Background
The several meta‐analyses of the effect of vitamin D on depression have produced inconsistent results and studies dealing with anxiety were not incorporated. There has been no ...comprehensive analysis of how results are affected by the nature of the sample or the dosage and duration of supplementation. The study is aimed to investigate whether vitamin D supplementation reduces negative emotions and to analyze the possible influence of sample and regimen.
Method
We conducted a systematic review and meta‐analysis of randomized controlled trials comparing the effect of vitamin D and placebo on negative emotion. Databases were searched for relevant articles published before February 2019.
Results
The analysis covered 25 trials with a total of 7,534 participants and revealed an effect of vitamin D on negative emotion (Hedges' g = −0.4990, 95% CI −0.8453, −0.1528, p = .0047, I2 = 97.7%). Subgroup analysis showed that vitamin D had an effect on patients with major depressive disorder and on subjects with serum 25(OH)D levels ≤50 nmol/L. The pooled data from trials of vitamin D supplementation lasting ≥8 weeks and dosage ≤4,000 IU/day indicated that vitamin D had an effect.
Conclusions
Our results support the hypothesis that vitamin D supplementation can reduce negative emotions. Patients with major depressive disorder and individuals with vitamin D deficiency are most likely to benefit from supplementation. But to interpret the results with high heterogeneity should still be cautious.
The continued threat of emerging, highly lethal infectious pathogens such as Middle East respiratory syndrome coronavirus (MERS‐CoV) calls for the development of novel vaccine technology that offers ...safe and effective prophylactic measures. Here, a novel nanoparticle vaccine is developed to deliver subunit viral antigens and STING agonists in a virus‐like fashion. STING agonists are first encapsulated into capsid‐like hollow polymeric nanoparticles, which show multiple favorable attributes, including a pH‐responsive release profile, prominent local immune activation, and reduced systemic reactogenicity. Upon subsequent antigen conjugation, the nanoparticles carry morphological semblance to native virions and facilitate codelivery of antigens and STING agonists to draining lymph nodes and immune cells for immune potentiation. Nanoparticle vaccine effectiveness is supported by the elicitation of potent neutralization antibody and antigen‐specific T cell responses in mice immunized with a MERS‐CoV nanoparticle vaccine candidate. Using a MERS‐CoV‐permissive transgenic mouse model, it is shown that mice immunized with this nanoparticle‐based MERS‐CoV vaccine are protected against a lethal challenge of MERS‐CoV without triggering undesirable eosinophilic immunopathology. Together, the biocompatible hollow nanoparticle described herein provides an excellent strategy for delivering both subunit vaccine candidates and novel adjuvants, enabling accelerated development of effective and safe vaccines against emerging viral pathogens.
To improve vaccination efforts against Middle East respiratory syndrome coronavirus (MERS‐CoV), a virus‐mimicking vaccine is herein prepared with a capsid‐like hollow polymeric nanoparticle loaded with STING agonists and coated in MERS‐CoV antigens. The viromimetic nanoparticle facilitates safe and effective vaccination against the lethal virus and offers a versatile platform for combatting emerging infectious threats.
Background The relationship between isotretinoin treatment for acne and depression is controversial. Quantitative analysis has not yet been conducted. Objective To conduct a meta-analysis, ...evidence-based examination of the relationship between isotretinoin and depression. Method A systematic review and meta-analysis of the literature published from inception to September 30, 2016, was conducted. Controlled or prospective non-controlled trials on ≥15 acne patients receiving isotretinoin treatment were included. The prevalence of depression and change in depression scores were calculated. Result Thirty-one studies met the inclusion criteria. In the controlled studies, the change in depression scores from baseline was not significantly different between patients receiving isotretinoin treatment and those receiving an alternative treatment (standardized mean difference SMD −0.334, 95% confidence interval CI −0.680 to 0.011). The prevalence of depression after isotretinoin treatment significantly declined (relative risk RR 0.588, 95% CI 0.382–0.904). The mean depression scores significantly decreased from baseline (SMD −0.335, 95% CI −0.498 to −0.172). Limitations No randomized controlled trials were reviewed; a large inter-study variation was observed. Conclusions Isotretinoin treatment for acne does not appear to be associated with an increased risk for depression. Moreover, the treatment of acne appears to ameliorate depressive symptoms.
