Time to retire the theory of planned behaviour?: one of us will have to go! A commentary on Sniehotta,Presseau and Araújo-Soares

Abstract

Although research has consistently established that depression and elevated depressive symptoms are associated with an increased risk of coronary heart disease (CHD) recurrence and mortality, clinical trials have failed to show that conventional depression interventions offset this risk. As depression is a complex and heterogeneous syndrome, we believe that examining simpler, or intermediary, phenotypes rather than one complex phenotype may allow better identification of those at particular risk of CHD recurrence and mortality. This approach may further contribute to the development of specific depression treatments that would improve medical outcomes. Although there are many possible intermediary phenotypes (IPs), specifiers and dimensions of depression, we will focus on only two when considering the relation between depression and risk of CHD recurrence and mortality: Incident Depression and Anhedonic Depression. Future research on IPs of depression is needed to clarify which are associated with the greatest risk for CHD recurrence and mortality and which, if any, are benign. Theoretical advances in depression phenotyping may also help elucidate the behavioural and biological mechanisms underlying the increased risk of CHD among patients with specific depression phenotypes. Finally, tests of depression interventions may be guided by this new theoretical approach.     

Duration of clinical symptoms in children under two years of age with acute otitis media

Objective: To describe the course of symptoms during the first ten days of episodes of AOM in children under two years of age.

Methods: Within the framework of a placebo-controlled, double-blind, randomised trial studying the effect of amoxicillin on acute otitis media in children under two years of age in the Netherlands, symptoms were recorded in diaries by the parents. Durations of symptoms were plotted by means of Kaplan-Meier curves. Possible factors influencing the duration were analysed in a Cox regression.

Results: Data from 230 children were used in the analyses. The median duration of fever was two days and the median duration of the combination of earache and/or crying was eight days. The duration of earache and/or crying was not influenced by any factor analysed (including treatment allocation).

Conclusion: Fifty per cent of the children under two years with an episode of AOM had symptoms for more than eight days (95% CI: 6.9-9.1). Since antibiotic treatment did not influence this period, persistence of symptoms should not be a reason for changing antibiotic therapy.     

Anti-Diarrheal Activity and Toxicity of Learng Pid Samud Recipe

Learng Pid Samud (LPS) recipe is a traditional remedy in Thai folk medicine to ease the common diarrhea. The anti-diarrheal potential of LPS recipe was herein examined in vitro using a guinea-pig ileum model. The LPS exerted an inhibitory effect on acetylcholine-induced smooth muscle contraction in the guinea pig ileum. Significantly, not only did the LPS reduce the total amount of feces in the induced diarrhea rats, but also the intestinal transit in the charcoal meal test. A single oral administration with the recipe at 5,000 mg/kg did not cause acute toxicity and the daily oral administration (1,000, 2,000 and 4,000 mg/kg) for 90 days in rats did not produce any toxic signs and symptoms. In conclusion, the Learng Pid Samud recipe remedy is evidently safe and effective for the anti-diarrheal treatment which supports its therapeutic uses in the alternative medicine.     

Risk of Acute Kidney Injury after Exposure to Gadolinium-Based Contrast in Patients with Renal Impairment

Objectives: Gadolinium-based contrast media (Gd-CM) are reported to induce acute kidney injury (AKI) in a high-risk population group at the usual dose for magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) examinations. We assessed gadolinium-induced nephropathy in patients with renal impairment who underwent MRI or MRA examinations, and evaluated the risk factors. Materials and methods: In this retrospective study, 238 patients with baseline renal impairment, who received MRI or MRA examinations with Gd-CM, were recruited. After all other AKI causes—liver decompensation, severe heart failure, all kinds of shock, and severe sepsis—and patients on dialysis were excluded, 158 patients were enrolled. AKI was defined as a decrease in glomerular filtration rate (GFR) >10% of baseline data within 3 days after administration of Gd-CM. Regression analysis was used to find independent risk factors for gadolinium-induced AKI (Gd-AKI). Results: Twenty-six of the 158 patients (16.5%) developed Gd-AKI. There were no significant differences in gender, age, or baseline GFR between those who did and who did not develop AKI. Comorbid coronary artery disease, liver cirrhosis, diabetes mellitus, and hypertension were not significantly associated with the development of Gd-AKI. However, sepsis was an independent risk factor for Gd-AKI after multivariate regression analysis (adjusted odds ratio: 4.417; 95% confidence interval: 1.671–11.676, p = 0.03). Conclusions: It is potential AKI after administration of Gd-CM under sepsis condition at the dose for MRI and MRA examinations in patients with renal impairment. It is important to identify high-risk patients and closely monitor renal function after administration of Gd-CM.     

