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We aimed to report an overview of trends in suicide mortality and years of life lost (YLLs) among adolescents and young adults aged 10–24 years by sex, age group, Socio-demographic Index (SDI), region and country from 1990 to 2021 as well as the suicide mortality with age, period and birth cohort effects.
Methods
Estimates and 95% uncertainty intervals for suicide mortality and YLLs were extracted from the Global Burden of Diseases Study 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to describe the mortality and rate of YLLs trends. Age, period and cohort model was utilized to disentangle age, period and birth cohort effects on suicide mortality trends.
Results
Globally, suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021 (AAPC: −1.6 [−2.1 to −1.2]). In 2021, the global number of suicide death cases was 112.9 thousand [103.9–122.2 thousand] and led to 7.9 million [7.2–8.6 million] YLLs. A significant reduction in suicide mortality was observed in all sexes and age groups. By SDI quintiles, the high SDI region (AAPC: −0.3 [−0.6 to 0.0]) had the slowest decline trend, and low-middle SDI region remained the highest suicide mortality till 2021 (7.8 per 100,000 population [6.9–8.6]). Most SDI regions showed generally lower period and cohort effects during the study period, whereas high SDI region showed more unfavourable risks, especially period and cohort effects in females. Regionally, Central Latin America (AAPC: 1.7 [1.1–2.3]), Tropical Latin America (AAPC: 1.5 [0.9–2.0]), High-income Asia Pacific (AAPC: 1.2 [0.7–1.7]) and Southern sub-Saharan Africa (AAPC: 0.8 [0.4–1.2]) had the significance increase in suicide mortality. In 2021, Southern sub-Saharan Africa had the highest mortality (10.5 per 100,000 population [8.6–12.5]). Nationally, a total of 29 countries had a significant upward trend in suicide mortality and rate of YLLs over the past three decades, and certain countries in low-middle and middle regions exhibited an extremely higher burden of suicide.
Conclusions
Global suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021, but obvious variability was observed across regions and countries. Earlier mental health education and targeted management are urgently required for adolescents and young adults in certain areas.
According to the World Health Organization (WHO), there has been a 13% increase in mental health and substance abuse disorders within the last decade. Typical and atypical antipsychotics are the most common treatment mechanisms for mental health-related disorders such as schizophrenia, depression with psychotic symptoms and bipolar disorders. However, antipsychotic usage is associated with more than a 50% increase in CVD such as ischaemic heart disease, resulting in cardiovascular-related mortality.
This review aims to investigate the most common type of cardiovascular event causing mortality due to antipsychotic use.
Methods
A systematic search within PubMed and Medline was conducted on 3 October 2023. Selection criteria were limited to English, full-text studies excluding case reports. The time frame selected was up to 3 October 2023. All studies included adults only. Interventions of focus include typical and atypical antipsychotics licensed in the UK. Outcome measures include cardiovascular mortality/events post-antipsychotic prescription.
Results
13 studies were included out of 1088 records. Studies originated from 4 nations with the most studies coming from the USA (n = 7), UK (n = 2), Taiwan (n = 2) and Canada (n = 2).
The most common antipsychotic reported in the records was risperidone (n = 11), followed by haloperidol (n = 9), olanzapine (n = 8) and quetiapine (n = 8).
From data extraction, the most common cardiovascular events leading to death were sudden cardiac death/arrest (n = 6), ventricular arrhythmias (n = 6), myocardial infarction (n = 4), and heart failure (n = 2).
Due to data heterogeneity, discrete outcome measures were extracted from each record. This included outcomes measuring: relative risk between various groups (n = 9), rate of cardiovascular event per 100 patient year (n = 3), and mortality post cardiovascular event (n = 1).
