Objectives: The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was a revision of previous works. The main purpose of the current study was to amend guidelines for the treatment of a major depressive disorder (MDD) for children and adolescents. Methods: The survey consisted of 21 questionnaires for children and adolescents. A total of 33 of the 46 experts in child and adolescent psychiatry answered the survey. Results: Antidepressant (AD) monotherapy was selected as the 1st line option for MDD with mild to moderate severity. As the 1st line of treatment for MDD severe without psychotic features in children and adolescents, AD monotherapy and AD augmented with atypical antipsychotics (AAP) were recommended. For MDD with psychotic features, AD augmented with AAP was preferred as the 1st line of treatment. Conclusion We developed an algorithm for child and adolescent populations with depressive disorders, more specifically than the KMAP-DD 2017. We expect this algorithm will provide clinicians useful information and help in the treatment of children and adolescents with depressive disorders.

Objectives: The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was developed in 2002 and revised in 2006, 2012, 2017. In 2021, the fifth edition was published.This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021. Methods: Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances.Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary. Results: For persisting depressive disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) (escitalopram, fluoxetine, sertraline, paroxetine), serotoninnorepinephrine reuptake inhibitor (SNRI) (desvenlafaxine, venlafaxine, duloxetine, milnacipran), vortioxetine, and mirtazapine, was recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, vortioxetine, and mirtazapine also were recommended as first-line medications. For mixed features, SSRI, bupropion, mirtazapine, SNRI, except for duloxetine, and milnacipran were recommended as first-line medications. For anxious distress, SSRI, mirtazapine, and SNRI, except milnacipran, were recommended as first-line medications. Conclusion The preferences of antidepressants by experts differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the subtype of depression involved.

Objectives: The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for depressive disorders, we have undertaken a fourth revision of the KMAP-DD. Methods: The review committee for the new version of the KMAP-DD (KMAP-DD 2021) included 143 Korean psychiatrists with clinical experience in the field of depressive disorders. Each treatment strategy or treatment option was evaluated with an overall score of nine, and the treatment option was categorized into the three levels of recommendation of primary, secondary, and tertiary. Results: The first-line pharmacotherapeutic strategy for mild to moderate major depressive episodes (MDE) was antidepressant (AD) monotherapy. For severe MDE without psychotic features, AD monotherapy or the combination of AD and atypical antipsychotics (AAP) was the first-line strategy. The combination of AD and AAP was recommended as the first-line for the MDE with psychotic features as well. When treatment response to initial AD monotherapy was insufficient, a combination of AAP or another AD was recommended. In the case of unsatisfactory response to initial treatment with an AD and AAP combination, switching to another AAP or adding another AD was recommended. Conclusion Generally, there were no significant changes in the recommendations for MDE management in the KMAP-DD 2021 compared to previous versions. However, it was notable that the preference for the use of AAP and AD with the novel mechanism of action including vortioxetine and agomelatine increased.

Objectives: The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was a revision of previous works. The main purpose of the current study was to amend guidelines for the treatment of a major depressive disorder (MDD) for children and adolescents. Methods: The survey consisted of 21 questionnaires for children and adolescents. A total of 33 of the 46 experts in child and adolescent psychiatry answered the survey. Results: Antidepressant (AD) monotherapy was selected as the 1st line option for MDD with mild to moderate severity. As the 1st line of treatment for MDD severe without psychotic features in children and adolescents, AD monotherapy and AD augmented with atypical antipsychotics (AAP) were recommended. For MDD with psychotic features, AD augmented with AAP was preferred as the 1st line of treatment. Conclusion We developed an algorithm for child and adolescent populations with depressive disorders, more specifically than the KMAP-DD 2017. We expect this algorithm will provide clinicians useful information and help in the treatment of children and adolescents with depressive disorders.

Objectives: The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was developed in 2002 and revised in 2006, 2012, 2017. In 2021, the fifth edition was published.This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021. Methods: Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances.Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary. Results: For persisting depressive disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) (escitalopram, fluoxetine, sertraline, paroxetine), serotoninnorepinephrine reuptake inhibitor (SNRI) (desvenlafaxine, venlafaxine, duloxetine, milnacipran), vortioxetine, and mirtazapine, was recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, vortioxetine, and mirtazapine also were recommended as first-line medications. For mixed features, SSRI, bupropion, mirtazapine, SNRI, except for duloxetine, and milnacipran were recommended as first-line medications. For anxious distress, SSRI, mirtazapine, and SNRI, except milnacipran, were recommended as first-line medications. Conclusion The preferences of antidepressants by experts differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the subtype of depression involved.

