Abstract The global prevalence of non-suicidal self-harm (NSSI) among adolescents is becoming increasingly severe. Traditional mental health services are struggling to meet the growing social demand due to limited resource allocation and service accessibility. The rapid development of artificial intelligence (AI) technology provides a new technological path. The article systematically reviews the research progress of AI technology in adolescent NSSI, demonstrating key technologies such as machine learning, natural language processing, and deep learning in predicting NSSI risk prediction, emotion recognition and online intervention for adolescents. However, challenges remain, including algorithm bias, data privacy protection, model interpretability and ethical decision making. Future research should focus on multi disciplinary collaborative cooperation based on artificial intelligence to build a safe, effective and sustainable digital psychological intervention system, so as to provide innovative strategies and technical support for the early warning and intervention of NSSI behavior in adolescents.

Objective To explore the effect of proprioceptive neuromuscular facilitation(PNF)on the knee abduction torque and vastus medialis-medial gastrocnemius(VM-MG)co-contraction index during walking among the old patients with medial compartment knee osteoarthritis. Methods From March to May,2022,32 old patients with medial compartment knee osteoarthritis in communities in Ji'nan were enrolled and randomly allocated to control group(n=16)and training group(n=16).The training group received PNF and the control group received home-based exercise,for six weeks.The knee abduction torque and VM-MG co-contraction index were measured using an infrared motion capture system synchronized with 3D force plate and electromyography system before and after treatment. Results Three cases in the control group and two cases in the training group dropped off.The first and the second peaks of knee abduction torque,and the VM-MG co-contraction index improved in the training group after treatment(|t|>2.460,P<0.05),and the first and the second peaks of knee abduction torque were better in the training group than in the control group(|t|>2.454,P<0.05). Conclusion PNF may optimize the load distribution between the medial and lateral compartments of the knee in patients with knee osteoarthritis.

Objective:To study the use of the da Vinci robot in distal pancreatectomy.Methods:The data of 53 patients who underwent minimally invasive distal pancreatectomy at the Department of General Surgery of the Affiliated Hospital of Xuzhou Medical University from February 2017 to March 2022 were retrospectively analysed. There were 16 males and 37 females, aged (48.2±16.9) years. These patients were divided into the robot assisted pancreatectomy group (the robot group, n=18) and the laparoscopic pancreatectomy group (the laparoscopic group, n=35) based on the surgical treatment methods. The operations were performed by the same team of surgeons. All patients were diagnosed to have benign or borderline malignant tumors of body and tail of pancreas by preoperative examinations. The success rate of spleen preservation distal pancreatectomy, operation time, intraoperative bleeding, and postoperative complications (including pancreatic fistula, postoperative bleeding, abdominal infection) were compared between the two groups. Results:Spleen preserving distal pancreatectomy was successfully carried out in 13 patients (72.2%) in the robot group and 15 patients (42.9%) in the laparoscopic group. The rate of spleen preservation in the robot group was significantly higher than that in the laparoscopic group (χ 2=4.11, P=0.043). Intraoperative blood loss (104.4±69.3) ml and time to first postoperative passage of flatus were (3.7±1.0) d in the robot group were significantly better than the laparoscopic group (199.4±102.9) ml and (4.8±1.3) d, respectively (both P<0.05). The total incidence of complications in the robot group was 7 cases (38.9%), compared with 14 cases (40.0%) in the laparoscopic group, with no significant difference between the two groups(χ 2=0.006, P=0.938). Conclusions:Robotic-assisted distal pancreatectomy was safe and feasible, and it had advantages in resulting in better spleen preservation than laparoscopic distal pancreatectomy.