Conclusion
From this study, ventricular arrhythmias and sudden cardiac deaths were the most common cardiovascular events secondary to antipsychotic use leading to mortality. Owing to patient safety and benefits, patients with psychotic illness are unable to go untreated. They are consequently very vulnerable to the cardiovascular side effects of prescribed high-dose antipsychotic drugs. Despite current monitoring guidelines worldwide, cardiovascular-associated mortality in patients on antipsychotics is still elevated. This may indicate the potential inadequacy of current measures for these patients while demonstrating the need for more aggressive cardioprotective interventions and monitoring.
The Holocene is a critical period for understanding the East Asian monsoon system (EAM) over long timescales, but high-precision dating and high-resolution records from the Holocene epoch at monsoonal margins of East Asia are lacking. Here, on the basis of closely spaced radiocarbon and optically stimulated luminescence dating results obtained from a typical loess–paleosol sequence on the northern Chinese Loess Plateau (CLP), we provide an independent age-based, high-resolution depositional record of East Asian summer (EASM) and winter monsoons (EAWM) variations over the past ~14 ka. We find that both the EASM and EAWM simultaneously strengthened sometime during the Holocene optimum (~7–5 ka BP), with greater seasonality, and weakened during the Late Holocene. These findings are counterintuitive to our understanding of the EAM variations based on loess records at suborbital scales during interglacial periods, providing an alternative scenario of the monsoon system evolution. We postulate that high-latitude forcing and surface feedbacks, such as vegetation change, have modulated the EAM variations during the Holocene warmth.
This study aims to understand the epidemiological characteristics of SARS-CoV-2 infection in the paediatric population during the outbreak of the Omicron variant in Shanghai. We retrospectively analysed the population-based epidemiological characteristics and clinical outcome of SARS-CoV-2 Omicron variant infection in children in Minhang District, Shanghai, based on the citywide surveillance system during the outbreak period in 2022 (March to May). During this time, a total of 63,969 cases of SARS-CoV-2 infection were notified in Minhang District, out of which 4,652 (7.3%) were children and adolescents <18 years. The incidence rate of SARS-CoV-2 infections in children was 153 per 10,000. Of all paediatric cases, 50% reported to be clinically symptomatic within 1–3 days after PCR confirmation by parents or themselves, with 36.3% and 18.9% of paediatric cases reporting fever and cough. Also, 58.4% of paediatric cases had received at least one dose of the COVID-19 vaccine and 52.1% had received two doses of the COVID-19 vaccination. Our findings are informative for the implementation of appropriate measures to protect children from the threat of SARS-CoV-2 infection.
About a fourth of Chinese adolescents developed clinically significant depressive symptoms following a disaster. However, little is known about whether and how post-trauma negative life events and a sense of security are associated with depressive symptoms in this population. This study examined the psychological experiences of Chinese young people who had experienced the 2013 Ya’an earthquake in Sichuan, China.
Methods:
This cross-sectional study was conducted in 2019. A total of 693 Chinese middle school students completed a questionnaire that measured their level of depressive symptoms, trauma exposure, stressful life events, and sense of security.
Results:
Results of hierarchical multiple-regression analyses showed that the level of life stress from stressful life events was positively associated with the level of depressive symptoms (β = 0.416, P < 0.001) and the level of the sense of security was negatively associated with the level of depressive symptoms (β = −0.352, P < 0.001) when analysis controlled for age, gender, and trauma exposure.
Conclusions:
These findings highlight the importance of considering the influence of life stressors and the sense of security in devising measures and strategies for the prevention of the manifestation of depression among young people, particularly those who were exposed to disasters.
