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Introduction:Depression is a common mental disorder worldwide. The pathology of depression may involve the dysregulation of neurotransmitters and immunity and produce genetic and environmental effects. Traditional Chinese Medicine (TCM) has been practiced for several thousand years and has a different understanding of depression compared to Western medicine. However, this approach has not been widely accepted by scientific communities as TCM mainly focuses on clinical practice.Methods:In this study, we conducted a cross-sectional study among 100 participants in a rehabilitation hospital to analyze the plausible pathways linking TCM-based liver function and depression, which we hypothesized in a prior theoretical review.Results:A significant relationship between adrenocorticotropic hormone and TCM-based liver function was found (r = 0.211, p = 0.041). Cortisol was significantly associated with norepinephrine (r = 0.243, p = 0.015) and adrenocorticotropic hormone (r = 0.302, p r = 0.272, p p = 0.690).Discussion:These results suggest that TCM-based liver function can be interpreted using the hypothalamic-pituitary-adrenal axis. This is a pioneering study to examine the mechanisms of depression in relation to liver function by integrating Eastern and Western medical approaches. The findings of this study are valuable for a deeper understanding of depression and public education.

Narrative review.To evaluate the availability and quality of breastfeeding guidelines for women with spinal cord injury (SCI).International Collaboration on Repair Discoveries (ICORD), Department of Medicine, Vancouver, BC.An environmental scan restricted to English language literature was performed to identify existing postpartum and breastfeeding guidelines. Guidelines were evaluated using a structured, validated tool (AGREE II) by 13 appraisers [medical/research experts (n = 10) and those with lived experience (n = 3)] from Vancouver and two international sites. Seven guidelines were evaluated across Domain 1 of the AGREE II tool to determine if they were applicable to mothers with SCI/physical disabilities. Domains 2 to 7 were evaluated if the guideline made mention of the SCI population.Of the seven guidelines evaluated, only one mentioned SCI (Postpartum Care in SCI from BC Women's Hospital). Other guidelines were excluded from further evaluation as they did not address the issue of breastfeeding in women with SCI. The overall scaled score for this guideline was 34.5%. There was significant variability between domains but no AGREE II domain scored greater than 50%, indicating substantial limitations.Current breastfeeding guidelines are not targeted to persons with SCI. The one guideline that made mention of women with SCI had significant global deficits. This highlights the importance of developing guidelines for health care providers focused specifically on women with SCI to support and optimize breastfeeding in this unique population for the benefit of mother and infant across the lifespan.

This study examined the effects of storytelling with or without contextual information on children with autism spectrum disorder (ASD) and typical development (TD) using eye-tracker. They were randomized into two groups-the stories included and did not include social contextual information respectively. Training was delivered in groups, with eight sessions across four weeks, 30 min/session. Participants' fixation duration, visit duration, and fixation count on human faces from 20 photos and a video were recorded. Our findings revealed that storytelling with social contextual information enhanced participants' eye gazes on eyes/ faces in static information (photos) for both children with ASD and TD, but the same advantage could not be seen for children with ASD in regard to dynamic information (videos).Clinical Trial Registration Number (URL: http://www.clinicaltrials.gov ): NCT04587557.

Background: Transcranial direct-current stimulation (tDCS) facilitates cognitive improvement in healthy and pathological populations. It has been increasingly used in cases of mild cognitive impairment (MCI) and dementia. Our research question is: Can tDCS serve as a clinical intervention for improving the cognitive functions of persons with MCI (PwMCI) and dementia (PwD)? Objective: This systematic review evaluated the evidence to determine the efficacy of tDCS in improving cognitive outcomes in PwD and PwMCI. Methods: A systematic review was conducted of studies published up to November 2017 involving tDCS in cases of MCI and dementia. Studies were ranked according to the level of evidence (Oxford Center for Evidence-Based Medicine) and assessed for methodological quality (Risk of Bias Tool in the Cochrane Handbook for Systematic Reviews of Interventions). Data was extracted on all protocol variables to establish a reference framework for clinical interventions. Different modalities, tDCS alone or combined with cognitive training, compared with sham tDCS were examined in both short and long-term effects. Four randomized control trials (RCTs) with memory outcomes were pooled using the fixed-effect model for the meta-analysis. Results: Twelve studies with 195 PwD and four with 53 PwMCI met the inclusion criteria. Eleven articles were ranked as Level 1b. The results on the meta-analysis on pooled effects of memory indicated a statistically significant medium effect size of 0.39 (p = 0.04) for immediate effects. This improvement was not maintained in the long term 0.15 (p = 0.44). Conclusion: tDCS improves memory in PwD in the short term, it also seems to have a mild positive effect on memory and language in PwMCI. However, there is no conclusive advantage in coupling tDCS with cognitive training. More rigorous evidence is needed to establish whether tDCS can serve as an evidence-based intervention for both populations.

