The diversity of autoantibodies produced in systemic lupus erythematosus (SLE) 1 (1) differentiates this disease from other autoimmune disorders in which the autoantibodies react with a narrow range of antigenic determinants. In autoimmune thyrotoxicosis (2), myasthenia gravis (3), and autoimmune hemolytic anemia (4), as examples, the diversity of autoantibody reactions is limited by comparison with the serological findings in SLE. A typical lupus serum can react with nucleic acids (native or denatured DNA; RNA) and nucleoproteins (Sm and RNP antigens; ribosomes; nucleohistones), cell surface antigens, cardiolipin, and certain coagulant activities of the blood, but usually not with any organ-or receptor-specific autoantigens (reviewed in [1]). Therefore, there is restricted heterogeneity within the serological polymorphism of SLE. The extent of autoantibody diversity in SLE is of fundamental importance because it pertains to the widely held view that this disease is a result of a generalized disturbance of the immune system (5, 6).We have undertaken an analysis of the diversity of lupus autoantibodies by means of hybridoma technology (7,8). The advantage of this method over analysis of serum antibodies is that individual molecular species of autoantibody can be examined so that true diversity can be distinguished from cross-reactivity. The hybridomas under study were prepared by fusion of spleen cells from unimmunized MRL/1 mice with mouse myeloma cells. MRL/1 mice were chosen because they spontaneously develop a severe form of SLE and because they produce high levels of anti-DNA antibodies (9). Some of the hybridoma anti-DNA autoantibodies we prepared have an immunochemical preference for particular purine bases, whereas others react with a wide range of polynucleotides (8). The latter kind of autoantibody might be reactive with the sugar-phosphate backbone of nucleic acids, a structural feature of all polynucleotides (8). The sugar-phosphate backbone of nucleic acids consists of phosphate groups, in phosphodiester linkage, separated by three carbon atoms of adjacent sugar molecules. The phospholipid cardiolipin also contains phosphodiester-linked phos-

Trend monitoring of peritransfusion VSVs, especially blood pressures, may aid in the bedside recognition of TACO/FC-STRs. A subset of these patients may also present with febrile and/or inflammatory signs and symptoms.

Notch1 signaling sustains the proinflammatory behavior of Th1 cells, implicated in the development of aplastic anemia in humans and mice.

There has been a worldwide increase in the incidence of asthma, and the disease has greatly impacted the public health care system. Chlamydia pneumoniae has been reported as a possible contributing factor in asthma. The organism has been detected by polymerase chain reaction (PCR) in bronchial tissue, but there has been no direct evidence of viability. To determine the frequency of viable Chlamydia in children, blood and bronchoalveolar lavage were collected from 70 pediatric patients undergoing flexible fiberoptic bronchoscopy. Forty-two of these patients had asthma, whereas the remaining patients had various respiratory disorders. Fifty-four percent (38) of the bronchoalveolar lavage samples were PCR-positive for Chlamydia, and 31% (22) of the PCR-positive samples were positive when cultured on macrophages. Twenty-eight samples (40%) and 14 samples (20%) of the PCR- and culture-positive samples, respectively, were from patients with asthma. Culture of the blood samples revealed that 24 (34.3%) of 70 were positive for Chlamydia compared with 8 (11%) of 70 matched nonrespiratory control subjects (p < 0.01); 17 (24%) of the positive blood cultures from the respiratory group were from patients with asthma. Elevation of total IgE was strongly associated with lavage culture positivity for Chlamydia. We therefore conclude that viable Chlamydia pneumoniae organisms are frequently present in the lung lavage fluid from this cohort of predominantly asthmatic pediatric patients.

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An emerging body of evidence suggests that half of asthma in both children and adults is associated with chronic lung infection. The aim of the present study was to determine the frequency of viable Chlamydia pneumoniae (Cp) and C. trachomatis (Ct) in the respiratory tracts of paediatric patients with chronic respiratory diseases.Bronchoalveolar lavage fluid (BALF) samples obtained from 182 children undergoing bronchoscopy for clinical reasons were assayed using PCR analysis, in vitro tissue culture and immunofluorescence staining for the presence of Cp and Ct.Chlamydia-specific DNA was detected by PCR in 124 (68%) out of 182 patients; 79 were positive for Cp, 77 positive for Ct and 32 for both organisms; 75 patients had cultivable Chlamydia. Ct DNA prevalence decreased, whereas Cp positivity generally increased with age. A total of 59 out of 128 asthma patients and 16 out of 54 nonasthmatics were Chlamydia culture positive. When the patients were divided into inflammatory versus noninflammatory airway disease, there were 69 (46%) out of 150 and six (18%) out of 32 BALF samples with cultivable Chlamydia, respectively.Viable Chlamydia pneumoniae and Chlamydia trachomatis occur frequently in children with chronic respiratory diseases and may be more prevalent in asthma patients. To the current authors' knowledge, this is the first report of viable Chlamydia trachomatis in the lungs of children.

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BackgroundControlled trials have found therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) infusion therapy to be equally efficacious in treating Guillain-Barré syndrome (GBS). Due to increases in the price of IVIg compared to human serum albumin (HSA), used as a replacement fluid in TPE, we examined direct hospital-level expenditures for TPE and IVIg for meaningful cost-differences between these treatments.MethodsUsing financial data from our two institutions, hospital cost profiles for IVIg and 5% albumin were established. Reimbursement amounts were obtained from publicly available Medicare data resources to determine payment rates for TPE, non-tunneled central catheter line placement, and drug infusion therapy. A model was developed which allows hospitals to input cost and reimbursement amounts for both IVIg and TPE with HSA that results in real-time valuations of these interventions.ResultsThe direct cost of five IVIg infusion sessions totaling 2.0 grams per kilogram (g/kg) body weight was $10,329.85 compared to a series of five TPE procedures, which had direct costs of $4,638.16.ConclusionsIn GBS patients, direct costs of IVIg therapy are more than twice that of TPE. Given equivalent efficacy and similar severity and frequencies of adverse events, TPE appears to be a less expensive first-line therapy option for treatment of patients with GBS.