Abstract:The depressive disorder in children and adolescents has severe disease burden and is characterized by low rates of early identification and consultation， as well as a high rate of misdiagnosis. There are difficulties in the clinical diagnosis and treatment process， such as the complicated etiology and the unclear pathogenesis， lack of objective diagnostic markers and lack of safe and effective treatment methods. This article reviews the research on the diagnosis and treatment of depression in children and adolescents， focusing on the aforementioned issues.

Abstract:Objective To explore the functional differences of hippocampal network in patients with different outcomes of acute disturbance of consciousness （aDOC） by functional magnetic resonance imaging （fMRI）， construct and verify the support vector machine （SVM） machine learning prediction model. Methods Clinical data of 43 patients with aDOC admitted to the Department of Neurosurgery of the First Affiliated Hospital of Nanjing Medical University and completed fMRI examination from September 2022 to July 2023 were retrospectively analyzed. All patients were followed up for three months after discharge. The revised version of the Coma Recovery Scale （CRS-R） was used to evaluate the consciousness of the subjects during follow-up， and patients with unqualified imaging data were excluded. Finally， 37 patients were included， including 19 patients with spontaneous cerebral hemorrhage and 18 patients with traumatic brain injury. According to the follow-up CRS-R score， patients with aDOC were divided into emergence from minimally conscious state （eMCS） group （n=13） and prolonged disorders of consciousness （pDOC） group （n=24）. The clinical data of two groups of patients were compared. Based on the MATLAB platform， fMRI data were analyzed for hippocampal functional network FC values. The internal SVM code in MATLAB was used for machine learning， while leave-one-out was used for cross validation. Receiver operating characteristic （ROC） curve was adopted to demonstrate predictive performance. Results There was no statistically significant difference in clinical and demographic data between the two groups of patients （P＞ 0.05）. There were statistically significant differences in Glasgow Coma Scale score ［（9.0±1.8） vs. （6.0±2.1）］ and Full Outline of Unresponsiveness Scale score ［13.00 （11.00， 13.00） vs. 10.00 （8.25， 11.75）］ between eMCS group and pDOC group （t=3.67， Z=-3.24； P＜ 0.01）. The comparative sequence hippocampal network analysis of blood oxygen level dependent （BOLD） in fMRI showed that there were statistically significant differences in brain activity between the two groups of patients in the bilateral anterior cingulate cortex （t=4.632， P＜0.005， TFCE corrected） and the right lingual gyrus （t=3.940， P＜ 0.005， TFCE corrected）. The ROC curve of the SVM model based on the differences in FC values of the hippocampal network in all brain regions using fMRI data showed that the area under the ROC curve （AUC） was 0.85， the sensitivity was 0.69， and the specificity was 0.83. The AUC， accuracy， sensitivity， and specificity of the SVM model based on the anterior cingulate cortex in different brain regions were 0.88， 81.08， 0.86， and 0.83， respectively. The AUC， accuracy， sensitivity， and specificity of the SVM model based on the right lingual gyrus in different brain regions were 0.75， 70.27， 0.77， and 0.71， respectively. Conclusions There are differences in the activity of fMRI hippocampal networks in the bilateral anterior cingulate cortex and right lingual gyrus of aDOC patients with different outcomes. Based on these differences in brain regions， the machine learning model can be constructed to accurately predict the outcome of aDOC patients， which provides ideas and targets for exploring the recovery mechanism and treatment of aDOC.

Abstract:Objective To compare the differences in default mode network （DMN） and affective network （AN） between adolescents with depressive disorder and a healthy control group in a resting state based on independent component analysis （ICA）. Methods From October 2022 to July 2023， 47 adolescents with depressive disorder admitted to the outpatient and inpatient departments of Suzhou Guangji Hospital were selected as adolescent depression group， while 35 healthy controls matched for gender， age， and education were selected as the healthy control group during the same period. Two groups of subjects underwent resting state functional magnetic resonance imaging （rs-fMRI） scans. ICA was used to extract the DMN and AN of two groups of subjects， compare the intra network differences between the two groups. Pearson correlation was used to analyze the correlation between differential brain regions and Patient Health Questionnaire-9 （PHQ-9） score and disease course in adolescents with depressive disorder. Results Compared with healthy control group， the left superior frontal gyrus， left angular gyrus， left posterior cingulate gyrus， left inferior parietal lobule， and right superior temporal gyrus were significantly activated in DMN of adolescent depression group， and the left anterior cingulate gyrus， left temporal pole superior temporal gyrus， left anterior cingulate cortex， and right insula in AN were significantly activated （FWE correction， P＜ 0.05， voxel size ＞ 25）. The left anterior cingulate gyrus in the adolescent depression group was positively correlated with PHQ-9 score （r=0.327， P=0.025）， the left anterior cingulate gyrus was positively correlated with the patient's disease course （r=0.394， P=0.006）， and the right superior temporal gyrus was positively correlated with the patient's disease course （r=0.297， P=0.043）， with statistically significant differences. Conclusions Adolescents with depressive disorder exhibit abnormal activation of DMN and AN brain regions in a resting state， and some brain regions are significantly correlated with scale scores and disease course， suggesting that it may be related to cognitive function changes such as emotional processing and memory processing in adolescents with depressive disorder.

