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PubMed2006

Psychoeducational treatment for school-aged children with bipolar disorder.

Bipolar disorder (BPD) has received increasing attention from public and professional sources. Although pharmacologic treatments are considered the sine qua non in the treatment of youth with BPD, psychosocial interventions are critical to assist the child and family cope with symptoms that carry with them significant morbidity and mortality. Treatments developed to date are few in number; all are psychoeducationally based, using cognitive-behavioral and family systems interventions within a biopsychosocial framework. This paper reviews possible mediators of outcome, including caregiver concordance, children's social skills, hopelessness, and family stress. The author has developed two family-based psychoeducational interventions for the treatment of youth with BPD: multifamily psychoeducation groups (MFPG) and individual family psychoeducation (IFP). These treatments are both described and the results from a previously published randomized clinical trial (RCT) of MFPG are summarized. Then, new findings from an RCT of IFP are presented, along with preliminary pilot data from an expanded version of IFP. The paper concludes with recommendations for future research.

Adolescent↗
PubMed2005

A three-dimensional molecular model of lipid-free apolipoprotein A-I determined by cross-linking/mass spectrometry and sequence threading.

Apolipoprotein (apo) A-I, a 243-residue, 28.1-kDa protein is a major mediator of the reverse cholesterol transport (RCT) pathway, a process that may reduce the risk of cardiovascular disease in humans. In plasma, a small fraction of lipid-free or lipid-poor apoA-I is likely a key player in the first step of RCT. Therefore, a basic understanding of the structural details of lipid-free apoA-I will be useful for elucidating the molecular details of the pathway. To address this issue, we applied the combined approach of cross-linking chemistry and high-resolution mass spectrometry (MS) to obtain distance constraints within the protein structure. The 21 lysine residues within apoA-I were treated with homo bifunctional chemical cross-linkers capable of covalently bridging two lysine residues residing within a defined spacer arm length. After trypsin digestion of the sample, individual peptide masses were identified by MS just after liquid chromatographic separation. With respect to the linear amino acid sequence, we identified 5 short-range and 12 long-range cross-links within the monomeric form of lipid-free apoA-I. Using the cross-linker spacer arm length as a constraint for identified Lys pairs, a molecular model was built for the lipid-free apoA-I monomer based on homology with proteins of similar sequence and known three-dimensional structures. The result is the first detailed model of lipid-free apoA-I. It depicts a helical bundle structure in which the N- and C-termini are in close proximity. Furthermore, our data suggest that the self-association of lipid-free apoA-I occurs via C- and N-termini of the protein based on the locations of six cross-links that are unique to the cross-linked dimeric form of apoA-I.

Amino Acid Sequence↗
PubMed2004

Molecular mechanism of reverse cholesterol transport: reaction of pre-beta-migrating high-density lipoprotein with plasma lecithin/cholesterol acyltransferase.

A 70-75 kDa high-density lipoprotein (HDL) particle with pre-beta-electrophoretic migration (pre-beta(1)-HDL) has been identified in several studies as an early acceptor of cell-derived cholesterol. However, the further metabolism of this complex has not been determined. Here we sought to identify the mechanism by which cell-derived cholesterol was esterified and converted to mature HDL as part of reverse cholesterol transport (RCT). Human plasma selectively immunodepleted of pre-beta(1)-HDL was used to study factors regulating pre-beta(1)-HDL production. A major role for phospholipid transfer protein (PLTP) in the recycling of pre-beta(1)-HDL was identified. Cholesterol binding, esterification by lecithin/cholesterol acyltransferase (LCAT) and transfer by cholesteryl ester transfer protein (CETP) were measured using (3)H-cholesterol-labeled cell monolayers. LCAT bound to (3)H-free cholesterol (FC)-labeled pre-beta(1)-HDL generated cholesteryl esters at a rate much greater than the rest of HDL. The cholesteryl ester produced in pre-beta(1)-HDL in turn became the preferred substrate of CETP. Selective LCAT-mediated reactivity with pre-beta(1)-HDL represents a novel mechanism increasing the efficiency of RCT.

Apolipoprotein A-I↗
PubMed2006

Fabrication of electroactive layer-by-layer films of myoglobin with gold nanoparticles of different sizes.

