Schizophrenia is a chronic and debilitating mental disorder.Around 20%to 40%of patients do not respond well to normal antipsychotic medication,and are ultimately diagnosed with treatment-resistant schizophrenia(TRS),representing the most severe and challenging form of schizophrenia.Currently,clozapine is the standard treatment for TRS.Early identification and standardized treatment can be beneficial to patients with TRS by controlling acute-phase symptoms as soon as possible,reducing suicidal rate and improving their quality of life.Under the guidance of the Steering Committee,this consensus was formed after multiple discussions by 30 psychiatric experts and anonymous Delphi surveys including 17 consensus opinions on treatment-resistant schizophrenia,which cover risk factors and prevention,diagnosis and evaluation,standardized clozapine treatment and management of adverse reactions,treatment regimens for clozapine resistance and intolerance,and psychosocial intervention,etc.The consensus-making process also incorporated evidence-based medicine to help standardize and guide diagnosis and treatment for adults with TRS in China.

Objective To investigate the association of insulin resistance(IR)and its related indices,including triacylglycerol-glucose(TyG)index and metabolic score of insulin resistance(Mets-IR),with the occurrence of early neurological deterioration(END)in patients with branch atheromatous disease(BAD),and develop a risk prediction model based on these factors.Methods A total of 189 BAD patients were consecutively recruited from the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University between March 2020 and August 2024.Based on the occurrence of END within 7 d after admission,the participants were stratified into END(75 cases)and non-END(114 cases)groups.Demographic characteristics,clinical parameters,TyG index and Mets-IR values were systematically collected and analyzed.Multivariate logistic regression analysis was performed to identify independent risk factors for END in BAD-related stroke.Receiver operating characteristic curve(ROC)analysis was subsequently conducted to evaluate the predictive performance of significant variables,followed by construction of a nomogram prediction model.Results The END group exhibited significantly elevated fasting blood glucose[6.47(5.74,7.86)mmol/L vs 5.83(5.14,6.70)mmol/L]and triacylglycerol[1.65(1.21,2.04)mmol/L vs 1.27(0.99,1.57)mmol/L]levels,higher body mass index[25.02(23.88,26.67)kg/m2 vs 23.71(22.66,25.27)kg/m2]and TyG index(9.03±0.41 vs 8.71±0.45),and increased Mets-IR(39.98±4.23 vs 36.85±4.38)and NIHSS score[5.00(3.00,7.00)vs 3.00(2.00,5.00)]at admission when compared with the non-END group(P＜0.05).Multivariate logistic regression analysis showed that high TyG index(OR=3.751,95％CI:1.592-9.202,P＜0.01),Mets-IR(OR=1.146,95％CI:1.049-1.252,P＜0.01),and NIHSS score at admission(OR=1.279,95％CI:1.128-1.451,P＜0.01)were risk factors for the occurrence of END in BAD patients(P＜0.05).ROC curve indicated that the AUC value of TyG index,Mets-IR,and NIHSS score at admission in predicting END occurrence was 0.698(95％CI:0.623-0.774,P＜0.01),0.698(95％CI:0.620-0.775,P＜0.01),and 0.666(95％CI:0.586-0.745,P＜0.01),respectively.The nomogram prediction model based on these factors demonstrated significant clinical benefits by decision curve analysis and goodness of fit in internal calibration analysis.Conclusion IR shows significant association with END in BAD patients.The IR related indices,TyG index and Mets-IR,have certain predictive efficiency for occurrence and progression of END.

Schizophrenia is a chronic and debilitating mental disorder.Around 20%to 40%of patients do not respond well to normal antipsychotic medication,and are ultimately diagnosed with treatment-resistant schizophrenia(TRS),representing the most severe and challenging form of schizophrenia.Currently,clozapine is the standard treatment for TRS.Early identification and standardized treatment can be beneficial to patients with TRS by controlling acute-phase symptoms as soon as possible,reducing suicidal rate and improving their quality of life.Under the guidance of the Steering Committee,this consensus was formed after multiple discussions by 30 psychiatric experts and anonymous Delphi surveys including 17 consensus opinions on treatment-resistant schizophrenia,which cover risk factors and prevention,diagnosis and evaluation,standardized clozapine treatment and management of adverse reactions,treatment regimens for clozapine resistance and intolerance,and psychosocial intervention,etc.The consensus-making process also incorporated evidence-based medicine to help standardize and guide diagnosis and treatment for adults with TRS in China.

