Objective To explore the application value of intravoxel incoherent motion(IVIM)imaging parameters in the differential diagnosis of benign and malignant breast nodules and their correlation with the expression of Ki-67 receptor in breast cancer.Methods The data of 41 female patients who completed 3.0 T breast magnetic resonance imaging(MRI)with complete surgical pathology results in the Second Hospital of Jiaxing City from October 2022 to January 2025 were analysed and evaluated.Conventional images and diffusion-weighted images with 11 b values were collected.The IVIM imaging parameters of real diffusion coefficient(D),perfusion related diffusion coefficient(D*)and perfusion fraction(f)were measured and calculated in the region of interest of each lesion.The receiver operating characteristic curve were plotted to quantify the differential diagnostic efficacy of each parameter of IVIM imaging in benign and malignant breast nodules.The differences of parameters between benign and malignant breast nodules and between the groups with different expression levels of Ki-67 receptor in breast cancer were analysed,and the correlation between each parameter and the expression level of Ki-67 in breast cancer was counted.Results The D value of benign breast nodules group(benign groups)was significantly higher than that of malignant breast nodules group(malignant groups),and the D*value was significantly lower than that of malignant group,and the differences between benign group and malignant group were statistically significant(t=-4.773,t=2.063,P＜0.05);Thefvalue of benign group was slightly lower than that of malignant group,and the differences between two groups were not statistically significant(t=0.035,P＞0.05).Among the parameters of IVIM imaging,D value had the best differential diagnostic efficacy for benign and malignant breast nodules,with area under the curve(AUC)of 0.870(95％CI:0.755-0.985)and a specificity of 75.0％;D*value had the second best differential diagnostic efficacy after D value,with an AUC of 0.789(95％CI:0.658-0.920),but it had the highest sensitivity of 88.2％;And the differential diagnosis efficiency off value was the worst,much less than D and D*values.The D value in the high Ki-67 expression group of breast cancer was lower than that in the low expression group,while the D* and f values in the high expression group were higher than that in the low expression group,and the differences of each imaging parameter of IVIM were not statistically significant between two groups(t=-2.617,t=2.169,t=0.647,P＞0.05).There was a significant negative correlation between the expression of the Ki-67 receptor and the D value(r=-0.615,P＜0.05),and no significant correlation was seen with either D *or f value(r=0.223,r-0.031,P＞0.05).Conclusion The D and D*values of IVIM imaging parameters have great clinical value in the differential diagnosis of benign and malignant breast nodules.

Objective To investigate the therapeutic effects and mechanisms of electroacupuncture for stress urinary incontinence(SUI)in rats.Methods A total of 30 rats were randomly divided into three groups:normal group,model group,and electroacupuncture group[electroacupuncture at Shenshu(BL23)and Huiyang(BL35)acupoints],with 10 rats per group.Except for the normal group,a SUI model was established in the other two groups.After grouping interventions,the following assessments including sneeze test,urodynamic parameter measurements(including intravesical pressure),serum levels of lactate dehydrogenase(LDH)and creatine kinase(CK)were conducted,urethral histopathological change was detected by hematoxylin-eosin(HE)staining,and Western Blot was used to detect protein expression of transforming growth factor β1(TGF-β1),Smad2,Smad3,Smad7,typeⅠ collagen(Col Ⅰ),and type Ⅲ collagen(Col Ⅲ)in urethral tissues.Results Compared with the normal group,the model group exhibited significant increases in the number of sneeze test-positive rats,urine volume,residual urine volume,and serum LDH and CK levels,and protein expression of urethral Smad2 and Smad3,moreover,the model group showed significant decreases in urodynamic parameters[maximum bladder capacity(MBC),leak point pressure(LPP),abdominal leak point pressure(ALPP)],voiding efficiency,and protein expression of urethral TGF-β1,Smad7,ColⅠand Col Ⅲ,the differences being statistically significant(P＜0.05).In comparison to the model group,the electroacupuncture group demonstrated significant reductions in sneeze test-positive rats,urine volume,residual urine volume,serum LDH and CK levels,and protein expression of urethral Smad2 and Smad3,additionally,the electroacupuncture group displayed significant improvements in urodynamic parameters(MBC,LPP,ALPP)and voiding efficiency,upregulation of protein expression of urethral TGF-β1,Smad7,Col Ⅰ and Col Ⅲ,the differences being statistically significant(P＜0.05).Conclusion Electroacupuncture may ameliorate SUI by activating the TGF-β1/Smad pathway to promote pelvic collagen synthesis and reduce urethral injury,thus improving urinary function.

