Zusammenfassung Die Entscheidung des Bundesverfassungsgerichts zur Zulässigkeit der Suizidassistenz wirft grundlegende Fragen nach klinischen und verfahrensbezogenen Standards im Umgang mit vulnerablen Patient:innen auf. Gerade bei psychischen Erkrankungen stellt die Prüfung der Freiverantwortlichkeit eine besondere Herausforderung dar. Der vorliegende Fallbericht beschreibt eine Patientin mit rezidivierender depressiver Störung und histrionischer Persönlichkeitsstörung, die während einer teilstationären psychiatrischen Behandlung mit Unterstützung einer Sterbehilfeorganisation verstarb. Das externe Gutachten basiert auf einem einmaligen Videogespräch zwölf Tage zuvor. Der Fall zeigt, wie depressive Symptomatik und ambivalente Therapieeinstellungen die Beurteilung eines freiverantwortlich begründeten Sterbewunsches erschweren und verweist auf den Bedarf an klaren, kontextsensiblen Kriterien zur Einschätzung der Freiverantwortlichkeit sowie an verlässlichen institutionellen Qualitätssicherungsverfahren.

Stigma toward individuals with alcohol use disorders is widespread and contributes to negative consequences for those affected. Health care professionals may share the public's stigmatizing attitudes, and this may impede effective care. In China, the use of involuntary treatment and detention for substance use disorders remains prevalent and concerning. However, limited empirical research has examined how health care professionals' prejudices impact their endorsement of segregation and coercion. This cross-sectional study surveyed 492 health care professionals from diverse disciplines across 31 province-level regions in Mainland China. Participants completed validated measures assessing perceived stigma, attributions of dangerousness, controllability and personal responsibility, emotional reactions, helping and avoidant behaviors, and the endorsement of segregation and coercion (analyzed jointly as a single construct in this study). Higher levels of perceived stigma, controllability, and dangerousness were directly associated with increased endorsement of segregation-coercion and were also significantly indirectly mediated by the attribution of personal responsibility (beta = 0.02, beta = 0.06, and beta = 0.02, respectively), controlling for age, gender, years of work experience, mental health background, and alcohol consumption. A higher perceived controllability was linked to both increased helping and avoidance behaviors, which in turn were associated with the endorsement of segregation-coercion. The model showed good fit (CFI = 0.99, RMSE = 0.03) and explained 64% of the variance in segregation-coercion. Findings underscore the need for antistigma programs that promote nonblaming attitudes and respectful care. Policymakers should enact and enforce policies to mitigate public stigma associated with alcohol use disorders and foster nonstigmatizing practices in health care settings.

Purpose Research from Western societies indicates pervasive public stigma against people with alcohol use disorders (AUDs). However, there is a lack of knowledge about the interactions between different components of stigma and their contribution to discriminatory behaviour towards individuals with AUDs within the Chinese cultural context. The aim of the present study was therefore to investigate the relationships of (mis-)conceptions, stereotypes, emotional reactions, perceived public stigma and their contribution to the desire for social distance among the Chinese adults. Methods (Mis-)conceptions, stereotypes, emotional responses, willingness to help and avoid, perceived stigma, and the desire for social distance from individuals with AUDs were assessed via a cross-sectional online survey with a sample of 1,100 adults from the Chinese population. Results Three-fourth of the participants recognised AUDs as mental illnesses, though 70% of the sample did not support health insurance coverage for the treatment of AUDs. A stronger desire for social distance was associated with greater recognition of alcohol use disorders as mental illnesses, heightened perceptions of dangerousness and personal responsibility, increased fear, and more willingness to avoid and withhold help, controlling for age, gender, education, employment, mental health service utilisation, and alcohol consumption. Fear fully mediated the effects of perceptions of dangerousness and responsibility on the desire for social distance. Conclusions To improve social integration for individuals with AUDs in China, culturally tailored anti-stigma programmes are needed to reduce negative attitudes and discriminatory behaviours among the Chinese population.

