Obsessive Compulsive Disorder (OCD) is increasingly recognised to be relatively common and responsive to some drug treatments (serotonin reuptake inhibitors). Clinical studies utilising recognised diagnostic criteria have identified some relevant negative prognostic factors: early age at disease onset, severe baseline disease, and failure of previous drug treatments all of which reduce the apparent success rates of SRI drugs. Furthermore, patients with comorbid tics seem to respond best to a combination of SRI activity and dopamine blockade. Short term efficacy studies are best performed with a parallel group design and a duration of around 3 months. Long term efficacy studies should probably use the relapse prevention design, with open label responders randomised to double blind continuation or placebo. Does finding has not been properly explored, and any one fixed dose will only be optimal for some patients. Efficacy can be reliably measured using the YBOCs, NIMH-OC and CGI rating scales.

The aim of this study was to evaluate the advantages of the two-step embryo transfer (ET) strategy combining a day 2/3 ET with a day 5/6 blastocyst transfer. In an observational comparative study, 400 infertile women were enrolled from two assisted reproductive technology (ART) units according to inclusion criteria: age below 42 years and at least three embryos obtained on day 2 thus allowing an extended in vitro culture. Two groups were defined according to the ET strategy adopted: group 1 had a two-step ET; and group 2 had a day 2/3 ET with (subgroup 2a) or without (subgroup 2b) blastocysts cryopreserved on day 5/6. Live birth rate was significantly higher in group 1 than in subgroups 2a and 2b (36.5% versus 29.4% and 13.4%, respectively; p < 10−3). Multiple pregnancy rates were comparable between groups. After adjusting on major prognostic factors, the two-step ET strategy was still associated with a significantly higher live birth rate than the day 2/3 ET (OR = 2.23; 95% CI: 1.32–3.77). The two-step ET provides better live birth rates than the cleavage-stage ET. It does not increase multiple pregnancy rates if the number of embryos transferred is limited. It also prevents cycle loss when embryos fail to develop into blastocysts.

Purpose: To look for the therapeutic benefit of radiotherapy after surgery in patients with T1–T2 breast tumour.

Methodology: From 1990 to 2000, 915 patients with T1–T2 breast tumour who underwent mastectomy or conservative breast surgery (CBS) with or without radiotherapy were analysed retrospectively for age, disease stage, radiation therapy technique, dose, the use of chemotherapy or hormonal therapy and other clinical and/or pathologic characteristics. The Kaplan–Meier method was used to estimate locoregional recurrence-free survival (LRRFS) and overall survival (OS). The Cox proportional hazard regression model was used to determine significant prognostic factors affecting LRRFS and OS.

Results: At a median follow up of 74 months, LRR rate was 5.3% and distant metastases rate was 19%. Disease-free survival (DFS) and OS at 10 year was 72% and 76%, respectively. LRR in patients with CBS followed with radiation was 3% as compared to 33% without radiation. LRR in patients with post-mastectomy radiation was 3% as compared to 19% without radiation. In patients with N0 nodes, LRR was 4% with radiation and 20% without radiation. Worst case was in patients with CBS-N0 who were not given radiation. LRR in such patients was 32% as compared to 5% in those who were given radiation post-CBS. In patients with mastectomy with N0 status, LRR was 3% with radiation as compared to 18% with out radiation. On univariate analysis factors affecting LRRFS were type of surgery, nodal involvement, radiotherapy and hormonal therapy. Factors affecting OS were nodal involvement, grade, lymphovascular invasion (LVI), ductal carcinoma in situ (DCIS), extracapsular extension (ECE), chemotherapy and radiotherapy. On multivariate analysis factors affecting LRRFS were type of surgery, nodal involvement, radiotherapy and hormonal therapy. Factors affecting OS were nodal involvement, LVI, DCIS, ECE, chemotherapy and radiotherapy.

Conclusion: Radiation use offered a therapeutic advantage for all patients with T1–T2 breast cancer.

This controlled prospective study examined the evolution and predictors of cognitive decline in Parkinson’s disease (PD). Consecutive patients diagnosed at baseline with PD (n = 89), established PD (EPD) patients (n = 52) with a mean disease duration of 6.5 years, and healthy control subjects (n = 64) underwent extensive neuropsychological assessment twice, approximately 3 years apart. A standardized regression-based method, normative data, and multivariate normative comparisons were used to assess the cognitive course of PD. Cognitive performance of newly diagnosed patients decreased significantly over time, particularly on measures of psychomotor speed and attention and to a lesser extent on tests of memory, visuospatial skills, and executive functions. About 50% of the patients showed cognitive decline and 9% developed dementia. Similar results were observed in EPD patients. None of the baseline features predicted cognitive change in newly diagnosed patients, whereas age at disease onset and axial impairment (postural and gait disorders) contributed to decline in established patients. We conclude that within few years after diagnosis, PD patients show faster rate of cognitive decline than matched healthy subjects, particularly in domains of attention and psychomotor speed. Selection bias probably led to underestimation of the true extent of cognitive decline in established patients. (JINS, 2009, 15, 426–437.)

