Hormone receptor (HR)-positive/HER2-negative early breast cancer is the most common subtype of breast cancer, and endocrine therapy serves as the cornerstone of adjuvant treatment. In recent years, with the publication of key clinical trials such as SOFT, TEXT, and monarchE, and breakthroughs in novel agents studies like lidERA, the endocrine therapy strategy for HR-positive/HER2-negative early breast cancer has evolved toward increased precision and intensity. This article systematically reviews the latest advances in endocrine therapy, focusing on the consolidation of ovarian function suppression as a standard for high-risk premenopausal patients with updated follow-up evidence, the benefit-risk assessment of extended endocrine therapy, and the current application and interdrug differences of CDK4/6 inhibitors in the adjuvant setting. This manuscript also addresses existing challenges, including optimizing treatment-related quality of life and precisely identifying beneficiary populations, and briefly introduces the clinical trial progress of novel agents, such as oral selective estrogen receptor degraders. Furthermore, it outlines evidence-based strategies for ovarian protection during chemotherapy and fertility preservation for young patients. This review aims to provide clinicians with a comprehensive perspective, balancing the pursuit of maximal efficacy with patients′ long-term quality of life and individualized needs.

Pre-admission is a critical initiative to optimize medical service processes and alleviate the challenge of "difficult access to healthcare. "However, there is currently a lack of standardized protocols for pre-admission procedures. This study aims to systematically analyze key nodes and risk factors in pre-admission process design and propose optimization strategies, providing a foundation for policy formulation and hospital practices. By constructing a "forward-reverse" dual-process model of pre-admission and identifying risk points based on stakeholder theory (patients, hospitals, healthcare administration, and insurance), the study reveals that while pre-admission can reduce the average length of stay, improve bed turnover rates, and enhance patient satisfaction, it also presents risks such as cross-period financial settlement, challenges in insurance policy adaptability, demands for information system integration, and the need for defining medical safety boundaries. To optimize the pre-admission process and mitigate these risks, this study explores framework improvements in areas including eligibility criteria, mode selection, cost settlement, transition between pre-admission and inpatient status, and cancellation of pre-admission, offering practical guidance for public hospitals. The authors argue that pre-admission requires tripartite collaboration among hospitals, insurers, and healthcare administrations: hospitals should establish top-level design, continuously refine processes, and implement dynamic risk assessment mechanisms; insurance providers should support cross-period settlement policies; and healthcare administrations should issue guiding policies or standardized protocols. Through multi-department coordination and collaborative efforts, the optimization and innovation of pre-admission processes can be advanced, ultimately delivering more efficient and convenient healthcare experiences for patients.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective To evaluate the effectiveness of thermal tomography in breast cancer (BC) screening. Methods We conducted a general population-based BC screening in three regions of Hubei Province (Xiantao, Hongan, and Yangxin Districts). Participants underwent a questionnaire-based interview for baseline data collection. They then received a physical examination, thermal tomography, and ultrasound from doctors and technicians. We compared the efficacies, including sensitivity, specificity, and false-positive rates, of ultrasound and thermal tomography in BC screening. Results A total of 59 712 eligible women were included in this screening program. The BI-RADS 1, 2, 3, 4, and 5 accordance rates between the two screening methods were 0.9549, 0.8047, 0.9037, 0.3352, and 0, respectively. The overall accordance rate was 0.933 1. The kappa consistency results showed that the Cicchetti-Allison and Fleiss-Cohen kappa values were 0.7970 and 0.8583, respectively. Although the two methods had equal sensitivities, specificity was higher in thermal tomography than in ultrasound. The false-positive rate was lower in thermal tomography than in ultrasound. The area under the receiver operating characteristic (ROC) curve of thermal tomography was significantly larger than that of ultrasound. Conclusion The general consistency between thermal tomography and ultrasound in BC screening was high. Thermal tomography outperformed ultrasound in terms of specificity and diagnostic efficiency. Therefore, thermal tomography has a high application value for general population-based BC screening.

