A randomized controlled trial of alanyl-glutamine supplementation in peritoneal dialysis fluid to assess impact on biomarkers of peritoneal health.

In early clinical testing, acute addition of alanyl-glutamine (AlaGln) to glucose-based peritoneal dialysis (PD) fluids restored peritoneal cellular stress responses and leukocyte function. This study was designed to test the effect of extended treatment with AlaGln-supplemented PD fluid on biomarkers of peritoneal health. In a double-blinded, randomized crossover design, stable PD patients were treated with AlaGln (8 mM) or placebo added to PD fluid for eight weeks. As primary outcome measures, dialysate cancer-antigen 125 (CA-125) appearance rate and ex vivo stimulated interleukin-6 (IL-6) release were assessed in peritoneal equilibration tests. In 8 Austrian centers, 54 patients were screened, 50 randomized, and 41 included in the full analysis set. AlaGln supplementation significantly increased CA-125 appearance rate and ex vivo stimulated IL-6 release. AlaGln supplementation also reduced peritoneal protein loss, increased ex vivo stimulated tumor necrosis factor (TNF)-α release, and reduced systemic IL-8 levels. No adverse safety signals were observed. All 4 peritonitis episodes occurred during standard PD fluid treatment. A novel AlaGln-supplemented PD fluid improves biomarkers of peritoneal membrane integrity, immune competence, and systemic inflammation compared to unsupplemented PD fluid with neutral pH and low-glucose degradation. A phase 3 trial is needed to determine the impact of AlaGln supplementation on hard clinical outcomes.

Facilitated communication and authorship: a systematic review.

Facilitated Communication (FC) is a technique whereby individuals with disabilities and communication impairments allegedly select letters by typing on a keyboard while receiving physical support, emotional encouragement, and other communication supports from facilitators. The validity of FC stands or falls on the question of who is authoring the typed messages--the individual with a disability or the facilitator. The International Society for Augmentative and Alternative Communication (ISAAC) formed an Ad Hoc Committee on FC and charged this committee to synthesize the evidence base related to this question in order to develop a position statement. The purpose of this paper is to report this synthesis of the extant peer-reviewed literature on the question of authorship in FC. A multi-faceted search was conducted including electronic database searches, ancestry searches, and contacting selected authors. The authors considered synopses of systematic reviews, and systematic reviews, which were supplemented with individual studies not included in any prior reviews. Additionally, documents submitted by the membership were screened for inclusion. The evidence was classified into articles that provided (a) quantitative experimental data related to the authorship of messages, (b) quantitative descriptive data on the output generated through FC without testing of authorship, (c) qualitative descriptive data on the output generated via FC without testing of authorship, and (d) anecdotal reports in which writers shared their perspectives on FC. Only documents with quantitative experimental data were analyzed for authorship. Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities. Hence, FC is a technique that has no validity.

Pro- and anticarcinogenic mechanisms of piceatannol are activated dose dependently in MCF-7 breast cancer cells.

Estrogenic procarcinogenic effects of piceatannol (PIC) contrast reports about anticarcinogenic activities of PIC. To explain this contradiction, we investigated PIC in estrogen-dependent MCF-7 breast cancer cells and elucidated those cellular mechanisms that correlated with the observed cell effects induced by PIC. Low PIC concentrations (50 nM) induced c-Myc that depended on progesterone receptor (PR) and estrogen receptor (ER). PR-mediated c-Myc induction by PIC was independent of nuclear PR activity but depended on mitogen-activated protein kinase (MAPK) signaling and was associated with an acceleration of cancer cell proliferation. In contrast, 25 µM PIC inhibited deoxynucleotide triphosphate synthesis, activated Chk2 and p38-MAPK and this was accompanied by an attenuation of cancer cell growth. Apoptosis was most probably inhibited due to activation of Akt; however, high PIC concentrations (>100 µM) permitted apoptosis-like cell death in consequence to disruption of orchestrated mitotic signaling. The presented results show for the first time that nanomolar PIC concentrations signal through PR and Erk1/2 and provide a mechanistic explanation why moderate wine consumption-but not other alcoholic beverages-increases the breast cancer risk in women. In contrast, higher PIC concentrations in the micromolar range are considered for adjuvant anticancer therapeutic concepts.

[Literature review on the validity of the Stepping Stones Triple P Program]. / Literatur-Review zur Validität des präventiven Elterntrainings Stepping Stones Triple P.

