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Biomedical subjects

J Wilder

Publications and source records attributed to J Wilder.

At least 19 recordsLinked to original sources
PubMed2005

The efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC).

OBJECTIVE: To determine the efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC). METHODS: A retrospective multi-institutional investigation was performed to identify surgically staged patients with Stage I UPSC who were (1) treated after surgery with 3-6 courses of platinum-based chemotherapy without radiation from 1990-2003, and (2) followed for a minimum of 12 months, or until recurrence. RESULTS: Six patients (IA-2, IB-3, IC-1) were treated with carboplatin (AUC 6) or cisplatin (50 mg/m2) alone. One patient recurred to the vagina, was treated with chemo-radiation, and is alive and well at 122 months. One patient recurred to the lung, liver, and brain, and died of disease at 24 months. The remaining 4 patients are alive with no evidence of disease 15-124 months (mean 62 months) after treatment. Two patients (IB-1, IC-1) were treated with cisplatin (50 mg/m2) and cyclophosphamide (1000 mg/m2), and both are alive and well with no evidence of disease 75 and 168 months after treatment. Twenty-one patients (IA-5, IB-13, IC-3) were treated with a combination of carboplatin (AUC 6) and paclitaxel (135 mg/m2-175 mg/m2). One patient recurred to the vagina after 3 cycles of carboplatin/paclitaxel, and was treated with chemo-radiation. She is now without evidence of disease 10 months after treatment. At present, all 21 patients with Stage I UPSC treated following surgical staging with carboplatin/paclitaxel chemotherapy are alive and well with no evidence of disease 10-138 months (mean 41 months) after treatment. CONCLUSION: Combination carboplatin/paclitaxel chemotherapy following surgery is effective in the treatment of Stage I UPSC.

Aged↗
PubMed2003

Behaviour style and interaction between seven children with multiple disabilities and their caregivers.

INTRODUCTION: Recent studies show that the existing interaction patterns of children with multiple disabilities should be taken into consideration when planning communication interventions. For children with disabilities, it is especially important that the partner in interaction is sensitive and well aware of the importance of a qualitatively successful interaction. Wilder (unpublished report) found that the behaviour style of 30 children with multiple disabilities was more related to the caregiver-perceived interaction than the communicative skills and functional abilities of the children. This study inductively explored the caregivers' perceptions of interaction within seven caregiver-child dyads. The research questions were: How do the caregivers perceive the interaction? How do the caregivers perceive the children's behaviour style to be related to the interaction with the caregivers? METHOD: The children were selected individually from the participants in Wilder (unpublished report) depending upon the responses the caregivers had given about the children's self-regulation and reactivity in the Carolina Record of Individual Behaviour questionnaire. The study was undertaken by means of home visits where the caregivers participated in an interview asking about their strategies for interaction, how they perceived the roles of the children and their own roles in interaction, the caregivers' opinion of what an interaction constituted of and the caregivers' aims and aspiration for interaction. The data analysis was performed by meaning concentration and categorization through a pendulum between the parts and the entirety of the interviews. In this way, hermeneutics and thematic analysis were both being practised. RESULTS: The results of the interviews are presented as a model with categorizations as a network. The categorizations reflect the system of themes that permeate how the caregivers perceived interaction in the dyad. The themes are: sharing of experience, successful interaction, role of the child, role of the caregiver, interaction methods, obstacles and facilitators and aims and aspirations. DISCUSSION: The caregivers perceived their own role in interaction to be of a sensitive leading kind. The caregivers lead the interaction by using their knowledge about the children's usual way of interacting, the children's behaviour styles, functional abilities, the children's current mood and situation as well as the whole context. They monitored the interaction such that, throughout an interaction sequence, the caregivers always tried to optimize the interaction between the parties in the dyad. The behaviour style was a background factor that the caregivers had knowledge of and scanned in their everyday turn taking. Although there were differences in the children's behaviour styles, the caregivers discussed the same themes in the interviews. The behaviour style became a facilitator for the whole interaction, forced the interaction in certain directions and made the interaction more complete with turn taking of different kinds from both parties. The findings show that it is imperative to see caregivers as experts on their children and to make them assertive in this in relation to professionals. Furthermore, as a successful interaction can boost the development of children, it is essential to direct interventions to the everyday interaction in caregiver-child dyads.

