The ethical review of clinical research involving mental disorders in the ethical governance of scientific and technological has obvious particularities， especially in the field of artificial intelligence and brain-computer interfaces which are reflected in the impact on mental autonomy， the impaired informed consent ability of participants with severe mental disorders in research， and other aspects. In addition， the stigma of illness， the use of placebo， and psychological assessment methods in clinical research have also drawn attention to the ethical review of psychiatry. In 2020， the Beijing Municipal Health Commission issued the Guidelines for Ethical Review of Clinical Research Involving Mental Disorders （Guidelines）. Shen Yucun’s Psychiatry， compiled in 2023， revised the application of the Guidelines in the context of ethical governance. An analysis was conducted on the purpose and significance of its issuance and revision， its scope of application， the principal responsibility of ethical review in medical and health institutions， and the key content of ethical review in psychiatry， to improve the quality of ethical review in clinical research involving mental disorders and promote the standardized development of clinical research in psychiatry.

Objective:This study aimed to explore the status of radiological Kashin-Beck disease (KBD) among school-aged children in Chamdo City, Tibet, through a 3-year monitoring survey, providing epidemiological evidence for prevention and control strategies.Methods:The target areas for this study were Luolong, Bianba, and Basu counties in Chamdo City, Tibet Autonomous Region, identified as having the most severe historical cases of KBD. Children aged 7-12 years attending school were enrolled as study subjects. Anteroposterior X-ray films of the right-hand were taken, and radiological diagnoses were made based on the "Diagnosis of Kashin-Beck Disease" criteria (WS/T 207-2010). Two experienced researchers independently reviewed the X-rays, and intra- and inter-group consistency were assessed using weighted Kappa values and percentage agreement. Cross-sectional surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD, and logistic regression analysis was employed to construct a predictive model of risk factors for radiological KBD cases.Results:In 2017, a total of 5,711 children aged 7-12 years in Chamdo City, Tibet, participated in the baseline cross-sectional survey (average age 9.2 years, 48.0% female), with 28 cases of radiological KBD. The age- and gender-standardized prevalence rate was 0.527%. In 2020, 6,771 participants (average age 9.3 years, 49.5% female) underwent a second cross-sectional survey, with 9 cases of radiological KBD and a standardized prevalence rate of 0.134%. Logistic regression analysis indicated that older age [ OR=2.439, 95% CI(1.299, 4.580), P=0.006] and female gender [ OR=8.157, 95% CI(1.016, 65.528), P=0.048] were independent risk factors for radiological KBD cases. Conversely, higher residential altitude, under the premise of Tibet's high altitude, was a protective factor [ OR=0.995, 95% CI(0.990, 0.999), P=0.032). Conclusion:The radiographically positive detection rate of KBD among school-aged children in Chamdo City, Tibet Autonomous Region, is at an extremely low level and showing a declining trend, reaching the historical standard in 2020. Considering the absence of positive signs in affected children, it suggests that local KBD has been effectively eliminated.

As guided by the policy of building national regional medical centers, it is imperative to advance the construction of the national regional medical centers for mental health to achieve the sustainable and balanced development of the mental health cause of the country. The authors summarized the current status of national regional medical centers, and analyzed challenges faced in management and operation mode, government investment and compensation mechanism, expansion of high-quality psychiatric medical resources, as well as research and innovation of mental diseases of these centers. On such basis, the authors put forward corresponding countermeasures and suggestions for the next stage of development.

OBJECTIVE： To rapidly identify chemical components of Zhitong huazheng capsules （shorted for “ZTHZC”）， and to provide reference for further elucidating the pharmacodynamic material basis and overall quality control. METHODS： UPLC-Q-TOF/MS method was adopted to separate the chemical components of ZTHZC. By reviewing literatures that related to chemical components of ZTHZC and its single Chinese traditional medicinal crops， the chemical structure of the chemical components was saved into a .mol format file， and supplemented the UNIFI database. The chemical constituents of ZTHZC were qualitatively analyzed by UNIFI database screening， and validated according to their precise molecular mass， characteristic ions， neutral loss， secondary mass spectrometry cleavage， chromatographic retention behavior， combined reference information and literature reports. RESULTS： A total of 70 chemical components were identified in this experiment， including 38 organic acids and organic acid esters， 8 alkaloids， 9 flavonoids， 5 triterpenoid saponins， 5 aldehydes， 2 ketones， 1 quinone， 1 polyacetylene and 1 monoterpenoid. CONCLUSIONS： This study provides a rapid detection and identification method for chemical components of ZTHZC， and also provides a scientific basis for the clarification of ZTHZC’s quality control and pharmacodynamics.

