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Biomedical subjects

N Schmitz

Publications and source records attributed to N Schmitz.

At least 73 records · Page 4Linked to original sources
PubMed2000

Blood stem cells compared with bone marrow as a source of hematopoietic cells for allogeneic transplantation. IBMTR Histocompatibility and Stem Cell Sources Working Committee and the European Group for Blood and Marrow Transplantation (EBMT).

Peripheral blood cells are increasingly used in place of bone marrow as a source of hematopoietic stem cells for allogeneic transplantation. The relative efficacy of these 2 approaches is unknown. This retrospective multivariate analysis compared results of 288 HLA-identical sibling blood stem cell transplantations with results of 536 HLA-identical sibling bone marrow transplantations. No transplants were T-cell depleted. Median follow-up was 12 months, and analyses focused on 1-year outcomes. Recipients of blood stem cell transplants had more rapid recovery of neutrophils to at least 0.5 x 10(9)/L (median time to recovery, 14 days, compared with 19 days for marrow transplants; P <.001) and of platelets to at least 20 x 10(9)/L (median time, 18 days, compared with 25 days for marrow transplants; P <.001). There was no significant difference in the incidence of grades II to IV acute graft versus host disease (GVHD). The incidence of chronic GVHD was significantly higher after blood stem cell transplantation (1-year probability [95% confidence interval], 65% [56%-72%] compared with 53% [47%-59%]; P =.02) Relapse incidence in the 2 transplant groups did not differ significantly. Treatment-related mortality rates were lower and leukemia-free survival rates were higher with blood stem cell transplants in patients with advanced leukemia (acute leukemia in second remission or chronic myelogenous leukemia in accelerated phase) but not in early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in chronic phase). The median time from transplantation to hospital discharge was 23 days after blood stem cell transplantation and 28 days after bone marrow transplantation (P =.003). Further study with longer follow-up is necessary to definitively establish the role of blood stem cells for allogeneic transplantation, especially in patients with good-risk disease. (Blood. 2000;95:3702-3709)

Acute Disease↗
PubMed2000

The network of brain areas involved in the motion aftereffect.

A network of brain areas is expected to be involved in supporting the motion aftereffect. The most active components of this network were determined by means of an fMRI study of nine subjects exposed to a visual stimulus of moving bars producing the effect. Across the subjects, common areas were identified during various stages of the effect, as well as networks of areas specific to a single stage. In addition to the well-known motion-sensitive area MT the prefrontal brain areas BA44 and 47 and the cingulate gyrus, as well as posterior sites such as BA37 and BA40, were important components during the period of the motion aftereffect experience. They appear to be involved in control circuitry for selecting which of a number of processing styles is appropriate. The experimental fMRI results of the activation levels and their time courses for the various areas are explored. Correlation analysis shows that there are effectively two separate and weakly coupled networks involved in the total process. Implications of the results for awareness of the effect itself are briefly considered in the final discussion.

Adult↗
PubMed2000

Application of stratum-specific likelihood ratios in mental health screening.

BACKGROUND: The accuracy of a diagnostic procedure is commonly assessed by measuring sensitivity, specificity and positive and negative predictive values. Likelihood ratios provide an alternative method for describing these results, though they are typically reported only for dichotomized outcomes. However, likelihood ratios can also be applied to ordinal or continuous results. METHODS: The present paper discusses the application of stratum-specific likelihood ratios in a primary care setting using the General Health Questionnaire (GHQ-12) and the Symptom Check List 90-R (SCL-90-R). A randomly selected sample (n = 408) of adult outpatients from primary care offices in Düsseldorf was screened using the German versions of the GHQ-12 and the SCL-90-R. RESULTS: Logistic regression analysis indicated that stratum-specific or multilevel likelihood ratios preserve more information than a fixed threshold approach with a single cutoff point. For each test, five clinically useful strata with monotonically increasing stratum-specific likelihood ratios were selected. CONCLUSIONS: Stratum-specific likelihood ratios have enormous practical value, and they are becoming an important way of expressing and comparing the usefulness of different tests. Stratum-specific likelihood ratios reduce the spectrum bias that might arise if only two categories (cases and non-cases) are chosen. Additionally, multilevel likelihood ratios can be used as bedside information to obtain the post-test probability from the pre-test probability of the disorder.

