Evaluation of the surface radiation dose and dose gradient in early stage breast cancer using high-dose-rate brachytherapy MammoSite applicator

PURPOSE: To monitor the radiation dose delivered and dose homogeneity to the skin and adjacent tissues around a MammoSite applicator. METHODS AND MATERIALS: Radiation surface dose was measured on 67 consecutive patients with Stage T1-T2N0M0 breast cancer implanted with the MammoSite balloon. Thermoluminescent dosimeters and metal oxide semiconductor field effect transistors were used to measure surface dose directly over the balloon, contralateral breast, thyroid, axilla, and inframammary fold. The dose homogeneity was retrospectively studied from the treatment plans in 25 patients. RESULTS: The mean maximum skin dose was 267 cGy, with a range of 56-488 cGy per fraction, 4 cGy (+/-2 cGy) to the contralateral breast, 8 cGy (+/-4 cGy) to the thyroid, 47 cGy to the ipsilateral axilla (+/-33 cGy), and 52 cGy (+/-47 cGy) to the ipsilateral inframmammary fold. The mean dose gradients were 127%, 110%, 99%, 96%, and 89% for inflated volumes of 35, 40, 50, 60, and 70 mL, respectively. CONCLUSIONS: All patients completed therapy with no or minimal skin reaction with radiation doses comparable to or better to external beam radiation. Considering the dose homogeneity, the larger inflated volume allows for better homogeneity of dose distribution, minimizes the volume of contiguous tissue that receives relatively high doses, and may reduce the risk of fat necrosis.     

Treating major depression by creating positive expectations for the future: a pilot study for the effectiveness of future-directed therapy (FDT) on symptom severity and quality of life

Introduction: This nonrandomized pilot study assesses the efficacy of a new future‐oriented form of therapy, known as future‐directed therapy (FDT), as a treatment for patients with Major Depressive Disorder (MDD) in a naturalistic hospital‐based outpatient psychiatry clinic. The study measured symptom severity of depression and anxiety, in addition to quality of life pre‐ and posttreatment. Aims: The study examined a new manualized treatment designed to help people anticipate a more positive future. The intervention consists of twenty 90‐min group sessions administered twice a week over 10 weeks. The intervention was compared to depressed patients in the same clinic who enrolled in traditional cognitive‐based group psychotherapy. Sixteen patients with MDD completed the FDT intervention as part of their outpatient treatment for depression. Seventeen patients with MDD participated in treatment as usual (TAU) cognitive‐based group therapy. The Quick Inventory of Depressive Symptoms, the Beck Anxiety Inventory, and the Quality‐of‐Life Enjoyment and Satisfaction Questionnaire short form, self‐report instruments were administered prior to and immediately after the completion of therapy. Results: Patients treated with FDT demonstrated significant improvements in depression (P= 0.001), anxiety (P= 0.021) and quality of life (P= 0.035), and also reported high satisfaction with the therapy. Compared to the TAU group, patients treated with FDT showed greater improvements in depressive symptoms (P= 0.049). Conclusions: FDT may have the potential of becoming an additional treatment option for patients with MDD.     

Low levels of co-receptor CCR5 are sufficient to permit HIV envelope-mediated fusion with resting CD4 T cells

The susceptibility of phenotypically CCR5-negative resting CD4 T cells for membrane fusion with a CCR5-specific HIV-1 envelope was analysed using a novel sensitive fusion assay. A very low overall density of CCR5 on T cells expressing high levels of CD4 was shown to be sufficient for HIV envelope-mediated membrane fusion. These findings are relevant to the understanding of how HIV-1 R5 strains enter and replicate in resting CD4 T cells in vivo.     

B cell- and monocyte-activating chemokine (BMAC), a novel non-ELR alpha-chemokine

A novel alpha-chemokine, designated KS1, was identified from an EST database of a murine immature keratinocyte cDNA library. The EST has 94% similarity to a recently cloned human gene, BRAK, that has no demonstrated function. Northern analysis of mouse and human genes showed detectable mRNA in brain, intestine, muscle and kidney. Tumour panel blots showed that BRAK was down-regulated in cervical adenocarcinoma and uterine leiomyoma, but was up-regulated in breast invasive ductal carcinoma. KS1 bound specifically to B cells and macrophages, as well as two B cell lines, CESS and A20, and a monocyte line, THP-1. KS1 showed no binding to naive or activated T cells. In addition, KS1 stimulated the chemotaxis of CESS and THP-1 cells but not T cells. The s.c. injection of KS1 creates a mixed inflammatory response in Nude and C3H/HeJ mice. The above data indicates that KS1 and its human homologue represents a novel non-ELR alpha-chemokine that may have important roles in trafficking of B cells and monocytes. We propose the name B cell- and monocyte-activating chemokine (BMAC) for this molecule to reflect the described biological functions.     

The use of behavioural couple therapy and couple-based interventions in the treatment of substance use disorders

The association between relationship distress and substance use is often described as one of “reciprocal causality”, wherein substance use by one partner appears to contribute to conflict in the relationship, and at the same time, conflict in the relationship is a major contributor to substance use and relapse for the abusing partner. Despite strong research support for the efficacy of using Behavioural Couple Therapy (BCT) for substance use, couple interventions and BCT have limited use in the treatment of substance use disorders. This article outlines the empirical support and clinical rationale for the use of couple interventions like BCT to treat substance use problems.     

What predicts drive for muscularity in college students?

While research has established that men tend to exhibit greater levels of DFM than women, little research has examined the relation between DFM and other forms of disordered eating and exercise behaviors. Study 1 examined the influence of disordered eating and obligatory exercise on DFM in male and female college students. In women, DFM was related to eating concern and obligatory exercise; whereas in men, DFM was related to obligatory exercise and shape concern. Study 2 examined the influence of exercise motivations and body dissatisfaction on DFM in male and female college students. In women, DFM was predicted by personal goal achievement exercise motives, exercising to cope, and dissatisfaction with specific body areas. In men, DFM was predicted by appearance orientation, personal goal achievement, affiliation, and recognition exercise motives.     

Prevalence and recognition of depression among primary care outpatients

Studies indicate that more individuals suffering from depressive symptoms will present to the primary care outpatient clinic than to any other medical care setting. Unfortunately, most of these patients complain of somatic problems, not mood disturbances. Consequently, less than one half of all depressed patients in the primary care clinic are initially identified and treated for their depression. As depression causes considerable morbidity and some mortality and is treatable, methods of improving recognition should be sought. Some of these include maintaining a high index of suspicion, conducting a brief but thorough screening interview for depression, and using a depression rating scale. Benefits derived from early recognition include saving time, effort, and money spent on unnecessary tests and inappropriate treatment, and avoiding substantial suffering. The threshold for many somatic complaints can be substantially raised with resolution of depression.