Purpose: Dual anti–human epidermal growth factor receptor 2 (HER2) drugs have become the standard regimen for neoadjuvant systemic treatment (NST) to HER2-positive breast cancer patients. However, the efficacy varies greatly among patients with different HER2 protein expression levels. Materials and Methods: A total of 575 HER2-positive breast cancer patients from multiple centers throughout China from 2013 to 2022 were retrospectively analyzed. We compared clinicopathological features in different HER2 immunohistochemistry classes (HER2 2+/in situ hybridization [ISH] + or HER2 3+), and their difference in response to NST and survival with single or dual anti-HER2 drugs. Drug sensitivity assays were used to evaluate different efficacy of anti-HER2 drugs in vitro. Results: Compared to HER2 3+ subgroup, the HER2 2+/ISH+ group had a higher proportion of hormone receptor–positive status (48.7% vs. 76.1%, p < 0.001), more HER2 protein loss after NST, lower pathological complete response (pCR) rate (46.07% vs. 16.24%, p < 0.001), and tended to have worse disease-free survival (DFS). In HER2 2+/ISH+ patients, treated with pertuzumab and trastuzumab in combination had no significant improvement in pCR (19.12% vs. 12.24%, p=0.287) and DFS (p=0.908) than using alone. Drug sensitivity assay showed poor efficacy with dual anti-HER2 drugs in HER2 2+/ISH+ cell lines; however, fam-trastuzumab deruxtecan drugs had a satisfactory effect. Conclusion Owing to the differences in clinicopathological features and treatment efficacy, we considered the HER2 2+/ISH+ group to be a distinct subtype and defined it as the HER2-moderate–positive subgroup. In this subgroup, dual anti-HER2 drugs did not exert significant improvement in pCR and DFS. Therefore, treatment optimization is warranted, with antibody-drug conjugate drugs as potential options.

Objective: To examine the effects of combined aerobic and resistance exercise on health related physical fitness (HPF) and depressive symptoms among senior high school freshmen, and to examine whether HPF mediates the relationship between exercise intervention and depressive symptoms, so as to provide a scientific basis for the coordinated promotion of mental health and physical fitness in schools. Methods: In March 2022, 190 senior high school freshmen from a secondary school of Suzhou in Anhui Province were selected by the random cluster sampling method and randomly assigned to an intervention group ( n = 99) and a control group ( n =91). The control group maintained routine activities, while the intervention group underwent a 10 week combined aerobic and resistance exercise program, three sessions per week, 40 minutes per session. Height, weight, standing long jump, sit ups, 20 m shuttle run, and sit and reach were measured before and after the intervention. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Analysis of covariance (ANCOVA), Mann-Whitney U test, and Wilcoxon test were employed to compare outcomes before and after the intervention, and mediation analysis was conducted. Results: After controlling for pre test scores, ANCOVA results showed that compared with the control group, the intervention group demonstrated the following post intervention changes: a lower body mass index of 0.1 kg/m 2 among girls; higher standing long jump (13.2 cm for boys, 7.4 cm for girls), higher sit ups (5.5 reps for boys, 3.7 reps for girls), higher 20 m shuttle run (7.4 times for boys, 5.1 times for girls), and higher sit and reach (3.2 cm for boys, 0.4 cm for girls) ( F =17.88-84.44); and lower CES-D scores (5.5 for boys, 4.0 for girls) ( Z =-2.51, -2.06) (all P <0.05). The indirect effect of HPF in the relationship between combined aerobic and resistance exercise and depressive symptoms was -2.11, supporting a partial mediation effect ( P < 0.01 ). Conclusions Combined aerobic and resistance exercise improves HPF and alleviates depressive symptoms to varying degrees among senior high school freshmen. HPF served as a partial mediator through which exercise intervention reduces depressive symptoms.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.

