As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

Objective:To investigate altered neurovascular coupling in patients with depression(DEP)using resting-state functional magnetic resonance imaging(MRI)and arterial spin labeling perfusion MRI,as well as its association with depressive symptoms.Methods:Neuropsychological assessment and multimodal MRI scans were performed for 25 DEP patients and 35 healthy controls(HCs).Arterial spin labeling perfusion MRI was used to calculate cerebral blood flow(CBF),and functional MRI was used to calculate regional homogeneity(ReHo).The Pearson correlation coefficient between CBF and ReHo was calculated to obtain neurovascular cou-pling.Results:At the whole-brain level,CBF-ReHo coupling was reduced in DEP patients compared with HCs.At the brain region level,CBF-ReHo coupling was reduced in 26 brain regions in DEP patients,which were mainly located in the visual network,the default network,and the auditory network.The correlation analysis showed that the coupling values of the left suboccipital gyrus,the left angular gyrus,and the left thalamus were negatively correlated with Hamilton Depression Scale score.Conclusion:There is a sig-nificant reduction in neurovascular coupling in DEP patients,which is correlated with the severity of DEP.

Objective:To establish the quality standard of the standard decoction of wine-processed Coptidis Rhizoma by studying the extraction rate, fingerprint and component quantitative analysis.Methods:ccording to the Technical Requirements for Quality Control and Standard Formulation of Chinese Medicine Formula Granules, 15 batches of the standard decoction of wine-processed Coptidis Rhizoma were prepared, and the paste rate was determined; HPLC fingerprints of 15 batches of standard decoction of wine-processed Coptidis Rhizoma were established, and evaluated by combining similarity evaluation, clustering analysis, principal component analysis and orthogonal partial least squares discriminant analysis; the contents of berberine, epiberberine, pamadine, and safranine in the samples of the 15 batches were determined and analyzed their transfer rates.Results:A total of 15 batches of standard decoction samples were calibrated with 11 common peaks, referring to the recognition of 8 components. The similarity between the samples and the control product was greater than 0.900; the clustering analysis could cluster the 15 batches of samples into 2 classes; the results of the principal component analysis showed that the cumulative variance contribution rate of the 3 principal component factors was 89.388%; the OPLS-DA screened out the 3 components of the quality difference; the 15 batches of samples out of the paste rate was 15.7% -20.8%, and the mass fractions of berberine, epiberberine, safranine, and palmatine were 18.47%-24.38%, 2.82%-3.49%, 5.08%-6.69%, and 4.84%-6.68%, respectively, with transfer rates of 41.7%-61.7%, 46.9%-68.7%, 39.8%-61.5%, and 43.8%-65.2%.Conclusion:The fingerprint and content determination method established in this study is accurate, stable, simple, and can be used for the quality control and evaluation of the standard decoction of wine-processed Coptidis Rhizoma.

