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Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), but initial outcomes can be modest.
Aims
To compare SSRI dose optimisation with four alternative second-line strategies in MDD patients unresponsive to an SSRI.
Method
Of 257 participants, 51 were randomised to SSRI dose optimisation (SSRI-Opt), 46 to lithium augmentation (SSRI+Li), 48 to nortriptyline combination (SSRI+NTP), 55 to switch to venlafaxine (VEN) and 57 to problem-solving therapy (SSRI+PST). Primary outcomes were week-6 response/remission rates, assessed by blinded evaluators using the 17-item Hamilton Depression Rating Scale (HDRS-17). Changes in HDRS-17 scores, global improvement and safety outcomes were also explored. EudraCT No. 2007-002130-11.
Results
Alternative second-line strategies led to higher response (28.2% v. 14.3%, odds ratio = 2.36 [95% CI 1.0–5.6], p = 0.05) and remission (16.9% v. 12.2%, odds ratio = 1.46, [95% CI 0.57–3.71], p = 0.27) rates, with greater HDRS-17 score reductions (−2.6 [95% CI −4.9 to −0.4], p = 0.021]) than SSRI-Opt. Significant/marginally significant effects were only observed in both response rates and HDRS-17 decreases for VEN (odds ratio = 2.53 [95% CI 0.94–6.80], p = 0.067; HDRS-17 difference: −2.7 [95% CI −5.5 to 0.0], p = 0.054) and for SSRI+PST (odds ratio = 2.46 [95% CI 0.92 to 6.62], p = 0.074; HDRS-17 difference: −3.1 [95% CI −5.8 to −0.3], p = 0.032). The SSRI+PST group reported the fewest adverse effects, while SSRI+NTP experienced the most (28.1% v. 75%; p < 0.01), largely mild.
Conclusions
Patients with MDD and insufficient response to SSRIs would benefit from any other second-line strategy aside from dose optimisation. With limited statistical power, switching to venlafaxine and adding psychotherapy yielded the most consistent results in the DEPRE'5 study.
This study aimed to investigate the mechanisms by which the association between maternal hyperglycemia and postnatal high-fat diet (HFD) exposure compromises metabolic parameters and hepatic autophagy in adult female pups. For this, Sprague Dawley rats, female pups from nondiabetic (control = FC) or diabetic (FD) mothers, were fed a standard diet (SD) or HFD from weaning until adulthood (n minimum = 5 rats/group): FC/SD, FC/HFD, FD/SD, and FD/HFD. In adulthood, these rats were tested with the oral glucose tolerance test, euthanized, and serum biochemistry parameters were analyzed. Liver samples were collected to evaluate cytokines, redox status, and protein expression autophagy and apoptosis markers. Histomorphometric analyses and an assessment of lipofuscin accumulation were also performed to reflect incomplete autolysosomal digestion. The FC/HFD, FD/SD, and FD/HFD groups showed glucose intolerance and an increased number of hepatocytes. Furthermore, FD/SD and FD/HFD rats showed hyperlipidemia and insulin resistance. Adaptations in hepatic redox pathways were observed in the FD/SD group with increased antioxidant defense marker activity. The FD/SD group also exhibited increased autophagy protein expression, such as p-AMPK, LC3-II/LC3-I, and p62/SQSTM1, lipofuscin accumulation, and caspase-3 activation. After exposure to HFD, the adult female pups of diabetic rats had a reduced p-AMPK and LC3-II/LC3-I ratio, the presence of steatosis, oxidative stress, and inflammation. The reduction of autophagy, stimulated by HFD, may be of vital importance for the susceptibility to metabolic dysfunction-associated fatty liver disease induced by maternal diabetes.
High-whiteness kaolinite mining reserves are scarce. In some locations, it is necessary to remove material to access them (adding to the cost). Therefore, processes have been developed to eliminate contaminants, such as iron, and provide alternatives to the used contaminated materials that, after being treated, meet quality criteria. In our previous research, we developed an electrochemical process for kaolin whitening at the laboratory level and bench scale, demonstrating the reaction mechanisms that occur during the removal of iron from kaolin. However, the geometry used at the laboratory level does not present the most suitable position for the electrodes. Therefore, in the present study, we focused on the geometry and the function of the electrodes. This is necessary during the escalation process to reach the pilot-scale level. The study was carried out using computer-aided engineering in the COMSOL Multiphysics computer program and by analysing the distribution of the electric potential and the electric current of the geometries considered while performing the scaling. The results indicated that the change in the anode position from perpendicular to parallel to the discs improved the distribution of electric current density on the cathode surface and so increased the elimination of iron through electrochemical deposition. Similarly, to reduce the amount of material used in the construction of the reactor, the anode-size effect was analysed, revealing that relatively small anodes improved the distribution of electric current density over the entire surface of the electrode and not only at the edges.