Objective To explore the relationship between lipid metabolism and the risk of proliferative retinopathy(PDR)in patients with peripheral diabetic retinopathy(DR).Methods A total of 276 patients with type 2 diabetes mellitus(T2DM)who visited our hospital from May 2022 to July 2023 were selected and divided into the simple T2DM group(n=164)and the combined DR(DR)group(n=112).The DR group was further divided into the non-proliferative retinopathy(NPDR)subgroup(n=58)and the PDR subgroup(n=54)based on the severity of DR.Spearman correlation analysis was used to analyze the relationship between lipid metabolism indicators and PDR,and Logistic regression analysis was used to analyze the influencing factors of PDR.Results In the DR group,DM duration,the utilization rate of insulin(Ins),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),Leptin,TG/high-density lipoprotein cholesterol(HDL-C),residual cholesterol(RC),serum creatinine(Scr),and serum uric acid(SUA)were higher than those in the T2DM group(P<0.05),while fasting C-peptide(FC-P),HDL-C and adiponectin(APN)were lower than those in the T2DM group(P<0.05).The levels of SBP,HbA1c,TC,TG,LDL-C,Leptin,TG/HDL-C,RC,Scr and SUA in the PDR subgroup were higher than those in the NPDR subgroup(P<0.05),while FC-P,HDL-C and APN were lower than those in the NPDR subgroup(P<0.05).Spearman correlation analysis showed that PDR was positively correlated with the levels of TG/HDL,RC,and Leptin(r=0.331,0.264,0.358,P<0.05),and negatively correlated with APN(r=-0.174,P<0.05).Logistic regression analysis showed that TG/HDL-C(OR 2.067,95%CI 1.827～2.643),RC(OR 1.538,95%CI 1.336～2.372),Leptin(OR 1.673,95%CI 1.361～2.474),APN(OR 0.674,95%CI 0.231～0.865),and FC-P(OR 0.147,95%CI 0.067～0.887)were the influencing factors for the progression of NPDR to PDR.Conclusions Lipid metabolism is closely related to the progression from DR to PDR.Clinically,lipid metabolism monitoring of DR patients should be done well to improve prognosis.

Objective:To study the role of cadherin 1 (CDH1) gene DNA methylation in autoimmune thyroiditis (AIT) in population from different water-iodine regions.Methods:From May to June 2019, the information of AIT cases and healthy individuals in Shandong Province were collected in three types of water-iodine regions: iodine-fortification (IF) region, iodine-adequate (IA) region and iodine-excess (IE) region. A case-control study design was applied to match 176 AIT cases (case group) with age, gender, body mass index, and place of residence in a 1 ∶ 1 ratio to 176 healthy individuals (control group). Fasting urine and whole blood samples were collected to test the contents of urinary iodine, thyroid function indicators [serum free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid stimulating hormone (TSH)], and serum iodine. The DNA methylation levels of the target region of the CDH1 gene and its four CpG sites in whole blood were determined using methylation sequencing technology for target regions (MethylTarget TM). Results:The DNA methylation level of the target region of CDH1 gene in the case group was 0.832 ± 0.044, and that in the control group was 0.828 ± 0.049, there was no statistically significant difference between the two groups ( t = 0.76, P = 0.448). There was no statistically significant difference in DNA methylation levels of the four CpG sites in the target region of CDH1 gene between the case group and the control group ( P > 0.05). There was no statistically significant difference in the DNA methylation level of the CDH1 gene target region between the case group and the control group in IF, IA and IE regions ( P > 0.05). The detection results of DNA methylation levels at CpG sites in the target region of CDH1 gene in different water iodine regions showed that the DNA methylation level at site 83 in case group in IF region was higher than that in the control group ( t = 2.30, P = 0.023). However, there was no statistically significant difference in the DNA methylation levels of the four CpG sites between the case group and the control group in IA and IE regions ( P > 0.05). The DNA methylation level of CDH1 gene target region in AIT patients was not significantly correlated with urinary iodine, serum iodine, and serum FT 3, FT 4, and TSH contents ( P > 0.05), but was significantly negatively correlated with age ( r =-0.19, P = 0.014). Conclusions:The DNA methylation level at CpG site 83 of CDH1 gene in AIT patients in IF region is significantly higher than that in control population, indicating that DNA methylation at this locus may be involved in the occurrence and development of AIT after iodine fortification. The DNA methylation level of CDH1 gene is negatively correlated with age.

Objective To explore the impact of the interaction between fasting plasma glucose(FPG)and serum uric acid(SUA)on peripheral diabetic retinopathy(DR).Methods Peripheral DR patients(n=188)admitted to our hospital from July 2022 to June 2023 were selected as the research subjects and divided into mild to moderate non-proliferative diabetic retinopathy(NPDR)group(M-NPDR,n=114)and severe NPDR(S-NPDR,n=74)group.DM patients without diabetic retinopathy admitted to our hospital during the same period were set as the control(T2DM,n=100)group.The general data and biochemical indicators were compared among the three groups.Logistic regression was used to analyze the relationship between FPG and SUA and the severity of DR.The interaction between FPG and SUA was evaluated.A nomogram model was established to predict the occurrence of severe NPDR.Results The DM duration,best corrected visual acuity converted to logarithm of minimum resolution angles(logMAR BCVA),FPG,SUA and urinary albumin/creatinine ratio(UACR)in M-NPDR and S-NPDR groups were higher than those in T2DM group(P＜0.05).Subfoveal choroidal thickness(SFCT),albumin(ALB)and free triiodothyronine(FT3)were lower than those in the T2DM group(P＜0.05).BUN in S-NPDR group was higher than that in T2DM group(P＜0.05).The DM duration,logMAR BCVA,FPG,TC,TG and SUA in S-NPDR group were higher than those in M-NPDR group(P＜0.05),and SFCT was lower than that in M-NPDR group(P＜0.05).SFCT,FPG,ALB,SUA,and(UACR)were independent influencing factors of severe NPDR(P＜0.05).The column chart model predicted the probability of severe NPDR occurrence,with area under curve of 0.919 and 0.910 before and after validation,and the average absolute error of the calibration curve 0.013,which can be used as risk tool to predict DR severity of T2DM patients.Conclusions FPG and SUA are risk factors affecting the severity of DR and there is an interaction.Early warning of risk factors based on the nomogram model is helpful to improve the prognosis of patients with peripheral DR.

