3D hotspot engineering and analytes strategy enabled ultrasensitive SERS platform for biosensing of depression biomarker.

Nowadays, the diagnose of depression mainly relies on clinical examination while impossible to accurately evaluate the occurrence of depression. Chemical approaches are captivating to analyze stress biomarkers for feedbacking body's endocrine response to stress stimuli. However, it remains challenging in exploring accurate, reliable and sensitive approaches. Herein, we rationally design a newly SERS platform with integrated hotspots engineering and analyte strategy to achieve highly sensitive analysis for estrogen, a typical depression biomarker in adolescent female. On the one hand, the 3D micro/nano plasmonic substrate containing Au-Ag Alloy Nanourchins (AAA-NUs) and arrays-based monolayer films of Au nanoparticles (Au NSs) was constructed to achieve high density and availability of hotspots. On the other hand, the analyte strategy was designed via rapid azotizing reaction to further enhance the scattering cross-section of estrogen in the form of azido compounds. With the synergism of them, the proposed SERS platform displayed high sensitivity for estrogen with a limit of detection down to 10-11 mg/mL. More importantly, the blood estrogen levels of depressed patients were evaluated via the proposed SERS platform and presented high consistence with clinical diagnostic results. This integrated SERS platform paves the way for universal and ultrasensitive biosensing and possess great potential for applying in multi-target detection and disease prediction.

TRPV1 is a risk factor for sleep disturbance in patients with gastro-oesophageal reflux disease: a case control study.

BACKGROUND/AIMS: Gastro-oesophageal reflux disease (GORD) is a chronic high-morbidity disease with a bidirectional relationship with sleep disturbance (SD) that may occur via the transient receptor potential vanilloid type 1 receptor (TRPV1) in the oesophageal mucosa. Yet the related mechanism was still unclear, the aim of this study is to investigate whether TRPV1 is associated with the presence of SD in GORD patients. METHODS: A case-control study was performed. After the screening, A total of 88 subjects were assigned to GORD without sleep disturbance (GORD + NOSD, n = 28), GORD comorbid sleep disturbance (GORD + SD, n = 30) and matched healthy controls (n = 30). Mucosal tissue was obtained from the participants by digestive endoscopy, the levels of TRPV1 expressed in the oesophageal mucosa were detected via RT-qPCR and western blot in different groups, and the correlation between GORD and SD were also analysed. RESULTS: In this study, we found that the Gastroesophageal Reflux Disease Diagnostic Questionnaire (GerdQ) scores was positively correlated with Pittsburgh Sleep Quality Index (PSQI) scores but negatively correlated with total sleep time (TST). We also found that the level of TRPV1 expressed in the oesophageal mucosa of GORD + SD was significantly higher than GORD + NOSD patients, and they were all higher than healthy controls. CONCLUSION: The current study suggested a closer link exists between GORD and sleep disturbance, and TRPV1 in oesophageal mucosa may be a crucial factor affecting sleep in GORD patients.

Benzodiazepine-Receptor Agonist Utilization in Outpatients with Anxiety Disorder: A Retrospective Study Based on Electronic Healthcare Data from a Large General Tertiary Hospital.

Benzodiazepine-receptor agonists (BZRAs), including benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs), are commonly used for anxiety, but often have side effects. We retrospectively investigated the utilization and prescription characteristics of BZRAs for patients with anxiety disorders in a large tertiary care general hospital between 2018 and 2021, based on electronic healthcare records. We also examined the pattern of simultaneous consumption of multiple BZRA drugs, and the diseases coexisting with anxiety that are associated with this. The numbers of patients and BZRA prescriptions increased over the 4 years. Moreover, 7195 prescriptions from 694 patients contained two or more BZRAs, of which 78.08% contained both BZDs and Z-drugs, 19.78% contained multiple BZDs, and 2.14% contained multiple Z-drugs. For anxiety patients with concomitant Alzheimer's disease or Parkinson's disease, and dyslipidemia, they were more likely to consume multiple BZRAs simultaneously, whereas patients with concomitant insomnia, depression, hypertension, diabetes, or tumors were less likely to consume multiple BZRAs (all p < 0.05). Furthermore, older patients who consume multiple BZRAs simultaneously may have higher probabilities of long-term drug use. Better interventions supporting standardized BZD utilization may be needed to minimize the side effects of inappropriate BZRA administration.

