bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the Efficacy and Safety of Aripiprazole Versus Bupropion Augmentation in Patients With Major Depressive Disorder Unresponsive to Selective Serotonin Reuptake Inhibitors
Authors: Cheon Eun-Jin , Lee Kwang-Hun , Park Young-Woo , Lee Jong-hun , Koo Bon-Hoon , Lee Seung-Jae , Sung Hyung-Mo 
Published: February 2017

Abstract

Purpose
The purpose of this study was to compare the efficacy and safety of aripiprazole versus bupropion augmentation in patients with major depressive disorder (MDD) unresponsive to selective serotonin reuptake inhibitors (SSRIs).

Methods
This is the first randomized, prospective, open-label, direct comparison study between aripiprazole and bupropion augmentation. Participants had at least moderately severe depressive symptoms after 4 weeks or more of SSRI treatment. A total of 103 patients were randomized to either aripiprazole (n = 56) or bupropion (n = 47) augmentation for 6 weeks. Concomitant use of psychotropic agents was prohibited. Montgomery Asberg Depression Rating Scale, 17-item Hamilton Depression Rating scale, Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores were obtained at baseline and after 1, 2, 4, and 6 weeks of treatment.

Results
Overall, both treatments significantly improved depressive symptoms without causing serious adverse events. There were no significant differences in the Montgomery Asberg Depression Rating Scale, 17-item Hamilton Depression Rating scale, and Iowa Fatigue Scale scores, and response rates. However, significant differences in remission rates between the 2 groups were evident at week 6 (55.4% vs 34.0%, respectively; P = 0.031), favoring aripiprazole over bupropion. There were no significant differences in adverse sexual events, extrapyramidal symptoms, or akathisia between the 2 groups.

Conclusions
The present study suggests that aripiprazole augmentation is at least comparable to bupropion augmentation in combination with SSRI in terms of efficacy and tolerability in patients with MDD. Both aripiprazole and bupropion could help reduce sexual dysfunction and fatigue in patients with MDD. Aripiprazole and bupropion may offer effective and safe augmentation strategies in patients with MDD who are unresponsive to SSRIs. Double-blinded trials are warranted to confirm the present findings.
Guarding the Gate
Authors: Freeman Marlene P. , Pooley James , Flynn Martina J. , Baer Lee , Mischoulon David , Mou David , Fava Maurizio 
Published: February 2017

Abstract

Background
Failed treatment trials are common in major depressive disorder and treatment-resistant depression, and remotely performed multifaceted, centralized structured interviews can potentially enhance signal detection by ensuring that enrolled patients meet eligibility criteria.

Methods
We assessed the use of a specific remote structured interview that validated the diagnosis, level of treatment resistance, and depression severity. The objectives were to (1) assess the rate at which patients who were deemed eligible for participation in trials by site investigators were ineligible, (2) assess the reasons for ineligibility, (3) compare rates of ineligibility between academic and nonacademic sites, (4) compare eligibility between US and non-US sites, and (5) report the placebo response rates in trials utilizing this quality assurance approach, comparing its placebo response rates with those reported in the literature. Methods included a pooled analysis of 9 studies that utilized this methodology (SAFER interviews).

Results
Overall, 15.33% of patients who had been deemed eligible at research sites were not eligible after the structured interviews. The most common reason was that patients did not meet the study requirements for level of treatment resistance. Pass rates were significantly higher at non-US compared with US sites (94.6% vs 83.3%, respectively; P < 0.001). There was not a significant difference between academic and nonacademic sites (87.8% vs 82.4%; P = 0.08). Placebo response rates were 13.0% to 27.3%, below the 30% to 40% average in antidepressant clinical trials, suggesting a benefit of the quality assurance provided by these interviews.

Conclusions
The use of a remotely structured interview by experienced clinical researchers was feasible and possibly contributed to lower-than-average placebo response rates. The difference between US and non-US sites should be the subject of further research.
Clinical Use of Mood Stabilizers With Antidepressants in Asia
Authors: Rajaratnam Kamini , Xiang Yu-Tao , Tripathi Adarsh , Chiu Helen F.K. , Si Tian-Mei , Chee Kok-Yoon , Avasthi Ajit , Grover Sandeep , Chong Mian-Yoon , Kuga Hironori , Kanba Shigenobu , He Yan-Ling , Lee Min-Soo , Yang Shu-Yu , Udomratn Pichet , Kallivayalil Roy A. , Tanra Andi J. , Maramis Margarita M. , Shen Winston W. , Sartorius Norman , Kua Ee-Heok , Tan Chay-Hoon , Mahendran Rathi , Shinfuku Naotaka , Sum Min Yi , Baldessarini Ross J. , Sim Kang 
Published: February 2017

Abstract

Objective
As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries.

