Major depressive disorder in adolescents is a serious psychiatric condition characterized by profound impairment in psychosocial functioning. Its primary symptoms include low mood, irritability, and anhedonia. Although pharmacological treatments and psychotherapy are currently recommended as first-line treatments, their effectiveness is limited, and pharmacological treatments may carry the risk of increased suicidal ideation. Therefore, exploring new, effective, and safe treatment options is an urgent priority. In recent years, intermittent theta burst stimulation (iTBS), a novel form of transcranial magnetic stimulation, has shown promising results in treating treatment-resistant depression in adults, drawing growing interest in its potential use in adolescents. iTBS modulates neural activity through magnetic stimulation of the cerebral cortex and has been shown to alleviate depressive symptoms, particularly when targeting the left dorsolateral prefrontal cortex (DLPFC). Given the high neuroplasticity of the adolescent brain during this critical developmental stage, adolescents may exhibit heightened sensitivity to iTBS, resulting in more enduring neuroregulatory effects. Research highlights the importance of precise targeting and individualized adjustment of stimulation intensity for optimal therapeutic outcomes. Additionally, accelerated iTBS (aiTBS) protocols have demonstrated faster clinical effects in treating acute or severe depression in adolescents, improving treatment adherence and partially mitigating suicidal tendencies. This review summarizes recent progress in the application of iTBS in adolescent depression, with a focus on its mechanisms, treatment parameters, and related research. The goal is to provide theoretical support and practical guidance for the clinical application of iTBS in adolescent depression care.

Objectives:To explore the CT classification and evaluation methods of thoracoabdominal folded deformity in ankylosing spondylitis(AS).Methods:A retrospective analysis was conducted on 31 patients with AS thoracolumbar kyphosis who underwent thoracolumbar CT examinations between July 2017 and January 2024.There were 28 males and 3 females,with an average age of 45.0±8.9 years.The thoracoabdominal folded angle(TAFA)and the distances between xiphoid process and the superior edge of the pubic symphysis(XP)were measured on the mid-sagittal plane of thoracolumbar CT.The global kyphosis(GK),thoracic kypho-sis(TK),and lumbar lordosis(LL)Cobb angle and sagittal vertical axis(SVA)were measured on the full-length lateral radiograph of the spine.According to the effect of sagittal lumbar physiological curvature on the change of abdominal volume,a CT classification of AS thoracoabdominal folded deformity was innovatively classified into three types,type Ⅰ when there was physiological lordosis in the lumbar spine,type Ⅱ when the physiological curvature of the lumbar spine became straight,and type Ⅲ when there was lumbar kyphosis deformity.According to TAFA,type Ⅲ patients were divided into two subtypes:TAFA＞90° was subtype A,and TAFA ≤90° was subtype B.Five trained spinal surgeons independently evaluated and classified the clini-cal data of patients(with a 10d interval),and used Kendall's W-test to analyze the consistency of multiple observation results.Using one-way analysis of variance to compare the differences in the above measurement parameters between different types.Results:Among the 31 patients,there were 5 cases of thoracoabdominal folded deformity type Ⅰ,8 cases of type Ⅱ,12 cases of type Ⅲ A,and 6 cases of type ⅢB.The Kendall's W consistency coefficient for inter-observer classification was 0.954(P＜0.001).The average GK,TK,LL,SV A,TAFA,and XP of patients were 83.7°±29.9°,48.7°±21.3°,-13.9°±25.3°,22.8±14.9cm,128.1°±50.5°,and 16.8±8.9cm,respectively;The Kendall's W consistency coefficients between the different groups'measurement values of TAFA and XP were 0.946(P＜0.001)and 0.979(P＜0.001),respectively;There were significant differ-ences in TAFA and XP pairwise comparisons between different subtypes(P＜0.001).Conclusions:CT imaging classification can objectively evaluate the thoracoabdominal folded deformity in AS,and the distance between the xiphoid process and pubic symphysis and the TAFA are important indicators for evaluating the thoracoab-dominal folded deformity in AS.