Abstract:Objective To explore the psychological factors influencing non-suicidal self-injury （NSSI） in depressive disorder adolescents. Methods From May 2022 to November 2023， 127 adolescents with depressive disorder admitted to the Department of Psychology of the 904th Hospital （Changzhou Branch） of the Joint Logistics Support Force of the Chinese People's Liberation Army were selected as participants. Patients were divided into non-NSSI group （n=59） and NSSI group （n=68） based on the occurrence of NSSI. Childhood Trauma Questionnaire-Short Form （CTQ-SF）， Self-Esteem Scale （SES）， Trait Coping Style Questionnaire （TCSQ）， Adolescent Resilience Scale， and Defense Style Questionnaire （DSQ） were used to assess psychological factors such as childhood abuse， self-esteem， coping styles， psychological resilience， and defense mechanisms in patients. Multivariate Logistic regression was used to analyze the influencing factors of NSSI in adolescents with depressive disorder. Results Univariate analysis showed that there were statistically significant differences in emotional abuse， physical abuse， emotional neglect， physical neglect， negative coping， total SES， emotional control， family support， total psychological resilience， and mature defense mechanism psychological trait scores between the two groups of patients （t=-6.741，-2.204，-3.991，-2.861，-5.665，3.826，2.223，4.580， 4.058， 4.501； all P＜ 0.05）. Multivariate Logistic regression analysis showed that emotional abuse ［OR=1.273， 95%CI （1.080， 1.501）， P=0.004］ and negative coping ［OR=1.129， 95%CI （1.032， 1.236）， P=0.008］ were risk factors for the occurrence of NSSI in adolescents with depressive disorder， while family support ［OR=0.825， 95%CI （0.691，0.984），P=0.033］ and mature defense mechanisms ［OR=0.918，95%CI （0.866，0.972）， P=0.003］ were protective factors for NSSI in adolescents with depressive disorder. Conclusions The incidence of NSSI is relatively high in adolescents with depressive disorder， and family support and mature defense mechanisms are protective factors for this behavior， while emotional abuse and negative coping are risk factors.

Abstract:Objective To explore the therapeutic effect of family participation combined with transcranial magnetic therapy on adolescents with depressive disorder and non-suicidal self-injury （NSSI）. Methods From January 2020 to December 2023， 100 adolescents with depressive disorder and NSSI admitted to the Department of Psychological Rehabilitation of Sinopharm North Hospital of Inner Mongolia Autonomous Region were selected as participants. Patients were randomly divided into a study group and a control group using a random number table method， with 50 cases in each group. Both groups were orally administered with sertraline hydrochloride tablets， and control group received transcranial magnetic therapy on this basis， while study group received treatment in combination with family participation on the basis of control group. The total effective rate， family function， psychological resilience， and improvement of NSSI were compared between two groups of patients before and after treatment. Results After treatment， the total effective rate of study group was 94.00% （47/50）， which was higher than control group's 80.00% （40/50）， and the difference was statistically significant （χ2 =4.332， P＜ 0.05）. The psychological resilience scores of both groups of patients after treatment were higher than before treatment， and the psychological resilience scores of study group after treatment were higher than those of control group， with statistical differences （t=3.243， 3.120， 3.201； all P ＜ 0.05）. The difference in strength and optimism of the two groups of patients before and after treatment was statistically significant （Z=-3.095， -2.475； P＜ 0.05）. The incidence of NSSI and addiction score in both groups of patients after treatment were lower than before treatment， while the self-control score was higher than before treatment， and the addiction score in study group was lower than those in control group after treatment， while the self-control score was higher than that in control group， and the differences were statistically significant （all P＜0.05）. There was a statistically significant difference in addiction and self-control score between the two groups before and after treatment （Z=3.693， -4.350； P ＜ 0.05）. After treatment， the family function scores of both groups were lower than before treatment， and the family function scores of study group were lower than those of control group after treatment， with statistical differences （t=7.177， 2.098， 5.157， 5.740， 3.334， 7.432， 3.906； all P ＜ 0.05）. The difference in problem-solving， role， emotional response， behavioral control， emotional intervention， and overall function between two groups of patients before and after treatment was statistically significant （Z/t=-3.874， 3.986， 3.873， -3.226， 2.720， 3.670； P＜ 0.05）. During the treatment process， there was no statistically significant difference in the incidence of adverse reactions between the two groups ［study group 6.00%（3/50） vs control group 8.00%（4/50）］ （χ2 =0.154， P＞ 0.05）. Conclusions Family participation combined with transcranial magnetic therapy is beneficial for leveraging the family function of adolescents with depressive disorder and NSSI， enhancing their psychological resilience， and improving NSSI.