The preventive parent training program Stepping Stones Triple P (SSTP) (Sanders et al., 2004a), which was originally developed in Australia, is currently being examined in German-speaking countries. The object of this paper is to review the actual status of research on the validity of the SSTP program. Within this context, aspects of theoretical, internal and external (social) validity are examined. Based on two controlled-randomized primary studies on the effectiveness of SSTP, a secondary analysis was carried out in order to calculate effect sizes. The findings indicate (a) a positive internal validity, shown by replicated substantial and stable effects of the program onto child problem behavior as well as parental behavior; (b) a generally positive theoretical validity which has however certain restrictions regarding the shaping of the timeout component as well as the role of operant methods, and (c) a generally positive external validity which has however certain restrictions, in particular regarding the controversial social evaluation of the time-out component. From the results conclusions were drawn for a selective adaptation of the program as well as implementing SSTP as a preventive intervention method in families with children with developmental disabilities in German-language regions in the future.

[Implementation and evaluation of a parent training for language delayed children]. / Durchführung und Evaluation eines Elterntrainings bei Sprachentwicklungsverzögerung.

Two-year old children speaking fewer than 50 words are language delayed and at a 50 % risk for a persistent language impairment (Grimm, 2000). The present study pioneers as it presents for the first time an evaluation of the parent program "It Takes Two to Talk" (from the Hanen Early Language Parent Program, Girolametto et al., 1986) in this country. A nonrandomized controlled pre-post study design was implemented with the experimental treatment group of 9 mothers of language delayed toddlers and the matched waiting-control group of 8 mothers of language delayed toddlers. The Hanen Parent Program was carried out in the treatment group. The main outcome measures included (a) expressive language (measured with ELFRA-2, Grimm u. Doil, 2000); (b) ratings of outcome and process quality by mothers and therapist (measured with FBB, Mattejat u. Remschmidt, 1998). The central findings were as follows: (a) In the two-factor ANOVA with repeated measures on one factor no significant interaction was demonstrated between group factor and pre-post factor for the expressive language scale "vocabulary" (p = 0.18); the average gain in the treatment group (increase from M(-pre) = 13,6 to M(-post) = 62,3 words) was numerically larger than the average gain in the control group (M(-pre) = 15,5, M(-post) = 44,1), while the pre-post differences were significant in both groups (t-test: p = 0.001 in EG; p = 0.03 in CG); (b) process and outcome qualities of the parent intervention were rated "positive" or "very positive" by parents and therapist. The conclusions drawn from this study are as follows: The experimental validity of the present clinical pilot study was influenced by several methodological limitations. The overall findings at least support the assumption that the early intervention parent program examined indicates some social validity. In order to evaluate the effectiveness of this program more conclusively, further research is urgently needed.

Brief report: outcomes of a teacher training program for autism spectrum disorders.

In this study a teacher training program for Autism Spectrum Disorders (ASD), based on "structured teaching" (Mesibov et al., The TEACCH approach to autism spectrum disorders, 2006) was developed and evaluated within a Pre-Post design. In total, 10 teachers working with 10 students with ASD (mean age 10.0 years) in special education classrooms in Germany were involved in the training, The Pre-Post outcomes measured by teacher questionnaires indicated significant improvement on the Classroom Child Behavioral Symptom Scale as well as on the corresponding Classroom Teachers' Stress Reaction Scale. In addition, teachers implemented two structured teaching methods on average in their classrooms. These findings provide some first evidence for the clinical and social validity of the training program examined.

The effect of kidney transplantation on distal tubular vacuolar H+-ATPase.

BACKGROUND: The presence of vacuolar (v)H+-ATPase in distal tubule alpha-intercalated cells is essential for hydrogen excretion and maintenance of acid-base homeostasis. Loss of vH+-ATPase after kidney transplantation could cause posttransplant distal renal tubular acidosis (dRTA). METHOD: Immunostaining of the kidney specific vH+-ATPase of cortical collecting duct cells (CCT) was performed in 37 kidney biopsies taken immediately prior to transplantation and after engraftment (median [range]: 10 [1-181] months). Apical or intracytoplasmatic staining intensity was classified as grade 0 (absent), grade 1 (weak), or grade 2 (strong), and positive cells expressed as percentage of all CCT cells. In addition, kidney biopsies were scored for damage by the Banff schema. Serum and urinary pH, anion gap, and serum potassium were obtained for the diagnoses of dRTA. RESULTS: Fourteen transplant recipients had dRTA type I, 5 had rate-limited RTA, six had type IV dRTA, and 12 had no RTA. In pretransplant biopsies, 40% [3-77%] of CCT cells were positive for vH+-ATPase but only 17% [0-39%] after transplantation (P<0.0001). The loss of vH+-ATPase expression was similar in patients with dRTA type I (-21%), type IV (-25%), rate limited RTA (-21%), or no RTA (-29%). The decrease affected predominantly the apical proton pump expression. The individual loss of vH+-ATPase expression was not related to the time elapsed since transplantation, immunosuppressive drugs, acute transplant rejection, or tubulointerstitial changes. CONCLUSION: Kidney transplantation leads to a general decrease of distal tubular vH+-ATPase expression. Loss of proton pump activity occurs unrelated to immunosuppressive therapy or transplant related histologic changes.

