The Clinical Characteristics and Manifestation of Anxious Depression Among Patients With Major Depressive Disorders-Results From a Taiwan Multicenter Study

Objective@#Anxious depression is a prevalent characteristic observed in Asian psychiatric patients diagnosed with major depressive disorder (MDD). This study aims to investigate the prevalence and clinical presentation of anxious depression in Taiwanese individuals diagnosed with MDD. @*Methods@#We recruited psychiatric outpatients aged over 18 who had been diagnosed with MDD through clinical interviews. This recruitment took place at five hospitals located in northern Taiwan. We gathered baseline clinical and demographic information from the participants. Anxious depression was identified using a threshold of an anxiety/somatization factor score ≥7 on the 21-item Hamilton Rating Scale for Depression (HAM-D). @*Results@#In our study of 399 patients (84.21% female), 64.16% met the criteria for anxious depression. They tended to be older, married, less educated, with more children, and an older age of onset. Anxious depression patients had higher HAM-D and Clinical Global Impression–Severity scale score, more panic disorder (without agoraphobia), and exhibited symptoms like agitation, irritability, concentration difficulties, psychological and somatic anxiety, somatic complaints, hypochondriasis, weight loss, and increased insight. Surprisingly, their suicide rates did not significantly differ from non-anxious depression patients. This highlights the importance of recognizing and addressing these unique characteristics. @*Conclusion@#Our study findings unveiled that the prevalence of anxious depression among Taiwanese outpatients diagnosed with MDD was lower compared to inpatients but substantially higher than the reported rates in European countries and the United States. Furthermore, patients with anxious depression exhibited a greater occurrence of somatic symptoms.

[Moxibustion at Baihui combined with acupuncture for cervical vertigo: a Meta-analysis and trial sequential analysis].

OBJECTIVE: To evaluate the efficacy and safety of moxibustion at Baihui (CV20) combined with acupuncture in treatment of cervical vertigo. METHODS: From the databases, such as CNKI, VIP, WanFang, CBM, PubMed, Cochrane Library and Embase, the studies of randomized controlled trials (RCTs) on moxibustion at CV20 combined with acupuncture for cervical vertigo were searched from inception to September 15th, 2021. The Cochrane risk of bias assessment tool was utilized to evaluate the quality of the included literature. Using RevMan5.3, Stata12.0 and TSA0.9.5.0 10 Beta software, the Meta-analysis and trial sequential analysis (TSA) were performed. RESULTS: Seventeen RCTs with 1 232 patients were included. Meta-analysis showed that in the trial group (moxibustion at CV20 combined with acupuncture), the total effective rate (RR=1.17, 95%CI［1.12, 1.22］, P<0.000 1), the curative and remarkably-effective rate (RR＝1.28，95%CI［1.20，1.36］，P<0.000 1) and the score of cervical vertigo (WMD=2.88, 95%CI［1.87, 3.89］, P<0.000 1) were all better when compared with the control group (simple acupuncture or electroacupuncture group). The results of trial sequential analysis indicated that for the cumulative Z-score of each RCT, the Z-curve crossed the conventional test boundary and TSA boundary, which further confirmed the clinical efficacy of moxibustion at CV20 combined with acupuncture on cervical vertigo. CONCLUSION: The clinical efficacy of moxibustion at CV20 combined with acupuncture is determined in treatment of cervical vertigo.

Treatment Retention Rates of 3-monthly Paliperidone Palmitate and Risk Factors Associated with Discontinuation: A Population-based Cohort Study

