Bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis of randomized controlled trials

There has been concern regarding the use of controversial paradigms for repetitive transcranial magnetic stimulation (rTMS) to manage treatment-resistant depression (TRD). This meta-analysis assessed the efficacy of bilateral rTMS compared with unilateral and sham rTMS in patients with TRD. PubMed, Embase, CENTRAL, PsycINFO, Web of Science, EAGLE and NTIS databases were searched to identify relevant studies, and randomized controlled trials (RCTs) on bilateral rTMS for TRD patients were included. The response was defined as the primary outcome, and remission was the secondary outcome. Ten RCTs that included 634 patients met the eligibility criteria. The risk ratio (RRs) of both the primary and secondary outcomes of bilateral rTMS showed non-significant increases compared to unilateral rTMS (RR=1.01, P=0.93; odds ratio [OR]=0.77, P=0.22). Notably, the RR of the primary bilateral rTMS outcome was significantly increased compared to that for sham rTMS (RR=3.43, P=0.0004). The results of our analysis demonstrated that bilateral rTMS was significantly more effective than sham rTMS but not unilateral rTMS in patients with TRD. Thus, bilateral rTMS may not be a useful paradigm for patients with TRD.

Preventive effect of reduced glutathione on contrast-induced nephropathy in elderly patients undergoing coronary angiography or intervention: a randomized, controlled trial

Coronary angiography can be a high-risk condition for the incidence of contrast-induced nephropathy (CIN) in elderly patients. Reduced glutathione, under a variety of mechanisms, may prevent CIN in this procedure. We prospectively examined whether hydration with reduced glutathione is superior to hydration alone for prevention of CIN in an elderly Han Chinese population. A total of 505 patients (271 males and 234 females) aged 75 years or older who underwent non-emergency coronary angiography or an intervention were randomly divided into two groups. The treatment group received hydration with reduced glutathione (n=262) and the control group received hydration alone (n=243). Serum creatinine and blood urea nitrogen levels were measured prior to coronary angiography and 48 h after this procedure. The primary endpoint was occurrence of CIN, which was defined as 25% or 44.2 µmol/L above baseline serum creatinine levels 48 h after the procedure. The overall incidence of CIN was 6.49% in the treatment group and 7.41% in the control group, with no significant difference between the groups (P=0.68). In subgroup analysis by percutaneous coronary intervention, no significant differences were found between the two groups. In summary, reduced glutathione added to optimal hydration does not further decrease the risk of CIN in elderly patients undergoing coronary angiography or an intervention.

Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial

Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects.

Contact force-guided catheter ablation for the treatment of atrial fibrillation: a meta-analysis of randomized, controlled trials

Contact force (CF) sensing technology allows real-time monitoring during catheter ablation for atrial fibrillation (AF). However, the effect of CF sensing technology on procedural parameters and clinical outcomes still needs clarification. Because of the inconsistent results thus far in this area, we performed a meta-analysis to determine whether CF sensing technology can improve procedural parameters and clinical outcomes for the treatment of AF. Studies examining the benefits of CF sensing technology were identified in English-language articles by searching the MEDLINE, Web of Science, and Cochrane Library databases (inception to May 2015). Ten randomized, controlled trials involving 1834 patients (1263 males, 571 females) were included in the meta-analysis (681 in the CF group, 1153 in the control group). Overall, the ablation time was significantly decreased by 7.34 min (95%CI=-12.21 to -2.46; P=0.003, Z test) in the CF group compared with the control group. CF sensing technology was associated with significantly improved freedom from AF after 12 months (OR=1.55, 95%CI=1.20 to 1.99; P=0.0007) and complications were significantly lower in the CF group than in the control group (OR=0.50, 95%CI=0.29 to 0.87; P=0.01). However, fluoroscopy time analysis showed no significantly decreased trend associated with CF-guided catheter ablation (weighted mean difference: -2.59; 95%CI=-9.06 to 3.88; P=0.43). The present meta-analysis shows improvement in ablation time and freedom from AF after 12 months in AF patients treated with CF-guided catheter ablation. However, CF-guided catheter ablation does not decrease fluoroscopy time.

