Analysis of risk factors for postpartum depression after cesarean section in women with early-onset preeclampsia

BACKGROUND Early-onset preeclampsia significantly increases maternal and fetal morbidity and mortality.Many pregnant women with early onset preeclampsia choose cesarean section as their delivery method.Although extensive research has explored the association between postpartum depression(PPD)and cesarean section,few studies have investigated the risk factors after cesarean section in women with early-onset preeclampsia.AIM To examine these risk factors through a retrospective,observational analysis of 287 women who underwent a cesarean section for early preeclampsia between June 2014 and March 2024.METHODS Participants were assessed in person during the 32nd week of pregnancy,2 days post-cesarean,and 6 weeks postpartum.According to the Edinburgh Postnatal Depression Scale(EPDS),participants who underwent cesarean section were divided into PPD(n=60)and non-PPD groups(n=227).Furthermore,PPD was diagnosed at 6 weeks postpartum according to depressive symptoms(EPDS score≥11).The demographic and clinical features of PPD were screened.Multivariate logistic regression analysis was used to identify PPD risk factors.RESULTS The prevalence of PPD was 20.9%(60/287)among the 287 women who underwent cesarean section for early-onset preeclampsia.Multivariate logistic regression analyses revealed that advanced age(age>40 years)[odds ratio(OR)=1.93,95%CI:1.31-2.82],previous preeclampsia(OR=7.15,95%CI:5.81-8.85),pre-pregnancy obesity(OR=2.42,95%CI:1.62-3.63),gestational diabetes mellitus(OR=3.52,95%CI:2.51-4.92),preexisting hypertension(OR=1.35,95%CI:1.03-1.89),PPD symptoms(EPDS≥11)at 2 days postpartum(OR=6.15,95%CI:1.32-28.35),high prenatal self-rating anxiety scale score(OR=1.13,95%CI:1.06-1.18),and pain at 6 weeks postpartum(OR=2.16,95%CI:1.28-3.66)were independently associated with PPD.CONCLUSION Risk factors for PPD after cesarean section in women with early-onset preeclampsia include advanced age(age>40 years),pre-pregnancy obesity,previous preeclampsia,gestational diabetes mellitus,preexisting hypertension,PPD symptoms(EPDS≥11)at 2 days postpartum,prenatal anxiety,and pain at 6 weeks postpartum.The early identi-fication of these factors and interventions can mitigate the risk of PPD.

Antidepressant effects of Peiyuan Jieyu formula in a mouse model of chronic stress in conjunction with lipopolysaccharide-induced depression

Objective:To explore the mechanism of the Peiyuan Jieyu formula in treating depression by assessing its impact on a lipopolysaccharide-induced(LPS-induced)depression mouse model.Methods:We created a mouse model of depression by exposing mice that had previously received chronic stress to intraperitoneal LPS injections.The mice were divided into the following groups:control,model,fluoxetine,Tiansi Yin,Sini powder,and low-,medium-,and high-dose Peiyuan Jieyu formula groups.Forced swim and tail suspension tests were used to assess the efficacy of the depression(despair)model,and weight gain rates were also measured.Furthermore,serum levels of various depression and inflammation-associated molecules,including tumor necrosis factor-a(TNF-a),interferon-γ(IFN-γ),tryptophan,5-hydroxytryptamine,kynurenine(KYN),and kynurenic acid(KA)were assessed.Furthermore,the expression levels of ionic calcium-binding adaptor molecule-1(IBA-1)and indoleamine 2,3-dioxygenase(IDO)mRNA in hippocampal microglia were measured.Results:The model group displayed greater despair-associated immobility,which was shortened in response to various doses of Peiyuan Jieyu formula.Furthermore,formula administration significantly reduced serum TNF-a levels and hippocampal IDO mRNA expression.The high formula dose also reduced IFN-γand IBA-1 levels,the latter was also decreased in response to the medium formula dose.However,the low formula dose reduced serum KYN level and KYN/tryptophan(TRP)and KYN/KA ratios.Conclusion:The Peiyuan Jieyu formula holds immense potential in treating depression in a mouse model,potentially inhibiting inflammation and improving TRP-KYN metabolic disorders.

