Objective:To analyze the clinical characteristics and treatment outcomes of children with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody-mediated necrotizing myopathy, and to explore early identification and management strategies to provide reference for clinical diagnosis and treatment.Methods:A retrospective analysis was conducted on the clinical data and treatment outcomes of 10 pediatric patients with anti-HMGCR antibody-mediated necrotizing myopathy admitted to the Department of Rheumatology, Children′s Hospital of Fudan University from December 2020 to December 2024. Statistical description was performed using SPSS 22.0.Results:Among the 10 patients, the male-to-female ratio was 1:4, the age of onset was (7.2±4.0) years, and the disease duration at diagnosis was (22.2±19.6) months. None had a history of statin exposure. Six patients presented with muscle weakness, and4 were diagnosed due to asymptomatic elevation of creatine kinase (CK); 4 had dermatomyositis-like rashes. All patients showed significantly elevated CK levels [median 3 291(1 969, 8 776)U/L] and underwent muscle biopsy. Histopathological findings revealed myofiber degeneration, necrosis, and regeneration in all cases, with inflammatory infiltration in 9 cases, MHC-Ⅰ positivity in all, and C5b-9 positivity in 9 cases. The median follow-up duration was (15.7±6.3) months. At the last follow-up, muscle strength was normal or nearly normal, and the CK median value had decreased to 977.5 (211.0, 3 536.0) U/L.Conclusion:For patients with suspected idiopathic inflammatory myopathy and significantly elevated CK, muscle-specific antibody testing-including anti-HMGCR-and muscle biopsy should be performed promptly regardless of the presence of skin rash, to ensure accurate diagnosis and guide treatment, thereby avoiding misdiagnosis or missed diagnosis.

A medical image segmentation network (RPR-MLP) based on multi-scale convolution and parallel reverse attention is presented. In the encoder,Res2net modules and tokenized multi-layer perceptron modules are used as the backbone structure to extract multi-scale information and enhance the diversity of semantic features. Meanwhile,the accuracy of semantic information extraction in the decoder is improved through parallel partial decoder. Additionally,reverse attention module re-emphasizes the focus on important regions for further improving the accuracy of segmentation results. The proposed method achieves Dice scores of 0.8967 and 0.8762 on the Kvasir and ISIC 2018 public datasets,respectively,demonstrating its effectiveness and generalization ability in medical image segmentation. Furthermore,when applied to the lung tumor CT image dataset (LungCancer dataset) collected in the study,the proposed network has Dice score,IoU and F1 score of 0.7278,58.83％and 67.85％,respectively,outperforming baseline network (UNeXt) and common CNN (U-Net,AttU-Net,U-Net++and PraNet) by 0.0301-0.0578、3.16％-4.70％,and 6.72％-18.53％,respectively. The study confirms the effectiveness and generalization ability of RPR-MLP network on different datasets,providing important technical support for lung tumor image segmentation.

Clinical practice guideline adaptation(hereinafter referred to as"guideline adaptation")is the consolidation and revision of existing high-quality guidelines so that the recommendations are better suited to the specific needs of different regions,thereby guiding optimal clinical practice.Currently,the guideline adap-tations is increasing in number internationally,but their reporting quality still needs to be improved.In 2022,the RIGHT-Ad@pt guideline adaptation reporting checklist was released.It provides a detailed description of the guideline adaptation process and reporting content,which will significantly enhance the rigor,transparency,and standardization of guideline adaptations.This paper interprets and analyzes the 34 items on the checklist,with the aim of providing reference for guideline adapters to standardize the reporting process.

