In vivo assessment of secondary caries and dentin characteristics after traditional amalgam restorations

OBJECTIVE

This study aimed to evaluate in vivo the occurrence of secondary caries and dentin characteristics in permanent molars after traditional amalgam restorations, by means of clinical visual examination, radiographs and laser-induced fluorescence (LF) (DIAGNOdent).

METHODS

Thirty first permanent molars of 30 schoolchildren in the 7 to14 year-old age group were included. Caries was removed by hand. Thus, indirect pulp capping was performed with glass-ionomer cement (GIC), the cavity was varnished and amalgam filled. LF was measured before and after cavity preparation and after a 12-month observation period. Dentin color after cavity preparation and after the 12-month observation period was recorded. Recurrent caries was also investigated by visual clinical and radiographic examinations, in addition to dentin thickness between pulp and indirect GIC pulp capping. Data was analyzed by ANOVA for repeated measurements, paired "t" test and descriptive statistic.

RESULTS

There were statistically significant differences (P<.05) among LF scores for dentin in all periods evaluated, with the lowest scores shown after 12 month of observation. There was no statistical difference between dentin color after cavity preparation and following 12 months of observation. Moreover, there was no recurrent caries attack at 12-month follow-up; dentin thickness between pulp and indirect GIC pulp capping was similar between baseline and final observation periods. It was concluded that the clinical restorative procedure using hand caries removal, indirect pulp capping with GIC, varnishing and amalgam filling the cavity did not provide secondary caries and increased dentin mineral content after 12 months.

Eradication of Helicobacter pylori increases childhood growth and serum acylated ghrelin levels

AIM: To determine whether Helicobacter pylori (H. pylori)-infected children have reduced body weight (BW) and height (BH) growth, and if H. pylori eradication may restore growth while improving serum acylated ghrelin.

METHODS: This longitudinal cohort study with one-year follow-up enrolled 1222 children aged 4 to 12 years old into an observation cohort (18 with and 318 without H. pylori) and intervention cohort (75 with and 811 without). The 7-d triple therapy was used for eradication in the intervention cohort. The net increases of BW and BH as well serum acylated ghrelin after one-year follow-up were compared between successful eradicated H. pylori-infected children and controls.

RESULTS: In the observation cohort, the H. pylori-infected children had lower z score of BW (-1.11 ± 0.47 vs 0.35 ± 0.69, P = 0.01) and body mass index (BMI) (0.06 ± 0.45 vs 0.44 ± 0.73, P = 0.02) at enrollment and lower net BW gain after one-year follow-up (3.3 ± 2.1 kg vs 4.5 ± 2.4 kg, P = 0.04) than the non-infected controls. In the intervention cohort, the H. pylori-infected children had lower z score of BMI (0.25 ± 1.09 vs 0.68 ± 0.87, P = 0.009) and serum acylated ghrelin levels (41.8 ± 35.6 pg/mL vs 83.6 ± 24.2 pg/mL, P < 0.001) than the non-infected controls. In addition to restoring decreased serum ghrelin levels (87.7 ± 38.0 pg/mL vs 44.2 ± 39.0 pg/mL, P < 0.001), the H. pylori-infected children with successful eradication had higher net gains (P < 0.05) and increase of z scores (P < 0.05) of both BW and BH as compared with non-infected controls after one-year follow-up.

CONCLUSION: H. pylori-infected children are associated with low serum acylated ghrelin and growth retardation. Successful eradication of H. pylori restores ghrelin levels and increases growth in children.

Locally Delivered 0.5% Azithromycin as an Adjunct to Non-Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial

BACKGROUND

Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes.

METHODS

A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL).

RESULTS

Both therapies resulted in significant improvements. Using a patient-based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1.

CONCLUSION

Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.

What is the problem in clinical application of sentinel node concept to gastric cancer surgery?

More than ten years have passed since the sentinel node (SN) concept for gastric cancer surgery was first discussed. Less invasive modified surgical approaches based on the SN concept have already been put into practice for malignant melanoma and breast cancer, however the SN concept is not yet placed in a standard position in gastric cancer surgery even after two multi-institutional prospective clinical trials, the Japan Clinical Oncology Group trial (JCOG0302) and the Japanese Society for Sentinel Node Navigation Surgery (SNNS) trial. What is the problem in the clinical application of the SN concept to gastric cancer surgery? There is no doubt that we need reliable indicator(s) to determine with certainty the absence of metastasis in the lymph nodes in order to avoid unnecessary lymphadenectomy. There are several matters of debate in performing the actual procedure, such as the type of tracer, the site of injection, how to detect and harvest, how to detect metastases of SNs, and learning period. These issues have to be addressed further to establish the most suitable procedure. Novel technologies such as indocyanine green (ICG) fluorescence imaging and one-step nucleic acid amplification (OSNA) may overcome the current difficulties. Once we know what the problems are and how to tackle them, we can pursue the goal.