Efficacy of an internet-based cognitive behavioral therapy for subthreshold depression among Chinese adults: a randomized controlled trial.

BACKGROUND: Subthreshold depression (sD) negatively impacts well-being and psychosocial function and is more prevalent compared with major depressive disorder (MDD). However, as adults with sD are less likely to seek face-to-face intervention, internet-based cognitive-behavioral therapy (ICBT) may overcome barriers of accessibility to psychotherapy. Although several trials explored the efficacy of ICBT for sD, the results remain inconsistent. This study evaluated whether ICBT is effective in reducing depressive symptoms among Chinese adults with sD. METHODS: A randomized controlled trial was performed. The participants were randomly assigned to 5 weeks of ICBT, group-based face-to-face cognitive-behavioral therapy (CBT), or a waiting list (WL). Assessments were conducted at baseline, post-intervention and at a 6-month follow-up. The primary outcome measured depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D). Outcomes were analyzed using a mixed-effects model to assess the effects of ICBT. RESULTS: ICBT participants reported greater reductions on all the outcomes compared to the WL group at post-intervention. The ICBT group showed larger improvement on the Patient Health Questionnaire-9 (PHQ-9) at post-intervention (d = 0.12) and at follow-up (d = 0.10), and with CES-D at post-intervention (d = 0.06), compared to the CBT group. CONCLUSIONS: ICBT is effective in reducing depressive symptoms among Chinese adults with sD, and improvements in outcomes were sustained at a 6-month follow-up. Considering the low rates of face-to-face psychotherapy, our findings highlight the considerable potential and implications for the Chinese government to promote the use of ICBT for sD in China.

Left intermittent theta burst stimulation combined with right low-frequency rTMS as an additional treatment for major depression: A retrospective study.

Background: Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depression (MD). We retrospectively analyzed the efficacy of intermittent theta burst stimulation (iTBS) on the left dorsolateral prefrontal cortex (DLPFC) combined with low-frequency rTMS (LF-rTMS) on the right DLPFC as an additional therapy to standard medication treatment. Materials and Methods: The study included 54 patients with MD who completed 10 courses (5 days per week) of rTMS as an add-on therapy. Thirty patients were treated in the combination group (120% resting motor threshold; left DLPFC, iTBS, 600 stimuli + right DLPFC, 1-Hz rTMS, 600 stimuli), while 24 patients were in the high-frequency rTMS (HF-rTMS) group (120% resting motor threshold; left DLPFC, 10-Hz rTMS, 3000 stimuli). The outcome was assessed based on the changes in scores of 24-item Hamilton Depression Scale (HAMD-24) and 14-item Hamilton Anxiety Scale (HAMA-14). Results: Both depression and anxiety were significantly improved after 2 weeks of treatment by rTMS combined with medication. The combination of iTBS and LF-rTMS was significantly superior to HF-rTMS in improving the scores of HAMD-24 (P = 0.041) and HAMA-14 (P = 0.0095), and the response rate (P = 0.027). Conclusion: The pilot study showed that the combination of iTBS and LF-rTMS may hold promise as a potentially effective alternative therapy for MD due to its efficacy and time-saving benefit. The preliminary results shed light on the study of the efficacy and acceptability of the combination of iTBS and LF-rTMS for MD.

Gender differences in psychiatric outpatients: a before and during COVID-19 pandemic study in general hospitals from China.

BACKGROUND: Little is known about the gender characteristics and the Corona Virus Disease 2019 (COVID-19) impact on psychiatric department outpatients in general hospitals in China. METHODS: We retrospectively collected 225,947 outpatient clinic records before and during COVID-19 pandemic from January 1, 2019 to December 31, 2020 in the psychiatric clinic of 3 general hospitals, gender composition of patients was analyzed in different five age groups and nine diagnostic categories at three levels: total patient visits, number of patients and number of first-visit patients. RESULTS: The total male-to-female ratio of psychiatric outpatient records in 3 general hospitals from 2019 to 2020 was 1:1.69. Women were more common in all age groups. Overall, the proportion of women was further increased in 2020 compared to that in 2019, especially in age group below 34 years and anxiety disorders category. Most mental disorders showed higher demands for females than that for males except mental and behavioral disorders due to psychoactive substance use with the male-to-female ratio was 1:0.05. CONCLUSIONS: The demand for female psychiatric outpatient services is obviously higher than that for males. It is necessary to pay more attention to explore targeted mechanism or psychosocial service strategy for female patients with mental disorders. Trial registration ChiCTR2100044894, March 31, 2021 retrospectively registered.

