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Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.
Methods
A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.
Results
Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.
Conclusions
The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.
Triceps skinfold thickness (TSF) is a surrogate marker of subcutaneous fat. Evidence is limited about the association of sex-specific TSF with the risk of all-cause mortality among maintenance hemodialysis (MHD) patients. We aimed to investigate the longitudinal relationship of TSF with all-cause mortality among MHD patients. A multicenter prospective cohort study was performed in 1034 patients undergoing MHD. The primary outcome was all-cause mortality. Multivariable Cox proportional hazards models were used to evaluate the association of TSF with the risk of mortality. The mean (standard deviation) age of the study population was 54.1 (15.1) years. 599 (57.9%) of the participants were male. The median (interquartile range) of TSF was 9.7 (6.3–13.3 mm) in males and 12.7 (10.0–18.0 mm) in females. Over a median follow up of 4.4 years (interquartile range, 2.4-7.9 years), there were 548 (53.0%) deaths. When TSF was assessed as sex-specific quartiles, compared with those in quartile 1, the adjusted HRs (95%CIs) of all-cause mortality in quartile 2, quartile 3 and quartile 4 were 0.93 (0.73, 1.19), 0.75 (0.58, 0.97) and 0.69 (0.52, 0.92), respectively (P for trend =0.005). Moreover, when analyzed by sex, increased TSF (≥9.7 mm for males and ≥18mm for females) was significantly associated with a reduced risk of all-cause mortality (quartile 3-4 vs. quartile 1-2; HR, 0.70; 95%CI: 0.55, 0.90 in males; quartile 4 vs. Quartile 1-3; HR, 0.69; 95%CI: 0.48, 1.00 in females). In conclusion, high TSF was significantly associated with lower risk of all-cause mortality in MHD patients.
Patients with chronic insomnia are characterized by alterations in default mode network and alpha oscillations, for which the medial parietal cortex (MPC) is a key node and thus a potential target for interventions.
Methods
Fifty-six adults with chronic insomnia were randomly assigned to 2 mA, alpha-frequency (10 Hz), 30 min active or sham transcranial alternating current stimulation (tACS) applied over the MPC for 10 sessions completed within two weeks, followed by 4- and 6-week visits. The connectivity of the dorsal and ventral posterior cingulate cortex (vPCC) was calculated based on resting functional MRI.
Results
For the primary outcome, the active group showed a higher response rate (≥ 50% reduction in Pittsburgh Sleep Quality Index (PSQI)) at week 6 than that of the sham group (71.4% versus 3.6%) (risk ratio 20.0, 95% confidence interval 2.9 to 139.0, p = 0.0025). For the secondary outcomes, the active therapy induced greater and sustained improvements (versus sham) in the PSQI, depression (17-item Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale), and cognitive deficits (Perceived Deficits Questionnaire-Depression) scores. The response rates in the active group decreased at weeks 8–14 (42.9%–57.1%). Improvement in sleep was associated with connectivity between the vPCC and the superior frontal gyrus and the inferior parietal lobe, whereas vPCC-to-middle frontal gyrus connectivity was associated with cognitive benefits and vPCC-to-ventromedial prefrontal cortex connectivity was associated with alleviation in rumination.
Conclusions
Targeting the MPC with alpha-tACS appears to be an effective treatment for chronic insomnia, and vPCC connectivity represents a prognostic marker of treatment outcome.
Recent studies have increasingly utilized gradient metrics to investigate the spatial transitions of brain organization, enabling the conversion of macroscale brain features into low-dimensional manifold representations. However, it remains unclear whether alterations exist in the cortical morphometric similarity (MS) network gradient in patients with schizophrenia (SCZ). This study aims to examine potential differences in the principal MS gradient between individuals with SCZ and healthy controls and to explore how these differences relate to transcriptional profiles and clinical phenomenology.
