Reinnervation of motor endplates and increased muscle fiber size after human insulin-like growth factor I gene transfer into the paralyzed larynx

Current surgical strategies for the treatment of laryngeal paralysis are limited by the muscle atrophy associated with denervation. Moreover, attempts at reinnervation have not effected significant change in surgical outcome. To address this clinical problem, we have developed a rat laryngeal paralysis model to study novel gene transfer strategies. Using this model, the human insulin-like growth factor I (hIGF-I) gene was introduced into paralyzed rat laryngeal muscle to assess the benefit of sustained local hIGF-I production. A muscle-specific nonviral vector containing the alpha-actin promoter and hIGF-I gene was used in formulation with a polyvinyl-based delivery system and injected into paralyzed adult rat laryngeal muscle. Twenty-eight days after a single injection, gene transfer efficiency, muscle fiber size, motor endplate length, and nerve-to-motor endplate contact were evaluated. Gene transfer was detected in 100% of injected animals by PCR. Gene transfer with expression, as measured by RT-PCR for hIGF-I mRNA, occurred in 81.3 % of injected animals. When compared with controls, hIGF-I-transfected animals presented a significant increase in muscle fiber diameter [17.56 (+/-0.97 SD) microm versus 14.70 (+/-1.43 SD) microm; p = 0.0002], a significant decrease in motor endplate length [20.88 (+/-1.42 SD) microm versus 25.41 (+/-3.19 SD) microm; p = 0.0025], and a significant increase in percentage of endplates with nerve contact (20.3% (+/-13.9 SD) versus 4.4% (+/-4.2 SD); p = 0.0079). In the context of laryngeal paralysis, gene therapy represents a tremendous opportunity to augment current surgical treatment modalities by preventing or reversing muscle atrophy, and by enhancing nerve sprouting and reinnervation.     

Positive regard.

This article reviews the research on the association between therapists' provision of positive regard and therapeutic outcome. Rogers' attempts to define the concept of positive regard are noted and two examples of positive regard are presented. A new meta-analysis, focusing on 18 studies, yielded an aggregate effect size of .27 (CI = .16, .38; p k = 18; N = 1067), indicating that positive regard has a moderate association with psychotherapy outcomes; like many other relational factors, it is a significant but not exhaustive part of the process-outcome equation. Therapists' provision of positive regard is strongly indicated in practice; at a minimum, it provides the basis for other mutative interventions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Meta-analysis of free-response studies, 1992–2008: Assessing the noise reduction model in parapsychology.

[Correction Notice: An erratum for this article was reported in Vol 136(5) of Psychological Bulletin (see record 2010-17510-009). In the article, the second to last sentence of the abstract (p. 471) was stated incorrectly. The sentence should read as follows: “The mean effect size value of the ganzfeld database was significantly higher than the mean effect size of the standard free-response database but was not higher than the effect size of the nonganzfeld noise reduction database.”] We report the results of meta-analyses on 3 types of free-response study: (a) ganzfeld (a technique that enhances a communication anomaly referred to as “psi”); (b) nonganzfeld noise reduction using alleged psi-enhancing techniques such as dream psi, meditation, relaxation, or hypnosis; and (c) standard free response (nonganzfeld, no noise reduction). For the period 1997–2008, a homogeneous data set of 29 ganzfeld studies yielded a mean effect size of 0.142 (Stouffer Z = 5.48, p = 2.13 × 10?8). A homogeneous nonganzfeld noise reduction data set of 16 studies yielded a mean effect size of 0.110 (Stouffer Z = 3.35, p = 2.08 × 10?4), and a homogeneous data set of 14 standard free-response studies produced a weak negative mean effect size of ?0.029 (Stouffer Z = ?2.29, p = .989). The mean effect size value of the ganzfeld database were significantly higher than the mean effect size of the nonganzfeld noise reduction and the standard free-response databases. We also found that selected participants (believers in the paranormal, meditators, etc.) had a performance advantage over unselected participants, but only if they were in the ganzfeld condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prognostic significance of B-lineage leukemic cell growth in SCID mice: a Children's Cancer Group Study

