Mental health and insomnia problems in healthcare workers after the COVID-19 pandemic:A multicenter cross-sectional study

BACKGROUND Healthcare workers(HCWs)are at increased risk of contracting coronavirus disease 2019(COVID-19)as well as worsening mental health problems and insomnia.These problems can persist for a long period,even after the pandemic.However,less is known about this topic.AIM To analyze mental health,insomnia problems,and their influencing factors in HCWs after the COVID-19 pandemic.METHODS This multicenter cross-sectional,hospital-based study was conducted from June 1,2023 to June 30,2023,which was a half-year after the end of the COVID-19 emergency.Region-stratified population-based cluster sampling was applied at the provincial level for Chinese HCWs.Symptoms such as anxiety,depression,and insomnia were evaluated by the Generalized Anxiety Disorder-7,Patient Health Questionnaire-9,and Insomnia Severity Index.Factors influencing the symptoms were identified by multivariable logistic regression.RESULTS A total of 2000 participants were invited,for a response rate of 70.6%.A total of 1412 HCWs[618(43.8%)doctors,583(41.3%)nurses and 211(14.9%)nonfrontline],254(18.0%),231(16.4%),and 289(20.5%)had symptoms of anxiety,depression,and insomnia,respectively;severe symptoms were found in 58(4.1%),49(3.5%),and 111(7.9%)of the participants.Nurses,female sex,and hospitalization for COVID-19 were risk factors for anxiety,depression,and insomnia symptoms;moreover,death from family or friends was a risk factor for insomnia symptoms.During the COVID-19 outbreak,most[1086(76.9%)]of the participating HCWs received psychological interventions,while nearly all[994(70.4%)]of them had received public psychological education.Only 102(7.2%)of the HCWs received individual counseling from COVID-19.CONCLUSION Although the mental health and sleep problems of HCWs were relieved after the COVID-19 pandemic,they still faced challenges and greater risks than did the general population.Identifying risk factors would help in providing targeted interventions.In addition,although a major proportion of HCWs have received public psychological education,individual interventions are still insufficient.

Gut microbiota modulating intestinal stem cell differentiation

Proliferation and differentiation of intestinal stem cell(ISC)to replace damaged gut mucosal epithelial cells in inflammatory states is a critical step in ameliorating gut inflammation.However,when this disordered proliferation continues,it induces the ISC to enter a cancerous state.The gut microbiota on the free surface of the gut mucosal barrier is able to interact with ISC on a sustained basis.Micro-biota metabolites are able to regulate the proliferation of gut stem and progenitor cells through transcription factors,while in steady state,differentiated colono-cytes are able to break down such metabolites,thereby protecting stem cells at the gut crypt.In the future,the gut flora and its metabolites mediating the regulation of ISC differentiation will be a potential treatment for enteropathies.

Effect of Shuanghuanglian Oral Solution on Liver Function in a Mouse Model of Non-alcoholic Steatohepatitis

[Objectives]To observe the effect of Shuanghuanglian oral solution on liver function in BABL/cJ mice in non-alcoholic steatohepatitis(NASH)model.[Methods]The BABL/cJ mice were randomly divided into three groups:a control group,a model group,and an experimental group.The experimental group was administered with 10%Shuanghuanglian oral solution at a dose of 0.1 mL/(10 g·d),while the control group and experimental group received an equivalent dosage of normal saline.All three groups were treated for a period of 28 d.The liver function of the mice in each group was examined after the treatment.[Results]The body mass,liver index,triacylglycerol(TG),total cholesterol(TC),aspartate aminotransferase(AST),and alanine aminotransferase(ALT)levels were all significantly reduced compared to the model group(P<0.05).[Conclusions]Shuanghuanglian oral solution has a beneficial effect on liver function in BABL/cJ mice.

