Breast cancer is one of the most common tumor-related causes of death in women， accounting for the first place in the incidence of female malignant tumors， with its incidence increasing yearly and the age of onset gradually becoming younger. Lymph node（LN）metastasis is the most important predictor to evaluate the recurrence and survival rate of patients with breast cancer. Accurate assessment of axillary lymph node involvement is an important part for breast cancer staging. Sentinel lymph node biopsy（SLNB）and axillary lymph node dissection（ALND）are both invasive procedures with high risk of complications and false negative rate. Therefore， using non-invasive imaging methods to predict axillary lymph node metastasis have become a research hotspot in recent years. Multimodal magnetic resonance has the advantages of no radiation， high soft tissue resolution， multiple parameters， and multiple sequences compared with other imaging methods in predicting lymph node metastasis of breast cancer. It is widely used in the differentiation of benign and malignant breast lesions， evaluation of prognosis of breast cancer patients， evaluation of lymph node metastasis status， and evaluation of the efficacy of neoadjuvant chemotherapy. This article reviews the research progress of multimodal MRI in predicting axillary lymph node metastasis of breast cancer with various index models and kurtosis diffusion imaging.

By the year of 2020， the number of breast cancer patients has reached the highest worldwide， while the prognosis for advanced breast cancer remains extremely poor. Chemotherapy is currently the main treatment method； however， its strong side effects and the development of drug resistance limit the clinical benefits of the therapy. Neoangiogenesis plays a crucial role in tumor development and metastasis， making anti?angiogenesis therapy a hot point in cancer research. VEGFR， an important vascular endothelial growth factor receptor， promotes blood vessel growth and is overexpressed in multiple tumors including breast cancer. Therefore， inhibiting activity of VEGFR can effectively suppress tumor angiogenesis and normalize tumor blood vessels. Numerous small molecule anti?angiogenesis drugs have been studied clinically for breast cancer treatment. This article aims to explore VEGFR tyrosine kinase inhibitors （VEGFR?TKIs） as an effective treatment option for advanced breast cancer patients， and the efficacy， safety， and potential side effects of these inhibitors. Additionally， it provides new insights into palliative care for advanced breast cancer.

Objective To analyze the diagnostic value of the expression of Granzyme B and Perforin in peripheral blood T lymphocytes and NK cells in patients with breast cancer （BC）， to investigate the correlation between the expression of granzyme B and perforin and the clinicopathological characteristics of BC， including molecular typing and tumor stage， and the evaluation of the therapeutic effect on BC. Methods Flow cytometry was used to detect the expression of granzyme B and perforin in CD3⁺T cells， CD8⁺T cells and NK cells in 108 patients with BC and 70 benign breast disease controls， and to evaluate the diagnostic efficiency of the receiver operating characteristic （ROC） curve of each indicator in BC； to compare the expression of granzyme B and perforin in patients with different clinicopathological characteristics and the changes of various indicators before and after treatment. Results The expressions of granzyme B and perforin in T lymphocyte subsets and NK cells in BC patients were significantly higher than those of the control group （P < 0.05）. ROC analysis showed that the area under the curve （AUC） of granzyme B and perforin positive rates in CD3⁺T cells， CD8⁺T cells and NK cells was greater than 0.5. The expression of granzyme B and perforin in CD3⁺T cells was positively correlated with the tumor size and clinical stage of BC （P < 0.05）， and granzyme B in CD8⁺T cells was also positively correlated with the tumor size and clinical stage of BC （P < 0.05）. The expression of granzyme B and perforin in CD3⁺T cells in BC patients with lymph node metastasis was significantly greater than that in BC patients without lymph node metastasis （P < 0.05）. The expression of granzyme B and perforin in peripheral blood T lymphocytes in BC patients after treatment was greater than that before treatment （P < 0.05）. Conclusion The expression of granzyme B and perforin in CD3⁺T cells， CD8⁺T cells and NK cells in peripheral blood has certain reference for the diagnosis of BC， and has correlation with tumor size， lymph node metastasis and clinical stage， which can assist in the early screening， diagnosis and treatment evaluation of BC.

Objective To investigate the effect of inhibiting miR-767-5p on migration， invasion and epithelial-mesenchymal transition（EMT） of breast cancer cells. Methods Breast cancer cells were cultured in vitro， and miR-767-5p inhibitor and inhibitor NC were transfected into breast cancer cells. The cells were divided into three groups： Control group， miR-767-5p inhibitor group and inhibitor-NC group. The effects of miR-767-5p inhibitor on the proliferation， invasion and migration of breast cancer cells were detected by CCK-8 assay， Transwell Migration assay and scratch test. Western blot was used to detect the expression levels of migration related proteins MMP-2 and MMP-9. The dual luciferase reporter gene experiment verifies the targeted binding effect of miR-767-5p and IGF1. RT-qPCR and Western blot experiments were used to detect the expression levels of IGF1 mRNA and protein. Western blot was used to detect the expression level of EMT related proteins. Results CCK-8 assay showed that compared with the control group and inhibitor-NC group， the miR-767-5p inhibitor group significantly inhibited the proliferation of MCF-7 cells（P < 0.05）. Transwell assay showed that the number of invasive cells of breast cancer cells in miR-767-5p inhibitor group was significantly lower than that in control group and inhibitor NC group （P < 0.05）. Scratch test showed that compared with the control group and inhibitor NC group， the migration rate of breast cancer cells in miR-767-5p inhibitor group decreased significantly （P < 0.05）. Luciferase reporter gene assay showed that miR-767-5p targeted IGF1 binding. Western blot showed that compared with the control group and inhibitor NC group， the expression level of E-cadherin protein in the miR-767-5p inhibitor group was significantly increased （P < 0.05）， while the expression levels of N-cadherin， MMP-2， and MMP-9 protein were significantly reduced （P < 0.05）. Compared with the control group and inhibitor-NC group， the mRNA and protein expression levels of IGF1 in the miR-767-5p inhibitor group were significantly reduced （P < 0.05）. Conclusion Suppressing the expression of miR-767-5p may inhibit the proliferation， invasion， migration and EMT of breast cancer cells by down-regulating IGF1.

