Sex-associated differences in frequencies and prognostic impact of recurrent genetic alterations in adult acute myeloid leukemia (Alliance, AMLCG)

Clinical outcome of patients with acute myeloid leukemia (AML) is associated with demographic and genetic features. Although the associations of acquired genetic alterations with patients' sex have been recently analyzed, their impact on outcome of female and male patients has not yet been comprehensively assessed. We performed mutational profiling, cytogenetic and outcome analyses in 1726 adults with AML (749 female and 977 male) treated on frontline Alliance for Clinical Trials in Oncology protocols. A validation cohort comprised 465 women and 489 men treated on frontline protocols of the German AML Cooperative Group. Compared with men, women more often had normal karyotype, FLT3-ITD, DNMT3A, NPM1 and WT1 mutations and less often complex karyotype, ASXL1, SRSF2, U2AF1, RUNX1, or KIT mutations. More women were in the 2022 European LeukemiaNet intermediate-risk group and more men in adverse-risk group. We found sex differences in co-occurring mutation patterns and prognostic impact of select genetic alterations. The mutation-associated splicing events and gene-expression profiles also differed between sexes. In patients aged <60 years, SF3B1 mutations were male-specific adverse outcome prognosticators. We conclude that sex differences in AML-associated genetic alterations and mutation-specific differential splicing events highlight the importance of patients' sex in analyses of AML biology and prognostication.

Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis

BACKGROUND

In patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT), a calcineurin inhibitor plus methotrexate has been a standard prophylaxis against graft-versus-host disease (GVHD). A phase 2 study indicated the potential superiority of a post-transplantation regimen of cyclophosphamide, tacrolimus, and mycophenolate mofetil.

METHODS

In a phase 3 trial, we randomly assigned adults with hematologic cancers in a 1:1 ratio to receive cyclophosphamide-tacrolimus-mycophenolate mofetil (experimental prophylaxis) or tacrolimus-methotrexate (standard prophylaxis). The patients underwent HSCT from an HLA-matched related donor or a matched or 7/8 mismatched (i.e., mismatched at only one of the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci) unrelated donor, after reduced-intensity conditioning. The primary end point was GVHD-free, relapse-free survival at 1 year, assessed in a time-to-event analysis, with events defined as grade III or IV acute GVHD, chronic GVHD warranting systemic immunosuppression, disease relapse or progression, and death from any cause.

RESULTS

In a multivariate Cox regression analysis, GVHD-free, relapse-free survival was significantly more common among the 214 patients in the experimental-prophylaxis group than among the 217 patients in the standard-prophylaxis group (hazard ratio for grade III or IV acute GVHD, chronic GVHD, disease relapse or progression, or death, 0.64; 95% confidence interval [CI], 0.49 to 0.83; P = 0.001). At 1 year, the adjusted GVHD-free, relapse-free survival was 52.7% (95% CI, 45.8 to 59.2) with experimental prophylaxis and 34.9% (95% CI, 28.6 to 41.3) with standard prophylaxis. Patients in the experimental-prophylaxis group appeared to have less severe acute or chronic GVHD and a higher incidence of immunosuppression-free survival at 1 year. Overall and disease-free survival, relapse, transplantation-related death, and engraftment did not differ substantially between the groups.

CONCLUSIONS

Among patients undergoing allogeneic HLA-matched HSCT with reduced-intensity conditioning, GVHD-free, relapse-free survival at 1 year was significantly more common among those who received cyclophosphamide-tacrolimus-mycophenolate mofetil than among those who received tacrolimus-methotrexate. (Funded by the National Heart, Lung, and Blood Institute and others; BMT CTN 1703 ClinicalTrials.gov number, NCT03959241.).

Outcome prediction by the 2022 European LeukemiaNet genetic-risk classification for adults with acute myeloid leukemia: an Alliance study