ObjectiveTo investigate the effect and mechanism of Biejiajian Wan on liver fibrosis by regulating the polarization of macrophages. MethodRaw264.7 cells were cultured in vitro by serum pharmacological method， and the hypoxia model of RAW264.7 cells was established by stimulating RAW264.7 cells with cobalt chloride （CoCl₂）. The cells were randomly divided into blank group， CoCl₂ hypoxia model group （200 mmol·L^-1）， Biejiajian Wan low-dose group （200 mmol·L^-1+0.55 g·kg^-1 Fuzheng Quyu capsules）， medium-dose group （200 mmol·L^-1+1.1 g·kg^-1 Biejiajian Wan）， and high-dose group （200 mmol·L^-1+2.2 g·kg^-1 Biejiajian Wan） and Fuzheng Quyu capsule group （200 mmol·L^-1+0.56 g·kg^-1 Biejiajian Wan）. Cell proliferation was detected by cell counting kit-8 （CCK-8）， and the gene expression of hypoxia inducible factor-1α （HIF-1α）， interleukin-1β （IL-1β） and interleukin-6 （IL-6） in macrophages was detected by real time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The expression of macrophage polarization-related protein and HIF-1α/nuclear factor-kappa B （NF-κB） signaling pathway-related protein was tested by Western blot， and the distribution and expression of NF-κB signaling pathway-related protein and HIF-1α were determined by cell immunofluorescence. ResultCompared with the conditions in the blank group， the proliferation of RAW264.7 cells was inhibited after CoCl₂ stimulation for 24 hours （P<0.05）， the mRNA expression of HIF-1α， IL-1β and IL-6 in the model group were increased （P<0.05）， the protein expression of HIF-1α and M1 macrophage phenotypic proteins IL-6 and tumor necrosis factor-α （TNF-α） was boosted while that of M2 macrophage phenotypic protein interleukin-10 （IL-10） was reduced （P<0.05）， the protein expression of NF-κB p65， phosphorylation （p）-NF-κB p65， phosphorylated NF-κB inhibits protein kinase α/β （p-IKKα/β） and phosphorylated NF-κB inhibits protein α (p-IκBα） was elevated （P<0.05）， the nuclear expression of HIF-1α and NF-κB p65 was promoted. Compared with the conditions in the model group， after 24 hours of treatment with corresponding drug-containing serum， each treatment group promoted the proliferation of RAW264.7 cells （P<0.05）， the mRNA expression levels of HIF-1α， IL-1β and IL-6 in macrophages were reduced （P<0.05）， the protein expression of HIF-1α， IL-6 and TNF-α was decreased， while that of CD163 and IL-10 was increased （P<0.05）， the protein expression of NF-κB p65， p-NF-κB p65， p-IKKα/β and p-IκBα was lowered （P<0.05）， the nuclear expression of HIF-1α and NF-κB p65 was inhibited. ConclusionBiejiajian Wan could modulate the polarization of macrophages， attenuate the injury of macrophage-associated inflammatory response under hypoxia， and thus delay the progression of liver fibrosis， which might be related to its regulation of HIF-1α/NF-κB signaling pathway.

Objective: To investigate the safety and efficacy of 3-dimensional (3D) printing noncoplanar templates (PNCT) assisted computer tomography (CT) guided radioactive125I seed implantation (RISI) for the treatment of recurrent cervical carcinoma (RCC) after external beam radiotherapy (EBRT). Methods: A total of 103 patients with inoperable post-EBRT RCC were included in this retrospective study. A total of 111 lesions received RISI. Eight lesions were at the pelvic center, 75 lesions were at the pelvic lateral, and 28 lesions were extra-pelvic metastasis. The median prescription dose was 120 Gy. The primary end points were adverse events and local control (LC), and the secondary end points were overall survival (OS) and progression-free survival. Results: Grade 2 adverse events of acute nausea, diarrhea, and pollakiuria occurred in 1, 2, and 1 patient, respectively. One patient suffered from grade 3 acute proctitis. Late toxicity was observed in 2 patients with rectovaginal fistula. No grade 5 toxicity occurred. The 3-year LC and OS rates were 75.1% and 20.8%, respectively. The median OS was 17 months. The multivariate analysis showed that the minimum dose received by the “hottest” 90% of the gross tumor volume (D 90 ) ≥130 Gy, squamous cell carcinoma, hemoglobin ≥80 g/L and good short-term efficacy (complete response or partial response) were independent predictors of LC and OS (all p<0.05). Conclusions 3D-PNCT assisted CT-guided RISI is a safe, effective, and minimally invasive modality for RCC. The hemoglobin level, pathological type, dose distribution and short-term efficacy are considered as independent factors for clinical outcomes.

