Objective:To describe the current situation of mental health service utilization of community pa-tients with five mental disorders in Inner Mongolia Autonomous Region and provide reference for health education and formulating relevant policies.Methods:The multistage stratified sampling method with unequal probability was used to select a total of 12 315 community residents aged 18 and over in Inner Mongolia Autonomous Region.Using Composite International Diagnostic Interview,mood disorders,anxiety disorders,substance use disorders,intermit-tent explosive disorders,and eating disorders,and health service utilization were investigated.Descriptive statistics was completed by single factor analysis method.Results:The lifetime rates of consultation and treatment of any mental disorder were 18.7％and 10.2％,respectively.The highest proportion of patients received treatment by non-medical professionals was 31.4％,followed by psychiatrists in psychiatric hospital or psychologists in general hospitals.Among the patients,1.1％of them received medication,and 2.5％received psychotherapy.Conclusion:The utilization rate of mental health services in community patients with five mental disorders is relatively low.It is necessary to conduct health education for medical help seeking properly.

Objective:To explore the changes of large-scale functional brain networks and network topological properties in patients with major depressive disorder (MDD) whose diagnosis had not changed after 5 years of follow-up.Methods:Totally 521 cases of hospitalized MDD patients were recruited from January 2012 to August 2018, and another 204 cases of gender- and age-matched healthy controls were recruited. All participants completed resting-state functional magnetic resonance scanning and clinical assessment. Their diagnosis were reviewed 5 years after discharge.A total of 258 participants whose diagnosis had not changed were counted into the MDD group for analysis. The differences in large-scale brain network connectivity between the two groups were analyzed by constructing a whole-brain functional network, on the basis of which the altered topological properties of the sensorimotor network (SMN), visual network (VN) and default mode network (DMN) were further analyzed between the two groups.The SPSS 24.0 software was used for data analysis and the independent sample t-test and χ2 test were used for the data comparison of the two groups. Results:Compared with the healthy controls, the MDD group had significantly decreased network clustering, mainly involving the SMN, VN and DMN (edge P<0.001, cluster P<0.05). The MDD group had decreased functional connectivity(FC) strength within the SMN, VN and DMN networks, the FC strength between the SMN and VN networks, between the frontoparietal network (FPN) and the DAN networks were decreased(all P<0.05, FDR corrected). Graph-theory analysis showed that local efficiency, clustering coefficient, and normalized shortest path length were decreased in the MDD group, node efficiency was decreased in the left ventral medial prefrontal cortex and the middle of the bilateral insula, node centrality was decreased in the middle of the bilateral insula and occipital lobe, and the betweenness was decreased in the middle of the right insula (all P<0.05, FDR corrected). Conclusion:MDD exhibits abnormal network functional connectivity, disruption of network topological properties, diminished optimal information processing, and to some extent reflects the severity of depressive symptoms. The decreased ability of information transfer flow in the insula plays an important role for the functional abnormality of the network.

Objective:To investigate the effects of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy.Methods:A total of 100 patients who were scheduled to undergo painless colonoscopy were selected as the study subjects and randomly divided into two groups by a computerized number method. Ten patients in both groups dropped out because of disruption of the study protocol, and 45 patients from each group were included in the final analysis. Before anesthesia induction, patients in group glycopyrrolate (group G) were injected with 0.2 mg glycopyrrolate, while those in congtrol group (group C) were injected with an equal amount of saline. The heart rate, systolic blood pressure, and diastolic blood pressure were recorded at T 0 (baseline period), T 1 (after anesthesia induction), T 2 (colonoscopy over sigmoid colon), T 3 (colonoscopy over the liver region), T 4 (after the end of examination), and T 5 (at the awakening phase), and the degree of intestinal spasm was assessed intraoperatively using the Likert′s four-point scale. The numerical rating scale (NRS) was used to assess preoperative and postoperative pain. The incidence of adverse events was recorded. Results:The general data at baseline were not statistically different between the two groups ( P>0.05). During the procedure, patients in group G had lower intraoperative intestinal spasm scores than those in group C ( P=0.028). Intraoperative hypotension and bradycardia occurrence were lower in group G than in group C ( P<0.05), and intraoperative norepinephrine use was also lower than in the group C ( P=0.034). Postoperative visual analog scale pain scores were lower in group G ( P=0.047), but patients who used glycopyrrolate had a higher proportion of dry mouth ( P=0.035). Conclusion:During painless colonoscopy, preoperative administration of glycopyrrolate significantly improved intraoperative hemodynamic fluctuations, reduced the incidence of hypotension and bradycardia, and relieved postoperative pain. However, glycopyrrolate use resulted in the risk of dry mouth.

