BackgroundFamily functioning is one of the factors influencing non-suicidal self-injury （NSSI） behaviors in adolescents with depressive disorders. Previous studies have treated family functioning as a unitary construct， which may obscure the differential impacts of specific dimensions on NSSI behaviors. ObjectiveTo explore the relationships between various dimensions of family functioning and NSSI behaviors in adolescents with depressive disorders， aiming to provide precise targets for family-based interventions for adolescents with depressive disorders who exhibit NSSI behaviors. MethodsIn this cross-sectional study， 217 adolescent patients who were treated at the outpatient or inpatient department of The First Psychiatric Hospital of Harbin from January to July 2025 and met the diagnostic criteria for depressive disorders as stipulated in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were included as the research subjects. Assessments included a self-designed questionnaire， the Hamilton Depression Scale-17 item （HAMD-17）， and the Family Assessment Device （FAD）. Univariate Logistic regression analysis was employed to investigate the association between each dimension of family functioning and the NSSI behaviors， and multivariate Logistic regression was used to test the independent effect of each dimension of family functioning on the NSSI behaviors. ResultsA total of 204 cases （94.01%） of adolescent patients with depressive disorders completed the valid questionnaire survey. Among them， 134 cases （65.69%） exhibited NSSI behaviors （NSSI group）， and 70 cases （34.31%） did not exhibit NSSI behaviors （non-NSSI group）. Compared with the non-NSSI group， the NSSI group had a higher HAMD-17 score ［（20.97±7.50） vs. （17.79±6.95）， t=8.705， P=0.004］， a higher FAD total score ［（155.68±21.84） vs. （148.87±22.72）， t=4.348， P=0.038］， and a higher problem-solving dimension score ［（2.54±0.49） vs. （2.34±0.51）， t=7.399， P=0.007］. All the differences were statistically significant. The results of the Logistic regression analysis showed that the FAD total score （OR=1.014， 95% CI： 1.001–1.028， P=0.041） and the problem-solving dimension score （OR=2.241， 95% CI： 1.228–4.090， P=0.009） were both risk factors for NSSI behaviors. After adjusting for gender， age， residence， educational level， monthly family income， and whether being an only child， the correlation between the FAD total score and NSSI behaviors was not statistically significant （OR=1.010， 95% CI： 0.995–1.025， P=0.185）， while the correlation between the FAD problem-solving dimension score and NSSI behaviors remained statistically significant （OR=2.000， 95% CI： 1.028–3.889， P=0.041）. ConclusionImpaired problem-solving capacity within family functioning may constitute a risk factor for NSSI behaviors in adolescents with depressive disorders. ［Funded by Research Project of Heilongjiang Provincial Health Commission （number， 20240303090148， 20230303090154）］

AIM:To evaluate the clinical efficacy of 0.05% cyclosporine eye drops(Ⅱ)combined with sodium hyaluronate eye drops in treating patients with type 2 diabetes mellitus(T2DM)and moderate-to-severe dry eye.METHODS:A total of 120 T2DM patients(120 eyes)with moderate-to-severe dry eye, treated at the endocrinology and ophthalmology departments at the Affiliated Hospital of Xuzhou Medical University from January 2024 to September 2024, were enrolled in the study. The patients were randomly divided into two groups: combination group [0.05% cyclosporine eye drops(Ⅱ)+ sodium hyaluronate eye drops] and control group(sodium hyaluronate eye drops alone), with 60 cases(60 eyes)in each group. Assessments were conducted at baseline and at 1, 2, and 3 mo post-treatment, including the ocular surface disease index(OSDI), non-contact tear meniscus height(NITMH), first non-invasive tear breakup time(NIBUTf), meibomian gland loss score, lipid layer thickness grade, conjunctival hyperemia grade, and corneal fluorescein staining(FL)score. At 3 mo after treatment, changes in tear inflammatory factors were observed, and corneal subbasal nerve plexus(SBN)morphology/density were analyzed using in vivo confocal microscopy(IVCM).RESULTS:At 1, 2, and 3 mo post-treatment, both groups showed statistically significant increases in NITMH and NIBUTf compared to baseline(all P<0.05), with greater improvement observed in the combination group(both P<0.05). OSDI and FL scores significantly decreased from baseline(all P<0.05), with more pronounced reductions in the combination group(both P<0.05). Meibomian gland loss scores showed no significant improvement in either group(all P>0.05). At 3 mo after treatment, tear levels of interleukin 6(IL-6)and matrix metalloproteinase-9(MMP-9)significantly decreased in both groups(all P<0.001), with a greater reduction noted in the combination group(both P<0.001). The combination group displayed increased corneal nerve branch density and nerve fiber density, along with decreased nerve tortuosity and dendritic cell(DC)density compared to baseline(all P<0.001), while the control group did not show significant changes(all P>0.05).CONCLUSION: The combination of 0.05% cyclosporine eye drops(Ⅱ)and sodium hyaluronate eye drops significantly improves clinical outcomes in T2DM patients with moderate-to-severe dry eye. This treatment effectively alleviates ocular surface inflammation, restores corneal nerve morphology and density, and demonstrates a favorable safety profile.

