Metabolic reprogramming， as one of the core hallmarks of malignant tumors， plays a key role in the occurrence， development and treatment of breast cancer （BC）. Abnormal changes in glucose metabolism， amino acid metabolism， lipid metabolism， as well as the tricarboxylic acid （TCA） cycle and oxidative phosphorylation （OXPHOS） pathways significantly influence the pathogenesis and progression of BC. Studies have shown that various active components of traditional Chinese medicine （TCM） （such as berberine， matrine， quercetin， curcumin， etc.） and their compound formulations （e.g. Xihuang pill， Danzhi xiaoyao powder， Yanghe decoction， etc.） can inhibit the proliferation and migration of BC cells and induce apoptosis by regulating key metabolic pathways such as glycolysis， lipid synthesis， and amino acid metabolism. TCM demonstrates multi-target and holistic regulatory advantages in intervening in BC metabolic reprogramming， showing significant potential in modulating key molecules like hypoxia inducible factor-1α， hexokinase-2， pyruvate kinase M2， lactate dehydrogenase A， glucose transporter-1， fatty acid synthase， and signaling pathways such as AKT/mTOR. However， current researches still focus predominantly on glucose metabolism， with insufficient mechanistic studies on lipid metabolism， amino acid metabolism， the TCA cycle， and OXPHOS. The precise targets， molecular mechanisms， and clinical translation value of these interventions require further validation and clarification through more high-quality experimental studies and clinical trials.

AIM: To investigate the expression levels of follistatin-like protein 1(FSTL1)and a disintegrin and metalloproteinase with thrombospondin type 1 motif 13(ADAMTS13)in the serum of patients with proliferative diabetic retinopathy(PDR), and to analyze their predictive value for visual disability.METHODS:A prospective study. From January 2022 to September 2024, patients with diabetes retinopathy(DR)were selected from Fengfeng General Hospital of North China Medical and Health Group. They were divided into non-proliferative diabetes retinopathy(NPDR)group and PDR group. In the same period, simple type 2 diabetes(T2DM)patients were selected as T2DM group, and healthy people were selected as control group. Enzyme linked immunosorbent assay was used to detect serum levels of FSTL1 and ADAMTS13. Patients in the PDR group were followed up for 12 mo to observe the occurrence of visual disability, and were accordingly divided into a non-visual disability group and a visual disability group. Risk factors for visual disability in PDR patients were analyzed by Logistic regression, and the predictive value was assessed via receiver operating characteristic(ROC)curves and decision curve analysis(DCA).RESULTS: This study included 220 DR patients, including 119 cases in the NPDR group and 101 cases in the PDR group. There were 120 cases in the T2DM group and 120 cases in the control group. The control group had an age of 56.92±8.15 y, with 66 males and 54 females. The T2DM group had an age of 57.21±8.30 y, with 63 males and 57 females. The NPDR group had an age of 57.36±8.25 y, with 60 males and 59 females. The PDR group had an age of 57.45±8.22 y, with 53 males and 48 females. There were 68 patients without visual disability and 33 patients with visual disability in the PDR group. The non-visual disability group had a mean age of 57.26±8.14 y, including 35 males and 33 females. The visual disability group had a mean age of 57.85±8.37 y, including 18 males and 15 females. Diabetes duration was progressively longer in the T2DM, NPDR, and PDR groups. Levels of fasting plasma glucose(FPG), glycated hemoglobin(HbA1c), and FSTL1 progressively increased, while ADAMTS13 levels progressively decreased across the control, T2DM, NPDR, and PDR groups(all P<0.001). Within the PDR group, serum FSTL1 levels increased sequentially while ADAMTS13 levels decreased sequentially in patients with grade Ⅳ, Ⅴ and Ⅵ lesions(all P<0.001). The visual disability group had significantly longer diabetes duration and higher levels of FPG, HbA1c, and FSTL1, as well as lower ADAMTS13 levels, compared to the non-visual disability group(all P<0.001). The diabetes duration, FSTL1, ADAMTS13 were the influencing factors of visual disability in PDR patients(all P<0.001). ROC curve and DCA curve analysis showed that the predictive value of combined detection of serum FSTL1 and ADAMTS13 levels is higher than that of individual measurement(all P<0.05).CONCLUSION:PDR patients have higher serum FSTL1 levels and lower ADAMTS13 levels. Both are related to the severity of PDR. The combined measurement has a high predictive value for visual disability in PDR patients.

