In vivo evaluation of a breast-specific magnetic resonance guided focused ultrasound system in a goat udder model.

PURPOSE: This work further evaluates the functionality, efficacy, and safety of a new breast-specific magnetic resonance guided high intensity focused ultrasound (MRgFUS) system in an in vivo goat udder model. METHODS: Eight female goats underwent an MRgFUS ablation procedure using the breast-specific MRgFUS system. Tissue classification was achieved through the 3D magnetic resonance imaging (MRI) acquisition of several contrasts (T1w, T2w, PDw, 3-point Dixon). The MRgFUS treatment was performed with a grid trajectory executed in one or two planes within the glandular tissue of the goat udder. Temperature was monitored using a 3D proton resonance frequency (PRF) MRI technique. Delayed contrast enhanced-MR images were acquired immediately and 14 days post MRgFUS treatment. A localized tissue excision was performed in one animal and histological analysis was performed. Animals were available for adoption at the conclusion of the study. RESULTS: The breast-specific MRgFUS system was able to ablate regions ranging in size from 0.4 to 3.6 cm(3) in the goat udder model. Tissue damage was confirmed through the correlation of thermal dose measurements obtained with realtime 3D MR thermometry to delayed contrast enhanced-MR images immediately after the treatment and 14 days postablation. In general, lesions were longer in the ultrasound propagation direction, which is consistent with the dimensions of the ultrasound focal spot. Thermal dose volumes had better agreement with nonenhancing areas of the DCE-MRI images obtained 14 days after the MRgFUS treatment. CONCLUSIONS: The system was able to successfully ablate lesions up to 3.6 cm(3). The thermal dose volume was found to correlate better with the 14-day postablation nonenhancing delayed contrast enhanced-MR image volumes. While the goat udder is not an ideal model for the human breast, this study has proven the feasibility of using this system on a wide variety of udder shapes and sizes, demonstrating the flexibility that would be required in order to treat human subjects.

Lesbians and their sisters as a control group: demographic and mental health factors.

Lesbians and their heterosexual sisters were compared on demographic variables and mental health subscales, so that the feasibility of using heterosexual sisters as a control group for lesbians could be investigated Lesbians were significantly more educated, more likely to live in urban areas, and more geographically mobile than their heterosexual sisters. Heterosexual sisters were more likely than lesbians to be married and homemakers, to have children, and to identify with a formal religion. There was no difference in mental health, but lesbians had higher self-esteem. When all respondents were included, bisexual women had significantly poorer mental health than did lesbians and heterosexual women. This is the first study to use sisters as a control group in lesbian research.

A burning love for lesbian literature.

ABSTRACT Barbara Grier's enjoyment of and commitment to lesbian literature have been guiding forces in her life. While working non-professional jobs for little pay, she managed to find money to buy the books she loved. Her enthusiasm led her to devote considerable time and energy to The Ladder while simultaneously working a full-time job. When The Ladder was no longer financially viable, she founded Naiad Press, and, for the first nine years of its existence, continued to hold a full-time job. In 1982, she became the first paid employee of Naiad, which enabled her to focus exclusively on her passions: writing, editing, and publishing lesbian literature.

Potent suppression of IL-12 production from monocytes and dendritic cells during endotoxin tolerance.

Endotoxin tolerance, the down-regulation of a subset of endotoxin-driven responses after an initial exposure to endotoxin, may provide protection from the uncontrolled immunological activation of acute endotoxic shock. Recent data suggest, however, that the inhibition of monocyte/macrophage function associated with endotoxin tolerance can lead to an inability to respond appropriately to secondary infections in survivors of endotoxic shock. IL-12 production by antigen-presenting cells is central to the orchestration of both innate and acquired cell-mediated immune responses to many pathogens. IL-12 has also been shown to play an important role in pathological responses to endotoxin. We therefore examined the regulation of IL-12 during endotoxin tolerance. Priming doses of lipopolysaccharide ablate the IL-12 productive capacity of primary human monocytes. This suppression of IL-12 production is primarily transcriptional. Unlike the down-regulation of TNF-alpha under such conditions, the mechanism of IL-12 suppression during endotoxin tolerance is not dependent upon IL-10 or transforming growth factor-beta, nor is IL-12 production rescued by IFN-gamma or granulocyte-macrophage colony-stimulating factor. Of note, human dendritic cells also undergo endotoxin tolerance, with potent down-regulation of IL-12 production. Endotoxin tolerance-related suppression of IL-12 production provides a likely mechanism for the anergy seen during the immunological paralysis which follows septic shock.

N-acetyl-cysteine and L-2-oxothiazolidine-4-carboxylic acid enhance contact-dependent growth of HIV in resting peripheral blood mononuclear cells (PBMC) in vitro and increase recovery of HIV from human-PBMC SCID mice.

