Understanding the Legal Rights and Mental Health Needs of Unaccompanied Immigrant Children in US Government Custody and Beyond

This article addresses the mental health rights of unaccompanied children, the ways in which the US immigration system does not sufficiently support children's mental health, and how clinicians can play a role in meeting immigrant children's mental health needs.

Characterizing oil and gas wells with fugitive gas migration through Bayesian multilevel logistic regression

Oil and gas wells are engineered with barriers to prevent fluid movement along the wellbore. If the integrity of one or more of these barriers fails, it may result in subsurface leakage of natural gas outside the well casing, a process termed fugitive gas migration (GM). Knowledge of the occurrence and causes of GM is essential for effective management of associated potential risks. In the province of British Columbia, Canada (BC), oil and gas producers are required to report well drilling, completion, production, and abandonment records for all oil and gas wells to the provincial regulator. This well data provides a unique opportunity to identify well characteristics with higher likelihoods for GM to develop. Here we employ Bayesian multilevel logistic regression to understand the associations between various well attributes and reported occurrences of GM in 0.6% of the 25,000 oil and gas wells in BC. Our results indicate that there is no association between the occurrence of GM and hydraulic fracturing. Overall, there appears to be no well construction or operation attribute in the study database that is conclusively associated with GM. Wells with GM more frequently exhibit indicators of well integrity loss (i.e., surface casing vent flow, remedial treatments, and blowouts) and geographic location appears to be important. We ascribe the spatial clustering of GM cases to the local geologic environment, and we speculate that there are links between particular intermediate gas-bearing formations and GM occurrence in the Fort Nelson Plains Area. The results of this study suggest that oil and gas wells in high GM occurrence areas and those showing any attribute associated with integrity failure (e.g., surface casing vent flow) should be prioritized for monitoring to improve the detection of GM.

A concept for ab initio prediction of cis-regulatory modules

An important concern in the attempt of understanding the functional code of eukaryotic genes is to elucidate the control structures for regulating gene activation and suppression. One objective in the attempt to understand mechanisms of gene regulation is the elucidation of the regulatory network structure. A preliminary step of a detailed network analysis is identifying the transcription factor binding sites of a regulatory network. Known as cis-regulatory module (CRM), it is understood as part of the genome that comprises a set of short length binding sites. Gene regulatory systems are known to be quite stable during evolution, as compared to relatively frequent replication processes of genes and mutations of the coding sequences. This conservation property of regulatory code can advantageously be used for identifying cis-regulatory modules of potentially co-regulated genes. As the degree of similarity is expected to depend on the phylogenetic distance of homologs or orthologs, we favor an approach that is based on a comparison paradigm. The paper introduces a novel concept for measuring the similarity ofcis-regulatory modules which can then be used in an algorithm for comparing regulatory regions. The proposed algorithm searches for pairs of similar modules, and a prototype implementation is applied to human and mouse liver sequences. The results are compared to that of random sequences, and it is shown that a clear decision about co-regulation is possible at this level.

A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma

BACKGROUND

In the past, diffuse malignant peritoneal mesothelioma (DMPM) was regarded as a preterminal condition. The length of survival was dependent upon the aggressive versus indolent biologic behavior of the neoplasm. The overall median survival was approximately 1 year after systemic chemotherapy. Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been used as a treatment alternative, but the efficacy of this combined treatment remains to be established.

PATIENTS AND METHODS

Searches for relevant studies published in peer-reviewed medical journals on CRS and PIC for DMPM before May 2006 were carried out on six databases. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies. Expert academic surgeons in Washington, DC, USA were asked whether they knew about any important unpublished data. Two investigators independently evaluated each study according to predefined criteria. The quality of each study was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results of all included studies.

RESULTS

Seven prospective observational studies from six tertiary institutions were available, allowing 240 DMPM patients for assessment. The median survival ranged from 34-92 months. The 1-, 3- and 5-year survival varied from 60% to 88%, 43% to 65% and 29% to 59%, respectively. The perioperative morbidity varied from 25% to 40% and mortality ranged from 0% to 8%.