Methods
This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling.

Results
Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose.

Conclusions
The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.
Short-Term Effects of Methylphenidate on Math Productivity in Children With Attention-Deficit/Hyperactivity Disorder are Mediated by Symptom Improvements
Authors: Kortekaas-Rijlaarsdam Anne Fleur , Luman Marjolein , Sonuga-Barke Edmund , Bet Pierre M. , Oosterlaan Jaap 
Published: February 2017

Abstract

Background
Although numerous studies report positive effects of methylphenidate on academic performance, the mechanism behind these improvements remains unclear. This study investigates the effects of methylphenidate on academic performance in children with attention-deficit/hyperactivity disorder (ADHD) and the mediating and moderating influence of ADHD severity, academic performance, and ADHD symptom improvement.

Methods
Sixty-three children with ADHD participated in a double-blind placebo-controlled crossover study comparing the effects of long-acting methylphenidate and placebo. Dependent variables were math, reading, and spelling performance. The ADHD group performance was compared with a group of 67 typically developing children.

Results
Methylphenidate improved math productivity and accuracy in children with ADHD. The effect of methylphenidate on math productivity was partly explained by parent-rated symptom improvement, with greater efficacy for children showing more symptom improvement. Further, children showing below-average math performance while on placebo profited more from methylphenidate than children showing above-average math performance.

Conclusions
The results from this study indicate positive effects of methylphenidate on academic performance, although these were limited to math abilities. In light of these results, expectations of parents, teachers, and treating physicians about the immediate effects of methylphenidate on academic improvement should be tempered. Moreover, our results implicate that positive effects of methylphenidate on math performance are in part due directly to effects on math ability and in part due to reductions in ADHD symptoms.
Efficacy of Desvenlafaxine Compared With Placebo in Major Depressive Disorder Patients by Age Group and Severity of Depression at Baseline
Authors: Mosca Daniel , Zhang Min , Prieto Rita , Boucher Matthieu 
Published: February 2017

Abstract

Purpose
This post hoc meta-analysis evaluated the efficacy and safety of desvenlafaxine 50 and 100 mg versus placebo across age groups and severity of depression at baseline in patients with major depressive disorder.

Methods
Data from placebo and desvenlafaxine 50-mg and 100-mg dose arms were pooled from 9 short-term, placebo-controlled, major depressive disorder studies (N = 4279). Effects of age (18–40 years, >40 to <55 years, 55–<65 years, and ≥65 years) and baseline depression severity (mild, 17-item Hamilton Rating Scale for Depression total score [HAM-D17] ≤18; moderate, HAM-D17 >18 to <25; severe, HAM-D17 ≥25) on desvenlafaxine efficacy were assessed using analysis of covariance for continuous end points and logistic regression for categorical end points.

Findings
Desvenlafaxine-treated (50 or 100 mg/d) patients had significantly (P < 0.05, 2-sided) greater improvement in most measures of depression and function compared with placebo for patients 18 to 40 years, older than 40 to younger than 55 years, and 55 to younger than 65 years, with no significant evidence of an effect of age. Desvenlafaxine significantly improved most measures of depression and function in moderately and severely depressed patients. There was a significant baseline severity by treatment interaction for HAM-D17 total score only (P = 0.027), with a larger treatment effect for the severely depressed group.

Implications
Desvenlafaxine significantly improved depressive symptoms in patients younger than 65 years and in patients with moderate or severe baseline depression. Sample sizes were not adequate to assess desvenlafaxine efficacy in patients 65 years or older or with mild baseline depression.
Renal Transplant Recipients: The Factors Related to Immunosuppressive Medication Adherence Based on the Health Belief Model
Authors: Kung Pen-Chen , Yeh Mei Chang , Lai Ming-Kuen , Liu Hsueh–Erh 
Published: February 2017

ABSTRACT

Background:
Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior.

