Background: The association between specific chemical components of PM2.5 and depression remains largely unknown. Methods: We conducted a time-stratified case-crossover analysis with a distributed lag nonlinear model (DLNM) to evaluate the relationship of PM2.5 and its chemical components, including black carbon (BC), organic matter (OM), sulfate (SO42−), nitrate (NO3−), and ammonium (NH4+), with the depression incidence. Daily depression outpatients were enrolled from Huizhou, Shenzhen, and Zhaoqing. Results: Among 247,281 outpatients, we found the strongest cumulative effects of PM2.5 and its chemical components with the odd ratios (ORs) of 1.607 (95% CI: 1.321, 1.956) and 1.417 (95% CI: 1.245, 1.612) at the 50th percentile of PM2.5 and OM at lag 21, respectively. Furthermore, the ORs with SO42− and NH4+ at the 75th percentile on the same lag day were 1.418 (95% CI: 1.247, 1.613) and 1.025 (95% CI: 1.009, 1.140). Relatively stronger associations were observed among females and the elderly. Conclusions: Our study suggests that PM2.5 and its chemical components might be important risk factors for depression. Reducing PM2.5 emissions, with a particular focus on the major sources of SO42− and OM, might potentially alleviate the burden of depression in South China.

The detests contain age, gender, treatment date of daily outpatients for mental diseases, including sleep disorder, anxiety, depression, bipolar disorder, schizophrenia as well as PM2.5 chemical components in lag days from three Chinese cities: Huizhou, Shenzhen, and Zhaoqing.

目的 了解广东省惠州市纳入国家基本公共卫生服务管理的精神分裂症(SCHIZ)合并2型糖尿病(T2DM)患者现况,评价共病患者管理效果,为该人群的T2DM防治提供参考依据.方法 2020年3-5月收集辖区35岁及以上在管SCHIZ患者健康档案信息并开展问卷调查,对SCHIZ合并T2DM患者分为已管理组(纳入T2DM管理)和未管理组(未纳入T2DM管理),SCHIZ患者及T2DM共病患者的人口学特征、重点慢性病及其危险因素和T2DM共病患者血糖控制效果.结果 SCHIZ患者中T2DM的患病率为22.3％;管理组高血压患病率(x2=7.397)、T2DM患者知晓率(x2=98.694)、血糖控制率(x2=114.004)、健康知识关注度(x2=26.071)均高于未管理组,差异有统计学意义(P＜0.01);口味较未管理组轻,差异有统计学意义(x2=8.018,P＜0.05).结论 惠州地区SCHIZ患者中T2DM的患病率较高,共病患者血糖管理更为困难;该地区开展国家基本公共卫生慢性病管理服务具有一定成效,但在行为改变方面效果不明显;应注重共病患者协同管理作用,有针对性地提供健康指导,促进健康行为的改变.

Background Contrast associated acute kidney injury (CA-AKI) is a major cause of acute renal failure and the incidence of CA-AKI is still high in recent years. Risk stratification is traditionally based on glomerular filtration rate(GFR). Hence, the aim of this study was to explore the novel risk factors for CA-AKI after enhanced computed tomography (CT). Methods A retrospective cohort study was conducted in 632 in-hospital patients undergoing enhanced CT. The patients were divided into CA-AKI and no-CA-AKI groups. For comparative analyses, we applied one-to-four cohorts of those two groups using propensity score-matching methods addressing the imbalances of age, gender, weight, and smoking. The baseline clinical and biochemical data were compared. Logistic regression analysis was employed to investigate the CA-AKI risk factors. The receiver operating characteristic (ROC) curve was adopted to test the value of RDW in predicting CA-AKI after enhanced CT. Results 25 (3.96%) patients suffered from CA-AKI. Those subjects who developed CA-AKI had advanced age, severer renal functional injury, lower albumin, higher baseline RDW, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) than those without CA-AKI. It also exhibited more severe anemia including decreased hemoglobin and red blood cell count (all p < 0.05). The baseline RDW, albumin and PLR between the two groups were statistically significant different after PSM. Binary logistic regression analysis showed that baseline RDW, albumin and eGFR were correlated with CA-AKI after contrast-enhanced CT examination. The RDW exhibited moderated discrimination ability for predicting CA-AKI beyond eGFR, with an AUC of 0.803 (95% CI [0.702–0.90]) vs 0.765 (95% CI [0.70–0.83]). Conclusion Increased baseline RDW and decreased eGFR are risk factors for CA-AKI after enhanced CT. RDW exhibited good predictive value and can be used as an early warning marker for patients suffering from CA-AKI after enhanced CT.

