Objective:To summarize the clinical and imaging presentations of the pontine tegmental cap dysplasia (PTCD).Methods:The clinical, high resolution CT(HRCT) and MRI materials of 4 patients with PTCD between August 2007 to December 2024 were retrospectively analyzed. Among these, there were 2 males and 2 females, their ages ranged from 10 months to 16 years.Results:Of 4 PTCD patients, severe or profound severe hearing loss ( n=8 ears), developmental delay, hypotonia and severe facioplegia ( n=3 cases) were found. On HRCT, all of 4 cases were associated with temporal anomalies [including a narrow bony cochlear nerve canal ( n=8 ears), duplicated (each n=4 ears) or narrow ( n=1 ear) internal auditory canal, enlarged vestibular aqueduct ( n=2 ears), enlarged vestibules and dysplastic lateral semicircular canals ( n=3 ears), ossicular deformation( n=2 ears). The stenosis of the labyrinthine segments of the facial nerve canal ( n=3 ears) and facial nerve canal ectopia(n=6 ears)], atrial or ventricular septal defect (each n=1 case), thoracic or lumbar vertebral anomalies and ribs fusion ( n=3 cases). On the brain MRI, the variable flattening of the ventral pons and dysmorphism of the dorsal upper pons cap-like bulging and protruding in the fourth ventricle were shown in all cases, the vermian and cerebellar peduncles hypoplasia gave rise to a molar tooth appearance. The dysplastic ( n=3 ears), aplastic( n=5 ears) cochlear nerves and dysplastic facial nerves ( n=3 ears) were found. Conclusion:The PTCD patients usually present severe hearing loss, developmental delay, hypotonia, and facioplegia. The flattening of the ventral pons and the dorsal upper pons cap-like bulging usually with duplicated internal auditory canal and severe facial and auditory nerves dysplasia are its imaging features.

Objective:To explore the clinical characteristics and healthcare burden in patients with McCune-Albright syndrome (MAS).Methods:A cross-sectional study was conducted at the Children′s Hospital, Zhejiang University School of Medicine. Clinical and healthcare burden data were systematically collected through structured questionnaires in 164 children with MAS from February 2022 to May 2023. According to the clinical characteristics, patients were categorized into 3 groups: monosymptomatic, bisymptomatic and trisymptomatic groups. Patients were also divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Comparative analyses of clinical characteristics and healthcare burden were conducted across age, sex, and symptom categories.Results:The cohort comprised 59 males (36.0%) and 105 females (64.0%) with an age of 4.6 (2.0, 7.4) years. Age stratification revealed 117 cases (71.3%) aged 0-<7 years, 29 cases (17.7%) aged 7-<10 years, and 18 cases (11.0%) aged 10-<18 years. Among monosymptomatic (67 cases, 40.9%), the cohort comprised 32 females (47.8%) and 35 males (52.2%), predominantly presenting with fibrous dysplasia (57 cases, 85.1%). This subgroup showed peak prevalence in the 0-<7 years age range (29 cases (50.9%)). The bisymptomatic cohort (56 cases, 34.1%) consisted of 39 females (69.6%) and 17 males (30.4%), predominantly manifesting fibrous dysplasia with skin hyperpigmentation (25 cases, 44.6%). Peak prevalence occurred in the 0-<7 years subgroup(16 cases (64.0%)). The trisymptomatic cohort (41 cases, 25.0%) consisted of 34 females (82.9%) and 7 males (17.1%), with peak prevalence occurring in the 0-<7 years subgroup (36 cases (87.8%)). The diagnostic journey analysis revealed 94 cases (57.3%) required 1-3 referrals, and 34 cases (20.7%) necessitated >3 referrals from symptom onset to definitive diagnosis. Healthcare expenditure analysis revealed 69 families (42.1%) incurred direct medical costs of 10 000-100 000 CNY, with 11 families (6.7%) exceeding >100 000 CNY. Direct non-medical costs reached of 10 000-100 000 CNY for 62 families (37.8%) and >100 000 CNY for 4 families (2.4%). Productivity loss affected 58 families (35.4%) at 10 000-100 000 CNY and 8 families (4.9%) above 100 000 CNY during the study period.Conclusion:MAS requires increased attention to skeletal manifestations, especially in children aged 0-<7 years. Moreover, the significant financial burden on families necessitates a society-wide support system.