Primary leukemic cells isolated from children (N = 681 ) with newly diagnosed B-lineage ALL enrolled on risk-adjusted treatment protocols of the Children's Cancer Group (CCG) were injected via the tail vein into 7-10 week old SCID mice. Leukemic cells from 104 of 681 patients (15.3%) were able to engraft and proliferate in one or more SCID mouse organs. These SCID+ patients were somewhat more likely than SCID patients to be older than 10 years of age (p = 0.03) and have WBC counts >20,000/microL (p = 0.04), but the groups were similar with respect to all other presenting features. Event-free survival (EFS) outcome at 3 years of follow-up was similar for SCID+ patients compared with SCID- patients (79.2%, SD = 5. 1% vs. 84.8%, SD = 2.8%; p = 0.20). Overall survival also was similar between the two groups (p = 0.93). This result was maintained within the subgroups of lower risk (N = 448) and higher risk (N = 233) patients. However, there were trends for poorer outcome among patients whose cells caused overt leukemia in SCID mice and infiltrated either 6 or more organs (p = 0.03), skeletal muscle (p = 0.0003), kidney (p = 0.05), or spleen (p = 0.06). Thus, engraftment of primary leukemic cells in SCID mice was not a significant predictor of outcome for the aggregate population of B-lineage ALL patients, the majority of whom were low risk, treated according to contemporary intensive chemotherapy programs of the CCG. However, development of disseminated overt leukemia and infiltration of SCID mouse skeletal muscle by primary leukemic cells from adjacent bone marrow may reflect a biologically more aggressive disease and identify patients at higher risk for treatment failure.     

“Meta-analysis of free-response studies, 1992–2008: Assessing the noise reduction model in parapsychology”: Correction to Storm, Tressoldi, and Di Risio (2010).

Reports an error in "Meta-analysis of free-response studies, 1992–2008: Assessing the noise reduction model in parapsychology" by Lance Storm, Patrizio E. Tressoldi and Lorenzo Di Risio (Psychological Bulletin, 2010[Jul], Vol 136[4], 471-485). In the article, the second to last sentence of the abstract (p. 471) was stated incorrectly. The sentence should read as follows: “The mean effect size value of the ganzfeld database was significantly higher than the mean effect size of the standard free-response database but was not higher than the effect size of the nonganzfeld noise reduction database.” (The following abstract of the original article appeared in record 2010-12718-001.) We report the results of meta-analyses on 3 types of free-response study: (a) ganzfeld (a technique that enhances a communication anomaly referred to as “psi”); (b) nonganzfeld noise reduction using alleged psi-enhancing techniques such as dream psi, meditation, relaxation, or hypnosis; and (c) standard free response (nonganzfeld, no noise reduction). For the period 1997–2008, a homogeneous data set of 29 ganzfeld studies yielded a mean effect size of 0.142 (Stouffer Z = 5.48, p = 2.13 × 10?8). A homogeneous nonganzfeld noise reduction data set of 16 studies yielded a mean effect size of 0.110 (Stouffer Z = 3.35, p = 2.08 × 10?4), and a homogeneous data set of 14 standard free-response studies produced a weak negative mean effect size of ?0.029 (Stouffer Z = ?2.29, p = .989). The mean effect size value of the ganzfeld database were significantly higher than the mean effect size of the nonganzfeld noise reduction and the standard free-response databases. We also found that selected participants (believers in the paranormal, meditators, etc.) had a performance advantage over unselected participants, but only if they were in the ganzfeld condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repairing alliance ruptures.

In this article, we review the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture-repair episodes and treatment outcome (r = .24, z = 3.06, 95% CI [.09, .39], p = .002, k = 3, N = 148). The second meta-analysis reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles (prepost r = .65, z = 5.56, 95% CI [.46, .78], p k = 8, N = 376). Both meta-analyses provided promising evidence regarding the relevance of alliance rupture-repair processes to therapeutic outcome. The limitations of the research reviewed are discussed as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p     

Videothoracoscopy versus thoracotomy in the diagnosis of diffuse interstitial disease

Histopathology plays an important role in the diagnosis of diffuse interstitial lung disease. New endoscopic techniques allow performance of sampling procedures that have the same diagnostic accuracy and fewer complications that open lung biopsy (OLB). We evaluated our experience with video thoracoscopic lung biopsy (VTLB) in comparison with OLB in terms of diagnostic accuracy, duration of pleural drainage and hospital stay, number and size of samples and complications. Thirty patients who underwent VTLB from March 1987 to January 1995, and 28 patients who underwent OLB from May 1987 to January 1995 were studied retrospectively. Diagnosis was achieved in the VLTB group in 96.66% of cases and in the OLB group in 92.85%. The number of specimens obtained was 1.5 (SD 0.5) in the VTLB group (p = 0.47). Overall specimen size expressed in cm3 was 13.3 (SD-15.4) in the VTLB group and 18.5 (SD 21) in the OLB group (p = 0.284). Length of pleural drainage in hours was 52 (SD 39.9) in the VTLB group and 89.1 (SD 47) in the OLB group (p = 0.002). Length of hospital stay in days was 3.5 (SD 2) in the VTLB group and 8.7 (3.5) in the OLB group (p = 0.001). Complications were fewer and less severe after VLTB. VLTB is as useful as OLD for obtaining lung biopsies in diffuse interstitial lung disease. VLTB also causes fewer complications and is less expensive because drainage times and hospital stays are shorter.     

