ObjectiveTo observe the influence and therapeutic effect of quercetin on cuproptosis in rheumatoid arthritis rats and to explore its possible mechanism based on the solute carrier family 31 member 1 （SLC31A1）/ferredoxin 1 （FDX1） pathway. MethodsSixty male SD rats were divided into six groups： A control group， a model group， high- and low-dose quercetin groups （150 and 50 mg·kg^-1）， a cuproptosis inhibitor （tetrathiomolybdate， TTM） group （10 mg·kg^-1）， and a methotrexate group （2 mg·kg^-1）， 10 rats in each group. Except for the control group， the model of rheumatoid arthritis （CIA） rats was established by type Ⅱ collagen induction method. After successful modeling， each drug group was intervened according to the corresponding dose of drugs， and the control group and the model group were given the same amount of normal saline by gavage， once a day， which lasted for 4 weeks. The swelling degree of rats' feet was observed， and the clinical arthritis scores were determined. The levels of serum rheumatoid factor （RF）， matrix metalloproteinase-3 （MMP-3）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， interleukin-10 （IL-10）， and ceruloplasmin （Cp） were detected by enzyme-linked immunosorbent assay （ELISA）. The content of copper ion （Cu）， malondialdehyde （MDA）， superoxide dismutase （SOD）， and glutathione （GSH） in joint tissue was detected. Hematoxylin-eosin （HE） staining was used to observe the pathological changes of joint tissue. The levels of reactive oxygen species （ROS） and dihydrolipoic acid transacetylase （DLAT） were detected by immunofluorescence （IF）. The protein and mRNA expression of SLC31A1， FDX1， lipoic acid synthase （LIAS）， heat shock protein 70 （HSP70）， pyruvate dehydrogenase E1 subunit β （PDHB）， and copper transporting P-type ATPase β （ATP7B） was detected by immunohistochemistry （IHC） and real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared to the control group， the model group exhibited joint swelling and deformity， significantly increased clinical arthritis scores， obvious bone destruction， synovial hyperplasia， and inflammatory cell infiltration in joint tissue. In addition， the serum levels of RF， MMP-3， TNF-α， IL-1β， and Cp showed significant elevation， while the level of IL-10 was significantly reduced. The levels of Cu， MDA， ROS， and DLAT in joint tissue were markedly increased， whereas SOD and GSH content was significantly decreased. The protein and mRNA expression of SLC31A1 and HSP70 was significantly up-regulated， while the protein and mRNA expression of FDX1， LIAS， PDHB， and ATP7B was significantly down-regulated （P<0.01）. Compared to the model group， each treatment group exhibited varying degrees of improvement in joint swelling and deformation as well as clinical arthritis scores in rats. Additionally， there was a reduction in joint bone destruction， inflammatory cell infiltration， and synovial hyperplasia in rats. Furthermore， the serum levels of RF， MMP-3， TNF-α， IL-1β， and Cp significantly decreased， while the level of IL-10 increased significantly. In joint tissue， the levels of Cu， MDA， ROS， and DLAT showed significant decreases， while SOD and GSH content exhibited significant increases. The protein and mRNA expression of SLC31A1 and HSP70 was down-regulated， while the protein and mRNA expression of FDX1， LIAS， PDHB， and ATP7B was up-regulated （P<0.05）. ConclusionQuercetin effectively reduces synovial hyperplasia and inflammatory infiltration in rats with rheumatoid arthritis， thereby alleviating pathological damage to joint tissue. This effect may be attributed to the blockade of the SLC31A1/FDX1 signaling pathway activation and inhibition of excessive cuproptosis.

