Background Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning...Background Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning principles, RCs represent a recent mental health innovation. Since the first RC opened in England in 2009, RCs have expanded to 28 countries and territories. However, most RC research has been conducted in Western countries with similar cultural characteristics, limiting understanding of how RCs can be culturally adapted. The 12-item Recovery Colleges Characterisation and Testing (RECOLLECT) Fidelity Measure (RFM) evaluates the operational fidelity of RCs based on 12 components, but cultural influences on these components remain underexplored.Aims To assess associations between Hofstede’s cultural dimensions and RFM items to identify cultural influences on fidelity components.Methods A cross-sectional survey of RC managers was conducted across all 221 RCs. Mixed-effects regression models examined associations between Hofstede’s country-level cultural dimensions and item-level RFM scores, adjusted for healthcare expenditure and income inequality. Four cultural dimensions, obtained from Hofstede, were analysed: individualism (prioritising personal needs), indulgence (enjoyment-oriented), uncertainty avoidance (preference for predictability) and long-term orientation (future-focused).Results The RFM was completed by 169 (76%) RC managers. Seven RFM items showed associations with cultural dimensions. Equality was linked to short-term orientation, while learning was associated with individualism and uncertainty avoidance. Both individualism and indulgence influenced co-production and community focus. Commitment to recovery was shaped by all four cultural dimensions, with the strongest associations seen for individualism and indulgence. Individualism enhanced explicit focus on strengths-based practice, while uncertainty avoidance influenced course distinctiveness.Conclusions This study demonstrates how culture shapes RC fidelity components, providing actionable insights for cultural adaptation. Incorporating under-represented dimensions, such as collectivism and restraint, could improve the RFM’s global applicability, facilitating implementation. Future research should explore cultural nuances, engage diverse stakeholders and refine fidelity measures to enhance RC inclusivity and effectiveness worldwide.展开更多
The glucagon-like peptide 1 is a pleiotropic hormone that has potent insulinotropic effects and is key in treating metabolic diseases such as diabetes and obesity.Glucagon-like peptide 1 exerts its effects by activati...The glucagon-like peptide 1 is a pleiotropic hormone that has potent insulinotropic effects and is key in treating metabolic diseases such as diabetes and obesity.Glucagon-like peptide 1 exerts its effects by activating a membrane receptor identified in many tissues,including diffe rent brain regions.Glucagon-like peptide 1 activates several signaling pathways related to neuroprotection,like the support of cell growth/survival,enhancement promotion of synapse formation,autophagy,and inhibition of the secretion of proinflammatory cytokines,microglial activation,and apoptosis during neural morphogenesis.The glial cells,including astrocytes and microglia,maintain metabolic homeostasis and defe nse against pathogens in the central nervous system.After brain insult,microglia are the first cells to respond,followed by reactive astrocytosis.These activated cells produce proinflammato ry mediators like cytokines or chemokines to react to the insult.Furthermore,under these circumstances,mic roglia can become chro nically inflammatory by losing their homeostatic molecular signature and,consequently,their functions during many diseases.Several processes promote the development of neurological disorders and influence their pathological evolution:like the formation of protein aggregates,the accumulation of abnormally modified cellular constituents,the formation and release by injured neurons or synapses of molecules that can dampen neural function,and,of critical impo rtance,the dysregulation of inflammato ry control mechanisms.The glucagonlike peptide 1 receptor agonist emerges as a critical tool in treating brain-related inflammatory pathologies,restoring brain cell homeostasis under inflammatory conditions,modulating mic roglia activity,and decreasing the inflammato ry response.This review summarizes recent advances linked to the anti-inflammato ry prope rties of glucagon-like peptide 1 receptor activation in the brain related to multiple sclerosis,Alzheimer’s disease,Parkinson’s disease,vascular dementia,or chronic migraine.展开更多
AIM: To evaluate the effectiveness of an intervention for reducing social stigma towards mental illness in adolescents. The effect of gender and knowledge of someone with mental illness was measured. METHODS: Two hund...AIM: To evaluate the effectiveness of an intervention for reducing social stigma towards mental illness in adolescents. The effect of gender and knowledge of someone with mental illness was measured. METHODS: Two hundred and eighty secondary school students were evaluated using the Community Attitudes towards Mental Illness(CAMI) questionnaire. The schools were randomized and some received the intervention and others acted as the control group. The programme consisted of providing information via a documentary film and of contact with healthcare staff in order to reduce the social stigma within the school environment. RESULTS: The intervention was effective in reducing the CAMI authoritarianism and social restrictiveness subscales. The intervention showed significant changes in girls in terms of authoritarianism and social restrictiveness, while boys only showed significant changes in authoritarianism. Following the intervention, a significant reduction was found in authoritarianism and social restrictiveness in those who knew someone with mental illness, and only in authoritarianism in those who did not know anyone with mental illness. CONCLUSION: The intervention was effective to reduce social stigma towards people with mental illness, especially in the area of authoritarianism. Some differences were found depending on gender and whether or not the subjects knew someone with mental illness.展开更多
AIM: To validate a multimodal [structural and functional magnetic resonance (MR)] approach as coincidence brain clusters are hypothesized to correlate with clinical severity of auditory hallucinations. METHODS: Twenty...AIM: To validate a multimodal [structural and functional magnetic resonance (MR)] approach as coincidence brain clusters are hypothesized to correlate with clinical severity of auditory hallucinations. METHODS: Twenty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, DSM-IV) criteria for schizophrenia and experiencing persistent hallucinations together with 28 healthy controls were evaluated with structural and functional MR imaging with an auditory paradigm designed to replicate those emotions related to the patients’ hallucinatory experiences. Coincidence maps were obtained by combining structural maps of gray matter reduction with emotional functional increased activation. Abnormal areas were correlated with the brief psychiatric rating scale (BPRS) and the psychotic symptom rating scale (PSYRATS) scales. RESULTS: The coincidence analysis showed areas with coexistence gray matter reductions and emotional activation in bilateral middle temporal and superior temporal gyri. Significant negative correlations between BPRS and PSYRATS scales were observed. BPRS scores were negatively correlated in the middle temporal gyrus (right) (t = 6.86, P = 0.001), while negative PSYRATS correlation affected regions in both the superior temporal gyrus (left) (t = 7.85, P = 0.001) and middle temporal gyrus (left) (t = 4.97, P = 0.002). CONCLUSION: Our data identify left superior and middle temporal gyri as relevant areas for the understanding of auditory hallucinations in schizophrenia. The use of multimodal approaches, sharing structural and functional information, may demonstrate areas specifically linked to the severity of auditory hallucinations.展开更多
