Image 1.

The second edition of the Chinese guideline for the prevention and treatment of anxiety disorders was published in August 2023, 13 years after the first edition. The revision principles for the second edition were maintaining the first edition's framework, and based on that framework, making necessary revisions by incorporating research progress and supplementing the latest research findings from the domestic studies and the overseas literature. Referring to the DSM-5 and ICD-11 classifications of mental disorders and the actual clinical situation in China, the anxiety disorders in the second edition were panic disorder, generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, and anxiety disorder due to another medical condition. The latest epidemiological data on anxiety disorders in China were added. Following the international guidelines, medications not included in the first edition have been added. Chinese traditional medicines, physical therapy, and internet web-based psychotherapy were also supplemented to fit Chinese clinical settings. Based on a literature review, the latest information on the risks of using antidepressants during pregnancy has been added.A whole course of treatment across the acute phase, consolidation phase, and maintenance phase was further addressed as the treatment principle. First-line and second-line recommendations are provided for medication selections.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective To explore the diagnostic value of energy spectrum CT quantitative parameters combined with serum thy-roid stimulating hormone receptor-messenger ribonucleic acid(TSHR-mRNA)for papillary thyroid microcarcinoma(PTMC).Methods A total of 105 patients with thyroid micronodules confirmed by surgery and pathology were collected,61 of whom were PTMC(PTMC group),and 44 patients with micronodular goiter(MNG)(MNG group).Energy spectrum CT quantitative parameters and serum TSHR-mRNA expression were compared between the two groups.The diagnostic value of energy spectrum CT quantitative parame-ters alone and combined with serum TSHR-mRNA for PTMC was analyzed by receiver operating characteristic(ROC)curve.Results The iodine concentration and slope of energy spectrum CT quantitative parameters between PTMC group and MNG group were signifi-cantly different in plain scan,arterial and venous phases(P＜0.05).The mean serum TSHR-mRNA expression in the PTMC group was higher than that in MNG group(P＜0.05).The area under the curve(AUC)for diagnosing PTMC using quantitative parame-ters of energy spectrum CT combined with serum TSHR-mRNA was 0.913,and the accuracy,sensitivity,and negative predictive value of diagnosing PTMC were significantly higher than those of quantitative parameters of energy spectrum CT or serum TSHR-mRNA(P＜0.05).Conclusion Both energy spectrum CT quantitative parameters and serum TSHR-mRNA can be used to diagnose PTMC alone,and the combination of both is more accurately.

Objective:To assess the efficacy and safety of the treat-and-extend (TAE) regimen and pro re nata (PRN) regimen of intravitreal conbercept in polypoidal choroidal vasculopathy (PCV) patients.Methods:A non-randomized controlled study was performed.Ninety-one patients (91 eyes) diagnosed with treatment-na?ve PCV from October 2016 to January 2019 at Department of Ophthalmology, Peking University People's Hospital were enrolled.All the patients received the intravitreal injection of 0.5 mg conbercept.After the initial treatment, the patients were divided into 3+ PRN group and 3+ TAE group according to their willingness.The follow-up time was one year.All the eyes underwent visual acuity test with ETDRS chart, optical coherence tomography (OCT) examination, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Best corrected visual acuity (BCVA), central retinal thickness (CRT), maximum retinal thickness (MRT), pigment epithelium detachment (PED) height, the number and area of polypoidal lesions, the area of retinal hemorrhage and the area of branching vascular network (BVN) were recorded.Treatment interval and injection frequencies during the one-year follow-up were compared between the two groups.This study adhered to the Declaration of Helsinki.The study protocol was approved by Peking University People's Hospital (No.2020PHB250-01). Written informed consent was obtained from each patient.Results:One-year after treatment, the BCVA improvement in the 3+ PRN group and 3+ TAE group was 5.0(-2.0, 15.0) and 6.0(-1.0, 14.0) letters, respectively, showing no significant difference ( Z=-0.352, P=0.725). No significant differences were found in CRT, MRT and PED height between the two groups ( Z=-0.145, -0.529, -0.985, all at P>0.05). There was no significant difference in polypoidal lesions number, polypoidal lesions area, the number of eyes with different degrees of polyp regression, BVN area and retinal hemorrhage area between the two groups ( Z=-0.502, -0.300, -0.047, -0.265, -1.243, all at P>0.05). After the one-year follow-up, the mean injection frequency of 3+ PRN group was (7.6±0.9) times, which was lower than (8.4±2.0) times of 3+ TAE group, showing a significant difference ( t=2.432, P=0.019). The mean follow-up frequency was (11.3±1.5) times of 3+ PRN group, which was significantly higher than (10.1±1.7) times of 3+ TAE group ( t=3.403, P=0.001). For the 3+ TAE group, 17.1%(6/35) of patients achieved an extension interval of 12 weeks after the first 3 doses, and 48.5%(17/35) of patients achieved an extension interval of 8 weeks or more, with a mean maximum extension interval of (9.5±2.0) weeks.During the follow-up, 10 patients in 3+ PRN group and 8 patients in 3+ TAE group received photodynamic therapy as a rescue treatment. Conclusions:The 3+ PRN and 3+ TAE regimens of intravitreal injection of conbercept combined with photodynamic therapy as a rescue treatment have similar efficacy in visual and anatomical outcomes for PCV patients.3+ TAE regimen has a higher treatment frequency and fewer follow-up visits.

