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Cancer-related fatigue (CRF) is a highly distressing symptom in patients with cancer. Although various interventions have been reported to reduce fatigue, few are available for use in terminally ill cancer patients, and it is unknown which interventions are effective. They are also often difficult to implement in terminally ill patients with cancer. We, therefore, assessed the recommended interventions to reduce CRF in terminally ill cancer patients.Four electronic databases were searched to identify studies published between January 2015 and March 2021. The inclusion criteria were terminally ill cancer patients; non-pharmacological interventions; studies in which usual care or control groups were compared, or comparisons were made prior to the post-intervention period; studies in which the primary outcome was fatigue scale or symptom scale (including those measuring fatigue on a subscale); and experimental study designs including randomised controlled trials (RCTs) and quasi-experimental studies. A summary of the data extracted from each study was created. We also conducted a meta-analysis of the RCTs.A total of 1,954 publications were identified from the initial database, eight of which were included in this study. Three RCTs and five non-RCTs were included in the final evaluation. Most of the studies had a small number of participants. We conducted a meta-analysis of two of the three RCTs included in this study. There was insufficient evidence to determine the effects of the interventions compared to the controls [standard mean difference, -0.05; 95% confidence interval (CI): -0.48 to 0.37; two studies; 290 participants; I2=65%].Few reports exist on non-pharmacological interventions for patients with terminal cancer and there was insufficient evidence to determine the effect of the interventions on fatigue. This highlights the lack of RCTs on non-pharmacological procedures and therapies for reducing fatigue.

BackgroundChronic insomnia disorder is highly prevalent, disabling and costly. Cognitive-behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment. CBT-I may contain various educational, cognitive and behavioural strategies delivered in a range of formats, but the effect of each component remains unclear.MethodsWe performed a systematic review and component network meta-analysis (cNMA) of CBT-I trials for chronic insomnia. We searched PubMed, CENTRAL, PsycINFO and ICTRP for randomised controlled trials published from database inception to 14thMay 2022, comparing any form of CBT-I against each other or a control condition for chronic insomnia disorder in adults (aged ≥18 years). We included insomnia both with and without comorbidities. Concomitant treatments were allowed if they were equally distributed among the arms. Two independent reviewers identified components, extracted data, and assessed trial quality. Primary outcome of interest in this study was treatment efficacy (remission defined as reaching a satisfactory state at endpoint measured by any validated self-reported scale) at post-treatment. (PROSPERO; CRD42022324233)FindingsWe identified 226 trials, including 29,982 participants. Mean age was 45·7 years and 71% were women. The results suggests that critical components of CBT-I are cognitive restructuring (incremental odds ratio[iOR] 1·63 [95% confidence interval 1·25 to 2·14]), sleep restriction (iOR 1·44 [1·00 to 2·06]) and stimulus control (iOR 1·44 [1·00 to 2·07]) Sleep hygiene education was not essential (iOR 1·05 [0·79 to 1·38]) and relaxation procedures may be counterproductive (iOR 0·81 [0·64 to 1·03]). Face-to-face, therapist-led program was found to be most beneficial (iOR 1·86 [1·21to 2·85]). The overall risk of bias was low in 8% of the trials, some concerns in 56%, and high in 36%.InterpretationThis cNMA suggests that effective and efficient CBT-I packages can include cognitive restructuring, sleep restriction and stimulus control, but not relaxation.FundingNone.

Major depression is often a relapsing disorder. It is therefore important to start its treatment with therapies that maximize the chance of not only getting the patients well but also keeping them well. We examined the associations between initial treatments and sustained response by conducting a network meta-analysis of randomized controlled trials (RCTs) in which adult patients with major depression were randomized to acute treatment with a psychotherapy (PSY), a protocolized antidepressant pharmacotherapy (PHA), their combination (COM), standard treatment in primary or secondary care (STD), or pill placebo, and were then followed up through a maintenance phase. By design, acute phase treatment could be continued into the maintenance phase, switched to another treatment or followed by discretionary treatment. We included 81 RCTs, with 13,722 participants. Sustained response was defined as responding to the acute treatment and subsequently having no depressive relapse through the maintenance phase (mean duration: 42.2±16.2 weeks, range 24-104 weeks). We extracted the data reported at the time point closest to 12 months. COM resulted in more sustained response than PHA, both when these treatments were continued into the maintenance phase (OR=2.52, 95% CI: 1.66-3.85) and when they were followed by discretionary treatment (OR=1.80, 95% CI: 1.21-2.67). The same applied to COM in comparison with STD (OR=2.90, 95% CI: 1.68-5.01 when COM was continued into the maintenance phase; OR=1.97, 95% CI: 1.51-2.58 when COM was followed by discretionary treatment). PSY also kept the patients well more often than PHA, both when these treatments were continued into the maintenance phase (OR=1.53, 95% CI: 1.00-2.35) and when they were followed by discretionary treatment (OR=1.66, 95% CI: 1.13-2.44). The same applied to PSY compared with STD (OR=1.76, 95% CI: 0.97-3.21 when PSY was continued into the maintenance phase; OR=1.83, 95% CI: 1.20-2.78 when PSY was followed by discretionary treatment). Given the average sustained response rate of 29% on STD, the advantages of PSY or COM over PHA or STD translated into risk differences ranging from 12 to 16 percentage points. We conclude that PSY and COM have more enduring effects than PHA. Clinical guidelines on the initial treatment choice for depression may need to be updated accordingly.

