Systematic Review and Meta-Analysis of Salt Valproate Preventing Switch Associated with Antidepressants in Chinese Patients With Depressive Episodes.

Objective: This overview of systematic reviews (SRs) and meta-analyses aims to critically appraise the methodology and reporting quality of relevant SRs and meta-analyses with the aim of identifying whether or not the use of valproate can prevent the switch to mania associated with antidepressant treatment in Chinese patients with depressive episodes. Methods: Electronic databases China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database) and Wanfang Database were searched for related SRs and meta-analyses from inception to the search date within Chinese restrictions. A total of 2 reviewers independently selected SRs and meta-analyses and collected related data, and a third reviewer was introduced if any disagreement occurred during the assessment. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and the US Agency for Healthcare Research and Quality (AHRQ) were employed to evaluate quality of the reporting and methodology. Results: The switch rate in the sodium valproate group by 99% and was significantly lower than in the antidepressant-only group (0% vs 5.7%; OR = 0.18; 95% CI, 0.04-0.84; Z = 2.18; P = .03). The magnesium valproate group was similar to the sodium valproate group in switch rate; the switch rate in the antidepressant group was (2.2% vs 16.92%; OR = 0.11; 95% CI, 0.03-0.39; Z = 3.47; P = .0005). The switch rate in the salt valproate combined with a selective serotonin reuptake inhibitor (SSRI) group was lower than in the SSRI group (0.51% vs 8.4%; OR = 0.15; 95% CI, 0.04-0.51; Z = 3.01; P = .003). The switch rate in the valproate combined with serotonin noradrenaline reuptake inhibitor (SNRI) group was similar to the valproate combined with SNRI group (2.3% vs 17.5%; OR = 0.12; 95% CI, 0.03-0.53; Z = 2.79; P = .05). Conclusion: Salt valproate can reduce the switch rate related to antidepressant treatment in patients with depression.

Lamotrigine and Lithium Combination for Treatment of Rapid Cycling Bipolar Disorder: Results From Meta-Analysis.

Objective: The objective of this study is to observe the effect of combination of lithium and lamotrigine in treatment of rapid-cycling bipolar disorder (RCBD). Method: We searched MEDLINE, EMBASE, Cochrane Library in English and CBM, CNKI, WANFANG, and CSSCI in Chinese to find literature from 1 January 2000 to 31 December 2020 related to the combination of lithium carbonate and lamotrigine for treatment of RCBD. Results: Five comparison studies with 265 subjects of 131 cases in a study group and 134 cases in a control group met the inclusion criteria and were included for the final meta-analysis. The comprehensive analysis shows that the study group had a significant lower score in mental symptoms than the control group (Z = 2.34, P = 0.02) with a random model (X 2 = 33.02, df = 7, P < 0.01). However, the differences were only shown in PANSS (Z = 5.18, P < 0.01) and BPRS (Z = 3.08, P < 0.01). There was no difference in response rate (54.9 vs. 45.7%; OR = 1.47; 95% CI: 0.79~2.73; Z = 1.21, P > 0.05,) and remission rate (47.9 vs. 45.9%; OR = 1.05; 95% CI: 0.49~2.25; Z = 0.13, P > 0.05,) found between the two groups. The response rate of lamotrigine and lithium combination was significantly higher compare to that of monotherapy of lithium in patients with no treatment resistant (82 vs. 54%; OR = 4.26; 95% CI: 1.65~10.99; Z = 3.99, P < 0.01) with the fixed effect model (X 2 = 0.89, df = 1, P > 0.05, I 2 = 0%). Conclusion: The combination of lithium and lamotrigine resulted in better improvement of psychotic symptoms and higher response rate in patients with RCBP with no treatment resistant.

Traditional Chinese Medicine Syndrome Types Among Single-Syndrome Bipolar Mania Cases Described in Chinese Literature.

