The core aberrant behaviors of attention deficit hyperactivity disorder (ADHD) are primarily manifested as inattention, hyperactivity, and impulsivity, which are closely associated with specific neuropathological features.Virtual reality (VR) technology, leveraging its immersive, interactive, and customizable properties, demonstrates potential in ameliorating the abnormal behavioral manifestations of individuals with ADHD. This article aims to synthesize existing evidence from neurobiological mechanism research and explore the therapeutic efficacy of VR interventions in improving abnormal behavioral presentations in ADHD patients. An evidence-integrated framework posits that: (1) VR enhances inhibitory control and working memory by promoting neural plasticity remodeling within key brain regions through highly contextualized simulation tasks, thereby optimizing functional connectivity.(2) VR reduces attentional lapses and impulsive behaviors by regulating the dynamic interplay efficiency among the default mode network, executive control network, and salience network.(3) VR elevates motivational levels and cognitive flexibility by dynamically modulating dopaminergic-noradrenergic system homeostasis, synergizing with brain-derived neurotrophic factor mediated synaptic plasticity. Delving deeper into these underlying mechanisms will facilitate the optimization of multi-target VR intervention design and provide novel insights for personalized behavioral therapy in ADHD.

Obstructive sleep apnea(OSA)is a dis-order characterized by chronic intermittent hypoxia and sleep fragmentation,usually manifested by ob-struction of the upper respiratory tract,resulting in sleep fragmentation,intermittent hypoxia,and hy-percapnia.OSA and significant comorbidities are as-sociated with perioperative complications.Opioids,as the most commonly used pain relievers,may fur-ther affect perioperative pain management in OSA and comorbidities.Studies have shown that OSA patients are more susceptible to the respiratory de-pressant effects of opioids.OSA also increases the risk of opioid-induced respiratory depression.There-fore,understanding the effects and mechanisms of opioids on OSA has important clinical significance for optimizing drug use,improving prognosis,and reducing respiratory adverse events.This article aims to review the effects of opioids on OSA and their relationship.

The core aberrant behaviors of attention deficit hyperactivity disorder (ADHD) are primarily manifested as inattention, hyperactivity, and impulsivity, which are closely associated with specific neuropathological features.Virtual reality (VR) technology, leveraging its immersive, interactive, and customizable properties, demonstrates potential in ameliorating the abnormal behavioral manifestations of individuals with ADHD. This article aims to synthesize existing evidence from neurobiological mechanism research and explore the therapeutic efficacy of VR interventions in improving abnormal behavioral presentations in ADHD patients. An evidence-integrated framework posits that: (1) VR enhances inhibitory control and working memory by promoting neural plasticity remodeling within key brain regions through highly contextualized simulation tasks, thereby optimizing functional connectivity.(2) VR reduces attentional lapses and impulsive behaviors by regulating the dynamic interplay efficiency among the default mode network, executive control network, and salience network.(3) VR elevates motivational levels and cognitive flexibility by dynamically modulating dopaminergic-noradrenergic system homeostasis, synergizing with brain-derived neurotrophic factor mediated synaptic plasticity. Delving deeper into these underlying mechanisms will facilitate the optimization of multi-target VR intervention design and provide novel insights for personalized behavioral therapy in ADHD.

Objective:To systematically evaluate the incidence and influencing factors of emergence agitation (EA) after general anesthesia in patients undergoing non-cardiac surgery.Methods:Literature on EA after general anesthesia in adult patients undergoing non-cardiac surgery was electronically retrieved from PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc. The search period was from the establishment of the database to June 1, 2024. Two researchers independently screened literature, extracted data, conducted quality assessments, and used RevMan 5.3 to perform the Meta-analysis.Results:A total of 22 studies were included, involving 16 853 patients. Meta-analysis indicated that the incidence of EA after general anesthesia in patients undergoing non-cardiac surgery was 18.00%. Advanced age, male, high anesthesia grade, obesity, smoking, hypertension, diabetes, preoperative anxiety, preoperative benzodiazepine use, high preoperative leukocyte, low preoperative serum albumin, prolonged operative time, intraoperative hypothermia, type of surgery, inhalation anesthesia, hypoxemia during emergence, pain during emergence, indwelling urinary catheter, and indwelling drainage tube were risk factors for EA ( P<0.05). The use of dexmedetomidine during surgery and analgesic pump after surgery were protective factors for EA ( P<0.05) . Conclusions:The EA in patients undergoing general anesthesia for non-cardiac surgery is the result of multiple factors acting together. Clinical healthcare providers should enhance their ability to identify risk factors for EA and implement targeted interventions at an early stage to improve the quality of patient awakening and clinical outcomes.

