Unipolar Group Research Articles

A comparative study of the outcome of displaced fractures neck of femur treated with unipolar prosthesis and fenestrated bipolar prosthesis in active elderly patients

Background: Fractures of the neck or femur are among the most serious surgical problems affecting older groups. These fractures constitute a large burden on families and society due to the inability to stand and walk. Objectives were to compare the functional outcomes of unipolar (Austin-Moore) versus uncemented bipolar hemiarthroplasty in displaced fractures neck femur among these active elderly patients. Methods: This prospective interventional study was carried out at NITOR, Dhaka, Bangladesh in total 60 patients. Among them, 30 patients were treated with unipolar and 30 patients were treated with fenestrated bipolar prosthesis through a lateral approach. Results: There was no significant age difference between the two groups. Regarding the functional outcome, 6 (20%) patients in the unipolar group and 11 (36.67%) patients in the bipolar group had excellent outcomes. About the same number of patients had good outcomes 36.67% in the unipolar and 43.33% in the bipolar group; the fair and poor outcome was more in the unipolar group than the bipolar group. So, the final outcome after 6 months of operation, 57.57% of patients had satisfactory results in the unipolar group whereas 80% of patients had satisfactory results in the bipolar group. The average Harris hip score was 77.14±14.58 in the unipolar group and 84.63±10.15 in the bipolar group and the p=0.01 which is below 0.05. So, the result is statistically significant. Conclusions: Uncemented bipolar hemiarthroplasty with a fenestrated stem can give better functional outcomes for displaced intracapsular femoral neck fractures in active elderly patients compared to Austin-Moore prostheses.

Is the use of bipolar hemiarthroplasty over monopolar hemiarthroplasty justified? A propensity score-weighted analysis of a multicentre randomized controlled trial.

Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA). This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and (MCS) were compared between the two HA groups using a propensity score-weighted analysis. Of 746 HAs performed in the HEALTH trial, 404 were bipolar prostheses and 342 were unipolar. After propensity score weighting, adequate balance between the bipolar and unipolar groups was obtained as shown by standardized mean differences less than 0.1 for each covariable. A total of 24 months after HA, the total WOMAC score and its subcomponents showed no statistically significant difference between the unipolar and bipolar groups. Similarly, no statistically significant difference was found in the PCS and MCS scores of the SF-12 questionnaire. In participants aged 70 years and younger, no difference was found in any of the functional outcomes. From the results of this study, the use of bipolar HA over unipolar design does not provide superior functional outcomes at 24 months postoperatively. The theoretical advantage of reduced acetabular wear with bipolar designs does not appear to influence functional outcomes in the first two years postoperatively.

Distinct Predictors of Clinical Response after Repetitive Transcranial Magnetic Stimulation between Bipolar and Unipolar Disorders

Background: Repetitive transcranial magnetic stimulation (rTMS) has been shown to be therapeutically effective for patients suffering from drug-resistant depression. The distinction between bipolar and unipolar disorders would be of great interests to better adapt their respective treatments. Methods: We aimed to identify the factors predicting clinical improvement at one month (M1) after the start of rTMS treatment for each diagnosis, which was preceded by a comparison of the patients' clinical conditions. We used the data collected and the method employed in a previous publication on 291 patients. Results: Although the bipolar group had fewer responders, these patients seemed to better maintain their post-rTMS improvement on anxiety and perception of the severity of their illness than those in the unipolar group. For the bipolar group, young age coupled with low number of medications and high fatigue was shown to be the best combination for predicting improvement at M1. The duration of current depressive episode, which was previously demonstrated for whole group, combined with being attached was shown to favor clinical improvement among the patients in unipolar group. Conclusion: We were able to define a combination of specific factors related to each diagnosis for predicting the patients' clinical response. This could be extremely useful to predict the efficacy of rTMS during routine clinical practice in neuromodulation services.

