Separation of chronic lymphocytic-leukemia (cll) cells by a discontinuous density gradient - correlation with clinical stage

Peripheral blood or bone marrow cells of 15 patients with chronic lymphocytic leukemia (CLL) were separated on an albumin density gradient. In 5 of 5 CLL patients, the distribution of malignant B lymphocytes was similar across the gradient when blood and bone marrow were compared, but different from the distribution of cells from healthy volunteers. In 10 patients, B cell colony formation was measured in vitro from peripheral blood cells after gradient fractionation. Although most of the cells in all patients were found in fraction 4, the majority of B-lymphocyte colonies were found in light density fractions (1+2, 3) in patients with more advanced disease (Rai stages 3 or 4), and in heavier fractions (4, bottom) in patients with less advanced disease (Rai stages 0, 1 or 2). The density of CLL cells might provide a new prognostic marker in this disease.     

Concomitant chemoradiotherapy as primary therapy for locoregionally advanced head and neck cancer.

PURPOSE: To achieve locoregional control of head and neck cancer, survival, and organ preservation using intensive concomitant chemoradiotherapy. PATIENTS AND METHODS: This study was a phase II trial of chemoradiotherapy with cisplatin 100 mg/m(2) every 28 days, infusional fluorouracil 800 mg/m(2)/d for 5 days, hydroxyurea 1 g orally every 12 hours for 11 doses, and radiotherapy twice daily at 1.5 Gy/fraction on days 1 through 5 (total dose, 15 Gy). Five days of treatment were followed by 9 days of rest, during which time patients received granulocyte colony-stimulating factor. Five cycles (three with cisplatin) were administered over 10 weeks (total radiotherapy dose, locoregional). Surgery after concomitant chemoradiotherapy is feasible. Compliance with adjuvant chemoprevention is poor. Identification of less toxic regimens and improved distant disease control emerge as important future research goals.     

Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil

Background  

Proper knowledge of HIV transmission is not enough for people to adopt protective behaviors, but deficits in this information may increase HIV/AIDS vulnerability.     

Outcomes of revascularization strategies for two-vessel coronary artery disease involving the proximal left anterior descending artery in an era of improved pharmacotherapy and stenting

BACKGROUND

The best therapeutic strategy for patients with double-vessel coronary artery disease and proximal left anterior descending artery involvement (2VD + pLAD) is not clear.

OBJECTIVES

To compare the survival experience of a cohort of cardiac catheterization patients with 2VD + pLAD based on chosen therapeutic strategy (medical management versus percutaneous coronary intervention [PCI] versus coronary artery bypass graft surgery [CABG]).

METHODS

The authors identified and studied a total of 603 patients with 2VD + pLAD from all patients who underwent diagnostic coronary angiography in Alberta between January 1997 and May 1999. The primary end point was five-year survival from index catheterization for each of the treatment groups and from time of revascularization when the two revascularization strategies were compared.

RESULTS

Risk-adjusted hazard ratios (HR) comparing cumulative five-year survival rates of patients treated medically, or with PCI or CABG indicated a survival benefit for patients treated with CABG (HR 0.24, 95% CI 0.11 to 0.54; P<0.001) and PCI (HR 0.43, 95% CI 0.24 to 0.77; P=0.003) compared with medical management. Meanwhile, a risk-adjusted comparison of revascularization strategies suggested a possible trend toward higher mortality for PCI-treated patients versus CABG-treated patients (HR 1.56, 95% CI 0.65 to 3.72; P=0.125).

CONCLUSIONS

The results of this registry-based observational study suggest a survival benefit from revascularization compared with medical management in patients with 2VD + pLAD. Furthermore, the authors found a trend toward better survival in CABG-treated patients compared with PCI-treated patients.     

The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease

OBJECTIVES: This study was designed to examine the use of cardiovascular medications and outcomes in patients with heart failure (HF) and renal dysfunction. BACKGROUND: Renal insufficiency is associated with poorer outcomes in patients with HF, but the mechanisms are uncertain. In particular, the degree of therapeutic nihilism in these patients, and whether it is appropriate, is unclear. METHODS: This was a prospective cohort study with a one-year follow-up. RESULTS: In 6,427 patients with cardiologist-diagnosed HF and angiographically proven coronary artery disease (mean age 69 years; 65% men; one-year mortality, 10%), 39% had creatinine clearances <60 ml/min. Patients with renal insufficiency were less likely to be prescribed angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, statins, or aspirin (all p < 0.001). However, users of aspirin (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.57 to 0.85), statins (OR 0.79, 95% CI 0.64 to 0.97), and beta-blockers (OR 0.75, 95% CI 0.62 to 0.90) were less likely to die in the subsequent 12 months than nonusers, irrespective of renal function (all OR adjusted for covariates including atherosclerotic burden and ejection fraction). Although ACE inhibitor users with creatinine clearances > or =60 ml/min had lower 12-month mortality (OR 0.72, 95% CI 0.48 to 0.99), ACE inhibitor users with clearances <60 ml/min did not (OR 1.21, 95% CI 0.97 to 1.51). CONCLUSIONS: Renal insufficiency is common in patients with HF and coronary artery disease, and these patients have more advanced coronary atherosclerosis. Patients with renal insufficiency are less likely to be prescribed efficacious therapies, but have better outcomes if they receive these medications.     

