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Biomedical subjects

S Pierce

Publications and source records attributed to S Pierce.

At least 55 records · Page 3Linked to original sources
PubMed1997

Temperament, social competence, and adrenocortical activity in preschoolers.

The relations among temperament, social competence, and levels of a stress-sensitive hormone (salivary cortisol) were examined in two studies of preschoolers children (Study 1, N = 29; Study 2, N = 46). In both studies, we sampled cortisol daily for the initial weeks of school year (Group Formation period) and for several weeks later in the year (Familiar Group period). For each child, we examined two measures of cortisol activity (separately for each period) based on the distribution of cortisol levels across days: (a) median cortisol (50th percentile) and (b) cortisol reactivity (the difference between the 75th and 50th percentile). Median cortisol was modestly stable across periods, but cortisol reactivity was not. Children who showed high cortisol reactivity (75th minus 50th percentile > or = 0.10 micrograms/dl) during the Group Formation period but low-to-normal cortisol reactivity during the Familiar Group period were outgoing, competent, and well liked by their peers. In contrast, children who changed from low/normal to high cortisol reactivity and those who maintained high cortisol reactivity from the Group Formation to Familiar Group period were affectively negative and solitary. Children who showed high median cortisol during the Familiar Group period or over both periods scored lower on a measure of attentional and inhibitory control. Together, these results suggest that relations among temperament, social competence, and neuroendocrine reactivity reflect both individual and contextual differences.

Affect↗
PubMed1997

Association between increased body mass index and a diagnosis of acute promyelocytic leukemia in patients with acute myeloid leukemia.

We had observed that several patients with acute promyelocytic leukemia (APL) were markedly obese. Therefore we determined the relationship between obesity and a diagnosis of APL among patients with acute myelocytic leukemia (AML). Between 1980 and 1995 we saw 1245 patients with newly-diagnosed AML of whom 120 had APL. Increasing body mass index (BMI) was strongly associated with a diagnosis of APL (P=0.0003). Like Douer et al (Blood 1996; 8: 303-313) we found APL to be more frequent in Latinos and younger patients (P < 10[-4] for both). Logistic regression indicated that increasing BMI, decreasing age, and Latino origin were each independently associated with a diagnosis of APL (multivariate P values <10[-4], <10[-4], 0.0035, respectively). Since the mean BMI in the non-APL patients (25.1) resembled that of the general US population, it appears that APL patients are 'heavy' and not that non-APL patients are 'thin'. Five of the APL patients (4.2%) had a BMI >50 (vs none of the other 1125 AML patients). Given the distribution of BMI in the general US population ages 17-74, the probability that five of 120 normal adults would have a BMI >50 is virtually nil. Excluding the five very heavy APL patients does not alter the conclusion that increasing BMI predicted for APL in patients with AML. Although the mechanism is unclear there appears to be an association between increasing BMI and a diagnosis of APL among patients with AML. There may also be an association between APL and obesity.

Acute Disease↗
PubMed1997

Long-term follow-up results of alpha-interferon-based regimens in patients with late chronic phase chronic myelogenous leukemia.

The aim of this analysis was to evaluate the efficacy of alpha-interferon (alpha-IFN) regimens in late chronic phase (diagnosis >12 months) chronic myelogenous leukemia (CP-CML). Long-term follow-up results were evaluated in 137 patients with Philadelphia chromosome (Ph)-positive late CP-CML. The alpha-IFN programs were sequential studies with human leukocyte alpha-IFN (seven patients), recombinant alpha-IFN alone (15 patients) or with IFN-gamma (29 patients), hydroxyurea (HU) (19 patients), or low-dose cytarabine (Ara-C) (67 patients). Overall, 57% of the patients achieved complete hematological response (CHR), and 7% obtained partial hematological response. Nineteen patients (15% of the 123 evaluable patients) had a cytogenetic response which was major (Ph-positive <35%) in 10 patients (8%). A trend for better responses was observed with shorter disease duration. The median overall survival from start of therapy was 49 months, with an estimated 5-year survival rate of 41%. Some common pretreatment prognostic factors associated with response did not show statistical associations when applied in late CP-CML; however, characteristics such as smaller spleen size, and lower percentages of peripheral blood and marrow blasts and basophils were associated with better survival experience. When patients were subgrouped according to risk, no significant differences in the incidence of cytogenetic response and in survival outcomes were observed among various risk groups. This study confirms that alpha-IFN-based regimens have a modest activity in late CP-CML, and supports the need to develop investigational strategies aimed at improving patient prognosis in this phase.

