BackgroundIn recent years， the prevalence of depression among adolescents has risen steadily， alongside an increasing prominence of non-suicidal self-injury （NSSI） behaviors in this population， which may elevate suicide risk and constitute a serious public health problem. Negative emotions such as anxiety and depression are closely related to NSSI behaviors. Previous studies have predominantly relied on retrospective reports， limiting the ability to dynamically capture temporal relationships between emotional fluctuations and NSSI behaviors. Moreover， cognitive behavioral therapy （CBT） often lacks targeted design to address proximal triggers in interventions for NSSI behaviors. ObjectiveTo verify that anxiety as a proximal trigger factor for NSSI behaviors in adolescent patients with depression， and to evaluate the efficacy of modified CBT integrated with ecological momentary assessment （EMA） data in alleviating their anxiety and self-injury urges. MethodsA prospective cohort study design was adopted. A total of 132 adolescent patients with a history of NSSI behaviors who were treated at Jiujiang Fifth People's Hospital from January to December 2024 and met the diagnostic criteria for depression in the Diagnosed and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. A smartphone-based EMA application to conduct natural situation emotions on participants for 14 consecutive days. The monitoring period spanned from 10∶00 to 22∶00 daily， with randomized assessments pushed every 2 hours. The assessment tools included the Self-rating Anxiety Scale （SAS） and the negative affect subscale of the Positive and Negative Affect Schedule （PANAS）， with real-time recording of NSSI behaviors and emotional states before and after their occurrence. Repeated measures analysis of variance was used to compare the dynamic changes in the scores of each scale before and after the episodes of NSSI behaviors. A modified CBT was administered to 83 participants who completed EMA data collection， with sessions conducted once weekly for 12 weeks. Anxiety levels were accessed using the SAS， and the self-injury urges was evaluated using the Ottawa Self-injury Inventory （OSI） before and after the intervention. ResultsEMA data revealed that SAS scores were significantly higher during the 1-2 hours before NSSI episodes compared to baseline periods ［（56.19±11.06）vs.（52.83±10.25），P<0.01］. SAS scores were positively correlated with the NSSI behavioral scores （r=0.460，P<0.01，95% CI：0.310-0.580）. After receiving modified CBT intervention， adolescent patients with depression demonstrated statistically significant decreases in both SAS scores ［（52.30±8.10） vs.（48.70±7.30），t（82）=4.820，P<0.01，Cohen's d=0.420］ and the OSI self-injury impulse subcale scores ［（12.80±2.70） vs.（9.60±2.50），t（82）=5.170，P<0.01，Cohen's d=0.510］ compared to their pre-intervention levels. ConclusionAnxiety may serve as a proximal trigger for NSSI behaviors in adolescent patients with depression. Modified CBT integrating EMA data could potentially alleviate their anxiety level and self-injury urges. ［Funded by Science and Technology Plan Project of Jiangxi Provincial Health Commission （number， SKJP220227629）］

The paper reports one case of primary cutaneous amyloidosis (PCA) treated by tapping with plum-blossom needle combined with sulfur ointment and local irradiation. PCA in this case was manifested as generalized erythema, papules, plaques, lichenification, and severe pruritus. In treatment, tapping with plum-blossom needle was delivered at typical lesions to induce local congestion, redness, and minimal bleeding. After cleaned with sterile gauze for 10 s, 25% sulfur ointment was evenly applied, followed by local irradiation with a TDP lamp for 15 min. This session was repeated twice a week. In 1 month of treatment, the lesions turned flat and the skin was soft as the normal, with pigmentation and mild pruritus left. In 3 months of follow-up, no papules recurred, and mild pruritus presented occasionally.
Humans ; Ointments/administration & dosage* ; Sulfur/administration & dosage* ; Skin Diseases, Genetic/radiotherapy* ; Middle Aged ; Amyloidosis, Familial/radiotherapy* ; Male ; Acupuncture Therapy/instrumentation* ; Female ; Combined Modality Therapy