Objective To develop a knowledge-attitude-practice assessment scale for home prevention and man-agement of parastostomy hernia in ostomy patients,and to test its reliability and validity,to provide a reliable tool for evaluating the knowledge and practice level of home prevention and management of parastostomy hernia in pa-tients with ostomy.Methods Based on the theory of knowledge,attitude and practice,the initial scale was generat-ed through literature review,semi-structured interviews,expert correspondence,research group discussion and pre-sur-vey.From May to December 2023,685 patients with ostomy from the ostomy clinic of a tertiary hospital in Tianjin were investigated by purpose sampling method,and the reliability and validity were tested.Results A total of 673 valid questionnaires were collected,the results showed that the knowledge-attitude-practice assessment scale for pre-venting and managing parastomal hernia of ostomy patients at home included 3 dimensions of knowledge,attitude and practice,with a total of 27 items.The response rates of 2 rounds of the questionnaire were both 100％;the au-thority coefficients were all 0.915;the Kendall's coefficients of concordance were 0.279 and 0.301,respectively.The content validity index of each item was 0.875～1.000;the content validity index of the average scale level was 0.988;after 2 exploratory factor analysis,the cumulative variance contribution rate was 65.920％.The results of con-firmatory factor analysis showed that the model had a good fit,with a chi-square degree of freedom ratio(/df)of 1.945,the fitting goodness index(GFI)of 0.851,the comparative goodness of fit index(CFI)of 0.919,the root means square error of approximation(RMSEA)of 0.060.The Cronbach's alpha coefficient result of the scale is 0.957,with a test-retest reliability of 0.826 and a half reliability of 0.934.Conclusion The knowledge-attitude-practice assessment scale has good reliability and validity,and can be used as an assessment tool for home prevention and management of parastostomy hernia in ostomy patients.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.

AIM To study the chemical constituents from salt-processed Litchi Semen and their antioxidant activities.METHODS The 85％ethanol extract from salt-processed Litchi Semen was isolated and purified by silica gel,Sephadex LH-20,MCI,ODS and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.DPPH and ABTS+free radical scavenging method were used to evaluate their antioxidant activities.RESULTS Fifteen compounds were isolated and identified as dehydrocostuslactone(1),ananosmoside A(2),funingensin A(3),(2S)-pinocembrin-7-O-(6-O-α-L-rhamnopyranosyl-β-D-glucopyranoside)(4),liquiritienin(5),quercetin(6),rutin(7),isorhamnetin-3-O-β-rutinoside(8),procyanidin A2(9),procyanidin A1(10),ethyl protocatechuate(11),5-hydroxymethylfurfural(12),di(2-ethyl-hexyl)phthalate(13),nicotinamide(14),(10E,15Z)-9,12,13-trihydroxyoctadeca-10,15-dienoic acid(15).Compounds 6-7,9-10 exhibited scavenging activities against DPPH radicals with IC50 values of(12.929±1.232),(14.104±0.946),(10.417±1.736),(6.944±0.030)μmol/L,respectively.Compounds 6-10 exhibited scavenging activities against ABTS+radicals with IC50 values of(21.952±0.577),(25.683±0.625),(22.970±1.336),(20.210±1.435),(18.725±0.324)μmol/L,respectively.CONCLUSION Compounds 1,5,14-15 are isolated from Litchi genus for the first time.Compounds 6-7,9-10 have strong in vitro antioxidant activities.

Objective To develop a knowledge-attitude-practice assessment scale for home prevention and man-agement of parastostomy hernia in ostomy patients,and to test its reliability and validity,to provide a reliable tool for evaluating the knowledge and practice level of home prevention and management of parastostomy hernia in pa-tients with ostomy.Methods Based on the theory of knowledge,attitude and practice,the initial scale was generat-ed through literature review,semi-structured interviews,expert correspondence,research group discussion and pre-sur-vey.From May to December 2023,685 patients with ostomy from the ostomy clinic of a tertiary hospital in Tianjin were investigated by purpose sampling method,and the reliability and validity were tested.Results A total of 673 valid questionnaires were collected,the results showed that the knowledge-attitude-practice assessment scale for pre-venting and managing parastomal hernia of ostomy patients at home included 3 dimensions of knowledge,attitude and practice,with a total of 27 items.The response rates of 2 rounds of the questionnaire were both 100％;the au-thority coefficients were all 0.915;the Kendall's coefficients of concordance were 0.279 and 0.301,respectively.The content validity index of each item was 0.875～1.000;the content validity index of the average scale level was 0.988;after 2 exploratory factor analysis,the cumulative variance contribution rate was 65.920％.The results of con-firmatory factor analysis showed that the model had a good fit,with a chi-square degree of freedom ratio(/df)of 1.945,the fitting goodness index(GFI)of 0.851,the comparative goodness of fit index(CFI)of 0.919,the root means square error of approximation(RMSEA)of 0.060.The Cronbach's alpha coefficient result of the scale is 0.957,with a test-retest reliability of 0.826 and a half reliability of 0.934.Conclusion The knowledge-attitude-practice assessment scale has good reliability and validity,and can be used as an assessment tool for home prevention and management of parastostomy hernia in ostomy patients.

