Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

Objective:To investigate the causal impact of maternal smoking around birth(MSAB)on off-spring's risk of attention deficit hyperactivity disorder(ADHD),autism spectrum disorder(ASD),bipolar disorder(BD),and major depressive disorder(MDD).Methods:The datasets for MSAB and 4 psychiatric disorders were extracted from genome-wide association studies(GWAS).Mendelian randomization(MR)was employed,using in-verse variance weighting(IVW)as the primary analysis method.Sensitivity analyses and outlier correction were conducted using weighted median(WM),MR-Egger regression,and MR-PRESSO.The results were expressed as odds ratios(OR)and corrected for false discovery rate(FDR).Results:MR analysis showed significant causal re-lationships between MSAB and increased risk of ADHD(OR=5.36,95％CI=2.58-7.63,PFDR=0.003),MDD(OR=1.92,95％CI=1.29-2.88,PFDR=0.003),and BD(OR=6.33,95％CI=1.56-8.73,PFDR=0.013).However,no statistically significant association was found between MSAB and ASD(OR=1.66,95％CI=0.23-5.87,PFDR=0.616).Conclusion:This study suggests a potential causal link between maternal smoking around the time of birth and an increased risk of attention deficit hyperactivity disorder,bipolar disorder,and major depressive disorder in offspring.

Objective:To investigate the causal impact of maternal smoking around birth(MSAB)on off-spring's risk of attention deficit hyperactivity disorder(ADHD),autism spectrum disorder(ASD),bipolar disorder(BD),and major depressive disorder(MDD).Methods:The datasets for MSAB and 4 psychiatric disorders were extracted from genome-wide association studies(GWAS).Mendelian randomization(MR)was employed,using in-verse variance weighting(IVW)as the primary analysis method.Sensitivity analyses and outlier correction were conducted using weighted median(WM),MR-Egger regression,and MR-PRESSO.The results were expressed as odds ratios(OR)and corrected for false discovery rate(FDR).Results:MR analysis showed significant causal re-lationships between MSAB and increased risk of ADHD(OR=5.36,95％CI=2.58-7.63,PFDR=0.003),MDD(OR=1.92,95％CI=1.29-2.88,PFDR=0.003),and BD(OR=6.33,95％CI=1.56-8.73,PFDR=0.013).However,no statistically significant association was found between MSAB and ASD(OR=1.66,95％CI=0.23-5.87,PFDR=0.616).Conclusion:This study suggests a potential causal link between maternal smoking around the time of birth and an increased risk of attention deficit hyperactivity disorder,bipolar disorder,and major depressive disorder in offspring.

Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

Objective To explore the effect and safety of right unilateral modified electroconvulsive therapy(RUL-MECT)for major depressive disorder patients(MDD).Methods A randomized controlled trial was conducted on 70 patients with MDD who were randomly divided into a study group and a control group.The study group underwent age-based RUL-MECT,while the control group underwent bitemporal MECT.The participants were evaluated using the 17-item Hamilton depression scale(HAMD-17),MATRICS consensus cognitive battery(MCCB)and orientation recovery tests(ORT).Any adverse reactions that occurred during each intervention process were recorded.Results Before treatment,there were no significant differences in the HAMD-17(32.89±5.68 vs.33.54±4.78)between the two groups(P>0.05).The HAMD-17 score of the intervention group was 6.83±4.68,while the control group was 7.20±4.60 after 8 interventions,repeated measures analysis of variance showed the time effect(P<0.001)was significant.The intergroup effect and interaction effect was not significant(P>0.05).In terms of MCCB scores,there were significant main effect(P<0.001)in connectivity tests,symbol coding,language memory,spatial breadth,number sequence,maze test,visual memory,emotional management and the duration of continuous operation.The intergroup effects of language memory,number sequence,visual memory,speech fluency,and continuous operation were significant(P<0.05).The interaction effect of language memory and continuous operation were significant(P<0.05).After the intervention,the recovery of orientation time was significantly shorter in the study group than that in the control group[(508.57±104.48)s vs.(631.66±212.27)s](P<0.05).The incidence of adverse reactions between two groups(28.6% vs.40.0% )has no significance(P>0.05).Conclusions Compared with bitemporal MECT,RUL-MECT has comparable efficacy in treating depressant and better performance in improving cognitive function and recovery of orientation.

