Objective To explore specific magnetic resonance imaging(MRI)features of somatic symptoms in depression by comparing the differences of brain gray matter volume in depression patients with and without somatic symptoms using voxel-based morphometry(VBM).Methods A total of 52 depression patients were recruited and divided into somatic and no somatic symptoms group according to the patient health questionnaire-15 score(＞9 and≤9,respectively).Forty gender-age-matched healthy volunteers were recruited as the control group.All subjects underwent MRI scanning.Imaging data were analyzed to explore the differences in brain gray matter between groups using VBM.Results Compared with control group,gray matter volume increased in the right superior temporal gyrus,and decreased in the right inferior orbitofrontal gyrus,right inferior temporal gyrus,left inferior orbitofrontal gyrus,and left superior temporal gyrus for depressive patients with somatic symptoms(P＜0.001);gray matter volume increased in the right middle temporal gyrus,and decreased in the right superior temporal gyrus and right inferior temporal gyrus for depressive patients without somatic symptoms(P＜0.001).Only the volume in the right tongue and left cingulate gyrus increased in depressive patients with somatic symptoms compared with that in patients without somatic symptoms(P＜0.01).Conclusion VBM-MRI has demonstrated increased volume in the tongue and cingulate gyrus in the somatic symptoms of depression.

Objective:To compare the clinical efficacy of axillary transthoracic approach and posterior approach in the treatment of upper thoracic tuberculosis with vertebral clearance, bone graft fusion, and internal fixation surgery.Methods:Fifty five patients with upper thoracic tuberculosis admitted to Changsha Central Hospital, University of South China from March 2017 to March 2022 were selected and divided into axillary transthoracic group and posterior group according to different surgical approaches. The incision length, surgical time, intraoperative blood loss, and postoperative hospitalization time were compared between the two groups of patients. Two groups of patients were recorded for preoperative and postoperative pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores at 1 week, 3 months, and 12 months, preoperative and postoperative serum inflammatory indicators, CD4 + /CD8 + ratio of T lymphocyte subsets, and complications. Results:The incision length, operation time, and intraoperative blood loss in the axillary transthoracic group were significantly less than those in the posterior group, and the differences were statistically significant (all P<0.05). However, there was no statistically significant difference in postoperative hospitalization time between the two groups of patients ( P>0.05). The VAS and ODI scores of the two groups of patients showed significant improvement compared to preoperative levels at 1 week, 3 months, and 12 months after surgery (all P<0.05); And at 1 week and 3 months after surgery, the VAS scores of patients in the axillary transthoracic group were significantly lower than those in the posterior group (all P<0.05), and the ODI scores at 3 and 12 months after surgery were significantly lower than those in the posterior group (all P<0.05). The erythrocyte sedimentation rate and CRP levels of both groups of patients increased significantly one week after surgery compared with preoperative levels (all P<0.05), but the erythrocyte sedimentation rate and CRP levels basically returned to normal levels at three months after surgery. The CD4 + /CD8 + ratio of T lymphocyte subsets in both groups was lower than preoperative levels at one week after surgery, but with the continuation of treatment, the CD4 + /CD8 + ratio increased significantly at three months after surgery. Conclusions:Both axillary and posterior approaches can be used for surgical treatment of upper thoracic tuberculosis, but axillary and thoracic approaches have the advantages of less trauma, less bleeding, and faster recovery.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective: To investigate the correlation of carriage and expression of quorum sensing(QS) system regulatory genes and virulence genes with drug resistance inPseudomonas aeruginosastrains isolated from clinical sources. Methods: A total of 97 strains ofPseudomonas aeruginosaisolated from various clinical specimens in the laboratory were collected. Firstly, Drug-resistance were detected by the vitek2-compact instrument method and the standard disc diffusion method, 4 QS system-regulated genes and 7 virulence genes were detected by polymerase chain reaction(PCR). After that, the expression of regulatory genes LasI, Rh1 R and virulence genes exoS and PCN were detected by real-time fluorescence quantitative PCR(qRT-PCR), and moreover linearly analysis was used to analyze the correlation of the two types of genes. Results: The resistance rates of 97 strains to 11 antibacterial drugs. The resistance rate of tobramycin, gentamicin, and amikacin was less than 10%, and the minimum amikacin was 2.06%. The resistance rate to the remaining drugs was all above 11%, and the highest was imipenem 25.77%, and 43 strains were multi-drug resistant bacteria, and the respiratory-derived strains were more resistant to antimicrobials. The results of PCR gene detection showed: the detection rates of the four QS system-regulated genes LasI, LasR, Rh1 I and Rh1 R were all 100%; the highest detection rate of 7 virulence genes was exoT 98.97%(96/97),and the lowest was exoU 13.40%(13/97),PCN 43.30%(42/97),and the rest were above 86%. The strains without virulence genes were resistant to 6 antibiotics including ceftazidime, and the strains with 7 virulence genes were only resistant to ceftazidime; among the PCN, exoS, and exoU positive strains, the proportion of non-multidrug resistantPseudomonas aeruginosa(NMDR-PA)was higher; PCN+ strains were more resistant to piperacillin/tazobactam and the difference was statistically significant; compared with exoS+/exoU-strains, the types of antibiotics resistant to exoS-/exoU+ strains decreased significantly. The relative expression levels of regulatory genes rh1 R and LasI in NMDR-PAwere higher and the difference of LasI was statistically significant; the expression of the regulatory gene rh1 R and the virulence gene exoS and the regulatory gene LasI and the virulence gene PCN showed a positive linear relationship. Conclusion The drug-resistance ofPseudomonas aeruginosais still serious and multi-drug resistance. QS system regulatory genes exist in the strain stably, except for exoU and PCN, the other virulence genes exoS, exoT, exoY, ToxA and LasB have higher carrying rates, the regulatory genes rh1 R and LasI positively regulate the expression of virulence genes, both QS system regulatory genes and virulence genes affect drug resistance inPseudomonas aeruginosa.

