Adjunctive continuous theta burst stimulation for major depressive disorder or bipolar depression: A meta-analysis of randomized controlled studies

OBJECTIVES

As a novel type of theta burst stimulation (TBS), continuous TBS (cTBS) has been shown to have mixed therapeutic effects for major depressive disorder (MDD) or bipolar depression (BD). Thus, we performed a meta-analysis of randomized controlled trials (RCTs) of cTBS for treating major depressive episodes in patients with MDD or BD.

METHODS

A systematic search of four major bibliographic databases (PubMed, EMBASE, Cochrane Library, and PsycINFO) was conducted from inception dates to February 3, 2023 to identify eligible studies. The data were analyzed using a random-effects model.

RESULTS

Three RCTs (n = 78, active cTBS = 37 and sham cTBS = 41) were included the meta-analysis. No significant differences were found in terms of change in Hamilton Depression Rating Scale (HAMD) scores (3 RCTs, n = 78, SMD = -0.09, 95 % CI: -0.53 to 0.36; I2 = 0 %; P = 0.71) and study-defined response (2 RCTs, n = 58, 26.7 % versus 21.4 %, RR = 1.20, 95 % CI: 0.48 to 2.96; I2 = 0 %; P = 0.70) between active and sham cTBS groups. Similarly, no group differences were found in the rates of adverse events and discontinuation due to any reason (P > 0.05).

LIMITATIONS

Meta-analysis had small sample sizes and low number of included studies.

CONCLUSIONS

Although cTBS appeared to be a safe and well-tolerated option for treating major depressive episodes in MDD or BD patients, no advantage in treatment effects was found in this meta-analysis. Future large-scale studies are warranted to assess the efficacy of cTBS for MDD or BD patients with a major depressive episode.

Transcranial alternating current stimulation for schizophrenia: a systematic review of randomized controlled studies

Background

In randomized clinical trials (RCTs) investigating the application of transcranial alternating current stimulation (tACS) in schizophrenia, inconsistent results have been reported. The purpose of this exploratory systematic review of RCTs was to evaluate tACS as an adjunct treatment for patients with schizophrenia based on its therapeutic effects, tolerability, and safety.

Methods

Our analysis included RCTs that evaluated adjunctive tACS' effectiveness, tolerability, and safety in schizophrenia patients. Three independent authors extracted data and synthesized it using RevMan 5.3 software.

Results

Three RCTs involving 76 patients with schizophrenia were encompassed in the analysis, with 40 participants receiving active tACS and 36 receiving sham tACS. Our study revealed a significant superiority of active tACS over sham tACS in improving total psychopathology (standardized mean difference [SMD] = -0.61, 95% confidence interval [CI]: -1.12, -0.10; I2 = 16%, p = 0.02) and negative psychopathology (SMD = -0.65, 95% CI: -1.11, -0.18; I2 = 0%, p = 0.007) in schizophrenia. The two groups, however, showed no significant differences in positive psychopathology, general psychopathology, or auditory hallucinations (all p > 0.05). Two RCTs examined the neurocognitive effects of tACS, yielding varied findings. Both groups demonstrated similar rates of discontinuation due to any reason and adverse events (all p > 0.05).

Conclusion

Adjunctive tACS is promising as a viable approach for mitigating total and negative psychopathology in individuals diagnosed with schizophrenia. However, to gain a more comprehensive understanding of tACS's therapeutic effects in schizophrenia, it is imperative to conduct extensive, meticulously planned, and well-documented RCTs.

Stanford neuromodulation therapy for treatment-resistant depression: a systematic review

Objective

This systematic review of randomized controlled studies (RCTs) and observational studies evaluated the efficacy and safety of stanford neuromodulation therapy (SNT) for patients with treatment-resistant depression (TRD).

Methods

A systematic search (up to 25 September, 2023) of RCTs and single-arm prospective studies was conducted.

Results

One RCT (n = 29) and three single-arm prospective studies (n = 34) met the study entry criteria. In the RCT, compared to sham, active SNT was significantly associated with higher rates of antidepressant response (71.4% versus 13.3%) and remission (57.1% versus 0%). Two out of the three single-arm prospective studies reported the percentage of antidepressant response after completing SNT, ranging from 83.3% (5/6) to 90.5% (19/21). In the three single-arm prospective studies, the antidepressant remission rates ranged from 66.7% (4/6) to 90.5% (19/21). No severe adverse events occurred in all the four studies.

