Objective: The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) demonstrates high specificity with relatively limited sensitivity for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. This study aimed to explore the possibility of improving sensitivity by combining CT/MRI LI-RADS v2018 with second-line contrast-enhanced ultrasound (CEUS) LI-RADS v2017 using sulfur hexafluoride (SHF) or perfluorobutane (PFB). Materials and Methods: This retrospective analysis of prospectively collected multicenter data included high-risk patients with treatment-naive hepatic observations. The reference standard was pathological confirmation or a composite reference standard (only for benign lesions). Each participant underwent concurrent CT/MRI, SHF-enhanced US, and PFB-enhanced US examinations. The diagnostic performances for HCC of CT/MRI LI-RADS alone and three combination strategies (combining CT/ MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or a modified algorithm incorporating the Kupffer-phase findings for PFB [modified PFB]) were evaluated. For the three combination strategies, apart from the CT/MRI LR-5 criteria, HCC was diagnosed if CT/MRI LR-3 or LR-4 observations met the LR-5 criteria using LI-RADS SHF, LI-RADS PFB, or modified PFB. Results: In total, 281 participants (237 males; mean age, 55 ± 11 years) with 306 observations (227 HCCs, 40 non-HCC malignancies, and 39 benign lesions) were included. Using LI-RADS SHF, LI-RADS PFB, and modified PFB, 20, 23, and 31 CT/MRI LR-3/4 observations, respectively, were reclassified as LR-5, and all were pathologically confirmed as HCCs. Compared to CT/MRI LI-RADS alone (74%, 95% confidence interval [CI]: 68%–79%), the three combination strategies combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or modified PFB increased sensitivity (83% [95% CI: 77%–87%], 84% [95% CI: 79%–89%], 88% [95% CI: 83%–92%], respectively; all P < 0.001), while maintaining the specificity at 92% (95% CI: 84%–97%). Conclusion The combination of CT/MRI LI-RADS with second-line CEUS using SHF or PFB improved the sensitivity of HCC diagnosis without compromising specificity.

Objective: The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) demonstrates high specificity with relatively limited sensitivity for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. This study aimed to explore the possibility of improving sensitivity by combining CT/MRI LI-RADS v2018 with second-line contrast-enhanced ultrasound (CEUS) LI-RADS v2017 using sulfur hexafluoride (SHF) or perfluorobutane (PFB). Materials and Methods: This retrospective analysis of prospectively collected multicenter data included high-risk patients with treatment-naive hepatic observations. The reference standard was pathological confirmation or a composite reference standard (only for benign lesions). Each participant underwent concurrent CT/MRI, SHF-enhanced US, and PFB-enhanced US examinations. The diagnostic performances for HCC of CT/MRI LI-RADS alone and three combination strategies (combining CT/ MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or a modified algorithm incorporating the Kupffer-phase findings for PFB [modified PFB]) were evaluated. For the three combination strategies, apart from the CT/MRI LR-5 criteria, HCC was diagnosed if CT/MRI LR-3 or LR-4 observations met the LR-5 criteria using LI-RADS SHF, LI-RADS PFB, or modified PFB. Results: In total, 281 participants (237 males; mean age, 55 ± 11 years) with 306 observations (227 HCCs, 40 non-HCC malignancies, and 39 benign lesions) were included. Using LI-RADS SHF, LI-RADS PFB, and modified PFB, 20, 23, and 31 CT/MRI LR-3/4 observations, respectively, were reclassified as LR-5, and all were pathologically confirmed as HCCs. Compared to CT/MRI LI-RADS alone (74%, 95% confidence interval [CI]: 68%–79%), the three combination strategies combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or modified PFB increased sensitivity (83% [95% CI: 77%–87%], 84% [95% CI: 79%–89%], 88% [95% CI: 83%–92%], respectively; all P < 0.001), while maintaining the specificity at 92% (95% CI: 84%–97%). Conclusion The combination of CT/MRI LI-RADS with second-line CEUS using SHF or PFB improved the sensitivity of HCC diagnosis without compromising specificity.

