Potential efficacy of parent-infant psychotherapy with mothers and their infants from a high-risk population: a randomized controlled pilot trial.

BACKGROUND: Psychotherapy of mother-child dyads is an intervention which was developed to prevent maltreatment and negative children's development. There is a lack of good-quality research investigating psychotherapeutic interventions and social care for mothers at high-risk living in Mother-Child Facilities in Germany. The present randomized controlled pilot trial (RCT) aimed to evaluate the need for parent-infant psychotherapy (PIP) and to explore its impact on the mother-infant relationship. Primary feasibility objectives were recruitment and attrition, with potential efficacy defined as the secondary feasibility objective. METHODS: This pilot RCT focused on (young) mothers with cumulative risk factors and their infants under 7 months of age living in Mother-Child Facilities. N=32 mother-child dyads were randomly allocated to PIP or Care as usual (CAU). Outcomes were assessed at baseline, 3 months, and 6 months of intervention. The primary potential efficacy outcome was maternal sensitivity. Secondary outcomes were maternal mental health problems, reflective functioning, parenting stress, personality organization, infant's development, and attachment. RESULTS: At baseline, all mothers showed low levels of emotional availability, but results revealed improvements in sensitivity, mental health problems, stress, and depressive symptomatology favoring PIP after 6 months. Positive developments in maternal sensitivity, a healthy aspect of mother-child interaction, were only found in the PIP group. Overall attrition was high at 6 months. Some evidence of fewer depressive symptoms and lower maternal distress after 6 months of PIP-intervention exists that did not reach significance. CONCLUSION: Findings revealed improvements in the mother's well-being for both groups, but PIP had a higher impact on the mother-child dyad. In sum, there is some evidence that PIP may represent an effective intervention offer besides the social and pedagogical support in these facilities, but further research is demanded. TRIAL REGISTRATION: DRKS00022485 (retrospectively registered).

Computer-aided planning in orthognathic surgery-systematic review.

The aim of this study was to conduct a systematic review to evaluate the accuracy and benefits of computer-aided planning in orthognathic surgery. The search was performed in PubMed, EMBASE, Cochrane Library, LILACS, and SciELO. The articles identified were assessed independently and in a blinded manner by two authors using selection criteria and eligibility criteria. The database search yielded 375 studies. Following the application of search and eligibility criteria, a final nine studies were included in the systematic review. The level of agreement between the authors in the study selection process was substantial (κ=0.767) and study eligibility was considered excellent (κ=0.863). The accuracy of translation was <1.2mm in the maxilla (vertical) and <1.1mm in the mandible (sagittal), and for rotation was <1.5° in the maxilla (pitch) and <1.8° in the mandible (pitch). Two studies showed a medium potential risk of bias and six studies showed a high potential risk of bias. Computer-aided planning in orthognathic surgery was considered accurate for the studies included in this systematic review. However, the low quality of these studies means that randomized clinical trials are needed to compare computer-aided planning to conventional planning in orthognathic surgery.

Assessing change in quality of life using the Oral Health Impact Profile (OHIP) in patients with different dentofacial deformities undergoing orthognathic surgery: a before and after comparison.

Dentofacial deformities and their treatment have physical and psychological repercussions on quality of life (QOL). Seventy-four patients were evaluated preoperatively (T0) and at 4-6 months postoperatively (T1). Oral health-related QOL was assessed using the short form of the Oral Health Impact Profile (OHIP-14). There was a statistically significant reduction in the average overall OHIP-14 score between T0 (13.23±6.45) and T1 (3.26±4.19). In addition, there were significant decreases in all seven OHIP-14 domains. Class III patients benefited in all domains evaluated, while a significant improvement was seen only in the psychological disability domain for class I patients. Class II patients showed a significant benefit in all domains except the domain of functional limitation. With regard to the total sample (n=74) and class III patients (n=58), correlations between domains were identified for all domains. The same correlation was not identified for class I (n=5) and II (n=11) patients. The entire sample and class III patients showed significant improvements in OHIP-14 scores for all degrees of postoperative sensory disturbance in the upper and lower lips, except for patients with degree 5 (extreme) disturbance of the upper lip. Orthognathic surgical treatment had a positive impact on oral health-related QOL in the patients evaluated.

