Herbal medicine as adjunctive therapy with antidepressants for post-stroke depression: a systematic review and network meta-analysis of randomized controlled trials.

Background: Herbal medicine can provide adjunctive therapy for adults with post-stroke depression. This study summarizes the latest evidence regarding the harms and benefits of herbal antidepressants. Methods: The literature searched from the Cochrane Library (using the OVID platform), Embase, PubMed, the China National Knowledge Infrastructure (CNKI), the Wan Fang Data Knowledge Service Platform, and the China Scientific Journal Database (VIP) from their inception to 18 August 2021, for randomized controlled trials of herbal medicine in adults with post-stroke depression, were included in this systematic review and network meta-analysis. The search was updated on 1 December 2022. To summarize the evidence, the frequentist random-effect network meta-analyses were conducted. To categorize interventions, rate the certainty of the evidence, and present the findings, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) frameworks were carried out. The registration number of this study on PROSPERO website is CRD 42021273956. Findings: Of 1132 citations identified from the search, 51 randomized clinical trials, totaling 4,507 participants, met the inclusion criteria for this study. For response rate, Shugan Jieyu capsule (SJC) plus selective serotonin reuptake inhibitors (SSRI), Jie-Yu Pills plus SSRI, and Wuling capsule plus SSRI were shown to be among the most effective with moderate certainty of evidence (RR: 1·45, 95%CI: 1·23 to 1·7; RR: 1·35, 95%CI: 1·09 to 1·68; RR: 1·32, 95%CI: 1·09 to 1·59). In terms of mean changes in Hamilton depression scale (HAMD) score after the completion of treatment, Wuling capsule plus Hypericum and Wuling capsule plus SSRI were found to be among the most effective in reducing symptoms of depression with moderate certainty of evidence (MD: 10·12, 95%CI: -17·25 to -2·99; MD: -3·81, 95%CI: -6·19 to -1·42). The network meta-analysis (NMA) showed that SJC may be a safer intervention than SSRI in terms of both total gastrointestinal and total nervous system events with moderate certainty of evidence (RR:0.34, 95%CI:0.18, 0.62 and RR: 0.11, 95%CI: 0.03, 0.35, respectively). Interpretation: SJC plus SSRI, Jie-Yu Pills plus SSRI, and Wuling capsule plus SSRI were among the most effective in terms of HAMD score reduction response rates. Low to very low certainty of evidence revealed no increased risk of gastrointestinal and nervous system events. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=273956; Identifier: CRD42021273956.

Microstructure and Tensile Property of Laser Cladding Assisted with Multidimensional High-Frequency Vibration.

Laser cladding is a promising surface modification technology to fabricate high-performance parts. However, defects such as porosity, cracks and residual tensile stress are easily produced in laser cladding, leading to significant property reduction and poor reliability. In this study, laser cladding with multidimensional high-frequency vibration was investigated. The effects of multidimensional high-frequency vibration on the improvement of microstructure and mechanical properties were analyzed and discussed based on the vibration-assisted laser cladding experiments. In addition, a numerical model was conducted to help understand the significance of the vibration on flow field and temperature field. Results show that 3D vibration led to the primary dendrite spacing reduction from 11.1 to 6.8 µm, microhardness increase from 199 to 221 HV0.2, and a nearly 110% improvement in the elongations. The findings of this study confirmed the significant benefits of multidimensional high-frequency vibration applied in laser cladding and provided a basis to uncover the underlying mechanisms of multidimensional vibration on the rapid melting and solidification.

The Long-Term Maintenance Effect of Remote Pulmonary Rehabilitation via Social Media in COPD: A Randomized Controlled Trial.