Alternate adsorption of oppositely charged myoglobin (Mb) and gold nanoparticles with different sizes were used to assemble {Au/Mb}n layer-by-layer films on solid surfaces by electrostatic interaction between them. The direct electrochemistry of Mb was realized in {Au/Mb}n films at pyrolytic graphite (PG) electrodes, showing a pair of well-defined, nearly reversible cyclic voltammetry (CV) peaks for the Mb heme FeIII/FeII redox couple. Quartz crystal microbalance (QCM), electrochemical impedance spectroscopy (EIS), and CV were used to monitor or confirm the growth of the films. Compared with other Mb layer-by-layer films with nonconductive nanoparticles or polyions, {Au/Mb}n films showed much improved properties, such as smaller electron-transfer resistance (Rct) measured by EIS with Fe(CN)3-/4- redox probe, higher maximum surface concentration of electroactive Mb (Gamma*max), and better electrocatalytic activity toward reduction of O2 and H2O2, mainly because of the good conductivity of Au nanoparticles. Because of the high biocompatibility of Au nanoparticles, adsorbed Mb in the films retained its near native structure and biocatalytic activity. The size effect of Au nanoparticles on the electrochemical and electrocatalytic activity of Mb in {Au/Mb}n films was investigated, demonstrating that the {Au/Mb}n films assembled with smaller-sized Au nanoparticles have smaller Rct, higher Gamma*max, and better biocatalytic reactivity than those with larger size.

Adsorption↗
PubMed2006

Selective anion sensing based on tetra-amide calix[6]arene derivatives in solution and immobilized on gold surfaces via self-assembled monolayers.

Two anion receptors, 1 and 2, based on the calix[6]crown-4 architecture were synthesized and characterized by NMR (1H, 13C, COSY), UV-vis, and MALDI-MS. 1H NMR measurements demonstrate that receptors 1 and 2 exhibit the highest binding affinity for fluoride ions compared to other anions including Cl-, Br-, NO3-, HSO4-, H2PO4-, and AcO-. The binding constants of 1 with F- and AcO- are 326 (+/-32) and 238 (+/-23) M-1, whereas those of 2 with F- and AcO- are 222 (+/-25) and 176 (+/-21) M-1. The fluorescent titration of 2 with various anions such as Cl-, Br-, NO3-, HSO4-, and H2PO4- led to essentially no change in excimer emission and a slight enhancement of monomer emission. In contrast, a dramatic change was observed in the fluorescence spectra upon the addition of F- and AcO- to 2. Self-assembled monolayers (SAMs) of 1 were formed on gold surfaces and characterized by reductive desorption and other techniques. Cyclic voltammetry (CV) and electrochemical impedance spectroscopy were used to monitor anion recognition by the SAM-modified gold electrodes. The gold electrodes modified by SAMs of 1, upon binding with the F- anion, exhibit a dramatic increase in charge-transfer resistance (Rct) values. This is due to the repulsion between the negatively charged electrode surfaces and the negatively charged Fe(CN)6(3-/4-) redox probe in the electrolyte solution. In contrast, smaller increases in Rct values were observed in the cases of other monovalent anions investigated.

Journal Article↗
PubMed2001

Evaluation and appraisal of randomized controlled trials in myeloma.

PURPOSE: To critically appraise therapeutic innovations tested in randomized controlled trials (RCTs) in multiple myeloma from 1966-1998. DESIGN: We performed a comprehensive search to identify published RCTs in multiple myeloma. Quality dimensions of the design, conduct, analysis and reporting of each trial were assessed. RESULTS: We identified 136 RCTs reported in 114 papers. Overall, therapeutic efforts in multiple myeloma resulted in a 5% absolute gain in five-year survival at a cost of a 0.35% increase in treatment related deaths. Hence on average a patient enrolled in a RCT in myeloma is 14 (5/35) times more likely to be helped than harmed. However, when the RCTs were critically appraised for key quality dimensions of trials' conduct, we found that only 7%) of the trials (10 of 136) were analyzed according to intention-to-treat (ITT), 9% (12 of 136) reported a power analysis (beta error), 32% (35 of 111) adequately concealed treatment allocation, 78% (106 of 136) provided a detailed description of patient withdrawals, and 83%) (19 of 22) of the double blind RCTs had appropriately described methodology. CONCLUSIONS: Therapeutic innovations tested through RCTs have improved the outcomes of patients with multiple myeloma. However, the quality of RCT reporting and methodology in multiple myeloma could be substantially improved. Most therapeutic strategies in multiple myeloma are based on modest quality, low power evidence. Despite these shortcomings our findings suggest patients may often clinically benefit from enrollment in clinical trials when available. Patients on average received modest benefit from innovative therapies tested in RCTs at little additional risk of side effects.