PURPOSE: Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone administered every 3 weeks (R-CHOP-21) is the standard care for diffuse large B-cell lymphoma (DLBCL). It is unknown whether the dose-dense R-CHOP (R-CHOP-14) could improve the outcome of the disease in Asian population. MATERIALS AND METHODS: Newly diagnosed DLBCL patients were centrally, randomly assigned (1:1) to receive R-CHOP-14 or R-CHOP-21. R-CHOP-14 was administered every 2 weeks, and R-CHOP-21 was administered every 3 weeks. Primary end point was disease-free survival (DFS). Secondary end points included overall survival (OS), progression-free survival (PFS), response rate and toxicities. RESULTS: Seven hundred and two patients were randomly assigned to receive R-CHOP-14 (n=349) or R-CHOP-21 (n=353). With a median follow-up of 45.6 months, the two groups did not differ significantly in 3-year DFS (79.6% for R-CHOP-14 vs. 83.2% for R-CHOP-21, p=0.311), 3-year OS (77.5% for R-CHOP-14 vs. 77.6% for R-CHOP-21, p=0.903), or 3-year PFS (63.2% for R-CHOP-14 vs. 66.1% for R-CHOP-21, p=0.447). Patients with an International Prognostic Index (IPI) score ≥ 2 had a poorer prognosis compared to those with an IPI score < 2. Grade 3/4 hematologic and non-hematologic toxicities were manageable and similar between R-CHOP-14 and R-CHOP-21. CONCLUSION: R-CHOP-14 did not improve the outcome of DLBCL compared to R-CHOP-21 in Asian population. With manageable and similar toxicities, both of the two regimens were suitable for Asian DLBCL patients. For high-risk patients with IPI ≥ 2, new combination regimens based on R-CHOP deserve further investigation to improve efficacy.
Asian Continental Ancestry Group ; B-Lymphocytes ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Follow-Up Studies ; Humans ; Lymphoma, B-Cell ; Prednisone ; Prognosis ; Rituximab ; Vincristine

OBJECTIVETo clarify the role of waist circumference (WC) in estimating organ damage and assessing the prognosis in young and middle-aged patients with cardiovascular disease undergoing cardiac rehabilitation program (CRP).

METHODSWe recruited 147 young and middle-aged patients with cardiovascular disease to participate in the CRP for 4 or 5 weeks. The baseline clinical data and results of routine fasting blood test and ultrasonic cardiography were evaluated for these patients.

RESULTSWC had a linear correlation with the indices reflecting cardiac structure alteration (LVSd and LVPWd) of the patients after CRP but showed a negative correlation with their HDL-C levels. The fasting blood glucose (FBG) and serum uric acid (UA) levels showed a positive correlation with WC before CRP but not after CRP.

CONCLUSIONWC monitoring allows accurate assessment of organ damage in patients undergoing CRP after cardiovascular disease and has special value in evaluating the changes in cardiac structure and function.

