To summarize the nursing care of a patient with spinal shock following combined mechanical circulatory support after heart valve surgery.The mainly nursing points are as follows.In the acute stage,hemodynamic and internal environment stability were maintained,and extracorporeal cardiopulmonary resuscitation was implemented by a multidisciplinary rapid response team.In the period of mechanical circulatory support,related complications were closely monitored,and a protocolized weaning strategy was implemented.During the spinal shock period,the focus was on maintaining spinal cord,lung and bowel function.During the recovery period,phased enhancement of early rehabilitation and intervention in negative psychological emotions were conducted.The patient successfully removed the mechanical circulatory device on the 9th day postoperatively,achieved grade 4 muscle strength in the left upper and grade 3 in other limbs after 32 days of hospitalization,ultimately discharged successfully from the hospital.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

To summarize the nursing care of a patient with spinal shock following combined mechanical circulatory support after heart valve surgery.The mainly nursing points are as follows.In the acute stage,hemodynamic and internal environment stability were maintained,and extracorporeal cardiopulmonary resuscitation was implemented by a multidisciplinary rapid response team.In the period of mechanical circulatory support,related complications were closely monitored,and a protocolized weaning strategy was implemented.During the spinal shock period,the focus was on maintaining spinal cord,lung and bowel function.During the recovery period,phased enhancement of early rehabilitation and intervention in negative psychological emotions were conducted.The patient successfully removed the mechanical circulatory device on the 9th day postoperatively,achieved grade 4 muscle strength in the left upper and grade 3 in other limbs after 32 days of hospitalization,ultimately discharged successfully from the hospital.

Objective:To investigate the clinical and genetic characteristics of KDM6B gene variation associated neurological developmental disorder in a child. Methods:Clinical data were collected from a child of KDM6B gene variation associated neurological developmental disorder admitted to Children′s Hospital Affiliated to Zhengzhou University in July 2021. His clinical manifestations and genetic variation profiles were retrospectively analyzed and literature review was conducted. Results:The patient was a one-year-six-month old male, with protruding forehead, joint laxity, distal skeletal abnormalities, and behavioral, cognitive, language, intellectual, and psychomotor development disorder. The whole-exome sequencing and Sanger sequencing confirmed that there was a de novo heterozygous frameshift variation c.1718delC(p.Pro573Hisfs *9) in exon 11 of the KDM6B gene. This variation was classified as pathogenic (PVS1+PS2+PM2_supporting) according to the American College of Medical Genetics and Genomics and the Association for Molecular Pathology guidelines, with no prior reports. By literature review, no relevant Chinese literature was retrieved, whereas 4 English literatures were found, reporting 98 patients, totally 99 patients (including this case) with nervous system development disorder due to KDM6B gene variation. The main manifestations were neurodevelopmental disorders such as speech, motor, and behavioral abnormalities, mental retardation, as well as facial deformities, hypotonia, infantile feeding difficulties/gastroesophageal reflux, joint/ligament laxity, and abnormalities of the hands and toes/palms. A total of 83 variation sites were found, including 37 frameshift variations, 18 missense variations, 21 nonsense variations, and 7 splicing variations, all of which were heterozygous variations. Conclusions:The KDM6B gene variation can lead to neurodevelopmental disorder, craniofacial developmental and skeletal abnormalities. The de novo heterozygous variation in the KDM6B gene is considered to be the genetic etiology of this child. This study extends the spectrum of KDM6B gene variant.

Objective:To investigate the efficacy and safety of percutaneous trans-hepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent hepatobiliary calculi under enhanced recovery after surgery (ERAS) mode.Methods:Clinical data of 88 patients with recurrent hepatobiliary calculi, who were treated with PTCSL at Zhengzhou Central Hospital Affiliated to Zhengzhou University and the First Affiliated Hospital of Xi'an Jiaotong University between June 2022 and June 2024 were retrospectively analyzed, including 34 males and 54 females, aged (52.0±13.8) years. The scheme includes preoperative education, prophylactic antibiotic application, ensuring the quality of surgery, early postoperative feeding and activity, etc. The operation can be divided into two fashions: percutaneous transhepatic cholangial drainage and PTCSL, which can be completed in one stage (one-stage expansion method) or in two stages (staged expansion method). Clinical data such as gender, age, operative time, intraoperative blood loss, residual stone, and surgical complications were recorded.Results:All 88 patients underwent PTCSL under ERAS mode successfully, including 52 cases using one-stage expansion method and 36 cases using staged expansion method. The operative time was (53±20) min, the intraoperative blood loss was (9.7±3.8) ml, the postoperative hospital stay was (3.6±1.7) d, and the hospitalization cost was (17 500±4 700) yuan. Sixty-nine patients (78.4%, 69/88) had one-time stone removal in the first PTCSL. A total of 19 cases of residual stones were managed again by percutaneous sinus soft choledochoscopy, of which 12 cases were managed by one-time choledochoscopy, five cases by two-time choledochoscopy, and two cases by three-time choledochoscopy. The rate of residual stone was significantly higher in one-stage expansion method compared to staged expansion method [28.8% (15/52) vs. 11.1% (4/36), P=0.040]. No death, conversion to open surgery, or severe complications such as intra-abdominal hemorrhage or bile leakage occurred in the patients. No residual stones or recurrence were found during the follow-ups of (7.5±2.1) months after discharge. Conclusion:PTCSL under ERAS mode is safe and effective in the treatment of recurrent hepatobiliary calculi.