Objective: To evaluate the differences of serum total light chain(sTLC), urine total light chain(uTLC) and serum free light chain(sFLC) in different stages of chronic kidney disease(CKD) and their correlation with renal function indexes. To investigate the predictive value of light chain indexes in CKD staging. Methods: 292 patients with CKD were analyzed retrospectively, and plasma cell diseases, acute kidney injury and tumor diseases were excluded. According to the estimated glomerular filtration rate(eGFR), CKD patients were divided into five groups from CKD 1 stage to CKD 5 stage. The levels of sTLC, uTLC, sFLC and corresponding biochemical indexes of CKD patients were detected, and the differences and correlations among the indexes of each group were compared. The receiver operating curve(ROC curve) was used to analyze the predictive value of each light chain index in CKD stage, with CKD1-2 stage combined as control group and CKD3-5 stage combined as case group. Results: There was no significant difference in sTLC κ, sTLC λ, sTLC κ/λ and sFLC κ/λ among CKD1-5 stage(P>0.05). There were significant differences between sFLC κ, sFLC λ and uTLC κ, uTLC λ among CKD1-5 stage(P<0.05), which increased with the increase of CKD staging. The correlation between sFLC κ, sFLC λ and serum creatinine(Scr), blood urea nitrogen(BUN), eGFR were better than uTLC κ, uTLC λ(P<0.001). The sTLC κ, sTLC λ, sTLC κ/λ and sFLC κ/λ had no correlation with renal function indexes(P>0.05). The best critical points of sFLC κ and sFLC λ for predicting CKD3-5 stage were 35.4 mg/L and 52.8 mg/L, and AUC was 0.916(0.883-0.949) and 0.915(0.881-0.949), which were higher than uTLC κ and uTLC λ,AUC was 0.811(0.754-0.869) and 0.787(0.728-0.846), respectively. Conclusion With the increase of CKD staging, the levels of sFLC and uTLC gradually increase. The sFLC and uTLC can effectively predict patients with CKD3 and above, which has an important reference value in stratified management of patients with CKD.

