The effectiveness of the Inspiring Futures parenting programme in improving behavioural and emotional outcomes in primary school children with behavioural or emotional difficulties: study protocol for a randomised controlled trial

BACKGROUND

There is a need to build the evidence base of early interventions promoting children's health and development in the UK. Malachi Specialist Family Support Services ('Malachi') is a voluntary sector organisation based in the UK that delivers a therapeutic parenting group programme called Inspiring Futures to parents of children identified as having behavioural and emotional difficulties. The programme comprises two parts, delivered sequentially: (1) a group-based programme for all parents for 10-12 weeks, and (2) one-to-one sessions with selected parents from the group-based element for up to 12 weeks.

METHODS/DESIGN

A randomised controlled trial will be conducted to evaluate Malachi's Inspiring Futures parenting programme. Participants will be allocated to one of two possible arms, with follow-up measures at 16 weeks (post-parent group programme) and at 32 weeks (post-one-to-one sessions with selected parents). The sample size is 248 participants with a randomisation allocation ratio of 1:1. The intervention arm will be offered the Inspiring Futures programme. The control group will receive services as usual. The aim is to determine the effectiveness of the Inspiring Futures programme on the primary outcome of behavioural and emotional difficulties of primary school children identified as having behavioural or emotional difficulties.

DISCUSSION

This study will further enhance the evidence for early intervention parenting programmes for child behavioural and emotional problems in the UK.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN32083735 . Retrospectively registered 28 October 2014.

Evidence for a polygenic contribution to androgenetic alopecia

BACKGROUND

Male pattern baldness (androgenetic alopecia, AGA) is a highly heritable trait and the most common form of hair loss in humans. Eight genome-wide significant risk loci for AGA have been identified.

OBJECTIVES

To determine whether a polygenic component contributes to the genetic risk for AGA.

METHODS

This study used a German case-control sample for AGA, which comprised 581 severely affected patients and 617 controls, to determine the contribution of polygenic variance to AGA risk. The sample was divided evenly into discovery and test samples. An additive polygenic risk score was calculated from risk alleles with increasingly liberal P-values in the discovery dataset, which was then used to test for the enrichment of AGA risk score alleles in the independent test samples.

RESULTS

The polygenic score analysis provided significant evidence for a polygenic contribution to AGA where the amount of variance explained was 1·4-4·5%.

CONCLUSION

This study provides evidence for the specific contribution of a polygenic component to the overall heritable risk for AGA. To some degree, the polygenic architecture of AGA might reflect the complexity of the biological pathways involved. Further analyses and strategies that complement conventional genome-wide association studies are needed to identify these factors. These may include pathway-based analyses, the analysis of functional candidate genes and tests for epistatic effects with known loci.

Follow-up of loci from the International Genomics of Alzheimer's Disease Project identifies TRIP4 as a novel susceptibility gene

To follow-up loci discovered by the International Genomics of Alzheimer's Disease Project, we attempted independent replication of 19 single nucleotide polymorphisms (SNPs) in a large Spanish sample (Fundació ACE data set; 1808 patients and 2564 controls). Our results corroborate association with four SNPs located in the genes INPP5D, MEF2C, ZCWPW1 and FERMT2, respectively. Of these, ZCWPW1 was the only SNP to withstand correction for multiple testing (P=0.000655). Furthermore, we identify TRIP4 (rs74615166) as a novel genome-wide significant locus for Alzheimer's disease risk (odds ratio=1.31; confidence interval 95% (1.19-1.44); P=9.74 × 10(-)(9)).

Microdeletions including FMR1 in three female patients with intellectual disability - further delineation of the phenotype and expression studies

Fragile X syndrome (FXS) is one of the most common causes of intellectual disability/developmental delay (ID/DD), especially in males. It is caused most often by CGG trinucleotide repeat expansions, and less frequently by point mutations and partial or full deletions of the FMR1 gene. The wide clinical spectrum of affected females partly depends on their X-inactivation status. Only few female ID/DD patients with microdeletions including FMR1 have been reported. We describe 3 female patients with 3.5-, 4.2- and 9.2-Mb de novo microdeletions in Xq27.3-q28 containing FMR1. X-inactivation was random in all patients, yet they presented with ID/DD as well as speech delay, macrocephaly and other features attributable to FXS. No signs of autism were present. Here, we further delineate the clinical spectrum of female patients with microdeletions. FMR1 expression studies gave no evidence for an absolute threshold below which signs of FXS present. Since FMR1 expression is known to be highly variable between unrelated females, and since FMR1 mRNA levels have been suggested to be more similar among family members, we further explored the possibility of an intrafamilial effect. Interestingly, FMR1 mRNA levels in all 3 patients were significantly lower than in their respective mothers, which was shown to be specific for patients with microdeletions containing FMR1.