目的 评价惠州市艾滋病防治"一站式服务"的工作效果,进一步提高其工作质量.方法 对2016年1月1日至2019年12月31日惠州市报告艾滋病病毒(HIV)感染者和艾滋病(AIDS)患者的抗体确证检测、CD4+T淋巴细胞检测及开始抗病毒治疗时间等资料进行分析.结果 开展服务前后对比,14 d内的确证-治疗时间间隔占比从21.6％(67/610)提高到67.4％(424/629,x2=194.09,P＜0.01);初始 CD4+T 淋巴细胞检测率从87.7％(272/310)提高至95.1％(598/629,x2=20.45,P＜0.01);抗病毒治疗覆盖率由57.0％(310/544)提高至88.5％(629/711,x2=162.13,P＜0.01).多元线性回归分析提示,接受"一站式服务"的HIV感染者和AIDS患者,确证-治疗时间间隔缩短.结论 惠州市艾滋病"一站式服务"工作有效提高了艾滋病抗病毒治疗效率,值得延续和推广.

While sensorimotor abnormalities in schizophrenia (SZ) are of increasing scientific interest, little is known about structural changes and their developmental origins that may underlie parkinsonism. This multimodal magnetic resonance imaging (MRI) study examined healthy controls (HC, n = 20) and SZ patients with (SZ-P, n = 38) and without (SZ-nonP, n = 35) parkinsonism, as defined by Simpson-Angus Scale total scores of ≥4 or ≤1, respectively. Using the Computational Anatomy Toolbox (CAT12), voxel- and surface-based morphometry were applied to investigate cortical and subcortical gray matter volume (GMV) and three cortical surface markers of distinct neurodevelopmental origin: cortical thickness (CTh), complexity of cortical folding (CCF) and sulcus depth. In a subgroup of patients (29 SZ-nonP, 25 SZ-P), resting-state fMRI data were also analyzed using a regions-of-interest approach based on fractional amplitude of low frequency fluctuations (fALFF). SZ-P patients showed increased CCF in the left supplementary motor cortex (SMC) and decreased left postcentral sulcus (PCS) depth compared to SZ-nonP patients (p < 0.05, FWE-corrected at cluster level). In SMC, CCF was associated negatively with activity, which also differed significantly between the patient groups and between patients and HC. In regression models, severity of parkinsonism was associated negatively with left middle frontal CCF and left anterior cingulate CTh. These data provide novel insights into altered trajectories of cortical development in SZ patients with parkinsonism. These cortical surface changes involve the sensorimotor system, suggesting abnormal neurodevelopmental processes tightly coupled with cortical activity and subcortical morphology that convey increased risk for sensorimotor abnormalities in SZ.

目的 分析单纯2型糖尿病(A组)、有并发症2型糖尿病(B组)及2型糖尿病与精神分裂症共病患者(C组)3组间的糖尿病自我管理障碍与促成因素,了解不同患者的自我管理效能.方法 收集2019年10月—2020年4月335例目标人群进行问卷调查;运用因子分析法降维提取公因子,命名及解释其现实意义;借鉴Likert评分法,比较各组间总得分、各公因子的得分差异.结果 大部分受访者对题目观点的认可度较高,平均同意比例达73.0％,但在"管理我的糖尿病比管理我的心理健康更重要"(18.6％)、"控制糖尿病需要特殊技能"(31.4％)、"我的精防医生帮助我管理好我的糖尿病"(57.7％)方面认可度较低.将27个变量降维后,共提取6个公因子,累积解释方差达到70.019％,分别是管理糖尿病正向信念(F1)、管理糖尿病的社会及医学支持(F2)、管理糖尿病的能力(F3)、管理糖尿病负向信念(F4)、如果未管理好糖尿病的健康态度(F5)、管理糖尿病的心理健康需求(F6).A组的总得分、F1、F4、F5得分高于其他两组,差异有统计学意义(P<0.001),A组F2得分低于B组;C组的F2、F3、F4和F5得分均低于其他两组,差异有统计学意义(P<0.001),在F6的得分最高.结论 有并发症2型糖尿病患者特别是2型糖尿病与精神分裂症共病患者实施糖尿病自我管理的障碍较大,2型糖尿病与精神分裂症共病患者对心理健康的需求更大;开展糖尿病自我管理应针对性解决不同人群特别是共病患者人群的自我管理障碍因素,予以更广泛的社会及医学关注,提高其自我管理效能.

