Biomedical subjects

James Moon

Publications and source records attributed to James Moon.

12 recordsLinked to original sources

PubMed2006

A phase II evaluation of a 3-hour infusion of paclitaxel, cisplatin, and 5-fluorouracil in patients with advanced or recurrent squamous cell carcinoma of the head and neck: Southwest Oncology Group study 0007.

BACKGROUND: Previous data from an institutional pilot study in patients with advanced or recurrent squamous cell carcinoma of the head and neck (SCCHN) who received treated a combined chemotherapy regimen of paclitaxel, cisplatin, and 5-fluorouracil indicated an overall response rate of 60% and a median survival of 6 months. To validate these results and to determine the feasibility of this combination, a Phase II study was conducted by the Southwest Oncology Group (SWOG S0007). METHODS: Patients with advanced or recurrent SCCHN were eligible if they had received 1 previous regimen of induction/adjuvant chemotherapy or no prior systemic therapy. Patients received treatment with paclitaxel (135 mg/m(2) on Day 1), followed by cisplatin (75 mg/m(2) on Day 1), and 5-fluorouracil (1000 mg/m(2)per day as a 96-hour continuous infusion on Days 1-4) every 21 days. RESULTS: Seventy-six patients received a combined total of 286 cycles of chemotherapy. Sixty-nine patients were evaluable for response. There were 5 complete responses (7%) and 23 partial responses (33%) partial responses, for an overall response rate of 41%. The median progression-free survival was 4 months, and the median overall survival was 10 months. Six treatment-related deaths were documented, including deaths in 2 patients who had a Zubrod PS of 2. Grade 3 or 4 neutropenia (according to National Cancer Institute Common Toxicity Criteria [version 2.0]) was observed in 47% of patients. Other Grade 3 or 4 adverse events included mucositis (34% of patients), nausea (20% of patients), anemia (9% of patients), and neuropathy (8% of patients). CONCLUSIONS: The combination of paclitaxel, cisplatin, and 5-fluorouracil had efficacy similar to that of standard treatment regimens in patients with advanced or recurrent SCCHN but with increased toxicity.

Adult↗

PubMed2006

Microfluidic alignment of collagen fibers for in vitro cell culture.

Three dimensional gels of aligned collagen fibers were patterned in vitro using microfluidic channels. Collagen fiber orientation plays an important role in cell signaling for many tissues in vivo, but alignment has been difficult to realize in vitro. For microfluidic collagen fiber alignment, collagen solution was allowed to polymerize inside polydimethyl siloxane (PDMS) channels ranging from 10-400 microm in width. Collagen fiber orientation increased with smaller channel width, averaging 12+/-6 degrees from parallel for channels between 10 and 100 microm in width. In these channels 20-40% of the fibers were within 5 degrees of the channel axis. Bovine aortic endothelial cells expressing GFP-tubulin were cultured on aligned collagen substrate and found to stretch in the direction of the fibers. The use of artificially aligned collagen gels could be applied to the study of cell movement, signaling, growth, and differentiation.

Adsorption↗

PubMed2006

Contrast echocardiography versus gated single photon emission computed tomography for the assessment of parameters of left ventricular remodeling after acute myocardial infarction.

BACKGROUND: Assessment of parameters of left ventricular (LV) remodeling after acute myocardial infarction (AMI) has both therapeutic and prognostic implication. Contrast echocardiography (CE) has the advantage of simultaneously assessing myocardial perfusion and LV remodeling. We aimed to evaluate the accuracy of CE to assess LV remodeling after AMI compared with technetium-99m sestamibi gated single photon emission computed tomography (SPECT). METHODS: Accordingly, 36 consecutive patients underwent gated SPECT, CE, and cardiovascular magnetic resonance imaging (CMR) 7 to 10 days after AMI. LV ejection fraction (LVEF), and LV end-systolic and end-diastolic volumes were assessed. RESULTS: Absolute differences for LVEF and LV end-diastolic volume between CMR and CE were significantly smaller than that between CMR and SPECT. CE estimate of LVEF more accurately classified patients into LVEF less than 35%, 35% to 45%, and greater than 45% (agreement = 83%, kappa = 0.66 with CMR) compared with SPECT (agreement = 61%, kappa = 0.36 with CMR). CONCLUSION: CE is more accurate than gated SPECT for the estimation of LV remodeling after AMI.