Background: Although the benefits of conventional pulmonary rehabilitation (PR) maintenance are well documented, it is challenged by many difficulties. We investigated whether remote home-based PR maintenance strategy via social media (WeChat) is effective on clinical improvements and reducing the risk for acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: The eligible stable COPD patients completing an initial 8-week PR were allocated into three groups randomly. Group A: PR maintenance via social media supervision at home. Group B: PR maintenance at hospital. Group C: Usual care. During a 12-month follow-up, the frequency of acute exacerbation of COPD (AECOPD), 6 minutes walking test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) were evaluated every 3 months. Results: At the end of the follow-up, compared to the decline in the usual care group (n = 49), the clinical improvements of 6MWD, CAT, and mMRC were sustained in both the home-based group (n = 47) and the hospital-based maintenance group (n = 44) (p < 0.001), no difference was observed between these two groups (p > 0.05). In multivariate analysis, the home-based PR maintenance and hospital-based PR maintenance were independent predictors of lower risk for AECOPD (incidence rate ratio (IRR) 0.712, 95% CI 0.595-0.841, p < 0.001 and IRR 0.799, 95% CI 0.683-0.927, p = 0.002), respectively. Conclusion: Remote PR maintenance via social media is effective in reducing the risk for AECOPD and keeping the clinical improvement from decline. Remote PR maintenance via social media might be used to deliver alternatives to conventional PR.

Eriodictyol Attenuates MCAO-Induced Brain Injury and Neurological Deficits via Reversing the Autophagy Dysfunction.

The present study was designed to investigate the protective effect of eriodictyol on MCAO-induced brain injury and its regulation of neural function and to explore the mechanism of its regulation of autophagy in rats. Brain injury was induced by middle cerebral artery occlusion (MCAO) in adult rats and pretreated with eriodictyol (low dose: 20 mg/kg; medium dose: 40 mg/kg; high dose: 80 mg/kg) or saline. Rats in the treatment group had a smaller volume of infarction and improved neurological outcome and reduced the latency to the platform, increased the time spent in the correct quadrant compared to MCAO rats pretreated with saline. ELISA kits results confirmed that eriodictyol reduced the inflammatory response induced by MCAO. The results of apoptosis and proliferation by Nissl staining and immunofluorescence detection indicated that eriodictyol could inhibit apoptosis and promote the proliferation in MCAO rats. The expressions of LC3, ATG5, p62, and Beclin1 were used to evaluate the autophagy, as well as the reversal of the autophagy activator (rapamycin) on the neuroprotective effect of eriodictyol, which suggested that the protective effect of eriodictyol on brain injury may be related to the inhibition of autophagy. In summary, we, therefore, suggested that eriodictyol could reduce the inflammation response of brain injury and inhibit neuroapoptosis, directly affecting autophagy to alleviate brain injury. It will provide theoretical support for eriodictyol in the treatment of ischemic stroke.

Branched Aggregates with Tunable Morphology via Hierarchical Self-Assembly of Azobenzene-Derived Molecular Double Brushes.

Hierarchical self-assembly is one of the most effective approaches to fabricate nature-inspired materials with subtle nanostructures. We report a distinct hierarchical self-assembly process of molecular double brushes (MDBs) with each graft site carrying a poly(azobenzene-acrylate) (PAzo) chain and a poly(ethylene oxide) (PEO) chain. Asymmetric tapered worm (ATW) nanostructures with chain-end reactivity assembling from the azobenzene-derived MDBs serve as primary subunits to prepare branched supermicelles by increasing water content (Cw ) in THF/water. Various natural Antedon-shaped multiarm worm-like aggregates (MWAs) can be created via the particle-particle connection of ATWs. Intriguingly, the azobenzene moieties undergo trans-cis isomerization upon UV irradiation and further promote a morphology evolution of MWAs. Multiscale supermicelles comprised of starfish shapes with differing central body and arm morphologies (e.g., compare to the biological specimens Luidia ciliaris and Crossaster papposus) were prepared by manipulating irradiation time.

Body Orientation and Vital Sign Measurement With IR-UWB Radar Network.

Utilizing Impulse Radio Ultra-WideBand (IR-UWB) radar for vital sign monitoring has attracted growing interest due to the noncontact measurement without privacy concerns. Most of existing researches assume that the subject's chest is directed to the radar antenna, to ensure the strength of backscattered signals from chest movement. However, a large angle between the antenna and the subject's chest caused by the body orientation badly affects the monitoring accuracy. Multiple observations of the same cardiopulmonary activity from different orientations provide more available measurements. This paper addresses the challenge by using an IR-UWB radar network instead of a single radar. Three IR-UWB radars are placed as endpoints of an equilateral triangle to collect vital sign information of a subject sitting at the center. A Conditional Generative Adversarial Network (CGAN) method is proposed to fuse multisensory data. First, the body orientation is classified by combining signal features and a random forest classifier. Then the impact of different angles on vital sign monitoring results is discussed and validated in each orientation. The data fusion process is modelled as an extended generative network with orientation based condition to produce the enhanced vital signal. This signal is optimized with the discriminator network to a fitted sinusoidal wave with heartbeat and respiratory information. Experimental results on measuring Heartbeat Rate (HR) in different orientations reveal the effectiveness and stability of the proposed method.