Objectives: The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for depressive disorders, we have undertaken a fourth revision of the KMAP-DD. Methods: The review committee for the new version of the KMAP-DD (KMAP-DD 2021) included 143 Korean psychiatrists with clinical experience in the field of depressive disorders. Each treatment strategy or treatment option was evaluated with an overall score of nine, and the treatment option was categorized into the three levels of recommendation of primary, secondary, and tertiary. Results: The first-line pharmacotherapeutic strategy for mild to moderate major depressive episodes (MDE) was antidepressant (AD) monotherapy. For severe MDE without psychotic features, AD monotherapy or the combination of AD and atypical antipsychotics (AAP) was the first-line strategy. The combination of AD and AAP was recommended as the first-line for the MDE with psychotic features as well. When treatment response to initial AD monotherapy was insufficient, a combination of AAP or another AD was recommended. In the case of unsatisfactory response to initial treatment with an AD and AAP combination, switching to another AAP or adding another AD was recommended. Conclusion Generally, there were no significant changes in the recommendations for MDE management in the KMAP-DD 2021 compared to previous versions. However, it was notable that the preference for the use of AAP and AD with the novel mechanism of action including vortioxetine and agomelatine increased.

To scientifically evaluate the intervention effect of Chinese medicine preventive administration(combined use of Huo-xiang Zhengqi Oral Liquid and Jinhao Jiere Granules) on community population in the case of coronavirus disease 2019(COVID-19), a large cohort, prospective, randomized, and parallel-controlled clinical study was conducted. Total 22 065 subjects were included and randomly divided into 2 groups. The non-intervention group was given health guidance only, while the traditional Chinese medicine(TCM) intervention group was given two coordinated TCM in addition to health guidance. The medical instructions were as follows. Huoxiang Zhengqi Oral Liquid: oral before meals, 10 mL/time, 2 times/day, a course of 5 days. Jinhao Jiere Granules: dissolve in boiling water and take after meals, 8 g/time, 2 times/day, a course of 5 days, followed up for 14 days, respectively. The study found that with the intake of medication, the incidence rate of TCM intervention group was basically maintained at a low and continuous stable level(0.01%-0.02%), while the non-intervention group showed an overall trend of continuous growth(0.02%-0.18%) from 3 to 14 days. No suspected or confirmed COVID-19 case occurred in either group. There were 2 cases of colds in the TCM intervention group and 26 cases in the non-intervention group. The incidence of colds in the TCM intervention group was significantly lower(P<0.05) than that in the non-intervention group. In the population of 16-60 years old, the incidence rate of non-intervention and intervention groups were 0.01% and 0.25%, respectively. The difference of colds incidence between the two groups was statistically significant(P<0.05). In the population older than 60 years old, they were 0.04% and 0.21%, respectively. The incidence of colds in the non-intervention group was higher than that in the intervention group, but not reaching statistical difference. The protection rate of TCM for the whole population was 91.8%, especially for the population of age 16-60(95.0%). It was suggested that TCM intervention(combined use of Huoxiang Zhengqi Oral Liquid and Jinhao Jiere Granules) could effectively protect community residents against respiratory diseases, such as colds, which was worthy of promotion in the community. In addition, in terms of safety, the incidence of adverse events and adverse reactions in the TCM intervention group was relatively low, which was basically consistent with the drug instructions.
Adolescent ; Adult ; Betacoronavirus ; Coronavirus Infections ; drug therapy ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Middle Aged ; Pandemics ; Pneumonia, Viral ; drug therapy ; Prospective Studies ; Young Adult

