The pathological subtypes of breast cancer can be further divided into different molecular subtypes based on their immunohistochemical staining, such as estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor2 (HER2) and Ki67 expression, including luminal subtype, HER2 overexpression subtype and triple negative subtype. The luminal subtype is defined as ER and/or PR positive. In molecular mechanism, the expression activity of ER can regulate the expression of PR, so the expression of ER and PR is usually consistent. However, in the process of detection, some breast cancers with inconsistent ER/PR expression often appear, especially those with ER (-) /PR (+) . There is still controversy about whether such cases are true. Patients with this type of breast cancer should be subjected to ER and PR immunohistochemical staining again, and then reclassified according to HER2 status. The expression of ER/PR is closely related to the efficacy of endocrine therapy for breast cancer, so its test results will directly affect the treatment options of clinician. This article will review and discuss the research progress of the causes and mechanisms of ER (-) /PR (+) breast cancer.

Aim To investigate the effects of 17β-es-tradiol on the apoptosis induced by ketamine in primary cultured cortical neurons. Methods Primary cultured cortical neurons were treated with different concentra-tions of ketamine or 17β-estradiol respectively. 24 hours after various treatments, neuron viability was measured by MTT assay. The structure of neurons was analyzed using microscope. Apoptotic neurons were de-termined by the TUNEL assay. The level of pAkt ex-pression was analyzed by Western blot. ResultsCompared with the control group, ketamine decreased neuron viability in a dose-dependent manner. Com-pared with ketamine group, 17β-estradiol increased neuron viability in a dose-dependent manner. Lack of three-dimensional sense,faded color,uncleared outline
were observed, and fractured neuron axons or neurons death were also observed in neurons treated by 100μmol · L-1 ketamine. 100 μmol · L-1 ketamine in-creased the number of apoptotic neurons and decreased the expression of pAkt. 0.1 μmol · L-1 17β-estradiol decreased the number of apoptotic neurons and in-creased the expression of pAkt. LY294002 inhibited the protective effects of 17β-estradiol, the number of apoptotic neurons increased, and the level of pAkt de-creased significantly. Conclusion 17β-estradiol ex-erts the neuroprotective effects against ketamine-in-duced neuroapoptosis by activating the PI3 K/Akt sig-naling pathway.

Objective To investigate the changes in the expression of mitochondrial transcription factor A (mtTFA) during one-lung ventilation (OLV)-induced lung injury in rabbits.Methods Sixty healthy male New Zealand white rabbits,weighing 2.5-3.0 kg,were randomized into 2 groups (n =8 each):two-lung ventilation (TLV) group and OLV group.The animals were anesthetized with iv 3％ pentobarbital sodium 30 mg/kg and tracheostomized.A self-made double lumen catheter was then intubated.Bilateral lungs were ventilated for 3 h in group TLN.In group OLV the left lung was ventilated for 2 h followed by 1 h TLV.Arterial blood samples were taken for blood gas analysis immediately after the beginning of ventilation,at 1 and 2 h of ventilation,and immediately after the end of ventilation.The oxygenation index was calculated.The animals were sacrificed after the end of ventilation and the apex of the left lung was removed and then cut and stained with HE for microscopic examination.The pathological changes of the lung were scored.The expression of mtTFA in lung tissues was measured by Western blot.Results Oxygenation index was significantly decreased,lung injury score was increased,the expression of mtTFA was down-regulated in group OLV compared with group TLV (P ＜ 0.05).The pathological changes of the lung were aggravated in group OLV.Conclusion OLV induces lung injury by down-regulation of mtTFA expression in rabbit lung tissues.

Objective To analyze the relationship between onset of myocardial infarction(MI)to bivalent antibiotics therapy and outcome in elderly female MI patients.Methods One hundred and fourteen elderly MI patients admitted to our hospital from January 2016to January 2018were divided intoΔT≤188min group(n=57)andΔT＞188min group(n=57)according to the onset of MI to bivalent antibiotics therapy.The major adverse cardiac events(MACE),arrhythmia,angina pectoris,heart failure and death were compared between the two groups.Results MACE occurred in 44out of the 144MI patients included in this study.Of the 44MI patients,17died,6 were diagnosed with arrhythmia,16were diagnosed with angina pectoris,5were diagnosed with heart failure.The incidence of arrhythmia,heart failure and the mortality were significantly higher while the incidence of angina pectoris was significantly lower inΔT≤188min group than inΔT＞ 188min group(7.0％vs 3.5％,7.0％vs 1.8％,15.8％vs 14.0％,7.0％vs 21.1％,P＜0.05).Age,diabetes,ΔT,hyperlipidemia,hypertension and coronary artery disease were the independent influencing factors for the poor outcome in MI patients(P＜0.05,P＜0.01).Conclusion TheΔT should be shortened,the MI patients should be timely treated,the criminal blood vessels should be opened,and the ischemic myocardium should be saved in order to prevent the occurrence of severe cardiovascular events and reduce the mortality in elderly MI patients.

