Objective: To explore the dynamic developmental trajectories of college students class belongingness during their college years and its longitudinal predictive effects on depressive symptoms, so as to provide targeted insights for precise campus psychological interventions. Methods: In October 2021 (T1), a total of 4 720 college students from a university in Shandong Province were selected by cluster sampling method and followed up for 3 years. Surveys were conducted annually (T2: October 2022, T3: October 2023, T4: October 2024). The Class Belongingness Scale and Patient Health Questionnaire-9 (PHQ-9) were used to assess students class belongingness and depressive symptoms. Latent growth mixture modeling was employed to identify trajectories of class belonging, and multinomial Logistic regression analysis was used to examine the predictive effects of these trajectory classes on depressive symptoms. Results: Mean scores of class belongingness across T1-T4 were (73.24±11.95, 74.76±12.25, 75.25±12.38, 77.64±11.63), and the scores of depressive symptoms were [1.00 (0, 5.00), 0 (0, 3.00), 0 (0, 2.00), 0 (0, 2.00)]. The developmental trajectories of class belongingness were categorized into three types: the high-starting ascending group ( 56.61 %), the low-starting descending group (11.91%), and the medium-starting stable group (31.48%). Multinomial Logistic regression analysis showed that, compared to the medium-starting stable group, the high-starting ascending group had a lower probability of developing mild depressive symptoms ( OR=0.27, 95%CI =0.15-0.47) and moderate or above depressive symptoms ( OR=0.29, 95% CI = 0.14-0.60) (both P <0.05). Conversely, the low-starting descending group had a higher probability of developing mild depressive symptoms ( OR=2.31, 95%CI =1.65-3.22) and moderate or above depressive symptoms ( OR=7.49, 95%CI = 3.82-14.69) (both P <0.05). Conclusion Declining trajectory of class belongingness is a risk factor for depressive symptoms, while sustained upward trend may mitigate such risks.

Objective:To evaluate the diagnostic value of micro flow imaging (MFI) supported by Image Pro Plus (IPP) software for BI-RADS classification of breast nodules and the correlation between its parameters and Ki-67 expression level.Methods:A total of 205 cases of breast solid nodules with ultrasound BI-RADS classification of 4 categories were enrolled in this study. BI-RADS classification, CDFI score, MFI score, CDFI-IPP score and MFI-IPP score by IPP software were performed for each nodule. Ki-67 immunohistochemical staining of invasive ductal carcinoma was performed to analyze the correlation between MFI-IPP-VI and Ki-67 expression levels.Results:The combined BI-RADS classification for diagnosis of malignant nodules had the largest area under the ROC curve, which was significantly higher than that of BI-RADS, MFI-IPP-VI, MFI score, CDFI-IPP-VI, and CDFI score (all P<0.05). The combined BI-RADS classification had the best diagnostic efficacy for the diagnosis of malignant nodules with a sensitivity of 96.4%, specificity of 65.6% and accuracy of 82.4%. In addition, the agreement between experienced and inexperienced sonographers applying MFI-IPP-VI was higher than MFI (Kappa=0.780 vs. Kappa=0.743). The mean value of Ki-67 in invasive ductal carcinoma was 21.93%±16.37%, and Spearman's correlation analysis showed a positive correlation between MFI-IPP-VI and Ki-67 expression level ( r=0.815, P<0.05). Conclusions:MFI-IPP can assist sonographers to classify breast nodules by BI-RADS, providing an effective basis for puncture biopsy. MFI-IPP-VI offers the possibility of noninvasively predicting the expression level of Ki-67 in invasive ductal carcinoma.