Assessing myocardial indices and inflammatory factors to determine anxiety and depression severity in patients with chronic heart failure

BACKGROUND Patients with chronic heart failure(CHF)have a progressive disease that is associated with poor quality of life and high mortality.Many patients experience anxiety and depression(A&D)symptoms,which can further accelerate disease progression.We hypothesized that indicators of myocardial function and inflammatory stress may reflect the severity of A&D symptoms in patients with CHF.Changes in these biomarkers could potentially predict whether A&D symptoms will deteriorate further in these individuals.AIM To measure changes in cardiac and inflammatory markers in patients with CHF to determine A&D severity and predict outcomes.METHODS We retrospectively analyzed 233 patients with CHF treated at the Jingzhou Hospital,Yangtze University between 2018-2022 and grouped them according to Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores.We compared clinical data in the no-A&D,mild-A&D,moderate-A&D,and severe-A&D groups,the SAS and SDS scores with the New York Heart Association(NYHA)functional classification,and cardiac markers and inflammatory factors between the no/mild-A&D and moderate/severe-A&D groups.Regression analysis was performed on the markers with P<0.05 to determine their ability to predict A&D severity in patients and the area under the receiver operating characteristic curve(AUROC)was used to evaluate their accuracy.RESULTS In the inter-group comparison,the following variables had an effect on A&D severity in patients with CHF:NYHA class,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,N-terminal pro-brain natriuretic peptide(NT-proBNP),interleukin-6(IL-6),and tumor necrosis factor-alpha(P<0.05).Other variables did not differ significantly between the A&D groups(P>0.05).In addition,we found that higher NYHA classes were associated with higher the SAS and SDS scores(P<0.05).Regression analysis showed that LVEF,NTproBNP,and IL-6 were independent risk factors for A&D severity(P<0.05).Among them,NT-proBNP had the best predictive ability as a single indicator(AUROC=0.781).Furthermore,the combination of these three indicators exhibited a good predictive effect toward discriminating the extent of A&D severity among patients(AUROC=0.875).CONCLUSION Cardiac and inflammatory biomarkers,such as LVEF,NT-proBNP,and IL-6,are correlated with A&D severity in patients with CHF and have predictive value.

Antidepressant effects of Yuanzhi (Polygalae Radix) extract on chronic unpredictable mild stress-induced depression in rats: modulation of the NLRP3 inflammasome and NF-κB pathway

Objective To investigate the antidepressant effects of Yuanzhi(Polygalae Radix;PR)aqueous extract on chronic unpredictable mild stress(CUMS)-induced depression rat models and the underlying mechanisms.Methods A total of 40 male Sprague Dawley(SD)rats were randomly divided into control;model;low dose of PR(PR-L;0.5 g/kg);high dose of PR(PR-H;1 g/kg);and fluoxetine(10 mg/kg)groups;with 8 rats in each group.Except for the rats in control group;those in the other four groups underwent CUMS-induced depression modeling.PR and fluoxetine were administered intragastrically once daily;30 min prior to the CUMS procedure;for 14 consecu-tive days until the behavioral tests were performed.After CUMS modeling;the sucrose prefer-ence test(SPT);open field test(OFT);novelty-suppressed feeding test(NSFT);forced swim test(FST);and tail suspension test(TST)were employed to assess the pharmacological ef-fects of PR on the mitigation of depressive-like behaviors in rat models.Additionally;the en-zyme-linked immunosorbent assay(ELISA)was utilized to quantify the serum levels of tumor necrosis factor(TNF)-α;interleukin(IL)-6;and IL-1βin the rats.Western blot analysis was al-so conducted to evaluate the protein expression levels of nuclear factor kappa-B(NF-κB);in-ducible nitric oxide synthase(iNOS);cyclooxygenase-2(COX-2);nucleotide-binding oligomerization domain(NOD)-like receptor family pyrin domain containing 3(NLRP3);apoptosis-associated speck-like protein containing caspase recruitment domain(ASC);and caspase-1 in the hippocampal tissues of the rats.Immunofluorescence staining was per-formed to observe the morphological changes in ionized calcium-binding adapter molecule 1 positive(Iba-1+)cells in the dentate gyrus(DG)of rats with CUMS-induced depression.Results(i)Treatment with PR-H and fluoxetine resulted in significant enhancements in both the total distance and time the rats moved during tests(P<0.01 and P<0.05;respectively).Post-administration of PR-H and fluoxetine also led to statistically significant increase in su-crose preference among rats(P<0.05).Besides;PR-L;PR-H;and fluoxetine treatment markedly decreased the latency of ingestion(P<0.05;P<0.05;and P<0.01;respectively).As observed from the FST;PR-L;PR-H;and fluoxetine presented antidepressant effects on rats with CUMS-induced depression;leading to the reduction in time of their immobility(P<0.05;P<0.01;and P<0.01;respectively).The results of TST indicated reduced immobility time in rats receiving PR-H and fluoxetine treatment as well(P<0.01).(ii)Rats in model group showed an increase in the levels of Iba-1+microglia in their left and right brains in compari-son with control group(P<0.01).However;such increase was negated post PR treatment(P<0.01).Treatment with PR-L;PR-H;and fluoxetine considerably reduced the levels of inflam-matory factors(TNF-α;IL-1β;and IL-6;P<0.01).In addition;treatment of PR-L and PR-H ef-fectively counteracted the elevated levels of NLRP3;ASC;and caspase-1;and markedly down-regulated the expression levels of phosphorylated p65(p-p65);COX-2;and iNOS in rats’hip-pocampus(P<0.01).Conclusion Collectively;these findings indicate that PR exerts an antidepressant effect on rats with CUMS-induced depression partially through the modulation of the NLRP3 and NF-κB signaling pathways.

Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.

Clinical intervention effect of Xuefu Zhuyu decoction on chronic heart failure complicated with depression

BACKGROUND The diagnosis and treatment of depression in patients with chronic heart failure(CHF)is challenging,with no ideal treatment at present.AIM To analyze the clinical intervention effect of Xuefu Zhuyu decoction(XFZYD)on CHF complicated with depression.METHODS The study cohort comprised 116 patients with CHF complicated with depression who received treatment from July 2020 to July 2023,of which 55 received Western medicine(control group)and 61 received XFZYD(research group).Data on clinical effectiveness,traditional Chinese medicine(TCM)syndrome score,cardiac function,negative emotions,and serum inflammatory factors,were collected for comparative analyses.RESULTS Compared with the control group,the research group had an evidently higher total effective rate.Furthermore,there were marked reductions in TCM symptom score,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,Self-Rating Depression Scale,Hamilton Depression Scale,high-sensitivity C-reactive protein,monocyte chemoattractant protein-1,and matrix metalloproteinase-9 in the research group after treatment,and these were lower than the corresponding values in the control group.Left ventricular ejection fraction was increased and higher in the research group compared with the control group after treatment.CONCLUSION Our findings conclusively proved that XFZYD was considerably superior to Western medicine for treating CHF complicated with depression because it significantly alleviated patients’symptoms,improved cardiac function,relieved negative emotions,and reduced the levels of serum inflammatory factors.

Double role of depression in gastric cancer:As a causative factor and as consequence

In this editorial we comment on the article“Hotspots and frontiers of the rela-tionship between gastric cancer and depression:A bibliometric study”.Gastric cancer(GC)is a common malignancy in the digestive system with increased mortality and morbidity rates globally.Standard treatments,such as gastrectomy,negatively impact patients'quality of life and beyond the physical strain,GC patients face psychological challenges,including anxiety and depression.The prevalence of depression can be as high as 57%,among gastrointestinal cancer patients.Due to the advancements in treatment effectiveness and increased 5-year overall survival rates,attention has shifted to managing psychological effects.However,the significance of managing the depression doesn’t lie solely in the need for a better psychological status.Depression leads to chronic stress acti-vating the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis,leading release of catecholamines inducing tumor proliferation,migration,and metastasis,contributing to GC progression.The dysregulation of neurotrans-mitters and the involvement of various signaling pathways underscore the complex interplay between depression and GC.Comprehensive strategies are required to address the psychological aspects of GC,including region-specific interventions and increased monitoring for depression.Understanding the intricate relationship between depression and GC progression is essential for developing effective therapeutic strategies and improving overall outcomes for patients facing this complex disease.In this Editorial we delve into double role of depression in the pathogenesis of GC and as a complication of it.

Potential role of hippocampal neurogenesis in spinal cord injury induced post-trauma depression

It has been reported both in clinic and rodent models that beyond spinal cord injury directly induced symptoms, such as paralysis, neuropathic pain, bladder/bowel dysfunction, and loss of sexual function, there are a variety of secondary complications, including memory loss, cognitive decline, depression, and Alzheimer's disease. The largescale longitudinal population-based studies indicate that post-trauma depression is highly prevalent in spinal cord injury patients. Yet, few basic studies have been conducted to address the potential molecular mechanisms. One of possible factors underlying the depression is the reduction of adult hippocampal neurogenesis which may come from less physical activity, social isolation, chronic pain, and elevated neuroinflammation after spinal cord injury. However, there is no clear consensus yet. In this review, we will first summarize the alteration of hippocampal neurogenesis post-spinal cord injury. Then, we will discuss possible mechanisms underlie this important spinal cord injury consequence. Finally, we will outline the potential therapeutic options aimed at enhancing hippocampal neurogenesis to ameliorate depression.