Understanding user perceptions of interacting with the virtual world is one of the research focuses in recent years, given the rapid proliferation of virtual reality (VR) and driven to establish the metaverse. Users can generate a familiar connection between their bodies and the virtual world by being embodied in virtual hands, and hand representations can induce users’ embodiment in VR. The sense of embodiment represents the cognitive awareness of one's manifestation and includes three subcomponents: the sense of body ownership, agency and self-location. There is insufficient evidence in the literature about the effects of hand designs on the embodiment, especially based on studying its three subcomponents. This study investigates how virtual hand designs with five realism levels influence the three subcomponents of embodiment in VR. This research employs a self-report questionnaire commonly used in the literature to assess embodiment and evaluates agency and self-location by introducing implicit methods (intentional binding and proprioceptive measurement) derived from psychology. Besides, the objective data of eye tracking is used to explore the connection between embodiment and hand designs, and classifying participants’ eye tracking data to help analyze the link between embodiment and user attention. Overall, this research makes a major contribution through a systematic exploration of users’ embodied experience in VR and offers important evidence of the effects of virtual hand designs on body ownership, agency, and self-location, respectively. In addition, this study provides a valuable reference for further investigation of embodiment through implicit and objective methods, and practical design recommendations for virtual hand design in VR applications.
Alkali barnyardgrass [Echinochloa crus-galli var. zelayensis (Kunth) Hitchc] and junglerice [Echinochloa colona (L.) Link] are problematic annual weeds in direct-seeded rice (Oryza sativa L.) fields in China. The emergence ecology of the two weed species may differ in response to environmental factors. Laboratory and screenhouse experiments were conducted to evaluate the effects of light, burial depth, mulching with wheat (Triticum aestivum L.) residue, and time and depth of flooding on the emergence of the two weed species collected from Nanjing, China. Light strongly increased seed germination. Under dark conditions, E. crus-galli seed germination (85%) was higher than that of E. colona (70%). The seeds of both species exhibited the greatest germination (90% for E. crus-galli and 80% for E. colona) when sown on the soil surface, and emergence decreased with increasing soil burial depth. Burial depths of 2.2 and 1.4 cm reduced seedling emergence by 50% for E. crus-galli and E. colona, respectively. No emergence was found at a depth of 6 cm. The seedling emergence for E. colona was lower than for E. crus-galli at the same soil burial depth. Mulching with wheat residue considerably reduced the seedling emergence and aboveground biomass of both species. The inhibitory effect of mulching with wheat residue on E. colona was more notable than on E. crus-galli. Early and deep flooding significantly suppressed the emergence, height, and biomass of E. crus-galli and E. colona, especially E. colona. The results gained from this study could provide fundamental ecological knowledge for managing Echinochloa species in direct-seeded rice systems.
Depressive symptoms, functional impairment, and decreased quality of life (QOL) are three important domains of major depressive disorder (MDD). However, the possible causal relationship between these factors has yet to be elucidated. Moreover, it is not known whether certain symptoms of MDD are more impairing than others. The network approach is a promising solution to these shortfalls.
Methods
The baseline data of a multicenter prospective project conducted in 11 governances of China were analyzed. In total, 1385 patients with MDD were included. Depressive symptoms, functioning disability, and QOL were evaluated by the 17-item Hamilton Depression Rating Scale (HAMD-17), the Sheehan Disability Scale (SDS), and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). The network was estimated through the graphical Least Absolute Shrinkage and Selection Operator (LASSO) technique in combination with the directed acyclic graph.
Results
Three centrality metrics of the graphical LASSO showed that social life dysfunction, QOL, and late insomnia exhibited the highest strength centrality. The network accuracy and stability were estimated to be robust and stable. The Bayesian network indicated that some depressive symptoms were directly associated with QOL, while other depressive symptoms showed an indirect association with QOL mediated by impaired function. Depressed mood was positioned at the highest level in the model and predicted the activation of functional impairment and anxiety.
Conclusions
Functional disability mediated the relationship between depressive symptoms and QOL. Family functionality and suicidal symptoms were directly related to QOL. Depressed mood played the predominant role in activating both anxiety symptom and functional impairment.
The relationship of a diet low in fibre with mortality has not been evaluated. This study aims to assess the burden of non-communicable chronic diseases (NCD) attributable to a diet low in fibre globally from 1990 to 2019.
Design:
All data were from the Global Burden of Disease (GBD) Study 2019, in which the mortality, disability-adjusted life-years (DALY) and years lived with disability (YLD) were estimated with Bayesian geospatial regression using data at global, regional and country level acquired from an extensively systematic review.
