The effects of swLORETA Z-score neurofeedback for patients comorbid with major depressive disorder and anxiety symptoms.

BACKGROUND: Patients with major depressive disorder (MDD) exhibit atypical brain activities in the frontal, temporal, and parietal lobes. The study aimed to investigate the effects of standardized weighted low-resolution electromagnetic tomography Z-score neurofeedback (swLZNFB) on symptoms of depression and anxiety, electroencephalography (EEG) parameters, and deep brain activities in patients with MDD. METHOD: Forty-eight patients with MDD comorbid with anxiety symptoms were assigned to the swLZNFB group and the control group. Participants completed the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) and a 5-minute resting EEG at the pre-and post-tests. The swLZNFB group received ten sessions of one-hour treatment twice weekly. The control group received treatment as usual. The scores for BDI-II and BAI, number of EEG abnormalities, percentage of EEG abnormalities, and current source density (CSD) measured in the prefrontal cortex (PFC), anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and amygdala were compared at pre-and post-tests between the two groups. RESULTS: There were decreased scores of BDI-II and BAI, number of EEG abnormalities, and percentage of EEG abnormalities at post-test compared with pre-test in the swLZNFB group, and lower scores of BDI-II and BAI at post-test in the swLZNFB group compared with the control group. Moreover, decreased CSD of beta1 and beta3 in the PFC, ACC, PCC, and amygdala at post-test compared to pre-test in the swLZNFB group. LIMITATIONS: Not a randomized controlled trial. CONCLUSION: Ten sessions of swLZNFB reduced clinical symptoms and atypical brain activities, it serves as a potential psychological intervention for patients with MDD.

Length of stay in relation to the risk of inpatient and post-discharge suicides: A national health insurance claim data study.

BACKGROUND: This study aimed to compare the predictors of suicides among psychiatric inpatients and recently discharged patients and to examine the association between the length of stay and suicides. METHODS: Data from psychiatric inpatients were extracted from the National Health Insurance databank and merged with information from the Cause of Death data using unique identification numbers. Poisson regression analyses were used to estimate the incidence rate ratio for inpatient and post-discharge suicides, which included the variables of sex, age, psychiatric diagnosis, and number of admissions in the preceding year. The associations between length of stay and inpatient and post-discharge suicide were examined using multivariate Poisson regression analyses that were adjusted for these variables. RESULTS: A diagnosis of affective disorders and a higher number of previous admissions increased both inpatient and post-discharge suicides. Patients older than 15-24 years had a significantly lower inpatient suicide risk but were more likely to die by suicide post-discharge. The risk of suicide both during the inpatient stay and post-discharge statistically significantly decreased when the length of stay was longer. LIMITATIONS: As there were variations in societal, environmental, and facility-level factors that might have influenced the association between length of stay and suicide, the generalization of our findings to different settings may be impeded. CONCLUSIONS: This study provides additional evidence that hospitalization helps to reduce the suicide risk. It suggests that medical professionals should be alert to inpatient suicide and that they should determine the optimal length of stay considering post-discharge suicide.

Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis.

OBJECTIVE: To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. DESIGN: Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES: A comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019. STUDY SELECTION: Randomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated. RESULTS: 109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (-0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (-1.90 (-5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference -1.00 (-2.41 to 0.40)), bipolar enucleation (0.87 (-1.80 to 0.07)), and holmium laser enucleation (-0.84 (-1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (-1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes. CONCLUSION: Eight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods. STUDY REGISTRATION: CRD42018099583.

The effects of alpha asymmetry and high-beta down-training neurofeedback for patients with the major depressive disorder and anxiety symptoms.