Objectives:To explore the CT classification and evaluation methods of thoracoabdominal folded deformity in ankylosing spondylitis(AS).Methods:A retrospective analysis was conducted on 31 patients with AS thoracolumbar kyphosis who underwent thoracolumbar CT examinations between July 2017 and January 2024.There were 28 males and 3 females,with an average age of 45.0±8.9 years.The thoracoabdominal folded angle(TAFA)and the distances between xiphoid process and the superior edge of the pubic symphysis(XP)were measured on the mid-sagittal plane of thoracolumbar CT.The global kyphosis(GK),thoracic kypho-sis(TK),and lumbar lordosis(LL)Cobb angle and sagittal vertical axis(SVA)were measured on the full-length lateral radiograph of the spine.According to the effect of sagittal lumbar physiological curvature on the change of abdominal volume,a CT classification of AS thoracoabdominal folded deformity was innovatively classified into three types,type Ⅰ when there was physiological lordosis in the lumbar spine,type Ⅱ when the physiological curvature of the lumbar spine became straight,and type Ⅲ when there was lumbar kyphosis deformity.According to TAFA,type Ⅲ patients were divided into two subtypes:TAFA＞90° was subtype A,and TAFA ≤90° was subtype B.Five trained spinal surgeons independently evaluated and classified the clini-cal data of patients(with a 10d interval),and used Kendall's W-test to analyze the consistency of multiple observation results.Using one-way analysis of variance to compare the differences in the above measurement parameters between different types.Results:Among the 31 patients,there were 5 cases of thoracoabdominal folded deformity type Ⅰ,8 cases of type Ⅱ,12 cases of type Ⅲ A,and 6 cases of type ⅢB.The Kendall's W consistency coefficient for inter-observer classification was 0.954(P＜0.001).The average GK,TK,LL,SV A,TAFA,and XP of patients were 83.7°±29.9°,48.7°±21.3°,-13.9°±25.3°,22.8±14.9cm,128.1°±50.5°,and 16.8±8.9cm,respectively;The Kendall's W consistency coefficients between the different groups'measurement values of TAFA and XP were 0.946(P＜0.001)and 0.979(P＜0.001),respectively;There were significant differ-ences in TAFA and XP pairwise comparisons between different subtypes(P＜0.001).Conclusions:CT imaging classification can objectively evaluate the thoracoabdominal folded deformity in AS,and the distance between the xiphoid process and pubic symphysis and the TAFA are important indicators for evaluating the thoracoab-dominal folded deformity in AS.

Major depressive disorder in adolescents is a serious psychiatric condition characterized by profound impairment in psychosocial functioning. Its primary symptoms include low mood, irritability, and anhedonia. Although pharmacological treatments and psychotherapy are currently recommended as first-line treatments, their effectiveness is limited, and pharmacological treatments may carry the risk of increased suicidal ideation. Therefore, exploring new, effective, and safe treatment options is an urgent priority. In recent years, intermittent theta burst stimulation (iTBS), a novel form of transcranial magnetic stimulation, has shown promising results in treating treatment-resistant depression in adults, drawing growing interest in its potential use in adolescents. iTBS modulates neural activity through magnetic stimulation of the cerebral cortex and has been shown to alleviate depressive symptoms, particularly when targeting the left dorsolateral prefrontal cortex (DLPFC). Given the high neuroplasticity of the adolescent brain during this critical developmental stage, adolescents may exhibit heightened sensitivity to iTBS, resulting in more enduring neuroregulatory effects. Research highlights the importance of precise targeting and individualized adjustment of stimulation intensity for optimal therapeutic outcomes. Additionally, accelerated iTBS (aiTBS) protocols have demonstrated faster clinical effects in treating acute or severe depression in adolescents, improving treatment adherence and partially mitigating suicidal tendencies. This review summarizes recent progress in the application of iTBS in adolescent depression, with a focus on its mechanisms, treatment parameters, and related research. The goal is to provide theoretical support and practical guidance for the clinical application of iTBS in adolescent depression care.