Pros and cons factors influence population attitudes toward non-pharmaceutical interventions and vaccination during post-COVID-19.

OBJECTIVES: Population compliance greatly influences the effectiveness of vaccination and non-pharmaceutical interventions (NPIs) for the curtaining of COVID-19 transmission. We aimed to determine the conceptual framework of potential factors that influence compliance. STUDY DESIGN: This was a cross-sectional study. METHODS: Questionnaires were used to survey population attitudes toward vaccination and NPIs in China. Confirmatory factor analysis of the survey data by structural equation model was used to define the pros and cons factors of attitudes. The strength and direction of each factor's effect on population attitudes were illustrated by Bayesian network analysis. RESULTS: A total of 1700 respondents aged 18-70 years were surveyed with a panel of 34 questionnaires. Of these questionnaires, the confirmatory factor and structural equation model analysis identified five categories contributing to positive attitudes, including response efficiency, willingness and behavior, trust, cues to action, and knowledge, as well as four categories contributing to negative attitudes, including autonomy, perceived barriers, threat, and mental status. Bayesian networks revealed that cues to action produced a driving force for positive attitudes, followed by willingness and behavior, trust, response efficiency, and knowledge, whereas perceived barriers produced a driving force for negative attitudes, followed by autonomy and threat. CONCLUSIONS: This study established a concise and representative list of questionnaires that could be applied to investigate the conceptual framework of potential pros and cons factors of attitudes toward vaccination and NPIs for COVID-19 prevention. The factors with driving forces should be addressed with a priority to effectively improve population compliance.

Influence of Dietary Salt Intake on T2D Treatment.

Backgrounds: To what extent patients undergoing long-term T2D treatment are affected by dietary salt intake has not been completely investigated. Objectives: We aimed to investigate the influence of dietary salt intakes on T2D treatment, including glucose-lowering effect and indices related to T2D progression. Methods: The study recruited 1090 patients with T2D at Ningbo City First Hospital from January 1, 2018, to December 30, 2021. We compared their one-year follow-up outcomes in terms of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), blood pressure, obesity, and prevalence of retinopathy and neuropathy among groups with different dietary salt intakes. Results: The 1090 patients consisted of 287(26.3%) decreasing-, 190(17.4%) increasing-, 175(16.0%) steadily low-, 243(22.3%) steadily medium-, and 195(17.9%) steadily high-dietary salt intake patients. Compared to increasing-, steadily medium-, and steadily high-dietary salt intake patients, decreasing and steadily low salt intake led to lower baseline FBG, HbA1c, systolic blood pressure (SBP), BMI, and visceral fat area (VFA) (all p<0.05), to a larger decrease in FBG, HbA1c, SBP, BMI, and VFA after one-year treatment (all p<0.05), as well as to a slightly lower prevalence of retinopathy and a significantly lower prevalence of neuropathy. The steadily low salt patients had lower urine albumin/creatinine ratio (UAR) both at baseline and after treatment. Notably, the fasting insulin in the steadily low salt group was higher than the remaining groups after treatment (p<0.01). Conclusions: The present study concludes that lowered dietary salt intake benefits T2D treatment in multiple aspects, including main treatment targets such as FBG and HbA1c, and indices reflecting potential complications of T2D, including BMI, VFA, SBP, UAR, retinopathy, and neuropathy. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03811470.

Safety of inactivated SARS-CoV-2 vaccines in patients with allergic diseases.