Caregivers↗
PubMed2001

Mobile elements and the genesis of microsatellites in dipterans.

Factors that influence the genesis and genomic distribution of microsatellite DNA are poorly understood. We have identified a novel class of Dipteran mobile elements, mini-me elements, which help elucidate both of these issues. These retroposons contain two internal proto-microsatellite regions that commonly expand into lengthy microsatellite repeats. These elements are highly abundant, accounting for approximately 1.2% of the Drosophila melanogaster genome, giving them the potential to be a prolific source of microsatellite DNA variation. They also give us the opportunity to observe the outcomes of multiple microsatellite genesis events (initiating from the same proto-microsatellite) at separate mini-me loci. Based on these observations, we determined that the genesis of microsatellites within mini-me elements occurs through two separate mutational processes: the expansion of preexisting tandem repeats and the conversion of sequence with high cryptic simplicity into tandemly repetitive DNA. These modes of microsatellite genesis can be generalized beyond the case of mini-me elements and help to explain the genesis of microsatellites in any sequence region that is not constrained by selection.

Animals↗
PubMed2000

Doubling expression of the low density lipoprotein receptor by truncation of the 3'-untranslated region sequence ameliorates type iii hyperlipoproteinemia in mice expressing the human apoe2 isoform.

The primary receptor mediating clearance of apolipoprotein (apo)E- and apoB100-containing lipoproteins from the circulation is the low density lipoprotein (LDL) receptor. Reduced expression of the LDLR is believed to be a precipitating factor in the pathogenesis of type III hyperlipoproteinemia (HLP) in some humans homozygous for the apoE2 allele (APOE*2). To test the effect of genetic changes in LDL receptor expression on the pathogenesis of type III HLP, we have generated a variant allele at the endogenous mouse Ldlr locus that expresses the human LDL receptor transcript. Transcription of the human LDLR minigene is regulated by the endogenous mouse promoter sequence, but a truncation of 3'-untranslated region results in increased mRNA stability. Consequently, in liver of heterozygotes, steady state levels of mouse and human LDLR transcripts are 50 and 180% the levels of total transcript in wild type mice, respectively. Overall, the 2.3-fold normal level of LDLR message in heterozygotes completely ameliorates type III HLP caused by the homozygosity for the human APOE*2 allele, normalizing their plasma lipoprotein profile. We conclude that a modest increase in expression of the LDLR through message stabilization is sufficient to prevent precipitation of type III HLP in mice.

3' Untranslated Regions↗
PubMed2000

Aortic wall damage in mice unable to synthesize ascorbic acid.

By inactivating the gene for L-gulono-gamma-lactone oxidase, a key enzyme in ascorbic acid synthesis, we have generated mice that, like humans, depend on dietary vitamin C. Regular chow, containing about 110 mg/kg of vitamin C, is unable to support the growth of the mutant mice, which require L-ascorbic acid supplemented in their drinking water (330 mg/liter). Upon withdrawal of supplementation, plasma and tissue ascorbic acid levels decreased to 10-15% of normal within 2 weeks, and after 5 weeks the mutants became anemic, began to lose weight, and die. Plasma total antioxidative capacities were approximately 37% normal in homozygotes after feeding the unsupplemented diet for 3-5 weeks. As plasma ascorbic acid decreased, small, but significant, increases in total cholesterol and decreases in high density lipoprotein cholesterol were observed. The most striking effects of the marginal dietary vitamin C were alterations in the wall of aorta, evidenced by the disruption of elastic laminae, smooth muscle cell proliferation, and focal endothelial desquamation of the luminal surface. Thus, marginal vitamin C deficiency affects the vascular integrity of mice unable to synthesize ascorbic acid, with potentially profound effects on the pathogenesis of vascular diseases. Breeding the vitamin C-dependent mice with mice carrying defined genetic mutations will provide numerous opportunities for systematic studies of the role of antioxidants in health and disease.

