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

Pregnancy with chronic kidney disease (CKD), particularly in stages 4-5, carries high risks of adverse outcomes including maternal renal failure, preeclampsia/eclampsia, fetal growth restriction, and preterm birth. This report described a 26-year-old woman with congenital solitary kidney, polycystic ovaries, and uterine septum due to PAX2 gene variant, complicated by CKD stage 4. Through multidisciplinary team precision management and individualized treatment strategies, including timely initiation of dialysis, the patient successfully maintained pregnancy until 34 +1 weeks and delivered a female infant via cesarean section. This case summarizes key management experiences for end-stage renal disease in pregnancy, highlighting early risk assessment, precise nutritional management, hemodialysis protocol optimization, and the crucial role of multidisciplinary collaboration, providing valuable references for managing CKD-complicated pregnancies.

Objective:To construct a clinical practice training system for master′s degree students specializing in oral nursing based on the competency iceberg model for job performance, and to provide a valuable reference for the clinical training of master′s students in oral nursing.Methods:The research team initially formulated the components of the clinical practice training system through an extensive literature review and semi-structured interviews. From October 17, 2023, to November 13, 2023, the Delphi expert consultation methodology was utilized to facilitate two rounds of inquiries involving 20 specialists in the domain of oral care.Results:The positive coefficients of the two rounds of expert inquiries were 95.24% (20/21) and 100.00% (21/21). The authority coefficients were 0.925 and 0.929, while the variation coefficients ranged from 0.00 to 0.22 and from 0.05 to 0.11. Additionally, Kendall′s harmony coefficients were 0.229 and 0.319 (both P<0.01). The finalized training system included training objectives, training content, training requirements and examinations, totaling 3 first-level items, 18 second-level items and 67 third-level items. Conclusions:The training system of clinical practice for oral nursing graduate students constructed in this study is informative and reliable, and can provide reference for clinical practice of professional postgraduates in oral nursing.

Objective:To construct a clinical practice training system for master′s degree students specializing in oral nursing based on the competency iceberg model for job performance, and to provide a valuable reference for the clinical training of master′s students in oral nursing.Methods:The research team initially formulated the components of the clinical practice training system through an extensive literature review and semi-structured interviews. From October 17, 2023, to November 13, 2023, the Delphi expert consultation methodology was utilized to facilitate two rounds of inquiries involving 20 specialists in the domain of oral care.Results:The positive coefficients of the two rounds of expert inquiries were 95.24% (20/21) and 100.00% (21/21). The authority coefficients were 0.925 and 0.929, while the variation coefficients ranged from 0.00 to 0.22 and from 0.05 to 0.11. Additionally, Kendall′s harmony coefficients were 0.229 and 0.319 (both P<0.01). The finalized training system included training objectives, training content, training requirements and examinations, totaling 3 first-level items, 18 second-level items and 67 third-level items. Conclusions:The training system of clinical practice for oral nursing graduate students constructed in this study is informative and reliable, and can provide reference for clinical practice of professional postgraduates in oral nursing.

Pregnancy with chronic kidney disease (CKD), particularly in stages 4-5, carries high risks of adverse outcomes including maternal renal failure, preeclampsia/eclampsia, fetal growth restriction, and preterm birth. This report described a 26-year-old woman with congenital solitary kidney, polycystic ovaries, and uterine septum due to PAX2 gene variant, complicated by CKD stage 4. Through multidisciplinary team precision management and individualized treatment strategies, including timely initiation of dialysis, the patient successfully maintained pregnancy until 34 +1 weeks and delivered a female infant via cesarean section. This case summarizes key management experiences for end-stage renal disease in pregnancy, highlighting early risk assessment, precise nutritional management, hemodialysis protocol optimization, and the crucial role of multidisciplinary collaboration, providing valuable references for managing CKD-complicated pregnancies.

