Associations of executive function and age of first use of methamphetamine with methamphetamine relapse.

Background and aims: Methamphetamine (MA) is a psychostimulant associated with a high relapse rate among patients with MA use disorder (MUD). Long-term use of MA is associated with mental disorders, executive dysfunction, aggressive behaviors, and impulsivity among patients with MUD. However, identifying which factors may be more closely associated with relapse has not been investigated. Thus, we aimed to investigate the psychological factors and the history of MA use that may influence MA relapse. Methods: This cross-sectional study included 168 male MUD patients (MUD group) and 65 healthy male residents (control group). Each patient was evaluated with self-report measures of executive dysfunction, psychopathological symptoms, impulsiveness, aggressiveness, and history of MA use. Data were analyzed with t-tests, analyses of variance, and correlation and regression analyses. Results: The MUD group reported greater executive dysfunction, psychopathological symptoms, impulsivity, and aggression than the control group. Lower age of first MA use was associated both with having relapsed one or more times and with having relapsed two or more times; greater executive dysfunction was associated only with having relapsed two or more times. Conclusion: Patients with MUD reported worse executive function and mental health. Current results also suggest that lower age of first MA use may influence relapse rate in general, while executive dysfunction may influence repeated relapse in particular. The present results add to the literature concerning factors that may increase the risk of relapse in individuals with MUD.

Predictive Role of Executive Function in the Efficacy of Intermittent Theta Burst Transcranial Magnetic Stimulation Modalities for Treating Methamphetamine Use Disorder-A Randomized Clinical Trial.

Background: Repetitive transcranial magnetic stimulation (rTMS) has therapeutic effects on craving in methamphetamine (METH) use disorder (MUD). The chronic abuse of METH causes impairments in executive function, and improving executive function reduces relapse and improves treatment outcomes for drug use disorder. The purpose of this study was to determine whether executive function helped predict patients' responses to rTMS treatment. Methods: This study employed intermittent theta burst stimulation (iTBS) rTMS modalities and observed their therapeutic effects on executive function and craving in MUD patients. MUD patients from an isolated Drug Rehabilitation Institute in China were chosen and randomly allocated to the iTBS group and sham-stimulation group. All participants underwent the Behavior Rating Inventory of Executive Function - Adult Version Scale (BRIEF-A) and Visual Analog Scales (VAS) measurements. Sixty-five healthy adults matched to the general condition of MUD patients were also recruited as healthy controls. Findings: Patients with MUD had significantly worse executive function. iTBS groups had better treatment effects on the MUD group than the sham-stimulation group. Further Spearman rank correlation and stepwise multivariate regression analysis revealed that reduction rates of the total score of the BRIEF-A and subscale scores of the inhibition factor and working memory factor in the iTBS group positively correlated with improvements in craving. ROC curve analysis showed that working memory (AUC = 87.4%; 95% CI = 0.220, 0.631) and GEC (AUC = 0.761%; 95% CI = 0.209, 0.659) had predictive power to iTBS therapeutic efficacy. The cutoff values are 13.393 and 59.804, respectively. Conclusions: The iTBS rTMS had a better therapeutic effect on the executive function of patients with MUD, and the improved executive function had the potential to become a predictor for the efficacy of iTBS modality for MUD treatment. Clinical Trial Registration: ClinicalTrials.gov, identifier: ChiCTR2100046954.

Career choice and influential factors among medical students majoring in psychiatry in China.