Objective:To compare the current situation of research on workplace violence (WPV) among nurses at home and abroad, providing directions for further research.Methods:Research on WPV among nurses published in PubMed, Web of Science, EBSCO, China national knowledge infrastructure, Wanfang, and VIP databases from January 1, 2003 to October 14, 2023 were searched and screened, using visualization software CiteSpace and VOSviewer to analyze the distribution and correlation of countries, authors, institutions and keywords of the included studies.Results:A total of 1 082 Chinese articles and 2 770 English articles were included. From 2003 to 2023, the annual publication volume of research on nurse WPV showed a continuous upward trend in both Chinese and English literature. Among domestic institutions, Harbin Medical University published the most articles ( n=25). Among international research institutions, North South University ( n=9) and University of Malaya ( n=9) led in publication output. A total of 67 core authors were identified in Chinese literature and 194 in the English literature. Analysis of high-frequency keywords showed that the research topics could be summarized as research types, occurrence mechanisms, negative effects, high-risk precursors, intervention strategies, negative effects and population differences. Chinese Nursing Research ( n=40) and Journal of Nursing Management ( n=186) published the most Chinese and English articles. Conclusions:The amount of research on workplace violence among nurses has generally increased in recent years. The mechanisms of occurrence, high-risk precursors, and intervention strategies are important research directions. It is still necessary to further deepen the research content in the future.

Objective:To investigate clinical characteristics and genetic variations in a case of self-improving collodion ichthyosis in the adult stage.Methods:An adult patient with clinically suspected self-improving collodion ichthyosis was collected from the Department of Dermatology, Henan Provincial People′s Hospital in April 2023. Clinical data were collected from the patient and her parents. Peripheral blood samples were obtained from them, and whole blood DNA was extracted. Whole-exome sequencing was performed to screen genetic variation sites, which were then verified by Sanger sequencing. The deleteriousness of the identified variants was assessed using pathogenicity analysis software.Results:The 54-year-old female patient presented with facial and neck flushing, mild dry skin on the trunk and limbs, sheepskin-like skin of the dorsal hand, and short fingers. Genetic testing identified two in-frame deletion mutations c.406_408del (p.E136del) and c.769_801del (p.H257_Q267del) in the non-repetitive region of the ALOX12B gene in the patient, which were inherited from her father and mother respectively. Bioinformatics analysis revealed that both genetic variations were deleterious pathogenic mutations.Conclusions:Two in-frame deletion mutations c.406_408del (p.E136del) and c.769_801del (p.H257_Q267del) were identified in the non-repetitive region of the ALOX12B gene in the patient with self-improving collodion ichthyosis, which may contribute to the clinical phenotype of the patient. The mutation c.769_801del had not been reported in literature.

With the increasing aging population in China and rising incidence rates of diseases such as cancer and cardiovascular conditions, the demand for palliative care services continues to grow. In recent years, the integration of artificial intelligence and medical disciplines has advanced significantly, with machine learning research and applications in the palliative care field progressing steadily. This paper reviews the overview of machine learning, its applications in palliative care, and effectiveness evaluations. It also discusses existing limitations in current research and provides recommendations for future studies. The aim is to assist healthcare professionals in improving palliative care services and offer valuable insights for the development of palliative care in China.

Objective To explore the application value of the Plan-Do-Check-Act(PDCA)cycle in the refined whole-process management of low-value medical consumables.Methods Using the PDCA cycle as a framework,the Plan phase in-volved analyzing the causes of traceability difficulties for low-value medical consumables.The Do phase implemented multiple im-provement measures,including establishing standardized management systems,strengthening personnel supervision,creating a split-item tertiary inventory,and introducing the Unique Device Identification(UDI)system.The Check phase evaluated man-agement effectiveness by comparing data from June to December 2023 and June to December 2024.The Act phase refined institu-tional norms and operational processes through a closed-loop feedback mechanism.Results After PDCA management,the appli-cation time for low-value medical consumables[(6.16±1.47)min]and the collection time[(15.08±1.89)min]were signif-icantly shorter than before implementation(P＜0.001).The acceptance qualification rate increased from 92.96％to 99.11％.The application of the split-item tertiary inventory ensured synchronization between inventory deduction and billing data.Conclu-sion The PDCA cycle improves the traceability of low-value medical consumables through systematic quality improvement.Its dynamic feedback mechanism supports continuous improvement,providing an effective pathway for hospitals to achieve refined management and cost control.