Setting:
All data sourced from the GBD Study 2019.
Participants:
All age groups for both sexes.
Results:
The age-standardised mortality rates (ASMR) declined in most GBD regions; however, in Southern sub-Saharan Africa, the ASMR increased from 4·07 (95 % uncertainty interval (UI) (2·08, 6·34)) to 4·60 (95 % UI (2·59, 6·90)), and in Central sub-Saharan Africa, the ASMR increased from 7·46 (95 % UI (3·64, 11·90)) to 9·34 (95 % UI (4·69, 15·25)). Uptrends were observed in the age-standardised YLD rates attributable to a diet low in fibre in a number of GBD regions. The burden caused by diabetes mellitus increased in Central Asia, Southern sub-Saharan Africa and Eastern Europe.
Conclusions:
The burdens of disease attributable to a diet low in fibre in Southern sub-Saharan Africa and Central sub-Saharan Africa and the age-standardised YLD rates in a number of GBD regions increased from 1990 to 2019. Therefore, greater efforts are needed to reduce the disease burden caused by a diet low in fibre.
To investigate spiritual care perceptions, spiritual well-being, and empathy, examine the correlations among spiritual care perceptions, spiritual well-being, and empathy, and explore the mediating role of spiritual well-being between other two variables of Chinese nursing students.
Methods
A cross-sectional design was implemented, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist was used to ensure quality reporting of the study. A cluster sample of 2,718 nursing students was selected from 7 universities and colleges in China. The demographic characteristics questionnaire, the Chinese Version of the Spiritual Care-Giving Scale (C-SCGS), the Spiritual Health Scale Short Form (SHS-SF), and the Jefferson Scale of Physician Empathy-Nursing Student (JSPE-NS) were used. Descriptive statistics, correlation, and process plug-in mediation effect analyses were used to analyze the data.
Results
The total score of spiritual care perceptions, spiritual well-being, and empathy were 173.83 ± 25.62, 98.74 ± 12.87, and 105.04 ± 21.34, respectively. Spiritual care perceptions were positively correlated with spiritual well-being (r = 0.617, p < 0.01) and empathy (r = 0.528, p < 0.01). And spiritual well-being played a partial mediating role between the other two variables (accounting for 28.1%).
Significance of results
Spiritual care perceptions, spiritual well-being, and empathy were quite moderate, which need in improving. It is suggested that nursing educators pay attention to the spiritual care education of nursing students, perfect the spiritual care education system, and take targeted measures according to nursing students’ individual personality traits and differences, improve their spiritual well-being and empathy in multiple ways, so as to improve their spiritual care perceptions and competence.
Two prevailing trends in livestock production include increasing farm sizes and higher recycling rates of manure. Using beef cattle farms in China as a case study, we examine the impact of farm size on farmers' choice of manure disposal modes. Three forms of manure disposal modes are identified: (1) selling to neighboring farmers, (2) giving away to neighboring farmers and (3) self-use. Based on primary data from a field survey of beef cattle farmers in China, we estimate the choice of the above-mentioned three disposal modes using the constrained singular Seemingly Unrelated Regression (SUR) model. We find a significant and nonlinear impact of farm size on farmers' choice of manure disposal modes. Specifically, there is a significant and inversed U-shaped relationship between farm size and manure giving away, and a significant U-shaped relationship between farm size and manure selling or self-use. We additionally find several other factors that affect farmers' choice of manure disposal: the educational level of a farmer has a positive impact on manure selling; the better a farmer's physical health condition, the more likely the farmer self uses manure and less likely gives it away; land acquisition, as well as engagement in crop farming, increases manure self-use and reduces manure giving away and selling; the availability of manure treatment facilities reduces manure self-use; and the willingness of nearby crop growers to accept manure significantly decreases manure self-use and increases manure selling and giving away. Policy implications are also discussed.
