Objective
To systematically examine the randomized controlled trial (RCT) evidence regarding efficacy and tolerability of topiramate cotreatment with antipsychotics in schizophrenia‐spectrum ...disorders.
Methods
Random‐effects meta‐analysis of RCTs of topiramate cotreatment with antipsychotics vs. placebo/ongoing antipsychotic treatment in schizophrenia‐spectrum disorders. Standardized or weighted mean difference (SMD/WMD), risk ratio (RR) ±95% confidence intervals (CIs), and number needed to harm (NNH) were calculated.
Results
Across 16 RCTs (n = 934, duration = 11.8 ± 5.6 weeks), topiramate outperformed the comparator regarding change/endpoint of total (SMD: −0.58, 95% CI: −0.82, −0.35, P < 0.00001), positive (SMD: −0.37, 95% CI: −0.61, −0.14, P = 0.002), negative (SMD: −0.58, 95% CI: −0.87, −0.29, P < 0.0001), and general symptoms (SMD: −0.68, 95% CI: −0.95, −0.40, P < 0.00001). Furthermore, topiramate was superior regarding body weight (WMD: –2.75 kg, 95% CI: −4.03, −1.47, P < 0.0001), body mass index (BMI) (WMD: –1.77, 95% CI: −2.38, −1.15, P < 0.00001), triglycerides (P = 0.006), and insulin levels (P < 0.00001). Superiority regarding psychopathology and body weight/BMI was consistent across Chinese/Asian and Western RCTs, double‐blind and open designs, clozapine and non‐clozapine cotreatment, augmentation and co‐initiation RCTs, and higher and lower quality RCTs. In meta‐regression analyses, topiramate's efficacy for total symptoms was moderated by shorter illness duration (P = 0.047), while weight loss was greater in prevention/co‐initiation vs. intervention/augmentation RCTs (−4.11 kg, 95% CI: −6.70, −1.52 vs. −1.41 kg, 95% CI: −2.23, −0.59, P < 0.001). All‐cause discontinuation was similar between topiramate and comparators (RR: 1.28, 95% CI: 0.91, 1.81, P = 0.16). While topiramate led to more concentration/attention difficulties (P = 0.03, NNH = 8, 95% CI=4–25), psychomotor slowing (P = 0.02, NNH = 7, 95% CI = 4–25), and paresthesia (P = 0.05, NNH = 2, 95% CI = 4–33), it led to less ≥7% weight gain (P = 0.0001, NNH = 2, 95% CI = 2–3) and constipation (P = 0.04, NNH = 9, 95% CI = 5–100) than the comparator.
Conclusions
These results indicate that adjunctive topiramate to antipsychotics is an effective and safe treatment choice for symptomatic improvement and weight reduction in patients with schizophrenia‐spectrum disorders.
Objective
This systematic review and meta‐analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N‐acetylcysteine (NAC), an antioxidant drug, in treating major ...depressive disorder (MDD), bipolar disorder, and schizophrenia.
Methods
The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed.
Results
Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = −0.74, 95% CI: −1.43, −0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders.
Conclusions
Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.
The current research deals with the postbuckling behavior of axially-loaded graphene-reinforced composite (GRC) laminated cylindrical shells under thermal environmental conditions. The piece-wise GRC ...layers are arranged in a functionally graded (FG) pattern along the thickness direction of the shells. The material properties of GRCs are assumed to be temperature-dependent and are estimated by the extended Halpin–Tsai micromechanical model. The governing equations for the GRC laminated cylindrical shells are based on the Reddy’s third order shear deformation shell theory and include the effects of the temperature variation. The nonlinearity effects are taken into account in the sense of von Kármán nonlinear kinematic assumptions. The buckling loads and the postbuckling equilibrium paths for the perfect and geometrically imperfect GRC laminated cylindrical shells can be obtained by solving the governing equations with a singular perturbation technique in conjunction with a two-step perturbation approach. The results show that the buckling loads and the postbuckling strengths of the GRC laminated cylindrical shells may be enhanced through piece-wise functionally graded distribution of graphene reinforcement.
Breast cancer incidence rates are increasing among Asian women, likely due to the changes in risk factors caused by globalization. Trends in breast cancer rates among Chinese women may differ from ...other Asian regions due to the implementation of a nationwide family planning program and resulting changes in women's reproductive practices. Appraisal of cancer trends can direct cancer control and public health planning, but relevant studies in China are scarce due to a lack of long-term data. We sought to evaluate secular time trends in breast cancer incidence and mortality using 40 years of cancer registry data for women in urban Shanghai.
Data on invasive breast cancer incidence and mortality were collected by the Shanghai Cancer Registry. Age-standardized rates (ASRs) for incidence and mortality were calculated using the Segi/Doll 1960 world standard population. Age, period, and birth cohort effects were evaluated using age–period–cohort (APC) Poisson regression models. Overall linear trends, interpreted as the estimated annual percentage change (EAPC), were derived from the net drift in age–drift models.
A total of 53 885 breast cancer cases and 17 235 breast cancer-specific deaths were documented among women in urban Shanghai between 1 January 1973 and 31 December 2012. Breast cancer incidence and mortality ASRs increased by 141.2% and 26.6%, respectively. Significant age, cohort, and period effects were identified in both incidence and mortality APC models; cohort effects were pronounced. Overall, a substantial increase in breast cancer incidence (EAPC = 2.96%/year) and a moderate increase in breast cancer mortality (EAPC = 0.87%/year) was observed. A notable downward trend in mortality was identified among younger women born after 1960.
