ObjectiveTo explore the influencing factors of tumor regression patterns after neoadjuvant chemotherapy （NACT） in breast cancer， construct and validate a predictive model for tumor regression patterns. MethodsA total of 1 314 breast cancer patients who received NACT between March 1， 2019， and March 1， 2024， were selected as study subjects and randomly divided into a validation cohort （n=301） and a study cohort （n=603）. Within the study cohort， patients were further stratified based on post-NACT tumor regression patterns into a concentric regression group（case group）（n=387） and a non-concentric regression group（control group）（n=216）. General clinicopathological data were collected and compared between the two groups. Unconditional logistic regression was used to analyze the influencing factors of tumor regression patterns post-NACT and establish a predictive model. The Hosmer-Lemeshow test and receiver operating characteristic （ROC） curve were employed to evaluate the model's goodness-of-fit and predictive performance， followed by external validation. ResultsAmong all subjects in the study cohort， 174 patients （28.9%） achieved pathological complete response （pCR）， 213 （35.3%） showed unifocal regression， 92 （15.3%） had multifocal regression， 78 （12.9%） presented main residual lesions with satellite lesions， 43 （7.1%） had stable disease， and 3 （0.5%） experienced disease progression. Significant differences were observed between the two groups in age， estrogen receptor（ER）， progesterone receptor（PR）， Ki-67， human epidermal growth factor receptor 2（HER2）， histological grade， prognostic nutritional index（PNI）， and chemotherapy regimen （all P ＜ 0.05）. Logistic regression analysis revealed that age （OR=0.563， 95% CI： 0.358–0.885）， ER （OR=0.521， 95% CI： 0.350–0.773）， PR（OR=0.552， 95% CI： 0.379–0.806）， HER2（OR=3.729， 95% CI： 2.488–5.590）， Ki-67 （OR=1.804， 95% CI： 1.071–3.039）， PNI （OR=2.285， 95% CI： 1.307–3.997） and histological grade （Ⅲ） （OR=2.194 95% CI： 1.283–3.751） were independent influencing factors for concentric regression post-NACT （all P ＜ 0.05）. The Hosmer-Lemeshow test for the logistic regression model yielded a P-value of 0.927， and the area under the ROC curve was 0.731 （95%CI： 0.690-0.772， P ＜ 0.001）. External validation demonstrated that the area under the ROC curve of this prediction model was 0.764 （95% CI： 0.709–0.820， P＜0.001）， with a sensitivity of 75.0% and a specificity of 65.7%. The Youden's index was 0.407. ConclusionThis logistic regression model exhibits high predictive value and provides a reference for clinicians to predict tumor regression patterns in breast cancer patients after NACT.

BACKGROUND: Spicy food consumption has been reported to be inversely associated with mortality from multiple diseases. However, the effect of spicy food intake on the incidence of vascular diseases in the Chinese population remains unclear. This study was conducted to explore this association. METHODS: This study was performed using the large-scale China Kadoorie Biobank (CKB) prospective cohort of 486,335 participants. The primary outcomes were vascular disease, ischemic heart disease (IHD), major coronary events (MCEs), cerebrovascular disease, stroke, and non-stroke cerebrovascular disease. A Cox proportional hazards regression model was used to assess the association between spicy food consumption and incident vascular diseases. Subgroup analysis was also performed to evaluate the heterogeneity of the association between spicy food consumption and the risk of vascular disease stratified by several basic characteristics. In addition, the joint effects of spicy food consumption and the healthy lifestyle score on the risk of vascular disease were also evaluated, and sensitivity analyses were performed to assess the reliability of the association results. RESULTS: During a median follow-up time of 12.1 years, a total of 136,125 patients with vascular disease, 46,689 patients with IHD, 10,097 patients with MCEs, 80,114 patients with cerebrovascular disease, 56,726 patients with stroke, and 40,098 patients with non-stroke cerebrovascular disease were identified. Participants who consumed spicy food 1-2 days/week (hazard ratio [HR] = 0.95, 95% confidence interval [95% CI] = [0.93, 0.97], P <0.001), 3-5 days/week (HR = 0.96, 95% CI = [0.94, 0.99], P = 0.003), and 6-7 days/week (HR = 0.97, 95% CI = [0.95, 0.99], P = 0.002) had a significantly lower risk of vascular disease than those who consumed spicy food less than once a week ( Ptrend <0.001), especially in those who were younger and living in rural areas. Notably, the disease-based subgroup analysis indicated that the inverse associations remained in IHD ( Ptrend = 0.011) and MCEs ( Ptrend = 0.002) risk. Intriguingly, there was an interaction effect between spicy food consumption and the healthy lifestyle score on the risk of IHD ( Pinteraction = 0.037). CONCLUSIONS Our findings support an inverse association between spicy food consumption and vascular disease in the Chinese population, which may provide additional dietary guidance for the prevention of vascular diseases.
Humans ; Male ; Female ; Prospective Studies ; Middle Aged ; Aged ; Vascular Diseases/etiology* ; Risk Factors ; China/epidemiology* ; Adult ; Proportional Hazards Models ; Cerebrovascular Disorders/epidemiology* ; East Asian People