BACKGROUND: Alpha-asymmetry neurofeedback (ALAY) was applied to patients with major depressive disorder (MDD) based on the theory of frontal alpha asymmetry. Neurophysiological studies have found a higher high-beta activity of electroencephalography (EEG) at the posterior cortex among patients with comorbid MDD and anxiety symptoms. The present study examined the effects of ALAY and high-beta down-training (Beta) neurofeedback in symptoms of depression and anxiety and EEG parameters. METHOD: Eighty-seven patients with comorbid MDD and anxiety symptoms were allocated to the ALAY, Beta, or control groups. Both neurofeedback groups received ten-session neurofeedback. All participants completed the Beck Depression Inventory II (BDI-II), Beck Anxiety Inventory (BAI), and five minutes resting EEG recording at pre-test and post-test. EEG raw signals were transformed into an A1 score [log (F4 alpha) - log (F3 alpha)], P3 and P4 high-beta power. RESULTS: BDI-II and BAI scores decreased at post-test in both ALAY and Beta groups, but no significant difference between the two groups. No significant interaction effect in A1 score at pre-test and post-test between the ALAY, Beta, and control groups. The P3 high-beta was significantly decreased in the Beta group, an increase in the control group, and no change in the ALAY group at post-test compared to the pre-test. CONCLUSIONS: Both neurofeedback groups decreased symptoms of depression and anxiety. The Beta group was more effective in decreasing high-beta power at the parietal cortex compared to other groups. This non-invasive psychological intervention can be used in the future for patients with comorbid MDD and anxiety symptoms.

Comparative Efficacy of Noninvasive Neurostimulation Therapies for Acute and Subacute Poststroke Dysphagia: A Systematic Review and Network Meta-analysis.

OBJECTIVE: To investigate the effectiveness of noninvasive neurostimulation therapies in patients with poststroke dysphagia. DATA SOURCES: Electronic databases, including Embase, PubMed, Scopus, and the Cochrane Library, were searched up to May 31, 2018. STUDY SELECTION: All published randomized controlled trials (RCTs) comparing neurostimulation therapies, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface neuromuscular electrical stimulation (sNMES), and pharyngeal electrical stimulation (PES), in patients with acute and subacute poststroke dysphagia were included. Nineteen RCTs were enrolled in the meta-analysis. DATA EXTRACTION: Full texts were independently reviewed. Two independent raters assessed the risk of bias of RCTs with the Cochrane risk-of-bias tool. The primary outcome measure was swallowing function evaluated before and after neurostimulation therapy. DATA SYNTHESIS: Both pairwise and network meta-analysis revealed that rTMS, tDCS, and sNMES significantly improved poststroke dysphagia compared with placebo. Differences in functional improvement between PES and placebo were not significant. Based on probability ranking, rTMS seemed the best treatment among the 4 neurostimulation therapies. In the network meta-analysis, rTMS showed the best efficacy compared with placebo (standardized mean difference=1.02, 95% confidence interval, 0.61-1.43). CONCLUSIONS: Among the 4 noninvasive neurostimulation therapies, rTMS, tDCS, and sNMES were effective for treating poststroke dysphagia; furthermore, rTMS may be the most effective therapy according to probability ranking.

Chinese Herbal Medicine Treatment Improves the Overall Survival Rate of Individuals with Hypertension among Type 2 Diabetes Patients and Modulates In Vitro Smooth Muscle Cell Contractility.

Type 2 diabetes (T2D) is a chronic, multifactorial, and metabolic disorder accounting for 90% diabetes cases worldwide. Among them, almost half of T2D have hypertension, which is responsible for cardiovascular disease, morbidity, and mortality in these patients. The Chinese herbal medicine (CHM) prescription patterns of hypertension individuals among T2D patients have yet to be characterized. This study, therefore, aimed to determine their prescription patterns and evaluate the CHM effect. A cohort of one million randomly sampled cases from the National Health Insurance Research Database (NHIRD) was used to investigate the overall survival rate of CHM users, and prescription patterns. After matching CHM and non-CHM users for age, gender and date of diagnosis of hypertension, 980 subjects for each group were selected. The CHM users were characterized with slightly longer duration time from diabetes to hypertension, and more cases for hyperlipidaemia. The cumulative survival probabilities were higher in CHM users than in non-CHM users. Among these top 12 herbs, Liu-Wei-Di-Huang-Wan, Jia-Wei-Xiao-Yao-San, Dan-Shen, and Ge-Gen were the most common herbs and inhibited in vitro smooth muscle cell contractility. Our study also provides a CHM comprehensive list that may be useful in future investigation of the safety and efficacy for individuals with hypertension among type 2 diabetes patients.