Objective To make a comprehensive review about transitional care practice for patients receiving percutaneous transhepatic biliary drainage(PTBD)and to analyze the current transitional care contents and evaluation indexes so as to provide guidance for improving the quality of transitional care services for discharged patients carrying a PTBD tube.Methods A scoping review study design was used to conduct a computerized retrieval of academic papers concerning the transitional care practice for discharged patients carrying a PTBD tube from the databases of PubMed,WOS Core Collection,CINAHL,Embase,Cochrane Library,CNKI,VIP,Wanfang med online,and Sinomed.The retrieval time period was from the establishment of the database to August 20,2024.Two investigators independently screened the literature to determine the studies to be included and the relevant information to be extracted.Results A total of 18 papers were enrolled in this study.The transitional care ways included telephone follow-up,home visit,online platform follow-up,and outpatient clinic follow-up.The intervention contents extended from in-hospital to out-of-hospital for up to 6 months.The evaluation indexes focused on the patient's knowledge about PTBD tube,the incidence of tube-related complications,the satisfaction with care,self-care ability,etc.Conclusion At present,the transitional care for discharged patients carrying a PTBD tube has a variety of content elements,which can improve the self-care ability and quality of life of the discharged patients carrying a PTBD tube to a certain extent,although more individualized transitional care modes need to be further explored.The evaluation indexes are mainly the outcome assessment of PTBD tube care.It is necessary to strengthen the quality supervision of organizational structure and nursing process.

Thyroid-associated ophthalmopathy(TAO)is a progressive eye disease characterized by immune-mediated inflammation of the extraocular muscles and orbital connective tissue.TAO tends to have complex and diverse symptoms and signs,with the features of diversity and concealment,which seriously affect the quality of life of patients.The pathogenesis of TAO is closely associated with thyroid autoimmunity.This article reviews the pathogenesis,clinical features,and treatment of TAO.

A medical image segmentation network (RPR-MLP) based on multi-scale convolution and parallel reverse attention is presented. In the encoder,Res2net modules and tokenized multi-layer perceptron modules are used as the backbone structure to extract multi-scale information and enhance the diversity of semantic features. Meanwhile,the accuracy of semantic information extraction in the decoder is improved through parallel partial decoder. Additionally,reverse attention module re-emphasizes the focus on important regions for further improving the accuracy of segmentation results. The proposed method achieves Dice scores of 0.8967 and 0.8762 on the Kvasir and ISIC 2018 public datasets,respectively,demonstrating its effectiveness and generalization ability in medical image segmentation. Furthermore,when applied to the lung tumor CT image dataset (LungCancer dataset) collected in the study,the proposed network has Dice score,IoU and F1 score of 0.7278,58.83％and 67.85％,respectively,outperforming baseline network (UNeXt) and common CNN (U-Net,AttU-Net,U-Net++and PraNet) by 0.0301-0.0578、3.16％-4.70％,and 6.72％-18.53％,respectively. The study confirms the effectiveness and generalization ability of RPR-MLP network on different datasets,providing important technical support for lung tumor image segmentation.

This study investigates the feasibility of the VP8*protein as a subunit vaccine target for porcine rotavirus A(PoRVA),a major causative agent of diarrhea in piglets.The VP8* genes of PoRVA P[13]and P[23]genotype strains were amplified by RT-PCR.These genes were then liga-ted into the pET-28a(+)vector,yielding recombinant plasmids pET-28a-XJWF1-VP8*-P[23]and pET-28a-ShXYW13-VP8*-P[13].These plasmids were subsequently transformed into BL21(DE3)competent cells.The VP8*protein,induced by IPTG,was purified using affinity chroma-tography,and its expression and purification were verified by SDS-PAGE and Western blot.The purified VP8* protein was used to immunize mice,and serum samples were collected after three immunizations.Cross-neutralization assays were conducted to evaluate the ability of the VP8*protein immune serum to neutralize different genotype strains.The results demonstrated the ex-pression of soluble VP8*protein,with SDS-PAGE and Western blot analyses showing that the purified VP8*protein existed in both monomeric(27 kDa)and homodimeric(54 kDa)forms.ELISA results indicated that high levels of antibodies were produced in mice immunized with VP 8*-P[13]and VP8*-P[23]after three immunizations.Serum cross-neutralization assays revealed that the neutralizing titers of PoRVA VP8*-P[13]and VP8*-P[23]immune sera against homol-ogous genotype strains ranged from 1∶4 800 to 1∶19 200,significantly higher than those against heterologous genotype strains(1∶1 200).This suggests that the VP8*protein of different geno-type strains exhibits both antigenic conservation and distinct variability.The data obtained in this study provide a solid foundation for further exploration of the antigenic structure of the PoRVA VP8* protein and the development of novel subunit vaccines.