Objective To investigate the influence of infertility duration on the outcomes of frozen-thawed embryo transfer(FET)in women under 30 years old.Methods A retrospective analysis was conducted on 540 FET cycles at reproductive center.The cycles were categorized into clinical pregnancy and non-clinical pregnancy groups based on the occurrence of clinical pregnancy.Furthermore,patients were stratified into four groups based on infertility duration:Group A(1-2 years),Group B(3-4 years),Group C(5-6 years),and Group D(7-8 years).Differences in baseline characteristics and clinical pregnancy outcomes among the groups were analyzed.Results Baseline characteristics showed statistical significance only in age differences among the groups(P＜0.05),with no other significant differences.The clinical pregnancy rate(33.93％)and embryo implantation rate(25％)in group C were the lowest,but only the difference in clinical pregnancy rate was statistically significant(P＜0.05).Early miscarriage rates did not show significant differences among the four groups.Conclusion Infertility duration has a discernible impact significant impact on clinical pregnancy rate of FET in women under 30 years old.However,the effect does not linearly increase with longer infertility duration.

To investigate the clinical and pathological characteristics of duodenal-type follicular lymphoma (D-FL), and to deepen the understanding of Duodenal-type follicular lymphoma. The clinical symptoms, endoscopic features, pathologic features, immunophenotype, molecular pathological features and treatment follow-up of 18 D-FL patients diagnosed in Department of Pathology, Beijing Tiantan Hospital affiliated to Capital Medical University between January 2020 and July 2023 were summarized. A total of 18 patients with D-FL were included, including 10 males and 8 females. The median age was 49 (32-69) years respectively. Most of the patients were found during gastroenteroscopy or presented with the common gastrointestinal symptoms of stomach pain, acid reflux, vomiting and diarrhea. Most endoscopic findings were multiple small gray and white polyposis. In the pathological morphology, the mucous layer and submucous layer showed lymphoid follicular structures with full and strained follicles. The immunophenotype showed that the tumor cells strongly expressed CD20 and BCL2 and had low proliferation activity. Immunoglobulin clonal analysis of 1 case showed IgK monoclonal rearrangement (1/1). FISH showed 1 case of BCL2 gene rearrangement (1/3). All patients did not receive targeted chemotherapy and adopted a wait-and-see strategy. Median follow-up was 12 (2-34) months. This study shows that D-FL is an indolent lymphoma, which tends to occur in the duodenum and has a good prognosis.

Chronic atrophic gastritis （CAG）， a common digestive system disease， has an unclear pathogenesis. Currently， it is mostly believed to be related to Helicobacter pylori （Hp） infection， immune factors， dietary factors， bile reflux， long-term use of antibiotics and anti-inflammatory drugs， and other factors. Ferroptosis is a regulated cell death mechanism that is iron-dependent and characterized by disruption of iron metabolism and accumulation of lipid peroxides. More and more studies have found that ferroptosis is closely related to the onset of CAG. Professor LI Diangui， a master of traditional Chinese medicine， first proposed the turbid toxin theory， which holds that spleen deficiency and turbid toxin is the main pathogenic mechanism of CAG. Abnormal iron metabolism regulation is a prerequisite for the accumulation of turbid toxin in CAG， and ferroptosis is in accordance with the pathogenic mechanism （spleen deficiency and turbid toxin） of CAG. This article explores the pathological mechanism of spleen deficiency and turbid toxin in CAG from the perspectives of iron metabolism， oxidative stress， and lipid peroxidation， providing theoretical support of traditional Chinese medicine for the modern research on CAG. It enriches the modern scientific connotation of the turbid toxicity theory and provides new ideas and breakthrough points for the clinical treatment of CAG.