CONCLUSIONS

This systematic review evaluated the current evidence for CRS and PIC for DMPM. Seven observational studies were available for assessment, which demonstrated an improved overall survival, as compared to historical controls, using systemic chemotherapy and palliative surgery.

The absence of depth constancy in contour stereograms

Stereoscopic surfaces constructed from Kanizsa-type illusory contours or explicit luminance contours were tested for three-dimensional (3-D) shape constancy. The curvature of the contours and the apparent viewing distance between the surface and the observer were manipulated. Observers judged which of two surfaces appeared more curved. Experiment 1 allowed eye movements and revealed a bias in 3-D shape judgment with changes in apparent viewing distance, such that surfaces presented far from the observer appeared less curved than surfaces presented close to the observer. The lack of depth constancy was approximately the same for illusory-contour surfaces and for explicit-contour surfaces. Experiment 2 showed that depth constancy for explicit-contour surfaces improved slightly when fixation was required and eye movements were restricted. These experiments suggest that curvature in depth is misperceived, and that illusory-contour surfaces are particularly sensitive to this distortion.

Motion capture depends on signal strength

When flickering dots are superimposed onto a drifting grating, the dots appear to move coherently with the grating. In this study we examine: (i) how the perceived direction of a compound stimulus composed of superimposed grating and dots, moving in opposite directions with equal speeds, is influenced by the relative strength of the motion signals; (ii) how the perceived speed of a compound stimulus composed of superimposed grating and dots, moving in the same direction but at different speeds, is influenced by the relative strength of the motion signals; and (iii) whether this stimulus is discriminable from its metameric speed match. Dot signal strength was manipulated by using different proportions of signal dots in noise and different dot lifetimes. Both the perceived direction and speed of these compound stimuli depended upon the relative motion-signal strengths of the grating and the dots. Those compound stimuli that appeared coherent were not discriminable from the speed-matched metameric compound stimuli. When the signals were completely integrated into a coherent compound stimulus, the local motion signals were no longer perceptually available, though both contributed to the global percept. These data strongly support a weighted-combination model where the relative weights depend on signal strength, instead of a winner-takes-all model.

Newly designed retraction devices for intestine control during laparoscopic aortic surgery: a comparative study in an animal model

BACKGROUND

Recent clinical studies have demonstrated the feasibility of laparoscopic surgery for aortic occlusive and aneurysmal disease. However, transperitoneal aortic access is compromised by poor exposure in the operative field from uncontrolled bowel. The retractors that are currently available are inadequate for this task. The development of new retractors would help to facilitate laparoscopic aortic surgery.

METHODS

Six female piglets (28-30 kg) in each group underwent laparoscopy with pneumoperitoneum (12 mmHg). Exposure of the infrarenal aorta and cross-clamping were undertaken through a transperitoneal approach. Two paddles inserted in a polyester bilayer (mobile device, group A) or a mesh net fixed to the abdominal wall (fixed device, group B) were used to retain the bowel. Aortotomy and suturing were performed to mimic a vascular procedure. After bleeding was controlled, the intraabdominal pressure (IAP) was lowered to 6 mmHg, and retraction was assessed for 30 min. The main outcome measures were time to deploy the retractors, time to perform the vascular procedure, time to withdraw the devices, and total procedural time. Blood loss and frequency of retraction failure were also recorded.

RESULTS

Mean time to deploy the device was 22 +/- 12 min in group A and 36 +/- 34 min in group B (n.s.). Vascular surgery time averaged 60 +/- 24 min in group A and 68 +/- 16 min in group B (n.s.). The times to withdraw the nets were 3.6 +/- 1.2 min and 13.5 +/- 8.2 min, respectively (p < 0.05). Total surgery time was 155 +/- 41 min vs 174 +/- 49 min (n.s.). There were six retraction failures, five in group A and one in group B. When lower IAP was used, there was only one failure in each study group. Mean blood loss was <150 ml in both groups. There were no major complications.

