Pain and salivary biomarkers of stress in temperomandibular disorders were affected by maxillary splints

BACKGROUND

Longitudinal intervention studies on treatment options in temporomandibular dysfunction (TMD) including self reports and salivary biomarkers of stress are rare and the exact therapeutic function of occlusal splints widely unknown.

METHODS

We examined the therapeutic effects of a Michigan splint with occlusal relevance in patients with TMD using a placebo-controlled, delayed-start design. Two intervention groups received a Michigan splint, while one of them had a placebo palatine splint for the first 3 weeks. We collected pain intensities (at rest and after five occlusal movements), salivary measures associated with stress (cortisol and alpha-amylase) and self-reported psychological distress (stress, anxiety, catastrophizing) at baseline and 3 and 7 weeks after onset of intervention.

RESULTS

At baseline, we observed increased pain intensity and psychological distress in TMD patients compared to 11 matched healthy controls. Baseline anxiety was linked to movement pain intensity through stress. Over therapy reductions in pain intensity and morning cortisol were more pronounced in those patients starting immediately with the Michigan splint, while psychological distress decreased similarly in both groups.

CONCLUSION

Our results suggest that perceived stress plays a role for the association between anxiety and TMD pain and underlines the need for an interdisciplinary perspective on the pathogenesis and therapy of TMD in a setting where psychotherapeutic knowledge is still scarce or rarely applied.

Physiological data for affective computing in HRI with anthropomorphic service robots: the AFFECT-HRI data set

In human-human and human-robot interaction, the counterpart influences the human's affective state. Contrary to humans, robots inherently cannot respond empathically, meaning non-beneficial affective reactions cannot be mitigated. Thus, to create a responsible and empathetic human-robot interaction (HRI), involving anthropomorphic service robots, the effect of robot behavior on human affect in HRI must be understood. To contribute to this understanding, we provide the new comprehensive data set AFFECT-HRI, including, for the first time, physiological data labeled with human affect (i.e., emotions and mood) gathered from a conducted HRI study. Within the study, 146 participants interacted with an anthropomorphic service robot in a realistic and complex retail scenario. The participants' questionnaire ratings regarding affect, demographics, and socio-technical ratings are provided in the data set. Five different conditions (i.e., neutral, transparency, liability, moral, and immoral) were considered during the study, eliciting different affective reactions and allowing interdisciplinary investigations (e.g., computer science, law, and psychology). Each condition includes three scenes: a consultation regarding products, a request for sensitive personal information, and a handover.

Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration

Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.

Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour

Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.

Barriers and facilitators to the adoption of physical activity policies in elementary schools from the perspective of principals: An application of the consolidated framework for implementation research-A cross-sectional study

Background

Studies have shown that policies to promote physical activity in schools can have a positive impact on children's physical activity behavior. However, a large research gap exists as to what determinants may influence the adoption of such policies. Applying the Consolidated Framework for Implementation Research (CFIR), we investigated barriers and facilitators to the adoption of physical activity policies in elementary schools in Baden-Wuerttemberg, Germany, from the perspective of school principals.

Methods

A cross-sectional study was conducted between May and June 2021. School principals from elementary and special needs schools (n = 2,838) were invited to participate in the study. The online questionnaire used was developed based on the CFIR and included questions on school characteristics and constructs of the CFIR domains inner setting, characteristics of individuals, and process. Logistic regression analyses were performed to examine associations between policy adoption and school characteristics as well as CFIR determinants.

Results

In total, 121 schools (4%) participated in the survey, of which 49 (40.5%) reported having adopted a policy to promote physical activity. Positive associations with policy adoption were found for general willingness among teaching staff [odds ratio (OR): 5.37, 95% confidence interval (CI): 1.92-15.05], available resources (OR: 2.15, 95% CI: 1.18-3.91), access to knowledge and information (OR: 2.11, 95% CI: 1.09-4.09), and stakeholder engagement (OR: 3.47, 95% CI: 1.24-9.75).

Conclusions

This study provides a first insight into potential barriers and facilitators at the organizational level of schools that may be relevant to the adoption of physical activity policies, from the perspective of school principals. However, due to a low response rate, the results must be interpreted with caution. A strength of this study includes theoretical foundation through the use of the CFIR. The CFIR could be well-adapted to the school setting and provided valuable support for developing the questionnaire and interpreting the study results.

Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes

BACKGROUND

Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents.

METHODS

A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science).

RESULTS

Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability.

CONCLUSION

Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.

Sustainable Urban Mobility Plans: implementation process and indicators to evaluate effects on physical activity

BACKGROUND

Active mobility and public transport increase physical activity (PA) levels. With varying intensity and effectiveness, European cities implement Sustainable Urban Mobility Plans (SUMPs) to spur transport-related PA. Therefore, we aim to examine drivers and barriers to SUMP implementation and assess its influence on PA across European cities.

METHODS

We screened policy reports to gain insights into SUMP implementation in one Danish, two German and two Polish cities. Further, we conducted semi-structured interviews with SUMP stakeholders in these cities to explore their experiences with SUMP implementation. Thematic analysis of interview transcripts was applied to identify similarities and differences across cities. To assess the effect of SUMP implementation on PA, we searched for data on indicators of transport-related PA.

RESULTS

All investigated cities are committed to sustainable mobility. Nonetheless, complex institutional structures, the dominant role of motorized traffic as well as complex regional and local policy integration hamper SUMP implementation. Danish, German and Polish cities face different contexts in terms of financing, national guidelines and the prominence of sustainability as a policy objective. Each city adopts unique indicators for monitoring the effects of SUMPs on transport-related PA. The variety of indicators and limited data availability impede a comparative evaluation across cities. Constrained by this restriction, we identified motorization rate, modal split and public transport ridership as suitable indicators.

CONCLUSIONS

Local idiosyncrasies need to be accounted for when assessing the implementation of SUMPs. Nonetheless, consistent indicators and data transparency are essential for comparing the effectiveness of SUMPs and their impact on PA.

What we know about the actual implementation process of public physical activity policies: results from a scoping review

BACKGROUND

Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix).

METHODS

A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included.