Objective:This study aims to analyze the gamma band effective connectivity characteristics of the prefrontal-striatal circuitry in bipolar disorder patients with and without a history of manic episodes, as well as in major depressive disorder patients, during the recognition of positive emotional faces, this study aims to identify unique neurophysiological features that may aid in the early detection of bipolar disorder.Methods:This retrospective study collected clinical data and magnetoencephalography (MEG) imaging data from patients performing a positive emotional face recognition task at the Affiliated Brain Hospital of Nanjing Medical University from May 2009 to December 2019. The study included 75 patients with major depressive disorder and 29 patients with bipolar disorder in a depressive episode (rBD group). Concurrently, 39 age-and gender-matched healthy controls (HC group) were recruited. After a follow-up period of at least 5 years, 23 out of the 75 patients with major depressive disorder converted to bipolar disorder (ctBD group), while the remaining 52 who did not convert maintained a diagnosis of major depressive disorder.Results:There were statistically significant differences in gamma-band effective connectivity in the prefrontal-striatal circuit when recognizing positive emotional faces among the converted to bipolar disorder (ctBD), raw bipolar disorder, major depressive disorder, and HC groups ( H=9.04, 10.30, 8.30, 13.43, 14.38, 12.62, 9.82, 8.94, 24.62, 7.89, 18.53, 9.97, 9.58, 12.79, P<0.05). The ctBD group, rBD group, and major depressive group all showed reduction in effective connectivity from the right orbital inferior frontal gyrus (ORBinf.R) to the left orbital inferior frontal gyrus (ORBinf.L) [ Z=-1.98, -3.38, -2.88], from the right orbital inferior frontal gyrus to the right ventral striatum (VS.R) ( Z=-2.05, -2.76, -2.11; P<0.05) and from the left ventral striatum (VS.L) to the left orbital middle frontal gyrus (ORBmid.L) ( Z=-2.76, -1.98, -2.43; P<0.05). Among the disease groups, the ctBD group showed significantly enhanced effective connectivity strength compared to the major depressive group from the right amygdala (AMYG.R) to the left orbital inferior frontal gyrus(0.04(0.03, 0.08)), from the right amygdala to the left ventral striatum(0.05(0.03, 0.09)), and from the right ventral striatum to the right anterior cingulate and paracingulate gyri (ACG.R) (0.04(0.02, 0.08)) ( Z=4.17, 3.70, 3.35; P<0.001).The ctBD group also exhibited enhanced effective connectivity compared to the rBD group from ORBinf.R to the ACG.R, fron the AMYG.R to the ORBinf.L, from the AMYG.R to the VS.L, and from the VS.R to the ACG.R ( Z=2.05, 4.61, 3.60, 3.04; P<0.05).The rBD group demonstrated reduced effective connectivity compared to the major depressive disorder group from the right orbital middle frontal gyrus(ORBmid.R) to the left anterior cingulate and paracingulate gyri (ACG.L), ORBinf.R to the ACG.R and from the ORBinf.R to the AMYG.R ( Z=-2.12, -2.40, -2.22; P<0.05). Conclusion:There are significant differences in the gamma-band effective connectivity characteristics of the prefrontal-striatal pathway when recognizing positive emotional faces between patients with bipolar disorder in depressive episodes and those with depression, as well as differences between bipolar depressed patients with and without a history of manic episodes.

Objective:To explore the differences in the whole-brain functional connectivity characteristics of magnetoencephalography gamma sub-band in resting state between patients with depression with high and low suicidal ideation.Methods:Clinical data of 60 patients with depression (depression group) who visited the Department of Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2021 to June 2024 were prospectively collected, including 20 males and 40 females aged 16-41 years. During the same period, 75 healthy controls (healthy control group) were recruited, matched for gender and age, comprising 33 males and 42 females, aged 18-43 years. The Hamilton Depression Scale-17 items (HAMD-17) was used to assess the degree of depression in patients, and the score of the third item was used to divide the patients into a high suicidal ideation group of 37 cases (2-3 points) and a low suicidal ideation group of 23 cases (0-1 points). The Beck Scale for Suicide Ideation-Chinese Version (BSI-CV) was used to assess the intensity of suicidal ideation in patients in the last week and at the most severe stage. Brain imaging data of the subjects were collected using a CTF-275 channel magnetoencephalography device and a 3 T magnetic resonance imaging device. The functional connectivity matrix of the gamma sub-band depression group, healthy control group, high suicidal ideation group, and low suicidal ideation group was calculated using the envelope correlation method. The network-based statistics (NBS) algorithm was used to correct for multiple comparisons and compare the differences in brain network functional connectivity between the depression group/healthy control group and between the high/low suicidal ideation groups.Results:Compared with the healthy control group, the functional connectivity between the bilateral middle frontal gyrus, right inferior frontal gyrus orbital part, right anterior cingulate gyrus, left middle frontal gyrus orbital part, and right superior parietal lobule in the depression group was significantly enhanced in the low gamma frequency band (30-60 Hz) ( θ=3, P=0.042). Compared with the low suicidal ideation group, the functional connectivity between the right amygdala as a central node and the right superior frontal gyrus, left hippocampus, right upper temporal pole, and left transverse temporal gyrus in the high suicidal ideation group was significantly enhanced in the high gamma frequency band (60-90 Hz) ( θ=3, P=0.049). Conclusion:In the low gamma frequency band, patients with depression have neural dysfunction mainly in the frontal lobe. In the high gamma frequency band, patients with high suicidal ideation have functional connectivity abnormalities centered on the amygdala.