MMT-HEAR: Multiple Moving Targets Heartbeats Estimation and Recovery Using IR-UWB Radars.

Populations around the world are rapidly ageing. Age-friendly environments address the significance of continuous inhome vital sign monitoring. Impulse Radio Ultra-WideBand (IR-UWB) radar serves as a household healthcare assistance, providing non-contact vital sign monitoring without privacy issues and illumination limitation. However, the body movements bring difficulty in extracting heartbeat from radar signals, let alone obtaining complete information with body occlusions among multiple targets. This paper proposes a Multiple Moving Targets Heartbeat Estimation And Recovery (MMT-HEAR) approach to extract vital signs using IR-UWB radars. CLEAN and Joint Probability Data Association (JPDA) algorithms are firstly performed on each radar to estimate target-to-antenna distances of multiple targets. Considering signal obstruction and attenuation for targets occluded by others, the location-based distance optimization is proposed to refine these distances by combining information from all radars. Then the mapping from signal amplitudes to refined distances is introduced and combined with the Variational Nonlinear Chirp Mode Decomposition (VNCMD) to extract vital signs with body movements. To the best of our knowledge, this is the first attempt to monitor vital signs of multiple moving targets with radars. The averaging accuracy for two moving targets heartbeat monitoring during a 20-minutes observation is 85.93% with MMT-HEAR. Compared to two other conventional methods, the MMT-HEAR approach yields improvements of 16.11% and 10.16%, revealing the efficiency and robustness of this proposed approach.

Potential value of serum Aspergillus IgG antibody detection in the diagnosis of invasive and chronic pulmonary aspergillosis in non-agranulocytic patients.

BACKGROUND: At present, serum Aspergillus IgG and IgM antibody detection is mainly used in the diagnosis of chronic pulmonary aspergillosis (CPA), but its value in the diagnosis of invasive pulmonary aspergillosis (IPA) in non-agranulocytic patients is still unclear. IgM can be used as a marker of acute infection to help diagnose acute infection-related diseases. IgG is a marker of long-term infection and is used to assist in the diagnosis of pre-existing or chronic infection-related diseases. The aim of this study was to investigate and compare the value of serum Aspergillus IgG and IgM antibody detection in the diagnosis of IPA and CPA in non-agranulocytic patients. METHODS: Fifty-eight cases of pulmonary aspergillosis (37 IPA and 21 CPA cases), 15 cases of community-acquired bacterial pneumonia and 50 cases in the healthy control group were collected. The serum (1,3)-ß-D-glucan test (G test) was performed with a chromogenic method, and the galactomannan test (GM test) and Aspergillus IgG and IgM antibody detection were performed by commercial enzyme-linked immunosorbent assay (ELISA) in all patients. The sensitivity and specificity, cut-off value and area under the curve (AUC) of Aspergillus IgG and IgM antibodies were further obtained by receiver operating characteristic (ROC) curves. RESULTS: The positive rate of the G test, Aspergillus IgG antibody detection and the GM test also showed notable differences among the IPA, CPA, community-acquired bacterial pneumonia and healthy groups (P = 0.006, P <  0.001 and P = 0.217, respectively). Only the positive rate of the GM test showed a significant difference between the IPA and CPA groups (P = 0.04). ROC curves indicated that Aspergillus IgG antibody detection had a higher specificity in the IPA group than in the CPA group (0.952). The detection of Aspergillus IgG antibody can preferably distinguish IPA from community-acquired bacterial pneumonia and healthy controls (sensitivity = 0.923, specificity = 0.459, cut-off value = 134.46, AUC = 0.727). It can also distinguish CPA from community-acquired bacterial pneumonia and healthy controls (sensitivity = 0.952, specificity = 0.692, cut-off value = 75.46, AUC = 0.873). CONCLUSIONS: Serum Aspergillus IgG antibody detection may have certain clinical value in the diagnosis of IPA and CPA in non-agranulocytic patients.

