Objective:To explore the relationship between depression, perfectionism and self-injurious function in adolescents with self-injury.Methods:A total of 6 149 adolescents from two middle schools were selected by multi-stage random sampling method to conduct a cross-sectional investigation, and 530 cases with self-injurious behaviors were screened out as the self-injury group, while the remaining 5 619 students served as the non-self-injury group.The self-rating depression scale, the Chinese-revised Frost multidimensional perfectionism scale, and the Ottawa self-injury inventory Chinese revised version were used for investigation.SPSS 24.0 software was used for descriptive statistics and Spearman correlation analysis, and the PROCESS 4.1 macro program was used for mediating effect test(model 4)and moderating effect test(model 7).Results:(1)The incidence of self-injury among adolescents was 8.62%(530/6 149), which was significantly different in gender( χ2=50.942, P<0.01) and grade( χ2=37.401, P<0.01). (2)The scores of depression(48(41, 55)) and maladaptive perfectionism(64(53, 76)) in the self-injury group were higher than those in the non-self-injury group(36(29, 43), 49(35, 61)), and the differences were statistically significant( Z=-23.233, -18.599, both P<0.01). (3)Adolescents with self-injury mostly had external emotion regulation(70.38%(373/530)) as the dominant function.(4)The results of Spearman correlation analysis showed that self-injurious function was significantly and positively correlated with depression( r=0.382, P<0.01) and maladaptive perfectionism( r=0.356, P<0.01), and depression was significantly and positively correlated with maladaptive perfectionism( r=0.352, P<0.01). (5)Maladaptive perfectionism partially mediated the relationship between depression and self-injurious function( β=0.086, P<0.001), and the mediating effect accounted for 21.88%(0.086/0.393)of the total effect.(6)Gender moderated the first stage of the mediation pathway(depression→maladaptive perfectionism)( β=0.180, P<0.05), which indicated that depression had a stronger predictive effect on maladaptive perfectionism in women( βsimple=0.105, 95% CI=0.063-0.154, P<0.05). Conclusion:In the prediction of depression on self-injurious function, maladaptive perfectionism plays a partial mediating role, and this mediating effect is moderated by gender.

Objective:To explore the relationship between depression, perfectionism and self-injurious function in adolescents with self-injury.Methods:A total of 6 149 adolescents from two middle schools were selected by multi-stage random sampling method to conduct a cross-sectional investigation, and 530 cases with self-injurious behaviors were screened out as the self-injury group, while the remaining 5 619 students served as the non-self-injury group.The self-rating depression scale, the Chinese-revised Frost multidimensional perfectionism scale, and the Ottawa self-injury inventory Chinese revised version were used for investigation.SPSS 24.0 software was used for descriptive statistics and Spearman correlation analysis, and the PROCESS 4.1 macro program was used for mediating effect test(model 4)and moderating effect test(model 7).Results:(1)The incidence of self-injury among adolescents was 8.62%(530/6 149), which was significantly different in gender( χ2=50.942, P<0.01) and grade( χ2=37.401, P<0.01). (2)The scores of depression(48(41, 55)) and maladaptive perfectionism(64(53, 76)) in the self-injury group were higher than those in the non-self-injury group(36(29, 43), 49(35, 61)), and the differences were statistically significant( Z=-23.233, -18.599, both P<0.01). (3)Adolescents with self-injury mostly had external emotion regulation(70.38%(373/530)) as the dominant function.(4)The results of Spearman correlation analysis showed that self-injurious function was significantly and positively correlated with depression( r=0.382, P<0.01) and maladaptive perfectionism( r=0.356, P<0.01), and depression was significantly and positively correlated with maladaptive perfectionism( r=0.352, P<0.01). (5)Maladaptive perfectionism partially mediated the relationship between depression and self-injurious function( β=0.086, P<0.001), and the mediating effect accounted for 21.88%(0.086/0.393)of the total effect.(6)Gender moderated the first stage of the mediation pathway(depression→maladaptive perfectionism)( β=0.180, P<0.05), which indicated that depression had a stronger predictive effect on maladaptive perfectionism in women( βsimple=0.105, 95% CI=0.063-0.154, P<0.05). Conclusion:In the prediction of depression on self-injurious function, maladaptive perfectionism plays a partial mediating role, and this mediating effect is moderated by gender.

