Objective: To compare the effects of seasonal autoregressive integrated moving average (SARIMA) , seasonal autoregressive integrated moving average with exogenous regressors (SARIMAX) and long short-term memory neural network (LSTM) models in predicting the incidence of hand, foot, and mouth disease (HFMD). Methods: Monthly incidence data of HFMD in Kunming City from 2010 to 2019 were collected. SARIMA, SARIMAX and LSTM models were established using the monthly incidence of HFMD from 2010 to 2018 to predict the monthly incidence of HFMD from January to December 2019. The prediction performance of the three models was compared using mean squared error (MSE), root mean squared error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE). The optimal prediction model was selected based on the principle of minimizing MSE, RMSE, MAE and MAPE. Results: The HFMD cases were reported every month in Kunming City from 2010 to 2019, with the incidence fluctuating between 188.27/105 and 363.15/105. The disease exhibited a biennial high-incidence bimodal distribution. Among the four evaluation indicators for the training and testing sets, the LSTM model had the smaller values: MSE was 63.182 and 102.745, RMSE was 7.949 and 10.136, MAE was 6.535 and 7.620, and MAPE was 46.726% and 31.138%. The LSTM model performed the better, followed by the SARIMA model, while the SARIMAX model had the relatively poorest performance. Conclusion The LSTM model outperforms the SARIMA and SARIMAX models in predicting the incidence of HFMD.

BackgroundGraduate students frequently face life events， many of which may adversely affect their mental well-being. However， the interaction between life events and the development of depression， anxiety， and somatic symptoms remains unclear. ObjectiveTo explore the relationship between life events and the development of depressive， anxiety and somatic symptoms in graduate students， thereby informing prevention strategies for these conditions. MethodsA sample of 6 722 newly enrolled graduate students at a comprehensive university in Southwest China from September to November 2018 was selected. The assessment was conducted using the Adolescent Self-rating Life Events Checklist （ASLEC）， the 7-item Generalized Anxiety Disorder scale-7 item （GAD-7）， the Patient Health Questionnaire Depression Scale-9 item （PHQ-9）， and the Patient Health Questionnaire-15 （PHQ-15）. Network analysis was implemented by using the bootnet and qgraph packages in the R software （version 4.2.3）， with centrality indices calculated to identify core and bridge symptoms within the network. ResultsThe study encompassed a total of 6 171 graduate students， representing 91.80% of the target population. The prevalence rates of anxiety， depressive， and somatic symptoms among graduate students were 12.59% （777/6 171）， 16.63% （1 026/6 171）， and 27.66% （1 707/6 171）， respectively. Network analysis revealed that 'academic stress' was the core symptom with the highest strength and expected influence （both values=1.207）， while 'feeling down， depressed， or hopeless' was the bridge symptom with the highest bridge strength and bridge expected influence （both values=0.454）. There was no significant difference in global network strength and edge weight between women and men （P>0.05）. ConclusionAcademic stress， emerging as the core symptom， assumes a dominant position within the symptom network and exhibits strong interactions with other negative affective states. There was no gender difference in the network structure.

Objective:To investigate the application effect of bullet screen interaction in the teaching of internal medicine of traditional Chinese medicine.Methods:A randomized controlled trial was conducted, and 150 students were randomly divided into bullet screen interaction group and traditional interaction group and received teaching with bullet screen interaction and traditional interaction, respectively. Flanders Interaction Analysis System (FIAS), class rating, questionnaire survey, and performance test were used to evaluate the effect of classroom interaction and teaching achievement. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:Compared with the traditional interaction group, the bullet screen interaction group had a significantly lower teacher's language ratio [(62.63±2.83)% vs. (71.05±3.19)%] and significantly higher student's language ratio [(32.68±2.62)% vs. (22.79±1.32)%], teacher's indirect/direct influence ratio [(96.63±9.59)% vs. (69.84±3.48)%], and teacher's positive/negative influence ratio [(122.89±6.43)% vs. (50.58±2.35)%]. Compared with the traditional interaction group, the bullet screen interaction group had significantly higher scores of teacher's emotional atmosphere (23.82±6.54 vs. 21.01±6.51), quality of classroom activities (25.67±5.51 vs. 22.56±11.95), and information transmission of teacher's classroom interactive activities (25.46±10.30 vs. 18.44±6.52). The questionnaire survey showed that compared with the traditional interaction group, the bullet screen interaction group had a significantly higher number of the students who selected excellent and good for student interest in classroom, dullness of classroom, and the mastery of classroom knowledge [104 (69.33%)/110 (73.33%)/106 (70.67%) vs. 72(48.00%)/74 (49.33%)/84(56.00%)], and the bullet screen interaction group had significantly higher scores of basic knowledge and case analysis than the traditional interaction group (84.30±4.13/78.53±7.21 vs. 79.26±5.67/72.56±4.22).Conclusions:The application of bullet screen interaction teaching in the teaching of internal medicine of traditional Chinese medicine can help to improve interactive effect and teaching achievement.

