Family asthma management and physical activity among urban children

INTRODUCTION

Urban, low-income, and Black and Latino children with asthma experience higher morbidity and poorer outcomes compared to their suburban, higher-income, and non-Latino White counterparts. This risk is further compounded by higher rates of co-occurring overweight or obesity. Physical activity contributes to both asthma and overweight/obesity status, however, little is known about factors that may promote/limit physical activity among youth from low-income, urban, and racial/ethnic backgrounds. This study evaluates associations between asthma management behaviors and physical activity among a sample of racially/ethnically diverse youth with asthma of both healthy weight and overweight/obesity status.

METHOD

147 children with asthma (Mage = 8.3; 50% overweight/obese status, 58% Hispanic/Latino, and 26% Black) and their families completed the Family Asthma Management System Scale (FAMSS; McQuaid et al., 2005) between 2013 and 2015. Physical activity was measured with waist-worn accelerometers. Differences in FAMSS scores by physical activity levels and associations between FAMSS scores and physical activity for the total sample and by race/ethnicity and weight status were evaluated.

RESULTS

Children who met recommended physical activity guidelines had higher FAMSS "medication adherence", t(89) = -2.04, p < .05, and "collaboration with health care provider", t(89) = -2.09, p < .05. More optimal "environmental control" related to lower levels of physical activity (β = -.21, p < .05) while more optimal "medication adherence" was associated with higher levels of physical activity (β = .21, p < .05). Differences in these associations were identified by race/ethnicity, though not weight status.

CONCLUSIONS

Asthma management behaviors were associated with physical activity, with notable differences by race/ethnicity. Tailored interventions simultaneously addressing multiple health behaviors may be warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

0198 Remote Saliva Sample Collection for Dim Light Melatonin Onset (DLMO) Measurement in Urban Children with Asthma During the COVID-19 Pandemic

Introduction

The COVID-19 pandemic has challenged researchers to use remote data collection. Our project includes determining DLMO phase, requiring a family-friendly without face-to-face interaction. We describe here our protocol, experiences, lessons learned, and findings from the first 15 participants.

Methods

Fifteen urban-dwelling children with moderate to severe persistent asthma [7 girls, ages 7 (n=1) to 10 years; and 8 boys, 8 or 9 years] and caregiver (CG) participated. CG tracked bedtimes and risetimes in daily diaries for 10-14 days; average bedtimes from 5 nights preceding saliva collection were used to determine timing for 10 half-hourly samples. CG and child were oriented and then watched a demo video. A “spit-kit” was delivered to the home the afternoon of the study. Kits included a small cooler bag with bottle of water, 10 numbered and 5 spare Salivette tubes (Starstedt, Germany), plastic bag, dark wraparound glasses with securing strap, and log sheet. Data collection began with a zoom call with staff, CG, and child to reiterate the instructions, answer questions, and observe the first sample. Thereafter, a staff member telephoned the caregiver every 30 minutes to prompt the next sample and query whether glasses had been kept on. CG placed kit outside the home for morning pick up. Samples were centrifuged and frozen (-20°) until sending to the assay lab (SolidPhase, Portland, ME) for melatonin radioimmunoassay (Alpco, Windham, NH).

Results

DLMO phase was determined with a 4pg/ml threshold for 11 children. DLMO phases (mtime=21:46±68 min) and average bedtimes (mtime=20:40±88min) were positively correlated (r=.87). Challenges identified for missed DLMOs included: one child supervised by a teenaged sibling (not CG); one child/CG identified as potentially uncooperative. The other two “misses” likely arose from low saliva quantity, inconsistencies with staff training, and inadequate description of requirements for wearing glasses. Procedure modifications included strategies tailored to families’ needs, experiences, and home environment that can challenge adherence to protocol, greater emphasis on wearing glasses, and cartoon reminder card and scales added to kit. Subsequent samples were successful.

Conclusion

Our approach was effective for determining DLMO phase in children using a remote approach with careful application of methods.

Support (If Any)

R01HL142058, P20GM139743

Physical activity, lung function, and sleep outcomes in urban children with asthma

OBJECTIVES

To examine (1) whether daily declines in physical activity (PA) level and/or in lung function (FEV1) predict an asthma exacerbation in a sample of urban children with asthma, and (2) the association between number of sleep awakenings and decline in daytime PA in this group.

