CSF1R inhibition promotes neuroinflammation and behavioral deficits during graft-versus-host disease in mice

ABSTRACT

Chronic graft-versus-host disease (cGVHD) remains a significant complication of allogeneic hematopoietic stem cell transplantation. Central nervous system (CNS) involvement is becoming increasingly recognized, in which brain-infiltrating donor major histocompatibility complex (MHC) class II+ bone marrow-derived macrophages (BMDM) drive pathology. BMDM are also mediators of cutaneous and pulmonary cGVHD, and clinical trials assessing the efficacy of antibody blockade of colony-stimulating factor 1 receptor (CSF1R) to deplete macrophages are promising. We hypothesized that CSF1R antibody blockade may also be a useful strategy to prevent/treat CNS cGVHD. Increased blood-brain barrier permeability during acute GVHD (aGVHD) facilitated CNS antibody access and microglia depletion by anti-CSF1R treatment. However, CSF1R blockade early after transplant unexpectedly exacerbated aGVHD neuroinflammation. In established cGVHD, vascular changes and anti-CSF1R efficacy were more limited. Anti-CSF1R-treated mice retained donor BMDM, activated microglia, CD8+ and CD4+ T cells, and local cytokine expression in the brain. These findings were recapitulated in GVHD recipients, in which CSF1R was conditionally depleted in donor CX3CR1+ BMDM. Notably, inhibition of CSF1R signaling after transplant failed to reverse GVHD-induced behavioral changes. Moreover, we observed aberrant behavior in non-GVHD control recipients administered anti-CSF1R blocking antibody and naïve mice lacking CSF1R in CX3CR1+ cells, revealing a novel role for homeostatic microglia and indicating that ongoing clinical trials of CSF1R inhibition should assess neurological adverse events in patients. In contrast, transfer of Ifngr-/- grafts could reduce MHC class II+ BMDM infiltration, resulting in improved neurocognitive function. Our findings highlight unexpected neurological immune toxicity during CSF1R blockade and provide alternative targets for the treatment of cGVHD within the CNS.

Donor bone marrow-derived macrophage MHC II drives neuroinflammation and altered behavior during chronic GVHD in mice

Graft-versus-host disease (GVHD) remains the leading cause of nonrelapse mortality after allogeneic stem cell transplantation for hematological malignancies. Manifestations of GVHD in the central nervous system (CNS) present as neurocognitive dysfunction in up to 60% of patients; however, the mechanisms driving chronic GVHD (cGVHD) in the CNS are yet to be elucidated. Our studies of murine cGVHD revealed behavioral deficits associated with broad neuroinflammation and persistent Ifng upregulation. By flow cytometry, we observed a proportional shift in the donor-derived T-cell population in the cGVHD brain from early CD8 dominance to later CD4 sequestration. RNA sequencing of the hippocampus identified perturbations to structural and functional synapse-related gene expression, together with the upregulation of genes associated with interferon-γ responses and antigen presentation. Neuroinflammation in the cortex of mice and humans during acute GVHD was recently shown to be mediated by resident microglia-derived tumor necrosis factor. In contrast, infiltration of proinflammatory major histocompatibility complex (MHC) class II+ donor bone marrow (BM)-derived macrophages (BMDMs) was identified as a distinguishing feature of CNS cGVHD. Donor BMDMs, which composed up to 50% of the CNS myeloid population, exhibited a transcriptional signature distinct from resident microglia. Recipients of MHC class II knockout BM grafts exhibited attenuated neuroinflammation and behavior comparable to controls, suggestive of a critical role of donor BMDM MHC class II expression in CNS cGVHD. Our identification of disease mediators distinct from those in the acute phase indicates the necessity to pursue alternative therapeutic targets for late-stage neurological manifestations.

Cep55 regulation of PI3K/Akt signaling is required for neocortical development and ciliogenesis

