Objective To preliminary explore the imaging manifestations of digital breast tomosynthesis (DBT) and contrast-enhanced mammography (CEM) in triple-negative breast cancer (TNBC) patients with different levels of human epidermal growth factor receptor 2 (HER2) expression. Methods A retrospective analysis was conducted on TNBC patients who underwent preoperative DBT or CEM examinations at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2019 and Shanghai Second People’s Hospital from January 2022 to May 2025. Clinical data, pathological and immunohistochemical results, and imaging data were collected. Results A total of 69 TNBC patients pathologically confirmed as invasive ductal carcinoma were included, among which 34 underwent DBT and 35 underwent CEM. Among these patients, 34 (49.28%) had HER2-low expression and 35 (50.72%) had HER2-zero expression. DBT results showed that the proportion of spiculation signs in HER2-low group (n＝14) was significantly higher than that in HER2-zero group (n＝20; P＝0.009, P_adj＝0.045). However, there were no significant differences in breast density type, mass shape, or calcification between the two groups. CEM results showed that on low-energy images, the proportion of spiculation signs in the HER2-low group (n＝20) was higher than that in the HER2-zero group (n＝15; P＝0.011, P_adj＝0.077). Results of CEM showed that on reconstructed images, differences in background parenchymal enhancement and mass enhancement patterns between the two groups were not statistically significant; in both groups, heterogeneous enhancement was the most common, followed by homogeneous enhancement, with ring enhancement being the least common. Conclusions TNBC with low HER2 expression and TNBC with zero HER2 expression may have potential differences in the presentation of spiculation signs on DBT. However, the correlation between CEM manifestations and TNBC with different HER2 expression levels requires further research.

Nipah virus (NiV) and related viruses form a distinct henipavirus genus within the Paramyxoviridae family. NiV continues to spillover into the humans causing deadly outbreaks with increasing human-bat interaction. NiV encodes the large protein (L) and phosphoprotein (P) to form the viral RNA polymerase machinery. Their sequences show limited homologies to those of non-henipavirus paramyxoviruses. We report two cryo-electron microscopy (cryo-EM) structures of the Nipah virus (NiV) polymerase L-P complex, expressed and purified in either its full-length or truncated form. The structures resolve the RNA-dependent RNA polymerase (RdRp) and polyribonucleotidyl transferase (PRNTase) domains of the L protein, as well as a tetrameric P protein bundle bound to the L-RdRp domain. L-protein C-terminal regions are unresolved, indicating flexibility. Two PRNTase domain zinc-binding sites, conserved in most Mononegavirales, are confirmed essential for NiV polymerase activity. The structures further reveal anchoring of the P protein bundle and P protein X domain (XD) linkers on L, via an interaction pattern distinct among Paramyxoviridae. These interactions facilitate binding of a P protein XD linker in the nucleotide entry channel and distinct positioning of other XD linkers. We show that the disruption of the L-P interactions reduces NiV polymerase activity. The reported structures should facilitate rational antiviral-drug discovery and provide a guide for the functional study of NiV polymerase.
Nipah Virus/chemistry* ; Cryoelectron Microscopy ; Viral Proteins/genetics* ; RNA-Dependent RNA Polymerase/genetics* ; Phosphoproteins/genetics* ; Humans ; Models, Molecular ; Protein Binding

Objective:To explore the effect of exercise on glycemic control and physical indicators among community-dwelling persons with type 2 diabetes mellitus (T2DM).Methods:A total of 42 T2DM patients undergoing regular follow-up at a community health center were divided into a control group and an exercise group. To minimize confounding factors, 1∶1 propensity score matching was performed, resulting in 21 patients in each group. Both groups received standardized diabetes management, including medication, dietary guidance and diabetes health education. The exercise group additionally performed exercises which integrated sports and medical care models. The experiment lasted 8 weeks. Before and after the intervention, glycosylated hemoglobin A1c (HbA1c) levels, body weight, body mass index (BMI), fat mass, visceral fat area (VFA), fat mass index (FMI) and appendicular skeletal muscle mass index (ASMI) were recorded and compared between the two groups. Moreover, the actual exercise compliance of the exercise group was observed, along with any adverse events such as hypoglycemia or exercise-related injuries, as well as changes in antidiabetic medication dosage.Results:After the intervention, significant improvement was observed in both groups in all of the measurements, but with the average HbA1c, BMI, fat mass, VFA and FMI values of the exercise group then significantly better than the control group′s averages. The average compliance rate in the exercise group was 60%. No cases of hypoglycemia or exercise-related injuries were reported during the intervention, and there were no changes in the use of anti-diabetes medications.Conclusions:Exercise effectively improves glycemic control and physical indicators among community-dwelling T2DM patients. However, exercise compliance needs improving.

