Psychosocial crisis intervention for coronavirus disease 2019 patients and healthcare workers / 中南大学学报(医学版)

OBJECTIVES@#Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model.@*METHODS@#The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention.@*RESULTS@#The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful.@*CONCLUSIONS@#Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.

High efficiency of left superior frontal gyrus and the symptom features of major depressive disorder / 中南大学学报(医学版)

OBJECTIVES@#Major depressive disorder (MDD) patients with anhedonia tend to have a poor prognosis. The underlying imaging basis for anhedonia in MDD remains largely unknown. The relationship between nodal properties and anhedonia in MDD patients need to be further investigated. Herein, this study aims to explore differences of cerebral functional node characteristics in MDD patients with severe anhedonia (MDD-SA) and MDD patients with mild anhedonia (MDD-MA) before and after the antidepressant treatment.@*METHODS@#Ninety participants with current MDD were recruited in this study. 24-Item Hamilton Depression Scale (HAMD-24) and Snaith-Hamilton Pleasure Scale (SHAPS) were used to assess the severity of depression and anhedonia at baseline and the end of 6-months treatment. The MDD patients who scored above the 25th percentile on the SHAPS were assigned to an MDD-SA group (n=19), while those who scored below the 25th percentile were assigned to an MDD-MA group (n=18). All patients in the 2 groups received antidepressant treatment. Functional magnetic resonance imaging (fMRI) images of all the patients were collected at baseline and the end of 6-months treatment. Graph theory was applied to analyze the patients' cerebral functional nodal characteristics, which were measured by efficiency (ei) and degree (ki).@*RESULTS@#Repeated measures 2-factor ANCOVA showed significant main effects on group on the ei and ki values of left superior frontal gyrus (LSFG) (P=0.003 and P=0.008, respectively), and on the ei and ki values of left medial orbital-frontal gyrus (LMOFG) (P=0.004 and P=0.008, respectively). Compared with the MDD-MA group, the significantly higher ei and ki values of the LSFG (P=0.015 and P=0.021, respectively), and the significantly higher ei and ki values of the LMOFG (P=0.015 and P=0.037, respectively) were observed in the MDD-SA group at baseline. Meanwhile, higher SHAPS scores could result in higher ei and ki values of LSFG (P=0.019 and P=0.026, respectively), and higher ei value of LMOFG (P=0.040) at baseline; higher SHAPS scores could result in higher ei values of LSFG (P=0.049) at the end of 6-months treatment. The multiple linear regression analysis revealed that sex were negatively correlated with the ei and ki values of LSFG (r= -0.014, P=0.004; r=-1.153, P=0.001, respectively). The onset age of MDD was negatively correlated with the ki value of LSFG (r=-0.420, P=0.034) at the end of 6-months treatment. We also found that SHAPS scores at baseline were positively correlated with the HAMD-24 scores (r=0.387, P=0.022) at the end of 6-months treatment.@*CONCLUSIONS@#There are obvious differences in nodal properties between the MDD-SA and the MDD-MA patients, such as the high ei of LSFG in the MDD-SA patients, which may be associated with the severity of anhedonia. These nodal properties could be potential biomarkers for the prognosis of MDD. The increased ei and ki values in the LSFG of MDD-SA patients may underlie a compensatory mechanism or protective mechanism. The mechanism may be an important component of the pathological mechanism of MDD-SA. The poor prognosis in the MDD-SA patients suggests that anhedonia may predict a worse prognosis in MDD patients. Sex and onset age of MDD may affect the nodal properties of LSFG at baseline and the end of 6-months treatment.

