Breast cancer stands as the most prevalent malignancy and the primary cause of cancer-related mortality among women globally.The lymph node status is not only pivotal for accurate clinical staging of breast cancer but also significantly associated with patients'prognosis.Magnetic resonance imaging(MRI)has advantages in evaluating lymph nodes status and the response effect of neoadjuvant therapy,serving as a valuable complement to other imaging modalities.Standardized scoring systems,such as Node Reporting and Data System(Node-RADS),integrate key features including lymph node size,margin characteristics,and enhancement patterns,effectively minimizing interobserver variability in evaluation.MRI radiomics,by extracting quantitative features at high throughput,converts medical images into mineable and analyzable data.Further integrating MRI radiomics,clinicopathological features and molecular subtype information to construct multi-omics models,can effectively predict axillary lymph node metastasis,thereby providing a biological basis for personalized treatment.Artificial intelligence(AI)leverages extensive search algorithms and parameter spaces to generate predictive models.AI-driven MRI analysis has proven effective in predicting lymph node metastasis and treatment responses.In the evaluation of neoadjuvant chemotherapy,the fully automated-integrated system based on deep learning(FAIS-DL)system,which combines multi-region dynamic contrast enhanced-MRI(DCE-MRI)and clinical data,can efficiently predict axillary pathological complete response.This innovation has substantially reduced the rate of unnecessary axillary lymph node dissection(ALND)from 47.9%to 6.8%.This article reviewed the prediction of lymph node status in breast cancer by MRI at different developmental stages,with the aim of enhancing the understanding of clinicians and radiologists regarding the application of MRI in the assessment of lymph node status in breast cancer and evaluating the efficacy of neoadjuvant therapy,and providing assistance for the construction of a model for accurately predicting lymph node status in breast cancer.

Breast cancer stands as the most prevalent malignancy and the primary cause of cancer-related mortality among women globally.The lymph node status is not only pivotal for accurate clinical staging of breast cancer but also significantly associated with patients'prognosis.Magnetic resonance imaging(MRI)has advantages in evaluating lymph nodes status and the response effect of neoadjuvant therapy,serving as a valuable complement to other imaging modalities.Standardized scoring systems,such as Node Reporting and Data System(Node-RADS),integrate key features including lymph node size,margin characteristics,and enhancement patterns,effectively minimizing interobserver variability in evaluation.MRI radiomics,by extracting quantitative features at high throughput,converts medical images into mineable and analyzable data.Further integrating MRI radiomics,clinicopathological features and molecular subtype information to construct multi-omics models,can effectively predict axillary lymph node metastasis,thereby providing a biological basis for personalized treatment.Artificial intelligence(AI)leverages extensive search algorithms and parameter spaces to generate predictive models.AI-driven MRI analysis has proven effective in predicting lymph node metastasis and treatment responses.In the evaluation of neoadjuvant chemotherapy,the fully automated-integrated system based on deep learning(FAIS-DL)system,which combines multi-region dynamic contrast enhanced-MRI(DCE-MRI)and clinical data,can efficiently predict axillary pathological complete response.This innovation has substantially reduced the rate of unnecessary axillary lymph node dissection(ALND)from 47.9%to 6.8%.This article reviewed the prediction of lymph node status in breast cancer by MRI at different developmental stages,with the aim of enhancing the understanding of clinicians and radiologists regarding the application of MRI in the assessment of lymph node status in breast cancer and evaluating the efficacy of neoadjuvant therapy,and providing assistance for the construction of a model for accurately predicting lymph node status in breast cancer.

Sepsis is one of the leading causes of death in intensive care unit(ICU)patients,typically resulting from excessive inflammation induced by infection,leading to multiple organ dysfunction syndrome and life-threatening complications.Exosomes are a type of extracellular vesicle that are lipid bilayered nanoparticles secreted by cells.In recent years,numerous studies have demonstrated their involvement in the occurrence and development of sepsis.The various molecular substances carried by exosomes have been shown to regulate sepsis-related inflammation and organ damage.In particular,different types of exosomes hold promise as diagnostic biomarkers for sepsis patients,and also provide new therapeutic targets for improving patient outcomes.This review was conducted on the research progress concerning the relationship between exosomes and sepsis,sepsis associated-acute lung injury(SA-ALI),sepsis associated encephalopathy(SAE),sepsis associated-acute kidney injury(SA-AKI),sepsis associated cardiomyopathy(SIC),and other organ injuries related to sepsis.This study aims to assist in guiding clinical diagnosis and treatment.

