OBJECTIVE To report the diagnosis and treatment process of 1 case of Streptomyces thermoviolaceus pneumonia， and provide reference for the diagnosis and treatment of this type of infection by combining literature on Streptomyces pneumonia. METHODS A case study was conducted on a patient with S. thermoviolaceus pneumonia treated at the First Affiliated Hospital of Army Medical University. Additionally， a systematic literature review of Streptomyces pneumonia cases was performed. RESULTS The patient with S. thermoviolaceus presented with left lung consolidation and mass-like opacity. Initial diagnosis via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry failed， but 16S rRNA gene amplification and sequencing confirmed S. thermoviolaceus as the causative pathogen. Six-month therapy with Amoxicillin capsules （1 g orally， three times daily） resulted in near-complete lesion resolution. The literature analysis of Streptomyces pneumonia revealed that 13 patients with Streptomyces pneumonia were included （including the patient reported in the article）， age range of 18-77 years， more males （8 cases）， and mostly suffering from underlying diseases. In terms of clinical symptoms， all enrolled cases exhibited cough， and some cases were accompanied by variable dyspnea. Imaging findings included that there was no characteristic predilection site for Streptomyces pneumonia lesions， and CT images commonly showed lung consolidation and bilateral nodules. Definitive diagnosis relied on 16S rRNA sequencing. Treatment regimens included tetracyclines， β -lactam drugs combined with enzyme inhibitors， ceftriaxone， aminoglycosides， macrolides， or carbapenems， administered for prolonged duration （6 months）. Follow-up indicated a good prognosis， and only one mortality occurred. CONCLUSIONS 16S rRNA gene sequencing should be prioritized for diagnosing S. pneumonia. Effective antimicrobial options include tetracyclines，β-lactam drugs combined with enzyme inhibitors， ceftriaxone， aminoglycosides， macrolides， and carbapenems. Prolonged therapy correlates with favorable prognosis.

OBJECTIVE To study the general situation and characteristics of the adverse drug reactions(ADRs) associated with polatuzumab vedotin(combined with bendamustine and rituximab), so as to provide reference for clinical rational drug use. METHODS The clinical data of all patients who were hospitalized at Tianjin Cancer Hospital Airport Hospital and treated with polatuzumab vedotin during hospitalization from January 2021 to August 2022 were collected by searching Hospital Information System. The basic patient information, medication status, incidence of adverse reactions, etc, were collected and analyzed. RESULTS A total of 7 patients were enrolled in the analysis, which there were 4 males(57.1%) and 3 females(42.8%). The toxicity profile of polatuzumab vedotin consisted mainly of neutropenia and leukopenia. ADRs mainly occured within 3 months after administration, and it could be recovered after symptomatic treatment or observation, and there was no death due to ADRs. CONCLUSION During the rational use of polatuzumab vedotin in clinical practice, clinicians and pharmacists should reinforce the monitoring on its using to ensure the safe and effective of polatuzumab vedotin clinical application.

Objective To investigate the treatment of female bladder neck obstruction by 1470nm laser transurethral modified enlarged female bladder neck obstruction(FBNO).Methods The clinical data of 34 patients with FBNO from January 2019 to November 2021 were retrospectively analyzed.The patient underwent a 1470nm laser transurethral modified enlarged bladder neck incision.The 1470nm laser was used to vaporise the bladder neck at 12 o'clock(lithotomy),and the incision site was expanded along the bladder neck to 9 o'clock and 3 o'clock to form a semi-circular surgical wound.The patients were followed up for complications,scored form of Bristol female lower urinary tract symptoms questionnaire(BFLUTS-SF)urination symptom subscale,quality of life(QoL)score and the maximum urinary flow rate(Qmax),detrusor pressure at maximum flow rate(PdetQmax),post-void residual(PVR)were reviewed at 1,4,and 10 months after operation.Results After 10 months of follow-up,the subjective indexes of BFLUTS-SF and QoL scores were significantly improved compared with those before operation(P<0.001),and the objective indexes of Qmax,PdetQmax,and PVR were significantly improved compared with those before operation(P<0.001).Two patients had mild urgency urinary incontinence and urinary tract infection symptoms half a month after operation,and the symptoms were improved after anti-infection and pelvic floor rehabilitation treatment.During the follow-up period,there were no complications such as vesicovaginal fistula,stress urinary incontinence,or recurrent bladder neck obstruction.Conclusion 1470nm laser transurethral modified enlarged bladder neck resection can effectively relieve bladder neck obstruction without significant postoperative complications,with high safety and good patient satisfaction.

