Beneficial and harmful effects of tricyclic antidepressants for adults with major depressive disorder : a systematic review with meta-analysis and trial sequential analysis

Question: Tricyclic antidepressants are used to treat depression worldwide, but the adverse effects have not been systematically assessed. Our objective was to assess the beneficial and harmful effects of all tricyclic antidepressants for adults with major depressive disorder. Study selection and analysis: We conducted a systematic review with meta-analysis and trial sequential analysis. We searched CENTRAL, MEDLINE, Embase, LILACS and other sources from inception to January 2023 for randomised clinical trials comparing tricyclic antidepressants versus placebo or ‘active placebo’ for adults with major depressive disorder. The primary outcomes were depressive symptoms measured on the 17-item Hamilton Depression Rating Scale (HDRS-17), serious adverse events and quality of life. The minimal important difference was defined as three points on the HDRS-17. Findings: We included 103 trials randomising 10 590 participants. All results were at high risk of bias, and the certainty of the evidence was very low or low. All trials only assessed outcomes at the end of the treatment period at a maximum of 12 weeks after randomisation. Meta-analysis and trial sequential analysis showed evidence of a beneficial effect of tricyclic antidepressants compared with placebo (mean difference −3.77 HDRS-17 points; 95% CI −5.91 to −1.63; 17 trials). Meta-analysis showed evidence of a harmful effect of tricyclic antidepressants compared with placebo on serious adverse events (OR 2.78; 95% CI 2.18 to 3.55; 35 trials), but the required information size was not reached. Only 2 out of 103 trials reported on quality of life and t-tests showed no evidence of a difference. Conclusions: The long-term effects of tricyclic antidepressants and the effects on quality of life are unknown. Short-term results suggest that tricyclic antidepressants may reduce depressive symptoms while also increasing the risks of serious adverse events, but these results were based on low and very low certainty evidence

Effects of hypodontia on craniofacial structures and mandibular growth pattern

Introduction This study was performed to examine craniofacial structures in persons with hypodontia and to reveal any differences, that may occur, when agenetic teeth are only found in the maxilla, the mandible or in both jaws. The groups consistent of 50 children (33 girls, 17 boys) aged between 9 and 13.5 years were analyzed and assigned to three subgroups. Group 1= upper jaw hypodontia. Group 2= lower jaw hypodontia. Group 3= hypodontia in both jaws. Material and methods Eleven angular and three index measurements from lateral encephalographs and two linear measurements from dental blaster casts were calculated. All data was statistically analyzed, parameters with p<5% were investigated for each subgroup respectively. Results In comparison with standards the study group showed bimaxillary retrognathism and a reduction of the lower anterior facial height. Moreover both overbite and overjet significantly increased. Other values laid within the normal ranges. Evaluating results of the subgroups, differences in the means of SNA, SNB and overjet between the groups were observed. Analysis of the mandibular growth pattern revealed, that neither vertical nor horizontal patterns are dominant in hypodontia patients. Conclusions In certain dentofacial parameters differences between persons with hypodontia and such with full dentition exist. According to our findings agenetic teeth may have a negative influence on the saggital development of a jaw and the lower face and may be responsible for increased overbites. This should receive attention in orthodontic treatment of hypodontia patients

Effects of mechanical and bacterial stressors on cytokine and growth-factor expression in periodontal ligament cells

The goal of the study was to examine the effects of a mechanical (orthodontic force simulation by static compressive loading) and a bacterial (endotoxins from a heat-inactivated gram-negative periodontal pathogen) stressor on the expression patterns of factors that are key to regulating osteoclastogenesis and bone remodeling. Three experimental groups were formed with fifth-passage periodontal ligament (PDL) fibroblasts treated by the static application of compressive force (2 g/cm(2)), heat-inactivated aggregatibacter actinomycetemcomitans (1 x 10(7) cells), or both of these stressors combined. Real-time polymerase chain reaction (RT-PCR) was used to study gene expression of IL-6, IL-8, COX-2, IGF-1, VEGF, and MMP-13 in the 3 groups. Protein levels of COX-2, prostaglandin E2 (PGE(2)), and IL-8 production were quantified using immunoblotting and enzyme-linked immunosorbent assay (ELISA). The mechanical stressor upregulated the genes of COX-2, IL-8, IGF-1, and MMP-13 in PDL fibroblasts and the bacterial stressor upregulated IL-6, IL-8, COX-2 and MMP-13. Both stressors in combination upregulated VEGF and caused COX-2 gene expression to increase further; the latter effect was also detected at the protein level and indirectly via the enhanced production of PGE(2). We noted that the posttranscriptional regulation of IL-8 was induced by the mechanical stressor and influenced by PGE(2). While mechanical-stressor application increased the gene expression of COX-2, IL-8, and VEGF in the presence of the bacterial stressor, IL-8 production was posttranscriptionally regulated by the mechanical stressor, whereas COX-2 expression correlated with enhanced production of the inflammatory tissue hormone PGE(2), which exerted a suppressive effect on endotoxin-induced IL-8 production

The role of apoptosis in early embryonic development of the adenohypophysis in rats

Abstract Background Apoptosis is involved in fundamental processes of life, like embryonic development, tissue homeostasis, or immune defense. Defects in apoptosis cause or contribute to developmental malformation, cancer, and degenerative disorders. Methods The developing adenohypophysis area of rat fetuses was studied at the embryonic stage 13.5 (gestational day) for apoptotic and proliferative cell activities using histological serial sections. Results A high cell proliferation rate was observed throughout the adenohypophysis. In contrast, apoptotic cells visualized by evidence of active caspase-3, were detected only in the basal epithelial cones as an introducing event for fusion and closure of the pharyngeal roof. Conclusion We can clearly show an increasing number of apoptotic events only at the basic fusion sides of the adenohypophysis as well as in the opening region of this organ. Apoptotic destruction of epithelial cells at the basal cones of the adenohypophysis begins even before differentiation of the adenohypophyseal cells and their contact with the neurohypophysis. In early stages of development, thus, apoptotic activity of the adenohypophysis is restricted to the basal areas mentioned. In our test animals, the adenohypophysis develops after closure of the anterior neuroporus.</p

Shear bond strength of different retainer wires and bonding adhesives in consideration of the pretreatment process

Introduction: We aimed to compare the shear bond strength (SBS) of three different retainer wires and three different bonding adhesives in consideration of the pretreatment process of enamel surface sandblasting. Methods: 400 extracted bovine incisors were divided into 10 groups of 20 paired specimens each. 10 specimens of each group were pretreated by enamel sandblasting. The retainer wires Bond-A-Braid™, GAC-Wildcat®-Twistflex and everStick®ORTHO were bonded to the teeth with the adhesives Transbond™-LR, Tetric-EvoFlow™ and Stick®FLOW and then debonded measuring the SBS. Results: While sandblasting generally increased SBS for all tested combinations, the retainer wires bonded with Transbond™-LR showed the highest SBS both with and without prior sandblasting. Significantly lower SBS were found for Tetric-EvoFlow™ that were comparable to those for everStick®ORTHO. Conclusions: Pretreatment of enamel surfaces by sandblasting increased the SBS of all retainer-wires. Transbond™-LR showed the best results compared to Tetric-EvoFlow™ and everStick®ORTHO, while all combinations used provided sufficient bonding strengths for clinical use.<br