AIM: To explore the risk factors associated with diabetic retinopathy(DR)based on ultra-widefield swept-source optical coherence tomography angiography(UWF-SS-OCTA), and to establish a clinical prediction model.METHODS:A total of 235 patients(235 eyes)with type 2 diabetes mellitus who were treated in the Affiliated Hospital of Xuzhou Medical University from July to November 2024 were selected as the research objects. According to the presence or absence of DR, they were divided into 120 cases(120 eyes)in non-DR group(NDR group)and 115 cases(115 eyes)in non-proliferative DR group(NPDR group). Data on general characteristics, laboratory tests, and OCTA results were collected for both groups. Univariate analysis was employed to identify DR-related risk factors. Logistic regression analysis was conducted to analyze these risk factors and to establish a DR prediction model. The efficacy of the model was evaluated using the receiver operating characteristic(ROC)curve, calibration curve, and decision curve analysis(DCA).RESULTS: The duration of diabetes, fasting blood glucose, blood urea nitrogen(BUN), history of hypertension, and the choroidal vascular index(CVI)were found to be statistically significant in the model(all P<0.05). Specifically, the duration of diabetes, fasting blood glucose, BUN, and history of hypertension were identified as risk factors for DR among diabetic patients, while CVI was recognized as a protective factor. The area under the curve for the model predicting the probability of DR was 0.898(0.859-0.938), with a diagnostic threshold of 0.438. The corresponding sensitivity and specificity were 87.8% and 78.3%, respectively, indicating that the model possesses high predictive value for the occurrence of DR.CONCLUSION: The duration of diabetes, fasting blood glucose, BUN, history of hypertension, and CVI are significantly correlated with DR. The established prediction model demonstrates a substantial screening capability for DR.

AIM:To quantitatively assess the early alterations of retinal and choroidal microcirculation and microstructure in systemic lupus erythematosus(SLE)patients without coexisting retinopathy via ultra-widefield swept-source optical coherence tomography angiography(UWF SS-OCTA).METHODS:Cross-sectional study. Totally 64 cases(64 eyes)that diagnosed as SLE without associated retinopathy at the Affiliated Hospital of Xuzhou Medical University from May to October 2024 were enrolled as the study group(Randomly assign one eye to the study group). Simultaneously, age-and gender-matched healthy individuals were recruited as the control group. All participants underwent UWF SS-OCTA. The deep capillary plexus(DCP), superficial capillary plexus(SCP), total retina, choriocapillaris(CC), as well as the choroidal medium and large vessel density(VD)in both the central and peripheral retinal areas of both groups of patients were compared. Additionally, parameters such as choroidal vascularity volume(CVV), choroidal vascularity index(CVI), thickness of the inner retina, outer retina, entire retina, and choroid in both central and peripheral area. SLE patients were categorized into three subgroups based on the SLE disease activity index(SLEDAI-2K), including 20 cases(20 eyes)in mild-and no-activity group(SLEDAI-2K≤6), 20 cases(20 eyes)in moderate-activity group(7

Objective To explore the feasibility of applying artificial intelligence (AI) technology in chromosomal aberration (CA) analysis for occupational health surveillance of radiation workers and in biological dose estimation during nuclear emergency responses. Methods Peripheral blood samples from healthy volunteers were irradiated in vitro with X-rays and cobalt-60 (⁶⁰Co) γ rays. Chromosome slides were prepared using an automated harvesting and dropping device. The data training and outcome evaluation of CA analysis was performed on the AI software using chromosome images from occupational medical examination of radiation workers from the current lab or chromosome slides from blood samples irradiated with X-rays. The trained AI software was then used to assist in CA analysis and biological dose estimation among occupational medical examination of radiation workers, with results compared with manual reading and actual exposure doses. Results The trained AI software achieved a CA recognition accuracy of 95.11%. In the occupational health examination of radiation workers, the positive CA detection rate using AI + manual review was 2.25% higher than that in manual reviewing alone. The errors in biological dose estimation for ⁶⁰Co γ rays and X-rays using AI + manual review analysis were 11.86% and 7.33%, respectively, both within the acceptable 20.00% error margin. Conclusion AI + manual review can be effectively applied in CA analysis for occupational health examination and biological dose estimation during nuclear emergencies, significantly improving analysis efficiency.

