Objective:To explore the correlation of different HBV DNA loads with peripheral blood lymphocyte subsets and interleukin-6 (IL-6) in patients with chronic hepatitis B.Methods:A cross-sectional study was conducted. A total of 519 patients with chronic hepatitis B admitted to the Fifth Medical Center of the General Hospital of the People′s Liberation Army from April 2019 to June 2024 were included. The patients were divided into high, medium, and low viral load groups and a negative group based on HBV DNA load. Another 100 healthy individuals who underwent physical examinations during the same period were recruited as the control group. The quantities of peripheral blood lymphocyte subsets and IL-6 levels were compared among the groups. Meanwhile, alanine aminotransferase (ALT) levels were recorded and compared among the groups. The correlation of HBV DNA levels with lymphocyte subsets and IL-6 was analyzed using Pearson correlation analysis.Results:HBV DNA loads were negatively correlated with the counts of CD3 +, CD4 +, CD8 +, CD19 +, and CD56 + lymphocyte subsets (correlation coefficients r were -0.483, -0.508, -0.524, -0.573, and -0.561, respectively; all P<0.001) and positively correlated with IL-6 levels ( r=0.862, P<0.05). Compared with the control group, the counts of each lymphocyte subset were higher in the high, medium, and low viral load groups ( P<0.05). In the HBV DNA-negative chronic hepatitis B group, the counts of CD8 + and CD19 + lymphocyte subsets were significantly higher [712.32(526.00,898.64) and 495.62(345.74,645.50) cells/μl] than those in the control group [612.10(479.89,744.31) and 470.32 (396.00,544.64) cells/μl] ( P<0.05). Conclusion:The degree of HBV replication activity in patients with chronic hepatitis B is associated with the immune status of the body, and negatively correlated with the quantities of lymphocyte subsets and positively correlated with IL-6 levels.

Objective:By analyzing the concentration distribution and hydrophilic/hydrophobic proportion differences of 15 bile acid subtypes in the serum of patients with hepatitis B virus（HBV）infection complicated with liver cirrhosis and primary biliary cholangitis（PBC）complicated with liver cirrhosis，this study aims to explore the potential associations between bile acid metabolism and these diseases，providing a reference basis for identifying disease-specific metabolic fingerprints in the diagnosis，treatment，and prognosis of liver diseases. Furthermore，building on the pharmacological mechanisms of ursodeoxycholic acid（UDCA）in the treatment of PBC，this research investigates potential therapeutic applications of bile acid drugs in HBV infection.Methods:A retrospective analysis method was adopted. We enrolled 27 HBV infection complicated with liver cirrhosis patients and 59 PBC complicated with liver cirrhosis patients who received outpatient or inpatient treatment at the Fifth Medical Center of PLA General Hospital from November 2024 to April 2025. The general data and routine clinical laboratory data of the two groups of patients were collected and analyzed. Using the ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry（UHPLC-QqQ-MS/MS）platform，precise quantification and differential analysis of 15 bile acid subtypes were performed in serum samples. Partial least squares discriminant analysis（PLS-DA）was employed to perform discriminant analysis on serum bile acid profiles data between the two groups，and variable importance in projection（VIP）values were calculated to identify key bile acid subtypes that could differentiate the two diseases. Box plots were constructed to analyze proportion differences in serum hydrophilic and hydrophobic bile acids between the two groups，aiming to explore potential associations between bile acid metabolism and the diseases.Results:The HBV infection group and the PBC group exhibited similar impairment of routine liver function parameters. The HBV infection group had higher serum concentrations of cholic acid（CA），chenodeoxycholic acid（CDCA）and deoxycholic acid（DCA），but lower concentrations of UDCA，glycoursodeoxycholic acid（GUDCA）and tauroursodeoxycholic acid（TUDCA）. The score plot generated by the PLS-DA model demonstrated significant differences in bile acid profile characteristics between the two diseases，with VIP values for UDCA，CDCA，GUDCA，TUDCA，and DCA all greater than 1. Box plots demonstrated a higher proportion of hydrophobic bile acids in the bile acid profile of the HBV infection group compared to the PBC group.Conclusion:This study found significant differences in serum bile acid profile characteristics between patients with HBV infection complicated with liver cirrhosis and those with PBC complicated with liver cirrhosis，specific bile acid subtypes such as CDCA and DCA have the potential to become specific metabolic fingerprints for these two diseases. HBV infection group exhibited higher proportion of hydrophobic bile acids in their bile acid profiles compared to PBC group. The characteristic changes in bile acid profiles can reflect the pathological characteristics of liver diseases，and their differences in hydrophilic/hydrophobic bile acids proportion represents a novel dimension independent of traditional liver function indicators，with potential value for disease prognosis assessment. UDCA or its derivatives may hold therapeutic potential for HBV infection patients with liver cirrhosis who exhibit accumulation of hydrophobic bile acids.