Objective@#Limited evidence exists regarding real-world 3-monthly paliperidone palmitate (PP3M) treatment retention and associated factors. @*Methods@#We conducted a retrospective, nationwide cohort study using the Taiwan National Health Insurance Research Database between October 2017 and December 2019. Adult patients with schizophrenia initiated on PP3M were enrolled. The primary outcomes were time to PP3M discontinuation, time to psychiatric hospitalization, and the proportions of patients receiving the next PP3M dose within 120 days among first-, second-, and third-dose completers. Key covariates included prior PP1M duration and adequate PP3M initiation. @*Results@#The PP3M treatment retention rates were 79.7%, 66.3%, and 52.5% after 6, 12, and 24 months, respectively, with 86.4%, 90.6%, and 90.0% of respective first-, second-, and third-dose completers receiving the next PP3M dose. Adequate PP3M initiation and prior PP1M treatment duration ＞ 180 days were associated with favorable PP3M treatment retention. In multivariate analyses, PP1M durations of 180−360 days (adjusted relative risk [aRR], 1.76) or ＜ 180 days (aRR, 2.79) were associated with PP3M discontinuation at the second dose. Inadequate PP3M initiation was associated with discontinuation at the third dose (aRR, 2.18). Patients fully adherent to PP3M treatment in the first year had a higher probability of being free from psychiatric hospitalization (86.7% at 2 years), compared with those partially adherent or non-adherent to PP3M in the first year. @*Conclusion@#Prior PP1M duration and adequate PP3M initiation are major factors affecting PP3M treatment retention. Higher PP3M treatment retention is associated with a lower risk of psychiatric hospitalization.

[Effect of ZhuLian's type â ¡ inhibition needling technique on endocrine metabolism in rats with polycystic ovary syndrome and insulin resistance].

OBJECTIVE: To observe the effect of ZhuLian's type Ⅱ inhibition needling technique on sex hormones, insulin resistance and ovarian morphology in rats with polycystic ovary syndrome (PCOS), so as to explore its mechanism on regulating endocrine and metabolic dysfunction of PCOS. METHODS: Twenty-four female SD rats were randomly divided into control, model and ZhuLian acupuncture groups (n=8 in each group). The PCOS model was established by continuous gavage of letrozole combined with high-fat diet. Rats of the ZhuLian acupuncture group were stimulated at "Guanyuan"(CV4) and bilateral "Guilai"(ST29), "Zusanli"(ST36), "Sanyinjiao"(SP6), and "Fenglong"(ST40) by ZhuLian's type Ⅱ inhibition needling technique for 30 min, continuously intervented for 28 days. The body weight was measured before and after modeling and after intervention. The ovarian volume was calculated. HE staining was used to observe the changes of ovarian histology. Plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and fasting insulin (FINS) were measured by ELISA. LH/FSH ratio and insulin resistance index (HOMA-IR) were calculated. RESULTS: After modeling, the rats' body weight and the ovarian volume were increased (P<0.05), and the ovaries showed polycystic changes in the model group compared with the control group. And the FINS level, HOMA-IR, LH content and LH/FSH ratio were significantly increased (P<0.05), while the FSH level was decreased (P<0.05). After the intervention, the rats' body weight and ovarian volume were decreased (P<0.05), and a small number of preantral follicles and more antral follicles were observed under microscope, and the levels of LH, LH/FSH, FINS and HOMA-IR were significantly decreased (P<0.05), while FSH content was increased (P<0.05) in the ZhuLian acupuncture group than in the model group. CONCLUSION: ZhuLian's type Ⅱ inhibition needling technique can improve the endocrine and metabolic disorders in PCOS rats, which may be related to the regulation of endocrine system.

[Efficacy and action mechanism of ZHU Lian inhibition type â acupuncture for acne with spleen-stomach dampness-heat].

OBJECTIVE: To observe the efficacy of ZHU Lian inhibition type Ⅰ acupuncture for acne with spleen-stomach dampness-heat, and to explore its possible action mechanism. METHODS: A total of 82 patients of acne with spleen-stomach dampness-heat were randomly divided into an observation group and a control group, 41 cases in each group. The patients in the control group were treated with danshentong capsules (1 g, 3 times per day) and 0.1% adapalene gel smear (once every night) for 4 weeks. The patients in the observation group were treated with ZHU Lian inhibition type Ⅰ acupuncture at Hegu (LI 4), Neiting (ST 44), Quchi (LI 11), Yangbai (GB 14), Sibai (ST 2), Qihai (CV 6), Xuehai (SP 10), Yinlingquan (SP 9) and skin lesions, once every other day, 7 times as a course of treatment, totaling for 2 courses of treatment. The skin lesion score of the global acne grading system (GAGS) and quality of life-acne (Qol-Acne) score as well as the serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were compared between the two groups before and after treatment; the clinical efficacy were compared between the two groups, and the recurrence rate was evaluated 4 weeks after treatment. RESULTS: After treatment, the skin lesion scores of GAGS in the two groups were reduced (P<0.05), and the score in the observation group was lower than that in the control group (P<0.05). After treatment, the Qol-Acne scores were increased in the two groups (P<0.05), and the score in the observation group was higher than that in the control group (P<0.05). The serum levels of TNF-αand IL-6 in the two groups were reduced after treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). The total effective rate was 95.1% (39/41) in the observation group, which was higher than 82.9% (34/41) in the control group (P<0.05). Four weeks after treatment, the recurrence rate of acne lesions was 10.3% (4/39) in the observation group, which was lower than 32.4% (11/34) in the control group (P<0.05). CONCLUSION: ZHU Lian inhibition type Ⅰ acupuncture is effective for acne with spleen-stomach dampness-heat, and the recurrence rate is low. Its mechanism may be related to the reduction of serum inflammatory factor TNF-α and IL-6.

