Creating virtual 3-dimensional models for teaching pre-clinical tooth preparation: Students' usages and perceptions.

PURPOSE: This research aimed to evaluate the students' usage and perceptions of using smartphones in their general dental education and learning tooth preparation with the individually designed virtual 3D instructional models in the pre-clinical removable partial denture course. MATERIALS AND METHODS: Second-year dental students were asked to voluntarily participate in a survey to investigate their demographic information, general usages of smartphones, perception of smartphones usage in dental education (construct 1) and perception of individually designed virtual 3D instructional models (construct 2). Students' responses of general usages of the smartphones were compared with their demographic and educational backgrounds using nonparametric Kruskal-Wallis test (for age) and Fisher's exact test (for sex, race and educational background). The sums of scores of the construct 1 and construct 2 were tested for associations with student's demographic and educational backgrounds using the Pearson product-moment correlation (for age), t test (for sex and educational background) or one-way ANOVA F test (for race) (α = .05). RESULTS: A 75% response rate (N = 90) was achieved in this study, and all 90 participants owned smartphones. Students' responses to general usages of the smartphones were not significantly influenced by their demographic background. For the construct 1, more than 73% of participants responded either agree or strongly agree to the usage of smartphones in general dental education and pre-clinical setting; however, only 49% of participants responded the same way in the clinical setting. For the construct 2, 48 of 90 participants viewed the 3D models, and more than 73% of these 48 participants responded either agree or strongly agree to the usage of the 3D models in the pre-clinical course. Student's demographic background did not have significant influence on the sums of scores of the construct 1 and construct 2. CONCLUSIONS: Within the limitations of this study, high usages and ownerships of smartphones were found amongst the students surveyed. The individually designed virtual 3D instructional models as supplemental teaching materials in the pre-clinical course were perceived positively by the students.

Effect of smile index and incisal edge position on perception of attractiveness in different age groups.

Changes in occlusal vertical dimension (OVD) and age have been found to affect Smile Index (SI, width/height of smile). Limited information is available regarding the aesthetic effects of these changes. The objective of this study was to evaluate the attractiveness of digitally manipulated smile images with differences in SI and incisal edge position (IEP) judged by respondents in different age groups. A total of 12 smile images were generated with varying SI (3·5, 5·3, 7·2, 9·0) and IEP (High, Medium, Low). Fifty respondents each in four age groups (15-24, 25-39, 40-54, 55+) evaluated the attractiveness of the 12 images using a 0-10 visual analog scale (VAS, 10 being most attractive). A repeated-measures three-factorial mixed model assessed differences. SI, IEP and age of respondents were found to significantly influence attractiveness score (P < 0·01 for all). With all age groups combined, SI = 7·2/IEP = Medium was most attractive (VAS = 7·22), followed by SI = 9·0/IEP = Medium, and SI = 5·3/IEP = Medium (VAS = 6·53 and 6·48, respectively). SI = 3·5/IEP = High and SI = 3·5/IEP = Low were least attractive (VAS = 1·99 and VAS = 2·58, respectively). Age group significantly influenced aesthetic perception, with younger respondents more critical in differences in SI and IEP. SI and IEP significantly influenced attractiveness of the smile in all respondent age groups. Low SI (i.e. 3·5) combined with high or low IEP was unattractive. Medium SI to high SI (i.e. 5·3-9·0) combined with medium IEP were considered attractive.

Post-surgical neuromas in patients with total alloplastic temporomandibular joint reconstruction: a retrospective case series.

This study evaluated pain scores and maximal incisal opening (MIO) in patients with total alloplastic temporomandibular joints found to have post-surgical neuromas following revision arthroplasty, compared with patients who underwent revision arthroplasty without neuromas. 19 cases were reviewed of which 11 had neuromas excised. Data were available for 8 cases in the immediate postoperative period and 7 cases had follow-up data. 8 patients had revision arthroplasty with excision of scar tissue (7 with postoperative, 4 with long-term data). Follow-up ranged from 2 months to 5.9 years (mean 1.2 years). 6 of 8 patients obtained clinically significant pain reduction in the immediate postoperative period when their neuromas were excised, compared with 3 of 7 patients without neuromas. On long-term follow-up, 3 of 7 patients in the neuroma group had clinically significant pain reduction, 3 reported lower pain scores, 1 had no pain change. No patients had increased pain. 1 of 4 patients in the scar revision group had clinically significant pain reduction, 2 had no change, 1 reported increased pain. Mean MIO was 23 mm preoperative and 28 mm postoperative in patients with neuromas, compared with 27.75 mm and 31.25 mm, respectively, in patients without neuromas.