Objective: The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) demonstrates high specificity with relatively limited sensitivity for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. This study aimed to explore the possibility of improving sensitivity by combining CT/MRI LI-RADS v2018 with second-line contrast-enhanced ultrasound (CEUS) LI-RADS v2017 using sulfur hexafluoride (SHF) or perfluorobutane (PFB). Materials and Methods: This retrospective analysis of prospectively collected multicenter data included high-risk patients with treatment-naive hepatic observations. The reference standard was pathological confirmation or a composite reference standard (only for benign lesions). Each participant underwent concurrent CT/MRI, SHF-enhanced US, and PFB-enhanced US examinations. The diagnostic performances for HCC of CT/MRI LI-RADS alone and three combination strategies (combining CT/ MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or a modified algorithm incorporating the Kupffer-phase findings for PFB [modified PFB]) were evaluated. For the three combination strategies, apart from the CT/MRI LR-5 criteria, HCC was diagnosed if CT/MRI LR-3 or LR-4 observations met the LR-5 criteria using LI-RADS SHF, LI-RADS PFB, or modified PFB. Results: In total, 281 participants (237 males; mean age, 55 ± 11 years) with 306 observations (227 HCCs, 40 non-HCC malignancies, and 39 benign lesions) were included. Using LI-RADS SHF, LI-RADS PFB, and modified PFB, 20, 23, and 31 CT/MRI LR-3/4 observations, respectively, were reclassified as LR-5, and all were pathologically confirmed as HCCs. Compared to CT/MRI LI-RADS alone (74%, 95% confidence interval [CI]: 68%–79%), the three combination strategies combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or modified PFB increased sensitivity (83% [95% CI: 77%–87%], 84% [95% CI: 79%–89%], 88% [95% CI: 83%–92%], respectively; all P < 0.001), while maintaining the specificity at 92% (95% CI: 84%–97%). Conclusion The combination of CT/MRI LI-RADS with second-line CEUS using SHF or PFB improved the sensitivity of HCC diagnosis without compromising specificity.

Objective: The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) demonstrates high specificity with relatively limited sensitivity for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. This study aimed to explore the possibility of improving sensitivity by combining CT/MRI LI-RADS v2018 with second-line contrast-enhanced ultrasound (CEUS) LI-RADS v2017 using sulfur hexafluoride (SHF) or perfluorobutane (PFB). Materials and Methods: This retrospective analysis of prospectively collected multicenter data included high-risk patients with treatment-naive hepatic observations. The reference standard was pathological confirmation or a composite reference standard (only for benign lesions). Each participant underwent concurrent CT/MRI, SHF-enhanced US, and PFB-enhanced US examinations. The diagnostic performances for HCC of CT/MRI LI-RADS alone and three combination strategies (combining CT/ MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or a modified algorithm incorporating the Kupffer-phase findings for PFB [modified PFB]) were evaluated. For the three combination strategies, apart from the CT/MRI LR-5 criteria, HCC was diagnosed if CT/MRI LR-3 or LR-4 observations met the LR-5 criteria using LI-RADS SHF, LI-RADS PFB, or modified PFB. Results: In total, 281 participants (237 males; mean age, 55 ± 11 years) with 306 observations (227 HCCs, 40 non-HCC malignancies, and 39 benign lesions) were included. Using LI-RADS SHF, LI-RADS PFB, and modified PFB, 20, 23, and 31 CT/MRI LR-3/4 observations, respectively, were reclassified as LR-5, and all were pathologically confirmed as HCCs. Compared to CT/MRI LI-RADS alone (74%, 95% confidence interval [CI]: 68%–79%), the three combination strategies combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or modified PFB increased sensitivity (83% [95% CI: 77%–87%], 84% [95% CI: 79%–89%], 88% [95% CI: 83%–92%], respectively; all P < 0.001), while maintaining the specificity at 92% (95% CI: 84%–97%). Conclusion The combination of CT/MRI LI-RADS with second-line CEUS using SHF or PFB improved the sensitivity of HCC diagnosis without compromising specificity.

