Objective To examine the diagnosis and treatment of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia and improve the awareness of the pathogen in clinical and laboratory practice.Methods A case of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia in Shanghai Children's Hospital was retrospectively analyzed,including diagnosis and treatment details.Similar cases were identified from PubMed,Wanfang Data,VIP,and CNKI databases since database establishment until June 30,2024,using search terms"Enterocytozoon bieneusi".The relevant literature was reviewed.Results This child had acute lymphoblastic leukemia as the underlying disease and was admitted to hospital for antimicrobial treatment due to fever and abdominal discomfort.The case was considered bacterial infection complicated with Enterocytozoon bieneusi infection,confirmed by detection of Klebsiella pneumoniae in blood and detection of Enterocytozoon bieneusi in blood and ascites by metagenomic next-generation sequencing(mNGS).The treatment was switched to tigecycline plus trimethoprim-sulfamethoxazole at a sufficient dose,which resulted in resolution of symptoms.Six months later,the patient suffered from acute lymphoblastic leukemia and bone marrow depression,Enterocytozoon bieneusi disseminated infection,septic shock.Her family gave up treatment and the child died.Literature review indicated that most patients infected with Enterocytozoon bieneusi had underlying conditions such as organ transplantation,AIDS,and leukemia associated with poor immunity.The onset symptoms are diarrhea,abdominal discomfort,and fever.Enterocytozoon bieneusi was detected by using methods such as modified Masson's trichrome stain,fluorescent calcofluor white staining,molecular detection techniques,and immunofluorescence.The patients were treated with drugs such as albendazole,nitazoxanide,fumagillin,and trimethoprim-sulfamethoxazole.Conclusions Enterocytozoon bieneusi is an opportunistic pathogenic fungus that infects immunocompromised patients and can cause abdominal discomfort,diarrhea,fever,and even disseminated infection and death.Conventional laboratory methods cannot culture Enterocytozoon bieneusi.Molecular detection techniques can be used to identify the pathogen early.

Objective:To investigate the impact of different ventilation modalities during initial resuscitation on short-term outcomes in adult patients with in-hospital cardiac arrest (IHCA).Methods:This retrospective study included adult patients (age ≥18 years) admitted to the emergency resuscitation or observation units of our hospital from September 2019 to December 2021. Demographic data, comorbidities, and short-term outcomes of IHCA patients who underwent airway management during resuscitation were recorded. Participants were stratified into non-advanced airway and advanced airway groups based on ventilation modality. The primary outcome was defined as sustained return of spontaneous circulation (ROSC) ≥20 min, and secondary outcomes included survival to discharge and favorable neurological status at discharge. Logistic regression analyses were performed to assess the impact of different ventilation modalities on short-term outcomes among adult IHCA patients. and developed a prediction model of ROSC for adult IHCA patients, and its predictive performance was evaluated by the area under the curve (AUC) of the receiver operating characteristic.Results:Among 285 IHCA patients (non-advanced airway: n=75; advanced airway: n=210), 127 achieved ROSC ≥20 min, 51 survived to discharge, and 35 had favorable neurological outcomes. Logistic regression identified ventilation modality, epinephrine dose, and arrest location as independent predictors of ROSC in adult IHCA patients. Advanced airway management demonstrated significantly higher ROSC rates compared to non-advanced interventions ( OR=3.698, 95% CI:1.844-7.419, P<0.001). However, no significant associations were observed between ventilation modalities and survival to discharge ( OR=1.097, 95% CI:0.506-2.376, P=0.815) or favorable neurological outcomes at discharge ( OR=0.548, 95% CI:0.224-1.339, P=0.187). Ventilation modality, epinephrine dose, and arrest location were incorporated as predictors in a multivariable logistic regression model to develop a ROSC prediction model for adult IHCA patients. The discriminative ability of model was evaluated through receiver operating characteristic (ROC) curve analysis, yielding an AUC of 0.735 (95% CI:0.678-0.793). Subgroup analyses demonstrated that early advanced airway management significantly enhanced ROSC rates in noncardiac etiology cases, whereas no such benefit was observed in cardiac etiology cases, while this intervention correlated with decreased survival to discharge rates and deteriorated neurological outcomes among survivors. Conclusions:Advanced airway management demonstrated improved ROSC rates in adult IHCA cases, while showing no significant improvement in survival rates or favorable neurological outcomes at discharge. Ventilation modality, epinephrine dose, and arrest location are independent predictors of ROSC. A model integrating these factors exhibits moderate predictive utility for IHCA outcomes.

