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Abstract Background Abnormal health anxiety, also called hypochondriasis, has been successfully treated by cognitive behaviour therapy (CBT) in patients recruited from primary care, but only one pilot trial has been carried out among those attending secondary medical clinics where health anxiety is likely to be more common and have a greater impact on services. The CHAMP study extends this work to examine both the clinical and cost effectiveness of CBT in this population. Method/Design The study is a randomized controlled trial with two parallel arms and equal randomization of 466 eligible patients (assuming a 20% drop-out) to an active treatment group of 5-10 sessions of cognitive behaviour therapy and to a control group. The aim at baseline, after completion of all assessments but before randomization, was to give a standard simple explanation of the nature of health anxiety for all participants. Subsequently the control group was to receive whatever care might usually be available in the clinics, which is normally a combination of clinical assessment, appropriate tests and reassurance. Those allocated to the active treatment group were planned to receive between 5 and 10 sessions of an adapted form of cognitive behaviour therapy based on the Salkovskis/Warwick model, in which a set of treatment strategies are chosen aimed at helping patients understand the factors that drive and maintain health anxiety. The therapy was planned to be given by graduate research workers, nurses or other health professionals trained for this intervention whom would also have their competence assessed independently during the course of treatment. The primary outcome is reduction in health anxiety symptoms after one year and the main secondary outcome is the cost of care after two years. Discussion This represents the first trial of adapted cognitive behaviour therapy in health anxiety that is large enough to test not only the clinical benefits of treatment but also whether the cost of treatment is offset by savings from reduced use of other health services in comparison to the control group. Cognitive behaviour therapy for Health Anxiety in Medical Patients (CHAMP) Trial registration Current Controlled Trials ISRCTN14565822

The effect of affinity purified La(SSB) on immunoglobulin synthesis in vitro by mononuclear cells (MNC) from anti-La(SSB)-positive systemic lupus erythematosus (SLE) patients and healthy controls was studied. La(SSB) was prepared from calf thymus extract and characterized by SDS-polyacrylamide gel electrophoresis and immunoblotting. Silver staining of gels reveals nine major bands at 68 kD, 43-48 kD and 30-33 kD, of which six were recognized on immunoblois by sera from anti-La(SSB) positive SLE patients. Studies in vitro showed that La(SSB) alone did not stimulate total IgG or IgM synthesis in controls or SLE patients. Low concentrations of La(SSB) (optimal dose <0.02 ng/ml) suppressed pokeweed mitogen (PWM )-driven IgG synthesis by controls hut not by anti-La(SSB) positive SLE patients. IgM responses were unaffected. Anti-La(SSB) and anti-DNA were detected in PWM-stimulated cultures from both study groups. In the presence of La(SSB) IgM anti-La(SSB) synthesis was enhanced in anti-La(SSB)-positive patients in a dose-dependent manner. In contrast, La(SSB) inhibited anti-La(SSB) production by controls (maximal at 2 ng/ml). La(SSB) had no effect on anti-DNA production in cither group. Pre-incubation of control or anti-La(SSB)-positive SLE MNC with La(SSB) before addition to autologous PWM-driven cultures did not induce suppressor cells, although pre-incubation with Concanavalin A (ConA) did. Thus we suggest that La(SSB)-induced suppression of IgG synthesis in PWM-driven control cultures may not he due to induction of regulator cells, possibly missing from SLE cultures, but perhaps is a direct effect on B cells. [ABSTRACT FROM AUTHOR]

Helper and suppressor cells have been identified in lymph nodes of multiparous pregnant mice using one-way mixed lymphocyte reactions. Primiparous C57B1 and C57B1/10ScSn females during pregnancy and immediately post-partum gave unaltered MLR reactivity compared to virgin controls when stimulated with paternal or third-party alloantigens. In contrast, multiparity produced strain-dependent alterations in responsiveness: C57B1 females being hyporesponsive while C57B1/10ScSn mice were hyper-responsive to these antigens. To evaluate regulator activity, the cells were treated with mitomycin C and mixed with normal syngeneic MLR responder populations. Results showed that mixtures of para-aortic and inguinal lymph node cells from pregnant C57B1 females suppressed while those from pregnant C57B1/10ScSn increased normal virgin MLR responses. Treatment of the regulator cells with anti-Thy-1.2 plus complement showed that suppressor activity was predominantly non-T cell in nature while C57B1/10ScSn helper activity was wholly T cell-dependent. The regulator cells appeared to be non-specific since they were found in syngeneically as well as allogeneically mated females but covert specificity could not be totally excluded. Embryo resorption in the C57B1 strain was associated with helper rather than suppressor activity. These results suggest that suppressor cells are not essential for the maintenance of pregnancy and that the presence of regulator cells probably reflects the normal homeostatic mechanisms controlling the maternal immune response to the conceptus. [ABSTRACT FROM AUTHOR]

Cytotoxic cell activity directed against paternal alloantigens was investigated in primiparous C57BL/10 and CBA/Ca mice using a microcytotoxicity assay. Most allogeneically or syngeneically mated females lacked effector cells in their spleens or paraaortic lymph nodes both during pregnancy and immediately postpartum. However, spleen, cells from 33% of C57BL/10 females mated to CBA/Ca males exhibited low levels of paternal target cell killing (P<0·05–0·01). Alloimmunization of virgin mice prior to mating resulted in only allogeneically mated females producing cytotoxic cells and alloantibody. These responses were not detectable during pregnancy bat appeared immediately postpartum. The ability of pregnancy to induce memory cell formation was tested by allowing females one successful pregnancy before challenging them postpartum with allogeneic spleen cells. Kinetic studies of cytotoxic cell production showed that C57BL/10 females that had borne (C57DL/10 × CBA/Ca)F1 litters responded earlier than their syngeneically meted sisters giving a peak response at 4 days compared to 7 days after immunization. This indicates that a single allogeneic pregnancy can prime the mother against paternal alloantigens suggesting that the conceptus is weakly immunogenic. [ABSTRACT FROM AUTHOR]