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Objectives Early intervention and preventive strategies have become major targets of research and service development in psychiatry over the last few years. Compared to schizophrenia, bipolar disorder ( BD) has received limited attention in this regard. In this paper, we review the available literature in order to explore the public health significance of BD and the extent to which this may justify the development of early intervention strategies for this disorder. Methods The main computerized psychiatric literature databases were accessed. This included Medline and PsychInfo, using the following keywords: bipolar, early intervention, staging model, burden, caregiver, public health, and manic depression. Results BD is often recurrent and has an impact that goes well beyond symptomatic pathology. The burden it incurs is linked not only to its cardinal clinical features, but also to cognitive dysfunction, poor functional outcome, poor physical health, high rate of comorbidities, and suicide. At a societal level, BD induces enormous direct and indirect costs and has a major impact on caregivers. The available literature reveals a usually long delay between illness onset and the start of treatment, and the absence of specific guidelines for the treatment of the early phase of BD. Conclusions Considering the major impact of BD on patients and society, there is an urgent need for the development of early intervention strategies aimed at earlier detection and more specific treatment of the early phase of the disorder. [ABSTRACT FROM AUTHOR]

Aims Metabolic dysregulation may disrupt the complex neuroprotective mechanisms essential for brain health. Recent studies have pointed out the possible aetiological role of metabolic dysregulation in the onset of schizophrenia and the associated cognitive impairment. In this paper, we aimed to generate a theoretical model of how a combination of physical exercise and dietary glucose supplement may help to alleviate cognitive impairment in schizophrenia. Methods Literature on metabolic dysregulation, especially insulin resistance, in relation to the onset of schizophrenia and the associated cognitive impairment is reviewed. The cognitive enhancement effects of physical exercise and dietary glucose supplement are then summarised. Finally, we propose a theoretical model based on the concerted effects of physical exercise and glucose supplement. Results In general, the joint action of physical exercise and dietary glucose supplement could up-regulate glucose and insulin transport into the brain, as well as augmenting the release of insulin growth factor-1 and brain-derived neurotrophic factor. Physical exercise and glucose supplement could enhance energy supply and neuroplasticity in brain, subsequently leading to potential cognitive enhancement in schizophrenia. However, glucose supplement is not suitable for patients with abnormal metabolic profile. Conclusions The combination of physical exercise and glucose supplement has potential therapeutic values in treating cognitive impairment in schizophrenia. Further research is necessary to investigate the optimal patterns of exercise and doses of glucose for treating cognitive impairment in schizophrenia. [ABSTRACT FROM AUTHOR]

Objectives Physical exercise has been associated with a range of positive outcomes including improvements in psychological well-being. The aim of the present study was to review current evidence on the effects of physical activity interventions for carers of people with dementia. Methods Systematic review. We searched electronic databases and key articles of studies that have evaluated the effectiveness of physical activity interventions in improving psychological well-being in carers of people with dementia. Relevant papers were scored according to established criteria set by the Cochrane Review Group. Selection criteria for studies were a randomized controlled trial (RCT) design, and comparing physical activity with a control group receiving no specific physical activity intervention. Two reviewers worked independently to select trials, extract data, and assess risk of bias. Results A total of four RCTs met the inclusion criteria. Studies evaluated home-based supervised physical activity of low to moderate intensity, which included either aerobic exercise, or endurance training. Pooled data showed that physical activity reduced subjective caregiver burden in carers, standardized mean difference −0.43; 95% confidence interval (CI) −0.81 to −0.04, in comparison to a control group of usual care. Conclusions There is evidence from two RCTs that physical activity reduces subjective caregiver burden for carers of people with dementia. Although statistically significant, the observed benefits should be interpreted with caution as the studies conducted so far have limitations. Further high-quality trials are needed for evaluating the effectiveness of physical activity in improving psychological well-being in carers of people with dementia. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A recently published study by Butler et al. concluded that incretin treatment had adverse effects on the human type 2 diabetic pancreas including 'a marked expansion of the exocrine and endocrine pancreatic compartments, the former being accompanied by increased proliferation and dysplasia and the latter by α-cell hyperplasia with the potential for evolution into neuroendocrine tumours'. Incretin therapy has become widely used for type 2 diabetes, so these conclusions have instigated major concerns with regard to patient safety. We reassessed both the clinical case information and virtual microscopy images of the same 34 cases that were used in the Butler study as well as Network for Pancreatic Organ Donation ( nPOD) cases that were not included. Whereas we would like to stress that it is important to investigate in depth any indication that incretin treatment may lead to inflammation or dysplasia in the pancreas, we find that the data presented in the Butler paper have serious methodological deficiencies that preclude any meaningful conclusions. [ABSTRACT FROM AUTHOR]

Background Methylchloroisothiazolinone ( MCI) and methylisothiazolinone ( MI) are the active ingredients in commonly used preservative systems (e.g. Kathon CG®). MCI/ MI is present in the European baseline patch test series at 100 ppm aq. Since 1986, 200 ppm (dose 0.006 mg/cm2) has been used in Sweden without causing skin irritation. Centres in Spain, the United Kingdom and Ireland have also used 200 ppm in their baseline series. Objectives To find the optimal patch test concentration for MCI/ MI. Materials and methods MCI/ MI 100 ppm aq. and MCI/ MI 200 ppm aq. were simultaneously patch tested in 3300 consecutively tested dermatitis patients at eight European patch test clinics and one US patch test clinic. With the Finn Chambers® technique (diameter 8 mm), 15 µl was micropipetted on to the filter paper in the chamber. The corresponding volume for Van der Bend® chambers was 20 µl, and that for IQ Chambers® was 25 µl. Results Contact allergy to MCI/ MI at 100 and 200 ppm was found in 1.2% and 2.1% of patients, respectively ( p < 0.001). Conclusions MCI/ MI 200 ppm aq. (dose 0.006 mg/cm2) diagnoses significantly more contact allergy than the presently used concentration of 100 ppm (dose 0.003 mg/cm2), without resulting in more adverse reactions. MCI/ MI at 200 ppm should therefore be considered for inclusion in the European baseline test series. [ABSTRACT FROM AUTHOR]

