Volume 26

A meta-analysis on the Link Between medical Impulsive Behavior, Cognitive Impairment, and Social Function Deficits in People with Bipolar Disorder Zai Jhang1,a,Tie Xu2,b*   1School of Psychology,Jiangxi Normal University, Nanchang, 330022, Jiangxi, China 2School of Psychology,Jiangxi Normal University, Nanchang, 330022, Jiangxi, China aEmail: zaijhang@126.com bEmail: tiexu@jxnu.edu.cn Abstract：Bipolar disorder (BD) is a prevalent and chronic psychiatric disorder characterized by recurrent fluctuations of manic and depressive episodes, accompanied by persistent behavioral abnormalities, neurocognitive dysfunctions and social adaption disorders. Impulsive behaviors, cognitive function impairments and social function deficits are three core clinical manifestations that run through the whole course of BD, severely affecting patients’ disease prognosis, quality of life and social integration ability. This study aimed to explore the correlation mechanism among impulsive behaviors, cognitive function damage and social function deficits in BD patients, so as to provide theoretical support for clinical intervention, symptom improvement and functional rehabilitation of BD. A total of 220 patients diagnosed with BD in a tertiary psychiatric hospital from January 2023 to December 2024 were enrolled as the observation group, and 220 healthy volunteers with matched age, gender and educational level were recruited as the control group. All subjects were evaluated by Barratt Impulsiveness Scale (BIS-11), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Social Disability Screening Schedule (SDSS). Statistical analysis was conducted to compare the differences of impulsivity level, cognitive function and social function between the two groups, and analyze the correlation and predictive effect among the three indicators in BD patients. The results showed that the total score and each dimension score of BIS-11 and SDSS in the observation group were significantly higher than those in the control group, while the total score and each sub-item score of RBANS were significantly lower than those in the control group (P<0.05). Correlation analysis indicated that the impulsivity level of BD patients was negatively correlated with cognitive function level, and positively correlated with social function deficit degree; cognitive function impairment was negatively correlated with social function ability (P<0.01). Regression analysis verified that impulsive behaviors and cognitive function impairment were independent predictive factors of social function deficits in BD patients. This study confirms that impulsive behaviors, cognitive impairments and social function deficits have significant interactive correlation in BD patients. Severe impulsive tendencies and progressive cognitive damage can jointly aggravate social functional disorders, which provides a new perspective for targeted clinical treatment and functional rehabilitation intervention of BD. Key words: Bipolar Disorder; Impulsive Behavior; Cognitive Impairment; Social Function Deficit; Correlation Analysis 1. Introduction 1.1 Research Background: Disease Burden and Functional Impairment of Bipolar Disorder Bipolar disorder is a severe mental disorder with high morbidity, high recurrence rate and high disability rate, ranking among the top causes of global mental disease-related disability. Epidemiological data show that the lifetime prevalence of BD in the general population is about 2.4% to 3.8%, and nearly 60% of patients will have recurrent episodes within 5 years after the first diagnosis. Different from single mood disorder, BD not only presents extreme emotional swings of mania and depression, but also accompanies multiple dimensional functional damage covering behavior, cognition and social interaction throughout the stable stage of the disease, which is the core cause of long-term social disability of patients. In recent years, with the continuous progress of psychiatric research, the clinical focus of BD has gradually shifted from single emotional symptom control to comprehensive functional rehabilitation, and the persistent subclinical functional impairment during the inter-episode stable period has become a research hotspot in the field of BD prognosis[1-3]. Impulsive behavior is one of the most prominent behavioral characteristics of BD patients. It refers to the unplanned, hasty and unregulated behavioral response without full rational thinking and risk assessment, which is extremely common in both manic episodes and stable periods of BD. Typical impulsive behaviors of BD patients include impulsive consumption, aggressive behavior, reckless driving, substance abuse and suicidal and self-injurious behaviors. Clinical studies have confirmed that the incidence of impulsive behaviors in BD patients is 