Objective:To explore the association of central obesity, pain, their joint effect, and interaction with frailty in middle-aged and old people in China.Methods:A total of 14 359 participants aged ≥45 years in 2011, 2013 and 2015 were selected from the China Health and Retirement Longitudinal Study to construct a cohort database. Cox proportional hazards regression models were used to estimate the association of waist-to-height ratio (WHtR) and pain with the risk for frailty. Joint effect and interaction analyses were performed.Results:In the follow-up of 77 783 person-years, frailty developed in 3 198 participants, with an incidence density of 41.11 per 1 000 person-years. Compared with the Q1 level of WHtR, its Q2, Q3 and Q4 level increased risk for frailty by 17% ( HR=1.17, 95% CI: 1.05-1.31), 24% ( HR=1.24, 95% CI: 1.11-1.40), and 43% ( HR=1.43, 95% CI: 1.25-1.63), respectively. Compared with painlessness, suffering from pain increased the risk for frailty by 97% ( HR=1.97, 95% CI: 1.83-2.11), and having 1, 2, and ≥3 pain sites increased the risk by 42% ( HR=1.42, 95% CI: 1.25-1.61), 86% ( HR=1.86, 95% CI: 1.64-2.11), and 138% ( HR=2.38, 95% CI: 2.18-2.60), respectively. The results of restricted cubic spline showed that WHtR level was associated with the risk for frailty in a J-type dose-response relationship (total P<0.001, nonlinear P<0.001), and pain quantity was positively associated with the risk in a nonlinear dose-response relationship (total P<0.001, nonlinear P<0.001). Threshold effect analysis revealed that the inflection points of WHtR and pain site number were 0.46 and 2.00, respectively ( P<0.001). Joint effect analysis showed that the Q2, Q3 and Q4 levels of WHtR combined with pain increased the risk for frailty by 146% ( HR=2.46, 95% CI: 2.11-2.87), 169% ( HR=2.69, 95% CI: 2.30-3.16), and 157% ( HR=2.57, 95% CI: 2.18-3.03). Conclusions:The risk for frailty increased with the level of WHtR and the number of pain sites in middle-aged and old people, and there was joint effect between WHtR and pain. Comprehensive management and intervention of obesity and pain are significant for the early prevention of frailty.