AIM To study the chemical constituents from salt-processed Litchi Semen and their antioxidant activities.METHODS The 85％ethanol extract from salt-processed Litchi Semen was isolated and purified by silica gel,Sephadex LH-20,MCI,ODS and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.DPPH and ABTS+free radical scavenging method were used to evaluate their antioxidant activities.RESULTS Fifteen compounds were isolated and identified as dehydrocostuslactone(1),ananosmoside A(2),funingensin A(3),(2S)-pinocembrin-7-O-(6-O-α-L-rhamnopyranosyl-β-D-glucopyranoside)(4),liquiritienin(5),quercetin(6),rutin(7),isorhamnetin-3-O-β-rutinoside(8),procyanidin A2(9),procyanidin A1(10),ethyl protocatechuate(11),5-hydroxymethylfurfural(12),di(2-ethyl-hexyl)phthalate(13),nicotinamide(14),(10E,15Z)-9,12,13-trihydroxyoctadeca-10,15-dienoic acid(15).Compounds 6-7,9-10 exhibited scavenging activities against DPPH radicals with IC50 values of(12.929±1.232),(14.104±0.946),(10.417±1.736),(6.944±0.030)μmol/L,respectively.Compounds 6-10 exhibited scavenging activities against ABTS+radicals with IC50 values of(21.952±0.577),(25.683±0.625),(22.970±1.336),(20.210±1.435),(18.725±0.324)μmol/L,respectively.CONCLUSION Compounds 1,5,14-15 are isolated from Litchi genus for the first time.Compounds 6-7,9-10 have strong in vitro antioxidant activities.

OBJECTIVE To acquire the real-world incidence of ceftazidime-avibactam sodium(CAZ)-related ad-verse reactions of blood system among a large sample of drug medication patients based on the active monitoring system so as to provide reference for safe clinical use of drugs.METHOD With the help of'Adverse Drug Event Active Surveillance and Assessment System-Ⅱ'(ADE-ASAS-Ⅱ),the use of CAZ of the patients who were hospi-talized in Chinese PLA General Hospital from Jan.1,2020 to Dec.31,2023 were retrospectively and automatical-ly monitored,the patients who were alarmed by system were evaluated by two persons,the incidence rates of CAZ-related thrombocytopenia,hemoglobin decreased and leucopenia were calculated,and the related influencing factors were analyzed.RESULTS Among the 278 case-times(191 cases)of patients who were treated with drugs and were enrolled in the study,there were 3(1.08％)case-times of thrombocytopenia,8(2.88％)case-times of hemoglobin decreased and 19(6.83％)case-times of leucopenia;the total incidence of adverse reactions of blood system was 10.79％.Logistic regression analysis showed that age and duration of drug administration were the in-fluencing factors for the CAZ-related adverse reactions of blood system.CONCLUSIONS It is common for the CAZ-related adverse reactions of blood system.The middle-aged and elderly patients who take drug therapy for a long time period are more likely to have the blood system-related adverse reactions.It is necessary to focus on the monitoring of renal function of the patients and adjust the dosage of administration in a timely manner so as to re-duce the incidence of adverse reactions of the blood system.

Objective:Based on value orientation,it aimed to scientifically define the concept and connotation of accessibility to novel anticancer drugs,in order to deeply understand the nature and current status of the accessibility issues of novel anticancer drugs,and to provide a reference for the formulation and optimization of policies related to novel anticancer drugs.Methods:Data was collected through literature review and expert interviews,and the concept of drug accessibility was defined using the atomic diagram method.Results:The core images include"affordability","availability","high quality"and"patients".The concept of accessibility to novel anticancer drugs is defined as"the process of ensuring the sustainable supply,equitable access,affordability,and rational use of high-quality anticancer drugs to safeguard the realization of patient benefit goals."The connotation of the value orientation in policies on the accessibility of novel anticancer drugs is profoundly reflected in the multi-dimensional value-driven approach to ensure the ultimate benefit of patients,which includes quality,sustainability,equity,affordability,and rational use.Conclusion:The proposal of the concept and connotation of accessibility provides a theoretical basis for a deep understanding of the accessibility of novel anticancer drugs and offers valuable references for subsequent policy-making and practical operations.