ObjectiveTo establish a risk recognition model for coronary artery stenosis by using a machine learning method and to identify the key causative factors. MethodsPatients aged ≥18 years，diagnosed with coronary heart disease through coronary angiography from January 2013 to May 2020 in two prominent hospitals in Shanxi Province， were continuously enrolled. Logistic regression，back propagation neural network （BPNN）， and random forest（RF）algorithms were used to construct models for detecting the causative factors of coronary artery stenosis. Sensitivity （TPR）， specificity （TNR）， accuracy （ACC）， positive predictive value （PV+）， negative predictive value （PV-）， area under subject operating characteristic curve （AUC）， and calibration curve were used to compare the discrimination and calibration performance of the models. The best model was then employed to predict the main risk variables associated with coronary stenosis. ResultsThe RF model exhibited superior comprehensive performance compared to logistic regression and BPNN models. The TPR values for logistic regression，BPNN，and RF models were 75.76%， 74.30%， and 93.70%， while ACC values were 74.05%， 72.30%， and 79.49%， respectively. The AUC values were：logistic regression 0.739 9； BPNN 0.723 1； RF 0.752 2. Manifestations such as chest pains，abnormal ST segments on ECG，ventricular premature beats with hypertension， atrial fibrillation， regional wall motion abnormalities（RWMA） by color echocardiography， aortic regurgitation（AR）， pulmonary insufficiency （PI）， family history of cardiovascular diseases，and body mass index（BMI）were identified as top ten important variables affecting coronary stenosis according to the RF model. ConclusionsRandom forest model shows the best comprehensive performance in identification and accurate assessment of coronary artery stenosis. The prediction of risk factors affecting coronary artery stenosis can provide a scientific basis for clinical intervention and help to formulate further diagnosis and treatment strategies so as to delay the disease progression.

Objective: To analyze the current status and influencing factors of psychological crisis among college students, so as to provide a scientific basis for the formulation of psychological crisis intervention plans in colleges and universities. Methods: From September to December 2024, 645 college students from a medical undergraduate university in Heilongjiang Province were selected with a convenience sampling method. A convergent mixed analysis design was used. Quantitative analysis was conducted using College Students Psychological Crisis Screening Scale, Emotion Regulation Questionnaire, Short-Egna Minnen av Barndoms Uppfostran and Perceived School Climate Scale. Binary Logistic regression analysis was used to explore the related factors of psychological crisis among college students. Qualitative research was conducted on 15 college students with psychological crisis identified in the quantitative analysis by a purposive sampling method. The interview data were organized and analyzed using the thematic framework analysis method. Results: Among the surveyed college students, 92 (14.3%) had psychological crisis. Binary Logistic regression analysis results showed that positive parenting style ( OR=0.97,95%CI =0.95-0.99), negative parenting style ( OR=1.01,95%CI =1.00-1.02), cognitive reappraisal ( OR=0.88, 95%CI =0.83-0.92), expressive suppression ( OR=1.08, 95%CI =1.02-1.15), and perceived campus atmosphere ( OR=0.97, 95%CI =0.95-0.98) were all related factors of psychological crisis among college students ( P <0.05). The qualitative analysis results showed that there were three themes for the influencing factors of college students psychological crisis, including differential impact of emotion regulation strategies on psychological state, shaping of psychological state of college students by family and bidirectional effect of perceived campus atmosphere on psychological state. Mixed analysis results showed that the influencing factors of college students psychological crisis were consistent in terms of emotion regulation strategies, and were expansive in terms of parenting style and perceived campus atmosphere. Conclusion Schools and mental health service departments can reduce the risk of psychological crisis by optimizing cognitive reappraisal and reducing expressive suppression, improve the level of psychological crisis by strengthening positive family interaction and blocking negative parenting style, and maintain the mental health level of college students by building a supportive campus environment and alleviating high pressure.