Objective:To explore the efficacy and safety of aripiprazole in the treatment of antipsychotic-induced hyperprolactinemia (AIH).Methods:Randomized controlled trials (RCTs) of aripiprazole in treating AIH were collected by searching relevant databases at home and abroad (up to November 29, 2020). Patients in the trial group was treated with aripiprazole on the base antipsychotic drugs, and those in the control group was treated with or without additional placebo. Outcome indicators included serum prolactin normalization rate, serum prolactin level, and the incidence of major adverse events. Meta-analysis was performed using RevMan 5.4 software. The effect size of counting data was risk ratio ( RR) and its 95% confidence interval ( CI), and the effect size of measurement data was standardized mean difference ( SMD) and its 95 %CI. Results:A total of 23 RCTs were entered in the analysis, including 1 530 patients, 816 patients in the trial group and 714 patients in the control group. The meta-analysis results showed that the normalization rate of serum prolactin in the trial group was higher than that in the control group at the end of the treatment course (4-24 weeks) [73.5% (150/204) vs. 4.1% (8/194), RR=16.58, 95 %CI: 8.61-31.93, P<0.001]. According to the dose of aripiprazole, the patients were divided into 5 mg/d and 10 mg/d subgroups. The analysis results showed that the serum prolactin levels in patients in the 2 trial subgroups were lower than those in their corresponding control groups at the end of the treatment, and the differences were statistically significant [ SMD= -1.25, 95 %CI: -1.66- -0.84, P<0.001; SMD=1.93, 95 %CI: -2.38- -1.48, P<0.001]. There were no significant differences in the incidence of overall adverse events, extrapyramidal reactions, insomnia, somnolence, and weight gain in patients between the trial and control groups during the trial [26.5% (103/388) vs. 24.1% (94/390), RR=1.10, 95 %CI: 0.90-1.36, P=0.35; 26.0% (53/204) vs. 34.0% (70/206), RR=0.77, 95 %CI: 0.58-1.02, P=0.06; 8.4% (31/368) vs. 9.9% (37/372), RR=0.86, 95 %CI: 0.56-1.33, P=0.50; 5.6% (19/340) vs. 4.7% (16/342), RR=1.16, 95 %CI: 0.64-2.12, P=0.63; 0 vs. 7.9% (7/89), RR=0.18, 95 %CI: 0.03-0.99), P=0.05]. Conclusion:Aripiprazole is safe and effective in the treatment of AIH, but the long-term efficacy and safety need to be explored.

Objective:To explore the efficacy and safety of aripiprazole in the treatment of antipsychotic-induced hyperprolactinemia (AIH).Methods:Randomized controlled trials (RCTs) of aripiprazole in treating AIH were collected by searching relevant databases at home and abroad (up to November 29, 2020). Patients in the trial group was treated with aripiprazole on the base antipsychotic drugs, and those in the control group was treated with or without additional placebo. Outcome indicators included serum prolactin normalization rate, serum prolactin level, and the incidence of major adverse events. Meta-analysis was performed using RevMan 5.4 software. The effect size of counting data was risk ratio ( RR) and its 95% confidence interval ( CI), and the effect size of measurement data was standardized mean difference ( SMD) and its 95 %CI. Results:A total of 23 RCTs were entered in the analysis, including 1 530 patients, 816 patients in the trial group and 714 patients in the control group. The meta-analysis results showed that the normalization rate of serum prolactin in the trial group was higher than that in the control group at the end of the treatment course (4-24 weeks) [73.5% (150/204) vs. 4.1% (8/194), RR=16.58, 95 %CI: 8.61-31.93, P<0.001]. According to the dose of aripiprazole, the patients were divided into 5 mg/d and 10 mg/d subgroups. The analysis results showed that the serum prolactin levels in patients in the 2 trial subgroups were lower than those in their corresponding control groups at the end of the treatment, and the differences were statistically significant [ SMD= -1.25, 95 %CI: -1.66- -0.84, P<0.001; SMD=1.93, 95 %CI: -2.38- -1.48, P<0.001]. There were no significant differences in the incidence of overall adverse events, extrapyramidal reactions, insomnia, somnolence, and weight gain in patients between the trial and control groups during the trial [26.5% (103/388) vs. 24.1% (94/390), RR=1.10, 95 %CI: 0.90-1.36, P=0.35; 26.0% (53/204) vs. 34.0% (70/206), RR=0.77, 95 %CI: 0.58-1.02, P=0.06; 8.4% (31/368) vs. 9.9% (37/372), RR=0.86, 95 %CI: 0.56-1.33, P=0.50; 5.6% (19/340) vs. 4.7% (16/342), RR=1.16, 95 %CI: 0.64-2.12, P=0.63; 0 vs. 7.9% (7/89), RR=0.18, 95 %CI: 0.03-0.99), P=0.05]. Conclusion:Aripiprazole is safe and effective in the treatment of AIH, but the long-term efficacy and safety need to be explored.

