This paper reported a type 1 diabetes patient who had severe diabetic nephropathy, retinopathy, hypertension, and hypothyroidism before pregnancy. The patient's blood glucose control was poor before pregnancy, and the complications were not properly treated. This was an unintended pregnancy, with a pre-pregnancy glycated hemoglobin A1c of 7.8% and early pregnancy urine protein of 3.81-4.53 g/24 h. Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy, a multidisciplinary consultation at an external hospital recommended termination of the pregnancy. However, the patient was determined to continue the pregnancy and was referred to Peking University First Hospital. Through strict blood glucose control, monitoring and evaluation of complications, and comprehensive management, the patient's blood glucose and blood pressure were well controlled during pregnancy. Regular monitoring of urine protein, renal function, and ocular fundus was conducted. At 31 weeks and 4 days of gestation, the patient's 24-hour urine protein significantly increased. After promoting fetal lung maturity, a cesarean section was performed at 34 weeks and 1 day of gestation, resulting in a successful delivery with good maternal and neonatal outcomes. At the 42-day postpartum follow-up, the patient's blood glucose and blood pressure were stable, urine protein returned to pre-pregnancy levels, and the infant was in good general condition.

OBJECTIVE To explore the changes of serum Toll-like receptor(TLR)2,TLR4 and 25 hydroxyvitamin D[25(OH)D]in the general anesthesia orthopedic surgery patients with postoperative pulmonary infections and analyze the distribution and drug resistance of pathogens.METHODS A total of 59 general anesthesia orthopedic surgery patients with postoperative pulmonary infections who were treated in Tianjin Fifth Central Hospital from Jul.2019 to Jul.2024 were chosen as the infection group,meanwhile,65 patients who underwent the same surger-y but did not have postoperative pulmonary infection or other acute and chronic infections were chosen as the non-infection group.The etiological characteristics of the postoperative pulmonary infections and the drug re-sistance rates were analyzed.The clinical data and the levels of serum TLR2,TLR4 and 25(OH)D were observed and compared between the two groups of patients.The values of the above indicators in diagnosis of the postopera-tive pulmonary infections in the general anesthesia orthopedic surgery were analyzed.RESULTS Totally 63 strains of pathogens were isolated from the 59 general anesthesia orthopedic surgery patients with postoperative pulmona-ry infections,36(57.14％)of which were gram-negative bacteria.3 of 15 Pseudomonas aeruginosa strains were resistant to meropenem;4 of 12 Klebsiella pneumoniae strians were resistant to meropenem;all of the 11 Staph-ylococcus aureus strains were methicilin-resistant S.aureus.The proportions of patients with age,hypoproteine-mia and diabetes mellitus,the serum TLR2 and TLR4 levels were higher in the infection group than in the non-infection group(P＜0.05),while the 25(OH)D level of the infection group was lower than that of the no in-fection group(P＜0.05).The area under the curves(AUCs)of serum TLR2,TLR4,25(OH)D and the joint de-tection of the above indicators were respectively 0.817,0.801,0.787 and 0.917 in diagnosis of postoperative pul-monary infections in the general anesthesia orthopedic surgery patients,and the AUC of the joint detection of the indicators was greater than that of the single detection(P＜0.05).CONCLUSIONS The general anesthesia or-thopedic surgery patients with postoperative pulmonary infections show high expressions of serum TLR2 and TLR4 and the low expression of 25(OH)D.The joint detection of the above indexes has higher diagnostic value.The gram-negative bacteria are dominant among the pathogens causing the infections.The pathogens vary in the drug resistance.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