The relationship between SFA consumption and the risk of overweight/obesity remains unclear. Epidemiological evidence is lacking among Chinese population. This study aimed to investigate the association between individual dietary SFA intake and the risk of overweight/obesity in Chinese adults. Data from 8465 adults with BMI < 24 kg/m2 at entry in the China Health and Nutrition Survey (1989–2011) were analysed. Three-day 24-h dietary records were used to collect dietary data. Cox proportional hazards regression models were constructed to estimate hazard ratios (HR) and 95 % CI for the risk of developing overweight or obesity. A total of 3171 incident cases of overweight/obesity were identified (1649 for women and 1522 for men) during a median of 11 years of follow-up. Compared with the lowest category, the intake of total SFA (TSFA) showed no significant association with the risk of overweight/obesity. However, an increased risk of overweight/obesity was observed with a higher intake of medium chain SFA (MCSFA) (Ptrend = 0·004), especially decanoic acid (10:0) (HR was 1·25 (95 % CI 1·10, 1·42) comparing the highest category with the reference group; Ptrend < 0·001), whereas an inverse relationship was observed for hexanoic acid (6:0) consumption; compared with non-consumers, 6:0 intake was associated with 32 % lower risk of overweight/obesity (HR: 0·68 (95 % CI 0·56, 0·84); Ptrend < 0·001). Overall, the intake of subtypes of MCSFA but not TSFA was associated with the risk of overweight/obesity. Increasing hexanoic acid (6:0) and limiting decanoic acid (10:0) consumption may be protective for overweight/obesity among Chinese population.
A kind of tapered segmented cladding fiber (T-SCF) with large mode area (LMA) is proposed, and the mode and amplification characteristics of T-SCFs with concave, linear, and convex tapered structures are investigated based on finite-element method (FEM) and few-mode steady-state rate equation. Simulation results indicate that the concave tapered structure can introduce high loss for high-order modes (HOMs) that is advantageous to achieve single-mode operation, whereas the convex tapered structure provides large effective mode area that can help to mitigate nonlinear effects. Meanwhile, the small-to-large amplification scheme shows further advantages on stripping off HOMs, and the large-to-small amplification scheme decreases the heat load density induced by the high-power pump. Moreover, single-mode propagation performance, effective mode area, and heat load density of the T-SCF are superior to those of tapered step index fiber (T-SIF). These theoretical model and numerical results can provide instructive suggestions for designing high-power fiber lasers and amplifiers.
Thermal time models have been widely applied to predict temperature requirements for seed germination. Generally, a log-normal distribution for thermal time [θT(g)] is used in such models at suboptimal temperatures to examine the variation in time to germination arising from variation in θT(g) within a seed population. Recently, additional distribution functions have been used in thermal time models to predict seed germination dynamics. However, the most suitable kind of the distribution function to use in thermal time models, especially at suboptimal temperatures, has not been determined. Five distributions (log-normal, Gumbel, logistic, Weibull and log-logistic) were used in thermal time models over a range of temperatures to fit the germination data for 15 species. The results showed that a more flexible model with the log-logistic distribution, rather than the log-normal distribution, provided the best explanation of θT(g) variation in 13 species at suboptimal temperatures. Thus, at least at suboptimal temperatures, the log-logistic distribution is an appropriate candidate among the five distributions used in this study. Therefore, the distribution of parameters [θT(g)] should be considered when using thermal time models to prevent large deviations; furthermore, an appropriate equation should be selected before using such a model to make predictions.
Membranes with special wettability have attracted increasing interest for oil/water separation. Herein, the cellulose-based nanofibrous membrane was fabricated in an aqueous system by an electrospinning technique. The membrane was then modified successively through coating polydopamine and polyethyleneimine on the surface, which endowed the membrane with superhydrophilic and underwater superoleophobic character. The composition and morphology of the resultant membrane were characterized by attenuated total reflectance Fourier transform infrared spectra, X-ray photoelectron spectroscopy, and field-emission scanning electron microscope, respectively. Surfactant-stabilized oil-in-water emulsions were used to evaluate the separation performance of the membrane at different pH values. It was found that the membrane displayed the excellent antifouling property and separation performance for all different emulsions, with separation efficiency above 99.1% due to the development of a hydration layer underwater on the membrane surface. The reusability study indicated that the modification coating was stable enough to effectively separate emulsions after recycling at least 20 times. The developed nanofibrous membrane, as well as the corresponding modification strategy, enriched the application of membranes with special wettability in the field of oil spills and oily wastewater treatments.
