Previous studies reported that plasma aldosterone concentration (PAC) and aldosterone-to-renin ratio (ARR) exhibit high intraindividual variability among hypertensive patients, but analyses of their variability and impact factors measured by liquid chromatography with tandem mass spectrometry (LC‒MS/MS) and under standard conditions are lacking. This prospective cohort study was conducted in a tertiary hospital in China. A total of 120 inpatients with hypertension, including 80 patients with primary aldosteronism(PA) and 40 patients with essential hypertension(EH), who underwent PA screening twice on different days were included. The coefficients of variation (CVs) for PAC and ARR in the PA group were greater than those in the group without PA (PAC: 30.44

Sleep disturbances are highly prevalent in autism spectrum disorder (ASD), yet conventional single-night polysomnography (PSG) provides limited insight into dynamic sleep regulatory processes. Using the Synaptic Homeostasis Hypothesis as a conceptual framework, we quantified night-to-night changes (Δ; Night 2 - Night 1) in sleep architecture across two consecutive nights of home-based PSG and examined their association with ASD symptom severity. Seventy-nine children with ASD, stratified into mild ASD (M-ASD, n = 35) and moderate-to-severe ASD (MS-ASD, n = 44) subgroups using the Childhood Autism Rating Scale, and 30 typically developing controls (TDC) participated. Overall sleep-continuity changes were broadly comparable between ASD and TDC groups. However, sleep-architecture Δ measures showed a severity-related pattern: the M-ASD subgroup exhibited an overnight increase in rapid eye movement sleep percentage (ΔREM% = +2.6%, p = 0.002), whereas the MS-ASD subgroup showed no significant change (ΔREM% = -0.1%, p = 0.922). An adjusted pairwise comparison indicated a greater ΔREM% increase in M-ASD than in MS-ASD (adjusted mean difference = 3.4%, 95% CI: 1.2 to 5.6; Bonferroni-corrected p = 0.009). A similar exploratory difference was observed for NREM1%. ΔREM% was modestly and negatively associated with ASD symptom severity in correlation analysis (ρ = -0.234, p = 0.038) and age- and gender-adjusted regression analysis (β = -0.286, p = 0.016). Sensitivity analyses showed broadly consistent patterns, although severity-stratified overall effects were attenuated after FDR correction. These findings support further investigation of PSG-derived dynamic sleep measures as hypothesis-generating correlates of clinical heterogeneity in ASD.

Accurate subtyping of primary aldosteronism (PA) is essential for treatment selection. This study examined whether soluble CXC chemokine receptor type 4 (sCXCR4) in peripheral blood reflects adrenal CXCR4 expression assessed by 68Ga-pentixafor PET/MR, and whether sCXCR4 aids PA classification. A total of 160 subjects were enrolled, including 88 patients with PA (52 aldosterone-producing adenoma [APA], 36 idiopathic hyperaldosteronism [IHA]) and 72 healthy volunteers. Serum sCXCR4 was measured by enzyme-linked immunosorbent assay. Group comparisons, correlation analyses, and receiver operating characteristic curves were used to evaluate diagnostic performance. Serum sCXCR4 did not differ significantly among APA, IHA, and controls, and showed no correlation with adrenal SUV_max on PET/MR. The discriminatory value for distinguishing APA from IHA was poor (AUC 0.52; 95% CI 0.40-0.64). These results suggest that circulating sCXCR4 does not mirror adrenal CXCR4 expression and has no diagnostic role in PA subtyping.

A rate-limiting step in the prevention and early intervention of osteoporosis is identifying its asymptomatic onset. Accumulating evidence shows that sleep disorders are associated with an increased risk of osteoporosis. Given their early detectable and modifiable nature, integrating sleep disorder management into osteoporosis prevention and care pathways offers a novel approach for enhancing skeletal health. This expert consensus represents a collaborative effort by specialists in sleep medicine and orthopedics from across the world, integrating epidemiological, mechanistic, and interventional evidence to provide general guidance for prevention and clinical practice, and to foster multidisciplinary collaboration in the management of sleep disorders and osteoporosis.

