Objective To explore the clinical characteristics and specific risk factors of breast cancer-related lymphedema(BCRL)patients with different initial swelling sites(chest wall,upper arm,forearm and hand).Methods A total of 130 BCRL inpatients in Jing'an District Centre Hospital of Shanghai from December,2015 to March,2024 were reviewed.The patients were grouped by initial swelling sites;baseline characteristics,treatment meth-ods,edema indicators and upper limb dysfunction were compared among groups.Results The sample size of the chest wall group was too small(n=2),so it was excluded from the statistical analysis.There was no significant difference in baseline characteristics,treatment methods,edema indicators or the upper limb dysfunction among the other three groups.Multivariate Logistic regression analysis showed that:age(OR=1.059,P=0.013)and edema onset time(OR=0.984,P=0.011)were the independent related factors for initial swelling in the upper arm,edema onset time(OR=1.014,P=0.011)was the independent risk factor for initial swelling in the forearm,and limitation of shoulder motion(OR=0.125,P=0.044)was the independent protec-tive factor for initial swelling in the hand.Conclusion Age,edema onset time and shoulder joint function of BCRL patients may affect the initial sites of swelling.The initial sites of swelling may indicate different etiologies of edema.

Objective:To conduct a scoping review of the role responsibilities and competencies of oncology nurse specialist in the management of cutaneous immune-related adverse events (cirAEs), with a view to providing scientific guidance and reference for nursing practice in the field of oncology immunotherapy.Methods:Using the scoping review methodology as the framework, the relevant literatures on oncology nurse specialist in the management of cirAEs in databases including PubMed, Web of Science, CINAHL, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and China Biology Medicine from their inception to September 20, 2024 were systematically searched. Two researchers independently screened the included literature, extracted information, and conducted a summary analysis.Results:A total of 24 articles were included. Based on the summary and categorization of the literature, six categories were identified, including dynamic monitoring and assessment, classification and intervention of cirAEs, precise symptom management, multidisciplinary management, continuity of care, and specialized training, along with 18 related responsibility items.Conclusions:Oncology nurse specialist plays a significant role in the management of cirAEs. In the future, it should draw on the training models and curricula of advanced practice oncology nurses from abroad to optimize oncology nurse specialist training and nursing practices, thereby enhancing the professionalism of nursing services and the quality of patient care.

Purpose To investigate the expression of thioredoxin-interacting protein(TXNIP)in placental tissues of gestational diabetes mellitus(GDM)and its role in lipid deposition in the placental trophoblast.Methods The pla-centa tissues of 16 GDM pregnant women and 25 women with normal glucose tolerance(NGT)were collected.Mean-while,in vitro models of high-glucose induced human chorionic trophoblast cells(HTR-8/SVneo)were established,which were divided into normal glucose control group(NG),high glucose group(HG),high glucose+si nonsense in-terference group(HG+siNC)and high glucose+TXNIP siRNA group(HG+siTXNIP).The pathological structure and morphological changes of placenta were observed by HE staining.Lipid droplet formation was detected by oil red O staining.The expression and localization of TXNIP in cells were detected by immunocytochemical EnVision method.The mRNA and protein expression levels of TXNIP and lipogenic protein SREBP1 were detected by real-time fluorescent quantitative PCR and Western blot.The relationships between TXNIP expression and lipid droplet accumulation in-duced by high glucose was analyzed.Results High glucose results in abnormal placental structure of GDM.The area of human chorionic intervillous tissue in placenta of GDM group was decreased,the size of fetal capillaries was different and the lumen was dilated.Compared with those NGT group,the accumulation of lipid droplets and the expression of TXNIP mRNA and protein in placental tissue of GDM were increased(P＜0.05).The TXNIP and SREBP1 were up-regulated and the formation of droplets increased in high glucose induced HTR-8/SVneo cells(P＜0.05).On the con-trary,TXNIP siRNA transfection reversed the gene expression level and lipid deposition in high glucose induced cells(P＜0.05).Conclusion TXNIP is involved in abnormal lipid deposition in the placental trophoblast of GDM.

