Ductal carcinoma in situ of the breast (DCIS) most commonly manifests as asymptomatic calcifications at mammography. The most common manifestation of MRI is nonmass enhancement. The ultrasound mainly presents as a hypoechoic irregular hypervascular mass without posterior features. Core-needle biopsy is a commonly used method for preoperative diagnosis of DCIS. Due to differences in needle type and sample size, there is a certain degree of pathological upgrading of the lesion. In recent years, there has been controversy over the diagnosis and treatment of DCIS. With the development of breast disease diagnostic technology, advances in digital breast tomography, artificial intelligence, and radiomics are expected to help DCIS management and address issues such as overdiagnosis.

Objective To investigate the correlation of human epididymis protein 4(HE4)with proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods A total of 147 T2DM patients from January 2020 to July 2023 in Jiujiang NO.l People's Hospital were enrolled in observation group.According to the severity of proteinuria,observation group was divided into three groups:Normal albuminuria group(101 cases),microalbuminuria group(25 cases),and massive albuminuria group(21 cases).50 healthy examinees with gender and age matching during the same period were selected as control group.HE4 levels and clinical indicators in each group were compared and analyzed.Correlation between HE4 and proteinuria was analyzed by using univariate and multivariate linear regression.Results The correlation network diagram reveals that HE4 functions was a pivotal node linking serum albumin,urinary microalbumin,urinary microalbumin-to-creatinine ratio(UACR),and renal function biomarkers.Compared to control group,HE4 levels significantly elevated in observation group(P＜0.01).Both univariate and multivariate linear regression analysis demonstrate a positive correlation between HE4 and UACR.Logistic regression analysis shew that after adjusting for confounding factors including age,gender,estimated glomerular filtration rate(eGFR),albumin(ALB),blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),lactate dehydrogenase(LDH)etc.elevated HE4 levels was a risk factor for proteinuria(OR=1.110,95％CI:1.005-1.226).Conclusion Elevated HE4 levels in patients with T2DM is positivly correlated with UACR.Increase its level increases the risk of proteinuria in T2DM patients.

Objective:To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China.Methods:A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors.Results:The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A ( χ2=7.91 and 8.06, both P=0.005) and vitamin D ( χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively ( OR=0.68 and 0.22, 95% CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB ( χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively ( χ2=93.22 and 202.54, both P<0.001). Conclusions:Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.

BackgroundSleep disorder can adversely affect human physical and mental health， with important implications for socioeconomic development. And higher vocational college students are subject to various pressures and stimuli exerted by academic studies， job seeking and family socioeconomic status， which may contribute to the onset insomnia symptom or sleep disorder. ObjectiveTo discuss the sleep status and influencing factors among higher vocational college students， and to provide references for improving their sleep status. MethodsIn January and February， 2022， a stratified random sampling method was utilized to enroll 3 300 students from five higher vocational colleges in Wenjiang district of Chengdu city. All the participants were assessed using Insomnia Severity Index （ISI）， Patient Health Questionnaire Depression Scale-9 item （PHQ-9） and Generalized Anxiety Disorder Scale-7 （GAD-7）. Pearson correlation analysis was conducted to test the correlation of ISI with PHQ-9 and GAD-7 scores， and the Logistic regression analysis was performed to identify the influencing factors of insomnia symptom in higher vocational college students. ResultInsomnia symptom was detected in 81.90% （2 497 / 3 300） of higher vocational college students. The detection rate of insomnia symptom among vocational college students yielded statistical difference in terms of gender， family socioeconomic status， being an only child or having siblings， degree of psychological pressure exerted by academic studies or job seeking， amount of hours spent on Internet per day， frequency of physical exercise， and the presence or absence of anxiety symptom and depression symptom （χ²=21.032， 22.172， 8.983， 75.939， 36.781， 32.350， 54.512， 86.561， P<0.01 or 0.05）. Among higher vocational college students， ISI score was positively correlated with GAD-7 and PHQ-9 scores （r=0.620， 0.714， P<0.01）， and GAD-7 score was positively correlated with PHQ-9 score （r=0.824， P<0.01）. Gender， family socioeconomic status， degree of psychological pressure exerted by academic studies or job seeking， amount of hours spent on Internet per day， frequency of physical exercise， and the presence or absence of anxiety symptom and depression symptom were effective factors in predicting the insomnia symptom in higher vocational college students （P<0.01 or 0.05）. ConclusionFemale gender， average and below average family socioeconomic status， moderate-to-severe degree of psychological pressure exerted by academic studies or job seeking， spending 2~5 h， 5~7 h or >7 h on Internet per day， inadequate physical exercise and presence of depressive symptom are the risk factors for insomnia symptom in higher vocational college students.［Funded by Sichuan Provincial Primary Health Development Research Center in 2022， North Sichuan Medical College （number， SWFZ22-C-89）］