Objectives:To investigate the current willingness of depressive outpatients and their doctors in China to engage in shared decision-making (SDM), and to analyze the factors influencing this willingness.Methods:A questionnaire survey was conducted among doctors and patients with depression in 12 tertiary psychiatric hospitals and general hospitals by scanning two-dimensional code and filling in the questionnaire on the mobile terminal. The questionnaire covered patient demographics, emotional state scores, initial diagnosis and treatment, treatment expectations and concerns, symptom improvement needs, medication safety requirements, and diagnosis details (completed by the attending physician). Doctors provided basic information, current depression diagnosis and treatment status, and concerns regarding medications. Logistic regression analysis (univariate and multivariate) was used to identify factors influencing patients′ and doctors′ willingness to engage in SDM.Results:A total of 622 valid patient questionnaires and 45 valid physician questionnaires were collected. Both patients and doctors had a strong willingness to make shared decisions (80.39% (500/622) vs. 60.00% (27/45)). Multivariate binary logistic regression analysis showed that residential location (town versus rural areas: OR (95% CI)=1.895 (1.087-3.305)), acceptable monthly medical expenses (≥1 000-<2 000 CNY vs.<300 CNY: OR (95% CI)=0.194 (0.088-0.427);≥2 000 CNY vs.<300 CNY: OR (95% CI)=0.267 (0.094-0.754)), acceptance of online treatment and consultation (accept versus not accept: OR (95% CI)=3.196 (2.024-5.046)), and knowing about psychotherapy (yes versus no: OR (95% CI)=1.711 (1.003-2.921)) were the factors influencing the willingness of shared decision-making in patients (all P<0.05). For the doctors, the time spent on initial consultation was the factor influencing the willingness to engage in SDM ( OR (95% CI)=1.090 (1.004-1.184), P=0.040). Conclusions:Both depression patients and doctors in tertiary outpatient clinics in China show a strong willingness to engage in SDM, providing a solid foundation for clinical application. However, it is necessary to pay attention to the influence of residential location, acceptable monthly medical expenses, acceptance of online treatment and consultation, and knowledge of psychotherapy should be considered for patients, while the time spent on initial consultations should be considered for doctors.

Objectives:To investigate the current willingness of depressive outpatients and their doctors in China to engage in shared decision-making (SDM), and to analyze the factors influencing this willingness.Methods:A questionnaire survey was conducted among doctors and patients with depression in 12 tertiary psychiatric hospitals and general hospitals by scanning two-dimensional code and filling in the questionnaire on the mobile terminal. The questionnaire covered patient demographics, emotional state scores, initial diagnosis and treatment, treatment expectations and concerns, symptom improvement needs, medication safety requirements, and diagnosis details (completed by the attending physician). Doctors provided basic information, current depression diagnosis and treatment status, and concerns regarding medications. Logistic regression analysis (univariate and multivariate) was used to identify factors influencing patients′ and doctors′ willingness to engage in SDM.Results:A total of 622 valid patient questionnaires and 45 valid physician questionnaires were collected. Both patients and doctors had a strong willingness to make shared decisions (80.39% (500/622) vs. 60.00% (27/45)). Multivariate binary logistic regression analysis showed that residential location (town versus rural areas: OR (95% CI)=1.895 (1.087-3.305)), acceptable monthly medical expenses (≥1 000-<2 000 CNY vs.<300 CNY: OR (95% CI)=0.194 (0.088-0.427);≥2 000 CNY vs.<300 CNY: OR (95% CI)=0.267 (0.094-0.754)), acceptance of online treatment and consultation (accept versus not accept: OR (95% CI)=3.196 (2.024-5.046)), and knowing about psychotherapy (yes versus no: OR (95% CI)=1.711 (1.003-2.921)) were the factors influencing the willingness of shared decision-making in patients (all P<0.05). For the doctors, the time spent on initial consultation was the factor influencing the willingness to engage in SDM ( OR (95% CI)=1.090 (1.004-1.184), P=0.040). Conclusions:Both depression patients and doctors in tertiary outpatient clinics in China show a strong willingness to engage in SDM, providing a solid foundation for clinical application. However, it is necessary to pay attention to the influence of residential location, acceptable monthly medical expenses, acceptance of online treatment and consultation, and knowledge of psychotherapy should be considered for patients, while the time spent on initial consultations should be considered for doctors.

