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 explore the effect of physical fitness training on social adaptive behavior of children with global developmental delay (GDD), in order to provide treatment experience for GDD children. 【Methods】 From November 2021 to December 2022, a total of 60 children with GDD diagnosed and treated in the Third Affiliated Hospital of Jiamusi University were enrolled in this study, and were randomly divided into control group (n=30) and test group (n=30).The control group received routine rehabilitation treatment, and the test group received physical fitness training additionally.The intervention lasted for 12 weeks, with the frequency of 3times/week, 30min/time.All subjects were tested for physical fitness and children′s social adaptive behavior before and after training. 【Results】 Before treatment, the difference between the results of physical fitness test and social adaptive behavior scores of the GDD children in two groups was not statistically significant (P>0.05).After 3 months of treatment, the physical fitness test scores, except body mass index (BMI), and social adaptive behavior scores of the GDD children in two groups were significantly different from those before treatment (P<0.05), and the physical fitness test scores (except for height, weight and BMI) and the social adaptive behavior of the test group were better than those of the control group (t=2.363,4.020,3.331,3.338,P<0.05). 【Conclusion】 Physical fitness training can significantly improve the adaptive behavior, independent function, cognitive function and social/self-control ability of GDD children.

Objective The study aimed to elucidate the evolution of the syndromes in Traditional Chinese Medicine(TCM)and TCM syndrome elements in different chronic stages of psoriasis vulgaris.Methods A database was constructed using electronic medical records collected from July 2019 to March 2024 from 1,049 patients with psoriasis vulgaris.The study used Sankey diagrams and network association graphs to analyze the evolution of TCM syndromes and their elements in patients at the different stages:initial diagnosis,progressive stage(Week 2-3),progressive stage(Week 4-5),skin lesion improvement stage(Week 6-7),and remission stage.The syndrome elements network was constructed using community detection algorithms,and the association rules between local skin lesion syndrome differentiation and overall syndrome differentiation were displayed using heatmaps.Results(ⅰ)Initial diagnosis.In the syndrome differentiation of local skin lesions,blood heat syndrome was the most common(79.79％);among the disease location of TCM syndrome elements(called"disease location"),liver was the most prevalent(35.62％);and among the pathological factors of TCM syndrome elements(called"pathological factors"),fire(heat)was the most common(75.48％).(ⅱ)Active stage(Week 2-3).In the syndrome differentiation of local skin lesions,blood heat syndrome remained the most prevalent(73.13％);among the disease location,liver was still the most prevalent(31.71％);and among the pathological factors,fire(heat)continued to be the most common(82.11％),while dampness(22.26％)and qi stagnation(8.39％)began to increase.(ⅲ)Active stage(Week 4-5).The syndrome differentiation of local skin lesions was dominated by blood heat syndrome(45.91％)and blood dryness syndrome(37.19％);among disease location,the interior was the most prevalent(15.25％);and among the pathological factors,fire(heat)remained the most common(50.66％),with an increase in yin deficiency(34.26％).(ⅳ)Skin lesion improvement stage(Week 6-7).In the syndrome differentiation of local skin lesions,both blood dryness syndrome(49.44％)and blood stasis syndrome(33.33％)increased;among the disease location,meridians increased most significantly and became the most prevalent(13.44％);and among the pathological factors,blood stasis increased most significantly and became the most prevalent(28.20％).(ⅴ)Remission stage.In the syndrome differentiation of local skin lesions,blood stasis syndrome became the primary(55.69％),while the percentage of blood dryness syndrome decreased(21.16％);meridians(25.71％)and blood stasis(62.34％)remained the most predominant syndrome elements related to disease location or pathological factors.Conclusion The overall pattern of TCM syndromes in psoriasis vulgaris evolved from excess to deficiency.From the initial diagnosis to the active phase(Week 2-3),heat syndrome dominated;during the active phase(Week 4-5),heat syndrome coexisted with damp syndrome or yin deficiency syndrome;changes in the syndrome element network were the most significant during the lesion improvement phase,with blood stasis gradually increasing and peaking during the remission phase.Blood stasis,dampness,and qi stagnation were pervasive throughout psoriasis vulgaris;qi stagnation and blood stasis may be the main elements causing further deterioration and prolonged course of the disease during the active phase in patients.

