BACKGROUND: Neoadjuvant chemoradiotherapy followed by radical surgery has been a common practice for patients with locally advanced rectal cancer, but the response rate varies among patients. This study aimed to develop a ResNet-Vision Transformer based magnetic resonance imaging (MRI)-endoscopy fusion model to precisely predict treatment response and provide personalized treatment. METHODS: In this multicenter study, 366 eligible patients who had undergone neoadjuvant chemoradiotherapy followed by radical surgery at eight Chinese tertiary hospitals between January 2017 and June 2024 were recruited, with 2928 pretreatment colonic endoscopic images and 366 pelvic MRI images. An MRI-endoscopy fusion model was constructed based on the ResNet backbone and Transformer network using pretreatment MRI and endoscopic images. Treatment response was defined as good response or non-good response based on the tumor regression grade. The Delong test and the Hanley-McNeil test were utilized to compare prediction performance among different models and different subgroups, respectively. The predictive performance of the MRI-endoscopy fusion model was comprehensively validated in the test sets and was further compared to that of the single-modal MRI model and single-modal endoscopy model. RESULTS: The MRI-endoscopy fusion model demonstrated favorable prediction performance. In the internal validation set, the area under the curve (AUC) and accuracy were 0.852 (95% confidence interval [CI]: 0.744-0.940) and 0.737 (95% CI: 0.712-0.844), respectively. Moreover, the AUC and accuracy reached 0.769 (95% CI: 0.678-0.861) and 0.729 (95% CI: 0.628-0.821), respectively, in the external test set. In addition, the MRI-endoscopy fusion model outperformed the single-modal MRI model (AUC: 0.692 [95% CI: 0.609-0.783], accuracy: 0.659 [95% CI: 0.565-0.775]) and the single-modal endoscopy model (AUC: 0.720 [95% CI: 0.617-0.823], accuracy: 0.713 [95% CI: 0.612-0.809]) in the external test set. CONCLUSION The MRI-endoscopy fusion model based on ResNet-Vision Transformer achieved favorable performance in predicting treatment response to neoadjuvant chemoradiotherapy and holds tremendous potential for enabling personalized treatment regimens for locally advanced rectal cancer patients.
Humans ; Rectal Neoplasms/diagnostic imaging* ; Magnetic Resonance Imaging/methods* ; Male ; Female ; Middle Aged ; Neoadjuvant Therapy/methods* ; Aged ; Adult ; Chemoradiotherapy/methods* ; Endoscopy/methods* ; Treatment Outcome

Objective:To explore the mediating role of disease progression′s fear and positive affect in the relationship between disease perception and demoralization in patients with chronic heart failure. It provided a theoretical basis for targeted interventions for healthcare workers.Methods:From October 2022 to March 2023, 320 patients with chronic heart failure in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by convenience sampling. The General Information Questionnaire, Demoralization Scale Redacted Mandarin Version, Brief Illness Perception Questionnaire, Fear of Progression Questionnaire-Short Form, Positive and Negative Affect Schedule (Positive Affect Schedule) were used to conduct the questionnaire survey exploring the mediating effects of fear of disease progression and positive emotions between disease perception and disorientation by construction structural equation model.Results:There were 268 valid questionnaires. Of the 268 patients, 168 were male and 100 were female, 3.36% (9/268) were ≤40 years old, 55.22% (148/268) were 41-65 years old, and 41.42% (111/268) were >65 years old. Correlation analysis showed that disease perception was positively correlated with disease progression ′s fear, and every dimension of demoralization ( r values were 0.300-0.586, all P<0.01), and negatively correlated with positive affect ( r=-0.374, P<0.01); disease progression′s fear was negatively correlated with positive affect ( r=-0.318, P<0.01), and positively correlated with every dimension of demoralization ( r values were 0.339-0.464, all P<0.01); positive affect was negatively correlated with every dimension of demoralization ( r values were -0.430--0.334, all P<0.01). Structural equation model analysis showed that the direct effect of disease perception on demoralization was significant ( β=0.407, P<0.01), and both mediating effects of disease progression ′s fear and positive affect between disease perception and demoralization in patients with chronic heart failure were significant ( β=0.074, 0.079, both P<0.01). The chain mediating effect of disease progression ′s fear and positive effect was also significant ( β=0.019, P<0.01). Conclusions:Disease perception could directly predict the demoralization of patients with chronic heart failure and indirectly predict the demoralization of patients with chronic heart failure through the mediating effect of disease progression ′s fear, positive affect, and the chain mediating effect of disease progression ′s fear and positive affect.