Conclusion

This systematic review found SNT significantly improved depressive symptoms in patients with TRD within 5 days, without severe adverse events.

Bilateral theta burst stimulation for patients with acute unipolar or bipolar depressive episodes: A systematic review of randomized controlled studies

OBJECTIVE

This meta-analysis of randomized controlled trials (RCTs) evaluated the overall efficacy and safety of bilateral theta-burst stimulation (TBS) as an intervention for patients with mood disorders.

METHODS

A systematic search (up to December 7, 2022) of RCTs was conducted to address the study aims. A random-effects meta-analysis was performed by including study-defined responses and remission as primary outcomes.

RESULTS

Analyses included six RCTs comprising 285 participants with major depressive disorder (MDD) (n = 233) or a depressive episode in the course of bipolar disorder (BD) (n = 52) who had undergone active bilateral TBS (n = 142) versus sham stimulation (n = 143). Active bilateral TBS outperformed sham stimulation with respect to study-defined improvements (55.1 % versus 20.3 %, 4 RCTs, n = 152, 95%CI: 1.63 to 4.39, P < 0.0001; I2 = 0 %) and remission rates (37.2 % versus 14.3 %, 2 RCTs, n = 85, 95%CI: 1.13 to 5.95, P = 0.02; I2 = 0 %) in MDD patients but not those with bipolar or unipolar mixed depression. Superiority of active bilateral TBS over sham stimulation was confirmed for improvements in depressive symptoms at post-bilateral TBS assessments and 8-week follow-ups in patients with either MDD or mixed depression (all P < 0.05). Discontinuation rates due to any reason and adverse events (i.e., headache, dizziness) were similar between TBS and sham stimulation groups with MDD or mixed depression (all P > 0.05).

CONCLUSION

Bilateral TBS targeting the dorsolateral prefrontal cortex (DLPFC) appears to be a well-tolerated form of repetitive transcranial magnetic stimulation (rTMS) that has substantial antidepressant effects, particularly in patients with MDD. Effects of bilateral TBS on bipolar and unipolar mixed depression should be further investigated.

Efficacy and safety of intermittent theta burst stimulation versus high-frequency repetitive transcranial magnetic stimulation for patients with treatment-resistant depression: a systematic review

Objective

Intermittent theta-burst stimulation (iTBS), which is a form of repetitive transcranial magnetic stimulation (rTMS), can produce 600 pulses to the left dorsolateral prefrontal cortex (DLPFC) in a stimulation time of just over 3 min. The objective of this systematic review was to compare the safety and efficacy of iTBS and high-frequency (≥ 5 Hz) rTMS (HF-rTMS) for patients with treatment-resistant depression (TRD).

Methods

Randomized controlled trials (RCTs) comparing the efficacy and safety of iTBS and HF-rTMS were identified by searching English and Chinese databases. The primary outcomes were study-defined response and remission.

Results

Two RCTs (n = 474) investigating the efficacy and safety of adjunctive iTBS (n = 239) versus HF-rTMS (n = 235) for adult patients with TRD met the inclusion criteria. Among the two included studies (Jadad score = 5), all were classified as high quality. No group differences were found regarding the overall rates of response (iTBS group: 48.0% versus HF-rTMS group: 45.5%) and remission (iTBS group: 30.0% versus HF-rTMS group: 25.2%; all Ps > 0.05). The rates of discontinuation and adverse events such as headache were similar between the two groups (all Ps > 0.05).

Conclusion

The antidepressant effects and safety of iTBS and HF-rTMS appeared to be similar for patients with TRD, although additional RCTs with rigorous methodology are needed.

