Objective: To explore the effectiveness of different intervention modalities on nonsuicidal selfinjury (NSSI) in adolescents, so as to provide an evidencebased basis for the intervention strategy of NSSI in adolescents. Methods: Randomized controlled trials on interventions for adolescent NSSI were retrieved from databases, such as CNKI, Wanfang, VIP, CBM, Web of Science, PubMed, Embase, and Cochrane Library, spanning from the inception of these databases to March 5, 2025. Network Metaanalysis was performed by using Stata 17.0 and Review Manager 5.3 software, and the standardized mean difference (SMD) and 95%CI were used as the effect indicators to compare the differences in the effectiveness of the interventions and rank the effect. Results: A total of 26 articles with 2 034 adolescents with NSSI were included in the study, including 10 intervention modalities:dialectical behavior therapy, emotional regulation intervention, mentalizationbased therapy, family therapy, cutting down programme, cognitive behavioral therapy, narrative therapy, stepped care approach, positive psychological intervention, and acceptance and commitment therapy. The results showed that compared with the treatment as usual, positive psychological intervention [SMD(95%CI)=-2.12(-3.51 to -0.74)], stepped care intervention [SMD(95%CI)=-2.07(-3.43 to -0.71)], and dialectical behavior therapy [SMD(95%CI)=-1.70(-2.60 to -0.80)], cognitive behavioral therapy [SMD(95%CI)=-1.54(-2.61 to -0.48)], and acceptance and commitment therapy[SMD(95%CI)=-1.50(-2.68 to -0.32)] were statistically significant differences in reducing adolescents NSSI behaviors(P<0.05). Positive psychological intervention, stepped care intervention, and dialectical behavior therapy were more effective than the mentalizationbased therapy and the cutting down programme (SMD=-2.08, -2.03, -1.66, -2.06, -2.01, -1.64,P<0.05); the area under the cumulative ranking probability graph revealed that positive psychological intervention may have the best effect in improving NSSI among adolescents (82.5). Conclusions Positive psychological interventions show the best results in improving adolescent NSSI among multiple intervention modalities. It is recommended to give priority to positive psychological interventions in clinical interventions.

BackgroundThe occurrence rate of dangerous behaviors in patients with severe mental disorders is higher than that of the general population. In China， there is limited research on the prediction of dangerous behaviors in community-dwelling patients with severe mental disorders， particularly in terms of predicting models using data mining techniques other than traditional methods. ObjectiveTo explore the influencing factors of dangerous behaviors in community-dwelling patients with severe mental disorders and testing whether the classification decision tree model is superior to the Logistic regression model. MethodsA total of 11 484 community-dwelling patients with severe mental disorders who had complete follow-up records from 2013 to 2022 were selected on December 2023. The data were divided into a training set （n=9 186） and a testing set （n=2 298） in an 8∶2 ratio. Logistic regression and classification decision trees were separately used to establish predictive models in the training set. Model discrimination and calibration were evaluated in the testing set. ResultsDuring the follow-up period， 1 115 cases （9.71%） exhibited dangerous behaviors. Logistic regression results showed that urban residence， poverty， guardianship， intellectual disability， history of dangerous behaviors， impaired insight and positive symptoms were risk factors for dangerous behaviors （OR=1.778， 1.459， 2.719， 1.483， 3.890， 1.423， 2.528， 2.124， P<0.01）. Being aged ≥60 years， educated， not requiring prescribed medication and having normal social functioning were protective factors for dangerous behaviors （OR=0.594， 0.824， 0.422， 0.719， P<0.05 or 0.01）. The predictive effect in the testing set showed an area under curve （AUC） of 0.729 （95% CI： 0.692~0.766）， accuracy of 70.97%， sensitivity of 59.71%， and specificity of 72.05%. The classification decision tree results showed that past dangerous situations， positive symptoms， overall social functioning score， economic status， insight， household registration， disability status and age were the influencing factors for dangerous behaviors. The predictive effect in the testing set showed an AUC of 0.721 （95% CI： 0.705~0.737）， accuracy of 68.28%， sensitivity of 64.46%， and specificity of 68.60%. ConclusionThe classification decision tree does not have a greater advantage over the logistic regression model in predicting the risk of dangerous behaviors in patients with severe mental disorders in the community. ［Funded by Chengdu Medical Research Project （number， 2020052）］