A thermosensitive morphine-containing hydrogel for the treatment of large-scale skin wounds

PURPOSE

Topically applied opioids are an option to induce efficient analgesia in patients with severe skin wounds. For ongoing pain reduction, the vehicle should provide sustained drug release in order to increase the intervals during the regular wound dressing changes. In addition, the formulation should not impair wound healing. Hydrogels provide a moist wound environment, which is known to facilitate the healing process.

METHODS AND RESULTS

Investigating poloxamer hydrogels as a carrier system for morphine in terms of release behavior and (per-)cutaneous absorption, poloxamer 407 25wt.% hydrogel sustained morphine release up to 24h. The drug release rate decreased with increasing concentration of the gel forming triblock copolymer. Poloxamer 407 25wt.% hydrogel retarded morphine uptake into reconstructed human skin and percutaneous drug absorption compared to a hydroxyethyl cellulose reference gel.

CONCLUSIONS

The results of our in vitro study indicate that the thermosensitive poloxamer 407 25wt.% hydrogel is an appropriate carrier system for the topical application of morphine with regard to sustained drug release and ongoing analgesia.

Susceptibility variants on chromosome 7p21.1 suggest HDAC9 as a new candidate gene for male-pattern baldness

BACKGROUND

Male-pattern baldness (androgenetic alopecia, AGA) is the most common form of hair loss among humans. Research has shown that it is caused by genetic factors. Numerous studies have unequivocally identified two major genetic risk loci for AGA: the X-chromosomal AR/EDA2R locus, and the PAX1/FOXA2 locus on chromosome 20.

OBJECTIVES

To identify further candidate genes for AGA, and thus gain further insights into this phenotype.

METHODS

A German sample of 581 severely affected cases and 617 controls was used to perform a genome-wide association study. The identified associated locus was further analysed by fine-mapping, and then independently replicated in an Australian sample. Expression and pathway analyses were performed to characterize the susceptibility gene identified.

RESULTS

The most significant association signal was obtained for rs756853 (P = 1·64 × 10(-7) ), which is located intronically in the histone deacetylase 9 (HDAC9) gene. Fine-mapping and a family-based analysis revealed that rs756853 and the 6-kb distal rs2249817 were the most highly associated single nucleotide polymorphisms. The association finding was replicated in an independent Australian sample, when the analysis was restricted to severely affected cases and unaffected controls (P = 0·026). Analysis of rs2249817 in a combined sample of severely affected German and Australian cases and unaffected controls revealed a strong association signal (P = 9·09 × 10(-8) ). Tissue expression studies demonstrated HDAC9 expression in various tissues, including tissues of relevance to AGA. No strong genotypic effects were observed in genotype-specific expression or splice studies. Pathway analyses supported the hypothesis that HDAC9 plays a functional role in AGA via interaction with the AR gene.

CONCLUSIONS

The present study suggests that HDAC9 is the third AGA susceptibility gene.

3D-wound healing model: influence of morphine and solid lipid nanoparticles

For efficient pain reduction in severe skin wounds, topically applied opioids may be a new option. Moreover, by stimulating keratinocyte migration opioids may also accelerate wound healing. Yet, conventional formulations failed to consistently provide sufficient pain control in patients which may be due to local drug degradation or insufficient concentrations at the target site. After having excluded major morphine glucuronidation by keratinocytes and fibroblasts, we next aimed for an optimised formulation. Since long intervals for painful wound dressing changes are intended, the formulations should allow for prolonged opioid release and should not impair the healing process. We developed morphine-loaded solid lipid nanoparticles (SLN, mean size about 180 nm), and tested improvement of wound closure in a new human-based 3D-wound healing model. Standardised wounds were induced by CO(2)-laser irradiation of reconstructed human full-thickness skin equivalents (EpiDermFT). Morphine, morphine-loaded and unloaded SLN accelerated reepithelialization. Keratinocytes almost completely covered the dermis equivalent after 4 days, which was not the case when applying the vehicle. In conclusion, acceleration of wound closure, low cytotoxicity and irritation as well as possible prolonged morphine release make SLN an interesting approach for innovative wound management.

[Effects of systemic or topical administration of corticosteroids and vitamin B in patients with olfactory loss]

BACKGROUND

Aim of the present, unblinded, multicentric, open trial was to compare effects of 3 treatments in patients with olfactory dysfunction.

