Resective epilepsy surgery and its impact on depression in adults: a systematic review, meta-analysis, and implications for future research.

BACKGROUND: How epilepsy surgery influences the bidirectional relationship of epilepsy and depression remains poorly defined. METHOD: For a better understanding of this question, we conducted a systematic review and meta-analysis of risk ratio on depression prevalence before and after epilepsy surgery, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Three databases were comprehensively screened for all studies assessing depression before and after resective surgery in adult epileptic patients until 8 October 2022. Studies were included if depression was assessed before and after epilepsy surgery regardless of the time of follow-up. A total of 1917 studies were screened for eligibility and 91 full-texts up for inclusion; 35 studies were finally included, 25 studies and 2563 patients were included in main meta-analysis and 10 for exploratory analysis. Risk of bias was assessed using Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) from Cochrane. To derive the pooled depression rates before and after surgery, a meta-analysis with inversed-variance was performed using random-effects logistic models with Peto's correction and a 95% CI. Heterogeneity was assessed with Cochran's Q-test along with its derived measure of inconsistency I2. RESULTS: Overall, the depression rates before and after resective epilepsy surgery were 0.70 (0.53 to 0.91) 95% CI, suggesting that the rate of depression at last follow-up evaluation tends to decrease after Resective Epilepsy Surgery (RES). Subgroup analysis suggest a positive long-term effect appears with a significant lower rates of depression already 6 months (0.61 (0.38 to 0.98)), after surgery which is maintained over time after 1 year (0.53 (0.31 to 0.90)), and after 2 years (0.62 (0.42 to 0.92)). CONCLUSION: This important finding should be taken in consideration before resective surgery for drug-resistant epilepsies. However, prospective studies should be conducted to characterise which patient, at the individual level, might be at risk of de novo or worsening of depression. PROSPERO REGISTRATION NUMBER: CRD42022355386.

The unfolded protein response transcription factor XBP1s ameliorates Alzheimer's disease by improving synaptic function and proteostasis.

Alteration in the buffering capacity of the proteostasis network is an emerging feature of Alzheimer's disease (AD), highlighting the occurrence of endoplasmic reticulum (ER) stress. The unfolded protein response (UPR) is the main adaptive pathway to cope with protein folding stress at the ER. Inositol-requiring enzyme-1 (IRE1) operates as a central ER stress sensor, enabling the establishment of adaptive and repair programs through the control of the expression of the transcription factor X-box binding protein 1 (XBP1). To artificially enforce the adaptive capacity of the UPR in the AD brain, we developed strategies to express the active form of XBP1 in the brain. Overexpression of XBP1 in the nervous system using transgenic mice reduced the load of amyloid deposits and preserved synaptic and cognitive function. Moreover, local delivery of XBP1 into the hippocampus of an 5xFAD mice using adeno-associated vectors improved different AD features. XBP1 expression corrected a large proportion of the proteomic alterations observed in the AD model, restoring the levels of several synaptic proteins and factors involved in actin cytoskeleton regulation and axonal growth. Our results illustrate the therapeutic potential of targeting UPR-dependent gene expression programs as a strategy to ameliorate AD features and sustain synaptic function.

Cardiovascular and connective tissue disorder features in FLNA-related PVNH patients: progress towards a refined delineation of this syndrome.

BACKGROUND: FLNA Loss-of-Function (LoF) causes periventricular nodular heterotopia type 1 (PVNH1), an acknowledged cause of seizures of various types. Neurological symptoms are inconstant, and cardiovascular (CV) defects or connective tissue disorders (CTD) have regularly been associated. We aimed at refining the description of CV and CTD features in patients with FLNA LoF and depicting the multisystemic nature of this condition. METHODS: We retrospectively evaluated FLNA variants and clinical presentations in FLNA LoF patient with at least one CV or CTD feature, from three cohorts: ten patients from the French Reference Center for Rare Vascular Diseases, 23 patients from the national reference diagnostic lab for filaminopathies-A, and 59 patients from literature review. RESULTS: Half of patients did not present neurological symptoms. Most patients presented a syndromic association combining CV and CTD features. CV anomalies, mostly aortic aneurysm and/or dilation were present in 75% of patients. CTD features were present in 75%. Variants analysis demonstrated an enrichment of coding variants in the CH1 domain of FLNA protein. CONCLUSION: In FLNA LoF patients, the absence of seizures should not be overlooked. When considering a diagnosis of PVNH1, the assessment for CV and CTD anomalies is of major interest as they represent interlinked features. We recommend systematic study of FLNA within CTD genes panels, regardless of the presence of neurological symptoms.

