Objective To construct a dynamic prediction model for JC polyomavirus (JCV) reactivation after kidney transplantation. Methods A retrospective analysis was conducted on the clinical data of 128 recipients who met the inclusion criteria and received kidney transplantation in Nanfang Hospital, Southern Medical University, from June 2021 to December 2024. Dynamic Cox regression and dynamic restricted mean survival time (RMST) regression based on the landmark method were adopted to establish the dynamic prediction models, and Monte Carlo cross-validation was used to evaluate model performance. Results The dynamic models could predict the incidence and onset time of JCV reactivation within the subsequent 3 months according to covariates at each landmark time point from the 1st to the 6th month after transplantation. Remuzzi score, body mass index and warm ischemia time were independent risk factors for JCV reactivation, while a history of urinary BK polyomavirus reactivation served as a protective factor. The median values of the area under the curve, C-index and Brier score of the dynamic Cox model were 0.873, 0.851 and 0.065 respectively, and the C-index of the dynamic RMST model was 0.829, all of which were superior to those of the static model. Conclusions The landmark-based dynamic models exhibit excellent predictive performance, which may integrate baseline data and post-transplant follow-up information to realize dynamic assessment of the risk and time window of JCV reactivation, thereby providing evidence for optimizing post-operative monitoring and individualized intervention strategies.

BackgroundWith the rapid development of the networking technologies， internet addiction has increasingly become a serious mental health issue. Previous studies have revealed the link between childhood trauma and internet addiction， while the mediating role of perceived stress in this link is not yet clear. ObjectiveTo investigate the role of medical students' perceived stress in the relationship between childhood trauma and internet addiction， so as to provide references for the intervention of internet addiction. MethodsFrom February to March 2023， a random sampling technique was used to select 1 232 undergraduate students from the School of Clinical Medical Sciences of Southwest Medical University as research subjects. The Childhood Trauma Questionnaire-Short Form （CTQ-SF）， Perceived Stress Scale （PSS）， Internet Gaming Disorder Scale （IGDS）， and Bergen Social Media Addiction Scale （BSMAS） were used for assessment. Pearson's correlation coefficients were calculated. The mediation effect of perceived stress in the relationship between childhood trauma and internet addiction was tested using Model 4 in the SPSS Process 4.1， and Bootstrapping procedure involving 5 000 replicates was employed to confirm the statistical significance. ResultsA total of 1 016 （82.47%） valid completed questionnaires were gathered. The CTQ-SF scores of medical students were positively correlated with PSS scores， IGD scores， and BSMAS scores （r=0.583， 0.474， 0.465， P<0.01）. PSS scores were positively correlated with IGD scores and BSMAS scores （r=0.369， 0.479， P<0.01）. Childhood trauma in medical students was found to positively predict perceived stress （β=0.191， P<0.01）， social media addiction （β=0.160， P<0.01）， and internet gaming disorder （β=0.106， P<0.01）. Perceived stress played a significant mediating role in the relationship between childhood trauma and internet gaming disorder， indirect effect value was 0.018 （95% CI： 0.009~0.027）， accounting for 16.98%. Perceived stress also exhibited a significant mediating role in the relationship between childhood trauma and social media addiction， indirect effect value was 0.063 （95% CI： 0.048~0.079）， accounting for 39.38%. ConclusionChildhood trauma in medical students may affect internet gaming disorder and social media addiction through perceived stress. ［Funded by 2022 Annual Research Project of Sichuan Applied Psychology Research Center，（number，CSXL-22102）］