Blood Glucose ; chemistry ; Body Mass Index ; Cardiovascular Diseases ; diagnosis ; physiopathology ; Humans ; Middle Aged ; Prognosis ; Uric Acid ; blood ; Waist Circumference

Objective To evaluate the expression of transient receptor potential melastatin 7(TRPM7)in cholangiocarcinoma and its correlation with prognosis.Methods The expressions of TRPM7 were detected by SP immunohistochemical in 49 cases of cholangiocarcinoma,7 cases of benign bile duct lesions and 36 cases of adjacent histologically noncancerous bile duct tissues,and to analysis its relationship with the clinical pathological characteristics of cholangiocarcinoma.Results The positive expression rate of TRPM7 in cholangiocarcinoma was 77.6%(38/49),which was higher than that in benign bile duct lesions(0,0/7)and adjacent his-tologically noncancerous bile duct tissues(2.8%,1/36),the difference was statistically significant(P <0.05).The positive expres-sion of TRPM7 in cholangiocarcinoma was correlated with the TNM stage of tumor,lymph node metastasis and organ metastasis (P <0.05),but not related to patients′age,gender,site,differentiation and hepatitis(P >0.05).Kaplan-Meier analysis showed that increased expression of TRPM7 was associated with shorted overall survival (P <0.05).Cox regression analysis showed that the expression level of TRPM7 was significantly associated with prognosis and an independent risk factor for prognosis(P <0.05 ). Conclusion TRPM7 plays an important role in the tumorigenesis progression,invasion,and metastasis of cholangiocarcinoma,and is an important factor for prognosis in patients with cholangiocarcinoma.

OBJECTIVETo analyze the clinical and molecular characteristics of patients with X-linked thrombocytopenia (XLT) and their responsiveness to treatment with various doses of corticosteroids or intravenous immunoglobulin (IVIG) separately.

METHODData from 15 XLT patients who were hospitalized in Children's Hospital Affiliated to Chongqing Medical University from March 2010 to July 2014 were analyzed retrospectively, including clinical manifestations, scores, peripheral blood, immunological functions, responses to IVIG and steroid treatment with various doses and duration.

RESULTAll 15 XLT patients met the inclusion criteria and showed microthrombocytopenia with or without mild-to-moderate eczema or minor infections. Platelet counts ranged from (8-80) × 10⁹/L. The platelet volume value ranged between 5.6 and 10.9 fl (normal range: 9.4-12.5 fl). Raised serum IgG was found in 5 cases, while low serum IgG was found in 2 cases. WAS gene analysis revealed missense mutations in 14 patients, including 4 hotspots (V75M, R86C, R86H, R86L) and 1 novel mutation (Y107C). Flow cytometer analysis of 13 patients showed various amounts of WAS protein (WASP) expression, 2 patients had normal amounts of WASP expression, 5 had reduced amounts, and 6 had absent WASP expression. Their responses to individual steroid and IVIG treatment with various doses and duration were also reviewed. Fourteen patients who were misdiagnosed as immune thrombocytopenic purpura at first received 28 courses of steroids and (or) 47 courses of IVIG treatment. The post-treatment platelet counts of 1 000-2 000 mg/(kg × d) IVIG(25 courses) at 2-7 d and 8-14 d time points were (60 ± 10) × 10⁹/L and (41 ± 7) × 10⁹/L, which indicate a significantly better responsiveness than those by [(31 ± 7) × 10⁹/L, (21 ± 2) × 10⁹/L] of 400-500 mg/(kg·d) IVIG(22 courses) (Z = -4.419, -1.592;P = 0.002,0.011). However, there were no significant differences between the responsiveness of 3 doses [1-2 mg/(kg·d)(8 courses), 3-6 mg/(kg·d) (11 courses) and 20-30 mg/(kg × d)(9 courses)] of steroids (F = 0.387,0.252;P = 0.980,0.761) at 2-7 d and 8-14 d time points. The platelet counts gradually decreased to the primary level at 15-30 d after any doses of steroids and (or) IVIG treatment. The effective rate of 1 000-2 000 mg/(kg × d) IVIG treatment was 18/25, which was significantly higher than that (2/22) of 400-500 mg/(kg × d) (χ² = 9.836, P = 0.008). The effective rate of 20-30 mg/(kg × d) steroids treatment (7/9) was relatively higher than 1-2 mg/(kg × d) (4/8) and 3-6 mg/(kg × d) (6/11) with no significant difference (χ⁹ = 3.235, P = 0.581). After the treatment with steroids and /or IVIG 14 cases with hemorrhage were all improved.