Animals↗
PubMed2000

Proteins with selected sequences: a heteropolymeric study.

Protein sequences are expected not to be random but selected in order to form a stable native structure that is kinetically accessible. Therefore our model contains a selective temperature in sequence space (see [S. Ramanathan and E. Shakhnovich, Phys. Rev. E 50, 1303 (1994)] ) to optimize the sequence for the target conformation statistically. Replica calculations, which go beyond quadratic approximations in the field-theoretical Hamiltonian, are presented. A phase diagram indicating the temperatures and selective temperatures at which transitions to a frozen globule, i.e., the native state, occur is obtained. It is shown that going beyond the quadratic approximation in the field Hamiltonian is very important, since it results in a significant change of the phase diagram. Moreover, we suggest that a one-step replica permutation symmetry scheme is sufficient to solve the model. In addition to this we present a result for the sequence correlation function along the chain in the case of a short-ranged potential between the monomers. A correlation function between monomers that form a contact in the native state is given depending on the temperature and the interaction parameter.

Amino Acid Sequence↗
PubMed1997

Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome.

BACKGROUND: Specific concerns and expectations may be a key reason that people with common physical complaints seek health care for their symptoms. OBJECTIVES: To determine the frequency of symptom-related patient concerns and expectations, physician perceptions and actions, and the relationship of these factors to patient satisfaction and symptom outcome. METHODS: This was a prospective cohort study of 328 adult outpatients presenting for evaluation of a physical complaint. The setting was a general medicine clinic in a teaching hospital. Measures included previsit patient questionnaire to identify symptom-related concerns and expectations; a postvisit physician questionnaire to determine physician perceptions and actions; and a 2-week follow-up patient questionnaire to assess symptom outcome and satisfaction with care. RESULTS: Pain of some type accounted for 55% of common symptoms, upper respiratory tract illnesses for 22%, and other physical complaints for 23%. Two thirds of patients were worried their symptom might represent a serious illness, 62% reported impairment in their usual activities, and 78%, 46%, and 41% hoped the physician would prescribe a medication, order a test, or provide a referral. Physicians often perceived symptoms as less serious or disabling and frequently did not order anticipated tests or referrals. While symptoms improved 78% of the time at 2-week follow-up, only 56% of patients were fully satisfied. Residual concerns and expectations were the strongest correlates of patient satisfaction. CONCLUSIONS: Improved recognition of symptom-related concerns and expectations might improve satisfaction with care in patients presenting with common physical complaints.

Activities of Daily Living↗
PubMed1995

Simultaneous better than sequential for brief presentations.

During perceptually intensive tasks such as reading, there is a bottleneck in the information transfer between the large number of alphanumeric characters available and the acquiring of these characters. This is due mainly to the limited number of characters that one can report at a glance (also known as the "magic number 7 +/- 2") [Psychol. Rev. 63, 81 (1956)]. To examine where in the perceptual pathway this bottleneck occurred, several investigators tested and compared performance with simultaneous and with sequential target presentations [J. Exp. Psychol. 79, 1 (1969); 93, 72 (1972); Percept. Psychophys. 14, 231 (1973)]. They found that performance was nearly equal in the two cases and concluded that the bottleneck must be due to the limitation of short-term memory. However, these studies were limited either by a long stimulus-onset asynchrony (SOA), or time interval between onsets of icon presentations, or by a lack of poststimulus masking. We report on experiments designed to overcome these limitations. We used shorter SOA's than did previous investigators, and we removed persistence effects by poststimulus masking. Our stimuli were presented either sequentially or simultaneously. For the sequential presentation a numeral ranging from 0 to 9 was displayed at any one of eight positions 1.5 deg from a central fixation cross. The appearance of the next numeral in another part of the display coincided with the masking of the previous numeral. This was done for trials of one to four numerals and SOA's of 16.7, 33.3, and 50.0 ms.(ABSTRACT TRUNCATED AT 250 WORDS)

Attention↗
PubMed1995

Context effect of common objects on visual processing.

