To analyse the clinical characteristics of children and adolescents with first-episode depression who visited the outpatient clinic, as well as the risk of non-suicidal self-injury (NSSI) and protective factors.

A total of 441 patients with first-episode depression who visited the Child Mental Health Research Centre at Nanjing Brain Hospital affiliated with Nanjing Medical University between January 2020 and December 2023 were selected. Among them, 313 (71.0%) had NSSI and 128 (29.0%) did not. The Children's Self-Awareness Scale and the 90-item Symptom Checklist (SCL-90) were used to assess the clinical symptoms of these children and adolescents. Chi-square tests and independent t-tests were used to compare the differences in clinical characteristics between those with and without NSSI, and Logistic regression was further used to explore the influencing factors.

In the comparison of SCL-90 questionnaire scores, the group without NSSI had significantly lower scores of somatisation (t=-5.342, P＜0.001), obsessive-compulsive symptoms (t=-3.430,P=0.001), interpersonal relationships(t=-5.258, P＜0.001), depression (t=-5.673, P＜0.001), anxiety (t=-4.870, P＜0.001), hostility (t=-5.299, P＜0.001), phobia (t=-3.292, P=0.001), paranoia (t=-5.000, P＜0.001), psychoticism (t=-5.802, P＜0.001), and other (t=-5.854, P＜0.001) than the non-NSSI group. In the comparison of Children's Self-Awareness Scale scores between the two groups, the total self-awareness score (t=3.635, P＜0.001), as well as the scores of self-awareness behaviour (t=4.765, P＜0.001), self-awareness anxiety (t=2.462, P=0.014), and self-awareness happiness and satisfaction (t=3.414, P=0.001), was significantly higher in the non-NSSI group than in the group with NSSI. Further Logistic regression analysis indicated that female gender (odds ratio [OR]=2.033, 95% confidence interval [CI]: 1.188~3.478), somatisation (OR=1.040, 95%CI: 1.005~1.077), interpersonal relationships (OR=1.064, 95%CI: 1.003~1.129), and psychoticism (OR=1.076, 95%CI: 1.019~1.137) were positively associated with NSSI in patients with depression, while horror (OR=0.948, 95%CI: 0.900~0.999), obsessive-compulsive symptoms (OR=0.908, 95%CI: 0.858~0.961), and self-awareness behaviour (OR=0.902, 95%CI: 0.829~0.982) were negatively associated with NSSI.

High-risk factors for NSSI in children and adolescents with first-episode depression include female gender, somatisation symptoms, interpersonal sensitivity, and psychotic symptoms. Protective factors include obsessive-compulsive symptoms, phobic symptoms, and self-conscious behaviour.

To explore the influencing factors of longitudinal trajectory of cardio-ankle vascular index (CAVI) in middle-aged and elderly community populations and its correlation with new-onset major adverse cardiovascular events (MACEs), so as to provide a basis for the early intervention of arterial stiffness and dynamic management of cardiovascular risk.

Eligible subjects were selected from the longitudinal data management cohort of health check-ups (2020~2023) at Jinding Street Community Health Management Center in Shijingshan District, Beijing. A group-based trajectory model (GBTM) was used to construct and classify CAVI change trajectory models. Repeated-measures analysis of variance was applied to describe the model characteristics; unordered multinomial Logistic regression was used to analyze the influencing factors of different trajectory groups; and Cox regression model was employed to explore the correlation between different trajectory groups and new-onset MACEs.

A total of 883 subjects were included. GBTM classified the longitudinal trajectory of CAVI into three groups: low-level fluctuation group (17.89%), medium-level fluctuation group (62.85%), and high-level fluctuation group (19.25%). Repeated-measures analysis of variance showed that there were statistically significant differences in CAVI across different time points and different groups (P＜0.05). Taking the low-level fluctuation group as the reference, unordered multinomial Logistic regression revealed that subjects with advanced age, high systolic blood pressure, high levels of homocysteine (HCY) and serum creatinine (Scr), current alcohol consumption, or hyperlipidemia were more likely to be classified into the medium-level fluctuation group, while subjects with advanced age, male gender, high systolic blood pressure, high levels of fasting blood glucose (FBG), HCY, blood urea nitrogen (BUN), Scr and glycated hemoglobin (HbA1c), smoking history, current alcohol consumption, hypertension, diabetes mellitus, or hyperlipidemia were more likely to be classified into the high-level fluctuation group. Cox regression analysis indicated that compared with the low-level fluctuation group, the risk of new-onset MACEs was significantly increased in the medium-level fluctuation group (hazard ratio [HR]=9.71, 95% confidence interval [CI]: 1.33~70.97, P=0.025) and the high-level fluctuation group (HR=18.33, 95%CI: 2.45~136.94, P=0.005).

