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Background Low back pain is a common complication in patients with old thoracolumbar fractures with kyphosis (OTLFK), and intervertebral disc degeneration (IDD) is a major contributor. Mechanical abnormalities are believed to play a key role in the development to IDD. This study aimed to investigate the characteristics of lumbar disc degeneration and underlying mechanical mechanisms in patients with OTLFK. Methods A total of 52 patients with OTLFK were included from February 2017 to March 2023 as the observation group (OG). A control group (CG) of individuals with chronic low back pain were matched for age, body mass index, and gender. The disc degeneration grades and distribution in both groups were observed. Intact, 20°, 30°, and 40° kyphotic finite element (FE) models were established. Intervertebral disc pressures (IDPs) were calculated under standing, flexion, extension, lateral bending, and axial rotation conditions. Results The overall IDD in the OG was higher than that in the CG. The grades from T11 to L3 were higher in the OG ( p  < 0.05), while there was no significant difference from L4 to S1. Degeneration levels IV and V were concentrated in the T11–L3 segment in the OG; whereas, in the CG, this was in L4/5 and L5/S1 ( p  < 0.05). The FE analysis results showed that, in the kyphotic model, the IDP was higher than the intact model in the standing position, flexion, lateral bending, and rotation, but lower in extension. Conclusions Patients with OTLFK exhibit higher-grade disc degeneration concentrated in the thoracolumbar segment. Abnormal mechanical stress may contribute to this degeneration, highlighting the importance of managing stress in kyphotic deformities.

Old thoracolumbar fracture with kyphosis (OTLFK) often results in low back pain, with intervertebral disc degeneration being a significant contributor. We hypothesized that patients with OTLFK exhibit distinct patterns of disc degeneration compared to those with chronic low back pain without kyphotic deformity. This study aimed to investigate the characteristics of disc degeneration in OTLFK patients and explore its association with sagittal spinal parameters and endplate injury. A retrospective analysis was conducted on 52 patients with OTLFK (observation group, OG) and 104 age-, gender-, and BMI-matched patients with chronic low back pain (control group, CG) treated at our hospital between February 2017 and March 2023. Intervertebral disc degeneration from T11/12 to L5/S1 was assessed using MRI T2-weighted images and the Pfirrmann grading system. Sagittal spinal parameters—including lumbar lordosis (LL), thoracic kyphosis (TK), local kyphosis Cobb angle (LKCA), thoracolumbar kyphosis (TLK), pelvic tilt(PT), sacral slope(SS), and sagittal vertical axis (SVA)—and endplate injury grades were measured in the OG. Differences in disc degeneration between the two groups were compared, and correlations between disc degeneration, sagittal parameters, and endplate injury were analyzed. The OG exhibited significantly higher overall disc degeneration grades compared to the CG ( p  < 0.05), particularly at levels T11/12, T12/L1, L1/2, and L2/3. In the OG, grade IV and V degenerations were predominantly found from T11/12 to L2/3, whereas in the CG, they were mainly at L4/5 and L5/S1. Disc degeneration in the OG was significantly correlated with sagittal parameters and endplate injury grades ( p  < 0.05). Patients with OTLFK have higher grades of disc degeneration in the thoracolumbar region compared to those with chronic low back pain without kyphosis. Disc degeneration in OTLFK is associated with abnormal sagittal alignment and endplate injury, suggesting that kyphotic deformity and altered spinal biomechanics contribute to accelerated disc degeneration.

