It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of “R0 resection” as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from “maximal resection” to “minimal effective treatment” de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China′s national conditions is the common goal of breast surgeons at this stage.

Objective: To explore the network structure of middle school students basic psychological needs and psychological behavioral problems, and identify the core nodes within the network, as well as examine demographic subgroup differences, so as to provide support for targeted mental health interventions for adolescents. Methods: In September and October of 2023, a total of 2 000 junior and senior high school students were selected with multistage cluster random sampling from 8 schools in Jiaojiang District and Tiantai County, Taizhou City. An online self administered questionnaire was used to assess emotional and behavioral problems, perceived autonomy, self awareness, loneliness, and social support. The instruments included the Strengths and Difficulties Questionnaire (SDQ), Perceived Choice and Awareness of Self Scale (PCASS), Mental Health Literacy Questionnaire (MHLQ), University of California,Los Angeles Loneliness Scale (UCLA-LS), and the Multidimensional Scale of Perceived Social Support (MSPSS). A network analysis approach was employed to construct a network representing adolescents basic psychological needs and psychological behavioral problems, focusing on centrality measures and demographic subgroup differences. Results: A total of 418 students (20.9%) reported abnormal emotional and behavioral problems. Perceived autonomy and competence were negatively correlated with emotional problems (weights: 0.12, 0.14) and hyperactivity (weights: 0.10, 0.16). Social support showed negative correlation with peer relationship issues, hyperactivity, and conduct problems (weights: 0.16, 0.13, 0.10). Loneliness was positively correlated with emotional symptoms and peer relationship problems (weights: 0.28, 0.18). In the overall network, perceived relationships (social support and loneliness), emotional symptoms, and hyperactivity emerged as central nodes. Significant differences in network structure were observed between gender subgroups ( P =0.02). Girls internalizing issues were more influenced by loneliness and perceived autonomy frustration, while social support exhibited higher centrality in boys. Conclusions Perceived relationships, emotional problems, and hyperactivity are key nodes in the network of adolescents basic psychological needs and psychological behavioral problems. Loneliness demonstrates a prominent influence within the network, and the overall network exhibits gender differences.

It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of “R0 resection” as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from “maximal resection” to “minimal effective treatment” de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China′s national conditions is the common goal of breast surgeons at this stage.

Objective:To explore the relationship between childhood trauma and anxiety symptom among high school students,as well as the mediating role of social support and the moderating role of stressful life events.Methods:A total of 3 075 high school students were selected.The Short Form of the Childhood Trauma Questionnaire(CTQ-SF),Social Support Rate Scale(SSRS),Adolescent Self-Rating Life Events Checklist(ASLEC)and Chinese Secondary School Students Anxiety Scale(CSSAS)were used to assess the levels of child-hood trauma,social support,stressful life events,and anxiety symptom severity.The SPSS PROCESS 3.3 macropro-gram was used to test the mediating effect and moderated mediation effect.Results:The CTQ-SF scores were posi-tively correlated with CSSAS scores(r=0.26,P＜0.001).The SSRS scores and the subjective support(S2)scores and availability of support(S3)scores in the SSRS played partial mediating effects between CTQ-SF scores and CSSAS scores.The mediating effects were 0.11(95％CI:0.09-0.12,P＜0.001),0.08(95％CI:0.06-0.09,P＜0.001),0.04(95％CI:0.03-0.06,P＜0.001)respectively,which accounted for 44.00％,32.00％,16.00％of the total effect respectively.The ASLEC scores moderated the relationship between CTQ-SF scores and CSSAS scores(β=0.02,P=0.044),and the relationship between SSRS scores and CSSAS scores(β=0.08,P＜0.001).Conclusion:Among high school students,social support and the subjective support and availability of support in so-cial support play partial mediating effects between childhood trauma and anxiety symptom,and stressful life events moderates the relationship between childhood trauma,social support and anxiety symptom.

