The ultrasonic manifestations of benign and malignant breast imaging-reporting and data system(BI-RADS)4 lesions overlap in some degrees,is able to result in unnecessary biopsy or untimely therapy.Accurate classifying the nature of BI-RADS 4 breast lesions can provide reliable references for clinical decision-making.The progresses of application of new ultrasonic technologies,including automated breast volume scanner,superb micro-vascular imaging,elastography,contrast-enhanced ultrasound and artificial intelligence for assisting diagnosis of BI-RADS 4 lesions were reviewed in this article.

Zedoary turmeric oil， volatile oil extracted from zedoary turmeric， composed mainly of monoterpenes （including α-pinene， β-pinene， etc.） and sesquiterpenes （including β-elemene， zedoary alcohol， zedoary ketone， etc.）， and has been used in clinical practice to treat various malignant tumors such as ovarian cancer， cervical carcinoma， colorectal cancer， lung cancer and liver cancer. Zedoary turmeric oil regulates vascular endothelial growth factor and nuclear factors- κB， signal transducers and activator of transcription 3 signaling pathways to play a role in inhibiting tumor angiogenesis， inhibiting tumor cell proliferation， inducing tumor cell apoptosis， and blocking cell cycle. However， due to its insolubility in water and poor stability， its clinical application is limited； the application of new formulations and technologies such as liposomes， microspheres， and nanoemulsion improves the solubility and stability of zedoary turmeric oil. This paper summarizes recent research progress on the chemical composition， anti-tumor effects， and formulations of zedoary turmeric oil， both domestically and internationally， providing a reference for further expanding the clinical application and formulation development of zedoary turmeric oil in the anti-tumor field.

Zedoary turmeric oil， volatile oil extracted from zedoary turmeric， composed mainly of monoterpenes （including α-pinene， β-pinene， etc.） and sesquiterpenes （including β-elemene， zedoary alcohol， zedoary ketone， etc.）， and has been used in clinical practice to treat various malignant tumors such as ovarian cancer， cervical carcinoma， colorectal cancer， lung cancer and liver cancer. Zedoary turmeric oil regulates vascular endothelial growth factor and nuclear factors- κB， signal transducers and activator of transcription 3 signaling pathways to play a role in inhibiting tumor angiogenesis， inhibiting tumor cell proliferation， inducing tumor cell apoptosis， and blocking cell cycle. However， due to its insolubility in water and poor stability， its clinical application is limited； the application of new formulations and technologies such as liposomes， microspheres， and nanoemulsion improves the solubility and stability of zedoary turmeric oil. This paper summarizes recent research progress on the chemical composition， anti-tumor effects， and formulations of zedoary turmeric oil， both domestically and internationally， providing a reference for further expanding the clinical application and formulation development of zedoary turmeric oil in the anti-tumor field.

Objective:To retrieve, evaluate and integrate the relevant evidence of prevention of lower limb ischemic complications in venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients, and provide reference for the development of scientific and complete prevention and management of lower limb ischemic complications.Methods:According to the evidence-based methodology, clinical decisions, guidelines, expert consensus, evidence summary, systematic review, randomized controlled trials and experimental studies related to lower limb ischemia complications in VA-ECMO patients were searched from CNKI, Wanfang, PubMed, Cochrane Library and other domestic and foreign databases as well as relevant professional websites. The literature search period was from the establishment of the database to August 2023. Two researchers independently evaluated the literature quality, and then extracted and summarized the evidence according to the theme.Results:A total of 27 004 articles were obtained in the preliminary search, and 11 articles were finally included after screening, including 1 guide, 2 expert consensus, 2 systematic reviews and 6 original studies. Through literature reading, evidence extraction and classification, and expert group meetings, a total of 24 best evidences were concluded in four dimensions, including team training and management, VA-ECMO pre-computer evaluation, VA-ECMO catheter selection, and the monitoring and management of lower limb ischemia.Conclusions:This study summarized the best evidence for the prevention of lower limb ischemia complications associated with VA-ECMO patients, and can provide reference for healthcare providers in clinical practice. In order to ensure the safety of VA-ECMO treatment and reduce the incidence of related complications, healthcare professionals should carefully select and apply evidence according to the clinical context and patients′ wishes.

