Objective: To evaluate the diagnostic performance of magnetic resonance spectroscopy (MRS) in discriminating fumarate hydratase-deficient (FH-d) uterine leiomyomas (ULs) from FH-preserved ULs. Materials and Methods: This study consisted of three stages, with independent cohorts recruited for each stage: 1) sample-size estimation was retrospectively performed on UL specimens (diameter ≥3 cm; age, 20–40 years) from our database with immunohistochemistry (IHC) for 2-succinocysteine (2-SC) as the reference, without genetic testing, 2) MRS sequence optimization in confirmed FH germline mutation participants with ultrasound-detected ULs (diameter ≥3 cm), without IHC analysis, and 3) prospective diagnostic test accuracy was evaluated in consecutive participants with ultrasound-detected ULs (diameter ≥3 cm;age, 20–40 years), using IHC for 2-SC for determining the FH status and subsequent genetic testing in those with positive 2-SC results to identify whether FH mutations were germline or somatic in origin. The choline and fumarate peaks in MRS were classified as positive, negative, or technical failure (TF). TFs were analyzed separately and excluded from the primary diagnostic accuracy calculations. T1-, T2-, and diffusion-weighted images were interpreted as hyperintense or hypointense. The enhancement rate and apparent diffusion coefficient were also acquired. Diagnostic performance was compared between MRS and various magnetic resonance imaging (MRI) features. Results: The optimal MRS parameters for the fumarate peak were echo time (TE) = 140 ms and an average of 256. Among the 360 prospective participants, 37 were confirmed to have FH-dULs. MRS showed positive fumarate peaks in 35 of 37 FH-dULs.After excluding six TFs, the positive fumarate peak on MRS showed 94.6% (35/37) sensitivity, 99.7% (316/317) specificity, and 99.2% (351/354) accuracy, all of which were significantly superior to those of other MRI features (P ≤ 0.002). Conclusion A positive fumarate peak on MRS may be a useful imaging biomarker for diagnosing FH-dULs.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

OBJECTIVE: To explore the genetic basis for a child with metachromatic leukodystrophy (MLD). METHODS: Clinical data of the patient was collected. Genomic DNA was extracted from peripheral blood samples of the child and his family members. Potential variant was screened by whole exome sequencing (WES), and candidate variant was verified by Sanger sequencing. The pathogenicity the variant was analyzed by multiple sequence alignment of the amino acid sequence and three-dimensional model prediction of its protein product. RESULTS: The child was found to harbor compound heterozygous variants c.257G>A (p.R86Q) and c.467del (p.G156Afs*6) of the ARSA gene, among which the c.467del (p.G156Afs*6) frameshift variation was unreported previously. Multiple sequence alignment showed that the site of the c.257G>A (p.R86Q) missense variant is highly conserved. Three-dimensional structure modeling analysis showed that the partial deletion due to the p.G156Afs*6 variant may cause significant alteration of the structure of ARSA protein. CONCLUSION The discovery of novel variant in ARSA has enriched the mutational spectrum of MLD and may facilitate the understanding of the genotype-phenotype correlation of MLD.
Cerebroside-Sulfatase/genetics* ; DNA ; Genetic Association Studies ; Humans ; Leukodystrophy, Metachromatic/genetics* ; Mutation

Objective:To explore the frailty status of elderly inpatients and its influencing factors, so as to provide a basis for early identification of frailty status of elderly inpatients and scientific intervention.Methods:From January to December 2021, the convenient sampling was used to select 617 elderly patients (aged greater than or equal to 80 years old) in Department of Geriatric Medicine in Xuanwu Hospital, Capital Medical University as the research objects. The General Information Questionnaire, FRAIL Scale, Activities of Daily Living (ADL) Assessment Scale, NRS-2002 Nutritional Risk Screening Scale, John Hopkins Fall Risk Assessment Tool (JHFRAT) and Braden Scale were used to conduct cross-sectional survey. Multiple Logistic regression was used to analyze the influencing factors of frailty in elderly inpatients. A total of 617 questionnaires were distributed and 616 valid questionnaires were recovered, with an effective recovery rate of 99.8% (616/617) .Results:Among 616 elderly inpatients, the incidence of frailty was 60.9% (375/616) . The results of multiple Logistic regression analysis showed that advanced age, high fall risk, dependence on self-care ability of daily living and increased C-reactive protein were risk factors for frailty in elderly inpatients ( P<0.05) . Conclusions:Elderly inpatients have a high incidence of frailty. Advanced age, high fall risk, poor daily living ability and elevated C-reactive protein are related to the occurrence of frailty. Therefore, medical staff should do a good job of assessing the frailty of elderly patients in clinical work and formulate professional, diversified and safe intervention programs in combination with their physical conditions, so as to delay the frailty process of elderly inpatients, improve quality of life of patients and promote healthy aging.

