Breast cancer is a malignant tumor that occurs in the glandular epithelium of the breast, and it is one of the most common tumors that seriously affect the physical and mental health of women. With the aggravation of population aging, the incidence of breast cancer in the elderly has increased year by year in recent years. Elderly patients with breast cancer often have a variety of underlying diseases, and their prognosis is usually related to many factors such as cancer staging, cancer classification, treatment status and health status, with a significant difference in survival rate among patients. Due to the unique clinical and pathological characteristics of elderly patients with breast cancer compared to young and middle-aged patients, there are many studies on the treatment of elderly breast cancer patients in the past, and there are few reviews on the influencing factors of prognosis in elderly patients. This paper reviews the research progress of influencing factors of prognosis in elderly patients with breast cancer from the aspects of clinicopathological factors, treatment options and prognosis factors, in order to provide a reference for clinical determination of treatment options for elderly patients with breast cancer in the future.

ObjectiveTo elucidate the mechanism by which total flavonoids of Abelmoschi Corolla （TFA） treat immunoglobulin A （IgA） nephropathy （IgAN） through serum metabolomics analysis. MethodsSPF-grade male SD rats were randomly assigned into six groups （n=10）： blank， model， low-dose TFA （TFA-L， 27 mg·kg^-1）， medium-dose TFA （TFA-M， 54 mg·kg^-1）， high-dose TFA （TFA-H， 108 mg·kg^-1）， and losartan potassium （LST， 4.5 mg·kg^-1） groups. The remaining five groups， excluding the blank group， were modeled with bovine serum albumin （BSA）， lipopolysaccharide （LPS）， and carbon tetrachloride （CCl₄）. Specifically， from weeks 1 to 10， BSA was administered via gavage every other day， and a mixture of castor oil and CCl₄ was injected subcutaneously once a week， with LPS injected into the tail vein at weeks 6 and 8. After successful modeling， each intervention group was administrated with the medication prepared with distilled water once daily by gavage for a continuous period of 4 weeks. The levels of 24-hour urinary total protein （24 h UP） and serum creatinine （SCr） were quantified by kits， and the serum IgA level was determined by enzyme-linked immunosorbent assay （ELISA）. Renal pathological changes were observed by hematoxylin-eosin （HE） staining and periodic acid-Schiff （PAS） staining. Renal IgA deposition was assessed by immunofluorescence （IF）. Endoplasmic reticulum （ER） stress was observed by transmission electron microscopy. Western blot and immunohistochemistry （IHC） were employed to detect the expression of ER stress-related factors. Non-targeted metabolomics was used to screen differential metabolites for analysis， and key metabolites arachidonic acid （AA）， prostaglandin E₂ （PGE₂）， and cyclooxygenase-2 （COX-2） were validated. ResultsCompared with the blank group， the model group showed increased 24-hour urine protein （24 h UP） and serum creatinine （SCr） levels （P<0.01）， obvious renal pathological damage， elevated serum IgA level （P<0.01）， increased renal AA and PGE₂ levels （P<0.01）， and up-regulated protein levels of COX-2， glucose-regulated protein 78 （GRP78）， phosphorylated eukaryotic initiation factor 2α （P-EIF2α）， activating transcription factor 4 （ATF4）， inositol-requiring enzyme 1α （IRE1α）， and spliced X-box binding protein 1 （XBP1s） in the renal tissue （P<0.05， P<0.01）. Compared with the model group， the intervention groups showed reductions in 24 h UP and SCr levels （P<0.05， P<0.01）， alleviated renal pathological injury， decreased serum IgA level （P<0.05， P<0.01）， and reduced renal AA and PGE₂ levels （P<0.01）. Western blot and IHC results showed that TFA reduced the levels of COX-2， GRP78， P-EIF2α， ATF4， IRE1α， and XBP1s in the renal tissue （P<0.05， P<0.01）. Metabolomics results indicated that 51 commonly differential metabolites were found among the normal， model， and TFA-M groups. TFA ameliorated IgAN by affecting metabolic pathways related to the biosynthesis of arachidonic acid and arginine through L-aspartic acid， prostaglandin 2α， leukotriene B₄， leukotriene D₄， among others. ConclusionTFA can regulate the arachidonic acid metabolism pathway， thereby modulating ER stress， reducing renal damage， and ameliorating IgA nephropathy.

