Widespread reductions in cortical thickness following ketamine abuse.

BACKGROUND: Esketamine is a version of ketamine that has been approved for treatment-resistant depression, but our previous studies showed a link between non-medical use of ketamine and brain structural and functional alterations, including dorsal prefrontal grey matter reduction among chronic ketamine users. In this study, we sought to determine cortical thickness abnormalities following long-term, non-medical use of ketamine. METHODS: We acquired structural brain images for patients with ketamine use disorder and drug-free healthy controls. We used FreeSurfer software to measure cortical thickness for 68 brain regions. We compared cortical thickness between the 2 groups using analysis of covariance with covariates of age, gender, educational level, smoking, drinking, and whole-brain mean cortical thickness. RESULTS: We included images from 95 patients with ketamine use disorder and 169 controls. Compared with healthy controls, patients with ketamine use disorder had widespread decreased cortical thickness, with the most extensive reductions in the frontal (including the dorsolateral prefrontal cortex) and parietal (including the precuneus) lobes. Increased cortical thickness was not observed among ketamine users relative to comparison participants. Estimated total lifetime ketamine consumption was correlated with reductions in the right inferior parietal and the right rostral middle frontal cortical thickness. LIMITATIONS: We conducted a retrospective cross-sectional study, but longitudinal studies are needed to further validate decreased cortical thickness after nonmedical use of ketamine. CONCLUSION: This study provided evidence that, compared with healthy controls, chronic ketamine users have widespread reductions in cortical thickness. Our study underscores the importance of the long-term effects of ketamine on brain structure and serves as a reference for the antidepressant use of ketamine.

Boosting Smoking Cessation Intervention Utilization in Chinese Healthcare Providers: A Randomized Controlled Trial of the 'WeChat WeQuit' Medical Education Program.

INTRODUCTION: In China, standard smoking cessation practices are rarely used by healthcare service providers (HSPs). WeChat, a popular social media app, has been widely used in China. METHODS: In this single-blind, randomized trial, undertaken in China with 8-week interventions and follow-up to 34 weeks, 1887 HSPs were randomly selected to the intervention (n=942) or control group (n=945) from Oct 2020 to Oct 2021. The intervention group received regular smoking cessation training program messages from the professional team for 8 weeks and followed for 34 weeks. The control group received thanks messages for 8 weeks, and follow-up to 34 weeks. Both groups received a hard copy of the manual after randomization. The primary outcome measure was the utilization rate of behavioral and pharmacotherapy interventions for smoking patients from 9 to 34 weeks. This trial is registered at ClinicalTrials.gov (number NCT03556774). RESULTS: HSPs in the intervention group demonstrated a better overall utilization rate of smoking cessation at 20-week follow-up compared to the control group (35.54% vs 31.41%, p=0.036). Additionally, both groups showed a significant increase in the adoption of various components of the 5A's model - including "Assess", "Assist: set a quit date", "Assist: recommend cessation program", "Assist: provide information", "Assist: recommend medication", and "Arrange" - at the 9-week follow-up relative to baseline. Notably, at the 20-week follow-up, the intervention group reported significantly enhanced utilization rates for all these components, except "Assist: set a quit date". CONCLUSIONS: The "Wechat Wequit" training program effectively enhanced smoking cessation intervention adoption among Chinese HSPs. IMPLICATION: 'WeChat WeQuit' training program was effective in increasing the provision of effective tobacco cessation interventions by Chinese-speaking HSPs to patients with cigarette smoking, which could provide valuable insights into bridging the gap between need and services for smoking cessation in China.

The prevalence and possible risk factors of gaming disorder among adolescents in China.