There are three distinct patterns of CAVI longitudinal trajectory in middle-aged and elderly community populations, and the population characteristics differ among different trajectory groups. Both the medium-level and high-level CAVI fluctuation groups are associated with an increased risk of new-onset MACEs, so targeted intervention for high-risk populations should be strengthened.

To evaluate the diagnostic accuracy and performance of transient elastography (TE) for liver fibrosis in autoimmune hepatitis (AIH) patients and identify factors influencing liver stiffness measurements (LSM).

We retrospectively analyzed the clinical data of 87 AIH patients who underwent both liver biopsy and TE at Tianjin Medical University General Hospital between January 2016 and December 2024. Diagnostic performance of LSM and serological models for fibrosis staging were assessed using receiver operating characteristic (ROC) curves. Independent LSM determinants were explored via multiple linear regression analysis.

LSM exhibited a significantly stronger positive correlation with histological fibrosis stage (r=0.839, P＜0.001) than the serological models. LSM demonstrated high diagnostic accuracy for significant fibrosis (≥F2; area under the curve [AUC]=0.966, 95% confidence interval [CI]: 0.925~1.000), advanced fibrosis (≥F3; AUC=0.940, 95%CI:0.887~0.993), and cirrhosis (F4; AUC=0.940, 95%CI: 0.882~0.997), with optimal cut-offs of 8.61 kPa, 10.54 kPa, and 15.62 kPa, respectively. The AUC of LSM surpassed that of the serological model across all stages. Fibrosis stage and immunoglobulin G (IgG) were independent predictors of LSM.

TE provides high diagnostic efficacy for liver fibrosis staging in AIH, outperforming serological models. Elevated IgG may influence LSM accuracy.

To analyze the clinical disease types, clinical characteristics, and prognosis of neonates undergoing enterostomy, as well as the risk factors for postoperative complications.

A retrospective analysis was conducted on the data of neonates who underwent enterostomy in Baoding Hospital Affiliated to Capital Medical University from January 2013 to August 2023. These neonates were divided into an NEC (necrotizing enterocolitis) group and a non-NEC group according to the primary disease. The differences in clinical data between the groups were analyzed, and the clinical characteristics of neonates with enterostomy in the two groups were summarized. Based on whether postoperative complications occurred in NEC neonates, they were further grouped for analysis. Multivariate logistic regression models were employed to analyze the risk factors for postoperative complications.

A total of 80 neonates were included in this study. Among them, 37 cases (46.3%) were in the NEC group with the primary disease being NEC, and 43 cases (53.7%) were in the non-NEC group. The gestational age and birth weight of neonates in the NEC group were lower than those of the non-NEC group, and the proportion of low-birth-weight neonates was higher (all P＜0.05). The number of neonates with onset symptoms (fever, abdominal distension, hematochezia, and apnea), the number of neonates with hyponatremia, laboratory test results (e.g., C-reactive protein), postoperative clinical characteristics and complications (such as the time to achieve full enteral feeding, the incidence of high-flow diarrhea, and the incidence of combined tetinopathy of prematurity) were all significantly higher in the NEC group than in the non-NEC group (P＜0.05). The systemic immune-inflammation index (SII) in the NEC group was lower than that of the non-NEC group (P＜0.05). Within the NEC group, the onset age of neonates with complications was significantly later, and the incidence of respiratory failure was significantly higher than that of neonates without complications (both P＜0.05). Multivariate logistic regression analysis demonstrated that respiratory failure was a risk factor for postoperative complications in NEC neonates after enterostomy.

Neonates with NEC undergoing enterostomy have a younger gestational age, lower weight, later onset of age, more severe clinical manifestations, a higher incidence of postoperative complications, and a poorer prognosis. Respiratory failure is a significant risk factor for postoperative complications in NEC neonates undergoing enterostomy.

To identify the risk factors for acute respiratory distress syndrome (ARDS) in patients with acute organophosphorus pesticide poisoning (AOPP) to provide a theoretical basis for early prevention and diagnosis of this fatal complication.

The case information of AOPP patients treated in Huangshi Central Hospital from January 2016 to December 2024 was retrospectively collected. Based on the occurrence of ARDS or not, the AOPP patients were divided into an ARDS group (77 cases) and a non-ARDS group (226 cases). The differences in clinical characteristics between the two groups were compared, and their general clinical data and laboratory test results were analyzed. Utilizing univariate and multivariate Logistic regression models, the potential risk factors for ARDS in AOPP were identified. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of these risk factors for the occurrence of ARDS, and to further explore the risk factors and early diagnostic biomarkers for ARDS in AOPP.