Humans↗
PubMed2006

[Psychotherapy for anxiety disorders in childhood and adolescence--what is evidence-based?].

Anxiety disorders are the most frequent mental disorders in children and adolescents. They are also an important risk factor for psychological disturbances in adulthood and require adequate treatment. The effectiveness of psychotherapy in the treatment of anxiety disorders today can no longer be questioned. However, a meta-analysis of treatment studies shows that so far, only cognitive-behavior therapy has proved, on the basis of randomized, controlled trials (RCT), to be successful in the treatment of anxiety disorders in children and adolescents. Regardless of whether the cognitive behavior therapy took place individually or in a group, or whether it was carried out with the child alone or with the inclusion of the family, no differences in the effectiveness were found. The follow-up data show that the therapy success persisted for several years and that it was not limited only to the symptoms of anxiety. Although for many psychotherapeutic interventions there is still no empirical basis, initial RCT prove the short-term effectiveness of psychopharmacological treatment (SSRI). The central, empirically validated psychotherapeutic interventions include psychoeducation, cognitive treatment of dysfunctional thoughts, and systematic exposure to the situation triggering anxiety. These interventions will be presented briefly and open questions in psychotherapy research will be discussed in the conclusion.

Adolescent↗
PubMed2001

The influence of a dominating centre on a quantitative systematic review of granisetron for preventing postoperative nausea and vomiting.

BACKGROUND: We performed a meta-analysis on granisetron in the prevention of postoperative nausea and vomiting (PONV) and further investigated whether total results and the dose-response characteristics may be significantly affected by a single centre. METHODS: Systematically searched randomised controlled trials (RCT) using granisetron for the prevention of PONV after general anaesthesia were included in the analysis. The pooled relative risks (RR) and numbers needed to treat (NNT) with their corresponding 95%-confidence intervals (CI) were calculated. For all centres, one dominating centre and other centres pooled, comparisons were performed according to all doses, low dose ( 20 microg/kg) granisetron. RESULTS: A total of 27 RCT with 2938 patients were included in the analysis. RR (CI) to suffer from PONV with granisetron when all comparisons were considered was 0.46 (0.39-0.54), 0.7 (0.6-0.81) and 0.34 (0.28-0.41) for all doses, low and high dose, respectively. RR of the dominating centre (1867 patients) were significantly better compared to the remaining centres (1071 patients), with 0.41 (0.34-0.49) and 0.60 (0.49-0.73), respectively. In the dominating centre low dose granisetron was ineffective with a RR of 0.84 (0.68-1.04), while high dose granisetron led to a strong decrease with a RR of 0.30 (0.26-0.36). In contrast, the RR of other centres pooled for low and high dose granisetron were comparable with 0.62 (0.49-0.79) and 0.56 (0.42-0.75), respectively. CONCLUSIONS: Overall results and dose-response characteristics of meta-analyses may be significantly altered by one dominating centre. Further, if data of a dominating centre do not appear to be valid for other centres, it may seem advisable to either exclude them from the analysis or to perform sub-group analyses so that results without the data from the dominating centre are available.

Antiemetics↗
PubMed2003

Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.

AIM: To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. DESIGN: Multicentre, prospective study. SETTING: The departments of oral and maxillo-facial surgery in two district general hospitals. METHOD: One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000. RESULTS: Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy. CONCLUSIONS: Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. The commonest site of subsequent periradicular rarefaction seems to be 'apical' whilst failure at the furcation is probably comparatively rare. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%.

Adult↗
PubMed2005

Oral lycopene--an efficacious treatment for oral leukoplakia?

