Efficacy and safety of ketamine and esketamine for unipolar and bipolar depression: an overview of systematic reviews with meta-analysis.

Background: Unipolar and bipolar depression present treatment challenges, with patients sometimes showing limited or no response to standard medications. Ketamine and its enantiomer, esketamine, offer promising alternative treatments that can quickly relieve suicidal thoughts. This Overview of Reviews (OoR) analyzed and synthesized systematic reviews (SRs) with meta-analysis on randomized clinical trials (RCTs) involving ketamine in various formulations (intravenous, intramuscular, intranasal, subcutaneous) for patients with unipolar or bipolar depression. We evaluated the efficacy and safety of ketamine and esketamine in treating major depressive episodes across various forms, including unipolar, bipolar, treatment-resistant, and non-resistant depression, in patient populations with and without suicidal ideation, aiming to comprehensively assess their therapeutic potential and safety profile. Methods: Following PRIOR guidelines, this OoR's protocol was registered on Implasy (ID:202150049). Searches in PubMed, Scopus, Cochrane Library, and Epistemonikos focused on English-language meta-analyses of RCTs of ketamine or esketamine, as monotherapy or add-on, evaluating outcomes like suicide risk, depressive symptoms, relapse, response rates, and side effects. We included studies involving both suicidal and non-suicidal patients; all routes and formulations of administration (intravenous, intramuscular, intranasal) were considered, as well as all available comparisons with control interventions. We excluded meta-analysis in which the intervention was used as anesthesia for electroconvulsive therapy or with a randomized ascending dose design. The selection, data extraction, and quality assessment of studies were carried out by pairs of reviewers in a blinded manner. Data on efficacy, acceptability, and tolerability were extracted. Results: Our analysis included 26 SRs and 44 RCTs, with 3,316 subjects. The intervention is effective and well-tolerated, although the quality of the included SRs and original studies is poor, resulting in low certainty of evidence. Limitations: This study is limited by poor-quality SRs and original studies, resulting in low certainty of the evidence. Additionally, insufficient available data prevents differentiation between the effects of ketamine and esketamine in unipolar and bipolar depression. Conclusion: While ketamine and esketamine show promising therapeutic potential, the current evidence suffers from low study quality. Enhanced methodological rigor in future research will allow for a more informed application of these interventions within the treatment guidelines for unipolar and bipolar depression. Systematic review registration: [https://inplasy.com/inplasy-2021-5-0049/], identifier (INPLASY202150049).

Mental Pain Correlates with Mind Wandering, Self-Reflection, and Insight in Individuals with Psychotic Disorders: A Cross-Sectional Study.

Understanding the cognitive processes that contribute to mental pain in individuals with psychotic disorders is important for refining therapeutic strategies and improving patient outcomes. This study investigated the potential relationship between mental pain, mind wandering, and self-reflection and insight in individuals diagnosed with psychotic disorders. We included individuals diagnosed with a 'schizophrenia spectrum disorder' according to DSM-5 criteria. Patients in the study were between 18 and 65 years old, clinically stable, and able to provide informed consent. A total of 34 participants, comprising 25 males and 9 females with an average age of 41.5 years (SD 11.5) were evaluated. The Psychache Scale (PAS), the Mind Wandering Deliberate and Spontaneous Scale (MWDS), and the Self-Reflection and Insight Scale (SRIS) were administered. Statistical analyses involved Spearman's rho correlations, controlled for potential confounders with partial correlations, and mediation and moderation analyses to understand the indirect effects of MWDS and SRIS on PAS and their potential interplay. Key findings revealed direct correlations between PAS and MWDS and inverse correlations between PAS and SRIS. The mediation effects on the relationship between the predictors and PAS ranged from 9.22% to 49.8%. The largest statistically significant mediation effect was observed with the SRIS-I subscale, suggesting that the self-reflection and insight component may play a role in the impact of mind wandering on mental pain. No evidence was found to suggest that any of the variables could function as relationship moderators for PAS. The results underscore the likely benefits of interventions aimed at reducing mind wandering and enhancing self-reflection in psychotic patients (e.g., metacognitive therapy, mindfulness). Further research will be essential to elucidate the underlying mechanisms.

Agile Detection of Chemical Warfare Agents by Machine Vision: a Supramolecular Approach.

The supramolecular detection by image analysis of a simulant chemical warfare agent on a solid device containing a selective molecular sensor based on a BODIPY scaffold is reported. The recognition properties were investigated in solution, demonstrating high affinity (log K 6.60) and sensitivity (LOD 10 ppt). A test strip also confirmed the sensing properties in gas phase. Image analysis of the solid device allows quantitative information about the simulant to be obtained, recovering the sensor almost 5 times and thus confirming the goal of the supramolecular approach.