Objective To investigate the prognostic value of remnant lipoprotein cholesterol(RLP-C)and platelet-lymphocyte ratio(PLR)for elderly patients with acute myocardial infarction(AMI)stratified by body mass index(BMI).Methods A total of 130 elderly AMI patients admitted to our hospital from January 2022 to January 2024 were recruited,and then based on their BMI,they were categorized into low(n=18),normal(n=60),and high BMI groups(n=52).Multivariate logistic regression analysis was used to identify the risk factors for poor prognosis in elderly AMI patients.Spearman correlation analysis was conducted to examine the relationship of RLP-C and PLR with prognostic outcomes.ROC curve analysis was performed to evaluate the predictive per-formance of the two indicators for prognosis in elderly AMI patients of different BMI.Results Significant differences in RLP-C and PLR levels were observed among the above three groups(P＜0.05,P＜0.01).In the overall population,as well as in the low,normal and high BMI groups,both RLP-C and PLR were positively correlated with adverse outcomes in elderly AMI patients(P＜0.01).PLR and RLP-C were independent risk factors for poor prognosis in elderly AMI pa-tients(P＜0.01),and they were independently associated with prognosis in each BMI group(P＜0.01).The combined the three indicators together significantly improved the sensitivity and speci-ficity in predicting adverse outcomes in elderly AMI patients when compared to single indicator alone(sensitivity:54.29％,75.94％,64.18％vs 82.61％;specificity:68.83％,70.22％,72.15％vs 80.49％;P＜0.01).Conclusion RLP-C and PLR are influencing factors for poor prognosis in eld-erly AMI patients,and can serve as predictive factors for prognosis,which are helpful for provi-ding valuable guidance for early treatment and prevention of adverse outcomes.

Objective:To analyze the clinical features, imaging features and diagnosis and treatment process of a female pelvic epithelioid inflammatory myofibroblastic sarcoma (EIMS) with peritoneal metastasis, so as to improve the clinical understanding and diagnostic ability of the disease and avoid misdiagnosis and missed diagnosis.Methods:The clinical data of a female patient with pelvic EIMS combined with peritoneal metastasis in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:The triad examination of the patient involved an irregular solid mass in the pelvic cavity about 8.0 cm×9.0 cm in size. Laboratory examination revealed human epididymal protein 4(HE4)154.00 pmol/L. The ultrasonography showed multiple low-echo masses in deep pelvic cavity with unclear boundary and uneven internal echo, and color doppler flow imaging (CDFI) showed abundant internal blood flow signals. Enhanced CT showed uneven and obvious enhancement of the lesion. Pathological examination showed the infiltration of inflammatory cells in the mucous interstitial background. The tumor cells were round and epithelioid, with large nuclei, deep staining and obvious nucleolus. Immunohistochemistry showed anaplastic lymphoma kinase (ALK) positive, and molecular pathology fluorescence in situ hybridization showed ALK gene amplification (positive). Combined with pathological, immunohistochemical and genetic tests, EIMS was diagnosed. Conclusions:EIMS should be considered when there are single or multiple solid or cystic nodules or masses in the pelvic cavity with obvious enhancement, invasive growth and peritoneal implantation metastasis, and the correct diagnosis can be made according to the pathological findings, immunohistochemistry and genetic test results.

