ObjectiveTo investigate the non-suicidal self-injury （NSSI） behaviors in adolescents with depressive disorder， analyze related influencing factors， and provide theoretical basis and reference for the prevention and treatment of NSSI. MethodsAccording to DSM-5 criteria， 95 depressive adolescents were divided into two groups： one with NSSI （NSSI group） and one without NSSI （nNSSI group）. All patients were assessed with Adolescent Non-suicidal Self-injury Assessment Questionnaire （ANSAQ）， Self-Rating Depression Scale （SDS）， Self-Rating Anxiety Scale （SAS）， Simplified Coping Style Questionnaire （SCSQ）， Experiences in Close Relationships-Relationship Structures Scale （ECR-RS）， and Childhood Trauma Questionnaire-Short Form （CTQ-SF）. The inter-group differences were compared. The influencing factors of NSSI were analyzed by using binary logistic regression. ResultsOf the 95 depressive adolescents， 59 cases of NSSI were identified， with a detection rate of 62.11%. NSSI group had higher scores than nNSSI group on SDS， SAS， negative coping style， paternal attachment anxiety， maternal attachment anxiety and avoidance， CTQ-SF total score， emotional neglect， physical neglect， emotional abuse， and sexual abuse （all P<0.05）. Binary logistic regression analysis showed that anxiety， negative coping style， maternal attachment avoidance and emotional abuse increased the risk of NSSI among adolescents with depressive disorders （all P< 0.05）. ConclusionsAdolescents with depression have a high incidence of NSSI behaviors， which is related to anxiety， negative coping style， maternal attachment avoidance and emotional abuse. In addition to improving patients' depression and anxiety in clinical setting， attention should also be paid to patients' coping styles， parent-child relationship and childhood trauma to reduce the occurrence of NSSI behaviors.

Cognitive dysfunction is the impairment of higher brain functions.Cognitive impairment caused by neuropsychiatric diseases has caused serious impact on patients'quality of life and the outcome of the disease.The transcranial alternating current stimulation(tACS)improves cognitive function by modulating neural oscillations of specific frequencies,affecting the release of neurotransmitters such as serotonin and dopamine,and enhancing local and distal synchronization of brain networks.Specific frequencies of tACS can improve the cognitive impairment caused by Alzheimer disease(AD),schizophrenia,and depression,among which the gamma and theta frequencies of tACS have the most significant effects on cognitive function.tACS has high safety and low operational difficulty,and has great potential to improve cognitive function.

Objective:To explore the prognostic value of serum deoxyribonuclease 1 like 3 (Dnase1L3), C-reactive protein/albumin ratio (CAR) combined with monocyte to high-density lipoprotein cholesterol ratio (MHR) in decompensated hepatitis B cirrhosis patients.Methods:A prospective selection was conducted on 236 decompensated hepatitis B cirrhosis patients (liver disease group) admitted to the Third Hospital of Qinhuangdao from January 2020 to December 2021, and 185 healthy volunteers (control group) who underwent outpatient physical examinations. The serum levels of Dnase1L3, CAR, MHR, and liver function were detected, and Pearson analysis was conducted to investigate the correlation between Dnase1L3, CAR, MHR, and liver function. Tracking the survival status of patients after 30 days of hospitalization, the risk factors affecting 30 day mortality in decompensated hepatitis B cirrhosis patients were analyzed using a multivariate logistic regression equation. The receiver operating characteristic (ROC) curve analysis was used to assess the value of Dnase1L3, CAR, and MHR in predicting 30 day in-hospital mortality in decompensated hepatitis B cirrhosis patients.Results:The serum levels of Dnase1L3, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBiL), CAR, and MHR in the liver disease group were higher than those in the control group (all P<0.05). The serum levels of Dnase1L3, CAR, and MHR in the liver disease group were positively correlated with AST, ALT, and TBiL (all P<0.05). Among 236 patients, 32 died within 30 days. Model for end-stage liver disease (MELD) scores>18, high Dnase1L3, high CAR, and high MHR were risk factors for 30 day mortality in decompensated hepatitis B cirrhosis patients (all P<0.05). The combined prediction of Dnase1L3, CAR, MHR, and MELD scores for 30 day mortality in decompensated patients with hepatitis B cirrhosis showed an area under the curve of 0.904, which was higher than the predicted values of 0.719, 0.678, 0.763, and 0.742 for individual indicators. Conclusions:The serum Dnase1L3 levels, CAR, and MHR are elevated in patients with decompensated hepatitis B cirrhosis, and are associated with the degree of liver function damage and mortality within 30 days of hospitalization. They have high value in predicting the prognosis of decompensated hepatitis B cirrhosis.