Objective:To investigate the attention deficit/hyperactivity disorder(ADHD) like behavior of offspring mice induced by stress during pregnancy and its mechanism.Methods:Chronic unpredictable stress was applied to ICR pregnant mice in different gestational periods. The offspring mice were randomly selected and the behavior changes of each group were observed in open field experiment (CG: control group; SG1: cums stress stimulation from 8 to 14 days of gestation; SG2: cums stress stimulation from 15 days of gestation to childbirth). The plasma concentrations of GABA, its metabolic enzymes and dopamine were detected by ELISA.Results:The results of open field experiment showed that the total distance, the time of stay in central area, the speed in central area, and the speed in surrounding area in SG1 group, SG2 group and CG group were statistically significant ( F=8.30, 5.01, 8.05, 7.15, all P<0.05). The total distances of SG1 group and SG2 group were significantly longer than that of CG group ((5 221.07±469.95)mm, (4 825.63±545.49)mm, (3 781.17±111.34)mm, both P<0.05).The times of stay in central area of SG1 and SG2 groups were shorter than that in CG group ((5.95±3.32)s, (8.59±3.42)s, (11.10±3.61)s, all P<0.05). The speeds in central area of SG1 and SG2 groups were faster than that of CG group ((30.93±5.79)mm/s, (32.48±9.06)mm/s, (20.57±5.07)mm/s, all P<0.05).The speed in surrounding area in SG1 group was faster than that in CG group ((16.91±1.64)mm/s), (12.42±3.77)mm/s, P<0.05). ELISA results showed that there were significant differences in mice plasma GABA, GAD65, GAD67 and DA among CG group, SG1 group and SG2 group ( F=16.52, 6.42, 11.04, 7.26, all P<0.05).The plasma concentrations of GABA in SG1 group and SG2 group were lower than that in CG group ((3.70±0.80)μmol/L, (4.40±0.80)μmol/L, (6.06±1.01)μmol/L, all P<0.05).The plasma concentrations of GAD65 ((5.36±0.75)μg/L, (6.99±1.01)μg/L, P<0.05)and GAD67((10.52±1.09)μg/L, (9.84±1.35)μg/L, (12.83±1.67)μg/L, P<0.05)in SG1 group were lower than those in CG group. The plasma DA concentration in SG1 group ((82.81±8.59)ng/L) was higher than that in CG group ((69.43±9.42)ng/L, P<0.05) and SG2 group ((66.36±10.77)ng/L, P<0.05). Conclusion:Prenatal stress can induce ADHD-like behavioural phenotypes in offspring mice, which may be related to the influence of plasma GABA metabolism and DA concentration.

Objective:To explore the correlation between serum C1q, thyroid hormone (serum FT 3, FT 4, TSH) and depression by detecting the difference of serum C1q, thyroid hormone (serum FT 3, FT 4, TSH) between depression patients and normal people. Methods:A total of 275 depressive patients(depression group) and 275 healthy controls(healthy group) were recruited.The serum levels of C1q, FT 3, FT 4 and TSH were compared between the two groups.The serum levels of C1q, FT 3, FT 4 and TSH in depression patients with different age, gender, course of disease and HAMD were compared.Further regression analysis was used to evaluate the effects of serum C1q, FT 3, FT 4 and TSH levels on the incidence and severity of depression in patients with depression. Results:Serum C1q, FT 3, TSH of depression group(C1q: 203(165, 239)mg/L, FT 3: (4.39±0.70)pmol/L, TSH: 1.69(1.17, 2.46)mIU/L) were significantly lower than those of healthy group(C1q: (236.25±27.06)mg/L, FT 3: 4.61(4.29, 4.95)pmol/L, TSH: 2.04(1.42, 3.01)mIU/L)(all P<0.01). Compared with the serum indexes in depression group, the level of C1q and TSH in men(C1q : 188.00 (164.00, 221.00) mg/L, TSH: 1.52(1.13, 2.16)mIU/L) were significantly lower than those in women(C1q : 213.00 (168.25, 247.75) mg/L, TSH: 1.85(1.28, 2.57)mIU/L)( P<0.05), and the level of FT 3 and FT 4 in men(FT 3: 4.64 (4.23, 5.06) pmol/ L, FT 4: 16.76(15.05, 18.20)pmol/L) were significantly higher than those in women (FT 3: 4.34 (3.82, 4.72) pmol/L, FT 4: 15.92(14.35, 17.40)pmol/L). Serum C1q ( B=-0.020, P<0.01, OR95% CI: 0.980 (0.975, 0.985)), FT 3 ( B=-0.576, P<0.01, OR95% CI: 0.562 (0.408, 0.775)), TSH ( B=-0.274, P<0.01, OR95% CI: 0.761 (0.648, 0.893)) level were the influencing factors of depression. Conclusion:Serum C1q and thyroid hormone may be involved in the pathogenesis of depression, and may be affected by gender factors.

