BackgroundNon-suicidal self-injury （NSSI） in adolescents is a serious global public health issue. Self-stigma is identified as a key factor hindering adolescents from seeking professional psychological help， while only a few studies have dealt with the self-stigma in adolescents with mood disorder exhibiting NSSI behavior. ObjectiveTo investigate the influencing factors of self-stigma among adolescents with mood disorder who exhibit NSSI behavior， and to examine the chained mediation role of self-esteem and social avoidance/distress in the relationship between NSSI behavior and self-stigma， with the aim of providing references for the detection and intervention of self-stigma in such patients. MethodsA total of 220 consecutive adolescent patients with mood disorder who met "the International Classification of Diseases， Tenth Edition"（ICD-10） diagnostic criteria for depressive disorder or depressive episode of bipolar disorder and attended the Fourth People's Hospital of Wuhu from November 2022 to November 2023 were recruited. The Adolescent Non-suicidal Self-injury Assessment Questionnaire （ANSAQ）， Internalized Stigma of Mental Illness （ISMI） Scale， Self-Esteem Scale （SES）， and Social Avoidance/Distress Scale （SADS） were employed to assess the participants. Correlation among variables was evaluated using Pearson's correlation coefficient. Multivariate linear regression analysis was utilized to identify the factors influencing self-stigma among adolescent patients with mood disorder exhibiting NSSI. The proposed mediating hypotheses were tested using Model 6 in the SPSS Process macro （version 3.0）. ResultsValid responses were received from 204/220 （92.73%） participants， including 153 cases with NSSI and 51 cases without NSSI. The NSSI （vs. no NSSI） group reported significantly higher scores on ISMI and SADS （t=-5.187， -4.564， P<0.01）， and lower scores on SES （t=4.478， P<0.01）. In the NSSI group， the total score of ISMI demonstrated a positive correlation with the total score of SADS and the behavioral questionnaire score in ANSAQ （r=0.644， 0.316， P<0.01）， and a negative correlation with the total score of SES （r=-0.724， P<0.01）. Multivariate linear regression analysis revealed that NSSI severity （β=0.132， P<0.05） and social avoidance/distress （β=0.309， P<0.01） were found to be positive predictors of the self-stigma， whereas self-esteem （β=-0.493， P<0.01） was a significant negative predictor of the self-stigma. Additionally， self-esteem and social avoidance/distress partially mediated the relationship between NSSI and self-stigma， with a mediating effect of 0.237 （95% CI： 0.103~0.374）， which constituted 55.89% of the total effect. The mediating effect included two paths： NSSI behavior→self-esteem→self-stigma （effect size was 0.163， 95% CI： 0.069~0.273） and NSSI behavior→self-esteem→social avoidance/distress→self-stigma （effect size was 0.063， 95% CI： 0.020~0.119）. ConclusionThe severity of NSSI can affect self-stigma in adolescents with mood disorders either directly through mediating self-esteem or indirectly through the chained mediation path of self-esteem and social avoidance/distress.［Funded by Scientific Research Projects of Wuhu Fourth People's Hospital in 2000（number，kjxm202203）］

Objective： ：To detect the gene mutation in cholangiocarcinoma patients using the next generation sequencing (NGS) technology, and to analyze its correlation to the prognosis of the patients. Methods: From June 2016 to June 2018, 40 patients diagnosed with cholangiocarcinoma received NGS examination to screen the possible mutations (single base mutation, structural variation, copy number variation and gene fusion, etc.). The disease control rates (DCR), progression-free survival (PFS) and overall survival (OS) of the patients, who received the first line therapy, were retrospectively reviewed to analyze the relationship between signaling pathway as well as its genetic variation and the prognosis of cholangiocarcinoma patients. Results: The median PFS of patients with and without TP53 mutation was 11.0 and 8.3 months, respectively (P=0.332), while OS was 14.3 and 32.9 months, respectively (P=0.041). The median PFS of patients with and without PI3K mutations was 8.3 and 11.0 months, respectively (P=0.285), while OS was 14.3 and 37.0 months, respectively (P=0.020). The median PFS of patients with and without mTOR pathway mutations was 6.3 and 10.3 months, respectively (P=0.020), while OS was 15.6 and 19.6 months, respectively (P=0.892). There was no significant effect of pathway-related gene mutations on patients’survival. Conclusion: The prognosis of cholangiocarcinoma patients with TP53 and PI3K pathway activation had obviously poor prognosis than those without. No significant difference was observed between the patients with and without mTOR pathway activation and IDH mutation.

