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The T cell and NK cell immune response to exercise.

Exercise elicits an increase in the numbers of circulating lymphocytes and lymphocyte subsets (including NK cells) which is followed by a decrease in the numbers of cells during recovery from exercise; this lymphocytopenia appears to be due to a decrease in the percentage of type 1 T cells and NK cells in the circulation at this time. A decrease in mitogen-stimulated T cell proliferation and T cell production of IL-2 and IFN-gamma is reported immediately after acute, intensive exercise. NK cell cytolytic activity per cell (NKCA) does not appear to change much after exercise unless the bout was prolonged, intense and stressful, in which case NKCA can be depressed for several hours. Resting immune function is not very different in athletes compared with non-athletes. However, periods of intensified training in already well trained athletes can result in a depression of immunity in the resting state which may be due to the cumulative effects of repeated bouts of intense exercise with the consequent elevation of stress hormones, particularly cortisol and anti-inflammatory cytokines (e.g. IL-6, IL-10, IL-Ira) causing temporary inhibition of type 1 T cell cytokine production with a relative dampening of the type I (cell-mediated) response.

Exercise↗

Aging and immune response to exercise.

Human immune function undergoes adverse changes with aging. The T cells, which have a central role in cellular immunity, show the largest age-related differences in distribution and function, with thymus involution as the apparent underlying cause. The immune responses to acute exercise and training have not been studied extensively in the elderly. The natural killer (NK) cell response to a single exercise challenge is normal in older individuals, but immediately after exercise the elderly subjects manifest less suppression of phytohemagglutinin (PHA)-induced lymphocyte proliferation than younger individuals. In contrast, a strenuous exercise seems to induce a more sustained postexercise suppression of cellular immunity in older individuals than in their young peers. A few cross-sectional comparisons of immune status between physically fit elderly individuals and young sedentary controls suggest that habitual physical activity may enhance NK cell activity, checking certain aspects of the age-related decline in T cell function, such as reduced mitogenesis in response to plant lectins and decreases in the production of certain types of cytokine. The clinical implications, however, remain to be clarified by future study.

Adult↗

[Reserve potentials of immunity].

The immunological examination of 350 top level sportsmen has been made at different stages of training and competitions. This examination has revealed that the reaction of the immune system to superextreme loading can be divided into 4 phases: activation, compensation, decompensation and restoration. In the process of adaptation to increasing muscular loading, characteristic of modern competitive sport, the reserves of the immune system are mobilized, and the immunological characteristics are thus maintained at the initial level. In some of healthy adults the action of superextreme physical and psychoemotional loading produces the exhaustion of immunity reserves, which is manifested by the disappearance of certain classes of immunoglobulin from the blood and biological secretions 1-2 hours after the cessation of this action.

Adaptation, Physiological↗

Immune system adaptation in elite athletes.

PURPOSE OF REVIEW: To evaluate the effects of exercise on immune function in relation to infection susceptibility. RECENT FINDINGS: Postexercise immune function depression is most pronounced when exercise is continuous, prolonged, of moderate to high intensity and performed without food intake. Periods of intensified training that result in overreaching have been shown to chronically depress immune function, with leukocyte functions measured at rest still depressed 24 h after the last exercise bout. Several studies indicate that the incidence of symptoms of upper respiratory tract illness is increased in the days following prolonged strenuous endurance events and it has been generally assumed that this is due to the temporary exercise-induced depression of immune function. More recently it has been proposed that at least some of these symptoms are attributable to inflammation of the upper respiratory tract rather than to infectious episodes. SUMMARY: Although elite athletes are not clinically immune deficient, it is possible that the combined effects of small changes in several immune parameters may compromise resistance to common minor illnesses. Although it is possible that immune depression linked with prolonged intensive training may determine susceptibility to infection, convincing evidence of a cause and effect relationship remains elusive.

Adaptation, Physiological↗

Exercise during late-follicular menstrual phase: influence on immune parameters.