CONCLUSIONS

Both methods provided adequate exposure of the infrarenal aorta. Vascular surgery time and blood loss were similar for both groups. The movable device proved more usable and, at lower IAP, more effective. The results of this study demonstrate effective bowel retraction for laparoscopic aortic surgery.

A quality management approach to optimizing delivery and administration of preoperative antibiotics

OBJECTIVE

To optimize the process for delivering and administering preoperative antibiotics in order to prevent potential adverse patient outcomes.

DESIGN

Using a multidisciplinary quality-improvement team, an evaluation of the preoperative medication order and delivery process was conducted. Charts were reviewed by selected time periods, with winter 1994 discharges for orthopedic surgeries (n = 97) and spring 1995 discharges for open heart procedures (n = 50) being used to arrive at baseline data (n = 147). A plan was devised to mainstream the medication-use process so that it would be standardized hospitalwide. A goal of administering preoperative antibiotics within 30 to 60 minutes prior to cut time was established. Following redesign and education, a repeat chart review of orthopedic surgeries (n = 33) and open heart procedures (n = 168) was conducted during April 1997 for discharges from the same diagnosis-related groups to total (n = 201).

SETTING

A nearly 1,000-bed tertiary referral center and teaching hospital with three separate campuses.

RESULTS

We identified multiple ordering mechanisms, multiple medication sources and delivery sites, multiple administration sites and administering personnel, and other logistical conflicts. Thirty-one percent of cases received antibiotics less than 30 minutes prior to start time, 39% between 30 to 60 minutes, and 30% greater than 60 minutes before start time. Following the multidisciplinary redesign and education, an increase from 39% to 61% receiving preoperative antibiotics between 30 to 60 minutes prior to surgery start time and a decrease from 31% to 18% receiving them in less than 30 minutes was documented. The percentage of patients receiving preoperative antibiotics in 60 minutes or less increased from 70% to 80%.

CONCLUSION

A continuous quality-improvement approach that engages all departments involved in patient care is necessary to achieve meaningful change in complicated hospital processes.

The effect of inducer polarity and contrast on the perception of illusory figures

A study designed to determine how inducer-surround contrast and inducer polarity affect the contour clarity and the lightness of illusory figures is reported. Using magnitude estimation procedures, ten naive subjects rated both the contour clarity and the lightness of Kanizsa squares. The magnitude of the inducer-surround contrast and the inducer polarity (all-black, all-white, or black-and-white) were varied randomly on each trial. The data indicate that contour clarity increases with contrast at the same rate across polarity conditions but that contour clarity at any given contrast level depends significantly on polarity. Contour clarity judgments were significantly lower when the inducers were all-white than when the inducers were all-black or black-and-white, and significantly greater in the 'mixed' polarity case (black-and-white inducers) than in the 'same' polarity case (the average of the all-black and all-white inducer conditions). Inducer contrast and polarity significantly affected the lightness of the illusory figure in a manner consistent with simultaneous spatial contrast. Also, for a given increment in contrast, contour clarity altered significantly more than surface lightness, regardless of inducer polarity. The findings suggest that the mechanism which mediates boundary formation is sensitive to the direction of contrast, and that the boundary formation mechanism is more sensitive than the surface lightness mechanism to changes in contrast magnitude. The results are considered within the context of neural network models of form perception.

The design of arm pressure covers to alleviate pain in high G maneuvers

HYPOTHESIS

Arm pain has been noted especially when increased coverage anti-G suits are worn in combination with PBG (pressure breathing during G) in high G centrifuge test runs. Arm pain has forced the termination of test runs and has the potential to cause a serious decrement in a pilot's ability to function effectively during high-G flight. Based on the theory that arm pain is caused by fluid pooling in the arm, four new pressure cover systems for the arm were designed and tested.

