Bowel sounds can reflect the movement and health status of the gastrointestinal tract.However,the traditional manual auscultation method has subjective deviation and is time-consuming and labor-intensive.In order to better assist doctors in diagnosing bowel sounds and improve the reliability and efficiency of bowel sound detection,this study proposed a deep neural network model that combines a residual neural network(ResNet),a bidirectional long short-term memory network(BiLSTM),and an attention mechanism.Firstly,a large number of labeled clinical data was collected using the self-developed multi-channel bowel sound acquisition system,and the multi-scale wavelet decomposition and reconstruction method was used to preprocess the bowel sounds.Then,log Mel spectrogram features were extracted and sent to the network for training.Finally,the performance and effectiveness of the model were evaluated and verified by 10-fold cross-validation and an ablation experiment.The experimental results showed that the precision,recall,and F1 score of the model reached 83%,76%,and 79%,respectively,and it could effectively detect bowel sound segments and locate their start and end times,performing better than previous algorithms.This algorithm can not only provide auxiliary information for doctors in clinical practice but also offer technical support for further analysis and research of bowel sounds.

Objective:To analyze the effect of birth parity on life expectancy (LE) and healthy life expectancy (HLE) among rural women.Method:A total of 15 304 women aged 40 to 79 years who participated in baseline and follow-up surveys were selected from a rural cohort in Henan province. The LE and HLE of women with different birth parity were calculated by using multi-state life table.Results:There were 1 195 (7.8%), 7 782 (50.8%), 3 867 (25.3%) and 2 460 (16.1%) women with 1, 2, 3 and 4 birth parities, respectively, and the M ( Q1 and Q3) of age were 50.3 (47.3, 53.4) and 53.3 (48.8, 60.7), 62.6 (55.4, 66.9) and 69.5 (64.7, 73.4) years old, respectively. LE at 40 years old was 44.5, 44.8, 45.1 and 45.4 years old, and HLE was 17.7, 18.3, 18.8 and 19.3 years old, respectively. LE at age 40 increased by 0.3, 0.6, and 0.9 years in women with 2, 3, and 4 birth parities or more and HLE increased by 0.5, 1.1, and 1.6 years, respectively, compared with women with 1 birth parity. For women with higher and lower socioeconomic status who had 4 birth parities or more, the LE at age 40 was 47.1 and 43.9 years, respectively, an increase of 0.2 and 0.1 years over women with 1 birth parity, respectively; and the HLE was 20.4 and 18.7 years, respectively, an increase of 1.4 and 1.3 years over women with 1 birth parity, respectively. Conclusion:LE and HLE show an upward trend with the increase of birth parity among rural women.

Objective To explore the changes of the thickness of myometrium(MT),apparent diffusion coefficient value of myometrium(ADCM),thickness of junctional zone(JZT)and apparent diffusion coefficient value of junctional zone(ADCJz)in patients with endometrial fibrosis.Methods A total of 59 patients with endometrial fibrosis and 34 healthy women(volunteer)of childbearing age were prospectively included.The JZT,ADCJz,MT and ADCM were measured.Independent samples t-test was used to compare the differences in JZT,ADCJZ,MT,and ADCM between the two groups.A combined prediction model was established using binary logistic regression analysis(combining mean JZT,mean ADCJZ,and mean MT).The efficiency of each parameter's mean value and the combined prediction model in diagnosing endometrial fibrosis was evaluated using the receiver operating characteristic(ROC)curve.Results JZT(anterior wall,posterior wall,fundus and mean;P=0.007,0.035,0.001 and＜0.001,respectively),ADCJZ(anterior wall,posterior wall,fundus and mean;all P＜0.001)and MT(anterior wall,posterior wall and mean;P=0.003,＜0.001 and 0.003,respectively)were significantly larger in patients with endometrial fibrosis compared to volunteer.Mean ADCJZ[area under the curve(AUC)=0.872]and the combined prediction model(AUC=0.953)had high value for diagnosing endometrial fibrosis.Conclusion MRI can be used for noninvasively assessing the changes of myometrium and JZ in patients with endometrial fibrosis.

