Objective:This study aims to develop a questionnaire for transsexualism screening and validate its reliability and validity, to provide a culturally adapted screening tool for Chinese clinicians.Methods:Referencing internationally validated instruments related to transsexualism, items closely aligned with the diagnostic criteria of the International Classification of Diseases, 10th Revision (ICD-10) for transsexualism were extracted. Items reflecting Chinese family cultural characteristics were integrated. The overall structure of the questionnaire was refined through expert consultations. A total of 111 patients diagnosed with transsexualism according to ICD-10 diagnostic criteria (78 male-to-female (MtF), 33 female-to-male (FtM)) were recruited from the outpatient clinic of Shanghai Mental Health Center between June 2021 and April 2024. Additionally, 232 cisgender participants, whose self-reported gender identity aligned with their birth sex, were recruited via the Wenjuanxing platform from June 14 to 22, 2022, comprising 64 heterosexual males, 16 non-heterosexual males, 120 heterosexual females, and 32 non-heterosexual females. Both the transsexual and cisgender groups completed the screening questionnaire. The internal consistency reliability was assessed using Cronbach′s α coefficient, and the corrected item-total correlation (CITC) was employed to measure the relationship between individual items and the total score. Structural validity was verified through structural equation modeling (SEM) using AMOS software. The receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal screening cutoff value, with the area under the curve (AUC) used to evaluate diagnostic accuracy. Effect sizes (Cohen's d) were calculated to compare the average scores of the questionnaire across groups. Results:The Transsexualism Screening Questionnaire consists of 15 items including 4 reverse-scored questions, rated on a 5-point Likert scale. The Cronbach′s α coefficient was 0.953 and the CITC for all items exceeded the recommended threshold of 0.3. After rotation based on eigenvalues>1, one principal component explained 61.67% of the total variance. Confirmatory factor analysis indicated acceptable model fit (χ2/ df = 3.887, standardized root mean square residual (SRMR) = 0.064, root mean square error of approximation (RMSEA)=0.092, comparative fit index (CFI)=0.952, normed fit index (NFI)=0.936, Tucker-Lewis index (TLI)=0.943, incremental fit index (IFI)=0.952). Factor loadings for each item ranged from 0.435 to 0.914. ROC curve analysis revealed that the optimal cutoff values were a mean score of 2.83 and a total score of 42.5, achieving 100% sensitivity and 98.7% specificity, with a Youden index of 0.987. Effect size comparisons showed a Cohen′s d of 6.112 between MtF individuals and cisgender heterosexual males, and a Cohen′s d of 9.287 between FtM individuals and cisgender heterosexual females. Conclusion:The Transsexualism Screening Questionnaire exhibits acceptable reliability, validity, sensitivity, and specificity, and is suitable for screening transsexualism in the Chinese population.

Objective:To search, evaluate, and summarize the best evidence of built-in fecal incontinence management device, to inform the management of incontinence dermatitis by clinical healthcare professionals.Methods:BMJ Best Practice, UpToDate, Guideline International Network, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses′Association of Ontario, The Cochrane Library, Medline, Embase, SinoMed, CINAHL, PubMed, Web of Science, OVID, China National Knowledge Infrastructure, Wanfang Database were systematically searched for all evidence regarding the application of fecal collection devices. It included clinical practice, guidelines, systematic reviews, expert consensuses, evidence summaries, and randomized controlled trial. Two researchers independently evaluated the literature quality and extracted the literature that met the standards.Results:A total of 12 pieces of the literature were involved, including 2 best practice, 5 guidelines, 3 expert consensuses, and 2 systematic reviews. This study summarized 26 pieces of best evidence in relation to the following 5 themes: indications and contraindications, device insertion, device maintenance, device removal and effectiveness evaluation.Conclusions:This study scientifically and systematically summarized the best evidence regarding the insertion and maintenance of built-in fecal incontinence management device. We recommend that clinical practitioners integrate this evidence into their practice, while considering individual patient preferences and medical contexts. Adhering to individualization for evidence translation improves standardization and benefits patients in the clinical use of fecal collection devices.