Continuous Positive Airway Pressure Effectively Alleviates Arrhythmias in Patients with Obstructive Sleep Apnea:Possible Relationship with Counteracting Oxidative Stress

This work is aimed at exploring the clinical efficacy of continuous positive airway pressuie(CPAP)in treatment of patients with arrhythmias combined with obstructive sleep apnea(OSA).Through evaluating serum native thiol,malonaldehyde(MDA)and nicotinamide adenine dinucleotide phosphate oxidase(NADPH oxidase)in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months,we confirmed the impact of oxidative stress on arrhythmias.A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information.Patients were divided into two groups(paired experiment design):32 patients in group A(control group),who received unchanged anti-arrhythmia treatment and 32 patients in group B,who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP.OSA related parameters were compared between the two groups after 3-month therapy.And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy.After 3 months of CPAP therapy,compared with the control group,the percentage of sage N3(NREM 3)and stage R(REM)in total sleep time was significantly increased,while apnea-hypopnea index(AHI)and the Epworth Sleepiness Scale(ESS)score were evidently decreased.Meanwhile,the lowest oxygen saturation(LSpCh)was also elevated after CPAP treatment for 3 months.The CPAP therapy significantly prevented the occurrence of arrhythmias(P<0.05).Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A(P<0.05).But serum native thiol was improved by CPAP treatment(P<0.05).In conclusion,proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.

Clinical observation of soft palate-pharyngoplasty in the treatment of obstructive sleep apnea hypopnea syndrome in children

BACKGROUND Childhood obstructive sleep apnea hypopnea syndrome(OSAHS)is a common clinical disease that can cause serious complications if not treated in time.The preferred treatment for OSAHS in children is surgery.AIM To observe the effects of soft palate-pharyngoplasty on postoperative outcome,pharyngeal formation,and possible complications.METHODS A total of 150 children with snoring,hernia,and mouth breathing were selected.A polysomnography test was performed to confirm the diagnosis of OSAHS.The children were randomly divided into experimental and control groups.The experimental group underwent adenoidectomy,tonsillectomy,and soft palatepharyngoplasty.The control group underwent adenoidectomy and tonsillectomy.The t-test and chi-square test were used to compare conditions such as postoperative fever,postoperative hemorrhage,and pharyngeal reflux.Postoperative efficacy and complications were interrogated and observed in the form of outpatient follow-up and telephone follow-up at 6 mo and 1 year after surgery.The curative effects were divided into two groups:Cure(snoring,snoring symptoms disappeared)and non-cure.RESULTS The effective rate of the experimental group was significantly higher than that of the control group,but the difference was not statistically significant(P>0.05).The incidence of postoperative bleeding was lower in the experimental group.There was no postoperative pharyngeal reflux in either group.In the experimental group,the incidence of hyperthermia(body temperature exceeded 38.5°C)was lower than that in the control group.The difference in postoperative swallowing pain scores between the experimental and control groups was significant.CONCLUSION Soft palate-pharyngoplasty can more effectively enlarge the anteroposterior diameter and transverse diameter of the isthmus faucium.Compared with surgery alone,it can better treat OSAHS in children,improve the curative effect,reduce the risk of perioperative bleeding,close the surgical cavity,reduce the risk of postoperative infection,reduce the proportion of postoperative fever,and accelerate healing.Although this process takes more time,it is simple,safe,and effective.

Effects of mindful breathing combined with sleep-inducing exercises in patients with insomnia

