Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder primarily caused by pathogenic variants in the TSC1 or TSC2 genes. It is characterized by multisystem hamartomatous lesions and neuropsychiatric manifestations. Here we report a young male patient with TSC involving multiple organs, caused by a heterozygous frameshift mutation in TSC2 (c.2071delC, p.Arg691Alafs^*7). The patient initially presented with classic facial angiofibromas and hypomelanotic macules, and subsequently developed psychiatric and behavioral disturbances with auditory hallucinations. Neuroimaging revealed an intracranial mass lesion, which was confirmed as a subependymal giant cell astrocytoma on postoperative histopathology following surgery performed at an outside institution. After admission, the patient underwent a comprehensive diagnostic workup, and multidisciplinary treatment evaluation revealed extensive multisystem involve-ment, including the nervous system, skin, kidneys, lungs, heart, eyes, pancreas, liver and bones. Combined with relevant literature, this article discusses the molecular mechanisms, clinical phenotypes, and comprehensive management of TSC, in order to provide a reference for the standardized and individualized management of this disease.

ObjectiveTo explore the value of a multimodal MRI-based radiomics nomogram for differentiating human epidermal growth factor receptor-2 （HER-2） negative breast cancer molecular subtypes.MethodsA retrospective analysis was conducted on 190 patients with HER-2 negative breast cancer who underwent multimodal MRI examination， and the patients were divided into two molecular subtype groups： a HER-2 low expression group （n=108） and a HER-2 zero expression group （n=82）. The cases were randomly stratified and sampled at a ratio of 7∶3 and divided into a training set of 133 cases and a testing set of 57 cases. The clinical and radiological features of the patients were collected， the radiomics features based on T2-weighted imaging （T2WI）， diffusion-weighted imaging （DWI）， and dynamic contrast-enhanced （DCE）-MRI were extracted， and the clinical-radiological model， unimodal radiomics model， multimodal radiomics model， and combined model were constructed respectively. Then the nomogram combined multimodal radiomics signature （radsocre） with clinical-radiological features was used to construct a visualized predictive model， and the area under the curve （AUC） was used to compare the effectiveness of different models in distinguishing HER-2 low expression and zero expression subtypes.ResultsA significant difference in radscore was demonstrated between the HER-2 low and HER-2 zero expression groups in both the training （P<0.000 1） and testing sets （P<0.01）. The AUC of the multimodal radiomics model in the training set and the testing set were 0.914 and 0.836， respectively， which was superior to any unimodal radiomics model. The nomogram demonstrated great diagnostic efficacy （AUC=0.930 in training set； AUC=0.865 in testing set）.ConclusionA multimodal MRI-based nomogram incorporating radsocre and clinical-radiological features can accurately distinguish the subtypes of HER-2 negative breast cancer.

