Depression is a chronic brain dysfunctional disease mainly due tomood disorders.Currently,the pathogenesis of depression is unclear,and its pathogenesis,pathophysiology and treatment have consistently been a major focus of academic research.This review provides an overview of the role of serum inflammatory factors in the pathogenesis,diagnosis,and treatment of depression.The inflammatory factor pathway provides a theoretical basis for the development of diagnostic and therapeutic methods for depression.It is expected to provide accurate personalized treatment for patients with depression through the treatment of inflammatory factors,improve the treatment outcomest,and reduce the risk of disease progression.

Depression is a chronic brain dysfunctional disease mainly due tomood disorders.Currently,the pathogenesis of depression is unclear,and its pathogenesis,pathophysiology and treatment have consistently been a major focus of academic research.This review provides an overview of the role of serum inflammatory factors in the pathogenesis,diagnosis,and treatment of depression.The inflammatory factor pathway provides a theoretical basis for the development of diagnostic and therapeutic methods for depression.It is expected to provide accurate personalized treatment for patients with depression through the treatment of inflammatory factors,improve the treatment outcomest,and reduce the risk of disease progression.

Objective:To observe the effectiveness and safety of pars plana vitrectomy (PPV) combined with inner limiting membrane (ILM) removal and 41G microneedle subretinal injection of balanced salt solution (BSS) in the treatment of refractory macular hole.Methods:A prospective clinical study. From January to June 2023, 20 cases (20 eyes) of refractory macular hole patients diagnosed through examination at The Affiliated Eye Hospital of Nanchang University were included in the study. The basal diameter of the affected eye's basal diameter (BD) was >1 000 μm. Macular hole index (MHI) was <0.5. The affected eye received treatment with 23G PPV combined with ILM removal and 41G microneedle subretinal injection of BSS. Best corrected visual acuity (BCVA), microperimetry, and optical coherence tomography angiography (OCTA) were performed before and 1, 2, 3, and 6 months after surgery for the affected eye. BCVA examination was performed using standard logarithmic visual acuity chart, and convert it to logarithmic minimum resolution angle (logMAR) visual acuity for statistical purposes. MP-3 microperimetry was used for micro view examination, record the mean sensitivity (MS) of the retinal within a 12° range of the fovea. OCTA was used to measure the area of the avascular zone of the macula (FAZ), perimeter of the FAZ (PERIM), retinal vascular length density (VLD), and vascular perfusion density (VPD). The changes in BCVA, MS, FAZ area, PERIM, VLD, VPD before and after surgery were compared and analyzed. After the same time, the closure of macular hole and the occurrence of complications after surgery were observed. Single factor analysis of variance was used to compare the observation indicators at different times before and after surgery. The correlation between various observation indicators and preoperative minimum diameter (MD), BD, and hiatus height at 6 months after surgery were analyzed using Pearson correlation analysis.Results:Among the 20 cases with 20 eyes, there were 2 males with 2 eyes and 18 females with 18 eyes. Age was (61.45±8.56) years old. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD of the affected eye were 1.46±0.21, (16.20±5.81) dB、(0.40±0.17) mm 2, (2.89±0.99) mm, (6.23±3.59) mm -1, (0.17±0.10)%, respectively. Six months after surgery, out of 20 eyes, macular hole closure and incomplete closure were 18 (90.0%, 18/20) and 2 (10.0%, 2/20) eyes, respectively. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD were 0.80±0.20, (22.20±4.60) dB, (0.18±0.10) mm 2, (1.83±0.80) mm, (9.54±2.88) mm -1, (0.31±0.14)%. Compared with before surgery, the differences were statistically significant ( P<0.05). The correlation analysis results showed a positive correlation ( P<0.05) between preoperative BD and postoperative 6-month PERIM and VPD. There was a negative correlation between preoperative MD and postoperative VLD at 6 months ( P<0.05). There was a negative correlation between preoperative MHI and logMAR BCVA and VPD at 6 months after surgery ( P<0.05). No complications such as elevated or decreased intraocular pressure, damage to retinal pigment epithelium, retinal hemorrhage, endophthalmitis, or retinal detachment occurred after surgery in all affected eyes. Conclusion:Minimally invasive PPV combined with ILM removal and 41G microneedle subretinal injection of BSS can effectively improve the closure rate of refractory macular hole patients in the short term, improve vision, and have good safety.

