BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Systemic lupus erythematosus （SLE） is an autoimmune disease in which the immune system mistakenly attacks multiple tissues and organs of the body. The comorbid anxiety and depression are highly prevalent conditions among SLE， thereby worsening the prognosis of patients and posing a serious diagnostic challenge to the clinicians. The purpose of this article is to review the literature available for the influencing factors of comorbid anxiety and depression in SLE， and to provide references for optimizing treatment strategies for SLE patients with comorbid anxiety and depression. A total of 25 original research articles are included to provide a systematic and quantitative review， in which the genetic， immune， central nervous system and socio-psychological factors affecting the comorbid anxiety and depression in SLE are explored.

Objective:To explore the expression pattern of aryl hydrocarbon receptor (AhR) in mice peritoneal macrophages (PMs) after major trauma and analyze the effects of enhanced AhR expression on the inflammatory cytokine level and bactericidal ability after trauma.Methods:The experimental study method was used. Forty 6-8-week-old male C57BL/6J mice (the same mouse age, sex, and strain below) were divided into control group, post trauma hour (PTH) 2 group, PTH 6 group, and PTH 12 group according to the random number table (the same grouping method below), with 10 mice in each group. Mice in the latter 3 groups were constructed as severe trauma model with fracture+blood loss, while mice in control group were left untreated. The primary PMs (the same cells below) were extracted from the mice in control group, PTH 2 group, PTH 6 group, and PTH 12 group when uninjured or at PTH 2, 6, and 12, respectively. Then the protein and mRNA expressions of AhR were detected by Western blotting and real-time fluorescence quantitative reverse transcription polymerase chain reaction, respectively, and the gene expressions of AhR signaling pathway related molecules were analyzed by transcriptome sequencing. Twenty mice were divided into control group and PTH 6 group, with 10 mice in each group, and the PMs were extracted. The level of ubiquitin of AhR was detected by immunoprecipitation. Twelve mice were divided into dimethyl sulfoxide (DMSO) alone group, PTH 6+DMSO group, MG-132 alone group, and PTH 6+MG-132 group, with 3 mice in each group. After the corresponding treatment, PMs were extracted, and the protein expression of AhR was detected by Western blotting. Twenty mice were constructed as PTH 6 model. Then, the PMs were extracted and divided into empty negative control adenovirus (Ad-NC) group and AhR overexpression adenovirus (Ad-AhR) group. The protein expression of AhR was detected by Western blotting at 36 h after some PMs were transfected with the corresponding adenovirus. The rest cells in Ad-NC group were divided into Ad-NC alone group and Ad-NC+endotoxin/lipopolysaccharide (LPS) group, and the rest cells in Ad-AhR group were divided into Ad-AhR alone group and Ad-AhR+LPS group. The expressions of interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) in the cell supernatant were detected by enzyme-linked immunosorbent assay at 12 h after the corresponding treatment ( n=6). Twenty mice were obtained to extract PMs. The cells were divided into control+Ad-NC group, PTH 6+Ad-NC group, control+Ad-AhR group, and PTH 6+Ad-AhR group, and the intracellular bacterial load was detected by plate spread method after the corresponding treatment ( n=6). Data were statistically analyzed with one-way analysis of variance, least significant difference test, analysis of variance for factorial design, and independent sample t test. Results:Compared with 1.16±0.28 of control group, the protein expressions of AhR in PMs in PTH 2 group (0.59±0.14), PTH 6 group (0.72±0.16), and PTH 12 group (0.71±0.17) were all significantly decreased ( P<0.05). The overall comparison of the difference of AhR mRNA expression in PMs among control group, PTH 2 group, PTH 6 group, and PTH 12 group showed no statistical significance ( P>0.05). The AhR signaling pathway related molecules included AhR, AhR inhibitor, cytochrome P450 family member 1b1, cytochrome P450 family member 11a1, heat shock protein 90, aryl hydrocarbon receptor-interaction protein, and heat shock protein 70 interaction protein. The heat shock protein 90 expression of PMs in PTH 2 group was higher than that in control group, while the expressions of other molecules did not change significantly after trauma. Compared with that in control group, the level of ubiquitin of AhR in PMs in PTH 6 group was increased. Compared with that in DMSO alone group, the protein expression of AhR in PMs in PTH 6+DMSO group was decreased, while that in PMs in MG-132 alone group had no significant change. Compared with that in PTH 6+DMSO group, the protein expression of AhR in PMs in PTH 6+MG-132 group was up-regulated. At transfection hour 36, compared with that in Ad-NC group, the protein expression of AhR in PMs in Ad-AhR group was increased. At treatment hour 12, compared with those in Ad-NC+LPS group, the expressions of IL-6 and TNF-α in PM supernatant of Ad-AhR+LPS group were significantly decreased (with t values of 4.80 and 3.82, respectively, P<0.05). The number of intracellular bacteria of 1×10 6 PMs in control+Ad-NC group, PTH 6+Ad-NC group, control+Ad-AhR group, and PTH 6+Ad-AhR group was (3.0±1.8), (41.8±10.2), (1.8±1.2), and (24.2±6.3) colony forming unit, respectively. Compared with that in PTH 6+Ad-NC group, the number of intracellular bacteria of PMs in PTH 6+Ad-AhR group was significantly decreased ( t=3.61, P<0.05). Conclusions:Ubiquitin degradation of AhR in PMs of mice after major trauma results in decreased protein expression of AhR. Increasing the expression of AhR in post-traumatic macrophages can reduce the expressions of LPS-induced inflammatory cytokines IL-6 and TNF-α, and improve the bactericidal ability of macrophages after trauma.