BACKGROUND: Nowadays, moderate gaming behaviors can be a pleasant and relaxing experiences among adolescents. However, excessive gaming behavior may lead to gaming disorder (GD) that disruption of normal daily life. Understanding the possible risk factors of this emerging problem would help to suggest effective at preventing and intervening. This study aimed to investigate the prevalence of GD and analyze its possible risk factors that adolescents with GD. METHODS: Data were collected between October 2020 and January 2021. In total, a sample of 7901 students (4080 (52%) boys, 3742 (48%) girls; aged 12-18 years) completed questionnaires regarding the Gaming-Related Behaviors Survey, Gaming Disorder Symptom Questionnaire-21 (GDSQ-21); Behavioral Inhibition System and Behavioral Activation System Scale (BIS/BAS Scale); Emotion Regulation Questionnaire (ERQ); Short-form Egna Minnenav Barndoms Uppfostran for Chinese (s-EMBU-C); and Adolescent Self-Rating Life Events Checklist (ASLEC). RESULTS: The prevalence of GD was 2.27% in this adolescent sample. The GD gamers were a little bit older (i.e., a higher proportion of senior grades), more boys, with more gaming hours per week in the last 12 months, with more reward responsiveness, maternal rejecting and occurrence of negative life events (e.g., interpersonal relationships, being punished and bereavement factors). CONCLUSION: These possible risk factors may influence the onset of GD. Future research in clinical, public health, education and other fields should focus on these aspects for provide target prevention and early intervention strategies.

Multiple serum anti-glutamate receptor antibody levels in clozapine-treated/naïve patients with treatment-resistant schizophrenia.

BACKGROUND: Glutamatergic function abnormalities have been implicated in the etiology of treatment-resistant schizophrenia (TRS), and the efficacy of clozapine may be attributed to its impact on the glutamate system. Recently, evidence has emerged suggesting the involvement of immune processes and increased prevalence of antineuronal antibodies in TRS. This current study aimed to investigate the levels of multiple anti-glutamate receptor antibodies in TRS and explore the effects of clozapine on these antibody levels. METHODS: Enzyme linked immunosorbent assay (ELISA) was used to measure and compare the levels of anti-glutamate receptor antibodies (NMDAR, AMPAR, mGlur3, mGluR5) in clozapine-treated TRS patients (TRS-C, n = 37), clozapine-naïve TRS patients (TRS-NC, n = 39), and non-TRS patients (nTRS, n = 35). Clinical symptom severity was assessed using the Positive and Negative Symptom Scale (PANSS), while cognitive function was evaluated using the MATRICS Consensus Cognitive Battery (MCCB). RESULT: The levels of all four glutamate receptor antibodies in TRS-NC were significantly higher than those in nTRS (p < 0.001) and in TRS-C (p < 0.001), and the antibody levels in TRS-C were comparable to those in nTRS. However, no significant associations were observed between antibody levels and symptom severity or cognitive function across all three groups after FDR correction. CONCLUSION: Our findings suggest that TRS may related to increased anti-glutamate receptor antibody levels and provide further evidence that glutamatergic dysfunction and immune processes may contribute to the pathogenesis of TRS. The impact of clozapine on anti-glutamate receptor antibody levels may be a pharmacological mechanism underlying its therapeutic effects.

Predictive value of the triglyceride-glucose index for short- and long-term all-cause mortality in patients with critical coronary artery disease: a cohort study from the MIMIC-IV database.

BACKGROUND: Triglyceride-glucose (TyG) index is linked to a poor prognosis for cardiovascular condition and is a valid indicator of insulin resistance. This study evaluated the potential predicting usefulness of the TyG index for all-cause mortality, both short- and long-term, for those concerning critical coronary artery disease (CAD). METHODS: In this study, information from 5452 critically-ill individuals with CAD in intensive care units were gathered from the Medical Information Marketplace in Intensive Care (MIMIC-IV) database. Depending on the TyG index degree, the patients were categorized into three categories. Clinical outcomes included short-term (30-day) and long-term (365-day) all-cause mortality. The corresponding relationships involving the TyG index and clinical outcomes were examined by deploying restricted cubic spline (RCS) regression analysis and Cox proportional risk regression. RESULTS: An increased TyG index was associated with increased 30-day (Tertile 1: 6.1%, Tertile 2: 7.3%, Tertile 3: 9.2%, P = 0.001) and 365-day (Tertile 1: 15.2%, Tertile 2: 17.0%, Tertile 3: 19.6%, P = 0.002) death rates across all causes. Cox regression with multiple variables indicates that higher TyG indices were linked to higher all-caused mortality hazard ratios throughout the short and long terms, with a larger predictive value for the former. RCS regression analyses suggested that the risk of death was notably and linearly that is associated with TyG index. CONCLUSIONS: The TyG index is a reliable predictor of all-cause mortality at different stages in critically ill CAD patients, with a higher predictive ability for short-term mortality. Early intervention in patients with elevated TyG index may improve their survival outcomes. Future research should delve into understanding its pathophysiological mechanisms and develop intervention strategies based on the TyG index, providing new insights and strategies to enhance the outlook for critically ill CAD patients.

