This study was conducted to determine whether CD4 T cell responses to citrullinated fibrinogen occur in patients with rheumatoid arthritis (RA), especially in HLA-DR4-positive subjects. Whole peripheral blood mononuclear cells (PBMCs) of RA patients and control subjects were stimulated with citrullinated fibrinogen peptides, and T-cell production of proliferation and proinflammatory cytokines, such as interferon-gamma(IFN-gamma) and interleukin-17A (IL-17A), were measured. In addition, CD4 T cells from RA patients were stimulated with the citrullinated fibrinogen peptide, Fib-alpha R84Cit, identified as a DRB1*0401-restricted T cell epitope in HLA-DR4 transgenic mice, and the degree of T cell activation was examined similarly. No proliferative responses to the citrullinated fibrinogen peptides were observed in whole PBMCs or CD4 T cells from RA patients. Furthermore, no increased production of IFN-gamma or IL-17A was found in whole PBMCs or CD4 T cells stimulated with the citrullinated fibrinogen peptides, although these cells responded to recall antigen, a mixture of tetanus toxoid, purified protein derivative (PPD) from Mycobacterium tuberculosis, and Candida albicans. The results of this study indicate that anti-citrulline immunity in RA patients may be mediated by fibrinogen because there is no evidence of CD4 T cell-mediated immune responses to citrullinated fibrinogen peptides.
Animals ; Arthritis, Rheumatoid ; Candida albicans ; Cytokines ; Epitopes, T-Lymphocyte ; Fibrinogen ; HLA-DR4 Antigen ; Humans ; Interleukin-17 ; Mice ; Mice, Transgenic ; Mycobacterium tuberculosis ; Peptides ; T-Lymphocytes ; Tetanus Toxoid

BACKGROUND: The intensity of stimulation of intubation was expressed as the product of its force and duration. Theoretically, use of a lightwand might cause less adrenergic stimulation because the elevation of the epiglottis by the laryngoscope blade was not required. However, whether the hemodynamic responses to intubation with the lightwand differ from those with direct laryngoscope was a controversial topic. Additionally, there has been no clear study showing that the hemodynamic response to intubation is affected by intubation time. This study was designed to analyze the relationship between the magnitude of hemodynamic responses and the intubation time. METHODS: 50 ASA class 1, 2 elective surgical patients were randomly allocated into two groups; lightwand or direct laryngoscope group. Anesthesia was induced by a standardized technique. The changes in MAP and HR were recorded just before intubation, after intubation and 1 minute after intubation. Also the intubation time was recorded. RESULTS: There were no differences in MAP, HR, and intubation time between the groups. The following was the final regression equation from multiple linear regression analysis:the degrees of blood pressure elevation = + 11.2239 (P = 0.0296) + 6.6331 (P = 0.0846) x (group) + 1.0400 (P = 0.0004) x (intubation time). Adjusted R2 is 0.84 (P<0.05). CONCLUSIONS: There was a linear relation between the degree of blood pressure elevation and intubation time in direct laryngoscope group and lightwand group.
Anesthesia ; Blood Pressure* ; Epiglottis ; Hemodynamics ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes* ; Linear Models