ObjectiveTo explore whether fluoroethylnormemantine （FENM）， an NMDA receptor antagonist， could improve compulsive-like behaviors and to investigate its underlying mechanisms in the RU24969-induced obsessive-compulsive disorder （OCD） mouse model. MethodsThirty-two mice were randomly assigned to four groups： Saline （n=8）， RU24969 （n=8）， RU+FENM （n=8）， and FENM （n=8）. Mice received FENM or an equivalent volume of saline for pre-treatment， followed by RU24969 or saline for model induction 30 minutes later. Behavioral tests were performed 1 hour after modeling， and serum samples were collected to measure the level of brain-derived neurotrophic factor （BDNF）. Evans Blue dye was intravenously injected to assess dye content in brain tissue， thereby evaluating potential blood-brain barrier damage. ResultsFENM treatment significantly improved repetitive stereotyped circling behavior （F=39.850， P＜0.001） and alleviated persistent motor activity （F=50.200， P＜0.001） in RU24969 model mice. Additionally， FENM treatment significantly increased serum BDNF level in RU24969-induced OCD mice （F=18.930， P＜0.001）. ConclusionsFENM ， an NMDA receptor antagonist， may alleviate compulsive behaviors in OCD mice by modulating BDNF levels ， thereby exerting anti-compulsive effects. Neither the RU24969 model nor FENM treatment significantly affectes blood-brain barrier integrity.

Objective:To analyze the clinical efficacy of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope.Methods:The clinical data of 96 patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery, the Third Hospital of Nanchang from September 2021 to November 2024 were retrospectively analyzed. There were 49 male and 47 female patients, aged (59.2±13.9) years. The 96 patients were randomly divided into two groups according to the surgical methods: the flexible ureteroscope group ( n=48) and the choledochotomy group ( n=48), patients who underwent laparoscopic cholecystectomy plus flexible ureteroscope for common bile duct exploration and stone removal via the cystic duct were included in the flexible ureteroscope group; patients who underwent laparoscopic cholecystectomy plus choledocholithotomy and T-tube drainage placement were included in the choledochotomy group. Clinical data including operation time, intraoperative blood loss, postoperative intestinal function recovery time, abdominal drainage tube removal time, postoperative hospital stay and postoperative complications were compared between the two groups. Results:Compared with the choledochotomy group, the operation time [150 (120, 176) min vs. 197 (165, 240) min], intraoperative blood loss [20 (10, 30) ml vs. 30 (20, 50) ml], postoperative intestinal function recovery time [2 (1, 2) d vs. 3 (2, 4) d], abdominal drainage tube removal time [6 (4, 7) d vs. 7 (6, 8) d], and postoperative hospital stay [8 (6, 9) d vs. 16 (13, 17) d] in the flexible ureteroscope group were all reduced, and the differences were statistically significant (all P<0.05). The incidence of postoperative complications in the choledochotomy group was 10.4% (5/48), compared with 2.1% (1/48) in the flexible ureteroscope group. There was no statistically significant difference ( χ2=1.60, P=0.206). Conclusion:Compared with laparoscopic choledocholithotomy plus T-tube drainage, laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope can shorten the hospital stay of patients with choledocholithiasis, offering a minimally invasive, safe and effective treatment method.

Objective:To analyze the clinical efficacy of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope.Methods:The clinical data of 96 patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery, the Third Hospital of Nanchang from September 2021 to November 2024 were retrospectively analyzed. There were 49 male and 47 female patients, aged (59.2±13.9) years. The 96 patients were randomly divided into two groups according to the surgical methods: the flexible ureteroscope group ( n=48) and the choledochotomy group ( n=48), patients who underwent laparoscopic cholecystectomy plus flexible ureteroscope for common bile duct exploration and stone removal via the cystic duct were included in the flexible ureteroscope group; patients who underwent laparoscopic cholecystectomy plus choledocholithotomy and T-tube drainage placement were included in the choledochotomy group. Clinical data including operation time, intraoperative blood loss, postoperative intestinal function recovery time, abdominal drainage tube removal time, postoperative hospital stay and postoperative complications were compared between the two groups. Results:Compared with the choledochotomy group, the operation time [150 (120, 176) min vs. 197 (165, 240) min], intraoperative blood loss [20 (10, 30) ml vs. 30 (20, 50) ml], postoperative intestinal function recovery time [2 (1, 2) d vs. 3 (2, 4) d], abdominal drainage tube removal time [6 (4, 7) d vs. 7 (6, 8) d], and postoperative hospital stay [8 (6, 9) d vs. 16 (13, 17) d] in the flexible ureteroscope group were all reduced, and the differences were statistically significant (all P<0.05). The incidence of postoperative complications in the choledochotomy group was 10.4% (5/48), compared with 2.1% (1/48) in the flexible ureteroscope group. There was no statistically significant difference ( χ2=1.60, P=0.206). Conclusion:Compared with laparoscopic choledocholithotomy plus T-tube drainage, laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope can shorten the hospital stay of patients with choledocholithiasis, offering a minimally invasive, safe and effective treatment method.