RESULTS

The current evidence includes high-income countries (USA, n = 7; UK, New Zealand and Oman, n = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n = 4), state (n = 1), county (n = 1), school district (n = 1) and city (n = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors.

CONCLUSION

Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour.

Pro-inflammatory and (Epi-)genetic markers in saliva for disease risk in childhood obesity

BACKGROUND AND AIM

Childhood obesity is an emerging problem often leading to earlier onset of non-communicable diseases in later life. Biomarkers to identify individual risk scores are insufficient in routine clinical practice, which is related to the need for easily sampled, non-invasive survey methods in children. We aimed to investigate and strengthen possible pro-inflammatory markers and epigenetic risk factors in saliva of obese children compared to lean controls.

METHODS AND RESULTS

19 overweight/obese (OC, 10.1 ± 1.9 years, BMI 27.7 ± 3.2 kg/m²) and 19 lean control children (CC, 9.7 ± 2.5 years, BMI 16.4 ± 1.8 kg/m²) participated in this explorative pilot study. Anthropometric measures, saliva and cheek swab samples were taken. Saliva profiles were examined for acute phase proteins (CRP and neopterin) and pro-inflammatory cytokines (IL-17a/IL-1β/IL-6). Cheek swabs were analyzed to investigate DNA methylation differences with subsequent hierarchical cluster and principal component analyses (PCA). Saliva analysis showed significant increased CRP concentrations in OC compared to CC (p < 0.001). There were no significant differences, but high intra-individual values in neopterin, IL-17a, IL-1β and IL-6. An unsupervised PCA of CpG loci with high variance (σ/σ_max > 0.2) clearly separated OC and CC according to their methylation pattern. Furthermore, a supervised approach revealed 7125 significantly differentially methylated loci, whose corresponding genes were significantly enriched for genes playing roles in e.g., cellular signalling, cytoskeleton organization and cell motility.

CONCLUSIONS

CRP and methylation status determinations in saliva are suitable as non-invasive methods for early detection of risks for non-communicable diseases in children/adolescents and might be a useful supplementary approach in the routine clinical practice/monitoring.

Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity

Background

This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle.

Methods

Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias.

Results

Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%).

Conclusions

These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13340-4.

Sugar-sweetened beverage tax implementation processes: results of a scoping review

Taxing sugar-sweetened beverages (SSB) is seen as a win–win situation for governments. It is argued that SSB taxes are relatively easy to implement from a practical perspective compared to for example other nutrition policies. However, the implementation of SSB taxation laws does not happen by itself. Therefore, this work examines implementation processes for SSB taxation in terms of (1) pre-implementation context, (2) taxation instruments used and (3) interactions in the implementation process. Ten databases and grey literature were systematically searched for studies reporting on SSB taxation implementation processes up to February 2020. All studies (N = 1248) were screened independently by two reviewers according to predefined criteria. The selection of variables to be extracted was based on the policy cycle heuristic and informed by intervention implementation research. Information on the process of implementing SSB taxation is limited. Only six cases based on three publications were identified, indicating a gap in this research area. SSB taxation implementation was accomplished by hiring a subcontractor for the implementation or using pre-existing tax collection structures. Political and public support within the implementation process seems to be supportive for the city of Berkeley and for Portugal but was not reported for the Pacific Islands. However, the existing data are very limited, and further research on SSB taxation implementation processes is needed to determine whether the aim of the policy and the envisaged outcome are linked in practice.

Registration The protocol was registered with the Open Science Framework (OSF) (osf.io/7w84q/)

Frameworks for implementation of policies promoting healthy nutrition and physically active lifestyle: systematic review

Background

Policy frameworks focusing on policy implementation may vary in terms of their scope, included constructs, relationships between the constructs, and context factors. Although multiple policy implementation frameworks exist, the overarching synthesis characterizing differences between the frameworks is missing. This study investigated frameworks guiding implementation of policies aiming at healthy nutrition, physical activity promotion, and a reduction of sedentary behavior. In particular, we aimed at examining the scope of the frameworks and the content of included constructs (e.g., referring to implementation processes, determinants, or implementation evaluation), the level at which these constructs operate (e.g., the individual level, the organizational/community level), relationships between the constructs, and the inclusion of equity factors.

Methods

A systematic review (the PROSPERO registration no. CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analyzed.

Results

Across the frameworks, 47.4% (18 in 38) addressed three aims: description of the process, determinants, and the evaluation of implementation. The majority of frameworks (65.8%; 25 in 38) accounted for constructs from three levels: individual, organizational/community, and the system level. System-level constructs were included less often (76.3%; 29 in 38) than individual-level or organizational/community-level constructs (86.8% [33 in 38 frameworks] and 94.7% [36 in 38 frameworks] respectively). The majority of frameworks (84.2%, 32 in 38) included at least some sections that were solely of descriptive character (a list of unassociated constructs); 50.0% (19 in 38) included sections of prescriptive character (general steps of implementation); 60.5% (23 in 38) accounted for explanatory sections (assuming bi- or uni-directorial associations). The complex system approach was accounted for only in 21.1% (8 in 38) of frameworks. More than half (55.3%; 21 in 38) of frameworks did not account for any equity constructs (e.g., socioeconomic status, culture).

Conclusions

The majority of policy implementation frameworks have two or three aims (combining processes, determinants and/or the evaluation of implementation), include multi-level constructs (although the system-level determinants are less frequently included than those from the individual- or organizational/community-level), combine sections of purely descriptive character with sections accounting for prescriptive and/or explanatory associations, and are likely to include a little or no equity constructs.

Registration

PROSPERO, #CRD42019133251.

Barriers and facilitators to implementation of direct fruit and vegetables provision interventions in kindergartens and schools: a qualitative systematic review applying the consolidated framework for implementation research (CFIR)

BACKGROUND

Although children's intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR).

METHODS

A systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR.

RESULTS

The following CFIR constructs were found relevant: 1) intervention characteristics domain: 'design quality and packaging', 'adaptability' 'cost'; 2) outer setting: 'cosmopolitanism', 'external policy and incentives' 'patients' needs and resources'; 3) inner setting: 'implementation climate', 'readiness for implementation' and 'structural characteristics'; 4) characteristics of individuals: 'individual stage of change', 'knowledge and beliefs about the intervention' 5) process: 'engaging', 'executing' and 'reflecting and evaluating'. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts.