Objective To explore the effect and mechanism of fibroblast growth factor 2 （FGF2） knockout on proliferation， migration， invasion and apoptosis of human breast cancer cell line MCF?7. Methods FGF2?sgRNA gene sequence was inserted into the vector lenticrispv2 to create CRISPR?cas9?FGF2 stably transfected cell line， and FGF2 knockout in the cell lines and related apoptotic protein and cyclin indicators were detected by using Western blot. MCF?7 cells were separated into two groups： CRISPR?cas9?NC （control） and CRISPR?cas9?FGF2 （FGF2 knockout）. CCK?8 assay and cell colony formation assay were used to detect cell proliferation ability， so were cell scratch assay and Transwell assay to detect cell migration and invasion ability， and flow cytometry to detect changes in cell cycles. Results （1） All three designed FGF2?sgRNA sequences were successfully linked to the carrier lenticrispv2. Western blot showed that FGF2?sgRNA1 knockout effect was more obvious （P < 0.000 1）. The cellular proliferation， migration， and invasion ability were markedly lowered in the FGF2 knockout group as compared with the control group （P < 0.01）. Expressions of Cyclin CDK2 and cyclinA were dramatically reduced （P < 0.001）， the expression of pro?apoptotic protein Bax was increased （P < 0.001）， whereas the expression of anti?apoptotic protein Bcl?2 was decreased （P < 0.001）. A decline in the ratio of Bcl?2/Bax promoted apoptosis. Conclusions FGF2 gene knockout significantly inhibited proliferation， migration， and invasion of breast cancer cells， blocked cells in the S phase， inhibited cell division， and promoted cell apoptosis， indicating that FGF2 gene has become a potential molecular target for breast cancer therapy.

Objective To investigate the influence of ultrasound imaging parameters on the diagnosis of S?Detect technology. Methods Between October 2021 and March 2022， a total of 143 breast nodules from 133 patients were included in this study. Five ultrasound imaging parameters were set， including basic parameter （single focus， focus located at the middle level of the lesion， and suitable depth of the lesion）， dual focus parameter， superficial focus location， over?depth focus location， and scanning over?depth parameter. The ultrasound images were preserved in different ultrasound imaging parameters to obtain the results of S?Detect. The consistency of diagnosis and ultrasonographic feature interpretation under different ultrasound imaging parameters were investigated. And the diagnostic performance under the four parameters were compared with the basic one. The pathologic results were used as a “golden standard”. Results The diagnostic consistency （kappa = 0.771） of the scanning over?depth parameter was lower than the other settings. The consistency of interpretation of the two ultrasonographic features ［shape （kappa = 0.489） and internal echo （kappa = 0.442）］ were also lower than the other settings. Meanwhile， the diagnostic performance of the scanning over?depth parameter （AUC = 0.716） was the lowest among those ultrasound imaging parameters， and it has the largest gap with the diagnostic efficacy of the basic parameter setting. The other parameter conditions was consistent with the basic parameter， and there was no significant difference between the diagnostic efficacy and basic parameter setting. Conclusions As compared with the basic imaging parameter setting， the consistency of diagnosis， the ultrasonographic feature interpretation and diagnostic performance of the scanning over?depth setting were lower than other ultrasound imaging settings. Therefore， the scanning over?depth settings should be avoided when applying the S?Detect technology.

Objective To investigate the effect of CCN5 gene knockdown on the proliferation of human breast cancer cells， to explore the mechanism of CCN5 in the proliferation of these cancer cells， and to explore the association of CCN5 with the occurrence and development of breast cancer. Methods CCN5siRNA transfection group， lentivirus empty vector transfection group and blank control group were set up by different treatment methods. CCN5siRNA transfection group （hereinafter referred to as transfection group）： transfection of human breast cancer cells MCF?7 with CCN5siRNA mediated by lentiviral vector， lentivirus empty vector transfection group （hereinafter referred to as no?load group）： transfection of cells MCF?7 with empty lentivirus vector. No transfection was performed in the blank control group. MTT assay was used to detect the changes in cell proliferation capacity in each group， so were RT?PCR and Western blotting to detect the mRNA and protein expressions of CCN5， Skp2 and p27Kip1. Results MTT assay showed that proliferation ability of MCF?7 in transfection group was higher than that in empty vector group and control group. The results of RT?PCR and Western blotting showed that the mRNA and protein levels of CCN5 in transfection group were lower than those in empty vector group and control group （P < 0.05）， the mRNA and protein levels of Skp2 in transfection group were higher than those in empty vector group and control group （P < 0.05）， while the mRNA and protein levels of p27Kip1 in transfection group were lower than those in empty vector group and control group （P < 0.05）. Conclusions CCN5siRNA inhibits the mRNA and protein expression of CCN5， promotes and induces the proliferation of breast cancer cells by up?regulating Skp2 and down?regulating P27Kip1.