Somatic symptom disorder in the context of Chinese yin-yang culture:A case report and literature review / 中南大学学报(医学版)

Somatic symptom disorder (SSD) is a somatic disorder characterized by excessive anxiety over various somatic symptoms for a long time, which makes patients feel very painful and the quality of personal life significantly decreased. Previous studies have shown that there is a connection between the clinical manifestations of SSD patients and their cultural background. The patient in this case report was highly affected by Chinese yin-yang culture, displaying obvious Chinese characteristics. We report a patient with SSD, whose clinical manifestations were mainly sexual dysfunction and mood symptoms which were closely related to the Traditional Chinese culture of Yin and Yang. In this case, Hamilton Anxiety Scale, Hamilton Depression Scale, and International Erectile Function Questionnaire were used to evaluate the patients ' anxiety, depression, and sexual function, and the scores were 32, 33, and 9, respectively. The patient was treated with a combination of venlafaxine and mirtazapine. After 5 weeks of treatment, the patient's clinical symptoms improved significantly. The clinical manifestations of some Chinese SSD patients have obvious characteristic relevance to Chinese theory of Yin and Yang, making SSD easily to be misdiagnosed. Therefore, clinicians should pay atlention to this situation. In addition, the combination of venlafaxine and mirtazapine may have a better effect on SSD patients with chronic pain and sexual dysfunction.

Pathological mechanisms of chronic insomnia: Evidence from neuro-electrophysiology and neuroimaging research / 中南大学学报(医学版)

As a widely recognized public health problem as well as prevalent and challenging to modern society, chronic insomnia is involved in wide brain areas (such as prefrontal cortex, anterior cingulate cortex, amygdala, hippocampus, and thalamus) and emotion-cognition neuro-circuit. It is closely related to the conditioned hyperarousal and the increased information process and/or the impaired inhibitory ability to withdraw from awaking state. Thus, some specific abnormal mode may exist in the emotion-cognition circuit, which is associated with abnormal cognition load, such as repeated retrieval/intrusion of aversive memories during night. Studies through the combination of multiple techniques including psychology, electrophysiology and neuroimaging methods are needed to further enhance the understanding of chronic insomnia.

Value of ultrasonic probe in the diagnosis of submucosal tumor of colorectum / 中华消化内镜杂志

Objective To assess the value of ultrasonic probe (USP) in the diagnosis of Submucous eminence of colorectume.Methods Sixty-eight patients with colorectal submucous eminence in 70 areas received USP under colonoscope.The accuracy of diagnosis was evaluated.Results Twenty carcinoid tumor were detected which manifested submucous hypoechoic ; Lipoma 12,located in right half colon which manifested submucous layer,clear boundaries hyperechoic; Cyst 12 manifested single or multi lattices no-echo on submucous which have integrated involucrum.Mesenchymoma or myoma levicellulare 12,most of them located inthe rectum manifested uniform or no-uniform hypoechoic on the muscularis mucosa or below and were difficult to discriminate.Malignant lymphoma,3 manifested muscularis mucosa and submucosa thickening,muscularis propria were seldom affected.Vascular diseases (hemangioma,varicosity) 3,manifested no-echoic on mucosa or submucosa,some medium,high echoic,circular or irregular,and also endometriosis 2,pigment deposition 1,appendix abscess 1,extramural compression 2,ultrasonic test is marched with clinic diagnosis.Accuracy rate is 100％.Conclusion USP can diagnose colorectal submucous eminence with high accuracy,and even provide information about the size,layer of origin,border of the colorectal submucous eminence and can distinguish benign or malignant tumor according to ultrasonic check,at the same time provide differentiation with extramural compressive lesions.

Clinical value of determination of serum IDO and KYN in ulcerative colitis / 安徽医科大学学报

Objective Detecting the level of IDO and KYN in ulcerative colitis (UC) patients; using ROC curve to discuss their value in the diagnosis of patients with active UC. Methods 60 cases of UC group, 18 cases of dis-ease control group and 20 cases of healthy control group were included in the study. Immunohistochemical staining methods were used to detect the expression of IDO in colonic mucosa of UC, enzyme-linked immunosorbent (ELISA) methods were used to detect the serum levels of IDO, KYN and CRP, and the value with ROC curve method was analyzed. Results ① There was a positive correlation between IDO level and IDO expression (P<0.05). There was a positive correlation between KYN level and IDO expression (P<0.05). ②The levels of IDO and KYN in UC group were higher than those of disease control group and health control group (P<0.05). ③The levels of IDO and KYN in patients with active UC were significantly higher than that in patients with catabasis UC (P<0.01), and the levels increased with severity of inflammation. ④ The levels of IDO and KYN in active UC were positively related to disease activity and CRP levels (P<0.05). ⑤The IDO,KYN and CRP area under ROC curve were 0.976, 0.856 and 0.864;best cut-off point were 53.66 U/L, 2.34 nmol/L and 1.75 mg/ml;sensitiv-ity were 90.5%, 78.65% and 100.0%; specifity were 94.4%, 83.3% and 61.1%; Youden index were 0.839 2, 0.619 0 and 0.611 1. Conclusion The levels of IDO and KYN in serum can be used as an important index to judge the severity of UC. They have important value in the diagnosis of active UC . The value of IDO is higher than KYN and CRP.