This study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children aged <14 years from Andalusia (2018–2020). Pneumococcal invasive isolates collected between 2006 and 2009 in the two largest tertiary hospitals in Andalusia were used as pre-PCV13 controls for comparison of serotype/genotype distribution. Overall IPD incidence rate was 3.55 cases per 100 000 in 2018; increased non-significantly to 4.20 cases per 100 000 in 2019 and declined in 2020 to 1.69 cases per 100 000 (incidence rate ratio 2020 vs. 2019: 0.40, 95% confidence interval (CI) 0.20–0.89, P = 0.01). Proportion of IPD cases due to PCV13 serotypes in 2018–2020 was 28% (P = 0.0001 for comparison with 2006–2009). Serotypes 24F (15%) and 11A (8.3%) were the most frequently identified non-PCV13 serotypes (NVT) in 2018–2020. Penicillin- and/or ampicillin-resistant clones mostly belonged to clonal complex 156 (serotype 14-ST156 and ST2944 and serotype 11A-ST6521). The proportion of IPD cases caused by PCV13 serotypes declined significantly after the initiation of the PCV13 vaccination programme in 2016. Certain NVT, such as serotypes 24F and 11A, warrant future monitoring in IPD owing to invasive potential and/or antibiotic resistance rates.
Clinical and epidemiological studies show that maternal hyperglycemia can change the programming of offspring leading to transgenerational effects. These changes may be related to environmental factors, such as high-fat diet (HFD) consumption, and contribute to the comorbidity onset at the adulthood of the offspring. The objective of this study was to evaluate the hyperglycemic intrauterine environment, associated or not with an HFD administered from weaning to adult life on the periovarian adipose tissue of rat offspring Maternal diabetes was chemically induced by Streptozotocin. Female offsprings were randomly distributed into four experimental groups (n = 5 animals/group): Female offspring from control or diabetic mothers and fed an HFD or standard diet. HFD was prepared with lard enrichment and given from weaning to adulthood. On day 120 of life, the rats were anesthetized and sacrificed to obtain adipose tissue samples. Then, the hyperglycemic intrauterine environment and HFD fed after weaning caused a higher body weight, total fat, and periovarian fat in adult offspring, which could compromise the future reproductive function of these females. These rats showed higher adiposity index and adipocyte area, contributing to hypertrophied adipose tissue. Therefore, maternal diabetes itself causes intergenerational changes and, in association with the HFD consumption after weaning, exacerbated the changes in the adipose tissue of adult female offspring.
Cardiopulmonary exercise test (CPET) allows quantification of functional capacity of patients with Fontan. The objective of this study was to determine the role of CPET parameters in predicting a higher maximum oxygen consumption (VO2 max) and to analyse the role of CPET parameters in predicting an unfavourable outcome.
Methods:
A retrospective, cross-sectional, descriptive study was carried out on 57 patients with Fontan, who had undergone incremental CPET with cycloergometer between 2010 and 2020. Determinants of VO2 max and determinants of clinical deterioration were analysed.
Results:
In the univariate analysis, the variables significantly related to VO2 max were: age, sex, body mass index (BMI), years of Fontan evolution, intracardiac Fontan, oxygen consumption at anaerobic threshold (VO2AT), CO2 equivalents at anaerobic threshold (VE/VCO2) and chronotropic insufficiency. The multiple linear regression model that best fitted the relationship between VO2 max and independent variables (correlation coefficient 0.73) included sex (correlation index 3.35; p = 0.02), BMI (−0.27; p = 0.02), chronotropic failure (−2.79; p = 0.01) and VO2AT (0.92; p < 0.0001). In the univariate analysis of the prognostic CPET variables related to an unfavourable clinical situation, significance was only obtained with chronotropic insufficiency (p = 0.003). In multivariate analysis, chronotropic insufficiency maintains its association [p= 0.017, OR = 4.65 (1.3–16.5)].