As an upper-middle-income country, China has a vast territory, a large population and substantial variations in the nature of mental health service provision. Guangzhou, one of the five biggest cities in China, is considered as indicative of the current development of mental health services in a more economically developed part of China. In this paper, we first introduce mental health services in Guangzhou and their historical development: from the rising development of mental health care (1949 to the mid-1960s), the stagnant development period of the psychiatric hospitals (1966–1976), the rapid development period of the psychiatric hospitals (1978 to the 1990s), to the integrated development period of community mental health care (2000–2020). This historical trajectory partly reflects the development of mental health services across China. Second, from the public health perspective, we introduce the current mental health care delivery system and resources in Guangzhou, including the psychiatric specialist hospitals, psychiatric units of general hospitals, and community mental health care. Third, based on the current mental health service system, we highlight community mental health care in Guangzhou. We will describe these elements of the mental health system under the following headings: organizational setup, management, and services. We also explore the design of community mental health service models and the challenges in the post-covid-19 era. Finally, we provide considerations and recommendations for mental health service delivery in Guangzhou in the future.

Over the past few years there have been considerable changes in China's mental health service system. This review provides an overview of the development of mental health services in China, including epidemiological data on psychiatric disorders, utilisation of mental health services, models of mental health service delivery, mental health resources and workforce, mental health policy framework and financial issues. We consider cultural and social factors including the involvement of family members in patient care, urbanisation and internal migration as well as the application of traditional Chinese medicine, which provides implications for mental health research and practice. Additionally, we also discuss major challenges and conclude by providing some specific recommendations on improving mental health services in China.

目的:探讨自由呼吸肺静脉容积CT扫描的可行性研究.方法:选择行肺静脉CT造影者(PCTV)患者140例,随机分为A组常规屏气扫描组70例和B组自由呼吸扫描组70例,比较两组的图像质量、辐射剂量和对比剂用量.结果:两组测量区平均CT值、信噪比之间差异无统计学意义,主观图像质量评分差异无统计学意义(P=1.152);辐射剂量(P=0.482)和对比剂用量(P=0.585)比较,差异无统计学意义.结论:采用宽体探测器CT前瞻性心电门控容积扫描模式,在自由呼吸状态下PCTV具有可行性.

Background: Coronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiac magnetic resonance imaging (CMRI). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMRI Methods: A total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMRI examination in this study. The CMRI protocol consisted of black blood fat-suppressed T2 weighted imaging (BB-T2WI), T2 star mapping, left ventricle cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). Myocardium edema and LGE were assessed in recovered COVID-19 patients. The left ventricle (LV) and right ventricle (RV) function and LV mass were assessed and compared with normal controls. Results: Finally, 44 recovered COVID-19 patients and 31 normal controls were included in this study. No edema was observed in any patient. LGE was found in 13 patients. All LGE lesions were located in the middle myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased left ventricle peak global circumferential strain (LVpGCS), right ventricle peak global circumferential strain (RVpGCS), right ventricle peak global longitudinal strain (RVpGLS) as compared to non-LGE patients ( p ＜0.05), while no difference was detected between the non-LGE patients and normal controls. Conclusion: Myocardium injury existed in about 30% of COVID-19 patients. These patients had peak right ventricle strain that decreased at the 3-month follow-up. Cardiac MRI can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of left ventricle circumferential contraction dysfunction and right ventricular dysfunction.

Objectives: The results of coronary CTA for patients with arrhythmia were compared under different phase One-Beat scanning mode. Methods: 100 patients with arrhythmia were selected and randomly divided into control group and observation group. The relative phase-scanning mode and absolute phase-scanning mode were used for examination. Subjective and objective evaluation methods were used for image quality analysis, while variance analysis and Spearman correlation analysis were used for statistical analysis. Results: The subjective scores of all 13 segments in the observation group were higher than those in the control group, and the differences in 6 segments were statistically significant (P<;0.05). CNR values in 3 segments in the observation group were higher than those in the control group, with statistically significant differences (P<; 0.05). In the observation group, the correlation between the evaluation data and heart rate was weak (0<;r<;0.3), while the correlation in the control group was significantly negative (- 0.8<;r<;-0.3). Conclusions: The image quality in the absolute time-phase scanning mode is better than that in the relative time-phase and is not affected by the heart rate. Therefore, the absolute time-phase scanning mode has a good application value in the CCTA for patients with arrhythmia.