Nonadherence in Home-Based Pulmonary Rehabilitation Program for COPD Patients.

Background: The pulmonary rehabilitation (PR) is beneficial for COPD patients. Due to the poor rate of adherence, we evaluate the factors which will predict the nonadherence of PR. Method: We analyzed the data from a retrospective study of COPD patients who were enrolled to attend the PR program. Patients were classified as the adherence group and the nonadherence group according to completion of over 50% sessions during the 8-week PR program. Demographic characteristics, 6-minute walking distance (6MWD), COPD assessment test (CAT), modified Medical Research Council scale (mMRC), and emotional function were compared between two groups. Univariate and multivariable analyses were performed to determine the factors of poor adherence of PR. Results: Among 418 patients, 170 patients (40.7%) who completed less than 50% sessions of the PR program were categorized as "nonadherence." Compared to completers, "nonadherence" patients had more cigarette consumption, higher emotional score, less 6MWD, more exacerbation, using nebulizer frequently, and higher rate of smoking at enrollment. On multivariate analysis, more exacerbation frequency (odds ratio (OR) = 1.434, 95% confidence interval (CI): 1.191∼1.796, P=0.046) and smoking at enrollment (OR = 3.349, 95% CI: 1.194∼6.302, P=0.012) were predict factors associated with nonadherence of PR. Conclusion: COPD patients with frequent exacerbation and smoking currently were more likely to be nonadherence during PR.

Self-Assembly and Photoinduced Spindle-Toroid Morphology Transition of Macromolecular Double-Brushes with Azobenzene Pendants.

Asymmetric macromolecular double-brushes (MDBs) are composed of two different side chains grafted on a linear backbone, possessing distinct assembly behaviors in comparison with conventional amphiphiles, owing to the Janus architecture and combined effects of backbone and hetero double-brushes. Additionally, the introduction of unique functionalities and responsiveness into the self-assembly system of MDBs endows extra opportunities to pursue morphologic diversity and intriguing properties. Herein, we report the synthesis of Janus-like MDBs of polyacrylate-g-poly(6-(4-butyl-4'-oxyazobenzene) hexyl acrylate)/poly(ethylene oxide) (PA-g-PAzo/PEO), in which hydrophilic PEO and hydrophobic PAzo brushes were grafted using the combination of concurrent ATRP and click reaction. Due to the special Janus topology and inter/intramolecular association of pendant azobenzene groups, amphiphilic PA-g-PAzo/PEO self-assembled into multimolecular rod and spindle-like aggregates. It is interesting that a transition of spindle-toroid-spindle was observed upon the alternative irradiation between UV and visible light, which is ascribed to the trans-to-cis isomerization of azobenzene molecular brushes. To our best knowledge, this is the first time that azobenzene-containing MDBs enable the fabrication of distinctive self-assembled morphologies and photoinduced toroid formation. The controlled synthesis of MDBs with unique functionalities and subsequent development of their structure-property relationships would shed light on the design and optimization of bottlebrush-based nanomaterials.

Characteristics and related factors of bronchiectasis in chronic obstructive pulmonary disease.

The purpose of this study was to understand the incidence, clinical characteristics and related factors of bronchiectasis in chronic obstructive pulmonary disease (COPD) patients.From January 2015 to January 2017, 133 patients with moderate to severe COPD admitted to our hospital were enrolled in the study. Bronchiectasis analysis was performed by high resolution CT of the chest, the clinical data of all patients were collected including increasing state of COPD, peripheral blood samples, pulmonary function, blood gas. And sputum samples were collected for detection of microorganisms.the patients were aged 70.18 ±â€Š8.31 years, and 62.4% of the patients were male. FEV1 accounted for an estimated value of 37.91 ±â€Š10.68%, and 104 (78.2%) were severe COPD, and 43 (32.3%) had bronchiectasis. Bronchiectasis is mainly bilateral, multiple and columnar bronchiectasis. The most easily involved sites are the left lower lobe, left lingual lobe and right middle lobe. Bronchiectasis is associated with history of disease (P = .027), at least one hospitalization exacerbated by COPD in the past year (P = .025), and the separation of potential pathogenic microorganisms from sputum (P = .022). The most commonly isolated pathogen was Pseudomonas aeruginosa (P < .001).Bronchiectasis should be noted in patients with COPD who often suffer from exacerbation or repeated respiratory infections, especially in those who isolate P aeruginosa from respiratory specimens.