Systematic review: extracorporeal bio-artificial liver-support system for liver failure

BACKGROUND

Orthotopic liver transplantation (OLT) is the only effective long-term treatment for liver failure by now. However, it is not yet a perfect choice due to donor-organ shortage and the need of a lifelong immunosuppressive therapy. Therefore, it is necessary to find a new approach to fighting the disease. Several published clinical trials have reported the therapeutic effect of bio-artificial liver (BAL) for liver failure.

OBJECTIVE

To overview and evaluate the current clinical application and outcomes of extracorporeal BAL support system during the past 15 years.

METHODS

Relevant studies were retrieved from PubMed and Cochrane Library databases. Independent assessments and the final consensus decision were performed by three independent reviewers. Acceptable study designs included randomized controlled trials, controlled clinical trials, and case reports. A total of 31 studies were tabulated and critically appraised in terms of characteristics, methods, and outcomes.

RESULTS

There was a trend of falling into the normal ranges with the clinical and biochemical parameters after the BAL treatment. The neurological status of most patients was improved or stabilized during BAL treatment as well. No significant effect on survival could be seen after the BAL treatment.

CONCLUSIONS

Although BAL system proved to be a success in some clinical cases reported, it still needs to be improved greatly.

A long road for stem cells to cure sick hearts: update on recent clinical trials

The contribution of stem cells to cure damaged hearts has finally been unraveled. A large number of preclinical and clinical studies have showed beneficial outcomes after myocardial infarction. In this review, the current understanding of stem cell therapy in preclinical and clinical experiences is summarized. Stem cells from bone marrow have shown a potential to improve cardiac performance after myocardial infarction in animal and early clinical studies. Clinical trials from all over the world have provided safety assessments of stem cell therapy with marginal improvement of clinical outcomes. Thus, further investigations should be encouraged to resolve the discrepancies between studies, clinical issues, and unclear translational findings. This review provides information and commentary on key trials for stem cell-based treat-ment of cardiovascular disease.

Scientific Rigor Recommendations for Optimizing the Clinical Applicability of Translational Research

The approval of new therapies to treat neurodegenerative disease conditions by the Food and Drug administration (FDA) has been hindered by many failed clinical trials, which were based upon "significant" efficacy in preclinical or translational studies. Additional problems during drug development related to significant adverse events and unforeseen toxicity have also hampered drug development. Recent reviews of preclinical data suggests that many studies have over-estimated efficacy due to poor or inadequate study design, exclusion of important data (negative or neutral) and lack of study randomization and blinding. This article describes in detail a set of recommendations to improve the quality of science being conducted in laboratories worldwide, with the goal of documenting in the peer-reviewed literature, including Journal of Neurology and Neurophysiology, the scientific basis for the continued development of specific strategies to treat neurodegenerative diseases such as Stroke, Alzheimer's disease, Huntington's disease, Parkinson's disease, Spinal cord injury, and Amyotrophic lateral sclerosis. The minimum recommendations for effective translational research include the need for model justification, study group randomization and blinding, power analysis calculations, appropriate statistical analysis of all data sets, and a conflict of interest statement by investigators. It will also be beneficial to demonstrate reproducible efficacy in multiple species and in studies done by independent laboratories.

A Double-Blind, Placebo-Controlled Study of the Aqueous Extract of Echium amoenum for Patients with General Anxiety Disorder

The aim of this study was to assess the efficacy and tolerability of the aqueous extract of Echium amoenum in combination with SSRIs in patients with General Anxiety Disorder (GAD). The study was an 8-week double-blind randomized clinical trial. Thirty-seven adult outpatients who met the DSM-IV-TR criteria for GAD based on the structured clinical interview participated in the trial. In this study, patients were randomly assigned to receive the aqueous extract (500 mg) plus fluoxetine or fluoxetine (20 mg/day) plus placebo. The results showed significant difference between the two groups in the treatment of GAD. Moreover, there was not any significant difference between the two groups in terms of observed side effects. E. amoenum is effective on anxiety disorder, especially in higher dosage, without any serious side effects.

Comparison of pap smear quality with anatomical spatula method and the common method (spatula-cytobrush): a single blind clinical trial

BACKGROUND

Cervical cancer is the third most common cancer in women in the world. Papanicolaou smear is known as a standard test for cervical cancer screening; however, the most important challenge is high rates of false negative results. The aim of this study was to compare the quality of smears obtained by anatomical spatula and spatula-cytobrush. The most important factor in false negative result is inappropriate tool of sampling.

METHODS

One hundred married women participated in this single blind clinical trial. All participants were interviewed; two samples were obtained from every participant: one with spatula-cytobrush and another one with anatomical spatula. All slides were encoded and were assessed by two pathologists. Then, data were analyzed by means of kappa coefficient.

RESULTS

Cell adequacy was 96.1 % in anatomical spatula method and 91.2 % in spatula-cytobrush method (p= 0.016). The rates for endocervical cells and metaplasia cells in anatomical spatula method were 70.6% and 24.5% respectively and these amounts were 69.6% and 24.5% respectively in the spatula-cytobrush method (p <0.001). No one reported any pain and the amount of bleeding was 38.2% in both methods (P>0.05). Regarding infection and inflammatory reactions there was no statistically significant difference between two methods (p>0.05).