OBJECTIVE: To compare the effects of double-channel core decompression (CD) combined with medullary cavity irrigation with those of simple CD on progression of collapse and clinical outcomes in non-traumatic osteonecrosis of the femoral head (ONFH). METHODS: A retrospective analysis was conducted on the clinical data of 19 patients (30 hips) with non-traumatic ONFH who underwent double-channel CD combined with medullary cavity irrigation and admitted between January 2024 and October 2024 (CD+irrigation group). According to a 1: 2 ratio, 54 patients (60 hips) who underwent simple CD and were matched in terms of age, gender, and body mass index (BMI) were included as the control (CD group). There was no significant difference in baseline data such as age, gender, BMI, affected side, ONFH type, preoperative Association Research Circulation Osseous (ARCO) stage, bone marrow edema stage, visual analogue scale (VAS) score for pain, and Harris score between the two groups ( P>0.05). The postoperative discharge time and occurrence of complications were recorded for both groups. The VAS scores before operation and at discharge after operation were compared, and the differences between pre- and post-operation (change values) were calculated for intergroup comparison. The Harris scores before operation and at discharge and 3 months after operation were also compared. During follow-up, X-ray film, CT, and MRI were performed for reexamination. The ARCO stage and bone marrow edema stage were evaluated at 3 months after operation and compared with those before operation to determine whether there was radiological progression or relief. RESULTS: All incisions in both groups healed by first intention after operation, with no infection, femoral neck fracture, or other operation-related complications. All patients were followed up, and the follow-up time of the CD+irrigation group was (146.8±27.7) days, and that of the CD group was (164.3±48.2) days; there was no significant difference between the two groups ( t=1.840, P=0.069). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). At discharge after operation, the VAS score of the CD+irrigation group was significantly lower than that of the CD group ( P<0.05), and the change value was significantly higher than that of the CD group ( P<0.05). The Harris scores at discharge and 3 months after operation in the CD+irrigation group were significantly higher than those in the CD group ( P<0.05). The Harris score gradually increased with time, and the differences between different time points were significant ( P<0.05). Radiological reexamination showed that there was no significant difference in the ARCO stage and the incidence of radiological progression between the two groups at 3 months after operation ( P>0.05); however, the bone marrow edema stage and the degree of bone marrow edema relief in the CD+irrigation group were better than those in the CD group, with significant differences ( P<0.05). CONCLUSION Double-channel CD combined with medullary cavity irrigation can significantly alleviate hip joint pain and improve joint function in patients with non-traumatic ONFH, reduce the degree of bone marrow edema in the femoral head, and delay the progression of ONFH.
Humans ; Femur Head Necrosis/therapy* ; Retrospective Studies ; Male ; Female ; Decompression, Surgical/methods* ; Therapeutic Irrigation/methods* ; Adult ; Treatment Outcome ; Middle Aged ; Femur Head/surgery*

