Youdong Wei

Left versus right repetitive transcranial magnetic stimulation in treating major depression: a meta-analysis of randomised controlled trials.

Although the majority of randomised controlled trials suggest that major depressive disorder (MDD, major depression) and treatment-resistant depression can be effectively treated by applying either high- (HF) or low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) to the left and right dorsolateral prefrontal cortex (DLPFC), respectively, it is not clear which rTMS approach is more effective or safer. This systematic review and meta-analysis was conducted on randomised controlled trials on HF and LF rTMS applied to the left and right DLPFC, respectively, for the treatment of MDD. Eight randomised controlled trials composed of 249 patients were selected to compare the effects of LF (≤ 1 Hz) rTMS over the right DLPFC to HF (10-20 Hz) rTMS over the left DLPFC. The therapeutic effects of both approaches were similar (odds ratio (OR) = 1.15; 95% confidence interval = 0.65-2.03). Dropout analysis based on only two studies was insufficient to draw a conclusion on the tolerability of LF rTMS. The pooled examination demonstrated that both rTMS methods were equally effective therapies for MDD. However, considering that LF right-sided rTMS produces fewer side effects and is more protective against seizures, its clinical applicability shows greater promise and should be explored further.

Bilateral vs. unilateral repetitive transcranial magnetic stimulation in treating major depression: A meta-analysis of randomized controlled trials

Previous studies have demonstrated inconsistent findings regarding the efficacy of bilateral vs. unilateral repetitive transcranial magnetic stimulation (rTMS) in treating major depressive disorder (MDD). Therefore, this meta-analysis was conducted to compare the efficacy of these two rTMS modalities. Data were obtained from seven randomized controlled trials (RCTs) consisting of 509 subjects. Bilateral and unilateral rTMS displayed comparable efficacy in treating MDD with a pooled odds ratios of 1.06 (95% confidence interval (CI)=0.58-1.91) for response rates and 1.05 (95% CI=0.52-2.11) for remission rates. Subgroup analysis found that bilateral rTMS was equally effective in comparison with both left and right unilateral rTMS. No significant differences in drop-out rates were found. No publication bias was detected. In conclusion, the pooled examination demonstrated that bilateral rTMS displays comparable anti-depressant efficacy and acceptability to unilateral rTMS in treating MDD. These findings suggest that simultaneous rTMS of the right and left dorsolateral prefrontal cortices in MDD patients does not provide marginal benefits in terms of efficacy or acceptability. As the number of RCTs included here was limited, further large-scale multi-center RCTs are required to validate our conclusions.

Divergent Urinary Metabolic Phenotypes between Major Depressive Disorder and Bipolar Disorder Identified by a Combined GC-MS and NMR Spectroscopic Metabonomic Approach.

Bipolar disorder (BD) is a complex debilitating mental disorder that is often misdiagnosed as major depressive disorder (MDD). Therefore, a large percentage of BD subjects are incorrectly treated with antidepressants in clinical practice. To address this challenge, objective laboratory-based tests are needed to discriminate BD from MDD patients. Here, a combined gas chromatography-mass spectrometry (GC-MS)-based and nuclear magnetic resonance (NMR) spectroscopic-based metabonomic approach was performed to profile urine samples from 76 MDD and 43 BD subjects (training set) to identify the differential metabolites. Samples from 126 healthy controls were included as metabolic controls. A candidate biomarker panel was identified by further analyzing these differential metabolites. A testing set of, 50 MDD and 28 BD subjects was then used to independently validate the diagnostic efficacy of the identified panel using an area under the receiver operating characteristic curve (AUC). A total of 20 differential metabolites responsible for the discrimination between MDD and BD subjects were identified. A panel consisting of six candidate urinary metabolite biomarkers (propionate, formate, (R*,S*)2,3-dihydroxybutanoic acid, 2,4-dihydroxypyrimidine, phenylalanine, and β-alanine) was identified. This panel could distinguish BD from MDD subjects with an AUC of 0.913 and 0.896 in the training and testing sets, respectively. These results reveal divergent urinary metabolic phenotypes between MDD and BD. The identified urinary biomarkers can aid in the future development of an objective laboratory-based diagnostic test for distinguishing BD from MDD patients.

