BackgroundLow medication compliance among patients with severe mental disorders increases the disease burden on both the patients' families and the society. Medication adherence is influenced by numerous factors. Traditional methods such as Logistic regression struggle to quantify the importance of these factors. By introducing Extreme Gradient Boosting （XGBoost） combined with Shapley Additive Explanations （SHAP）， enables the quantification of the relative contribution weights of each factor， providing support for identifying the core influencing factors. ObjectiveTo explore the influencing factors of medication adherence among patients with severe mental disorders in Zhuhai， aiming to provide references for optimizing patient management strategies. MethodsExtract the data of patients with severe mental disorders who were registered on the mental health system platform in Zhuhai City from January 1， 2023 to March 31， 2025. A total of 9 329 patients were finally included for analysis. Influencing factors were screened using univariate analysis and multivariate logistic regression analysis， and an XGBoost model combined with the SHAP algorithm was constructed to quantify the importance of each influencing factor. ResultsAmong 9 329 patients， 8 446 demonstrated medication adherence， yielding an adherence rate of 90.53%. Multivariable analysis identified several risk factors significantly associated with medication non-adherence， being unmarried （OR=1.237， 95% CI： 1.019–1.502） or divorced （OR=1.389， 95% CI： 1.038–1.832）， a diagnosis of mental retardation with psychiatric disorders （OR=3.025， 95% CI： 2.402–3.796） or paranoid psychosis （OR=5.117， 95% CI： 3.086–8.299）， a disease duration of 2–4 years （OR=1.355， 95% CI： 1.085–1.696）， 4–6 years （OR=2.143， 95% CI： 1.671–2.747）， or >6 years （OR=1.681， 95% CI： 1.365–2.079）， lack of guardian subsidies （OR=1.412， 95% CI： 1.099–1.801）， absence of a disability certificate （OR=1.900， 95% CI： 1.588–2.282）， not being enrolled in care and support groups （OR=1.384， 95% CI： 1.183–1.617） or community services （OR=1.313， 95% CI： 1.042–1.645）， and not cohabiting with a guardian （OR=1.257， 95% CI： 1.048–1.501）. Conversely， the enrollment in special outpatient disease programs （OR=0.716， 95% CI： 0.609–0.842） and a family history of mental illness （OR=0.713， 95% CI： 0.503–0.982） were identified as protective factors. The XGBoost model exhibited robust predictive performance， with a sensitivity of 0.433， specificity of 0.944， accuracy of 0.891， Area Under the Curve （AUC） of 0.837， and F1 value of 0.449. Feature importance ranking indicated that the top three factors were disease duration， diagnosis， and the acquisition of disability certificates. ConclusionPolicy-based support （acquisition of disability certificates， special outpatient disease enrollment） and clinical disease characteristics （disease duration， diagnosis type） are key factors affecting medication adherence among patients with severe mental disorders in Zhuhai City. ［Funded by Zhuhai Medical Research Project （number， 2220009000281）］

Objective:To explore the prognostic value of monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) in assessing patients with heart failure with reduced ejection fraction (HFrEF).Methods:Patients with HFrEF (LVEF<40%) admitted to the TEDA International Cardiovascular Disease Hospital between 2 January 2019 and 15 January 2023 were selected. The MHR levels were recorded at admission in patients with HFrEF who were followed up regularly for 12 months. The major adverse cardiovascular events (cardiac death and readmission for heart failure) were defined as poor prognosis. Multivariate Cox regression was used to analyze factors associated with poor prognosis. The receiver operator characteristic (ROC) curves were used to assess the diagnostic value of MHR for poor prognosis. The DeLong test was used to analyze whether there was a difference in the effectiveness of MHR and BNP for detecting poor prognosis. The critical value grouping for poor prognosis was evaluated by MHR, and survival analyses were performed using Kaplan-Meier.Results:A total of 286 subjects were enrolled in the study, including 206 males and 80 females, with a median age ( Q1, Q3) of 67 (58, 74) years. Multivariate Cox regression showed that MHR ( HR=1.482, 95% CI:1.015-2.164) and BNP ( HR=1.001, 95% CI:1.000-1.001) were associated with poor prognosis in patients with HFrEF. The area under the ROC curve for the adjunctive diagnostic value of MHR, BNP and the combination of both for poor prognosis in patients with HFrEF was 0.709, 0.738 and 0.769, respectively. The critical values were 0.486, 1 090 pg/ml and 0.41, respectively. The DeLong test showed no differences in the validity of MHR, BNP and their combination for detecting poor prognosis. Kaplan Meier survival analysis of 12-month follow-up showed that the time for poor prognosis in HFrEF patients with MHR>0.486 group (8.645 months) was significantly shorter than that in MHR≤0.486 group (10.296 months, P<0.001), and the risk of poor prognosis in MHR>0.486 group was 2.843 times higher than that in MHR≤0.486 group ( HR=2.843, 95% CI:1.867-4.327). Conclusion:MHR can be an indicator of poor prognosis in patients with HFrEF.