Establishment and validation of a nomogram for dropout intention in Chinese early year medical undergraduates.

BACKGROUND: The attrition rate of Chinese medical students is high. This study utilizes a nomogram technique to develop a predictive model for dropout intention among Chinese medical undergraduates based on 19 individual and work-related characteristics. METHOD: A repeated cross-sectional study was conducted, enrolling 3536 medical undergraduates in T1 (August 2020-April 2021) and 969 participants in T2 (October 2022) through snowball sampling. Demographics (age, sex, study phase, income, relationship status, history of mental illness) and mental health factors (including depression, anxiety, stress, burnout, alcohol use disorder, sleepiness, quality of life, fatigue, history of suicidal attempts (SA), and somatic symptoms), as well as work-related variables (career choice regret and reasons, workplace violence experience, and overall satisfaction with the Chinese healthcare environment), were gathered via questionnaires. Data from T1 was split into a training cohort and an internal validation cohort, while T2 data served as an external validation cohort. The nomogram's performance was evaluated for discrimination, calibration, clinical applicability, and generalization using receiver operating characteristic curves (ROC), area under the curve (AUC), calibration curves, and decision curve analysis (DCA). RESULT: From 19 individual and work-related factors, five were identified as significant predictors for the construction of the nomogram: history of SA, career choice regret, experience of workplace violence, depressive symptoms, and burnout. The AUC values for the training, internal validation, and external validation cohorts were 0.762, 0.761, and 0.817, respectively. The nomogram demonstrated reliable prediction and discrimination, with adequate calibration and generalization across both the training and validation cohorts. CONCLUSION: This nomogram exhibits reasonable accuracy in foreseeing dropout intentions among Chinese medical undergraduates. It could guide colleges, hospitals, and policymakers in pinpointing students at risk, thus informing targeted interventions. Addressing underlying factors such as depressive symptoms, burnout, career choice regret, and workplace violence may help reduce the attrition of medical undergraduates. TRIAL REGISTRATION: This is an observational study. There is no Clinical Trial Number associated with this manuscript.

Circadian Rhythms Correlated in DNA Methylation and Gene Expression Identified in Human Blood and Implicated in Psychiatric Disorders.

Circadian rhythms modulate the biology of many human tissues and are driven by a nearly 24-h transcriptional feedback loop. Dynamic DNA methylation may play a role in driving 24-h rhythms of gene expression in the human brain. However, little is known about the degree of circadian regulation between the DNA methylation and the gene expression in the peripheral tissues, including human blood. We hypothesized that 24-h rhythms of DNA methylation play a role in driving 24-h RNA expression in human blood. To test this hypothesis, we analyzed DNA methylation levels and RNA expression in blood samples collected from eight healthy males at six-time points over 24 h. We assessed 442,703 genome-wide CpG sites in methylation and 12,364 genes in expression for 24-h rhythmicity using the cosine model. Our analysis revealed significant rhythmic patterns in 6345 CpG sites and 21 genes. Next, we investigated the relationship between methylation and expression using powerful circadian signals. We found a modest negative correlation (ρ = -0.83, p = 0.06) between the expression of gene TXNDC5 and the methylation at the nearby CpG site (cg19116172). We also observed that circadian CpGs significantly overlapped with genetic risk loci of schizophrenia and autism spectrum disorders. Notably, one gene, TXNDC5, showed a significant correlation between circadian methylation and expression and has been reported to be association with neuropsychiatric diseases.

Implicit Theories of Smoking and Intention to Quit: A Serial Mediation Model.