Comparison of Clinical Features, Serum Lipid, and Uric Acid Levels in Patients with Unipolar Depression and Bipolar Depression.

The level of uric acid and serum lipids has been suggested as a possible biomarker of bipolar disorder. We aimed to investigate the differences in clinical features and serum levels of lipids and uric acid in patients with bipolar depression or unipolar depression in order to distinguish them. The clinical data of 53 patients with unipolar depression (unipolar group) and 61 patients with bipolar depression (bipolar group), who all met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV of the American Psychiatric Association, were compared with each other retrospectively. The serum levels of uric acid and lipids (including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides) were measured after hospital admission. The Statistical Package for the Social Science version 22.0 software was used for statistical analysis, and logistic regression was employed to identify the susceptible factors of bipolar depression. Taking into account confounding factors, logistic regression analysis revealed that the high levels of uric acid (odds ratio = 1.016, P = .001) and low levels of triglycerides (odds ratio = 0.457, P = .025) were significantly correlated with bipolar depression. It has been demonstrated from this study that individuals with bipolar depression have higher serum uric acid levels and lower triglyceride levels than unipolar depression ones. Therefore, serum levels of uric acid and triglycerides might have the potential to be the biomarkers for differential diagnosis between bipolar and unipolar depression.

A STUDY OF THYROID PROFILE IN PATIENTS OF UNIPOLAR AND BIPOLAR DEPRESSION

Background and Objectives: Dysfunctional hypothalamus-pituitary-thyroid (HPT) axis have been documented in patients with depression. Condition of both excess and insufcient thyroid hormones can cause mood abnormalities including depression. Thyroid dysfunction is a common feature in depression, with mixed type of response. Unipolar and bipolar depressions are also related differently in consideration to thyroid status. This study comprises of assessment of the thyroid disorder prevalence in depressive patients and comparative analysis among unipolar and bipolar groups. Gender wise males were dominant with majority in bipolar group in the younge Result: r age group. Most of the cases were normal with few hyperthyroid and hypothyroid cases. Bipolar group comprised the majority of overt hyperthyroid, whereas unipolars were more in the subclinical hypothyroid category. This study concludes that differences exist in Conclusions: the thyroid response among the unipolar and bipolar depression group, more numbers of hypothyroidism in unipolar group

Patients with femoral neck fractures treated by bipolar hemiarthroplasty have superior to unipolar hip function and lower erosion rates and pain: a systematic review and meta-analysis of randomized controlled studies.

We assessed acetabular erosion, hip function, quality of life (QoL), pain, deep infection, mortality, re-operation and dislocation rates in patients with displaced femoral neck fractures (dFNFs) treated with unipolar versus bipolar hemiarthroplasty at different postoperative time points. Relevant Randomized Controlled Trials (RCTs) were identified, following comprehensive literature research in Medline, Cochrane Central and Scopus databases, from conception until August 31th, 2021 and analyzed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Database research retrieved 120 studies; sixteen met eligibility criteria, providing 1813 (1814 hips) evaluable patients. Acetabular erosion was significantly higher for unipolar group at 6 and 12months (p = 0.02 and p = 0.01 respectively). Patients in the bipolar group presented significantly better hip function at 12 and 24months (p = 0.02 and p = 0.04 respectively). Postoperative pain was significantly less in the bipolar group at 12, 24 and 48months (p = 0.01). No statistically significant differences were found regarding the postoperative rates of deep infection, mortality, re-operation and dislocation. This study showed that patients with dFNFs treated with bipolar hemiarthroplasty have lower acetabular erosion rates at 6 and 12months postoperatively, better hip function at 12 and 24months, better QoL and less pain, when compared with unipolar. No statistically significant difference could be established regarding deep infection, mortality, re-operation and dislocation rates.

