It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of “R0 resection” as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from “maximal resection” to “minimal effective treatment” de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China′s national conditions is the common goal of breast surgeons at this stage.

Objective: To explore the network structure of middle school students basic psychological needs and psychological behavioral problems, and identify the core nodes within the network, as well as examine demographic subgroup differences, so as to provide support for targeted mental health interventions for adolescents. Methods: In September and October of 2023, a total of 2 000 junior and senior high school students were selected with multistage cluster random sampling from 8 schools in Jiaojiang District and Tiantai County, Taizhou City. An online self administered questionnaire was used to assess emotional and behavioral problems, perceived autonomy, self awareness, loneliness, and social support. The instruments included the Strengths and Difficulties Questionnaire (SDQ), Perceived Choice and Awareness of Self Scale (PCASS), Mental Health Literacy Questionnaire (MHLQ), University of California,Los Angeles Loneliness Scale (UCLA-LS), and the Multidimensional Scale of Perceived Social Support (MSPSS). A network analysis approach was employed to construct a network representing adolescents basic psychological needs and psychological behavioral problems, focusing on centrality measures and demographic subgroup differences. Results: A total of 418 students (20.9%) reported abnormal emotional and behavioral problems. Perceived autonomy and competence were negatively correlated with emotional problems (weights: 0.12, 0.14) and hyperactivity (weights: 0.10, 0.16). Social support showed negative correlation with peer relationship issues, hyperactivity, and conduct problems (weights: 0.16, 0.13, 0.10). Loneliness was positively correlated with emotional symptoms and peer relationship problems (weights: 0.28, 0.18). In the overall network, perceived relationships (social support and loneliness), emotional symptoms, and hyperactivity emerged as central nodes. Significant differences in network structure were observed between gender subgroups ( P =0.02). Girls internalizing issues were more influenced by loneliness and perceived autonomy frustration, while social support exhibited higher centrality in boys. Conclusions Perceived relationships, emotional problems, and hyperactivity are key nodes in the network of adolescents basic psychological needs and psychological behavioral problems. Loneliness demonstrates a prominent influence within the network, and the overall network exhibits gender differences.

It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of “R0 resection” as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from “maximal resection” to “minimal effective treatment” de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China′s national conditions is the common goal of breast surgeons at this stage.

Background: Adrenocortical hormones, particularly 11-oxygenated androgens, are pivotal in female reproductive health and fertility. Standardized detection kits and population-specific reference intervals are lacking in China, hindering related clinical applications. Methods: A HPLC-tandem mass spectrometry (HPLC-MS/MS) pipeline was developed, rigorously validated, and applied to simultaneously quantify corticosterone, cortisone, cortisol, 18-OH cortisol, androstenedione (A4), 11β-hydroxyandrostenedione (11-OH A4), dehydroepiandrosterone, and dehydroepiandrosterone sulfate in serum samples from 455 reproductive-aged women (18–45 yrs) in Guangxi, China. Age-dependent concentration trends were analyzed, and reference intervals stratified by age (2.5th to 97.5th percentiles) were established. Correlations with body-composition metrics, ethnicity, and the menstrual cycle were investigated. Results: The HPLC-MS/MS method demonstrated high precision (intra- and inter-assay CVs < 15%), accuracy, and sensitivity. All eight hormones exhibited significant age-related declines (P < 0.001 for seven hormones; P = 0.001 for 11-OH A4). Notably, 11-OH A4 levels were significantly lower in the 35–45-yr (3.05 nmol/L) and 25–34-yr (3.09 nmol/L) age groups than in the 18–24-yr (3.57 nmol/L) age group, whereas no significant difference was observed between the 35–45-yr and 25–34-yr age groups. Weak negative correlations were observed between the body mass index and corticosterone and cortisone levels, whereas ethnicity and the menstrual cycle showed no significant associations with hormone levels. Conclusions We developed an HPLC-MS/MS-based method for simultaneously quantifying eight adrenocortical hormones, including 11-OH A4, and defined age-specific reference intervals for reproductive-aged Chinese women. These findings advance the clinical utility of adrenocortical hormones in diagnosing and managing reproductive disorders.