Objective: To identify the functional connectivity characteristics of insula, sensory and social related brain regions in boys with autism spectrum disorder(ASD), to explore the central nervous basis of sensory abnormality affecting core symptoms in boys with ASD. Methods: Resting state functional magnetic resonance imaging (rs fMRI) data were collected from 34 boys with ASD and 29 typical development boys (TD group). Based on functional connectivity analysis, the sensory related brain regions, insula, and social related brain regions were taken as regions of interest to calculate the functional connectivity (FC) level between the regions of interest, the differences between the two groups were compared and the results were corrected by FDR. The Autism Diagnostic Observation Schedule (ADOS), Childhood Autism Rating Scale (CARS) and Autism Spectrum Quotient-Children s Version (AQ-Child) were used to assess the core phenotypes of boys with ASD. Results: Compared with the TD group, the levels of FC between tactile brain regions and insula, olfactory brain regions and insula, auditory brain regions and insula in boys with ASD group were significantly increased. The level of FC between the insula and bilateral amygdala，insula and the medial prefrontal cortex(mPFC) were significantly increased( P <0.05).Pearson correlation analysis showed that the level of FC between auditory brain region(BA42)and left insula in ASD group was negatively correlated with the scores of communication subscale of ADOS( r =-0.44)，social interaction subscale of ADOS( r =-0.43), communication & social interaction subscale of ADOS( r =-0.49),attention to details subscale of AQ-Child( r =-0.41). The level of FC between the right insula and right amygdala was positively correlated with the attention switch subscale of AQ-Child( r =0.38), the level of FC between right insula and mPFC was positively correlated with the scores of repetitive behavior subscale of ADOS( r =0.48), the attention switch subscale of AQ-Child( r =0.49), total scale subscale of AQ-Child( r =0.41), total scale of CARS( r =0.41)( P < 0.05 ). Conclusion The levels of FC between insula and sensory related, social related brain regions are abnormal in children with ASD, which have significant correlations with clinical symptoms. In depth studies can be conducted to explore underlying neutral mechanisms.

Objective: To explore the differences of sensory manifestations between ASD children and typical development children, and to clarify the characteristics of sensory abnormalities in ASD and their relationship with various clinical symptoms, so as to provide scientific basis for early identification and specific intervention. Methods: A total of 265 ASD children who received rehabilitation training in autism rehabilitation institutions in Heilongjiang Province were collected as the case group, and 223 typical development children in ordinary kindergartens and schools in Harbin were taken as the control group. Short Sensory Profile (SSP) was used to evaluate the difference of children s sensory perception level between the two groups, and Social Response Scale (SRS) and Autism Behavior Checklist (ABC) were used to evaluate the severity of symptoms including social disorder of autistic children. The correlation between SSP scores in ASD group and clinical scales was analyzed. Results: The comparison of SSP scores between the two groups found that the median scores of all sensory dimensions in ASD group (tactile=33, taste/smell=18, motion sensitivity=13, Low response/sensation seeking=28, auditory filtering=19, low strength=22, visual/auditory=20) were lower than those of the healthy control group( Z =-2.73,-4.36,-3.17,-5.09,-11.00,-10.45,-3.43, P <0.05). The abnormal rate of multisensory score in children in ASD group was 55.1%, and that in control group was 21.2%, with significant difference( χ 2=57.15, P <0.05). Correlation analysis showed that SSP score in ASD group was negatively correlated with all dimensions of SRS, nonverbal communication, and social function of ADI-R scale, ADOS communication and social interaction, and total scores of ABC and CARS( P < 0.05 ). Conclusion Children with ASD have atypical sensory experiences, especially in auditory filtering dimension, and the level of atypical sensation is related to the severity of clinical symptoms of autism. In the future clinical diagnosis, treatment and research, it is necessary to strengthen the ability to recognize the sensory symptoms of children with ASD, so as to realize the early diagnosis and intervention.