Quercetin regulates depression-like behavior in CUMS rat models via TLR4/NF-κB signaling

Background:Depression is becoming increasingly prevalent around the world,imposing a substantial burden on individuals,families,as well as society.Quercetin is known to be highly effective in treating depression.However,additional research is needed to dissect the mechanisms of its anti-depressive effects.Methods:For this study,Sprague-Dawley(SD)rats were randomized into the control,model,quercetin,or fluoxetine group.The latter three groups were exposed to chronic unpredictable mild stress(CUMS)for 42 d.The first two groups received saline solution daily via oral gavage.Meanwhile,the quercetin group was orally administered a quercetin suspension(52.08 mg/kg)every day,while the fluoxetine group was orally administered a fluoxetine solution(2.08 mg/kg).Here,fluoxetine served as the positive control drug to compare the therapeutic effects of quercetin.The experimental period was 6 weeks.Depressive behaviors in rats were assessed through various physiological and behavioral measures.Additionally,pathological changes in hippocampal tissues were examined using Nissl staining.Serum cytokines were detected using an enzymelinked immunosorbent assay(ELISA),and immunohistochemistry was employed to quantify the levels and integral optical density(IOD)values of ionized calcium binding adaptor molecule-1(Iba-1)expression in the brain.Real-time fluorescence quantitative PCR(RT-qPCR)was utilized to evaluate the mRNA levels of inflammatory indicators as well as toll-like receptor 4(TLR4),and nuclear factor-κappa B P65(NF-κB P65)in hippocampus.Western blot(WB)technique was employed to observe the protein levels of TLR4,NF-κB P65,and phospho-NF-κB P65(p-NF-κB P65).Results:After 42 d of exposure to CUMS,rats exhibited a slow increase in body weight,a reduction in food intake,an abnormal preference for sugar water,and aberrant open-field behaviors.Pathological analysis revealed the disintegration,rupture,interruption,and disorganization of hippocampal neuronal cells after CUMS exposure,along with a decrease in Nissl bodies in the CA1 region.This was accompanied by the elevated expression of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)in the serum and the upregulation of IL-1β,IL-6,and TNF-αmRNA expression in the hippocampus.Increases in Iba-1-positive cells and the IOD values of Iba-1 were detected in hippocampal microglia.Furthermore,TLR4 and NF-κB P65 mRNA and protein levels were upregulated in hippocampal tissues.Quercetin,an antidepressant,could alleviate depression-like symptoms in rats and downregulate inflammatory factors associated with the TLR4/NF-κB signaling pathway in hippocampal microglia,and its therapeutic effect was comparable to fluoxetine.Conclusion:In rat models of CUMS,quercetin may act as an antidepressant by inhibiting inflammation in hippocampal microglia via TLR4/NF-κB signaling pathway.These results offer experimental and theoretical support for applying quercetin in the clinical management of depression.

Anxiety, Depression and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common and frequently occurring disease, which not only has a higher fatality rate, but also leads to loss of labor force and an obvious decrease in the quality of life in the course of long-term disease, patients with chronic obstructive pulmonary disease complicated with anxiety and depression are a major public health problem. Objective: To investigate the status of anxiety, depression and quality of life and related factors in patients with COPD. Methods: One hundred patients admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Dali University with chronic obstructive pulmonary disease evaluated by anxiety self-assessment scale, depression self-assessment scale and quality of life rating scale for patients with chronic obstructive pulmonary disease. Results: The incidence of anxiety in COPD patients was 82.5%, and the incidence of depression was 87.3%. The probability of both anxiety and depression was high, and the prevalence of women was significantly higher than that of men. Correlation analysis and logistic regression results showed that education level was negatively correlated with the occurrence of anxiety, and age was positively correlated with the occurrence of anxiety. Elderly patients were prone to anxiety and had lower quality of life. Conclusion: The older and less educated the COPD patients are, the higher the incidence of anxiety and depression, and the higher the incidence in female patients.