ObjectiveTo investigate the effect and potential mechanism of Zhishi Daozhi Formula （枳实导滞方， ZDF） on inflammation in rats with sepsis-induced gastrointestinal dysfunction based on the Toll-like receptor 4/myeloid differentiation factor 88/nuclear factor-κB （TLR4/MyD88/NF‑κB） signaling pathway and intestinal flora. MethodsSixty SD rats were randomly divided into sham‑operation group， model group， ulinastatin group， and low‑， medium‑ and high‑dose ZDF groups， with 10 rats in each group. Except for the sham‑operation group， the rat model of sepsis‑induced gastrointestinal dysfunction was established by cecal ligation and puncture （CLP）. Three days before modeling and 12 h after modeling， the low-， medium- and high-dose ZDF groups were intragastrically administered with ZDF solution at doses of 3.80， 7.60 and 15.20 g·kg⁻¹·d⁻¹， respectively. The ulinastatin group received intraperitoneal injection of ulinastatin at 100,000 U/kg， while the sham-operation and model groups were given normal saline at 1 ml/100 g by gavage. All interventions were performed once daily for 4 consecutive days. Tow hours after the last intervention， gastric emptying rate and small intestinal propulsion rate were detected. Gastrointestinal function indicators including D‑lactic acid （D‑LA） and intestinal fatty acid binding protein （i‑FABP）， as well as inflammatory indicators including procalcitonin （PCT） and C‑reactive protein （CRP） were measured by ELISA 24 h after modeling. The counts of Escherichia coli， Bifidobacterium and Lactobacillus in the intestine were compared. The histopathological morphological changes of the rat intestinal mucosa were observed by HE staining. The protein and mRNA expressions of IκB kinase （Ikk）， TLR4， MyD88 and NF‑κB in ileal tissues were detected by western blot and qRT‑PCR， respectively. ResultsCompared to the sham-operation group， the model group showed decreased gastric emptying rate and small intestinal propulsion rate， increased intestinal Escherichia coli count， elevated serum D‑LA， i‑FABP， PCT and CRP levels， increased protein and mRNA expressions of Ikk， TLR4， MyD88 and NF-κB in ileal tissue， decreased counts of Lactobacillus and Bifidobacterium （P＜0.05）， accompanied by obvious pathological injury of ileal mucosa. Compared to the model group， all medication groups exhibited significant improvements in the above mentioned indicators and alleviated intestinal mucosal injury （P＜0.05）. Compared to the ulinastatin group， except for D-LA in the medium-dose ZDF group， the differences in the above indicators between the low- and medium-dose ZDF groups were statistically significant （P＜0.05）， while the differences between the high-dose ZDF group and the ulinastatin group were not statistically significant （P＞0.05）. With increasing dosage， the gastric emptying rate， small intestinal propulsion rate， Lactobacillus and Bifidobacterium counts in the rats of all three ZDF groups increased， while the levels of serum D-LA， PCT， CRP， and i-FABP， the protein levels of Ikk， TLR4， MyD88， and NF-κB in intestinal tissue， and the Escherichia coli count decreased （P＜0.05）. ConclusionZDF can ameliorate intestinal mucosal injury， maintain intestinal flora balance and inhibit inflammatory response in rats with sepsis‑induced gastrointestinal dysfunction， with the high-dose group showing the best efficacy， which may be achieved by down‑regulating the TLR4/MyD88/NF-κB signaling pathway.

BACKGROUND:In recent years,the rapid development of omics technologies has ushered oral medicine research into a new era.The extensive application of these technologies not only systematically reveals the complexity and dynamic changes within biological systems but also provides a comprehensive perspective for studying various diseases,including periodontitis.OBJECTIVE:To review the recent advancements in the application of omics technologies in periodontitis research,while also addressing existing challenges,thereby expanding the scope for the prevention and treatment of periodontitis and its applications in other clinical fields.METHODS:A literature search was conducted on PubMed and CNKI databases,covering publications from June 1993 to August 2024.The search terms included"omics,""periodontitis,""transcriptomics and periodontitis,""proteomics and periodontitis,""genomics and periodontitis,""metabolomics and periodontitis"and"multi-omics and periodontitis"in English and Chinese,respectively.A total of 72 relevant articles were included for further analysis.RESULTS AND CONCLUSION:(1)By using genomics,transcriptomics,proteomics,and metabolomics,researchers can conduct in-depth analyses of pathological processes,inflammatory responses,and associated biomarkers of periodontitis from multiple dimensions.(2)Recent studies have indicated that omics technologies can identify key genes and metabolites and other factors associated with periodontitis,facilitating a precise understanding and intervention of the disease.As these technologies continue to advance,omics analysis will be more widely applied in periodontitis research,driving the development of more effective preventive and therapeutic strategies,thereby improving patients'quality of life.