Objective To develop an assessment scale of oropharyngeal candidiasis risks in HIV-infected patients,and to test its reliability and validity.Methods The draft of the assessment scale was constructed by the literature analysis method,Delphi consultations and analytic hierarchy process.Totally 231 HIV-infected patients in a tertiary A hospital of Hangzhou were recruited for questionnaire survey in October 2023 to January 2024.Results The scale includes 3 dimensions,including general factors,HIV related factors and oral related factors,12 first-level items and 21 second-level items.The Cronbach's α coefficient of the scale was 0.813;the content validity index was 0.98;the correlation of each dimension was 0.574～0.733(P＜0.05).Confirmatory factor analysis showed that the 3 factor models fitted the data well.The critical value(30.5 points)of the scale was determined by ROC curve;the area under the curve was 0.909;the sensitivity of index system was 0.962,and specificity was 0.697.Conclusion The assessment scale of oropharyngeal candidiasis risks in HIV-infected patients has good reliability and validity,and it can be used as an auxiliary tool for effective identification and prediction of oropharyngeal candidiasis risk.

OBJECTIVES: This study aimed to construct a risk prediction model for the occurrence of the demora-lization syndrome in patients with oral cancer and provide a scientific basis for the prevention of this syndrome in patients with oral cancer and the development of personalized care programs. METHODS: A total of 486 patients with oral cancer in West China Hospital of Stomatology of Sichuan University and Sun Yat-sen Memorial Hospital of Sun Yat-sen University from 2024 March to July were selected by convenience sampling. We integrated clinical data and evidence from previous studies to identify the key variables affecting the demoralization syndrome in patients with oral cancer. The 486 patients were divided into a training set and a validation set in an 8∶2 ratio. A clinical risk prediction model was established based on the individual data of 365 patients in the development cohort. Through least absolute shrinkage and selection operator (LASSO) regression, a moderate to severe risk prediction model of demoralization syndrome in oral cancer was constructed, and a clinical machine-learning nomogram was constructed. Bootstrap resampling was used for internal validation. The data of 121 patients in the validation cohort were externally validated. RESULTS: The incidence of the demoralization syndrome in patients with oral cancer was 405 cases (83.3%), of which 279 cases (57.4%) were mild, 176 cases (36.2%) were moderate, and 31 cases (6.4%) were severe. The core model, including patient education level, disease understanding, and MDASI-HN score, was used to predict the risk of outcome. Internal validation of the model yielded C statistic of 0.783 6 (95% CI: 0.78-0.87), beta of 0.843 4, and calibration intercept of -0.040 6. Through external validation, the validation set C statistic was 0.80 (95%CI: 0.71-0.87), beta was 0.80, and calibration intercept was -0.08. CONCLUSIONS Our risk prediction mo-del of the demoralization syndrome in patients with oral cancer performed robustly in validation cohorts of different nur-sing environments. The model has good correction and good discrimination and can be used as an evaluation and prediction item at admission.
Humans ; Mouth Neoplasms/complications* ; Male ; Female ; Nomograms ; Middle Aged ; Syndrome ; Aged ; Adult ; Risk Factors ; Risk Assessment ; Machine Learning

Objective To investigate the effects of wearing high-heeled shoes at different heel heights on ankle joint motion control during walking in women with chronic ankle instability(CAI).Methods The Vicon infrared motion capture system and a three-dimensional force plate were used to synchronously collect kinematic and kinetic parameters within 200 ms before and after foot contact for 20 healthy females and 20 CAI females while walking on flat ground wearing high-heeled shoes at different heel heights(1,3,5,and 7 cm).Two-way repeated measures ANOVA was applied to analyze the data statistically.Results There was an interaction effect between group and heel height on the peak inversion angular velocity and peak inversion angle during foot strike.Post-hoc tests revealed that within the healthy group,compared to a 1 cm heel,the 5 cm(P=0.002)and 7 cm(P=0.002)heels had significantly greater peak inversion angular velocity within 200 ms before and after foot strike;there were significant differences in peak inversion angle between the 1 cm and 5 cm(P=0.018),7 cm(P＜0.001)heels.In the CAI group,compared to a 1 cm heel,the 5 cm(P=0.002)and 7 cm(P=0.002)heels had significantly greater peak inversion angular velocity within 200 ms before and after foot strike;there were significant differences in peak inversion angle between the 1 cm and 3 cm(P＜0.001),5 cm(P＜0.001),7 cm(P＜0.001)heels.There was a significant main effect of height on peak plantarflexion angle(P＜0.001),peak external rotation angle(P＜0.001),peak external rotation angular velocity(P＜0.001),and peak plantarflexion torque(P=0.048)within 200 ms before and after foot strike;there was a significant main effect of group on peak eversion torque(P＜0.001).Conclusions Compared to healthy individuals,women with CAI have reduced ankle joint control while walking with high-heeled shoes.As heel height increases,the ankle stability decreases.It is recomended that women with CAI should wear high-heeled shoes with a heel height of 3 cm or below.