BackgroundNon-suicidal self-injury （NSSI） behaviors are common among adolescents with depressive disorders， and school bullying is recognized as a major risk factor. Previous research has shown that self-esteem and alexithymia are closely associated with both school bullying and NSSI. However， the mediating roles of self-esteem and alexithymia in the link between school bullying and NSSI are unclear. ObjectiveTo explore the mediating roles of alexithymia and self-esteem in the relationship between school bullying and NSSI behaviors in adolescents with depressive disorders， in order to inform intervention strategies targeting NSSI in this population. MethodsA total of 335 adolescents diagnosed with depressive disorders and treated at the First Psychiatric Hospital of Harbin from July 2023 to October 2024 were enrolled. Assessments included a self-developed demographic questionnaire， Adolescent Non-suicidal Self-injury Assessment Questionnaire-Behavior （ANSAQ-B）， Delaware Bullying Victimization Scale-Student （DBVS-S）， Rosenberg Self-Esteem Scale （RSES）， and 26-item Toronto Alexithymia Scale （TAS-26）. Pearson correlation analysis was used to examine the relationship among variables. Controlling for gender and age at onset of depressive symptoms， mediation analysis was performed using the “mediation” package in R 4.4.2. ResultsScores on DBVS-S and TAS-26 were positively correlated with ANSAQ-B score （r=0.408， 0.417， P<0.01）， while RSES scores were negatively correlated（r=-0.300， P<0.01）. Regression analysis showed that school bullying and alexithymia significantly positively predicted NSSI behaviors （B=0.212， 0.333， P<0.01）， while self-esteem negatively predicted NSSI behaviors （B=-0.368， P<0.01）. Alexithymia was found to mediate the relationship between school bullying and NSSI behaviors， with an indirect effect of 0.040 （95% CI： 0.018~0.069） ，account for 17.17% of the total effect. The indirect effect through self-esteem was not statistically significant （95% CI： -0.004~0.069）. ConclusionExposure to school bullying and high levels of alexithymia are important predictors of NSSI behavior in adolescents with depressive disorders， and school bullying may indirectly influence NSSI behavior through alexithymia. ［Funded by Scientific Research Project of Health Commition of Heilongjiang Province，（number， 20230303090154］

Objective To observe the effectiveness and safety of pirfenidone in the prevention and treatment of radiation-induced lung injury in esophageal cancer.Methods We retrospectively analyzed the data of 103 patients with esophageal cancer,of whom 53 in the combined group were treated with simultaneous chemoradiotherapy combined with pirfenidone and 50 in the control group were treated with simultaneous chemoradiotherapy only.The patients were followed up for three years to observe the treatment effects,adverse effects,and survival,as well as the incidence of radiation-induced lung injury,lung function,and changes in lung injury cytokine levels within one year after radiotherapy.Results Treatment efficiency in the combined group was higher than that in the control group(86.8%vs.70.0%,P＜0.05).The two-and three-year survival rates in the combined group were 84.9%and 71.7%,respectively,which were higher than those(68.0%and 52.0%)in the control group(P＜0.05).The one-,two-,and three-year disease-free survival rates in the combined group were 86.8%,67.9%,and 47.2%,respectively,which were higher than those(62.0%,46.0%,and 28.0%)in the control group(P＜0.05).The incidence rates of radiation pneumonitis at three months,pulmonary fibrosis at six months,and one year after radiotherapy in the combined group were 22.6%,13.2%,and 14.0%,respectively,which were lower than those(42.0%,30.0%,and 31.8%)in the control group at the same time(P＜0.05).At the end of radiotherapy and at three months,six months and one year after radiotherapy,the combined group showed higher levels of lung function indicators but lower levels of lung injury-related cytokines than the control group(P＜0.05).The incidence of rash in the combined group was 18.9%,which was higher than that(2.0%)in the control group(P＜0.05).However,no statistically significant difference in the incidence and severity of other adverse reactions was found between the two groups(P＞0.05).Conclusion Pirfenidone not only effectively reduces radiation-induced lung injury and improves lung function in esophageal cancer patients undergoing simultaneous chemoradiotherapy,but also helps improve tumor control rates and patient survival with a good safety profile.