Senecavirus A (SVA) is a major viral pathogen causing disease in pigs, and effective monitoring of SVA infection is critical for disease control. In this study, we aimed to develop a reliable ELISA method for rapidly detecting neutralizing antibodies against SVA. We used HEK293F cells to express an SVA-specific porcine Fab antibody and verified the biological activity of the Fab antibody by indirect ELISA, immunofluorescence assay, virus neutralization test, and Western blotting. The Fab antibody was biotinylated and used as a competitive antibody to establish a competitive ELISA (C-ELISA) for detecting neutralizing antibodies against SVA. We then evaluated the C-ELISA in terms of sensitivity, specificity, repeatability, and result agreement rate with the VNT. The results showed that we successfully prepared an SVA-specific porcine Fab antibody, which showed high affinity for SVA. We named this antibody 1M33Fab and designated it as Bio-1M33Fab after biotin labeling. The assay conditions were optimized as follows: the coating concentration of SVA particles being 1 μg/mL, the working concentration of Bio-1M33Fab being 0.5 μg/mL, the optimal serum dilution of 1:10, and the optimal dilution of enzyme-labeled avidin being 1:30 000. At a percent inhibition (PI) of 47%, the assay demonstrated the highest sensitivity (96.88%) and specificity (100%), with no cross-reactivity observed with the positive sera of major porcine viral diseases. The intra-assay coefficient of variation ranged from 1.12% to 7.34%, while the inter-assay coefficient of variation ranged from 1.10% to 8.97%, indicating good repeatability. In the detection of 224 clinical pig serum samples, C-ELISA and VNT showed a result agreement rate of 93.75%. In conclusion, we successfully develop a C-ELISA method for detecting neutralizing antibodies against SVA by using a porcine-derived Fab antibody, which lays a foundation for the development of detection kits.
Animals ; Swine ; Antibodies, Neutralizing/immunology* ; Enzyme-Linked Immunosorbent Assay/methods* ; Immunoglobulin Fab Fragments/immunology* ; Antibodies, Viral/immunology* ; Picornaviridae/immunology* ; Humans ; HEK293 Cells ; Swine Diseases/diagnosis* ; Picornaviridae Infections/diagnosis*

Objective:A prognosis prediction model for pancreatic cancer was constructed based on multi-scale radiomics combined with deep learning, and the prediction effect of the model was evaluated.Methods:A retrospective analysis was conducted on the clinical data of 215 patients who underwent radical resection of pancreatic cancer at the First Affiliated Hospital of Naval Medical University from January 2017 to December 2017. Among them, 134 were male and 81 were female, with an age of (61.9±9.2) years. Patients were randomly divided into the training set ( n=151) and the test set ( n=64) in a ratio of 7: 3. Habitat features, peritumoral radiomics features, 3D radiomics features, and 2.5D deep learning features were extracted from preoperative CT images respectively. After feature screening, a survival prediction model was constructed using the CoxBoost machine learning algorithm that integrated the Boosting algorithm and the Cox proportional hazards model. The performance of the model was evaluated using the area under the time-dependent receiver operating characteristic curve and the consistency index. The clinical benefits of the model were evaluated using decision curve analysis. The survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used for the comparison of survivals between groups. Results:The LASSO, random forest and extreme gradient boosting models were each used to screen out the top 10 most important features and take the union, ultimately obtaining 20 radiomics features for modeling. In the training set and test set, the consistency index of the CoxBoost model in predicting overall survival was 0.717 (95% CI: 0.669-0.765) and 0.688 (95% CI: 0.610-0.766), respectively, and the area under the curve for predicting overall survival at 1, 2, and 3 years after surgery was 0.830 (95% CI: 0.752-0.898), 0.753 (95% CI: 0.665-0.833), 0.828 (95% CI: 0.735-0.908) and 0.690 (95% CI: 0.549-0.824), 0.780 (95% CI: 0.649-0.887 and 0.793 (95% CI: 0.660-0.897), respectively. The area under the curve for predicting long-term survival after surgery (≥40 months) was above 0.8. Based on the optimal cutoff value of -0.19 for the predicted value of the CoxBoost model calculated by the R package " survminer", the patients were divided into high-risk (predicted value >-0.19) and low-risk (predicted value <-0.19) groups. In both the training set and the test set, the survival of patients in the low-risk group was better than that in the high-risk group (training set: χ2=39.01, P<0.001; test set: χ2=12.34, P<0.001). The median survival period of patients in the high-risk group was lower than that in the low-risk group (training set: 15.80 vs 34.07 months; test set: 16.87 vs 43.07; months). Decision curve analysis shows that patients obtain survival benefit when the threshold probability of the training set is greater than 0.25 and that of the test set is greater than 0.45. Conclusion:The CoxBoost model has a good predictive ability for the overall survival of pancreatic cancer patients after surgery and can effectively screen out patient subgroups that may significantly benefit from surgical treatment.

