The need for large-scale randomized evidence

The reliable detection of moderate differences in major health outcomes that arise as a result of treatment requires large-scale randomized evidence (and the appropriate interpretation of this evidence once it has been generated). This may take the form of a single mega-trial or, exceptionally, a meta-analysis of many smaller randomized trials may provide worthwhile information. Small or non-randomized studies cannot generally be trusted to distinguish reliably between a moderate benefit, a moderate hazard, and a negligible difference in major outcomes. Simple design, streamlined data collection, and use of the 'uncertainty principle' to guide eligibility would all encourage the recruitment of larger samples in randomized trials. Future trials need to adopt these methods in order to detect any moderate improvements in major outcomes that may await discovery.     

Utilization of ileal digestible amino acids by pigs: lysine

Two experiments were conducted to determine the utilization of ileal digestible lysine by pigs. In the first, the apparent ileal digestibility of amino acids in cottonseed meal, meat-and-bone meal and soya-bean meal was determined in pigs fitted with 'T'-shaped cannulas. In the second experiment, three lysine-deficient diets were formulated to 0.36 g ileal digestible lysine/MJ digestible energy (DE), with lysine contributed from the three protein concentrates as the only source of lysine in sugar-based diets. An additional three diets were formulated with supplements of lysine to verify that lysine was limiting in the first three diets. The growth performance and retention of lysine by pigs given the six diets over the 20-45 kg growth phase were then determined. The apparent ileal digestibility of lysine in the three protein concentrates (proportion of total) was: cottonseed meal 0.74, meat-and-bone meal 0.78, soya-bean meal 0.89. Growth rates (g/d) of the pigs given the three diets formulated to 0.36 g ileal digestible lysine/MJ DE were significantly different (P less than 0.001): cottonseed meal 377, meat-and-bone meal 492, soya-bean meal 541. The response of pigs to the addition of lysine confirmed that lysine was limiting in these diets. Crude protein (nitrogen x 6.25) deposited by the pigs was significantly higher (P less than 0.001) for those given soya-bean meal (77 g/d), relative to meat-and-bone meal (66 g/d) and cottonseed meal (38 g/d). The proportion of ileal digestible lysine retained by pigs given the three protein concentrates was: cottonseed meal 0.36, meat-and-bone meal 0.60, soya-bean meal 0.75. The results indicate that values for the ileal digestibility of lysine in protein concentrates are unsuitable in dietary formulations as the assay does not reflect the proportion of lysine that can be utilized by the pig. It appears that, with heat-processed meals, a considerable proportion of the lysine is absorbed in a form(s) that is (are) inefficiently utilized.     

Understanding alcohol misuse and comorbid psychiatric disorders

PURPOSE OF REVIEW: This review examines the relationship between alcohol misuse and comorbid psychiatric disorders, and the treatment of these comorbid disorders. In the past, the literature was dominated by papers describing prevalence, clinical services and comorbidity with schizophrenia. It is now advancing into areas such as the relationship between alcohol misuse and the anxiety disorders, affective disorders and eating disorders, and considering the diagnostic paradigm. Knowledge is also emerging about the influences of genetics and adverse effects over different stages of the life cycle in the development of these disorders. RECENT FINDINGS: Recent studies have examined the relationships between alcohol dependence and psychiatric illness, particularly anxiety and depression, but also subthreshold conditions. Childhood trauma, having parents with substance dependence and genetic factors influence the development of alcohol and comorbid psychiatric disorders. There is a genetic contribution to suicidal behaviour in alcohol-dependent patients. Early diagnosis is important. Alcohol Use Disorders Identification Test scores on admission to psychiatric hospital were found to correlate with suicidal ideation and behaviour. In patients with alcohol use disorders, treatment for depression works better after a period of abstinence. Abstinence alone can help for anxiety disorders. High-intensity services had better outcomes for this comorbid population than less intensive services. SUMMARY: Depression in patients with alcohol use disorders cannot be ignored. Treatment of depression alone will not help the alcohol use problems. All psychiatric inpatients should be screened for alcohol use disorders as part of their risk assessment. Research is focusing more on examining the complexities of these disorders, but there are no specific pharmacotherapies to treat particular comorbid conditions.     

Increase in OKM1+ granular lymphocytes in patients with rheumatoid arthritis

Patients with very active rheumatoid arthritis that was being treated only with nonsteroidal antiinflammatory drugs had increased numbers of peripheral blood OKM1+ lymphocytes. In 3 patients, 90 degrees light scatter analysis revealed a double lymphocyte peak. When sorted, the high scatter peak contained a large percentage of granular lymphocytes. Patients with mild-to-moderately active rheumatoid arthritis had normal levels of OKM1+ lymphocytes, but when the drugs were discontinued, the activity of the disease and the numbers of OKM1+ cells increased. Administration of piroxicam was associated with clinical improvement and a decrease in levels of OKM1+ cells. OKM1+ granular lymphocytes are increased in some rheumatoid arthritis patients, and their numbers may correlate with clinical disease activity and/or therapy.