Echocardiography↗

PubMed2005

Impact of cryopreservation on tetramer, cytokine flow cytometry, and ELISPOT.

BACKGROUND: Cryopreservation of PBMC and/or overnight shipping of samples are required for many clinical trials, despite their potentially adverse effects upon immune monitoring assays such as MHC-peptide tetramer staining, cytokine flow cytometry (CFC), and ELISPOT. In this study, we compared the performance of these assays on leukapheresed PBMC shipped overnight in medium versus cryopreserved PBMC from matched donors. RESULTS: Using CMV pp65 peptide pool stimulation or pp65 HLA-A2 tetramer staining, there was significant correlation between shipped and cryopreserved samples for each assay (p <or= 0.001). The differences in response magnitude between cryopreserved and shipped PBMC specimens were not significant for most antigens and assays. There was significant correlation between CFC and ELISPOT assay using pp65 peptide pool stimulation, in both shipped and cryopreserved samples (p <or= 0.001). Strong correlation was observed between CFC (using HLA-A2-restricted pp65 peptide stimulation) and tetramer staining (p < 0.001). Roughly similar sensitivity and specificity were observed between the three assays and between shipped and cryopreserved samples for each assay. CONCLUSION: We conclude that all three assays show concordant results on shipped versus cryopreserved specimens, when using a peptide-based readout. The assays are also concordant with each other in pair wise comparisons using equivalent antigen systems.

Antigen Presentation↗

PubMed2005

Extreme regression.

We develop a new method for describing patient characteristics associated with extreme good or poor outcome. We address the problem with a regression model composed of extrema (maximum and minimum) functions of the predictor variables. This class of models allows for simple regression function inversion and results in level sets of the regression function which can be expressed as interpretable Boolean combinations of decisions based on individual predictors. We develop an estimation algorithm and present clinical applications to symptoms data for patients with Hodgkin's disease and survival data for patients with multiple myeloma.

Algorithms↗

PubMed2005

Organ preservation for advanced resectable cancer of the base of tongue and hypopharynx: a Southwest Oncology Group Trial.

PURPOSE: The Southwest Oncology Group designed a phase II trial for patients with base of tongue or hypopharyngeal cancer to evaluate the complete histologic response rate at the primary site after induction chemotherapy followed by chemoradiotherapy for responders. Secondary end points were the rate of organ preservation and the need for salvage surgery. PATIENTS AND METHODS: Fifty-nine eligible patients were enrolled; 37 had base of tongue cancer, and 22 had hypopharynx cancer. Forty-two percent had stage III disease, and 58% had stage IV disease. Induction chemotherapy was two cycles of cisplatin 100 mg/m(2) and fluorouracil 1,000 mg/m(2)/d for 5 days. Patients who had a greater than 50% response at the primary site were treated with radiation 72Gy and concurrent cisplatin 100 mg/m(2) for three cycles. Patients with less than partial response at the primary had immediate salvage surgery. RESULTS: Forty-five patients (76%) had a greater than 50% response at the primary after induction chemotherapy; 43 went on to receive definitive chemoradiotherapy. Thirty-two patients (54%) achieved a histologic complete response at the primary site, and an additional nine patients had a complete clinical response, but biopsy was not done. Seventy-five percent of patients did not require surgery at the primary tumor site. The 3-year overall survival was 64%. The 3-year progression-free survival with organ preservation was 52%. CONCLUSION: Patients with base of tongue or hypopharyngeal cancer treated with this regimen of induction chemotherapy followed by definitive chemoradiotherapy have a good rate of organ preservation without compromise of survival.