Adult↗
PubMed2000

Transplant activities in Germany in 1998--a survey facilitated by the National Registry for Hemopoietic Stem Cell Transplantation.

To improve the infrastructure of hemopoietic stem-cell transplantations in our country, the German Registry for Hemopoietic Stem-Cell Transplantations (DRST) was established in 1998. The present paper summarizes the current status of the DRST and gives a survey of transplant activities in Germany in 1998 in terms of transplant units, transplant types, transplant frequencies and underlying diseases.

Blood Cells↗
PubMed2000

Stress, burnout and locus of control in German nurses.

The aim of this study was to evaluate the effects of locus of control and work-related stress on burnout in hospital staff nurses. A convenience sample of 361 staff nurses from nine units in five German hospitals were surveyed using the Maslach Burnout Inventory, the Locus of Control Questionnaire and a Work-Related Stress Inventory. Causal modeling was used to explore the moderating effect of locus of control on burnout. Results support the hypothesized model and suggest that greater work-related stress and burnout would be associated with poorer locus of control in nurses. The findings supported the notion that perceived degree of control is instrumental in enabling nurses to cope with stress and burnout.

Adaptation, Psychological↗
PubMed2000

A prospective study of positive/negative ex vivo B-cell depletion in patients with chronic lymphocytic leukemia.

OBJECTIVE: Autologous peripheral blood stem cell (PBSC) transplantation is increasingly being used in patients with chronic lymphocytic leukemia (CLL). As the autografts are frequently contaminated with large numbers of tumor cells, we have prospectively investigated the feasibility and efficacy of ex vivo double purging of PBSC grafts in an open, nonrandomized, single-center phase I/II clinical study. MATERIALS AND METHODS: Twenty consecutive patients with poor-risk CLL underwent uniform stem cell mobilization with chemotherapy and granulocyte colony-stimulating factor (G-CSF). Double B-cell depletion of the harvested PBSC products was performed using immunomagnetic CD34(+) cell selection (Isolex300i Nexell, Irvine, CA) followed by a negative step with anti-CD19/20/23/37-labeled immunomagnetic beads. The purified PBSC were reinfused after myeloablative treatment with TBI/CY. RESULTS: A total of 25 separation runs was accomplished using collection products containing 3.4% (1.1-8.1) CD34(+) cells and 1.2% (0.1-42) CD19(+)CD5(+) CLL cells. After double selection, 33% (15-67) CD34(+) cells were recovered with a purity of 98.8% (89.1-99. 8). CLL cells were undetectable by high-resolution flow cytometry in 15 of 25 final products; median purging efficacy was 5 (4.1-6) log. The CD34(+) content of the 20 final grafts was 4.6 (2.2-6.5) x 10(6)/kg. Rapid and durable engraftment developed in all cases. With a median follow-up of 20 (6-29) months, 17 patients live in complete clinical remission, two have recurrent disease, and one patient died due to pulmonary embolism five months after transplant. Persistence of the leukemic clone on the molecular level was demonstrated by dot blotting with clone-specific CDR3 probes in an additional five patients. Serious or unexpected infectious complications did not occur. CONCLUSIONS: Positive/negative purging with the Isolex system allows preparation of highly purified CD34(+) fractions and up to six log of tumor cell depletion in patients with B-CLL and can be safety reinfused after myeloablative therapy without affecting hematopoietic engraftment.

Adult↗
PubMed2000

The Symptom Check-List-90-R (SCL-90-R): a German validation study.