Random-start controlled ovarian stimulation for emergency fertility preservation in a patient with myelodysplastic syndrome: a case report

This study reports a case of a gonadotropin-releasing hormone agonist trigger in a young female with myelodysplastic syndrome (MDS) who underwent fertility preservation using random-start controlled ovarian stimulation. This method involves the stimulation of the ovary regardless of a patient's menstrual-cycle phase. A review of the related literature is also provided. A 17-year-old patient was diagnosed with MDS and required initiation of peripheral blood stem cell transplantation within a maximum of 3 weeks and was in the luteal phase of the menstrual cycle when the possibility of attempting preservation of fertility was presented to her. She opted for a random-start controlled ovarian stimulation with gonadotropins. With successful hemorrhagic prophylaxis, 17 oocytes were retrieved including 10 mature and 7 immature oocytes. Of the immature oocytes, 3 were successfully matured in vitro and a vitrification protocol was used to freeze the 13 mature oocytes.

Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability

New generation antidepressant therapies, including serotonin-norepinephrine reuptake inhibitor (SNRIs), were introduced in the late 1980s; however, few comprehensive studies have compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in young patients. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to January 2015. Only clinical trials that randomly assigned one SNRI or placebo to patients aged 7 to 18 years who met the diagnostic criteria for major depressive disorder were included. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Primary efficacy was determined by pooling the risk ratios (RRs) of treatment response and remission. Acceptability was determined by pooling the RRs of dropouts for all reasons and for adverse effects as well as suicide-risk outcomes. Five trials with a total of 973 patients were included. SNRIs were not significantly more effective than placebo for treatment response but were for remission. The comparison of patients taking SNRIs that dropped out for all reasons and those taking placebo did not reach statistical significance. Significantly more patients taking SNRIs dropped out for adverse effects than those taking placebo. No significant difference was found in suicide-related risk outcomes. SNRI therapy does not display a superior efficacy and is not better tolerated compared to placebo in these young patients. However, duloxetine has a potential beneficial effect for depression in young populations, showing a need for further research.

Quality evaluation of fresh-cut ‘Pérola’ pineapple stored in controlled atmosphere

The purpose of this research was to determine the best gas mixture in controlled atmosphere conditions to store fresh-cut ‘Pérola’ pineapple, particularly in relation to the maintenance of visual quality and reduction of microbial growth. After sanitation, fruit was manually peeled, sliced and dipped in 20 mg.L-1 NaOCl solution for 30 seconds. Then, the excess liquid was drained and the slices were placed in sealed glass jars connected to a flowboard installed in a cold room (5 ± 1 °C). Desired gas mixtures were supplied continuously for 12 days from cylinders connected to the flowboard. Controlled atmospheres of 2:5, 2:10, 2:15, 5:5, 5:10, 5:15, 8:5, 8:10 and 8:15 (O2:CO2, %) and air were used. The product was evaluated for pulp color, total and fecal coliforms, mesophilic and psychrotrophic aerobic, mold and yeast counts. Total and fecal coliforms were not detected. The fresh-cut ‘Pérola’ pineapple was not very sensitive to storage in controlled atmosphere, considering that the slices had little browning and were free of contamination, that would affect the food safety at the end of the storage period

Effect of controlled atmosphere on postharvest quality of 'Douradão' peaches

This study was carried out with one of the most important cultivar grown in the State of Sao Paulo, Brazil, which has gained the preference of consumers, due to its sweet taste, intense skin color and large size; however, these fruits are susceptible to chilling injury when cold stored for long periods. The use of controlled atmosphere (CA) with elevated CO2 and reduced O2 concentrations prevent the onset of the chilling symptom. Thus, the effect of three different conditions of controlled atmosphere (CA1, CA2, CA3 and Control) was evaluated in order to extend the storage life of 'Douradão' peaches. After 14, 21 and 28 days, samples were withdrawn from CA and kept in fresh air at 25 ± 1 °C and 90 ± 5% RH to complete ripening. On the day of removal and after 4 days, were the peaches quality characteristics were evaluated. The results showed that the use of CA during cold storage reduced weight loss and prevented postharvest decay. CA2 and CA3 treatments were effective in keeping good quality of 'Douradão' peaches during 28 days of cold storage, the ripe fruits showed reduced incidence of woolliness, adequate juiciness and flesh firmness. CA1 and Control treatments did not present marketable conditions after 14 days of cold storage.