Objective:To investigate the effect of high-frequency repetitive transcranial magnetic stimulation combined with sertraline on depressive symptoms and self-injurious behaviors in adolescents with depression and non-suicidal self-injury.Methods:This study was a prospective study. A total of 112 adolescent patients with depression and non-suicidal self-injury who received treatment at the Third Hospital of Quzhou from January 2021 to September 2023 were included in this study. These patients were divided into a control group and a study group, with 56 patients per group, using the random digital table method. The control group was treated with sertraline, while the study group was treated with high-frequency repetitive transcranial magnetic stimulation combined with sertraline. The depression scores [assessed using the 24-item Hamilton Depression Scale (HAMD-24) and the Self-Rating Depression Scale (SDS)], self-injury status, and inflammatory factor levels (tumor necrosis factor-α, interleukin-10, and interleukin-1β levels) were compared before and after the intervention.Results:Before intervention, there were no statistically significant differences in HAMD-24 scores and SDS scores between the two groups (both P > 0.05). After intervention, both HAMD-24 scores and SDS scores decreased significantly in both groups (both P < 0.05). Additionally, the HAMD-24 scores [(13.46 ± 3.98) points] and SDS scores [(50.28 ± 5.13) points] in the study group were significantly lower than those in the control group [(19.89 ± 4.23) points, (71.62 ± 6.88) points, t = -8.28, -18.61, both P < 0.05]. Before intervention, there were no statistically significant differences in the number of self-injury incidents and self-injurious behavior scores between the two groups (both P > 0.05). After intervention, the number of self-injury incidents and the score of self-injurious behaviors significantly decreased in the study group compared with before intervention (both P < 0.05). After intervention, the number of self-injury incidents in the control group was decreased compared with before intervention ( P < 0.05), while the score of self-injurious behaviors did not differ significantly compared with before intervention ( P > 0.05). After intervention, the number of self-injury incidents [(2.15 ± 1.06) times] and the score of self-injurious behaviors [(2.41 ± 0.65) points] in the study group were significantly lower than those in the control group [5.43 ± 3.61) times, (12.04 ± 3.01) points, t = -7.78, -23.40, both P < 0.05]. Before intervention, there were no statistically significant differences in interleukin-1β, tumor necrosis factor-α, and interleukin-10 levels between the two groups (all P > 0.05). After intervention, interleukin-1β and tumor necrosis factor-α levels in the study group were significantly lower than those before intervention (both P < 0.05), while interleukin-10 levels in the study group were significantly higher than those before intervention ( P < 0.05). There were no statistically significant differences in the levels of interleukin-1β, tumor necrosis factor-α, and interleukin-10 between the pre- and post-intervention measurements in the control group (all P > 0.05). After intervention, interleukin-1β levels [(57.15 ± 6.33) ng/L] and tumor necrosis factor-α levels [(13.87 ± 5.91) ng/L] in the study group were significantly lower than those in the control group [(73.61 ± 8.52) ng/L, (17.12 ± 5.28) ng/L], while interleukin-10 levels [(1.62 ± 0.66) ng/L] were significantly higher than those in the control group [(1.19 ± 0.63) ng/L, t = -11.60, 3.53, -3.07, all P < 0.05]. Conclusion:High-frequency repetitive transcranial magnetic stimulation combined with sertraline can significantly reduce depressive symptoms and self-injurious behaviors in adolescents with depression and non-suicidal self-injury. The reason may be due to the decrease in inflammatory factor levels in patients.

Objective:To investigate the effect of high-frequency repetitive transcranial magnetic stimulation combined with fluvoxamine treatment on improving depression, impulsivity, and self-injury levels in adolescent patients with depression.Methods:A total of 124 adolescent patients with depression who received treatment at the Department of Psychiatry, The Third Hospital of Quzhou, China from January 2022 to November 2023 were included in this study. The patients were randomly divided into a control group and an observation group, with 62 patients per group, using the random number table method. Patients in the control group received treatment with fluvoxamine, while patients in the observation group underwent high-frequency repetitive transcranial magnetic stimulation and treatment with fluvoxamine. Clinical efficacy and the scores of the Hamilton Depression Scale, Hamilton Anxiety Scale, the Barratt Impulsiveness Scale-ll revised version, and the Non-Suicidal Self-Injury Assessment Tool revised version were compared between the two groups.Results:The total response rate in the observation group was 90.32% (56/62), which was significantly higher than that in the control group [72.58% (45/62), χ2 = 6.46, P < 0.05]. After treatment, scores of the Hamilton Depression Scale and Hamilton Anxiety Scale in the observation group were (12.08 ± 1.97) points and (11.58 ± 1.59) points, respectively, which were significantly lower than those in the control group [(16.42 ± 2.33) points, (14.42 ± 1.94) points, t = -8.28, -18.61, both P < 0.05]. After treatment, the scores of the Barratt Impulsiveness Scale-ll revised version and Non-Suicidal Self-Injury Assessment Tool revised version in the observation group were significantly lower than those in the control group [(28.25 ± 3.91) points, (9.23 ± 2.12) points, t = 5.42, 9.44, both P < 0.05]. Conclusion:High-frequency repetitive transcranial magnetic stimulation combined with fluvoxamine treatment can significantly reduce depressive symptoms, impulsivity, and self-injury levels in adolescent patients with depression.

