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For more information visit www.uptodate.com.) Increasing amounts of evidence support autoimmune-mediated inflammation early in the course of morphea.14 Early morphea lesions are characterized by the influx of large amounts of mononuclear lymphocytes (usually activated T lymphocytes), plasma cells, and eosinophils.15 This is likely the result of autoimmunity, as there is widespread autoimmune reactivity in morphea patients (elevated ANAs, cytokines, and adhesion molecules).5,12,16 Morphea patients also have concomitant autoimmune disease at higher expected frequency than a healthy population.5,11 Vessel damage and upregulation of adhesion molecules (ICAM-1, VCAM 1, and E-selectin) occur related to the inflammatory cell infiltrate which facilitates local monocyte recruitment.17 These adhesion molecules are upregulated by cytokines classically associated with a Th2 immune response (Il-4, Il-1, and TNFs)

Some local confusion after federal passage of new minimum age for tobacco purchases There has been local confusion at area retailers in central Wisconsin after the passage of the federal Tobacco 21 law just before the end of the year, raising the national age for purchasing tobacco products from 18 to 21

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However, the need to spit regularly and the association with stained teeth and bad breath have made it less appealing in todays increasingly health-conscious world

Not surprisingly, many smokers would like to stock up on cigarettes now, to save a little money before the price increase goes into effect