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.

Metastasis is one of the main causes of death in lung cancer,and tumor microenvironment(TME)disorders promote the formation of Kenang and accelerate lung cancer metastasis.The theory of"Kenang"in TCM is of great significance in explaining the pathogenesis of lung cancer metastasis and guiding clinical treatment.Based on the theory of"Kenang",this article discussed the pathogenesis and treatment of TME disorder in lung cancer metastasis,and analyzed the mechanism of Kenang in the process of lung cancer metastasis based on the pathological mechanism of Kenang formation and its similarity with TME disorder,combined with modern medical research results.The dynamic pathogenesis evolution of"healthy qi deficiency-phlegm-stasis-cancerous toxin"runs through the course of Kenang and lung cancer,and is closely related to the hypoxia,angiogenesis,and inflammatory microenvironment contained in TME disorders.Therefore,this article proposed a hypothesis that TME disorder may be the key to promote the formation of Kenang and accelerate the metastasis of lung cancer.The metastasis of lung cancer should be prevented and treated by the ideas of strengthening the healthy qi and promoting qi circulation,dissolving phlegm and removing stasis,clearing heat and detoxifying,so as to provide a theoretical for the prevention and treatment of lung cancer metastasis by integrated traditional Chinese and Western medicine.

Objective To explore the value of cranial CT perfusion imaging(CTP)parameters combined with head and neck CT angiography(CTA)in assessing collateral circulation status and predicting prognosis in acute ischemic stroke(AIS).Methods A retrospective analysis was carried out on 83 AIS patients who were treated in Taikang Xianlin Drum Tower Hospital from June 2018 to June 2023.CTP and head and neck CTA examinations were performed within 24 hours after admission.Digital subtraction angiography is the gold standard for assessing collateral circulation status in AIS patients.The general information of these patients was collected,and the patient's prognosis was evaluated using the modified Rankin scale through telephone or outpatient follow-up 90 days after the occurrence of AIS.Pearson or Spearman correlation was used to analyze the correlation between collateral circulation assessment and CTP parameters and head and neck CTA scores.The value of CTP parameters and head and neck CTA scores in predicting the prognosis of AIS patients was discussed using multivariate Logistic regression.Moreover,the receiver operating characteristic(ROC)curve was used to analyze the predictive value of CTP parameters,head and neck CTA,and the combination for the prognosis of AIS patients.Results The cerebral blood volume(CBV),cerebral blood flow(CBF),and CTA score were higher,while mean transit time(MTT)and time to peak(TTP)were shorter in the good collateral circulation group than in poor collateral circulation group(P<0.05).The collateral circulation status in AIS patients was negatively correlated with CBV,CBF,and CTA score,while positively correlated with MTT and TTP(P<0.05).Compared with poor prognosis group,good prognosis group had higher CBV,CBF,CTA,and shorter MTT and TTP(P<0.05).Multivariate Logistic regression analysis identified MTT and TTP as risk factors for poor prognosis,and CBV,CBF,and CTA scores as protective factors for poor prognosis in AIS patients(P<0.05).The ROC results showed that the area under the curve(AUC)of CBV,MTT,CBF,TTP,CTA score and the combination to predict the prognosis of AIS patients were 0.897,0.864,0.835,0.920,0.918,and 0.979,respectively,showing better predictive performance of the combination than single index alone(Z=2.194,2.910,2.521,2.229,2.171;P<0.05).Conclusion CTP parameters combined with CTA may effectively assess collateral circulation in patients with AIS and is significant for prognosis prediction.

Objective To explore the value of cranial CT perfusion imaging(CTP)parameters combined with head and neck CT angiography(CTA)in assessing collateral circulation status and predicting prognosis in acute ischemic stroke(AIS).Methods A retrospective analysis was carried out on 83 AIS patients who were treated in Taikang Xianlin Drum Tower Hospital from June 2018 to June 2023.CTP and head and neck CTA examinations were performed within 24 hours after admission.Digital subtraction angiography is the gold standard for assessing collateral circulation status in AIS patients.The general information of these patients was collected,and the patient's prognosis was evaluated using the modified Rankin scale through telephone or outpatient follow-up 90 days after the occurrence of AIS.Pearson or Spearman correlation was used to analyze the correlation between collateral circulation assessment and CTP parameters and head and neck CTA scores.The value of CTP parameters and head and neck CTA scores in predicting the prognosis of AIS patients was discussed using multivariate Logistic regression.Moreover,the receiver operating characteristic(ROC)curve was used to analyze the predictive value of CTP parameters,head and neck CTA,and the combination for the prognosis of AIS patients.Results The cerebral blood volume(CBV),cerebral blood flow(CBF),and CTA score were higher,while mean transit time(MTT)and time to peak(TTP)were shorter in the good collateral circulation group than in poor collateral circulation group(P<0.05).The collateral circulation status in AIS patients was negatively correlated with CBV,CBF,and CTA score,while positively correlated with MTT and TTP(P<0.05).Compared with poor prognosis group,good prognosis group had higher CBV,CBF,CTA,and shorter MTT and TTP(P<0.05).Multivariate Logistic regression analysis identified MTT and TTP as risk factors for poor prognosis,and CBV,CBF,and CTA scores as protective factors for poor prognosis in AIS patients(P<0.05).The ROC results showed that the area under the curve(AUC)of CBV,MTT,CBF,TTP,CTA score and the combination to predict the prognosis of AIS patients were 0.897,0.864,0.835,0.920,0.918,and 0.979,respectively,showing better predictive performance of the combination than single index alone(Z=2.194,2.910,2.521,2.229,2.171;P<0.05).Conclusion CTP parameters combined with CTA may effectively assess collateral circulation in patients with AIS and is significant for prognosis prediction.

