Purpose To investigate the value of the breast imaging reporting and data system (BI-RADS) score of low-energy image combined with enhancement score and clinical indicators in the differentiation of benign and malignant breast lesions based on contrast-enhanced spectral mammography (CESM). Materials and Methods A total of 193 female patients,who underwent CESM examination in the Third Affiliated Hospital of Soochow University from January 2018 to June 2023,with BI-RADS score of Class 3 or higher based on low-energy image were retrospectively collected. According to the surgical or puncture pathological results,all patients were divided into malignant and benign groups. The general information,imaging features and enhancement degree between the two groups were compared,respectively. Logistic regression was used to construct a predictive model (Model 3) for the combination of BI-RADS score based on low-energy image,enhancement score and clinical indicators. The predictive performance of Model 3 was evaluated and compared with Model 1 (BI-RADS score based on low-energy image) and Model 2 (BI-RADS score based on low-energy image+enhancement score). Results Of 193 patients,73 were benign and 120 were malignant. There were significant differences in age (t=3.75,P<0.001),menopausal history (x2=14.00,P<0.001),BI-RADS score based on low-energy image (x2=77.36,P<0.001) and enhancement score (x2=36.34,P<0.001) between the malignant and benign groups. The area under the curve (AUC) of Model 1,Model 2 and Model 3 were 0.852,0.859 and 0.871,respectively. The AUC,net reclassification improvement,integrated discrimination improvement and decision curve of Model 3 were better than those of Model 1 and Model 2. The optimal cutoff value for Model 3 was 0.595,with a corresponding sensitivity of 82.2％ and specificity of 83.3％. Conclusion In the suspected breast cancer patients of category 3 and above of BI-RADS based on low-energy image,the combination of enhancement score and clinical indicators based on BI-RADS score of low-energy image is helpful to improve the efficiency of CESM in diagnosing breast cancer.

Purpose To investigate the value of the breast imaging reporting and data system (BI-RADS) score of low-energy image combined with enhancement score and clinical indicators in the differentiation of benign and malignant breast lesions based on contrast-enhanced spectral mammography (CESM). Materials and Methods A total of 193 female patients,who underwent CESM examination in the Third Affiliated Hospital of Soochow University from January 2018 to June 2023,with BI-RADS score of Class 3 or higher based on low-energy image were retrospectively collected. According to the surgical or puncture pathological results,all patients were divided into malignant and benign groups. The general information,imaging features and enhancement degree between the two groups were compared,respectively. Logistic regression was used to construct a predictive model (Model 3) for the combination of BI-RADS score based on low-energy image,enhancement score and clinical indicators. The predictive performance of Model 3 was evaluated and compared with Model 1 (BI-RADS score based on low-energy image) and Model 2 (BI-RADS score based on low-energy image+enhancement score). Results Of 193 patients,73 were benign and 120 were malignant. There were significant differences in age (t=3.75,P<0.001),menopausal history (x2=14.00,P<0.001),BI-RADS score based on low-energy image (x2=77.36,P<0.001) and enhancement score (x2=36.34,P<0.001) between the malignant and benign groups. The area under the curve (AUC) of Model 1,Model 2 and Model 3 were 0.852,0.859 and 0.871,respectively. The AUC,net reclassification improvement,integrated discrimination improvement and decision curve of Model 3 were better than those of Model 1 and Model 2. The optimal cutoff value for Model 3 was 0.595,with a corresponding sensitivity of 82.2％ and specificity of 83.3％. Conclusion In the suspected breast cancer patients of category 3 and above of BI-RADS based on low-energy image,the combination of enhancement score and clinical indicators based on BI-RADS score of low-energy image is helpful to improve the efficiency of CESM in diagnosing breast cancer.