Conclusions:
In conclusion, together with the anthropometric parameters universally related to VO2 max, chronotropic insufficiency and VO2AT are the main determinants of functional capacity in patients with Fontan. Moreover, chronotropic insufficiency is closely related to unfavourable clinical evolution. Our data would support the intensive treatment of chronotropic insufficiency in order to improve the quality of life and the clinical situation of patients with Fontan.
In the present work, the photocatalytic activity of metal Fe-Zn nanoparticles was evaluated through the degradation of the synthetic AZO colorant allura red. A Phytosynthesis method developed here takes advantage for the first time of the plant extract of Hydrocotyle ranunculoides as the reducing agent. A fitted Folin-Ciocalteu assay showed about 40% of total polyphenolic compounds used in the nanoparticles generation. UV-Vis and TEM analysis allowed identification of the nanoparticles as oxides of Fe and Zn. Finally, during measurement of the photocatalytic activity a load of 0.5 g/L was applied on a 15 μM solution of allura red as standard model pollutant, while environmental oxygen was used as the initiating agent. Tests showed a 66% degradation of the azo-type dye obeying a degradation kinetics of the first order after short times.
In this work, green nanotechnology has been applied by using phytochemical compounds as reducing agents from the plant extract of Hydrocotyle ranunuculoides through three modifications of the phytosynthesis method to prepare Fe and Zn nanoparticles, in three different concentration of the metallic solution. In the third modification a MgO support was included to avoid the Fe and Zn NP agglomeration. The nanoparticles size was 5±1 nm, and for the Fe NPs, it was determined with a cubic structure a Fe3O4 composition, and Zn nanoparticles were obtained with a hexagonal structure and Zn° composition. In the third method, MgO nanoparticle, the support appears as Mg0 nanoparticles surrounded by Fe0 and Zn0 nanoparticles. According to the three used methods pathways, the main influence is the modification in the method synthesis. Hybrid nanocomposites provide a means in preventing agglomeration of the NPs and hence avoid coalescence and loss of properties.
Basel III is a comprehensive set of reform measures in banking regulation, supervision and risk management with a strong macroprudential component, which has the aim of preventing future crises by creating a sound financial system. Nevertheless, these changes on financial regulation have to co-ordinate with monetary policy. We address several key research questions. First, we analyse how the higher capital requirements implied by Basel I, II and III affect welfare for a given monetary policy of different agents in the economy. Second, we study how these regulations affect the way monetary policy needs to be conducted. Finally, we propose an automatic rule to implement the macroprudential countercyclical buffer in Basel III and find the optimal parameters for this rule and for monetary policy. We conclude that a Pareto-superior outcome can be reached using the optimal values, and the macroprudential objective can be achieved.
Due to its unique 400-year duration, the sunspot number is a central reference for understanding the long-term evolution of solar activity and its influence on the Earth environment and climate. Here, we outline current data recovery work. For the sunspot number, we find historical evidence of a disruption in the source observers occurring in 1947–48. For the sunpot group number, recent data confirm the clear southern predominance of sunspots during the Maunder Minimum, while the umbra-penumbra ratio is similar to other epochs. For the Dalton minimum, newly recovered historical observations confirm a higher activity level than in a true Grand Minimum.
Spinicaudatans (‘clam shrimps’) are small branchiopod crustaceans enclosed in a chitinous bivalved carapace that is often the only preserved element in the fossil record. However, few studies have analyzed the preservation of these carapaces, which have been found in continental facies from the Devonian to the present. The aim of this study was to contribute to a better understanding of the chemical preservation of fossil spinicaudatan carapaces, and it focused on spinicaudatan carapaces of the Cañadón Asfalto Formation from the Jurassic of Argentina. Semiquantitative energy-dispersive X-ray spectrometry (EDS) analysis provided elemental composition data that were interpreted using principal component analysis (PCA). The results showed a complex chemical mode of preservation for spinicaudatan carapaces. In some parts, EDS spectra of the specimens exhibit peaks of calcium, phosphorous, aluminum, and fluorine, representing the retention of original carapace material with some diagenetic recrystallization. Certain zones of the carapace show low-intensity peaks of the elements mentioned, while silicon and oxygen peaks (from the rock matrix) become the dominant spectral signals. These modes of preservation modify the interpretations and observations of the ornamentation of the carapace, which are used as taxonomic features. Our results suggest that specific diagenetic processes play a fundamental role in the preservation of spinicaudatans.