Efficacy and feasibility of antidepressant treatment in patients with post-stroke depression

Background:Depression greatly impacts the quality of life in most stroke survivors. Therefore, effective treatment of post-stroke depression (PSD) is critically important. However, evidence supporting the effectiveness and feasibility of antidepressant treatment in this population is limited and somewhat confusing. Methods:A comprehensive literature search of the Cochrane, PubMed, Web of Science, and Embase databases from inception up to November 2015 was conducted. We reviewed all randomized controlled trials (RCTs) that assigned patients with a clinical diagnosis of PSD to antidepressant or placebo treatment. Reduction in depression rating scale scores and response rate to antidepressants were defined as the efficacy outcomes. Rates of dropout for any reason and for adverse effects were defined as the acceptability outcomes. We also assessed improvements in activities of daily living (ADL) as functional outcomes. Results:In total, 11 trials consisting of 740 participants were indentified. A significant advantage of antidepressants compared with placebo treatment in PSD was observed in overall pooled effect size analysis (SMD = −0.96; 95% CI = −1.41 to −0.51; P <0.0001). In addition, patients receiving antidepressants presented a much greater improvement in various depressive symptoms than those with placebo (RR = 1.36; 95% CI = 1.01–1.83; P = 0.04). However, antidepressants were less well tolerated than placebo because of some adverse events (RR = 2.72; 95% CI = 1.37–5.43; P = 0.04). Intriguingly, no consistent evidence was found for a positive effect of antidepressants on ADL in our analysis. Conclusions:This meta-analysis suggests that antidepressants treatment confers potentially positive effects in patients with PSD as compared with simple placebo treatment. However, this must be carefully considered in light of its possible adverse events in some individual patients.

Association between processed meat and red meat consumption and risk for glioma: A meta-analysis from 14 articles

OBJECTIVE Epidemiologic studies evaluating the association between processed meat and red meat consumption and glioma risk have produced inconsistent results. Thus, the aim of this study was to conduct a meta-analysis to test the hypothesis that high levels of processed meat consumption could increase the risk for glioma. METHODS Pertinent studies were identified by a search of PubMed and Web of Knowledge up to February 2014. Random-effects model was used to combine the results. Publication bias was estimated using Eggers regression asymmetry test. RESULTS Fourteen studies involving 3641 cases about processed meat consumption and 3 studies involving 1156 cases about red meat consumption with risk for glioma were included in this meta-analysis. The combined relative risk (RR) of glioma associated with processed meat consumption was 1.25 (95% confidence interval [CI], 1.08-1.45) overall, and 1.28 (95% CI, 1.09-1.50) in the United States. For subgroup of study design, significant association was also found in case-control studies (RR, 1.33; 95% CI, 1.09-1.62), but not in the cohort studies. The association was not significant between red meat consumption and glioma risk (summary RR, 0.89; 95% CI, 0.71-1.12). No publication biases were found. CONCLUSIONS Our analysis indicated that high levels of processed meat consumption might increase the risk for glioma, and findings are consistent with the hypothesis. No association was found between red meat consumption and glioma risk.

iTRAQ-based quantitative proteomic analysis of cerebrospinal fluid reveals NELL2 as a potential diagnostic biomarker of tuberculous meningitis

Tuberculous meningitis (TBM) is a serious complication of tuberculosis that affects the central nervous system. As TBM may result in permanent sequelae and death, rapid, accurate diagnostic tests using novel biomarkers are required for the early diagnosis and treatment of TBM. A quantitative proteomic study was therefore performed to identify differential proteins in the cerebrospinal fluid (CSF) obtained from TBM patients (n=12) and healthy controls (n=12). CSF samples were labelled with iTRAQ™ and analyzed by LC-MS/MS. Gene ontology and Pathway analysis were conducted using DAVID bioinformatics resources. Neural epidermal growth factor-like like 2 (NELL2) with the largest fold-change value was selected for validation by western blotting. Proteomic phenotyping revealed over-representation in two inflammation-associated processes, complement and coagulation cascades as well as cell adhesion molecules. Western blotting showed a significant decrease in NELL2 levels in TBM subjects compared to healthy controls. The AUC analysis revealed NELL2 was able to distinguish TBM subjects from healthy controls with 83.3% sensitivity and 75% specificity. In conclusion, the results showed that CSF NELL2 is a potential diagnostic biomarker for TBM. Further evaluation of these findings in larger studies including anti-tuberculosis medicated and unmedicated patient cohorts with other intracranial infectious diseases is required for clinical translation.

