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Glioblastoma is the most common primary malignant brain tumor in adults and is associated with poor survival. The Ivy Foundation Early Phase Clinical Trials Consortium conducted a randomized, multi-institution clinical trial to evaluate immune responses and survival following neoadjuvant and/or adjuvant therapy with pembrolizumab in 35 patients with recurrent, surgically resectable glioblastoma. Patients who were randomized to receive neoadjuvant pembrolizumab, with continued adjuvant therapy following surgery, had significantly extended overall survival compared to patients that were randomized to receive adjuvant, post-surgical programmed cell death protein 1 (PD-1) blockade alone. Neoadjuvant PD-1 blockade was associated with upregulation of T cell- and interferon-γ-related gene expression, but downregulation of cell-cycle-related gene expression within the tumor, which was not seen in patients that received adjuvant therapy alone. Focal induction of programmed death-ligand 1 in the tumor microenvironment, enhanced clonal expansion of T cells, decreased PD-1 expression on peripheral blood T cells and a decreasing monocytic population was observed more frequently in the neoadjuvant group than in patients treated only in the adjuvant setting. These findings suggest that the neoadjuvant administration of PD-1 blockade enhances both the local and systemic antitumor immune response and may represent a more efficacious approach to the treatment of this uniformly lethal brain tumor.

For previous and current influenza A pandemics, postmortem studies have established a strong link between secondary bacterial infections and increased deaths (1,2). Numerous respiratory pathogens can be detected from a [...]

The Grief Experience Inventory and the MMPI were used to assess bereavement reactions in newly bereaved individuals. Intensities of bereavement reactions were compared across types of deaths experienced, i.e., spouse, child, and parent. Significantly higher intensities of grief were noted in parents surviving their child's death. (Author)

Interviewed bereaved persons shortly after the death of a close family member and 18 months later. Respondents were grouped according to mode of death. The short-term chronic illness group made the most favorable adjustment. Sudden death and long-term chronic illness death groups sustained higher intensities of bereavement. (Author/RC)

Younger spouses initially manifested greater grief; older spouses showed exacerbated grief reactions. While denial seemed to be a defense against anxiety, elevations on the Social Isolation, Depersonalization, and Death Anxiety scales for older spouses showed the debilitating effects of loneliness and fear. (Author)

Developing T cells face a series of cell fate choices in the thymus and in the periphery. The role of the individual T cell receptor (TCR) in determining decisions of cell fate remains unresolved. The stochastic/selection model postulates that the initial fate of the cell is independent of TCR specificity, with survival dependent on additional TCR/coreceptor "rescue" signals. The "instructive" model holds that cell fate is initiated by the interaction of the TCR with a cognate peptide-MHC complex. T cells are then segregated on the basis of TCR specificity with the aid of critical coreceptors and signal modulators [Chan S. Correia-Neves M, Benoist C, Mathis (1998) Immuno! Rev 165: 195-207]. The former would predict a random representation of individual TCR across divergent T cell lineages whereas the latter would predict minimal overlap between divergent T cell subsets. To address this issue, we have used highthroughput sequencing to evaluate the TCR distribution among key T cell developmental and effector subsets from a single donor. We found numerous examples of individual subsets sharing identical ICR sequence, supporting a model of a stochastic process of cell fate determination coupled with dynamic patterns of clonal expansion of T cells bearing the same TCR sequence among both CD4+ and CD8+ populations. [ABSTRACT FROM AUTHOR]

Many individuals who commit suicide are in psychological treatment at the time of their deaths. This article discusses the responses of therapists who have had a client who suicided. It has been shown that mental health professionals are vulnerable to grief reactions similar to those of close friends or family members. Severe anxiety and guilt comingle with feelings of defeat and despair. Professional competence is threatened and there appears a general attitude of having been betrayed by the client. It is important that therapists have adequate outlets for processing their emotional reactions to suicide without which their personal and professional functioning is jeopardized. It was concluded that the working through of grief responses can take months and is often akin to a process similar to a rite of passage. [ABSTRACT FROM PUBLISHER]

THE LAST LETTER TO THE PEBBLE PEOPLE: “Aldie Soars”, by Virginia Mine, Miami: St. Alden's in the Weeds, 138 pages, 1977, $5.50. Reviewed by Jeanne Achterberg, The University of Texas Health Science Center at Dallas. THE HUMAN ENCOUNTER WITH DEATH, by Stanislav Grof and Joan Halifax, New York: E. P. Dutton, 1977, 240 pages, $3.95 (soft cover), ISBN 0–525–47492–7. Reviewed by Richard A. Kalish, California School of Professional Psychology, Berkeley. THE BEREAVED PARENT, by Harriet Sarnoff Schiff, New York: Crown, 1977, 146 pages, $7.95, ISBN 0–517–52681–6. Reviewed by Margaret Shandor Miles, School of Nursing and Medicine, University of Kansas College of Health Sciences and Hospital. THE PSYCHOLOGY OF DEATH, DYING AND BEREAVEMENT, by Richard Schulz, Reading, Mass.: Addison-Wesley, 1978, 197 pages. Reviewed by Jon W. Hoelter, Bowling Green State University. FREEDOM TO DIE: Moral and Legal Aspects of Euthanasia, by O. Ruth Russell, New York: Dell, 1977, $14.95, ISBN 0-87705-311-1. Reviewed by Russell G. Henke, Temple University. THE WOMAN SAID YES: Encounters with Life and Death, by Jessamyn West, New York: Harcourt, 1976, $7.95, ISBN 0–15–198400-X. Reviewed by David J. Irvine, New York State Education Department. DEATH AND DYING EDUCATION, by Richard O. Win Washington, D.C.: National Education Association, 1977, 77 pages, $4.00 (paper), $7.25 (cloth). Reviewed by Murionne D. Cideon, Albert Einstein Medical Center, Philadelphia. [ABSTRACT FROM PUBLISHER]