Objective:To explore the application effect of multidisciplinary graded nutritional intervention in patients with cervical cancer undergoing radiochemotherapy.Methods:A convenience sampling method was used to select 160 patients with cervical cancer who received radiochemotherapy in the First Affiliated Hospital of Wenzhou Medical University from June 2022 to June 2024. According to the order of admission, 80 patients admitted between June 2022 and June 2023 were assigned to the control group, and 80 patients admitted between July 2023 and June 2024 were assigned to the observation group. The control group received routine nutritional intervention, while the observation group received multidisciplinary graded nutritional intervention. Serum albumin, prealbumin, hemoglobin, body mass index (BMI), and Functional Assessment of Cancer Therapy-General (FACT-G) scores were compared between the two groups before and after intervention.Results:Before the intervention, there were no statistically significant differences between the two groups in serum albumin, prealbumin, hemoglobin, BMI, and FACT-G dimension scores ( P>0.05). After the intervention, serum albumin, prealbumin, hemoglobin, BMI, and FACT-G dimension scores were all higher in the observation group than in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Multidisciplinary graded nutritional intervention can improve the nutritional status and quality of life of patients with cervical cancer undergoing radiochemotherapy, and is worthy of wider application.

Objective:To explore the application effect of multidisciplinary graded nutritional intervention in patients with cervical cancer undergoing radiochemotherapy.Methods:A convenience sampling method was used to select 160 patients with cervical cancer who received radiochemotherapy in the First Affiliated Hospital of Wenzhou Medical University from June 2022 to June 2024. According to the order of admission, 80 patients admitted between June 2022 and June 2023 were assigned to the control group, and 80 patients admitted between July 2023 and June 2024 were assigned to the observation group. The control group received routine nutritional intervention, while the observation group received multidisciplinary graded nutritional intervention. Serum albumin, prealbumin, hemoglobin, body mass index (BMI), and Functional Assessment of Cancer Therapy-General (FACT-G) scores were compared between the two groups before and after intervention.Results:Before the intervention, there were no statistically significant differences between the two groups in serum albumin, prealbumin, hemoglobin, BMI, and FACT-G dimension scores ( P>0.05). After the intervention, serum albumin, prealbumin, hemoglobin, BMI, and FACT-G dimension scores were all higher in the observation group than in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Multidisciplinary graded nutritional intervention can improve the nutritional status and quality of life of patients with cervical cancer undergoing radiochemotherapy, and is worthy of wider application.

Objective To examine the diagnosis and treatment of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia and improve the awareness of the pathogen in clinical and laboratory practice.Methods A case of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia in Shanghai Children's Hospital was retrospectively analyzed,including diagnosis and treatment details.Similar cases were identified from PubMed,Wanfang Data,VIP,and CNKI databases since database establishment until June 30,2024,using search terms"Enterocytozoon bieneusi".The relevant literature was reviewed.Results This child had acute lymphoblastic leukemia as the underlying disease and was admitted to hospital for antimicrobial treatment due to fever and abdominal discomfort.The case was considered bacterial infection complicated with Enterocytozoon bieneusi infection,confirmed by detection of Klebsiella pneumoniae in blood and detection of Enterocytozoon bieneusi in blood and ascites by metagenomic next-generation sequencing(mNGS).The treatment was switched to tigecycline plus trimethoprim-sulfamethoxazole at a sufficient dose,which resulted in resolution of symptoms.Six months later,the patient suffered from acute lymphoblastic leukemia and bone marrow depression,Enterocytozoon bieneusi disseminated infection,septic shock.Her family gave up treatment and the child died.Literature review indicated that most patients infected with Enterocytozoon bieneusi had underlying conditions such as organ transplantation,AIDS,and leukemia associated with poor immunity.The onset symptoms are diarrhea,abdominal discomfort,and fever.Enterocytozoon bieneusi was detected by using methods such as modified Masson's trichrome stain,fluorescent calcofluor white staining,molecular detection techniques,and immunofluorescence.The patients were treated with drugs such as albendazole,nitazoxanide,fumagillin,and trimethoprim-sulfamethoxazole.Conclusions Enterocytozoon bieneusi is an opportunistic pathogenic fungus that infects immunocompromised patients and can cause abdominal discomfort,diarrhea,fever,and even disseminated infection and death.Conventional laboratory methods cannot culture Enterocytozoon bieneusi.Molecular detection techniques can be used to identify the pathogen early.

