This case report presents a 16-year-old male patient with deficiency of adenosine deaminase 2(DADA2). The patient had a history of Raynaud′s phenomenon with digital ulcers since childhood. As the disease progressed, the patient developed retinal vasculitis, intracranial hemorrhage, skin necrosis, severe malnutrition, refractory hypertension, and gastrointestinal bleeding. Genetic testing revealed compound heterozygous mutations in the ADA2 gene (paternal c.1072G > A pathogenic mutation + maternal c.1065C > A variant of unknown clinical significance). ADA2 enzyme activity was significantly reduced (0.1 U/L). A multidisciplinary treatment team developed an individualized plan to address key issues, including nutritional support, blood pressure control, rehabilitation, pain management, and balancing anticoagulation/bleeding risks. After systematic intervention, the patient′s condition showed partial improvement. This case reveals clinical challenges such as anticoagulation decisions and nutritional support of DADA2. It also emphasizes the importance of early molecular diagnosis, tumor necrosis factor-α inhibitor targeted therapy, and multidisciplinary collaboration in management, underlining the core value of precision medicine in rare disease management.

Objective To prepare curcumin-loaded(CUR)mesoporous silica nanoparticles(MSN)modified by polydopamine(PDA),and study their pharmaceutical properties,drug release in vitro and antitumor activity in vitro.Methods Mesoporous silica nanoparticles were synthesized by template method and modified with PDA.The pharmaceutical properties of the nanoparticles were investigated.The responsive release of drug-loaded preparations at different pH was studied.The biocompatibility of the carrier and the inhibition rate of cell growth in vitro of the drug-loaded preparations were evaluated.The uptake of the drug-loaded preparations by tumor cells was examined.Results The particle size of MSN was uniform.After the PDA modification,the drug release rate of CUR@MSN-PDA was significantly dependent on pH.The results of biocompatibility experiments showed that,the cell survival rate was above 85％after co-cultured with MDA-MB-231 cells for 24 h.The results of in vitro tumor cell growth inhibition test showed that,the growth inhibition rate of CUR@MSN-PDA on tumor cells was significantly higher than that of CUR@MSN.The results of cell uptake showed that the fluorescent strength of CUR@MSN-PDA in the cell was significantly stronger than that of the CUR@MSN.Conclusion The nano-carrier constructed has significant pH response and enhanced anti-tumor activity,which can provide a theoretical basis for the drug delivery of CUR.

This paper reviews the current status, problems, challenges, and considerations of enhanced recovery after surgery (ERAS) nursing for hip fracture patients in China, and systematically elaborates on the ERAS nursing programs, nursing pathways, and quality evaluation standards for hip fracture patients in China. In response to the challenges of differentiated starting, difficult clinical practice, and incomplete quality evaluation system in implementing ERAS nursing for hip fracture patients in China, suggestions are proposed to focus on national policies, standardize basic service content, optimize perioperative treatment and nursing processes for elderly hip fracture patients, strengthen the construction of ERAS nursing teams, and implement full cycle process management.

Objective:To evaluate the body composition of ulcerative colitis (UC) patients by bioelectrical impedance analysis (BIA) and explore the correlation between body composition indices and disease activity, laboratory indices, and readmission.Methods:Patients with active UC hospitalized in the Department of Gastroenterology of Peking Union Medical College Hospital were enrolled continuously, and age and sex ratio-matched healthy volunteers were recruited through recruitment posters. Body composition was measured via BIA. Appendicular skeletal muscle index (ASMI) and trunk skeletal muscle index (TSMI) were calculated and adjusted for height (m 2). Muscle function was evaluated via handgrip strength. Moreover, patients were followed up after discharge and the readmissions due to recurrence or aggravation of UC were recorded. Results:This study enrolled 62 UC patients and 38 healthy volunteers. TSMI decreased significantly ( P<0.001) while ASMI showed no significant difference in male patients compared with healthy controls. ASMI ( P<0.001) and TSMI ( P=0.002) in female patients were significantly lower than those in healthy controls. Compared with patients with normal TSMI, a larger proportion of patients with low TSMI tended to show severe disease activity ( P=0.075), while no such trend was observed in patients with low ASMI. Handgrip strength and phase angle were significantly positively correlated with ALB in UC patients ( P<0.05). The proportion of patients with readmission was significantly higher in the low phase angle group than that in the normal phase angle group (58.3% vs. 22.0%, P=0.040). Conclusions:There were abnormal body composition and gender differences in UC patients. TSMI correlated better with clinical characteristics than ASMI in UC patients. Low phase angle might be predictive for readmission in UC patients.

