Towards health promotion indicators

This article examines the state of the art in health promotionindicator development over the past few years and presents fiveconclusions from this review, The authors put forward proposalsfor the development of health promotion indicators based onthe question, "What research in health promotion will lead toappropriate indicators?". The authors illustrate some areasof concern both for researchers and policymakers and suggesta number of indicators, appropriate to each of these groups,for important dimensions of health, health-related processesand health resources. The dialogue between health researchersand health decision-makers is growing and links are being made;it is important to continue this process.     

Comparative effectiveness and safety of the novel oral anticoagulants: do the pivotal clinical trials point to a new paradigm?

Spyropoulos AC, Goldenberg NA, Kessler CM, Kittelson J, Schulman S, Turpie AGG, Cutler NR, Hiatt WR, Halperin JL. Comparative effectiveness and safety of the novel oral anticoagulants: do the pivotal clinical trials point to a new paradigm? J Thromb Haemost 2012; 10: 2621–4.     

Surgical and prosthetic reconsiderations in patients with maxillectomy

Summary The purpose of this study was to establish and evaluate new possibilities for rehabilitation of patients with obturator prosthesis who had undergone partial or total maxillectomy because of tumour ablation surgery. Eleven patients with maxillary defects were reconstructed with a computer‐aided design/computer‐aided manufacturing designed prosthesis. Missing retention was gained by inserting implants in the remaining bone, so that an expansion of the surgical defect to gain further retention could be avoided. All patients were treated successfully according to the previously described treatment plan. The Obturator Functioning Scale (OFS) of the Memorial Sloan‐Kettering Cancer Centre was applied to evaluate the functional quality of the obturator prosthesis and patient’s satisfaction. It showed good results in all fields of functional outcome and social acceptance.     

A VARIANT FORM OF BRANCHED-CHAIN KETO ACIDURIA

A case of branched-chain keto aciduria is described. The boy's clinical picture was similar to that of patients with the intermittent form of this disorder, but severe mental retardation was present. It proved possible to treat him successfully with a diet low in branched-chain amino acids and, at the age of 3 years, after 18 months' treatment, his mental development corresponded with his age. Details are given of the clinical course and the dietary treatment. The findings in the patient's family are also described, with the results of oral loading tests with 1-leucine performed on all members of the family.     

Unusual thionation of a cyclic hexapeptide

One carbonyl oxygen of the cyclic hexapeptide cycle(-Gly¹-Pro²-Phe³-Val⁴-Phe⁵-Phe⁶-) (A) can be selectively exchanged with sulphur using Yokoyama's reagent. Surprisingly it was not the C=O of Gly¹ but that of Phe⁵ which was substituted and cyclo(-Gly¹-Pro62-Phe³-Va1⁴-Phe⁵ψ[CS-NH]Phe⁶-) (B)was obtained. Thionation results in a conformational change of the peptide backbone although the C=O of Phe⁵ and the corresponding C=S are not involved in internal hydrogen bonds. Two isomers in slow exchange, containing a CIS Gly¹-Pro² bond in a βVIa-turn (minor) and a trans Gly-Pro bond in a βII′-turn (major), were analyzed by restrained molecular dynamics in vacuo and in DMSO as well as using time dependent distance constraints. It is impossible to fit all experimental data to a static structure of each isomer. Interpreting the conflicting NOES, local segment flexibility is found. MD simulations lead to a dynamic model for each structure with evidence of an equilibrium between a βI- and βII-turn about the Val⁴-Phe⁵ amide bond in both the cis and trans isomers. Additionally proton relaxation rates in the rotating frame (R_1p) were measured to verify the assumption of this fast βI/βII equilibrium within each isomer. Significant contributions to R_1p-rates from intramolecular motions were found for both isomers. Therefore it is possible to distinguish between at least four conformers interconverting on different time scales based on NMR data and MD refinement. This work shows that thionation is a useful modification of peptides for conformation-activity investigations.