Backgrounds Insomnia is frequent in schizophrenia and is found to be negatively affected by stressful life events,psychotic symptoms and depressive disorder,while the relationship among the four remains understudied in community-dwelling patients with schizophrenia.Objective To analyze the effect of stressful life events on insomnia in community-dwelling patients with schizophrenia,and to explore the mediation effect of psychotic symptoms and depression,so as to provide references for the intervention of insomnia in community-dwelling patients with schizophrenia.Methods From April to June 2023,a sample of 1 105 patients with schizophrenia attending 48 community health centers in Chengdu,Sichuan province and fulfilling the International Classification of Diseases,tenth edition(ICD-10)diagnostic criteria were included.All subjects were assessed using Stressful Life Event Scale(SLEs),Athens Insomnia Scale(AIS),Psychosis Screening Questionnaire(PSQ),and Patient Health Questionnaire Depression Scale(PHQ-9).Spearman correlation analysis was used to determine the correlation among the scales.Then the mediation model was constructed using Smart PLS 4.0,and tested with partial least squares algorithm and Bootstrap techniques.Results 332 patients(30.05%)with community schizophrenia were found to have insomnia.AIS scores in patients with schizophrenia were positively correlated with the scores on SLEs,PSQ and PHQ-9(r=0.165,0.322,0.554,P<0.01).Stressful life events indirectly contributed to insomnia through both separate mediation path and chained mediation path of psychotic symptoms and depressive disorder,and the indirect effect size of 0.102,0.372 and 0.190 was obtained,accounting for 10.46%,38.15%and 19.49%,respectively.Conclusion The stressful life events not only directly exert an impact on insomnia,but also indirectly contribute to insomnia through both the separate and chained mediation effect of psychotic symptoms and depressive disorder.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

ObjectiveTo analyze the management and treatment for patients with severe mental disorders in Chengdu from 2016 to 2020， in order to provide references for the relevant authorities to formulate policies and improving the mental health service system. MethodsData relating to 22 districts （cities） and counties in Chengdu from January 1， 2016 to December 31， 2020 were extracted from the National Information System for Severe Mental Disorders. Indicators such as reported prevalence rate， management rate， standardized management rate， medication rate， regular medication rate and stable condition rate of patients with severe mental disorders were analyzed on a yearly basis. ResultsBy the end of 2020， there were 71 899 registered cases of severe mental disorders in Chengdu， with a reported prevalence rate of 0.34%， a standardized management rate of 95.53%， and a regular medication rate of 72.50%. From 2016 to 2020， except the reported prevalence rate （χ²=269.566， P<0.01）， management rate （χ²=384.030， P<0.01）， standardized management rate （χ²=309.742， P<0.01）， medication rate （χ²=414.252， P<0.01）， regular medication rate （χ²=316.172， P<0.01） and stable condition rate （χ²=288.335， P<0.01） had linear trends of increasing with the annual increase. ConclusionFrom 2016 to 2020， the management rate， treatment rate and regular medication rate of patients with severe mental disorders have been increased year by year in Chengdu. Nevertheless， the increase in reported prevalence rate should be accompanied by strengthened management and follow-up to increase the regular medication rate to maintain the stability of patients' conditions.

This article gives a review on domestic and foreign researches on the non-drug intervention for patients with perimenopausal depression published from 2012 to 2022， so as to provide a reference for clinical treatment and nursing. Currently， pharmacotherapy is the mainstay of treatment for perimenopausal depression， while many existing problems remain to be solved such as the variation in treatment effect and the difficulty in maintaining emotional stability. however，high safety and relatively low cost are the characteristics of non-drug intervention， so this article expounds on the non-drug intervention measures for perimenopausal depression， such as music therapy， dietary therapy， exercise therapy， acupuncture therapy and repetitive transcranial magnetic stimulation （rTMS）.

