Mendelian susceptibility to mycobacterial disease (MSMD) is a rare immunodeficiency characterized by increased vulnerability to weakly virulent mycobacteria. However, its clinical and molecular spectrum, as well as its susceptibility to infections beyond mycobacteria, remains incompletely understood. To evaluate the clinical and genetic characteristics of MSMD patients, focusing on their susceptibility to mycobacteria, SARS-CoV-2 and endemic fungal infections. Thirteen MSMD patients underwent genetic analyses, immunological assays, and clinical evaluations. COVID-19 outcomes were documented. Pathological findings and mNGS confirmed Talaromyces marneffei infections. Following BCG vaccination, 92.3

BackgroundNon-suicidal self-injury (NSSI) is an increasingly recognized clinical and public health issue among adolescents. This behavior exhibits certain addictive characteristics, leading it to be classified as a behavioral addiction. Response inhibition is believed to play a role in the occurrence of addictive behaviors and is often impaired in the context of negative emotional states. In this study, we compared the behavioral performance, ERP time-domain and time-frequency characteristics among depressed adolescents with NSSI, depressed adolescents, and healthy controls when exposed to negative emotional stimuli. The aim was to investigate the impact of negative emotional stimuli on the response inhibition in depressed adolescents with NSSI, clarify the role of response inhibition in NSSI behaviors, and provide neurophysiological evidence for its underlying mechanisms.MethodsSeventy-one depressed adolescents with NSSI (MDD+NSSI group: 12 males, 59 females; mean age: 14.37 years), 55 depressed adolescents (MDD group: 24 males, 31 females; mean age: 15.29 years) and 25 healthy subjects (HC group, 13 males, 12 females, mean age: 15.72 years) were recruited to perform a two-choice oddball task related to negative emotional cues. All participants completed a self-administered questionnaire to gather demographic information. A trained psychiatrist administered the Hamilton Depression Scale (HAMD-17) to assess depression severity and used the Ottawa Self-Injury Inventory (OSI) to assess self-injury. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline using the EEGLAB toolbox in MATLAB. The ERP time-domain features related to response inhibition were extracted from the difference waves, converted to the time-frequency features using the short-time Fourier transform (STFT), and the time-frequency values of the region of interest (ROI) were extracted and statistically analyzed.ResultsUnder exposure to negative emotional stimuli, depressed adolescents with NSSI exhibited significantly larger P300 amplitudes compared to both depressed adolescents and healthy controls. Moreover, depressed adolescents with NSSI showed significant event-related synchronization (ERS) in the Delta and Theta bands of FCz electrode from 0 to 0.6 seconds, and event-related desynchronization (ERD) in the Theta and Alpha bands of Pz electrode from 0.2 to 1.2 seconds, collectively reflecting functional processes associated with response inhibition.ConclusionsDepressed adolescents with NSSI showed increased P3d amplitudes, enhanced Delta/Theta ERS, and heightened Theta/Alpha ERD when receiving negative emotional stimuli, suggesting that depressed adolescents with NSSI have impaired response inhibition, which may contribute to the development of NSSI.

This study aims to explore the predictive value of adiposity measures and lipid-related indices for metabolic syndrome (MetS) in Chinese elderly people at high risk of stroke. A total of 7,693 community-dwelling individuals aged 60 years and older in Shanghai were included. Through ROC curve analysis, it was found that indices such as triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist-to-height-ratio (TyG-WHtR), and Lipid accumulation product (LAP) showed excellent performance in predicting MetS, with TyG-WC being the strongest predictor in both males (AUC = 0.90) and females (AUC = 0.90). These indices integrate information on both lipid metabolism and body fat distribution, allowing for more accurate identification of MetS. The study also revealed that ABSI had poor predictive performance. These findings suggest that the combined use of these indices may help identify MetS earlier and more accurately in elderly people at high risk of stroke, providing a basis for clinical intervention. Future research should validate the generalizability of these indicators in more diverse populations and explore their potential integration into clinical workflows.

