Differential heart rate responses to social and monetary reinforcement in women with obesity

Obesity is often accompanied by weight stigmatization; subsequently, individuals with obesity frequently face social rejection. It has been shown that recurrent negative social experiences can alter the perception of social cues. However, the way individuals with obesity process social stimuli is not well understood. This study aims to investigate obesity‐related alterations in social compared to nonsocial information processing. Women with obesity (n = 14) and without obesity (n = 14) participated in a social and a monetary incentive delay task in which they anticipated and received positive, negative, and neutral outcomes in the form of faces or money. During the experiment, phasic heart rate changes and reaction times were measured. Women with obesity, compared to lean women, exhibited a stronger differentiation during the anticipation of monetary and social reinforcement, showing slower reaction times to social cues compared to monetary cues. During the outcome processing phase, women with obesity relative to controls demonstrated diminished heart rate responses particularly to negative social outcomes. Interestingly, differences in cardiac responses in participants with obesity were moderated by weight‐related teasing experiences. In women with obesity, a higher BMI was associated with blunted cardiac responses to social cues relative to monetary cues only if they reported more emotional pain after weight‐related teasing. Our results contribute to a better understanding of social information processing in obesity and give first evidence for the role of negative social experiences in reinforcement processing.     

Low‐volume centre vs high‐volume: the role of a quality assurance programme in colon cancer surgery

Aim The study aimed to determine whether hospitals within a quality assurance programme have outcomes of colon cancer surgery related to volume. Method Data were used from an observational study to determine whether outcomes of colon cancer surgery are related to hospital volume. Hospitals were divided into three groups (low, medium and high) based on annual caseload. Cancer staging, resected lymph nodes, perioperative complications and follow up were monitored. Between 2000 and 2004, 345 hospitals entered 31 261 patients into the study: 202 hospitals (group I) were classified as low volume (< 30 operations; 7760 patients; 24.8%), 111 (group II) as medium volume (30–60; 14 008 patients; 44.8%) and 32 (groups III) as high volume (> 60; 9493 patients; 30.4%). Results High‐volume centres treated more patients in UICC stages 0, I and IV, whereas low‐volume centres treated more in stages II and III (P < 0.001). There was no significant difference for intra‐operative complications and anastomotic leakage. The difference in 30‐day mortality between the low and high‐volume groups was 0.8% (P = 0.023).Local recurrence at 5 years was highest in the medium group. Overall survival was highest in the high‐volume group; however, the difference was only significant between the medium and high‐volume groups. For the low and high‐volume groups, there was no significant difference in the 5‐year overall survival rates. Conclusion A definitive statement on outcome differences between low‐volume and high‐volume centres participating in a quality assurance programme cannot be made because of the heterogeneity of results and levels of significance. Studies on volume‐outcome effects should be regarded critically.     

Clinical Intensity Modulated Proton Therapy for Hodgkin Lymphoma: Which Patients Benefit the Most?

PurposeRadiation therapy (RT) improves control of Hodgkin lymphoma (HL), but patients who undergo RT are at risk for late effects, including cardiovascular disease and second cancers, because of radiation doses to organs at risk (OARs). Proton therapy (PT) can reduce OAR doses compared with conventional photon RT. However, access to PT is currently limited, so referrals must be appropriately selective. We aimed to identify subgroups of patients with HL who could benefit the most dosimetrically from RT with PT based on the prechemotherapy disease characteristics.Methods and materialsNormal tissue radiation doses were calculated for 21 patients with HL who were treated with deep-inspiration breath-hold pencil-beam scanning (PBS) PT and compared with doses from 3-dimensional conformal (3D-CRT) and partial arc volumetric modulated (PartArc) photon RT. Prechemotherapy disease characteristics associated with significant dosimetric benefits from PBS compared with photon RT were identified.ResultsTreatment with PBS was well tolerated and provided with good local control. PBS provided dosimetric advantages for patients whose clinical treatment volume extended below the seventh thoracic level and for female patients with axillary disease. In addition, an increasing dosimetric benefit for some OARs was observed for increasing target volume. PBS significantly reduced the mean dose to the heart, breast, lungs, spinal cord, and esophagus. Dose homogeneity and conformity within the target volume were also superior with PBS, but some high-dose measures and hot spots were increased with PBS compared with partial arc volumetric modulated photon RT.ConclusionsPBS gives good target coverage and local control while providing reductions in radiation dose to OARs for individuals who receive RT for HL compared with advanced photon RT. Our findings highlight groups of patients who would be expected to gain more dosimetric benefit from PBS. These findings facilitate the selection of patients who should be considered a priority for PT.     

Radiation therapy of occult choroidal neovascularisation (CNV) in age-related macular degeneration (AMD)

BACKGROUND: Occult choroidal neovascularisation secondary to age-related macular degeneration cause severe visual loss due to exsudation, hemorrhage and fibrovascular scarring. So far, no efficient treatment of this condition could be established. Recently, some publications described an improved prognosis after low-dose radiation therapy of the neovascular membranes. PATIENTS AND METHODS: Patients with occult choroidal neovascularisation as defined by the Macular Photocoagulation Study were inclosed in our study. Irradiation with Photons (10 to 12 MeV) in fractions of 5 x 2 Gy were administered. At three-month follow-up intervals visual acuity a complete ophthalmological examination including visual acuity, fluorescein- and ICG-angiography as well as fundus photography was performed. RESULTS: In our study 64 patients (74 +/- 7 years) with occult CNV secondary to AMD were included. Follow-up was between 3 and 39 months (14.5 +/- 10). Compared to studies who investigated the natural history of this disease, the visual acuity measured in our study did not differ significantly from the natural course. CONCLUSIONS: Our results do not support the general use of radiation therapy in patients with occult choroidal neovascularisation secondary to AMD. However, the controlled multicenter studies might provide a better basis for a general recommendations.