Objective:Although growth hormone was shown to be specifically released during slow wave sleep (SWS), no population-based evidence has demonstrated the association between sleep quality and childhood height. To address this gap, our study aims to investigate the relationship between SWS and height of children. Methods:We analyzed polysomnography data and z-scores for height in 2527 suspected obstructive sleep apnea (OSA) children (537 non-OSA children and 1990 OSA children) collected over the past 16 years. Different grades of z-scores for height and SWS were classified by the quartile method, and the lowest z-scores for height quartile defined short stature as the main outcome. Logistic regression models were used to assess the relationship between SWS and short stature. Results:1990 OSA children and 537 non-OSA children were included in analyses. The mean value of z-score for height from high to low were 0.80, 0.34, 0.23 and -0.19 in non-OSA children, and 0.47, 0.10, 0.14 and 0.05 in OSA children. Fully adjusted logistic regression models showed that, compared to the highest SWS quartile, the lowest quartile had 4.85-fold higher odds (95% CI, 2.4-9.4) of short stature in non-OSA children and 2.15-fold higher odds (95% CI, 1.5-3.0) in OSA children. Subgroup analyses demonstrated that in both non-OSA and OSA children, the reduction of SWS was significantly related to short stature in prepubertal children. Linear regression models confirmed positive correlations between SWS and z-score for height. Conclusion:Our findings emphasize the crucial role of adequate sleep quality in childhood growth and development, supporting the inclusion of sleep assessments and improvements in pediatric growth monitoring programs.

Schizophrenia,a severe mental illness characterized by high disability and chronicity,imposes a heavy disease burden on society and patients in China.Community-based management plays a crucial role in the long-term and comprehensive management of patients with schizophrenia.Through years of exploration,community-based management models—primarily focused on case management,assertive community treatment(ACT),and crisis intervention—have proven beneficial to the overall recovery of patients.However,notable differences exist in the implementation of these models between domestic and international practices.Given this context,we systematically analyze domestic and international research to examine the characteristics of different management models and the causes of the differences.Based on this analysis,we propose targeted recommendations for improving community-based management of schizophrenia in China.Regarding case management,a tiered approach should be adopted according to regional economic conditions and resource availability to optimize the efficiency of resource allocation.For ACT,we suggest developing a family-centered integrated intervention framework adapted to China's specific context.Finally,regarding crisis intervention,a collaborative family-community-police response mechanism should be established,complemented by enhanced professional training and streamlined referral procedures.We advocate enhancing resource allocation and theoretical research,along with broader involvement of all sectors of society,to jointly optimize the community-based management model for schizophrenia in China.

BACKGROUND:Although internet improves modern life, the corresponding consequences of internet gaming disorder (IGD), low social-connectedness and anger-emotion are emerging as global concerns. However, the association between these psychopathologies remain unclear. METHODS:This survey enrolled 9,616 adolescents (11-19 years) from multi-center in China from September 2022 to March 2023. Association of self-reported social-connectedness (20-item revised Social Connectedness Scale, SCS) with IGD (9-item Internet Gaming Disorder Scale-short Form) and anger (6-item DSM-5-TR-Level 2-Anger Form) were characterized. RESULTS:197 (2.05%) adolescents had been estimated as probable IGD, 364 (3.79%) reported severe-anger, and 1056 (10.98%) shown low reality social-connectedness (RSCS). The female (OR:2.16, 95%CI: 1.67-2.79), younger (OR:1.12; 95%CI: 1.04-1.20), IGD (OR:5.17; 95%CI: 3.30-8.08) were independent correlators of sever-anger after controlling the confounding of low RSCS (OR:7.21; 95%CI: 5.61-9.27). Furthermore, the RSCS could partially mediate the effects of IGD on Anger with indirect-effect of 29.50%. CONCLUSION:The effect of IGD contribution to anger might be not only directly accomplished by IGD itself, and also influenced by indirectly mediation of low social-connectedness with reality, especially in the negative dimension.

IntroductionInsomnia has emerged as a major concern among youth following the lifting of coronavirus disease 2019 (COVID-19) restrictions in China. This study aimed to explore the prevalence and influencing factors of insomnia, as well as its associations with mental health, in young students during this period.MethodsA cross-sectional survey was conducted among 82,873 students in Sichuan Province, China, using a self-designed questionnaire and standardized assessment tools. Chi-square tests, ANOVA with post-hoc test analyses, and logistic regression were employed to identify the prevalence and influencing factors of insomnia and its associations with mental health.ResultsA total of 28,178 (34.0%) students reported insomnia. Self-reported history of mental disorders, neglectful parenting, and initiating alcohol consumption during the pandemic were associated with higher odds of insomnia, whereas satisfaction with the academy, full recovery of daily routines, greatly improved family relationships, no change in friendships, and higher maternal education were associated with lower odds of insomnia (p < 0.001). Severe insomnia was strongly associated with depression, anxiety, and posttraumatic stress disorder (PTSD; ORs: 17.55, 3.35, and 17.45, respectively). Interaction effects were observed between mild to moderate insomnia and COVID-19 infection on depression, anxiety, and PTSD.ConclusionFollowing the lifting of COVID-19 restrictions, insomnia remained prevalent among young Chinese students. Preexisting self-reported mental disorders, neglectful parenting, and pandemic-related maladaptive behaviors increase the risk of insomnia, whereas positive lifestyle adjustments, stable relationships, and higher maternal education appear protective. A significant association was observed between insomnia severity and symptoms of depression, anxiety, and PTSD. These findings highlight the persistent links among social, behavioral, and demographic factors, sleep, and mental health, emphasizing the importance of addressing sleep disturbances after the public health crisis.

