Health-related quality of life and functioning in remitted bipolar I outpatients

The aim of this study was to characterize the health-related quality of life (HR-QOL) and functioning in 90 bipolar I remitted outpatients. According to Diagnostic and Statistical Manual of Mental Disorders IV remission specifiers, patients were categorized into 4 groups: group 1, fully remitted; group 2, less than 2 months remitted; group 3, with persisting manic symptoms; group 4, with persisting depressive symptoms. The severity of psychopathology was evaluated by using the Bech-Rafaelsen Mania-Melancholia Scale. The HR-QOL, functioning, and insight were assessed via the medical outcomes study 36-item short form, the global assessment of functioning scale, and the scale to assess unawareness of mental disorder, respectively. Fully remitted patients reported the highest scores in almost all domains of medical outcomes study 36-item short form, and had significantly higher scores on physical functioning, general health, social functioning, and mental health compared to patients with persisting depressive symptoms. Furthermore, patients with persisting manic symptoms reported significantly higher scores on general health, vitality and mental health than the group with persisting depressive symptoms. In contrast, the global assessment of functioning scale score differed among the 4 groups, with fully remitted patients reporting higher, although not statistically significant, scores than the other groups. Our data suggest that the persistence of depressive or manic symptoms seem to affect self-report measures of HR-QOL. An affectively biased cognition may explain the gap between patient's perception of functioning and estimated functional adjustment, as assessed by clinicians.     

Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: Non‐adherence or risk of non‐adherence?

MLVI has been used to assess adherence. To determine the MLVI in children <12 years of age at transplantation and to identify demographic correlates and consequences for the graft. This is a retrospective study of 50 outpatients (4.0 ± 3.5 years), at least 13‐month post‐liver transplantation. The outcomes evaluated were MLVI, ALT > 60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Student's t test and the chi‐square test were used. Statistical significance was set at P ≤ .05. Seventy‐two percent were infants or preschoolers, 62% biliary atresia. Seventy‐four percent of the mothers had middle‐school education, and 54% of the families had an income ≤3632.4 US$/y. Twenty‐two (44%) patients had a MLVI ≥ 2 SD; this was more prevalent in families with higher incomes (P = .045). ALT levels > 60 IU/L were more common in MLVI ≥ 2 SD group (P = .035). ACR episodes were similar between groups (P = 1.000). No patient died or lost the graft. MLVI ≥ 2 SD may be an indicator of the risk of medication non‐adherence.     

Dentin regional bond strength of self-etch and total-etch adhesive systems

OBJECTIVES: To evaluate the microtensile bond strength (MTBS) of self-etch (with or without H(3)PO(4)-etching) and total-etch bonding systems bonded to different regions of dentin. METHODS: Long flat dentin cavity preparations extending from top-crown to root-apex within the same tooth were performed and bonded: using two-step (Clearfil SE Bond/SEB, Resulcin Aqua Prime/RES) and one-step (Etch & Prime 3.0/EP, One-Up Bond F/OUB, Prompt L-Pop/PLP, Solist/SOL and Futurabond/FUT) self-etch adhesives; these same adhesives were also applied following H(3)PO(4)-etching of dentin and finally two more groups were bonded with total-etch adhesives (Single Bond/SB and Prime & Bond NT/PBNT). Build-ups of resin composite were constructed incrementally to ensure sufficient bulk for the MTBS test and the different regions of dentin were identified by painting with different colours on the top of the resin composite. Specimens were sliced into beams and tested in tension. ANOVA and multiple comparisons tests were used (p<0.05). RESULTS: Regardless of the tested dentin region, SEB attained the highest MTBS to smear layer-covered surfaces (i.e., coronal dentin: 42.7MPa), while H(3)PO(4)-etching of dentin hampered bonds (i.e., coronal dentin: 27.7MPa). When bonding with PBNT, SB, RES, EP, PLP, SOL and FUT, MTBS was similar for different dentin regions. H(3)PO(4)-etching of dentin did not alter the attained MTBS. SIGNIFICANCE: SEB yielded the highest MTBS to all regions of dentin. When bonding to parallel-cut dentin, previous H(3)PO(4)-etching of dentin did not increase MTBS and differences in bond strength among dentin regions were absent.     

Effect of previous treatments on bond strength of two self-etching adhesive systems to dental substrate

PURPOSE: The aim of this study was to evaluate the effectiveness of previous dental substrate treatments on the bond strength of two self-etching adhesives. MATERIALS AND METHODS: One hundred bovine incisors were sectioned at the cementoenamel junction. The labial tooth surface was ground to obtain flat superficial dentin. Teeth were randomly divided into two groups (n = 50): Clearfil Protect Bond and One Up Bond F. The specimens of each group were subdivided into five groups, according the dental substrate treatment, and then the adhesive system was applied as follows (n = 10): C: control, without previous treatment; TA: 37% phosphoric acid etching on enamel and dentin for 15 s; PA: 37% phosphoric acid etching only on enamel for 15 s; SB: Al2O3 sandblasting on dental surface; EDTA: enamel and dentin conditioning with 24% EDTA gel, pH 7.0. Resin composite blocks were fixed to the dental surfaces with dual-polymerized resin cement. Samples were sectioned in the mesiodistal direction and were trimmed to reduce the cross-sectional area to approximately 1.2 mm2. They were tested at a crosshead speed of 0.5 mm/min on a testing machine. Microtensile bond strength values from enamel, superficial dentin, and deep dentin were compared. Mean microtensile bond strength values were expressed in MPa and were analyzed by two-way ANOVA (2 x 3 x 5) and Tukey's tests. RESULTS: A significant difference was observed for interaction (p = 0.00001) among the factors. The highest mean bond strength to enamel was found with previous phosphoric acid etching, and to dentin when EDTA was previously applied. CONCLUSION: The most indicated previous treatment for increasing the bond strength to enamel and dentin simultaneously is EDTA for both self-etching adhesive systems used.     

