Analysis of treatment failure in patients with minimally differentiated acute myeloid leukemia (AML-M0)

Reports of treatment of patients with minimally differentiated acute myeloid leukemia (AML-M0) are limited, heterogeneous, and controversial. We verified the prognosis of this subtype by analyzing the results of 189 consecutive patients with de novo AML. Fifteen cases fitting the criteria of AML-M0 were identified. No clinical features distinguished them from other patients with AML. The median age was 61 years (range 27 to 70), with a leukocyte count ranging from 0.6 to 185 x 10(9)/L. In all cases the leukemic cells expressed CD34 and reacted with at least one of the antibodies to early myeloid antigens, ie, CD13, CD33, or myeloperoxidase. Immunophenotypic analysis also showed positivity for CD7 in seven samples and the multidrug-resistance P-glycoprotein (P-170) in six. Cytogenetic analysis was abnormal in 12 of the 13 patients in whom an adequate number of mitoses could be evaluated. No single abnormality prevailed, the most common findings being trisomy 8 (three cases) and aberrations of chromosome 7 (two cases). Antileukemic treatment differed according to age, but for remission induction, all patients received a combination of cytosine arabinoside and an anthracycline or mitoxantrone. The prognosis of patients with AML-M0 was remarkably poor as compared with the other French-American-British subtypes. Whereas the overall rate of complete remission (CR) was 58% with a median survival of 63 weeks, only 6 of the 15 patients with AML-M0 achieved a CR, and the median survival of this group was 16 weeks (range 3 to 39). The major determinant of treatment failure was unresponsiveness to chemotherapy, as only one patient died of infection during the hypoplastic phase. The CR duration of responders was short, ranging from 3 to 22 weeks, and no second remissions were observed. We conclude that conventional combination chemotherapy yields disappointing results in AML-M0. The reason for this may be the convergence of various unfavorable prognostic factors, such as (1) the high incidence of cytogenetic abnormalities; (2) the lack of differentiation features and the expression of immaturity markers such as CD34 and CD7; and (3) the frequent expression of P-170. Nonconventional therapeutic approaches should be developed to alter the prognosis of this form of leukemia.     

Biological versus social evolution.

Comments on the number of responses (e.g., L. G. Wispe and J. N. Thompson, Jr.; see record 1977-06633-001) to D. T. Campbell's (see record 1976-12046-001) American Psychological Association presidential address on the issue of biological vs social evolution. The author agrees with Wispe and Thompson on the link between evolutionary theory and political conservatism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biological response to ErbB ligands in nontransformed cell lines correlates with a specific pattern of receptor expression

The human epidermal growth factor receptor (HER or ErbB) family consists of four distinct members, including the epidermal growth factor (EGF) receptor (EGFR, HER1, or ErbB1), ErbB2 (HER2 or neu), ErbB3 (HER3), and ErbB4 (HER4). Activation of these receptors plays an important role in the regulation of cell proliferation, differentiation, and survival in several different tissues. Binding of a specific ligand to one of the ErbB receptors triggers the formation of specific receptor homo- and heterodimers, with ErbB2 being the preferred signaling partner. We analyzed the levels of various ErbB receptor messenger RNAs in a series of nontransformed cell lines by real time quantitative RT-PCR. The cell lines chosen were derived from a variety of tissues, including pancreas, lung, heart, and nervous system. Further, we measured biological responses in these cell lines upon treatment with EGF, betacellulin, and two types of neuregulins, heregulin and sensory and motor neuron-derived factor. All cell lines examined expressed detectable levels of ErbB2. High levels of expression of ErbB3 were correlated with responsiveness to heregulin and sensory and motor neuron-derived factor, whereas high levels of EGFR expression were correlated with responsiveness to EGF and betacellulin. Moreover, the sensitivity of a cell line to ErbB ligands was also correlated with the levels of expression of the appropriate ErbB receptors in that cell line. These results are consistent with our hypothesis that appropriate biological responsiveness to ErbB ligands is determined by the levels of expression of specific ErbB receptor combinations within a given tissue.     

Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer

BACKGROUND: The role of nonanatomic wedge resection in the management of stage I (T1 N0 M0) non-small-cell lung cancer continues to be debated against the present gold standard of care--anatomic lobectomy. METHODS: We analyzed the results of 219 consecutive patients with pathologic stage I (T1 N0 M0) non-small-cell lung cancer who underwent open wedge resection (n = 42), video-assisted wedge resection (n = 60), and lobectomy (n = 117) to assess morbidity, recurrence, and survival differences between these approaches. RESULTS: There were no differences among the three groups with regard to histologic tumor type. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having lobectomy. The mean hospital stay was significantly less in the wedge resection groups. There were no operative deaths among patients having wedge resection; however, a 3% operative mortality occurred among patients having lobectomy (p = 0.20). Kaplan-Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video-assisted wedge resection, 95%; lobectomy, 91%). At 5 years survival was 58% for patients having open wedge resection, 65% for those having video-assisted wedge resection, and 70% for those having lobectomy. Log rank testing demonstrated significant differences between the survival curves during the 5-year period of study (p = 0.02). This difference was a result of a significantly greater non-cancer-related death rate by 5 years among patients having wedge resection (38% vs 18% for those having lobectomy; p = 0.014). CONCLUSION: Wedge resection, done by open thoracotomy or video-assisted techniques, appears to be a viable "compromise" surgical treatment of stage I (T1 N0 M0) non-small-cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic lobectomy remains the surgical treatment of choice for patients with stage I non-small-cell lung cancer who have adequate physiologic reserve.     

Learned helplessness in humans: A frustration-produced response pattern.

Investigated with 120 undergraduates in 2 experiments the utility of the learned helplessness model vs A. Amsel's (1971, 1972) behavioral persistence model in explaining response deficits following uncontrollable loud noise exposures. Ss exposed to uncontrollable loud noise showed performance deficits relative to controllable and no-preexposure groups. ANOVAs indicated that the performance deficits were directly related to response–outcome relations learned during uncontrollable preexposure. This finding is in agreement with Amsel's behavioral persistence model and is in contradiction to the learned helplessness model. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glutathione levels in antigen-presenting cells modulate Th1 versus Th2 response patterns

Current thinking attributes the balance between T helper 1 (Th1) and Th2 cytokine response patterns in immune responses to the nature of the antigen, the genetic composition of the host, and the cytokines involved in the early interaction between T cells and antigen-presenting cells. Here we introduce glutathione, a tripeptide that regulates intracellular redox and other aspects of cell physiology, as a key regulatory element in this process. By using three different methods to deplete glutathione from T cell receptor transgenic and conventional mice and studying in vivo and/or in vitro responses to three distinct antigens, we show that glutathione levels in antigen-presenting cells determine whether Th1 or Th2 response patterns predominate. These findings present new insights into immune response alterations in HIV and other diseases. Further, they potentially offer an explanation for the well known differences in immune responses in "Th1" and "Th2" mouse strains.     

Septicemia due to a non-0:1, non-0:139 Vibrio cholerae

We describe a patient with a non-0:1, non-0:139 Vibrio cholerae septicemia associated with ecythema gangrenosa-like skin lesions. The patient acquired the infection in Puerto Rico. Given the high fatality rate, it is important for the medical community to consider the diagnosis in high risk patients with exposures in Puerto Rico tropical waters.     

Neonatal mesenchyme temporal bone study: typical receding pattern versus increase in Potter's sequence

The fate of mesenchyme, which lines the fetal and newborn bony middle ear, is not well understood. The authors wished to test previous observations that a greater amount of mesenchyme was found in Potter's sequence (renal anomalies, pulmonary hypoplasia, and oligohydramnios). Using celloidin-embedded neonatal temporal bones (68 cases, 123 ears), with clinical and autopsy information, middle ear volumes were compared among diagnostic groups using analysis of variance. In 16 ears of Potter's sequence cases the volume of mesenchyme increased in proportion to the size of the middle ear. Conversely, in all other cases the volume of mesenchyme remained constant compared to increasing middle ear size. Both the volume of the bony middle ear and the volume of the air cavity increased at 15 mm3/500 g of body weight (gbw). Mesenchyme percentage decreased by 2%/500 gbw. Middle ear mesenchyme appears to recede rather than reabsorb. However, in Potter's sequence cases the volume of mesenchyme increases, raising issues of a missing renal signal that inhibits mesenchymal growth under normal circumstances.     

Traitedness and the assessment of response pattern scalability.