METHODS

Seven test subjects wore each design in a series of runs in a dynamic flight simulator (DFS). Subjects experienced both gradual and rapid onset rate runs with G levels ranging from +3.0 G to +9.0 G. Data were collected on the maximum G's achieved, pain location, and pain intensity. Subjective responses on the comfort and function of each design and overall arm cover design preferences were also obtained via a questionnaire.

RESULTS

Analysis of the DFS data, using a two-factor ANOVA (subjects, designs), revealed that each of the new designs provided significantly better protection from arm pain than the control condition (no protection) and that each of the designs significantly improved the maximum G level attained during rapid onset acceleration in the range of +1 G.

CONCLUSION

No positive correlation was found between subject ranking of the four new design concepts at the conclusion of the study in terms of the pain reduction they provided and the pain levels reported during DFS testing.

Recruitment mechanisms in speed and fine-direction discrimination tasks

The minimum information necessary to specify motion requires a change in position across time. Previous studies have shown that human motion measurements improve with more than two frames of motion. This study clarifies how motion information is integrated to produce the best speed and direction discrimination. Using random-dot kinematograms, fine-direction discrimination thresholds and speed discrimination thresholds are assessed as a function of dot lifetime. Specifically, we ask if performance on both tasks depends on dot lifetime in the same manner. If both speed and direction discrimination performance improve the same way with increasing dot lifetime, this would indicate that both tasks have the same integration limit and both tasks may depend on the same underlying mechanisms. Experiment 1 shows that for both tasks a four-frame dot lifetime is necessary for observers to reach asymptotic threshold levels. The absolute level of performance improves with increasing stimulus duration or signal-to-noise ratio, but the integration limit itself does not vary. Experiment 2 examines whether this integration limit is constrained by the number of frames or by the temporal duration of the dot lifetime. The data in Experiment 2 suggest that both a minimum number of samples and a minimal temporal integration period determine the integration limit for recruitment mechanisms. The results suggest that speed and fine-direction discrimination depend upon the same underlying motion mechanisms. These results are discussed in relation to possible underlying physiological substrates and computational models of motion measurement.

Motion interference: perturbing perceived direction

The minimum stimulus necessary to define motion is a change in position from one location to another in time, but past studies have provided evidence that the human motion system integrates motion over more than two positions. In this study we demonstrate strong sequential interactions affecting perceived direction in apparent-motion sequences; a perturbing dot can bias the perceived direction of motion between two test dots to which it is relatively close in space (up to 100 min arc) and time (up to 300 msec). These sequential interactions suggest a motion mechanism sensitive to the spatial characteristics of motion trajectories; the interactions are greatest for evenly spaced targets positioned along a single axis. The implications for motion-detection models and models based on attention as a mechanism to create apparent motion are discussed.

Velocity-dependent improvements in single-dot direction discrimination

Thirty-six Brown University students participated in three experiments designed to address perceptual learning. In each experiment, visual discrimination thresholds were tracked over 4,200 trials. Results from Experiment 1 suggest that the pattern of threshold reduction on a single-dot motion-direction discrimination task was stimulus direction specific and matched (in a velocity-dependent manner) the threshold reduction pattern previously reported for a line-orientation discrimination task. In Experiment 2, it was determined that the stationary-line-orientation-specific practice effects originally reported by Vogels and Orban (1985) could be replicated but were contingent on line length. Similarly, the results from Experiment 3 suggest that practice effects originally reported by Ball and Sekuler (1987) could be replicated but were contingent on stimulus velocity. Implications for the mechanisms underlying direction and orientation discrimination are considered.