Homozygous nonsense mutations in CEP55 are associated with several congenital malformations that lead to perinatal lethality suggesting that it plays a critical role in regulation of embryonic development. CEP55 has previously been studied as a crucial regulator of cytokinesis, predominantly in transformed cells, and its dysregulation is linked to carcinogenesis. However, its molecular functions during embryonic development in mammals require further investigation. We have generated a Cep55 knockout (Cep55-/-) mouse model which demonstrated preweaning lethality associated with a wide range of neural defects. Focusing our analysis on the neocortex, we show that Cep55-/- embryos exhibited depleted neural stem/progenitor cells in the ventricular zone as a result of significantly increased cellular apoptosis. Mechanistically, we demonstrated that Cep55-loss downregulates the pGsk3β/β-Catenin/Myc axis in an Akt-dependent manner. The elevated apoptosis of neural stem/progenitors was recapitulated using Cep55-deficient human cerebral organoids and we could rescue the phenotype by inhibiting active Gsk3β. Additionally, we show that Cep55-loss leads to a significant reduction of ciliated cells, highlighting a novel role in regulating ciliogenesis. Collectively, our findings demonstrate a critical role of Cep55 during brain development and provide mechanistic insights that may have important implications for genetic syndromes associated with Cep55-loss.

Targeting BRF2 in Cancer Using Repurposed Drugs

Simple Summary

BRF2, a subunit of the RNA polymerase III transcription complex, is upregulated in a wide variety of cancers and is a potential therapeutic target; however, no effective drugs are available to target BRF2. The upregulation of BRF2 in cancer cells confers survival via the prevention of oxidative stress-induced apoptosis. In this manuscript, we report the identification of potential BRF2 inhibitors through in silico drug repurposing screening. We further characterized bexarotene as a hit compound for the development of selective BRF2 inhibitors and provide experimental validation to support the repurposing of this FDA-approved drug as an agent to reduce the cellular levels of ROS and consequent BRF2 expression in cancers with elevated levels of oxidative stress.

Abstract

The overexpression of BRF2, a selective subunit of RNA polymerase III, has been shown to be crucial in the development of several types of cancers, including breast cancer and lung squamous cell carcinoma. Predominantly, BRF2 acts as a central redox-sensing transcription factor (TF) and is involved in rescuing oxidative stress (OS)-induced apoptosis. Here, we showed a novel link between BRF2 and the DNA damage response. Due to the lack of BRF2-specific inhibitors, through virtual screening and molecular dynamics simulation, we identified potential drug candidates that interfere with BRF2-TATA-binding Protein (TBP)-DNA complex interactions based on binding energy, intermolecular, and torsional energy parameters. We experimentally tested bexarotene as a potential BRF2 inhibitor. We found that bexarotene (Bex) treatment resulted in a dramatic decline in oxidative stress and Tert-butylhydroquinone (tBHQ)-induced levels of BRF2 and consequently led to a decrease in the cellular proliferation of cancer cells which may in part be due to the drug pretreatment-induced reduction of ROS generated by the oxidizing agent. Our data thus provide the first experimental evidence that BRF2 is a novel player in the DNA damage response pathway and that bexarotene can be used as a potential inhibitor to treat cancers with the specific elevation of oxidative stress.

MHC II expression by donor bone marrow-derived macrophages underpins neuroinflammation and cognitive deficits during murine chronic GVHD

Chronic graft-versus-host disease (cGVHD) remains the leading cause of non-relapse mortality after allogeneic stem cell transplantation (SCT) for haematological malignancies. Manifestations of GVHD in the central nervous system (CNS) present as neurocognitive dysfunction in a significant proportion of patients. Neuroinflammation in the cortex of mice and humans in acute GVHD is dependent on host resident microglia-derived TNF. However, the mechanisms driving cGVHD in the CNS are yet to be elucidated. Here, our studies of murine cGVHD revealed a hippocampal-dependent spatial learning and memory deficit associated with inflammation and persistent IFN-γ upregulation. Hippocampal RNA sequencing identified perturbations to structural and functional synapse-related gene expression, in the context of upregulated genes associated with antigen presentation and IFN-γ responses. Brain T cell infiltration was initially dominated by CD8 T cells with an eventual expansion in CD4 T cells, in parallel with a marked infiltration of MHC Class II-expressing bone marrow-derived macrophages (BMDM). After day 70, BMDM constituted 50% of the brain macrophage pool and exhibited a transcriptional signature distinct from host resident microglia. Transfer of MHC class II–deficient BM grafts resulted in attenuated neuroinflammation, implicating donor BMDM as critical mediators of CNS cGVHD. Our identification of the hippocampus as a cGVHD target, and disease mediators distinct from those in the acute phase, highlights the necessity to pursue alternative therapeutic targets for late-stage neurological manifestations post-SCT.