Recently, the European LeukemiaNet (ELN) revised its genetic-risk classification of acute myeloid leukemia (AML). We categorized 1637 adults with AML treated with cytarabine/anthracycline regimens according to the 2022 and 2017 ELN classifications. Compared with the 2017 ELN classification, 2022 favorable group decreased from 40% to 35% and adverse group increased from 37% to 41% of patients. The 2022 genetic-risk groups seemed to accurately reflect treatment outcomes in all patients and patients aged <60 years, but in patients aged ≥60 years, relapse rates, disease-free (DFS) and overall (OS) survival were not significantly different between intermediate and adverse groups. In younger African-American patients, DFS and OS did not differ between intermediate-risk and adverse-risk patients nor did DFS between favorable and intermediate groups. In Hispanic patients, DFS and OS did not differ between favorable and intermediate groups. Outcome prediction abilities of 2022 and 2017 ELN classifications were similar. Among favorable-risk patients, myelodysplasia-related mutations did not affect patients with CEBPAbZIP mutations or core-binding factor AML, but changed risk assignment of NPM1-mutated/FLT3-ITD-negative patients to intermediate. NPM1-mutated patients with adverse-risk cytogenetic abnormalities were closer prognostically to the intermediate than adverse group. Our analyses both confirm and challenge prognostic significance of some of the newly added markers.

High early death rates, treatment resistance, and short survival of Black adolescents and young adults with AML

Survival of patients with acute myeloid leukemia (AML) is inversely associated with age, but the impact of race on outcomes of adolescent and young adult (AYA; range, 18-39 years) patients is unknown. We compared survival of 89 non-Hispanic Black and 566 non-Hispanic White AYA patients with AML treated on frontline Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology protocols. Samples of 327 patients (50 Black and 277 White) were analyzed via targeted sequencing. Integrated genomic profiling was performed on select longitudinal samples. Black patients had worse outcomes, especially those aged 18 to 29 years, who had a higher early death rate (16% vs 3%; P=.002), lower complete remission rate (66% vs 83%; P=.01), and decreased overall survival (OS; 5-year rates: 22% vs 51%; P<.001) compared with White patients. Survival disparities persisted across cytogenetic groups: Black patients aged 18 to 29 years with non-core-binding factor (CBF)-AML had worse OS than White patients (5-year rates: 12% vs 44%; P<.001), including patients with cytogenetically normal AML (13% vs 50%; P<.003). Genetic features differed, including lower frequencies of normal karyotypes and NPM1 and biallelic CEBPA mutations, and higher frequencies of CBF rearrangements and ASXL1, BCOR, and KRAS mutations in Black patients. Integrated genomic analysis identified both known and novel somatic variants, and relative clonal stability at relapse. Reduced response rates to induction chemotherapy and leukemic clone persistence suggest a need for different treatment intensities and/or modalities in Black AYA patients with AML. Higher early death rates suggest a delay in diagnosis and treatment, calling for systematic changes to patient care.

Abstract 1060: Introducing a novel DHODH inhibitor with superior in vivo activity as monotherapy or in novel combination regimen with immunotherapy for hematological malignancies

Acute myeloid leukemia (AML) is characterized by the uncontrolled expansion of un-differentiated hematopoietic progenitor myeloblasts. AML treatment is very challenging owing to its complex heterogeneity resulting in a dismal 5-year overall survival rate particularly in elderly patients unfit for standard induction chemotherapy. The expansion of AML requires the availability of sufficient nucleotides supporting the anabolic processes required for AML growth thus, targeting nucleotide biosynthesis can halt AML progression. Indeed, targeting dihydroorotate dehydrogenase (DHODH), a critical rate-limiting step in the de novo pyrimidine synthesis pathway not only induced cytotoxicity but has been shown to promote blast differentiation in a HOXA9/MEIS1 over-expressing model. We sought to develop a DHODH inhibitor that had superior properties to those reported for AML therapy. Compound 41 (cmpd 41) demonstrates sub-nanomolar 50% inhibitory concentration for DHODH biochemical activity and potent in vitro activity across several AML cell lines and primary AML cells independent of mutational subtype, including mutated TP53. Cmpd 41 also demonstrated superior in vivo anti-leukemic activity in multiple AML xenograft models as monotherapy and demonstrated synergy with a hypomethylating agent, decitabine in TP53 mutated AML. Given the heterogeneity of AML and frequent emergence of resistant clones, we aimed to investigate ways to enhance response to DHODH inhibitors through combination. After in vitro treatment of AML cell lines and primary patient samples with DHODH inhibitors, we observed an increase in CD38 surface expression suggesting synergy with CD38 targeting monoclonal antibody (mAb) immunotherapies. Indeed, we are the first to report synergy between DHODH inhibitors and anti-CD38 mAb in AML which emphasizes the synergy between this promising novel class of agents with immunotherapies via recruiting innate immunity. Consequently, given the relevance of CD38 mAb therapy to multiple myeloma (MM), we extended these studies to MM and remarkably found that cmpd 41 was highly efficacious as a monotherapy and in combination with CD38 mAb, resulted in complete tumor regression in a subcutaneous MM xenograft model. In summary, we introduce a best in class DHODH inhibitor with a data-driven combination strategy for both AML and MM. Our studies suggest a highly synergistic combination strategy involving immunotherapy for AML and other hematologic malignancies.