CONCLUSIONS

CFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group.

PROSPERO REGISTRATION

CRD42020167697.

Meta-review of implementation determinants for policies promoting healthy diet and physically active lifestyle: application of the Consolidated Framework for Implementation Research

BACKGROUND

Although multiple systematic reviews indicate that various determinants (barriers and facilitators) occur in the implementation processes of policies promoting healthy diet, physical activity (PA), and sedentary behavior (SB) reduction, the overarching synthesis of such reviews is missing. Applying the Consolidated Framework for Implementation Research (CFIR), this meta-review aims to (1) identify determinants that were systematically indicated as occurring during the implementation processes and (2) identify differences in the presence of determinants across reviews versus stakeholder documents on healthy diet/PA/SB policies, reviews/stakeholder documents addressing healthy diet policies versus PA/SB policies targeting any population/setting, and healthy diet/PA/SB policies focusing on school settings.

METHODS

A meta-review of published systematic scoping or realist reviews (k = 25) and stakeholder documents (k = 17) was conducted. Data from nine bibliographic databases and documentation of nine major stakeholders were systematically searched. Included reviews (72%) and stakeholder documents (100%) provided qualitative synthesis of original research on implementation determinants of policies promoting healthy diet or PA or SB reduction, and 28% of reviews provided some quantitative synthesis. Determinants were considered strongly supported if they were indicated by ≥ 60.0% of included reviews/stakeholder documents.

RESULTS

Across the 26 CFIR-based implementation determinants, seven were supported by 66.7-76.2% of reviews/stakeholder documents. These determinants were cost, networking with other organizations/communities, external policies, structural characteristics of the setting, implementation climate, readiness for implementation, and knowledge/beliefs of involved individuals. Most frequently, published reviews provided support for inner setting and individual determinants, whereas stakeholder documents supported outer and inner setting implementation determinants. Comparisons between policies promoting healthy diet with PA/SB policies revealed shared support for only three implementation determinants: cost, implementation climate, and knowledge/beliefs. In the case of healthy diet/PA/SB policies targeting school settings, 14 out of 26 implementation determinants were strongly supported.

CONCLUSIONS

The strongly supported (i.e., systematically indicated) determinants may guide policymakers and researchers who need to prioritize potential implementation determinants when planning and monitoring the implementation of respective policies. Future research should quantitatively assess the importance or role of determinants and test investigate associations between determinants and progress of implementation processes.

TRIAL REGISTRATION

PROSPERO, # CRD42019133341.

Effects of nutritional intervention strategies in the primary prevention of overweight and obesity in school settings: systematic review and network meta-analysis

Objective

To examine the effects of different nutritional intervention strategies in the school setting on anthropometric and quality of diet outcomes by comparing and ranking outcomes in a network meta-analysis.

Design

Systematic review and network meta-analysis.

Data sources

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Education Resources Information Centre (ERIC), PsycInfo, CAB Abstracts, Campbell Library, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) BiblioMap, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice (JBI EBP) database, Practice-based Evidence in Nutrition (PEN) database, ClinicalTrials.gov, Current Controlled Trials, and World Health Organization International Clinical Trials Registry Platform.

Eligibility criteria for selecting studies

A systematic literature search was performed from inception to 2 May 2022. Cluster randomised controlled trials meeting these study criteria were included: generally healthy school students aged 4-18 years; intervention with ≥1 nutritional components in a school setting; and studies that assessed anthropometric measures (eg, body mass index, body fat) or measures related to the quality of diet (eg, intake of fruit and vegetables), or both. Random effects pairwise meta-analyses and network meta-analyses were performed with a frequentist approach. P scores, a frequentist analogue to surface under the cumulative ranking curve, ranging from 0 to 1 (indicating worst and best ranked interventions, respectively) were calculated. Risk of bias was assessed with Cochrane's RoB 2 tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to rate the certainty of evidence.

Results

51 cluster randomised controlled trials involving 75 954 participants and seven intervention nodes were included. Inconsistency could not be assessed (except for intake of fruit and vegetables) because the network meta-analyses were based mainly on star shaped networks with no direct evidence for specific pairs of nutritional interventions. Overall, little or no evidence was found to support a difference in body mass index, body weight, body fat, or waist circumference and moderate improvements in intake of fruit and vegetables with nutritional interventions in a school setting. Low to moderate certainty of evidence further suggested that multicomponent nutritional interventions likely reduced the prevalence (odds ratio 0.66, 95% confidence interval 0.55 to 0.80) and incidence (0.67, 0.47 to 0.96) of overweight compared with a control group. Based on low certainty of evidence, nutrition education and multicomponent interventions may be more effective than a control group (ie, usual practice) for increasing intake of fruit and vegetables. Multicomponent nutritional interventions were ranked the most effective for reducing body mass index (P score 0.76) and intake of fat (0.82). Nutrition education was ranked as best for body mass index z score (0.99), intake of fruit and vegetables (0.82), intake of fruit (0.92), and intake of vegetables (0.88).

Conclusions

The findings suggest that nutritional interventions in school settings may improve anthropometric and quality of diet measures, potentially contributing to the prevention of overweight and obesity in childhood and adolescence. The findings should be interpreted with caution because the certainty of evidence was often rated as low. The results of the network meta-analysis could be used by policy makers in developing and implementing effective, evidence based nutritional intervention strategies in the school setting.

Systematic review registration

PROSPERO CRD42020220451.

Comparative efficacy of fibrinolytics and glycoprotein IIb/IIIa inhibitors in preventing coronary no-reflow: a network meta-analysis

Background

Coronary no-reflow is a potentially lethal complication of percutaneous coronary intervention (PCI). The optimal approach to preserve coronary reflow during primary PCI is still controversial.

Purpose

Therefore, we aimed to compare and rank the adjunctive use of fibrinolytic agents and glycoprotein IIb/IIIa inhibitors by network meta-analysis of randomized controlled trials.