ObjectiveTo investigate the mechanisms of Tongmai Yangxin pills （TMYX） and Tongxinluo capsules （TXL） in treating no-reflow （NR） after myocardial ischemia and reperfusion following the concept of treating the same disease with different methods， based on integrative pharmacology and experimental validation. MethodsEighty 8-week-old SPF-grade SD rats were randomly assigned into four groups （n=20）： sham operation， NR， TMYX （4 g·kg^-1）， and TXL （2 mg·kg^-1）. A rat model of myocardial ischemia-reperfusion no-reflow was established by in-situ ligation of the left anterior descending coronary artery. Gastric gavage was first performed 4 h after the operation， and samples were collected on day 7. Thioflavin S staining was used to observe the NR area in rat myocardium. Echocardiography was performed to examine the cardiac function. Hematoxylin-eosin （HE） staining was conducted to observe the pathological changes of the myocardial tissue. An automatic biochemical analyzer was adopted to measure myocardial enzyme activity. Then， integrated pharmacology was applied for Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analysis. Finally， Western blot was employed to quantify the protein levels of key targets in the myocardial tissue， including soluble guanylyl cyclase （sGC）， cyclic guanosine monophosphate （cGMP）/dependent protein kinase （PKG）， phosphorylated phosphatidylinositol 3-kinase （p-PI3K）， phosphorylated protein kinase B （p-Akt）， and hypoxia-inducible factor-1α （HIF-1α）. ResultsCompared with the sham operation group， the NR group showed increased NR area of myocardium， decreased left ventricular ejection fraction （EF）， left ventricular fractional shortening （FS）， left ventricular outflow tract peak velocity （LVOT Peak）， and left ventricular stroke volume （LVSV） （P<0.01）， fractured and disordered myocardial fibers as well as inflammatory cell infiltration in the myocardial tissue， enhanced activities of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， and lactate dehydrogenase （LDH） in the myocardial tissue （P<0.01）， and downregulated protein levels of sGC， PKG， phosphorylated （p）-PI3K （Tyr458）， and p-Akt （Tyr315） in the myocardial tissue （P<0.05， P<0.01）. The expression level of HIF-1α protein showed a downward trend. Compared with the NR group， the TMYX group and TXL group exhibited a decreasing trend in myocardial NR area， EF， FS， and LVOT Peak significantly increased （P<0.05， P<0.01）， LVSV showed an upward trend， ameliorated myocardial pathological morphology and inflammatory infiltration， reductions in CK， CK-MB， and LDH activities （P<0.05， P<0.01）， and upregulated protein levels of sGC， PKG， p-PI3K （Tyr458） in myocardial tissue （P<0.05， P<0.01）， the protein expressions of p-Akt （Tyr315） and HIF-1α showed an upward trend. A comparison of the therapeutic effects between the two compound prescriptions showed that TMYX tended to exert a better effect in restoring cardiac function and protecting cardiac structure in NR rats， whereas TXL was more effective in reducing myocardial NR area and lowering myocardial enzyme activities in NR rats. Integrative pharmacology analysis combined with experimental verification demonstrated that both TMYX and TXL could alleviate NR through the following mechanisms： activating the cyclic cGMP/PKG signaling pathway to regulate vascular tone， activating the PI3K/Akt signaling pathway to dilate blood vessels， and activating the HIF-1 signaling pathway to inhibit oxidative stress. However， TMYX had an advantage in activating the cGMP/PKG pathway， while TXL was superior in activating the PI3K/Akt pathway. The two compound prescriptions exerted comparable effects on the HIF-1 signaling pathway， which might serve as their common therapeutic pathway. ConclusionBoth TMYX and TXL could alleviate NR damage. TMYX exerts its protective effect against NR mainly by activating the cGMP/PKG signaling pathway， while TXL exerts its effect mainly through the PI3K/Akt pathway. The HIF-1α signaling pathway may be a common pathway for the two compound prescriptions to exert their protective effects against NR. This study reveals the similarities and differences between TMYX and TXL in the treatment effect and mechanism for NR， providing an experimental basis and a theoretical basis for better clinical application of the two compound prescriptions.