Objective To understand students' attitude changes before and after they started their internships in the department of psychiatry and evaluate their teachers' teaching methods. Methods Using a self-made questionnaire of Psychiatric Internship Attitude that has passed the reliability and validity test, from 2015 to 2016, a total of 208 undergraduate students in the clinical medicine mental health direction of Chongqing Medical University were selected through cluster random sampling to investigate their attitude changes towards psychiatry before and after they started their internships. At the end of their internships, another self-made Psychiatric Teach Evaluation Forming Questionnaire of the reliability and validity test was used to preliminarily evaluate the students' assessment of the teaching situation of their teachers during the internship. Results Before the internships, through the survey we found that 44.2% of the students felt nervous, 37.0% fearful, 57.2% compassionate, and the percentage of students who were willing to work in the department of psychiatry is only 41.4%. Through investigation, teachers carried out the teaching work with targeted goals, at the end of the internship the tension and fear decreased to 0.0%, the proportion of empathy rose to 78.4%, and the differences are statistically significant (P<0.05). Conclusion The students' attitude survey at the beginning of their internship can help teachers improve their teaching attitudes, con-cepts and methods, and make students' negative attitudes towards mental patients and psychiatry significantly reduce.

Objective To explore the characteristic of fractional amplitude of low frequency fluctuation (fALFF) and the relationship with the severity of depression, suicidal ideation and suicide risk in depression patients with suicidal ideation with resting-state functional magnetic resonance imaging (rs-fMRI). Methods Resting state functional magnetic resonance imaging maps were conducted using fractional amplitude of low frequency fluctuation (fALFF) in 52 depression patients (30 with suicidal ideation and 22 without) and 21 healthy controls (HCs). The severity of depression was evaluat-ed by using Hamilton Depression scale(HAMD). The suicidal ideation, the suicide risk in depression patients with sui-cidal ideation were both assessed by the Beck Scale for Suicide Ideation. The correlation between the fALFF value and the score of HAMD and the Beck Scale for Suicide Ideation was analyzed. Results MRI revealed significant differences in fALFF in the left superior/middle occipital gyrus and the right middle/inferior occipital gyrus (P<0.05, AlphaSim cor-rected)between depression patients with suicidal ideation and the HCs. Compared to the HCs, depression patients with-out suicidal ideation showed a higher fALFF in the left middle occipital gyrus (P<0.05, AlphaSim corrected). MRI re-vealed significant differences in fALFF in the left middle occipital gyrus (P<0.01, AlphaSim corrected)and the right mid-dle occipital gyrus (P<0.01, AlphaSim corrected) between depression patients with suicidal ideation and without. The fALFF of left middle occipital gyrus (r=0.366, P=0.046) and right middle occipital gyrus (r=0.513, P=0.004) were posi-tively correlated with the scores of HAMD, respectively whereas were not correlated with suicidal ideation and suicide risk. Conclusions Depression patients with suicidal ideation have an abnormal spontaneous activity in their left and right middle occipital gyrus. The increased activity in these brain areas are probably associated with the severity of de-pression whereas are not associated with suicidal ideation or suicide risk.

We investigated the baseline brain activity level in patients with major depressive disorder (MDD) by am plitude of low-frequency fluctuation (ALFF) based on resting-state functional MRI (fMRI). We examined 13 patients in the MDD group and 14 healthy volunteers in the control group by resting-state fMRI on GE Signa 3.0T. We calculated and compared the ALFF values of the two groups. In the MDD group, ALFF values in the right medial prefrontal were higher than those in control group, with statistically significant differences (P < 0.001). ALFF values in the left parietal in the MDD group were lower than those in control group with statistically significant differences (P < 0.001). This resting-state fMRI study suggested that the alteration brain activity in the right medial prefrontal and left parietal ALFF contributed to the understanding of the pathophysiological mechanism of MDD patients.
Brain ; physiopathology ; Brain Mapping ; Case-Control Studies ; Depressive Disorder, Major ; physiopathology ; Humans ; Magnetic Resonance Imaging