Automated subtraction CT angiography for visualization of the whole brain vasculature: a feasibility study.

RATIONALE AND OBJECTIVES To develop an automated computed tomography angiography (CTA) imaging protocol that allows visualization of the whole brain vasculature and evaluate the clinical usefulness of the technique for delineation of intracranial vessels in patients with cerebrovascular disorders. MATERIALS AND METHODS We prospectively included 100 patients who underwent automated subtraction CTA for suspected cerebrovascular disorders. The nonenhanced and contrast enhanced scans were obtained with the same table feeding speed. The x-ray tube start angles of the two scans were matched to enable accurate registration and subtraction of the CTA datasets. Subtracted CTA datasets were reformatted as three-dimensional volume rendering and maximum intensity projection images for further review. Two independent readers assessed the quality of subtraction and delineation of intracranial vessels. The visibility of ophthalmic arteries was also assessed. RESULTS Subtraction was successful in all patients. The image quality of bone removal was rated excellent in 95 patients, with no or minimal bone remnants. Incomplete bone removal was observed in five patients because of severe motions between the scans. In 97 of 100 patients, arterial segments at the circle of Willis could be clearly visualized. Excellent delineation of bilateral ophthalmic arteries was possible in 81 of 100 patients. CONCLUSIONS The whole brain vasculature would be clearly visualized by using the optimized automated CTA protocol. Our automated, single-source, dual-energy subtraction CTA protocol is a fully automated subtraction method that is capable of delineating major intracranial vessels as well as very small arteries.

Cerebrovascular risk factors for patients with cerebral watershed infarction: A case-control study based on computed tomography angiography in a population from Southwest China.

Abstract To determine cerebrovascular risk factors for patients with cerebral watershed infarction (CWI) from Southwest China. Patients suffering from acute ischemic stroke were categorized into internal CWI (I-CWI), external CWI (E-CWI), or non-CWI (patients without CWI) groups. Clinical data were collected and degrees of steno-occlusion of all cerebral arteries were scored. Arteries associated with the circle of Willis were also assessed. Data were compared using Pearson chi-squared tests for categorical data and 1-way analysis of variance with Bonferroni post hoc tests for continuous data, as appropriate. Multivariate binary logistic regression analysis was performed to determine independent cerebrovascular risk factors for CWI. Compared with non-CWI, I-CWI had higher degrees of steno-occlusion of the ipsilateral middle cerebral artery, ipsilateral carotid artery, and contralateral middle cerebral artery. E-CWI showed no significant differences. All the 3 arteries were independent cerebrovascular risk factors for I-CWI confirmed by multivariate binary logistic regression analysis. I-CWI had higher degrees of steno-occlusion of the ipsilateral middle cerebral artery compared with E-CWI. No significant differences were found among arteries associated with the circle of Willis. The ipsilateral middle cerebral artery, carotid artery, and contralateral middle cerebral artery were independent cerebrovascular risk factors for I-CWI. No cerebrovascular risk factor was identified for E-CWI.

Tricyclic antidepressants for preventing migraine in adults.