Objective:To identify the risk factors influencing the prognosis of patients with advanced breast cancer through LASSO-Logistic regression analysis and construct a nomogram model to evaluate their prognostic risk.Methods:A total of 178 patients with advanced breast cancer who visited the Department of Thyroid and Breast Surgery of Chengyang District People’s Hospital of Qingdao City from Jan. 2015 to Jan. 2023 were selected as the research subjects. According to the follow-up results, the patients were divided into a good-prognosis group and a poor-prognosis group. Clinical data of the patients were collected. LASSO-Logistic regression analysis was used to identify the risk factors affecting the prognosis of patients with advanced breast cancer. A nomogram model was constructed based on the analysis results. The predictive efficacy of the model for the prognostic risk of patients with advanced breast cancer was evaluated using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (H-L) test.Results:During the follow-up, 5 patients were lost to follow-up. Among the final 173 patients included, 60 had poor prognoses (accounting for 34.68%), and 113 had good prognoses (accounting for 65.32%). There were significant differences between the poor prognosis group and the good prognosis group in terms of the number of lymph node metastases ( χ 2=18.12), the number of organ metastases ( χ 2=14.28), the difference in ADC before and after treatment ( t=17.35), the difference in SER before and after treatment ( t=9.57), the enhancement of the echo behind the breast after treatment ( χ 2=13.00), and the proportion of increased calcification ( χ 2=8.06) (both P < 0.05). The clinical data with significant differences in the univariate analysis were included in the LASSO regression analysis. Six factors were finally selected: number of lymph node metastases > 5, number of organ metastases > 1, difference in ADC values before and after treatment, difference in SER values before and after treatment, enhanced echo behind the breast, and increased calcification. These six factors selected by LASSO regression were included in the Logistic regression analysis. The results showed that number of organ metastases > 1 ( OR=2.208, 95% CI: 1.153-3.263), small difference in ADC values before and after treatment ( OR=0.448, 95% CI: 0.287-0.608), enhanced echo behind the breast ( OR=2.474, 95% CI: 1.063-3.886), and increased calcification ( OR=3.762, 95% CI: 1.831-5.693) were independent risk factors for poor prognosis in patients with advanced breast cancer (both P<0.05). A nomogram model was constructed based on the analysis results. The ROC curve showed that the area under the curve (AUC) of the model was 0.778. The H-L test results showed that the calibration curve fit well with the ideal curve, with χ 2 = 0.69 and P = 0.273. Conclusion:The nomogram model constructed based on LASSO-Logistic regression analysis has good predictive efficacy for the prognosis of patients with advanced breast cancer.

Objective:To identify the risk factors influencing the prognosis of patients with advanced breast cancer through LASSO-Logistic regression analysis and construct a nomogram model to evaluate their prognostic risk.Methods:A total of 178 patients with advanced breast cancer who visited the Department of Thyroid and Breast Surgery of Chengyang District People’s Hospital of Qingdao City from Jan. 2015 to Jan. 2023 were selected as the research subjects. According to the follow-up results, the patients were divided into a good-prognosis group and a poor-prognosis group. Clinical data of the patients were collected. LASSO-Logistic regression analysis was used to identify the risk factors affecting the prognosis of patients with advanced breast cancer. A nomogram model was constructed based on the analysis results. The predictive efficacy of the model for the prognostic risk of patients with advanced breast cancer was evaluated using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (H-L) test.Results:During the follow-up, 5 patients were lost to follow-up. Among the final 173 patients included, 60 had poor prognoses (accounting for 34.68%), and 113 had good prognoses (accounting for 65.32%). There were significant differences between the poor prognosis group and the good prognosis group in terms of the number of lymph node metastases ( χ 2=18.12), the number of organ metastases ( χ 2=14.28), the difference in ADC before and after treatment ( t=17.35), the difference in SER before and after treatment ( t=9.57), the enhancement of the echo behind the breast after treatment ( χ 2=13.00), and the proportion of increased calcification ( χ 2=8.06) (both P < 0.05). The clinical data with significant differences in the univariate analysis were included in the LASSO regression analysis. Six factors were finally selected: number of lymph node metastases > 5, number of organ metastases > 1, difference in ADC values before and after treatment, difference in SER values before and after treatment, enhanced echo behind the breast, and increased calcification. These six factors selected by LASSO regression were included in the Logistic regression analysis. The results showed that number of organ metastases > 1 ( OR=2.208, 95% CI: 1.153-3.263), small difference in ADC values before and after treatment ( OR=0.448, 95% CI: 0.287-0.608), enhanced echo behind the breast ( OR=2.474, 95% CI: 1.063-3.886), and increased calcification ( OR=3.762, 95% CI: 1.831-5.693) were independent risk factors for poor prognosis in patients with advanced breast cancer (both P<0.05). A nomogram model was constructed based on the analysis results. The ROC curve showed that the area under the curve (AUC) of the model was 0.778. The H-L test results showed that the calibration curve fit well with the ideal curve, with χ 2 = 0.69 and P = 0.273. Conclusion:The nomogram model constructed based on LASSO-Logistic regression analysis has good predictive efficacy for the prognosis of patients with advanced breast cancer.