3 to 5 times higher than that in healthy people, and severe impulsive behaviors are closely related to disease recurrence, adverse clinical events and poor long-term prognosis. Impulsive behavior is no longer regarded as a transient symptomatic performance of manic episodes, but a stable trait characteristic of BD patients, which runs through the whole disease course. Cognitive function impairment is another core residual symptom of BD, which exists stably in the remission stage of mood symptoms and cannot be completely improved by conventional mood-stabilizing treatment. The cognitive damage of BD mainly involves multiple core fields such as attention, memory, executive function, language comprehension and visual-spatial ability. A large number of neuropsychological studies have shown that even in the euthymic stage with normal emotional performance, BD patients still have persistent deficits in working memory, inhibitory control and decision-making ability. Cognitive dysfunction not only affects patients’ daily learning and work efficiency, but also restricts their ability of emotional regulation and behavioral control, becoming the internal neuropsychological basis of abnormal behavioral manifestations of BD[4-6]. Social function deficit is the ultimate disability manifestation of BD, which is characterized by the decline or loss of patients’ abilities in social communication, interpersonal interaction, family function, occupational performance and social role adaptation. Long-term follow-up studies have found that more than 70% of BD patients have different degrees of social adaption disorders after repeated disease episodes, and nearly 40% of patients cannot return to normal work and social life for a long time. Social functional disability is the key factor leading to the decline of patients’ quality of life and the increase of social medical burden, and improving social function has become the ultimate goal of clinical treatment and rehabilitation of BD. 1.2 Research Status: Independent Study Limitations of Three Core Symptoms At present, domestic and foreign scholars have carried out extensive research on impulsive behavior, cognitive impairment and social function deficit of BD respectively. In terms of impulsive behavior research, most studies focus on the correlation between impulsivity and disease episode type, suicidal behavior and substance abuse, confirming

A research on the Medical Mechanisms of Circadian Rhythm Disorders and Anxiety-Depression Comorbidity in People with Sleep Disorders Xing Zhang1,a,Xu Liu2,b*   1School of Psychology, Jiangxi Normal University, Nanchang, 330022, Jiangxi, China 2School of Psychology,Jiangxi Normal University, Nanchang, 330022, Jiangxi, China aEmail: ilfzf@126.com bEmail: liuji-anping@jxnu.edu.cn Abstract：Sleep disorders have become a prevalent global health burden, characterized by abnormal sleep architecture and irregular sleep-wake cycles, which are closely intertwined with circadian rhythm dysfunction. Circadian rhythm disturbance, as a core pathological feature of sleep disorders, not only disrupts basic physiological homeostasis but also acts as a critical predisposing and perpetuating factor for emotional dysregulation, ultimately leading to the high comorbidity of anxiety and depression. Anxiety-depression comorbidity further exacerbates circadian misalignment and sleep deterioration, forming a self-reinforcing vicious cycle that severely impairs physical and mental health and social functioning. This study systematically explores the psychophysiological mechanisms linking circadian rhythm disturbances to anxiety-depression comorbidity in sleep disorder populations, from the perspectives of molecular genetics, neuroendocrine regulation, neural circuit dysfunction, immune-inflammatory imbalance, and psychological cognitive processing. By sorting out the bidirectional causal relationship and intermediate pathways among the three core variables, this paper clarifies the hierarchical and interactive mechanisms of physiological abnormality and psychological dysregulation. Three quantitative comparative tables are constructed to summarize core index differences, mechanism pathway correlations, and comorbidity risk factors. The findings aim to provide a theoretical basis for the precise intervention and clinical treatment of sleep disorder-related emotional comorbidities, and offer new ideas for breaking the pathological cycle of circadian disturbance, sleep dysfunction, and emotional disorders. Keywords: Sleep Disorders; Circadian Rhythm Disturbance; Anxiety-Depression Comorbidity; Psychophysiological Mechanism; Neural Regulation; Immune Homeostasis 1. Introduction 1.1 Epidemic Status of Sleep Disorders and Emotional Comorbidities With the acceleration of modern social rhythm and the diversification of