BACKGROUND Suicide is a leading cause of preventable death worldwide,with its peak of maximum incidence in later life.Depression often puts an individual at higher risk for suicidal behaviour.In turn,depression deserv...BACKGROUND Suicide is a leading cause of preventable death worldwide,with its peak of maximum incidence in later life.Depression often puts an individual at higher risk for suicidal behaviour.In turn,depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing.AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults,and to examine the effects of depression treatment to tackle suicide behaviour in this population.METHODS A systematic review of empirical studies,published from 2000 onwards,was conducted.Suicidal behaviour was addressed considering its varying forms(i.e.,wish to die,ideation,attempt,and completed suicide).RESULTS Thirty-five papers were selected for review,comprising both clinical and epidemiological studies.Most of studies focused on suicidal ideation(60%).The studies consistently pointed out that the risk was related to depressive episode severity,psychiatric comorbidity(anxiety or substance use disorders),poorer health status,and loss of functionality.Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults.Finally,the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response.Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms.CONCLUSION To sum up,common and age-specific risk factors seem to be involved in suicide development in depressive older adults.A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.展开更多
BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms ...BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms of the disorder.Nevertheless,many unknowns remain,including the optimal anatomical targets,the best stimulation parameters,the long-term(LT)effects of the therapy,and the clinical or biological factors associated with response.This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.METHODS A comprehensive search was conducted in the PubMed,Cochrane,Scopus,and ClinicalTrials.gov databases from inception to December 31,2020,using the following strategy:“(Obsessive-compulsive disorder OR OCD)AND(deep brain stimulation OR DBS).”Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool.The inclusion criteria were as follows:a main diagnosis of OCD,DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale(Y-BOCS)as primary outcome.Data were analyzed with descriptive statistics.RESULTS Forty articles identified by the search strategy met the eligibility criteria.Applying a follow-up threshold of 36 mo,29 studies(with 230 patients)provided information on short-term(ST)response to DBS in,while 11(with 155 patients)reported results on LT response.Mean follow-up period was 18.5±8.0 mo for the ST studies and 63.7±20.7 mo for the LT studies.Overall,the percentage of reduction in Y-BOCS scores was similar in ST(47.4%)and LT responses(47.2%)to DBS,but more patients in the LT reports met the criteria for response(defined as a reduction in Y-BOCS scores>35%:ST,60.6%vs LT,70.7%).According to the results,the response in the first year predicts the extent to which an OCD patient will benefit from DBS,since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation.Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients;but it is still controversial whether this improvement persists,increases or decreases in the long term.Three different patterns of LT response emerged from the analysis:49.5% of patients had good and sustained response to DBS,26.6% were non responders,and 22.5% were partial responders,who might improve at some point but experience relapses during follow-up.A significant improvement in depressive symptoms and global functionality was observed in most studies,usually(although not always)in parallel with an improvement in obsessive symptoms.Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters;however,some severe adverse events including intracranial hemorrhages and infections were also described.Hypomania was the most frequently reported psychiatric side effect.The relationship between DBS and suicide risk is still controversial and requires further study.Finally,to date,no clear clinical or biological predictors of response can be established,probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed.CONCLUSION The present review confirms that DBS is a promising therapy for patients with severe resistant OCD,providing both ST and LT evidence of efficacy.展开更多
The manuscript correspond to an editorial in order to assess the most important and effective interventions for people with psychosis in the early stages.
AIM:To investigate the effect of aqueous extract from Mangifera indica L.(MIE)on dextran sulfate sodium (DSS)-induced colitis in rats.METHODS:MIE(150 mg/kg)was administered in two different protocols:(1)rectally,over ...AIM:To investigate the effect of aqueous extract from Mangifera indica L.(MIE)on dextran sulfate sodium (DSS)-induced colitis in rats.METHODS:MIE(150 mg/kg)was administered in two different protocols:(1)rectally,over 7 d at the same time as DSS administration;and(2)once daily over 14 d (by oral gavage,7 d before starting DSS,and rectally for 7 d during DSS administration).General observations of clinical signs were performed.Anti-inflammatory activity of MIE was assessed by myeloperoxidase(MPO)activity. Colonic lipid peroxidation was determined by measuring the levels of thiobarbituric acid reactive substances (TBARS).Reduced glutathione(GSH)levels,expression of inflammatory related mediators[inducible isoforms of nitric oxide synthase(iNOS)and cyclooxygenase (COX)-2,respectively]and cytokines[tumor necrosis factor(TNF)-αand TNF receptors 1 and 2]in colonic tissue were also assessed.Interleukin(IL)-6 and TNF-α serum levels were also measured. RESULTS:The results demonstrated that MIE has anti-inflammatory properties by improvement of clinical signs,reduction of ulceration and reduced MPO activity when administered before DSS.In addition,administration of MIE for 14 d resulted in an increase in GSH and reduction of TBARS levels and iNOS,COX-2, TNF-αand TNF R-2 expression in colonic tissue,and a decrease in IL-6 and TNF-αserum levels. CONCLUSION:MIE has anti-inflammatory activity in a DSS-induced rat colitis model and preventive administration(prior to DSS)seems to be a more effective protocol.展开更多
Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Met...Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Methods:An umbrella review of systematic reviews with meta-analyses of observational studies was conducted.We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values,95%prediction intervals,heterogeneity,small-study effects,and excess significance.We graded the evidence from convincing(Class I)to weak(Class IV).Results:From 504 articles returned in a search of the literature,8 systematic reviews were included in our review,with a total of 11 outcomes.Overall,nine of the 11 of the outcomes reported nominally significant summary results(p<0.05),with 4 associations surviving the application of the more stringent p value(p<106).No outcome presented convincing evidence.Three associations showed Class II evidence(i.e.,highly suggestive):(1)higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population(n=34 studies;sample size=1,855,817;relative risk=0.72,95%confidence interval(95%CI):0.670.78),(2)cardiovascular death risk in mixed populations(n=15 studies;relative risk=0.84,95%CI:0.780.91),and(3)incidence of disability(n=7 studies;relative risk=0.76,95%CI:0.660.87).Conclusion:The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality,as well as disability.To further inform intervention strategies,future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.展开更多