OBJECTIVE: To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. METHODS: A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T ₁₀-L ₂, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. RESULTS: Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. CONCLUSION Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.
Male ; Female ; Humans ; Aged ; Fractures, Compression/surgery* ; Spinal Fractures/diagnostic imaging* ; Lumbar Vertebrae/surgery* ; Thoracic Vertebrae/surgery* ; Kyphosis/surgery* ; Osteoporotic Fractures/surgery* ; Lordosis ; Tomography, X-Ray Computed ; Retrospective Studies

OBJECTIVE: To investigate the changes in spinal-pelvic sagittal parameters from preoperative standing to prone position in old traumatic spinal fractures with kyphosis. METHODS: The clinical data of 36 patients admitted between December 2016 and June 2021 for surgical treatment of old traumatic spinal fractures with kyphosis, including 7 males and 29 females, aged from 50 to 79 years (mean, 63.9 years), were retrospectively analyzed. Lesion segments included 2 cases of T ₁₁, 12 cases of T ₁₂, 2 cases of T _{11, 12}, 4 cases of T ₁₂ and L ₁, 12 cases of L ₁, 2 cases of L ₂, 1 case of L _{2, 3}, and 1 case of L ₃. The disease duration ranged from 4 to 120 months, with an average of 19.6 months. Surgical procedures included Smith-Petersen osteotomy in 4 cases, Ponte osteotomy in 6 cases, pedicle subtraction osteotomy in 2 cases, and improved fourth level osteotomy in 18 cases; the remaining 6 cases were not osteotomized. The bone mineral density ranged from -3.0 to 0.5 T, with a mean of -1.62 T. The spinal-pelvic sagittal parameters from preoperative standing to prone positions were measured, including local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and PI and LL mismatch (PI-LL). The kyphotic flexibility=(preoperative standing LKCA-preoperative prone LKCA)/preoperative standing LKCA×100%. Spinal-pelvic sagittal parameters were compared between standing position and prone position before operation, and Pearson correlation was used to judge the correlation between the parameters of standing position and prone position before operation. RESULTS: When the position changed from standing to prone, LKCA and TK decreased significantly ( P<0.05), while SS, LL, PT, and PI-LL had no significant difference ( P>0.05). Pearson correlation analysis showed that LL was significantly correlated with SS and PI-LL in both standing and prone positions ( P<0.05), and the correlation strength between LL and SS in prone position was higher than that in standing position. In the standing position, LKCA was significantly correlated with SS and PT ( P<0.05). However, when the position changed from standing to prone, the correlation between LKCA and SS and PT disappeared, while PT and PI-LL was positive correlation ( P<0.05). The kyphotic flexibility was 25.13%-78.79%, with an average of 33.85%. CONCLUSION For the patients of old traumatic spinal fractures with kyphosis, the preoperative LKCA and TK decrease significantly from standing position to prone position, and the correlation between spinal and pelvic parameters also changed, which should be taken into account in the formulation of preoperative surgical plan.
Male ; Female ; Humans ; Spinal Fractures/surgery* ; Standing Position ; Retrospective Studies ; Lumbar Vertebrae/surgery* ; Kyphosis/surgery* ; Lordosis/surgery*

Objective:To evaluate the efficacy of esketamine for patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing modified radical mastectomy for breast cancer.Methods:Ninety elderly female patients, aged 65-78 yr, weighing 46-75 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective modified radical surgery for breast cancer under general anesthesia, were divided into 2 groups ( n=45 each) using a random number table method: esketamine PCIA group (group E) and sufentanil PCIA group (group S). Anesthesia was induced with target-controlled infusion of propofol, intravenous atracurium besylate and sufentanil and maintained with target-controlled infusion of propofol and remifentanil and intermittent intravenous boluses of cis-benzenesulfonic acid atracurium.The patients were connected to an analgesic pump for PCIA at 10 min before completion of operation.The PCIA solution in group E contained esketamine 2 mg/kg, ketorolac tromethamine 90 mg and tropisetron 5 mg in 100 ml of normal saline.The PCIA solution in group S contained sufentanil 1 μg/kg, ketorolac tromethamine 90 mg and tropisetron 5 mg in 100 ml of normal saline.The PCA pump was set up with a 1.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 1.5 ml/h, and the analgesia was performed until 48 h after operation.When numeric rating scale score ≥ 4 points and the efficacy of patient-controlled analgesia was not good, tramadol 100 mg was intravenously injected for rescue analgesia.Steward recovery scores were recorded at 4, 8, 24 and 48 h after operation.The requirement for rescue analgesia, effective pressing times of analgesic pump and time to first flatus were recorded within 48 h after operation.The nausea and vomiting, respiratory depression, dizziness and pruritus within 48 h after operation and delirium within 7 days after operation were recorded.The 40-item Quality of-Recovery scale was used to evaluate the early postoperative recovery of patients at 24 and 48 h after operation. Results:Compared with group S, the 40-item Quality of Recovery scale score was significantly increased at each time point, postoperative time to first flatus was shortened, the incidence of postoperative nausea and vomiting and pruritus was decreased ( P<0.05), and no significant change was found in the Steward recovery score at each time point after operation, effective pressing times of PCA and requirement for rescue analgesia in group E ( P>0.05). Conclusions:Esketamine provides better efficacy than sufentanil when used for PCIA in elderly patients undergoing modified radical mastectomy for breast cancer.

