BackgroundAdverse childhood experiences （ACEs） are strong predictors of psychopathology across the lifespan， exerting extensive adverse effects on physical and mental health during early development. While ACEs increase the risk of childhood psychopathology， sleep quality and impair cognitive function， the early neurobiological mechanisms mediating ACE-induced cognitive impairment remain unclear. ObjectiveTo explore the association between ACEs exposure and the risk of psychopathology， sleep disorders， and cognitive function， and to examine the mediating role of the putamen volume in the relationship between ACEs and cognitive function from a neurodevelopment perspective. MethodsData were obtained from the Adolescent Brain Cognitive Development （ABCD） study， comprising 10 572 children aged 9 to 10. Participants were categorized into five groups based on the cumulative score of ACEs reported by their parents and the children themselves： no-exposure group （0 types of ACEs）， the one-exposure group， the two-exposure group， the three-exposure group， and the high-risk exposure group （≥ 4 types of ACEs）. Logistic regression analysis was employed to evaluate the association between ACEs and psychopathological symptoms ［T score of the Child Behavior Checklist （CBCL） ≥ 65］. Multiple linear regression analysis was ultilized to analyze the correlations between ACEs and the scores of the Sleep Disturbance Scale for Children （SDSC）， the NIH Toolbox Cognition Battery （NIHTB-CB）， as well as the multiple structures in the cerebral cortex and subcortex. The Bootstrap method was applied to test the mediating effect of the putamen volume between ACEs and neurocognitive function. ResultsAfter adjusting for confounders， ACEs cumulative score was correlated with children's psychopathological symptoms in a dose-response manner. Compared with the no-exposed group， the high-risk exposure group had a 2.08-fold （OR=2.080， 95% CI： 1.401–3.088） increased risk of internalizing problems and a 3.13-fold （OR=3.132， 95% CI： 1.703–5.760） increased risk of externalizing problems， and the risk of conduct problems was 4.68 times that of the no-exposed group （OR=4.681， 95% CI： 2.528–8.669）. ACEs cumulative score positively predicted the total score of SDSC （β=0.080， 95% CI： 0.059–0.102）， with relatively stronger predictive effects on sleep-wake transition disorder （β=0.086， 95% CI： 0.063–0.109） and sleep onset and maintenance disorder （β=0.066， 95% CI： 0.043–0.089）. In terms of neurocognition and brain structure， ACEs cumulative score negatively predicted the overall cognitive composite score （β=-0.025， 95% CI： -0.050–-0.001）， the crystallized cognitive composite score （β=-0.035， 95% CI： -0.060–-0.010）， the volume of the left putamen nucleus （β=-0.025， 95% CI： -0.046– 0.003）， and the volume of the right putamen nucleus （β=-0.023， 95% CI： -0.044– 0.003）. The total putamen volume played a partial mediating role between ACEs and the overall cognitive composite score， the effect value was -0.002 （95% CI： -0.004–-0.001）， accounting for 7.49% of the total effect. ConclusionACEs exposure may increase the risk of psychopathological and sleep disturbances in children and may impair neurocognitive function. Reduced putamen volume may serve a potential neurobiological pathway underlying the impact of ACEs on childhood cognition. ［Funded by National Natural Science Foundation of China-Young Scientists Program （number， 82401763）； Sichuan University West China Hospital Full-time Postdoctoral Research and Development Fund Project （number， 2023HXBH084）］

Objective To translate the English version of communicative effectiveness index(CETI)into Chinese and validate its reliability and validity for use in the elderly population.Methods The English version of CETI was translated into Chinese and back-translated using the Brislin translation model.After adjustments and pilot testing,a Chinese version of CETI was created.Between January and March 2024,a total of 395 elderly individuals aged 60 years and over were recruited from Jiangsu and Henan Provinces via convenience sampling.A total of 30 elderly people were retested with the Chinese version of CETI after two weeks of primary test to assess the reliability and validity of the scale.Results The Chinese version of CETI comprised two dimensions:conversational comprehensibility(5 items)and conversational initiative(4 items).The Cronbach α coefficient of the scale was 0.831with the split-half reliability 0.785 and the test-retest reliability 0.909.The Cronbach α coefficients of each dimension ranged from 0.641 to 0.778.The test-retest reliability of each dimension ranged from 0.889 to 0.936.The KMO value of exploratory factor analysis was 0.893,Bartlett's sphericity test valueχ 2=583.291(P<0.01),and the total explanatory rate of variation was 63.305%.Conclusion The Chinese version of CETI has good reliability and validity.It is suitable to be used in the assessment of the status of verbal communicative function in the elderly.

