Malaria, a parasitic disease caused by infection with the species of Plasmodium and transmitted by Anopheles mosquito bites, is one of the major public health challenges that seriously threaten human health. Malaria parasites present diverse immune escape strategies to escape from the recognition and clearance of the host immune system, which poses a great challenge to the malaria control programme. This review presents the advances in the mechanisms underlying the immune escape of Plasmodium, including antigenic variation, epigenetic regulation, antagonism against IgM antibody, activation of the cyclic guanosine monophosphate-adenosine monophosphate (GMP-AMP) synthase-stimulator of interferon genes (cGAS-STING) signaling, suppression of splenic immune functions, and molecular camouflage, so as to provide insights into development of malaria vaccines and antimalarial agents and formulation of the malaria control strategy.

INTRODUCTION: Lecanemab has shown promise in treating early Alzheimer's disease (AD), but its safety and efficacy in Chinese populations remain unexplored. This study aimed to evaluate the safety and 6-month clinical outcomes of lecanemab in Chinese patients with mild cognitive impairment (MCI) or mild AD. METHODS: In this single-arm, real-world study, participants with MCI due to AD or mild AD received biweekly intravenous lecanemab (10 mg/kg). The study was conducted at Hainan Branch, Ruijin Hospital Shanghai Jiao Tong University School of Medicine. Patient enrollment and baseline assessments commenced in November 2023. Safety assessments included monitoring for amyloid-related imaging abnormalities (ARIA) and other adverse events. Clinical and biomarker changes from baseline to 6 months were evaluated using cognitive scales (mini-mental state examination [MMSE], montreal cognitive assessment [MoCA], clinical dementia rating-sum of boxes [CDR-SB]), plasma biomarker analysis, and advanced neuroimaging. RESULTS: A total of 64 patients were enrolled in this ongoing real-world study. Safety analysis revealed predominantly mild adverse events, with infusion-related reactions (20.3%, 13/64) being the most common. Of these, 69.2% (9/13) occurred during the initial infusion and 84.6% (11/13) did not recur. ARIA-H (microhemorrhages/superficial siderosis) and ARIA-E (edema/effusion) were observed in 9.4% (6/64) and 3.1% (2/64) of participants, respectively, with only two symptomatic cases (one ARIA-E presenting with headache and one ARIA-H with visual disturbances). After 6 months of treatment, cognitive scores remained stable compared to baseline (MMSE: 22.33 ± 5.58 vs . 21.27 ± 4.30, P = 0.733; MoCA: 16.38 ± 6.67 vs . 15.90 ± 4.78, P = 0.785; CDR-SB: 2.30 ± 1.65 vs . 3.16 ± 1.72, P = 0.357), while significantly increasing plasma amyloid-β 42 (Aβ42) (+21.42%) and Aβ40 (+23.53%) levels compared to baseline. CONCLUSIONS: Lecanemab demonstrated a favorable safety profile in Chinese patients with early AD. Cognitive stability and biomarker changes over 6 months suggest potential efficacy, though high dropout rates and absence of a control group warrant cautious interpretation. These findings provide preliminary real-world evidence for lecanemab's use in China, supporting further investigation in larger controlled studies. REGISTRATION ClinicalTrials.gov , NCT07034222.
Humans ; Alzheimer Disease/drug therapy* ; Male ; Female ; Aged ; Middle Aged ; Cognitive Dysfunction/drug therapy* ; Aged, 80 and over ; Amyloid beta-Peptides/metabolism* ; Biomarkers ; East Asian People

OBJECTIVES: To evaluate the efficacy of molecular targeted agents in children with progressive pediatric low-grade gliomas (pLGG). METHODS: A retrospective analysis was conducted on pLGG patients treated with oral targeted therapies at the Department of Pediatrics, Beijing Shijitan Hospital, Capital Medical University, from July 2021. Treatment responses and safety profiles were assessed. RESULTS: Among the 20 enrolled patients, the trametinib group (n=12, including 11 cases with BRAF fusions and 1 case with BRAF V600E mutation) demonstrated 4 partial responses (33%) and 2 minor responses (17%), with a median time to response of 3.0 months. In the vemurafenib group (n=6, all with BRAF V600E mutation), 5 patients achieved partial responses (83%), showing a median time to response of 1.0 month. Comparative analysis revealed no statistically significant difference in progression-free survival rates between the two treatment groups (P>0.05). The median duration of clinical benefit (defined as partial response + minor response + stable disease) was 11.0 months for vemurafenib and 18.0 months for trametinib. Two additional cases, one with ATM mutation treated with olaparib for 24 months and one with NF1 mutation receiving everolimus for 21 months, discontinued treatment due to sustained disease stability. No severe adverse events were observed in any treatment group. CONCLUSIONS Molecular targeted therapy demonstrates clinical efficacy with favorable tolerability in pLGG. Vemurafenib achieves high response rates and induces early tumor shrinkage in patients with BRAF V600E mutations, supporting its utility as a first-line therapy.
Humans ; Glioma/genetics* ; Male ; Female ; Child ; Child, Preschool ; Retrospective Studies ; Brain Neoplasms/genetics* ; Molecular Targeted Therapy/adverse effects* ; Adolescent ; Infant ; Proto-Oncogene Proteins B-raf/genetics* ; Pyrimidinones/therapeutic use* ; Mutation