Objective:To analyze the status and influencing factors of empathy fatigue in hospice nurses based on ABC-X model (A: stressor event; B:resources available to a family; C: family sperceptions of the stressor; X: likelihood of crisis), so as to provide a reliable basis for developing comprehensive intervention strategies.Methods:A total of 325 nurses engaged in hospice care in China from April 2022 to June 2022 were selected by convenient sampling method. The influencing factors of empathy fatigue of hospice care nurses were analyzed by ABC-X model (working environment, resilience and coping style). The hospice care nurses were investigated by self-made general questionnaire, Chinese version of Empathy Fatigue Scale, Simplified Coping Style Questionnaire, Coping Style Resilience Scale and Nursing Work Environment Scale. The statistical analysis was performed by SPSS.26.0 statistical software.Results:There were 316 females and 9 males with age of (33.0 ± 7.9) years old. The total score of empathy fatigue in 325 hospice nurses was (91.16 ± 9.60) points, the scores of empathy satisfaction, ocupational burnout and secondary traumatic stress were (31.35 ± 6.01), (28.43 ± 5.86), (31.38 ± 5.76) points respectively. The scores of positive coping style, negative coping style, psychological resilience and nursing working environment were (37.46 ± 5.69), (21.28 ± 6.90), (89.84 ± 16.46), (117.13 ± 19.95) points respectively. The negative predictive factor for empathy satisfaction among nurses with the professional title of palliative care ( t=-4.22, P<0.05), and the positive predictive factors for simple coping strategies, psychological resilience, and nursing work environment ( t=4.52, 3.05, 9.03, all P<0.05), could explain 56.7% of the total variation. Psychological resilience, simplified coping strategies, nursing work environment were negative predictive factors for occupational burnout among hospice nurses ( t=-6.93, -3.54, -2.51, all P<0.05), while work nature was a positive predictive factor ( t=2.36, P<0.05), which could explain 49.4% of the total variation. Simplified coping strategies, psychological resilience, and nursing work environment were all negative predictors of secondary traumatic stress in hospice nurses ( t=-5.40, -3.25, -5.95, all P<0.05), which could explain 48.8% of the total variation. Conclusions:Based on the ABC-X model, it is found that the empathic fatigue of hospice nurses is mainly affected by the nursing work environment, mental resilience and coping styles. It is necessary for nursing managers to actively take measures to improve the working environment and coping styles of nurses, enhance their mental resilience and reduce their empathic fatigue.

Objective:To explore the effect of a nurse-led family resilience intervention program on the primary caregivers of children with Hirschsprung′s disease, and provide reference for family resilience nursing intervention measures for pediatric chronic diseases.Methods:Using a randomized controlled trial method, a convenience sampling method was used to select 60 primary caregivers of first-time diagnosed Hirschsprung′s disease who were admitted to the pediatric surgery ward of the First Affiliated Hospital of Zhengzhou University from November 2022 to October 2023. Random digital table method was used to divide the primary caregivers into control group and observation group,with 30 cases in each group. The control group received routine care intervention, while the observation group received a nurse-led intervention program to enhance family resilience. The family resilience, depression,Family APGAR Index, and nursing satisfaction scores of the two groups before and after the intervention were compared.Results:Two groups of 30 patients each completed this study.There were 3 males and 27 females in the control group. The age was (28.61 ± 3.16) years old. There were 2 males and 28 females in the observation group. The age was (29.43 ± 3.48) years old.Before intervention, there were no statistically significant differences (all P>0.05) in the total family resilience score and its various dimensions, depression level, and family care score between the two groups of children′s primary caregivers. After intervention, the total score of family resilience of the main caregivers in the observation group was (142.53 ± 6.00) points,higher than (128.27 ± 5.06) points in the control group, the difference was significant ( t=-9.95, P<0.05). The depression score of the main caregivers in the observation group was (48.07 ± 8.46) points, and the family care score was (7.73 ± 0.98) points, which was better than the depression level of the main caregivers in the control group (50.77 ± 9.35) and the family care score (6.97 ± 1.00) ( t=2.49, -3.00, both P<0.05). After implementing intervention, the satisfaction level of the main caregivers in the observation group was 100.0%(30/30), higher than 83.3%(25/30) in the control group, the difference was significant ( χ2=6.41, P<0.05). Conclusions:The nurse-led family resilience improvement intervention program can effectively improve the family resilience and family care level of primary caregivers of children with Hirschsprung′s disease for the first time, which is helpful to improve the negative psychological emotions of primary caregivers and improve their satisfaction with nursing services.