Objective To translate the English version of communicative effectiveness index(CETI)into Chinese and validate its reliability and validity for use in the elderly population.Methods The English version of CETI was translated into Chinese and back-translated using the Brislin translation model.After adjustments and pilot testing,a Chinese version of CETI was created.Between January and March 2024,a total of 395 elderly individuals aged 60 years and over were recruited from Jiangsu and Henan Provinces via convenience sampling.A total of 30 elderly people were retested with the Chinese version of CETI after two weeks of primary test to assess the reliability and validity of the scale.Results The Chinese version of CETI comprised two dimensions:conversational comprehensibility(5 items)and conversational initiative(4 items).The Cronbach α coefficient of the scale was 0.831with the split-half reliability 0.785 and the test-retest reliability 0.909.The Cronbach α coefficients of each dimension ranged from 0.641 to 0.778.The test-retest reliability of each dimension ranged from 0.889 to 0.936.The KMO value of exploratory factor analysis was 0.893,Bartlett's sphericity test valueχ 2=583.291(P<0.01),and the total explanatory rate of variation was 63.305%.Conclusion The Chinese version of CETI has good reliability and validity.It is suitable to be used in the assessment of the status of verbal communicative function in the elderly.

Objective:To retrieve, screen, and summarize the best evidence for non-pharmacological management of Parkinson's disease patients with depression, so as to provide evidence-based basis for medical and nursing staff to standardize the non-pharmacological management.Methods:Following the "6S" evidence model, relevant literature was systematically searched from top to bottom in UpToDate, British Medical Journal, Joanna Briggs Institute Evidence-Based Health Care Center Database, National Institute for Health and Clinical Excellence, Guidelines International Network, Agency for Healthcare Research and Quality, Scottish Intercollegiate Guidelines Network, Medlive, Parkinson's Society of Canada, Cochrane Library, CINAHL, PubMed, Web of Science, Embase, China Biology Medicine, China National Knowledge Infrastructure, and WanFang Data. The search period was from database establishment to March 31, 2023. After conducting methodological quality evaluation based on literature standards, evidence was extracted and summarized from literature that met the standards, and the level of each evidence was determined.Results:A total of 22 articles were included, including one clinical decision-making, three guidelines, 14 systematic reviews, and four expert consensuses. A total of 30 best evidence were formed from six aspects, namely screening and evaluation, psychological intervention, physical therapy, traditional Chinese medicine therapy, exercise, and health education.Conclusions:The best evidence for non-pharmacological management of Parkinson's disease patients with depression summarized provides evidence-based basis for the development of non-pharmacological management plans for Parkinson's disease patients with depression.

Objective:To introduce the experience of reconstructing the pelvic floor with a pedicled large omental flap combined with a basement membrane biological mesh in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer combined with sacrococcygeal resection, and to discuss the feasibility, safety, and near-term therapeutic efficacy of this technique.Methods:For patients with sacrococcygeal resection of combined pelvic organs, a basement membrane mesh was used to rebuild the pelvic floor with a pedicled greater omentum flap to isolate the abdominopelvic cavity. The main operation was to pull the greater omentum, which preserved the double vascular arches, to the pelvic floor to cover the pelvic floor, and then the mesh was used to cover the posterior peritoneal defect and pelvic inlet with absorbable sutures of 2-0 or thicker.Results:In this study, a retrospective cohort study was used to collect clinical data through the China Rectal Cancer Combined Pelvic Organs Resections Case Database. Twenty patients with locally advanced or locally recurrent rectal cancer without extra-pelvic metastasis or only oligometastases underwent combined pelvic organ and sacrococcygeal resection in the Department of Anal and Intestinal Surgery of the Second Affiliated Hospital of the Naval Military Medical University during the period of July 1, 2022, to June 30, 2023, and 10 patients underwent simple basement membrane resection with a simple basement membrane. Among them, the pelvic floor were reconstructed by basement membrane mesh alone in 10 cases (mesh only group), and 10 cases were reconstructed the pelvic floor by pedicled large omental flap combined with basement membrane mesh (omental flap-combined mesh group). The recent outcomes of the two groups of patients were studied comparatively. Comparison of baseline data and intraoperative conditions between the two groups showed no statistically significant differences (all P>0.05); the drain removal time in the omental flap-combined mesh group was 26.7 (19-42) days, which was shorter than that in the mesh only group, which was 40.4 (24-56) days ( U=4.125, P=0.001); The empty pelvis healing time in the omental flap-combined mesh group was 29.4 (23~43) days, which was shorter than that of 42.2 (27~58) days in the mesh-only group ( U=4.043, P=0.001); the differences were all statistically significant. The postoperative complication rate of grade ≥III in the omental flap-combined mesh group was 1/10, which was lower than that of 6/10 in the mesh-only group; the difference was not statistically significant when comparing the two groups ( P = 0.057). Follow-up ended on 09/30/2023, with a median follow-up of 9.5 (3-15) months in 20 patients, and all 20 cases survived during the follow-up period, with no tumor recurrence at the surgical site. Conclusion:In locally advanced or locally recurrent rectal cancer undergoing combined pelvic organ resection with sacrococcygeal, compared with reconstruction of the pelvic floor by basement membrane mesh alone, reconstruction of the pelvic floor and isolation of the abdominopelvic cavity by a pedicled greater omentum flap combined with a basement membrane mesh is safe and feasible.