Number and Angle Analysis in UWB Radar Deployment for Vital Sign Monitoring.

In recent years, more studies focus on the UltraWide Band (UWB) radar to provide a noncontact vital sign monitoring service. To further improve the accuracy of vital sign monitoring, the UWB radar network composed by multiple radars is considered for providing information on different angles. The radar deployment is a key factor in the radar network to impact the monitoring results, since that different deployments bring diverse combinations of vital sign information. To the best of our knowledge, few studies attempt to optimize the radar deployment for the purpose of improving the vital sign monitoring accuracy. This paper provides an analysis on the number and angle in radar deployment for vital sign monitoring. To firstly validate the superiority of utilizing multiple radars rather than the single radar, the theoretical analysis is performed by combining the vital sign monitoring model and the Cramer-Rao Low Bound (CRLB) theory. Then experiments for discussing the effect of the radar number and the angle between radars are conducted in realistic environment. Considering the radar number from 2 to 4, signals are acquired from radars located symmetrically with the subject sitting at the center. Additionally, the deployments of two radars with angles of 0°, 60°, 120°, 180°, 240° and 300° are discussed, ensuring that at least one radar is directed to the chest of the subject. A Neural Network (NN) based data fusion method is performed to obtain the fused vital signal from the radars. The accuracy of the NN is discussed as the evaluating indicators for these deployments.

Assessment of a Domiciliary Integrated Pulmonary Rehabilitation Program for Patients with a History of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective 12-Month Observational Study.

BACKGROUND Integrated pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) may prevent acute exacerbations of COPD (AECOPD). The aim of this study was to evaluate the effectiveness, before and 12 months after, the use of an integrated PR program in patients discharged from hospital for AECOPD. MATERIAL AND METHODS A retrospective observational clinical study included patients diagnosed with COPD who participated in a domiciliary integrated PR program that included a weekly phone interview supervised by a respiratory team. A six-minute walk test (6MWT), COPD assessment test (CAT), and the modified Medical Research Council scale (mMRC) were evaluated every three months. RESULTS Of the 303 eligible patients, 267 patients (88.1%), with a mean age of 64.9±8.7 years, a mean FEV1 percentage predicted of 48.8±12.9%, successfully completed the 12-month study program and achieved a significant improvement in their clinical performance with a significantly reduced frequency of episodes of EACOPD (3.1±1.7 vs. 2.0±1.4) (p<0.001), a significant reduction in emergency department visits (2.5±1.5 vs. 1.2±1.1) (p<0.001), and significantly reduced episodes of hospitalization (2.0±1.2 vs. 1.4±1.2) (p<0.001). Significant patient benefits were found during the 12-month study, on CAT, mMRC, and patient well-being when compared with the end of the study after 12 months (p<0.001). CONCLUSIONS A multidisciplinary integrated PR program maintained a significant clinical improvement, in patients with COPD by reducing episodes of AECOPD, CAT, mMRC, emergency hospital admissions, and improved patient well-being, for the duration of the program.

A new pulmonary rehabilitation maintenance strategy through home-visiting and phone contact in COPD.