In previous experiments on visual processing it was shown that correct identification of sequentially and simultaneously presented numerals declined as the presentation interval was decreased from 50.0 to 16.7 ms/numeral. To determine how performance was influenced in context, common everyday objects were used in place of the numerals. These objects were grouped into 36 different categories with 4 objects per category. An example of a category was fruit: apple, banana, pear, pineapple. For all experimental trials, objects (ranging in number from one to four) were presented randomly at four possible positions 1.5 degrees from a central fixation point. In a sequential trial, the objects were displayed in succession at different locations for a stimulus onset asynchrony (SOA) of either 16.7, 33.3, or 50.0 ms. The masking of a previous object coincided with the onset of the object that followed in the sequence. A simultaneous trial consisted of 2, 3, or 4 objects presented concurrently. For these trials, simultaneous masking occurred at SOA's of 16.7, 33.3, or 50.0 ms. For both experimental paradigms, one-half of the trials consisted of objects from the same category, and one-half from mixed categories. Results taken from four observers showed that performance for all three SOA's was consistently better when the objects were related as opposed to when the objects were not for both presentation protocols. This lent support to the theory that there was simultaneous interaction of top-down and bottom-up processes in visual processing. In addition, as was found in the numerals study, performance was better when the objects were presented simultaneously as opposed to sequentially.

Adult↗
PubMed1992

Activation of B lymphocytes by NK cells.

The ability of NK cells to induce differentiation of B lymphocytes to IgM secretion in vitro has been investigated. Homogeneous preparations of NK cells obtained from IL-2 propagated splenocytes from SCID mice were found to have the ability to induce resting B lymphocytes to proliferate and secrete significant amounts of IgM. The induction is greatly enhanced by the presence of both IL-2 and IL-5 and does not require T lymphocytes or adherent cells in the responding population. Cell contact between the two populations is not necessary suggesting that the effect is mediated by soluble factor(s) which can be produced even by irradiated NK cells. Because the activity cannot be replaced by either r-tau-IFN or tumor necrosis factor-alpha or inhibited by antibodies to these lymphokines, a novel NK cell-derived factor(s) may be involved. The implications of this interaction between NK cells and B lymphocytes are discussed.

Animals↗
PubMed1991

Kaposi sarcoma associated with human immunodeficiency virus infection.

In the present study, 11 patients with epidemic Kaposi sarcoma were evaluated; 55% were in stage IV and 45% in stage II; in addition, 75% had systemic symptoms, 89% had low total and T-lymphocyte counts, and all of them had not only low T-helper lymphocyte counts but also T-helper/T-suppressor ratios. The majority of patients (89%) had low proliferative responses with phytohemagglutinin (PHA). Nine patients were treated with: alpha-2 interferon (five patients), zidovudine (two patients), doxorubicin and zidovudine (one patient), and radiotherapy (one patient). There were only five patients with stable disease, three treated with alpha-2 interferon, one with doxorubicin, and one with doxorubicin plus azidothymidine. Two patients (one with doxorubicin and one with doxorubicin plus zidovudine) needed lithium to increase leukocyte and platelet counts. In May 1989, 73% of patients were dead (median survival 8 +/- 2 months). It is concluded that: (1) it is important to select the patients who have the best chance to improve with treatment; (2) the response with alpha-2 interferon or monochemotherapy is low and there is no change in overall survival; (3) a low helper cell count, low T-helper/T-suppressor ratio, and low proliferative response with mitogens are features of poor prognosis; (4) toxicity with treatment was acceptable; and (5) lithium increased neutrophil and platelet counts.

Adult↗
PubMed1990

Role of intracavitary cuff boost after adjuvant external irradiation in early endometrial carcinoma.