AIM:To investigate the mechanism by which exosomes(EXOs)derived from neural stem cells(NSCs)pretreated with astragaloside IV(ASIV)alleviate brain damage in rats after ischemic stroke.METHODS:Rat NSCs were isolated from fetal rats within 24 h of birth,cultured for 3 d,and subsequently treated with ASIV for additional 5 d.The EXOs from untreated NSCs and ASIV-pretreated NSCs(ASIV-EXOs)were isolated via ultracentrifugation of the cell supernatant.These EXOs were characterized using Western blot to detect specific markers such as CD63,tumor sus-ceptibility gene 101(TSG101)and calnexin.Nanoparticle analysis was employed to determine the size,and the morpholo-gy of the EXOs was observed under electron microscope.Six to eight-week-old SD male rats were randomly assigned to 6 groups:sham group,middle cerebral artery occlusion/reperfusion(MCAO/R)model group,edaravone(EDA)treatment(MCAO/R+EDA)group,EXOs treatement(MCAO/R+EXOs)group and ASIV-EXOs treatment(MCAO/R+ASIV-EXOs)group.Tail vein injections were administered within 2 h following the successful establishment of the MCAO/R model.The Zea Longa method was utilized to evaluate neurological deficits,while the TTC method was employed to assess brain infarc-tion.Pathological changes were examined through HE staining,and TUNEL and caspase-1 immunofluorescence double staining were conducted to detect cellular pyroptosis.Serum levels of interleukin-1β(IL-1β)and IL-18 were measured us-ing ELISA,and Western blot was performed to evaluate the expression of caspase-1,nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),gasdermin D(GSDMD),and IL-18 proteins in the ischemic area of the rat cerebral cortex across all groups.RE-SULTS:The MCAO/R group exhibited significantly higher neurological deficit scores compared to the sham group(P＜0.01)and lower scores in the administered groups relative to the MCAO/R group(P＜0.05).Cerebral infarction was mark-edly increased in the MCAO/R group compared to the sham group(P＜0.01),whereas the infarction area was reduced in the administered groups compared to the MCAO/R group(P＜0.05).Serum levels of IL-1β and IL-18 were significantly el-evated in the MCAO/R group versus the sham group(P＜0.01)and were lower in the administered groups compared to the MCAO/R group(P＜0.01).Moreover,IL-1β and IL-18 levels in the MCAO/R+ASIV-EXOs group were lower than those in the MCAO/R+EXOs group(P＜0.05).HE staining revealed pronounced sieve-like infarction foci in the ischemic area of the rat cerebral cortex in MCAO/R group,characterized by disorganized neuronal arrangements,reduced or absent Nys-trom's vesicles,shrunken or fragmented nuclei,and numerous red neurons.In contrast,drug-treated groups exhibited milder pathological changes with clearer neuronal structures and a significant reduction in red neuron counts.Immunofluo-rescence double staining indicated a significant increase in double-positive cells in the MCAO/R group compared to the sham group(P＜0.01),with a decrease in double-positive cells in the administered groups relative to the MCAO/R group(P＜0.05)and a further reduction in the MCAO/R+ASIV-EXOs group compared to the MCAO/R+EXOs group(P＜0.05).The expression levels of caspase-1,NLRP3,ASC,IL-18 and GSDMD proteins in the ischemic region of the rat cerebral cortex were significantly reduced in the administered groups compared to the MCAO/R group(P＜0.01),with further re-duction observed in the MCAO/R+ASIV-EXOs group compared to the MCAO/R+EXOs group(P＜0.05).CONCLU-SION:Exosomes derived from ASIV-pretreated NSCs attenuate brain damage in ischemic stroke rats,potentially through a mechanism involving the inhibition of pyroptosis mediated by the NLRP3/caspase-1 pathway.