CONCLUSION

Based on our findings in this study, results of sampling with anatomical spatula method were more acceptable and better than those with spatula-cytobrush sampling.

An open-label, prospective clinical study to evaluate the efficacy and safety of TLPL/AY/01/2008 in the management of functional constipation

Functional constipation is one of the most common gastrointestinal symptoms across the globe. Its high prevalence rate, economic burden, and adverse implications on the quality of life make constipation a major public health issue. Though various treatment options are available for the management of constipation, evidence for their efficacy and safety are limited. An open-label, prospective, interventional, and exploratory clinical trial was carried out to evaluate the efficacy and safety of “TLPL/AY/01/2008” in 34 patients suffering from functional constipation. “TLPL/AY/01/2008” is an Ayurvedic proprietary polyherbal formulation in powder form, containing Isabgol husk, Senna extract, and Triphala extract. Administration of “TLPL/AY/01/2008” for 14 days showed a significant increase in mean weekly bowel movements from 10.19 ± 05.64 to 18.29 ± 05.72 (P<0.05). The mean average time spent on toilet for bowel evacuation reduced significantly from 11.02 ± 05.43 minutes (baseline value) to 08.70 ± 04.72 minutes on day 14 (P<0.05). Mean stool form score assessed on Bristol stool form scale was improved from 02.97 ± 00.48 (baseline value) to 04.61 ± 00.84 (P<0.05) on day 14. A significant improvement (P<0.05) was also noted in straining during defecation, sensation of incomplete evacuation, sensation of anorectal blockage, and other associated symptoms of functional constipation. The significant improvement in most of the above symptoms was endured for a post-treatment observatory period of one week. All the study patients showed an excellent tolerability to the study drug. These findings suggest that “TLPL/AY/01/2008” is an effective, safe, and non-habit-forming herbal laxative formulation for the management of constipation. Comparative clinical studies with larger sample size would be able to confirm the above findings.

The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population

Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used "standard practice" surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions.

Comparison of observational and controlled clinical trials of diltiazem in the treatment of chronic anal fissure

Diltiazem has been extensively studied in the treatment of chronic anal fissures, but efficacy in clinical practice is not fully established. The aim of the present study was to evaluate the safety and efficacy of topical application diltiazem in observational studies as well as in controlled clinical trials in the treatment of chronic anal fissures. A systematic literature search was carried out from 1966 to 31 December, 2007 on PubMed, Medline, Embase and Cochrane database, using the appropriate search words. We found six observational studies with 392 patients and five controlled clinical trials with 289 patients in which topical diltiazem treatment was given. Efficacy was found to be very high in observational studies (56.88%), whereas it was found to be modest in controlled clinical trials (29.41%). In observational studies, most of the patients reported complete healing of fissures within 6-12 weeks, whereas in controlled trials healing was reported within 8 weeks, with tolerable adverse effects of diltiazem. On the basis of the above studies, it can be concluded that topical application of diltiazem is useful in the treatment of chronic anal fissure, but to fully establish its efficacy, larger prospective double-blind study is required in the near future.

Distribution, function and physiological role of melatonin in the lower gut

Melatonin is a hormone with endocrine, paracrine and autocrine actions. It is involved in the regulation of multiple functions, including the control of the gastrointestinal (GI) system under physiological and pathophysiological conditions. Since the gut contains at least 400 times more melatonin than the pineal gland, a review of the functional importance of melatonin in the gut seems useful, especially in the context of recent clinical trials. Melatonin exerts its physiological effects through specific membrane receptors, named melatonin-1 receptor (MT1), MT2 and MT3. These receptors can be found in the gut and their involvement in the regulation of GI motility, inflammation and pain has been reported in numerous basic and clinical studies. Stable levels of melatonin in the lower gut that are unchanged following a pinealectomy suggest local synthesis and, furthermore, implicate physiological importance of endogenous melatonin in the GI tract. Presently, only a small number of human studies report possible beneficial and also possible harmful effects of melatonin in case reports and clinical trials. These human studies include patients with lower GI diseases, especially patients with irritable bowel syndrome, inflammatory bowel disease and colorectal cancer. In this review, we summarize the presently available information on melatonin effects in the lower gut and discuss available in vitro and in vivo data. We furthermore aim to evaluate whether melatonin may be useful in future treatment of symptoms or diseases involving the lower gut.

Early prophylactic inhaled beclomethasone in infants less than 1250 g for the prevention of chronic lung disease

OBJECTIVE

Inflammation plays an important role in the development of chronic lung disease (CLD), which has become a major cause of morbidity in surviving infants less than 1250 g at birth. The authors hypothesized that the progression of this inflammation and, therefore, the establishment of CLD would be decreased with the use of early prophylactic inhaled corticosteroids. Short, and long term respiratory and neurodevelopmental outcomes were also examined.

DESIGN

A double-blind, randomized placebo controlled trial.

SETTING

Level-III neonatal intensive care unit.

POPULATION STUDIED

Sixty infants less than 1250 g at birth, diagnosed with respiratory distress syndrome and requiring ventilatory support at 72 h of age were enrolled in the study.

