ObjectiveTo develop and validate a diagnostic prediction model for differentiating pulmonary tuberculosis from community-acquired pneumonia based on routine blood parameters. MethodsA total of 642 patients with pulmonary tuberculosis and 503 patients with community-acquired pneumonia were retrospectively enrolled from the Seventh Hospital of Tangshan. They were randomly divided into a training set and an internal validation set at a 7∶3 ratio. Additionally， 218 patients from the 981st Hospital were independently included as an external validation set. The Boruta algorithm and recursive feature elimination were employed to select predictors from 82 blood parameters， sex， and age. A multivariate Logistic regression model was established and evaluated using receiver operating characteristic （ROC） curves， calibration curves， and decision curve analysis. ResultsThe final model incorporated eight predictors， namely uric acid， urea nitrogen， alkaline phosphatase， monoamine oxidase， alanine aminotransferase， glutathione， neutrophil percentage， and age. The model achieved areas under the curve （AUCs） of 0.800 （95%CI： 0.769-0.830）， 0.787 （95%CI： 0.738-0.836）， and 0.736 （95%CI： 0.667-0.835） in the training， internal validation， and external validation sets， respectively. The model demonstrated good calibration， and decision curve analysis showed clinical net benefit within the threshold probability range of 10%-80%. ConclusionThe developed model exhibits good discriminative ability and clinical utility， serving as an effective early screening tool for primary healthcare institutions.

Objective:To explore the different categories of organizational involution among ICU nurses and its relationship with job burnout, so as to provide a basis for optimizing medical organization management strategies.Methods:From January to February 2025, 318 ICU nurses from four ClassⅢ hospitals in Taizhou City were selected as research subjects using convenience sampling. The General Information Questionnaire, Nursing Burnout Scale, and Organizational Involution Scale were used to conduct the survey. Latent profile analysis was used to identify latent categories of organizational involution among ICU nurses, and one-way analysis of variance was used to explore differences in ICU nurses' job burnout scores across different latent categories of organizational involution. A total of 318 questionnaires were distributed, and 306 valid questionnaires were returned, with a valid return rate of 96.23%.Results:The 306 ICU nurses' organizational involution was divided into three latent categories of low involution-high efficiency group (34.97%, 107/306), moderate involution-systemic consumption group (42.81%, 131/306), and high involution-total imbalance group (22.22%, 68/306). There were statistically significant differences in job burnout scores between different latent categories of organizational involution among ICU nurses ( P<0.05) . Conclusions:The overall level of organizational involution among ICU nurses is moderately high, and there is heterogeneity. There is a correlation between organizational involution and job burnout. Nursing managers should optimize organizational management, break the negative cycle of organizational involution and job burnout, and improve nurses' job satisfaction.

Malignant peritoneal mesothelioma (MPM), as a highly aggressive primary malignant tumor of the peritoneum, often leads to structural damage and functional impairment of female reproductive organs during its treatment course. This study presents a clinical case of an MPM patient who underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), subsequently achieving successful live birth through in vitro fertilization and embryo transfer. A comprehensive review of relevant literature was conducted to analyze both the potential benefits and associated risks. While the possibility of successful pregnancy exists for MPM patients following combined CRS and HIPEC treatment, significant clinical risks during the gestational process cannot be overlooked. Current evidence remains limited, necessitating more robust clinical data to substantiate these findings.

Objective:To explore the different categories of organizational involution among ICU nurses and its relationship with job burnout, so as to provide a basis for optimizing medical organization management strategies.Methods:From January to February 2025, 318 ICU nurses from four ClassⅢ hospitals in Taizhou City were selected as research subjects using convenience sampling. The General Information Questionnaire, Nursing Burnout Scale, and Organizational Involution Scale were used to conduct the survey. Latent profile analysis was used to identify latent categories of organizational involution among ICU nurses, and one-way analysis of variance was used to explore differences in ICU nurses' job burnout scores across different latent categories of organizational involution. A total of 318 questionnaires were distributed, and 306 valid questionnaires were returned, with a valid return rate of 96.23%.Results:The 306 ICU nurses' organizational involution was divided into three latent categories of low involution-high efficiency group (34.97%, 107/306), moderate involution-systemic consumption group (42.81%, 131/306), and high involution-total imbalance group (22.22%, 68/306). There were statistically significant differences in job burnout scores between different latent categories of organizational involution among ICU nurses ( P<0.05) . Conclusions:The overall level of organizational involution among ICU nurses is moderately high, and there is heterogeneity. There is a correlation between organizational involution and job burnout. Nursing managers should optimize organizational management, break the negative cycle of organizational involution and job burnout, and improve nurses' job satisfaction.