BACKGROUND:From the perspective of information processing, an integrated understanding of the structural and functional connectomes in depression patients is important, a multimodal meta-analysis is required to detect the robust alterations in graph metrics across studies. METHODS:Following a systematic search, 952 depression patients and 1447 controls in nine diffusion magnetic resonance imaging (dMRI) and twelve rest state functional MRI (rs-fMRI) studies with high methodological quality met the inclusion criteria and were included in the meta-analysis. RESULTS:Regarding the dMRI results, no significant differences of meta-analytic metrics were found; regarding the rs-fMRI results, the modularity and local efficiency were found to be significantly lower in the depression group than in the controls (Hedge's g = -0.330 and -0.349, respectively). CONCLUSION:Our findings suggested a lower modularity and network efficiency in the rs-fMRI network in depression patients, indicating that the pathological imbalances in brain connectomes needs further exploration. LIMITATIONS:Included number of trials was low and heterogeneity should be noted.

目的 对惠州市一起无症状感染者引起的新型冠状病毒肺炎(COVID-19)家庭聚集性疫情进行流行病学调查和分析,为COVID-19疫情防控积累经验.方法 对该起疫情所有病例及其密切接触者进行现场流行病学调查,并采集鼻咽拭子、咽拭子、肛拭子和血液标本,对一般接触者采集咽试子标本,采用RT-PCR法进行新型冠状病毒(SARS-COV-2)核酸检测和胶体金法检测IgM抗体和IgG抗体.结果 本起疫情共有1例确诊病例,2例无症状感染者;传染源可能是具有武汉居住史的无症状感染者C,并较大可能通过密切接触方式传染给无症状感染者B,由B传染给确诊病例A,但不排除由C先后传染给B和A;A是该起疫情的指示病例;根据流行病学调查和SARS-COV-2核酸检测以及血液标本IgM、IgG检测判定,本疫情为一起输入性无症状感染者导致本地感染的家庭聚集性疫情.结论 家庭聚集性疫情以密切接触方式传播为主,加强对家庭的个人卫生防护宣传;家庭聚集性疫情中如果存在无症状感染者其传染具有一定隐蔽性,是社区扩散的重要风险点,应加强对无症状感染者的管理,特别是对无症状感染者儿童应重视早期识别.