Objective:To evaluate the early efficacy and safety of transnasal endoscopic surgical resection of orbital cavernous hemangioma (OCH) at orbital resection by intranasal technique (ORBIT) stage Ⅲ.Methods:A retrospective study was conducted on 20 patients (20 eyes) who underwent nasal endoscopic surgery to remove ORBIT stage Ⅲ OCH at the Third Hospital of Peking University from July 2021 to July 2024. The cohort were included 10 males and 10 females, aged from 25 to 59 years, with a mean follow-up time of (5.10±4.51) months. Preoperative symptoms included visual field defects in 19 patients (95%), decreased visual acuity in 18 patients (90%), exophthalmos in 2 patients (10%), diplopia in 2 patients (10%), headache in 2 patients (10%), ocular pain in 2 patients (10%), and color vision abnormalities in 1 patient (5%). Data on patient demographics, medical history, imaging data, surgical approach, and postoperative outcomes were collected. Pre-and post-surgical outcomes including best corrected visual acuity (BCVA), visual field, proptosis, and intraocular pressure were compared. Surgical approaches included transnasal endoscopic OCH resection (12 cases, 60%) and transnasal endoscopic combined conjunctival approach OCH resection (8 cases, 40%). The results of the postoperative 2-week review were used as the postoperative short-term efficacy data, and those at 3 months were used for postoperative therapeutic efficacy analysis. SPSS 26.0 statistical software was applied for statistical analysis.Results:In 20 patients, all OCH were completely resected, and the BCVA, visual field, and exophthalmos were significantly improved post-operatively. The differences were statistically significant before and after surgery ( t values were 3.169, 5.127, and 3.350, respectively, all P<0.05). There were no serious complications in the short term after surgery. The short-term complications after endoscopic surgery alone were mainly new-onset diplopia in 1 case (1/12), and the short-term complications after combined approach were new-onset diplopia in 5 cases (5/8) and pupil dilation in 2 cases (2/8). All short-term complications recovered within 3 months, and no serious or permanent complications occurred in the long-term follow. Conclusion:The endoscopic transnasal surgery is a safe and effective approach for complete resection of ORBIT stage Ⅲ OCH, with promising early results.

Objective To explore the establishment,implementation,and outcomes of an integrated physician-nurse team-based comprehensive management model for breast cancer chemotherapy outpatients,ai-ming to provide a reference for standardized patient care.Methods In January 2019,the Breast Surgery De-partment of Peking Union Medical College Hospital developed an integrated physician-nurse team and estab-lished a full-cycle management pathway covering the pre-chemotherapy,chemotherapy,and inter-cycle phases.This model featured appointment-based scheduling,time-segmented visits,and closed-loop patient management.Key performance indicators-including healthcare efficiency,chemotherapy safety,staffing ratios,and satisfaction levels among patients and healthcare providers-were compared between pre-implementation(2018)and post-imple-mentation(2019)periods.Results Before implementation,patient waited times ranged from 30 to 120(75.40±20.97)minutes,with an annual chemotherapy volume of 8 715 cases.Two ward nurses were routinely redeployed daily to support the chemotherapy clinic.Post-implementation,patients received timely chemotherapy per scheduled appointments without delays,annual chemotherapy volume in-creased to 10 101 cases,and staffing between two chemotherapy units became flexibly adjustable.Ward nurses transitioned from an on-call to a reserve role.Adverse events(chemotherapy-related,catheter-related,and nursing incidents)remained at 0,consistent with pre-implementation levels.Both patient and staff satisfaction scores significantly improved across all domains(all P＜0.05).Conclusions The integrated physician-nurse team-based chemotherapy management model enhances service efficiency,ensures treatment safety,optimizes workforce allocation,and improves satisfaction among patients and healthcare providers.