Objective:To analyze the predictive value of age-adjusted Charlson comorbidity index (ACCI) on the risk of falls in elderly patients with femoral neck fractures.Methods:This study was a retrospective cohort study. From June 2021 to June 2022, cluster sampling was used to select 1 050 patients with femoral neck fractures at the Honghui Hospital affiliated with Xi'an Jiaotong University as the study subject. This study calculated the total ACCI score based on patient comorbidities, and divided patients into a low-risk fall group ( n=282) and a high-risk fall group ( n=768) based on whether the fall risk factor assessment score was ≥4.This study compared the differences in age, gender, American Society of Anesthesiologists (ASA) grading, ACCI score, white blood cell count, red blood cell count, platelet count, lymphocyte count, serum albumin, hemoglobin, creatinine, and urea nitrogen between the two groups. Independent variables with P<0.05 were included in binary Logistic regression to analyze the factors affecting the risk of falls in patients, and a receiver operating characteristic (ROC) curve was plotted. Results:There were statistically significant differences in age, ASA grading, red blood cell count, lymphocyte count, ACCI score, serum albumin, hemoglobin, creatinine, and urea nitrogen between the two groups of patients ( P<0.05). Logistic regression analysis found that age, ASA score, and ACCI score were independent risk factors for fall risk ( P<0.05), while serum albumin was an independent protective factor for fall risk ( P<0.05). The area under the ROC curve of ACCI for predicting fall risk was 0.892, and a score of 4 in ACCI was the cutoff value for predicting fall risk. Conclusions:ACCI can serve as an auxiliary tool for evaluating and predicting the risk of falls in elderly patients with femoral neck fractures, and can provide reference for clinical screening of high-risk individuals for falls.

Objective To identify the factors associated with frailty in lung transplant patients by a meta-analysis.Methods Computerized search was performed for studies on the influencing factors of frailty in lung transplant patients in the CNKI,WanFangData,VIP,CBM,PubMed,Web of Science,Embase,Elsevier ScienceDirect and CINAHL databases.The search was conducted from the time of database construction to November 2023.Literature screening,quality assessment,and data extraction were performed independently by 2 investigators,and Meta-analysis was performed using Stata 17.0 software.Results 10 cohort studies,including 1 999 patients,were finally included,and 13 influencing factors were extracted,including advanced age(OR=1.05),female(OR=2.50),BMI(OR=0.38),diagnosis of primary pulmonary disease(OR=2.90),6MWD(OR=0.34),and lung allocation score(OR=0.69),FVC(OR=0.60),pre-transplant frailty(OR=0.81),hypoproteinemia(OR=4.12),hemoglobin(OR=0.50),anemia(OR=4.37),length of ICU stay(OR=1.24),and total length of stay(OR=1.05).Short Physical Performance Battery is an assessment tool for frailty in lung transplant patients,with an incidence of frailty in 24％before transplantation and 50％in post-transplantation.Fried Frailty Phenotype is an assessment tool for frailty in lung transplant patients,with a pre-transplant frailty incidence of 30％.Conclusion There are many factors involved in the incidence of frailty in lung transplant patients,and nursing staff should dynamically evaluate the frailty of lung transplant patients,and give individualized and precise interventions in combination with a multidisciplinary model to improve or delay the progression of frailty.

Objective To evaluate the effect of remote interventions with digital health technologies in lung transplant patients.Methods Databases,including CKNI,Wangfang,VIP,CMB,Cochrane Library,PubMed,Embase,Web of Science,Scopus and BMJ Best Practice were searched from their inception to July 2023.There were 2 researchers who independently screened and extracted the literature,and then evaluated quality of the included studies.Meta-analysis was performed using RevMan 5.2.Results 10 studies with 1 262 patients were included.The results of meta-analysis showed that compared with conventional intervention,remote intervention based on digital health technology could improve self-monitoring compliance of lung transplant patients[0R=0.64,95％CI(0.46,0.88),P=0.006],improve quality of life including mental health status[OR=3.08,95％CI(0.41,5.74),P=0.020]and physical health status[OR=3.81,95％CI(1.19,6.43),P=0.004].In terms of the intervention forms,the application-based remote intervention had better self-monitoring compliance,and the difference was statistically significant(P=0.007).However,in terms of the comparison of readmission rate[OR=1.73,95％CI(0.98,3.04),P=0.060],anxiety[OR=-0.12,95％CI(-1.36,1.11),P=0.850],and depression[OR=0.62,95％CI(-0.80,2.03),P=0.390],the effect of intervention was unclear.Conclusion Remote intervention based on digital health technology can improve self-monitoring compliance and quality of life in lung transplant patients;applications are the optimal form of intervention.Limited by the quality and quantity of included studies and the heterogeneity of study results,more high-quality studies are needed to further verify the effects of digital health technology on readmission rates,anxiety and depression of lung transplant patients.

Objective To investigate the incidence and risk factors of post-transplant diabetes mellitus(PTDM)in adult lung transplant recipients.Methods Conducting a convenience sampling method,we retrospectively analyzed the clinical data of lung transplant recipients from January 2020 to December 2022 at a tertiary A hospital in Hangzhou,Zhejiang Province.According to the PTDM diagnostic criteria,lung transplant recipients are divided into a PTDM group and a non-PTDM group.The incidence rate of PTDM is calculated,and the influencing factors for PTDM occurrence are analyzed using both univariate and multivariate logistic regression methods.Results A total of 140 patients were included in this study,and 54 lung transplant recipients developed PTDM within 6 months,with an incidence of 38.57％.Univariate analysis showed that there were significant differences in age,gender,BMI,smoking history,pre-operative glycated albumin,pre-operative fasting blood glucose,early post-operative blood glucose and pre-operative creatinine between the 2 groups(P＜0.05).Multivariate Logistic analysis showed that gender(OR=5.283),BMI(OR=6.122),pre-operative glycated albumin(OR=1.330),and early post-operative blood glucose(0R=1.444)were the influencing factors.Conclusion Lung transplant recipients who were male,BMI ≥24.0,with high levels of glycated albumin before surgery,and high blood sugar early after surgery had a higher risk of developing PTDM.Clinical nurses can formulate relevant nursing measures according to the influencing factors to prevent the occurrence of PTDM.