We retrospectively analyzed 8 patients who had been on hemodialysis for over 30 years from two dialysis centers in Dalian, China. A literature review was conducted by searching PubMed, CNKI, Wanfang databases,and Chinese Medical Journal Network for cases of patients on hemodialysis for over 30 years. The 8 patients had good baseline health, with chronic glomerulonephritis as the primary renal disease and no comorbidities before initiating dialysis. They started hemodialysis between 21 and 38 years of age, predominantly using arteriovenous fistulas for vascular access. Dialysis was regular and adequate (KT/V 1.23-1.88). Key laboratory parameters, including hemoglobin (88-118 g/L), albumin (27.7-39.7 g/L), calcium (1.88-2.55 mmol/L), and phosphate (0.76-1.99 mmol/L), were generally within target ranges. Body mass index ranged from 15.20 to 22.96 kg/m2. This literature review of the study included 12 case reports and 4 orginal articles. Factors influencing long-term survival included baseline health status, primary renal disease, absence of comorbidities before dialysis initiation, age at dialysis initiation, type of vascular access, dialysis adequacy, complication management, and medical support. Standardized management and timely correction of complications can significantly improve prognosis and enhance long-term survival in hemodialysis patients.

Objective:To construct a health education checklist for safety management of oral antitumor drugs in tumor patients, so as to provide a guidance for clinical nurses in practice, thereby improving the drug safety of patients taking oral antitumor drugs.Methods:Based on the cognition-behavior theoretical framework, a preliminary draft of a health education checklist for safety management of oral antitumor drugs in tumor patients was developed through literature review. The Delphi method was used to conduct consultations with 17 experts from July to September 2024 to revise and add or delete the contents of the checklist based on the experts' assignments of importance to the indicators at each level and the textual comments made.Results:A total of two rounds of expert consultation were conducted. The final established health education checklist for safety management of oral antitumor drugs in tumor patients included 4 primary and 28 secondary indicators. In the two rounds of consultation, the positive coefficient of experts was 100.0%, the coefficient of expert authority was 0.93, the coefficients of variation for the two rounds of expert ratings were 0 to 0.173 and 0 to 0.151, and the coefficients of Kendall's concordance were 0.141 (χ 2=74.461, P<0.001) and 0.113 (χ 2=59.549, P=0.002) , respectively. Conclusions:The health education checklist for safety management of oral antitumor drugs in tumor patients has good scientific, reliable and clinical practical value, which can provide scientific, standardized and convenient practical guidance for clinical nurses to implement health education on drug safety management for patients taking oral antitumor drugs.

OBJECTIVE To explore the changes of serum Toll-like receptor(TLR)2,TLR4 and 25 hydroxyvitamin D[25(OH)D]in the general anesthesia orthopedic surgery patients with postoperative pulmonary infections and analyze the distribution and drug resistance of pathogens.METHODS A total of 59 general anesthesia orthopedic surgery patients with postoperative pulmonary infections who were treated in Tianjin Fifth Central Hospital from Jul.2019 to Jul.2024 were chosen as the infection group,meanwhile,65 patients who underwent the same surger-y but did not have postoperative pulmonary infection or other acute and chronic infections were chosen as the non-infection group.The etiological characteristics of the postoperative pulmonary infections and the drug re-sistance rates were analyzed.The clinical data and the levels of serum TLR2,TLR4 and 25(OH)D were observed and compared between the two groups of patients.The values of the above indicators in diagnosis of the postopera-tive pulmonary infections in the general anesthesia orthopedic surgery were analyzed.RESULTS Totally 63 strains of pathogens were isolated from the 59 general anesthesia orthopedic surgery patients with postoperative pulmona-ry infections,36(57.14％)of which were gram-negative bacteria.3 of 15 Pseudomonas aeruginosa strains were resistant to meropenem;4 of 12 Klebsiella pneumoniae strians were resistant to meropenem;all of the 11 Staph-ylococcus aureus strains were methicilin-resistant S.aureus.The proportions of patients with age,hypoproteine-mia and diabetes mellitus,the serum TLR2 and TLR4 levels were higher in the infection group than in the non-infection group(P＜0.05),while the 25(OH)D level of the infection group was lower than that of the no in-fection group(P＜0.05).The area under the curves(AUCs)of serum TLR2,TLR4,25(OH)D and the joint de-tection of the above indicators were respectively 0.817,0.801,0.787 and 0.917 in diagnosis of postoperative pul-monary infections in the general anesthesia orthopedic surgery patients,and the AUC of the joint detection of the indicators was greater than that of the single detection(P＜0.05).CONCLUSIONS The general anesthesia or-thopedic surgery patients with postoperative pulmonary infections show high expressions of serum TLR2 and TLR4 and the low expression of 25(OH)D.The joint detection of the above indexes has higher diagnostic value.The gram-negative bacteria are dominant among the pathogens causing the infections.The pathogens vary in the drug resistance.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

