Effects of transcranial direct current stimulation for post-stroke depression: A systematic review and meta-analysis.

OBJECTIVE: The aim of this investigation was to evaluate the effect of transcranial direct current stimulation (tDCS) on post-stroke depression (PSD). METHODS: Databases were searched through February 2021. Randomized Controlled Trial(RCT) investigating the efficacy of tDCS in PSD using a standardized depression scale as outcome measure was included. The Cochrane Manual of Systematic Evaluation 5.1.0 bias risk assessment tool was used to assess the risk of bias. Effect sizes were calculated from extracted data and combined for an overall summary statistic. RESULTS: Eight studies involving 412 patients were included. These trials revealed a significant pooled effect size (standardized mean differences(SMD) = 1.61, 95% confidence interval(CI) 1.02-2.19, P < 0.00001). For the subgroup analyses, neither comparisons of high- vs low-intensity or left dorsolateral prefrontal cortex vs primary motor cortex revealed a significant result. tDCS had no obvious effect on the anxiety state in patients with PSD(SMD = 1.09, 95% CI, -0.22 to 2.40, P = 0.10), while it resulted in improved ability of daily life(ADL) in these patients(SMD = 0.82, 95% CI, 0.16-1.48, P = 0.01) CONCLUSIONS: tDCS has an effect on improvement in PSD, while it is still not clear which stimulus program is best. SIGNIFICANCE: Further trials with larger sample sizes are needed to determine the best and most effective tDCS regimen and to realize potential clinical applications.

Concurrent chemoradiotherapy using gemcitabine and nedaplatin in recurrent or locally advanced head and neck squamous cell carcinoma.

BACKGROUND: Patients with recurrent or locally advanced head and neck squamous cell carcinoma (HNSCC) typically have limited treatment options and poor prognosis. AIM: To evaluate the efficacy and safety of two drugs with potent radio-sensitization properties including gemcitabine and nedaplatin as concurrent chemoradiotherapy regimens in treating HNSCC. METHODS: This single-arm prospective study enrolled patients with HNSCC to receive gemcitabine on days 1 and 8 and nedaplatin on days 1 to 3 for 21 days. Intensity-modulated radiation therapy with a conventional fraction was delivered 5 days per week. Objective response rate (ORR), disease control rate, and toxicity were observed as primary endpoints. Overall survival (OS) and progression free survival were recorded and analyzed as secondary endpoints. RESULTS: A total of 24 patients with HNSCC were enrolled. During the median 22.4-mo follow-up, both ORR and disease control rate were 100%. The one-year OS was 75%, and one-year progression-free survival (PFS) was 66.7% (median PFS was 15.1 mo). Recurrent HNSCC patients had a poorer prognosis than the treatment-naïve patients, and patients who achieved complete response had better survival than those in the PR group (all P < 0.05). The most common grade 1-4 (100%) or grade 3-4 toxicities (75%) were hematological, and the most common grade 3-4 non-hematological toxicity was mucositis in 17 (71%) patients. CONCLUSION: Gemcitabine plus nedaplatin with concurrent chemoradiotherapy is a therapeutic option for HNSCC with predictable tolerability. Considering the high adverse event rate, the optimized dose and schedule must be further explored.