Table of Content

20 January 2026, Volume 41 Issue 1

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Original article

Meta-analysis of the intervention effect of cognitive behavioral therapy on depressive symptoms in patients with type 2 diabetes mellitus

Xiang Yuxin, Zhong Yuhao

2026, 41(1):  5-11.  doi:10.3969/j.issn.1004-583X.2026.01.001

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Objective To evaluate the effect of cognitive behavioral therapy (CBT) for reducing depressive symptoms among adults with type 2 diabetes mellitus (T2DM). Methods We conducted a systematic search of CNKI, Wanfang, VIP, PubMed, Cochrane Library, Embase, ScienceDirect, for randomized controlled trials (RCTs) on the intervention effect of CBT for depressive symptoms among T2DM patients published from January 1, 2015 to May 1, 2025. Eligible studies were screened per predefined criteria and appraised using the Cochrane risk-of-bias tool. Pooled analyses were performed in RevMan 5.4 using standardized mean differences (SMDs). Results Ten RCTs including 1, 000 participants met the inclusion criteria. Pooled results indicated a large and statistically significant reduction in depressive symptoms following CBT (SMD=-2.10; 95%CI -3.07 to -1.12; Z=4.22; P<0.01). The benefit persisted in follow-up analyses (SMD=-3.76; 95%CI -5.57 to -1.96; Z=4.08; P<0.01). Subgroup analyses showed efficacy across delivery formats and dose: Individual CBT (SMD=-1.56; 95%CI -2.53 to -0.60; Z=3.17; P=0.002) and group CBT (SMD=-2.36; 95%CI -3.62 to -1.10; Z=3.66; P=0.0002), and shorter (≤8 sessions; SMD=-1.39; 95%CI -2.57 to -0.20; Z=2.30; P=0.02) as well as longer (>8 sessions; SMD=-2.70; 95%CI -4.25 to -1.15; Z=3.42; P=0.0006) intervention courses were all associated with significant symptom improvement. Conclusion CBT is effective in alleviating depressive symptoms among patients with T2DM. Given these findings, mental health professionals working with this population may consider incorporating CBT into routine care.

TyG and TyG-BMI indices predict major adverse cardiovascular events after emergency revascularization for acute myocardial infarction

Ouyang Weili, Jiang Yile

2026, 41(1):  12-17.  doi:10.3969/j.issn.1004-583X.2026.01.002

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Objective To evaluate the predictive value of the triglyceride-glucose index (TyG) and the TyG-body mass index (BMI) index for the prognosis of patients with acute myocardial infarction (AMI) treated with emergency percutaneous coronary intervention (PCI). Methods We retrospectively analyzed 201 consecutive AMI patients who underwent emergency PCI to open the culprit vessel within 12 hours at the People's Hospital of Danyang between January 1, 2021 and December 31, 2022. Patients were classified by electrocardiogram (ECG) into non ST elevation myocardial infarction (NSTEMI) group(n=40) and ST elevation myocardial infarction (STEMI) group (n=161). Based on the cohort median TyG value, patients were dichotomized into below-median (Q1) group (n=100) and above-median (Q2) TyG group (n=101). Ninety-six contemporaneous patients with negative coronary angiography served as controls. Clinical and laboratory data, including TyG and TyG-BMI indices, were collected. Patients were followed for 24 months for occurrence of major adverse cardiovascular events (MACE). The predictive value of TyG and TyG-BMI indices for the prognosis of patients with AMI treated with emergency PCI was analyzed. Results Both NSTEMI and STEMI patients had higher TyG and TyG-BMI indices than controls (TyG: NSTEMI 9.16±0.72 and STEMI 9.46±0.69 vs control 8.66±0.50, both P<0.01; TyG-BMI: NSTEMI 241.04±39.49 and STEMI 255.50±44.45 vs control 212.74±33.27, both P<0.01). STEMI patients exhibited higher TyG and TyG-BMI than NSTEMI patients (9.46±0.69 vs 9.16±0.72,255.50±44.45 vs 241.04±39.49, P<0.05). TyG-BMI correlated positively with cardiac troponin I (cTnI; R=0.23, P<0.01), left ventricular end-diastolic diameter (LVDd; R=0.505, P<0.01), and Gensini score (R=0.44, P<0.01), and negatively with left ventricular ejection fraction (LVEF; R=-0.581, P<0.01). At 24 months, MACE incidence was higher in the NSTEMI and STEMI groups than in controls (P<0.05), and higher in the TyG above-median (Q2) group than the below-median (Q1) group (P<0.05). Kaplan-Meier analysis showed fewer MACE events among patients with lower TyG values. Conclusion The TyG and TyG-BMI indices show prognostic value for patients undergoing emergency PCI.

