Objective To investigate the serum levels of uric acid (UA) in bipolar disorder patients and their clini?cal significance. Methods Serum levels of UA was measured in 126 bipolar disorder patients including 77 mania pa?tients and 49 depression patients, 69 first-episode schizophrenic patients and 126 healthy controls (control group). Bipo?lar disorder patients was assessed by using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAMD). Results The serum UA levels were significantly higher in bipolar group [(349.34 ± 107.21) μmol/L] than in schizophrenic group [(319.71±84.48)μmol/L] and in control group [(280.94±71.90)μmol/L] (P<0.01). There were signifi?cant differences in serum UA levels between manic episode and depressive episode [(366.45 ± 104.01) μmol/L vs. (322.45±107.69)μmol/L]. The serum UA levels were higher in both manic episode and depressive episode groups than in control group (P<0.01). The serum UA levels was not significantly different between patients with and without medication (P>0.05). Correlation analysis indicated that the correlation of serum UA levels with YMRS scores and HAMD scores was not significant in bipolar disorder patients (P>0.05). Conclusions Patients with bipolar disorder has elevated serum uric acid levels which may be a biomarkers of bipolar disorder.

Objective: To explore the relationship among cognitive flexibility, depression and eating attitude of adolescents and the influencing factors of eating attitude. Methods: A total of 1 231 subjects were assessed using general information questionnaire, Kutcher Adolescent Depression Scale 11 item(KADS-11), Cognitive Flexibility Inventory(CFI), Eating Attitude Test 26(EAT-26). Data were analyzed by independent sample t-test, univariate linear regression, spearman correlation analysis and Logistic regression. Results: There were significant differences in EAT 26 among adolescents between genders and between those with or without depression(P<0.01). Statistically significant differences were observed in CFI, flexible control and KADS 11 among adolescents with or without eating disorders(P<0.01). The scores of EAT 26 was negatively correlated with CFI (r=-0.19, P<0.01) and flexible control(r=-0.23, P<0.01). And there was a significant positive correlation between EAT 26 and KADS 11(r=0.23, P<0.01). Female(OR=2.40, 95%CI=1.87-3.23), depression (OR=1.76, 95%CI=1.35-2.29) and poor flexible control (OR=1.94, 95%CI=1.48-2.54) were risk factors for eating disorders. Conclusion Female, individuals with depressive symptoms or with poor flexible control ability are more likely to have eating disorders which need more attention.

Objective:To explore the situation of insomnia, fatigue, depression, anxiety and cognitive impairment in adolescents with different characteristics, and the chain mediating effect of fatigue, depression and anxiety on insomnia and cognitive impairment.Methods:The general demographic data of 6 014 adolescents were collected.Insomnia severity index (ISI), the multidimensional fatigue inventory (MFI-20), patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) and perceived deficits questionnaire-depression(PDQ-D) were used to compare the insomnia, fatigue, depression, anxiety and cognitive impairment of adolescents with different characteristics.Spearman correlation analysis was conducted by SPSS 20.0 software.The significance of mediating effect was tested by deviation corrected nonparametric percentile Bootstrap method using SPSS macro program PROCESS.Results:The detection rates of insomnia, fatigue, depression, anxiety and cognitive impairment were different in adolescents with different genders, grades and academic achievements.Cognitive impairment was significantly positively correlated with insomnia ( r=0.654, P<0.01), fatigue ( r=0.476, P<0.01), depression ( r=0.677, P<0.01), anxiety ( r=0.655, P<0.01), which was suitable for mediating effect test.Fatigue, depression and anxiety in adolescents had a chain mediating effect between insomnia and cognitive impairment.Insomnia indirectly affects cognition by affecting fatigue and depressive symptoms.The intermediary effect value was 1.253, the effect amount was 55.60%, and the total effect was 2.254.Insomnia indirectly affects cognition by affecting fatigue and anxiety symptoms.The intermediary effect value was 1.161, the effect amount was 51.50%, and the total effect was 2.254. Conclusion:Insomnia can not only directly affect their cognitive impairment, but also indirectly affect their cognitive impairment through the chain mediation of fatigue, depression and anxiety of adolescents.

Objective? To explore the status of self-management and sleep quality among schizophrenia patients with type 2 diabetes and to analyze the correlations between them. Methods? From July 2017 to September 2019, we selected schizophrenia inpatients with type 2 diabetes at a Class Ⅲ Grade A psychiatric hospital as subjects by convenience sampling. The Chinese version Scale of the Diabetes Self-care Activities (SDSCA) and Pittsburgh Sleep Quality Index (PSQI) were used to investigate those patients. We described the general information and self-management of patients, and analyzed the correlations between self-management and sleep quality with the correlation statistic method. A total of 150 questionnaires were sent out with 96.7% for the valid rate. Results? Among 145 schizophrenia patients with type 2 diabetes, the total score of SDSCA was (39.06±16.91) and 53.79% of them were with an intermediate level of self-management. The scores of foot care and blood glucose monitoring were low. Correlation analysis showed that the total score of SDSCA had a positive correlation with sleep duration (r=0.195,P＜0.05), and had negative correlations with sleep latency (r=-0.232, P＜0.01), sleep disturbances (r=-0.190,P＜0.05) as well as daytime dysfunction (r=-0.177,P＜0.05). Foot care was positively correlated with sleep duration (r=0.379,P＜0.01) and habitual sleep efficiency (r=0.222,P＜0.01), and were negatively correlated with sleep latency (r=-0.384,P＜0.01), sleep disturbances (r=-0.351,P＜0.01), sleep medications (r=-0.298,P＜0.01), daytime dysfunction (r=-0.317,P＜0.01) as well as the total score of PSQI (r=-0.288,P＜0.01). Conclusions? Schizophrenia patients with type 2 diabetes have a low level of self-management and most of them have intermediate levels. We should help patients develop high levels of self-management to improve sleep quality so as to improve the glucose control and delay the complications.