Prescribing for inpatients with schizophrenia: an international multi-center comparative study.

BACKGROUND: This study compares prescription practices for acute inpatients with schizophrenia among six academic departments located in China, Japan, Hungary, and the U.S. METHODS: Prescription data for a sample of 429 inpatients from six academic departments were collected on a randomly chosen census day. All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years. RESULTS: While patients at the different centers varied in their demographic and clinical characteristics, i. e., age, sex, and length of illness, a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied (i. e., number and dose antipsychotics, atypical and depot antipsychotics, other psychotropic drugs, multiple antipsychotics, and daily dose) except antidepressant use. In most cases these differences persisted even after adjusting for demographic and clinical characteristics (age, sex, and length of illness) of the subjects. Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs, including anticholinergics, anticonvulsants, benzodiazepines, and non-benzodiazepine hypnotics. Anticholinergic use was more common with typical antipsychotics. Rates of atypical antipsychotic drug use were lowest in the Japanese center. The Japanese center had by far the highest mean daily dose of antipsychotics. CONCLUSIONS: The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia. The results also confirm previous findings that prescribing practices for schizophrenia vary greatly among centers and countries. A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs, such as anticholinergics, hypnotics, anticonvulsants, and benzodiazepines, administered in multiple daily doses.

Effect of latanoprost 0.005% and brimonidine tartrate 0.2% on pulsatile ocular blood flow in normal tension glaucoma.

AIM: To determine the effect of brimonidine tartrate 0.2% and latanoprost 0.005% on pulsatile ocular blood flow (POBF) in patients with normal tension glaucoma (NTG). METHOD: NTG patients with progressive optic neuropathy, new disc haemorrhage, or field defects that threatened fixation were enrolled into a randomised, investigator masked, crossover study. Group I patients received 4 weeks each of latanoprost, lubricant, and brimonidine, while group II patients received 4 weeks each of brimonidine, lubricant, and latanoprost. Diurnal POBF was measured at baseline and after each 4 week treatment. RESULTS: 25 patients completed the study and had reliable POBF measurement at each visit. There was no significant diurnal change in baseline POBF (p = 0.768). Latanoprost increased POBF by 213 (SD 257) micro l/min (22.8%, p <0.001) while brimonidine increased it by 97 (183) micro l/min (10.4%, p = 0.014). POBF increased at 8 am (p = 0.004), 12 noon (p = 0.002), and 4 pm (p <0.001) with latanoprost, while it increased only at 8 am (p = 0.016) with brimonidine. After adjusting for the factor of IOP, neither latanoprost nor brimonidine increased POBF significantly. CONCLUSIONS: Latanoprost increases the mean POBF that is related to its IOP lowering effect. The increase in POBF noted after brimonidine is within the range of long term variation and may not be attributable to the drug effect.

Pulsatile ocular blood flow in asymmetric exudative age related macular degeneration.

BACKGROUND/AIMS: Decreased perfusion or increased vascular resistance of the choroidal vessels had been proposed as the vascular pathogenesis for age related macular degeneration (AMD). This study planned to answer the question whether pulsatile ocular blood flow (POBF) was different in patients with asymmetric exudative AMD between eyes with drusen, choroidal neovascularisation (CNV), or disciform scar. METHODS: 37 patients with asymmetric exudative AMD were enrolled in this observational case series study. POBF were measured in both eyes of each subject. Eyes with high myopia, anisometropia, recent laser treatment, and glaucoma were excluded. RESULTS: After adjusting for ocular perfusion pressure, intraocular pressure, and pulse rate, multivariate regression analysis with generalised estimating equation showed POBF was significantly higher in eyes with CNV (1217 (SD 476) microl/min) than the contralateral eyes with drusen (1028 (385) microl/min) (p = 0.024). Eyes with disciform scar had lower POBF than the contralateral eyes with drusen (999 (262) microl/min and 1278 (341) microl/min, respectively, p<0.001). There was no significant correlation between the POBF and the lesion size of the CNV. CONCLUSION: The POBF in eyes with drusen was lower than their fellow eyes with CNV, but higher than their fellow eyes with disciform scar. This finding suggests that haemodynamic differences between fellow eyes in individuals are relevant to the development of CNV and the formation of disciform scar. Further studies on the follow up patients might shed light on the pathogenesis of exudative AMD.