AIM: The purpose of this study was to examine whether training status and plasma hormones (estradiol--E2, progesterone--P, luteinizing hormone--LH, and follicle-stimulating hormone--FSH) have an effect on selected immune indexes during or following an acute bout of exercise. METHODS: Seven female triathletes (TRI) and 7 recreationally active (REC) females were randomly assigned to rest (RE) and exercise (EX) trials during the late-follicular menstrual phase (LF). The EX was 1 hour of cycling at 63.1+/-6% VO2peak (TRI) and 61+/-5.1% VO2peak (REC) and RE was 1 hour of sitting. Blood was drawn for both trials at baseline (0H), 1 hour (1H), and at 3 hours (3H). RESULTS: Positive correlations were found between E2 and CD19+ cells for both groups as well as P and CD8+ cells for the REC group. E2 increased during EX and returned to baseline at 3HEX for both groups, however, LH remained elevated at 3HEX for REC. There were significant exercise time effects for CD3+, CD4+, CD8+, and CD3- CD16+ CD56+ cells. The NCMC and 1:1 were elevated at 1HEX for both groups and returned to baseline by 3HEX. During RE, CD3- CD16+ CD56+ cell numbers for both groups and NCMC for REC remained elevated at 3HRE. CONCLUSIONS: E2 and P correlated with CD19+ and CD8+ cells, respectively. Although there were transient exercise-induced changes in immune indexes and E2 and LH, with LH remaining elevated at 3HEX for REC, both training groups elicited similar responses for plasma hormones, lymphocyte subpopulations, and NCMC.

Adult↗

Valtrex therapy for Epstein-Barr virus reactivation and upper respiratory symptoms in elite runners.

PURPOSE: The aim of the study was to examine the effectiveness of prophylactic administration of the antiviral agent Valtrex for control of Epstein-Barr virus (EBV) reactivation and upper respiratory symptoms in elite distance runners. METHODS: Twenty elite male distance runners were randomized into a 4-month double-blind, placebo-controlled cross-over trial. Saliva samples were collected weekly and mucosal immune status assessed by measurement of secretory IgA (SIgA) using an enzyme-linked immunosorbent assay (ELISA). EBV reactivation was monitored at the same time by detection of EBV in saliva using a quantitative real-time polymerase chain reaction. The initial EBV status of the runners was determined by detecting EBV antibodies in serum using an ELISA. Upper respiratory symptoms were recorded using self-reporting illness logs. RESULTS: There was no evidence of any marked change in maximal oxygen uptake (P = 0.86), training volume (P = 0.30), or mucosal immunity (P = 0.21) over the study period. Valtrex treatment resulted in an 82% reduction in the detectable EBV load in saliva for EBV seropositive runners compared with the placebo treatment (P = 0.04). The incidence of upper respiratory symptoms was not reduced by Valtrex treatment. CONCLUSIONS: The prophylactic administration of Valtrex reduced EBV reactivation but was not an effective intervention strategy for limiting upper respiratory symptoms in this cohort of elite distance runners. The upper respiratory symptoms in the distance runners could not be directly attributed to infection and may be of a noninfectious inflammatory nature.

Acyclovir↗

Psychoneuroendocrine immunology: site of recognition, learning and memory in the immune system and the brain.