Can computers conceive the complexity of cancer to cure it? Using artificial intelligence technology in cancer modelling and drug discovery

Drug discovery and the development of safe and effective therapeutics is an intricate procedure, further complicated in the context of cancer research by the inherent heterogeneity and complexity of the disease. To address the difficulties of identifying, validating, and pursuing a promising drug target, artificial intelligence (AI) technologies including machine learning (ML) have been adopted at all stages throughout the drug development pipeline. Various methods are widely employed to efficiently process and learn from experimental data sets, with agent-based models garnering thorough interest due to their ability to model individual cell populations with aberrant phenotypes. The predictive power of artificial intelligence modelling techniques founded in comprehensive datasets and automated decision-making generates an obvious avenue of interest for application in the drug discovery pipeline.

Maternal domestic violence screening in an office-based pediatric practice

BACKGROUND

Maternal domestic violence (MDV) screening by pediatricians is not well-studied. Objectives. To determine the practicality and dynamics of routine MDV screening in a private pediatric office and to determine the rate of MDV in Upper Cape Cod, Massachusetts.

SETTING

A 3-pediatrician, private pediatric office in Falmouth, Massachusetts.

PARTICIPANTS

Mothers of children aged 1 month to 10 years scheduled to undergo a well-child visit between February 7 and July 7, 2000.

INTERVENTION

Completion of an 11-item questionnaire related to violence.

RESULTS

Seven hundred sixty-six families were scheduled for well visits. Five hundred ninety-two eligible mothers presented to the office. Five hundred fifty-three completed questionnaires were returned (71.2%). The rate of MDV was 2.5% in current relationships (95% confidence interval [CI]: 1.4-4.3), 14.7% in past relationships (95% CI: 11.9-18.0), and 16.5% overall (95% CI: 13.5-19.9). Increased incidence of MDV was associated with the following variables: 1) harm to a child (odds ratio [OR]: 57.3, 95% CI: 7.3-1232.4), 2) being in a relationship other than a first marriage (OR: 4.6, 95% CI: 2.7-7.8), 3) having been previously asked about MDV (OR: 3.5, 95% CI: 2.1-6.1), 4) having 4 or more children (OR: 3.1, 95% CI: 1.6-6.1), 5) Women, Infants, and Children's program eligibility (OR: 3.0, 95% CI: 1.8-5.0), 6) having public insurance (ie, Medicaid or Children's Medical Security Plan) (OR: 2.2, 95% CI: 1.3-3.7), 7) a history of failure to present for a scheduled well-child visit (no-show; OR: 2.0, 95% CI: 1.0-4.2) and 8) anonymous questionnaire completion (OR: 1.7, 95% CI: 1.0-2.9). Thirty-two and one-half percent (32/91, 95% CI: 25.6-46.0) of mothers with a history of MDV recall having previously been asked about this by a health professional, compared with 16.9% overall (93/551, 95% CI: 13.9-20.3). Eighty-two and eight tenths (82.8) percent (457/552, 95% CI: 79.3-85.8) of mothers favored pediatricians asking about MDV.

DISCUSSION

This information was gathered within the context of normal work hours in a busy office. No additional staff were required. Hence, routine MDV screening appears feasible. The results suggest that a documented history of child abuse in a family makes it very likely that the mother has also been abused. However, child abuse among abused mothers is probably underreported. Furthermore, because most mothers favor domestic violence screening, concerns about lack of acceptance of maternal screening at pediatric visits seem to be unfounded. Screening may actually increase satisfaction with care. In addition, families who do not show up for appointments are at higher risk. Therefore, screening only at well visits will miss an important group.

CONCLUSIONS

Maternal domestic violence screening at well-child visits is practical in a private pediatric office setting. Current rates of screening are low; however, most mothers favor such screening. Furthermore, MDV screening should also be offered on a catch-up basis for those who miss well-child visits, as is currently recommended for immunizations.

Felbamate urolithiasis

PURPOSE

To report a case of felbamate (FBM) urolithiasis.

METHODS

Urographic imaging [sonography, abdominal computed tomography (CT), intravenous pyelogram, voiding cystourethrogram] and urologic procedures (cystoscopy with lithotripsy, ureteral stent) to define and capture the stones. Stone identification was by infrared spectroscopy and gas chromatography/mass spectrometry.

RESULTS

A 15-year-old boy had painful hematuria, bilateral ureteral obstruction, and urinary retention. Kidney, bladder, and ureteral stones were found, and ureteral stent placement was required to relieve obstruction. The stone material was identified as FBM by chemical analysis. Stone formation ceased with discontinuation of FBM.