Methods
MS network was constructed in this study, and its gradient of the network was computed in 203 patients with SCZ and 201 healthy controls, who shared the same demographics in terms of age and gender. To examine irregularities in the MS network gradient, between-group comparisons were carried out, and partial least squares regression analysis was used to study the relationships between the MS network gradient-based variations in SCZ, and gene expression patterns and clinical phenotype.
Results
In contrast to healthy controls, the principal MS gradient of patients with SCZ was primarily significantly lower in sensorimotor areas, and higher in more areas. In addition, the aberrant gradient pattern was spatially linked with the genes enriched for neurobiologically significant pathways and preferential expression in various brain regions and cortical layers. Furthermore, there were strong positive connections between the principal MS gradient and the symptomatologic score in SCZ.
Conclusions
These findings showed changes in the principal MS network gradient in SCZ and offered potential molecular explanations for the structural changes underpinning SCZ.
This study focused on the effect of the cognitive behavioral therapy (CBT) combined with aripiprazole on cognitive functions and psychological state of schizophrenia patients.
Method:
Seventy-eight schizophrenia patients were divided into two groups. One group received aripiprazole with conventional nursing treatment for 3 months (control group, n = 39), and the other received aripiprazole with CBT for 3 months (observation group, n = 39) (1 session per week, each session lasting 60 minutes. In the two groups before and after treatment, the severity of symptoms was evaluated using the Psychiatric Symptom Rating Scale (BPRS). Cognitive function was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The Positive and Negative Symptom Scale (PANSS) was utilized to evaluate mental status, while the Generalized Self-Efficacy Scale (GSES) measured psychological state. Additionally, the quality of life was assessed using the General Quality of Life Inventory-74 (GQOLI-74). In the final analysis, post-treatment efficacy and complications for the two groups were counted.
Results:
Both groups showed significant improvements: BPRS and PANSS scores decreased, while RBANS, GSES, and GQOLI-74 scores increased. The observation group showed greater improvements than the control group. The total improvement rate was 89.74% (35/39) in the observation group, higher than the 71.79% (28/39) in the control group. The complication rate was 33.33% (13/39) in the observation group and 38.46% (15/39) in the control group.
Conclusion:
The treatment of CBT combined with aripiprazole for schizophrenia has a significantly positive effect on the cognitive functions and psychological state of patients.
This paper provides an overview of the current status of ultrafast and ultra-intense lasers with peak powers exceeding 100 TW and examines the research activities in high-energy-density physics within China. Currently, 10 high-intensity lasers with powers over 100 TW are operational, and about 10 additional lasers are being constructed at various institutes and universities. These facilities operate either independently or are combined with one another, thereby offering substantial support for both Chinese and international research and development efforts in high-energy-density physics.
Immunological castration can be an alternative to traditional surgical castration. The active immunization against GnRH or kisspeptin has a castrating effect. To date, the fusion protein vaccine of combination with GnRH and kisspeptin have not been studied. Thus, the present study will develop a GnRH6-kisspeptin vaccine by genetic engineering method and investigate its immunocastration effect in male rats. Twenty 20-day-old male rats were randomly divided into two groups: the control group (n=10) and the immunization group (n=10). The initial immunization took place at week 0 followed by three booster doses administered intervals. The control group received an equivalent dose of white oil adjuvant. Orbital blood samples were collected at various time points following the initial immunization, at 0, 2, 4, 6, 8, 10 and 12 weeks, respectively. The entire left testis was weighed and its volume measured at week 12. Samples from the right testis were obtained for histological analysis. Serum levels of GnRH and kisspeptin antibodies, as well as testosterone levels were determined using ELISA. The results showed that the serum levels of GnRH and kisspeptin antibody titres of the immunized rats were significantly higher compared to the control group (P<0.05). Additionally, the testosterone concentration was effectively reduced following the intensified immunization. The testes of the immunized group exhibited a reduction in size and a significant decrease in the number of spermatogonia in the testicular tissue compared to the control group (P<0.05). These data indicate that the recombinant GnRH6-kisspeptin protein effectively induced immunological castration in rats.