OBJECTIVE To evaluate the efficacy and safety of high-dose ilaprazole combined with amoxicillin for newly diagnosed elderly patients with Helicobacter pylori （Hp） infection， and analyze independent risk factors for failure of Hp infection eradication treatment. METHODS Totally 200 cases of newly diagnosed elderly patients with Hp infection in Xinxiang Central Hospital from August 1， 2021 to December 1， 2024 were selected and randomly divided into control group and study group， with 100 cases in each group. The control group was treated with classic quadruple therapy regimen （Amoxicillin capsules+ Clarithromycin tablets+Bismuth potassium citrate tablets+Ilaprazole enteric-coated tablets）. The study group was treated with high- dose Ilaprazole enteric-coated tablets+Amoxicillin capsules. All patients were administered medication for 2 weeks. Hp eradication rates in the two groups were compared using intention-to-treat （ITT） and per-protocol （PP） analyses. The incidence of adverse reactions in both groups was also recorded. The multiple-factor Logistic regression analysis was used to identify independent risk factors for failure of Hp infection eradication treatment. RESULTS In ITT and PP analyses， there was no significant difference of Hp eradication rates between the two groups （P＞0.05）. There was no significant difference in incidence of mild to moderate adverse reactions between the two groups （P＞0.05）. BMI ≤18.5 kg/m2， BMI ＞23.9 kg/m2， rural residence， concomitant diabetes and concomitant heart disease were identified as independent risk factors influencing the failure of Hp infection eradication treatment （P＜0.05）. CONCLUSIONS The efficacy and safety of high-dose ilaprazole combined with amoxicillin are comparable to classic quadruple therapy regimen in treating newly diagnosed elderly patients with Hp infection. Independent risk factors influencing the failure of Hp infection eradication treatment include BMI ≤18.5 kg/m2， BMI ＞23.9 kg/m2， rural residence， concomitant diabetes and concomitant heart disease.

Emergence agitation （EA） is a common complication after general anesthesia， especially in children and adolescents. Remifentanil， as a short-acting μ-receptor agonist， has become an important drug for the prevention and treatment of EA due to its rapid recovery and low risk of respiratory depression. This article reviews the mechanism of action and clinical research progress of remifentanil in the prevention and treatment of EA. Its mechanism of action involves the inhibition of pain signals mediated by traditional μ-receptor activation and potential new mechanism based on neural-endocrine-immune network， including regulation of microglial inflammatory pathways， and the modulation of cytokines and chemokines，etc. Clinical studies have shown that remifentanil can significantly shorten the recovery time， reduce the incidence of EA， and further optimize the analgesic effect and recovery quality by combining with other drugs （such as local anesthetics， sedatives， and opioid drugs）. Future research should further explore the mechanism of action of remifentanil， optimize clinical treatment strategies， and conduct large- scale clinical trials to standardize the drug use plan， while paying attention to its long-term effects and the development of multimodal treatment plans to promote the further development of EA prevention and treatment plans.

Virtual reality technology is an emerging technology that integrates multiple disciplines. It has the advantages of immersion, interactivity and imagination, which provides convenience for intelligent nursing in the field of rehabilitation treatment. This paper summarizes the application research of virtual reality technology in patients with kinetophobia, focusing on classification, application mechanism, application status, limitations and future development of virtual reality technology in various diseases of kinetophobia, so as to provide reference and basis for the rehabilitation nursing of patients with kinetophobia based on virtual reality technology in the future.

Objective:To systematically review the factors related to the aggressive behavior of hospitalized patients with schizophrenia in China.Methods:CNKI,Wanfang,VIP,China Biomedical Literature Database,PubMed,Cochrane Library,and Embase databases were searched to collect case-control studies on factors related to aggression in hospitalized patients with schizophrenia in China from its inception to June 2023.Analysis was per-formed using ReviewManager 5.3 to calculate pooled OR(95％CI)values.Results:Thirty-three studies were in-cluded.Medical staff coercive measures(OR=3.86,95％CI:2.75-5.43),unemployment(OR=1.44,95％CI:1.14-1.81),positive family history(OR=2.97,95％CI:2.29-3.87),poor medication compliance(OR=4.37,95％CI:3.36-5.69),young age(OR=3.13,95％CI:2.66-3.69),involuntary hospitalization(OR=3.34,95％CI:2.81-3.97),depression(OR=2.11,95％CI:1.68-2.66),emotional abuse(OR=1.13,95％CI:1.04-1.23),male(OR=2.70,95％CI:2.20-3.31),delusions(OR=2.14,95％CI:1.69-2.71),auditory hallucina-tions(OR=2.23,95％CI:1.70-2.94),and major life events(OR=3.21,95％CI:1.90-5.42)and previous history of aggressive behavior(OR=2.20,95％CI:2.06-2.34)were risk factors associated with aggressive be-havior in Chinese patients with schizophrenia,and social support(OR=0.46,95％CI:0.31-0.67)was a protec-tive factor.Conclusion:There are various factors related to aggressive behavior in hospitalized Chinese patients with schizophrenia,and medical staff should identify high-risk groups early according to the relevant factors,and effec-tively intervene in controllable factors to reduce the occurrence of aggressive behavior.