Objective:To analyze the clinical features, imaging features and diagnosis and treatment process of a female pelvic epithelioid inflammatory myofibroblastic sarcoma (EIMS) with peritoneal metastasis, so as to improve the clinical understanding and diagnostic ability of the disease and avoid misdiagnosis and missed diagnosis.Methods:The clinical data of a female patient with pelvic EIMS combined with peritoneal metastasis in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:The triad examination of the patient involved an irregular solid mass in the pelvic cavity about 8.0 cm×9.0 cm in size. Laboratory examination revealed human epididymal protein 4(HE4)154.00 pmol/L. The ultrasonography showed multiple low-echo masses in deep pelvic cavity with unclear boundary and uneven internal echo, and color doppler flow imaging (CDFI) showed abundant internal blood flow signals. Enhanced CT showed uneven and obvious enhancement of the lesion. Pathological examination showed the infiltration of inflammatory cells in the mucous interstitial background. The tumor cells were round and epithelioid, with large nuclei, deep staining and obvious nucleolus. Immunohistochemistry showed anaplastic lymphoma kinase (ALK) positive, and molecular pathology fluorescence in situ hybridization showed ALK gene amplification (positive). Combined with pathological, immunohistochemical and genetic tests, EIMS was diagnosed. Conclusions:EIMS should be considered when there are single or multiple solid or cystic nodules or masses in the pelvic cavity with obvious enhancement, invasive growth and peritoneal implantation metastasis, and the correct diagnosis can be made according to the pathological findings, immunohistochemistry and genetic test results.

Objective:To investigate the efficacy and safety of percutaneous trans-hepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent hepatobiliary calculi under enhanced recovery after surgery (ERAS) mode.Methods:Clinical data of 88 patients with recurrent hepatobiliary calculi, who were treated with PTCSL at Zhengzhou Central Hospital Affiliated to Zhengzhou University and the First Affiliated Hospital of Xi'an Jiaotong University between June 2022 and June 2024 were retrospectively analyzed, including 34 males and 54 females, aged (52.0±13.8) years. The scheme includes preoperative education, prophylactic antibiotic application, ensuring the quality of surgery, early postoperative feeding and activity, etc. The operation can be divided into two fashions: percutaneous transhepatic cholangial drainage and PTCSL, which can be completed in one stage (one-stage expansion method) or in two stages (staged expansion method). Clinical data such as gender, age, operative time, intraoperative blood loss, residual stone, and surgical complications were recorded.Results:All 88 patients underwent PTCSL under ERAS mode successfully, including 52 cases using one-stage expansion method and 36 cases using staged expansion method. The operative time was (53±20) min, the intraoperative blood loss was (9.7±3.8) ml, the postoperative hospital stay was (3.6±1.7) d, and the hospitalization cost was (17 500±4 700) yuan. Sixty-nine patients (78.4%, 69/88) had one-time stone removal in the first PTCSL. A total of 19 cases of residual stones were managed again by percutaneous sinus soft choledochoscopy, of which 12 cases were managed by one-time choledochoscopy, five cases by two-time choledochoscopy, and two cases by three-time choledochoscopy. The rate of residual stone was significantly higher in one-stage expansion method compared to staged expansion method [28.8% (15/52) vs. 11.1% (4/36), P=0.040]. No death, conversion to open surgery, or severe complications such as intra-abdominal hemorrhage or bile leakage occurred in the patients. No residual stones or recurrence were found during the follow-ups of (7.5±2.1) months after discharge. Conclusion:PTCSL under ERAS mode is safe and effective in the treatment of recurrent hepatobiliary calculi.

Objective To investigate the prognostic value of remnant lipoprotein cholesterol(RLP-C)and platelet-lymphocyte ratio(PLR)for elderly patients with acute myocardial infarction(AMI)stratified by body mass index(BMI).Methods A total of 130 elderly AMI patients admitted to our hospital from January 2022 to January 2024 were recruited,and then based on their BMI,they were categorized into low(n=18),normal(n=60),and high BMI groups(n=52).Multivariate logistic regression analysis was used to identify the risk factors for poor prognosis in elderly AMI patients.Spearman correlation analysis was conducted to examine the relationship of RLP-C and PLR with prognostic outcomes.ROC curve analysis was performed to evaluate the predictive per-formance of the two indicators for prognosis in elderly AMI patients of different BMI.Results Significant differences in RLP-C and PLR levels were observed among the above three groups(P＜0.05,P＜0.01).In the overall population,as well as in the low,normal and high BMI groups,both RLP-C and PLR were positively correlated with adverse outcomes in elderly AMI patients(P＜0.01).PLR and RLP-C were independent risk factors for poor prognosis in elderly AMI pa-tients(P＜0.01),and they were independently associated with prognosis in each BMI group(P＜0.01).The combined the three indicators together significantly improved the sensitivity and speci-ficity in predicting adverse outcomes in elderly AMI patients when compared to single indicator alone(sensitivity:54.29％,75.94％,64.18％vs 82.61％;specificity:68.83％,70.22％,72.15％vs 80.49％;P＜0.01).Conclusion RLP-C and PLR are influencing factors for poor prognosis in eld-erly AMI patients,and can serve as predictive factors for prognosis,which are helpful for provi-ding valuable guidance for early treatment and prevention of adverse outcomes.