Objective To design and synthesize derivatives of oleanolic acid and ursolic acid, and investigate their anti-hepatitis C virus （HCV） activity along with that of common triterpenoid acids. To explore the structure-activity relationship and provide a reference for the research of anti-HCV drugs derived from natural products through obtaining compounds with higher activity. Methods Oleanolic acid and ursolic acid were directly reacted with corresponding amines using PyBOP as a condensing agent in the presence of DIEA. Alternatively, the target compounds were prepared through PCC oxidation followed by the Baeyer-Villiger reaction catalyzed by m-CPBA. In vitro anti-HCV activity was tested using the HCVcc infection model. Molecular docking was performed by Autodock software to investigate the interaction between the active compounds and HCV NS5B. Results Oleanolic acid, glycyrrhetinic acid, ursolic acid, and asiatic acid all exhibited certain anti-HCV effects. Specifically, oleanolic acid derivatives OA2-OA4, OA6, and OA7, as well as ursolic acid derivatives UA1 and UA2, demonstrated superior anti-HCV activity compared to their parent compounds. Preliminary structure-activity relationship analysis revealed that introducing a bulky group to 28-COOH of oleanolic acid and ursolic acid enhanced their activity. Molecular docking results demonstrated that the active compounds could stably bind to HCV NS5B, thereby exhibiting antiviral activity. Conclusion Pentacyclic triterpenoids possessed anti-HCV effects, and their derivatives coud be synthesized to obtain more active compounds. The anti-HCV mechanism of these compounds may be associated with their inhibition of NS5B.

Extracorporeal membrane oxygenation (ECMO), as an important treatment technology for circulatory and respiratory support, is widely used in the treatment of critically ill patients. Nurses play a vital role in the management of ECMO patients during the initiation and operation processes. This article comprehensively reviews the current status of ECMO nursing specialty practice, analyzes existing problems and challenges, and explores the future development trends of ECMO nursing specialty practice. The aim is to provide reference for promoting the standardized development of ECMO nursing specialty practice.

Objective:To analyze the relationship between blood urea nitrogen (BUN)/albumin (ALB) ratio (B/A) and prognosis of patients undergoing percutaneous coronary intervention (PCI) guided by ultrasound before operation.Methods:A total of 116 patients who underwent PCI under the guidance of intra-coronary ultrasound in Xianyang Central Hospital from February 2020 to December 2022 were retrospectively selected as the observation group, and 120 healthy people in the same period were selected as the control group. All patients were followed up for 1 year after surgery, and 116 patients were divided into poor prognosis group ( n=33) and good prognosis group ( n=83), taking major adverse cardiovascular events (MACE) as the end point during follow-up. The levels of BUN and ALB in peripheral blood of all subjects were detected after admission, and B/A was calculated. The basic data, biochemical indexes and B/A of each group were analyzed and compared. The predictive value of preoperative BUN, ALB and B/A on postoperative MACE in patients with PCI guided by intra-coronary ultrasound was analyzed by receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was used to evaluate the related influencing factors of postoperative MACE in patients with PCI guided by intra-coronary ultrasound. Results:The left ventricular end-diastolic inner diameter (LVEDD), N-terminal B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), BUN and B/A in the observation group were higher than those in the control group, and left ventricular ejection fraction (LVEF) and ALB were lower than those in the control group (all P<0.05). NT-proBNP, CK-MB, BUN and B/A in the poor prognosis group were higher than those in the good prognosis group, and LVEF and ALB were lower than those in the good prognosis group (all P<0.05). ROC curve results showed that the AUC of peripheral blood BUN, ALB and B/A predicting postoperative MACE in patients with PCI guided by intra-coronary ultrasound were 0.833(95% CI: 0.783-0.883), 0.859(95% CI: 0.809-0.909) and 0.922(95% CI: 0.872-0.972). Multivariate logistic regression analysis showed that LVEF [ OR(95% CI)=1.952(1.317-2.895)], NT-proBNP [ OR(95% CI)=2.625(1.643-4.193)], BUN [ OR(95% CI)=3.353(1.922-5.851)], ALB [ OR(95% CI)=3.792(2.049-7.018)] and B/A [ OR(95% CI)=3.277(2.000-5.370)] were all the influencing factors of postoperative MACE in patients undergoing PCI guided by intra-coronary ultrasound ( P<0.05). Conclusions:The level of B/A in patients with PCI guided by intra-coronary ultrasound increased before surgery, and the high level of B/A is a risk factor for postoperative MACE, which can be used as a biological index to evaluate the postoperative MACE in patients with PCI guided by intra-coronary ultrasound.

