Breast cancer has become the malignant tumor with the highest incidence rate among women， seriously threatening the life and health of women all over the world. The pathogenic factors and development mechanisms of breast cancer are complex and diverse. The development of breast cells from ordinary hyperplasia to atypical hyperplasia， and from pre-cancerous lesions to cancerous lesions， is a long-term progressive process. Therefore， early screening and prevention of breast cancer is particularly important. Western medicine has a relatively mature treatment program for breast cancer， which is mainly based on surgery and systemic treatment， whereas the ensuing complications and adverse reactions often bring a heavy burden to patients. For the precancerous lesions of breast cancer， surgery is also the mainstay of treatment. In recent years， traditional Chinese medicine （TCM） has increasingly highlighted its advantages in the prevention and treatment of breast cancer. Increasing studies have shown that in the prevention and treatment of breast cancer and pre-cancerous lesions， TCM compound prescriptions， single herbs or herb pairs， and active components are able to regulate a variety of intracellular signaling pathways through multi-targets to inhibit the proliferation and invasion， promote the apoptosis and autophagy of tumor cells， and regulate the cell cycle and the immune microenvironment， thus exerting anti-tumor effects. At the same time， they can significantly attenuate the toxic side effects of radiotherapy and drug resistance of patients. However， the specific mechanisms of TCM in the prevention and treatment of breast cancer and precancerous lesions have not been fully clarified. The available studies are tanglesome regarding the TCM inhibition of tumor development through the regulation of classical signaling pathways such as phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR）， Wnt/β-catenin， and Notch， which still need to be verified by a large number of clinical and experimental studies. Therefore， this paper reviews the research progress in the prevention and treatment of breast cancer and precancerous lesions by TCM through interfering with the relevant signaling pathways in recent years， aiming to summarize the possible mechanisms of TCM in the prevention and treatment of breast cancer and provide references for subsequent studies.

Objective:To evaluate a novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and a new grading system for accuracy and safety of sacroiliac screw placement.Methods:A retrospective study was conducted to analyze the data of 132 patients with pelvic fracture who had undergone percutaneous fixation of the posterior pelvic ring with sacroiliac screws at Department of Emergency Surgery, Qilu Hospital of Shandong University from January 2023 to January 2025. In this cohort, 79 cases were male and 53 ones female, with an age of (44.9±12.4) years. According to the Denis classification of sacral fractures, 69 cases were of type 1, 54 cases of type 2 and 9 cases of type 3. A total of 160 sacroiliac screws were placed in this cohort. Based on the preoperative CT axial plain scans of the sacrum, a novel CT classification of sacroiliac screw bony channels was proposed as follows: S 1 screw parallel channel (71 screws inserted), S 1 screw oblique channel (31 screws inserted), and S 2 screw parallel channel (58 screws inserted). A new grading system for accuracy and safety of sacroiliac screw placement was developed based on the position of sacroiliac screw relative to that of sacroiliac bony channel in postoperative CT axial scan: grade 1: screw completely within the bony channel; grade 2: screw incompletely within the bony channel without contacting the anterior or posterior cortex; grade 3: contacting but not penetrating the cortex; grade 4: penetrating the cortex. Six senior surgeons verified the inter-observer consistency and intra-observer repeatability of the new grading system for accuracy and safety of sacroiliac screw placement. Results:According to the new grading system for accuracy and safety of sacroiliac screw placement, of the 160 sacroiliac screws placed in the 132 patients, 122 were graded as grade 1, 19 as grade 2, 9 as grade 3, and 10 as grade 4, yielding an excellent and good rate of 88.13% (141/160), and an acceptability rate of 93.75% (150/160). The Kappa values for inter-observer consistency and intra-observer repeatability of the new grading system were 0.87 and 0.97, respectively. All the 132 patients were followed up for (18.3±3.6) months after surgery. During the follow-up period, none of the patients experienced such complications as retraction, breakage, or infection of the screws. Screw loosening occurred in some patients who were followed up for more than 1 year [5.51% (7/127), with 3 S 1 screws of grade 3 and 4 S 1 screws of grade 4]. Conclusion:The novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and the new grading system for accuracy and safety of sacroiliac screw placement can lead to a high acceptability rate of sacroiliac screw placement, indicating clinical practicality of the novel classification and the new grading system.