Background::Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods::This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Na?ve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis.Results::The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score ( P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. Conclusions::Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Objective:To investigate the clinical efficacy and safety of amlodipine besylate and benazepril hydrochloride tablets (II) in the treatment of primary hypertension.Methods:A total of 280 patients with primary hypertension who were treated at Shougang Shuigang Hospital between June 2022 and June 2023 were selected as study subjects. A clinical case-control study was conducted, and the RAND function method was utilized to randomly allocate the subjects into four groups, each receiving a different treatment: amlodipine besylate group (Group A, n = 70), benazepril hydrochloride group (Group B, n = 70), compound formulation amlodipine besylate and benazepril hydrochloride tablets group (Group C, n = 71), and amlodipine besylate plus benazepril hydrochloride group (Group D, n = 69). Relevant therapeutic indicators (blood pressure compliance rate, changes in blood pressure values) and safety indicators (adverse reactions, medication adherence) were observed. Results:The blood pressure compliance rates of Group C and Group D were 91.5% (65/71) and 89.9% (62/69), respectively. There was no statistically significant difference between the two groups ( χ2 = 1.24, P = 0.143), but both were higher than the rates of 77.1% (54/70) and 74.3% (52/70) in Group A and Group B, respectively ( χ2 = 5.68, 4.86, P = 0.004, 0.012). Before treatment, there was no statistically significant difference in systolic and diastolic blood pressure among the four groups of patients (all P > 0.05). After treatment, there was a statistically significant decrease in both systolic and diastolic blood pressure among the four groups compared with their pre-treatment levels (all P < 0.05). Specifically, Group C and Group D exhibited significant reductions in blood pressure following treatment ( t = 4.35, 5.12, 7.25, 5.86, all P < 0.05). Meanwhile, there was no statistically significant difference in systolic blood pressure between Group C and Group D after treatment ( P > 0.05), while diastolic blood pressure was lower in Group C than Group D after treatment ( t = 6.01, P < 0.05). There was a significant downward trend observed in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels (all P < 0.05). Notably, Group B and Group D reported higher incidences of dry cough, with 15 and 10 cases, respectively, compared with Group A and Group C, which had 1 and 3 cases, respectively. These differences were statistically significant ( χ2 = 4.25, 5.04, both P < 0.05). Furthermore, the treatment compliance rates for Group A, Group B, and Group C were 72.9% (51/70), 71.4% (50/70), and 74.6% (53/71), respectively, all exceeding the 46.4% (32/69) compliance rate of Group D. These differences were also statistically significant ( χ2 = 4.68, 5.24, 4.98, all P < 0.05). Conclusion:The clinical efficacy and safety of the compound formulation amlodipine besylate and benazepril hydrochloride tablets (II) in the treatment of primary hypertension are superior to those of single tablets and combination therapy.

Objective To investigate the factors influencing prognosis in patients with acute myocardial infarction complicated with cardiogenic shock undergoing primary percutaneous coronary intervention(PPCI).Methods Patients with acute myocardial infarction complicated with cardiogenic shock who underwent PPCI at our hospital between January 2015 and December 2019 were enrolled.Clinical baseline characteristics,coronary angiography and PCI-related parameters,and mechanical support information were collected.The patients were followed up for one year and divided into survival and death groups based on their survival status within one year.Differences in various factors between the two groups were compared.Results A total of 40 patients were enrolled,including 26 in the survival group and 14 in the death group.There were no differences in baseline data,diagnosis,risk factors,and comorbidities between the two groups.The survival group had a lower heart rate and higher blood pressure trend at admission compared to the death group.Myocardial enzymes were significantly lower in the survival group compared to the death group(median CK peak:496.00(198.25,2 830.00)U/L vs.3 040.00(405.75,5 626.53)U/L,P=0.003;median CK-MB peak:52.65(31.75,219.50)U/L vs.306.00(27.25,489.63)U/L,P=0.006).When comparing coronary angiography and PCI-related indicators between the two groups,the survival group had a higher rate of complete revascularization compared to the control group(53.85％vs.21.43％,P=0.048).The survival group had a higher proportion of extracorporeal membrane oxygenation(ECMO)combined with intra-aortic balloon pump(IABP)support compared to the control group[38.46％vs.7.14％,P=0.034].Conclusions Survival in patients with acute myocardial infarction complicated with cardiogenic shock undergoing PPCI is associated with lower level of myocardial enzymes,ECMO combined with IABP support and complete revascularization.