A total of 303 AOPP patients were included, among which 77 (25.4%) were complicated with ARDS. There were statistically significant differences between the two groups in terms of age (P＜0.001), aspiration (P＜0.001), ventilator-associated pneumonia (P＜0.001), albumin (P＜0.001), serum amylase (P＜0.001), and creatinine (P＜0.001). Multivariate Logistic regression showed that age, aspiration, ventilator-associated pneumonia, albumin, serum amylase, and creatinine were independent risk factors for ARDS in patients with AOPP. The area under the ROC curve for predicting ARDS in patients with AOPP by combining the six independent factors was 0.986 (95% confidence interval: 0.986-0.999).

Age, aspiration, ventilator-associated pneumonia, albumin, serum amylase, and creatinine are closely related to the occurrence of ARDS in patients with AOPP. In clinical work, these six factors can be comprehensively considered to help identify high-risk cases early and take timely intervention measures to improve the prognosis of patients.

Maintenance hemodialysis (MHD) is the principal renal-replacement modality for end-stage renal disease in China, yet mortality remains high and heterogeneous. We aimed to delineate differential risk factors for infection-related versus cardiovascular-cerebrovascular death and to develop cause-specific prediction tools.

In this single-centre retrospective cohort, 164 MHD inpatients who died between 2020 and 2025 in Peking University Shougang Hospital were stratified into either an infection death group (n = 56) or a cardiovascular-cerebrovascular death group (n =108). Demographics, laboratory indicators, (ALB, PA, CRP, PTH, and β₂-microglobulin), and dialysis adequacy (kt/v) were collected. Multivariable logistic regression was used to identify independent predictors, and a joint nomogram incorporating gender, kt/v, PTH, β₂-microglobulin, and CRP was constructed. Model performance was evaluated by ROC, calibration, and decision-curve analyses.

Among the 164 patients included, infection death (n=56) and cardiovascular-cerebrovascular death (n=108) differed significantly: females were more prevalent in the cardiovascular death group (48% vs 29%; P=0.016), while CRP levels were higher in the infection death group [(116.5±113.3 vs 76.4±71.8) mg/L; P=0.006]. Multivariable logistic regression showed that infection death was independently associated with female gender (odds ratio [OR]=0.20, 95% confidence interval [CI]: 0.08~0.52), CRP elevation (OR=1.006 per 1 mg/L), kt/v ＜ 1.2 (OR=12.71), and lower PTH (OR = 0.996 per 10 pg/ml). Cardiovascular-cerebrovascular death was driven by female gender (OR=4.95, 95%CI: 1.93~12.69), reduced kt/v (OR = 0.92 per 0.1 increment), elevated PTH (OR = 1.004 per 10 pg/ml), elevated β₂-microglobulin (OR=1.047 per 1 mg/L), and lower CRP (OR = 0.994 per 1 mg/L). The joint model achieved an area under the ROC curve  of 0.757 for cardiovascular-cerebrovascular death, with good net clinical benefit across 10~70% risk thresholds.

MHD patients exhibit distinct risk profiles for infection versus cardiovascular -cerebrovascular mortality. The validated cause-specific nomogram enables rapid, individualized risk stratification and targeted preventive strategies.

The aim of this study was to integrate multiple metabolic indicators from diverse systems and clinical research data to develop a predictive model for metabolic associated fatty liver disease (MAFLD) complicated by coronary heart disease (CHD).

Patients diagnosed with MAFLD between January 2020 and January 2025 were recruited from Xinjiang Production and Construction Corps Hospital. Those with malignant tumors or cognitive impairments were excluded. The patients were categorized into two groups according to the presence or absence of concurrent coronary heart disease. Univariate analysis was performed on commonly used clinical indicators to screen out those with significant inter-group differences. These selected indicators were then subjected to multivariate Logistic regression analysis to identify risk factors.

Univariate analysis revealed significant abnormalities in the CHD group regarding age (mean difference: -12.35 years, P=5.4e-37), liver function markers (ALT increased by 11.72 U/L, GGT increased by 23.58 U/L), lipid profiles (TG increased by 0.56 mmol/L, LDL-C increased by 0.43 mmol/L), and urinary protein levels (increased by 49.69 mg/dl) (P＜0.05). A binary predictive model was developed using logistic regression, incorporating key predictors including age, urinary protein, AST, and GGT. The model demonstrated superior performance with an area under the curve of 0.798 in the 80% training set and 0.85 in cross-validation, exhibiting a sensitivity of 0.89 sensitivity, specificity of 0.9, and f1-score of 0.9, significantly outperforming traditional single-indicator assessment methods.