BACKGROUND Insomnia is the most common sleep disorder.It disrupts the patient’s life and work,increases the risk of various health issues,and often requires long-term intervention.The financial burden and inconvenience of treatments discourage patients from complying with them,leading to chronic insomnia.AIM To investigate the long-term home-practice effects of mindful breathing combined with a sleep-inducing exercise as adjunctive insomnia therapy.METHODS A quasi-experimental design was used in the present work,in which the patients with insomnia were included and grouped based on hospital admission:40 patients admitted between January and April 2020 were assigned to the control group,and 40 patients admitted between May and August 2020 were assigned to the treatment group.The control group received routine pharmacological and physical therapies,while the treatment group received instruction in mindful breathing and a sleep-inducing exercise in addition to the routine therapies.The Pittsburgh Sleep Quality Index(PSQI),Generalized Anxiety Disorder 7-item(GAD-7)scale,and Insomnia Severity Index(ISI)were utilized to assess sleepquality improvement in the patient groups before the intervention and at 1 wk,1 mo,and 3 mo postintervention.RESULTS The PSQI,GAD-7,and ISI scores before the intervention and at 1 wk postintervention were not significantly different between the groups.However,compared with the control group,the treatment group exhibited significant improvements in sleep quality,daytime functioning,negative emotions,sleep latency,sleep duration,sleep efficiency,anxiety level,and insomnia severity at 1 and 3 mo postintervention(P<0.05).The results showed that mindful breathing combined with the sleep-inducing exercise significantly improved the long-term effectiveness of insomnia treatment.At 3 mo,the PSQI scores for the treatment vs the control group were as follows:Sleep quality 0.98±0.48 vs 1.60±0.63,sleep latency 1.98±0.53 vs 2.80±0.41,sleep duration 1.53±0.60 vs 2.70±0.56,sleep efficiency 2.35±0.58 vs 1.63±0.49,sleep disturbance 1.68±0.53 vs 2.35±0.53,hypnotic medication 0.53±0.64 vs 0.93±0.80,and daytime dysfunction 1.43±0.50 vs 2.48±0.51(all P<0.05).The GAD-7 scores were 2.75±1.50 vs 7.15±2.28,and the ISI scores were 8.68±2.26 vs 3.38±1.76 for the treatment vs the control group,respectively(all P<0.05).CONCLUSION These simple,cost-effective,and easy-to-implement practices used in clinical or home settings could have profound significance for long-term insomnia treatment and merit wide adoption in clinical practice.

Brain network correlates of epilepsy occurrence in multiple sclerosis and neuroinflammation

Multiple sclerosis(MS),the most common inflammatory condition of the central nervous system in young adults,is characterized by immunemediated demyelination and neurodegeneration that translate into heterogeneous clinical phenotypes and disease trajectories.

Research progress on the biological effects of BDNF and proBDNFs in post-traumatic stress disorder

Many people were affected psycho-logically and even traumatized by the outbreak of new coronavirus pneumonia in 2020,which has the potential to lead to post-traumatic stress disorder.Many neuropsy-chiatric illnesses are aided by brain-derived neurotrophic factor and its predecessors.Brain-derived neurotrophic factor precursors have the biological impact of triggering neuronal apoptosis and hindering neural regeneration,and brain-derived neurotrophic factor itself can help increase the growth,survival,and differentiation of central and peripheral nerve cells.This article provides an in-depth study of their biological impacts in post-traumatic stress disorder in an attempt to understand the biological effects of brain-derived neurotrophic factor and its precursor proteins.

Research progress on the effects of positive stress reduction on positive awareness and psychosocial functioning in patients with depressive disorders

To review the current research status of positive thought stress reduction therapy(PTSRT),psychosocial functioning of patients with depressive disorders,the shortcomings and outlook of the influence of PTSRT on positive thought awareness,and psychosocial functioning of patients with depressive disorders.This review has the objective to provide clinical healthcare personnel with essential information about the use of PTSRT to improve the level of positive thought and psychosocial functioning of patients with depressive disorders.

Endothelial PDGF-BB/PDGFR-βsignaling promotes osteoarthritis by enhancing angiogenesis-dependent abnormal subchondral bone formation

The mechanisms that coordinate the shift from joint homeostasis to osteoarthritis(OA)remain unknown.No pharmacological intervention can currently prevent the progression of osteoarthritis.Accumulating evidence has shown that subchondral bone deterioration is a primary trigger for overlying cartilage degeneration.We previously found that H-type vessels modulate aberrant subchondral bone formation during the pathogenesis of OA.However,the mechanism responsible for the elevation of H-type vessels in OA is still unclear.Here,we found that PDGFR-βexpression,predominantly in the CD31^(hi)Emcn^(hi) endothelium,was substantially elevated in subchondral bones from OA patients and rodent OA models.A mouse model of OA with deletion of PDGFR-βin endothelial cells(ECs)exhibited fewer H-type vessels,ameliorated subchondral bone deterioration and alleviated overlying cartilage degeneration.Endothelial PDGFR-βpromotes angiogenesis through the formation of the PDGFR-β/talin1/FAK complex.Notably,endothelium-specific inhibition of PDGFR-βby local injection of AAV9 in subchondral bone effectively attenuated the pathogenesis of OA compared with that of the vehicle-treated controls.Based on the results from this study,targeting PDGFR-βis a novel and promising approach for the prevention or early treatment of OA.