Objective:To search, evaluate, and summarize the best evidence of built-in fecal incontinence management device, to inform the management of incontinence dermatitis by clinical healthcare professionals.Methods:BMJ Best Practice, UpToDate, Guideline International Network, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses′Association of Ontario, The Cochrane Library, Medline, Embase, SinoMed, CINAHL, PubMed, Web of Science, OVID, China National Knowledge Infrastructure, Wanfang Database were systematically searched for all evidence regarding the application of fecal collection devices. It included clinical practice, guidelines, systematic reviews, expert consensuses, evidence summaries, and randomized controlled trial. Two researchers independently evaluated the literature quality and extracted the literature that met the standards.Results:A total of 12 pieces of the literature were involved, including 2 best practice, 5 guidelines, 3 expert consensuses, and 2 systematic reviews. This study summarized 26 pieces of best evidence in relation to the following 5 themes: indications and contraindications, device insertion, device maintenance, device removal and effectiveness evaluation.Conclusions:This study scientifically and systematically summarized the best evidence regarding the insertion and maintenance of built-in fecal incontinence management device. We recommend that clinical practitioners integrate this evidence into their practice, while considering individual patient preferences and medical contexts. Adhering to individualization for evidence translation improves standardization and benefits patients in the clinical use of fecal collection devices.

Objective:This study aims to develop a questionnaire for transsexualism screening and validate its reliability and validity, to provide a culturally adapted screening tool for Chinese clinicians.Methods:Referencing internationally validated instruments related to transsexualism, items closely aligned with the diagnostic criteria of the International Classification of Diseases, 10th Revision (ICD-10) for transsexualism were extracted. Items reflecting Chinese family cultural characteristics were integrated. The overall structure of the questionnaire was refined through expert consultations. A total of 111 patients diagnosed with transsexualism according to ICD-10 diagnostic criteria (78 male-to-female (MtF), 33 female-to-male (FtM)) were recruited from the outpatient clinic of Shanghai Mental Health Center between June 2021 and April 2024. Additionally, 232 cisgender participants, whose self-reported gender identity aligned with their birth sex, were recruited via the Wenjuanxing platform from June 14 to 22, 2022, comprising 64 heterosexual males, 16 non-heterosexual males, 120 heterosexual females, and 32 non-heterosexual females. Both the transsexual and cisgender groups completed the screening questionnaire. The internal consistency reliability was assessed using Cronbach′s α coefficient, and the corrected item-total correlation (CITC) was employed to measure the relationship between individual items and the total score. Structural validity was verified through structural equation modeling (SEM) using AMOS software. The receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal screening cutoff value, with the area under the curve (AUC) used to evaluate diagnostic accuracy. Effect sizes (Cohen's d) were calculated to compare the average scores of the questionnaire across groups. Results:The Transsexualism Screening Questionnaire consists of 15 items including 4 reverse-scored questions, rated on a 5-point Likert scale. The Cronbach′s α coefficient was 0.953 and the CITC for all items exceeded the recommended threshold of 0.3. After rotation based on eigenvalues>1, one principal component explained 61.67% of the total variance. Confirmatory factor analysis indicated acceptable model fit (χ2/ df = 3.887, standardized root mean square residual (SRMR) = 0.064, root mean square error of approximation (RMSEA)=0.092, comparative fit index (CFI)=0.952, normed fit index (NFI)=0.936, Tucker-Lewis index (TLI)=0.943, incremental fit index (IFI)=0.952). Factor loadings for each item ranged from 0.435 to 0.914. ROC curve analysis revealed that the optimal cutoff values were a mean score of 2.83 and a total score of 42.5, achieving 100% sensitivity and 98.7% specificity, with a Youden index of 0.987. Effect size comparisons showed a Cohen′s d of 6.112 between MtF individuals and cisgender heterosexual males, and a Cohen′s d of 9.287 between FtM individuals and cisgender heterosexual females. Conclusion:The Transsexualism Screening Questionnaire exhibits acceptable reliability, validity, sensitivity, and specificity, and is suitable for screening transsexualism in the Chinese population.

Objective:To establish an in vivo infection model of West Nile virus (WNV) pseudovirus and evaluate the neutralizing activity of antibody WNV-XH1.Methods:A stable cell line that can package the WNV pseudovirus was established in the early stage to prepare the pseudovirus supernatant. The supernatant was concentrated and infected BHK21 cells to detect the titer of the pseudovirus. After intraperitoneal injection of the pseudovirus into C57BL/J mice, bioluminescence imaging was performed to observe the infection status of the pseudovirus in the mice. After simultaneous infection, blood was collected and ELISA was used to detect NS1 levels in mouse serum. The in vivo functional activity of antibody WNV-XH1 was evaluated using the established mouse infection model.Results:Fluorescence was detected in C57BL/J mice infected with WNV pseudovirus, and the NS1 levels in the peripheral blood serum of mice infected with pseudovirus were significantly higher than those of non infected mice (1.453±0.09vs0.305±0.018). After intravenous administration of WNV-XH1 antibody before the attack, the fluorescence signal in the mice decreased and the serum NS1 level decreased (0.384±0.015).Conclusions:A successful in vivo infection model of WNV pseudovirus was established, and it was confirmed that the antibody WNV-XH1 had a protective effect against WNV pseudovirus infection in vivo.