OBJECTIVES: To investigate the relationship between the polygenic risks for various psychiatric disorders and clinical and neuropsychological characteristics in children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Using a cross-sectional design, 285 children with ADHD and 107 healthy controls were assessed using the Child Behavior Checklist, the Behavior Rating Inventory of Executive Function for parents, the Wechsler Intelligence Scale for Children, Fourth Edition, and the Cambridge Neuropsychological Test Automated Battery. Blood samples were collected for genetic data. Polygenic risk scores (PRSs) for various psychiatric disorders were calculated using the PRSice-2 software. RESULTS: Compared with the healthy controls, the children with ADHD displayed significantly higher PRSs for ADHD, major depressive disorder, anxiety disorder, and obsessive-compulsive disorder (P<0.05). In terms of daily-life executive function, ADHD-related PRS was significantly correlated with the working memory factor; panic disorder-related PRS was significantly correlated with the initiation factor; bipolar disorder-related PRS was significantly correlated with the shift factor; schizophrenia-related PRS was significantly correlated with the inhibition, emotional control, initiation, working memory, planning, organization, and monitoring factors (P<0.05). The PRS related to anxiety disorders was negatively correlated with total IQ and processing speed index (P<0.05). The PRS related to obsessive-compulsive disorder was negatively correlated with the processing speed index and positively correlated with the stop-signal reaction time index of the stop-signal task (P<0.05). CONCLUSIONS PRSs for various psychiatric disorders are closely correlated with the behavioral and cognitive characteristics in children with ADHD, which provides more insights into the heterogeneity of ADHD.
Humans ; Attention Deficit Disorder with Hyperactivity/genetics* ; Child ; Male ; Female ; Cross-Sectional Studies ; Neuropsychological Tests ; Multifactorial Inheritance ; Adolescent ; Mental Disorders/etiology* ; Executive Function ; Genetic Risk Score

Pyroptosis is an identified programmed cell death that has been highly linked to endoplasmic reticulum (ER) dynamics. However, the crucial proteins for modulating dynamic ER membrane curvature change that trigger pyroptosis are currently not well understood. In this study, a biotin-labeled chemical probe of potent pyroptosis inducer α-mangostin (α-MG) was synthesized. Through protein microarray analysis, reticulon-4 (RTN4/Nogo), a crucial regulator of ER membrane curvature, was identified as a target of α-MG. We observed that chemically induced proteasome degradation of RTN4 by α-MG through recruiting E3 ligase UBR5 significantly enhances the pyroptosis phenotype in cancer cells. Interestingly, the downregulation of RTN4 expression significantly facilitated a dynamic remodeling of ER membrane curvature through a transition from tubules to sheets, consequently leading to rapid fusion of the ER with the cell plasma membrane. In particular, the ER-to-plasma membrane fusion process is supported by the observed translocation of several crucial ER markers to the "bubble" structures of pyroptotic cells. Furthermore, α-MG-induced RTN4 knockdown leads to pyruvate kinase M2 (PKM2)-dependent conventional caspase-3/gasdermin E (GSDME) cleavages for pyroptosis progression. In vivo, we observed that chemical or genetic RTN4 knockdown significantly inhibited cancer cells growth, which further exhibited an antitumor immune response with anti-programmed death-1 (anti-PD-1). In translational research, RTN4 high expression was closely correlated with the tumor metastasis and death of patients. Taken together, RTN4 plays a fundamental role in inducing pyroptosis through the modulation of ER membrane curvature remodeling, thus representing a prospective druggable target for anticancer immunotherapy.
Pyroptosis/immunology* ; Humans ; Endoplasmic Reticulum/immunology* ; Animals ; Nogo Proteins/antagonists & inhibitors* ; Mice ; Cell Line, Tumor ; Xanthones/pharmacology* ; Neoplasms/pathology* ; Mice, Nude

