PURPOSE:To explore ChatGPT's utility in evaluating medical students' implicit attitudes toward the doctor-patient relationship (DPR). MATERIALS AND METHODS:This study analyzed interview transcripts from 10 medical students, categorizing implicit DPR attitudes into Care and Share dimensions, each with 5 levels. We first assessed ChatGPT's ability to identify DPR-related textual content, then compared grading results from experts, ChatGPT, and participants' self-evaluations. Finally, experts evaluated ChatGPT's performance acceptability. RESULTS:ChatGPT annotated fewer DPR-related segments than human experts. In grading, pre-course scores from experts and ChatGPT were comparable but lower than self-assessments. Post-course, expert scores were lower than ChatGPT's and further below self-assessments. ChatGPT achieved an accuracy of 0.84-0.85, precision of 0.81-0.85, recall of 0.84-0.85, and F1 score of 0.82-0.84 for attitude classification, with an average acceptability score of 3.9/5. CONCLUSIONS:Large language models (LLMs) demonstrated high consistency with human experts in judging implicit attitudes. Future research should optimize LLMs and replicate this framework across diverse contexts with larger samples.

Objective: To evaluate the psychometric properties of the Union Physio-Psycho-Social Assessment Questionnaire (UPPSAQ-70) among general hospital psychiatric outpatients. Methods: A total of 2000 participants responded to the survey. Factor analyses were used to test the construct validity of the scale. Convergent validity was evaluated by the correlation between UPPSAQ-70 and symptoms measured using the Chinese versions of Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Patient Health Questionnaire-15 (PHQ-15), Somatic Symptom Disorder - B Criteria Scale (SSD-12) and Pittsburgh Sleep Quality Index (PSQI). Results: The nine-factor model was supported (chi(2) = 8816.395, df = 2309, chi(2)/df = 3.818, RMSEA = 0.053, CFI = 0.929). The UPPSAQ-70 showed significant correlation with the SAS (r = 0.396, P G .001), SDS (r = 0.451, P G .001), PHQ-15 (r = 0.381, P G .001), SSD-12 (r = 0.324, P G .001) and PSQI (r = 0.220, P G .001). UPPSAQ-70 and its subscales showed good internal consistency with Cronbach's alpha coefficients ranging from 0.79 to 0.96. Conclusions: The UPPSAQ-70 was a rating scale with good construct validity and reliability, which can measure overall health in the biological, psychological, and social domains for Chinese psychiatric outpatients, but its convergent validity still requires further empirical research.

Objective: This study aimed to understand the long-term symptom trajectories of Chinese patients with major depressive disorder (MDD) using piecewise latent growth modeling and growth mixture modeling. The investigation also aimed to identify the baseline characteristics indicative of poorer treatment outcomes. Methods: A total of 558 outpatients with MDD were assessed using a sequence of surveys. The Hamilton Rating Scale for Depression (HRSD), Hamilton Anxiety Rating Scale (HAMA), and Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) were used to evaluate baseline depression, anxiety, and cognitive function. Depression symptom severity was subsequently measured at the 1-month, 2-month, 6-month, 1-year, and 2-year follow-ups. Results: Results indicated three depressive symptomology trajectories, including (a) severe, improving class (12.72 %), (b) partially responding, later deteriorating class (6.09 %), and (c) moderate, improving class (81.18 %). Logistic regression analyses showed that a history of cardiovascular disease (CVD) increased the odds of belonging to the partially responding, later deteriorating class, whereas higher baseline depression increased the odds of belonging to the severe, improving class compared to the moderate, improving class. Patients who experienced less depression relief during the first month of treatment had a lower probability of belonging to the moderate, improving class. Limitations: Participant attrition in this study may have inflated the estimated rate of treatment-resistant patients. Conclusions: The burden of CVD and poorer initial treatment response are plausible risk factors for poorer treatment outcomes, highlighting targets for intervention in Chinese MDD patients.

