Serum and urine TNF-like weak inducer of apoptosis, monocyte chemoattractant protein-1 and neutrophil gelatinase-associated lipocalin as biomarkers of disease activity in patients with systemic lupus erythematosus

OBJECTIVES

TNF-like weak inducer of apoptosis (TWEAK), monocyte chemoattractant protein-1 (MCP-1) and neutrophil gelatinase-associated lipocalin (NGAL) are proinflammatory cytokines/chemokines that are considered as potential biomarkers reflecting disease activity in systemic lupus erythematosus (SLE). In this study, we aimed to investigate the association of serum (s) and urine (u) levels of TWEAK, MCP-1 and NGAL with disease activity in both renal and extra-renal SLE.

METHODS

Thirty active patients with SLE (15 renal and 15 extra-renal) were recruited. Thirty-one inactive patients with SLE (16 renal and 15 extra-renal), 14 patients with ANCA-associated vasculitis (AAV) all of whom had active renal involvement and 20 healthy volunteers were selected as control groups. Serum and urine levels of TWEAK, MCP-1 and NGAL were tested using ELISA.

RESULTS

Serum and urine levels of TWEAK and NGAL were significantly higher in the active SLE group compared to the inactive SLE group (sTWEAK p = 0.005; uTWEAK p = 0.026; sNGAL p < 0.001; uNGAL p = 0.002), whilst no significant differences regarding serum and urine MCP-1 levels were observed (p = 0.189 and p = 0.106, respectively). uTWEAK (p = 0.237), sMCP-1 (p = 0.141), uMCP-1 (p = 0.206), sNGAL (p = 0.419) and uNGAL (p = 0.443) levels did not differ between patients with active renal and extra-renal SLE. Serum TWEAK was higher in patients with active renal SLE (p = 0.006). There were no differences between active renal SLE and active renal AAV. Levels of all biomarkers were correlated with the SLE Disease Activity Index.

CONCLUSION

sTWEAK, uTWEAK, sNGAL and uNGAL are biomarkers showing disease activity in SLE. However, our results implicate that these biomarkers may not be specific for SLE, and can be elevated in patients with active renal involvement of AAV.

Evaluation of shear bond strength of zirconia-based monolithic CAD-CAM materials to resin cement after different surface treatments

Objective

To compare the shear bond strength of resin cement to zirconia-based monolithic CAD-CAM materials subjected to different surface treatments.

Methods

2 brands of monolithic zirconia blocks (Vita YZ HT, Sirona inCoris TZI), yttrium-stabilized tetragonal zirconia (IPS e.max ZirCAD) and zirconia-reinforced lithium silicate ceramic (Vita Suprinity) were divided into six groups according to the surface treatment received: no treatment (control), HF acid etching, sandblasting, sandblasting + Er:YAG laser irradiation, Er:YAG laser irradiation and CoJet. Composite resin cylinders were bonded to blocks with self-adhesive resin cement (Theracem). Shear bond strength was evaluated after thermocyling. Failure modes were examined using SEM. Data was analyzed statistically by using 2-way ANOVA and post-hoc Tukey's test (P < 0,05).

Results

The bond strength was significantly affected by the surface treatment and the type of CAD-CAM blocks (P < 0,001). Surface treatment with CoJet revealed significantly higher bond strength compared to sandblasting in Y-TZP and monolithic zirconia specimens.

Conclusions

Monolithic zirconia blocks showed higher bond strength values compared to Y-TZP zirconia block in sandblasting and CoJet groups. HF acid etching is more effective than sandblasting and CoJet for Vita Suprinity.

Temperature, Hydrostatic Pressure, and Osmolyte Effects on Liquid-Liquid Phase Separation in Protein Condensates: Physical Chemistry and Biological Implications