BACKGROUND AND OBJECTIVES:Germline pathogenic variants in the mucosa-associated lymphoid tissue lymphoma translocation gene 1 (MALT1) encodes a caspase-like protease that plays a crucial role in the caspase recruitment domain (CARD)-B-cell lymphoma 10 (BCL10)-MALT1 (CBM) complex. This complex mediates the activation of nuclear factor-kB (NF-kB) pathway and are associated with diverse human diseases including combine immunodeficiency (CID), lymphoproliferation and others. This study aimed to determine the underlying cause of immune deficiency and immune dysregulation in a patient presented with recurrent respiratory infections, aphthous ulcers, dermatitis, chronic diarrhea, failure to thrive and early death. METHODS:Clinical and laboratory records were reviewed. Patients underwent next-generation sequencing (NGS), and analysis of genomic DNA was performed on the patient and her parents. Lymphocyte subsets, MALT1 expression and NF-kB signaling was evaluated by flow cytometry, RT-PCR and immunoblotting. RESULTS:The patient carried a novel pathogenic biallelic loss-of-function variant in MALT1 (c.1411G > A; p.D471N) located in the caspase-like domain, leading to severely reduced MALT1 protein expression. Impaired CBM-mediated NF-κB activation was confirmed by reduced phosphorylation of the p65 subunit, resulting in deficient production of IL-2 and TNF-α. This functional defect caused lower Tfr and Treg cells, a normal proportion of Tfh cells, with higher expression of activation markers PD-1 and ICOS. The patient displayed low NK cell and B cell counts, together with a developmental block at the transitional B cell stage. Additionally, the proportion of marginal zone-like B cells (MZB-like) was markedly decreased, indicating impaired B cell differentiation. CONCLUSIONS:Human MALT1 deficiency causes profound CID by impairing CBM-mediated NF-kB signaling and MALT1-paracaspase activity. Consistent with the reported variants located in the caspase-like domain, our patient presented with an inflammatory phenotype, supporting the notion that the MALT1 D471N mutation phenocopies a partial loss of both MALT1 scaffolding function and paracaspase activity. Prompt hematopoietic stem cell transplantation (HSCT) is highly recommended as an effective therapy for MALT1 deficiency.

Background: Post-percutaneous coronary intervention (PCI) management is essential for improving patient outcomes. Digital health services (DHS) offer the potential to enhance recovery outcomes and care quality through real-time monitoring and personalized interventions. Purpose: This systematic review and meta-analysis aims to evaluate the effectiveness and safety of DHS in improving outcomes for post-PCI patients. Methods: A systematic search of databases was conducted for randomized controlled trials on DHS for post-PCI patients. Results: Eleven studies involving 2568 patients were included. DHS significantly improved quality of life, 6-minute walk test performance, medication adherence, patient satisfaction, and smoking cessation rates, while reducing complications and readmission rates. Subgroup analysis showed DHS was particularly effective for patients over 60 years. Conclusion: DHS significantly improve post-PCI management and patient outcomes, with marked benefits for older patients. Further large-scale, long-term studies are recommended to confirm these findings.

Our study aims to examinate the relationships between exposure to perchlorate, nitrate, and thiocyanate and the risk of hypertension. A total of 21,321 participants were selected from the National Health and Nutritional Examination Survey (NHANES). We used logistic regressions models to explore the odds ratio of urinary perchlorate, nitrate, and thiocyanate on the risk of hypertension and restricted cubic splines to check the nonlinearity. 2851 (13.4

