OBJECTIVE To investigate the protective effect of 2-dodecyl-6-methoxy-2，5-diene-1，4-cyclohexanedione （DMDD）， an active component from Averrhoa carambola root， on myocardial injury in diabetic mice based on the nuclear receptor coactivator 4/ferritin heavy chain 1/autophagy-related protein 8 （NCOA4/FTH1/ATG8） axis. METHODS The successfully modeled diabetic mice were randomly divided into model group and DMDD low-， medium-， and high-dose （12.5， 25， 50 mg/kg） groups， while an additional non-modeled control group was established， with 6 mice in each group. Each group received the corresponding drug solution or an equal volume of normal saline intragastically once daily for 21 consecutive days. After the administration， the levels of fasting blood glucose （FBG）， serum lactate dehydrogenase （LDH）， and creatine kinase isoenzyme MB （CK-MB） were measured. Myocardial pathological changes， degree of fibrosis， and myocardial cell ultrastructure were observed. Myocardial cell death index and NCOA4 protein positive index were detected. The protein expression levels of NCOA4， FTH1， ATG8， solute carrier family 7 member 11 （SLC7A11）， and glutathione peroxidase 4 （GPX4） in cardiac tissue were measured. RESULTS Compared with model group， each DMDD group showed significant alleviation of cardiac pathological injury and varying degrees of improvement in the myocardial cell ultrastructure. The FBG and serum LDH and CK-MB levels， the myocardial cell death index and NCOA4 protein positive index，the protein expression levels of NCOA4， FTH1， and ATG8 in cardiac tissue were significantly decreased （ P ＜0.001）， while the protein expression levels of SLC7A11 and GPX4 were significantly increased （ P ＜0.001）. CONCLUSIONS DMDD can reduce blood glucose levels， alleviate myocardial histopathological injury， and inhibit cell death in diabetic mice. The mechanism is associated with inhibiting excessive activation of the NCOA4/FTH1/ATG8 axis and reducing ferritinophagy.

This study retrospectively analyzed 12 patients with transfusion-dependent, non-severe aplastic anemia (TD-NSAA) refractory to cyclosporine A (CsA) , who were treated with lusutrombopag monotherapy. These patients either had a variety of chronic comorbidities or medication-related risks, or they were unresponsive to or intolerant of other thrombopoietin receptor agonists (TPO-RA) . The median treatment duration with lusutrombopag was 4 months (range: 3-11 months) , while the median follow-up period was 8 months (range: 6-11 months) . The overall response (OR) rates at months 3, 6, and the end of follow-up were 50.0%, 58.3%, and 50.0%, respectively, with a median time to OR of 2 months (range: 1-4 months) . Complete response (CR) rates were 8.3%, 16.7%, and 16.7% at the same time points, with a median time to CR of 4 months (range: 2-5 months) . Adverse events were all Grade 1, with an incidence rate of 25.0%. During follow-up, one patient experienced a loss of OR after discontinuing treatment, with a relapse rate of 14.3%; no clonal evolution or mortality was observed. These findings suggest that lusutrombopag is both effective and well-tolerated in CsA-refractory TD-NSAA patients and represents a promising therapeutic option for those with poor treatment tolerability.