Liquid-liquid phase separation (LLPS) of proteins and other biomolecules play a critical role in the organization of extracellular materials and membrane-less compartmentalization of intra-organismal spaces through the formation of condensates. Structural properties of such mesoscopic droplet-like states were studied by spectroscopy, microscopy, and other biophysical techniques. The temperature dependence of biomolecular LLPS has been studied extensively, indicating that phase-separated condensed states of proteins can be stabilized or destabilized by increasing temperature. In contrast, the physical and biological significance of hydrostatic pressure on LLPS is less appreciated. Summarized here are recent investigations of protein LLPS under pressures up to the kbar-regime. Strikingly, for the cases studied thus far, LLPSs of both globular proteins and intrinsically disordered proteins/regions are typically more sensitive to pressure than the folding of proteins, suggesting that organisms inhabiting the deep sea and sub-seafloor sediments, under pressures up to 1 kbar and beyond, have to mitigate this pressure-sensitivity to avoid unwanted destabilization of their functional biomolecular condensates. Interestingly, we found that trimethylamine-N-oxide (TMAO), an osmolyte upregulated in deep-sea fish, can significantly stabilize protein droplets under pressure, pointing to another adaptive advantage for increased TMAO concentrations in deep-sea organisms besides the osmolyte's stabilizing effect against protein unfolding. As life on Earth might have originated in the deep sea, pressure-dependent LLPS is pertinent to questions regarding prebiotic proto-cells. Herein, we offer a conceptual framework for rationalizing the recent experimental findings and present an outline of the basic thermodynamics of temperature-, pressure-, and osmolyte-dependent LLPS as well as a molecular-level statistical mechanics picture in terms of solvent-mediated interactions and void volumes.

Analyzing protein-ligand and protein-interface interactions using high pressure

All protein function is based on interactions with the environment. Proteins can bind molecules for their transport, their catalytic conversion, or for signal transduction. They can bind to each other, and they adsorb at interfaces, such as lipid membranes or material surfaces. An experimental characterization is needed to understand the underlying mechanisms, but also to make use of proteins in biotechnology or biomedicine. When protein interactions are studied under high pressure, volume changes are revealed that directly describe spatial contributions to these interactions. Moreover, the strength of protein interactions with ligands or interfaces can be tuned in a smooth way by pressure modulation, which can be utilized in the design of drugs and bio-responsive interfaces. In this short review, selected studies of protein-ligand and protein-interface interactions are presented that were carried out under high pressure. Furthermore, a perspective on bio-responsive interfaces is given where protein-ligand binding is applied to create functional interfacial structures.

Pressure-Induced Dissolution and Reentrant Formation of Condensed, Liquid-Liquid Phase-Separated Elastomeric α-Elastin

We investigated the combined effects of temperature and pressure on liquid-liquid phase separation (LLPS) phenomena of α-elastin up to the multi-kbar regime. FT-IR spectroscopy, CD, UV/Vis absorption, phase-contrast light and fluorescence microscopy techniques were employed to reveal structural changes and mesoscopic phase states of the system. A novel pressure-induced reentrant LLPS was observed in the intermediate temperature range. A molecular-level picture, in particular on the role of hydrophobic interactions, hydration, and void volume in controlling LLPS phenomena is presented. The potential role of the LLPS phenomena in the development of early cellular compartmentalization is discussed, which might have started in the deep sea, where pressures up to the kbar level are encountered.

Turkish health field periodical editors' Views on publication process and ethical problems

Objective

We aimed in this study to investigate views and suggestions of health field editors about the publication process and ethical problems.

Materials and Methods

The study involved 42 journal editors who accepted to participate in the study. The data were collected through 70-item "Editor Views Questionnaire" which was developed by the researchers in line with the related literature.

Results

The editors who participated in the study were asked about their views about the most common problems they encountered related to publication ethics; the top three problems indicated by the editors included unjustified authorship (40.5%), duplicate publication (33.3%), and falsification (26.2%). An analysis of the problems encountered in the initial evaluation stage revealed the top three issues as articles that did not follow the writing rules of the journal (33.3%), unqualified articles (30.1%), and negligence of the author(s) (14.3%). Views in relation to the problems about the referee evaluation stage included evaluations that were not completed within the time given (28.6%), insufficient importance attached to the evaluation (23.9%), and inability to find sufficient number of referees (16.7%).

Conclusion

some editors were found to encounter violation of publication ethics, to experience problems in the revision stage, and not to feel fully independent in their contribution to article publication and thus the improvement of the journal quality. Identification of journal editors' views and problems is an important step for the solution to these problems; it could thus contribute to improving the quality of publication process and journal quality.