DESIGN: This was a randomised controlled trial (RCT) of the treatment of oral leukoplakia with the carotenoid lycopene. INTERVENTION: A total of 58 patients received either 8 mg oral lycopene in two doses daily (n=20), 4 mg oral lycopene in two doses daily (n=18) or placebo capsules (n=18), for a 3-month period. Progress of patients was followed for a further 2 months. OUTCOME MEASURES: An objective clinical response, evaluated by bidimensional measurement of the lesion and colour photography, was classified as complete, partial, stable or progression. Histological status was categorised and ranked as normal (0), atypical hyperplasia (1), mild dysplasia (2), moderate dysplasia (3) or severe dysplasia (4). Histological response was then described by the change in rank, for example, from moderate dysplasia (3) to atypical hyperplasia (1) would indicate an improvement of 2 units. RESULTS: There was no significant difference in the clinical response of people who took 8 mg lycopene compared with those taking 4 mg lycopene. The clinical responses measured in both these groups were significantly greater, however, than those in the control group (P<0.01). The response, assessed histologically, after the 8-mg lycopene treatment was significantly better than that from 4 mg lycopene (P<0.05) and than the response seen in the control group (P<0.001). Patients taking 4 mg lycopene also responded significantly better than those in the control group (P<0.05). CONCLUSIONS: Oral lycopene appears, from this small RCT conducted over 5 months, to be effective in the treatment and management of oral leukoplakia.

Comment↗
PubMed2005

Prosthetic posterior teeth with cusps may improve patient satisfaction with complete dentures.

DATA SOURCES: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, OLDMedline, Embase, Zetoc (Zetoc provides access to the British Library's electronic table of contents of approx. 20,000 current journals and 16,000 conference proceedings published per year. The database covers 1993 to date and is updated daily. It includes an e-mail alert service to enable you to keep up-to-date with relevant new articles and papers), System for Information on Grey Literature in Europe (SIGLE) (SIGLE is a bibliographic database covering European non-conventional (or 'grey') literature in the fields of pure and applied science and technology, economics, social sciences and humanities), and the Science Citation Index were used to source studies. Reference lists of identified, relevant trials and review articles were scanned. Unpublished data were sought through personal contact with experts in the field. There was no language restriction. STUDY SELECTION: Randomised controlled trials (RCT) or quasi-RCT were selected that recruited edentulous adults and compared complete dentures with different occlusal schemes, with regard to patient satisfaction and masticatory function. DATA EXTRACTION AND SYNTHESIS: The quality assessment of included trials was undertaken independently and in duplicate by two reviewers. Data were also extracted by two reviewers independently. Disagreements were discussed and a third reviewer consulted as necessary. Authors were contacted for clarification or missing information. Data were excluded until further clarification if agreement could not be reached. RESULTS: Thirteen trials were thought to be potentially relevant. Ten of these studies were subsequently excluded following further analysis. Two trials require further information from the author before being considered eligible for inclusion. Only one crossover trial (n=30), which compared lingualised teeth and zero-degree teeth, fully met the review's inclusion criteria. Twenty patients preferred the lingualised denture, five the zero-degree denture and five patients had no preference. There was a statistically significant difference in favour of the lingualised denture with an odds ratio of 10.00 (95% confidence interval, 2.04-48.96). CONCLUSIONS: There is weak evidence that it may be advantageous for dentists who provide a complete denture service to prescribe prosthetic posterior teeth with cusps, rather than cuspless teeth, to improve patient satisfaction. This conclusion may only be made tentatively until further, well-conducted trials are undertaken that compare different occlusal schemes for complete dentures.

Comment↗
PubMed2005

Insufficient evidence to support or refute the need for 6-monthly dental check-ups. What is the optimal recall frequency between dental checks?