Functional magnetic resonance imaging of brain of college students with internet addiction / 中南大学学报(医学版)

OBJECTIVE@#To explore the functional locations of brain regions related to internet addiction (IA)with task-functional magnetic resonance imaging (fMRI).@*METHODS@#Nineteen college students who had internet game addition and 19 controls accepted the stimuli of videos via computer. The 3.0 Tesla MRI was used to record the Results of echo plannar imaging. The block design method was used. Intragroup and intergroup analysis Results in the 2 groups were obtained. The differences between the 2 groups were analyzed.@*RESULTS@#The internet game videos markedly activated the brain regions of the college students who had or had no internet game addiction. Compared with the control group, the IA group showed increased activation in the right superior parietal lobule, right insular lobe, right precuneus, right cingulated gyrus, and right superior temporal gyrus.@*CONCLUSION@#Internet game tasks can activate the vision, space, attention and execution center which are composed of temporal occipital gyrus and frontal parietal gyrus. Abnormal brain function and lateral activation of the right brain may exist in IA.

Dysfunctional beliefs and attitudes on sleep and sleep disturbances pre- and post-antidepressant treatments in patients with major depression / 中南大学学报(医学版)

Objective To explore the relationship between dysfunctional beliefs and attitudes on sleep and sleep disturbances before and after a short-term pharmacotherapy in patients with major depression. Methods Sixty-six (29 male, 37 female, 34.0±9.5 years old) patients with major depression were recruited before the treatment. Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire, Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Scale (HAMA) were assessed before and after a 4-week antidepressant treatment. Results After the 4-week antidepressant treatment, depressive and anxiety symptoms were alleviated significantly, whereas sleep disturbance still persisted. And sleep quality was closely related with problematic sleep beliefs after the treatment.Conclusion Some evidences are provided for cognitive behavioral therapy during antidepressant therapy, and the therapy should be matched with problematic beliefs and attitudes.

Clinical Traits and Treatment of Urinary Tract Infection Based on TCM Symptom Differentiation among Elderly Patients / 中华医院感染学杂志

OBJECTIVE To discuss the clinical traits,pathogenesis and TCM stepwise treatments of urinary tract infection(UTI) based on symptom differentiation among elderly patients.METHODS Because of the whole and the partial immune defense function descending,the elderly patients easily suffered from UTI,which was characterized by non-typical symptom,complex and serious condition.In the aspects of the pathogenesis of UTI among elderly patients,the principal aspect of which was the deficiency of the kidney and spleen(weakened body resistance)and the secondary incidental was accumulated damp-heat in the lower warmer(affected pathogenic factor),viz weaken healthy qi and excessive pathogenic factor.Hence during the clinical treatment we should attach importance to regulate entire faculty condition.Considering the acute attack stage and non-acute phase,we will differently inflict therapies of clearing away the heat-evil,dissolving dampness,treating stranguria,hemostasis,and invigorating spleen and kidney assisted by treating stranguria and so on,according to differentiation of symptoms and treatments,in which way we could give attention to both the principal and the secondary aspects of a disease.RESULTS The TCM stepwise therapy of UTI among elderly patients had the characteristics of high efficacy,few side reactions and stable long-term curative effects.CONCLUSIONS The TCM therapy of UTI among elderly patients has more potentiality and predominance,which deserves further study.