Diabetic nephropathy(DN)is a chronic complication that leads to the high mortality of diabetes mellitus(DM)patients.Many researchers are devoted to the diagnosis,etiology,process and molecular mechanism of treatment of DN.At present,the regulation of small molecular lipids on renal function and the role in the pathogenesis of DN are gradually becoming clear,and lipidomics has also become a powerful tool in DN research.DN is characterised by disorders of lipid metabolism,and lipidomics plays an important role in the characterisation of lipid metabolic profiles,diagnosis,mechanistic investigation and treatment of DN because of its unique relevance.But at the same time,the lipids in the body are complex,which brings great challenges to the detection and analysis of lipids.In the future,multidisciplinary crossover and multi-omics association is the direction of lipidomics breakthrough.This article outlines the progress of the application of lipidomics in DN research strategies,lipid metabolic profiling,early diagnosis,drug efficacy and mechanism exploration,and histological co-analysis,and further discusses the opportunities and challenges of the future application of lipidomics in DN,with the aim of providing a clear picture of the current status of the research and the prospects for researchers in the relevant directions.

Objective To investigate the value of Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic liver failureⅡ(COSSH-ACLF Ⅱ)score in predicting the short-term prognosis of patients with hepatitis B virus-related acute chronic liver failure(HBV-ACLF)comorbid with hepatic encephalopathy(HE).Methods A retrospective analysis was performed for 134 patients who were admitted to The First Hospital of Shanxi Medical University from January 2019 to October 2024 and were diagnosed with HBV-ACLF and HE,and according to the survival status of the patients on day 90 of follow-up,they were divided into survival group with 60 patients and death group with 74 patients.Related scores were calculated,including COSSH-ACLF Ⅱ score,COSSH-ACLF score,Model for End-Stage Liver Disease(MELD)score,MELD combined with serum sodium concentration(MELD-Na)score,and MELD 3.0 score,and the two groups were compared in terms of basic clinical data,laboratory markers,complications,and the scores of each model.The chi-square test was used for comparison of categorical data between two groups,and the t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups.The receiver operating characteristic(ROC)curve was used to assess the performance of each score in predicting the prognosis of patients with comorbidity of HBV-ACLF and HE.Results The death group had a significantly higher age than the survival group(56.09±10.52 years vs 49.23±11.57 years,t=2.720,P=0.007).Compared with the survival group,the death group had significantly higher incidence rate of complications(upper gastrointestinal bleeding and ascites)and laboratory markers(white blood cell count,neutrophil count,total bilirubin,international normalized ratio,serum creatinine,and blood urea nitrogen)(all P<0.05).The death group had significantly higher COSSH-ACLF Ⅱ,COSSH-ACLF,MELD,MELD-Na,and MELD 3.0 scores than the survival group(all P<0.001).The patients were stratified into low-,moderate-,and high-risk groups based on COSSH-ACLF Ⅱs score,and comparison between groups showed that the mortality rate of patients increased with the increase in COSSH-ACLF Ⅱ score(χ2=44.371,P<0.001).The ROC curve analysis showed that COSSH-ACLF Ⅱ score had an area under the ROC curve(AUC)of 0.883(95%confidence interval:0.837-0.919)in predicting the 90-day mortality of patients with comorbidity of HBV-ACLF and HE,with a sensitivity of 90.5%,a specificity of 78.7%,and a predictive accuracy of 85.07%at the cut-off value of 7.25.COSSH-ACLF Ⅱscore had a better performance than COSSH-ACLF(AUC=0.841,P<0.05),MELD 3.0(AUC=0.733,P<0.05),MELD-Na(AUC=0.723,P<0.05),and MELD(AUC=0.716,P<0.05).Conclusion COSSH-ACLF Ⅱ score can improve the accuracy of predicting 90-day prognosis in patients with comorbidity of HBV-ACLF and HE,and COSSH-ACLF Ⅱ risk stratification can help to simplify the grading of patients.