Depression and risk of incident cardiovascular disease in middle-aged and older adults with CKM stages 0-3: A 7-year retrospective cohort study

Wen Guixian, Zhao Shixia, Zhang Feifei, Xu Xingchen, Liu Huiliang

2026, 41(1):  18-23.  doi:10.3969/j.issn.1004-583X.2026.01.003

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Objective To evaluate the association between depression and subsequent development of cardiovascular disease (CVD) in middle-aged and older adults with cardiovascular-kidney-metabolic syndrome (CKM) stages 0-3. Methods We performed a retrospective cohort analysis using data from the first wave (2011) of the China Health and Retirement Longitudinal Study. The cohort comprised 7, 912 participants with CKM stages 0-3 and no history of CVD at baseline, followed for 7 years. Participants were categorized according to incident CVD status during follow-up (incident CVD, n=1, 487; no CVD, n=6, 425). Associations between baseline depression severity and incident CVD were estimated using Cox proportional hazards models with adjustment for potential confounders. Subgroup analyses assessed the consistency of associations across strata, and restricted cubic spline modeling examined dose-response relationships between depression scores and CVD risk. Results During 7-year follow-up, 1, 487 of 7, 912 participants developed incident CVD (cumulative incidence 18.79%). The prevalence of depression among those with incident CVD was 42.7%. After multivariable adjustment, compared with participants without depression, those with mild depression (HR=1.293; 95%CI=1.144-1.462; P<0.001), moderate depression (HR=1.297; 95%CI=1.096-1.535; P=0.002), and severe depression (HR=1.864; 95%CI=1.491-2.330; P<0.001) had significantly higher risks of incident CVD. Subgroup analyses showed no significant interactions (all P for interaction >0.05), indicating stable associations across examined strata. Restricted cubic spline analysis suggested a nonlinear increase in CVD risk when depression scores exceeded 7 points in the overall CKM 0-3 cohort; sex-stratified analyses indicated that the risk increased for men at depression scores >6 and for women at scores >7. Conclusion In this large Chinese cohort of middle-aged and older adults with CKM stages 0-3, baseline depression was independently associated with a higher risk of incident CVD over seven years, with risk increasing progressively with depression severity.

Exploring the association between diabetes mellitus and peripheral arterial atherosclerosis using Mendelian randomization and bioinformatics: Identification of key genes and pathways

Sun Mengmeng, Zhang Zhigong

2026, 41(1):  24-32.  doi:10.3969/j.issn.1004-583X.2026.01.004

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Objective To investigate the genetic causal relationship between diabetes mellitus (DM) and peripheral arterial atherosclerosis (PAA), and to elucidate shared molecular mechanisms, using Mendelian randomization (MR) and bioinformatics approaches. The aim is to provide a theoretical basis for early screening and targeted interventions. Methods We employed an MR framework based on genome-wide association study (GWAS) data. Instrumental variables were selected and multiple MR models (including inverse-variance weighted, IVW) and sensitivity analyses were conducted to assess and validate the causal effect of DM on PAA. Concurrently, gene expression datasets from the Gene Expression Omnibus (GEO) database were analyzed to identify differentially expressed genes (DEGs) for each condition. Shared DEGs were subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, and a protein-protein interaction (PPI) network was constructed to identify hub genes. Results MR analysis demonstrated a significant positive causal effect of DM on PAA (OR=1.413; 95%CI: 1.316-1.516; P<0.01). Bioinformatics analysis identified 156 overlapping DEGs between DM and PAA, which were enriched in immune- and inflammation-related functions and pathways. PPI network analysis highlighted hub genes including Toll-like receptor 2 (TLR2), colony stimulating factor-1 receptor (CSF1R), cytochrome b558 heavy chain gene (CYBB), interleukin-1-beta (IL1B), and salmonella pathogenicity island 1 (SPI1). Conclusion There is a significant positive genetic causal association between DM and peripheral arterial atherosclerosis. Shared pathogenic mechanisms likely involve activation of immune-inflammatory pathways and the identified hub genes (TLR2, CSF1R, CYBB, IL1B, SPI1). These findings offer a theoretical framework and potential experimental targets for early risk prediction and targeted interventions in patients with DM at risk for PAA.