Scalability statistics are used to measure the degree to which an examinee's item responses to a self-report measure conform to a special pattern. This article proposes that a scalability index based on the item response theory (called ZL) offers promise for detecting individual differences in traitedness. The ZL index is described and applied to data from 1,000 Ss who were administered the Mulidimensional Personality Questionnaire (A. Tellegen, 1982). Low split-half reliabilities were found for ZL index scores computed within 11 personality scales. However, further data scrutiny revealed that valuable information about an individual's trait structure can still be gleaned from a scalability analysis. It is concluded that scalability indices can be used, albeit judiciously, to explore the fit between an individual's behavior and a personality trait construct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological reactions during in-vitro fertilization: similar response pattern in husbands and wives

The purpose of this study was to examine differences in daily emotional, physical and social reactions among husbands and wives during in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Forty couples about to undergo ICSI or IVF at a private infertility clinic monitored their emotional, physical and social reactions daily for one complete treatment cycle from the first day of stimulation until the outcome of treatment was known (approximately 35 days). The results showed that men and women had a similar response pattern to oocyte retrieval, fertilization, embryo transfer and the pregnancy test. These stages were associated with the most significant changes in reactions for both spouses. The pattern of results suggested that the most important psychological determinant of reactions during IVF was the uncertainty of treatment procedures. Spouses appeared to be equally sensitive to this uncertainty and both appeared to respond to it with ambivalent feelings involving emotional distress and positive feelings of hope and intimacy.     

The war between the words: Biological versus social evolution and some related issues.

Representative responses to the 1975 American Psychological Association presidential address, "On the conflicts between Biological and Social Evolution and between Psychology and Moral Tradition," by D. T. Campbell (see record 1976-12046-001), selected by 2 guest editors, are presented in 3 sections: (a) biological vs social evolution, (b) the genetic basis of behavior (especially of altruism), and (c) the value of tradition. As a reprise, Campbell presents his general reactions. (21/2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimation of IRT graded response models: Limited versus full information methods.

The performance of parameter estimates and standard errors in estimating F. Samejima’s graded response model was examined across 324 conditions. Full information maximum likelihood (FIML) was compared with a 3-stage estimator for categorical item factor analysis (CIFA) when the unweighted least squares method was used in CIFA’s third stage. CIFA is much faster in estimating multidimensional models, particularly with correlated dimensions. Overall, CIFA yields slightly more accurate parameter estimates, and FIML yields slightly more accurate standard errors. Yet, across most conditions, differences between methods are negligible. FIML is the best election in small sample sizes (200 observations). CIFA is the best election in larger samples (on computational grounds). Both methods failed in a number of conditions, most of which involved 200 observations, few indicators per dimension, highly skewed items, or low factor loadings. These conditions are to be avoided in applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control: Monitoring the target behavior versus monitoring a competing response.

Monitoring and recording one's own behavior is often an effective way to change that behavior. 86 undergraduates chose to modify either a desirable behavioral deficit or an undesirable behavioral excess. Ss were instructed to monitor either the target behavior itself or a competing response, namely, its nonoccurrence. The predicted interaction between style of monitoring and the deficit or excess status of the target behavior did not occur. Instead, monitoring the target behavior per se was the most effective tactic and produced the lowest dropout rate and greatest maintenance of self-monitoring at follow-up. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrasting interpersonal orientations in hypnosis: Collaborative versus contractual modes of response.

Tested 36 susceptible and 36 insusceptible Ss to examine the effect of markedly contrasting styles of interpersonal orientation of the hypnotist on their responsiveness. Ss were allocated to a 2 * 2 factorial design that varied group identity (real or simulating) and nature of test setting (contractual or collaborative). The collaborative setting attempted to promote much franker and more open communication between S and hypnotist than the traditional contractual setting. Results indicate that context of testing had an appreciable effect on Ss' attitudes toward the hypnotic situation, but little effect on their objective performance on routine test items. Hypnotic Ss were more willing than role-playing Ss to engage in dialogue with the hypnotist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reactivity of trypsin in reverse micelles: pH-effects on the W0 versus enzyme activity profiles

We have adapted the new MxA gene-induction bioassay to measure neutralizing antibodies to interferon-beta1b (IFN-beta1b, the active ingredient in Betaseron) in sera from patients treated with Betaseron. This antibody assay has been validated to quantify neutralizing titers of 1:20 and above, with a precision of +/- 0.20 in log10. We have used this MxA gene-induction antibody assay to reinvestigate serum samples from multiple sclerosis (MS) patients treated with Betaseron. The titers measured were closely comparable to those obtained in antiviral assays. Data obtained by both methods show that neutralizing antibodies may appear and subsequently disappear over time in the sera of some patients treated with Betaseron. Sera from some patients contain binding antibodies to IFN-beta1b. It was shown that binding antibody titers do not correlate quantitatively or qualitatively with neutralizing antibody titers, and indeed, a number of patients develop high levels of binding antibodies but never form measurable levels of neutralizing antibodies.