Depression and circadian rhythms exhibit bidirectional interactions,suggesting a close association with the biological clock system.The biological clock in the suprachiasmatic nucleus of the hypothalamus is regulated by circadian genes.Recent clinical and basic research has revealed multifaceted associations between depression and circadian genes.For instance,significant phase abnormalities in BMAL1,PER2,and PER3 were detected in brain tissue from depressed patients,while plasma levels of CRY1,ARNTL,and PER1 proteins showed marked reduction,demonstrating good diagnostic value.Mice with CLOCK and BMAL1 knockouts exhibited depression-like behaviors.Single nucleotide polymorphisms(SNPs)in genes such as PER1 and PER3 directly influence depression susceptibility.Methylation levels of BMAL1,PER3,and CLOCK genes correlate closely with depressive symptoms.Antidepressant mechanisms like ketamine exert their effects by downregulating PER2 and other genes.This review summarizes the differential expression patterns of circadian clock genes in depression and associated therapeutic approaches,aiming to provide new theoretical foundations for precision diagnosis and personalized treatment strategies for depression.

Idiopathic pulmonary fibrosis (IPF), a chronic interstitial lung disease, is characterized by aberrant wound healing, excessive scarring and the formation of myofibroblastic foci. Although the role of alternative splicing (AS) in the pathogenesis of organ fibrosis has garnered increasing attention, its specific contribution to pulmonary fibrosis remains incompletely understood. In this study, we identified an up-regulation of serine/arginine-rich splicing factor 7 (SRSF7) in lung fibroblasts derived from IPF patients and a bleomycin (BLM)-induced mouse model, and further characterized its functional role in both human fetal lung fibroblasts and mice. We demonstrated that enhanced expression of Srsf7 in mice spontaneously induced alveolar collagen accumulation. Mechanistically, we investigated alternative splicing events and revealed that SRSF7 modulates the alternative splicing of pyruvate kinase (PKM), leading to metabolic dysregulation and fibroblast activation. In vivo studies showed that fibroblast-specific knockout of Srsf7 in conditional knockout mice conferred resistance to bleomycin-induced pulmonary fibrosis. Importantly, through drug screening, we identified lomitapide as a novel modulator of SRSF7, which effectively mitigated experimental pulmonary fibrosis. Collectively, our findings elucidate a molecular pathway by which SRSF7 drives fibroblast metabolic dysregulation and propose a potential therapeutic strategy for pulmonary fibrosis.

Heart failure,as a severe consequence or late-stage manifestation of various cardiac conditions,is marked by high morbidity,high mortality,and high rates of readmission,significantly compromising patients' quality of life.Despite ongoing advancements in novel drugs and technologies that have improved the clinical efficacy of heart failure,5％to 10％of patients still progress to end-stage heart failure annually.Heart transplantation stands as an effective approach to enhance both the quality of life and survival rates for patients with end-stage heart failure.However,due to the scarcity of donor organs,it falls short of meeting the needs of a large number of patients.In this scenario,left ventricular assist device(LVAD)implantation emerges as a promising alternative therapeutic option for these patients.Acute kidney injury(AKI)represents one of the common complications encoun-tered after LVAD implantation,with notable morbidity and mortality rates.This article synthesized relevant research findings and literature to investigate the risk factors associated with the development of AKI in patients following LVAD implantation.

Cardiac surgery patients often present with multiple comorbidities,the risk of periop-erative complications and the complexity of postoperative rehabilitation have significantly increased,posing higher demands on comprehensive perioperative management.Preoperative exercise pre-reha-bilitation,as a multidisciplinary collaborative intervention strategy,has been demonstrated to signifi-cantly improve the clinical prognosis of patients undergoing elective cardiac surgery by enhancing their cardiopulmonary function,muscle strength,and overall physiological functional reserve,thereby in-creasing the body's tolerance to surgical stress.Although phase-specific research achievements have been made domestically and internationally in the field of exercise pre-rehabilitation,its standardized implementation and clinical translation on a global scale still face numerous obstacles,necessitating systematic review and in-depth exploration.Therefore,this study aimed to conduct a systematic re-view of the intervention protocols,clinical efficacy,safety,and feasibility of preoperative exercise pre-rehabilitation in patients undergoing elective cardiac surgery,with the goal of providing theoretical evidence and practical references for optimizing perioperative management pathways and promoting the implementation of enhanced recovery after surgery concepts.