CONCLUSIONS

FBM urolithiasis can occur, and possible contributory factors include high felbamate dosage, drug polypharmacy, and risk factors for forming stones of other types. FBM urolithiasis may be heralded by crystalluria.

Decision-making for a successful bowel continence program

Bowel continence is one of the most difficult challenges for patients with spina bifida. Incontinence acts as a social stigma for children and a barrier for adults seeking employment. We present an algorithm for stepwise decision-making in construction of personalized continence programs for greater likelihood of success. The protocol contains 13 assessment points including; stool consistency, frequency and amount; mobility; level of paraplegia: diet; medication; anal/rectal canal tone; prior programs attempted; family routines; age; accessibility; and learning issues. Based on outcomes of these assessments, an individualized bowel program is constructed. The algorithm helps the practitioner and patient decide on components and indicators of a successful continence program. The recommended program might include timed toileting, suppository, continence enema, and ACE procedure, or a combination. Evaluation and patient education address adequate fluid/fiber, appropriate toileting equipment, and use of stool softeners/laxatives. Descriptions are available. Key elements in monitoring a continuing plan for continence include: the degree of constipation and its etiology; changing age; family availability for assistance until interdependence is optimal; wheelchair accessibility of the toilet; and ability to transfer to and from the toilet. Use of the algorithm allows for careful decision-making based on information from the patient and family. This has led to greater success in bowel continence in children with spina bifida.

Initial experience with intravenous pentobarbital sedation for children undergoing MRI at a tertiary care pediatric hospital: the learning curve

OBJECTIVE

Our purpose is to describe the initial experience with intravenous pentobarbital sedation in children undergoing MRI at a tertiary pediatric hospital to identify errors associated with inexperience.

SUBJECTS AND METHODS

The study included the first 100 children sedated with intravenous pentobarbital prior to magnetic resonance examination at a tertiary pediatric hospital. The protocol included a maximum dose of 6 mg/kg administered in three divided doses with the total dose not to exceed 200 mg. Flow sheets documenting vital signs, administered drug doses, and adverse reactions were maintained contemporaneous to sedation.

RESULTS

Sedation was successful in 92 children. Of the eight children who failed sedation, three were at least 12 years old and three weighed more than 50 kg. chi2 tests identified significantly greater failure rates in children older than 11 years or weight greater than 50 kg. Two children had prolonged sedation after the maximum suggested dose was exceeded.

CONCLUSIONS

The success rate was good, but could have been improved by restricting the use of pentobarbital to children less than 12 years of age and weighing less than 50 kg. Radiologists inexperienced with intravenous sedation should strictly observe the maximum suggested dose of pentobarbital to prevent prolonged sedation.

Autologous TMJ disk replacement

Several techniques have been advocated for replacement of displaced or diseased temporomandibular joint disks. Techniques are reviewed and the author's experience in managing this complex problem is presented.

Sedation of difficult-to-sedate children undergoing MR imaging: value of thioridazine as an adjunct to chloral hydrate

OBJECTIVE

The purpose of this prospective study was to evaluate the safety and efficacy of thioridazine as an adjunct to chloral hydrate sedation when children undergoing MR imaging are difficult to sedate.

SUBJECTS AND METHODS

All 87 children in the study either could not be sedated with chloral hydrate alone or were mentally retarded. Thioridazine (2-4 mg/kg) was administered orally 2 hr before and chloral hydrate (50-100 mg/kg) was administered orally 30 min before the 104 MR examinations. All children were monitored by continuous pulse oximetry. All images were individually evaluated by pediatric radiologists and were graded acceptable if they contained only minimal motion artifact or no motion artifact. Studies were considered successful only when 95% or more of the images were acceptable.

RESULTS

MR imaging was successful in 93 (89%) of 104 examinations. The success rate for children entered into the study because of prior failure of chloral hydrate sedation was not significantly different from the success rate for children with mental retardation. A tendency for increasing failure rate with age was not significant. No serious complications occurred during the study. The most common adverse reaction, transient reduced oxygen saturation, was seen in five children. Other adverse effects encountered were vomiting in four children, hyperactivity in two children, transient tachycardia in one child, and prolonged sedation in one child. No child required hospitalization because of an adverse reaction to sedation.

CONCLUSION

The study indicates that thioridazine is a safe and effective adjunct to chloral hydrate when a child undergoing MR imaging is difficult to sedate.

