Evaluating cognitive assessment tools for patients with major depressive disorder receiving electroconvulsive therapy: A systematic review and meta-analysis.

BACKGROUND: Major Depressive Disorder (MDD) affects 350 million people worldwide. Electroconvulsive therapy (ECT) is effective, yet research on cognitive assessments post-treatment is lacking. This study systematically reviews and meta-analyzes the effectiveness of cognitive assessment tools post-ECT to optimize MDD treatment. METHODS: Following PRISMA guidelines, this review was pre-registered on PROSPERO (CRD42023470318). Searches were conducted across nine databases up to November 12, 2023. Quality assessment for Randomized Controlled Trials (RCTs) and quasi-experimental studies was performed using the Cochrane risk of bias tool, JBI critical appraisal tools, and the Jadad scale. Meta-analyses for short-term and long-term cognitive function involved 24 and 18 tools, respectively. FINDINGS: Thirty studies (20 RCTs and 10 quasi-experimental) involving 2462 MDD patients were evaluated. Results indicated no significant differences in overall short-term and long-term cognitive functions post-ECT. Short-term analysis showed impairments in memory, learning, and verbal abilities but improvements in attention and processing speed. Long-term analysis revealed enhancements in memory, learning, verbal, and visuospatial abilities compared to baseline. Based on GRADE classification, we recommend 11 tools for assessing acute cognitive function and 10 tools for chronic cognitive impairment. These tools demonstrated high reliability and validity, supporting their clinical use. INTERPRETATION: These findings provide critical evidence for future ECT clinical guidelines in managing MDD. The recommended tools can aid clinicians in adjusting ECT regimens, identifying early cognitive changes, and improving therapeutic outcomes in MDD treatment.

Efficacy and safety of eight enhanced therapies for treatment-resistant depression: A systematic review and network meta-analysis of RCTs.

BACKGROUND: Treatment-Resistant Depression (TRD) challenges psychiatric treatment, with existing guidelines covering only a subset of augmentation strategies. METHODS: A network meta-analysis following PRISMA guidelines examined the efficacy and safety of TRD treatments, analyzing 72 randomized controlled trials from eight databases, assessing response and remission rates, tolerability, and safety through the Cochrane Risk of Bias Tool and CINeMA framework. FINDINGS: Including 12,105 participants, the analysis highlighted ECT, Ketamine, Esketamine, and Psilocybin as superior first-line treatments due to their optimal balance between effectiveness and tolerability. Brexpiprazole and Quetiapine showed no significant efficacy over placebo in response rates, while Esketamine and Psilocybin exhibited lower tolerability. INTERPRETATION: The results advocate for ECT, Ketamine, Esketamine, and Psilocybin as preferred treatments for TRD, guiding clinical practice with evidence-based recommendations for enhancing treatment outcomes. This study underscores the importance of considering both efficacy and safety in selecting augmentation strategies for TRD.

Traditional Chinese Medicine: Communicating Informational and Symbolic Functions in the Linguistic Landscape.

While dissemination of information is a key function of health communication, signage at medical facilities has other functions: signs can be a type of marketing (e.g., services offered), can promote credibility and inspire trust, can exacerbate or ameliorate social inequalities and can provide educational opportunities. All of these functions are influenced by cultural, contextual and social factors as evidenced by a linguistic landscape (LL) perspective. Traditional Chinese medicine (TCM) is a particularly instructive case for considering the functions of signage in healthcare LL as it has a strong cultural component from its historical Chinese roots, but its practice has been popularized around the globe in recent years. Given the role of TCM as a main or complementary medical treatment and healthcare option, this study investigates TCM LLs as sites of healthcare communication. Specifically, we analyze a set of 1,659 signs from two TCM hospitals in a multilingual, ethnic minority region of China as a case study which can be useful for healthcare providers when considering their own use of LL. We describe the way language and other sign features are used for informational, symbolic and other functions, showing how explicit communication channels as well as implicit ideological channels can impact healthcare communication. We discuss these findings in light of the need for healthcare communication which is sensitive to stakeholder needs.

A Specific, Measurable, Achievable, Relevant, Timed (SMART) Nursing Project Reduces Anxiety, Depression, and Post-Traumatic Stress Disorder in Parents of Childhood or Adolescent Osteosarcoma Patients.