Serum levels of CTRP12 and Lp-PLA2 in patients with acute cerebral infarction and their relationship with carotid atherosclerosis

Ji Ruyi, Zhao Lirong, Liu Sha

2026, 41(1):  33-37.  doi:10.3969/j.issn.1004-583X.2026.01.005

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Objective To detect serum levels of C1q/ tumor necrosis factor-related protein-12 (CTRP12) and lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with acute cerebral infarction (ACI), and to analyze their relationship with carotid atherosclerosis. Methods From April 2022 to April 2025, 172 ACI patients admitted to the Second People's Hospital of Pingdingshan were selected. After excluding 7 dropouts, a total of 165 patients were included. According to the intima-media thickness (IMT) of the carotid artery, ACI patients were divided into the normal intima group (50 cases), the thickened intima group (54 cases), and the plaque group (61 cases). The Spearman rank correlation coefficient was used to analyze the correlation of serum levels of CTRP12 and Lp-PLA2 with carotid atherosclerosis in ACI patients. The receiver operating characteristic (ROC) curve was constructed to evaluate the predictive value. Results The lowest serum CTRP12 was detected in the plaque group, followed by the thickened intima group and normal intima group. The highest serum Lp-PLA2 was detected in the plaque group, followed by the thickened intima group and normal intima group (P<0.05). The degree of carotid atherosclerosis in ACI patients was negatively correlated with serum CTRP12 and positively correlated with serum Lp-PLA2 (P<0.05). By ROC analysis, the areas under the curve for evaluating plaque formation in ACI patients by serum CTRP12 and Lp-PLA2 levels alone and in combination were 0.859, 0.809, and 0.911; the sensitivities were 0.852, 0.803, and 0.885; and the specificities were 0.817, 0.788, and 0.865, respectively (P<0.05). Conclusion Serum CTRP12 and Lp-PLA2 in ACI patients are closely related to their carotid atherosclerosis, and the two indicators can be used as biological indicators for evaluating plaque formation.

Diagnostic value of CTA combined with serum TNF-α and IFN-γ for carotid plaques in ischemic stroke patients

Lu Minyan, Zhou Li, Qi Zhiqiang, Lu Yang

2026, 41(1):  38-43.  doi:10.3969/j.issn.1004-583X.2026.01.006

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Objective To evaluate the diagnostic value of computed tomography angiography (CTA) combined with serum tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) for detecting carotid artery plaques in patients with ischemic stroke. Methods From January 1 to December 31, 2024, sixty-nine consecutive ischemic stroke inpatients treated in the Department of Neurology at Jiangsu Shengze Hospital were enrolled as the observation group; sixty-six contemporaneous healthy examinees served as controls. All patients underwent both digital subtraction angiography (DSA) and CTA; CTA findings were compared with DSA to assess diagnostic performance. Serum TNF-α and IFN-γ levels were measured in both groups. Based on the DSA results, the patient cohort was divided into plaque-positive (n=44) and plaque-negative (n=25) subgroups. TNF-α and IFN-γ levels were compared between subgroups. A diagnostic model combining CTA with serum TNF-α and IFN-γ was constructed and its performance evaluated by receiver operating characteristic (ROC) curve analysis. Results CTA identified carotid plaques in 43 of 69 ischemic stroke patients (62.3%). Versus DSA, CTA demonstrated sensitivity 93.2%, specificity 92.0%, positive predictive value 95.3%, negative predictive value 88.5%, and overall diagnostic accuracy 92.8%. Serum TNF-α and IFN-γ were significantly higher in ischemic stroke patients than in healthy controls (P<0.05), and levels were significantly greater in the plaque-positive subgroup compared with the plaque-negative subgroup (P<0.05). The combined CTA+TNF-α+IFN-γ diagnostic model showed excellent discrimination (area under the ROC curve [AUC]=0.966) with high sensitivity and specificity (P<0.05); the model’s high specificity indicates particular value for excluding patients without carotid plaque. Conclusion A multimodal diagnostic approach that integrates CTA imaging with serum TNF-α and IFN-γ measurements provides high sensitivity and specificity for detecting carotid plaques in patients with ischemic stroke. By combining anatomical localization from imaging with biomarker-based biological characterization, this strategy offers a more comprehensive basis for vascular risk stratification in ischemic stroke patients.

