Cognitive-behavioral therapy for patients with somatoform disorders: A pilot preliminary randomized controlled trial.

Background and objective: Cognitive-behavioral therapy (CBT) for somatoform disorders (SFDs) is understudied in China. Western findings may not be applicable to Chinese culture. This preliminary study evaluated the efficacy of CBT for patients in China, relative to treatment-as-usual (TAU). Methods: Seventy patients with SFDs randomly received either combined CBT and TAU (CBT + TAU), or TAU alone between January 2018 to May 2019. The CBT + TAU group received 12 weekly individual 50-minute CBT sessions. Participants were blindly assessed at 4 timepoints (baseline, week 6, end of treatment: week 12; 12 weeks post-treatment: week 24) using the following outcome measures: SQSS (Self-screening Questionnaire for Somatic Symptoms); PHQ-15 (Patient-Health-Questionnaire-15) and the WI (Whiteley Index); GAD-7 (General Anxiety Disorder-7); HAMD-17 (Hamilton Depression Rating Scale-17); Family Burden Interview Schedule (FBIS); Sheehan Disability Scale (SDS); and the Short Form of Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). The primary endpoint was the difference between the SQSS total score at week 24 and the baseline. A mixed model for repeated measures was used to analyze inter- and intra-group changes from the baseline. Results: At week 24, The least-squares mean (LSM) change of the total score on the SQSS was -18.87 points and -9.69 points, respectively in the CBT + TAU group and in the TAU group (LSM difference, -9.18 points; 95% confidence interval, -15.72 to -2.64; P = 0.0068). At week 24, the LSM changes from baseline in the WI, HAMD, PHQ15, FBIS and SDS total scores were significantly different between the two groups, however, there was no significant difference in the Q-LES-Q-SF. The SQSS of group effect sizes were 0.63 at 24 weeks. The dropout rates of the CBT + TAU and TAU groups were comparable (22.9% and 19.3%). Conclusions: These preliminary findings suggest that CBT may be helpful for improving the symptoms of patients with SFDs in China.

Functional and structural MRI based obsessive-compulsive disorder diagnosis using machine learning methods.

BACKGROUND: The success of neuroimaging in revealing neural correlates of obsessive-compulsive disorder (OCD) has raised hopes of using magnetic resonance imaging (MRI) indices to discriminate patients with OCD and the healthy. The aim of this study was to explore MRI based OCD diagnosis using machine learning methods. METHODS: Fifty patients with OCD and fifty healthy subjects were allocated into training and testing set by eight to two. Functional MRI (fMRI) indices, including amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), degree of centrality (DC), and structural MRI (sMRI) indices, including volume of gray matter, cortical thickness and sulcal depth, were extracted in each brain region as features. The features were reduced using least absolute shrinkage and selection operator regression on training set. Diagnosis models based on single MRI index / combined MRI indices were established on training set using support vector machine (SVM), logistic regression and random forest, and validated on testing set. RESULTS: SVM model based on combined fMRI indices, including ALFF, fALFF, ReHo and DC, achieved the optimal performance, with a cross-validation accuracy of 94%; on testing set, the area under the receiver operating characteristic curve was 0.90 and the validation accuracy was 85%. The selected features were located both within and outside the cortico-striato-thalamo-cortical (CSTC) circuit of OCD. Models based on single MRI index / combined fMRI and sMRI indices underperformed on the classification, with a largest validation accuracy of 75% from SVM model of ALFF on testing set. CONCLUSION: SVM model of combined fMRI indices has the greatest potential to discriminate patients with OCD and the healthy, suggesting a complementary effect of fMRI indices on the classification; the features were located within and outside the CSTC circuit, indicating an importance of including various brain regions in the model.

Predicting responses to cognitive behavioral therapy in obsessive-compulsive disorder based on multilevel indices of rs-fMRI.