Objective:To investigate the predictive value of serum β 2-microglobulin (β 2M) and pro-inflammatory cytokines for post-stroke depression (PSD) in patients with acute ischemic stroke (AIS). Methods:Patients with AIS admitted to the Department of Neurology, the Affiliated Municipal Hospital of Xuzhou Medical University from January 2020 to May 2023 were included retrospectively. At the 6-month outpatient follow-up, the Self-rating Depression Scale (SDS) was used to assess depression. Multivariate logistic regression analysis was used to determine the independent influencing factors of PSD. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of individual and combined independent influencing factors on PSD. Results:A total of 161 patients were enrolled, including 82 males (50.93%), aged 61.78±11.95 years; 47 patients (29.20%) developed PSD. Univariate analysis showed that the proportion of males, serum β 2M, interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, high-sensitivity C-reactive protein level, and baseline National Institutes of Health Stroke Scale (NIHSS) score in the PSD group were significantly different from those in the non-PSD group (all P<0.05). Multivariate logistic regression analysis showed that serum β 2M (odds ratio [ OR] 4.257, 95% confidence interval [ CI]1.441-12.574; P=0.009), IL-1β ( OR 1.415, 95% CI 1.116-1.793; P=0.004), IL-6 ( OR 1.262, 95% CI 1.020-1.561; P=0.032), and TNF-α ( OR 1.246, 95% CI 1.021-1.521; P=0.030) were the independent influencing factors of PSD. ROC curve analysis showed that the area under the curve of serum β 2M for predicting PSD was 0.753 (95% CI 0.668-0.838), with an optimal cutoff value of 2.255 mg/L. The sensitivity and specificity were 59.6% and 80.7%, respectively. When serum β 2M was combined with IL-1β, IL-6 and TNF-α for prediction, the area under the curve increased to 0.893 (95% CI 0.837-0.948). Conclusion:The serum β 2M in combination with pro-inflammatory cytokines has good predictive value for PSD.

Myocardial infarction is a serious type of myocardial ischemic disease. Traditional treatments can only alleviate clinical symptoms and cannot repair damaged myocardium. In this review, the application progress of chitosan-based composite scaffolds in myocardial repair and regeneration after myocardial infarction was reviewed. Combining chitosan with polymers, such as natural proteins and natural polysaccharides can mimic the properties of natural myocardial tissue, reducing ventricular wall stress while increasing biological activity and promoting the retention, repair or regeneration of myocardial cells. Combining chitosan with synthetic polymers and nanomaterials can promote the repair and regeneration of myocardial cells, improve the electrophysiological function of the infarcted area and resynchronise cardiac contraction.

Objective To evaluate the clinical efficacy of Shanghai-style pediatric tuina combined with visceral acupoint manipulation in children with adenoid hypertrophy(AH)of lung-spleen qi deficiency type.Methods Sixty-six AH children with lung-spleen qi deficiency treated at Foshan Hospital of Traditional Chinese Medicine from December 2023 to December 2024 were randomized into trial group(n=33,receiving Shanghai-style tuina+visceral acupoint manipulation)and control group(n=33,receiving conventional tuina)for 2 weeks.Traditional Chinese medicine(TCM)syndrome scores(primary/secondary symptoms),Disease-Specific Quality of Life for Children with Obstructive Sleep Apnea 18-item Survey(OSA-18)scores,and endoscopic adenoid obstruction scores were observed before and after treatment,and the clinical efficacy and safety were evaluated.Results(1)After two weeks of treatment,the total effective rate was 93.94％(31/33)in the trial group versus 72.73％(24/33)in the control group.The intergroup comparison(by chi-square test)showed that the efficacy in the trial group was superior to that in the control group(P＜0.05).(2)After treatment,both groups showed reduction in the primary TCM symptom score and secondary TCM symptom score(P＜0.01),with greater reductions in the trial group(P＜0.05 or P＜0.01).(3)After treatment,OSA-18 scores were decreased in both groups(P＜0.01),with greater reductions in the trial group(P＜0.01).(4)After treatment,adenoid obstruction scores were improved in both groups(P＜0.01),with superior outcomes in the trial group(P＜0.05).(5)No adverse events(e.g.,myalgia,pruritus,allergy)were reported in either group.Conclusion Shanghai-style tuina combined with visceral acupoint manipulation effectively improves clinical symptoms and quality of life in AH children with lung-spleen qi deficiency syndrome,demonstrating high safety.

