To explore the feasibility of using indocyanine green(ICG) visualizing the deep infiltrating endometriosis (DIE) during robotic surgery.

A patient with DIE in Department of Genecology and Obstetrics, Chinese PLA General Hospital was selected and underwent total hysterectomy with bilateral adnexectomy and endometriosis lesion excision with perfect preoperative examination and no surgical contraindication. Near-infrared fluorescence imaging with indocyanine green was used in the operation to visualize the endometriosis lesions.

The location of the lesions were accurate and the patient discharged from hospital successfully.

Near-infrared fluorescence imaging system with indocyanine green may clearly visualize the deep infiltrating endometriosis during robotic surgery. It is characterized by brief operation, accuracy and real time. With this technique, we can comprehensively evaluate the scope of our surgery.

To address the prominent issues in graduate education in critical care medicine, such as insufficient teaching resources and the disconnection between theory and practice, this study explores an innovative teaching approach based on artificial intelligence (AI) to enhance graduate students' clinical reasoning and emergency response capabilities.

A research team was established at the Department of Critical Care Medicine, Tianjin Medical University General Hospital. Fifty real and typical clinical cases from 2019 to 2023, covering all core diseases in critical care medicine, were selected. After double-blind desensitization, these cases were transformed into teaching cases suitable for graduate training using AI and classified into three difficulty levels: elementary (basic cases), intermediate (multidisciplinary collaborative cases), and advanced (difficult/technologically innovative cases). A knowledge graph was constructed to enable dynamic case generation and personalized case recommendations, and an intelligent teaching platform was built, integrating functions such as pre-test-based stratified learning, virtual emergency scenario simulation, and mind mapping for comparing with expert decision-making. A three-stage teaching process of "pre-class preparation—in-class simulation—post-class reflection" was adopted. Thirty-three graduate students majoring in critical care medicine from the 2022–2024 cohorts of Tianjin Medical University were selected as the experimental group (using the intelligent platform + novel teaching model), and 34 graduate students of the same major from the 2021–2023 cohorts served as the control group (adopting the traditional teaching model). There were no statistically significant differences in baseline data between the two groups (P＞0.05), indicating comparability. The observation indicators included the scores of case analysis questions in the final examination, and the results of a questionnaire survey on students' satisfaction with the teaching model and evaluation of ability improvement.

The average score of the experimental group on case analysis questions was 75.94, which was significantly higher than that of the control group (65.64), with an improvement of 10.3 points. The questionnaire survey results showed that 81.8% (27/33) of the experimental group students believed the model facilitated the deepening of theoretical understanding and application, 90.9% (30/33) reported enhanced clinical decision-making and emergency response capabilities, 87.9% thought it helped improve medical humanistic literacy, and 87.9% expressed willingness to continue using the platform for self-directed learning.

Through systematic case design, hierarchical adaptive teaching, personalized case recommendations, and a three-stage teaching process, the AI-based intelligent case platform can significantly improve critical care medicine graduate students' clinical case analysis ability, clinical decision-making, and emergency response capabilities. Widely recognized by students, it provides an effective new teaching paradigm for graduate education in critical care medicine and has the potential to be promoted to other clinical disciplines.

To explore the effect of a virtual simulation system combined with case-based learning (CBL) in extracorporeal membrane oxygenation (ECMO) nursing training.

Using convenience sampling, a total of 55 ICU nurses from a tertiary hospital in Shandong Province between March and June 2024 were included. They were divided into an experimental group (27 cases, 1 person withdraw, leaving 26 people remaining) and a control group (28 cases, 2 persons withdraw, leaving 26 people remaining) by random number table method. The experimental group received nurse training using the virtual simulation system of ECMO combined with CBL, while the control group received traditional training. Theoretical knowledge scores, general self-efficacy scale (GSES) and nurses clinical reasoning scale (NCRS) were compared between the two groups before and after the intervention. The system satisfaction of the experimental group was evaluated post-intervention.

