Repetitive Transcranial Magnetic Stimulation With and Without Text4Support for the Treatment of Resistant Depression: Protocol for a Patient-Centered Multicenter Randomized Controlled Pilot Trial.

BACKGROUND: Treatment-resistant depression (TRD) is the inability of a patient with major depressive disorder (MDD) to accomplish or achieve remission after an adequate trial of antidepressant treatments. Several combinations and augmentation treatment strategies for TRD exist, including the use of repetitive transcranial magnetic stimulation (rTMS), and new therapeutic options are being introduced. Text4Support, a text message-based form of cognitive behavioral therapy that allows patients with MDD to receive daily supportive text messages for correcting or altering negative thought patterns through positive reinforcement, may be a useful augmentation treatment strategy for patients with TRD. It is however currently unknown if adding the Text4Support intervention will enhance the response of patients with TRD to rTMS treatment. OBJECTIVE: This study aims to assess the initial comparative clinical effectiveness of rTMS with and without the Text4Support program as an innovative patient-centered intervention for the management of patients diagnosed with TRD. METHODS: This study is a multicenter, prospective, parallel-design, 2-arm, rater-blinded randomized controlled pilot trial. The recruitment process is scheduled to last 12 months. It will involve active treatment for 6 weeks, observation, and a follow-up period of 6 months for participants in the study arms. In total, 200 participants diagnosed with TRD at rTMS care clinics in Edmonton, Alberta, and rTMS clinics in Halifax, Nova Scotia will be randomized to 1 of 2 treatment arms (rTMS sessions alone or rTMS sessions plus Text4Support intervention). Participants in each group will be made to complete evaluation measures at baseline, and 1, 3, and 6 months. The primary outcome measure will be the mean change in the scores of the Patient Health Questionnaire-9 (PHQ-9). The secondary outcome measures will involve the scores of the 7-item Generalized Anxiety Disorders Scale (GAD-7), Columbia-Suicide Severity Rating Scale (CSSRS), and World Health Organization-Five Well-Being Index (WHO-5). Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses. Qualitative data will be analyzed using the thematic analysis framework. RESULTS: The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the rTMS plus Text4Support intervention treatment arm of the study will achieve superior outcomes compared with the outcomes of participants enrolled in the rTMS alone arm. CONCLUSIONS: The application of the combination of rTMS and Text4Support has not been investigated previously. Therefore, we hope that this study will provide a concrete base of data to evaluate the practical application and efficacy of using the novel combination of these 2 treatment modalities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46830.

Facile, Efficient, and Cheap Electrode based on SnO2/Activated Carbon Waste for Supercapacitor and Capacitive Deionization Applications.

Activated carbon granules present in our household filters used in water purification are significant waste. Activated carbon waste (ACW) was ground to a fine powder, then impregnation of SnO2 on ACW was performed under mild conditions followed by calcination of SnO2-ACW at 700 °C for 2 h, producing a SnO2-ACW hybrid composite. This hybrid composite material was used in the preparation of electrodes for supercapacitor and capacitive deionization applications. The electrochemical performance of the electrodes was investigated by using cyclic voltammetry, galvanostatic charge-discharge, and electrochemical impedance spectroscopy. Calcination and addition of SnO2 contributed to an obtained electrode with a high specific capacitance of 30.46 F g-1 in a solution of 1 M Na2SO4 compared to the original ACW (0.122 F g-1) and calcined-ACW (1.42 F g-1) at an actual current of 1 mA. This electrode was also investigated for water desalination through the capacitive deionization technique and exhibited an electrosorption capacity of 6.44 mg/g compared to the commercial AC (8.9 mg/g) so it is a highly promising and economic electrode.

NOD2/CARD15 polymorphisms (P268S, IVS8+158, G908R, L1007fs, R702W) among Kuwaiti patients with Crohn's disease: A case-control study.