Objective To investigate the relationship between the severity of insomnia and the curative effect in acute stage in patients with major depressive disorder (MDD). Methods The Insomnia Severity Index (ISI) was used to evaluate and group the severity of insomnia in the 57 patients with MDD. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The 24－item Hamilton Depression Scale (HAMD24) was used to evaluate depressive symptoms, and the effect of acute stage (4～6 weeks) was evaluated with its reduction rate. The difference of curative effect was compared among patients with different insomnia levels. Results There was a significantly different recovery rate in acute stage in 3 groups of patients with mild, moderate and severe insomnia ( X2=22.34,P＜0.01). The severity of insomnia in patients with MDD (PSQI) was negatively correlated with the curative effect of acute stage (r=－0.44,P＜0.01). The total score, anxiety/somatization factor score, retardant factor score and despair factor score were significantly higher in severe insomnia group than in the moderate and mild insomnia groups after acute treatment (P＜0.01). Conclusion The severity of insomnia in patients with MDD can predict the curative effect in acute stage. The depressive patients with severe insomnia have residual anxiety/somatization, retardant, feelings of despair and other symptoms more obvious than mild and moderate insomnia patients after acute treatment.

Objective To explore the short term effects of five second-generation antipsychotics on the serum pro?lactin levels of first-episode schizophrenia patients. Methods Two hundred fifty first-episode schizophrenia patients were randomly divided into five groups and were then treated with risperidone, olanzapine, paliperidone, quetiapine or ziprasidone, respectively. The serum prolactin were tested at baseline, and every week following initiation of treatment. The positive and negative symptom scale (PANSS) and the treatment emergent symptom scale (TESS) were used to evalu?ate the effect and side effect of treatment. Results Repeated measure ANOVA for serum prolactin showed that the main effects of time, the main effect of group, and the interactive effect of time and group were significant (all P<0.01). At the first week, the serum prolactin level of risperidone group was higher than all the other four groups (P<0.05). At the sec?ond, third, fourth and fifth week, the serum prolactin level of risperidone group and olanzapine group was higher than the other three groups (P<0.05). At the end of the sixth week, the serum prolactin level of risperidone group, olanzapine group and paliperidone group was higher than the quetiapine and ziprasidone groups (P<0.05). But serum prolactin level of risperidone group and olanzapine group was higher than that of paliperidone group (P<0.05). The changes of PANSS before and after treatment were significantly different among groups (P<0.05). However, the incidence of the side effects was not significantly different among groups (P>0.05). Conclusion The level of serum prolactin gradually increases in schizophrenia patients receiving treatment of antipsychotics. The short term effects of different second generation antipsy?chotics on serum prolactin vary differently. Risperidol and olanzapine result in the elevation of serum prolactin level in the early period of treatment.

ObjectiveTo investigate the change of mood and cognitive function of patients with liver cirrhosis before and after liver transplantation (LT).MethodsA total of 26 patients with liver cirrhosis before LT and 24 patients after LT admitted in the Third Afifliated Hospital of Sun Yat-sen University from September 2012 to September 2013 were included in this prospective study. Moreover, 26 healthy controls were also included in normal control group. The informed consents of all participants were obtained and the local ethical committee approval had been received. The 26 patients before LT were assigned in preoperative group, among them, 23 were males and 3 were females with the average age of (50±9) years old. The 24 patients after LT were assigned in postoperative group, among them, 22 were males and 2 were females with the average age of (50±6) years old. Among the healthy controls, 23 were males and 3 were females with the average age of (49±9) years old. Clinical data of the three groups were collected respectively. The mood status and the cognitive function of the participants were assessed with Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA), Number Connection Test A (NCT-A) , Digit Symbol Test (DST). The results of multiple groups were compared with one-way analysis of variance and pairwise comparisons were conducted with LSD-t test.ResultsThe HAMD, HAMA scores, NCT-A results and DST scores of the preoperative group were (16.2±3.5), (17±5), (56±13) s and (36±11) and those of the postoperative group were (14.2±3.7), (16±3), (52±12) s and (42±7) and those of the normal control group were (7.3±2.4), (8±3), (38±8) s and (54±9). Compared with the normal control group, the HAMD, HAMA scores and NCT-A results of the preoperative group increased significantly (LSD-t=11.919, 8.596, 6.883;P<0.05) and the DST scores decreased significantly (LSD-t=-6.972,P<0.05). Compared with the normal control group, the HAMD, HAMA scores and NCT-A results of the postoperative group increased significantly (LSD-t=8.591, 9.942, 5.475;P<0.05) and the DST scores decreased significantly (LSD-t=-5.599,P<0.05). Compared with preoperative group, the HAMD scores of the postoperative group decreased significantly (LSD-t=-2.209,P<0.05) and the DST scores increased significantly (LSD-t=1.243,P<0.05).ConclusionsPatients with liver cirrhosis have obvious depression, anxiety and cognitive disorder before LT. A month after LT, depression and cognitive disorder improve obviously, but cannot recover to the normal level. The anxiety improvement is not obvious.