Objective: The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) demonstrates high specificity with relatively limited sensitivity for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. This study aimed to explore the possibility of improving sensitivity by combining CT/MRI LI-RADS v2018 with second-line contrast-enhanced ultrasound (CEUS) LI-RADS v2017 using sulfur hexafluoride (SHF) or perfluorobutane (PFB). Materials and Methods: This retrospective analysis of prospectively collected multicenter data included high-risk patients with treatment-naive hepatic observations. The reference standard was pathological confirmation or a composite reference standard (only for benign lesions). Each participant underwent concurrent CT/MRI, SHF-enhanced US, and PFB-enhanced US examinations. The diagnostic performances for HCC of CT/MRI LI-RADS alone and three combination strategies (combining CT/ MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or a modified algorithm incorporating the Kupffer-phase findings for PFB [modified PFB]) were evaluated. For the three combination strategies, apart from the CT/MRI LR-5 criteria, HCC was diagnosed if CT/MRI LR-3 or LR-4 observations met the LR-5 criteria using LI-RADS SHF, LI-RADS PFB, or modified PFB. Results: In total, 281 participants (237 males; mean age, 55 ± 11 years) with 306 observations (227 HCCs, 40 non-HCC malignancies, and 39 benign lesions) were included. Using LI-RADS SHF, LI-RADS PFB, and modified PFB, 20, 23, and 31 CT/MRI LR-3/4 observations, respectively, were reclassified as LR-5, and all were pathologically confirmed as HCCs. Compared to CT/MRI LI-RADS alone (74%, 95% confidence interval [CI]: 68%–79%), the three combination strategies combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or modified PFB increased sensitivity (83% [95% CI: 77%–87%], 84% [95% CI: 79%–89%], 88% [95% CI: 83%–92%], respectively; all P < 0.001), while maintaining the specificity at 92% (95% CI: 84%–97%). Conclusion The combination of CT/MRI LI-RADS with second-line CEUS using SHF or PFB improved the sensitivity of HCC diagnosis without compromising specificity.

Objective:To investigate the effects of three surgical methods on anorectal dynamics indexes, pain symptoms and postoperative complications in patients with moderate to severe mixed hemorrhoids.Methods:Eighty patients with moderate to severe mixed hemorrhoids diagnosed and treated in Tongling People′s Hospital from March 2021 to December 2022 were retrospectively selected as the study objects, and they were divided into mucosal resection group (30 cases), sphincterotomy group (30 cases) and mixed hemorrhoidal resection group (20 cases) according to the treatment methods. The basic conditions of operation, anorectal dynamics indexes, pain symptoms and postoperative complications were compared among the three groups.Results:The operative time, intraoperative blood loss, first postoperative defecation time, postoperative bed time and hospital stay in the mucosa resection group were all shorter than those in the sphincterotomy group and the mixed hemorrhoidectomy group:(20.57 ± 5.85) min vs. (24.68 ± 4.66) and (33.86 ± 4.27) min, (4.19 ± 0.54) ml vs. (6.34 ± 0.82) and (9.25 ± 1.39) ml, (1.57 ± 0.12) d vs. (1.95 ± 0.32) and (2.48 ± 0.54) d, (1.43 ± 0.35) d vs. (1.64 ± 0.41) and (1.90 ± 0.44) d, (4.57 ± 0.39) d vs. (5.83 ± 0.47) and (7.64 ± 0.55) d, there were statistical differences ( P<0.05). The above indexes in the sphincterectomy group were shorter than those in the mixed hemorrhoidectomy group, there were statistical differences ( P<0.05). The maximum rectal volume threshold (RMTV), rectal perception threshold (RSTV) and maximum rectal systolic blood pressure (MASP) in the resection group were higher than those in the sphincterotomy group: (201.59 ± 40.13) ml vs. (178.45 ± 38.59) ml, (65.54 ± 18.29) ml vs. (54.62 ± 20.39) ml, (126.36 ± 12.29) mmHg (1 mmHg = 0.133 kPa) vs. (42.23 ± 14.46) mmHg, anal canal resting pressure (RASP) was lower than that in the sphincterotomy group: (32.59 ± 10.25) mmHg vs. (63.50 ± 13.69) mmHg, there were statistical differences ( P<0.05). The RMTV and RSTV in the sphincterotomy group were higher than those in the mixed hemorrhoidectomy group: (178.45 ± 38.59) ml vs. (135.85 ± 35.68) ml, (54.62 ± 20.39) ml vs. (41.34 ± 20.55) ml, the RASP and MASP were lower than those in the mixed hemorrhoidectomy group :(63.50 ± 13.69) mmHg vs. (73.33 ± 15.69) mmHg, (42.23 ± 14.46) mmHg vs. (128.66 ± 16.33) mmHg, there were statistical differences ( P<0.05). The postoperative visual analogue scale (VAS) score in the mucosa resection group were lower than