Objective:To explore the current status, research hotspots, and development trends of shared decision-making in the field of cardiovascular disease nursing, and to provide a reference for future research.Methods:Relevant literature on shared decision-making in cardiovascular disease nursing published up to October 31, 2024, was retrieved from the Web of Science Core Collection and China National Knowledge Infrastructure. CiteSpace 6.4.R1 software was used for visualized analysis.Results:A total of 2 748 publications were identified, including 2 446 in English and 302 in Chinese. The overall number of publications has shown an increasing trend. Research hotspots include quality of life, palliative care, machine learning, and artificial intelligence. The emerging trend involves integrating evidence-based approaches with artificial intelligence technologies to build scientific evidence frameworks that support patients in making optimal decisions.Conclusions:Research on shared decision-making in cardiovascular disease nursing has been increasing year by year but remains largely concentrated in developed countries. Future studies should draw on international research frontiers while considering China's national and cultural contexts, enhance academic exchange and collaboration, and explore effective strategies to promote shared decision-making between Medical staff and patients.

Obstructive sleep apnea(OSA)is a dis-order characterized by chronic intermittent hypoxia and sleep fragmentation,usually manifested by ob-struction of the upper respiratory tract,resulting in sleep fragmentation,intermittent hypoxia,and hy-percapnia.OSA and significant comorbidities are as-sociated with perioperative complications.Opioids,as the most commonly used pain relievers,may fur-ther affect perioperative pain management in OSA and comorbidities.Studies have shown that OSA patients are more susceptible to the respiratory de-pressant effects of opioids.OSA also increases the risk of opioid-induced respiratory depression.There-fore,understanding the effects and mechanisms of opioids on OSA has important clinical significance for optimizing drug use,improving prognosis,and reducing respiratory adverse events.This article aims to review the effects of opioids on OSA and their relationship.

Objective To explore the application value of intravoxel incoherent motion(IVIM)imaging parameters in the differential diagnosis of benign and malignant breast nodules and their correlation with the expression of Ki-67 receptor in breast cancer.Methods The data of 41 female patients who completed 3.0 T breast magnetic resonance imaging(MRI)with complete surgical pathology results in the Second Hospital of Jiaxing City from October 2022 to January 2025 were analysed and evaluated.Conventional images and diffusion-weighted images with 11 b values were collected.The IVIM imaging parameters of real diffusion coefficient(D),perfusion related diffusion coefficient(D*)and perfusion fraction(f)were measured and calculated in the region of interest of each lesion.The receiver operating characteristic curve were plotted to quantify the differential diagnostic efficacy of each parameter of IVIM imaging in benign and malignant breast nodules.The differences of parameters between benign and malignant breast nodules and between the groups with different expression levels of Ki-67 receptor in breast cancer were analysed,and the correlation between each parameter and the expression level of Ki-67 in breast cancer was counted.Results The D value of benign breast nodules group(benign groups)was significantly higher than that of malignant breast nodules group(malignant groups),and the D*value was significantly lower than that of malignant group,and the differences between benign group and malignant group were statistically significant(t=-4.773,t=2.063,P＜0.05);Thefvalue of benign group was slightly lower than that of malignant group,and the differences between two groups were not statistically significant(t=0.035,P＞0.05).Among the parameters of IVIM imaging,D value had the best differential diagnostic efficacy for benign and malignant breast nodules,with area under the curve(AUC)of 0.870(95％CI:0.755-0.985)and a specificity of 75.0％;D*value had the second best differential diagnostic efficacy after D value,with an AUC of 0.789(95％CI:0.658-0.920),but it had the highest sensitivity of 88.2％;And the differential diagnosis efficiency off value was the worst,much less than D and D*values.The D value in the high Ki-67 expression group of breast cancer was lower than that in the low expression group,while the D* and f values in the high expression group were higher than that in the low expression group,and the differences of each imaging parameter of IVIM were not statistically significant between two groups(t=-2.617,t=2.169,t=0.647,P＞0.05).There was a significant negative correlation between the expression of the Ki-67 receptor and the D value(r=-0.615,P＜0.05),and no significant correlation was seen with either D *or f value(r=0.223,r-0.031,P＞0.05).Conclusion The D and D*values of IVIM imaging parameters have great clinical value in the differential diagnosis of benign and malignant breast nodules.

This article reports a rare case of thrombotic microangiopathy (TMA) with renal involvement complicated by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The patient appeared increased serum creatinine 20 d after allo-HSCT, and gradually appeared hypertension, oliguria and edema. Despite discontinuing suspected medications, serum creatinine level did not decrease. Treatment with basiliximab and mycophenolate mofetil was initiated to prevent rejection, leading to gradual normalization of urine output and serum creatinine level. However, after stopping mycophenolate mofetil, the patient experienced recurrent increased blood pressure and decreased pulse oximetry, responding well to prednisone but recurring upon cessation, with gradually increased serum creatinine level. Renal pathology indicated that chronic TMA after allo-HSCT caused renal injury, primarily affecting the glomeruli. The renal function achieved long-term stability through low-dose prednisone and symptomatic treatment. By reviewing relevant literature, we discussed the clinical manifestations, laboratory tests, pathological features and treatment strategies of TMA with renal involvement complicated by allo-HSCT.