Objectives.To compare the performances of two impedancecardiographs, the RheoCardioMonitor (RCM) and the BoMed NCCOM3, usingtrend analysis. This involved a series of head-up tilts, a simulation ofthe stroke volume (SV) and cardiac output (CO) response, calculation ofprediction errors and cumulative sums (Cusum). Methods.Eighthealthy male volunteers, aged 27–37 years, were tilted on fouroccasions to angles of 55°, 15°, 30° and 55°, whilstrecording SV and CO every 10-sec. Baseline and percentage changes withtilting were calculated. A simulation of the tilt response wasconstructed, and from this residuals (observed-predicted) and predictionerrors ((observed-predicted)/predicted) ×100% werecalculated at 10-sec intervals. Trend analysis was performed by multipleanalysis of the variance of serial measurements and graphicallyassessing changes in serial SV prediction errors, using Cusums. Resultsare presented as mean (range or SD). Results.Baseline values forRCM-SV were 76 (35–94) ml and for CO 4.7 (2.8–6.1)litre· min−1. For BoMed-SV they were 113(90–164) ml and for CO 7.2 (5.5–11.9) litre·min−1. Head-up tilting to 55° resulted in a 32(12)% decrease in RCM-SV and a 21 (11)% decrease inBoMed-SV (p< 0.01). Prediction errors for RCM-SV were (6.5(4.9)%) and for BoMed-SV (6.8 (5.2)%) (p=0.048). Cusum analysis showed that in 84% of tests, impedancemeasurements remained within ± 10% of the initialcalibration. There was no difference between devices (χ 2= 0.92). Conclusions.Simulation of a physiological response,such as that to head-up tilting, and using a trend analysis based onprediction errors and Cusum, is a useful technique. The trendingabilities of the RCM and BoMed were similar.

A systematic review of the effectiveness of rehabilitation for persons with unilateral neglect (UN) after stroke was conducted by searching the computerized databases from 1997 through 2012. Randomized controlled trials (RCTs) of neglect treatment strategies for stroke patients which used the Behavioral Inattention Test (BIT) as the primary outcome measure were eligible for inclusion. Out of 201 studies initially identified, 12 RCTs covering 277 participants were selected for analysis. All had the same weakness of low power with smaller samples and limitation in the blinding of the design. Prism Adaptation (PA) was the most commonly used intervention while continuous Theta-burst stimulation (cTBS) appeared to be a new approach. Meta-analysis showed that for immediate effects, the BIT conventional subscore had a significant and large mean effect size (ES = 0.76; 95% CI 0.28–1.23; p = 0.002) whereas the BIT total score showed a modestly significant mean ES (ES = 0.55; 95% CI 0.16–0.94; p = 0.006). No significant mean ES in sensitivity analysis was found for long-lasting effects across all BIT outcomes. PA appeared to be the most effective intervention based on the results of pooled analysis. More rigorous studies should be done on repetitive transcranial magnetic stimulation (rTMS) before it can be concluded that it is a promising treatment for UN.

