Neurons and glia in the central nervous system can express the key enzymes for the synthesis of neurosteroids .Once the concentration of neurosteroids is high enough , they will exert paracrine effects .Synthesis of neurosteroids declines with age in brain .So does it under stressful circumstances .Recent research reports indicate that the decrease of neurosteroids is associated with the neuronal dysfunction and degeneration in the brain .This paper reviews recent research on the most studied neurosteroids ( for example , dehydroepiandrosterone , pregnenolone and their sulphate esters, progesterone and allopregnanolone ) in affecting neuronal survival , neurite outgrowth and neurogenesis , and the potential roles of these neurosteroids in the treatment of neurodegenerative disease as well .

Kidney transplantation (KT) is one primary treatment of end-stage renal disease (ESRD). As reported by different centers, 10-year survival rate of transplanted kidneys fluctuates from 75% to 80%. Capable of reducing all-cause mortality in renal failure, KT can significantly improve survival rate and quality-of-life of ESRD patients. The risk of post-transplant rejection is much higher in pre-sensitised recipients than in non-sensitised ones due to the pre-existing anti-human leukocyte antigen antibodies. However, with a rapid development of various desensitisation techniques, transplantation rate and postoperative human/kidney survival rate of recipients have been greatly enhanced. And presensitisation is no longer a contraindication to KT. This review focused upon the latest advances in desensitisation therapeutic agents for pre-sensitised KT.

Chronic kidney disease has been a global public health problem with a heavy disease burden.As a kidney replacement therapy, kidney transplantation(KT)has a higher long-term survival rate and quality-of-life as compared with dialysis.Antibody-mediated rejection(AMR)is a major complication after KT.Currently its core treatments are steroid hormones, plasma exchange and immunoglobulin.However, the effectiveness of new therapeutic agents such as anti-CD20 antibody and bortezomib has remained controversial.Despite these combination treatments, AMR is still a predominant cause of graft loss and it is imperative to seek novel effective treatments.Interleukin-6(IL-6)is a vital cytokine involved in the regulation of inflammation and the development, maturation and activation of T/B cells.Specifically targeting IL-6, ptolizumab and crazizumab are currently widely applied for managing AMR and blunting highly sensitized KT recipients.This review summarized the clinical applications of IL-6 for AMR.

Objective:To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of negative symptoms in patients with schizophrenia and its effect on brain-derived neurotrophic factor (BDNF).Methods:A total of 130 patients with negative symptoms of schizophrenia who received treatment at The Third Hospital of Quzhou from March 2021 to March 2023 were included in this randomized controlled study. They were divided into a control group and a study group ( n = 65 per group). Both groups of patients were treated with antipsychotic drugs. Based on this, patients in the study group were treated with high-frequency rTMS, while those in the control group were treated with pseudo-rTMS. After 8 weeks of treatment, Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Negative Symptoms (SANS), and Personal and Social Performance Scale (PSP) scores were evaluated in each group before and after treatment. Serum BDNF levels were compared between the two groups before and after treatment. Adverse reactions were observed during the treatment. Results:After 8 weeks of treatment, the PANSS negative subscale score and SANS score in the study group were (16.45 ± 3.98) points and (35.41 ± 6.29) points, respectively, which were significantly lower than (20.08 ± 4.16) points and (41.76 ± 7.36) points in the control group ( t = -7.46, -6.85, both P < 0.05). PSP score in the study group was (66.85 ± 8.93) points, which was significantly higher than (58.79 ± 8.28) points in the control group ( t = 5.62, P < 0.001). There were no significant differences in PANSS positive subscale score, general psychopathology scale score or total score between the two groups (all P > 0.05). After 8 weeks of treatment, the serum BDNF level in the study group was (12.05 ± 2.13) μg/L, which was significantly higher than (8.86 ± 1.94) μg/L in the control group ( t = 9.73, P < 0.001). There was no significant difference in the incidence of adverse reactions during the treatment period between the two groups ( P > 0.05). Serum BDNF level was negatively correlated with PANSS and SANS scores ( r = -0.81, -0.85, both P < 0.001), while it was positively correlated with PSP score ( r = 0.82, P < 0.001). Conclusion:High-frequency rTMS can effectively alleviate the negative symptoms of schizophrenia, increase the secretion of BDNF, and be highly safe.