Objective: To evaluate the incidence, treatment, and survival outcomes of Swyer syndrome with gonadal non-dysgerminoma malignant germ cell tumor (MGCT-NDG). Methods: A retrospective study was performed on Swyer syndrome patients with MGCT-NDG between January 2011 and December 2022 in Peking Union Medical College Hospital to investigate their characteristics and outcomes. Results: A total of 15 patients (4.9%, 15/307) with Swyer syndrome were identified in 307 MGCT-NDG patients. The average age at diagnosis of MGCT-NDG and Swyer syndrome were (16.8±6.7) and (16.7±6.6) years, respectively. Six cases were preoperatively diagnosed as Swyer syndrome, of which 4 cases received bilateral gonadectomy with or without hysterectomy, while the other 2 cases underwent removal of gonadal tumor and unilateral gonadectomy with hysterectomy, respectively. Of the 9 patients postoperatively diagnosed as Swyer syndrome, unilateral gonadectomy, removal of gonadal tumor, and unilateral gonadectomy with hysterectomy were performed in 6 patients, 2 patients, and 1 patient, respectively. Mixed malignant germ cell tumor (MGCT;10 cases), yolk sac tumor (4 cases), and immature teratoma (1 case) were the pathological subtypes, in the descending order. There were International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ in 6 cases, stage Ⅱ in 3 cases, stage Ⅲ in 5 cases, and stage Ⅳ in 1 case, respectively. Eleven patients received reoperation for residual gonadectomy after a average delay of (7.9±6.2) months, including 8 MGCT-NDG patients and 1 gonadoblastoma patient, no tumor involved was seen in the remaining gonads in the other 2 cases. Ten patients experienced at least one recurrence, with a median event free survival of 9 months (5, 30 months), of which 2 patients received surgery only at the time of initial treatment. All patients with recurrence received surgery and combined with postoperative chemotherapy. After a median follow-up of 25 months (15, 42 months), 10 patients were disease-free, 3 patients died of the tumor, 1 died of side effects of leukemia chemotherapy, and 1 survived with disease. Conclusion: The incidence rate of Swyer syndrome in patients with MGCT-NDG is about 4.9%; timely diagnosis and bilateral gonadectomy should be emphasized to reduce the risk of reoperation and second carcinogenesis in this population.
Female ; Humans ; Retrospective Studies ; Gonadal Dysgenesis, 46,XY/surgery* ; Gonadoblastoma/surgery* ; Neoplasms, Germ Cell and Embryonal/surgery* ; Ovarian Neoplasms/pathology*

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective To investigate the effect of cognitive-motor dual-task training on balance and gait in patients within six months post stroke. Methods From May,2022 to April,2023,68 stroke patients in Beijing Puren Hospital were randomly divided into con-trol group(n=34)and experimental group(n=34).Both groups received conventional rehabilitation training.The control group received single-task walking training,and the experimental group received cognitive-walking dual-task training,in addition,for four weeks.They were assessed with Fugl-Meyer Assessment-Lower Extremi-ties(FMA-LE)before and after training,and measured static balance posture trajectory,stability limits,gait anal-ysis with Pro-kin and OptoGait in both single-task and dual-task states. Results After training,the scores of FMA-UE increased in both groups(|t|>10.239,P<0.001),and no difference was found between two groups(P>0.05).In single-task state,all the parameters of balance improved in both groups after training(|t|>2.934,P<0.01),and the length of movement locus with eyes closed was longer in the experi-mental group than in the control group(t=3.330,P=0.001);all the parameters of gait improved in both groups after training(|t|>6.823,P<0.05),and the walk speed was better in the experimental group than in the control group(t=2.355,P=0.022).In dual-task state,all the parameters of balance improved in both groups after train-ing(|t|>2.472,P<0.05),expect the length of trajectory with eyes open in the control group(P>0.05),and no difference was found in other parameters between two groups(P>0.05);and all the parameters of gait improved in both groups after training(|t|>2.238,P<0.05),and the stride length and walk speed were better in the experi-mental group than in the control group(t>2.443,P<0.05). Conclusion Cognitive-motor dual-task training can effectively improve lower limb motor function,balance function and walking ability in convalescent stroke patients,and it is superior to single-task walking training in improving some gait parameters.