Background: Patients with generalized anxiety disorder (GAD) are among the highest users of healthcare resources. The broadening of the DSM-IV criteria for GAD has been a subject of controversy in the literature, but ...Background: Patients with generalized anxiety disorder (GAD) are among the highest users of healthcare resources. The broadening of the DSM-IV criteria for GAD has been a subject of controversy in the literature, but its consequences have not been analyzed to date. Objective: The purpose of this study was to analyze how the broadening of the DSM-IV criteria affects healthcare resource utilization and related costs. Methods: A multicentre, prospective, observational study was conducted in randomly selected outpatient psychiatric clinics between October 2007 and April 2008. Patients diagnosed according to DSM-IV or broader criteria (1 month of excessive or non-excessive worry and only 2 associated DSM-IV symptoms) for the first time were consecutively enrolled. Socio-demographic data, healthcare resources and corresponding costs were collected over a 6-month period. Results: A total of 3549 patients were systematically recruited, 1815 in the DSM-IV criteria group (DG) and1264 inthe broad criteria group (BG). Treatments prescribed were similar for antidepressants in both groups (77.0% in the DG vs. 75.3% in the BG, p = 0.284), and slightly higher in the DG for benzodiazepines (71.5% vs. 67.2% respectively, p = 0.011) and anticonvulsants (72.1% vs. 67.0% respectively, p = 0.002). Healthcare resource utilization was statistically reduced to a similar extent in both groups as a consequence of treatment, yielding a reduction in the cost of illness of €1196 (SD = 1158) and €1112 (SD = 874) respectively;p = 0.304, over a 6-month period. Conclusion: The broadening of the GAD criteria could lead to earlier diagnosis not necessarily associated with an increase in healthcare resource utilization or costs to the National Health System in the six-month follow-up.展开更多
Attachment style,which has been theorized to be rooted in childhood bonding experiences,influences adult cognitive,emotional and interpersonal functioning.Despite its relationship with early experiences,research indic...Attachment style,which has been theorized to be rooted in childhood bonding experiences,influences adult cognitive,emotional and interpersonal functioning.Despite its relationship with early experiences,research indicates that the continuity of attachment style across childhood and adulthood is only partial,being a malleable tendency that is shaped throughout development,with an increasing influence of genetics,as it occurs in other cognitive and behavioral phenotypes.Genetic research indicates that up to 45% of the variability in anxious and 39% in avoidant adult attachment style could be explained by genetic causes,but the precise mechanisms remain unclear.A narrative review is conducted analyzing the existing literature regarding the implication of candidate genes related to oxytocin,dopaminergic pathways,serotonergic pathways and brainderived neurotrophic factor in adult attachment,with both vulnerability and differential susceptibility approaches,yielding mixed results.We highlight the lack of genome-wide studies and the scarcity of epigenetic investigation.Based on the existing data,we conclude that the genetics of adult attachment is an area that requires further research to clarify its etiological role and that it should be preferably approached as an interaction between nature and nurture.展开更多
Depression is a common,recurrent mental disorder and one of the leading causes of disability and global burden of disease worldwide.Up to 15%-40%of cases do not respond to diverse pharmacological treatments and,thus,c...Depression is a common,recurrent mental disorder and one of the leading causes of disability and global burden of disease worldwide.Up to 15%-40%of cases do not respond to diverse pharmacological treatments and,thus,can be defined as treatment-resistant depression(TRD).The development of biomarkers predictive of drug response could guide us towards personalized and earlier treatment.Growing evidence points to the involvement of the glutamatergic system in the pathogenesis of TRD.Specifically,the N-methyl-D-aspartic acid receptor(NMDAR)andα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor(AMPAR),which are targeted by ketamine and esketamine,are proposed as promising pathways.A literature search was performed to identify studies on the genetics of the glutamatergic system in depression,focused on variables related to NMDARs and AMPARs.Our review highlights GRIN2B,which encodes the NR2B subunit of NMDAR,as a candidate gene in the pathogenesis of TRD.In addition,several studies have associated genes encoding AMPAR subunits with symptomatic severity and suicidal ideation.These genes encoding glutamatergic receptors could,therefore,be candidate genes for understanding the etiopathogenesis of TRD,as well as for understanding the pharmacodynamic mechanisms and response to ketamine and esketamine treatment.展开更多
Objective Previous studies have shown that meteorological factors may increase COVID-19 mortality,likely due to the increased transmission of the virus.However,this could also be related to an increased infection fata...Objective Previous studies have shown that meteorological factors may increase COVID-19 mortality,likely due to the increased transmission of the virus.However,this could also be related to an increased infection fatality rate(IFR).We investigated the association between meteorological factors(temperature,humidity,solar irradiance,pressure,wind,precipitation,cloud coverage)and IFR across Spanish provinces(n=52)during the first wave of the pandemic(weeks 10–16 of 2020).Methods We estimated IFR as excess deaths(the gap between observed and expected deaths,considering COVID-19-unrelated deaths prevented by lockdown measures)divided by the number of infections(SARS-CoV-2 seropositive individuals plus excess deaths)and conducted Spearman correlations between meteorological factors and IFR across the provinces.Results We estimated 2,418,250 infections and 43,237 deaths.The IFR was 0.03%in<50-year-old,0.22%in 50–59-year-old,0.9%in 60–69-year-old,3.3%in 70–79-year-old,12.6%in 80–89-year-old,and26.5%in≥90-year-old.We did not find statistically significant relationships between meteorological factors and adjusted IFR.However,we found strong relationships between low temperature and unadjusted IFR,likely due to Spain’s colder provinces’aging population.Conclusion The association between meteorological factors and adjusted COVID-19 IFR is unclear.Neglecting age differences or ignoring COVID-19-unrelated deaths may severely bias COVID-19 epidemiological analyses.展开更多