Objective To investigate and analyze the detection of early gastric cancer (ECG) and explore the endoscopic and pathological characteristics. Methods Clinical data of patients underwent gastroscopy in 2016 were retrospectively collected for the screening and statistics of the detection rate of ECG (detected in examination and confirmed by pathology). In addition, the clinical data of 43 detected patients with ECG (47 lesions) were retrospectively summarized. Endoscopic characteristics under a white light endoscope and a magnifying endoscope with narrow band imaging (NBI) as well as pathological characteristics of ECG were compared. Results The overall detection rate of ECG was 0.23% (43/18,534), accounting for 24.71% (43/174) in the total detected cases of gastric cancer. This study revealed that ECG was the most commonly detected in the gastric antrum (36.17%, 17/47), lesion size >1.0 cm was the most common (68.09%, 32/47), and 0-IIc type were the most common under the endoscope, accounting for 55.32% (26/47). Under the white light endoscope, 35 (74.47%, 35/47) lesions showed mucosal redness, 43 (91.49%, 43/47) lesions presented clear boundaries, 42 (89.36%, 42/47) lesions exhibited irregular surface, 39 (82.98%, 39/47) lesions demonstrated mucosal atrophy and (or) intestinal metaplasia, 17 (36.17%, 17/47) lesions presented edge burrs, 8 (17.02%, 8/47) lesions showed WOS, 13 (27.66%, 13/47) lesions had superficial ulcers, and 21 (44.68%, 21/47) lesions demonstrated spontaneous bleeding. Magnifying endoscopy with NBI was conducted in 30 lesions, revealing clear boundaries in 86.67% (26/30) lesions, irregular or disappeared submucosal microvasculature in 96.67% (29/30) lesions, and irregular or disappeared epithelial microstructure and pit pattern in 90.00% (27/30) lesions. Differentiated pathological type was dominant (89.36%, 42/47). Conclusion ECG mainly occurs in the gastric antrum and 0-IIc type are dominant. Careful observation of the changes and characteristics of the local tone of gastric mucosa under a white light endoscope as well as the changes in lesion boundaries, submucosal microvasculature, epithelial microstructure and pit pattern under a magnifying endoscope with NBI is helpful to improve the diagnosis rate of ECG.

BACKGROUNDThe emergency department (ED) has a pivotal influence on the management of acute heart failure (AHF), but data concerning current ED management are scarce. This Beijing AHF Registry Study investigated the characteristics, ED management, and short- and long-term clinical outcomes of AHF.

METHODSThis prospective, multicenter, observational study consecutively enrolled 3335 AHF patients who visited 14 EDs in Beijing from January 1, 2011, to September 23, 2012. Baseline data on characteristics and management were collected in the EDs. Follow-up data on death and readmissions were collected until November 31, 2013, with a response rate of 92.80%. The data were reported as median (interquartile range) for the continuous variables, or as number (percentage) for the categorical variables.

RESULTSThe median age of the enrolled patients was 71 (58-79) years, and 46.84% were women. In patients with AHF, coronary heart disease (43.27%) was the most common etiology, and myocardium ischemia (30.22%) was the main precipitant. Most of the patients in the ED received intravenous treatments, including diuretics (79.28%) and vasodilators (74.90%). Fewer patients in the ED received neurohormonal antagonists, and 25.94%, 31.12%, and 33.73% of patients received angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and spironolactone, respectively. The proportions of patients who were admitted, discharged, left against medical advice, and died were 55.53%, 33.58%, 7.08%, and 3.81%, respectively. All-cause mortalities at 30 days and 1 year were 15.30% and 32.27%, respectively.

CONCLUSIONSSubstantial details on characteristics and ED management of AHF were investigated. The clinical outcomes of AHF patients were dismal. Thus, further investigations of ED-based therapeutic approaches for AHF are needed.

The effects of cetyltrimethylammonium bromide ( CTAB) , ascorbic acid, NaBH4 and AgNO3 , as well as the stirring time and reaction time on the preparation of gold nanorods synthesized with seedless growth method were studied. The optimum preparation conditions were obtained in the process of growth of gold nanorods. The gold nanorods prepared under different conditions were characterized by visible absorption spectroscopy and transmission electron microscopy ( TEM ) . Under the optimum conditions such as room temperature, 0. 1 mol/L CTAB, 96 μmol/L AgNO3 , 0. 97 mmol/L ascorbic acid, 1. 5 μmol/L NaBH4 and stirring for 25 s, micro-sized gold nanorods with uniform morphology, good dispersibility, small shaft width and high aspect ratio were prepared within 6 h. The gold nanorods were expected to be applied to the detection of mercury ion in water environment.