Objective To investigate the safety， efficacy and influencing factors of nipple-sparing mastectomy with different reconstruction methods. Methods A total of 1408 patients who underwent nipple-sparing breast reconstruction in Shanghai Jiaotong University Breast Cancer Database from March 2010 to March 2022 were retrospectively analyzed. According to the reconstruction method， they were divided into one-stage group （n = 876） and two-step group （n = 532）. The cosmetic effect of breast appearance， satisfaction， complications， postoperative recurrence rate and quality of life were compared between the two groups. According to the recurrence， the patients were divided into recurrence group （n = 162） and non-recurrence group （n = 1 246）. Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of recurrence after nipple-sparing mastectomy. Results The excellent rate of breast appearance and postoperative satisfaction in the one-step group were significantly higher than those in the two-step group （P < 0.05）. There was no significant difference in the incidence of complications and local recurrence between the two groups （P > 0.05）. Six months after surgery， the FACT-B scores of the two groups were higher than those before surgery， and the FACT-B scores of the one-step group were higher than those of the two-step group （P < 0.05）. The proportion of patients older than 35 years old， with invasive cancer of no special type， without endocrine therapy， and without radiotherapy in the recurrence group was significantly higher than that in the non-recurrence group （P < 0.05）. Multivariate Logistic regression analysis showed that age > 35 years old， invasive cancer of no special type， and no adjuvant radiotherapy were independent risk factors for recurrence of reconstruction surgery in patients with nipple-sparing mastectomy for breast cancer （P < 0.05）. Conclusions One-step reconstruction has high application value for the patients undergoing radical mastectomy and is worthy of widespread clinical promotion. Age > 35 years， invasive non-specific cancer， and no adjuvant radiotherapy were independent risk factors for recurrence in patients undergoing radical mastectomy with nipple areola preservation.

Objective To investigate the effect of circulating tumor cells （CTCS） combined with ductoscopy imaging system to improve the diagnostic efficiency of malignant lesions in patients with bloody nipple discharge. Methods Clinical data of 120 patients with bloody nipple discharge in our hospital from September 2019 to June 2023 were retrospectively analyzed， and all patients underwent peripheral blood CTC and ductoscopy. With pathological results as the gold standard， the diagnostic efficacy of CTC and ductoscopy in the diagnosis of malignant lesions in patients with bloody nipple discharge alone and in combination is evaluated. Results Pathological results of 120 patients showed benign lesions in 88 cases and malignant lesions in 32 cases. The count of CTCS in malignant lesion group was 1（0.5， 2.5）cells/3.2 mL， higher than that in benign lesion group 0（0， 1）cells/3.2 mL（P < 0.001）. ROC curve showed that the best cutoff value of CTC count for the diagnosis of malignant lesions in patients with bloody nipple discharge was 2 cells /3.2 mL. A total of 103 benign lesions and 17 malignant lesions were detected. 77 benign lesions and 43 malignant lesions were detected by ductoscopy imaging system. Using pathological results as the gold standard， the diagnostic sensitivity， specificity， accuracy， positive predictive value and negative predictive value of CTC for malignant lesions in patients with bloody nipple discharge were 46.88%， 97.73%， 84.17%， 88.24% and 83.50%， respectively. 84.38%， 81.82%， 82.50%， 62.79%， 93.51% for ductoscopy， and 96.88%， 81.82%， 85.83%， 65.96%， 98.63% for CTC combined with ductoscopy. Conclusion The diagnosis of malignant lesions in patients with bloody nipple discharge by CTC combined with ductoscopic imaging system is more effective.

Pulmonary arterial hypertension is a progressive cardiovascular disease caused by multiple factors， with poor prognosis. Pregnancy with pulmonary arterial hypertension is more prone to serious complications such as right heart failure， pulmonary arterial hypertension crisis， malignant arrhythmia， and cardiogenic shock， with a high mortality rate. There is currently no standardized diagnosis and treatment guideline for pregnancy complicated with pulmonary arterial hypertension. In recent years， the diagnosis， treatment， and management of pregnancy complicated with pulmonary arterial hypertension have received attention. This article provides an important explanation of the diagnosis and treatment of pregnancy complicated with pulmonary arterial hypertension， in order to provide reference for clinical practice.

Objective To study the effect of overexpression of HSG gene （MFN2） on Wnt signaling pathway in airway fibroblasts of rats with chronic obstructive pulmonary disease （COPD）. Methods The rat COPD model was induced by protease， and then the airway fibroblasts of COPD model rats were isolated in primary culture. The expression vector of HSG gene was constructed and transfected into rat airway fibroblasts to obtain rat airway fibroblasts overexpressing HSG. In Experiment 1， cells were treated with phorbol ester （TPA）， a Wnt signaling pathway agonist， and the expressions of HSG and Wnt5a were detected by WB and qPCR； In Experiment 2， the cells were treated with EGF factor， an agonist of MAPK signal pathway， and the expressions of HSG and ERK1/2 were detected by WB and qPCR； Moreover， ELISA was used to detect TGF in cell culture medium in each experiment-β1. The contents of PDGF and MMP-9， CCK8， cell proliferation and apoptosis were detected by flow cytometry. Results Airway fibroblasts were successfully isolated from COPD model rats. In Experiment 1 and Experiment 2， WB and qPCR showed that overexpression of HSG could inhibit the expression of genes Wnt5a and ERK1/2. After treatment with corresponding agonists， the expression of these genes was up-regulated and the expression of HSG was inhibited； The results of ELISA showed that overexpression of HSG could reduce TGF-β1. The contents of PDGF and MMP-9， TGF after treatment with corresponding agonists-β1. The contents of PDGF and MMP-9 increased， but overexpression of HSG still had inhibitory effect. CCK8 detection showed that overexpression of HSG could inhibit cell proliferation， while flow cytometry showed that overexpression of HSG could significantly increase the apoptosis rate， and the corresponding agonist treatment would reduce the effect of overexpression of HSG on cell apoptosis. Flow cytometry showed that the effect of overexpression of HSG on cell cycle was not obvious. Conclusion Overexpression of HSG gene in airway fibroblasts of COPD rats can inhibit Wnt， MAPK and other signal pathways， and overexpression of HSG gene can promote fibroblast apoptosis and inhibit cell proliferation. It can be speculated that promoting HSG expression can inhibit airway fibrosis of COPD rats.