After the intervention, the theoretical knowledge score in the experimental group was (81.35±5.62), which was higher than that in the control group (76.04±6.10). The GSES score in the experimental group was (3.14±0.51), which was higher than that in the control group (2.71±0.40). The NCRS score in the experimental group [(61.96±5.14) scores] was higher than that in the control group [(56.03±4.21) scores], and the differences were statistically significant (P＜0.05). Nurses in the experimental group were highly satisfied with all system dimensions, and the overall scores were (35.23±2.01) points.

The virtual simulation system of ECMO combined with CBL in nursing training was highly satisfactory. It improved the knowledge level, self-efficacy, and clinical reasoning ability of nurses and enriched a high-quality information-based training method.

This article summarizes the application of objective assessment-guided precision analgesia and sedation in a patient with severe ARDS. The main nursing interventions included: accurate assessment-based analgesic therapy; neuromuscular transmission (NMT) monitoring to quantify muscle relaxation; bispectral index (BIS) monitoring to precisely adjust the depth of sedation; and progressive rehabilitation exercise. After active treatment and meticulous nursing care, the patient improved and was discharged after 21 days of hospitalization.

To investigate the clinical characteristics, diagnosis, and treatment course of a patient with lung malignancy complicated by severe pneumonia caused by Chlamydia psittaci infection.

The clinical data of a patient with lung malignancy complicated by Chlamydia psittaci induced severe pneumonia, admitted to the Department of Respiratory and Critical Care Medicine of the General Hospital of Western Theater Command on December 3, 2023, were retrospectively analyzed. Relevant literature was also reviewed to summarize the clinical features and management strategies for severe Chlamydia psittaci pneumonia.

A 60-year-old female patient presented with high fever, cough, and sputum production. After admission, she received non-invasive ventilation and broad-spectrum antibiotic therapy with meropenem. However, her condition deteriorated rapidly, and her oxygen saturation remained difficult to maintain even after endotracheal intubation and invasive mechanical ventilation. Subsequently, bronchoscopy and bronchoalveolar lavage (BAL) were performed under extracorporeal membrane oxygenation (ECMO) support. Metagenomic next-generation sequencing (mNGS) of the BAL fluid identified Chlamydia psittaci as the causative pathogen. Targeted antimicrobial therapy with doxycycline, azithromycin, and levofloxacin was sequentially administered, leading to clinical improvement. Ultimately, the patient underwent thoracoscopic radical resection for lung cancer. Postoperative genetic testing of the specimen revealed a deletion variation on exon 19 of EGFR. Adjuvant therapy with icotinib was initiated, resulting in complete remission.

mNGS technology can effectively improve the detection rate of Chlamydia psittaci and prevent further clinical deterioration. For patients with severe Chlamydia psittaci pneumonia, early respiratory support combined with precise targeted antimicrobial therapy is crucial for improving patient prognosis.

To explore the clinical manifestations, complications, diagnosis, treatment and prognosis in neonatal Ureaplasma parvum (Up) meningitis.

A preterm infant with early-onset Up meningitis (infant 1), who was admitted to Xuzhou Central Hospital on October 31, 2023 was included into this study. A retrospective analysis was conducted on the clinical data of infant 1, including medical history, physical examination findings at admission, relevant auxiliary examination results, and the diagnosis and treatment process. Using the search terms " Ureaplasma parvum" " meningitis" " neonate/newborn" " preterm/premature" both in Chinese and English, literature related to neonatal Up meningitis indexed in domestic databases (Wanfang Data Knowledge Service Platform, CNKI, and VIP Database) and international databases (PubMed, Embase, and Web of Science) from the inception of each database to April 2025 was searched. A comprehensive analysis of the clinical manifestations, complications, diagnosis, treatment, and prognosis of Up meningitis in newborns was conducted on the related literature. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

