Studying the effectiveness of psychotherapy. How well can clinical trials do the job?

Although there has been much discussion of the recent Consumer Reports (CR) study (1995) on the effectiveness of psychotherapy, there is little new information reported either in the CR article or in M. E. P. Seligman's (1995) discussion of the findings. The findings that are new are hard to interpret because of serious methodological problems. In fact, the CR study is similar in many ways to H. J. Eysenck's (1952) controversial report on the effectiveness of psychotherapy, a study that has been rejected by the field despite the fact that it avoided some of the methodological shortcomings of the CR study. It would be a mistake to put forth a design rejected in the 1950s as an exemplar of good effectiveness research, especially when better alternatives exist. Clinical trials, despite many limitations, can answer all of the questions regarding the effectiveness of psychotherapy posed by M. E. P. Seligman, without the interpretive ambiguities and other methodological problems inherent in surveys such as the one published in CR.

Phase Transition of KNO3 Monitored by Synchrotron X-ray Powder Diffraction

The solid-state phase transitions of KNO3 were studied at atmospheric pressure in the temperature range 303 to 533 K by synchrotron X-ray powder diffraction. The detectors used were (i) a curved position-sensitive detector and (ii) a moving imaging-plate system built for time-, temperature- and wavelength-dependent powder diffraction. On heating, the transition from α-KNO3 to β-KNO3 occurs at 401 K. On cooling with a cooling rate of 7 K min−1, the transition from β-KNO3 to γ-KNO3 was observed at 388 K. The phase transition from γ-KNO3 to α-KNO3 occurred at temperatures that strongly depended upon the cooling rate. With a high cooling rate of 15 K min−1 from 403 to 303 K, the γ-KNO3 phase was obtained as a pure phase at 303 K, but it was eventually transformed to α-KNO3 at this temperature, and the phase transition at 303 K was complete within 15 min. With a slow cooling rate of 0.5 K min−1 from 403 to 303 K, the γ-KNO3 phase was formed at 391 K and transformed at 370 K to α-KNO3. With a cooling rate of 7 K min−1 from 403 to 303 K, the γ-KNO3 phase transformed to α-KNO3 in a temperature range between 377 and 353 K. The two phases could exist simultaneously in temperature ranges that were apparently dependent upon the thermal history of the sample. The unit-cell parameters of γ-KNO3 from 383 K to room temperature are reported.

A randomized, double-blind, multicentre study comparing the clinical effects of two sequential estradiol-progestin combinations containing either desogestrel or norethisterone acetate in climacteric women with estrogen deficiency symptoms

OBJECTIVES

The aim of this study was to compare a new estradiol-desogestrel (E2-DG) regimen with an E2-norethisterone acetate (NETA) combination (Trisekvens) regarding the treatment of menopausal complaints, bleeding pattern, histology of the endometrium and the occurrence of adverse experiences.

METHODS

A total of 310 peri-/postmenopausal women with climacteric symptoms were randomly allocated to oral sequential treatment with either the E2-DG combination (1.5 mg E2 for 24 days with 0.15 mg DG for the last 12 days followed by 1 placebo tablet for 4 days) or with the E2-NETA combination (Trisekvens, 2 mg E2 for 22 days with 1 mg NETA for the last 10 days followed by 1 mg E2 for 6 days). Treatments were administered double-blind for 12 cycles of 28 days.

RESULTS

One hundred and four women, 48 in the E2-DG group and 56 in the E2-NETA group, discontinued the study due to bleeding irregularities and various adverse effects. Both treatments reduced menopausal symptoms and complaints effectively and almost equally. The alleviation of perspirations and the improvement of general fitness were more apparent (P = 0.009) during cycle 1 with the E2-NETA treatment but were greater (P < 0.02) during the last 9/10-12 cycles of E2-DG treatment compared to E2-NETA. Regular withdrawal bleeding appeared in 93% and 90% of the women during treatment with E2-DG and E2-NETA, respectively. Intermenstrual bleeding occurred in 8% of women receiving E2-DG and in 13% of women treated with E2-NETA. The corresponding figures for intermenstrual bleeding-spotting were 21% and 22%. Secretory endometrium was detected in 65% and 54% of the samples taken at the end of treatment with E2-DG and E2-NETA, respectively. No hyperplasia or atypia was found. No serious adverse events related to treatment occurred.

