The follow-up effect after acute repetitive transcranial magnetic stimulation (rTMS) for major depressive episodes remains unclear. Furthermore, the benefits of maintenance rTMS are poorly ...understood.
To investigate the trajectory of changes in depressive symptoms after acute rTMS and effects of maintenance rTMS during this period.
This meta-analysis (PROSPERO: CRD42022374077) searched major databases up to October 1, 2022. Treatment outcome was depressive scores collected at least 3 months after the end of an acute rTMS course for depression. We extracted data at different time points after acute rTMS and categorized by whether maintenance rTMS was performed. A single-stage random-effects dose-response meta-analysis was undertaken to model the nonlinear relationships. Effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs).
24 eligible studies comprising 911 total patients—225 of whom received maintenance rTMS—were included. Maintenance rTMS contributed to relative stability in patients' mood symptoms during the first 5 months (SMD 95% CI: 3rd month, −0.10 −0.30 to 0.10; 5th month, 0.00 −0.55 to 0.55), with heterogeneity characterized as low to moderate. Further analysis revealed that maintenance rTMS performed monthly or more frequently provided sustained benefits for up to 6–12 months. Conversely, patients without maintenance rTMS had moderate to high heterogeneity, although the change in mean mood symptom scores during the 12-month follow-up was also minor (6th month, 0.03 −0.51 to 0.56; 12th month, 0.10 −0.59 to 0.79).
Maintenance rTMS might keep patients' mood relatively stable for up to 5 months after acute rTMS. Monthly or more frequent maintenance rTMS offers greater benefits.
•The follow-up effect of acute repetitive transcranial magnetic stimulation (rTMS) on depressive symptoms is unclear.•Maintenance rTMS might keep patients' mood relatively stable for up to 5 months after acute rTMS.•Monthly or more frequently administered maintenance rTMS might provide longer-lasting therapeutic effects after acute rTMS.
Right ventricular (RV) function has been found to be a major factor of exercise capacity in patients with heart failure. However, the role of RV function in exercise capacity in healthy subjects has ...not been well studied. This study aims to validate the role of RV strain derived from speckle tracking echocardiography for exercise capacity for health check-up subjects.
This study prospectively recruited subjects from a routine health examination. All of them were symptom free. RV function represented by RV strain was derived from speckle tracking echocardiography in addition to traditional echocardiography parameters. Functional capacity was determined by a symptom limited treadmill exercise test with the Bruce protocol.
Among 164 recruited subjects (age 52.2 ±9.2 years, 66.4% male), 32 subjects represented impaired functional capacity (MET<8), which was significantly correlated with age, left ventricular mass index, left ventricular filling pressure (E/e'), global longitudinal strain of the left ventricle (LVGLS) (-16.0±2.5% vs. -18.9±3.8%, p < 0.001) and RV free wall strain (RVLS_FW) (-17.0±4.9% vs. -21.9±3.2%, p <0.001). After multivariate logistic regression, RVS_FW was an independent predictor for impaired functional capacity (OR 1.62, CI 1.32-1.98; p <0.001).
In conclusion, RV strain is independently associated with exercise capacity for health check-up subjects. RV function is an important factor for functional capacity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Sorafenib, a small-molecule inhibitor targeting several tyrosine kinase pathways, is the standard treatment for advanced hepatocellular carcinoma (HCC). However, not all patients with HCC respond ...well to sorafenib, and 30% of patients develop resistance to sorafenib after short-term treatment. Galectin-1 modulates cell-cell and cell-matrix interactions and plays a crucial role in HCC progression. However, whether Galectin-1 regulates receptor tyrosine kinases by sensitizing HCC to sorafenib remains unclear. Herein, we established a sorafenib-resistant HCC cell line (Huh-7/SR) and determined that Galectin-1 expression was significantly higher in Huh-7/SR cells than in parent cells. Galectin-1 knockdown reduced sorafenib resistance in Huh-7/SR cells, whereas Galectin-1 overexpression in Huh-7 cells increased sorafenib resistance. Galectin-1 regulated ferroptosis by inhibiting excessive lipid peroxidation, protecting sorafenib-resistant HCC cells from sorafenib-mediated ferroptosis. Galectin-1 expression was positively correlated with poor prognostic outcomes for HCC patients. Galectin-1 overexpression promoted the phosphorylation of AXL receptor tyrosine kinase (AXL) and MET proto-oncogene, receptor tyrosine kinase (MET) signaling, which increased sorafenib resistance. MET and AXL were highly expressed in patients with HCC, and AXL expression was positively correlated with Galectin-1 expression. These findings indicate that Galectin-1 regulates sorafenib resistance in HCC cells through AXL and MET signaling. Consequently, Galectin-1 is a promising therapeutic target for reducing sorafenib resistance and sorafenib-mediated ferroptosis in patients with HCC.