Objective To investigate the clinical effect of respiratory trainer in the patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) undergoing non-invasive positive pressure ven-tilation.Methods A total of 85 patients with COPD undergoing non-invasive positive pressure ventilation ad-mitted and treated in the Affiliated Minda Hospital of Hubei Nationalities University during 2019-2023 were selected as the study subjects and divided into the experiment group and the control group through random number table method.The control group adopted the symptomatic and supportive treatment such as routine non-invasive positive pressure ventilation,anti-infection,preparation aspiration for spasmolysis and eliminating phlegm,while on the base of the control group,the experiment group adopted respiratory trainer (K5) for re-spiratory training each once in the morning and at night.The differences in the related indexes were compared between the two groups.Results The percentage of forced expiratory volume in the first second (FEV1％),forced expiratory volume in 1 second/forced lung capacity (FEV1/FVC),COPD assessment test (CAT) score,modified Medical Research Council Dyspnea Scale (mMRC) score,6-min walking distance (6MWD),SGRQ score,maximum inspiratory pressure (MIP),maximum expiratory pressure (MEP),partial pressure of carbon dioxide (PaCO2) and PaO2 on 3,7 d after treatment in both groups had statistically significant differ-ence compared with before treatment (P<0.05),and the improvement of the above indicators in the experi-ment group was more significant compared with the control group (P<0.05).Conclusion Respiratory train-er could improve the clinical effect and pulmonary ventilation function in the patients with acute exacerbation of COPD undergoing non-invasive positive pressure ventilation.

Objective To investigate the clinical value of extracellular volume(ECV)based on CT delayed phase in combination with pathologic indicators in predicting early recurrence of gastric mesenchymal tumors after surgery.Methods A retrospective case-control trial was conducted on the imaging,clinical and pathological data of 110 patients with gastric mesenchymal tumors who were surgically resected at the First Affiliated Hospital of Army Medical University from January 2011 to August 2022.They were 60 males and 50 females,at a mean age of 58±10 years.All of them received preoperative multiphase dynamic CT enhancement examination of the abdomen,and ECV value was calculated with the formula:ECV=(1-hematocrit)×(△HU tumor/△HU aorta).According to the postoperative recurrence within 24 months after surgery,they were divided into early recurrence group and non early recurrence group.Statistical indexes:① Consistency analysis.② The factors affecting early recurrence after resection of gastric mesenchymal stromal tumors were analyzed and a prediction model was conducted.Delong test was used to assess the predictive value of the model.Then a nomogram was plotted based on the combines model,and calibration curves were drawn to assess the efficacy of the column charts,and decision curve analysis(DCA)was adopted to assess the value of the model for clinical application.Results ① Consistency analysis.After 2 radiologists outlined the region of interest and obtained ECV value according to the above formula,The intraclass correlation coefficient(ICC)was 0.806.② For the 110 subjected patients,21 cases of them had early recurrence,and 89 one did not.Multivariate analysis showed that ECV value,risk degree,and tumor length were independent influencing factors for predicting early recurrence.Receiver operating characteristic(ROC)curve analysis indicated that the area under the curve(AUC)value of ECV,hazard degree,and tumor length diameter in predicting early recurrence was 0.838(95％CI 0.758～0.918),0.774(95％CI 0.656～0.892),and 0.700(95％CI 0.589～0.810),respectively,and the value of their combined model was 0.899(95％CI 0.811～0.987),which was higher than that of each independent model.The sensitivity and specificity of the combined model was 85.71％and 86.52％,respectively,and the optimal cutoff value was 0.19.Delong test revealed that there was statistical difference between the combined model and the clinical model established by the hazard level(Z=6.548,P＜0.001,95％CI 0.140～0.259).Calibration curve analysis suggested that the combined model had a better fit,and DCA displayed that the combined model had a better net benefit.Conclusion The model established by ECV combined with pathological indicators has good predictive performance and can be used as a more effective predictor of early recurrence of gastric mesenchymal tumors after surgery.