The aim was to investigate the impact of the main prognostic factors on HIV evolution. A multi-state Markov model was applied in a cohort of 2126 patients to estimate impact of these factors on patients' clinical and immunological evolutions. Clinical progression and immunological deterioration shared most of their prognostic factors: male gender, intravenous drug use, weight loss, low haemoglobin level (<110 g/l), CD8 cell count (<500/mm3) and HIV viral load (>5 log10 copies/ml). Highly active retroviral therapy reduced the risks of clinical progression and immune deterioration whatever patients' CD4 cell count. Risk reductions were 41–60% for protease inhibitor-based and 27–68% for non-nucleoside reverse transcriptase inhibitor-based regimens. Three-year transition probabilities showed that only patients with a CD4 cell count ⩾350 CD4/mm3 could in most cases maintain their immunity. This model provides ‘real life’ transition probabilities from one immunological stage to another, allowing decision analyses that could help determine the beneficial therapeutic strategies for HIV-infected patients.

There is marked diversity in the reported success rates for achieving an intact tympanic membrane following myringoplasty. Controversy exists about the factors thought to influence surgical outcome. Both of these facts have important implications for obtaining informed consent prior to surgery.

This study reviews the factors thought to determine the likelihood of achieving complete closure of the tympanic membrane following surgical closure.

Objective: A basic issue in randomized controlled trials (RCTs) is whether we can safely assume comparability between groups at baseline with respect to all potentially important prognostic factors. In other words, did randomization work sufficiently well? In small trials balanced allocation procedures are employed, whereas in large-scale trials simple randomization will do. The question is: When should balancing be considered?

Methods: We performed a simulation study in which we varied the number of categories in the prognostic factors and the number of patients.

Results: Simulation showed that, in all instances, a balancing procedure almost always led to perfect or almost perfect balance, while the imbalance with simple randomization was larger. To study the effect of balanced and random allocation on subgroup analyses in our OME trial, we compared the quotient of the width of the confidence intervals (CI). The widest CI in random allocation over the 13 hospitals was on average 13% wider than in balanced allocation.

Conclusion: Investigators should always consider balanced allocation, especially in categories with a low number of patients and when subgroup analysis over many categories is requested.

Zunächst wird auf einige Rahmenbedingungen hingewiesen.

Forschungshemmend sind :

• • Die noch nicht völlig überwundenen Folgen von Nationalsozialismus und Krieg, insbesondere der Verlust von Forschern, die Tabuisierung von Forschungsgebieten, die Störungen der internationalen Kommunikation und die Teilung Deutschlands ;

• • Die Ablenkung des wissenschaftlichen Nachwuchses auf sozialpsychiatrische Reformpraxis in den 70-iger Jahren ;

• • Die Überlastung und Erschöpfung der Universitätskliniken durch übermäßige Lehraufgaben und kontinuierliche bürokratische Umorganisation, durch ungünstige Lösungen für Probleme der institutionellen und personellen Struktur ;

• • Extensive Auslegung von Datenschutzgesetzen ;

• • Die Sprachbarriere.

Forschungsförderlich sind :

• • Die “kritische Masse” von zwei psychiatrischen Großforschungseinrichtungen (MPIP und ZISG) ;

• • Die finanzielle Förderung und unabhängig-externe wissenschaftliche Kontrolle von Forschungsprojekten (einzeln, in Sonderforschungsbereichen und in Schwerpunktprogrammen) durch die DFG und andere Stiftungen ;

• • Regelmäßige Symposien und Tagungen wissenschaftlich aktiver Arbeitsgemeinschaften in speziellen Forschungsgebieten ;

• • Eine wachsende Zahl von Preisen für wissenschaftliche Leistungen.

Dann werden einige Beispiele patientenbezogener empirischer Forschung zu

• • Methodologie und Diagnostik,

• • Disposition, Pathogenese und Verlauf, und

• • Therapie- und Versorgungsforschung bei psychischen Krankheiten skizziert.

Schließlich wird es als eine zentrale Forschungsaufgabe der Zukunft angesehen, die explosive Entwicklung der Neurowissenschaften für die Lösung von Problemen der psychiatrischen Krankheitsforschung nutzbar zu machen und gleichzeitig die Methoden und Ergebnisse empirischer Forschung aus Psychologie und Soziologie im Sinne einer Mehr-Ebenenforschung zu berücksichtigen. In einer die konventionelle Nosologie übergreifenden Forschungsstrategie werden besonderes Gewicht haben :

• • Erfassung und Differenzierung von Indikatoren für State- und trait-abhängige Variable ;

• • Erfassung und Gewichtung der Entstehungsbedingungen von Dispositionsvariablen ;

• • Analyse der Wirkungsmechanismen psychopathogener Interaktionen zwischen Dispositionsvariablen und peristatischen Ereignissen ;

• • Erfassung von Prädiktoren für den spontanen Krankheitsverlauf sowie den Verlauf unter Behandlung ;

• • Analyse von Wirkungsmechanismen der Verlaufsgestaltung, insbesondere bei Remission und Chronifizierung psychischer Krankheit.