INTRODUCTION: There is growing evidence that implicit theories of smoking-whether smokers perceive smoking behavior as malleable or fixed-are significant predictors of quitting intentions. The present study aims to investigate the underlying mechanisms of implicit theories on smoking in predicting smokers' intentions to quit. METHODS: This was a cross-sectional study. We conducted multiple linear regression with quitting intentions as the dependent variable, implicit theories of smoking as the independent variable, and sociodemographic variables, quitting attempts in the past year, and whether receiving quitting advice in the past 12 months as the covariates. The mediating role of consideration of future consequences and self-efficacy in the relationship between ITS and quitting intentions was evaluated by mediation analyses. RESULTS: A total of 510 smokers were included in the final analyses. Smokers holding a higher incremental theory of smoking reported a higher likelihood of considering future consequences (ß = 0.289, p < 0.001) and a weaker possibility of considering immediate results (ß = -0.317, p < 0.001), which, in turn, enhanced their quitting self-efficacy and then led to stronger intentions to quit smoking (ß = 0.261, p < 0.001). CONCLUSIONS: The current study enriched our understanding of the underlying mechanisms that connect smokers' implicit theories of smoking and their likelihood of smoking cessation such that higher incremental theories of smoking predict stronger intention to quit smoking, and the effect was serially mediated by smokers' likelihood of considering future consequences of their behavior and their perceived self-efficacy for smoking cessation. IMPLICATIONS: This study indicated the mediating role of consideration of future consequences and self-efficacy for smoking cessation on the relationship between the implicit theories of smoking and quitting intentions. These two psychological factors and the pathways may be important points for understanding the model of implicit theories for smoking and improving the effectiveness of implicit theories-based intervention on smoking cessation.

Six addiction components of problematic social media use in relation to depression, anxiety, and stress symptoms: a latent profile analysis and network analysis.

BACKGROUNDS: Components of addiction (salience, tolerance, mood modification, relapse, withdrawal, and conflict) is the most cited theoretical framework for problematic social media use (PSMU). However, studies criticized its ability to distinguish problematic users from engaged users. We aimed to assess the association of the six criteria with depression, anxiety, and stress at a symptom level. METHODS: Ten thousand six hundred sixty-eight participants were recruited. Bergen Social Media Addiction Scale (BSMAS) was used to detect six addiction components in PSMU. We applied the depression-anxiety-stress scale to assess mental distress. Latent profile analysis (LPA) was conducted based on BSMAS items. Network analysis (NA) was performed to determine the symptom-symptom interaction of PSMU and mental distress. RESULTS: (1) Social media users were divided into five subgroups including occasional users (10.6%, n = 1127), regular users (31.0%, n = 3309), high engagement low risk users (10.4%, n = 1115), at-risk users (38.1%, n = 4070), and problematic users (9.8%, n = 1047); (2) PSMU and mental distress varied markedly across subgroups. Problematic users had the most severe PSMU, depression, anxiety, and stress symptoms. High engagement users scored high on tolerance and salience criteria of PSMU but displayed little mental distress; (3) NA showed conflict and mood modification was the bridge symptoms across the network, while salience and tolerance exhibited weak association with mental distress. CONCLUSIONS: Salience and tolerance might not distinguish engaged users from problematic users. New frameworks and assessment tools focusing on the negative consequences of social media usage are needed.

The latent profile analysis of Chinese adolescents' gaming disorder: examination and validation.

BACKGROUND: Gaming disorder is a new disease, which is included in the disease unit of disorder caused by addiction in the 11th revision of the International Classification of Diseases. This study examined the symptom characteristics of gaming disorders in Chinese adolescents using the latent profile analysis. METHODS: Totally, 5988 students (including 3285 boys and 2703 girls; aged 12-18 years) from junior high schools and senior high schools were enrolled. The Gaming Disorder Symptom Questionnaire-21 (GDSQ-21) was used to screen gaming disorder. A latent profile analysis was used for classifying the subgroups based on the extent of gaming usage. The relationship between adolescent gamers and demographic variables was analyzed by logistic regression. RESULTS: The results of latent profile analysis supported the models of four latent profiles, which were defined as healthy gamers (Profile 1, 56.83%), impaired control gamers (Profile 2, 26.09%), impaired control-game priority gamers (Profile 3, 9.72%) and gamers with disorder (Profile 4, 7.36%), respectively. Logistic regression analysis found that, compared with girls, boys were more likely to be classified into the group dominated by the impaired gamers, the impaired control-game priority gamers, and the gamers with disorder. CONCLUSIONS: This study highlighted that the latent profile analysis identified four different groups of adolescent gamers, showing a clearer conceptualization of heterogeneous gamers. Gender and average weekly gaming time can predict the latent profile of adolescents. Our findings may facilitate the design of individualized assessment and early intervention programs for adolescent gamer users based on different gaming usage symptoms.

Determination of the cutoff point for Smartphone Application-Based Addiction Scale for adolescents: a latent profile analysis.