Citation Format: Ola A. Elgamal, Sandip Vibhute, Sydney Fobare, Abeera Mehmood, Mariah L. Johnson, Jean Truxall, Emily Stahl, Bridget Carmichael, Shelley J. Orwick, Ramasamy Santhanam, Kasey Hill, Susheela Tridandapani, Christopher C. Coss, Alice S. Mims, Karilyn T. Larkin, Mitch A. Phelps, Sharyn D. Baker, Alex Sparreboom, Thomas E. Goodwin, Gerard Hilinski, Chad E. Bennett, Erin Hertlein, John C. Byrd. Introducing a novel DHODH inhibitor with superior in vivo activity as monotherapy or in novel combination regimen with immunotherapy for hematological malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1060.

Optimizing extracellular vesicles' isolation from chronic lymphocytic leukemia patient plasma and cell line supernatant

In chronic lymphocytic leukemia (CLL) and very likely all cancer types, extracellular vesicles (EVs) are a common mechanism by which intercellular messages are communicated between normal, diseased, and transformed cells. Studies of EVs in CLL and other cancers have great variability and often lack reproducibility. For CLL patient plasma and cell lines, we sought to characterize current approaches used in isolating EV products and understand whether cell culture-conditioned media or complex biological fluids confound results. Utilizing nanoparticle tracking analysis, protein quantification, and electron microscopy, we show that ultracentrifugation with an OptiPrep cushion can effectively minimize contaminants from starting materials including plasma and conditioned media of CLL cell lines grown in EV-depleted complete RPMI media but not grown in the serum-free media AIM V commonly used in CLL experimental work. Moreover, we confirm the benefit of including 25 mM trehalose in PBS during EV isolation steps to reduce EV aggregation, to preserve function for downstream applications and characterization. Furthermore, we report the highest particles/μg EVs were obtained from our CLL cell lines utilizing the CELLine bioreactor flask. Finally, we optimized a proliferation assay that offers a functional evaluation of our EVs with minimal sample requirements.

Detecting white coat and reverse white coat effects in clinic settings using measures of blood pressure habituation in the clinic and patient self-monitoring of blood pressure

To examine the utility of blood pressure (BP) habituation within and across multiple clinic visits and patient-determined home BP monitoring for detecting white coat (WCE) and reverse white coat effects (RWCE) commonly observed in medical settings, 54 patients undergoing evaluation for hypertension in an internal medicine group practice were categorized according to the magnitude of differences between systolic BP (SBP) and diastolic BP (DBP) obtained in the clinic and through ambulatory BP monitoring. BPs were measured four times during three separate clinic visits, during a 1-week home BP monitoring period, and during a single 24-h ambulatory monitoring period. Patients whose mean clinic and average daytime BPs were within +/-5 mm Hg were categorized as having stable BP; patients whose clinic BPs were >5 mm Hg of their daytime BPs were categorized as showing a WCE and patients whose average daytime BPs were >5 mm Hg of their clinic BPs were categorized as showing a RWCE. Results revealed that degree of habituation occurring between the first and third clinic visits significantly predicted magnitude of both the WCE and RWCE for SBP, with greater habituation being associated with the WCE and lesser habituation associated with the RWCE. Greater SBP habituation within clinic visits was associated with the WCE for SBP and greater DBP habituation within clinic visits was associated with the WCE for DBP. Lesser DBP habituation within clinic visits was associated with the RWCE for both SBP and DBP. Home BP monitoring did not contribute to predicting either WCE or RWCE.

