ObjectiveTo establish a mouse model of rheumatoid arthritis with interstitial lung disease （RA-ILD） in DBA/1 mice using Porphyromonas gingivalis （Pg） infection combined with collagen-induced arthritis （CIA）， and to comprehensively evaluate pathological characteristics in joints， lungs， and serum. MethodsForty DBA/1 mice were randomly divided into four groups， i.e.， Control， Pg infection （Pg）， CIA， and Pg infection combined with CIA （Pg+CIA）， with 10 mice in each group. Arthritis clinical symptoms were evaluated by recording arthritis incidence and clinical scores. Micro-CT scanning was used to assess knee joint pathology. Histopathological changes and collagen deposition in knee joints and lung tissues were analyzed using hematoxylin-eosin （HE） and Masson staining. Immunohistochemistry was performed to detect protein expression of α-smooth muscle actin （α-SMA）， typeⅠ collagen （ColⅠ）， and fibronectin （FN） in lung tissues. Real-time quantitative polymerase chain reaction（Real-time PCR）was used to measure mRNA expression levels of α-SMA， ColⅠ， FN， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and IL-1β in lung tissues. Enzyme-linked immunosorbent assay （ELISA） was used to detect serum levels of Pg， cyclic citrullinated peptide （CCP）， and immunoglobulin G （IgG）. ResultsJoint lesions： The CIA and Pg+CIA groups showed 100% arthritis incidence， with evident joint redness， swelling， and deformity. The number of affected limbs was 27 and 28， and clinical scores were 68 and 70， respectively. No obvious clinical symptoms were observed in the Pg group. Histopathological and imaging analyses showed severe joint lesions in the CIA and Pg+CIA groups， with significantly increased histopathological scores， bone mineral density， bone volume fraction， trabecular thickness， and trabecular number compared to the Control group （P<0.01）. No obvious joint pathology was observed in the Pg group. Lung lesions： The Pg+CIA group exhibited marked alveolar inflammation， interstitial inflammatory cell infiltration， and alveolar wall thickening， with pronounced blue staining of collagen fibers. Histopathological scores and collagen area ratios were significantly higher than those of the Control， Pg， and CIA groups （P<0.05）. Lung protein and mRNA expression levels of α-SMA， ColⅠ， and FN were markedly increased， and mRNA levels of IL-6， TNF-α， and IL-1β were significantly elevated compared to the Control group （P<0.05）. Serology： The Pg+CIA group showed significantly higher levels of CCP， Pg， and IgG compared with the Control， Pg， and CIA groups （P<0.05）. ConclusionDBA/1 mice subjected to Pg infection combined with CIA exhibited pronounced symptoms and pathological features of RA-ILD， along with elevated serum anti-CCP antibody levels. This model represents a novel RA-ILD mouse model， providing a valuable experimental tool for investigating RA-ILD pathogenesis and developing new therapeutics， and serves as a basis for establishing anti-cyclic citrullinated peptide antibody （ACPA）-positive RA-ILD animal models.

OBJECTIVE T o explore the long-term effect of multidimensional evidence-based interventions based on i-PARIHS theoretical framework on reduction of incidence of central line-associated bloodstream infections(CLABSI)in pediatric intensive care units(PICU)of pediatrics department and evaluate the impact on nurses'compliance to taking the interventions and use intensity of catheters.METHODS By means of quasi-experimental design,the multidimensional intervention system covering multidisciplinary collaboration,standardized operation procedures,information system optimization and hierarchical training was established and staged for implementa-tion of 5 years(from T0 baseline stage to T3 maintenance stage).The variations in implementation rates of cathe-ter maintenance(daily maintenance,dressings change,catheter removal)were analyzed by Chi-square test,and the change of incidence of CLABSI was monitored with the use of statistical process control U chart.RESULTS The nurses'compliance to operations was remarkably improved(P＜0.05)o The implementation rate of dressings change continuously increased from 52.91％in T0 to81.62％in T3(x2=72.444,P＜0.001),the implementa-tion rate of catheter removal increased from 48.72％to 79.31％(x2=8.179,P=0.042).The incidence rate of CLABSI decreased from 1.92％0 in 2019 to 0.5％0 in 2022,and the control chart showed that most of the months fluctuated within control limits.CONCLUSIONS The multidimensional evidence-based interventions can achieve a long term control of CLABSI by raising the nurses' compliance to operations.The information monitoring and closed-loop management are crucial to maintenance of the interventional effect,and the risk early warning system should be optimized with the combination of artificial intelligence technology.

