Objective: To investigate the prevalence of depressive symptoms and their associated factors among students in Zhejiang Province, so as to provide evidence for targeted prevention strategies. Methods: A stratified cluster random sampling method was used to select 23 829 college students and primary and secondary school students aged 11-22 years in Zhejiang Province from December 2019 to February 2020. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Three machine learning algorithms, including Logistic regression, random forest, and eXtreme Gradient Boosting (XGBoost), were applied to construct predictive models, and key associated factors were identified by comparing model performance. Results: The detection rate of depressive symptoms among students in Zhejiang Province was 19.92%; the rates were 17.20% in boys and 22.87% in girls( χ 2=164.89, P <0.05). The CES-D total score was 9.00(4.00,13.00). Multiple Logistic regression analysis revealed that loneliness had the strongest association with depressive symptoms ( AOR =9.58, 95% CI =8.90-10.30), while bullying exposure ( AOR =4.39, 95% CI =4.02-4.80), female students( AOR =1.81, 95% CI =1.68-1.94)，never eating breakfast ( AOR = 2.34，95% CI =2.00-2.67) and overweight/obesity( AOR =1.10，95% CI =1.08-1.12) were significant associated factors of depressive symptoms among students (all P <0.05). Analysis based on the XGBoost model produced highly consistent results, identifying the above 5 factors as the core features with the highest correlation strength (all P <0.05). Conclusions Female, loneliness, bullying exposure, frequency of weekly breakfast and BMI are strongly associated with depressive symptoms among students. Mental health education for high risk groups should be strengthened, and coordinated prevention efforts between families and schools are recommended.

ObjectiveTo explore the driving forces for oncology nurses’ participation in palliative care work， thereby providing a theoretical basis for the improvement of education and training， incentive mechanisms， and other aspects of the palliative care nursing staff. MethodsEmploying a qualitative research method， semi-structured interviews lasting 40-60 minutes were conducted with 14 nurses who had participated in palliative care work. The interview data were analyzed using the Colaizzi seven-step analysis method. ResultsInternal positive driving forces were job interest， empathy， and a sense of professional responsibility， while the negative was low psychological resilience. External positive driving forces included high work support， professional identity， mutual benefits for nurses and patients， and positive patient attitudes， whereas negative driving forces comprised busy routine clinical work， lack of a reward and incentive system， and bland or negative patient attitudes. ConclusionIt is essential to provide a flexible platform for the enhancement of nurses’ professional capabilities in palliative care， intensify the publicity of palliative care and death education； intervene and guide nurses’ negative emotions， improve and implement relevant incentive systems， and standardize the job recognition and scope of responsibilities of palliative care nurses.

Locomotion, a fundamental motor function encompassing various forms such as swimming, walking, running, and flying, is essential for animal survival and adaptation. The mesencephalic locomotor region (MLR), located at the midbrain-hindbrain junction, is a conserved brain area critical for controlling locomotion. This review highlights recent advances in understanding the MLR’s structure and function across species, from lampreys to mammals and birds, with a particular focus on insights gained from optogenetic studies in mammals. The goal is to uncover universal strategies for MLR-mediated locomotor control. Electrical stimulation of the MLR in species such as lampreys, salamanders, cats, and mice initiates locomotion and modulates speed and patterns. For example, in lampreys, MLR stimulation induces swimming, with increased intensity or frequency enhancing propulsive force. Similarly, in salamanders, graded stimulation transitions locomotor outputs from walking to swimming. Histochemical studies reveal that effective MLR stimulation sites colocalize with cholinergic neurons, suggesting a conserved neurochemical basis for locomotion control. In mammals, the MLR comprises two key nuclei: the cuneiform nucleus (CnF) and the pedunculopontine nucleus (PPN). Both nuclei contain glutamatergic and GABAergic neurons, with the PPN additionally housing cholinergic neurons. Optogenetic studies in mice by selectively activating glutamatergic neurons have demonstrated that the CnF and PPN play distinct roles in motor control: the CnF drives rapid escape behaviors, while the PPN regulates slower, exploratory movements. This functional specialization within the MLR allows animals to adapt their locomotion patterns and speed in response to environmental demands and behavioral objectives. Similar to findings in lampreys, the CnF and PPN in mice transmit motor commands to spinal effector circuits by modulating the activity of brainstem reticular formation neurons. However, they achieve this through distinct reticulospinal pathways, enabling the generation of specific behaviors. Further insights from monosynaptic rabies viral tracing reveal that the CnF and PPN integrate inputs from diverse brain regions to produce context-appropriate behaviors. For instance, glutamatergic neurons in the PPN receive signals from other midbrain structures, the basal ganglia, and medullary nuclei, whereas glutamatergic neurons in the CnF rarely receive inputs from the basal ganglia but instead are strongly influenced by the periaqueductal grey and inferior colliculus within the midbrain. These differential connectivity patterns underscore the specialized roles of the CnF and PPN in motor control, highlighting their unique contributions to coordinating locomotion. Birds exhibit exceptional flight capabilities, yet the avian MLR remains poorly understood. Comparative studies suggest that the pedunculopontine tegmental nucleus (PPTg) in birds is homologous to the mammalian PPN, which contains cholinergic neurons, while the intercollicular nucleus (ICo) or nucleus isthmi pars magnocellularis (ImC) may correspond to the CnF. These findings provide important clues for identifying the avian MLR and elucidating its role in flight control. However, functional validation through targeted experiments is urgently needed to confirm these hypotheses. Optogenetics and other advanced techniques in mice have greatly advanced MLR research, enabling precise manipulation of specific neuronal populations. Future studies should extend these methods to other species, particularly birds, to explore unique locomotor adaptations. Comparative analyses of MLR structure and function across species will deepen our understanding of the conserved and evolved features of motor control, revealing fundamental principles of locomotion regulation throughout evolution. By integrating findings from diverse species, we can uncover how the MLR has been adapted to meet the locomotor demands of different environments, from aquatic to aerial habitats.