Biobehavioral responses to interpersonal conflict during anger expression among anger-in and anger-out men

To examine whether typical modes of anger expression (ie., anger-in, anger-out) were related to cardiovascular, affective, behavioral, and cognitive responses to interpersonal conflict, 20 anger-in and 20 anger-out undergraduate men participated in 2 role plays, one in which they were instructed to exhibit their anger overtly and the other in which they inhibited their anger Results showed that anger-in individuals used significantly more repression self-statements than anger-out individuals across both role play interactions (p <.01). Anger-out persons showed exaggerated diastolic blood pressure response in contrast to anger-in participants, but only during the exhibited anger role play (p <.04). When the anger exhibition role play followed anger inhibition, diastolic bloodpressure responses were more intense (p <. 05), and heart rate recovery was significantly slower (p <.03) among anger-outparticipants in contrast to anger-in participants. These findings indicate that modes of anger expression (trait) and contextual demands of the interaction (state) interact in complex ways to influence biobehavioral reactions to anger provocation.

Changes in hemodynamic response to mental stress with heart rate feedback training

This study was designed to examine underlying hemodynamic changes that accompany observed reductions in heart rate (HR) response to mental stress following HR feedback training. Twenty-five college males, assigned to either a HR feedback training group (FB+) or a control group (FB-), were presented with a videogame and mental arithmetic challenge, as HR, blood pressure, and impedance cardiography-derived measures of hemodynamic functioning were recorded. During training, the FB+ group received HR feedback and the FB- group was not provided with HR feedback while playing a videogame. At posttraining, results revealed that the FB+ group exhibited significantly lower HR, systolic blood pressure, stroke volume, and total peripheral resistance responses to the videogame compared to that at pretraining. There was no evidence that the acquired skills generalized to a mental arithmetic task. These results suggest that HR feedback training is an effective method for reducing cardiovascular and hemodynamic responses to a mental stressor; however, the generalizability of this effect remains questionable.

Psychophysiological arousal in older adults: a critical review

In spite of the relatively high prevalence rates of anxiety disorders (AD) and related symptoms, very little is known about the experience, presentation, and assessment of anxiety in later life. Because the physiology of the autonomic nervous system changes with age, an enhanced understanding of how these developmental changes affect the somatic-physiological response patterns to anxiety-evoking stimuli among older adults may help explain whether we can generalize current assessment and treatment practices and procedures for AD from younger to older adults. In this paper, we describe and critically evaluate studies that have employed psychophysiological recording of autonomic arousal to anxiety-arousing or stressful stimuli among samples of younger and older adults. The conclusions one can draw from the review are quite limited by both the paucity of relevant literature and the methodological limitations of the published studies.

Cardiovascular and behavioral response to social confrontation: measuring real-life stress in the laboratory

Laboratory investigations of cardiovascular reactivity to mental stress often ignore concomitant differences in cognitive, affective, and behavioral responses that are commonly observed among study participants. To provide a more systematic laboratory methodology to examine relations among cardiovascular, behavioral, and self-report measures of cognitive and affective responses to stress, we developed and tested a social confrontation procedure involving standardized interactions during two scenes. Results of three investigations are presented to illustrate the utility of the social confrontation procedure. In the first two studies, this multidimensional assessment strategy produced results which may foster research projects that bridge separate areas of psychological inquiry. In one application, persons with hypertensive parents, in contrast to persons with normotensive parents, exhibited characteristic negative behavioral responses during both interactions as well as the more commonly-observed exaggerated blood pressure reactions. In the other study, students from less functional families (regarding cohesion and adaptability) were shown to exhibit exaggerated blood pressure reactions in addition to their commonly-reported negative cognitive and behavioral coping styles. Finally, a third study examined how a simple instructional set regarding the expression or suppression of anger influenced participants' responses. Significant differences were observed across response domains, with anger expression resulting in a more intense response than anger suppression. In sum, the social confrontation procedure represents an important methodological development for exploring the relation between response domains, the relation between cardiovascular response to stress and psychosocial risk for cardiovascular disease, and the physiological and behavioral distinction between anger expression and anger suppression.

Effects of gender of observer and fear of negative evaluation on cardiovascular reactivity to mental stress in college men

This study investigated the relation between mere observation, the gender of a confederate observer and cardiovascular reactivity to two laboratory challenges, a math task and verbal anagrams, in both individuals with high and low social fear (e.g. fear of negative evaluation). Forty-eight undergraduate males completed the Fear of Negative Evaluation Scale and were categorized as either high or low social fear based on a median split. Sixteen subjects were tested alone, 16 subjects were observed by a male confederate during task performance and 16 subjects were observed by a female confederate during task performance. Cardiovascular measures of heart rate and blood pressure were measured during both tasks and intervening rest periods. Results revealed subjects with high social fear exhibited higher heart rate reactions to the math task and higher diastolic blood pressure reactions to the anagram challenge than low social fear participants, but only when observed by a female confederate. In addition, participants in the male and female observation conditions exhibited greater SBP responses to the anagram task than participants in the alone condition. No group differences on task performance were observed. Cardiovascular reactivity to the two tasks used in this study was impacted by both contextual laboratory factors (i.e. gender of observer) and dispositional attributes of the participant (i.e. social fear).