How the interaction between the brain and immune system takes place has not been clearly defined. Because multiple changes are occurring simultaneously in all organ systems (e.g., cardiovascular, gastrointestinal, reproductive, renal, respiratory, immune, CNS), how many single systems interacts with the brain becomes extraordinarily difficult to understand. The problem boils down to developing an approach that not only allows one to study the whole organism and define the mediators of the interacting systems, but also permit one to establish the connection and physiologic relevance of the responses that are being evaluated. Conditioning, a phenomenon made popular by the work of Pavlov (1906, 1927), may provide insight into the pathways of communication between the brain and possibly any organ system of the body. Conditioning allows one to separate the afferent from the efferent circuits. That is, signals from the immune system to the CNS (IS-->CNS) can be effectively separated from signals from the CNS to immune system (CNS-->IS). This permits one to study each pathway individually. Simple, single association trial models to condition fever, natural killer (NK) cell and cytotoxic lymphocyte (CTL) activities have been developed to evaluate the pathways. Single trial learning is not new. Pavlov has observed that "The electric buzzer set going before administration of food established a conditioned alimentary reflex after only a single combination," whereas the reverse order of presentation failed to condition the animal (Pavlov 1927 p. 27). Thus, conditioning can be used to train the brain to activate the immune system and other organ systems participating in the response. During the course of the conditioned response, presumably the CNS via the hypothalamus integrates in a cohesive orderly fashion all input and output signals and coordinates the responses made by the brain to the organ systems. The odor of camphor, the conditioned stimulus (CS) can be associated with the response produced by an unconditioned stimulus (US). The unconditioned stimuli used are poly I:C to raise fever and nonimmunospecific NK cell activity or alloantigens to raise immunospecific CTL activity. The unconditioned stimulus serves only as a means to activate the immune system and unbalance the homeostasis so that a transient but new bidirectional communication loop can be established between the immune system and the CNS (IS<-->CNS). The expression of the conditioned response (i.e., elevation of fever, NK cell, or CTL activity) induced with the CS (odor stimulus) is an outcome of neural activity (CNS-->IS). This infers that during conditioning, the signals generated by the CS and US imprints a neural pathway located within the central nervous system and leaves behind a CS/US memory of the association. The immune activity (NK cell or CTL activity) which is modulated indicate that the memory pathway was activated in the brain of the animal expressing the conditioned response. The immune cells that are modulated can be considered to be casual bystander cells. These cells however must be in the proper (ready) state of activation to receive salient signals from the brain. Along with changes in the indicator cell population, other complex physiological processes are altered by the brain via sympathetic and neuroendocrine pathways to raise the fever response. These observations suggest that the physiological changes which are being evaluated such as fever, NK cell or CTL activities or perhaps blood pressure, heart rate, fat metabolism, oxygen consumption serve only as indicators (readouts), and infer that the CNS has made a coordinated reply in response to the CS signal.

Humans↗

Quality of child health services in primary health care facilities in south-east Nigeria.

BACKGROUND: To assess the quality of child health services in primary health care (PHC) facilities in Calabar, south-east Nigeria. DESIGN: Cross-sectional, descriptive design. METHODS: Key informant interviews, structured observation, self-administered questionnaire and focus group discussion. SETTING: Calabar, south-east Nigeria. Participants All 10 PHC facilities in Calabar, 252 PHC workers serving in the facilities, and 76 mothers whose children received care in the facilities. OUTCOME MEASURES: Adequacy of structure (equipment and personnel); process (diagnosis, training and knowledge, use of national case-management algorithm, and supervision), and output (clients' satisfaction). MAIN RESULTS: PHC facilities were adequately equipped to the extent of providing immunization services and management of diarrhoea but not for other aspects of care expected of a PHC centre, including management of acute respiratory infections (ARI), a common problem in children in the region. Supply of essential drugs was inadequate in all centres and facilities for emergency care were lacking. Many of the health care workers (68.3%) had adequate training in immunization, and their knowledge scores on immunization issues (62%) was higher than in other aspect of PHC. Use of the national case management algorithm was low among PHC workers. Results of the focus group discussions with mothers showed that a few perceived quality of care to be poor. The main concerns were long waiting time, lack of essential drugs, and attitude of the health workers. CONCLUSIONS: Inadequacy in the quality of child health services in PHC facilities is a product of failures in a range of quality measures -- structural (lack of equipment and essential drugs), process failings (non-use of the national case management algorithm and lack of a protocol of systematic supervision of health workers). Efforts to improve the quality of child health services provided by PHC workers in the study setting and similar locales in less developed countries should focus not only on resource-intensive structural improvements, but also on cheap, cost-effective measures that address actual delivery of services (process), especially the proper use of national guidelines for case management, and meaningful supervision.

Acute Disease↗

The organization, delivery and audit of a specialist immunization clinic.