CONCLUSIONS

Both regimens alleviated effectively menopausal complaints and did not induce hyperplasia of endometrium. The minor differences recorded between the two regimens were probably due to the differences in their composition concerning the amount of estradiol and its distribution along the cycle, the amount and type of progestin and the length of estradiol/progestin combination phase.

Human papillomavirus infection in cervical biopsies from Norwegian gynecological in-patients

Polymerase chain reaction (PCR) and Southern blotting were used to assess the prevalence of HPV in cervical biopsies of 100 women who were treated at the gynecology department of Telemark Central Hospital for non-cancerous conditions. Nine (9%) of the biopsies were HPV positive. Four (4%) were of HPV type 18, one (1%) was HPV11 positive, and four contained different unrecognized HPV types (HPVX). HPV16 was not detected.

The longitudinal impact of demand and withdrawal during marital conflict

Forty-eight couples completed a measure of relationship satisfaction and participated in 2 video-taped problem-solving interactions, 1 focused on an issue identified by the woman and 1 focused on an issue identified by the man. Thirty-six men and 36 women completed the satisfaction measure again 2.5 years later. Demandingness, and to a lesser extent withdrawal, during the interactions showed many significant associations with both Time 1 and Time 2 satisfaction. The relationship of demandingness and withdrawal to change in satisfaction was also examined using both change scores and partial correlations. Withdrawal by men and woman demand-man withdraw during discussions of issues identified by the women reliably predicted change (decline) in wives' relationship satisfaction.

Very low density lipoprotein receptor binds and mediates endocytosis of urokinase-type plasminogen activator-type-1 plasminogen activator inhibitor complex

Very low density lipoprotein receptor (VLDL-R) was found to be expressed in bovine mammary gland and the human breast carcinoma cell line MCF-7 as an M(r) 105,000 variant, and in Chinese hamster ovary (CHO) cells transfected with human VLDL-R cDNA as an M(r) 130,000 variant. The receptor was purified by ligand affinity chromatography with immobilized M(r) 40,000 receptor-associated protein (RAP). The purified receptor was found to bind urokinase-type plasminogen activator-type-1 plasminogen activator inhibitor complex (u-PA.PAI-1), while there was no or very weak binding of active site blocked u-PA (DFP-u-PA), PAI-1 or u-PA-type-2 plasminogen activator inhibitor complex. The binding of u-PA.PAI-1 was blocked by RAP. The transfected CHO cells had an efficient, RAP-sensitive endocytosis of u-PA.PAI-1, severalfold higher than non-transfected parental CHO cells. u-PA.PAI-1 endocytosis was partially inhibited by DFP-u-PA, which blocks binding of the complex to the u-PA receptor. RAP and DFP-u-PA sensitive u-PA.PAI-1 endocytosis was also observed in MCF-7 cells, which were without detectable levels of other RAP-binding endocytosis receptors. These results show that VLDL-R represents a novel endocytosis mechanism for u-PA receptor-bound u-PA.PAI-1.

Very low density lipoprotein receptor from mammary gland and mammary epithelial cell lines binds and mediates endocytosis of M(r) 40,000 receptor associated protein

We here report that the M(r) 40,000 receptor associated protein (RAP), previously found to bind to alpha 2-macroglobulin receptor/low density lipoprotein receptor related protein (alpha 2MR/LRP) and glycoprotein 330 (gp330), binds to an M(r) 105,000 membrane protein from bovine mammary gland, human mamma tumors and mammary epithelial cell lines. We have purified this protein from bovine and human sources. N-terminal amino acid sequencing and immunoblotting analyses showed that the protein was identical or closely related to very low density lipoprotein receptor (VLDL-R). Experiments with the human mamma carcinoma cell line MCF-7 showed that this receptor was able to mediate an efficient endocytosis of RAP. These novel findings strongly suggest that RAP functions as a modulator of ligand binding to VLDL-R, similarly to alpha 2MR/LRP and gp330.