Maternal mental health and integrated programs for mothers with substance abuse issues.

To examine the impact of integrated treatment programs (those with substance use treatment and pregnancy-, parenting-, or child-related services) on maternal mental health, we compiled a database of studies of integrated programs published between 1990 and 2007 with outcome data on maternal mental health. There were 18 cohort studies, 3 randomized trials, and 2 quasi-experimental studies. Of the five studies comparing integrated to nonintegrated programs, three studies provided enough information to allow for them to be combined in a meta-analysis. The average effect size was 0.23 (95% CI = 0.15 to 0.31, SE = 0.04), p Q = 5.66, p = .059. This meta-analysis is the first systematic quantitative review of studies evaluating the impact of integrated programs on maternal mental health. Findings suggest that integrated programs may be associated with a small advantage over nonintegrated programs in improving maternal mental health. This review highlights the need for further research with improved methodology, study quality, and reporting to improve our understanding of how best to meet the mental health needs of mothers with substance abuse issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing countertransference.

In this article, we review the history and definition of countertransference as well as empirical research on countertransference, its management, and the relation of both to psychotherapy outcome. Three meta-analyses are presented, as well as studies that illustrate findings from the meta-analyses. The first meta-analysis indicated that countertransference reactions are related inversely and modestly to psychotherapy outcomes (overall weighted effect r = ?.16, p = .002, 95% CI [?.26, ?.06], k = 10 studies, N = 769 participants). The second meta-analysis suggested that countertransference management factors that have been studied to date play little to no role in actually attenuating countertransference reactions (r = ?.14, p = .10, 95% CI [?.30, .03], k = 11 studies, N = 1065 participants). However, the final meta-analysis revealed that managing countertransference successfully is related to better therapy outcomes (r = .56, p = .000, 95% CI [.40, .73], k = 7 studies, N = 478 participants). We conclude by summarizing the limitations of the research base and highlighting the therapeutic practices predicated on research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cohesion in group therapy.

Cohesion is the most popular of several relationship constructs in the clinical and empirical group therapy literature. This article reviews the most frequently cited definitions and studied measures of group cohesion. We briefly introduce a new measure, the Group Questionnaire, which elucidates group relationships by suggesting two latent factors of cohesion—relationship quality (positive bond, positive work, and negative relationship) and structure factors (member-leader and member-member). To further understand the literature, we conducted a meta-analysis examining the relationship between cohesion and treatment outcome in 40 studies. Results indicate cohesion that the weighted aggregate correlation was statistically significant with outcome r = .25, k (40), N (3,323), z = 6.54 (p     

Performance following ability-focused physical therapy intervention in individuals with severely limited physical and cognitive abilities

BACKGROUND AND PURPOSE: Do individuals with severely limited physical and cognitive abilities improve their gross motor abilities when given physical therapy intervention, and does improvement transfer to nontreatment settings? SUBJECTS: The subjects were 24 individuals (10 female, 14 male), aged 3 to 30 years (X = 20.1, SD = 8.1), who were nonambulatory and had limited adaptive behavior. METHODS: Change in gross motor ability during 18 weeks of twice-weekly therapy was measured using goal attainment scaling (GAS). Three gross motor goals were developed for each subject based on individual or caregiver needs, with one goal randomly selected as a control. Physical impairments were treated, and behavioral management principles, low-level communication approaches, high-repetition practice of goals, and a progressive reduction of both physical assistance and multisensory cues were used. An independent rater scored goal level from randomly ordered videotapes recorded during therapy and in recess and home settings. RESULTS: Mean GAS T scores were higher for treatment goals (X = 45.6, SD = 10.5) compared with control goals (X = 34.6, SD = 11.8). When the expected goal level (50) was met during therapy, mean GAS T scores in recess settings ( X = 35.9, SD = 11.5) and home settings (X = 42.2, SD = 12.2) were lower. At the conclusion of therapy, there were no differences in goal levels between treatment and control goals in both the recess and home settings. CONCLUSION AND DISCUSSION: The subjects demonstrated improvement of gross motor abilities practiced during therapy. Level of ability during therapy, however, did not consistently transfer to the recess of home settings. [Brown DA, Effgen SK, Palisano RJ. Performance following ability-focused physical therapy intervention in individuals with severely limited physical and cognitive abilities.     