The aim of the present study was to investigate the effects of dietary Zn level on growth performance, Zn bioaccumulation, antioxidant capacity and innate immunity in juvenile mud crabs (Scylla paramamosain). Six semi-purified diets were formulated to contain dietary Zn levels of 44·5, 56·9, 68·5, 97·3, 155·6 or 254·7 mg/kg. Dietary Zn level significantly influenced percentage weight gain (PWG), with the highest observed in crabs fed the diet containing 97·3 mg/kg Zn. Tissue Zn concentrations significantly increased as dietary Zn levels increased from 44·5 to 254·7 mg/kg. Retention of Zn in hepatopancreas increased with dietary Zn levels up to 68·5 mg/kg and then significantly decreased. Moreover, inadequate dietary Zn (44·5 and 56·9 mg/kg) reduced antioxidation markers including total superoxide dismutase (SOD) and Cu/Zn SOD activities and total antioxidant level. Crabs fed the diet with 44·5 mg/kg Zn also showed significantly lower expression of genes involved in antioxidant status, such as Cu/Zn SOD, glutathione peroxidase, catalase and thioredoxin than those fed diets containing 68·5 and 97·3 mg/kg Zn. The highest activities of phenoloxidase and alkaline phosphatase were recorded in crabs fed the diets containing 68·5 and 97·3 mg/kg Zn. Expression levels of prophenoloxidase and toll-like receptor 2 were higher in crabs fed the 97·3 mg/kg Zn diet compared with crabs fed the other diets. Based on PWG alone, the optimal dietary Zn level was estimated to be 82·9 mg/kg, with 68·5 to 97·3 mg/kg recommended for maintaining optimal Zn bioaccumulation, oxidation resistance and innate immune response of juvenile mud crabs.
We aimed to evaluate the relationship of plasma Mg with the risk of new-onset hyperuricaemia and examine any possible effect modifiers in hypertensive patients. This is a post hoc analysis of the Uric acid (UA) Sub-study of the China Stroke Primary Prevention Trial (CSPPT). A total of 1685 participants were included in the present study. The main outcome was new-onset hyperuricaemia defined as a UA concentration ≥417 μmol/l in men or ≥357 μmol/l in women. The secondary outcome was a change in UA concentration defined as UA at the exit visit minus that at baseline. During a median follow-up duration of 4·3 years, new-onset hyperuricaemia occurred in 290 (17·2 %) participants. There was a significantly inverse relation of plasma Mg with the risk of new-onset hyperuricaemia (per sd increment; OR 0·85; 95 % CI 0·74, 0·99) and change in UA levels (per sd increment; β −3·96 μmol/l; 95 % CI −7·14, −0·79). Consistently, when plasma Mg was analysed as tertiles, a significantly lower risk of new-onset hyperuricaemia (OR 0·67; 95 % CI 0·48, 0·95) and less increase in UA levels (β −8·35 μmol/l; 95 % CI −16·12, −0·58) were found among participants in tertile 3 (≥885·5 μmol/l) compared with those in tertile 1 (<818·9 μmol/l). Similar trends were found in males and females. Higher plasma Mg levels were associated with a decreased risk of new-onset hyperuricaemia in hypertensive adults.