Heat transfer by three types of hot pack and its implication on the flexibility of the lower back: a randomized, controlled trial / Transferência de calor por três tipos de compressas quentes e sua implicação na flexibilidade da região lombar: ensaio clínico randomizado e controlado / Transferencia de calor por tres tipos de compresas calientes y su implicación en la flexibilidad en la región lumbar: ensayo clínico aleatorio y controlado

ABSTRACT The use of hot pack is a common superficial thermotherapy strategy and one of its benefits is the increase of muscle flexibility. However, there is a lack of information about the effects of the heat pack alone, without being used in association with other therapeutic interventions, in the flexibility of the lumbar region. The aim of this study was to compare the effects generated by the application of three different pack on the flexibility of the lower backs of healthy students. Three sessions of 15 minutes of superficial heat through a hot pack (moist heat pack-MHP, seed pack-SP or gel pack-GP) were applied to the lower back. Pack and lower back temperatures and erythema were registered every 5 minutes. A Schober test was performed before the first session and after the third session. After 15 minutes of treatment, pack temperature was higher in the SP group. At the same time, lumbar temperature was lower in the GP group. The heat treatment also increased erythema in the lower back for all three groups. There was a significant increase in intragroup flexibility as assessed by the Schober Test for all groups. There are significant differences in the effect generated between the three types of pack on the flexibility of the lower back. The MHP was able to transfer more heat to the lumbar area and provided a more pronounced increase in the flexibility of lower back tissues.

RESUMO O uso de compressas quentes é uma estratégia de termoterapia superficial amplamente utilizada e um de seus benefícios é o aumento da flexibilidade muscular. Porém, existem poucas informações sobre os efeitos das compressas quentes, quando não associadas a outras intervenções terapêuticas, na flexibilidade da região lombar. O objetivo do seguinte trabalho foi comparar os efeitos gerados pela aplicação de três tipos diferentes de compressas quentes na flexibilidade da região lombar de estudantes saudáveis. Três sessões de 15 minutos de calor superficial aplicado através de compressas quentes (compressa úmida quente, compressa de sementes e compressa de gel). A temperatura da compressa e da região lombar e a ocorrência de eritema foram registradas a cada 5 minutos. O teste de Schober foi realizado antes da primeira e após a última sessão. Após 15 minutos de tratamento, a compressa de sementes apresentou maior temperatura final. No mesmo período, a menor temperatura lombar foi obtida pela compressa de gel. O tratamento com os três tipos de compressa aumentou a ocorrência de eritema e causou aumento significativo da flexibilidade da região lombar avaliada pelo teste de Schober. Existem diferenças significativas no efeito gerado pelos três tipos de compressas quentes sobre a flexibilidade da região lombar. A compressa úmida quente proporcionou maior transferência de calor para a região lombar e propiciou um aumento mais pronunciado da flexibilidade da região lombar.

RESUMEN El empleo de compresas calientes es muy utilizado por la termoterapia superficial como forma de aumentar la flexibilidad muscular. Pero son pocas las informaciones sobre sus efectos, cuando asociadas a otras intervenciones terapéuticas, en la flexibilidad de la región lumbar. Este estudio tiene el objeto de comparar los efectos de la aplicación de tres tipos distintos de compresas calientas en la flexibilidad de la región lumbar en estudiantes saludables. Fueron tres sesiones de quince minutos de calor superficial aplicadas a través de compresas calientes (compresa húmeda, compresa de semillas y compresa de gel) en la región lumbar de estos participantes. Se registraban cada cinco minutos la temperatura de la compresa y de la región lumbar y la existencia de eritema. Se empleó la prueba de Schober realizada antes de la primera y después de la última sesión. Tras quince minutos de tratamiento, la compresa de semillas presentó una temperatura final mayor. En este mismo periodo, la menor temperatura lumbar la registró la compresa de gel. El tratamiento con tres tipos de compresas aumentó la existencia de eritema y el significativo aumento de la flexibilidad de la región lumbar, evaluado por la prueba de Schober. Diferencias significativas ocurrieron con el empleo de los tres tipos de compresas calientes sobre la flexibilidad de la región lumbar. La compresa húmeda caliente tuvo una transferencia de calor para la región lumbar mayor, por lo que aumentó más la flexibilidad de la región evaluada.