Multiple myeloma(MM),a common malignancy of plasma cells,remains an incurable disease de-spite significant therapeutic advancements.A defining characteristic of MM is the recurrent occurrence of cytogenetic ab-normalities,particularly the gains of chromosome 1q21(1q21+),which are among the most frequently observed anoma-lies in this condition,affecting approximately 40%of patients with newly diagnosed MM.While numerous studies have identified 1q21+as an independent prognostic marker linked to poor outcomes in MM,its prognostic significance continues to be debated.An increasing number of national and international prognostic stratification systems classify 1q21+as a high-risk factor;however,its predictive value remains contentious.Variations in 1q21 copy numbers significantly impact genomic instability,drug resistance,and the likelihood of early disease progression,highlighting its growing importance in clinical management strategies.Despite the availability of various therapeutic approaches,such as autologous hemato-poietic stem cell transplantation,immunomodulatory drugs,and proteasome inhibitors,the adverse prognostic implica-tions of 1q21+persist unresolved.This review will explore the latest advancements in understanding the 1q21+in MM,fo-cusing on its pathogenesis,prognostic relevance,and implications for clinical management.

Objective:To analyze the relationship between blood urea nitrogen (BUN)/albumin (ALB) ratio (B/A) and prognosis of patients undergoing percutaneous coronary intervention (PCI) guided by ultrasound before operation.Methods:A total of 116 patients who underwent PCI under the guidance of intra-coronary ultrasound in Xianyang Central Hospital from February 2020 to December 2022 were retrospectively selected as the observation group, and 120 healthy people in the same period were selected as the control group. All patients were followed up for 1 year after surgery, and 116 patients were divided into poor prognosis group ( n=33) and good prognosis group ( n=83), taking major adverse cardiovascular events (MACE) as the end point during follow-up. The levels of BUN and ALB in peripheral blood of all subjects were detected after admission, and B/A was calculated. The basic data, biochemical indexes and B/A of each group were analyzed and compared. The predictive value of preoperative BUN, ALB and B/A on postoperative MACE in patients with PCI guided by intra-coronary ultrasound was analyzed by receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was used to evaluate the related influencing factors of postoperative MACE in patients with PCI guided by intra-coronary ultrasound. Results:The left ventricular end-diastolic inner diameter (LVEDD), N-terminal B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), BUN and B/A in the observation group were higher than those in the control group, and left ventricular ejection fraction (LVEF) and ALB were lower than those in the control group (all P<0.05). NT-proBNP, CK-MB, BUN and B/A in the poor prognosis group were higher than those in the good prognosis group, and LVEF and ALB were lower than those in the good prognosis group (all P<0.05). ROC curve results showed that the AUC of peripheral blood BUN, ALB and B/A predicting postoperative MACE in patients with PCI guided by intra-coronary ultrasound were 0.833(95% CI: 0.783-0.883), 0.859(95% CI: 0.809-0.909) and 0.922(95% CI: 0.872-0.972). Multivariate logistic regression analysis showed that LVEF [ OR(95% CI)=1.952(1.317-2.895)], NT-proBNP [ OR(95% CI)=2.625(1.643-4.193)], BUN [ OR(95% CI)=3.353(1.922-5.851)], ALB [ OR(95% CI)=3.792(2.049-7.018)] and B/A [ OR(95% CI)=3.277(2.000-5.370)] were all the influencing factors of postoperative MACE in patients undergoing PCI guided by intra-coronary ultrasound ( P<0.05). Conclusions:The level of B/A in patients with PCI guided by intra-coronary ultrasound increased before surgery, and the high level of B/A is a risk factor for postoperative MACE, which can be used as a biological index to evaluate the postoperative MACE in patients with PCI guided by intra-coronary ultrasound.