Background: Migraine, ranked as the 7th-highest specific cause of disability worldwide, has caused an enormous burden on the economy and society. Tricyclic antidepressant (TCA) is one of the most commonly drugs for migraine prevention. However, evidence about the efficacy and tolerability of TCAs in the prophylaxis of migraine in adults is somewhat confusing. Methods: A computerized literature search of the PubMed, Embase, Cochrane, and Web of Science databases from inception to July 2016 was conducted. We reviewed all randomized controlled trials that assigned adults with a clinical diagnosis of migraine to TCAs or other treatments (placebo or other antidepressants). Reduction in migraine frequency or index and response rates to treatment were defined as the efficacy outcomes. Rates of dropout due to adverse effects were defined as the tolerability outcomes. Results: In total 12 trials consisting of 1006 participants were identified: 9 trials compared TCAs with placebo, and the other 3 compared amitriptyline with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). A significant advantage of TCAs compared with placebo in the prevention of migraine in adults was observed (standardized mean difference [SMD] = −.75; 95% confidence interval [CI] = −1.05 to −.46; P < .00001). Participants receiving TCAs were more likely to experience an ≥50% reduction in their headache burden than those receiving placebo (risk ratio [RR] =1.40; 95% CI = 0.89–2.20; P = .14). In addition, the efficacy between amitriptyline and SSRIs or SNRIs did not differ for migraine prevention in adults (SMD = −.01; 95% CI = −0.31 to 0.28; P = .94) based on the available limited trials. However, TCAs were less well tolerated than placebo (RR = 1.73; 95% CI = 1.00–2.99; P = .05) and SSRI or SNRI (RR = 2.85; 95% CI = 0.97–8.41; P = .06) on account of adverse events. Conclusions: This research reveals that TCAs were more effective than placebo, but no more than SSRI or SNRI in ameliorating the headache burden in adults with migraine. However, TCAs appeared to be less tolerated than placebo and SSRIs or SNRIs for some side effects.

Posterior reversible encephalopathy syndrome in a patient with systemic lupus erythematosus after cessation of oral prednisone

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder that is first described by Hinchey and colleagues in 1996 [1]. It is associated with various clinical features such as hypertension, seizures, headache, visual changes and conscious disturbance [2]. In previous reports, PRES have been reported in patients with SLE. The use of immunosuppressive drugs was an established cause of PRES in SLE [3]. Here we describe a case of PRES due to cessation of oral prednisone. To the best of our knowledge, this is the first report of PRES due to cessation of oral prednisone. A 34-year-old man presented to our department with headache and blurred vision for 1 day. He had a history of SLE and lupus nephritis for 6 years. Three months before admission, the patient presented to the department of rheumatology with a flare of SLE including malar rash, arthritis, and pancytopenia. The patient was free of ophthalmologic and neurologic symptoms then. He was hospitalized and received intravenous pulse therapy of methylprednisone at 250 mg/day given intravenously for 3 days. The patient was discharged symptom free and was taking a maintenance dose of oral prednisone at 60 mg/day. A week before admission, the patient had suddenly stopped taking oral prednisone. He gradually developed bilateral headache and blurred vision 6 days after cessation of oral prednisone. His headaches were described as constant, bilateral temporoparietal and were associated with nausea and vomiting. The patient was only able to distinguish between light and dark. The visual acuity was severely impaired and he was unable to count fingers before his eyes. On examination, the pupils were round, equal and accommodate to light. Optical fundus examination was unremarkable. The anti-nuclear antibodies and anti-dsDNA antibodies were positive. Laboratory examinations revealed urea nitrogen 13.7 mmol/l, serum creatinine 197 lmol/l, uric acid 885 lmol/l, C3 of 0.46 g/l (reference range 0.79–1.52 g/l), C4 of 0.16 (reference range 0.16–0.38 g/l). The admission head MRI was performed and fluid attenuated inversion recovery (FLAIR) sequence showed bilateral hyperintensities in the frontal, parietal, temporal, occipital lobes and the cerebellum, which is consistent with vasogenic edema (Fig. 1a). The patient continued oral prednisone at a dose of 50 mg on a daily basis after admission. The patient was free of symptoms 1 week after restoration of the oral prednisone treatment. Follow-up brain MRI was performed 6 days after admission and the vasogenic edema on FLAIR images was obviously resolved (Fig. 1b). The patient was discharged with complete clinical resolution. Posterior reversible encephalopathy syndrome is a clinical and radiological entity that may present with a constellation of symptoms including headache, seizures, visual disturbances and altered mental status. Although the precise mechanism remains incompletely understood, blood–brainbarrier leakage and endothelial dysfunction seem to play key role in the development of PRES. Radiological examination is important to rule out alternative causes and aid Q. Li Y. Wei P. Xie (&) Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China e-mail: peng_xie@yahoo.com