Efficacy and safety of established and off-label ADHD drug therapies for cognitive impairment or attention-deficit hyperactivity disorder symptoms in bipolar disorder: A systematic review by the ISBD Targeting Cognition Task Force.

BACKGROUND: Abnormalities in dopamine and norepinephrine signaling are implicated in cognitive impairments in bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD). This systematic review by the ISBD Targeting Cognition Task Force therefore aimed to investigate the possible benefits on cognition and/or ADHD symptoms and safety of established and off-label ADHD therapies in BD. METHODS: We included studies of ADHD medications in BD patients, which involved cognitive and/or safety measures. We followed the procedures of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed, Embase and PsycINFO from inception until June 2023. Two authors reviewed the studies independently using the Revised Cochrane Collaboration's Risk of Bias tool for Randomized trials. RESULTS: Seventeen studies were identified (N = 2136), investigating armodafinil (k = 4, N = 1581), methylphenidate (k = 4, N = 84), bupropion (k = 4, n = 249), clonidine (k = 1, n = 70), lisdexamphetamine (k = 1, n = 25), mixed amphetamine salts (k = 1, n = 30), or modafinil (k = 2, n = 97). Three studies investigated cognition, four ADHD symptoms, and 10 the safety. Three studies found treatment-related ADHD symptom reduction: two involved methylphenidate and one amphetamine salts. One study found a trend towards pro-cognitive effects of modafinil on some cognitive domains. No increased risk of (hypo)mania was observed. Five studies had low risk of bias, eleven a moderate risk, and one a serious risk of bias. CONCLUSIONS: Methylphenidate or mixed amphetamine salts may improve ADHD symptoms in BD. However, there is limited evidence regarding the effectiveness on cognition. The medications produced no increased mania risk when used alongside mood stabilizers. Further robust studies are needed to assess cognition in BD patients receiving psychostimulant treatment alongside mood stabilizers.

Stressful life events are associated with striatal dopamine receptor availability in alcohol dependence.

Stress plays a key role in modulating addictive behavior and can cause relapse following periods of abstinence. Common effects of stress and alcohol on the dopaminergic system have been suggested, although the precise mechanisms are unclear. Here, we investigated 20 detoxified alcohol-dependent patients and 19 matched healthy controls and assessed striatal D2/D3 availability using [18F]-fallypride positron emission tomography and stressful life events. We found a strong association between striatal D2/D3 availability and stress in patients, but not in healthy controls. Interestingly, we found increased D2/D3 receptor availability in patients with higher stress levels. This mirrors complex interactions between stress and alcohol intake in animal studies and emphasizes the importance to investigate stress exposure in neurobiological studies of addiction. CLINICAL TRIAL REGISTRATION: NCT01679145.

Microdamage evaluation in human trabecular bone based on nonlinear ultrasound vibro-modulation (NUVM).

The primary aim of this work is to investigate the potential of nonlinear ultrasound for microdamage detection in human bone. Microdamage evaluation in human bone is of great importance, because it is considered a significant parameter for characterizing fracture risk. Experiments employing nonlinear acoustic vibro-modulation were carried out in human femoral trabecular specimens removed during surgery. A frequency mixing (inter-modulation) was observed between an ultrasound wave, propagating in the bone, and a low-frequency vibration applied directly to the bone specimens. The appearance of side frequencies, which are related to the vibrational excitation, around the fundamental ultrasound frequency manifests the modulation nonlinear phenomenon. Instead of inducing microdamage by mechanical fatigue loading, specimens with different degree of osteoporosis were used. The experiments demonstrated that osteoporotic bone exhibits stronger nonlinearity compared to healthy bone presenting significant increase of the modulation amplitude with increasing degree of osteoporosis. The obtained results indicate that, in contrast to conventional hysteretic nonlinearity, dissipative acoustic nonlinearity can be of significance in the generation of nonlinear modulation effects. In the proposed technique the size and the shape of samples are not crucial compared to nonlinear resonant ultrasound spectroscopy (NRUS). Furthermore, the method is sensitive to the presence of microdamage, non-invasive, easy to implement and most important, it can be proved valuable tool for in vivo bone damage characterization.

Anatomy of the median part of the septum depressor muscle in aesthetic surgery.

When a person smiles and talks, everyone in his or her own specific way, it can be noticed that the tip of the nose drops and the upper lip shortens, making the nasolabial angle more acute. The importance of the upper lip in the dynamics of the nose makes necessary a more detailed study of the morphology and anatomical relations of the median part of the nasal septum depressor muscle, contributing in this way to new techniques in plastic surgery. The authors proposed to study the anatomy of the nasal septum depressor muscle and its relationship with the dermocartilaginous ligament of Pitanguy and the upper lip, important components of the nasal dynamics of facial expression. In this way they seek to contribute to the treatment of the nasal tip in aesthetic rhinoplasties.