Background Though several epidemiological surveys of psychiatric disorders have been carried out in China, only a few of them are concerned about the prevalence of psychiatric disorders in central Hunan and reveal the distribution of common psychiatric disorders and their comorbidities. Methods Achenbach’s Child Behavior Checklist (CBCL), the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) were administered to a stratified sample of 17,071 participants aged 6 to 16 years old from two cities in the central part of Hunan province. Twelve-month prevalence rates were calculated. Results Twelve-month prevalence of the population was 9.74%. The most common psychiatric disorders were attention deficit hyperactivity disorder (ADHD) (4.96%), oppositional defiant disorder (ODD) (2.98%) and generalized anxiety disorder (GAD) (1.77%). Of those with a 12-month prevalence diagnosis, 34.6% had one or more comorbid psychiatric disorders. Most notably, ADHD had comorbidity rates of 25.15% with ODD, 18.18% with CD, 6.38% with GAD, and 3.66% with MDD. Conclusions Psychiatric disorders are common in Chinese children and adolescents. Being the most prevalent mental disorder, ADHD requires continued focus and support in awareness and education.

PurposeThis study aims to introduce an innovative adjustable prone positioning frame (APPF) and explore its feasibility and safety for treatment of severe kyphosis secondary to ankylosing spondylitis (AS) with two-level osteotomy. MethodsA retrospective, non-controlled study was conducted to illustrate the process where 13 patients diagnosed with severe kyphosis secondary to AS received operations on the APPF. Parameters of chin brow vertical angle (CBVA), global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. Positioning time, operation time, intraoperative blood loss aḥd complications were also determined. The Scoliosis Research Society outcomes instrument (SRS-22) was applied for clinical assessment.ResultsAll patients were placed on the APPF successfully with the positioning time of 2.92 ± 0.76 min, received operation with 457.00 ± 88.04 min and had blood loss of 2330.77 ± 1423.25 ml. Four cases experienced pain due to tensional skin of the abdomen and one case suffered cerebrospinal fluid leakage postoperatively, but these patients were all cured conservatively. No neurological complications were observed, although sagittal translation occurred in four patients. Significant improvements were detected in CBVA, GK, TLK, LL and SVA postoperatively (P < 0.05), but no significant difference was observed between postoperation and the final follow-up (P > 0.05). The SRS-22 scores at 2 years after operation were significantly higher than those before operation (P < 0.05).ConclusionThe innovative APPF provided great convenience to place patients with severe kyphosis secondary to AS in a prone position. Performing two-level osteotomy with the aid of APPF is safe, feasible and effective.

Previous studies in small samples have identified inconsistent cortical abnormalities in major depressive disorder (MDD). Despite genetic influences on MDD and the brain, it is unclear how genetic risk for MDD is translated into spatially patterned cortical vulnerability. Here, we initially examined voxel-wise differences in cortical function and structure using the largest multi-modal MRI data from 1660 MDD patients and 1341 controls. Combined with the Allen Human Brain Atlas, we then adopted transcription-neuroimaging spatial correlation and the newly developed ensemble-based gene category enrichment analysis to identify gene categories with expression related to cortical changes in MDD. Results showed that patients had relatively circumscribed impairments in local functional properties and broadly distributed disruptions in global functional connectivity, consistently characterized by hyper-function in associative areas and hypo-function in primary regions. Moreover, the local functional alterations were correlated with genes enriched for biological functions related to MDD in general (e.g., endoplasmic reticulum stress, mitogen-activated protein kinase, histone acetylation, and DNA methylation); and the global functional connectivity changes were associated with not only MDD-general, but also brain-relevant genes (e.g., neuron, synapse, axon, glial cell, and neurotransmitters). Our findings may provide important insights into the transcriptomic signatures of regional cortical vulnerability to MDD. Our combined large-scale neuroimaging and brain transcriptome study demonstrates genetic substrates underlying cortical functional abnormalities in depression, suggesting transcriptomic decoding of regional cortical vulnerability to depression.