BACKGROUND: Considering the considerable prevalence of allergic disease in the general population, an urgent need exists for inactivated SARS-CoV-2 vaccines that can be safely administered to those subjects. METHODS: This retrospective cohort study including 1926 participants who received inactivated SARS-CoV-2 vaccines, compared their local and systemic reactions in 7 days after each dose of inactivated SARS-CoV-2 vaccine, and anti-SARS-CoV-2 IgG after vaccination in all participants. RESULTS: Pain at the injection site within seven days after the first injection was the most commonly reported local reaction, occurring in 31.0% of the patients with allergic disease and 18.9% in the control group, respectively (P < 0.001). After the first dose, systemic events were more frequently reported in patients with allergic disease than control group (30.2% vs. 22.9%, P < 0.001). After the second dose, systemic events occurred less often, affecting 17.1% of the patients with allergic disease and 11.1% of the control group (P < 0.002). The occurrence of fatigue, vertigo, diarrhea, skin rash, sore throat were the most frequent systemic reactions. Overall, a lower incidence of local and systemic reactive events was observed after the second dose than the first dose in patients with allergic disease and control group. Nearly all participants had positive IgG antibodies, and participants with allergic disease had higher frequencies compared with control group (100.0 vs.99.4%). CONCLUSIONS: Although local and systemic reactions were more frequently reported in patients with allergic disease than control group, administration of the inactivated SARS-CoV-2 vaccine was safe and well tolerated by all participants; no participants experienced a serious adverse event, and none were hospitalized. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2100048549. Registered Jul 10, 2021.

Age-Specific Transmissibility Change of COVID-19 and Associations With Breathing Air Volume, Preexisting Immunity, and Government Response.

Background: The comprehensive impacts of diverse breathing air volumes and preexisting immunity on the host susceptibility to and transmission of COVID-19 at various pandemic stages have not been investigated. Methods: We classified the US weekly COVID-19 data into 0-4, 5-11, 12-17, 18-64, and 65+ age groups and applied the odds ratio (OR) of incidence between one age group and the 18-64 age group to delineate the transmissibility change. Results: The changes of incidence ORs between May, 2020 and November, 2021 were 0.22-0.66 (0-4 years), 0.20-1.34 (5-11 years), 0.39-1.04 (12-17 years), and 0.82-0.73 (65+ years). The changes could be explained by age-specific preexisting immunity including previous infection and vaccination, as well as volumes of breathing air. At the early pandemic, the ratio that 0-4-year children exhaled one-fifth of air and discharge a similar ratio of viruses was closely associated with incidence OR between two age groups. While, after a rollout of pandemic and vaccination, the much less increased preexisting immunity in children resulted in rapidly increased OR of incidence. The ARIMA model predicted the largest increase of relative transmissibility in 6 coming months in 5-11-year children. Conclusions: The volume of breathing air may be a notable factor contributing to the infectivity of COVID-19 among different age groups of patients. This factor and the varied preexisting greatly shape the transmission of COVID-19 at different periods of pandemic among different age groups of people.

Early clinical and CT features of COVID-19 and community-acquired pneumonia from a fever observation ward in Ningbo, China.

INTRODUCTION: We aimed to compare the early clinical manifestations, laboratory results and chest computed tomography (CT) images of COVID-19 patients with those of other community-acquired pneumonia (CAP) patients to differentiate CAP from COVID-19 before reverse transcription-polymerase chain reaction results are obtained. METHODS: The clinical and laboratory data and chest CT images of 51 patients were assessed in a fever observation ward for evidence of COVID-19 between January and February 2020. RESULTS: 24 patients had laboratory-confirmed COVID-19, whereas 27 individuals had negative results. No statistical difference in clinical features was found between COVID-19 and CAP patients, except for diarrhoea. There was a significant difference in lymphocyte and eosinophil counts between COVID-19 and CAP patients. In total, 22 (91.67%) COVID-19 patients had bilateral involvement and multiple lesions according to their lung CT images; the left lower lobe (87.50%) and right lower lobe (95.83%) were affected most often, and all lesions were located in the peripheral zones of the lung. The most common CT feature of COVID-19 was ground-glass opacity, found in 95.83% of patients, compared to 66.67% of CAP patients. CONCLUSION: Diarrhoea, lymphocyte counts, eosinophil counts and CT findings (e.g. ground-glass opacity) could help to distinguish COVID-19 from CAP at an early stage of infection, based on findings from our fever observation ward.

Deficits in N-Methyl-D-Aspartate Receptor Function and Synaptic Plasticity in Hippocampal CA1 in APP/PS1 Mouse Model of Alzheimer's Disease.