Objective:To explore the correlation of different HBV DNA loads with peripheral blood lymphocyte subsets and interleukin-6 (IL-6) in patients with chronic hepatitis B.Methods:A cross-sectional study was conducted. A total of 519 patients with chronic hepatitis B admitted to the Fifth Medical Center of the General Hospital of the People′s Liberation Army from April 2019 to June 2024 were included. The patients were divided into high, medium, and low viral load groups and a negative group based on HBV DNA load. Another 100 healthy individuals who underwent physical examinations during the same period were recruited as the control group. The quantities of peripheral blood lymphocyte subsets and IL-6 levels were compared among the groups. Meanwhile, alanine aminotransferase (ALT) levels were recorded and compared among the groups. The correlation of HBV DNA levels with lymphocyte subsets and IL-6 was analyzed using Pearson correlation analysis.Results:HBV DNA loads were negatively correlated with the counts of CD3 +, CD4 +, CD8 +, CD19 +, and CD56 + lymphocyte subsets (correlation coefficients r were -0.483, -0.508, -0.524, -0.573, and -0.561, respectively; all P<0.001) and positively correlated with IL-6 levels ( r=0.862, P<0.05). Compared with the control group, the counts of each lymphocyte subset were higher in the high, medium, and low viral load groups ( P<0.05). In the HBV DNA-negative chronic hepatitis B group, the counts of CD8 + and CD19 + lymphocyte subsets were significantly higher [712.32(526.00,898.64) and 495.62(345.74,645.50) cells/μl] than those in the control group [612.10(479.89,744.31) and 470.32 (396.00,544.64) cells/μl] ( P<0.05). Conclusion:The degree of HBV replication activity in patients with chronic hepatitis B is associated with the immune status of the body, and negatively correlated with the quantities of lymphocyte subsets and positively correlated with IL-6 levels.

Objective:By analyzing the concentration distribution and hydrophilic/hydrophobic proportion differences of 15 bile acid subtypes in the serum of patients with hepatitis B virus（HBV）infection complicated with liver cirrhosis and primary biliary cholangitis（PBC）complicated with liver cirrhosis，this study aims to explore the potential associations between bile acid metabolism and these diseases，providing a reference basis for identifying disease-specific metabolic fingerprints in the diagnosis，treatment，and prognosis of liver diseases. Furthermore，building on the pharmacological mechanisms of ursodeoxycholic acid（UDCA）in the treatment of PBC，this research investigates potential therapeutic applications of bile acid drugs in HBV infection.Methods:A retrospective analysis method was adopted. We enrolled 27 HBV infection complicated with liver cirrhosis patients and 59 PBC complicated with liver cirrhosis patients who received outpatient or inpatient treatment at the Fifth Medical Center of PLA General Hospital from November 2024 to April 2025. The general data and routine clinical laboratory data of the two groups of patients were collected and analyzed. Using the ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry（UHPLC-QqQ-MS/MS）platform，precise quantification and differential analysis of 15 bile acid subtypes were performed in serum samples. Partial least squares discriminant analysis（PLS-DA）was employed to perform discriminant analysis on serum bile acid profiles data between the two groups，and variable importance in projection（VIP）values were calculated to identify key bile acid subtypes that could differentiate the two diseases. Box plots were constructed to analyze proportion differences in serum hydrophilic and hydrophobic bile acids between the two groups，aiming to explore potential associations between bile acid metabolism and the diseases.Results:The HBV infection group and the PBC group exhibited similar impairment of routine liver function parameters. The HBV infection group had higher serum concentrations of cholic acid（CA），chenodeoxycholic acid（CDCA）and deoxycholic acid（DCA），but lower concentrations of UDCA，glycoursodeoxycholic acid（GUDCA）and tauroursodeoxycholic acid（TUDCA）. The score plot generated by the PLS-DA model demonstrated significant differences in bile acid profile characteristics between the two diseases，with VIP values for UDCA，CDCA，GUDCA，TUDCA，and DCA all greater than 1. Box plots demonstrated a higher proportion of hydrophobic bile acids in the bile acid profile of the HBV infection group compared to the PBC group.Conclusion:This study found significant differences in serum bile acid profile characteristics between patients with HBV infection complicated with liver cirrhosis and those with PBC complicated with liver cirrhosis，specific