Date (Phoenix dactylifera L.) pits, by-products of date fruit processing industries, can provide many essential nutrients and potential health benefits to the human body. The chemical composition of date pits includes dietary fiber, fat, protein, minerals, sugar, antioxidants, and phytosterols. Nutritional and medicinal activities of date pits are related to their chemical composition. Many studies indicate that date pits have antioxidant, anti-inflammatory, gastroprotective, antiviral, hepatoprotective, nephroprotective, and gonadotropic activities. Date pits have shown a potential application in the food, fermentation, chemical, and feed industries. In this paper, we review chemical composition, nutritional and medicinal value, and the utilization of date pits. [ABSTRACT FROM AUTHOR]

LINKED CONTENT This article is linked to Rundquist et al and Roblin et al. papers. To view these articles, visit https://doi.org/10.1111/apt.16193 and https://doi.org/10.1111/apt.16212 [ABSTRACT FROM AUTHOR]

LINKED CONTENT This article is linked to Rundquist et al papers. To view these articles, visit https://doi.org/10.1111/apt.16193 and https://doi.org/10.1111/apt.16241 [ABSTRACT FROM AUTHOR]

LINKED CONTENT This article is linked to Lim et al papers. To view these articles, visit https://doi.org/10.1111/apt.16149 and https://doi.org/10.1111/apt.16226 [ABSTRACT FROM AUTHOR]

It seems like the intersection of public policy and psychopharmacology has been very crowded over the past 18 months. Given the events of the past couple of years and the scope of our field, I suppose that shouldn't be surprising. Maybe our colleagues in other medical disciplines feel the same way (I'm looking at you, infectious disease specialists). In any case, loath as I am to contribute to the traffic jam, a paper I saw recently in BMJ compels comment. [ABSTRACT FROM AUTHOR]

Linked Content This article is linked to Strik et al and Strik, D'Heans papers. To view these articles visit https://doi.org/10.1111/apt.13994 and https://doi.org/10.1111/apt.14071. [ABSTRACT FROM AUTHOR]

Linked Content This article is linked to W. E. Whitehead et al papers. To view these articles visit https://doi.org/10.1111/apt.13957 and https://doi.org/10.1111/apt.13839. [ABSTRACT FROM AUTHOR]

A commentary on a paper which describes a case of a mandibular degloving injury of a 5-month-old colt that responded well to surgical repair with transmandibular horizontal mattress sutures is presented. Topics covered include factors that likely enhance the healing of wounds within the oral cavity, factors to consider when selecting the suture material to use in the oral cavity and examination of injuries.

A great deal of research has addressed the elevation of C-reactive protein (CRP) among psoriatic patients and the role of this marker in assessment of disease severity and progression. However, there are some discrepancies in this area. We sought to figure out the relationship between CRP values and disease severity as well as the changes in marker levels after treatment through an extensive literature review. Comparison between CRP levels in psoriatic patients and those in healthy or non-psoriatic individuals was also another focus of this review. A thorough search in Pubmed and Embase was conducted for articles investigating different aspects of CRP measurement in patients with psoriasis. Overall, 32 articles were found to meet our inclusion criteria. Of 28 studies comparing the CRP values in psoriatic patients with those of controls, 24 found a statistically significant difference. In addition, 12 out of 16 papers examining the association between disease severity and CRP values noted significant results. With regard to CRP changes over the course of a treatment, all 15 studies addressing this issue revealed a significant decrease in marker levels. In conclusion, high CRP levels only for moderate and severe forms of disease might be inferred from the literature and there is no sufficient evidence suggesting a similar association for mild disease as well. Moreover, CRP may serve interchangeably with Psoriasis Area and Severity Index ( PASI) as a measure of disease severity in the case of untreated psoriatic patients who do not have disease related arthritis. For other patients, however, a careful clinical examination and PASI calculation still remain the mainstay of severity assessment. [ABSTRACT FROM AUTHOR]

Problem Recent concerns that hormonal contraception ( HC) may increase risk of HIV acquisition has led to keen interest in using non-human primates ( NHP) to understand the underlying mechanism and the magnitude of the risk. This is, in part, because some experiments which would be difficult or logistically impossible in women are more easily conducted in NHP. Method of study NHP models of HIV can inform HIV acquisition and pathogenesis research and identify and evaluate biomedical preventions and treatments for HIV/ AIDS. Widely used species include rhesus, pigtail, and cynomolgous macaques. Results This paper reviews past, current and proposed NHP research around the intersection of HIV and HC. Conclusion NHP research may lead to the identification of hormonally regulated biomarkers that correlate with HIV-acquisition risk, to a ranking of existing or next-generation HC along an HIV-acquisition risk profile, and inform research around new biomedical preventions for HIV. [ABSTRACT FROM AUTHOR]