BackgroundPatients with depressive disorder often exhibit impaired decision-making functions. However， the relationship between decision-making abilities and depressive and anxiety symptoms in these patients remains unclear. ObjectiveTo explore the characteristics of decision-making behavior in patients with depressive disorder， and to analyze its relationship with clinical symptoms. MethodsA total of 48 patients diagnosed with depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders， fourth edition （DSM-IV） were recruited from the Department of Psychosomatic Medicine of the Affiliated Hospital of Southwest Medical University from October 2020 to May 2023. Concurrently， 52 healthy individuals matched for age and gender were recruited from Luzhou as the control group. Beck Depression Inventory （BDI） and Beck Anxiety Inventory （BAI） were used for assessment， and decision-making behavior was evaluated using Probabilistic Reversal Learning （PRL） task. Indicators assessed included the number of trials to criterion， perseverative errors， win-stay rate and lose-shift rate. Spearman correlation analysis was used to assess the correlation between BDI and BAI scores and PRL task indicators. ResultsThe depression group showed a significantly higher lose-shift rate compared with the control group （t=3.684， P<0.01）. There were no statistically significant differences between two groups in trials to criterion， perseverative errors and win-stay rate （t=0.329， 0.132， 0.609， P>0.05）. In depression group， BDI and BAI scores were positively correlated with the win-stay rate（r=0.450， 0.398， P<0.01）. ConclusionPatients with depressive disorder are more likely to change their decision-making strategies following negative outcomes. Furthermore， the severity of depressive and anxiety symptoms is associated with a greater propensity to maintain existing decisions after receiving positive feedback. ［Funded by 2019 Joint Project of Luzhou Science and Technology Bureau-Southwest Medical University （number， 2019LZXNYDJ39］

Objective To investigate the achievement of early fluid resuscitation targets and factors influencing 28-day outcomes in patients with sepsis.Methods A retrospective cohort analysis was conducted.A total of 164 patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University between January 2022 and January 2024 were enrolled.Patients were divided into survival and death groups based on 28-day survival status,with both groups receiving early fluid resuscitation.Comparisons were made between groups for general characteristics[gender,age,body mass index(BMI),infection site,comorbidities],primary indicators[central venous pressure(CVP),mean arterial pressure(MAP),urine output],and secondary indicators[blood lactate acid(Lac),procalcitonin(PCT),heart rate,sequential organ failure assessment(SOFA)on intensive care unit(ICU)admission day,Glasgow coma scale(GCS),duration and dose of vasoactive medication use].Univariate analysis identified variables associated with prognosis,followed by multivariate Logistic regression to select independent risk factors.Receiver operator characteristic(ROC curve)were plotted to assess predictive performance of each risk factor for the 28-day prognosis of patients with sepsis.Results This study included 164 patients.The primary infection sites were mainly the lungs,abdominal cavity,and urinary system,accounting for 42.7%(70/164),38.4%(63/164),and 9.1%(15/164)respectively.The survival group comprised 141 patients,while the the death group included 23 patients.No statistically significant differences existed between groups in gender,BMI,infection site(soft tissue infection vs.others),underlying diseases,MAP,urine output(all P>0.05).Compared to the survival group,the death group showed significantly higher age,pulmonary infection rate,Lac levels,vasoactive drug duration/dose,heart rate,and SOFA scores,while the rates of abdominal,and urinary tract infection,as well as CVP,PCT,and GCS scores were significantly lower(all P<0.05).The achievement rates of early fluid resuscitation parameters:MAP target achievement was highest at 78.7%(129/164),followed by urine output compliance at 78.0%(128/164),while CVP compliance was the lowest at 39.0%(64/164).The overall compliance rate was 21.3%(35/164).Univariate analysis showed that age,pulmonary infection,Lac levels,duration and dose of vasoactive drugs,heart rate,PCT,GCS score,and SOFA score were all risk factors affecting the 28-day prognosis of patients with sepsis(all P<0.05).Multivariate Logistic regression analysis showed Lac levels,and pulmonary infection were independent risk factors affecting 28-day prognosis of patients with sepsis[odds ratio(OR)were 0.801,3.966,0.812,95%confidence interval(95%CI)were 0.711-0.903,1.149-13.696,0.674-0.979 respectively,P values were<0.001,0.029,0.029 respectively].ROC curve analysis demonstrated that age,Lac levels,and pulmonary infection all possessed predictive value for 28-day outcomes(all P<0.05).Age exhibited the highest predictive value with an AUC of 0.922.At the optimal cut-off of 76.6 years,sensitivity reached 95.7%and specificity 80.9%.Conclusion The overall achievement rate of early fluid resuscation in sepsis patients was low,with age,Lac levels,and pulmonary infection being major factors influencing poor prognosis.