To investigate the clinical value of endoscopic ultrasound-guided puncture drainage in the treatment for liver abscess and abdominal and pelvic abscess with difficulty in conventional puncture drainage. Data of 12 such patients in the Second Affiliated Hospital of Soochow University from January 2015 to November 2023 were retrospectivly analyzed. Results showed liver abscess in 4 cases, abdominal and pelvic abscess in 8 cases. All patients had fever with varying degrees of abdominal pain. Twelve patients with liver abscess and abdominal and pelvic abscess received 13 times of endoscopic ultrasound-guided puncture (1 patient with a large abdominal and pelvic cyst complicated with infection received transgastric and transrectal puncture of 2 times). The puncture needle was successfully penetrated into the pus cavity. Four patients with liver abscess underwent endoscopic ultrasound-guided suction and irrigation, and the abscess was almost completely aspirated. Seven patients with abdominal and pelvic abscess underwent endoscopic ultrasound-guided suction and irrigation, of which 5 cases were almost completely aspirated, and 2 cases had poor drainage effect due to the viscous pus (1 case returned to normal temperature after anti-infection treatment; 1 case had recurrent fever after the operation, and septic shock and death occurred 2 weeks after the operation). A patient with recurrent abdominal and pelvic sclerosis after the operation had multiple abscesses in the abdomen and pelvis, and percutaneous CT-guided drainage was performed for abdominal abscess, but the fever was still repeated. Endoscopic ultrasound-guided balloon dilation plus double pig tail and nasobiliary duct drainage were performed. The patient's temperature returned to normal and abdominal pain was relieved 48 hours after the operation. The total effective rate of abscess drainage was 83.3% (10/12), and the effective rate of suction combined with irrigation for abscess drainage was 81.8% (9/11), and no operation-related complications were observed in all patients. After 3 months of follow-up, no recurrence occurred in 10 patients with effective drainage of abscess, and abscess was self-absorbed in 1 patient with pelvic abscess without effective drainage and no recurrence was observed. Endoscopic ultrasound-guided puncture drainage is of certain clinical value for some liver abscesses and abdominal and pelvic abscesses that are difficult to be drained by conventional puncture, and can reduce the secondary trauma caused by surgical operations.

Objective To explore the impact of ondansetron's use within 24 h before delirium assess-ment in ICU patients on the risk of delirium occurrence.Methods All data were derived from the Critical Care Medical Information Database(MIMIC)-Ⅲ,MIMIC-Ⅳ and the eICU Collaborative Research Database.The research subjects were the patients who were admitted to ICU for treatment for the first time and had re-cords of delirium assessment.The research variable was whether ondansetron was used within 24 h before de-lirium assessment.The main observation indicator was whether delirium occurred after the patient entering to ICU,and whether the patient died during hospitalization or was discharged and returned home was taken as the secondary observation indicator.The propensity score matching eliminated confounding factors,and the stepwise logistic regression and nearest neighbor matching were used to analyze the influencing factors.Results A total of 78 364 patients had the delirium assessment records,among them 22 158 patients had the positive assessment results.A total of 294 patients who used ondansetron within 24 h before delirium assess-ment were taken as the ondansetron group,and 78 070 patients who did not use ondansetron were taken as the control group.Propensity score matching corrected most of the covariates between the two groups.The results of multivariate logistic regression analysis showed that the use of ondansetron was a protective factor for the delirium occurrence(OR=0.72,95％CI:0.53-0.96),and the results of nearest neighbor matching analysis also supported this association(OR=0.48,95％CI:0.31-0.76).However,the use of ondansetron had no effect on the outcome of in-hospital death or discharge home for critically ill patients(P＞0.05).Conclusion Ondansetron may be an effective drug for the prevention or treatment of delirium in critically ill patients.