Objective:To explore the relationship between the levels of serum complement C3 and C4 and the degree of renal pathological injury in patients with IgA nephropathy (IgAN).Methods:It was a retrospective study. The clinical and pathological data of patients with primary IgAN diagnosed by renal biopsy in the Department of Nephrology of the Second People's Hospital of Qujing City, Yunnan Province from December 1, 2019 to December 31, 2022 were collected. According to the IgAN Oxford classification criteria, the patients were divided into mild renal pathological injury group (mild group, <3 pathologic types) and severe renal pathological injury group (severe group, ≥3 pathological types). The levels of serum C3 and C4 and other clinical data were compared between the two groups. Spearman correlation method was used to analyze the correlation between serum C3, C4 levels and estimated glomerular filtration rate (eGFR) during renal biopsy.Multivariate logistic regression model was used to analyze the influencing factors of the pathological injury degree in IgAN patients and the forest map depicted the effect of risk factors.Results:A total of 164 IgAN patients were included in the study, including 77 males (47.0%), aged (35.5±12.9) years old. There were 60 patients in the mild group and 104 patients in the severe group. Compared with the mild group, the patients in the severe group were older, had higher levels of serum C4, serum uric acid, low density lipoprotein cholesterol and 24 h urinary protein, higher proportions of hypertension, glucocorticoids/immunosuppressant therapy, C3 deposition in renal tissues and microscopic hematuria, and had lower hemoglobin and serum C3 level (all P<0.05). The results of Spearman correlation analysis showed that the level of serum C3 was positively correlated with eGFR ( r=0.303, P<0.001), and the level of serum C4 was negatively correlated with eGFR ( r=-0.238, P=0.002). Multivariate logistic regression analysis results showed that serum C3 (every 0.01 g/L increase, OR=0.976, 95% CI 0.957-0.996, P=0.018), serum C4 (every 0.01 g/L increase, OR=1.091, 95% CI 1.020-1.166, P=0.011), hemoglobin ( OR=0.969, 95% CI 0.950-0.988, P=0.002), and serum uric acid ( OR=1.005, 95% CI 1.001-1.009, P=0.012) were independent related factors of renal pathological damage (severe injury /mild injury) in IgAN patients. Conclusions:Serum C3 and C4 are independent related factors of the severity of renal pathological injury in IgAN patients.

Objective:To investigate the effect of polypeptide N-acetylgalactosaminaminyltransferase 2 (GALNT2) on the proliferation and apoptosis of human retinal vascular endothelial cells (HRCECs) cultured in high glucose and its possible mechanism.Methods:The small hairpin RNA (shRNA) targeting GALNT2 gene was constructed to interfere with the lentiviral vector and infect HRCECs.HRCECs were divided into blank control group, model group, NC-shGALNT2 group and shGALNT2 group, which were cultured in medium containing 5.5 mmol/L glucose, 25 mmol/L glucose, shGALNT2 negative control virus 25 mmol/L glucose and shGALNT2 knockdown virus 25 mmol/L glucose for 24 hours, respectively.The relative expression of GALNT2 mRNA in the four groups was detected by real-time fluorescence quantitative PCR.The relative expression levels of GALNT2, epidermal growth factor (EGF), EGF receptor (EGFR) and phosphorylated EGFR (p-EGFR) were detected by Western blot.The proliferative values of HRCECs were detected by cell counting kit-8 method.The apoptosis rate of different groups was detected by flow cytometry. Results:The relative expression levels of GALNT2 mRNA and protein were significantly higher in model group than in blank control group, and were significantly lower in shGALNT2 group than in blank control group (all at P<0.05). The cell proliferation value was significantly lower in model group than in blank control group, and was significantly higher in shGALNT2 than in model group and NC-shGALNT2 group (all at P<0.05). The apoptosis rates of blank control group, model group, NC-shGALNT2 group and shGALNT2 group were (4.73±0.26)%, (8.66±0.25)%, (9.26±1.12)% and (5.47±0.18)%, respectively, with a significant overall difference ( F=342.921, P<0.001). The apoptosis rate was significantly higher in model group than in blank control group, and was significantly lower in shGALNT2 group than in model group and NC-shGALNT2 group (all at P<0.05). The relative expression level of EGFR protein was significantly higher and the relative expression level of p-EGFR protein was significantly lower in model group than in blank control group (all at P<0.05). The relative expression of p-EGFR protein was significantly higher in shGALNT2 group than in model group (all at P<0.05). Conclusions:Knocking down GALNT2 can improve the proliferative ability of HRCECs under high glucose culture and reduce apoptosis, which may be related to the activation of EGFR signaling pathway.

