Objective To develop a risk assessment scale for immune checkpoint inhibitor (ICI)-associated myocarditis based on multidisciplinary collaboration, and to evaluate its diagnostic performance. Methods Based on multidisciplinary cooperation, integrating clinical experience from oncology and cardiology, literature data, and patient conditions, a risk assessment scale for ICI-associated myocarditis was developed. A total of 101 patients with malignancies who received immunotherapy at Zhongshan Hospital, Fudan University, from October 2020 to October 2024 were included as the validation cohort. Patients were stratified into low-risk (0-1 point), medium-risk (2-4 points), and high-risk (≥5 points) groups based on their scale scores. The association between pretictive risk stratifications and actual assessment results was assessed using the Cox proportional hazards regression model. The predictive value of the scale for ICI-associated myocarditis was evaluated using receiver operating characteristic (ROC) curve. Agreement between the scale scores and actual assessment results was assessed using Cohen’s Kappa coefficient. Results Based on the scale pretictive results, 28(27.7%), 8(7.9%), 65(64.4%) patients were at low risk, medium risk, and high risk for ICI-related myocarditis, respectively; however, 46(45.5%), 8(7.9%), 47(46.5%) were at low risk, medium risk, and high risk actually. Kaplan-Meier survival analysis showed that the cumulative incidence of ICI-related myocarditis in the high-risk group was significantly higher than that in the medium- and low-risk groups (P＜0.05). In the multivariable-adjusted Cox proportional hazards model, the ICI-related myocarditis risk in high-risk group was about 4 times that in the low-risk group. ROC curve analysis demonstrated that the average area under the curve (AUC) for predicting ICI-related myocarditis was 0.81, with an accuracy of 0.74. The Cohen’s Kappa coefficient was 0.55, indicating moderate agreement. In the actual high-risk group, no patient was predicted to be at low risk; in the actual low-risk group, 16 patients were predicted to be at high risk. Conclusions This risk assessment scale for ICI-associated myocarditis shows high predictive performance. It provides oncologists with a simple yet effective multidisciplinary diagnostic reference tool, potentially enhancing early identification of ICI-associated myocarditis.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective To explore the clinical effect of balanced cupping intervention in treatment of patients with primary dysmenorrhea differentiated as type of qi stagnation and blood stasis Methods A total of 64 patients with primary dysmenorrhea differentiated as type of qi stagnation and blood stasis in the First Affiliated Hospital of Henan University of Chinese Medicine from January 2020 to December 2021 were selected as the research objects, and they were divided into observation group and control group according to the order of consultation and patients' wishes, with 32 cases in each group. The control group received routine health guidance for dysmenorrhea, while the observation group received balanced cupping intervention on the basis of the control group. The Visual Analogue Scale (VAS) score, dysmenorrhea symptom score, serum prostaglandin E₂ (PGE₂), estradiol (E₂), menstrual onset time, menstrual cycle, menstrual volume, and efficacy were compared between the two groups before and after treatment. Results There were significant differences in VAS scores during the 1st, 2nd and 3rd menstruation compared with those before intervention between the two groups (P<0.05); the VAS scores of the observation group during the 1st, 2nd and 3rd menstruation were significantly lower than those of the control group (P<0.05). There were significant differences in dysmenorrhea symptom scores during the 1st, 2nd and 3rd menstruation with those before intervention between the two groups (P<0.05); the dysmenorrhea symptom score of the observation group during the 1st, 2nd and 3rd menstruation was significantly lower than those of the control group (P<0.05). The total effective rate of the observation group was significantly higher than that of the control group (P<0.05). There were significant differences in PGE₂ and E₂ levels during the 1st, 2nd and 3rd menstruation with those before intervention between the two groups (P<0.05). There were significant differences in PGE₂ and E₂ levels between the two groups during the 1st, 2nd and 3rd menstruation (P<0.05). There were no significant differences in menstrual cycle, menstrual duration and menstrual volume between the two groups (P>0.05). Conclusion Balanced cupping intervention has a good effect and high safety in the treatment of patients with primary dysmenorrhea differentiated as type of qi stagnation and blood stasis.