BackgroundThe occurrence rate of dangerous behaviors in patients with severe mental disorders is higher than that of the general population. In China， there is limited research on the prediction of dangerous behaviors in community-dwelling patients with severe mental disorders， particularly in terms of predicting models using data mining techniques other than traditional methods. ObjectiveTo explore the influencing factors of dangerous behaviors in community-dwelling patients with severe mental disorders and testing whether the classification decision tree model is superior to the Logistic regression model. MethodsA total of 11 484 community-dwelling patients with severe mental disorders who had complete follow-up records from 2013 to 2022 were selected on December 2023. The data were divided into a training set （n=9 186） and a testing set （n=2 298） in an 8∶2 ratio. Logistic regression and classification decision trees were separately used to establish predictive models in the training set. Model discrimination and calibration were evaluated in the testing set. ResultsDuring the follow-up period， 1 115 cases （9.71%） exhibited dangerous behaviors. Logistic regression results showed that urban residence， poverty， guardianship， intellectual disability， history of dangerous behaviors， impaired insight and positive symptoms were risk factors for dangerous behaviors （OR=1.778， 1.459， 2.719， 1.483， 3.890， 1.423， 2.528， 2.124， P<0.01）. Being aged ≥60 years， educated， not requiring prescribed medication and having normal social functioning were protective factors for dangerous behaviors （OR=0.594， 0.824， 0.422， 0.719， P<0.05 or 0.01）. The predictive effect in the testing set showed an area under curve （AUC） of 0.729 （95% CI： 0.692~0.766）， accuracy of 70.97%， sensitivity of 59.71%， and specificity of 72.05%. The classification decision tree results showed that past dangerous situations， positive symptoms， overall social functioning score， economic status， insight， household registration， disability status and age were the influencing factors for dangerous behaviors. The predictive effect in the testing set showed an AUC of 0.721 （95% CI： 0.705~0.737）， accuracy of 68.28%， sensitivity of 64.46%， and specificity of 68.60%. ConclusionThe classification decision tree does not have a greater advantage over the logistic regression model in predicting the risk of dangerous behaviors in patients with severe mental disorders in the community. ［Funded by Chengdu Medical Research Project （number， 2020052）］

Objective:To introduce the experience of reconstructing the pelvic floor with a pedicled large omental flap combined with a basement membrane biological mesh in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer combined with sacrococcygeal resection, and to discuss the feasibility, safety, and near-term therapeutic efficacy of this technique.Methods:For patients with sacrococcygeal resection of combined pelvic organs, a basement membrane mesh was used to rebuild the pelvic floor with a pedicled greater omentum flap to isolate the abdominopelvic cavity. The main operation was to pull the greater omentum, which preserved the double vascular arches, to the pelvic floor to cover the pelvic floor, and then the mesh was used to cover the posterior peritoneal defect and pelvic inlet with absorbable sutures of 2-0 or thicker.Results:In this study, a retrospective cohort study was used to collect clinical data through the China Rectal Cancer Combined Pelvic Organs Resections Case Database. Twenty patients with locally advanced or locally recurrent rectal cancer without extra-pelvic metastasis or only oligometastases underwent combined pelvic organ and sacrococcygeal resection in the Department of Anal and Intestinal Surgery of the Second Affiliated Hospital of the Naval Military Medical University during the period of July 1, 2022, to June 30, 2023, and 10 patients underwent simple basement membrane resection with a simple basement membrane. Among them, the pelvic floor were reconstructed by basement membrane mesh alone in 10 cases (mesh only group), and 10 cases were reconstructed the pelvic floor by pedicled large omental flap combined with basement membrane mesh (omental flap-combined mesh group). The recent outcomes of the two groups of patients were studied comparatively. Comparison of baseline data and intraoperative conditions between the two groups showed no statistically significant differences (all P>0.05); the drain removal time in the omental flap-combined mesh group was 26.7 (19-42) days, which was shorter than that in the mesh only group, which was 40.4 (24-56) days ( U=4.125, P=0.001); The empty pelvis healing time in the omental flap-combined mesh group was 29.4 (23~43) days, which was shorter than that of 42.2 (27~58) days in the mesh-only group ( U=4.043, P=0.001); the differences were all statistically significant. The postoperative complication rate of grade ≥III in the omental flap-combined mesh group was 1/10, which was lower than that of 6/10 in the mesh-only group; the difference was not statistically significant when comparing the two groups ( P = 0.057). Follow-up ended on 09/30/2023, with a median follow-up of 9.5 (3-15) months in 20 patients, and all 20 cases survived during the follow-up period, with no tumor recurrence at the surgical site. Conclusion:In locally advanced or locally recurrent rectal cancer undergoing combined pelvic organ resection with sacrococcygeal, compared with reconstruction of the pelvic floor by basement membrane mesh alone, reconstruction of the pelvic floor and isolation of the abdominopelvic cavity by a pedicled greater omentum flap combined with a basement membrane mesh is safe and feasible.