Objective To investigate the serum levels of soluble B7-H3(sB7-H3)and glucose regulated protein 78(GRP78)in children with ulcerative colitis(UC)and their relationship with the condition and prognosis.Methods From August 2019 to August 2020,78 children with UC who were diagnosed and treated in our hospital were collected as the research group,and 75 children who underwent health examinations were collected as the reference group.According to the severity of condition,research group was separated into a mild group of 29 cases,a moderate group of 32 cases,and a severe group of 17 cases.The research group was followed up for 3 years and separated into a poor prognosis group of 22 cases and a good prognosis group of 56 cases based on the prognosis.Enzyme-linked immunosorbent assay(ELISA)was applied to measure the levels of serum sB7-H3,GRP78,and inflammatory factors such as interferon-r(IFN-r),interleukin-1(IL-1),and interleukin-33(IL-33);blood pressure measuring instrument was used to detect levels of diastolic and systolic blood pressures.Pearson method was applied to analyze the correlation between serum sB7-H3 and GRP78 with inflammatory factors,respectively;Logistic regression was applied to analyze the factors that affected the poor prognosis of children with UC;receiver operating characteristic(ROC)curve was applied to analyze the clinical value of serum sB7-H3 and GRP78 levels in predicting poor prognosis in children with UC.Results The serum levels of sB7-H3,GRP78,IFN-r,IL-1,and IL-33 in the research group were obviously higher than those in the reference group(P＜0.05).As the severity of UC increased,the serum levels of sB7-H3,GRP78,IFN-r,IL-1,and IL-33 increased(P＜0.05).Serum sB7-H3 and GRP78 were positively correlated with IFN-r,IL-1,and IL-33,respectively(P＜0.05).The serum levels of sB7-H3,GRP78,IFN-r,IL-1,and IL-33 in the adverse group were obviously higher than those in the good group(P＜0.05).Serum sB7-H3,GRP78,and IL-33 were risk factors for poor prognosis in children with UC(P＜0.05).The area under the curve(AUC)for poor prognosis in children with UC detected by serum sB7-H3,GRP78,and their combination was 0.874,0.884,and 0.969,respectively,the combined detection of the two was obviously higher than the single detection(Z combination-sB7-H3=1.878,Zcombination_GRP78=1.931,P＜0.05).Conclusion The serum levels of sB7-H3 and GRP78 in children with UC increase,and their levels increase with the severity of condition.The combination of the two can better predict the occurrence of poor prognosis in children with UC.

Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.

Objective:To investigate the treatment and prognosis of acute carotid artery occlusion during perioperative period of carotid endarterectomy (CEA).Methods:The clinical data of 112 carotid artery stenosis patients who underwent CEA from January 2017 to December 2021 in Lianyungang Hospital Affiliated to Xuzhou Medical University were retrospectively analyzed. The patients were followed up at 6 to 9 months after surgery, the clinical prognosis was evaluated by Glasgow outcome score (GOS), and the head and neck CT angiography (CTA) was performed.Results:Among the 112 patients, 5 patients underwent acute carotid artery occlusion during the perioperative period, including 1 case of intraoperative acute occlusion of internal carotid artery and 1 case of intraoperative internal carotid artery combined with external carotid artery cute occlusion, both of them were re-sutured, and multi-mode monitoring showed that each carotid artery was unobstructed; 2 cases of intraoperative external carotid artery occlusion, no re-suture was performed during the operation; 1 case of intraoperative monitoring showed no obvious abnormality, and the contralateral limb hemiplegia was observed after surgery, and the muscle strength was grade 1, the carotid color Doppler ultrasound showed the occlusion of the internal carotid artery on the operation side. The CT and CTA examination showed focal infarction and common carotid artery on the operation side, and drugs and conservative treatment were given. The follow-up result: GOS 5 scores was in 4 cases, and 4 scores in 1 case; the muscle strength of hemiplegia patient recovered to grade 4; head and neck CTA examination, except for 1 case of common arterial occlusion, the other 4 cases showed no special abnormality.Conclusions:Intraoperative acute carotid artery occlusion can be detected timely by intraoperative multi-mode hemodynamic monitoring during CEA. Vascular recanalization after acute occlusion is possible by adopting active and effective treatment methods, the occurrence of postoperative ischemic stroke can be effectively prevented and the prognosis of patients can be improved.