Objective:Compared to imprecisely repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC), this study aimed to explore whether localizing the DLPFC precisely or targeting on the right orbital frontal cortex (rOFC) can improve the rTMS efficacy for the treatment of depressive disorder.Methods:From January 2018 to March 2021, this study recruited patients who met the DSM-Ⅳ diagnostic criteria for depressive disorder in Shanghai Mental Health Center. Nineteen patients were located in the imprecise DLPFC group, 19 patients in the precise DLPFC group, and 14 patients in the rOFC group. All patients were assessed by the 17-item Hamilton Depression Scale (HAMD 17) and Hamilton Anxiety Scale (HAMA) at baseline and after 10-session rTMS treatments. The primary outcome of this study was the HAMD 17 response rate, and the second outcome included the reduction score and reduction ratio of the HAMD 17/HAMA. Results:At baseline, there was no significant group difference in HAMD 17 or HAMA scores among the three groups. After the rTMS treatment, the HAMD 17 response rate was significantly different among the three groups (χ2=6.86, P=0.032). The HAMD 17 response rate in the precise DLPFC group (74%) was significantly higher than that in the imprecise DLPFC group (32%, χ2=6.76, P=0.011), but was comparable with that in the rOFC group (57%, χ2=2.16, P=0.133). HAMD 17 response rate did not significantly differ between the precise DLPFC group and the rOFC group (χ2=0.99, P=0.266). The HAMD 17 reduction score tended to be significantly different among the three groups ( F=2.95, P=0.062), with the precise DLPFC group presented the highest HAMD 17 reduction score. There were no significantly differences in the reduction score of HAMD and the reduction ratio of HAMA and HAMD 17 among the three groups. Conclusions:Precisely localizing the DLPFC target may be helpful to improve the rTMS efficacy for the treatment of depressive disorder, while rOFC may be a candidate target for rTMS treatment of the depressive disorder.

Objective:Compared to imprecisely repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC), this study aimed to explore whether localizing the DLPFC precisely or targeting on the right orbital frontal cortex (rOFC) can improve the rTMS efficacy for the treatment of depressive disorder.Methods:From January 2018 to March 2021, this study recruited patients who met the DSM-Ⅳ diagnostic criteria for depressive disorder in Shanghai Mental Health Center. Nineteen patients were located in the imprecise DLPFC group, 19 patients in the precise DLPFC group, and 14 patients in the rOFC group. All patients were assessed by the 17-item Hamilton Depression Scale (HAMD 17) and Hamilton Anxiety Scale (HAMA) at baseline and after 10-session rTMS treatments. The primary outcome of this study was the HAMD 17 response rate, and the second outcome included the reduction score and reduction ratio of the HAMD 17/HAMA. Results:At baseline, there was no significant group difference in HAMD 17 or HAMA scores among the three groups. After the rTMS treatment, the HAMD 17 response rate was significantly different among the three groups (χ2=6.86, P=0.032). The HAMD 17 response rate in the precise DLPFC group (74%) was significantly higher than that in the imprecise DLPFC group (32%, χ2=6.76, P=0.011), but was comparable with that in the rOFC group (57%, χ2=2.16, P=0.133). HAMD 17 response rate did not significantly differ between the precise DLPFC group and the rOFC group (χ2=0.99, P=0.266). The HAMD 17 reduction score tended to be significantly different among the three groups ( F=2.95, P=0.062), with the precise DLPFC group presented the highest HAMD 17 reduction score. There were no significantly differences in the reduction score of HAMD and the reduction ratio of HAMA and HAMD 17 among the three groups. Conclusions:Precisely localizing the DLPFC target may be helpful to improve the rTMS efficacy for the treatment of depressive disorder, while rOFC may be a candidate target for rTMS treatment of the depressive disorder.

Objective To explore the role of default mode network (DMN) in the pathophysiology of depression and the correlations between the functional connectivity (FC) of DMN and the clinical characteristics of depression through the resting-state fMRI scan in depressed patients. Methods Sixteen medication-na?ve patients with major depressive disorder and 15 healthy controls were recruited and underwent the resting-state MRI scan. Hamiliton depression rating scale (HAMD) was used to evaluate patients’symptom. The FC of DMN and its correlations with clinical features of pa-tients were analyzed. Results Compared with healthy controls, the FC within DMN in depressed patients is disturbed. There were negative correlations between the left mPFC-left hippocampus FC and HAMD total scores (r=-0.569, P=0.021) and subscale scores for sluggishness (r=-0.498, P=0.050). The left mPFC-right hippocampus FC in patients was negatively correlated with HAMD scores (r=-0.508, P=0.045). There were negative correlations between FC in the hippo-campus and HAMD subscale scores for cognitive impairment (r=-0.509, P=0.044). Conclusions The results suggest that there is abnormal FC within DMN in drug-na?ve patients with depression during resting state and some abnormal altera-tions of FC may be correlated with the clinical characteristics in depression.