[Development and evaluation of an ADHD teacher group training--a pilot study]. / Entwicklung und Evaluation eines Lehrergruppen--trainings bei Kindern mit ADHS--eine Pilotstudie.

In the introduction is shown that no controlled studies of teacher training programs in children with Attention Deficit Hyperactivity Disorder (ADHD) have been published in German research literature as yet in spite of high demand for educational inservice training. The aim of the present study is the development and evaluation of a two-step ADHD teacher group training. In step 1 a group training (12 h) was performed with 18 advisory teachers. The curriculum included ADHD theory, contingency management and "antecedent" TEACCH-oriented school-based interventions (Schopler 1997; Bregman and Gerdtz 1997). In step 2 then a subsample of 6 advisory teachers supervised 10 classroom teachers of 11 primary school students (mean age 8.6 yrs.) with ADHD symptoms, who were assigned to two experimental groups. The classroom teachers of the Standard Treatment Group (n=5 students) received the basic module "ADHD theory and school-based interventions" (6 h), the teachers of the Intensive Treatment Group (n=6 students) received the same basic module plus the module "Student-related training in Contingency Management" (in total 14h). The group training process was evaluated by teacher satisfaction ratings and knowledge test. The training effect on student behavior was evaluated by teacher ratings within a two-group-pre-post-follow-up design. The main results are: (a) The group training process was mostly evaluated favorably; knowledge increased significantly; (b) ADHD symptoms were reduced significantly in both treatment groups, with stronger and sustained improvement of problem behaviors and adaptive functioning in the Intensive Treatment Group. These findings provide some consistent evidence, that classroom behaviors of children with ADHD symptoms can be improved substantially by a teacher mediator training approach.

[Development and evaluation of a psychoeducational group training programme for teachers of autistic pupils with mental retardation]. / Entwicklung und Evaluation eines psychoedukativen Gruppentrainings für Lehrer von Schülern mit einer autistischen Entwicklungsstörung und Intelligenzminderung.

OBJECTIVES: Teachers of autistic pupils show profiles of increased stress that are caused by the social, communicational, and cognitive deficits of these children. The aim of the present study was to develop and evaluate a psycho-educational group training programme for teachers. METHODS: The curriculum covered theoretical issues of autism as well as educational skills focusing on "structured teaching" (TEACCH: Schopler, 1997). The training outcomes were evaluated within a pre-post (9 months) design. A total of 10 teachers working with 10 autistic children (mean age: 10 years) from schools for mentally retarded pupils participated in the training programme which included three one-day group sessions followed by six half-hour individual training sessions in the classroom (over a period of six months). The outcome variables were measured by means of teacher questionnaires assessing child behavioural symptoms, teachers' stress reactions, effects on the teachers' psychological adaptation, teacher-student-interaction and implementation of methods. RESULTS: The training programme resulted in significant effects (p < 0.5) on child symptoms as well as on teachers' stress reactions. In addition, the teachers' psychological adaptation and teacher-student-interaction improved. On average, teachers implemented about two structured teaching methods. CONCLUSIONS: These findings indicate some evidence for the clinical validity of the teacher training procedure examined, taking into consideration some methodological limitations.

[Development and evaluation of a psychoeducational parent group training program for families with autistic children]. / Entwicklung und Evaluation eines psychoedukativen Elterngruppen-Trainingsprogramms für Familien mit autistischen Kindern.

In the introduction of this study, the concept of "psychoeducational parent training" is analyzed, and an outline of the research literature on "parent training in families with autistic children" is presented. Based on these findings a psychoeducational group parent training, which focused on (1) addressing issues of nature, etiology, treatment and family-related consequences of autism (2) teaching child management and education skills was developed, and the training outcomes were evaluated within a 3-months-follow-up design. A total of 24 parents of 23 autistic children (mean age: 9 yrs.) participated in the center-based training program which was performed in three small groups in different areas of Germany in 3 one-day sessions succeeding in 1-month-intervals. The outcome variables included: (a) group training assessments by parents; they evaluated quality of trainer variables, curriculum, and group atmosphere using a questionnaire format of bipolar rating scale-items (b) parental 3-months-follow-up assessments of the effects of group training on parent-child interactions and family adaptation, using a questionnaire based on rating scales, and a semi-structured questionnaire on training-related child and parent behaviors in the family. The parent training resulted in (a) a high degree of parent satisfaction with the training format and (b) positive effects on daily parent-child interactions from the perspective of parents. These findings provide some evidence for both clinical and social validity of the parent training procedure examined in this study.