[Effect of electroacupuncture combined with Zhuang-medicine-thread moxibustion on silent information regulator-1/nuclear factor κB signaling pathway in gastric antrum of diabetic gastroparesis rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) combined with Zhuang-medicine-thread moxibustion on silent information regulator-1 (SIRT1)/nuclear factor kappa B (NF-κB) signal pathway and inflammatory factor expression in gastric antrum tissue of diabetic gastroparesis (DGP) rats, so as to explore its mechanism underlying improvement of DGP. METHODS: Male SD rats were randomly divided into normal, model, medication, EA, Zhuang-medicine-thread moxibustion (moxibustion) and EA+moxibustion groups (n=12 per group). The DGP model was established by intraperitoneal injection of streptozotocin (STZ). Rats of the medication group were treated by gavage of 0.15 mg/mL mosapride citrate suspension. EA (10 Hz /50 Hz, 2 mA) or moxibustion (3 cones) or EA+moxibustion was applied to "Zhongwan"(CV12), bilateral "Neiguan"(PC6) and bilateral "Sanyinjiao"(SP6) of the related group for 20 min, once a day for 3 weeks. Blood glucose, gastric emptying rate and intestinal propulsion rate were measured. The levels of serum interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor-α(TNF-α) were detected by ELISA; the phosphorylation level of the phosphorylated inhibitor of nuclear factor κBα inhibitor (pIκ-Bα), the protein and mRNA expression of NF-κB p65 and SIRT1 in the gastric antrum tissue were detected by Western blot and real-time quantifitative PCR, respectively. RESULTS: (1) Compared with the normal group, the levels of blood glucose, serum IL-6, IL-8, TNF-α, and gastric pIκ-Bα and NF-κB p65 protein and mRNA expressions were significantly increased (P<0.01), and the gastric emptying rate, intestinal propulsion rate, serum IL-10 level, and SIRT1 protein and mRNA expressions were considerably decreased in the model group (P<0.01). (2) In contrast to the model group, the blood glucose in the EA, moxibustion and EA+moxibustion groups, serum IL-6, IL-8 and TNF-α levels in the 4 treatment groups, as well as NF-κB p65 protein expression in the medication and EA+moxibustion groups, and NF-κB p65 mRNA expression and pIκ-Bα protein and mRNA expression in the 4 treatment groups were significantly decreased (P<0.01, P<0.05); while the gastric emptying rate and intestinal propulsive rate and IL-10 content in the 4 treatment groups, and SIRT1 protein and mRNA expression in the medication and EA+moxibustion groups were obviously increased (P<0.05, P<0.01). (3) The effects of EA+moxibustion were significantly superior to those of simple EA and moxibustion in increasing gastric emptying rate, IL-10, SIRT1 protein expression (P<0.05, P<0.01), and in lowering IL-8 and TNF-α contents, pIκ-Bα protein and mRNA expression and NF-κB p65 mRNA expression (P<0.05, P<0.01). No significant differences were found among the 4 intervention groups in promoting the intestinal propulsive rate and among the EA, moxibustion and EA+moxibustion groups in lowering blood glucose (P>0.05). CONCLUSION: EA combined with Zhuang-medicine-thread moxibustion can effectively reduce the level of serum inflammatory factors and regulate SIRT1/NF-κB signal pathway in DGP rats, which may contribute to its function in improving gastrointestinal movement.