Objectives:To explore the early clinical efficacies of unilateral decompression and bilateral decompression by one-hole split endoscope(OSE)technique for moderate-severe lumbar spinal stenosis(LSS)with unilateral symptoms amongst middle aged and elderly people.Methods:A retrospective analysis was performed on the patients with moderate-severe LSS who underwent unilateral decompression and bilateral decompression using OSE technique between January 2021 and December 2021.According to the inclusion and exclusion criteria,a total of 120 patients were enrolled in this study,with 60 patients in the unilateral decompression group(group A)and 60 patients in the bilateral decompression group(group B).The length of hospitalization,operative time,incision length and intraoperative blood loss were counted and compared between group A and group B.Moreover,range of motion(ROM)and sagittal translation(ST)on lumbar dynamic X-ray,facet preservation rate on the approach side,and cross-sectional area of the canal(CAC)of the surgical segment before and after operation were recorded and compared.The visual analogue scale(VAS)of back and leg pain was used before surgery,and at 7 days,3 months and 18 months after surgery,the Oswestry disability index(ODI)was used to evaluate the functional improvement,and the clinical efficacy was evaluated by modified Macnab criteria at the last follow-up.All the clinical scores of both groups were analyzed and compared between before and after surgery.Results:All the patients underwent surgical inter-vention successfully.There was no statistical significance in the length of hospitalization between groups A and B(P＞0.05),but group B was longer in operative time,bigger in incision,and more in blood loss than group A,with statistical significance(P＜0.05).The VAS for back and leg pain and the ODI after operation in both groups were all significantly lower than those before surgery,respectively(P＜0.05),and the values at each postoperative time point within group were significantly different when compared pairwise(P＜0.05);There was no significant difference between the two groups before surgery(P＞0.05),but group B had more significant improvement than group A at 7 days,3 months and 18 months after surgery(P＜0.05).There was no statistical significance in ST and ROM of surgical segment before and after surgery between the two groups(P＞0.05).The postoperative facet preservation rate was higher in group B than in group A(P＜0.05).There was no sig-nificant difference in the CAC of the surgery segment before operation between the two groups(P＞0.05),how-ever,the CAC of the surgical segment in group B was larger than that in group A(P＜0.05).The rate of im-provement in CAC was higher in group B than in group A(P＜0.05).The CAC of the surgical segment postop-eratively in both groups were significantly larger than before surgery,with statistical significance(P＜0.05).Ex-cellent-good rate at 18 months after surgery was 86.7％in group A and 91.7％in group B.There was no significant difference in the number of excellent and good cases between the two groups at 18 months after operation(P＞0.05).One patient in group A had numbness and discomfort in the lower limb on the healthy side after surgery,and one case with mild dural tear in group B.Conclusions:Both unilateral decompression and bilateral decompression under OSE are safe and effective in the treatment of moderate and severe central canal and bilateral lateral recess stenosis with unilateral symptoms in the middle-aged and elderly people,with definite early clinical efficacy.Bilateral decompression is more complete and better in clinical efficacy than unilateral decompression,but further follow-up is required in the long term.

The prevention and control of chronic and non-communicable diseases is an important public health problem in China. The general environment in the northwestern China is unique, and the health and disease status of local population is distinctive. In order to meet the urgent need for in-depth research of the causes, mechanisms and prognosis of chronic and non-communicable diseases in this area, a general population cohort in Shaanxi Province, Gansu Province and Qinghai Province, Ningxia Hui Autonomous Region and Xinjiang Uygur Autonomous Region was established during 2017-2019. A total of 117 644 general individuals aged 35-74 years in the multi-ethnic groups (Han, Hui, Uygur, Kazak and Tibetan) were recruited according to the special ecological environment, population size and ethnic distribution. The baseline information about individual exposure, environment and society were collected. More than 900 000 biological samples, including whole blood, plasma, serum and buffy coat, were collected and stored at -80 ℃ in standardized biobank. The long-term observation has started in forms of routine monitoring and active follow-up. The average age of the cohort members was 52.43 years, and 70 391 cohort members were women (59.8%). There were some differences in socio-economic status and lifestyle among different ethnic groups. Although the cohort members in different ethnic groups had similar health status, different characteristics still existed. The cohort can serve as a platform for in-depth research of the relationship between major chronic and non-communicable diseases and environment, people's lifestyle and genetic factors, and the research results can be used as important epidemiological evidence for clarifying the causes of chronic and non-communicable diseases and long-term health hazards in different ethnic groups in this area and reference for the national chronic and non-communicable disease prevention and control. This paper briefly introduces the design and practice of general population cohort in northwestern China.

In 2016, a national one million general population cohort project was set up in China for the first time in "Precision Medicine Research" Key Project, National Key Research and Development Program of China, which consists of general population cohorts in seven areas in China. As one of the seven major areas in China, northeastern China has unique climate and specific dietary patterns, and population aging is serious in this area. And the burden of chronic and non-communicable diseases ranks tops in China. Therefore, it is of great significance to establish a large general population cohort in northeastern China to explore the area specific exposure factors related to pathogenesis and prognosis of chronic and non-communicable diseases, develop new prevention strategies to reduce the burden of the diseases and improve the population health in northeastern China. In July 2018, the general population cohort study in northeastern China was launched, the study includes questionnaire survey, health examination and blood, urine and stool sample collection and detection in recruited participants. By now, the cohort has covered all age groups, and the baseline data of 115 414 persons have been collected. This paper summarizes the design and practice of the general population cohort study in northeastern China to provide reference for related research in China.