The N-methyl-D-aspartate receptor is a critical molecule for synaptic plasticity and cognitive function. Impaired synaptic plasticity is thought to contribute to the cognitive impairment associated with Alzheimer's disease (AD). However, the neuropathophysiological alterations of N-methyl-D-aspartate receptor (NMDAR) function and synaptic plasticity in hippocampal CA1 in transgenic rodent models of AD are still unclear. In the present study, APP/PS1 mice were utilized as a transgenic model of AD, which exhibited progressive cognitive impairment including defective working memory, recognition memory, and spatial memory starting at 6 months of age and more severe by 8 months of age. We found an impaired long-term potentiation (LTP) and reduced NMDAR-mediated spontaneous excitatory postsynaptic currents (sEPSCs) in the hippocampal CA1 of APP/PS1 mice with 8 months of age. Golgi staining revealed that dendrites of pyramidal neurons had shorter length, fewer intersections, and lower spine density in APP/PS1 mice compared to control mice. Further, the reduced expression levels of NMDAR subunits, PSD95 and SNAP25 were observed in the hippocampus of APP/PS1 mice. These results suggest that NMDAR dysfunction, impaired synaptic plasticity, and disrupted neuronal morphology constitute an important part of the neuropathophysiological alterations associated with cognitive impairment in APP/PS1 mice.

Internet-based cognitive behavioral therapy for psychological distress in older adults without cognitive impairment living in nursing homes during the COVID-19 pandemic: A feasibility study.

BACKGROUND: The COVID-19 pandemic has had a detrimental effect on the mental health of older adults living in nursing homes. Very few studies have examined the effects of Internet-based Cognitive Behavioral Therapy (ICBT) on older adults living in nursing homes during the pandemic. We conducted a feasibility study using a single-group design, to explore the effectiveness of ICBT on psychological distress in 137 older adults (without cognitive impairment) from 8 nursing homes in 4 southeast cities in China, between January and March 2020. METHODS: Symptoms of depression, anxiety, general psychological distress, and functional disability were measured at baseline, post-treatment (5 weeks) and at a 1-month follow-up. Mixed-effects model was used to assess the effects of ICBT. RESULTS: Statistically significant changes with large effect sizes were observed from pre- to post-treatment on the PHQ-9 (p < .001, Cohen's d = 1.74), GAD-7 (p < .001, d = 1.71), GDS (p < .001, d = 1.30), K-10 (p < .001, d = 1.93), and SDS (p < .001, d = 2.03). Furthermore, improvements in treatment outcomes were sustained at 1-month follow-up, and high levels of adherence and satisfaction were indicated. CONCLUSION: ICBT was effective in reducing psychological distress in older adults without cognitive impairments living in nursing homes during the COVID-19 pandemic. Thus, it could be applied in improving the mental health of this vulnerable group during the pandemic.

REM Sleep Fragmentation in Patients With Short-Term Insomnia Is Associated With Higher BDI Scores.

Objective: To observe the changes in sleep characteristics and BDI scores in patients with short-term insomnia disorder (SID) using a longitudinal observational study. Methods: Fifty-four patients who met the criteria for SID of the International Classification of Sleep Disorders, third edition, were recruited. Depression levels were assessed using the Beck depression inventory (BDI) at enrollment and after 3 months of follow-up, respectively. Sleep characteristics were assessed by polysomnography. Results: After 3 months of follow-up, the group was divided into SID with increased BDI score (BDI >15) and SID with normal BDI score (BDI ≤ 15) according to the total BDI score of the second assessment. The differences in rapid eye movement (REM) sleep latency, REM sleep arousal index, and NREM sleep arousal index between the two groups were statistically significant. The total BDI score was positively correlated with REM and NREM sleep arousal index and negatively correlated with REM sleep latency, which were analyzed by Pearson correlation coefficient. Multiple linear regression was used to construct a regression model to predict the risk of depression in which the prediction accuracy reached 83.7%. Conclusion: REM sleep fragmentation is closely associated with future depressive status in patients with SID and is expected to become an index of estimating depression risk.

