The effects of vagus nerve stimulation on the course and outcomes of patients with bipolar disorder in a treatment-resistant depressive episode: a 5-year prospective registry.

BACKGROUND: To compare illness characteristics, treatment history, response and durability, and suicidality scores over a 5-year period in patients with treatment-resistant bipolar depression participating in a prospective, multicenter, open-label registry and receiving Vagus Nerve Stimulation Therapy (VNS Therapy) plus treatment-as-usual (VNS + TAU) or TAU alone. METHODS: Response was defined as ≥ 50% decrease from baseline Montgomery-Åsberg Depression Rating Scale (MADRS) total score at 3, 6, 9, or 12 months post-baseline. Response was retained while MADRS score remained ≥ 40% lower than baseline. Time-to-events was estimated using Kaplan-Meier (KM) analysis and compared using log-rank test. Suicidality was assessed using the MADRS Item 10 score. RESULTS: At baseline (entry into registry), the VNS + TAU group (N = 97) had more episodes of depression, psychiatric hospitalizations, lifetime suicide attempts and higher suicidality score, more severe symptoms (based on MADRS and other scales), and higher rate of prior electroconvulsive therapy than TAU group (N = 59). Lifetime use of medications was similar between the groups (a mean of 9) and was consistent with the severe treatment-resistant nature of their depression. Over 5 years, 63% (61/97) in VNS + TAU had an initial response compared with 39% (23/59) in TAU. The time-to-initial response was significantly quicker for VNS + TAU than for TAU (p < 0.03). Among responders in the first year after implant, the KM estimate of the median time-to-relapse from initial response was 15.2 vs 7.6 months for VNS + TAU compared with TAU (difference was not statistically significant). The mean reduction in suicidality score across the study visits was significantly greater in the VNS + TAU than in the TAU group (p < 0.001). CONCLUSIONS: The patients who received VNS + TAU included in this analysis had severe bipolar depression that had proved extremely difficult to treat. The TAU comparator group were similar though had slightly less severe illnesses on some measures and had less history of suicide attempts. Treatment with VNS + TAU was associated with a higher likelihood of attaining a response compared to TAU alone. VNS + TAU was also associated with a significantly greater mean reduction in suicidality. LIMITATIONS: In this registry study, participants were not randomized to the study treatment group, VNS Therapy stimulation parameters were not controlled, and there was a high attrition rate over 5 years. Trial registration ClinicalTrials.gov NCT00320372. Registered 3 May 2006, https://clinicaltrials.gov/ct2/show/NCT00320372 (retrospectively registered).

Influence of delay between dental bleaching with 35% hydrogen peroxide and orthodontic brackets on the bond strength at the enamel/adhesive interface.

BACKGROUND: The aim of this study was to evaluate the influence of waiting time between the bleaching with 35% hydrogen peroxide and orthodontic brackets bonding on shear bond strength (SBS) in enamel. MATERIAL AND METHODS: Eighty bovine teeth were randomly divided into four groups (G): G1(negative control) and G2, G3 and G4 (experimental groups). The experimental groups were submitted to bleaching. Prior to orthodontic brackets bonding to enamel the procedure was adopted different waiting times, as follows: G2 (1 day); G3 (7 days) and G4 (14 days). It was performed enamel etching (30s), washing water (30s), application of adhesive system followed by photoactivation (20s). A thin layer of composite resin was placed between the adhesive and the brackets. The applied pressure was measured by tensiometer (300N/40s). The composite resin was light-cured (40s). After 24 hours the shear test was held (0.5mm/min). To compare the SBS it was used ANOVA one-way followed by Tukey test (α = 0.05). The Adhesive Remaining Index (ARI) was analyzed using the Kruskal-Wallis test. RESULTS: The SBS values were significantly lower in G2 (15.51 MPa) and G3 (17.77 MPa) compared to G1 (30.14 MPa) and G4 (28.50 MPa) (p<0.05). The ARI revealed significant difference between the G3 and the other groups (p<0.05). CONCLUSIONS: It was concluded that the bond strength in enamel in the interfaces/adhesive system/composite resin/orthodontic brackets was more effective 14 days after the bleaching with 35% hydrogen peroxide. Key words:Dental materials, teeth bleaching, orthodontic brackets.

