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.

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.

Objective:To discuss the alleviative effect of ginsenoside Rg1 on chronic intermittent hypoxia(CIH)-induced brain injury in the mice,and to clarify its possible mechanism.Methods:Forty male C57BL/6 mice were randomly divided into control group,model group,inhibitor group(treated with calpain-1 inhibitor),low dose of ginsenoside Rg1 group(treated with 10 mg·kg-1 ginsenoside Rg1),and high dose of ginsenoside Rg1 group(treated with 20 mg·kg-1 ginsenoside Rg1).Except for the control group,the mice in all other groups were placed in a hypoxic chamber with automatically regulated oxygen concentration to induce hypoxic brain injury.The peripheral blood oxygen saturation(SpO2)of tail of the mice in various groups was detected;the escape latencies and path lengths and the frequency of swimming route crossing the target quadrant of the mice in various groups were determined by Morris water maze test;the levels of blood urea nitrogen(BUN),lactate(LA),malondialdehyde(MDA),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)and the activities of superoxide dismutase(SOD)and lactate dehydrogenase(LDH)in serum of the mice in various groups were detected by kits;the degrees of brain tissue injury of the mice in various groups were observed by HE staining.The levels of reactive oxygen species(ROS)in CA1 region of hippocampus tissue of the mice in various groups were detected by dihydroethidium(DHE)probe;the expression levels of calpain-1,IL-6,and TNF-α proteins in brain tissue of the mice in various groups were detected by Western blotting method.Results:Compared with control group,the SpO2 of the mice in model group was significantly decreased(P＜0.01),indicating that the model was successfully established.Compared with model group,the SpO2 of the mice in inhibitor group,low dose of ginsenoside Rg1 group and high dose of ginsenoside Rg1 group were significantly increased(P＜0.01).The Morris water maze test results showed that compared with control group,the escape latency and path length of the mice in model group were significantly prolonged(P＜0.01),and the frequency of swimming route of crossing the target quadrant was significantly decreased;compared with model group,the escape latencies and path lengths of the mice in inhibitor group,low dose of ginsenoside Rg1 group and high dose of ginsenoside Rg1 group were significantly shortened(P＜0.01),and the frequency of swimming route of crossing the target quadrant was significantly increased.Compared with control group,the levels of BUN,LA,MDA,IL-6,and TNF-α in serum of the mice in model group were significantly increased(P＜0.01),while the activity of LDH was significantly increased(P＜0.01),and the activity of SOD was significantly decreased(P＜0.01);compared with model group,the levels of BUN,LA,MDA,IL-6,and TNF-α in serum of the mice in inhibitor group,low dose of ginsenoside Rg1 group and high dose of ginsenoside Rg1 group were significantly decreased(P＜0.01),while the activities of LDH were significantly decreased(P＜0.01),and the activities of SOD were significantly increased(P＜0.01).The HE staining results showed that compared with control group,the pyramidal neurons in CA1 region of hippocampus tissue of the mice in model group were loosely arranged,while some neurons were triangular,with nuclear pyknosis,cytoplasmic hyperchromasia,and a few neurons were lost,indicating obvious hypoxic neuronal injury;compared with model group,the hypoxic neuronal injury in CA1 region in hippocampus tissue of the mice in inhibitor group,low dose of ginsenoside Rg1 group and high dose of ginsenoside Rg1 group was effectively alleviated.The DHE probe detection showed that compared with control group,the level of ROS in CA1 region in hippocampus tissue of the mice in model group was significantly increased(P＜0.01);compared with model group,the levels of ROS in CA1 region in hippocampus tissue of the mice in inhibitor group,low dose of ginsenoside Rg1 group and high dose of ginsenoside Rg1 group were significantly decreased(P＜0.01).The Western blotting results showed that compared with control group,the expression levels of calpain-1,TNF-α,and IL-6 proteins in hippocampus tissue of the mice in model group were significantly increased(P＜0.01);compared with model group,the expression levels of calpain-1,TNF-α,and IL-6 proteins in hippocampus tissue of the mice in inhibitor group,low dose of GRg1 group and high dose of GRg1 group were significantly decreased(P＜0.01).Conclusion:Ginsenoside Rg1 can alleviate brain tissue injury of the mice induced by CIH;its mechanism may be related to the inhibition of brain tissue inflammatory response and oxidative stress,and the downregulation of calpain-1 expression.