Positive effect of balneotherapy on post-PID symptoms.

OBJECTIVE: The aim of this study was investigation of effect of balneotherapy after antibiotic treatment of PID. PATIENTS AND INTERVENTIONS: Fifty-seven patients with PID, diagnosed by laparoscopy, were treated by the same antibiotic scheme (oxytetracycline and metronidazole). After treatment of the acute phase, we studied the effect of balneotherapy (mud baths or mud packs, mineral baths, electrotherapies, and gynecological exercises) under sanatorium conditions in 30 patients. Twenty-seven patients without balneotherapy served as a control group. Second-look laparoscopy with dye insufflation was carried out about 12 weeks after the first operation. RESULTS: The rate of tubal occlusion after balneotherapy was 31% vs. 28% in patients without balneotherapy (P > .05). Moderate or severe adhesions seen at first look were similar in both groups (40.7% vs. 46.7%) and were nearly unchanged during second-look laparoscopy (44.4% vs. 46.6%). Twelve of 27 (44.4%) control patients had subjective or objective complaints compared to only 2 of 30 (6.7%, P < .05). CONCLUSION: Although balneotherapy after antibiotic therapy for acute PID does not improve fallopian tube patency, it is useful to reduce the frequency of lower abdominal pain.

[Treatment of acute salpingitis with tetracycline/metronidazole with or without additional balneotherapy, Augmentin or ciprofloxacin/metronidazole: a second-look laparoscopy study]. / Zur Behandlung der akuten Salpingitis mit Tetracyclin/Metronidazol mit oder ohne zusätzliche Heilbadkur, Augmentan oder Ciprofloxacin/Metronidazol: Eine second look-Laparoskopie-Studie.

110 patients suffering from laparoscopical verified salpingitis and desire for a baby, were treated with tetracycline (oxytetracycline or doxycycline; TC)/metronidazole (n = 67), augmentan (n = 22) or cipropfloxacin/metronidazole (n = 21). After an average period of 11.6 weeks, all patients underwent second-look laparoscopy with dye insufflation. In 34 patients treated with TC/metronidazole, the effects of additional physio-therapeutical measures were examined under conditions as they prevail in a Spa. 33 patients without balneotherapy served as controls. All the 4 groups were comparable (p greater than 0.05) in respect of mean age, percentage, share of nulliparous women, salpingitis gonorrhoica, contraceptive behaviour and also of the stage of salpingitis. All antibiotic regimens used resulted in a prompt decrease of inflammatory clinical signs after five days (temperature, blood sedimentation rate, leukocytes). Only 2 of 34 patients treated by additional cure at a Spa reported complaints, whereas complaints were reported by 14 of 33 control patients (p less than 0.01), 7 of 22 (p less than 0.01) treated with augmentan and to 7 of 21 (p less than 0.01) treated with ciprofloxacin/metronidazole. The tubal occlusion rates amounted to 33.3% (TC/metronidazole), 32.3% (TC/metronidazole and balneotherapy), 22.7% (augmentan) and 23.8% ciprofloxacin/metronidazole. The differences did not attain statistical significance (p greater than 0.05). With regard to adhesions, there were, likewise, no significant differences between findings at first laparoscopy and second look-laparoscopy, respectively. It is concluded, that additional physiotherapeutic measures, after antibiotic therapy of acute salpingitis, reduce the frequency of lower abdominal pain, but do not result in an improvement of tubal occlusion and reduction of adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)

[The problems of spotted breeds of rabbits. 1. Fattening and body condition at slaughter, organ parameters]. / Zur Problematik der Scheckenzucht bei Kaninchen. 1. Mitteilung: Mast- und Schlachtkörpereigenschaften, Organbefunde.

