Maintenance Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder: A Meta-analysis.

ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) is an effective therapy for acute treatment of major depressive disorder (MDD). However, the efficacy and optimal strategy of delivering maintenance rTMS beyond acute treatment remains unclear. This meta-analysis aims to quantify the treatment effect of maintenance rTMS therapy in MDD and compares the difference in treatment effect between the fixed and rescue maintenance rTMS protocols. We conducted a meta-analysis of 14 studies (N = 705) comparing depression rating scores before and after maintenance rTMS. Standardized mean scores adjusted for sample size (Hedges g) were used as the effect size. Subgroup analysis was performed to compare the fixed and rescue maintenance rTMS treatment. Maintenance rTMS was associated with a statistically significant improvement in depression scores (standardized mean difference [SMD] = 0.75; confidence interval [CI] = -1.25 to -0.25). The random effects model had the Q value = 142.67 (P < 0.0001) and I2 = 90%, supporting significant heterogeneity among studies. The prediction interval yielded a possible effect size from -2.54 to 1.05. The subgroup analysis showed a stronger treatment effect for rescue maintenance protocol (SMD = -1.17; CI = -2.13 to -0.21) compared to fixed maintenance protocol (SMD = -0.45; CI = -1.00.16). Although not statistically significant (Q-between = 2.56, df-between = 1, P = 0.1096), a large difference in effect size was observed between subgroups. Maintenance rTMS appears to be an effective strategy for maintaining remission and preventing relapse in MDD. Significant heterogeneity among the studies warrants caution in interpreting the results. These findings suggest the need for standard protocols and consensus guidelines for the optimal delivery of maintenance rTMS treatment.

Comparison of Seed Morphology and Seed Coat Chemistry in Ophrys (Orchidaceae) Species.

Orchidaceae is the largest flowering plant family in the world and holds significant importance in terms of biological diversity. Many of the species are found in endemic regions, serving as important indicators for the conservation of biological diversity. Therefore, research on the morphology, seed and embryo structures, chemical composition, and taxonomy of orchids is crucial for species conservation, habitat restoration, and the sustainability of natural habitats. This research involves comparing the morphometric and chemical contents of seeds belonging to certain Ophrys L. species and examining interspecies relationships. The micromorphological features of the seeds were analyzed by using light microscopy and scanning electron microscopy (SEM), while their chemical contents were compared by using Fourier transform infrared spectroscopy (FT-IR) analysis. Seed and embryo morphology, morphometric analysis, and seed coat chemistry hold diagnostic significance. In species of the Ophrys genus, features like anticlinal wall structure and periclinal wall reticulation are considered weak taxonomic characters. FT-IR analysis identifies specific chemical groups in orchid samples, revealing significant differences in absorbance values and chemical compositions among the different orchid species. Particularly, Ophrys lycia (Lycian Kas Orchid) shows distinct separation from closely related species at peak points such as 2917 and 2850, 1743, 1515, 1240, and 1031 cm-1. Common peak points in the fingerprint region (1200- 700 cm-1) indicate similarity between O. apifera and O. reinholdii subsp. reinholdii. O. ferrum-equinum, O. mammosa subsp. mammosa, O. fusca subsp. leucadica, O. reinholdii subsp. reinholdii, and O. iricolor exhibit similar absorbance values in the range of 1500-1000 cm-1. These results provide valuable preliminary information about the structure of orchid seed coats, reticulation presence and pattern, chemical profiles, distribution, and dormancy-germination processes.

The usefulness of transcervical ultrasonography for the prediction of obstructive sleep apnea in children.

OBJECTIVE: It was aimed to investigate the role of tonsil ultrasonography(USG) in the diagnosis of pediatric OSAS. METHODS: Before tonsillectomy (±adenoidectomy) for OSAS, all patients tonsil USG and polysomnography (PSG) tests were performed. Tonsil volume was measured preoperatively with the Brodsky tonsil grading scale and by postoperative water displacement test. RESULTS: In total, 47 patients were included in the study. We observed a positive correlation between tonsil volumes measured by preoperative USG and water displacement test postoperatively. There was a statistically significant correlation between tonsil sizes measured by tonsil USG, PSG AHI and questionnaire scores(p < .05). CONCLUSION: Preoperative tonsil USG may be helpful test in children with suspected OSAS.