BACKGROUNDS: The Smartphone Application-Based Addiction Scale (SABAS) is a validated 6-item measurement tool for assessing problematic smartphone use (PSU). However, the absence of established cutoff points for SABAS hinders its utilities. This study aimed to determine the optimal cutoff point for SABAS through latent profile analysis (LPA) and receiver operating characteristic curve (ROC) analyses among 63, 205. Chinese adolescents. Additionally, the study explored whether PSU screening with SABAS could effectively capture problematic social media use (PSMU) and internet gaming disorder (IGD). METHOD: We recruited 63,205. adolescents using cluster sampling. Validated questionnaires were used to assess PSMU, IGD, and mental health (depression, anxiety, sleep disturbances, well-being, resilience, and externalizing and internalizing problems). RESULTS: LPA identified a 3-class model for PSU, including low-risk users (38.6%, n = 24,388.), middle-risk users (42.5%, n = 26,885.), and high-risk users (18.9%, n = 11,932.). High-risk users were regarded as "PSU cases" in ROC analysis, which demonstrated an optimal cut-off point of 23 (sensitivity: 98.1%, specificity: 96.8%). According to the cutoff point, 21.1% (n = 13,317.) were identified as PSU. PSU adolescents displayed higher PSMU, IGD, and worse mental health. PSU screening effectively captured IGD (sensitivity: 86.8%, specificity: 84.5%) and PSMU (sensitivity: 84.5%, specificity: 80.2%). CONCLUSION: A potential ideal threshold for utilizing SABAS to identify PSU could be 23 (out of 36). Employing SABAS as a screening tool for PSU holds the potential to reliably pinpoint both IGD and PSMU.

Prevalence and associated factors of depressive and anxiety symptoms among Chinese secondary school students.

BACKGROUND: Depressive and anxiety symptoms affect about one-fourth of Chinese secondary school students. However, the prevalence and correlates of mental distress among secondary school students from Western China remain largely unexplored. This study aimed to examine the prevalence and associations of depressive and anxiety symptoms with demographic, family, school, life, and behavior factors in a large, representative sample of secondary school students in Zigong, a city in Western China. METHODS: Secondary school students were recruited using cluster sampling. The 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire, Multidimensional Peer-Victimization Scale, the Pittsburgh Sleep Quality Index, and Nine-Item Internet Gaming Disorder Scale-Short Form were used. Descriptive statistic was used to describe the sociodemographic characteristics of participants. The clustering effect was adjusted by the "survey" package of R to calculate weighted prevalence. Univariate and multivariate logistic regression were used to explore associated factors of depression and anxiety, respectively. RESULTS: A total of 63,205 participants were involved, in which the weighted prevalence of depression in all subjects was 23.0% (95% CI: 19.6- 27.0%), and the weighted prevalence of anxiety was 13.9% (95% CI: 11.2- 17.0%). Logistic regression results showed girls, being single-child, non-nuclear family, peer bullying, sleep disturbance, and internet gaming disorder symptoms were positively associated with depressive and anxiety symptoms. CONCLUSION: Depressive and anxiety symptoms were prevalent among secondary school students in Western China. Our results can guide policy strategies for the assessment, prevention, and intervention of psychological status among Chinese secondary school students.

Sex differences in the association of treatment-resistant schizophrenia and serum interleukin-6 levels.

BACKGROUND: Low-grade inflammation and altered inflammatory markers have been observed in treatment-resistant schizophrenia (TRS). Interleukin-6 (IL-6) is one of the pro-inflammatory cytokines linked with TRS and receives increasing attention. Previous studies showed that patients with TRS might have higher IL-6 levels compared with healthy individuals and treatment-responsive patients. Besides, emerging evidence has suggested that there are sex differences in the associations between IL-6 levels and various illnesses, including chronic hepatitis C, metabolic syndrome, etc.; however, there is limited study on TRS. In this present study, we aimed to compare the serum IL-6 levels of TRS and partially responsive schizophrenia (PRS) and explore potential sex differences in the association of TRS and IL-6 levels. METHODS: The study population consisted of a total of 90 patients with schizophrenia: 64 TRS patients (45.3% males and 54.7% females) and 26 PRS patients (46.2% males and 53.8% females). We measured serum IL-6 levels using enzyme-linked immunosorbent assay (ELISA) and analyzed them separately by gender, controlling for confounders (age, education, medication, body mass index, and PANSS scores) rigorously. RESULT: The results showed that patients with TRS had higher serum IL-6 levels than patients with PRS (p = 0.002). In females, IL-6 levels increased significantly in the TRS group compared with the PRS group (p = 0.005). And a positive correlation tendency was observed between IL-6 levels and PANSS general sub-scores (r = 0.31, p = 0.039), although this correlation was not significant after correcting for multiple comparisons. Whereas, there were no differences in IL-6 levels between the TRS and PRS (p = 0.124) in males. CONCLUSION: Our findings provided evidence supporting the hypothesis that the inflammatory response system (IRS) may play a role in the pathogenesis of TRS in a sex-dependent manner. In addition, sex differences in the immune dysfunction of individuals with schizophrenia cannot be neglected, and inflammation in male and female TRS should be discussed separately.