Previous studies have demonstrated that electroconvulsive therapy (ECT) augmentation of antipsychotics is highly effective for treatment-resistant schizophrenia patients or those who require a rapid response [[1]Zheng W. Cao X.L. Ungvari G.S. Xiang Y.Q. Guo T. Liu Z.R. et al.Electroconvulsive therapy added to non-clozapine antipsychotic medication for treatment resistant schizophrenia: meta-analysis of randomized controlled trials.PloS One. 2016; 11e0156510Crossref PubMed Scopus (28) Google Scholar]. Despite the effectiveness of ECT, its use is limited primarily due to adverse events (AEs) [[2]Kristensen D. Bauer J. Hageman I. Jorgensen M.B. Electroconvulsive therapy for treating schizophrenia: a chart review of patients from two catchment areas.Eur Arch Psychiatr Clin Neurosci. 2011; 261: 425-432Crossref PubMed Scopus (35) Google Scholar,[3]Tor P.-C. Ying J. Ho N.F. Wang M. Martin D. Ang C.P. et al.Effectiveness of electroconvulsive therapy and associated cognitive change in schizophrenia: a naturalistic, comparative study of treating schizophrenia with electroconvulsive therapy.J ECT. 2017; 33: 272-277Crossref PubMed Scopus (19) Google Scholar], which may be related to ECT dosing, seizures or electrode placement [[3]Tor P.-C. Ying J. Ho N.F. Wang M. Martin D. Ang C.P. et al.Effectiveness of electroconvulsive therapy and associated cognitive change in schizophrenia: a naturalistic, comparative study of treating schizophrenia with electroconvulsive therapy.J ECT. 2017; 33: 272-277Crossref PubMed Scopus (19) Google Scholar,[4]Sackeim H.A. Prudic J. Nobler M.S. Fitzsimons L. Lisanby S.H. Payne N. et al.Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.Brain stimulation. 2008; 1: 71-83Abstract Full Text Full Text PDF PubMed Scopus (354) Google Scholar]. Notably, a study demonstrated that nonconvulsive electrotherapy (NET) or low-charge electrotherapy (LCE) may have similar antidepressant effects to ECT but without serious AEs in a sample of patients with depression [[5]Regenold W.T. Noorani R.J. Piez D. Patel P. Nonconvulsive electrotherapy for treatment resistant unipolar and bipolar major depressive disorder: a proof-of-concept trial.Brain stimulation. 2015; 8: 855-861Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar]. We conducted a pilot randomized controlled trial (RCT) and found that schizophrenia patients in the LCE group showed significantly fewer AEs compared with those in the ECT group [[6]Li M.Z. Chen L.C. Rong H. Xu S.X. Li Y. Yang Q.F. et al.Low-charge electrotherapy for patients with schizophrenia: a double-blind, randomised controlled pilot clinical trial.Psychiatr Res. 2019; 272: 676-681Crossref PubMed Scopus (2) Google Scholar]. However, our subsequent in-house data suggested that the initial remission may be slower in the LCE group than in the ECT group, and the patients in the LCE group required more treatment sessions. To combine the advantages of ECT (rapid remission) and LCE (fewer side effects), we designed a simple but novel energy set strategy for ECT, termed hybrid-ECT (HECT), for schizophrenia patients, in which the first four sessions use ECT (Phase 1) for rapid remission and the subsequent sessions use LCE (Phase 2) to reduce side effects, similar to the depression version [[7]Rong H. Xu S.X. Zeng J. Yang Y.J. Zhao J. Lai W.T. et al.Study protocol for a parallel-group, double-blinded, randomized, controlled, noninferiority trial: the effect and safety of hybrid electroconvulsive therapy (Hybrid-ECT) compared with routine electroconvulsive therapy in patients with depression.BMC Psychiatr. 2019; 19: 344Crossref PubMed Scopus (1) Google Scholar]. To examine the efficacy and acceptability of HECT compared with standard ECT (all sessions were ECT) for schizophrenia patients, we performed the present RCT. This RCT was conducted at the Second People's Hospital of Huizhou in accordance with the Declaration of Helsinki (revised edition, 2008). The protocol was approved by the Human Ethics Committee of the Second People's Hospital of Huizhou. Written informed consent was obtained from all participants or their legal guardians. Patients or their legal guardians could withdraw at any time. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000033507). All 30 inpatients were recruited from June 5th, 2020, to December 20th, 2020 (Supplementary Fig. 1), and no significant biases of baseline characteristics were observed (Supplementary Table 1). Bitemporal ECT or LCE sessions were performed three times a week with a spECTRUM 5000Q ECT instrument (MECTA Corporation, OR, USA). Dose titration to determine the seizure threshold (ST) was performed at the first ECT session. The charge dose for subsequent ECT sessions was set at 1.5 ∗ ST. For LCE sessions, the energy was set at 0.5 ∗ ST, regardless of whether seizures were induced. The clinical status was measured at baseline (visit 1), post-Phase 1 (visit 2), post-Phase 2 (visit 3), and after the one-week follow-up period (visit 4). The changes in Positive and Negative Syndrome Scale (PANSS) subscale scores (PANSS-P, PANSS-N, and PANSS-G) from visit 1 to visit 3 were used as the primary outcome measures. Orientation recovery tests were used to measure the recovery of orientation time (ORT). Any AE or patient who dropped out for any reason was recorded to analyze the safety of ECT/LCE. Detailed methods are presented in Supplementary File. All patients completed assessments at four visits. In the intention-to-treat analysis, significant improvements were achieved with ECT and HECT (Hedges' g and 95% confidence interval (CI): PANSS-P: 1.55 (0.75–2.35) versus 1.95 (1.10–2.81); PANSS-N: 0.76 (0.04–1.49) versus 1.23 (0.47–2.00); PANSS-G: 1.68 (0.86–2.49) versus 3.21 (2.14–4.29)). However, between-group differences were nonsignificant (Hedges’ g and 95% CI: PANSS-P: −0.29 (−1.01-0.42); PANSS-N: −0.41 (−1.13-0.31); PANSS-G: −0.63 (−1.36-0.11)) (see Fig. 1). (The detailed results of the main and sensitivity analyses are presented in Supplementary Tables 2 and 4) The differences in ECT/LCE number, ST, ORT, energy, EEG activity, and seizure duration in Phase 1 between the two arms were nonsignificant. The energy in the HECT arm was significantly lower, and patients in the HECT arm experienced significantly fewer seizures, a shorter seizure duration, and a shorter ORT in Phase 2 (Supplementary Table 3). It is worth noting that the number of sessions in the HECT arm (11.0 ± 1.9) was higher than that in the ECT arm (9.9 ± 2.1); this difference was nonsignificant, but could become significant as the sample size increases. HECT demonstrated significantly better acceptability. Two participants in the ECT arm withdrew: one because of subjective memory impairment and the other because of vomiting, hypokalemia, and subjective memory impairment. AE rates were not different in Phase 1 (Fisher's exact test, p = 1.000), but significantly lower with HECT in Phase 2 (Fisher's exact test, p = 0.006) (Supplementary Table 3). This phenomenon of fewer AEs occurring in the LCE phase is similar to our previous trial [[6]Li M.Z. Chen L.C. Rong H. Xu S.X. Li Y. Yang Q.F. et al.Low-charge electrotherapy for patients with schizophrenia: a double-blind, randomised controlled pilot clinical trial.Psychiatr Res. 2019; 272: 676-681Crossref PubMed Scopus (2) Google Scholar]. Another small but significant difference was the shorter ORT of Phase 2 in the HECT arm. Similarly, a study of magnetic seizure therapy found that the recovery times for consciousness were shorter in the magnetic seizure therapy group than in the ECT group [[8]Zhang J. Ren Y. Jiang W. Luo J. Yan F. Tang Y. et al.Shorter recovery times and better cognitive function-A comparative pilot study of magnetic seizure therapy and electroconvulsive therapy in patients with depressive episodes.Brain Behav. 2020; 10e01900Crossref PubMed Scopus (2) Google Scholar]. Considering that magnetic seizure therapy also uses electrical currents to induce seizures and that the strength of the electric field in the brain is smaller than that of ECT [[9]Lee W.H. Lisanby S.H. Laine A.F. Peterchev A.V. Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model.Eur Psychiatr. 2016; 36: 55-64Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar], we speculated that the fewer AEs and decreased ORT may be related to the absence of seizures or lower energy. There has been concern that some common comorbid somatic diseases, such as diabetes, cerebrovascular disease, cardiovascular disease, and pulmonary disease, may increase the risk of ECT [[3]Tor P.-C. Ying J. Ho N.F. Wang M. Martin D. Ang C.P. et al.Effectiveness of electroconvulsive therapy and associated cognitive change in schizophrenia: a naturalistic, comparative study of treating schizophrenia with electroconvulsive therapy.J ECT. 2017; 33: 272-277Crossref PubMed Scopus (19) Google Scholar,[10]Wilkins K.M. Ostroff R. Tampi R.R. Efficacy of electroconvulsive therapy in the treatment of nondepressed psychiatric illness in elderly patients: a review of the literature.J Geriatr Psychiatr Neurol. 2008; 21: 3-11Crossref PubMed Scopus (30) Google Scholar]. Due to the low incidence of AEs and shorter ORT, HECT has shown its potential to serve more psychiatric patients. The individual participant data are presented in Supplementary file. It is worth noting that this trial failed to find a statistically significant difference in efficacy. The result should not be misinterpreted as the effects of the two arms are equal. It is more suitable to consider this the result of low statistical power. Furthermore, a noninferiority RCT with sufficient power could answer this question. The follow-up period was relatively short. We hope to extend the follow-up period to observe the long-term performance of HECT in future studies. In short, HECT and standard ECT showed similar antipsychotic effects, but HECT was accompanied by fewer AEs. Additionally, we hope this trial can lead to a rethinking of the relationship among electric energy, seizures, efficacy, and side effects of ECT. Xin-hui Xie designed and supervised the whole study. Jia Li, Zhao-yun Jiang and Shu-xian Xu collected the data. Wen-feng Deng analyzed the data. Xin-hui Xie and Shu-xian Xu drafted the manuscript. Han Rong and Xiao-ming Kong revised the manuscript. All authors read and approved the final manuscript. None. This work was supported by the Science and Technology Program of Huizhou (Grant Numbers: 2018Y128 and 2018Y129 ), the Sanming Project of Medicine in Shenzhen (Grant Number: SZSM201812052 ), and the Science and Technology Program of Shenzhen (Grant Numbers: JCYJ20160429190927063 and JCYJ20170413101017457 ). This work has not received funding/assistance from any commercial organizations. The funding sources had no roles in the design of this study and will not have any roles during the execution, analyses, interpretation of the data, or decision to submit the results. The authors would like to thank Dr. Bao-yi Li, Dr. Wan-qi Tang, Dr. Lun Zeng, Dr. Dong Huang, Dr. Xiao-ping Li, Dr. Yan-xiu Yuan, Dr. Wei Wang and Dr. Chuang-bin Chen from the Department of Psychiatry of the Second People's Hospital of Huizhou for their assistance with the participant recruitment. We would like to thank Mr. Shun-Qi Chen and Miss Ting Li from the Second People's Hospital of Huizhou for their help organizing the data.