[Should the great saphenous vein be stripped in routine surgery for uncomplicated varicose veins?]

Stripping of the great saphenous vein is widely used in the surgical treatment for varicose veins. With the increasing demand of vein material in coronary- and femoro-distal bypass surgery, this routine creates a conflict. A review of the literature reveals the possibility of vein-saving procedures that do not increase the recurrence rates. By utilizing modern diagnostic methods, it is possible to make an exact preoperative diagnosis as to the extent of the varicose disease and thus make an individualized operation, that is just as radical as necessary, but at the same time as vein-preserving as possible.

Response to selection for litter size in Danish Landrace pigs: a Bayesian analysis

A replicated selection experiment aimed at increasing litter size (total number of pigs born per litter) in Danish Landrace pigs was conducted from 1984 to 1991. The experiment included two selection and two control lines. In each generation, 30 and 14 first litters were produced in selection and control lines, respectively, and dams produced two litters. Each replicate, consisting of one selection and one control line, was founded from 60 families chosen randomly from the population at large. Family selection was practiced, and the criterion was the predicted breeding value for litter size computed using a repeatability animal model, and taking into account all available information. The data consisted of 947 records from 523 dams (424 dams had two litters) representing five cycles of selection of increased litter size. Data were analyzed from a Bayesian perspective, based on marginal posterior distributions of genetic parameters of interest. Marginalization was achieved using Gibbs sampling, with a single chain length of 1 205 000. After discarding the first 5 000 iterations, a sample was drawn every ten iterations, so 120 000 samples in total were saved. Densities were estimated and plotted, and summary statistics were computed from the estimated densities. The posterior means (± standard error) of heritability and repeatability were 0.22 ± 0.06 and 0.32 ± 0.05, respectively. These point estimates of genetic parameters were within the range of literature values, although on the high side. The posterior mean (± standard error) of genetic response to selection, defined as the difference between the mean breeding values of the selected lines and that of the base population, was 1.37 ± 0.43 pigs after five cycles of selection. The regression (through the origin) of breeding values in the selected lines on generation was 0.25 ± 0.08 pigs. Several informative priors constructed from information obtained with field data in this population were used to examine their influence on inferences. The priors were influential because of the relatively small scale of the experiment. An analysis excluding data from one of the control lines gave smaller genetic variance and heritability, and a smaller response to selection. However, it appears that selection for litter size is effective, but that the true rate of response is probably smaller than data from this experiment suggest.

Application of dual-digitonin-pulse perfusion to the study of hepatic mRNA zonation

Heterogeneous zonation of hepatic protein expression over the liver lobule has been recognized by using several analytical techniques, including microdissection, selective cell isolation, immunohistochemistry and hybridization of mRNA in situ. We previously employed the technique of dual-digitonin-pulse perfusion for the highly selective collection and analysis of periportal and perivenous soluble protein. In the present work we have now documented the feasibility of the application of this technique to the study of zonal distribution of mRNA. By using a split-stream design, both protein and RNA fractions can be simultaneously collected from hepatic zones. High-quality RNA (average yield approximately 9-33 micrograms of total RNA per mg of eluted protein) is obtained for analysis. As analysed by immunoblotting and Northern-blot analysis, the zonal distribution of several important cytosolic metabolic enzymes and their mRNAs can be documented. This technique is also applicable to the study of mRNAs for organelle- and membrane-associated proteins that are not recoverable with this digitonin-lysis technique. The application of this experimental technique should allow further molecular insight into the mechanisms underlying zonation of hepatic function.

Gender and conflict structure in marital interaction: a replication and extension

Twenty-nine married couples engaged in 2 videotaped discussions: 1 in which the husband requested a change in the wife and 1 in which the wife requested a change in the husband. Conflict behavior was assessed by self-report and observer ratings. Neither conflict structure (who requested the change) nor gender was associated with the positivity or negativity of spouses' behavior. During discussions of husbands' issues, wives and husbands did not differ in demand/withdraw behavior, whereas when discussing wives' issues, wives were more demanding and husbands were more withdrawing. Husband-demand/wife-withdraw interaction predicted an increase in wives' satisfaction 1 year later, whereas wife-demand/husband-withdraw interaction predicted a decline in wives' satisfaction 1 year later. These results replicate and extend those of our earlier study (Christensen & Heavey, 1990).