Objective To explore the effect and mechanism of electroacupuncture （EA） on gastric hypersensitivity in rats with functional dyspepsia （FD）. Methods Rats were randomly divided into blank group， model group， EA group， inhibitor group and EA+inhibitor group. The blank group was not subjected to special treatment， and the model group， EA group， inhibitor group， and EA+inhibitor group were modeled using a multi factor stimulation method. After the modeling， the model group was given routine feeding， the EA group and the EA+inhibitor group were treated with daily electroacupuncture at Zusanli， and the inhibitor group and the EA+ inhibitor group were treated with daily intraperitoneal injection of anti-nerve growth factor（NGF）. Gastric hypersensitivity and gastric compliance were detected by intragastric balloon implantation， the degree of mast cell activation were observed by methylamine blue staining， the localization expression of gastric transient receptor potential vanillin subtype 1（TRPV1） was detected by immunohistochemistry， the expression of gastric NGF/tropomyosin receptor kinase （TrkA）/TRPV1 protein was detected by Western blot， and the content of gastric calcitonin gene-related peptide （CGRP） was detected by enzyme-linked immunosorbent assay. Results Compared with the blank group， the weight of the model group rats increased slowly， gastric sensitivity increased， compliance decreased， the number of gastric mast cell and degranulation rate increased significantly， and the protein expression and CGRP content of NGF， TrKA， TRPV1 increased significantly. Compared with the model group， the rats in the EA group， the inhibitor group and the EA+inhibitor group gained weight， improved gastric hypersensitivity and compliance significantly， reduced the number and activation of mast cell significantly， and reduced gastric NGF/TrKA/TRPV1 protein expression and CGRP content significantly. Compared with the EA group and the inhibitor group， the expression of NGF/TrKA/TRPV1 protein and CGRP content in the stomach of the EA+inhibitor group were further reduced， and the difference was statistically significant. Conclusion EA may relieve the gastric hypersensitivity of FD rats by regulating the NGF/TrKA/TRPV1 pathway activated by mast cells.

Objective To investigate the role of long non-coding RNA family with sequence similarity 83 member A antisense RNA 1 in retinoblastoma （RB） cells and its potential molecular mechanism. Methods RB cells were cultured in vitro， and Vector， pcDNA-FAM83A-AS1， NC-siRNA， and FAM83A-AS1-siRNA were transfected into cells to detect the expression of FAM83A-AS1， RB cell proliferation ability， and apoptosis rate in RB cells. Bioinformatics and dual-luciferase reporter gene experiments were performed to predict and verify the targeting relationship between FAM83A-AS1 and miR-150， and miR-150 and the high-mobility family protein A2 （HMGA 2）. The expression of miR-150 and HMGA2 mRNA in RB cells was measured by RT-qPCR； HMGA 2 protein in RB cells by Western blot； and the proliferation and apoptotic capacity of RB cells after transfection by MTT assay and flow cytometry. Results The expression of FAM83A-AS1 in the pcDNA-FAM83A-AS1 group was significantly higher than that of the Vector group and lower than that of the NC-siRNA group （P < 0.05）. The cell proliferation capacity in the pcDNA-FAM83A-AS1 group was significantly higher， and the apoptosis rate was significantly lower （P < 0.05）. Compared with NC-siRNA group， FAM83A-AS1-siRNA group showed significantly increased apoptosis rate （P < 0.05）. The miR-150 mimic significantly inhibited the proliferation capacity of RB cells and promoted cell apoptosis. However， pcDNA-HMGA 2 significantly reversed the effect of miR-150 mimic on the proliferation and apoptosis of RB cells. Conclusion Knockdown of lncRNA FAM83A-AS1 inhibited RB cell proliferation and promoted apoptosis by regulating the miR-150/HMGA2 axis.

Objective To investigate the effects of Schisandrin B （SchB） on myocardial function and apoptosis in Hyperthyroidism heart disease （HHD） rats， and to provide theoretical basis for the mechanism of SchB's intervention on myocardial apoptosis and myocardial function. Methods Hyperthyroidism model group and SchB drug intervention group were established into HHD rat model， and SchB drug intervention group was given SchB thinner ［80 mg/（kg·d）］. Velocity Vector imaging Technology （VVI） was used to analyze each group. Serum TT3， TT4 and NF-κB levels were detected by ELISA. Apoptosis of cardiomyocytes was observed by TUNEL staining. Western blot was used to explore the expression of samples' NF-κB. The tissue cells of left ventricular samples were observed by electron microscope. Results Compared with CON group， peak systolic and diastolic velocities （Vs， Vd）， peak strain （Smax） and peak systolic and diastolic strain rates （sSRr， dSRr） in HHD group were decreased （P < 0.01）； The serum TT3 （P < 0.01）， TT4 （P < 0.01）， NT-proBNP （P < 0.05） and NF-κB （P < 0.01） concentrations increased. The number of TUNEL positive particles increased significantly. The expression of NF-κB was increased by Western blotting （P < 0.05）.The structure of myocardial cells was disordered and apoptosis was obvious under electron microscope. Compared with HHD group， Vs （P < 0.01）， Vd （P < 0.05）， Smax （P < 0.01）， sSRr （P < 0.05） and dSRr （P < 0.05） were increased in HHD+SC group； The serum TT3 （P < 0.05）， TT4 （P < 0.05）， NT-proBNP （P < 0.05） and NF-κB （P < 0.01） levels were decreased. The number of TUNEL positive particles decreased significantly. The expression of NF-κB was decreased by Western blot （P < 0.05）. Under electron microscope， the structure of myocardial cells was more orderly and the apoptosis was reduced. Conclusion SchB can ameliorate HHD myocardial injury and inhibit apoptosis of myocardial cells.