Background Most of the drugs used in anesthesia are off-label in children even if they present solid clinical evidence in adults. This lack of authorization is caused by multiple factors including the difficulty in conducting research in this area (due to the ethical concerns and/or the low number of available participants, the high variability of the outcome measures) and the lack of economic interest of the pharmaceutical companies (due to the limited market). Objective Define a list of medicinal products commonly used off-label in pediatrics anesthesia to be reimbursed by Italian National Health System. Methods and results We hereby describe the methodological framework used to allow reimbursed use of a list of medicinal products, widely used off-label in pediatric patients, ensuring the best therapeutic results with the lowest possible risk for children. A task force of pediatric anesthesiologists from Italy petitioned the Italian Medicines Agency ( AIFA) to allow a number of commonly utilized but off-label drugs for pediatric anesthesia to be reimbursed for specific indications. For each drug, both the supporting literature and expert opinion were used, and the resulting list of drugs allowed to be used/reimbursed officially by AIFA was significantly expanded. This paper documents one approach to the problem of off-label use of drugs for pediatric patients that can be a model for future efforts. Conclusion Continuous efforts are needed from government institutions and sponsors on drug development and on drug approval process in pediatrics, as research on drug effectiveness and safety is mandatory in children as in adults. At the same time, clinicians must become more familiar with the drug-approval process, participate to sponsored trials, and perform ztrials themselves. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper describes a therapeutic mentoring program involving 150 children over a period of three years. The program is operated from an outpatient clinic, in this case using psychodynamic supportive therapy delivered in the home as a clinical hub for high-risk families referred by child welfare, juvenile justice, or courts. This program is part of Massachusetts Children's Behavioral Health Initiative (CBHI, 2013). This model of therapeutic mentoring requires all youth be involved with individual or family therapy and that the technique is designed to stabilize aggressive behavior in the community and begin to develop lasting social skills that can be sustainable in the community as a protective factor against poverty, social deviance and violence. The process of mentoring is viewed as an adjunct to therapy and a concrete way to practice mentalizing while learning to engage in a positive community activity. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Wilson's disease is an autosomal recessively inherited copper overload disorder that leads to hepatic and/or neurologic symptoms. More than a century after the first description of Wilson's disease, the available medical treatment options have not been standardized. The efficacy of the commonly used drugs is satisfactory for hepatic disease, but disappointing in the neurologic patients, including the risk of neurologic deterioration after the initiation of chelation therapy. An approach to overcome this problem is the careful and systematic assessment of biochemical response patterns and the quantitative monitoring of symptoms using validated rating scales. Standardized dosage strategies that address changes in copper pools might improve adherence and reduce side effects. Such an approach may reduce long-term morbidity. In this paper, we discuss considerations for an effective medical treatment and requirements for future studies in Wilson's disease. [ABSTRACT FROM AUTHOR]

Objective At least 50% of bipolar disorder ( BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive-compulsive disorder ( OCD). Defining the nosology of BD- OCD comorbidity has important clinical implications, given that treatments for OCD can worsen BD outcomes. Method A systematic review was conducted on: i) BD- OCD comorbidity lifetime prevalence and ii) on standard diagnostic validators: phenomenology, course of illness, heredity, biological markers, and treatment response. Relevant papers published through March 30th 2013 were identified searching the electronic databases MEDLINE, Embase, Psyc INFO, and the Cochrane Library. Results Sixty-four articles met inclusion criteria. Lifetime comorbidity prevalence was 11-21% in BD patients and 6-10% in OCD patients. Compared to non-comorbid subjects, BD- OCD has a more episodic course of OC symptoms (up to 75% vs. 3%), typically with worsening during depression (78%) and improvement during mania/hypomania (64%), as well as a higher total mean number of depressive episodes (8.9 ± 4.2 vs. 4.1 ± 2.7) and perhaps more antidepressant-induced mania/hypomania (39% vs. 9%). Conclusion In this first systematic review of BD- OCD comorbidity, it appears that OC symptoms are usually secondary to BD, rather than representing a separate disease. [ABSTRACT FROM AUTHOR]

Objective This paper aimed to evaluate the effects of coadministered immediate-release morphine and ethanol on safety, pharmacokinetic, and pharmacodynamic measures. Methods In the first stage of a randomized, double-blind, placebo-controlled, crossover study, 16 healthy men with a history of moderate drinking received morphine 50 mg + ethanol 0.7 g/kg, morphine 50 mg + ethanol placebo, and morphine placebo + ethanol 0.7 g/kg. In the second stage, participants received either a lower (30 mg) or higher (80 mg) morphine dose (alone and in combination with ethanol) depending on their tolerability to treatments in stage 1. Safety, pharmacodynamic (including visual analog scales, pupillometry, capnography, and psychomotor and cognitive measures), and pharmacokinetic assessments were conducted. Results With the exception of one severe adverse event (AE), all others were mild or moderate in intensity. Morphine resulted in dose-related increases in AEs. When morphine was administered with ethanol, similar AEs were observed (dizziness, headache, somnolence, nausea, and vomiting), but these were sometimes more frequent compared with those observed with either drug alone. No consistent additive or interaction effects were observed on pharmacodynamic measures. Ethanol had no apparent effects on the pharmacokinetics of morphine or its metabolites. Conclusions Coadministration of single doses of morphine and ethanol tested in this study did not affect the safety, pharmacodynamics, or pharmacokinetics of morphine or ethanol administered alone. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim To compare the chemomechanical reduction and regrowth of Enterococcus faecalis between rotary and reciprocating systems in root canal preparation. Methodology Seventy-six single-rooted human mandibular premolars were selected and standardized to 15 mm in length. Root canals were enlarged up to a size 25 K-file and irrigated with distilled water and then were infected with E. faecalis for 4 weeks. The specimens were divided into 3 groups ( n = 24) for instrumentation with Mtwo, Twisted File and WaveOne. Each group was further divided into two subgroups ( n = 12) according to the irrigant used: distilled water or 5.25% sodium hypochlorite ( NaOCl). Before and after rotary preparation, microbiological samples were collected using three sterilized paper points, and efficacy was expressed as reduction in percentage. The proportion of grown samples for 60 days was evaluated using nonparametric Kaplan- Meier survival analysis. Differences amongst groups were tested using the log-rank test at a significance level of 0.05. Results In the main root canal, the percentage reduction in the distilled water and 5.25% NaOCl groups ranged from 95.9% to 100%, with no significant differences amongst the three systems ( P > 0.05). The bacterial regrowth in NaOCl groups revealed that Mtwo had the lowest number of samples regrown at 60 days, giving statistically significant differences with respect to Twisted File ( P = 0.029) and WaveOne ( P = 0.005). Conclusions Reciprocating and rotary systems resulted in similar percentage reduction in E. faecalis when using either distilled water or 5.25% NaOCl solution. Over time, the Mtwo system was more effective regarding disinfection. [ABSTRACT FROM AUTHOR]