Major depressive disorder (MDD) is common and disabling, but its neuropathophysiology remains unclear. Most studies of functional brain networks in MDD have had limited statistical power and data analysis approaches have varied widely. The REST-meta-MDD Project of resting-state fMRI (R-fMRI) addresses these issues. Twenty-five research groups in China established the REST-meta-MDD Consortium by contributing R-fMRI data from 1,300 patients with MDD and 1,128 normal controls (NCs). Data were preprocessed locally with a standardized protocol before aggregated group analyses. We focused on functional connectivity (FC) within the default mode network (DMN), frequently reported to be increased in MDD. Instead, we found decreased DMN FC when we compared 848 patients with MDD to 794 NCs from 17 sites after data exclusion. We found FC reduction only in recurrent MDD, not in first-episode drug-naïve MDD. Decreased DMN FC was associated with medication usage but not with MDD duration. DMN FC was also positively related to symptom severity but only in recurrent MDD. Exploratory analyses also revealed alterations in FC of visual, sensory-motor, and dorsal attention networks in MDD. We confirmed the key role of DMN in MDD but found reduced rather than increased FC within the DMN. Future studies should test whether decreased DMN FC mediates response to treatment. All R-fMRI indices of data contributed by the REST-meta-MDD consortium are being shared publicly via the R-fMRI Maps Project.

Aberrant topological organization of whole-brain networks has been inconsistently reported in studies of patients with major depressive disorder (MDD), reflecting limited sample sizes. To address this issue, we utilized a big data sample of MDD patients from the REST-meta-MDD Project, including 821 MDD patients and 765 normal controls (NCs) from 16 sites. Using the Dosenbach 160 node atlas, we examined whole-brain functional networks and extracted topological features (e.g., global and local efficiency, nodal efficiency, and degree) using graph theory-based methods. Linear mixed-effect models were used for group comparisons to control for site variability; robustness of results was confirmed (e.g., multiple topological parameters, different node definitions, and several head motion control strategies were applied). We found decreased global and local efficiency in patients with MDD compared to NCs. At the nodal level, patients with MDD were characterized by decreased nodal degrees in the somatomotor network (SMN), dorsal attention network (DAN) and visual network (VN) and decreased nodal efficiency in the default mode network (DMN), SMN, DAN, and VN. These topological differences were mostly driven by recurrent MDD patients, rather than first-episode drug naive (FEDN) patients with MDD. In this highly powered multisite study, we observed disrupted topological architecture of functional brain networks in MDD, suggesting both locally and globally decreased efficiency in brain networks.

Suicidal behavior is a major concern for patients who suffer from major depressive disorder (MDD). However, dynamic alterations and dysfunction of resting-state networks (RSNs) in MDD patients with suicidality have remained unclear. Thus, we investigated whether subjects with different severity of suicidal ideation and suicidal behavior may have different disturbances in brain RSNs and whether these changes could be used as the diagnostic biomarkers to discriminate MDD with or without suicidal ideation and suicidal behavior. Then a multicenter, cross-sectional study of 528 MDD patients with or without suicidality and 998 healthy controls was performed. We defined the probability of dying by the suicide of the suicidality components as a ‘suicidality gradient’. We constructed ten RSNs, including default mode (DMN), subcortical (SUB), ventral attention (VAN), and visual network (VIS). The network connections of RSNs were analyzed among MDD patients with different suicidality gradients and healthy controls using ANCOVA, chi-squared tests, and network-based statistical analysis. And support vector machine (SVM) model was designed to distinguish patients with mild-to-severe suicidal ideation, and suicidal behavior. We found the following abnormalities with increasing suicidality gradient in MDD patients: within-network connectivity values initially increased and then decreased, and one-versus-other network values decreased first and then increased. Besides, within- and between-network connectivity values of the various suicidality gradients are mainly negatively correlated with HAMD anxiety and positively correlated with weight. We found that VIS and DMN-VIS values were affected by age (p < 0.05), cingulo-opercular network, and SUB-VAN values were statistically influenced by sex (p < 0.05). Furthermore, the SVM model could distinguish MDD patients with different suicidality gradients (AUC range, 0.73–0.99). In conclusion, we have identified that disrupted brain connections were present in MDD patients with different suicidality gradient. These findings provided useful information about the pathophysiological mechanisms of MDD patients with suicidality.