Gender differences in alcohol abuse/dependence among medical undergraduates during the post-COVID­19 pandemic period (October 20, 2020-April 5, 2021) in China.

BACKGROUND: This study aimed to assess the prevalence and the gender-specific risk factors of alcohol abuse/dependence among medical undergraduates during the post-COVID­19 pandemic period in China. METHOD: The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to identify respondents with alcohol abuse/dependence. A questionnaire on basic demographics and mental distresses (learning burnout, depression symptoms, anxiety symptoms, excessive daytime sleepiness, and history of mental disorders) was used. The logistic regression model was used to explore the associations between the above characteristics and alcohol abuse/dependence. RESULTS: A total of 3,412 medical undergraduates were included in the analysis. Males showed a higher prevalence of alcohol abuse/dependence than females (16.6% vs 7.4%, p < 0.001). Alcohol abuse/dependence was associated with learning burnout (OR: 2.168, p < 0.001) and having a partner (OR: 1.788 p = 0.001) among female medical undergraduates. Among male medical undergraduates, excessive daytime sleepiness (OR: 1.788 p = 0.001) and older age (OR: 1.788, p = 0.001) were independently associated with alcohol abuse/dependence. CONCLUSION: Alcohol abuse/dependence was common among medical undergraduates during the post-COVID­19 pandemic period. Substantial gender differences in the prevalence and risk factors of alcohol abuse/dependence were found among medical undergraduates in this study, which highlighted the need for timely gender-specific screening and interventions. However, the cross-sectional design adopted in this study has limited the examination of causality, thus further longitudinal studies are warranted.

De-Escalation Dual Antiplatelet Therapy Prevail over Potent P2Y12 Inhibitor Monotherapy in Patients with Acute Coronary Syndrome Undergone Percutaneous Coronary Intervention: A Network Meta-Analysis.

Background: Dual antiplatelet therapy (DAPT) with potent P2Y12 inhibitor is the cornerstone of acute coronary syndrome (ACS) management. Balancing the effects of different strategies of antiplatelet therapy including DAPT de-escalation, potent P2Y12 inhibitor monotherapy, and conventional DAPT is a hot topic. Methods: A systematic search was conducted from the MEDLINE, PubMed, and Embase through October 2021 to identify various DAPT strategies in randomized controlled trials (RCTs) for treatment of ACS patients after undergoing PCI with drug-eluting stent (DES). The network meta-analysis was performed to investigate the net clinic benefit of the DAPT de-escalation, potent P2Y12 inhibitor monotherapy, as well as conventional DAPT. The primary outcome was net adverse clinical events, defined as a composite of major bleeding and cardiac death, myocardial infarction, stroke, stent thrombosis, or target-vessel revascularization. The secondary outcomes include major adverse cardiac events and trial-defined major or minor bleeding. Results: A total of 14 RCTs with 63,982 patients were included. The DAPT de-escalation was associated with a lower risk of the primary outcome compared with potent P2Y12 inhibitor monotherapy (De-escalation vs monotherapy odds ratio (OR): 0.72 95% confidence interval (CI): 0.55-0.96), and other antiplatelet strategies (De-escalation vs clopidogrel + aspirin OR: 0.49 95% CI: 0.39-0.63; De-escalation vs prasugrel + aspirin OR: 0.76 95% CI: 0.59-0.98; De-escalation vs ticagrelor + aspirin OR: 0.76 95% CI: 0.55-0.90). There were no statistical differences in the incidence of bleeding (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.73 95% CI: 0.47-1.12) and major adverse cardiac events (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.79 95% CI: 0.59-1.08) between DAPT de-escalation and potent P2Y12 inhibitor monotherapy. Conclusions: This network meta-analysis showed that DAPT de-escalation would reduce the net adverse clinical events, compared with potent P2Y12 inhibitor monotherapy, for ACS patients undergone PCI treatment.