Objective:To explore effects of transcutaneous auricular vagus nerve stimulation(taVNS)with task-oriented training(TOT)on upper extremity function and brain plasticity in post stroke hemiplegia patients. Method:Forty patients with stroke hemiplegia were randomly assigned to the experiment group(n=20)and the control group(n=20).The experiment group received taVNS combined with TOT,while the control group received only TOT.At baseline and at the end of treatment,the patients were assessed with motor evoked po-tentials(MEP),the Fugl-Meyer assessment upper extremity(FMA-UE),the Hongkong version of functional test for the hemiplegic upper extremity(FTHUE),the action research arm test(ARAT),the modified Barthel index(MBI),and the fatigue severity scale(FSS).The side effects were monitored during the treatment. Result:There were no significant differences in FMA-UE,FTHUE,ARAT,MBI and FSS between the two groups at baseline(P＞0.05).After treatment,all the functional outcomes except FSS in both two groups in-creased significantly compared with baseline(P＜0.05),and the FMA-UE、FTHUE、ARAT、MBI(occupational abili-ty)scores in the experiment group were significantly higher than those in the control group(P＜0.05).There were no significant differences in the latency,amplitude and induced rate of motor evoked potential(MEP)at baseline between the two groups(P＞0.05).Compare with the control group after treatment,the latency of con-tralesional MEP in the experiment group was significantly shorter than that in the control group(P＜0.05),and the induced rates of ipsilesional MEP were significantly higher(P＜0.05),but there were no significant differenc-es in contralesional amplitudes between the two groups.There was a significant correlation between the chang-es of contralesional MEP latency and the changes of FMA-UE(r=-0.705),FTHUE(r=-0.458),MBI in occu-pation(r=-0.654)in the experiment group(P＜0.05). Conclusion:taVNS combined with TOT can improve upper extremity motor function in patients with stroke hemiplegia by modulating plasticity of motor cortex.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective:To conduct a scoping review of the current research status, influencing factors, and assessment tools regarding social isolation in lung cancer survivors and provide research ideas for clinical medical and nursing staff to develop interventional measures.Methods:Based on the framework of a scoping review, systematic searches were conducted in databases including CNKI, Wanfang, VIP, CBM, Embase, PubMed, Web of Science, CINAHL, and Cochrane Library for studies on social isolation in lung cancer survivors, up to March 18, 2023.Results:Eighteen articles were included, with research distributed across three continents (Asia, North America, Europe) and in seven countries, including China, the USA, and Spain. Frequently used research tools included the University of California Los Angeles Loneliness Scale and the Cancer Loneliness Scale. Rates and severity of social isolation varied across different studies. Factors influencing social isolation in lung cancer survivors included demographic factors, disease-related factors, symptom factors, and psychosocial factors.Conclusions:Social isolation in lung cancer survivors can affect their quality of life to a certain extent. Although there are various tools for assessing social isolation in lung cancer survivors, there is a general lack of specific assessment tools. This suggests that medical and nursing personnel should consider developing and applying more specific research tools when developing related assessment tools in the future and develop personalized intervention measures based on influencing factors to help patients alleviate social isolation.

Malnutrition, as an independent predictor of incidence and mortality in patients with chronic heart failure (CHF), has a serious impact on the treatment effect of patients. Conducting nutritional risk assessment and providing nutritional interventions for CHF patients can effectively improve their quality of life. On the basis of elaborating on the risk factors for malnutrition in CHF patients, this paper reviews the assessment tools for malnutrition in CHF patients, aiming to promote the localization of malnutrition assessment tools and the research and clinical application of malnutrition specific assessment tools, making nutrition assessment a routine part of overall health assessment for CHF patients.