Objective:To analyze the clinical data and results of prenatal diagnosis for fetuses with high-risk for trisomy/monosomy 13 by non-invasive prenatal testing (NIPT).Methods:Clinical data of pregnant women with fetus at a high risk for trisomy/monosomy 13 by NIPT at the First Affiliated Hospital of Zhengzhou University from May 2016 to May 2024 were reviewed, and relevant data such as Z-score, positive predictive value (PPV) and fetal fraction (FF) were analyzed to assess the correlation between them. This study was approved by the Ethics Committee of the Hospital (No. 2018-YB-08). Results:71 fetuses were found to have a high risk by NIPT, including 58 cases for trisomy 13 (T13) and 13 cases for monosomy 13 (M13). 52 women had opted invasive prenatal diagnosis and 13 cases were confirmed, which yielded a positive prediction value (PPV) of 25%. 12 fetuses were confirmed as T13 (PPV = 29.3%; 12/41), 1 was confirmed as M13 (PPV = 9.1%; 1/11). The PPV had increased along with the Z-score. Fetal faction (FF) was not correlated with the age of woman but gestational age, and was negatively correlated with the body mass index. No statistical difference was found in FF and Z-score between true- and false-positive fetuses, and there was a weak correlation between the Z-score and FF. The PPV of the NIPT could be improved by combining the results of ultrasonography. Conclusion:The high false positive rate for T13 may be related to confined placental mosaicism, PPV is related to the Z-score, which in turn is related to FF. High-risk women are strongly recommended to undergo genetic counseling and prenatal diagnosis. Clinicians should consider relevant information such as the age of women, gestational age, indication for prenatal screening, Z-score, PPV, and FF in order to accurately interpret the result of NIPT, reduce anxiety, and avoid direct termination of the pregnancy.

OBJECTIVE: To analyze the clinical data and results of prenatal diagnosis for fetuses with high-risk for trisomy/monosomy 13 by non-invasive prenatal testing (NIPT). METHODS: Clinical data of pregnant women with fetus at a high risk for trisomy/monosomy 13 by NIPT at the First Affiliated Hospital of Zhengzhou University from May 2016 to May 2024 were reviewed, and relevant data such as Z-score, positive predictive value (PPV) and fetal fraction (FF) were analyzed to assess the correlation between them. This study was approved by the Ethics Committee of the Hospital (No. 2018-YB-08). RESULTS: 71 fetuses were found to have a high risk by NIPT, including 58 cases for trisomy 13 (T13) and 13 cases for monosomy 13 (M13). 52 women had opted invasive prenatal diagnosis and 13 cases were confirmed, which yielded a positive prediction value (PPV) of 25%. 12 fetuses were confirmed as T13 (PPV = 29.3%; 12/41), 1 was confirmed as M13 (PPV = 9.1%; 1/11). The PPV had increased along with the Z-score. Fetal faction (FF) was not correlated with the age of woman but gestational age, and was negatively correlated with the body mass index. No statistical difference was found in FF and Z-score between true- and false-positive fetuses, and there was a weak correlation between the Z-score and FF. The PPV of the NIPT could be improved by combining the results of ultrasonography. CONCLUSION The high false positive rate for T13 may be related to confined placental mosaicism, PPV is related to the Z-score, which in turn is related to FF. High-risk women are strongly recommended to undergo genetic counseling and prenatal diagnosis. Clinicians should consider relevant information such as the age of women, gestational age, indication for prenatal screening, Z-score, PPV, and FF in order to accurately interpret the result of NIPT, reduce anxiety, and avoid direct termination of the pregnancy.
Humans ; Female ; Pregnancy ; Trisomy 13 Syndrome/genetics* ; Adult ; Prenatal Diagnosis/methods* ; Noninvasive Prenatal Testing/methods*

