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Objective: This study aims to investigate the effectiveness of mindfulness-based cognitive therapy (MBCT) combined with medication therapy in preventing the recurrence of major depressive disorder (MDD) in convalescent patients. Methods: A total of 130 patients with convalescent MDD were enrolled in this prospective study. Sixty-five patients were assigned to the experimental group and received medication therapy combined with MBCT, and 65 patients were assigned to the control group and treated with medication alone. The recurrence rate and related hormonal changes were compared between the two groups. Results: After 1 year of MBCT intervention, eight patients experienced recurrence in the experimental group, a recurrence rate of 12.31%, and 19 patients experienced recurrence in the control group, a recurrence rate of 29.23%. The Hamilton Depression Rating Scale (HAM-D) and the World Health Organization Quality of Life Scale (WHOQOL-BREF) scores in both the experimental and the control groups were significantly improved after treatment (P < 0.05). The difference in the HAM-D scores before and after treatment in the experimental group was 16.74 ± 4.54; this was significantly higher than that of the control group (8 ± 3.89, P < 0.0001). The WHOQOL-BREF scores in the experimental group were significantly improved compared with those of the control group (P < 0.0001). The differences in the levels of corticotrophin-releasing hormone (CRH), adrenocorticotropic hormone, and cortisol before and after treatment in the experimental group and the control group were statistically significant (P < 0.05). The difference in CRH before and after treatment in the experimental group was 16.8 ± 7.2, which was higher than that of the control group (2.75 ± 9.27, P < 0.0001). The intervention with MBCT had a significant impact on the recurrence of MDD [ß = 1.206, P = 0.039, 95% (confidence interval) CI = 0.0790-1.229]. The difference in the HAM-D scores also had a significant impact on the recurrence of MDD (ß = 1.121, P = 0.0014, 95% CI = 0.805-0.976). Conclusion: Compared with medication therapy alone, the use of MBCT combined with medication therapy can effectively prevent the recurrence of MDD in convalescent patients.

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OBJECTIVE: The present study aims to (1) follow up with 4-year changes in the efficacy outcome, defense style questionnaire (DSQ) score, and clinical features of patients with obsessive-compulsive disorder (OCD) and (2) analyze the relationship between different levels of efficacy and changes in the patients' psychological defense mechanisms. METHODS: The following data collection and 4-year follow-up were completed for 153 patients with OCD: (1) the treatment process, efficacy outcome, course of disease, and clinical features of OCD were collected using a self-made general information questionnaire and (2) the control method was used to analyze the changes in clinical symptoms (Yale-Brown obsessive compulsive scale [YBOCS], Hamilton anxiety score [HAMA], and Hamilton depression scale [HAMD]) in patients with OCD. Moreover, the changes in the psychological defense mechanism (measured by DSQ) and the relation between the prognosis and DSQ score were investigated. RESULTS: (1) The HAMA score (8.7 ±â€¯4.8 points), HAMD score (12.0 ±â€¯6.6 points) and YBOCS score (16.4 ±â€¯8.4 points) were significantly lower during the follow-up than at the time of enrollment (p < 0.01). In the two DSQ evaluations, there were no significant differences in the factors, with the exception of a significant decrease in the use of "reaction formation" (t = 2.533, p = 0.015). The changes of mature defense factors in the significant efficacy group significantly increased (p < 0.01). Which was mainly manifested in the significant increase in the score of "sublimation" item, and the difference was extremely significant (t = -3.093, p = 0.006). CONCLUSION: An abnormal psychological defense mechanism plays an important role in OCD, and the use of a mature defense mechanism is significantly related to the treatment efficacy.