Objective:To investigate the effects of self-efficacy on evidence-based nursing practice (EBNP) behaviors and its underlying mechanisms.Methods:Between September and October 2023, nurses from the otolaryngology departments of 51 hospitals in Henan Province were selected for this study by convenience sampling. Data were collected using general demographic surveys, Self-Efficacy Scale, Information Iiteracy Questionnaire, EBNP Competency Scale, and EBNP Behavior Scale. Pearson correlation analysis was used to explore the relationships among self-efficacy, information literacy, EBNP competencies, and EBNP behaviors. The mediating effects of information literacy and EBNP competencies between self-efficacy and EBNP behaviors were analyzed using Process v4.2.Results:A total of 580 questionnaires were distributed, with 551 valid responses, yielding a response rate of 95%. Scores for self-efficacy, information literacy, EBNP competencies, and EBNP behaviors were (28.60±6.48), (78.56±11.88), (34.86±8.59), and (28.26±7.64), respectively. Pearson correlation analysis indicated that information literacy was positively correlated with self-efficacy, EBNP competencies, and EBNP behaviors ( r=0.640, 0.687, and 0.661, respectively; P<0.001). Mediation tests confirmed the direct effect of self-efficacy on EBNP behaviors and the individual and serial mediating effects of information literacy and EBNP competencies, with mediating effect sizes of 27.273%, 18.379%, and 44.862%, respectively. Conclusions:The serial mediating roles of information literacy and EBNP competencies between self-efficacy and EBNP behaviors among otolaryngology nurses are validated. Future strategies could involve enhancing otolaryngology nurses' information literacy and EBNP competencies to promote their EBNP behaviors.

Objective:To explore the application effect of home rehabilitation exercise prescription in non-surgical treatment of patients with lumbar disc herniation.Methods:Using the convenient sampling method, a total of 66 patients with non-surgical treatment of lumbar disc herniation who visited Outpatient Department of the First Affiliated Hospital of Zhengzhou University from January to August 2023 were selected as the research objects. The patients were divided into the control group and the observation group using the random number table method, with 33 cases in each group. The control group implemented routine home rehabilitation nursing measures, while the observation group formed an outpatient home rehabilitation nursing team based on this, constructed a home rehabilitation exercise prescription and implemented targeted home rehabilitation training. Pain Numberic Rating Scale (NRS), Oswestry Disability Index (ODI), Modified Japanese Orthopaedic Association (JOA) Scores and exercise compliance were compared between the two groups after 6 weeks of home rehabilitation.Results:After 6 weeks of home rehabilitation exercise, NRS score and ODI score of observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05). The JOA score and compliance score of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Home rehabilitation exercise prescription can promote the rehabilitation of patients with non-surgical treatment of lumbar disc herniation, effectively relieve pain, improve the symptoms of limb dysfunction and improve the compliance of rehabilitation exercise.

Purpose/Significance To construct a risk prediction model for postoperative massive bleeding in nasopharyngeal carcino-ma after radiotherapy,and to evaluate its predictive performance.Method/Process Inpatients with major bleeding after radiotherapy for nasopharyngeal cancer in the First Affiliated Hospital of Zhengzhou University from 2016 to 2019 are selected as the study objects,and the same number of patients without major bleeding are randomly selected as the control group.The medical record index data of the two groups of patients are collected,and various machine learning algorithms are applied respectively and the optimal algorithm is selected to build the model.Result/Conclusion The model based on support vector machine(SVM)algorithm has a recall rate of 0.94,an F1 val-ue of 0.93,and a precision of 0.93,showing the best performance.It can be used to construct a prediction model for postoperative mas-sive bleeding in nasopharyngeal carcinoma,and provide more accurate personalized prediction for patients,which has good clinical appli-cation prospects.

Objective:To analyze the research hotspots and trends of swallowing disorders in patients with head and neck tumors both domestically and internationally, to provide reference for future research directions.Methods:Using the China National Knowledge Infrastructure and Web of Science core collection databases as data sources, research literature related to swallowing disorders in head and neck tumor patients published from January 1, 2013, to December 31, 2022, was retrieved. A knowledge graph was drawn using Cite Space 6.2 R3 software, and the graph was interpreted and analyzed from the aspects of publication volume, publication country, and institution, high-frequency keyword co-occurrence and clustering, and emergent words.Results:A total of 427 English literature were included. The overall number of publications is on the rise. The countries with a high volume of collaborative publications were the United States, Australia, the Netherlands, and the United Kingdom. The top three institutions in terms of publication volume were the University of Queensland in Australia, the University of Newcastle in the UK, and the Amsterdam Institute in the Netherlands. A total of 10 cluster clusters and 25 prominent keywords were obtained. The hot topics of research and analysis were "swallowing dysfunction" "associated complications" and "long-term effects", with the forefront being "radiation-induced dry mouth syndrome".Conclusions:Compared to foreign countries, China currently has a relatively small number of publications, loose cooperation between research authors and institutions, and a need for more diverse disciplines and research methods. Focusing on hot topics and cutting-edge content, exploring the mechanism of swallowing disorders in head and neck tumors, implementing targeted interventions, strengthening health education, predicting postoperative dangerous complications, constructing feasible nursing plans, and improving the quality of life of patients will become the development trend of future research.