Objective:To explore the job preference and willingness to pay of resident training physicians in Chengdu, China.Methods:The questionnaire was designed by means of the discrete choice experiment. The questionnaire contains the basic information of the survey object and the discrete choice set (including workplace, working intensity, monthly salary, staffing of public institution, and career development, each with several levels). A total of 116 resident training physicians recruited by three standardized residents training centers in Chengdu were selected to conduct the questionnaire survey, and grouped based on their identity and major. The mixed logit model was used to analyze job preferences and willingness to pay of resident training physicians.Results:Except for career development, other four attributes had statistically significant effects on job selection of resident training physicians ( P<0.05), of which working intensity was the most influential attribute, with the highest willingness to pay. The subgroup analysis results showed that staffing of public institution was concerned by clinical postgraduates and resident training physicians in non-scarce majors. Conclusions:Economic and non-economic factors both affect the job preferences of resident training physicians, while working intensity is the most important factor. Resident training policy should focus on adjusting the scale and type of resident physician enrollment, and strengthen humanistic care and career education of resident training physicians.

Objective:To explore the job preference and willingness to pay of resident training physicians in Chengdu, China.Methods:The questionnaire was designed by means of the discrete choice experiment. The questionnaire contains the basic information of the survey object and the discrete choice set (including workplace, working intensity, monthly salary, staffing of public institution, and career development, each with several levels). A total of 116 resident training physicians recruited by three standardized residents training centers in Chengdu were selected to conduct the questionnaire survey, and grouped based on their identity and major. The mixed logit model was used to analyze job preferences and willingness to pay of resident training physicians.Results:Except for career development, other four attributes had statistically significant effects on job selection of resident training physicians ( P<0.05), of which working intensity was the most influential attribute, with the highest willingness to pay. The subgroup analysis results showed that staffing of public institution was concerned by clinical postgraduates and resident training physicians in non-scarce majors. Conclusions:Economic and non-economic factors both affect the job preferences of resident training physicians, while working intensity is the most important factor. Resident training policy should focus on adjusting the scale and type of resident physician enrollment, and strengthen humanistic care and career education of resident training physicians.

Objective To observe the effectiveness and safety of pirfenidone in the prevention and treatment of radiation-induced lung injury in esophageal cancer.Methods We retrospectively analyzed the data of 103 patients with esophageal cancer,of whom 53 in the combined group were treated with simultaneous chemoradiotherapy combined with pirfenidone and 50 in the control group were treated with simultaneous chemoradiotherapy only.The patients were followed up for three years to observe the treatment effects,adverse effects,and survival,as well as the incidence of radiation-induced lung injury,lung function,and changes in lung injury cytokine levels within one year after radiotherapy.Results Treatment efficiency in the combined group was higher than that in the control group(86.8%vs.70.0%,P＜0.05).The two-and three-year survival rates in the combined group were 84.9%and 71.7%,respectively,which were higher than those(68.0%and 52.0%)in the control group(P＜0.05).The one-,two-,and three-year disease-free survival rates in the combined group were 86.8%,67.9%,and 47.2%,respectively,which were higher than those(62.0%,46.0%,and 28.0%)in the control group(P＜0.05).The incidence rates of radiation pneumonitis at three months,pulmonary fibrosis at six months,and one year after radiotherapy in the combined group were 22.6%,13.2%,and 14.0%,respectively,which were lower than those(42.0%,30.0%,and 31.8%)in the control group at the same time(P＜0.05).At the end of radiotherapy and at three months,six months and one year after radiotherapy,the combined group showed higher levels of lung function indicators but lower levels of lung injury-related cytokines than the control group(P＜0.05).The incidence of rash in the combined group was 18.9%,which was higher than that(2.0%)in the control group(P＜0.05).However,no statistically significant difference in the incidence and severity of other adverse reactions was found between the two groups(P＞0.05).Conclusion Pirfenidone not only effectively reduces radiation-induced lung injury and improves lung function in esophageal cancer patients undergoing simultaneous chemoradiotherapy,but also helps improve tumor control rates and patient survival with a good safety profile.