Adolescent↗
PubMed1997

Comparison of acute myeloid leukemia patients at MD Anderson: 1982-1986 vs 1992-1996.

We compared the acute myeloid leukemia (AML) population seen at UT MD Anderson Cancer Center in the period from 1982 to 1986 with the population seen in the period of 1992 to 1996. The population seen in the 1990s was significantly (P < 0.01) older than the population seen in the 1980s, and was more likely (P < 0.001) to have abnormalities of chromosomes 5 and/or (5q-, -5, 7q-, -7). The increase in the incidence of -5/-7 was seen in both younger and older patients. Because the populations differed in these ways it is likely that they differed in other, less quantifiable ways. Our results suggest caution when using historical controls and when generalizing findings from randomized studies.

Adult↗
PubMed1997

Treatment of newly diagnosed acute promyelocytic leukemia without cytarabine.

PURPOSE: To determine the effect of omission of cytarabine (ara-C) from treatment of newly diagnosed acute promyelocytic leukemia (APL), which allows administration of more anthracycline. PATIENTS AND METHODS: Induction consisted of all-trans retinoic acid (ATRA) 45 mg/m2 daily until complete remission (CR) and idarubicin 12 mg/m2 daily for 4 days beginning on day 5 of ATRA. Patients in CR received two courses of idarubicin 12 mg/m2 daily for 3 days and then, until 2 years post-CR date, alternated three cycles of mercaptopurine, vincristine, methotrexate, and prednisone (POMP) with one cycle of idarubicin 12 mg/m2 daily for 2 days. Results in the 43 patients treated (41 with t(15;17) on standard or Southern analysis) were compared with those in 57 historic newly diagnosed APL patients given ara-C with either doxorubicin, amsacrine (AMSA), or daunorubicin without ATRA, using logistic and Cox regression to assess effects of non-treatment-related covariates on patient outcomes. RESULTS: The CR rate in the current group was 77% (95% confidence interval [CI], 62% to 88%) and was not significantly different from the historic rate. In contrast, disease-free survival (DFS) in CR is superior in the current group (probability at 1 year 0.87; 95% CI, 0.73 to 1.0). This has translated into superior overall DFS for the current group (P = .03 adjusting for the predictive covariates initial WBC and platelet count; 1-year DFS probability 0.67; 95% CI, 0.52 to 0.82; median follow-up 102 weeks). The current treatment appears better both in patients with and without t(15; 17) on standard cytogenetic analysis. CONCLUSION: Given the difficulties inherent in comparing sequential studies and recognizing the multiple differences in treatment between current and historic groups, our results suggest that a large randomized trial incorporating use of ATRA should assess the utility of omitting ara-C from treatment of newly diagnosed APL, thus allowing delivery of more anthracycline.

Adolescent↗
PubMed1997

Object identification without foveal vision: evidence from an artificial scotoma paradigm.

The purpose of the present study was to investigate the degree to which foveal information is necessary for object identification. To explore this question, we used an artificial moving scotoma paradigm to eliminate a region of a currently viewed display in real time as a function of eye position. Subjects examined linear arrays of four line drawings of objects while their eye movements were recorded. Immediately following each array, a test probe was presented to test the degree to which the subject had identified those objects. Three conditions were compared, one in which a central foveal scotoma was created, one in which an extrafoveal scotoma was created, and a control condition in which the scotoma was absent. The main result was that identification accuracy was very good, but eye-movement behavior was disrupted when a foveal scotoma was present. These results suggest that foveal information is not necessary but is beneficial for perceptual encoding during object identification; the loss of foveal information can be overcome as long as compensatory extrafoveal processing is possible.

Eye Neoplasms↗
PubMed1996

Topotecan, a topoisomerase I inhibitor, is active in the treatment of myelodysplastic syndrome and chronic myelomonocytic leukemia.