The alliance in child and adolescent psychotherapy.

The therapeutic alliance has a long history in the child and adolescent psychotherapy literature. This article examines prominent views on the alliance with youth and considers a number of issues that distinguish youth alliance from its adult counterpart. A meta-analysis of alliance–outcome associations in individual youth therapy is presented. In order to provide a direct comparison with the adult literature, the review included only prospective studies of individual youth therapy that used an explicit measure of alliance. Results from 16 studies revealed consistency with the adult literature with a weighted mean correlation of .22 (k = 16, n = 1306, p     

Alliance in couple and family therapy.

Couple and family therapy (CFT) is challenging because multiple interacting working alliances develop simultaneously and are heavily influenced by preexisting family dynamics. An original meta-analysis of 24 published CFT alliance-retention/outcome studies (k = 17 family and 7 couple studies; N = 1,416 clients) showed a weighted aggregate r = .26, z = 8.13 (p r = .24; z = 6.55, p r = .37; z = 6.16, p     

Hydrochlorothiazide is superior to isradipine for reduction of left ventricular mass: results of a multicenter trial. The Isradipine Study Group

OBJECTIVES: We sought to determine the efficacy of isradipine in reducing left ventricular (LV) mass and wall thickness in hypertensive patients. BACKGROUND: LV hypertrophy on the echocardiogram is a strong predictor of cardiovascular events. Reduction of LV mass may be a desirable goal of drug therapy for hypertension. However, although thiazide diuretic drugs have been advocated as first-line therapy for hypertension, their efficacy in reducing LV mass has been questioned. METHODS: Patients with mild to moderate diastolic hypertension and LV mass in excess of 1 SD of normal values were randomized to isradipine (n = 89) or hydrochlorothiazide therapy (n = 45). Evaluations were obtained at baseline, after 3 and 6 months of treatment and 2 weeks after treatment was stopped. RESULTS: At 6 months, LV mass decreased by 43 +/- 45 g (mean +/- SD) with hydrochlorothiazide (p < 0.001) but only by 11 +/- 48 g with isradipine (p = NS; between-group comparison, p < 0.001). Two weeks after drug therapy was stopped, LV mass remained 24 +/- 41 g lower than that at baseline in the hydrochlorothiazide group (p = 0.003) but only 7 +/- 50 g lower in the isradipine group (p = NS). Septal and posterior wall thicknesses were significantly and equally reduced with both isradipine and hydrochlorothiazide. Greater LV mass reduction with hydrochlorothiazide was related to a 2.8 +/- 3.3-mm reduction of LV cavity size with hydrochlorothiazide but no reduction with isradipine. At 6 months of treatment, diastolic blood pressure (BP) by design was equally reduced in both treatment groups. At 3 months, systolic BP was reduced by 17 +/- 15 mm Hg with isradipine and by 26 +/- 15 and 25 +/- 17 mm Hg at 3 and 6 months, respectively, with hydrochlorothiazide (p = 0.003, between-group comparison). However, on stepwise multivariable regression analysis, treatment selection (partial r2 = 0.082, p = 0.001), change in average 24-h systolic BP (partial r2 = 0.032, p = 0.029) and change in average sitting systolic BP (partial r2 = 0.017, p = 0.096) were predictive of LV mass reduction. CONCLUSIONS: Despite an equivalent reduction of diastolic BP, 6 months of therapy with hydrochlorothiazide is associated with a substantial reduction of LV mass, greater than that with isradipine. The superior efficacy of hydrochlorothiazide for LV mass reduction is associated with a greater reduction of systolic BP as well as drug selection itself. These data may have important therapeutic implications.     

The associations among self-awareness, emotional well-being, and employment outcome following acquired brain injury: A 12-month longitudinal study.