Iatrogenic bile duct injury(IBDI)is a common type of bile duct injury,most frequently occurring during cholecystectomy.With the widespread use of laparoscopic cholecystectomy,its incidence is significantly higher than that of open surgery,and the number of complex cases combined with vascular injury(VI)has been increasing,posing greater challenges for diagnosis and treatment.In severe cases,it may result in hepatic ischemia and atrophy.Hepaticojejunostomy is the standard reconstructive procedure after bile duct injury,whereas hepatectomy may be required when VI is involved.We report the case of a 53-year-old woman who was admitted with bile leakage following cholecystectomy.After two multidisciplinary team(MDT)discussions,preoperative evaluation revealed injury to the right hepatic artery and a portal vein branch,accompanied by atrophy of the right anterior lobe.Based on intraoperative findings,the patient underwent right hepatectomy combined with Roux-en-Y hepaticojejunostomy of the left hepatic duct.Postoperative recovery was uneventful,and the patient remained symptom-free during a 6-month follow-up.By reviewing the diagnosis and management of this case in conjunction with relevant literature,we summarize the clinical features,treatment strategies,and the value of MDT management in complex IBDI,aiming to provide reference for clinical practice.

Iatrogenic bile duct injury(IBDI)is a common type of bile duct injury,most frequently occurring during cholecystectomy.With the widespread use of laparoscopic cholecystectomy,its incidence is significantly higher than that of open surgery,and the number of complex cases combined with vascular injury(VI)has been increasing,posing greater challenges for diagnosis and treatment.In severe cases,it may result in hepatic ischemia and atrophy.Hepaticojejunostomy is the standard reconstructive procedure after bile duct injury,whereas hepatectomy may be required when VI is involved.We report the case of a 53-year-old woman who was admitted with bile leakage following cholecystectomy.After two multidisciplinary team(MDT)discussions,preoperative evaluation revealed injury to the right hepatic artery and a portal vein branch,accompanied by atrophy of the right anterior lobe.Based on intraoperative findings,the patient underwent right hepatectomy combined with Roux-en-Y hepaticojejunostomy of the left hepatic duct.Postoperative recovery was uneventful,and the patient remained symptom-free during a 6-month follow-up.By reviewing the diagnosis and management of this case in conjunction with relevant literature,we summarize the clinical features,treatment strategies,and the value of MDT management in complex IBDI,aiming to provide reference for clinical practice.

Objective To explore the effect and possible mechanism of berberine on the macro-phage polarization of human myeloid leukemia monocytic cell line THP-1 induced by oxidized low-density lipoprotein(ox-LDL).Methods THP-1 cells were induced into macrophages by PMA,and then according to different concentrations of berberine,the cells were divided into con-trol group,and 5,10,20,40 and 50 μmol/L berberine groups.After intervention for 24 or 48 h,CCK8 assay was used to detect cell viability for optimal concentration and time of berberine treat-ment.PMA-induced THP-1 macrophages were assigned into blank group,model group(ox-LDL),berberine group,inhibitor group(phosphatidyl inositol 3-kinase(PI3K)inhibitor LY294002)and berberine+inhibitor group(berberine+LY294002).The contents of inducible nitric oxide syn-thase(iNOS)and TGF-β1 were detected by ELISA.qPCR was employed to measure the mRNA expression of TNF-α,arginase 1(Arg1),PI3K and protein kinase B Akt1,and Western blotting was applied to detect the protein levels of Akt1 and phosphorylated protein kinase B antibody(p-Akt1).Results In 24 h after intervention,the macrophage activity was significantly lower in the 40 and 50 μmol/L berberine groups than the control group(P＜0.05),and after 48 h,the ac-tivity in all the 5 doses of berberine groups was obviously lower than that in the control group[(0.89±0.02)％,(0.82±0.03)％,(0.71±0.02)％,(0.62±0.03)％and(0.53±0.02)％vs(1.01±0.01)％,P＜0.05].Berberine treatment of 20 μmol/L for 24 h had little effect on cell viability,and the dose and the time were regarded as the best concentration and time.Compared with the blank group,iNOS content and TNF-α mRNA level were increased in the model group,while TGF-β1 content,mRNA levels of Arg1,PI3K and Akt1,and p-Akt1/Akt1 protein levels were de-creased(P＜0.05).iNOS content and TNF-α mRNA level were decreased,while TGF-β1 content,mRNA levels of Arg1,PI3K and Akt1 and protein levels of p-Akt1/Akt1s were increased in the berberine group than the model group(P＜0.05).Compared with the berberine group,iNOS con-tent and TNF-α mRNA level were increased,while mRNA levels of Arg1,PI3K and Akt1 and protein levels of p-Akt1/Akt1 were decreased in the berberine+inhibitor group(P＜0.05).Con-clusion Berberine can inhibit the inflammatory response of THP-1 macrophages induced by ox-LDL by activating PI3K/Akt1 pathway,and inhibit the M1 polarization and promote the M2 polarization of macrophages.