ObjectiveTo develop and validate a nomogram for predicting the risk of concurrent cognitive impairment in older adults with heart disease. MethodsSelf-reported data from 2 673 respondents in the 2020 China Health and Retirement Longitudinal Study were analyzed. The participants were randomly divided into a training set (n = 1 871) and a validation set (n = 802). Heart disease status was determined using a self-report questionnaire. Logistic regression analysis was performed to identify predictors, and a nomogram for predicting the risk of concurrent cognitive impairment in older adults with heart disease was developed using R software. Bootstrap resampling was used for internal validation, and model performance was further evaluated in the randomly split validation set. The predictive performance of the model was assessed using the area under the receiver operating characteristic curve (AUC) and calibration curves.. ResultsA total of 2 673 older adults with heart disease were included, out of whom 315 participants in the training set had cognitive impairment. Lasso regression analysis identified age, education level, place of residence, instrumental activities of daily living and depression as predictors of concurrent cognitive impairment. A prediction model incorporating these five variables was constructed. The AUC were 0.827 (95%CI 0.804 to 0.850) in the training set and 0.847 (95%CI 0.812 to 0.882) in the validation set. The Hosmer-Lemeshow test yielded P = 0.154 and P = 0.716 in the training and validation sets, respectively. Calibration curves showed good agreement between predicted and observed probabilities. Decision curve analysis indicated that the model provided favorable net benefit and predictive performance. ConclusionThe nomogram may provide a useful reference for risk screening and early intervention for cognitive impairment in older adults with heart disease.

It is believed that psoriasis with anxiety and depression presents the pathogenesis of "depression-blood-spirit"， with qi depression as the initiating factor， and that the disease mechanism is understood from three aspects， including "qi depression transforming into fire， blood stasis disturbing the spirit"， "depressed fire consuming yin， causing blood dryness and spirit agitation"， "qi stagnation leading to blood stasis， resulting in obstructed channels and spirit depression". The treatment proposes three methods， firstly， cooling blood and resolving depression， secondly， nourishing blood and soothing depression， and thirdly， activating blood and regulating depression， which applies prescriptions as modified Liangxue Huoxue Decoction （凉血活血汤） combined with Zhiqiao （Poncirus trifoliata）， Foshou （Citrus medica）， and Lianqiaoxin （Forsythia suspensa） for cooling blood and resolving depression； modified Yangxue Jiedu Decoction （养血解毒汤） combined with Baishao （Paeonia lactiflora Pall）， Zhenzhumu （Margaritifera Concha）， and calcined Muli （Ostreidae） for nourishing blood and soothing depression； and modified Huoxue Sanyu Decoction （活血散瘀汤） combined with Yujin （Curcuma aromatica） and Hehuanpi （Albiziae Cortex） for activating blood and regulating depression. These three methods integrate the "depression-blood-spirit" pathogenesis to achieve harmony of body and spirit by clearing blood heat， nourishing yin and blood， and removing blood stasis， complemented with medicinals that soothing the liver， calming the spirit， and regulating depression.

Objective:To analyze the real-world effectiveness and safety of tofacitinib in the treatment of alopecia ophiasis, and to compare characteristics of patients with different clinical responses.Methods:A retrospective study was conducted on patients with alopecia ophiasis who visited the Department of Dermatology, China-Japan Friendship Hospital from March 1, 2022, to July 31, 2023. All patients received tofacitinib in combination with topical minoxidil or glucocorticoids, intralesional glucocorticoid injections, oral isotretinoin, antidepressants, antihistamines, traditional Chinese medicine, etc., and were followed up for 36 weeks. The primary outcome was the number of patients achieving complete remission and partial remission at week 36; secondary outcomes included the number of patients achieving a severity of alopecia tool (SALT) score of ≤ 20 points and those with a response rate of ≥ 50% in scalp hair regrowth (SALT50) . Clinical characteristics were compared between patients who achieved and did not achieve a SALT score of ≤ 20 points. Comparisons among groups were performed using the two-independent-sample t test, Mann-Whitney U test, and Fisher's exact test. Results:A total of 21 patients with alopecia ophiasis were collected, and all received oral tofacitinib citrate at a dose of 5 mg twice daily for at least 36 weeks. After a 36-week follow-up, 2 patients (9.5%) achieved complete remission, 16 (76.2%) achieved partial remission, and 3 (14.3%) showed no response. SALT50 was achieved in 12 patients (57.1%) , and 13 (61.9%) had a SALT score of ≤ 20 points. Adverse reactions included mild liver transaminase elevation (1 case) , headache (1 case) , and folliculitis (2 cases) . At week 36, the patients achieving a SALT score of ≤ 20 points exhibited significantly decreased proportions of patients with body hair loss (7/13) and of patients with childhood-onset alopecia ophiasis (7/13) compared with those having a SALT score of > 20 points (both 8/8, both P = 0.046) . However, there were no significant differences between the above two groups in gender, age, body mass index, total disease duration, baseline SALT scores, positivity rates of thyroid antibodies or prevalence of total allergen-specific IgE abnormalities (all P > 0.05) . Conclusion:Combination therapy with tofacitinib showed generally good efficacy and safety in the treatment of alopecia ophiasis, and poorer outcomes were likely to be observed in patients with body hair involvement and childhood-onset alopecia ophiasis.