Soft and hard tissue changes in skeletal Class III patients treated with double-jaw orthognathic surgery-maxillary advancement and mandibular setback.

The soft tissues of the facial profile may change after skeletal movement in orthognathic surgery. The aim of this study was to evaluate and compare the differences and correlation between hard and soft tissues after double-jaw surgery in skeletal Class III subjects. Radiographs from the following time points were assessed using Dolphin Imaging software: preoperative (T0), 2-4 months postoperative (T1), and 6-12 months postoperative (T2). Eleven hard and soft tissue points of the facial profile were evaluated. The Student's t-test was used to assess the significance of differences between the time intervals; Pearson's correlation coefficient was used to assess the significance of correlation existing between these points; significance was set at P<0.05. In the sample of 58 subjects, the correlation between hard and soft tissues in the mandible was greater than in the maxilla. Similarly, the correlations only between hard tissues and only between soft tissues presented a greater correlation in the mandible. The results are similar to those found in studies on single-jaw surgery for both the maxilla and the mandible. The influence of movements in hard tissues was restricted to the soft tissues of the same jaw, although there were exceptions.

Distinguishing between pain intensity and pain resolution: using acute post-surgical pain trajectories to predict chronic post-surgical pain.

BACKGROUND: High intensity of acute post-surgical pain is one of the strongest predictors for chronic post-surgical pain (CPSP). We investigated the predictive power of acute post-surgical pain trajectories and the interplay of pain trajectories and diverse psychosocial risk factors in the development of CPSP. METHODS: Data from 199 patients were examined using latent growth curve analysis by means of structural equation modelling. This analytical approach was used to explicitly test the mediating role of acute pain trajectories within the association between preoperative psychosocial vulnerability factors and CPSP. RESULTS: Both initial pain intensity and pain resolution during the first five post-operative days independently contributed to the prediction of CPSP 6 months after surgery. In terms of vulnerability, anxiety and depression had clear but opposing effects on post-operative pain trajectories. Whereas depressive patients exhibited impaired pain resolution, patients with high anxiety showed better rates of pain resolution after surgery. Both effects on acute pain resolution extended to chronic pain 6 months after surgery. CONCLUSIONS: In this study, we demonstrated that going beyond conventional one-time measurements of acute pain by modelling pain trajectories may substantially enhance research on pain chronification in two ways: First, pain trajectories bear great potential to improve the prediction of CPSP. Second, they represent a meaningful link between psychosocial vulnerability and CPSP because they can be used to uncover mechanisms by which psychosocial vulnerability unfolds. The reported findings suggest that the incidence of CPSP may be reduced by optimizing post-operative pain monitoring.

Evaluation of tissue response and genotoxicity of poly(L/D-lactic acid) disks implanted in rat calvarium.

The aim of the present study was to evaluate local and cytotoxicity systemic tissue reaction in the skull of rats using the implantation of disks of poly (lactic L/D-acid) and evaluate its genotoxicity. 25 males Wistar rats were used, 20 animals underwent surgical procedures and had the discs implanted in the parietal bone, and 5 animals received postoperative medication in the same way, serving as a control group for genotoxicity. The results were subjected to statistical evaluation by analysis of variance (ANOVA). In histological evaluation, between periods of 90 and 120 days in the control group, a new formation at the edges of the defect was noticed. In the experimental group, there was new bone formation at the edges of the defect, migrating below the site occupied by the disk, an absence of inflammatory infiltrate. Regarding the evaluation of genotoxicity, a significant reduction in the frequency of polychromatic erythrocytes in relation to negative control or significant increase in the polychromatic erythrocytes with micronuclei was not detected. So, the material used in this study is biocompatible and well tolerated by the tissues studied, and found to be negative for chromosomal mutagenicity.

