Consensus on the pharmacological treatment of acute stress disorder in Chinese pilots: a Delphi study.

BACKGROUND: Appropriate medication is very important for pilots with acute stress disorder. Improper medication can not only affect the physical and mental health of the pilots but can also endanger flight safety. Hence, we aimed to quickly and effectively relieve symptoms and restore cognitive function by forming a consensus of Chinese experts on the pharmacological treatment of acute stress disorder in pilots using the Delphi method. METHODS: Relevant literature was searched to enumerate the current status of pharmacological treatment of acute stress disorder in pilots, followed by two rounds of expert consultation and discussion according to the listed status of the survey using the Delphi method. A descriptive statistical method was used to analyze the basic information, authority coefficients, concentration of opinions, and survey items of the experts to develop a consensus on the pharmacological treatment of acute stress disorder in pilots. RESULTS: A total of 16 experts in psychiatry, pharmacology, and aerospace medicine from different provinces and cities across China were invited for consultation. The recovery rate of the two rounds of consultation was 100%, and the expert authority coefficients were 0.897 and 0.906, respectively. Kendall's coefficient of concordance of indicators at all levels was 0.564-0.594 (p < 0.01). Based on the number of votes received, alprazolam tablets (16), eszopiclone tablets (15), and lorazepam tablets (14) were recommended for the treatment of excitatory psychomotor symptoms of acute stress disorder; paroxetine tablets (15) and sertraline tablets (15) were available for psychomotor depressive symptoms; olanzapine tablets (15), olanzapine orally disintegrating tablets (14), and quetiapine fumarate tablets (14) were selected for psychotic symptoms. CONCLUSIONS: This study formed a consensus on rapid and effective pharmacological treatment for different symptoms of acute stress disorder pilots, which provides a reference for clinical treatment.

Network structure of depression and anxiety symptoms in Chinese female nursing students.

BACKGROUND: Comorbidity between depressive and anxiety disorders is common. From network perspective, mental disorders arise from direct interactions between symptoms and comorbidity is due to direct interactions between depression and anxiety symptoms. The current study investigates the network structure of depression and anxiety symptoms in Chinese female nursing students and identifies the central and bridge symptoms as well as how other symptoms in present network are related to depression symptom "thoughts of death". METHODS: To understand the full spectrum of depression and anxiety, we recruited 776 Chinese female nursing students with symptoms of depression and anxiety that span the full range of normal to abnormal. Depression symptoms were measured by Patient Health Questionnaire-9 while anxiety symptoms were measured by Generalized Anxiety Disorder 7-Item Questionnaire. Network analysis was used to construct networks. Specifically, we computed the predictability, expected influence and bridge expected influence for each symptom and showed a flow network of "thoughts of death". RESULTS: Nine strongest edges existed in network were from the same disorder. Four were between depression symptoms, like "sleep difficulties" and "fatigue", and "anhedonia" and "fatigue". Five were between anxiety symptoms, like "nervousness or anxiety" and "worry too much", and "restlessness" and "afraid something will happen". The symptom "fatigue", "feeling of worthlessness" and "irritable" had the highest expected influence centrality. Results also revealed two bridge symptoms: "depressed or sad mood" and "irritable". As to "thoughts of death", the direct relations between it and "psychomotor agitation/retardation" and "feeling of worthlessness" were the strongest direct relations. CONCLUSIONS: The current study highlighted critical central symptoms "fatigue", "feeling of worthlessness" and "irritable" and critical bridge symptoms "depressed or sad mood" and "irritable". Particularly, "psychomotor agitation/retardation" and "feeling of worthlessness" were identified as key priorities due to their strongest associations with suicide ideation. Implications for clinical prevention and intervention based on these symptoms are discussed.

The relations between different components of intolerance of uncertainty and symptoms of generalized anxiety disorder: a network analysis.