The rapid development of artificial intelligence (AI), especially generative AI (GenAI), has already brought, and will continue to bring, revolutionary changes to our daily production and life, as well as create new opportunities and challenges for diagnostic and therapeutic practices in the medical field. Haihe Hospital of Tianjin University collaborates with the National Supercomputer Center in Tianjin, Tianjin University, and other institutions to carry out research in areas such as smart healthcare, smart services, and smart management. We have conducted research and development of a full-process disease diagnosis and treatment assistance system based on GenAI in the field of smart healthcare. The development of this project is of great significance. The first goal is to upgrade and transform the hospital's information center, organically integrate it with existing information systems, and provide the necessary computing power storage support for intelligent services within the hospital. We have implemented the localized deployment of three models: Tianhe "Tianyuan", WiNGPT, and DeepSeek. The second is to create a digital avatar of the chief physician/chief physician's voice and image by integrating multimodal intelligent interaction technology. With generative intelligence as the core, this solution provides patients with a visual medical interaction solution. The third is to achieve deep adaptation between generative intelligence and the entire process of patient medical treatment. In this project, we have developed assistant tools such as intelligent inquiry, intelligent diagnosis and recognition, intelligent treatment plan generation, and intelligent assisted medical record generation to improve the safety, quality, and efficiency of the diagnosis and treatment process. This study introduces the content of a full-process disease diagnosis and treatment assistance system, aiming to provide references and insights for the digital transformation of the healthcare industry.
Artificial Intelligence ; Humans ; Delivery of Health Care ; Generative Artificial Intelligence

To explore the value of general information and rapid laboratory tests obtained from the emergency department in the early diagnosis and prevention of young patients with acute myocardial infarction and acute myocarditis, in order to prevent the disease from progressing to a critical stage. This study employs a retrospective observational study, compiling clinical data from young patients diagnosed with acute myocardial infarction or acute myocarditis who were admitted to the Department of Cardiology or Emergency Department of the Second Affiliated Hospital of Soochow University from January 2015 to September 2024. Demographic information and laboratory test results from both the outpatient and emergency departments were retrieved. The acute myocardial infarction group comprised 267 patients (257 males, 10 females) aged 23-44 ys, while the acute myocarditis group included 134 patients (93 males, 41 females) aged 18-44 ys. A comparative analysis of the clinical data between the two groups was conducted, encompassing variables such as age, gender, comorbidities, high-risk factors, emergency blood routine tests, high-sensitivity C-reactive protein levels, coagulation profiles, renal function tests, NT-proBNP levels, myocardial injury markers, electrocardiogram readings, blood pressure, and heart rate. The results showed that:Compared with the young myocarditis group, the myocardial infarction group was older (ys)[38(35, 42) vs 30(25, 37), U=7 893, P<0.001], more male [257(96.3%) vs 93(69.4%), χ2=57.95, P<0.001], more smoking [211(79.0%) vs 38(28.4%), χ2=97.32, P<0.001], drinking history [125(46.8%) vs 22(16.4%), χ2=35.51, P<0.001], family history of coronary heart disease [45(16.9%) vs 3(2.2%), χ2=18.09, P<0.001], hypertension [100(37.5%) vs 12(9.0%), χ2=36, P<0.001] and diabetes [42(15.7%) vs 4(3.0%), χ2=14.27, P<0.001]. Systolic blood pressure (mmHg)[126(114, 144) vs 119(101, 126), U=11 389.50, P<0.001], diastolic blood pressure (mmHg)[80(70, 93) vs 72(62, 81), U=12 220.50, P<0.001], total white blood cell count (10 9/L)[11.3(9.2, 14.1) vs 8.5(6.6, 11.2), U=10 825.50, P<0.001], hemoglobin (g/L)[157(147, 166) vs 143(129, 154), U=9 404.50, P<0.001], platelet count (10 9/L)[244(206, 297) vs 207(173, 253), U=11 680, P<0.001], uric acid (μmol/L)[380(315, 446) vs 347(265, 412), U=14 805.50, P=0.005], ST segment elevation [204(76.4%) vs 57(42.5%), χ2=73.03, P<0.001] and Q wave formation [76(28.5%) vs 17(12.7%), χ2=12.47, P<0.001] in ECG were higher than those in myocarditis group. The duration of onset (hs) [6(3, 25) vs 48(24, 73), U=27911, P<0.001], heart rate (beats/min)[82(74, 92) vs 92(78, 103), U=22 347, P<0.001], D-dimer (μg/ml)[0.23(0.17, 0.51) vs 0.61(0.30, 1.38), U=25 806, P<0.001], High-sensitivity troponin T/99th percentile upper reference limit [5(1, 36) vs 16(8, 39), U=22 577, P<0.001], NT-proBNP (pg/ml) [204(64, 644) vs 824(189, 4 043), U=25 134, P<0.001], C-reactive protein (mg/L)[6(3, 9) vs 24(6, 55), U=26 349.50, P<0.001] and body temperature (℃) [36.50(36.30, 36.60) vs 37.35(36.50, 38.50), U=26 961, P<0.001] were significantly lower than those in myocarditis group, the symptoms of chest pain in myocardial infarction group was significantly higher than those in myocarditis group [262(98.1%) vs 83(61.9%), χ2=97.24, P<0.001], and the history of prodromal infection [12(4.5%) vs 112(83.6%), χ2=261.26, P<0.001], syncope [11(4.1%) vs 18(13.4%), χ2=11.53, P<0.001] and shock [6(2.2%) vs 22(16.4%), χ2=27.59, P<0.001] in myocardial infarction group were significantly lower than those in myocarditis group. With acute myocardial infarction as the target outcome, 8 influencing factors selected by LASSO regression, and 5 independent influencing factors were found after multiple Logistic regression, those were age ( OR=1.21, 95% CI: 1.12-1.31; P<0.001), pre-infection ( OR=0.02, 95% CI: 0.01-0.06; P<0.001), body temperature ( OR=0.37, 95% CI: 0.18-0.77; P=0.008), chest pain ( OR=26.75, 95% CI: 5.87-121.81; P<0.001) and white blood cell count ( OR=1.27, 95% CI: 1.12-1.44; P<0.001). Younger age, high body temperature and pre-infection are independent predictors for acute myocarditis, while chest pain and elevated white blood cell count are independent predictors for acute myocardial infarction. The five influencing factors selected by multivariate logistic regression and their combined diagnostic model were subjected to ROC analysis. The AUC reached 0.969, sensitivity reached 0.940 and specificity reached 0.925. Calibration curve and decision curve analysis(DCA) demonstrate that the model possesses excellent clinical application value. In conclusion, age, chest pain, pre-infection, body temperature and white blood cell count were independent factors in distinguishing acute myocardial infarction and acute myocarditis in young people. The clinical differential diagnosis model based on 5 independent factors may has high efficiency and good clinical practicability.

