Radiotherapy in the presence of contrast agents: a general figure of merit and its application to gold nanoparticles

Delivering sufficient dose to tumours while sparing surrounding tissue is one of the primary challenges of radiotherapy, and in common practice this is typically achieved by using highly penetrating MV photon beams and spatially shaping dose. However, there has been a recent increase in interest in the possibility of using contrast agents with high atomic number to enhance the dose deposited in tumours when used in conjunction with kV x-rays, which see a significant increase in absorption due to the heavy element's high-photoelectric cross-section at such energies. Unfortunately, the introduction of such contrast agents significantly complicates the comparison of different source types for treatment efficacy, as the dose deposited now depends very strongly on the exact composition of the spectrum, making traditional metrics such as beam quality less valuable. To address this, a 'figure of merit' is proposed, which yields a value which enables the direct comparison of different source types for tumours at different depths inside a patient. This figure of merit is evaluated for a 15 MV LINAC source and two 150 kVp sources (both of which make use of a tungsten target, one with conventional aluminium filtration, while the other uses a more aggressive thorium filter) through analytical methods as well as numerical models, considering tissue treated with a realistic concentration and uptake ratio of gold nanoparticle contrast agents (10 mg ml(-1) concentration in 'tumour' volume, 10: 1 uptake ratio). Finally, a test case of human neck phantom is considered with a similar contrast agent to compare the abstract figure to a more realistic treatment situation. Good agreement was found both between the different approaches to calculate the figure of merit, and between the figure of merit and the effectiveness in a more realistic patient scenario. Together, these observations suggest that there is the potential for contrast-enhanced kilovoltage radiation to be a useful therapeutic tool for a number of classes of tumour on dosimetric considerations alone, and they point to the need for further research in this area.

LDL particle size in habitual exercisers, lean sedentary men and abdominally obese sedentary men

Habitual exercisers enjoy considerable protection from coronary heart disease (CHD). Often, however, only modest differences in traditional CHD risk factors are apparent between habitual exercisers and their sedentary counterparts. For this reason, there is increasing interest in novel predictors of CHD, such as a preponderance of small, dense low-density lipoprotein (LDL) particles. Polyacrylamide gel electrophoresis was used to separate lipoprotein subfractions in 32 lean exercisers, 36 lean sedentary men and 21 obese sedentary men aged 30-45 years. Well-validated equations were used to determine LDL concentration and peak particle diameter. Waist girth was used to identify lean (<100 cm) and obese ( >= 100cm) individuals. LDL concentration was lower in lean exercisers than in lean sedentary men (2.64 +/- 0.44 vs. 3.76 +/- 0.79 mmol.l(-1), p <0.001), suggesting that habitual exercise influences this risk factor. In contrast, there were no significant differences in LDL peak particle diameter between lean exercisers, lean sedentary men and obese sedentary men (27.92 +/- 0.67, 28.09 +/- 0.62 and 27.77 +/- 0.77 nm, respectively). In multiple linear regression analysis, triglyceride concentration was the only significant predictor of LDL PPD. These data suggest that habitual exercise influences LDL concentration but does not influence LDL particle size in men aged 30-45 years.

School Refusal, Parental Control and Wider Systems: Lessons from the management of two cases. Journal of Psychological Medicine, .

Two cases of school refusal are presented. From the experience of these two cases, and support from the literature, early assessment of parental control in cases of school refusal is advocated. When parental control, even with professional therapeutic support, is not sufficient to effect an early return to school, intervention in the wider systems organised around the problem is recommended.

