Gray matter abnormalities in patients with major depressive disorder and social anxiety disorder: a voxel-based meta-analysis.

BACKGROUND: Major depressive and social anxiety disorders have a high comorbidity rate and similar cognitive patterns. However, their unique and shared neuroanatomical characteristics have not been fully identified. METHODS: Voxel-based morphometric studies comparing gray matter volume between patients with major depressive disorder/social anxiety disorder and healthy controls were searched using 4 electronic databases from the inception to March 2022. Stereotactic data were extracted and subsequently tested for convergence and differences using activation likelihood estimation. In addition, based on the result of the meta-analysis, behavioral analysis was performed to assess the functional roles of the regions affected by major depressive disorder and/or social anxiety disorder. RESULTS: In total, 34 studies on major depressive disorder with 2873 participants, and 10 studies on social anxiety disorder with 1004 subjects were included. Gray matter volume conjunction analysis showed that the right parahippocampal gyrus region, especially the amygdala, was smaller in patients compared to healthy controls. The contrast analysis of major depressive disorder and social anxiety disorder revealed lower gray matter volume in the right lentiform nucleus and medial frontal gyrus in social anxiety disorder and lower gray matter volume in the left parahippocampal gyrus in major depressive disorder. Behavioral analysis showed that regions with lower gray matter volume in social anxiety disorder are strongly associated with negative emotional processes. CONCLUSIONS: The shared and unique patterns of gray matter volume abnormalities in patients with major depressive and social anxiety disorder may be linked to the underlying neuropathogenesis of these mental illnesses and provide potential biomarkers. PROSPERO registration number: CRD42021277546.

[Effect of acupuncture combined with low frequency rTMS on comorbid mild-to-moderate depressive disorder and insomnia: a randomized controlled trial].

OBJECTIVE: To observe the impacts of acupuncture on depressive mood and sleep quality in patients with comorbid mild-to-moderate depressive disorder and insomnia, and explore its effect mechanism. METHODS: A total of 60 patients with comorbid mild-to-moderate depressive disorder and insomnia were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 2 cases dropped off). In the observation group, acupuncture and low frequency repeated transcranial magnetic stimulation (rTMS) were combined for the intervention. Acupuncture was applied to Baihui (GV 20), Yintang (GV 24+), Neiguan (PC 6) and Yanglingquan (GB 34), etc., the needles were retained for 30 min; and the intradermal needles were embedded at Xinshu (BL 15) and Danshu (BL 19) for 2 days. After acupuncture, the rTMS was delivered at the right dorsolateral prefrontal cortex (R-DLPFC), with 1 Hz and 80% of movement threshold, lasting 30 min in each treatment. In the control group, the sham-acupuncture was adopted, combined with low frequency rTMS. The acupoint selection and manipulation were the same as the observation group. In the two groups, acupuncture was given once every two days, 3 times weekly; while, rTMS was operated once daily, for consecutive 5 days a week. The duration of treatment consisted of 4 weeks. Hamilton depression scale-17 (HAMD-17) and Pittsburgh sleep quality index (PSQI) scores were observed before and after treatment, as well as 1 month after the treatment completion (follow-up period) separately. Besides, the levels of nerve growth factor (BDNF) and γ-aminobutyric acid (GABA) in the serum were detected before and after treatment in the two groups. RESULTS: After treatment and in follow-up, the HAMD-17 scores were lower than those before treatment in the two groups (P<0.05), and the scores in the observation group were lower than the control group (P<0.05). After treatment, the total scores and the scores of each factor of PSQI were reduced in the two groups in comparison with those before treatment except for the score of sleep efficiency in the control group (P<0.05); the total PSQI score and the scores for sleep quality, sleep latency, sleep efficiency and daytime dysfunction in the observation group were all lower than those in the control group (P<0.05). In the follow-up, except for the scores of sleep duration and sleep efficiency in the control group, the total PSQI score and the scores of all the other factors were reduced compared with those before treatment in the two groups (P<0.05); the total PSQI score and the scores of sleep quality, sleep latency, sleep duration, sleep efficiency and daytime dysfunction in the observation group were lower than the control group (P<0.05). After treatment, the levels of serum BDNF and GABA were increased in comparison with those before treatment in the observation group (P<0.05), and the level of serum BDNF was higher than that in the control group (P<0.05). CONCLUSION: Acupuncture relieves depressive mood and improves sleep quality in patients with comorbid mild-to-moderate depressive disorder and insomnia. The effect mechanism may be related to the regulation of BDNF and GABA levels and the promotion of brain neurological function recovery.

Low-dose S-ketamine exerts antidepressant-like effects via enhanced hippocampal synaptic plasticity in postpartum depression rats.

Rapid antidepressant effects of S-ketamine have repeatedly been confirmed in patients with depression, as well as in chronic unpredictable mild stress (CUMS) animal models. However, the pharmacological study of S-ketamine for anti-postpartum depression has not been considered. In this study, the classical method of reproductive hormone withdrawal was used to construct a rat model of postpartum depression (PPD). Subsequently, the study evaluated the effects of low-dose S-ketamine on behavior and synaptic plasticity, which is related to depression, in the hippocampus of PPD rats. Multiple behavioral tests were used to evaluate depression-like behaviors in PPD models. Synaptic plasticity of the hippocampus can be demonstrated by Western blot, Golgi staining, transmission electron microscopy, and electrophysiological recording. Our study provides insight into the role of low-dose S-ketamine in antidepressant as well as antianxiety and indicates that maintaining synaptic plasticity is a key target for S-ketamine therapy for postpartum depression induced by reproductive hormone withdrawal.

The efficacy and safety of acupoint catgut embedding for peripheral facial paralysis sequela: A protocol for systematic review and meta-analysis.