We retrospectively analyzed 8 patients who had been on hemodialysis for over 30 years from two dialysis centers in Dalian, China. A literature review was conducted by searching PubMed, CNKI, Wanfang databases,and Chinese Medical Journal Network for cases of patients on hemodialysis for over 30 years. The 8 patients had good baseline health, with chronic glomerulonephritis as the primary renal disease and no comorbidities before initiating dialysis. They started hemodialysis between 21 and 38 years of age, predominantly using arteriovenous fistulas for vascular access. Dialysis was regular and adequate (KT/V 1.23-1.88). Key laboratory parameters, including hemoglobin (88-118 g/L), albumin (27.7-39.7 g/L), calcium (1.88-2.55 mmol/L), and phosphate (0.76-1.99 mmol/L), were generally within target ranges. Body mass index ranged from 15.20 to 22.96 kg/m2. This literature review of the study included 12 case reports and 4 orginal articles. Factors influencing long-term survival included baseline health status, primary renal disease, absence of comorbidities before dialysis initiation, age at dialysis initiation, type of vascular access, dialysis adequacy, complication management, and medical support. Standardized management and timely correction of complications can significantly improve prognosis and enhance long-term survival in hemodialysis patients.

Objective To investigate the clinical value of serum leucine-rich α-2-glycoprotein 1(LRG1),uncoupling protein 2(UCP2)and sestrin2 in evaluating the cognitive status and prognosis of patients with acute ischemic stroke(AIS).Methods A total of 164 AIS patients who were treated and hospitalized in the Department of Neurology of our hospital from April 2020 to May 2023 were selected as the study subjects.According to the Chinese version of the Montreal cognitive assessment scale(MoCA),the patients were divided into cognitive impairment group and non-cognitive impairment group.The levels of serum LRG1,UCP2 and Sestrin2 were compared between the two groups.Pearson correlation analysis was used to test the correlation between serum LRG1,UCP2 and Sestrin2 and MoCA score.After discharge,the patients were followed up for 3 months.The mRS was used to divide the patients into poor prognosis group and good prognosis group.The data and serum levels of LRG1,UCP2 and Sestrin2 were compared between the two groups.Multivariate Logistic regression analysis was used to explore the prognostic factors of AIS patients.ROC curve was constructed to evaluate the predictive efficacy of serum LRG1,UCP2 and Sestrin2 alone and in combination on cognitive status and prognosis of AIS patients.Results There were 115 cases in the non-cognitive impairment group and 49 cases in the cognitive impairment group.The serum levels of LRG1 and UCP2 in the non-cognitive impairment group were significantly higher than those in the cognitive impairment group,while the Sestrin2 level was significantly lower than that in the cognitive impairment group(all P＜0.05).Serum LRG1 and UCP2 levels were positively correlated with MoCA score,while Sestrin2 level was negatively correlated with MoCA score(all P＜0.05).The area under the curve(AUC)of serum LRG1,UCP2 and Sestrin2 in cognitive status of AIS patients was 0.723,0.689 and 0.789,respectively,while the AUC of the combined detection of the three reached 0.892,and the 95％CI of the AUC of all indicators did not contain 0.5(all P＜0.05).There were 134 cases in the good prognosis group and 30 cases in the poor prognosis group.The NIHSS score,mRS score and Sestrin2 level in the good prognosis group were significantly lower than those in the poor prognosis group,while the MoCA score,LRG1 and UCP2 levels were significantly higher than those in the poor prognosis group(all P＜0.05).The increase of NIHSS score(OR=1.419),mRS score(OR=1.153)and serum Sestrin2 level(OR=1.462)were risk factors affecting the prognosis of AIS patients,while the increase of MoCA score(OR=0.657),serum LRG1 level(OR=0.756)and UCP2 level(OR=0.733)were protective factors affecting the prognosis of AIS patients(all P＜0.05).From the AUC value,the combination of the three(0.899)was significantly higher than Sestrin2(0.755),LRG1(0.730)and UCP2(0.712).The combination of sensitivity,specificity and Youden index was also significantly higher than other single indicators(all P＜0.05).Conclusion The combined detection of serum LRG1,UCP2 and Sestrin2 shows higher efficiency than single detection in the evaluation of cognitive status and prognosis of AIS patients,and its AUC,sensitivity,specificity and other indicators are better,providing more accurate and reliable evaluation basis for clinical practice.