Objective:To analyze the clinical characteristics and treatment outcomes of children with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody-mediated necrotizing myopathy, and to explore early identification and management strategies to provide reference for clinical diagnosis and treatment.Methods:A retrospective analysis was conducted on the clinical data and treatment outcomes of 10 pediatric patients with anti-HMGCR antibody-mediated necrotizing myopathy admitted to the Department of Rheumatology, Children′s Hospital of Fudan University from December 2020 to December 2024. Statistical description was performed using SPSS 22.0.Results:Among the 10 patients, the male-to-female ratio was 1:4, the age of onset was (7.2±4.0) years, and the disease duration at diagnosis was (22.2±19.6) months. None had a history of statin exposure. Six patients presented with muscle weakness, and4 were diagnosed due to asymptomatic elevation of creatine kinase (CK); 4 had dermatomyositis-like rashes. All patients showed significantly elevated CK levels [median 3 291(1 969, 8 776)U/L] and underwent muscle biopsy. Histopathological findings revealed myofiber degeneration, necrosis, and regeneration in all cases, with inflammatory infiltration in 9 cases, MHC-Ⅰ positivity in all, and C5b-9 positivity in 9 cases. The median follow-up duration was (15.7±6.3) months. At the last follow-up, muscle strength was normal or nearly normal, and the CK median value had decreased to 977.5 (211.0, 3 536.0) U/L.Conclusion:For patients with suspected idiopathic inflammatory myopathy and significantly elevated CK, muscle-specific antibody testing-including anti-HMGCR-and muscle biopsy should be performed promptly regardless of the presence of skin rash, to ensure accurate diagnosis and guide treatment, thereby avoiding misdiagnosis or missed diagnosis.

This study investigates the feasibility of the VP8*protein as a subunit vaccine target for porcine rotavirus A(PoRVA),a major causative agent of diarrhea in piglets.The VP8* genes of PoRVA P[13]and P[23]genotype strains were amplified by RT-PCR.These genes were then liga-ted into the pET-28a(+)vector,yielding recombinant plasmids pET-28a-XJWF1-VP8*-P[23]and pET-28a-ShXYW13-VP8*-P[13].These plasmids were subsequently transformed into BL21(DE3)competent cells.The VP8*protein,induced by IPTG,was purified using affinity chroma-tography,and its expression and purification were verified by SDS-PAGE and Western blot.The purified VP8* protein was used to immunize mice,and serum samples were collected after three immunizations.Cross-neutralization assays were conducted to evaluate the ability of the VP8*protein immune serum to neutralize different genotype strains.The results demonstrated the ex-pression of soluble VP8*protein,with SDS-PAGE and Western blot analyses showing that the purified VP8*protein existed in both monomeric(27 kDa)and homodimeric(54 kDa)forms.ELISA results indicated that high levels of antibodies were produced in mice immunized with VP 8*-P[13]and VP8*-P[23]after three immunizations.Serum cross-neutralization assays revealed that the neutralizing titers of PoRVA VP8*-P[13]and VP8*-P[23]immune sera against homol-ogous genotype strains ranged from 1∶4 800 to 1∶19 200,significantly higher than those against heterologous genotype strains(1∶1 200).This suggests that the VP8*protein of different geno-type strains exhibits both antigenic conservation and distinct variability.The data obtained in this study provide a solid foundation for further exploration of the antigenic structure of the PoRVA VP8* protein and the development of novel subunit vaccines.