Antiseptics used in endodontics for disinfection purposes include root canal dressings and irrigants. Osmotic shock is known to cause the alteration of microbial cell viability and might have a role in the mechanism of action of root canal antiseptics. The aim of this review was to determine the role of osmolarity on the performance of antiseptics in root canal treatment. A literature search using the Medline electronic database was conducted up to 30 May 2013 using the following search terms and combinations: 'osmolarity AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmolality AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmotic AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmosis AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; sodium chloride AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm'. Publications were included if the effects of osmolarity on the clinical performance of antiseptics in root canal treatment were stated, if preparations with different osmolarities values were compared and if they were published in English. A hand search of articles published online, 'in press' and 'early view', and in the reference list of the included papers was carried out following the same criteria. A total of 3274 publications were identified using the database, and three were included in the review. The evidence available in endodontics suggests a possible role for hyperosmotic root canal medicaments as disinfectants, and that there is no influence of osmolarity on the tissue dissolution capacity of sodium hypochlorite. There are insufficient data to obtain a sound conclusion regarding the role of hypo-osmosis in root canal disinfection, or osmosis in any further desirable ability. [ABSTRACT FROM AUTHOR]

The evolution in adhesive dentistry has broadened the indication of esthetic restorative procedures especially with the use of resin composite material. Depending on the clinical situation, some restorative techniques are best indicated. As an example, indirect adhesive restorations offer many advantages over direct techniques in extended cavities. In general, the indirect technique requires two appointments and a laboratory involvement, or it can be prepared chairside in a single visit either conventionally or by the use of computer-aided design/computer-aided manufacturing systems. In both cases, there will be an extra cost as well as the need of specific materials. This paper describes the clinical procedures for the chairside semidirect technique for composite onlay fabrication without the use of special equipments. The use of this technique combines the advantages of the direct and the indirect restoration. Clinical Significance The semidirect technique for composite onlays offers the advantages of an indirect restoration and low cost, and can be the ideal treatment option for extended cavities in case of financial limitations. [ABSTRACT FROM AUTHOR]

Comorbidity is a well-established and documented phenomenon in mental disorders and medicine with heuristic value. The concept of comorbidity remains however poorly defined and lacks a comprehensive and coherent theoretical framework. There is a need to develop coherent methodological strategies in order to promote a fuller understanding of the implications of comorbidity and to exploit its potential value with regard to etiopathogenic and therapeutic issues. This position paper makes recommendations of improved methodological standards and procedures and discusses a range of options that can provide incremental information that is likely to improve therapeutic outcomes. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Cognitive problems early after surgery are often considered transient in nature. Neuropsychological performance and its relation to other recovery parameters have rarely been systematically assessed during this period. Methods A subanalysis of the Post-operative Quality of Recovery Scale ( PQRS) feasibility study included patients who completed the PQRS on day 3, and were categorised as recovered or not recovered in the cognitive domain using the revised scoring method. Results Of the 449 patients included in this paper, 388 (86.4%) recovered in the cognitive domain and 61 (13.6%) had not recovered at 3 days. Cognitive recovery in the early post-operative time points up to day 1 was significantly lower in patients who had not recovered at day 3 ( P < 0.001). Of those not recovered on day 3, 59.1% had recovered on day 1, but lapsed to non-recovery on day 3. The non-recovered group demonstrated less recovery in the physiological ( P = 0.019), activity of daily living ( P = 0.049) and nociceptive ( P = 0.033) domains, but no difference was found in the emotive domain. The non-recovered group had a higher incidence of major surgery ( P = 0.021), a higher proportion of patients with difficulty eating (4.9% vs. 0.5%, P = 0.002 and a clinically unimportant but lower temperature (36.6° vs. 36.4°C, P = 0.010). Conclusion Failure of cognitive recovery is reasonably common 3 days after surgery, can fluctuate and is associated with poorer early recovery in the activities of daily living, nociceptive and physiological domains. [ABSTRACT FROM AUTHOR]

Objectives Thyroid hormones play a critical role in the functioning of the adult brain, and thyroid diseases impair both mood and cognition. This paper reviews gender differences in thyroid system function that are relevant to the diagnosis and treatment of bipolar disorder. Methods The study comprised a comprehensive literature review of gender differences in thyroid disease that are pertinent to mood disorders. Results The prevalence of thyroid disease was found to be much higher in females than males, and to increase with age. The most commonly detected abnormality was subclinical hypothyroidism, which was found to occur in up to 20% of postmenopausal women. Females also had higher rates of thyroid autoimmunity. Individuals at risk for thyroid disease, such as adult females, may have had less ability to compensate for additional challenges to thyroid metabolism, including lithium treatment. Thyroid abnormalities were associated with a poorer response to standard treatments for mood disorders. Females with treatment-resistant mood disorders may have responded better than males to adjunctive therapy with thyroid hormones. Conclusions Disturbances of thyroid system function, which occur commonly in females, may complicate the diagnosis and treatment of mood disorders. In particular, this is clinically relevant during lithium treatment because lithium may impair vital thyroid metabolic pathways secondary to its anti-thyroid activity. [ABSTRACT FROM AUTHOR]