Purpose To compare the 5.0T gradient echo coronary magnetic resonance angiography(CMRA)using compressed sensing(CS)acceleration technology(5.0TCS-CMRA)vs.3.0T gradient echo-CMRA(3.0TCS-CMRA)using CS.Materials and Methods Twenty-five healthy volunteers aged 23 to 30 years from December 16,2023 to January 14,2024 at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences were prospective enrolled in this study.The interval between 3.0TCS-CMRA and 5.0TCS-CMRA was within two weeks.3.0TCS-CMRA used T2 preparation and 5.0TCS-CMRA did not use T2 preparation.The image quality scores,coronary artery length,signal-to-noise ratio(SNR)and contrast-to-noise ratio between coronary blood and adjacent myocardium or tissue(CNRmyo-blood)were evaluated.Results On 5.0TCS-CMRA,the SNR and CNRmyo-blood of the proximal right coronary artery(RCA)in 25 healthy volunteers were significantly higher than those of 3.0TCS-CMRA(SNR:318.07±94.06 vs.223.81±51.19,t=-5.609,P<0.001;CNRmyo-blood:212.75±91.44 vs.149.70±59.53,Z=-3.619,P<0.001),while the SNR and CNRmyo-blood of proximal left anterior descending coronary artery(LAD)and left circumflex coronary artery(LCX)were not significantly higher than those of 3.0TCS-CMRA(SNR:315.52±102.49 vs.306.35±92.85,t=-0.627,P=0.536;289.72±88.79 vs.272.87±84.68,t=-1.226,P=0.232;CNRmyo-blood:135.83±93.53 vs.203.94±74.30,t=4.132,P<0.001;117.66±79.63 vs.161.60±78.91,t=3.127,P=0.005).The length of the three coronary arteries measured by 5.0TCS-CMRA was significantly shorter than that of 3.0TCS-CMRA[RCA:(126.04±31.54)mm vs.(137.20±29.93)mm,t=2.911,P=0.008;LAD:(122.68±24.63)mm vs.(134.24±23.38)mm,Z=-3.026,P=0.002;LCX:(57.07±26.70)mm vs.(68.27±24.02)mm,t=2.552,P=0.018].There was no significant difference in the scanning time required between 3.0TCS-CMRA and 5.0TCS-CMRA[(8.60±2.84)min vs.(8.30±2.32)min,Z=-0.183,P=0.855].The image scores of the three major coronary arteries of 5.0TCS-CMRA were significantly lower than those of 3.0TCS-CMRA(RCA:2.52±0.59 vs.3.16±0.69,Z=-3.258,P=0.001;LAD:2.72±0.74 vs.3.24±0.66,Z=-2.540,P=0.011;LCX:2.44±0.71 vs.3.00±0.87,Z=-2.462,P=0.014).Conclusion In the absence of T2 preparation,5.0TCS-CMRA can still show obvious advantages in the SNR and CNRmyo-blood of proximal RCA compared with 3.0TCS-CMRA,which suggests the application potential of 5.0TCS-CMRA.In the future,a suitable T2 preparation pulse or potential alternative may significantly improve the performance of the 5.0TCS-CMRA.

Objective:To investigate the value of transrectal shear-wave elastography(SWE)quantitative parameters and Prostate Imaging Reporting and Data System(PI-RADS)v2.1 scores in combined diagnosis for clinically significant prostate cancer(csPCa).Methods:A total of 80 patients with suspected PCa who admitted to Affiliated Santai Hospital of North Sichuan Medical College from January to December 2023 were prospectively enrolled,who were divided into csPCa group(52 cases)and non-csPCa group(28 cases)based on the results of pathological diagnosis.All patients underwent combined examination of SWE and magnetic resonance imaging(MRI),and pathological validation with systematic puncture.The SWE was used to quantitatively obtain the maximum value(Emax),mean value(Emean),and standard deviation(SD)of Young's modulus of lesions,and the MRI morphologic assessment was conducted according to PI-RADS v 2.1 standard.A multivariate logistic regression was used to construct a combined diagnostic model,which stability was verified by Bootstrap resampling.The area under curve(AUC)values of the receiver operating characteristic(ROC)curves were compared between single parameters and the combined diagnosis.Results:In the 80 patients with suspected prostate cancer,pathological confirmation showed 52 cases(65.0%)were csPCa,and 28 cases(35.0%)were non-csPCa.SWE-Emax values of the csPCa group and the non-csPCa group were respectively 68.5 kPa and 32.4 kPa,and csPCa group was significantly higher than non-csPCa group,with statistically significant differences(Z=6.731,P<0.001).The PI-RADS scores of csPCa group was 4.5 points,and that of non-csPCa group was 2.9 points,and the points of csPCa group was significantly higher than that of non-csPCa group,and the difference was significant(t=9.782,P<0.05).Spearman analysis revealed a strongly positive correlation between SWE-Emax and PI-RADS scores(r=0.83,P<0.001),and a negative correlation between SWE-Emax and apparent diffusion coefficient(ADC)values(r=-0.71,P<0.001).The AUC value of combined diagnosis reached to 0.943(95%CI:0.898-0.988),which was significantly better than 0.891 of single SWE-Emax or 0.854 of single PI-RADS(Delong test P<0.05),and the sensitivity and specificity of combined diagnosis were respectively 96.2%and 85.7%.In addition,the diagnostic specificity increased to 93.8%when the combined threshold was set at PI-RADS≥4 and Emax≥48.5 kPa.Conclusion:SWE quantitative parameters and PI-RADS scores have significant complementary value in diagnosing csPCa.The combined diagnosis can effectively enhance the discriminative efficacy for PCa lesions with Gleason scores≥3+4 by integrating tumor stiffness and morphological heterogeneity features,which can provide an innovative imaging fusion strategy for precise stratification of patients in the gray zone of prostate-specific antigen(PSA).