A new machine learning-derived screening measure for differentiating bipolar from unipolar mood disorders

BackgroundWhile there are several accepted screening measures for identifying those with a bipolar disorder, variations in overall classification rates argue for the pursuit of a more discriminating measure. Extant measures, as well as the DSM-5, rate each diagnostic criterion as having equivalent weighting values; an approach which may compromise diagnostic assignment if symptoms vary considerably in their diagnostic sensitivity. We therefore sought to develop a new measure and examine whether a weighted rating scale was superior to one assigning equivalent weightings to each item. MethodsAn international sample of 165 bipolar patients and a comparison sample of 29 unipolar patients completed a measure assessing 96 putative manic/hypomanic symptoms. A previous machine learning analysis had identified the twenty most discriminating items. In this study, analysis was undertaken involving only the ten most discriminating items. ResultsWhether items were scored as each having equivalent value or as weighted by their machine learning-generated values, classificatory accuracy was extremely high (in the order of 96%). Analyses also identified optimal cut-off scores. High classificatory accuracy was also obtained when scores for separate bipolar I and bipolar II groups were compared with scores from the unipolar group. LimitationsThe sample consisted of comparatively few unipolar patients. ConclusionsThe ten-item set allows a new measure for researchers to evaluate, while the items should assist clinician assessment as to whether a patient has a bipolar or unipolar mood disorder.

A distinct neurocognitive profile: unipolar mania

Objective Despite a growing number of studies reporting patients with a history of mania without depression have several socio-demographic and clinical differences than bipolar disorder patients, unipolar mania is recognized as bipolar I disorder in the most commonly used classification systems. Studies showing that unipolar mania is a separate clinical entity are insufficient in number, and to the best of our knowledge, there has been no study investigating the neuropsychological differences in this area. The aim of this study is to evaluate the neurocognitive differences between unipolar mania, bipolar I disorder and healthy controls, and to reveal the underlying neurocognitive differences. Materials and Methods Cambridge Neuropsychological Test Automated Battery was applied to 18 unipolar mania, 19 bipolar I disorder patients and 21 healthy controls matched for age, sex and education levels. Results Unipolar mania group had worse performance regarding visual memory and executive functions, and had specific social cognition deficits compared to both bipolar I disorder and healthy control groups. Conclusion The results of our study indicate that unipolar mania might have unique neurocognitive differences compared to bipolar I disorder, which might support the hypothesis that unipolar mania is a distinct neurocognitive disorder within bipolar spectrum disorders.

Dual mobility versus unipolar total hip arthroplasty for neck of femur fractures: a single centre study

Current national guidelines (NICE) recommends that all medically fit, independently-mobile patients without cognitive impairment receive a total hip arTHAoplasty(THA) for displaced intracapsular neck of femur (NOF) fractures. Dislocation is a concern(2-10%). Dual mobility cups have been suggested to address this complication. Our study sets out to compare dislocation rates between dual mobility cups versus unipolar cups. We performed a retrospective single centre multiple surgeon study of all THAs performed for NOFs between January 2012 and May 2018. A total of 322 total hip replacements (127 dual mobility and 195 unipolar ; Age range of patients, 29 to 91, mean 70 years) were identified for analysis using a database. Data was obtained from electronic patient records and radiographs. 12 patients sustained a dislocation of their THA out of our 322 patients. Of these, 10 dislocations occurred in the unipolar group (5.13%). From the dual mobility cups, 2 had dislocations(1.57%), both with a 28mm head. Both of these dislocations were in alcohol dependent patients with increased susceptibility to falls. Statistical analysis of our data was performed using chi-squared test (p value = 0.0723) In 'Getting It Right First Time' (GIRFT), the authors recommend that all patients that sustain a NOF fracture meeting the criteria of a THA to be offered a dual mobility acetabular cup to reduce the risk of dislocation. The cost of the dual mobility acetabular cup is offset from the cost of overall revision surgery. Limitations of our study are its retrospective nature and selection bias.