Aim Prior research has indicated a connection between CD4+ T cells and the development of anxiety, but the specific CD4+ T cell subsets linked to anxiety disorders remain uncertain. Our study seeks to investigate the relationship between distinct CD4+ T cell subsets and anxiety, as well as to explore whether CD4+ T cell subsets mediate the effect of chronic psychological stress on anxiety. Methods 56 eligible matched participants were recruited in Peking Union Medical College Hospital. The diagnosis was made based on DSM-5 diagnostic criteria. The severity of anxiety and depression symptoms was assessed using the Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale, respectively. The Life Events Scale (LES) evaluated the chronic stress level. CD4+ T cell subsets were characterized using multiparametric flow cytometry. To assess the impact of CD4+ T cells on the effect of chronic psychological stress on anxiety, Partial Least Squares Structural Equation Modeling (PLS-SEM) analysis was employed. Results We discovered fifteen notably distinct CD4+ T-cell subsets in anxiety disorder patients compared to healthy controls. Multiple linear regression analysis unveiled an association between anxiety severity and CD27+CD45RA− Th cells, CD27+CD28+ Tregs, and the total Life Events Scale (LES) score. The PLS-SEM analysis demonstrated that CD4+ T cell subsets and LES could explain 80.2% of the variance in anxiety. Furthermore, it was observed that CD27+CD28+ Th/Treg cells acted as inverse mediators of the effects of LES on anxiety (P = 0.031). Conclusions Drug naïve anxiety disorder patients exhibited significant alterations in numerous CD4+ T-cell subsets. Specifically, the memory subset of CD27+CD45RA− Th cells and the naïve subset of CD27+CD28+ Treg cells were found to be independent factors associated with the severity of anxiety. Additionally, the CD27+CD28+ Th and Treg cell subsets played a significant mediating role in the influence of long-term psychological stress on anxiety.

Abstract Background The mental health of patients with rare diseases deserves attention, but conducting the research is difficult. This study uses medical records of consultation-liaison psychiatry and provides the possibility of examining the mental health of patients with rare diseases. Methods The medical records of patients diagnosed with erythroderma in the consultation-liaison psychiatry system of the Department of Psychological Medicine of Peking Union Medical College Hospital were analyzed. Results Twenty two patients with erythroderma received psychiatric consultations during 2008 to 2021, and 8 patients (36.4%) were Beijing natives. The course of the disease ranged from 22 days to 33 years. Seven patients (31.8%) were diagnosed with erythroderma psoriasis. The common reasons for psychiatric consultation were anxious or depressive symptoms (10/22, 45.5%), insomnia (8/22, 36.4%), and disease pressure (4/22, 18.2%). The most common diagnosis were “depression”, “depressive state” or “anxious depression”, followed by “anxious state” or “anxiety”, “insomnia” and “delirium”. Antidepressants, benzodiazepines or nonbenzodiazepine sleep aids, and antipsychotics were prescribed. Five patients (22.7%) received only psychological counseling. Conclusions Anxiety, depression and insomnia were common in patients with erythroderma. Patients with severe disease or elderly inpatients might present with delirium, which is a common reason for consultation-liaison psychiatry. Antidepressants, antipsychotics and sleeping aids arecommonly used in drug therapy. Resource-oriented psychological counseling was the most common intervention.

