To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

With the continuous development of imaging techniques such as magnetic resonance imaging,the detection rate of brain metastases is increasing.Although the incidence rate of cystic brain metastasis is far lower than that of solid brain metastasis,patients with cystic brain metastasis are in urgent condition and have obvious space occupying effect,which is an urgent clinical problem.Previous literature has reported that cystic brain metastasis is more common in breast cancer and lung adenocarcinoma,especially in lung cancer patients with positive driver gene.This article reports a case of small cell lung cancer with cystic brain metastasis,which started with neurological symptoms,and was clinically cured under a multidisciplinary diagnosis and treatment model.Through dynamic imaging evaluation and molecular residual lesion detection,the patient can avoid overtreatment and achieved a relatively higher quality of life on the basis of prolonging survival.

Objective The clinical characteristics of 21 cases of nocardiosis were reviewed and antimicrobial resistance of Nocardia strains was analyzed in order to improve the accuracy of clinical diagnosis and treatment of nocardiosis.Methods Clinical data of patients diagnosed with nocardiosis in Zhoukou Central Hospital from 2019-2023 and the corresponding results of antimicrobial susceptibility testing were retrospectively analyzed to summarize the clinical characteristics and outcomes of patients.Results Overall,the 21 cases of nocardiosis included 9 males and 12 females,aged 2-91 years.Underlying disease was reported in 15 patients.Most common type of nocardiosis was pulmonary nocardiosis in 15 cases,followed by skin and soft tissue infection,pleurisy,lymphadenitis,and disseminated nocardiosis.Laboratory tests showed increased levels of WBC,neutrophils percentage,erythrocyte sedimentation rate,C-reactive protein,and procalcitonin.The 21 strains of Nocardia included 4 strains of Nocardia cyriacigeorgica,2 strains each of Nocardia brasiliensis,Nocardia abscessus,Nocardia asiatica,Nocardia otitidiscaviarum and Nocardia beijingensis,and 1 strain each of Nocardia puris,Nocardia asteroides,Nocardia farcinica,Nocardia pneumoniae,Nocardia amamiensis,and 2 strains of unclassified Nocardia.All of the Nocardia strains(100％)were susceptible to linezolid,amikacin,and trimethoprim-sulfamethoxazole,followed by various levels of susceptibility to cefotaxime,moxifloxacin,imipenem and ceftriaxone,and lower susceptibility rate to cefepime,minocycline,ciprofloxacin and clarithromycin.Antimicrobial susceptibility of Nocardia strains varied with different Nocardia species.Of the 21 patients,two were referred to other hospitals,another two died,two patients received unknown treatment,and the remaining 15 patients were improved after antibiotic treatment,including sulfonamides combined with other antibiotics in 11 cases,other antibiotics in 4 cases.Conclusions Immunocompromised patients or those with underlying diseases are more susceptible to nocardiosis.The clinical features are complex and diverse.Antimicrobial susceptibility of Nocardia strains varied with different Nocardia species.Accurate identification and antimicrobial susceptibility test are essential for prescribing effective antibiotic treatment.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective To explore the effect of rituximab on cellular immunity and cytokines in children with new-onset steroid-sensitive nephrotic syndrome(SSNS).Methods Clinical data of 60 children with new-onset SSNS treated at Xuzhou Children's Hospital from December 2021 to March 2023 were retrospectively analyzed.Children were allocated according to rituximab use into a control group(no rituximab)and an observation group(rituximab).The relapse rate,T-lymphocyte subsets and cytokines before and after treatment,and the incidence of adverse reactions were compared between groups.Results The relapse rate was lower in the observation group than in the control group(27%vs 73%,P<0.05).After treatment,CD3+and CD4+T-lymphocyte counts,the CD4+/CD8+ratio,and serum interleukin-2 increased in the observation group and were higher than in the control group(P<0.05).Interleukin-6 and tumor necrosis factor-α levels decreased after treatment in the observation group and were lower than in the control group(P<0.05).After treatment,CD8+T-lymphocyte counts decreased,interferon-γ increased,and interleukin-10 decreased in both groups,with no significant differences between the two groups(P>0.05).The incidence of adverse reactions did not differ significantly between the two groups(P>0.05).Conclusions Rituximab can reduce the relapse rate in children with new-onset nephrotic syndrome and shows good safety.Its therapeutic effect is achieved by regulating the number and function of T cells and by modulating the anti-inflammatory effects of cytokines.

Objective To explore the effect of rituximab on cellular immunity and cytokines in children with new-onset steroid-sensitive nephrotic syndrome(SSNS).Methods Clinical data of 60 children with new-onset SSNS treated at Xuzhou Children's Hospital from December 2021 to March 2023 were retrospectively analyzed.Children were allocated according to rituximab use into a control group(no rituximab)and an observation group(rituximab).The relapse rate,T-lymphocyte subsets and cytokines before and after treatment,and the incidence of adverse reactions were compared between groups.Results The relapse rate was lower in the observation group than in the control group(27%vs 73%,P<0.05).After treatment,CD3+and CD4+T-lymphocyte counts,the CD4+/CD8+ratio,and serum interleukin-2 increased in the observation group and were higher than in the control group(P<0.05).Interleukin-6 and tumor necrosis factor-α levels decreased after treatment in the observation group and were lower than in the control group(P<0.05).After treatment,CD8+T-lymphocyte counts decreased,interferon-γ increased,and interleukin-10 decreased in both groups,with no significant differences between the two groups(P>0.05).The incidence of adverse reactions did not differ significantly between the two groups(P>0.05).Conclusions Rituximab can reduce the relapse rate in children with new-onset nephrotic syndrome and shows good safety.Its therapeutic effect is achieved by regulating the number and function of T cells and by modulating the anti-inflammatory effects of cytokines.