PRIMARY OBJECTIVE: The aim of this study was to identify and understand the syndromes of mania in traditional Chinese medicine (TCM), as described in Chinese literature on the integrated treatment of mania using TCM and Western medicine. METHODS: A literature search conducted in Chinese databases identified 27 articles that were included in a statistical analysis to determine the proportion of mania cases represented by various TCM syndromes. RESULTS: After combining similar syndromes, we found that the TCM syndromes of mania could be categorized as phlegm-fire disturbance of the mind (Tanhuoraoshen), phlegm-heat stagnation (Tanreyujie), qi stagnation and blood stasis (Qizhixueyu), liver qi stagnation (Gandanyure), and fire injury Yin (Huoshengshnagyin). These syndrome categories accounted for 55.6%, 18.5%, 14.8%, 7.4% and 3.7% of mania cases, respectively. Manic symptom severity scores differed significantly among phlegm-fire disturbance of the mind (26.8 ± 1.6), phlegm-heat stagnation (31.1 ± 1.9), and qi stagnation and blood stasis (23.5 ± 2.2). CONCLUSION: The largest proportion of mania cases involved phlegm-fire disturbance of the mind, phlegm-heat stagnation, or qi stagnation and blood stasis. Cumulatively, these syndromes accounted for 88.9% of cases; the severity of manic symptoms different significantly among the 3 syndrome categories. Smaller proportions of cases represented liver qi stagnation or fire injury Yin.

Preventive Effects of Lithium Carbonate on Antidepressant-Induced Switch During Depressive Episodes: Chinese Data Analysis.

CONTEXT: Some patients experiencing depressive episodes can switch to mania or become mania during treatment with antidepressants. Avoiding a switch is an important part of any therapeutic plan, whether a patient suffers from unipolar or bipolar depression. One method of avoiding switching is use of a mood stabilizer, such as lithium carbonate. DESIGN: The research team performed a narrative review by searching Chinese electronic databases: the Chinese Biomedical Database (CBM), the China National Knowledge Infrastructure (CNKI), WANFANG, and the Chinese Social Sciences Citation Index (VIP). The search used the keywords depression-bipolar depression and depressive episode-and lithium carbonate. Results such as comments, letters, reviews, and case reports were excluded. SETTING: The study took place at Jinhua Second Hospital, China. RESULTS: A random effect model was used to account for the data, using Revman 5.2. The switch rate for the intervention groups was 8.28% or 29 out of 351 participants and of the control groups was 25.29% or 87 out of 344 participants (OR = 0.25, 95% CI: 0.16 to 0.39). Lithium carbonate reduced the switch rate by 67.25% [(25.29%-8.28%) /25.29%]. In the bipolar depression group, lithium carbonate reduced the switch rate by 68.11% [(25.84%-8.24%) /25.84%]. In the depression and unipolar depression groups, lithium carbonate reduced the switch rate by 67.07% [(25.29%-8.26%) /25.29%]. In the group of patients treated with selective serotonin reuptake inhibitors (SSRIs), lithium reduced the switch rate by 60.3% [(29.85%-11.85%) /29.85%]. In group of patients treated by tricyclic antidepressants (TCAs), lithium carbonate reduced the switch rate by 73.14% [(22.28%-6.01%) /22.28%]. CONCLUSIONS: As typical mood stabilizer, lithium carbonate can reduce the antidepressant-induced switch rates in patients with depressive episodes regardless of the type of antidepressant and the type of depressive episode. Further research should compare the effectiveness of lithium carbonate to that of other mood stabilizers in preventing switching associated with antidepressants.

The Study of Diagnostic Value of Bipolarity Index for Bipolar Disorder in China: Meta-analysis of Sensitivity and Specificity.