BACKGROUND: Intolerance of uncertainty (IU) is considered as a specific risk factor in the development and maintenance of generalized anxiety disorder (GAD). Yet, researches have investigated the relations between IU and GAD (or worry) using total scores on self-report measures. This ignores that there are different components exist in IU and the heterogeneity of GAD symptoms. In the present study, we explored the relations among different components of IU and symptoms of GAD. METHODS: A dimensional approach which take individual differences into consideration in different components of IU along a full range of normal to abnormal symptom severity levels of GAD were used in this study. Components of IU were measured by 12-item Intolerance of Uncertainty Scale and symptoms of GAD were measured by Generalized Anxiety Disorder 7-Item Questionnaire. Regularized partial-correlation network was estimated using cross-sectional data from 624 university students. RESULTS: Four strongest edges are between components of IU, like "Unforeseen events upset me greatly" and "It frustrates me not having all the information I need". Two strongest edges are between symptoms of GAD, like "Being so restless that it is hard to sit still" and "Feeling afraid as if something awful might happen". Symptom "Worrying too much about different things" and component "It frustrates me not having all the information I need" have the highest expected influences in the present network. In the community of IU, component "It frustrates me not having all the information I need" has the highest bridge expected influence. And in the community of GAD, symptoms "Worrying too much about different things" and "Not being able to stop or control worrying" have the highest bridge expected influence. CONCLUSIONS: This study reveals potential pathways between different components of IU and various symptoms of GAD. Understanding how putative risk factors such as different components of IU are related to symptoms of GAD may provide some references for related preventions and interventions, such as targeting component "It frustrates me not having all the information I need" may be more effective at reducing symptoms of GAD than targeting other components of IU.

The Relationship Between Negative Coping Styles, Psychological Resilience, and Positive Coping Styles in Military Personnel: A Cross-Lagged Analysis.

Background: Military personnel experience prolonged exposure to high-stress environments. Positive coping styles can assist in maintaining their mental and behavioral well-being, whereas negative coping styles cannot. Health behavior change theory specifies that an individual can transition from a negative to a positive coping style. The psychological resilience concept may prove vital in this transition. Methods: In a longitudinal study design, two questionnaires were administered to 233 military personnel twice, the first at T1 in April 2023 and the second at T2 in July 2023. The questionnaire measured individual negative coping style, positive coping style and psychological resilience. Results: The data showed that the negative coping style at T1 negatively predicted the level of psychological resilience at T2 (γ= - 0.26, p < 0.001) and the positive coping style at T2 (γ= - 0.16, p < 0.001). The level of psychological resilience at T1 positively predicted the positive coping style at T2 (γ= 0.22, p < 0.01). Psychological resilience played a mediating role between negative coping style and positive coping style. In addition, there was an interaction between psychological resilience and positive coping style in military personnel at the two time points. Conclusion: The negative coping styles that presently exist among military personnel have the potential to diminish their future positive coping styles by lowering their psychological resilience. This highlights the need to focus on the development and training of psychological resilience for military personnel, as it can effectively counteract negative coping styles and promote positive coping styles.

The systemic inflammation markers as possible indices for predicting respiratory failure and outcome in patients with myasthenia gravis.

OBJECTIVE: This study aimed to explore the relationship between systemic inflammation markers and clinical activity, respiratory failure, and prognosis in patients with myasthenia gravis (MG). METHODS: One hundred and seventeen MG patients and 120 controls were enrolled in this study. Differences in the four immune-related markers of two groups based on blood cell counts: neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and systemic immune-inflammation index (SII) were measured. The stability of the associations between systemic inflammation markers and respiratory failure in MG patients was confirmed by adjusted logistic regression analysis. Moreover, Kaplan-Meier curve and multivariate COX regression models were applied to assess the factors affecting the outcome of MG. RESULTS: NLR, PLR, and SII were higher in MG patients than those in controls and were positively associated with MGFA classification, but not LMR. Adjusted logistic regression analysis showed that PLR was an independent predictor of MG with respiratory failure. The ROC curve demonstrated that PLR showed good sensitivity and specificity for the diagnosis of MG with respiratory failure. Kaplan-Meier curve showed that GMG, positive AchR-Ab, respiratory failure, high NLR, PLR, SII, and IVIg exposure correlated with the risk for poor outcomes in MG patients. The multivariate COX regression models indicated that GMG and high SII was a risk factor for poor outcome of MG. INTERPRETATION: The systemic inflammation markers expressed abnormally in MG patients, in which PLR may be an independent predictor of respiratory failure, and high SII and GMG were predictive risk factors for poor outcomes in MG patients.