PurposeWe aimed to investigate risk factors for COVID-19 pneumonia in patients with hematological malignancies (HM) after Omicron infection.MethodsData from a registered multi-center, prospective, observational study (ChiCTR2300071830) during the latest Omicron BA.5.2 wave in Chongqing, China was used for analysis.ResultsA total of 475 HM patients enrolled in this study. COVID-19 pneumonia was observed in 15.8% (75/475) of patients, with a median age of 58 years (interquartile range [IQR], 48-69 years) and males accounting for 61.3%. Risk factors associated with COVID-19 pneumonia included: 1) Active disease status of HM at infection, with an odds ratio (OR) of 3.42 (95% confidence interval [CI]: 1.59-7.37, P=0.002) compared to complete remission (CR); 2) Incomplete COVID-19 vaccination, 1-2 doses of the vaccine (OR=2.55, 95% CI: 1.28-5.10, P=0.008) or no vaccination (OR=4.81, 95% CI: 2.45-9.43, P<0.001), as opposed to 3 doses (booster); 3) chemotherapy prior to infection, <6 months (OR=2.58, 95% CI: 1.12-5.96, P=0.027) or ≥ 6 months (OR=2.93, 95% CI: 1.31-6.53, P=0.009) compared to no chemotherapy history; 4) NK-cell reduction (< 150/μL) (OR=2.19, 95% CI: 1.27-3.79, P=0.005) versus a normal range of NK cells. During the 6-week follow-up period, 12 patients (2.5%) died, accounting for 16% of COVID-19 pneumonia patients.ConclusionsOur study investigated risk factors for COVID-19 pneumonia in HM patients after Omicron BA.5.2 infection. Highlights that HM patients with these risk factors may be susceptible to lung involvement after Omicron BA.5.2 infection and need to be taken seriously in clinical practice.Clinical Trial Registrationhttps://www.chictr.org.cn/bin/project/edit?pid=195998, identifier ChiCTR2300071830.

This study aimed to investigate the aperiodic properties and aperiodic-adjusted alpha-band oscillations in children with ADHD, focusing on the influence of different scalp regions and lateralization on these neural correlates. Sixty-two ADHD children and 52 typical developing children aged 6–12 years were enrolled. EEG recordings were made with eyes closed for a minimum of 6 minutes. The ‘FOOOF’ was used to compute aperiodic parameters (exponent and offset), and aperiodic-adjusted alpha-band features including center frequency (CF), adjusted power (AP), and bandwidth (BW). Mixed-design ANOVAs were conducted with two between-subjects levels (ADHD and control groups) and two within-subjects’ factors (lateralization and scalp region). ANCOVAs were conducted after accounting for sex and age. The ADHD group showed a significantly lower exponent compared to the control group, and this difference was not influenced significantly by factors like lateralization, scalp region, or sex. There were no notable distinctions between the groups for other measures. We noticed alpha-band CF tends to increase with age, while only frontal AP shows a significant positive correlation with age. Significant main effects of sex and lateralization were observed for offset, along with an interaction effect between sex and lateralization for CF. Our findings indicate that children aged 6–12 with ADHD have a markedly lower exponent, suggesting that this measure could potentially serve as a biomarker for ADHD. Future studies should consider factors such as age, sex, lateralization, and scalp region when investigating aperiodic and aperiodic-adjusted features.

AIOLOS, a vital member of the IKAROS protein family, plays a significant role in lymphocyte development and function through DNA binding and protein–protein interactions. Mutations in the IKZF3 gene, which encodes AIOLOS, lead to a rare combined immunodeficiency often linked with infections and malignancy. In this study, we evaluated a 1-year-4-month-old female patient presenting with recurrent infections, diarrhea, and failure to thrive. Laboratory investigations revealed decreased T lymphocyte and immunoglobulin levels. Through whole-exome and Sanger sequencing, we discovered a de novo mutation in IKZF3 (NM_012481; exon 5 c.571G > C, p.Gly191Arg), corresponding to the third DNA-binding zinc finger region of the encoded protein AIOLOS. Notably, the patient with the AIOLOS G191R mutation showed reduced recent thymic emigrants in naïve CD4+T cells compared to healthy counterparts of the same age, while maintaining normal levels of Th1, Th2, Th17, Treg, and Tfh cells. This mutation also resulted in decreased switched memory B cells and lower CD23 and IgM expression. In vitro studies revealed that AIOLOS G191R does not impact the expression of AIOLOS but compromises its stability, DNA binding and pericentromeric targeting. Furthermore, AIOLOS G191R demonstrated a dominant-negative effect over the wild-type protein. This case represents the first reported instance of a mutation in the third DNA-binding zinc finger region of AIOLOS highlighting its pivotal role in immune cell functionality.