Objective:To investigate the effects of baicalin on ferroptosis of mouse fibroblasts (Fbs) under high glucose treatment and its mechanism, and to provide a basis for the treatment of diabetic wounds.Methods:The study was an experimental study. Mouse Fbs were collected and divided into control group with conventional culture, high glucose group treated with glucose at final molarity of 30.0 mmol/L, and low baicalin group and high baicalin group pretreated with baicalin at final molarties of 5 and 10 μmol/L respectively and then treated as that in high glucose group. After 48 h of culture, the cell survival rate was detected by the cell counting kit-8, the reactive oxygen species level in cells was detected by the fluorescent probe method, the levels of malondialdehyde, glutathione, and ferrous ion in cells were detected by colorimetry, and the protein expression levels of solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) in cells and nuclear factor-erythroid 2-related factor 2 (Nrf2) in cytoplasm and nucleus were detected by Western blotting. Another batch of mouse Fbs were collected and divided into control group, high glucose group, high baicalin group, and high baicalin+ML385 group. The cells in the first three groups were treated as before, the cells in the last group were pretreated with baicalin and ML385 of Nrf2 inhibitor at final molarties of 10 μmol/L and then treated as that in high glucose group. After 48 h of culture, the protein expression levels of SLC7A11 and GPX4 in cells and the protein expression level of Nrf2 in cytoplasm and nucleus were detected as before. Except that the sample number in detecting SLC7A11 and GPX4 was 4, the sample number in detecting other indexes was 3.Results:After 48 h of culture, the cell survival rates in control group, high glucose group, low baicalin group, and high baicalin group were (100.0±10.7)%, (70.0±5.0)%, (80.9±3.2)%, and (91.4±1.9)%, respectively. Compared with those in control group, the cell survival rate, the glutathione level, and SLC7A11 and GPX4 protein expression levels in cells, and nuclear Nrf2 protein expression level were significantly decreased in high glucose group ( P<0.05), and the levels of reactive oxygen species, malondialdehyde, and ferrous ion in cells, and cytoplasmic Nrf2 protein expression level were significantly increased in high glucose group ( P<0.05). Compared with those in high glucose group, the cell survival rate, glutathione level, SLC7A11 and GPX4 protein expression levels in cells, and nuclear Nrf2 protein expression level in low baicalin group and high baicalin group were significantly increased ( P<0.05), the reactive oxygen species and ferrous ion levels in cells, and cytoplasmic Nrf2 protein expression level in low baicalin group and high baicalin group were significantly decreased ( P<0.05), and the malondialdehyde level in cells in high baicalin group was significantly decreased ( P<0.05). Compared with those in low baicalin group, the cell survival rate, glutathione level, SLC7A11 and GPX4 protein expression levels in cells, and nuclear Nrf2 protein expression level in high baicalin group were significantly increased ( P<0.05), and the reactive oxygen species, malondialdehyde, and ferrous ion levels in cells, and cytoplasmic Nrf2 protein expression level in high baicalin group were significantly decreased ( P<0.05). After 48 h of culture, compared with those in control group, the nuclear Nrf2 protein expression level and SLC7A11 and GPX4 protein expression levels in cells were significantly decreased ( P<0.05), and the cytoplasmic Nrf2 protein expression level was significantly increased in high glucose group ( P<0.05); compared with those in high glucose group, the cytoplasmic Nrf2 protein expression level was significantly decreased ( P<0.05), and the nuclear Nrf2 protein expression level and SLC7A11 and GPX4 protein expression levels in cells were significantly increased in high baicalin group ( P<0.05); compared with those in high baicalin group, the cytoplasmic Nrf2 protein expression level was significantly increased ( P<0.05), and the nuclear Nrf2 protein expression level and SLC7A11 and GPX4 protein expression levels in cells were significantly decreased in high baicalin+ML385 group ( P<0.05). Conclusions:Baicalin can inhibit the occurrence of ferroptosis in cells by activating the Nrf2 signaling pathway and up-regulating the expressions of proteins related to SLC7A11/GPX4 axis in Fbs in high glucose treatment, thus increasing the cell survival rate.