The MAFLD-CHD risk prediction model established in this study exhibits high clinical applicability, providing a quantitative tool for individualized screening and stratified management. Routine combined assessment of urinary protein, liver enzymes, and age is recommended for MAFLD patients to facilitate early identification of high-risk populations and initiate lifestyle interventions or pharmacological treatments, thereby reducing cardiovascular event incidence.

To investigate the causal relationship between cathepsins and rheumatoid arthritis (RA) using a two-sample Mendelian randomization (MR) approach.

Genome-wide association study (GWAS) data were used, with cathepsins as exposures and RA as the outcome variable. Inverse variance weighting (IVW), MR-Egger regression, weighted median, simple mode, and weighted mode methods were applied to explore the causal relationship between exposures and the outcome, with IVW serving as the primary analytical method. Sensitivity analyses were performed to verify the reliability of the results. Additionally, a reverse MR analysis was conducted with RA as the exposure and cathepsins as the outcome variables.

According to the IVW statistics, cathepsin B was positively causally associated with the risk of RA (odds ratio [OR]=1.044, 95% confidence interval [CI]=1.005~1.084, P=0.026); cathepsin F was inversely causally associated with the risk of RA (OR=1.068, 95%CI=1.020~1.118, P=0.005). The robustness of the results was confirmed by sensitivity analyses.

Individuals with genetically predicted higher cathepsin B levels may have an increased risk of RA, while the occurrence of RA may induce elevated cathepsin F levels.

To investigate clinical practitioners' attitudes toward granting prescription rights to public health physicians in Jiangsu primary care settings and to provide evidence for advancing integrated medicine-public health services.

A convenience sampling survey was conducted among 255 primary care physicians in Jiangsu Province, China. Data were analyzed using chi-square and Fisher's exact tests.

Although 94.90% of respondents supported granting limited prescription rights to public health physicians after training, only 58.43% believed that they were competent. Key barriers included ambiguous regulations (83.53%) and inadequate standardized training (72.94%). The most likely problem brought by empowerment is the increase in the workload of public health physicians (74.12%). Chronic disease management (90.10%) and immunization (85.95%) were preferred scenarios for authorization. One-year clinical training (42.98%) led by attending physicians (34.30%) was recommended.

Despite their support, primary care physicians express concerns about competency. Implementing a tiered authorization system, along with legal clarification and enhanced clinical training, is crucial.

As the global population ages, the prevalence of thrombotic diseases and the use of antithrombotic drugs are rising. For patients undergoing digestive endoscopy, this presents a clinical dilemma: continuing medication increases bleeding risks, while discontinuing it raises the threat of thromboembolism. This article systematically reviews the latest domestic and international guidelines and consensus statements, focusing on stratifying bleeding risk for different digestive endoscopy procedures, assessing thromboembolism risk based on patients' comorbidities, and outlining perioperative management strategies for antithrombotic drugs. The aim is to provide a reference for the management of antithrombotic drugs during the perioperative period of digestive endoscopy in clinical practice.

In acute or chronic liver injury and malignant liver tumors, the expression of CXC chemokine ligand 12 (CXCL12) is significantly increased. CXCL12 can activate two different chemokine receptors-CXC chemokine receptor-4 (CXCR4) and CXC chemokine receptor-7 (CXCR7)-to play different roles. The CXCL12-CXCR7 axis modulates acute liver injury and liver regeneration, while CXCL12-CXCR4 signaling promotes the progression of liver fibrosis by activating hepatic stellate cells and recruiting bone marrow mesenchymal stem cells from the bone marrow. In addition, CXCL12 and its receptors can promote tumor growth, invasion, metastasis, and angiogenesis. This article summarizes the recent progress in the understanding of CXCL12 and its receptors CXCR4/CXCR7 in liver-related diseases, with the aim of providing new directions and ideas for the diagnosis and treatment of liver-related diseases.

Neurogenic supine hypertension, a manifestation of autonomic failure, predominantly occurs in patients with neurogenic orthostatic hypotension. Both conditions result from structural damage to the autonomic nervous system, leading to impaired vascular constriction and blood pressure regulation. Blood pressure management in patients with neurogenic orthostatic hypotension combined with supine hypertension poses significant clinical challenges. While this comorbidity is more common in middle-aged and elderly populations, it is exceptionally rare in young patients, resulting in limited diagnostic and therapeutic references. This article reports the case of a young female patient presenting with recurrent dizziness and blood pressure fluctuations, aiming to provide insights for the diagnosis and management of similar cases.