Methods

Pairwise and network meta-analysis were performed using the random-effects model within a frequentist framework. The primary outcome was coronary TIMI flow grade immediately following the intervention.

Results

82 studies with a total of 20666 participants were identified, including 7 multi-arm studies. This enabled 94 pairwise comparisons of 35 different adjunctive anticoagulant regimens, all administered in the context of primary PCI. Overall, risk of bias in these studies was rated moderate, and heterogeneity was low with a global I2 value of 20.8%. The figure shows the ranking of the interventions in relation to no adjunctive treatment (NON) and placebo (PLA). In particular, Tirofiban (TIR) alone or in combination with Adenosin (ADE) Nicorandil (NIC) was effective in preventing coronary no-reflow. The route of its administration, intravenous (IV) vs intracoronary (IC), did not matter much. However, its timing as an early IV injection upstream of primary PCI was not beneficial. Eptifibatide (EPT) given as IC bolus followed by continuous IV infusion had an effect comparable to TIR, as well as, among the fibrinolytics, Pamiteplase (PAM) given IV and Urokinase (URO) given IC.

Conclusions

This comprehensive comparison of fibrinolytics and glycoprotein IIb/IIIa inhibitors demonstrates that TIR, EPT, PAM, and URO can effectively and equally prevent coronary no-reflow in primary PCI.

Funding Acknowledgement

Type of funding sources: None.

Does objectively measured light-intensity physical activity reduce the risk of cardiovascular mortality? A meta-analysis

AIMS

Current physical activity guidelines emphasize little on light-intensity physical activity (LPA) in terms of reducing the risk of cardiovascular mortality. This meta-analysis aimed to bridge this gap by assessing their association using objectively measured LPA data.

METHODS AND RESULTS

Databases of PubMed and Scopus were searched to April 2020 for prospective cohort studies that reported the association of LPA assessed by activity monitors with the risk of cardiovascular mortality in the general population. Multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Dose-response and subgroup analyses were also performed. Six cohort studies with seven datasets enrolling 13 960 participants were included. LPA was all measured by accelerometers. The HR of LPA per 30 min/day for cardiovascular mortality was pooled to be 0.80 (95% CI 0.67-0.96). This association was non-linearly shaped (Pnonlinearity < 0.01) and unaffected by sex difference. Moreover, substituting LPA for sedentary time of 30 min/day lowered the risk of cardiovascular mortality by 16% (95% CI 0.73-0.96). Results showed further that LPA was inferior to moderate-to-vigorous physical activity in reducing the risk of cardiovascular mortality when performed with an equal time-length set at 30 min/day (HR 0.83 vs. 0.54, Pcomparison = 0.046), but became comparable if at an equal activity-amount set at 150 metabolic equivalents-min/day (HR 0.67 vs. 0.54, Pcomparison = 0.41).

CONCLUSION

LPA shows potential in reducing the risk of cardiovascular mortality, and interventions targeting at LPA improvement are worth being encouraged.

Policy implementation evaluation: a stakeholder-centred approach

Work Package 4, Policy Evaluation Network, JPI “A Healthy Diet for a Healthy Life”, Germany

Objectively-Measured Light-Intensity Physical Activity and Risk of Cancer Mortality: A Meta-analysis of Prospective Cohort Studies

BACKGROUND

The impact of light-intensity physical activity (LPA) in preventing cancer mortality has been questioned. To address this concern, the present meta-analysis aimed to quantify the association between objectively-measured LPA and risk of cancer mortality.

METHODS

We conducted a systematic literature search in PubMed and Scopus to January 2020. Prospective cohort studies reporting the association between objectively-measured LPA using activity monitors (e.g., accelerometers) and risk of cancer mortality in the general population were included. The summary hazard ratios (HR) per 30 min/day of LPA and 95% confidence intervals (CI) were obtained using a random-effects model. Dose-response analysis was used to plot their relationship.

RESULTS

Five prospective cohort studies were included, in which the definition of LPA based on accelerometer readings was mainly set within 100 to 2,100 counts/min. The summary HR for cancer mortality per 30 min/day of LPA was 0.86 (95% CI, 0.79-0.95; I ² < 1%), and the association between LPA and risk reduction in cancer mortality was linearly shaped (P _nonlinearity = 0.72). LPA exhibited a comparable magnitude of risk reduction in cancer mortality of moderate-to-vigorous physical activity regardless of equal time-length (0.87 per 30 min/day vs. 0.94 per 30 min/day, P _interaction = 0.46) or equal amount (0.74 vs. 0.94 per 150 metabolic equivalents-min/day, P _interaction = 0.11). Furthermore, replacing sedentary time by LPA of 30 min/day decreased the risk of cancer mortality by 9%.

CONCLUSIONS

Objectively-measured LPA conferred benefits in decreasing the risk of cancer mortality.

IMPACT

LPA should be considered in physical activity guidelines to decrease the risk of cancer mortality.

P332Comparative efficacy of intracoronary agents for acute treatment of coronary no-reflow: a network meta-analysis

Background

Coronary no-reflow is a potentially lethal complication of percutaneous coronary intervention (PCI). There is a growing body of evidence on how to best prevent this condition by the proper stenting technique and other mechanical measures or adjunctive drug treatments. However, it is still controversial how to tackle coronary no-reflow when it occurs.

Purpose

We aimed to compare and rank intracoronary agents for acute treatment of coronary no-reflow by considering both indirect and direct evidence from the literature in a network meta-analysis.

Methods

We searched the databases PubMed, Embase and Central for randomised controlled trials of the acute treatment of coronary no-reflow following primary PCI in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI. Trials with patients suffering from stable angina and/or receiving elective PCI, observational study design and no measure of coronary flow were excluded. Two blinded reviewers independently collected studies, assessed risk of bias with the Cochrane risk of bias tool and extracted data. The primary outcome was a measure of coronary flow immediately following the intervention (TIMI flow grade, TIMI frame count or myocardial bush grade), secondary outcome were major adverse cardiovascular events during follow-up. Pairwise and network meta-analysis were performed using the random-effects model within a frequentist framework.