Objective To analyze the feasibility of hospitalized treatment of inpatients’ mental disorders in a general hospital by an innovative consultation-liaison psychiatric hospitalized treatment mode.MethodsRetrospective study involved the patients in the department of physical diseases of Peking Union Medical College Hospital who received hospitalized treatment in the Department of Psychological Medicine from July 1, 2020 to June 30, 2021（study group）. All patients who received consultation-liaison psychiatry（CLP） services by Department of Psychological Medicine from January 1 to December 31 in 2019 were taken as the control group. The control group conducted liaison consultation and invited consultation based on the CLP concept, whereas the study group integrated a three-level check-in and follow-up system based on the CLP concept to facilitate the diagnosis and treatment of inpatient mental disorders through consultation and follow-up. According to the consultation records, the diagnosis results and intervention methods were extracted, and the consultation rate and follow-up rate were calculated. Results A total of 1196 patients（1647 times of consultation） were included in the study group and 1269 patients（1558 times of consultation） in control group. The consultation departments involved all the physical disease departments of the hospital. Compared with the control group, in the study group the general consultation rate[1.21%（1196/98 496） vs. 1.10%（1269/114 917）], the general follow-up rate[23.08%（276/1196） vs. 17.65%（224/1269）] were improved to varying degrees. The diagnosis results of consultation-liaison hospitalized treatment involved almost all mental disorders, among which anxiety disorder（18.76%, 309/1647）, depressive disorder（17.1%, 282/1647） and brain organic mental disorder（16.45%, 271/1647） accounted for a high proportion. As for the intervention mode of patients, 30.66%（505/1647） only needed psychological counseling or treatment, and almost all patients had non-drug treatment intervention. Conclusion It is feasible for general hospitals to realize hospitalized treatment of mental disorders based on CLP concept, combined with three-level ward round and follow-up system, which can improve the accessibility of mental medical services.

The diagnostic procedure of pleural effusion (PEs) is challenging due to low detection rates and numerous aetiologies. Hence, any attempt to enhance diagnosis is worthwhile. We present a clinical pathway to guide combined application of interventional pulmonology (IP) for tracing causes of undiagnosed PEs. Subjects with undiagnosed PEs were identified in the Hospital Information System of Dalian Municipal Central Hospital from January 1, 2012, to December 31, 2018. Eligible subjects were divided into a group of combined tests and a group of medical thoracoscopy (MT). Optimal and subsequent diagnostic tests were performed depending on the guidance of the clinical pathway by matching profitable chest lesions with the respective adaptation. As the guidance of clinical pathway, common bronchoscopy would be preferentially selected if pulmonary lesions involved or within the central bronchus, EBUS-TBNA was favoured when pulmonary lesions were adjacent to the central bronchus or with the enlarged mediastinal/hilar lymph nodes, guided bronchoscopy would be preferred if pulmonary nodules/masses were larger than 20 mm with discernible bronchus signs, CT-assisted transthoracic core biopsy was preferred if pulmonary nodules were less than 20 mm, image guided cutting needle biopsy was the recommendation if the pleural thickness was larger than 10 mm and pulmonary lesions were miliary. MT was preferred only when undiagnosed PEs was the initial symptom and pulmonary lesions were miliary or absent. A total of 83.57% cases of undiagnosed PEs were eligible for the clinical pathway, and 659 and 216 subjects were included in the combined tests and MT groups, respectively, depending on the optimal recommendation of the clinical pathway. The total diagnostic yields in the combined tests and MT groups were 95.99% and 91.20%, respectively, and the difference in total diagnostic yield was statistically significant (χ2 = 7.510, p = 0.006). Overall, clinical pathway guidance of the combined application of IP is useful for tracing the causes of undiagnosed PEs. The diagnostic yield of undiagnosed PEs is significantly increased compared with that of MT alone.