Objective: Bipolarity index (BI) is one of the diagnostic scales that assist the diagnosis of bipolar disorder (BD), and should be analyzed comprehensively for use in China. Methods: We searched the Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), WANFANG, and Chinese Social Sciences Citation Index (CSSCI) in Chinese to find literature from July 31, 2004 to July 31, 2020, for results related to BI in the diagnosis for bipolar disorder (BD), among which results such as comments, letters, reviews, and case reports were excluded. The rates of sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in diagnosis were synthesized and discussed.A total of 1237 patients were included in 5 studies. The criteria used for their selection were an anlysis of their results on the BI, and the diagnostic indexes of BI for BD in China.Thesensitivity, specificity, positive predictive value, negative predictive value, and accuracy of BI for BD in China were summarized in every study.Results: A total of 1237 subjects were included in 5 studies. The random effect model was used to account for the data with RevMan 5.2. The results showed that the diagnostic sensitivity of BI was 0.93 (95% CI: 0.93-1.00), and the specificity was 85% (95% CI: 0.69-0.96). The positive predictive value (PPV)was 74% (95% CI: 0.53-0.91). The negative predictive value (NPV) was 95% (95% CI: 0.81-1.00), and accuracy was 86% (95% CI: 0.77-0.93). Significant heterogeneity was detected across studies regarding these incidence estimates.Conclusion: The ideal diagnostic value of BI was found, although the studies showed significant heterogeneity. The results must be cautiously and attentively interpreted, in comparison to other diagnostic scales, to perfect the use of BI in clinical psychiatry.

Using Transcriptome Analysis to Identify Genes Involved in Switchgrass Flower Reversion.

Floral reversion is a process in which differentiated floral organs revert back to vegetative organs. Although this phenomenon has been described for decades, the underlying molecular mechanisms remain unclear. In this study, we found that immature switchgrass (Panicum virgatum) inflorescences can revert to neonatal shoots when incubated on a basal medium with benzylaminopurine. We used anatomical and histological methods to verify that these shoots were formed from floret primordia through flower reversion. To further explore the gene regulation of floral reversion in switchgrass, the transcriptome of reversed, unreversed, and uncultured immature inflorescences were analyzed and 517 genes were identified as participating in flower reversion. Annotation using non-redundant databases revealed that these genes are involved in plant hormone biosynthesis and signal transduction, starch and sucrose metabolism, DNA replication and modification, and other processes crucial for switchgrass flower reversion. When four of the genes were overexpressed in Arabidopsis thaliana, vegetative growth was facilitated and reproductive growth was inhibited in transgenic plants. This study provides a basic understanding of genes regulating the floral transition in switchgrass and will promote the research of floral reversion and flower maintenance.

Efficacy and safety of duloxetine for depression in China :a meta-analysis / 中华行为医学与脑科学杂志

Objective To systematically evaluate the efficacy and adverse effects of duloxetine in the treatment of domestic depression patients,and compare with those who were treated with SSRIs drugs in the same period to explore the difference between them to guide the clinical medication.Methods A search was conducted in CBMdisc,Wanfang database,CNKI,VIP,Pubmed.The double-blind randomized controlled trials on duloxetine for depression in China were collected.The quality of the included trials was assessed according to the Cochrane Handbook 5.0,and the systematic analysis was conducted by using RevMan 5.3 soft ware.Results Seven double-blind randomized controlled trials (two of duloxetine versus fluoxetine,five of duloxetine versus paroxetine) involving 1 193 patients were included.The results of rmeta-analysis showed that:①After 6-8 weeks of treatment,there were no significant differences in the effective rate (RR =1.02,95％CI=0.78-1.32,Z=0.12,P=0.90),and the final cure rate (RR=0.95,95％CI=0.75-1.19,Z=0.47,P=0.64) between the duloxetine and fluoxetine/paroxetine groups.②Adverse reactions:the incidence rate was not significantly different between duloxetine and fluoxetine/paroxetine groups (RR =1.03,95％ CI =0.86-1.23,Z=0.32,P=0.75).Conclusion After 6-8 weeks of treatment,there are no significant differences in the effective rate and the final cure rate between duloxetine and fluoxetine/paroxetine.There is no significantly difference in common adverse reactions.

Effects of moderate acute hypervolemic hemodilution combined with controlled hypotension on hemodynamics and regional cerebral blood flow / 中华麻醉学杂志

0 05) HR in group A was faster than that in group B at T 3 (P