Breviscapine Ameliorates Fear Extinction and Anxiety in BALB/cJ Mice.

OBJECTIVE: In this research, the influence of breviscapine on anxiety, fear elimination, and aggression and the potential mechanism was investigated. METHODS: Anxiety and locomotion were analyzed by elevated plus maze and open field test in mice. Bussey-Saksida Mouse Touch Screen Chambers were used to perform fear conditioning. Territorial aggression was assessed by resident intruder test. Protein levels were evaluated by Western blot. Breviscapine improved fear-extinction learning in BALB/cJ mice. RESULTS: Breviscapine at 20-100 mg/kg increased center cross number, total distance traveled, and velocity in a dose-dependent manner. On the other hand, breviscapine at 20-100 mg/kg decreased the immobility time in open field test. In addition, breviscapine at 20-100 mg/kg increased the ratio of time on the open arm, time on the distal parts of the open arm, and total distance traveled in elevated plus maze. Breviscapine at 100 mg/kg increased the average attack latency and decreased the number of attacks over the last 3 days of resident intruder test. In hippocampus, protein levels of postsynaptic density protein-95 and synaptophysin were elevated by breviscapine at these three doses. CONCLUSION: The administration of breviscapine alleviates fear extinction, anxiety, and aggression, while increases locomotor in a dose-dependent manner, which might be associated with its influence on synaptic function.

Network Analysis of Anxiety Symptoms in Front-Line Medical Staff during the COVID-19 Pandemic.

BACKGROUND: This research analyses the relations between anxiety symptoms from the network perspective to deepen the understanding of anxiety in front-line medical staff during the COVID-19 pandemic and can also provide a reference for determining potential goals of clinical interventions. METHODS: A convenience sampling was adopted, and the Generalized Anxiety Disorder 7-item scale (GAD-7) was administered to front-line medical staff through online platforms. A regularized partial correlation network of anxiety was constructed and then we evaluated its accuracy and stability. The expected influence and predictability were used to describe the relative importance and the controllability, using community detection to explore community structure. The gender-based differences and the directed acyclic graph were implemented. RESULTS: The connections between A1 "Feeling nervous, anxious or on edge" and A2 "Not being able to stop or control worrying", A6 "Becoming easily annoyed or irritable" and A7 "Feeling afraid as if something awful might happen", etc., were relatively strong; A2 "Not being able to stop or control worrying" and A3 "Worrying too much about different things" had the highest expected influence, and A2 "Not being able to stop or control worrying" had the highest predictability. The community detection identified two communities. The results of the gender network comparison showed the overall intensity of the anxiety network in women was higher than that in men; DAG indicated that A2 "Not being able to stop or control worrying" had the highest probabilistic priority; the lines from A2 "Not being able to stop or control worrying" to A1 "Feeling nervous, anxious or on edge" and A2 "Not being able to stop or control worrying" to A7 "Feeling afraid as if something awful might happen" represented the most important arrows. CONCLUSION: There exist broad interconnections among anxiety symptoms of front-line medical staff on the GAD-7. A2 "Not being able to stop or control worrying" might be the core symptom and a potential effective intervention target. It was possible to bring an optimal result for the entire GAD symptom network by interfering with A2 "Not being able to stop or control worrying". GAD may have two "subsystems". The modes of interconnection among anxiety may be consistent between genders.

PTSD of Chinese nurses in the normalisation of COVID-19 pandemic prevention and control: Prevalence and correlates.

Background: Though the severe prevention and control measures faced by Chinese nurses had changed during the normalisation stage of the coronavirus 2019 (COVID-19) pandemic, they still worked under great stress. Due to a lack of related evidence, we aimed to investigate the prevalence and correlates of post-traumatic stress disorder (PTSD) among Chinese nurses during the normalisation of COVID-19 pandemic prevention and control measures. Methods: Using convenience sampling, we recruited 784 nurses in Jiangsu province, China to complete a survey via their mobile devices. We used a demographic questionnaire, the Perceived Social Support Scale, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, and The Impact of Event Scale-Revised to collect data and applied binary logistic regression analysis to identify factors associated with PTSD. Results: The prevalence of PTSD was 26.4%. Married nurses were less likely to experience PTSD than unmarried ones (odds ratio (OR) = 0.573; 95% confidence interval (CI) = 0.33-0.99, P = 0.046). Social support (OR = 0.96; 95% CI = 0.94-0.98, P = 0.000) and resilience (OR = 0.98; 95% CI = 0.97-0.99, P = 0.004) were significant predictors of PTSD. Conclusions: PTSD remained prevalent among Chinese nurses as COVID-19 pandemic prevention and control measures became normalised, with an incidence rate of 26.4%. Resilience, social support, and marital status were factors associated with PTSD. Chinese hospital management must intervene to improve resilience and social support for nurses to reduce symptoms of PTSD.

The relationship between obsessive-compulsive symptoms and depressive symptoms in patients with obsessive-compulsive disorder: A network analysis.

Aim: The network model suggests that the comorbidity of obsessive-compulsive disorder (OCD) and depression is due to direct interactions between OCD and depression symptoms. The study investigates the network structure of OCD and depressive symptoms in patients with OCD and explores the pathways that connect the OCD and depression symptoms. Materials and Methods: The items of Yale-Brown Obsessive-Compulsive Symptom (Y-BOCS) Scale and the Depression Self-Rating Scale of 445 patients with OCD were analyzed by network model. Statistical analysis and visualization of the network were conducted using R software. Results: Two bridge edges "uneasiness" and "time consumed by obsessions" and "low spirit" and "distress caused by obsessions" connected the OCD symptoms to depressive symptoms. Two closely related edges were between "interference due to obsessions" and "interference due to compulsions" and between "difficulty resisting obsessions" and "difficulty resisting compulsions." The symptoms "interference due to compulsions," "distress caused by obsessions," "time consumed by compulsions," and "uneasiness" had the highest expected influence centrality. Conclusions: This study highlighted the relationship between "uneasiness" and "time consumed by obsessions" and between "low spirit" and "distress caused by obsessions." In addition, "interference due to compulsions" is found as the core symptom in the network. Targeting these symptoms may help prevent and treat the comorbidity of obsession-compulsion and depression in patients with OCD.

Effects of intermittent theta-burst transcranial magnetic stimulation on post-traumatic stress disorder symptoms: A randomized controlled trial.

Post-traumatic stress disorder (PTSD) is a prevalent and debilitating illness, which can be alleviated by transcranial magnetic stimulation (TMS). Intermittent theta burst stimulation (iTBS), a newer form of repetitive transcranial magnetic stimulation (rTMS), offers the advantage of shorter treatment sessions compared to the standard 10 Hz rTMS treatment. In order to compare the two forms of TMS, we enrolled 75 participants aged between 18 and 55 years who presented with (PCL-C) scale score of at least 50. Participants were randomly assigned to groups in a ratio of 1:1:1, receiving either 10 Hz rTMS, iTBS, or sham-controlled iTBS. Participants in the two treatment groups underwent 15 therapies which consisted of 1800 pulses and targeted the right dorsolateral prefrontal cortex (DLPFC). The main outcomes included changes in scores on the PCL-C and the Post-Traumatic Growth Inventory (PTGI). After intervention, the PCL-C and PTGI scores in iTBS and rTMS groups were significantly different from those in sham-controlled iTBS group. No significant differences in PCL-C and PTGI were found between the two active treatment groups. ITBS, with a shorter treatment duration, can effectively improve the symptoms of PTSD, with no significant difference in effect from that of rTMS. Future studies need to further elucidate the mechanisms, optimize the parameters and investigate the therapeutic potential and efficacy of iTBS in PTSD.

The relations between mental well-being and burnout in medical staff during the COVID-19 pandemic: A network analysis.

Background: Although poor mental well-being (MW) has been documented among individuals experiencing burnout during the coronavirus-19 (COVID-19) pandemic, little is known about the complex interrelationship between different components of MW and burnout. This study investigates this relationship among medical staff during the COVID-19 pandemic through network analysis. Methods: A total of 420 medical staff were recruited for this study. Components of MW were measured by the 14-item Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and components of burnout were measured by a 15-item Maslach Burnout Inventory-General Survey (MBI-GS) Questionnaire. Network structure was constructed via network analysis. Bridge variables were identified via the bridge centrality index. Results: The edges across two communities (i.e., MW community and burnout community) are almost negative, such as edge MW2 ("Useful") - B14 ("Worthwhile") and edge MW1 ("Optimistic about future") - B13 ("Happy"). The edges within each community are nearly positive. In the MW community, components MW1 ("Optimistic about future") and MW6 ("Dealing with problems") have the lowest bridge centrality. And in the community of burnout, components B13 ("Happy") and B14 ("Worthwhile") have the lowest bridge expected influence. Conclusion: We present the first study to apply the network approach to model the potential pathways between distinct components of MW and burnout. Our findings suggest that promoting optimistic attitudes and problem-solving skills may help reduce burnout among medical staff during the pandemic.

Changes in mental health levels among Chinese physical education college students from 1995 to 2019.

To explore the changes in the mental health levels of Chinese physical education college students, the present study conducted a cross-temporal meta-analysis of 43 papers that adopted the Symptom Checklist 90 (SCL-90) from 1995 to 2019. The results showed that the average scores of the seven SCL-90 factors were negatively correlated with the year of data collection. The socioeconomic indicators (GDP, per capita GDP and household consumption level) were significantly negatively correlated with the eight dimension scores of the SCL-90 (except for phobic anxiety). The mean effect sizes of the sex differences in the seven dimension scores (except depression and phobic anxiety) were lower than the small effect size. In conclusion, Chinese physical education college students' mental health levels have increased in the past 25 years. This phenomenon may be related to Chinese socioeconomic growth, the implementation of national sports policies, and the provision of mental health education for college students. In addition, although the increasing trend in the mental health level of female students was more obvious, there were no significant sex differences.

A Cross-Temporal Meta-Analysis on Marital Satisfaction of Chinese Couples.

Objective: To investigate the changing trend of Chinese couples' marital satisfaction and its relationship with social changes. Methods: A cross-temporal meta-analysis was performed on 118 original studies (n = 31,909) reporting marital satisfaction of Chinese couples from 1994 to 2020, primarily using correlation analysis and regression analysis. Results: (1) Overall, the marital satisfaction of Chinese couples showed a downward trend over time. (2) Men's marital satisfaction displayed almost no change, while women's marital satisfaction had a more obvious downward trend. (3) Changes in macrosocial factors (per capita consumption expenditure, housing prices, old-age dependency ratio, and divorce rate) could significantly predict the downward trend of marital satisfaction, especially for women. Conclusion: In the past 27 years, the overall marital satisfaction level of Chinese couples has shown a downward trend, and there are gendered differences, which may be related to changes in the socioeconomic and cultural environments.

Effects of Audiovisual Interactions on Working Memory Task Performance-Interference or Facilitation.

(1) Background: The combined n-back + Go/NoGo paradigm was used to investigate whether audiovisual interactions interfere with or facilitate WM. (2) Methods: College students were randomly assigned to perform the working memory task based on either a single (visual or auditory) or dual (audiovisual) stimulus. Reaction times, accuracy, and WM performance were compared across the two groups to investigate effects of audiovisual interactions. (3) Results: With low cognitive load (2-back), auditory stimuli had no effect on visual working memory, whereas visual stimuli had a small effect on auditory working memory. With high cognitive load (3-back), auditory stimuli interfered (large effect size) with visual WM, and visual stimuli interfered (medium effect size) with auditory WM. (4) Conclusions: Audiovisual effects on WM follow the resource competition theory, and the cognitive load of a visual stimulus is dominated by competition; vision always interferes with audition, and audition conditionally interferes with vision. With increased visual cognitive load, competitive effects of audiovisual interactions were more obvious than those with auditory stimuli. Compared with visual stimuli, audiovisual stimuli showed significant interference only when visual cognitive load was high. With low visual cognitive load, the two stimulus components neither facilitated nor interfered with the other in accordance with a speed-accuracy trade-off.

Network structure of PTSD symptoms in Chinese male firefighters.

The network perspective of mental disorder offers a novel way of understanding the psychopathology of post-traumatic stress disorder (PTSD). In this framework, PTSD may arise from direct interactions between its symptoms. In the present study, we used the Post-Traumatic Stress Disorder Checklist-civilian Version (PCL-C) to investigate the network structure of PTSD symptoms in 994 Chinese male firefighters. We also calculated the micro (i.e., edges weight and node expected influence) and middle (i.e., community) indicators of the final network. Nine strongest edges existed in the final network were from the same dimension of PCL-C, like "avoidance of thoughts" and "avoidance of reminders". Symptoms "emotional reactivity", "avoidance of reminders" and "exaggerated startle response" had the highest expected influence. As for the results of community detection, the spinglass and walktrap algorithm detected the same three communities which are slightly different from the original dimensions of PCL-C (i.e., symptoms "avoidance of thoughts", "avoidance of reminders" and "trauma-related amnesia" of avoidance dimension of PCL-C were added to the intrusion dimension of PCL-C). The present study explored the network structure of PTSD symptoms in Chinese male firefighters and provided several implications for clinical prevention and intervention to address the mental health needs in this special group.

Increased Expression of CD95 in CD4+ Effector Memory T Cells Promotes Th17 Response in Patients with Myasthenia Gravis.

Emerging data have revealed that CD95 can evoke non-apoptotic signals, thereby promoting pro-inflammatory functions that link to the severity of autoimmune disorders. Here, we reported that the expression of CD95 in CD4+ effector memory T (CD4+ TEM) cells was increased in myasthenia gravis (MG) patients. We also found increased expression of CD95 in CD4+ TEM cells from MG patients correlated positively with clinical severity scores (QMGs), serum IL-17 levels and plasma cells (PCs) frequencies. Conventional treatment, such as glucocorticoid, could down-regulate the expression of CD95 in CD4+ TEM cells, QMGs, serum IL-17 levels and PCs frequencies from MG patients. In vitro, low-dose of agonistic anti-CD95 mAb could promote Th17 cell development. This effect was reversed by CD95 siRNA. Moverover, CD95 stimulation induced the phosphorylation of p38 and Erk1/2 and Th17 cell differentiation, and p38 specific inhibitor SB203580 or Erk1/2 specific inhibitor PD98059 could induce opposite changes. However, SB203580 or PD98059 do not abrogate the increase of CCR6+IL-17A+ cells, ROR-γt and IL-17 expression induced by CD95 triggering relatively to each corresponding control. This suggests that p38 and Erk1/2 MAPK pathway plays a role in expression of CCR6+IL-17A+ cells, ROR-γt and IL-17, but not in their increase induced by CD95 triggering. Taken together, this study revealed that increased expression of CD95 in CD4+ TEM cells promotes Th17 response under the microenvironment of MG.

When Collaborating in Constructive Task With Spouse: Attachment Orientation Predicts Exploratory Behavior Among Older Couples.

In order to examine the function of the attachment system in later life, this study investigated the relationships between attachment orientation and exploratory behavior in a collaborative constructive activity with one's spouse among older adults. In total, 49 older couples completed a collaborative constructive task, and their behaviors were videotaped. Each participant's exploratory behavior (i.e., engagement, enjoyment, and distress) was coded by independent raters. The results revealed older adults highly engaged in the collaborative activity. In addition, based on the actor-partner interdependence model, the results indicated that attachment avoidance positively predicted the individuals' enjoyment as well as their partners' distress during the collaborative activity. The current findings extend the literature regarding the effects of attachment on exploration from early adulthood to later life, from the workplace to family life, and from individual's own behavior to collaborative situation.

Increased serum interleukin-34 levels as a novel diagnostic and prognostic biomarker in patients with acute ischemic stroke.

