OBJECTIVE To investigate the clinical characteristics of euglycemic diabetic ketoacidosis （euDKA） induced by empagliflozin， and provide references for safe medication. METHODS Case reports of euDKA induced by empagliflozin were retrieved and analyzed from PubMed， Web of Science， CNKI， and Wanfang Data. The Naranjo’s scale was adopted to assess the causal relationship between empagliflozin and euDKA. RESULTS A total of 29 patients were enrolled， including 16 males and 13 females，with a median age of 58 years. All patients were diagnosed with type 2 diabetes mellitus； 22 patients had at least one comorbidity. The median time to euDKA onset was 60 days after administration， and 7 cases occurred within 2 weeks of treatment. Perioperative periods，fasting，and low-carbohydrate or ketogenic diets were the main predisposing factors. Common presentations included nausea，vomiting， fatigue， tachypnea，and tachycardia. The causal relationship between empagliflozin and euDKA was assessed as “probable” in all cases. According to adverse reaction severity grading， 13 cases were grade 3 （severe） and 16 cases were grade 4 （life-threatening）. All patients discontinued empagliflozin and recovered after corresponding treatment. CONCLUSIONS euDKA is a serious adverse reaction to empagliflozin， which mostly occurs early in treatment. Perioperative periods， fasting， and ketogenic diets are prone to induce euDKA. Elderly patients and those with comorbidities are at higher risk. Risk assessment should be conducted before clinical administration； blood ketones and acid-base monitoring should be strengthened in the early medication period； withhold the drug before elective surgery， avoid prolonged fasting；upon diagnosis， discontinue empagliflozin and initiate intravenous insulin， provide fluid resuscitation promptly， and use other treatments to improve patient prognosis.

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.

Nonalcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis and insulin resistance and there are currently no approved drugs for its treatment. Hyperactivation of mTOR complex 1 (mTORC1) and subsequent impairment of the transcription factor EB (TFEB)-mediated autophagy-lysosomal pathway (ALP) are implicated in the development of NAFLD. Accordingly, agents that augment hepatic TFEB transcriptional activity may have therapeutic potential against NAFLD. The objective of this study was to investigate the effects of nuciferine, a major active component from lotus leaf, on NAFLD and its underlying mechanism of action. Here we show that nuciferine activated ALP and alleviated steatosis, insulin resistance in the livers of NAFLD mice and palmitic acid-challenged hepatocytes in a TFEB-dependent manner. Mechanistic investigation revealed that nuciferine interacts with the Ragulator subunit hepatitis B X-interacting protein and impairs the interaction of the Ragulator complex with Rag GTPases, thereby suppressing lysosomal localization and activity of mTORC1, which activates TFEB-mediated ALP and further ameliorates hepatic steatosis and insulin resistance. Our present results indicate that nuciferine may be a potential agent for treating NAFLD and that regulation of the mTORC1-TFEB-ALP axis could represent a novel pharmacological strategy to combat NAFLD.