Predicting the final result is a very important factor in implant restorations. When a fixed implant-supported restoration is planned for the restoration of completely edentulous patients, it is important to recognize the esthetic performance of the prosthesis in the initial stages. Bone resorbtion may result in an unfavorable interarch relationship, and soft tissue support may be needed. A detailed presurgical evaluation (including tooth setup, construction of radiological and surgical guide) is needed to ensure the placement of implants in prosthetically favored positions. In this paper, a technique is presented where a detailed wax-up of the restoration is accomplished on provisional implant abutments and tried on the patient after implant placement. This setup may offer valuable information on the expected lip support and the need of gingiva-colored ceramic. In this way, the esthetic result can be evaluated at early stages before any irreversible laboratory stages are performed and needed corrections can be done accordingly. Clinical Significance In extended implant-supported fixed restorations, it is very important to predict the final esthetic result at an early stage. The presented technique allows a safe and accurate evaluation of the expected esthetic result before any construction stage. [ABSTRACT FROM AUTHOR]

Context The urinary reconstructive options available after radical cystectomy ( RC) for bladder cancer are discussed, as are the criteria for selection of the most appropriate diversion, and the outcomes and complications associated with different diversion options., Objective To critically review the peer-reviewed literature on the function and oncological outcomes, complications, and factors influencing choice of procedure with urinary diversion after RC for bladder carcinoma., Evidence Acquisition A Medline search was conducted to identify original articles, review articles, and editorials on urinary diversion in patients treated with RC. Searches were limited to the English language., Keywords included: 'bladder cancer', 'cystectomy', 'diversion', 'neobladder', and 'conduit'., The articles with the highest level of evidence were selected and reviewed, with the consensus of all of the authors of this paper., Evidence Synthesis Both continent and incontinent diversions are available for urinary reconstruction after RC. In appropriately selected patients, an orthotopic neobladder permits the elimination of an external stoma and preservation of body image without compromising cancer control. However, the patient must be fully educated and committed to the labour-intensive rehabilitation process. He must also be able to perform self-catheterisation if necessary., When involvement of the urinary outflow tract by tumour prevents the use of an orthotopic neobladder, a continent cutaneous reservoir may still offer the opportunity for continence albeit one that requires obligate self-catheterisation., For patients who are not candidates for continent diversion, the ileal loop remains an acceptable and reliable option., Conclusions Both continent and incontinent diversions are available for urinary reconstruction after RC., Orthotopic neobladders optimally preserve body image, while continent cutaneous diversions represent a reasonable alternative., Ileal conduits represent the fastest, easiest, least complication-prone, and most commonly performed urinary diversion. [ABSTRACT FROM AUTHOR]

Probably the greatest challenge to those managing patients with oral diseases is the dilemma of attempting to predict which oral erythroplakias, leukoplakias, lichenoid and other potentially malignant mucosal disease ( PMD) such as oral submucous fibrosis will progress to neoplasia - notably oral squamous cell carcinoma ( OSCC). The paper reviews progress over the past decade and the application to the clinical situation. [ABSTRACT FROM AUTHOR]

Recently, attention has turned to the possibility of enhancing human cognitive abilities via pharmacological interventions. Known as 'cognitive enhancers', these drugs can alter human mental capacities, and in some cases can effect significant improvements. One prime example is modafinil, a drug used to treat narcolepsy, which can help combat decreases in wakefulness and cognitive capacity that arise due to fatigue in otherwise healthy individuals. In this paper, we respond to calls in the philosophical and ethical literature that surgeons and other medical professionals should be morally obliged to take cognitively enhancing drugs. We examine whether surgeons who make fatigue-related errors during patient care might be considered legally obliged to enhance themselves. We focus on liability for a failure to medicate, and conclude that it is highly unlikely that surgeons will be legally obliged to address their fatigue through the use of cognitive enhancing drugs. [ABSTRACT FROM AUTHOR]

Objective Tremor occurs frequently as a side-effect of lithium, and it is, however, easily overlooked in the clinical setting. In this article, we attempt to review the pathophysiology and the clinical approach of lithium tremor. Method We searched the Pubmed and Cochrane Library for relevant articles up to the year 2012. Sixty-four articles including 10 review papers, 3 clinical trials, and 12 case reports were reviewed. Results Lithium tremor is classified as a postural tremor and subcategorized as an exaggerated physiologic tremor. Differential diagnosis includes metabolic abnormalities, benign essential tremor, Parkinson's disease, and lithium toxicity. Various methods of evaluating lithium tremor and treatment options are discussed. Conclusion When lithium tremor has developed, thorough history taking, physical examination, and blood examination including serum lithium level are needed. Pharmacotherapy is indicated only in patients with disabling tremor. [ABSTRACT FROM AUTHOR]

The food choices and eating habits of athletes and sportspeople are influenced by their lifestyle, the practical considerations of their sports and the physiological demands of training and competition programmes. There is a growing interest in foods with a functional benefit in sports performance and in products and foods which can enhance recovery post-exercise and therefore support a faster return to training. This paper provides an overview of the nutritional functions of foods and fluids of current scientific interest to athletes and sportspeople. Practical dietary strategies are provided to illustrate how emerging research can be translated into food ideas, which can enhance the functional benefits to their maximum potential within existing scientific recommendations to minimise reliance on unnecessary dietary supplements. [ABSTRACT FROM AUTHOR]

