Cognitive behavioral therapy(CBT)has consistently received much attention in the intervention approach of adolescent depression,with its application potential expanding alongside technological advancements.CBT primarily alleviates depressive symptoms by identifying and restructuring negative automatic thoughts,and incorporating behavioral activation strategies to improve emotional regulation and coping skills.Traditional face-to-face CBT(FtF-CBT)demonstrates significant advantages in establishing therapeutic alliances and addressing severe depressive symptoms in adolescents.In contrast,internet-based CBT(i-CBT)demonstrates comparable efficacy in adolescents with mild to moderate depression,while offering additional benefits such as lower cost and increased flexibility.Blended CBT(b-CBT),which integrates both online and offline modalities,enhances accessibility while retaining the personalized guidance and real-time feedback characteristic of in-person interventions,potentially improving overall treatment effectiveness.With the rapid development of digital health technologies,artificial intelligence,and virtual reality,future research is expected to further enhance the precision and efficiency of CBT in treating adolescent depression,providing a solid foundation for clinical application and theoretical advancement.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

OBJECTIVES: To explore the value of serum cystatin C (CysC) levels in evaluating renal prognosis in IgA nephropathy (IgAN) patients. METHODS: We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January, 2014 to December, 2018. Based on baseline serum CysC levels, the patients were divided into high serum CysC (>1.03 mg/L) group and normal serum CysC (≤1.03 mg/L) group. The composite endpoint for poor renal prognosis was defined as ≥50% decline in estimated glomerular filtration rate (eGFR) and/or progression to end-stage renal disease (ESRD). Lasso regression, multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups. Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes. A nomogram model was constructed and its predictive performance was evaluated using concordance index, calibration curve, receiver operating characteristic (ROC) curve and the area under curve (AUC). RESULTS: A total of 356 IgAN patients were enrolled, who were followed up for 4.65±0.93 years. The composite endpoint occurred in 74 patients. High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN (HR=2.142, 95% CI 1.222 to 3.755), and the patients with high serum CysC levels had a lower renal survival rate (Log-rank χ²=47.970, P<0.001). In patients with serum CysC below 2.12 mg/L, a higher CysC level was associated with an increased risk of poor renal prognosis (β=3.487, 95% CI: 2.561-4.413, P<0.001), while above this level, the increase of the risk was not significant (β=0.676, 95% CI: -0.642-1.995, P=0.315). The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873 (95% CI: 0.839-0.907) and an AUC of 0.909 (95% CI: 0.873-0.945). CONCLUSIONS Serum CysC levels are associated with renal prognosis in IgAN patients, and high serum CysC an independent risk factor for poor renal prognosis.
Humans ; Glomerulonephritis, IGA/diagnosis* ; Cystatin C/blood* ; Prognosis ; Risk Factors ; Retrospective Studies ; Glomerular Filtration Rate ; Kidney Failure, Chronic ; Male ; Female ; Adult ; Nomograms ; Middle Aged

Cognitive behavioral therapy(CBT)has consistently received much attention in the intervention approach of adolescent depression,with its application potential expanding alongside technological advancements.CBT primarily alleviates depressive symptoms by identifying and restructuring negative automatic thoughts,and incorporating behavioral activation strategies to improve emotional regulation and coping skills.Traditional face-to-face CBT(FtF-CBT)demonstrates significant advantages in establishing therapeutic alliances and addressing severe depressive symptoms in adolescents.In contrast,internet-based CBT(i-CBT)demonstrates comparable efficacy in adolescents with mild to moderate depression,while offering additional benefits such as lower cost and increased flexibility.Blended CBT(b-CBT),which integrates both online and offline modalities,enhances accessibility while retaining the personalized guidance and real-time feedback characteristic of in-person interventions,potentially improving overall treatment effectiveness.With the rapid development of digital health technologies,artificial intelligence,and virtual reality,future research is expected to further enhance the precision and efficiency of CBT in treating adolescent depression,providing a solid foundation for clinical application and theoretical advancement.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

