Formula with reduced content of improved,partially hydrolyzed protein and probiotics: infant growth and health

Objective

This study determined growth and stool characteristics of infants fed a formula with reduced content of a partially hydrolyzed protein of improved quality and assessed the effect of the addition of a probiotic on infant growth and health.

Design, methods

The double-blind study involved three formulas: a reduced protein (1.90 g/100 kcal) formula (formula RP), the same formula with Bifidobacterium lactis (formula RP+P), and a higher-protein (2.39 g/100 kcal) control formula (C). Protein of the formulas consisted of partially hydrolyzed modified whey proteins. Normal term infants were randomly assigned to one of the formulas, which were fed from soon after birth to 4 months of age; 88 infants completed the study. Growth was measured and formula tolerance, stool characteristics, and illness incidence were recorded.

Results

All three formulas supported growth equally well. Plasma concentrations of urea and of threonine and proline were markedly (significantly) lower with RP and RP+P than with C. No differences in feeding-related behaviors were noted, but stools were softer with formula C than with the other formulas. Infants fed RP+P had significantly fewer episodes of diarrhea (0.21 episodes) than infants fed RP (0.41 episodes) or C (0.91 episodes).

Conclusion

A reduced-protein formula with and without added probiotics (B. lactis) supports normal growth of infants during the first 4 months. In addition, it leads to lower plasma levels of urea, threonine, and proline. Supplementation of the formula with Bifidobacterium lactis offers protection against diarrheal illness.

     

Hypohidrotic ectodermal dysplasia with tibial aplasia

We report an inbred Tunisian family, in which 19 members had an ectodermal syndrome involving the teeth, hair, nails and skin. Ectrodactyly occurred as an isolated manifestation in one, and with tibial aplasia in two others. None had facial clefts. Dysplastic ears were part of the syndrome.     

An observational clinical study of the efficacy and tolerability of donepezil in the treatment of Alzheimer's disease

An open-label, observational Post-Marketing Surveillance (PMS) study was undertaken in Germany to examine the efficacy and tolerability of donepezil in routine clinical practice. Alzheimer's disease (AD) patients were treated with donepezil (5 or 10 mg once daily) and observed for a period of approximately 3 months. Study assessments included the Mini-Mental State Examination (MMSE), the Nurses' Observation Scale for Geriatric Patients (NOSGER), and adverse events (AEs). A total of 2,092 patients (mean age 73.0 years; mean +/- SD MMSE score 17.8 +/- 5.8) were included in the efficacy assessments. MMSE and NOSGER scores showed statistically significant improvements in the total patient population and in the subpopulations with severe AD or AD with concomitant Parkinsonian symptoms (ADPS cohort). AEs were reported in a total of 12% of patients and were mostly due to peripheral cholinergic effects. In this observational PMS study, donepezil was shown to be an effective and well-tolerated therapy in the overall patient population, in patients with severe AD, and in the ADPS cohort.     

Acceptance of telemedicine and new media: a survey of Austrian medical students

Telemedicine and new media (e.g. the Internet, tele-teaching and tele-learning) are increasingly being used in medicine. We surveyed the awareness and acceptance of these developments on the part of medical students (n =750) at the University of Innsbruck. A 16-item questionnaire was handed out in randomly chosen medical classes and collected immediately after completion, which resulted in a response rate of 99.9%. Nearly all of the students used the Internet regularly (68%) or at least sometimes (30%). Telemedicine was already known to most of the students, mainly from articles in magazines and newspapers (41%), but the great majority of them (95%) reported that they did not know about the telemedicine lectures offered by the University of Innsbruck. Most students (75%) thought that they would benefit from tele-teaching or tele-learning. The survey suggested that medical schools should offer more special lectures, as well as undergraduate or postgraduate qualifications in telemedicine. The marketing of such opportunities needs to be improved.     