A high pressure study of calmodulin-ligand interactions using small-angle X-ray and elastic incoherent neutron scattering

Calmodulin (CaM) is a Ca²⁺ sensor and mediates Ca²⁺ signaling through binding of numerous target ligands. The binding of ligands by Ca²⁺-saturated CaM (holo-CaM) is governed by attractive hydrophobic and electrostatic interactions that are weakened under high pressure in aqueous solutions. Moreover, the potential formation of void volumes upon ligand binding creates a further source of pressure sensitivity. Hence, high pressure is a suitable thermodynamic variable to probe protein-ligand interactions. In this study, we compare the binding of two different ligands to holo-CaM as a function of pressure by using X-ray and neutron scattering techniques. The two ligands are the farnesylated hypervariable region (HVR) of the K-Ras4B protein, which is a natural binding partner of holo-CaM, and the antagonist trifluoperazine (TFP), which is known to inhibit holo-CaM activity. From small-angle X-ray scattering experiments performed up to 3000 bar, we observe a pressure-induced partial unfolding of the free holo-CaM in the absence of ligands, where the two lobes of the dumbbell-shaped protein are slightly swelled. In contrast, upon binding TFP, holo-CaM forms a closed globular conformation, which is pressure stable at least up to 3000 bar. The HVR of K-Ras4B shows a different binding behavior, and the data suggest the dissociation of the holo-CaM/HVR complex under high pressure, probably due to a less dense protein contact of the HVR as compared to TFP. The elastic incoherent neutron scattering experiments corroborate these findings. Below 2000 bar, pressure induces enhanced atomic fluctuations in both holo-CaM/ligand complexes, but those of the holo-CaM/HVR complex seem to be larger. Thus, the inhibition of holo-CaM by TFP is supported by a low-volume ligand binding, albeit this is not associated with a rigidification of the complex structure on the sub-ns Å-scale.

Bioresponsive interfaces composed of calmodulin and poly(ethylene glycol): Toggling the interfacial film thickness by protein-ligand binding

Responsive interfaces are often realized by polymer films that change their structure and properties upon changing the pH-value, ionic strength or temperature. Here, we present a bioresponsive interfacial structure that is based on a protein, calmodulin (CaM), which undergoes a huge conformational change upon ligand binding. At first, we characterize the conformational functionality of a double Cys mutant of CaM by small-angle X-ray scattering (SAXS) and Fourier transform infrared (FTIR) spectroscopy. The CaM mutant is then used to cross-link poly(ethylene glycol) (PEG) chains, which are bound covalently to a supporting planar Si surface. These films are characterized by X-ray reflectometry (XR) in a humidity chamber providing full hydration. It is well known that Ca²⁺-saturated holo-CaM binds trifluoperazine (TFP) and changes its conformation from an open, dumbbell-shaped to a closed, globular one in solution. At the interface, we observe an increase of the PEG-CaM film thickness, when TFP is binding and inducing the closed conformation, whereas the removal of Ca²⁺-ions and a concomitant release of TFP is associated with a decrease of the film thickness. This toggling of the film thickness is largely reversible. In this way, a structural change of the interface is achieved via protein functionality which has the advantage of being selective for ligand molecules without changing the environmental conditions in a harsh way via physico-chemical parameters.

Building Polyelectrolyte Multilayers with Calmodulin: A Neutron and X-ray Reflectivity Study

We have studied the formation and functional properties of polyelectrolyte multilayers where calmodulin (CaM) is used as a polyanion. CaM is known to populate distinct conformational states upon binding Ca²⁺ and small ligand molecules. Therefore, we have also probed the effects of Ca²⁺ ions and trifluoperazine (TFP) as ligand molecule on the interfacial structures. Multilayers with the maximum sequence PEI-(PSS-PAH)_x-CaM-PAH-CaM-PAH have been deposited on silicon wafers and characterized by X-ray and neutron reflectometry. From the analysis of all data, several remarkable conclusions can be drawn. When CaM is deposited for the second time, a much thicker sublayer is produced than in the first CaM deposition step. However, upon rinsing with PAH, very thin CaM-PAH sublayers remain. There are no indications that ligand TFP can be involved in the multilayer buildup due to strong CaM-PAH interactions. However, there is a significant increase in the multilayer thickness upon removal of Ca²⁺ ions from holo-CaM and an equivalent decrease in the multilayer thickness upon subsequent saturation of apo-CaM with Ca²⁺ ions. Presumably, CaM can still be toggled between an apo and a holo state, when it is embedded in polyelectrolyte multilayers, providing an approach to design bioresponsive interfaces.