Syntheses and Anti-lung Cancer Effects of Two Novel Dy(Ⅲ)Complexes Based on 1,3,5-Benzenetricarbocylic Acid and 1,3,5-Benzenetrisbenzoic Acid,respectively

The reactions of 1,3,5-benzenetricarbocylic acid（H3BTC） and 1,3,5-benzenetrisbenzoic acid（H3BTB） with Dy（NO3）3·6H2O afford two novel Dy（III） coordination polymers respectively, Dy（BTC）（H2O）DMF（1） and [Dy（BTB）（Et OH）]（DMF）（2）（DMF = N,N-dimethylformamide）. 1 shows a 3D framework composed of available Lewis-acid metal sites which are occupied by the coordinated water molecules, and 2 features a noninterpenetrated open 3D framework with a 5-connected bnn hexagonal topology possessing the point symbol（46.64）. In addition, in vitro antitumor activities of compounds 1 and 2 on three human lung cancer cells（H1975, HCC827 and A549） were further determined.

Reduced SARS-CoV-2 infection risk is associated with the use of Seven-Flavor Herb Tea:A multi-center observational study in Shanghai,China

Objective:Omicron,a severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variant,is responsible for numerous infections in China.This study investigates the association between the use of Seven-Flavor Herb Tea(SFHT)and the risk of SARS-CoV-2 infection to develop precise and differentiated strategies for control of the coronavirus disease 2019(COVID-19).Methods:This case-control study was conducted at shelter hospitals and quarantine hotels in China.A total of 5348 laboratory-confirmed COVID-19 patients were enrolled between April 1 and May 31,2022,while 2190 uninfected individuals served as healthy controls.Structured questionnaires were used to collect data on demographics,underlying diseases,vaccination status,and use of SFHT.Patients were propensity-score-matched using 1:1 nearest-neighbor matching of the logit of the propensity score.Subsequently,a conditional logistic regression model was used for data analysis.Results:Overall,7538 eligible subjects were recruited,with an average age of[45.54±16.94]years.The age of COVID-19 patients was significantly higher than that of uninfected individuals([48.25±17.48]years vs[38.92±13.41]years;t=22.437,P<0.001).A total of 2190 COVID-19 cases were matched with uninfected individuals at a 1:1 ratio.The use of SFHT(odds ratio=0.753,95%confidence interval:0.692,0.820)was associated with a lower risk of SARS-CoV-2 infection compared to untreated individuals.Conclusion:Our findings suggest that taking SFHT reduces the risk of SARS-CoV-2 infection.This is a useful study in the larger picture of COVID-19 management,but data from large-sample multi-center,randomized clinical trial are warranted to confirm the finding.

Epigenetic regulation in major depression and other stressrelated disorders: molecular mechanisms, clinical relevance and therapeutic potential

Major depressive disorder(MDD)is a chronic,generally episodic and debilitating disease that affects an estimated 300 million people worldwide,but its pathogenesis is poorly understood.The heritability estimate of MDD is 30–40%,suggesting that genetics alone do not account for most of the risk of major depression.Another factor known to associate with MDD involves environmental stressors such as childhood adversity and recent life stress.Recent studies have emerged to show that the biological impact of environmental factors in MDD and other stress-related disorders is mediated by a variety of epigenetic modifications.These epigenetic modification alterations contribute to abnormal neuroendocrine responses,neuroplasticity impairment,neurotransmission and neuroglia dysfunction,which are involved in the pathophysiology of MDD.Furthermore,epigenetic marks have been associated with the diagnosis and treatment of MDD.The evaluation of epigenetic modifications holds promise for further understanding of the heterogeneous etiology and complex phenotypes of MDD,and may identify new therapeutic targets.Here,we review preclinical and clinical epigenetic findings,including DNA methylation,histone modification,noncoding RNA,RNA modification,and chromatin remodeling factor in MDD.In addition,we elaborate on the contribution of these epigenetic mechanisms to the pathological trait variability in depression and discuss how such mechanisms can be exploited for therapeutic purposes.