Objective To establish and validate an individualized risk prediction nomogram model for the occurrence of gestational diabetes mellitus in pregnant women with hypothyroidism. Methods A total of 160 pregnant women with hypothyroidism were selected as the study subjects, including 85 patients with gestational diabetes mellitus (observation group) and 75 patients with normal blood glucose levels (control group). The age, gravidity, parity as well as pre-pregnancy body mass index, thyroid peroxidase antibody (TPOAb), homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of beta-cell function (HOMA-β), free thyroxine (FT4), free triiodothyronine (FT3) and thyroid stimulating hormone (TSH) were compared between the two groups. Multivariable analysis was used to analyze the risk factors for gestational diabetes mellitusin pregnant women with hypothyroidism. The nomogram model was used to predict the risk of gestational diabetes mellitus in pregnant women with hypothyroidism. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the nomogram model for gestational diabetes mellitus in pregnant women with hypothyroidism. Results The age, gravidity, parity as well as pre-pregnancy body mass index, TPOAb, HOMA-IR and HOMA-β were higher in the observation group than in the control group, while pre-pregnancy FT4, FT3 and TSH were lower (P < 0.05). Multivariable analysis showed that older age, gravidity, parity as well as pre-pregnancy body mass index, TPOAb, HOMA-IR and HOMA-β, and lower pre-pregnancy FT4, FT3 and TSH were risk factors for gestational diabetes mellitusin pregnant women with hypothyroidism. The nomogram model prediction showed that older age (28 to 31 years), gravidity (more than 2 times), parity (more than 1 time) as well as pre-pregnancy body mass index (above 24.00 kg/m²), TPOAb (> 421.33 IU/mL), HOMA-IR (> 2.21) and HOMA-β (> 115.66), and lower pre-pregnancy FT4 (< 0.33 ng/dL), FT3 (< 1.65 pg/mL) and TSH (< 0.26 mIU/mL) were risk factors for gestational diabetes mellitus in pregnant women with hypothyroidism. ROC curve analysis showed that the area under the curve of the nomogram model for predicting gestational diabetes mellitus in pregnant women with hypothyroidism was 0.785, indicating good predictive performance. Conclusion The risk prediction nomogram model has high value in individualized prediction of gestational diabetes mellitus in pregnant women with hypothyroidism.

Objective:To investigate the clinical efficacy of modified biliary-intestinal anasto-mosis by pancreaticoduodenectomy and influencing factors of postoperative biliary leakage.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopatholo-gical data of 165 patients with benign and malignant diseases around the ampullary who underwent pancreaticoduodenectomy in the Affiliated Hospital of Inner Mongolia Medical University from June 2014 to October 2020 were collected. There were 92 males and 73 females, aged (59±10)years. Of the 165 patients, 44 patients undergoing modified biliary-intestinal anastomosis within pancreatico-duodenectomy were divided into the modified group, and 121 patients undergoing traditional biliary-intestinal anastomosis within pancreaticoduodenectomy were divided into the traditional group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative situations; (3) analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the corresponding statistical methods based on data type. All indicators in univariate analysis were included in multivariate analysis. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 165 patients, 72 cases were successfully matched, including 36 cases in the modified group and 36 cases in the traditional group, respectively. The elimination of jaundice, preoperative reduction of jaundice and hypertension confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. All patients in the two groups underwent surgery successfully. The operation time, postoperative pathological type (lower bile duct cancer, pancreatic head cancer, pancreatic cystic tumor, chronic pancreatitis, duodenal cancer), time of no drainage fluid in the drainage tube around biliary-intestinal anastomosis were 371(270,545)minutes, 6, 12, 1, 2, 15, (12±7)days in patients of the modified group, versus 314(182,483) minutes, 13, 14, 1, 4, 4, (16±8)days in patients of the traditional group, showing significant differences in the above indicators between the two groups ( Z=-3.54, χ2=10.01, t=-2.34, P<0.05). Cases with postoperative grade A biliary leakage was 0 in patients of the modified group, versus 6 in patients of the traditional group, showing a significant difference between the two groups ( P<0.05). Cases with postoperative grade B biliary leakage, cases with postoperative grade B pancreatic fistula, cases with postoperative bleeding, cases with abdominal infection, cases with incision infection, cases with delayed gastric emptying, cases undergoing unplanned readmission were 1, 0, 1, 4, 1, 5, 1 in patients of the modified group, versus 0, 1, 2, 5, 2, 5, 2 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with postoperative grade A pancreatic fistula, cases with overall complications, cases with Clavien-Dindo grade Ⅰ-Ⅱ complications, cases with Clavien-Dindo grade Ⅲ-Ⅳ complications were 6, 12, 6, 6 in patients of the modified group, versus 7, 14, 8, 6 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.09, 0.24, 0.36, 0.00, P>0.05). None of patient in the two groups had postoperative grade C biliary leakage and postoperative grade C pancreatic fistula. (3) Analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Results of multivariate analysis showed that preoperative reduction of jaundice and traditional biliary-intestinal anastomosis were independent risk factors for biliary leakage after pancreaticoduodenectomy ( odds ratio=11.37, 12.27, 95% confidence interval as 1.76-73.35, 1.14-131.23, P<0.05). Conclusions:Compared with traditional biliary-intestinal anastomosis, modified biliary-intestinal anastomosis within pancreaticoduodenectomy is safe and feasible. Preoperative reduction of jaundice and traditional biliary-intestinal anastomosis are independent risk factors for biliary leakage after pancreaticoduodenectomy.