Management of early endometrial carcinoma often consists of surgicopathologic staging followed by adjuvant radiation therapy (RT) for patients at risk of local recurrence. While an intracavitary vaginal cuff boost (VCB) is commonly given after external beam radiation therapy, its effects on local control and complication rates are unknown. To assess these effects, we reviewed 157 patients with FIGO Stage I (n = 134) or incidentally diagnosed (n = 23) endometrial adenocarcinomas. After surgery and external radiation therapy, 103 patients (65.6%) received a vaginal cuff boost of 3000-5000 cGy surface dose (Group I) and 54 (34.4%) did not (Group II). One hundred and two Group I and 52 Group II patients were evaluable for analysis. Median follow-up was 78.0 months for Group I and 60.0 months for Group II. Despite a preponderance of poor prognostic factors in Group II, no significant difference in local failure was seen. A component of local failure was seen in 6 Group I patients (6.0%) and 4 Group II patients (7.7%), p = 0.74. Distant failure, reflecting more advanced disease, was higher in Group II (19.2%) than in Group I (9.0%). Late complications included rectal bleeding/proctitis in 18.6% of Group I patients and 3.8% of Group II patients (p = 0.01). Overall, grade 2 complications occurred in 27.5% and 15.4% of Group I and II patients, respectively (p = 0.09). No difference in frequency of grade 3 complications was evident. Based on this retrospective study, intracavitary vaginal cuff boost after surgery and postoperative external beam radiation therapy does not appear to improve local control in early endometrial adenocarcinoma. Its possible effect on complication rates is uncertain.

Adult↗
PubMed1989

Analysis of failure patterns in stage III endometrial carcinoma and therapeutic implications.

The poor outcome of certain patients with Stage III endometrial carcinoma has led some investigators to direct adjuvant therapy to the abdominal cavity. To better define failure patterns, a review of 126 patients with Stage III endometrial carcinoma treated at four institutions was performed. Seventy-four patients were diagnosed at surgery with pathologic Stage III disease, whereas 52 patients presented with clinical Stage III disease. Most patients received external beam irradiation to the pelvis with a variety of boost techniques. Site of disease, grade, depth of invasion, and pathology were examined for prognostic significance. Actuarial techniques were used to analyze survival and recurrences. For the 52 clinical Stage III patients, 5-year survival was 36%. The median survival of 20 patients who were treated with radiation therapy (RT) following biopsy was 9 months. Pelvic control was poor in these patients, with 16/18 evaluable patients failing locally. Thirty-two patients who underwent resection with adjunctive RT had a 5-year survival of 48%. Local failure occurred in 40% of patients, whereas 38% of patients had abdominal failure. Isolated abdominal failure was infrequent with 6% failing as isolated recurrence, and 16% failing as the only site of distant disease. For 74 pathologic Stage III patients, 5-year survival was 54%. Local failure resulted in 20% of patients, and isolated abdominal failure occurred in 7% of patients. The subset of patients with ovarian or tubal involvement included 42 patients, with a 5-year survival of 60%. Further analysis of this subset by grade and depth of myometrial penetration was found to be prognostically significant. Twenty-four patients who were Stage III because of parametrial or pelvic peritoneal involvement had a 5-year survival of 44%. Local control and survival is improved in Stage III patients treated with surgical resection. The high rate of distant metastases in both abdominal and extra-abdominal sites has significant therapeutic implications.

Adult↗
PubMed1977

Male and female: the significance of values.

Women's personal values as well as societal values regarding them have been undergoing significant changes. This trend is supported by recent rapid technological advances reaching into home and working place, by the development of birth-control measures and of treatment for venereal diseases, and by women's easier access to education and careers.

Culture↗
PubMed1975

The lure of magic thinking.

The development of the thinking processes from childhood to maturity is analyzed and three stages are distinguished: the magic omnipotent stage of the preschool child, the development of the realistic ego, and the future-directed value-building superego. The role of the lure to return to the magic thinking in our culture is described.

Age Factors↗