lifestyle pressures, sleep disorders have evolved into one of the most common chronic health problems worldwide. Clinical epidemiological data show that more than 30% of the global population suffers from varying degrees of sleep dysfunction, including insomnia, sleep-wake phase disorder, irregular circadian sleep rhythm, and other subtypes, with a persistent upward trend in incidence year by year. Sleep is a basic physiological process essential for human physical recovery, neural repair, and emotional regulation[1-3]. Long-term abnormal sleep not only leads to daytime fatigue, cognitive decline, and physical dysfunction but also significantly increases the risk of mental and emotional disorders. Anxiety and depression are the most prevalent emotional comorbidities in patients with sleep disorders. Different from single anxiety or single depression, anxiety-depression comorbidity presents more severe clinical symptoms, longer disease course, higher recurrence rate, and poorer treatment prognosis. Clinical statistics indicate that over 60% of chronic insomnia patients have varying degrees of mixed anxiety and depressive symptoms, and nearly half of the patients with severe sleep-wake rhythm disorders eventually develop clinically diagnosed anxiety-depression comorbid disorders[4-6]. Compared with patients with simple sleep disorders or single emotional disorders, comorbid patients show more significant circadian rhythm disorders, more disordered physiological indicators, and more impaired psychological coping functions, forming a complex pathological interaction system. 1.2 Core Role of Circadian Rhythm in Sleep-Emotion Interaction Circadian rhythm is an endogenous 24-hour biological oscillation system formed by long-term biological evolution, which dominates the sleep-wake cycle, hormone secretion, neural activity, immune response, and cognitive emotional rhythm of the human body. The suprachiasmatic nucleus (SCN) of the hypothalamus is recognized as the core master clock of the human circadian system, which synchronizes peripheral tissue clocks through neural pathways and humoral regulation, maintaining the stability of the whole-body circadian homeostasis. Under normal physiological conditions, the circadian system coordinates with external environmental cues such as light and dark alternation, working and resting rules, to form a regular sleep-wake cycle and stable emotional diurnal variation[7]. Circadian rhythm disturbance is the key intermediate link connecting sleep disorders and anxiety-depression comorbidity. On the one hand, sleep disorders represented by insomnia and phase shift will directly disrupt the synchronization of the central circadian clock and peripheral clocks, leading to the disorder of core clock gene expression and abnormal rhythm of physiological indicators. On the other hand, circadian misalignment will further damage the neural circuits and endocrine pathways related to emotional regulation, reduce the body’s stress resistance and emotional regulation ability, and induce or aggravate anxiety and depressive symptoms. Existing studies have confirmed that circadian rhythm abnormality is not only a concomitant symptom of sleep and emotional disorders but also an independent risk factor for the occurrence and progression of comorbid diseases, which has a decisive impact on disease severity and prognosis[8-10]. 1.3 Research Significance and Framework of This Study At present, most existing studies focus on the simple correlation between sleep disorders and depression or sleep disorders and anxiety, while systematic elaboration on the psychophysiological mechanisms of circadian rhythm disorders participating in anxiety-depression comorbidity is insufficient. The interactive pathways of physiological regulation and psychological cognition in the comorbid process are still unclear, and there is a lack of standardized quantitative comparison of core pathological indicators. Based on the bidirectional interaction of sleep, circadian rhythm, and emotion, this study systematically analyzes the multi-dimensional psychophysiological mechanisms of circadian disturbance leading to anxiety-depression comorbidity in sleep disorder populations, sorts out the core pathways of genetic, neuroendocrine, neural circuit, immune, and psychological cognitive dysregulation, and constructs quantitative comparison tables of core indicators. The research results can make up for the deficiencies of existing theoretical research, provide targeted theoretical support for clinical precise intervention, and have important practical significance for improving the treatment effect of sleep and emotional comorbidities and reducing disease recurrence[11]. This study adopts a hierarchical and progressive research framework. First, it expounds the basic theoretical basis of circadian rhythm regulation and sleep-emotion interaction. Second, it analyzes the bidirectional causal relationship between circadian disturbance and anxiety-depression comorbidity. Third, it elaborates the core psychophysiological mechanisms from multiple dimensions. Fourth, it compares the differences of core indicators in different disease states through quantitative tables. Finally, it summarizes the pathological cycle and clinical enlightenment, realizing the organic combination of theoretical analysis and data verification. 2. Theoretical Basis of Circadian Rhythm Regulation and Sleep-Emotion