To explore the accuracy of unilateral primary aldosteronism (UPA) classification via adrenal vein sampling (AVS) and C-X-C chemoking receptor 4 (CXCR4)-directed positron emission tomography (PET) with 68Ga-pentixafor (CXCR4-directed molecular imaging). A retrospective cohort study was conducted with 89 patients who were diagnosed with UPA and who underwent unilateral adrenalectomy (ADX) at West China Hospital of Sichuan University from January 2021 to June 2023. For these patients, surgical decisions were made on the basis of either AVS (AVS group) or CXCR4-directed molecular imaging (CXCR4 group), and patients were regularly followed up for more than 6 months after surgery. Whether biochemical and clinical success was achieved 6 months after surgery was determined on the basis of the primary aldosteronism surgical outcomes (PASO) criterion. The complete success rates were compared between the AVS group and CXCR4 group. One-way analysis of variance was used to compare preoperative factors, postoperative biochemical success rates and clinical success rates between the two groups. Additionally, the postoperative outcomes of adrenal nodules of different sizes were compared. 1. Among the 89 patients with UPA, 66 patients received ADX on the basis of AVS results, and 23 patients on the basis of CXCR4-directed molecular imaging results. The median age of the CXCR4 group [M (P25, P75): 45.00 years (39.00, 51.00)] was significantly lower than that of the AVS group [M (P25, P75): 49.00 years (40.75, 54.00)]. No significant differences in sex, history of hypertension, maximum blood pressure, antihypertensive drug defined daily dose (DDD), plasma aldosterone concentration (PAC), direct renin concentration (DRC), aldosterone-to-renin ratio (ARR), PAC after the captopril challenge test (CCT), PAC after the seated saline infusion test (SSIT), urea nitrogen, estimated glomerular filtration rate (eGFR), serum potassium level, diameter of the adrenal nodules or bilateral adrenal involvement were found. 2. There was no significant difference in the postoperative biochemical complete succcess rate (80.30 vs. 91.30

Aldosterone-producing adenoma (APA) is one of the main types of primary aldosteronism (PA). APAs are predominantly unilateral, whereas bilateral APAs are rare. Currently, clinical experience in the diagnosis and treatment of bilateral APAs is limited, posing significant challenges. This article reports the case of a PA patient with bilateral adrenal nodules. Adrenal venous sampling (AVS) revealed no dominant lateral secretion, but 68Ga-Pentixafor PET/MR imaging, which targets CXCR4, revealed bilateral positive lesions. The patient achieved biochemical and clinical remission after undergoing bilateral partial adrenalectomy, and CYP11B2 immunohistochemical staining confirmed that both nodules were APAs. This case report suggests that 68Ga-Pentixafor nuclear imaging, which targets CXCR4, is a noninvasive and reliable method for PA subtyping and may be the optimal method for the definitive diagnosis of bilateral APA. Bilateral partial adrenalectomy may be an effective and safe surgical procedure for the treatment of bilateral APAs. This study provides new insights and considerations for clinicians in the diagnosis and treatment of bilateral APAs.

ObjectiveThe high prevalence and addictive features of nonsuicidal self-injury (NSSI) in adolescents have been documented, but the role of addictive features in the process from NSSI functions to behaviour remains unclear. The major aim of this study was to investigate the effect of addictive features on NSSI functions and the severity of repeated NSSI.MethodsA total of 10781 students from primary and middle schools in Chengdu and Karamay were invited to participate in the online cross-sectional survey, and 10,501 completed the survey. Two self-report questionnaires, the Ottawa Self-Injury Inventory (OSI) and the Adolescent Self-Harm Scale (ASHS), were used to collect data from all participants.ResultsAmong the students, 23.45% and 6.64% reported having engaged in NSSI at least once or at least five times in the past year. Being a girl, being an only child, and being in a single-parent family were significantly associated with more severe NSSI. Addictive features have high value for predicting repeated NSSI. In addition to their significant independent/direct additive effects, addictive features mediated and moderated the relationship between NSSI functions and increased severity of NSSI in adolescents.Discussion and conclusionsThe findings suggest that addictive features play a critical role in the development of repeated NSSI in adolescents, which indicates that addiction models may partially explain the mechanism underlying increased severity of NSSI. This may enhance understanding of the reasons for repeated NSSI and inform interventions for repeated NSSI among adolescents.