Objective To explore the clinical efficacy of preoperative precise rehabilitation on endoscopic spinal decompression （Endo-LOVE） for lumbar spinal stenosis （LSS）. Methods A retrospective study was conducted among 52 patients with Endo-LOVE from January 2020 to April 2022. The patients were equally divided into observation group and control group， treated with precision rehabilitation and traditional rehabilitation according to the different rehabilitation patterns， respectively. The two groups were compared in terms of the score by Visual Analogue Scale （VAS）， Oswestry Disability Index （ODI） and JOA scores as well as the ratio of left and right supporting phases in gait parameters before the operation， 7 days and 3 months after the operation. Results There were no serious surgical complications in all patients. The VAS and ODI scores 7 days and 3 months after the operation were significantly lower （P < 0.05） and the JOA score and the ratio of left and right supporting phases were significantly higher than before the operation（P < 0.05）. The indexes of the observation group were statistically significantly different with those of the control group 7 days and 3 months after the operation （P < 0.05）. Conclusion Preoperative precise rehabilitation in Endo-LOVE for LSS can relieve postoperative residual pain， improve walking function， reduce the degree of lumbar dysfunction， improve the ability of daily living， and shorten the rehabilitation period. It is of value for clinical application.

Objective To investigate the correlation between serum levels of small dense low density lipoprotein-cholesterol （sdLDL-C） and chemokine CXC motifligand12 （CXCL12） and diabetes mellitus with cardiovascular disease（CVD）. Methods A total of 256 diabetic patients treated in our hospital between June 2021 and September 2022 were selected as the diabetic group. The patients were grouped according to whether they had combined CVD or not. And the serum sdLDL-C as well as CXCL12 levels of each group were compared with healthy volunteers. Risk factors for the complication of CVD in diabetic patients were analyzed. To analyze the diagnostic value of sdLDL-C， CXCL12 and combined test for diabetic patients with complicated CVD. Results Serum sdLDL-C and CXCL12 levels were higher in the diabetes group than in the control group （P < 0.05）. The duration of disease， BMI， LDL-C， and serum sdLDL-C and CXCL12 levels were higher in the cardiovascular disease group than in the non-cardiovascular disease group （P < 0.05）. A multifactorial logistic regression analysis showed that sdLDL-C and CXCL12 were independent risk factors for the complication of CVD in diabetic patients （P < 0.05）. The sensitivity and specificity of serum sdLDL-C and CXCL12 combined test were higher than that of single test. Conclusion Elevated serum sdLDL-C and CXCL12 levels in patients with diabetes mellitus are independent risk factors for the complication of CVD， and the combination of these two tests has a high diagnostic value for diabetes mellitus with CVD.

Objective To investigate the predictive value of neutrophil to lymphocyte and platelet ratio （N/LPR） in the prognosis of children with sepsis. Methods Clinical data of 171 children with sepsis admitted to the pediatric intensive care unit （PICU） of the First Affiliated Hospital of Gannan Medical University from January 1st， 2018 to November 30th， 2022 were retrospectively collected. The pediatric clinical illness score （PCIS） within 24 hours after admission was recorded. Procalcitonin （PCT）， C-reactive protein （CRP） and platelet （PLT） count were collected within 24 hours after diagnosis of sepsis. N/LPR， platelet to lymphocyte ratio （PLR）， neutrophil to lymphocyte ratio （NLR）， and neutrophil to prealbumin ratio （NPRI） were calculated. According to the prognosis， the children were divided into survival group （n = 110） and death group （n = 61）. The difference of N/LPR， PLR， NLR， NPRI， PCIS， PCT， CRP and PLT was compared between the two groups. Receiver operating characteristic （ROC） curve was plotted to analyze the accuracy of N/LPR， PLR and PCIS in predicting 28-day mortality risk in children with sepsis. According to the cut-off value of ROC curve， the 28-day mortality risk of children was analyzed in the subgroups， and the Kaplan-Meier method was used to analyze the survival of children with sepsis in each subgroup. According to PCIS， children with sepsis were divided into three groups （non-critical group， critical group and extremely critical group）， and the relationship between N/LPR， PLR and disease severity was evaluated. Results The level of PCT， CRP and N/LPR in the death group were higher than that in the survival group， while the level of PLT， PLR and PCIS was lower than that in the survival group， and the difference was statistically significant （P < 0.05）. ROC curve showed that the area under curve （AUC） of N/LPR， PLR and PCIS for predicting the 28-day mortality risk of children with sepsis was 0.659， 0.595 and 0.716， respectively. Subgroup analysis showed that the risk of death in N/LPR ≥ 1.5 group was higher than that in N/LPR < 1.5 group （χ² = 11.224， P = 0.001）； that in PLR < 85.58 group was higher than that in PLR ≥ 85.58 group （χ² = 5.708， P = 0.017）； and that in PCIS ≥ 84 group was lower than that in PCIS < 84 group （χ² = 19.312， P = 0.000）. The result of survival analysis was consistent with that of subgroup analysis. In addition， N/LPR might be associated with the risk stratification in children with sepsis. Conclusion N/LPR has a certain predictive value for 28-day mortality risk in children with sepsis.