Higher glutamatergic activity in the medial prefrontal cortex in chronic ketamine users.

BACKGROUND: The medial prefrontal cortex (mPFC) plays an important role in depression and addiction. Previous studies have shown alterations in glutamatergic activity in the mPFC following the administration of ketamine in patients with depression and healthy controls. However, it remains unclear whether chronic, nonmedical use of ketamine affects metabolites in the mPFC. METHODS: Using proton magnetic resonance spectroscopy, we measured metabolites (glutamate and glutamine [Glx]; phosphocreatine and creatine [PCr+Cr]; myo-inositol; N-acetyl-aspartate; and glycerophosphocholine and phosphocholine [GPC+PC]) in the mPFC of chronic ketamine users (n = 20) and healthy controls (n = 43). Among ketamine users, 60% consumed ketamine once per day or more, 10% consumed it every 2 days and 30% consumed it every 3 or more days. Using analysis of covariance, we evaluated between-group differences in the ratios of Glx:PCr+Cr, myo-inositol:PCr+Cr, N-acetyl-aspartate:PCr+Cr and GPC+PC:PCr+Cr. RESULTS: Chronic ketamine users showed significantly higher Glx:PCr+Cr ratios than healthy controls (median 1.05 v. 0.95, p = 0.008). We found no significant differences in myoinositol:PCr+Cr, N-acetyl-aspartate:PCr+Cr or GPC+PC:PCr+Cr ratios between the 2 groups. We found a positive relationship between N-acetyl-aspartate:PCr+Cr and Glx:PCr+Cr ratios in the healthy control group (R = 0.345, p = 0.023), but the ketamine use group failed to show such an association (ρ = 0.197, p = 0.40). LIMITATIONS: The cross-sectional design of this study did not permit causal inferences related to higher Glx:PCr+Cr ratios and chronic ketamine use. CONCLUSION: This study provides the first evidence that chronic ketamine users have higher glutamatergic activity in the mPFC than healthy controls; this finding may provide new insights relevant to the treatment of depression with ketamine.

Impaired delay discounting and time sensitivity in methcathinone use disorder.

Substance use disorder (SUD) is characterized by continued drug use despite adverse consequences. Methcathinone is a new type of psychoactive substance that is associated with high excitement and impulsive behaviors. However, it is unclear if individuals with methcathinone use disorders (MCUD) are with impaired decision-making ability. We analyzed the task performance in 45 male MCUD subjects and 35 male matched healthy controls (HC) with intertemporal decision-making task. Constant sensitivity discounting model was used to estimate potential changes in both discounting rate and time sensitivity. The results showed that MCUD individuals exhibited a higher delay discounting rate (p = 0.003, Cohen's d = 0.683) and reduced sensitivity to time (p < 0.001, Cohen's d = 1.662). The delay discounting rate was correlated to the first age for drug use (r = - 0.41, p = 0.004), and the time sensitivity was negatively correlated with the duration of abstinence (r = - 0.31, p = 0.036). We conclude that MCUD individuals are with impaired decision-making ability and time perception disturbances.

Impact of cigarette package warnings on attitudes towards sharing and gifting cigarettes in China: a nationwide study of smokers and non-smokers.

BACKGROUND: Sharing and gifting cigarettes are common in China. These social practices promote cigarette consumption, and consequently may reduce quit rates in China. This study investigated sharing and gifting cigarettes, and the relationship of observing pictorial health warnings to attitudes towards sharing and gifting cigarettes in China. METHODS: We conducted an online nationwide cross-sectional study of 9818 adults in China. Experiences of sharing and gifting cigarettes, and attitudes towards sharing and gifting cigarettes before and after viewing text and pictorial health warnings on the packages were assessed, and compared between smokers and non-smokers. RESULTS: Most current smokers reported experiences of sharing (97%) and gifting (around 90%) cigarettes. Less than half of non-smokers reported sharing cigarettes and receiving gifted cigarettes, but over half (61.4%) gave cigarettes as a gift to others. More than half of non-smokers but less than 10% of smokers disagreed with sharing and gifting cigarettes. After observing both text and pictorial health warnings on the packages, disagreement with sharing and gifting cigarettes increased by more than 10 percentage points among both smokers and non-smokers. CONCLUSION: Having pictorial health warnings on cigarette packages may reduce sharing and gifting cigarettes in China.