Although higher dietary intake of MUFA has been shown to improve glycaemic control and lipid profiles, whether MUFA consumption from different sources is linked to the development of type 2 diabetes (T2D) remains unclear. We aimed to prospectively assess the associations of plant-derived MUFA (P-MUFA) and animal-derived MUFA (A-MUFA) intakes with T2D risk in a nationwide oriental cohort. Overall, 15 022 Chinese adults, aged ≥20 years, from the China Health and Nutrition Survey (CHNS 1997–2011) were prospectively followed up for a median of 14 years. Consumption of MUFA from plant and animal sources was assessed using 3-d 24-h recalls in each survey, and the cumulative average of intake was calculated. Multivariable-adjusted Cox models were constructed to estimate the hazard ratios (HR) of T2D according to quartiles of MUFA intake. P-MUFA were mainly consumed from cooked vegetable oils, fried bread sticks and rice, while A-MUFA were mainly consumed from pork, lard and eggs. Intake of P-MUFA was associated with a higher risk of T2D (HRQ4 v. Q1 1·50 (95 % CI 1·18, 1·90); Ptrend = 0·0013), whereas A-MUFA showed no significant association (HRQ4 v. Q1 0·84 (95 % CI 0·59, 1·20); Ptrend = 0·30). When further considering the cooking method of food sources, consumption of P-MUFA from fried foods was positively associated with T2D risk (HRQ4 v. Q1 1·60 (95 % CI 1·26, 2·02); Ptrend = 0·0006), whereas non-fried P-MUFA were not associated. Intake of MUFA from fried plant-based foods may elevate T2D risk among the Chinese population.
This study aimed to examine the efficacy of combining paroxetine and mirtazapine v. switching to mirtazapine, for patients with major depressive disorder (MDD) who have had an insufficient response to SSRI monotherapy (paroxetine) after the first 2 weeks of treatment.
Methods
This double-blind, randomized, placebo-controlled, three-arm study recruited participants from five hospitals in China. Eligible participants were aged 18–60 years with MDD of at least moderate severity. Participants received paroxetine during a 2-week open-label phase and patients who had not achieved early improvement were randomized to paroxetine, mirtazapine or paroxetine combined with mirtazapine for 6 weeks. The primary outcome was improvement on the Hamilton Rating Scale for Depression 17-item (HAMD-17) scores 6 weeks after randomization.
Results
A total of 204 patients who showed early non-response to paroxetine monotherapy were randomly assigned to receive either mirtazapine and placebo (n = 68), paroxetine and placebo (n = 68) or mirtazapine and paroxetine (n = 68), with 164 patients completing the outcome assessment. At week 8, the least squares (LS) mean change of HAMD-17 scores did not significantly differ among the three groups, (12.98 points) in the mirtazapine group, (12.50 points) in the paroxetine group and (13.27 points) in the mirtazapine plus paroxetine combination group. Participants in the paroxetine monotherapy group were least likely to experience adverse effects.
Conclusions
After 8 weeks follow-up, paroxetine monotherapy, mirtazapine monotherapy and paroxetine/mirtazapine combination therapy were equally effective in non-improvers at 2 weeks. The results of this trial do not support a recommendation to routinely offer additional treatment or a switch in treatment strategies for MDD patients who do not show early improvement after 2 weeks of antidepressant treatment.
Nowadays, hierarchical materials have received tremendous interests because of their unique physical and chemical properties. In this article, a novel and facile particle aggregation method was used to fabricate vertically aligned diamondoid nanowires and hierarchical branched nanowire cluster array by using an electrophoresis template method. Triamantane, a three-cage diamondoid, was applied as raw material in current research. Diamondoids are nanometer-sized, hydrogen-terminated diamond-like, saturated hydrocarbons, which process great potential in nanotechnology due to biocompatibility and ultrahard nature. By electrophoresis template method, triamantane molecules dissolved in toluene were transferred into a porous alumina template by electric field and form the one-dimensional (1D) nanostructure with high aspect ratio. After that, a two-step thermal treatment was applied to the nanowires to achieve hierarchical branched nanowires. The surface morphologies of triamantane nanowire array with different treatments were characterized by scanning electron microscopy. This approach opens a new avenue for mass production of the vertically aligned diamondoid nanowires and hierarchical branched nanowire cluster arrays.