Objective To investigate the potential application value of microbiology rapid on-site evaluation （M-ROSE） in patients with severe pneumonia. Methods Sixty patients with severe pneumonia admitted to our hospital from February 2021 to February 2023 were randomly divided into two groups， with 30 cases in each group. The control group was given empirical antibacterial therapy， while the M-ROSE group received antibacterial therapy according to the rapid detection results. The level of interleukin 6 （IL-6） and IL-10 was detected on day 1 and 7， respectively； the level of inflammatory indicators （C-reactive protein （CRP） and white blood cell （WBC）） on day 1 and day 7 after enrollment were recorded， and the difference of fever duration， length of mechanical ventilation， length of stay in ICU， 28-day mortality between the two groups was compared. Results The expression level of IL-6， IL-10 and IL-6/IL-10 in M-ROSE group on day 7 was lower than that in experience group （P < 0.05）. The duration of fever disappearance， length of mechanical ventilation and length of stay in ICU in M-ROSE group were shorter than those in the control group （P < 0.05）. There was no significant difference in 28-day mortality between the two groups （P > 0.05）. Conclusion M-ROSE is a valuable tool for the initial assessment of etiology in patients with severe pneumonia. Its potential value is to improve symptoms and inflammation， and shorten length of mechanical ventilation and length of stay in ICU.

Objective This study aimed to explore the clinical value of DR?dacryocystography （DR?DCG） in lacrimal duct obstructive disease， and to further explore the guiding significance of DR?DCG in preoperative evaluation. Methods The DR?DCG of 913 patients （1129 eyes） who came to Zhongshan Ophthalmic Center from January 2019 to December 2019 were collected and analyzed retrospectively. Results （1）Among the 913 cases （1129 eyes） with dacryocystography， a total of 971 eyes were clearly visualized， accounting for 86%； （2） Situation of lacrimal sac visualization： enlarged lacrimal sac in 55 eyes， normal in 438 eyes， and shrink in 478 eyes； （3） The classification of lacrimal obstruction： anterior lacrimal sac obstruction in 80 eyes， high nasolacrimal duct obstruction in 874 eyes， and low nasolacrimal duct obstruction in 97 eyes； （4） Patients with lacrimal drainage system obstruction are 826 patients， accounting for 90.5%， and there were 61 patients with lacrimal duct stenosis， accounting for 6.7%； （5）Patients who chose dacryocystorhinostomy to treat accounted for 62.3%. 902 patients were cured， accounting for 98.9%. Conclusion DR?DCG can clarify the size of the lacrimal sac， the specific site of lacrimal obstruction and its degree of dilatation， with the advantages of simplicity and intuition， and has clinical guidance value for the diagnosis and treatment of lacrimal obstructive diseases.

Objective The study aimed to explore the efficacy and safety of single?dose CTX intravenous pulse therapy for severe gastrointestinal involvement of Henoch Sch?nlein purpura in children. Methods A total of 256 children with abdominal Henoch?Sch?nlein purpura admitted to the Department of Pediatrics of Jingzhou Hospital affiliated to Yangtze University from January 1 in 2017 to June 1 in 2022 were divided into three groups according to the pain digital evaluation scale （NRS?11） and clinical characteristics，which were common type group （157 cases） and severe type group （99 cases）. According to the different treatment options of IVIG and CTX， the severe group was divided into IVIG group （53 cases） and CTX group （46 cases）. 50 healthy children admitted to the hospital for physical examination during the same period were selected as the control group. The changes of laboratory indicators were compared in each group， and the drug efficacy， repeated conditions， complications and adverse reactions were analyzed. Results There was no difference in all laboratory indicators between the healthy control group and the common type group （P > 0.05）. Compared with common type group， WBC， NE and CRP were significantly higher in severe group （P < 0.05）； HGB， ALB and IgG were significantly decreased （P < 0.05）； there was no difference in RDW， PLT， Cr， CystatinC， IgA， C3 and C4 （P > 0.05）. Meanwhile， there was no difference in laboratory indicators between the CTX group and the IVIG group before treatment. Resolution of abdominal pain， hemafecia， time of fasting， duration of intravenous methylprednisolone and the average hospitalization were significantly shortened （P < 0.05）； cumulative use of methylprednisolone， recurrence of abdominal pain and new rashes were significantly reduced （P < 0.05）. In addition， there were no obvious adverse reactions in CTX group， such as hemorrhagic cystitis， leukopenia or severe gastrointestinal reactions. Conclusion When the child is in a high inflammatory state and low IgG level， and it is difficult to withdraw the high dose of glucocorticoid， the early use of single?dose CTX intravenous treatment could quickly control the disease activity， reduce the amount of glucocorticoid， decrease the recurrence rate of bloody stools and abdominal pain， and have no obvious adverse reactions. The efficacy is superior to IVIG.