Objective:To investigate the epidemiological characteristics and morbidity trends of hypertensive disorders of pregnancy (HDP) in Shenzhen, China.Methods:This study was a cross-sectional study. Data were based on the Shenzhen Birth Cohort. Pregnant women who gave birth from January 1, 2018 to March 31, 2023 were included. Incidence and change trends of HDP and its different pathological types were analyzed. The enrolled pregnant women were divided into the HDP group and the non-HDP group according to whether HDP occurred. General clinical data and pregnancy outcomes were collected from both groups. The incidence of adverse pregnancy outcomes among pregnant women with different pathological types of HDP was analyzed, and subgroup analyses were performed based on age and body mass index (BMI).Results:A total of 90 117 pregnant women were enrolled, aged (31.6±4.4) years. There were 4 117 cases in the HDP group and 86 000 in the non-HDP group. The overall incidence of HDP in the whole study population was 4.57% (4 117/90 117). From 2018—2023, the incidence of HDP in Shenzhen showed an increasing trend year by year, from 2.88% (523/18 155) to 7.04% (271/3 851). Specifically, the incidence of gestational hypertension increased from 0.93% (168/18 155) to 3.09% (119/3 851), the incidence of preeclampsia-eclampsia increased from 1.78% (323/18 155) to 3.17% (122/3 851), the incidence of chronic hypertension increased from 0.01% (1/18 155) to 0.42% (16/3 851), and the incidence of chronic hypertension with superimposed preeclampsia increased from 0.17% (31/18 155) to 0.36% (14/3 851). The age ((32.8±4.8) years vs. (31.5±4.3) years, P<0.05) and BMI in the first trimester ((23.37±3.77) kg/m 2 vs. (21.35±2.91) kg/m 2, P<0.05) of HDP group were higher than those of the non-HDP group. Subgroup analysis showed that the incidence of HDP in pregnant women aged≥50.0 years was the highest in all age subgroups (42.86% (6/14)). The incidence of HDP in pregnant women with BMI≥30.0 kg/m 2 in the first trimester was the highest among all BMI subgroups (20.44% (241/1 179)). The proportions of preterm birth, gestational diabetes, fetal growth restriction, small for gestational age, placental abruption, and late abortion in HDP group were 30.82% (1 269/4 117), 30.46% (1 254/4 117), 6.80% (280/4 117), 4.86% (200/4 117), 3.59% (148/4 117), and 0.80% (33/4 117), respectively. Conclusions:The incidence of HDP among pregnant women has been increased year by year in Shenzhen, China. With the increase in age and BMI during early pregnancy, the incidence of HDP showed an overall upward trend.