Objective:To explore the echocardiographic characteristics of isolated brachiocephalic artery branches, and to analyze the reason of missed diagnosis and misdiagnosis in order to improve the diagnostic accuracy.Methods:Echocardiographic features of isolated subclavian artery and brachibrachial trunk confirmed by operation or CT angiography (CTA) or digital subtraction angiography (DSA) were retrospectively analyzed in Hebei Children′s Hospital from May 2017 to July 2021. Related literatures of other rare types of isolated brachiocephalic artery branches retrieved in PubMed were reviewed, and the echocardiographic characteristics of such vascular malformations were summarized.Results:A total of 4 children with isolated brachiocephalic artery branches were included. Echocardiography correctly diagnosed isolated brachiocebrachial trunk in 1 case and missed or misdiagnosis in 3 cases, including isolated subclavian artery was missed in 1 case, isolated subclavian artery was misdiagnosed as aberrant subclavian artery in 1 case and patent ductus arteriosus in 1 case. A total of 105 cases of isolated brachiocephalic artery branches were reviewed, including isolated brachiocephalic artery in 31 cases (53.3%), isolated common carotid artery in 15 cases (29.5%), isolated common carotid artery in 15 cases (14.3%) and isolated internal carotid artery in 3 cases (2.9%). The characteristic of echocardiography was that the brachiocephalic branch of the aortic arch was disconnected from the aortic arch, often via the ductus arteriosus or directly connected to the bifurcation of the pulmonary artery.Conclusions:Isolated brachiocephalic artery branches have certain characteristic echocardiographic features and these kinds of vascular malformations are accompanied by different degrees of stealing blood phenomenon. Careful tracing of the origin of brachiocephalic artery branches and combined with cervical vascular ultrasound when necessary can improve the diagnosis rate of isolated brachiocephalic artery branch lesions.

Objective:To provide references for the aeromedical qualification of flying personnel with myocardial bridges by retrospectively analysising the clinical characteristics and aeromedical qualification results.Methods:The clinical characteristics and aeromedical qualification of military flying personnel who underwent coronary angiography examinations and diagnosed as myocardial bridges in Air Force Medical Center from January of 2010 to January of 2020 were compared and analyzed.Results:A total of 84 segments of myocardial bridge diseases were detected in 79 flying personnel diagnosed as myocardial bridges located in the left coronary artery system, of which the middle segment of the left anterior descending artery accounted for 73.81% (62/84). A total of 77 single-segment myocardial bridges occurred in the anterior descending artery in 79 flying personnel diagnosed as myocardial bridges, of which 28 cases were combined with atherosclerotic lesions of the anterior descending artery. The areomedical qualification concluded that 49 cases were qualified for flight, 27 cases were temporarily disqualified, and 3 cases were disqualified. There were significant differences in treadmill exercise results and myocardial ischemia between the qualified and temporarily disqualified groups ( χ2 =7.902, 7.832, both P=0.005). Conclusions:Myocardial bridges in military flying personnel mainly occurs in the middle of the left anterior descending artery, which is easy to merge with proximal coronary atherosclerotic lesions, and the existing clinical evaluation indicators are not accurate enough, and the basis for areomedical qualification needs to be further improved.