METHODS

In this sample of urban children aged 7-9 years with persistent asthma (N = 147), objective methods assessing lung function via a handheld spirometer and moderate-to-vigorous physical activity (MVPA) via accelerometry were measured over a 4-week period during the fall and early winter of each year as part of a larger 5-year study.

RESULTS

In the entire sample, a significant association between PA and lung function was noted such that a greater decline in daily MVPA was associated with lower odds of exacerbation. Ethnic group differences showed that this association was also significant only among Latino children (odds ratio [OR] = 0.98; 95% confidence interval [CI]:0.97-0.99). A greater number of sleep awakenings were associated with greater declines in daily MVPA among Latinos only (p = .05).

CONCLUSIONS

Results suggest that declining MVPA may contribute to lower risk for an exacerbation. Reasons for declining MVPA need to be further explored in this group. Children with asthma may avoid or be fearful of engaging in PA or may face early symptoms which influence patterns of PA, and this may minimize risk for an exacerbation. Results also suggest reasons for night-time disruptions may need to be targeted in further research or interventions as they can contribute to PA avoidance in this high-risk group.

Pediatric asthma management within Latino and non-Latino White families

Pediatric asthma disparities exist with Latino children, especially from Island Puerto Rico (PR), experiencing greater asthma prevalence and morbidity than non-Latino White (NLW) children. Families must balance attention to child asthma with other child and family needs, defined as the "balanced integration of asthma." This study examined the impact of culturally related factors on the balanced integration of asthma in NLW and Latino families in Rhode Island (RI) and PR, as well as associations between balanced integration and asthma morbidity. Participants included 601 caregivers and their children with asthma (7-16 years) from NLW and Latino backgrounds in RI and PR. Caregivers and children completed interview-administered assessments and a semistructured interview related to family asthma management. Balanced integration of asthma differed significantly by ethnic group/site (p < .001), with Island PR families having the lowest levels of balanced integration. Higher balanced integration was associated with fewer concerns about asthma medications, higher levels of Spanish proficiency in RI Latino families, lower levels of functional limitation, and no emergency department visits in the last year (all ps < .05). Findings suggest that Latino families may experience more difficulty adjusting to child asthma in the context of other child and family demands. Medication beliefs and language proficiency may begin to explain these differences. Our study suggests the importance of continuing to understand how families balance asthma with other aspects of daily life, as culturally appropriate interventions to improve family adjustment to asthma may serve to reduce child asthma morbidity.

Differences in Environmental Control and Asthma Outcomes Among Urban Latino, African American, and Non-Latino White Families

Latino and African American children with asthma are at increased risk for asthma morbidity compared with non-Latino White children. Environmental control (ie, environmental exposures and family strategies to control them) may contribute to greater asthma morbidity for ethnic minority children living in urban environments. This study examined ethnic differences in a semi-structured assessment of environmental control, associations between environmental control and asthma outcomes (asthma control, functional limitation, and emergency department [ED] use), and ethnic differences in environmental triggers in a sample of urban Latino, African American, and non-Latino White families. One hundred thirty-three children (6-13 years of age) and their caregivers completed demographic questionnaires, measures of asthma control and morbidity, and a semi-structured interview assessing environmental control. Reported environmental control differed significantly by ethnicity (P<0.05), with Latino families reporting higher levels of environmental control. Reported environmental control was significantly associated with asthma control (P<0.017) and functional limitation (P<0.017). Reported environmental control and ED use were significantly associated in Latino families (P<0.05). Non-Latino White and African American families reported more secondhand smoke exposure than Latino families (P<0.001). Latino families reported more optimal home environmental control than other ethnic groups. Substantial ethnic differences in asthma triggers suggest that observed ethnic disparities in asthma may be due, at least in part, to differences in the home environment.

Quality of life in children following treatment for a malignant primary bone tumour around the knee

Purpose. We report on the quality of life following treatment for a malignant primary bone tumour around the knee in skeletally immature children.

Patients. Patients (n = 41; mean age = 18 years; range 8–28) had all experienced chemotherapy in a neo-adjuvant setting, surgical excision of the tumour and endoprosthetic replacement.

Methods. Interviews were conducted separately with the child and mother and focused on mobility, body image and the impact of treatment on schooling, employment and plans for the future.