Antidepressant efficacy for major depressive disorder (MDD) remains limited, with the neural mechanisms underlying treatment response poorly understood. The default mode network (DMN), particularly the connectivity between the medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC), has been implicated in MDD pathophysiology and may be linked to treatment outcomes. However, its potential as a biomarker for antidepressant response has not been validated. Here, we investigate the relationship between DMN connectivity and antidepressant treatment response in MDD. Resting-state fMRI data from four large MDD cohorts ( n  = 4271) were analyzed using Granger causality to examine directional effective connectivity (EC) within the DMN. Linear mixed-effects models compared EC between recurrent MDD patients, first-episode drug-naïve patients, and healthy controls. We also examined associations between EC, medication use, illness duration, depressive symptoms, and treatment outcomes. Additionally, Support Vector Machine (SVM) classifiers and support vector regression (SVR) were trained using EC from mPFC to PCC to predict treatment response. Our results revealed that recurrent MDD patients exhibited significantly reduced EC from mPFC to PCC compared to healthy controls and first-episode patients, with this reduction correlating with antidepressant medication use and illness duration. Importantly, DMN connectivity was associated with treatment improvement rather than core depressive symptoms, including suicide, anhedonia, or emotional blunting. Crucially, EC from mPFC to PCC predicted antidepressant treatment response, and SVM classifiers demonstrated high predictive accuracy for therapeutic outcomes. In conclusion, reduced EC from mPFC to PCC may serve as a biomarker for antidepressant treatment response in MDD, offering insights into MDD neurobiology and supporting the clinical potential of DMN connectivity measures for guiding treatment decisions. The SAINT, Xijing_QG, and Xijing_KG datasets were approved by the Ethics Committee of the First Affiliated Hospital, Fourth Military Medical University (approval numbers: KY20202066-F-1, XJLL-KY20222111, and KY20222165-F-1, respectively) and registered with clinicaltrials.gov (identifiers: NCT 04653337, NCT 05577481, and NCT 05544071, respectively).

Abstract Background Paranoia, or excessive suspiciousness of others, has been one of the core psychotic symptoms of schizophrenia. Recent studies have extended the study of psychotic symptoms in clinical groups to psychotic-like experiences in the general population. Few studies have systematically examined the prevalence of paranoid thinking or its attenuated form, social mistrust, in young children in the community. The present study examined the Social Mistrust Scale (SMS) and utilized it to examine the structure, prevalence, and heritability of social mistrust in a large sample of Chinese children and adolescents. Methods We administered the SMS to 1047 pairs of healthy twins aged 8 to 14 years and conducted structural equation modelling (SEM) to assess the structure of the SMS. Heritability of social mistrust was estimated in a sub-sample of twins (n=959 pairs). Finally, we examined administered the SMS to 32 adolescents with childhood-onset schizophrenia and 34 healthy controls to examine the convergent validity between the SMS and the Positive and Negative Syndrome Scale (PANSS). Results The SEM showed a three-factor structure for social mistrust (home, school, and general mistrust). Social mistrust was moderately heritable (39%, 95% CI [21%-59%]) with context-dependent sex differences. The SMS exhibited good discriminant validity in distinguishing adolescents with childhood-onset schizophrenia from healthy controls (AUC=0.80), and good convergent validity with the Positive and Negative Syndrome Scale (rs = 0.33–0.45). Discussion Taken together, the present findings showed a stable latent structure of the SMS in a large-scale non-clinical sample of children and adolescents. We found a moderate heritability estimate for social mistrust (39%) in a large healthy-twin sample. In addition, significant gender differences were found, where home mistrust was heritable for males (58%) but not for females, and school mistrust was heritable for females (54%) but not for males. Finally, we also demonstrated that the SMS possesses good discriminate validity in identifying adolescents with childhood-onset schizophrenia from healthy controls and convergent validity with standardized clinical measures of schizophrenia symptoms.