This study aims to analyze the screening results and epidemiological characteristics of prostate cancer (PCa) among elderly males in the rural areas of Songjiang, Shanghai City, through the implementation of a preliminary prostate-specific antigen (PSA) screening based on a community-linkage model, and to explore an effective screening approach. A retrospective observational study design was employed to collect data from residents who underwent PSA screening at Songjiang Hospital affiliated to Shanghai Jiao Tong University School of Medicine, in collaboration with multiple community health service centers in Songjiang District, Shanghai City, between June 2022 and June 2024, through free clinics and annual health examinations. Prostate biopsy was recommended for individuals with total PSA (tPSA) levels >10 ng/ml and those with 4 ng/ml≤tPSA≤10 ng/ml and abnormal free-to-total PSA (f/tPSA) ratios. Clinical characteristics of detected PCa patients were analyzed. Follow-up was conducted through phone calls and home visits by family doctors, coupled with enhanced health education. The results indicated that a total of 17 198 residents participated in the screening, among which 2 234 (12.99%) had tPSA levels between 4 ng/ml and 10 ng/ml, and 257 (1.49%) had tPSA levels >10 ng/ml. Ultimately, 417 residents underwent prostate biopsy, with 171 being diagnosed with PCa, yielding a positive biopsy rate of 41.00% and a PCa detection rate of 0.99%. The predominant pathological subtype among PCa patients was adenocarcinoma (168 cases, 98.24%). Of the 146 PCa patients who received treatment, the majority were classified as intermediate or high-risk (124 cases, 84.93%). Furthermore, with the optimization of the screening model, there was a significant increase in the proportion of subsequent outpatient visits. In conclusion, the community-linkage-based PSA screening model demonstrated high effectiveness in screening for PCa among elderly males in the rural areas of Songjiang, Shanghai City. Epidemiological findings revealed that PCa patients in this region are primarily composed of intermediate and high-risk groups, highlighting the need for intensified early screening and health education.