INTERVENTION

Infants enrolled received either placebo or beclomethasone diproprionate by a metered dose inhaler, which was used in-line with the ventilator circuit while the infant was ventilated and then via a spacer until 28 days of age.

RESULTS

Thirty infants were given beclomethasone and 30 were given placebo. There were two deaths in each group. Among the surviving infants, the frequency of moderate-to-severe CLD was 17% in each study group. Mean time to extubation was not different for beclomethasone compared with placebo at 16.4 and 12.5 days (P=0.12), respectively. The requirement for intravenous corticosteroids was lower in the beclomethasone-treated group (RR 0.67, 95% CI 0.43 to 1.04), although this difference was not statistically significant. The incidence of growth failure, infection and intraventricular hemmorhage did not differ between the two groups. Long term outcomes were not different with respect to the incidence of respiratory re-admissions, cerebral palsy, developmental delay, blindness or deafness.

CONCLUSIONS

Early treatment with inhaled beclomethasone diproprionate did not reduce the incidence of CLD or decrease the duration of mechanical ventilation. The decrease in intravenous corticosteroid use was not statistically significant. Long term outcome was not affected.

Idiotype vaccines for lymphoma: Potential factors predicting the induction of immune responses

Over the last two decades, lymphoma idiotype vaccines have been the first human cancer vaccines to show striking evidence of biological and clinical efficacy on the one hand, as well as clinical benefit on the other. More recently, however, three large-scale, independent, randomized clinical trials on idiotypic vaccination have failed to achieve their main clinical endpoints for reasons likely to depend more on flaws in each clinical trial’s study design than on each vaccination strategy per se. Independently of these considerations, a major hurdle for the development of this substantially innocuous and yet potentially very effective type of treatment has been the fact that, even to date, no factors ascertainable before vaccination have been prospectively singled out as predictors of subsequently vaccine-induced, idiotype-specific immune as well as clinical responses. The aim of this review article is precisely to analyze what has been and what could be done in this respect in order to give a greater chance of success to future trials aimed at regulatory approval of idiotype vaccines.

Cell transplantation for hepatic disease: current research status

Cell transplantation is a promising way to restore liver function. Treatment of end-stage liver disease with stem cells, especially bone marrow stem cells, has attracted wild attention. There is ongoing research to use mature hepatocytes, liver progenitor cells, bone marrow stem cells and embryonic stem cells to restore liver function in patient with hepatic disease. Here we review the current research status of cell transplantation for hepatic disease in terms of cell biology, animal models and clinical trials.

Extended Release Quetiapine Fumarate (Quetiapine XR) as Adjunct Therapy in Patients with Generalized Anxiety Disorder and a History of Inadequate Treatment Response: A Randomized, Double-Blind Study

OBJECTIVE

To evaluate the efficacy and tolerability of adjunct extended release quetiapine fumarate (quetiapine XR) in patients with generalized anxiety disorder (GAD) and inadequate response to selective serotonin reuptake inhibitors/ serotonin norepinephrine reuptake inhibitors (SSRI/SNRIs).

METHODS

11-week (1-week single-blind placebo run-in; 8-week randomized treatment; 2-week post-treatment period), double-blind, placebo-controlled study. Patients were randomized to quetiapine XR or placebo adjunct to SSRI/SNRI. 50 mg initial dose; 150 mg/day, Day 3; 300 mg/day, Weeks × and 4 if indicated (Clinical Global Impressions-Severity of Illness [CGI-S] ≥ 4; 150 mg/day tolerated). Primary endpoint: change from randomization to Week 8 in HAM-A total score. Secondary variables: Hamilton Rating Scale for Anxiety (HAM-A) psychic/somatic clusters, response and remission; and CGI-S.

RESULTS

409 patients were randomized to quetiapine XR (n = 209) or placebo (n = 200); 41% and 55% of patients, respectively, had dose increases (300 mg/day). Week 8 mean change in HAM-A total score was not statistically significant for quetiapine XR (-10.74; p = 0.079) versus placebo (-9.61). Secondary variables were generally consistent with the primary analysis, except a significant reduction in HAM-A total score at Week 1 (-6.45, quetiapine XR versus -4.47, placebo; p < 0.001); significant improvements in HAM-A psychic cluster (p < 0.05) and CGI-S total (p < 0.05) scores at Week 8. Adverse events (.10% either group) were dry mouth, somnolence, sedation, headache, and dizziness.

CONCLUSIONS

In patients with GAD and inadequate response to SSRI/SNRI, adjunct quetiapine XR did not show a statistically significant effect for the primary endpoint at Week 8, although some secondary endpoints were statistically significant versus placebo. Quetiapine XR was generally well tolerated.

p53 gene therapy in combination with transcatheter arterial chemoembolization for HCC: One-year follow-up

AIM: To evaluate the efficacy and safety of combination therapy with recombinant adenovirus p53 injection (rAdp53) and transcatheter hepatic arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC).