BACKGROUND:Neuropathic pain in neuromyelitis optica spectrum disorder (NMOSD) is common but has always been overlooked. This study was conducted to explore factors correlated with neuropathic pain in NMOSD and to evaluate associations between pain and quality of life.METHODS:In this cross-sectional study, NMOSD patients were interviewed face-to-face. The Brief Pain Inventory, Douleur Neuropathique 4, and Neuropathic Pain Symptom Inventory scales were used to evaluate pain. Patients completed the Beck Depression Inventory-II and Social Functioning-36 tests to evaluate depression and quality of life.RESULTS:A total of 122 NMOSD patients were enrolled. Eighty-one (66.4%; 95% CI, 39.9% to 92.9%) had current pain, of which 35 (28.7%; 95% CI, 20.7% to 36.7%) had neuropathic pain. Forty-nine (40.2%; 95% CI, 31.5% to 48.9%) patients experienced depression, which was moderate to severe in 22 patients. Multinomial logistic regression showed that significantly more patients with neuropathic pain had depression than those with other pain (OR, 4.15; 95% CI, 1.40 to 12.35; P=0.010) or no pain (OR, 5.65; 95% CI, 1.74 to 18.18; P=0.004). Significantly more patients with neuropathic pain had initial spinal cord involvement than those in the no-pain group (OR, 15.78; 95% CI, 1.37 to 182.15; P=0.027). Quality of life was severely affected in NMOSD patients with neuropathic pain. Only 29.6% were treated with analgesics, and none were prescribed antidepressants.CONCLUSION:Depression was correlated with neuropathic pain and was often overlooked. Initial spinal cord involvement might indicate a higher risk for neuropathic pain. Neuropathic pain in NMOSD patients requires scrutiny.

Background It is important to maintain the psychological well-being of front-line healthcare staff during the coronavirus disease 2019 (COVID-19) pandemic. Aims To examine COVID-19-related stress and its immediate psychological impact on healthcare staff. Method All healthcare staff working in the fever clinic, from 20 January 2020 to 26 March 2020, of a tertiary general hospital were enrolled. Stress management procedures were in place to alleviate concerns about the respondents’ own health and the health of their families, to help them adjust their work and to provide psychological support via a hotline. Qualitative interviews were undertaken and the Sources of Distress and the Impact of Event Scale-Revised (IES-R) were administered. Results Among the 102 participants (25 males; median age 30 years, interquartile range (IQR) = 27–36), the median IES-R total score was 3 (IQR = 0–8), and 6 participants (6.0%) scored above the cut-off on the IES-R (≥20). Safety and security were acceptable or better for 92 (90.2%) participants. The top four sources of distress were worry about the health of one's family/others at 0.88 (IQR = 0.25–1.25), worry about the virus spread at 0.50 (IQR = 0.00–1.00), worry about changes in work at 0.50 (IQR = 0.00–1.00) and worry about one's own health at 0.25 (IQR = 0.25–0.75). There was a moderate correlation between the IES-R score and the Sources of Distress score (rho = 0.501, P = 0.001). Conclusions The stress levels of healthcare staff in the fever clinic during the COVID-19 epidemic were not elevated. Physio-psychosocial interventions, including fulfilment of basic needs, activation of self-efficacy and psychological support, are helpful and worth recommending in fighting COVID-19.

Background: To investigate the effects of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blockers (ARBs) administration to hypertension patients with the coronavirus disease 2019 (COVID-19) induced pneumonia. Methods: We recorded the recovery status of 67 inpatients with hypertension and COVID-19 induced pneumonia in the Raytheon Mountain Hospital in Wuhan during February 12, 2020 and March 30, 2020. Patients treated with ACEI or ARBs were categorized in group A (n = 22), while patients who were not administered either ACEI or ARBs were categorized into group B (n = 45). We did a comparative analysis of various parameters such as the pneumonia progression, length-of-stay in the hospital, and the level of alanine aminotransferase (ALT), serum creatinine (Cr), and creatine kinase (CK) between the day when these patients were admitted to the hospital and the day when the treatment ended. Results: These 67 hypertension cases counted for 33.17% of the total COVID-19 patients. There was no significant difference in the usage of drug treatment of COVID-19 between groups A and B (p > 0.05). During the treatment, 1 case in group A and 3 cases in group B progressed from mild pneumonia into severe pneumonia. Eventually, all patients were cured and discharged after treatment, and no recurrence of COVID-2019 induced pneumonia occurred after the discharge. The length of stays was shorter in group A as compared with group B, but there was no significant difference (p > 0.05). There was also no significant difference in other general parameters between the patients of the groups A and B on the day of admission to the hospital (p > 0.05). The ALT, CK, and Cr levels did not significantly differ between groups A and B on the day of admission and the day of discharge (p > 0.05). Conclusions: To treat the hypertension patients with COVID-19 caused pneumonia, anti-hypertensive drugs (ACEs and ARBs) may be used according to the relative guidelines. The treatment regimen with these drugs does not need to be altered for the COVID-19 patients.