DATA SOURCES: Trials were sourced using the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials, Medline and Embase. Reference lists from relevant articles were scanned and the authors of some papers were contacted to identify further trials and obtain additional information. STUDY SELECTION: Trials were selected if they met the following criteria:design: random allocation of participants;participants: all children and adults receiving dental check-ups in primary-care settings, irrespective of their level of risk for oral disease;interventions: recall intervals for either clinical examination only, clinical examination plus scale and polish, clinical examination plus preventive advice, clinical examination plus scale and polish plus preventive advice, no recall interval/patient-driven attendance (which may be symptomatic), or clinician risk-based recall intervals;outcomes: clinical status outcomes for dental caries including, but not limited to, mean dmft/DMFT, dmfs/DMFS scores, caries increment, filled teeth (including replacement restorations), early carious lesions (arrested or reversed); periodontal disease (including, but not limited to, plaque, calculus, gingivitis, periodontitis, change in probing depth, and attachment level); oral mucosa (presence or absence of mucosal lesions, potentially malignant lesions, cancerous lesions, and size and stage of cancerous lesions at diagnosis). In addition, the following outcomes were considered where reported: patient-centred outcomes, economic-cost outcomes, other outcomes such as improvements in oral health knowledge and attitudes, harms, changes in dietary habits, and any other oral health-related behavioural change. DATA EXTRACTION AND SYNTHESIS: Information regarding methods, participants, interventions, outcome measures, and results were independently extracted, in duplicate, by two authors. Authors were contacted, where deemed necessary and where possible, for further details regarding study design and for data clarification. A quality assessment of the included trial was carried out. The Cochrane Oral Health Group's statistical guidelines were followed. RESULTS: Only one study (with 188 participants) was included in this review and was assessed as having a high risk of bias. This study provided limited data for dental caries outcomes (dmfs/DMFS increment) and economic cost outcomes (reported time taken to provide examinations and treatment). CONCLUSIONS: There is insufficient evidence from randomised controlled trials (RCT) to draw any conclusions regarding the potential beneficial and harmful effects of altering the recall interval between dental check-ups. There is insufficient evidence to support or refute the practice of encouraging patients to attend for dental check-ups at 6-monthly intervals. It is important that high quality RCT are conducted for the outcomes listed in this review in order to address its objectives.

Comment↗
PubMed2006

What is the most effective adhesive for attaching orthodontic bands?

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase were used and a search of the internet also undertaken. There was no restriction with regard to publication status or language of publication. STUDY SELECTION: Randomised controlled trials (RCT) and controlled clinical trials (CCT), including split-mouth studies, of adhesives used to attach orthodontic bands to molar teeth were selected. DATA EXTRACTION AND SYNTHESIS: All review authors were involved in study selection, validity assessment and data extraction without blinding to the authors, adhesives used or results obtained. All disagreements were resolved by discussion. RESULTS: Five RCT and three CCT were identified as meeting the review's inclusion criteria. All the included trials were of split-mouth design. Four trials compared chemically cured zinc phosphate and chemically cured glass ionomer; three trials compared chemically cured glass ionomer cement with light-cured compomer; one trial compared chemically cured glass ionomer with a chemically cured glass phosphonate. Data analysis was often inappropriate within the studies that did meet the inclusion criteria. CONCLUSIONS: There is insufficient evidence to determine the most effective adhesive for attaching orthodontic bands to molar teeth in patients with full-arch fixed orthodontic appliances.

Comment↗
PubMed2006

Several therapies may prevent or reduce the severity of oral mucositis associated with cancer treatment.

DATA SOURCES: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were searched to April 2006. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information. STUDY SELECTION: For inclusion, an article had to satisfy the following criteria: document a randomised controlled trial (RCT); participants should be people receiving chemotherapy or radiotherapy treatment for cancer; prescribe agents to prevent oral mucositis; and have the primary outcome of preventing mucositis. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently and in duplicate. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. For dichotomous outcomes, risk ratios (RR) were calculated using a random-effects model. RESULTS: The search identified 202 articles, of which 71 studies had useable data comprising 5217 patients. Of the 29 interventions included in the trials, 10 studies showed some evidence of a weak benefit for preventing or reducing the severity of mucositis. Interventions where more than one trial in the meta-analysis found a significant difference compared with placebo/ no treatment were as follows: amifostine: provided minimal benefit in preventing moderate and severe mucositis (RR, 0.84 and 0.60, respectively); antibiotic paste or pastille: demonstrated moderate benefit in preventing mucositis (RR, 0.87); hydrolytic enzymes: reduced moderate and severe mucositis (RR, 0.52 and 0.17, respectively); and ice chips: prevented mucositis at all levels (RR, 0.63, 0.43 and 0.27). Other interventions showing some benefit in only one study were benzydamine, calcium phosphate, honey, oral care protocols, povidone and zinc sulphate. CONCLUSIONS: Several of the interventions were found to have some benefit at preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for well-designed RCT with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.

Comment↗
PubMed2006

Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity.

OBJECTIVES: To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting. DESIGN: Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey. SETTING: Twenty nine general practices, Melbourne, Australia. PARTICIPANTS: (1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002; (2) RCT: individually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control). INTERVENTION: Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials. MAIN OUTCOME MEASURES: Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status; child-reported health status, body satisfaction and appearance/self-worth. RESULTS: Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1; P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5; P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms. CONCLUSIONS: This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief individualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient; however, increasing either would have significant cost and resource implications at a population level.