METHODS: A total of 82 patients with advanced HCC treated only with TACE served as control group. Another 68 patients with HCC treated with TACE in combination with recombinant adenovirus-p53 injection served as p53 treatment group. Patients were followed up for 12 mo. Safety and therapeutic effects were evaluated according to the improvement in clinical symptoms, leukocyte count, Karnofsky and RECIST criteria. Survival rate was calculated with Kaplan-Meier method.

RESULTS: The total effective rate was 58.3% for p53 treatment group, and 26.5% for control group (P < 0.05). The incidence of gastrointestinal symptoms was lower in p53 treatment group than in control group (P < 0.05). The 3-, 6- and 12-mo survival rates were significantly higher for p53 treatment group than for control group (P < 0.01). The combination treatment was well tolerated with such adverse events as fever (51.5%, P = 0.006) and pain of muscles and joints (13.2%, P = 0.003), which were significantly higher than the chemotherapy. Except for these minor adverse effects, no severe vector-related complications were identified. With respect to the efficacy, patients in p53 treatment group had less gastrointerestinal symptoms (P = 0.062), better improvement in tumor-related pain (P = 0.003), less downgrade of leukocyte counts (P = 0.003) and more upgrade of Karnofsky performance score (P = 0.029) than those in control group. The total effective rate (CR + PR) for p53 treatment group and control group was 58.3% and 26.5%, respectively, with distributions of different effect in two groups (P = 0.042). The survival rates were 89.71%, 76.13%, and 43.30% for p53 treatment group, and 68.15%, 36.98%, and 24.02% for control group, respectively, 3, 6 and 12 mo after treatment, suggesting that the survival rates are significantly higher for p53 treatment group than for control group (P = 0.0002).

CONCLUSION: The rAd-p53 gene therapy in combination with TACE is a safe and effective treatment modality for advanced HCC.

High dose Senna or Poly Ethylene Glycol (PEG) for elective colonoscopy preparation: a prospective randomized investigator-blinded clinical trial

BACKGROUND

The aim of this study was to determine the efficacy of two methods of colon preparation for colon cleansing in a randomized controlled trial.

METHODS

In this prospective randomized investigator-blinded trial, consecutive outpatients indicated for elective colonoscopy were randomized into two groups. Patients in Senna group took 24 tablets of 11 mg Senna in two divided doses 24 hour before colonoscopy. In Poly Ethylene Glycol (PEG) group they solved 4 sachets in 4 liters of water the day before the procedure and were asked to drink 250 ml every 15 minutes. The overall quality of colon cleansing was evaluated using the Aronchick scoring scale. Difficulty of the procedure, patients' tolerance and compliance and adverse events were also evaluated.

RESULTS

322 patients were enrolled in the study. There was no significant difference in the quality of colon cleansing, patients' tolerance, compliance and the difficulty of the procedure between two groups (p > 0.05). The incidence of adverse effects was similar between two groups except for abdominal pain that was more severe in Senna group (p < 0.05) and nausea and vomiting that was more common in PEG group (p < 0.05)

CONCLUSIONS

In conclusion we deduce that Senna has the same efficacy and patient's acceptance as Polyethylene glycol-electrolyte solution (PEG-ES) and it could be prescribed as an alternative method for bowel preparation.

The effect of Frankincense in the treatment of moderate plaque-induced gingivitis: a double blinded randomized clinical trial

BACKGROUND AND THE PURPOSE OF THE STUDY

Extract of Boswellia Serrata species has been used in the Indian traditional medicine in the treatment of various inflammatory diseases. The present study was designed to evaluate anti-inflammatory effects of Frankincense in the treatment of gingivitis, which is a periodontal tissue inflammatory disease.

METHODS

This double blind randomized placebo controlled trial was carried out among high school female students with moderate plaque-induced gingivitis. Based on either administration of 0.1 gram of Frankincense extract or 0.2 gram of its powder or placebo and whether the patients undergone scaling and root planning (SRP) or not, they were randomly assigned to 6 groups. The primary efficacy outcome was changes in Gingival Index (Loe & Sillness) and the secondary outcomes were alteration in plaque index (Sillness & Loe), bleeding index (Cowell) and probing pocket depth (WHO probe). All indices were measured in the 0, 7th and 14th days of the study.

RESULTS

Seventy five patients ranged of 15-18 years old were enrolled. At the end of the study, the indices in all groups showed significant decreases in comparison to the first day (p< 0.05), except for the bleeding index in the group without SRP and drug therapy (p=0.111). More precise analysis of data revealed that SRP in association with Frankincense application (either extract or powder) can lead to remarkable decrease in inflammatory indices in comparison to the groups without SRP and drug therapy (p<0.001). In addition, no significant difference was observed between powder or extract therapy (p >0.05) and between patients received either SRP or treatment alone (p=0.169).

CONCLUSION

Frankincense, a safe and low-cost herbal medicine, may be feasibly applied to improve inflammation based disease of gingival as an adjunct to the conventional mechanical therapy.