2.5 years on: what are the effects of a 'frequent attenders' service in the Emergency Department?

This study focused on an evaluation over 2.5 years to establish if a frequent attenders' service in an Emergency Department (ED) impacted on the overall number of patients attending as well as the numbers of their attendances. For this, three patient lists from April-September 2015 and three lists from a matched period in 2017 were randomly selected and the two samples compared. Results showed both a reduction in the number of total patients identified as frequent attenders as well as a reduction on the number of attendances to ED. The study suggests that the implementation of a frequent attenders' service is associated with benefits, not only for the individual attendances per patient, but also in an overall reduction of the number patients classed as frequent attenders.Declaration of interestThe authors have no conflict of interest to declare regarding this manuscript.

Are temporomandibular joint signs and symptoms associated with magnetic resonance imaging findings in juvenile idiopathic arthritis patients? A longitudinal study.

The aims of this longitudinal study were to perform a comprehensive clinical evaluation of temporomandibular joint (TMJ) and to investigate the association between the clinical and magnetic resonance imaging (MRI) findings in the TMJs of patients with juvenile idiopathic arthritis (JIA). Seventy-five patients with JIA participated in this study. All patients underwent a rheumatological examination performed by a paediatric rheumatologist, a TMJ examination performed by a single dentist and an MRI with contrast of the TMJs. These examinations were scheduled on the same date. The patients were examined again 1 year later. Twenty-eight (37.3 %) patients reported symptoms at the first evaluation and 11 (14.7 %) patients at the second evaluation. In relation to signs, 35 (46.7 %) of the patients presented at least one sign at the first evaluation and 29 (38.7 %) at the second. Intense contrast enhancement of TMJ was significantly associated with disease activity (p < 0.001) at the first evaluation and a trend to significance was observed at the second (p = 0.056), with poly/systemic subtypes (p = 0.028 and p = 0.049, respectively), with restricted mouth opening capacity (p = 0.013 and p = 0.001, respectively), with the presence of erosions at both evaluations (p = 0.0001 and p < 0.0001, respectively) and with altered condylar shape at the second evaluation (p = 0.0005). TMJ involvement is highly prevalent in JIA patients, with asymptomatic children presenting severe structural alterations of the TMJ. The TMJ should always be evaluated in JIA patients, even in the absence of signs and symptoms.

Craniofacial bone abnormalities and malocclusion in individuals with sickle cell anemia: a critical review of the literature.

This study aims to critically review the literature in respect to craniofacial bone abnormalities and malocclusion in sickle cell anemia individuals. The Bireme and Pubmed electronic databases were searched using the following keywords: malocclusion, maxillofacial abnormalities, and Angle Class I, Class II and lass III malocclusions combined with sickle cell anemia. The search was limited to publications in English, Spanish or Portuguese with review articles and clinical cases being excluded from this study. Ten scientific publications were identified, of which three were not included as they were review articles. There was a consistent observation of orthodontic and orthopedic variations associated with sickle cell anemia, especially maxillary protrusions. However, convenience sampling, sometimes without any control group, and the lack of estimates of association and hypotheses testing undermined the possibility of causal inferences. It was concluded that despite the high frequency of craniofacial bone abnormalities and malocclusion among patients with sickle cell anemia, there is insufficient scientific proof that this disease causes malocclusion.

Craniofacial bone abnormalities and malocclusion in individuals with sickle cell anemia: a critical review of the literature

This study aims to critically review the literature in respect to craniofacial bone abnormalities and malocclusion in sickle cell anemia individuals. The Bireme and Pubmed electronic databases were searched using the following keywords: malocclusion, maxillofacial abnormalities, and Angle Class I, Class II and lass III malocclusions combined with sickle cell anemia. The search was limited to publications in English, Spanish or Portuguese with review articles and clinical cases being excluded from this study. Ten scientific publications were identified, of which three were not included as they were review articles. There was a consistent observation of orthodontic and orthopedic variations associated with sickle cell anemia, especially maxillary protrusions. However, convenience sampling, sometimes without any control group, and the lack of estimates of association and hypotheses testing undermined the possibility of causal inferences. It was concluded that despite the high frequency of craniofacial bone abnormalities and malocclusion among patients with sickle cell anemia, there is insufficient scientific proof that this disease causes malocclusion.