Summarizing the nursing experience of nutritional support therapy during the perioperative period for a child with short bowel syndrome undergoing small intestine transplantation.Nursing key points:dynamic assessment of nutritional risk,development and timely adjustment of nutritional support programs;implementation of nutritional support strategies to promote growth and development;combination with exercise interventions to improve nutritional status;to strengthen the monitoring of rejection,to promote the recovery of intestinal function;to strengthen the continuity of care,and do a good job of nutritional monitoring and guidance.After 141 days of careful treatment and nursing care,the child was discharged successfully.

Objective:To develop and validate artificial intelligence (AI) models based on deep learning for precise boundary identification of early gastric cancer (EGC) in narrow-band imaging (NBI) and near focus narrow-band imaging (NF-NBI) endoscopic images.Methods:Endoscopic submucosal dissection (ESD) images from 282 patients diagnosed as having EGC by postoperative pathology at the Department of Gastroenterology, the First Affiliated Hospital of Soochow University were retrospectively collected from February 2016 to June 2024. The images were randomly divided into the training set and the validation set at an approximate 8∶2 ratio. In the NBI modality, 980 images from 171 patients were used for training, 235 images from 61 patients were used for validation. In the NF-NBI modality, 1 273 images from 128 patients were used for training, and 373 images from 35 patients were used for validation. This study trained a total of six convolutional neural network (CNN) models: two independent CNN1 models, two independent CNN2 models, and two fused CNN3 models. Using expert-delineated EGC boundaries based on post-ESD pathological findings as the gold standard, the intersection over union (IOU) value of the CNN3 models was compared against junior (<5 years experience), mid-level (5-10 years), and senior (>10 years) endoscopists.Results:In NBI validation set, the IOU value of CNN3 model was significantly higher than that of junior (0.732 VS 0.489, Z=11.528, P<0.001) and mid-level endoscopists (0.732 VS 0.521, Z=11.184, P<0.001). However, no significant difference was observed between CNN3 model and senior endoscopists (0.732 VS 0.739, Z=0.593, P=0.554). Similarly, in NF-NBI validation set, CNN3 model outperformed junior (0.757 VS 0.537, Z=15.944, P<0.001) and mid-level endoscopists (0.757 VS 0.597, Z=9.722, P<0.001), while matching senior endoscopists (0.757 VS 0.769, Z=0.854, P=0.394). Conclusion:The fused CNN3 model achieves senior expert-level accuracy in delineating EGC boundaries in both NBI and NF-NBI images, demonstrating potential to assist less-experienced endoscopists in precise identification of EGC boundaries.

Objective The aim of this study was to develop a method for the determination of nine vulcanizing agents and accelerators in pharmaceutical rubber stoppers by headspace gas chromatography with sulfur chemiluminescence detector(HS-GC-SCD).Methods A DB-1 capillary column(30 m×0.32 mm×0.25 μm)was used with He as the carrier gas.The injection port temperature was 220 ℃,the split ratio was 10∶1,and the carrier gas flow rate was 1.5 mL·min-1.The temperature program was as follows:the starting temperature was 40 ℃,and it was increased to 60 ℃ at a rate of 5 ℃ per minute,and then to 260 ℃ at a rate of 15℃per minute.SCD detector parameters:base temperature was 280℃,combustion chamber temperature was 800 ℃,air flow rate was 60 mL·min-1,and hydrogen flow rate was 40 mL·min-1.Results The sample pretreatment method was simple and convenient,and it effectively reduced the extraction loss.The methodological results showed that all sulfides showed good linear relationships within the concentration range(r2≥ 0.990).The RSD was less than 2％;and the average recovery rate was 86.4％-97.5％.From the analysis of the sample test results,free sulfur is commonly found in rubber stoppers.Among all the samples of the vulcanization system,the free sulfur detected in the sulfur vulcanization system is higher than the free sulfur produced by degradation of other vulcanization systems.Conclusions This method is simple to operate,compared with other existing detection methods.HS-GC-SCD has a smaller matrix effect,higher sensitivity and selectivity,and is appropriate for quantifying the concentrations of sulfide present in various rubber stoppers.