Objective:To explore the prevalence and independent associated factors of vascular calcification (VC) in non-dialysis chronic kidney disease (CKD) patients of stage 3-5.Methods:It was a single-center cross-sectional observational study. Non-dialysis stage 3-5 CKD patients ≥18 years old who were admitted to the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University from May 1, 2022 to December 31, 2022 with VC evaluation were enrolled. The patients' general information, laboratory examination and imaging data were collected. Coronary artery calcification (CAC), thoracic aorta calcification (TAC), abdominal aorta calcification (AAC), carotid artery calcification and aortic valve calcification (AVC) were evaluated by cardiac-gated electron-beam CT (EBCT) scans, lateral lumbar x-ray, cervical macrovascular ultrasound and echocardiography, respectively. The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared, and the prevalence of VC at different sites of patients in different age groups [youth group (18-44 years old), middle-aged group (45-64 years old) and elderly group (≥65 years old)] and patients with or without diabetes were compared. Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas.Results:A total of 206 patients aged (51±14) years were included, including 129 (62.6%) males. There were 44 patients with CKD stage 3 (21.4%), 51 patients with CKD stage 4 (24.8%), and 111 patients with CKD stage 5 (53.9%). CKD was caused by chronic glomerulonephritis [104 cases (50.5%)], diabetic kidney damage [35 cases (17.0%)], hypertensive kidney damage [29 cases (14.1%)] and others [38 cases (18.4%)]. Among 206 patients, 131 (63.6%) exhibited cardiovascular calcification, and the prevalence of CAC, TAC, AAC, carotid artery calcification, and AVC was 37.9%, 43.7%, 37.9%, 35.9% and 9.7%, respectively. The overall prevalence of VC in young, middle-aged and elderly patients was 24.6%, 73.6% and 97.4%, respectively. With the increase of age, the prevalence of VC in each site gradually increased, and the increasing trend was statistically significant (all P<0.001). The overall prevalence of VC in CKD patients with diabetes was 92.5% (62/67), and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes (all P<0.001). Multivariate logistic regression analysis revealed that age (every 10 years increase, OR=2.51, 95% CI 1.77-3.56, P<0.001), hypertension ( OR=5.88, 95% CI 1.57-22.10, P=0.009), and diabetes ( OR=4.66, 95% CI 2.10-10.35, P<0.001) were independently correlated with CAC; Age (every 10 years increase, OR=6.43, 95% CI 3.64-11.36, P<0.001) and hypertension ( OR=6.09, 95% CI 1.33-27.84, P=0.020) were independently correlated with TAC; Female ( OR=0.23, 95% CI 0.07-0.72, P=0.011), age (every 10 years increase, OR=3.90, 95% CI 2.42-6.29, P<0.001), diabetes ( OR=5.37, 95% CI 2.19-13.19, P<0.001) and serum magnesium ( OR=0.01,95% CI 0-0.35, P=0.014) were independently correlated with AAC. Moreover, age and diabetes were independently correlated with carotid artery calcification, AVC and overall VC Conclusions:The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%, of which CAC reaches 37.9%, TAC is the most common one (43.7%), while AVC is the least one (9.7%). Age and diabetes are the independent associated factors for VC of all sites except TAC, while hypertension is an independent associated factor for both CAC and TAC.