Impulsivity has been widely studied in the context of traffic. The trait is believed to be the root of some accidents, along with other variables like aggression and anger. The present research objective is to develop a new scale – the I-Driving Scale (IDS) – to evaluate and measure the construct of impulsivity in specific driving situations. To that end, two studies were conducted, with 162 and 107 participants, respectively. In both studies, participants were recruited via their social networks, and answered anonymously. In addition to the IDS, they completed the Use the Vehicle to Express Anger subscale of the Driving Anger Expression Inventory (DAX), the Driving Anger Scale (DAS), and the Barratt Impulsivity Scale (BIS11), and also provided demographic information. The final scale had 11 items falling into two factors: impatience, and aggressiveness/abruptness. The results show a high consistency (αT = .81, αI = .70, and αA = .85 in the first study; αT = .83, αI = .80, and αA = .88 in the second study). Statistical results of Exploratory Factor Analysis in the first sample indicated goodness of fit to a two-factor model (RMSR = .057, GFI = .98). The second study confirmed that factorial structure (χ2/df = 80.50/43 = 1.87, RMSEA = .088, CFI = .94, TLI = .92). Correlations with other measures indicated the Impatience subscale is associated with different expressions of anger behind the wheel, and directly correlated with the loss of driver’s license points. Furthermore, the Aggressiveness or Abruptness subscale was associated with more mechanical aspects, and correlated inversely with age.
Two of the problems that currently affect a large proportion of university students are high levels of anxiety and stress experienced in different situations, which are particularly high during the first years of their degree and during exam periods. The present study aims to investigate whether mindfulness training can bring about significant changes in the manifestations of depression, anxiety, and stress of students when compared to another group undergoing a physical activity program and a control group. The sample consisted of 125 students from the Bachelor of Education Program. The measuring instrument used was the Abbreviated Scale of Depression, Anxiety and Stress (DASS-21). The results indicate that the effects of reducing the identified variables were higher for the mindfulness group than for the physical education group and for the control group F(2) = 5.91, p = .004, η2 = .106. The total scores for all variables related to the mindfulness group decreased significantly, including an important stress reduction t(29) = 2.95, p = .006, d = .667. Mindfulness exercises and some individual relaxing exercises involving Physical Education could help to reduce manifestations of stress and anxiety caused by exams in students.
Body dysmorphic disorder (BDD) is a condition characterized by an intense preoccupation with an imagined or slight defect in physical appearance. Although there is a general consensus that psychosocial factors play a major role in the development of BDD, there is some evidence suggesting that an organic somatosensorial disturbance may also exist in this condition. Several psychiatric and neurological disorders, including the interparietal syndrome, Gertsman's syndrome, inferoparietal syndrome, phantom limb syndrome, genital retraction syndrome, panencephalitis, cerebrovascular syndromes, and pharyngeal streptococcia affecting the basal ganglia, can present with somatosensorial disturbances similar to BDD. The cerebral pathology in all these disorders appears to be localized in the parietal-occipital region, indicating that cerebral involvement may also be associated with BDD. An interdependence exists between cerebral regions through integrated neural networks that enable efficient processing of information. Disturbances in these association pathways can lead to an imbalance in the extensive cerebral loops. Therefore, it is possible that a defect in information-processing may play a role in the pathogenesis of BDD.
This research assesses Health-Related Quality of Life (HRQoL) in a Spanish sample of adolescent cancer survivors, and analyzes the relationship between HRQoL, coping styles and physical exercise. Forty-two survivors (12–19 years), who were ≥ 1 year of remission, completed standardized measures of HRQoL (CHIP-AE), coping strategies (ACS) and physical exercise (AECEF). Mean scores in all HRQoL domains were within normative values. Multiple regression analysis revealed that physical exercise and productive coping were related to higher HRQoL, whereas non-productive coping was related to lower HRQoL. This sample of survivors reported good levels of HRQoL, which are mediated by coping styles and physical exercise.