Due to traditional professional divisions, the practice of endoscopy by gastro-intestinal surgeons in China remains controversial. However, with the evolution of treatment philo-sophies, medical technology, and equipment advancements, a trend of integration between tradi-tional surgery and endoscopy is emerging. Gastrointestinal surgeons performing endoscopy can maxi-mize patient benefits, and they naturally possess advantages in conducting endoscopic procedures. It is recommended to further establish entry thresholds for surgeons to perform endoscopy, provide standardized endoscopic training for surgeons, and coordinate efforts at the administrative depart-ment. With the support of artificial intelligence, more patients can receive minimally invasive, indivi-dualized, and precise treatments.

Objective:To investigate the clinical application of EWSR1 gene rearrangement by fluorescence in situ hybridization (FISH) in bone and soft tissue tumors and to analyze the cases with atypical signal pattern.Methods:The cases detected for EWSR1 gene rearrangement by FISH in Beijing Jishuitan Hospital, Capital Medical University from 2014 to 2021 were collected, and the value of detecting EWSR1 gene rearrangement for diagnosing bone and soft tissue tumors was analyzed. The cases with atypical positive signals were further analyzed by next generation sequencing (NGS).Results:FISH using EWSR1 break-apart probe kit was successfully performed in 97% (205/211) of cases, 6 cases failed. Four of the 6 failures were due to improper decalcification, 1 case due to signal overlap caused by thick slices, and 1 case due to signal amplification and disorder. EWSR1 gene rearrangements were positive in 122 cases (122/205, 59%), atypical positive signal in 8 cases (8/205, 4%), and negative in 75 cases (75/205, 37%). In cases testing positive, the percentage of positive cells ranged from 34% to 98%, with 120 cases (120/122, 98%) showing a positive cell percentage greater than 50%. Among the 205 successfully tested cases, 156 cases were histologically diagnosed as Ewing′s sarcoma, of which 110 were positive (110/156, 71%), 7 were atypical positive (7/156, 4%), and 39 were negative (39/156, 25%). Nine cases were histologically diagnosed as clear cell sarcoma of soft tissue, of which 6 were positive (6/9), 1 was atypical positive (1/9), and 2 were negative (2/9). Five cases were histologically diagnosed as extraskeletal myxoid chondrosarcoma, of which 2 were positive (2/5) and 3 were negative (3/5). Three cases were histologically diagnosed as angiomatoid fibrous histiocytoma, of which 2 were positive (2/3) and 1 was negative (1/3). Two cases were histologically diagnosed as myoepithelioma of soft tissue, of which 1 was positive (1/2) and 1 was negative (1/2). One case was histologically diagnosed as olfactory neuroblastoma with a positive result. The 29 other tumor cases including osteosarcoma, synovial sarcoma, and malignant melanoma and others were all negative. Basing on histology as the standard for diagnosis and considering atypical positive cases as negative, comparing with the 29 cases of other tumors as control group, the sensitivity for diagnosing Ewing′s sarcoma through the detection of EWSR1 gene rearrangement was 71%, and the specificity was 100%; the sensitivity for diagnosing clear cell sarcoma of soft tissue was 67%, and the specificity was 100%; the sensitivity for diagnosing extraskeletal myxoid chondrosarcoma was 40%, and the specificity was 100%; the sensitivity for diagnosing angiomatoid fibrous histiocytoma was 67%, and the specificity was 100%; the sensitivity for diagnosing myoepithelioma of soft tissue was 50%, and the specificity was 100%; the sensitivity for diagnosing olfactory neuroblastoma was 100%, and the specificity was 100%. Four of 8 cases with atypical positive signals analyzed by NGS showed EWSR1 rearrangement, including EWSR1::FLI1 in one case of Ewing sarcoma, EWSR1::NFATC2 in one case of EWSR1::NFATC2-rearranged sarcoma, EWSR1::ATF1 in one case of clear cell sarcoma of soft tissue and EWSR1::NR4A3 in one case of extraskeletal myxoid chondrosarcoma.Conclusions:Detection of EWSR1 rearrangement by FISH is of utmost significance in the diagnosis of bone and soft tissue tumors. Cases with atypical positive signals should be further scrutinized, correlating with their histomorphology and verifying by NGS if necessary.