Objective:To analyze the effect of laparoscopic primary suture in patients with choledocholithiasis of different common duct diameters.Methods:The clinical data of 99 patients with choledocholithiasis who received laparoscopic cholecystectomy (LC)+ laparoscopic common bile duct exploration (LCBDE) primary suture in the Zhangjiakou First Hospital from April 2020 to January 2022 were retrospectively analyzed, and according to different choledocholithiasis diameters they were divided into group A ( n=40, common bile duct diameter >8 mm), group B ( n=34, common bile duct diameter >6-8 mm), group C ( n=25, common bile duct diameter >4-6 mm). All patients were treated with intravenous anesthesia combined with LC+ LCBDE suture. General data, surgical indexes, liver function, stress response, immune function and postoperative complications were compared among the three groups. Results:There were no significant differences in gender, number of cases with acute mild cholangitis, age, body mass index and number of common bile duct stones among 3 groups (all P>0.05).There were no significant differences in operation success rate, operation time, conversion rate and intraoperative blood loss among the 3 groups (all P>0.05). 24 hours after surgery, serum alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST) [(58.46±7.12)U/L, (32.87±4.32)μmol/L, (67.59±8.60)U/L] in the group A were higher than those in the group B [(49.02±6.58)U/L, (26.54±3.40)μmol/L, (48.01±6.52)U/L], in the group C [(37.85±4.60)U/L, (21.06±2.17)μmol/L, (36.38±4.56)U/L] (all P<0.05). The levels of ALT, TBIL and AST in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) in the group A [(19.24±4.76)ng/ml, (148.04±14.30)ng/ml] were higher than those in the group B [(16.91±3.72)ng/ml, (131.24±11.65)ng/ml] and in the group C [(14.60± 2.83)ng/ml, (119.87±8.06)ng/ml] (all P<0.05). Serum ACTH and Cor levels in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, Serum immunoglobulin M (IgM) and immunoglobulin A (IgA) [(0.65±0.10)ng/ml, (1.07±0.25)ng/ml] in the group A were lower than those in the group B [(0.85±0.19)ng/ml, (1.35±0.29)ng/ml] and in the group C [(0.92±0.24)ng/ml, (1.60±0.34)ng/ml] (all P<0.05). Serum IgM and IgA levels in the group B were lower than those in the group C (all P<0.05). There were no significant differences in biliary leakage rate, incision infection rate, choledocholithiasis recurrence rate, peritoneal infection rate, pulmonary infection rate and postoperative bile duct stenosis rate among 3 groups (all P>0.05). Conclusions:Patients with choledocholithiasis with different common duct diameters can be treated with LC+ LCBDE one-stage suture with significant effect, which will not affect postoperative complications. However, the larger the diameter, the more the recovery of liver function will be affected, the stress reaction will be aggravated, and the immune function will be reduced.

Objective:To analyze the effect of laparoscopic primary suture in patients with choledocholithiasis of different common duct diameters.Methods:The clinical data of 99 patients with choledocholithiasis who received laparoscopic cholecystectomy (LC)+ laparoscopic common bile duct exploration (LCBDE) primary suture in the Zhangjiakou First Hospital from April 2020 to January 2022 were retrospectively analyzed, and according to different choledocholithiasis diameters they were divided into group A ( n=40, common bile duct diameter >8 mm), group B ( n=34, common bile duct diameter >6-8 mm), group C ( n=25, common bile duct diameter >4-6 mm). All patients were treated with intravenous anesthesia combined with LC+ LCBDE suture. General data, surgical indexes, liver function, stress response, immune function and postoperative complications were compared among the three groups. Results:There were no significant differences in gender, number of cases with acute mild cholangitis, age, body mass index and number of common bile duct stones among 3 groups (all P>0.05).There were no significant differences in operation success rate, operation time, conversion rate and intraoperative blood loss among the 3 groups (all P>0.05). 24 hours after surgery, serum alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST) [(58.46±7.12)U/L, (32.87±4.32)μmol/L, (67.59±8.60)U/L] in the group A were higher than those in the group B [(49.02±6.58)U/L, (26.54±3.40)μmol/L, (48.01±6.52)U/L], in the group C [(37.85±4.60)U/L, (21.06±2.17)μmol/L, (36.38±4.56)U/L] (all P<0.05). The levels of ALT, TBIL and AST in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) in the group A [(19.24±4.76)ng/ml, (148.04±14.30)ng/ml] were higher than those in the group B [(16.91±3.72)ng/ml, (131.24±11.65)ng/ml] and in the group C [(14.60± 2.83)ng/ml, (119.87±8.06)ng/ml] (all P<0.05). Serum ACTH and Cor levels in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, Serum immunoglobulin M (IgM) and immunoglobulin A (IgA) [(0.65±0.10)ng/ml, (1.07±0.25)ng/ml] in the group A were lower than those in the group B [(0.85±0.19)ng/ml, (1.35±0.29)ng/ml] and in the group C [(0.92±0.24)ng/ml, (1.60±0.34)ng/ml] (all P<0.05). Serum IgM and IgA levels in the group B were lower than those in the group C (all P<0.05). There were no significant differences in biliary leakage rate, incision infection rate, choledocholithiasis recurrence rate, peritoneal infection rate, pulmonary infection rate and postoperative bile duct stenosis rate among 3 groups (all P>0.05). Conclusions:Patients with choledocholithiasis with different common duct diameters can be treated with LC+ LCBDE one-stage suture with significant effect, which will not affect postoperative complications. However, the larger the diameter, the more the recovery of liver function will be affected, the stress reaction will be aggravated, and the immune function will be reduced.