Objective:To investigate the safety and efficacy of the TRIANGLE operation after neoadjuvant chemotherapy in locally advanced pancreatic cancer(LAPC).Methods:This study is a retrospective case series analysis. Between January 2020 and December 2022, a total of 103 patients were diagnosed as LAPC who underwent neoadjuvant chemotherapy at the Pancreas Center, the First Affiliated Hospital of Nanjing Medical University. Among them, 26 patients (25.2%) underwent the TRIANGLE operation. There were 15 males and 11 females,with a age of (59±7) years (range: 49 to 74 years). The pre-treatment serum CA19-9( M(IQR)) was 248.8(391.6)U/ml (range: 0 to 1 428 U/ml),and the serum carcinoembryonic antigen was 4.1(3.8)μg/L(range: 1.4 to 13.4 μg/L). The neoadjuvant chemotherapy regimens included: mFOLFIRINOX regimen in 6 cases(23.1%), GnP regimen in 14 cases(53.8%), and mFOLFIRINOX+GnP regimen in 6 cases(23.1%). The follow-up duration extended until June 2023 or until the occurrence of the patient′s death or loss to follow-up. The Kaplan-Meier method was employed to estimate the 1-year and 3-year overall survival rates. Results:After neoadjuvant chemotherapy,CA19-9 levels decreased by 92.3(40.1)%(range:2.1% to 97.7%). Evaluation of the response to treatment revealed 13 cases(50.0%) of stable disease,11 cases(42.3%) of partial response,and 2 cases(7.7%) of complete response. The surgical operation consisted of 12 cases(46.2%) of pancreaticoduodenectomy,12 cases(46.2%) of distal pancreatectomy,and 2 cases(7.7%) of total pancreatectomy. Margin determination was based on the “standardised pathology protocol” and the “1 mm” principle. No R2 and R1(direct) resections were observed,while the R0 resection rate was 61.5%(16/26), and the R1(1 mm) resection rate was 38.5%(10/26).The R1(1 mm) resection rates for the anterior margin,posterior margin,transected margin,portal vein groove margin,and uncinate margin were 23.1%(6/26),19.2%(5/26),12.5%(3/24),2/14, and 1/12, respectively. The overall postoperative complication rate was 57.8%(15/26),with major complications including grade B/C pancreatic fistula 25.0%(6/24,excluding 2 cases of total pancreatectomy),delayed gastric emptying in 23.1%(6/26),wound complications 11.5%(3/26),postoperative hemorrhage 7.7%(2/26), chylous fistula 7.7%(2/26) and bile fistula 3.8%(1/26). No reoperation was performed during the perioperative period(<90 days). One patient died on the 32 nd day postoperatively due to a ruptured pseudoaneurysm. A total of 25 patients were followed up,with a follow-up time of 21(24)months(range: 8 to 42 months). During the follow-up period,8 cases(32.0%) died due to tumor recurrence and metastasis,while 17 patients(68.0%) remained alive,including 11 cases of disease-free survival,5 cases of distant metastasis,and 1 case of local recurrence. The overall survival rates at 1- and 3-year after the initiation of neoadjuvant chemotherapy were 95.8% and 58.9%, respectively. The overall survival rates at 1- and 3-year after surgery were 77.7% and 57.8%, respectively. Conclusion:Performing pancreatoduodenectomy according to the Heidelberg triangle protocol in LAPC patients after neoadjuvant chemotherapy might increase the R0 resection rate without increasing perioperative mortality or the incidence of major postoperative complications.