A Double-Blind Randomized Clinical Trial for Evaluation of Galactogogue Activity of Asparagus racemosus Willd

Asparagus racemosus Willd. has repeatedly been mentioned as a galactogogue in Ayurvedic literature and has been confirmed through animal experiments as well. This randomized double-blind clinical trial evaluates its galactogogue effect in 60 lactating mothers by measurement of changes in their prolactin hormone level during the study. Several secondary parameters namely mothers' weight, babies' weight, subjective satisfaction of mothers and well-being and happiness of babies were studied to corroborate the primary findings. The oral administration of the research drug led to more than three-fold increase in the prolactin hormone level of the subjects in the research group as compared to the control group. The primary findings were corroborated by the secondary outcome measures and were found to be statistically significant (p < 0.05).

Comparison between the Efficacy of Herbal and Conventional Dentifrices on Established Gingivitis

BACKGROUND

Bacteria in dental plaque are one of the main factors causing periodontal disease. The aim was to evaluate and compare the effectiveness of antimicrobial dentifrices with herbal extracts and conventional toothpaste with no antimicrobial action for improvement of oral hygiene and reduction of gingival inflammation.

METHODS

48 volunteers with chronic marginal gingivitis were randomly divided into three groups. Groups 1 and 2 received herbal extract dentifrices. Group 3 used a conventional dentifrice. Subjects were asked to use the allocated dentifrice, three times a day, for 42 days. Values of Patient Hygiene Performance, Approximal Plaque, Gingival, and Sulcular Bleeding indices were assessed at baseline, after 14, 28 and 42 days. Data were analyzed by Student's t-test (α = 0.05).

RESULTS

Oral hygiene (tooth brushing with dentifrices for 42 days) led to a significant decrease in plaque accumulation on smooth (by 61.2% and 57.2 in herbal test groups 1 and 2, respectively) and approximal (by 57.4 and 52.8% in herbal test groups 1 and 2, respectively) tooth surfaces, reduction of gingival inflammation (by 68.0 and 70.6% in herbal test groups 1 and 2, respectively) and gingival sulcus bleeding (by 79.5 and 81.2% in herbal test groups 1 and 2, respectively). Final indices values in both herbal test groups were significantly (P <60; 0.001) lower compared to those at baseline and those after 42 days in the conventional group.

CONCLUSION

Continuous application of herbal tooth paste provided significant improvement of oral hygiene level in patients with gingivitis.

Socket preservation using deproteinized horse-derived bone mineral

PURPOSE

The healing process following tooth extraction apparently results in a pronounced resorption of the alveolar ridge. As a result, the width of alveolar ridge is reduced and severe alveolar bone resorption occurs. The purpose of this experiment is to clinically and histologically evaluate the results of using horse-derived bone mineral for socket preservation.

METHODS

The study comprised 4 patients who were scheduled for extraction as a consequence of severe chronic periodontitis or apical lesion. The extraction was followed by socket preservation using horse-derived bone minerals. Clinical parameters included buccal-palatal width, mid-buccal crest height, and mid-palatal crest height. A histologic examination was conducted.

RESULTS

The surgical sites healed uneventfully. The mean ridge width was 7.75 ± 2.75 mm at baseline and 7.00 ± 2.45 mm at 6 months. The ridge width exhibited no significant difference between baseline and 6 months. The mean buccal crest height at baseline was 7.5 ± 5.20 mm, and at 6 months, 3.50 ± 0.58 mm. The mean palatal crest height at baseline was 7.75 ± 3.10 mm, and at 6 months, 5.00 ± 0.82 mm. There were no significant differences between baseline and 6 months regarding buccal and palatal crest heights. The amount of newly formed bone was 9.88 ± 2.90%, the amount of graft particles was 42.62 ± 6.57%, and the amount of soft tissue was 47.50 ± 9.28%.

CONCLUSIONS

Socket preservation using horse-derived bone mineral can effectively maintain ridge dimensions following tooth extraction and can promote new bone formation through osteoconductive activities.

Is soft tissue massage an effective treatment for mechanical shoulder pain? A study protocol

Very little research has been conducted into the effectiveness of soft tissue massage as an intervention for the treatment of mechanical shoulder pain. Studies that have been conducted suffer from methodological issues, poor long-term follow-up and have conflicting results. The aim of this study, therefore, is to provide treating clinicians with improved evidence regarding the effectiveness of soft tissue massage for shoulder pain of local mechanical origin. Participants referred to the trial with mechanical shoulder pain will be assessed for range of motion, functional ability, and pain by a blinded assessor. Participants will then be randomly allocated to either an exercise-only group or an exercise and soft tissue massage group. Both groups will receive seven treatment sessions from a physical therapist over a period of 4 weeks. One week after the cessation of treatment, all participants will be reassessed by the same blinded assessor. Three months after cessation of treatment, subjects will again be reassessed. The primary outcome will be pain measured on a visual analogue scale (VAS) 1 week following the cessation of treatment. Secondary analyses will be pain at 3 months, the descriptive and present pain index sections of the short form McGill pain questionnaire, patient specific functional scale, and percentage improvement in pain scores and range of motion at 1 week following the cessation of treatment and at 3 month follow-up. Analysis of data will be carried out by a statistician who is blinded to group membership. Primary analyses will by intention-to-treat.