Midsagittal corpus callosum area, intelligence, and language dominance in epilepsy

Alterations in midsagittal corpus callosum (CC) area and morphology have been suggested in several disease processes of the nervous system. In addition, some studies found a relation of CC area to handedness, language dominance, and gender. The relation of CC area to measures of intelligence and memory and the effect of epilepsy on CC area have received less attention. In this study CC area was measured on midsagittal magnetic resonance images in 48 patients undergoing presurgical evaluation of epilepsy and in 20 control subjects. All patients had the Wada test and formal neuropsychological testing. The mean CC area of the epilepsy group was significantly smaller than that of control subjects (p < 0.00001). CC area showed a positive correlation with presurgical performance IQ (p = 0.008) and full-scale IQ (p = 0.048), but not with memory scores or language dominance. There was no relation of CC area to location of epileptic focus, seizure types, age at onset, epilepsy duration, or etiology. The presence of an atrophic lesion was associated with a smaller CC area. The correlation of total CC area with performance and full-scale IQs may reflect axonal loss in patients with a low IQ resulting from the etiology of epilepsy or the epilepsy itself.

Why construction is different

Construction differs markedly from many other types of manufacturing in that the nature of the work exacerbates the safety and health risks faced by workers. Even for workers who have health care coverage, the authors point out, the transient nature of the industry makes it difficult to trace an individual's exposure to health hazards.

Perspectives on the future

There is a growing trend toward new forms of labor-management cooperation, through negotiated agreements involving job-site safety and health, workers' compensation, and preventive medicine (see chapter 14). These developments are likely to change safety and health in the industry. At the same time, they provide opportunities for practitioners and researchers in occupational safety and health. If we can venture to express a professional wish, it would be to find answers to the following: How can we, as the professions concerned with the well being of workers, help preserve the characteristics of construction work that are positive while reducing the aspects of the industry's functioning that are so deleterious to health? How do we preserve the crafts with their fostering of self-esteem: through individual freedom on the job, team work, or empowerment? Meanwhile, how do we reduce the destructive patterns of work, not just on the work site, but also involving the pressures and lifestyle associated with intermittent and uncertain employment? The rewards for safety and health professionals in the construction industry are immediate and striking. Whether through the practice of safety and health or through research, results can be measured in short order. That is a professional benefit afforded by few other industries. To structure occupational safety and health programs for construction workers, the safety and health professions need to engage in the labor-management processes that are changing the industry. In construction, it is not enough to think about what needs to be done in individual workplaces. In construction, we must think industry-wide, because that is how workers are employed.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical surveillance programs for construction workers

In summary, the basic medical examination and carefully documented work and medical history are essential parts of the health examinations of construction workers. To achieve their best potential in preventing occupational and chronic diseases, the examinations should be conducted by professionals who know the working conditions in construction and have a positive attitude toward preventive medicine. One important aspect of these examinations is the opportunity to trigger workplace investigations, followed by exposure reduction. Simultaneously, such examinations provide an opportunity for health education of the worker and an education about work-related health problems for the health care provider.

MRI asymmetries and language dominance

OBJECTIVE

To examine the relationship between language dominance, as measured by Wada testing, and hemispheric asymmetries on MR brain images.

BACKGROUND

A previous report that did not include verification of language dominance compared the length of the planum temporale with hemispheric asymmetries seen on CT and inferred that occipital lobe asymmetry is related to language dominance.

METHODS

Language dominance was identified by the Wada test in 57 patients evaluated for surgical treatment of epilepsy. Fifty-five had an MRI scan that allowed accurate measurement. In a blinded fashion, two examiners independently measured bilateral frontal, parietal, and occipital lobe lengths on MR scan for each patient. Measurements of asymmetries were compared with language dominance established by the Wada test.

RESULTS

Reliability of measurement between the examiners was 97%. Asymmetry of the occipital lobe length on MR scan 10 mm above the tentorium was the only measurement significantly related to language dominance (p < 0.01). Occipital lobe length was longer on the left in 19 (40%) and on the right in 10 (21%) patients with left dominance. The right lobe was longer in six of seven (86%) patients with bilateral dominance. One patient with right hemisphere dominance had a longer left lobe. None of the measurements significantly related to handedness.

CONCLUSION

Asymmetries of occipital lobe length relate to language dominance, but such dominance cannot be reliably identified by MR in an individual patient.