[Value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid for predicting refractory Mycoplasma pneumoniae pneumonia in children].

OBJECTIVE: To evaluate the value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid (BALF) for predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. METHODS: A total of 50 children with common Mycoplasma pneumoniae pneumonia (MPP) and 22 children with RMPP were enrolled. The two groups were compared in terms of clinical features, laboratory examination results, imaging findings, and YKL-40 levels in BALF. The receiver operating characteristic (ROC) curve was used to evaluate the value of YKL-40 in BALF for predicting RMPP. RESULTS: Compared with the common MPP group, the RMPP group had significantly higher incidence rates of fever, shortness of breath, lung consolidation, and pleural effusion (P < 0.05) and significantly higher serum levels of C-reactive protein and lactate dehydrogenase (P < 0.05). The RMPP group had a significantly higher level of YKL-40 in BALF than the common MPP group (P < 0.05). The ROC curve plotted based on the level of YKL-40 in BALF had an area under the ROC curve of 0.750, a sensitivity of 72.7% and a specificity of 64.0% for predicting RMPP. CONCLUSIONS: There is an increase in the level of YKL-40 in BALF in children with RMPP, and the level of YKL-40 in BALF has a certain value for predicting RMPP.

[Association of YKL-40 in bronchoalveolar lavage fluid with airway damage in children with Mycoplasma pneumoniae pneumonia].

OBJECTIVE: To investigate the association of YKL-40 in bronchoalveolar lavage fluid (BALF) with airway damage in children with Mycoplasma pneumoniae pneumonia (MPP). METHODS: A total of 60 children with MPP who were admitted to the hospital were enrolled as the MPP group, and 12 children with bronchial foreign bodies were enrolled as the control group. According to the imaging findings, the MPP group was further divided into 3 subgroups: pulmonary patchy shadow (n=34), pulmonary consolidation (n=19) and pulmonary ground-glass opacity (n=7). According to the bronchoscopic findings, the MPP group was further divided into 3 subgroups: mucosal congestion/edema (n=38), mucous secretion (n=18) and plastic bronchitis (n=4). The clinical manifestations and laboratory characteristics of the children with MPP were analyzed, the expression of YKL-40 in BALF was measured. RESULTS: The MPP group had significantly higher levels of serum lactate dehydrogenase and BALF YKL-40 than the control group (P<0.05). The pulmonary consolidation subgroup had significantly higher levels of serum C-reactive protein and lactate dehydrogenase than the pulmonary patchy shadow subgroup (P<0.05), and the pulmonary consolidation and pulmonary ground-glass opacity subgroups had a significantly higher level of BALF YKL-40 than the pulmonary patchy shadow subgroup (P<0.05). The plastic bronchitis subgroup had a significantly higher level of BALF YKL-40 than the mucous secretion and mucosal congestion/edema subgroups (P<0.05). The mucous secretion and plastic bronchitis subgroups had a significantly higher proportion of children with shortness of breath than the mucosal congestion/edema subgroup (P<0.05). The plastic bronchitis subgroup had significantly higher serum levels of C-reactive protein and lactate dehydrogenase than the mucosal congestion/edema subgroup (P<0.05). CONCLUSIONS: The level of BALF YKL-40 is associated with airway damage and disease severity in children with MPP.

Combined Assessment of Serum Alpha-Synuclein and Rab35 is a Better Biomarker for Parkinson's Disease