Categorical differentiation of the unipolar and bipolar disorders

There has been a longstanding debate as to whether the bipolar disorders differ categorically or dimensionally, with some dimensional or spectrum models including unipolar depressive disorders within a bipolar spectrum model. We analysed manic/hypomanic symptom data in samples of clinically diagnosed bipolar I, bipolar II and unipolar patients, employing latent class analyses to determine if separate classes could be identified. Mixture analyses were also undertaken to determine if a unimodal, bimodal or a trimodal pattern was present. For both a refined 15-item set and an extended 30-item set of manic/hypomanic symptoms, our latent class analyses favoured three-class solutions, while mixture analyses identified trimodal distributions of scores. Findings argue for a categorical distinction between unipolar and bipolar disorders, as well as between bipolar I and bipolar II disorders. Future research should aim to consolidate these results in larger samples, particularly given that the size of the unipolar group in this study was a salient limitation.

Short to midterm functional outcome of unipolar uncemented hemiarthroplasty versus bipolar uncemented hemiarthroplasty in displaced fracture neck of femur in elderly individuals

Background: Hemiarthroplasty (HA) is best treatment option for fracture neck of femur in elderly individuals above 60 years with early mobilisation and less complications associated with internal fixation. However, there is inadequate evidence to support the choice between unipolar or bipolar HA. This study is aimed primarily at comparing the post-hemiarthroplasty functional results in subjects with fracture neck of femur using ‘Austin-Moore’s and bipolar prosthesis and studying the associated complications.Methods: 55 subjects who were admitted between October 2014 to august 2016, operated with Austin-Moore’s prosthesis were allocated to Group A and subjects operated with bipolar Prosthesis were allocated to Group B, in K.R.HOSPITAL, Mysore Medical College, Mysore. All subjects were functionally assessed using the Harris Hip Score (HHS) and complications, if any, were documented. X-ray pelvis with both hip in anteroposterior view taken.Results: In this study, mean age in Unipolar and Bipolar group was 76 and 72 years respectively. The mean Harris hip score in unipolar and bipolar groups was 84 and 92 respectively. There were no major differences in functional activities in either group, bipolar group has slightly better functional outcome which is statistically insignificant. In unipolar group there is marginal increase in chances of acetabular erosion. Complications rate is similar in both groups.Conclusions: Based on the results of our study, unipolar and bipolar has its own advantages and disadvantages, we recommend unipolar arthroplasty in less ambulatory, low socioeconomic status, subjects with short life expectancy. Bipolar-arthroplasty in elderly medically fit individuals who are physically active.

Ruminations and their correlates in depressive episodes: Between-group comparison in patients with unipolar or bipolar depression and healthy controls

BackgroundRumination is an important feature of affective disorders. Relationships between rumination, cognitive function, emotion regulation, and psychological resilience have been examined in unipolar depression; but few studies have determined whether unipolar and bipolar depressive episodes are distinguishable in terms of these variables. This study examined rumination in relation to clinical and cognitive variables in patients with unipolar depression or bipolar depression, and healthy controls. MethodsIn total, 150 participants (50 bipolar, 50 unipolar, 50 controls) were included. Assessments comprised the Ruminative Response Scale-Short Form, Positive Beliefs about Rumination Scale, Negative Beliefs about Rumination Scale, Brief Resilience Scale, Emotion Regulation Questionnaire, Stroop Test, and Trail Making Test A and B. ResultsThe unipolar group had significantly higher scores in ruminative response and performed better in a neuropsychological test (Trail Making Test Part A) than the bipolar group. When duration of illness was controlled, no significant difference was found between depression groups in terms of rumination. There was a negative relationship between rumination and emotion regulation (cognitive reappraisal subscale), and rumination and psychological resilience in both patient groups, but no significant relationship was found in healthy controls. LimitationsRelatively small sample size: future studies in larger clinical samples would increase knowledge of rumination in both unipolar and bipolar depression. ConclusionsPatients experiencing unipolar or bipolar depressive episodes are potentially distinguishable in terms of ruminative response levels and cognitive functions. This differentiation may help in developing targeted interventions for unipolar and bipolar depression.