Results

8 studies with a total of 540 participants were identified, including 4 multi-arm studies. This enabled 19 pairwise comparisons of 12 different treatments, all administered via intracoronary route (ADE=adenosine, DIL=diltiazem, DIP=dipyridamole, NIT= nitroglycerin, NPR=nitroprusside, PLA=placebo, TIR=tirofiban, U+V=urokinase combined with verapamil, URA=urapidil, URO=urokinase, VER=verapamil X+T= Xuesaitong combined with tirofiban). Overall, risk of bias in these studies was rated moderate. For graphical representation of the network for the primary outcome, see left panel of the figure. It exhibited a low level of inconsistency and heterogeneity with a global I2 value of 20.9%. Among the different treatments, URA, X+T, and TIR were more effective in re-establishing coronary flow with the caveat that the results of URA depended on one singular trail with a large variance, see right panel of the figure. NIT was even slightly worse than placebo in the primary outcome, the other agents were equivalent with placebo. In terms of major cardiovascular events during follow-up, TIR exhibited a protective effect compared with placebo at borderline statistical significance (OR 0.3843 [95% CI 0.1488; 0.9923]. For URA, data on secondary outcome were not available.

Conclusions

Urapidil and Tirofiban are potentially effective candidate drugs for larger randomised controlled trials, which are needed to validate the sparse evidence that is available to date on the acute treatment of coronary no-reflow.

[Sex survey research in Germany and Europe : Liebesleben (LoveLives): A pilot study into the sexual experiences, attitudes and relationships of adults in Germany]

At the Hamburg Institute for Sex Research in Germany, a nationwide study is currently being carried out into the sexual experiences, attitudes and relationships of adults (18-75 years). The main focus of this pilot study is to test the comprehensibility and length of a data collecting instrument as well as the comparison of two data collecting methods with regard to reliability and representativeness of the results as well as of the refusal rate. To this end face-to-face interviews (n = 500) and questionnaires sent by post (n = 500) are to be compared with each other as methods. The data to be collected relates to sexuality, particularly the prevention of HIV and other sexually transmitted infections (STIs). The WHO definition of sexual health forms the basis for the study and thus connects up with the existing sex survey research in Europe and western industrial nations. Comparable surveys have been conducted over the past ten years in more than 30 European countries using a variety of methods. The focus of the study is placed upon the increase that has been observed for several years now in certain STIs. The article provides an overview of existing sex survey research in Europe. It becomes clear that the studies conducted so far are very heterogeneous with regard to chosen method, sampling techniques and the choice of content focus, so that no suitable data for cross-national comparability are currently available.

Young age at school entry and attention-deficit hyperactivity disorder-related symptoms during primary school: results of a prospective cohort study conducted at German Rudolf Steiner Schools

OBJECTIVES

Young age at school entry (ASE) for students has been related to their impaired mental health in higher grades. To avoid the negative health consequences of young ASE, preschool examinations and individual school entry deferral for young children are routinely performed by some school authorities. We aimed to investigate whether ASE was associated with attention-deficit hyperactivity disorder (ADHD)-related symptoms in pupils attending schools using a selective school enrolment procedure.

DESIGN

Prospective open cohort study with baseline assessments at school entry and two follow-ups in the second and fourth grades.

SETTING

Up to 128 Rudolf Steiner Schools (Waldorf Schools) located within Germany.

PARTICIPANTS

Of the 3079 children from whom data were gathered in the second or fourth grade, 2671 children born between 1 July 2001 and 31 October 2002 (age at baseline: mean 6.7, min 5.91, max 7.24 years, 50% girls) were selected for analysis to avoid bias introduced by individuals at the edges of the ASE distribution.

MAIN OUTCOME MEASURES

ADHD-related symptoms were assessed at school entry and second and fourth grades by parent-reported and teacher-reported versions of the Strengths and Difficulties Questionnaire (Hyperactivity-Inattention Subscale).

RESULTS

The agreement between parent-reported and teacher-reported symptoms was poor (intra-class correlation: 0.41 and 0.44 in second and fourth grade assessments, respectively). Regarding teacher reports, ASE was negatively associated with ADHD-related symptoms in the second grade (regression coefficient β=-0.66 per year, P=0.0006) and fourth grade (β=-0.56, P=0.0014). Associations remained after adjusting for potential confounders and pre-existing symptoms at baseline. Regarding parent reports, associations were markedly weaker in both grades (second grade: β=-0.22, P=0.12; fourth grade: β=-0.09, P=0.48).

CONCLUSIONS

Using a prospective study design and comprehensive adjustment for confounding and baseline symptoms, we confirmed prior evidence of the association between young ASE and teacher-reported ADHD symptoms in primary school.

Characterization of patients at high risk of melanoma in Austria

BACKGROUND

Risk of melanoma is determined by genetic and exogenous factors. Only a few studies have included both characteristics in a comprehensive multivariable analysis.

OBJECTIVES

To find determinants of patients at high risk of melanoma in Austria, including phenotype, genotype and lifestyle characteristics in comprehensive analyses.

METHODS

In total, 1668 patients with melanoma from the M3 case-control study were studied. Overall, 567 participants were sequenced for CDKN2A, 232 for CDK4, 123 for MITF encoding the variant E318K and 964 for MC1R.

RESULTS

Patients with melanoma with a positive family history (n = 190, 11·6%), multiple primary melanomas (n = 261, 15·7%) and younger age (< 50 years, n = 675, 40·5%) were defined as being at high risk. All other patients with melanoma were defined as the reference group. We found significant differences between those two groups and between the high-risk subgroups (positive family history, multiple primary melanomas and younger age). Pigmentation phenotype was associated with the high-risk group in general (childhood freckling, odds ratio 1·46, P = 0·007; blond/reddish hair colour, odds ratio 1·43, P = 0·011). Patients with a positive family history and patients with early-onset disease were similar regarding both their phenotypic characteristics and external factors. Established high-risk mutations in CDKN2A were found in cases with a positive family history (n = 12) or multiple melanomas (n = 2). Moreover, we found three patients carrying the MITF p.E318K variant, two with a CDK4 variant and seven with nonsynonymous MC1R variants with undescribed biological significance, of which four were predicted as damaging.