BACKGROUND: The undergraduate program of psychiatry has been widely established in recent years to improve the education and recruitment of psychiatrists in China. We aim to investigate the career choice of medical students majoring in psychiatry in China and the influential factors. METHOD: This multicenter study was conducted in 26 medical schools in China from May to October of 2019. Participants included 4610 medical students majoring in psychiatry and 3857 medical students majoring in clinical medicine. Multivariable logistic regression was used to investigate the influential factors of students' choices of psychiatry at matriculation and as a career. RESULTS: 44.08% of psychiatry majored students gave psychiatry as a first choice at matriculation, and 56.67% of them would choose psychiatry as a career, which was in sharp contrast to the proportion of clinical medicine majored students who would choose psychiatry as a career (0.69%). Personal interest (59.61%), suggestions from family members (27.96%), and experiencing mental problems (23.19%) were main reasons for choosing psychiatry major at matriculation. Personal interest (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.87-2.40), experiencing a psychiatry clerkship (OR = 1.99, 95% CI = 1.28-3.08), being female (OR = 1.50, 95% CI = 1.30-1.68), experiencing mental problems (OR = 1.33, 95% CI = 1.28-1.56), and suggestions from family members (OR = 1.25, 95% CI = 1.08-1.46) correlated positively with students' choice of psychiatry as career. Students who lacked psychiatry knowledge (OR = 0.49, 95% CI = 0.29-0.85) or chose psychiatry because of lower admission scores (OR = 0.80, 95% CI = 0.63-0.97) were less likely to choose psychiatry as a career. CONCLUSION: More than half of psychiatry majored medical school students planned to choose psychiatry as their career, whereas very few students in the clinic medicine major would make this choice. Increasing students' interest in psychiatry, strengthening psychiatry clerkships, and popularizing psychiatric knowledge are modifiable factors to increase the psychiatry career intention. The extent to which medical students' attitudes toward psychiatry can be changed through medical school education and greater exposure to psychiatry will need further investigation.

Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant left ventricle.

PURPOSE: To analyze the efficacy of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle. METHODS: Eighty cardiac patients with previous sternotomy and giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm, who underwent mitral valve surgery at our center from January 2006 to January 2019 were analyzed. We divided all patients into minimally invasive beating heart technique group (n = 30) and conventional median resternotomy arrested heart technique group (n = 50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups. RESULTS: Minimally invasive beating heart technique compared to the conventional median resternotomy arrested heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle had significant differences in operation time(P = 0.002), cardiopulmonary bypass (CPB) time(P < 0.001), intraoperative blood loss(P < 0.001), postoperative transfusion ratio(P = 0.01), postoperative transfusion amount(P < 0.001), postoperative drainage volume(P = 0.001), extubation time(P = 0.04), intensive care unit (ICU) stay time(P = 0.04) and postoperative hospital stay time(P < 0.001), but no significant differences in re-exploration for bleeding, postoperative 30-day mortality, postoperative complications and 6 months postoperative echocardiographic parameters. CONCLUSIONS: Using the method of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle is effective and reliable, meanwhile reduce the operation time and CPB time, decrease the transfusion ratio and transfusion amount, shorten postoperative ICU stay and hospital stay time, promote the early extubation so that accelerate the patients' early recovery. All of these show a benefit of minimally invasive beating heart technique compared to conventional median resternotomy arrested heart technique.

Clinical and Basic Research on Renshen Yangrong Decoction.

Renshen Yangrong Decoction has been used to treat asthenic disease symptoms, such as exhaustion, and qi and blood deficiency diseases. It not only promotes hematopoietic function and improve immune functions, but also alleviates coronary heart diseases, diabetic complications, malignant tumor, and brain injury. It has satisfactory curative effect on sleep disorders and fatigue. Herein, we provide an overview of fundamental research on Renshen Yangrong Decoction focusing on its hematopoietic and immune functions and the status of clinical research with regard to the above-mentioned diseases in recent years.

[Water Quality Analysis of Beijing Segment of South-to-North Water Diversion Middle Route Project].