bile acid subtypes such as CDCA and DCA have the potential to become specific metabolic fingerprints for these two diseases. HBV infection group exhibited higher proportion of hydrophobic bile acids in their bile acid profiles compared to PBC group. The characteristic changes in bile acid profiles can reflect the pathological characteristics of liver diseases，and their differences in hydrophilic/hydrophobic bile acids proportion represents a novel dimension independent of traditional liver function indicators，with potential value for disease prognosis assessment. UDCA or its derivatives may hold therapeutic potential for HBV infection patients with liver cirrhosis who exhibit accumulation of hydrophobic bile acids.

Objective To summarize the successful experience of extracorporeal membrane oxygenation (ECMO) combined with inhaled nitric oxide (iNO) in the treatment of severe acute respiratory distress syndrome (ARDS) after empyema surgery in a morbid obesity patient,and to explore the nursing points. Methods On July 3,2023,a patient was admitted to the department of intensive care unit (ICU) of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University following the failure of closed thoracic drainage and catheterization at another hospital. Using the rapid integration of the WeChat group,a multidisciplinary team (MDT) model was built. This approach enabled the professional and standardized integration of clinical data and the implementation of targeted treatments,significantly reducing response times and optimizing the overall nursing process. Results A 27-year-old male patient with morbid obesity was admitted to the hospital due to dyspnea and chest pain for more than 7 days. ① Treatment process:on July 4,the patient underwent video-assisted thoracic surgery (VATS),including right chest exploration,pleural adhesion release,and empyema,performed under general anesthesia. Two thoracic drainage tubes were retained and water-sealed bottles were connected. The drainage fluid was purulent. After the operation,the patient was short of breath and the condition was aggravated and transferred to ICU. On admission,the patient's bedside chest X-ray showed that more moist rales were heard in both lungs,especially on the right side. At 18:30 on July 10,the pluse oxygen saturation (SpO2) was 0.75-0.80,and fiberoptic bronchoscopy was performed immediately. The ventilator parameters were up-regulated,the position was changed,and 20 mg of furosemide injection was injected intravenously,the effect was not good. Attempted to perform prone position ventilation,SpO2 did not improve. At 21:30,the SpO2 gradually decreased to 0.60,and the extracorporeal circulation was immediately decided. After veno-venous ECMO (VV-ECMO) at 2:30 on July 11,the SpO2 was 0.90,and the blood gas was stable after multiple reexaminations. During July 12,there was still shortness of breath and poor oxygenation index. According to the MDT consultation opinion,during the emergency treatment combined with iNO treatment,oxygenation improved rapidly to 172 mmHg (1 mmHg≈0.133 kPa) and 190 mmHg after 1 hour and 2 hours,respectively. After 6 days,the oxygenation index stabilized between 222-285 mmHg. On July 17,the iNO support was gradually reduced and successfully removed. On July 21,a chest X-ray showed that the patient's lung lesions were significantly improved,and ECMO support parameters were gradually reduced until ECMO treatment was successfully discontinued. On August 3,the patient's consciousness returned to normal,and the indicators returned to normal. The ventilator-assisted breathing was stopped,and the high-flow oxygen therapy was observed after extubation. He was transferred from the ICU on August 8 and was discharged on August 15. ② Nursing points:we focus on personalized analgesia and sedation,and adjust the types and doses of sedative drugs in stages to reduce oxygen consumption and reduce complications. For the treatment of ARDS with ECMO combined with iNO to improve oxygenation,close monitoring and supportive care were carried out. Special attention was paid to the fixation of ECMO pipeline and tracheal intubation in patients with morbid obesity and individualized fine skin care was implemented. Actively prevent the potential complications of ICU acquired myasthenia,and carry out phased psychological nursing to establish rehabilitation confidence. Conclusion ECMO combined with iNO treatment requires professional teamwork,close observation,effective nursing and perfect monitoring technology to ensure the safety of patients with severe ARDS morbid obesity,reduce complications and improve prognosis,which has important reference significance for relevant medical practice.