Objective:To explore the clinical value of N terminal pro B type natriuretic peptide (NT-proBNP) in diagnosing or predicting heart failure in peridialysis chronic kidney disease (CKD) population.Methods:It was a single-center retrospective study. Patients with peridialysis CKD who visited the Department of Nephrology, First Affiliated Hospital of Zhengzhou University from January 2021 to June 2021 were collected and divided into 4 groups according to the presence or absence of heart failure and the level of left ventricular ejection fraction (LVEF), namely the non-heart failure group, heart failure with reduced ejection fraction (HFrEF) group (LVEF<40%), heart failure with mid-range ejection fraction (HFmrEF) group (40％≤LVEF<50％), and heart failure with preserved ejection fraction (HFpEF) group (LVEF≥50％). The NT-proBNP, echocardiography and other indicators of the 4 groups were compared. The value of plasma NT-proBNP in diagnosing heart failure, HFpEF, HFmrEF and HFrEF was analyzed by drawing receiver operating characteristic curve (ROC curve). Logistic regression analysis was used to analyze the related factors of heart failure in peridialysis CKD patients.Results:A total of 508 patients were included, including 11 cases in the HFrEF group, 29 cases in the HFmrEF group, 152 cases in the HFpEF group, and 316 cases without heart failure. The differences in age, 24-h urine volume, hemodialysis proportion, non-dialysis proportion, serum creatinine, estimated glomerular filtration rate, hemoglobin, serum albumin, C-reactive protein, NT-proBNP, cardiac troponin I, left ventricular internal diameter, LVEF, pulmonary artery systolic pressure, left ventricular end-diastolic volume, E/A value, septal thickness, and left ventricular posterior wall thickness among the four groups were statistically significant ( P < 0.05, respectively). A two-pair comparison (all P values corrected by Bonferroni method) revealed that the 24-h urine volume was higher in the non-heart failure group than in the other three groups (corrected P<0.05, respectively), while the proportion of hemodialysis patients and the levels of NT-proBNP and C-reactive protein were lower in the non-heart failure group than in the other three groups (corrected P<0.001, respectively); the levels of hemoglobin and serum albumin were lower in the HFpEF group than in the non-heart failure group (corrected P<0.001, respectively); troponin I was lower in the non-heart failure group than in the HFpEF group (corrected P<0.001), HFmrEF group (corrected P=0.001) and HFrEF group (corrected P<0.001), and troponin I was lower in the HFpEF group than in the HFrEF group (corrected P=0.008); LVEF was higher in the non-heart failure group than in the other three groups (corrected P<0.001, respectively), and LVEF in the HFpEF group was higher than in the HFmrEF and HFrEF groups (corrected P<0.001, respectively). For patients with peridialysis CKD, the cut-off values of plasma NT-proBNP for diagnosing or predicting heart failure, HFpEF, HFmrEF and HFrEF were 4 943.33 ng/L, 4 976.83 ng/L, 14 964.5 ng/L and 17 847.55 ng/L, respectively. Multivariate logistic regression analysis showed that NT-proBNP (every 500 ng/L increase, OR=1.390, 95% CI 1.287-1.501, P<0.001), LVEF ( OR=0.747, 95% CI 0.656-0.851, P<0.001) and 24-h urine volume (every 100 ml increase, OR=0.842, 95% CI 0.763-0.929, P=0.001) were independently correlated with heart failure. Conclusions:The cut-off value of plasma NT-proBNP for diagnosing or predicting heart failure in peridialysis CKD patients is much higher than that in patients with normal renal function. NT-proBNP, LVEF and 24-h urine volume are independently associated with heart failure in peridialysis CKD patients.

Objective:To explore the risk signals of brigatinib-related adverse events (AEs) and provide reference for the safe use in clinical practice.Methods:The US FDA Adverse Event Reporting System database was searched and AE reports on brigatinib as the primary suspect drug from April 1, 2017 to March 31, 2022 were collected. AEs were standardized and classified according to the preferred terms (PT) and system organ class (SOC) of Medical Dictionary for Regulatory Activities 24.0. Reported odds ratio ( ROR) and proportional reporting odds ratio ( PRR) methods were used to mine the AE risk signals of brigatinib. An AE with reports ≥3, ROR≥2, 95% confidence interval ( CI) lower limit of ROR>1, or reports ≥3, PRR≥2, and χ2>4 was defined as a positive signal. Positive PT signals were analyzed using descriptive method. Results:A total of 1 564 AE reports were included in the analysis, involving 672 PTs. After analysis using ROR and PRR methods, 52 PTs with positive risk signals were obtained, involving 16 SOCs. The top 10 PTs in report amount were fatigue, diarrhea, nausea, cough, abnormal serum creatine phosphokinase, dyspnea, headache, rash, vomiting, and hypertension, all of which were common AEs in the instructions. The top 10 PTs in signal intensity were pituitary infarction, radiation necrosis, elevated amylase, esophageal varices, early saturation, elevated lipase, abnormal serum creatine phosphokinase, pulmonary toxicity, prolonged activated partial thromboplastin time, and photosensitivity. Among them, the PTs ranked 1st, 2nd, 4th, 5th, 8th, and 10th were not recorded in the label. Pneumonia and interstitial lung disease (ILD) were serious AEs, with 31 and 8 reports, respectively. In the 52 PTs, 28 were not included in the drug label, involving 12 SOCs. Conclusions:The main adverse reactions of brigatinib were diarrhea, nausea, cough, and abnormal serum creatine phosphokinase and serious adverse reactions such as pneumonia and ILD were both reported, which were consistent with the common AE recorded in the drug label. In addition, brigatinib might cause pituitary infarction, radiation necrosis, pulmonary toxicity, photosensitivity, etc., which should be vigilant in clinical practice.