OBJECTIVE: This study aimed to identify neuroimaging predictors to predict the response of cognitive behavioral therapy (CBT) in patients with obsessive-compulsive disorder (OCD) based on indices of resting-state functional magnetic resonance imaging (rs-fMRI). METHODS: Fifty patients with OCD were enrolled and allocated to either high or low responder groups after CBT using a 50 % response rate as the delineator. The pre-treatment amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and degree centrality (DC) in each cerebrum region, defined by automated anatomical labeling atlas, were extracted. Least absolute shrinkage and selection operator and logistic regression were used to select features and establish models. RESULTS: The combination of multilevel rs-fMRI indices achieved the best performance, with a cross-validation area under the receiver operating characteristic curve (AUC) of 0.900. In this combined model, an increase of interquartile range (IQR) in fALFF of right inferior orbital frontal gyrus (IOFG), and ReHo of left hippocampus and superior occipital gyrus (SOG) corresponded to a 26.52 %, 38.67 % and 24.38 % increase in the possibility to be high responders of CBT, respectively. ALFF of left thalamus and ReHo of left putamen were negatively associated with the response to CBT, with a 14.30 % and 19.91 % decrease per IQR increase of the index value. CONCLUSION: The combination of ALFF, fALFF and ReHo achieved a better predictive performance than separate index. Pre-treatment ALFF of the left thalamus, fALFF of the right IOFG, ReHo of the left hippocampus, SOG and putamen can be used as predictors of CBT response.

Comprehensive Cortical Structural Features Predict the Efficacy of Cognitive Behavioral Therapy in Obsessive-Compulsive Disorder.

Although cognitive behavioral therapy (CBT) is effective for patients with obsessive-compulsive disorder (OCD), 40% of OCD patients show a poor response to CBT. This study aimed to identify the cortical structural factors that predict CBT outcomes in OCD patients. A total of 56 patients with OCD received baseline structural MRI (sMRI) scanning and 14 individual CBT sessions. The linear support vector regression (SVR) models were used to identify the predictive performance of sMRI indices, including gray matter volume, cortical thickness, sulcal depth, and gyrification value. The patients' OC symptoms decreased significantly after CBT intervention (p < 0.001). We found the model with the comprehensive variables exhibited better performance than the models with single structural indices (MAE = 0.14, MSE = 0.03, R2 = 0.36), showing a significant correlation between the true value and the predicted value (r = 0.63, p < 0.001). The results indicated that a model integrating four cortical structural features can accurately predict the effectiveness of CBT for OCD. Future models incorporating other brain indicators, including brain functional indicators, EEG indicators, neurotransmitters, etc., which might be more accurate for predicting the effectiveness of CBT for OCD, are needed.

Seed dormancy, germination and storage behavior of Magnolia sinica, a plant species with extremely small populations of Magnoliaceae.

Magnolia sinica is one of the most endangered Magnoliaceae species in China. Seed biology information concerning its long-term ex situ conservation and utilization is insufficient. This study investigated dormancy status, germination requirements and storage behavior of M. sinica. Freshly matured seeds germinated to ca. 86.5% at 25/15 °C but poorly at 30 °C; GA3 and moist chilling promoted germination significantly at 20 °C. Embryos grew at temperatures (alternating or constant) between 20 °C and 25 °C, but not at 5 °C or 30 °C. Our results indicate that M. sinica seeds possibly have non-deep simple morphophysiological dormancy (MPD). Seeds survived desiccation to 9.27% and 4.85% moisture content (MC) as well as a further 6-month storage at -20 °C and in liquid nitrogen, including recovery in vitro as excised embryos. The established protocol ensured that at least 58% of seedlings were obtained after both cold storage and cryopreservation. These results indicate that both conventional seed banking and cryopreservation have potential as long-term ex situ conservation methods, although further optimized approaches are recommended for this critically endangered magnolia species.

Using eye movements in the dot-probe paradigm to investigate attention bias in illness anxiety disorder.