High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacy in relation to age

OBJECTIVE

Sedation is frequently essential for successful MR imaging, and chloral hydrate is the most commonly used drug for this purpose in infants and children. Our experience with these patients suggested that this sedative is less effective in older children, even when administered in high doses. However, no prospective study comparing the efficacy of chloral hydrate sedation for children of different ages undergoing MR imaging has been reported. Accordingly, we performed a study to evaluate the effectiveness and safety of chloral hydrate sedation in children of various ages.

SUBJECTS AND METHODS

The study included 300 infants and children, 1 month to 11 years old (mean, 3 years), who were given oral chloral hydrate, 100 mg/kg, for sedation before MR imaging. The maximum total dose administered was 2.5 g, which limited the study to children who weighed 25 kg or less. Sedation was considered successful when MR studies were completed and at least 95% of the images had little or no motion artifact.

RESULTS

Sedation was successful in 273 (91%) of 300 children. It was unsuccessful in nine of the 203 children who were 48 months old or younger (96% success rate) and in 18 of the 97 children who were more than 48 months old (81% success rate). A single-tailed t-test showed that the children in whom sedation was unsuccessful were significantly older than those in whom it was successful to the .0005 level of significance. The failure rate increased steadily for children more than 48 months old. Several failures may also have resulted from lengthy examination times. Adverse reactions to chloral hydrate sedation included hyperactivity (6%), vomiting (4%), and mild respiratory depression (4%). No adverse reaction was severe enough to require hospitalization.

CONCLUSION

The higher failure rate for chloral hydrate sedation in children more than 48 months old suggests that the patient's age is an important limitation to the usefulness of chloral hydrate sedation for children undergoing MR imaging. However, the low rate of adverse reactions makes chloral hydrate a safe drug for sedation of children undergoing MR imaging.

Regulation of the tension of human chorionic vasculature by histamine and prostaglandin F2 alpha

The calcium dependence of potassium chloride-, prostaglandin F2 alpha (PGF2 alpha)-, and histamine-induced contractions of human chorionic vasculature segments was investigated. In physiologic buffer that contained 1.5 mM calcium chloride, 60 mM potassium chloride induced a rapid and sustained contraction of the vasculature. Potassium chloride-induced contractions were completely inhibited by the calcium channel blockers diltiazem and nifedipine or by excluding Ca2+ from the medium. Histamine (100 microM) induced a rapid increase in vascular tension in physiologic buffer which rapidly faded or desensitized after maximal tension was obtained. The maximal contractile responses to histamine were reduced approximately 50% by diltiazem and nifedipine in physiologic buffer or by suspension in calcium-free medium (OCaPB). Pretreatment of vessels with 20 mM caffeine in OCaPB completely abolished histamine-dependent contractile responses. Prostaglandin F2 alpha (100 nM)-induced increases in vascular tension developed slowly but remained maximal for at least 40 minutes. Contractile responses to PGF2 alpha were reduced 50% to 65% by diltiazem and nifedipine in physiologic buffer or by suspension in OCaPB. Caffeine pretreatment failed to alter the contractile response to PGF2 alpha in OCaPB. The differences in responsiveness of potassium chloride, histamine, and PGF2 alpha under the various conditions used suggest that these agents act by different mechanisms to elicit contractions in chorionic vessels. The potential roles of PGF2 alpha, histamine, and calcium channel blockers in modulating the fetoplacental circulation is discussed.

Enhancing interdepartmental relations

In summary, it is important that the hospital manager have a positive attitude; recognize that not all projects will gain approval and that competition with others for scarce resources is a reality. A well throughout plan, anticipating questions, objections, and including affected departments, is a necessary first step to enhancing the manager's image. Being a polished orator is not essential, but being organized is. Most important, a progressive, "can-do" attitude is always respected by others.

PharmaTrend as a management tool: evaluation of the program

A critical evaluation of PharmaTrend, a personal computer-based program for the analysis of pharmacy workload and productivity, is presented. The use of PharmaTrend is facilitated by a number of support features. A tutorial program instructs first-time and infrequent users on how to negotiate PharmaTrend's data-entry screens. The manual is well written and organized, and a toll-free number is available should more technical questions arise. However, some of PharmaTrend's definitions are confusing, as is the program's method of capturing workload data on the preparation of intravenous solutions. Some of the data currently maintained in pharmacies will need considerable modification before they can be used as PharmaTrend entries. A few minor changes would transform PharmaTrend from a good to an exceptional program. In addition to clearer definitions, an option allowing the user to edit the definitions shown on the screen is needed. A line should be added to the data-entry screen to remind the user that F1 is the help key. Reporting would be facilitated if deadlines were changed to reflect standard quarters. PharmaTrend is advantageous for the analysis of departmental operations because it provides regional and national standards for comparison. It can also help justify proposals and defend existing services and staffing. The monthly and quarterly reports generated with PharmaTrend are useful in analyzing pharmacy operations, and the user can modify work-load times on the basis of local circumstances. These difficulties notwithstanding, the current cost of PharmaTrend appears to be a bargain. Although some aspects of PharmaTrend need refinement, its basic features make it a valuable management tool.