Highlights • Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly. • This is the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance. • The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF. • This case warns the physicians of patients who have CNS symptoms., Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly. We report the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance due to a convulsion accompanied by unconsciousness. He had never been to any foreign countries. He felt generalized fatigue and fever (day 1). He saw doctors nearby twice (day 2 and 5) and was prescribed Laninamivir and antipyretic agents, His family visited his home and found that he was unconsciousness and lying on the floor in his vomit. He was immediately transported to this hospital by ambulance (day 9). Under emergency transport, he had transient generalized seizures that lasted about a minute. He had obvious neck stiffness. The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF. Anti- HSV 1 and varicella-zoster IgM antibodies were not detected in serum samples. A brain MRI showed hyperintensity along the wall of right lateral ventricle and hyperintense signal changes in the right mesial temporal lobe and hippocampus, suggesting the possibility of SARS-CoV-2 meningitis. This case warns the physicians of patients who have CNS symptoms.

At ambient temperature condition, the one-stage partial nitritation/anammox (PNA) process has been successfully adopted to treat the filtrate from the mainstream anaerobic membrane bioreactor (AnMBR). However, there is no investigation of the performance of this process at low-temperature condition. In this study, the nitrogen removal performance of a pilot-scale PNA reactor at the temperature of 15 °C for treating the filtrate of a mainstream AnMBR was investigated. The nitrogen removal rate of 0.09 kg/m

A pilot-scale anaerobic membrane bioreactor (AnMBR) integrated with a one-stage partial nitritation-anammox (PN/A) reactor was operated for the treatment of municipal wastewater (MWW) at seasonal temperatures of 15-25 °C. The removal efficiencies of COD and total nitrogen (TN) were always 90% and 75% respectively. The methanogenesis and PN/A were identified as the primary removal pathways of COD and TN, respectively, and were suppressed at low temperatures. With the temperature dropped from 25 °C to 20 °C to 15 °C, the methane-accounted COD decreased from 63.1% to 59.6% to 48.4%, and the PN/A-accounted TN decreased from 58.1% to 51.7% to 45.3%. The AnMBR and PN/A mutually complement each other in this combined process, as the AnMBR removed 8.5%-16.1% of TN by sludge entrainment and the PN/A reactor removed 2.6%-3.4% of COD by denitrification and aerobic oxidation. These results highlighted the strong feasibility of applying the AnMBR-PN/A process to the treatment of MWW in temperate climate.

BACKGROUND The number of mobile health (mHealth) apps continues to rise each year. Widespread use of the Mobile App Rating Scale (MARS) has allowed objective and multidimensional evaluation of the quality of these apps. However, no Japanese version of MARS has been made available to date. OBJECTIVE The purposes of this study were (1) to develop a Japanese version of MARS and (2) to assess the translated version’s reliability and validity in evaluating mHealth apps. METHODS To develop the Japanese version of MARS, cross-cultural adaptation was used using a universalist approach. A total of 50 mental health apps were evaluated by 2 independent raters. Internal consistency and interrater reliability were then calculated. Convergent and divergent validity were assessed using multitrait scaling analysis and concurrent validity. RESULTS After cross-cultural adaptation, all 23 items from the original MARS were included in the Japanese version. Following translation, back-translation, and review by the author of the original MARS, a Japanese version of MARS was finalized. Internal consistency was acceptable by all subscales of objective and subjective quality (Cronbach α=.78-.89). Interrater reliability was deemed acceptable, with the intraclass correlation coefficient (ICC) ranging from 0.61 to 0.79 for all subscales, except for “functionality,” which had an ICC of 0.40. Convergent/divergent validity and concurrent validity were also considered acceptable. The rate of missing responses was high in several items in the “information” subscale. CONCLUSIONS A Japanese version of MARS was developed and shown to be reliable and valid to a degree that was comparable to the original MARS. This Japanese version of MARS can be used as a standard to evaluate the quality and credibility of mHealth apps.

Sphingosine 1-phosphate (S1P), an inflammatory mediator, is abundantly contained in red blood cells and platelets. We hypothesized that the S1P concentration in the peritoneal cavity would increase especially during the menstrual phase due to the reflux of menstrual blood, and investigated the S1P concentration in the human peritoneal fluid (PF) from 14 non-endometriosis and 19 endometriosis patients. Although the relatively small number of samples requires caution in interpreting the results, S1P concentration in the PF during the menstrual phase was predominantly increased compared to the non-menstrual phase, regardless of the presence or absence of endometriosis. During the non-menstrual phase, patients with endometriosis showed a significant increase in S1P concentration compared to controls. In vitro experiments using human intra-peritoneal macrophages (MΦ) showed that S1P stimulation biased them toward an M2MΦ-dominant condition and increased the expression of IL-6 and COX-2. An in vivo study showed that administration of S1P increased the size of the endometriotic-like lesion in a mouse model of endometriosis.