Objective: To analyze the hepatitis B virus serological markers (HBVM) and abnormal rates of liver function indexes among primary liver cancer (PLC) patients with different HBVM profiles, so as to provide a reference for risk stratification and optimization of diagnosis and treatment strategies for PLC patients. Methods: Patients diagnosed with PLC at Qidong People's Hospital between January 2017 and June 2024 were selected for this study. Basic information such as gender and age was collected through the hospital information management system. Venous blood samples were drawn to test for HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc, as well as ten liver function indexes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), cholinesterase (CHE), and adenosine deaminase (ADA). Compare the abnormal rates of liver function indexes among the six HBVM profiles: "big three yang" (HBsAg+, HBeAg+, anti-HBc+), "small three yang" (HBsAg+, anti-HBe+, anti-HBc+), triple antibody positive (anti-HBs+, anti-HBe+, anti-HBc+), s/c antibody positive (anti-HBs+, anti-HBc+), e/c antibody positive (anti-HBe+, anti-HBc+), and all negative. Results: A total of 1 434 patients with PLC were enrolled in this study. Among them, 1 043 (72.73%) were males and 391 (27.27%) were females. The median age was 64.00 (interquartile range, 16.00) years. The positive rates for HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc were 51.95%, 29.43%, 10.81%, 60.32%, and 88.42%, respectively. The "big three yang", "small three yang", triple-antibody positive, s/c antibody positive, e/c antibody positive, and all-negative profiles accounted for 85 (5.93%), 491 (34.24%), 170 (11.85%), 148 (10.32%), 100 (6.97%), and 121 (8.44%) cases, respectively. The abnormal rates of ALT among PLC patients with six HBVM profiles were 26.19%, 28.33%, 13.94%, 22.60%, 20.41%, and 14.91%, respectively. The abnormal rates of AST were 33.33%, 36.17%, 23.03%, 24.66%, 22.45%, and 18.42%, respectively. The abnormal rates of LDH were 62.16%, 68.22%, 53.73%, 61.19%, 60.00%, and 68.42%, respectively. The abnormal rates of CHE were 0%, 1.81%, 0%, 2.11%, 2.22%, and 3.88%, respectively. The abnormal rates of ADA were 59.09%, 57.27%, 24.27%, 33.33%, 45.00%, and 37.04%, respectively. These differences were statistically significant (all P<0.05). Conclusions In this study, the HBVM profiles were mainly characterized by "small triple positive" among PLC patients. The significant differences in liver function indexes abnormal rates among PLC patients with six HBVM profiles could reflect the liver injury status.

Objective:To explore the association of central obesity, pain, their joint effect, and interaction with frailty in middle-aged and old people in China.Methods:A total of 14 359 participants aged ≥45 years in 2011, 2013 and 2015 were selected from the China Health and Retirement Longitudinal Study to construct a cohort database. Cox proportional hazards regression models were used to estimate the association of waist-to-height ratio (WHtR) and pain with the risk for frailty. Joint effect and interaction analyses were performed.Results:In the follow-up of 77 783 person-years, frailty developed in 3 198 participants, with an incidence density of 41.11 per 1 000 person-years. Compared with the Q1 level of WHtR, its Q2, Q3 and Q4 level increased risk for frailty by 17% ( HR=1.17, 95% CI: 1.05-1.31), 24% ( HR=1.24, 95% CI: 1.11-1.40), and 43% ( HR=1.43, 95% CI: 1.25-1.63), respectively. Compared with painlessness, suffering from pain increased the risk for frailty by 97% ( HR=1.97, 95% CI: 1.83-2.11), and having 1, 2, and ≥3 pain sites increased the risk by 42% ( HR=1.42, 95% CI: 1.25-1.61), 86% ( HR=1.86, 95% CI: 1.64-2.11), and 138% ( HR=2.38, 95% CI: 2.18-2.60), respectively. The results of restricted cubic spline showed that WHtR level was associated with the risk for frailty in a J-type dose-response relationship (total P<0.001, nonlinear P<0.001), and pain quantity was positively associated with the risk in a nonlinear dose-response relationship (total P<0.001, nonlinear P<0.001). Threshold effect analysis revealed that the inflection points of WHtR and pain site number were 0.46 and 2.00, respectively ( P<0.001). Joint effect analysis showed that the Q2, Q3 and Q4 levels of WHtR combined with pain increased the risk for frailty by 146% ( HR=2.46, 95% CI: 2.11-2.87), 169% ( HR=2.69, 95% CI: 2.30-3.16), and 157% ( HR=2.57, 95% CI: 2.18-3.03). Conclusions:The risk for frailty increased with the level of WHtR and the number of pain sites in middle-aged and old people, and there was joint effect between WHtR and pain. Comprehensive management and intervention of obesity and pain are significant for the early prevention of frailty.