Aim Intra-abdominal desmoid disease is one of the most common extra-intestinal manifestations of familial adenomatous polyposis. Small bowel obstruction occurs frequently in affected patients and is notoriously difficult to treat. The aim of this study was to review the management and outcome of desmoid-related small bowel obstruction. Method This was a retrospective, descriptive study of patients with familial adenomatous polyposis and intra-abdominal desmoid disease who developed small bowel obstruction. Demographic data and data concerning the presentation, diagnosis and treatment of the bowel obstructions were abstracted from the polyposis database or patients' records. Patients with obstruction unrelated to desmoid disease were excluded. Results There were 47 patients (30 women and 17 men). Median age at first bowel obstruction was 24.2 (interquartile range 19.2-34.2) years. The median time from index surgery to first bowel obstruction was 4.1 (interquartile range 1.5-9.0) years. Twenty-two patients had a colectomy and ileorectal anastomosis and 21 a proctocolectomy and ileoanal pouch. Obstruction was treated medically in 29% of cases and surgically in 69%. Thirteen patients had total parental nutrition. Thirty (63.8%) had a second episode of small bowel obstruction at a mean of 5.3 years after the first, 50% of which were treated medically. Eighteen (37.5%) patients had more than two episodes of bowel obstruction. There were 118 operations, including lysis of adhesions (29), small bowel resection (14), bypass (12), ileostomy (12), desmoid excision (9) and stricturoplasty (2). Conclusion Desmoid-related small bowel obstruction in familial adenomatous polyposis patients requires multiple surgical strategies to restore a patent gastrointestinal tract. What does this paper add to the literature? This is the only series in the literature specifically addressing small bowel obstruction in patients with familial adenomatous polyposis and intra-abdominal desmoid disease. The data show that small bowel obstruction is common, tends to recur, but can be successfully managed by a combination of medical and well selected surgical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Global scale up of antiretroviral therapy is changing the context of HIV‐related stigma. However, stigma remains an ongoing concern in many countries. Groups of people living with HIV can contribute to the reduction of stigma. However, the pathways through which they do so are not well understood. Methods: This paper utilizes data from a qualitative study exploring the impact of networked groups of people living with HIV in Jinja and Mbale districts of Uganda. Participants were people living with HIV (n=40), members of their households (n=10) and their health service providers (n=15). Data were collected via interviews and focus group discussions in 2010, and analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ anti‐stigma activities. Results: Study participants reported that HIV stigma in their communities had declined as a result of the collective activities of groups of people living with HIV. However, they believed that stigma remained an ongoing challenge. Gender, family relationships, social and economic factors emerged as important drivers of stigma. Challenging stigma collectively transcended individual experiences and united people living with HIV in a process of social renegotiation to achieve change. Groups of people living with HIV provided peer support and improved the confidence of their members, which ultimately reduced self‐stigma and improved their ability to deal with external stigma when it was encountered. Conclusions: Antiretroviral therapy and group‐based approaches in the delivery of HIV services are opening up new avenues for the collective participation of people living with HIV to challenge HIV stigma and act as agents of social change. Interventions for reducing HIV stigma should be expanded beyond those that aim to increase the resilience and coping mechanisms of individuals, to those that build the capacity of groups to collectively cope with and challenge HIV stigma. Such interventions should be gender sensitive and should respond to contextual social, economic and structural factors that drive stigma. [ABSTRACT FROM AUTHOR]

Introduction and Aims Support groups are typically offered as part of specialist alcohol or other drug treatment. However, their usefulness with Indigenous Australians has not been examined. This paper provides a profile of Aboriginal women attending an inner city outpatient alcohol and other drug treatment service, insight into how effective women and staff perceive the support group to be at meeting their needs and suggestions for improvements. Design and Methods Structured interviews were conducted with 24 Aboriginal female clients of an outpatient treatment service and with 21 staff from across that service and the local Aboriginal Medical Service. Client interviews also assessed alcohol consumption and mental health risk ( Indigenous Risk Impact Screen). Results Clients reported social and health indicators illustrating disadvantage and complex needs. Most clients and staff perceived the group to be useful and easily accessible. The participants discussed positive elements including opportunities for shared experience in a non-judgemental environment, practical support and health education. Staff reported how the safe, relaxed environment of the group helped with early identification of issues and user-friendly pathways for treatment access. Suggested improvements included greater involvement from Aboriginal staff and community members and enhanced communication with other staff. Discussion and Conclusions Clients and staff recognised the usefulness of the group, including the opportunities it provided for socialisation and early intervention. Comprehensive research is needed to determine the types and sources of support that best assist Aboriginal women with substance use disorders. [Lee KS K, Dawson A, Conigrave K M. The role of an Aboriginal women's group in meeting the high needs of clients attending outpatient alcohol and other drug treatment. Drug Alcohol Rev 2013;32:618-626] [ABSTRACT FROM AUTHOR]

Synopsis Objective This paper addresses the question of the coordination environment of copper ( II) in hair. Methods The research is based on electron paramagnetic resonance ( EPR), a spectroscopic technique that detects specifically paramagnetic molecules. Samples were investigated from various male and female subjects of different ages and races. Results The Cu( II) EPR signals seemed to be a combination of two components in widely differing relative proportions, although both have the relationship g// > g⊥ > 2.0 expected for the unpaired electron in a [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives This study was designed to examine the factors that influence doctors' decision in initiating or switching from warfarin to dabigratran. Method A survey questionnaire was sent to 181 doctors who were most likely to prescribe dabigatran (e.g. cardiologists and general internists) at the University of California, San Francisco Medical Center between November 2011 and February 2012. Survey participants were asked to complete an electronic or a paper version of the questionnaire, which consisted of 17 multiple-choice questions. Fisher's exact test and Cochran- Mantel- Haenszel test were used to compare survey responses between cardiologists and general internists. Results A total of 65 survey responses were received (35.9% response rate). There were 13 cardiologists and 51 general internists who participated in the study. Cost (25%), renal function (21%) and CHADS2 score (18%) were the three factors doctors considered most often to determine a patient's eligibility for dabigatran in warfarin-naïve patients. On the other hand, histories of unstable international normalized ratio (37%) and missed appointments (17%) along with cost (19%) were most often considered in patients on warfarin. Cardiologists had prescribed dabigatran more often and had a significantly higher level of comfort with prescribing the drug than general internists ( P = 0.003; 77% vs. 27%). Conclusions Cost was the most important factor influencing doctors' decision to prescribe dabigatran. Safety and effectiveness of dabigatran as well as patient preference were additional factors influencing their decision. General internists were less comfortable with prescribing dabigatran than cardiologists. [ABSTRACT FROM AUTHOR]