Abstract:The incidence of depressive disorder in adolescents is increasing year by year， which not only affects their mental health development， but also brings serious burdens to families and society. At present， the etiology of depressive disorder is not yet clear， and its diagnosis mainly relies on symptomatology， lacking objective basis. Magnetic resonance imaging （MRI） and other brain imaging techniques are widely used to explore neurobiological markers related to depressive disorder， which are of great significance for early detection， diagnosis， treatment， prognosis， and treatment response prediction of diseases. This paper reviews the research on brain structural imaging of adolescents with depressive disorders in recent years.

Abstract:Objective To construct a prognostic model for the overall survival of intracranial germ cell tumors （iGCT） based on the Surveillance， Epidemiology， and End Results （SEER） database， so as to predict prognosis and guide treatment. Methods Clinical pathological and sociodemographic data of 1 105 iGCT patients from 1975 to 2020 were collected from the SEER database. The patients were randomly divided into a training set and a validation set in a 1∶1 ratio. Univariate and multivariate Cox regression were used to screen for independent prognostic factors and construct the Outcome Scale to predict the overall survival of iGCT patients. The area under the receiver operating characteristic curve （AUC）， consistency index （C-index）， calibration curve， and decision curve analysis （DCA） indicators were used to evaluate the performance of the Outcome Scale. Results The median follow-up time for all iGCT patients was 84 months， including 79 months for adult patients and 87 months for pediatric patients. Primary site ［HR=0.616， 95%CI （0.451， 0.843）， P=0.002］， radiotherapy ［HR=0.390， 95%CI （0.286， 0.533）， P＜ 0.001］， chemotherapy ［HR=0.656， 95%CI （0.475， 0.905）， P=0.01］， and age ［HR=0.658， 95%CI （0.479， 0.905）， P=0.01］ were independent prognostic factors for overall survival， with statistically significant differences. The Outcome Scale for predicting overall survival constructed using these clinical factors showed that the AUC of the 1-year， 5-year， and 10-year survival rates in the training set were 0.751， 0.658， and 0.644， respectively， and the C-indices were 0.739， 0.645， and 0.649， respectively. The AUC of the 1-year， 5-year， and 10-year survival rates in the validation set were 0.862， 0.752， and 0.734， respectively， and the C-indices were 0.850， 0.716， and 0.720， respectively. The calibration curve had a good overlap with the standard reference curve. DCA suggested that the training set of the model had a high net return between risk probabilities of 0.125 and 0.25， while the validation set has a high net return between risk probabilities of 0.25 and 0.375. The model had a good overlap with the curve of the full variable prediction model. Conclusions The primary site， treatment method， age， and prognosis of iGCT patients are correlated， and the Outcome Scale constructed based on this can help predict patient prognosis and guide treatment.

Abstract:Objective To explore the significance of high-frequency oscillations （HFOs） in scalp electroencephalography in predicting the risk of recurrence of self-limited epilepsy with centro-temporal spikes （SeLECTS） with central temporal spikes after the first seizure. Methods A retrospective study was conducted on 114 children with first onset SeLECTS who were admitted or treated in the outpatient department of Jiangxi Children's Hospital from June 2019 to June 2022. Their scalp EEG HFOs were measured and followed up for 6 months. According to whether epilepsy recurs or not， they were divided into a recurrent group and a nonrecurrent group， and the detection rate of HFOs in the two groups of children was compared. Results Among 114 children with SeELECTS， 42 cases （36.84%） experienced recurrent epilepsy within 6 months of their first seizure. At the initial diagnosis， HFOs were recorded in 7 cases （9.72%） of the non-recurrence group and 13 cases （30.95%） of the recurrence group on the EEG. The difference between the two was statistically significant （χ2 =6.786，P＜ 0.05）. Six months later， the EEG was re-examined， HFOs were recorded in 5 cases （6.94%） of the non-recurrence group and 11 cases （26.19%） of the recurrence group. The difference between the two groups was also statistically significant（χ2 =8.144，P ＜ 0.05）. Conclusions The detection of HFOs in scalp electroencephalography of children with SeLECTS can to some extent indicate an increased and relatively stable risk of recurrence of the first seizure