The ninth edition of TNM staging for lung cancer has been announced at the 2023 World Lung Cancer Congress and implemented from January 1, 2024. The focus of the ninth TNM staging change is dividing N2 into N2a and N2b, as well as M1c into M1c1 and M1c2. Although the T staging has not changed, it has played an important role in verifying the eighth edition of the T staging. The subdivision of stage N2 has led some patients with ⅢA of the eighth edition to experience ascending or descending stages, which will more accurately help to assess the condition and prognosis of patients with mediastinal lymph node metastasis, as well as the design of related clinical studies. Modifying the M1c staging will help define oligometastasis and explore new treatment models in the future. The ninth edition of the TNM staging system provides a more detailed division of different tumor loads, but there is no clear explanation for the staging of lung cancer after neoadjuvant therapy. Further data analysis is needed, and it is expected to be answered in the tenth edition of TNM staging.

The ninth edition of TNM staging for lung cancer has been announced at the 2023 World Lung Cancer Congress and implemented from January 1, 2024. The focus of the ninth TNM staging change is dividing N2 into N2a and N2b, as well as M1c into M1c1 and M1c2. Although the T staging has not changed, it has played an important role in verifying the eighth edition of the T staging. The subdivision of stage N2 has led some patients with ⅢA of the eighth edition to experience ascending or descending stages, which will more accurately help to assess the condition and prognosis of patients with mediastinal lymph node metastasis, as well as the design of related clinical studies. Modifying the M1c staging will help define oligometastasis and explore new treatment models in the future. The ninth edition of the TNM staging system provides a more detailed division of different tumor loads, but there is no clear explanation for the staging of lung cancer after neoadjuvant therapy. Further data analysis is needed, and it is expected to be answered in the tenth edition of TNM staging.

Objective:To establish a performance validation method for mNGS applied in BALF samples.Method:Hela cells were used as a representative of host cells, and simulated BALF samples were prepared by adding different concentrations of Hela cells, seven species of isolated pathogens (including Streptococcus pneumonia, Hemophilus influenza, Klebsiella pneumonia, Candida albicans, Cryptococcus neoformans, Aspergillus fumigatus, and Adenovirus), and interfering substances to sterile normal saline. Clinical BALF samples were collected simultaneously, and the results of mNGS were evaluated using traditional detection methods as a reference. The limit of detection (LOD), precision, anti-interference ability, stability, and accuracy of mNGS were determined. Results:In the simulated samples, the LOD of Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Candida albicans, Cryptococcus neoformans, Aspergillus fumigatus, and Adenovirus were 150, 262, 102, 67, 96, 83 CFU/ml, and 439 copies/ml, respectively. The repeatability of the detection results for all pathogens of simulated positive BALF samples was 100%. The anti-interference test showed that the higher the concentration of human DNA, the fewer pathogen sequences detected by mNGS. Escherichia coli and Shigella sonnei were used to evaluate the ability of mNGS to distinguish closely related species. The results showed that the system could stably distinguish Escherichia coli and Shigella sonnei when the concentration of Shigella sonnei was 4, 000 CFU/ml. The stability test results showed that there was no significant change in the number of pathogen sequences detected whether after 1 to 3 freeze-thaw cycles or storage at 4 ℃, -20 ℃, or -80 ℃ for 36 h. Compared with traditional detection methods, the accuracy of 17 clinical samples was 82.4%(14/17). Continuous evaluation of clinical BALF samples simultaneously tested by mNGS and traditional methods at Tongji Hospital from October 25, 2021, to September 14, 2022, showed that the accuracy of mNGS compared to bacterial culture, fungal culture, mycobacterial culture, Mycobacterium tuberculosis culture, and conventional PCR techniques was 67.5%(472/699), 81.5%(570/699), 92.3%(335/363), 96.4%(350/363), and 86.8%(132/152), respectively. Compared with conventional PCR techniques, the accuracy of mNGS for detecting Pneumocystis jirovecii, Adenovirus, and Mycoplasma pneumoniae was 89.4%(84/94), 93.3%(56/60), and 87.1%(61/70), respectively. Conclusion:By preparing simulated BALF samples and using traditional detection methods as a reference, the performance characteristics of mNGS in detecting BALF samples can be preliminarily evaluated.