Purpose: This study examined the diagnostic value of high-frequency ultrasound (HFUS) features in differentiating between benign and malignant skin lesions. Methods: A total of 1,392 patients with 1,422 skin lesions who underwent HFUS examinations were included in an initial dataset (cohort 1) to identify features indicative of malignancy. Qualitative clinical and HFUS characteristics were recorded for all lesions. To determine which HFUS and clinical features were suggestive of malignancy, univariable and multivariable logistic regression analyses were employed. The diagnostic performance of HFUS features combined with clinical information was evaluated. This assessment was validated using internal data (cohort 2) and multicenter external data (cohort 3). Results: Features significantly associated with malignancy included age above 60 years; lesion location in the head, face, and neck or genital regions; changes in macroscopic appearance; crawling or irregular growth pattern; convex or irregular base; punctate hyperechogenicity; blood flow signals; and feeding arteries. The area under the receiver operating characteristic curve, sensitivity, and specificity of HFUS features combined with clinical information were 0.946, 92.5%, and 86.9% in cohort 1; 0.870, 93.1%, and 80.8% in cohort 2 (610 lesions); and 0.864, 86.2%, and 86.6% in cohort 3 (170 lesions), respectively. However, HFUS is not suitable for evaluating lesions less than 0.1 mm in thickness or lesions exhibiting surface hyperkeratosis. Conclusion In a clinical setting, the integration of HFUS with clinical information exhibited good diagnostic performance in differentiating malignant and benign skin lesions. However, its utility was limited in evaluating extremely thin lesions and those exhibiting hyperkeratosis.

Objective To explore the influencing factors of medication experience in patients with schizophrenia based on benefit-risk perception.Methods Patients with stable schizophrenia who were hospitalized in 2 tertiary psychiatric hospitals in Heilongjiang Province from September to December 2023 were selected by convenience sampling method.A convergent mixed method was adopted.In quantitative study,data of 400 patients were collected by general situation questionnaire,Subjective Well-being Under Neuroleptic Treatment Scale,the Living with Medicines Questionnaire,Beliefs about Medication Questionnaire,Positive and Negative Syndrome Scale.Binary logistic regression analysis was used to explore the influencing factors of medication experience in patients with schizophrenia.15 patients with adverse medication experience in quantitative study were selected for qualitative study,and the interview data were sorted and analyzed according to the topic frame analysis method.Results Quantitative results:medication burden,medication beliefs,and psychiatric symptoms of patients with schizophrenia were influential factors of medication experience(P<0.05).Qualitative results:the medication experience of schizophrenia patients includes 4 themes,namely perceived necessity of medication,perceived benefit of medication,perceived risk of medication,and the need for multi-party cooperation to improve the medication experience.The results of quantitative and qualitative research are complementary in terms of perceived benefit,consistent in terms of perceived risk,and expansive in terms of perceived value.Conclusion Psychiatric nurses can reduce patients'perceived risk of medication,enhance the perceived benefit of medication,and then improve patients'adverse medication experience and promote mental rehabilitation.

Objective:To evaluate the relationship between the occipitocervical angle(basilar vertebral angle [O-C 2 angle], mento-pharyngeal angle [M-P angle], and cervical range of motion [CROM]) and difficult airway after occipitocervical fusion surgery in the patients. Methods:This was a retrospective study. The clinical data from patients who underwent occipitocervical fusion surgery at our hospital from March 2018 to March 2023 were retrospectively collected. Preoperative and last follow-up airway assessment data and cervical lateral X-rays were collected to measure the O-C 2 angle, M-P angle and CROM. Patients were divided into negative group (Mallampati grade Ⅰ or Ⅱ, suggesting no difficulty in intubation) and positive group (Mallampati grade Ⅲ or Ⅳ, suggesting possible difficulty in intubation) based on the last follow-up modified Mallampati classification. Results:A total of 53 patients were finally included, with 18 cases in positive group and 35 in negative group. There were no statistically significant differences in the O-C 2 angle and CROM between preoperative and last follow-up in the 53 patients ( P>0.05), and the M-P angle was significantly decreased at the last follow-up compared with that before operation ( P<0.05). Compared with negative group, O-C 2 angle and M-P angle were significantly decreased at the last follow-up ( P<0.05), and no significant change was found in CROM in positive group ( P<0.05). Compared with that before operation, the M-P angle was significantly decreased at the last follow-up in both groups, and the O-C 2 angle was significantly decreased at the last follow-up in positive group ( P<0.05). The areas under the receiver operating characteristic curves of O-C 2 angle, M-P angle and CROM in predicting difficult airway were 0.895, 0.888 and 0.519 respectively. Conclusions:The decrease in the O-C 2 angle and M-P angle after occipitocervical fusion surgery can increase the risk of difficult airway, and both can be used for airway assessment in the patients undergoing this kind of surgery.