Specific, measurable, achievable, relevant, timed (SMART) principle improves the nursing utility by setting individual goals for participants and helping them to achieve these goals. Our study intended to investigate the impact of a SMART nursing project on reducing mental stress and post-traumatic stress disorder (PTSD) in parents of childhood or adolescent osteosarcoma patients. In this randomized, controlled study, 66 childhood or adolescent osteosarcoma patients and 126 corresponding parents were enrolled and divided into SMART or normal care (NC) groups at a 1:1 ratio. All parents received a 3-month corresponding intervention and a 6-month interview. Our study revealed that the self-rating anxiety scale score at the 3rd month (M3) (P < 0.05) and the 6th month (M6) (P < 0.01), and anxiety rate at M3 (P < 0.05) and M6 (P < 0.05) were lower in parents in SMART group vs. NC group. The self-rating depression scale score at M3 and M6, and depression rate at M3 and M6 were lower in parents in SMART group vs. NC group (all P < 0.05). Impact of events scale-revised score at the 1st month (M1) (P < 0.05), M3 (P < 0.05), and M6 (P < 0.01) were lower in parents in SMART group vs. NC group. By subgroup analyses, the SMART nursing project showed better impacts on decreasing anxiety, depression, and PTSD in parents with an undergraduate education or above than in those with a high school education or less. Conclusively, SMART nursing project reduces anxiety, depression, and PTSD in parents of childhood or adolescent osteosarcoma patients, which is more effective in those with higher education.

Long-term cognitive effects of electroconvulsive therapy in major depressive disorder: A systematic review and meta-analysis.

OBJECTIVE: Electroconvulsive therapy (ECT) is endorsed as a principal treatment approach for major depressive disorder (MDD) worldwide. Despite prior studies highlighting potential short-term cognitive deficits post-ECT, the debate regarding its long-term implications persists. This study endeavors to elucidate the reasons for this contention using an evidence-based approach. METHODS: This investigation, meticulously aligned with PRISMA guidelines, was prospectively enlisted on PROSPERO (CRD42023439259). A comprehensive search was performed across various databases, including PubMed, Cochrane Library, Web of Science, Embase, SCOPUS, PsycINFO, CINAHL Plus, and OpenGrey. This review, traversing the literature from inception until June 2023, encapsulated 10 studies (five RCTs and five quasi-experimental studies) involving a cohort of 868 individuals diagnosed with major depressive disorder. RESULTS: The meta-analysis revealed that the persistent discourse on ECT-induced long-term cognitive impairment chiefly emanates from the inadequacies in the specificity and sensitivity of conventional assessment instruments. Conversely, subgroup analyses showed that cognitive impairment in ECT, as gauged by the nascent assessment tool, Electroconvulsive Therapy Cognitive Assessment (ECCA) (SMD = -0.94, 95 % CI [-1.33, -0.54], p < 0.00001), exerted a detrimental influence on the long-term trajectory of individuals with MDD. Notably, there was an adverse effect of ECT on the subdomain of long-term learning cognitive abilities in patients with MDD (SMD = -0.37, 95 % CI [-0.55, -0.18], p < 0.0001). Contrarily, memory (SMD = 0.16, 95 % CI [-0.02, 0.34], p = 0.08), attention (SMD = 0.23, 95 % CI [-0.07, 0.54], p = 0.14), language (SMD = -0.10, 95 % CI [-0.25, 0.05], p = 0.19), spatial perception, and orientation (SMD = -0.04, 95 % CI [-0.28, 0.20], p = 0.75) exhibited no significant detriments. Intriguingly, ECT showed favorable effects on executive function and processing speed among patients with MDD (SMD = 0.52, 95 % CI [0.29, 0.74], p < 0.00001). CONCLUSION: This meta-analysis underscores ECCA's superior sensitivity of the ECCA compared to the MMSE or MoCA in detecting cognitive changes in patients with post-ECT MDD. Following Electroconvulsive Therapy (ECT), deterioration was observed in overall cognitive function and learning capabilities, while memory, attention, language, and spatial perception remained stable. Notably, enhancements were discerned in executive function and processing speed, which not only augmented academic perspectives but also steered the formulation of international clinical guidelines, accentuating the progressive role of ECT in the therapeutic approach to MDD.