The aim of this study was to evaluate the activity of topotecan in patients with myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML). Forty-seven patients with a diagnosis of MDS (n = 22) or CMML (n = 25) were treated. The median age was 66 years. Chromosomal abnormalities were present in 70% and thrombocytopenia less than 50 x 10(3)/microL in 51%. Evaluation of outcome and of differences among subgroups was performed according to standard methods; the criteria for response were those used for acute leukemia. Topotecan was administered as 2 mg/ m2 by continuous infusion over 24 hours daily for 5 days (10 mg/m2 per course) every 3 to 4 weeks until remission, then once every month for a maximum of 12 courses. Thirteen patients (28%) achieved a complete response (CR) and six (13%) had hematologic improvement. A CR was achieved in six of 22 patients with MDS (27%) and in seven of 25 with CMML (28%). All eight patients who presented with cytogenetic abnormalities (five chromosome 5 or 7 abnormalities) who achieved CR were cytogenetically normal in CR. Characteristics for which there was evidence of association with a higher response rate were lack of prior chemotherapy, less than 10% marrow monocytes, and absence of RAS oncogene mutations. In contrast, CR rates were similar in patients with or without abnormal karyotypes. Mucositis occurred in 64% of patients (severe in 19%) and diarrhea in 32% (severe in 13%). Febrile episodes occurred in 85% of patients and documented infections in 47%. With a median follow-up duration of 8 months, the 12-month survival rate was 38%, median survival time 10.5 months, and median remission duration 7.5 months. We conclude that topotecan has significant activity in MDS and CMML, with acceptable side effects. Future studies will investigate topotecan combined with topoisomerase II reactive agents, cytarabine, or hypomethylating agents (azacytidine and decitabine).

Adult↗
PubMed1996

Routine bone marrow exam during first remission of acute myeloid leukemia.

To detect relapse acute myeloid leukemia (AML) treatment protocols have called for bone marrow exams every 2 to 4 months in remission. To investigate the effect of replacing this policy with one calling for marrows only when blood count is abnormal (platelets < 100,000, neutrophils < 1,000, circulating blasts > 0%, unrelated to prior chemotherapy), we reviewed the records of all 444 patients with AML whose disease recurred ( > or = 5% marrow blasts unrelated to prior chemotherapy) for the first time between 1980 and 1995. The 375 patients with adequate follow-up were classified as (1) simultaneous--blood count abnormal when relapse noted without a normal marrow intervening between first abnormal count and relapse, 289 patients (77% of 375), (2) marrow first--blood count normal when relapse noted, 60 patients (16%), or (3) blood first--a normal marrow intervened between first abnormal blood count and relapse, 26 patients (7%). Interval between marrow exams and blood counts did not differ in the three groups (a 25-patient sample of the 289 patient simultaneous group was analyzed as representative of this group) with marrows done at a median of once monthly and blood counts at a median of once weekly from complete remission (CR) date to relapse date. The three groups also had similar first CR duration, and pretreatment cytogenetics. CR rates following salvage chemotherapy were 32% to 33% in the simultaneous and marrow first groups and 17% in the blood first group. We conclude that routine marrow exams for morphology are not needed in the great majority of AML patients in first CR.

Adolescent↗
PubMed1996

A prospective study of conservative surgery alone in the treatment of selected patients with stage I breast cancer.

BACKGROUND: Randomized clinical trials have clearly demonstrated that the use of radiation therapy (RT) following breast-conserving surgery (CS) substantially reduces the risk of local recurrence. However, the low rate of local recurrence after CS and RT for patients without known risk factors, and the recent increase in the detection of smaller cancers due to mammographic screening have led to the speculation that a subgroup of patients who have a low risk of local recurrence without RT might be identified. In 1986, we initiated a one-arm, prospective clinical trial of CS alone for treatment of highly selected breast cancer patients without known risk factors for local recurrence. METHODS: The study had a sequential design with a planned accrual of 90 patients. Criteria for entry into the trial were: a unicentric, clinical TI infiltrating ductal, mucinous or tubular carcinoma without an extensive intraductal component or lymphatic vessel invasion; a wide excision with a pathologically-documented negative margin of at least 1 cm; and histologically negative axillary lymph nodes. No adjuvant RT or systemic therapy was administered. Seventy-six per cent of the lesions were detected by mammography alone. The median gross pathologic tumor size was 0.9 cm. The median patient age was 67 years. RESULTS: Eighty-seven patients were enrolled in the trial before it closed prematurely in 1992 because the predefined stopping boundary was crossed (i.e., the sixth local recurrence was observed). At that time, the average annual local recurrence rate was 4.2%. With a median follow-up of 56 months, there are now 14 patients (16%) with local recurrence as their site of first failure (average annual local recurrence rate: 3.6%). Four patients without local recurrence developed distant metastases. Three patients have died, one of metastatic breast cancer and two of unrelated causes. CONCLUSIONS: Even in a highly selected group of patients with early-stage breast cancer, there is a substantial risk of early local recurrence for those treated with wide excision alone.

Adenocarcinoma, Mucinous↗
PubMed1996

Result of interferon-alpha therapy in patients with chronic myelogenous leukemia 60 years of age and older.