Aim
To analyse large‐scale cardiovascular outcome trials of sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors to evaluate whether there are safety concerns with respect to major adverse limb events ...overall or among various high‐risk subgroups of patients.
Methods
We performed a quantitative meta‐analysis of randomized, placebo‐controlled, cardiovascular outcome trials of SGLT‐2 inhibitors in patients with type 2 diabetes. We searched the PubMed, Embase and Cochrane databases for trials published up until 30 June 2020. The efficacy outcomes analysed included amputations and were stratified by several subgroup variables, including age, duration of diabetes, glucose control, renal function, established peripheral artery disease and diabetes microvascular complications. This review was registered before completing the analysis.
Results
Among 383 records identified, six studies assessing the following three SGLT‐2 inhibitors met our inclusion criteria: empagliflozin (EMPA‐REG OUTCOME study), canagliflozin (CANVAS Program and CREDENCE study), dapagliflozin (DECLARE‐TIMI 58 and DAPA‐HF trials) and ertugliflozin (VERTIS CV study). Of a total of 51 713 participants, 858 required amputation operations. The event rates of amputation were 2.0% (535/26 778) and 1.3% (323/24 927) in the SGLT‐2 inhibitor and control groups, respectively. The random effects model revealed that SGLT‐2 inhibitors were not significantly associated with an increased risk of amputation with substantial heterogeneity (pooled risk ratio, 1.24; 95% confidence interval, 0.96 to 1.60; I2 = 67.5%). This neutral effect of SGLT‐2 inhibitors was also consistent across different levels of subgroups, including subgroups with or without established peripheral artery disease (PAD).
Conclusions
SGLT‐2 inhibitors are not associated with increased risks of amputation operations even among various high‐risk subgroups, including patients with PAD. The amputation events primarily arise from critical limb ischaemia and infection instead of acute limb ischaemia. A multi‐centre study focused on major adverse limb events with a longer follow‐up is needed to confirm these results and provide guidelines for clinical practice.
Aims
Patients with anxiety disorders (AD) have been found to have lower heart rate variability (HRV) than healthy individuals in some studies, but this was inconsistent. Furthermore, the influence of ...distinct diagnoses, study design, and demographic factors on the results was not comprehensively examined.
Methods
We gathered studies comparing HRV in patients with AD and in healthy controls. The parasympathetic activity in the hierarchical order principle was adopted in the main analysis. We adopted the random effects model to calculate the standardized mean difference.
Results
Of the 7805 screened studies, 99 were included in the quantitative analysis, with a total of 4897 AD patients and 5559 controls finally entered the meta‐analysis. AD patients had a significantly lower resting‐state HRV for parasympathetic activity compared to control (Hedges' g = −0.3897). For the diagnostic subgroup analysis relative to the controls, resting‐state HRV was significantly lower in post‐traumatic stress disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder patients. HRV reactivity (all reactivity data, data on physiological challenge, and psychological challenge) did not show significant inter‐group differences between AD patients and healthy subjects.
Conclusions
The results supported that patients with AD had significantly lower resting‐state HRV than the healthy population, but no alterations were found for HRV reactivity.
Abstract Recently, Beloborodov suggested that there exists a resonance phenomenon between an extremely intense electromagnetic wave and internal magnetized particles. The particles exchange energy ...with the wave at frequent resonance events and then reach the radiation reaction limit immediately. This process greatly enhances the scattering cross section of the particles. Note that these results only involve an extraordinary (X) mode wave. In this paper, we focus on an intense ordinary (O) mode wave propagating through magnetized particles and compare it with the case of the X-mode wave. Our result shows that the scattering cross section of the particles in the O-mode wave is significantly smaller than that in the X-mode wave. This has important implications for the transparency of a fast radio burst (FRB) inside the magnetosphere of a magnetar. We argue that there is a strong scattering region in the stellar magnetosphere, within which an O-mode wave is more transparent than an X-mode wave for an FRB.