Propofol suppresses OGD/R-induced ferroptosis in neurons by inhibiting the HIF-1α/YTHDF1/BECN1 axis.

BACKGROUND: Ischemia/reperfusion (I/R) is a pathological process that causes severe damage. Propofol is known to alleviate I/R-related injury; however, the exact function and underlying mechanisms are not fully understood. METHODS: Using an oxygen glucose deprivation/re-oxygenation (OGD/R) method, an in vitro I/R injury model was induced. The cell viability and the level of Fe2+, glutathione synthetase (GSH), and malondialdehyde (MDA) were evaluated using kits. Luciferase reporter gene assay, chromatin immunoprecipitation, and RNA immunoprecipitation (RIP) were used to verify the interaction between molecules. The m6A level of BECN1 mRNA was determined through methylated RIP. RESULTS: Propofol-treated OGD/R models showed reduced levels of Fe2+ and MDA, while the cell viability and the level of GSH increased. Propofol inhibited ferroptosis by down-regulating HIF-1α in OGD/R-treated HT22 cells. HIF-1α is bound to the promoter region of YTHDF1 to promote its transcription, and YTHDF1 promoted ferroptosis by stabilizing the mRNA of BECN1. The suppressive effect of propofol on OGD/R-induced ferroptosis was reversed by the overexpression of YTHDF1. CONCLUSIONS: Our study revealed that the HIF-1α/YTHDF1/BECN1 axis in OGD/R-treated HT22 cells promotes ferroptosis, and administration of propofol can inhibit this axis to avoid cell death. This study provides a novel insight for the neuroprotective function of propofol.

A pilot study on improvements in attention function in major depressive disorder after 12 weeks of escitalopram monotherapy or combined treatment with agomelatine.

Objective: This study aimed to explore both impairments in attention function in patients with major depressive disorder (MDD) and the efficacy of escitalopram monotherapy or combination therapy with agomelatine. Methods: A total of 54 patients with MDD and 46 healthy controls (HCs) were included. Patients were treated with escitalopram for 12 weeks; those who presented with severe sleep impairments were also given agomelatine. Participants were evaluated using the Attention Network Test (ANT), which included tests of alerting, orienting, and executive control networks. Concentration, instantaneous memory, and resistance to information interference were tested using the digit span test, and the logical memory test (LMT) was used to evaluate abstract logical thinking. The Hamilton Depression Rating Scale-17 items, Hamilton Anxiety Rating Scale, and Pittsburgh Sleep Quality Index were used to assess depression, anxiety, and sleep quality, respectively. Patients with MDD were assessed at the end of weeks 0, 4, 8, and 12. HCs were assessed once at baseline. Results: Compared with HCs, patients with MDD showed significantly different alerting, orienting, and executive control functions of attention networks. Treatment with escitalopram alone or combined with agomelatine significantly improved LMT scores at the end of weeks 4, 8, and 12 and restored scores to the level of HCs at the end of week 8. Total Toronto Hospital Test of Alertness scores in patients with MDD increased significantly after 4 weeks of treatment. The ANT executive control reaction time in patients with MDD decreased significantly after 4 weeks of treatment, with this decrease lasting until the end of week 12, but scores did not return to the levels of HCs. Combined treatment with escitalopram and agomelatine led to more improvement in ANT orienting reaction time and was accompanied by a greater reduction of total scores on the Hamilton Depression Rating Scale-17 items and Hamilton Anxiety Rating Scale compared with escitalopram monotherapy. Conclusions: Patients with MDD showed overall impairments in three domains of attention networks as well as the LMT and a test of subjective alertness. Escitalopram monotherapy significantly improved the LMT scores and the executive control function scores in the ANT at the end of the fourth week of treatment, and the improvement was more extensive with combined escitalopram and agomelatine treatment.

Measurement of exhaled breath temperature in patients under general anesthesia: A feasibility study.