Hepatic osteodystrophy is a common complication in patients with chronic liver disease and is influenced by various risk factors， and it has become one of the important influencing factors for the prognosis of liver transplantation. By analyzing the influencing factors for bone health and bone metabolism during the perioperative period of liver transplantation， this article emphasizes the importance of a comprehensive assessment of bone health and necessary interventions at this stage， with an aim to reduce the risk of postoperative complications and improve the long-term prognosis of patients. A deeper exploration of the association between hepatic osteodystrophy and the prognosis of liver transplantation can help to reveal the key influencing factors for postoperative outcomes， thus providing a theoretical basis for optimizing postoperative management strategies. Furthermore， advances in this research field will offer new insights into the treatment of patients receiving liver transplantation， and it is expected to further improve quality of life and long-term survival rate.

Objective To investigate the value of Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic liver failureⅡ(COSSH-ACLF Ⅱ)score in predicting the short-term prognosis of patients with hepatitis B virus-related acute chronic liver failure(HBV-ACLF)comorbid with hepatic encephalopathy(HE).Methods A retrospective analysis was performed for 134 patients who were admitted to The First Hospital of Shanxi Medical University from January 2019 to October 2024 and were diagnosed with HBV-ACLF and HE,and according to the survival status of the patients on day 90 of follow-up,they were divided into survival group with 60 patients and death group with 74 patients.Related scores were calculated,including COSSH-ACLF Ⅱ score,COSSH-ACLF score,Model for End-Stage Liver Disease(MELD)score,MELD combined with serum sodium concentration(MELD-Na)score,and MELD 3.0 score,and the two groups were compared in terms of basic clinical data,laboratory markers,complications,and the scores of each model.The chi-square test was used for comparison of categorical data between two groups,and the t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups.The receiver operating characteristic(ROC)curve was used to assess the performance of each score in predicting the prognosis of patients with comorbidity of HBV-ACLF and HE.Results The death group had a significantly higher age than the survival group(56.09±10.52 years vs 49.23±11.57 years,t=2.720,P=0.007).Compared with the survival group,the death group had significantly higher incidence rate of complications(upper gastrointestinal bleeding and ascites)and laboratory markers(white blood cell count,neutrophil count,total bilirubin,international normalized ratio,serum creatinine,and blood urea nitrogen)(all P<0.05).The death group had significantly higher COSSH-ACLF Ⅱ,COSSH-ACLF,MELD,MELD-Na,and MELD 3.0 scores than the survival group(all P<0.001).The patients were stratified into low-,moderate-,and high-risk groups based on COSSH-ACLF Ⅱs score,and comparison between groups showed that the mortality rate of patients increased with the increase in COSSH-ACLF Ⅱ score(χ2=44.371,P<0.001).The ROC curve analysis showed that COSSH-ACLF Ⅱ score had an area under the ROC curve(AUC)of 0.883(95%confidence interval:0.837-0.919)in predicting the 90-day mortality of patients with comorbidity of HBV-ACLF and HE,with a sensitivity of 90.5%,a specificity of 78.7%,and a predictive accuracy of 85.07%at the cut-off value of 7.25.COSSH-ACLF Ⅱscore had a better performance than COSSH-ACLF(AUC=0.841,P<0.05),MELD 3.0(AUC=0.733,P<0.05),MELD-Na(AUC=0.723,P<0.05),and MELD(AUC=0.716,P<0.05).Conclusion COSSH-ACLF Ⅱ score can improve the accuracy of predicting 90-day prognosis in patients with comorbidity of HBV-ACLF and HE,and COSSH-ACLF Ⅱ risk stratification can help to simplify the grading of patients.