Objective:We design a prospective control study on the utilization of transbronchial cryobiopsy guided by EBUS-GS (EBUS-GS-TBCB) to diagnose PPLs.Methods:PPLs were defined as pulmonary nodules or masses with a diameter from 10 mm to 50 mm. PPLs were randomly divided into group EBUS-GS-TBCB and transbronchial biopsy by forceps guided under EBUS-GS (EBUS-GS-TBB).Results:28 cases were involved in group EBUS-GS-TBCB and 31 cases were in group EBUS-GS-TBB. The mean sizes of PPLs were 30.23 ± 11.10 mm in group EBUS-GS-TBCB and 28.69 ± 8.62 mm in group EBUS-GS-TBB (t = 0.600, p=0.551). The diagnostic yields of EBUS-GS-TBCB and EBUS-GS-TBB were 75% and 64.52% respectively, and the difference between the two groups was not significant (χ 2 value = 0.137, p=0.711). If only the first specimen was taken into account, the diagnostic yields from EBUS-GS-TBCB and EBUS-GS-TBB were 64.29% (18/28 cases) and 35.48% (11/31 cases), respectively. The difference was statistically significant by Fisher's Exact Test (χ 2 value = 4.883, p=0.038). The total incidence rates of bleeding were 21.43% and 6.45%, respectively, in groups EBUS-GS-TBCB and EBUS-GS-TBB. The total incidence rates of pneumothorax were 7.14% and 0, respectively, in groups EBUS-GS-TBCB and EBUS-GS-TBB.Conclusion:The diagnostic yield of EBUS-GS-TBCB was slightly higher than that of EBUS-GS-TBB for the diagnosis of PPLs. EBUS-GS-TBCB might be useful if only the first sample was taken into account.

Background: This study aimed to evaluate cognitive function in patients with anxious depression. Methods: This was a part of the “Objective Diagnostic Indicators and Individualized Drug Intervention of Major Depressive Disorder (MDD)” study. All participants, including patients with MDD and healthy controls (HCs), completed the 17-item Hamilton Depression Scale (HAMD17) and the Hamilton Anxiety Scale (HAMA). Anxious depression was defined as a HAMD17 anxiety/somatization factor score ≥7. Cognitive function was assessed at baseline and at the end of week 8. HC cognitive function was assessed at baseline. Results: A total of 1048 people were included in the analysis, including 328 patients in the anxious depression group (G1=328), 221 patients in the MDD without anxious depression group (G2=221), and 499 in the HC group (G3=499). There were significant differences in the HAMA at baseline (t=13.050, p<0.001), HAMD17 at baseline (t=16.722, p<0.001), and HAMA at weekend 8 (z=-3.477, p=0.001) between G1 and G2. Cognitive functioning on the Hopkins Verbal Learning Test-Revised (HVLT-R) (t=2.948, p=0.003) and the Brief Visual Memory Test-Revised (BVMT-R) (t=2.843, p=0.005) was better in G1 than in G2 at baseline. Cognitive functioning on the HVLT-R (OR=1.081, p=0.006) was better in G1 than in G2 at weekend 8. The Stroop-color-word test (SCWT) (OR=0.976, p=0.004) and the Continuous Performance Test (CPT) (OR=0.698, p=0.007) showed significant differences at baseline; however, after the acute treatment phase, there were no significant differences in executive function (assessed by SCWT) (p=0.148) or attention/vigilance (assessed by CPT) (p=0.416) between G1 and G3. Conclusions: Patients with anxious depression have more severe depressive symptoms but better cognitive function, especially for verbal learning, compared with nonanxious depression patients. After the acute treatment phase, executive function and attention/vigilance in anxious depression patients may be remitted.