Convergent validity and neuropsychological correlates of the schedule for the assessment of negative symptoms (SANS) attention subscale.

Cognitive deficits have come to be viewed as a hallmark feature of schizophrenic illness. Although laboratory based assessment of patients' cognitive deficits has been well investigated, few studies to date have examined the utility of clinical ratings of cognitive symptoms using the Schedule for the Assessment of Negative Symptoms (SANS) attention subscale. In this report, we examined the convergence between clinical ratings of cognitive impairment using the SANS attention subscale and performance on a variety of neurocognitive tests designed to measure attentional impairment, as well as other cognitive constructs such as working memory and executive functioning. A total of 56 acute schizophrenic inpatients were clinically rated with the SANS and completed the Continuous Performance Test, Digit Span Distraction Test, Wisconsin Card Sorting Task, and the Trailmaking Test. A series of correlational and regression analyses were conducted to test the concurrent and discriminant validity of the SANS attention subscale. Performance measures of attention, but not working memory or executive functioning, were significantly correlated with and moderately predicted the severity of SANS rated inattention. Additionally, the attention subscale was discriminated from the other SANS negative symptom subscales in predicting a laboratory measure of attentional functioning. The SANS attention subscale demonstrated both concurrent and discriminant validity. These data indicate that attentional dysfunction in schizophrenia can be meaningfully rated and interpreted using the SANS.

Non-penetrating trabeculectomy for open angle glaucoma.

BACKGROUND: Non-penetrating trabeculectomy is used as the surgical intervention for open angle glaucoma. It has advantage of creating gradual filtration through the thin trabeculo-Descemet membrane to reduce markedly the postoperative complications typical for penetrating operation. We described our experience of the non-penetrating trabeculectomy for open angle glaucoma. METHODS: This is a retrospective study of 28 eyes of 28 patients with primary open glaucoma (POAG). Non-penetrating trabeculectomy was performed by one surgeon from July 1998 to March 2000. Examinations were performed preoperatively and postoperatively in 1 and 7 days and 1, 3, 6, 12 and 21 months. RESULTS: The mean follow-up was 12.5 +/- 6.3 months (S.D.). The mean preoperative intraocular pressure (IOP) was 27.8 +/- 6.7 mmHg. The mean postoperative IOP was 11.5 +/- 6.2 mmHg in 1 day and 15.7 +/- 5.8 mmHg in 1 week, and it remained stable in the following 12 months. IOP of 71.3% (20/28) of the eyes could be controlled below or equal to 21 mmHg with no or only topical antiglaucoma medication. There were only few postoperative complications. CONCLUSIONS: Non-penetrating trabeculectomy is efficient in controlling intraocular pressure of open angle glaucoma. No entering the anterior chamber diminishes the postoperative complications typical of the penetrating trabeculectomy.

Haloperidol blood levels in acute mania with psychosis.

In this study, the authors examined the relationship between steady-state haloperidol blood levels and clinical response in patients with acute psychotic mania. Fifty-four inpatients with acute mania were randomly assigned to receive either haloperidol 25 mg/day or haloperidol 5 mg/day. Each subject also received a concomitant medication: lorazepam 4 mg/day, lithium, or placebo. The relationship between steady-state haloperidol blood levels and clinical improvement was studied using analysis of covariance. There was wide interindividual variation in the haloperidol blood level-dose ratio. Haloperidol blood levels (log-transformed) were found to significantly correlate with clinical response in acute mania. Low-dose haloperidol with concomitant lithium may produce an optimal response in acute mania. Haloperidol blood levels may be clinically useful in identifying patients who are nonresponsive because of low drug levels and, hence, in enhancing optimal haloperidol dosing for acute mania with psychosis.

Color Doppler imaging study of retrobulbar hemodynamics in chronic angle-closure glaucoma.