The aim of this study was to examine the psychometric properties of the Brief version of the Fear of Negative Evaluation Scale – Straightforward Items (BFNE-S) in a non-clinical Spanish population. Rodebaugh et al. (2004) recommended the use of this scale composed of 8 straightforwardly-worded items, instead of the 12-item version of the BFNE. The sample consisted of 542 undergraduate students, 71.3% of whom were women and 28.7% were men; the mean age was 21.71 (4.78) years. Exploratory factor analysis produced one factor which accounted for 51.28% of variance. The internal consistency of the scale was α = .89. The BFNE-S correlated with the Social Avoidance and Distress Scale (r = .44), the Personal Report of Confidence as Speaker – Modified (r = .44), the Public Speaking Self-Efficacy Questionnaire (r = -.38) and both subscales of the Self-Statements during Public Speaking (SSPS-P r = -.22; SSPS-N r = .53). ANOVAs revealed significant differences in the BFNE-S amongst a non-clinical population, persons suffering from specific social phobia, non-generalized social phobia and generalized social phobia.
Teachers constitute one of the professional collectives most affected by psychological problems. The purpose of this quasi-experimental study is to examine the efficacy of a mindfulness training programme to reduce psychological distress in a group of teachers. The sample comprised 68 teachers of Secondary School Education, from various public schools; half of them formed the experimental group, and the another half the control group. The levels of psychological distress were measured, in both groups, by the Symptom Checklist-90-R (SCL-90-R) before and after the application of the programme. Statistical analysis shows the significant reduction of three general measures of psychological distress (Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total), as well in all its dimensions (somatization, obsessive-compulsive, interpersonal sensibility, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism), in the experimental group compared with the control group. Follow-up measures show that these results were maintained for four months after termination of the intervention in the experimental group.
We presented results using the Nearby Galaxies Legacy Survey (NGLS), which is being carried out with the James Clerk Maxwell Telescope (JCMT) on Mauna Kea in Hawai'i. We have obtained CO J=3−2 data for 155 nearby galaxies to trace the dense molecular gas in which stars are believed to be born. The sample of this survey covers a wide morphological range and has been selected to include galaxies that have been thoroughly studied in the literature, and for which abundant observational data are available. In parallel, we have observed the same sample of galaxies using the Hα spectral line, which traces massive star formation.
We combine 12CO J = 3 − 2 for 155 nearby galaxies, obtained as part of the James Clerk Maxwell Telescope (JCMT) Nearby Galaxies Legacy Survey (NGLS), with star formation rates derived from Hα luminosities to probe the relation between warm, dense gas and star formation. These data are compared with ancillary data from the literature, including infrared (IR) and 1.4 GHz radio continuum luminosities and Hi masses. We find a good correlation between CO J = 3 − 2 luminosities and Hα-derived star formation rates (SFRs), which is in agreement with previous studies. Several groups of galaxies show a peculiar behaviour in the SFR(Hα) − LCOJ = 3 − 2 plot, which disappears when using IR data. We analyse these regions and propose several hypotheses to explain this behaviour, including group interactions and very recent (≲20 Myr) bursts of star formation only traced by Hα emission. While atomic hydrogen is hardly related with SFR, molecular and total gas (Hi + H2) show similar correlations with Hα luminosities. No correlation is found between CO J = 3−2 luminosity and metallicity, although galaxies with low metallicity are more likely to not be detected. We discuss that CO J = 3 − 2 does not seem to be a significantly better tracer of the star-forming gas, but its independence from metallicity may be used to constrain the conversion factor between CO and H2.
The presence of psychotic-like experiences in the general population has been amply reported. Nevertheless, the degree of concern or anxiety that such experiences may generate is an aspect that has not received as much appraisal. In this sense, mindfulness is an approach to intervention based on the modification of the individual's relationship with the symptoms, instead of their elimination. The goal of the present study is to compare the effect of mindfulness training on distressing hallucination-like experiences. Eighteen participants were assigned to the experimental group, and they received 8 sessions of mindfulness training; 20 participants were assigned to a control group that viewed 8 sessions of a video forum. The results showed that upon completing the mindfulness training, there was a significant and large effect on the decrease of anxiety caused by hallucination-like experiences. These results were maintained at the 16-week follow-up. The repercussions of these results are underlined.