Global aphasia with seizure onset in the dominant basal temporal region

A 33-year-old right-handed woman had intractable simple and complex partial seizures (SPS, CPS) that began with global aphasia. EEG closed-circuit TV (EEG-CCTV) monitoring with sphenoidal electrodes showed left inferomesial temporal ictal onset of CPS. Subdural electrodes were implanted over the left frontotemporal convexity, subtemporally and subfrontally. Stimulation of the basotemporal cortex produced global aphasia. A posterolaterotemporal language area was also identified. Spontaneous SPS had focal onset in the basal temporal language area (BTLA). Ictal discharges did not involve the posterotemporal region. This case shows that aphasic speech arrest at seizure onset may be due to seizure discharge in the basotemporal region and that the BTLA is clinically relevant in seizure semiology.

Carbon monoxide controversies: neuropsychologic testing, mechanism of toxicity, and hyperbaric oxygen

Recent animal and clinical data require a reevaluation of the traditional approach to the patient exposed to carbon monoxide. Unfortunately, these new data are inconclusive and generate controversies regarding the indications and value of neuropsychologic testing, cause of carbon monoxide toxicity, and indications (if any) for hyperbaric oxygen therapy. These controversies and their implications for the emergency physician are discussed.

Improving education and resources for health care providers

Workers and citizens are turning increasingly to the health care system for information about occupational and environmental reproductive hazards, yet most primary care providers and specialists know little about the effects of occupational/environmental toxicants on the reproductive system or how to evaluate and manage patients at potential risk. Although it is unrealistic to expect all clinicians to become experts in this area, practitioners should know how to take a basic screening history, identify patients at potential risk, and make appropriate referrals. At present, occupational and environmental health issues are not well integrated into health professional education in the United States, and clinical information and referral resources pertaining to reproductive hazards are inadequate. In addressing these problems, the conference "Working Group on Health Provider Education and Resources" made several recommendations that are detailed in this report. Short-term goals include enhancement of existing expertise and resources at a regional level and better integration of information on occupational/environmental reproductive hazards into curricula, meetings, and publications of medical and nursing organizations. Longer term goals include development of a comprehensive, single-access information and referral system for clinicians and integration of occupational and environmental medicine into formal health professional education curricula at all levels.

Three-dimensional illusory contours and surfaces

Under general viewing conditions, objects are often partially camouflaged, obscured or occluded, thereby limiting information about their three-dimensional position, orientation and shape to incomplete and variable image cues. When presented with such partial cues, observers report perceiving 'illusory' contours and surfaces (forms) in regions having no physical image contrast. Here we report that three-dimensional illusory forms share three fundamental properties with 'real' forms: (1) the same forms are perceived using either stereo or motion parallax cues (cue invariance); (2) they retain their shape over changes in position and orientation relative to an observer (view stability); and (3) they can take the shape of general contours and surfaces in three dimensions (morphic generality). We hypothesize that illusory contours and surfaces are manifestations of a previously unnoticed visual process which constructs a representation of three-dimensional position, orientation and shape of objects from available image cues.

Neural computing in cancer drug development: predicting mechanism of action

Described here are neural networks capable of predicting a drug's mechanism of action from its pattern of activity against a panel of 60 malignant cell lines in the National Cancer Institute's drug screening program. Given six possible classes of mechanism, the network misses the correct category for only 12 out of 141 agents (8.5 percent), whereas linear discriminant analysis, a standard statistical technique, misses 20 out of 141 (14.2 percent). The success of the neural net indicates several things. (i) The cell line response patterns are rich in information about mechanism. (ii) Appropriately designed neural networks can make effective use of that information. (iii) Trained networks can be used to classify prospectively the more than 10,000 agents per year tested by the screening program. Related networks, in combination with classical statistical tools, will help in a variety of ways to move new anticancer agents through the pipeline from in vitro studies to clinical application.