Objective To summarize the successful experience of extracorporeal membrane oxygenation (ECMO) combined with inhaled nitric oxide (iNO) in the treatment of severe acute respiratory distress syndrome (ARDS) after empyema surgery in a morbid obesity patient,and to explore the nursing points. Methods On July 3,2023,a patient was admitted to the department of intensive care unit (ICU) of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University following the failure of closed thoracic drainage and catheterization at another hospital. Using the rapid integration of the WeChat group,a multidisciplinary team (MDT) model was built. This approach enabled the professional and standardized integration of clinical data and the implementation of targeted treatments,significantly reducing response times and optimizing the overall nursing process. Results A 27-year-old male patient with morbid obesity was admitted to the hospital due to dyspnea and chest pain for more than 7 days. ① Treatment process:on July 4,the patient underwent video-assisted thoracic surgery (VATS),including right chest exploration,pleural adhesion release,and empyema,performed under general anesthesia. Two thoracic drainage tubes were retained and water-sealed bottles were connected. The drainage fluid was purulent. After the operation,the patient was short of breath and the condition was aggravated and transferred to ICU. On admission,the patient's bedside chest X-ray showed that more moist rales were heard in both lungs,especially on the right side. At 18:30 on July 10,the pluse oxygen saturation (SpO2) was 0.75-0.80,and fiberoptic bronchoscopy was performed immediately. The ventilator parameters were up-regulated,the position was changed,and 20 mg of furosemide injection was injected intravenously,the effect was not good. Attempted to perform prone position ventilation,SpO2 did not improve. At 21:30,the SpO2 gradually decreased to 0.60,and the extracorporeal circulation was immediately decided. After veno-venous ECMO (VV-ECMO) at 2:30 on July 11,the SpO2 was 0.90,and the blood gas was stable after multiple reexaminations. During July 12,there was still shortness of breath and poor oxygenation index. According to the MDT consultation opinion,during the emergency treatment combined with iNO treatment,oxygenation improved rapidly to 172 mmHg (1 mmHg≈0.133 kPa) and 190 mmHg after 1 hour and 2 hours,respectively. After 6 days,the oxygenation index stabilized between 222-285 mmHg. On July 17,the iNO support was gradually reduced and successfully removed. On July 21,a chest X-ray showed that the patient's lung lesions were significantly improved,and ECMO support parameters were gradually reduced until ECMO treatment was successfully discontinued. On August 3,the patient's consciousness returned to normal,and the indicators returned to normal. The ventilator-assisted breathing was stopped,and the high-flow oxygen therapy was observed after extubation. He was transferred from the ICU on August 8 and was discharged on August 15. ② Nursing points:we focus on personalized analgesia and sedation,and adjust the types and doses of sedative drugs in stages to reduce oxygen consumption and reduce complications. For the treatment of ARDS with ECMO combined with iNO to improve oxygenation,close monitoring and supportive care were carried out. Special attention was paid to the fixation of ECMO pipeline and tracheal intubation in patients with morbid obesity and individualized fine skin care was implemented. Actively prevent the potential complications of ICU acquired myasthenia,and carry out phased psychological nursing to establish rehabilitation confidence. Conclusion ECMO combined with iNO treatment requires professional teamwork,close observation,effective nursing and perfect monitoring technology to ensure the safety of patients with severe ARDS morbid obesity,reduce complications and improve prognosis,which has important reference significance for relevant medical practice.

