Objective:To investigate the alterations in brain functional activity before and after chemotherapy in breast cancer patients with chemotherapy-related cognitive impairment (CRCI) using resting-state functional magnetic resonance imaging (rs-fMRI) and their relations with cognitive impairment.Methods:A prospective observational study was performed; female breast cancer patients with CRCI admitted to Department of Oncology, Affiliated Hospital 6 of Nantong University were recruited, and age- and education level-matched female healthy controls were chosen. Before and one month after chemotherapy, statuses of cognitive function, depression and anxiety in breast cancer patients with CRCI were evaluated by Montreal cognitive assessment (MoCA), functional assessment of cancer therapy-cognitive function (FACT-cog), self-rating depression scale (SDS), and self-rating anxiety scale (SAS); subsequently, conventional MRI and resting-state functional magnetic resonance imaging (rs-fMRI) were conducted. The healthy controls accepted MoCA, SDS, and SAS, followed by conventional MRI and rs-fMRI. Differences in clinical data and amplitude of low-frequency fluctuation (ALFF, rs-fMRI brain spontaneous neural activity index) were compared between breast cancer patients with CRCI before chemotherapy and healthy controls, and in the breast cancer patients with CRCI between before and after chemotherapy. Taking the brain regions with significant differences in ALFF before and after chemotherapy in breast cancer patients with CRCI as seed points, the difference in whole-brain functional connectivity (FC) before and after chemotherapy was compared in breast cancer patients with CRCI. Pearson or Spearman correlation tests were used to analyze the correlations of ALFF and FC in brain regions with significant differences in ALFF with cognitive function scores in breast cancer patients with CRCI.Results:(1) A total of 22 breast cancer patients with CRCI and 22 healthy controls were enrolled. Compared with the healthy controls, the breast cancer patients with CRCI before chemotherapy had significantly higher SDS and SAS scores ( P<0.05). Compared with breast cancer patients with CRCI before chemotherapy, the breast cancer patients with CRCI after chemotherapy had significantly lower MoCA, FACT-cog-perceived cognitive impairment, FACT-cog-comment from others on cognitive function, and FACT-cog-perceived cognitive ability ( P<0.05). (2) Compared with those before chemotherapy, breast cancer patients with CRCI after chemotherapy exhibited significantly increased ALFF in the right precuneus, right middle occipital gyrus, and left superior frontal gyrus, while statistically decreased FC in the right middle occipital gyrus-left middle temporal gyrus, right precentral gyrus-right middle temporal gyrus, and left superior frontal gyrus-left fusiform gyrus ( P<0.05). (3) ALFF in the right precentral gyrus in breast cancer patients with CRCI after chemotherapy was negatively correlated with difference value of FACT-cog before and after chemotherapy ( r=-0.497, P=0.018) and difference value of PCA before and after chemotherapy ( r s=-0.436, P=0.042); FC in the left superior frontal gyrus-left fusiform gyrus was positively correlated with score of FACT-cog-perceived cognitive impairment ( r=0.621, P=0.002). Conclusion:Chemotherapy induces compensatory enhancement of spontaneous neural activity in multiple brain regions in breast cancer patients with CRCI, accompanied by FC disruption at specific brain areas, which are associated with cognitive impairment.

