Pulmonary Epithelial Cell-Derived Cytokine TGF-β1 Is a Critical Cofactor for Enhanced Innate Lymphoid Cell Function

Epithelial cells orchestrate pulmonary homeostasis and pathogen defense and play a crucial role in the initiation of allergic immune responses. Maintaining the balance between homeostasis and inappropriate immune activation and associated pathology is particularly complex at mucosal sites that are exposed to billions of potentially antigenic particles daily. We demonstrated that epithelial cell-derived cytokine TGF-β had a central role in the generation of the pulmonary immune response. Mice that specifically lacked epithelial cell-derived TGF-β1 displayed a reduction in type 2 innate lymphoid cells (ILCs), resulting in suppression of interleukin-13 and hallmark features of the allergic response including airway hyperreactivity. ILCs in the airway lumen were primed to respond to TGF-β by expressing the receptor TGF-βRII and ILC chemoactivity was enhanced by TGF-β. These data demonstrate that resident epithelial cells instruct immune cells, highlighting the central role of the local environmental niche in defining the nature and magnitude of immune reactions.

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Epithelial-derived TGF-β drives pulmonary response to allergen

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Epithelial TGF-β promotes GATA3-driven cytokine production by suppression of Sox4

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TGF-β is chemoactive for innate lymphoid cells that express TGF-βRII

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The local pulmonary environmental niche defines the nature of immune reactions

Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice

BACKGROUND & AIMS

The relative sensitivities of barium enema and colonoscopy for colorectal cancer are still debated. The aim of this study was to determine the relative sensitivity of barium enema and colonoscopy in general clinical practice.

METHODS

Medical records of 2193 consecutive colorectal cancer cases identified in 20 central Indiana hospitals were reviewed. All procedures performed within 3 years of the diagnosis were identified.

RESULTS

The sensitivity of colonoscopy for colorectal cancer (95%) was greater than that for barium enema (82.9%), with an odds ratio of 3.93 for a missed cancer by barium enema compared with colonoscopy. The sensitivity of double-contrast barium enema (85.2%) was not different from that of single-contrast (81.8%). Barium enema performed no better in the right than the left colon. Cancers detected by colonoscopy were more likely to be Dukes' class A (24.9%) than cancers detected by barium enema (9.8%). Colonoscopy performed by gastroenterologists was more sensitive (97.3%) for cancer than colonoscopy by nongastroenterologists (87%), with an odds ratio of 5.36 for a missed cancer by a nongastroenterologist compared with a gastroenterologist.

CONCLUSIONS

Hospital quality assurance committees and/or third-party payors should review the sensitivity of barium enema and colonoscopy by practitioners in their institutions. Corrective measures are recommended when sensitivity deviates significantly below the standard set by gastroenterologists performing colonoscopy in this study.

Planning for effective use of on-line systems

A perspective of developments in the field of computerized information retrieval is presented, and policies are suggested for the efficient use of on-line systems. Examples of MEDLINE, CHEMCON, AND TOXLINE searches are given with cost data and compared, where possible, with manual searches. The lowest costs were obtained with on-line searching by information scientists. MEDLINE is superior in quality to manual searching of Index Medicus, but on-line searching of Chemical Abstracts keywords is not an effective substitute for manual searching of Chemical Abstracts Substance Indexes.