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 investigate the association of peripheral blood inflammatory markers and lymphocyte subsets with different severities of acute ischemic stroke(AIS).Methods:A total of 128 AIS patients who were admitted to Department of Neurology,The First Affiliated Hospital of Chongqing Medical University,from January to December 2022 were enrolled as subjects,and according to the National Institutes of Health Stroke Scale(NIHSS)score,the patients were divided into mild AIS group(67 patients with an NIHSS score of<4)and moderate-to-severe AIS group(61 patients with an NIHSS score of≥4).The two groups were compared in terms of baseline clinical data,blood biochemical parameters,and peripheral[MLR],neutrophil-to-lymphocyte ratio[NLR],and platelet-to-lymphocyte ratio[PLR]).Flow cytometry was used to measure the number and percentage of lymphocyte subsets.Results:Compared with the mild AIS group,the moderate-to-severe AIS group had a significantly higher proportion of patients with hyperlipidemia blood inflammatory markers(C-reactive protein[CRP],systemic immune-inflammation index[SII],monocyte-to-lymphocyte ratio(47.761%vs.67.213%,P=0.032),with relatively high values of low-density lipoprotein(LDL)/high-density lipoprotein(HDL)ratio(P=0.025)and total cholesterol(TCHO)/HDL ratio(P=0.020),as well as significantly higher levels of the peripheral blood inflamma-tory markers CRP(P<0.001),platelet count(P=0.001),MLR(P<0.001),and NLR(P<0.001),significantly higher numbers of periph-eral blood CD3 T cells(P=0.006),CD4 T cells(P=0.009),CD8 T cells(P=0.032),and CD3-/CD16+/CD56+NK cells(P=0.002),and a significantly higher proportion of T helper cells(P=0.041).The binary logistic regression analysis showed that platelet count(odds ratio[OR]=1.035,P=0.004),CRP(OR=2.016,P<0.001),NLR(OR=2.585,P=0.030),the proportion of total lymphocytes(OR=1.169,P<0.001),and the number of lymphocytes(OR=1.008,P<0.001)were significantly associated with moderate-to-severe AIS.The receiver operating characteristic(ROC)curve analysis showed that NLR,CRP,and the proportion of total lymphocytes had an area under the ROC curve of 0.760,0.812,and 0.777,respectively.Conclusion:Patients with moderate-to-severe AIS tend to have high levels of the peripheral blood inflammatory markers NLR and CRP,a high lymphocyte count,and a high proportion of lymphocytes.NLR,CRP,and the proportion of lymphocytes are independent risk factors for the development of moderate-to-severe AIS.

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.

By reviewing the necessity, current status of cognitive attitudes, influencing factors, and improvement strategies of inpatients’ living wills, this paper proposed to strengthen the publicity and promotion of living wills to advance the development of death with dignity, improve relevant influencing factors, and provide feasible solutions for living wills, and actively develop tools to assess the cognition and attitude of living wills, with a view to providing reference for further promoting the application of living wills in inpatients and improving related research.

In recent years, cancer had become one of the main causes of death in children and adolescents, which had great adverse effects on their physiology and psychology, leading to serious physiological and psychological problems. Adventure based counseling had the effect of improving physical and mental health and quality of life, and had been widely used in the nursing of children with cancer. This paper reviewed the concept, intervention methods, applicable population and its application in the nursing of children and adolescents with cancer, in order to provide reference for the further research and application of adventure based counseling in children and adolescents with cancer in China.

Objective:To investigate the physiological role of F1Fo-ATP synthase α-subunit encoding gene (ATP1) in promoting Candida albicans ( C. albicans) to escape from macrophage killing through eliminating intracellular reactive oxygen species (ROS) by using a reverse genetics approach. Methods:An ATP1 deletion strain and a parental strain of C. albicans were cultured on the YPD media, and the number of formed colonies on the plates was counted to evaluate in vitro viability of C. albicans. To evaluate their in vivo viability, the ATP1 deletion strain and parental strain of C. albicans were inoculated into mice through the caudal vein, kidney tissues were taken out from the mice 1-7 days after the infection, and inoculated onto the YPD medium followed by numeration of colonies after 48 hours of culture. After co-culture of overnight-cultured C. albicans suspensions with macrophages, some of the C. albicans suspensions were inoculated onto the YPD solid medium followed by numeration of colonies and determination of survival rate, and some culture supernatants were inoculated into the 96-well plate for detection of the level of lactate dehydrogenase (LDH) released by macrophages by LDH release assay. A model mimicking oxidative stress in macrophages was established by using hydrogen peroxide. After treatment with hydrogen peroxide, the number of colonies was counted to compare the viability of the C. albicans strains. DCFH-DA staining was conducted to detect the intracellular ROS level in C. albicans after co-culture with macrophages or treatment with hydrogen peroxide, and real-time fluorescence-based quantitative PCR to measure mRNA expression of catalase 1 (CAT1) , superoxide dismutase 4 (SOD4) and SOD5 genes in C. albicans after treatment with hydrogen peroxide. Statistical analysis was carried out by using two-way analysis of variance or Student t test. Results:In vitro, the colony number in both the parental strain group and ATP1 deletion strain group gradually increased over time; after 24 hours, the colony number of the ATP1 deletion strain group was only 10% of that in the parental strain group ( F = 481.84, P < 0.001) . The number of colony formed by the parental strain-infected mouse kidney tissues gradually increased over time, but that by the ATP1 deletion strain-infected mouse kidney tissues gradually decreased, and there was a significant difference between the two groups ( F = 78.27, P = 0.001) . After in vitro co-culture of C. albicans with macrophages, the survival rate in the ATP1 deletion strain group (62.67% ± 3.51%) was significantly lower than that in the parental strain group (82.33% ± 2.52%, t = 7.88, P = 0.001) , and the percentage of LDH released by macrophages was also significantly lower in the ATP1 deletion strain group (27.80% ± 3.54%) than in the parental strain group (87.78% ± 0.17%, t = 33.89, P < 0.001) , which were consistent with the in vivo results. In the model mimicking oxidative stress, the viability of the ATP1 deletion strain group was significantly lower than that of the parental strain group ( F = 3 440.65, P < 0.001) . Both in the co-culture model with macrophages and in the model mimicking oxidative stress in macrophages, the intracellular ROS levels were significantly higher in the ATP1 deletion strain group than in the parental strain group (both P < 0.001) . Furthermore, the mRNA expression of CAT1, SOD4 and SOD5 genes was significantly lower in the ATP1 deletion strain group than in the parental strain group after treatment with hydrogen peroxide (all P < 0.001) . Conclusion:ATP1 deletion may reduce the capabilities of C. albicans to counteract oxidative stress and eliminate ROS, likely by down-regulating the expression of oxidative stress- and ROS clearance-related genes respectively, which may prevent C. albicans from escaping from the macrophage killing and lead it to be eliminated by the host ultimately.

