[Singing is not associated with temporomandibular disorders]. / Zingen gaat niet gepaard met kaakklachten.

This research investigated whether vocalists report pain-related forms of temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) sounds more often than musicians who do not load their masticatory system while playing. In addition, we investigated which risk indicators were associated with TMDs among musicians. A total of 1,470 musicians from 50 different music ensembles completed a questionnaire, including 306 vocalists (the group investigated) and 209 musicians who do not load their jaw while playing (the control group). The prevalence of self-reported TMD pain among the vocalists was 21.9%, compared with 12.0% in the control group. 19.6% of the vocalists reported TMJ sounds versus 14.8% of the controls. From the multiple regression model, taking into account the effect of confounders, such as age and gender, singers were not shown to report TMD pain and jaw joint sounds more often than non-singers. Various forms of physical workload were, however, positively associated with the presence of self-reported TMDs among musicians, namely the intensity of harmful oral habits with TMD pain and TMJ sounds, the number of hours of daily practice with TMD pain, and the number of years of playing experience with TMJ sounds.

Adenovirus-mediated interleukin 3 beta gene transfer by isolated limb perfusion inhibits growth of limb sarcoma in rats.

Cytokine gene transfer using (multiple) intratumoral injections can induce tumor regression in several animal models, but this administration technique limits the use for human gene therapy. In the present studies we describe tumor growth inhibition of established limb sarcomas after a single isolated limb perfusion (ILP) with recombinant adenoviral vectors harboring the rat IL-3 beta gene (IG.Ad.CMV.rIL-3 beta). In contrast, a single intratumoral injection or intravenous administration did not affect tumor growth. Dose-finding studies demonstrated a dose-dependent response with a loss of antitumor effect below 1 x 10(9) IU of IG.Ad.CMV.rIL-3 beta. Perfusions with adenoviral vectors bearing a weaker promoter (MLP promoter) driving the rIL-3 beta gene did not result in antitumor responses, suggesting that the rIL-3 beta-mediated antitumor effect depends on the amount of rIL-3 beta protein expressed by the infected cells. Furthermore, it was shown by direct comparison that ILP with IG.Ad.CMV.rIL-3 beta in the ROS-1 osteosarcoma model is at least as efficient as the established therapy with the combination of TNF-alpha and melphalan. Treatment with IG.Ad.CMV.rIL-3 beta induced a transient dose-dependent leukocytosis accompanied by an increase in peripheral blood levels of histamine. Leukocyte infiltrations were also histopathologically demonstrated in tumors after perfusion. These results demonstrate that ILP with recombinant adenoviral vectors carrying the IL-3 beta transgene inhibits tumor growth in rats and suggest that cytokine gene therapy using this administration technique might be beneficial for clinical cancer treatment.

Isolated limb perfusion for local gene delivery: efficient and targeted adenovirus-mediated gene transfer into soft tissue sarcomas.

OBJECTIVE: To evaluate the potential of isolated limb perfusion (ILP) for efficient and tumor-specific adenovirus-mediated gene transfer in sarcoma-bearing rats. SUMMARY BACKGROUND DATA: A major concern in adenovirus-mediated gene therapy in cancer is the transfer of genes to organs other than the tumor, especially organs with a rapid cell turnover. Adjustment of the vector delivery route might be an option creating tumor specificity in therapeutic gene expression. METHODS: Rat hind limb sarcomas (5-10 mm) were transfected with recombinant adenoviruses. Intratumoral luciferase expression after ILP was compared with systemic administration, regional infusion, or intratumoral injection using a similar dose of adenoviruses carrying the luciferase marker gene. Localization studies using lacZ as a marker gene were performed to evaluate the intratumoral distribution of transfected cells after both ILP and intratumoral injection. RESULTS: Intratumoral luciferase activity after ILP or intratumoral administration was significantly higher compared with regional infusion or systemic administration. After ILP, luciferase gene expression was minimal in extratumoral organs, whether outside or inside the isolated circuit. Localization studies demonstrated that transfection was confined to tumor cells lying along the needle track after intratumoral injection, whereas after ILP, lacZ expression was found in viable tumor cells and in the tumor-associated vasculature. CONCLUSIONS: Using ILP, efficient and tumor-specific gene transfection can be achieved. The ILP technique might be useful for the delivery of recombinant adenoviruses carrying therapeutic gene constructs to enhance tumor control.

Babies, brains and culture: optimizing neurodevelopment on the savanna.