Objective:To determine the application effect of the "full chain" information-based health management model in the home care of children with bronchial asthma.Methods:Sixty children with bronchial asthma who were hospitalized in the Respiratory Department of Xuzhou Children's Hospital from January to June 2020 were selected and divided into a control group and an observation group according to a random number table with 30 cases in each group. The control group received routine nursing care, and the observation group implemented a "full-chain" informatized health management on the basis of the control group.The intervention time was 6 months. The condition control, medication compliance, self-management and airway function were observed and compared between the two groups.Results:After 6 months of intervention, the frequency of attacks, emergency cases, the medication compliance, the maximum expiratory flow rate, symptom days and peak expiratory flow days were 6.67%(2/30), 3.33%(1/30), 93.33%(28/30), (1.83±0.23) L, (163.00±6.74) d, (168.00±3.78) d in the observation group, and 26.67%(8/30), 20.00%(6/30), 66.67%(20/30), (1.67±0.24) L, (144.00±5.88) d, (157.00±4.08) d in the control group. The differences were statistically significant (χ 2 values were 4.320, 4.043, 6.667, t values were 2.636, 11.635, 10.833, P<0.05). There was no significant difference in the ratio of forced expiratory volume and forced expiratory volume in forced vital capacity in the first second after 6 months of intervention between the two groups ( P>0.05). Conclusions:"Full chain" information health management can reduce the number of attacks and emergency visits of children with asthma, effectively improve medication compliance, thus improving airway function and improving the quality of life of children.

Objective:To determine the level of epilepsy knowledge of caregivers for children with epilepsy and analyze its influencing factors, and investigate caregivers' educational needs and their acceptance for remote education, in order to provide reference for clinical telenursing education.Methods:From March to September 2022, 221 caregivers of epileptic children in the outpatient department and ward of neurology department of Xuzhou Children's Hospital were recruited by convenient sampling method for cross-sectional investigation. The status of caregivers' knowledge and educational needs were investigated by the general information questionnaire, epilepsy knowledge questionnaire, epilepsy knowledge needs questionnaire and telenursing acceptance questionnaire, and the influencing factors of knowledge level were analyzed by multiple linear regression.Results:The average score of epilepsy knowledge of caregivers was (15.68 ± 6.43) points. The course of disease, taking medicine on time, education background and monthly income of caregivers were the influencing factors of caregivers' knowledge level, and the difference was statistically significant ( P <0.05). 94.12% (208/221)- 96.38% (213/221) of the caregivers had high educational needs, and they had the highest demand for safety guidance during seizures. Caregivers' acceptance of remote education was moderate, ranging from 34.39% (76/221) to 71.95% (159/221). Conclusions:Caregivers' epilepsy knowledge needs to be improved. Medical institutions should formulate education plans according to the different characteristics of caregivers. Caregivers have a high demand for nursing knowledge, and medical staff should increase health education. Before giving health education based on remote nursing platform, we should fully understand the attitude of caregivers to the platform, so that they can master disease knowledge, strengthen their disease management ability, and improve the quality of life of children.

Objective: To explore the mediating effect of anxiety, insomnia, and family cohesion between Internet addiction and non suicidal self injury (NSSI) behavior among junior and senior school students, so as to develop interventions to promote adolescent mental health. Methods: A total of 3 026 junior and senior school students from Yixing, Jiangsu Province, China, were selected by stratified cluster sampling from December 2022 to February 2023, and were administered the Ottawa Self injury Inventory (OSI), Depression, Anxiety and Stress Scale-21 (DASS-21), Family Environment Scale-Chinese Version (FES-CV), Insomnia Severity Index (ISI), and Chinese Internet Addiction Scale Revised (CIAS-R). A mediating effect model was constructed to analyze the mediating effect of anxiety, insomnia, and family cohesion on Internet addiction and NSSI. Results: Internet addiction ( r = 0.24), insomnia ( r =0.28), and anxiety ( r =0.27) were positively correlated with NSSI, while the latter was negatively correlated with family cohesion ( r =-0.23) ( P <0.01). The mediating effect model was well fitted ( CFI=0.999, TLI=0.978, RMSEA = 0.030 ). Anxiety (mediation effect value:0.12, 95% CI =0.08-0.18) and family cohesion (mediation effect value:0.08, 95% CI = 0.03 -0.13) had a separate mediating effect. A chain meditating effect was found in the case of anxiety and insomnia (mediation effect value:0.14, 95% CI =0.10-0.20), family cohesion and anxiety (mediation effect value:0.05, 95% CI =0.03-0.07), family cohesion and insomnia (mediation effect value:0.05, 95% CI =0.03-0.07), and family cohesion, anxiety, and insomnia (mediation effect value:0.06, 95% CI =0.04-0.08). The mediating effect accounted for 14.9%, 10.1%, 17.5%, 6.0%, 5.6%, and 7.1%, respectively. Conclusions Anxiety, insomnia, and family cohesion partially mediate Internet addiction and NSSI. Schools and families should pay attention to Internet addiction among junior and senior school students and develop appropriate interventions to promote adolescent mental health, so as to reduce the prevalence of NSSI.

