Neural correlates of social exchanges during the Prisoner's Dilemma game in depression.

BACKGROUND: Depression is a disabling disorder that significantly impacts on the interpersonal functioning of individuals. However, little is known about the neural substrates of such difficulties. In the last few years neuroeconomics, which combines imaging with multiplayer behavioural economic paradigms, has been used to study the neural substrates of normal and abnormal interpersonal interactions. METHOD: This study used functional magnetic resonance imaging to investigate neural activity in unmedicated depressed participants (n = 25) and matched healthy controls (n = 25). During scanning, participants played a behavioural economic game, the Prisoner's Dilemma. In this game, the participant and a co-player independently choose either to cooperate or not cooperate with each other. RESULTS: Depressed participants reported higher levels of negative feelings (betrayal, guilt) during the game than did controls. Neural activation was compared between 'imbalanced' events [when one of the players cooperated and the other defected ('CD' and 'DC')] and 'draw' events [when both players either cooperated or defected ('CC' and 'DD')]. Participants preferentially activated the anterior insula and the dorsolateral prefrontal cortex (DLPFC), a region implicated in cognitive control and regulation of emotions. Importantly, compared to controls depressed participants showed reduced activation in the left DLPFC, with the extent of signal reduction correlating with increased self-report feelings of guilt associated with DC outcomes. CONCLUSIONS: Our findings suggest that depression is associated with reduced activation of the DLPFC during social events that involve unreciprocated cooperation. This abnormality may underlie anomalies in cognitive control and top-down regulation of emotions during challenging social exchanges.

Measuring the visual salience of alignments by their non-accidentalness.

Quantitative approaches are part of the understanding of contour integration and the Gestalt law of good continuation. The present study introduces a new quantitative approach based on the a contrario theory, which formalizes the non-accidentalness principle for good continuation. This model yields an ideal observer algorithm, able to detect non-accidental alignments in Gabor patterns. More precisely, this parameterless algorithm associates with each candidate percept a measure, the Number of False Alarms (NFA), quantifying its degree of masking. To evaluate the approach, we compared this ideal observer with the human attentive performance on three experiments of straight contours detection in arrays of Gabor patches. The experiments showed a strong correlation between the detectability of the target stimuli and their degree of non-accidentalness, as measured by our model. What is more, the algorithm's detection curves were very similar to the ones of human subjects. This fact seems to validate our proposed measurement method as a convenient way to predict the visibility of alignments. This framework could be generalized to other Gestalts.

High response rate with a lower dose of paclitaxel in combination with cisplatin in heavily pretreated patients with advanced breast carcinoma.

BACKGROUND: Paclitaxel has been found to be efficacious in the treatment of breast carcinoma either when administered alone or in combination with other anticancer agents. Synergistic interaction between paclitaxel and cisplatin has been demonstrated in vitro. METHODS: Thirty-two patients with breast carcinoma that was resistant to anthracyclines and to several other antineoplastic agents were selected to receive 80 mg/m(2) of paclitaxel on Day 1 and 80 mg/m(2) of cisplatin on Day 2 with a 3-week interval between the courses. RESULTS: High response rates were observed, with 3 complete responses (9.4%) and 13 partial responses (40.6%) reported. Furthermore, the disease remained stable in 7 patients (21.9%) and progressed in only 9 patients (28.1%). CONCLUSIONS: The results show that high response rates can be achieved with the combination of paclitaxel and cisplatin, even in heavily pretreated breast carcinoma patients. The combination of paclitaxel plus cisplatin was found to be highly efficacious and well tolerated.

Prophylactic filgrastim (G-CSF) during mitomycin-C, mitoxantrone, and methotrexate (MMM) treatment for metastatic breast cancer. A randomized study.

Patients with metastatic breast cancer were randomly assigned to receive as second-line chemotherapy either MMM (mitomycin 8 mg/m2 day 1; mitoxantrone 8 mg/m2 days 1 and 22; methotrexate 35 mg/m2 days 1 and 22) alone or in combination with filgrastim (5 micrograms/kg s.c. days 4-17, 24-37). The courses were repeated every 42 days for a maximum of six courses. Thirty-one patients are evaluable for safety and efficacy. The 16 patients in the filgrastim arm received a total of 42 cycles compared with 34 cycles in the 15 control patients. Tumor responses were few in both patient groups (one partial response in the filgrastim group and two partial responses in control group). Nevertheless, a difference in survival was seen (filgrastim median 10.7 months, control median 6.5 months; p = 0.02 log rank). The treatment was well tolerated. Doses were reduced six times in the filgrastim arm and eleven times in the control arm. Grade IV neutropenia was seen in four patients in the filgrastim arm and in twelve patients in the control arm. The observed survival benefit needs to be confirmed in a larger patient group.

Immunodetection of Pneumocystis carinii in bronchoalveolar lavage specimens compared with methenamine silver stain.

Immunodetection of Pneumocystis carinii, based on immunofluorescence and use of a monoclonal antibody specific for an antigen located within the cyst wall and detectable after trypsin digestion only, was compared with a methenamine silver stain in 553 bronchoalveolar lavage specimens from immunosuppressed patients. P. carinii was found by immunofluorescence in 72 (86%) and by silver stain in 68 (81%) of the total of 84 positive samples detected by either or both of these methods.

Management of peritoneal effusions with intracavitary mitoxantrone or bleomycin.