Objective This research aimed to study the values of the deep learning convolutional neural network model trained from scratch（DL?CNN（fs）） in assessment of acute pulmonary thromboembolism （APE）. Methods A total of 214 patients with suspected APE who underwent computed tomography pulmonary angiography（CTPA） were retrospectively studied， including 137 patients with APE and 77 patients without APE. The presence or absence of APE was determined by the radiologists based on CTPA. The Qanadli score， Mastora score and other parameters on CTPA were measured by the radiologists. The clot volumes and distribution were measured by U?net model which was based on DL?CNN. The performance of DL?CNN（fs） in measuring clot distribution and clot burden was evaluated. The correlation between clot burden and Qanadli score， Mastora score and other CTPA parameters was calculated. Results Sensitivity， specificity and AUC of the central pulmonary artery clot distribution measured by DL?CNN（fs） were 100%， 16.8%， AUC = 0.584 （95%CI： 0.508 ~ 0.661）. Sensitivity， specificity and AUC of the peripheral pulmonary artery clot distribution were high （R1?R9， 60.8% ~ 95.2%，67.9% ~ 87.1%，0.740 ~ 0.844； L1?L10， 64.6% ~ 93.4%， 62.7% ~ 83.1%， 0.732 ~ 0.791）. Strong positive correlation was noted between clot volumes measured by DL?CNN （fs） model and Qanadli score （r = 0.867，P < 0.001）， as well as Mastora score （r = 0.854， P < 0.001）. Clot volumes measured by DL?CNN （fs） model were correlated with the right ventricular functional parameters（right ventricular diameter/left ventricular diameter， right ventricular area/left ventricular area，r = 0.549， 0.559， P < 0.01）. Conclusion The DL?CNN （fs） model has high value in detecting peripheral pulmonary embolism， and its diagnostic specificity for central pulmonary embolism needs to be further improved. The clot volumes from DL?CNN（fs） were correlated with metrics of pulmonary embolism and right ventricular function， which may help doctors to quickly evaluate the clot burden and risk stratification of acute pulmonary thromboembolism.

Objective To investigate the risk factor of acute exacerbation in near future of elderly COPD patients in a stable stage and construct prediction model to provide more reference for early identification of high-risk groups of unplanned hospitalization and formulation of more active and effective intervention programs. Methods 654 elderly patients with COPD in stable stage were retrospectively chosen in the period from January 2018 to June 2022 in our hospital and grouped according to whether acute exacerbation occurred within 6 months of follow-up or not into with exacerbation group （134 cases） and non-exacerbation group （520 cases）. Univariate and multivariate methods were used to analyze the independent influencing factors of short-term acute exacerbations risk in elderly COPD stable patients， and the prediction model based on the above independent influencing factors was constructed and the clinical efficacy of prediction model for short-term acute exacerbations risk was further evaluated. Results Univariate analysis showed that gender， body mass index， cough， FEV1， FVC， the frequency and duration of acute exacerbations in recent 1 year may be related to the occurrence of acute exacerbations in elderly patients with COPD in stable stage （P < 0.05）. Multivariate analysis results of Logistic regression model showed that gender， body mass index， FEV1， FVC， the number and duration of acute exacerbations in recent 1 year were independent factors influencing the risk of acute exacerbations in elderly patients with COPD in stable stage （P < 0.05）. The model equation was constructed according to the independent variable partial regression coefficient： near-term acute exacerbation risk ［Logit （p/1-p）］=-2.981 + 0.642× sex -0.517× body mass index +0.316× the number of acute exacerbations in recent 1 year + 0.028× duration of acute exacerbation in recent 1 year -0.621×FEV1. ROC curve analysis results showed that the area under the curve for predicting the risk of acute exacerbation in near future of elderly COPD patients in stable stage was 0.84 （95%CI： 0.79 - 0.92）， the optimal cut-off value was 0.23， and the sensitivity and specificity were 82.71% and 70.85%， respectively. Conclusion The occurrence of acute exacerbations in aged COPD patients in a stable stage was related to sex， body mass index， FEV1， FVC， the number and duration of acute exacerbations in recent 1 year and the prediction model based on the above independent factors can accurately predict the risk of acute exacerbations in the near future.

Objective To invesigate the prevalence and genetic characteristics of ParechovirusA （PeV-A） in tropical areas. Methods Acute diarrhea disease surveillance was conducted at Sanya Central Hospital between January 2019 and August 2020. Patient data and fecal specimens were collected. PeV-A was detected by nested RT-PCR， and phylogenetic analyses of specific gene sequences were performed. Results Two hundred and sixty-seven patients with acute gastroenteritis were included in this study. The PeV-A detection rate was 3.37% （9/267）， and three PeV-A genotypes （HPeV1， HPeV3， and HPeV5） were detectable， which were most closely related to the reference strains from either Beijing or Hong Kong. The HPeV-positive patients were predominantly young children under the age of 2 years. The detection rate of PeV-A was higher in summer and winter （May to August and December to February， respectively）. Patients with PeV-A-positive diarrhea had a higher proportion of respiratory infections， abdominal pain， vomiting， and fever than those with PeV-A-negative diarrhea. Rotavirus and norovirus were the most common viruses co-infected with PeV-A in patients with acute gastroenteritis. Conclusions PeV-A is an important pathogen of acute gastroenteritis in Sanya， and its prevalent genotypes are similar to those reported in other regions of China.

Objective To explore the cluster analysis of TCM syndromes in patients with type 2 diabetic nephropathy （T2DN） and its relationship withdisease staging. Methods A total of 170 patients with T2DN admittedto our hospital from March 2020 to October 2022 were selected. The general dataof TCM syndromes of T2DN patients， and the distribution of TCM syndromes were observed， including the original TCM syndrome and the concurrent TCM syndrome. The cluster diagram was drawnby using systematic cluster analysis. The correspondence between TCM syndrome types and disease severity was analyzed by simple correspondence. Results The main TCM syndromes of early T2 DN， clinical T2 DN and end-stage renal disease （ESRD） were qi and yin deficiency with blood stasis syndrome （38.46%）， qi stagnation and phlegm stasis syndrome （37.88%）， qi stagnation and phlegm stasis syndrome （50.00%）. The different positions of the cluster diagram were intercepted， and the syndrome types were different. Among them， the D-point interception was divided into five syndromes： liver and kidney yin syndrome， heart and kidney deficiency syndrome， liver and stomach fire syndrome， qi and yin deficiency with stasis syndrome and qi stagnation and phlegm stasis syndrome. Among 170 patients with T2DN， there were 40 cases （23.53%） of liver and kidney yin syndrome， 26 cases （15.29%） of heart and kidney deficiency syndrome， 29 cases （17.06%） of liver and stomach fire syndrome， 20 cases （11.76%） of qi and yin deficiency with blood stasis syndrome， and 55 cases （32.35%） of qi stagnation and phlegm stasis syndrome. In the middle of the two-dimensional projection， qi and yin deficiency with blood stasis syndrome and qi stagnation and phlegm and blood stasis syndrome were not biased towards a certain grade of T2 DN lesion degree； the liver-stomach fire syndrome was biased towards stage V， the heart-kidney deficiency syndrome was biased towards stage Ⅳ， and the liver-kidney yin syndrome was biased towards stage Ⅰ-Ⅲ. Conclusion The basic TCM syndromes of T2 DN patients were liver and kidney yin， heart and kidney deficiency， liver and stomach fire， qi and yin deficiency with blood stasis and qi stagnation and phlegm and blood stasis. With the development of T2DN， TCM syndromes gradually changed from liver and kidney yin to heart and kidney deficiency to liver and stomach fire， and qi and yin deficiency with blood stasis and qi stagnation and phlegm stasis accompanied T2DN patients at all stages.