This article reviews the overview of digital integration of geriatric patients and related influencing factors, the current situation of smart outpatient service, and the aging measures of smart outpatient service, with a view to providing reference for Chinese scholars to further study digital integration of geriatric patients.

Objective:To explore the application effect of multi-mode teaching guided by objective management in the standardized training of nursing students.Methods:A total of 39 standardized training nursing students from April 2019 to April 2020 in the department of oncology of a tertiary hospital were selected as the control group by cluster sampling method and they received traditional teaching; 40 standardized nursing students in the department of oncology from June 2020 to June 2021 were selected as the experimental group and the group adopted multi-mode teaching guided by objective management. The differences of theoretical and operational assessment scores, teaching satisfaction, critical thinking ability and nurse-patient communication ability between the two groups were studied. SPSS 20.0 was used for t-test and Chi-square test. Results:The scores of theoretical assessment [(86.17±3.74) vs. (83.92±4.93)] and operational assessment [(92.83±2.19) vs. (90.74±3.52)] in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05). The teaching satisfaction of the experimental group was higher than that of the control group [(46.10±2.96) vs. (42.67±2.45)], and the difference was statistically significant ( P<0.05). There were statistically significant differences in critical thinking, intellectual curiosity and analytical skills ( P<0.05). In terms of nurse-patient communication ability, except that there was no difference in collecting information, the rest were statistically significant( P<0.05). Conclusion:Multi-mode teaching guided by objective management can improve the theoretical and operational ability of nurses, nurse-patient communication ability, and teaching satisfaction.

Objective:To observe the application effect of outcome-based education (OBE) concept on the teaching of otorhinolaryngology nursing.Methods:A total of 97 nursing interns from the Department of Otorhinolaryngology in The Second Affiliated Hospital of Army Medical University were selected as the research objects. Among them, 46 ones from March 2017 to February 2019 were collected as the control group, and 51 ones from March 2019 to February 2021 as the observation group. The control group adopted traditional nursing clinical teaching, and the observation group adopted the nursing clinical teaching based on the OBE concept. All the nursing students had an internship for 3 weeks, and had an evaluation in terms of the clinical communication ability of the two groups of nursing students when they leave the department (the nursing students' clinical communication ability assessment scale), the daily life problem solving ability (simplified Chinese version of the daily life problem solving questionnaire), theoretical and operational assessment results, and the internship satisfaction (nursing student internship satisfaction scale). SPSS 19.0 was used for independent-sample t test. Results:When leaving the department, the observation group's clinical communication ability scores were significantly higher than those of the control group in such dimensions as establishing a harmonious relationship, keen listening, confirming patient problems, participating together, transmitting effective information, and verifying feelings ( P<0.05). The scores of simplified Chinese version of the daily life problem solving questionnaire of rational problem solving and positive problem orientation of the observation group were significantly higher than those of the control group ( P<0.05), while the scores of negative problem orientation, avoidance style and impulsivity/carelessness style were significantly lower than those of the control group ( P<0.05). The scores of theoretical and operational evaluations of the observation group were significantly higher than those of the control group ( P<0.05). The practice satisfaction scores on each dimension of the observation group, including clinical teaching, classroom teaching, and internship plan, support and resources were significantly higher than those of the control group ( P<0.05). Conclusion:The OBE concept applied in the teaching of otorhinolaryngology nursing can enhance the clinical communication ability and daily life problem-solving ability of nursing students, increase the theoretical and operational assessment results, and improve the satisfaction of internship.