Body Image↗
PubMed1998

Duplication and overexpression of the mutant allele of the MET proto-oncogene in multiple hereditary papillary renal cell tumours.

Previous karyotyping showed a combined trisomy of chromosome 7 and 17 in sporadic and hereditary papillary renal cell tumours (RCT). A recent molecular analysis revealed a mutation in the MET tyrosine kinase (chromosome 7q31) in the germline of four out of seven families with hereditary papillary RCT (HPRCT). We have analysed germline cells as well as multiple tumours obtained from HPRCT families and sporadic cases for alteration of the MET tyrosine kinase and for allelic duplication at chromosome 7 and 17. We have detected a germ line mutation in the MET tyrosine kinase in one of the two families with HPRCTs and also found the same mutation in the germ line of one patient with clinically recognized multiple, bilateral papillary RCTs but without family history. The mutant MET allele is consequently duplicated and overexpressed in tumour cells indicating that duplication of the mutant MET allele is necessary before cells enter the tumorigenic pathway. The lack of germline mutation in two members of another HPRT family and duplication of the same parental allele of chromosome 7 in multiple tumours suggests that a germ line event other than mutation of MET tyrosine kinase is involved in the development of these tumours. Duplication of different alleles of chromosome 7 in sporadic and of chromosome 17 in both types of tumours excludes a germline mutation at these chromosomal sites.

Adenoma↗
PubMed2006

Orthodontic anchorage: a systematic review.

The aim of this systematic review was to examine, in an evidence-based way, what kind of orthodontic anchorage systems/applications are evaluated and their effectiveness. A literature survey from the Pub Med and Cochrane databases covering the period from January 1966 to December 2004 was performed. Randomized controlled trials (RCT), prospective and retrospective controlled studies, and clinical trials comparing at least two anchorage situations were included. Two reviewers selected and extracted the data independently and also assessed the quality of the retrieved studies. The search strategy resulted in 494 articles, of which 14 met the inclusion criteria. Two main anchorage situations were identified: anchorage of molars during space closure after premolar extractions and anchorage loss in the incisor or premolar region (or both) during molar distalization. Because of contradictory results and the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate anchorage efficiency during space closure. Intraoral molar distalization leads to anchorage loss in various amounts depending on the choice of distalization unit. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which anchorage system is the most effective in the respective anchorage situation. Further studies should also consider patient acceptance and cost analysis as well as implants as anchorage.

Bicuspid↗
PubMed2001

Ranitidine bismuth citrate-based triple therapies after failure of the standard 'Maastricht triple therapy': a promising alternative to the quadruple therapy?

BACKGROUND: Triple therapy with proton pump inhibitor, clarythromycin, and amoxicillin has been proposed in Maastricht as the first-line treatment of H. pylori infection. AIM: To determine whether ranitidine bismuth citrate (RBC) based regimens may be used as second-line treatments after 'Maastricht therapy' failure. METHODS: A total of 285 patients with H. pylori infection were given a 7-day treatment with pantoprazole 40 mg b.d., clarythromycin 500 mg b.d., and amoxicillin 1 g b.d. Patients who were still infected were randomly given one of the following 14-day treatments: RBC 400 mg b.d. plus amoxicillin 1 g b.d. and tinidazole 500 mg b.d. (RAT group), RBC 400 mg b.d. plus amoxicillin 1 g b.d. and clarythromycin 500 mg b.d. (RAC group), and RBC 400 mg b.d. plus clarythromycin 500 mg b.d. and tinidazole 500 mg b.d. (RCT group). RESULTS: The 'Maastricht therapy' achieved an eradication rate of 59% (95% CI: 54-65) on intention-to-treat analysis. The RAT, RAC, and RCT regimens achieved eradication rates of 81% (95% CI: 67-94), 43% (95% CI: 26-60), and 62% (95% CI: 44-80), respectively, on intention-to-treat analysis. Patient compliance was optimal in RAT and RAC groups. CONCLUSION: RBC plus tinidazole and either amoxicillin or clarythromycin can be used as second-line therapies after failure of the Maastricht triple therapy.

2-Pyridinylmethylsulfinylbenzimidazoles↗