The aim of the present study was to investigate the respiratory parameters that influence the exhaled breath temperature (EBT) and the feasibility of using the latter to monitor the core temperature under general endotracheal anesthesia. A total of 20 patients undergoing abdominal surgery were included in the present study. At the first stage of the experiment, the respiratory rate was adjusted, while the other respiratory parameters [tidal volume, inspiratory and expiratory time ratio (TI:TE), and positive end expiratory pressure (PEEP)] were maintained at a constant level. At the second stage, the tidal volume was adjusted, while the other respiratory parameters were maintained at a constant level. At the third stage, the TI:TE was adjusted, while the other parameters were maintained at a constant level. At the fourth stage, PEEP was adjusted, while the other parameters were maintained at a constant level. In each experiment, the EBT, the maximum temperature of exhaled air in each min, the inhaled air temperature and the nasopharyngeal temperature (T nose) were recorded every min. During the first stage of the experiment, no significant difference was noted in the EBT at different levels of respiratory rate. During the second, third and fourth stage, no significant difference was noted in the EBT at different tidal volumes, TI:TE and PEEP, respectively. The EBT was significantly correlated with the T nose. Overall, the present study demonstrated that the EBT of patients undergoing abdominal surgery under general endotracheal anesthesia was not affected by the examined respiratory parameters and that it could be considered a feasible method of monitoring core temperature.

A longitudinal evaluation on 3-year change of anxiety and depression, and their risk factors among parents of childhood and adolescence patients with resectable osteosarcoma: A cohort study.

Psychological disorders often occur among parents of children with cancer. The current study aimed to explore the longitudinal change of anxiety and depression and their related factors among parents of childhood and adolescence patients with osteosarcoma. A total of 56 childhood and adolescence patients with osteosarcoma who underwent tumor resection and corresponding 104 parents were enrolled. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and HADS-Depression (HADS-D) of parents were evaluated at baseline (the day of patients' hospital discharge), 0.5 year, 1 year, 2 years, and 3 years. From baseline to the 3rd year, HADS-A (from 8.3 ±â€…3.1 to 9.4 ±â€…3.1. P < .001), HADS-D score (from 7.7 ±â€…3.2 to 8.8 ±â€…2.9, P = .001), anxiety rate (from 45.2% to 60.6%, P = .038), depression rate (from 38.5% to 57.7%, P = .002) were elevated; meanwhile, anxiety severity (P = .001) and depression severity (P = .001) were also increased. Furthermore, multivariate logistic regression analysis presented that the role of mother, divorced/widowed marital status, declined family annual income, elevated Enneking stage, and amputation were independently correlated with elevated risk of parents' baseline anxiety or depression (all P < .05). Additionally, declined family annual income, elevated Enneking stage, and amputation were independently correlated with increased risk of parents' 3-year anxiety or depression (all P < .05). Anxiety and depression deteriorate with time in parents of childhood and adolescence patients with osteosarcoma, which are affected by parental role, marital status, family annual income, surgery type, and Enneking stage.

Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis.

BACKGROUND: It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published up to July 2015 in which pulmonary compliance or the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio was assessed in ICU patients without ALI or ARDS, who received mechanical ventilation via different strategies. The data for study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used a Bayesian fixed-effects model to combine direct comparisons with indirect evidence. RESULTS: Seventeen randomized controlled trials including a total of 575 patients who received one of six ventilation strategies were included for network meta-analysis. Among ICU patients without ALI or ARDS, strategy C (lower tidal volume (VT) + higher positive end-expiratory pressure (PEEP)) resulted in the highest PaO2/FIO2 ratio; strategy B (higher VT + lower PEEP) was associated with the highest pulmonary compliance; strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay; and strategy D (lower VT + zero end-expiratory pressure (ZEEP)) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance. CONCLUSIONS: For ICU patients without ALI or ARDS, strategy C (lower VT + higher PEEP) was associated with the highest PaO2/FiO2 ratio. Strategy B (higher VT + lower PEEP) was superior to the other strategies in improving pulmonary compliance. Strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay, whereas strategy D (lower VT + ZEEP) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance.

Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.

To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients.

Mechanical ventilation modes for respiratory distress syndrome in infants: a systematic review and network meta-analysis.