Development of a risk index for the prediction of chronic post-surgical pain.

The incidence of chronic post-surgical pain (CPSP) after various common operations is 10% to 50%. Identification of patients at risk of developing chronic pain, and the management and prevention of CPSP remains inadequate. The aim of this study was to develop an easily applicable risk index for the detection of high-risk patients that takes into account the multifactorial aetiology of CPSP. A comprehensive item pool was derived from a systematic literature search. Items that turned out significant in bivariate analyses were then analysed multivariately, using logistic regression analyses. The items that yielded significant predictors in the multivariate analyses were compiled into an index. The cut-off score for a high risk of developing CPSP with an optimal trade-off between sensitivity and specificity was identified. The data of 150 patients who underwent different types of surgery were included in the analyses. Six months after surgery, 43.3% of the patients reported CPSP. Five predictors multivariately contributed to the prediction of CPSP: capacity overload, preoperative pain in the operating field, other chronic preoperative pain, post-surgical acute pain and co-morbid stress symptoms. These results suggest that several easily assessable preoperative and perioperative patient characteristics can predict a patient's risk of developing CPSP. The risk index may help caregivers to tailor individual pain management and to assist high-risk patients with pain coping.

Surface characterizations of mono-, di-, and tri-aminosilane treated glass substrates.

The surface properties and structure of mono-, di-, and tri-aminosilane treated glass surfaces were investigated using surface analytical techniques including X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, atomic force microscopy (AFM), and streaming potential. An optimized dip-coating process was demonstrated to produce roughly silane monolayer coverage on the glass surface. The surface charge measurements indicated that aminosilanization converts the glass surface from negative to positive potentials at neutral pH values. Higher positive streaming potential was observed for tri-compared with mono- and di-aminosilane treated glass surfaces. For all aminosilane treated glass samples, the high-resolution N 1s XPS spectra indicated a preferential orientation of the protonated amino-groups towards the glass surface whereas the free amino groups were protruding outward. This study aimed to obtain uniform, reproducibly thin, strongly adhering, internally cross-linked, and high positively charged aminosilane-coated glass surfaces for the attachment of DNA fragments used in microarraying experiments.

Lamotrigine therapy in treatment-resistant menstrually-related rapid cycling bipolar disorder: a case report.

AIMS/OBJECTIVES: To evaluate lamotrigine in a woman with a 30-year history of treatment-resistant menstrually-entrained rapid cycling bipolar II disorder with follicular phase depressive and luteal phase mood elevation symptoms. METHODS: Lamotrigine was started at 5 mg/day and gradually increased up to 300 mg/day, while venlafaxine was tapered gradually and discontinued, and divalproex sodium 500 mg/day and levothyroxine 175 mcgm/day were continued. Daily self-reported mood ratings were obtained from the patient, using ChronoRecord software. RESULTS: As lamotrigine was increased gradually, mood cycle amplitude attenuated. There was notable decrease in the severity and duration of depressive symptoms specifically during the follicular phase of the menstrual cycle. At the time of submission of this paper, the subject had remained euthymic for a total of 12 months. CONCLUSION: This case suggests the potential utility of lamotrigine in treatment-resistant menstrually-related rapid cycling bipolar disorder, and raises the possibility that lamotrigine might be able to treat pathological entrainment of mood with the menstrual cycle. Both of these issues merit systematic assessment.