Objective:To evaluate the clinical applicability of CT angiography (CTA) for locating the perforator vessels of anterolateral thigh flap(ALTF) and the effects of individualized ALTF designed by CTA for the reconstruction of the soft tissue defects of tongue after the resection of tongue carcinoma.Methods:21 patients with tongue squamous cell carcinoma underwent CTA for locating the perforator vessels of ALTFs and for the design of individualized ALTFs before operation.The patients underwent soft tissue defect reconstruction with individualized ALTFs after tumor removal.Results:All the operations came off as preoperative designed,the intraoperative findings of the blood vessel alignment were consistent with the preoperative CTA results.The size of flaps was 6.0 cm × 5.0 cm-11.0 cm× 8.5 cm.20 ALTFs survived,2 ALTFs appeared vascular crisis,1 remained survival and the other was necrotic after surgical exploration.During 6 ～ 60 momhs of follow-up,the survival condition of flaps and the wound healing condition were both satisfactory.1 patient died because of distant metastasis 18 months after operation.20 patients reminded free of carcinoma and satisfied with the reconstructive effects of chewing,swallowing and linguistic function.Conclusion:CTA can accurately locate perforator vessels for the design of individualized AFLT.AFLT designed by CTA is an ideal choice for the reconstruction of postoperative soft tissue defects after resection tongue carcinoma.

Objective This paper aims to construct a system integrating mixed reality technology with artificial algo-rithm and to evaluate its effectiveness in vascular localization during anterolateral thigh perforator flap surgery to provide new insights for clinical practice.Methods Twenty patients undergoing anterolateral thigh perforator flap repair were selected.After attaching positioning devices on the lower limb,CT angiography(CTA)scans were performed.The 2D data obtained were converted into a 3D model of the positioning device and vessels.Mixed reality technology was uti-lized to achieve 3D visualization of perforator vessels.An artificial algorithm was developed in HoloLens 2 to match the positioning device automatically with its 3D model intraoperatively to overlap the perforator vessels with their 3D mod-els.The number of perforator vessels identified within the flap harvesting area and the actual number detected during sur-gery were recorded to calculate the accuracy rate of vessel identification based on CTA data reconstruction.The distance between the perforator vessel exit points located by the system and the actual exit points was measured,and the error val-ues were calculated.The surgical time required for the system to harvest the anterolateral thigh perforator flap was docu-mented and compared with the surgical time required by conventional methods.The clinical applicability of the system was discussed.Results The CTA data reconstruction identified 30 perforator vessels,while the actual number found during surgery was 32,resulting in an identification accuracy rate of 93.75％.The average distance between the perfora-tor vessel exit points located by the system and the actual exit points was(1.65±0.52)mm.The average surgical time for flap harvesting with the assistance of the system was(43.45±4.6)min compared with(57.6±7.9)min required by conven-tional methods.All perforator flaps survived the procedure.One case of flap infection occurred seven days postoperative-ly,and one case of partial flap necrosis was treated with symptomatic therapy,resulting in delayed healing.Conclusion The system constructed in this paper can achieve 3D visualization of perforator vessels through mixed reality technology and improve the accuracy of perforator vessel localization using artificial algorithms,hence demonstrating potential ap-plication in anterolateral thigh perforator flap harvesting surgeries.

ObjectiveTo discuss the relationship between objective sleep quality and cognitive function in remission depression patients with insomnia. MethodsA total of 47 patients with depression in remission in Beijing Huilongguan Hospital were enrolled. Insomnia Severity Index （ISI） and the sleep efficiency calculated by the first four items of Pittsburgh Sleep Quality Index （PSQI） were defined as insomnia. Among the selected patients， 22 subjects were classified into insomnia group， and 25 subjects in non-insomnia group. The objective sleep status of all subjects was evaluated by polysomnography （PSG）， and the cognitive function was evaluated with the Repeatable Battery for Assessment of Neuropsychological Status （RBANS）. A regression model was established to explore the relationship between objective sleep quality and cognitive function in remission depression patients with insomnia. ResultsThere was statistically significant difference in immediate memory factor scores of RBANS between depression patients in remission with and without insomnia （t=-2.102， P<0.05）. The sleep efficiency （Z=-2.113， P<0.05）， the proportion of N3 sleep stage （Z=-3.175， P<0.01） and the duration of N3 sleep stage （Z=-3.196， P<0.01） in insomnia group were all lower than those in non-insomnia group， and the nocturnal awakening （Z=-2.058， P<0.01）， the proportion of N1 sleep stage （Z=-2.399， P<0.05） and the duration of N1 sleep stage （Z=-2.463， P<0.05） were higher than those of the insomnia group. Within insomnia group， the increased proportion of REM sleep was correlated with the improvement of attention function （β=0.953， 95% CI： 0.123~2.038， P<0.05）， and the increase of nocturnal awakening was correlated with the decline of delayed memory （β=-0.173， 95% CI： -0.325~-0.024， P<0.05）. ConclusionObjective sleep is associated with cognitive impairment in remission depression patients with insomnia， the proportion of REM sleep has a positive impact on attention function， and frequent nocturnal awakening at night has a negative impact on delayed memory.