Objective:To explore the clinical significance of hepatitis B virus (HBV) DNA detection in screening patients with hepatitis B.Methods:Clinical data of 682 331 hepatitis B patients were retrospectively analyzed. The HBV DNA of these patients was detected in the Fifth Medical Center of the PLA General Hospital from January 2017 to December 2021, there were 481 159 males and 201 172 females in this cohort, the average age was (41.34±16.13) years. Patients were divided into HBV DNA positive group (219 879 cases) and HBV DNA negative group (462 452 cases). Clinical characteristics, data of five serologic markers of hepatitis B and hepatitis B surface antigen quantification (HBsAg-QN), liver function, alpha fetoprotein (AFP) and prothrombin time (PT) results were collected and analyzed and compared between the two groups.Results:The positive rate of HBV DNA was 32.22% (219 879/682 331) in this cohort. Among the different age groups, the positive rate of HBV DNA was the highest (40.34%, 128 038/317 380) in young people aged 18-44 years. The proportion of patients was lower among aged <1, 45-59 and ≥60 years patients in HBV DNA positive group than that in HBV DNA negative group, while the proportion of patients was higher among aged 1-17 and 18-44 years patients in HBV DNA positive group than that in HBV DNA negative group (all P<0.001). Among 2 291 <1-year-old infants tested for HBV DNA, 71 infants were HBV DNA positive. The positive rates of HBV DNA from 2017 to 2021 were 4.86% (27/556), 3.68% (14/380), 3.47% (17/490), 1.55% (6/386) and 1.46% (7/479) respectively, showing a downward trend year by year. The positive rate of HBV DNA in acute hepatitis B (AHB) patients was the highest (49.88%, 208/417) among 680 040 patients with hepatitis B. The proportion of AHB patients (0.09%, 208/219 808) and chronic hepatitis B (80.44%, 176 806/219 808) in HBV DNA positive group was higher than that in HBV DNA negative group [0.05% (209/460 232) and 65.45% (301, 216/460 232)], while the proportion of patients with HBV-related liver cirrhosis (11.28%, 24 793/219 808), HBV-related liver cancer (6.72%, 14 775/219 808), liver cancer surgery (1.39%, 3 055/219 808) and liver transplantation (0.08%, 171/219 808) were lower than that in HBV DNA negative group [22.99% (105 813/460 232), 7.25% (33 385/460 232), 3.50% (16 129/460 232) and 0.76% (3 480/460 232)] (all P<0.001). At the same time, positive rate of hepatitis B surface antigen (HbsAg), HBsAg-QN, hepatitis B e antigen (HbeAg), level of total bilirubin, total bilirubin, AFP and PT were higher in HBV DNA positive group than those in HBV DNA negative group, while the age, male ratio and albumin results in HBV DNA positive group were lower than those in HBV DNA negative group (all P<0.01). The HBV DNA loads were higher in HBsAg positive group, hepatitis B surface antibody positive group and HBeAg positive group than those in respective negative groups, while the HBV DNA loads were lower in hepatitis B e antibody positive group and hepatitis B core antibody positive group than those in respective negative groups (all P<0.001). Conclusions:The mother to child transmission rate of<1-year-old infants decreases year by year. HBV DNA is an important factor for the progression of hepatitis B disease. HBV DNA positive hepatitis B patients with higher HBsAg-QN values are more likely to have abnormal serum markers such as liver dysfunction. HBV DNA detection is therefore of clinical importance in screening patients with hepatitis B.

Objective:To retrieve and summarize the evidence of indications for extubation in neurosurgical tracheotomy patients, so as to provide reference for promoting timely and safe extubation of neurosurgical tracheotomy patients.Methods:Evidence-based problems were identified according to the population, intervention, professional, outcome, setting, type of evidence (PIPOST) model. According to the "6S" classification model of the evidence-based retrieval database, all evidences of extubation indications of neurosurgical tracheotomy patients in the database, guideline website and professional institution website were systematically retrieved, including clinical guidelines, systematic review, expert consensus, evidence summary and clinical decision-making. The search period was from the establishment of the database to May 31, 2022. Two researchers independently evaluated the quality of the included article and extracted evidence.Results:A total of 12 articles were included, including four guidelines, four systematic reviews, two expert consensuses, one evidence summary, and one clinical decision-making. A total of 18 pieces of best evidence for extubation indications of neurosurgical tracheotomy patients were summarized, including 7 themes: disease condition, consciousness and autonomous activity, respiratory function, cough function, swallowing function, airway condition, multidisciplinary team and equipment support.Conclusions:The extubation of neurosurgical tracheotomy patients should consider many factors. The summary of evidence has a certain degree of scientific and practical significance, which can provide evidence-based basis for medical and nursing staff to apply evidence in a targeted manner.