ObjectiveTo analyze the feasibility， reliability and validity of the disability assessment for dementia scale for the elderly. MethodsA total of 290 dementia patients from 17 survey sites in 13 districts and counties of Chengdu were enrolled by convenient sampling method， and they were assessed using demographic data inventory， Mini-Mental State Examination （MMSE）， Neuropsychiatric Inventory （NPI）， Physical Self-Maintenance Scale （PSMS） and disability assessment for dementia scale for the elderly. Cronbach's α coefficient， Spearman-Brown coefficient， Guttman split-half coefficient and test-retest reliability were used to evaluate the internal consistency of above scales. Criterion-related validity of the scale was analyzed based on MMSE， NPI and PSMS. ResultsA total of 276 patients （95.17%） completed valid questionnaires. The intraclass correlation coefficient of the total score and each dimension were between 0.828~0.976， the Spearman-Brown coefficient were between 0.790~0.917， the Guttman split-half coefficient were between 0.812~0.857， and the Cronbach’s α coefficient were between 0.737~0.886. The cognitive function dimension score was positively correlated with the MMSE score （r=0.948， P<0.01）， the mental behavior symptom dimension score was positively correlated with the NPI score （r=0.893， P<0.01）， and the daily living ability dimension score was positively correlated with the PSMS score （r=0.997， P<0.01）. The dimensions scores were positively correlated with the total score of the scale （r=0.634~0.841， P<0.05）. ConclusionDisability of dementia assessment scale has good feasibility， reliability and validity， which is a reliable tool to assess senile dementia and disability.

Objective:To investigate the infection status of Kaeng Khoi virus (KKV) in bat flies in Yunnan province.Methods:Specimens of the ectoparasitic bat flies on bats in Baoshan city in 2014 and Ruili city in 2017 were collected and identified, virus isolation was performed by cell culture. The positive isolates were amplified and sequenced to obtain the complete genome sequences, and homology comparison and phylogenetic analysis were carried out.Results:Three positive isolates (WDBC1704, WDBC1710 and BSBC1406) were identified from bat flies in Ruili city and Baoshan city. The supernatant was inoculated into BHK-21 cells for virus isolation, all of which could cause cytopathic effects (CPE) included shrinking, rounding and falling off of BHK-21 cells. The complete genome sequences of the three positive isolates were produced by RT-PCR and high-throughput sequencing. Phylogenetic analysis showed that the S, M, and L genes of all three positive isolates were in the same evolutionary branch as the original KKV strain PSC-19 isolated in Thailand. In this study, three KKV strains isolated were most closely related to the previous isolate WDBC1403 from Yunnan province, of which the BSBC1406 strain formed a small independent branch. The sequence comparison showed that there were significant differences in the M gene among the three isolates. The similarity between BSBC1406 and the other two strains (WDBC1704 and WDBC1710) was only 78.0%-78.1%, the amino acid similarity of the Gc protein in the open reading frame region was 85.3%.Conclusions:Three KKV strains from bat flies were quite different from the prototype strain, especially the BSBC1406 strain was somewhat different from other isolates and may have undergone variation. Surveillance of KKV carried by vector insects in Yunnan province and its relationship with human diseases should be strengthened.

Objective:To study the whole genome and genetic evolution characteristics of the Banna virus carried by Culicoides in Cangyuan County. Methods:Culicoides were collected in Cangyuan county in 2018. After grinding, the supernatant was inoculated onto BHK-21 cells for virus isolation. At the same time, the virus carrying status of Culicoides was detected by metatranscriptomics technology. Perl, Mafft and other bioinformatics softwares were used for sequence alignment, homology and molecular genetic evolution analysis. Results:Through metatranscriptomics method, the whole genome of Banna virus CYC1801 strain was obtained. Analysis of the whole genome showed that segment 4 and segment 7 are closely related to the Vietnamese strains, other segments are closely related to China strains. According to the phylogenetic analysis of the segment 12 gene, CYC1801 and the A2 gene subtype are in the same evolutionary branch and belong to the A2 gene subtype of Banna virus.Conclusions:Banna virus was carried by Culicoides collected in Cangyuan county, which may cause disease epidemic as a vector, so monitoring and prevention should be strengthened.