CONCLUSIONS

Austrian patients could represent a reservoir for novel genetic variants. Further investigation of populations in Central and Eastern Europe might reveal more novel and disease-relevant variants.

Kernresonanzuntersuchung der Molekülrotation in festem Benzol: T1-Spektroskopie / Nuclear Magnetic Resonance Investigation of Molecular Rotation in Solid Benzene: T1-spectroscopy

We have extended Haeberlen’s and Maier’s NMR investigation of the molecular rotation in solid polycrystalline benzene (C6H6), performed in 1967 in the Larmor frequency range from 88 MHz to 22 MHz, to lower frequencies down to 4.4 MHz. In some cases monocrystalline samples were also studied. The extensive data show that the presently accepted model of purely uncorrected rotations of the benzene molecules around their sixfold axis has to be rejected. Instead, two results found, namely

- a slight increase of the rotational activation energy when approaching the melting point of benzene and

- the width of the T1 relaxation minima as a function of the reciprocal temperature suggest an additional relevance of correlated molecular motions, like e.g. the ‘gear-wheel mechanism’ first proposed by Cox. By appropriate modifications of Haeberlen’s theory, i.e. by assuming a rate equation with temperature dependent activation energy and by emphasizing the effect of simultaneous rotations of neighbouring rings compared with the purely statistical, uncorrelated case, we succeeded to describe the considered T1 measurements quantitatively.

Actinic damage on the back is significantly determined by MC1R variants and previous sun exposure compared with other body sites in a multivariate analysis

BACKGROUND

Only recently, site-dependent associations of actinic damage with melanoma were identified in our study population.

OBJECTIVES

To elucidate the diverse aetiologies for actinic damage at different body sites.

METHODS

We performed multivariate logistic regression analyses to identify independent risk factors for actinic damage on the face, hands and the back in 2112 participants of central European origin.

RESULTS

For actinic damage on the face, age was the only risk factor that remained consistently significant in a multivariate analysis, whereas actinic damage on the back was predominantly associated with number of sunburns, freckles in childhood, holiday weeks and male sex. Moreover, we identified a particular significance of MC1R variants and dorsal actinic skin damage.

CONCLUSIONS

The particular effect of MC1R variants and sun exposure during recreational time on dorsal actinic damage indicates that actinic damage on the back is more informative regarding susceptibility to sunlight and past sun exposure associated with melanoma risk.

Bak functionally complements for loss of Bax during p14ARF-induced mitochondrial apoptosis in human cancer cells

In contrast to the initial notion that the biological activity of p14(ARF) strictly depends on a functional mdm-2/p53 signaling axis, we recently demonstrated that p14(ARF) mediates apoptosis in a p53/Bax-independent manner. Here, we show that p14(ARF) induces breakdown of the mitochondrial membrane potential and cytochrome c release before triggering caspase-9- and caspase-3/7-like activities in p53/Bax-deficient DU145 prostate cancer cells expressing wild-type Bak. Re-expression of Bax in these cells failed to further enhance p14(ARF)-induced apoptosis, suggesting that p14(ARF)-induced apoptosis primarily depends on Bak but not Bax in these cells. To further define the role of Bak and Bax in p14(ARF)-induced mitochondrial apoptosis, we employed short interference RNA for the knockdown of bak in isogeneic, p53 wild-type HCT116 colon cancer cells either proficient or deficient for Bax. There, combined loss of Bax and Bak attenuated p14(ARF)-induced apoptosis whereas single loss of Bax or Bak was only marginally effective, as in the case of DU145. Notably, HCT116 cells deficient for Bax and Bak failed to release cytochrome c and showed attenuated activation of caspase-9 (LEHDase) and caspase-3/caspase-7 (DEVDase) upon p14(ARF) expression. These data indicate that p14(ARF) triggers apoptosis via a Bax/Bak-dependent pathway in p53-proficient HCT116, whereas Bax is dispensable in p53-deficient DU145 cells. Nevertheless, a substantial proportion of p14(ARF)-induced cell death proceeds in a Bax/Bak-independent manner. This is also the case for inhibition of clonogenic growth that occurs, at least in part, through an entirely Bax/Bak-independent mechanism.

Induction of p21CIP/WAF-1 and G2 arrest by ionizing irradiation impedes caspase-3-mediated apoptosis in human carcinoma cells

There is an ongoing controversy regarding the relevance of apoptosis induction by ionizing irradiation as compared with other end points including transient or permanent cell cycle arrest of damaged cells. Here, we show that such permanent cell cycle arrest and apoptosis represent two sides of the same coin. MCF-7 cells fail to express procaspase-3, which results in resistance to apoptosis induced by anticancer drugs. Conversely, restoration of procaspase-3 sensitizes MCF-7 cells to chemotherapeutics including epirubicine, etoposide and taxol. In contrast, irradiation does not trigger apoptotic cell death but results in prolonged arrest in the G2 phase of the cell division cycle regardless of procaspase-3 expression. This suggested that the propensity of MCF-7 cells to arrest at the G2 checkpoint results in resistance to apoptosis upon gamma-irradiation. This G2 arrest was associated with upregulation of p21CIP/WAF-1. Inhibition of DNA-damage-induced stress kinases and p21CIP/WAF-1 expression by caffeine abrogated G2 arrest and induced apoptosis of the irradiated cells in a caspase-3-dependent manner. Inhibition of cell cycle progression by adenoviral expression of the cyclin dependent kinase inhibitor p21CIP/WAF-1 prevented apoptosis upon caffeine treatment indicating that cell cycle progression, that is, G2-release, is required for induction of apoptosis. Likewise, cells homozygously deleted for p21CIP/WAF-1 (HCT116 p21-/-) display enhanced irradiation-induced apoptosis via a caspase-3-dependent mechanism. These data indicate that the disruption of G2 checkpoint control overcomes cell cycle arrest and resistance to gamma-irradiation-induced cell death. Thus, DNA damage may trigger a permanent G2 arrest as an initial inactivation step of tumor cells where the phenomenon of apoptosis is hidden unless cell cycle arrest is overcome. The efficient induction of apoptosis upon G2 release thereby depends on the propensity to activate the key executioner caspase-3. This finding is of crucial importance for the understanding of molecular steps underlying the efficacy of ionizing radiation to delete tumor cells.