Objective:To evaluate the optimized efficacy of thoracic paravertebral nerve block and subcostal transversus abdominis plane block combined with general anesthesia for elderly patients undergoing thoracic combined with laparoscopic radical resection of esophageal cancer.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ orⅡ patients of both sexes, aged 66-78 yr, weighing 46-80 kg, undergoing elective thoracoscopic combined with laparoscopic radical resection of esophageal cancer, were divided into 2 groups ( n=40 each) using a random number table method: general anesthesia group (group G) and thoracic paravertebral nerve block and subcostal transversus abdominis plane block combined with general anesthesia group (TSG group). Both groups received target-controlled infusion of propofol and remifentanil and intravenous injection of cisatracurium besilate for anesthesia induction and maintenance, with BIS value maintained at 45-60 during operation.Thoracic paravertebral nerve block on the affected side was performed under ultrasound guidance after the end of anesthesia induction, and 0.5% ropivacaine 15 ml was injected in TSG group.The patients were turned to the supine position after the thoracic operation was completed, and the bilateral subcostal approach to the transversus abdominis plane block was performed under ultrasound guidance, and 0.3% ropivacaine 20 ml was injected into each side.Sufentanil was used for patient-controlled intravenous anesthesia (PCIA) after operation.The background infusion rate was 0.05 μg·kg -1·h -1, PCA was 0.04 μg/kg, and the lockout interval was 10 min in group G. The background infusion rate was 0.03 μg·kg -1·h -1, PCA was 0.025 μg/kg, the lockout interval was 10 min in group TSG.Both groups received analgesia until 48 h after operation, and VAS score was maintained ≤3.When VAS score ≥ 4, tramadol 100 mg was intravenously injected for rescue analgesia.At 1 day before operation (T 0), immediately before anesthesia induction (T 1), at 1 h after emergence from anesthesia (T 2), and 4, 8, 12, 24 and 48 h after operation (T 3-7), venous blood samples were collected for determination of serum norepinephrine, epinephrine and cortisol concentrations (by enzyme-linked immunosorbent assay). The intraoperative consumption of remifentanil and occurrence of cardiovascular events were recorded.The pressing times of PCA, consumption of sufentanil and requirement for rescue analgesia within 48 h after operation were recorded.The occurrence of nerve block-related complications (hematoma at the puncture site, infection, local anesthetic poisoning, etc.) and adverse reactions such as nausea and vomiting, respiratory depression and pruritus were recorded within 48 h after the operation. Results:Compared with group G, the concentrations of serum epinephrine, norepinephrine and cortisol were significantly decreased, the consumption of intraoperative remifentanil and postoperative sufentanil and pressing times of PCA were reduced, the rate of rescue analgesia was decreased, scores of satisfaction with analgesia were increased, and the incidence of intraoperative cardiovascular events and postoperative adverse reactions such as nausea and vomiting, pruritus and respiratory depression were decreased in group TSG ( P<0.05). Conclusion:Thoracic paravertebral nerve block and subcostal transversus abdominis plane block combined with general anesthesia can reduce the perioperative consumption of opioids and inhibit perioperative stress responses and postoperative hyperalgesia with fewer adverse reactions when used for the elderly patients undergoing thoracic combined with laparoscopic radical resection of esophageal cancer.