Cervical cancer is a common malignancy in women. Surgery and radiotherapy are the main therapeutic approaches. The recurrence rate of cervical cancer is high and the prognosis is relatively poor. Recurrent cervical cancer can be classified into the central pelvic, lateral pelvic and extra-pelvic recurrence. The management of recurrent cervical cancer mainly depends on previous therapeutic approaches and the recurrence site. Surgical resection is the optimal option for patients who have no history of radiotherapy, if feasible, chemoradiotherapy±brachytherapy can be considered. Patients with central pelvic recurrence after radiotherapy are suitable candidates for pelvic exenteration±intraoperative radiotherapy. However, the indications are highly selective, the incidence of postoperative complications is high and the quality of life is poor. Patients with lateral pelvic recurrence after radiotherapy could be treated by re-radiotherapy or chemotherapy. However, the incidence of serious side effects of re-radiotherapy is higher than that of the initial radiotherapy. The indications for stereotactic body radiotherapy are limited and the surgical skill of the surgeons is demanding. In recent years, radiotherapy technology has become more precise. Image-guided brachytherapy, such as high-dose-rate interstitial brachytherapy and radioactive 125I seed implantation, has achieved high efficacy and safety, which may provide new treatment options for recurrent cervical cancer. In this article, research progress on brachytherapy for recurrent cervical cancer was summarized and reviewed.

Objective Todiscusstheangiographicfeaturesofhepaticneuroendocrineneoplasm(NEN),and to analyze the survival time of patients.Methods The clinical data of 60 patients with hepatic NEN were retrospectively reviewed.Transcatheter arterial chemoembolization (TACE),used as main therapy,was employed in 17 patients,22 patients received palliative treatment with no use of TACE,and 21 didn't receive any related treatment.The angiographic features of hepatic NEN were analyzed.Kaplan-Meier method was used to calculate the survival rate,and the survival prognostic factors were evaluated by Cox multivariate analysis method.Results Angiography showed that most neuroendocrine tumors (NETs) were characterized by hypovascular lesion,while neuroendocrine carcinomas (NECs) were manifested as hypervascular mass.The median overall survival time of 60 patients was 13.8 months.The 6-month,one-,2-and 3-year cumulative survival rates were 85.0％,52.0％,40.0％ and 33.8％,respectively.Cox regression analysis indicated that pathological grade of tumor (P=0.001) and treatment mode (P＜0.001) were the independent prognostic factors.Conclusion The rich or poor vascularity of hepatic NEN is helpful for the judgment of tumor grading.Patients whose hepatic NENs belong to high pathological grade (grade Ⅲ) usually have a poor prognosis.TACE is an effective therapy for hepatic NEN.

Objective To discuss the safety and efficacy of using ExoSealTM vascular closure device to obtain rapid hemostasis of puncture site in interventional procedure via retrograde femoral artery access.Methods The clinical data of 124 patients,who were admitted to authors' hospital during the period from March 2016 to April 2016 to receive interventional procedure via retrograde femoral artery access,were retrospectively analyzed.During the performance of intervention,ExoSealTM vascular closure device (ExoSealTM group,n=52) or manual compression (MC group,n=72) was employed to make femoral artery puncture point hemostasis.The time spent for hemostasis,the manual compression time,the limb immobilization time,the amount of blood loss during compression process,and the procedure-related complications were recorded and the results were compared between the two groups.Results Technical success rate in ExoSealTM group was 98.1％(51/52).In ExoSealTM group and MC group,the time spent for hemostasis was (0.28±0.08) min and (5.83±1.46) min respectively,the manual compression time was (2.65 ±0.57) min and (7.70± 1.88) min respectively,the limb immobilization time was (2.72±0.43) h and (6.15±0.69) h respectively;all the differences between the two groups were statistically significant (P＜0.01).In ExoSealTM group subcutaneous hemotoma occurred in one patient,while in MC group subcutaneous hemotoma occurred in 3 patients and pseudoaneurysm in one patient;the complication rates were 1.92％ (1/52) and 5.56％ (4/72) respectively,but the difference was not statistically significant (P＞0.05).In MC group the amount of blood loss during compression process was (1.11±0.86) ml,which was remarkably less than (7.83±2.08) ml in ExoSealTM group,the difference between the two groups was statistically significant (P＜0.01).Conclusion For hemostasis of puncture site in interventional management via retrograde femoral artery access,the use of ExoSealTM vascular closure device is safe and effective.