Methods: Cervical radiographs were analyzed. EOP hyperplasia was classified into three subtypes with standardized length measurements. Variables encompassed demographics, ONL-related indices, and sagittal parameters. Subtype comparisons and multivariate regression analyses (with EOP length as dependent variable) were conducted. Results: Analysis of 187 CSM patients (64.2% male) identified gender-specific patterns: males exhibited greater EOP length (9.4±6.8 mm vs. 4.6±3.4 mm, p<0.001). Type III EOP demonstrated male predominance (82.4% vs. type I 31.8%, type II 51.4%; p<0.001), with associated longer hyperplasia length (11.6±6.6 mm vs. type II 5.1±1.9 mm, p<0.001). Type III EOP was associated with higher ONL prevalence (type III 64.8% vs. type I 45.5%, type II 41.9%; p=0.010) and longer ONL osteophyte length (type III 18.8±9.8 mm vs. type I 14.2±8.1 mm, type II 14.2±9.4 mm; p=0.046). Multivariate regression confirmed male sex (β=–3.82, p=0.009), ONL osteophyte length (β=0.16, p=0.017), T1 slope (β=0.27, p=0.041), and spino-cranial angle (β=–0.19, p=0.009) as factors independently associated with EOP length (adjusted R²=0.382). Conclusions Severe EOP hyperplasia exhibits a male-predominant distribution pattern and demonstrates significant radiological associations with ONL and cervical sagittal imbalance in CSM patients. These findings advocate for EOP evaluation in clinical evaluations to identify high-risk biomechanical profiles.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Objective To investigate the influence of different embryo development rates on the clinical outcomes of assisted reproductive technology(ART).Methods The clinical data of female patients who underwent in vitro fertilization and intracytoplasmic sperm injection embryo transfer in Reproductive Medicine Center of The First Affiliated Hospital of Naval Medical University from Jan.1,2015 to Dec.31,2023 were retrospectively analyzed.A total of 1 556 cycles were included.Group A was transferred on day 3,and they were assigned to subgroups according to the embryo development rates until day 3:subgroup A1(≤6 cell stages),subgroup A2(7-9 cell cleavage stages),or subgroup A3(≥10 cell cleavage stages).Group B was transferred on day 4,and they were assigned to subgroups according to the embryo development rates until day 4:subgroup B1(cleavage stages),subgroup B2(1st or 2nd period blastocyst or morula stages),or subgroup B3(3rd period blastocyst or higher stages).Group C was transferred on day 5,and they were assigned to subgroups according to the embryo development rates until day 5:subgroup C1(1st or 2nd period blastocyst or morula stages),subgroup C2(4th or 5th period blastocyst stages),or subgroup C3(6th period blastocyst stages).Group D was transferred on day 6,and they were assigned to subgroups according to the embryo development rates until day 6:subgroup D1(morula or 1st or 2nd period blastocyst stages),or subgroup D2(5th or 6th period blastocyst stages).The clinical pregnancy and live birth rates were calculated for each group.Results Pairwise comparisons of the subgroups A1,B1,C1 and D1,all with relatively slow development rates,showed that the clinical pregnancy rates were 23.7%,37.3%,26.9%and 35.9%,respectively(P＜0.05),the live birth rates were 16.4%,28.4%,19.2%and 26.9%,respectively(P＜0.05),and the clinical pregnancy rate and live birth rate were both the highest in the B1 group.Pairwise comparisons of the subgroups A2,B2,C2 and D2 with normal development rates,the clinical pregnancy rates were 58.0%,59.4%,62.2%and 61.5%,respectively(P＜0.05),the live birth rates were 47.5%,49.4%,53.8%and 52.3%,respectively(P＜0.05),and the clinical pregnancy rate and live birth rate were both the highest in the subgroup C2.Pairwise comparisons of the subgroups A3,B3 and C3 with relatively fast development rates showed that the clinical pregnancy rates were 62.2%,64.6%and 63.5%,respectively(P＜0.05),the live birth rates were 52.2%,56.9%and 54.1%,respectively(P＜0.05),and the clinical pregnancy rate and live birth rate were both the highest in the subgroup B3.Conclusion The 4th day fast-developing blastocysts have better development potential and clinical outcomes.Embryos with slower development rate should be transferred on the 4th day,and embryos with normal development rate are recommended to be cultured and transferred to the 5th day.

OBJECTIVE To provide a reference for revising the safety content of traditional Chinese medicine（TCM） instructions. METHODS A systematic analysis was conducted on the relevant announcements on the revision of TCM instruction from 2013 to 2024， including the year of publication， drug name， drug formulation， announcement release time， and the average number of revisions made to three safety contents （contraindication， adverse drug reaction， and precaution）. According to the report data of national adverse drug reaction monitoring from 2013 to 2024， analyze the proportion of TCM in all adverse drug reactions， the composition ratio of adverse drug reaction of different dosage forms of drugs [TCM injection， oral TCM， other （topical） TCM]. RESULTS From 2013 to 2024， the National Medical Products Administration issued a total of 101 notices on the revision of TCM instruction， involving 241 types of TCM. Among them， there were 163 types of oral TCM， 25 types of TCM injection， and 53 types of other （topical） TCM. There were 3， 10 and 0 types of TCM injection， oral TCM， and other （topical） TCM with missing safety content， respectively. The main source of adverse drug reaction data for TCM injections was post- marketing monitoring data （accounting for 48.00%）； the main source of adverse drug reaction data for oral TCM was monitoring data （accounting for 71.17%）； 73.58% of other （topical） TCM did not mention the source of adverse drug reaction data. The report on national adverse drug reaction monitoring showed that the proportion of all adverse drug reactions of TCM had decreased from 17.3% in 2013 to 12.1% in 2024. Among them， the proportion of adverse drug reaction of TCM injection in the three dosage forms of TCM had decreased from 61.3% in 2015 to 24.6% in 2024， while the proportion of adverse drug reaction of oral TCM in the three dosage forms of TCM had increased from 34.7% in 2015 to 64.0% in 2024. CONCLUSIONS The risk management of TCM safety content has achieved results in China， but still faces three major challenges： strongdependence on passive monitoring， insufficient data traceability， and missing key content. It is urgent to improve safety content by dosage form， optimize data sources， and fully utilize real-world evidence to supplement safety content.