Objective:To explore the prognostic value of monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) in assessing patients with heart failure with reduced ejection fraction (HFrEF).Methods:Patients with HFrEF (LVEF<40%) admitted to the TEDA International Cardiovascular Disease Hospital between 2 January 2019 and 15 January 2023 were selected. The MHR levels were recorded at admission in patients with HFrEF who were followed up regularly for 12 months. The major adverse cardiovascular events (cardiac death and readmission for heart failure) were defined as poor prognosis. Multivariate Cox regression was used to analyze factors associated with poor prognosis. The receiver operator characteristic (ROC) curves were used to assess the diagnostic value of MHR for poor prognosis. The DeLong test was used to analyze whether there was a difference in the effectiveness of MHR and BNP for detecting poor prognosis. The critical value grouping for poor prognosis was evaluated by MHR, and survival analyses were performed using Kaplan-Meier.Results:A total of 286 subjects were enrolled in the study, including 206 males and 80 females, with a median age ( Q1, Q3) of 67 (58, 74) years. Multivariate Cox regression showed that MHR ( HR=1.482, 95% CI:1.015-2.164) and BNP ( HR=1.001, 95% CI:1.000-1.001) were associated with poor prognosis in patients with HFrEF. The area under the ROC curve for the adjunctive diagnostic value of MHR, BNP and the combination of both for poor prognosis in patients with HFrEF was 0.709, 0.738 and 0.769, respectively. The critical values were 0.486, 1 090 pg/ml and 0.41, respectively. The DeLong test showed no differences in the validity of MHR, BNP and their combination for detecting poor prognosis. Kaplan Meier survival analysis of 12-month follow-up showed that the time for poor prognosis in HFrEF patients with MHR>0.486 group (8.645 months) was significantly shorter than that in MHR≤0.486 group (10.296 months, P<0.001), and the risk of poor prognosis in MHR>0.486 group was 2.843 times higher than that in MHR≤0.486 group ( HR=2.843, 95% CI:1.867-4.327). Conclusion:MHR can be an indicator of poor prognosis in patients with HFrEF.

Background and Aims:The incidence of papillary thyroid carcinoma (PTC) has shown a significant upward trend. Given its favorable prognosis,there is a growing trend toward de-escalating its treatment to improve patients' quality of life. Pathologists have renamed the encapsulated follicular variant of PTC with indolent biological behavior as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP),providing a theoretical basis for treatment de-escalation. However,challenges persist in the clinical pathological diagnosis of NIFTP,and it is still predominantly managed as classical PTC in most cases. This study was performed to explore the clinicopathologic diagnostic characteristics,surgical challenges,and prospects for de-escalation treatment of NIFTP.Methods:The clinical data of 33 patients with thyroid disease who were admitted to Xuanwu Hospital Capital Medical University from November 2017 to December 2022 and confirmed as NIFTP by final paraffin pathology were retrospectively analyzed. Results:Among the 33 NIFTP patients,there were 11 males and 22 females,with an average age of 50 years. Tumor sizes ranged from 0.6 to 7.5 cm. There were 31 cases of solitary NIFTP tumor and 2 cases of multifocal tumors (each involving 2 sites). Eleven patients had coexisting PTC (one lesion in each case),with 4 lesions located on the same side as the NIFTP and 7 on the opposite side. All patients underwent surgical treatment,including 27 cases of conventional open surgery and 6 cases of endoscopic surgery. Suspicious or potentially malignant lesions were treated according to PTC surgical principles (lobectomy of the affected side plus central compartment lymph node dissection on the same side). Preoperative ultrasonography revealed that the nodules were predominantly hypoechoic,relatively regular in shape,well-defined,often accompanied by calcifications,and had a longitudinal-to-transverse diameter ratio of<1. TI-RADS classifications were as follows:5 cases as grade 3,9 cases as grade 4a,and 11 cases as grade 4b or higher. Among 29 patients who underwent preoperative fine-needle aspiration,1 case was diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),12 as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),12 as suspicious for malignancy (SUS),and 4 as PTC. BRAFV600E mutation testing was performed postoperatively in 25 cases,and 7 mutations were detected,all in cases with concomitant PTC.Conclusion:The introduction of the NIFTP concept provides a foundation for de-escalation or individualized treatment of certain less aggressive thyroid tumors. However,the preoperative and intraoperative diagnosis of NIFTP remains challenging in clinical practice. More precise preoperative diagnostic criteria and methods are needed to enable surgeons to adjust treatment decisions accordingly.