Objective:To explore the effect of exercise on glycemic control and physical indicators among community-dwelling persons with type 2 diabetes mellitus (T2DM).Methods:A total of 42 T2DM patients undergoing regular follow-up at a community health center were divided into a control group and an exercise group. To minimize confounding factors, 1∶1 propensity score matching was performed, resulting in 21 patients in each group. Both groups received standardized diabetes management, including medication, dietary guidance and diabetes health education. The exercise group additionally performed exercises which integrated sports and medical care models. The experiment lasted 8 weeks. Before and after the intervention, glycosylated hemoglobin A1c (HbA1c) levels, body weight, body mass index (BMI), fat mass, visceral fat area (VFA), fat mass index (FMI) and appendicular skeletal muscle mass index (ASMI) were recorded and compared between the two groups. Moreover, the actual exercise compliance of the exercise group was observed, along with any adverse events such as hypoglycemia or exercise-related injuries, as well as changes in antidiabetic medication dosage.Results:After the intervention, significant improvement was observed in both groups in all of the measurements, but with the average HbA1c, BMI, fat mass, VFA and FMI values of the exercise group then significantly better than the control group′s averages. The average compliance rate in the exercise group was 60%. No cases of hypoglycemia or exercise-related injuries were reported during the intervention, and there were no changes in the use of anti-diabetes medications.Conclusions:Exercise effectively improves glycemic control and physical indicators among community-dwelling T2DM patients. However, exercise compliance needs improving.

Objective:To explore the association between triglyceride glucose index (TyG)- waist to height ratio (WHtR)(TyG-WHtR) and cognitive impairment in middle-aged and elderly population.Methods:A cohort database was constructed using the data from the China Health and Retirement Longitudinal Study, with 8 946 participants in 2011 and 2015 as the baseline population. Cox proportional hazards regression models were used to estimate the association between TyG-WHtR levels at baseline and the risk of cognitive impairment in middle-aged and elderly population. The analysis was stratified by age and gender, respectively.Results:A total of 8 946 participants were included, with an average follow-up of 7.08 person-years and incidence density of cognitive impairment for 21.15 per 1 000 person-years. Compared with the Q1 level of TyG-WHtR, its Q3 and Q4 level increased the risk of cognitive impairment by 32% ( HR=1.32, 95% CI: 1.09-1.60) and 47% ( HR=1.47, 95% CI: 1.14-1.91), respectively. Trend test showed that the risk of cognitive impairment increased with the increase of TyG-WHtR level, and there was a dose-response relationship ( P=0.001). Stratified analysis showed that in the population aged 45-59 years, compared with the Q1 level of TyG-WHtR, its Q3 level increased the risk of cognitive impairment by 34% ( HR=1.34, 95% CI: 1.02-1.78). In the population aged 60 years and above, compared with the Q1 level, its Q3 and Q4 level increased the risk of cognitive impairment by 31% ( HR=1.31, 95% CI: 1.01-1.72) and 63% ( HR=1.63, 95% CI: 1.15-2.31), respectively. In the male group, there was no significant association between TyG-WHtR level and the risk of cognitive impairment ( P>0.05). In the female group, compared with the Q1 level of TyG-WHtR, its Q4 level increased the risk of cognitive impairment by 76% ( HR=1.76, 95% CI: 1.26-2.46). Conclusions:Middle-aged and elderly population with a higher TyG-WHtR level may increase the risk of cognitive impairment, and there were age and sex differences. Early cardiovascular health management and scientific and reasonable weight management are of great significance to preventing cognitive impairment.