Objective:To explore the predictive value of very low frequency (VLF) for the efficacy of vitamin D treatment in children with postural orthostatic tachycardia syndrome (POTS).Methods:A retrospective case-control study was conducted. A total of 65 POTS children from the Department of Pediatrics of the Second Hospital of Lanzhou University from November 2023 to May 2024 were selected as the research subjects, while 102 healthy children from the same period were selected as the control group. The 25 (OH) D levels between POTS children and healthy children were compared. The frequency of eight main symptoms, including palpitations, headache, cold sweat, blurred vision, chest tightness, dizziness, fainting, and digestive discomfort in the POTS group were analyzed, the symptom scores of the orthostatic intolerance were calculated, and the parameters related to short-range heart rate variability (HRV) during the upright test, head-up tilt test (HUTT) were collected. The correlation between 25 (OH) D levels and symptom scores of orthostatic intolerance symptoms and HRV parameters in children with POTS were analyzed by Pearson correlation analysis. The total symptom scores of children with POTS were compared for 3 months before treatment and 2 months after treatment with vitamin D 800 U/d. The difference in score before and after treatment was ≥2 as responsive group, and the score difference before and after treatment was <2 as non-responsive group. The demographic characteristics including age, gender, height, weight, body mass index, as well as HRV parameters such as the standard deviation of nn intervals (SDNN), the standard deviation of the average NN intervals (SDANN), the root mean square of successive differences (rMSSD), low-frequency (LF), high-frequency (HF), very-low-frequency (VLF) were compared between the responsive group and non-responsive group. Multivariate Logistic regression was analyzed to screen independent influencing factors of vitamin D treatment efficacy for POTS. The marker molecules related to the efficacy of vitamin D treatment in children with POTS were analyzed through receiver operating characteristic (ROC) curve.Results:A total of 167 children were included in this study. There were 65 children in the POTS group, 38 males and 27 females, with the age of (10.6±2.2) years. There were 102 healthy children in the control group, 53 males and 49 females, with the age of (11.2±1.8) years.There was no statistically significant difference in gender and age between the two groups (both P>0.05). The serum 25 (OH) D level in children in the POTS group was (37±18)nmol/L, lower than that in the control group (61±17)nmol/L ( P<0.05).Pearson correlation analysis showed that serum 25(OH)D was positively correlated with VLF, SDNN and HF ( r=0.43, 0.65, 0.36, respectively, all P<0.05). Among the POTS children, there were 48 cases in responsive group and 17 cases in non-responsive group. Univariate analysis revealed that responsive group exhibited significantly lower values in age, SDNN, SDANN, and VLF compared to the non-responsive group (all P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.47, 95% CI 1.08-2.01), SDNN ( OR=1.01, 95% CI 1.00-1.22) and VLF ( OR=1.01, 95% CI 1.00-1.15) were independent influencing factors in the effect of vitamin D in POTS children (all P<0.05). ROC curve analysis showed that the area under the curve of VLF predicting response to vitamin D treatment for POTS was 0.72 (95% CI 0.58-0.85, P=0.008). When the cutoff value was 1 272 ms 2, the sensitivity and specificity were both 70%. Conclusion:VLF may help predict the efficacy of vitamin D treatment in children with POTS.