BackgroundDepressive disorder is one of the most common mental disorders in the elderly and the existing meta-analyses on the prevalence of depressive disorder among the elderly have mainly summarized the findings from patient self-rating scales or examiner-rating scales. ObjectiveTo examine the prevalence of depressive disorder among elderly people in China using Meta-analysis， aiming to provide references for interventions targeting elderly patients with depressive disorder. MethodsOn December 20， 2022， a computerized searches were conducted in databases including CNKI， Wanfang， VIP， SinoMed， PubMed， Springer， Web of Science and Embase to collect studies on the prevalence of depressive disorder among the elderly in China. The Joanna Briggs Institute （JBI） quality assessment tool was used to evaluate the included literature. A meta-analysis was conducted using the statistical software R version 4.2.2. ResultsA total of 29 studies involving 2 341 elderly patients with depressive disorder were included. The prevalence of depressive disorder among the elderly in China was 3.90% （95% CI： 0.030~0.049）. Subgroup analysis revealed that there was a statistical difference in the prevalence of depressive disorder between elderly people without spouses and those with spouses （χ²=6.844， P<0.01）. ConclusionThe prevalence of depressive disorder among the elderly in China is relatively high， and the prevalence of depressive disorder among those without a spouse is higher than that of those with a spouse. ［Funded by Hangzhou Science and Technology Development Project （number， 20201203B192）］

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.

Abnormal homeostasis of glutamate(Glu)and γ-aminobutyric acid(GABA)in the brain is one of pathophysiological mechanisms of brain dysfunction in major depressive disorder(MDD).Neurotransmitters play an important role in maintaining chemical balance in the brain,and pharmacological and non-pharmacological therapies based on resetting excitation-inhibitory neurotransmitter system rebalancing are of interest.Studies based on magnetic resonance spectroscopy(MRS)have shown a homeostasis imbalance of Glu and GABA in the brain of MDD patients.Pharmacological therapies such as ketamine,selective serotonin reuptake inhibitors,and other novel receptor modulators and non-pharmacological therapies such as repetitive transcranial magnetic stimulation,electroconvulsive therapy,and physical exercise can target on the regulation of neurotransmitter levels.Abnormal homeostasis of Glu and GABA provides theoretical support for revealing pathophysiologic mechanisms of MDD,exploring neurotransmitter biomarkers,guiding clinical practice and facilitating personalized treatment.

The prevalence of cardiovascular disease in our country is increasing, and it has been a big problem affecting the social and economic development. It has been demonstrated that early intervention of cardiovascular risk factors can effectively reduce cardiovascular disease-caused mortality. Therefore, extensive implementation of cardiovascular testing and risk factor screening in the general population is the key to the prevention and treatment of cardiovascular disease. However, the categories of devices available for quick cardiovascular testing are limited, and in particular, many existing devices suffer from various technical problems, such as complex operation, unclear working principle, or large inter-individual variability in measurement accuracy, which lead to an overall low popularity and reliability of cardiovascular testing. In this study, we introduce the non-invasive measurement mechanisms and relevant technical progresses for several typical cardiovascular indices (e.g., peripheral/central arterial blood pressure, and arterial stiffness), with emphasis on describing the applications of biomechanical modeling and simulation in mechanism verification, analysis of influential factors, and technical improvement/innovation.
Arterial Pressure ; Biomechanical Phenomena ; Blood Pressure ; Blood Pressure Determination ; Humans ; Reproducibility of Results ; Risk Factors

Objective: To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients. Methods: A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy. Results: Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23%, 36.52%, 41.11% and 3.14% respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P<0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1%. The right internal jugular vein stenosis rate was 66.4% and 44.1% in the age<65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0% and 32.8% (P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95% CI 1.083-2.568, P=0.020). Conclusions There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.