BACKGROUND: The benefit of pulmonary rehabilitation (PR) for patients with COPD diminishes over time. We investigated a new strategy involving home-visit and phone contact and compared this to usual care in maintenance of PR benefits. METHODS: A total of 172 stable COPD patients receiving 8-week PR program were recruited for this prospective study. Patients were allocated into usual care group (UC) and PR maintenance group (PRMG) randomly. Patients in PRMG participated in maintenance strategy at home under supervision through home-visit and phone contact. The 6-minute walking test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) scores were evaluated every 3 months. RESULTS: Of the total, 151 patients completed 8-week PR program with satisfactory PR results (p<0.001), and 104 patients finished the follow-up. The clinical improvements in 6MWT, CAT, and mMRC scores were maintained (p<0.001) in PRMG. In comparison, the benefit of PR diminished gradually in UC. The differences in 6MWT, CAT, and mMRC scores between groups were observed 6, 9, and 6 months after PR, respectively (p<0.05). Total frequency of exacerbations in PRMG was lower than UC (p=0.021). CONCLUSION: Maintenance strategy involving home-visit and phone contact is superior to usual care to preserve PR benefits, and reduces the acute COPD exacerbation rate.

[Assessment of cognition and associated factors in patients with stable chronic obstructive pulmonary disease].

OBJECTIVE: To explore and analyze the cognitive function in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: The cognition differences between patients with COPD and healthy subjects were analyzed by Montreal Cognitive Assessment (MoCA). GOLD grade, PaO2, PaCO2, the education degree and the age were included as associated factors. The correlation between those factors with cognition were analyzed. RESULTS: The MoCA in patients with COPD was 20.6 ± 2.3, and that in healthy subjects was 25.3 ± 1.7; the difference between the 2 groups being significant (P < 0.01). The MoCA was 22.4 ± 0.8 in patients with GOLD grade I disease, 21.7 ± 1.0 in grade II, 20.2 ± 1.2 in grade III, and 19.1 ± 1.20 in grade IV diseases; the difference among the 4 subgroups being significant (F = 31.69, P < 0.05). The MoCA in GOLD grade I was higher than that in GOLD grade II, but the difference did not reach significance (P > 0.05). The MoCA of GOLD grade II was higher than that in GOLD grade III (P < 0.05) , and the MoCA of GOLD grade III was higher than that GOLD grade IV (P < 0.05). The MoCA in non-hypoxemia subgroup and hypoxemia subgroup was 22.2 ± 1.1 and 19.8 ± 1.1, respectively (P < 0.05) , while the MoCA in hypercapnia subgroup and non-hypercapnia subgroup was 20.0 ± 1.3 and 22.3 ± 1.0 respectively (P < 0.05). By regression analysis, the score of MoCA was correlated positively to education degree (Standard B1 = 0.134, P < 0.01), GOLD grade(Standard B2 = 0.351, P < 0.01) and PaO2(Standard B3 = 0.305, P < 0.01), while the score of MoCA was correlated negatively to age(Standard B4 = -0.146, P < 0.01) and PaCO2(Standard B5 = -0.145, P < 0.01). CONCLUSIONS: The MoCA score in patients with COPD was lower than that in healthy people. Lower MoCA score was found in patients with severe COPD. The MoCA scores in both hypoxemia subgroup and hypercapnia subgroup were lower. The cognitive dysfunction in patients with stable COPD was positively correlated with education degree, GOLD grade, and PaO2, but negatively with age and PaCO2.

Perioperative plasma brain natriuretic peptide and cardiotrophin-1 in off-pump coronary artery bypass.

OBJECTIVE: It has been suggested that brain natriuretic peptide (BNP) and cardiotrophin-1 (CT-1) are associated with myocardial dysfunction. The present prospective study was designed to investigate perioperative changes of plasma levels of BNP and CT-1 in off-pump coronary artery bypass (OPCAB). METHOD: Forty-nine patients undergoing elective OPCAB were divided into three groups. Group I: no previous myocardial infarction; Group II: previous myocardial infarction more than 12 weeks; Group III: recent myocardial infarction within 4-8 weeks. Perioperative BNP and CT-1 levels were measured, and hematochemical parameters were also collected. RESULTS: Higher preoperative BNP and CT-1 levels were found in group III as compared to those in group I. BNP levels increased after operation, and reached peak value at 3-7 days after the operation. However, the postoperative changes of BNP levels were not different among groups in any time points. CT-1 levels did not change significantly after the operation as compared to baseline. CONCLUSION: Higher BNP and CT-1 levels were associated with recent myocardial infarction. BNP elevated after OPCAB, but CT-1 showed no significant postoperative changes. Postoperative changes of BNP and CT-1 do not associated with cardiac function in OPCAB.