Altered neurochemical metabolites in Alzheimer's disease patients with unawareness of deficits.

BACKGROUND: Unawareness of deficits is common and is associated with poor outcomes in Alzheimer's disease (AD); however, little is known about correlated neurobiochemical changes. METHODS: Proton magnetic resonance spectroscopy was used to examine neurobiochemical correlates of unawareness of deficits as assessed by the Dementia Deficit Scale in 36 patients with AD. Magnetic resonance spectroscopy spectra were acquired from the anterior cingulate area and right orbitofrontal area. Concentrations of N-acetyl-aspartate (NAA), total creatine, and other neurometabolites were calculated. RESULTS: Nineteen (52.8%) participants had relative unawareness of deficits. This condition was negatively correlated with NAA/creatine in the anterior cingulate area (ß = -0.36, p = 0.025) and positively correlated with NAA/creatine in the right orbitofrontal area (ß = 0.41, p = 0.009) after controlling for dementia severity. CONCLUSIONS: These findings suggest unawareness of deficits in AD was associated with the altered neurochemical metabolites in the anterior cingulate area and right orbitofrontal area. However, the two areas might have opposite neuronal functions in unawareness of deficits.

Effect of Qigong on quality of life: a cross-sectional population-based comparison study in Taiwan.

BACKGROUND: Qigong, similar to Tai Chi Chuan, is beneficial to health. In Taiwan, Waitankung, a type of Qigong, is as popular as Tai Chi Chuan. This population-based comparison study compares the health-related quality of life between people practicing Waitankung and their comparable community residents. METHODS: A total of 165 individuals practicing Waitankung were matched by age and sex with 660 general individuals for comparison. Information about health-related quality of life, measured by the SF-36, and other basic and health conditions was obtained from the questionnaires. This study used the linear mixed-effect regression model to examine the association between health-related quality of life and the practice of Waitankung. RESULTS: Compared with either sedentary individuals or individuals practicing other types of exercise, the Waitankung group scored higher for eight and five out of ten SF-36 components, respectively. The Waitankung group scored better in general health, vitality, and physical component summary compared to individuals participating in other types of exercise, even when considering the energy expended by exercise. CONCLUSION: The results suggest that Waitankung exercising is significantly associated with health-related quality of life. Waitankung may serve as an exercise choice for middle-aged and older people to improve overall quality of life.

Brain biochemical correlates of the plasma homocysteine level: a proton magnetic resonance spectroscopy study in the elderly subjects.

BACKGROUND: An elevated plasma homocysteine level has been reported to be associated with various neuropsychiatric diseases. However, little is known about the brain biochemical changes associated with the higher plasma homocysteine level. The main goal of this study was to examine the sex difference in brain biochemical concentrations using brain proton magnetic resonance spectroscopy (H MRS), and to elucidate the biochemical changes associated with plasma homocysteine levels by sex in healthy elderly subjects. METHODS: Seventy elderly subjects without any clinical psychiatric and neurological disease underwent 3-T brain H MRS. MRS spectra were acquired from voxels placed on the left side of the basal ganglia, frontal lobe, and hippocampus. Brain biochemical concentrations were compared between the elderly male and female participants. Correlations between these biochemical concentrations and plasma homocysteine levels by sex were analyzed. RESULTS: Female participants had significantly higher levels of choline in the left frontal lobe and hippocampus, and lower creatine and myo-inositol, in the left basal ganglia than did males. A higher homocysteine level was correlated with a lower N-acetylaspartate (NAA) concentration in the left hippocampus in elderly women (r = -0.44; p = 0.03) but not in elderly men. CONCLUSIONS: This study found that there was a sex difference in brain biochemical concentrations in the elderly participants. A higher plasma homocysteine level was associated with a lower NAA in the hippocampus of elderly women. The sex difference in association between brain biochemical concentrations and plasma homocysteine levels needs further investigation. We speculate that after menopause, women lose protection of estrogen from the neurotoxic effects of homocysteine in the hippocampus. Future studies are required to examine this speculation.

