Gorham-Stout disease(GSD) is a rare osteolytic disorder characterized by spontaneous and progressive osteolysis, along with abnormal angiogenesis and lymphangiogenesis, with no new bone formation. We present a case of a 15-year-old female admitted due to " recurrent right leg pain for 5 years, 11 months after undergoing right femoral fracture surgery". Through comprehensive integration of the patient's clinical phenotype, laboratory tests, imaging findings, pathological examinations, and molecular biological test results, GSD was considered highly likely. A multidisciplinary treatment approach was conducted, including a combination of zoledronic acid and sirolimus to inhibit osteolysis, along with rehabilitation training and orthopedic intervention, providing a personalized and comprehensive treatment strategy.

This paper summarizes Professor SHI Zaixiang's clinical experience in treating high fever caused by sepsis using Chaihu Guizhi Ganjiang Decoction （柴胡桂枝干姜汤）. He holds that the key pathogenesis of sepsis involves constrained heat in the shaoyang and internal accumulation of water and fluids. The clinical manifestations such as high fever， chills， and alternating sensations of cold and heat are attributed to pathogenic heat constrained in the shaoyang. Meanwhile， soft tissue edema and serous cavity effusions are due to shaoyang dysfunction and internal water retention. In clinical practice， treating sepsis-related high fever requires addressing both the shaoyang-constrained heat and the associated edema and effusions. The therapeutic approach focuses on harmonizing the shaoyang and resolving internal fluids， using Chaihu Guizhi Ganjiang Decoction as the base formula with flexible modifications. Professor SHI emphasizes that this formula shows a rapid antipyretic effect， particularly in cases where multiple anti-infective treatments have failed.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To evaluate the service efficiency of nursing homes in China from a medical care integration per-spective and analyze influencing factors.Methods The three-stage Data Envelopment Analysis(DEA)model was applied to e-liminate the influence of environmental factors to analyze the efficiency of nursing homes in various provinces in China.Addition-ally,a Tobit model was used to examine the determinants of efficiency.Results During the research period,the traditional DEA model overestimated the comprehensive efficiency and scale efficiency of nursing homes in 31 provinces,municipalities,and au-tonomous regions in China,and underestimated the pure technical efficiency.Environmental factors such as per capita GDP,the elderly dependency ratio,and the proportion of urban population impacted the input variables to significantly different extents,with a comprehensive efficiency score of 0.785,a pure technical efficiency score of 0.870,and a scale efficiency score of 0.901.Key influencing factors of the service efficiency of elderly care institutions included basic elderly care facilities,regional popula-tion size,residents'consumption capacity,degree of disability of the care recipients,quality of human resources,and capacity of medical services.Conclusion After eliminating the influence of environmental factors through the three-stage DEA,the efficien-cy evaluation is more accurate.The service efficiency of nursing homes varies across different regions in China:the eastern region exhibits the highest efficiency,followed by the central region and the western region.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective To evaluate the service efficiency of nursing homes in China from a medical care integration per-spective and analyze influencing factors.Methods The three-stage Data Envelopment Analysis(DEA)model was applied to e-liminate the influence of environmental factors to analyze the efficiency of nursing homes in various provinces in China.Addition-ally,a Tobit model was used to examine the determinants of efficiency.Results During the research period,the traditional DEA model overestimated the comprehensive efficiency and scale efficiency of nursing homes in 31 provinces,municipalities,and au-tonomous regions in China,and underestimated the pure technical efficiency.Environmental factors such as per capita GDP,the elderly dependency ratio,and the proportion of urban population impacted the input variables to significantly different extents,with a comprehensive efficiency score of 0.785,a pure technical efficiency score of 0.870,and a scale efficiency score of 0.901.Key influencing factors of the service efficiency of elderly care institutions included basic elderly care facilities,regional popula-tion size,residents'consumption capacity,degree of disability of the care recipients,quality of human resources,and capacity of medical services.Conclusion After eliminating the influence of environmental factors through the three-stage DEA,the efficien-cy evaluation is more accurate.The service efficiency of nursing homes varies across different regions in China:the eastern region exhibits the highest efficiency,followed by the central region and the western region.