Purpose:
The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model.

Methods:
This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson’s correlation, and multiple regression.

Results:
Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens.

Conclusions:
The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and perceived benefits of adherence to treatment were found to predict adherence rates. Patient education should be enhanced to reduce the risks of rejection and increase adherence rates to improve outcomes.
Procedural Learning Perspectives of Pulmonary Fellows and Practitioners
Authors: Lee Hans J. , Coleman Briana , Lerner Andrew D. , Feller-Kopman David , Semaan Roy , Frimpong Bernice , Yarmus Lonny 
Published: February 2017

Background:
Procedural learning requires both didactic knowledge and motor skills. Optimal teaching styles and techniques remain to be defined for pulmonary procedural learning. We investigated the preferences of learners at 2 different points in a pulmonary career; as pulmonary fellows and as clinical practitioners.

Methods:
A perception survey was conducted among pulmonary fellows and practitioners from multiple institutions throughout the United States. Fellows and practitioners were immediately surveyed on procedural learning factors after completing a procedural learning course using low/high-fidelity and/or cadaver simulators. Survey questions consisting of biographical information and multiple choice, Likert style, and qualitative questions regarding learning preferences were collected.

Results:
Seventy-five physicians (44 pulmonary fellows, 31 practitioners) from 35 centers completed the survey. Pulmonary practitioners preferred an academic expert, whereas fellows preferred familiar faculty as lecturers for procedural learning (P=0.03). There were no statistical differences between fellows/practitioners value of the use of simulators, didactics, or handouts. Both groups preferred animal/cadaver and high-fidelity simulators to low-fidelity simulators. Both groups also preferred a traditional course structure to problem-based learning/flipped classroom. The most common answer to barriers for learning a new procedure was “time” for training followed by “opportunities” to learn.

Conclusions:
Pulmonary fellows and practitioners we surveyed preferred a traditional course structure with cadaver/animal models and high-fidelity simulation training as compared with a flipped classroom model and low-fidelity simulators, but whether this holds true for the wider population is unknown. Larger studies are needed to validate learning perception with outcomes.
Can the Video Head Impulse Test Define Severity of Bilateral Vestibular Hypofunction?
Authors: Judge Paul D. , Janky Kristen L. , Barin Kamran 
Published: February 2017

Objective:
The objective of the study was to compare rotary chair and video head impulse test (vHIT) findings in patients with bilateral vestibular hypofunction (BVH) to determine whether vHIT can: 1) define severity of BVH and 2) accurately predict rotary chair findings in patients with BVH.

Study Design:
Retrospective chart review.

Setting:
Research hospital.

Patients:
Twenty subjects with bilateral vestibular hypofunction as assessed by rotary chair.

Intervention:
Rotary chair and vHIT.

Main Outcome Measures:
The main outcome measures were rotary chair phase, gain, and symmetry and vHIT vestibulo-ocular reflex (VOR) gain. Rotary chair and vHIT results were assessed and subjects were stratified into groups according to the severity of their vestibular hypofunction. For rotary chair, subjects were classified as mild, moderate, or severe BVH. For vHIT, subjects were classified as normal, unilateral, or bilateral.

Results:
Average lateral canal vHIT VOR gain: 1) significantly increased as severity of BVH decreased, and 2) demonstrated a significant and positive, linear relationship with rotary chair gains. vHIT was in disagreement with rotary chair in the classification of five subjects, which could be due to right-left asymmetry of BVH.

Conclusion:
vHIT can serve as an initial tool for identifying patients with BVH. Lower vHIT gains are consistent with having severe BVH. There was disagreement between vHIT and rotary chair, though not for any patients with severe BVH. Compared with rotary chair, the clinical gold standard for identifying BVH, vHIT possesses 100% sensitivity for excluding severe BVH when average vHIT gains are greater than 0.46.
Improvements in Gait With Hearing Aids and Cochlear Implants
Authors: Shayman Corey S. , Earhart Gammon M. , Hullar Timothy E. 
Published: February 2017

Objective:
To evaluate whether wearing auditory assistive devices can improve gait and dynamic balance.