Mental health implications of music: insight from neuroscientific and clinical studies.

Neuroscientific and clinical studies of music over the past two decades have substantially increased our understanding of its use as a means of therapy. The authors briefly review current literature related to music's effect on people with different mental illnesses, and examine several neurobiological theories that may explain its effectiveness or lack thereof in treating psychiatric disorders. Neuroscientific studies have shown music to be an agent capable of influencing complex neurobiological processes in the brain and suggest that it can potentially play an important role in treatment. Clinical studies provide some evidence that music therapy can be used as an alternative therapy in treating depression, autism, schizophrenia, and dementia, as well as problems of agitation, anxiety, sleeplessness, and substance misuse, though whether it can actually replace other modes of treatment remains undetermined. Future research should include translational studies involving both neuroscience and clinical medicine that investigate the long-term effects of music intervention and that lead to the development of new strategies for music therapy.

Brain proton magnetic resonance spectroscopic study of insight among elders with late-life depression in remission.

BACKGROUND: Insight refers to an awareness and attribution of disorders and attitude toward treatment. While neurocognitive studies indicate that lack of insight is associated with frontal lobe dysfunction, little is known about the neurobiochemical profile of insight. We investigated the neurobiochemical characteristics of insight within the frontal lobe using proton magnetic resonance spectroscopy ((1)H MRS) among elderly people with major depressive disorders in remission. METHODS: Seventy-five elderly patients with major depressive disorder in remission underwent assessment of insight using the Mood Disorders Insight Scale (MDIS), including awareness, attribution, and need for treatment. Brain (1)H MRS spectra were acquired from voxels located in the left frontal lobe. Ratios of N-acetylaspartate (NAA), choline, and myo-inositol reference to total creatine (tCr) were calculated. Correlations between these biochemical ratios and insight were examined. Secondary analyses included the association of biochemical ratios with each of the subscales of insight. RESULTS: Twenty (26.7%) study participants scored full points on the MDIS scale. Total scores of MDIS correlated with NAA/tCr (rho=0.31; p<0.006) in the left frontal lobe. Secondary analyses showed the depressive elders with inadequate attribution to their disease had lower levels of NAA/tCr than those with full insight regarding attribution. CONCLUSIONS: Biochemical changes on (1)H MRS support that the left frontal lobe may involve insight and relate more specifically to disease attribution. Lower levels of NAA/tCr suggest that the neuronal dysfunction in the left frontal lobe is associated with inadequate insight in late-life depression.

Seven-day intravenous low-dose omeprazole infusion reduces peptic ulcer rebleeding for patients with comorbidities.

BACKGROUND: Patients with comorbidities have an increased risk of ulcer rebleeding, especially within the 28 days after endoscopic therapy. Omeprazole infusion can prevent rebleeding after endoscopic therapy in patients with peptic ulcer bleeding. However, the optimal duration is uncertain, especially for those patients with comorbidities. OBJECTIVE: To determine whether prolonged low-dose intravenous omeprazole could reduce rebleeding for patients with comorbidities. DESIGN: A prospective randomized control study. SETTING: National Cheng Kung University, Tainan, Taiwan. PATIENTS: A total of 147 patients with comorbidities and peptic ulcer bleeding controlled by endoscopic hemostasis were enrolled. INTERVENTIONS: The enrolled patients were randomized into either the 7-day low-dose group or the 3-day high-dose group, who received 3.3 mg/h or 8 mg/h continuous omeprazole infusion, respectively. After omeprazole infusion, oral esomeprazole 40 mg every day was given. MAIN OUTCOME MEASUREMENTS: To compare the rebleeding rates within 28 days after gastroscopy between the 2 study groups. RESULTS: The 7-day cumulative rebleeding rate was similar between the 2 groups (9.5% vs 9.7%, P > .05), but the 7-day low-dose group had a lower risk of rebleeding between the 8th and 28th day compared with the 3-day high-dose group (0% vs 10.7%, P = .03; relative risk, 0.52 [95% CI, 0.43-0.63]). The Kaplan-Meier curves confirmed that the 7-day low-dose group had a significantly higher cumulative rebleeding-free proportion between the 8th and 28th day than the 3-day high-dose group (P = .02, log-rank test). CONCLUSIONS: In Asian patients, prolonged low-dose omeprazole infusion for 7 days may reduce peptic ulcer rebleeding during the first 28 days in patients with comorbidities.