Adult↗

PubMed2005

Improved accuracy of low-power contrast echocardiography for the assessment of left ventricular remodeling compared with unenhanced harmonic echocardiography after acute myocardial infarction: comparison with cardiovascular magnetic resonance imaging.

BACKGROUND: Assessment of left ventricular (LV) remodeling after acute myocardial infarction (AMI) has both therapeutic and prognostic implications. Low-power contrast echocardiography (CE) has the advantage of simultaneously assessing myocardial perfusion and LV remodeling. OBJECTIVE: This study aimed to evaluate the accuracy of low-power CE to assess LV remodeling after AMI compared with unenhanced harmonic echocardiography (HE). METHODS: A total of 36 consecutive patients underwent HE, CE (SonoVue), and cardiovascular magnetic resonance (CMR) imaging 7 to 10 days after AMI. Left ventricular ejection fraction (LVEF), end-systolic volume (LVESV), and end-diastolic volume (LVEDV) were assessed. RESULTS: Absolute differences for LVESV and LVEDV between CMR and CE were significantly smaller than those between CMR and HE. CE estimate of LVEF more accurately classified patients into LVEF < 35%, 35% to 45%, and > 45% (agreement, 83%; kappa = 0.66 with CMR) compared with HE (agreement, 69%; kappa = 0.33 with CMR). CONCLUSIONS: Low-power CE is more accurate than HE for estimating LV remodeling after AMI.

Echocardiography↗

PubMed2005

Adaptive risk group refinement.

We construct interpretable prognostic rules based on a sequence of "box-shaped" regions in the predictor space indexed by the fraction of patients in the prognostic group. In addition, the method can be used as a building block to construct more general prognostic rules based on unions of boxes, or even as a tool to find multiple prognostic groups. Simulations are used to study the properties of the new method and compare it to constructing prognostic groups based on regression trees and linear proportional hazards (PH) models. We consider an example based on data from several completed clinical trials for patients with multiple myeloma.

Algorithms↗

PubMed2004

A Phase II trial of vinorelbine tartrate in patients with disseminated malignant melanoma and one prior systemic therapy: a Southwest Oncology Group study.

BACKGROUND: Single-agent chemotherapy with dacarbazine continues to be the standard of care for the treatment of metastatic melanoma. However, there is a large population of patients who have failed first-line therapy and might benefit from additional treatment. In the current study, the authors evaluated the antitumor effects and toxicity of vinorelbine therapy in patients who had failed one prior systemic therapy. METHODS: Patients were required to have a histologic diagnosis of melanoma and be of Stage IV with measurable disease, a Southwest Oncology Group (SWOG) performance status (PS) of 0-2, no evidence of brain metastases, and adequate bone marrow and liver function. Treatment was comprised of vinorelbine given at a dose of 30 mg/m(2)/week by intravenous bolus. RESULTS: Twenty-four patients were registered to the study, 3 of whom were determined to be ineligible. The 21 eligible patients had a median age of 58 years with a SWOG PS of 0 in 7 patients, 1 in 13 patients, and 2 in 1 patient. There were no complete or partial responses observed, for a response rate of 0 of the 21 patients studied (95% confidence interval [95% CI], 0-16%); the study closed after the first stage of accrual. The estimated median progression-free survival was 2 months (95% CI, 1.5-3.3 months) and the estimated median overall survival was 6 months (95% CI, 3.7-8.3 months). There was one death due to febrile neutropenia reported, with six patients experiencing one or more Grade 4 toxicities, including neutropenia/granulocytopenia, leukopenia, dyspnea, and fatigue. CONCLUSIONS: Despite impressive preclinical activity against melanoma, vinorelbine does not appear to have enough clinical activity to be of interest in previously treated patients with disseminated melanoma. The progression-free and overall survival results noted in previously treated patients in the current study were similar to results reported in prior SWOG Phase II trials in untreated patients. The group of previously treated patients may be used to evaluate new agents for the treatment of disseminated melanoma.

Adult↗

PubMed2004

Wasting of the left ventricle in patients with cardiac cachexia: a cardiovascular magnetic resonance study.