Results. Mobility in the group was variable. Only 12% reported that they could run with any confidence. The proportion who were able to swim (49%) or ride a bike (46%) was higher. All had experienced major disruption in schooling (mean absence following diagnosis = 12 months). Eight had repeated a school year and 41% patients reported that their schoolwork was affected. As a result of their experience, eight (six females and two males) chose health-related employment. Concerns for the future were highest among males and those with manual jobs. Three patients were receiving psychiatric support, in relation to extreme concern about the risk of recurrence. All expressed satisfaction with treatment, and older patients believed that the prosthesis gave a better quality of life than amputation.

Discussion. Our data suggest that outcome following limb-salvage surgery is variable. Education is disrupted. Even so, only two left school with no qualifications. Employment is most restricted among males with few qualifications who may benefit from sensitive vocational counselling.

Symptom perception in pediatric asthma: resistive loading and in vivo assessment compared

BACKGROUND

Inaccurate symptom perception contributes to asthma morbidity and mortality in children and adults. Various methods have been used to quantify perceptual accuracy, including psychophysical (resistive loading) approaches, ratings of dyspnea during induced bronchoconstriction, and in vivo monitoring, but it is unclear whether the different methods identify the same individuals as good or poor perceivers. The objectives of the study were as follows: (1) to compare in the same asthmatic children two methods of quantifying perceptual ability: threshold detection of added resistive loads and in vivo symptom perception; and (2) to determine which method best predicts asthma morbidity.

METHODS

Seventy-eight asthmatic children 7 to 16 years of age completed two threshold detection protocols in the laboratory and recorded their subjective estimates of lung function prior to spirometry at home twice daily for 5 to 6 weeks. Summary measures from both methods were compared to each other and to asthma morbidity (as measured with the Rosier asthma functional severity scale).

RESULTS

Symptom perception ability, as summarized by either method, varied greatly from child to child. Neither of the resistive load detection thresholds were significantly related to any of the three in vivo perception scores, nor were they related to asthma morbidity. The three in vivo scores did show a significant or marginal relationship with morbidity (p < 0.01, p < 0.06, and p < 0.07, respectively).

CONCLUSIONS

Resistive loading techniques may not be useful in assessing symptom perception ability in children. Measuring estimates of symptoms in relation to naturally occurring asthma can identify children at risk for greater asthma morbidity.

The Perceived Illness Experience Scale (PIE): reliability and validity revisited

This paper reports psychometric evaluation of the Perceived illness Experience Scale (PIE). This includes eight sub-scales developed to determine the impact of a chronic illness from the patient's perspective. The sample included 34 patients (mean age = 17 years) successfully treated by limb salvage procedures for a primary bone tumour. Patients also completed measures of well-being (the SF-36) and function. To determine the relationship between patient and proxy ratings, mothers also completed the PIE. Evidence of construct validity of the PIE was obtained from significant correlations between PIE and SF-36 scale scores. There were also significant correlations between function and three of the eight sub-scales of PIE. Good correlations between patients' and mothers' ratings suggests that mothers can be useful proxy raters where patients are unable to provide data themselves. These data suggest that evaluations of patients following limb salvage surgery should not be limited to function measures alone, but need to include assessment of the perceived impact of treatment.

The Role of Monitoring in Determining Quality of Life Following Treatment for A Bone Tumor

Interviews were conducted with 34 young people who had previously been treated for a malignant bone tumor around the knee. These interviews focused on the impact of treatment on activities and perceptions of the risk of recurrence and need for future surgery A coding schema based on a "monitoring-blunting" framework was adopted (Miller, 1995). Quality of life was assessed using a generic and disease-specific measure. Based on interview data, respondents were categorized as negativistic monitors, adaptive monitors, and nonmonitors. There were no differences between groups in terms medical indicators (number of operations). Negativistic monitors reported poorer quality of life compared with the other two groups. There was no increase in nonmonitoring with time since diagnosis as reported in previous work. It is suggested that patients' self-ratings of quality of life are related to the way in which they monitor information and this may be independent of clinical function. Clinical implications, especially in terms of how potentially threatening information about late-effects of treatment are given to patients, are discussed.

What are the motivational needs behind volunteer work?

Identification of an individual's motivational need and desired volunteer work enables volunteer administrators to capitalize on the motivation a person brings to the organization as well as to make effective use of the role by being cognizant of the levels of participation behind the differing volunteer assignments. The Motivation by Maslow Questionnaire was used to identify motivational needs of 35 helpline (crisis) volunteers, and three categories of volunteer work were used to classify their levels of participation. Implications for improving volunteer commitment to the formal voluntary organization and recruitment and retention strategies relative to volunteer motivational needs are discussed.