A systematic review of efficacy and tolerability of mebeverine in irritable bowel syndrome

We evaluated the efficacy and tolerability of mebeverine, a musculotropic antispasmodic agent, in irritable bowel syndrome (IBS) and compared its usual dosages by meta-analysis. Medical databases and all relevant literature were searched from 1965 to June 2009 for any placebo-controlled clinical trials of mebeverine, using search terms such as mebeverine, clinical trials, and IBS. Eight randomized trials met our criteria, including six trials that compared mebeverine with placebo and two that compared mebeverine tablets with capsules. These eight trials included 555 patients randomized to receive either mebeverine or placebo with 352 (63%) women and 203 (37%) men in all subtypes of IBS. The pooled relative risk (RR) for clinical improvement of mebeverine was 1.13 (95% CI: 0.59-2.16, P = 0.7056) and 1.33 (95% CI: 0.92-1.93, P = 0.129) for relief of abdominal pain. The efficacy of mebeverine 200 mg compared to mebeverine 135 mg indicated RRs of 1.12 (95% CI: 0.96-1.3, P = 0.168) for clinical or global improvement and 1.08 (95% CI: 0.87-1.34, P = 0.463) for relief of abdominal pain. Thus, mebeverine is mostly well tolerated with no significant adverse effects; however, its efficacy in global improvement of IBS is not statistically significant.

Effect of hydrogenated, liquid and ghee oils on serum lipids profile

BACKGROUND

Trans fatty acids are known as the most harmful type of dietary fats, so this study was done to compare the effects of hydrogenated, liquid and ghee oils on serum lipids profile of healthy adults.

METHODS

This study was a randomized clinical trial conducted on 129 healthy participants aged from 20 to 60 years old who were beneficiaries of Imam-e-Zaman charitable organization. Subjects were randomly divided into 3 groups and each group was treated with a diet containing cooking and frying liquid, ghee, or hydrogenated for 40 days. Fasting serum lipids, including total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), apoprotein A (Apo A), and apoprotein B (Apo B) were measured before and after the study.

RESULTS

TC, TG and Apo B had a significant reduction in the liquid oil group compared to the hydrogenated oil group. In the ghee group TG declined and Apo A increased significantly (P < 0.01). Liquid oil group had a significant reduction in HDL-C, compared to the ghee oil group (P < 0.05).

CONCLUSION

It was concluded that consuming liquid oil along with frying oil caused to reduce all serum lipid levels. However, ghee oil only reduced TG and increased HDL-C levels.

Effective Strategies for Maintaining Research Participation in Clinical Trials

Achieving high protocol adherence is essential for ensuring the overall success and scientific merit of clinical trials. Strategies for maximizing recruitment and treatment adherence have been previously explored in the literature. There has been less focus, however, on effective methods for maintaining participants in research follow-up. This article examines factors associated with poor follow-up rates as well as strategies for facilitating research commitment and addressing sources of nonadherence. Special attention is devoted to alcohol- and substance-dependent populations, groups known to have poor adherence rates. Examples are drawn from the COMBINE Study, an NIAAA-funded, nationwide, multisite, combined behavioral and pharmacotherapy trial for alcohol problems that achieved high one-year follow-up rates. The important role of coordinating centers in facilitating research retention is also discussed.

Safety and efficacy of terbinafine in a pediatric Iranian cohort of patients with Tinea capitis

BACKGROUND AND OBJECTIVES

Tinea capitis is a common infection of the scalp and hair shaft caused by dermatophyte fungi that mainly affects prepubescent children. Systemic therapy is required for treatment and to prevent spread. The aim of present study was to assess the effect of terbinafine for Tinea capitis treatment in children.

METHODS

Thirty Iranian pediatric patients with a clinical diagnosis of Tinea capitis were enrolled in the study. The Study was conducted in a general and referral teaching hospital (Imam Medical Centre - Tehran, Iran) from 2006 to 2007. Eligible patients with less than 20 kg of body weight were given 62.5 mg terbinafine, and for patients between 20 and 40 kg the dose was 125 mg, on the first visit. All patients had the second clinical visit and second samples for microscopic study were taken. For each patient, direct mycology test (KOH test) and mycological culture were carried out before the study was started and after second, fourth, fifth, sixth and eighth weeks. Probable drug's adverse effects were also recorded.

RESULTS

Based on the results of mycological culture of patients' lesions, Microsporum canis and Trichophyton sheonlini were considered as major causes of Tinea capitis in these children. Out of 30 study patients, KOH test of 93% in the 5th week and 100% in the 6th week was negative. All patients healed completely from signs of infection, after six weeks. Also, no severe side effects were seen in any patients.

CONCLUSION

According to the results of this study, the use of terbinafine is an effective therapy in Iranian cases of Tinea capitis in children without severe side effects.