目的 探讨新型冠状病毒肺炎疫情期间发热门诊医务人员的基本需求,为全球抗疫医疗队提供借鉴.方法 设计半结构式定性访谈提纲,包括:(1)工作层面:发热门诊工作时间、工作强度和安全保障;(2)生活层面:饮食、睡眠和身体舒适度;(3)心理层面:情绪、压力、应对方式和人际资源等开放式问题.采取整群抽样方法对北京协和医院首批发热门诊医务人员的基本需求进行开放式电话访谈.结果 共37名医务人员接受访谈,其中男性8人(21.6％),女性29人(78.4％);医生16人(43.2％),护士19人(51.4％),医技2人(5.4％).工作层面,建议抗疫一线医务人员的连续工作时间为4～6 h,可设定备班岗应对不同工作强度,应准备充足的防护物资以保障其生命安全;生活层面,根据班次时间提供工作餐是保证饮食的关键,提供临时助眠药可保证其充分的休息;心理层面,医务人员的紧张、担忧等负面情绪反应较常见,家人和同伴支持是重要资源,运动有助于缓解身体不适和不良情绪,心理支持有助于减轻医务人员的情绪反应.结论 满足发热门诊医务人员的基本需求对疫情防控意义重大,保证医务人员得到充分休息,提供足够的防护物资,合理安排饮食和运动,同时关注其心理状态并主动提供心理支持是取得抗击新型冠状病毒肺炎疫情胜利的保障.

目的:探讨透明质酸钠注射填充改善鼻唇沟的有效性和安全性.方法:2014年-2019年,于中国医学科学院皮肤病医院整形美容外科选取80例就医者进行分析.术前,对就医者鼻唇沟凹陷分度进行评估,其中1度11例,2度22例,3度19例,4度23例,5度5例,就医者随访至6～12个月.通过锥筒注射方式填充中面部,使其容量补充,从而使鼻唇沟界沟外上侧组织得到提拉;同样通过锥筒注射方式填充鼻基底;通过蕨叶桥接方式将透明质酸钠注射到鼻唇沟真皮深层的凹陷部位.结果:80例就医者注射量为0.5～2毫升/侧,平均每侧1.2ml.患者术前评估的鼻唇沟凹陷程度为基线水平,术后就医者鼻唇沟改善程度:1个月后4度2例(2.50％),3度35例(43.75％),2度29例(36.25％),1度14例(17.50％);6个月后3度30例(37.50％),2度28例(35.00％),1度18例(22.50％),0度4例(5.00％);术后12个月3例就医者由于个人原因失访,3度23例(29.87％),2度24例(31.17％),1度21例(27.27％),0度9例(11.69％).结论:本次注射方法安全、可靠、维持时间长,值得在临床上推广.