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To investigate the role of RNA-binding motif protein X-linked(RBMX)in regulating the proliferation,migration,invasion and glycolysis in human bladder cancer cells.Methods A lentivirus vectors system and RNA interference technique were used to construct bladder cancer 1376 and UC-3 cell models with RBMX overexpression and knockdown,respectively,and successful cell modeling was verified using RT-qPCR and Western blotting.Proliferation and colony forming ability of the cells were evaluated using EdU assay and colony-forming assay,and cell migration and invasion abilities were determined using Transwell experiment.The expressions of glycolysis-related proteins M1 pyruvate kinase(PKM1)and M2 pyruvate kinase(PKM2)were detected using Western blotting.The effects of RBMX overexpression and knockdown on glycolysis in the bladder cancer cells were assessed using glucose and lactic acid detection kits.Results RT-qPCR and Western blotting confirmed successful construction of 1376 and UC-3 cell models with RBMX overexpression and knockdown.RBMX overexpression significantly inhibited the proliferation,clone formation,migration and invasion of bladder cancer cells,while RBMX knockdown produced the opposite effects.Western blotting results showed that RBMX overexpression increased the expression of PKM1 and decreased the expression of PKM2,while RBMX knockdown produced the opposite effects.Glucose consumption and lactate production levels were significantly lowered in the cells with RBMX overexpression(P<0.05)but increased significantly following RBMX knockdown(P<0.05).Conclusion RBMX overexpression inhibits bladder cancer progression and lowers glycolysis level in bladder cancer cells by downregulating PKM2 expression,suggesting the potential of RBMX as a molecular target for diagnosis and treatment of bladder cancer.

BackgroundThe prevalence of depressive disorder in adolescents is on the rise. There have been studies on the pairwise relations between dysfunctional attitude， negative automatic thoughts， positive coping style and depressive symptoms in the past. However， the impact of the intrinsic relations among dysfunctional attitude， negative automatic thoughts and positive coping style on depressive symptoms is still unclear. ObjectiveTo explore the influence of dysfunctional attitude on adolescent depressive symptoms and examine the action path of negative automatic thoughts and positive coping style on it， in order to provide references for intervention for adolescent patients with depressisve disorder. MethodsThis study involved 162 adolescent patients with depressive disorder， who met the diagnostic criteria for depressive episodes in the International Classification of Diseases， 10th edition （ICD-10） and received treatment in Taiyuan Psychiatric Hospital from October 1， 2022 to October 31， 2023. These patients were evaluated using Self-rating Depression Scale （SDS）， Dysfunction Attitude Scale （DAS）， Positive Coping Style Subscale in Simplified Coping Style Questionnaire（SCSQ） and Automatic Thoughts Questionnaire （ATQ）. Pearson correlation analysis was adopted to examine the correlation among scores of scales above. Model 6 in Process 3.4.1 was adopted to test the acting path of negative automatic thoughts and positive coping style between dysfunctional attitude and adolescent depression symptoms. ResultsA total of 148 adolescent patients with depressive disorder completed an effective questionnaire survey， with a response rate of 91.36%. The direct effect value of dysfunctional attitude on depressive symptoms was 0.423 and the effect size was 63.32%. Negative automatic thoughts and positive coping style affected as acting path between dysfunctional attitude and depressive symptoms， with effect values of 0.156 （accounting for 23.35% of the total effect） and 0.045 （accounting for 6.74% of the total effect） respectively. Meanwhile， negative automatic thoughts and positive coping style affected as a chain reaction pathway between dysfunctional attitude and depressive symptoms， with an effect value of 0.044， accounting for 6.59% of the total effect. ConclusionDysfunctional attitude can not only directly affect the depressive symptoms of adolescent patients with depressive disorder， but also affect the depressive symptoms of adolescent patients with depressive disorder through the independent path or chain path of negative automatic thoughts and positive coping style.