Objective To explore the effect and significance of electronic account books on the management of anesthesia and psychotropic drugs. Methods The data of electronic account books from January 2020 to June 2020 in the inpatient pharmacy of the hospital (observation group), and manual account books from July 2019 to December 2019 (control group) were collected respectively. The data of daily accounting time, monthly settlement accounting time and accounting accuracy between the two groups were compared and analyzed. Results The daily average time for pharmacists to manually accounting was (162.8±22.5) min, and the daily average time for pharmacists to make accounts electronically was (33.2±7.0) min. It took (245.5±7.2) min for manual accounting of monthly settlement and (46.8±2.5) min for electronic accounting of monthly settlement. The accuracy rate of daily counting records, special account books, special register and empty ampoule waste paste recovery records included in electronic accounting is up to 100%. Conclusion The implementation of electronic account books not only significantly improved the work efficiency of pharmacists, but also strengthened drug supervision, formed a comprehensive traceability system, which could ensure the safety of clinical medication, and make the management of narcotic psychotropic drugs more efficient and standardized.

Internuclear ophthalmoplegia mainly affects the horizontal movement disorder of the eyeball. "One and a half syndrome" is characterized by a combination of one eyeball on the affected side cannot be adducted and abducted, and the other eyeball cannot be adducted, but can be abducted accompanied by horizontal nystagmus due to the lesion of tegmental pontine. At present, articles have successively reported "eight and a half syndromes""nine syndromes""thirteen and a half syndromes" and so on. The rapid identification of "one and a half syndrome" spectrum is helpful for clinicians to make right positioning and clinical decision-making. A case of bilateral peripheral facial paralysis with bilaterally horizontal gaze palsy caused by pontine dorsal tegmental lesions is now reported, so as to improve the understanding of the anatomical location and heterogeneity of pontine lesion.

Objective To explore the anti-inflammatory and hepatoprotective mechanism of Shuganning injection through establishing the active ingredients-targets network and protein interactions network. Methods The main active ingredients of Artemisiae scopariae, Fructus gardenia, Radix scutellariae, Radix isatidis and Ganoderma in Shuganning injection were obtained by TCMSP; GeneCards and OMIM were used to screen the hepatitis-related targets among the corresponding targets of the active ingredient of Shuganning injection; The Cytoscape software was used to construct the active ingredient-targets network of Shuganning injection. The protein interactions network was constructed using the String database and Cytoscape software. The GO and KEGG pathways involved in the targets were analyzed by DAVID database. Results The results showed that 20 active ingredients and 83 targets of Shuganning injection were involved. GO analysis showed that Shuganning injection mainly affected the regulation of cellular processes and biological processes, as well as the response to chemical stimulation and stress. KEGG pathway analysis showed that the targets of the anti-inflammatory and hepatoprotective effect of Shuganning injection mainly involved in signaling pathways such as TNF, IL-17, and MAPK. Conclusion The anti-inflammatory and hepatoprotective effect of Shuganning injection have the characteristics of multiple components, multiple targets and multiple pathways, which may play a role by regulating pathways such as TNF、IL-17 and MAPK .