Objective:To report a case of hereditary fibrosing poikiloderma with tendon contracture, myopathy, and pulmonary fibrosis (POIKTMP), and analyze the genotype-phenotype correlation through a literature review.Methods:The clinical manifestations and genetic testing results of a Chinese Han child with POIKTMP were reported. Relevant literature was searched in databases using ′FAM111B gene′, ′hereditary fibrosing poikiloderma with tendon contracture, myopathy, and pulmonary fibrosis′ or ′POIKTMP′ as keywords, and the clinical manifestations, mutation sites of the FAM111B gene, and the correlation between them were statistically analyzed.Results:A 6.5-year-old girl developed POIKTMP at 6 months of age. Dermatological examination showed irregular brown patches and dotted hypopigmentation on the face and neck, mainly on the forehead and around the mouth, telangiectasia on the cheeks and nose, pigmentation and hypopigmentation on the limbs and trunk, as well as sparse, pale eyebrows. A total of 39 cases of POIKTMP were retrieved, including this case, all of which had clinical data and were definitively diagnosed. Fourteen variants of the FAM111B gene had been reported, including 1 in-frame deletion variant and 13 missense variants. Among the 39 cases, the incidence of poikiloderma/photosensitivity/facial erythema/telangiectasia was 100% (39/39), alopecia was 87.2% (34/39), and that of hypohidrosis/heat intolerance was 82.1% (32/39). The incidence of extracutaneous manifestations was as follows: tendon contractures/digital sclerosis, 69.2% (27/39) ; elevated liver transaminases, 46.2% (18/39) ; muscle pain/weakness/amyotrophy, 43.6% (17/39). The incidence of eczema-like lesions, bullous lesions, and elevated liver transaminases was significantly higher in the young versus the adult group ( P < 0.05) . Conclusions:This case of POIKTMP was characterized by brown patches, hypopigmentation, and sparse eyebrows. POIKTMP is a progressive multisystem disorder with age-related clinical manifestations. Early genetic testing is crucial for evaluating potential complications and providing genetic counseling.

Objective:To report a case of hereditary fibrosing poikiloderma with tendon contracture, myopathy, and pulmonary fibrosis (POIKTMP), and analyze the genotype-phenotype correlation through a literature review.Methods:The clinical manifestations and genetic testing results of a Chinese Han child with POIKTMP were reported. Relevant literature was searched in databases using ′FAM111B gene′, ′hereditary fibrosing poikiloderma with tendon contracture, myopathy, and pulmonary fibrosis′ or ′POIKTMP′ as keywords, and the clinical manifestations, mutation sites of the FAM111B gene, and the correlation between them were statistically analyzed.Results:A 6.5-year-old girl developed POIKTMP at 6 months of age. Dermatological examination showed irregular brown patches and dotted hypopigmentation on the face and neck, mainly on the forehead and around the mouth, telangiectasia on the cheeks and nose, pigmentation and hypopigmentation on the limbs and trunk, as well as sparse, pale eyebrows. A total of 39 cases of POIKTMP were retrieved, including this case, all of which had clinical data and were definitively diagnosed. Fourteen variants of the FAM111B gene had been reported, including 1 in-frame deletion variant and 13 missense variants. Among the 39 cases, the incidence of poikiloderma/photosensitivity/facial erythema/telangiectasia was 100% (39/39), alopecia was 87.2% (34/39), and that of hypohidrosis/heat intolerance was 82.1% (32/39). The incidence of extracutaneous manifestations was as follows: tendon contractures/digital sclerosis, 69.2% (27/39) ; elevated liver transaminases, 46.2% (18/39) ; muscle pain/weakness/amyotrophy, 43.6% (17/39). The incidence of eczema-like lesions, bullous lesions, and elevated liver transaminases was significantly higher in the young versus the adult group ( P < 0.05) . Conclusions:This case of POIKTMP was characterized by brown patches, hypopigmentation, and sparse eyebrows. POIKTMP is a progressive multisystem disorder with age-related clinical manifestations. Early genetic testing is crucial for evaluating potential complications and providing genetic counseling.

Objective To explore the application value of the Plan-Do-Check-Act(PDCA)cycle in the refined whole-process management of low-value medical consumables.Methods Using the PDCA cycle as a framework,the Plan phase in-volved analyzing the causes of traceability difficulties for low-value medical consumables.The Do phase implemented multiple im-provement measures,including establishing standardized management systems,strengthening personnel supervision,creating a split-item tertiary inventory,and introducing the Unique Device Identification(UDI)system.The Check phase evaluated man-agement effectiveness by comparing data from June to December 2023 and June to December 2024.The Act phase refined institu-tional norms and operational processes through a closed-loop feedback mechanism.Results After PDCA management,the appli-cation time for low-value medical consumables[(6.16±1.47)min]and the collection time[(15.08±1.89)min]were signif-icantly shorter than before implementation(P＜0.001).The acceptance qualification rate increased from 92.96％to 99.11％.The application of the split-item tertiary inventory ensured synchronization between inventory deduction and billing data.Conclu-sion The PDCA cycle improves the traceability of low-value medical consumables through systematic quality improvement.Its dynamic feedback mechanism supports continuous improvement,providing an effective pathway for hospitals to achieve refined management and cost control.