Objective:To examine factors that may have impact on the Mini-Mental State Examination ( MMSE) screening validity, which could lead to further establishing the general model of the MMSE score in Chinese health elderly and to improve the screening accuracy of the existing MMSE reference. Methods:Based on the data of the Chinese Longitudinal Healthy Longevity Survey ( CLHLS ) , the MMSE scores of 19 117 normal elderly and 137 dementia patients who met the inclusion criteria were used for the analysis. The area under the curve ( AUC) and validity indexes were used to compare the screening accuracy of various criteria. Multiple linear regression was used to identify factors that had impact on the MMSE score for both the normal and dementia elderly. Descriptive analysis was performed for differences in the MMSE scores by age trends and gender between the normal and dementia elderly. Results:The AUC of MMSE was≥0 . 75 ( P<0 . 05 ) . The MMSE score of the normal elderly declined nonlinearly as the age grew older(male:R2 =0. 924, P<0. 05; female: R2 =0. 951, P<0. 05), and increased nonlinearly as the education level rose(male: R2 =0. 948, P <0. 05; female: R2 =0. 859, P<0. 05). The females had significantly lower MMSE scores than the males, with a faster decline trend with age than the males (95%CI of female partial regression coefficient was not overlapped with 95%CI of male partial regression coefficient) . The dementia elderly showed a much lower MMSE score ( male:difference of Z score:-1 . 573 , P<0 . 05;female:difference of Z score:-1 . 222 , P<0 . 05 ) and ten-ded to with a faster decline speed than that of the normal elderly (95%CI of dementia partial regression coefficient included 95%CI of normal partial regression coefficient) . Conclusion:The screening validity of MMSE in CLHLS is not affected by educational level. The analysis of factors that may impact on the MMSE screening validity are gender, age, vision and residence which with validity identification. These four fac-tors can be used as assist tool of MMSE in the screening of dementia to improve the screening accuracy.

Objective: To explore the depression stares of the elderly experienced the Wenchuan earthquake and to know the related factors. Methods: Using the convenient sampling method, 390 elderly living in Chengdu and Deyang City were included in this investigation. Demographic data was recorded and the Center for Epidemiolog-ic Studies Depression (CES-D) was applied individually. Results: In this sample, 9.8% of the elderly had sus-pected depression symptom and 30.3% had depression symptom. Depression status was related to sex, education,habitual residence, occupation and experiences in earthquake. Compared with the elderly who were males, with middle school education degree, without horrible experiences in the past, with less fearful/helpless/horrible feel-ings in earthquake, the elderly who were females (OR=2.03), with education degree below primary school (OR =2.59), with horrible experiences in the past (OR=2.06), and with strong fearful/helpless/horrible feeling in earthquake (OR=1.59), had more serious depression. Conclusion: After 8 months of Wenchuan earthquake, lo-cal elderly victims are still in severe depression. The elderly who are female, with low education level, engaged in farm work, suffered great loss should be paid special attention.

BACKGROUND: 3,4-Methylenedioxymethamphetamine (MDMA) is one kind of amphetamine-type stimulants (ATS) with stimulating and hallucinogenic properties, and its damage to human is extremely serious and complicated. It has become a research hot in the field of addiction behavior abroad. OBJECTIVE: To observe the effect of long-term neurotoxicity of MDMA on cognitive function. DESIGN: A randomized control animal experiment. SETTING: Laboratory of Psychopharmacology, Mental Health Center, West China Hospital of Sichuan University. MATERIALS: The experiment was carried out in the Laboratory of Psychopharmacology of the Mental Health Center, West China Hospital of Sichuan University from July 2003 to February 2004. Sixteen male adult Wistar rats, provided by the animal center of Sichuan university, were randomly assigned to study group (n=10) and control group (n= 6). INTERVENTIONS: Rats in study group were administrated with MDMA (10 mg/kg), once per hour for four times, and the total amount was 40 mg/kg, and those in the control group were treated with saline of the same volume. The Morris water-maze test was performed at 2, 8, 26 and 32 weeks after the last administration respectively to observe the spatial learning and memory function. MAIN OUTCOME MEASURES: The escape latencies and the times of crossing the exact position of the former platform were observed at 2, 8, 26 and 32 weeks after the last administration respectively. RESULTS: Four rats in the study group died within 12 hours during the experiment, 1 in the study group and 1 in the control group died at 6 and 17 weeks respectively, finally 5 rats in the study group and control group left till 32 weeks respectively. At 2, 8, 26 and 32 weeks after the last administration, there were no .significant differences in the escape latencies between the two group (P ＞ 0.05), and the times of crossing the exact position of the former platform also had no significant differences [(7.67±2.16), (7.50±2.95) times; (6.60±1.14), (7.0±1.67) times;(7.40±1.52), (6.60±2.61) times; (6.80±4.55), (5.80±1.79) times; P ＞ 0.05]. CONCLUSION: The long-term neurotoxicity of MDMA has no obvious effect on the spatial learning and memory function.