Objective To analyze the clinical characteristics and high risk factors of prognosis in patients with chronic heart failure and renal insufficiency. Methods A total of 499 patients with chronic heart failure and renal insufficiency from September 2022 to September 2024 were selected. The clinical data of patients were collected, and the clinical characteristics were analyzed. After 3 months of follow-up, the patients were divided into survival group and death group according to the prognosis status. Univariate analysis, and multivariate logistic regression analysis were adopted to analyze the risk factors affecting the prognosis of patients. Results According to different ejection fraction values, patients were classified into HFrEF group (n=164), HFmrEF group (n=103) and HFpEF group (n=232). The age in HFpEF group was the lowest (P<0.05). The cardiac function grading was the highest in HFrEF group, and the systolic blood pressure was lower while the diastolic blood pressure was higher than that in the other two groups (P<0.05), and there were no differences in cardiac function, systolic blood pressure and diastolic blood pressure between HFmrEF group and HFpEF group (P>0.05). The levels of Hb and ALB in HFpEF group were higher than those in HFrEF group (P<0.05), and no differences were observed between HFmrEF group and the other two groups (P>0.05). HFrEF group had the lowest total cholesterol and Scr, and the highest serum uric acid, eGFR, BNP and cTnI (P<0.05). The level of hs-CRP in HFmrEF group was the lowest. The LVEDD was lower in HFpEF group than that in the other two groups (P<0.05). The levels of serum uric acid, Scr and hs-CRP in death group were higher while the eGFR was lower compared to survival group (P<0.05). After logistic analysis, it was found that elevated levels of serum uric acid and hs-CRP and decreased eGFR were risk factors for poor prognosis (P<0.05). Conclusion Patients with chronic heart failure and renal insufficiency are mainly HFpEF. Elevated serum uric acid and hs-CRP and decreased eGFR are the high risk factors for poor prognosis.

Objective:To investigate the alterations in brain functional activity before and after chemotherapy in breast cancer patients with chemotherapy-related cognitive impairment (CRCI) using resting-state functional magnetic resonance imaging (rs-fMRI) and their relations with cognitive impairment.Methods:A prospective observational study was performed; female breast cancer patients with CRCI admitted to Department of Oncology, Affiliated Hospital 6 of Nantong University were recruited, and age- and education level-matched female healthy controls were chosen. Before and one month after chemotherapy, statuses of cognitive function, depression and anxiety in breast cancer patients with CRCI were evaluated by Montreal cognitive assessment (MoCA), functional assessment of cancer therapy-cognitive function (FACT-cog), self-rating depression scale (SDS), and self-rating anxiety scale (SAS); subsequently, conventional MRI and resting-state functional magnetic resonance imaging (rs-fMRI) were conducted. The healthy controls accepted MoCA, SDS, and SAS, followed by conventional MRI and rs-fMRI. Differences in clinical data and amplitude of low-frequency fluctuation (ALFF, rs-fMRI brain spontaneous neural activity index) were compared between breast cancer patients with CRCI before chemotherapy and healthy controls, and in the breast cancer patients with CRCI between before and after chemotherapy. Taking the brain regions with significant differences in ALFF before and after chemotherapy in breast cancer patients with CRCI as seed points, the difference in whole-brain functional connectivity (FC) before and after chemotherapy was compared in breast cancer patients with CRCI. Pearson or Spearman correlation tests were used to analyze the correlations of ALFF and FC in brain regions with significant differences in ALFF with cognitive function scores in breast cancer patients with CRCI.Results:(1) A total of 22 breast cancer patients with CRCI and 22 healthy controls were enrolled. Compared with the healthy controls, the breast cancer patients with CRCI before chemotherapy had significantly higher SDS and SAS scores ( P<0.05). Compared with breast cancer patients with CRCI before chemotherapy, the breast cancer patients with CRCI after chemotherapy had significantly lower MoCA, FACT-cog-perceived cognitive impairment, FACT-cog-comment from others on cognitive function, and FACT-cog-perceived cognitive ability ( P<0.05). (2) Compared with those before chemotherapy, breast cancer patients with CRCI after chemotherapy exhibited significantly increased ALFF in the right precuneus, right middle occipital gyrus, and left superior frontal gyrus, while statistically decreased FC in the right middle occipital gyrus-left middle temporal gyrus, right precentral gyrus-right middle temporal gyrus, and left superior frontal gyrus-left fusiform gyrus ( P<0.05). (3) ALFF in the right precentral gyrus in breast cancer patients with CRCI after chemotherapy was negatively correlated with difference value of FACT-cog before and after chemotherapy ( r=-0.497, P=0.018) and difference value of PCA before and after chemotherapy ( r s=-0.436, P=0.042); FC in the left superior frontal gyrus-left fusiform gyrus was positively correlated with score of FACT-cog-perceived cognitive impairment ( r=0.621, P=0.002). Conclusion:Chemotherapy induces compensatory enhancement of spontaneous neural activity in multiple brain regions in breast cancer patients with CRCI, accompanied by FC disruption at specific brain areas, which are associated with cognitive impairment.