Virtual Reality as an Adjunct to Ketamine Infusion Therapy Increases Patient Satisfaction in the Management of Chronic Pain and Depression: A Retrospective Pilot Study

The management of patients with concomitant chronic pain (CP) and Major Depressive Disorder (MDD) remains challenging for clinicians. Current chronic pharmacologic management is often unsuccessful, or has intolerable side effects to the patients. While not restricted to patients with chronic pain, these patients are often diagnosed with depression, presenting with symptoms such as poor mood, anhedonia, and altered cognitive processes. It is estimated that a substantial proportion of treated patients do not derive a substantive benefit from traditional pharmacological treatments for depression. The present study involved a retrospective review of cases, exploring the patient-reported satisfaction with and tolerability of a novel use of virtual reality (VR), coined KVR, as an adjunct to intravenous ketamine infusion therapies. Specifically, the ketamine-virtual reality protocol was employed as a potential adjunctive intervention for patients suffering from chronic pain and depression. Visual Analog Scores (VAS) associated with pain were significantly lower on the third than on the first assessment day. Montgomery-?sberg Depression Rating Scale (MADRS) scores improved following infusion and across days (i.e., sessions). Lastly, 2/3 of patients preferred the use of VR with their ketamine infusion. The results are considered in terms of implementing prospective studies to examine whether the combination therapies have a synergistic benefit and the nature and magnitude of clinically meaningful treatment effects, if any.

Analysis of the Status and Factors Influencing Anxiety and Depression in Patients with Chronic Heart Failure and Their Primary Caregivers: Empirical Quantitative Research

Objective: This study examined the associations between anxiety, depression, and quality of life among hospitalized patients with chronic heart failure and their primary caregivers. Patients and Methods: Between May and September 2018, the data were collected from 61 patients and their caregivers. Demographic information of CHF patients was collected by questionnaires; the Hospital Anxiety and Depression Scale (HADS) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used to assess CHF patient’s anxiety, depression and quality of life (QOL); the HADS, the Family Caregiver Quality of Life (FAMQOL) were used to assess primary caregivers’ anxiety, depression and QOL. Descriptive statistics, correlation analysis, independent-sample t-test, one-way analysis of variance and multiple stepwise regression were used in the statistical analysis. SPSS 17.0 was used to manage and perform statistical analyses. Results: Quality of life, anxiety, and depression of the patients and caregivers had significant positive correlations. Gender, quality of life, number of hospitalizations, duration of patients’ heart failure, and the quality of life of caregivers influenced patients’ anxiety. Gender, quality of life, relationship with the patient, and depression of caregivers influenced their anxiety. The quality of life and anxiety of patients influenced their depression. Daily caregiving time, anxiety, relationship with patients, and the patients’ heart function influenced caregivers’ depression. Conclusion: The patients and caregivers experienced anxiety and depression, which interacts and decreases their quality of life. It is important to regularly assess anxiety, depression, and quality of life in patients with chronic heart failure and their primary caregivers.

Independent risk factors for depression in older adult patients receiving peritoneal dialysis for chronic kidney disease

BACKGROUND According to the trend of global population aging,the proportion of elderly patients with chronic kidney disease(CKD)is expected to increase.However,there are more than 20 million people in China with decompensated kidney function,of which 19.25%are elderly people.Therefore,special attention should be paid to the education years,sleep quality,anxiety status,comorbidities with diabetes,cardiovascular disease(CVD),and anemia as independent risk factors for depression in elderly CKD patients.This study explores the clinical management of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis.AIM To investigate depression risk factors in older patients receiving peritoneal dialysis,aiding future prevention of depression in these patients.METHODS This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022.We assessed the patients’mental status using the Beck Depression Inventory Score-II(BDI-II),Self-Rating Anxiety Scale(SAS),Anxiety Inventory Score,and the Pittsburgh Sleep Quality Index(PSQI).Logistic regression was employed to identify depression independent risk factors among these patients.RESULTS The non-depressed group had a significantly longer education period than the depressed group(P<0.05).The depressed group exhibited significantly higher mental status scores than the non-depressed group(P<0.001).Patients with diabetes mellitus(DM)or CVD had a higher probability of developing depression.Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression(P<0.05).Spearman correlation analysis of BDI-II scale scores,measuring depression,indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD.In contrast,years of education,hemoglobin levels,and peritoneal Kt/V were negatively correlated,serving as protective factors against depression.An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling,BDI-II,SAS,PSQI,DM,CVD,and hemoglobin levels independently influenced depression in older patients with CKD.CONCLUSION Education,BDI-II,SAS,PSQI,DM,and CVD are independent risk factors for depression in older patients with CKD;therefore,post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.