Personality and differential treatment response in major depression: a randomized controlled trial comparing cognitive-behavioural therapy and pharmacotherapy.

OBJECTIVE: Effective treatments for major depressive disorder exist, yet some patients fail to respond, or achieve only partial response. One approach to optimizing treatment success is to identify which patients are more likely to respond best to which treatments. The objective of this investigation was to determine if patient personality characteristics are predictive of response to either cognitive-behavioural therapy (CBT) or pharmacotherapy (PHT). METHOD: Depressed patients completed the Revised NEO Personality Inventory, which measures the higher-order domain and lower-order facet traits of the Five-Factor Model of Personality, and were randomized to receive either CBT or PHT. RESULT: Four personality traits--the higher-order domain neuroticism and 3 lower-order facet traits: trust, straightforwardness, and tendermindedness--were able to distinguish a differential response rate to CBT, compared with PHT. CONCLUSION: The assessment of patient dimensional personality traits can assist in the selection and optimization of treatment response for depressed patients.     

Ziprasidone in the Treatment of Affective Disorders: A Review

Ziprasidone was the fifth atypical antipsychotic approved by Food and Drug Administration (FDA) for use in bipolar mania and mixed episodes. This atypical antipsychotic has a unique profile, as it acts primarily through serotonergic and dopaminergic receptor antagonism, but also exerts effects as an inhibitor of norepinephrine reuptake. Moreover, one of the advantages of ziprasidone is its safety profile as it is not associated with clinically significant metabolic side effects and little or no effect on prolactin level or anticholinergic side effects. Most of the studies evaluating ziprasidone's efficacy and safety are short‐term double‐blind, placebo‐controlled studies in acute mania and mixed episodes. In two of them, ziprasidone was associated to significant improvement in the primary measures assessed. However, an add‐on study, lithium plus ziprasidone showed similar results than lithium monotherapy, although there was a significant advantage for the combination within the first week. In a more recent trial, ziprasidone was compared with placebo and haloperidol as monotherapies, again beating placebo. In that trial, ziprasidone appeared to be safer and better tolerated, although less likely efficacious than haloperidol. Particularly, subjects treated with ziprasidone were less likely to switch to depression. Despite the well‐studied efficacy of ziprasidone in the first weeks of treatment, there are no controlled trials that evaluate the role and efficacy of ziprasidone in long‐term treatment of bipolar disorder (BD). Overall, in the open‐label extension studies, there was a global improvement at all visits compared with baseline scores. Furthermore, ziprasidone appears to offer some antidepressant effect in patients with major depressive episode and resistant to treatment, as demonstrated in add‐on open‐label studies with ziprasidone plus selective serotonin reuptake inhibitor (SSRI).     

Component structure of the Repeatable Battery for the Assessment of Neuropsychological Status in dementia.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been studied relatively extensively in normal samples, and its theoretically derived index scores have been demonstrated to be useful in the assessment of a variety of clinical conditions. However, examinations of the empirical relationships between individual subtests are limited. The intent of the present study was to explore the component structure of the instrument in a sample of 351 individuals with a diagnosed memory disorder, to examine the impact of demographic factors on these empirically derived components, and to explore differences in performance between diagnostic groups. Findings suggested a three-component solution (Memory, Visuomotor Processing, and Verbal Processing). Demographic variables had relatively small, but significant relationships with various component scores. Significant differences were observed between probable Alzheimer's disease and non-Alzheimer's type dementia groups on the memory component score, but not on other component scores or on RBANS index scores.     

Effects of chronic monocular enucleation on calcium binding proteins calbindin-D28k and parvalbumin in the lateral geniculate nucleus of adult rhesus monkeys

The calcium binding proteins parvalbumin and calbindin-D_28k were localized immunocytochemically within the lateral geniculate nucleus of adult monkeys at 1–7 months after monocular enucleation. Within the deafferented magno- and parvocellular layers, parvalbumin and calbindin-D_28k immunoreactive fibers were depleted at all post-enucleation times. The neuronal staining for parvalbumin was similar in numerical density and intensity between the deafferented and intact layers. In hemispheres examined at 5 and 7 months post-enucleation, parvalbumin-immunoreactive fibers were also lost within the deprived ocular dominance bands in layers IVA, IVC and VI of the visual cortex, suggesting that cellular expression or axonal transport of parvalbumin may be decreased in the deafferented geniculate laminae. While the intact magno- and parvocellular layers contained very few neurons that were immunoreactive for calbindin-D_28k, the density of calbindin-D_28k-positive neurons increased in these layers after deafferentation. The counts of calbindin-D_28k and parvalbumin immunostained neurons were not statistically different at 4–7 months post-enucleation. Because virtually all magno- and parvocellular projection neurons express parvalbumin, many parvalbumin neurons that normally do not contain calbindin-D_28k may co-express this in response to injury. The findings suggest that long-term deafferentation imposes additional calcium buffering requirements on lateral geniculate neurons.