Abstract. A double-blind, placebo-controlled, treatment trial was conducted in Sichuan, China to investigate the unique and combined effects on the cognitive function (working memory) of children after treating geohelminth infections with albendazole and treating Schistosoma japonicum infection with praziquantel. One hundred eighty-one children 5-16 years of age participated. At baseline, the praziquantel and placebo groups were similar in all background characteristics. Three months after praziquantel treatment, there was a significant reduction in the prevalence and intensity of S. japonicum infection. There were significant age group by praziquantel treatment interaction effects in three of the five cognitive tests, Fluency, Picture Search, and Free Recall, with effects being strongest in the youngest children (5-7 years old). Exploratory analysis within the youngest children showed a significant positive main effect of treatment on Fluency (P Ͻ 0.001), after controlling for sex, anthropometric, and parasitic and iron status. There was also a treatment by height-for-age interaction (P ϭ 0.03) and a treatment by iron status interaction (P ϭ 0.024) on Fluency. There was a treatment by S. japonicum intensity interaction (P Ͻ 0.001) on Free Recall, but the main effect of treatment on Picture Search was not significant (P ϭ 0.058). Younger children and those who are physically the most vulnerable are likely to benefit the most from the treatment of S. japonicum infection in terms of improved performance on tests of working memory.Several studies have shown that moderate to heavy parasitic helminth infections of children are associated with lower scores on tests of cognitive function and of educational achievement than children who are uninfected or lightly infected.1-7 The specific effects on mental function are not clear and may depend not only on the duration and intensity of infection but also on the species of parasitic infection and whether or not the parasites are present as single or multiple species infections.The specific cognitive domains that are associated with parasitic infection have not been clearly defined but could be important for understanding the implications of the effects on children's educational achievement and development. For example, it was observed that performance on tests of reaction time was associated with Ascaris lumbricoides infection (Watkins WE, Pollitt E, unpublished data), whereas Levav and others 8 found that infection with A. lumbricoides was associated with poorer performance on tests of verbal ability.One cognitive domain that has been investigated in several studies with differing results is that of working memory. Working memory refers to a brain system that provides temporary storage and manipulation of the information necessary for more complex cognitive tasks such as language comprehension, learning, and reasoning. 9 The working memory model is composed of three main parts: an attentional controller/central executive supplemented by two subsidiary systems called the p...

Despite significant advances in prevention and treatment strategies, graftversus-host disease remains the most significant cause of morbidity and nonrelapse mortality after allogeneic hematopoietic cellular transplantation. Corticosteroids remain the standard frontline therapy for graft-versus-host disease; however, a considerable number of patients will not respond adequately and others will be significantly affected by adverse effects. Extracorporeal photopheresis is one of several secondary therapies which have shown promise in the clinical setting. While the procedure itself has been around for over 20 years, our understanding of the mechanisms from which therapeutic benefits are seen, and the population they are seen in, remains limited. In this article, we review the use of extracorporeal photopheresis for the treatment of graft-versus-host disease including details covering the procedure's mechanism of action, safety profile and clinical efficacy data.

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IntroductionCutaneous T-cell lymphomas (CTCLs) comprise a spectrum of malignant clonal proliferation of T lymphocytes with a predilection for skin involvement, and which have an increasing incidence. 1 CTCL presents commonly as mycosis fungoides (MF) and rarely as the leukemic variant, Sézary syndrome (SS); malignant cells in these disorders display effector/memory and central/memory T-cell phenotype, respectively. 2 CTCL cells are typically positive for CD4, CD45RO, cutaneous lymphocyteassociated antigen (CLA), and CC chemokine receptors (CCRs), but negative for CD7 and CD26. 3 Because existing treatments for CTCL rarely achieve complete remissions, especially for patients with advanced MF and SS, [4][5][6] it is important to better understand pathogenesis, identify more specific diagnostic markers, and develop better treatments.T-cell activation is dependent on signals delivered by antigen presenting cells (APCs) to the antigen (Ag)-specific T-cell receptor (TCR) and to accessory receptors on T cells. Accessory receptors can be costimulatory or coinhibitory. A costimulatory signal is transmitted by CD80 or CD86 on APCs to the CD28 receptor on T cells. By contrast, a variety of molecules transmit coinhibitory signals including programmed cell death-1 (PD-1) and its ligands PD-L1 and PD-L2 7,8 ; B-and T-lymphocyte attenuator (BTLA) and herpes virus entry mediator; 9,10 and Tim-3 ligand/Galectin-9 and Tim-3. 11,12 Different types of tumors have been shown to express PD-L1, 13 and malignant cells of acute myeloid leukemia and CTCL were reported to overexpress cytolytic T lymphocyte-associated antigen 4 (CTLA-4), 14,15 thereby suggesting that tumors can use coinhibitory molecules to suppress host antitumor immunity.The dendritic cell-associated heparan sulfate proteoglycanintegrin ligand (DC-HIL) is a type I transmembrane receptor (95-120 kDa) expressed constitutively at high levels by many different APCs and at lower levels by particular nonlymphoid cells. 16 DC-HIL is also known as glycoprotein nmb, 17 osteoactivin, 18 and hematopoietic growth factor-inducible neurokinin-1 type. 19 We have shown DC-HIL to bind heparan sulfate (HS) chains on syndecan-4 (SD-4) expressed on activated (but not resting) T cells, and this binding attenuates strongly TCR-induced activation. [20][21][22] Activated T cells appear to express unique HS on this SD-4 because DC-HIL does not bind to B cells that also express SD-4 constitutively at high levels.Having shown SD-4 to be expressed primarily by effector and memory T cells, 21 we suggested that CTCL cells also express it. Indeed, we found SD-4 to be overexpressed by CTCL cell lines and by malignant T cells in patients with SS, whereas T cells from healthy controls and patients with atopic dermatitis or psoriasis did not. Moreover, SD-4 on CTCL cell lines and SS cells featured distinct HS moieties at levels much greater than levels expressed by normal T cells activated in vitro. These HS moieties were responsible for the ability of SD-4 to inhibit activation of T cells via the followi...

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