Abstract:Objective To evaluate the efficacy of endovascular therapy in patients with progressive ischemic stroke beyond time window under the guidance of multimodal computed tomography （CT）. Methods From October 2021 to October 2023， 412 patients with acute progressive anterior circulation ischemic stroke and onset time of more than 8 hours in Department of Neurology of Yuebei People's Hospital were selected as participants. All selected patients underwent multimodal CT evaluation， and there was a mismatch between the low perfusion area and the core infarction area， with a ratio greater than 1.8. The patients were divided into a study group （cerebral vascular intervention treatment group） and a control group （conservative treatment group） based on whether they received interventional treatment for cerebrovascular disease. Chi square test was used to evaluate the incidence of symptomatic cerebral hemorrhage， severe complications， and mortality in two groups of patients. Repeated measures analysis of variance and independent sample t-test were used to analyze the National Institute of Health Stroke Scale （NIHSS） scores， modified Rankin Scale （mRS） scores， Barthel Index （BI） scores at 90 days after treatment， and good prognosis rate of two groups of patients before and after treatment. The surgical efficacy and risks of study group were also evaluated. Results After excluding 24 patients with failed vessel reperfusion or postoperative vessel occlusion， a total of 388 patients were included， including 134 in study group and 254 in control group. The vascular recanalization rate of study group was 85.0% （134/158）， and the incidence of surgical complications including arterial dissection， vascular rupture， and ectopic embolism was 6.72%（9/134）. In study group， the incidence of severe pneumonia was 23.88%（32/134）， which was lower than the 35.04%（89/254） in control group， and the tracheotomy rate was 8.96%（12/134）， lower than the control group's 16.93%（43/254）， and the incidence of symptomatic cerebral hemorrhage was 9.70%（13/134）， which was higher than the control group's 1.57%（4/254）， and the incidence of cerebral herniation and large area cerebral infarction was 31.34%（42/134）， which was lower than the 59.84% （152/254） in control group， and the above differences were statistically significant （all P ＜ 0.05）. The rate of automatic discharge and death of study group was 8.21%（11/134）， which was lower than the 15.35%（39/254） of control group， and the difference was statistically significant （P＜ 0.05）. The NIHSS scores of study group at 24 hours， two weeks， and 90 days were （10.51±3.27）， （8.57±1.39）， （5.39±1.32）， respectively， all lower than those of control group （19.57±1.35）， （12.30±2.35）， and （9.39±2.37）， and the differences were statistically significant （P＜ 0.05）. After 90 days of treatment， the mRS score of study group was （1.54±0.46）， which was lower than that of control group （3.19±0.57）， and the difference was statistically significant （P ＜ 0.05）. The BI score of study group was （71.56±12.43）， which was higher than that of control group （57.23±10.37）， and the difference was statistically significant （P ＜ 0.05）. The good prognosis （mRS ≤ 2） rate of study group after 90 days was 38.81%（52/134）， which was higher than control group's 27.17%（69/254）， and the difference was statistically significant （χ2 =5.539，P＜ 0.05）. Conclusions Under the guidance of multimodal CT， there is a certain risk of symptomatic cerebral hemorrhage in patients with acute progressive anterior circulation ischemic stroke beyond time window undergoing endovascular therapy. However， timely blood vessel reperfusion under the guidance of multimodal CT can reduce the poor prognosis and mortality of patients， alleviate neurological deficits， improve activities of daily living and prognosis.

Abstract:Insomnia is the most common sleep problem， with a high prevalence among the general population and a gradual trend towards younger age groups. Dimdazenil is a novel sleep medication that belongs to the category of partial GABAA-R agonists. By selectively acting on the alpha 1 subunit of GABAA-R， it exerts sedative and hypnotic effects while reducing adverse reactions caused by complete agonists. In addition， the elimination half-life of Dimdazenil is 3-4 hours， and the risk of tolerance and residual adverse reactions is also reduced. As of now， the Phase Ⅰ - Ⅲ clinical trials of this drug have been completed， all of which have shown its good efficacy and safety， and have great prospects in the treatment of insomnia. This article mainly elaborates on the pharmacological mechanism and three-stage clinical research of Dimdazenil in the treatment of insomnia.

Abstract:Magnetic seizure therapy （MST） is a new neuromodulation technique which is developed based on repetitive transcranial magnetic stimulation and electroconvulsive therapy （ECT）. The non-invasive， focused，and targeted stimulation provided by MST has the advantage of preserving cognitive functions while exerting a neuromodulatory effect. MST has been applied in intervention studies for various mental disorders such as depressive disorder，bipolar disorder，and schizophrenia，but further clinical research and evidence are needed. This review summarizes the mechanisms，current treatment procedure，clinical efficacy，and safety profile of MST.

Abstract:The occurrence of mood disorders is related to the dysfunction of the hypothalamic-pituitaryadrenal （HPA） axis. FK506-binding protein 5 （FKBP5）， a glucocorticoid receptor （GR） chaperone protein， regulates HPA axis function by regulating GR sensitivity. This article reviews FKBP5 gene and its application in drug therapy， electroconvulsive therapy， psychotherapy and FKBP5 antagonists in mood disorders.