Objective:To investigate the clinical phenotype and genetic characteristics of patients with Fabry disease caused by a GLA variant, IVS4+919G>A.Methods:It was a prospective study. Fabry disease screening was conducted among high-risk population in Ninghai from October 2021 to August 2023. Those children with decreased α-galactosidase enzyme activity<2.40 μmol/(L·h) or elavated Lyso-GL-3 level>1.10 μg/L in dried blood spot (DBS) method underwent GLA genetic testing for diagnosis confirmation. Meanwhile, family screening was carried out. A proband and his family members diagnosed with Fabry disease were research subjects. The clinical and genetic characteristics of patients with Fabry disease caused by the GLA variant (IVS4+919G>A) were analyzed.Results:The female proband aged 9.8 years with pain in both lower limbs as the initial symptom was found to have a heterozygous GLA variant IVS4+919G>A among 102 patients. In family screening, there were 4 family members (proband's father, elder sister, elder male cousin and elder female cousin) with Fabry disease and a family member (proband's fifth aunt) with a GLA variant. Among these 4 diagnosed family members, the elder male cousin of the proband, a boy aged 13.2 years had a heterozygous GLA variant, IVS4+919G>A with intermittent pain in both lower limbs as the initial symptom. The proband′s father had knee joint pain. The proband′s elder sister had decreased vision and his elder female cousin had no obvious symptoms. The proband′s fifth aunt with a GLA variant had decreased vision.Conclusions:High-risk screening in children and family screening are helpful for early diagnosis and treatment of Fabry disease. Neuropathic pain may be a early symptom in children with Fabry disease caused by the GLA variant, IVS4+919G>A.

Objective To investigate the changes in cerebral blood flow(CBF)and whole-brain functional connectivity(FC)in patients with neuromyelitis optica spectrum disorder(NMOSD)examined by conventional MRI.Methods Twenty-two patients with NMOSD and 25 matched healthy controls(HC)were included,and all subjects'conventional MRI sequences,arterial spin labeling(ASL),and resting-state functional magnetic resonance imaging(rs-fMRI)image data were acquired,and the brain regions with CBF differences between groups extracted based on ASL were used as seed points for whole-brain FC analysis,the FC differences between the groups were compared,and the correlation between the parameter values and the expanded disability status scale(EDSS)scores were analyzed.Results NMOSD patients exhibited a decrease in CBF value in the right supratemporal gyrus,bilateral calcarine fissure and right supplementary motor area,while the right middle temporal gyrus displayed an increase when compared to HC.Whole-brain FC analysis based on seed points revealed an increase in FC value between bilateral calcarine fissure and olfactory cortex,as well as between right supplementary motor area and left superior frontal gyrus.While FC value between the right supplementary motor area and left precentral gyrus,bilateral thalamus,right supraoccipital gyrus were decreased.The FC value between the right supratemporal gyrus and right inferior parietal lobule,left supratemporal gyrus,right precuneus lobes showed a decrease[Gaussian random field(GRF)-corrected,P＜0.05].There was a correlation between CBF values of bilateral calcarine fissure and EDSS scores in NMOSD patients(rs=-0.456,P=0.033).Conclusion There are CBF and FC abnormalities in multiple brain regions in NMOSD patients,which provide imaging basis and insights for the brain micropathological changes of NMOSD,and help to understand the pathology and neural mechanism of NMOSD.

Objective:To construct a rehabilitation nursing program for total knee arthroplasty (TKA) patients with kinesiophobia based on capacity, opportuniy, motivation-behavior (COM-B) theoretical model, and to provide reference for clinical staff to implement rehabilitation treatment.Methods:From August to December 2023, literature analysis was used to construct a preliminary program, combined the COM-B theoretical model with the rehabilitation exercise guidelines and expert consensus. The rehabilitation nursing program for TKA patients with kinesiophobia was formed through 2 rounds of Delphi expert correspondence consultation, and the analytic hierarchy process was used to calculate the weight of each item.Results:A total of 15 experts were included, including 4 males and 11 females, aged (45.80 ± 5.72) years old. The effective recovery rate of the 2 rounds of expert correspondence questionnaires were 15/15, the expert authority coefficients were 0.860 and 0.875, and the Kendall coordination coefficients were 0.155 and 0.172, and the differences were statistically significant ( χ2 = 97.70, 105.91, both P<0.01). The final rehabilitation nursing program for TKA patients with kinesiophobia included 3 primary indexes, 8 secondary indexes and 25 tertiary indexes. Conclusions:The rehabilitation nursing program for TKA patients with kinesiophobia constructed based on COM-B theoretical model is scientific and practical, and can provide a practical basis for clinical staff.