To summarize LI Qiangou's clinical experience in treating laryngopharyngeal reflux disease （LPRD） based on the theory of "yang transforming qi while yin constituting form". It is believed that "insufficiency of yang transforming qi and excess of yin constituting form" is the key mechanism of LPRD， in which yang deficiency of the lungs， spleen and kidneys is an important factor causing "insufficiency of yang transforming qi"， while phlegm， dampness and other tangible yin turbidities are the pathological products of "excess of yin constituting form". The key treatment principle is to reinforce yang qi and dispel yin turbidity. Starting from regulating the qi transformation of the sanjiao， the treatment is based on the different pathologies of lung yang insufficiency and phlegm congestion in the upper jiao， spleen yang failing to ascend and dampness accumulation in the middle jiao， and kidney yang deficiency and phlegm-fluid retention in the lower jiao， prescribed by modified Suzi Jiangqi Decoction （苏子降气汤）， Shengyang Chushi Decoction （升阳除湿汤）， and Jingui Shenqi Pill （金匮肾气丸）， the prescriptions could also combine with Banxia Houpo Decoction （半夏厚朴汤） to dissolve phlegm and relieve pharyngeal pains， and regulate qi to direct counterflow downward.

Background and purpose:Tumor-associated macrophages(TAM)as the main stromal cells in the tumor microenvironment play an important role in tumor progression.This study aimed to explore the clinical significance of M1 type TAM infiltration in hepatocellular carcinoma(HCC).Methods:We collected tissue paraffin samples from 320 HCC patients who underwent surgery at the Affiliated Nantong Hospital Three of Nantong University from January 2012 to December 2020.Immunohistochemical methods were used to detect the distribution of CD86 labeled M1 type TAM in HCC tissues,and positive cell density was calculated.Groups were established according to cell density,high-density group had cells with greater than average density(29 cells/mm2),and low-density group had cells with less than or equal to average density.The correlation and prognostic significance of M1 TAM density with clinicopathologic features and tumor infiltrating CD8+T lymphocytes of HCC were analyzed.Using immunohistochemistry to detect the expression of programmed death ligand-1(PD-L1),the cases were divided into four groups based on the cell density of CD86 and PD-L1.In the CD86+high-density group,PD-L1 high-density(CD86highPD-L1high)and PD-L1 low-density(CD86highPD-L1low)groups were included.In the CD86+low-density group,the PD-L1 high-density(CD86lowPD-L1high)and PD-L1 low-density(CD86lowPD-L1low)groups were included.We analyzed the prognostic significance of CD86+M1 type TAM density combined with PD-L1 expression.This study was approved by the Ethics Committee of Affiliated Nantong Hospital Three of Nantong University(ethics number:EK2022005).Results:CD86+M1 type TAM was mainly distributed in the tumor stroma.Its high-density rate was 44.7%(143/320).The density of CD86+M1 type TAM was positively correlated with tumor infiltrating CD8+T lymphocyte density(P＜0.001)and negatively correlated with hepatitis B virus surface antigen(HBsAg)positivity(P=0.003),and had no significant correlation with clinical and pathological features such as patient age,gender,cirrhosis,tumor size,histological grading and microvascular invasion.The CD86+M1 type TAM high-density group had better overall survival(OS)and disease-free survival(DFS)than the low-density group,and the differences were statistically significant(all P＜0.001).Multivariate Cox proportional hazards regression model analysis showed that low-density CD86+M1 type TAM was an independent risk factor for evaluating OS and DFS(OS:HR=1.468,P=0.022;DFS:HR=2.233,P＜0.001).The CD86highPD-L1high group had poor OS and DFS than the CD86highPD-L1low group,and the differences were statistically significant(both P＜0.05).The CD86lowPD-L1high group had poor OS and DFS than the CD86lowPD-L1low group.The difference in OS between the two groups was statistically significant(P＜0.05),while the difference in DFS was not statistically significant.Conclusion:The presence of high-density CD86+M1 type TAM in HCC tissue suggests a good prognosis and is an independent prognostic factor.Expression of PD-L1 in HCC tissue suggests increased invasiveness and poorer prognosis.