Activity of dental pulp cells in semisolid 3D cultures initiated by transforming growth factor-β1 and bone morphogenetic protein 2, 4

The intention of this study was to investigate the effect of modified 3D culture conditions on dental pulp cells (DPCs). DPCs were isolated from extracted primary molar, premolar, and wisdom teeth. Tooth samples were divided into three groups as control group; plated into methyl cellulose medium without any supplementation, growth factor (GF) group; supplemented with bone morphogenetic proteins (BMP2, BMP4), transforming growth factor&mdash;&#946;1 (TGF&mdash;&#946;1) and growth factor+conditioned medium (GF+CM) group; supplemented with both growth factors and pulp conditioned medium. The DPCs were tested for colony forming ability, proliferation capacity and morphology. The highest colony forming ability was detected in the GF and GF+CM groups of DPCs isolated from wisdom teeth. The proliferation capacity was higher in GF+CM group of DPCs isolated from primary molars, and in GF and GF+CM groups of DPCs isolated from wisdom teeth. Scanning electron microscope (SEM) observation of the wisdom teeth samples showed cell&mdash;cell interactions in the GF and GF+CM groups. Our results indicate that growth factors and pulp conditioned medium in methyl cellulose culture created proper environment to follow the behavior of dental cells three&mdash;dimensionally.

Acute high dose-fentanyl exposure produces hyperalgesia and tactile allodynia after coronary artery bypass surgery

OBJECTIVE

Opioid-induced hyperalgesia is well known complication of acute high dose and chronic opioid therapy. In this study, we evaluated development of opioid-induced hyperalgesia following intraoperative short-term use of µ-opioid agonist fentanyl after coronary artery bypass surgery.

PATIENTS AND METHODS

100 patients undergoing elective coronary artery bypass graft surgery is divided into two groups. In group I (low dose), anesthesia was induced with propofol 1-2.5 mg/kg and fentanyl 2 mcg/kg, in group II (high dose) fentanyl 40-70 mcg/kg was used. In group I, propofol 5-10 mg/kg/h, fentanyl 1-3 mcg/kg/h, in group II fentanyl 5-10 mcg/kg/h was used for maintenance of anesthesia. The tactile and thermal thresholds were measured before surgery and in 1st, 3rd and 7th postoperative days by using Von Frey filaments and a thermal source, respectively.

RESULTS

Tactile thresholds were significantly decreased at the first (6,08±0.21 and 3.76±0.13 g; p<0.001) and third (6.76±0.24 and 4.96±0.16 g; p<0.001) postoperative days compared to baseline preoperative values (7.72±0.26, and 7.60±0.21 g; p=816) in two groups. Postoperative 1st (13.45±0.33 and 10.05±0.24 sec; p<0.001) and 3rd day (14.77±0.28 and 13.17±0.26 sec; p<0.001) assessments showed a statistically significant thermal hyperalgesia compared to the preoperative baseline values (16.67±0.51 and 16.45±0.42 sec; p=0.997) in two groups. This decrease in both tactile and thermal thresholds returned to baseline control values at the 7th day of measurement.

CONCLUSIONS

Our results showed that patients undergoing coronary artery bypass surgery receiving fentanyl anesthesia developed postoperative tactile allodynia and thermal hyperalgesia and this was more prominent in high dose group.

The course of depressive symptoms in unipolar depressive disorder during electroconvulsive therapy: a latent class analysis

BACKGROUND

Research examining the course of depressive symptoms during electroconvulsive therapy (ECT) is relatively scarce.

OBJECTIVE

To classify patients according to the course of their depressive symptoms while receiving ECT.

METHODS

The sample consisted of 156 consecutive patients receiving ECT for unipolar depressive disorder. Depressive symptoms were measured weekly with the Montgomery-Asberg Depression Rating Scale. Latent class analysis was applied to identify distinct trajectories of symptom improvement.

RESULTS

We identified five classes of different trajectories (improvement rates) of depressive symptoms, i.e. fast improvement (39 patients), intermediate improvement (47 patients), slow improvement (30 patients), slow improvement with delayed onset (18 patients), and finally a trajectory with no improvement (20 patients). The course of depressive symptoms at the end of the treatment within the trajectories of intermediate improvement, slow improvement and slow improvement with delayed onset, was still improving and did not achieve a plateau.