Immunization is a key primary prevention activity which has assisted in the reduction of childhood morbidity and premature mortality. Uptake rates for two-year-old children are now in excess of 90 per cent throughout the UK and for the vast majority of infants immunization is a routine procedure with a high benefit-to-risk ratio. Concerns about particular children, either because of their previous medical history or an adverse vaccine event, have been responded to in various ways. The experiences of a specialist immunization facility established in 1987, which since inception has seen just over 3,000 children are described. The clinic operates four sessions a week, with two held in the District General Hospital and two in community clinics; the resource requirements for the clinic are identified. A parent satisfaction survey for the first 1,700 attenders was undertaken in 1992 and the results are reported; their comments led to changes in the method of service delivery. A study of GPs' views was also undertaken at the same time; their satisfaction with the service is reflected in the continuing level of referrals, It is believed that all provider units should consider developing a similar facility for five reasons. First, it provides a source of expert advice for both professionals and parents; second, it facilitates the immunization of children with problem histories; third, it enables the investigation of serious post-vaccination adverse events; and fourth, the clinic provides a means of co-ordinating and delivering neonatal immunizations (including BCG, HBV, Varicella zoster and the vaccination of pre-term infants). And finally the clinic offers training for health care staff involved in primary immunization programmes and travel vaccination services.

Child↗

Beta-N-acetylhexosaminidase activity and isoenzyme profile in the kidney and urine of trained rats.

Lysosomes play an important role in the immune system functioning and are involved in different aspects of inflammatory reaction, repair processes and tissue damage at various levels. Among various effects, it is known that physical exercise influences the release of different lysosomal components. The aim of this study was to evaluate enzyme activity and isoenzymatic profile of beta-N-acetylhexosaminidase both in kidney and urine of normal and trained rats. Enzyme activity was measured by fluorimetric assay while beta-N-acetylhexosaminidase isoenzymes were separated using DEAE-cellulose chromatography. Hexosaminidase specific activity was significantly increased in urine of trained rats whereas there was no increase in the kidneys of trained rats. Indeed, no significant differences were observed in the isoenzyme profile of kidney and urine extracts from normal and trained rats. Our findings suggest the exercise-induced release of lysosomal enzymes is a functional effect and not due to disruption of lysosomal membranes.

Animals↗

A new measurement of noise immunity and generalization ability for MLPs.

This paper shows a quantitative relation between the regularization techniques, the generalization ability, and the sensitivity of the Multilayer Perceptron (MLP) to input noise. Although many studies about these topics have been presented, in most cases only one of the problems is addressed, and only experimentally obtained evidence is provided to illustrate some kind of correlation between generalization, noise immunity and the use of regularization techniques to obtain a set of weights after training that provides the corresponding MLP with generalization ability and noise immunity. Here, a new measurement of noise immunity for a MLP is presented. This measurement, which is termed Mean Squared Sensitivity (MSS), explicitly evaluates the Mean Squared Error (MSE) degradation of a MLP when it is perturbed by input noise, and can be computed from the statistical sensitivities (previously proposed) of the output neurons. The MSS provides an accurate evaluation of the MLP performance loss when its inputs are perturbed by noise and can also be considered a measurement of the smoothness of the error surface with respect to the inputs. Thus, as the MSS can be used to evaluate the noise immunity or the generalization ability, it gives a criterion to select among different weight configurations that present a similar MSE after training.

Models, Neurological↗

Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in China.

PURPOSE: To evaluate the effect of an educational training program for hospital nurses on universal precautions in Changsha, Hunan Province, People's Republic of China. METHOD: Using a quasi-experimental design, 50 of 100 randomly selected hospital nurses were randomly assigned to receive an educational intervention. Questionnaires were administered to the 100 nurses prior to and 4 months after the training. FINDINGS: Knowledge, practice, and behaviors related to universal precautions and the prevalence of hepatitis B immunization improved among nurses in the group who received training. No significant change in the frequency of glove use was found. Underreporting of sharps injuries to hospital authorities continued in both groups. CONCLUSION: Although educational training significantly improved Chinese nurses' knowledge, practice, and behavior related to universal precautions, there remains room for improvement in glove use and needlestick injury reporting.

Adult↗

Infection in athletes.