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Objective To investigate the impacts of usnea acid(UA)on the proliferation of human ovarian cancer(OC)cells.Methods Ovarian adenocarcinoma cells SKOV3 were randomly divided into control group,L-UA group,M-UA group,H-UA group(with 10,20,and 50 μmol/L UA added respectively),pcDNA3.1-NC group and pcDNA3.1-PD-1 group.RT-qPCR method was applied to detect the expression of programmed cell death 1(PD-1)and programmed cell death ligand 1(PD-L1)in SKOV3 cells.CCK-8 assay and plate method were applied to detect the effect of UA on SKOV3 cell proliferation.The effect of UA on SKOV3 cells apoptosis was examined by flow cytometry.Mouse ovarian epithelial cancer cell line ID8 cells were collected to construct an OC mouse model,and the mass and volume of OC tumors were recorded.Immuno-histochemical microscopy was applied to detect the infiltration of PD-1,PD-L1,and CD8+T cells.Results The PD-1 mRNA,PD-L1 mRNA,colony count,A450 val-ue,PCNA protein,PD-1 protein,and PD-L1 protein in the L-UA,M-UA,and H-UA groups were lower than those in the control group,the apoptosis rate and Bax protein were higher in the control group(P<0.05).Com-pared with the H-UA group and the pcDNA3.1-NC group,the PD-1 mRNA,PD-L1 mRNA,colony count,A450 value,PCNA protein,PD-1 protein,and PD-L1 protein in the pcDNA-3.1-PD-1 group increased and the apoptosis rate and Bax protein decreased(P<0.05).The quality,volume,positivity rate of PD-1and PD-L1 of OC tumors in the UA group was lower than that in the control group,the counting number of CD8+T cell infiltration was higher than control group(P<0.05).Conclusions UA may inhibit progression of OC cell line SKOV3 by regula-ting cell proliferation,apoptosis,and immune escape.

Objective:To establish a reference interval for serum iodine of pregnant women with normal thyroid function and to analyze the relationship between serum iodine and thyroid disease risk.Methods:From July 2022 to October 2023, using cross-sectional survey method, pregnant women aged 18 to 48 years old who had lived in iodine-deficient areas in the six provinces of China (Shanxi Province, Fujian Province, Yunnan Province, Xinjiang Uygur Autonomous Region, Zhejiang Province, and Anhui Province) for more than six months were selected as the survey subjects. Blood samples were collected, serum iodine was tested, and the percentile method was used to establish a reference interval for serum iodine of pregnant women with normal thyroid function. Meanwhile, serum levels of free thyroxine, thyroid stimulating hormone, thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were tested, and logistic regression was used to analyze the relationship between serum iodine and thyroid disease risk.Results:A total of 1 409 pregnant women from 6 provinces were investigated, including 1 087 with normal thyroid function and 322 with abnormal thyroid function. The median serum iodine level of pregnant women with normal thyroid function was 79.74 μg/L, and the preliminary reference interval for serum iodine was 47.57 - 128.96 μg/L. When serum iodine levels were lower (< 47.57 μg/L), pregnant women had a significantly increased risk of developing TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis ( OR = 4.44, 2.91, 3.41, 41.67, 23.43, P < 0.05). When serum iodine levels were high (> 128.96 μg/L), pregnant women had a significantly increased risk of developing hyperthyroidism ( OR = 9.91, P = 0.001). Conclusions:The reference interval for serum iodine of pregnant women with normal thyroid function is successfully established. Low serum iodine levels are associated with an increased risk of TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis, while high serum iodine levels are associated with an increased risk of hyperthyroidism.