Objective:To investigate the efficacy and safety of oral testosterone therapy in individuals diagnosed with androgen insensitivity syndrome (AIS).Methods:A self-controlled study design was utilized, focusing on individuals with AIS who were genetically diagnosed at the Department of Endocrinology, Genetics, and Metabolism of Beijing Children′s Hospital between 2009 and 2021. These patients underwent treatment involving the administration of testosterone. The primary observed indexes include the measurement of penis length, which should meet the minimal surgical standard (penis length≥2.5 cm) or greater than or equal to -2.5 s (lower limit of normal). Secondary observed indexes include penile length standard deviation score (PL-SDS), an increase in penis longitude (ΔPL), medication dosage, the course of therapy, and safety indicators, among others. There were 4 courses of treatment. After each course, patients were evaluated to determine whether termination of treatment was appropriate. Patients who exhibited inadequate post-treatment penile length growth were advised to continue with further treatment. The statistical methodology included t-test, and a Wilcoxon rank sum test to describe efficacy and safety. The patients were followed up until 2023. Results:The study comprised a total of 51 individuals with AIS, comprising 33 males and 18 females (gender of registered permanent residence). Among these patients, 10 were diagnosed with complete androgen insensitivity syndrome (CAIS) and 41 were diagnosed with partial androgen insensitive syndrome (PAIS). There were 2 children with CAIS were diagnosed by doctors and prescribed testosterone undecanoate, but the children did not really take medicine.The penile length of CAIS patients could not be measured (penile length<0.5 cm) before and after treatment. For PAIS patients, baseline penile length and PL-SDS were (2.3±0.6) cm and -3.7±1.3, respectively. The measurements for penile length and PL-SDS after each treatment course were recorded as follows: (2.7±0.8), (2.8±0.6), (2.6±0.4), (2.6±0.4) cm and -2.8±1.6, 2.5±1.6, 2.9±1.2, -3.2±0.9, respectively. Both penile length and PL-SDS interventions showed statistically significant gains when compared to the baseline performance of the 4 courses ( t=4.05、3.56、2.55、2.23 and 3.88、3.50、2.50、2.19, all P<0.05). Before treatment, 13 PAIS patients (32%) reached 2.5 cm and seven (17%) reached greater than or equal to -2.5 s. Following the initial, subsequent, third, and fourth therapeutic interventions, 18 cases (44%), 24 cases (59%), 25 cases (61%), and 26 cases (63%) reached 2.5 cm, respectively. Additionally, A total of 12 cases (29%), 15 cases (37%), 20 cases (49%), and 21 cases (51%), respectively, were found to reach greater than or equal to -2.5 s. The study involved the longitudinal monitoring of patients with the highest recorded age being 13.7 years. The weight, height, body mass index, bone age/age, cholesterol, hemoglobin and so on were all within the normal range and the difference were not statistically significant (all P>0.05). All 49 patients were no abnormalities in blood electrolyte, liver and kidney function and thyroid function and no changes in precocious puberty, pubic hair growth, aggressive behavior, vulvar skin darkening, diarrhea or other conditions. Conclusions:Testosterone undecanote in children with CAIS was no effective. The initial course of treatment for patients with PAIS demonstrates observable enhancements in penile length and PL-SDS. For patients with inadequate penile length growth, continued treatment in subsequent courses (such as the second, third, and fourth courses) is recommended toenhance outcomes gradually. Testosterone undecanoate was safe and effective for the majority of individuals with PAIS patients, with few adverse effects and good treatment tolerance.

Objective To investigate the current status of regulatory focus among the nurses in operating room,analyse the influencing factors and summarise nursing strategies to provide a reference for development of the programs in targeted nursing management.Methods A total of 681 operating room nurses from 18 hospitals of Grade ⅡA and above in Jiangsu Province were selected by convenience sampling method from Arprial to July 2023.The nurses who participated in the study were surveyed with a general information questionnaire,the nurse regulatory focus scale(NRFQ),spiritual climate scale(SCS),calling scale-12(CS-12),and perceived stress scale(CPSS).Results All 681 operating room nurses completed the study.The promotive focus score was lower than the defensive focus(23.57±2.64 vs.24.06±2.72).It was found that the promotive focus and defensive focus were positively correlated with spiritual climate and occupational call,and negatively correlated with perceived stress(P<0.01).Spiritual climate,occupational call and perceived stress were the influencing factors that affected the promotion focus,jointly explaining 28.00％of the variance(all P<0.05).While occupational call and perceived stress among the operating room nurses were the influencing factors to the defensive focus,jointly explaining 23.60％of the variance(both P<0.05).Conclusion This study has identified that spiritual climate of nurses in operating room positively influences promotive focus in the regulatory focus.The regulatory focus as a whole is positively regulated by occupational call and negatively influenced by perceived stress.Therefore,nursing administrators should create a favourable spiritual climate to enhance the sense of professional call,reduce the perceived stress and increase the promotive and defensive focus among the nurses in operating room,hence to increase the nursing efficiency,thereby improving the quality of nursing care.