Objective:To understand the current status and analyze the factors of demoralization of patients with chronic heart failure (CHF), providing references for targeted psychological interventions of nursing staff.Methods:Using the cross-sectional survey method, from August 2022 to January 2023, 282 CHF patients who were followed up in the Cardiovascular Department of the First Affiliated Hospital of Zhengzhou University were selected as the study subjects. They were investigated using the General Information Questionnaire, Demoralization Scale Revised Mandarin Version, Brief Illness Perception Questionnaire (BIPQ), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the factors influencing the demoralization of CHF patients were analyzed using univariate analysis and multiple linear regression.Results:Among 282 cases, male 172 cases, female 110 cases, aged (62.29±10.05) years old. The Demoralization Scale Revised Mandarin Version′s score of CHF patients was (30.30 ± 10.37) points; the score of BIPQ was (42.18 ± 13.94) points; the score of FoP-Q-SF was (35.41 ± 7.29)points, which were at high level. The results of multiple linear regression analysis showed that patient disease duration, disease stages, New York heart association cardiac function classification, the score of BIPQ, and the score of FoP-Q-SF were factors influencing the demoralization of CHF patients ( t values were 3.08 to 12.50, all P<0.05). Conclusions:There is an urgent need to focus on the current status of the demoralization of CHF patients. It is necessary to develop a systematic and effective intervention strategy for demoralization, to take into account patient disease duration, disease stages, illness perception, and fear of progression in a comprehensive manner.

Objective:To construct a nomogram model for nasopharyngeal bleeding risk in nasopharyngeal carcinoma patients underwent radiotherapy, and to verify the application value of the model.Methods:From June 2020 to December 2021, 317 nasopharyngeal carcinoma patients underwent radiotherapy in the First Affiliated Hospital of Zhengzhou University were enrolled by the convenience sampling method, and divided into the bleeding group and the non-bleeding group according to the occurrence of nasopharyngeal hemorrhage bleeding. Univariate analysis and Logistic regression analysis were used to analyze the independent risk factors of nasopharyngeal hemorrhage patients underwent radiotherapy, and a nomogram model was constructed. Correction curve, Hosmer- Lemeshow ( H- L) goodness fit test and receiver operating characteristic (ROC) curve were used to evaluate the predictive efficiency of the model, and the area under ROC curve was calculated. Results:Multivariate Logistic regression analysis results showed that hypertension, skull base invasion, synchronous chemotherapy, anterior field+skull base irradiation, tumor rectum growth and average radiation dose≥70 Gy were the independent risk factors of nasopharyngeal hemorrhage in nasopharyngeal carcinoma patients underwent radiotherapy ( P<0.05). H- L goodness fit test results showed that there was no significant difference between the calibration curve predicted by the nomogram model and the ideal model curve (χ 2=3.469, P=0.614), and the area under ROC curve was 0.778 (95% CI: 0.705-0.947) . Conclusions:Hypertension, skull base invasion, synchronous chemotherapy, anterior field+skull base irradiation, tumor crypt growth and radiation dose≥70 Gy were the independent risk factors for nasopharyngeal hemorrhage in nasopharyngeal cancer patients underwent radiotherapy. The nomogram model constructed in this study has good differentiation and accuracy, which can provide a reference for medical staffs to develop targeted intervention strategies.

Objective:To explore the effect of the transtheoretical model and stages of change (TTM) led by specialized nurses in the symptom cluster management of radiating muscle group in nasopharyngeal carcinoma.Methods:From January to October 2021, 58 nasopharyngeal carcinoma patients hospitalized in the First Affiliated Hospital of Zhengzhou University were selected as the study subject by convenience sampling. According to the random number table method, patients were divided into a control group and an experimental group, with 29 cases each. The control group implemented the routine nursing, while the experimental group used TTM staged nursing led by specialized nurses on the basis of the control group. We collected data before discharge and six months after discharge, and observed the changes in incisor distance, degree of mouth opening restriction, and swallowing difficulty in both groups of patients.Results:Six months after discharge, the distance between the incisors in the experimental group was greater than that in the control group, and the grading of mouth opening restriction was better than that in the control group, and the swallowing difficulty score of the patients was higher than that in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The TTM staged nursing led by specialized nurses can improve the symptom cluster management of radiating muscle group and the quality of life of nasopharyngeal cancer patients after radiotherapy, which is worthy of clinical practice.

Objective:To explore the effects of solution-focused group therapy nursing intervention on body image and anxiety and depression in young patients with nasopharyngeal carcinoma.Methods:Using a convenience sampling method, 60 young patients with nasopharyngeal carcinoma hospitalized in the First Affiliated Hospital of Zhengzhou University from December 2020 to December 2021 were selected as the study subjects, and were divided into an observation group and a control group using the random number table method, with 30 cases each. The control group received conventional care, and the patients in the observation group implemented a focal solution-oriented group counselling nursing intervention on the basis of the control group. The scores on the Body Image Scale (BIS) and the Hospital Anxiety and Depression Scale (HADS) were compared between the two groups before and after the intervention.Results:Before the intervention, there were no statistically significant differences between the BIS and HADS scores of the two groups ( P>0.05). After the intervention, the total score of BIS and each dimension in the observation group and the score of HADS were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The nursing intervention of solution-focused group therapy can effectively alleviate the body image dysregulation condition and reduce the level of anxiety and depression in young patients with nasopharyngeal carcinoma.