OBJECTIVE:Adolescents with depression is characterized by high rates of recurrence and functional impairment, with a significant association with suicide risk. Antidepressants are commonly prescribed to treat depression, yet few reproducible neurobiological markers for depression and antidepressant treatment response have been identified. Therefore, discovering a stable and reliable neurobiological marker holds significant value for both the clinical diagnosis and treatment of depression in adolescents. METHODS:One hundred and seven patients with major depressive disorder (MDD group, 30 males, 77 females, mean age: 14.80 years), and 25 healthy subjects (HC group, 13 males, 12 females, mean age: 15.72 years) were recruited to perform a two-choice oddball task related to negative emotional cues. All participants completed a self-administered questionnaire to gather demographic information. A trained psychiatrist administered the Hamilton Depression Scale (HAMD-17) to assess depression severity. Of the 107 adolescents with depression, 61 received antidepressant medication for 8 weeks, and 61 of these patients were followed up. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline using the EEGLAB toolbox in MATLAB. The ERP component characteristics associated with emotional processing were extracted from the difference waves and statistically analyzed. RESULTS:Adolescents with depression exhibited significantly larger P300 amplitudes than healthy controls in response to both neutral and negative emotional cues. Following sertraline treatment, both depression scores and P300 amplitudes decreased significantly in adolescents with depression. Moreover, a strong positive correlation was observed between changes in depression scores and changes in P300 amplitude in response to negative emotional cues before and after treatment. CONCLUSIONS:Changes in neural reactivity to negative emotional stimuli among adolescents with depression can be selectively modulated by sertraline and are significantly associated with improvements in depressive symptoms. SIGNIFICANCE:Changes in P300 amplitude to negative emotional stimuli significantly correlate with treatment responsiveness to sertraline in adolescents with depression.

Neuroimaging studies have revealed abnormal brain activities in depressed teenagers who engage in non-suicidal self-injury (NSSI). We used resting-state electroencephalography (EEG) microstate analysis, which indicates the brief overlap of brain network activation for exploring the characteristics of large-scale cortical activities in depressed adolescents engaged with NSSI to clarify the underlying temporal mechanism. A modified k-means cluster algorithm was used to segment 64-channel resting-state EEG data into microstates. Data from 27 healthy adolescents, 37 adolescents with major depressive disorder (MDD), and 53 adolescents with both MDD and NSSI were examined in this study. The resting-state microstate parameters were compared among groups using the one-way ANOVA and Spearman correlation. Then the associations between significantly different microstate parameters and the depressive severity and self-harming data in the patient groups were further analyzed. The MDD group had higher contribution (p < 0.01), occurrence (p < 0.01) of microstate A, and higher microstate E→A transition (p < 0.05) than the HC and the NSSI group. The MDD group showed a distinctly longer duration (p < 0.05) of microstate A and microstate A→C transition than the HC. The transition probability from B to C was increased in the NSSI group compared to the HC. In the MDD group, the HAMD correlated with the duration of microstate A (Spearman's rho = 0.34, p = 0.044), as the PHQ-9 correlated with its occurrence (Spearman's rho = 0.37, p = 0.028). This research revealed that whereas depressive adolescents with NSSI and MDD displayed similar patterns with healthy controls in EEG microstate, the MDD group did not. Additionally, the non-random transition from microstate E→A may protect against recent self-harm in adolescents with MDD.