those in the sphincterotomy group and the mixed hemorrhoidectomy group: (1.57 ± 0.25) score vs. (2.57 ± 0.36) and (3.42 ± 0.52) score, there were statistical differences ( P<0.05). The VAS scores in the sphincterectomy group was lower than that in the mixed hemorrhoidectomy group, there was statistical difference ( P<0.05). The incidence of postoperative complications in the mucosa resection group was lower than that in the sphincterectomy group: 3.33% (1/30) vs. 20.00% (6/30), and the incidence of postoperative complications in the sphincterectomy group was lower than that in the mixed hemorrhoidectomy group: 20.00% (6/30) vs. 50.00% (10/20), there were statistical differences ( χ2 = 4.04, 4.96, P<0.05). Conclusions:Compared with partial internal anal sphincterotomy and external stripping and internal ligation of mixed hemorrhoids, partial rectal mucosal resection is more effective in the treatment of Ⅲ~Ⅳ grade mixed hemorrhoids, which can effectively restore anorectal dynamic indexes, reduce postoperative pain and reduce the occurrence of complications.

Objective:To investigate the effects of three surgical methods on anorectal dynamics indexes, pain symptoms and postoperative complications in patients with moderate to severe mixed hemorrhoids.Methods:Eighty patients with moderate to severe mixed hemorrhoids diagnosed and treated in Tongling People′s Hospital from March 2021 to December 2022 were retrospectively selected as the study objects, and they were divided into mucosal resection group (30 cases), sphincterotomy group (30 cases) and mixed hemorrhoidal resection group (20 cases) according to the treatment methods. The basic conditions of operation, anorectal dynamics indexes, pain symptoms and postoperative complications were compared among the three groups.Results:The operative time, intraoperative blood loss, first postoperative defecation time, postoperative bed time and hospital stay in the mucosa resection group were all shorter than those in the sphincterotomy group and the mixed hemorrhoidectomy group:(20.57 ± 5.85) min vs. (24.68 ± 4.66) and (33.86 ± 4.27) min, (4.19 ± 0.54) ml vs. (6.34 ± 0.82) and (9.25 ± 1.39) ml, (1.57 ± 0.12) d vs. (1.95 ± 0.32) and (2.48 ± 0.54) d, (1.43 ± 0.35) d vs. (1.64 ± 0.41) and (1.90 ± 0.44) d, (4.57 ± 0.39) d vs. (5.83 ± 0.47) and (7.64 ± 0.55) d, there were statistical differences ( P<0.05). The above indexes in the sphincterectomy group were shorter than those in the mixed hemorrhoidectomy group, there were statistical differences ( P<0.05). The maximum rectal volume threshold (RMTV), rectal perception threshold (RSTV) and maximum rectal systolic blood pressure (MASP) in the resection group were higher than those in the sphincterotomy group: (201.59 ± 40.13) ml vs. (178.45 ± 38.59) ml, (65.54 ± 18.29) ml vs. (54.62 ± 20.39) ml, (126.36 ± 12.29) mmHg (1 mmHg = 0.133 kPa) vs. (42.23 ± 14.46) mmHg, anal canal resting pressure (RASP) was lower than that in the sphincterotomy group: (32.59 ± 10.25) mmHg vs. (63.50 ± 13.69) mmHg, there were statistical differences ( P<0.05). The RMTV and RSTV in the sphincterotomy group were higher than those in the mixed hemorrhoidectomy group: (178.45 ± 38.59) ml vs. (135.85 ± 35.68) ml, (54.62 ± 20.39) ml vs. (41.34 ± 20.55) ml, the RASP and MASP were lower than those in the mixed hemorrhoidectomy group :(63.50 ± 13.69) mmHg vs. (73.33 ± 15.69) mmHg, (42.23 ± 14.46) mmHg vs. (128.66 ± 16.33) mmHg, there were statistical differences ( P<0.05). The postoperative visual analogue scale (VAS) score in the mucosa resection group were lower than those in the sphincterotomy group and the mixed hemorrhoidectomy group: (1.57 ± 0.25) score vs. (2.57 ± 0.36) and (3.42 ± 0.52) score, there were statistical differences ( P<0.05). The VAS scores in the sphincterectomy group was lower than that in the mixed hemorrhoidectomy group, there was statistical difference ( P<0.05). The incidence of postoperative complications in the mucosa resection group was lower than that in the sphincterectomy group: 3.33% (1/30) vs. 20.00% (6/30), and the incidence of postoperative complications in the sphincterectomy group was lower than that in the mixed hemorrhoidectomy group: 20.00% (6/30) vs. 50.00% (10/20), there were statistical differences ( χ2 = 4.04, 4.96, P<0.05). Conclusions:Compared with partial internal anal sphincterotomy and external stripping and internal ligation of mixed hemorrhoids, partial rectal mucosal resection is more effective in the treatment of Ⅲ~Ⅳ grade mixed hemorrhoids, which can effectively restore anorectal dynamic indexes, reduce postoperative pain and reduce the occurrence of complications.