Background: White blood cell (WBC) and its subset counts are standard, inexpensive, direct markers of inflammation. Obstructive sleep apnea (OSA) is implicated in changes in inflammation markers, and sex differences are evident in both OSA and inflammation. It is unknown whether sex modulates the relationship between OSA severity and leukocyte measures. Methods: 1222 patients (914 males, 308 females) underwent overnight laboratorial polysomnography and measurement of WBC and its subset (lymphocyte, neutrophil, monocyte) counts. Patients were divided into primary snoring and mild, moderate, and severe OSA groups, and differences in leukocyte parameters were analyzed separately by sex in multivariable analyses. Results: In multiple regression models, higher apnea-hypopnea index (AHI) was independently associated with neutrophil counts only in men, and with higher total WBC, lymphocyte and monocyte counts both in women and men. Further ordinal logistic regression analysis revealed a significant association between AHI and total WBC (OR 1.87, 95% CI 1.09-3.23) and neutrophil (OR 1.77, 95% CI 1.02-3.07) counts in men only. Correlation analysis also revealed more robust relationships between leukocyte measures and cardiometabolic risk markers in men than in women. Conclusion: This study provides novel data suggesting a significant association between neutrophil count and OSA severity only in men but not women. Similarly, the relationship between leukocyte parameters and cardiometabolic risk markers were more pronounced in men than women. Our findings suggest a sex-specific impact of OSA on leukocyte measures and on their relationship with indices of cardiometabolic risk.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Aldosterone/cortisol co-secreting adenomas (A/CPA) are a rare type of primary aldosteronism(PA), and cases of aldosterone/cortisol co-secreting adenomas during pregnancy are extremely rare, with no reported cases to date. The unique physiological state of pregnancy increases cortisol secretion through the hypothalamic-pituitary-adrenal (HPA) axis and leads to elevated levels of all components of the renin-angiotensin-aldosterone system (RAAS). This can cause overlapping symptoms with abnormal cortisol and aldosterone secretion, making diagnosis very challenging. This case involves a 29-year-old woman who developed hypercortisolism at 33 weeks of pregnancy. Despite receiving treatment for her symptoms and having a successful delivery, she continued to experience hypertension and hypokalaemia after giving birth. Eventually, she was diagnosed with ACTH-independent Cushing’s syndrome and primary aldosteronism due to independent cortisol and aldosterone secretion from bilateral adrenal adenomas. Following a thorough diagnosis, classification, treatment, and follow-up, the patient achieved a clinical cure while preserving normal adrenal function. Further investigation revealed that both diseases were caused by KCNJ5 and PRKACA mutations found in the bilateral adrenal adenomas.

To investigate the clinical characteristics and the risk factors associated with excessive daytime sleepiness (EDS) in patients with early- and late-onset narcolepsy. Patients with narcolepsy were consecutively recruited. All patients were separated into early- and late-onset groups according to the onset age of disease ≤ 15 and > 15 years, respectively. Demographic, clinical, and sleep parameters were compared between the two groups. Linear regressions were performed to examine the risk factors of subjective and objective EDS in patients with early- and late-onset narcolepsy. A total of 101 patients with narcolepsy (median age at recruitment = 18.0 years) were classified into an early-onset group (67 patients with median age at onset = 12.0 years) and a late-onset group (34 patients with median age at onset = 28.5 years). Compared with early-onset group, late-onset group scored significantly higher on Epworth Sleepiness Scale (ESS), Ullanlinna Narcolepsy Scale (UNS), sleep paralysis, rapid eye movement (REM) sleep behavior disorder (RBD) questionnaire-Hong Kong (all P < 0.050). UNS-cataplexy and sleep paralysis had significantly positive associations with subjective EDS, and N1

Obstructive sleep apnea (OSA) and depressive disorders are common diseases in adults and they share in common many clinical symptoms, including sleep disturbance, fatigue, lack of concentration and cognitive function impairment. OSA and depressive disorders also share some common pathophysiological changes, including increased activity of the hypothalamic-pituitary-adrenal (HPA) axis, chronic low-grade inflammation, oxidative stress, and changes in gut microbiota and neurotransmitters, which may contribute to the comorbidity of OSA and depressive disorders. In the case of comorbid OSA and depressive disorders, OSA and depressive disorders may affect and exacerbate each other, thereby increasing the severity of diseases, entailing greater risk of cardiovascular and metabolic diseases, and causing greater difficulty in treatment. Herein, we summarized the latest research findings on the epidemiology, possible mechanisms, harms, and treatment of comorbid OSA and depressive disorders. This review may help improve clinicians' understanding of the comorbidity of OSA and depression disorders, thereby promoting early screening, prompt diagnosis and treatment, and improved prognosis. Further studies are needed for better understanding of the effect of the comorbidity of OSA and depressive disorders and treatment on cardiometabolic diseases.