目的 通过4DCT(four-dimensional CT)动态评估咽鼓管功能障碍(Eustachian tube dysfuction,ETD)患者Valsava动作时的咽鼓管(Eustachian tube,ET)功能.方法 2018年11月～2019年3月期间就诊于首都医科大学附属北京安贞医院的ETD患者15例,无中耳疾病的志愿者15名.使用咽鼓管测压(tubomanometry,TMM),七项咽鼓管功能障碍评分量表(the seven-item Eustachian tube dysfunction questionnaire,ETDQ-7)和咽鼓管评分量表-7(the Eustachian tube score-7,ETS-7)等方法对所有对象咽鼓管功能做初步评价.嘱患者做Valsava动作,行ADCT动态扫描,记录ET开放过程,重建图像.测量ET数值,判断阻塞部位,进行统计学分析.结果 正常对照组可观察到ET全长,ETD组均有不同程度的阻塞.ETD组ET长度和角度显著大于对照组[(44.41±2.21)mm vs(40.60±2.20)mm,P<0.01;(168.73±4.66)mm vs(162.88±5.44)mm,P<0.01],前鼓室部直径显著小于对照组[(3.5±0.8)mm vs(5.3±1.1)mm,P<0.001].结论 ET长度越长、角度越大,越容易发生ETD.ADCT动态扫描可准确评估ETD患者ET阻塞部位,对咽鼓管球囊扩张术适应证具有指导意义,辐射剂量低,可作为ET常规检查方法.

目的:探讨拉普拉斯-高斯(LOG)边缘检测算法在优化冠状动脉CT血管造影(CCTA)图像质量中的应用价值.方法:选取在医院放射科行CCTA检查的100例患者,将CCTA检查的曲面重建(CPR)图像主观检测数据纳入对照组,LOG算子边缘检测数据纳入观察组.以容积再现(VR)图像为参照标准,对比两组冠状动脉狭窄程度的诊断准确性和分段的质量评分.结果:对100例患者经VR影像诊断,确诊为轻度狭窄67例(占67％),中度狭窄24例(占24％),重度狭窄9例(9％).对照组诊断的真阳性率低于观察组,组间轻度、中度和重度狭窄真阳性率比较,差异均有统计学意义(x2=4.107,x2=5.400,x2=5.143;P<0.05);对照组右冠状动脉、左回旋支动脉、左前降支和冠状动脉的质量评分低于观察组,组间差异均有统计学意义(t=2.126,t=2.333,t=2.183,t=2.762;P<0.05).结论:LOG边缘检测算法可提高冠状动脉CCTA图像的清晰度和血管边缘锐利度,血管边缘信息连贯且对比度高,其在优化CCTA图像质量中具有较高的临床应用价值.

目的 探讨心脏磁共振应变分析在心电图显示宽大倒置T波而心尖部心肌尚未达到15 mm的临床前期心尖肥厚型心肌病患者中的应用,比较其与正常者心肌应变的差异.资料与方法 回顾性收集2015年9月—2018年7月北京安贞医院临床前期心尖肥厚型心肌病且行心脏磁共振检查的29例患者,同时将25例正常者作为对照组.应用加拿大Circle Cardiovascular图像软件(CVI425.9.0版)进行图像分析,比较两组左心室射血分数(LVEF)、左心室室壁厚度和左心室心肌应变的差异.结果 临床前期心尖肥厚型心肌病组的LVEF与对照组比较,差异无统计学意义(68.75％±6.78％比63.64％±6.40％,P=0.06),左心室心尖部厚度高于对照组[(11.71±1.39)mm比(5.63±0.95)mm,P<0.05],其心尖部周向应变低于对照组(-20.34±8.81比-24.68±3.97,P=0.027),心内膜下整体长轴最大纵向应变与心外膜下整体长轴最大纵向应变的差值高于对照组(-2.96±1.74比-1.33±1.34,P<0.01).结论 临床前期心尖肥厚型心肌病患者LVEF保持在相对较高的水平,但心尖部心肌的最大周向应变下降,表明其周向收缩能力下降.心脏磁共振心肌应变分析可为此类患者提供新的诊断依据及诊断方法.