Background:Nonsuicidal self-injury (NSSI) is a common mental health threat in adolescents, peaking in adolescence with a lifetime prevalence of ~17%-60%, making it a high-risk risk factor for suicide. In this study, we compared changes in microstate parameters in depressed adolescents with NSSI, depressed adolescents, and healthy adolescents during exposure to negative emotional stimuli, and further explored the improvement of clinical symptoms and the effect of microstate parameters of repetitive transcranial magnetic stimulation (rTMS) in depressed adolescents with NSSI, and more evidence was provided for potential mechanisms and treatment optimization for the occurrence of NSSI behaviors in adolescents. Methods:Sixty-six patients with major depressive disorder (MDD) exhibiting NSSI behavior (MDD + NSSI group), 52 patients with MDD (MDD group), and 20 healthy subjects (HC group) were recruited to perform neutral and negative emotional stimulation task. The age range of all subjects was 12-17 years. All participants completed the Hamilton Depression Scale, the Patient Health Questionnaire-9, the Ottawa Self-Injury Scale and a self-administered questionnaire to collect demographic information. We provided two different treatments to 66 MDD adolescents with NSSI; 31 patients received medication and completed post-treatment scale assessments and EEG acquisitions, and 21 patients received medication combined with rTMS and completed post-treatment scale assessments and EEG acquisitions. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline, using the EEGLAB toolbox in MATLAB. Use the Microstate Analysis Toolbox in EEGLAB for segmentation and computation of microstates, and calculate a topographic map of the microstate segmentation of the EEG signal for a single subject in each dataset, and four parameters were obtained for each microstate classification: global explained variance (GEV), mean duration (Duration), average number of occurrences per second (Occurrence), and average percentage of total analysis time occupied (Coverage), which were then statistically analyzed. Results:Our results indicate that MDD adolescents with NSSI exhibit abnormalities in MS 3, MS 4, and MS 6 parameters when exposed to negative emotional stimuli compared to MDD adolescents and healthy adolescents. The results also showed that medication combined with rTMS treatment improved depressive symptoms and NSSI performance more significantly in MDD adolescents with NSSI compared to medication treatment, and affected MS 1, MS 2, and MS 4 parameters in MDD adolescents with NSSI, providing microstate evidence for the moderating effect of rTMS. Conclusion:MDD adolescents with NSSI showed abnormal changes in several microstate parameters when receiving negative emotional stimuli, and compared to those not receiving rTMS treatment, MDD adolescents with NSSI treated with rTMS showed more significant improvements in depressive symptoms and NSSI performance, as well as improvements in EEG microstate abnormalities.

Microstates are analogous to characters in a language, and short fragments consisting of several microstates (kmers) are analogous to words. We aimed to investigate whether microstate k-mers could be used as neurophysiological biomarkers to differentiate between depressed patients and normal controls. We utilized a bag-ofwords model to process microstate sequences, using k-mers with a k range of 1-10 as terms, and the term frequency (TF) with or without inverse-document-frequency (IDF) as features. We performed nested crossvalidation on Dataset 1 (27 patients and 26 controls) and Dataset 2 (34 patients and 30 controls) separately and then trained on one dataset and tested on the other. The best area under the curve (AUC) of 81.5% was achieved for the model with L1 regularization using the TF of 4-mers as features in Dataset 1, and the best AUC of 88.9% was achieved for the model with L1 regularization using the TF of 9-mers as features in Dataset 2. When Dataset 1 was used as the training set, the best AUC of predicting Dataset 2 was 74.1% for the model with L2 regularization using the TF-IDF of 9-mers as features, while the best AUC of predicting Dataset 1 was 70.2% for the model with L1 regularization using the TF of 8-mers as features. Our study provided novel insights into the potential of microstate k-mers as neurophysiological biomarkers for individual-level classification of depression. These may facilitate further exploration of microstate sequences using natural language processing techniques.

Nonsuicidal self-injury (NSSI) is a serious risk behavior in adolescents and is a high risk factor for suicide, while negative emotions can lead to increased NSSI behaviors. In this study, we investigated the altered behavioral performance and neural reactivity of adolescents with NSSI by using a two-choice oddball paradigm when exposed to negative emotional stimuli, and analyzed the brain lateralization effect. Our data indicated that adolescents with NSSI exhibit more pronounced N250, P300, and LPP components during negative emotional face stimulation, as evidenced by a smaller N250 wave amplitude, larger P300 wave amplitude, steeper LPP waveform, and faster fallback baseline; and the presence of brain lateralization responses in both the N250 component and the LPP component. These results suggested that adolescents with NSSI showed significant alterations in cognitive EEG components associated with emotional processing during negative emotional face stimulation, particularly in EEG components representing inhibitory control, and there was a lateralization effect on emotional processing in the brain, with different processing stages and different dominance of the left and right brain.