①Infant 1: a female preterm infant with early-onset Up meningitis born at a gestational age of 34^{+ 1} weeks, was admitted to our hospital on the day of birth due to " moaning and frothing for 30 minutes" after delivery. Antenatal vaginal swab from the mother and a postnatal nasal swab from the infant 1 both tested positive for Ureaplasma Urealyticum (UU) nucleic acid. On day 6 after admission, the infant 1 began to experience recurrent low-grade fevers accompanied by apnea. Combined with a cerebrospinal fluid white blood cell count (WBC) of 62×10⁶/L, a glucose concentration of 0.55 mmol/L, and a protein level of 1.29 g/L, metagenomic next-generation sequencing (mNGS) detected Up in the cerebrospinal fluid, with a sequence count of 154 and a relative abundance of 32.25%, Up meningitis was diagnosed. On day 7 after admission, high-dose intravenous azithromycin was initiated at 20 mg/(kg·d) once daily. The dose was reduced to 5 mg/(kg·d) once daily on day 10 after admission. From day 18 to 27 after admission, due to " intraventricular hemorrhage and severe obstructive supratentorial hydrocephalus", daily therapeutic cerebrospinal fluid aspiration (10 mL/kg) was performed. The cerebrospinal fluid parameters gradually normalized, and azithromycin was discontinued on day 27 after admission. However, the hydrocephalus did not significantly improve. On day 29 after admission, the infant 1 was transferred to another hospital for Ommaya reservoir placement. From 3 to 6 months after birth, there was no longer any need to withdraw hydrocephalus fluid, and the symptoms of hydrocephalus improved. At a corrected age of 6 months, the development of infant 1 was assessed as essentially normal. ②Literature review results: A literature search identified 15 relevant articles on neonatal Up meningitis, reporting on 16 affected neonates (infants 2-17). Including infant 1, a total of 17 neonates with Up meningitis were analyzed. Among these 17 cases, excluding one case whose gender was not reported, there were 6 males and 10 females; gestational age was not reported in one case, but the median gestational age of the remaining 16 cases was 31.5 weeks (27.3, 39.8 weeks), with 10 cases being preterm (gestational age at birth < 37 weeks); birth weight was not reported in one case, but the median birth weight of the remaining 16 cases was 1 860 g (997, 3 355 g), with 9 cases having low birth weight (birth weight < 2 500 g); the median age at onset was 7 days after birth (3.0, 10.5 days), and 9 cases were classified as early-onset (within 7 days after birth) Up meningitis. Clinically, 12 cases presented with fever, 6 with neurological abnormalities, and 4 with respiratory abnormalities. Complications included hydrocephalus in 10 cases and intracranial hemorrhage in 3 cases. The cerebrospinal fluid examination results showed an elevated WBC count (median: 608×10⁶/L), a significantly increased protein level (3.7±2.0) g/L, and a significantly decreased glucose concentration (median: 0.5 mmol/L). In 10 cases, mNGS was the sole method used to detect Up in the cerebrospinal fluid. Commonly used antibiotics for Up meningitis included erythromycin, azithromycin [often at a dose of 20 mg/(kg·d)], and quinolones, with treatment courses ranging from 3 to 10 weeks. Hydrocephalus was managed with Ommaya reservoir insertion alone in 4 cases. Regarding outcomes, follow-up information was unavailable for one infant. Of the remaining 16 cases, follow-up assessments indicated normal intellectual and motor development in 14 infants.

Neonatal Up meningitis predominantly occurs in preterm infants, with early-onset cases being the most common. The primary clinical manifestation is fever, while the incidence of neurological abnormalities is relatively low. Some infants may present with respiratory abnormalities, and the condition is frequently associated with complications such as hydrocephalus and intracranial hemorrhage. Cerebrospinal fluid analysis typically reveals an elevated WBC count, significantly increased protein levels, and markedly decreased glucose concentrations. mNGS is commonly used for the detection of Up. Macrolides and quinolones are the antibiotics of choice for treatment, while Ommaya reservoir implantation alone is the preferred approach for managing hydrocephalus. The prognosis is favorable for the vast majority of infants following treatment.

To investigate the clinical characteristics, genetic features, and diagnostic and therapeutic strategies of deficiency in ELF4, X-linked (DEX).

A child with DEX who was hospitalized at the Children′s Hospital of Soochow University in September 2022 was enrolled as the proband. Clinical data, including clinical manifestations, laboratory findings, imaging features, genetic testing results, treatment, and follow-up outcomes, were retrospectively analyzed. Whole-exome sequencing (WES) was performed to identify ELF4 gene variants, which were subsequently confirmed by Sanger sequencing, and their pathogenicity was evaluated according to the guidelines of the American College of Medical Genetics and Genomics (ACMG). A literature search was conducted using the keywords " " ELF4 deficiency" and " ELF4 mutation" in Chinese and English across the Wanfang Data, China National Knowledge Infrastructure (CNKI), Chinese Medical Journal Network, and PubMed databases. The search period ranged from inception to December 30, 2025. This study was approved by the Medical Ethics Committee of the Children′s Hospital of Soochow University (Approval No. 2024CS087), and written informed consent was obtained from the patient′s guardian.

