The Prevalence and Significance of HTLV-I/II Seroindeterminate Western Blot Patterns

Human T-lymphotropic virus type I (HTLV-I) infects an estimated 15–20 million persons worldwide. A number of diseases have been associated with the virus including adult T-cell leukemia (ATL), HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), HTLV-I uveitis, and HTLV-I-associated infective dermatitis. Once it was shown that there is an increased risk for developing HAM/TSP associated with blood transfusion, screening for HTLV-1 among blood banks was implemented in Japan, United States, France, and the Netherlands. This process includes detection by an enzyme immunoassay (EIA) followed by a confirmatory Western blot (WB) in which recombinant proteins specific for HTLV-I Env glycoproteins are incorporated into WB strips. HTLV-I seropositive results are defined by the presence of antibodies against either gp46 or gp62/68 (both Env protein bands) and either p19, p24, or p53 (one of the gag bands). HTLV-II seropositivity is confirmed by the presence of rgp46-II. However, numerous cases have been documented in which serum samples are reactive by EIA, but an incomplete banding pattern is displayed by subsequent confirmatory WB. Although the significance of these HTLV-I/II seroindeterminates is unclear, it may suggest a much higher incidence of exposure to HTLV-I/II than previously estimated

High Expression of CD244 and SAP Regulated CD8+ T Cell Responses of Patients with HTLV-I Associated Neurologic Disease

HTLV-I-specific CD8+ T cells have been characterized with high frequencies in peripheral blood and cerebrospinal fluid and production of proinflammatory cytokines, which contribute to central nervous system inflammation in HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, little is known about the differences in CD8+ T cell activation status between asymptomatic carrier (ACs) and patients with HAM/TSP. The expression of CD244, a signaling lymphocyte activation molecule (SLAM) family receptor, was significantly higher on CD8+ T cells in HTLV-I-infected patients, both ACs and patients with HAM/TSP, than those on healthy normal donors (NDs). Blockade of CD244 inhibited degranulation and IFN-γ production in CD8+ T cells of patients with HAM/TSP, suggesting that CD244 is associated with effector functions of CD8+ T cells in patients with HAM/TSP. Moreover, SLAM-associated protein (SAP) was overexpressed in patients with HAM/TSP compared to ACs and NDs. SAP expression in Tax-specific CTLs was correlated in the HTLV-I proviral DNA loads and the frequency of the cells in HTLV-I-infected patients. SAP knockdown by siRNA also inhibited IFN-γ production in CD8+ T cells of patients with HAM/TSP. Thus, the CD244/SAP pathway was involved in the active regulation of CD8+ T cells of patients with HAM/TSP, and may play roles in promoting inflammatory neurological disease

Minocycline modulates antigen-specific CTL activity through inactivation of mononuclear phagocytes in patients with HTLV-I associated neurologic disease

<p>Abstract</p> <p>Background</p> <p>The activation of mononuclear phagocytes (MPs), including monocytes, macrophages and dendritic cells, contributes to central nervous system inflammation in various neurological diseases. In HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), MPs are reservoirs of HTLV-I, and induce proinflammatory cytokines and excess T cell responses. The virus-infected or activated MPs may play a role in immuneregulation and disease progression in patients with HTLV-I-associated neurological diseases.</p> <p>Results</p> <p>Phenotypic analysis of CD14⁺monocytes in HAM/TSP patients demonstrated high expression of CX₃CR1 and HLA-DR in CD14^lowCD16⁺monocytes, compared to healthy normal donors (NDs) and asymptomatic carriers (ACs), and the production of TNF-α and IL-1β in cultured CD14⁺cells of HAM/TSP patients. CD14⁺cells of HAM/TSP patients also showed acceleration of HTLV-I Tax expression in CD4⁺T cells. Minocycline, an inhibitor of activated MPs, decreased TNF-α expression in CD14⁺cells and IL-1β release in PBMCs of HAM/TSP patients. Minocycline significantly inhibited spontaneous lymphoproliferation and degranulation/IFN-γ expression in CD8⁺T cells of HAM/TSP patients. Treatment of minocycline also inhibited IFN-γ expression in CD8⁺T cells of HAM/TSP patients after Tax11-19 stimulation and downregulated MHC class I expression in CD14⁺cells.</p> <p>Conclusion</p> <p>These results demonstrate that minocycline directly inhibits the activated MPs and that the downregulation of MP function can modulate CD8⁺T cells function in HAM/TSP patients. It is suggested that activated MPs may be a therapeutic target for clinical intervention in HAM/TSP.</p

The grief process of patient's family over the death at hospital against the cancer

近年,在宅で死を迎えたいという人が増えている｡本研究の目的は,終末期を在宅で迎えようとしていた癌患者が,病状の悪化により病院死となった場合の事例を対象に,家族の悲嘆反応の変化を把握し,家族に対しどのような援助が必要なのかを明らかにすることである｡インタビューを患者の夫と娘に行い,A. Deekenによる12の悲嘆のプロセスの概念を基に分析を行った｡その結果,夫はA. Deekenの概念のうち7段階に該当しており,娘は5段階に該当していた｡悲嘆反応に影響を与えた要因としては,急な病変の経験,家族間の協力や仕事,告知に関する心残りがあげられた｡在宅療養継続か入院かを見極めること,キーパーソンをみつけること,家族の仕事をアセスメントすること,家族が告知をどう捉えているかを把握し尊重することなどが,必要な援助であることが示唆された。The aim of this study was to clarify the grief process of patient's family and to know how to support the family when the cancer patient who had been given terminal home care, was forced to die at hospital against the patient's will owing to aggravated condition. We interviewed patient's husband and daughter to analyze the family grief process on the basis of A. Deeken's grief process. The results showed that husband's grade was the 7th and daughter's was the 5th. The factor that caused the grief of the patient's family are listed as follows: the experience of rapidly changing circumstances surrounding them and family's regretting feeling concerning the notification of the cancer

聴覚障害と精神障害を併せ持つ人への支援の概念モデルの構築 : 支援における複合的交互作用現象

　本研究の目的は，精神保健福祉領域の実践現場で応用できるような聴覚障害と精神障害を併せ持つ人への支援の概念モデルを構築することである。そのために，まず現状把握として文献調査を行い，内容分析法により，聴覚障害と精神障害を併せ持つ人への支援における困難性の構造を明らかにした。次に支援の可能性を探るために，精神保健福祉領域における精神保健福祉士にインタビュー調査を行い，修正版グラウンデッド・セオリー・アプローチ（M-GTA）による分析から，一定の概念化された支援行為における対象者理解のプロセスを導き出した。　この二つの調査研究を踏まえた総合考察により，5層（①感覚・知覚，②行動，③認識，④機関システム，⑤社会文化システム）の交互作用現象と，利用者と支援者，聴覚障害と精神障害，聴覚障害支援と精神障害者支援といった双方的な要素を併せ持つ，支援における複合的交互作用現象を見出した。その上で，本研究では，複合的交互作用現象を含む多層構造の聴覚障害と精神障害を併せ持つ人への支援の概念モデルを提示した