目的:探讨第三代双源CT在急诊胸痛患者CTA临床应用和图像质量分析.方法:选取2018年1月至2018年7月,急诊胸痛患者210例,均行全主动脉CTA检查.按扫描时监测心率分为低心率组109例A组(＜80次/min)和高心率组101例B组(≥80次/min).每一组再分为两个亚组即自由呼吸组(A1、B1)和屏气检查组(A2、B2).评价比较各组间CTA的图像质量和图像可诊断率.结果:主动脉CTA平均曝光时间(0.9±0.16)s,平均辐射剂量(2.32±0.48) mSv.主动脉图像质量评分A组(1.06±0.11),B组(1.08±0.15),差异无统计学意义(P＞0.05).自由呼吸亚组(1.04±0.07)与屏气检查亚组(1.10±0.05)比较差异无统计学意义(P＞0.05).肺动脉图像质量评分A组(1.2±0.19),B组(1.25±0.28)差异无统计学意义(P＞0.05).自由呼吸亚组(1.26±0.31)与屏气检查亚组(1.16±0.17)比较差异无统计学意义(P＞0.05).冠状动脉图像质量评分A组(1.67±0.65)B组(2.48±0.69)差异有统计学意义(P＜0.05).A1组(1.68±0.58)与A2组(1.65±0.72)比较差异无统计学意义(P＞0.05).各组血管内平均CT值,信噪比之间差异无统计学意义(P＞0.05).结论:第三代双源对于急诊胸痛患者提供一站式成像解决方案.由于时间分辨率提高,在自由呼吸状态下不降低扫描的图像质量.但对于高心率患者,图像质量较低心率组有一定下降.

Help-seeking is important to access appropriate care and improve mental health. However, individuals often delay or avoid seeking help for mental health problems. Interventions to improve help-seeking have been developed, but their effectiveness is unclear. A systematic review and meta-analysis were therefore conducted to examine the effectiveness of mental health related help-seeking interventions. Nine databases in English, German and Chinese were searched for randomised and non-randomised controlled trials. Effect sizes were calculated for attitudes, intentions and behaviours to seek formal, informal and self-help. Ninety-eight studies with 69 208 participants were included. Interventions yielded significant short-term benefits in terms of formal help-seeking, self-help, as well as mental health literacy and personal stigma. There were also positive long-term effects on formal help-seeking behaviours. The most common intervention types were strategies to increase mental health literacy, destigmatisation (both had positive short-term effects on formal help-seeking behaviours) as well as motivational enhancement (with positive long-term effects on formal help-seeking behaviours). Interventions improved formal help-seeking behaviours if delivered to people with or at risk of mental health problems, but not among children, adolescents or the general public. There was no evidence that interventions increased the use of informal help. Few studies were conducted in low- and middle-income countries (LMICs). This study provides evidence for the effectiveness of help-seeking interventions in terms of improving attitudes, intentions and behaviours to seek formal help for mental health problems among adults. Future research should develop effective interventions to improve informal help-seeking, for specific target groups and in LMICs settings.

