Prognosis of immune checkpoint inhibitor-related myocarditis: Retrospective experience of a single institution.

BACKGROUND: Myocarditis related to immune checkpoint inhibitors (ICIs) treatment is a rare but potentially life-threatening adverse event. To gain insight into this condition, we analyzed the clinical characteristics and prognosis of patients with ICI-related myocarditis. METHODS: Data on the clinical characteristics, management, and outcomes of patients diagnosed with ICI-related myocarditis between August 2018 and August 2023 in our institution were gathered retrospectively from medical records. Outcomes included the occurrence of major adverse cardiac events (MACE). RESULTS: Among 8875 patients who received ICI therapy, 31 patients experienced ICI-related myocarditis. These 31 patients had a mean age of 62 ± 12 years and included 24 (77.4 %) males and 19 patients (61.3 %) with at least one risk factor for cardiovascular disease. The median duration from ICI initiation to the onset of myocarditis symptoms was 6.3 weeks (interquartile range, 4.3-8.1 weeks). Twenty-one patients (67.7 %) developed grade 3-4 myocarditis. Thirteen patients (42 %) experienced MACE after myocarditis onset, and 15 patients (48.4 %) showed a troponin rise > 4 times the maximum limit of the standard range. On receiver operating characteristic curve analysis, troponin level could predict MACE in patients with ICI-related myocarditis with an area under the curve of 0.82 (95 % confidence interval [CI]: 0.66-0.98, p = 0.003). From Kaplan-Meier analysis, the occurrence of MACE (p = 0.002) was an independent influencing factor on patients' overall survival. CONCLUSIONS: ICI-related myocarditis frequently leads to MACE, which is associated with poor prognosis. Elevated troponin levels and electrocardiogram abnormalities in these patients may help predict the occurrence of MACE.

Comparative efficacy of six programmed cell death Protein-1 inhibitors as first-line treatment for advanced non-small cell lung cancer: a multicenter retrospective cohort study.

The purpose of this study was to assess the comparative efficacy of six programmed cell death-1 inhibitors (nivolumab, pembrolizumab, sintilimab, tislelizumab, toripalimab, and camrelizumab) that have been used as first-line therapy for Chinese patients with advanced non-small cell lung cancer (NSCLC), which remains unclear. We determined the differences in efficacy by observing patient survival data, with the goal of informing future treatment options. Retrospective data analysis from June 2015 to April 2023 included 913 patients across six groups: nivolumab (123%, 13.5%), pembrolizumab (421%, 46.1%), sintilimab (239%, 26.1%), tislelizumab (64%, 7.0%), toripalimab (39%, 4.3%), and camrelizumab (27%, 3.0%). The median progression-free survival (PFS) for each group was 16.0, 16.1, 18.4, 16.9, 23.7, and 12.8 months, and the median overall survival (OS) was 33.7, 36.1, 32.5, not reached, 30.9 and 46.0 months for the nivolumab, sintilimab, pembrolizumab, tislelizumab, toripalimab, and camrelizumab groups, respectively. While differences existed in the objective response rates among groups (p < 0.05), there were no significant differences (all p > 0.05) in PFS or OS. The findings suggest comparable efficacy among these PD-1 inhibitors for NSCLC treatment, underscoring their collective suitability and aiding treatment decisions.

Prognosis of immune checkpoint inhibitor-induced myasthenia gravis: a single center experience and systematic review.

Background: Immune checkpoint inhibitors (ICI)-induced myasthenia gravis (MG) is an uncommon but potentially fatal neurotoxicity. We aim to help physicians familiarize themselves with the clinical characteristics of ICI-induced MG, facilitating early diagnosis and prompt intervention. Methods: We searched the Chinese People's Liberation Army General Hospital medical record system from January 2017 to August 2023 for patients diagnosed with ICI-induced MG. We systematically reviewed the literature until August 2023 to identify all similar patients. We collected clinical information on these patients. Results: 110 patients were identified, 9 from our institution and 101 from case reports. In our institution, Median age was 66 years (range: 49-79 years). 6 were males. The most common was lung cancer (n = 4). All patients had no previous history of MG and received PD-1 or PD-L1 inhibitors. The median time from ICI initiation to first MG symptoms was 4 weeks (range: 2-15 weeks). ICIs were discontinued in all patients. Most patients initially received high-dose corticosteroids, and their symptoms improved. Some patients are discharged with corticosteroids maintenance therapy. In addition, 55 patients (50%) with concomitant myositis and/or myocarditis and MG-induced mortality were more common in the myositis and/or myocarditis group (10.9% vs. 34.5%, p = 0.016). Overlap of myositis with MG (OR = 3.148, p = 0.009) and anti-AChR antibody positivity (OR = 3.364, p = 0.005) were both significantly associated with poor outcomes. Conclusion: Our study reveals the prognosis of ICI-induced MG and suggests that myositis and/or myocarditis are severe comorbidities of ICI-induced MG, emphasizing the importance of early diagnosis and clinical intervention.

Model for preventing tissue injury in the process of athlete training / Modelo para prevenção de lesões teciduais no processo de treinamento de atletas / Modelo para prevención de lesiones tisulares en el proceso de entrenamiento de atletas

ABSTRACT Introduction: The topic of preventing tissue damage during sports is a heavily debated one. Uncovering factors related to sports injuries is essential to deal with this issue. Objective: To analyze the causes of athletes' sports injuries, providing a theoretical basis for reducing the occurrence of sports injuries and increasing the success rate of athletes. Methods: This article uses statistical methods to investigate and analyze the causes of athletes' sports injuries. Results: Four important factors lead to athletes' sports injuries: poor physical fitness, inadequate warm-up activities, incorrect techniques, and excessive loads. Conclusion: Coaches should systematically prepare multi-year training plans, step by step, and pay attention to long-term effects. This is the only way athletes can achieve their best performance at the appropriate age. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A prevenção de danos teciduais durante a prática esportiva é um tópico acaloradamente debatido. Descobrir os fatores relacionados a ferimentos esportivos é essencial para lidar com esse agravo. Objetivo: Analisar as causas dos ferimentos esportivos em atletas, fornecendo uma base teórica para reduzir o número de ferimentos esportivos e aumentar a taxa de sucesso de atletas. Métodos: Esse artigo usa métodos estatísticos para investigar e analisar a causa das lesões esportivas em atletas. Resultados: Quatro fatores importantes levam às lesões esportivas dos atletas: preparo físico ruim, aquecimento inadequado, técnica incorreta e cargas excessivas. Conclusão: Técnicos deveriam preparar, passo-a-passo, treinamentos sistemáticos com duração de vários anos, levando em consideração seus efeitos de longo prazo. Só assim atletas podem atingir sua melhor performance na idade adequada Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: La prevención de daños tisulares durante la práctica deportiva es un tópico muy debatido. Descubrir los factores relacionados con las lesiones deportivas es esencial para lidiar con este problema. Objetivo: Analizar las causas de las lesiones deportivas en atletas, suministrando una base teórica para reducir el número de lesiones deportivas y aumentar la tasa de éxito de atletas. Métodos: Este artículo usa métodos estadísticos para investigar y analizar la causa de las lesiones deportivas en atletas. Resultados: Cuatro factores importantes ocasionan las lesiones deportivas de los atletas: preparación física insuficiente, calentamiento inadecuado, técnica incorrecta y cargas excesivas. Conclusión: Técnicos deberían preparar, paso a paso, entrenamientos sistemáticos con duración de varios años, teniendo en cuenta sus efectos a largo plazo. Solo así los atletas podrían alcanzar su mejor desempeño en la edad adecuada. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.