Peritoneal effusion is a common complication in disseminated cancer. Intracavitary instillation of various agents has achieved control rates of 30-60% with no rational preference for one agent or another. However, serious side effects have also been observed and deaths due, for instance, to bleomycin have been reported. Mitoxantrone has recently been tested to treat effusions, and preliminary results suggest the high efficacy of this drug in the treatment of peritoneal, pericardial and pleural effusions. Nevertheless, some results have been conflicting. In the present study, 41 patients with peritoneal effusions were treated with intracavitary bleomycin or intracavitary mitoxantrone. The median duration of control of effusion was 5 months (range 1 week to 14 months) with mitoxantrone and 4 months (range 1 week to 12 months) with bleomycin. We conclude that, taking into account their limitations, both agents can be used successfully in the treatment of peritoneal effusions.

Renal cell carcinoma in a natural remaining kidney after two kidney transplantations. Case report.

A 57-year-old woman with nephropathy following a streptococcal infection had received a kidney transplant in 1980 and 1986 and immunosuppressive treatment since 1980. Renal cell carcinoma was found in the right native kidney in 1991, with skeletal metastases. Nephrectomy was performed and radiotherapy given. Removal of non-functioning kidneys would prevent development of such cancer.

Sudden tumour regression with enhanced natural killer cell accumulation in a patient with stage IV breast cancer.

Spontaneous regression of advanced breast cancer is a rare phenomenon. Efforts have been made in order to explain it by means of immunological mechanisms. Corticosteroids have demonstrated important efficacy in the treatment of breast cancer. We present a patient with stage IV breast cancer in whom large tumour masses dramatically regressed during treatment with dexamethasone alone. In this patient, histological and hormonal findings, with results of analyses on surface and intracellular blood cells markers demonstrated significant redistribution of lymphocytes and accumulation of natural killer cells in tumour masses. It seems that dexamethasone has acted through the hypophyse against cancer.

Skin protection by sucralfate cream during electron beam therapy.

Acute skin reactions, such as erythema and moist desquamation, constitute major problems during radiotherapy of superficially located tumours. There are no drugs available for the skin care. Sucralfate, a widely used anti-ulcer drug, has anti-inflammatory properties, and it activates cell proliferation. Based on these data and our previous experience of sucralfate cream on the aging skin we performed a double-blind randomized study to compare the efficacy of sucralfate cream to a base cream in 50 breast cancer patients receiving postoperative electron beam therapy to their chest wall. The acute radiation reaction of the skin was statistically significantly prevented by the sucralfate cream. The recovery of the skin was also significantly faster in the sucralfate cream group. Side-effects due to the cream were rare.

Cancer of unknown primary. A retrospective study based on 109 patients.

Cases of 109 patients with metastases from cancer of unknown primary (CUP) were retrospectively analyzed. The highest survival rates were observed in patients with high performance status and metastases limited to the cervical lymph nodes. With other metastatic presentations, the survival was generally very short. Tumor markers did not demonstrate diagnostic value. The primary tumor was revealed by autopsy in 43 of 64 cases. Lungs were the most common primary site, followed by the gastrointestinal tract. Extensive clinical investigations during the initial diagnostic period were, as a rule, fruitless. Patients with CUP require efficacious treatment, but need to be investigated with adequate measures.

Bleomycin and mitoxantrone in the treatment of malignant pleural effusions. A comparative study.

Effusions are common in advanced cancer. Intracavitary instillation of various agents such as bleomycin has achieved control rates varying between 20% and 60%. However, serious side effects have also been observed, and cases of death due, for instance, to bleomycin have been reported. Mitoxantrone has been tested recently in the treatment of effusions, and preliminary results suggest high efficacy of this drug in the treatment of peritoneal, pericardial, and pleural effusions. Nevertheless, certain results have been conflicting. In the present study, 29 patients with pleural effusions were treated either with intracavitary bleomycin or intracavitary mitoxantrone. Effusions were controlled almost equally by both agents; 67% with mitoxantrone and 64% with bleomycin. We conclude that both agents can be used successfully in the treatment of pleural effusions.

Granulocyte colony-stimulating factor (G-CSF) with or without a quinolone in the prevention of infection in cancer patients.

59 patients who had earlier developed an infection following antineoplastic chemotherapy were randomised to receive either granulocyte colony-stimulating factor (G-CSF) alone or G-CSF+quinolone as prophylaxis during subsequent identical chemotherapy courses. 30 patients received 48 courses of G+CSF, while 29 patients received 44 courses of G-CSF+ofloxacin or ciprofloxacin. The overall infection rate was 23%. Patients with WHO grade IV leukopenia at the onset of prophylactic treatment developed infection in 61% of cases when on G-CSF, but only in 22% when on G-CSF+quinolone (P = 0.002). Patients with initial leukopenia of grade WHO III-I had only a 11% infection rate showing no significant difference between the treatment groups. The median duration of leukopenia < 1 x 10(9)/l was 4 days for patients receiving G-CSF alone and 3.5 days for those receiving additional quinolone. Patients developing infection had grade IV leukopenia for a median of 5 days. Both prophylactic treatments were well tolerated. We conclude that when prophylactic G-CSF is initiated at WHO grade IV leukopenia, addition of an oral quinolone reduces the risk of infection.

Oral tegafur in the treatment of metastatic breast cancer: a phase II study.

Between February 1985 and October 1989, 26 patients previously treated for metastatic breast cancer received oral tegafur, at a median daily dose of 1200 mg. Of these, 21 were evaluable for response. The overall response rate was 29%; six (two in lungs, two in skin and two in lymph nodes) of 44 evaluable lesions (14%) responded to therapy. Haematological toxicity was mild, and no other dose-limiting toxicity was seen. The data indicate some activity in heavily pretreated metastatic breast cancer even after previous 5-FU therapy.