Objective: To evaluate the implementation process of a school-family collaborative "online+offline" tobacco control intervention program in junior high school in Beijing and to explore the execution status, influencing factors and sustainability potential of the intervention, so as to provide evidence for optimizing youth tobacco control strategies. Methods: In November 2024, using the random number table method, four first year junior high school classes were selected from three schools each in Fengtai District, Tongzhou District, and Fangshan District of Beijing. One class served as the control group, while the other three classes were designated as intervention groups (one each for online intervention, offline intervention, and combined online offline intervention). The control group received only conventional education.The online intervention group was engaged in WeChat push interventions, including watching micro videos, viewing promotional materials, participating in online quizzes and mini games; the offline intervention group attended knowledge lectures, played peer games, and participated in offline knowledge competitions; the combined online offline intervention group integrated all the aforementioned online and offline intervention measures. The intervention period was from November 2024 to June 2025, spanning a total of 7 months. Based on the Practical, Robust Implementation and Sustainability Model(PRISM) framework, a qualitative research design was employed to conduct semi structured interviews with 48 participants (12 in each of the intervention groups and 12 organizational staff members) from the Centers for Disease Control and Prevention (CDC) in 3 districts and 3 sampled schools. The interview outlines were designed according to the intervention plan. Data was managed using Nvivo 12.0 software and analyzed following Colaizzi s seven step phenomenological analysis method. Theoretical saturation was assessed using a reserved subset of transcripts. Results: Four core themes were identified in the tobacco control intervention process. Overall fidelity of intervention implementation was largely consistent with the original plan, and students showed strong willingness and positive evaluations toward interactive formats such as knowledge contests and peer games, though occasional breakdowns in school-family communication and blurred boundaries between online and offline components were observed; the participants showed a polarized response in terms of satisfaction and participation, most students and parents recognized the significance of the activity, and some parents observed a reduction in smoking behavior; the implementation of internal tobacco control policies in the school was strict, and the atmosphere was favorable, but there was still room for improvement, such as the scarcity of community tobacco control activities and the difficulty in implementing smoke free units; implementation and sustainability infrastructure were preliminarily established, such as through homeroom teacher supervision and training student assistants to assisted in activities, while the sustainability support system required further refinement. Conclusion The school-family collaborative "online+offline" tobacco control intervention has demonstrated significant positive effects, but further optimization of activity design, enhancement of community reward mechanisms, and standardized training are required to improve the efficacy and sustainability of the intervention.

This report describes the clinical course， diagnosi and treatment of a patient with neuromyelitis optica spectrum disorder （NMOSD） who presented initially with depression and delusion. The patient was a 38-year-old woman who initially presented with low mood， accompanied by nausea and vomiting. Mental examination revealed delusions of jealousy and psychomotor retardation. Subsequently， she developed fever and decreased muscle strength. Magnetic resonance imaging (MRI） revealed lesions involving pons and upper cervical spinal cord. Cerebrospinal fluid testing was positive for aquaporin 4 （AQP4） antibodies， and metagenomic sequencing of cerebrospinal fluid detected DNA fragments of Escherichia coli and Klebsiella pneumoniae. Following treatment with glucocorticoid pulse therapy combined with anti-infective therapy， the patient's mood， psychiatric symtoms， and neurological symptoms improved. This case suggests that psychiatric symptoms including depression and delusion may be the presenting features of NMOSD， and that infectious factors might play a role in triggering autoimmune responses. These observations offer valuable clinical clues for the early identification of NMOSD.