BACKGROUND: The "cachectic heart" has been described as a pathologic decrease in the size and mass of the heart, but no in vivo studies have shown changes in cardiac dimensions or left ventricular (LV) mass over time in chronic heart failure (CHF) associated with body wasting (cardiac cachexia). Cardiovascular magnetic resonance (CMR) has high reproducibility and is more sensitive than other techniques. METHODS: CMR studies of LV volumes and mass were performed at baseline and a mean of 15 months later in nine CHF patients with cardiac cachexia and 28 matched CHF controls without cachexia (mass index 23 +/- 1 vs. 29 +/- 5 kg/m2, P=0.0005). RESULTS: At baseline, LV end-diastolic volume (197 +/- 78 vs. 203 +/- 65 ml), end-systolic volume (131 +/- 75 vs. 126 +/- 63 ml), LV mass (213 +/- 44 vs. 222 +/- 62 g), and LV ejection fraction (38 +/- 19% vs. 40 +/- 16%) did not differ between cachectic patients and controls (all P>0.10). During follow-up, there was a significant decrease in LV mass in patients with cachexia (-16 g, P<0.05) and a trend to increase in LV mass in patients without cachexia (+7 g, P=0.12, comparison between groups: P=0.010). CONCLUSIONS: The direction of changes over time in LV mass differs in CHF patients with cachexia as compared with non-cachectic controls. A significant decrease in LV mass occurs in patients with cardiac cachexia. This study documents in vivo the occurrence of wasting of the left ventricle in patients with CHF who demonstrate general body wasting.

Aged↗

PubMed2004

Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model.

BACKGROUND: Sentinel lymph node (SLN) biopsy allows surgeons to identify patients with subclinical nodal involvement who may benefit from lymphadenectomy and, possibly, adjuvant therapy. Several factors have been variably, and sometimes discordantly, reported to have predictive value for SLN metastasis to best select which patients require SLN biopsy. METHODS: We reviewed 419 patients who underwent SLN biopsy for melanoma from a prospectively collected melanoma database. To derive a probabilistic model for the occurrence of a positive SLN, a multivariate logistic model was fit by using a stepwise variable selection method. The accuracy of each model was evaluated by using receiver operator characteristic curves. RESULTS: On univariate analysis, the number of mitoses per square millimeter, increasing Breslow depth, decreasing age, ulceration, and melanoma on the trunk showed a significant relationship to a positive SLN. Multivariate analysis revealed that once age, mitotic rate, and Breslow thickness were included, no other factor, including ulceration, was significantly associated with a positive SLN. The data suggest that younger patients with tumors <1 mm may still have a substantial risk for a positive SLN, especially if the mitotic rate is high. CONCLUSIONS: In addition to Breslow depth, mitoses per square millimeter and younger age were factors identified as independent predictors of a positive SLN. This model may identify patients with thin melanoma at sufficient risk for metastases to justify SLN biopsy.

Adult↗

PubMed2004

Prevalence of leptospira antibodies in U.S. Army blood bank donors in Hawaii.

Leptospirosis is a zoonotic infection of worldwide distribution that is commonly endemic in tropical regions. In the United States, the annual incidence rate in the state of Hawaii is approximately 30 times higher than that reported nationally. U.S. troops deployed to disease-endemic tropical environments and those training in the state of Hawaii are potentially at high risk for acquiring leptospirosis. Serum and risk factor data were obtained from 488 blood donors attending military-sponsored blood drives on the island of Oahu. Testing of sera for the presence of Leptospira-specific antibodies was performed with microscopic agglutination testing (MAT). Seven active duty U.S. Army soldiers were found to be seropositive by MAT (seroprevalence, 1.4%), 2 of 76 newly arrived residents (2.6%) and 5 of 412 established residents (1.2%). Positive MAT results were statistically more common among female subjects and those 18 to 30 years old. Seropositivity was not associated with specific exposures or prolonged residence in the state of Hawaii.

Adolescent↗