PURPOSE: To evaluate the retrobulbar hemodynamics in patients with chronic angle-closure glaucoma (CACG) by using color Doppler imaging (CDI) and to correlate the degree of glaucomatous visual field loss with the hemodynamic parameters. DESIGN: Prospective case series. PARTICIPANTS AND CONTROLS: Twenty-six Chinese patients with CACG and 26 age-matched and gender-matched normal subjects were recruited. All CACG patients had history of chronic intraocular pressure (IOP) elevation and asymmetric visual field defects between their fellow eyes. After receiving laser peripheral iridotomy and/or filtration surgery, all of them had bilateral medication-free controlled IOP before enrolling into the study. METHODS: Each subject underwent CDI measurement in the central retinal artery (CRA) and the nasal and temporal short posterior ciliary arteries (PCA). Visual fields of the CACG patients were obtained with Humphrey 24-2 program. The visual field defects were scored with the Advanced Glaucoma Intervention Study (AGIS) system. For each CACG patient, the eye with lower AGIS score was defined as the better eye and the eye with higher score as the worse eye. MAIN OUTCOME MEASURES: Peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were determined. RESULTS: The EDV in the CRA and the temporal PCA was decreased significantly (P = 0.041 and 0.023, respectively) in the worse eyes of CACG patients compared with those in the control eyes. The better eyes of CACG patients showed no significant change in hemodynamic parameters compared with the control eyes. While comparing the fellow eyes of CACG patients, the worse eyes had significantly lower EDV in the temporal PCA (P = 0.012) than the contralateral better eyes. In 11 CACG patients with a difference of at least 8 in AGIS visual field scores between their fellow eyes, the worse eyes had significantly lower EDV (P = 0.041) in the CRA and lower PSV (P = 0.018) and EDV (P = 0.018) in the temporal PCA compared with those in the contralateral eyes. In multivariate regression analysis, the AGIS scores were significantly correlated with the PSV in the CRA (P = 0.015) and with the EDV (P < 0.001) and RI (P = 0.027) in the temporal PCA in patients with CACG. CONCLUSIONS: Patients with well-controlled CACG may have decreased retrobulbar blood flow velocities and increased vascular resistance in the CRA and temporal PCA. The degree of retrobulbar hemodynamic impairment was well correlated with the degree of glaucomatous visual field loss.

Characteristics of silicon nitride after O2 plasma surface treatment for pH-ISFET applications.

Silicon nitride (Si3N4) sensing gate pH-ion-selective field effect transistors (ISFETs) were treated by 2.54-GHz microwave O2 plasma, the results show the ISFET sensitivity has an advantage up to 24% increment after the plasma treatment. Electron spectroscopy for chemical analysis (ESCA) is used to make sure that the plasma treatment is not just a native oxide cleaning procedure. The samples, which were immobilized with glutaraldehyde used as a bifunctional reagent and 3-aminopropyItriethoxysilane used as an adhesion promoter were studied. The binding force between the glucose oxidase and glutaraldehyde immobilized samples, and the element concentrations of nitrogen in 3-aminopropyltriethoxysilane immobilized samples are higher which were treated by plasma.

Risperidone in acutely exacerbated schizophrenia: dosing strategies and plasma levels.

BACKGROUND: The optimal risperidone dosing strategy for acute schizophrenia requires elucidation. Furthermore, plasma levels of risperidone and its active metabolite (9-hydroxyrisperidone) at a given dose vary greatly among different individuals. For patients who metabolize risperidone slowly, a medium dose results in excessively high plasma levels, which might be related to adverse events and perhaps poor response. We thus investigated whether dose reduction to diminish adverse reactions associated with ordinary risperidone doses could still yield efficacy for acutely exacerbated schizophrenia. METHOD: Thirty-one newly hospitalized Chinese patients with acute exacerbation of schizophrenia (DSM-IV) entered this prospective, 6-week open trial. Risperidone doses were titrated to 6 mg/day (if tolerable) over 3 days, but were lowered thereafter if side effects appeared. Efficacy and side effect assessments were conducted on days 0, 4, 14, 28, and 42. Endpoint steady-state plasma levels of risperidone and 9-hydroxyrisperidone were analyzed by high performance liquid chromatography with ultraviolet detection. RESULTS: Thirty patients completed the trial. Of them, 17 tolerated the 6-mg target dose well, while the other 13 received lower final doses (mean +/- SD = 3.6 +/- 0.9 mg, p = .0001) for curtailing treatment-emergent side effects. At endpoint, 92.3% of the 13 low-dose individuals responded to treatment (20% or more reduction in the total Positive and Negative Syndrome Scale score), compared with 52.9% of the 17 high-dose subjects (p < .05). No significant between-group differences were revealed in other minor efficacy measures. Of note, endpoint plasma levels of the active moiety (risperidone plus 9-hydroxyrisperidone) were similar between the low- and high-dose groups (40.4 +/- 31.1 ng/mL vs. 49.7 +/- 13.4 ng/mL, NS). CONCLUSION: The results of this preliminary trial suggest that up to 6 mg of risperidone is efficacious in treating patients with acute exacerbation of schizophrenia. Nearly 60% of the patients could tolerate a 6-mg dose. For the other 40%, reducing dosages to 3.6 +/- 0.9 mg for relieving side effects still yielded efficacy. The 2 dose groups were comparable in the endpoint steady-state plasma drug concentrations.

