Treatment-resistant depression: definition,prevalence, detection,management, and investigational interventions

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.     

Use of arboreal and terrestrial space by a small mammal community in a tropical rain forest in Borneo, Malaysia

Aim Small mammals were live‐trapped in a primary rain forest to evaluate the relative distribution of species to each other and to microhabitat properties on the ground and in the canopy. Location Kinabalu National Park in Borneo, Sabah, Malaysia. Methods Seven trapping sessions were conducted along two grids with 31 trap points at distances of 20 m on the ground and in the lower canopy at an average height of 13.5 m. Results Species diversity and abundance of small mammals proved to be high: 20 species of the families Muridae, Sciuridae, Tupaiidae, Hystricidae, Viverridae and Lorisidae were trapped, with murids being dominant in both habitat layers. The terrestrial community was significantly more diverse with 16 captured species (Shannon–Wiener's diversity index = 2.47), while 11 species were trapped in the canopy ( = 1.59). The Whitehead's rat, Maxomys whiteheadi, and the red spiny rat, Maxomys surifer, dominated the terrestrial community whereas the large pencil‐tailed tree mouse, Chiropodomys major, was by far the most abundant species in the canopy. Other abundant species of the canopy community, the dark‐tailed tree rat, Niviventer cremoriventer, and the lesser treeshrew, Tupaia minor, were also abundant on the ground, and there was no clear boundary between arboreal and terrestrial species occurrences. Main conclusions As most species were not confined to specific microhabitats or habitat layers, species seemed to rely on resources not necessarily restricted to certain microhabitats or habitat layers, and separation of species probably resulted mainly from a species’ concentrated activity in a preferred microhabitat rather than from principal adaptations to certain habitats. Ecological segregation was stronger in the more diverse terrestrial community, though microhabitat selection was generally not sufficient to explain the co‐occurrences of species and the variability between local species assemblages. Constraints on small mammal foraging efficiency in the three‐dimensional more complex canopy may be responsible for the similarity of microhabitat use of all common arboreal species. Community composition was characterized by mobile species with low persistence rates, resulting in a high degree of variability in local species assemblages with similar turnover rates in both habitats.     

Li+ Pre‐Insertion Leads to Formation of Solid Electrolyte Interface on TiO2 Nanotubes That Enables High‐Performance Anodes for Sodium Ion Batteries

Recently, sodium ion batteries (SIBs) have been widely investigated as one of the most promising candidates for replacing lithium ion batteries (LIBs). For SIBs or LIBs, designing a stable and uniform solid electrolyte interphase (SEI) at the electrode–electrolyte interface is the key factor to provide high capacity, long‐term cycling, and high‐rate performance. In this paper, it is described how a remarkably enhanced SEI layer can be obtained on TiO₂ nanotube (TiO₂ NTs) arrays that allows for a strongly improved performance of sodium battery systems. Key is that a Li⁺ pre‐insertion in TiO₂ NTs can condition the SEI for Na⁺ replacement. SIBs constructed with Li‐pre‐inserted NTs deliver an exceptional Na⁺ cycling stability (e.g., 99.9 ± 0.1% capacity retention during 250 cycles at a current rate of 50 mA g^?1) and an excellent rate capability (e.g., 132 mA h g^?1 at a current rate of 1 A g^?1). The key factor in this outstanding performance is that Li‐pre‐insertion into TiO₂ NTs leads not only to an enhanced electronic conductivity in the tubes, but also expands the anatase lattice for facilitated subsequent Na⁺ cycling.     

An interaction map of endoplasmic reticulum chaperones and foldases

Chaperones and foldases in the endoplasmic reticulum (ER) ensure correct protein folding. Extensive protein-protein interaction maps have defined the organization and function of many cellular complexes, but ER complexes are under-represented. Consequently, chaperone and foldase networks in the ER are largely uncharacterized. Using complementary ER-specific methods, we have mapped interactions between ER-lumenal chaperones and foldases and describe their organization in multiprotein complexes. We identify new functional chaperone modules, including interactions between protein-disulfide isomerases and peptidyl-prolyl cis-trans-isomerases. We have examined in detail a novel ERp72-cyclophilin B complex that enhances the rate of folding of immunoglobulin G. Deletion analysis and NMR reveal a conserved surface of cyclophilin B that interacts with polyacidic stretches of ERp72 and GRp94. Mutagenesis within this highly charged surface region abrogates interactions with its chaperone partners and reveals a new mechanism of ER protein-protein interaction. This ability of cyclophilin B to interact with different partners using the same molecular surface suggests that ER-chaperone/foldase partnerships may switch depending on the needs of different substrates, illustrating the flexibility of multichaperone complexes of the ER folding machinery.     

Determination of the antiproliferative activity of human recombinant interferon (reaferon) on diploid human cells

Dependence of the antiproliferative activity of reaferon in cultures of human diploid cells on the drug dose and duration of its action on the cells was studied by counting viable cells in the Goriaev chamber. No relationship was detected. However, such dependence was clearly evident with using tumor cells. With counting of mitoses it was shown that in doses of 10(4) and 10(3) IU reaferon significantly inhibited the cell mitotic activity when the mitotic index in the control of the strain M-19 cells exceeded 25%. When the mitotic index was lower than 25% reaferon in all the doses had no inhibitory effect on the cells. On the contrary it was noted that there was even a certain tendency to stimulation of the mitotic activity. Therefore, the line of the human diploid fibroblast cells (strain M-19) may be used for assay of reaferon antiproliferative activity in case of high mitotic activity in its monolayer (the mitotic index higher than 25%). It was also demonstrated that the dose of reaferon should be not lower than 1000 IU per 1 ml of the medium.     

Stigmatization of patients suffering from schizophrenia

For the general public, but also for healthcare professionals, schizophrenia is still one of those areas of medicine connected with feelings of unease, fear and prejudice. These feelings lead to stigmatization and discrimination which are unjust processes which put patients suffering from mental illnesses into undesirable and unequal positions. Aim of this research was to establish the extent of stigmatization of mentally ill patients among the population of healthcare professionals and future healthcare professionals and if they differ from general population. Results show that stigmatization of schizophrenic patients is high among all included populations. Although there were no statistical differences between groups regarding the assessment of schizophrenic patients, nurses employed in psychiatric wards exhibited a tendency towards higher acceptance of schizophrenic patients, as well as better understanding of that illness. This data emphasizes a growing need for continuous education of general population but also of healthcare professionals.