The Symptom Check-List-90-R (SCL-90-R) is a widely used psychological status symptom inventory. The properties of the German SCL-90-R version were studied in two clinical samples: psychosomatic outpatients and primary care patients. The data were compared with a German community sample. The internal consistency, measured by Cronbach's alpha coefficients, was found to be high, for the global scale and all original subscales. Mokken scale analysis indicated hierarchical structure for most of the subscales. Concurrent validity, evaluated by studying the relationship between the SCL-90-R subscales and the Inventory of Interpersonal Problems (IIP-C) and the General Health Questionnaire (GHQ-12) was also high. On the basis of receiver operating characteristic (ROC) analyses, it was found that the SCL-90-R was able to differentiate between subjects known to have a given psychological disorder and those who do not. Results of exploratory and confirmatory factor analysis failed to support the original nine factor model and two subsequent factor models. The strong interdependence of the original subscales and the strong first unrotated factor of the exploratory factor analyses raised concern regarding the multi-dimensionality of the SCL-90-R subscales. We concluded that the SCL-90-R is a useful tool for measuring psychological status, measuring change in outcome studies, or screening for mental disorders.

Adult↗
PubMed2000

Comparison of the standard and the computerized versions of the Symptom Check List (SCL-90-R): a randomized trial.

OBJECTIVE: The purpose of this study was to examine whether computer administration of the Symptom Check List (SCL-90-R) is equivalent to paper-and-pencil originals. METHOD: 282 psychosomatic outpatients were randomly assigned to computer or paper-and-pencil conditions. Statistical equivalence tests were used to examine psychometric equivalence for the means. Reliabilities and correlations were compared for the two methods of administration. RESULTS: No systematic differences were observed in group means for most of the subscales. Subjects of the computer-administered group scored higher on the SCL-90-R subscale 'Obsessive-Compulsive' and 'Anger-Hostility' than the control subjects. Gender and administration mode interaction was observed for one subscale, while age and administration interaction was observed for another subscale. CONCLUSION: Using computer-administered tests makes administration and scoring of tests more efficient. The differences between the two administration modes were small, although noticeable. Further research is needed to determine whether computer environment, computer experience and age may influence the test results.

Adult↗
PubMed2000

The impact of autologous stem cell transplantation on the prognosis of mantle cell lymphoma: a joint analysis of two prospective studies with 46 patients.

INTRODUCTION: The purpose of this analysis was to investigate if early sequential high-dose therapy with autologous stem cell transplantation (ASCT) can improve the poor prognosis of patients with disseminated mantle cell lymphoma (MCL). PATIENTS AND METHODS: A joint analysis of two parallel single center studies was performed. Both were characterized by a sequential high-dose therapy consisting of an intensive chemotherapy ('HAM' or 'Dexa-BEAM') for mobilization of peripheral blood stem cells and induction of minimal disease followed by a total body irradiation-containing myeloablative regimen and ASCT. Forty-six patients with reference panel-confirmed stage III/IV MCL were included. Thirty-four patients were accrued to the protocol immediately after diagnosis ('upfront ASCT' group). These 34 patients received a standard first-line regimen prior to mobilization. The remaining 12 patients were put on the protocol later during the course of their disease ('delayed ASCT' group). RESULTS: All patients were in remission after mobilization chemotherapy and proceeded to ASCT; there were no exclusions due to poor response, poor mobilization, or patient refusal. With a follow-up of 24 (2-73) months post transplant, the event-free and overall survival probabilities at 2 years were 77 and 100% for the upfront ASCT group compared to 30% (P=0.0007) and 54% (P=0.0016) for the delayed ASCT group. Event-free and overall survival tended to be longer in the upfront ASCT group than in the delayed ASCT group also if calculated from initial diagnosis (76 and 93% vs 42 and 63%, respectively, at 4 years after diagnosis; median follow-up 35 months), although this was not statistically significant. Besides timing of ASCT, only spleen size was identified as an independent predictor of survival by univariate and multivariate analysis. CONCLUSION: ASCT is not curative but may improve the prognosis of patients with MCL if performed as part of an intensive first-line treatment strategy. In contrast, the benefits of this approach for salvaging individuals with relapsed disease appear to be limited.