Objective To explore the possibility of predicting postnatal depression based on Hospital Anxiety and Depression (HAD) scale for women during the third trimester of pregnancy.Methods 1 230 pregnant women were evaluated during their third trimester of pregnancy using HAD scale deriving from common questionnaire and self-related questionnaire,and again 4 weeks postnatal using Edinburgh Postnatal Depression Scale (EPDS).Results (1) The incidences for depression and anxiety during the third trimester of pregnancy were 5.20％ (64 /1 230) and 4.07％ (50 /1 230),respectively.The incidence of postnatal depression was 9.98％ (121 /1 213).(2) According to the two step screening diagnosis for severe postnatal depression,the 1 230 cases were categorized into patient group (121 cases) and normal group (1 092 cases).There were statistically significant differences between the two groups in age,the relationship of the couple,work and study pressure,knowledge of childbirth,parenting and postnatal depression,maternal gender discrimination,group HAD score and EPDS score (x2 =6.54,6.92,8.07,23.82,21.88,10.24,9.26,6.63,5.66,P ＜ 0.05 for all).There were no significant differences between the two groups in marital status,personality,level of education,occupation,history of abnormal delivery,complications of pregnancy,gender discrimination from the husband and/or family.(3) In ROC curve the optimal critical value of the HAD during postnatal depression was 9 symptoms.For the cases who got an A or D in the HAD scale,the sensitivity and specificity of predicting postnatal depression were 86.21％/87.64％,95.43％/94.72％,respectively.(4) For the cases who got an A or D in the HAD scale,the area under the ROC curve were 0.941 and 0.914,respectively.(5) The optimal critical value of HAD was related to the scores of EPDS after delivery (r =0.852,0.846,both P ＜ 0.01).(6) For the cases with HAD ≥ 9 points,the probability for the risk of postnatal depression will be increased by 15.891 and 18.264 times,respectively.Conclusion HAD scale can be used as a routine screening method for women in late stage pregnancy.Women with HAD ≥ 9 points should be comprehensively evaluated for the risk of postnatal depression.

Objective To explore the possibility of predicting postnatal depression based on Hospital Anxiety and Depression (HAD) scale for women during the third trimester of pregnancy.Methods 1 230 pregnant women were evaluated during their third trimester of pregnancy using HAD scale deriving from common questionnaire and self-related questionnaire,and again 4 weeks postnatal using Edinburgh Postnatal Depression Scale (EPDS).Results (1) The incidences for depression and anxiety during the third trimester of pregnancy were 5.20％ (64 /1 230) and 4.07％ (50 /1 230),respectively.The incidence of postnatal depression was 9.98％ (121 /1 213).(2) According to the two step screening diagnosis for severe postnatal depression,the 1 230 cases were categorized into patient group (121 cases) and normal group (1 092 cases).There were statistically significant differences between the two groups in age,the relationship of the couple,work and study pressure,knowledge of childbirth,parenting and postnatal depression,maternal gender discrimination,group HAD score and EPDS score (x2 =6.54,6.92,8.07,23.82,21.88,10.24,9.26,6.63,5.66,P ＜ 0.05 for all).There were no significant differences between the two groups in marital status,personality,level of education,occupation,history of abnormal delivery,complications of pregnancy,gender discrimination from the husband and/or family.(3) In ROC curve the optimal critical value of the HAD during postnatal depression was 9 symptoms.For the cases who got an A or D in the HAD scale,the sensitivity and specificity of predicting postnatal depression were 86.21％/87.64％,95.43％/94.72％,respectively.(4) For the cases who got an A or D in the HAD scale,the area under the ROC curve were 0.941 and 0.914,respectively.(5) The optimal critical value of HAD was related to the scores of EPDS after delivery (r =0.852,0.846,both P ＜ 0.01).(6) For the cases with HAD ≥ 9 points,the probability for the risk of postnatal depression will be increased by 15.891 and 18.264 times,respectively.Conclusion HAD scale can be used as a routine screening method for women in late stage pregnancy.Women with HAD ≥ 9 points should be comprehensively evaluated for the risk of postnatal depression.