Differential effect of immune cells on non-pathogenic Gram-negative bacteria-induced nuclear factor-kappaB activation and pro-inflammatory gene expression in intestinal epithelial cells.

We have previously shown that non-pathogenic Gram negative bacteria induce RelA phosphorylation, nuclear factor (NF)-kappaB transcriptional activity and pro-inflammatory gene expression in intestinal epithelial cells (IEC) in vivo and in vitro. In this study, we investigated the molecular mechanism of immune-epithelial cell cross-talk on Gram-negative enteric bacteria-induced NF-kappaB signalling and pro-inflammatory gene expression in IEC using HT-29/MTX as well as CaCO-2 transwell cultures Interestingly, while differentiated HT-29/MTX cells are unresponsive to non-pathogenic Gram negative bacterial stimulation, interleukin-8 (IL-8) mRNA accumulation is strongly induced in Escherichia coli- but not Bacteroides vulgatus-stimulated IEC cocultured with peripheral blood (PBMC) and lamina propria mononuclear cells (LPMC). The presence of PBMC triggered both E. coli- and B. vulgatus-induced mRNA expression of the Toll-like receptor-4 accessory protein MD-2 as well as endogenous IkappaBalpha phosphorylation, demonstrating similar capabilities of these bacteria to induce proximal NF-kappaB signalling. However, B. vulgatus failed to trigger IkappaBalpha degradation and NF-kappaB transcriptional activity in the presence of PBMC. Interestingly, B. vulgatus- and E. coli-derived lipopolysaccharide-induced similar IL-8 mRNA expression in epithelial cells after basolateral stimulation of HT-29/PBMC cocultures. Although luminal enteric bacteria have adjuvant and antigenic properties in chronic intestinal inflammation, PBMC from patients with active ulcerative colitis and Crohn's disease differentially trigger epithelial cell activation in response to E. coli and E. coli-derived LPS. In conclusion, this study provides evidence for a differential regulation of non-pathogenic Gram-negative bacteria-induced NF-kappaB signalling and IL-8 gene expression in IEC cocultured with immune cells and suggests the presence of mechanisms that assure hyporesponsiveness of the intestinal epithelium to certain commensally enteric bacteria.

A comparison of the susceptibility of growing mukota and large white pigs to infection with Ascaris suum.

The influence of A. suum infection on the haematology, liver-related serum enzymes, blood urea and live weight gain in Mukota and Large White (LW) weaner pigs was compared. Six pigs of each genotype were infected with a single dose of 4000 A. suum eggs per pig and another six were not. The pigs were kept for 100 days. Blood was collected daily for the first 7 days and also after 100 days. In the infected pigs, there was an increase (p<0.05) in alanine aminotransferase (ALT) activity in the LW but not in the Mukota pigs. Although the alkaline phosphatase (ALP) activity rose (p<0.05) in both infected and non-infected LW pigs from day 1 to day 3, the activity in the non-infected LW pigs then decreased, while that of the infected LW pigs remained elevated. The infected LW pigs had higher (p<0.05) levels of ALT, ALP and aspartate aminotransferase than their non-infected counterparts. Non-infected LW pigs tended to have higher (p<0.05) haematological parameters, daily weight gain and urea concentrations than infected LW pigs, but these differences were not significant. These preliminary findings suggest that more A. suum larvae reached the livers in the LW than in the Mukota pigs and that the latter may be more resistant to A. suum infection.

Bronchiolitis.

Bronchiolitis is a commonly encountered disease of infants and young children. Mortality is low, but morbidity is significant. Treatment requires considerable commitment of time from medical and nonmedical personnel. Decisions about treatment modalities remain controversial. Patients may remain susceptible to pulmonary problems for years and may be predisposed to the development of asthma. Much is known about this disease, but much remains to be learned.

Child abuse: a model for the use of structured clinical forms.

OBJECTIVE: To assess the effectiveness of structured forms in the collection and documentation of information essential to the evaluation of abused children. DESIGN: Retrospective chart review. PARTICIPANTS: Five hundred sixty-seven children were evaluated for physical or sexual abuse during a 24-month period. MEASUREMENTS AND MAIN RESULTS: Specific items crucial to the evaluation of abuse were selected for both physical and sexual abuse. By using these items as markers, we compared the data obtained and documented during abuse evaluations after the introduction of the forms with those obtained before their introduction. The information that occurred more frequently when using the structured forms included: a history of the assault from both the child and an adult (and in cases of physical abuse, a developmental history); specific sexual acts; mechanism of injury; a detailed description of the genital examination; drawings of findings (both sexual and physical); documentation of laboratory studies, photographs, and radiographic studies; and reporting to Child Protective Services. CONCLUSIONS: Structured forms significantly increased the information collected and documented in medical records during evaluations of abused children. These forms were found to be more effective than the previously used unstructured, institutional form.

Poisoning in the elderly: characterization of exposures reported to a poison control center.

OBJECTIVE: To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age. DESIGN: Concurrent, observational survey. SETTING: The Virginia Poison Center in Richmond, Virginia. PARTICIPANTS: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992. MEASUREMENTS: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures. RESULTS: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6-month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P < 0.05). CONCLUSIONS: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention education.

School health services.

Since compulsory public education began in the United States, a component of that system which now is titled, School Health Services, has existed. Even with this history, the concept remains somewhat nebulous, even in the minds of its supporters, because of a paucity of verifiable, reproducible research in the area. Until research catches up with practice, and legislation is guided by firm data, it is essential to continue to clarify and strengthen the existing system. That system with a professionally prepared school nurse as its central focus provides the greatest hope for addressing the problems that are within the scope of school health service practice.

The child with arthritis in the school setting.

The school experience is a crucial one for the child with arthritis. In school, these children face obstacles common to all chronically ill children and certain problems unique to a child with arthritis. The school environment for these children has changed drastically in the last two decades with the new civil rights legislation on the state and federal levels. Today there is a better chance of a child with arthritis having a relatively problem-free school experience than ever before. The pediatrician can be a source of information, advice, support, and help with any school problems that the child and parent cannot solve. Most minor problems, such as medication at school, physical education problems, an extra set of books, and extra time between classes, may be solved by an informal telephone call or a letter. More severe problems, such as prolonged and frequent absences, multiple modifications of the school environment, and contesting of school placement, may require the use of more formal channels, including the IEP process and parent advocacy groups. When chronic problems exist in the school system, the pediatrician may choose to work for needed changes that improve the school situation of these and other chronically ill children. The pediatrician also may serve as a valued adviser and educator to the school system in the difficult task of educating these special children.