Objective To explore the effectiveness of an integrated laparoscopic simulation training course (best essential surgical technique training, BEST) in enhancing laparoscopic peritoneal suturing techniques in surgical residents.Methods As an integrated two-stage program, the BEST course applied basic laparoscopic training system with simple molds in phase Ⅰ training, and then adopted advanced laparoscopic training system, 3D Laparoscope and ex-vivo animal models in phase Ⅱ training. The laparoscopic suturing techniques were practiced in phase Ⅱ training. From August 2021 to July 2024, surgical residents in the second year of the national standardized training program were divided into pilot and control groups based on whether they had undergone the BEST course. Two cases of laparoscopic peritoneal suture were performed by the surgical residents under supervision in the department of gastrointestinal surgery. The operative time, quality of suture, and independent completion rate were compared between the two groups.Results A total of 33 surgical residents (19 in pilot group and 14 in control group) were included in this study, and a total of 66 cases of laparoscopic peritoneal suture were performed (38 in pilot group and 28 in control group). The operative time was significantly shorter in pilot group than that in control group (15.7 min vs. 17.5 min, P=0.025). The quality of suture was significantly better in pilot group compared to control group (P=0.023). In pilot group, all peritoneal sutures were performed by residents independently, whereas in control group, 3 cases (10.7%) were assisted by the supervisor, and the independent completion rate was different significantly (P=0.039).Conclusions The BEST course can help improve surgical residents′ laparoscopic peritoneal suturing techniques and could be promoted in the national standardized training program for surgical residents.

Objective:To evaluate the clinical efficacy and impact on quality of life of the biofeedback (BF) therapy combined with the Wenyang Yiqi Prescription and self-efficacy interventions in patients with functional defecation disorders (FDD).Methods:A prospective, randomized controlled trial design was employed. A total of 128 FDD patients were selected from the Pelvic Floor Center of the Department of Proctology, Suzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, between January 2021 and April 2023. These patients were randomly divided into two groups, with 64 cases in each group. Additionally, 41 historical control patients, who had received conventional BF training between June 2015 and January 2018 at the same center, were included for comparison. The historical control group received conventional BF therapy, the intervention group 1 combined BF therapy with self-efficacy interventions, and the intervention group 2 added the Wenyang Yiqi Prescription based on intervention group 1's treatment. All three groups underwent two treatment courses. Constipation symptom scores before and after treatment were performed; self-efficacy was assessed via the Self-Rated Abilities for Health Practices scale (SRAHP); health behaviors were evaluated using the Health-Promoting Lifestyle Profile (HPLP); anxiety and depression were evaluated through Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS); quality of life was measured through SF-36. Clinical efficacy was evaluated based on constipation symptom scores.Results:During the treatment period, seven patients dropped out due to personal reasons, leaving 61 patients in intervention group 1 and 60 patients in intervention group 2 for efficacy analysis.　The total effective rates were 80.32% (49/61) in intervention group 1, 83.33% (50/60) in intervention group 2, and 56.10% (23/41) in the historical control group. The total effective rates of both intervention groups were significantly higher than those in the historical control group ( χ2=7.06, 9.15; P=0.029, 0.010, respectively). After treatment, intervention group 2 showed significantly lower constipation-related straining scores [1 (1, 2) vs. 2 (1, 2), Z=-4.51] compared to intervention group 1 ( P<0.05). Additionally, intervention group 2 had lower scores for straining [1 (1, 2) vs. 2 (1, 2), Z=-3.15] and defecation time [1 (0, 1) vs. 1 (1, 2), Z=-3.13] compared to the historical control group ( P<0.05). Psychological comfort efficacy (19.13 ± 2.51 vs. 16.98 ± 1.86, t=5.36), health responsibility efficacy (23.63 ± 4.69 vs. 22.59 ± 3.05, t=2.06), and overall SRAHP scores (75.98 ± 4.44 vs. 72.33 ± 5.16, t=4.17) were higher in intervention group 2 compared to intervention group 1 ( P<0.05). The HPLP scores (79.33 ± 11.13 vs. 72.80 ± 9.20, t=3.10) of intervention group 2 were higher than those of the historical control group ( P<0.05). Emotional functioning scores (75.98 ± 18.45 vs. 68.92 ± 20.58 and 68.55 ± 18.21, F=20.91) in intervention group 2 were higher than in both intervention group 1 and the historical control group ( P<0.05). Conclusion:The combination of the Wenyang Yiqi Prescription with BF therapy and self-efficacy interventions effectively improves the clinical symptoms and quality of life in FDD patients.