PURPOSE: To determine the response rate to interferon-alpha (IFN-alpha) in patients with chronic myelogenous leukemia (CML) aged 60 years and older. PATIENTS AND METHODS: Patients with CML aged 60 years and older included in all protocols with INF-alpha therapy for chronic phase CML at the M.D. Anderson Cancer Center were analyzed. They were treated with human leukocyte or recombinant human IFN-alpha 5x10(6) U/m2 daily alone or in combination with hydroxyurea or IFN gamma. The clinical characteristics of the patients were analyzed and their hematologic and cytogenetic responses to IFN-alpha and survival from the initiation of therapy were determined. Results were compared with those of younger patients treated in the same protocols. Treatment-related toxicity was also analyzed. RESULTS: Thirty-five of 274 (13%) patients included in trials of IFN-alpha-based regimens for CML were 60 years and older. Older patients had a higher percentage of bone marrow blasts (P = 0.04) and basophils (P = 0.09) than younger patients. Sixty-nine percent achieved a complete hematologic remission with IFN-alpha therapy, and 51% had a cytogenetic response, which was major in 26% and complete (Philadelphia chromosome-positive cells = 0%) in 20%, Their median survival was 64 months, and the estimated 5-year survival rate was 62%. These results were not different from those in younger patients. Twenty-two patients (63%) had at least grade 2 toxicity requiring dose adjustment. The most frequent side effects were neurotoxicity in 31% and chronic fatigue in 29%. CONCLUSIONS: Patients with CML 60 years of age and older respond well to IFN-alpha therapy, but experience more toxicity. This therapy should be considered for these patients if they are otherwise in good condition, with careful attention to IFN-alpha toxicity and its management.

Age Factors↗
PubMed1996

Changing the relationship among nurses' knowledge, self-reported behavior, and documented behavior in pain management: does education make a difference?

An educational program designed to change knowledge in order to change pain management practices and patient outcomes was offered to nurses who provide day-to-day care to patients with cancer in communities in a predominantly rural state. A quasi-experimental time-series design was used to measure the effectiveness of the program in changing nurse knowledge, attitude and behavior, and to evaluate the relationships between the outcomes. Data were collected from nurses (N = 29) and patient charts before (N = 209) and after (N = 163) the program. Nurses' knowledge increased, but the change was not statistically significant; the mean percent of correct answers on the three subtests were different and differences persisted throughout the study. Nurses believed that patients should be "pain free." Documentation of behaviors, for example, practice activities, occurred infrequently and showed little change until 6 months after the program. Increase in documentation of pain-intensity ratings, pain location, number of sites of pain, presence of confusion, anxious or depressed mood, sleep, nausea and vomiting, constipation, and general activity were noted. Documentation of the use of a propoxyphene-containing analgesic decreased; increase in the use of hydromorphone methadone and transdermal fentanyl was noted. Analysis of the relationships between correct responses to nurse knowledge questions and documentation of behavior provided interesting, statistically insignificant results that need to be reexamined in future research. Future programs should emphasize analgesic dosing and calculation of equianalgesic doses. Current practices in chart documentation may provide incomplete information regarding change in practice behaviors; more detailed documentation of pain management practices is needed. Nurses who participated in the program anecdotally reported feelings of increased credibility and effectiveness. Although change in behavior is slow to occur, education does make a difference.

Adult↗
PubMed1996

Treatment of newly-diagnosed acute myelogenous leukaemia in patients aged 80 years and above.

In order to assess outcome following treatment of acute myeloid leukaemia (AML) in patients aged 80 years and above, we have studied 33 patients aged > or = 80 years treated between 1980 and 1994; 29 of these received treatment. The median age was 82 years (range 80-89). Three patients received daunorubicin ( > or = 60 mg/m2 daily x 3) alone or with low-dose ara-C, two patients received '3+7' with post treatment GM-CSF; 24 patients had higher doses of ara-C, generally with anthracyclines or fludarabine, and in nine cases with G or GM-CSF. The median survival of the treated patients was 3-4 weeks and only two were alive after 1 year (at 66 and 79 weeks). Complete remission (CR) occurred in 9/29 (31%). Only one of the nine remains alive in remission, at 76 weeks after the date of CR, whereas the other eight died in remission or had disease recurrence at a median of 11 weeks (range 5-37 weeks) after CR. The median survival of the four untreated patients was 10 weeks (range 3-38). Patients aged > or = 80 had, on average, worse outcomes than those observed in patients aged 70-79. Our results confirm that currently available chemotherapy is generally not indicated in patients aged 80 or over with AML.