OBJECTIVE： To analyze the development status of neuropsychotropic therapeutic drug monitoring （TDM）， and to provide reference for improving the quality of TDM in neuropsychiatry department. METHODS： The laboratory data of neuropsychotropic TDM external quality assessment （EQA） were collected from Website of Clinical Laboratory Center of Ministry of Health （http：//www.clinet.com.cn） during 2008-2017， and then analyzed statistically in respects of TDM project， the number of involved laboratory， monitoring method， etc. RESULTS： By the end of 2017， the Clinical Laboratory Center of the Ministry of Health had conducted 5 neuropsychiatric TDM projects involving 4 drugs， including 3 items of serum TDM （carbamazepine， valproic acid， phenytoin）， lithium ion monitoring （lithium carbonate） in biochemical routine and newly added pharmacokinetic laboratory biological sample monitoring （carbamazepine） in 2014. From 2008 to 2017， the number of involved laboratories increased from 209 to 603， with carbamazepine （serum， plasma） and valproic acid showing good annual growth trend， exceeding 200 and phenytoin 107， but only 27 in lithium carbonate until 2017. Among all monitoring methods of involved laboratories， the number of laboratories which adopted fluorescence polarization immunoassay （FPIA） decreased year by year. By the end of 2017， there were fewer than 10 laboratories. The number of laboratories using acridinium direct chemiluminescence， enzyme-multiplied immunoassay technique （EMIT）， and high performance liquid chromatography （HPLC） had steadily increased. By the end of  2017， acridinium direct chemiluminescence was the most used in laboratory， followed by EMIT and HPLC. CONCLUSIONS： Due to the increasing number of participating laboratories， it can be seen that the consciousness of quality control of laboratory personnel is increasing day by day； but the complexity of TDM monitoring methods limits the types of drugs used in external quality evaluation. It is suggested to formulate guidelines， quality control standards and operation rules as soon as possible， so as to ensure the accuracy of test results.

Objective To investigate the effects of exendin-4 (exenatide) on insulin sensitivity and adipocytokine in high-fat-fed rats. Methods Rats were divided randomly into normal-chow group (NC), high-fat group (HF) and high-fat+exendin treated group (HE). HE rats were given exenatide (2 μg/kg) twice daily for 6 wk. The insulin sensitivity was evaluated by intravenous insulin tolerance test (IVITT). Insulin-stimulated changes in insulin signal transduction, visfatin and adiponectin mRNA expressions as well as their plasma levels were also observed in these rats. Results Plasma free fatty acids (FFA), triglyceride (TG), total cholesterol (TC) levels were significantly reduced after exenatide treatment (in HE rats all P<0.01). And IVITT parameters were also improved in these rats. Insulin-stimulated IRS-1 tyrosine phosphorylation was slightly increased in exenatide-treated rats as compared with HF rats (P<0.05). In addition,plasma visfatin level was significantly reduced in HF and HE groups as compared with controls (P<0.05 and P<0.01). The adiponectin mRNA expression in adipose tissues and circulating adiponectin level were significantly elevated in exenatide-treated rats as compared with untreated rats and controls (P<0.01). Conclusions Chronic exenatide treatment improves insulin resistance in high-fat-fed rats, and the changes of IRS-1 tyrosine phosphorylation and adiponectin may be related to the role of exenatide in elevating insulin sensitivity