Calidad de vida en pacientes con diabetes mellitus controlados en Hospital Galvarino, Servicio de Salud Araucania Sur / Quality of life of patients with diabetes mellitus controlled at the Galvarino Hospital, Health Service of Araucania South

Diabetes mellitus is a chronic disease with an increasing prevalence and a raised life expectancy of patients.Since it is a disease presenting with multiple complications during its evolution special emphasis should be given to ever greather efforts for improving quality of life of the patients.A sample of 50 persons comprising 50 per cent of the diabetic population controlled by the Cardiovascular Programme of the Galvarino Hospital were studied, including a survey to assess their quality of life. Results showed that 100 per cent of the patients had one associated pathology, high blood pressure being the most frequent; 72 per cent were obese while a high percentage showed a deficient metabolic control. 71 per cent had a poorly compensated diabetes and 85 per cent presented high tensional figures at the time of assessment.A Cause of special concern is that none of the patients had a recent eye examination nor a fundoscopy.The above results show the ineffectiveness of the Cardiovascular Health Programme developed by the municipality of Galvarino as well as the absence of basic tools to carry out a proper assessment of diabetic patients.

Priapismo como manifestación de leucemia mieloide cronica / Priapism as a sign of chronic myeloid leukaemia

En base a un caso clínico se realiza una revisión bibliográfica acerca de las recomendaciones formuladas en el diagnóstico y manejo de los pacientes con priapismo. Se describe lo fundamental en lo que respecta a la distinción entre un priapismo de alto o bajo flujo y al tratamiento de instauración precoz a fin de optimizar el pronóstico de potencia sexual a largo plazo. En la revisión de la literatura, destaca el escaso número de casos descritos por lo que aún se requiere mayor experiencia y seguimiento para definir y precisar el mejor protocolo terapÚutico en pacientes leucÚmicos con priapismo. Se insiste en la importancia de una historia clínica exhaustiva con el propósito de distinguir factores etiológicos y la utilidad del hemograma como herramienta económica en el diagnóstico diferencial.

Influencia de histocompatibilidad HLA en sobrevida de injerto renal: análisis de 135 casos / Infuence of the HLA histocompatibility in renal graft survival: analysis of 135 cases

Debido a los avances en la inmunosupresión conseguidos en los últimos años se ha logrado un aumento en la sobrevida del injerto a corto plazo. Sin embargo, la supervivencia a largo plazo ha permanecido invariable, constituyendo el rechazo crónico una de las causas más frecuentes de pérdida tardía del trasplante. Ante lo multifactorial de la etiopatogenia del rechazo crónico, la importancia de la histocompatibilidad HLA como factor decisivo en la distribución de riñones de donante cadáver constituye un punto controversial. Esta comunicación tiene como objetivos reportar resultados globales de un programa de trasplante renal local, y analizar la influencia de la histocompatibilidad en la sobrevida de injertos renales realizados en el Hospital San Juan de Dios. Se estudiaron 135 trasplantados primarios de donante cadáver entre enero 1994- junio 2001 analizándose sobrevida del paciente e injerto, y la influencia de histocompatibilidad. Se usaron los test estadísticos de Kaplan-Meier y de Mantel Hanzel. La sobrevida actuarial de pacientes e injertos a 1, 3 y 5 años fue de 96, 93 y 88 por ciento; y de 84,78 y 70 por ciento, respectivamente. En el grupo de pacientes con 0 a 3 incompatibilidades HLA la sobrevida del injerto a uno y 5 años fue 83 y 73 por ciento, respectivamente; y en el grupo con 3 a 6 incompatibilidades fueron de 83 por ciento al año y 68 por ciento a los 5 años. Estos resultados no evidenciaron diferencias estadísticamente significativas. La sobrevida del injerto depende de muchas variables, entre ellas la histocompatibilidad, por lo que su ponderación debe analizarse en atención a las evidencias

Repetitive Applications of the Biocontrol Agent Pseudomonas putida 06909-rif/nal and Effects on Populations of Phytophthora parasitica in Citrus Orchards.