Randomised prospective comparative analysis of functional outcome of hemiarthroplasty with cemented bipolar and uncemented unipolar prosthesis

<p class="abstract"><strong>Background:</strong> Hemiarthroplasty (HA) has been considered as better treatment modality in elderly patients compared to internal fixation because of better outcome, early mobilization, associated with HA. However, there is inadequate evidence to support the choice between unipolar or bipolar HA. The aim of this study was to compare the outcome of uncemented unipolar with the cemented bipolar prosthesis in geriatric patients especially in an Indian setup.</p><p class="abstract"><strong>Methods:</strong> Sixty five patients above 60 years of age and displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar HA, in the Department of Orthopaedics, between September 2014 and October 2016. Functional outcome was assessed and compared using Harris hip score and radiological parameters with X-ray with serial follow-up at 3, 6, 12 and 18 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> The two groups of patients with mean age of 68±7 years in bipolar group and 68±6 years in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. The mean Harris hip score in cemented bipolar and uncemented unipolar groups was 86±8.53 and 85.27±10.09, respectively (p=0.687). There were no differences in functional activities either group.</p><p class="abstract"><strong>Conclusions:</strong> Based on the results of our study, there appears to be no statistical difference between the two groups, uncemented unipolar HA and cemented bipolar HA in terms of functional outcome and various complications discussed. Uncemented unipolar HA is cheap, less technically demanding, suitable in fragile old patients.</p>

Evaluation of oxidative stress with thiol disulfide balance parameters in unipolar depression patients with and without mixed symptoms

Objective: Number of studies evaluating oxidative stress in unipolar depression are increasing. The aim of this study was to evaluate the scores of oxidative stress in unipolar depression patients and in mixed type of unipolar depression and to compare these scores with healthy subjects in terms of dynamic thiol/disulfide balance para-meters. Methods: Ninety-eight patients aged between 18 and 65 years with the diagnosis of unipolar depressive disorder diagnosed according to DSM-5 criteria and 97 age- and sex-matched 97 healthy individuals who applied to the Psychiatry Outpatient Clinic of Canakkale Onsekiz Mart University Faculty of Medicine Psychiatry Department between April 2018 and September 2018 were included in the study. Hamilton Depression Rating Scale (HAM-Dand Modified Hypomania Checklist (M-HCL) were used respectively to determine depressive symptoms, manic symptoms and the severity of the disease. Oxidative stress parameters were measured by evaluating fasting blood samples taken from all participants. Results: In the unipolar depression group, the levels of disulfide, total thiol, oxidation-reduction and oxidized thiol levels were found to be statistically significant in favor of oxidation (p

Comparison of blood lipid profile/thyroid function markers between unipolar and bipolar depressed patients and in depressed patients with anhedonia or suicidal thoughts

BackgroundThis study aimed to investigate the differences in the serum levels of glucose, lipid, and thyroid function markers between unipolar and bipolar depressed patients, as well as the effect of anhedonia and suicidal thoughts on the levels of these biochemical parameters.MethodsA total of 287 unmedicated depressed patients from January 2016 to December 2017 were included in this study, including 92 bipolar depressions and 195 unipolar depressions. Anhedonia was determined using the item 32 of Symptom Checklist (SCL-90). Suicide ideation was assessed by item 15 of SCL-90.ResultsThe bipolar group had significantly lower lipid levels (including triglycerides, cholesterol, low-density lipoprotein cholesterol [LDL], very low-density lipoprotein cholesterol [VLDL]) and insulin resistance index but higher levels of prolactin, low triiodothyronine (T3) and free T3 (FT3) as well as higher incidence of anhedonia as compared with the unipolar group. Depressed patients with anhedonia had significantly higher LDL level than those without anhedonia. Depressed patients with suicidal thoughts had cholesterol and high-density lipoprotein cholesterol (HDL) level. The above-mentioned differences were confirmed by logistic regression analysis. Receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve (AUC) ranged from 0.546 to 0.685.ConclusionTriglycerides, cholesterol, LDL, VLDL T3, FT3 levels were significantly different between unipolar and bipolar depressed patients, which might have the potential to be the markers for differential diagnosis. Patients with anhedonia had lower LDL level, while patients with suicidal thoughts had higher levels of cholesterol and HDL as compared with the corresponding control groups.

Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: A pooled analysis of 30,250 participants data

PurposeTo assess the clinical outcomes of unipolar versus bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures in older patients and to report whether bipolar implants yield better long-term functional results. MethodsWe searched PubMed, Scopus, EBSCO, and Cochrane Library for relevant randomized clinical trials (RCTs) and observational studies, comparing unipolar and bipolar hemiarthroplasty. Data were extracted from eligible studies and pooled as relative risk (RR) or mean difference (MD) with corresponding 95% confidence intervals (CI) using RevMan software for Windows. ResultsA total of 30 studies were included (13 RCTs and 17 observational studies). Analyses included 30,250 patients with a mean age of 79 years and mean follow-up time of 24.6 months. The overall pooled estimates showed that bipolar was superior to unipolar hemiarthroplasty in terms of hip function, range of motion and reoperation rate, but at the expense of longer operative time. In the longer term the unipolar group had higher rates of acetabular erosion compared to the bipolar group. There was no significant difference in terms of hip pain, implant related complications, intraoperative blood loss, mortality, six-minute walk times, medical outcomes, and hospital stay and subsequently cost. ConclusionsBipolar hemiarthroplasty is associated with better range of motion, lower rates of acetabular erosion and lower reoperation rates compared to the unipolar hemiarthroplasty but at the expense of longer operative time. Both were similar in terms of mortality, and surgical or medical outcomes. Future large studies are recommended to compare both methods regarding the quality of life.

Measuring the consequences of a bipolar or unipolar mood disorder and the immediate and ongoing impacts.

Mood disorders may lead to major life consequences. This study builds on our preliminary examination of the impact of an extensive set of consequences and was undertaken in a larger clinical sample. Two hundred and forty four adults diagnosed with either unipolar depressive disorder or a bipolar disorder (type I or II) were administered an online survey of 60 items, listing potential consequences of having a mood disorder. Participants estimated the degree of impact (0–100) of each consequence on their life initially, and in the longer term. Items loading highly on the first ‘general’ factor of a bi-factor analysis were examined. Most items were affirmed by at least 75% of the sample. Significant group differences emerged on ten items. The bipolar group was 1.44–2.27 times more likely to experience difficulty with debts, education, speeding fines, increased risk of harm and delayed family planning. The unipolar group was 1.11–1.67 times more likely to experience social withdrawal, lowered life satisfaction, decreased overall wellbeing and ambition, and missed opportunities. Only one positive consequence (i.e. increased empathy) was identified. This extensive range of mood disorder consequences was highly endorsed by both BP and UP patients and with substantial immediate and ongoing impacts reported.

Retrospective comparative study of fracture neck of femur treated with Uni polar Vs bipolar hemiarthroplasty

Background and Objective: Intracapsular femoral neck fractures are common in the elderly population. To avoid the poor outcome of internal fixation and for early mobilization, hemiarthroplasty is performed. However, there is inadequate evidence to support the choice between unipolar or bipolar hemiarthroplasty. The aim of this study was to compare the outcome of unipolar with the bipolar prosthesis in geriatric patients especially in rural population of kolar. Methods: sixty patients above 60 years of age and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar hemiarthroplasty, in the Department of Orthopaedics, between September 2009 and October 2012. Functional outcome was assessed and compared using Harris hip score and radiological parameters with a follow-up of one year. Results: The two groups of patients with mean age of 68.3% in bipolar group and 69.9% in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. There was no significant difference between a Moore’s and a bipolar prosthesis regarding hip pain, functional hip scores, rates of acetabular erosion, component migration, revision surgery and complications rates. Conclusion: Use of the more expensive bipolar prosthesis in elderly and premorbidly ambulant patient is not justified especially in rural population.