Objective:To establish a set of dynamic definition methods and key operational techniques for community pediatric services contents within the framework of an integrated children health services model.Methods:This was a cross-sectional study. From December 2023 to June 2024, a study was conducted at the Shanghai Gumei Community Health Service Center. The study was divided into three phases: identifying the health needs of community children (Phase A), developing the service content and methods for community children (Phase B), and establishing a community children service network (Phase C). A variety of methods, including questionnaires and focus group interviews, were comprehensively employed in each phase to develop the ABC demand network and its construction approach for community children, and to establish a networked service system.Results:A total of 512 questionnaires were distributed in Phase A, of which 499 were returned for an effective recovery rate of 97.5%. Of the parents, 488 (97.8%, 488/499) would actively seek information related to children′s health. Of those parents, 90.6% (452/499), 80.8% (403/499), and 71.9% (359/499) expressed concern about their children′s growth and development, mental health and social adaptation, and the prevention and treatment of common, frequently occurring diseases, respectively. The research clarified the health needs of children in the community and the health issues of children in different age groups. This included the mental health and social adaptation of community children, as well as common and frequently occurring diseases. The study also revealed a lack of mental health and social adaptation's services for children in the community. After sorting the community′s services into categories such as children′s growth and development detection, diagnosis and treatment of common diseases, and planned immunizations, and establishing corresponding service methods, it was found that Gumei community Health Service Center had strong diagnostic service capabilities for children aged 0-3 and 4-6, but need improved for children aged 7-12 and 13-15. At the same time, a service network consisting of five major categories, represented by medical alliances, has been established to address unmet needs in diagnosis and rehabilitation care for mental health and social adaptation, as well as major diseases.Conclusions:The study has developed an ABC demand network and its construction method for community children. It provides new ideas for defining the content of community pediatric services and establishing supporting methods, and it offers a practical basis for the constructing a community pediatric service system.

Objective:To summarize the evidence for the application and management of continuous glucose monitoring, providing evidence-based support for the clinical application and management.Methods:BMJ Best Clinical Practice, UpToDate, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang and other databases, Yimaitong and and other guide networks, and diabetes related association websites were searched for the application and management of continuous glucose monitoring, the search time limit was from the establishment of the database to July 7, 2024. Researchers evaluated the quality of the included literature, extracted and summarized the evidence based on the topic.Results:A total of 13 articles were included, including 5 guidelines, 5 expert consensuses, 1 systematic review and 2 randomized controlled trials. The best evidences for the application and management of continuous glucose monitoring were summarized, including 3 themes and 13 aspects, practice norms (before, during, and after wearing), application norms, management norms (personnel, systems, information, materials, methods), with 31 pieces of evidence.Conclusions:This study summarized the evidences for the application management of continuous glucose monitoring, which could standardize the operation process of continuous glucose monitoring, provide response strategies for related nursing issues, and ensure that there were unified and clear management standards to follow.

Objective:To study the role of cadherin 1 (CDH1) gene DNA methylation in autoimmune thyroiditis (AIT) in population from different water-iodine regions.Methods:From May to June 2019, the information of AIT cases and healthy individuals in Shandong Province were collected in three types of water-iodine regions: iodine-fortification (IF) region, iodine-adequate (IA) region and iodine-excess (IE) region. A case-control study design was applied to match 176 AIT cases (case group) with age, gender, body mass index, and place of residence in a 1 ∶ 1 ratio to 176 healthy individuals (control group). Fasting urine and whole blood samples were collected to test the contents of urinary iodine, thyroid function indicators [serum free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid stimulating hormone (TSH)], and serum iodine. The DNA methylation levels of the target region of the CDH1 gene and its four CpG sites in whole blood were determined using methylation sequencing technology for target regions (MethylTarget TM). Results:The DNA methylation level of the target region of CDH1 gene in the case group was 0.832 ± 0.044, and that in the control group was 0.828 ± 0.049, there was no statistically significant difference between the two groups ( t = 0.76, P = 0.448). There was no statistically significant difference in DNA methylation levels of the four CpG sites in the target region of CDH1 gene between the case group and the control group ( P > 0.05). There was no statistically significant difference in the DNA methylation level of the CDH1 gene target region between the case group and the control group in IF, IA and IE regions ( P > 0.05). The detection results of DNA methylation levels at CpG sites in the target region of CDH1 gene in different water iodine regions showed that the DNA methylation level at site 83 in case group in IF region was higher than that in the control group ( t = 2.30, P = 0.023). However, there was no statistically significant difference in the DNA methylation levels of the four CpG sites between the case group and the control group in IA and IE regions ( P > 0.05). The DNA methylation level of CDH1 gene target region in AIT patients was not significantly correlated with urinary iodine, serum iodine, and serum FT 3, FT 4, and TSH contents ( P > 0.05), but was significantly negatively correlated with age ( r =-0.19, P = 0.014). Conclusions:The DNA methylation level at CpG site 83 of CDH1 gene in AIT patients in IF region is significantly higher than that in control population, indicating that DNA methylation at this locus may be involved in the occurrence and development of AIT after iodine fortification. The DNA methylation level of CDH1 gene is negatively correlated with age.