ABSTRACT Pseudomonas putida 06909-rif/nal was applied repetitively during the irrigation season in two citrus orchards over 3 years. In a mature (50-yearold) commercial citrus orchard covering 2.02 ha, weekly applications of Pseudomonas putida 06909-rif/nal with an in-field fermentor resulted in soil populations that fluctuated between 2.83 log CFU + 1 per g of soil and 4.35 log CFU + 1 per g of soil. Resulting rhizosphere populations of Phytophthora parasitica were significantly reduced in 1999 but not 1997 or 1998. In a newly planted citrus orchard, yearly applications of Pseudomonas putida 06909-rif/nal at the beginning of the irrigation season resulted in high soil populations of Pseudomonas putida 06909-rif/nal that declined rapidly and never reduced the rhizosphere populations of Phytophthora parasitica. When Pseudomonas putida 06909-rif/nal was applied weekly, soil populations increased throughout the 1997 and 1998 irrigation seasons, reaching a maximum in 1998 and remained high throughout the 1999 irrigation season. Rhizosphere populations of Phytophthora parasitica were significantly reduced in 1998. Yearly applications of the fungicide metalaxyl and the nematicide phenamiphos reduced rhizosphere populations of Phytophthora parasitica in 1997 but not in 1998 or 1999. Pseudomonas putida 06909-rif/nal was uniformly distributed throughout the soil profile to a depth of 75 cm in both yearly and weekly applications. When applied through low-volume minisprinklers, Pseudomonas putida 06909-rif/nal was found in aerosols up to 3 m away.

Helix-coil transition of PrP106-126: molecular dynamic study.

A set of 34 molecular dynamic (MD) simulations totaling 305 ns of simulation time of the prion protein-derived peptide PrP106-126 was performed with both explicit and implicit solvent models. The objective of these simulations is to investigate the relative stability of the alpha-helical conformation of the peptide and the mechanism for conversion from the helix to a random-coil structure. At neutral pH, the wild-type peptide was found to lose its initial helical structure very fast, within a few nanoseconds (ns) from the beginning of the simulations. The helix breaks up in the middle and then unwinds to the termini. The spontaneous transition into the random coil structure is governed by the hydrophobic interaction between His(111) and Val(122). The A117V mutation, which is linked to GSS disease, was found to destabilize the helix conformation of the peptide significantly, leading to a complete loss of helicity approximately 1 ns faster than in the wild-type. Furthermore, the A117V mutant exhibits a different mechanism for helix-coil conversion, wherein the helix begins to break up at the C-terminus and then gradually to unwind towards the N-terminus. In most simulations, the mutation was found to speed up the conversion through an additional hydrophobic interaction between Met(112) and the mutated residue Val(117), an interaction that did not exist in the wild-type peptide. Finally, the beta-sheet conformation of the wild-type peptide was found to be less stable at acidic pH due to a destabilization of the His(111)-Val(122), since at acidic pH this histidine is protonated and is unlikely to participate in hydrophobic interaction.

Modeling the 3D structure of GPCRs from sequence.

G-protein-coupled receptors (GPCRs) are a large and functionally diverse protein superfamily, which form a seven transmembrane (TM) helices bundle with alternating extra-cellular and intracellular loops. GPCRs are considered to be one of the most important groups of drug targets because they are involved in a broad range of body functions and processes and are related to major diseases. In this paper we present a new technology, named PREDICT, for modeling the 3D structure of any GPCR from its amino acid sequence. This approach takes into account both internal protein properties (i.e., the amino acid sequence) and the properties of the membrane environment. Unlike competing approaches, the new technology does not rely on the single known structure of rhodopsin, and is thus capable of predicting novel GPCR conformations. We demonstrate the capabilities of PREDICT in reproducing the known experimental structure of rhodopsin. In principle, PREDICT-generated models offer new opportunities for structure-based drug discovery towards GPCR targets.

Evidence for novel functions of the keratin tail emerging from a mutation causing ichthyosis hystrix.