BACKGROUND AND PURPOSE: It is essential to develop a reliable predictive serum biomarker for Parkinson's disease (PD). The accumulation of alpha-synuclein (αSyn) and up-regulated expression of Rab35 participate in the etiology of PD. The purpose of this investigation was to determine whether the combined assessment of serum αSyn and Rab35 is a useful predictive biomarker for PD. METHODS: Serum levels of αSyn or Rab35 were determined in serum samples from 59 sporadic PD patients, 19 progressive supranuclear palsy (PSP) patients, 20 multiple system atrophy (MSA) patients, and 60 normal controls (NC). Receiver operating characteristics (ROC) curves were calculated to determine the diagnostic accuracy of αSyn or/and Rab35 in discriminating PD patients from NC or atypical parkinsonian patients. RESULTS: The levels of αSyn and Rab35 were increased in PD patients. The serum level of Rab35 was positively correlated with that of αSyn in PD patients. Compared to analyzing αSyn or Rab35 alone, the combined analysis of αSyn and Rab35 produced a larger area under the ROC curve and performed better in discriminating PD patients from NC, MSA patients, or PSP patients. When age was dichotomized at 55, 60, 65, or 70 years, the combined assessment of αSyn and Rab35 for classifying PD was better in the group below the cutoff age than in the group above the cutoff age. CONCLUSIONS: Combined assessment of serum αSyn and Rab35 is a better biomarker for discriminating PD patients from NC or atypical parkinsonian patients, and is a useful predictive biomarker for younger sporadic PD patients.

SUMO2 modification of Aurora B and its impact on follicular development and atresia in the mouse ovary.

In the mammalian ovary, >99% follicles fail to ovulate due to apoptosis in granulosa cells. Aurora B, a core subunit enzyme of the chromosomal passenger complex, exerts a crucial role in microtubule­kinetochore attachment, and has been reported to be modified by small ubiquitin­related modifier (SUMO) proteins. However, the details of how Aurora B and its SUMOylation impact on follicular development have yet to be fully elucidated. The aim of the present study was to explore the roles, and possible molecular mechanism, of Aurora B and its SUMOylation in the granulosa cells of the mouse follicle. It was revealed that the protein level of Aurora B increased with follicular development and the growth of the granulosa cells. Aurora B impacted follicular development and atresia through mediating the p38 mitogen­activated protein kinase and FasL/Fas pathways, and caused the downregulation of cyclin­dependent kinase 4, proliferating cell nuclear antigen, Bcl­2, and upregulation of caspases­3 and ­8 to modulate the viability of the granulosa cells. In addition, Aurora B undergoes modification by SUMO2, but not by SUMO1, in vivo and in vitro, and Lys­207 is a major modification site. SUMOylation modulates follicular development through an increase in Aurora B localization in the nucleus, and by stabilizing the protein level of Aurora B and keeping the viability of the granulosa cells. Taken together, Aurora B and its SUMOylation are important for follicular development and atresia in the ovaries of mice.

Particle chain display--an optofluidic electronic paper.

A particle-based display medium and a driving mechanism insensitive to the charge polarity of those particles, based on the transformation of particle chains, are developed for reflective electronic paper displays. Particle chains are formed by dipole-dipole interactions between polarized particles with an appropriate electric field applied across the tested display medium, i.e. the solution that regulates the light in the field of display technology, containing neutral polystyrene (PS) particles dispersed in water. Formation of the particle chains results in a large change in optical transmittance and reflectance of the display medium. The performance of the particle chain displays (PCD) was evaluated according to macroscopic (device), microscopic (particle) and optical (reflectance) points of view. A display medium (thickness 100 µm) containing colored PS particles (3 µm, 2.5% w/v) was polarized to display the fixed images of the directly driven electrodes and programmable images of arrayed (5 × 5) electrodes with electric fields (0.48 MV m(-1) and 0.09 MV m(-1), 500 kHz, respectively). The formation of particle chains under electric fields (0.2 MV m(-1) and 0.4 MV m(-1), 500 kHz) was observed in the microscopic images of a display medium (thickness 100 µm) with fluorescent PS particles (5 µm, 1%). Images recorded with a confocal microscope demonstrated the particle chains. The opacity, a common parameter serving to characterize a display medium, was derived by measuring the reflectance ratio of a black background to a white background of the display medium with varied thickness and particle concentration. The temporal response of a display medium (thickness 50 µm) with black PS particles (3 µm, 5%) was tested. When an electric field (0.6 MV m(-1), 500 kHz) was applied, the reflectance increased twice at the first data point in 0.7 s, attaining a contrast ratio of 2. Application of a voltage (20 s) yielded a contrast ratio of 10. The performance of a tested display medium, composed of simple PS particles and water and driven to form particle chains by polarization, is reported.