Objective To investigate the clinical value of serum leucine-rich α-2-glycoprotein 1(LRG1),uncoupling protein 2(UCP2)and sestrin2 in evaluating the cognitive status and prognosis of patients with acute ischemic stroke(AIS).Methods A total of 164 AIS patients who were treated and hospitalized in the Department of Neurology of our hospital from April 2020 to May 2023 were selected as the study subjects.According to the Chinese version of the Montreal cognitive assessment scale(MoCA),the patients were divided into cognitive impairment group and non-cognitive impairment group.The levels of serum LRG1,UCP2 and Sestrin2 were compared between the two groups.Pearson correlation analysis was used to test the correlation between serum LRG1,UCP2 and Sestrin2 and MoCA score.After discharge,the patients were followed up for 3 months.The mRS was used to divide the patients into poor prognosis group and good prognosis group.The data and serum levels of LRG1,UCP2 and Sestrin2 were compared between the two groups.Multivariate Logistic regression analysis was used to explore the prognostic factors of AIS patients.ROC curve was constructed to evaluate the predictive efficacy of serum LRG1,UCP2 and Sestrin2 alone and in combination on cognitive status and prognosis of AIS patients.Results There were 115 cases in the non-cognitive impairment group and 49 cases in the cognitive impairment group.The serum levels of LRG1 and UCP2 in the non-cognitive impairment group were significantly higher than those in the cognitive impairment group,while the Sestrin2 level was significantly lower than that in the cognitive impairment group(all P＜0.05).Serum LRG1 and UCP2 levels were positively correlated with MoCA score,while Sestrin2 level was negatively correlated with MoCA score(all P＜0.05).The area under the curve(AUC)of serum LRG1,UCP2 and Sestrin2 in cognitive status of AIS patients was 0.723,0.689 and 0.789,respectively,while the AUC of the combined detection of the three reached 0.892,and the 95％CI of the AUC of all indicators did not contain 0.5(all P＜0.05).There were 134 cases in the good prognosis group and 30 cases in the poor prognosis group.The NIHSS score,mRS score and Sestrin2 level in the good prognosis group were significantly lower than those in the poor prognosis group,while the MoCA score,LRG1 and UCP2 levels were significantly higher than those in the poor prognosis group(all P＜0.05).The increase of NIHSS score(OR=1.419),mRS score(OR=1.153)and serum Sestrin2 level(OR=1.462)were risk factors affecting the prognosis of AIS patients,while the increase of MoCA score(OR=0.657),serum LRG1 level(OR=0.756)and UCP2 level(OR=0.733)were protective factors affecting the prognosis of AIS patients(all P＜0.05).From the AUC value,the combination of the three(0.899)was significantly higher than Sestrin2(0.755),LRG1(0.730)and UCP2(0.712).The combination of sensitivity,specificity and Youden index was also significantly higher than other single indicators(all P＜0.05).Conclusion The combined detection of serum LRG1,UCP2 and Sestrin2 shows higher efficiency than single detection in the evaluation of cognitive status and prognosis of AIS patients,and its AUC,sensitivity,specificity and other indicators are better,providing more accurate and reliable evaluation basis for clinical practice.