OBJECTIVES:Childhood traumatic experiences greatly influenced the brain network activities of patients with depression, and there is an urgent need to explore the temporal dynamics for these changes. This study aims to investigate the abnormalities of resting-state electroencephalogram (EEG) microstates in eye-open state of depressed adolescents and to explore the correlations between their EEG microstates and the childhood traumatic experience.METHODS:Using resting-state EEG microstate analysis, we explored the temporal dynamics of brain activity in patients with adolescent depression. This study selected 66 adolescents with depression as a patient group, and 27 healthy adolescents as a healthy control group. A modified k-means clustering algorithm was used to classify the 64-channel resting-state EEG data into different microstates. Independent sample t-tests were used to compare the microstate parameters between the 2 groups and further assciations between these parameters and childhood traumatic experience in patients were explored via using Spearman correlation.RESULTS:In this study, significant differences were observed in the occurrence and transition probabilities of EEG microstates between the healthy control and the patient group. Notably, there was a statistically significant difference (P<0.05) in the occurrence of microstate A across 2 groups, exhibiting a negative correlation with the emotional abuse component within the childhood trauma scores (Spearman's rho=-0.31, P=0.013). Furthermore, patient-specific, non-random transitions from microstate B to A (Spearman's rho=-0.30, P=0.015) and C to A (Spearman's rho=-0.31, P=0.013) were inversely associated with the scores of emotional abuse factors from childhood trauma in the patient group, showing statistically significant differences when comparing to the healthy controls (P<0.05). Upon stratification into quartiles based on the emotional abuse factor scores, the occurrence of microstate A, as well as the transition rates from microstates B to A and C to A, retained statistical significance following adjustment for multiple comparisons (all P<0.05).CONCLUSIONS:The abnormal temporal dynamics in brain networks of adolescents with depression are linked to childhood emotional abuse. Those who have suffered severe emotional abuse may show greater impairments in the brain's visual and central executive networks. EEG microstate analysis could be a potential tool for detecting adolescent depression with severe childhood trauma.

Objective: The 25-item Bodily Distress Syndromes (BDS) checklist was developed to assess BDS symptoms with high validity and reliability. The aim of this study was to reveal the psychometric properties of the Chinese version of the BDS checklist in Chinese outpatients of general hospitals. Method: A cross-sectional study was carried out in nine Chinese general hospitals, consisting of three different medicine settings: biomedicine, traditional medicine, and psychosomatic medicine. The 25-item BDS checklist was translated into the Chinese version and conducted on outpatients from all nine centers. We performed validity and reliability analyses, including test-retest reliability, construct validity, and internal consistency reliability, on the collected checklist data. The convergent validity of the BDS checklist was analyzed with Pearson's Coefficient vs. Patient Health Questionnaire-15 (PHQ-15). The discriminant validity of the BDS checklist was analyzed with Pearson's Coefficient vs. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Whiteley-8 (WI-8). Results: A total of 699 patients were included in this study. The test-retest reliability, construct validity, and internal consistency reliability of the Chinese version of the BDS were satisfactory in our study. Factor analyses identified five distinct determining factors: cardiopulmonary, gastric, intestinal, musculoskeletal, and general symptoms. Pearson's coefficients were found to be high in both discriminant validity and convergent validity analyses. Conclusion: The results provide empirical support for the Chinese version of the BDS checklist in patients in general hospitals. The Chinese version of the BDS checklist is potentially valuable for case finding in both clinical practice and research in Chinese.

BackgroundNonsuicidal self-injury (NSSI) may be a type of addiction, that is characterized by cue reactivity. We aimed to explore the behavioral performance and neural reactivity during exposure to self-injury cues in adolescents with NSSI and major depressive disorder (MDD).MethodsEighteen MDD patients, 18 MDD patients with NSSI, and 19 healthy controls (HC) were recruited to perform a two-choice oddball paradigm. All subjects were 12–18 years old. Neutral cues and self-injury related cues separately served as deviant stimuli. Difference waves in N2 and P3 (N2d and P3d) were derived from deviant waves minus standard waves. Accuracy cost and reaction time (RT) cost were used as behavioral indexes, while the N2d and P3d were used as electrophysiological indexes; the N2d reflects early conflict detection, and the P3d reflects the process of response inhibition.ResultsNo significant main effects of group or cue or an effect of their interaction were observed on accuracy cost and P3d latency. For RT cost, N2d amplitude, and N2d latency, there was a significant main effect of cue. For P3d amplitude, there was a significant main effect of cue and a significant group × cue interaction. In the NSSI group, the P3d amplitude with self-injury cues was significantly larger than that with neutral cues. However, there was no such effect in the MDD and HC groups.ConclusionsAdolescents with NSSI showed altered neural reactivity during exposure to self-injury cue. Further studies with larger sample sizes are needed to confirm our results.