Quality of life after coronary revascularization in the elderly.

AIMS: To describe health status outcomes at 4 years for a cohort of elderly patients with cardiac disease. METHODS AND RESULTS: Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, an outcomes initiative capturing all patients undergoing cardiac catheterization in Alberta, Canada, health status was measured using the Seattle Angina Questionnaire (SAQ) and crude and risk-adjusted outcomes were determined and compared for patients treated with percutaneous coronary intervention or coronary artery bypass surgery (CABG) vs. medical therapy. Response rates among surviving, consenting patients were 64.8% for patients <70 years (n=7883), 77.3% for patients aged 70-79 years (n=2940), and 77.7% for patients >or=80 years of age (n=439). For patients aged <70 years, and those aged 70-79 years, for all dimensions of the SAQ, scores were significantly better for patients treated with revascularization procedures than with medical therapy. For patients over the age of 80 years, scores for patients treated with CABG in particular were significantly better, with the exception of exertional capacity. At 3 years, all scores remained stable or improved, and continued to favour revascularization. CONCLUSION: Elderly patients undergoing revascularization have better health status at 4 years than do those in the same age group who do not undergo revascularization. These findings suggest that age should not deter against revascularization given the combined survival and quality-of-life benefits.     

The BATTLE trial: personalizing therapy for lung cancer

The Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE) trial represents the first completed prospective, biopsy-mandated, biomarker-based, adaptively randomized study in 255 pretreated lung cancer patients. Following an initial equal randomization period, chemorefractory non-small cell lung cancer (NSCLC) patients were adaptively randomized to erlotinib, vandetanib, erlotinib plus bexarotene, or sorafenib, based on relevant molecular biomarkers analyzed in fresh core needle biopsy specimens. Overall results include a 46% 8-week disease control rate (primary end point), confirm prespecified hypotheses, and show an impressive benefit from sorafenib among mutant-KRAS patients. BATTLE establishes the feasibility of a new paradigm for a personalized approach to lung cancer clinical trials. SIGNIFICANCE: The BATTLE study is the first completed prospective, adaptively randomized study in heavily pretreated NSCLC patients that mandated tumor profiling with "real-time" biopsies, taking a substantial step toward realizing personalized lung cancer therapy by integrating real-time molecular laboratory findings in delineating specific patient populations for individualized treatment.     

The effects of childlessness on the care and psychological well-being of older adults with disabilities

Objectives: Adult children are a primary focus of family and caregiver research. In contrast, relatively little is known about childless elders with a disability, including their care needs and the state of their overall well-being compared to elderly parents. We addressed this gap by examining the relationship between childlessness and the care and well-being of adults aged 75 and older with a disability.

Methods: Parents and childless persons aged 75 and older were compared using data from the 1998 to 2004 waves of the Health and Retirement Study (HRS). We used logistic regression to examine the relationship between childlessness and care provision (personal care and assistive devise use) and ordinal regression to examine the relationships of parental status, personal care, and use of assistive devices with well-being. The analysis was based on 2048 observations from 1456 community-dwelling respondents who had difficulty walking across a room or getting into or out of bed.

Results: Compared to parents, childless elders with a disability generally do not receive less care or have worse psychological well-being. However, being unmarried reduces the likelihood of having personal care and is associated with depressive affect. Use of assistive devices is associated with less depressive affect.

Conclusion: Childless older adults are similar to parents on measures of psychological well-being and care provision. This finding has important implications, as it is projected that 30% of baby boomers who will need assistance will lack care from spouses or adult children. Further exploration of compensatory resources is suggested.     

Influence of communicator's race on efficacy of an HIV/STD prevention intervention among African American and Caucasian college students

ABSTRACT Objectives: The present research examined the influence of communicator's race on the efficacy of intervention videos in the reduction of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among African American and Caucasian college females.
Design: Experimental HIV/STD prevention digital versatile disks (DVDs) featured a White female as a primary or a secondary communicator relative to a Black female, while a control DVD featured 2 Black females. Respondents watched 1 DVD and completed questionnaires before and after viewing the DVD as well as 2 and 4 weeks later.
Sample: 79 African American females and 88 Caucasian females participated.
Measurements: Perceptions of the DVDs, HIV/STD risk, intentions to use condoms, and number of condoms purchased after viewing the videos were assessed.
Results: The intervention was effective in increasing intentions to use condoms with a current partner across the follow-up periods. There was no effect of race of communicator on any variable for African American or Caucasians.
Conclusions: While communicator's race did not affect this intervention, more research is necessary. Future studies should use multiple Black and White communicators to isolate the role of race and should be conducted where larger samples of African American college students can be recruited.