Objective:To investigate the clinical experience about the transconjunctival lower eyelid blepharoplasty with correction of the eyelid orbital sulcus deformity.Methods:This group received 67 cases from June 2016 to July 2018, including 3 males and 64 females. The average age was 22 years. All the cases were diagnosed as lower eyelid bag with different degrees of fat herniation after orbital septum, with no or slight lower eyelid skin relaxation. Orbital sulcus of different degree appeared with outline of bony orbital margin, or accompanied by underdevelopment of the suborbital region. Through a transconjunctival incision or with short external canthal incision, the adipose mass was fully exposed behind the anterior wall of lower eyelid, the arcuate edge was released, and the pedicled orbital fat was transferred to the gap between the orbital eyelid sulcus and fixed in the lower orbital margin. If there was insufficient fat behind the orbital septum, a retroauricular fascia graft was used to make up.Results:No postoperative complications occured in all cases. After followed up for more than 3-month, 3 of 67 cases showed mild fat bulging pouch deformity in bilateral eyelids and 1 case was in unilateral eyelid. In other cases, deformity of the pouch and the eyelid orbital sulcus were improved significantly, and dynamic expression (orbicularis muscle contraction) showed no local uplift in lower eyelid morphology.Conclusion:The transconjunctival lower eyelid blepharoplasty with correction of the eyelid orbital sulcus deformity can obtain good clinical results in lower eyelid area.

Objective To explore the role of clinical pharmacists in rational drug use through the pharmacy care of an elderly pneumonia patient with Chlamydia psittaci infection and drug-induced liver injury. Methods The clinical pharmacists participated in the treatment of one patient with Chlamydia psittaci pneumonia and drug-induced liver injury. Based on the results of second-generation gene sequencing, the characteristics of the pathogen were learned by literature search. The clinical pharmacists monitored the patient’s liver and kidney function, provided a new medication treatment plan to Doctors, and performed patient education during the treatment. Results The initial empirical anti-infective treatment with teicoplanin and imipenem-cilastatin was not effective. After the diagnosis of Chlamydia psittaci and Candida albicans infection, the combination of doxycycline with azithromycin and fluconazole was administered. Drug-induced liver injury was found with this treatment. The clinical pharmacist proposed to switch to doxycycline and clarithromycin with co-administration of magnesium isoglycyrrhizinate and polyene phosphatidylcholine to protect the liver. With this new regime, patient's liver function was improved and the infection was under control. Conclusion Individualized pharmaceutical cares provided by clinical pharmacists helped the safe, rational and effective use of medications.

Objective:To investigate the relationship of triglyceride (TG), fasting blood glucose (FPG) and triglyceride glucose product index (TyG) with the incidence of hypertension, and provide basic data for the prevention and treatment of hypertension in the population.Methods:A total of 23 581 individuals who met the research criteria in Jinchang cohort were selected as the research subjects, the Cox proportional hazard model was used to analyze the relationship of TG, FPG, and TyG with the risk of hypertension. A stratified analysis was conducted by sex.Results:After adjusting for confounding factors, compared with the normal TG group, the HR(95% CI) of the elevated TG margin group and the elevated group were 1.16 (1.01-1.34) and 1.49 (1.30-1.70), respectively in the total population. Among men, they were 1.13 (1.01-1.27) and 1.17 (1.06-1.30), and among women, they were 1.05 (0.88-1.26) and 1.06 (0.88-1.28). Compared with the normal FPG group, the HR (95% CI) of the FPG-impaired group were 1.29 (1.13-1.48) in the total population, 1.26 (1.08-1.48) in men and 1.59 (1.14-2.21) in women. Taking the lowest quartile array as a reference, the HR (95% CI) of the highest quartile array of TyG was 1.73 (1.45-2.07) in the total population, 1.32 (1.14-1.53) in men and 1.87 (1.37-2.54) in women. TG, FPG had a nonlinear dose-response relationship with the risk of hypertension, while TyG had a linear correlation with the risk of hypertension. Conclusions:Higher TG, FPG, and TyG levels are independent risk factors for the incidence of hypertension. People with higher TG, FPG and TyG are at high risk for hypertension, to which close attention should be paid in the prevention and treatment of hypertension.