Knowledge of the critical periods of crop–weed competition is crucial for designing weed management strategies in cropping systems. In the Lower Yangtze Valley, China, field experiments were conducted in 2011 and 2012 to study the effect of interference from mixed natural weed populations on cotton growth and yield and to determine the critical period for weed control (CPWC) in direct-seeded cotton. Two treatments were applied: allowing weeds to infest the crop or keeping plots weed-free for increasing periods (0, 1, 2, 4, 6, 8, 10, 12, 14, and 20 wk) after crop emergence. The results show that mixed natural weed infestations led to 35- to 55-cm shorter cotton plants with stem diameters 10 to 13 mm smaller throughout the season, fitting well with modified Gompertz and logistic models, respectively. Season-long competition with weeds reduced the number of fruit branches per plant by 65% to 82%, decreasing boll number per plant by 86% to 96% and single boll weight by approximately 24%. Weed-free seed cotton yields ranged from 2,900 to 3,130 kg ha−1, while yield loss increased with the duration of weed infestation, reaching up to 83% to 96% compared with permanent weed-free plots. Modified Gompertz and logistic models were used to analyze the impact of increasing weed control duration and weed interference on relative seed cotton yield (percentage of season-long weed-free cotton), respectively. Based on a 5% yield loss threshold, the CPWC was found to be from 145 to 994 growing degree days (GDD), corresponding to 14 to 85 d after emergence (DAE). These findings emphasize the importance of implementing effective weed control measures from 14 to 85 DAE in the Lower Yangtze Valley to prevent crop losses exceeding a 5% yield loss threshold.
In recent years, the rapid convergence of artificial intelligence (AI) and low-altitude flight technology has driven significant transformations across various industries. These advancements have showcased immense potential in areas such as logistics distribution, urban air mobility (UAM) and national defense. By adopting the AI technology, low-altitude flight technology can achieve high levels of automation and operate in coordinated swarms, thereby enhancing efficiency and precision. However, as these technologies become more pervasive, they also raise pressing ethical or moral concerns, particularly regarding privacy, public safety, as well as the risks of militarisation and weaponisation. These issues have sparked extensive debates. In summary, while the integration of AI and low-altitude flight presents revolutionary opportunities, it also introduces complex ethical challenges. This article will explore these opportunities and challenges in depth, focusing on areas such as privacy protection, public safety, military applications and legal regulation, and will propose strategies to ensure that technological advancements remain aligned with ethical or moral principles.
Based on a 4f system, a 0° reflector and a single laser diode side-pump amplifier, a new amplifier is designed to compensate the spherical aberration of the amplified laser generated by a single laser diode side-pump amplifier and enhance the power of the amplified laser. Furthermore, the role of the 4f system in the passive spherical aberration compensation and its effect on the amplified laser are discussed in detail. The results indicate that the amplification efficiency is enhanced by incorporating a 4f system in a double-pass amplifier and placing a 0° reflector only at the focal point of the single-pass amplified laser. This method also effectively uses the heat from the gain medium (neodymium-doped yttrium aluminium garnet) of the amplifier to compensate the spherical aberration of the amplified laser.
