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Cognitive symptoms are common during and following episodes of depression. Little is known about the persistence of self-reported and performance-based cognition with depression and functional outcomes.
This is a secondary analysis of a prospective naturalistic observational clinical cohort study of individuals with recurrent major depressive disorder (MDD; N = 623). Participants completed app-based self-reported and performance-based cognitive function assessments alongside validated measures of depression, functional disability, and self-esteem every 3 months. Participants were followed-up for a maximum of 2-years. Multilevel hierarchically nested modelling was employed to explore between- and within-participant variation over time to identify whether persistent cognitive difficulties are related to levels of depression and functional impairment during follow-up.
508 individuals (81.5%) provided data (mean age: 46.6, s.d.: 15.6; 76.2% female). Increasing persistence of self-reported cognitive difficulty was associated with higher levels of depression and functional impairment throughout the follow-up. In comparison to low persistence of objective cognitive difficulty (<25% of timepoints), those with high persistence (>75% of timepoints) reported significantly higher levels of depression (B = 5.17, s.e. = 2.21, p = 0.019) and functional impairment (B = 4.82, s.e. = 1.79, p = 0.002) over time. Examination of the individual cognitive modules shows that persistently impaired executive function is associated with worse functioning, and poor processing speed is particularly important for worsened depressive symptoms.
We replicated previous findings of greater persistence of cognitive difficulty with increasing severity of depression and further demonstrate that these cognitive difficulties are associated with pervasive functional disability. Difficulties with cognition may be an indicator and target for further treatment input.
Several studies suggest that patients with late-onset major depression (MD) have an increased load of cerebral white-matter lesions (WMLs) compared with age-matched controls. Vascular risk factors such as hypertension and smoking may confound such findings. Our aim was to investigate the association between the localization and load of WMLs in late-onset MD with respect to vascular risk factors.
We examined 22 consecutive patients with late-onset first-episode MD and 22 age- and gender-matched controls using whole-brain magnetic resonance imaging (MRI). The localization, number and volume of WMLs were compared between patients and controls, while testing the effect of vascular risk factors.
Among subjects with one or more WMLs, patients displayed a significantly higher WML density in two white-matter tracts: the left superior longitudinal fasciculus and the right frontal projections of the corpus callosum. These tracts are part of circuitries essential for cognitive and emotional functions. Analyses revealed no significant difference in the total number and volume of WMLs between groups. Patients and controls showed no difference in vascular risk factors, except for smoking. Lesion load was highly correlated with smoking.
Our results indicate that lesion localization rather than lesion load differs between patients with late-onset MD and controls. Increased lesion density in regions associated with cognitive and emotional functions may be crucial in late-onset MD, and vascular risk factors such as smoking may play an important role in the pathophysiology of late-onset MD, consistent with the vascular depression hypothesis.
Three fundamentally different methods were used to fabricate nanometric surface features on polymers or fused silica. Phase separation of binary polymer mixes resulted in randomly distributed features whose depth and shape could be tightly controlled over large areas. Colloidal resist patterned large areas randomly and uniformly with very fine spikes. In contrast e-beam and reactive ion etching were used to create a set of regular spaced pillars on an orthogonal pattern. Some of the surfaces were replicated by in situ polymerization, solvent casting, embossing or melt molding onto polystyrene (PS) or ε–poly caprolactone (ε–PCL). Nanometric features down to 60nm were imprinted onto the polymers with high fidelity. Cells were seeded onto the nanometric surfaces and adhesion, morphology and cytoskeleton investigated. Cells respond to regular features of 170/80nm (width/depth) with reduced adhesion and changes in overall morphology and cytoskeleton. Small nanofeatures (13nm, 35nm depth) made by phase separation on the other hand increased adhesion and promoted cytoskeletal differentiation. The responses of the cells are indicative that nanometric surface features are useful modifications on scaffolds for tissue engineering or on medical implants.
Healthy pregnant women (n 23) were supplemented with fish-oil capsules (2·7 g n-3 polyunsaturated fatty acids/d) from the 30th week of gestation until delivery. Subjects in a control group were either supplemented with olive-oil capsules (4 g/d, n 6) or received no supplementation (n 10). Fatty acid compositions of the phospholipids isolated from umbilical plasma and umbilical arterial and venous vessel walls were determined. Fatty acid compositions of maternal venous plasma phospholipids were determined as well. Maternal plasma phospholipids of the fish-oil-supplemented group contained more n-3 fatty acids and less n-6 fatty acids. Moreover, the amounts of the essential fatty acid deficiency markers Mead acid (20:3n-9) and Osbond acid (22:5n-6) were significantly lower. The extra amount of n-3 fatty acids consumed by the mothers resulted in higher contents of n-3 fatty acids, and of docosahexaenoic acid (22:6n-3) in particular, in the phospholipids of umbilical plasma and vessel walls. It is, indeed, possible to interfere with the docosahexaenoic acid status at birth: children born to mothers supplemented with fish oil in the last trimester of pregnancy start with a better docosahexaenoic acid status at birth, which may be beneficial to neonatal neurodevelopment.
The requirement for a training period prior to a choice feeding regime was assessed using 36 weaned piglets whose initial live weight was 6·2 (s.d. 1·21) kg. Two foods (H and L) were offered ad libitum as the choice and these were similar in energy but differed in crude protein (CP) concentration (291 g/kg and 155 g/kg fresh matter respectively). The pigs ivere subjected to one of three training treatments: treatment ALTERNATE allowed piglets the two foods separately on alternate days for 6 days, followed by a free choice of the two foods; treatment THREE allowed 3 days of one food followed by 3 days of the other prior to the free choice; treatment CHOICE gave the animals free choice immediately. Piglets on a fourth treatment, CONTROL, were given a single food M (242 g CP per kg fresh food) as a control. Weight gain (0·60, 0·59, 0·59 and 0·61 (s.e. 0·005) kg/day) and food intake (0·776, 0·752, 0·771 and 0·747 (s.e. 0·010) kg/day) did not differ significantly between treatments ALTERNATE, THREE, CHOICE and CONTROL respectively in the 19-day post-training period. A significant difference was seen in the protein consumption (0·145, 0·150, 0·139 and 0·177 (s.e. 0·005) kg/day). This together with a tendency for the proportion of food H selected to decline as the growth period progressed, indicated that newly weaned piglets are capable of regulating their protein intake when offered a free choice of two foods differing in their CP concentration, without a necessity for an initial training period.
Two-hundred-and-twenty-one patients with squamous carcinoma of the oropharynx treated by irradiation are presented.
The primary recurrence rate at five years in the previously untreated patients was 27%, but was dictated by neither host factors (age, sex and general condition) nor tumour factors (site, T-stage and histological grade).
Pre-operative histological diagnosis had a very high sensitivity but a low specificity, indicating that false positives are common but false negatives unusual. Twenty per cent of patients with a recurrent primary tumour were untreatable.
The five year survival after a primary recurrence was 31 per cent. Sixty-eight per cent of patients undergoing major surgery recovered without a major complication, and the hospital mortality rate was three per cent, due entirely to major medical catastrophes. The major complication rate in those undergoing flap repair after major resection was seven percent.
The metastatic rate in lymph nodes was 44 per cent at five years, and again this did not depend on any host or tumour factors. The survival at five years after node recurrence was a mere 19 per cent, and the length of survival was related to the primary site of the original tumour and the presence of extranodal disease. Two-thirds of patients had advanced disease (N2 and N3) when node recurrence was diagnosed and about 15 percent were unsuitable for surgery.