Objective:To analyze risk factors for early trauma-induced coagulopathy (TIC) in pediatric patients with moderate-to-severe traumatic brain injury (msTBI), develop a predictive model and evaluate its predictive performance.Methods:A retrospective cohort study was conducted to analyze the clinical data of 290 pediatric patients with msTBI who were admitted to Children′s Hospital of Soochow University between January 2016 and December 2024, including 188 boys and 102 girls, aged 0.2-15.7 years [5.2(2.8, 9.3)years]. Based on the coagulation test results at admission, the patients were divided into TIC group ( n=162) and non-TIC group ( n=128). The patients were randomly allocated into training set ( n=203) and validation set ( n=87) at a ratio of 7∶3. Demographic characteristics, clinical data, vital signs, imaging findings, arterial blood gas analysis results, and coagulation profiles of the patients were collected. Univariate analysis and Lasso regression analysis were used to identify risk factors associated with early TIC in children with msTBI and multivariate Logistic regression analysis was performed to determine independent risk factors and construct a predictive model. The model′s discrimination and calibration were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), Hosmer-Lemeshow (H-L) test, and calibration curve. Its clinical utility was assessed through decision curve analysis (DCA). Results:Significant differences were observed between the TIC group and non-TIC group in terms of age, weight, time from injury to admission, child′s Glasgow coma scale (CGCS) score, pediatric trauma score (PTS), shock index, heart rate, respiratory rate, systolic blood pressure, Rotterdam CT score, intraventricular hemorrhage, cerebral contusion, brain herniation, long bone fracture, pelvic fracture, hemopneumothorax, pulmonary contusion, intra-abdominal organ injury, actual bicarbonate, base excess, base excess in the extracellular fluid, blood glucose, hemoglobin (Hb), osmolarity, blood calcium, anion gap, blood lactate, prothrombin time, activated partial thromboplastin time, international normalized ratio, and platelet count ( P<0.05). With coagulation-related variables excluded, the following features were identified with Lasso regression including CGCS score, PTS, heart rate, systolic blood pressure, long bone fracture, blood glucose, and Hb. Multivariate Logistic regression analysis revealed that CGCS score≤8 points ( OR=3.05, 95% CI 1.65, 5.63), PTS>5 points ( OR=0.45, 95% CI 0.23, 0.89), systolic blood pressure ( OR=0.98, 95% CI 0.97, 0.99), blood glucose ( OR=1.09, 95% CI 1.01, 1.17), and long bone fracture ( OR=2.47, 95% CI 1.13, 5.42) were influencing factors for early TIC in children with msTBI ( P<0.05). The regression equation of the predictive model was established as follows: Logit[ P/(1- P)]=1.01×"CGCS score≤8 points"-0.69×"PTS>5 points"- 0.02×"systolic blood pressure"+0.89×"long bone fracture"+0.08×"blood glucose"+1.32. The ROC curve analysis showed that the training set had an AUC of 0.86 (95% CI 0.78, 0.94), with sensitivity and specificity of 76.6% and 92.5%, while the AUC was 0.80 (95% CI 0.74, 0.86), with sensitivity and specificity of 75.7% and 79.6% in the validation set. H-L test results showed a χ2 value of 8.18 ( P=0.416) in the training set and 5.30 ( P=0.216) in the validation set. The calibration curves for both sets demonstrated good agreement with the actual curves, indicating that the predicted probabilities closely matched the observed probabilities. The DCA results indicated that both the training set and validation set demonstrated positive net benefits within threshold probabilities ranges of 10%-100% and 15%-96%. Conclusions:Independent risk factors for early TIC in pediatric msTBI patients include CGCS score≤ 8 points, PTS≤5 points, low systolic blood pressure, long bone fracture, and high blood glucose. The predictive model constructed based on these factors demonstrates favorable predictive performance and clinical application value.