Objective To test the efficacy of cognitive behavioral self help therapy for chronic insomnia (CBTI-SH) patients with hypnotic long-term use.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited.Participants were randomly assigned to either intervention group (IG,n =30) if they had used hypnotics more than 6 months,or control group(CG,n =30) if they had never used hypnotics in the past 6 months.All the patients were given CBTI-SH for 4 weeks.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency(SL),Wake after Sleep Onset(WASO),Total Sleep Time(TST),Time In Bed(TIB),Sleep Efficiency(SE) which were evaluated on baseline and at the end of the 2nd,4th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the conclusion of treatment,each participant was asked how many days per week they enacted each of 6 core elements of the CBT regimen.Linear regression models were examined to determine net predictors of CBTI-SH adherence.Results The MANOVA showed a significant treatment group × time interaction,as well as time main effects for SE,TIB and WASO(P＜0.05).The patients in CG made better improvements than those in IG on SE,TIB and WASO((0.19 ±0.08) vs(0.09 ±0.09),(92.48 ± 32.64) vs (78.06 ±60.05),(103.08 ±64.82) vs (64.92 ±56.36),respectively) (P ＜ 0.05).Effect size were 1.14,0.85 and 0.62 respectively.Self-ratings of treatment adherence showed patients in the IG reported less adherence to standard rise time and TIB prescription than those in CG.(P ＜ 0.05).According to the linear regression models,both age and the comorbidity of chronic somatic diseases explained net associations with CBTI-SH adherence (P ＜ 0.05).Conclusion Chronic insomnia patients with hypnotic long-term use show less sleep improvement and less adherence to CBTI-SH compared with those who don' t use these medicines.Both age and the comorbidity of chronic somatic diseases explain net associations with CBTI-SH adherence.

Objective To explore the magnetic resonance spectroscopy characteristics of prefrontal white matter in bipolar Ⅱ disorder and its relation with executive function.Methods Thirty bipolar Ⅱ disorder patients and twenty healthy controls were evaluated with Multi-Voxel proton magnetic resonance spectroscopy (1H-MRS)scans on prefrontal white matter to assess the N-acetyl-aspartate (NAA),Choline (Cho),Creatine (Cr) and myoinositol (MI),and then the ratios of NAA/Cr,Cho/Cr,MI/Cr,NAA/Cho and NAA/Cho + Cr were calculated.All subjects were assessed for executive function using the Wisconsin Card Sorting Test (WCST).Results NAA/Cr in right prefrontal white matter(1.43 ± 0.26) and NAA/Cr,NAA/Cho,NAA/Cho + Cr in left prefrontal white matter (separatelyl.40 ± 0.29,1.13 (1.53,0.24),0.62 ± 0.12) were lower than healthy controls (separately 1.58 ±0.18,1.59,0.23,1.30 (0.53 ± 0.29),0.71 ± 0.08) (P ＜ 0.05).The correct trials and the number of categories of WCST in Bipolar Ⅱ disorder (separately 26.97 ± 8.97,3(6,3)) were less than in healthy controls(separately 36.35±4.85,5 (3,2)),and perseverative errors and random errors were more in patients (separately 12.77 ±5.73,7 (21,5)) than healthy controls (separately 7.35 ± 3.01,4 (13,2)).NAA/Cho and NAA/Cho + Cr in left prefrontal white matter were positively correlated with correct trials,number of categories,and negatively related with perseverative errors (P＜0.05).Conclusions Bilateral prefrontal white matter fiber damage occurs to bipolar Ⅱ disorder.And left prefrontal white matter fiber damage in bipolar Ⅱ disorder may lead to executive impairment.

Thyroid function [triiodothyronine(T3), thyroxine(T4), free T3(FT3), free T4(FT4),and thyroid stimulating hormone (TSH) ] were tested by radioimmunoassay in 56 depressive patients with attempted suicide, 85 patients without suicide attempt and 40 healthy subjects (controls).The serum levels of T3 and FT3 in the patients with attempted suicide were lower than those in the patients without suicide attempt and the controls ( F = 4.937 and 5.01 1, both P ＜ 0.05 ).The lower serum levels of T3 and FT3might be the risk factor of suicide in depressive patients.