A comparative study of two different doses of cytarabine for acute myeloid leukemia: a phase III trial of Cancer and Leukemia Group B

Between 1982 and 1986, 326 evaluable patients with acute myeloid leukemia (AML) were randomized to receive cytarabine (Ara-C) at 200 mg/m2 (A200) or 100 mg/m2 (A100) for induction and maintenance therapy. Cycle 1 of induction therapy consisted of 7 days of continuous intravenous (IV) Ara-C and 3 days of i.v. daunorubicin (DNR); cycle 2, if needed, consisted of 5 days of Ara-C and 2 days of DNR. Complete responders (CR) then received monthly subcutaneous (SC) Ara-C at the respective doses (A100 or A200) with 6-thioquanine (6TG) at months 1 and 5, with vincristine (VCR) and prednisone at months 2, 4, 6, and 8, and with DNR at months 3 and 7. Complete response rates were 58% (A100) and 64% (A200) (P = .29). Median survival was 46 weeks (A100) and 38 weeks (A200) (P = .64); 5-year survival was 10% (A200) and 8% (A100). Median time to remission was 6.7 weeks (A200) and 8.1 weeks (A100) (P = .18). Median disease-free survival was 41 weeks (A200) and 44 weeks (A100) (P = .86). Deaths were attributed to therapy-related toxicities in 21% (A200) and 13% (A100) (P = .05). The 5-year survival was 15% for patients with performance status (PS) 0, 8% for PS 1 to 2, and 2% for PS 3 to 4, 18% for patients less than 40 years, 8% for ages 40 to 59, and 3% for age 60 or greater. Stratification of data by age and PS suggested that A200 may improve survival in patients less than 60 years with a good PS 0 (P = .05). This trial does not support the superiority of A200 over A100 in the treatment of AML.

Oncogenic potential of tamoxifen on endometria of postmenopausal women with breast cancer--preliminary report

Tamoxifen (TAM), a nonsteroidal antiestrogen, is used for pre- and postmenopausal patients with breast cancer. Recent reports suggest that TAM may cause endometrial neoplasia. This study is designed to evaluate the oncogenic potential of low-dose TAM on the endometrium. Initially, endometrial screening of patients with breast cancer who had received TAM therapy for at least 12 months was conducted. Seventy patients were interviewed and office endometrial biopsies were obtained from thirty-eight patients. Seven (18%) had hyperplastic changes, ranging from simple hyperplasia through complex hyperplasia with atypia. The following prospective study was conducted: after breast surgery and prior to initiation of TAM therapy, an office endometrial sampling was obtained as a control. After initiation of TAM therapy, biopsies were repeated every 4 to 6 months as long as the patients remained asymptomatic. Nineteen patients were interviewed. Twelve patients were biopsied and followed from 3 to 15 months. One patient refused additional biopsies. Eleven patients had repeat biopsies after initiation of TAM. New hyperplastic changes were found in 3/11 (27%) patients. The preliminary results of this study (although with a small number of patients) indicate that TAM may have some neoplastic effect on the endometrium of postmenopausal patients with breast cancer. This study is still in progress. Additional prospective studies are warranted before a significant correlation between TAM and endometrial neoplasia is confirmed.

A randomized trial of anticoagulation with warfarin and of alternating chemotherapy in extensive small-cell lung cancer by the Cancer and Leukemia Group B

The Cancer and Leukemia Group B (CALGB) conducted a prospective randomized trial to evaluate the role of warfarin and alternating chemotherapy in extensive small-cell lung cancer (SCCL). After stratification for sex and performance status, patients were randomly assigned to receive chemotherapy with methotrexate, doxorubicin (Adriamycin; Adria Laboratories, Columbus, OH), cyclophosphamide, and lomustine (CCNU) (MACC), or MACC plus warfarin (MACC + W), or mitomycin, etoposide, cisplatin, and hexamethylmelamine alternating with MACC (MEPH/MACC). Warfarin was given continuously to maintain a prothrombin time of one and one half to twice the control values. A total of 328 patients were enrolled, and 294 were evaluable. There was a statistically significant advantage in objective response rates (complete [CR] and partial responses [PR], respectively) for MACC + W (17% and 50%) as compared with MACC alone (8% and 43%) or MEPH/MACC (10% and 38%) (P = .012). Both failure-free survival (P = .054 Wilcoxon test) and overall survival (P = .098 Wilcoxon test) were higher on MACC + W (median, 6.6 months and 9.3 months, respectively), as compared with MACC (5.0 months and 7.9 months) and MEPH/MACC (5.0 months and 7.9 months). Toxicity was comparable among the three arms, except for increased hemorrhagic events on MACC + W, which were life-threatening in four patients (4%), and lethal in two others (2%). These data support the role of warfarin in the treatment of SCCL, but do not establish its mechanism of action. Warfarin deserves further studies in SCCL, particularly in patients with limited disease.