Stereotactic radiotherapy is widely favored because of its high treatment precision and less fractionations.ZND-A is a new domestic gamma-ray cone-beam focused stereotactic radiotherapy system.Herein the technical characteristics of ZND-A system are described in detail from the aspects of the treatment frame,gamma-ray module,collimator module,six-dimensional treatment couch module and image-guided system module,and the main parameters are compared with the mainstream gamma knife equipments at home and abroad.With reference to Response Evaluation Criteria in Solid Tumors(RECIST 1.1),the initial efficacy of the patients treated by the ZND-A system is analyzed to evaluate the advantages and disadvantages of the ZND-A system for providing a reference for the hospital clinical use of this type of gamma knife.

Objective:To investigate the impact of high-dose fractionated irradiation on NK cell function and immune checkpoint expression.Methods:A total of 10 female C57BL/6N mice aged 6-8 weeks were subcutaneously injected with Lewis lung carcinoma (LLC) cells on the right shoulder to establish a subcutaneous tumor model. Mice were randomly divided into two groups: the control (Ctrl) group and the radiation (RT) group, with five mice in each group. The RT group received fractionated irradiation of 8 Gy × 3 fractions, while the Ctrl group was not irradiated. Three days later, flow cytometry was performed to compare the numbers of NK cells and the expressions of immune checkpoints, including programmed death-1 (PD-1) and T-cell immunoreceptor with Ig and ITIM domains (TIGIT), in the spleen, draining lymph nodes, and tumor tissue between the two groups. The activation state and cytotoxicity of NK cells were assessed by the expression of lysosomal-associated membrane protein 1 (CD107a) on the NK cell surface. Additionally, a second experiment was conducted with 20 tumor-bearing mice divided into four groups: Ctrl, RT, anti-TIGIT (αTIGIT) treatment, and RT combined with αTIGIT treatment (RT+ αTIGIT), with five mice per group. The RT and RT+ αTIGIT groups received fractionated RT, while the αTIGIT and RT+ αTIGIT groups were treated with blocking antibody αTIGIT at 0.5 mg/kg every 3 days and the Ctrl group was treated with isotype control IgG. Tumor size was monitored during the experiment. On day 20, mice were euthanized, Ki67 immunohistochemistry and TUNEL immunofluorescence staining were used to evaluate tumor cell proliferation and apoptosis.Results:Compared with the Ctrl group, fractionated high-dose RT resulted in a decrease in NK cell numbers in the spleen, tumor-draining lymph nodes, and tumor microenvironment in the RT group ( t=6.79-7.54, P<0.05), together with a significant upregulation of the mean fluorescence intensity of PD-1 and TIGIT ( t=4.16-5.65, P<0.05; t=6.12-21.13, P<0.05), and a decrease in CD107a+ expression ( t=5.64-8.99, P<0.05). Compared with the RT group, the RT+ αTIGIT group showed reduced tumor weight ( t=2.50, 9.12, P<0.05), decreased Ki67 expression ( t=12.10, P<0.05), and increased TUNEL expression ( t=5.42, P<0.05). Conclusions:The fractioned high-dose RT can impair NK cell function and upregulate immune checkpoint expression, thereby limiting the immune response. The combination of irradiation with anti-TIGIT antibody treatment can partially reverse this trend and improve tumor treatment efficacy.

OBJECTIVE T o explore the long-term effect of multidimensional evidence-based interventions based on i-PARIHS theoretical framework on reduction of incidence of central line-associated bloodstream infections(CLABSI)in pediatric intensive care units(PICU)of pediatrics department and evaluate the impact on nurses'compliance to taking the interventions and use intensity of catheters.METHODS By means of quasi-experimental design,the multidimensional intervention system covering multidisciplinary collaboration,standardized operation procedures,information system optimization and hierarchical training was established and staged for implementa-tion of 5 years(from T0 baseline stage to T3 maintenance stage).The variations in implementation rates of cathe-ter maintenance(daily maintenance,dressings change,catheter removal)were analyzed by Chi-square test,and the change of incidence of CLABSI was monitored with the use of statistical process control U chart.RESULTS The nurses'compliance to operations was remarkably improved(P＜0.05)o The implementation rate of dressings change continuously increased from 52.91％in T0 to81.62％in T3(x2=72.444,P＜0.001),the implementa-tion rate of catheter removal increased from 48.72％to 79.31％(x2=8.179,P=0.042).The incidence rate of CLABSI decreased from 1.92％0 in 2019 to 0.5％0 in 2022,and the control chart showed that most of the months fluctuated within control limits.CONCLUSIONS The multidimensional evidence-based interventions can achieve a long term control of CLABSI by raising the nurses' compliance to operations.The information monitoring and closed-loop management are crucial to maintenance of the interventional effect,and the risk early warning system should be optimized with the combination of artificial intelligence technology.