Lipid metabolism patterns and relevant clinical and molecular features of coronary artery disease patients: an integrated bioinformatic analysis.

BACKGROUND: Hyperlipidaemia is an important factor that induces coronary artery disease (CAD). This study aimed to explore the lipid metabolism patterns and relevant clinical and molecular features of coronary artery disease patients. METHODS: In the current study, datasets were fetched from the Gene Expression Omnibus (GEO) database and nonnegative matrix factorization clustering was used to establish a new CAD classification based on the gene expression profile of lipid metabolism genes. In addition, this study carried out bioinformatics analysis to explore intrinsic biological and clinical characteristics of the subgroups. RESULTS: Data for a total of 615 samples were extracted from the Gene Expression Omnibus database and were associated with clinical information. Then, this study used nonnegative matrix factorization clustering for RNA sequencing data of 581 lipid metabolism relevant genes, and the 296 patients with CAD were classified into three subgroups (NMF1, NMF2, and NMF3). Subjects in subgroup NMF2 tended to have an increased severity of CAD. The CAD index and age of group NMF1 were similar to those of group NMF3, but their intrinsic biological characteristics exhibited significant differences. In addition, weighted gene coexpression network analysis (WGCNA) was used to determine the most important modules and screen lipid metabolism related genes, followed by further analysis of the DEGs in which the significant genes were identified based on clinical information. The progression of coronary atherosclerosis may be influenced by genes such as PTGDS and DGKE. CONCLUSION: Different CAD subgroups have their own intrinsic biological characteristics, indicating that more personalized treatment should be provided to patients in each subgroup, and some lipid metabolism related genes (PDGTS, DGKE and so on) were related significantly with clinical characteristics.

Tracking the Impact of COVID-19 and Lockdown Policies on Public Mental Health Using Social Media: Infoveillance Study.

BACKGROUND: The COVID-19 pandemic and its corresponding preventive and control measures have increased the mental burden on the public. Understanding and tracking changes in public mental status can facilitate optimizing public mental health intervention and control strategies. OBJECTIVE: This study aimed to build a social media-based pipeline that tracks public mental changes and use it to understand public mental health status regarding the pandemic. METHODS: This study used COVID-19-related tweets posted from February 2020 to April 2022. The tweets were downloaded using unique identifiers through the Twitter application programming interface. We created a lexicon of 4 mental health problems (depression, anxiety, insomnia, and addiction) to identify mental health-related tweets and developed a dictionary for identifying health care workers. We analyzed temporal and geographic distributions of public mental health status during the pandemic and further compared distributions among health care workers versus the general public, supplemented by topic modeling on their underlying foci. Finally, we used interrupted time series analysis to examine the statewide impact of a lockdown policy on public mental health in 12 states. RESULTS: We extracted 4,213,005 tweets related to mental health and COVID-19 from 2,316,817 users. Of these tweets, 2,161,357 (51.3%) were related to "depression," whereas 1,923,635 (45.66%), 225,205 (5.35%), and 150,006 (3.56%) were related to "anxiety," "insomnia," and "addiction," respectively. Compared to the general public, health care workers had higher risks of all 4 types of problems (all P<.001), and they were more concerned about clinical topics than everyday issues (eg, "students' pressure," "panic buying," and "fuel problems") than the general public. Finally, the lockdown policy had significant associations with public mental health in 4 out of the 12 states we studied, among which Pennsylvania showed a positive association, whereas Michigan, North Carolina, and Ohio showed the opposite (all P<.05). CONCLUSIONS: The impact of COVID-19 and the corresponding control measures on the public's mental status is dynamic and shows variability among different cohorts regarding disease types, occupations, and regional groups. Health agencies and policy makers should primarily focus on depression (reported by 51.3% of the tweets) and insomnia (which has had an ever-increasing trend since the beginning of the pandemic), especially among health care workers. Our pipeline timely tracks and analyzes public mental health changes, especially when primary studies and large-scale surveys are difficult to conduct.