Independent Component Analysis and Graph Theoretical Analysis in Patients with Narcolepsy

The present study was aimed to evaluate restingstate functional connectivity and topological properties of brain networks in narcolepsy patients compared with healthy controls.Resting-state fMRI was performed in 26 adult narcolepsy patients and 30 matched healthy controls.MRI data were first analyzed by group independent component analysis,then a graph theoretical method was applied to evaluate the topological properties in the whole brain.Small-world network parameters and nodal topological properties were measured.Altered topological properties in brain areas between groups were selected as regionof-interest seeds,then the functional connectivity among these seeds was compared between groups.Partial correlation analysis was performed to evaluate the relationship between the severity of sleepiness and functional connectivity or topological properties in the narcolepsy patients.Twenty-one independent components out of 48 were obtained.Compared with healthy controls,the narcolepsy patients exhibited significantly decreased functional connectivity within the executive and salience networks,along with increased functional connectivity in the bilateral frontal lobes within the executive network.There were no differences in small-world network properties between patients and controls.The altered brain areas in nodal topological properties between groups were mainly in the inferior frontal cortex,basal ganglia,anterior cingulate,sensory cortex,supplementary motor cortex,and visual cortex.In the partial correlation analysis,nodal topological properties in the putamen,anterior cingulate,and sensory cortex as well as functional connectivity between these regions were correlated with the severity of sleepiness(sleep latency,REM sleep latency,and Epworth sleepiness score)among narcolepsy patients.Altered connectivity within the executive and salience networks was found in narcolepsy patients.Functional connection changes between the left frontal cortex and left caudate nucleus may be one of the parameters describing the severity of narcolepsy.Changes in the nodal topological properties in the left putamen and left posterior cingulate,changes in functional connectivity between the left supplementary motor area and right occipital as well as in functional connectivity between the left anterior cingulate gyrus and bilateral postcentral gyrus can be considered as a specific indicator for evaluating the severity of narcolepsy.

Quality and readability of online information resources on insomnia

The internet is a major source for health information. An increasing number of people, including patients with insomnia, search for remedies online; however, little is known about the quality of such information. This study aimed to evaluate the quality and readability of insomnia-related online information. Google was used as the search engine, and the top websites on insomnia that met the inclusion criteria were evaluated for quality and readability. The analyzed websites belonged to nonprofit, commercial, or academic organizations and institutions such as hospitals and universities. Insomnia-related websites typically included definitions （85%）, causes and risk factors （100%）, symptoms （95%）, and treatment options （90%）. Cognitive behavioral therapy for insomnia （CBT-I） was the most commonly recommended approach for insomnia treatment, and sleep drugs are frequently mentioned. The overall quality of the websites on insomnia is moderate, but all the content exceeded the recommended reading ease levels. Concerns that must be addressed to increase the quality and trustworthiness of online health information include sharing metadata, such as authorship, time of creation and last update, and conflicts of interest; providing evidence for reliability; and increasing the readability for a layman audience.

Identification of surgical patients at high risk of OSAS using the Berlin Questionnaire to detect potential high risk of adverse respiratory events in post anesthesia care unit

Obstructive sleep apnea syndrome （OSAS） increases the risk of post-surgery complications. This study uses Berlin Questionnaire （BQ） to identify Chinese adult surgical patients who are at a high risk of OSAS and to determine if the BQ could be used to detect potential high risk of adverse respiratory events in the post anesthesia care unit （PACU）. Results indicated that only 11.4% of the patients were considered at a high risk of OSAS. Age and body mass index are the key factors for the risk of OSAS prevalence in China and also gender specific. Furthermore, the incidence of adverse respiratory events in the PACU was higher in patients with high risk of OSAS than others （6.8% vs. 0.9%, P 〈 0.001）. They also stayed longer than others in the PACU （95 ~ 28 min vs. 62 ~ 19 min, P 〈 0.001）. Age, high risk for OSAS, and smoking were independent risk factors for the occurrence of adverse respiratory events in the PACU. The BQ may be adopted as a screening tool for anesthesiologists in China to identify patients who are at high risk of OSAS and determine the potential risk of developing postoperative respiratory complications in the PACU.