Gender differences in post-stroke depression: A longitudinal analysis of prevalence,persistence and predictive value of known risk factors

ABSTRACT

Post-stroke depression (PSD) is the most frequent psychiatric condition after stroke with a prevalence of approximately 33%. In the general population, depression is consistently reported to be more frequent in women than in men. Evidence about gender differences in PSD remains inconclusive and it is unknown if established risk factors exert gender-specific influence. The authors examined gender differences in PSD prevalence, persistence and influence of established risk factors using χ ²- and Welch’s t-tests and continuous-time structural equation modelling (CT-SEM). Patients (N?=?301) from the longitudinal Berlin-PSD-study were assessed six weeks (baseline), and up to four times during the first 2.5 years post-stroke using DSM-5 depression criteria and the Geriatric Depression Scale (GDS). Established risk factors were assessed at baseline. Women showed higher PSD prevalence and severity at baseline (p?<?.01) but not thereafter (p?≥?.43). CT-SEM analysis revealed that known risk factors predicted depression, yet predictive value and persistence did not differ between genders. Our results showed that established PSD risk factors influence both genders to a similar extent and that in contrast to depression in the general population, gender differences in PSD prevalence and severity disappeared within six months post-stroke. Thus, for reasons yet to be deciphered, gender differences in PSD appear to be time-dependent after stroke.     

Impact of surgical site infection and surgical debridement on lumbar arthrodesis: A single-institution analysis of incidence and risk factors

This study identifies the rate of pseudarthrosis following surgical debridement for deep lumbar spine surgical site infection and identify associated risk factors. Patients who underwent index lumbar fusion surgery from 2013 to 2014 were included if they met the following criteria: 1) age >18 years, 2) had debridement of deep lumbar SSI, and had 3) lumbar spine AP, lateral and flexion/extension X-rays and computed tomography (CT) at 12 months or greater postoperatively. Criteria for fusion included 1) solid posterolateral, facet, or disk space bridging bone, 2) no translational or angular motion on flexion/extension X-rays, and 3) intact posterior hardware without evidence of screw lucency or breakage. Twenty-five patients (age 63.2 ± 12.6 years, 10 male) involving 58 spinal levels met inclusion criteria. They underwent fusion at a mean of 2.32 [range 1–4] spinal levels. Sixteen (64.0%) patients received interbody grafts at a total of 34 (58.6%) spinal levels. All underwent surgical debridement with removal of all non-incorporated posterior bone graft and devascularized tissue. At one-year postoperatively, (56%) patients and 30 (52%) spinal levels demonstrated radiographic evidence of successful fusion. Interbody cage during initial fusion was significantly associated with successful arthrodesis at follow-up (p = 0.017). There is a high rate of pseudoarthrosis in 44% of patients (48% of levels) undergoing lumbar fusion surgery complicated by SSI requiring debridement. Use of interbody cage during initial fusion was significantly associated with higher rate of arthrodesis.     

Impact of molecular and clinical variables on survival outcome with immunotherapy for glioblastoma patients: A systematic review and meta‐analysis

BackgroundGiven that only a subset of patients with glioblastoma multiforme (GBM) responds to immuno‐oncology, this study aimed to assess the impact of multiple factors on GBM immunotherapy prognosis and investigate the potential predictors.MethodsA quantitative meta‐analysis was conducted using the random‐effects model. Several potential factors were also reviewed qualitatively.ResultsA total of 39 clinical trials were included after screening 1317 papers. Patients with O6‐methylguanine‐DNA methyltransferase (MGMT) promoter methylation [hazard ratio (HR) for overall survival (OS) = 2.30, p < 0.0001; HR for progression‐free survival (PFS) = 2.10, p < 0.0001], gross total resection (HR for OS = 0.70, p = 0.02; HR for PFS = 0.56, p = 0.004), and no baseline steroid use (HR for OS = 0.52, p = 0.0002; HR for PFS = 0.61, p = 0.02) had a relatively significant favorable OS and PFS following immunotherapy. Patients with a Karnofsky Performance Status score < 80 (HR = 1.73, p = 0.0007) and undergoing two prior relapses (HR = 2.08, p = 0.003) were associated with worse OS. Age, gender, tumor programmed death‐ligand 1 expression, and history of chemotherapy were not associated with survival outcomes. Notably, immunotherapy significantly improved the OS among patients undergoing two prior recurrences (HR = 0.40, p = 0.008) but not among patients in any other subgroups, as opposed to non‐immunotherapy.ConclusionSeveral factors were associated with prognostic outcomes of GBM patients receiving immunotherapy; multiple recurrences might be a candidate predictor. More marker‐driven prospective studies are warranted.     

Social comparison in the brain: A coordinate‐based meta‐analysis of functional brain imaging studies on the downward and upward comparisons

Social comparison is ubiquitous across human societies with dramatic influence on people's well‐being and decision making. Downward comparison (comparing to worse‐off others) and upward comparison (comparing to better‐off others) constitute two types of social comparisons that produce different neuropsychological consequences. Based on studies exploring neural signatures associated with downward and upward comparisons, the current study utilized a coordinate‐based meta‐analysis to provide a refinement of understanding about the underlying neural architecture of social comparison. We identified consistent involvement of the ventral striatum and ventromedial prefrontal cortex in downward comparison and consistent involvement of the anterior insula and dorsal anterior cingulate cortex in upward comparison. These findings fit well with the “common‐currency” hypothesis that neural representations of social gain or loss resemble those for non‐social reward or loss processing. Accordingly, we discussed our findings in the framework of general reinforcement learning (RL) hypothesis, arguing how social gain/loss induced by social comparisons could be encoded by the brain as a domain‐general signal (i.e., prediction errors) serving to adjust people's decisions in social settings. Although the RL account may serve as a heuristic framework for the future research, other plausible accounts on the neuropsychological mechanism of social comparison were also acknowledged. Hum Brain Mapp 39:440–458, 2018. © 2017 Wiley Periodicals, Inc.