Metastasis is one of the main causes of death in lung cancer,and tumor microenvironment(TME)disorders promote the formation of Kenang and accelerate lung cancer metastasis.The theory of"Kenang"in TCM is of great significance in explaining the pathogenesis of lung cancer metastasis and guiding clinical treatment.Based on the theory of"Kenang",this article discussed the pathogenesis and treatment of TME disorder in lung cancer metastasis,and analyzed the mechanism of Kenang in the process of lung cancer metastasis based on the pathological mechanism of Kenang formation and its similarity with TME disorder,combined with modern medical research results.The dynamic pathogenesis evolution of"healthy qi deficiency-phlegm-stasis-cancerous toxin"runs through the course of Kenang and lung cancer,and is closely related to the hypoxia,angiogenesis,and inflammatory microenvironment contained in TME disorders.Therefore,this article proposed a hypothesis that TME disorder may be the key to promote the formation of Kenang and accelerate the metastasis of lung cancer.The metastasis of lung cancer should be prevented and treated by the ideas of strengthening the healthy qi and promoting qi circulation,dissolving phlegm and removing stasis,clearing heat and detoxifying,so as to provide a theoretical for the prevention and treatment of lung cancer metastasis by integrated traditional Chinese and Western medicine.

Background and purpose:Outcomes for cancer patients with steroid-resistant immune checkpoint inhibitor-associated myocarditis(srICIAM)are poor.Intensified immunosuppressive therapies,including tofacitinib,a novel Janus kinase(JAK)inhibitor,may have some therapeutic benefits.However,due to the lack of sufficient clinical data,the effectiveness of such treatments and their impact on cardiovascular outcomes remain unclear.This study aimed to investigate the therapeutic effect of tofacitinib on srICIAM.Methods:This retrospective case-control study included 36 malignant tumor patients who received immune checkpoint inhibitor treatment at Zhongshan Hospital affiliated to Fudan University from July 2019 to May 2022 and developed srICIAM.Patients receiving corticosteroids in combination with tofacitinib were assigned to the tofacitinib group(n=19),while those not treated with tofacitinib were allocated to the control group(n=17).The study compared clinical characteristics,laboratory findings,and imaging results between the two groups.Additionally,follow-up was conducted to monitor the incidence of cardiovascular endpoints in these patients.The research plan was approved by the Ethics Committee of Zhongshan Hospital Affiliated to Fudan University(Approval Number:B2021-275R).This study was conducted in accordance with the ethical guidelines of the Helsinki Declaration.Results:Compared to the control group,and with no significant difference in the cumulative dose and duration of corticosteroids(P＜0.05),the tofacitinib group showed a shorter myocarditis recovery time(median recovery time:86.5 days vs 126.5 days,P=0.021).The myocarditis-related mortality rate was significantly lower in the tofacitinib group than in the control group(5%vs 35%,P=0.025).Conclusion:Tofacitinib may reduce mortality and promote cardiac recovery in srICIAM patients without impeding the anti-tumor effect.It may become one of the potential treatment strategies in the future.

Tumor immunotherapeutics include immune checkpoint inhibitors,adoptive cellular therapy,tumor vaccines,immunomodulators,which regulate or induce anti-tumor activity by blocking immunosuppressive signals,infusing in vitro-induced anti-tumor effector cells,and enhancing the immunogenicity of tumor cells in the fight against cancer.The effect mechanisms of tumor immunotherapy is different from that of other tumor therapeutic approaches,such as surgery and chemotherapy.Therefore,in the evaluation of anti-tumor efficacy,the use of conventional imaging methods to detect the volume change of tumor lesions shows special response patterns such as"false progression"and"superprogression",which cannot timely and accurately evaluate the objective efficacy of tumor immunotherapy.This review is an attempt to focus on those challenges in evaluating immunotherapy efficacy and the latest developments of relevant evaluation criteria,and is aimed at providing reference for the scientific evaluation of tumor immunotherapy efficacy and the selection of appropriate immunotherapy strategies for tumor patients.

Objective To explore the effect of extracurricular activities based on specialist nursing clinic. Methods Thirty-four undergraduate nursing students of grade 2013 in the Capital Medical University were enrolled in the study. After learning of nursing theories for senile dementia, the extracurricular activities based onspecialist nursing clinicwere carried out. Before and after the second class activities, the caring ability inventory scale and self scale-rating for self-directed learning (SRSSDL) were used to assess 34 students. Result After the activities, students' caring ability and self-directed learning ability were statistically significantly improved (P<0.01). Conclusion The extracurricular activities based onspecialist nursing cliniccan stimulate the learning interest of nursing students and improve their self-directed learning ability and humanistic care ability.