Molecularly targeted therapy: toxicity and quality of life considerations in advanced colorectal cancer

Colorectal cancer (CRC) is the third most common malignancy and cause of death from cancer among adults worldwide. In recent years, the use of 5-fluorouracil-based regimens in combination with molecularly targeted agents has greatly expanded treatment options for patients with metastatic disease. With a more capillary use of this new class of agents comes the recognition of diverse adverse events related to disturbance of critical biological pathways involved in physiological functions. Proactive management and prevention of adverse events, with a focus on the necessary compromise between adverse events and tumor control, are often effective and allows for uninterrupted, full-dose therapy with targeted agents. Quality of life does not appear deteriorated, rather improved due to efficacy in prolonging wellness.     

手术时机对重症胰腺炎治疗效果的影响观察

目的探讨手术时机对重症胰腺炎治疗效果的影响。方法回顾性分析本院2010年3月～2012年3月诊治的206例重症胰腺炎患者的病历资料,据治疗情况分为保守治疗组、早期手术组及中转手术组,其中保守治疗组96例,早期手术治疗73例,37例选择中转手术治疗。结果通过9d治疗后观察,共治愈173例,无效33例,其中保守治疗总有效率为90.63%;早期手术治疗组总有效率为71.23%;中转手术治疗组总有效率为91.89%。保守治疗组与中转手术治疗组治疗总有效率比较,差异无统计学意义（P〉0.05）;保守治疗、中转手术治疗组分别与早期手术治疗组比较,差异有统计学意义（P〈0.05）。结论手术时机对重症胰腺炎治疗效果至关重要,无明显合并症患者均应选择保守治疗,出现严重并发症或手术适应证患者应积极中转手术治疗。     

89例老年急性胆囊炎的临床治疗体会

目的探讨老年急性胆囊炎的临床治疗方法。方法选取牡丹江某医院2009年2月-2010年9月收治的89例老年急性胆囊炎患者,将其分为对照组（46例）与研究组（43例）。对照组患者采取保守治疗,研究组患者采取手术治疗,通过对比2组患者的治愈情况及平均住院时间,评价不同治疗方法的效果。结果研究组治愈率97.67%,对照组治愈率95.65%,差异无统计学意义;研究组患者平均住院时间明显比对照组短,差异有统计学意义（P〈0.05）。结论针对老年急性胆囊炎患者,应根据实际病情采取适宜的方式进行治疗。     

Metabolomic Study of Biochemical Changes related to toxicity induced by bupleurotoxin Using LC-MSCoupled with a Pattern Recognition Approach

The purpose of this study was to detect changes in urine of mice and to clarify the toxicity induced by bupleurotoxin (BETX) using liquid chromatography/quadrupole time-of-flight mass spectrometry (LC-Q-TOF-MS). A procedure for urine analysis using pattern recognition was proposed to evaluate the toxicity induced by BETX in male BALB/c mice. BETX at 2.5 mg/kg was administered intraperitoneally (i.p.), and urine samples for the metabolomic study were collected from control and BETX experimental groups. Changes in the concentrations of some urine metabolites were detected exclusively in the experimental group. All results suggested that exposure to BETX might cause a disturbance in fatty acid metabolism and the oxidative stress system. These results may not only clarify the underlying mechanism of diverse intoxication effects of BETX but also provide the guidance in preclinical toxicity screening for new drugs.     

Influence of trial design,heterogeneity and regulatory environment on the results of clinical trials: An appraisal in the context of recent trials on acute stroke intervention

The outcome of randomized controlled trials can vary depending on the eligibility criteria of the patients entering into the trial, as well as the heterogeneity of the eligible population and/or the interventions. If the subject population and/or interventions are heterogeneous, the final outcome of the trial depends on the degree of concordance of effects of the subgroups of interventions on the subgroups of the subject population. The considerations that go into the calculation of sample size and determination of the study stopping rules also would affect the nature of the outcome of the study. In this paper we try to examine these phenomena with respect to the recent trials on endovascular therapy in acute ischemic stroke.