Objective:To compare the effects of standard cognitive behavioral therapy for insomnia (CBT-I) and enhanced cognitive behavioral therapy for insomnia(CBT-I Plus) in patients with chronic insomnia disorder comorbid anxiety or depressive symptoms.Methods:This prospective study included 148 patients with chronic insomnia disorder and anxiety/depression symptoms who were treated at the Sleep Disorder clinic of Shanghai Mental Health Center between July 2020 and August 2023. Participants (56 males, 92 females; aged 18-65 years, mean age 35.08±10.30 years) were randomly assigned in a 1∶2 ratio to the CBT-I group ( n=54) or CBT-I Plus group ( n=94). The CBT-I Plus group received additional treatments targeting anxiety and depressive symptoms. Treatment lasted 8 weeks, with assessment conducted at baseline, weeks 2, 4, and 8. Depression severity was measured using the 17-item Hamilton Depression Rating Scale (HAMD 17), anxiety severity with the Hamilton Anxiety Scale (HAMA), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Paired sample t-tests were used to evaluate within-group changes, repeated-measures ANOVA compared treatment effects between groups, and ANCOVA was employed to adjust for confounding variables. Results:Significant reductions in PSQI, HAMD 17, and HAMA scores were observed in both groups after treatment: CBT-I group: PSQI ((14.15±2.54) vs. (7.50±3.35), t=13.25), HAMD 17 ((14.70±4.09) vs. (7.40±4.61), t=9.33), and HAMA ((14.94±4.11) vs. (5.56±3.67), t=12.38) (all P<0.001).CBT-I Plus group: PSQI ((14.87±3.01) vs. (7.19±3.86), t=18.75), HAMD 17 ((16.84±3.91) vs. (6.84±4.79), t=17.42), and HAMA ((15.57±3.93) vs. (6.10±4.57), t=18.39) (all P<0.001). After adjusting for HAMD 17 scores and medication use, no statistically significant between-group differences were observed in changes in PSQI, HAMD 17, and HAMA scores ( P>0.05). A significant time-by-group interaction was found for the PSQI daytime dysfunction subscale ( F=4.87, P<0.01). Conclusion:Both CBT-I and CBT-I Plus improve sleep and emotional symptoms in patients with chronic insomnia disorder and comorbid anxiety/depression symptoms. However, CBT-I Plus has no significant advantages over standard CBT-I. Further studies are needed to refine the timing and content of interventions.

Objective:To compare the effects of standard cognitive behavioral therapy for insomnia (CBT-I) and enhanced cognitive behavioral therapy for insomnia(CBT-I Plus) in patients with chronic insomnia disorder comorbid anxiety or depressive symptoms.Methods:This prospective study included 148 patients with chronic insomnia disorder and anxiety/depression symptoms who were treated at the Sleep Disorder clinic of Shanghai Mental Health Center between July 2020 and August 2023. Participants (56 males, 92 females; aged 18-65 years, mean age 35.08±10.30 years) were randomly assigned in a 1∶2 ratio to the CBT-I group ( n=54) or CBT-I Plus group ( n=94). The CBT-I Plus group received additional treatments targeting anxiety and depressive symptoms. Treatment lasted 8 weeks, with assessment conducted at baseline, weeks 2, 4, and 8. Depression severity was measured using the 17-item Hamilton Depression Rating Scale (HAMD 17), anxiety severity with the Hamilton Anxiety Scale (HAMA), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Paired sample t-tests were used to evaluate within-group changes, repeated-measures ANOVA compared treatment effects between groups, and ANCOVA was employed to adjust for confounding variables. Results:Significant reductions in PSQI, HAMD 17, and HAMA scores were observed in both groups after treatment: CBT-I group: PSQI ((14.15±2.54) vs. (7.50±3.35), t=13.25), HAMD 17 ((14.70±4.09) vs. (7.40±4.61), t=9.33), and HAMA ((14.94±4.11) vs. (5.56±3.67), t=12.38) (all P<0.001).CBT-I Plus group: PSQI ((14.87±3.01) vs. (7.19±3.86), t=18.75), HAMD 17 ((16.84±3.91) vs. (6.84±4.79), t=17.42), and HAMA ((15.57±3.93) vs. (6.10±4.57), t=18.39) (all P<0.001). After adjusting for HAMD 17 scores and medication use, no statistically significant between-group differences were observed in changes in PSQI, HAMD 17, and HAMA scores ( P>0.05). A significant time-by-group interaction was found for the PSQI daytime dysfunction subscale ( F=4.87, P<0.01). Conclusion:Both CBT-I and CBT-I Plus improve sleep and emotional symptoms in patients with chronic insomnia disorder and comorbid anxiety/depression symptoms. However, CBT-I Plus has no significant advantages over standard CBT-I. Further studies are needed to refine the timing and content of interventions.