Abstract Background To study the effect of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) on the outcome of hospitalization in patients with hypertension and novel coronavirus disease 2019 (COVID-19). Methods A retrospective analysis was performed in 202 COVID-19 patients who were hospitalized in Thunder-God Hospital, Wuhan from 12 February 2020 to 30 March 2020. According to whether taking ACEI or ARB, 67 (33.0%) patients with hypertension were divided into 3 groups: A, patients received ACEI or ARB after admission (n = 22); B, patients received ACEI or ARB before admission but interrupted after admission (n = 24); and C, patients were not treated with ACEI or ARB before or after admission (n = 21). Changes of therapeutic indicators in all groups of patients and their application relationship with ACEI/ARB were compared and analyzed. Results There were no significant differences in age, gender, blood pressure, underlying disease severity, or serum biochemical indicators (ALT, LDH, creatinine, and creatine kinase levels) at admission among 3 groups (all P > 0.05). During hospitalization, there were no significant differences in COVID-19-related treatment, oxygen use, hospital mortality, recovery and discharge rate, or days of throat swab nucleic acid turning negative among 3 groups (all P > 0.05). The proportion of calcium channel blocker in groups B and C was higher than group A (95.8% and 85.7% vs. 40.9%, P < 0.01), but there was no significant difference in blood pressure or compliance rates at discharge (P > 0.05). Group A, B, and C patients were hospitalized for 27.4 ± 6.4, 30.0 ± 8.8, and 30.1 ± 9.3 days, respectively (all P > 0.05). Compared with admission values, there were no significant differences in serum ALT, LDH, creatinine, or creatine kinase levels among all 3 groups during hospitalization (all P > 0.05). Conclusions ACEI or ARB has no significant effect on the outcome of hospitalization in patients with hypertension and COVID-19.

a Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; b Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; c Department of Psychology, University of Bologna, Bologna, Italy Received: February 26, 2020 Accepted after revision: March 23, 2020 Published online: March 30, 2020

Background: The outbreak of COVID-19 puts major psychological pressure on medical workers exposed to patients. We examined COVID-19-related stress and its immediate psychological impact on medical staff, to provide evidence to help improve the management of stress among them. Methods: Stress management procedures to alleviate worries about the health of their own and families, to help adjustment of their work, and to give psychological support by hotline were carried out. Psychiatrists and psychological evaluators conducted telephone interviews with each medical worker at the fever clinic of a general hospital in Beijing from Feb 6 to Mar 28, 2020. Qualitative interviews, the Chinese versions of the Impact of Event Scale-Revised (IES-R), and the Sources of Stress Questionnaire were administered. Findings: One hundred and two participants were enrolled. The median age of the participants was 30 (27, 36) years, 25 (24·5%) participants were males. Ninety-three of the participants (91·2%) had contact with COVID-19 patients or their specimen in the fever clinic. The total score on the IES-R was 3 (0, 8), six subjects (6·0%) screened positive for IES-R scores (≥20). The top four Sources of Distress were worry about the health of one's family/others at 0·88 (0·25, 1·25), worry about the virus spread at 0·50 (0·00, 1·00), worry about changes in work at 0·50 (0·00, 1·00) and worry about one's own health at 0·25 (0·25, 0·75). There was a moderate correlation between the IES-R score and the Sources of Distress score (r=0·501, P=0·000). Safety and security were acceptable or better for 92 (90·2%) participants, and the top four sources of security were sufficient protective devices (53 subjects, 52·0%), supervision of protection procedures (37 subjects, 36·3%), standardized protection processes (20 subjects, 19·6%) and training before rotation to the fever clinic (nine subjects, 8·8%). Interpretation: The stress levels of medical workers in the fever clinic during the COVID-19 epidemic were acceptably moderate. The stress levels were associated with their worries about health of their own and their family members, the spread of the virus and changes in their work. Management focus on their sources of stress to medical workers should be helpful and worth recommending in fighting with COVID-19.Funding Statement: This work was supported by Peking Union Medical College Hospital (grant number: ZC201903505 to XH, grant number: ZC201902261 to JW). XH was also supported by the 2019 teaching quality project, Peking Union Medical College (grant number: 2019zlgc0122). Declaration of Interests: The authors have no conflicts of interest to declare.Ethics Approval Statement: The study was approved by the ethics committee of the hospital. Oral informed consent was obtained before the interview began.

