This study demonstrated that MRI is useful in examining local anesthetic distribution in axillary blocks because it can show the correlation between MRI distribution pattern and clinical effect. The cross-sectional spread of fluid around the brachial-axillary artery was often incomplete-inhibited, and the clinical effect often inadequate.

A considerable fraction of T cells express two distinct T cell receptors (TCR), mainly due to expression of two TCR alpha chains. It has been suggested that such dual-TCR cells could have a role in autoimmunity. However, as such cells express less of each TCR, they could be less sensitive to their physiological ligand, i.e. peptide plus major histocompatibility complex molecules (MHC). We tested this hypothesis in a transgenic TCR model in which most T cells express different amounts of the transgene-encoded TCR, due to expression of endogenous TCR alpha chains. Five Th1 clones derived from lambda2(315) immunoglobulin light chain-specific TCR-transgenic mice expressed different levels of the transgene-encoded TCR, ranging from approximately 10,000 to approximately 50,000 TCR per cell. Cytosolic Ca2+ mobilization in single T cells from these clones elicited by lambda2(315) peptide-pulsed, I-Ed-expressing antigen-presenting cells, correlated linearly with the relative transgene-encoded TCR expression. The peptide requirement for half-maximal T cell proliferation showed a similar correlation, with low TCR levels requiring higher peptide concentration. Corroborative evidence was obtained by deployment of short-term polyclonal CD4+ lines from TCR-transgenic mice. Such lines had reduced early (Ca2+ mobilization) and late (lymphokine and proliferation) responses, compared with T cell lines from recombination-deficient TCR-transgenic severe combined immunodeficiency mice (which express only a single transgene-encoded TCR). Taken together, the Ca2+ responses increase gradually with increasing TCR expression per cell, similar to the previously described analog Ca2+ signaling elicited by increasing amounts of peptide/MHC [Røtnes et al., Eur. J. Immunol. 1994. 24: 851]. Surprisingly small reductions in TCR expression per cell reduce T cell responsiveness. This suggests that dual-TCR T cells are immunologically less effective than single-TCR T cells.

We have investigated Ca2+ mobilization in single T cells stimulated with their physiological ligand, i.e. antigenic peptide bound to major histocompatibility complex (MHC) molecules on antigen-presenting cells (APC). Fibroblasts expressing I-Ed class II molecules were pulsed with a peptide derived from the lambda 2(315) immunoglobulin light chain. Onto such antigen-pulsed fibroblasts were sedimented cloned Th1 cells loaded with Fura-2. Changes in cytosolic Ca2+ concentration in single T cells were continually monitored by use of an imaging system based on fluorometry. Ca2+ mobilization was both peptide-specific and MHC-restricted. Within seconds of the initial APC-T cell contact, a Ca2+ spike could be observed. The Ca2+ response gradually declined over a 25-min period, during which oscillations were noted. Various parameters characterizing the magnitude of the Ca2+ response (latency, increase rate, max and mean Ca2+ increase, frequency and period of oscillations) all correlated with the amount of peptide used for pulsing the fibroblasts. Thus, Ca2+ mobilization in single T cells appears not to be an all or none phenomenon. Rather, activation is incremental (analog signaling), the degree of Ca2+ mobilization probably being related to the number of stimulatory peptide-MHC complexes on the surface of the APC. The extent of calcium mobilization and lymphokine production (interleukin (IL)-2, IL-3, interferon-gamma) correlated, at least at the population level.

Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator.