Effects and central mechanism of electroacupuncture and MRI-navigated rTMS for PSD: study protocol for an fMRI-based single-center, randomized, controlled, open-label trial.

Background: Post-stroke depression (PSD) is the most common mental complication after stroke and has a serious impact on functional outcomes and quality of life for stroke patients. Antidepressants are the first-line treatment for PSD; however, many reported side effects remain. Clinical research and practice guidelines have shown that electro-acupuncture (EA) or rTMS have a positive effect on PSD. However, there are few clinical studies on EA and MRI-navigated rTMS for PSD that explore the fMRI-based central mechanism in depression. Methods: In this randomized, controlled, open-label trial, 64 patients with PSD will be randomly allocated into the experiment group (n = 32) or control group (n = 32). The experiment group will receive EA and MRI-navigated rTMS and the control group will receive MRI-navigated rTMS treatment, in 12-20 sessions over 4 weeks. In addition, 10 healthy people for fMRI scanning will be recruited as a healthy control group without any intervention. The primary outcome will be the change from baseline in the Hamilton Depression Scale-24 item (HAMD-24) scores at week 4. The primary analysis of the central mechanism will mainly involve cortical morphology, local spontaneous brain activity, and the default mode network (DMN) functional connectivity based on fMRI at 0 and 4 weeks. Secondary outcomes will include the neuro-patho-physiological and quality of life changes in cortical excitability, determined using the motor evoked potential test (MEP), National Institutes of Health Stroke Scale (NIHSS), EuroQol Five Dimensions Questionnaire (EQ-5D) Scale, Modified Barthel Index (MBI) Scale, and Health Scale of Traditional Chinese Medicine (HSTCM). Additional indicators will include the Acceptability Questionnaire and Health Economics Evaluation (cost-effectiveness analysis) to assess the acceptability and economic practicality of the treatment under study. Outcomes will be assessed at baseline and post intervention. Discussion: EA and MRI-navigated rTMS therapy could become an alternative treatment for PSD, and it is expected that this trial will provide reliable clinical evidence and a potential central mechanism for the future use of EA and MRI-navigated rTMS for PSD. Clinical trial registration: NCT05516680, ClinicalTrials.gov (registered in August 2022).

Personality traits influence the effectiveness of hypomania checklist-32 in screening for bipolar disorder.

Background: It is clinically challenging to distinguish bipolar disorder (BD) from major depressive disorder (MDD) in the early stages. While the hypomania checklist-32 (HCL-32) is a proper auxiliary tool that is useful to differentiate between BD and MDD, there is currently no standard cut-off value. The variations in HCL-32 cut-off values could potentially be influenced by personality traits. Therefore, the aim of this study is to explore the effect of personality traits on the screening performance of HCL-32. Methods: In this retrospective cross-sectional study, 168 patients with BD or MDD were evaluated with the Eysenck Personality Questionnaire (EPQ) and HCL-32. The associations between demographic data, diagnosis and clinical rating scales were analyzed. Results: Diagnosis was not associated with extraversion but was related to neuroticism. HCL-32 scores in typical extraverted patients were higher in contrast to atypical extraverted patients. The best cut-off value for BD recognition of typical and atypical extraversion groups were 15 and 12.5, respectively. In patients with MDD, HCL-32 score of typical neuroticism was higher than the atypical type, but there was no difference in patients with BD. In typical neuroticism, there was no difference in HCL-32 scores between patients with MDD and BD. But among atypical neurotic patients, HCL-32 scores of BD were higher compared to MDD, with a cut-off value of 14.5. Limitations: This study had a small sample size. Conclusion: HCL-32 scores were affected by personality traits, with higher scores for typical extraversion and neuroticism. Clinicians should also consider the patients' personality traits when referring to HCL-32 scores, so as to increase the recognition rate of BD and eliminate false positives.

Fluoxetine regulates glucose and lipid metabolism via the PI3K­AKT signaling pathway in diabetic rats.

Diabetes mellitus poses a major threat towards global heath due to a lack of effective treatment. Fluoxetine hydrochloride, a selective 5­hydroxytryptamine reuptake inhibitor, is the most commonly used antidepressant in clinical therapy; however, the potential molecular mechanisms of fluoxetine in diabetes remain unknown. In the present study, reduced glucose, total cholesterol and triglyceride levels and lipid metabolism, as well as upregulated proliferator­activated receptor γ, fatty acid synthase and lipoprotein lipase, and downregulated sterol regulatory element­binding protein 1­c were detected in rats with streptozotocin (STZ)­induced diabetes following treatment with fluoxetine. Furthermore, fluoxetine significantly inhibited the expression levels of glucose metabolism­associated proteins in liver tissues, including glycogen synthase kinase 3ß (GSK­3ß), glucose­6 phosphatase catalytic subunit (G6PC), phosphoenolpyruvate carboxykinase (PEPCK) and forkhead box protein O1 (FOXO1). In addition, fluoxetine treatment notably attenuated morphological liver damage in rats with STZ­induced diabetes. Additionally, fluoxetine could inhibit the phosphatidylinositol 3­kinase­protein kinase B (PI3K­AKT) signaling pathway, whereas LY294002, a specific inhibitor of PI3K, suppressed the function of PI3K­AKT signaling and suppressed the expression levels of glucose metabolism­associated proteins, including GSK­3ß, G6PC, PEPCK and FOXO1 in BRL­3A cells. The results of the present study revealed that fluoxetine may regulate glucose and lipid metabolism via the PI3K­AKT signaling pathway in diabetic rats.

Work-family conflict and job burn-out among Chinese doctors: the mediating role of coping styles.

BACKGROUND: Burn-out among doctors threatens their own health, and that of their patients. To identify risk factors of the doctor burn-out is vital to improving their health and increasing the quality of healthcare services. This study aims to explore the relationship between work-family conflict (WFC) and burn-out among Chinese doctors and the mediating role of coping styles in this relationship. METHODS: A cross-sectional survey was conducted in China, with a questionnaire packet which consisted of the Chinese Maslach Burnout Inventory (CMBI), WFC Scale and the Simplified Coping Style Questionnaire (SCSQ). A total of 2530 doctors participated in the survey. Correlation analysis was performed to explore the relationship between CMBI, WFC and SCSQ scores. A linear regression model was set to determine the mediating role of coping styles on the relationship between WFC and burn-out. RESULTS: Doctors who had higher scores on work interfering with family conflict, reported more emotional exhaustion (r=0.514, P<0.001) and had a sense of accomplishment (r=-0.149, P<0.001). Simultaneously, family interfering with work (FIW) was positively associated with all dimensions of burn-out (r=0.213, 0.504, 0.088, respectively, P<0.001). Coping styles had partial, complete and even mediating effects on the relationship between WFC and burn-out among Chinese doctors. CONCLUSIONS: WFC was correlated with burn-out, and coping style was a mediator in this relationship among Chinese doctors. Coping style was a positive resource against burn-out.

[Change of cerebral metabolism rate of glucose of cerebral white matter in Alzheimer's disease: a study with statistical parametric mapping software].

OBJECTIVE: To study the change of cerebral metabolism rate of glucose (CMRglc) of cerebral white matter in Alzheimer's Disease. METHODS: Positron emission tomography (PET) was performed on 13 AD patients, 6 with behavioral and psychological symptoms of dementia (BPSD) and 7 without BPSD, and 10 healthy controls. The regional cerebral metabolism of glucose (rCMRglc) of some brain regions and nuclei were detected. RESULTS: (1) The rCMRglc of the cerebral white matter decreased extensively in the AD patients, especially in the right frontal lobe, superior gyrus of the left frontal lobe (P = 0.001). (2) The rCMRglc of subcortical white matter of the left medial prefrontal lobe and the left cuneus of occipital lobe increased in the AD patients. (3) The levels of rCMRglc of the subcortical white matter of both side middle occipital lobe, left cuneus of occipital lobe, right inferior parietal lobule, left fusiform gyrus of temporal lobe and the left medial prefrontal lobe were all significantly higher in the AD patients with BPSD than in those without BPSD (P = 0.001). While the levels of rCMRglc of the subcortical white matter of both side paracentral lobule, right superior and middle frontal lobe, and left superior temporal lobe were all significantly lower in the AD patients with BPSD than in those without BPSD (all P = 0.001). CONCLUSION: There is diffuse abnormal rCMRglc in the cerebral white matter in the AD patients: the rCMRglc decreases in the frontal-temporal-occipital association area, and the rCMRglc of the medial prefrontal lobe and cuneus of occipital lobe increases. BPSD is correlated with the abnormal metabolism of related cerebral regions.