Social anxiety disorder has a significant negative impact on individuals'social interaction and normal life,and childhood trauma plays an important role in the occurrence and development of SAD.Childhood trauma affects the development of self-awareness,impairs the ability of information processing,hinders the normal development of prefrontal cortex-limbic system loop and default mode network,and causes abnormal secretion of glucocorticoid and oxytocin,which leads to individuals'inability to correctly understand social clues and reasonably regulate emotions,and thus unable to produce adaptive emotional and behavioral responses in social situations,which may lead to SAD.In conclusion,childhood trauma has a lasting adverse effect on social function from both psychological and physiological aspects.

Objective:To investigate the functional connectivity of default mode network (DMN) and limbic system, the expression level of inflammatory cytokine and their correlation in bipolar disorder type Ⅱ(BDⅡ) patients with depressive episodes.Methods:Thirty-three BD Ⅱ patients with depressive episodes and forty-six healthy controls were recruited to complete the resting-state functional magnetic resonance imaging (rs-fMRI). After image preprocessing, the DMN and limbic system were extracted from the image data by independent component analysis (ICA), so as to compare the differences of functional connectivity of resting brain network between the patients and the controls.Serum levels of inflammatory cytokines interleukin-6 (IL-6), interleukin-8(IL-8), interleukin-10(IL-10), tumor necrosis factor-α (TNF-α), and C-C motif chemokine ligand 4 (CCL4) in patients and healthy controls were detected.The correlation between functional connectivity of different brain regions and inflammatory cytokines was analyzed.SPSS 17.0 software was used for data statistical analysis.The two samples were compared using t-test or Mann-Whitney U-test, and Spearman was used for correlation testing. Results:In BDⅡ patients, the functional connectivity of the right medial prefrontal cortex(cluster-size=7 voxel, cluster-level PGRF<0.05, MNI: x=6, y=54, z=9, t=-3.765) and the left superior frontal gyrus(cluster-size=10 voxel, cluster-level PGRF<0.05, MNI: x=-21, y=54, z=15, t=-4.139) in DMN decreased, while the left cerebellum Ⅳ and Ⅴ lobules of limbic system (cluster-size=21 voxel, cluster-level PGRF<0.05, MNI: x=-15, y=-24, z=-30, t=4.468) and cerebellar tonsil of left cerebellum posterior lobe(cluster-size=8 voxel, cluster-level PGRF<0.05, MNI: x=-15, y=-51, z=-45, t=4.138) in the limbic system increased.Compared with the healthy controls, the serum levels of IL-10(7.39 (6.33, 9.32) pg/mL vs 6.54 (5.84, 7.39) pg/mL, Z=-2.937, P=0.003)and CCL4 (39.31 (25.77, 68.70) pg/mL vs 31.30 (20.32, 40.89) pg/mL, Z=-2.209, P=0.027) were higher in BDⅡ patients.The functional connectivity of the left cerebellum Ⅳ and Ⅴ lobules was positively correlated with the serum levels of IL-10 ( r=0.432, P=0.031) and that of the cerebellar tonsil of left cerebellum posterior lobe was positively correlated with the serum levels of IL-10 ( r=0.429, P=0.032) and CCL4 ( r=0.402, P=0.046). Conclusion:The functional connectivity of DMN and limbic system in BDⅡ patients with depressive episode is abnormal in resting-state fMRI.The expression level of inflammatory cytokines in patients' serum increases, and has correlation with the functional connection of limbic system.

Objective:To investigate the differences in personality characteristics and cognitive functions in depression patients with and without obsessive-compulsive.Methods:From October 2020 to October 2021, 31 patients diagnosed as major depressive disorder(MDD) with obsessive-compulsive symptoms(OCS), totally 29 patients diagnosed as MDD without OCS, and 30 healthy controls(HC group) were recruited.The personality characteristics of all subjects were assessed with Eysenck personality questionnaire(EPQ), personality diagnostic questionnaire-4(PDQ-4) and Minnesota multiphasic personality inventory(MMPI), while cognitive functions were assessed with measurement and treatment research to improve cognition in schizophrenia(MATRICS)consensus cognitive battery(MCCB). SPSS 25.0 software was used for data processing, and univariate analysis of variance and simple effect analysis were used to compare the differences in personality characteristics and cognitive functions among the three groups of subjects.Results:The comparison of EPQ scores showed that the psychoticism scores of the group with and without OCS((50.32±10.08), (49.83±11.69)) were significantly lower than that of the HC group(59.47±10.41)( P=0.004, 0.003), while the neuroticism scores((61.94±12.36), (63.10±10.56)) were significantly higher than that of the HC group(46.13±8.33)(both P<0.05). The comparison of PDQ-4 scores showed that the schizoid score of the group with OCS(5.00(2.00, 7.00)) was significantly higher than that of the group without OCS(3.00(1.00, 5.00))( P=0.024). The comparison of MMPI scores showed that except for the two dimensions of masculinity-femininity and hypomania, the scores of the other eight dimensions in the group with and without OCS were significantly higher than those in the HC group(all P<0.01). The comparison of MCCB scores showed that the attention/alertness and visual learning scores of the group with OCS were significantly lower than those of the HC group( P=0.042, 0.004), meanwhile there was no difference of the all dimension scores of MCCB between the MDD patients with and without OCS. Conclusion:There are differences in personality and cognitive function between MDD patients with and without OCS and healthy controls.There is no difference in score of schizotypal personality traits between MDD patients with OCS and MDD patients without OCS, however the related cognitive function of MDD patients without OCS is not significantly different from that of MDD patients with OCS.It is suggested that MDD patients with OCS may have more deviated personality characteristics than those without OCS.Further research is needed to investigated the differences in cognitive impairment.