Objective To investigate the achievement of early fluid resuscitation targets and factors influencing 28-day outcomes in patients with sepsis.Methods A retrospective cohort analysis was conducted.A total of 164 patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University between January 2022 and January 2024 were enrolled.Patients were divided into survival and death groups based on 28-day survival status,with both groups receiving early fluid resuscitation.Comparisons were made between groups for general characteristics[gender,age,body mass index(BMI),infection site,comorbidities],primary indicators[central venous pressure(CVP),mean arterial pressure(MAP),urine output],and secondary indicators[blood lactate acid(Lac),procalcitonin(PCT),heart rate,sequential organ failure assessment(SOFA)on intensive care unit(ICU)admission day,Glasgow coma scale(GCS),duration and dose of vasoactive medication use].Univariate analysis identified variables associated with prognosis,followed by multivariate Logistic regression to select independent risk factors.Receiver operator characteristic(ROC curve)were plotted to assess predictive performance of each risk factor for the 28-day prognosis of patients with sepsis.Results This study included 164 patients.The primary infection sites were mainly the lungs,abdominal cavity,and urinary system,accounting for 42.7%(70/164),38.4%(63/164),and 9.1%(15/164)respectively.The survival group comprised 141 patients,while the the death group included 23 patients.No statistically significant differences existed between groups in gender,BMI,infection site(soft tissue infection vs.others),underlying diseases,MAP,urine output(all P>0.05).Compared to the survival group,the death group showed significantly higher age,pulmonary infection rate,Lac levels,vasoactive drug duration/dose,heart rate,and SOFA scores,while the rates of abdominal,and urinary tract infection,as well as CVP,PCT,and GCS scores were significantly lower(all P<0.05).The achievement rates of early fluid resuscitation parameters:MAP target achievement was highest at 78.7%(129/164),followed by urine output compliance at 78.0%(128/164),while CVP compliance was the lowest at 39.0%(64/164).The overall compliance rate was 21.3%(35/164).Univariate analysis showed that age,pulmonary infection,Lac levels,duration and dose of vasoactive drugs,heart rate,PCT,GCS score,and SOFA score were all risk factors affecting the 28-day prognosis of patients with sepsis(all P<0.05).Multivariate Logistic regression analysis showed Lac levels,and pulmonary infection were independent risk factors affecting 28-day prognosis of patients with sepsis[odds ratio(OR)were 0.801,3.966,0.812,95%confidence interval(95%CI)were 0.711-0.903,1.149-13.696,0.674-0.979 respectively,P values were<0.001,0.029,0.029 respectively].ROC curve analysis demonstrated that age,Lac levels,and pulmonary infection all possessed predictive value for 28-day outcomes(all P<0.05).Age exhibited the highest predictive value with an AUC of 0.922.At the optimal cut-off of 76.6 years,sensitivity reached 95.7%and specificity 80.9%.Conclusion The overall achievement rate of early fluid resuscation in sepsis patients was low,with age,Lac levels,and pulmonary infection being major factors influencing poor prognosis.