Objective:To investigate the structural changes in the spinal cord in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) and their relationship with clinical disability.Methods:This study was cross-sectional. A retrospective analysis of clinical and imaging data from 124 patients with MS (MS group), 101 patients with aquaporin-4 antibody-positive NMOSD (NMOSD group), and 110 healthy controls (HC group) from seven medical centers were conducted from January 2018 to October 2021. All subjects underwent 3D T 1WI, and the upper cervical spinal cord cross-sectional area (MUCCA) was segmented and measured. All patients completed the expanded disability status scale (EDSS) assessments at baseline and during follow-up, as well as the baseline 25-foot walk test (T25FW) and the nine-hole peg test (NHPT). Patients were classified into EDSS progression and non-progression groups based on follow-up EDSS scores. Comparisons of MUCCA among the three groups were conducted using analysis of covariance, controlling for age and sex as covariates. Pairwise comparisons between groups were performed using the HSD test. Univariate linear regression and logistic models were employed to identify candidate predictors of baseline clinical disability status or EDSS progression in the MS and NMOSD groups. L1 regularized multivariable linear regression analysis was used to determine independent predictors of baseline clinical disability status or EDSS progression. Independent predictors were then combined to establish a logistic regression model, and the model′s performance in predicting EDSS progression was evaluated using receiver operating characteristic analysis and the area under the curve (AUC). Results:A total of 144 patients completed follow-up EDSS assessments, with a follow-up duration of 3.30 (1.10, 6.42) years, including 82 patients in the MS group and 62 patients in the NMOSD group. Controlling for sex and age as covariates, the overall difference in MUCCA among the MS, NMOSD, and HC groups was statistically significant ( P=0.001). The MUCCA in the MS group was lower than that in the HC group, with a significant difference ( t=-2.54, P=0.007); the MUCCA in the NMOSD group was also lower than that in the HC group, with a significant difference ( t=-2.80, P=0.002). However, the difference in MUCCA between the MS and NMOSD groups was not statistically significant ( t=-0.40, P=0.882). In the MS group, MUCCA was an independent predictor of baseline EDSS score (β=-0.03), baseline T25FW score (β=-0.09), and baseline NHPT score (β=-0.30). In the NMOSD group, MUCCA (β=-0.08), age (β=0.06), and baseline EDSS score (β=-0.43) were independent predictors of EDSS progression, and the logistic regression model incorporating these three factors predicted EDSS progression with an AUC of 0.82. Conclusions:Significant spinal cord atrophy occurs in patients with both MS and NMOSD. Atrophy of the upper cervical spinal cord can predict the degree of disability in MS patients and the progression of clinical disability in NMOSD patients.

Objective To design a practice courses and competency-oriented training in rehabilitation psychology,in response to the demands of team-based and interprofessional practices for professionals,based on World Health Organization re-habilitation competency framework(RCF).Methods Using the five core domains of RCF(practice,professionalism,learning and development,management and leadership,and research),this study analyzed the competencies and role positioning of undergraduate rehabilita-tion psychology students within team-based and interprofessional rehabilitation settings.It identifies the core competencies needed in these contexts and corresponding practical teaching approaches,to enhance students'ability to translate disciplinary knowledge into team-based and interprofessional practice competencies in real-world rehabilitation scenarios.Results The study yielded a competency-oriented practical curriculum structured around the teamwork and interprofes-sional practice requirements for rehabilitation psychology professionals.Based on RCF,we defined specific core competencies and developed a curricular framework incorporating pedagogical methods such as integrated as-sessments based on International Classification of Functioning,Disability and Health,motivational interviewing,case study analysis,and standardized patient simulations.These methods are designed to build student proficien-cy in team communication,collaborative decision-making,case management and evidence-based practice.Conclusion In undergraduate rehabilitation psychology education,developing competency-based practical courses tar-geting team-based and interprofessional service competencies,which grounded in RCF,can enhance the quality and efficiency of talent cultivation in the field.It also helps improve students'capabilities in collaborative and in-terprofessional practice.RCF provides a theoretical foundation,practical tools,and reference frameworks for building competency-oriented curricula and instructional methods in rehabilitation psychology.