Few studies have investigated the weight of patients with schizophrenia in China. The aim of this study was to analyse the prevalence, clinical characteristics and influencing factors of obesity and underweight in patients with chronic schizophrenia in China. A total of 325 patients with schizophrenia and 172 sex- and age-matched healthy controls from the community were recruited. Socio-demographic data and laboratory measurements were collected for all subjects. Using the Positive and Negative Syndrome Scale (PANSS), we evaluated the psychiatric symptoms of patients with schizophrenia. According to the body mass index (BMI) criteria in China, BMI ≥ 28 kg/m2 indicates obesity, and BMI < 18.5 kg/m2 indicates underweight. Of the patients with schizophrenia, 16.3% were obese, and 6.8% were underweight; 11.0% of the healthy controls were obese, and 3.5% were underweight. There was no difference between the two groups in the prevalence of obesity and underweight. After controlling for relevant variables, the obesity rate remained non significant, but the underweight rate appeared to be different. The multinomial regression analysis revealed that among the patients with schizophrenia, female sex, triglyceride level and LDL level were independent risk factors for obesity and that HDL level was an independent protective factor against obesity. In contrast, male sex and HDL level were independent risk factors for underweight. We found that the patients with schizophrenia had an increased rate of underweight and some factors related to weight. Level V, descriptive study