Background: This is a meta-analysis of randomized controlled trials (RCTs) of mindfulness-based interventions (MBIs) for a current episode of major depressive disorder. Methods: Both English (PubMed, PsycINFO, Embase, and Cochrane Library databases) and Chinese (WanFang and CNKI) databases were systematically and independently searched. Standardized mean differences (SMDs) and risk ratio (RR) +/- their 95% confidence intervals (CIs) based on the random effects model were calculated. Results: A total of 11 RCTs with 12 treatment arms (n = 764; MBIs = 363; and control group = 401) were identified and analyzed. Compared to the control group, MDD subjects receiving MBIs showed significant reduction in depressive symptoms (n = 722; SMD:-0.59, 95% CI:-1.01 to-0.17, I-2 = 85%, p = 0.006) at post-MBIs assessment, but the significance disappeared by the end of posttreatment follow-up. Subgroup analyses revealed that positive benefits of MBIs was associated with studies that had treatment as usual (TAU) control group, Chinese participants, open label design, no gender predominance, subjects younger than 44.4 years, and Jadad score >= 3, other illness phase and MBIs as augmentation group. Conclusion: This meta-analysis found that MBIs was associated with reduction of depression severity immediately after MBIs but not at follow up endpoint. Further, the positive effects of MBIs were mainly driven by outlying studies. Higher quality of RCTs with larger samples and longer study duration are needed to confirm the findings.

AIMS:Suicide rates are increased among unemployed individuals and mental illness stigma can contribute to both unemployment and suicidality. Persons with mental illness perceive negative attitudes among the general public and experience discrimination in their everyday life (=public stigma components) potentially leading to self-stigma and anticipated discrimination (=individual stigma components). Previous research found evidence for an association between aspects of mental illness stigma and suicidality, but has not yet clarified the underlying pathways explaining how different stigma components interact and contribute to suicidal ideation.METHOD:Public and individual stigma components and their association with suicidal ideation were examined among 227 unemployed persons with mental illness. A path model linking public stigma components (experienced discrimination, perceived stigma) with suicidal ideation, mediated by individual stigma components (anticipated discrimination, self-stigma), was examined using structural equation modelling within Mplus.RESULTS:Our sample was equally split in terms of gender, on average 43 years old and about half reported no suicidal ideation during the past 30 days. In bivariate analyses all stigma components were significantly associated with suicidal ideation. In the path model and controlling for symptoms, the association between experienced discrimination and suicidal ideation was fully mediated by anticipated discrimination and self-stigma. Perceived stigma's contribution to suicidal ideation was fully mediated by anticipated discrimination, but not by self-stigma.CONCLUSIONS:In general, programmes addressing multiple stigma components seem to be most effective in improving suicide prevention. Besides interventions targeting negative attitudes and discriminating behaviours of the general public, programmes to support persons with mental illness in coping with perceived and experienced stigma could improve suicide prevention. Future studies should test the short- and long-term effects of such interventions on suicidality and further investigate the role of stigma coping (e.g. secrecy) and emotional consequences (e.g. hopelessness and loneliness) for the association between stigma components and suicidality.

PURPOSE:To examine the levels and associations of differentiation of self based on Bowen's theory and adult attachment in a sample with anxiety-related disorders.DESIGN AND METHODS:One hundred fourteen adults with anxiety-related disorders and 117 age- and gender-matched controls were recruited. Levels of differentiation of self, adult attachment, and trait and state anxiety were assessed.FINDINGS:Adults with anxiety-related disorders showed significantly lower global levels of differentiation of self after controlling for socio-demographic characteristics. Adults with anxiety-related disorders also displayed significantly higher levels of anxiety and avoidant attachment.PRACTICE IMPLICATIONS:These constructs may be appropriate targets for intervention research in the study of anxiety-related disorders.

People with severe mental illness and a history of involuntary hospitalization may experience stigma-related stress and suffer negative consequences as a result. However, the long-term impact of stigma stress on suicidality in this population remains unknown. This longitudinal study therefore examined stigma stress, self-stigma, self-esteem and suicidal ideation among 186 individuals with mental illness and recent involuntary hospitalization. After adjusting for age, gender, diagnoses and symptoms, more stigma stress at baseline predicted suicidal ideation after 2 years, mediated by increased self-stigma and decreased self-esteem after 1 year. Anti-stigma interventions that reduce stigma stress and self-stigma could therefore support suicide prevention.