Deposition pattern of heliox-driven bronchodilator aerosol in the airways of stable asthmatics

To compare the deposition patterns of heliox-driven and air-driven radiolabeled bronchodilator aerosol, a prospective randomized study was undertaken at the Ben Taub Hospital in Houston, Texas. The working hypothesis was that nebulization with heliox would improve the peripheral deposition of a bronchodilator aerosol. Twelve mild-moderate known asthmatics were recruited for the study. They were asked to withhold medications for 8-24 hours prior to reporting for the study. Each subject was randomized to receive either heliox or oxygen for delivery of albuterol labeled with Tc-99m DTPA. Prior to the nebulization, baseline spirometry was performed. Following nebulization, the subjects were scanned for 1,000,000 counts on the ADAC Genesis Scanner. A postbronchodilator spirometry was then performed. Subjects returned about a week later, this time to have the same process repeated with the other gas. The normalized pixel counts were obtained, and the frequency distribution histograms were constructed for each of the deposition images. Skew and kurtosis were calculated. A lower skew and kurtosis value suggests a more peripheral distribution of the bronchodilator, whereas a higher pixel count corresponds with an increased area and uniformity of deposition. There were no statistically significant differences in baseline PFTs on the 2 days of the study. The pixel count was statistically higher after the heliox-driven nebulization than the air-driven nebulization. The skew and kurtosis values were lower after the heliox-driven nebulization than after the air-driven nebulization of radiolabeled aerosol. All patients had a good bronchodilator response with either driving gas. However, the degree of improvement was more with heliox-driven nebulization than with air-driven nebulization. We conclude that aerosol delivery with heliox results in more uniform and peripheral deposition. Thus, this mode of delivery can be used when uniform, peripheral deposition is desired as with drug delivery during an exacerbation or with aerosolized gene therapy.

Factors associated with participation in a campaign of mass treatment against lymphatic filariasis, in Leogane, Haiti

In October 2000, to interrupt transmission of Wuchereria bancrofti, an intense health-education campaign followed by a mass drug administration (MDA) with diethylcarbamazine and albendazole was undertaken in Leogane, Haiti. Three months after the MDA, which was the first in the study area, a knowledge-attitude-practice (KAP) survey, with a cluster-sample design and probability sampling, was undertaken, to determine the existing knowledge of the local residents, their attitudes toward the MDA, and the possible reasons for non-compliance. Questionnaire-based interviews were used to explore the KAP of 304 subjects (one randomly chosen resident aged > 14 years from each selected household) in 33 communities. Most (93%) of the interviewees were aware of filariasis and 72% knew at least one clinical sign of the disease. Awareness of the MDA was high (91%). The most frequently mentioned sources of information were other people (56%) and radio announcements (33%). More than 80% of the respondents encouraged other people to take the drugs distributed in the MDA and 63% had been treated. The primary reasons given for failing to take the drugs were absenteeism during the distribution (17%), use of contraceptive drugs (12%) and pregnancy (11%). In a multivariate analysis, being male [odds ratio (OR) = 3.3; 95% confidence interval (CI) = 1.5-7.4], knowing that a mosquito transmits the disease (OR = 2.6; CI = 1.2-5.4), and having learned about the MDA through posters and banners (OR = 2.9; CI = 1.2-7.5) were found to be positively associated with taking the drugs. Information from such post-treatment surveys should be useful in developing better health communication for subsequent MDA.

Uncertainty analysis of the weighted equivalent lung dose per unit exposure to radon progeny in the home

A parameter uncertainty analysis has been performed to derive the probability distribution of the weighted equivalent dose to lung for an adult (w(lung) H(lung)) per unit exposure to radon progeny in the home. The analysis was performed using the ICRP Publication 66 human respiratory tract model (HRTM) with tissue weighting factor for the lung, w(lung) = 0.12 and the radiation weighting factor for alpha particles, wR = 20. It is assumed that the HRTM is a realistic representation of the physical and biological processes, and that the parameter values are uncertain. The parameter probability distributions used in the analysis were based on a combination of experimental results and expert judgement from several prominent European scientists. The assignment of the probability distributions describing the uncertainty in the values of the assigned fractions (ABB, Abb, AAI) of the tissue weighting factor proved difficult in practice due to lack of quantitative data. Because of this several distributions were considered. The results of the analysis give a mean value of w(lung) H(lung) per unit exposure to radon progeny in the home of 15 mSv per working level month (WLM) for a population. For a given radon gas concentration, the mean value of w(lung) H(lung) per unit exposure is 13 mSv per 200 Bq.m(-3).y of 222Rn. Parameters characterising the distributions of w(lung) H(lung) per unit exposure are given. If the ICRP weighting factors are fixed at their default values (ABB, Abb, AAI = 0.333, 0.333, 0.333; w(lung) = 0.12; and wr = 20) then on the basis of this uncertainty analysis it is extremely unlikely (P approximately 0.0007) that a value of Hw/Pp for exposure in the home is as low as 4 mSv per WLM, the value determined with the epidemiological approach. Even when the uncertainties in the ABB, Abb, AAI, values are included then this probability is predicted to be between 0.01 to 0.08 depending upon the distribution assumed for describing the uncertainties in the ABB, Abb, AAI, values. Thus, it is concluded that the uncertainties in the HRTM parameters considered in this study cannot totally account for the discrepancy between the dosimetric and epidemiological approaches.