Objective To investigate the clinical efficacy of fire acupuncture in treating patients with knee osteoarthritis and its effects on osteoarthritis index （WOMAC） scale scores， visual analog （VAS） scores， tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β）. Methods A total of 90 patients with knee osteoarthritis who visited the outpatient department of acupuncture and moxibustion of the First Affiliated Hospital of Guangzhou University of Chinese Medicine and Chongqing Traditional Chinese Medicine Hospital from July 2021 to February 2022 were selected as the research objects， and were divided into 45 cases in the observation group and 45 cases in the control group， according to the randomized number table method， and were treated three times a week （once every other day） for a 4-week treatment period. The WOMAC score， VAS score， serum IL-1β and TNF-α levels of the two groups were compared. Results The cure rate of the treatment group was 88.89%， which was better than that of the control group （66.67%） （P < 0.05）. The cure rate of the treatment group was 88.89%， which was better than that of the control group （66.67%） （P < 0.05）. On the other hand， that were significant differences in serum IL-1β， serum TNF-α， WOMAC score， VAS score， effective rate， between the two groups before and after treatment （P < 0.05）， and the effect of fire acupuncture observation group was better than that of ordinary acupuncture control group （P < 0.05）. No adverse safety events occurred in all patients during treatment. There were significant statistical differences in WOMAC score， VAS score， effective rate， IL-1β and TNF-α between the two groups before and after treatment （P < 0.01）， and the effect of observation group was better than that of control group （P < 0.05）. No adverse safety events occurred in all patients during treatment. Conclusion Fire acupuncture treatment for knee osteoarthritis can significant relieve pain， improve joint mobility and is safe and reliable， and its mechanism may be related to the dowm-regulated of serum IL-1β and TNF-α levels.

Objective To explore the application effect of hospital discharge preparation service in elderly cardiovascular disease patients with comorbidity. Methods A total of 97 elderly cardiovascular disease patients with comorbidity in the geriatric ward of our center were selected as the study objects and divided into observation group （48 cases） and control group （49 cases）. The discharge readiness， discharge guidance quality， self-management capacity， complication rate and readmission rate of elderly cardiovascular disease patients with comorbidity were compared between these two groups. Results Compared with the control group， the three dimensions of personal status， adaptive ability and anticipatory support in the Readiness for Hospital Discharge Scale of the observation group significantly increased （P < 0.05）. The three dimensions of patients' needs， acquired contents， guidance skills and effects in the Quality of Discharge Teaching Scale also increased （P < 0.05）. Moreover， the three dimensions of the self-management ability evaluation scale of patients in the observation group were higher than those in the control group （P < 0.05）， and the complication rate and the readmission rate of patients were lower than the control group （P < 0.05）. Conclusion Discharge preparation service significantly improved the discharge readiness， self-management ability of elderly cardiovascular disease patients with comorbidity， the discharge guidance quality， and reduced the complication rate as well as the readmission rate of patients， which indicated the bright perspective of discharge preparation service in elderly cardiovascular disease patients with comorbidity.

Transcriptomics technology has been developed rapidly in recent years. It can perform transcriptome analysis of acute leukemia （AL）， and objectively and accurately detect abnormal genes and functional changes in AL cells， which is of great significance to further reveal the molecular mechanism of AL occurrence and development. RNA?sequencing （RNA?seq） technology is transcriptome sequencing technology. It not only can identify new oncogene fusions and characteristic molecular markers for more accurate classification and risk assessment of AL but also detect abnormal genes or cell subsets for adopting corresponding targeted therapy to improve the prognosis of AL patients. In addition， the combination of transcriptomics technology with other omics technologies can monitor the multi?omics changes of AL from different levels， and more comprehensively analyze the molecular mechanism of the occurrence and development of AL. With the continuous application of RNA?seq technology， it will provide new precise targets and clinical strategies for the treatment of AL.

Several drugs have been developed for the treatment of diabetes， but many patients still fail to achieve ideal glycemic control. In January 2023， the U.S. Food and Drug Administration （FDA） approved the marketing of the sodium-glucose cotransporter 2 inhibitor， bexagliflozin， for use to improve glycemic control in adults with type 2 diabetes as an adjunctive therapy to diet and exercise. The drug has been shown to be effective and safe in the treatment of diabetes mellitus. Several clinical studies have demonstrated its efficacy and safety in type 2 diabetes， and it also has potential applications in the treatment of obesity， cardiovascular disease， and chronic kidney disease. This article summarizes the mechanism of action， clinical studies， efficacy and safety of bexagliflozin to provide reference for its clinical application in China.