BACKGROUND: Peripheral facial paralysis sequela (PFPS) is a group of sequence syndrome after the acute onset of peripheral facial paralysis. Nearly 70% of patients with peripheral facial paralysis recover completely, but nearly 30% of patients leave multiple sequelae, which have serious negative impacts on the physical and psychological health of patients. Without a high risk of side effect, acupoint catgut embedding (ACE), a common acupuncture therapy, is widely used to treat this disorder. And a number of studies have shown the efficacy of this therapy for PFPS. But in fact, the evidence of the overall effect of ACE in the treatment of PFPS is still insufficient. Therefore, the purpose of this study is to evaluate the efficiency and safety of ACE for PFPS. METHODS: Two reviewers will collect randomized controlled trials (RCTs) on ACE for PFPS by searching the following databases, including The Cochrane Library, PubMed, Web of Science, EMBASE, China Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database, from their initiation to May 2021. The searching of publications will include English and Chinese without any restriction of countries and regions. Besides, 2 reviewers will independently include in studies that meet the inclusion criteria and extract data we need, then use Cochrane Collaboration's Risk of Bias Tool to assess their methodological quality. The efficacy and safety of ACE as a treatment for PFPS will be assessed according to the synthetic risk ratio (RR), odds ratio (OR), or weighted mean difference (WMD), standardized mean difference (SMD) with consistent 95% confidence intervals (95% CI). And the Review Manager 5.3 software will be adopted to conduct the statistical analysis. RESULTS: The protocol for meta-analysis will systematically evaluate the efficacy and safety of ACE for PFPS. And the final result of this search will provide sufficient evidence and an authentic assessment focusing on the problem. CONCLUSION: This search will explore whether ACE could be used as an effective and non-drug external therapy of TCM for PFPS and offer supports for clinical practice. PROSPERO REGISTRATION NUMBER: CRD42021240004.

Application of Midazolam Injection in Patients with Intraoperative Nerve Block Anesthesia and Sedation Assisted by Imaging Guidance.

OBJECTIVE: In the present study, we explored the clinical effect of midazolam as an adjuvant analgesic and tranquilizer after brachial plexus block anesthesia with the aid of imaging guidance. METHODS: We selected 106 patients who had undergone elective unilateral upper extremity surgery from January 2017 to December 2019 and randomly divided them into groups A and B, with 53 cases in each group. All the patients had undergone brachial plexus block anesthesia. Group A received imidazole-assisted sedation, and group B received fentanyl plus midazolam-assisted sedation. Under ultrasound-guided intermuscular sulcus brachial plexus block, we observed and recorded the ultrasound anatomical images before injection, including the distance from the lower edge of the upper, middle, and lower trunk of the forearm brachial plexus to the skin. We also recorded the anesthesia and operation times, effects of the anesthetic block, and incidence of adverse reactions. RESULTS: The distance from the lower edge of each nerve trunk to the skin averaged 1.002 cm for the upper stem, 1.598 cm for the middle stem, and 2.26 cm for the lower stem. The average anesthesia procedure time was 3 minutes, 56 seconds and was within 3-5 minutes for 92% of the procedures. The anesthesia effect was excellent, good, and poor in 81%, 11%, and 6%, respectively, and ineffective for 2% and effective for 92%. CONCLUSIONS: The ultrasound-guided inferior intermuscular sulcus approach for brachial plexus block is suitable for unilateral upper extremity radial hand surgery. For surgery involving the upper extremity ulnar hand side, a larger dose (concentration) of local anesthetic should be used within a safe range and/or an additional ulnar nerve block might be necessary. Midazolam adjuvant medication can have a good sedative and amnestic effect in brachial plexus block anesthesia, helping to reduce pain and inhibit the increase in stress levels.

Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy.

STUDY OBJECTIVE: To evaluate the effects of postoperative dexmedetomidine infusion on sleep quality in patients undergoing abdominal hysterectomy. DESIGN: Randomized, double-blind study. SETTING: Postoperative recovery area and ward. PATIENTS: Sixty patients of American Society of Anesthesiologists physical status I or II scheduled for elective hysterectomy were enrolled. INTERVENTIONS: Patients in group C received sufentanil infusion (a continuous dosage of 0.02 µg kg-1 h-1, a bolus dose of 0.02 µg/kg, a 10-minute lockout interval), and patients in group D received combined infusion of sufentanil with dexmedetomidine (a continuous dosage of sufentanil 0.02 µg kg-1 h-1 with dexmedetomidine 0.05 µg kg-1 h-1, a bolus doses of sufentanil 0.02 µg/kg with dexmedetomidine 0.05 µg/kg, a 10-minute lockout interval). MEASUREMENTS: Polysomnography (PSG) was performed on the following 3 nights: the night before surgery (PSG1), the first night after surgery (PSG2), and the second night after surgery (PSG3). Postoperative pain scores using visual analog scoring scale, levels of sedation, and cumulative sufentanil consumptions were also recorded. RESULTS: After surgery, patients suffered from significant sleep disturbance with a lower sleep efficiency index and subjective sleep quality and a higher arousal index at PSG2 and PSG3. Compared with group C, postoperative administration of dexmedetomidine significantly improved the sleep efficiency index and subjective sleep quality. Although the rapid eye movement and N3 stage sleep did not differ between the 2 groups, the N1 stage and arousal index were lower and the N2 stage in group D at PSG2 and PSG3 was higher. Compared with group C, patients in group D have better pain relief with a lower visual analog scoring scale and cumulative sufentanil consumptions at 6, 24, and 48 hours after surgery. CONCLUSIONS: Dexmedetomidine infusion not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing hysterectomy.