Psychopathological Features of Bipolar Depression: Italian Validation of the Bipolar Depression Rating Scale (I-BDRS).

Background: Aim of the study was the validation of the Bipolar Disorder Rating Scale (BDRS) in an Italian population. Secondary aim was the evaluation of differences between unipolar and bipolar depression and between bipolar I and II depressed patients.Method: 125 Bipolar Disorder and 60 Major Depressive Disorder patients were administered an Italian translation of the BDRS (I-BDRS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Temperament and Character Inventory-Revised (TCI-R).Results: I-BDRS showed considerable validity and reliability. Factor analysis found 3 subscales, two linked to depressive symptoms and one to mixed symptoms. Measures concerning depression (MADRS and HAM-D) were positively related to the I-BDRS's subscales, but mostly to the two subscales measuring depression. In mixed symptoms, the mean of the bipolar group was significantly higher than the unipolar group suggesting that the BDRS was able to distinguish between unipolar and bipolar depressed patients.Conclusion: I-BDRS is a valid scale for the measurement of depression in BD patients, with a notable internal consistency (Cronbach's α 0.82), a significant consistency between items/total (Cronbach's α from 0.80 to 0.82) and positive correlation with other scales (MADRS r = 0.67, p < 0.001; HDRS r = 0.81, p < 0.001; YMRS r = 0.46 p < 0.0001). The mixed state sub-scale shows usefulness in differentiating bipolar from unipolar patients. I-BDRS could be a sensitive tool, both in pure depression and in mixed states, and could be used in the everyday screening and treatment of Bipolar Disorder.

Higher cartilage wear in unipolar than bipolar hemiarthroplasties of the hip at 2 years: A randomized controlled radiostereometric study in 19 fit elderly patients with femoral neck fractures

Background and purpose — The use of unipolar hemi­arthroplasties for femoral neck fractures is increasing in some countries due to reports of higher reoperation rates in bipolar prostheses. On the other hand, it has been proposed that bipolar hemiarthroplasties have clinical advantages and less cartilage wear than unipolar hemiarthroplasties. We compared cartilage wear between bipolar and unipolar hemiarthroplasties using radiostereometric analyses (RSA), in patients aged 70 years or older.Patients and methods — 28 ambulatory, lucid patients were randomized to treatment with a unipolar or a bipolar hemiarthroplasty for an acute femoral neck fracture. Migration of the prosthetic head into the acetabulum was measured using RSA. Secondary outcomes were Harris Hip Score (HHS), and EQ-5D scores. Patients were assessed at 3, 12. and 24 months.Results — 19 patients were available for follow-up at 2 years: mean proximal penetration was 0.83 mm in the unipolar group and 0.24 mm in the bipolar group (p = 0.01). Mean total point movement was 1.3 mm in the unipolar group and 0.95 mm in the bipolar group (p = 0.3). Median HHS was 78 (62–96) in the unipolar group and 100 (70–100) in the bipolar group (p = 0.004). Median EQ-5D Index Score was 0.73 (0.52–1.00) in the unipolar group and 1.00 (0.74–1.00) in the bipolar group (p = 0.01). Median EQ-5D VAS was 70 (50–90) in the unipolar group and 89 (70–95) in the bipolar group (p = 0.03)Interpretation — Patients with unipolar hemiarthroplasties had higher proximal cartilage wear and lower functional outcomes. Unipolar hemiarthroplasties should be used with caution in ambulatory, lucid patients.