Although it is well established that gestational diabetes mellitus (GDM) is associated with fetal overgrowth in singleton pregnancies, little is known about its role in twins. We aimed to explore the relationship between GDM and the longitudinal fetal growth in twin pregnancies. This was a retrospective matched cohort study of GDM and non-GDM twin pregnancies delivered ≥36 weeks without other complications. All the women performed ≥3 ultrasounds after 22 weeks. Linear mixed models (LMMs) were used to explore the relationships between longitudinal fetal growth trajectories and GDM. Group-based trajectory modeling (GBTM) and generalized estimating equation (GEE) were applied to identify the latent growth patterns and investigate their relationships with GDM. In total, 215 GDM and 645 non-GDM twins were included, the majority of the patients did not require medication therapy (n = 202, GDMA1). LMM revealed that, compared with non-GDM, GDM was associated with an average increase in fetal weight of 4.36 g (95% CI [1.25, 7.48]) per week. GBTM and GEE further revealed that GDM increased the odds of fetal weight trajectory to nearly 40% of the total fetal weight trajectory, classified into the high-speed group (aOR = 1.39, 95% CI [1.03, 1.88]), associating with a 49.44 g (95% CI [11.41, 87.48]) increase in birth weight. Subgroup analysis revealed that all these differences were only significant among the GDMA1 pregnancies (p < .05). GDM (GDMA1) is significantly associated with an increase in fetal weight during gestation in twin pregnancies. However, this acceleration is mild, and its significance requires further exploration.
Suicidal ideation (SI) is very common in patients with major depressive disorder (MDD). However, its neural mechanisms remain unclear. The anterior cingulate cortex (ACC) region may be associated with SI in MDD patients. This study aimed to elucidate the neural mechanisms of SI in MDD patients by analyzing changes in gray matter volume (GMV) in brain structures in the ACC region, which has not been adequately studied to date.
Methods
According to the REST-meta-MDD project, this study subjects consisted of 235 healthy controls and 246 MDD patients, including 123 MDD patients with and 123 without SI, and their structural magnetic resonance imaging data were analyzed. The 17-item Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms. Correlation analysis and logistic regression analysis were used to determine whether there was a correlation between GMV of ACC and SI in MDD patients.
Results
MDD patients with SI had higher HAMD scores and greater GMV in bilateral ACC compared to MDD patients without SI (all p < 0.001). GMV of bilateral ACC was positively correlated with SI in MDD patients and entered the regression equation in the subsequent logistic regression analysis.
Conclusions
Our findings suggest that GMV of ACC may be associated with SI in patients with MDD and is a sensitive biomarker of SI.
The emotion regulation network (ERN) in the brain provides a framework for understanding the neuropathology of affective disorders. Although previous neuroimaging studies have investigated the neurobiological correlates of the ERN in major depressive disorder (MDD), whether patients with MDD exhibit abnormal functional connectivity (FC) patterns in the ERN and whether the abnormal FC in the ERN can serve as a therapeutic response signature remain unclear.
Methods
A large functional magnetic resonance imaging dataset comprising 709 patients with MDD and 725 healthy controls (HCs) recruited across five sites was analyzed. Using a seed-based FC approach, we first investigated the group differences in whole-brain resting-state FC of the 14 ERN seeds between participants with and without MDD. Furthermore, an independent sample (45 MDD patients) was used to evaluate the relationship between the aforementioned abnormal FC in the ERN and symptom improvement after 8 weeks of antidepressant monotherapy.
Results
Compared to the HCs, patients with MDD exhibited aberrant FC between 7 ERN seeds and several cortical and subcortical areas, including the bilateral middle temporal gyrus, bilateral occipital gyrus, right thalamus, calcarine cortex, middle frontal gyrus, and the bilateral superior temporal gyrus. In an independent sample, these aberrant FCs in the ERN were negatively correlated with the reduction rate of the HAMD17 score among MDD patients.
Conclusions
These results might extend our understanding of the neurobiological underpinnings underlying unadaptable or inflexible emotional processing in MDD patients and help to elucidate the mechanisms of therapeutic response.