Abdominal wall reconstruction with intraperitoneal prosthesis in desmoid tumors surgery.

Desmoid tumor (DT), also known as aggressive fibromatosis, is a rare soft tissue neoplasm. For those tumors localized in the anterior abdominal wall, radical resection and reconstruction with mesh are indicated. Due to the rarity of this disease, there have been no randomized trials, but in reported retrospective series, although it is considered a benign lesion, it is clear that local recurrence is not uncommon. Records from seven consecutive patients (1 man, 6 women; mean age 35 years, range 25-60 years) presenting with desmoid tumors of the anterior abdominal wall were analyzed. In all cases the surgical strategy was the same: wide surgical excision and immediate plastic reconstruction with ePTFE mesh after intraoperative confirmation by frozen section of disease-free margins >1 cm. No immediate postoperative complications were recorded, and no patients developed recurrence after a median follow-up period of 60 months. The long-term mean of global health status recorded was 100%. Radical resection aided by intraoperative margin evaluation by frozen sections, followed by immediate mesh reconstruction, is a safe procedure and can provide a definitive cure without functional limitations for patients with desmoid tumors of the anterior abdominal wall.

[Acute postoperative acalculous cholecystitis]. / Colecistite acuta alitiasica postoperatoria.

After a brief review of acute postoperative acalculous cholecystitis, the Authors report their experience over the past 10 years consisting of 9 out of 520 cases (1.73%) of acute cholecystitis operated on in their department. They describe the surgical procedures after which acute cholecystitis developed, the diagnostic tools used, the laboratory test results and the types of cholecystitis encountered. Morbidity was 50% (4 cases) and mortality 11.1% (1 case). Acute postoperative acalculous cholecystitis obliges the surgeon to make an early diagnosis and intervene equally rapidly with treatment.

Drainage useful in the excision and closure "per primam" of pilonidal sinus: technical notes.

Pilonidal sinus treatment is still controversial, since all the most commonly used methods cause the patients considerable discomfort ("open" method) or increase the recurrence rate ("closed" method). In view of this, we reviewed our series of 52 patients treated by "en bloc" excision of all pathological tissue following closure "per primam" of the wound, after applying an aspirating drainage, which was then removed on day 2 or 3. Routine use of the drainage, antibiotic prophylaxis continued until postoperative day 6 or 7 and thorough daily disinfection of the wound and its neighbouring skin until removal of the suture, enabled us to achieve encouraging results (slight complications in 3 cases and only one recurrence).

Acute abdomen due to wandering spleen infarction: a case report.

We report a rare clinical case of acute abdomen due to partial infarction of a wandering spleen in the pelvis in a 60-year-old woman. The patient was suffering from stabbing pain in the external lower quadrant of the abdomen, irradiating back to the lumbosacral area, together with an unremitting feverish state (38 degrees C), sickness and constipation. After carrying out serological examinations, which revealed an increase in CPK and leukocytosis, ultrasonography and CT examinations were performed, revealing a mass in the left iliac cavity, which in all probability was a wandering spleen with an abnormally long pedicle and a dyshomogeneous lower area bearing witness to a splenic infarction. The patient was therefore submitted to surgery consisting in splenectomy after lysis of the adherences, which were plainly inflammatory. A wandering spleen, especially when infarcted, is a very rare clinical condition that may be congenital or acquired. Its presence can be confirmed by serological, ultrasonographical and CT examinations and must be suspected when there is no clearly defined acute abdomen.

[Polypoid lesions of the gallbladder: indications for surgical treatment]. / Le lesioni polipoidi della colecisti: indicazioni all'intervento chirurgico.

Through the study of a population of 176 patients with polypoid lesions of the gallbladder, our aim was to demonstrate the advantages of ultrasonography in the identification of those cases in which surgical intervention is indicated. From among our patients, specific criteria were used to select 92 patients to submit to cholecystectomy. These criteria were based on a thorough evaluation of the clinical data (patient's age, familiarity, presence of symptoms), and on careful examination of the ultrasonographic images (number and size of lesions, presence of associated cholelithiasis, state of the gallbladder wall). The histological results and the literature data confirmed the validity of our protocol. The risk factors for carcinoma are age (> 60 years), coexistence of gallstone disease, and the size of the lesions (> 10 mm). Therefore, when these risk factors are present, cholecystectomy is justified even in asymptomatic patients.