Objective:To explore the efficacy and safety of B-Raf proto-oncogene, serine/threonine kinase (BRAF) inhibitor and epidermal growth factor receptor (EGFR) inhibitor combined with immune checkpoint inhibitor in microsatellite stable (MSS) BRAF V600E metastatic colorectal cancer (mCRC) patients.Methods:The data and outcomes of mCRC patients with MSS BRAF V600E who received BRAF inhibitor, EGFR inhibitor combined with immune checkpoint inhibitor in Tianjin Medical University Cancer Hospital from May 2022 to April 2024 were retrospectively collected.Results:A total of 12 mCRC patients were included in this study, the objective response rate was 50.0%, the disease control rate was 66.7%, and the median disease control time of patients who achieved objective response was 8.0 months. The median progression-free survival was 6.8 months and the median overall survival was 8.4 months. Overall adverse reactions were controllable, the most common treatment-related adverse events were fatigue (8 cases), fever (5 cases), and rash (4 cases). There were no grade 4 adverse event, serious adverse event, and treatment-related death.Conclusion:BRAF inhibitor and EGFR inhibitor combined with immune checkpoint inhibitor show good efficacy and controllable safety in BRAF V600E mCRC patients.

Objective:To explore the relationship between childhood trauma and anxiety symptom among high school students,as well as the mediating role of social support and the moderating role of stressful life events.Methods:A total of 3 075 high school students were selected.The Short Form of the Childhood Trauma Questionnaire(CTQ-SF),Social Support Rate Scale(SSRS),Adolescent Self-Rating Life Events Checklist(ASLEC)and Chinese Secondary School Students Anxiety Scale(CSSAS)were used to assess the levels of child-hood trauma,social support,stressful life events,and anxiety symptom severity.The SPSS PROCESS 3.3 macropro-gram was used to test the mediating effect and moderated mediation effect.Results:The CTQ-SF scores were posi-tively correlated with CSSAS scores(r=0.26,P＜0.001).The SSRS scores and the subjective support(S2)scores and availability of support(S3)scores in the SSRS played partial mediating effects between CTQ-SF scores and CSSAS scores.The mediating effects were 0.11(95％CI:0.09-0.12,P＜0.001),0.08(95％CI:0.06-0.09,P＜0.001),0.04(95％CI:0.03-0.06,P＜0.001)respectively,which accounted for 44.00％,32.00％,16.00％of the total effect respectively.The ASLEC scores moderated the relationship between CTQ-SF scores and CSSAS scores(β=0.02,P=0.044),and the relationship between SSRS scores and CSSAS scores(β=0.08,P＜0.001).Conclusion:Among high school students,social support and the subjective support and availability of support in so-cial support play partial mediating effects between childhood trauma and anxiety symptom,and stressful life events moderates the relationship between childhood trauma,social support and anxiety symptom.