Effects of Chinese wolfberry (Lycium chinense P. Mill.) leaf hydrolysates on the growth of Pediococcus acidilactici.

Growth stimulating effects of LYCH leaf hydrolysates on Pediococcus acidilactici IMT101 cells were observed when MRS broth was supplemented with 20% (v/v) H1+H2, the mixture of hydrolysates prepared by a traditional tea-making process. Cells grown on MRS containing H1+H2 showed a shortened lag phase while yielding a cell concentration (X(s)) significantly higher than other conditions investigated entering stationary phase. The maximal specific growth rate (mu(max)) was also the highest among all. Microwave-assisted extraction (MAE) at 80 degrees C for 2h (M80(2h)) released more amino acids but less sugar (fructose, glucose, and sucrose) than in H1+H2. Both X(s) and mu(max) reached in M80(2h)-supplemented MRS broth were lower than those in MRS containing H1+H2. No correlations between amino acids and cell growth were found. P. acidilactici cells grown in MRS broth in general showed higher consumption of carbohydrate in comparison with those in M17 broth containing the same carbohydrate. In the absence of FOS, the increased glucose concentration in MRS when supplemented by H1+H2 hydrolysates appeared to be responsible for the stimulatory effects on P. acidilactici growth. The growth-enhancing effects of LYCH leaf hydrolysates indicate the potential of developing new applications for LYCH leaves in promoting the growth of other probiotic cells using a simple process.

An investigation into competence in TCM of BSN graduates from technological universities in Taiwan.

The purpose of this study was to determine what competences in Traditional Chinese Medicine (TCM) should be possessed by Bachelor of Science in Nursing (BSN) graduates from technological universities in Taiwan. There were two phases in this study: focus groups and expert panel discussion. First, we held four focus groups, and interviewed 31 participants, including consumers, nursing staff and clinical nursing faculty. The interview tapes were transcribed verbatim, were proofed for accuracy and the content was analyzed. The results were then discussed by four academic experts in a panel discussion. Results indicated that the TCM competences of BSN graduates from technological universities should include the following: (1) to understand the basic concepts of TCM, including Yin/Yang, the Five Evolutive Phases, holistic view, the Five Viscera and Six Bowels, Meridians, etiology, and concepts of therapy and health preservation; (2) to recognize the cold and hot nature of food; (3) to illustrate the common dietetic care for immune enhancement in the four seasons, and the foods that help postnatal and postoperative physical regeneration; (4) to illustrate the properties, indications, and administration of common Chinese medicines, including: Ginseng, Lycium, Astragalus, Angelica sinensis (danggui), Chrysanthemum, Pinellia, Zizyphi fructus; (5) to describe the properties, indications, adverse effects, and administration of Siwutang and Shenghuatang; (6) to describe basic principles of administering both Chinese medicine and Western medicine; (7) to describe the indications and cautions of the following techniques: acupuncture, scraping therapy, and cupping; (8) to implement acupressure as a measure for promoting comfort under the following conditions: pain, vomiting, insomnia, palpitations; and (9) to demonstrate an open mind and cautious attitude to respect consumers using TCM. Results of the study can serve as a reference for nurse educators when training BSN graduates from technological universities in TCM competences.