Background: The effects of ambient air pollution on specific mental disorders are rarely studied, and the reported results are inconsistent. Objective: To assess the short-term effect of ambient air pollution on the morbidity of mental disorders in three subtropical Chinese cities. Methods: Daily concentrations of air pollution were averaged from 19 fixed monitoring stations across each city, and data on patients were collected from three psychiatric specialty hospitals. A time-series study combined with a generalized additive Poisson model was conducted to investigate the association between air pollution and mental disorders. The exposure-response relationships were explored and stratified analyses by age and sex were conducted. Results: A total of 1,133,220 outpatient visits were recorded in three subtropical cities (Huizhou, Shenzhen, and Zhaoqing). The number of daily outpatient visits for mental disorders increased with higher air pollutant (PM2.5, PM10, SO2 and NO2) concentrations, and the effect of NO 2 appeared to be consistently significant across the three cities, with excess risk (ER) of 4.45% (95% CI: 2.90%, 6.04%) in Huizhou, 7.94% (95% CI: 6.28%, 9.62%) in Shenzhen, and 2.19% (95% CI: 0.51%, 3.89%) in Zhaoqing, respectively, at 1ag03. We also observed significant effect of PM2.5 at lag0 (ER = 1.20%, 95% CI: 0.28%, 2.13%), PM 10 at lag0 (ER = 0.99%, 95% CI: 0.36%, 1.62%), and SO2 at lag0 (ER = 10.74%, 95% CI: 3.20%, 18.84%) in Shenzhen. For specific mental disorders, significant associations were found in all the air pollutants except between SO2 and affective disorder and between PM2.5 and schizophrenia. In addition, we found that air pollution exhibited stronger effects for males and adults (>= 18 years). Conclusion: Acute exposure to air pollution, especially NO2, might be an important trigger of mental disorders.