Objective:To investigate the correlation between adiponectin gene polymorphism and osteoporosis in patients with differentiated thyroid after thyroid stimulating hormone (thyroid stimulating hormone, TSH) suppression therapy.Methods:A total of 79 patients who underwent resection of thyroid cancer and TSH suppression therapy were collected as research objects. After 5 years of follow-up, the bone mineral density of the patients was measured, and they were divided into normal bone mass group and osteoporosis group. The general data of the two groups of patients were compared, and the distribution frequencies of rs1063539, rs266729, rs3774261, and rs710445 genotypes in the two groups of patients were analyzed. The differences in bone mineral density of patients with different genotypes of rs1063539, rs266729, rs3774261, and rs710445 were analyzed. To explore the risk factors of osteoporosis in patients treated with TSH suppression after differentiated thyroid surgery.Results:General data analysis showed that the family history of osteoporosis ( P=0.021) and preoperative thyroid hormone status ( P=0.022) were significantly different between the two groups (all P<0.05). The genotype frequency deviations of rs1063539, rs266729, rs3774261, and rs710445 conformed to the Hardy-Weinberg equilibrium law. The distribution of the three genotypes of rs1063539 locus was significantly different between the two groups, and the bone mineral density T value of rs1063539 CC+CG genotype (-3.68±0.61) was significantly lower than that of GG type (-3.14±0.47) ( t=3.142, P=0.003). Logistic regression analysis showed that no family history of osteoporosis was a protective factor for osteoporosis in patients with TSH suppression after thyroid cancer surgery ( OR: 0.258, OR 95%CI: 0.082-0.773, P=0.020). Preoperative hyperthyroidism ( OR: 2.203, OR 95%CI: 1.134-4.541, P=0.025) and rs1063539 CC+CG genotype ( OR: 4.392, OR 95%CI: 1.248-17.652, P=0.027) were the risk factors inducing osteoporosis. Conclusion:Adiponectin rs1063539 gene polymorphism is associated with bone mineral density in patients, and rs1063539 CC+CG genotype can increase the risk of osteoporosis in patients treated with TSH suppression after differentiated thyroid surgery.

Objective:To investigate the correlation between serum recombinant sclerostin (SOST) and dickkopf-related protein 1 (DKK-1) levels and bone metabolism indexes in patients with osteoporosis after differentiated thyroid cancer surgery.Methods:A total of 110 patients diagnosed with osteoporosis after differentiated thyroid cancer surgery were recruited as the study group, and another 110 patients without osteoporosis diagnosed after differentiated thyroid cancer surgery were recruited as the control group. The general data, bone mineral density, serum SOST, DKK-1 levels and bone metabolism indicators N-terminal propeptide of type I procollagen (PINP), bone alkaline phosphatase (BALP), beta-isomerized C-telopeptide (β-CTX), 25-hydroxyvitamin D3 [25- (OH) D3] levels were compared between the two groups. The correlation between serum SOST, DKK-1 levels and bone metabolism indexes was analyzed, and the risk factors affecting the formation of osteoporosis were explored.Results:The T value of bone mineral density in the study group (-3.27±0.92) was significantly lower than that in the control group (-1.23±0.27, t=22.32, P<0.001). The serum SOST (15.84±1.34, t=32.53, P<0.001) and DKK-1 (5.96±1.40, t=4.82, P<0.001) levels in the study group were significantly higher than those in the control group (SOST: 10.24±1.21, DKK-1: 5.05±1.40). The serum PINP (40.95±9.84, t=7.59, P<0.001), BALP (23.14±5.26, t=5.06, P<0.001) and β-CTX (1.07±0.54, t=4.96, P<0.001) in the study group were significantly higher than those in the control group (31.48±8.64, 19.64±4.99, 0.78±0.29), and the 25- (OH) D3 level (13.68±4.49) was significantly lower than that of the control group (18.31±5.72, t=6.68, P<0.001). Serum SOST was positively correlated with PINP ( r=0.33, P=0.001), BALP ( r=0.23, P=0.016) and β-CTX ( r=0.19, P=0.046), but not with 25- (OH) D3 ( r=-0.09, P=0.349). Serum DKK-1 was positively correlated with PINP ( r=0.19, P=0.044), BALP ( r=0.26, P=0.007) and β-CTX ( r=0.21, P=0.028), but not with 25- (OH) D3 ( r=-0.16, P=0.088). Serum SOST and DKK-1 levels were independent risk factors for osteoporosis (all P<0.05) . Conclusion:Serum SOST and DKK-1 levels are independent risk factors for the formation of osteoporosis, which are significantly positively correlated with bone metabolism indexes PINP, BALP, and β-CTX in patients with osteoporosis after differentiated thyroid cancer surgery.