Chronic Cardio-Metabolic Disease Increases the Risk of Worse Outcomes Among Hospitalized Patients With COVID-19: A Multicenter, Retrospective, and Real-World Study.

Background Although chronic cardio-metabolic disease is a common comorbidity among patients with COVID-19, its effects on the clinical characteristics and outcome are not well known. Methods and Results This study aimed to explore the association between underlying cardio-metabolic disease and mortality with COVID-19 among hospitalized patients. This multicenter, retrospective, and real-world study was conducted from January 22, 2020 to March 25, 2020 in China. Data between patients with and without 5 main cardio-metabolic diseases including hypertension, diabetes mellitus, coronary heart disease, cerebrovascular disease, and hyperlipidemia were compared. A total of 1303 hospitalized patients were included in the final analysis. Of them, 520 patients (39.9%) had cardio-metabolic disease. Compared with patients without cardio-metabolic disease, more patients with cardio-metabolic disease had COVID-related complications including acute respiratory distress syndrome (9.81% versus 3.32%; P<0.001), acute kidney injury (4.23% versus 1.40%; P=0.001), secondary infection (13.9% versus 9.8%; P=0.026), hypoproteinemia (12.1% versus 5.75%; P<0.001), and coagulopathy (19.4% versus 10.3%; P<0.001), had higher incidences of the severe type of COVID-19 (32.9% versus 16.7%; P<0.001), more were admitted to the intensive care unit (11.7% versus 7.92%; P=0.021), and required mechanical ventilation (9.8% versus 4.3%; P<0.001). When the number of the patients' cardio-metabolic diseases was 0, 1, and >2, the mortality was 4.2%, 11.1%, and 19.8%, respectively. The multivariable-adjusted hazard ratio of mortality among patients with cardio-metabolic disease was 1.80 (95% CI, 1.17-2.77). Conclusions Cardio-metabolic disease was a common condition among hospitalized patients with COVID-19, and it was associated with higher risks of in-hospital mortality.

Time-Series Analysis of Continuous Glucose Monitoring Data to Predict Treatment Efficacy in Patients with T2DM.

CONTEXT: There is a challenge to predict treatment effects in patients with type 2 diabetes mellitus (T2DM). OBJECTIVE: To assess and predict treatment effects in patients with T2DM through time-series analysis of continuous glucose monitoring (CGM) measurements. METHOD: We extracted and clustered the trend components of CGM measurements to generate representative time-series profiles, which were used as a predictor of treatment effects in groups of patients. SETTING AND PARTICIPANTS: We recruited 111 outpatients with T2DM at Ningbo City First Hospital, China. INTERVENTION: The patients underwent CGM measurement for 14 days at the beginning of glucose-lowering treatment. MAIN OUTCOME MEASURES: Hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) were obtained at the beginning and after 6 months of treatment. RESULTS: 111 patients each had 960 to 1344 CGM measurements for 14 days at 96 measurements per day. The patients were classified into 3 groups according to the profiles of trend components of CGM observed values by time-series clustering method, including decreasing (47 patients), increasing (26 patients), and unchanged (38 patients) profiles. After 6 months of glucose-lowering treatment, FPG declined from 10.2 to 6.8 mmol/L (a decline of 3.4 mmol/L) in the decreasing group, from 8.9 to 9.2 mmol/L (a rise of 0.3 mmol/L) in the increasing group, and from 8.4 to 7.5 mmol/L (a decline of 0.9 mmol/L) in the unchanged group. The changes of HbA1c were 2.3%, 0.2%, and 0.9% for the 3 groups (P < 0.01), respectively. CONCLUSIONS: Clustering of the trend components of CGM data generates representative CGM profiles that are predictive of 6-month therapeutic effects for T2DM.

Reduced inflammatory responses to SARS-CoV-2 infection in children presenting to hospital with COVID-19 in China.