Amisulpride,a kind of the second generation antipsychotics,was marketed in China in 2010.A series of clinical research and experience before and after listed,especially the data based on Chinese population,provided evidence for the generalization and application of amisulpride.In order to optimize the clinical application of amisulpride,and improve the prognosis of patients,Expert Advice on the Practical Use of Amisulpride in the Treatment of Schizophrenia is presented here.This advice is based on the recent evidence and clinical experience,for guiding the clinical medication of amisulpride.

Objective To investigate the trend of antimicrobial resistance and the prevalence of resistant genes in Pseudomonas aeruginosa strains isolated from Hangzhou First People's Hospital.Methods Antimicrobial susceptibilities of 1489 Pseudomonas aeruginosa strains isolated from 2003 to 2007 were statistically analyzed using WHONET.MICs of 11 antimicrobisis to 36 multi-drug-resistant Pseudomonas aerugionosa strains were determined by agar dilution method.Genes of β-lactamases(BLA)and aminoglycoside-modifying enzymes(AMEs)were detected by PCR and the PCR products were sequenced.Results The resistant rates to aztreonam,imipenem,ceftazidime,cefepime,piperacillin,piperacillin/tazobactam.cefoperazone/sulbactam,ciprofloxacin,levofloxacin,gentamicin and amikacin were increased from 13.4%,10.6%,8.7%,7.9%,12.7%,12.7%,6.7%, 15.8%,20.5%,24.7% and 10.9%in 2003 to 35.3%,40.9%,18.4%, 32.4%,32.9%,32.0%,21.9%,37.8%,38.6%, 39.4% and 34.8% in 2007.respectively.Hish MICs of 11 antimicrobiMs for multi-drug resistant Pseudomonas aerouginosa were determined with MIC90≥128 μg/mL.In 36 multi-drug resistant Pseudomonas aeruginosa strains,21(58.3%)strains carried β-lactamase genes and 32 strains(88.9%)carried aminoglycosidemodifying enzyme genes,while the deletion rate of oprD2 was 80.6%(29/36).Conclusions The resistant rates to common antibiotics of Pseudomonas aeruginosa have increased.resulting in multi-drug resistance.Genes of β-lactamases and aminoglycoside-medifying enzymes are prevalent in multi-drug resistant Pseudomonas aeruginosa strains,with the common deletion of oprD2.

OBJECTIVE To investigate the resistance and the distribution of the main ?-lactamases encoding gene in Acinetobacter baumannii isolated from four hospitals in Hangzhou city to provide the basic data for the optional treatment of A.baumannii infection.METHODS The identification of A.baumannii was performed using VITEK-AMS60.The minimum inhibitory concentrations(MIC) was examined by agar dilution and E-test.The homology of the resistant isolates was finished by pulsed field gel electrophoresis(PFGE).PCR and sequencing were used to analyze the ?-lactamases encoding gene of the 36 strains of imipenem-resistant A.baumannii.RESULTS All of the imipenem-resistant isolates produced carbapenemase OXA-23,and 5 isolates produced PER-1,2 isolates produced TEM-1 except OXA-23.No metallo-?-lactamases were detected.No plasmid was extracted.Clone transmission of the imipenem-resistant strains existed in the 4 hospitals.Most strains were isolated from intensive care unit(ICU). CONCLUSIONS The clone transmission of imipenem-resistant A.baumannii strains is occurred in 4 hospitals.All strains produce carbapenemase OXA-23.Five strains also produce PER-1 type extended-spectrum ?-lactamases.Two strains also produce TEM-1 type extended-spectrum ?-lactamases.