The second edition of the Chinese guideline for the prevention and treatment of anxiety disorders was published in August 2023, 13 years after the first edition. The revision principles for the second edition were maintaining the first edition's framework, and based on that framework, making necessary revisions by incorporating research progress and supplementing the latest research findings from the domestic studies and the overseas literature. Referring to the DSM-5 and ICD-11 classifications of mental disorders and the actual clinical situation in China, the anxiety disorders in the second edition were panic disorder, generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, and anxiety disorder due to another medical condition. The latest epidemiological data on anxiety disorders in China were added. Following the international guidelines, medications not included in the first edition have been added. Chinese traditional medicines, physical therapy, and internet web-based psychotherapy were also supplemented to fit Chinese clinical settings. Based on a literature review, the latest information on the risks of using antidepressants during pregnancy has been added.A whole course of treatment across the acute phase, consolidation phase, and maintenance phase was further addressed as the treatment principle. First-line and second-line recommendations are provided for medication selections.

Objective: This study’s objective is to assess the efficacy and safety of Pulsed Magnetic Therapy System (PMTS) in improving insomnia disorder. Methods: Participants with insomnia disorder were randomly assigned to receive either PMTS or sham treatment for four weeks (n= 153; PMTS: 76, sham: 77). Primary outcomes are the Insomnia Severity Index (ISI) scores at week 0 (baseline), 1, 2, 3, 4 (treatment), and 5 (follow-up). Secondary outcomes are the Pittsburgh Sleep Quality Index at baseline and week 4, and weekly sleep diary-derived values for sleep latency, sleep efficiency, real sleep time, waking after sleep onset, and sleep duration. Results: The ISI scores of the PMTS group and the sham group were 7.13±0.50, 11.07±0.51 at week 4, respectively. There was a significant group×time interaction for ISI (F3.214, 485.271=24.25, p<0.001, ηp 2=0.138). Only the PMTS group experienced continuous improvement throughout the study; in contrast, the sham group only experienced a modest improvement after the first week of therapy. At the end of the treatment and one week after it, the response of the PMTS group were 69.7% (95% confidence interval [CI]: 58.6%–79.0%), 75.0% (95% CI: 64.1%–83.4%), respectively, which were higher than the response of the sham group (p<0.001). For each of the secondary outcomes, similar group×time interactions were discovered. The effects of the treatment persisted for at least a week. Conclusion PMTS is safe and effective in improving insomnia disorders.