Objective:To analyze the effect of birth parity on life expectancy (LE) and healthy life expectancy (HLE) among rural women.Method:A total of 15 304 women aged 40 to 79 years who participated in baseline and follow-up surveys were selected from a rural cohort in Henan province. The LE and HLE of women with different birth parity were calculated by using multi-state life table.Results:There were 1 195 (7.8%), 7 782 (50.8%), 3 867 (25.3%) and 2 460 (16.1%) women with 1, 2, 3 and 4 birth parities, respectively, and the M ( Q1 and Q3) of age were 50.3 (47.3, 53.4) and 53.3 (48.8, 60.7), 62.6 (55.4, 66.9) and 69.5 (64.7, 73.4) years old, respectively. LE at 40 years old was 44.5, 44.8, 45.1 and 45.4 years old, and HLE was 17.7, 18.3, 18.8 and 19.3 years old, respectively. LE at age 40 increased by 0.3, 0.6, and 0.9 years in women with 2, 3, and 4 birth parities or more and HLE increased by 0.5, 1.1, and 1.6 years, respectively, compared with women with 1 birth parity. For women with higher and lower socioeconomic status who had 4 birth parities or more, the LE at age 40 was 47.1 and 43.9 years, respectively, an increase of 0.2 and 0.1 years over women with 1 birth parity, respectively; and the HLE was 20.4 and 18.7 years, respectively, an increase of 1.4 and 1.3 years over women with 1 birth parity, respectively. Conclusion:LE and HLE show an upward trend with the increase of birth parity among rural women.

Objective:To study the survival and prognostic factors for the recurrent extracranial malignant germ cell tumors (MGCTs) in children, and to explore feasible salvage treatment.Methods:A retrospective study.Pediatric patients with recurrent extracranial MGCTs diagnosed in Shanghai Children′s Medical Center between January 2010 and January 2020 were retrospectively recruited.Comprehensive treatment regimens included surgery, chemotherapy and radiation.Kaplan-Meier survival analysis and Cox regression model were employed to analyze the survival and prognostic factors for children with recurrent extracranial MGCTs.Results:A total of 172 children with extracranial MGCTs were treated, including 21 (12.2%) recurrent cases.The median time of MGCT recurrence after the end of the first treatment was 11 months.Finally, 19 patients were recruited after excluding 2 non-eligible cases, including 10 boys and 9 girls with the age at recurrence of 26 (8-170) months.The follow-up time was 57 (13-122) months.Salvage chemotherapy, complete resection and radiotherapy were performed in 16, 14 and 4 patients, respectively.The 4-year overall survival (4yr-OS) rate was (82.5±9.2)%(19 cases). The 4yr-OS rate was significantly higher in patients managed with surgery but without adjuvant chemotherapy at the initial treatment (13 cases) than those managed with chemotherapy at the initial treatment (6 cases)[(92.3±7.4)% vs.(60.0%±21.9)%, P=0.002]. Univariant and Cox multivariant regression analyses showed that failure to achieve the normal range of alpha fetoprotein after 3 cycles of chemotherapy significantly influenced the survival of recurrent extracranial MGCTs. Conclusions:For patients with recurrent extracranial MGCTs, comprehensive treatment approaches like complete surgical resection, chemotherapy, and radiotherapy offer a favorable survival rate.Specifically, recurrent and re-treated patients who initially received surgery alone without adjuvant chemotherapy have a higher survival rate compared to those who received chemotherapy during the initial treatment.

Objective:To determine the motion detection uncertainty of the real-time CybeRay ? imaging system and patient intrafractional motion with thermoplastic mask-based immobilization. Methods:Real-time CybeRay ? imaging system was used for irradiation and treatment for head phantom and patients with brain tumors. All patients were immobilized with thermoplastic masks. Real-time imaging was delivered using kilovoltage projection images during radiotherapy. The detected patient motion data was collected from 5 head phantom measurements and 27 treatment fractions of 9 brain tumor patients admitted to Kaifeng Cancer Hospital. The accuracy and uncertainty of the motion monitoring system were determined. Results:The mean and standard deviation (SD) of the detected motion in the X, Y, and Z directions for phantom were (-0.02±0.41) mm, (-0.05±0.22) mm and (0.01±0.35) mm, respectively. The detected motion in the X, Y and Z directions for patents were (-0.13±0.48) mm, (-0.05±0.48) mm and (0.11±0.36) mm, respectively. After removing the motion detection uncertainty, the actual intrafractional motion of patients were (-0.11±0.25) mm, (0±0.43) mm and (0.10±0.08) mm in three directions, respectively. Conclusions:The uncertainty of real-time imaging-based motion monitoring system of CybeRay ? is less than 0.5 mm. It is feasible to apply thermoplastic masks for brain tumor patients in clinical practice, which can provide steady immobilization and limit the SD of patient intrafractional motion within 0.5 mm. Real-time imaging-based motion monitoring system of CybeRay ? is accurate for patient motion monitoring during frameless stereotactic radiosurgery/radiotherapy.