Background:The effect of remote monitoring (RM) in atrial arrhythmia detection, stroke reduction, and anticoagulation therapy remains unknown, particularly for patients with implantable or wearable ...cardiac devices.Methods and Results:We performed a systematic review and meta-analysis to evaluate the role of RM in atrial arrhythmia detection, stroke reduction and anticoagulation therapeutic intervention. Online databases were queried to include randomized controlled trials comparing detection of atrial arrhythmia and stroke risk between patients undergoing RM and those receiving in-office (IO) follow-up. Outcomes and complications of RM-guided anticoagulation therapy and conventional therapy in patients with atrial fibrillation were also reviewed. A total of 16 studies were included. Compared with patients receiving IO follow-up, patients undergoing RM had a significantly higher detection rate of atrial arrhythmia (risk ratio RR, 1.363; 95% confidence interval CI, 1.147–1.619), and a lower risk of stroke (RR, 0.539; 95% CI, 0.301–0.936). The higher rate of atrial arrhythmia was only noted in patients with wearable devices (RR, 4.070; 95% CI, 2.408–6.877), and the lower risk of stroke was only noted in patients with cardiovascular implantable electronic devices (CIED) (RR, 0.513; 95% CI, 0.265–0.996).Conclusions:RM is effective for atrial arrhythmia detection in patients using wearable devices and for reducing the risk of stroke in patients with CIED.
MR‐guided radiotherapy (MRgRT) is one of the most significant advances in radiotherapy in recent years. The hybrid systems were designed to visualize patient anatomical and physiological changes ...during the course of radiotherapy, enabling more precise treatment. However, before MR‐linacs reach their full potential in delivering safe and accurate treatments to patients, the radiotherapy team must understand how a magnetic field alters the dosimetric properties of the radiation beam and its potential impact on treatment quality and clinical outcomes.
This review aims to provide an in‐depth description of the magnetic field induced dose effects for the two widely available systems, the 0.35 T and the 1.5 T MR‐linacs. In MR‐linac treatments, the primary photon beam passes through MR components that never exist in conventional linacs, which alter both in‐field and out‐of‐field doses. More importantly, the interplay between the always‐on magnetic field and the secondary electrons is not negligible. This interplay affects dose deposition in the patient, resulting in reduced in‐field skin dose due to purged‐out contaminant electrons, shortened build‐up distance and a shifted crossline profile owing to asymmetric dose kernel. Especially two effects, namely, electron return effect (ERE) and electron stream effect (ESE), are not seen in conventional radiotherapy.
This review also summarizes the clinical observations on the site‐specific treatments influenced mostly by the magnetic field. In MR‐linac treatment, the head and neck region is one of the most challenging sites as ERE occurs at low and high density tissue interfaces and around air cavities, generating hot and cold spots. In breast cancer treatment, consideration should be given to the increased in‐field skin dose induced by ERE and the increased out‐of‐field dose caused by ESE for regions such as the ears, chin, and neck. In lung cancer treatments, tissue inhomogeneity combined with ERE will exacerbate target dose heterogeneity and increase or decrease interface dose. Lastly, treatment in the abdomen and pelvic region will be affected by the presence of gas pockets near the target. The review provides practical recommendations to mitigate these effects.
Patients with rosacea commonly experience stigmatization, which induces stress and thereby exacerbates their symptoms. Given the strong effects of rosacea on health-related quality of life (HRQoL), ...addressing the physical and psychosocial aspects of rosacea is essential. To examine the effects of rosacea on HRQoL, we conducted a systematic review and meta-analysis involving real-world data. PubMed, EMBASE, and the Cochrane Library were searched, and randomized controlled trials (RCTs), cross-sectional studies, and case series evaluating the HRQoL of patients with rosacea were included. HRQoL assessment tools such as the Dermatology Life Quality Index (DLQI) and Rosacea-Specific Quality-of-Life Questionnaire (RosaQoL) were used. Data on 13,453 patients were retrieved from 52 eligible studies: 4 RCTs, 15 case series, and 33 cross-sectional studies. Compared with healthy controls, patients with rosacea had significantly lower DLQI scores (standardized mean difference SMD = −1.09, 95% confidence interval CI = −0.81 to −1.37). The DLQI scores after treatment were higher than those before treatment (SMD = −1.451, 95% CI = −1.091 to −1.810). The pooled estimates for the overall DLQI and RosaQoL scores were 8.61 and 3.06, respectively. In conclusion, patients with rosacea have lower HRQoL compared with healthy individuals, and treatment for rosacea improves their HRQoL.
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