Objective To investigate the regulatory mechanism of Rehmanniae Radix Praeparata and its active components rehmannioside D and catalpol on γ-aminobutyric acid(GABA)in the brain based on the xylosy-transferase I(xylt-1)signaling pathway.Methods(1)SD rats were randomly divided into normal group,model group and treatment group(Rehmanniae Radix Praeparata group,30 g·kg-1),with eight rats in each group,half male and half female.The rat model of yin deficiency was established by intragastric administration of traditional Chinese medicine compound(30 g·kg-1)with acrid-warm nature and dampness-drying and dampness-draining,once in the morning and once in the evening,for 10 consecutive days.After modeling,the treatment group was given Rehmanniae Radix Praeparata decoction by gavage,once in the morning and once in the evening,for 10 consecutive days.The body mass of rats was measured and recorded,and the activity,crossing times and total distance were detected by open field behavior experiment.The levels of serum gonadotropin-releasing hormone(GnRH),thyrotropin-releasing hormone(TRH),corticotropin-releasing hormone(CRH),luteinizing hormone(LH)and follicle-stimulating hormone(FSH)in rats were detected by ELISA.The mRNA and protein expression levels of xylt-1,multiligand proteoglycan 1(SDC-1),early growth response factor 1(EGR1)and glutamate decarboxylase 1(GAD67)in rat brain tissue were detected by qPCR and automatic capillary Western Blot.The content of GABA in brain tissue was detected by HPLC.(2)The xylt-1 gene of rat well-differentiated adrenal pheochromocytoma cells(PC12)was silenced by siRNA.The cells were divided into normal group,negative control group,silencing group,silencing+rehmannioside D(10 μmol·L-1)group,silencing+catalpol(10 μmol·L-1)group.The expression levels of xylt-1,SDC-1,EGR1 and GAD67 mRNA in cells were detected by qPCR.The content of GABA in intracellular and extracellular fluid was detected by HPLC.The expression level of SDC-1 in cells was detected by immunofluorescence.(3)PC12 cells were transfected with lentivirus to overexpress xylt-1 gene.The cells were divided into normal group,negative control group(empty vector group)and overexpression group.The mRNA expression levels of xylt-1,SDC-1,EGR1 and GAD67 in cells were detected by qPCR.Results(1)Compared with the normal group,the body mass of the rats in the model group was significantly decreased(P＜0.01),the activity was significantly increased(P＜0.01),and the number of crossings and the total distance were significantly increased(P＜0.01).The levels of serum LH,FSH,GnRH,CRH and TRH were significantly increased(P＜0.01).The content of GABA in hippocampus and cerebral cortex was significantly decreased(P＜0.05,P＜0.01).The expression of xylt-1,SDC-1,EGR1 and GAD67 mRNA(hippocampus,cerebral cortex)and protein(hypothalamus,cerebral cortex)in brain tissue were significantly down-regulated(P＜0.05,P＜0.01).Compared with the model group,the body mass of the rats in the treatment group was significantly increased(P＜0.05),the activity was significantly decreased(P＜0.01),and the total distance was significantly shortened(P＜0.05).The levels of serum LH,FSH,GnRH,CRH and TRH were significantly decreased(P＜0.01).The content of GABA in hippocampus and cerebral cortex was significantly increased(P＜0.05,P＜0.01).The content of GABA in hippocampus and cerebral cortex was significantly increased(P＜0.05,P＜0.01).The expressions of xylt-1,SDC-1,EGR1 and GAD67 mRNA(hippocampus,cerebral cortex)and protein(hypothalamus,cerebral cortex)in brain tissue were significantly up-regulated(P＜0.05,P＜0.01).(2)Compared with the negative control group,the mRNA expressions of xylt-1,SDC-1,EGR1 and GAD67 in the silencing group was significantly down-regulated(P＜0.01).The content of GABA in intracellular and extracellular fluid was significantly decreased(P＜0.05,P＜0.01).The expression of SDC-1 in cells was significantly down-regulated(P＜0.01).Compared with the silencing group,the expression of xylt-1 mRNA in the silencing+rehmannioside D group was up-regulated,but the difference was not statistically significant(P＞0.05).The mRNA expression of xylt-1 in the silencing+catalpol group was significantly up-regulated(P＜0.05).The mRNA expressions of SDC-1,EGR1 and GAD67 in the silencing+rehmannioside D group and the silencing+catalpol group was significantly up-regulated(P＜0.05,P＜0.01),the content of GABA in the intracellular and extracellular fluid was significantly increased(P＜0.01),and the expression of SDC-1 in the cells was significantly up-regulated(P＜0.05,P＜0.01).(3)Compared with the normal group and the negative control group,the mRNA expression of xylt-1 in the overexpression group was significantly up-regulated(P＜0.01).Compared with the negative control group,the mRNA expressions of SDC-1,EGR1 and GAD67 in the overexpression group was significantly up-regulated(P＜0.01),and the GABA content in the intracellular and extracellular fluid was significantly increased(P＜0.01).Conclusion There may be a xylt-1/SDC-1/EGR1/GAD67 pathway that regulates GABA synthesis in the brain.Rehmanniae Radix Praeparata may increase GABA levels in the brain by up-regulating this pathway.