Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial

BACKGROUND: The selective serotonergic medication fluoxetine has demonstrated efficacy in the treatment of major depression and has suggested efficacy in the treatment of alcoholism. However, no completed trials with any selective serotonergic medication have been reported in patients who display both major depression and alcoholism, despite previous observations that both depression and alcoholism are associated with low serotonergic functioning. METHODS: Fifty-one patients diagnosed as having comorbid major depressive disorder and alcohol dependence were randomized to receive fluoxetine (n = 25) or placebo (n = 26) in a 12-week, double-blind, parallel-group trial. Weekly ratings of depression and alcohol consumption were obtained throughout the 12-week course of the study. RESULTS: The improvement in depressive symptoms during the medication trial was significantly greater in the fluoxetine group than in the placebo group. Total alcohol consumption during the trial was significantly lower in the fluoxetine group than in the placebo group. CONCLUSIONS: Fluoxetine is effective in reducing the depressive symptoms and the alcohol consumption of patients with comorbid major depressive disorder and alcohol dependence. It is unknown whether these results generalize to the treatment of less depressed and less suicidal alcoholics.     

Combined modality therapy in previously untreated patients with advanced Hodgkin's disease: A 24-year follow-up study

PURPOSE: To describe the long-term results of treatment with chemotherapy plus adjuvant low-dose, involved-field radiation therapy (CMT) in patients with advanced Hodgkin's disease. Data on disease-free and failure-free survival, second malignancies, and the results of salvage therapy are presented. PATIENTS AND METHODS: From 1969 to 1989, CMT was administered to 186 patients with previously untreated stage IIB, III, and IV Hodgkin's disease. Chemotherapy included MVVPP (47%), MOPP (25%), MOPP/ABVD (26%) and ABVD (2%). After 6 months of chemotherapy, patients received radiation to all involved sites with the exception of the bone marrow. RESULTS: The failure-free survival for all patients was 63% at 5 years, 56% at 10 years, and 40% at 23.5 years, respectively. Significantly worse results were observed in patients older than 40 years and those with stage IV disease. The overall survival of 45 patients after recurrence was 39% at 10 years, but was only 21% if the initial complete remission lasted less than 1 year. Thus far, 21 of 165 patients (12.7%) who achieved complete remission have developed a second malignancy, and 16 have died. CONCLUSIONS: In comparison with comparable chemotherapy programs, chemotherapy plus radiation therapy may improve disease-free survival; however, the results of treatment in patients older than age 40 or with stage IV disease are still poor. Although patients with initial remissions lasting longer than 1 year can have durable second remissions, the long-term disease-free survival is poor and in the current series the majority of failures were due to recurrent Hodgkin's disease.     

Single subject image analysis using the complex general linear model--an application to functional magnetic resonance imaging with multiple inputs

A linear time invariant model is applied to functional fMRI blood flow data. Based on traditional time series analysis, this model assumes that the fMRI stochastic output sequence can be determined by a constant plus a linear filter (hemodynamic response function) of several fixed deterministic inputs and an error term assumed stationary with zero mean. The input function consists of multiple exponential distributed (time delay between images) visual stimuli consisting of negative and erotic images. No a priori assumptions are made about the hemodynamic response function that, in essence, is calculated at each spatial position from the data. The sampling rate for the experiment is 400 ms in order to allow for filtering out higher frequencies associated with the cardiac rate. Since the statistical analysis is carried out in the Fourier domain, temporal correlation problems associated with inference in the time domain are avoided. This formal model easily lends itself to further development based on previously developed statistical techniques.     