Objective:To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods:Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern, central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire. Information on occurrence of unintended pregnancy within 2 years after delivery, postpartum contraceptive use, sexual resumption, breastfeeding, and women′s socio-demographic characteristics, and so on, were collected. Life-table analysis, cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results:A total of 18 045 postpartum women were investigated. The cumulative 1- and 2-year unintended pregnancy rates after delivery were 5.3% (95% CI: 4.5%－6.1%) and 13.1% (95% CI: 11.3%－14.8%), respectively. Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women, ethnic minorities, women with abortion history, and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation (all P<0.01). The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth (all P>0.05). Conclusions:In China, the risk of unintended pregnancy within 2 years after delivery is relatively high. Service institutions and service providers should improve the quality of postpartum family planning services, promote the use of high effect contraceptive methods, and educate women to use a method at the time of their sexual resumption or even before.

Objective: To compare the difference of cognitive fusion, empirical avoidance between patients with obsessive-compulsive disorder and healthy control group, and to explore the relationship between obsessive-compulsive score and cognitive fusion, empirical avoidance. Methods: The cognitive fusion questionnaire(CFQ), acceptance and action questionnaire-2nd edition(AAQ-II) and Yale-Brown scale for obsessive-compulsive symptoms (Y-BOCS) were used to investigate 100 subjects with obsessive-compulsive disorder (OCD) and 166 healthy controls.And the differences in cognitive fusion and empirical avoidance scores were compared between the two groups.The relationship of obsessive-compulsive symptoms and cognitive fusion, empirical avoidance was analyzed using multiple linear regression analysis. Results: The scores of cognitive fusion ((49.89±10.62) vs (33.88±11.44), t=-11.345, P<0.01)and empirical avoidance ((29.75±9.53) vs (21.59±7.03), t=-7.995, P<0.01) in obsessive-compulsive disorder group were significantly higher than those in healthy control group.There were significant differences in cognitive fusion and empirical avoidance in age variables (F=8.63, P<0.01). In AAQ-Ⅱ, item 2 (r=0.246, P<0.05), item 6 (r=0.223, P<0.05) and total score (r=0.240, P<0.05) were positively correlated with the total score of Y-BOCS.Item 2 (r=0.311, P<0.01), item 3 (r=0.286, P<0.05), item 6 (r=0.248, P<0.05) and total score (r=0.229, P<0.05) were positively correlated with the scores of obsessive-thinking.In CFQ, item 2 (r=0.231, P<0.0) 5), item 4 (r=0.242, P<0.05), item 7 (r=0.308, P<0.05), item 8 (r=0.277, P<0.05) and item 9 (r=0.249, P<0.05) were positively correlated with the total score of Y-BOCS.Item 8 (r=0.261, P<0.05) was positively correlated with the scores of obsessive-thinking, item 7 (r=0.237, P<0.05) and item 9 (r=0.238, P<0.05) were positively correlated with scores of obsessive-compulsive behavior.When predicting total obsessive-compulsive scores, only CF item 7 of Q (B=1.827, P<0.01), item 3 (B=0.956, P<0.05), and item 6 of AAQ-Ⅱ (B=0.584, P<0.05) entered the equation with a joint explanatory variation of 19%.When predicting the score of obsessive-thinking, only item 2 of AAQ-Ⅱ (B=0.446, P<0.01) entered the equation, explaining the variance was 9.7%.In the prediction of obsessive-compulsive behavior, only item 9 (B=0.815, P<0.05) of CFQ entered the equation, and the explanatory variation was 5.6%. Conclusion Cognitive fusion in the patients with obsessive-compulsive disorder and the high level of empirical avoidance may be an important factor for the maintenance of the symptoms.