Anger management training with mild essential hypertensive patients

Casual blood pressures and measures of cardiovascular and behavioral reactions to neutral and confrontive interactions were obtained from 13 essential hypertensive patients who received training in anger management and 9 no-treatment control patients. At pre- and posttraining, heart rate (HR) and blood pressure (BP) were measured (a) at rest and (b) during role-play interactions consisting of neutral and confrontation scenes. Behavioral responses were also coded for each interaction. For treatment subjects, a 6-week program in anger management was conducted, which included relaxation training, self-statement modification, and role-play assertiveness training. Treatment subjects exhibited significantly lower casual DBPs at posttraining (M = 90.2 mm Hg) than control subjects (M = 95.7 mm Hg). Posttreatment casual SBPs for treatment and control subjects were not significantly different. Treatment subjects exhibited significantly more assertive skill and lesser DBP reactivity at posttreatment than their control counterparts during the confrontive interaction but not during the neutral role-play interaction.

Women, anger, and cardiovascular responses to stress

Cardiovascular reactivity (CVR) to stressful stimuli is predictive of future development of cardiovascular disease (CVD). Anger appears to be an important mediator of this relationship. Unfortunately, the majority of research in this area has utilized predominantly male subjects, leaving the relationship between CVD and anger in females largely unexplored. To address the dearth of research among females, the present study examined the relationship between Anger-In, as well as Anger-Out, and CVR to stressors among women. Females reporting moderate levels of Anger-Out exhibited lower blood pressure reactions to a mental arithmetic stressor than females reporting high and low levels of Anger-Out. Females reporting moderate levels of Anger-Out also exhibited lower heart rate reactions than individuals reporting high levels of Anger-Out. Anger-In was not related to CVR in the present study.

Behavioral and cardiovascular responses to interpersonal challenges among male offspring of essential hypertensives

Behavioral, cardiovascular, and self-report of cognitive and affective responses to 2 interpersonal challenges were examined among 20 men with a positive (FH+) and 20 with a negative (FH-) family history of hypertension. Heart rate (HR) and blood pressure (BP) were measured throughout the laboratory session; Ss were requested to self-report positive and negative cognitions, state anger, and state anxiety that occurred during interactions with a male and female confederate. Behavioral responses to interpersonal tasks were videotaped, coded, and categorized into 4 major groupings (positive verbal, positive nonverbal, negative verbal, and negative nonverbal). FH+ individuals exhibited significantly higher resting HR and systolic BP (SBP) reactivity to both interactions than FH- counterparts. Analyses of behavioral responses for both interactions revealed significantly more negative verbal and nonverbal behavior and less positive nonverbal behavior among FH+ as compared with FH-Ss.

Behavioral and cardiovascular responses to interpersonal challenges among male offspring of essential hypertensives

Behavioral, cardiovascular, and self-report of cognitive and affective responses to 2 interpersonal challenges were examined among 20 men with a positive (FH+) and 20 with a negative (FH-) family history of hypertension. Heart rate (HR) and blood pressure (BP) were measured throughout the laboratory session; Ss were requested to self-report positive and negative cognitions, state anger, and state anxiety that occurred during interactions with a male and female confederate. Behavioral responses to interpersonal tasks were videotaped, coded, and categorized into 4 major groupings (positive verbal, positive nonverbal, negative verbal, and negative nonverbal). FH+ individuals exhibited significantly higher resting HR and systolic BP (SBP) reactivity to both interactions than FH- counterparts. Analyses of behavioral responses for both interactions revealed significantly more negative verbal and nonverbal behavior and less positive nonverbal behavior among FH+ as compared with FH-Ss.