①The proband was a 4-year-10-month-old boy, the second-born of a twin pregnancy. His main clinical manifestations included perianal abscess, recurrent fever, abdominal pain, and oral ulcers. Colonoscopy revealed a large ulcer in the ileocecal region. WES identified a missense variant in the ELF4 gene (NM_001421.3), c.799C>T (p.R267W), located within the ETS domain. Sanger sequencing confirmed that the variant was maternally inherited, and it was classified as likely pathogenic according to the ACMG guidelines. Immunological evaluation indicated abnormalities in certain T- and B-lymphocyte subsets. The patient′s condition gradually improved following combined treatment with glucocorticoids, immunosuppressants, and biologic agents. His monozygotic twin brother presented only with recurrent oral ulcers and had milder symptoms. ②Literature review: A total of 29 pediatric patients with DEX were included. Among them, 89.7% (26/29) were male, and 64.3% (18/28) had disease onset at ≤6 years of age. The main clinical manifestations included oral ulcers (86.2%, 25/29), gastrointestinal symptoms (69.0%, 20/29), and fever (58.6%, 17/29). Glucocorticoids and biologic agents were the main therapeutic options. Overall, 72.4% (21/29) of patients achieved clinical remission after treatment, of whom 76.2% (16/21) required combination therapy. One patient maintained remission without medication, and one patient died due to multiple lymphomas. A total of 23 distinct ELF4 gene variants were identified in the 29 patients, with missense and frameshift variants being the most common, each accounting for 39.1% (9/23). Notably, 87.0% (20/23) of the variants involved the ETS domain, and variants affecting this domain were more likely to be associated with an autoinflammatory phenotype.

DEX exhibits marked clinical heterogeneity, and most patients require combination therapy for disease control. The disease predominantly presents with autoinflammatory features and may manifest as inflammatory bowel disease-like or Behçet′s disease-like phenotypes. ELF4 variants are mainly clustered in the ETS domain and variants involving the ETS domain of ELF4 may be associated with an autoinflammatory phenotype. Given that effective disease control often requires multi-drug therapy, early genetic testing should be considered in patients with early onset, atypical clinical manifestations, or poor response to treatment to establish a definitive diagnosis and guide individualized therapy.

To raise the awareness of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), which presents as tumefactive demyelinating lesions, and to improve the early diagnosis and treatment, and to avoid the misdiagnosis and inappropriate management.

The clinical data and management of a patient with MOGAD admitted to the Affiliated Hospital of Jining Medical University on December 30th, 2024 were analyzed, retrospectively, and relevant literature were reviewed.

A 60-year-old female patient presented with dizziness and headache lasting more than 20 days, as well as unsteady gait and aphasia for 6 days, whose clinical presentation was consistent with a brain tumefactive demyelinating lesions. The patient’s serum and cerebrospinal fluid samples were both positive for anti-myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) antibodies at a titre of 1∶10+. Cranial magnetic resonance imaging (MRI) revealed subcortical brain tissue swelling with abnormal signals in the bilateral temporal and frontal lobes, presenting as tumour-like changes. A diagnosis of MOG-associated demyelinating encephalopathy (MOGAD) was confirmed. The patient was treated with a corticosteroid pulse therapy of 500 mg/d of methylprednisolone, gradually tapered to 62.5 mg/d, followed by combination therapy with the immunosuppressant mycophenolate mofetil capsules, resulting in significant symptom relief. A follow-up MRI performed longer than three months after discharge showed that the abnormal intracranial signals had resolved by approximately 70% compared with the previous scan, with a favourable prognosis.

The clinical presentation of MOG is complex and requires differential diagnosis from other central nervous system disorders, and the importance of MOG-IgG testing must be given high priority to avoid misdiagnosis and inappropriate treatment.