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Biomedical subjects

K Buhrer

Publications and source records attributed to K Buhrer.

7 recordsLinked to original sources

Antigen processing of vesicular stomatitis virus in situ. Interdigitating dendritic cells present viral antigens independent of marginal dendritic cells but fail to prime CD4(+) and CD8(+) T cells.

Acute macrophage (M phi) depletion, using a liposome-mediated 'suicide technique', markedly suppressed priming of splenic CD4(+) and CD8(+) T-cell responses to vesicular stomatitis virus (VSV). However, phagocytic marginal dendritic cells (MDC), but not interdigitating dendritic cells (IDC), are now known to be also depleted by this technique. To clarify the role splenic dendritic cell (DC) subsets and M phi play in priming for a virus-specific T-cell-mediated immune response, DC and M phi were purified from VSV-infected mice and assayed for the presence of epitopes recognized by VSV helper T (Th) cells and cytotoxic T lymphocytes (CTL). Antigen pulse experiments performed in situ demonstrated that VSV Th cell and CTL epitopes became transiently associated only with DC, but not M phi or B cells, indicating that DC represent the critical antigen-presenting cell (APC) population in vivo for this virus. The failure of MDC/M phi-deficient mice to become primed was not due to the complete elimination of antigen-presenting DC because VSV peptide/class I and II complexes were detected on IDC following lipsome-mediated elimination of phagocytic cells. However, the VSV-induced chemokine response was dramatically suppressed in these mice. Thus, despite the expression of VSV peptide/class I and II complexes, IDC are not sufficient to prime VSV Th cells in the absence of MDC and/or splenic M phi.

Animals↗

T cell priming against vesicular stomatitis virus analyzed in situ: red pulp macrophages, but neither marginal metallophilic nor marginal zone macrophages, are required for priming CD4+ and CD8+ T cells.

Since extensive degradation may be required to present complex Ags, we addressed whether macrophages (M phi) might function as APC for anti-viral cell-mediated immune responses. To study this question, murine splenic M phi were depleted by i.p. administration of liposome-encapsulated dichloromethylene diphosphonate (Cl2MDP-liposomes or clodronate-liposomes) before priming mice with vesicular stomatitis virus (VSV). Cl2MDP-liposome treatment resulted in the rapid (1-day) depletion of splenic M phi that was associated with a suppression of the ability of M phi-deficient mice to generate secondary anti-VSV CTL and Th cell proliferative responses in vitro. Control studies demonstrated that splenic dendritic cells were not adversely affected by treatment with Cl2MDP-liposomes. To assess the contribution of splenic M phi subpopulations to T cell priming against this virus, priming was delayed following treatment with Cl2MDP-liposomes until specific M phi subsets had repopulated the spleen. This analysis revealed that repopulation by red pulp M phi, but not with other splenic M phi subsets, was associated with the ability to mount normal secondary CTL and Th cell responses against VSV. Depletion of splenic, but not resident, peritoneal M phi by i.v. injection of Cl2MDP-liposomes did not rescue T cell priming in VSV-infected mice. Thus, only red pulp M phi, and not other splenic or peritoneal M phi populations, are necessary for T cell priming to VSV, a biochemically complex Ag.

Animals↗

Perspectives on a state enacted hearing screening assessment program in the newborn population.

OBJECTIVE: A review of the early performance of Ohio's statewide infant hearing screening program was performed to provide insight as to the impact of the current medical and socioeconomic climate on its implementation. BACKGROUND: In March 1988, the State of Ohio enacted a law that required universal screening of newborn children for hearing loss through a program known as the Infant Hearing Screening and Assessment Program (IHSAP). The program design consisted of a universally applied high-risk questionnaire followed by a screening auditory assessment for those who fail. Although the value of such a program engendered little early public debate, the institution of such a program represented a significant challenge from a public health perspective. STUDY DESIGN: The program performance was analyzed using data from the index population of 160,000 live births per annum and hospital surveys. RESULTS: The questionnaires were found to be failing twice the number of newborns as originally projected, whereas completion rates and compliance were excellent. The assessment arm was plagued with poor compliance rates and limited resources. Lack of resources for effective data management has prevented an accurate evaluation of the program's sensitivity and specificity. CONCLUSION: IHSAP performance is being hampered by poor assessment follow-up and resource limitations, both in terms of screening equipment and habilitative follow-up services for infants identified as hearing impaired. The reasons for these problems are discussed in relation to existing legislative guidelines and medicoeconomic realities.

Audiology↗

Ohio's infant hearing screening and assessment program. A decade in development.

The early detection of hearing impairments in infants is essential to the initiation of medical and educational services which will enhance optimal development of communication and social skills. Ohio has successfully implemented a legislatively mandated two-tiered Infant Hearing Screening and Assessment Program. This statewide screening program is in accordance with the child find and early intervention services requirements of P.L. 99-457.

Child Health Services↗

Reliability and performance of the acoustic reflectometer.

Test-retest reliability and performance of an acoustic reflectometer were evaluated for 78 patients in two clinical settings. For a majority of the cases, the repeat measurements did not vary by more than one or two units from the first measurement. The accuracy of the instrument, when compared with standard clinical instruments, indicated that the acoustic reflectometer performed adequately with cases of middle ear effusion and could be used most effectively as a supplement to pneumatic otoscopy.

Acoustic Impedance Tests↗

The acoustic reflectometer as a screening device: a comparison.

Sixty children (120 ears) were evaluated using reflectometry, pure tones, immittance, otologic examination, and pure-tone air and bone conduction thresholds. Comparisons were made between the various screeners. Reflectometry was found to be the least sensitive and the least specific of the procedures. Results were then examined within each diagnostic category to determine test agreement with the otologists' judgments. The reflectometer categorization was found to be inconsistent with the otologic findings. Finally, the reflectometer was compared to each of the other screener results and pure-tone thresholds. The test results were significantly correlated but showed high over- and under-referral rates for the reflectometer. Seventy-eight children and adults (156 ears) were screened in a second study. Again, the acoustic reflectometer did not perform adequately as a general screening tool. When only cases of middle ear effusion were screened, the acoustic reflectometer did not perform as well as immitance.

Acoustics↗