Objective:To understand the awareness and influencing factors of core information on tuberculosis prevention and control in the elderly population in China.Methods:The study included all participants aged ≥60 from the "13 th Five-Year" National Tuberculosis Control Plan end-term assessment in 2020, with 13 706 valid questionnaires obtained. Multivariate logistic regression was used to analyze the influencing factors of the awareness rate of core information on tuberculosis prevention and control in the elderly. Results:The total awareness rate of core information on tuberculosis prevention and control in the elderly aged ≥60 was 78.4%, with the highest for "suspicious symptoms of pulmonary tuberculosis" (85.4%) and the lowest for "whether pulmonary tuberculosis can be cured" (65.3%). The complete awareness rate of core information on tuberculosis prevention and control in the elderly was 41.3%, and the proportion of those who received tuberculosis health education is 67.6%. Multivariate logistic regression analysis results showed that factors associated with low awareness of core information included females ( OR=0.93, 95% CI: 0.86-1.00), ages 70- ( OR=0.91, 95% CI: 0.84-0.98) and ≥80 ( OR=0.77, 95% CI: 0.68-0.87) and minority ethnicity ( OR=0.85, 95% CI: 0.74-0.99). Factors associated with high awareness of core information included educational levels of junior high school ( OR=1.46, 95% CI: 1.34-1.58), high school ( OR=1.62, 95% CI: 1.45-1.81), junior college ( OR=1.37, 95% CI: 1.11-1.68), and an undergraduate degree or higher ( OR=1.52, 95% CI: 1.09-2.11), and receiving tuberculosis health education ( OR=2.13, 95% CI: 1.97-2.27). Conclusions:In 2020, the awareness rate of core information on tuberculosis prevention and control in Chinese older adults aged ≥60 was lower than the national planning target. Therefore, there should be an increased focus on health education about tuberculosis for elderly females, those aged ≥70, ethnic minorities, and those with lower education levels.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objective To investigate the clinical efficacy and value of interventional treatment of iatrogenic massive vaginal bleed-ing.Methods Retrospective analysis was performed on 35 patients with postoperative vaginal massive hemorrhage in obstetrics and gynecology who were admitted.Abdominal aorta and bilateral internal iliac arteries angiography and embolization of abnormal vessels were performed under digital subtraction angiography(DS A),and relevant clinical data were recorded and analyzed.Results After interventional treatment,the vaginal bleeding of 33 patients basically stopped within 3 days,and the average interventional operation time was(57.5±17.2)min.The hemoglobin value,hematocrit and blood pressure decreased and the heart rate increased significantly before and after interventional embolization in obstetrics and gynecology,with statistical significance(P＜0.05).There were no sig-nificant changes in hemoglobin value and hematocrit between the completion of interventional embolization and 72 hours after interventional embolization(P＞0.05).The increase of blood pressure and the decrease of heart rate were statistically significant(P＜0.05).Two patients with cesarean section had poor hemostatic effect after interventional embolization,and the bleeding stopped after exploratory laparotomy and hysterectomy.Conclusion Interventional treatment has the advantages of small trauma,simple operation,signifi-cant curative effect,few adverse reactions,and rapid recovery.It plays an important role and clinical value in the diagnosis and treat-ment of iatrogenic vaginal bleeding.

Humans ; Nephrotic Syndrome ; Hematopoietic Stem Cell Transplantation ; Tissue Donors ; Transplantation Conditioning ; Graft vs Host Disease

Objective:To explore the impact of applying micro-video tracing training model to emerging infectious diseases (EIDs) knowledge training on the autonomous learning ability and learning outcomes among emergency department nurses.Methods:In this study, the training content was developed from the perspective of the historical development of EIDs. The training program was constructed in the form of a micro-video classification module and periodic WeChat group push-based autonomous learning. Convenience sampling was used to select 85 emergency nurses ( n=85) from a grade A tertiary general hospital in Shanghai for micro-video tracing training. The nurses were provided with EIDs knowledge training using a module consisting of 11 episodes, each of which included 5 sessions, i.e., enlightening thinking, micro-video learning, key point consolidation, key point analysis, and extension and expansion. After the intervention, the nurses were compared for their autonomous learning ability and their knowledge, belief, and action levels of EIDs, and their degree of satisfaction with the training model was evaluated. SPSS 20.0 and GraphPad Prism 9.3.0 were used for non-parametric Wilcoxon paired tests of quartiles ( Q25, M, and Q75). Results:After the training, the emergency department nurses had significantly higher scores in overall autonomous learning ability ( Z=-4.69, P<0.001) and in each dimension: concept of self-motivation ( Z=-4.48, P<0.001), task analysis ( Z=-4.06, P<0.001), self-monitoring and regulation ( Z=-4.50, P<0.001), and self-evaluation ( Z=-4.82, P<0.001); they had significantly higher scores in overall knowledge, belief, and action levels of EIDs ( Z=-4.65, P<0.001) and in each dimension: knowledge ( Z=-4.04, P<0.001), belief ( Z=-3.24, P=0.001), and action ( Z=-4.05, P<0.001). Emergency department nurses had a high degree of satisfaction with the training model (degree of satisfaction for each item >90%). Conclusions:The micro-video tracing training model can effectively improve the autonomous learning ability of emergency department nurses and their knowledge, belief, and action levels of EIDs, with a high degree of satisfaction among the nurses, making it promising for wide use.