Objective To compare the effects of endoscopic mucosal dissection(ESD)and endoscopic mucosal resection(EMR)on gastrointestinal function in patients with early gastric cancer.Methods According to different treatment methods,86 patients with early gastric cancer were divided into the ESD group and the EMR group,with 43 cases in each group.The operation duration,postoperative exhaust time and hospital stay of the two groups were observed and compared.Inflammatory factors including interleukin(IL-6)and IL-8 before surgery and 1 month after surgery were compared between the two groups of patients.Gastrointestinal hormone indexes including motilin(MTL),gastrin(GAS),apoptosis-related factors including anti-apoptotic factor(Livin)and epidermal growth factor(EGF),European Organization for Research and Treatment of Cancer(EORTC)Quality of Life Scale(QLQ-C30)score before surgery,3 months after surgery and 6 months after surgery were compared between the two groups of patients.An adverse reaction was also compared between the two groups of patients.Results The operation time,postoperative exhaust time and hospital stay were shorter in the ESD group than those of the EMR group(P＜0.05),and the intraoperative blood loss was significantly less than that of the EMR group(P＜0.05).Compared with the pre-operation,serological indexes such as IL-6,IL-8,MTL,GAS and Livin were decreased after surgery in the two groups(P＜0.05).One month after surgery,IL-6,IL-8 and Livin were decreased,and MTL and GAS were increased in the ESD group compared with those of the EMR group(P＜0.05).QLQ-C30 scores were higher at 3 months and 6 months after operation than those before operation in both groups,and the QLQ-C30 scores of the two groups were significantly higher at 6 months after operation(P＜0.05).The scale scores of the ESD group were significantly higher than those of the EMR group at 3 months and 6 months after operation(P＜0.05).The overall incidence rates of adverse reactions were(4.65%)in the ESD group and(20.93%)in the EMR group(P＜0.05).Conclusion Compared with EMR,ESD can more effectively improve the gastrointestinal function,improve the quality of life and reduce the levels of inflammation and apoptosis-related factors in patients with early gastric cancer.

Objective:To analyze the clinical characteristics of mannose phosphate isomerase-congenital disorders of glycosylation (MPI-CDG) and evaluated the outcomes following D-mannose treatment.Methods:This case-series study analyzed clinical manifestations, laboratory findings, imaging results, genetic data, and outcomes after D-mannose therapy in 5 children with MPI-CDG diagnosed at the Children′s Hospital of Fudan University between December 2014 and December 2024.Results:The age of onset ranged from 0.3 to 0.4 years in all 5 children, who initially presented with diarrhea and hypoglycemia. Associated manifestations included short stature (3 cases), anemia (3 cases), splenomegaly (3 cases), hepatomegaly (4 cases), elevated transaminases (4 cases), and hypoalbuminemia (4 cases). Liver pathology revealed hepatic fibrosis in 3 cases. Genetic testing identified 8 variants in the MPI gene, including 2 novel variants. Following D-mannose treatment, diarrhea and hypoglycemia resolved within 1-2 weeks in all children, with concurrent improvement in anemia. Notably except for Patient 1, who developed progressive splenomegaly, worsening hepatic fibrosis, and portal hypertension despite persistently normal transaminase and albumin levels, the other 4 children showed improvement in transaminase levels, resolution of hypoalbuminemia and amelioration of imaging abnormalities.Conclusions:MPI-CDG typically manifests in infancy with diarrhea and hypoglycemia, often accompanied by multi-system involvement. D-mannose treatment significantly improves metabolic abnormalities and most organ damages. However, close surveillance of liver status is warranted due to the risk of hepatic fibrosis progression in some cases.