Coaches and athletic team physicians have provided anecdotal information and case studies to support their beliefs that athletes may be unusually prone to illness during strenuous training or competition. Many athletes, in contrast, believe that physical activity improves their resistance to infectious disease. However, it is generally agreed that the stress of competition may make athletes temporarily more susceptible to infectious illness. A review of the literature shows that upper respiratory tract infections and skin infections are more prevalent in top level athletes than in the general population, particularly during periods of intensive training. Exercise induced changes occur in both the innate and adaptive components of the immune system; however, the relative importance of each component is unknown. Strenuous exertion and contact sports may compromise host defence both by reducing physical protection and by impairing immunosurveillance. Skin lacerations, vigorous sweating and maceration of the dermis impair the defence normally provided by the skin surface. In addition, adverse changes in soluble and cellular components of the immune system can increase susceptibility to infection. Persistence with strenuous training during an infectious illness can have deleterious effects; not only is athletic performance impaired, but the severity of the disease process can be augmented.

Exercise↗

Measles prevention and control in emergency settings.

Outbreaks of measles continue to be a common occurrence among refugee and famine-affected children in emergency relief camps. Extremely high measles-associated mortality rates have been reported from refugee camps--where undernutrition is common--in several countries over the past 10 years. Mortality from measles is, however, preventable, and immunization against the disease is a high priority in emergency relief programmes, second only in importance to the provision of adequate food rations. All children aged 6 months to 5 years should be immunized with measles vaccine as soon as they enter an organized camp or settlement. Should supplies of measles vaccine be inadequate, children in feeding centres, or those otherwise identified as undernourished, are the top priority for immunization. The occurrence of measles in a camp is not a contraindication to conducting an immunization campaign. Strong coordination by a designated lead agency is needed if such campaigns are to be successful; however, cooperation with the local expanded programme on immunization is essential to ensure that existing cold chain equipment, training protocols, and management manuals are used. If additional equipment is necessary, a complete immunization kit developed by the Office of the United Nations High Commissioner for Refugees, the World Health Organization, and Oxfam can be procured from Oxfam headquarters in the United Kingdom. Vitamin A supplements should be given routinely at the time of measles immunization in situations where malnutrition is severe. Mortality and morbidity in children with clinical measles can be reduced by administering high doses of vitamin A.

Child, Preschool↗

Elevated plasma interleukin-6 levels in trained male triathletes following an acute period of intense interval training.

The aim of the present study was to investigate possible changes in the plasma IL-6 levels, subjective reporting of sources and symptoms of stress and the innate immune system in response to an acute period of intensified run training in highly trained endurance athletes. Eight healthy endurance trained male subjects (mean +/- SD age 23 +/- 2 years, VO(2max) 64.8 +/- 2.6 ml kg(-1) min(-1), mass 77.1 +/- 2.9 kg) completed the study which took place over a 4 week period. In weeks 2 and 3, in addition to their normal endurance training, subjects completed interval-training run sessions on three successive days. Saliva and venous blood samples were taken at the end of each week. Blood samples were analysed for leukocyte counts; neutrophil function; plasma IL-6; creatine kinase activity; and cortisol. Symptoms and sources of stress were assessed by questionnaire. Plasma IL-6 and creatine kinase activity were elevated following intensified training. Neutrophil function was reduced but total leukocyte and neutrophil counts, plasma cortisol and salivary IgA remained unchanged. There was a worsening in symptoms of stress despite there being no significant change in the sources of stress during intensified training. In conclusion, an acute period of intensified training can induce a suppression of the innate immune system and a chronic elevation in IL-6. This was associated with an increase in fatigue and generalised malaise which lends support to the recent cytokine theories of unexplained, underperformance syndrome.

Adaptation, Physiological↗

The response of the novel pro-inflammatory molecules S100A8/A9 to exercise.