BACKGROUND: Illness anxiety disorder (IAD) is a common, distressing, and debilitating condition with the key feature being a persistent conviction of the possibility of having one or more serious or progressive physical disorders. Because eye movements are guided by visual-spatial attention, eye-tracking technology is a comparatively direct, continuous measure of attention direction and speed when stimuli are oriented. Researchers have tried to identify selective visual attention biases by tracking eye movements within dot-probe paradigms because dot-probe paradigm can distinguish these attentional biases more clearly. AIM: To examine the association between IAD and biased processing of illness-related information. METHODS: A case-control study design was used to record eye movements of individuals with IAD and healthy controls while participants viewed a set of pictures from four categories (illness-related, socially threatening, positive, and neutral images). Biases in initial orienting were assessed from the location of the initial shift in gaze, and biases in the maintenance of attention were assessed from the duration of gaze that was initially fixated on the picture per image category. RESULTS: The eye movement of the participants in the IAD group was characterized by an avoidance bias in initial orienting to illness-related pictures. There was no evidence of individuals with IAD spending significantly more time viewing illness-related images compared with other images. Patients with IAD had an attention bias at the early stage and overall attentional avoidance. In addition, this study found that patients with significant anxiety symptoms showed attention bias in the late stages of attention processing. CONCLUSION: Illness-related information processing biases appear to be a robust feature of IAD and may have an important role in explaining the etiology and maintenance of the disorder.

Effectiveness of acupuncture on anxiety disorder: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: A number of studies have shown the positive effects of acupuncture on state anxiety. However, the efficacy of acupuncture in treating anxiety disorder remains unclear. This review and meta-analysis aimed to explore whether acupuncture has a positive effect on anxiety disorder. METHODS: Randomised controlled trials (RCTs) published in English and Chinese were found through various electronic databases, including PubMed, Scopus, the Cochrane Central Register of Controlled Trials, Embase, and the Chinese databases WanFang data, VIP Chinese Sci tech periodical database, and China National Knowledge Infrastructure. The primary outcome variable was extent of anxiety symptoms. The secondary outcomes included side effects and dropout rate. Effect sizes were pooled by random-effects modelling using Rev Man 5.3. RESULTS: Twenty RCTs were included in this systematic review and meta-analysis. All included studies were designed for patients with generalised anxiety disorder (GAD), and 18 studies were published in Chinese. Egger's test showed that the asymmetry of the funnel plot in all studies was not significant (t = - 0.34, p = 0.74). The meta-analysis of anxiety symptoms showed that acupuncture was more effective than the control condition, with a standard mean effect size of - 0.41 (95% CI - 0.50 to - 0.31; p < 0.001), and that acupuncture intervention showed good tolerance and safety in the treatment of anxiety disorder. CONCLUSION: Our findings suggest that acupuncture therapy aimed at reducing anxiety in patients with GAD has certain beneficial effects compared to controls. More RCTs with high quality should be conducted to fully understand the role of acupuncture in the treatment of various types of anxiety disorder. The protocol of this review was registered at the Prospero International Prospective Register of Systematic Reviews (Registration ID: PROSPERO 2020CRD42020148536).

N-3-oxo-hexanoyl-homoserine lactone, a bacterial quorum sensing signal, enhances salt tolerance in Arabidopsis and wheat.

BACKGROUND: N-acyl-homoserine lactones (AHLs) are the quorum sensing (QS) signal molecules to coordinate the collective behavior in a population in Gram-negative bacteria. Recent evidences demonstrate their roles in plant growth and defense responses. RESULTS: In present study, we show that the treatment of plant roots with N-3-oxo-hexanoyl-homoserine lactone (3OC6-HSL), one molecule of AHLs family, resulted in enhanced salt tolerance in Arabidopsis and wheat. We found that the growth inhibition phenotype including root length, shoot length and fresh weight were significantly improved by 3OC6-HSL under salt stress condition. The physiological and biochemical analysis revealed that the contents of chlorophyll and proline were increased and the contents of MDA and Na+ and Na+/K+ ratios were decreased after 3OC6-HSL treatment in Arabidopsis and wheat under salt stress condition. Molecular analysis showed that 3OC6-HSL significantly upregulated the expression of salt-responsive genes including ABA-dependent osmotic stress responsive genes COR15a, RD22, ADH and P5CS1, ABA-independent gene ERD1, and ion-homeostasis regulation genes SOS1, SOS2 and SOS3 in Arabidopsis under salt stress condition. CONCLUSIONS: These results indicated that 3OC6-HSL enhanced plant salt tolerance and ABA-dependent and ABA-independent signal pathways and SOS signaling might be involved in the induction of salt resistance by 3OC6-HSL in plants. Our data provide a new insight into the plant-microbe inter-communication.