A scoping review of kinesiophobia in patients with rheumatoid arthritis

Liu Sanjiao, Ren Hua, Guo Yifan

2026, 41(1):  44-50.  doi:10.3969/j.issn.1004-583X.2026.01.007

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Objective To conduct a scoping review of the prevalence, assessment toolss, influencing factors, and interventions for kinesiophobia in patients with rheumatoid arthritis (RA), and to provide evidence and direction for clinical practice and future research. Methods We performed a scoping review using both controlled vocabulary and free-text terms to systematically search China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang, VIP, PubMed, Embase, Cochrane Library, Web of Science, PsycInfo, CINAHL, and Scopus from database inception through January 25, 2025. Two reviewers independently screened, extracted, classified, and analyzed the literature. Results Fourteen studies met the inclusion criteria. Reported prevalence of kinesiophobia among RA patients ranged from 44.97% to 77.40%, indicating a generally high burden. A variety of assessment instruments were used, but few were RA-specific; the Tampa Scale for Kinesiophobia was the most commonly applied tool. Identified influencing factors included sociodemographic variables, disease-specific factors, and psychosocial elements. Interventions reported in the literature comprised exercise programs, balneotherapy (sand therapy), and cognitive behavioral therapy (CBT). Conclusion Kinesiophobia is common among patients with RA and is influenced by a combination of sociodemographic, disease-related, and psychosocial factors. Existing assessment tools lack specificity for RA, highlighting the need to develop and validate localized, disease-specific instruments. Incorporating advanced methods such as machine learning and artificial intelligence could facilitate development of predictive tools for early identification of kinesiophobia. Interventions, primarily CBT, balneotherapy, and exercise, have been applied mainly in hospital and home settings; future work should explore community-based and internet-delivered approaches to broaden access and improve implementation.

Impact of virtual reality-based social skills training combined with parental behavioral interventions on social skills and anxiety in children with autism

Ma Xiaojie, Lu Meng, Liu Xiaoya

2026, 41(1):  51-56.  doi:10.3969/j.issn.1004-583X.2026.01.008

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Objective To investigate the impact of virtual reality (VR)-based social skills training combined with parental behavioral interventions on social skills and anxiety in children with autism. Methods A total of 100 children with autism diagnosed and admitted to the First People's Hospital of Shangqiu from May 2024 to May 2025 were selected as research subjects. They were randomly divided into the observation group and control group, with 50 cases in each group. Children in the control group received parental behavioral interventions alone, while those in the observation group received VR-based social skills training combined with parental behavioral interventions. The scores of Griffiths development scales (GDS), autism treatment evaluation checklist (ATEC), quality of life scale, Screen for Child Anxiety Related Emotional Disorders (SCARED), Psychoeducational Profile-Third Edition (PEP-3), and Childhood Autism Rating Scale (CARS) were compared between the two groups. Results Compared with values before interventions, post-intervention scores of personal-social, visual performance, hand-eye coordination, hearing and language, gross motor skills, practical reasoning, cognitive function, emotional function, physical health, and PEP-3 in both groups were significantly elevated (P<0.05), while the scores of social interaction, language communication, sensory cognition, health behavior, SCARED, and CARS were significantly reduced (P<0.05). Compared with the control group, children in the observation group had significantly higher scores of personal-social, visual performance, hand-eye coordination, hearing and language, gross motor skills, practical reasoning, cognitive function, emotional function, physical health, and PEP-3 (P<0.05), as well as significantly lower scores of social interaction, language communication, sensory cognition, health behavior, SCARED, and CARS after intervention (P<0.05). Conclusion VR-based social skills training combined with parental behavioral interventions can better promote the development of social skills and alleviate anxiety-related manifestations in children with autism.