OBJECTIVE To analyze the risk factors for excessive microbial contamination level tested for repaired endoscopes before reuse and to formulate targeted management strategies,providing a reference for handling such events.METHODS A total of 54 repaired endoscopes reused in the Digestive Endoscopy Room of a hospital in Shanxi Province from Oct.2021 to Jun.2024,with a total of 105 repairs,were selected as the study subjects.Mi-crobial contamination levels were tested for all repaired endoscopes before reuse,and they were divided into a posi-tive group(colony count＞20 CFU/item)and a negative group(colony count ≤20 CFU/item)based on the test results.The risk factors for excessive microbial contamination levels of repaired endoscopes before reuse were summarized.The positive rates of microbial contamination level tests for repaired endoscopes before reuse were compared between the pre-intervention period(from Oct.2021 to Jun.2024)and the post-intervention period(from Jul.2024 to Dec.2024).RESULTS The results of microbial contamination level tests of endoscopes with 105 repairs before reuse showed a positive rate of 27.62％(29/105).Shortening duration between cleaning and disin-fection before and after repair(OR=0.285)was a protective factor,scratches/grooves/leak repairs in the endo-scope tubes(OR=3.211),improper cleaning and disinfection(OR=5.257)and the less number of enzymatic brushing washes(OR=2.438)were identified as risk factors for excessive microbial contamination levels of re-paired endoscopes before reuse(P＜0.05).Before the intervention,the positive rate of microbial contamination level tests for repaired endoscopes was higher than that for non-repaired endoscopes(27.62％vs.3.45％,P＜0.001).After the intervention,there was no statistically significant difference in the positive rate of microbial con-tamination level tests between repaired and non-repaired endoscopes(5.26％vs.4.17％,P=0.681),but the posi-tive rate for repaired endoscopes was lower than that before the intervention(5.26％vs.27.62％,P=0.004).CONCLUSIONS The occurrence of excessive microbial contamination levels of repaired endoscopes before reuse frequemly occur.Formulating and implementing targeted management strategies may guarantee the qualified rate of cleaning and disinfection of endoscopes before the reuse,and enhance the safety for the reuse of repaired endoscopes.

Purpose To investigate the expression of thioredoxin-interacting protein(TXNIP)in placental tissues of gestational diabetes mellitus(GDM)and its role in lipid deposition in the placental trophoblast.Methods The pla-centa tissues of 16 GDM pregnant women and 25 women with normal glucose tolerance(NGT)were collected.Mean-while,in vitro models of high-glucose induced human chorionic trophoblast cells(HTR-8/SVneo)were established,which were divided into normal glucose control group(NG),high glucose group(HG),high glucose+si nonsense in-terference group(HG+siNC)and high glucose+TXNIP siRNA group(HG+siTXNIP).The pathological structure and morphological changes of placenta were observed by HE staining.Lipid droplet formation was detected by oil red O staining.The expression and localization of TXNIP in cells were detected by immunocytochemical EnVision method.The mRNA and protein expression levels of TXNIP and lipogenic protein SREBP1 were detected by real-time fluorescent quantitative PCR and Western blot.The relationships between TXNIP expression and lipid droplet accumulation in-duced by high glucose was analyzed.Results High glucose results in abnormal placental structure of GDM.The area of human chorionic intervillous tissue in placenta of GDM group was decreased,the size of fetal capillaries was different and the lumen was dilated.Compared with those NGT group,the accumulation of lipid droplets and the expression of TXNIP mRNA and protein in placental tissue of GDM were increased(P＜0.05).The TXNIP and SREBP1 were up-regulated and the formation of droplets increased in high glucose induced HTR-8/SVneo cells(P＜0.05).On the con-trary,TXNIP siRNA transfection reversed the gene expression level and lipid deposition in high glucose induced cells(P＜0.05).Conclusion TXNIP is involved in abnormal lipid deposition in the placental trophoblast of GDM.

AIM To sequence the chloroplast genome of Artemisia vestita Wall.ex Bess.METHODS Based on ethnobotanical surveys,sample collection and original plant identification were carried out.The chloroplast genome was sequenced using the Illumina platform,followed by assembly and annotation.A comprehensive comparative analysis was conducted with six Artemisia species.The maximum likelihood(ML)phylogenetic tree was constructed based on the chloroplast genome sequences of A.vestita and 32 other Asteraceae species,with Leptocodon hirsutus D.Y.Hong of Campanulaceae as outgroup.RESULTS The chloroplast genome of A.vestita was 151 204 bp in length,including a small single-copy region of 18 331 bp,a large single-copy region of 82 949 bp,and inverted repeat regions of 24 962 bp,with a total GC content of 37.45％.134 genes were annotated,including 89 protein-coding genes,8 ribosomal RNA genes,and 37 transfer RNA genes.A total of 67 SSRs and 44 LSRs were detected in the chloroplast genome.Comparative analysis with closely related species of Artemisia revealed 3 highly variable genes(clpP,rpl36,ycf1)and 6 highly variable intergenic regions(trnK-UUU-matK,rps18-rpl20,rpl36-infA,rpl14-rpl16,rpl16-rpl3 and trnL-UAG-ccsA),which could serve as candidate DNA barcodes for Artemisia identification.Phylogenetic analysis showed that Artemisia formed a highly supportive monophyletic group,with A.vestita and A.gmelinii Web.ex Stechm.being closely related.CONCLUSION This study may provide fundamental data for phylogenetic analysis of Artemisia,taxonomic identification and DNA barcoding construction of Tibetan herb.