CONCLUSION

The different courses of depressive symptoms during ECT probably contribute to mixed results of prediction studies of ECT outcome. Data suggest that for a large group of patients no optimal clinical endpoint can be identified, other than full remission or no improvement at all, to discontinue ECT.

A comparison of metronidazole 1% cream and pimecrolimus 1% cream in the treatment of patients with papulopustular rosacea: a randomized open-label clinical trial

BACKGROUND

There are various treatment options available for rosacea, depending on the subtype, but treatment is still generally unsatisfactory. Some reports have indicated beneficial effects of topical pimecrolimus.

AIM

To compare the efficacy and safety of pimecrolimus 1% cream and metronidazole 1% cream in the treatment of patients with papulopustular rosacea (PR).

METHODS

A group of 49 patients with PR was investigated in this single-centre, randomized, open-label study. Patients were randomly assigned treatment with either pimecrolimus 1% cream or metronidazole 1% cream for 12 weeks. Response was evaluated by the inflammatory lesion count, the severity of facial erythema and telangiectasia, Physician's Global Assessment (PGA), and safety and tolerability at baseline and at weeks 3, 6, 9 and 12.

RESULTS

In total, 48 patients completed the study. Both treatments were very effective in the treatment of PR. There were no significant differences between the treatments in inflammatory lesion counts, overall erythema severity scores and PGA evaluated from baseline to week 12 (P > 0.05). Neither treatment produced any clinically relevant improvement in telangiectasia.

CONCLUSION

Pimecrolimus cream is no more efficacious than metronidazole cream in the treatment of PR.

Oxidative stress in acne vulgaris

BACKGROUND

Acne vulgaris is one of the common dermatological diseases and its pathogenesis is multifactorial. In this study, we aimed to determine the effects of oxidative stress in acne vulgaris.

MATERIALS AND METHODS

The study involved 32 patients with acne vulgaris in the patient group and 34 healthy adults in the control group. The parameters of oxidative stress such as catalase (CAT), superoxide dismutase (SOD), xanthine oxidase (XO), nitric oxide (NO) and malondialdehyde (MDA) in the venous blood of patients were measured spectrophotometrically. The values were compared with those of the control group.

RESULTS

The serum levels of MDA and XO activity in the patients with acne vulgaris were significantly higher than those of the controls. A significantly lower SOD and CAT activity was found in the patient group than in the control group. Although the patient group had higher serum levels of NO than the control group, the difference was not statistically significant.

CONCLUSION

These results suggest that oxidative damage may play a role in the pathogenesis of acne; therefore, significant alterations may occur in the antioxidant defence system.

Effect of oral administration of kefir on serum proinflammatory cytokines on 5-FU induced oral mucositis in patients with colorectal cancer

In order to investigate the effect of kefir consumption on mucositis induced by 5-FU based chemotherapy (CT), we monitored the systemic immune response by measurement of the serum proinflammatory cytokine levels and we evaluated the anti-microbial effect of kefir with an agar diffusion method. Forty patients with colorectal cancer were included in this randomized prospective study. On the first 5 days of each CT cycle, the study group received oral lavage with kefir and then swallowed 250 ml of kefir while control group received oral lavage with 0.09% NaCl twice a day. Before and after every cycle of CT, the oral mucosa was assessed. Serum proinflammatory cytokine levels were evaluated before the initiation and after the third and the sixth cycle. Kefir was administered in 99 out of 205 courses. Mucositis developed in 27.3% of the courses given with kefir administration and in 21.7% of the courses given with 0.9% NaCl oral rinses. The difference between the two groups was not statistically significant (p > 0.05). When we compared the serum proinflammatory cytokine levels of the two groups at the baseline and following the third and the sixth cycles, we again found no statistically significant difference (p > 0.05). Kefir consumption at the mentioned doses made no statistically significant effect on serum proinflammatory cytokine levels and on the incidence of mucositis development in cancer patients. Under in vitro conditions, kefir inhibits only Staphylococcus epidermidis.

Radiographic technical quality of root fillings performed by dental students in Turkey

AIM

To evaluate the radiographic technical quality of root fillings performed by undergraduate students at a dentistry faculty in Turkey.