Objective:To assess the preliminary efficacy and safety of modified Société Internationale d′Oncologie Pédiatrique Epithelial Liver Tumor Study Group (SIOPEL)-4 protocol for pediatric hepatoblastoma (HB) with lung metastases.Methods:This prospective cohort study enrolled 27 newly diagnosed pediatric HB with lung metastases who received the modified SIOPEL-4 protocol at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, and Shanghai Children′s Hospital between January 2020 to December 2023. Clinical characteristics, lung response rates to induction chemotherapy, treatment outcomes, prognostic factors and sever chemotherapy toxicities at different stages were analyzed. Survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by Log-Rank test.Results:Of the 27 patients, there were 17 males and 10 females, with the age of 21 (15, 33) months. During the follow-up of 31 (12, 45) months for 17 continuous complete remission patients, 4 cases disease progression (2 cases death) and 6 cases relapse were observed. The 2-year event free survival (EFS) and overall survival (OS) rate was (58±11)% and (89±7)%, respectively. All the 27 patients had response to block 1-3 induction chemotherapy (cisplatin+doxorubicin), with 14 cases (52%) achieving complete response and 13 cases (48%) achieving partial response of lung metastatic lesions, the 2-year EFS rate was (81±12)% and (34±14)%, respectively ( χ 2=6.76, P=0.009), the 2-year OS rate was 100% and (79±13)%, respectively ( χ2=2.12, P=0.145). Patients with caudate lobe tumors or ≥10 pulmonary metastatic nodules had significantly lower EFS rates ( χ2=5.36, 7.84, P=0.021, 0.005, respectively). The incidence of grade 3/4 neutropenia after block 1-3 induction chemotherapy, CD (carboplatin+doxorubicin), and VI (vincristine+irinotecan) consolidation chemotherapy was 90% (73/81), 75% (58/77), and 31% (11/35), respectively. The incidence of grade 3/4 thrombocytopenia was 77% (62/81), 69% (53/77), and 14% (5/35), respectively. The incidence of grade 3/4 infections was 64% (52/81), 25% (19/77), and 20% (7/35), respectively. The differences between the groups were statistically significant ( χ2=43.51, 42.69, 33.00, all P<0.001). Two patients (10%) of the 20 evaluable patients for ototoxicity occurred grade 3 and higher hearing impairment, with 1 patient requiring a hearing aid. Conclusions:The modified SIOPEL-4 regimen shows good preliminary efficacy and safety in treating pediatric HB with lung metastases. The prognosis for patients with residual lesions in the lungs after induction chemotherapy needs to be improved. Attention should be given to the ototoxicity induced by high-dose cisplatin chemotherapy.

To summarize the nursing experience of a patient with coronary heart disease who was left in the radial artery during the removal of the radial artery sheath after coronary angiography via the radial artery pathway.Nursing points:to start the emergency transfer process,to shorten the treatment transfer time;to assist to locate the position of the sheath to provide a basis for the selection of surgical incision;to conduct dynamic assessment of hemostatic effect,prevention of radial artery occlusion;to closely monitor pain and signs to prevent vasovagal reflex;to implement the whole psychological intervention,and to reduce the psychological burden of patients and their families.The ruptured sheath tube was successfully removed by emergency surgery of vascular surgery.A total of 6 days after the operation,the patient was transferred to cardiac surgery for coronary artery bypass grafting,and was discharged 23 days later.After 3 months of follow-up,the blood supply of the limbs was good,and the incision healed well.

Objective:To retrieve, evaluate and integrate the evidence related to postoperative exercise rehabilitation for hip fracture in elderly frail patients, and provide reference for clinical rehabilitation nursing.Methods:Evidence on postoperative exercise rehabilitation of hip fractures in elderly frail patients was systemically retrieved in the guideline websites, professional association websites and databases, such as BMJ Best Practice, UpToDate, PubMed, Web of Science, CINAHL, Cochrane Library, Embase, Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang and VIP, including Best practices, guidelines, clinical decisions, evidence summaries, systematic reviews, and expert consensus. The retrieval time was from the establishment of the database to March 31, 2024.Results:A total of 33 articles were involved, including 12 guidelines, 2 clinical decisions, 7 systematic reviews, 7 expert consensuses, 5 evidence summaries. Forty pieces of evidence were summarized in 7 aspects: the role of exercise, exercise assessment, exercise planning, exercise content, exercise intensity, exercise adherence, exercise nursing, exercise guidance.Conclusions:Healthcare professionals should combine patients' tolerance, rehabilitation goals, and specific clinical situations to target and guide patients in exercise rehabilitation to promote the recovery of postoperative limb function, mitigate frailty, and improve the quality of life.