Suffering is prevalent in the palliative care population and is an important factor affecting the quality of life of palliative care patients and their family caregivers. In this paper, we review the assessment content, measurement methods, current application status and advantages and disadvantages of suffering assessment tools for palliative care patients, analyze the problems of current suffering assessment tools for palliative care patients and make suggestions, aiming to provide reference for palliative suffering treatment in China.

Objective:To compare the efficacy and safety of telbivudine (LDT) and tenofovir disoproxil fumarate (TDF) treatment during the second and third trimester in pregnant women with high viral load of hepatitis B virus (HBV).Methods:Totally 506 pregnancy women with HBV infection who received antiviral therapy during the second and third trimester of pregnancy in the obstetrical clinic of The Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine from January 1, 2016 to December 31, 2018 were retrospectively enrolled, and the anti-viral efficacy and safety in mothers and neonates were evaluated. Pregnancy women were divided into TDF group and LDT group according the medications. The efficacies including decline and negative rate of HBV DNA, the vertical transmission (VT) rate, the normalization rate of liver function in mothers between the two groups were compared. The safeties including birth weight of neonates, congenital deformities and the rates of preterm between the two groups were also compared. Chi-square test, independent sample t test or rank sum test were used for statistical analysis. Results:There were 239 pregnant women in the LDT group and 267 in the TDF group. The maternal HBV DNA levels before treatment in the LDT and TDF groups were (7.83±0.75) lg IU/mL and (7.82±0.66) lg IU/mL, respectively, while the maternal HBV DNA levels prior to delivery were 2.91(1.20) lg IU/mL and 2.83(1.01) lg IU/mL, respectively. The normalization rates of alanine aminotransferase (ALT) of chronic hepatitis B (CHB) pregnant women prior to delivery in TDF group and LDT group were 95.00%(38/40) and 98.18%(54/55), respectively. There were all no significant differences between the two groups ( t=0.097, U=1.040 and χ2=0.767, respectively, all P>0.05). For CHB pregnant women, the HBV DNA negative rate at one month postpartum in TDF group was 85.45%(47/55) and that in LDT group was 82.50%(33/40). The normalization rate of ALT in TDF group was 94.55%(52/55), and that in LDT group was 92.50%(37/40). There were no significant differences between the two groups ( χ2=0.152 and 0.164, respectively, P=0.697 and 0.687, respectively). The VT rates were 0(0/262) in TDF group and 0.43%(1/231) in LDT group, which had no significant difference between the two groups ( χ2=1.127, P=0.288). Two patients in LDT group who continued taking LDT 11 months postpartum switched to TDF because of HBV rt204 mutation, and no one had virus mutation in TDF group. No significant increased in creatine kinase in LDT group, and no significant abnormal calcium and phosphorus metabolism in the TDF group. The preterm rate was 7.87%(21/267) in TDF group and 4.18%(10/239) in LDT group, but there was no significant difference between the two groups ( χ2=2.970, P=0.085). However, the birth weight of neonates in TDF group ((3 204.72±490.50) g) was lower than that in LDT group ((3 374.31±467.50) g), and the difference was statistically significant ( t=3.780, P<0.01). During the course of treatment, no pregnant women discontinued treatment due to drug intolerance, and no infants presented with drug-related birth defects. Safeties for mothers and neonates were both good. Conclusions:Both LDT and TDF treatment could reduce the VT rate in pregnant women with high HBV viral load. The safety is good for both mothers and neonates. However, for CHB pregnant women who continue antiviral therapy postpartum, TDF is superior to LDT because of lower virus mutation, thus to reduce the risk of drug resistance.