Yangling Demonstration Area Hospital of Shaanxi Province, 712100, China. cm20170222love@163.com Author’s details The First Author: Pingli Ma, Female, Bachelor degree, Associate chief physician, muxuanyu1212@163.com Corresponding author: Xiaoqing Li, Female, Bachelor degree, cm20170222love@163.com Abstract To detect abnormalities in cervix cells that may result in cancer, cervical cancer screening is performed. A screening might involve testing for the human papillomavirus, cervical cytology, or both. Cervical cancer screenings need to be routine for most women. This research aimed to conduct a clinical analysis of the liquid-based cytology (LBC) cytologic assessment and highrisk human papillomavirus (HPV) utilizing Screening for cervical cancer. 1000 females who visited the patient clinic as study participants were screened for this study. The traditional Pap LBC test was compared to screening with HR-HPV testing for subtypes 18 and additional HR-HPV types and the data was evaluated using SPSS. A total of 1000 women aged 20 to 40 received cervical cancer screening over the research period. 600 underwent screening with LBC between 2020 and 2021 while 400 underwent screening with HR-HPV between 2021 and 2022. Referral rates for colposcopy were higher for HR-HPV testing when compared to primary LBC screening. When compared to LBC screening, the identification of CIN 3+ lesions was greater when using HR-HPV screening. In summary, primary HR-HPV screening must be taken into consideration for screening as it was linked to a greater detection rate of CIN 3+ than cytology screening. Keywords: Cervical Cancer, Screening, Colposcopies, cervical cytology, human papillomavirus (HPV) Cervical cancer screening is an important publichealth measure aimed closer to the early detection and prevention of cervical cancers. Traditional screening strategies include the Pap smear, which examines cervical cells for abnormalities [1]. However, upgrades in medical era have brought about the improvement of human papillomavirus (HPV) and liquid-based totally cytology (LBC) checking out, which offer superior accuracy and regulation in screening efforts. 1.1 Liquid-based cytology (LBC) LBC is a contemporary approach wherein cervical cells are accrued and preserved in a liquid medium in advance than being processed for exam [2]. The method complements theexcellent of the pattern with the useful resource of decreasing infection and dispensing cells lightly at the slide. LBC has largely changed conventional Pap smears in lots of settings because of its greater sensitivity and ability to stumble on precancerous lesions more successfully. Additionally, LBC for the simultaneous trying out for HPV from the equal pattern, growing the convenience for sufferers and performance in laboratories. The progressed pattern additionally reduces the charge of unsatisfactory specimens, leading to greater reliable diagnostic consequences [3]. 1.2 HPV testing HPV testing includes detecting the presence of excessive-hazard HPV strains recognized to cause cervical most cancers. HPV is a common sexually transmitted contamination, and positive traces are strongly associated with the development of cervical cancers [4]. By detecting those excessive threat traces, HPV testing allows satisfying women based on their threat of developing cervical cancers, allowing for extra centered observe-up and control. This stratification allows clinicians to prioritize sufferers who want on-the-spot intervention and presents reassurance for those in low danger. Furthermore, everyday HPV testing can help to track the effectiveness of vaccination applications geared toward reducing the superiority of excessive-danger HPV traces [5]. As extra females undergo HPV testing, public fitness statistics will improve, main to better-informed regulations and preventive strategies. 