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BACKGROUND AND OBJECTIVES: To evaluate the effectiveness of insulin addition to the total nutrition admixture (TNA) for glycemic control among patients with gastric cancer (GC) receiving supplementary parenteral nutrition (SPN) after gastrectomy. METHODS AND STUDY DESIGN: A retrospective cohort study was conducted among 208 noncritical ill patients who underwent gastrectomy for GC from 2017 to 2019 at a tertiary teaching hospital in Lanzhou, China. All the included patients received individualized SPN and enteral nutrition treatment after gastrectomy. The patients were randomly divided into insulin and noninsulin groups based on the TNA composition. Blood glucose (BG) measurements, glycemic fluctuation, and hypoglycemia incidence during SPN were compared between the two groups. The postoperative comprehensive complications index (CI) and infections were compared according to insulin regimen and postoperative glycemic status. RESULTS: The mean BG was significantly lower and fluctuated less in the insulin group than in the noninsulin group (p<0.05). One unit of insulin per 6 g of parenteral nutrition glucose addition to TNA did not increase hypoglycemia incidence (p>0.05). Comparing CI and the infection rate, no significance was observed between the insulin and noninsulin groups, but a higher postoperative CI was observed in patients with hyperglycemia than in euglycemic patients (p<0.05). CONCLUSIONS: Appropriate insulin addition to TNA has an overall positive effect on glycemic management in patients with noncritical GC who received SPN after gastrectomy. Postoperative glycemic status was associated with the incidence of relevant complications. Further research is needed for conclusive recommendations.

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OBJECTIVE: The present study provides an overview of studies investigating white matter (WM) integrity in patients with obsessive-compulsive disorder (OCD) using diffusion tensor imaging (DTI). Furthermore, it studies the correlation of fractional anisotropy (FA) in abnormal cerebral WM areas with the course and clinical signs of the disease. METHODS: The study subjects were divided into two groups, the OCD group (n=38) and the control group (n=40), based on the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) diagnostic criteria for OCD. Patients with untreated first-episode OCD were assigned to the OCD group, while healthy volunteers were assigned to the control group. The study group was evaluated in accordance with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). Subjects who met the inclusion criteria underwent whole-brain scanning via 3.0 T structural magnetic resonance imaging (sMRI). The WM FA values in different brain areas were compared between the two groups using voxel-based analysis (VBA). Subsequently, the correlations of the patient Y-BOCS score and disorder course with the FA values in significantly improved encephalic areas were analyzed. RESULTS: (I) The FA values of the right precentral gyrus (PreCG.R), left insular lobe, left inferior frontal gyrus and right inferior occipital gyrus (Occipital_Inf_R) WM were significantly lower in the OCD group than in the control group (P<0.05). Elevated FA values were not observed in the OCD group. (II) FA values of PreCG.R, left insular lobe/left inferior frontal gyrus, and Occipital_Inf_R were not found in relation to the total Y-BOCS score (P=0.122; P=0.401; P=0.134), obsessional thoughts score (P=0.299; P=0.760; P=0.062), compulsive activities checklist (P=0.487; P=0.420; P=0.431), and disease course (P=0.604; P=0.380; P=0.182). CONCLUSIONS: Multiple microstructural cerebral WM changes were observed in the frontal lobe, occipital lobe, and insula in patients with untreated first-episode OCD, presenting the correlation of these changes with OCD occurrence.

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Objective: Mindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial program that prevents relapse/recurrence in major depression. The present study aimed to analyze the effects of augmented MBCT along with standard treatment dominated by pharmacotherapy on psychological state, compliance, brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) expression levels in patients with depression. Methods: A total of 160 eligible patients with depression in The First Affiliated Hospital of Zhengzhou University were included in this study. The study randomly assigned the patients to the experimental group (n = 80) and control group (n = 80). All participants were assessed with the questionnaires including the 17-item Hamilton Depression Rating Scale (HAMD-17), Rosenberg Self-esteem Scale (RSES), Self-Acceptance Questionnaire (SAQ), and Stigma Scale (Scale of Stigma in People with Mental Illness, SSPM). The serum levels of BDNF and NGF were detected by enzyme-linked immunosorbent assay (ELISA). Results: After 8 weeks of treatment, the experimental group showed significant lower HAMD-17 score, higher RSES, and SAQ score, as well as lower SSPM score compared with the control group (P < 0.01). Furthermore, ELISA revealed that the serum levels of BDNF and NGF remarkably increased in the experimental group after treatment (P < 0.001). Conclusions: Our data showed that augmented MBCT combined with pharmacotherapy contributed to improvement on patients' psychological state, compliance, and disease recurrence.