Objective:To compare the medical costs of using standard fortified donor human milk (DHM) or preterm formula (PF) to supply very low birth weight [VLBW, defined as birth weight (BW) ≥1 000 g but <1 500 g] and extremely low birth weight (ELBW, defined as BW <1 000 g) premature infants with insufficient maternal breast milk.Methods:VLBW and ELBW preterm infants hospitalized in Peking Union Medical College Hospital from September 2017 to October 2020 were retrospectively enrolled and assigned into DHM group and PF group based on complementary feeding methods. The cost of parenteral nutrition (PN), cost of antibiotics, and total medical expenses during hospitalization were compared between the two groups.Results:A total of 89 infants were enrolled in this study, out of whom 50 was in the DHM group and 39 the PF group. The gestational age in DHM group and PF group were both (29±2) weeks. The BW of DHM group was 1 170 (919, 1 380)?g and that of PF group was 1 170 (1 010, 1 360) g. There were no significant differences in gestational age, BW, maternal age at delivery, delivery mode, gender ratio, proportion of small-for-gestational-age infants and length of hospital stay between the two groups (all P>0.05). The cost of parenteral nutrition in DHM group was significantly lower than that in PF group [3 500 (1 922, 5 704) Chinese yuan vs 7 995 (5 579, 10 788) Chinese Yuan, P<0.01]. The cost of antibiotics in DHM group was significantly lower than that in PF group [6 529 (2 265, 10 860) Chinese Yuan vs 13 676 (10 480, 18 506) Chinese Yuan, P<0.01]. The difference in total medical expense during hospitalization showed no statistical significance between two groups ( P>0.05). Amorg VLBW preterm infants, the cost of PN, cost of antibiotics, total cost of hospitalization, and daily cost of hospitalization in HDM group was significantly lower than that in PF group (all P<0.05). In ELBW preterm infants, the cost of PN and the cost of antibiotics in HDM group were significantly lower than that in PF group (both P<0.05), but the total cost of hospitalization and the daily cost of hospitalization between two groups showed no significant difference (all P>0.05). Conclusions:When mother's own milk is insufficient, using donor human milk reduces the costs of PN and antibiotics in VLBW and ELBW preterm infants compared with using PF. In VLBW preterm infants, using DHM can also reduce the total and daily cost of hospitalization.

With the continuous development of imaging techniques such as magnetic resonance imaging,the detection rate of brain metastases is increasing.Although the incidence rate of cystic brain metastasis is far lower than that of solid brain metastasis,patients with cystic brain metastasis are in urgent condition and have obvious space occupying effect,which is an urgent clinical problem.Previous literature has reported that cystic brain metastasis is more common in breast cancer and lung adenocarcinoma,especially in lung cancer patients with positive driver gene.This article reports a case of small cell lung cancer with cystic brain metastasis,which started with neurological symptoms,and was clinically cured under a multidisciplinary diagnosis and treatment model.Through dynamic imaging evaluation and molecular residual lesion detection,the patient can avoid overtreatment and achieved a relatively higher quality of life on the basis of prolonging survival.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective:To compare the medical costs of using standard fortified donor human milk (DHM) or preterm formula (PF) to supply very low birth weight [VLBW, defined as birth weight (BW) ≥1 000 g but <1 500 g] and extremely low birth weight (ELBW, defined as BW <1 000 g) premature infants with insufficient maternal breast milk.Methods:VLBW and ELBW preterm infants hospitalized in Peking Union Medical College Hospital from September 2017 to October 2020 were retrospectively enrolled and assigned into DHM group and PF group based on complementary feeding methods. The cost of parenteral nutrition (PN), cost of antibiotics, and total medical expenses during hospitalization were compared between the two groups.Results:A total of 89 infants were enrolled in this study, out of whom 50 was in the DHM group and 39 the PF group. The gestational age in DHM group and PF group were both (29±2) weeks. The BW of DHM group was 1 170 (919, 1 380)?g and that of PF group was 1 170 (1 010, 1 360) g. There were no significant differences in gestational age, BW, maternal age at delivery, delivery mode, gender ratio, proportion of small-for-gestational-age infants and length of hospital stay between the two groups (all P>0.05). The cost of parenteral nutrition in DHM group was significantly lower than that in PF group [3 500 (1 922, 5 704) Chinese yuan vs 7 995 (5 579, 10 788) Chinese Yuan, P<0.01]. The cost of antibiotics in DHM group was significantly lower than that in PF group [6 529 (2 265, 10 860) Chinese Yuan vs 13 676 (10 480, 18 506) Chinese Yuan, P<0.01]. The difference in total medical expense during hospitalization showed no statistical significance between two groups ( P>0.05). Amorg VLBW preterm infants, the cost of PN, cost of antibiotics, total cost of hospitalization, and daily cost of hospitalization in HDM group was significantly lower than that in PF group (all P<0.05). In ELBW preterm infants, the cost of PN and the cost of antibiotics in HDM group were significantly lower than that in PF group (both P<0.05), but the total cost of hospitalization and the daily cost of hospitalization between two groups showed no significant difference (all P>0.05). Conclusions:When mother's own milk is insufficient, using donor human milk reduces the costs of PN and antibiotics in VLBW and ELBW preterm infants compared with using PF. In VLBW preterm infants, using DHM can also reduce the total and daily cost of hospitalization.