Objective:To assess the agreement of manual measurement, semi-automatic measurement based on computer-aided diagnosis (CAD), and automatic measurement based on artificial intelligence (AI) in measuring diameters and volumes of solid pulmonary nodules.Methods:The clinical and low dose CT (LDCT) data of 165 participants in lung cancer screening of Sichuan Cancer Hospital from July 2018 to April 2020 were retrospectively analyzed. The largest nodule of each participant was selected to analyze, and its diameter and volume were measured by one junior and one senior radiologist using manual measurement, semi-automatic measurement based on CAD, and automatic measurement based on AI. Referring to Lung CT imaging reporting and data system (Lung-RADS, version 1.1), all nodules were classified into Lung-RADS 2, 3, 4A, 4B, 4X categories and low and high risk groups according to the diameter and volume measured by different measurement methods. Repeated-measures analysis of variance and paired t-test were used to compare the differences in the diameter and volume of lung nodules measured by different methods. The consistency of the three methods in measuring nodule diameter and volume was assessed by the correlation coefficient (ICC). Linear weighted Kappa coefficient was applied to assess the consistency of different measurement methods in Lung-RADS classification results; simple Kappa coefficient was applied to assess the consistency of different methods in high and low risk grouping results. Results:Difference in the diameters of pulmonary nodules measured by manual measurement, semi-automatic measurement based on CAD, and automatic measurement based on AI was statistically significant [(14.9±6.3) mm, (17.0±6.7) mm, (15.0±5.7) mm, F=88.39, P<0.001], and the pairwise comparisons showed that there was significant difference between semi-automatic measurement based on CAD and manual measurement method ( t=10.97, P<0.001), semi-automatic measurement based on CAD and automatic measurement based on AI ( t=10.07, P<0.001), but no significant difference between manual measurement method and automatic measurement based on AI method ( t=1.04, P=0.301). There was no significant difference in the measurement of pulmonary nodule volumes between the semi-automatic measurement and the automatic measurement method based on AI ( Z=0.70, P=0.482). The consistency of pulmonary nodules diameter measured by different measurement methods was high (ICC>0.75), and the consistency of semi-automatic and automatic measurement of lung nodule volume was high (ICC=0.927). The consistency of three methods for lung-RADS classification and high-and low-risk grouping according to nodule diameter was good (Kappa>0.80). The agreements between the semi-automatic measurement and the automatic measurement method for Lung-RADS classification and high-and low-risk grouping according to nodule volume were good (Kappa>0.80). Conclusion:In terms of diameter measurement of solid pulmonary nodules, automatic measurement based on AI is more consistent with manual measurement than semi-automatic measurement based on CAD. The agreement between automatic measurement and semi-automatic measurement is high in terms of volume measurement.

ObjectiveTo understand the status of stigma and subjective well-being of patients with mental disorders and co-resident family members， to analyze the correlation between them， and to compare the impact of stigma upon the subjective well-being of patients and family members of the same household. MethodsPatients with mental disorders （n=154） and their families （n=154） who visited the outpatient department of a tertiary psychiatric hospital in Chengdu from October to November 2019 were selected， and four instruments were used for collecting the data， including self-designed demographic information questionnaire， self-designed disease-related information questionnaire， brief version of Internalized Stigma of Mental Illness Scale （ISMI-10） and Index of Well-Being Scale （IWB）. ResultsA total of 118 （76.62%） patients with mental disorders and 151 （98.05%） family members experienced stigma. The total score and each factors score in ISMI-10 of family members were higher than those of patients （P<0.01）， and the total score and each dimension score in IWB were lower than those of patients （P<0.01）. Pearson correlation analysis showed that ISMI-10 total score of patients and family members was negatively correlated with IWB total score （r=-0.600，-0.202， P<0.05 or 0.01）. After controlling demographic and disease-related variables， multiple linear regression analysis showed that the regression model of mental disorder patients achieved good fit effect （adjusted R²=0.457）， with statistical significance （F=26.746， P<0.01）， while the regression model of co-living family members was lack of fit （adjusted R²=0.035）. After controlling for family demographic variables， the model was at the statistical level （F=3.769， P<0.01）. ConclusionMental disorder patients have low illness stigma and high subjective well-being， whereas the opposite is true for family members. Moreover， there is a negative relationship between stigma and subjective well-being for both patients and family members， stigma is a significant factor affecting subjective well-being for people with mental disorders.