Effect of cyclophosphamide and levan treatment on bone marrow and peripheral blood cells in B16-F10 melanoma-bearing mice

Immunotherapeutic agents have often been found to provoke opposite effects on tumor growth--inhibitory or stimulatory--depending on dose, timing or route of administration. The reason for these opposite effects is not yet known. Levan (polyfructose), an immunomodulatory polysaccharide, has been found to exert opposite effects on the growth of the F10 variant of B16 melanoma. Low doses inhibit and high doses enhance the growth of this tumor. Cyclophosphamide (CY) augments the inhibitory effect of the polysaccharide. In order to elucidate the mechanism of these opposite effects, we tried to determine the changes induced by levan at inhibitory and stimulatory doses, alone or in conjunction with CY, on the lymphatic and hematopoietic systems of B16-F10 melanoma-bearing mice. In a previous study we reported the effect of these treatments on the morphology of spleen and lymph nodes (Leibovici, Kopel, Siegal & Gal-Mor (1986). Int. J. Immunopharmac., 8, 391). In the present study, we examined the effect of the treatments on bone marrow and peripheral blood composition. The growth of the tumor itself, as well as the various treatments, induced very marked changes in both bone marrow and blood. Tumor inoculation produced a sharp leukopenia and anemia followed by a restoration of both white and red blood cells. In the bone marrow, the tumor caused a gradual decrease in lymphocyte number. CY accentuated the severe leukopenia caused by the tumor. Lymphocyte depletion was prolonged, while restoration of granulocytes was achieved by day 7. A similar pattern of changes was observed in the bone marrow. With levan, opposite effects were observed in blood and bone marrow with the two doses in relation to the number of the cells of the lymphoid and myeloid lines: while 0.1 mg (tumor inhibitory) doses caused a more active restoration of lymphocytes as compared to 10 mg (tumor stimulatory) doses, an opposite effect was seen on the myeloid series--the high dose induced a more pronounced granulocytosis than the low dose. In the combined treatment, the low levan dose accelerated lymphocyte restoration in bone marrow compared to CY, while the high dose delayed the recovery of these cells. The results of the present study in conjunction with our previous study may explain the basis of the intriguing tumor inhibitory-stimulatory effects of some immunomodulators. Moderate increases in myeloid cell series appear to favor tumor inhibition and high increases favor tumor stimulation. In addition, the results of this study suggest that a regulatory relation might exist between the proliferation of the lymphoid and myeloid cell series.

Bone marrow and peripheral blood modifications in C57BL mice administered with cyclophosphamide and levan

The effects of cyclophosphamide (CY) and levan at low (0.1 mg) and high (10 mg) doses (previously found to inhibit and stimulate, respectively, B16 melanoma growth) were studied. in single and combined administration, on the blood and bone marrow of C57BL mice. Very marked changes in the cellular composition of blood and bone marrow were induced by the various treatments. CY caused a sharp depletion of leukocytes in blood and bone marrow followed by a restoration of granulocytes while lymphocytes remained low. Levan caused a sharp dose-dependent depletion in bone marrow lymphocytes. Blood lymphocytes were not affected, however, by the polysaccharide. With the high levan dose, after a temporary granulocytopenia and monocytopenia, prominent granulocytosis was observed. While CY affected equally the different types of cells, levan decreased the number of lymphocytes and erythroblasts to a greater degree than the number of granulocytes. In the combined CY-levan treatments, the low levan dose generally attenuated the suppressive effect of CY, while the high concentration aggravated it.