Objective The aim of this study was to develop a method for the determination of nine vulcanizing agents and accelerators in pharmaceutical rubber stoppers by headspace gas chromatography with sulfur chemiluminescence detector(HS-GC-SCD).Methods A DB-1 capillary column(30 m×0.32 mm×0.25 μm)was used with He as the carrier gas.The injection port temperature was 220 ℃,the split ratio was 10∶1,and the carrier gas flow rate was 1.5 mL·min-1.The temperature program was as follows:the starting temperature was 40 ℃,and it was increased to 60 ℃ at a rate of 5 ℃ per minute,and then to 260 ℃ at a rate of 15℃per minute.SCD detector parameters:base temperature was 280℃,combustion chamber temperature was 800 ℃,air flow rate was 60 mL·min-1,and hydrogen flow rate was 40 mL·min-1.Results The sample pretreatment method was simple and convenient,and it effectively reduced the extraction loss.The methodological results showed that all sulfides showed good linear relationships within the concentration range(r2≥ 0.990).The RSD was less than 2％;and the average recovery rate was 86.4％-97.5％.From the analysis of the sample test results,free sulfur is commonly found in rubber stoppers.Among all the samples of the vulcanization system,the free sulfur detected in the sulfur vulcanization system is higher than the free sulfur produced by degradation of other vulcanization systems.Conclusions This method is simple to operate,compared with other existing detection methods.HS-GC-SCD has a smaller matrix effect,higher sensitivity and selectivity,and is appropriate for quantifying the concentrations of sulfide present in various rubber stoppers.

Summarizing the nursing experience of nutritional support therapy during the perioperative period for a child with short bowel syndrome undergoing small intestine transplantation.Nursing key points:dynamic assessment of nutritional risk,development and timely adjustment of nutritional support programs;implementation of nutritional support strategies to promote growth and development;combination with exercise interventions to improve nutritional status;to strengthen the monitoring of rejection,to promote the recovery of intestinal function;to strengthen the continuity of care,and do a good job of nutritional monitoring and guidance.After 141 days of careful treatment and nursing care,the child was discharged successfully.

Objective:To develop and validate artificial intelligence (AI) models based on deep learning for precise boundary identification of early gastric cancer (EGC) in narrow-band imaging (NBI) and near focus narrow-band imaging (NF-NBI) endoscopic images.Methods:Endoscopic submucosal dissection (ESD) images from 282 patients diagnosed as having EGC by postoperative pathology at the Department of Gastroenterology, the First Affiliated Hospital of Soochow University were retrospectively collected from February 2016 to June 2024. The images were randomly divided into the training set and the validation set at an approximate 8∶2 ratio. In the NBI modality, 980 images from 171 patients were used for training, 235 images from 61 patients were used for validation. In the NF-NBI modality, 1 273 images from 128 patients were used for training, and 373 images from 35 patients were used for validation. This study trained a total of six convolutional neural network (CNN) models: two independent CNN1 models, two independent CNN2 models, and two fused CNN3 models. Using expert-delineated EGC boundaries based on post-ESD pathological findings as the gold standard, the intersection over union (IOU) value of the CNN3 models was compared against junior (<5 years experience), mid-level (5-10 years), and senior (>10 years) endoscopists.Results:In NBI validation set, the IOU value of CNN3 model was significantly higher than that of junior (0.732 VS 0.489, Z=11.528, P<0.001) and mid-level endoscopists (0.732 VS 0.521, Z=11.184, P<0.001). However, no significant difference was observed between CNN3 model and senior endoscopists (0.732 VS 0.739, Z=0.593, P=0.554). Similarly, in NF-NBI validation set, CNN3 model outperformed junior (0.757 VS 0.537, Z=15.944, P<0.001) and mid-level endoscopists (0.757 VS 0.597, Z=9.722, P<0.001), while matching senior endoscopists (0.757 VS 0.769, Z=0.854, P=0.394). Conclusion:The fused CNN3 model achieves senior expert-level accuracy in delineating EGC boundaries in both NBI and NF-NBI images, demonstrating potential to assist less-experienced endoscopists in precise identification of EGC boundaries.

The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) system, belonging to the type II CRISPR/Cas system, is an effective gene-editing tool widely used in different organisms, but the size of Streptococcus pyogenes Cas9 (SpCas9) is quite large (4.3 kb), which is not convenient for vector delivery. In this study, we used a codon-optimized Staphylococcus aureus Cas9 (SaCas9) system to edit the tyrosinase (tyr), oculocutaneous albinism II (oca2), and paired box 6.1 (pax6.1) genes in the fish model medaka(Oryzias latipes), in which the size of SaCas9 (3.3 kb) is much smaller and the necessary protospacer-adjacent motif (PAM) sequence is 5'-NNGRRT-3'. We also used a transfer RNA (tRNA)‍-single-guide RNA (sgRNA) system to express the functional sgRNA by transcription eitherin vivo or in vitro, and the combination of SaCas9 and tRNA-sgRNA was used to edit the tyr gene in the medaka genome. The SaCas9/sgRNA and SaCas9/tRNA-sgRNA systems were shown to edit the medaka genome effectively, while the PAM sequence is an essential part for the efficiency of editing. Besides, tRNA can improve the flexibility of the system by enabling the sgRNA to be controlled by a common promoter such as cytomegalovirus. Moreover, the all-in-one cassette cytomegalovirus (CMV)‍-SaCas9-tRNA-sgRNA-tRNA is functional in medaka gene editing. Taken together, the codon-optimized SaCas9 system provides an alternative and smaller tool to edit the medaka genome and potentially other fish genomes.
Animals ; Oryzias/genetics* ; Gene Editing/methods* ; CRISPR-Cas Systems ; Codon ; RNA, Guide, CRISPR-Cas Systems/genetics* ; Monophenol Monooxygenase/genetics* ; CRISPR-Associated Protein 9/genetics* ; RNA, Transfer/genetics* ; Staphylococcus aureus/genetics* ; PAX6 Transcription Factor/genetics*