Objective To evaluate the reliability of Vitek 2 AST-N335 card for determining the susceptibility of Acinetobacter bauman-nii(AB)to cefoperazone/sulbactam.Methods A total of 318 non-repeated clinical isolates of AB collected in 2023 were tested for antimicrobial susceptibility to cefoperazone/sulbactam using broth microdilution(BMD),the AST-N335 card,and the Kirby-Bauer(K-B)disk diffusion method.Using BMD as the reference method,the reliability of AST-N335 card was assessed,and the accuracy of K-B disk diffusion method as the confirmatory test was validated.Results Compared with BMD,the susceptibility testing of 318 AB strains to cefoperazone/sulbactam using the AST-N335 card showed categorical agreement(CA)of 87.8％(279/318),very major er-ror(VME)of 6.0％(19/318),major error(ME)of 0％(0/318),and minor error(mE)of 1.9％(6/318),which fall outside of the acceptable error range.In contrast,the K-B method achieved CA of 99.4％(316/318),VME of 0％,ME of 0.3％(1/318),and mE of 0.3％(1/318),all within acceptable limits.Of these,the errors with AST-N335 card occurred within the minimum inhibitory concentration(MIC)range of 8-32 μg/mL.Using BMD as the reference method,further analysis was performed on the 171 AB strains with AST-N335 card MIC values of 8-32 μg/mL for cefoperazone/sulbactam.It was revealed that at MIC of 32 μg/mL,the CA was 0％;at MIC of 16 μg/mL,CA was 5.3％(1/19)and VME rate was 84.2％(16/19),both of which substantially exceeded accepta-ble error ranges.At MIC of 8 μg/mL,the CA was 94.9％(131/138)and VME was 2.2％(3/138),both approaching the acceptable ranges.Conclusion The results obtained with Vitek 2 AST-N335 card in determining for cefoperazone/sulbactam are unreliable when the MIC values fall within the range of 8-32 μg/mL,which leads to an underestimation of the resistance rate to cefoperazone/sulbac-tam.This issue requires urgent attention in both laboratories and clinical practice.The K-B disk diffusion method could serve as a sup-plementary verification approach in routine laboratories.

Objective:To retrieve and integrate the best evidence on foot offloading management for diabetic high-risk foot patients, and to provide evidence-based basis for effectively preventing the occurrence and development of diabetic foot ulcers.Methods:Clinical practice guidelines, evidence summaries, systematic reviews and expert consensus on the management of foot offloading at high risk of diabetes were searched in Chinese and English databases, domestic and foreign diabetes association websites, clinical decision websites and guideline websites, retrieval time for libraries to March 31, 2024, respectively, by the 2 researchers quality evaluation, evidence extraction, the final summary.Results:A total of 16 articles were included, including 6 guidesline, 5 expert consensuses, 1 evidence summary and 4 systematic reviews. According to the existing evidence, the best evidence of foot offloading management in patients with diabetic high-risk foot was summarized from 6 aspects: evaluation, monitoring, referral, offloading brace, exercise advice and risk factor intervention, 14 subcategories, 32 best evidences for foot offloading management in patients with high-risk diabetic foot.Conclusions:This study summarized the best evidence for foot offloading management in patients with high-risk of diabetic foot, which is convenient for the further development of clinical practice of foot offloading management in patients with high-risk of diabetes, and provides evidence-based basis for clinical medical staff to expand related research.