Objective:To investigate the diagnostic value of circular RNA circ_100367 in thyroid cancer (THCA) and its relationship with immune-related factors.Methods:According to the data chip provided by the National Center for Biotechnology Information (NCBI) website, the differentially expressed circRNAs in THCA were analyzed, then circ_100367 was included in this study. The serum of 175 THCA patients and healthy people were collected, and the expression levels of circ_100367 and its linear transcript DCAF8 mRNA in serum samples were detected by qRT-PCR, and the correlation between circ_100367 and DCAF8 was calculated. The correlation between the expression of circ_100367 and the clinicopathological characteristicsof the patients, immune infiltration level and immunosuppressive factor PD-1 was analyzed.Results:Compared with serum of healthy people (1.00±0.37) , expression level of circ_100367 in serum of THCA patients was significantly increased (1.37±0.41) ( t=8.80, P<0.001) , and there was no significant difference in DCAF8 mRNA expression ( t=1.67, P=0.095) , but circ_100367 was positively correlated with DCAF8 mRNA expression ( r=0.17, P=0.028) . Analysis of expression and clinicopathological characteristics of circ_100367 showed that compared with patients in M0 group (1.26±0.40) , circ_100367 was overexpressed in M1 and Mx patients (1.43±0.40) ( t=2.63, P=0.009) ; compared with N0 patients (1.24±0.36) , circ_100367 was overexpressed in serum of N1 and Nx patients (1.45±0.42) ( t=3.48, P=0.001) ; compared with serum of patients with negative lymph node detection (1.28±0.36) , circ_100367 was overexpressed in serum of positive patients (1.42±0.43) ( t=2.14, P=0.034) ; compared with T1+T2 stage patients (1.30±0.37) , circ_100367 expression was overexpressed in serum ofT3+T4 patients (1.40±0.43) ( t=2.22, P=0.028) . Analysis of the expression and immune infiltration levels of circ_100367 found that highly expressed circ_100367 was associated with CD8+ T cells ( r=0.25, P=0.024) , macrophages ( r=0.22, P=0.038) , CD4+ T cells ( r=0.25, P=0.020) and B cell ( r=0.23, P=0.033) levels. The expression of circ_100367 was also positively correlated with the immunosuppressive factor PD-1 ( r=0.19, P=0.011) . Conclusion:circ_100367 can be used as a marker for the diagnosis of THCA and its expression is strongly correlated with immune-related factors.