Objective:To investigate the effect of inflammatory factors(IL-2,INF-γ,IL-10,TNF-α)and CD4+and CD8+T cells in vaginal lavage in high-grade cervical squamous intraepithelial lesions(HSIL)and early cervical cancer(CC).Methods:To collect clinical data of HSIL(n=120)and early CC patients(n=44)after high-risk human papilloma virus(HR-HPV)infection.And healthy middle-aged women not infected with HR-HPV were randomly selected as control.The clinical data of the subjects in three groups were compared,inflammatory factors distribution and ratio of CD4+and CD8+T cells in serum and vaginal lavage fluid were compared.Multivariate Logistic regression performed to analyze the influencing factors of HSIL progression to early CC,ROC and calibration plot were drawn to evaluate the model.Results:The difference was not statistically significant in serum IL-2,INF-γ,IL-10,TNF-α levels,CD4+T cell distribution,CD8+T cell distribution and CD4+/CD8+ratio in sub-jects of control group,HSIL group and early CC group(P>0.05).The difference was statistically significant in the vaginal lavage levels of IL-2,INF-γ,IL-10,TNF-α levels,CD4+T cell distribution,CD8+T cell distribution and CD4+/CD8+ratio(P<0.05),plus the level of HSIL patients was higher than that of control subjects(P<0.05).Logistic regression analysis showed that parity>2(OR=3.119,95%CI:4.353～6.737)and the percentage of CD4+T cells in vaginal lavage fluid(OR=0.327,95%CI:0.188-0.478)in model 2(P<0.001,AUC=0.908),CD4+/CD8+(OR=0.809,95%CI:0.356-1.868)(P<0.001,AUC=0.873)in model 3 has an independent influence on the development of HSIL to early CC;the difference is not significant(Z=1.550 4,P=0.121)in ROC curves of the two models.CD4+/CD8+ratio as only one indictor in Model 3 can be good predic-tion,and the calibration curve of this model is close to the standard curve.Conclusions:After HR-HPV infection,the systemic immune status does not participate in HSIL and HSIL progression to early CC,but the cervical local immune status is involved,in which CD4+/CD8+T cell ratio is an independent protective factor.

Objective To explore and implement a differentiated management strategy for multi-campus hospitals to improve patient experience and satisfaction,and achieve the goal of homogenized management.Methods In December 2021,the Picker Patient Experience Questionnaire was used to survey the patient experience at 3 campuses of a tertiary A hospital in Hangzhou,and the reasons for the differences were analyzed.Based on policy document reviews,special group discussions,and expert meetings,differentiated management strategy for multi-campus hospitals was formulated.The patient experience and satisfaction before(December 2021)and after(December 2023)the implementation were compared.Results After the application of the one-hospital multi-campus difference management strategy,the overall medical experience score of the patients in the 3 campus was(58.54±2.36)points,which was higher than(58.13±3.24)points before the application(t=-3.223,P=0.001),and there was no statistically significant differences among the patients in the 3 campuses(F=0.781,P=0.458).After the application of the management strategy,the overall satisfaction score of the patients in the 3 campus was(98.44±6.22)points,which was higher than(97.98±6.87)points before the application of the management strategy(t=-2.490,P=0.013),and there was no statistical significance among the patients in the 3 campus(F=1.128,P=0.324).The number of banners and letters of commendation received by the 3 campuses increased from 1 661 before the application to 2 190 after the application,with a growth rate of 31.85％.Conclusion Differentiated management in a multi-campus hospital,aiming at homogenized quality through differentiated strategies,is practicable and can significantly improve the patient experience and satisfaction across different campuses.