Exercise shares many similarities with the acute phase response of inflammatory diseases. Recently, elevated serum levels of the novel pro-inflammatory molecules of the S100 protein family, S100A8 and S100A9, have been associated with various inflammatory diseases. The present study was conducted to assess their potential roles as inflammatory markers in monitoring the exercise-induced immune response. Seventeen male subjects of different training status performed a marathon run. Furthermore 13 subjects (10 male, 3 female) performed three different treadmill tests: strenuous (STE), moderate (MTE), and downhill (DTE). S100A8/A9 complexes were measured by ELISA, while white blood cell count (WBC) and C-reactive protein (CRP) were used as markers of the inflammatory response. Serum creatine kinase (CK) concentration was determined as a marker for muscle damage. After marathon S100A8/A9 increased dramatically during the early post-exercise period and returned to resting levels one day after the run. A similar pattern was found for WBC, while CK and CRP reached their maximum on the day after the run. Moreover, S100A8/A9 release was higher in the subgroup of well-trained athletes. The kinetic of the S100A8/A9 release after the treadmill tests depended on exercise intensity and was prolonged after eccentric exercise. In summary, the present results indicate that the novel pro-inflammatory molecules S100A8/A9 are very early and sensitive markers of the exercise-induced inflammatory response. Further investigations are necessary to evaluate the applicability of S100A8/A9 for monitoring the training process and to elucidate the dependence on training status.

Adult↗

Effect of exercise, heat stress, and hydration on immune cell number and function.

PURPOSE: The purpose of this study was to determine the effect of thermal stress and hydration status on immune function during exercise. METHODS: Ten trained men completed four cycle ergometer rides at 55% VO2peak under the following conditions: EN (euhydrated neutral; 22 degrees C, 30% RH), DN (dehydrated neutral), EH (euhydrated hot; 38 degrees C, 45% RH), and DH (dehydrated hot). During EN and EH, a carbohydrate/electrolyte beverage was consumed at a rate matching sweat loss, and during DN and DH, no fluid was ingested. Blood samples were drawn pre- and postexercise, and at 2 and 24 h of recovery. Cell counts were determined by automated counting and flow cytometry. Neutrophil activity was assessed as superoxide production, lymphocyte function was determined via PHA-stimulated mitogenesis, and natural killer (NK) cell activity was measured with a 51Cr-release assay. Cortisol was assayed via RIA. RESULTS: Lymphocytes proliferation was depressed 2 h after exercise in all conditions (P < 0.05); however, when expressed on a per cell basis, function was greater in the DH and EH conditions. NK activity (max x 10(3) cells) was greater post compared with preexercise in all conditions (EH = 25.5 +/- 16.8, DH = 26.2 +/- 10.5, EN = 19.3 +/- 11.0, and DN = 16.5 +/- 8.7) but was not different between conditions. Leukocyte, neutrophil, lymphocyte, and NK cell counts were also elevated postexercise with the former two remaining elevated 2 h postexercise in the EH and DH conditions. Cortisol was greater postexercise in EH (22.1 +/- 1.3) and DH (27.7 +/- 1.3) compared with EN (17.8 +/- 2.1) and DN (18.9 +/- 1.6 microg x dL(-1). CONCLUSION: Euhydration did not affect cell number or function when compared with a dehydrated state; however, the hot environment caused more severe disturbances in these measures compared with a neutral environment.

Adult↗

Pulmonary DNA vaccination: concepts, possibilities and perspectives.

Mucosal immunity establishes the first line of defence against pathogens entering the body via mucosal surfaces. Besides eliciting both local and systemic immunity, mucosal vaccination strategies that are non-invasive in nature may increase patient compliance and reduce the need for vaccine application by trained personnel. A relatively new concept is mucosal immunization using DNA vaccines. The advantages of DNA vaccines, such as the opportunity to combine the genetic information of various antigen epitopes and stimulatory cytokines, the enhanced stability and ease of production make this class of vaccines attractive and suitable for mucosal application. In contrast to the area of intranasal vaccination, only a few recent studies have focused on pulmonary immunization and the involvement of the pulmonary immune system in eliciting protective immune responses against inhaled pathogens. This review focuses on DNA vaccine delivery to the lung as a promising approach to prevent pulmonary-associated diseases caused by inhaled pathogens. Attractive immunological features of the lung as a site for immunization, the mechanisms of action of DNA vaccines and the pulmonary application of such vaccines using novel delivery systems will be discussed. We also examine pulmonary diseases prone to prevention or therapeutical intervention by application of DNA vaccines.

Humans↗