Repetitive transcranial magnetic stimulation (rTMS) has become an essential method in psychiatric disorders. However, many problems occurred in clinical application. This article interpreted the Association Standard T/CMEAS 011-2023'Operating Specifications for Repetitive Transcranial Magnetic Stimulation in Clinical Applications on Psychiatric Disorders′ released by the Chinese Medicine Education Association. The main content included a range of applications, normative references, terms and definitions, site specifications, equipment specifications, ability specifications of rTMS operators and rTMS process specifications.This article provided suggestions for clinical applications of rTMS on psychiatric disorders.

Repetitive transcranial magnetic stimulation (rTMS) has become an essential method in psychiatric disorders. However, many problems occurred in clinical application. This article interpreted the Association Standard T/CMEAS 011-2023'Operating Specifications for Repetitive Transcranial Magnetic Stimulation in Clinical Applications on Psychiatric Disorders′ released by the Chinese Medicine Education Association. The main content included a range of applications, normative references, terms and definitions, site specifications, equipment specifications, ability specifications of rTMS operators and rTMS process specifications.This article provided suggestions for clinical applications of rTMS on psychiatric disorders.

Objective:To know the clinical characteristics, seasonal pattern and influencing factors of atypical depression(AD) patients.Methods:A total of 203 depressed outpatients of Peking University Sixth Hospital from January 2021 to August 2021 were included.They were assessed with demographic questionnaire, inventory of depressive symptomatology self-report(IDS-SR30) and seasonal pattern assessment questionnaire(SPAQ). According the score of IDS-SR30, all patients were classified as atypical depression(AD) and non-atypical depression(non-AD). The data were analyzed by t-test, non-parametric test and Logistic regression using SPSS 26.0 software. Results:The prevalence of AD among depressed patients was 36.0% (95% CI=29.3%-42.6%). The IDS-30 score of the AD group was (41.59±10.59), and IDS-30 score of the non-AD group was (36.08±13.17), and the difference between the two groups was statistically significant ( t=3.062, P<0.05). The global seasonal score of the AD group was 6 (3, 9), and 17.8% of the AD group had seasonal pattren.The global seasonal score of the non-AD group was 5 (3, 8), and 14.6% of the non-AD group had seasonal pattern.There was no significant difference in the global seasonal score and the proportion of seasonal pattern between the two groups ( Z=0.389, χ2=0.359, P>0.05). Depression patients who were females ( β=1.08, OR=2.95, 95% CI=1.32-6.59, P<0.05), low self-evaluation ( β=0.82, OR=2.27, 95% CI=1.12-4.59, P<0.05)and psychomotor retardation ( β=0.93, OR=2.54, 95% CI=1.33-4.85, P<0.05) were more likely to be diagnosed as AD, and depression patients having mood variation ( β=-0.94, OR=0.39, 95% CI=0.19-0.81, P<0.05) were more likely to be diagnosed as non-AD. Conclusion:Women, low self-evaluation, psychomotor retardation and unobvious mood variation can predict and help to diagnose atypical depression in depressed patients.

Objective : To investigate the effects of one night of sleep deprivation on adults ’cognitive performance and sleepiness. Methods : The study employed a repeated⁃measures design. Participants performed cognitive performance tasks , which included the Continuous Performance Test and Digit Span Test and Karolinska Sleepiness Scale. The data were analyzed using one⁃way repeated⁃measures ANOVA. Results : 48 participants were included in this study. Sleep deprivation during night shift had a adversely affect on sustained attention performance and alertness (P < 0. 05) . Compared with the beginning of night shift work , the correct number decreased , the number of errors , missed number and reaction time increased , and the score of Karolinska sleepiness scale decreased after the night shift work. The sleep deprivation has no significant effect on working memory performance (P > 0. 05) . Conclusion One night of sleep deprivation has significant deleterious effects on cognitive performance and subjec⁃ tive sleepiness. However, no effect on the working memory performances has been found.

Objective To explore the sensitivity and specificity of near-infrared spectroscopy ( NIRS) in the diagnosis of depression. Methods From March 2013 to August 2013,62 patients with de-pression and 70 normal controls were collected from Peking University Sixth Hospital. Optical Tomography System (52 channels) was used to collect the NIRS data during the Verbal Fluency Test (VFT),and the number of words produced during VFT task was recorded. The wave analysis was performed by a professional psychiatrist. Results There was statistical difference in the number of words produced during VFT task be-tween the patients with depression (8.65±0.49)and control group(10.19±0.43) ( t=2.385, P<0.05). Through the wave analysis of NIRS to test patients with depression,the results demonstrated that the sensitivi-ty was 66.1% and the specificity was 91.4%. Conclusion The results of NIRS test display high specificity in the diagnosis of depression,which can be used as an objective index for clinical auxiliary diagnosis.