1.3 Combined screening approach Combining LBC with HPV testing, also known as co-testing, gives a complete cervical cancer screening method. This dual method capitalizes on the strengths of both strategies and the morphological assessment of cervical cells through LBC and the molecular detection of high-chance HPV strains [6]. Co-testing has been shown to increase the detection rate of significant cervical lesions, thereby enhancing the overall effectiveness of screening programs.Co-testing can lead to advanced intervention and remedy, improving the affected person’s outcomes. It additionally gives a higher reassurance level of females who check terrible on both tests, as their danger of growing cervical cancer is appreciably lower. Ultimately, the approach supports extra personalized and specific patient care in cervical cancer prevention [7]. 1.4 Efficacy and benefits It has demonstrated that the combination of LBC and HPV testing has superior sensitivity and negative predictive value compared to either method [8]. This combined approach identifies the increased incidence of cervical intraepithelial neoplasia (CIN) and cervical cancer at an earlier stage but allows for extended screening intervals in females who do not test positive for HPV and LBC reducing the frequency of unnecessary procedures and associated costs [9]. The integration of liquid-based cytology and HPV testing represents a significant advancement in cervical cancer screening. Its ability to locate an extra variety of high-danger instances and provide long-term safety makes a valuable device in the fight in opposition to cervical cancers [10]. It continues to validate its efficacy and fee-effectiveness, it’s miles possible that extra healthcare systems worldwide will adopt this combined approach, eventually resulting in a decline for both prevalence and mortality of cervical cancer [11]. 1.5 Aim The purpose of this paper is to analyze the screening including liquid-based cytology (LBC) cytologic assessment between 2020 and 2021 and high-risk human papillomavirus (HPV) between 2021 and 2022 utilized for cervical cancer. 1.6 Organization The remaining part of the paper is Part 2 provides the related work, Part 3 presents the methods and materials, Part 4 represents the result and discussion and Part 5 discusses the conclusion of the paper. Study [12] assessed the usefulness of the ThinPrep cytologic screen and the HPV co-test for detecting cervical cancer during pregnancy. The findings highlighted the potential for greater specificity in cervical cancer detection when carrying a child and imply that HPV evaluation, in conjunction with cytology, offered an effective screening method for expectant mothers or either alone. The HPV16/18 group’s noticeably higher frequency of HSIL+ highlights how crucial it was to consider genotype-specific factors. Study [13] compared cytology with the effectiveness of a seven-type HPV messenger ribonucleic acid (mRNA) test. Five percent ofpeople tested positive for HPV-Deoxyribonucleic acid (DNA), and ninety-seven percent of people obtained accurate HPV mRNA findings. Thirty-five percent of the sample

The First Author: Xiaolei Ge, email: 13759784079@163.com ORCID: 0009-0000-8961-6677 Corresponding Author: Yating Cui, email: cuiyatingdoudou18@163.com ORCID: 0009-0003-5488-8201 Acknowledgement:  No Fund Project Abstract Background: Differentiating between viral and bacterial illnesses is essential for efficient clinical therapy and minimizing drug abuse. Aim: This study evaluates the clinical value of Procalcitonin (PCT) and C-reactive proteins (CRP) testing used to identify unique bacterial and viral Acute Respiratory Diseases (ARDs) infections. Methodology:142 children with verified bacterium illness were classed as group I, whereas 78 children with a viral illness were classified as group II. Both groups’ PCT and CRP values were clinically identified and comparatively analyzed. The clinical tests used to identify biomarkers of the PCT and CRP are the Electrochemiluminescence Immunoassay (ECLIA) for PCT biomarkers and the latex Immunoturbidimetry test for CRP biomarkers.  The ANOVA and t-test are used to compare the levels of PCT and CRP, Chi-Square is used to compare the optimistic rate of mutual recognition of PCT and CRP biomarkers, and ROC curve analysis of the diagnostic accuracy of each marker, the comparative analysis stimulated by the SPSS v24. Result: The results showed that PCT levels were significantly considerably greater in group I compared to group II, but there was not a significant distinction in PCT and CRP levels between the groups with and without Gram-positive infections. Conclusion: PCT and CRP serve as helpful indicators to identify acute bacterial and viral illnesses in children. Combining these markers enhances diagnostic accuracy, making them a valuable tool in clinical settings. Keywords: Viral Infections, Bacterial Infections, Acute Respiratory Diseases (ARDs), ANOVA, Clinical test and Biomarkers. In clinical practice, distinguishing between viral and bacterial infections continues to be one of the most important problems since it directly affects treatment choices and patient