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OBJECTIVE: Bone marrow mesenchymal stem cells (BMSCs)-derived exosomes have been widely applied in disease therapies. However, the role of BMSCs-derived exosomes in depression remains obscure. This study aims to explore the mechanism of BMSCs-derived exosomal microRNA-26a (miR-26a) on hippocampal neuronal injury of depressed rats. METHODS: BMSCs and their exosomes were obtained and identified. Rat models of depression were established by corticosterone injection, then injected with BMSCs-derived exosomes. The contents of superoxide dismutase (SOD), imalondialdehyde (MDA), lactate dehydrogenase (LDH), tumor necrosis factor α (TNF-α), and interleukin-1ß (IL-1ß) in rats' serum, hippocampal tissues and neurons were determined. The expression of miR-26a in hippocampal tissues and neurons was detected by RT-qPCR. The injury models of rat hippocampal neurons were established to figure out the role of BMSCs-derived exosomes and miR-26a in neuron apoptosis and proliferation. RESULTS: In hippocampal tissues of depressed rats, miR-26a was lowly expressed, and BMSCs-derived exosomes upregulated miR-26a expression. BMSCs-derived exosomes restrained apoptosis in hippocampal tissues of depressed rats. BMSCs-derived exosomes and upregulated miR-26a elevated SOD level, lessened MDA, LDH, TNF-α and IL-1ß levels, boosted hippocampal neuron proliferation and suppressed apoptosis in depressed rats. CONCLUSION: Collectively, our study reveals that miR-26a is lowly expressed in depressed rats, and BMSCs-derived exosomes improve hippocampal neuron injury of rat with depression by upregulating miR-26a.

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The present study aims to discuss the effect of escitalopram in glial cell line-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF) levels, and 5-Hydroxytryptamine (5-HT) in obsessive-compulsive disorder rats. A total of 42 rats were divided into three groups randomly: control group (n = 14), model group (n = 14) (obsessive-compulsive disorder group), and escitalopram group (n = 14) (model + obsessive-compulsive disorder group + escitalopram treatment). The open-field method was used to test the rat behavior, enzyme-linked immunosorbent assay (ELISA) was used to determine the serum GDNF and BDNF levels. In addition, Western blot was used to determine the brain tissue protein levels of GDNF and BDNF and high-performance liquid chromatography + electrochemistry method to determine the 5-HT level of brain tissue. Visiting place was changed, rotational frequency and fixed duration enhanced in escitalopram group compared to model group (P < 0.05). Besides, GDNF and BDNF levels of serum and brain tissue were decreased in model group and escitalopram group compared to control group (P < 0.05), while GDNF and BDNF levels of serum and brain tissue were increased in escitalopram group compared to model group (P < 0.05). Moreover, the 5-HT level of brain tissue in escitalopram group was higher than that in model group (P < 0.05). Escitalopram could increase GDNF and BDNF levels and 5-HT content in serum and brain tissue in obsessive-compulsive disorder rats, which contributes to a function on the treatment of obsessive-compulsive disorder.

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OBJECTIVE: To analyse the synergistic effect of polymorphism of the tandem repeat sequence u-VNTR of 5-hydroxytryptamine 2A (5-HT2A) receptor gene and monoamine oxidase A (MAOA) gene on the negative emotion in frontal lobe of patients with depression through functional magnetic resonance imaging (fMRI) technique. METHODS: Functional magnetic resonance imaging scanning was performed for 72 patients with depression and 70 gender, age-matched healthy people with physical examination under negative emotion recognition task. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was adopted to analyse genotype. The superior, middle and inferior gyrus of bilateral frontal lobe was regarded as the brain region of interest, and then the difference of activation intensity in frontal lobe subregion between control groups and patient groups with different genotypes, and the interaction between the two kinds of polymorphism were compared. RESULTS: The activation intensity in right frontal middle gyrus of patients with CC genotype increased obviously compared with TT and TC genotype patient groups and TT genotype control group (P<0·01); the activation intensity in right frontal inferior gyrus of patients with CC genotype increased obviously compared with TT and TC genotype patient groups and control groups (P<0·01); the activation intensity in right frontal middle gyrus and left frontal inferior gyrus of patients with MAOA high-activity genotype increased obviously compared with patient and control groups with MAOA low-activity genotype (P<0·01). In sum, there existed synergistic effect of the two genotypes on the activation abnormality of negative emotion recognition in right frontal middle gyrus (F = 6·18, P = 0·029). The negative activation in right frontal middle gyrus of patients with CC+H genotypes increased most obviously (P<0·05). CONCLUSION: The frontal abnormality of patients with depression had certain 5-HT genetic basis, and 5-HT2A receptor CC allele and MAOA-H genotype had synergistic effect on the activity abnormality when recognizing negative emotion in right frontal middle gyrus of patients with depression.

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