BACKGROUND:Little is known about the association between ambient temperature and cause-specific mental disorders, especially in subtropical areas. OBJECTIVE:To investigate the effect of ambient temperature on mental disorders in subtropical cities. METHOD:Daily morbidity data for mental disorders in three Chinese cities (Shenzhen, Zhaoqing, and Huizhou) were collected from medical record systems of local psychiatric specialist hospitals, covering patients of all ages. Case-crossover design combined with a distributed lag nonlinear model (DLNM) was used to assess the nonlinear and delayed effects of temperatures on five specific mental disorders (affective disorders, anxiety, depressive disorders, schizophrenia, and organic mental disorders), with analyses stratified by gender and age. The temperature of minimum effect was used as the reference value to calculate estimates. RESULTS:We observed inversed J-shaped exposure-response curves between temperature and mental morbidity and observed that low temperatures had a significant and prolonged effect on most types of mental disorders in the three cities. For example, the effect of the cold (2.5th percentile) on anxiety was consistently observed in the three cities with an odds ratio (OR) of 1.29 (95% CI: 1.06-1.57) in Zhaoqing, 1.26 (95% CI: 1.18-1.34) in Shenzhen, and 1.45 (95% CI: 1.17-1.81) in Huizhou. Low temperature was also associated with an increased risk of depressive disorders and schizophrenia. For the high temperature exposure (97.5th percentile), we only observed a significant, harmful effect on anxiety [OR = 1.30 (95% CI: 1.08, 1.58) in Shenzhen, OR = 1.16 (95% CI: 1.00, 1.34) in Zhaoqing], affective disorders [OR = 1.32 (95% CI: 1.08, 1.62) in Shenzhen], and schizophrenia [OR = 1.24 (95% CI: 1.03, 1.48) in Zhaoqing, OR = 1.03 (95% CI: 1.00, 1.06) in Huizhou]. CONCLUSIONS:Our study suggests that both low and high temperatures might be important drivers of morbidity from mental disorders, and low temperature may have a more general and wide-spread effect on this cause-specific morbidity than high temperature.

BACKGROUND:The microbiome-gut-brain axis, especially the microbial tryptophan biosynthesis and metabolism pathway (MiTBamp), is closely connected to bipolar disorder with current major depressive episode (BPD). METHODS:We performed shotgun metagenomics sequencing (SMS) of faecal samples from 25 BPD patients and 28 healthy controls (HCs). Except for the microbiota taxa and MiTBamp analyses, we also built a classification model using the Random Forests (RF) and Boruta algorithm to find the microbial biomarkers for BPD. RESULTS:Compared to HCs, the phylum Bacteroidetes abundance was significantly reduced, whereas that of the Actinobacteria and Firmicutes were significantly increased in BPD patients. We also identified 38 species increased and 6 species decreased significantly in the BPD group. In the MiTBamp, we identified that two Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologies (KOs) (K00658 and K00837) were significantly lower in the BPD, and five KOs (K01696, K00382, K00626, K01667, and K03781) were significantly higher in the BPD group. We also identified significant genera and species which were closely related to these KOs. Finally, RF classification based on gut microbiota at the genus level can achieve an area under the receiver operating characteristic curve of 0.997. LIMITATIONS:The features of cross-sectional design, limited sample size, the heterogeneity of bipolar disorders, and a lack of serum/plasma tryptophan concentration measurements. CONCLUSIONS:The present findings enable a better understanding of changes in gastrointestinal microbiome and MiTBamp in BPD. Alterations of microbes may have potential as biomarkers for distinguishing the BPD patients form HCs.