Objective To construct and evaluate an evaluation index system for the training effect of cardiac surgery specialist nurses and provide a reference for the quality evaluation of cardiac surgery specialist nurse training.Methods Based on the Kirkpatrick Model,the preliminary draft of the evaluation index system for the training effect of cardiac surgery specialist nurses was formed through literature review and semi-structured interviews.The Delphi method was used to conduct the expert consultation with 24 experts nationwide in September 2024,and the weight of each index was determined by the analytic hierarchy process.In February 2025,60 cardiac surgery nurses from 3 tertiary A hospitals in Nanjing were selected as the survey subjects,and a satisfaction questionnaire on the evaluation index system for the training effect of cardiac surgery nurses was used for the survey.Results The effective recovery rates of the 2 rounds of expert questionnaires were 96％and 100％,respectively.The expert authority coefficient was 0.913,and the Kendall harmony coefficient was 0.127-0.212 and 0.152-0.176,respectively(both P＜0.05).The final evaluation index system for the training effect of cardiac surgery specialist nurses included 4 primary indexes,14 secondary indexes and 59 tertiary indicators.The satisfaction questionnaire score of the evaluation index system for the training effect of cardiac surgery nurses was(18.75±2.21).Conclusion The evaluation index system for the training effect of cardiac surgery specialist nurses was scientific and reliable,and can guide significance for the subsequent training,assessment and evaluation of cardiac surgery specialist nurses.

Objective:To analyze the clinical features and prognosis of acute B lymphoblastic leukemia (B-ALL) children carrying a TCF3: : PBX1 fusion gene and to evaluate the prognostic value of this gene.Methods:Retrospective cohort study.A total of 2 164 B-ALL children aged 0-18 years diagnosed and treated at 19 pediatric centers from October 2016 to June 2022 were enrolled.They were divided into the positive group and the negative group according to whether they carried a TCF3: : PBX1 fusion gene.The clinical characteristics, treatment response, adverse reactions, and prognosis of the 2 groups of patients were analyzed.The rank sum and Kruskal-Wallis tests were used to compare two and more than two groups of numerical variables, respectively.Fisher′s exact test was used to compare categorical variables.Results:Among the 2 164 patients, 116 (5.4%) were TCF3: : PBX1 positive, of which 70 patients were female, accounting for 60.3%.There were 840 female patients in the TCF3: : PBX1-negative group, accounting for 41.0%.There was a significant difference in the ratio of females between the TCF3: : PBX1-positive and TCF3: : PBX1-negative groups ( P<0.001).No significant difference was observed in age of onset between the two groups( P>0.05).The proportion of bone marrow naive cells [54.00 (14.00, 76.50)% vs.29.00 (3.00, 68.00)%], white blood cell counts [25.30 (10.46, 60.94)×10 9/L vs.9.03 (4.38, 30.73)×10 9/L] and hemoglobin counts [82.00(63.00, 101.00) g/L vs.74.00(60.00, 90.00) g/L] in the TCF3: : PBX1-positive group were significantly higher than those in the negative group at the onset (all P<0.05).In terms of treatment response, the proportion of peripheral blood naive cells on Day 8 in the TCF3: : PBX1-positive group was significantly higher than that in the negative group [2.00 (0, 9.00)% vs.0 (0, 2.00)%, P<0.001].The proportion of minimal residual disease <0.1% on Day 15 in the TCF3: : PBX1-positive group was significantly higher than that in the negative group ( P=0.038).There were no significant differences in cumulative recurrence rate, treatment-related mortality (TRM), and overall survival (OS) between the TCF3: : PBX1-positive group and TCF3: : PBX1-negative group (all P>0.05).The cumulative recurrence risk of TCF3: : PBX1-positive patients was 9.646 times higher than that of ETV6: : RUNX1-positive patients with better prognosis( HR=9.646, 95% CI: 1.026-90.700, P=0.047).There were no significant differences in TRM and OS between TCF3: : PBX1-positive and ETV6: : RUNX1-positive patients (all P>0.05).A significant enrichment of PAX5 mutations was detected in TCF3: : PBX1-positive patients.Among the 7 high-risk TCF3: : PBX1-positive patients in a single center, 4 patients had PAX5 mutations, and this proportion was significantly higher than that in other patients ( P<0.001). Conclusions:B-ALL children carrying a TCF3: : PBX1 fusion gene have a high remission rate and good long-term prognosis after intensive chemotherapy.It is suggesting that TCF3: : PBX1-positive B-ALL patients should be rated at intermediate risk to receive intensive chemotherapy.