Forty years of cancer registry data document a tremendous increase in incidence and a slight increase in mortality for breast cancer among women in Shanghai. Effective, appropriate, and affordable breast cancer prevention and control strategies are urgently needed in China.
•We propose a multi-scale approach for nonlinear analysis of FG-CNTRC beams.•Beam with intermediate material properties does not necessarily have intermediate frequencies.•Beam with intermediate ...material properties does not necessarily have intermediate temperatures.•Thermal postbuckling path of unsymmetric FG-CNTRC beams is no longer of the bifurcation type.
This paper studies the behaviors of large amplitude vibration, nonlinear bending and thermal postbuckling of nanocomposite beams reinforced by single-walled carbon nanotubes (SWCNTs) resting on an elastic foundation in thermal environments. Two types of carbon nanotube-reinforced composite (CNTRC) beams, namely, uniformly distributed (UD) and functionally graded (FG) reinforcements, are considered. The material properties of FG-CNTRCs are assumed to be graded in the beam thickness direction, and are estimated through a micromechanical model. The motion equations of a CNTRC beam on an elastic foundation are derived based on a higher order shear deformation beam theory. The thermal effects are also included in the motion equations and the material properties of CNTRCs are assumed to be temperature-dependent. Numerical studies are carried out for the nonlinear vibration, nonlinear bending and thermal postbuckling of CNTRC beams resting on Pasternak elastic foundations under different thermal environmental conditions. It is found that a CNTRC beam with intermediate CNT volume fraction does not necessarily have intermediate nonlinear frequencies, buckling temperatures and thermal postbuckling strengths. Thermal postbuckling path of unsymmetric FG-CNTRC beams is no longer the bifurcation type.
This paper deals with the large amplitude vibration of functionally graded graphene-reinforced composite laminated plates resting on an elastic foundation and in thermal environments. The ...temperature-dependent material properties of piece-wise functionally graded graphene-reinforced composites (FG-GRCs) are assumed to be graded in the thickness direction of a plate, and are estimated through a micromechanical model. Based on a higher-order shear deformation plate theory, the motion equations are developed with geometric nonlinearity taking the form of von Kármán strains. The plate–foundation interaction and thermal effects are also included. The motion equations are then solved by a two-step perturbation technique to determine the nonlinear frequencies of the FG-GRC laminated plates. The numerical illustrations concern the nonlinear vibration characteristics of FG-GRC laminated plates under different sets of thermal environmental conditions, from which results for uniformly distributed GRC laminated plates are obtained as comparators. The effects of distribution type of reinforcements, temperature variation, foundation stiffness and different in-plane boundary conditions are also investigated.
•The concept of functionally graded materials is extended to the GRC laminated plates.•A multi-scale approach for nonlinear vibration analysis of FG GRC laminated plates is proposed.•The plate–foundation interaction and temperature-dependent material properties are both taken into account.•FG reinforcement has a significant effect on the vibration characteristics of GRC laminated plates.
This paper investigates the large amplitude vibration behavior of nanocomposite cylindrical shells reinforced by single-walled carbon nanotubes (SWCNTs) in thermal environments. The SWCNTs are ...assumed to be aligned and straight with a uniform layout. Two kinds of carbon nanotube-reinforced composite (CNTRC) shells, namely, uniformly distributed (UD) and functionally graded (FG) reinforcements, are considered. The material properties of FG-CNTRC shells are assumed to be graded in the thickness direction, and are estimated through a micromechanical model. The motion equations are based on a higher-order shear deformation theory with a von Kármán-type of kinematic nonlinearity. The thermal effects are also included and the material properties of CNTRCs are assumed to be temperature-dependent. The equations of motion are solved by an improved perturbation technique to determine the nonlinear frequencies of the CNTRC shells. Numerical results demonstrate that in most cases the natural frequencies of the CNTRC shells are reduced but the nonlinear to linear frequency ratios of the CNTRC shells are increased as the temperature rises. It is found that the natural frequencies are increased by increasing the CNT volume fraction, whereas the CNTRC shells with intermediate CNT volume fraction do not have intermediate nonlinear to linear frequency ratios.
Aims
To examine the average point prevalence of major depressive disorder in people with Type 2 diabetes and its associated factors in a comprehensive meta‐analysis.
Methods
Two researchers ...independently conducted a systematic literature search of PubMed, EMBASE, PsycINFO and Cochrane databases. Studies reporting the prevalence of major depressive disorder in people with Type 2 diabetes were identified and analysed using a random‐effects model.
Results
A total of 26 studies meeting the inclusion criteria were included in the study. The point prevalence of major depressive disorder was 14.5% (95% CI 7.9–25.3; I²=99.65). People with Type 2 diabetes were more likely to have major depressive disorder compared with the general population (odds ratio 1.73, 95% CI 1.38–2.16). Subgroup and meta‐regression analyses showed that study site, study type, diagnostic criteria and age significantly moderated the prevalence of major depressive disorder.
Conclusions
In this meta‐analysis, the average point prevalence of major depressive disorder in people with Type 2 diabetes was high. Routine screening and more effective interventions should be implemented for this population.
What's new?
This was the first meta‐analysis to examine the prevalence of major depressive disorder in people with Type 2 diabetes in studies using standardized diagnostic instruments.
People with Type 2 diabetes were more likely to have major depressive disorder compared with the general population.
Routine screening and more effective treatments and interventions should be implemented for people with Type 2 diabetes and major depressive disorder.
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