Many studies have found a correlation between suicidal behavior (SB) and anhedonia, the main symptom of depression, in terms of both psychological and neurophysiological findings. The purpose of this review is to find the relationship between the two neuroimaging mechanisms, and to provide help for the future study of how the brain imaging changes can promote the mechanism of SB in depression patients with anhedonia symptoms. This review also emphasizes the necessity of intervention for the symptoms of anhedonia when preventing depression from committing suicide. The latest research results were reviewed about anhedonia in depression and magnetic resonance imaging of SB.The results showed that the default network, insula, lateral orbitofrontal gyrus, anterior cingulate gyrus, ventral striatum gyrus, ventral lateral and dorsolateral prefrontal gyrus, thalamus and habenula nucleus were dysfunction in depression with state anhedonia symptoms, affecting SB in terms of mood, execution, reward and aversion processing, especially the low lethal SB.

Objective:To analyze the compliance with enhanced recovery after surgery (ERAS) protocol in geriatric patients with fresh fracture.Methods:A retrospective study was conducted on the data of the patients with fresh extremity fracture which had been included in the ERAS perioperative protocol database during May 2019 and January 2022 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. The patients ≥65 years were selected as a study group which was matched by a control group of the patients < 65 years in sex, fracture type and date frame of hospitalization at a ratio of 1∶1. The 2 groups were compared in the compliance with the 14 ERAS core perioperative elements.Results:The study group and the control group each included 66 patients who were matched in sex and fracture type. 62.1% (41/66) of the patients in the study group had combined diseases, significantly more than that [16.7% (11/66)] in the control group( P<0.001). Altogether, the compliance with the 14 ERAS core perioperative elements was 78.6 (71.4, 85.7) % in both groups, showing no significant difference between them ( P>0.05). Respectively, the compliance with the postoperative oral intake in the study group (80.3%, 53/66) was significantly lower than that in the control group (92.4%, 61/66) ( P<0.05); the compliance with the other 13 elements showed no statistically significant difference between the 2 groups ( P>0.05). Conclusion:The ERAS perioperative protocol can be carried out smoothly in geriatric patients with fresh fracture whose compliance may be comparable to that of the none-elderly patients.

Objective:To investigate the molecular epidemiological characteristics of HIV-1 infection among men who have sex with men (MSM) in Jiaxing city, and provide methods and ideas for the prevention and control of HIV-1 infection.Methods:This study retrospectively collected the blood samples from all newly reported cases of HIV-1 infection among MSM without antiviral treatment from 2020 to 2022. HIV-1 pol genes in the blood samples were amplified and sequenced. MEGA v6.0 software was used to analyze nucleic acid sequences. A phylogenetic tree was constructed to analyze HIV-1 subtypes. The calibrated population resistance program (CPR) was used to detect drug-resistant mutations. After calculating the genetic distance between gene sequences, molecular transmission networks were constructed using Cytoscape v3.6.0 software. Results:A total of nine genetic subtypes were identified, with CRF07_BC (43.3%) and CRF01_AE (36.9%) accounting for the most. The recombinant forms that were not clustered with the reference subtype accounted for 5.0%. Drug-resistant mutations were identified in 21 cases (7.0%), and the mutation rates among strains of CRF07_BC and CRF01_AE subtypes were 8.2% and 7.8%, respectively. The detection rates of drug-resistant mutations to protease inhibitors, nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors were 1.7%, 0.7% and 4.7%, respectively. The optimal genetic distance threshold of the molecular network was 0.018. At this genetic distance, the molecular network access rate was 43.3%, and 38 molecular clusters (ranging from 2 to 26 nodes per cluster) were included. Cases with ≥6 homosexual partners and a degree value of ≥4 were more likely to access the active molecular cluster. The population of high-risk transmission cases with TNS>0.75 were mainly nonlocal residents and commercial service providers. The recombinant forms showed high similarity in sequences with the strains from other provinces.Conclusions:The distribution of HIV-1 subtypes in MSM in Jiaxing city was complex. Given the increasing detection rate of recombinant forms, the high transmission rate of drug-resistant mutations, and the active molecular clusters and high-risk transmission clusters mainly detected in nonlocal residents and commercial service providers, strengthened surveillance and intervention are needed.