White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing ...White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing myocarditis or pneumonia during clozapine titrations.Prescribers worldwide are largely unaware of that.Meanwhile,as they worry about agranulocytosis,their clozapine-treated patients are at risk of dying from pneumonia or myocarditis.Consequently,an international guideline with 104 authors from 50 countries/regions was recently published to provide personalised clozapine titration schedules for adult inpatients.This forum article reviews pneumonia and myocarditis occurring during clozapine titration,as well as the three most innovative aspects of this new guideline:(1)personalised titration,(2)C reactive protein(CRP)measures,and(3)dose predictions based on blood levels.Clozapine metabolism is influenced by 3 levels of complexity:(1)ancestry groups,(2)sex-smoking subgroups,and(3)presence/absence of poor metabolizer status.These 3 groups of variables should determine the maintenance dose and speed of clozapine titration;they are summarised in a table in the full-text.The international clozapine titration guideline recommends measuring CRP levels simultaneously with WBC,at baseline and weekly at least for the first 4 weeks of titration,the highest risk period for clozapine-induced myocarditis.展开更多
The coronavirus disease 2019(COVID-19)pandemic has raised concerns about the mental health and social well-being of youth,including its potential to increase or exacerbate substance use behaviors[1].Among adolescents,...The coronavirus disease 2019(COVID-19)pandemic has raised concerns about the mental health and social well-being of youth,including its potential to increase or exacerbate substance use behaviors[1].Among adolescents,the COVID-19pandemic has resulted in limited face-to-face school contact and thus missed milestones in preventing alcohol and substance use.展开更多
Background:The choice of unicompartmental knee arthroplasty(UKA)vs.total knee arthroplasty(TKA)in the surgical treatment of knee osteoarthritis(KOA)remains controversial.This study aimed to perform a systematic review...Background:The choice of unicompartmental knee arthroplasty(UKA)vs.total knee arthroplasty(TKA)in the surgical treatment of knee osteoarthritis(KOA)remains controversial.This study aimed to perform a systematic review and meta-analysis of randomized controlled trials(RCTs)to compare the clinical results of UKA and TKA for treating unicompartmental KOA.Methods:PubMed,Embase,and the Cochrane Library were systematically searched for articles published up to January 2,2023.The literature was rigorously screened to include only RCTs comparing UKA and TKA for unicompartmental KOA.A systematic review and meta-analysis were performed to calculate the mean difference(MD),relative risk(RR),and 95%confidence interval(CI)according to the Cochrane standards.Results:Thirteen publications involving 683 UKAs and 683 TKAs were analyzed.Except for one study with a follow-up period of 15 years,all outcome measures reported were within 5 years of follow-up.Meta-analysis showed better knee recovery(MD:1.23;95%CI:1.01–1.45;P<0.001),greater knee function(MD:1.78;95%CI:0.34–3.22;P=0.020),less pain(MD:0.75;95%CI:0.43–1.06;P<0.001),and better health status(MD:3.75;95%CI:0.81–6.69;P=0.010)after UKA than TKA.However,considering the minimal clinically important difference values for these variables,the findings were not clinically relevant.Moreover,UKA patients had fewer complications(RR:0.59;95%CI:0.45–0.78;P<0.001)and shorter hospital stays(MD:–0.89;95%CI:–1.57 to–0.22;P=0.009)than did TKA patients.There were no statistically significant differences in terms of postoperative range of movement,revision,failure,operation time,and patient satisfaction.Conclusions:In terms of clinical efficacy,there was no obvious advantage of UKA over TKA in the surgical treatment of knee OA when considering the minimal clinically important difference.The main advantage of UKA over TKA is that it leads to fewer complications and a shorter length of hospital stay.It is ideal to perform prospective studies with longer follow-up periods to fully evaluate the long-term efficacy and safety of the two procedures in the future.展开更多
Cognitive control is fundamental to human goal-directed behavior.Understanding its trajectory across the lifespan is crucial for optimizing cognitive function throughout life,particularly during periods of rapid devel...Cognitive control is fundamental to human goal-directed behavior.Understanding its trajectory across the lifespan is crucial for optimizing cognitive function throughout life,particularly during periods of rapid development and decline.While existing studies have revealed an inverted U-shaped trajectory of cognitive control in both behavioral and anatomical domains,the age-related changes in functional brain activities remain poorly understood.To bridge this gap,we conducted a comprehensive meta-analysis of 139 neuroimaging studies using conflict tasks,encompassing 3765 participants aged 5 to 85 years.We adopted the seed-based d mapping(SDM),generalized additive model(GAM),and model comparison approaches to investigate age-related changes in brain activities to characterize the lifespan trajectories of cognitive control.Our analyses revealed two key findings:(1)The predominant lifespan trajectory is inverted U-shaped,rising from childhood to peak in young adulthood(between 27 and 36 years)before declining in later adulthood;(2)Both the youth and the elderly show weaker brain activities and greater left laterality than young adults.These results collectively reveal the lifespan trajectories of cognitive control,highlighting systematic fluctuations in brain activities with age.展开更多
Introduction Antibiotic use for acute otitis media(AOM)is one of the major sources of antimicrobial resistance.However,the effective minimal antibiotic duration for AOM remains unclear.Moreover,guidelines often recomm...Introduction Antibiotic use for acute otitis media(AOM)is one of the major sources of antimicrobial resistance.However,the effective minimal antibiotic duration for AOM remains unclear.Moreover,guidelines often recommend broad ranges(5-10 days)of antibiotic use,yet the clinical impact of such a wide window has not been assessed.Methods We systematically searched PubMed/MEDLINE,Embase,Scopus,Web of Science,and Cochrane Library from database inception to 6 October 2021.Network meta-analysis was conducted on randomized controlled trials that assessed antibiotic treatment for AOM in children(PROSPERO CRD42020196107).Results For amoxicillin and amoxicillin-clavulanate,7-day regimens were noninferior to 10-day regimens in clinical responses[amoxicillin:risk ratio(RR)0.919(95%CI 0.820-1.031),amoxicillin-clavulanate:RR 1.108(0.957-1.282)],except for≤2 years.For the third-generation cephalosporins,7-day and 10-day regimens had similar clinical responses compared to placebo[7-day:RR 1.420(1.190-1.694),10-day:RR 1.238(1.125-1.362)compared to placebo].However,5-day regimens of amoxicillin-clavulanate and third-generation cephalosporins were inferior to 10-day regimens.Compared to amoxicillin,a shorter treatment duration was tolerable with amoxicillin-clavulanate.Conclusions Our findings indicated that 1O days of antibiotic use may be unnecessarily long,while the treatment duration should be longer than 5 days.Otherwise,5-day regimens would be sufficient for a modest treatment goal.Our findings revealed that the current wide range of recommended antibiotic durations may have influenced the clinical outcome of AOM,and a narrower antibiotic duration window should be re-established.展开更多
基金This study is part of the RECOLLECT 2 programme,a five-year(2020-2025)project funded by the National Institute for Health and Care Research,which investigates the effectiveness and cost-effectiveness of recovery colleges.