Objective:To compare the performances of different time series models in predicting COVID-19 in different countries.Methods:We collected the daily confirmed case numbers of COVID-19 in the USA, India, and Brazil from April 1 to September 30, 2020, and then constructed an autoregressive integrated moving average (ARIMA) model and a recurrent neural network (RNN) model, respectively. We applied the mean absolute percentage error (MAPE) and root mean square error (RMSE) to compare the performances of the two models in predicting the case numbers from September 21 to September 30, 2020.Results:For the ARIMA models applied in the USA, India, and Brazil, the MAPEs were 13.18%, 9.18%, and 17.30%, respectively, and the RMSEs were 6 542.32, 8 069.50, and 3 954.59, respectively. For the RNN models applied in the USA, India, and Brazil, the MAPEs were 15.27%, 7.23% and 26.02%, respectively, and the RMSEs were 6 877.71, 6 457.07, and 5 950.88, respectively.Conclusions:The performance of the prediction models varied with country. The ARIMA model had a better prediction performance for COVID-19 in the USA and Brazil, while the RNN model was more suitable in India.

OBJECTIVE:To provide reference for safe application of antibiotic drugs in single or inter-medical institution ser-vices. METHODS:An antibiotic drug safety evaluation index system was established by reference to literatures. Medical records tracing method was adopted to obtain the medical records of children with respiratory infectious diseases under the medical consor-tium model. The medical records were matched and evaluated by experts to analysis the safety of antibiotic drug use in single medi-cal institution and the connection between two medical institutions with respect to the safety of antibiotic drug use. RESULTS:248 effective medical records had been obtained. Under the medical consortium model,the rate of the combination of antibiotic drugs in large hospitals was 86.29%,higher than the community hospitals of 77.02%(χ2=5.49,P<0.05). The error rate of antibiotic drug use by children in large hospitals was 14.52%,lower than the community hospitals of 25.81%(χ2=9.733,P<0.05). There were many contradictions in antibiotic drug use between the medical institution where children received treatment initially and the medi-cal institution which the children were referred to and hospitalized in. There were totally 128 cases of unsafe antibiotic drug use, with the overall incidence of 51.61%. CONCLUSIONS:Under the medical consortium model,the safety of antibiotic drug use by the hospitalized children in single medical institution is worrying,and the connection between two medical institutions with respect to the safety of antibiotic drug use by children who are referred and hospitalized is less reliable.

Objective To determine whether erythromycin-resistant propionibacteria isolated from patients with acne in Wuhan city harbor 23S rRNA gene mutations as well as the transposon Tn5432 carrying ermX genes.Methods Twenty-nine Propionibacterium strains isolated from outpatients with acne in Wuhan city were included in this study.The E-test method was used to determine the susceptibility of these strains to erythromycin and clindamycin.PCR was performed to amplify the 23S rRNA,ermX,ermX (cj),IS1249a and IS1249b genes from resistant strains followed by DNA sequencing and nucleotide alignment.Results Among the 29 Propionibacterium strains,19 were identified as P.acnes and 10 as P.avidum.All of these Propionibacterium strains were resistant to erythromycin (MIC ＞ 256 μg/ml) and clindamycin (MIC ＞ 256 μg/ml),except for 3 P.acnes strains sensitive to clindamycin.Seven P.acnes strains resistant to both antibiotics exhibited an A→G transition at a position cognate with Escherichia coli 23S rRNA 2058.An A→G transition at a position cognate with E.coli 23S rRNA 2059 was identified in one clindamycin-resitant and three clindamycin-sensitive P.acnes isolates.The ermX gene was found in the remaining 8 P.acnes isolates and 2 P.avidum isolates,with the sequence 100％ identical to the reference sequence of the ermX gene of P.acnes in Genbank.Meanwhile,the ermX (cj) gene was successfully amplified from the other 8 P.avidum isolates,which showed 99％ sequence homology with the ermX (cj) gene of Corynebacterium jeikeium,but 94％ homology with the ermX gene of P.acnes in Genbank.Both IS1249a and IS1249b genes were amplified in the 10 ermX gene-positive Propionibacterium strains,but not in the other ermX gene-negative strains.Conclusions The erythromycin resistance in Propionibacterium isolates from Wuhan city may be associated with the A→G transition at the E.coli equivalent bases 2058 and 2059 of the 23S rRNA gene,as well as the presence of the erm X (transferred through the transposon Tn5432) and ermX (c j) genes.