State of the Problem The proper representation of soft tissue contours for a natural aspect of the peri-implant mucosa and its mimesis with the adjacent teeth is a crucial aspect of the esthetic area restoration. Purpose This paper describes a method for the easy transfer of the peri-implant tissue morphology onto impression material with a view to achieving an accurate, custom implant restoration. The procedure described is suitable both for single and multi-unit implant-supported prostheses. Clinical Procedures Once the peri-implant mucosa is sculpted by the provisional restoration, the emergence profile is duplicated. The implant analog is embedded into laboratory stone or plaster in a mixing cup and allowed to set. The provisional restoration is removed from the oral cavity and screwed to the implant analog; then, a polyether material is placed in the mixing cup so that the provisional restoration is put into impression material at the level of the prosthetic emergence profile. After the polyether polymerizing, the provisional prosthesis is unscrewed and replaced with the stock hexed transfer for the final impression. Next, cold self-curing resin is poured into this gap and left to set. A custom transfer for this single implant site is thus obtained. This modified transfer is then removed and screwed onto the implant in the oral cavity for the definitive impression. Conclusions The technique described enables a faithful reproduction of the peri-implant soft tissues and emergence profile. Clinical Significance An emergence profile that mimics the natural tooth should be obtained by successful esthetic implant restoration. Moreover, it allows proper hygiene, which is fundamental for implant maintenance. The best way to achieve the correct emergence profile is to sculpture the peri-implant mucosa by means of a provisional prosthesis. Prefabricated provisional crowns cannot mimic the complexity and the variations of human soft tissue. Therefore, only a chair-side modification of the provisional restoration can accomplish the optimal result. Such a requirement can be satisfied by the clinical method described in the present report. [ABSTRACT FROM AUTHOR]

Adulthood cardiovascular diseases ( CVD) burdening in adulthood have been suggested to have possible predisposition early in life. We aimed to systematically review the literatures on retinal microvasculature among paediatric population in relation to a range of environmental and systemic changes. Papers with quantitative retinal vascular assessment and epidemiological design were reviewed. Conclusion This review supports the theory that major vascular diseases have pathological predisposition early in life by providing morphological evidence on retinal microcirculation in vivo. [ABSTRACT FROM AUTHOR]

Objective This paper identified barriers which prevent rural health care providers from utilising rt- PA in acute ischaemic stroke and proposes possible support mechanisms to increase its utilisation. Methods This descriptive study uses data from anonymous surveys distributed to health care providers involved in acute stroke patient care in three rural hospitals with rt- PA pathways. Saturation sampling was used. Surveys gathered self assessed ratings of experience, practice environment, attitudes, existing support, barriers and possible enablers regarding rt- PA use in acute stroke. Results Physicians reported the strongest barriers to the use of rt- PA in acute stroke as pre-hospital delays (91%), risk of intracerebral haemorrhage ( ICH) (73%) and clinical diagnostic uncertainty (60%). They reported high levels of confidence in the support received from their stroke units (90%). Nurses identified a poor level of stroke education and knowledge on rt- PA utilisation in acute stroke. A third of nurses could correctly list six different stroke signs. The risk of ICH following rt- PA administration in stroke was also a significant barrier for nurses. Response rate from physicians was 26% (10/38) and 19% (13/69) for nurses. Conclusions To reduce barriers to rt- PA utilisation in rural facilities physicians require education on the calculated risk of ICH as well as exposure and experience to improve their ability to confidently diagnose stroke patients who are eligible for rt- PA treatment. Education for nurses on symptoms of stroke and rt- PA utilisation and administration is recommended. [ABSTRACT FROM AUTHOR]

Autosomal dominant polycystic kidney disease ( ADPKD) is the most common inherited kidney disease and results from mutations in PKD1 or PKD2. Cyst initiation and expansion arise from a combination of abnormal cell proliferation, fluid secretion and extracellular matrix defects and results in kidney enlargement and interstitial fibrosis. Since its first description over 200 years ago, ADPKD has been considered an untreatable condition and its management is limited to blood pressure reduction and symptomatic treatment of disease complications. Results of the recently reported TEMPO 3/4 trial thus represent a paradigm shift in demonstrating for the first time that cystic disease and loss of renal function can be slowed in humans. In this paper, we review the major therapeutic strategies currently being explored in ADPKD including a range of novel approaches in preclinical models. It is anticipated that the clinical management of ADPKD will undergo a revolution in the next decade with the translation of new treatments into routine clinical use. [ABSTRACT FROM AUTHOR]

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease and results from mutations in PKD1 or PKD2. Cyst initiation and expansion arise from a combination of abnormal cell proliferation, fluid secretion and extracellular matrix defects and results in kidney enlargement and interstitial fibrosis. Since its first description over 200 years ago, ADPKD has been considered an untreatable condition and its management is limited to blood pressure reduction and symptomatic treatment of disease complications. Results of the recently reported TEMPO 3/4 trial thus represent a paradigm shift in demonstrating for the first time that cystic disease and loss of renal function can be slowed in humans. In this paper, we review the major therapeutic strategies currently being explored in ADPKD including a range of novel approaches in preclinical models. It is anticipated that the clinical management of ADPKD will undergo a revolution in the next decade with the translation of new treatments into routine clinical use. [ABSTRACT FROM AUTHOR]