Objective To investigate the association of insulin resistance(IR)and its related indices,including triacylglycerol-glucose(TyG)index and metabolic score of insulin resistance(Mets-IR),with the occurrence of early neurological deterioration(END)in patients with branch atheromatous disease(BAD),and develop a risk prediction model based on these factors.Methods A total of 189 BAD patients were consecutively recruited from the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University between March 2020 and August 2024.Based on the occurrence of END within 7 d after admission,the participants were stratified into END(75 cases)and non-END(114 cases)groups.Demographic characteristics,clinical parameters,TyG index and Mets-IR values were systematically collected and analyzed.Multivariate logistic regression analysis was performed to identify independent risk factors for END in BAD-related stroke.Receiver operating characteristic curve(ROC)analysis was subsequently conducted to evaluate the predictive performance of significant variables,followed by construction of a nomogram prediction model.Results The END group exhibited significantly elevated fasting blood glucose[6.47(5.74,7.86)mmol/L vs 5.83(5.14,6.70)mmol/L]and triacylglycerol[1.65(1.21,2.04)mmol/L vs 1.27(0.99,1.57)mmol/L]levels,higher body mass index[25.02(23.88,26.67)kg/m2 vs 23.71(22.66,25.27)kg/m2]and TyG index(9.03±0.41 vs 8.71±0.45),and increased Mets-IR(39.98±4.23 vs 36.85±4.38)and NIHSS score[5.00(3.00,7.00)vs 3.00(2.00,5.00)]at admission when compared with the non-END group(P＜0.05).Multivariate logistic regression analysis showed that high TyG index(OR=3.751,95％CI:1.592-9.202,P＜0.01),Mets-IR(OR=1.146,95％CI:1.049-1.252,P＜0.01),and NIHSS score at admission(OR=1.279,95％CI:1.128-1.451,P＜0.01)were risk factors for the occurrence of END in BAD patients(P＜0.05).ROC curve indicated that the AUC value of TyG index,Mets-IR,and NIHSS score at admission in predicting END occurrence was 0.698(95％CI:0.623-0.774,P＜0.01),0.698(95％CI:0.620-0.775,P＜0.01),and 0.666(95％CI:0.586-0.745,P＜0.01),respectively.The nomogram prediction model based on these factors demonstrated significant clinical benefits by decision curve analysis and goodness of fit in internal calibration analysis.Conclusion IR shows significant association with END in BAD patients.The IR related indices,TyG index and Mets-IR,have certain predictive efficiency for occurrence and progression of END.

Objective:To establish a machine learning model for the diagnosis of clinically significant prostate cancer based on transrectal contrast-enhanced ultrasound parameters and clinically relevant data.Methods:A retrospective analysis was performed on 151 patients in Chongqing University Cancer Hospital who underwent transrectal contrast-enhanced ultrasonography and transrectal ultrasound-guided needle biopsy from November 2018 to September 2021. The time intensity curve was drawn using VueBox software and 12 parameters such as rise time, peak time, average transit time, peak intensity, and rising slope were quantitatively analyzed. Age, total prostate-specific antigen, free prostate-specific antigen, free prostate-specific antigen ratio, volume, prostate-specific antigen density, and transrectal contrast-enhanced ultrasonography parameters, a total of 18 characteristic parameters, were analyzed and screened through relevant attribute values and information gain attribute values. The screening features were trained and tested by the machine learning single algorithm and integrated algorithm, and then the model was evaluated by the F1 value and the area under the ROC curve(AUC).Results:Using the related attribute value and the information gain attribute value, 12 variables and 5 variables were screened out respectively to establish a machine learning model. The model established by the ensemble algorithm was better than the single algorithm. For the two variable selection methods, the AUC (0.810 vs 0.789) and F1 values (0.748 vs 0.742) of the Bagging ensemble algorithm model, which basic algorithm was decision tree, were the highest, followed by Logistic regression and support vector machine(SVM) in order of AUC and F1 values.Conclusions:Based on transrectal contrast-enhanced ultrasound parameters and clinical data, the Bagging ensemble model based on decision tree has the best performance in diagnosing clinically significant prostate cancer.

Objective To evaluate the effect of the treatment with low-concentration hydrogen peroxide (H2O2) on the adhesive function of and autophagy in human melanocytes,and to screen long noncoding RNAs (lncRNAs) related to autophagy.Methods Melanocytes were isolated from foreskins of healthy males after circumcision,and subjected to cultivation.Melanocytes at exponential growth phase were divided into 3 groups:control group receiving no treatment,H2O2 group treated with 400 μ mol/L H2O2,and H2O2 + NAC group pretreated with 4 mmol/L NAC for 2 hours followed by the treatment with 400 μmol/L H2O2.After 5-day treatment,immunofluorescence study was performed to determine the expression of Ecadherin,microtubule-associated protein 1 light chain 3 (LC3)and p62,and Western blot analysis to determine the expression of autophagy-related protein LC3 and p62.Cell structures and autophagosomes were observed by transmission electron microscopy,and autophagy-related lncRNAs were screened using gene chip technology.Statistical analysis was done with Graphpad Prism 6 software using one-way analysis of variance for comparison among groups,and Tukey's test for multiple comparisons.Results Under the confocal microscopy,the H2O2 group showed significantly decreased fluorescence intensity of E-cadherin and LC3 in the melanocytes and decreased number of autophagosomes in melanocytes,but significantly increased fluorescence intensity of p62 compared with the control group and H2O2 + NAC group.Western blot analysis showed that the LC3-Ⅱ/LC3-Ⅰ ratio in the melanocytes was significantly lower in the H2O2 group (0.604 ± 0.012) than in the control group (1.200 ± 0.081,q =7.718,P ＜ 0.01) and H2O2 + NAC group (1.017 ± 0.062,q =5.076,P ＜ 0.05),while the p62/β-actin ratio in the melanocytes was significantly higher in the H2O2 group (0.881 ± 0.079) than in the control group (0.456 ± 0.121,q =4.847,P ＜ 0.05) and H2O2 + NAC group (0.492 ± 0.049,q =4.439,P ＜ 0.05).There were no significant differences in the LC3-Ⅱ/LC3-Ⅰ ratio or p62/β-actin ratio between the H2O2 + NAC group and control group (P ＞ 0.05).Gene chip technology showed that 18 autophagy-related lncRNAs were associated with premature senescence of melanocytes and differentially expressed in the H2O2 group compared with the control group,and the autophagy-related lncRNA NONHSAT190308.1 (＞ 10-fold increase) was screened out.Conclusion Lowconcentration H2O2 can decrease the expression of E-cadherin and the level of autophagy in melanocytes,and can up-regulate the expression of autophagy-associated lncRNA NONHSAT190308.1.