Objective:To evaluate the stability of percutaneous screw fixation for minimally invasive treatment of intra-articular calcaneal fractures using three-dimensional finite element analysis.Methods:CT scan was performed on the calcaneus of a normal adult for three-dimensional reconstruction. The DICOM data were imported into Mimics software to establish a model of a Sanders type IIB intra-articular calcaneal fracture. Based on the Essex-Lopresti classification of posterior facet morphology, the model was subdivided into two subtypes: tongue-type and depression-type. The calcaneus was divided into four fragments: sustentaculum tali, posterior tuberosity, anterior process (three points), and posterior articular surface (one surface). Two types of fixation methods, classical lateral anatomical plates and combinations of percutaneous screws, were simulated and performed. A three-dimensional finite element analysis was conducted by applying a stress combination of 420 N on the posterior subtalar articular surface, 200 N on the middle subtalar articular surface, and 300 N at the Achilles tendon insertion point. The maximum displacement and von Mises stress values of each bone fragment and implant were recorded to evaluate the biomechanical stability. For clinical validation, 34 patients with Sanders type IIB calcaneal fractures from Orthopedics Department of the Sixth Affiliated People's Hospital of Shanghai Jiao Tong University were treated with percutaneous reduction and screw fixation using the following configurations.Results:Under simulated stress, the A4 group with medial support screws in the tongue-type fracture subgroup demonstrated minimal overall calcaneal displacement (0.22 mm) and internal fixation displacement (0.14 mm). For the depression-type, the B2 group with medial support screws showed lower maximum stress in the calcaneus and internal fixation, at 22.04 MPa and 41.14 MPa, respectively, along with the lowest overall displacement (0.14 mm). The peak stress of all groups of implants remained below the material yield strength. The A4 and B2 protocols were applied to 15 cases of tongue-type calcaneal fractures and 19 cases of collapse-type calcaneal fractures. At the final follow-up The American Orthopaedic Foot & Ankle Society ankle-hindfoot score scale was 86.1±5.82 and 87.2±5.18, respectively, while the visual analog scale for pain was 1.60±1.24 and 1.58±1.02, respectively.Conclusions:Percutaneous screw fixation provided reliable stability for Sanders type IIB calcaneal fractures. The fixation configuration incorporating a medial support screw offers superior biomechanical performance in both tongue-type and depression-type fractures, representing an optimized minimally invasive technique with strong clinical applicability.

Objective:To evaluate the efficacy of high-flow nasal cannula oxygen therapy for lumbosacral plexus block combined with intravenous anesthesia for hip replacement in elderly patients.Methods:Twenty-two elderly patients of either sex, aged 65-89 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective lateral approach to unilateral hip replacement, capable of cooperating to complete the Mini-Mental State Examination with a score of ≥25, were included. Preoperative lumbosacral plexus block was performed on the affected side under ultrasound guidance. Sufentanil 0.1 μg/kg was intravenously injected at 5 min before skin incision, and propofol was given by target-controlled infusion at a plasma target concentration of 1.0-2.0 μg/ml. During the operation, spontaneous breathing was preserved and high-flow nasal cannula oxygen therapy was performed. FiO 2 was set at 60%, gas flow rate at 60 L/min, temperature at 37 ℃, humidity at 100%. The values of Bispectral Index were 60 -75, and the Surgical Pleth Index value was 30-60. If the Surgical Pleth Index value > 60, an additional sufentanil 0.05 μg/kg was added. PaO 2, FiO 2 and PaCO 2 were recorded immediately before nerve block (T 1), immediately after the start of surgery (T 2), 30 min after the start of surgery (T 3), 90 min after the start of surgery (T 4), immediately after the end of surgery (T 5) and immediately after leaving postanesthesia care unit (T 6). Lung ultrasound scores were recorded at T 1 and T 6. The development of intraoperative hypotension, bradycardia and hypoxemia and occurrence of postoperative nausea and vomiting, new pulmonary infection, delirium and cognitive dysfunction were recorded. Results:Nerve block was completed within 15 min in all the patients, and all the patients underwent surgery successfully. PaO 2/FiO 2 increased at T 4 and T 5, while at T 6 it decreased to the level observed at T 1 ( P<0.05); PaCO 2 increased at T 2-T 6 and reached the peak value at T 2 ( P<0.05). There was no significant difference in lung ultrasound scores at all time points ( P>0.05). There were 8 patients (36%) with hypotension and 2 patients (9%) with bradycardia, and no hypoxemia was found during operation. Postoperative nausea and vomiting occurred in 2 cases (9%) and delirium in 2 cases (9%), and no new pulmonary infection or cognitive dysfunction was found after operation. Conclusions:High-flow nasal cannula oxygen therapy can be safely and effectively used in elderly patients undergoing hip replacement with lumbosacral plexus block combined with intravenous anesthesia.