Objective:To investigate the effects of low-dose ropivacaine combined with sufentanil on the onset time of anesthesia and postoperative rectal traction reflectance in patients undergoing mixed hemorrhoid surgery.Methods:A total of 96 patients who underwent mixed hemorrhoid surgery at the General Hospital of the Southern Theater Command of the Chinese People′s Liberation Army from January 2020 to June 2021 were selected. They were randomly divided into a control group and an observation group using a random number table method, with 48 cases in each group. The control group was anesthetized with low-dose ropivacaine; The observation group was anesthetized with low-dose ropivacaine combined with sufentanil. The anesthesia effect, hemodynamic changes, pain score, bleeding score, postoperative rectal traction reflectance, and incidence of adverse reactions were compared between two groups of patients.Results:Compared with the control group, the observation group had a shorter onset time of anesthesia ( P<0.05) and a longer duration of anesthesia maintenance ( P<0.05). Before surgery, there was no statistically significant difference in heart rate and mean arterial pressure between the two groups of mixed hemorrhoid patients (all P>0.05); After surgery, both groups of patients had an increase in heart rate, a decrease in mean arterial pressure, and a more significant change in the control group (all P<0.05). Before surgery, there was no statistically significant difference in Visual Analogue Scale (VAS) scores and bleeding scores between the two groups of mixed hemorrhoid surgery patients (all P>0.05); After 1 day of surgery, the VAS score and bleeding score of both groups of patients were significantly reduced (all P<0.05), and the observation group showed a more significant decrease (all P<0.05). The postoperative recovery rate of anal contraction in the observation group was higher than that in the control group ( P<0.05), and the rectal traction reflectance was lower than that in the control group ( P<0.05). The total incidence of adverse reactions in the observation group was significantly lower than that in the control group (χ 2=4.667, P<0.05). Conclusions:The combination of low-dose ropivacaine and sufentanil has a definite anesthetic effect on patients undergoing mixed hemorrhoid surgery. It can improve the onset time of anesthesia and postoperative rectal traction reflectivity, alleviate patient pain, and has high safety.

The role and function of nurses in the application of assisted reproductive technology were sorted out.Addressing potential ethical dilemmas,this paper analyzed the restrictive factors in dealing with difficulties in nursing practice and proposed the construction of a nursing ethics literacy system.It is suggested to improve ethical rules and education systems,strengthen case education,enhance risk prevention capabilities,and cultivate a healthy ethical culture,so as to effectively enhance nurses'ethical literacy.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objectives: . Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system. Methods: . We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables. Results: . The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16–2.57); were older (MD, 5.47 years, 95% CI, 2.44–8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33–2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56–3.44 cm); exhibited limited mouth opening (MD, −0.52 cm; 95% CI, −0.88 to −0.15 cm); had limited neck flexibility (MD, −10.05 cm; 95% CI, −14.10 to −6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07–5.48). Conclusion . We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.

OBJECTIVE To explore the independent risk factors of voriconazole(VCZ)-related liver injury in elderly patients with hypoproteinemia.METHODS Elderly patients with invasive fungal infection and hypoproteinemia who were hospitalized in the respiratory intensive care unit of our hospital and treated with VCZ from August 2020 to July 2023 were selected.They were divided into group A(liver injury group)and group B(non-liver injury group)based on whether the liver injury occurred after using VCZ.Pearson correlation analysis was used to analyze the correlation between minimum concentration(cmm)of VCZ and inflammatory factor[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)],as well as liver function[alanine transaminase(ALT),aspartate transaminase(AST),alkaline phosphatase(ALP),gamma-glutamyl transpeptidase(GGT),total bilirubin(TBIL)];univariate analysis was performed by using x2 test;Logistic regression analysis was used to analyze the independent risk factors affecting the occurrence of liver injury.RESULTS A total of 320 patients were included in the study,of whom 56 developed liver injury,with an incidence of 17.50％.The VCZ cmin in group A was significantly higher than group B(P=0.021).CRP,PCT,IL-6,and TBIL were correlated with VCZ cmin(P＜0.05).CRP,PCT,IL-6,and TBIL had a significant impact on VCZ cmin(P＜0.05).VCZ cmin,PCT,and TBIL were independent risk factors for liver injury(P＜0.05).The patients with VCZ cmin≥3.76 mg/L had a significantly increased risk of liver injury.CONCLUSIONS VCZ cmin,PCT,and TBIL are independent risk factors for the occurrence of liver injury in elderly patients with hypoproteinemia.For patients with high PCT and TBIL,VCZ cmin and liver function should be closely monitored during VCZ treatment to reduce the risk of liver injury.