Objective To explore the changes of bulbocavemosus sphincter reflex (BCR) in male rabbit models of spinal cord ischemia injury of different levels at acute stage and their values in predicting spinal cord functions,and provide theoretical basis for protecting the spinal cord function by neurophysiology examination in clinical microsurgical operation.Methods Thirty-six adult New Zealand rabbits were randomly divided into 6 groups:a control group (n=6) was used to eliminate the effects of anesthesia and surgery on BCR;rabbits in the experimental group (n=30) were randomly divided into 5 groups (n=6) according to different levels of lumbar arteries being ligatured between the left renal artery and arterial bifurcate (subgroups of one,two,three,4 and 5 lumbar arteries being ligatured).BCR was recorded continuously within two h of ligation;rabbits in each group were subjected to double-blind Tarlov lower limb motor function scale before and 2 d after surgery;and ischemic spinal cord specimens were performed hematoxylin and eosin (HE) staining to observe pathological changes in sacral spinal cord ischemic areas after 2 days.Results There was no significant difference in BCR amplitude and latency between different time points after anesthesia (P＞0.05);there was no significant difference in BCR amplitude and latency between different time points before and after operation (P＞0.05).There was no significant change in the amplitude of BCR before and after one lumbar artery ligation;however,the BCR amplitude immediately changed after ligaturing two,three,4 or 5 lumbar arteries:the latency of BCR immediately began to extend and amplitude immediately began to reduce;amplitude was stable respectively after (0.7±0.4),(0.7±0.3),(0.7±0.3) and (0.6±0.3) min of ligation.The amplitude variation of BCR was positively correlated with Tarlov lower limb motor function scale scores 2 days after ligation (r=0.791,P=0.0001).HE staining showed that the normal sacral spinal cord structure was observed in the control group,subgroups of one and two lumbar arteries being ligatured;the basically normal sacral spinal cord structure was observed in the subgroup of three lumbar arteries being ligatured;the normal sacral spinal cord structure basically disappeared in the subgroup of 5 lumbar arteries being ligatured;the spinal cord injury of subgroup of 4 lumbar arteries being ligatured was between that of subgroup of three lumbar arteries being ligatured and subgroup of 5 lumbar arteries being ligatured.Conclusion The amplitude and latency of BCR in male rabbits are sensitive to sacral cord ischemic injury,which can help find ischemic injury in the reversible phase of the sacral cord ischemia and provide theoretical basis for the prevention of occurrence of male irreversible sacral spinal cord injury during microsurgery.

Objective To investigate the clinical effect of polyvinyl alcohol (PVA) particles combined with chemoembolization using chemotherapeutic agents or chemotherapeutic agents lipiodol emulsion (CALE)in the treatment of hepatocellular carcinoma (HCC) complicated by hepatic arteriovenous shunt (HAVS) and related prognostic factors.Methods A retrospective analysis was performed for the clinical data of 133 patients with HCC complicated by HAVS.HAVS was classified into slow-flow HAVS,intermediate-flow HAVS,and high-flow HAVS,which were treated with 300-500 μm,500-710 μm,and 710-1000 μm PVA particles,respectively.The patients with slow-flow and intermediate-flow HAVS underwent embolization with PVA combined with chemotherapeutic agents followed by CALE,while those with high-flow HAVS underwent the treatment with PVA combined with chemotherapeutic agents alone.The survival time,progression-free survival time,and postoperative complications were followed up and analyzed.The Kaplan-Meier method was used to calculate cumulative survival rate and the Cox proportional hazards model was used to determine prognostic factors.Results The median overall survival (OS) of 133 patients was 9.1 months,and the 6-,12-,and 24-month survival rates were 73.7％,36.2％,and 10.2％,respectively.The median OS of slow-flow group (36 patients),intermediate-flow group (58 patients),and high-flow group (39 patients) were 7.3,9.1,and 10.8 months,respectively.And the 6-and 12-month survival rates were 69.2％/19.0％,72.4％/39.2％,and 77.8％/42.7％,respectively.There was no significant difference in survival time between the patients with different types of HAVS (x 2 =2.865,P =0.239).The incidence rates of postoperative gastroesophageal variceal bleeding and acute liver failure were 1.1％ and 0.4％,respectively.The results of Cox regression analysis showed that preoperative alpha-fetoprotein level ≥ 400 ng/ml (HR =2.105,P =0.006) was an independent risk factor,while multiple embolizations (H7 =0.482,P =0.011),tumor remission (HR =0.431,P =0.041),and multimodality therapy (HR =0.416,P =0.004) were independent protective factors.Conclusion PVA particles combined with chemotherapeutic agents or CALE is safe and effective in the treatment of HCC complicated by HAVS.Patients with multiple embolizations,tumor remission,and multimodality therapy tend to have good prognosis,while those with a high level of alpha-fetoprotein before embolization often have poor prognosis.