Pretreatment plasma HVA and haloperidol response in acute mania.

INTRODUCTION: Pretreatment plasma homovanillic acid (HVA) levels have been reported to be a correlate of clinical response to typical antipsychotics for schizophrenic, bipolar manic, and mixed groups of psychotic patients. Biological markers of clinical response to antipsychotics could be useful for optimizing drug treatment. METHOD: Thirty-one consenting acute inpatient subjects between ages 19 and 66 years with a DSM-III-R clinical diagnosis of bipolar disorder, manic with psychotic features were entered into this double-blind study and were randomly assigned to receive either haloperidol 25 mg/day or haloperidol 5 mg for the 3-week study. Subjects also received one of the following concomitant medications: standard lithium, lorazepam 4 mg/day, or placebo. RESULTS: The primary multiple regression analysis, including all subjects on both haloperidol doses, yielded a significant main effect for pretreatment plasma HVA (n=31, F=5.7, P=0.025), indicating that higher pretreatment plasma HVA was predictive of better clinical response. In addition, the interaction between haloperidol dose and pretreatment plasma HVA was also significantly associated with clinical response (F=12.59, P=0.0015). When the two haloperidol doses were analyzed separately, we found that pretreatment plasma HVA was only correlated with clinical response in the low haloperidol 5 mg/day group (n=18, F=11.73, P=0.0038) and was unrelated to clinical response to the high haloperidol 25 mg/day group. LIMITATIONS: The sample size was small. Results may have been confounded by prior antipsychotic treatment and concomitant use of lithium or lorazepam. DISCUSSION: These results suggest that pretreatment plasma HVA could be useful for dosing antipsychotics. Patients with high plasma HVA levels would be good candidates for low-dose treatment because they are more likely to improve on such a dose, while patients with low plasma HVA levels might warrant more rapid dosage escalation.

A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group.

BACKGROUND: Long-term outcomes are often poor in patients with bipolar disorder despite treatment; more effective treatments are needed to reduce recurrences and morbidity. This study compared the efficacy of divalproex, lithium, and placebo as prophylactic therapy. METHODS: A randomized, double-blind, parallel-group multicenter study of treatment outcomes was conducted over a 52-week maintenance period. Patients who met the recovery criteria within 3 months of the onset of an index manic episode (n = 372) were randomized to maintenance treatment with divalproex, lithium, or placebo in a 2:1:1 ratio. Psychotropic medications were discontinued before randomization, except for open-label divalproex or lithium, which were gradually tapered over the first 2 weeks of maintenance treatment. The primary outcome measure was time to recurrence of any mood episode. Secondary measures were time to a manic episode, time to a depressive episode, average change from baseline in Schedule for Affective Disorders and Schizophrenia-Change Version subscale scores for depression and mania, and Global Assessment of Function scores. RESULTS: The divalproex group did not differ significantly from the placebo group in time to any mood episode. Divalproex was superior to placebo in terms of lower rates of discontinuation for either a recurrent mood episode or depressive episode. Divalproex was superior to lithium in longer duration of successful prophylaxis in the study and less deterioration in depressive symptoms and Global Assessment Scale scores. CONCLUSIONS: The treatments did not differ significantly on time to recurrence of any mood episode during maintenance therapy. Patients treated with divalproex had better outcomes than those treated with placebo or lithium on several secondary outcome measures.

Learning and memory impairment in cocaine-dependent and comorbid schizophrenic patients.