Objective:To evaluate the early efficacy and safety of the exclusively transnasal endoscopic approach and the combined transconjunctival-endoscopic approach in the resection of benign orbital apex lesions.Methods:A retrospective analysis was conducted on 51 patients who underwent transnasal endoscopic resection of benign lesions in the orbital apex at Peking University Third Hospital from May 2021 to December 2024. The study population was composed of 17 males and 34 females, with the age of (39.4±12.4) years (range: 4 to 65 years). Pathology diagnoses were identified as orbital cavernous hemangioma (OCH, n=38), schwannoma ( n=8), solitary fibrous tumor ( n=1), mucocele ( n=1), optic nerve sheath meningioma ( n=1), pseudotumor ( n=1), and organized hematoma ( n=1). Two surgical approaches were compared as the exclusively transnasal endoscopic resection ( n=27) and the combined transconjunctival-endoscopic approach (combined approach, n=24). Preoperative and postoperative evaluations were conducted for the best corrected visual acuity (BCVA), visual field, intraocular pressure (IOP), and exophthalmos before and after surgery. Demographic characteristics, tumor features, and postoperative complications were analyzed between the two surgical groups. Differences in Orbital Resection by Intranasal Technique (ORBIT) stage between the two surgical approaches were analyzed. SPSS 27.0 software was used for statistical analysis. Results:Among the 51 patients, 3 schwannomas underwent intracapsular resection (1 via exclusively transnasal endoscopic approach, and 2 via combined approach), and the remaining 48 patients underwent complete tumor resection. Significant postoperative improvements were observed in BCVA, visual field, IOP and exophthalmos ( t value was 2.96, 4.34, 4.85, and 4.63, respectively, all P<0.05). The combined approach required longer operative time but showed comparable intraoperative blood loss. Tumors resected via the combined approach were larger in volume, though not statistically significant. Postoperative complications (e.g., diplopia, mydriasis) were more frequent in the combined approach group but resolved within a short-term period. There was no significant difference in ORBIT stage between the two groups ( P=0.178). Conclusions:Both exclusively transnasal and combined transconjunctival-endoscopic approaches prove safe and effective for benign orbital apex lesions resection. The combined approach ensures complete tumor removal.

Objective:Middle ear cholesteatoma is a common otolaryngological disease, and traditional diagnostic methods have certain limitations. This study aims to construct a computer-aided diagnosis model for middle ear cholesteatoma based on integrated convolutional neural networks (CNNs) to improve diagnostic accuracy and efficiency.Methods:Firstly, Data were collected from patients who visited the Department of Otorhinolaryngology Head and Neck Surgery at the First People′s Hospital of Yinchuan between January 2020 and December 2021. 8 000 temporal bone CT images were collected, including 5 000 images diagnosed pathologically as middle ear cholesteatoma and 3 000 normal images. A five-fold cross-validation method was used to divide the dataset into training and testing sets. Next, a transfer learning approach was used to initialize model parameters, and the AlexNet, GoogleNet, and ResNet networks were pre-trained to extract deep features from the images. Then, the Softmax classification algorithm was applied to classify the features, resulting in three independent classifiers. These classifiers were combined using an ensemble learning method with a weighted voting approach to obtain the final diagnostic results. Finally, the model was evaluated by comparing the ensemble classifier with individual classifiers to assess its accuracy, precision, sensitivity, specificity, and diagnostic time, and a comparison with low-mid-and high-experience physician groups was conducted to comprehensively evaluate the model′s diagnostic performance.Results:The experimental results showed that the model achieved an accuracy of 88.8%(178/200), precision of 92.9%,(112/120) sensitivity of 89.8%(108/120), and specificity of 88.1%(70/80). The average diagnostic time for individual patient temporal bone CT images was reduced to 2-3 seconds. Compared to the diagnostic results from low-mid-and high-experience physician groups, the model demonstrated significant advantages and effectively assisted clinicians in making rapid and accurate middle ear cholesteatoma diagnoses.Conclusion:The proposed middle ear cholesteatoma diagnostic model based on integrated convolutional neural networks exhibits high recognition accuracy and rapid diagnostic speed, significantly improving clinical diagnostic efficiency, especially in early screening and auxiliary diagnosis, making it of considerable value in clinical practice.