The precision of size constancy

The precision of objective size judgments, made when target disparity changed at random from trial-to-trial, was compared to the precision of angular size judgments made under the same condition. Subjects judged incremental changes in the vertical distance separating a pair of horizontal lines. For the objective judgments (in cm), the angle subtended by the target separation decreased with increasing depth consistent with the natural geometry of physical objects. For the angular judgments (in arc min), the angular separation did not change with disparity. For separations subtending an angle < 10 arc min, objective thresholds were considerably higher than angular thresholds, indicating that size constancy does not function well at small scales. At larger scales (> 20 arc min), the Weber fractions for angular and objective thresholds were nearly equal (approximately 6%) for two of the three subjects. These same two subjects also learned to judge "objective size" when angular subtense systematically increased with increasing depth in an exact inversion of the natural relationship. Although their "anti-constancy" judgments were less precise (approximately 9%) than their constancy judgments, the fact that subjects could learn this task with little practice suggests that constancy itself may be a learned response. Angular thresholds for targets presented only in the fixation plane were significantly lower than the angular thresholds measured with random changes in disparity, showing that observers with normal stereopsis do not have direct access to information about the angle subtended at the retina.

The treatment of a chronic organic mental disorder with dextromethorphan in a man with severe mental retardation

Response to dextromethorphan (15 mg b.i.d.), an antitussive agent not usually considered to have psychotropic properties, was seen in a 25-year-old man with severe developmental disabilities, congenital rubella, and an organic mental disorder. Dextromethorphan affects CNS serotonergic systems, and this was the probable therapeutic mechanism. This and other published cases suggest the existence of a distinct organic mental syndrome in developmentally disabled persons which responds to drugs that increase indoleaminergic activity.

Engraftment of leukocyte subsets following autologous bone marrow transplantation in acute myeloid leukemia using anti-myeloid (CD14 and CD15) monoclonal antibody-purged bone marrow

The cell surface phenotype of leukocyte subsets during reconstitution following autologous bone marrow transplantation (ABMT) using bone marrow purged with anti-myeloid monoclonal antibodies (MoAbs) and complement (C') was evaluated in 20 patients with acute myeloid leukemia (AML). Repopulation of B and T lymphocytes, natural killer (NK) cells, and myeloid cells was assessed by phenotypic analysis using two-color cytofluorography of peripheral blood mononuclear cells (PBMNC) at several time points up to 2 years post-transplantation. In spite of removal of the majority of monomyeloid cells of the autograft by purging with anti-CD14 and anti-CD 15, engraftment occurred rapidly. The myeloid cells appeared normal by surface phenotype. An early rise in NK cells, characterized by expression of CD57 and CD 16, was seen. The CD4:CD8 ratio remained low throughout the study period, primarily due to a persistently low CD4 level. ABMT using bone marrow purged with the anti-myeloid MoAbs PM-81 and AML-2-23 and C' resulted in prompt engraftment of neutrophils. Although there was a prolonged time for recovery of lymphocyte subsets, this did not result in an increased risk of early infectious complications. Late infectious complications post-transplantation were limited to herpes zoster infection in one patient 18 months post-transplantation, and bacterial meningitis in that same patient 2 months later. This study demonstrates that ABMT in patients with AML using bone marrow purged with the anti-myeloid MoAbs PM81 (anti-CD15) and AML-2-23 (anti-CD14) and C' results in rapid hematologic engraftment and delayed phenotypic immunologic reconstitution without significant acute or chronic clinical toxicities.

Surveillance of sentinel occupational mortality in the District of Columbia: 1980 to 1987

Epidemiological surveillance of sentinel occupationally related deaths commonly relies on computerized analyses of mortality data obtained from vital statistics records. A computer search of death records in the District of Columbia for the period 1980 to 1987 identified 15 cases that noted asbestosis, silicosis, coal worker's pneumoconiosis, or primary cancer of the pleura/mesothelioma as the underlying cause of death. A manual review of the death certificates for the same period identified three times as many cases (n = 48) with any mention of these conditions. Problems with performing surveillance of these events using death certificates include the lack of sufficient information to identify mesotheliomas and the failure to code and computerize all contributing causes of death.