Accelerated intermittent theta burst stimulation for major depressive disorder or bipolar depression: A systematic review and meta-analysis

We aimed to systematically evaluate the clinical efficacy and safety of accelerated intermittent theta burst stimulation (aiTBS) for patients with major depressive disorder (MDD) or bipolar depression (BD). A random-effects model was adopted to analyze the primary and secondary outcomes using the Review Manager, Version 5.3 software. This meta-analysis (MA) identified five double-blind randomized controlled trials (RCTs) comprising 239 MDD or BD patients with a major depressive episode. Active aiTBS overperformed sham stimulation in the study-defined response. This MA found preliminary evidence that active aiTBS resulted in a greater response in treating major depressive episodes in MDD or BD patients than sham stimulation.

Low-frequency repetitive transcranial magnetic stimulation for children and adolescents with first-episode and drug-naïve major depressive disorder: A systematic review

OBJECTIVE

This systematic review of randomized controlled trials (RCTs) was conducted to explore the therapeutic effects and safety of active low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) versus sham LF-rTMS in children and adolescent patients with first-episode and drug-naïve (FEDN) major depressive disorder (MDD).

METHODS

A systematic literature search was performed, and data were extracted by two independent researchers. The coprimary outcomes were study-defined response and remission.

RESULTS

A systematic search of the literature yielded 442 references, of which 3 RCTs (130 children and adolescents with FEDN MDD, 50.8% male, and mean age range from 14.5 to 17.5 years) met the inclusion criteria. Among the two RCTs (66.7%, 2/3) examining the effects of LF-rTMS on study-defined response and remission and cognitive function, active LF-rTMS was more efficacious than sham LF-rTMS in terms of study-defined response rate and cognitive function (all p < 0.05) but not regarding study-defined remission rate (all p > 0.05). No significant group differences were found with regard to adverse reactions. None of the included RCTs reported the dropout rate.

CONCLUSION

These findings preliminarily found that LF-rTMS could benefit children and adolescents with FEDN MDD in a relatively safe manner, although further studies are warranted.

[A primary intestinal-derived adenocarcinoma in intestine bladder substitutes: a case report]

Intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine is a very rare long-term complication after complete urethral reconstruction of the bladder. The probability of its occurrence is low. However, in recent years, it has been proved to be objective, but there is rare literature about its diagnosis and treatment methods. This article describes a case of cystectomy and Studer ileal conduit in Peking University Third Hospital due to bladder cancer. After 9 years, he was discovered with a primary intestinal-derived adenocarcinoma in the bladder substitutes by the intestine. A male patient, 64 years old, with persistent abdominal pain in the lower abdomen for two weeks. There was carrion-like material in the urine, no gross hematuria, no urinary frequency, urgency, dysuria, and no abnormalities in the examination. Urinary CT showed intestinal metaplasia in the bladder. There was 5.7 cm×2.4 cm×4.8 cm irregular tissue shadow, and ureteroscopy found, on the right side, the bladder tumor whose diameter was 4-5 cm. We performed open lumpectomy and repaired the bladder, and postoperative pathology showed middle-high differentiated adenocarcinoma. The patient recovered well after the surgery. This article reviewed the similar intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine and found that it had the highest incidence in the elderly male population. The pathogenetic factor was most closely related to the smoking. If the patients developed hematuria, carrion-like substances in the urine, and bladder irritation, the possibility of tumor development should be suspected. Then the patients should promptly take the tests, such as urine exfoliation cytology, urine FISH, urinary system B-ultrasound, cystoscopy, etc. The microscope was the most direct observation of the lesion site examination. If the pathological tumor occurred ,and then the tumor should be immediately removed, and a new urinary diversion was needed to avoid further progress of the tumor. And postoperative smoking was strictly prohibited, also the patients should strictly control their eating habits and regularly adhere to the follow-up at least 4 years or more, but the lifelong follow-up and review was a must. The mechanism of intestinal primary intestinederived adenocarcinoma of the bladder substituted by the intestine is still unclear. Studies suggest that it may be related to N-nitroso compounds, smoking, and postoperative inflammatory reactions.