目的 探讨和评价单项肥胖判定指标和各项肥胖判定指标联合使用对高血压患病风险的预测价值.方法 对调查地区3216名成年居民的体质指数(BMI)、腰围(WC)、腰臀比(WHR)、腰高比(WHtR)等结果进行横断面分析;通过建立Logistic回归模型,确立预测高血压的最优肥胖指标;分析各肥胖判定指标和各肥胖判定指标联合使用对预测高血压的ROC曲线,比较各ROC曲线下面积(AUC),探索预测高血压患病风险能力的最佳组合.结果 BMI、腰围、腰臀比和腰高比均为检出高血压的危险因素,男性OR值分别为1.46(95％CI:0.98～1.89)、1.72(95％CI:1.10～2.52)、1.81(95％CI:1.18～2.62)、2.05(95％CI:1.40～3.05);女性OR值分别为1.84(95％CI:1.34～2.52)、1.57(95％CI:1.08～2.43)、2.02(95％CI:1.24～3.10)、1.86(95％CI:1.21～2.78).单项指标不同性别间AUC最大的指标均为腰高比,分别达到0.685和0.718,其AUC与BMI、腰围和腰臀比差异均有统计学意义,除女性腰高比的AUC>0.7,其余均在0.5～0.7之间,诊断准确度较低.对各指标组合后,AUC随指标组合增多而增大,准确度较高,BMI&腰围&腰高比与腰围&腰高比、腰围&腰臀比&腰高比差异无统计学意义,其余差异均有统计学意义,且男性和女性的AUC均在BMI&腰围&腰高比组合达到最高值,分别达到0.703和0.740.结论 单项指标中,腰高比为预测高血压患病风险的最佳指标,但预测准确性不高;BMI&腰围&腰高比组合可能是预测高血压患病风险的最佳组合;以腰高比为必选项的组合指标有助于提高高血压预测能力,同时应在健康教育和健康促进工作中引起重视.

BACKGROUND:To probe the differences of gut microbiota among major depressive disorder (MDD), bipolar disorder with current major depressive episode (BPD) and health participants. METHODS:Thirty one MDD patients, thirty BPD patients, and thirty healthy controls (HCs) were recruited. All the faecal samples were analyzed by shotgun metagenomics sequencing. Except for routine analyses of alpha diversity, we specially designed a new indicator, the Gm coefficient, to evaluate the inequality of relative abundances of microbiota for each participant. RESULTS:The Gm coefficients are significant decreased in both MDD and BPD groups. The relative abundances of increased phyla Firmicutes and Actinobacteria and decreased Bacteroidetes were significantly in the MDD and BPD groups. At genus level, four of top five enriched genera (Bacteroides, Clostridium, Bifidobacterium, Oscillibacter and Streptococcus) were found increased significantly in the MDD and BPD groups compared with HCs. The genera Escherichia and Klebsiella showed significant changes in abundances only between the BPD and HC groups. At the species level, compared with BPD patients, MDD patients had a higher abundance of Prevotellaceae including Prevotella denticola F0289, Prevotella intermedia 17, Prevotella ruminicola, and Prevotella intermedia. Furthermore, the abundance of Fusobacteriaceae, Escherichia blattae DSM 4481 and Klebsiella oxytoca were significantly increased, whereas the Bifidobacterium longum subsp. infantis ATCC 15697 = JCM 1222 was significantly reduced in BPD group compared with MDD group. CONCLUSIONS:Our study suggested that gut microbiota may be involved in the pathogenesis of both MDD and BPD patients, and the nuances of bacteria may have the potentiality of being the biomarkers of MDD and BPD.

BACKGROUND:Electroconvulsive therapy (ECT) is the most rapid and effective treatment for patients with depression, ECT can achieve remarkable antidepressant effects in the initial 3-4 sessions, but significant side effects limit its use. However, recent low-charge electrotherapy (LCE) studies have demonstrated antidepressant or antipsychotic effects with significantly fewer side effects. The aim of this study is to propose a novel two-step charge set strategy for ECT treatment, referred to as Hybrid-ECT, to decrease side effects by using a low charge while preserving treatment efficacy. METHODS/DESIGN:A randomized, double-blinded, standard-controlled, parallel-group design will be carried out. We plan to enroll 112 inpatients diagnosed with depression (unipolar or bipolar) and randomly assign them to conventional ECT (control group) or to Hybrid-ECT (treatment group, 3 ECT sessions followed by LCE sessions (approximately 2.8 joules per session)). We will evaluate participants across a wide variety of domains including clinical symptoms, cognitive, psychological and functional metrics. We will also perform magnetic resonance imaging (MRI) and event-related potential (ERPs) assessments during treatment to explore brain function differences between ECT and LCE. DISCUSSION:This research proposes a simple but completely novel ECT strategy that aims to rapidly relieve depressive symptoms and minimize side effects. The mechanism of ECT and LCE will be further discussed. TRIAL REGISTRATION:Chinese Clinical Trial Registry, Number: ChiCTR1900022905 (Registration date: April 30, 2019).