METHODS

Treatments included administration of systemic corticosteroids (oral prednisolone), local corticosteroids (mometasone nasal spray), and systemic vitamin B, respectively. A total of 192 patients participated (95 women, 97 men; mean age 56 years). Duration of the smell loss ranged from 1 to 288 months (average 45 months). Olfactory dysfunction was due to infections of the upper respiratory tract (n = 72), sinunasal disease (n = 19), and posttraumatic olfactory loss (n = 10); the largest portion was classified as idiopathic (n = 85); other causes were rare (n = 6).

RESULTS

Following systemic administration of corticosteroids improvement of olfactory function was observed (p < 0.001). Similarly, improvement of the sense of smell was found 2 (p = 0.03) and 6 months (p = 0.001) after local administration of mometasone, respectively. In contrast, after administration of vitamin B no significant change of olfactory function was seen after 2 months, while improvement was present after 6 months (p = 0.001). Duration of olfactory dysfunction had no effect on changes of smell function.

CONCLUSIONS

These results indicate that improvement of olfactory function is found in olfactory dysfunction of different causes. Adequately controlled, blinded studies are needed to further explore potential effects of the various treatments.

Clinical presentation of qualitative olfactory dysfunction

Many patients with olfactory dysfunction not only experience quantitative reduction of olfactory function, but also suffer from distorted olfactory sensations. This qualitative dysfunction is referred to as parosmia (also called "troposmia") or phantosmia, with the major difference that distorted olfactory sensations are experienced in the presence or absence of an odor, respectively. Our clinical observations corroborate the literature in terms of a general underestimation of the incidence of olfactory distortions. Based on selected cases we try to show that olfactory distortions exhibit a large variance in their clinical appearance. Further, emphasis is placed on the fact that only a detailed and directed history of the patient can provide cues to the correct diagnosis.

Immunohistochemical distribution of galectin-1, galectin-3, and olfactory marker protein in human olfactory epithelium

The expression pattern of galectin-1 and galectin-3 in the human olfactory epithelium was investigated in relation to olfactory marker protein (OMP) using confocal laser immunofluorescence in human specimens and postmortem biopsies. OMP expression was found in olfactory receptor neurons (ORNs) in the olfactory mucosa and in fibers of the olfactory nerve crossing the submucous connective tissue. Galectin-1 was expressed in both the connective tissue of the nasal cavity and in the basal layer of the olfactory epithelium. In contrast, galectin-3 expression was limited to cells of the upper one-third of the olfactory epithelium. Expression of galectin-3 occurred in a subset of OMP-positive cells. However, between areas of galectin-1 and galectin-3 expression in the lower and upper portion of the epithelium, OMP-positive ORNs did not stain for both galectins. Considering the potential role of galectin-1 and galectin-3 in cell differentiation and maturation, the differential localization of galectins in the olfactory epithelium appears to be consistent with a significant role of these molecules in the physiological turnover of ORNs.

[Gustatory olfactory function test with the Güttich technique: an evaluation of the clinical value]

BACKGROUND

Testing of retronasal olfactory sensitivity is routinely performed in many ENT-departments in German speaking countries. One of the most popular tests relates to an anecdotal report by Güttich [1]. In this test, liquids are placed on the patient's tongue; the patient is then asked to describe the aroma. Assuming that anosmic patients should not use other descriptors than "sweet," "sour," "salty," and "bitter", this test design is frequently applied in disability compensation settings. Surprisingly though, so far there are no studies regarding the sensitivity or specificity of this test in terms of the differentiation between hyposmic and anosmic patients.

METHODS

The present investigation was performed in 50 anosmics, 42 hyposmics, and 13 normosmics. The diagnosis "hyposmia" or "anosmia" was based on 1. the patients' history, 2. psychophysical tests using an established test of olfactory function, the "Sniffin' Sticks," and 3. the recording of olfactory evoked potentials.

RESULTS

We obtained the following major results: 1. In comparison to hyposmis and normosmics, anosmic patients had greater difficulty identifying the aromas. However, correct identification was not always possible for normosmics. 2. Regarding the differentiation between anosmic and hyposmic patients, the test's sensitivity was 86% with a specificity of 62%. This clearly limits routine clinical application of this test.

CONCLUSIONS

Retronasal testing appears to be an elegant and simple means in order to screen olfactory function. However, the presently investigated approach is limited with regard to the discrimination between anosmic and hyposmic patients.