We aimed to fill the literature gap by identifying the clinical benefits of aromatherapy in older adults with dementia, and its efficacy in reducing behavioral and psychological symptoms of dementia (BPSD) based on available randomized controlled trials (RCT). A systematic review of 11 clinical trials shortlisted from electronic databases from 1995 to 2011 was carried out. The RCT showed that aromatherapy had positive effects on reduction of BPSD, improvement in cognitive functions, increasing quality of life, enhancing independence of activities of daily living and so on. However, adverse effects were noted in some studies. Limitations on methodology are discussed and suggestions on directions of further studies are made. It is recommended that aromatherapy shows the potential to be applied as a therapeutic and safe complementary and alternative therapy for the management of BPSD on more evidence collected from better designed RCT.

Predictors of employment outcomes of individuals with schizophrenia have continued to be studied over the past decade with implications for the development of vocational interventions to help the mentally ill get and keep jobs.A total of 62 relevant studies since 1998 were systematically reviewed by means of meta-analysis and frequency counts. Frequency count allowed all 62 studies to be included, whereas the meta-analysis excluded studies with inadequate information but made it possible to estimate the magnitude of effects.Both methods resulted in similar findings. In contrast to an earlier review, cognitive functioning received overwhelming support as a significant predictor. Other significant predictors included education, negative symptoms, social support and skills, age, work history (previous history of successful employment), and rehabilitation service to restore community functioning and well-being by occupational therapists, psychiatrists, psychologists, social workers and other mental health professionals. Positive symptoms, substance abuse, gender and hospitalization history were found to be non-significant predictors. The frequency count did not support marital status as a significant predictor but the meta-analysis did.This review highlights increasing sophistication in understanding the links between individual characteristics and functional impairments. It also suggests that more research is needed into other potentially important predictors that may be changeable and relate to recovery. These include attitudes and beliefs about disability payments and psychological processes such as self-stigmatization, negative beliefs, and social skills deficits for which intervention may be possible.

Background and Objective: To assess the effect of publication bias and country effect on the results and conclusion of a systematic review of wrist P6 acupoint stimulation for the prevention of postoperative nausea and vomiting. Methods: Reanalysis of a systematic review of 26 randomized trials comparing P6 acupoint stimulation with sham published in the Cochrane Database of Systematic Reviews using the Copas' sensitivity approach. Results: If it is assumed that all studies that have ever been carried out are included, or that those selected for review are truly representative of all such studies, then the estimated relative risk (RR) for nausea was 0.71 (95% Cl: 0.58 to 0.88, P

To compare the performances of two impedance cardiographs, the RheoCardioMonitor (RCM) and the BoMed NCCOM3, using trend analysis. This involved a series of head-up tilts, a simulation of the stroke volume (SV) and cardiac output (CO) response, calculation of prediction errors and cumulative sums (Cusum).Eight healthy male volunteers, aged 27-37 years, were tilted on four occasions to angles of 55 degrees, 15 degrees, 30 degrees and 55 degrees, whilst recording SV and CO every 10-sec. Baseline and percentage changes with tilting were calculated. A simulation of the tilt response was constructed, and from this residuals (observed-predicted) and prediction errors ((observed-predicted)/predicted) x 100% were calculated at 10-sec intervals. Trend analysis was performed by multiple analysis of the variance of serial measurements and graphically assessing changes in serial SV prediction errors, using Cusums. Results are presented as mean (range or SD).Baseline values for RCM-SV were 76 (35-94) ml and for CO 4.7 (2.8-6.1) litre x min(-1). For BoMed-SV they were 113 (90-164) ml and for CO 7.2 (5.5-11.9) litre x min(-1). Head-up tilting to 55 degrees resulted in a 32 (12)% decrease in RCM-SV and a 21 (11)% decrease in BoMed-SV (p0.01). Prediction errors for RCM-SV were (6.5 (4.9)%) and for BoMed-SV (6.8 (5.2)%) (p = 0.048). Cusum analysis showed that in 84% of tests, impedance measurements remained within +/- 10% of the initial calibration. There was no difference between devices (chi2 = 0.92).Simulation of a physiological response, such as that to head-up tilting, and using a trend analysis based on prediction errors and Cusum, is a useful technique. The trending abilities of the RCM and BoMed were similar.