Brand-Name Antidepressants Outperform Their Generic Counterparts in Preventing Hospitalization for Depression: The Real-World Evidence from Taiwan

BackgroundGeneric antidepressants are approved on the market based on evidence of bioequivalence to their brand-name versions. We aimed to assess whether generic antidepressants exert equal effectiveness as their brand-name counterparts for treating patients with depressive disorders.MethodsIn a nationwide, population-based cohort in Taiwan from 1997 through 2013, patients with a diagnosis of a depressive disorder aged between 18 and 65 years who were new users of antidepressant drugs were classified into either the brand-name group or the generic group. All patients were followed up until medication discontinuation or the end of the study period. We assessed the risk for hospitalization as a primary outcome and augmentation therapy, daily dose, medication discontinuation, or switching to another antidepressant as secondary outcomes.ResultsA total of 277 651 brand-name users (35.8% male; mean age: 41.2 years) and 270 583 generic users (35.8% male; mean age: 41.0 years) were divided into 10 different antidepressant groups (fluoxetine, sertraline, paroxetine, escitalopram, citalopram, venlafaxine, mirtazapine, moclobemide, imipramine, and bupropion). We found that patients treated with the generic form of sertraline, paroxetine, escitalopram, venlafaxine, mirtazapine, and bupropion demonstrated significantly higher risks of psychiatric hospitalization (adjusted hazard ratios ranged from 1.20–2.34), compared to their brand-name counterparts. The differences between brand-name antidepressants and their generic counterparts in secondary outcomes varied across different drugs.ConclusionsCompared to most generic antidepressants, brand-name drugs exhibited more protective effects on psychiatric hospitalization for depressive patients. These findings could serve as an important reference for clinicians when encountering patients with depressive disorder.     

大鼠头颅瞬间侧向旋转后脑干水肿的形成及其超微形态学基础

目的：探讨头颅瞬间旋转后脑干水肿的形成及超微形态学基础。     

大鼠急性颅脑损伤后脑微循环的变化

目的 研究鼠急性颅脑损伤后脑微循环的改变,以找出影响颅脑损伤与恢复变化的规律。方法 大鼠１００只随机分为５组,采用自由落体致大鼠脑损伤,伤后０．５,３．２４和１６８ｈ取材,研究脑微血管形态学变化,并用核磁共振波谱法分析颅脑损伤局部脑组织代谢的变化。结果 大鼠实验性脑损伤后０．５～２４ｈ大脑皮层微血管减少,并有“微无血管区”,微血管内可见微血栓形成;血脑屏障（ＢＢＢ）通透性增加,出现脑水肿,颅脑损伤     

Erratum to: Inflammation in Patients with Schizophrenia: The Therapeutic Benefits of Risperidone Plus Add-On Dextromethorphan

Journal of Neuroimmune Pharmacology -     

A Placebo-Controlled Trial of Dextromethorphan as an Adjunct in Opioid-Dependent Patients Undergoing Methadone Maintenance Treatment

Background:

Low-dose dextromethorphan (DM) might have anti-inflammatory and neurotrophic effects mechanistically remote from an NMDA receptor. In a randomized, double-blind, controlled 12 week study, we investigated whether add-on dextromethorphan reduced cytokine levels and benefitted opioid-dependent patients undergoing methadone maintenance therapy (MMT).

Methods:

Patients were randomly assigned to a group: DM60 (60mg/day dextromethorphan; n = 65), DM120 (120mg/day dextromethorphan; n = 65), or placebo (n = 66). Primary outcomes were the methadone dose required, plasma morphine level, and retention in treatment. Plasma tumor necrosis factor (TNF)-α, C-reactive protein, interleukin (IL)-6, IL-8, transforming growth factor–β1, and brain-derived neurotrophic factor (BDNF) levels were examined during weeks 0, 1, 4, 8, and 12. Multiple linear regressions with generalized estimating equation methods were used to examine the therapeutic effect.

Results:

After 12 weeks, the DM60 group had significantly longer treatment retention and lower plasma morphine levels than did the placebo group. Plasma TNF-α was significantly decreased in the DM60 group compared to the placebo group. However, changes in plasma cytokine levels, BDNF levels, and the methadone dose required in the three groups were not significantly different.

Conclusions:

We provide evidence—decreased concomitant heroin use—of low-dose add-on DM’s efficacy for treating opioid-dependent patients undergoing MMT.     

The Associations between Visual Attention and Facial Expression Identification in Patients with Schizophrenia

Objective

Visual search is an important attention process that precedes the information processing. Visual search also mediates the relationship between cognition function (attention) and social cognition (such as facial expression identification). However, the association between visual attention and social cognition in patients with schizophrenia remains unknown. The purposes of this study were to examine the differences in visual search performance and facial expression identification between patients with schizophrenia and normal controls, and to explore the relationship between visual search performance and facial expression identification in patients with schizophrenia.