Objective:To investigate the expression of miRNA-221-3p (miR-221-3p) in pancreatic cancer cells and its effect on apoptosis of pancreatic cancer cells, and the possible related mechanisms.Methods:Pancreatic cancer cell line PATU8988T was selected and transfected with miR-221-3p mimics, miR-221-3p inhibitors and their corresponding negative control sequences using Lipofectamine 3000. PATU8988T cells were divided into negative control group (without any treatment), miR-221-3p mimics negative control group, miR-221-3p mimics group, miR-221-3p inhibitors negative control group, and miR-221-3p inhibitors group. Real-time quantitative fluorescence polymerase chain reaction (qRT-PCR) was used to detect the relative expression level of miR-221-3p, flow cytometry was used to detect the influence of miR-221-3p on apoptosis of pancreatic cancer cells, and Western blotting was used to detect the expressions of P53 and PTEN proteins in PATU8988T cell line.Results:The relative expression levels of miR-221-3p in negative control group, miR-221-3p mimics negative control group, miR-221-3p mimics group, miR-221-3p inhibitors negative control group and miR-221-3p inhibitors group were 1.02±0.18, 1.50±0.33, 2.96±0.70, 1.62±0.30, and 0.36±0.05, respectively, and the difference was statistically significant ( F = 12.61, P < 0.05); the relative expression level of miR-221-3p in miR-221-3p mimics group was higher than that in negative control group and miR-221-3p mimics negative control group ( t = 1.94, P < 0.05; t = 1.45, P < 0.05); the relative expression level of miR-221-3p in miR-221-3p inhibitors group was lower than that in negative control group and miR-221-3p inhibitors negative control group ( t = -0.65, P < 0.05; t = -1.26, P < 0.05). The apoptosis rates in negative control group, miR-221-3p mimics negative control group, miR-221-3p mimics group, miR-221-3p inhibitors negative control group and miR-221-3p inhibitors group were (8.60±0.20)%, (8.60±0.26)%, (4.27±0.31)%, (8.83±0.29)%, and (13.63±0.60)%, respectively, and the difference was statistically significant ( F = 253.80, P < 0.01); the apoptosis rates in miR-221-3p mimics group was lower than that in negative control group and miR-221-3p mimics negative control group ( t = -4.33, P < 0.05; t = 4.33, P < 0.05); the apoptosis rate in miR-221-3p inhibitors group was higher than that in negative control group and miR-221-3p inhibitors negative control group ( t = 5.03, P < 0.05; t = 4.80, P < 0.05). There was no statistical difference in expression levels of P53 and PTEN proteins between miR-221-3p mimics negative control group and miR-221-3p inhibitors negative control group (P53: t = 0.22, P > 0.05; PTEN: t = 0.33, P > 0.05); the expression levels of P53 and PTEN proteins in miR-221-3p mimics group were decreased compared with the miR-221-3p mimics negative control group (P53: t = 4.31, P < 0.05; PTEN: t = 8.49, P < 0.05); the expression levels of P53 and PTEN proteins in miR-221-3p inhibitors group were increased compared with the miR-221-3p inhibitors negative control group (P53: t = 5.17, P < 0.05; PTEN: t = 6.21, P < 0.05). Conclusions:miR-221-3p is highly expressed in pancreatic cancer PATU8988T cells, which can inhibit the apoptosis of pancreatic cancer cells. miR-221-3p may regulate the progression of pancreatic cancer through P53 and PTEN.

Objective To summarize clinicopathologic features of papillary thyroid carcinoma (PTC) coexistent with chronic lymphocytic thyroiditis (CLT) and investigate risk factors for lymph node metastasis.Methods The medical records of 4 264 consecutive papillary thyroid carcinoma patients who received surgical treatment from Oct 2013 to Oct 2015 in Peking Union Medical College Hospital were reviewed.The diagnoses was confirmed by histopathological tests.Univariate analysis was performed to identify specific clinicopathologic features of PTC with CLT.Univariate and multivariate analysis were performed to determine whether each clinicopathologic feature was an independent risk factor for lymph node metastasis.Results In all 4 265 cases,there were 3 059 papillary thyroid microcarcinoma (PTMC) (71.7％),1 010 PTC patients (23.7％) with CLT.909 female patients (90％),624 cases with multifocal lesions (61.8％),422 cases with extra-thyroid extension (41.8％),429 cases with lymph node metastasis (42.5％),and 133 cases with metastatic lymph nodes(LNs) ≥6 (13.2％).The median age was 43 years old and median tumor size was 0.8 cm.Patients with CLT were more females (90.0％ vs.70.2％;P ＜ 0.001),younger median age (43 vs.44 years;P =0.001),and lower incidence of lymph node metastasis (42.5％ vs.50.9％;P ＜0.001).CLT was not associated with tumor size,multifocal lesions,extra-thyroid extension and metastatic LNs≥6 (0.8 cm vs.0.7 cm,61.8％ vs.62.9％,41.8％ vs.42.1％ and 13.2％ vs.14.8％,respectively,all P ＞ 0.05).In multivariate analysis,CLT was an independent protective factor for lymph node metastasis (OR =0.713,95％ CI 0.609-0.835,P ＜0.001).In PTC patients with lymph node metastasis,CLT was not associated with lymph node metastasis number (3 vs.3,P =0.300).Conclusions Chronic lymphocytic thyroiditis was an independent protective factor for papillary thyroid carcinoma patients with lymph node metastasis.But in patients with lymph node metastasis,the metastatic number didn't decrease.