A case of Dipylidium caninum in Baton Rouge, Louisiana

The relevant literature concerning human dipylidiasis has been reviewed with specific reference to the association of children and their pet dog and cats. A specific case is recounted which is considered to be typical of the condition as encountered by pediatricians and general practitioners.

Supportive personnel training program based at a technical college

A supportive personnel training program based at a technical college is described. During the nine-month curriculum, the students spend time in the classroom and in a laboratory on the college campus. Part of the program is taught by the college faculty, providing the students with courses on basic chemistry, anatomy and physiology, medical vocabulary, typing, and math fundamentals. The other part of the curriculum is taught by pharmacists, including courses on hospital pharmacy, pharmacology, and pharmacy mathematics. The students' first experiences with unit-dose and i.v.-admixture programs are in an artificial laboratory under controlled conditions. Later in the program, the students rotate through each of the participating hospitals for thorough on-the-job training. By combining the resources of a local technical college and the area hospitals, a uniform program of training supportive personnel has been implemented that produces enough technical support for all the participating hospital pharmacies.

Readability--its applicability to education of patients by pharmacy

The applicability of readability to the development of pharmacy educational materials is reviewed. The importance of reading skills must be recognized in all areas of education, including pharmacy patient education. If people are to perform certain tasks, they must understand the instructions for those tasks. To be understandable, the instructions must be written on the reading level of the people who will be following the instructions. Readability has been defined as those characteristics of reading materials, involving certain mental processes, that make for ease or difficulty of comprehension of the reading material. It is the task of the reader to use as few or as many of these mental processes as necessary to grasp the intended meaning of the material. It has been estimated that the average reading level of the American public is approximately 7th to 8th grade. However, many adults do not have sufficient reading skills to comprehend fully material written on these levels. Therefore, pharmacy educational material should be written on the reading level of the patient population it serves. Several readability formulas have been developed to evaluate the various characteristics of reading material that lead to reading comprehension. Among the ones recommended for use with pharmacy educational materials are the Fry Readability Graph and the Gunning Fog Index.

Pharmacy involvement in a multidisciplinary diabetic teaching program

The following article describes a method of developing a workable diabetic teaching program within a hospital setting. Emphasis is placed on involving other health professionals with expertise in their respective areas. Development of behavioral and learning objectives along with learning activities and methods of evaluation are discussed. The purposes of this program are: 1) to reduce the overlap in educational instructions given to patients with diabetes, and 2) to remove the problem of an unorganized patient education effort by placing such patients into a structured learning situation in which they feel comfortable and which is conducive to learning. This program has proved successful and provides a viable means of involving staff pharmacists with patients. It has taken a minimal amount of time and did not necessitate an increase in our staff.

Clinical usefulness of polymorphonuclear leukocyte vacuolization in predicting septicemia in febrile children

Vacuolization of the polymorphonuclear leukocyte (PMN) has generally been regarded as an indication of bacterial infection and has been particularly useful in diagnosing septicemia. In an effort to predict septicemia, peripheral blood smears from 69 febrile children were examined and systematically scored for severity of vacuolization. Thirteen children had remarkable vacuolization compared to the others. These 13 included only five children with bacterial illnesses and only one of the seven children with septicemia. Our finding that PMN vacuolization was neither diagnostic of septicemia nor predictive of bacterial infection suggests that the specificity of the link between vacuoles and bacteremia needs to be reassessed.

Perceptual correlates of the rod-and-frame test: a critical response

One of the recent research reports that has proffered a bifactorial explanation of field independence-dependence is critiqued for its use of factor analysis. A more traditional and conservative use of the statistic supports the original definition and suggests mirror-tracing speed as an additional assessment tool.

A CASE OF OBSTRUCTION OF THE STOMACH BY AN IMPACTED MASS OF HAIR

Images