Objective:To systematically evaluate the incidence and influencing factors of emergence agitation (EA) after general anesthesia in patients undergoing non-cardiac surgery.Methods:Literature on EA after general anesthesia in adult patients undergoing non-cardiac surgery was electronically retrieved from PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc. The search period was from the establishment of the database to June 1, 2024. Two researchers independently screened literature, extracted data, conducted quality assessments, and used RevMan 5.3 to perform the Meta-analysis.Results:A total of 22 studies were included, involving 16 853 patients. Meta-analysis indicated that the incidence of EA after general anesthesia in patients undergoing non-cardiac surgery was 18.00%. Advanced age, male, high anesthesia grade, obesity, smoking, hypertension, diabetes, preoperative anxiety, preoperative benzodiazepine use, high preoperative leukocyte, low preoperative serum albumin, prolonged operative time, intraoperative hypothermia, type of surgery, inhalation anesthesia, hypoxemia during emergence, pain during emergence, indwelling urinary catheter, and indwelling drainage tube were risk factors for EA ( P<0.05). The use of dexmedetomidine during surgery and analgesic pump after surgery were protective factors for EA ( P<0.05) . Conclusions:The EA in patients undergoing general anesthesia for non-cardiac surgery is the result of multiple factors acting together. Clinical healthcare providers should enhance their ability to identify risk factors for EA and implement targeted interventions at an early stage to improve the quality of patient awakening and clinical outcomes.

Objective:To investigate the value of triglyceride glucose index(TyG)and monocyte to high-density lipoprotein choles-terol ratio(MHR)in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by heart fail-ure(HF),as well as the correlation of TyG and MHR with cardiac function in AECOPD patients.Methods:A retrospective analysis was performed for the clinical data of 298 AECOPD patients who were admitted to The First Hospital of Lanzhou University from January 2020 to December 2021,and according to the clinical manifestation,B-type natriuretic peptide/N-terminal B-type natriuretic peptide precursor,and echocardiography,the 298 AECOPD patients were divided into HF group with 127 patients and non-HF group with 171 patients.Related clinical indicators were compared between the two groups,and a regression analysis was used to identify the pos-sible risk factors for HF in AECOPD patients.The receiver operat-ing characteristic(ROC)curve analysis was used to investigate the value of TyG and MHR alone or in combination in the diagnosis of AECOPD complicated by HF,and a correlation analysis was used to investigate the correlation of TyG and MHR with cardiac function parameters(ejection fraction,ventricular wall thickness,cardiac chamber size,and valve regurgitation velocity)and pulmonary artery pressure in AECOPD patients.Results:The binary logistic regres-sion analysis showed that fasting blood glucose,absolute monocyte count,high-density lipoprotein cholesterol(HDL-C),arrhythmia,TyG,and MHR were independent risk factors for HF in AECOPD patients,and the HF group had significantly higher levels of TyG and MHR than the non-HF group(P<0.001).TyG had an area under the ROC curve(AUC)of 0.805(95%CI=0.754-0.856,P<0.001)in the diagnosis of AECOPD complicated by HF,and MHR had an AUC of 0.762(95%CI=0.707-0.817,P<0.001),while TyG combined with MHR had an AUC of 0.870(95%CI=0.828-0.912,P<0.001).The correlation analysis showed that TyG was negatively correlated with left ventricular ejection fraction and left ventricular fractional shortening and was positively correlated with end-diastolic interven-tricular septal thickness,mitral regurgitation velocity,and left ventricular end-diastolic posterior wall thickness,while MHR was nega-tively correlated with left ventricular stroke volume and left ventricular fractional shortening and was positively correlated with end-diastolic interventricular septal thickness,right ventricular anteroposterior diameter,right ventricular superior-inferior diameter,right ventricular transverse diameter,tricuspid regurgitation velocity,left ventricular end-diastolic posterior wall thickness,and pulmonary artery pressure.Conclusion:Fasting blood glucose,absolute monocyte count,HDL-C,arrhythmia,TyG,and MHR are independent risk factors for AECOPD complicated by HF.Both TyG and MHR have a certain value in the diagnosis of HF,and the combination of TyG and MHR has a better efficacy than each indicator alone in the diagnosis of AECOPD complicated by HF.TyG is correlated with the cardiac function parameters such as left ventricular ejection fraction,ventricular wall thickness,and mitral regurgitation velocity in patients with AECOPD and may have a stronger correlation with the left ventricle;MHR is correlated with right ventricular chamber size,tricuspid regurgitation velocity,and pulmonary artery pressure and may have a stronger correlation with the right ventricle.