage Pregnant and Parenting Demonstration: TAPP). TAPP was implemented at 3 sites in Phoenix or Tucson, Arizona, during 1985-89 and compared with 4 other sites. TAPP enrolled students during pregnancy and aimed to keep pregnant and parenting students in school. Each program provided comprehensive services. 5 program models were represented in the 7 participating program sites. Model 1 included the 2 sites for the TAPP program, which mainstreamed pregnant students with regular students and recruited pregnant school dropouts over the summer months. The unique feature was case management for each student, which was coordinated with student's classroom teachers. Models 2-5 are described. 789 students were enrolled in the evaluation. Of the 39% of nonparticipants, 44% had dropped out of school in Models 1 and 2, 42% gave birth before they could participate; in Models 4 and 5, 27% had dropped out, 24% gave birth before enrollment, and 34% refused IN Model 3, there were not program dropouts. Ethnic distribution was 40% Hispanic, 34% whites, 18% blacks, and 8% Native Americans. Survival analysis was used to examine dropouts and logistic regression was used to analyze program model and educational persistence. The results showed that Model 1 was the most successful at keeping study participants in high school at 12 and at 24 months. Model 1 was also the most effective at school retention for those in grades 9, 10, 11 and when controlling for the effects of academic grades. Model 1 was also the most successful at retaining students who had given birth. The regression analysis indicated that living with one's boyfriend or receiving public assistance reduced the likelihood of education persistence. Those enrolled in the study in their last trimester were less likely to continue in school. The strongest and most consistent predictor of education persistence was previous success in school. A stepwise regression, which was performed separately by ethnic group, showed that Model 1 had a stronger impact for Hispanic students; the log likelihood test did not isolate the distinctive differences. The evaluation reinforced that comprehensive community-linked and school-based programs are particularly successful for Hispanics and younger students, those living with their partner, and those enrolled early in pregnancy. Critical program features were strong campus and community-wide outreach and case management.

Increased expression of actin-like contractile protein in preneoplastic and neoplastic lesions in rat liver.

Cryostat sections of 16 preneoplastic and 14 neoplastic hepatic lesions induced in rats by 3'-methyl-4-dimethylaminoazobenzene (3'-Me-DAB) were examined by indirect immunofluorescence with human serum containing smooth-muscle antibody (SMA). Preneoplastic lesions showed strong cytoplasmic staining of proliferating oval cells and of the cell outlines of hepatocytes, in areas of nodular hyperplasia. In carcinomas, poorly differentiated hepatocytes showed staining of cell outlines, while well differentiated tumour cells forming glandular structures showed only staining of the luminar surfaces. The stromal cells also showed cytoplasmic staining. Morphologically normal areas of 3'-Me-DAB-treated livers showed weak staining of cell outlines, similar to normal liver. Specificity of the staining reactions was established by failure of staining in parallel control sections treated with normal human serum, or SMA serum neutralized by absorptions with homogenates of smooth muscle or extracts of actin. The results suggest that there is an increased expression of actin-like contractile protein in preneoplastic and poorly differentiated neoplastic liver cells.