Relationship of estrogen and progesterone receptors to prognosis in breast cancer

To ascertain the role of estrogen (ER) and progesterone (PR) receptors as prognostic indicators of resectable breast cancer, the records of 204 patients were analyzed whose receptor studies were done at the Maimonides Medical Center from 1975 to 1983. All patients had radical or modified radical mastectomies and did not show any evidence of distant metastases at the time of operation. Median follow-up was 37 months. An additional 117 patients received some form of adjuvant therapy, mainly chemotherapy, and were analyzed separately. Life table analysis using the log rank test for measuring significance, and a Cox multivariate analysis was performed. At 48 months, 22% of the ER positive (ER+) group versus 33% of the ER negative (ER-) group had recurred as compared to 16% and 35% for the PR+ versus PR- groups, respectively. Life table analysis of the disease free interval (DFI) showed that the difference between the ER+ and ER- groups was not significant (p greater than 0.1), while the difference in DFI between the PR+ and PR- groups was significant (p less than 0.05). Multivariate analysis revealed that the most important factors in predicting the DFI were nodal status (p less than 0.001), tumor size (p less than 0.025), and progesterone receptor status (p less than 0.05). Estrogen receptor status was not found to be significant. In conclusion, PR- patients have a shorter DFI than PR+ patients and that PR status is a more valuable predictor of DFI than ER status.

Chemohormonal therapy in advanced carcinoma of the breast: Cancer and Leukemia Group B protocol 8081

In a prospective, randomized trial Cancer and Leukemia Group B (CALGB) evaluated CAF chemotherapy (cyclophosphamide + doxorubicin + 5-fluorouracil [5-FU]) v CAF plus tamoxifen (TCAF) in advanced breast cancer. Patients were stratified by estrogen receptor (ER) status, dominant site of metastatic disease, menopausal status, and prior adjuvant therapy. Regardless of ER status or menopausal status, the addition of tamoxifen conferred no significant advantage in response rate, response duration, time to treatment failure (TTF) or survival over CAF alone. A secondary objective was to compare the response to CAF of ER positive (ER+) and ER negative (ER-) patients to determine if there was a differential response to cytotoxic chemotherapy. Response rates of ER+ and ER- patients to CAF were identical (56%), but the response duration, time to treatment failure, and survival of ER+ patients were significantly longer than ER- patients. This lack of differential response implies that chemotherapy and hormonal therapy may compete for the same pool of ER+ cells. It also suggests that chemotherapy kills breast cancer cells indiscriminately, regardless of ER status.

Comparison of three remission induction regimens and two postinduction strategies for the treatment of acute nonlymphocytic leukemia: a cancer and leukemia group B study

Patients with acute nonlymphocytic leukemia were randomized to receive remission induction therapy consisting of seven days of cytosine arabinoside and three days of daunorubicin ("7 + 3") or to receive the same regimen intensified by either the addition of 6-thioguanine or by extension of the administration of cytosine arabinoside to ten days. Additionally, all patients were randomized to receive or not to receive cotrimoxazole antibacterial prophylaxis during the remission induction phase. Neither an increase in intensity of chemotherapy nor the antibacterial prophylaxis increased the remission rate above the 53% for patients treated with the standard "7 + 3" regimen. The second part of this study addressed the issue of the utility of long-term maintenance chemotherapy. To this end, patients were randomized to discontinue all treatment after 8 months of maintenance chemotherapy or to continue maintenance therapy for a total of 3 years. Although there was a transient increase in the relapse rate for patients who discontinued therapy, the proportion of long-term remitters was identical in the two patient groups. Additionally, there is a suggestion of a survival advantage for patients randomized to discontinue all therapy at 8 months.

Effect of splenectomy on treatment of Lewis lung carcinoma by an immunomodulatory polysaccharide and a cytotoxic agent

The effect of the spleen on the efficiency of chemotherapy (cyclophosphamide) and immunotherapy (the polysaccharide levan) of C57BL mice bearing the Lewis lung carcinoma was studied. The development of Lewis lung carcinoma caused a gradual splenomegaly in the C57BL mice. Splenectomy did not, however, affect tumor growth in the nontreated host. Levan induced a pronounced splenomegaly. Splenectomy reduced markedly the antitumoral effect of the polysaccharide. These results indicate that spleen elements participate in the inhibitory activity of levan. By contrast, splenectomy had no effect on the efficiency of treatment of cyclophosphamide.