Objective:The current study aims to explore the factors related to the efficacy of cognitive behavior therapy for insomnia (CBT-I) from the perspective of patients and to provide references for more effective implementation of CBT-I.Methods:Using qualitative research methods, 21 insomnia patients with depression/anxiety were treated with CBT-I for 8 consecutive times. Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD 17), and Hamilton Anxiety Scale (HAMA) were assessed at baseline and the end of the 8th week of treatment. The paired sample t-test was conducted. Semi-structured interviews were performed at week 2, week 4, and week 8 respectively and thematic analysis was used to code and analyze the interview data. Results:Compared with baseline data, the symptoms of insomnia (13.6±2.0 vs. 6.9±2.4), depression (14.6±5.5 vs. 5.0±3.6), and anxiety (17.2±3.4 vs. 5.3±3.9) were significantly improved after 8 weeks of CBT-I treatment ( t=-3.31, -3.19, -2.94, all P<0.01). The patient factors influencing the efficacy of CBT-I were treatment expectation and approval, motivation, compliance, and internalization of treatment content. The therapist factors were professionalism, well-directed, treatment style, supervision, and giving hope. Conclusion:Compliance and high levels of participation of the patients can benefit the treatment efficacy of CBT-I. Therapists should have sufficient experience, stimulate patients′ motivation, improve patients′ compliance, and carry out adequate psychological education in the early stage to increase the efficacy of CBT-I.

Objective:The current study aims to explore the factors related to the efficacy of cognitive behavior therapy for insomnia (CBT-I) from the perspective of patients and to provide references for more effective implementation of CBT-I.Methods:Using qualitative research methods, 21 insomnia patients with depression/anxiety were treated with CBT-I for 8 consecutive times. Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD 17), and Hamilton Anxiety Scale (HAMA) were assessed at baseline and the end of the 8th week of treatment. The paired sample t-test was conducted. Semi-structured interviews were performed at week 2, week 4, and week 8 respectively and thematic analysis was used to code and analyze the interview data. Results:Compared with baseline data, the symptoms of insomnia (13.6±2.0 vs. 6.9±2.4), depression (14.6±5.5 vs. 5.0±3.6), and anxiety (17.2±3.4 vs. 5.3±3.9) were significantly improved after 8 weeks of CBT-I treatment ( t=-3.31, -3.19, -2.94, all P<0.01). The patient factors influencing the efficacy of CBT-I were treatment expectation and approval, motivation, compliance, and internalization of treatment content. The therapist factors were professionalism, well-directed, treatment style, supervision, and giving hope. Conclusion:Compliance and high levels of participation of the patients can benefit the treatment efficacy of CBT-I. Therapists should have sufficient experience, stimulate patients′ motivation, improve patients′ compliance, and carry out adequate psychological education in the early stage to increase the efficacy of CBT-I.

Objective: To investigate the effects of terlipressin (TP) on blood pressure and survival in septic mice following trauma and its mechanism. Methods: ① Survival experiment: 120 male C57BL/6 mice aged 6-8 weeks were enrolled, the posttraumatic sepsis mice model was reproduced by traumatic hemorrhage (bilateral femoral fracture + 45% of total blood loss) followed by cecal ligation and puncture (CLP) after 8 hours. Intraperitoneal injection of TP was used for intervention. Sixty model mice were used to observe the effect of 0.05 μg/g TP at different intervention times (the drug was given immediately after traumatic hemorrhage + the administration was repeated after 6 hours, the drug was given immediately after traumatic hemorrhage + the administration was repeated every 6 hours until the end of the experiment, the drug was given at 4 hours after CLP + the administration was repeated every 6 hours until the end of the experiment) on 48-hour cumulative survival rate of mice with posttraumatic sepsis for finding the best intervention time of TP. The other 60 model mice were used to observe the effect of different TP intervention doses (0.01, 0.05, 0.25 μg/g) at the best intervention time on the 48-hour cumulative survival rate of mice with posttraumatic sepsis for finding the best intervention dose of TP. ② Intervention experiment: the other 45 mice were enrolled, and they were randomly divided into traumatic hemorrhage + sham group (TH+sham