Sensory profile of 'Douradão' peaches cold stored under controlled atmosphere

The sensory quality of 'Douradão' peaches cold stored in three different conditions of controlled atmosphere (CA1, CA2, CA3 and Control) was studied. After 14, 21 and 28 days of cold storage, samples were withdrawn from CA and kept for 4 days in ambient air for ripening. The sensory profile of the peaches and the descriptive terminology were developed by methodology based on the Quantitative Descriptive Analysis (QDA). The panelists consensually defined the sensory descriptors, their respective reference materials and the descriptive evaluation ballot. Fourteen panelists were selected based on their discrimination capacity and reproducibility. Seven descriptors were generated showing similarities and differences between samples. The data were analyzed by ANOVA, Tukey test and Principal Component Analysis (PCA). Results showed significant differences in the sensory profiles of the peaches. The PCA showed that CA2 and CA3 treatments were more characterized by the fresh peach flavor, fresh peach appearance, juiciness and flesh firmness, and were effective in keeping the good quality of the 'Douradão' peaches during the 28 days of cold storage. The Control and CA1 treatments were characterized by the mealiness and were ineffective for quality maintenance of the fruits during cold storage.

Quality of yellow passion fruit stored under refrigeration and controlled atmosphere

In this study, it was evaluated the quality of yellow passion fruits stored under refrigeration and controlled atmospheres of different composition aiming to extend the postharvest life of the fruits. The characteristics of skin color, appearance, mass loss, as well as the chemical quality of the juice of yellow passion fruits stored at: 21% O2 plus 0.03% CO2; 1% O2 plus 0.03% CO2; 5% O2 plus 0.03% CO2; 12% O2 plus 5% CO2; and 5% O2 plus 15% CO2, with 1 control treatment (refrigeration at 13 ºC and 90% UR) were determined. The analyses were performed before and after 30 days of storage and after removing the controlled atmospheres and storage for 9 days under refrigeration at ambient atmosphere. The data were interpreted by simple statistical analysis using the test by confidence intervals with 95% of probability. It was concluded that the application of atmospheres with low oxygen concentration and high carbon dioxide level minimized quality losses. At atmosphere with 5% O2 and 15% CO2, it was observed the lowest color change indexes and mass loss, and also the smallest decrease in acidity, soluble solids content, vitamin C, reducing sugars, and total soluble sugars.

Evaluation of lignin content of soybean seed coat stored in a controlled environment

Breeding soybean for high seed quality is an important approach for developing cultivars for tropical regions, and the lignin content in the seed coat is one of the screening parameters for this trait. Considering that many breeding lines are evaluated in each growing season using the presently recommended method for lignin determination, a long period is required for the evaluation of the whole breeding program. This time limitation may influence lignin content assessment, if lignin is degraded during storage. This research reported was designed to determine whether lignin was degraded in the seed coat of soybean seed cultivars stored for one year in a controlled environment (10°C temperature and 50% air relative humidity). Seeds of 12 selected soybean cultivars that had a range in seed coat lignin content were evaluated. Seeds were hand harvested just after physiological maturity and evaluated for seed coat lignin content at harvest and after one year of storage in a cold room (10°C and 50% RH). The lignin content in seed coats differed significantly among cultivars in both analyses, but for both results the sequence of cultivar classification and the lignin content values of each cultivar did not change. A regression analysis of lignin content at harvest and after one year of storage indicated a direct relationship between both lignin determinations suggesting no differences between the lignin content of each cultivar due to prolonged storage (r² = 0.98***). This indicates that the lignin determination in the soybean seed coat can be performed over a long time period without any bias due to change in its content.

Accelerated aging of ipê seeds under controlled conditions of storage

This research was aimed at studying effects of storage and accelerated aging on germination and profile of storage proteins in Handroanthus albus seeds. These were stored into a cold chamber (± 8 ºC; RH ± 40%) and after periods of 0, 3, 6, 9, and 12 months of storage, were subjected to accelerated aging for 0, 24, 48, 72, and 96 hours. Relationships between germination and proteins profile were assessed. Germination test was performed at 25 ºC, under constant light. For protein extraction, 125 mg of seeds were macerated in 2 mL of extraction buffer (1M Tris-HCl; pH 8.8) and applied to SDS-PAGE polyacrylamide gel at 80 V .15 h-1. Twelve month storage, combined with 72 hours accelerated aging have increased germination in approximately 65% when compared to non-aged seeds or to seeds with 24 h of accelerated aging. Besides beneficial effects, degradation and synthesis of different proteins were observed. It was concluded that germination of Handroanthus albus seeds, when not subjected to accelerated aging, is favored by storage in cold chamber during three to six months, or from nine to 12 months when subjected to accelerated aging process. Storage proteins may be associated to those increases, and hence further studies are needed.