Epstein-barr virus-associated acute cerebellitis: A case report and literature review

Wang Sixin, Yu Qun, He Jiasheng

2026, 41(1):  57-59.  doi:10.3969/j.issn.1004-583X.2026.01.009

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Objective To characterize the clinical features, diagnostic workup, and management of acute cerebellitis caused by Epstein-Barr virus (EBV). MethodsWe performed a retrospective case analysis of a 53-year-old man diagnosed with EBV-associated acute cerebellitis at our institution, reviewing his presenting symptoms, laboratory and imaging findings, therapeutic interventions, and clinical course, and contextualized the case with a literature review. Results The patient presented with acute onset of dizziness, unsteady gait, dysarthria, and gaze-evoked nystagmus. CSF analysis revealed pleocytosis (66×10⁶/L) and elevated total protein (586.6 mg/L). Targeted next-generation sequencing (tNGS) of CSF identified 2, 402 EBV reads. Serologic testing showed elevated anti-EBV viral capsid antigen (VCA) IgA, and peripheral blood EBV DNA was positive. The patient was treated with intravenous acyclovir and systemic glucocorticoids, after which neurological symptoms improved substantially. Conclusion Although uncommon, EBV-related cerebellitis should be included in the differential diagnosis of acute cerebellar syndromes, as it may be mistaken for cerebrovascular events. Early consideration of viral etiologies and timely laboratory evaluation, including serology and CSF viral testing, can facilitate diagnosis and allow prompt initiation of antiviral and immunomodulatory therapy, which may improve outcomes.

Antibiotic-associated acquired factor Ⅴ inhibitor: A case report and literature review

Ren Xiyan, Ma Liyun, Ren Guanjun, Xue Qishan, Yan Chunliang, Jing Shuxian

2026, 41(1):  60-63.  doi:10.3969/j.issn.1004-583X.2026.01.010

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Objective To investigate the clinical characteristics of patients with antibiotic associated acquired factor Ⅴ inhibitor (AFⅤI). Methods We describe the clinical presentation, laboratory findings, diagnostic and therapeutic course, and outcome of a patient with antibiotic-associated AFⅤI, and we review and discuss relevant literature. Results An 84-year-old patient without a history of hereditary coagulation factor deficiency developed elevated levels of FV inhibitor after receiving antibiotics for pneumonia. Conclusion AFⅤI-related coagulopathy is a rare disorder, and exposure to antibiotics is a common precipitating factor.

Musical obsessions: A case report and literature review

Sun Zhenxiao, Zhang Jixiang

2026, 41(1):  64-67.  doi:10.3969/j.issn.1004-583X.2026.01.011

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Objective To characterize the clinical features, diagnosis, differential diagnosis, and treatment of musical obsessions. Methods We report a case of musical obsessions and review the literature to discuss clinical presentation, diagnostic considerations, differential diagnosis, and therapeutic approaches. Results A 15-year-old male presented with a oneyear history of intrusive, uncontrollable songs repeatedly playing in his mind. The phenomenon progressively worsened until musical fragments recurred on an almost continuous loop during wakefulness. The patient experienced persistent, changing sung phrases that he could not suppress, causing severe distress, anxiety, and despair and substantially impairing his academic performance and daily functioning. Physical and ancillary examinations were unremarkable. Based on the phenomenology, he was diagnosed with obsessive-compulsive disorder (OCD) presenting with musical obsessions and was treated with sertraline combined with cognitive behavioral therapy (CBT), resulting in symptomatic improvement. Conclusion Musical obsessions are an uncommon but clinically important manifestation of OCD. Clinicians, especially psychiatrists, should be alert to this presentation to ensure timely recognition and appropriate treatment.