Objective To investigate the value of ultrasound and contrast enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic neuroendocrine tumor(PNET)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was performed on the clinical data,ultrasound findings,and CEUS findings of 74 patients with PNET and their characteristic manifestations were analyzed and compared with those of 74 patients with PDAC.Data of the two groups were compared using the t-test and x 2 test,or Fisher's exact test.Results There were 18,26,and 30 patients with PNET lesions and 52,8,and 14 patients with PDAC located in the head,body,and tail of the pancreas,respectively.The patients with hypoechoic lesions,regular lesion morphology,clear boundaries,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 86.49％,83.78％,78.38％,18.92％and 32.43％in the PNET group,respectively,whereas in the PDAC group,such patients accounted for 94.59％,29.73％,27.03％,75.68％and 21.62％,respec-tively.There was a significant intergroup differences in lesion location,morphology,boundaries and pancreatic duct dilatation or cutoff(x 2=31.862,x2=44.048,x 2=39.141,and x 2=47.815,respectively,P＜0.05),with no significant differences in hypoechoic and blood flow signal(x2=2.840 and x2=2.193,P＞0.05).Among the 52 patients with PNET,CEUS showed that 38 had hyperenhancement and 14 had iso-enhancement in the arterial phase,whereas 40 had iso-enhancement and 12 had hypoenhancement in the venous phase.CEUS was performed in 74 patients with PDAC;70 patients showed hypoenhancement in the arterial phase and 72 showed hypoenhancement in the venous phase.There were significant differences in the enhancement pattern in the arterial and venous phases between the two groups(x 2=56.582 and x 2=37.852,P＜0.05).Conclusion Ultrasound and CEUS revealed some characteristics of PNET that can be used for the differential diagnosis of PNET and PDAC,when combined with enhancement pattern.

AIM:To investigate the mechanism by which exosomes(EXOs)derived from neural stem cells(NSCs)pretreated with astragaloside IV(ASIV)alleviate brain damage in rats after ischemic stroke.METHODS:Rat NSCs were isolated from fetal rats within 24 h of birth,cultured for 3 d,and subsequently treated with ASIV for additional 5 d.The EXOs from untreated NSCs and ASIV-pretreated NSCs(ASIV-EXOs)were isolated via ultracentrifugation of the cell supernatant.These EXOs were characterized using Western blot to detect specific markers such as CD63,tumor sus-ceptibility gene 101(TSG101)and calnexin.Nanoparticle analysis was employed to determine the size,and the morpholo-gy of the EXOs was observed under electron microscope.Six to eight-week-old SD male rats were randomly assigned to 6 groups:sham group,middle cerebral artery occlusion/reperfusion(MCAO/R)model group,edaravone(EDA)treatment(MCAO/R+EDA)group,EXOs treatement(MCAO/R+EXOs)group and ASIV-EXOs treatment(MCAO/R+ASIV-EXOs)group.Tail vein injections were administered within 2 h following the successful establishment of the MCAO/R model.The Zea Longa method was utilized to evaluate neurological deficits,while the TTC method was employed to assess brain infarc-tion.Pathological changes were examined through HE staining,and TUNEL and caspase-1 immunofluorescence double staining were conducted to detect cellular pyroptosis.Serum levels of interleukin-1β(IL-1β)and IL-18 were measured us-ing ELISA,and Western blot was performed to evaluate the expression of caspase-1,nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),gasdermin D(GSDMD),and IL-18 proteins in the ischemic area of the rat cerebral cortex across all groups.RE-SULTS:The MCAO/R group exhibited significantly higher neurological deficit scores compared to the sham group(P＜0.01)and lower scores in the administered groups relative to the MCAO/R group(P＜0.05).Cerebral infarction was mark-edly increased in the MCAO/R group compared to the sham group(P＜0.01),whereas the infarction area was reduced in the administered groups compared to the MCAO/R group(P＜0.05).Serum levels of IL-1β and IL-18 were significantly el-evated in the MCAO/R group versus the sham group(P＜0.01)and were lower in the administered groups compared to the MCAO/R group(P＜0.01).Moreover,IL-1β and IL-18 levels in the MCAO/R+ASIV-EXOs group were lower than those in the MCAO/R+EXOs group(P＜0.05).HE staining revealed pronounced sieve-like infarction foci in the ischemic area of the rat cerebral cortex in MCAO/R group,characterized by disorganized neuronal arrangements,reduced or absent Nys-trom's vesicles,shrunken or fragmented nuclei,and numerous red neurons.In contrast,drug-treated groups exhibited milder pathological changes with clearer neuronal structures and a significant reduction in red neuron counts.Immunofluo-rescence double staining indicated a significant increase in double-positive cells in the MCAO/R group compared to the sham group(P＜0.01),with a decrease in double-positive cells in the administered groups relative to the MCAO/R group(P＜0.05)and a further reduction in the MCAO/R+ASIV-EXOs group compared to the MCAO/R+EXOs group(P＜0.05).The expression levels of caspase-1,NLRP3,ASC,IL-18 and GSDMD proteins in the ischemic region of the rat cerebral cortex were significantly reduced in the administered groups compared to the MCAO/R group(P＜0.01),with further re-duction observed in the MCAO/R+ASIV-EXOs group compared to the MCAO/R+EXOs group(P＜0.05).CONCLU-SION:Exosomes derived from ASIV-pretreated NSCs attenuate brain damage in ischemic stroke rats,potentially through a mechanism involving the inhibition of pyroptosis mediated by the NLRP3/caspase-1 pathway.