Impairments in verbal learning and memory functioning have been found to be cardinal features among individuals with schizophrenia as well as among non-schizophrenic cocaine abusers. Cognitive deficits in these areas, moreover, have been associated with poor treatment response and short-term outcome. Little is known, however, about the acute effects of cocaine abuse on schizophrenic patients' learning and memory functioning. Consequently, a potentially reversible and treatable source of cognitive impairment has been virtually ignored. The present study examined the extent of verbal learning and memory impairment in a group of cocaine-dependent schizophrenic patients (n=42) and a group of non-schizophrenic cocaine-dependent patients (n=21) within 72 h of the last cocaine use using the California Verbal Learning Test (CVLT). Schizophrenic patients (n=34) without any substance-use disorders were also tested in an identical time frame and served as a comparison group. Results revealed that all groups demonstrated significant learning and memory impairment relative to CVLT published age and gender corrected norms. Both cocaine-dependent and non-substance abusing schizophrenic groups presented a very similar pattern of impaired learning and recall performance across all CVLT task domains. Comorbid patients, in contrast, presented with marked deficits in their ability to learn and recall verbal information relative to either schizophrenic or cocaine-only groups. Moreover, the cocaine-abusing schizophrenic patients showed significant forgetfulness of the information that they did acquire during delayed recall conditions. The performance deficits exhibited by cocaine-abusing schizophrenic patients differed not only in relative severity of impairment, but also qualitatively in their increased rates of forgetfulness of acquired information. These results are interpreted in terms of the neurobiological substrates of learning and memory and the neurobiological impact of cocaine on schizophrenic patients' cognition during the early phase of inpatient hospitalization. These results suggest that comorbid patients should be targeted for specialized remediation efforts at the beginning phases of inpatient treatment.

Effect of mitomycin C for combined trabeculectomy and phacoemulsification.

BACKGROUND: To evaluate the efficacy and safety of intraoperative mitomycin C (MMC) for trabeculectomy combined with phacoemulsification (phacotrab) in patients with coexisting glaucoma and cataract. METHODS: We retrospectively reviewed the charts of consecutive patients who underwent phacotrab from July, 1996, to March, 1998. The pre- and postoperative intraocular pressure (IOP), number of glaucoma medications, visual acuity (VA), and postoperative complications were compared among 22 patients (22 eyes) who received intraoperative MMC and 18 patients (18 eyes) who did not receive MMC, served as the control group. Data of age, gender, type of glaucoma, number of glaucoma medications, cup-to-disc ratio of the optic nerve and the extent of visual field defects were also evaluated. Kaplan-Meier survival analysis was used to compare the surgical success rates between two groups. RESULTS: The mean IOP decreased from 16.1 +/- 4.2 mmHg to 10.94 +/- 3.6 mmHg in the MMC group, and from 18.7 +/- 6.9 mmHg to 14.6 +/- 1.9 mmHg in the control group at one year of follow-up. The mean postoperative IOPs were significantly lower in the MMC group than in the control group at one week, two weeks, and one, two, nine and 12 months. Postoperative mean VA log10 minimum angle of resolution (MAR) improved significantly in both groups. The mean number of medications decreased from 1.91 +/- 0.75 to 0.18 +/- 0.50 in the MMC group, and from 1.89 +/- 0.47 to 0.72 +/- 0.75 in the control group (p < 0.001 for both). The one-year complete success rate was significantly higher in the MMC group (p = 0.0038) than in the control group. No major complication was found throughout the study. CONCLUSIONS: Intraoperative MMC in phacotrab may improve postoperative filtration with less dependence on glaucoma medication. No significant adverse effects were associated with MMC application.

Clinical research on antipsychotics in bipolar disorder.