The use of antibodies for characterization and quantification of a recombinant protein

In this study, we characterized proteinase A secreted by recombinant Saccharomyces cerevisiae bearing a multicopy plasmid containing the encoding gene (PEP4). Polyclonal and monoclonal antibodies were raised to study the product heterogeneity. Characterization of proteinase A was performed by immunoelectrophoresis and immunoblotting techniques. None of the monoclonal antibodies raised against proteinase A was found to react with the glycosyl side chains; thus cross-reaction with other glycosylated proteins (e.g. carboxypeptidase Y) was very low. This study allowed us to develop an ELISA method for the quantification of proteinase A in culture supernatants as well as the evaluation of monoclonal antibodies for their use in immunoaffinity chromatography.

[Bone changes in long-term therapy with etretinate (Tigason)]

We report on a 10-year-old girl with ichthyosis vulgaris, suffering from pains in her left arm and wrist after 1 1/2 years' treatment with etretinate (Tigason) The activity of the alkaline phosphatase was increased. Scintigraphy with technetium showed increased accumulation of activity as well as beginning transformation processes of the left ulna, which recovered after the reduction of the maintenance dose and are no longer detectable after a total of 3 1/2 years' treatment. The potential bone toxicity must be taken into consideration in long-term treatment with retinoids. Its manifestation should be prevented by thorough follow-up.

[Psoriasis therapy with the aromatic retinoid Ro 10-9359 (Tigason)]

At three University Departments of Dermatology (Berlin, Leipzig, Erfurt) of the GRD, 63 psoriatics (46 men, 17 women) were treated with aromatic retinoid Ro 10-9359 (Tigason) up to a maximum of 84 weeks. In 34 of these cases, photochemotherapy was additionally applied. This combination resulted in a more rapid healing than Tigason alone. The average initial dose amounted to 1 mg per kg body weight. Only in cases of psoriatic erythroderma, the treatment started with a daily rate of 25 mg Tigason. The maintenance dose came to 50 to 25 mg daily. On account of deterioration of the cutaneous condition and/or heavy itching, the treatment had to be discontinued in 4 cases. Side effects as cheilitis, rhagades, loss of hair, and onycholysis disappeared after reduction of the dose. Our study confirmed the good therapeutical effect of Tigason with the various forms of psoriasis.

[Echographic early diagnosis of chronic alcoholic pancreatitis? (author's transl)]

The normal size of the pancreas should be checked and classified in a large collection of abstinent people of various ages. We are of the opinion that abstinent persons have a pancreas less than 1.5 cm thick and that great deviations are of exogenous origin. Alcohol presumably leads to edema of the pancreas. If alcohol is abused increasingly and/or persistently, a low-echo enlargement of the pancreas of more than 2.5 cm appears. A clinically detectable pancreatic insufficiency only occurs when the lymph drainage in the acini of the pancreas is damaged through decompensation and a reduction of secretion results. This process seems to have a course of 6-10 years and to run parallel with the consumption of alcohol.

[Echography, laparoscopy and histology in diffuse liver diseases (author's transl)]

The incidence of error of echography (21.0%), laparoscopy (15.0%) and histology (17.4% was investigated in 504 cases of diffuse liver disease. In the assessment of fatty liver, acute fatty liver, fatty cirrhosis and fibroses the accuracy of echography was comparable to that of laparoscopy and histology. A prerequisite for this is that the assessment of the spleen is given particular attention during the diagnosis of diffuse liver diseases. The assessment of diffuse liver diseases demands a high degree of training of the echography diagnostician.

[Impetigo herpetiformis and PUVA-treatment (author's transl)]

Report on a 20 years old pregnant woman, who fulfilled the criteria of the impetigo herpetiformis as well as later those of the pustular psoriasis Zumbusch in her clinical course. The impetigo herpetiformis is interpreted as a variant of the pustular psoriasis occurring during the pregnancy with lowered calcium-level, which increases the endogeneous eruption pressure. After negative attempts of treatment with Prednisolon, antibiotics, and later with Methotrexat an excellent therapeutic effect could be achieved by oral PUVA-treatment.

[The effect of caerulein on intraluminal pressures of the common bile duct and duodenum in man (author's transl)]

Caerulein is a dekapeptide related to gastrin and cholecystokinin with profound effects on gastrointestinal motility. In the present study we examined the effect of intravenously administered caerulein (0.1 microgram/kg body weight) on the intraluminal pressure of common bile duct and duodenum in 12 patients. The pressure recordings were obtained by endoscopic perfusion manometry. The tip of the perfused catheter was positioned under radiological control and the measurements were carried out under standardized conditions. Following the injection of caerulein there was a rise in pressure in the common bile duct and the mid portion of the duodenum. The pressure increase in the common duct appears to be predominantly due to contraction of the gallbladder as it is considerably less pronounced in patients with cholecystectomy. The problems inherent to endoscopic pressure recordings under pharmacological stimulation are discussed.