Objective To investigate the risk factors for mortality and bleeding complications in extracorporeal membrane oxygenation(ECMO)treated patients and to evaluate the impact of thrombocytopenia severity on the prognosis of ECMO therapy.Methods A total of 153 patients who received ECMO treatment at Peking University Third Hospital between January 2013 and September 2024 were en-rolled in this study.The patients were divided into death group(n=97)and recovery group(n=56)based on their final outcomes.Additionally,the patients were categorized into bleeding group(n=104)and non-bleeding group(n=49)based on the occurrence of bleeding complications during ECMO.Clinical baseline characteristics and extreme laboratory values during ECMO were compared be-tween groups.Logistic regression was used to analyze the risk factors for mortality and bleeding.The patients were further divided,based on the initial platelet(PLT)values on the day of catheter placement and the lowest platelet count during ECMO,into normal group(PLT≥ 100× 109/L),moderate reduction group[PLT=(50～99)× 109/L],and severe reduction group(PLT＜50× 109/L).Kaplan-Meier analysis was used to compare survival rates among these groups.The patients in the moderate and severe reduction groups were further divided into a platelet transfusion group and a non-transfusion group,and the outcomes and complication rates were com-pared.Results The recovery group had a higher proportion of myocarditis,higher minimum values of PLT,Hb,and Fib,and higher initial PLT values,while the maximum values of lactic dehydrogenase(LDH),total bilirubin(T-Bil),prothrombin time(PT),and procalcitonin(PCT)were lower(all P＜0.05)with significant differences.Logistic regression showed that age and maximum PCT were independent risk factors for mortality(OR=1.025 and 1.015 respectively,all P＜0.05).The bleeding group had longer ECMO dura-tions,more plasma transfusions,lower minimum Hb values,and higher maximum values of WBC,neutrophils(Neu),and APTT(all P＜0.05)with statistical differences.The minimum PLT value,maximum WBC value,and maximum APTT value were independent risk factors for bleeding complications(OR=0.986,1.062,and 1.004 respectively,all P＜0.05).Kaplan-Meier analysis showed that the patients in the severe reduction group had lower survival rates,regardless of whether the grouping was based on initial or minimum platelet counts(all P＜0.05).Platelet transfusion improved the mortality in the severe reduction group(P＜0.05)but had no effect on the moderate reduction group.Conclusion Age and peak value of PCT are the risk factors for mortality in ECMO patients,while mini-mum PLT count,peak value of WBC and APTT are the risk factors for bleeding complications.Early intervention for infection and in-flammation during ECMO may improve the outcome of patients.Severe thrombocytopenia during ECMO therapy increased the risk of mortality,and targeted platelet transfusion may improve the survival of these patients.

As a unique type of job burnout,caregiving burnout not only reduces the quality of care,but also significant impacts the physical and mental health of both caregivers and care recipinets,extending its affects to families and society at large.This paper reviews the concept,measurement tools,and theoretical models of caregiv-ing burnout;and examines its antecedent and consequential variables.Future research should focus on distinguishing between formal and informal caregiving burnout,improving measurement methods,and developing effective inter-vention strategy tailoered to Chinese culture context.

Parental burnout is a set of negative symptoms resulting from parenting roles and chronic paren-ting stress,such as feelings of depletion associated with the parenting role and maintaining emotional distance from children.This paper analyzes a representative body of literature on parental burnout published through 2023 and pro-vides an overview of the literature around parental burnout definition and measurement,antecedent variables,and consequential variables.The results indicate that demographic variables,individual and family factors can influence parental burnout,and that the consequences of parental burnout are primarily reflected in the parents themselves and their children.The prevalence of parental burnout is influenced by sociocultural factors,but the mechanism of action is unclear and there is less research on interventions for parental burnout.Future research should pay full attention to the role and place of sociocultural factors in the study of parental burnout and actively pursue intervention research on parental burnout.

Objective:To revise the Effort-Reward Imbalance in Household and Family Work(ERI-HF)in a sample of middle school parents,and examine its adaptation.Methods:The Parenting Behavior Effort-Reward Im-balance Scale(ERI-PB)was formed by translating and linguistically adjusting ERI-HF,combining with expert eval-uation results.Parents of 1 062 seventh-grade students in a middle school were selected and surveyed twice with an interval of one and a half months on a family basis.The Perceived Partner Responsiveness Scale(PPRS),Parenting Anxiety Questionnaire(PAQ),and Satisfaction with Marital Scale(SMS)were used to test the criterion-related va-lidity.Results:There were 22 items in ERI-PB,which contained 3 factors of effort,reward,and over-commitment,the factor load of each factor was 0.39-0.84,and the cumulative variance explanation rate was 47.27％.The ab-solute values of correlations between the scores of effort,reward,over-commitment and PPRS,PAQ,SMS were 0.14-0.53(Ps＜0.01).The Cronbach α coefficients of the three factors were 0.76-0.91,the McDonaldωcoef-ficients were 0.76-0.91,and the retest reliabilities(ICC)were 0.50-0.70.Conclusion:The ERI-PB shows good validity and reliability in a group of parents of middle school students.

As a unique type of job burnout,caregiving burnout not only reduces the quality of care,but also significant impacts the physical and mental health of both caregivers and care recipinets,extending its affects to families and society at large.This paper reviews the concept,measurement tools,and theoretical models of caregiv-ing burnout;and examines its antecedent and consequential variables.Future research should focus on distinguishing between formal and informal caregiving burnout,improving measurement methods,and developing effective inter-vention strategy tailoered to Chinese culture context.