BACKGROUND: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children is associated with better outcomes than in adults. The inflammatory response to COVID-19 infection in children remains poorly characterised. METHODS: We retrospectively analysed the medical records of 127 laboratory-confirmed COVID-19 patients aged 1 month to 16 years from Wuhan and Jingzhou of Hubei Province. Patients presented between January 25th and March 24th 2020. Information on clinical features, laboratory results, plasma cytokines/chemokines and lymphocyte subsets were analysed. FINDINGS: Children admitted to hospital with COVID-19 were more likely to be male (67.7%) and the median age was 7.3 [IQR 4.9] years. All but one patient with severe disease was aged under 2 and the majority (5/7) had significant co-morbidities. Despite 53% having viral pneumonia on computed tomography (CT) scanning only 2 patients had low lymphocyte counts and no differences were observed in the levels of plasma proinflammatory cytokines, including interleukin (IL)-2, IL-4, IL-6, tumour necrosis factor (TNF)- α , and interferon (IFN)- γ between patients with mild, moderate or severe disease. INTERPRETATIONS: We observed that the immune responses of children to COVID-19 infection is significantly different from that seen in adults. Our evidence suggests that SARS-CoV-2 does not trigger a robust inflammatory response or 'cytokine storm' in children with COVID-19, and this may underlie the generally better outcomes seen in children with this disease.

Psychometric properties of the Clinically Useful Depression Outcome Scale supplemented with DSM-5 Mixed subtype questionnaire in Chinese patients with mood disorders.

BACKGROUND: With the modification of DSM-5 mixed features specifier, a brief scale to screen mixed features in patients with mood disorders is needed in clinical practice. This study aimed to explore the psychometric properties of the Chinese version of the Clinically Useful Depression Outcome Scale supplemented with DSM-5 Mixed subtype (CUDOS-M-C) for the Chinese patients with mood disorders. METHODS: Overall, 300 patients with major depressive episode were recruited. All participants were assessed using CUDOS-M-C, Young Mania Rating Scale, Hamilton Anxiety Scale and Montgomery-Asberg Depression Rating Scale. The receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cut-off values of CUDOS-M-C score. The reliability and validity of CUDOS-M-C were examined using Cronbach's alpha, intraclass correlation coefficient (ICC) and principal component analysis (PCA). RESULTS: The results of PCA indicated two-factor structure as the best solution for CUDOS-M-C, which explained 54.82% of cumulative variance. The Cronbach's alpha was 0.892 and the ICC was 0.853. The area under the ROC curve of the CUDOS-M-C for participants with mixed depression was 0.927 (p<0.001) and the suitable cut-off value was 8, with a sensitivity of 91.6% and specificity of 79.9%. LIMITATIONS: Most of the patients were recruited from eastern China and further research with larger sample is warranted. And this study did not perform confirmatory factor analysis to identify the generalization of factor structure of CUDOS-M-C. Besides, the study performed the test-retest reliability of CUDOS-M-C and further analysis is needed to ascertain the patient's post-treatment changes. CONCLUSION: The CUDOS-M-C demonstrated to have satisfactory psychometric properties as a self-report scale, and could be applied to screen patients with mixed depression in clinical practice.

Increased plasma asprosin levels in patients with drug-naive anorexia nervosa.

PURPOSE: Asprosin is a centrally acting appetite-promoting hormone and promotes glucose production in the liver. This study is the first to investigate the difference in asprosin in the plasma between anorexia nervosa (AN) and healthy controls, and to explore the relationship between asprosin changes and plasma glucose levels and AN symptoms. METHODS: Plasma asprosin and glucose concentrations were detected in AN patients (n = 46) and healthy control subjects (n = 47). Eating Disorder Inventory-2 (EDI-2) was used to assess subjects' eating disorder symptoms and related personality traits. The patient's concomitant levels of depression and anxiety were also measured using the beck depression inventory and beck anxiety inventory, respectively. RESULTS: Results indicate that AN patients had a higher asprosin concentration in their plasma compared to healthy controls (p = 0.033). Among AN patients, plasma asprosin levels correlated positively with EDI-2 interoceptive awareness subscale score (p = 0.030) and negatively with duration of illness (p = 0.036). Multiple linear regression analyses showed that increases in asprosin levels (p = 0.029), glucose levels (p = 0.024) and body mass index (p = 0.003) were associated with an increase of the score of EDI-2 bulimia subscale. CONCLUSIONS: Our findings suggest that the increase in plasma asprosin concentration in patients with AN may be a compensation for the body's energy shortage, and asprosin may be involved in the development of bulimia and lack of interoceptive awareness in AN patients. LEVEL OF EVIDENCE: Level III, case-control analytic study.