Objective To investigate the changing trend and correlation of platelet count and spleen diameter in patients with digestive system malignancy receiving oxaliplatin-based chemotherapy. Methods We retrospectively analyzed clinical data of 72 patients with digestive system cancer, recorded and analyzed platelet count and spleen diameter during and after oxaliplatin-based chemotherapy. Results The incidence of thrombocytopenia in all patients was 65.3%. The median time of thrombocytopenia after the beginning of chemotherapy was 2.53±0.49 months, and the median cumulative dose of oxaliplatin was 520±35.81 mg/m²; the median time of lowest platelet count after the beginning of chemotherapy was 4.03±0.49 months, and the median cumulative dose of oxaliplatin was 780±36.32 mg/m². Splenomegaly occurred in 52(72.2%) patients during the follow-up. The median increase rate was (18.82±0.01)%. The median time of splenomegaly after the beginning of chemotherapy was 2.15±0.19 months, the median time for the largest spleen diameter was 4.68±2.89 months; after the end of chemotherapy, the median time for spleen contraction was 3.28±0.44 months, and the median time for spleen recovery was 8.80±1.05 months. Conclusion Oxaliplatin-based chemotherapy can cause thrombocytopenia and splenomegaly, and it is difficult to recover to baseline for a long time after the end of chemotherapy. The increase of spleen diameter was positively correlated with splenomegaly and thrombocytosis.

Objective:To explore the profile and gene functional changes of gut microbiota (GM) in women with postmenopausal osteoporosis (PMOP) in Northwest China, and the correlations between GM and bone mineral density (BMD).Methods:From November 2018 to October 2019, postmenopausal women were screened on their initial visits to our hospital, and 24 new osteoporosis (OP) patients, 30 new osteopenia patients and nine negative controls were recruited. Fecal samples were collected for GM DNA extraction, and Illumina platforms were used for high-throughput sequencing of 16S rRNA and metagenome. Species annotation, GM profile and gene functions were viewed and analyzed.Results:GM profiles were significatly different in different groups, and the LDA scores of Peptostreptococcaceae, Romboutsia, unidentified Clostridiales, Megamonas, Erysipelatoclostridium, Klebsiella and Erysipelatoclostridium ramosum were more than 3 in OP group. Metagenomic sequencing analysis indicated that gene numbers were positively correlated with BMD, and metabolism, carbohydrate metabolism, starch and sucrose metabolism and oxidative phosphorylation were negatively correlated with BMD. Receiver operating characteristic curve(ROC) showed that carbohydrate metabolism, starch and sucrose metabolism, amino sugar and nucleotide sugar metabolism, oxidative phosphorylation, respectively, could identify OP with preferable sensitivity and specificity (areas under curve were 0.70, 0.72, 0.73 and 0.75, respectively). Conclusions:High-throughput sequencing had great potential for GM analysis of postmenopausal women with OP, providing evidence of the correlations between GM and BMD.

OBJECTIVE：To establish a method for the content determination of to tal flavonoids from Amomum tsao-ko ，and to optimize the purification technology by macroporous resin. METHODS ：The content of total flavonoids was measured by HPLC. The determination was performed on Eclipse Plus C 18 column with mobile phase consisted of acetonitrile- 1％ acetic acid solution （15∶85，V/V）at the flow rate of 0.8 mL/min. The column temperature was 40 ℃，and the detection wavelength was set at 256 nm. The sample size was 10 μL. Taking the adsorption and desorption performance as indexes，6 kinds of macroporous resins were screened out by static adsorption and desorption tests ；adsorption and desorption time were investigated by static adsorption and desorption kinetics tests. Using the content of total flavonoids （calculated by rutin ）as index ，with sample concentration ，sample pH，ethanol volume fraction and elution amount as factors ，based on single factor test ，orthogonal design was used to optimize the purification technology of total flavonoids from A. tsao-ko ，and validation test was performed. RESULTS ：The linear range of rutin were 0.028-0.281 mg/mL（r＝0.999 9）. The limit of quantification was 437.5 ng/mL and the limit of detection was 109.4 ng/mL. RSDs of precision ，stability and reproducibility tests were all lower than 2％；the recoveries were 96.24％-99.75％（RSD＜2％，n＝ 6）. The comprehensive capacity of adsorption and desorption of HPD 450 macroporous resin was the most suitable ，and the best static adsorption and desorption time both were 12 h. The optimal purification technology was 1.854 4 mg/mL ； ethanol elution was 8 times of the column volume. Vertificationtests show that after optimized ，the content of total flavonoids from A. tsao-ko increased from 22.556 7 mg/g to 57.728 2 mg/g. The purity of was 2.56 and stable for the content determination. Optimal purification technology is stable and feasible ，which is suitable for purifieation of total flavonoids from A. tsao-ko .