Cross-cultural child development research has demonstrated the influence of infant experience as well as constitutional, neurodevelopmental influences in infant outcomes. African infant precocity found in a number of studies is examined in the light of developmental models and in the context of the enriched child-rearing environment of pre-industrial societies. Examples are drawn from fieldwork in East Africa that demonstrate the different contributions of pregnancy, nutrition, early learning and cultural factors on developmental outcomes. The multiple enhancing infant rearing and nutritional factors are postulated to optimize the rate of neuro-development thereby contributing to psychomotor precocity.

Tumor necrosis factor-alpha in isolated perfusion systems in the treatment of cancer: the Rotterdam preclinical-clinical program.

The clinical success of the application of tumor necrosis factor-alpha (TNFalpha) in isolated limb perfusions in patients with advanced sarcomas, melanomas and other tumors has renewed the interest in this agent as an anticancer drug. At the Rotterdam Cancer Center, we have developed an interactive preclinical-clinical TNFalpha program that explores new methods to use TNFalpha in various settings. Regional organ perfusion models were developed and the effectivity of targeting of TNFalpha to the tumor by means of systemic administration of liposomes are tested. Furthermore various drugs and mechanisms that may enhance the activity of TNFalpha are under investigation. A summary of this comprehensive program is presented here.

Changes in daily life experience associated with clinical improvement in depression.

Changes in depressed outpatients' experience of daily activities after 6 weeks of antidepressant treatment were assessed with the experience sampling method (ESM). On the sickness impact profile, treatment responders (HAM-D < or = 7, n = 12) improved more than nonresponders (n = 9) in the domains of household chores, leisure and social activities. On ESM measures completed 10 x each day for 6 days pre- and posttreatment, responders showed greater increases in time spent in chores and greater decreases in passive leisure time than nonresponders. Responders showed greater increases in positive affect and greater decreases in negative affect during all activities. Thus, ESM provides quantitative evidence of changes in real life time use and subjective experience accompanying clinical improvement.

Agoraphobic behavior in daily life: effects of social roles and demographic characteristics.

Agoraphobia is related to demographic characteristics and social roles. To unravel behavioral aspects from demographic characteristics, daily life situations were registered with the Experience Sampling Method for 65 panic patients with and without agoraphobia. Surprisingly, panic patients with and without agoraphobia did not differ as hypothesized in reported frequencies of visits to public places. Panic subjects with agoraphobia did, however, spend significantly more time at home and with their families than did panic patients without agoraphobia and normal controls. When adjusted for demographic variables such as sex, marital status, family life, and employment, no significant differences between panic patients with and without agoraphobia emerged on the avoidance variables of remaining at home or being with a family member. The lack of discrimination of the diagnosis on these crucial behavioral variables highlights the influence of demographic characteristics and social roles on agoraphobia in daily life. Such findings challenge current diagnostic conceptualizations that rely on retrospective reports by patients of the avoidance of public places. Moreover, reliance on retrospective reports obscured the important role of significant others for understanding etiology and course.

To what extent are medical interviewing skills teachable?

Growth patterns of medical interviewing skills during a 6-year undergraduate curriculum are assessed by studying 563 medical students taken from five year-groups, interviewing simulated patients. In a cross-sectional, quasi-experimental design their skills are rated by means of the Maastricht History-taking and Advice Checklist (MAAS), an observation instrument which measures five categories of interviewing skills pertaining to initial medical consultations. The findings suggest that the skills for 'history-taking', 'presenting solutions' and 'structuring of the interview' are effectively learned. These learning effects result from a continuous small group teaching program with expert and peer review of videotaped encounters with simulated patients. The teaching effects of this program seem less for the skills pertinent to the phase of 'exploring the reasons for encounter' and to the 'basic interviewing skills', because the students' growing medical knowledge and the increasing ability to solve medical problems exert a counteracting influence on the acquisition of these easily deteriorating skills. The results might be helpful to curriculum planners in order to make their programs for medical interviewing skills more effective.

Consensus in patient-therapist interactions. A measure of the therapeutic relationship related to outcome.

This paper discusses consensus between patient and therapist as a measure of the quality of the psychotherapeutic relationship. Consensus is defined by two interpersonal concepts, agreement and understanding, and two intrapersonal concepts, congruency and experienced consensus. 162 patients and their therapists in a Dutch Center for Comprehensive Mental Health Care were rated on the degree of consensus. Two patient self-report outcome measures and one reported by the therapist were related to consensus. The three consensus measures that predicted outcome after 6 months were understanding by the therapist as well as agreement and experienced consensus by the patient. This result suggests that a complementary patient-therapist relationship favors a good psychotherapy result. The instruments in this paper provide a means to measure consensus during the process of psychotherapy. This is a feasible way to both monitor progress and improve the chances of a successful outcome.