Gender and conflict structure in marital interaction: a replication and extension

Twenty-nine married couples engaged in 2 videotaped discussions: 1 in which the husband requested a change in the wife and 1 in which the wife requested a change in the husband. Conflict behavior was assessed by self-report and observer ratings. Neither conflict structure (who requested the change) nor gender was associated with the positivity or negativity of spouses' behavior. During discussions of husbands' issues, wives and husbands did not differ in demand/withdraw behavior, whereas when discussing wives' issues, wives were more demanding and husbands were more withdrawing. Husband-demand/wife-withdraw interaction predicted an increase in wives' satisfaction 1 year later, whereas wife-demand/husband-withdraw interaction predicted a decline in wives' satisfaction 1 year later. These results replicate and extend those of our earlier study (Christensen & Heavey, 1990).

Communication, conflict, and psychological distance in nondistressed, clinic, and divorcing couples

This study compared communication patterns and conflicts over psychological distance in 25 nondistressed couples, 15 clinic couples, and 22 divorcing couples. Data consisted of questionnaire reports completed independently by husbands and wives. The two distressed groups, compared with nondistressed couples, had less mutual constructive communication, more avoidance of communication, more demand/withdraw communication, and more conflict over psychological distance in their relationships. In addition, the divorcing group had less mutual constructive communication than the clinic group and evidenced a trend for more conflict over psychological distance than the clinic group. Consistent with past research, wife demand/husband withdraw communication was more likely across all groups than husband demand/wife withdraw communication. Results are discussed in terms of skills deficits and incompatability models of marital discord.

Communication, conflict, and psychological distance in nondistressed, clinic, and divorcing couples

This study compared communication patterns and conflicts over psychological distance in 25 nondistressed couples, 15 clinic couples, and 22 divorcing couples. Data consisted of questionnaire reports completed independently by husbands and wives. The two distressed groups, compared with nondistressed couples, had less mutual constructive communication, more avoidance of communication, more demand/withdraw communication, and more conflict over psychological distance in their relationships. In addition, the divorcing group had less mutual constructive communication than the clinic group and evidenced a trend for more conflict over psychological distance than the clinic group. Consistent with past research, wife demand/husband withdraw communication was more likely across all groups than husband demand/wife withdraw communication. Results are discussed in terms of skills deficits and incompatability models of marital discord.

Gender and social structure in the demand/withdraw pattern of marital conflict

This study examined the effects of gender and social structure on the demand/withdraw pattern of marital conflict. In this pattern, the demander, usually the woman, pressures the other through emotional requests, criticism, and complaints, and the withdrawer, usually the man, retreats through defensiveness and passive inaction. In this study, 31 couples were assessed in 2 conflict situations: 1 in which husband wanted a change in wife and 1 in which wife wanted a change in husband. Data from husbands, wives, and observers consistently revealed a significant main effect of gender (wife-demand/husband-withdraw interaction was more likely than husband-demand/wife-withdraw interaction) and a significant interaction of gender and conflict structure (wife-demand/husband-withdraw interaction was more likely than the reverse only when discussing a change the wife wanted). Separate analyses of demand and withdraw behaviors indicated that both husband and wife were more likely to be demanding when discussing a change they wanted and more likely to be withdrawing when discussing a change their partner wanted. However, men were overall more withdrawn than women, but women were not overall more demanding than men.

Clinical evidence supporting the radical scavenger mechanism of 5-aminosalicylic acid

5-Aminosalicylic acid, the therapeutically active metabolite of sulfasalazine, was exposed to oxygen-derived free radicals produced by the Fenton reaction in vitro, and several metabolites were detected and characterized by high performance liquid chromatography and ultraviolet spectrophotometry. The majority of these metabolites were present in methanolic extracts of feces samples from sulfasalazine-treated patients with inflammatory bowel disease but not in rheumatoid arthritis patients with normal bowel function. The presence of these metabolites, which have not been demonstrated in vivo before, provides evidence of an interaction between 5-aminosalicylic acid and oxygen-derived free radicals in sulfasalazine-treated patients with inflammatory bowel disease. Since the concentration of lipid peroxides, which is dependent on the release of oxygen-derived free radicals, was significantly increased in pretreatment rectal biopsies of the patients, and further was normalized concomitantly with a significant improvement in disease activity over the 5-wk treatment period, an important role of the radical scavenger mechanism of 5-aminosalicylic acid in sulfasalazine therapy of chronic inflammatory bowel disease is strongly suggested.