CONCLUSIONThe clinical characteristics of X-linked thrombocytopenia were microthrombocytopenia with or without mild-to-moderate eczema or minor infections. WAS gene and WASP analysis were diagnostic methods. There were no significant differences between the responsiveness of 3 doses of steroids; 1 000-2 000 mg/(kg·d) IVIG had a significantly better responsiveness. However, IVIG and steroids with any dose and duration may only transiently increase peripheral platelet level of XLT patients.

Adrenal Cortex Hormones ; administration & dosage ; Child ; Genetic Diseases, X-Linked ; drug therapy ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; Platelet Count ; statistics & numerical data ; Retrospective Studies ; Thrombocytopenia ; drug therapy ; Treatment Outcome

Objective To determine,in our experience,the prevalence and presence of risk factors for metabolic syndrome (MS) in heart transplant recipients.Methods We studied 135 patients who underwent heart transplantation in our hospital from September 2000 to December 2011,According to the diagnostic criteria of MS,they were divided into two groups.All variables that could be related to the development of MS during the follow-up period were analyzed.The prevalence and presence of risk factors for MS in our experience were determined.Student t-test,Wilcoxon rank sum test and x2 test were used for univariate statistical analysis and logistic regression for multivariate analysis.Results (1) Of the 135 patients,63 developed MS (46.67％) during a mean follow-up period of 47.3 months.The multivariate analysis identified the follows as predictive factors for the development of MS:age (OR=1.09,95％ CI 1.01-1.22,P＜0.05),body mass index (BMI) (OR=1.65,95％ CI 1.16-1.87,P＜0.05),history of DM (OR =3.27,95％ CI 1.12-34.21,P＜0.05).Conclusion In our population,the prevalence of MS after heart transplant is 46.67％ during a mean follow-up period of 47.3 months.Age,pre-operative overweight especially BMI,and history of DM were significant and independent risk factors for the development of MS during the follow-up period.For these patients,dose of immunosuppressant and diet control are important.

Objective To investigate the function of phosphatidylinositol phospholipase C encoded by LB361 gene of L.interrogans ( L-PI-PLC) and its mechanism in inducing macrophage apoptosis .Meth-ods The PI-PLC domains in the sequence of LB 361 gene of L.interrogans serovar Lai strain were analyzed by bioinformatics method .Prokaryotic expression system was established to express the recombinant L -PI-PLC ( rL-PI -PLC).The enzymatic activity of rL-PI-PLC in hydrolyzing phosphatidylinositol -4,5-bisphos -phate (PIP2) substrate into inositol-1,4,5-trisphosphate (IP3) was determined by IP3 fluorescence polariza-tion assay.LB361gene expressions at mRNA and protein levels as well as the secretion of LB 361gene prod -ucts were detected by real-time fluorescent quantitative RT -PCR and Western blot assay after infection of hu-man THP-1 macrophages with L.interrogans serovar Lai strain.A LB361 gene-transfected THP -1cell line was generated for evaluation of the mechanism of LB 361 gene products in elevating intracellular free Ca 2+( [Ca 2+] i) concentration and inducing the apoptosis of transfected THP -1 cells with the use of laser confocal microscopy and flow cytometry.Re sul ts The rL-PI-PLC hydrolyzed PIP2 into IP3 with a Km of 199 μmol/L and a Kcat of 8.566×10-5 S-1 .The expressions of LB361gene at mRNA and protein levels were both signifi -cantly up-regulated after infection of THP-1 cells with L.interrogans serovar Lai strain .Moreover , the exter-nal secretion of L-PI-PLC was also found during infection .The concentrations of IP 3 and [ Ca2+] i in the LB361 gene-transfected THP-1 cells were significantly increased compared to those in the non-transfected THP-1 cells, resulting in a high [Ca2+]i-dependent apoptosis of partial THP-1 cells.Conclusion PI-PLC is encoded by the LB361 gene of L.interrogans, which could induce the apoptosis of macrophages through el-evating [ Ca2+] i concentration during infection of microphages with L.interrogans.