Objective To develop a HPLC-MS/MS method for the absolute bioavailability study of salidroside in Beagle dogs. Methods Gastrodin was used as internal standard. Plasma samples were treated by protein precipitation and separated by Symmetry RP₁₈ column (100 mm×4.6 mm, 3.5 μm). 0.1% formic acid in water(A) and 0.1% formic acid in acetonitrile: methanol (20 : 80, V/V) (B) were used as the mobile phase for isocratic elution with 35% mobile phase B. The flow rate was 0.4 ml/min. Column temperature was 40 ℃. Injection volume was 2 μl. By electrospray ionization source (ESI) and multi-reaction monitoring (MRM) mode, the MRM ion pairs of salidroside and gastrodin were identified as m/z 299.1→118.9 and m/z 285.1→122.9, separately. Blood samples were collected at different time points after oral or intravenous administration of salidroside. The harvested plasma samples were analyzed by HPLC-MS/MS method to assess the pharmacokinetics and absolute bioavailability of salidroside. Results Excellent linearity(r>0.998 6) was found in the concentration range of 10−10 000 ng/ml for salidroside and the lowest quantitative concentration was 10 ng/ml. The recovery was 89.5%−91.8%. The intra-day precision (RSD) was less than 9.7%, and the inter-day precision (RSD) was less than 7.3%. After a single oral dose of 15 mg/kg or an intravenous injection of 1.5 mg/kg of salidroside, c_max was (9 680±3725) and (9 310±1 645) ng/ml; t_max was (1.25±0.67) and (0.011±0.017) h, AUC_0−t was (20 535.4±5 200.0) and (4 646.7±720.5) ng·h/ml, AUC_0−∞ was (20 607.9±5 266.2) and (4 691.6±715.2) ng·h/ml; t_1/2 was (1.31±0.63) and (0.98±0.13) h, respectively. Conclusion The LC-MS/MS method established in this study was simple, rapid, sensitive and reliable. It meets the regulatory requirements of biological analysis for pharmacokinetic properties of salidroside in Beagle dogs. The absolute bioavailability of salidroside in Beagle dogs is (43.9±11.2)%.

Objective:To investigate the correlation between the number of circulating tumor cells (CTC) in peripheral blood and clinicopathological features of patients with breast cancer.Methods:The clinical data of 104 breast cancer patients at Guangzhou Panyu Central Hospital between January 2017 and May 2020 were retrospectively analyzed. The number of CTC in peripheral blood, the levels of serum tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen (CA)125, CA153] were detected. In blood samples, the number of CTC ≥ 2/ml was defined as CTC positive. Immunohistochemistry was used to analyze the protein expression of Ki-67 in tumor tissues. The association of CTC with clinicopathological features, serum tumor markers and Ki-67 protein expression was also analyzed.Results:The CTC positive rate was 80.77% (84/104). There were statistically significant differences in composition of whether there was vascular tumor thrombus (χ 2 = 0.860, P = 0.009), axillary lymph node metastasis (χ 2 = 12.382, P<0.01), N staging ( P = 0.002) and TNM staging (χ 2 = 7.698, P = 0.006) between patients with CTC positive and negative. However, there were no statistically significant differences in composition of age ( t = 0.634, P = 0.528), tumor quadrant (χ 2 = 6.523, P = 0.163), molecular subtyping (χ 2 = 4.164, P = 0.384), histological grade (χ 2 = 1.901, P = 0.387), T staging ( P = 0.099) and whether there was nerve invasion (χ 2 = 0.092, P = 0.761). The levels of serum CEA and CA125 in CTC positive patients were higher than those in CTC negative patients [median ( P25, P75): 2.50 ng/ml (2.21 ng/ml, 2.92 ng/ml) vs. 1.89 ng/ml (1.61 ng/ml, 2.35 ng/ml); 13.81 U/ml (11.79 U/ml, 16.28 U/ml) vs. 11.17 U/ml (8.91 U/ml, 12.80 U/ml); all P < 0.05], and CTC was positively correlated with serum CEA and CA153 levels ( r = 0.520, P<0.01; r = 0.497, P<0.01); CTC was not related to Ki-67 protein expression (χ 2 = 0.512, P = 0.474). Conclusion:The number of CTC in peripheral blood is closely related to clinical staging, lymph node or hematogenous metastasis, tumor markers CEA and CA153 levels of breast cancer. The increased number of CTC may cause tumor progression and metastasis.