Objective:To provide references for the aeromedical qualification of flying personnel with myocardial bridges by retrospectively analysising the clinical characteristics and aeromedical qualification results.Methods:The clinical characteristics and aeromedical qualification of military flying personnel who underwent coronary angiography examinations and diagnosed as myocardial bridges in Air Force Medical Center from January of 2010 to January of 2020 were compared and analyzed.Results:A total of 84 segments of myocardial bridge diseases were detected in 79 flying personnel diagnosed as myocardial bridges located in the left coronary artery system, of which the middle segment of the left anterior descending artery accounted for 73.81% (62/84). A total of 77 single-segment myocardial bridges occurred in the anterior descending artery in 79 flying personnel diagnosed as myocardial bridges, of which 28 cases were combined with atherosclerotic lesions of the anterior descending artery. The areomedical qualification concluded that 49 cases were qualified for flight, 27 cases were temporarily disqualified, and 3 cases were disqualified. There were significant differences in treadmill exercise results and myocardial ischemia between the qualified and temporarily disqualified groups ( χ2 =7.902, 7.832, both P=0.005). Conclusions:Myocardial bridges in military flying personnel mainly occurs in the middle of the left anterior descending artery, which is easy to merge with proximal coronary atherosclerotic lesions, and the existing clinical evaluation indicators are not accurate enough, and the basis for areomedical qualification needs to be further improved.

Objective:To propose the application of recognizing bone species by touching blindly (ARBTB) and verify its application effect in human anatomy experimental courses.Methods:The study included experiment 1 and experiment 2, and the research objects were 60 students majoring in clinical medicine in Batch 2019 and 60 students majoring in preventive medicine in Batch 2018, respectively. The research objects in each experiment were randomized into mainstream teaching method group and ARBTB group, with 30 students in each group. In experiment 1, after students studying for the same hours, both of two groups carried out the same test, and then the average scores of the two groups were compared. In experiment 2, the average time spent by the two groups of students in osteology learning was compared.Results:In experiment 1, ARBTB group's average score of the test was significantly higher than that of the mainstream teaching group ( P<0.001). In experiment 2, the ARBTB group took much less time in osteology learning than the mainstream teaching group ( P<0.001). Conclusion:Compared with the mainstream teaching method, ARBTB is more effective in osteology learning, which is worth popularizing.

Objective To investigate the clinical characteristics,diagnosis and treatment of congenital tracheobiliary fistula (CTBF) in children.Methods A case of CTBF admitted into the Department of Pediatric Respiration,Hubei Maternal and Child Health Care Hospital in 2016 was reported,and the related literatures were reviewed.The clinical features,diagnostic methods,treatment status and clinical outcomes of the disease were analyzed.Results The patient was 3 years and 7 months old.The main clinical manifestations were recurrent cough,pneumonia and atelectasis.CTBF was diagnosed by means of iodine oil radiography and treated with biological glue plugging under bronchoscopic guidance.So far,only 30 cases of CTBF have been reported in the English literatures,but only 2 cases in the Chinese literatures.The main clinical manifestations were cough,dyspnea,sputum or bile vomiting,aspiration pneumonia,atelectasis or emphysema.Diagnostic methods for CTBF included bronchoscopy,bronchial angiography and cholangiography,hepatobiliary scan,CT scan and magnetic resonance imaging.Except for this case treated with biological glue plugging under bronchoscopic guidance,all other patients were treated with surgery.The operation methods included fistula ligation,gastrostomy,liver resection,fistula jejunum Roux-en-Y anastomosis,hepatic hilum jejunum anastomosis,gallbladder jejunum anastomosis,etc.Only 4 cases died,and the rest of the patients recovered.Conclusions CTBF should be suspected in children with persistent chronic cough.Iodine oil radiography through bronchoscopy is a simple and feasible method for diagnosis of CTBF.Besides surgery,the lavage and the biological glue plugging method through bronchoscopy is also an effective way to treat CTBF in children without severe biliary malformation.