Incidence and Related Factors for Hospital-Acquired Pneumonia Among Older Bedridden Patients in China: A Hospital-Based Multicenter Registry Data Based Study.

Objective: To identify the incidence and related factors for hospital-acquired pneumonia (HAP) among older bedridden patients in China. Study design and setting: This multicenter registry data-based study conducted between November 2015 and March 2016 surveyed 7,324 older bedridden patients from 25 hospitals in China (six tertiary, 12 non-tertiary, and seven community hospitals). The occurrence of HAP among all participants was monitored by trained investigators. Demographics, hospitalization information and comorbidity differences were compared between patients with and without HAP. A multilevel regression analysis was used to explore the factors associated with HAP. Results: Among 7,324 older bedridden patients, 566 patients were diagnosed with HAP. The incidence of HAP in this study was 13.9 per 1,000 person-days. There were statistical differences in gender, age, length of bedridden days, BMI, smoking, department, undergoing general anesthesia surgery, ventilator application, Charlson comorbity index (CCI) score, disturbance of consciousness, tranquilizer use, glucocorticosteroid use, and antibiotic use between patients with HAP and patients without HAP (all p < 0.05). Multilevel regression analysis found no significant variance for HAP at the hospital level (0.332, t = 1.875, p > 0.05). There were significant differences for the occurrence of HAP among different departments (0.553, t = 4.320, p < 0.01). The incidence density of HAP was highest in the ICU (30.1‰) among the selected departments, followed by the departments of neurosurgery (18.7‰) and neurology medicine (16.6‰). Individual patient-level factors, including older age, disturbance of consciousness, total CCI score, ICU admission, and glucocorticoid and antibiotic use, were found to be associated with the occurrence of HAP (all p < 0.05). Conclusion: A relatively high incidence density of HAP among older bedridden patients was identified, as well as several factors associated with HAP among the population. This suggests that attention should be paid to the effective management of these related factors of older bedridden patients to reduce the occurrence of HAP.

Functional trade-offs and the phylogenetic dispersion of seed traits in a biodiversity hotspot of the Mountains of Southwest China.

The diversity of traits associated with plant regeneration is often shaped by functional trade-offs where plants typically do not excel at every function because resources allocated to one function cannot be allocated to another. By analyzing correlations among seed traits, empirical studies have shown that there is a trade-off between seedling development and the occupation of new habitats, although only a small range of taxa have been tested; whether such trade-off exists in a biodiverse and complex landscape remains unclear. Here, we amassed seed trait data of 1,119 species from a biodiversity hotspot of the Mountains of Southwest China and analyzed the relationship between seed mass and the number of seeds and between seed mass and time to germination. Our results showed that seed mass was negatively correlated with seed number but positively correlated with time to germination. The same trend was found regardless of variation in life-form and phylogenetic conservatism. Furthermore, the relation between seed mass and other seed traits was randomly dispersed across the phylogeny at both the order and family levels. Collectively, results suggest that there is a functional trade-off between seedling development and new habitat occupation for seed plants in this region. Larger seeds tend to produce fewer seedlings but with greater fitness compared to those produced by smaller seeds, whereas smaller seeds tend to have a larger number of seeds that germinate faster compared to large-seeded species. Apart from genetic constraints, species that produce large seeds will succeed in sites where resource availability is low, whereas species with high colonization ability (those that produce a high number of seeds per fruit) will succeed in new niches. This study provides a mechanistic explanation for the relatively high levels of plant diversity currently found in a heterogeneous region of the Mountains of Southwest China.