文摘Background Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning principles, RCs represent a recent mental health innovation. Since the first RC opened in England in 2009, RCs have expanded to 28 countries and territories. However, most RC research has been conducted in Western countries with similar cultural characteristics, limiting understanding of how RCs can be culturally adapted. The 12-item Recovery Colleges Characterisation and Testing (RECOLLECT) Fidelity Measure (RFM) evaluates the operational fidelity of RCs based on 12 components, but cultural influences on these components remain underexplored.Aims To assess associations between Hofstede’s cultural dimensions and RFM items to identify cultural influences on fidelity components.Methods A cross-sectional survey of RC managers was conducted across all 221 RCs. Mixed-effects regression models examined associations between Hofstede’s country-level cultural dimensions and item-level RFM scores, adjusted for healthcare expenditure and income inequality. Four cultural dimensions, obtained from Hofstede, were analysed: individualism (prioritising personal needs), indulgence (enjoyment-oriented), uncertainty avoidance (preference for predictability) and long-term orientation (future-focused).Results The RFM was completed by 169 (76%) RC managers. Seven RFM items showed associations with cultural dimensions. Equality was linked to short-term orientation, while learning was associated with individualism and uncertainty avoidance. Both individualism and indulgence influenced co-production and community focus. Commitment to recovery was shaped by all four cultural dimensions, with the strongest associations seen for individualism and indulgence. Individualism enhanced explicit focus on strengths-based practice, while uncertainty avoidance influenced course distinctiveness.Conclusions This study demonstrates how culture shapes RC fidelity components, providing actionable insights for cultural adaptation. Incorporating under-represented dimensions, such as collectivism and restraint, could improve the RFM’s global applicability, facilitating implementation. Future research should explore cultural nuances, engage diverse stakeholders and refine fidelity measures to enhance RC inclusivity and effectiveness worldwide.
基金supported by the European Union Grant Alehoop(H2020-BBIJTI-2019-887259)And from the Xunta de Galicia(Centro singular de Investigación de Galicia accreditation 2016-2019),ED431 G/02(to FM)。
文摘The glucagon-like peptide 1 is a pleiotropic hormone that has potent insulinotropic effects and is key in treating metabolic diseases such as diabetes and obesity.Glucagon-like peptide 1 exerts its effects by activating a membrane receptor identified in many tissues,including diffe rent brain regions.Glucagon-like peptide 1 activates several signaling pathways related to neuroprotection,like the support of cell growth/survival,enhancement promotion of synapse formation,autophagy,and inhibition of the secretion of proinflammatory cytokines,microglial activation,and apoptosis during neural morphogenesis.The glial cells,including astrocytes and microglia,maintain metabolic homeostasis and defe nse against pathogens in the central nervous system.After brain insult,microglia are the first cells to respond,followed by reactive astrocytosis.These activated cells produce proinflammato ry mediators like cytokines or chemokines to react to the insult.Furthermore,under these circumstances,mic roglia can become chro nically inflammatory by losing their homeostatic molecular signature and,consequently,their functions during many diseases.Several processes promote the development of neurological disorders and influence their pathological evolution:like the formation of protein aggregates,the accumulation of abnormally modified cellular constituents,the formation and release by injured neurons or synapses of molecules that can dampen neural function,and,of critical impo rtance,the dysregulation of inflammato ry control mechanisms.The glucagonlike peptide 1 receptor agonist emerges as a critical tool in treating brain-related inflammatory pathologies,restoring brain cell homeostasis under inflammatory conditions,modulating mic roglia activity,and decreasing the inflammato ry response.This review summarizes recent advances linked to the anti-inflammato ry prope rties of glucagon-like peptide 1 receptor activation in the brain related to multiple sclerosis,Alzheimer’s disease,Parkinson’s disease,vascular dementia,or chronic migraine.
基金Supported by The PI011/1347,of the Plan Nacional de I+D+Ico-funded by ISCⅢ-Subdirección General de Evaluación y Formento de la Investigación Sanitaria,Fondo Europeo de Desarrollo Regional(FEDER)Parc Sanitari Sant Joan de Déu and Escola Amiga Program
文摘AIM: To evaluate the effectiveness of an intervention for reducing social stigma towards mental illness in adolescents. The effect of gender and knowledge of someone with mental illness was measured. METHODS: Two hundred and eighty secondary school students were evaluated using the Community Attitudes towards Mental Illness(CAMI) questionnaire. The schools were randomized and some received the intervention and others acted as the control group. The programme consisted of providing information via a documentary film and of contact with healthcare staff in order to reduce the social stigma within the school environment. RESULTS: The intervention was effective in reducing the CAMI authoritarianism and social restrictiveness subscales. The intervention showed significant changes in girls in terms of authoritarianism and social restrictiveness, while boys only showed significant changes in authoritarianism. Following the intervention, a significant reduction was found in authoritarianism and social restrictiveness in those who knew someone with mental illness, and only in authoritarianism in those who did not know anyone with mental illness. CONCLUSION: The intervention was effective to reduce social stigma towards people with mental illness, especially in the area of authoritarianism. Some differences were found depending on gender and whether or not the subjects knew someone with mental illness.
文摘AIM: To validate a multimodal [structural and functional magnetic resonance (MR)] approach as coincidence brain clusters are hypothesized to correlate with clinical severity of auditory hallucinations. METHODS: Twenty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, DSM-IV) criteria for schizophrenia and experiencing persistent hallucinations together with 28 healthy controls were evaluated with structural and functional MR imaging with an auditory paradigm designed to replicate those emotions related to the patients’ hallucinatory experiences. Coincidence maps were obtained by combining structural maps of gray matter reduction with emotional functional increased activation. Abnormal areas were correlated with the brief psychiatric rating scale (BPRS) and the psychotic symptom rating scale (PSYRATS) scales. RESULTS: The coincidence analysis showed areas with coexistence gray matter reductions and emotional activation in bilateral middle temporal and superior temporal gyri. Significant negative correlations between BPRS and PSYRATS scales were observed. BPRS scores were negatively correlated in the middle temporal gyrus (right) (t = 6.86, P = 0.001), while negative PSYRATS correlation affected regions in both the superior temporal gyrus (left) (t = 7.85, P = 0.001) and middle temporal gyrus (left) (t = 4.97, P = 0.002). CONCLUSION: Our data identify left superior and middle temporal gyri as relevant areas for the understanding of auditory hallucinations in schizophrenia. The use of multimodal approaches, sharing structural and functional information, may demonstrate areas specifically linked to the severity of auditory hallucinations.