Objective: To analyze the association of personality characteristics and cognitive adjustment strategies among parents of adolescents with non suicidal self injury(NSSI) with adolescent NSSI. Methods: Adolescents with NSSI who visited the hospital from January 2020 to January 2021 were recruited as the case group( n =60), and healthy adolescents recruited in the school, community and hospital were selected as the control group( n =60). The participants parents completed the Chinese Big Five Personality Inventory and the Chinese version of the Cognitive Emotion Regulation Questionnaire (CERQ-C), Logistic regression was used to explore the associations. Results: Parents of the control group had higher scores of openness (40.90±6.19) and conscientiousness (48.18±6.12) than parents of the case group (36.88±5.02)(44.12±6.58) ( t =3.90，3.50， P <0.05). In terms of negative events, scores of acceptance, positive reappraisal, refocusing on planning, positive refocusing and putting into perspective were higher among parents of the control group than among parents of the case group ( t =3.43，3.58，2.36，5.44，3.53， P <0.05). Among parents of the case group, neuroticism was positively correlated with putting into perspective ( r =0.31) and catastrophizing ( r =0.37). Openness was positively correlated with positive refocusing ( r =0.30) and positive reappraisal ( r =0.27). Acceptance was negatively correlated with extroversion ( r = -0.29 ), openness ( r =-0.40), conscientiousness ( r =-0.26),while other blame was negatively correlated with extroversion ( r = -0.35 ), agreeableness ( r =-0.36). Extraversion was negatively associated with positive refocusing ( r =-0.32)( P <0.05). According to binary regression analysis, the income of parents in the case group ( OR =0.49), education ( OR =0.60), acceptance ( OR =0.59), positive reappraisal ( OR =0.45), putting into perspective ( OR =0.53), neuroticisms ( OR =0.81), openness ( OR =0.76) and conscientiousness ( OR =0.74) were risk factors, whereas refocusing on planning ( OR =2.09) and self blame ( OR =1.55) were protective factors of NSSI in the case group( P <0.05). Conclusion When confronted with adverse events, the personality characteristics of parents of children with NSSI, and the emotional regulation strategies adopted by these parents, have influence on the prevalence of NSSI in this population.

Purpose: Cerebral ischemia-reperfusion (IR) injury is a severe secondary injury induced by reperfusion after stroke. Didymin has been reported to have a protective effect on intracerebral hemorrhage. However, the underlying mechanism of didymin on regulating cerebral IR injury remains largely unknown. Materials and Methods: A rat cerebral IR model and oxygen-glucose deprivation/reperfusion (OGD/R) model in PC12 cells were established. Hematoxylin and eosin (H&E) was used to detect the pathological changes in brain tissues, and TUNEL staining was performed to detect apoptosis of brain tissues. MTT and flow cytometry were used to measure the viability and apoptosis of PC12 cells. QRT-PCR and western blot were used to detect inflammation cytokines in PC12 cells. Western blot was used to measure the expression of PPAR-γ, RXRA, Bax, c-caspase-3, and Bcl-2. Results: Didymin pretreatment decreased apoptotic rates, reduced levels of Bax and c-caspase-3, and increased Bcl-2 level in vivo and in vitro. Additionally, didymin pretreatment increased viability and decreased the inflammation levels [interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and monocyte chemotactic protein (MCP)-1] of OGD/R treated PC12 cells. Moreover, didymin activated the peroxisome proliferator-activated receptors (PPAR) signaling pathway and increased the expression of PPAR-γ and RXRA in OGD/R treated PC12 cells. Inhibition of PPAR-γ eliminated the protective effect of didymin on OGD/R treated cells. Conclusion Didymin protected neuron cells against IR injury in vitro and in vivo by activation of the PPAR pathway. Didymin may be a candidate drug for IR treatment.

OBJECTIVE: To compare the clinical application and health economic values of non-invasive prenatal testing (NIPT) and second trimester serum screening (STSS). METHODS: A retrospective analysis was carried out on 54 026 singleton pregnant women undergoing NIPT and STSS from March 1, 2018 to December 31, 2019 in Changsha Maternal and Child Health Care Hospital. For pregnant women with high-risk results of NIPT, prenatal diagnosis and follow-up of pregnancy outcomes were conducted. The data was grouped to 4 screening models, and their cost-benefit was analyzed. RESULTS: The sensitivity, specificity and positive predictive value of NIPT were all higher than STSS. Screening models 1 to 4 have prevented the birth of 71, 29, 52 and 54 patients with Down syndrome, respectively. The safety index of screening models 1 to 4 were 0.0036, 0.3944, 02215 and 0.1281, respectively. When the price of NIPT was decreased to 600 RMB, the cost-benefit of the screening models 1 to 4 was 0.46, 0.65, 0.44 and 0.40 million RMB, respectively. CONCLUSION NIPT has a better detection performance than STSS. When the price of NIPT is 600 RMB, screening model 1 has the best screening effect and the highest accuracy, safety index and health economical value.
Child ; China ; Cost-Benefit Analysis ; Down Syndrome/diagnosis* ; Female ; Humans ; Pregnancy ; Prenatal Diagnosis/methods* ; Retrospective Studies