OBJECTIVE Major depressive disorder(MDD) is a highly heterogeneous mental illness.Further classification may help characterize its heterogeneity.The purpose of this study was to examine metabolomic and brain connectom...OBJECTIVE Major depressive disorder(MDD) is a highly heterogeneous mental illness.Further classification may help characterize its heterogeneity.The purpose of this study was to examine metabolomic and brain connectomic associations with traditional Chinese medicine(TCM) diagnostic classification of MDD.METHODS Fifty unmedicated depressed patients were classified into Liver Qi Stagnation(LQS,n=30) and Heart and Spleen Deficiency(HSD,n=20) subtypes according to TCM diagnosis.Healthy volunteers(n=28) were included as controls.Gas chromatography-mass spectrometry(GC-MS) and diffusion tensor imaging were used to detect serum and urinary metabolomic profiles and whole-brain white matter connectivity,respectively.RESULTS In metabolomic analysis,28 metabolites were identified for good separations between TCM subtypes and healthy controls in serum and urine samples.While both TCM subtypes had similar profiles in proteinogenic branched-chain amino acids and energy metabolism-related metabolites that were differentiated from healthy controls,the LQS subtype additionally differed from healthy controls in multiple amino acid metabolites that are involved in the biosynthesis of monoamine and amino acid neurotransmitters.Several metabolites are differentially associated with the two subtypes.In connectomic analysis,The LQS subtype showed significant differences in multiple network metrics of the angular gyrus,middle occipital gyrus,calcarine sulcus,and Heschl′ s gyrus when compared to the other two groups.The HSD subtype had markedly greater regional connectivity of the insula,parahippocampal gyrus,and posterior cingulate gyrus than the other two groups,and microstructural abnormalities of the frontal medial orbital gyrus and middle temporal pole.The insular betweenness centrality was strongly inversely correlated with the severity of depression and dichotomized the two subtypes at the optimal cutoff value with acceptable sensitivity and specificity.CONCLUSION The LQS subtype may represent an MDD subpopulation mainly characterized by abnormalities in the biosynthesis of monoamine and amino acid neurotransmitters,closer associations with stress-related pathophysiology,and aberrant connectivity of the audiovisual perception-related temporal-occipital network,whereas the HSD subtype is more closely associated with hyperconnectivity and microstructural abnormalities of the limbicparalimbic network.Certain metabolomic and connectomic variables are potential biomarkers for TCM diagnostic subtypes which is perhaps an alternative classification for depressive disorders.展开更多
[目的]比较双钢板(double plate, DP)与逆行髓内钉和钢板(retrograde intramedullary nail and plate, NP)结合自体骨移植治疗股骨远端骨折术后骨不连的临床疗效。[方法]回顾性研究2015年1月~2018年9月于本院治疗的股骨远端骨不连患者2...[目的]比较双钢板(double plate, DP)与逆行髓内钉和钢板(retrograde intramedullary nail and plate, NP)结合自体骨移植治疗股骨远端骨折术后骨不连的临床疗效。[方法]回顾性研究2015年1月~2018年9月于本院治疗的股骨远端骨不连患者29例。依据术前医患沟通结果,15例采用DP治疗,14例采用NP治疗。比较两组围手术期、随访与影像等资料。[结果]两组患者均顺利完成手术,术中均无血管、神经损伤等严重并发症发生。NP组在总住院时间、术后引流量、切口总长度及术中透视次数方面显著优于DP组(P<0.05),两组手术时间及术中出血量的差异无统计学意义(P>0.05)。NP组在下地行走时间[(30.21±3.85) d vs (33.47±3.94) d,P<0.05]、完全负重活动时间[(24.00±4.24)周vs (30.20±6.95)周,P<0.05]均显著早于DP组。与术前相比,末次随访时两组膝关节HSS评分、膝关节伸屈活动度显著增加,下肢短缩畸形及内外翻畸形显著改善(P<0.05)。末次随访时,两组间膝关节HSS评分、下肢短缩及内外翻畸形矫正的差异均无统计学意义(P>0.05)。影像方面,两组骨折复位质量的差异无统计学意义(P>0.05),NP组骨折愈合时间显著早于DP组(P<0.05)。末次随访两组均无内固定松动、断裂。[结论]两种治疗方式治疗股骨远端骨不连均可取得满意效果,相比之下,NP的临床结果优于DP。展开更多
基金National Natural Science Foundation of China(81403502)General Research Fund ofResearch Grants Council of Hong Kong (17124418).