Objective:To analyze the clinical data and results of prenatal diagnosis for fetuses with high-risk for trisomy/monosomy 13 by non-invasive prenatal testing (NIPT).Methods:Clinical data of pregnant women with fetus at a high risk for trisomy/monosomy 13 by NIPT at the First Affiliated Hospital of Zhengzhou University from May 2016 to May 2024 were reviewed, and relevant data such as Z-score, positive predictive value (PPV) and fetal fraction (FF) were analyzed to assess the correlation between them. This study was approved by the Ethics Committee of the Hospital (No. 2018-YB-08). Results:71 fetuses were found to have a high risk by NIPT, including 58 cases for trisomy 13 (T13) and 13 cases for monosomy 13 (M13). 52 women had opted invasive prenatal diagnosis and 13 cases were confirmed, which yielded a positive prediction value (PPV) of 25%. 12 fetuses were confirmed as T13 (PPV = 29.3%; 12/41), 1 was confirmed as M13 (PPV = 9.1%; 1/11). The PPV had increased along with the Z-score. Fetal faction (FF) was not correlated with the age of woman but gestational age, and was negatively correlated with the body mass index. No statistical difference was found in FF and Z-score between true- and false-positive fetuses, and there was a weak correlation between the Z-score and FF. The PPV of the NIPT could be improved by combining the results of ultrasonography. Conclusion:The high false positive rate for T13 may be related to confined placental mosaicism, PPV is related to the Z-score, which in turn is related to FF. High-risk women are strongly recommended to undergo genetic counseling and prenatal diagnosis. Clinicians should consider relevant information such as the age of women, gestational age, indication for prenatal screening, Z-score, PPV, and FF in order to accurately interpret the result of NIPT, reduce anxiety, and avoid direct termination of the pregnancy.

Objective: The nine diagnostic criteria for Internet Gaming Disorder (IGD) proposed in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have been widely adopted, but have also faced significant criticism. This study evaluated the psychometric properties of the nine DSM-5 criteria for IGD using item response theory (IRT). Methods: Four DSM-5-based scales, including the Game Addiction Scale, the Internet Gaming Disorder Scale Short-Form, the Ten- Item Internet Gaming Disorder Test, and the Internet Gaming Disorder Scale, were administered to 1,530 Chinese adolescents and young adults. IRT models were used to assess the psychometric properties of these criteria. The potential for differential item functioning (DIF) related to sex and between adolescents and adults was also evaluated. Results: All nine DSM-5 criteria demonstrated very high to perfect discrimination (a >1.38), providing substantial diagnostic information (item information >0.476) for diagnosing IGD. These scales, despite variations in wording and scoring methods, exhibited strong correlations in total scores (r≥0.502, p<0.001) and high consistency (Kendall’s W ≥0.656, p<0.05) concerning the fitted IRT parameters. Among the nine criteria, escape showed the lowest cross-scale discrimination, item information, and difficulty. In contrast, withdrawal showed the highest item information and discrimination, and the second highest difficulty. Additionally, there was no evidence of DIF related to sex or age (adolescents vs. adults) across nearly all scale items. Conclusion These findings indicate that the nine DSM-5 criteria generally possess acceptable psychometric properties for diagnosing IGD. Notably, withdrawal may represent a core symptom of IGD. Conversely, escape demonstrated inferior performance compared to the other eight criteria, indicating a potential need for further revision.

Objective: Self-determination theory (SDT) deems that people have three causality orientations: autonomy orientation, control orientation, and impersonal orientation. Previous studies suggested that lower autonomy orientation or higher control and impersonal orientations may be associated with more addictive behaviors. Our study aimed to investigate if these associations exist in Internet gaming disorder (IGD), and if sensation seeking, anxiety, and depression could influence the associations between causality orientations and IGD symptoms. Methods: A total of 1,400 college students completed the Internet Gaming Disorder Scale, General Causality Orientation Scale, Brief Sensation Seeking Scale, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire. Correlation, multiple linear regressions, structural equation model (SEM) analyses, and moderation analyses were conducted to explore the associations. Results: The control and impersonal orientations were positively associated with IGD symptoms, while the autonomy orientation was negatively associated with them. Moreover, SEM analyses showed that the autonomy-IGD relationship was totally mediated by anxiety and depression, the impersonal-IGD relationship was partially mediated by anxiety, and the control-IGD relationship was partially mediated by depression. Finally, the effects of causality orientations on IGD were moderated by sensation seeking. Conclusion Overall, autonomy orientation is linked to fewer gaming problems, whereas control and impersonal orientations are associated with more gaming problems. Moreover, the relationships between causality orientations and IGD symptoms are mediated by anxiety and depression and moderated by sensation seeking. Our findings inform theory on the motivations of gaming behaviors and may shed light on the prevention and intervention of IGD from the perspective of SDT.