T cell interactions with extracellular matrix proteins in patients with thyroid-associated ophthalmopathy

Although thyroid-associated ophthalmopathy (TAO) is now generally accepted as an autoimmune inflammatory disorder of the extraocular muscles and the orbital connective tissue, its aetiopathogenesis remains poorly understood. Recent data indicate that impaired interactions between T cells and extracellular matrix (ECM) proteins may play an important role in development and maintaining of an inflammatory process. We report here results of the study focusing on interactions between T lymphocytes and collagen-I (Coll-I), collagen-IV (Coll-IV), fibronectin (FN), laminin (LM) in patients with TAO. Using a standard peripheral blood mononuclear cells (PBMC) proliferation assay, we observed a markedly enhanced T cell response to Coll-I in patients with active TAO (mean SI=4.5). The proliferatory response to Coll-I was significantly greater (Wilcoxon test; p < 0.001) than in normal subjects (mean SI=1.88), patients with stable TAO (mean SI=2.05) and patients with thyroid autoimmune diseases (AITD) without ophthalmopathy (mean SI=2.49). PBMC stimulation by Coll-I is likely to be antigen-dependent requiring engagement of the T cell receptor with collagen peptides, rather than mediated via integrins. The percentage of circulating CD29+ (beta1 integrin chain) T cells was not increased in patients with active TAO. Additionally in the assay of costimulation of CD3-mediated proliferation, we found that peripheral blood T cells from patients with TAO and AITD were costimulated only by FN. On the other hand a markedly enhanced costimulation of CD3-mediated proliferative responses by Coll-I, Coll-IV, FN and LM were observed in a retrobulbar T cell line. We conclude that abnormalities in T cell interactions with ECM proteins, especially Coll-I may play a role in the pathogenesis of TAO.

Blinding eye injury during a rock concert

A 17-year-old girl attended a rock concert where promotional compact discs were being thrown into the audience as prizes. She suffered an extensive corneoscleral laceration with vitreous hemorrhage and retinal detachment when a compact disc struck her in the eye. An alternative, safer method must be used for distributing compact discs as prizes.

The evaluation and treatment of extraocular motility deficits

Binocular diplopia, monocular diplopia and oscillopsia may be manifestations of skull base lesions or may result from skull base surgery. An ophthalmologic perspective on the diagnosis and treatment of these extraocular motility deficits is reviewed.

Federal tax developments affecting health care organizations--Part II: New rulings and court decisions

Health care providers face numerous federal tax law changes in 1997 legislation, agency rulings, and court decisions. In the conclusion of this article, the author covers agency rulings and court decisions, with particular focus on tax-exempt hospitals forming delivery systems with for-profit entities.

Federal tax developments affecting health care organizations--Part 1: New legislation

Health care providers face numerous federal tax law changes in 1997 through legislation, agency rulings, and court decisions. The author provides an overview of these changes. The first part of this two-part series discusses the legislation enacted in 1996 that will affect health care today.

Immunogenic and protective response in mice immunized with a purified, inactivated, Dengue-2 virus vaccine prototype made in fetal rhesus lung cells

The feasibility of a purified, inactivated vaccine (PIV) against dengue type 2 (DEN-2) virus was explored. Dengue-2 virus strain 16681 was used for producing a monotypic PIV. Virus adapted to fetal rhesus lung (FRhL-2) cells was harvested from roller bottle culture supernatant fluids, concentrated, and purified on sucrose gradients. Analysis of purified virus preparations by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting showed primarily envelope (E) and premembrane (prM) antigens. These preparations had a purity, estimated from silver-stained gels, of approximately 70%, and a yield, based on recovery of virus and viral antigen, of 10-20%. The purified virus was inactivated with 0.05% formalin at 22 degrees C, or alternatively, with 7 mRads from a 60Co source. Vaccinated mice developed high titers of anti-DEN-2 virus neutralizing antibody and were partially protected from virus challenge. These results warrant further testing and development of PIVs for the other DEN virus serotypes.

Federal tax concerns in structuring integrated delivery systems. Part II: Systems with taxable and tax-exempt participants

The concluding segment of this two-part article covers the tax rules for integrated delivery systems that incorporate both taxable and tax-exempt participants. The author also analyzes the different organizational forms such ventures may take.

Federal tax concerns in structuring integrated delivery systems. Part I: Background, tax rules, and exempt systems

As health care providers develop integrated delivery systems, they need to be aware of the Internal Revenue Service's careful scrutiny of these systems. In the first installment of this two-part article, the author reviews the current tax rules for exempt health care providers.

Diagnosing oral diseases that affect the eyes

Dentists can often help diagnose diseases that affect the eyes. This article discusses the diseases and iatrogenic dental conditions where ophthalmic and oral findings play a key role in diagnosis and treatment.