Histological changes in spleen and lymph nodes of mice administered cyclophosphamide and levan

Morphological changes in spleen and lymph nodes of C57B1 mice induced by the cytotoxic agent cyclophosphamide and the polysaccharide levan, separately and in combination were studied. In the spleen, an early decrease (phase 1) and a late increase (phase 2) in weight were found to result from all drug administrations. The hypocellularity of phase 1 was due to a depletion in the white pulp affecting mainly the B-region. Splenic weight decrease was parallel to B-cell depletion and most marked in animals exposed to cyclophosphamide with levan. The splenomegaly observed during phase 2 with all treatments was due to extramedullary hematopoiesis in the red pulp. In the lymph nodes, administration of cyclophosphamide and levan produced opposite effects on the B-cell region: cyclophosphamide eliminated the germinal centers for 8 days, but levan seemed to enhance B-cell activity. In animals given both cyclophosphamide and levan, inhibition of B-cell activity began earlier than with cyclophosphamide alone. Levan does not antagonize the suppressive effect of cyclophosphamide on the B-cell component at the early phase when the drugs are given together.

Effect of tumor inhibitory and stimulatory doses of levan, alone and in combination with cyclophosphamide, on spleen and lymph nodes

Immunotherapeutic agents are often reported to induce opposite effects -- inhibitory and stimulatory -- on tumor growth, depending on the dose, timing or route of administration of the drug. The reason underlying these opposite effects is not yet known. The immunomodulatory polysaccharide levan (polyfructose) has been found to exert such opposite effects on the growth of the F10 variant of B16 melanoma. Low doses inhibit and high doses enhance tumor growth. Cyclophosphamide (CY) augment the inhibitory effect of levan. In order to clarify the mechanism of this switch, we tried in the present study to determine the changes induced by levan at inhibitory and stimulatory treatments, alone or with CY, on the morphology of spleens and lymph nodes of the melanoma-bearing mice. The growth of the tumor in non-treated mice was found to induce a moderate splenomegaly. Microscopically, two main changes were observed: a mild extramedullary hematopoiesis and a sharp increase in the number of germinal centers. A parallel increase in germinal center number was found in the lymph nodes. The data presented suggest that the immune system plays a role in both the inhibition and stimulation of tumor growth by levan. Levan induced a dose dependent splenomegaly, even more pronounced in combination with CY, due to an extramedullary hematopoiesis. Levan reduced the B cell activity caused by the tumor, proportionally to its dose. In combination with CY, levan accelerated the recovery of the B cell activity at the low dose, while the high dose prevented it. A similar trend was found in the lymph nodes. The changes involved in the switch inhibition-stimulation could be either the degree of reduction in B cell activity or the degree of extramedullary hematopoiesis or some interplay between the myelocytic and lymphocytic series, which was found to change in an opposite fashion under the influence of various treatments. Since the immune system is a finely equilibrated system, it is possible that immunomodulation rather than immunostimulation should be aimed at in cancer immunotherapy. However, the conditions required for achieving this equilibrium have to be defined.

Opposite effects on tumor growth depending on dose of an immunomodulatory polysaccharide with or without cyclophosphamide

Opposite effects on the growth of the F10 variant of B16 melanoma--inhibitory and stimulatory--were found with varying doses of the polysaccharide levan. Low (0.1 and 1 mg) daily doses inhibited, while high (5 and 10 mg) doses enhanced tumor growth. In combined cyclophosphamide-levan treatment, these opposite effects were more pronounced.

Different biological behavior of AKR lymphoma cells from primary and metastatic tumors

AKR lymphoma cells derived from primary s.c. tumors (PT) and cells from their metastases (MT) were inoculated into recipient mice in order to compare their malignant behavior. A higher malignant potential of MT compared to PT cells was found. The results support the hypothesis that metastasis is a process of selection of cells possessing a potential to metastasize, which preexist in the primary tumor. In the model used, both the selection of 'variants' of malignancy and the assay of malignancy were as close as possible to natural tumor progression.