Objective:To explore potential risk factors for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of 304 PTMC patients admitted to Baotou Cancer Hospital from Oct 2021 to Mar 2023 were retrospectively analyzed. The risk factors of CLNM were analyzed using unifactorial and multifactorial regression.Results:The rate of central regional lymph node metastasis in 304 patients with PTMC was 46.7% (142/304). Univariate analysis showed that male, age <45 years, maximum cancerous lesion diameter ≥5 mm, total cancerous lesion diameter ≥9.5 mm, anterior-posterior lesion diameter ≥5 mm, anterior-posterior lesion diameter ratio of cancerous lesions ≥0.48, breaching of thyroid capsule, number of lymph nodes on the side of cancerous lesions ≥5, and antithyroid peroxidase antibody ≤34 IU/ml were associated with CLNM (all P<0.05); Logistic multivariate regression analysis showed that. male, age <45 years, total diameter of cancer foci ≥9.5 mm ( OR=2.052, 95% CI: 1.176-3.581, P=0.011), anteroposterior diameter ratio of cancer foci ≥0.48 ( OR=2.076, 95% CI: 1.161-3.711, P=0.014), number of lymph nodes on the side of cancer foci ≥5, and anti-thyroid peroxidase antibody ≤34 IU/ml were independent risk factors for CLNM. Conclusion:Male, age ,total diameter of cancer foci, anterior-posterior diameter ratio of cancer foci, number of lymph nodes on the side of cancer foci, and anti-thyroid peroxidase antibody level are all independent risk factors for CLNM in patients with PTMC.

Objective:To analyze the risk factors and prognosis of pyogenic liver abscess (PLA) complicated with myocardial injury.Methods:A retrospective selection was made of 108 PLA patients treated in Beijing Friendship Hospital from January 2016 to June 2022 as the research subjects. Patients were divided into the myocardial injury group and non-myocardial injury group according to the occurrence of myocardial injury. Baseline characteristics, laboratory test data, imaging and etiological examination results, echocardiographic indicators, and prognosis were compared between the two groups. A logistic regression model was used to identify the risk factors for PLA complicated with myocardial injury.Results:Among the 108 PLA patients, 24 cases (22.2%) were complicated with myocardial injury. The age of the myocardial injury group was (71±13)years, which was significantly higher than that of the non-myocardial injury group [(59±14)years, P<0.05]. The levels of neutrophil ratio, C-reactive protein (CRP), procalcitonin (PCT), aspartate transaminase (AST), and D-dimer in the myocardial injury group were significantly higher than those in the non-myocardial injury group, while the levels of platelet count (PLT) and albumin (ALB) were significantly lower, with statistically significant differences (all P<0.05). In terms of blood culture, the positive detection rate in the myocardial injury group was as high as 54.2%(13/24), among which the detection rate of Klebsiella pneumoniae was 41.7%(10/24); the positive rate of blood culture in the non-myocardial injury group was only 17.9%(15/84), and the detection rate of Klebsiella pneumoniae was 14.3%(12/84), with statistically significant differences (all P<0.05). The left ventricular ejection fraction in the myocardial injury group was lower than that in the non-myocardial injury group, and the brain natriuretic peptide (BNP) level, the incidence of left ventricular diastolic dysfunction, the proportion of transfer to emergency intensive care unit (EICU), shock, and death were significantly higher than those in the non-myocardial injury group (all P<0.05). Logistic regression analysis showed that age was an independent risk factor for myocardial injury in PLA patients ( P<0.05), and for each 1-year increase in age, the risk of myocardial injury increased by 11.9%. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of age for myocardial injury, with an area under the curve (AUC) of 0.729( P<0.05), and the cut-off value calculated by Youden index was 64.5 years. Conclusions:Age is an independent risk factor for myocardial injury in PLA patients. PLA patients complicated with myocardial injury have poor cardiac function, higher incidence of transfer to EICU, shock, and death, and poor prognosis.