An 86-year-old male patient received IV infusions of meropenem (1 g once per 12 hours) combined with ciprofloxacin lactate and sodium chloride injection (200 mg once daily) for pneumonia, respiratory failure, and multidrug resistant Pseudomonas aeruginosa infection suggested by sputum bacterial culture. On the 4th day of treatments, the patient developed a sudden drop in blood pressure, and his pulse could not be measured. ECG monitoring suggested ventricular fibrillation. After the treatments of electric defibrillation and amiodarone injection, his sinus rhythm restored. The next day the patient had another three episodes of ventricular fibrillation. All electrolytes were normal during emergency examination and ECG examination showed that the QT interval was normal. Ciprofloxacin was discontinued and replaced by meropenem combined with fosfomycin, and ventricular fibrillation did not recur. Twenty-six days later, the patient′s pneumonia was aggravated and sputum bacterial culture result showed multidrug resistant Pseudomonas aeruginosa infection, which was sensitive to ciprofloxacin and moderately sensitive to levofloxacin. Then meropenem (the same dosage and usage as before) combined with levofloxacin injection (200 mg once daily) were given. On the fifth day of treatments, the patient developed ventricular fibrillation again and his heart rhythm returned to normal after electric defibrillation and amiodarone treatment. Levofloxacin was discontinued and meropenem combined with fosfomycin were given again. Then ventricular fibrillation did not recur. The patient′s ventricular fibrillation was considered to be possibly related to ciprofloxacin and levofloxacin.

An 86-year-old male patient received IV infusions of meropenem (1 g once per 12 hours) combined with ciprofloxacin lactate and sodium chloride injection (200 mg once daily) for pneumonia, respiratory failure, and multidrug resistant Pseudomonas aeruginosa infection suggested by sputum bacterial culture. On the 4th day of treatments, the patient developed a sudden drop in blood pressure, and his pulse could not be measured. ECG monitoring suggested ventricular fibrillation. After the treatments of electric defibrillation and amiodarone injection, his sinus rhythm restored. The next day the patient had another three episodes of ventricular fibrillation. All electrolytes were normal during emergency examination and ECG examination showed that the QT interval was normal. Ciprofloxacin was discontinued and replaced by meropenem combined with fosfomycin, and ventricular fibrillation did not recur. Twenty-six days later, the patient′s pneumonia was aggravated and sputum bacterial culture result showed multidrug resistant Pseudomonas aeruginosa infection, which was sensitive to ciprofloxacin and moderately sensitive to levofloxacin. Then meropenem (the same dosage and usage as before) combined with levofloxacin injection (200 mg once daily) were given. On the fifth day of treatments, the patient developed ventricular fibrillation again and his heart rhythm returned to normal after electric defibrillation and amiodarone treatment. Levofloxacin was discontinued and meropenem combined with fosfomycin were given again. Then ventricular fibrillation did not recur. The patient′s ventricular fibrillation was considered to be possibly related to ciprofloxacin and levofloxacin.

Mood disorders and substance use disorders often co-occur,but few evidence-based data have been conducted to guide the management of comorbidity bipolar disorder with alcohol use disorder. Therefore,it's lack of clinical researches and expert consensus. This review inducted the research progress of the comorbidities of bipolar disorder and alcohol use disorder in recent years,and finds that drug treatment or combined treatment with other treatment methods has certain curative effect suggesting that the comprehen-sive treatment of drug or combined non-drug treatment for comorbidities is the future direction.

Mood disorders and substance use disorders often co-occur, but few evidence-based data have been conducted to guide the management of comorbidity bipolar disorder with alcohol use disorder.Therefore, it's lack of clinical researches and expert consensus.This review inducted the research progress of the comorbidities of bipolar disorder and alcohol use disorder in recent years, and finds that drug treatment or combined treatment with other treatment methods has certain curative effect suggesting that the comprehensive treatment of drug or combined non-drug treatment for comorbidities is the future direction.