Objective To analyze the whole-brain structural-functional coupling imaging characteristics of patients with cerebral small vessel disease(CSVD)based on multiparametric functional and structural MRI,and to explore their correlation with cognitive function.Methods A prospective,consecutive study enrolled 60 CSVD patients from the Department of Neurology,the Second Affiliated Hospital of Anhui Medical University,between May 2021 and December 2023,and 47 controls matched for age,sex,education level,and handedness recruited from the community during the same period.Baseline data,including demographic information(age,sex,education),cognitive function,and imaging data,were collected for both groups.All participants underwent standardized neuropsychological assessments in a quiet environment.Emotional function was assessed using the patient health questionnaire-9(PHQ-9).Global cognitive function was screened using the Montreal cognitive assessment scale(MoCA)and Alzheimer's disease 8-item questionnaire(AD-8).Executive function was evaluated using the trail making test-B(TMT-B),the TMT time difference(TMT-B time minus TMT-A time),and the verbal fluency test(VFT).Attention and processing speed were assessed using TMT-A and the digit span test(DS).Memory function was evaluated using the Chinese auditory verbal learning test(AVLT),including learning,immediate recall,and delayed recall.Multimodal brain functional and structural MRI images were acquired for all participants.Fractional amplitude of low-frequency fluctuations(fALFF)and gray matter volume(GMV)were calculated using the DPABI software.A structure-function coupling index was computed by integrating the fALFF and GMV values of corresponding voxels.Structural-function coupling changes in CSVD patients and controls were assessed,and the correlations between fALFF,GMV,fALFF/GMV and cognitive function were explored.Results(1)Compared to the control group,CSVD patients showed significant lower scores in MoCA score(21.5[20.0,24.0]vs.24.3[23.0,26.0],Z=-4.094),higher PHQ-9 score(5.4±5.0vs.2.1±2.2,t=4.150),less VFT(15.5±3.8 vs.17.2±4.3,t=-3.258),increased TMT-B time([164.4±72.7]s vs.[123.6±45.7]s,t=3.307),TMT-A time([83.8±34.3]s vs.[62.9±22.7]s,t=3.704),and less DS forward span(6.3[5.0,8.0]vs.7.4[6.0,8.0],Z=-3.679),DS backward span(3.7±1.2 vs.4.5±1.4,t=-3.119),AVLT-learning(7.0±1.8 vs.8.7±1.9,t=-4.523),A VLT-immediate recall(7.2[6.0,9.0]vs.9.6[7.2,11.8],Z=-4.105),AVLT-delayed recall(6.9±3.1 vs.9.6±3.0,t=-4.310;all P＜0.01).No significant differences were observed in age,education,sex,AD-8 score,or TMT time difference(all P＞0.05).(2)CSVD patients showed decreased fALFF values in the right anterior cingulate gyrus(1.00±0.06 vs.1.07±0.06,t=-4.66)and increased fALFF values in the left superior parietal lobule(1.14±0.07 vs.1.07±0.07,t=5.68)and the right postcentral gyrus(1.08±0.05 vs.1.01±0.05,t=5.22;both P＜0.01).CSVD patients had increased GMV in the bilateral caudate nucleus(right:[0.27±0.06]mm3 vs.[0.21±0.04]mm3,t=6.12,left:[0.27±0.05]mm3 vs.[0.22±0.04]mm3,t=6.67;both P＜0.01)but decreased fALFF/GMV in the bilateral caudate nucleus(left:6.27±0.97 vs.7.75±1.70,t=-7.33;right:3.12±0.97 vs.4.18±0.95,t=-5.96)and the right globus pallidus(14.11±4.14 vs.19.99±4.03,t=-6.36;all P＜0.01).(3)Right anterior cingulate gyrus fALFF positively correlated with DS backward scores(R=0.348,P=0.013).Left superior parietal lobule fALFF negatively correlated with PHQ-9 scores(R=-0.308,P=0.029)and TMT time difference(R=-0.360,P=0.012).Right postcentral gyrus fALFF negatively correlated with TMT-A time(R=-0.419,P=0.003).Right caudate nucleus GMV positively correlated with TMT time difference(R=0.293,P=0.042),while left caudate nucleus GMV negatively correlated with AD-8 score(R=-0.284,P=0.043).fALFF/GMV in the right caudate nucleus(R=0.288,P=0.046)and right globus pallidus(R=0.290,P=0.045)positively correlated with VFT.After multiple comparison corrections,only the negative correlation between right postcentral gyrus fALFF and TMT-A time remained significant(P(alse discovery rate adjusted=0.024).Conclusions CSVD patients exhibit significant structure-function decoupling values in bilateral caudate nucleus and right globus pallidus are reduced,and this reduction is associated with a decline in verbal fluency.The results of this study still need to be further validated in larger sample size studies.