Objective As part of a series of papers examining chronobiology ['Getting depression clinical guidelines right: time for change?' Kuiper et al. Acta Psychiatr Scand 2013; 128(Suppl. 444):24-30; and 'Manipulating melatonin in managing mood' Boyce & Hopwood. ActaPsychiatrScand 2013; 128(Suppl. 444):16-23], in this article, we review and synthesise the extant literature pertaining to the chronobiology of depression and provide a preliminary model for understanding the neural systems involved. Method A selective literature search was conducted using search engines such as MEDLINE/ Pub Med, combining terms associated with chronobiology and mood disorders. Results We propose that understanding of sleep-wake function and mood can be enhanced by simultaneously considering the circadian system, the sleep homoeostat and the core stress system, all of which are likely to be simultaneously disrupted in major mood disorders. This integrative approach is likely to allow flexible modelling of a much broader range of mood disorder presentations and phenomenology. Conclusion A preliminary multifaceted model is presented, which will require further development and testing. Future depression research should aim to examine multiple systems concurrently in order to derive a more sophisticated understanding of the underlying neurobiology. [ABSTRACT FROM AUTHOR]

Objective As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013; 128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013; 128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines ( CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach. Method Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis. Results Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended. Conclusion Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities. [ABSTRACT FROM AUTHOR]

Objective Disturbances in circadian rhythms have been associated with major depression and may be an underlying mechanism for the disorder. Resynchronisation of circadian rhythms may provide a new approach to treatment, especially by manipulating melatonin secretion. Melatonin is secreted at night and is a stable marker of circadian rhythms. The timing of its secretion can be changed by exogenous melatonin, agonism of specific melatonin receptors in the suprachiasmatic nucleus, its suppression by light and by sleep deprivation. Method As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013; 128 (Suppl. 444): 2-15; and 'Getting depression clinical practice guidelines right: time for change?' Kuiper et al. Acta Psychiatr Scand 2013; 128 (Suppl. 444): 24-30.] addressing chronobiology, in this article, we conducted a selective review of studies that have examined the antidepressant effects of exogenous melatonin, light therapy, sleep deprivation and melatonin receptor agonists. Results Antidepressant effects were identified for bright light therapy, especially for seasonal affective disorder; sleep deprivation, although its antidepressant effect is time limited; and for the novel antidepressant agomelatine with agonistic properties for the MT1 and MT2 receptors and antagonism of 5HT2c receptor. The role of melatonin as an antidepressant has yet to be demonstrated. Conclusion Shifting the circadian secretion of melatonin using the strategies reviewed offers a new approach to treating depression. [ABSTRACT FROM AUTHOR]

Aims The aim was to improve medication safety in an emergency department ( ED) by enhancing the integration and presentation of safety information for drug therapy. Methods Based on an evaluation of safety of drug therapy issues in the ED and a review of computer-assisted intervention technologies we redesigned an electronic case sheet and implemented computer-assisted interventions into the routine work flow. We devised a four step system of alerts, and facilitated access to different levels of drug information. System use was analyzed over a period of 6 months. In addition, physicians answered a survey based on the technology acceptance model TAM2. Results The new application was implemented in an informal manner to avoid work flow disruption. Log files demonstrated that step I, 'valid indication' was utilized for 3% of the recorded drugs and step II 'tooltip for well-known drug risks' for 48% of the drugs. In the questionnaire, the computer-assisted interventions were rated better than previous paper based measures (checklists, posters) with regard to usefulness, support of work and information quality. Conclusion A stepwise assisting intervention received positive user acceptance. Some intervention steps have been seldom used, others quite often. We think that we were able to avoid over-alerting and work flow intrusion in a critical ED environment. [ABSTRACT FROM AUTHOR]

SUMMARY In this paper, the application of new visualization technologies in correction of funnel chest is presented. Often, such defects cause problems with breathing, and therefore, to improve the cardiorespiratory efficiency, a correction is required. The virtual model of chest was formulated to determine the strains and stresses after correction of deformation with using the stabilizing plate. From biomechanical point of view, the knowledge of the load-affecting stabilizer is necessary to select optimal parameters of the plate. The force-affecting plate that was used in the correction of chest deformation by Nuss method was determined on the basis of finite element model of funnel chest. The main aim of this work was to select the optimal thickness of plate. Calculations were conducted for three alternative constraints. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Recurrent aphthous stomatitis ( RAS) is one of the most common oral mucosal diseases in many parts of the world. However, there is very limited published clinical evidence for the therapies used in this condition. This could be partly due to the difficulty in evaluating the efficacy of oral ulcer treatment objectively. In this paper, we present a method for assessing and monitoring the severity of oral ulcers before and after treatment. Methods Six ulcer characteristics, number, size, duration, ulcer-free period, site and pain, were used to generate an ulcer severity score (USS). The scores for 223 RAS patients were determined, and 79 were scored again after 3-month therapy with topical betamethasone. Results The scores for the minor RAS group were between 18 and 43 (mean 29.2 ± 5.3). The mean score in the major ulcers group (range: 28-60, mean 39.9 ± 6.1) was significantly greater than in the minor group ( P < 0.001). The herpetiform recurrent ulcers score range was wide (range: 18-57, mean 36.6 ± 8.4). The mean severity score decreased significantly after treatment ( P < 0.001). Conclusions The USS was indicative of the disease activity in recurrent oral ulceration. It helped in assessing the efficacy of therapy, as the change in the numerical score reflected the change in ulcer severity in response to treatment. This tool may well prove to be of value in clinical management, research and in clinical trials. [ABSTRACT FROM AUTHOR]

Aims The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness. Methods The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda. Results Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small. Conclusions German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated. [ABSTRACT FROM AUTHOR]