The effectiveness of video training in improving intensive care nurses' knowledge about brain death identification.

BACKGROUND: Because patients diagnosed with brain death in intensive care units constitute a potential cadaveric donor group for organ transplantation, intensive care units are potential donor sources. Nurses who closely monitor the patient collaborate with medical personnel in the recognition and early diagnosis of brain death. Nurses also have an important role in supporting the patient's family. Therefore, it is very important for nurses to know the diagnostic criteria for brain death. AIM: The aim of this study was to compare the effectiveness of theoretical education and video-assisted education in equipping intensive care nurses to recognize brain death. STUDY DESIGN: A randomized, experimental study was conducted between February and May 2020 with a total of 50 intensive care nurses, split into 25 in the video-assisted training group and 25 in the theoretical training group. In study, intensive care nurses were given a theoretical training and video-assisted training on brain death criteria. One group was trained theoretically and the other group used a video showing criteria for brainstem reflexes (pupil assessment, spontaneous breathing, corneal reflex, retching and coughing assessments) and deep tendon reflexes in a simulated patient, supported by animation. The data were collected before, immediately after and 3 months after the training using the Brain Death Criteria Knowledge Test, the Brain Death Case Test, and the Training Effectiveness Evaluation Form. The independent samples t-test, Mann-Whitney U test, Friedman test, Wilcoxon test, and Chi-square test were used for statistical analysis of data. RESULTS: It was found that the knowledge scores of both groups immediately after training and 3 months after training were higher than before the training (p < .001). However, the post-training knowledge scores of the video-assisted training group were significantly higher than those of the theoretical training group (p = .011). CONCLUSIONS: To enable intensive care nurses to identify brain death, video-assisted training with a simulated patient is recommended, as is repeating the training at regular intervals. RELEVANCE TO CLINICAL PRACTICE: The simulated patient video-assisted training method can be used for in-service training to provide intensive care nurses with the ability to identify brain death. The training may be repeated at regular intervals (e.g., every 3 months) to increase nurse recall.

A new species of Dianthus (Caryophyllaceae) from Antalya, South Anatolia, Turkey.

Dianthus multiflorus from Gazipasa (Antalya), south Anatolia (Turkey), is described as a new annual species with verrucose calyx. The morphological differences from the species within the same group with Dianthus multiflorus, which are Dianthus aydogdui, Dianthus cyri and Dianthus tripunctatus, are discussed. The International Union for Conservation of Nature (IUCN) threat category and observations on the ecology of the populations are noted. The karyology and seed micromorphology of Dianthus multiflorus and Dianthus tripunctatus were examined by light microscopy and scanning electron microscopy.

Chemical composition, antimicrobial and antioxidant activities of the essential oils of Sideritis erythrantha Boiss. and Heldr. (var. erythrantha and var. cedretorum P.H. Davis) endemic in Turkey.

In the present study, chemical compositions, antimicrobial and antioxidant activities of the essential oils of Sideritis erythrantha var. erythrantha (SE) and Sideritis erythrantha var. cedretorum (SC), which are endemic taxa in Turkey, were investigated. The essential oils obtained by hydrodistillation were analyzed by gas chromatography-mass spectrometry (GC-MS). α-Pinene was the major component of the essential oils of SC and SE. SC essential oil was as effective as antibiotic against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus faecalis (VRE), ampicillin resistant Haemophilusinfluenzae and vancomycin sensitive E. faecalis. Similarly, SE essential oil was also as effective as antibiotic against VRE and ampicillin resistant H. influenzae. Antioxidant activities of the essential oils of SC and SE were determined by 1,1-diphenyl-2-picrylhydrazyl (DPPH), ß-carotene/linoleic acid and reducing power. Both essential oils exhibited weak antioxidant activity. This is the first report on antimicrobial and antioxidant activities of the essential oils of SC and SE.