Gene Narcotic Attenuation Program attenuates substance use disorder, a clinical subtype of reward deficiency syndrome

This study evaluated the effects of a putative activator of brain reward circuitry on outcomes in a 1 -y prospective comprehensive outpatient clinical program. As part of the Gene Narcotic Attenuation Program, Haveos (Synaptamine)™ was administered for the treatment of substance use disorder. Seventy-six patients (45 males and 31 females; mean age, 33 y [standard deviation, 7.0]) who had been given a diagnosis of serious substance use disorder were recruited. After exclusion of 15 patients who dropped out before the end of the study, self-reported craving decreased from program entrance to 12 wk (visual analog scale whereby 0 represents no craving and 5, the strongest craving) for 61 compliant patients (mean decrease, 2.85, 95% confidence interval [Cl], 2.65, 3.05); this improvement was significant (P < .001). Building up to relapse scores (each of 5 individual items and summary value) showed similar improvement after 1 y of treatment; the mean decrease in scores was significant for stress (t=3.3; P=.002), depression (t=4.0;P < .001), anger (t=4.4;P < .001), anxiety (t=4.5,P < .001), drug craving (t=5.4,P < .001), and summary building up to relapse (t=4.1;P < .001). Also, recovery score measures of energy level (t=8.4;P < .001) and ability to refrain from drug-seeking behavior (t=7.4;P < .001) showed significant mean increases from entry to 1 y. During the study, the alcoholic dropout rate was only 7% (4 of 57), which was significantly (Fisher’s exact test,P < .001) lower than the 73% (11 of 15) dropout rate reported for psychostimulant users. Although these results are significant, any interpretation must await the performance of rigorous double-blind studies.     

Interdisciplinary management of an adult patient with significant restorative treatment needs and a complex malocclusion

Transverse maxillary deficiency may be associated with dental crowding, compromised aesthetics and impaired function. Non‐surgical correction of maxillary transverse deficiency through rapid maxillary expansion is routinely performed for young patients; however, surgical intervention is generally required for adults. An interdisciplinary treatment approach is necessary to achieve the desired treatment objectives for challenging cases. This case report demonstrates a pleasing treatment outcome for a patient with a severe maxillary transverse deficiency, significant crowding and extensive active caries.     

The effect of vaginal pH on labor induction with vaginal misoprostol

Objective.?To estimate the association of vaginal pH on the induction to vaginal delivery interval in labor induction with vaginal misoprostol.

Methods.?Women presenting at term with intact membranes for labor induction were recruited. The pH of the vagina was measured during a digital examination of the cervix to determine the Bishop Score. Labor was induced with 25?μg of vaginal misoprostol placed every 6?h until spontaneous rupture of membranes or active labor occurred. The primary outcome was the induction to vaginal delivery interval in the lower pH (?<?5) versus higher pH (???5) group. Secondary outcomes assessed maternal and neonatal morbidities. Sample size calculated a priori estimated 120 subjects were required for a power of 95% and a 2-tailed α of 0.05.

Results.?120 women met inclusion criteria and had available pH data. There was no difference in the induction to vaginal delivery interval in the lower pH (1455?min) versus higher pH group (1295 minutes, Mean difference 160[?147,468] P?=. 30). No difference was observed for operative delivery rates or neonatal outcomes.

Conclusion.?The pH of the vagina may not affect the length of the induction to vaginal delivery interval in women undergoing labor induction with vaginal misoprostol. Further research is required to determine factors that may influence the efficacy of vaginal misoprostol when used for labor induction.     

Medical device evaluation in the United Kingdom: past,present and future

The evaluation of medical devices in the UK has been through many changes since the early hospital equipment assessments in the 1960s. The range of medical devices evaluated has increased and the evaluation reports published have changed, but the evaluation programme continues to be a respected service for the NHS and social care. This review documents the history of the Device Evaluation Service, from its beginnings to the present day, and looks forward to its future. Following an independent strategic review and the Healthcare Industries Task Force (HITF) recommendations, the Device Evaluation Service is now entering a new and exciting developmental phase.     

Using Tree-Based Recursive Partitioning Methods to Group Haplotypes for Increased Power in Association Studies

Motivated by the increasing availability of high‐density single nucleotide polymorphism (SNP) markers across the genome, various haplotype‐based methods have been developed for candidate gene association studies, and even for genome‐wide association studies. Although haplotype approaches dramatically reduce the multiple comparisons problem (as compared to single SNP analysis), even the number of existing haplotypes is relatively large, which increases the degrees of freedom and decreases the power for the corresponding test statistic. Grouping haplotypes is a way to reduce the degrees of freedom. We propose a procedure that uses a tree‐based recursive partitioning algorithm to group haplotypes into a small number of clusters, and conducts the association test based on groups of haplotypes instead of individual haplotypes. The method can be used for both population‐based and family‐based association studies, with known or ambiguous phase information. Simulation studies suggest that the proposed method has the right type I error rate, and is more powerful than some existing haplotype‐based tests.