Objective To investigate the antibacterial performance and biocompatibility of silver nanoparticles-coated root canal nickel titanium instruments(AgNPs-NiTi).Methods AgNPs-NiTi was prepared using pulse electrochemical deposition.The morphol-ogy of AgNPs-NiTi was observed using field emission scanning electron microscopy(FE-SEM),and the elemental composition and con-tent were analyzed using X-ray diffraction(XRD)and energy dispersive spectroscopy(EDS).The mechanical properties of AgNPs-NiTi were tested.After Co-culturing AgNPs-NiTi with E.faecalis,the antibacterial effect was detected by colony-forming units method.By constructing an in vitro model of E.faecalis biofilm in the root canal of teeth,the antibacterial effect of AgNPs-NiTi was observed using FE-SEM and live/dead bacterial staining.In addition,AgNPs-NiTi was co-cultured with Raw 264.7 cells,and its cytotoxicity was de-tected by CCK-8.Results The pulse electrochemical deposition was used to construct a silver nanoparticle(AgNPs)coating on NiTi instruments with no significant change in the mechanical properties.AgNPs-NiTi significantly inhibited the proliferation of E.faecalis and damaged E.faecalis biofilm in the root canal.AgNPs-NiTi had no significant influence on the proliferation of Raw264.7 cells and had no cytotoxicity.Conclusion The mechanical properties of AgNPs-NiTi are similar to those of nickel titanium instruments.AgNPs-NiTi inhibits E.faecalis proliferation with good biocompatibility.

Objective:To explore the effects of midazolam oral solution on preoperative sedation, hemodynamics, and awakening agitation in children undergoing tonsillectomy combined with adenoidectomy.Methods:A total of 267 pediatric patients who underwent tonsillectomy combined with adenoidectomy at the Children′s Hospital Affiliated to Zhejiang University School of Medicine from January to September 2022 were randomly divided into a low-dose group ( n=89), a high-dose group ( n=89), and a control group ( n=89) using a random number table method. 30 minutes before anesthesia, the low-dose group received 0.25 mg/kg of midazolam orally, the high-dose group received 0.5 mg/kg of midazolam orally, and the control group received 5 ml of 10% glucose mixture orally. We compared the extubation time and post anesthesia recovery room (PACU) retention time among three groups of pediatric patients; Mean arterial pressure (MAP) and heart rate (HR) levels before administration and 10, 20, and 30 minutes after administration; The Yale Modified Perioperative Anxiety Scale (mYPAS) score and restlessness incidence were measured before administration and 10 and 60 minutes after administration. Results:The retention time of PACU in the low-dose group was shorter than that in the high-dose group ( P<0.05), and there was no statistically significant difference between the low-dose group and the control group ( P>0.05). At 10, 20, and 30 minutes after administration, the levels of MAP and HR in the low-dose and high-dose groups were lower than before administration (all P<0.05), and at 10, 20, and 30 minutes after administration, the levels of MAP and HR in the low-dose and high-dose groups were lower than those in the control group (all P<0.05). Before administration, there was no statistically significant difference in mYPAS scores among the three groups (all P>0.05); At 10 and 60 minutes after administration, the mYPAS scores of the low-dose and high-dose groups were lower than before administration, and the mYPAS scores of the low-dose and high-dose groups were lower than those of the control group (all P<0.05); At 10 and 60 minutes after administration, there was no statistically significant difference in mYPAS scores between the control group and before administration (all P>0.05), while there was no statistically significant difference in mYPAS scores between the low-dose and high-dose groups (all P>0.05). There was no statistically significant difference in the incidence of agitation among the three groups ( P>0.05). Conclusions:Preoperative oral administration of 0.25 mg/kg or 0.5 mg/kg midazolam can effectively alleviate preoperative anxiety and improve hemodynamics in children undergoing tonsillectomy combined with adenoidectomy. However, due to the fast metabolism of midazolam, its effect on improving postoperative restlessness during the recovery period is not significant. The 0.25 mg/kg dose of midazolam can reduce the retention time of PACU compared to the 0.5 mg/kg dose, which is worthy of clinical recommendation.