Mental illness stigma is widely endorsed by the general public in China. Evidence-based anti-stigma interventions to reduce public stigma are needed. However, most studies on the efficacy of anti-stigma interventions took place in Western countries and existing Chinese studies were often not included in recent systematic reviews. This review evaluates the efficacy of anti-stigma interventions among the general population in Mainland China, Hong Kong, Taiwan and Macau. Eight databases in English and Chinese were searched for randomized and non-randomized controlled trials. Subgroup analyses compared interventions with and without consumer contact. Standardized mean differences were calculated from eligible studies where possible. We included 9 trials involving 2041 participants. Interventions yielded a small effect on stereotypes reduction and a similar effect on improving mental health literacy. No study assessed discrimination outcomes. Interventions with consumer contact were not superior to those without. There were insufficient data on medium and long term effects. Heterogeneity across studies was moderate. Quality of studies was modest. Further research using rigorous methods is required.

It is essential for physicians to obtain the accurate venous tree from abdominal CT angiography (CTA) series in order to carry out the preoperative planning and intraoperative navigation for hepatic surgery. In this process, one of the important tasks is to separate the given liver venous mask into its hepatic and portal parts. In this paper, we present a novel method for liver venous tree separation. The proposed method first concentrates on extracting potential vessel intersection points between hepatic and portal venous systems. Then, the proposed method focuses on modeling the vessel intersection neigh-borhoods with a robust twin-line random sample consensus (RANSAC) shape detector. Finally, the proposed method conducts the venous tree separation based on the results of the twin-line RANSAC as well as physical constraints posed by Murray’s Law. We test our method on 22 clinical CTA series and demonstrate its effectiveness.

Objective To investigate the feasibility of coronary CT angiography in single cardiac cycle and to analyze the image quality and radiation dose in patients with high heart rate(HR) using 256-row detector CT. Methods Ninety-two consecutive patients between October and November 2015 who were suspected coronary artery disease underwent coronary CT angiography(CCTA) were enrolled, which was performed with a 256-row detector CT(Revolution CT, GE Healthcare) using prospective ECG-triggered volume CCTA within a single cardiac cycle with snapshot freeze(SSF) technique. The patients were grouped by HR during CT scans: group A(80—89 bpm, n=56), group B(90—99 bpm, n=20), and group C(≥100 bpm, n=16). Image quality was compared before and after using SSF technique reconstructions in seventy-four patients. The image quality of coronary artery was evaluated blindly by 2 experienced radiologists using a four-point scale based on the 18-segment model according to the Society of Cardiovascular Computed Tomography guidelines. The differences in age, body mass index, heart rate and CT dose index volume,effective dose(ED) among the three groups were compared by using ANOVA analysis or Kruskal-Wallis test, the image quality and interpretability using χ2 test. Comparisons of image quality between standard and SSF were performed with paired Wilcoxon rank sum test. Kappa coefficient was used to test inter-observer agreement. Results A total of 1 065 coronary artery segments, 98.97%(1 054/1 065) met the requirements for diagnosis. No significant difference was found(χ2=1.274, P=0.563) for the diagnostic image quality of coronary artery segments among the 3 groups with 98.64%(651/660), 99.57%(232/233), 99.42%(171/172), respectively. Significant difference(χ2=68.811, P<0.05) was found for diagnostic image quality before and after using SSF with increase from 90.29%(772/855) to 99.44%(881/886). Image quality was improved with the use of SSF reconstructions and the diagnostic segments were also increased. The median of ED for group A, B and C was 2.03, 1.93, 2.37 mSv, respectively. There was no significant difference in ED among group A, B and group C(H=2.412,P>0.05). Conclusions Single cardiac cycle scan is feasibility for coronary CT angiography in patients with high heart rate using 256-row detector CT. This scan mode can maintain the diagnostic image quality with low radiation dose. SSF technique can improve the image quality.