Unraveling the molecular basis of inherited disorders of epithelial fragility has led to understanding of the complex structure and function of keratin intermediate filaments. Keratins are organized as a central alpha-helical rod domain flanked by nonhelical, variable end domains. Pathogenic mutations in 19 different keratin genes have been identified in sequences corresponding to conserved regions at the beginning and end of the rod. These areas have been recognized as zones of overlap between aligned keratin proteins and are thought to be crucial for proper assembly of keratin intermediate filaments. Consequently, all keratin disorders of skin, hair, nail, and mucous membranes caused by mutations in rod domain sequences are characterized by perinuclear clumping of fragmented keratin intermediate filaments, thus compromising mechanical strength and cell integrity. We report here the first mutation in a keratin gene (KRT1) that affects the variable tail domain (V2) and results in a profoundly different abnormality of the cytoskeletal architecture leading to a severe form of epidermal hyperkeratosis known as ichthyosis hystrix Curth-Macklin. Structural analyses disclosed a failure in keratin intermediate filament bundling, retraction of the cytoskeleton from the nucleus, and failed translocation of loricrin to the desmosomal plaques. These data provide the first in vivo evidence for the crucial role of a keratin tail domain in supramolecular keratin intermediate filament organization and barrier formation.

Solvent effects on the energy landscapes and folding kinetics of polyalanine.

The effect of a solvation on the thermodynamics and kinetics of polyalanine (Ala(12)) is explored on the basis of its energy landscapes in vacuum and in an aqueous solution. Both energy landscapes are characterized by two basins, one associated with alpha-helical structures and the other with coil and beta-structures of the peptide. In both environments, the basin that corresponds to the alpha-helical structure is considerably narrower than the basin corresponding to the beta-state, reflecting their different contributions to the entropy of the peptide. In vacuum, the alpha-helical state of Ala(12) constitutes the native state, in agreement with common helical propensity scales, whereas in the aqueous medium, the alpha-helical state is destabilized, and the beta-state becomes the native state. Thus solvation has a dramatic effect on the energy landscape of this peptide, resulting in an inverted stability of the two states. Different folding and unfolding time scales for Ala(12) in hydrophilic and hydrophobic chemical environments are caused by the higher entropy of the native state in water relative to vacuum. The concept of a helical propensity has to be extended to incorporate environmental solvent effects.

Anal paracoccidioidomycosis: an unusual presentation of disseminated disease.

We report a patient with an unusual anal ulceration. The biopsy of an anal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, observed in the lungs, small and large bowel. The anorectal disease frequently represents a secondary site of disease, and the patient must be better evaluated.

Protein-induced membrane disorder: a molecular dynamics study of melittin in a dipalmitoylphosphatidylcholine bilayer.

A molecular dynamics simulation of melittin in a hydrated dipalmitoylphosphatidylcholine (DPPC) bilayer was performed. The 19, 000-atom system included a 72-DPPC phospholipid bilayer, a 26-amino acid peptide, and more than 3000 water molecules. The N-terminus of the peptide was protonated and embedded in the membrane in a transbilayer orientation perpendicular to the surface. The simulation results show that the peptide affects the lower (intracellular) layer of the bilayer more strongly than the upper (extracellular) layer. The simulation results can be interpreted as indicating an increased level of disorder and structural deformation for lower-layer phospholipids in the immediate vicinity of the peptide. This conclusion is supported by the calculated deuterium order parameters, the observed deformation at the intracellular interface, and an increase in fractional free volume. The upper layer was less affected by the embedded peptide, except for an acquired tilt relative to the bilayer normal. The effect of melittin on the surrounding membrane is localized to its immediate vicinity, and its asymmetry with respect to the two layers may result from the fact that it is not fully transmembranal. Melittin's hydrophilic C-terminus anchors it at the extracellular interface, leaving the N-terminus "loose" in the lower layer of the membrane. In general, the simulation supports a role for local deformation and water penetration in melittin-induced lysis. As for the peptide, like other membrane-embedded polypeptides, melittin adopts a significant 25 degree tilt relative to the membrane normal. This tilt is correlated with a comparable tilt of the lipids in the upper membrane layer. The peptide itself retains an overall helical structure throughout the simulation (with the exception of the three N-terminal residues), adopting a 30 degree intrahelical bend angle.