group, only laparotomy without CLP), TH+CLP group, and TH+CLP+TP group (the best intervention time and dose of TP shown by survival experiment were used), with 15 mice in each group. Mean arterial pressure (MAP) of mice was monitored continuously. The orbital whole blood was collected at 2 hours after successful reproduction of the model, and the lung tissues were harvested at 12 hours and 24 hours, respectively. The pathological changes in lung tissue were observed with light microscope. The contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in serum and lung tissue were determined by enzyme linked immunosorbent assay (ELISA). The expressions of IL-1β and TNF-α mRNA in lung tissue were determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR). The expressions of nuclear factor-κB p65 (NF-κB p65) in the nucleus and cytoplasm of lung tissue were determined by Western Blot. Results: ① Survival experiment results showed that the 48-hour cumulative survival rate of mice was highest with TP intervention by 0.05 μg/g administration immediately after traumatic hemorrhage and repeated every 6 hours, which was the best intervention method of TP. ② Intervention experiment results showed that the pulmonary alveolar wall fracture accompanied by inflammatory cell infiltration was found at 12 hours after the successful reproduction of traumatic sepsis model, and the pathological damage was gradually increased with time prolongation. MAP was decreased sharply after traumatic hemorrhage, and it was continued to decrease after two-hit of CLP. The contents of IL-1β and TNF-α in serum and lung tissue, the expressions of IL-1β and TNF-α mRNA in lung tissue, and expressions of NF-κB p65 protein in cytoplasm and nucleus of TH+CLP group were significantly higher than those in TH+sham group. Compared with TH+CLP group, the pathological changes in lung tissue were improved significantly, and the MAP was decreased gently after TP intervention, the levels of inflammatory mediators in serum were significantly decreased [IL-1β (pg/L): 164.32±25.25 vs. 233.11±23.02, TNF-α (pg/L): 155.56±31.47 vs. 596.38±91.50, both P < 0.05], and their expressions in lung tissue [IL-1β content (ng/mg): 262.68±16.56 vs. 408.15±17.85, IL-1β mRNA (2^-ΔΔCt): 2.63±0.68 vs. 6.22±0.74; TNF-α content (ng/mg): 311.07±17.35 vs. 405.04±24.83, TNF-α mRNA (2^-ΔΔCt): 2.04±0.62 vs. 5.32±0.55, all P < 0.01], and NF-κB p65 protein expressions were significantly down-regulated (gray value: 0.47±0.01 vs. 1.28±0.05 in cytoplasm, 0.45±0.02 vs. 1.95±0.06 in nucleus, both P < 0.01]. Conclusions The continuous intervention with TP 0.05 μg/g administration immediately after traumatic hemorrhage and repeated every 6 hours could improve the MAP of mice with traumatic sepsis, and improve the prognosis. The mechanism may be related to alleviating the inflammatory response and inhibiting the activation of the NF-κB signaling pathway in the lung tissue.

OBJECTIVE: To investigate the effects of terlipressin (TP) on blood pressure and survival in septic mice following trauma and its mechanism. METHODS: (1) Survival experiment: 120 male C57BL/6 mice aged 6-8 weeks were enrolled, the posttraumatic sepsis mice model was reproduced by traumatic hemorrhage (bilateral femoral fracture + 45% of total blood loss) followed by cecal ligation and puncture (CLP) after 8 hours. Intraperitoneal injection of TP was used for intervention. Sixty model mice were used to observe the effect of 0.05 μg/g TP at different intervention times (the drug was given immediately after traumatic hemorrhage + the administration was repeated after 6 hours, the drug was given immediately after traumatic hemorrhage + the administration was repeated every 6 hours until the end of the experiment, the drug was given at 4 hours after CLP + the administration was repeated every 6 hours until the end of the experiment) on 48-hour cumulative survival rate of mice with posttraumatic sepsis for finding the best intervention time of TP. The other 60 model mice were used to observe the effect of different TP intervention doses (0.01, 0.05, 0.25 μg/g) at the best intervention time on the 48-hour cumulative survival rate of mice with posttraumatic sepsis for finding the best intervention dose of TP. (2) Intervention experiment: the other 45 mice were enrolled, and they were randomly divided into traumatic hemorrhage + sham group (TH+sham group, only laparotomy without CLP), TH+CLP group, and TH+CLP+TP group (the best intervention time and dose of TP shown by survival experiment were used), with 15 mice in each group. Mean arterial pressure (MAP) of