Coptis chinensis Franch. and Panax ginseng C. A. Mey. are traditional herbal medicines with millennia of documented use and broad therapeutic applications, including anti-diabetic properties. However, the synergistic effect of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng on type 2 diabetes mellitus (T2DM) and its underlying mechanism remain unclear. The research demonstrated that the optimal ratio of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng was 4∶1, exhibiting maximal efficacy in improving insulin resistance and gluconeogenesis in primary mouse hepatocytes. This combination demonstrated significant synergistic effects in improving glucose tolerance, reducing fasting blood glucose (FBG), the weight ratio of epididymal white adipose tissue (eWAT), and the homeostasis model assessment of insulin resistance (HOMA-IR) in leptin receptor-deficient (db/db) mice. Subsequently, a T2DM liver-specific network was constructed based on RNA sequencing (RNA-seq) experiments and public databases by integrating transcriptional properties of disease-associated proteins and protein-protein interactions (PPIs). The network recovery index (NRI) score of the combined treatment group with a 4∶1 ratio exceeded that of groups treated with individual components. The research identified that activated adenosine 5'-monophosphate-activated protein kinase (AMPK)/acetyl-CoA carboxylase (ACC) signaling in the liver played a crucial role in the synergistic treatment of T2DM, as verified by western blot experiment in db/db mice. These findings demonstrate that the 4∶1 combination of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng significantly improves insulin resistance and glucose and lipid metabolism disorders in db/db mice, surpassing the efficacy of individual treatments. The synergistic mechanism correlates with enhanced AMPK/ACC signaling pathway activity.
Animals ; Panax/chemistry* ; Ginsenosides/administration & dosage* ; Diabetes Mellitus, Type 2/metabolism* ; Mice ; Male ; Alkaloids/pharmacology* ; Coptis/chemistry* ; Drug Synergism ; Insulin Resistance ; Mice, Inbred C57BL ; Humans ; Transcriptome/drug effects* ; Blood Glucose/metabolism* ; Hypoglycemic Agents/administration & dosage* ; Drugs, Chinese Herbal/administration & dosage* ; Hepatocytes/metabolism*

Objective To explore the diagnostic value of lung ultrasound(LUS)score,computed tomo-graphy(CT)combined with serum CXC chemokine ligand 8(CXCL8)and soluble co stimulatory molecule B7-H3(sB7-H3)for severe Mycoplasma pneumoniae pneumonia(MPP)in children.Methods From April 2022 to April 2024,a total of 210 children with MPP who visited Maternal and Child Health Hospital of Zhan-gqiu District were included as research subjects,and they were separated into severe MPP group and non se-vere MPP group according to the severity of the disease.Enzyme-linked immunosorbent assay was applied to detect serum levels of CXCL8 and sB7-H3.LUS score and CT diagnosis were conducted.The value of LUS score,CT and serum CXCL8,sB7-H3 in the diagnosis of severe MPP was analyzed using the receiver operating characteristic curve.Results There were no statistically significant differences in height,age,fever days,weight,hospital stay,and gender between the severe MPP group and the non severe MPP group(P>0.05).Compared with the non severe MPP group,the serum levels of CXCL8,sB7-H3,and LUS score were all in-creased in the severe MPP group(P<0.05).The area under the curve(AUC)of LUS score,serum CXCL8,and sB7-H3 for diagnosing severe MPP was 0.865,0.785,and 0.750,respectively.The CT diagnosis results showed 35 false positives and 22 false negatives,with Kappa value of 0.459 compared to clinical examination results(P<0.05).The diagnostic results of LUS score,CT combined with serum CXCL8 and sB7-H3 showed 3 false positives and 15 false negatives,with Kappa vale of 0.828 compared to clinical examination results(P<0.05).The diagnosis of LUS score,CT combined with serum CXCL8,and sB7-H3 had higher specificity and accuracy than those of single detection of the four(P<0.05),and the sensitivity of the combined diagno-sis of the four was increased(P<0.05)and the missed diagnosis rate was reduced compared to the single de-tection of CXCL8 and sB7-H3(P<0.05).Conclusion The serum levels of CXCL8,sB7-H3,and LUS score in children with MPP increase.The specificity and accuracy of LUS score,CT combined with serum CXCL8,sB7-H3 in diagnosing severe MPP increase.