Laparoscopic cholecystectomy (LC) is a standard procedure for symptomatic cholelithiasis.Single incision laparoscopic cholecystectomy (SILC) as one kind of LC has been paid more attention nowadays.This article aims to review the therapeutic effect,complications and limitations of SILC.

Objective To observe the effects of Ganlu Xiaodu Dan and its incomplete prescription on expressions of MiR-146a and TLR4 mRNA in RD cells infected by EV71. Methods With technique of cell culturing, Ganlu Xiaodu Dan therapy group, incomplete Qing prescription therapy group, incomplete Li prescription therapy group, normal cells control group, model control group and ribavirin control group were set, and tests for virus toxicity and medicine toxicity in cells were taken, then expressions of miRNA-146a and TLR4 mRNA in these RD cells 24 hours after intervention with medicine were detected. Results Compared with normal cells control group, miR-146a in mRNA model control group decreased and TLR4 mRNA increased. Compared with model control group, miR-146a mRNA in Ganlu Xiaodu Dan therapy group, incomplete Qing prescription therapy group and incomplete Li prescription therapy group all increased while TLR4 mRNA decreased, and differences between ribavirin control group and model control group were not significant. Compared with Ganlu Xiaodu Dan therapy group, both expressions of miR-146a and TLR4 mRNA in incomplete Qing prescription therapy group were lower; miR-146a increased and TLR4 mRNA decreased in incomplete Li prescription therapy group. Compared with incomplete Qing prescription therapy group, miR-146a mRNA in incomplete Li prescription therapy group increased, but expression of TLR4mRNA between them was not significant. Conclusion Ganlu Xiaodu Dan can regulate the immune reactions caused by infection of EV71 by increasing expression of miR-146a mRNA and reducing expression of TLR4 mRNA. There may be antagonism effect between incomplete Qing prescription and incomplete Li prescription.

BACKGROUND:There are more literature reports about the floating shoulder injury in recent years, but there stil have obvious controversies about the treatment of the floating shoulder injury. Whether choose the conservative treatment or operative treatment is an important issue in face of every clinician. OBJECTIVE:To review the clinical features and present treatment situation of the floating shoulder injury. METHODS: A computer-based online search was performed in the PubMed and the China National Knowledge Infrastructure database for the clinical research papers on the treatment methods of the floating shoulder injury from January 1975 to August 2015. The key words were floating shoulder injury, diagnose, treatment method. The articles published earlier and repetitive researches were excluded. Finaly, 33 articles were included for further analysis. RESULTS AND CONCLUSION:(1) Floating shoulder injury is a kind of severe shoulder injury which is caused by high energy and violence. It is often complicated with severe systemic injury, which should be paid more attention in clinic. (2) The treatment of floating shoulder injury has been controversial, and there is no standard treatment guideline. Conservative treatment and operative treatment can get good outcomes. There are less reports about conservative treatment of the floating shoulder injury in recent years. The outcome of operative treatment may better than conservative treatment. (3) Conservative or simple clavicle fixation can be used for fractures without displacement or with smal displacement. Obviously displaced fractures can be treated with simple clavicle fixation or double fixation of clavicle and scapula, which may have good repair effects.