RESUMEN
IL-17 has emerged as a key player in the immune system, exhibiting roles in protection from infectious diseases and promoting inflammation in autoimmunity. Initially thought to be CD4 T-cell-derived, the sources of IL-17 are now known to be varied and belong to both the innate and adaptive arms of the immune system. Mechanisms for inducing IL-17 production in lymphoid cells are thought to rely on appropriate antigenic stimulation in the context of TGF-ß1, IL-6 and/or IL-1ß. Using culture protocols adapted from human studies, we have effectively induced both bovine CD4(+) and WC1(+) γδ T-cells to produce IL-17 termed Th17 and γδ17 cells, respectively. The negative regulatory effect of IFN-γ on mouse and human IL-17 production can be extended to the bovine model, as addition of IFN-γ decreases IL-17 production in both cell types. Furthermore we show that infection with the protozoan Neospora caninum will induce fibroblasts to secrete pro-IL-17 factors thereby inducing a γδ17 phenotype that preferentially kills infected target cells. Our study identifies two T-cell sources of IL-17, and is the first to demonstrate a protective effect of IL-17(+) T-cells in ruminants. Our findings offer further opportunities for future adjuvants or vaccines which could benefit from inducing these responses.
Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Interleucina-17/inmunología , Glicoproteínas de Membrana/inmunología , Neospora/inmunología , Receptores de Antígenos de Linfocitos T gamma-delta/inmunología , Células Th17/inmunología , Animales , Linfocitos T CD4-Positivos/metabolismo , Linfocitos T CD4-Positivos/parasitología , Bovinos , Células Cultivadas , Chlorocebus aethiops , Técnicas de Cocultivo , Citotoxicidad Inmunológica/inmunología , Fibroblastos/inmunología , Fibroblastos/metabolismo , Fibroblastos/parasitología , Interacciones Huésped-Parásitos/inmunología , Interferón gamma/inmunología , Interferón gamma/farmacología , Interleucina-17/metabolismo , Interleucina-6/inmunología , Interleucina-6/farmacología , Glicoproteínas de Membrana/metabolismo , Neospora/fisiología , Receptores de Antígenos de Linfocitos T gamma-delta/metabolismo , Células Th17/efectos de los fármacos , Células Th17/metabolismo , Factores de Tiempo , Factor de Crecimiento Transformador beta1/inmunología , Factor de Crecimiento Transformador beta1/farmacología , Células VeroRESUMEN
BACKGROUND: The Immediate Discharge Document is a tool used to communicate patient discharge information between hospitals and general practitioners. The standard of information provided may be variable, and sometimes delayed in arriving at the GP practice. Typed communication from the hospital can also be slow. This can result in difficulty managing patients in the community following their discharge. Our aim was to assess the quantity of information provided on Immediate Discharge Documents, and to assess the time scale taken for GPs to receive written communications from hospitals regarding patient discharges. An audit was initiated using a tool devised from Scottish Intercollegiate Guidelines Network Publication no 5 and involving four general practices within City of Perth, Scotland. Data was collected over a 28-day period in June/July 2001, by examining Immediate Discharge Documents relevant to each practice population received during this period, and by noting the time of arrival of a final typed summary. Data was analysed by Tayside Audit Resource for Primary Care. A total of 244 Documents were audited. Most significant results include basic administrative detail lacking in up to 30%. Of total documents, 13% failed to record a main condition or diagnosis; 93% recorded drug information, but only in 28% were follow up plans clear; 60% were received within five days of discharge, whilst final typed summaries were received from the hospitals within four weeks only in 51%. CONCLUSION: These results show there to be room for improvement with regard communication of patient discharge information, in regard to both the content of information provided and the time it takes to arrive. We require to raise awareness of this problem amongst hospital colleagues involving clinical governance and audit staff, with the objective to improve the quality and timescale of information transfer. WHERE THIS PIECE FITS: It is known that effective information transfer between health professionals is vital to optimise patient care. This work gives further impetus to improve the current standard of communication, and confirms a significant time delay that it takes information to reach GPs from the hospital setting.
Asunto(s)
Registros Médicos/normas , Alta del Paciente , Continuidad de la Atención al Paciente , Documentación , Medicina Familiar y Comunitaria , Humanos , Comunicación Interdisciplinaria , Auditoría MédicaRESUMEN
Despite reports questioning its relative safety, laparoscopic cholecystectomy has gained rapid acceptance on the surgical scene in the past few years due to its perceived, but unproven advantages related to patient recovery and health care costs. This article describes a study conducted at the Charleston Area Medical Center in order to prospectively evaluate the comparative outcomes and expenses for 17 patients undergoing open cholecystectomies by a single surgeon using techniques of vigorous perioperative care, as well as 30 patients undergoing laparoscopic cholecystectomies by a single experienced laparoscopist. Results indicated that although patients undergoing laparoscopic cholecystectomy had a slightly shorter average length of hospitalization and used fewer postoperative analgesics, the average recovery time and hospital costs for the two procedures were similar.
Asunto(s)
Colecistectomía/métodos , Laparoscopía , Adulto , Anciano , Colecistectomía/economía , Femenino , Costos de Hospital , Hospitales Comunitarios , Humanos , Laparoscopía/economía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
In this report, earlier findings of age-related changes in brain morphology on magnetic resonance (MR) images are extended to include measurements of individual cerebral grey matter structures and an index of white matter degeneration. Volumes of caudate, lenticular, and diencephalic structures are estimated, as are grey matter volumes in eight separate cortical regions. Results suggest that between 30 and 79 years significant decreases occur in the volume of the caudate nucleus, in anterior diencephalic structures, and in the grey matter of most cortical regions. The data suggest that the volumes of the thalamus and the anterior cingulate cortex may be unchanged. Among those cortical regions found to be affected in aging, some evidence is present for greater change in association cortices and mesial temporal lobe structures. There are also dramatic age-related changes in the white matter, manifest as lengthened T2 values on MR images.