Shuganheweitang Ameliorates Chronic Unpredictable Mild Stress-Induced Depression-Like Behaviors in Rats through the PI3K/AKT/mTOR Pathway: Involvement of Amino Acids, Glycerophospholipids, and Energy Metabolism

Background: Depression is a typical psychosomatic disease. Shuganheweitang (SGHWT) is a clinical formula that effectively treats depression. However, the potential mechanism used by SGHWT to ameliorate depression-like behaviors is still unclear. This study investigated the effects of SGHWT on metabolic change in the liver and hypothalamus with signaling pathways involved in chronic unpredictable mild stress (CUMS)-induced depression in rats to explore the mechanism of the anti-depressive effect. Methods: A total of 52 rats were used to create a model of depression by CUMS combined with solitary rearing for 6 weeks. Open field test (OFT), sucrose preference test (SPT), forced swim test (FST), and body weight (BW) were performed to analyze the pharmacodynamic effects of SGHWT. H&E staining, Nissl staining, immunofluorescence, immunohistochemistry, and western blot were used to evaluate the mechanism of action. Untargeted metabolomics techniques by ultra-performance liquid chromatography-quantitative time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS) were used to analyze all the metabolic differences in the liver and hypothalamus. Results: SGHWT improved CUMS-induced depression-like behaviors in vivo. SGHWT reduced hepatic c-Fos protein expression and increased hypothalamic c-Fos protein expression. Moreover, p-PI3K, p-AKT473, p-AKT308, and p-mTOR protein expressions were significantly downregulated in the liver and hypothalamus of CUMS rats. Notably, these alterations were reversed by the SGHWT administration. Furthermore, the metabolomic analysis identified 15 and 5 key differential SPT-associated metabolites in the liver and hypothalamus, respectively. Conclusion: This study suggests that SGHWT ameliorates chronic unpredictable mild stress-induced depression-like behaviors, by the involvement of amino acids, glycerophospholipids, energy metabolism, and the PI3K/AKT/mTOR pathway. Highlights: 1) Shuganheweitang was derived from the TCM herbal formula Sinisan. 2) SGHWT treatment reverses depression-like behaviors in CUMS-induced rats. 3) The mechanism of SGHWT on depression by the liver and hypothalamus metabolomics. 4) SGHWT regulates amino acids, glycerophospholipids, and energy metabolism. 5) SGHWT exerts antidepressant effects through the PI3K/AKT/mTOR pathway.

RANDOMIZED CONTROL STUDY ON DEPRESSION INDUCED BY CHRONIC PAIN TREATED WITH ACUPUNCTURE

Objective To study and verify the efficacy of acupuncture on depression caused by chronic pain and to further analyze the advantages of acupuncture. Methods According to random number table, the cases were randomized into experimental group and western medicine group, treated with acupuncture and antidepression drug （deanxit） respectively. Hamilton Depressive Scale （HAMD） and Visual Analogue Scale （VAS） were adopted for the evaluation before treatment and in the 1, 2 and 4 weeks after treatment in two groups successively. Results ① Very significant differences had been achieved on the comparisons of HAMD, VAS and HAMD reducing rate before and after treatment in experimental group （P 〈 0.01）. Very significant differences had been achieved in the comparisons of HAMD, VAS and HAMD reducing rate before and after treatment in western medicine group （P 〈 0.01 ）. ③Significant differences in HAMD reducing rate^＊ and VAS score^＊ ＊ had been achieved in the comparison between experiment group and western medicine group 1 week after treatment （^＊ P〈0.01, ^＊ ＊ P〈0.05）. ④ The significant differences had not been received in HAMD, VAS score and HAMD reducing rate in 2 and 4 weeks after treatment in the comparison between experimental group and western medicine group （P 〉0.05）. ⑤ No any harmful effect happened in experimental group after treatment, but it happened in western medicine group. Conclusion Both acupuncture and deanxit have achieved the definite therapeutic effects on depression caused by chronic pain, with similar efficacy. But the effects of acupuncture are obtained more quickly. In comparison of western medicine, acupuncture has no side and harmful effect. Additionally, acupuncture applies the multi-targeting and holistic modulation to the whole body.