An anisotropic microstructure and mechanical properties are big challenges in the development of various laser powder bed fusion (LPBF) alloys. This study investigated the roles of heat treatment and ...building direction (BD) on the microstructure and anisotropic mechanical properties of LPBF Corrax maraging stainless steel. The effects of solution treatment (ST) and integrated solution-aging treatment (SAT) were clarified. The results show that the grain size of martensite, amount of austenite, and features of grain boundaries were slightly varied with the building direction due to the thermal history. In the as-built state, the weak α′||BD, <1 1‾ 0>α′||X, and α′||BD textures could be found. After the SAT process, the <1 1‾ 0>α′||X texture was slightly intensified due to the coarsening of large columnar grains. However, the texture of the SAT sample was still weak.
Furthermore, the building direction and heat treatment did not lead to obvious anisotropic tensile properties or change the ductile fracture mode. The weak texture and pores in LPBF Corrax did not dominate the tensile properties. Irrespective of sample state, the horizontally-built samples exhibited comparable strengths and slightly higher elongation than the vertically-built ones did. In the as-built condition, this phenomenon can be mainly attributed to the transformation-induced plasticity effect. In the ST and SAT conditions, smaller grain sizes of martensite and higher high-angle grain boundary ratios in the horizontally-built samples provided more resistance to crack propagation. LPBF Corrax maraging stainless steel exhibited superior tensile performances and low anisotropic tensile properties, which are very beneficial to the stability of the material during service.
Autonomous vehicles need to continuously navigate complex traffic environments by efficiently analyzing the surrounding scene, understanding the behavior of other traffic agents, and predicting their ...future trajectories. The primary objective is to draw up a safe motion and reduce the reaction time for possibly imminent hazards. The main problem addressed in this paper is to explore the movement patterns of surrounding traffic-agents and accurately predict their future trajectories for assisting the vehicle to make a reasonable decision. Traditional trajectory prediction modules require explicit coordinate information to model the interaction between the autonomous car and its surrounding vehicles. However, it is hard to know the real coordinate of surrounding vehicles in real-world scenarios without communications between vehicles. A GAN (generative adversarial network)-based deep learning framework is presented in this paper for predicting the trajectories of surrounding vehicles of an autonomous vehicle in an RGB image sequence without explicit coordinate annotation to solve this problem. To automatically predict the trajectory from RGB image sequences, a coordinate augmentation module and a coordinate stabilization module are proposed to extract the historical trajectory from an image sequence. Meanwhile, the self-attention mechanism is also proposed to improve the social pooling module for better capturing the context information of trajectories of surrounding vehicles. Experimental results are demonstrated that the proposed method is effective and efficient.
This study investigated the impact of implementing ventilator-associated pneumonia (VAP) bundle care on the rates of VAP in intensive care units (ICUs) in Taiwan.
A total of 10 ICUs (bed number, ...170), including surgical (SICUs) (n = 7), cardiovascular/surgical (CV/S-ICUs) (n = 1), and medical ICUs (MICUs) (n = 2) from 10 hospitals (7 medical center hospitals and 3 regional hospitals) were enrolled in this quality-improvement project. This study was divided into the pre-intervention phase (1st January, 2012–31st July, 2013) and the intervention phase (1st August, 2013–31st October, 2014).
Among the 10 hospitals, the overall rates (cases per 1000 ventilator-days) of VAP declined significantly (p = 0.005; rate ratio, 0.71) from 1.9 in the pre-intervention period to 1.5 in the intervention period. Significant difference in VAP rates between these periods was found in the regional hospitals (from 1.6 to 0.7; p < 0.001) and the SICUs (from 2.1 to 1.4; p < 0.001), but not in the medical centers (2.0 vs. 1.9; p = 0.0667) or CV/S-ICUs (4.5 vs. 4.5; p = 0.5391). However, VAP rate increased significantly (cases per 1000 ventilator-days) in the MICUs between the two periods (from 0.5 to 1.0; p = 0.0489). For the VAP bundle care elements, the overall compliance rate was 87.7% with 83.6% and 97.9% in the medical centers and regional hospitals, respectively.