OBJECTIVES: To ascertain the effects of N-acetyl-cysteine (NAC) and L-2-oxothiazolidine-4-carboxylic acid (OTC) on HIV replication in resting T lymphocytes mixed with chronically infected U1 promonocytic cells; examine the phenotypes of NAC- and OTC-treated cells; and monitor HIV recovery from hu-PBMC SCID mice (SCID mice infected with HIV-1BaL reconstituted with human peripheral blood mononuclear cells) treated with oral OTC. DESIGN AND METHODS: Unstimulated PBMC from uninfected donors preincubated for 2 days with pH-adjusted NAC or OTC were cultured at a concentration of 1 x 10(6) cells/ml with 100 U1 cells that were chronically infected with HIV-1IIIB. HI-1 production in the presence or absence of zidovudine was measured by p24 assay at 1-3 weeks, and results were compared with values from the same cell cultures maintained without NAC or OTC exposure. In some experiments U1 cells were separated from PBMC by a 0.4 micron membrane. NAC-treated and -untreated cells were subjected to FACS analysis of multiple-cell-surface adhesion and activation molecules and the results were compared. Hu-PBMC SCID mice were fed OTC for 3 days prior to infection with HIV-1BaL and for the next 3 weeks. Mice were then sacrificed and peritoneal lavage cells were cultured for virus analysis. RESULTS: Unstimulated, non-dividing PBMC supported high levels of HIV replication when in direct contact with U1 cells in the presence of NAC or OTC; CD2 and CD54 (I-CAM1) were down-regulated on NAC-treated PBMC; and OTC-treated mice produced significantly higher yields of HIV-1 from peritoneal cells than did untreated mice. CONCLUSIONS: At concentrations < or = 5 mM, NAC and OTC potentiate HIV growth in unstimulated PBMC in vitro and in SCID mice. Caution in the use of these agents as antiviral monotherapies is advisable.

Moonlighting: what residents do in their free time is their decision.

Available data do not support the claim that moonlighting, or employment outside psychiatric residency programs, is a dangerous activity for residents, patients, or employers of moonlighters. Moonlighting may beneficially supplement the education of a psychiatric resident as well as be important to residents economically. The author contends that the role of psychiatric educators is to assure the competence of graduates of psychiatric residency programs to practice psychiatry. How residents use their free time is their own concern, not the concern of psychiatric educators, as long as residents fulfill their educational and training responsibilities.

The chronically mentally ill group treatment for individuals with schizophrenia.

Comprehensive treatment programs for individuals with schizophrenia usually include a variety of groups, many of which have concrete tasks as a focus: medication management, social skills training, meal preparation, etc. These groups can simultaneously serve more general rehabilitative purposes if leaders apply principles of group leadership which recognize the neuropathological substrate of schizophrenia and which take into account the specific interpersonal characteristics and needs of individuals who have the illness. This paper presents a framework for leading task-oriented groups for individuals with schizophrenia and give examples from a medication group in a psychosocial rehabilitation program.

A basic residency curriculum concerning the chronically mentally ill.

In this paper a group of knowledgeable individuals with expertise in psychiatric education present their recommendations for a basic psychiatric residency curriculum concerning the chronically mentally ill. The proposed curriculum consists of knowledge, skill, and attitude educational objectives, as well as clinical experiences, faculty supervision, didactics and seminars, and evaluation mechanisms. Recommendations are also made concerning changes in the Accreditation Council for Graduate Medical Education's Special Requirements for Residency Training in Psychiatry, which would require residency programs to place more emphasis on training to meet the needs of the chronically mentally ill. Obstacles to the implementation of the proposed recommendations are presented and possible solutions are discussed.

A model community psychiatry curriculum for psychiatric residents.

The ability of mental health practitioners to work well with persons with serious long-term mental illness has expanded significantly over the past two decades. Learning to do this well involves acquiring a broad base of knowledge and a complex range of skills. Such knowledge and experience must be incorporated into the basic residency curriculum for general psychiatrists, though with some notable exceptions this has not occurred for a number of important reasons, including money and the new image that psychiatry is trying to assume. The key elements of such a curriculum include 1) specific learning goals, 2) working within an effective treatment system with high quality clinical rotations, 3) good role models, 4) high quality psychiatric supervision, 5) a well-grounded didactic program, and 6) high quality clinical rotations. We discuss these elements in detail, and we describe the training program in community psychiatry at the University of Wisconsin Medical School Department of Psychiatry. Our residency training program and supervising faculty are affiliated with and partially funded by the Mental Health Center of Dane County to the benefit of both. This marriage between the public-sector mental health care provider and the academic psychiatric training program has created benefits for both parents plus a fertile environment for training future generations of psychiatrists.

Psychiatric nursing roles in a community mental health center.

We describe the addition of medication monitoring to the duties of nurses working as case managers in a day treatment program for the chronically mentally ill. The nurses used their medical and behavioral knowledge to form a more complete picture of the patient than either a visiting psychiatrist or a case-manager who was not a nurse could do. This improved the integration of medication and other patient management decisions. It also improved cooperation between psychiatrists and nurses, better using the time and skills of both.

A psychotherapeutic approach to task-oriented groups of severely ill patients.

This paper presents a conceptual approach for leading various types of groups of chronically mentally ill patients. Although these groups may have a concrete, task-oriented purpose, with skillful leadership they also function as psychotherapy groups. The developmental deficits in ego functions, object relations, and social skills that severely impair such groups can be compensated by non-interpretative actions of the therapists. The group leader must actively work to provide for the structure, stability, and safety of the group when group members are unable to provide these for themselves.

Early definitive treatment of electric burns of the mouth.

An approach in the evaluation and treatment of patients with electric burns of the mouth is presented. When the surgery was necessary, a tongue or buccal flap was used on the fourteenth to fifteenth day after the burn. The theory for this approach and the various technical aspects involved in our operation are discussed.