mice was monitored continuously. The orbital whole blood was collected at 2 hours after successful reproduction of the model, and the lung tissues were harvested at 12 hours and 24 hours, respectively. The pathological changes in lung tissue were observed with light microscope. The contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in serum and lung tissue were determined by enzyme linked immunosorbent assay (ELISA). The expressions of IL-1β and TNF-α mRNA in lung tissue were determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR). The expressions of nuclear factor-κB p65 (NF-κB p65) in the nucleus and cytoplasm of lung tissue were determined by Western Blot. RESULTS: (1) Survival experiment results showed that the 48-hour cumulative survival rate of mice was highest with TP intervention by 0.05 μg/g administration immediately after traumatic hemorrhage and repeated every 6 hours, which was the best intervention method of TP. (2) Intervention experiment results showed that the pulmonary alveolar wall fracture accompanied by inflammatory cell infiltration was found at 12 hours after the successful reproduction of traumatic sepsis model, and the pathological damage was gradually increased with time prolongation. MAP was decreased sharply after traumatic hemorrhage, and it was continued to decrease after two-hit of CLP. The contents of IL-1β and TNF-α in serum and lung tissue, the expressions of IL-1β and TNF-α mRNA in lung tissue, and expressions of NF-κB p65 protein in cytoplasm and nucleus of TH+CLP group were significantly higher than those in TH+sham group. Compared with TH+CLP group, the pathological changes in lung tissue were improved significantly, and the MAP was decreased gently after TP intervention, the levels of inflammatory mediators in serum were significantly decreased [IL-1β (pg/L): 164.32±25.25 vs. 233.11±23.02, TNF-α (pg/L): 155.56±31.47 vs. 596.38±91.50, both P < 0.05], and their expressions in lung tissue [IL-1β content (ng/mg): 262.68±16.56 vs. 408.15±17.85, IL-1β mRNA (2^{-Δ ΔCt}): 2.63±0.68 vs. 6.22±0.74; TNF-α content (ng/mg): 311.07±17.35 vs. 405.04±24.83, TNF-α mRNA (2^{-Δ ΔCt}): 2.04±0.62 vs. 5.32±0.55, all P < 0.01], and NF-κB p65 protein expressions were significantly down-regulated (gray value: 0.47±0.01 vs. 1.28±0.05 in cytoplasm, 0.45±0.02 vs. 1.95±0.06 in nucleus, both P < 0.01]. CONCLUSIONS The continuous intervention with TP 0.05 μg/g administration immediately after traumatic hemorrhage and repeated every 6 hours could improve the MAP of mice with traumatic sepsis, and improve the prognosis. The mechanism may be related to alleviating the inflammatory response and inhibiting the activation of the NF-κB signaling pathway in the lung tissue.
Animals ; Blood Pressure ; Interleukin-1beta ; Lypressin/analogs & derivatives* ; Male ; Mice ; Mice, Inbred C57BL ; Sepsis ; Terlipressin ; Tumor Necrosis Factor-alpha

Objective To explore the role of night waking in the cognitive development of infants and young toddlers. Method A total of 116 infants aged 2 to 30 months were randomly selected in Yiwu, Zhejiang from December 2011 to February 2013. Social-demographic factors were investigated through questionnaire;sleep information were collected via the Brief Infant Sleep Questionnaire (BISQ);Cognitive development was assessed in all infants using Baley development scale. Results The mean age was 12.99 month-old. 50.86%(59/116) were males. Ocassional night waking was reported in 5.26%, one night waking in 29.82%, multiple night waking accounted in 64.91%of children under one year old. Ocassional night waking was reported in 32.20%, one night waking in 45.76%, multiple night waking in 22.03%of children over one year old. The frequency of night waking was signiifcantly different between children under one year old and children over one year old (P<0.01). The average duration of waking was 0.49±0.31 h in children under one year old, and 0.31±0.48 h in children older than one year old, and the difference was signiifcantly different (Z=4.35, P<0.001). In children over one year old, the more frequent night waking, the lowered MDI scores (F=3.98, P=0.024). The waking duration was negatively correlated with MDI scores in children over one year old (r=-0.26, P=0.035). Neither night waking duration nor night waking frequency had signiifcant correlation with MDI scores in children under one year old. Multivariable linear regression conifrmed that night waking was an independent inlfuential factor of MDI and PDI scores in children over one year old. Conclusions Persistent night waking should warrant attention.