Intraopertive radiation therapy for breast cancer

The rapid patient accrual observed in the European breast IORT studies reported since 2000 indicates that surgeons, radiation oncologists, and women who have breast cancer are no longer content to continue to travel down the well-worn path of disfiguring ablative treatment. Breast conservation is currently viewed as the preferred mode of therapy for early-stage breast cancer in most clinical situations. Determination of the optimal combination of whole breast EBRT and localized IORT, for dose and fractionation, is a critical issue that only recently has been addressed [20,21]. Clearly, such clinical investigative endeavors should be regarded as high priority. The very low incidence of local in-breast recurrence of cancer to date suggests that another avenue for investigation might be the determination of the extent to which the lumpectomy procedure can be safely minimized when used in conjunction with IORT. For example, physicians might ask, "Are microscopically negative surgical margins still mandatory when IORT is applied at the time of lumpectomy?" If the answer to that question should turn out to be "no," then it should be much easier for surgeons to achieve the desired excellent cosmetic results when dealing with early-stage breast cancer. Another question remaining to be addressed pertains to the utility of IORT in the management of in-breast recurrence of cancer following conservative therapy. The incidence of local failure after organ-conserving treatment is generally reported to be approximately 5% to 10%. Currently, the preferred mode of salvage therapy in such a clinical situation is mastectomy. The proven efficacy of IORT concurrent with lumpectomy in the primary treatment of early-stage breast cancer suggests that even local recurrences following conventional conservative treatment might be dealt with effectively and expeditiously by means of local excision plus IORT. Such treatment, if safe and effective, could prove to be much less disfiguring than mastectomy. Because breast irradiation routinely produces a desmoplastic tissue response in the breast, there seems to be an opportunity here to address local recurrences of breast cancer with local surgical extirpation enhanced by IORT. Because there are currently few data regarding the use of IORT in this clinical situation, pilot studies would seem to be justified. The remarkably low incidence of local recurrence of breast malignancy observed in every breast IORT study reported to date may portend an important advancement in physicians' ability to better achieve local control of mammary carcinoma. It is hoped that such a putative improvement in the local control of breast cancer will soon translate into improved patient survival rates for this common malignancy.     

Combination of phenylbutyrate and 13-cis retinoic acid inhibits prostate tumor growth and angiogenesis

Differentiation-inducing agents, such as retinoids and short-chain fatty acids, have an inhibitory effect on tumor cell proliferation and tumor growth in preclinical studies. Clinical trials involving these compounds as single agents have been suboptimal in terms of clinical benefit. Our study evaluated the combination of phenylbutyrate (PB) and 13-cis retinoic acid (CRA) as a differentiation and antiangiogenesis strategy for prostate cancer. On the basis of previous evidence, common signal transduction pathways and possible modulation of retinoid receptors and retinoid response elements by PB could be responsible for such activities. We assessed the effect of the combination of PB and CRA on human and rodent prostate carcinoma cell lines. The combination of PB and CRA inhibited cell proliferation and increased apoptosis in vitro in an additive fashion as compared with single agents (P < 0.014). Prostate tumor cells treated with both PB and CRA revealed an increased expression of a subtype of retinoic acid receptor (retinoic acid receptor-beta), suggesting a molecular mechanism for the biological additive effect. The combination of PB and CRA also inhibited prostate tumor growth in vivo (up to 82-92%) as compared with single agents (P < 0.025). Histological examination of tumor xenografts revealed decreased in vivo tumor cell proliferation, an increased apoptosis rate, and a reduced microvessel density in the animals treated with combined drugs, suggesting an antiangiogenesis effect of this combination. Thus, endothelial cell treatment with both PB and CRA resulted in reduced in vitro cell proliferation. In vivo testing using the Matrigel angiogenesis assay showed an additive inhibitory effect in the animals treated with a combination of PB + CRA (P < 0.004 versus single agents). In summary, this study showed an additive inhibitory effect of combination of differentiation agents PB and CRA on prostate tumor growth through a direct effect on both tumor and endothelial cells.