Dual target therapy of dabrafenib combined with trametinib (DabTram) plays an important role in the treatment of malignancies. Ocular toxicities are adverse reactions which are relatively uncommon but potentially serious in DabTram treatment. At present, there is a lack of systematic research on ocular toxicities caused by DabTram, leading to insufficient understanding of this problem. In this paper, the literature on DabTram-related ocular toxicities are systematically reviewed, especially focusing on the incidence, clinical characteristics, mechanisms of occurrence, therapeutic measures and so on, and the corresponding management pathways in clinical medication were proposed to provide references for safe use of DabTram in clinic.

Objective:To explore the risk signals of brigatinib-related adverse events (AEs) and provide reference for the safe use in clinical practice.Methods:The US FDA Adverse Event Reporting System database was searched and AE reports on brigatinib as the primary suspect drug from April 1, 2017 to March 31, 2022 were collected. AEs were standardized and classified according to the preferred terms (PT) and system organ class (SOC) of Medical Dictionary for Regulatory Activities 24.0. Reported odds ratio ( ROR) and proportional reporting odds ratio ( PRR) methods were used to mine the AE risk signals of brigatinib. An AE with reports ≥3, ROR≥2, 95% confidence interval ( CI) lower limit of ROR>1, or reports ≥3, PRR≥2, and χ2>4 was defined as a positive signal. Positive PT signals were analyzed using descriptive method. Results:A total of 1 564 AE reports were included in the analysis, involving 672 PTs. After analysis using ROR and PRR methods, 52 PTs with positive risk signals were obtained, involving 16 SOCs. The top 10 PTs in report amount were fatigue, diarrhea, nausea, cough, abnormal serum creatine phosphokinase, dyspnea, headache, rash, vomiting, and hypertension, all of which were common AEs in the instructions. The top 10 PTs in signal intensity were pituitary infarction, radiation necrosis, elevated amylase, esophageal varices, early saturation, elevated lipase, abnormal serum creatine phosphokinase, pulmonary toxicity, prolonged activated partial thromboplastin time, and photosensitivity. Among them, the PTs ranked 1st, 2nd, 4th, 5th, 8th, and 10th were not recorded in the label. Pneumonia and interstitial lung disease (ILD) were serious AEs, with 31 and 8 reports, respectively. In the 52 PTs, 28 were not included in the drug label, involving 12 SOCs. Conclusions:The main adverse reactions of brigatinib were diarrhea, nausea, cough, and abnormal serum creatine phosphokinase and serious adverse reactions such as pneumonia and ILD were both reported, which were consistent with the common AE recorded in the drug label. In addition, brigatinib might cause pituitary infarction, radiation necrosis, pulmonary toxicity, photosensitivity, etc., which should be vigilant in clinical practice.

Dual target therapy of dabrafenib combined with trametinib (DabTram) plays an important role in the treatment of malignancies. Ocular toxicities are adverse reactions which are relatively uncommon but potentially serious in DabTram treatment. At present, there is a lack of systematic research on ocular toxicities caused by DabTram, leading to insufficient understanding of this problem. In this paper, the literature on DabTram-related ocular toxicities are systematically reviewed, especially focusing on the incidence, clinical characteristics, mechanisms of occurrence, therapeutic measures and so on, and the corresponding management pathways in clinical medication were proposed to provide references for safe use of DabTram in clinic.