Objective To investigate the value of ultrasound and contrast enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic neuroendocrine tumor(PNET)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was performed on the clinical data,ultrasound findings,and CEUS findings of 74 patients with PNET and their characteristic manifestations were analyzed and compared with those of 74 patients with PDAC.Data of the two groups were compared using the t-test and x 2 test,or Fisher's exact test.Results There were 18,26,and 30 patients with PNET lesions and 52,8,and 14 patients with PDAC located in the head,body,and tail of the pancreas,respectively.The patients with hypoechoic lesions,regular lesion morphology,clear boundaries,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 86.49％,83.78％,78.38％,18.92％and 32.43％in the PNET group,respectively,whereas in the PDAC group,such patients accounted for 94.59％,29.73％,27.03％,75.68％and 21.62％,respec-tively.There was a significant intergroup differences in lesion location,morphology,boundaries and pancreatic duct dilatation or cutoff(x 2=31.862,x2=44.048,x 2=39.141,and x 2=47.815,respectively,P＜0.05),with no significant differences in hypoechoic and blood flow signal(x2=2.840 and x2=2.193,P＞0.05).Among the 52 patients with PNET,CEUS showed that 38 had hyperenhancement and 14 had iso-enhancement in the arterial phase,whereas 40 had iso-enhancement and 12 had hypoenhancement in the venous phase.CEUS was performed in 74 patients with PDAC;70 patients showed hypoenhancement in the arterial phase and 72 showed hypoenhancement in the venous phase.There were significant differences in the enhancement pattern in the arterial and venous phases between the two groups(x 2=56.582 and x 2=37.852,P＜0.05).Conclusion Ultrasound and CEUS revealed some characteristics of PNET that can be used for the differential diagnosis of PNET and PDAC,when combined with enhancement pattern.

Objective:To explore the differences of the diagnostic performance between the most recent 2018 version of liver imaging reporting and data system (LI-RADS v2018) and 2017 version (LI-RADS v2017) based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI to diagnose hepatocellular carcinoma (HCC) in high-risk patients.Methods:The clinical data and imaging findings of 237 patients in high-risk of HCC who underwent Gd-EOB-DTPA enhanced MRI and obtained postoperative or biopsy pathological results within one month from June 2016 to December 2019 in Tianjin Third Central Hospital were collected retrospectively. A total of 282 observations were obtained as study objects. Two independent radiologists blindly reviewed the preoperative MRI of all patients. The observations were categorized according to LI-RADS v2018 and v2017 respectively. The inter-observer agreement of the categorization between the two radiologists was tested by kappa analysis. With the LR-5 and LR-4+5 as the diagnosis of HCC, the sensitivity, specificity, accuracy, and Youden index of the LI-RADS v2017 and LI-RADS v2018 were evaluated with postoperative histopathological results as references. The McNemar test was used to compare the diagnostic performance between the two versions.Results:The two physicians had good consistency in the categorization of observations, with kappa values between 0.536 and 0.793. Using LR-5 as the criterion for HCC diagnosis, the Youden index (0.687) of LI-RADS v2018 was higher than that of v2017 (0.612). The sensitivity [80.6% (166/206)] and accuracy [82.6% (233/282)] were both higher than those of LI-RADS v2017 [70.4% (145/206) and 75.9%(214/282)] (χ2=19.048, 14.087, both P<0.001). The specificity was slightly lower [88.2%(67/76) and 90.8%(69/76), respectively], but there was no statistical difference (χ2=0.500, P=0.500). With LR-4+5 as the diagnosis of HCC, the diagnostic performance of the two versions was the same. The sensitivity [91.3% (188/206)] and accuracy [87.6% (247/282)] were higher, and the specificity [77.6% (59/76)] were lower than the LR-5 standard of LI-RADS v2018 (χ2=20.045, P<0.001; χ2=5.633, P=0.018; χ2=16.056, P<0.001), and the Youden index (0.689) was also higher than the LR-5 standard of LI-RADS v2018. Conclusions:Based on Gd-EOB-DTPA enhanced MRI, the LI-RADS v2018 has higher sensitivity and accuracy in diagnosing HCC than v2017. Correct use can provide more objective diagnostic evidence for the clinic.