Objective:To summarize and evaluate the target and dose design of 125I seed brachytherapy treatment plan of pediatric borderline tumor in head neck region. Methods:Eleven patients underwent definitive 125I brachytherapy or combined with surgery in Peking University Hospital of Stomatology from January 2010 to December 2018 were retrospective analyzed. The target region was set by extending the tumor gross region by 0.5 to 1.0 cm. The prescription dose and activity ranged from 80 to 120 Gy and 18.5 MBq, respectively. The treatments were performed according to the plan under general anesthesia. Response and toxic reaction were recorded during follow-up. The preoperative and postoperative dosimetric results were compared; and the local control rate, objective response rate, complete response rate and acute toxic reaction rate were calculated. Results:There was no statistically significant difference between preoperative and postoperative dosimetric results ( P>0.05). The follow-up time ranged from 33 to 131 months, with a median of 48 months. The local control rate, objective response rate, complete response rate and acute toxic reaction rate were 100%, 100%, 71.4% and 81.8%, respectively. Conclusions:Under well-designed target and dose, 125I brachytherapy for treatment of pediatric borderline tumor in head neck region would bring ideal therapeutic and toxic outcomes, and could be regarded as a feasible therapy.

Obsessive-compulsive disorder (OCD) mainly manifests as obsessions and compulsions with the characteristics of early age of onset, long illness duration, and low diagnosis and treatment rate.The development of OCD involves mutations in genes associated with the 5-hydroxytryptamine, glutamate, and dopamine systems, as well as changes in the brain structure and function.However, how the potentially pathogenic genes affect brain structure and function and lead to different clinical manifestations remains unknown.Imaging genetics has been used to study the etiological mechanisms of OCD by combining genetics and imaging to analyze the relationship between genetic variation, neurologic and clinical manifestations.As a complex polygenic disease, imaging genetics that combines polygenic association analysis with epigenetic inheritance may become a new trend and perspective to explore the mechanism of the environment-gene-brain-behavior model in OCD.Therefore, this paper reviewed the related imaging genetics studies of OCD, and provided a theoretical basis for the etiological mechanism and precise intervention for OCD.

Major depressive disorder(MDD) is a kind of mental disorder with depression and decreased interest as the main clinical manifestations. The pathogenesis of MDD is unclear, and MDD is characterized by high incidence, high recurrence rate and high suicide rate. At present, the hypothesis of monomamine mechanism can not fully clarify its pathological characteristics, and a considerable number of patients with depression do not respond well to existing antidepressants. N-methyl-D-aspartate receptor (NMDAR) antagonist and γ-aminobutyric acid A(GABAA) receptor positive allosteric regulator have a potential rapid antidepressant effect, which may be a breakthrough in the pathogenesis and clinical treatment of depression. NMDAR has bidirectional regulation, when proper activation of NMDAR can promote dendrite development, neuronal growth and long-term potentiation, but overstimulation of NMDAR can cause toxic reaction, leading to synaptic atrophy and neuronal death. In addition, inflammation can induce changes in NMDAR function and lead to depressive symptoms. At present, ketamine, a new antidepressant NMDAR antagonist, may plays a role in rapid antidepressant and delayed recurrence of depression by increasing the release of BDNF, activating the signal pathway of mammalian target of rapamycin complex 1(mTORC1), and promoting protein synthesis and synaptic plasticity. Thus, ketamine has the effect of rapid antidepressant and delaying the recurrence of depression. However, due to the large variability of NMDAR gene in patients with MDD, its potential functional polymorphism affects clinical symptoms and drug sensitivity. Therefore, by analyzing the latest research at home and abroad, this review comprehensively summarizes the pathogenesis of NMDAR dysfunction, the pathogenesis of MDD, antidepressant treatment and clinical application status, in order to provide theoretical basis for clinical accurate treatment of MDD patients in the future.

The purpose of this article is to provide references for understanding the current provision of bipolar disorder with mixed features as well as future efforts in clinical practice. The article is to review the profile of assessment， management and treatment of suicide risk in bipolar disorder with mixed features. And this review also provides a theoretical framework toward future targeted therapeutic interventions and guidance for bipolar disorder with mixed features.

This paper aims to explore the main points of diagnosis， treatment and misdiagnosis of conversion disorder characterized by paroxysmal abdominal pain. The general hospitals had a high misdiagnose rate and no effective symptomatic treatment for conversion disorder patients with physical discomfort as main symptoms， which leading to heavy physical and mental burden of patients and waste of medical resources， so this paper retrospectively analyzed the etiology， diagnostic process， treatment and therapeutic effect of a case of conversion disorder with paroxysmal abdominal pain as the main symptom. Case analysis showed that the physical discomfort as chief complain of conversion disorder patients affected the rate of early correct diagnosis and treatment， so clinicians' ability of diagnosis and differential diagnosis of conversion disorder needs to be strengthened. At the same time， cognitive behavioral therapy （CBT） is effective in the clinical treatment and recurrence prevention of conversion disorder.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective To investigate functional connectivity between the two hemispheres in patients with positive symptoms of schizophrenia using voxel-mirrored homotopic connectivity ( VMHC ) based on resting-state functional magnetic resonance imaging (rs-fMRI). Methods Eighteen patients with positive symptoms of schizophrenia and 22 healthy controls underwent the rs-fMRI. The whole brain VMHC was calculated in order to provide imaging basis for the study of the pathological mechanism of schizophrenia. Results Compared to the controls, VMHC values were decreased in the bilateral orbitofrontal cortex (t=-5.31, P<0.01), fusiform gyrus (t=-5.16, P<0.01), middle occipital gyrus (t=-5.31, P<0.01) in patients with positive symptoms of schizophrenia. Conclusion The functional coordination between homotopic brain regions is impaired in patients with positive symptoms of schizophrenia .