Rabbits of the Giant German Spot Breed and of the English Spot Breed were bred, reared, fattened and evaluated under standardized conditions. A total of 50 animals (31 German spot = DRS; 19 English spot = ES; both derived from mating of heterozygotes) was tested, belonging to the three possible genotypes: Homozygous black (kk), heterozygous spotted (Kk, "standard animals") and homozygous spotted (KK, so-called "Chaplins"). As expected, breed differences consisted of better daily gains and higher carcass weights in DRS, but higher dressing percentages in ES. With respect to colour genotypes, only in DRS-KK depressions of daily gains and carcass weight were observed; food conversion efficiency however was even better in these animals (of both breeds), primarily because of lower feed uptake. Very distinct differences in some important organ traits could be demonstrated for those genotypes: A significantly augmented intestine (abs. and rel.) in KK-animals, specially with reference to the gross intestine--indicating a tendency to motility disturbances and/or chronic obstipation. This predisposition was underlined by the premature loss of three KK-rabbits suffering from severe corresponding symptoms. Seemingly analogous syndromes (Megacolon) in man and other species are cited, though further investigations are needed to clarify the etiology in spot rabbits. Significance of lower heart weights was stated in DRS-KK-animals, probably induced by minor activities observed in this genotype. Thus the K-gene can be classified as a subvital one when homozygous though manifestations of the symptoms obviously vary with the genetic background (breed, line) and perhaps with the environment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effectiveness of postoperative spa treatment at Bad Elster in patients with tubal sterility]. / Die Effektivität einer postoperativen Heilkur in Bad Elster bei Patientinnen mit tubarer Sterilität.

A survey of a gynecological therapy strategy is described. The results of postoperative cures at a spa (Bad Elster) in 69 women, suffering from tubar sterility, were investigated by means of physical examinations and questionnaires. It was found, that the number of pregnancies (8,7%) did not increase. - There was an improvement in state of health.

[Clinical experience with Hammacher's "CTG score"]. / Klinische Erfahrungen mit dem "CTG-Score" nach Hammacher.

The cardiotocograms of 340 pregnant women which are recorded ante partum and intra partum were analysed by the score of Hammacher. This score is representative for the intra partum period. We found a direct relation between variations of CTG and the Apgar-score of newborn. In the ante partum period only in pathological score this correlation can be observed.

[Ambulatory management of cysts and abscesses of the Bartholin gland]. / Ambulante Behandlung von Zysten und Abszessen der Bartholin-Drüse.

After marsupialisation of cysts and abscesses of the Bartholin's glands the insertion of an intrauterine devices is recommended. The treatment can be performed ambulatorily.

[Marsupialization with insertion of an IUD for the treatment of cysts and abscesses of Bartholin's gland]. / Marsupialisation mit Einlage eines IUD zur Behandlung von Zysten und Abszessen der Bartholin-Drüse

PIP: Marsupialization is the preferred therapy for cysts and abscesses of Bartholin's gland. In a Rostock clinic, IUDs (models Super Dana Size 1, Dana Super Lux Size 1, and Dana Cor Size 1) were inserted with marsupialization of 8 abscesses and 2 Bartholin cysts (4 recurrences). 4-8 weeks after the operation the IUDs were removed, in 7 cases without complications. In 3 cases, when the IUD had been in longer than 4 weeks, the device had attached itself in 1 small place. A cut was made through 1 side of the IUD and the operation proceeded painlessly. No analgesics were necessary. The different models were equal in performance. With marsupialization the insertion of an IUD for 4 weeks is recommended.^ieng

[Results of delivery in umbilical cord prolapse at the University-Gynecological Clinic Rostock in the years 1958 to 1973]. / Ergebnisse der Geburtsleitung beim Nabelschnurvorfall an der Universitäts-Frauenklinik Rostock in den Jahren 1958 bis 1973

Basing on a 16-year-analysis recommendations are given for the definitive management of delivery in cases of umbilical cord prolapsus in dependence of the cervical dilatation and the position of the fetus. The indication for cesarean section is to pronounce generously and inhibition of labour by tocolytical drugs is to demand.

[Cardiotocogram findings in antenatal monitoring of fetal hematoblastosis and during intrauterine intrafetal transfusion]. / Kardiotokogrammbefunde bei antenataler Uberwachung des Morbus haemolyticus fetalis und während der intrauterinen intrafetalen Transfusion

34 falls with Morbus haemolyticus fetalis were controled from the 30. to 40. week of pregnancy by cardiotocography. The order of the severity of fetal erythroblastosis and certain types of oscillation devoted: In slight cases of Morbus haemolyticus fetalis preponderated (Hb greater than 15 g%) a undulating curve of oscillation (80%). Middlesevere cases (Hb 9-15 g%) showed in 57.2% an undulating and in 42.8% a saltatoring types of oscillation. In cases of severe fetal anemia (Hb less than 9 g%) we found at 64.2% a silent to narrowed undulating and at 21.4% saltatoring types of oscillations. A normal type of oscillation we not observed in this group. The various degrees of a chronical fetal hypoxia caused by an anemia and a placental dysfunction have been discussed as a reason for the typical CTG-curves. At hydrops fetus et placentae are bearing silent and sinusoid heart frequency curve and the CTG-sign late deceleration. A fetal intrauterine transfusion seems not very successfully, at this findings. During the intrauterine transfusion were established in all cases to a restriction of fluctuation at simultaneous increase of frequency.