The effect of social support and physical touch on cardiovascular reactions to mental stress

To examine the effects of social support on cardiovascular reactions to behavioral stress, the present study tested the relative contribution of three elements of social support: the presence of another person in the laboratory; the presence of a person considered to be a friend; and physical touch. Sixty undergraduate females were assigned to one of the following groups: alone (A); friend present-touch (FT); friend present-no touch (FNT); stranger present-touch (ST); and stranger present-no touch (SNT). Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) measures were obtained across baseline phases and during presentation of two behavioral challenges (mental arithmetic, mirror-tracing). The findings suggest that neither the presence of a stranger nor physical touch are related to attenuated cardiovascular reactions to stress; rather, if the extent of cardiovascular reactivity is related to social support, the presence of a friend may be the important mediating variable.

Reducing heart rate reactivity to stress with feedback. Generalization across task and time

Heart rate (HR) reactions to two behavioral stressors (videogame and mental arithmetic) were measured in 8 experimental subjects who received biofeedback training and 8 matched control subjects during three assessment periods: pretraining, posttraining, and one-week follow-up. Experimental subjects exhibited significant reductions in HR following a training session in which they received ongoing HR feedback while playing a videogame. Control subjects, who played the same number of videogames without HR feedback, showed smaller HR reductions. During the training session, all subjects were instructed to reduce HR while maximizing game performance. In comparison to controls, experimental subjects (a) maintained lower HRs during videogame presentations after a one-week period and (b) generalized these HR reductions to the mental arithmetic challenge at follow-up. Performance on the videogame declined from posttraining to follow-up for experimental subjects but not for control subjects. No group difference in mental arithmetic performance was observed.

Treatment of paruresis with in vivo desensitization: a case report

In vivo desensitization was employed with a patient exhibiting chronic paruresis. Measures of urination delay, and subjective units of distress were obtained at pre-training, during training, at a generalization trial, and at a follow-up assessment. Urine volume was also measured at pre- and post-training. There was shorter delay in urination, greater urine output, and less subjective anxiety following treatment. These effects were also demonstrated during a generalization post-test in which the patient was exposed to an unknown observer. A follow-up trial involving exposure to a second unknown observer indicated that treatment effects were maintained at 7.5 months following treatment.

Cognitive response to a cold pressor challenge in high and low blood pressure reactive subjects

To examine the relationship between cognitive and cardiovascular reactions to a cold pressor challenge, 20 high and 20 low blood-pressure-reactive males were identified. Subjects were trained using a think-aloud procedure and asked to report their thoughts aloud during task presentation. In comparison to low-reactors, high-reactive subjects exhibited greater increases in systolic and diastolic blood pressure, but not heart rate, in response to the task. High-reactive subjects reported fewer distracting self-statements than low-reactors during the task. No group differences in positive, neutral, or negative self-statements were observed. These findings corroborate the importance of distraction strategies in mediating acute cardiovascular reactions to stress.

Assessment of cardiovascular reactivity across laboratory and natural settings

The purpose of this investigation was to examine the stability of heart rate and blood pressure reactions of individuals across laboratory challenges and a challenge in the natural environment. Undergraduate musicians' heart rates and blood pressures were measured during anticipation and in response to a mental arithmetic challenge and a visual-verbal concepts challenge in the laboratory and anticipation of a musical performance jury in the natural environment. Results revealed that systolic blood pressure reactivity measured in anticipation of laboratory challenges, but not during these tasks, was related to systolic blood pressure levels measured in anticipation to the musical performance jury. Generalization of heart rate and diastolic blood pressure reactivity across settings was not supported. Systolic blood pressure, diastolic blood pressure, and heart rate reactions were stable across laboratory tasks.

Predicting treatment outcome to progressive relaxation training in essential hypertensive patients

Nineteen borderline essential hypertensive patients participated in (a) a pretreatment assessment of sympathetic nervous system activity (SNS), (b) a progressive muscle relaxation training program, and (c) a posttreatment assessment of SNS functioning. During both pre- and posttreatment assessments, each subject participated in a laboratory session during which cardiovascular responses to two behavioral challenges were measured, a 24-hr urine collection for catecholamine analysis and the completion of relevant self-report questionnaires. Results revealed that subjects who improved the most with relaxation training (showed the greatest reduction in blood pressure) were individuals who, at pretreatment, (a) were less reactive to laboratory challenges, (b) possessed lower levels of resting epinephrine, and (c) scored lower on measures of trait anger and higher on assertiveness. Posttreatment assessment results showed that relaxation training did not affect cardiovascular reactivity to laboratory tasks or self-report of anger and assertion.