Objective:To investigate the efficacy and safety of anlotinib combined with gemcitabine + cisplatin (GP) regimen in the treatment of patients with recurrent or metastatic nasopharyngeal carcinoma.Methods:A retrospective case controlled study was conducted. The clinical data of 82 patients with nasopharyngeal carcinoma newly diagnosed as distant metastasis or recurrence and metastasis after radical chemoradiotherapy in the Second Affiliated Hospital of Guangxi University of Science and Technology and Laibin People's Hospital from January 2020 to December 2021 were retrospectively analyzed. Among 82 patients, 45 patients receiving anlotinib combined with GP regimen were treated as the treatment group, and 37 patients receiving GP chemotherapy regimen during the same period were treated as the control group. Short-term efficacy and adverse reactions were compared between the 2 groups. Kaplan-Meier method was used to compare the progression-free survival (PFS) and overall survival (OS), and log-rank test was performed. Cox proportional risk model was used to analyze the factors influencing the PFS of patients.Results:Among 82 patients, 63 were males and 19 were females, aged (48±10) years. The objective response rate (ORR) and disease control rate (DCR) in the treatment group were higher than those in the control group [ORR: 71.11% (32/45) vs. 62.16% (23/37); DCR: 86.67% (39/45) vs. 81.08% (30/37)], while there were no statistically significant differences (all P > 0.05). The median PFS time was 23.53 months (95% CI: 17.48-29.58 months), 17.40 months (95% CI: 13.33-21.47 months), respectively in the treatment group and the control group, and the difference in PFS was statistically significant ( P < 0.05). The median OS time was 34.03 months (95% CI: 29.42-38.64 months), 30.47 months (95% CI: 28.28-32.66 months), respectively in the treatment group and the control group, and the difference in OS was not statistically significant ( P > 0.05). Oral anlotinib, recurrence or metastasis at initial diagnosis were independent factors influencing the PFS of patients. The main adverse effects of anrotinib were grade 1-2 anorexia, fatigue, granulocytopenia, hypertension, hand-foot syndrome, oral mucositis, and liver function damage. The incidence of grade 3-4 was low, and the adverse reactions in most patients could be controlled after symptomatic treatment and adjustment of drug dosage. Conclusions:For patients with recurrent or metastatic nasopharyngeal carcinoma, oral anlotinib targeted therapy combined with GP chemotherapy regimen can prolong the PFS time of patients. Most anlotinib-related side effects can be tolerated.Objective To investigate the efficacy and safety of anlotinib combined with gemcitabine + cisplatin (GP) regimen in the treatment of patients with recurrent or metastatic nasopharyngeal carcinoma. Methods A retrospective case controlled study was conducted. The clinical data of 82 patients with nasopharyngeal carcinoma newly diagnosed as distant metastasis or recurrence and metastasis after radical chemoradiotherapy in the Second Affiliated Hospital of Guangxi University of Science and Technology and Laibin People's Hospital from January 2020 to December 2021 were retrospectively analyzed. Among 82 patients, 45 patients receiving anlotinib combined with GP regimen were treated as the treatment group, and 37 patients receiving GP chemotherapy regimen during the same period were treated as the control group. Short-term efficacy and adverse reactions were compared between the 2 groups. Kaplan-Meier method was used to compare the progression-free survival (PFS) and overall survival (OS), and log-rank test was performed. Cox proportional risk model was used to analyze the factors influencing the PFS of patients. Results Among 82 patients, 63 were males and 19 were females, aged (48±10) years. The objective response rate (ORR) and disease control rate (DCR) in the treatment group were higher than those in the control group [ORR: 71.11% (32/45) vs. 62.16% (23/37); DCR: 86.67% (39/45) vs. 81.08% (30/37)], while there were no statistically significant differences (all P > 0.05). The median PFS time was 23.53 months (95% CI: 17.48-29.58 months), 17.40 months (95% CI: 13.33-21.47 months), respectively in the treatment group and the control group, and the difference in PFS was statistically significant ( P < 0.05). The median OS time was 34.03 months (95% CI: 29.42-38.64 months), 30.47 months (95% CI: 28.28-32.66 months), respectively in the treatment group and the control group, and the difference in OS was not statistically significant ( P > 0.05). Oral anlotinib, recurrence or metastasis at initial diagnosis were independent factors influencing the PFS of patients. The main adverse effects of anrotinib were grade 1-2 anorexia, fatigue, granulocytopenia, hypertension, hand-foot syndrome, oral mucositis, and liver function damage. The incidence of grade 3-4 was low, and the adverse reactions in most patients could be controlled after symptomatic treatment and adjustment of drug dosage. Conclusions For patients with recurrent or metastatic nasopharyngeal carcinoma, oral anlotinib targeted therapy combined with GP chemotherapy regimen can prolong the PFS time of patients. Most anlotinib-related side effects can be tolerated.