Water quality is the key problem that water management departments concern. Water quality of Beijing segment of South-to-North Water Diversion Middle Route Project is closely related to water security and social stability in Beijing. Since the connection of Beijing part in Middle Route of South-to-North Diversion Project, water quality data of Daning regulation and storage reservoir and Daning surge tank was collected, and water quality indexes including water temperature, total nitrogen, nitrate nitrogen, chloride ion, sulfate, dissolved oxygen, permanganate index, pH, ammonia nitrogen, fluorine ion and total phosphorus, were monitored monthly. With variance analysis, water quality difference among different water sources of the South-to-North Water Diversion of Middle Route was analyzed. With factor analysis method, the water quality risk factors of Daning regulation and storage reservoir and Daning surge tank were identified. The results were as following, water from Hebei province had higher contents of nitrate nitrogen, total nitrogen, fluorine ion, chloride ion and sulfate than those of water from Danjiangkou reservoir, but the water quality was not as good as that from Danjiangkou reservoir. LSD difference test results showed that the dissolved oxygen, nitrate nitrogen and total nitrogen of the water from Hebei province had significant differences (P<0.05) between flood season and non-flood season, there was significant difference (P<0.05) in pH of water from Danjiangkou reservoir between flood season and non-flood season, and the water quality of Danjiangkou reservoir was more stable than water from Heibei province. No matter in flood season or non-flood season, there were no significant differences (P<0.05) in pH, dissolved oxygen, permanganate index, total phosphorus and ammonia nitrogen between the water from Danjiangkou reservoir and Heibei province, but there were significant differences (P<0.05) in nitrate nitrogen, total nitrogen, fluorine ion and sulfate ion and chloride ion. Contents of Nitrate nitrogen, total nitrogen, sulfate and chloride ion in 2015 (the mixture of water from Hebei province and Danjiangkou reservoir) in Daning regulation and storage reservoir were lower than those in 2012-2014 (water from Hebei province), and the water from Danjiangkou reservoir played a key role in dilution and adjustment of the water from Hebei province in Daning regulation and storage reservoir. The water quality differences test results between 2012-2014 and 2015 showed that there were significant differences (P<0.05) in the nitrate nitrogen, total nitrogen, fluorine ion, sulfate and chloride ion both in flood season and non-flood season, and the water quality of 2015 was better than that of 2012~2014 in non-flood season, but the differences of pH, dissolved oxygen, permanganate index, total phosphorus, ammonia nitrogen were not obvious (P<0.05). The difference test results between Daning regulation and storage reservoir and Daning surge tank showed that Permanganate index, total nitrogen, fluorine ion, sulfate and chloride ion had significant differences (P<0.05) both in flood season and non-flood season, and the contents of permanganate index, fluorine ion, sulfate and chloride ions in Daning regulation and storage reservoir were higher than those in Daning surge tank. The factor analysis results indicated that water quality potential risk factors both in Daning regulation and storage reservoir and Daning surge tank were mainly nitrogen, including ammonia nitrogen, nitrate nitrogen and total nitrogen, and potential risk factors also included total phosphorus in Daning regulation and storage reservoir.

Combined use of transmyocardial laser revascularization and endothelial progenitor cells enhances neovascularization and regional contractility in a canine model of ischemic hearts.

The purpose of this study was to determine the combined effect of transmyocardial laser revascularization (TMLR) and the implantation of endothelial progenitor cells (EPCs) on cardiac function of ischemic hearts in canines. The left anterior descending artery (LAD) was occluded to establish the canine model of acute myocardial infarct (AMI). Four weeks later, the animals were randomly divided into four groups: TMLR group, in which transmyocardial laser-induced channels were established at the ischemic region; EPCs+TMLR group, in which EPCs were locally transplanted into laser-induced channels at the ischemic region; EPCs group, in which the EPCs were injected into the ischemic region; control group, in which the AMI animals received neither TMLR nor EPCs. The peripheral blood (50 mL) was sampled in all groups. Mononuclear cells from the peripheral blood were separated and cultured to obtain spindle-shaped attaching (AT) cells in vitro. AT cells were labeled with 1, 1'-dioctadecyl-1 to 3,3, 3',3'-tetramethyl-indocarbocyanine perchlorate (DiI) before injecting into the laser-induced channels or ischemic region. Four weeks after the first operation, TMLR was performed in the TMLR group and EPCs+TMLR group, and at the same time, the EPCs originating from the AT cells were mixed with calcium alginate (CA). Then the EPCs-CA composites were implanted into myocardial channels induced by laser in the EPCs+TMLR group, and into the myocardial infarct area in the EPCs group. All dogs underwent echocardiography at second month after LAD occlusion. Finally the samples of myocardium around the LAD were subjected to histochemical and immunohistologic examinations. The results showed there was no significant difference in the diameter of left atrium and ventricle before treatment among all groups (P>0.05). Eight weeks after modeling, the regional contractility in the LAD territory in the EPCs+TMLR group was increased as compared with control group and TMLR group, but there was no significant difference between control group and TMLR group. Neoangiogenesis was observed in the EPCs+TMLR group, and the fibrosis was seen in the TMLR group. There was no significant difference in neoangiogenesis around the channels induced by laser among EPCs+TMLR, EPCs and TMLR groups. It was concluded that TMLR combined with EPCs could improve the regional and global cardiac function in AMI, and augment neovascularizaiton in channels of ischemic myocardium induced by laser.