Analysis of genetic diversity of Chinese dairy goats via microsatellite markers

In this study, 15 polymorphic microsatellite markers were used to analyze the genetic structure and phylogenetic relationships of 6 dairy goat breeds in China, including 4 native developed breeds and 2 introduced breeds. The results showed that a total of 172 alleles were detected in 347 samples of the dairy goat breeds included in this study. The mean number of effective alleles per locus was 4.92. Except for BMS0812, all of the remaining microsatellite loci were highly polymorphic (polymorphism information content [PIC] > 0.5). The analysis of genetic diversity parameters, including the number of effective alleles, PIC, and heterozygosity, revealed that the native developed dairy goat breeds in China harbored a rich genetic diversity. However, these breeds showed a low breeding degree and a high population intermix degree, with a certain degree of inbreeding and within-subpopulation inbreeding coefficient ( > 0). The analysis of population genetic differentiation and phylogenetic tree topologies showed a moderate state of genetic differentiation among subpopulations of native developed breed dairy goats in China (0.05 < gene fixation coefficient [] < 0.15). The native developed breeds shared a common ancestor, namely, the Saanen dairy goat, originating from Europe. The results showed that there was a close genetic relationship between Wendeng and Laoshan dairy goats while the Guanzhong dairy goat and the Xinong Saanen dairy goat were also found to have a close genetic relationship, which were both in agreement with the formation history and geographical distribution of the breeds. This study revealed that adopting genetic management strategies, such as expanding pedigree source and strengthening multi-trait selection, is useful in maintaining the genetic diversity of native developed breeds and improving the population uniformity of dairy goats.

Investigation of the diversity and origins of Chinese dairy goats via the mitochondrial DNA D-loop

To determine the genetic diversity, origins, and the phylogeography of Chinese dairy goats, we analyzed 162 complete mitochondrial DNA (mtDNA) D- loop sequences from 9 dairy goat breeds and compared them with 8 goat sequences that were previously reported in GenBank. The length of the mtDNA D-loop was 1,212 to 1,215 bp, and 97 polymorphic sites were identified. We also defined 62 haplotypes, including 35 unique haplotypes. The haplotype diversity value of all the dairy goats was 0.952, and the nucleotide diversity was 0.011 per site. Phylogenetic analyses revealed that Chinese dairy goats were divided into haplogroups A and B, with haplogroup A serving as the predominant group. Median-joining network and analyses of molecular variance indicated that Chinese dairy goats were more weakly phylogeographically structured than other domestic goats. A mismatch distribution analysis and Fu's test revealed that at least 1 population expansion event occurred in the demographic history of Chinese dairy goats.

Effect of disorder with long-range correlation on transport in graphene nanoribbon

Transport in disordered armchair graphene nanoribbons (AGR) with long-range correlation between quantum wire contacts is investigated by a transfer matrix combined with Landauer's formula. The metal-insulator transition is induced by disorder in neutral AGR. Therein, the conductance is one conductance quantum for the metallic phase and exponentially decays otherwise, when the length of AGR approaches infinity and far longer than its width. Similar to the case of long-range disorder, the conductance of neutral AGR first increases and then decreases while the conductance of doped AGR monotonically decreases, as the disorder strength increases. In the presence of strong disorder, the conductivity depends monotonically and non-monotonically on the aspect ratio for heavily doped and slightly doped AGR, respectively. For edge disordered graphene nanoribbon, the conductance increases with the disorder strength of long-range correlated disordered while no delocalization exists, since the edge disorder induces localization.

Conformational adjustments of SNase R and its N-terminal fragments probed by monoclonal antibodies

Two monoclonal antibodies specific for staphylococcal nuclease R (SNase R) (McAb2C9 and McAb1B8) were prepared and used to probe protein folding during peptide elongation, by measuring antibody binding to seven N-terminal fragments (SNR141, SNR135, SNR121, SNR110, SNR102, SNR79 and SNR52) of SNase R. Comparative studies of the conformations of the N-terminal fragments have shown that all seven fragments of SNase R have a certain amount of residual structure, indicating that folding may occur during elongation of the nascent peptide chain. We show that the binding abilities of the intact enzyme and its seven fragments to the monoclonal antibodies are not simply proportional to the length of the peptide chain, suggesting that there may be continuous conformational adjustment in the nascent peptide chain as new C-terminal amino acids are added. A folding intermediate close in structure to the native state but with structural features in common with SNR121 is highly populated in 0.6 M GuHCl, and is also formed transiently during folding.