Purpose To development a model to predict mixed cerebral palsy(CP)in infants with periventricular white matter injury(PWMI).Materials and Methods This study retrospectively included infants with PWMI on MRI aged 6 to 24 months and were diagnosed as CP after age of 2 years in the First Affiliated Hospital of Henan University of Chinese Medicine,from September 2015 to October 2022.The eligible infants were divided into mixed group and spastic CP group.Multivariable Logistic regression model was used to select the MRI features associated with PWMI and mixed CP,and was internal validated by using the five-fold cross and repeated cross validation.Model performance was evaluated by the discrimination,calibration and decision curve.The correlation between independent MRI features and the gross motor function classification system levels was evaluated.Results A total of 135 infants with PWMI and CP were included in this study,100 with spastic CP,and 35 with mixed CP.Multivariable Logistic regression analysis found that the involvement of ventralateral of thalamus(OR=27.500,95%CI 8.293-90.942),posterior putamen(OR=13.700,95%CI 4.489-41.549),hippocampus(OR=7.200,95%CI 1.702-30.813)and caudate nucleus(OR 5.800,95%CI 1.973-16.950)were associated with PWMI and mixed CP.A prediction model was constructed using the above four MRI features.The model yielded an area under the receiver operating characteristic curve of 0.960(95%CI 0.934-0.988)and 0.95,0.96 in the five-fold cross and repeated cross validation,respectively.The model had good calibration(χ2=3.712,P=0.529)and clinical application.Furthermore,the four MRI variables were associated with gross motor function classification system levels(r=0.559,0.581,0.171,0.409,all P<0.05).Conclusion The model can early and accurately predict infants with PWMI at high risk of mixed CP.

Purpose To construct and validate a machine learning-based diagnostic model for distinguishing between Mycobacterium avium-intracellular complex pulmonary disease(MAC-PD)and pulmonary tuberculosis(PTB)via chest CT images.Materials and Methods Retrospective data from patients diagnosed with MAC-PD and PTB between May 2021 and August 2022 at Beijing Chest Hospital,Capital Medical University,which were collected as the training set.The prospective external validation set was obtained from patients at the First Affiliated Hospital of Henan University of Chinese Medicine between September 2022 and May 2023.Clinical and radiological data were analyzed,and multivariable logistic regression,random forest and support vector machine(SVM)models were established and externally validated using the validation set.The diagnostic performance of models were evaluated using receiver operating characteristic curve and precision-recall curve,and the differences of the areas under the curve of various models were compared via the Delong test.Results There were significant differences in age and hemoptysis rate between the two groups(t=30.414,P<0.001;χ2=6.186,P=0.013).There were statistically significant differences in cavity types and morphology between the two groups(χ2=6.546,P=0.011;χ2=24.113,P<0.001),but there was no significant difference in the distribution and characteristics of cavitary lesions(P>0.05).There were significant differences in the types and distribution of bronchiectasis between the two groups(χ2=4.634,P=0.031;χ2=23.145,P<0.001).Compared with logistic regression and random forest models,the SVM model had better differential diagnostic performance,and the area under the receiver operating characteristic curve,sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 0.960(95%CI 0.935-0.985),85.7%,93.6%,90.5%,93.3%,88.0%and 0.885(95%CI 0.803-0.967),respectively,76.7%,80.0%,78.3%,79.3%,77.4%.The precision-recall curve showed that the SVM model had high precision and low recall,that was,the model performs well.Conclusion The machine learning-based models exhibits excellent diagnostic performance and can assist in differentiating MAC-PD and PTB.