Uterine leiomyoma extension into right atrium.

We report a case of an intravenous leiomyomatosis of uterine origin extending into the right atrium, which was treated by two-stage surgery.

[Estimation of nonpoint source pollutant loads and optimization of the best management practices (BMPs) in the Zhangweinan River basin].

One of the key techniques in establishing and implementing TMDL (total maximum daily load) is to utilize hydrological model to quantify non-point source pollutant loads, establish BMPs scenarios, reduce non-point source pollutant loads. Non-point source pollutant loads under different years (wet, normal and dry year) were estimated by using SWAT model in the Zhangweinan River basin, spatial distribution characteristics of non-point source pollutant loads were analyzed on the basis of the simulation result. During wet years, total nitrogen (TN) and total phosphorus (TP) accounted for 0.07% and 27.24% of the total non-point source pollutant loads, respectively. Spatially, agricultural and residential land with steep slope are the regions that contribute more non-point source pollutant loads in the basin. Compared to non-point source pollutant loads with those during the baseline period, 47 BMPs scenarios were set to simulate the reduction efficiency of different BMPs scenarios for 5 kinds of pollutants (organic nitrogen, organic phosphorus, nitrate nitrogen, dissolved phosphorus and mineral phosphorus) in 8 prior controlled subbasins. Constructing vegetation type ditch was optimized as the best measure to reduce TN and TP by comparing cost-effective relationship among different BMPs scenarios, and the costs of unit pollutant reduction are 16.11-151.28 yuan x kg(-1) for TN, and 100-862.77 yuan x kg(-1) for TP, which is the most cost-effective measure among the 47 BMPs scenarios. The results could provide a scientific basis and technical support for environmental protection and sustainable utilization of water resources in the Zhangweinan River basin.

[Spatiotemporal variation analysis and identification of water pollution sources in the Zhangweinan River basin].

In this study, several statistical methods including cluster analysis, seasonal Kendall test, factor analysis/principal component analysis and principal component regression were used to evaluate the spatiotemporal variation of water quality and identify the sources of water pollution in the Zhangweinan River basin. Results of spatial cluster analysis and principal component analysis indicated that the Zhangweinan River basin can be classified into two regions. One is the Zhang River upstream located in the northwest of the Zhangweinan River basin where water quality is good. The other one covers the Wei River and eastern plain of the Zhangweinan River basin, where water is seriously polluted. In this region, pollutants from point sources flow into the river and the water quality changes greatly. Results of temporal cluster analysis and seasonal Kendall test indicated that the study periods may be classified into three periods and two different trends were detected during the period of 2002-2009. The first period was the year of 2002-2003, during which water quality had deteriorated and serious pollution was observed in the Wei river basin and eastern plain of the Zhangweinan River basin. The second period was the year of 2004-2006, during which water quality became better. The year of 2007-2009 is the third period, during which water quality had been improved greatly. Despite that water quality in the Zhangweinan River basin had been improved during the period of 2004-2009, the water quality in the Wei River (southwestern part of the basin), the Wei Canal River and the Zhangweixin River (eastern plain of the basin) is still poor. Principal component analysis and multi-linear regression of the absolute principal component scores showed that the main pollutants of the Zhangweinan River basin came from point source discharge such as heavy industrial wastewater, municipal sewage, chemical industries wasterwater and mine drainage in upstream. Non-point source pollution such as agricultural pollution and runoff pollution caused by heavy rainfalls also showed considerable impact on water quality in the Zhangweinan River basin during flood seasons. These results provide useful information for better pollution control strategies in the Zhangweinan River basin.

[Relationship between groundwater quality index of physics and chemistry in riparian zone and water quality in river].