Patients:
Three adult users of bilateral hearing assistive devices: one with cytomegalovirus exposure wearing cochlear implants, one with Ménière's disease wearing hearing aids, and one with presbystasis wearing hearing aids.

Intervention:
Rehabilitative intervention involved participants performing gait and dynamic posture tasks with and without their hearing assistive devices.

Main Outcome Measures:
Gait velocity and Mini-BESTest score.

Results:
The participant with Ménière's disease showed a clinically significant improvement in gait in the aided versus the unaided condition (20.5 cm/s higher velocity and five point better Mini-BESTest score). The other two participants also improved with augmented audition, but to a lesser degree.

Conclusions:
Bilateral hearing augmentation may promote clinically significant improvements in gait, although the effects are not uniform among patients. Hearing aids or cochlear implants may be important interventions for improving stability during walking in some people with hearing loss.
Flow Rate Through Pigtail Catheter Used for Left Heart Decompression in an Artificial Model of Extracorporeal Membrane Oxygenation Circuit
Authors: Kim Won Ho , Hong Tae Hee , Byun Joung Hun , Kim Jong Woo , Kim Sung Hwan , Moon Sung Ho , Park Hyun Oh , Choi Jun Young , Yang Jun Ho , Jang In Seok , Lee Chung Eun , Yun Jeong Hee 
Published: February 2017

In refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) can be initiated. Although left heart decompression can be accomplished by insertion of a left atrial (LA) or left ventricular (LV) cannula using a percutaneous pigtail catheter, the venting flow rate according to catheter size and ECMO flow rate is unknown. We developed an artificial ECMO circuit. One liter saline bag with its pressure set to 20 mm Hg was connected to ECMO to mimic LV failure. A pigtail catheter was inserted into the 1 L saline bag to simulate LV unloading. For each pigtail catheter size (5–8 Fr) and ECMO flow rate (2.0–4.0 L/min), the moving distance of an air bubble that was injected through a three-way stopcock was measured in the arterial pressure line between the pigtail catheter and ECMO inflow limb. The flow rate was then calculated. We obtained the following equation to estimate the pigtail catheter flow rate.
Pigtail vent catheter flow rate (ml/min) = 8×ECMOflow rate(L /min)+9×pigtail catheter size(Fr)- 57
This equation would aid in designing of a further study to determine optimal venting flow rate. To achieve optimal venting flow, our equation would enable selection of an adequate catheter size.
X-Ray of Excised Cancerous Breast Tissue Does Not Affect Clinical Biomarker Expression
Authors: Lloyd Isaac E. , Welm Alana L. , DeRose Yoko , Neumayer Leigh A. , Kohan Jessica L. , Malmberg Elisabeth M. , Salama Mohamed E. , Factor Rachel E. 
Published: February 2017

Context:
College of American Pathologists (CAP) and the American Society of Clinical Oncology have emphasized the need to reduce preanalytic variables for evaluating predictive biomarker expression in breast cancer. Postoperative x-ray of excised breast tissue is commonplace, yet is a variable that has not been investigated previously. We asked whether such radiation affects expression of relevant biomarkers.

Design:
A previous study found that human breast cancers grown in mice demonstrate the same immunohistochemical and molecular profiles as the original tumors. Thirteen patient-derived xenografts were harvested fresh and divided for specimen radiography and a matched nonirradiated control, while following CAP/ASCO guidelines for cold ischemia time and fixation. Samples were processed in a tissue microarray for immunohistochemistry. Estrogen receptor (ER), progesterone receptor (PR), p53, and Ki67 staining was evaluated using an optimized scoring algorithm performed on digitally scanned slides. Samples were also scored manually by a blinded pathologist using the H-score method, and HER2 by the CAP/ASCO 2013 protocol. Histologic scores were compared by analysis of variance.

Results:
There was no significant difference in quantity or intensity of staining between irradiated and nonirradiated samples for estrogen receptor (P=0.28), p53 (P=0.96), and Ki67 (P=0.94). A small but statistically significant difference was observed for PR (P=0.0058). HER2 staining was similarly unchanged in the 1 tumor exhibiting 3+ staining.

Conclusions:
Our study demonstrates that x-ray of breast carcinomas does not significantly affect the expression of predictive biomarkers, with the exception of PR for unclear reasons. It also highlights the utility of the patient-derived xenograft model for biomarker studies.