Objective:To observe the effect of scleral buckling surgery (SB) in the treatment of rhegmatogenous retinal detachment (RRD) with subretinal hyperplasia (SRP).Methods:A retrospective case study. From January 2016 to December 2018, 31 patients with old RRD with SRP who were treated with SB in Department of Ophthalmology, Central Theater Command General Hospital were included in the study. There were 18 males with 20 eyes and 13 females with 15 eyes. Age was (26.5±8.7) years. The course of disease was (12.6±10.3) months. The best corrected visual acuity (BCVA) test was performed using the international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of recording. Retinal detachment ranges ≤2, >2-<3, ≥3 quadrants were 10 (28.6%, 10/35), 20 (57.1%, 20/35), and 5 (14.3%, 5/35) eyes, respectively. All affected eyes were treated with SB. Among them, 22 eyes (63.0%, 22/35) underwent local Scleral buckling, 11 eyes (31.4%, 11/35) underwent combined encircling buckle, and 2 eyes (5.7%, 2/35) underwent encircling buckle alone. Subretinal fluid drainage was performed in 33 eyes (94.3%, 33/35). The mean follow-up time was 18.2 months. Relevant examinations were performed with the same equipment and methods before operation to observe BCVA and retinal reattachment. Paired sample t test was used to compare logMAR BCVA before and after operation. Results:At the last follow-up, retinal reattachment occurred in 32 eyes (91.4%, 32/35) of 35 eyes. The retina did not reset in 3 eyes (8.6%, 3/35). logMAR BCVA of affected eye was 0.67±0.29 (finger counting-1.0). The difference of logMAR BCVA before and after operation was statistically significant ( t=5.133, P=0.036). In 35 eyes, visual acuity improved, stabilized and decreased in 19 (54.3%, 19/35), 13 (37.1%, 13/35) and 3 (8.6%, 3/35) eyes, respectively. Ten months after surgery, the silicone tape was exposed and infected 1 eye. After the silicone tape was removed, the infection subsided and the retina was in place. There were no intraocular hemorrhage, vitreoretinal impaction, endophthalmitis and other complications during and after operation. Conclusion:SB treatment of RRD with SRP can achieve good retinal reposition and improve visual acuity to some extent.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective To investigate the dosimetric differences between volumetric modulated arc therapy (VMAT) with a flattening filter (FF) and flattening filter-free (FFF) VMAT in fractionated stereotactic radiotherapy for brain metastases. Methods Seventeen patients with brain metastases were divided into FF-VMAT group (VMAT plans with the FF mode) and FFF-VMAT group (VMAT plans with the FFF mode). The two groups were compared in terms of target volume dose parameters (D_98%, D_2% and D_mean), the conformal index (CI), the gradient index (GI), the gradient, normal brain tissue dose parameters (V_5Gy, V_10Gy, V_12Gy and D_mean), monitor units, and beam-on time. Results Compared with the FF-VMAT group, the FFF-VMAT group had significantly lower GI (3.33 ± 0.37 vs 3.27 ± 0.35, P = 0.001), a significantly lower gradient [(0.85 ± 0.20) cm vs (0.84 ± 0.19) cm, P = 0.002], a significantly shorter beam-on time [(177.05 ± 62.68) s vs (142.71 ± 34.59) s, P = 0.001], and significantly higher D_2% [(65.69 ± 2.15) Gy vs (66.99 ± 2.03) Gy, P = 0.001] and D_mean [(58.77 ± 1.60) Gy vs (59.95 ± 1.43) Gy, P <0.001]. There were no significant differences in the CI, the D_98% of the target volume, the V_5Gy, V_10Gy, V_12Gy and D_mean of the normal brain tissue, and monitor units between FFF-VMAT and FF-VMAT. Conclusion FFF-VMAT can better protect the normal tissue around the target volume, reduce the beam-on time, and improve treatment efficiency.