Adult↗
PubMed2000

Is there a graft-versus-leukaemia effect in the absence of graft-versus-host disease in patients undergoing bone marrow transplantation for acute leukaemia?

During a 13-year period, 5200 autografts, 1039 HLA-identical sibling transplants without acute or chronic graft-vs.-host disease (GVHD) and 67 twins were reported to the European Group for Blood and Marrow Transplantation EBMT. Follow-up time was a median of 32 months. Diagnoses were acute myeloid leukaemia (AML, 4521) and acute lymphoblastic leukaemia (ALL, 1785) in first complete remission. The probability of relapse at 5 years was 51 +/- 1% in the autografts, 45 +/- 8% in the twins and 34 +/- 2% among the HLA-identical siblings (auto vs. sibs, P < 0.0001). In multivariate analyses, the following factors were significantly associated with an increased risk of relapse: ALL vs. AML M3 [relapse rate (RR) 2.29, P < 0.0001], AML non-M3 vs. AML M3 (RR 1.8, P < 0.0001), autograft vs. sibling transplant (RR 1.76, P < 0.0001), interval diagnosis to transplantation < 261 d (RR 1.45, P < 0.001) and other conditioning vs. total body irradiation (RR 1.16, P = 0.001). Transplant-related mortality was the same in the three groups at approximately 10% at 2 years. Five-year leukaemia-free survival was 42 +/- 1% in the autografts, 44 +/- 8% in the twins and 58 +/- 2% among the siblings (auto vs. sibs, P < 0.0001). The factors significant for relapse were also significant in multivariate analyses for leukaemia-free survival. In addition, children had a significantly better leukaemia-free survival than adults (RR 0.82, P < 0.0001). Recipients of bone marrow from HLA-identical siblings without GVHD had a lower risk of relapse and a better leukaemia-free survival than recipients of autografts. This may be as a result of a graft-vs.-leukaemia effect in the absence of GVHD.

Acute Disease↗
PubMed2000

[Narcissistic regulation and metabolic control in type-II diabetics].

The influence of narcissistic regulation on metabolic control was investigated in 130 patients with Type-II-diabetes in the course of a rehabilitation programme. Two groups were studied: a) diabetics on a non-drug therapy regimen, b) diabetics treated by insulin. At the end of the rehabilitation programme 55.6% of the non-insulin patients and 60.1% of the insulin treated patients exhibited a clinically significant improvement as measured by HbA1c. On the basis of the Düsseldorf Questionnaire for Narcissistic Regulation in Chronic Disease (DNACE) predictors of metabolic control were established. Using decision analysis, a correct prediction was possible in 73.1% resp. 85.4% of the cases. In the non-drug group, low values of the "helplessness/powerlessness" scale and high values of the "mourning" scale predicted an improvement of metabolic control at the end of the rehabilitation programme. On the other hand, in the insulin treated group the more successful patients were shown to have low values in the scales "distrust", "feeling of being ashamed of disease", "feeling of inferiority" and "fighting self-image" and high values in the scales "value ideal" and "symbiotic protection of the self". The results are discussed within the theoretical framework.

Blood Glucose Self-Monitoring↗
PubMed2000

Changes in abscisic acid content and embryo sensitivity to (+)-abscisic acid during the termination of dormancy of yellow cedar seeds.

Yellow cedar seeds are dormant at maturity. The abscisic acid (ABA) content of the embryo (but not the megagametophyte) decreased approximately 2-fold following exposure of seeds to a dormancy-breaking treatment; this process was also accompanied by a 10-fold lowered sensitivity of the embryo to S:-(+)-ABA. A decline in ABA within the seed is not sufficient for dormancy breakage; reduced embryo sensitivity to ABA is also required.