Objective:This study aims to analyze the gamma band effective connectivity characteristics of the prefrontal-striatal circuitry in bipolar disorder patients with and without a history of manic episodes, as well as in major depressive disorder patients, during the recognition of positive emotional faces, this study aims to identify unique neurophysiological features that may aid in the early detection of bipolar disorder.Methods:This retrospective study collected clinical data and magnetoencephalography (MEG) imaging data from patients performing a positive emotional face recognition task at the Affiliated Brain Hospital of Nanjing Medical University from May 2009 to December 2019. The study included 75 patients with major depressive disorder and 29 patients with bipolar disorder in a depressive episode (rBD group). Concurrently, 39 age-and gender-matched healthy controls (HC group) were recruited. After a follow-up period of at least 5 years, 23 out of the 75 patients with major depressive disorder converted to bipolar disorder (ctBD group), while the remaining 52 who did not convert maintained a diagnosis of major depressive disorder.Results:There were statistically significant differences in gamma-band effective connectivity in the prefrontal-striatal circuit when recognizing positive emotional faces among the converted to bipolar disorder (ctBD), raw bipolar disorder, major depressive disorder, and HC groups ( H=9.04, 10.30, 8.30, 13.43, 14.38, 12.62, 9.82, 8.94, 24.62, 7.89, 18.53, 9.97, 9.58, 12.79, P<0.05). The ctBD group, rBD group, and major depressive group all showed reduction in effective connectivity from the right orbital inferior frontal gyrus (ORBinf.R) to the left orbital inferior frontal gyrus (ORBinf.L) [ Z=-1.98, -3.38, -2.88], from the right orbital inferior frontal gyrus to the right ventral striatum (VS.R) ( Z=-2.05, -2.76, -2.11; P<0.05) and from the left ventral striatum (VS.L) to the left orbital middle frontal gyrus (ORBmid.L) ( Z=-2.76, -1.98, -2.43; P<0.05). Among the disease groups, the ctBD group showed significantly enhanced effective connectivity strength compared to the major depressive group from the right amygdala (AMYG.R) to the left orbital inferior frontal gyrus(0.04(0.03, 0.08)), from the right amygdala to the left ventral striatum(0.05(0.03, 0.09)), and from the right ventral striatum to the right anterior cingulate and paracingulate gyri (ACG.R) (0.04(0.02, 0.08)) ( Z=4.17, 3.70, 3.35; P<0.001).The ctBD group also exhibited enhanced effective connectivity compared to the rBD group from ORBinf.R to the ACG.R, fron the AMYG.R to the ORBinf.L, from the AMYG.R to the VS.L, and from the VS.R to the ACG.R ( Z=2.05, 4.61, 3.60, 3.04; P<0.05).The rBD group demonstrated reduced effective connectivity compared to the major depressive disorder group from the right orbital middle frontal gyrus(ORBmid.R) to the left anterior cingulate and paracingulate gyri (ACG.L), ORBinf.R to the ACG.R and from the ORBinf.R to the AMYG.R ( Z=-2.12, -2.40, -2.22; P<0.05). Conclusion:There are significant differences in the gamma-band effective connectivity characteristics of the prefrontal-striatal pathway when recognizing positive emotional faces between patients with bipolar disorder in depressive episodes and those with depression, as well as differences between bipolar depressed patients with and without a history of manic episodes.