Background Pesticide exposure may impact the reproductive health of women undergoing assisted reproductive technology (ART). However, data on pesticide exposure levels in women undergoing ART in China are scarce, and current research on influencing factors is limited. Objective To evaluate the preconceptional pesticide exposure levels and identify potential determinants among women undergoing ART. Methods This study was designed as a cross-sectional survey and recruited 508 women undergoing ART from July 2017 to December 2018 at the fertility clinic of the International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Gas chromatography/liquid chromatography-tandem mass spectrometry was used to determine the metabolite concentrations of organophosphate pesticides (OPs), pyrethroid pesticides (PYRs), and neonicotinoid pesticides (NEOs) in urine. The sum of molar concentrations of the three pesticide classes (∑₂OPs, ∑₂PYRs, and ∑₂NEOs) were calculated. A questionnaire was used to collect demographic characteristics, dietary habits, and behavioral information. Multiple linear regression was employed to analyze the associations of demographic characteristics, dietary habits, and behavioral variables with the concentrations of pesticide metabolites in urine among the participants. Results The median creatinine-adjusted concentrations of ∑₂OPs, ∑₂PYRs, and ∑₂NEOs in this study were 419.77, 2.95, and 20.36 nmol·g⁻¹, respectively. The multiple linear regression results showed that the urinary concentration of ∑₂OPs was 42.88% higher in the participants with daily vegetable intake than in those who consumed vegetables ≤3 d per week (P<0.05), and the urinary concentration of ∑₂PYRs was 37.24% higher in the participants with daily fruit intake than in those who consumed fruits ≤3 d per week (P<0.01). Similarly, the urinary concentrations of ∑₂NEOs were 24.51% and 29.30% higher in the participants who consumed fruits daily and 4-6 d per week, respectively, than in those who consumed fruits ≤3 d per week (P<0.05). Besides, we also found that the urinary concentration of ∑₂PYRs was negatively correlated with body mass index (BMI) in the participants (P<0.05). Furthermore, the urinary concentration of ∑₂NEOs was not only positively correlated with age (P<0.05), but also significantly associated with pet ownership and infertility causes among the participants. Specifically, the participants who continued to own pets after conception had a 30.11% higher urinary concentration of ∑₂NEOs than those who never owned pets (P<0.05), and the participants with infertility due to female factors had a 24.10% lower urinary concentration of ∑₂NEOs than those who received ART treatment for infertility caused by male factors (P<0.05). Conclusion The women undergoing ART in Shanghai are widely exposed to pesticides. Age, BMI, frequency of vegetable and fruit intake, pet ownership, and infertility causes may be related to the pesticide exposure levels in this population. However, more human data are needed to confirm these findings.

In recent years,the international drug control situation has become increasingly serious.According to the statistical data of the year 2021 from UNODC,in the past decade,the trafficking volume of traditional drug(such as methamphetamine,cannabis and cocaine)has continued to rise,new psychoactive substances(NPS)have emerged one after another,the drugs as well as their precursors and metabolites have become a new group of pollutants.They widely exist in environmental media such as water,air,sludge and soil,due to the manufacture and abuse of drugs,which endangers human and animal safety.Drug detection data from environmental samples can reflect the local drug use situation objectively,real-time,accurately and effectively,which is helpful to grasp the spatial distribution and time changes,monitor the development trends of drug abuse,assess the trend of drug abuse reasonably,and assist in combating related illegal and criminal activities through comprehensive data analysis.At present,sewage monitoring has become an important means of drug monitoring in countries around the world.Sewage testing can assess drug consumption in a place reasonably,and sewage network traceability technology can reduce the scope of regional investigation of drug manufacturing dens effectively,so as to combat accurately.Drug detection in the atmosphere,sludge and soil has been carried out in some foreign countries,but it has not been used as a long-term monitoring means.Long-term monitoring of drugs from the environment in a variety of ways not only helps to effectively update the drug situation in the region,but also to better understand local trends in drug use and identify new drugs of abuse.It will provide data support for more accurate monitoring and combating drug crimes in the future.This paper reviews the methods for detecting drugs and other related compounds in different environmental matrices including sewage,atmosphere and sludge in China and other countries,including the study on the sources and forms of related compounds in different environments,the preparation of different matrix samples and the quantitative analysis of drugs from environment,as well as the existing problems and shortcomings of various detection methods.Finally,the drug detection technology and comprehensive monitoring system in the environment are prospected.