BACKGROUND: Recent data reveal that interleukin-34 (IL-34) can drive inflammatory response, thereby participating in the pathogenesis of inflammatory diseases. However, the potential effect of IL-34 in acute ischemic stroke (AIS) remains unknown. The purpose of this study was to explore whether the levels of serum IL-34 were correlated with clinical severity or prognosis in AIS patients. METHODS: In this prospective cohort study, serum IL-34 levels were detected in 150 healthy controls and 155 AIS patients. Univariate and multivariate logistic regression analysis were conducted to investigate the effect of IL-34 on the diagnosis and prognosis of AIS. ROC curve was utilized to evaluate predictive values for IL-34. RESULTS: Serum IL-34 levels at admission were significantly higher in AIS patients than those in the healthy controls. Univariate and multivariate logistics regression analysis showed that IL-34 was an independent predictor of occurrence and functional outcome of AIS. The ROC curve demonstrated that IL-34 had a good predictive effect on the diagnosis and prognosis of AIS. CONCLUSIONS: IL-34 can be used as a novel and independent diagnostic and predicting prognostic biomarker in AIS.

IL-21 enhances STAT3/Blimp-1 signaling pathway in B cells and contributes to plasma cell differentiation in newly diagnosed patients with myasthenia gravis.

The transcription factor Blimp-1 is necessary for the B cell differentiation toward immunoglobulin-secreting plasma cells. However, the immunopathological mechanisms of Blimp-1 that regulates B cell differentiation remain unclear in MG. The purpose of this study was to perform a quantitative and functional analysis of Blimp-1 in MG. A total of 34 patients with MG (18 ocular MG (OMG) and 16 generalized MG (GMG) and 20 healthy controls (HC) were recruited in this study. CD19+ B cells were isolated by positive selection using CD19 beads. The expression of Blimp-1 and p-STAT3 protein in isolated B cells was assessed by Western blot. Plasma cells were analyzed by flow cytometry. Serum IL-21 levels were detected by ELISA. Our data demonstrated that Blimp-1 in peripheral blood B cell of MG patients was significantly increased compared with HC. The increased expression of Blimp-1 was positively associated with clinical severity score (QMGs), plasma cell frequency, and serum IL-21 levels. Furthermore, glucocorticoid (GC) treatment reduced the expression of Blimp-1 and p-STAT3 in B cells, and this change was accompanied with relieved clinical severity, reduced plasma cell frequency, and decreased serum IL-21 levels. In vitro assay demonstrated that IL-21 stimulation upregulated STAT3 phosphorylation, increased Blimp-1 expression in B cells, and promoted plasma cell differentiation, and these processes could be inhibited by dexamethasone or STAT3 inhibitor stattic. This work indicates for the first time that aberrant expression of Blimp-1 exists on B cells and contributes to the plasma cell differentiation in MG patients. Modulation of IL-21/STAT3/Blimp-1 signaling pathway in B cells may be one of the mechanisms of glucocorticoid in the treatment of MG.

Attentional Blink in Pilots and Its Relationship With Flight Performance.

OBJECTIVE: In flight, military pilots need to monitor changes in the external environment and monitor the situation of the aircraft at the same time. Attentional blink (AB) reflects attentional blindness in time. Therefore, the present study investigated the AB effect in military pilots and its relationship with flight performance. METHODS: Thirty male military pilots (44.23 ± 4.07 years old) and 29 control participants (44.07 ± 2.93 years old) underwent testing with the classic rapid serial visual presentation paradigm. The participants' accuracy in detecting a second target stimulus (T2/T1) on the basis of their correctly response to the first target stimulus (T1) was calculated to measure the AB effect. The flight performance of these military pilots was also collected. RESULTS: The participants' accuracy in detecting T2/T1 at positions of 180, 270, 360, and 450 ms was significantly lower than that in detecting T1 in both groups. The military pilots' detection accuracy of T2/T1 at the positions of 180 ms (p < 0.001) and 270 ms (p < 0.001) was significantly higher than that of the control participants, and their mean detection accuracy of T2/T1 (AB effect) at the positions of 180, 270, 360, and 450 ms was also significantly higher than that of the control participants (p < 0.001). There was a significant correlation between the AB effect and the lowest flight performance score for the military pilots (r = 0.52, p = 0.004), and the regression coefficient was significant (ß = 0.514, p = 0.004, R 2 = 0.31). CONCLUSIONS: Both groups experienced the AB effect, but the military pilots' performance regarding the AB effect was better than that of the control participants. The AB effect can predict the lowest flight performance score in military pilots. These findings may have implications for the grounding and selection of Chinese military pilots.