Chronic atrophic gastritis （CAG）， a common digestive system disease， has an unclear pathogenesis. Currently， it is mostly believed to be related to Helicobacter pylori （Hp） infection， immune factors， dietary factors， bile reflux， long-term use of antibiotics and anti-inflammatory drugs， and other factors. Ferroptosis is a regulated cell death mechanism that is iron-dependent and characterized by disruption of iron metabolism and accumulation of lipid peroxides. More and more studies have found that ferroptosis is closely related to the onset of CAG. Professor LI Diangui， a master of traditional Chinese medicine， first proposed the turbid toxin theory， which holds that spleen deficiency and turbid toxin is the main pathogenic mechanism of CAG. Abnormal iron metabolism regulation is a prerequisite for the accumulation of turbid toxin in CAG， and ferroptosis is in accordance with the pathogenic mechanism （spleen deficiency and turbid toxin） of CAG. This article explores the pathological mechanism of spleen deficiency and turbid toxin in CAG from the perspectives of iron metabolism， oxidative stress， and lipid peroxidation， providing theoretical support of traditional Chinese medicine for the modern research on CAG. It enriches the modern scientific connotation of the turbid toxicity theory and provides new ideas and breakthrough points for the clinical treatment of CAG.

ObjectiveTo construct traditional Chinese medicine （TCM） diagnostic scale of turbid toxin syndrome in order to provide corresponding reference for the standardization of TCM syndromes and studies. MethodsWe systematically searched the Chinese Medical Dictionary （CMD）， China Knowledge Network （CNKI）， Wanfang Data Knowledge Service Platform （WF） and VIP database for TCM classics and modern literature on turbid toxin syndrome， and initially screened the four diagnosis information of turbid toxin syndrome， established a pool of information entries， and conducted a cross-sectional clinical survey. Discrete trend method， correlation coefficient method， Cronbach's coefficient method， and factor analysis method were applied to objectively screen the entries. The diagnostic scale of turbid toxin syndrome were constructed through three rounds of Delphi method expert survey to determine the scale entries， using hierarchical analysis to get the judgement matrix scores and relative weight of each entry， after passing consistency test and then isometric expansion of the relative weight of the entries to get the weight of each entry and assign the value. ResultsA total of 35 articles were included， 45 entries were obtained after the initial screening. After the clinical investigation， 12 entries were not suitable by the discrete trend method， 23 entries not suitable by correlation coefficient method， 13 entries by the internal consistency screening were removed with the Cronbach's alpha coefficient rising， and 10 entries not suitable by the factor analysis method. Twenty-two entries were retained after objective screening by the combined use of the four statistical methods. The positive coefficients of experts in the three rounds of Delphi method of expert consultation were 96.67%， the coefficients of expert authority were 0.834， 0.856， and 0.867， and the coefficients of co-ordination were 0.126， 0.326， and 0.312， respectively. After consulting with clinical experts， and three rounds of Delphi method survey and hierarchical analysis method weight assignment， the diagnostic scale entries of turbid toxin syndrome were finally established. Primary symptoms： dark red or purple and dusky tongue， yellowish greasy or dry coating （10 points）； sticky and unpleasant stools （8 points）； disharmony of tastes including halitosis， sticky and greasy taste in the mouth， dry mouth and bitter taste in the mouth （6 points）； unfavourable or yellowish or red urination （5 points）； and dark complexion （4 points）. Secondary symptoms： heavy body （3 points）； dizziness （3 points）； profuse， sticky， foul-smelling secretions （2 points）； wiry and slippery， or slippery， or slippery and rapid pulse （2 points）； feeling of hardness in the abdomen （1 point）. ConclusionUsing Delphi method combined with the hierarchical analysis method， combining qualitative and quantitative study， a diagnostic scale of turbid toxin syndrome was initially developed.

Taking chronic atrophic gastritis （CAG） as an example， the frontier technologies in data science have been introduced into the inheritance， innovation and development of traditional Chinese medicine （TCM）， providing reference for conducting real-world clinical research on specialized diseases of TCM. This paper put forward the construction of CAG data science system by elaborating the connotation of data science and its application value in TCM， and discussed the path to build CAG data science system， namely through "data acquisition-knowledge expression-knowledge reasoning" to establish CAG database， knowledge base and develop diagnosis platform differentiating diseases and syndromes. Besides， this paper analyzed the prospects of CAG data science in improving data governance ability and knowledge discovery efficiency， deepening the level of knowledge sharing， promoting interdisciplinary integration， and strengthening the integration process of industry， academia and research.