Riparian zone hydrology is dominated by shallow groundwater with complex interactions between groundwater and surface water. There are obvious relations of discharge and recharge between groundwater and surface water. Flood is an important hydrological incident that affects groundwater quality in riparian zone. By observing variations of physical and chemical groundwater indicators in riparian zone at the Kouma section of the Yellow River Wetland, especially those took place in the period of regulation for water and sediment at the Xiaolangdi Reservoir, relationship between the groundwater quality in riparian zone and the flood water quality in the river is studied. Results show that, affected by the river and pond water, the highest point of groundwater temperature is near the pond in spring, and near the river in winter; and regulation for water and sediment at the Xiaolangdi Reservoir also affects groundwater temperature in riparian zone, which reaches its maximum at 100 m far from the river bank. There exists a strong zone of nitrification area at 50 m from the river bank, and in this area, the groundwater pH value is lower by 0.2 to 0.4 unit than that of the other regions, with great annual varieties. The turbidity of groundwater is affected by irrigation, which is more obvious than other indicators of groundwater. The turbidity of groundwater and river water increase rapidly during the early phase of flood retreat, and slope stability of river bank is the initial impact of the soil erosion of river bank. Conductivity, chloride and sulfate data show that the range of 50-200 m in riparian wetland is a very important salt accumulation zone, and the width of salt accumulation zone changes with seasons, and this area is also a very important zone of sulfur reduction. The quality of groundwater at 200 m from the river bank is also significantly affected by floods. Physical and chemical indicators of water change strongly in this area. The result indicates that there is a very close relationship between groundwater and surface water, and it is the typical land and water ecotone between groundwater of riparian zone and the river. Rational protection for this region is critical for the conservation of water quality both in the river and groundwater.

[Relationship between groundwater level in riparian wetlands and water level in the river].

The development and degradation processes of riparian wetlands are significantly affected by river hydrological processes. By observing the variation of groundwater levels in riparian wetlands at the Kouma section of the Yellow River Wetland, especially that during the period of regulation for water and sediment at the Xiaolangdi Reservoir, relationship between groundwater level in riparian wetlands and flood water level in the river is studied. The results show that groundwater level in riparian wetlands is significantly affected by water level in the river investigated. There is a negative exponential relationship between groundwater level and the distance between wells and river. The correlation coefficient shows the maximum (R2 > 0.98) during the period of regulation for water and sediment. Affected by the cultivation system in the flooding area, distance between monitoring wells and river bank, water level in the river variation of groundwater level in the wetland changed greatly. In artificial wetland, which is far from the river, the inter-annual variation in groundwater levels show a " (see symbol)" shape, while in the farmland, which is close to the river, the inter-annual variation of groundwater levels show a big peak. The groundwater level 400 m from the river is affected by flood events obviously, that in the area which is less than 200 m from the river is significantly affected by flood events in the area which is especially less than that in the area that is less than 100 m from the river, the groundwater level is affected by flood events intensively. The result indicated that there was a very close relationship between groundwater and surface water, and it was the hydrological ecotone between groundwater of riparian wetlands and the river. It is very important that rational protection for this region (very important for the area which is less than 100 m from the river, important for the area that is between 100 m and 200 m from the river) is critical for the conservation of water quality in the river and groundwater quality.

[Effect of cortisol on ischemic preconditioning in rabbit hearts].

OBJECTIVE: To determine the effects of reacting cortisol on ischemic preconditioning (IPC). METHODS: Thirty rabbits were randomized into ischemic preconditioning (IPC) group, etomidate (Etom) group, ischemic/reperfusion (IR) group, methylprednisolone (MP) group and a control group. The ratios of infarction size versus risk area (Infarct/Risk) were calculated. The elevations of serum CK activity and cTnI concentrations as well as serum cortisol concentrations were measured. RESULTS: The ratios of Infarct/Risk were 5.9%+/-2.8% for IPC, 11.3%+/-3.6% for Etom, 26.8%+/-4.5% for IR and 18.2%+/-3.7% for MP. The elevations of serum CK activity (U/L) were 255+/-89 for IPC, 314+/-160 for Etom, 855+/-371 for IR and 768+/-404 for MP, the elevations of serum cTnI concentrations (microg/L) were 3.6+/-0.6 for IPC, 5.9+/-2.0 for Etom, 8.1+/-3.6 for IR and 6.1+/-2.3 for MP. Those indicators among groups are all significantly different (P<0.01). Cortisol reacting was markedly diminished in Etom group. CONCLUSION: A blunted cortisol reaction can markedly undermine the benefit of ischemic preconditioning, methylprednisolone show a certain myocardial protection. Cortisol may play an important role in the IPC process.