Objective To analyze the whole-brain structural-functional coupling imaging characteristics of patients with cerebral small vessel disease(CSVD)based on multiparametric functional and structural MRI,and to explore their correlation with cognitive function.Methods A prospective,consecutive study enrolled 60 CSVD patients from the Department of Neurology,the Second Affiliated Hospital of Anhui Medical University,between May 2021 and December 2023,and 47 controls matched for age,sex,education level,and handedness recruited from the community during the same period.Baseline data,including demographic information(age,sex,education),cognitive function,and imaging data,were collected for both groups.All participants underwent standardized neuropsychological assessments in a quiet environment.Emotional function was assessed using the patient health questionnaire-9(PHQ-9).Global cognitive function was screened using the Montreal cognitive assessment scale(MoCA)and Alzheimer's disease 8-item questionnaire(AD-8).Executive function was evaluated using the trail making test-B(TMT-B),the TMT time difference(TMT-B time minus TMT-A time),and the verbal fluency test(VFT).Attention and processing speed were assessed using TMT-A and the digit span test(DS).Memory function was evaluated using the Chinese auditory verbal learning test(AVLT),including learning,immediate recall,and delayed recall.Multimodal brain functional and structural MRI images were acquired for all participants.Fractional amplitude of low-frequency fluctuations(fALFF)and gray matter volume(GMV)were calculated using the DPABI software.A structure-function coupling index was computed by integrating the fALFF and GMV values of corresponding voxels.Structural-function coupling changes in CSVD patients and controls were assessed,and the correlations between fALFF,GMV,fALFF/GMV and cognitive function were explored.Results(1)Compared to the control group,CSVD patients showed significant lower scores in MoCA score(21.5[20.0,24.0]vs.24.3[23.0,26.0],Z=-4.094),higher PHQ-9 score(5.4±5.0vs.2.1±2.2,t=4.150),less VFT(15.5±3.8 vs.17.2±4.3,t=-3.258),increased TMT-B time([164.4±72.7]s vs.[123.6±45.7]s,t=3.307),TMT-A time([83.8±34.3]s vs.[62.9±22.7]s,t=3.704),and less DS forward span(6.3[5.0,8.0]vs.7.4[6.0,8.0],Z=-3.679),DS backward span(3.7±1.2 vs.4.5±1.4,t=-3.119),AVLT-learning(7.0±1.8 vs.8.7±1.9,t=-4.523),A VLT-immediate recall(7.2[6.0,9.0]vs.9.6[7.2,11.8],Z=-4.105),AVLT-delayed recall(6.9±3.1 vs.9.6±3.0,t=-4.310;all P＜0.01).No significant differences were observed in age,education,sex,AD-8 score,or TMT time difference(all P＞0.05).(2)CSVD patients showed decreased fALFF values in the right anterior cingulate gyrus(1.00±0.06 vs.1.07±0.06,t=-4.66)and increased fALFF values in the left superior parietal lobule(1.14±0.07 vs.1.07±0.07,t=5.68)and the right postcentral gyrus(1.08±0.05 vs.1.01±0.05,t=5.22;both P＜0.01).CSVD patients had increased GMV in the bilateral caudate nucleus(right:[0.27±0.06]mm3 vs.[0.21±0.04]mm3,t=6.12,left:[0.27±0.05]mm3 vs.[0.22±0.04]mm3,t=6.67;both P＜0.01)but decreased fALFF/GMV in the bilateral caudate nucleus(left:6.27±0.97 vs.7.75±1.70,t=-7.33;right:3.12±0.97 vs.4.18±0.95,t=-5.96)and the right globus pallidus(14.11±4.14 vs.19.99±4.03,t=-6.36;all P＜0.01).(3)Right anterior cingulate gyrus fALFF positively correlated with DS backward scores(R=0.348,P=0.013).Left superior parietal lobule fALFF negatively correlated with PHQ-9 scores(R=-0.308,P=0.029)and TMT time difference(R=-0.360,P=0.012).Right postcentral gyrus fALFF negatively correlated with TMT-A time(R=-0.419,P=0.003).Right caudate nucleus GMV positively correlated with TMT time difference(R=0.293,P=0.042),while left caudate nucleus GMV negatively correlated with AD-8 score(R=-0.284,P=0.043).fALFF/GMV in the right caudate nucleus(R=0.288,P=0.046)and right globus pallidus(R=0.290,P=0.045)positively correlated with VFT.After multiple comparison corrections,only the negative correlation between right postcentral gyrus fALFF and TMT-A time remained significant(P(alse discovery rate adjusted=0.024).Conclusions CSVD patients exhibit significant structure-function decoupling values in bilateral caudate nucleus and right globus pallidus are reduced,and this reduction is associated with a decline in verbal fluency.The results of this study still need to be further validated in larger sample size studies.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

Objective To establish an ultra-high liquid chromatography(UPLC)characteristic spectrum of Rheum tanguticum Maxim.ex Balf.water decoction and conduct chemical pattern recognition analysis,and to identify the medicinal materials of different origins and different processed products.Methods:UPLC was adopted to establish the characteristic spectra of 15 batches of Rheum tanguticum Maxim.ex Balf.Cluster analysis combined with principal component analysis was used to analyze their quality.Rhei Radix et Rhizoma from different origins and different processed products of Rheum tanguticum Maxim.ex Balf.were identified.Results:The characteristic spectrum of Rheum tanguticum Maxim.ex Balf.water decoction was established,18 common peaks were identi-fied,and 15 batches of Rheum tanguticum Maxim.ex Balf.were divided into 2 categories according to their origins by cluster analysis.The similarity between 15 batches of samples from different origins and the control spectrum was greater than 0.900.According to OPLS-DA analysis,a total of 6 markers(rhein-8-O-β-D-glu-cosid,resveratrol-4'-O-β-D-(6''-O-D-gallyl)glucopyranside,isolindleyin,rhein,epicatechin-3-O-D-gallate,and catechin)affecting the quality of Rheum tanguticum Maxim.ex Balf.water decoction samples were found.Rhei Radix et Rhizoma from different origins and different processed products of Rheum tanguticum Maxim.ex Balf.can be effectively distinguished.Conclusion:The established characteristic spectrum method is easy to operate and has good repeatability.It can be used for the quality control of Rheum tanguticum Maxim.ex Balf.water decoction,and can provide reference for the formulation of quality standard of formula granules of Rhei Radix et Rhizoma.

Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

The clinical data of 3 patients with rhabdomyolysis (RM) caused by different viral infections were retrospectively reviewed. The diagnoses were established according to the clinical symptoms, physical signs, myocardial enzymes, and muscle biopsy. Case 1 was a 11-year-old boy with influenza A virus infection, whose major symptoms were fever, cough and myalgia. After the treatment of active anti-virus, hydration, and alkalinization, the patient completely recovered. Case 2 was a 10-year-old girl with Epstein-Barr (EB) virus infection who had significant musculoskeletal pain and muscle weakness symptoms with significantly elevated serum creatine kinase. After active hydration and anti-infective treatment, the patient's condition returned to normal. Case 3 was a 15-year-old boy with human cytomegalovirus infection, whose symptoms were mainly repeated fever, accompanied by myalgia and facial edema. Antibacterial therapy was ineffective, and the disease progressed with respiratory muscle weakness and multiple organ injuries. After antiviral treatment, respiratory support and hemofiltration, the symptoms relieved and patient recovered without sequela. With literature review, we believe that although influenza virus, Epstein-Barr virus and cytomegalovirus rarely cause RM in children, it should be attached attention to. With early diagnosis and treatment, the prognosis is favorable.

Objective To analyze the clinical value of immature granulocytes in peripheral blood for prediction of persistent systemic inflammatory response syndrome (SIRS) in patients with acute pancreatitis (AP). Methods 1 973 patients with AP in Hunan People's Hospital from 2012 to 2017 were retrospectively enrolled and divided by SIRS duration into the persistent SIRS group, temporary SIRS group and non-SIRS group. The independent risk factor for persistent SIRS in AP patients was evaluated by Logistic regression analysis, and predictive value of immature granulocytes for persistent SIRS in AP patients was analyzed by the receiver operating characteristic (ROC) curve. Results These 1 973 AP patients (1 165 males, 59.0%) with an average age of 49 (40, 60) years old, including 288 persistent SIRS, 189 temporary SIRS and 1 496 non-SIRS cases. There was no significant difference in gender, age and etiology among three groups. Compared with non-SIRS group, more severe symptoms were observed in the temporary and persistent SIRS groups. Moreover, The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), CT severity index (CTSI), multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS) incidence, mortality and C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT) and immature granulocytes in persistent SIRS group were further higher than those in the temporary SIRS group [APACHEⅡ: 9 (6, 12) vs. 5 (3, 7), CTSI: 6 (4, 6) vs. 4 (3, 6), MOF incidence: 92.0% vs. 32.8%, ARDS incidence: 39.9% vs. 10.1%, morbidity: 11.1% vs. 4.2%, CRP (mg/L): 25.00 (0.80, 212.25) vs. 0.80 (0.80, 123.50), WBC (×109/L): 15.17±6.78 vs. 14.84±5.86, PCT (μg/L): 0.23 (0.10, 1.76) vs. 0.10 (0.10, 0.31), immature granulocytes: 1.95 (0.90, 4.95) % vs. 0.80 (0.40, 2.10) %, all P < 0.05]. Logistic regression analysis showed that besides pancreatic necrosis, WBC and CRP, immature granulocyte was an independent risk factor for persistent SIRS associated with AP [odds ratio (OR) = 1.844, 95% confidence interval (95%CI) = 1.372-2.220]. ROC curve showed that immature granulocytes had better predictive value for persistent SIRS, the area under the curve (AUC) was 0.806, which was significantly higher than the APACHEⅡ (AUC = 0.783), CTSI (AUC = 0.752), PCT (AUC = 0.676), CRP (AUC = 0.677), WBC (AUC = 0.644). The cut-off value of immature granulocyte was 0.65%, the sensitivity was 84.0%, the specificity was 66.3%, the positive predictive value was 62.4%, and the negative predictive value was 76.3%. Conclusion Immature granulocyte in peripheral blood is a potential indicator for persistent SIRS in AP patients.