Objective To investigate how interference from motor and cognitive tasks affects the postural stability of older adults during stair descent.Methods A total of 52 elderly subjects were recruited.Using the Vicon infrared motion capture system and Kistler force plate,the kinematic and dynamic data were collected simultaneously during stair descent under three conditions:single task(ST),motor task(MT),and cognitive task(CT).The body stability during stair descent was assessed quantitatively using the margin of stability(MoS)algorithm.Repeated measures ANOVA was applied to compare differences across conditions.Results Compared to the ST condition,both step speed(P<0.001)and step frequency(P<0.001)were significantly reduced under MT and CT conditions.Step length(P=0.037)was also significantly reduced under the CT condition compared to those under the ST condition.In the aspect of anterior-posterior dynamic stability,compared to the ST condition,centroid velocity(P<0.001)and extrapolated centroid position(P<0.001)were significantly increased,while MoS(P<0.001)was significantly decreased under both MT and CT conditions.In comparison to the CT condition,centroid displacement(P=0.011)and velocity(P=0.014),as well as extrapolated centroid position(P<0.001),were significantly greater those under the MT condition.In the aspect of medial-lateral dynamic stability,compared to the ST condition,centroid displacement(P<0.001)was significantly reduced under MT and CT conditions.Additionally,the extrapolated centroid position(P=0.001)was significantly reduced,and MoS(P=0.038)was significantly increased under the MT condition compared to those under the ST condition.Conclusions Older adults adjust their gait in response to dual-task interference during stairs descent by'slowing down step speed,reducing step frequency,and shortening step length'.This adjustment helps maintain medial-lateral dynamic stability,but significantly decreases anterior-posterior dynamic stability,thereby increasing the risk of falls.

Objective:To explore the experiences of post-traumatic growth in patients with failed assisted reproductive technology (ART), providing a basis for individualized nursing interventions.Methods:This study was a qualitative study. From November to December 2023, purposive sampling was used to select ART failed patients at Reproductive Medicine Center of Affiliated Hospital of Nantong University as participants. Data was collected through semi-structured in-depth interviews, and Colaizzi 7-step analysis method was used to summarize and analyze the data and extract themes.Results:A total of 15 ART failed patients were included, their age was (31.8±3.6) years, years of infertility was (4.7±1.7) years. After analysis, a total of four themes and nine sub-themes were extracted, namely negative emotional experiences in the early stages of trauma (anxiety and depression, psychological stress) ; diversified support systems (family support, social support) ; positive coping styles (positive binary coping between spouses, individual coping) ; post-traumatic growth experiences (mobilizing one's own positive strength, strengthening altruistic awareness, and re-planning the future) .Conclusions:Infertility patients exhibit negative emotions after experiencing ART failure, but also experience post-traumatic growth. Medical and nursing staff should provide targeted guidance based on the psychological state of ART failed patients at different stages to improve their mental health.

Objective To investigate how interference from motor and cognitive tasks affects the postural stability of older adults during stair descent.Methods A total of 52 elderly subjects were recruited.Using the Vicon infrared motion capture system and Kistler force plate,the kinematic and dynamic data were collected simultaneously during stair descent under three conditions:single task(ST),motor task(MT),and cognitive task(CT).The body stability during stair descent was assessed quantitatively using the margin of stability(MoS)algorithm.Repeated measures ANOVA was applied to compare differences across conditions.Results Compared to the ST condition,both step speed(P<0.001)and step frequency(P<0.001)were significantly reduced under MT and CT conditions.Step length(P=0.037)was also significantly reduced under the CT condition compared to those under the ST condition.In the aspect of anterior-posterior dynamic stability,compared to the ST condition,centroid velocity(P<0.001)and extrapolated centroid position(P<0.001)were significantly increased,while MoS(P<0.001)was significantly decreased under both MT and CT conditions.In comparison to the CT condition,centroid displacement(P=0.011)and velocity(P=0.014),as well as extrapolated centroid position(P<0.001),were significantly greater those under the MT condition.In the aspect of medial-lateral dynamic stability,compared to the ST condition,centroid displacement(P<0.001)was significantly reduced under MT and CT conditions.Additionally,the extrapolated centroid position(P=0.001)was significantly reduced,and MoS(P=0.038)was significantly increased under the MT condition compared to those under the ST condition.Conclusions Older adults adjust their gait in response to dual-task interference during stairs descent by'slowing down step speed,reducing step frequency,and shortening step length'.This adjustment helps maintain medial-lateral dynamic stability,but significantly decreases anterior-posterior dynamic stability,thereby increasing the risk of falls.