Objectives To assess the effect of onset age on prefrontal activation during a working memory task in patients with bipolar disorder using a 52 multichannel functional near-infrared spectroscopy (NIRS).Methods Sixteen patients with early-onset (EO,onset age≤24 years old) and 14 with non-early-onset (NEO,onset age＞24 years old) bipolar Ⅰ disorder were consecutively recruited from wards of Peking University Sixth hospital between October 2013 and May 2014,also including 16 healthy controls (HC) from community.Three groups of participants were diagnosed using MINI,then accepted a cross-sectional comparison of the relative changes in oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) during 1-back working memory task.Results Results from single factor analyses suggested that EO group showed a significantly reduced activation in deoxy-Hb in the right inferior prefrontal gyrus region than HC (CH34:-0.091 vs.0.009,Z=-2.542,P=0.033),while a significant increase of deoxy-Hb changes in the right dorsolateral prefrontal cortex (CH13:0.145 vs.-0.025,Z=2.412,P=0.048) and right frontopolar cortex (CH15:0.053 vs.-0.032,Z=2.890,P=0.012) regions than NEO group.There were no significant differences in the oxy-Hb changes among three groups in any channel during task.After being adjusted by multiple factor analyses,no significant difference in prefrontal activation among three groups was observed in any channel.Conclusions Similar pattern of prefrontal activity during 1-back working memory task exits between EO and NEO group,indicating that onset age may have no effect on NIRS prefrontal activation under low memory load in patients with bipolar disorder,which provides a reference for further NIRS studies in bipolar disorder.

Objectives To assess the effect of onset age on prefrontal activation during a working memory task in patients with bipolar disorder using a 52 multichannel functional near-infrared spectroscopy (NIRS).Methods Sixteen patients with early-onset (EO,onset age≤24 years old) and 14 with non-early-onset (NEO,onset age＞24 years old) bipolar Ⅰ disorder were consecutively recruited from wards of Peking University Sixth hospital between October 2013 and May 2014,also including 16 healthy controls (HC) from community.Three groups of participants were diagnosed using MINI,then accepted a cross-sectional comparison of the relative changes in oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) during 1-back working memory task.Results Results from single factor analyses suggested that EO group showed a significantly reduced activation in deoxy-Hb in the right inferior prefrontal gyrus region than HC (CH34:-0.091 vs.0.009,Z=-2.542,P=0.033),while a significant increase of deoxy-Hb changes in the right dorsolateral prefrontal cortex (CH13:0.145 vs.-0.025,Z=2.412,P=0.048) and right frontopolar cortex (CH15:0.053 vs.-0.032,Z=2.890,P=0.012) regions than NEO group.There were no significant differences in the oxy-Hb changes among three groups in any channel during task.After being adjusted by multiple factor analyses,no significant difference in prefrontal activation among three groups was observed in any channel.Conclusions Similar pattern of prefrontal activity during 1-back working memory task exits between EO and NEO group,indicating that onset age may have no effect on NIRS prefrontal activation under low memory load in patients with bipolar disorder,which provides a reference for further NIRS studies in bipolar disorder.