Dynamic changes of behaviors, dentate gyrus neurogenesis and hippocampal miR-124 expression in rats with depression induced by chronic unpredictable mild stress

The depression-like behavior phenotype,neurogenesis in the dentate gyrus and miR-124 expression in the hippocampus are the focus of current research on the pathogenesis of depression and antidepressant therapy.The present study aimed to clarify the dynamic changes of depression-like behavior,dentate gyrus neurogenesis and hippocampal miR-124 expression during depression induced by chronic stress to reveal pathological features at different stages of depression and to further provide insight into depression treatment.Chronic unpredictable mild stress depression models were established by exposing Sprague-Dawley rats to various mild stressors,including white noise,thermal swimming,stroboscopic illumination,soiled cages,pairing with three other stressed animals,cold swimming,tail pinch,restraint and water and food deprivation.Chronic unpredictable mild stress model rats underwent dynamic observation from 1 to 8 weeks and were compared with a control group(normal feeding without any stressors).To observe changes in the depression-like behavior phenotype during chronic unpredictable mild stress-induced depression,a sucrose preference test was used to evaluate the degree of anhedonia.An open-field test was used to evaluate locomotor activity and anxiety status.Compared with the control group,chronic unpredictable mild stress rats lost weight but did not have a depression-like behavioral phenotype at 1-4 weeks.Chronic unpredictable mild stress rats presented decreased sucrose preference and locomotor activity at 5-8 weeks.In addition,chronic unpredictable mild stress rats did not have significant anxiety-like behavior during 1-8 weeks of modeling.To observe neurogenesis dysfunctions and changes in neuronal number in the dentate gyrus during chronic unpredictable mild stress-induced depression,markers(DCX and DCX/BrdU)of neural proliferation and differentiation and the neuronal marker NeuN were assessed by immunofluorescence.Compared with the control group,neurogenesis and the neuronal number in the dentate gyrus did not change from 2 to 6 weeks;however,neural proliferation and differentiation in the dentate gyrus decreased,and the number of neurons decreased until the eighth week in the chronic unpredictable mild stress group.Real-time quantitative reverse transcription polymerase chain reaction assays and fluorescence in situ hybridization were used to measure the expression of hippocampal miR-124 during chronic unpredictable mild stress-induced depression.The results showed that the expression of hippocampal miR-124 was unchanged during the first 4 weeks but increased from 5 to 6 weeks and decreased from 7 to 8 weeks compared with the control group.These findings indicate that during chronic unpredictable mild stress-induced depression,the behavioral phenotype,miR-124 expression in the hippocampus,neurogenesis in the dentate gyrus and neuronal numbers showed dynamic changes,which suggested that various pathological changes occur at different stages of depression.All experimental procedures and protocols were approved by the Experimental Animal Ethics Committee of Guangzhou University of Chinese Medicine of China in March 2015.

Association of erectile dysfunction with depression in patients with chronic viral hepatitis

AIM: To investigate the prevalence of erectile dysfunction(ED) and its association with depression in patients with chronic viral hepatitis.METHODS: This single center cross-sectional study was conducted from August 2013 through January 2014. All outpatients with chronic viral hepatitis in our liver clinic between 18 and 80 years of age were considered eligible for this study. The exclusion criteria included well-established causes of ED, such as diabetes, hypertension, hyperlipidemia, alcohol abuse, liver cirrhosis, ischemic heart disease, renal disease, neurologic disease, and malignancy. We also excluded the patients who had incompletely answered the questionnaires. ED was assessed using the validated Korean version of the International Index of Erectile Function(IIEF-5) scale. The Korean version of the self-administered Beck Depression Inventory(BDI) scale was used to assess depression in the patients. Demographic and medical data were obtained from the patients' medical records. Current or past history of psychiatric diagnosis and drug history including the use of an antiviral agent and an antidepressant were also recorded. RESULTS: A total of 727 patients met the initial eligibility criteria. Six hundred seventeen patients were excluded because their medical records contained one or more of the previously determined exclusion criteria. The remaining 110 patients were assessed based on the BDI and IIEF-5 questionnaires. Based on the IIEF-5 scale, the prevalence of ED among patients with chronic viral hepatitis was 40%. Compared with the non-ED group, patients in the ED group were older. The proportion of patients in the ED group who had a job or who were na?ve peg-interferon users was lower than that in patients in the non-ED group. Patients with ED had significantly lower scores on the IIEF-5 scale than patients without ED(11.75 ± 4.88 vs 21.33 ± 1.86, P = 0.000). Patients with ED rated significantly higher scores on the BDI scale compared with patients without ED(12.59 ± 7.08 vs 5.30 ± 4.00, P = 0.000). Also, the IIEF-5 scores were negatively correlated with age, employment, and BDI scores. In the multiple logistic regression analysis, age and depression were independently associated with erectile dysfunction(P =0.019 and 0.000,respectively).CONCLUSION:Patients with chronic viral hepatitis have a high prevalence of ED.Age and depression are independent factors for ED in male patients with chronic viral hepatitis.