Tune compounds for electrospray ionisation/in-source collision-induced dissociation with mass spectral library searching

Haloperidol, paracetamol, metronidazole and metamizole have been tested as tune compounds for electrospray ionisation in-source collision-induced dissociation MS (ESI-CID-MS) with two different mass spectrometers (Sciex API 365 and Agilent 1100 MSD SL). The different electrospray sources of API 365 and MSD 1100 SL consist of an orifice with nitrogen curtain gas and a capillary interface, respectively. In-source CID occurs in both interfaces in front of the skimmers, which separate a region with a vacuum of approximately 300 Pa and the high vacuum (<10(-3) Pa). Comparison of the breakdown curves of selected tune compounds, depending on collision energy (orifice or fragmentor voltage), showed, that very similar fragmentation can be obtained with both instruments, when adjusting the fragmentor voltage of the MSD 1100 SL to higher values than the orifice voltage of the API 365. For three energy levels--low, medium and high--the corresponding voltages were 20, 50 and 80 V for the API 365 and 110, 190, 230 V for the MSD 1100 SL. These voltages resulted in the most similar spectra for haloperidol and paracetamol with both instruments. The comparison of ESI-CID-MS of all tune compounds at three energy levels showed, that - despite variations in relative ion abundances - all significant ions were present in one of the three CID spectra. Therefore, mass spectral library searching of an ESI-CID-MS library set-up with one of the two instruments should be possible with the other instrument after adjusting the CID energies by means of at least two tune compounds such as haloperidol and paracetamol, metronidazole or metamizole.

Weekly docetaxel and estramustine in patients with hormone-refractory prostate cancer

The combination of docetaxel and estramustine has exhibited synergistic activity both in prostate cancer cell lines and in patients with hormone-refractory prostate cancer (HRPC). Based on these promising preclinical and phase I/II data, we conducted a study of weekly docetaxel and estramustine in patients with metastatic HRPC and a poor performance status. A total of 30 patients received (1) a 3-day course of oral estramustine during weeks 1 and 2 of each 3-week cycle plus (2) docetaxel, 35 mg/m(2) intravenously on day 2 of weeks 1 and 2. The median number of cycles per patient was 5, ranging from 1 to 22. The median patient age was 74 years (range, 61 to 90 years), and the median baseline Karnofsky performance status was 60% (range, 50% to 80%). Twenty-three patients (76%) had a > or =50% decrease in serum prostate-specific antigen (PSA); 17 (56%) of these patients had a > or =75% decrease in PSA. Pain scores and performance status likewise improved in 70% of patients. Three complete responses and four partial responses were observed among 12 patients with measurable disease. Toxicities were primarily nonhematologic in nature, with the most common being grade 1 through 3 nausea, asthenia, diarrhea, and edema. Given the activity and tolerability of weekly docetaxel and estramustine in this study, this regimen appears to be more suitable than previously studied docetaxel/estramustine administration schedules for treating metastatic HRPC in elderly patients with a poor performance status.

Timing for repeated treatment of hyperthyroid disease with radioactive iodine after initial treatment failure

PURPOSE

It has been reported that the effect of radioactive iodine (RAI) treatment is complete in 4 to 6 months. This retrospective study evaluated the appropriate time for repeated treatment of hyperthyroid disease with RAI after initial treatment failure.

METHODS

Outcomes of 128 patients treated with RAI for hyperthyroid disease were reviewed retrospectively at 3 and 6 months.

RESULTS

Eighty patients (group A) were treated successfully with a single dose of RAI. Twenty patients (group B) required a second treatment dose. Twenty-eight patients were lost to follow-up. All patients in group A were clinically improved to various degrees at 3 months and continued to improve at 6 months. All eight patients in group B who showed no improvement at 3 months remained the same at 6 months. The difference between the two groups was statistically significant.

CONCLUSION

Patients with hyperthyroid disease who are unimproved at 3 months can be retreated with RAI without further delay.

ICAM-1 costimulation induces IL-2 but inhibits IL-10 production in superantigen-activated human CD4+ T cells

We have previously reported that costimulatory pathways including B7-CD28 and lymphocyte function-associated antigen-3 (LFA-3)-CD2 shape distinct activation profiles in human CD4+ T cells. We now show that superantigen (SAg), in combination with intracellular adhesion molecule-1 (ICAM-1) costimulation drives a proliferative response accompanied by high levels of interleukin-2 (IL-2) and moderate levels of interferon-gamma (IFN-gamma) and tumour necrosis factor (TNF). This response profile differs from that observed in B7 or LFA-3 costimulated T cells because our previous results showed that B7-CD28 costimulation was accompanied by high levels of IL-2, IFN-gamma and TNF, whereas LFA-3 was a potent inducer of IFN-gamma and TNF, but had little influence on IL-2 production. The ICAM-1-induced IL-2 production could efficiently be abrogated with monoclonal antibody (mAb) against ICAM-1 or LFA-1, showing that the activation is dependent of a functional ICAM-1-LFA-1 pathway. SAg-induced IL-2, IFN-gamma and TNF were detected in both CD4+ and CD8+ T cells, whereas production of IL-10 was restricted to CD4+ T cells. A major finding in the present study was that ICAM-1 costimulation strongly inhibits IL-10 production in CD4+ T cells. Our data demonstrate that ICAM-1 costimulation is sufficient to induce large amounts of IL-2. The presence of ICAM-1 results in suppression of IL-10 production in T helper (Th) cells, which may favour the development of Th1 and not Th2 T cells.

Employment of the mdr1 promoter for the chemotherapy-inducible expression of therapeutic genes in cancer gene therapy

Numerous approaches in gene therapy of human cancers are focused on the establishment of cell type specific or inducible expression vectors allowing the targeted and regulated expression of therapeutic genes. Various conditionally active vectors have been created carrying promoters responding to certain factors or therapeutic modalities (eg hormones, irradiation). The promoter of the multidrug resistance gene (mdr1) harbors such responsive elements and two of these elements have been related to drug responsiveness. In earlier studies we and others have characterized the mdr1 drug responsive-element in CAT reporter assays demonstrating its inducibility by MDR-associated drugs. To exploit this property, we linked the mdr1 promoter sequence to the human tumor necrosis factor alpha (TNF) cDNA in a retroviral vector and transduced the vector into human mammary and colon carcinoma cell lines. These cells were treated with various mdr1-associated drugs to induce TNF expression in vitro. We have shown that the mdr1 promoter-driven TNF expression is drug-inducible and that this induction is drug concentration and time dependent. The studies demonstrate the feasibility of the novel vector system for a chemotherapy-inducible expression of a chemosensitizing cytokine that is successful at enhancing cytotoxicity of drugs in cancer therapy.