The effect of feedback-assisted reduction in heart rate reactivity on videogame performance

In 67 male volunteers, we examined the reduction of cardiovascular responsivity to a psychomotor challenge (videogame) achieved by use of heart rate (HR) feedback and effects of these procedures on concomitant behavioral performance. Each subject participated in a pretraining assessment of his cardiovascular responses to the videogame, a training condition, and a posttraining assessment identical to the initial evaluation. During training, subjects were assigned to one of four conditions: (a) a habituation control group receiving no instructions to alter HR (HC); (b) an instructions-only control group receiving instructions to maintain a low or unchanged HR during videogame presentations (IC); (c) a feedback group receiving instructions to reduce HR using ongoing HR feedback (FB-); or (d) a feedback group receiving instructions to lower HR and given HR feedback plus a score contingency in which total game score was jointly determined by subjects' game performance and success at HR control (FB+). Subjects receiving feedback (FB+, FB-) exhibited greater reductions in HR response to the videogame in the posttraining assessment than control (HC, IC) subjects; FB+ subjects showed greater HR reductions than subjects in any other group. FB+ and FB- subjects showed a lower SBP at posttraining relative to the two control groups, but no reduction in task-induced blood pressure reactivity. There were no group differences in videogame performance, either before or following training.

Persistent sympathetic nervous system arousal associated with tethering in cynomolgus macaques

The swivel-tether system has been used extensively in biomedical research involving nonhuman primates, yet there has been little or no investigation into potential adverse influences of this form of restraint on research results. In the study described here, a portable electrocardiographic telemetry system was used for continuous monitoring of the heart rate of 26 cynomolgus monkeys while: (a) pair-caged, 8 weeks prior to tethering; (b) singly-caged, tethered; (c) singly-caged, tethered, administered propranolol (30 mg/kg/day) in the diet; (d) group-housed (five monkeys per group), 1 week after group formation; and (e) group-housed (five monkeys per group), 4 weeks after group formation. Tethering resulted in persistent elevations in heart rate relative to the other conditions. Administration of propranolol, a beta-adrenergic antagonist, resulted in an abrupt, sustained decrease in heart rate indicating that the increase in heart rate associated with tethering was due to persistent stimulation of the sympathetic nervous system. Since multiple aspects of cardiovascular function are influenced by the sympathetic nervous system, and other organs and systems (e.g., pituitary-gonadal) also may be affected, investigators using the swivel-tether system should be cognizant of these potential effects when designing experiments and interpreting the results.

Validation of a simple method of assessing cardiac preejection period: a potential index of sympathetic nervous system activity

Traditional noninvasive assessment of sympathetic nervous system (SNS) activity in cardiovascular functioning has been confounded by concurrent parasympathetic influences. Analyses of specific intervals of the cardiac cycle have indicated that the systolic preejection period (PEP) may serve as a reliable index of SNS activity independent of parasympathetic inhibition. In the present study, PEP values derived from a technique employing peripheral pulse wave tracings were compared to values obtained from simultaneous impedance cardiograph recordings. Recordings were made on 15 male subjects who were instructed to rest quietly sitting in an upright position. Results indicated that values obtained from both methods were highly correlated and not significantly different when measurement adjustments on total systole were taken into account. These findings support the validity of the fingertip peripheral-pulse method in obtaining measures of systolic time intervals under resting conditions.

The neurobiology of the narcoleptic syndrome

Relevant electroencephalographic, psychopharmacologic, and genetic research reports are described in support of a neurobiological explanation of the narcoleptic syndrome. Despite increased support in this realm, no single neurobiological theory has won unanimous approval among sleep researchers, which has led toward speculation that the condition may be heterogeneous in nature. A multifactorial perspective, including psychological as well as neurobiological influences, appears to be the most productive model for research. Future investigation of sleep disorders utilizing such a model may enhance the understanding of neurobiological correlates of behavioural disorders.

Evaluation of experimenter as a method of reducing vascular stress

To validate a verbal measure of aggression, a replication of a study by Hokanson and Burgess (1962b) was conducted. 32 introductory psychology students were frustrated during a timed mental task by the experimenter. Systolic blood-pressure measurements indicated a significant elevation following the frustration. 16 subjects who completed a questionnaire evaluating the experimenter following the frustration were able to reduce vascular elevations to baseline readings. 16 control subjects, who completed a self-evaluation questionnaire instead of the experimenter-evaluation instrument, maintained significantly higher systolic blood-pressures.