基金Supported by Instituto de Salud Carlos III-FIS,co-supported by European Regional Development Fund(ERDF)’a way to build Europe’,No.PI20/00229 and No.PI19/01256。
文摘BACKGROUND Suicide is a leading cause of preventable death worldwide,with its peak of maximum incidence in later life.Depression often puts an individual at higher risk for suicidal behaviour.In turn,depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing.AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults,and to examine the effects of depression treatment to tackle suicide behaviour in this population.METHODS A systematic review of empirical studies,published from 2000 onwards,was conducted.Suicidal behaviour was addressed considering its varying forms(i.e.,wish to die,ideation,attempt,and completed suicide).RESULTS Thirty-five papers were selected for review,comprising both clinical and epidemiological studies.Most of studies focused on suicidal ideation(60%).The studies consistently pointed out that the risk was related to depressive episode severity,psychiatric comorbidity(anxiety or substance use disorders),poorer health status,and loss of functionality.Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults.Finally,the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response.Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms.CONCLUSION To sum up,common and age-specific risk factors seem to be involved in suicide development in depressive older adults.A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.
基金Supported by Carlos Ⅲ Health Institute,No.PI16/00950 and No.PI18/00856and FEDER funds(‘A way to build Europe’).
文摘BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms of the disorder.Nevertheless,many unknowns remain,including the optimal anatomical targets,the best stimulation parameters,the long-term(LT)effects of the therapy,and the clinical or biological factors associated with response.This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.METHODS A comprehensive search was conducted in the PubMed,Cochrane,Scopus,and ClinicalTrials.gov databases from inception to December 31,2020,using the following strategy:“(Obsessive-compulsive disorder OR OCD)AND(deep brain stimulation OR DBS).”Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool.The inclusion criteria were as follows:a main diagnosis of OCD,DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale(Y-BOCS)as primary outcome.Data were analyzed with descriptive statistics.RESULTS Forty articles identified by the search strategy met the eligibility criteria.Applying a follow-up threshold of 36 mo,29 studies(with 230 patients)provided information on short-term(ST)response to DBS in,while 11(with 155 patients)reported results on LT response.Mean follow-up period was 18.5±8.0 mo for the ST studies and 63.7±20.7 mo for the LT studies.Overall,the percentage of reduction in Y-BOCS scores was similar in ST(47.4%)and LT responses(47.2%)to DBS,but more patients in the LT reports met the criteria for response(defined as a reduction in Y-BOCS scores>35%:ST,60.6%vs LT,70.7%).According to the results,the response in the first year predicts the extent to which an OCD patient will benefit from DBS,since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation.Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients;but it is still controversial whether this improvement persists,increases or decreases in the long term.Three different patterns of LT response emerged from the analysis:49.5% of patients had good and sustained response to DBS,26.6% were non responders,and 22.5% were partial responders,who might improve at some point but experience relapses during follow-up.A significant improvement in depressive symptoms and global functionality was observed in most studies,usually(although not always)in parallel with an improvement in obsessive symptoms.Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters;however,some severe adverse events including intracranial hemorrhages and infections were also described.Hypomania was the most frequently reported psychiatric side effect.The relationship between DBS and suicide risk is still controversial and requires further study.Finally,to date,no clear clinical or biological predictors of response can be established,probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed.CONCLUSION The present review confirms that DBS is a promising therapy for patients with severe resistant OCD,providing both ST and LT evidence of efficacy.
基金The PI014/0044,of the Plan Nacional de I+D+I and co-funded by ISCⅢ–Subdirección General de Evaluación y Formento de la Investigación Sanitariaand Fondo Europeo de Desarrollo Regional(FEDER)
文摘The manuscript correspond to an editorial in order to assess the most important and effective interventions for people with psychosis in the early stages.
基金Supported by Spanish Ministry of Education(MEC,SAF0763138)the Instituto de Salud Carlos Ⅲ,Mental Health Research Network,CIBERSAM,and Foundation Santander-UCM(GR58/08)
文摘AIM:To investigate the effect of aqueous extract from Mangifera indica L.(MIE)on dextran sulfate sodium (DSS)-induced colitis in rats.METHODS:MIE(150 mg/kg)was administered in two different protocols:(1)rectally,over 7 d at the same time as DSS administration;and(2)once daily over 14 d (by oral gavage,7 d before starting DSS,and rectally for 7 d during DSS administration).General observations of clinical signs were performed.Anti-inflammatory activity of MIE was assessed by myeloperoxidase(MPO)activity. Colonic lipid peroxidation was determined by measuring the levels of thiobarbituric acid reactive substances (TBARS).Reduced glutathione(GSH)levels,expression of inflammatory related mediators[inducible isoforms of nitric oxide synthase(iNOS)and cyclooxygenase (COX)-2,respectively]and cytokines[tumor necrosis factor(TNF)-αand TNF receptors 1 and 2]in colonic tissue were also assessed.Interleukin(IL)-6 and TNF-α serum levels were also measured. RESULTS:The results demonstrated that MIE has anti-inflammatory properties by improvement of clinical signs,reduction of ulceration and reduced MPO activity when administered before DSS.In addition,administration of MIE for 14 d resulted in an increase in GSH and reduction of TBARS levels and iNOS,COX-2, TNF-αand TNF R-2 expression in colonic tissue,and a decrease in IL-6 and TNF-αserum levels. CONCLUSION:MIE has anti-inflammatory activity in a DSS-induced rat colitis model and preventive administration(prior to DSS)seems to be a more effective protocol.
文摘Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Methods:An umbrella review of systematic reviews with meta-analyses of observational studies was conducted.We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values,95%prediction intervals,heterogeneity,small-study effects,and excess significance.We graded the evidence from convincing(Class I)to weak(Class IV).Results:From 504 articles returned in a search of the literature,8 systematic reviews were included in our review,with a total of 11 outcomes.Overall,nine of the 11 of the outcomes reported nominally significant summary results(p<0.05),with 4 associations surviving the application of the more stringent p value(p<106).No outcome presented convincing evidence.Three associations showed Class II evidence(i.e.,highly suggestive):(1)higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population(n=34 studies;sample size=1,855,817;relative risk=0.72,95%confidence interval(95%CI):0.670.78),(2)cardiovascular death risk in mixed populations(n=15 studies;relative risk=0.84,95%CI:0.780.91),and(3)incidence of disability(n=7 studies;relative risk=0.76,95%CI:0.660.87).Conclusion:The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality,as well as disability.To further inform intervention strategies,future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.