Methods

Fourteen patients with schizophrenia (mean age=46.36±6.74) and 15 normal controls (mean age=40.87±9.33) participated this study. The visual search task, including feature search and conjunction search, and Japanese and Caucasian Facial Expression of Emotion were administered.

Results

Patients with schizophrenia had worse visual search performance both in feature search and conjunction search than normal controls, as well as had worse facial expression identification, especially in surprised and sadness. In addition, there were negative associations between visual search performance and facial expression identification in patients with schizophrenia, especially in surprised and sadness. However, this phenomenon was not showed in normal controls.

Conclusion

Patients with schizophrenia who had visual search deficits had the impairment on facial expression identification. Increasing ability of visual search and facial expression identification may improve their social function and interpersonal relationship.     

CD4+CD25+调节性T细胞在约氏疟原虫感染早期作用机制的实验研究

目的探讨CD4^＋CD25^＋调节性T细胞在约氏疟原虫感染早期的免疫调节机制。方法用抗CTLA-4 mAb和抗CD25 mAb分别与约氏疟原虫感染早期的小鼠脾细胞共同培养后,以ELISA法检测其培养上清的IL-10、TGF-β1及IFN-γ的含量。结果与抗CTLA-4 mAb共同培养后,脾细胞上清中IL-10的水平明显降低,但TGF-β1和IFN-γ水平未出现有意义的变化;与抗-CD25 mAb共同培养后,IL-10、TGF-β1和IFN-γ水平均未出现有意义的变化,但IL-10水平有一定的降低趋势。结论约氏疟原虫感染早期,IL-10可能是介导CD4^＋CD25^＋调节性T细胞参与免疫调节的关键性细胞因子,CD4^＋CD25^＋调节性T细胞可能通过CTLA-4发挥免疫抑制作用。     

DICE方案治疗复发或耐药中高度恶性非霍奇金淋巴瘤

背景与目的:复发或耐药非霍奇金淋巴瘤(non鄄Hodgkin蒺slymphoma,NHL)目前尚无标准的解救化疗方案,DICE、ESHAP、MINE和EPOCH等常见的解救治疗方案缓解率仅为30%～70%。本文旨在观察DICE方案作为解救化疗方案治疗复发或耐药中高度恶性NHL的疗效和安全性。方法:选取35例复发或耐药的中高度恶性NHL患者,其中T细胞和B细胞NHL分别为14和21例,既往接受过以CHOP或CHOP样方案为主中位6周期(2～12个周期)的化疗,采用DICE方案进行解救治疗。结果:35例患者接受了中位4周期(2～7个周期)的DICE方案化疗,所有患者均可评价疗效和不良反应。总的客观有效率为74.3%,完全缓解率为31.4%;中位缓解时间为4个月(1～30个月),中位至治疗失败时间为7个月(2～34个月),中位生存期为14个月(3～51个月),实际2年生存率为33.3%。T细胞和B细胞NHL的有效率分别为85.7%(12/14)和66.7%(14/21),完全缓解率分别为50.0%(7/14)和19.0%(4/21)(P=0.073)。LDH升高和伴有巨大肿块是影响解救治疗疗效的高危因素(P<0.05),DICE解救疗效是复发耐药患者生存期的独立预后因素(P=0.001)。主要不良反应为骨髓抑制,Ⅲ～Ⅳ度粒细胞和血小板减少的发生率分别为71.4%和8.6%。结论:DICE方案是复发或耐药中高度恶性NHL安全有效的解救治疗方案。LDH升高和伴有巨大     

Early and rapid detection of enterovirus 71 infection by an IgM-capture ELISA

Enterovirus 71 infection is more likely to induce severe complications and mortality than other enteroviruses. Laboratory diagnosis of enterovirus 71 in Taiwan still relies mainly on conventional virus isolation techniques that often require 5-10 days to obtain a result, thus hindering seriously the subsequent treatment and disease control measures. This study was to find a better alternative by developing a rapid enterovirus 71 detecting procedure, which can afford an earlier diagnosis and a more rapid outcome. In this study, an enterovirus 71-IgM-capture enzyme-linked immunosorbent assay (ELISA) was designed and tested with a total of 336 serum specimens collected from 236 cases of reported enterovirus infection with complications. Using virus isolation and neutralization test as standards, the sensitivity and specificity of the new protocol were 97.7 and 93.3%, respectively. Most of the IgM positive serum specimens were collected within 7 days after the onset of symptoms, while it appeared detectable up to 94 days after the onset of symptoms. Apart from being highly sensitive, rapid and low in cost, the new IgM-capture ELISA is sufficiently accurate to provide also reliable results for early detection of the virus. With this protocol, enterovirus 71 infections can be detected within 4h.