Aged↗
PubMed1996

Endosymbiotic chloroplasts in molluscan cells contain proteins synthesized after plastid capture

Endosymbiotic chloroplasts within the cells of the ascoglossan slug Elysia chlorotica synthesize a variety of proteins including the large subunit of ribulose-1,5-bisphosphate-carboxylase oxygenase (RuBisCO) and the photosystem II protein D1. In addition, the effects of protein synthesis inhibitors suggest that some chloroplast-associated proteins are synthesized in the animal cytosol and subsequently translocated into the chloroplasts. Thus, the plastids not only synthesize proteins during this long-lived association, but the host cell seems to play a role in plastid protein turnover.

Journal Article↗
PubMed1996

Third generation information systems: integrating costs and outcomes. Tools for professional development and program evaluation.

The authors present specific procedures for obtaining cost per closed case and a case outcome rating for each closed case, computer generated, yielding a cost-outcome report for single cases and aggregated cases. The procedures are illustrated with field data from an alcohol and drug addiction service. Cost per closed case is seen as the new unit cost datum. Combined with case outcome information, the cost-outcome report is seen as a promising new measure of efficiency. The potential of the cost-outcome report as a new basis for professional self-development, increased treatment effectiveness, and program evaluation is discussed.

Budgets↗
PubMed1996

Amsacrine and continuous-infusion high-dose cytosine arabinoside as induction therapy for patients with newly-diagnosed acute myelogenous leukemia.

The overall cure rate of adults with newly-diagnosed acute myelogenous leukemia (AML) treated with continuous infusion high-dose cytarabine (CIHDAC) is comparable to that with standard-dose ara-C plus anthracycline or amsacrine (AMSA). We tested whether the addition of AMSA to CIH-DAC improves the outcome of adults with untreated AML. 75 patients with untreated AML were treated with AMSA (75 mg/m2/day x 4) plus CIHDAC (1.5 g/m2/day x 4) for induction and, if in complete remission (CR), early and late intensification. Results were compared to those in 129 patients treated on a previous study with CIHDAC alone. The principal comparison in both groups was between those 117 patients (AMSA/CIHDAC n = 52, CIHDAC n = 65) who met the initial eligibility criteria for the AMSA/CIHDAC study (risk of early mortality < or = 1) and who were treated at a time when relatively few eligible patients were excluded (19% in the AMSA/CIHDAC group, 34% in the CIHDAC group). There was no difference between regimens in CR rate, remission duration, or survival in this cohort. When attention was turned to all 204 patients, outcome was superior with AMSA/CIHDAC very largely as a result of outcome in patients with APL. Aside from these patients, addition of amsacrine to CIHDAC did not appear to be productive.

Acute Disease↗
PubMed1996

Disseminated intravascular coagulation in adult acute lymphoblastic leukemia: frequent complications with fibrinogen levels less than 100 mg/dl.

In order to establish the frequency and clinical complications of DIC during remission induction of untreated adults with acute lymphoblastic leukemia, we retrospectively reviewed the records of 125 consecutive patients treated with vincristine, doxorubicin, and dexamethasone but without L-asparaginase. DIC, defined as hypofibrinogenemia in the presence of elevated fibrin-fibrinogen degradation products, was detected at presentation in 10% of 99 and during remission induction in 67% of 58 patients who were screened for DIC. Elevated levels of D-dimers (DD) were seen in all eight patients with DIC in whom they were measured. All cases of DIC were diagnosed by the ninth day of induction and were associated with infection in 15 of 39 patients. DIC did not cause any deaths but was temporally associated with two thromboses and four hemorrhages in six of the 16 patients with fibrinogen levels < 100 mg/dl but with only one hemorrhage among 23 patients (4%) with fibrinogen levels > 100 mg/dl (P < 0.01). Heparin was not administered to any patient, whereas platelets were administered to all to maintain platelet counts > 20 x 10(9)/l. Fresh frozen plasma (FFP) and/or cryoprecipitate were administered 26 patients resulting in a contemporaneous correction of the coagulopathy and in control of hemorrhages and thromboses. We conclude that DIC is rare at presentation but common during induction of adult ALL and is frequently associated with clinical complications when fibrinogen levels are < 100 mg/dl. We recommend daily testing of fibrinogen, PT, and DD during the first 10 days of induction, and for the patients with DIC platelet transfusions to maintain counts > 20 x 10(9)/l, and when fibrinogen levels fall below 100 mg/dl transfusions of FFP and/or cryoprecipitate. Additional studies are needed to determine the optimal management of the DIC during remission induction of adult acute lymphoblastic leukemia.

Adult↗