文摘Background: Patients with generalized anxiety disorder (GAD) are among the highest users of healthcare resources. The broadening of the DSM-IV criteria for GAD has been a subject of controversy in the literature, but its consequences have not been analyzed to date. Objective: The purpose of this study was to analyze how the broadening of the DSM-IV criteria affects healthcare resource utilization and related costs. Methods: A multicentre, prospective, observational study was conducted in randomly selected outpatient psychiatric clinics between October 2007 and April 2008. Patients diagnosed according to DSM-IV or broader criteria (1 month of excessive or non-excessive worry and only 2 associated DSM-IV symptoms) for the first time were consecutively enrolled. Socio-demographic data, healthcare resources and corresponding costs were collected over a 6-month period. Results: A total of 3549 patients were systematically recruited, 1815 in the DSM-IV criteria group (DG) and1264 inthe broad criteria group (BG). Treatments prescribed were similar for antidepressants in both groups (77.0% in the DG vs. 75.3% in the BG, p = 0.284), and slightly higher in the DG for benzodiazepines (71.5% vs. 67.2% respectively, p = 0.011) and anticonvulsants (72.1% vs. 67.0% respectively, p = 0.002). Healthcare resource utilization was statistically reduced to a similar extent in both groups as a consequence of treatment, yielding a reduction in the cost of illness of €1196 (SD = 1158) and €1112 (SD = 874) respectively;p = 0.304, over a 6-month period. Conclusion: The broadening of the GAD criteria could lead to earlier diagnosis not necessarily associated with an increase in healthcare resource utilization or costs to the National Health System in the six-month follow-up.
文摘Attachment style,which has been theorized to be rooted in childhood bonding experiences,influences adult cognitive,emotional and interpersonal functioning.Despite its relationship with early experiences,research indicates that the continuity of attachment style across childhood and adulthood is only partial,being a malleable tendency that is shaped throughout development,with an increasing influence of genetics,as it occurs in other cognitive and behavioral phenotypes.Genetic research indicates that up to 45% of the variability in anxious and 39% in avoidant adult attachment style could be explained by genetic causes,but the precise mechanisms remain unclear.A narrative review is conducted analyzing the existing literature regarding the implication of candidate genes related to oxytocin,dopaminergic pathways,serotonergic pathways and brainderived neurotrophic factor in adult attachment,with both vulnerability and differential susceptibility approaches,yielding mixed results.We highlight the lack of genome-wide studies and the scarcity of epigenetic investigation.Based on the existing data,we conclude that the genetics of adult attachment is an area that requires further research to clarify its etiological role and that it should be preferably approached as an interaction between nature and nurture.
文摘Depression is a common,recurrent mental disorder and one of the leading causes of disability and global burden of disease worldwide.Up to 15%-40%of cases do not respond to diverse pharmacological treatments and,thus,can be defined as treatment-resistant depression(TRD).The development of biomarkers predictive of drug response could guide us towards personalized and earlier treatment.Growing evidence points to the involvement of the glutamatergic system in the pathogenesis of TRD.Specifically,the N-methyl-D-aspartic acid receptor(NMDAR)andα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor(AMPAR),which are targeted by ketamine and esketamine,are proposed as promising pathways.A literature search was performed to identify studies on the genetics of the glutamatergic system in depression,focused on variables related to NMDARs and AMPARs.Our review highlights GRIN2B,which encodes the NR2B subunit of NMDAR,as a candidate gene in the pathogenesis of TRD.In addition,several studies have associated genes encoding AMPAR subunits with symptomatic severity and suicidal ideation.These genes encoding glutamatergic receptors could,therefore,be candidate genes for understanding the etiopathogenesis of TRD,as well as for understanding the pharmacodynamic mechanisms and response to ketamine and esketamine treatment.
文摘Objective Previous studies have shown that meteorological factors may increase COVID-19 mortality,likely due to the increased transmission of the virus.However,this could also be related to an increased infection fatality rate(IFR).We investigated the association between meteorological factors(temperature,humidity,solar irradiance,pressure,wind,precipitation,cloud coverage)and IFR across Spanish provinces(n=52)during the first wave of the pandemic(weeks 10–16 of 2020).Methods We estimated IFR as excess deaths(the gap between observed and expected deaths,considering COVID-19-unrelated deaths prevented by lockdown measures)divided by the number of infections(SARS-CoV-2 seropositive individuals plus excess deaths)and conducted Spearman correlations between meteorological factors and IFR across the provinces.Results We estimated 2,418,250 infections and 43,237 deaths.The IFR was 0.03%in<50-year-old,0.22%in 50–59-year-old,0.9%in 60–69-year-old,3.3%in 70–79-year-old,12.6%in 80–89-year-old,and26.5%in≥90-year-old.We did not find statistically significant relationships between meteorological factors and adjusted IFR.However,we found strong relationships between low temperature and unadjusted IFR,likely due to Spain’s colder provinces’aging population.Conclusion The association between meteorological factors and adjusted COVID-19 IFR is unclear.Neglecting age differences or ignoring COVID-19-unrelated deaths may severely bias COVID-19 epidemiological analyses.
基金Acknowledgements Lorraine Maw at the Mental Health Research Center at Eastern State Hospital,Lexington,Kentucky,USA helped with editing.Ms.Maw declares no competing interest in the last 36 months.
文摘White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing myocarditis or pneumonia during clozapine titrations.Prescribers worldwide are largely unaware of that.Meanwhile,as they worry about agranulocytosis,their clozapine-treated patients are at risk of dying from pneumonia or myocarditis.Consequently,an international guideline with 104 authors from 50 countries/regions was recently published to provide personalised clozapine titration schedules for adult inpatients.This forum article reviews pneumonia and myocarditis occurring during clozapine titration,as well as the three most innovative aspects of this new guideline:(1)personalised titration,(2)C reactive protein(CRP)measures,and(3)dose predictions based on blood levels.Clozapine metabolism is influenced by 3 levels of complexity:(1)ancestry groups,(2)sex-smoking subgroups,and(3)presence/absence of poor metabolizer status.These 3 groups of variables should determine the maintenance dose and speed of clozapine titration;they are summarised in a table in the full-text.The international clozapine titration guideline recommends measuring CRP levels simultaneously with WBC,at baseline and weekly at least for the first 4 weeks of titration,the highest risk period for clozapine-induced myocarditis.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health&WelfareRepublic of Korea[grant number:HV22C0233]。
文摘The coronavirus disease 2019(COVID-19)pandemic has raised concerns about the mental health and social well-being of youth,including its potential to increase or exacerbate substance use behaviors[1].Among adolescents,the COVID-19pandemic has resulted in limited face-to-face school contact and thus missed milestones in preventing alcohol and substance use.