Effect of splenectomy on the efficiency of chemo-immunotherapy of melanoma-bearing mice

Determination by the immune system of chemo- and immunotherapy of a murine tumor was investigated. The effect of cyclophosphamide and levan (polyfructose) in single and combined treatment on the growth of the F10 variant of B16 melanoma was tested in splenectomized and non-splenectomized mice. Splenectomy was found to increase markedly the efficiency of all treatments, particularly the combined treatment, as judged by the delay of appearance and size of the subcutaneous tumors at the site of inoculation. Nevertheless, mortality rate was not always in correlation with the rate of local tumor evolution: some of the treated splenectomized mice died earlier than expected, with relatively small local tumors, due to enhanced metastasis. The results indicate that elements in the spleen of C57BL mice decrease the therapeutic efficiency of the drugs tested. It can be deduced that splenectomy must not be considered to increase the risk of a tumor-bearing host in all cases. On the contrary, it may improve the efficiency of cancer treatment in certain tumor-host systems.

Change from inhibition to stimulation by levan of AKR lymphoma following serial transfers

A progressive increase in malignancy following serial passages of AKR lymphoma is often accompanied by loss in sensitivity to the antitumor agent, levan. In further transfers, stimulation of tumor growth, instead of inhibition, is sometimes observed. It is proposed that the shift from inhibition to stimulation of tumor growth by the immunomodulator levan may be due to a change during tumor progression in the sensitivity of the tumor cells to the reported dual effect of macrophages, inhibitory or stimulatory, on tumor growth.

T cell chronic lymphocytic leukemia: presence in bone marrow and peripheral blood of cells that suppress erythropoiesis in vitro

The pathogenesis of the anemia associated with malignancy was investigated in a patient with T cell chronic lymphocytic leukemia. The plasma clot culture system was used as a measure in vitro of erythropoiesis. The patient's peripheral blood and marrow T lymphocytes obtained both before and after transfusion therapy suppressed erythroid colony formation by normal human bone marrow cells. Pretreatment of the patient's bone marrow T cells by antithymocyte globulin (ATG) and complement reversed this suppression. In addition, pretreatment of the patient's marrow cells with ATG and complement markedly augmented erythropoiesis in vitro. The expression of erythroid activity caused by the selective destruction of the suppressor T lymphocytes in the patient's bone marrow with ATG and the suppression of normal erythropoiesis by the patient's bone marrow and peripheral blood lymphocytes suggest that interaction between the malignant T cell and the erythropoietin-responsive stem cell is important in production of anemia in this patient.

Cytomorphological determinants of prognosis in acute lymphoblastic leukemia of children

In children with ALL, the appearance of leukemic cells in stained spreads can be useful in predicting outcome of the disease. Cell size and nucleolar size and prominence are the two criteria, detectable on Romanowsky-stained bone marrow spreads, which permit such prediction. In a series of 93 children with ALL, 48 "poor risk" patients were detected. More than 1% of the bone marrow blast cells of these patients exceeded in diameter twice the diameter of nearby red blood cells, and, on average, more than one nucleolus was visible in every two leukemic cells. The survival of these 48 patients (estimated median 18 mo) was significantly worse (p = 0.0036) than that of the other 45 patients (estimated median over 5 yr). Analysis of the series with respect to other risk factors (age, leukocytosis at diagnosis) revealed the cytomorphological risk to be independent of the other two. Comparison of this method with others which have been used suggests that the proposed method may be more reproducible (capable of being learned) than others because it relies on specific characteristics rather than on total recognition of a "cell type," and that it may select a higher proportion of "poor risk" patients than other methods. PAS-positivity may be a useful additional criterion.

The role of attribution and self-perception in behavior change: implications for behavior therapy

In this report extrapolations were made to behavior therapy from two related lines of social-psychological research: attribution and self-perception. A review of the relevant research literature on attribution suggested that (a) the perception and causal attribution of physiological arousal is an important determinant of emotional behavior and (b) self-attribution of behavior change increases the likelihood of maintenance of that change. A review of research concerned with Bem's self-perception theory indicated that inferences arising from self-observation of one's own overt behaviors may affect subsequent behavior, attitudes, and beliefs. These two lines of research converge in suggesting that an individual's perception of himself (in terms of overt behavior, situational circumstances, and physiological states) may have a marked influence on behavior change and the maintenance of that change. In the major body of this paper the implications of this research are discussed, particularly in terms of new procedures and specific modifications for existing procedures in behavior therapy. The major areas of behavior therapy discussed include: (a) behavioral assessment; (b) role playing (behavior rehearsal); (c) operant procedures; and (d) self-control strategies. Emphasis was placed upon treating the specific implications delineated as hypotheses requiring empirical investigation in the clinical arena. Strategies for such research were outlined.