Effects of AIF on Knee Osteoarthritis Patients: Double-blind, Randomized Placebo-controlled Study

Anti-inflammatory factor (AIF) is a water soluble extract of three herbs, Panax notoginseng (Burk.) F. H. Chen, Rehmannia glutinosa Libosch and Eleutherococcus senticosus. The present study aimed to investigate the safety and efficacy of herb extracts, AIF, on Korean knee osteoarthritis patients for six weeks. Fifty seven patients with knee osteoarthritis, ranging from 43 to 73 years of age, who fulfilled the "American College of Rheumatology" (ACR) classification of idiopathic osteoarthritis of knee and radiographic criteria were randomly selected and enrolled for the study. After initial screening and resting period, two capsules each of AIF (Each capsule contains; 400 mg) and similar identical placebo were administered twice a day to both groups. Pain intensity at second, fourth, and sixth weeks of study as well as one week after discontinuation of drugs was assessed by using 100 mm visual analogue scale (VAS). Changes in the Korean version of the Western Ontario and McMaster Universities (K-WOMAC) index score were compared at the initiation and completion of the study. VAS assessed by patients were significantly reduced (at visit 2; 54.64+/-14.72, at visit 4, 37.32+/-16.58, p< 0.001) after AIF administration. Results showed an improvement in the physical function of K-WOMAC scale which was significantly higher (p=0.013) in AIF than placebo group, and decreases of total K-WOMAC score were also significantly higher (p=0.030) in AIF groups than placebo group. No serious adverse effect was observed, and there was no difference in incidence of adverse effect between AIF and placebo groups. In this population of Korean patients with knee osteoarthritis, AIF was found to be safe, tolerable and effective for symptomatic improvement of pain and physical function.

Gynecologic oncology group trials in uterine corpus malignancies: recent progress

The Gynecologic Oncology Group (GOG) has conducted multiple trials related to malignancies of the uterine corpus. Recently, several of these trials have been presented and/or published. Areas of focus included the feasibility of laparoscopic staging for endometrial cancer, the adjuvant management of locally advanced endometrial cancer, whole abdominal irradiation in maximally resected advanced endometrial carcinoma, and combination chemotherapy regimens for stage I and II carcinosarcoma after primary surgery and for advanced or recurrent carcinosarcoma. This article will discuss the background and details of each of these important advances.

Systemic 7-methylxanthine in retarding axial eye growth and myopia progression: a 36-month pilot study

The adenosine antagonist 7-methylxanthine (7-mx) works against myopia in animal models. In a clinical trial, 68 myopic children (mean age 11.3 years) received either placebo or 7-mx tablets for 12 months. All participants subsequently received 7-mx for another 12 months, after which treatment was stopped. Axial length was measured with Zeiss IOL-Master and cycloplegic refraction with Nikon Retinomax at -6, 0, 12, 24, and 36 months. Axial growth was reduced among children treated with 7-mx for 24 months compared with those only treated for the last 12 months. Myopia progression and axial eye growth slowed down in periods with 7-mx treatment, but when the treatment was stopped, both myopia progression and axial eye growth continued with invariable speed. The results indicate that 7-mx reduces eye elongation and myopia progression in childhood myopia. The treatment is safe and without side effects and may be continued until 18-20 years of age when myopia progression normally stops.

Present status and future direction of clinical trials in advanced endometrial carcinoma

Endometrial adenocarcinoma is staged surgically, and advanced endometrial carcinoma is considered to be FIGO stage III and IV. The Gynecologic Oncology Group (GOG) has come a long way in developing new strategies in the management of advanced endometrial carcinoma. Combining surgery, radiation, and chemotherapy, the 5-year survival has improved to between 40-60% in newly diagnosed advanced endometrial carcinoma. Recent findings in GOG184 indicate that multiple risk factors noted at the time of surgical staging could lead to concurrent clinical trials that could be completed expeditiously rather than a subsequent ten year long phase III trial including all the various risk subgroups of patients. This review is a focus on the accomplishments of the GOG in advanced endometrial carcinoma with an emphasis on future challenges.

Safety and efficacy of oral HD-03/ES given for six months in patients with chronic hepatitis B virus infection

AIM: To investigate the safety and efficacy of the formulation HD-03/ES capsules in the management of patients with chronic hepatitis B infection.

METHODS: A total of 25 patients were recruited to the study and were given HD-03/ES, two capsules twice daily for six months. Clinical assessment of symptoms and signs were done using the “clinical observation table” once a month before and after the treatment. Biochemical investigations of total bilirubin, ALT, AST, serum protein for liver function tests were done every month after initiating treatment. Serum was analyzed for HBV markers for HBsAg, HBeAg and HBV DNA at baseline, 4 and 6 mo after therapy using ELISA kits from Roche.

RESULTS: After 6 mo of therapy with HD-03/ES, a significant reduction of ALT values from 66.5 ± 11.1 to 39.1 ± 5.2 (P < 0.01) and a significant HBsAg loss (52%, P < 0.001), HBeAg loss (60%, P < 0.05) and HBV DNA loss (60%, P < 0.05) was observed. Adverse effects were mild and never warranted withdrawal of the drug.

CONCLUSION: The results of this pilot study indicate that HD-03/ES might be a safe and effective treatment for chronic hepatitis B infection and a long-term multicentric comparator trial is warranted and under way.