Background Bodily distress syndrome (BDS) is a new, empirical-based diagnosis of functional somatic symptoms. This study aimed to explore the prevalence of BDS and its association with psychosocial variables in a Chinese clinical population. Methods A multicentre cross-sectional study of 1269 patients was conducted in 9 different Chinese tertiary outpatient hospitals. The BDS was identified by trained interviewers face-to face, based on a brief version of the Schedules for Assessment in Neuropsychiatry (RIFD) and the BDS Checklist-25. Sociodemographic data and further information were characterised from psychometric questionnaires (The Patient Health Questionnaire-15, the Patient Health Questionnaire-9, the General Anxiety Disorder-7, the Whiteley scale-8) . Results Complete data were available for 697 patients. The prevalence of BDS was 26.8% (95% confidence interval (CI): 23.5–30.1). Among the participants, 5.8% (95% CI: 4.1–7.6) fulfilled the criteria for single-organ BDS, while 20.9% (95%CI: 17.9–24.0) had multi-organ BDS. Comparison of the PHQ-15, PHQ-9, GAD-7, and WI-8 scores revealed higher scores on all dimensions for patients with BDS. In a binary logistic regression analysis, BDS was significantly associated with increased health-related anxiety (WI-8) and depression (PHQ-9). The explained variance was Nagelkerke’s R 2 = 0.42. Conclusions In China, the BDS is a common clinical condition in tertiary outpatient hospital settings with high prevalence, and is associated with health anxiety and depressive symptoms. In this clinical population, the severe multi-organ subtype of BDS was the most frequent.

BACKGROUND:The knee has a high incidence of osteoarthritis (OA) following the anterior cruciate ligament (ACL) injury, which was reduced by ACL reconstruction including double-bundle (DB) techniques and single-bundle (SB) techniques. However, the effectiveness of preventing the progression of OA after the ACL reconstruction using DB and SB techniques is controversial. METHODS:This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. The databases, including PubMed, Embase, and Cochrane Library, were searched. Randomized controlled trials comparing DB with SB ACL reconstruction and reporting clinical outcomes of radiological OA were included. Quality of the included studies was assessed using the Cochrane Collaboration's risk of bias tool. The outcome was analyzed using the risk ratio (RR) and its corresponding 95% confidence interval (CI). RESULTS:Ten Randomized controlled trials studies were included in this meta-analysis (accounting 1062 knees: 475 SB and 587 DB). The rate of radiological OA after the ACL reconstruction was 39% in SB group and 34% in DB group. The results of meta-analysis showed no difference in the occurrence of radiological OA between DB group and in SB group (RR, 1.05; 95% CI, 0.85-1.30, P = .63), including subgroup of radiological scores of OA (subgroup of Minimal OA: RR, 0.95; 95% CI, 0.61-1.48; P = .82; subgroup of Notable OA: RR, 1.16; 95% CI, 0.75-1.78; P = .51), subgroup of follow-up time in 5 years and more than 5 years (RR, 0.98; 95% CI, 0.80-1.20; P = .85), and subgroup of autograft graft for ACL (RR, 0.97; 95% CI, 0.79-1.19; P = .77). However, the DB group had less incidences of knee OA than the SB group in subgroup of less than 5 years (RR, 1.48; 95% CI, 1.13-1.92; P = .004) and subgroup of allograft type (RR, 1.42; 95% CI, 1.06-1.91; P = .02). CONCLUSION:Overall, this meta-analysis showed that the DB technique was no more effective in preventing the progression of OA than the SB technique in ACL reconstruction at midterm follow-up.