Parental burnout is a set of negative symptoms resulting from parenting roles and chronic paren-ting stress,such as feelings of depletion associated with the parenting role and maintaining emotional distance from children.This paper analyzes a representative body of literature on parental burnout published through 2023 and pro-vides an overview of the literature around parental burnout definition and measurement,antecedent variables,and consequential variables.The results indicate that demographic variables,individual and family factors can influence parental burnout,and that the consequences of parental burnout are primarily reflected in the parents themselves and their children.The prevalence of parental burnout is influenced by sociocultural factors,but the mechanism of action is unclear and there is less research on interventions for parental burnout.Future research should pay full attention to the role and place of sociocultural factors in the study of parental burnout and actively pursue intervention research on parental burnout.

Objective:To revise the Effort-Reward Imbalance in Household and Family Work(ERI-HF)in a sample of middle school parents,and examine its adaptation.Methods:The Parenting Behavior Effort-Reward Im-balance Scale(ERI-PB)was formed by translating and linguistically adjusting ERI-HF,combining with expert eval-uation results.Parents of 1 062 seventh-grade students in a middle school were selected and surveyed twice with an interval of one and a half months on a family basis.The Perceived Partner Responsiveness Scale(PPRS),Parenting Anxiety Questionnaire(PAQ),and Satisfaction with Marital Scale(SMS)were used to test the criterion-related va-lidity.Results:There were 22 items in ERI-PB,which contained 3 factors of effort,reward,and over-commitment,the factor load of each factor was 0.39-0.84,and the cumulative variance explanation rate was 47.27％.The ab-solute values of correlations between the scores of effort,reward,over-commitment and PPRS,PAQ,SMS were 0.14-0.53(Ps＜0.01).The Cronbach α coefficients of the three factors were 0.76-0.91,the McDonaldωcoef-ficients were 0.76-0.91,and the retest reliabilities(ICC)were 0.50-0.70.Conclusion:The ERI-PB shows good validity and reliability in a group of parents of middle school students.

Objective To investigate the risk factors for mortality and bleeding complications in extracorporeal membrane oxygenation(ECMO)treated patients and to evaluate the impact of thrombocytopenia severity on the prognosis of ECMO therapy.Methods A total of 153 patients who received ECMO treatment at Peking University Third Hospital between January 2013 and September 2024 were en-rolled in this study.The patients were divided into death group(n=97)and recovery group(n=56)based on their final outcomes.Additionally,the patients were categorized into bleeding group(n=104)and non-bleeding group(n=49)based on the occurrence of bleeding complications during ECMO.Clinical baseline characteristics and extreme laboratory values during ECMO were compared be-tween groups.Logistic regression was used to analyze the risk factors for mortality and bleeding.The patients were further divided,based on the initial platelet(PLT)values on the day of catheter placement and the lowest platelet count during ECMO,into normal group(PLT≥ 100× 109/L),moderate reduction group[PLT=(50～99)× 109/L],and severe reduction group(PLT＜50× 109/L).Kaplan-Meier analysis was used to compare survival rates among these groups.The patients in the moderate and severe reduction groups were further divided into a platelet transfusion group and a non-transfusion group,and the outcomes and complication rates were com-pared.Results The recovery group had a higher proportion of myocarditis,higher minimum values of PLT,Hb,and Fib,and higher initial PLT values,while the maximum values of lactic dehydrogenase(LDH),total bilirubin(T-Bil),prothrombin time(PT),and procalcitonin(PCT)were lower(all P＜0.05)with significant differences.Logistic regression showed that age and maximum PCT were independent risk factors for mortality(OR=1.025 and 1.015 respectively,all P＜0.05).The bleeding group had longer ECMO dura-tions,more plasma transfusions,lower minimum Hb values,and higher maximum values of WBC,neutrophils(Neu),and APTT(all P＜0.05)with statistical differences.The minimum PLT value,maximum WBC value,and maximum APTT value were independent risk factors for bleeding complications(OR=0.986,1.062,and 1.004 respectively,all P＜0.05).Kaplan-Meier analysis showed that the patients in the severe reduction group had lower survival rates,regardless of whether the grouping was based on initial or minimum platelet counts(all P＜0.05).Platelet transfusion improved the mortality in the severe reduction group(P＜0.05)but had no effect on the moderate reduction group.Conclusion Age and peak value of PCT are the risk factors for mortality in ECMO patients,while mini-mum PLT count,peak value of WBC and APTT are the risk factors for bleeding complications.Early intervention for infection and in-flammation during ECMO may improve the outcome of patients.Severe thrombocytopenia during ECMO therapy increased the risk of mortality,and targeted platelet transfusion may improve the survival of these patients.