In this paper, we study the rapid transition in Richtmyer–Meshkov instability (RMI) with reshock through three-dimensional double-layer swirling vortex rings. The rapid transition in RMI with reshock has an essential influence on the evolution of supernovas and the ignition of inertial confinement fusion, which has been confirmed in numerical simulations and experiments in shock-tube and high-energy-density facilities over the past few years. Vortex evolution has been confirmed to dominate the late-time nonlinear development of the perturbed interface. However, few studies have investigated the three-dimensional characteristics and nonlinear interactions among vortex structures during the transition to turbulent flows. The coexistence of co-rotating and counter-rotating vortices is hypothesized to induce successive large-scale strain fields, which are the main driving sources for rapid development. The three-dimensional effect is reflected in the presence of local swirling motion in the azimuthal direction, and it decreases the translation velocity of a vortex ring. Large-, middle- and small-scale strain fields are employed to describe the development process of RMI with reshock, e.g. vorticity deposited by the reshock, formation of the coexistence of the co-rotating and counter-rotating vortices, iterative cascade under the amplification of the strain fields and viscous dissipation to internal energy. This provides theoretical suggestions for designing practical applications, such as the estimation of the hydrodynamic instability and mixing during the late-time acceleration phase of the inertial confinement fusion.
Reliability analysis of stress–strength models usually assumes that the stress and strength variables are independent. However, in numerous real-world scenarios, stress and strength variables exhibit dependence. This paper investigates the reliability estimation in a multicomponent stress–strength model for parallel-series system assuming that the dependence between stress and strength is based on the Clayton copula. The estimators for the unknown parameters and system reliability are derived using the two-step maximum likelihood estimation and the maximum product spacing methods. Additionally, confidence intervals are constructed by utilizing asymptotically normal distribution theory and bootstrap method. Furthermore, Monte Carlo simulations are conducted to compare the effectiveness of the proposed inference methods. Finally, a real dataset is analyzed for illustrative purposes.
The school–vacation cycle may have impacts on the psychological states of adolescents. However, little evidence illustrates how transition from school to vacation impacts students’ psychological states (e.g. depression and anxiety).
Aims
To explore the changing patterns of depression and anxiety symptoms among adolescent students within a school–vacation transition and to provide insights for prevention or intervention targets.
Method
Social demographic data and depression and anxiety symptoms were measured from 1380 adolescent students during the school year (age: 13.8 ± 0.88) and 1100 students during the summer vacation (age: 14.2 ± 0.93) in China. Multilevel mixed-effect models were used to examine the changes in depression and anxiety levels and the associated influencing factors. Network analysis was used to explore the symptom network structures of depression and anxiety during school and vacation.
Results
Depression and anxiety symptoms significantly decreased during the vacation compared to the school period. Being female, higher age and with lower mother's educational level were identified as longitudinal risk factors. Interaction effects were found between group (school versus vacation) and the father's educational level as well as grade. Network analyses demonstrated that the anxiety symptoms, including ‘Nervous’, ‘Control worry’ and ‘Relax’ were the most central symptoms at both times. Psychomotor disturbance, including ‘Restless’, ‘Nervous’ and ‘Motor’, bridged depression and anxiety symptoms. The central and bridge symptoms showed variation across the school vacation.
Conclusions
The school–vacation transition had an impact on students’ depression and anxiety symptoms. Prevention and intervention strategies for adolescents’ depression and anxiety during school and vacation periods should be differentially developed.
An advanced deformable Kirkpatrick–Baez (K-B) mirror system was developed, equipped with high-speed piezoelectric actuators, and designed to induce beam decoherence and significantly enhance the quality of X-ray imaging by minimizing undesirable speckles in synchrotron radiation or free-electron laser facilities. Each individual mirror is engineered with 36 independent piezoelectric actuators that operate in a randomized manner, orchestrating the mirror surface to oscillate at a high frequency up to 100 kHz. Through in situ imaging single-slit diffraction measurement, it has been demonstrated that this high-frequency-vibration mirror system is pivotal in disrupting the coherent nature, thereby diminishing speckle formation. The impact of the K-B mirror system is profound, with the capability to reduce the image contrast to as low as 0.04, signifying a substantial reduction in speckle visibility. Moreover, the coherence of the X-ray beam is significantly lowered from an initial value exceeding 80% to 13%.