Objective:To investigate the application effect of BOPPPS+team-based learning (TBL) based on the concept of outcome-based education (OBE) in the teaching of infectious rash and fever illnesses in children.Methods:A total of 199 undergraduate students of the class 2019 in the five-year program of Department of Pediatrics in Chongqing Medical University were selected as subjects, and they were divided into experimental group with 99 students and control group with 100 students using a random number table. The students in the experimental group received BOPPPS+TBL teaching based on the OBE concept, while those in the control group received traditional teaching. After the end of the curriculum, scores were compared between the two groups, and a questionnaire survey was conducted for self-evaluation of teaching and learning effectiveness and the acceptance of teaching models. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:The experimental group had a significantly higher score of the course than the control group [(88.08±5.31) vs. (85.62±8.44), P=0.014]. The questionnaire survey showed that compared with the control group, the experimental group had significantly higher scores of the self-evaluation of teaching effectiveness [(4.40±0.75) vs. (3.36±1.13), P<0.001] and learning effectiveness [(4.31±0.84) vs. (3.35±1.19), P<0.001]. In the experimental group, 96.96% (96/99) of the students believed that BOPPPS+TBL teaching based on the OBE concept could help students to master and understand the knowledge points, and 93.93% (93/99) of the students were willing to use this teaching model in future learning. Conclusions:BOPPPS+TBL teaching based on the OBE concept can help to achieve teaching objectives and significantly improve student satisfaction and learning outcomes.

Objective:To explore the molecular mechanism of TCM compound Shengxue Tongbian Granules in improving intestinal injury in septic rats through bioinformatics and experimental validation methods.Methods:The GSE131761 gene set was processed by bioinformatics to screen differential genes, then weighted gene co-expression network analysis (WGCNA) was applied to screen modular genes. The intersection of modular genes and differential genes was taken, and finally, the least absolute shrinkage and selection operator (LASSO) technique was applied to further obtain the key targets of sepsis, which was validated by experiments. Totally 72 SD rats were divided into sham-operation group, model group, dexamethasone group (0.15 mg/kg), Shengxue Tongbian Granules low- (0.3 g/kg), medium- (0.6 g/kg), and high-dosage (1.2 g/kg) groups, with 12 rats in each group. Corresponding drug interventions were administered to each treatment group before and 12 hours after modeling. The sham-operation group and the model group were gavaged daily with equal amounts of saline. Samples were collected after 24 hours. HE staining was used to detect the pathological morphology of intestinal tissues in each group of rats; ELISA was used to detect the levels of TNF-α, diamine oxidase (DAO), IL-6, IL-10, and myeloperoxidase (MPO) in rat serum. Immunohistochemistry was used to detect the protein expressions of MPO and neutrophil elastase (NE/LANE) in intestinal tissue, and Western blot was used to detect the protein expression of peptidyl arginine deaminase (PAD4) in intestinal tissue.Results:Seven final key genes related to sepsis were selected, namely ANXA3, CYP1B1, FCAR, LILRA5, PADI4, NOV, and S100A12. Experimental results showed that drug administration alleviated intestinal injury; compared with the model group, the levels of TNF-α, IL-6, MPO, and DAO decreased in the Shengxue Tongbian Granules high-dosage group ( P<0.05), the levels of ELANE and MPO were reduced in Shengxue Tongbian Granules low-, medium-, and high-dosage groups ( P<0.05), and PAD4 expression was reduced in the Shengxue Tongbian Granules high-dosage group ( P<0.05). Conclusion:Shengxue Tongbian Granules can improve the intestinal injury of septic rats, and the mechanism may be related to the inhibition of PAD4-mediated formation of NETs and the improvement of inflammatory response.

The S100 calcium-binding protein family member A16(S100A16)exhibits differential expression in various malignant tumors and plays a critical role in tumor progression,including effects on tumor cell proliferation,apoptosis,adhesion,epithelial-mesenchymal transition,migration,and invasion.Its aberrant expression is associated with adverse clinical outcomes,making it a potential prognostic biomarker.Fur-thermore,S100A16 is closely linked to the infiltration of immune cells within the tumor microenvironment,contributing to the establish-ment of an immunosuppressive state.The expression level of S100A16 in tumor-associated endothelial cells may also correlate with the formation of an inhibitory immune microenvironment.Additionally,S100A16 has been implicated in tumor chemotherapy resistance.This review summarizes recent advances in our understanding of the mechanisms by which S100A16 contributes to different types of tumors,its regulatory effects on the tumor immune microenvironment,and its role in drug treatment resistance.The aim of this review is to elucidate the underlying mechanisms of tumor prevention and treatment and provide a theoretical foundation for overcoming drug resistance in can-cer therapy.