Objective:To construct a prospective benefit evaluation model,and to explore its effect and value in the management of micro-injection pumps and infusion pumps in thoracic surgery.Methods:A prospective benefit evaluation model was constructed through three stages:data collection,data analysis,and data application.A total of 11 medical syringe pumps(6 micro-injection pumps and 5 infusion pumps)in clinical use in the Department of Thoracic Surgery of Chongqing General Hospital from 2021 to 2023 were selected,and the conventional management method was adopted during the equipment use period from January to December 2021,and the prospective benefit evaluation model management was adopted during the equipment use period from January 2022 to December 2023(referred to as prospective management).The equipment utilization efficiency and equipment operation benefit increase of the two management methods were compared.Results:The equipment availability rate,annual start-up rate,rate of return and utilization rate of equipment utilization efficiency using prospective management method were(0.98±0.12)%,(2.14±0.28)%,(1.31±0.19)%and(25.14±1.27)%,respectively,which were higher than those of conventional management method,and the difference was statistically significant(t=3.525,3.463,7.591,11.779,P＜0.05).The increase of equipment management cost,cost-effectiveness and social benefit using prospective management method were(0.65±0.23)%,(5.92±1.14)%and(6.31±1.29)%,respectively,the increase of management cost was lower than that of conventional management method,while the increase of cost-effectiveness and social benefit were higher than those of conventional management method,and the difference was statistically significant(t=3.099,3.763,4.798,P＜0.05).Conclusion:The application of prospective benefit evaluation model to the management of equipment of micro-injection pumps and infusion pumps in thoracic surgery can improve equipment utilization efficiency,strengthen equipment management quality,and improve the increase of equipment efficiency.

Objective:To study the dosimetric differences of hippocampal-avoidance whole brain radiotherapy(HA-WBRT)between non-uniform 9-fields intensity-modulated radiotherapy-flatten filter(9F-IMRT-FF)and 9-fields intensity-modulated radiotherapy-flatten filter-free(9F-IMRT-FFF)mode.Methods:From January to December 2023,the simulated images of computed tomography(CT)location of 20 patients with intracranial metastases who had completed whole-brain radiotherapy at the Department of Radiotherapy of Chengde Central Hospital were selected.The radiotherapy plans of two kinds of modes of brand-new 9F-IMRT-FF and 9F-IMRT-FFF were redesigned in the planning system.The differences of dosimetric parameters of the two kinds of mode plans were compared,as well as the differences of irradiation efficiency of accelerator.Results:The exposure dose(D2%)of 2%volume of target region of planned target volume(PTV)of 9F-IMRT-FFF mode was significantly lower than that of 9F-IMRT-FF mode(t=-2.496,P<0.05).The exposure dose(D100%)of 100%volume of target region,the maximum dose(Dmax)and the mean dose(Dmean)of the left side of hippocampus of 9F-IMRT-FFF mode plan were significantly lower than those of 9F-IMRT-FF mode plan,with statistically significant(Z=-3.179,-3.018,-2.145,P<0.05),respectively.The D100%and Dmax of the right side of hippocampus of 9F-IMRT-FFF mode plan were significantly lower than those of 9F-IMRT-FF mode plan,with statistically significant(Z=-3.099,-3.260,P<0.05),respectively.The monitor unit(MU)value of 9F-IMRT-FFF mode plan increased by 25%than that of 9F-IMRT-FF mode plan,while the treatment time of 9F-IMRT-FFF mode plan shortened 38%than that of 9F-IMRT-FF mode plan,with statistically significant(t=-9.664,-13.312,P<0.05),respectively.Conclusion:Both the non-uniform 9F-IMRT-FF and the 9F-IMRT-FFF can meet the clinically requirement.The 9F-IMRT-FFF has better modulation capabilities in beams,which has more advantages in reducing the dose of radiotherapy for hippocampus,and reducing treatment time,and increasing treatment efficiency.