Abscisic Acid↗
PubMed2000

[Not Available].

Using the data basis of the Mannheim Cohort Study the present paper investigates the correlation between socio-economic Status and psychogenic impairment due to predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative adult Community sample. The period of observation amounted up to 11,1 years. Subjects investigated within our follow-up study for this interval (n=301) were drawn from an representative adult Community population sample (N=600). Within the three step class model members of the lower class were at all investigation time points significantly stronger impaired compared to the members of the middleand upper class. Investigating the clinical impairment related to the intragenerative class mobility those subjects, which could achieve a social rise between two points of investigation were even prior, to the first investigation time point, less affected compared to the ones remaining in their social class. Vice versa subjects in the process of an social decline presented a stronger psychogenic impairment prior to their decline compared to those, which remained stable in their social class. These dynamic correlations offer evidence for the effect of the socalled "drift-hypothesis", which postulates, that persons due to their disease decline in their social Status respectively after improving rise to a higher social class.

Epidemiology↗
PubMed2000

Assessing clinically significant change: application to the SCL-90-R.

A Symptom Checklist (SCL-90-R) is a potentially useful measure of psychological distress; it is frequently used in psychotherapy research and clinical practice. The purpose of this study was to illustrate the use of the SCL-90-R for determining statistically reliable change and clinical significance outlined by Jacobson and Truax in 1991. This paper describes the concepts of statistical and clinical significance of change. A proposal for obtaining and characterizing samples is made. Then a clinician's perspective is taken. Reliable change estimates and cut-off scores are chosen based on outcome data. Selected data from a single psychotherapeutic process and outcome study then were used to test the estimates of change and cut-off scores.

Adult↗
PubMed2000

Stem-cell transplantation for chronic lymphocytic leukemia: the 1999 perspective.

BACKGROUND: The use of myeloablative intensive therapy followed by autologous or allogeneic stem-cell transplantation (SCT) for treatment of chronic lymphocytic leukemia (CLL) has largely increased over the last years. DESIGN: The present overview updates the available clinical results and discusses important aspects of SCT in patients with CLL including the type of SCT (autologous vs. allogeneic), myeloablative regimens, purging, the predictive value of molecular monitoring of residual disease, and prognostic factors for the outcome of transplant approaches. RESULTS: With appropriate supportive care, autologous SCT is safe and can induce long-lasting clinical and molecular remissions, which may improve the prognosis of patients with CLL. Feasibiliy and efficacy of autologous SCT appears to be best early during the course of the disease, but it is still unclear if autotransplantation can cure the disease even in this favorable subgroup. The role of purging is still unclear. The better disease control observed after allografting appears to be due to graft-versus-leukemia activity and may allow cure in at least a subset of poor-risk patients. Due to the extraordinarily high treatment-related mortality, however, the outcome after allogeneic SCT is still inferior to that after autologous SCT. CONCLUSIONS: Autologous transplantation is a valuable treatment option for younger patients with early or sensitive poor-risk CLL. Selected patients with advanced poor-risk disease and low probability of successful auto-SCT should be considered for allografting. However, it must be kept in mind that both autologous and allogeneic stem-cell transplantation are still experimental procedures and clinical trials further elucidating their value in the treatment of patients with CLL are warranted.

Clinical Trials as Topic↗
PubMed1999

Computerized administration of the Symptom Checklist (SCL-90-R) and the Inventory of Interpersonal Problems (IIP-C) in psychosomatic outpatients

This study investigated whether the method of administration (computer vs. paper-and-pencil) influenced mean scores on the Symptom-Checklist (SCL-90-R) and the Inventory of Interpersonal Problems (IIP-C). The performance of 32 psychosomatic outpatients on the computerized version was compared with the performance of a matched control group on the paper-and-pencil version. No systematic differences were observed in group means.

Journal Article↗