Objective:To explore the frailty status of elderly inpatients and its influencing factors, so as to provide a basis for early identification of frailty status of elderly inpatients and scientific intervention.Methods:From January to December 2021, the convenient sampling was used to select 617 elderly patients (aged greater than or equal to 80 years old) in Department of Geriatric Medicine in Xuanwu Hospital, Capital Medical University as the research objects. The General Information Questionnaire, FRAIL Scale, Activities of Daily Living (ADL) Assessment Scale, NRS-2002 Nutritional Risk Screening Scale, John Hopkins Fall Risk Assessment Tool (JHFRAT) and Braden Scale were used to conduct cross-sectional survey. Multiple Logistic regression was used to analyze the influencing factors of frailty in elderly inpatients. A total of 617 questionnaires were distributed and 616 valid questionnaires were recovered, with an effective recovery rate of 99.8% (616/617) .Results:Among 616 elderly inpatients, the incidence of frailty was 60.9% (375/616) . The results of multiple Logistic regression analysis showed that advanced age, high fall risk, dependence on self-care ability of daily living and increased C-reactive protein were risk factors for frailty in elderly inpatients ( P<0.05) . Conclusions:Elderly inpatients have a high incidence of frailty. Advanced age, high fall risk, poor daily living ability and elevated C-reactive protein are related to the occurrence of frailty. Therefore, medical staff should do a good job of assessing the frailty of elderly patients in clinical work and formulate professional, diversified and safe intervention programs in combination with their physical conditions, so as to delay the frailty process of elderly inpatients, improve quality of life of patients and promote healthy aging.

Objective:To investigate the relationship between iodine nutrition level and thyroid disease.Methods:Totally 299 patients with thyroid disease who were treated at Shandong Provincial Institute for Endemic Disease Prevention and Control from 2016 to 2018 were selected as case group which was further divided into Graves' disease group (GD group, 137 patients), chronic lymphocytic thyroiditis group (HT group, 90 patients) and thyroid nodule group (72 patients). At the same time, 75 healthy people with no history of thyroid disease, normal thyroid color ultrasound and thyroid function were selected as control group. Morning urine was collected and urinary iodine was detected by arsenic cerium catalytic spectrophotometry. Fasting venous blood was extracted, and serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid globulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were detected by electrochemiluminescence method. Results:The difference of median urinary iodine in the 4 groups was statistically significant ( H = 42.530, P < 0.05). The medians urinary iodine in GD and HT groups (326.79, 341.91 μg/L) were higher than those of thyroid nodule group and control group (235.01, 187.32 μg/L, P < 0.05). The levels of TSH, FT 3 and FT 4 in GD group were compared with those of control group, and the differences were statistically significant ( P < 0.05). The positive rates of TgAb and TPOAb in HT group were significantly higher than those in GD, thyroid nodule and control groups, and the positive rates of TgAb and TPOAb in GD group were higher than those in thyroid nodule and control groups ( P < 0.05). Conclusions:GD and HT patients have excessive iodine nutrition, and high iodine intake may lead to the occurrence of these thyroid diseases (GD and HT). Thyroid function test combined with laboratory urinary iodine test can be used to diagnose thyroid diseases simply and quickly.

Objective:To construct an evaluation index system for nursing teaching case base, so as to guide the construction of the nursing teaching case base, and provide a basis for evaluating the quality of the case base.Methods:From April to August 2020, the evaluation index system for nursing teaching case base was initially constructed through the integration of literature retrieval and semi-structured interview results, and based on the Donabedian model. A total of 17 experts were selected as the consultation subjects using the Delphi method. After 2 rounds of consultations, expert opinions tended to be unanimous to construct the evaluation index system for nursing teaching case base.Results:In the second round of consultation, the expert authority coefficient was 0.872, and the expert positive coefficient was 94.12% (16/17) , and the kendall's W was 0.115 with a statistical difference ( P<0.05) . Finally, the evaluation index system for nursing teaching case base included 3 first-level indicators, 8 second-level indicators, and 29 third-level indicators. Conclusions:The evaluation index system of nursing teaching case base based on the Donabedian model is scientific and credible, which can provide a basis for the evaluation of nursing teaching case base.

One of the characteristics of coronavirus disease 2019 (COVID-19) epidemiology is that asymptomatic infection is also a source of infection. There was no fever and/or respiratory symptoms in this patient before the operation, and the results of routine blood test showed decreased lymphocyte count and lymphocyte percentage, and novel coronavirus pathogen detection was not carried out in the hospital, and the detection was not performed, chest imaging examination showed no obvious ground glass shadow, so viral pneumonia was not considered. The medical staff involved in the operation all adopted standard secondary medical protection measures. Five days after the operation, the patient was tested positive for novel coronavirus nucleic acid, which was a confirmed case of COVID-19. The results of epidemiological investigation and analysis showed that the patient was in the incubation period of COVID-19 before operation, however, none of the medical staff involved in surgical anesthesia and none of the patients in the next operation were infected. The reason is that the author′s hospital has strict training for all staff in infection control, and surgical anesthesiology medical staff have mastered the relevant basic knowledge and operation skills, have a good sense of infection control in the operating room, and can standardize the implementation. This case also suggested that attention should be paid to the patients with significant preoperative simple lymphocyte level decline, and measures should be taken to identify asymptomatic infection early.

With the development of the COVID-19 epidemic, the psychological impacts and stress-related symptoms associated with it have gradually appeared. The preventative and therapeutic psychological crisis interventions are urgently needed. This article focused on the international psychological crisis intervention models, which included the critical incident stress management, the task model, and the assessment-crisis intervention-trauma treatment intervention model. The aim of the current study was to form the suitable interventions for COVID-19 according to existing intervention methods and the specific characteristics of COVID-19. Possible coping strategies were also proposed for COVID-19 psychological crisis, which provided a theoretical basis for establishing an integrated public health emergency system and mechanism for psychological crisis prevention, evaluation, intervention and follow-up in China.