Regional homogeneity of spontaneous brain activity in adult patients with obsessive-compulsive disorder before and after cognitive behavioural therapy.

BACKGROUND: Cognitive behavioural therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). Several neuroimaging studies have explored alterations of brain function in OCD patients as they performed tasks after CBT. However, the effects of CBT on the neural activityin OCD during rest remain unknown. Therefore, we investigated changes in regional homogeneity (ReHo) in OCD patients before and after CBT. METHODS: Twenty-two OCD patients and 22 well-matched healthy controls participated in the resting-state functional magnetic resonance imaging scans. We compared differences in ReHo between the OCD and control groups before treatment and investigated the changes of ReHo in 17 OCD patients who responded to CBT. RESULTS: Compared to healthy controls, OCD patients exhibited higher ReHo in the right orbitofrontal cortex (OFC), bilateral middle frontal cortex, right precuneus, left cerebellum, and vermis, as well as lower ReHo in the bilateral caudate, right calcarine, right posterior cingulate cortex, and right middle temporal cortex. Along with the clinical improvement in OCD patients after CBT, we found decreased ReHo in the right OFC, bilateral middle frontal cortex, left cerebellum and vermis, and increased ReHo in the left caudate. Improvement of OCD symptoms was significantly correlated with the changed ReHo in the right OFC and left cerebellum. CONCLUSIONS: Although these findings are preliminary and need to be replicated in larger samples, they indicate the presence of abnormal spontaneous brain activity of the prefrontal-striatal-cerebellar circuit in OCD patients, and provide evidence that CBT can selectively modulate the spontaneous brain activity of this circuit in OCD patients.

[siRNA-mediated silencing of ClC-2 gene inhibits proliferation of human U-87 glioma cells].

BACKGROUND & OBJECTIVE: Small interfering RNA (siRNA), which has been used to inhibit mammalian gene expression, is demonstrated to be an effective tool for gene function investigation. The aim of the present study was to observe the effect of siRNA, which was designed to target volume-regulated chloride channel ClC-2 gene, on the proliferation of a human glioma cell line U-87. METHODS: Two recombinant eukaryotic CIC-2 siRNA expression vectors were designed and constructed. Sequences were identified and confirmed by restrictive endonuclease digestion and DNA sequencing. The empty vector, pSUPER. puro, and two recombinant plasmids, pSUPER. puro-shRNA-ClC-21 and pSUPER. puro-shRNA-ClC-22, were transfected into U-87 cells using Lipofectamine2000 (Groups: PP0, PP1 and PP2, respectively). ClC-2 mRNA expression was detected by reverse transcription polymerase chain reaction (RT-PCR); the cellular proliferation rate was determined by MTT assay; the cell cycle was measured by flow cytometry (FCM); and the cell colony formation rate was measured by plate colony formation assay. RESULTS: The DNA fragments encoding siRNA targeting ClC-2-gene were successfully connected onto pSUPER. puro vector. ClC-2 mRNA expression and the cell growth rate in PP1 and PP2 groups were significantly inhibited compared to those in PP0 and control groups. Meanwhile, cell cycle was arrested in G1 phase and the percentage of G1 phase cells were increased by about 30.24% in PP1 and 18.04% in PP2 vs. in control and PP0 groups, P < 0.05. Moreover, the cell colony formation rates were statistically decreased in siRNA treated groups, which were (11.0+/-1.0)% in PP1 and (20+/-3.1)% in PP2 vs. (46.5+/-1.6)% in control and (47.5+/-2.8)% in PP0 groups (P<0.01). CONCLUSION: These results demonstrate that CIC-2 siRNA could inhibit the cell proliferation of a human glioma cell line U-87, thus ClC-2 gene may be used as a novel target for the suppression of the growth of human malignant glioma cells.