Objective To investigate the diagnostic value of multimodality-enhanced CT-based radiomics nomogram for muscle-inva-sive bladder urothelial carcinoma.Methods A retrospective analysis was performed on the preoperative data of 644 patients with pathologically confirmed bladder urothelial carcinoma from three medical centers.Region of interest(ROI)were drawn on preopera-tive contrast-enhanced CT images,and radiomics features were extracted.Patients from medical center 1 were randomly divided into training set and internal validation set in a 7∶3 ratio,while patients from medical centers 2 and 3 were combined as an external val-idation set.The diagnostic performance of the models was evaluated using receiver operating characteristic(ROC)curve.Results In the external validation set,the area under the curve(AUC)for diagnosing muscle-invasive bladder urothelial carcinoma using the multi-phase fusion radiomics model was 0.861[95％ confidence interval(CI)0.811-0.911].The nomogram constructed by combi-ning the multi-phase fusion radiomics model with clinical factors achieved an AUC of 0.901(95％ CI 0.862-0.939).Conclusion The nomogram combining multimodality-enhanced CT-based radiomics with clinical factors can effectively diagnose muscle-invasive bladder urothelial carcinoma.

With the establishment of bio-psycho-social medical model,both social and psychological factors play an important role in the occurrence,development and treatment of diseases.Hypertension is a common chronic multiple disease in China,and patients are often complicated with depression and other e-motional disorders.The interaction between hypertension and depression significantly increases the risk of poor prognosis.Current studies have shown a bidirectional promoting relationship between hypertension and depression,and they have some com-mon pathogenesis.However,the specific mechanism of their co-morbidity has not been fully elucidated.Renin-angiotensin sys-tem(RAS)plays an important role in the regulation of hyperten-sion and depression and other emotions.It is composed of two antagonistic pathways.The balance is maintained by angioten-sin-converting enzyme 2(ACE2).Therefore,this article reviews the relationship and mechanism of RAS in hypertension,depres-sion and comorbid states,in order to provide new treatment ide-as for hypertension and depression.

Objective To explore the clinical characteristics and specific risk factors of breast cancer-related lymphedema(BCRL)patients with different initial swelling sites(chest wall,upper arm,forearm and hand).Methods A total of 130 BCRL inpatients in Jing'an District Centre Hospital of Shanghai from December,2015 to March,2024 were reviewed.The patients were grouped by initial swelling sites;baseline characteristics,treatment meth-ods,edema indicators and upper limb dysfunction were compared among groups.Results The sample size of the chest wall group was too small(n=2),so it was excluded from the statistical analysis.There was no significant difference in baseline characteristics,treatment methods,edema indicators or the upper limb dysfunction among the other three groups.Multivariate Logistic regression analysis showed that:age(OR=1.059,P=0.013)and edema onset time(OR=0.984,P=0.011)were the independent related factors for initial swelling in the upper arm,edema onset time(OR=1.014,P=0.011)was the independent risk factor for initial swelling in the forearm,and limitation of shoulder motion(OR=0.125,P=0.044)was the independent protec-tive factor for initial swelling in the hand.Conclusion Age,edema onset time and shoulder joint function of BCRL patients may affect the initial sites of swelling.The initial sites of swelling may indicate different etiologies of edema.

A 62-year-old female patient underwent medical thoracoscopic pleural biopsy for undiagnosed pleural effusion. Preoperative vital signs in the patient were stable, with no cardiovascular, cerebrovascular or neurological underlying diseases. During the procedure, midazolam 2 mg (0.045 mg/kg) and fentanyl 150 μg (3.3 μg/kg) were administered by intravenous injection for sedation and analgesia. Two minutes later, the patient developed respiratory depression, and her oxygen saturation decreased to 42%. Immediate jaw thrust maneuver followed by bag-valve-mask ventilation was initiated, and the spontaneous respiration resumed and oxygen saturation recovered (>90%) after 2 minutes, allowing successful biopsy of a pleural nodule. The patient was fully conscious in the immediate postoperative period, with normal ability of communication and mobility. However, at 6 hours postoperatively, she developed anterograde and retrograde amnesia, disorientation, sensation disorders, nausea, and retching. Cranial magnetic resonance imaging revealed no significant abnormalities. These symptoms were considered to be related to transient higher cortical dysfunction induced by the sedative and analgesic agents. Given supportive treatments including fluid administration, the symptoms were gradually improved at 8 hours postoperatively, and resolved completely by 11 hours postoperatively.