Pharmacokinetics and metabolism of a leukotriene D4/E4-antagonist (2-[3'-(2"-quinolylmethoxy)phenylamino]benzoic acid) in rat, dog,guinea pig and man

1. The absorption, distribution, metabolism and excretion of 2-[3'-(2"-quinolyl-methoxy)phenylamino]benzoic acid (QMPB), a novel leukotriene D4/E4 antagonist, were investigated in rat, dog, guinea pig and man. 2. The oral absorption of the potassium salt of QMPB was rapid and almost complete (90%) in rats, and about 50% in dogs. In man, high oral bioavailability was indicated. Absorption in dogs of the zwitterion form was only 7%. 3. The distribution of 3H-QMPB was examined in rats and guinea pigs. Whole-body autoradiography in rats showed that radioactivity was concentrated predominantly in the liver, bile and intestinal lumen, after both oral and i.v. administration. 4. A major metabolite was identified as the O-ester beta-glucuronide of QMPB. 5. Renal excretion in rat, dog and man was very low. In rat, almost complete biliary excretion of QMPB as the glucuronide conjugate was demonstrated. 6. Pronounced enterohepatic circulation of QMPB was demonstrated in rats, and the plasma concentration curves and the negligible renal excretion in dog and man also indicate enterohepatic circulation in these species.

Gender and social structure in the demand/withdraw pattern of marital conflict

This study examined the effects of gender and social structure on the demand/withdraw pattern of marital conflict. In this pattern, the demander, usually the woman, pressures the other through emotional requests, criticism, and complaints, and the withdrawer, usually the man, retreats through defensiveness and passive inaction. In this study, 31 couples were assessed in 2 conflict situations: 1 in which husband wanted a change in wife and 1 in which wife wanted a change in husband. Data from husbands, wives, and observers consistently revealed a significant main effect of gender (wife-demand/husband-withdraw interaction was more likely than husband-demand/wife-withdraw interaction) and a significant interaction of gender and conflict structure (wife-demand/husband-withdraw interaction was more likely than the reverse only when discussing a change the wife wanted). Separate analyses of demand and withdraw behaviors indicated that both husband and wife were more likely to be demanding when discussing a change they wanted and more likely to be withdrawing when discussing a change their partner wanted. However, men were overall more withdrawn than women, but women were not overall more demanding than men.

Gastrocolic fistula resulting from chronic pancreatitis

Gastrocolic fistulas are rare, and are usually seen as complications of peptic ulcer or malignancy of the stomach and large intestine. We have described a case resulting from chronic relapsing pancreatitis. The patient was successfully treated with excision of the fistula and closure of the gastric and colonic wall.

Parental communication deviance: its relationship to parent, child, and family system variables

Audiotape recordings of family interaction samples from 30 nondistressed and 32 multiproblem families were coded for communication deviance (CD). Maternal CD was found to be higher in families high on measures of "preschizophrenic" child behavior, externalizing or "acting out" offspring behavior, overall family distress, and maladaptive marital and family alliance structures. Paternal CD was found to be higher in families in which offspring were rated high on externalizing behaviors.

Perforated gastric ulcer

A retrospective study is presented of 297 patients operated upon for perforated benign gastric ulcer in Denmark from 1975 to 1984. Male:female ratio was 0.9:1, mean age 64.2 years. The numbers of gastric and prepyloric perforations were almost equal (156:141), but gastric perforations were more frequent in elderly women and prepyloric perforations in younger men. Simple closure was performed in 83 per cent of the patients, gastric resection in 14 per cent and simple closure and vagotomy in 3 per cent. The postoperative mortality rate was 21 per cent and was related to the high proportion of elderly patients with concurrent diseases and delayed treatment.