Relationships between Chronic Diseases and Depression among Middleaged and Elderly People in China: A Prospective Study from CHARLS

Given the rapid increase in the prevalence of chronic diseases in aging populations,this prospective study including 17707 adults aged≥45 years from China Health and Retirement Longitudinal Study was used to estimate the associations between chronic discase,multimorbidity,and depression among middle-aged and elderly adults in China,and explore the mediating factors.Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale(CES-D-10)questionnaire.Twelve chronic physical conditions,including hypertension,diabetes,dyslipidemia,cancer,chronic lung disease,liver disease,heart failure,stroke,kidney disease,arthritis or rheumatism,asthma,digestive disease were assessed.The prevalence rates for physical multimorbidity and depression(CES-D-10≥10)were 43.23%and 36.62%,respectively.Through multivariable logistic models and generalized estimating equation(GEE)models,we found all 12 chronic physical conditions,and multimorbidity were significantly associated with depression.Both mobility problems and chronic pain explained more than 30%of the association for all chronic conditions,with particularly high percentages for stroke(51.56%)and cancer(51.06%)in mobility problems and cancer(53.35%)in chronic pain.Limited activities of daily living(ADL)explained 34.60%of the stroke-cancer relationship,while sleep problems explained between 10.15%(stroke)and 14.89%(chronic lung disease)of the association.Individuals with chronic diseases or multimorbidity are significantly more likely to be depressed.Functional symptoms involving limitations of ADL and mobility difficulties mediated much of the association between chronic diseases and incident depression.These symptoms could be targeted for interventions to ameliorate the incidence of depression among individuals with chronic conditions.

Combined Effects of Chronic Obstructive Pulmonary Disease and Depression on Spatial Memory in Old Rats

Objective To investigate the combined effects of chronic obstructive pulmonary disease(COPD)and depression on spatial memory in old rats,aiming to better understand the comorbidity of the two diseases in geriatric patients.Methods The SD rats were assigned into five groups:adult control group(n=6),elderly control group(n=6),elderly COPD group(n=6),elderly depression group(n=6)and elderly COPD with depression group(n=6).Smoking and chronic unpredictable mild stress(CUMS)with solitary support were used to induce COPD model,depression model,respectively,and the both were applied for the comorbidity model.Learning and memory deficits were assessed by Morris water maze(MWM)test.The activity of superoxide dismutase(SOD)and the content of malondialdehyde(MDA)in serum and hippocampus tissue were determined by Xanthinoxidase method and Thiobarbituric acid reaction(TBAR)method,respectively.Results The results of pulmonary histology,lung function,open-field test and sucrose consumption demonstrated the comorbidity models of COPD and depression in elderly rats were successfully established using smoking and CUMS with solitary support.Compared with the elderly control group,the group of COPD with depression had obviously longer time of latency and longer travel distance to reach the platform in MWM test(LSD-t=-10.116,P=0.000;LSD-t=-6.448,P=0.000).The SOD activity in serum and hippocampus decreased significantly(LSD-t=2.629,P=0.014;LSD-t=2.215,P=0.044)and the MDA content in serum and hippocampus increased significantly(LSD-t=-2.140,P=0.042;LSD-t=-2.070,P=0.049)in elderly COPD with depression group.Conclusions COPD in comorbidity of depression could induce spatial memory deficit in old rats.The mechanisms might be related to the overloaded and free radical metabolic imbalance.These results suggest a potential therapeutic target for comorbidity of COPD and depression in geriatric patients.

Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study

AIM To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.METHODS A total of 1736 patients with chronic digestive systemdiseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A selfdesigned General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient's general information, which included demographic data(including age, sex, marital status, and education) and disease characteristics(including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).RESULTS The overall detection rate was 31.11%(540/1736) for depression symptoms alone, 27.02%(469/1736) for anxiety symptoms alone, 20.68%(359/1736) for both depression and anxiety symptoms, and 37.44%(650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression(44.06%) and anxiety symptoms(33.33%). χ2 trend test showed: the higher the body mass index(BMI), the lower the detection rate of depression and anxiety symptoms(χ2trend = 13.697, P < 0.001; χ2trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms(χ2trend = 130.455, P < 0.001, χ2trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms(χ2trend = 85.759, P < 0.001; χ2trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression(57.55%) and anxiety(55.19%), followed by patients with liver cirrhosis(41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease. CONCLUSION Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.