Background and Aims:The incidence of papillary thyroid carcinoma (PTC) has shown a significant upward trend. Given its favorable prognosis,there is a growing trend toward de-escalating its treatment to improve patients' quality of life. Pathologists have renamed the encapsulated follicular variant of PTC with indolent biological behavior as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP),providing a theoretical basis for treatment de-escalation. However,challenges persist in the clinical pathological diagnosis of NIFTP,and it is still predominantly managed as classical PTC in most cases. This study was performed to explore the clinicopathologic diagnostic characteristics,surgical challenges,and prospects for de-escalation treatment of NIFTP.Methods:The clinical data of 33 patients with thyroid disease who were admitted to Xuanwu Hospital Capital Medical University from November 2017 to December 2022 and confirmed as NIFTP by final paraffin pathology were retrospectively analyzed. Results:Among the 33 NIFTP patients,there were 11 males and 22 females,with an average age of 50 years. Tumor sizes ranged from 0.6 to 7.5 cm. There were 31 cases of solitary NIFTP tumor and 2 cases of multifocal tumors (each involving 2 sites). Eleven patients had coexisting PTC (one lesion in each case),with 4 lesions located on the same side as the NIFTP and 7 on the opposite side. All patients underwent surgical treatment,including 27 cases of conventional open surgery and 6 cases of endoscopic surgery. Suspicious or potentially malignant lesions were treated according to PTC surgical principles (lobectomy of the affected side plus central compartment lymph node dissection on the same side). Preoperative ultrasonography revealed that the nodules were predominantly hypoechoic,relatively regular in shape,well-defined,often accompanied by calcifications,and had a longitudinal-to-transverse diameter ratio of<1. TI-RADS classifications were as follows:5 cases as grade 3,9 cases as grade 4a,and 11 cases as grade 4b or higher. Among 29 patients who underwent preoperative fine-needle aspiration,1 case was diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),12 as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),12 as suspicious for malignancy (SUS),and 4 as PTC. BRAFV600E mutation testing was performed postoperatively in 25 cases,and 7 mutations were detected,all in cases with concomitant PTC.Conclusion:The introduction of the NIFTP concept provides a foundation for de-escalation or individualized treatment of certain less aggressive thyroid tumors. However,the preoperative and intraoperative diagnosis of NIFTP remains challenging in clinical practice. More precise preoperative diagnostic criteria and methods are needed to enable surgeons to adjust treatment decisions accordingly.

Objective:To understand the status quo of neonatal palliative care attitude of nurses in neonatal intensive care unit (NICU) and analyze the influencing factors, in order to provide reference and direction for hospital management to improve the neonatal palliative care attitude of NICU nurses.Methods:A total of 237 NICU nurses in 9 hospitals in Shijiazhuang, Hebei Province were selected by cluster sampling method from November to December 2021, and the questionnaire was conducted using General Data Survey, Neonatal Palliative Care Attitude Scale (NiPCAS), the Jefferson Scale of Empathy (JSE) and Coping with Death Scale (CDS). And analyze the results.Results:The total score of the NICU nurses′ neonatal palliative care attitude was 89.35 ± 18.86. The average score of each dimension from high to low was belief, work experience, resources, organization, and obstacle; and the total score of neonatal palliative care attitude was positively correlated with empathy ability ( r=0.653, P<0.01) and death coping ability ( r=0.597, P<0.01), in addition the factor of barrier was negatively correlated with empathy and death coping ability ( r=-0.602, -0.526, both P<0.01) Multiple linear regression analysis showed that educational background, whether nursing dying infants, frequency of attending hospice nursing education in hospitals, empathy ability and death coping ability were the influencing factors of neonatal palliative care attitude, which could explain 47.3% of the total variation. Conclusions:NICU nurses′ neonatal palliative care attitude was generally at a moderate level, and affected by five factors such as education. It is suggested that hospital management should provide to improve empathy ability and death response ability as the premise of personalized, diversified education training support, multiple ways, multi-level improve its empathy ability and death coping ability, improve neonatal palliative care attitude, and then improve the quality of nursing service.