Objective To explore the mechanisms of mesenchymal stem cells (MSC) in the treatment of concanavalin A (ConA)-induced acute immune liver injury in mice.Methods MSC were isolated and cultured from bone of the four limbs of three-week-old C57BL/6 mice.The specific surface markers were identified and osteogenic,adipogenic differentiation ability were tested.A total of 15 six to seven-week old C57BL/6 mice were divided into control group,MSC treatment group and phosphate buffer saline (PBS) treatment group,five mice in each group.The mice of MSC treatment group was injected through tail firstly with ConA and then MSC,PBS treatment group was injected through tail firstly with ConA and then PBS,control group was injected through tail with PBS twice.The mice were sacrificed in 14 to 16 hours after injection.The level of alanine aminotransferase (ALT),aspartate transaminase (AST) in peripheral blood were detected and the pathological change in liver tissue was scored by Knodell score system.Activation rate of splenic CD4+ T cells and the proportion changes of T hepler cell (Th)1,Th2,Th17 and regulatory T cells (Treg) were detected by flow cytometry and the ratio of Th17/Treg was calculated.The levels of tumor necrosis factor α (TNF-α),interferon (IFN)-γ and interleukin (IL)-4 in peripheral blood were detected by enzyme linked immunosorbent assay (ELISA).Independent-sample t test was used for comparison between groups of measurement data.Results ALT,AST and Knodell score of MSC treatment group was (174.2± 46.9) U/L,(185.6± 71.6) U/L and 3.4±1.3,respectively,which were better than those of PBS treatment group ((647.0± 118.0) U/L,(749.0± 104.0) U/L and 5.2 ±0.8,respectively),and the differences were statically significant (t =8.33,9.98 and 2.55,all P＜0.05).The activation rate of splenic CD4+ T cell of PBS treatment group was (26.10±2.17) ％,the proportion of Th1 and Th2 in CD4+ T cell was (5.81±0.79) ％ and (5.98± 1.22)％,the ratio of Th17/Treg was 0.29±0.03,the levels of TNF-α,IFN-γ and IL4 in peripheral blood were (1 281.95±88.61) U/L,(1 838.66±196.91) U/L and (1 192.36±163.94) U/L,which were higher than those of control group ((13.74±1.59)％,(1.35±0.17)％,(2.13±0.17)％,0.15± 0.05,(21.71±2.50) U/L,(11.84±1.28) U/L and (24.46±3.96) U/L),and the differences were statistically significant (t=10.26,12.37,7.02,5.30,31.79,15.93 and 20.75,all P＜0.01).There was no statistically significant difference in the activation rate of splenic CD4+T cell between MSC treatment group and PBS treatment group ((26.20±3.09)％ vs (26.10±2.17)％,P＞0.05).However,in MSC treatment group,the proportion of Th1 and Th2 in CD4+ T cell ((1.83±0.52) ％ and (2.75±1.06％)),the ratio of Th17/Treg (0.18±0.02) and the levels of TNF-α,IFN-γ and IL-4 in peripheral blood ((760.71± 73.19) U/L,(742.49±76.46) U/L and (825.76±101.74) U/L) significantly decreased compared with those of PBS treatment group,and the differences were statistically significant (t=9.45,4.48,6.41,10.14,5.56 and 10.22,all P＜0.01).There was no significant difference in the ratio of Th17/Treg between MSC treatment group and control group (P＞0.05).Conclusions The therapeutic effects of MSC on ConA induced acute immune liver injury were through influence splenic CD4+ T cell subsets by decreasing the proportion of Th1 and Th2 and then declining the levels of secreted cytokines such as TNF,IFN-γ and IL-4 in peripheral blood,increasing the proportion of Treg and decreasing the proportion of Th17 and keeping the balance of Th17/Treg.

Objective To explore the effects of emotion on cognitive function in patients with depression.Methods Self-rating anxiety scale(SAS),self-rating depression scale (SDS) and the typical one-back task were done by 397 patients with depression in Peking University Sixth hospital out-patient and hospitalization during 2012 June to 2013 October.Results Both of the SAS standard score (51.81 ± 11.50) and SDS standard score (62.94 ± 13.06) were significantly related (r=0.125,P＜0.05.r=0.176,P＜0.01) to the reaction time of one-back task ((590.27±213.96)ms),and the correlation between SAS standard score and SDS standard score was significant (r=0.682,P＜0.01).The results of regression analysis suggested that,only SDS score could predict the reaction time of one-back task.Conclusion The emotion of anxiety and depression in patients with depression are correlated with cognitive function,and the emotion of depression is the main factor to affect the cognitive function.

Objective To investigate the characteristics,treatment and prognosis of the gastrointes-tinal iatrogenic perforation resulting from endoscopic operations.Methods The clinical data of the 107 pa-tients with gastrointestinal iatrogenic perforations caused by endoscopic operations from October 2003 to Octo-ber 2013 were retrospectively studied,and the characteristics,treatment and prognosis of these patients were analysed.Results The incidence of the gastrointestinal iatrogenic perforation resulting from endoscopic oper-ations was 0.041%(107 /263 549,among which 0.006% was diagnostic(13 /232 011),and 0.298% was therapeutic (94 /31 538).A total of 107 patients with gastrointestinal iatrogenic chose conservative medical management,endoscopic clipping or surgery according to different conditions after perforations.All patients had good prognosis.Conclusion Endoscopic therapeutic operations are more likely to lead to the occurrence of iatrogenic gastrointestinal perforations compared with diagnostic operations.And most patients could get good prognosis as long as the appropriate treatment is performed when the perforation occurs.