Background: Nucleotide-binding oligomerization domain-containing two (NOD2/CARD15) gene polymorphisms are implicated in the pathogenesis of Crohn's disease (CD). Aim: To describe the allelic frequency of NOD2/CARD15 gene variants among Kuwaiti patients with CD and investigate potential genotype/phenotype associations. Methods: Adult Kuwaiti citizens with an established diagnosis of CD and healthy controls were enrolled from October 2018 to May 2020. Three common NOD2/CARD15 polymorphisms (R702W, G908R, and L1007fs) and P268S and IVS8+158 polymorphisms were screened by polymerase chain reaction/restriction analysis length polymorphism (PCR/RFLP). Results: Ninety adult Kuwaiti patients with CD and 210 healthy subjects (as controls) were recruited. P268S, IVS8+158, G908R, and R702W minor alleles were identified in 38.9%, 21.1%, 12.2%, and 4.4% of CD patients, respectively. NOD2/CARD15 polymorphisms coexisted in 35 healthy controls (16.7%) and 21 CD patients (23.3%). Individuals with either a single or multiple polymorphism were approximately two times more likely to have CD than those with no polymorphism. Patients with multiple polymorphisms had significantly more stricturing and penetrating disease. Conclusion: NOD2/CARD15 gene polymorphisms were significantly associated with an increased risk of disease and aggressive phenotypes among the Kuwaiti CD population.

Serum uric acid as a predictor for nephritis in Egyptian patients with systemic lupus erythematosus.

OBJECTIVE: Lupus nephritis (LN) is closely associated with hyperuricemia, and uric acid is considered a risk factor for renal involvement in systemic lupus erythematosus (SLE). This study aimed to examine the association between serum uric acid (SUA) level and LN development and progression in SLE patients with normal renal function. METHODS: A total of 60 SLE patients with normal renal function from Ain Shams University Hospital were selected and assigned to group 1 (30 patients with LN) and group 2 (30 patients without LN). All patients were subjected to history taking, clinical examination, disease activity assessment based on SLE disease activity index (SLEDAI) and renal SLEDAI (SLEDAI-R) scores, and laboratory investigations, including as SUA, complete blood count, blood urea nitrogen (BUN), serum creatinine, creatinine clearance, urine analysis, protein/creatinine ratio, 24-h urinary protein excretion, Antinuclear antibodies (ANA), anti-dsDNA antibody, and serum complement (C3, C4). RESULTS: Disease duration, SLEDAI score, and SUA level were higher in group 1 than in group 2 (p < 0.001). SUA level was positively correlated with SLEDAI and SLEDAI-R scores, proteinuria, urinary casts, renal biopsy class, disease activity and chronicity indices, BUN level, and serum creatinine level but was negatively correlated with creatinine clearance (p < 0.05). SUA was a predictor of LN development in SLE patients (sensitivity, 83.3%; specificity, 70%). CONCLUSION: SUA is associated with the development of lupus nephritis in patients with normal kidney function also SUA in-dependently correlated with disease activity and chronicity in LN.

Cortical control of muscle relaxation: a lateralized readiness potential (LRP) investigation.

OBJECTIVE: We used the lateralized readiness potential (LRP) to investigate cortical mechanisms underlying the termination of muscle contraction. Active suppression and withdrawal of activation have been proposed as underlying mechanisms in isotonic and isometric relaxation. METHODS: Experiment 1 investigated isotonic wrist extension/release from extension. Experiment 2 investigated isometric activation/relaxation of a pinch grip. Tasks were performed with left and right hands and cued auditorily at variable intervals. EEG was recorded from 128 electrodes and processed to derive the LRP timelocked to the onset and offset of muscle contraction. RESULTS: LRPs for isotonic activation and relaxation were of identical amplitude at electrodes overlying the motor cortex, but differed at frontal locations due to higher amplitude re-afferent activity during activation. The isometric LRP was significantly smaller during relaxation than during activation, without differences in scalp distribution. CONCLUSION: The LRP findings confirm differences between isotonic and isometric relaxation, which may be partly explained by the need to suppress a stretch reflex in the former condition. The presence of an LRP associated with isometric relaxation reveals active preparation in the motor cortex, indicating that muscle relaxation in the isometric task cannot be explained solely by withdrawal of activation. SIGNIFICANCE: High-density LRP recordings isolate different cortical mechanisms underlying the termination of muscle contraction.