During the operation of warm needling, the needle may be tilted and bent to a large degree, which will cause high temperature of moxibustion on the skin surface around, and even burns in patients. To solve this problem, the team developed a balance fixator for acupuncture needle that can be used at acupoints in various parts of the body, such as on the abdomen, waist, limbs and face. The device is composed of 3 parts, including three (or more)-bifurcated sleeve, cushion pad, and circular fixed base-plate, forming an integrated structure. The three (or more)-bifurcated sleeve increases the contact area with the filiform needle body, which can quickly and easily reduce the curvature of the needle body and fix the filiform needle. According to the different locations of acupoints in clinical practice, the cushion pad is designed as three types, i.e. rectangle, large circle, and small circle. It can not only balance needle body, but also prevent skin burns to a certain extent. This device is simple to manufacture, lightweight in material, and environmental friendly; and is applicable to a simple and safe operation in clinical practice.
Humans ; Acupuncture Therapy/methods* ; Acupuncture Points ; Needles ; Equipment Design

Digital storytelling,as an emerging form of communication and therapy,is subtly transforming the landscape of clinical care.This paper systematically introduces the historical evolution,fundamental methods,and clinical applications of digital storytelling,while exploring and analyzing its effects on various patient groups.A comprehensive evaluation index system has been developed,with the aim of providing references and evidence for the broader application and development of digital sto-rytelling in clinical care,along with recommendations for improvement to address existing limitations.

Objective:To observe the relationship between the severity of acute pancreatitis(AP)and anxiety,quality of life and nutritional status.Methods:157 AP patients who were admitted to Shandong Provincial Third Hospital from January 2021 to May 2024 were included,they were divided into severe AP(SAP)group(n=68)and non-SAP(NSAP)group(n=89)according to the severity of the disease.The geriatric nutritional risk index(GNRI),self-rating anxiety scale(SAS)and short form-36 healthsurvey(SF-36)were compared between SAP group and NSAP group.Spearman was used to analyze the correlation between the severity of AP patients with anxiety,quality of life and nutritional status.General data of AP patients were collected,and the influencing factors of SAP occurrence were analyzed by univariate and multivariate logistic analysis.Results:SAS scores in SAP group was higher than that in NSAP group,and GNRI and SF-36 scores were lower than those in NSAP group(P＜0.05).The severity of AP patients was positively correlated with SAS scores,but negatively correlated with GNRI and SF-36 scores(P＜0.05).There were significant differences in age,length of stay,white blood cell count(WBC),blood amylase,serum albumin(HAS),lymphocyte count,blood calcium,urea nitrogen(BUN),D-dimer,fibrinogen,neutrophil count,alanine aminotransferase(ALT),aspartate transferase(AST),platelet count,procalcitonin(PCT),total bilirubin(DBIL),interleukin-6(IL-6),prothrombin time,and acute pancreatitis severity Bedside index(BISAP)scores in SAP group and NSAP group(P＜0.05).Multivariate logistic regression analysis showed that,high age,high PCT,high DBIL,high BISAP score,low GNRI,low SF-36 score and high SAS score were risk factors for AP patients of SAP occurrence,and high blood calcium was protective factor(P＜0.05).Conclusion:The severity of AP is associated with anxiety,malnutrition and low quality of life.High age,high PCT,high DBIL,high BISAP score,low GNRI,low SF-36 score and high SAS score are the risk factors for AP patients of SAP occurrence,and high blood calcium is the protective factor.