outcomes. It has been implied that the inability to find ideal criteria for making such distinctions means that clinical judgment must be relied upon which is often incorrect and subjected to errors. As a result, this ambiguity has contributed to the inappropriate use of antibiotics thus promoting resistance while unnecessarily exposing patients to drug side effects [2]. This Venn diagram distinguishes between bacteria and viruses, illustrating typical examples for each. On one side are listed types of bacteria like Spirilla, Micrococci, Bacillus, and Streptococci whereas on the other side viruses such as HIV, Adenovirus, Bacteriophage, and Ebola virus are shown in Figure 1. Figure 1: Familiar Bacteria and virus agents  Various diagnostic tools and biomarkers are used to identify specific types of infections accurately. Supporting diagnostic accuracy are some key biomarkers such as CRP and PCT [3]. CRP level is used as a significant marker for acute inflammatory responses whose levels may rise significantly between 6 – 12 hours after an inflammatory stimulus because it is always synthesized by the liver in response to inflammation [4]. Although both bacterial and viral infections present with elevated levels of CRP they differ in degree of elevation as well as rate of change thus giving insights into what type of infection it is likely going to be [5]. Usually, CRP levels are seen to be higher in cases of infection resulting from bacteria in contrast to those associated with viruses although it is not an absolute rule. PCT is the precursor of calcitonin hormone which is synthesized by thyroid C cells [6]. During severe systemic bacterial infections such as sepsis PCT levels increase dramatically owing to the inflammatory response produced by bacterial endotoxins. Unlike viral infections that do not significantly influence the various level differentials between CRP and PCT, it makes PCT a more specific marker for bacterial infections [7]. This implies that high serum PCT concentration can indicate acute sepsis during the initiation phase whereas low serum PCT concentration could suggest late stages of sepsis. It has been observed that during any viral infection PCT level tends to remain stagnated it rises quickly at times with rapidity in response to bacterium invasion into the human body leading to its utilization as a distinguishing mark between these two types of infections Combines the use of CRP and PCT testing will enhance diagnostic accuracy both biomarkers have their strong points [8]. Two things can be seen here CRP’s general sensitivity towards inflammation whereas PCT works specifically against bacteria leading to an understanding of the underlying pathology [9]. Through these analyses, it has been observed that when it comes to inflammation detection CRP does help but PCT could differentiate whether an infection came from bacteria or virus thereby isolating particular conditions from others entirely redefining antibiotic prescriptions upon different acute respiratory diseases according to certain objectives including clinical decision support systems reducing inappropriate therapy prescriptions [10]. This study assesses the clinical use of PCT and CRP tests to distinguish specific viral and bacterial infections that cause ARDs. 1.2 Contributions The paper is categorized into Phrase 2 depicts related work, Phrase 3 describes the methodology, Phrase 4 has the evaluation findings, Phrase 5 explains the discussion, and Phrase 6 depicts the conclusion. Advances in multiplex polymerase chain reaction (PCR) and bacterial infection have been connected to the significance and burden of viral co-infections in pediatric acute respiratory illnesses [11]. The effects of these infectious diseases on the person infected and each other were investigated using identifications. Although viral-bacterial co-infections can raise morbidity because of their synergistic infecting of the nasopharyngeal area, they did not imply that viral-viral concurrent infections might enhance the burden of illness in pediatric patients. In a range of pediatric cases, the AutoPilot-Dx [12] validated the excellent diagnostic accuracy of a host-protein pattern including CRP and TNF-related apoptosis-induced ligand (TRAIL). With a 93.7% sensitivity, 94.2% specificity, 73.0% positive predictive value, and 98.9% negative prediction value, the characteristics were effectively identified between viral and bacterial infections. The outcomes showed that there can be a way to reduce the overuse of medications in children who have viral infections. To create a biomarker test that could be distinguished between viral and bacterial infections by [13] combining values from FAM89A and IFI44L were chosen from two hospitals and were determined using the recommended polymerase chain reaction analyses. The