Implementing VAP bundle care has effectively reduced VAP in Taiwanese ICUs, but differences in performance and compliance rates of VAP bundle care among the different ICUs and hospital categories did exist.
We investigated whether chronological changes in portal flow and clinical factors play a role in the liver regeneration (LR) process after right donor-hepatectomy.
Participants in this prospective ...study comprised 58 donors who underwent right donor-hepatectomy during the period February 2014 to February 2015 at a single medical institution. LR was estimated using two equations: remnant left liver (RLL) growth (%) and liver volumetric recovery (LVR) (%). Donors were classified into an excellent regeneration (ER) group or a moderate regeneration (MR) group based on how their LR on postoperative day 7 compared to the median value.
Multivariate analysis revealed that low residual liver volume (OR = .569, 95% CI: .367- .882) and high portal venous velocity in the immediate postoperative period (OR = 1.220, 95% CI: 1.001-1.488) were significant predictors of LR using the RLL growth equation; high portal venous velocity in the immediate postoperative period (OR = 1.325, 95% CI: 1.081-1.622) was a significant predictor of LR using the LVR equation. Based on the two equations, long-term LR was significantly greater in the ER group than in the MR group (p < .001).
Portal venous velocity in the immediate postoperative period was an important factor in LR. The critical time for short-term LR is postoperative day 7; it is associated with long-term LR in donor-hepatectomy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess the association between prognostic nutritional index (PNI) and risk of postoperative delirium (POD) in adult patients.
MEDLINE, Google scholar, EMBASE, and Cochrane library databases were ...searched from inception till April 2022. The primary outcome was the association between PNI and the risk of POD, while the secondary outcomes were correlations of other prognostic factors with POD risk. The correlation between PNI and the incidence of POD was assessed with three approaches: Difference in preoperative PNI between POD and non-POD groups (Model 1) as well as the association of PNI as a continuous parameter (Model 2) or as a binary variable (i.e., low vs. high using a PNI cut-off value of 50) (Model 3) with POD risk.
Analysis of nine observational studies published from 2010 to 2021 recruiting 3,743 patients showed a POD incidence of 6.4-35%. Our meta-analysis demonstrated a lower PNI among patients in the POD group (MD: -3.78, 95% CI: -4.85 to -2.71,
< 0.0001,
= 54.2%) compared to the non-POD group (Model 1). Pooled results revealed a negative association between PNI and POD risk for both Model 2 (OR: 0.91, 95% CI: 0.86-0.97,
= 0.002,
= 71%) and Model 3 (OR: 1.68, 95% CI: 1.26-2.23,
< 0.0001,
= 0%). Besides, while our results supported an age-dependent increase in POD risk, other factors including body-mass index, surgical time, health status, hypertension, diabetes mellitus, and male gender were non-significant predictors of POD.
Our results demonstrated a negative association between PNI and POD, which warrant further large-scale studies for validation.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022323809.
The association of treatment resistance with physical and psychiatric comorbidities remains unclear in elderly patients with late-onset major depressive disorder (MDD).
Participants were selected ...from the Taiwan National Health Insurance Research Database. We included patients aged ≥ 65 years with first-episode MDD (
codes: 296.2X and 296.3X) between January 1, 2001, and December 31, 2010. All participants were followed for 1 year to investigate the incidence of treatment resistance. Treatment-resistant depression (TRD) was defined as unresponsiveness to at least 2 antidepressants, and treatment-resistant tendency (TRT) was defined as unresponsiveness to the first antidepressant. Physical comorbidities were assessed with the Charlson Comorbidity Index (CCI).
27,189 patients with late-onset MDD were included, among whom 16.6% had the diagnosis of anxiety disorders, 1.5% had alcohol use disorders, and 1.6% had substance use disorder. For physical comorbidities, only 16.6% of patients had a CCI score of 0. During the first year of treatment, 22.1% of patients met TRT criteria, and 1.6% developed TRD. Anxiety disorders (odds ratio: 2.06; 95% confidence interval CI, 1.67-2.53), substance use disorders (2.11; 95% CI, 1.26-3.53), and higher CCI scores (1.06; 95% CI, 1.01-1.10) were significantly associated with TRD, while anxiety disorders (1.44; 95% CI, 1.34-1.55) and higher CCI scores (1.06; 95% CI, 1.05-1.08) were significantly associated with TRT.
Approximately one-fourth of elderly patients responded poorly to the first antidepressant treatment during the first year of late-onset MDD. Psychiatric comorbidities were more associated with the risk of early TRT than were physical comorbidities.
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