Purpose To compare the 5.0T gradient echo coronary magnetic resonance angiography(CMRA)using compressed sensing(CS)acceleration technology(5.0TCS-CMRA)vs.3.0T gradient echo-CMRA(3.0TCS-CMRA)using CS.Materials and Methods Twenty-five healthy volunteers aged 23 to 30 years from December 16,2023 to January 14,2024 at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences were prospective enrolled in this study.The interval between 3.0TCS-CMRA and 5.0TCS-CMRA was within two weeks.3.0TCS-CMRA used T2 preparation and 5.0TCS-CMRA did not use T2 preparation.The image quality scores,coronary artery length,signal-to-noise ratio(SNR)and contrast-to-noise ratio between coronary blood and adjacent myocardium or tissue(CNRmyo-blood)were evaluated.Results On 5.0TCS-CMRA,the SNR and CNRmyo-blood of the proximal right coronary artery(RCA)in 25 healthy volunteers were significantly higher than those of 3.0TCS-CMRA(SNR:318.07±94.06 vs.223.81±51.19,t=-5.609,P<0.001;CNRmyo-blood:212.75±91.44 vs.149.70±59.53,Z=-3.619,P<0.001),while the SNR and CNRmyo-blood of proximal left anterior descending coronary artery(LAD)and left circumflex coronary artery(LCX)were not significantly higher than those of 3.0TCS-CMRA(SNR:315.52±102.49 vs.306.35±92.85,t=-0.627,P=0.536;289.72±88.79 vs.272.87±84.68,t=-1.226,P=0.232;CNRmyo-blood:135.83±93.53 vs.203.94±74.30,t=4.132,P<0.001;117.66±79.63 vs.161.60±78.91,t=3.127,P=0.005).The length of the three coronary arteries measured by 5.0TCS-CMRA was significantly shorter than that of 3.0TCS-CMRA[RCA:(126.04±31.54)mm vs.(137.20±29.93)mm,t=2.911,P=0.008;LAD:(122.68±24.63)mm vs.(134.24±23.38)mm,Z=-3.026,P=0.002;LCX:(57.07±26.70)mm vs.(68.27±24.02)mm,t=2.552,P=0.018].There was no significant difference in the scanning time required between 3.0TCS-CMRA and 5.0TCS-CMRA[(8.60±2.84)min vs.(8.30±2.32)min,Z=-0.183,P=0.855].The image scores of the three major coronary arteries of 5.0TCS-CMRA were significantly lower than those of 3.0TCS-CMRA(RCA:2.52±0.59 vs.3.16±0.69,Z=-3.258,P=0.001;LAD:2.72±0.74 vs.3.24±0.66,Z=-2.540,P=0.011;LCX:2.44±0.71 vs.3.00±0.87,Z=-2.462,P=0.014).Conclusion In the absence of T2 preparation,5.0TCS-CMRA can still show obvious advantages in the SNR and CNRmyo-blood of proximal RCA compared with 3.0TCS-CMRA,which suggests the application potential of 5.0TCS-CMRA.In the future,a suitable T2 preparation pulse or potential alternative may significantly improve the performance of the 5.0TCS-CMRA.

Diabetic nephropathy(DN)is a chronic complication that leads to the high mortality of diabetes mellitus(DM)patients.Many researchers are devoted to the diagnosis,etiology,process and molecular mechanism of treatment of DN.At present,the regulation of small molecular lipids on renal function and the role in the pathogenesis of DN are gradually becoming clear,and lipidomics has also become a powerful tool in DN research.DN is characterised by disorders of lipid metabolism,and lipidomics plays an important role in the characterisation of lipid metabolic profiles,diagnosis,mechanistic investigation and treatment of DN because of its unique relevance.But at the same time,the lipids in the body are complex,which brings great challenges to the detection and analysis of lipids.In the future,multidisciplinary crossover and multi-omics association is the direction of lipidomics breakthrough.This article outlines the progress of the application of lipidomics in DN research strategies,lipid metabolic profiling,early diagnosis,drug efficacy and mechanism exploration,and histological co-analysis,and further discusses the opportunities and challenges of the future application of lipidomics in DN,with the aim of providing a clear picture of the current status of the research and the prospects for researchers in the relevant directions.