Objective: To explore the association between negative emotion (depression, anxiety and stress), family intimacy and Internet addiction, so as to provide a basis for the intervention of Internet addiction among junior and senior high school students. Methods: Students were selected by stratified random cluster sampling method from junior high schools and senior high schools from December 2022 to February 2023 in Yixing City, Jiangsu Provicne. A total of 3 026 students completed the questionnaire survey, including the demographic characteristics, Depression, Anxiety and Stress Scale-21 (DASS-21), Family Environment Scale-Chinese Version (FES-CV), and Chinese Internet Addiction Scale Revised (CIAS-R). Bivariate correlation was used to analyzed the association of family intimacy, depression, anxiety, stress, and Internet addiction. Mediating effect model was used to analyzed the mediating effect of negative emotion between family intimacy and Internet addiction. Results: The average score of Internet addiction among junior and senior high school students was (46.26±15.58), and there were statistical differences in the average scores of Internet addiction across different grades ( F=87.15, P <0.01). Depression ( r =0.57), anxiety ( r =0.56), stress ( r = 0.57) were positively correlated with Internet addiction, and family intimacy ( r =-0.34) was negatively correlated with Internet diction ( P <0.01). In the mediating effect model, family intimacy negatively predicted negative emotion ( β =-0.48) and Internet addiction ( β =-0.10), and negative emotion positively predicted Internet addiction ( β =0.45) ( P <0.01). Negative emotion played a partial mediating role between family intimacy and Internet addiction (the mediation value:-1.71, 95% CI =-1.96--1.49, mediation ratio:67.9%, P <0.05). Conclusions There are associations between negative emotion, family intimacy and Internet addiction among junior and senior school students. Family intimacy indirectly affects Internet addiction mainly through negative emotion. It suggests that family education is in need of attention to reduce the prevalence rate of Internet addiction among junior and senior high school students, especially family intimacy.

Objective: To understand different types of depression and anxiety among primary and secondary school students, as well as their influencing factors, so as to provide a basis for the development of future intervention programs for adolescent mental health. Methods: From December 2022 to February 2023, a self administered questionnaire survey was administered among grades 4 to 6 students and junior school, senior school students in Yixing City using Depression Anxiety and Stress Scale-21 (DASS-21), Insomnia Severity Index (ISI), Family Environment Scale (FES), and modified Yale Food Addiction Scale 2.0 (mYFAS 2.0), Ottawa Self injury Inventory (OSI). A total of 4 180 students were included in the analysis. Different types of depression and anxiety in students and their influencing factors were analyzed by the Chi squaretest and multivariate Logistic regression. Results: The overall prevalence of depression and anxiety among primary and secondary school students were 16.6% and 22.4%, respectively, with 14.0% of depression and anxiety comorbidities. The Logistic regression results showed that, compared to students with low depression-low anxiety, students of depression and anxiety who had parents in conflicts ( OR =3.06), smoked ( OR =3.16), exhibited moderate food addiction ( OR =3.56), and had non suicidal self injury (NSSI) ( OR =2.26) were more likely to be classified as a depression predominant-depression anxiety type. Students of depression and anxiety who consumed alcohol ( OR =2.00), had serious food addiction ( OR =5.44), moderate to severe insomnia ( OR =3.25), and mild insomnia ( OR =1.88) were more likely to be classified as anxiety predominant-depression anxiety type. Students of depression and anxiety with low mood ( OR =10.87), mild food addiction ( OR =2.00), moderate food addiction ( OR =4.32), and severe food addiction ( OR =7.35), mild ( OR =2.96) or moderate to severe ( OR =16.52) insomnia, and NSSI ( OR =4.24) were more likely to be classified as the severe depression anxiety type( P < 0.05 ). Conclusions There are significant differences between different depression-anxiety types among primary and secondary school students with respect to food addiction, insomnia, NSSI, smoking, and alcohol use. Relevant departments should engage with schools and families to adopt targeted interventions for students to reduce the occurrence of mental health problems.

Background::Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown.Methods::A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen’s kappa test was used to assess the agreement between physicians and PLWH.Results::The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% ( P <0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis ( P <0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR] = 0.71, 95% CI: 0.59-0.87, P = 0.003) and a lower prevalence of anxiety issues (OR = 0.63, 95% CI: 0.52-0.76, P <0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR = 0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR = 0.81, 95% CI: 0.67-0.99). Conclusion::Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.