INTRODUCTION: The effects of different mechanical ventilation (MV) modes on mortality outcome in infants with respiratory distress syndrome (RDS) are not well known. METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published through April 2014 that assessed mortality in infants with RDS given different MV modes. We assessed studies for eligibility, extracted data, and subsequently pooled the data. A Bayesian fixed-effects model was used to combine direct comparisons with indirect evidence. We also performed sensitivity analyses and rankings of the competing treatment modes. RESULTS: In total, 20 randomized controlled trials were included for the network meta-analysis, which consisted of 2,832 patients who received one of 16 ventilation modes. Compared with synchronized intermittent mandatory ventilation (SIMV) + pressure support ventilation (PSV), time-cycled pressure-limited ventilation (TCPL) (hazard ratio (HR) 0.290; 95% confidence interval (CI) 0.071 to 0.972), high-frequency oscillatory ventilation (HFOV) (HR 0.294; 95% CI 0.080 to 0.852), SIMV + volume-guarantee (VG) (HR 0.122; 95% CI 0.014 to 0.858), and volume-controlled (V-C) (HR 0.139; 95% CI 0.024 to 0.677) ventilation modes are associated with lower mortality. The combined results of available ventilation modes were not significantly different in regard to the incidences of patent ductus arteriosus and intraventricular hemorrhage. CONCLUSION: Compared with the SIMV + PSV ventilation mode, the TCPL, HFOV, SIMV + VG, and V-C ventilation modes are associated with lower mortality.

Intraoperative mechanical ventilation strategies for obese patients: a systematic review and network meta-analysis.

Several intraoperative ventilation strategies are available for obese patients. However, the same ventilation interventions have exhibited different effects on PaO2 /FIO2 concerning obese patients in different trials, and the issue remains controversial. Therefore, we conducted a network meta-analysis to identify the optimal mechanical ventilation strategy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Embase, MEDLINE, CINAHL and Web of Science for studies published up to June 2014, and the PaO2 /FIO2 in obese patients given different mechanical ventilation strategies was assessed. We assessed the studies for eligibility and extracted data and then pooled the data and used a Bayesian fixed-effect model to combine direct comparisons with indirect evidence. Eligible studies evaluated different ventilation strategies for obese patients and reported the intraoperative PaO2 /FIO2 ratio, atelectasis and pulmonary compliance. Thirteen randomized controlled trials were included for network meta-analysis, including 476 patients who received 1 of 12 ventilation strategies. Volume-controlled ventilation with higher PEEP plus single recruitment manoeuvres (VCV + higher PEEP + single RM) was associated with the highest PaO2 /FiO2 ratio, improving intraoperative pulmonary compliance and reducing the incidence of intraoperative atelectasis.

Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis.

INTRODUCTION: There are approximately 19 million new cases of sepsis worldwide each year. Among them, more than one quarter of patients die. We aimed to assess the effects of heparin on short-term mortality in adult patients with sepsis and severe sepsis. METHODS: We searched electronic databases (Medline, Embase, and Cochrane Library databases; the Cochrane Controlled Trials Register) and conference proceedings (Web of Knowledge (Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Sciences & Humanities)) from inception to July 2014, expert contacts and relevant websites. Controlled trials of heparin versus placebo in sepsis or severe sepsis were identified. In total two reviewers independently assessed eligibility, and four authors independently extracted data; consensus was reached by conference. We used the chi-square test and I2 to assess statistical heterogeneity (P <0.05). The primary analysis was based on the fixed-effect model to produce pooled odds ratios with 95% confidence intervals. RESULTS: A total of nine publications were included in the meta-analysis. Heparin decreased 28-day mortality (n = 3,482, OR = 0.656, 95% CI = 0.562 to 0.765, P <0.0001). According to the meta-analysis of 28-day mortality, heterogeneity was not found among the eight randomized clinical trials (RCTs) (I2 = 0.0%). Heparin had no effect on bleeding events in sepsis (seven RCTs, n = 2,726; OR = 1.063; 95% CI = 0.834 to 1.355; P = 0.623; and I2 = 20.9%). Subgroup analysis demonstrated that the sample size may be a source of heterogeneity, but experimental design was not. CONCLUSIONS: Heparin may reduce 28-day mortality in patients with severe sepsis, at the same time, there was no increase in the risk of bleeding in the heparin group. We recommend the use of heparin for sepsis and severe sepsis.