La recuperación mutua en personas con trastornos psicológicos o diversidad funcional a través de la práctica creativa

En el presente artículo introducimos el concepto de “recuperación mutua” y proponemos las prácticas creativas como herramientas eficientesde recuperación de personas tanto con problemas de salud mental como con algún tipo de diversidad funcional. Frente al concepto clásico de “arte-terapia” nosotros proponemos el concepto de “práctica creativa” como más compatible con el modelo de “recuperación mutua”. Para ello, en primer lugar realizamos un breve repaso crítico a la relación del arte con la locura. Seguidamente, presentamos los conceptos hermanos de “recuperación” y “recuperación mutua” en el marco de lo que se ha venido a denominar las “health humanities”. Para finalizar, describimos dos prácticas creativas que en la actualidad están siendo evaluadas en España en el contexto de un proyecto de investigacióninternacional en recuperación mutua: Los seminarios creativos con personas con trastorno mental grave en el Museo de Arte Contemporáneo de Sevilla y el grupo de teatro con personas con diversidad funcional de la Asociación Síndrome de Down-Sevilla

Clinical pharmacy-led disease and medicine management programme for patients with COPD

center dot The concept of self-management plans for patients with chronic obstructive pulmonary disease (COPD) is derived from their success in asthma management.

Phenotype-environment correlations in a putative whitefish adaptive radiation

1. The adaptive radiation of fishes into benthic (littoral) and pelagic (lentic) morphs in post-glaciallakes has become an important model system for speciation. Although these systems are well stud-ied, there is little evidence of the existence of morphs that have diverged to utilize resources in theremaining principal lake habitat, the profundal zone.
2. Here, we tested phenotype-environment correlations of three whitefish (Coregonus lavaretus)morphs that have radiated into littoral, pelagic and profundal niches in northern Scandinavianlakes. We hypothesized that morphs in such trimorphic systems would have a morphology adaptedto one of the principal lake habitats (littoral, pelagic or profundal niches). Most whitefish popula-tions in the study area are formed by a single (monomorphic) whitefish morph, and we furtherhypothesized that these populations should display intermediate morphotypes and niche utiliza-tion. We used a combination of traditional (stomach content, habitat use, gill raker counts) andmore recently developed (stable isotopes, geometric morphometrics) techniques to evaluate pheno-type-environment correlations in two lakes with trimorphic and two lakes with monomorphicwhitefish.
3. Distinct phenotype-environment correlations were evident for each principal niche in whitefishmorphs inhabiting trimorphic lakes. Monomorphic whitefish exploited multiple habitats, hadintermediate morphology, displayed increased variance in gillraker-counts, and relied significantlyon zooplankton, most likely due to relaxed resource competition.
4. We suggest that the ecological processes acting in the trimorphic lakes are similar to each other,and are driving the adaptive evolution of whitefish morphs, possibly leading to the formation ofnew species.

Novel in vitro assays for the characterization of EMT in tumourigenesis

Background Two novel assays quantifying Epithelial to Mesenchymal Transition (EMT) were compared to traditional motility and migration assays. TGF-ß1 treatment of AY-27 rat bladder cancer cells acted as a model of EMT in tumourigenesis. Methods AY-27 rat bladder cancer cells incubated with 3ng/ml TGF-ß1 or control media for 24 or 48h were assessed using novel and traditional assays. The Spindle Index, a novel measure of spindle phenotype, was derived from the ratio of maximum length to maximum width of cells. The area covered by cells which migrated from a fixed coverslip towards supplemented agarose was measured in a novel chemoattractant assay. Motility, migration and immunoreactivity for E-cadherin, Vimentin and cytokeratin were assessed. Results TGF-ß1 treated cells had increased “spindle” phenotype together with decreased E-cadherin, decreased Cytokeratin-18 and increased Vimentin immunoreactivity. After 48h, the mean Spindle Index of TGF-ß1 treated cells was significantly higher than Mock (p=0.02 Bonferroni test) and there were significant differences in migration across treatment groups measured using the novel chemoattractant assay (p = 0.02, Chi-Square). TGF-ß1 significantly increased matrigel invasion. Conclusion The Spindle Index and the novel chemoattractant assay are valuable adjunctive assays for objective characterization of EMT changes during tumourigenesis.