Objective: To investigate the relationship between hope, mental suffering and quality of life in radiotherapy patients with cervical cancer, to provide the basis for the cancer patient′s psychological intervention. Methods: A cross-sectional study of 120 cases of radiotherapy cervical cancer patients was conducted, using the psychological distress thermometer, Herth Hope Scale, Life Quality Measurement Scale for patients with cervical cancer to evaluate patients′ hope, quality of life and psychological distress. Results: Radiotherapy cervical cancer patients′ psychological distress and hope were negatively correlated (r=-0.385, P <0.01), psychological distress and quality of life were negatively correlated (r=-0.602, P <0.01), hope and quality of life were positive correlation (r=0.711, P <0.01). Patients′ hope played partially mediated effect between psychological distress and quality of life, emotional status, functional status, played fully mediated effect between psychological distress and social family status. The Mediated effect sizes were 35.9%, 36.3%, 55.9% and 100.0%. Conclusions Psychological distress has not only a direct negative effect on the quality of life of cancer patients, but also an indirect negative effect through hope. During the Medical care, we should accurately assess of patient's psychological distress and hope, and take measures to help improve patients' hope and alleviate psychological distress, so as to improve patients′ quality of life.

Objectives To investigate the incidence of depression status and the related factors in patients with maintenance hemodialysis (MHD).Methods One hundred and forty three MHD patients were enrolled in the study.According to Hospital Anxiety and Depression Scale (HADS-D) score,50 patients (35.0％) were classified in depression group and 93 were in non-depression group.The basic clinical information,demographic characteristics and laboratory parameters were collected.Univariate analysis,Pearson correlation and hierarchical regression analysis were used to assess the related factors of depression status.Results The average HADS-D score in 143 MHD patients was 6.22 ± 2.35,and that in depression group and in non-depression group was 9.76 ± 3.85 and 3.64 ± 2.91,respectively.The prevalence of the symptoms in MHD patients varied from 15.9％ to 98.4％,and the score of symptom burden was 12-136 (72.54 ± 34.86).Univariate analysis revealed that marital status (x2 =4.493,P =0.034),economic status (x2 =4.187,P =0.04),symptom burden(r =0.68,P ＜ 0.001),symptom severity (r =0.59,P ＜ 0.001) and social support (r =-0.38,P =0.002) were associated with the depression.Hierarchical regression analysis revealed that depression was associated significantly with symptom burden(β =0.546,P ＜ 0.001),symptom severity (β =0.428,P ＜ 0.001) and social support (β =0.205,P =0.032).Symptom burden and severity could explain 30.5％ of the depression variance.Conclusions The prevalence of depression status is high in MHD patients,which is positively correlated with symptom burden.Among all influencing factors,symptom burden has the greatest impact on the depression status,and maybe an important predicting factor of depression.

Objective To explore the effect of integrated psycho-behavioral intervention for improvement of preschool children with attention deficit hyperactivity disorder.Methods A total of 58 preschool children in the Departments of Pediatrics and Clinical Psychology in our hospital were selected and divided into intervention group and observation group according to the order of visits.The intervention group was given Alpha-Stim SCS,sandplay therapy,biofeedback and sensory integration training,the observation group was treated by routine treatment.Results After treatment,the intervention group had a significant decrease in hyperactivity/impulsivity and hyperkinetic index (P ＜ 0.01),and scores of conduct disorders,learning problems,psychosomatic problems,and anxiety decreased significantly (P ＜ 0.05).After two months of treatment,the ratios of α-wave,θ-wave,and ratio of θ wave to β wave in the intervention group were significandy lower than the intervention before (P ＜0.01),and the β-wave and SMR rhythm were significantly higher than those the intervention before (P ＜0.01).After 6 months of treatment,scores of proprioception and vestibular sensation in the intervention group were significantly higher than treatment before (P ＜ 0.01),and scoresof the tactile defense and learning ability were significantly higher than treatment before (P ＜ 0.05).Conclusion Integrating psychological behavioral intervention can strengthen the integration of sensory,cognitive,and behavioral skills among preschool children with attention deficit hyperactivity disorder.It can not only improve the continuity and coordination of children from information acquisition,processing,and output,but also improve the stability of the nervous system,enhance physical coordination,improve self-control of behavior,and significantly improve the hyperactivity behavior of attention deficit hyperactivity children.