Objective To analyse the efficacy of Gao Mo therapy in the treatment of aromatase inhibitor-related osteoarticular symptoms in breast cancer patients.Methods A total of 80 breast cancer patients with aromatase inhibitor-related osteoarticular symptoms were selected from the breast clinic of a Tier-IIIA hospital in Guangdong Province between January and August 2024.The patients were divided into an intervention group and a control group according to the random number table,with 40 patients per group.Patients in the control group received routine nursing care,while the patients in the intervention group received Gao Mo therapy for 4 weeks based on the intervention of the control group.The two groups were compared with in terms of pain level,index of knee osteoarthritis,and quality of life of the patients with breast cancer before intervention and at 1st,2nd and 4th weeks after intervention.Results Before the intervention,the two groups presented no significant differences in scores of pain assessment,knee osteoarthritis index and quality of life(P>0.05).Analysis of variance for repeated measures showed that the main effects of time and group as well as the interaction effect,were statistically significant in scores of pain assessments in both groups(both P<0.05).The main effects of time and the interaction effect were statistically significant in scores of knee osteoarthritis index and quality of life assessments at different time points(both P<0.05),but there was no statistically significant difference in the main effect between groups(both P>0.05).After 4 weeks of intervention,the intervention group demonstrated significantly lower scores in knee function and pain assessments with a significantly higher scores in the total quality of life assessment in comparison with those of the control group(all P<0.05).Conclusion Gao Mo therapy can mitigate the aromatase inhibitor-related osteoarticular symptoms in breast cancer patients,enhance the function of knees,and improve the quality of life of the patients with breast cancer.

Objective:To investigate improvement effect of osthol(OST)on inflammatory response in gestational diabetes mel-litus(GDM)rats by regulating cGAS-STING signaling pathway.Methods:GDM rat model was established by intraperitoneal injection of 35 mg/kg streptozotocin on the fifth day of pregnancy,and randomly grouped into GDM group,OST-L group(1 mg/kg),OST-M group(10 mg/kg),OST-H group(50 mg/kg),OST-H+DMXAA group(50 mg/kg OST solution+25 mg/kg DMXAA),positive control group(200 mg/kg metformin hydrochloride),with 10 rats in each group,another 10 rats with 5-day pregnancy were regarded as con-trol group.After intervention,glucose meter was applied to detect fasting blood sugar;ELISA was applied to detect insulin and TNF-α,IL-6,IL-1β levels;automatic biochemical analyzer was applied to detect contents of total cholesterol(TC),triglyceride(TG)and high-density lipoprotein(HDL);pancreatic tissues were separated and Western blot was applied to detect cGAS and STING proteins expressions in pancreatic tissue;HE staining was applied to detect pathological changes in pancreatic tissue.Results:Compared with control group,pathological damage in GDM group was severe,cGAS and STING protein expressions,pathological score,TNF-α,IL-6,IL-1β,TC,TG,insulin and fasting blood sugar levels were increased obviously,HDL level was decreased obviously(P<0.05);compared with GDM group,pathological damage in OST-L group,OST-M group and OST-H group was improved,cGAS and STING protein expressions,pathological score,TNF-α,IL-6,IL-1β,TC,TG,insulin and fasting blood sugar levels were decreased obviously,HDL level was increased obviously(P<0.05);compared with OST-H group,pathological damage in OST-H+DMXAA group was aggravated,cGAS and STING protein expressions,pathological score,TNF-α,IL-6,IL-1β,TC,TG,insulin and fasting blood sugar levels were increased obviously,HDL level was decreased obviously(P<0.05),however,there was no difference in posi-tive control group(P>0.05).Conclusion:OST can alleviate inflammatory response in GDM rats by inhibiting cGAS-STING signaling pathway.