METHODOLOGY

A random sample of 2000 records of patients who received dental treatment at the Faculty of Dentistry, University of Gazi between 2000 and 2003 was investigated. The final sample consisted of 1,893 root-filled teeth with 3,692 root canals in 1,654 dental patients. For each root-filled tooth, at least three periapical radiographs were examined: preoperative, working length determination and postoperative. The length, density and taper of root fillings were recorded. The length of root fillings was recorded as adequate, short or overfilled. Density of root fillings was recorded as adequate or inadequate. Taper of root fillings was recorded as adequate or inadequate. Results were evaluated statistically using one-way analysis of variance (anova) and chi-square analysis.

RESULTS

Sixty-nine per cent, 53.2% and 68.3% of root fillings had adequate length, density and taper, respectively; only 33% of teeth fulfilled these three criteria at the same time. The relationship between the length, density and taper of the root filling and the presence of canal curvature was statistically significant (P < 0.001). There was no significant difference between maxillary and mandibular teeth according to the adequacy of the root fillings. The highest percentage of adequate root fillings was found in maxillary canines (51.5%).

CONCLUSIONS

The percentage of adequate root fillings performed by undergraduate students was only 33%.

Ion exchange with natural zeolites: an alternative for water softening?

Possibility of using natural zeolites for water softening was investigated. Quantitative data regarding separation of calcium from water at various levels of hardness through ion exchange with the ammonium selective natural zeolite clinoptilolite is reported. Capacity of the zeolite towards calcium removal in the presence of ammonium at low concentrations and calcium at higher concentrations, and breakthrough characteristics are presented. The results have revealed that removal of calcium, and hence hardness, through ion exchange with clinoptilolite under those circumstances is a promising alternative, with surface capacities reaching 11 mg calcium/g clinoptilolite.

Removal of ammonium from human urine through ion exchange with clinoptilolite and its recovery for further reuse

Ammonium, from separately collected human urine, had been removed through transfer onto the ammonium selective natural zeolite, clinoptilolite, through ion exchange. In the subsequent treatment steps of washing with tap water, ammonium removed from urine was eluted from the surface of the clinoptilolite to be recovered for further reuse. Different quantities of clinoptilolite were used for a survey of the capacity of the zeolite for the process and to identify removal efficiencies based on initial ammonium loads. The highest surface concentration attained under experimental conditions employed was 15.44 mg ammonium per gram of clinoptilolite for an initial concentration of 110 mg ammonia per litre, and the highest removal was 98%, obtained for a loading of 1 mg ammonium per gram clinoptilolite. In the subsequent elution process, better removals were observed as pH was increased and the highest removal was attained at pH 13. The recovery was calculated as 9.73 mg ammonium per gram of clinoptilolite, corresponding to an efficiency of 63% only through washing with tap water. The results have given positive indications for the possibility of using ion exchange with clinoptilolite for the removal of ammonium from human urine and an incentive for improving methods of elution for its recovery for further reuse.

Case report. Candida lusitaniae peritonitis in a patient on continuous ambulatory peritoneal dialysis

We report a case of Candida lusitania peritonitis in continuous ambulatory peritoneal dialysis. Since fluconazole therapy was not successful in this patient, the peritoneal catheter was removed and antifungal therapy continued, and the patient was then converted to haemodialysis. This treatment protocol was successful. We suggest that early peritoneal catheter removal should be considered in such cases.

The Constitutional Type Questionnaire: validation in the patient population of the Royal London Homoeopathic Hospital

In homeopathy the choice of a medicine is based on the total 'picture' presented by the patient. This picture includes 'constitutional type' which comprises personality, and general physical features. The Constitutional Type Questionnaire (CTQ) is designed to systematically assess constitutional types. This study examines the reliability and validity of the CTQ. Four hundred and seventy-two outpatients attending clinics at the Royal London Homoeopathic Hospital completed the CTQ, a 152-item scale rating features traditionally considered typical of 19 constitutional homeopathic medicine 'pictures' on 5-point frequency or severity scales. A subsample was retested after 1 week to measure the test-retest reliability. Another subsample was prescribed a medicine by a homeopathic doctor. Prescriptions were compared with the CTQ, to assess the content validity of the scale. The construct validity was measured by Grade of Membership (GOM) analysis. The scale demonstrated good test-retest reliability (r=0.73), internal consistency (r=0.95). The correlation between CTQ results and the medicine prescribed by the homeopathic doctor was 75.8%. The GOM analyses are reported by Davidson et al elsewhere in this issue of the journal. Although the CTQ could be improved, the scale displays good reliability and validity.