The first tumor-specific shared antigens and the cancer-germline genes that code for these antigens were identified with antitumor cytolytic T lymphocytes obtained from cancer patients. A few HLA class I-restricted antigenic peptides were identified by this 'direct approach'. A large set of additional cancer-germline genes have now been identified by purely genetic approaches or by screening tumor cDNA expression libraries with the serum of cancer patients. As a result, a vast number of sequences are known that can code for tumor-specific shared antigens, but most of the encoded antigenic peptides have not yet been identified. We review here recent 'reverse immunology' approaches for the identification of new antigenic peptides. They are based on in vitro stimulation of naive T cells with dendritic cells that have either been loaded with a cancer-germline protein or that have been transduced with viruses carrying cancer-germline coding sequences. These approaches have led to the identification of many new antigenic peptides presented by class I or class II molecules. We also describe some aspects of the processing and presentation of these antigenic peptides.
This article describes how the combination of reframing and joining creates an inherent auto-double-bind within the psychotherapeutic process. Reframing is one of the most frequently used tools in family therapy, and it cannot be used without joining. "Joining" is an essential way of creating therapeutic alliance, which has been acknowledged to be the most important common factor for the outcome of psychotherapy. The article demonstrates how the use of humor allows the therapist to resolve this particular double-bind, using both verbal and contradictory nonverbal communication to join and simultaneously reframe the clients' views of the world.
Considerable anecdotal evidence points to the usefulness of humor in the therapeutic process, but empirical evidence is still lacking. This study searched for an association between humor and therapy outcomes in a real-life population of 110 adult psychotherapy clients who attended at least 10 therapy sessions. Clients and their therapist evaluated the frequency and intensity of humorous events, as well as therapy effectiveness, therapeutic alliance, perceived hope and pleasure to participate in therapy sessions. We found a strong positive correlation between humor and therapy effectiveness, in both client (r s = .40; p < .0001) and therapist perspectives (r s = .37; p < .0001). The link between humor and effectiveness remained significant in more severe subgroups of clients, even though these clients reported less humor in their therapies. Further research is needed to determine if humor actually enhances therapy outcomes, or if positive outcomes trigger the occurrence of humor.
Antigens encoded by MAGE genes are of particular interest for cancer immunotherapy because of their tumoral specificity and because they are shared by many tumors. Antigenic peptide MEVDPIGHLY, which is encoded by MAGE-3 and is known to be presented by human leukocyte antigen (HLA)-B44, is currently being used in therapeutic vaccination trials. We report here that a cytolytic T lymphocyte (CTL) clone, which is restricted by HLA-B*1801, recognizes the same peptide and, importantly, lyzes HLA-B18 tumor cells expressing MAGE-3. These results imply that the use of peptide MEVDPIGHLY can now be extended to HLA-B18 patients. We also provide evidence that, under limiting amounts of protein MAGE-3, HLA B*1801 and B*4403 compete for binding to the peptide.
Résumé Comment interpréter l’humour des patients en psychiatrie ? Plusieurs modalités d’utilisation de l’humour sont analysées, permettant de différencier celles qui semblent saines pour le bien-être psychologique du patient, de celles qui semblent néfastes. Quels peuvent être les effets provoqués par l’humour de l’intervenant lui-même sur le patient et la relation thérapeutique ? Nous parlerons de son utilité potentielle pour faire baisser la tension, pour développer l’alliance et le processus thérapeutiques, et enfin pour recadrer les situations cliniques vécues par les patients. L’attention est attirée sur le type de patient avec qui l’humour est utilisé, et sur le risque de dérision et de sarcasme, susceptible de mettre à mal l’alliance thérapeutique, ou même d’envenimer la situation dans certaines circonstances. Les différents concepts sont illustrés à l’aide de vignettes cliniques.
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