Objective:To investigate the effect of hypoxemia(HYP)on the expression of myeloid cell trigger receptor-1(TREM-1)in macrophage exosomes(Exo)and the effect of TREM-1 on the biological behavior of ovarian cancer cells.Methods:The expression of TREM-1 in 27 cases of epithelial ovarian cancer tissues and 30 cases of benign ovarian cysts were detected by immuno-histochemical staining.The human mononuclear cell line THP-1 was induced into macrophages by chemical induction method,and the siRNA silencing TREM-1 was transfected into the differentiated macrophages under HYP conditions.The macrophages Exo derived from normoxia(NOR)and HYP were isolated and co-cultured with the ovarian cancer cell line SKOV3.The cells were divided into the NOR-Exo group,HYP-Exo-siRNA group,HYP-Exo-siTREM-1 group and Control group.Transwell assay,scratch assay and Western blot were used to detect the invasion,migration,epithelial-mesenchymal transition(EMT)ability of ovarian cancer cells in each group,the expression of TREM-1 protein in cells,and the protein phosphorylation levels of P65,ERK1/2 and AKT in the NF-κB,ERK1/2 and AKT signaling pathways,respectively.Results:Compared with benign ovarian cyst,the expression of TREM-1 in ovarian cancer macrophage was significantly increased(P<0.05).Compared with NOR,HYP could significantly promote the expression of TREM-1 in macrophage and its Exo(P<0.05).Compared with Control group,the invasion,migration and EMT ability and the protein phosphorylation levels of P65,ERK1/2 and AKT in HYP-Exo-siRNA group and HYP-Exo-siTREM-1 group were significantly in-creased(P<0.05),there was no significant change in the NOR-Exo group(P>0.05).Compared with HYP-Exo-siRNA group,the above detection indexes in NOR-Exo group and HYP-Exo-siTREM-1 group were significantly decreased(P<0.05).Conclusion:HYP can up-regulate the EMT,invasion and migration ability of ovarian cancer cells by promoting the high expression of TREM-1 in Exo de-rived from macrophages,which may be related to the activation of NF-κB,ERK1/2 and AKT signaling pathways.

Objective To establish an ICU nursing shift handover index based on the standardised communication framework of ISBAR(Identity,Situation,Background,Assessment,and Recommendation)and create an intelligent nursing shift handover system(hereinafter referred as"Smart ICU-ISBAR Nursing Shift Handover System"),thereby improving the standardisation,efficiency and quality of ICU nursing shift handovers with a standardised tool for planning ICU nursing shift handovers.Methods Literature was searched to identify the core elements of ISBAR and the key contents of ICU nursing shift handovers,then a preliminary draft of ICU nursing shift handover index was proposed.Delphi expert-consensus technique(20 experts)was used to screen and finalise the core dimensions and specific indicators of the index system,which were then integrated into the Smart ICU-ISBAR Nursing Handover System.Finally,the clinical effectiveness of the system was evaluated.Results Both Delphi rounds achieved 100.00%response rate.The expert authority coefficient was 0.83.The Kendall's W values of 2 rounds were 0.127 and 0.166(all P<0.001)respectively.The index importance scores ranged from 4.25-4.95 and 3.90-5.00,with coefficients of variation of 0.05-0.19 and 0.00-0.22,respectively.The final version of Smart ICU-ISBAR nursing shift handover system comprised 6 primary indicators and 60 secondary indicators.Over the clinical trials,the system achieved a 96.67%success rate in data-upload with an average response time of 1.80 sec.,the mean documentation time of shift handover at(1.97±0.58)min per patient,12 nurses'satisfaction with the shift handover quality of(4.47±0.25)and the rating of the system's usability of(4.75±0.08).The system was highly practical,convenient and intelligent.Conclusion The ICU nursing shift handover index system developed on the basis of ISBAR theory features a structural integrity,standardisation and ICU-specific characteristics and it is objective,scientific and rigorous.The Smart ICU-ISBAR Nursing Shift Handover System standardises the shift handover process,reduces information omissions,and improves efficiency and quality of nursing shift handover process.It serves as a standardised shift handover tool for ICU nursing shifts.