Objective:To investigate the status quo and influencing factors of spiritual care needs among elderly stroke inpatients, in order to provide reference for formulating targeted interventions.Methods:A total of 417 elderly stroke inpatients were selected in five Third-A hospitals from August 2021 to January 2022 by convenient sampling. The questionnaire was conducted using the General Data questionnaire, the Nurse Spiritual Therapeutics Scale (NSTS), the Stigma Scale for Chronic Illness (SSCI) and the Perceived Social Support Scale (PSSS). Multiple linear regression was used to analyze the influencing factors of spiritual care needs of elderly stroke inpatients.Results:The total score of NSTS among 417 elderly stroke inpatients was 31.98 ± 4.39. The dimension of highest and lowest average score were "create good atmosphere" (3.23 ± 0.58) and "help religion" (2.01 ± 0.62), respectively; the results of regression analysis showed that religious belief, education background, course, stigma, and social support were the main factors influencing spiritual care needs among elderly stroke inpatients ( t values were -6.54-7.11, P<0.05). Conclusions:The spiritual care needs among elderly stroke inpatients were moderate. It is suggested that nurses should strengthen their own spiritual care knowledge and ability, and take targeted spiritual care measures according to the individual characteristics and differences of patients, reduce their stigma, improve the social support, to meet their spiritual care needs to the greatest extent.

ObjectiveTo determine the epidemiological characteristics of norovirus infections in Lin’an District， Hangzhou City from 2012 to 2020， and provide scientific evidence for improving preventive and control measures. MethodsDescriptive epidemiological methods were used to characterize the epidemic and conduct statistical analysis to determine related factors. ResultsA total of 37 clustered outbreaks of norovirus infection were reported in Lin’an District of Hangzhou from 2012 to 2020， including 8 outbreaks in kindergartens， 15 ones in elementary schools， 8 ones in middle and high schools， 2 ones in universities， and 4 other ones. The total number of cases with norovirus infection was 1 194， with the average attack rate of 3.76%. The incidence of norovirus was higher in winter and spring. It was also higher in urban areas， followed by suburban and mountainous areas neighbored to traffic lines. Moreover， attack rates differed significantly by transmission routes， including mixed contact and aerosol transmission， contact transmission， food-borne transmission， and water-borne transmission （χ²=186.91，P<0.001）. There was significant difference in the incidence among kindergartens， schools， and universities （χ²=980.15，P<0.001）. In the 37 outbreaks， norovirus were mainly classified as GⅡ in the 34 ones （accounting for 91.89%）， and GⅠ in the remaining 3 ones. ConclusionThe epidemic of norovirus infection in Lin’an District， Hangzhou City is characterized by certain population， time， space， transmission routes， and strains. It warrants enhanced health education and promotion， preparedness and response plan， syndromic surveillance， early alerting， school closure， and environmental disinfection for further prevention and control of norovirus infection.

Objective: To conduct retrospective analysis of clinical features of patients with ulcerative colitis in JiangsuProvince Hospital of Traditional Chinese Medicine (TCM) . Methods: Ulcerative colitis medical records in jiangsuprovince hospital of TCM were selected and used to retrospectively analyze the feature such as gender, age, course of thedisease, clinical type, stage, severity, and pathological parts. Results: The study include 290 cases of male and 235 casesof female with the ratio of 1.2:1. Peak incidence was between 20 to 60 years old. Dietary factor was the most commoncause, followed by fatigue, environment, medicine and emotional factors. There were 28 (5.33％) patients at remissionstage, and 497 (94.67％) patients at active stage. In patients at active stage, there were 78 (15.69％) patients newlydiagnosed, and 419 (84.31％) patients with chronic recurrent type. There 92 (18.51％) rectum type patients, 156 (31.39％) left half colon type patients and 249 (50.10％) extensive colon type patients. There were 275 (55.33％) mild patients, 149 (29.98％) moderate patients and 73 (14.69％) severe patients. The main symptoms were bloody purulent stool, diarrheaand abdominal pain. There were 375 (71.43％) patients with bloody purulent stool, and symptom disappearance rate was89.07％ after treatment. There were 335 (63.81％) patients with diarrhea, and symptom disappearance rate was 71.64％after treatment. There were 319 (60.76％) patients with abdominal pain, and symptom disappearance rate was 85.89％after treatment. There were 3 cases of complications. Drug therapy was mainly based on integrated Chinese and westernmedicine (86.29％) . For Chinese medicine treatment, there were 453 patients (87.45％) with oral Chinese medicine, 401 patients (77.41％) with Chinese medicine enema, and 10 patients (1.93％) with foot bath. For western medicine treatment, there were 392 patients (75.68％) treated with oral amino salicylate drugs, 100 patients (19.31％) with anal used aminosalicylate drugs, 88 patients (16.99％) with glucocorticoid, 18 patients (3.47％) with immunosuppressive agent and 441 patients (85.14％) with microecological preparation. Conclusion: The types of ulcerative colitis patients in our hospitalwere mainly chronic recurrent type at active stage with mild to moderate and extensive colon type. The treatment wasmainly based on integrated Chinese and western medicine, with significant improvement in symptoms of bloody purulentstool, diarrhea and abdominal pain. 99.61％ patients were discharged with a better condition