基金This work was supported by the National Natural Science Foundation of China(Nos.82072506,82272611,92268115)National Key R&D Program of China(No.2019YFA0111900)+6 种基金Provincial Clinical Medical Technology Innovation Project of Hunan(Nos.2023SK2024,2020SK53709)Hunan Young Talents of Science and Technology(No.2021RC3025)Provincial Natural Science Foundation of Hunan(No.20203060)National Natural Science Foundation of Hunan Province(No.2023JJ30949)Program of Health Commission of Hunan Province(No.202204074879)Wu Jieping Medical Foundation(No.320.6750.2020-03-14)National Clinical Research Center for Geriatric Disorders(Xiangya Hospital,Nos.2021KFJJ02,2021LNJJ05).
文摘Background:The choice of unicompartmental knee arthroplasty(UKA)vs.total knee arthroplasty(TKA)in the surgical treatment of knee osteoarthritis(KOA)remains controversial.This study aimed to perform a systematic review and meta-analysis of randomized controlled trials(RCTs)to compare the clinical results of UKA and TKA for treating unicompartmental KOA.Methods:PubMed,Embase,and the Cochrane Library were systematically searched for articles published up to January 2,2023.The literature was rigorously screened to include only RCTs comparing UKA and TKA for unicompartmental KOA.A systematic review and meta-analysis were performed to calculate the mean difference(MD),relative risk(RR),and 95%confidence interval(CI)according to the Cochrane standards.Results:Thirteen publications involving 683 UKAs and 683 TKAs were analyzed.Except for one study with a follow-up period of 15 years,all outcome measures reported were within 5 years of follow-up.Meta-analysis showed better knee recovery(MD:1.23;95%CI:1.01–1.45;P<0.001),greater knee function(MD:1.78;95%CI:0.34–3.22;P=0.020),less pain(MD:0.75;95%CI:0.43–1.06;P<0.001),and better health status(MD:3.75;95%CI:0.81–6.69;P=0.010)after UKA than TKA.However,considering the minimal clinically important difference values for these variables,the findings were not clinically relevant.Moreover,UKA patients had fewer complications(RR:0.59;95%CI:0.45–0.78;P<0.001)and shorter hospital stays(MD:–0.89;95%CI:–1.57 to–0.22;P=0.009)than did TKA patients.There were no statistically significant differences in terms of postoperative range of movement,revision,failure,operation time,and patient satisfaction.Conclusions:In terms of clinical efficacy,there was no obvious advantage of UKA over TKA in the surgical treatment of knee OA when considering the minimal clinically important difference.The main advantage of UKA over TKA is that it leads to fewer complications and a shorter length of hospital stay.It is ideal to perform prospective studies with longer follow-up periods to fully evaluate the long-term efficacy and safety of the two procedures in the future.
基金supported by the National Natural Science Foundation of China(NSFC)(32400855 and 32300925)the STI 2030-Major Projects(2021ZD0201705)+5 种基金the Scientific Research Fund of Zhejiang Provincial Education Department(Y202249966)the Zhejiang Province Educational Science Planning Project(2024SCG018)the Starting Research Fund from Hangzhou Normal University(2021QDL079)the Eunice Kennedy Shriver National Institute of Child Health and Human Development(NICHD)(HD098235)the China Postdoctoral Science Foundation(2019M650884),the Ministry of Science and Technology of the People's Republic of China(2021ZD0200505).
文摘Cognitive control is fundamental to human goal-directed behavior.Understanding its trajectory across the lifespan is crucial for optimizing cognitive function throughout life,particularly during periods of rapid development and decline.While existing studies have revealed an inverted U-shaped trajectory of cognitive control in both behavioral and anatomical domains,the age-related changes in functional brain activities remain poorly understood.To bridge this gap,we conducted a comprehensive meta-analysis of 139 neuroimaging studies using conflict tasks,encompassing 3765 participants aged 5 to 85 years.We adopted the seed-based d mapping(SDM),generalized additive model(GAM),and model comparison approaches to investigate age-related changes in brain activities to characterize the lifespan trajectories of cognitive control.Our analyses revealed two key findings:(1)The predominant lifespan trajectory is inverted U-shaped,rising from childhood to peak in young adulthood(between 27 and 36 years)before declining in later adulthood;(2)Both the youth and the elderly show weaker brain activities and greater left laterality than young adults.These results collectively reveal the lifespan trajectories of cognitive control,highlighting systematic fluctuations in brain activities with age.
文摘Introduction Antibiotic use for acute otitis media(AOM)is one of the major sources of antimicrobial resistance.However,the effective minimal antibiotic duration for AOM remains unclear.Moreover,guidelines often recommend broad ranges(5-10 days)of antibiotic use,yet the clinical impact of such a wide window has not been assessed.Methods We systematically searched PubMed/MEDLINE,Embase,Scopus,Web of Science,and Cochrane Library from database inception to 6 October 2021.Network meta-analysis was conducted on randomized controlled trials that assessed antibiotic treatment for AOM in children(PROSPERO CRD42020196107).Results For amoxicillin and amoxicillin-clavulanate,7-day regimens were noninferior to 10-day regimens in clinical responses[amoxicillin:risk ratio(RR)0.919(95%CI 0.820-1.031),amoxicillin-clavulanate:RR 1.108(0.957-1.282)],except for≤2 years.For the third-generation cephalosporins,7-day and 10-day regimens had similar clinical responses compared to placebo[7-day:RR 1.420(1.190-1.694),10-day:RR 1.238(1.125-1.362)compared to placebo].However,5-day regimens of amoxicillin-clavulanate and third-generation cephalosporins were inferior to 10-day regimens.Compared to amoxicillin,a shorter treatment duration was tolerable with amoxicillin-clavulanate.Conclusions Our findings indicated that 1O days of antibiotic use may be unnecessarily long,while the treatment duration should be longer than 5 days.Otherwise,5-day regimens would be sufficient for a modest treatment goal.Our findings revealed that the current wide range of recommended antibiotic durations may have influenced the clinical outcome of AOM,and a narrower antibiotic duration window should be re-established.