Objective: We analysed our early-on psychological service to medical workers in fever clinic of a tertiary general hospital in Beijing during the outbreak of covid-19, so as to explore how to provide better psychological help to medical workers at the front line.Methods: From January 20 to March 28, 2020, we offered a resource-oriented supportive psychological hotline service to all medical workers in fever clinic of a general hospital in Beijing. Following data were also acquired and analysed: basic information, qualitative interview, Impact of Event Scale-Revised (IES-R), Patient Health Questionaire-9 (PHQ-9) and Maslach Burn-out Inventory (MBI).Results: A total of 102 participants completed the evaluation (response rate 97.1%). Most medical workers found safety measures and adjusting work time and work load important and helpful. Of all the participants, 2.9% had significant stress reactions, 18.6% showed professional burnout, and 6.9% had significant depression. Depression was associated with hyperarousal (b = 0.937, P < 0.001) and emotional exhaustion (b = 0.079, P = 0.012).Conclusion: Security should be the basis for our findings of relatively low stress reactions, burnout, and depression. Hyperarousal, emotional exhaustion and depression were found to be closely related. We call for attention on early integral interventions in similar situations, with special modalities focusing on decreasing hyperarousal.Funding Statement: JY.C received funding support from PUMCH: pumch-2016-3.3. J.W received funding support from PUMCH: ZC201902261.Declaration of Interests: The authors have no competing interests to report.Ethics Approval Statement: This study was approved by the ethics committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (S-K1045). All participants gave their oral consent.

Surgical lung biopsy is regarded as the golden standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). Here, we attempted to show the diagnostic accuracy of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC) , bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA). Patients with suspected interstitial lung diseases admitted from June 1, 2016 to December 31, 2018 were involved. Patients with known causes of interstitial lung diseases and typical idiopathic pulmonary fibrosis diagnosed through clinical, radiological information were excluded. Patients with atypical idiopathic pulmonary fibrosis and possible IIPs accepted transbronchial pathological evaluation. Initial multidisciplinary diagnosis (MDD) classifications were made depending on clinical, radiological and transbronchial pathological information by a multidisciplinary team (MDT). The final MDD classifications were confirmed by subsequent therapeutic effects. All patients were followed up for at least 6 months. A total of 70 patients were finally involved. The samples of lung parenchyma extracted through TBLC were enough for confirmation of pathological diagnoses in 68.6% (48/70) cases. Samples of 6 cases were extracted by EBUS-TBNA. Bacteriological diagnoses were positive in 1 case by BALF. Pathological diagnoses of 77.1% (54/70) cases were achieved through TBLC, EBUS-TBNA and BALF. During the follow up study, the pulmonary lesions of 60% patients were improved, 11.43% were relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% were leveled off and 8.57% were progressed. The diagnoses of 4 patients with progressed clinical feature were revised. As a result, 94.3% initial MDD classifications based on transbronchial pathology were consistent with the final MDD, and the difference of diagnostic yield wasn't significant between initial and final MDD (Z = -1.414,P = .157). Classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.

目的:探讨注射用A型肉毒毒素联合曲安奈德加5-FU联合注射治疗下颌角痤疮后增生性瘢痕的疗效.方法:选择2015年10月-2017年10月笔者科室诊治的30例下颌角痤疮后增生性瘢痕患者,均接受A型肉毒毒素联合曲安奈德加5-FU联合注射,增生性瘢痕面积0.3cm×0.5cm～2.0cm×3.0cm,高度0.5～1.5cm,评估咬肌肥大程度及颈阔肌紧张程度.使用注射用A型肉毒毒素注射咬肌及下颌缘,使用曲安奈德加5-FU行皮损内低压注射1次.间隔2周或3个月间断行皮损内低压注射,直至无复发情况出现.治疗后随访12～24个月,评价疗效.结果:30例患者均全部缓解,18例患者治疗1～2次后瘢痕完全萎缩,无复发情况;11例患者注射4～6次后瘢痕萎缩,随访1年,无复发情况;1例患者注射13次,随访1年,无复发.结论:注射用A型肉毒毒素联合曲安奈德加5-FU联合注射是治疗下颌角痤疮后增生性瘢痕较好的方法.