Objective To summarize and analyze the results of our university graduates' participation in the national medical licensing examination in order to investigate the clinical medical teaching reform.Methods There were 770 candidates who took the NMLE from 2011 to 2013.Excel 2007 was used to statistically analyze the total score,passing rate,average score and mastery rate for each subject,and average score and mastery rate at different cognitive level.Results In these three years,our candidates' total pass rate was higher than the national average total pass rate,respectively higher 17.11％,18.10％,17.82％;the pass rate of practical skills examination was also higher than the national average pass rate,respectively higher 7.30％ and 7.19％ and 5.90％;the pass rate of theory examination was higher than the national average pass rate,respectively higher 12.91％,12.97％ and 14.29％.The average score and mastery rate for each subject,the average score and mastery rate at different cognitive level were also all higher than those of the national average of medical colleges.Conclusions National medical licensure examination can be used as an important reference,through optimization of medical curriculum and teaching mode,optimization of clinical practice skills training system and optimization of clinical practical skill evaluation system etc.,to further improve the clinical medical personnel training mode.

OBJECTIVE:To establish a method for the content determination of paeoniflorin in Bazhen pill(concentrated pill). METHODS:HPLC was performed on the column of wondasil C18 with mobile phase of acetonitrile-1% phosphoric acid(15∶85, V/V)at a flow rate of 1.0 ml/min,the detection wavelength was 230 nm,and column temperature was 30 ℃. RESULTS:The lin-ear range of paeoniflorin was 0219-1.32 μg(r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 1%;recovery was 95.82%-101.82%(RSD=2.13%,n=6). CONCLUSIONS:The method is simple,stable and reproducible, and can be used for the content determination of Bazhen pill(concentrated pill).

Objective To explore the risk factors of meningoencephalitis with hand-foot-mouth disease (HFMD) for predictive evaluating and providing evidence for nursing measures. Methods According to the presence of meningoencephalitis, 998 cases with hand-foot-mouth disease were divided into the meningoencephalitis and non meningoencephalitis group. The difference of clinical manifestations, signs and laboratory test resultsbetween two groups were discussed by retrospective analyzing from the perspective of nursing, and we used single factor analysis method to reveal the risk factors of meningoencephalitis. Results The statistical analysis showed that there was a statistical significance in using frequently myoclonicjerk,limbjitter, vomiting,limb weakness, continued highfever, abnormal breathing, circulation dysfunction, blood WBC count and elevatedblood glucoseto predict meningoencephalitis with hand-foot-mouth disease ( P < 0. 05 ). The sensitivity respectively were frequently myoclonic jerk (95. 05% ),blood WBC count (90. 10% ),continued high fever (89. 11% ),abnormal breathing (77. 24% ), elevated blood glucose (63. 37% ),vomiting (42. 57% ), limb jitter (12. 38% ), circulation dysfunction ( 6. 93% ) and limb weakness ( 6. 93% ). The specificity respectively were circulation dysfunction (99. 87% ), limb weakness (99. 75% ), limb jitter (99. 75% ), frequently myoclonic jerk (99. 62% ),vomiting (91. 46% ),abnormal breathing (66. 33% ),continued high fever (65. 33% ), elevated blood glucose (47. 61% ) and blood WBC count (47. 24% ). Conclusions The nurses should strengthen the nursing observation on children with myoclonicjerk, limbjitter, vomiting, limbweakness, continued high fever, abnormal breathing, circulation dysfunction, blood WBC count and elevatedblood glucose. The corresponding nursing intervention measures are also formulated and timely finding meningoencephalitis with HFMD for reducing the developments of severe disease and the mortality.