Objective:To understand the rate of spirometry examination and its related factors among chronic obstructive pulmonary disease (COPD) patients aged ≥40 years in China from 2014 to 2015, and provide evidence for diagnosis, treatment and management of COPD patients normatively.Methods:Data were obtained from 2014-2015 COPD surveillance, China. The previous lung function examination status and other information of the subjects were collected by face-to-face survey. We defined COPD as a post-bronchodilator FEV 1: FVC less than 70%. A total of 9 130 COPD patients were included in the analysis of this study. The rate of spirometry examination and its 95% confidence interval ( CI) were estimated in COPD patients aged ≥40 years with complicated sampling weights. Meanwhile, the spirometry examination related factors were analyzed. Results:The estimated rate of spirometry examination among COPD patients was 5.9% (95% CI: 4.9%-6.9%), 6.1% (95% CI: 5.2%-7.1%) for men and 5.3% (95% CI: 4.0%-6.6%) for women. The rate was significantly higher in urban population than in rural ( P<0.001). With the increase of education level, the rate of spirometry examination among COPD patients increased gradually ( P<0.001). The rate of spirometry examination was 4.0% (95% CI: 3.1%-4.9%) among COPD patients in agricultural industry. The rate of spirometry examination among COPD patients with awareness of pulmonary function test was 32.3% (95% CI: 26.4%-38.1%). The rate of spirometry examination among COPD patients with previous chronic respiratory disease and respiratory symptoms were 13.7%(95% CI:11.5%-15.9%), 8.8%(95% CI:7.2%-10.4%), respectively. The rate of spirometry examination among COPD patients exposed to occupational dust and/or harmful gases was 5.7% (95% CI: 4.6%-6.9%). The rate of spirometry examination in former smokers among COPD patients was 10.2% (95% CI: 8.0%-12.4%), higher than those in current smokers (4.2%, 95% CI: 3.3%-5.1%) and non-smokers (6.3%, 95% CI: 5.1%-7.6%). Conclusion:The rate of spirometry examination is extremely low among COPD patients aged ≥40 in China, and the standardized diagnosis, treatment and management of COPD patients need to be improved urgently.

Objective:To understand the medication treatment rate and its associated factors among chronic obstructive pulmonary disease (COPD) patients aged ≥40 years in China, and to provide basic data for targeted interventions to improve the diagnosis and treatment of COPD patients.Methods:Data were from COPD surveillance of Chinese residents in 2014-2015. Questionnaire and pre-bronchodilator and post-bronchodilator spirometry were performed on all respondents. Individuals with post-bronchodilator FEV 1/FVC<70% were diagnosed as COPD patients. A total of 9 120 COPD patients were included in the analysis. Based on the complex sampling design, the medication treatment rate and 95% CI among COPD patients were estimated, and the associated factors were analyzed. Results:The medication treatment rate for COPD patients aged ≥40 years was 11.7% (95% CI: 10.2%-13.0%), the treatment rate with inhaled medication was 3.4% (95% CI: 2.9%-4.0%), and the treatment rate with oral or intravenous medication was 10.4% (95% CI: 9.0%-12.0%). All treatment rates were higher in patients who knew that they had COPD before the investigation. The rate of medication treatment in patients aged ≥60 years was higher than that in patients aged <60 years. Medication treatment rate, and oral or intravenous medication treatment rate among women were higher than those among men. These two treatment rates in patients with harmful occupational exposure were higher than those in patients without exposure. The medication treatment rate, and oral or intravenous medication treatment rate in former smokers were higher than those in current smokers and never smokers. Patients who knew that they had COPD before the investigation had higher rates of three treatments than those who were not aware of their disease conditions. Those with respiratory symptoms had higher three treatments rates than those without symptoms. Conclusion:In China, the rate of medication treatment for COPD patients aged ≥40 years old, especially the rate of inhaled medication treatment was very low. Being aware of their own COPD status and the emergence of respiratory symptoms were important factors associated with COPD medication treatment. Early diagnosis of COPD should be strengthened and the level of standardized treatment for patients should be improved.