文摘OBJECTIVE Major depressive disorder(MDD) is a highly heterogeneous mental illness.Further classification may help characterize its heterogeneity.The purpose of this study was to examine metabolomic and brain connectomic associations with traditional Chinese medicine(TCM) diagnostic classification of MDD.METHODS Fifty unmedicated depressed patients were classified into Liver Qi Stagnation(LQS,n=30) and Heart and Spleen Deficiency(HSD,n=20) subtypes according to TCM diagnosis.Healthy volunteers(n=28) were included as controls.Gas chromatography-mass spectrometry(GC-MS) and diffusion tensor imaging were used to detect serum and urinary metabolomic profiles and whole-brain white matter connectivity,respectively.RESULTS In metabolomic analysis,28 metabolites were identified for good separations between TCM subtypes and healthy controls in serum and urine samples.While both TCM subtypes had similar profiles in proteinogenic branched-chain amino acids and energy metabolism-related metabolites that were differentiated from healthy controls,the LQS subtype additionally differed from healthy controls in multiple amino acid metabolites that are involved in the biosynthesis of monoamine and amino acid neurotransmitters.Several metabolites are differentially associated with the two subtypes.In connectomic analysis,The LQS subtype showed significant differences in multiple network metrics of the angular gyrus,middle occipital gyrus,calcarine sulcus,and Heschl′ s gyrus when compared to the other two groups.The HSD subtype had markedly greater regional connectivity of the insula,parahippocampal gyrus,and posterior cingulate gyrus than the other two groups,and microstructural abnormalities of the frontal medial orbital gyrus and middle temporal pole.The insular betweenness centrality was strongly inversely correlated with the severity of depression and dichotomized the two subtypes at the optimal cutoff value with acceptable sensitivity and specificity.CONCLUSION The LQS subtype may represent an MDD subpopulation mainly characterized by abnormalities in the biosynthesis of monoamine and amino acid neurotransmitters,closer associations with stress-related pathophysiology,and aberrant connectivity of the audiovisual perception-related temporal-occipital network,whereas the HSD subtype is more closely associated with hyperconnectivity and microstructural abnormalities of the limbicparalimbic network.Certain metabolomic and connectomic variables are potential biomarkers for TCM diagnostic subtypes which is perhaps an alternative classification for depressive disorders.
文摘[目的]比较双钢板(double plate, DP)与逆行髓内钉和钢板(retrograde intramedullary nail and plate, NP)结合自体骨移植治疗股骨远端骨折术后骨不连的临床疗效。[方法]回顾性研究2015年1月~2018年9月于本院治疗的股骨远端骨不连患者29例。依据术前医患沟通结果,15例采用DP治疗,14例采用NP治疗。比较两组围手术期、随访与影像等资料。[结果]两组患者均顺利完成手术,术中均无血管、神经损伤等严重并发症发生。NP组在总住院时间、术后引流量、切口总长度及术中透视次数方面显著优于DP组(P<0.05),两组手术时间及术中出血量的差异无统计学意义(P>0.05)。NP组在下地行走时间[(30.21±3.85) d vs (33.47±3.94) d,P<0.05]、完全负重活动时间[(24.00±4.24)周vs (30.20±6.95)周,P<0.05]均显著早于DP组。与术前相比,末次随访时两组膝关节HSS评分、膝关节伸屈活动度显著增加,下肢短缩畸形及内外翻畸形显著改善(P<0.05)。末次随访时,两组间膝关节HSS评分、下肢短缩及内外翻畸形矫正的差异均无统计学意义(P>0.05)。影像方面,两组骨折复位质量的差异无统计学意义(P>0.05),NP组骨折愈合时间显著早于DP组(P<0.05)。末次随访两组均无内固定松动、断裂。[结论]两种治疗方式治疗股骨远端骨不连均可取得满意效果,相比之下,NP的临床结果优于DP。