Objective To analyze the main epidemiological characteristics of fungal infection in this hospital in the past 7 years,and to provide reference for clinical treatment and prevention and control strategies of fun-gal infection.Methods The fungal data and clinical data of related patients isolated from clinical samples in Peking Union Medical College Hospital from early January 2018 to the end of May 2024 were selected,and the main epidemiological characteristics of fungal infection in this hospital were identified and described through multi-angle statistical analysis.Results A total of 4 479 patients with filamentous fungal infection were en-rolled.The proportion of male patients[57.5％(2 576/4 479)]was higher than that of female patients[42.5％(1 903/4 143)],mainly distributed in internal medicine,Intensive Care Unit(ICU)and emergency de-partment,among which internal medicine accounted for the highest proportion[50.0％(2 241/4 479)].About 90.0％of the specimens were from the lower respiratory tract,in addition to specimens from skin and soft tis-sue,tissue,ear and blood culture.In terms of seasonal distribution,there are more patients in winter.The fun-gi were mainly composed of Aspergillus,Mucor,Cerdosporium,Fusarium and Penicillium,among which As-pergillus was the most abundant,accounting for 74.6％of the total.Aspergillus fumigatus was the most a-bundant Aspergillus,accounting for 42.5％of the total Aspergillus(1 418/3 340).Among the related infec-tions caused by mold,Aspergillus was the most common in the lower respiratory tract,accounting for 76.8％.Among them,Aspergillus fumigatus accounted for the highest proportion(33.6％).98.6％of the molds infected the ear were Aspergillus,of which Aspergillus niger and Aspergillus terreus were the most common.Skin infections are mainly caused by Sporothrix schenckii,Trichophyton rubrum,Microsporum ca-nis.The results of in vitro drug sensitivity test showed that the four common Aspergillus isolated in this hos-pital were sensitive to voriconazole,and amphotericin B had better antifungal activity against Mucorales in vitro.Conclusion Based on the main epidemiological characteristics of fungal infections in this hospital,it is recommended that special attention be paid to the admission of patients in the respiratory department during the peak infection period in autumn and winter.In the treatment of fungal infections in different regions and on different body parts,attention should be paid to the differences in the distribution of bacterial species.

Objective Based on the Ancient and Modern Medical Record Cloud Platform,the medication rules of Chinese herbal medicine for the treatment of polycystic ovary syndrome(PCOS)of liver stagnation type were explored.Methods From database inception till December 2023,the medical records of TCM in treating PCOS of liver stagnation type were retrieved from the databases of China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),Wanfang Data Knowledge Service Platform(Wangfang).After that,the data of prescription and TCM syndrome type were extracted,and then a database was constructed.The Ancient and Modern Medical Record Cloud Platform(V2.3.7)was used to conduct statistical analysis of relevant types of liver stagnation,occurrence frequency of Chinese herbal medicines,and the properties and efficacy of Chinese herbal medicines,as well as correlation analysis and clustering analysis for Chinese herbal medicines.The core prescriptions were mined by complex network analysis.Results A total of 108 prescriptions were included in this study,involving 174 Chinese herbal medicines.The syndrome of kidney deficiency and liver stagnation was most frequently seen,and Angelicae Sinensis Radix and Bupleuri Radix were the Chinese herbal medicines used most frequently.The Chinese herbal medicines usually have the meridian tropism of liver,spleen and kidney meridians,and most of them were mild and sweet in the proterties.The Chinese herbal medicines usually have the actions of soothing liver and alleviating depression.A total of 17 herbal groups such as"Angelicae Sinensis Radix-Paeoniae Radix Alba"and"Bupleuri Radix-Paeoniae Radix Alba"were obtained after association analysis,and the cluster analysis yielded four clustering combinations of Chinese herbal medicine.The core prescription was composed of Bupleuri Radix,Paeoniae Radix Alba,Angelicae Sinensis Radix,Poria,Glycyrrhizae Radix et Rhizoma,Cuscutae Semen,Rehmanniae Radix Praeparata,Cyperi Rhizoma,and Atractylodis Macrocephalae Rhizoma.Conclusion Chinese medicine treatment for PCOS of liver stagnation type focuses on soothing liver and invigorating spleen,nourishing liver and kidney,thus to harmonize qi and blood,and thoroughfare vessel and conception vessel.