Antipsychotics are commonly used in bipolar disorder, both for acute mania and in maintenance treatment. The authors review available clinical research concerning the use of both conventional and atypical antipsychotics in bipolar disorder and present recommendations for a number of key clinical situations based on this review. They also consider a number of important related questions, including whether there is evidence for an increased risk of tardive dyskinesia (TD) in patients with bipolar disorder, the potential role for antipsychotics in the treatment of bipolar depression, the role of antipsychotics in maintenance treatment of bipolar disorder, the potential for antipsychotics to induce depression in bipolar illness, and whether antipsychotics can be considered mood stabilizers with a place as monotherapy for bipolar mania. They conclude that standard treatment for acute mania should begin with a mood stabilizer, with benzodiazepines used as an adjunct for mild agitation or insomnia and antipsychotics used as an adjunct for highly agitated, psychotic, or severely manic patients. They also conclude that atypical antipsychotics are preferable to conventional antispychotics because of their more favorable side effect profile and reduced risk of tardive dyskinesia. They review the evidence for using atypical antipsychotics as first-line monotherapy for mania and conclude that more evidence concerning the risk of TD and their efficacy as maintenance treatment in bipolar disorder is needed before a conclusion can be made. Should the eventual risk of TD associated with atypical antipsychotics be found to be minimal and their efficacy in maintenance treatment found to be high, they could eventually be considered first line monotherapy for bipolar disorder. They conclude that treatment with an antipsychotic during bipolar depression should be limited to those patients who have psychosis and that atypical antipsychotics are preferred over conventional antipsychotics in this situation, not only because of their reduced risk of side effects but also because theoretically they may have antidepressant efficacy due to their effects on the serotonin system. The clinical research findings summarized in the article are, for the most part, supported by a recently published guideline based on a consensus of clinical experts.

Acute mania: haloperidol dose and augmentation with lithium or lorazepam.

Antipsychotic dosing for acute mania has not been well studied. Combined treatment with lithium and an antipsychotic is the most common treatment, but additional antimanic efficacy of a lithium-antipsychotic combination beyond that of an antipsychotic alone has not been well demonstrated. Furthermore, the possibility that lithium could affect antipsychotic dose requirement is believed to have never been studied. In this study, 63 acutely psychotic bipolar manic inpatients were randomly assigned to receive double-blind treatment with 1 of 2 haloperidol doses, 25 mg/day or 5 mg/day, for 21 days. In addition to haloperidol, subjects were randomly assigned to receive concomitant treatment with placebo, standard lithium, or lorazepam 4 mg/day. The high haloperidol dose produced greater improvement and more side effects than did the low dose. Lithium added to the low dose produced a markedly greater clinical response than did the low dose alone. Lorazepam did not improve the outcome for the patients receiving low-dose haloperidol. The clinical response produced by high-dose haloperidol was not enhanced by adding either lithium or lorazepam. All treatment effects emerged by the fourth day of treatment and persisted. Used alone, a haloperidol dose of 5 mg/day is too low for most manic patients, but concomitant lithium produces a dose-dependent enhancement of haloperidol response. Lorazepam 4 mg/day was insufficient to produce an advantage when added to low-dose haloperidol.

Effects of latanoprost 50 micrograms/ml on Chinese patients with primary open-angle glaucoma and ocular hypertension.

BACKGROUND: This study was designed to determine the efficacy and safety of latanoprost 50 micrograms/ml in Chinese patients with primary open-angle glaucoma (POAG) and ocular hypertension (OH). METHODS: A 14-day randomized, double-masked, parallel-group study comparing topical latanoprost with placebo was followed by a 10-week, one-armed, open-labeled latanoprost treatment study. Intraocular pressure (IOP), visual function, ocular manifestations and miscellaneous adverse effects were evaluated at baseline, and days 1, 7, 14, 15, week 6 and week 12 visits. RESULTS: Twenty-six eligible patients were enrolled in the study. The mean IOP was significantly reduced from baseline only in the latanoprost-treated eyes during the first study period (p = 0.003 on day 1; p = 0.004 on day 7; p < 0.001 on day 14). Meanwhile, the mean IOP was significantly lower in the latanoprost-treated eyes than that in the placebo-treated eyes (p = 0.03 on day 1; p = 0.001 on days 7 and 14). Eyes in both groups showed significantly reduced IOP at each visit of the secondary 10-week latanoprost treatment period, with a mean decrease of 6.12 mmHg. The IOP-lowering effect showed no diminution throughout the study course. Conjunctival hyperemia occurred in 16 of all patients who underwent latanoprost treatment and was the most frequent adverse effect observed. No patient withdrew from the study because of intolerable side-effects. CONCLUSIONS: Topical latanoprost is effective in reducing IOP for patients with POAG and OH. The pressure-lowering effect lasts for at least 24 hours after 1 drop instillation and no drift of effect is noted during this 12-week study. Conjunctival hyperemia was the most common side-effect, which was mild in degree and recovered after discontinuation of the medication.