Objective:To understand the smoking cessation behaviors in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention.Methods:COPD patients with post-bronchodilator FEV 1/FVC<70% were selected from COPD surveillance (2014-2015) of China, in which 5 791 current or former smokers defined by questionnaire survey were included in the study. The smoking cessation rate/ratio and the successful smoking cessation rate in COPD patients, the successful smoking cessation rate in COPD patients who ever smoked daily and the rate of attempting to quit smoking in current smokers with COPD were estimated using data adjusted by complicated sampling method. Results:The smoking cessation rate was 25.0% and the successful smoking cessation rate was 19.1% in COPD patients aged 40 years or older who ever smoked. The smoking cessation ratio was 23.1% and the successful smoking cessation ratio was 17.6% in COPD patients who ever smoked daily. The rate and ratio were higher in urban area than rural area ( P<0.05) and increased with age ( P<0.05). Patients who were aware of smoking being a risk factor for COPD had higher rate and ratio than patients who were not aware ( P<0.05). Patients with more severe airflow limitation and patients smoking less had higher rate and ratio ( P<0.05). Conclusions:The smoking cessation rate and ratio were low in COPD patients in China. More health education for COPD patients about smoking cessation needs to be strengthened. It is suggested for healthcare workers to actively advise smoking cessation and suggest smoking cessation ways for patients who smoke in their routine clinical service to increase the successful smoking cessation rate/ratio in COPD patients.

Objective:To understand the awareness of chronic obstructive pulmonary disease (COPD) status and awareness of COPD-related knowledge and its influencing factors in COPD patients aged ≥40 years in China in 2014-2015.Methods:The study subjects were selected through multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces (autonomous regions, municipalities) in China. The number of the subjects was 75 107. The relevant variables about COPD diagnosis and COPD-related knowledge awareness were collected by electronic questionnaire in face to face interviews. A total of 9 134 participates with post-bronchodilator FEV 1/FVC<70% were diagnosed with COPD. Based on the complex sampling design, the awareness rate of COPD status and related knowledge were estimated, and the influencing factors were analyzed. Results:A total of 9 132 COPD patients were included in the analysis. Among COPD patients aged ≥40 years in China, 0.9% were aware of their COPD status (95 %CI: 0.6%-1.1%), and 5.7% were aware of COPD related knowledge (95 %CI: 4.8%-6.6%), and 3.4% were aware of pulmonary function test (95 %CI: 2.8%-4.0%). The COPD status awareness rate was 3.9% in the patients with history of chronic respiratory disease (95 %CI: 2.9%-4.8%), 2.4% in the patients with respiratory symptoms (95 %CI: 1.7%-3.1%), and 7.1% in the patients with COPD related knowledge awareness (95 %CI: 4.5%-9.8%) respectively. The results of multivariate logistic regression analysis showed that chronic respiratory disease history, respiratory symptoms, occupational dust and/or harmful gas exposure and COPD related knowledge awareness had influences on the awareness rate of COPD status. Educational level and chronic respiratory disease history had influences on the awareness rate of COPD related knowledge. And ethnic groups, educational level and history of chronic respiratory diseases had influences on the awareness rate of pulmonary function test. Conclusions:The awareness rates of COPD status, COPD-related knowledge and pulmonary function test in COPD patients in China were low. The comprehensive intervention of COPD should be carried out to improve the level of diagnosis and the awareness COPD status of COPD patients.

Objective:To understand the pneumococcal vaccination rate in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention.Methods:COPD patients with post-bronchodilator FEV 1/FVC<70% in COPD surveillance (2014-2015) of China were used as study subjects, in which 9 067 patients with definite pneumococcal vaccination status were included. The pneumococcal vaccination rate and its 95 %CI in COPD patients were estimated using data adjusted by complicated sampling method. The factors in association with the vaccination rate were also identified. Results:The pneumococcal vaccination rate was 0.8% in the past five years in COPD patients aged 40 years or older in China (95 %CI: 0.3%-1.4%). The vaccination rate was 0.3% in the patients aged 40 to 59 years (95 %CI: 0.2%-0.5%) and 1.2% in the patients aged 60 years or older (95 %CI: 0.3%-2.1%) ( P<0.05). The rate was higher in the patients living in urban area (1.5%) than in those living in rural area (0.4%) ( P<0.05). The vaccination rate increased with the severity of airflow limitation ( P<0.05). The patients with comorbidities of other chronic lung diseases or diabetes had higher vaccination rate (1.7% and 2.1%) compared with those without comorbidities ( P<0.05). The vaccination rate was 1.4% in former smokers and 0.6% in current smokers. The pneumococcal vaccination rate in COPD patients was associated with age, education level, occupation, the severity of airflow limitation and the history of influenza vaccination. Conclusions:The pneumococcal vaccination rate was extremely low in COPD patients aged 40 years or older in China. It is necessary to strengthen the health education and recommendation for pneumococcal vaccination in COPD patients through different measures.