Aim To investigate the relationship between sleep deprivation and vascular aging,as well as the un-derlying mechanisms.Methods Male Sprague-Dawley rats were divided into control group,senescence group,sleep deprivation group,and sleep deprivation+senescence group,with 6 rats in each group.The modified level table method deprived rats of sleep duration.Senescence-associated β-galactosidase(SA-β-Gal)staining was used to detect the senes-cence status of rat vascular tissue.The mRNA and protein expression of tumor suppressor protein p53,silent information regulator 1(SIRT1)and clock gene cryptochrome 1(CRY1)was detected by real-time fluorescence quantification PCR(RT-qPCR),Western blot and immunohistochemistry.Results Compared with the control group,the intensity of SA-β-Gal staining was increased in the vascular tissues of the senescence group rats,the expression level of p53 was elevat-ed,the expression level of SIRT1 was decreased.Similar changes were observed in the sleep deprivation group and the sleep deprivation+senescence group,including intensified SA-β-Gal staining,elevated p53 levels,and reduced SIRT1 lev-els in vascular tissues.Additionally,compared with the control group,the sleep deprivation group showed reduced CRY1 levels in vascular tissues,while only CRY1 mRNA levels were reduced in the sleep deprivation+senescence group.Fur-thermore,compared with the senescence group,the sleep deprivation+senescence group exhibited intensified SA-β-Gal staining,increased p53 level,decreased SIRT1 level,and reduced CRY1 mRNA level in vascular tissues.Conclusion Sleep deprivation may promote the expression of vascular aging-related factors,potentially through the inhibition of CRY1 expression in vascular tissues.

Objective To investigate the clinical characteristics,treatment strategies,and prognostic factors of adenoid cystic carcinoma(ACC)of the external auditory canal(EAC),and to provide evidence for optimizing surgical extent and adjuvant therapy.Methods A retrospective cohort study was conducted on 58 patients with pathologically confirmed ACC of the EAC treated in Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,between January 2001 and December 2021.All patients underwent surgical treatment,with some receiving adjuvant radiotherapy.The primary outcome was local recurrence,while secondary outcomes included overall survival(OS)and local recurrence-free survival(LRFS).Survival analysis was performed by the Kaplan-Meier method,and Cox regression models were used to identify risk factors for recurrence.Results The median follow-up time for the entire cohort was 6.27(3.25,11.30)years.The 1-year,3-year,and 5-year OS rates were 96.55％,91.37％,and 89.66％.43.10％of cases were classified as T4 stage at diagnosis,indicating advanced local progression.Local recurrence occurred in 23 patients(39.66％),and distant metastasis was observed in 28 patients(48.28％),with pulmonary metastasis accounting for 92.86％of cases.Multivariate analysis revealed that the solid histological pattern(HR=2.729,95％CI:1.025-7.226,P=0.044)and perineural invasion(PNI)(HR=9.891,95％CI:3.525-27.752,P＜0.01)were independent risk factors for local recurrence.Conclusion ACC of the EAC is characterized by a high propensity for local recurrence and distant metastasis.The solid histological pattern and perineural invasion are critical prognostic determinants.Multimodal therapy(surgery combined with adjuvant radiotherapy)may improve clinical outcomes,and early diagnosis and intervention are pivotal for enhancing survival rates.

Knee osteoarthritis (KOA) is a common chronic degenerative disease that not only causes pain and reduces the quality of life for patients but also imposes a significant societal burden. Clinical pathways can be developed by referencing recommendations from clinical practice guidelines to localize guidelines within the context of integrated traditional Chinese and western medical systems. However, existing clinical pathways suffer from shortcomings such as deficiencies in integrated traditional Chinese and western medical diagnosis and treatment, inadequate shared decision-making between healthcare providers and patients, and suboptimal visualization of clinical pathways. This study aimed to address and optimize the clinical pathway of KOA by comprehensively organizing and localizing the recommended guidelines. The concept of integrated traditional Chinese and western medicine was reflected through the construction of a path of joint decision-making between doctors and patients, emphasizing the coexistence of diagnosis and screening, the combination of clinical and imaging staging, joint decision-making between doctors and patients, and treatment stages. This pathway emphasizes patient-centered approach, with pain relief and functional rehabilitation running parallel, achieving the implementation of evidence-based concepts in practical medical practice. It provides a concrete basis for joint decision-making between doctors and patients in the integrated treatment of KOA with traditional Chinese and western medicine, which helps to improve diagnosis and treatment efficiency and patient quality of life.