Objective To investigate the effect of CareDose 4D combined with Care kV on CT pulmonary ground glass nodule ( GGN) with respect to quality and radiation dose. Methods The thoracic model containing 6 GGN was performed by using 7 low-dose schemes. The CareDose 4D + Care kV was adopted in scheme 1. In schemes 2, 3 and 4, the tube voltage was 120 kV, and the tube current 30, 20 and 10 mAs respectively. In schemes 5, 6 and 7, the tube voltage was 100 kV, and the tube current was 30, 20 and 10 mAs, respectively. The image quality [ CT value, contrast noise ratio ( CNR) , noise value (SD) and subjective score] and effective dose (E) were compared. Results There was no statistically significant difference in CT value of GGN among different schemes (P>0. 05). The SD of scheme 1 was higher than those of schemes 2, 3 and 5, but lower than those f scheme 7, while the CNR of scheme 1 was lower than those of schemes 2, 3 and 5, but higher than that of scheme 7 ( t=13. 020, 9. 560, 8. 120,-5. 720, -7. 849, -5. 192, -4. 130, 1. 361,P<0. 05). SD and CNR of scheme 1 were not significantly different from those of scheme 4 and 6 ( P>0. 05) . The subjective scores of each GGN of schemes 1, 2, 3, 5 and 6 was over 3 points, but and the subjective scores of one GGN of each of schemes 4 and 7 were below 3 points. The value E of the scheme 1 was reduced by 63. 0％, 44. 4％, 38. 8％, and 9. 1％, compared with the schemes 2, 3, 5 and 6, respectively. Conclusions CareDose 4D combined with Care kV in low-dose lung CT scan can ensure the image quality of GGN and reduce the radiation dose effectively.

Objective To explore the influence of iterative algorithm on image quality in ultralow-dose CT scan of lung.Methods The thoracic model was scanned using different parameter combinations.The tube voltage was chose with 80,100 kV in ultra-low dose group and the mAs was selected by 10,15,20,25 and 30 mAs.The control group selected the parameters of 120 kV,30 mAs.All the images were reconstructed with filtered back projection (FBP group) and iterative algorithm (IR group).The image noise and effective dose (E) were compared.Results When tube current and voltage were constant,the image noise of IR group was lower than that of FBP group,and the difference was statistically significant (t =1.102-8.070,P＜0.05).When the tube current was constant,the image noise of the 80 kV with FBP group was higher than that of 100 kV with FBP group,and the image noise of the 80 kV with IR group was lower than the 100 kV with FBP group(t =-8.639-7.841,P＜0.05).Compared with the conventional low-dose with FBP group,the image noise of each ultra-low-dose with FBP group was significantly increased,and the image noise of (80 kV,10 mAs),(80 kV,15 mAs),(80 kV,20 mAs) with IR group was significantly increased,and the image noise of (100 kV,15 mAs),(100 kV,20 mAs),(100 kV,25 mAs),(100 kV,30 mAs) with IR group was significantly reduced (t=-8.140-23.028,P＜0.05).There was no significant difference in image noise between the groups of (80 kV,25 mAs),(80 kV,30 mAs),(100 kV,10 mAs) with IR and the group of conventional low dose with FBP (P＞0.05).Compared with the conventional low dose group,the E of the groups of (80 kV,25 mAs),(80kV,30mAs),(100kV,10 mAs),(100kV,15mAs),(100kV,20mAs),(100kV,25 mAs),(100 kV,30 mAs) was decreased by 75.9％,71.0％,79.8％,70.4％,60.3％,50.2％,40.0％,respectively.Conclusions The image quality of the ultra-low dose protocol (100 kV,10mAs) with iterative algorithm is similar to that of the conventional low dose with FBP group,and the radiation dose could be significantly reduced.