Objective: To investigate self-awareness and emotional well-being according to change in employment outcome in people with acquired brain injury (ABI). Design: A 12-month longitudinal study. Participants and Setting: Fifty adults with ABI attending outpatient rehabilitation (n = 17) or vocational rehabilitation services (n = 33). Time since injury ranged from 6 months to 12 years (M = 4.3 years, SD = 4.1). Main Outcome Measures: Self Awareness of Deficits Interview, Self-Regulation Skills Interview, Hospital Anxiety Depression Scale, and employment outcome (stable employment, improved employment, and stable unemployment). Results: At the initial assessment, level of awareness for the improved employment group was significantly lower than that for the stable employment group (p = .017), whereas no between-groups differences were found at the 12-month follow-up assessment. Employment outcome was not significantly associated with changes in self-monitoring or emotional well-being (p = .017). Demographic and injury-related variables were generally not related to employment outcome. Conclusions: The findings empirically support the theoretical view that an increase in self-awareness is associated with improved employment status, although the direction of this relation is unclear. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collecting client feedback.

While highly effective, psychotherapy outcome studies suggest 5–14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically collect feedback from psychotherapy clients are discussed and two systems for monitoring treatment response, feeding back this information, and assisting in problem-solving with such cases are described. Within these systems, obtaining client ratings of their relationship appear to be highly important. We summarize meta-analyses of the effects of these feedback systems (The combined weighted random effect size for the Partners for Change Outcome Management System was r = .23, 95% CI [.15, .31], p k = 3, n = 558; the effect size for the Feedback condition of the Outcome Questionnaire (OQ) system among not-on-track patients was r = .25, 95% CI [.15, .34], p k = 4, n = 454; the effect size for the Patient/Therapist Feedback condition of the OQ system among not-on-track patients was r = .25, 95% CI [.15, .34], p k = 3, n = 495; the effect size for the Clinical Support Tools feedback condition among not-on-track patients was r = .33, 95% CI [.25, .40], p k = 3, n = 535). The number of psychotherapy patients who deteriorate can be cut in half by use of these systems. We conclude with a series of practice implications, including that clinicians seriously consider making formal methods of collecting client feedback a routine part of their daily practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Peer-assisted learning interventions with elementary school students: A meta-analytic review.

A meta-analytic review of group comparison design studies evaluating peer-assisted learning (PAL) interventions with elementary school students produced positive effect sizes (ESs) indicating increases in achievement (unweighted mean ES = 0.59, SD = 0.90; weighted ES, d = 0.33, p     

Therapist adherence/competence and treatment outcome: A meta-analytic review.

Objective: The authors conducted a meta-analytic review of adherence–outcome and competence–outcome findings, and examined plausible moderators of these relations. Method: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. Results: R-type effect size estimates were derived from 32 adherence–outcome and 17 competence–outcome findings. Neither the mean weighted adherence–outcome (r = .02) nor competence–outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence–outcome and competence–outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence–outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. Conclusions: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence–outcome and competence–outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of Tissucol on connective tissue matrix during wound healing: an immunohistochemical study in rat skin

OBJECTIVE: Our goal was to identify prenatally available parameters that correlate with neonatal outcome and could be used for predicting such outcome in the extremely low-birth-weight pregnancy. STUDY DESIGN: From 1990 through 1995, obstetric and neonatal data of live-born nonanomalous singleton infants with birth weights between 400 and 1000 gm were reviewed. Only cases in which ultrasonographic biometry, including biparietal diameter, abdominal circumference, and femur length, was performed < or =3 days before delivery were included. Overall survival (defined as alive at discharge) and survival without specific severe neonatal morbidities (namely, retinopathy of prematurity [stage 3 or 4], intraventricular hemorrhage [grade 3 or 4], periventricular leukomalacia, chronic lung disease, and deafness) were ascertained. The best combination of prenatal parameters for the prediction of overall survival and survival without severe morbidity was determined by backward stepwise logistic regression analyses. RESULTS: The most significant prenatal predictors of overall survival were the obstetric estimate of gestational age and the abdominal circumference (chi2 = 11.8036, p = 0.0006 and chi2 = 8.1862, p < 0.005, respectively). Survival without severe morbidity was also predicted by the same combination of parameters (chi2 = 21.9079, p = 0.0001 and chi2 = 6.538, p = 0.01, respectively). The estimated fetal weight was not a significant independent predictor of either category of outcome (chi2 = 0.1249, p = 0.72 and chi2 = 0.0361, p = 0.85, respectively). On the basis of the regression formulas, curves displaying the probabilities of overall survival and survival without severe morbidity with any combination of gestational age and abdominal circumference were developed. CONCLUSION: The combination of gestational age and the abdominal circumference measurements appears to be superior to any combination that included estimated fetal weight data for predicting neonatal outcome in the neonates weighing < or =1000 gm. We developed a mechanism for predicting neonatal outcome in this weight category on the basis of prenatally available parameters. This information could prove useful for both parental counseling and obstetric decision making.