Modification of liquid/solid interface shape in directionally solidifying Al–Cu alloys by a transverse magnetic field

Al-0.85wt%Cu and Al-2.5wt%Cu alloys were directionally solidified under different transverse magnetic field (TMF) intensities to investigate the influence of TMF on the liquid/solid interface shape with respect to the various length scales appearing (planar, cellular, and dendritic interfaces). Results show that planar and cellular interfaces tilt to one side and then level off with increasing TMF although the dendritic interface appears not to behave in this manner. In situ synchrotron X-ray imaging was applied during directional solidification of the Al-4wt%Cu alloy under a 0.08T TMF, revealing leveling of the initially sloped interface. Solute redistribution, caused by thermoelectric magnetic convection (TEMC), responds to the changes in the interface shape. Because different typical length scales should be used in estimating the velocity of TEMC for planar, cellular, and dendritic interfaces, the maximum velocity of the convection ahead of the interface is obtained under different TMF intensities; correspondingly, leveling of the interface’s degree of slop varies with TMF.     

Minimal therapist-assisted cognitive–behavioral therapy interventions in stepped care for childhood anxiety.

New effective, efficient, and accessible service delivery methods for cognitive–behavioral therapies for pediatric anxiety disorders are needed. Many anxious children do not receive needed treatment because of barriers such as limited availability of trained practitioners, costs of treatment, and time. A cognitive–behavioral therapy (CBT) stepped care approach that “steps up” care as needed from less intensive therapies with minimal therapist assistance to therapist-directed treatment may address barriers and provide more accessibility to treatment. A stepped care approach does not necessarily mean that traditional weekly face-to-face therapy sessions will not be needed. However, different service delivery methods that begin with CBT minimal therapist-assisted interventions may be a first line of treatment because not all children may need the full treatment package. This article provides an overview of the current research on CBT minimal therapist-assisted interventions (i.e., modified CBT protocols, computer-based therapy, bibliotherapy, telephone-based therapy, group treatment, and pharmacology) and information on how these first-line treatments may be incorporated into a stepped care model. Minimal therapist-assisted interventions within a stepped care model are in the early stages of development, although there is evidence that these types of treatment may be a viable first step to treating pediatric anxiety disorders. More research on minimal therapist-assisted interventions within stepped care models is needed, and challenges associated with disseminating and implementing stepped care need to be addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pro- and Anti-Inflammatory Cytokines in the Context of NK Cell–Trophoblast Interactions

During pregnancy, uterine NK cells interact with trophoblast cells. In addition to contact interactions, uterine NK cells are influenced by cytokines, which are secreted by the cells of the decidua microenvironment. Cytokines can affect the phenotypic characteristics of NK cells and change their functional activity. An imbalance of pro- and anti-inflammatory signals can lead to the development of reproductive pathology. The aim of this study was to assess the effects of cytokines on NK cells in the presence of trophoblast cells in an in vitro model. We used TNFα, IFNγ, TGFβ and IL-10; the NK-92 cell line; and peripheral blood NK cells (pNKs) from healthy, non-pregnant women. For trophoblast cells, the JEG-3 cell line was used. In the monoculture of NK-92 cells, TNFα caused a decrease in CD56 expression. In the coculture of NK cells with JEG-3 cells, TNFα increased the expression of NKG2C and NKG2A by NK-92 cells. Under the influence of TGFβ, the expression of CD56 increased and the expression of NKp30 decreased in the monoculture. After the preliminary cultivation of NK-92 cells in the presence of TGFβ, their cytotoxicity increased. In the case of adding TGFβ to the PBMC culture, as well as coculturing PBMCs and JEG-3 cells, the expression of CD56 and NKp44 by pNK cells was reduced. The differences in the effects of TGFβ in the model using NK-92 cells and pNK cells may be associated with the possible influence of monocytes or other lymphoid cells from the mononuclear fraction.     

Performance of non-coherent digital equalisers in DECT systems

The performance, in terms of bit error rate, of various data detectors at the output of a 1 bit differential demodulator for DECT receivers, is evaluated assuming static channels. The relevant result is that a one-tap decision feedback equaliser with an optimised threshold value yields a similar performance to the much more complex Viterbi algorithm. Moreover, in the presence of channels with a strong intersymbol interference, the decision feedback equaliser gains more than 2 dB in terms of SNR at BER 10³ with respect to the threshold detector