Hemophilic arthritis(HA),caused by recurrent bleeding,can seriously affect patient quality of life and consumes extensive social and medical resources.There is thus a need to establish an animal model of HA for research;however,this is limited by ethical requirements.Here we review the recent literature and summarize research progress into animal models of HA at home and abroad,from the aspects of species selection,modeling method,histopathology,and imaging evaluation method.Species selection includes rodents such as mice,New Zealand rabbits,beagles,miniature pigs,and crab-eating macaques.Modeling method comprise gene knockout trauma models,gene knockout spontaneous models,and injection models.Among these,the gene knockout spontaneous model closely mimics the pathological process of spontaneous bleeding and concurrent arthritis in human HA,making it more relevant to human HA.However,due to high modeling costs,phenotypic instability,and low survival rates,this model is not the preferred choice for animal experimental studies.In contrast,gene knockout trauma models exhibit characteristics such as short modeling time,strong stability,and high success rates,thus being widely utilized in animal experimental research.Evaluation of HA models involves various imaging method including MRI,micro-CT,MSKUS/PD,in addition to various gross scoring method.By reviewing the progress of HA model research,more experimental evidence is provided for investigating the pathogenesis and validating the efficacy of HA treatments,thereby compensating for the lack of clinical data,particularly in the field of traditional Chinese medicine therapy.

Sphincter of Oddi dysfunction (SOD) refers to the abnormal physiological function of sphincter of Oddi, which causes a series of syndromes in biliary tract, pancreas and liver. At present, the related research of SOD is becoming a hot spot, but its pathogenesis is not clear. This article will review the domestic and international literatures on SOD, review the advantages and disadvantages of experimental animals such as rabbits, dogs and guinea pigs, and analyze the characteristics of drugs and surgical modeling, so as to provide references for future related model establishment.

Objective:To study the changes in the sphincter of Oddi pressure in rabbits after bilateral vagus nerve trunk severance and the therapeutic effect of Qingre Lidan Decoction, to provide a new way for the treatment of sphincter of Oddi dysfunction.Methods:Twenty-four 1.5~2.0 kg New Zealand Large White rabbits of either gender were randomly selected and divided into the control group, the model group, and the treatment group. In the control group, only pyloroplasty was performed; in the model group and the treatment group, pyloroplasty plus bilateral vagus nerve trunk dissection at the level of the diaphragm were performed, and in the treatment group, one month of gavage treatment with Qingre Lidan Decoction was carried out 7 days after the operation. Multi-channel bio-signal acquisition system was used to record the pressure changes of the sphincter of Oddi in rabbits of each group; ELISA was used to detect the changes of inflammatory factors IL-6 and tumor necrosis factor TNF-α in the serum of rabbits.Results:The pressure of the sphincter of Oddi in the model group was significantly higher than those in the control group [low-pressure area: (51.95±0.35) mmHg (1 mmHg=0.133 kPa) vs (21.60±1.13) mmHg ( P<0.05) ; High pressure area: (60.75±0.49) mmHg vs (20.70±0.85) mmHg ( P<0.05)], the pressure of sphincter of Oddi in the treatment group of Qingre Lidan Decoction was lower than that of the model group [low-pressure area: (22.70±1.13) mmHg vs (51.95±0.35) mmHg ( P<0.05); high-pressure area: (32.15±0.49) mmHg vs (60.75±0.49) mmHg ( P<0.05)]. Serum IL-6 and TNF-αwere significantly elevated in the model group compared to the control group; IL-6 and TNF-α levels were decreased in the treatment group compared to the model group, and the differences were statistically significant ( P<0.05). Conclusion:Bilateral vagus nerve trunk severance leads to Oddi sphincter dysfunction, and treatment with Qingre Lidan Decoction could improve Oddi sphincter dysfunction.

Traditional Chinese Medicine (TCM) non-drug therapy for gastroesophageal reflux mainly includes appropriate TCM techniques, such as conventional acupuncture, moxibustion, fire needle, etc. Emotional therapy, such as regulating emotion, transforming the patient's spirit and change the state of qi, the five-element music therapy, etc; exercise therapy, such as Baduanjin and Zhanzhuang, can be used alone, or in combination, or in combination with oral administration of Chinese materia medica. By reducing the probability of esophageal sphincter relaxation, inhibiting gastric acid secretion, improving esophageal motility disorder, reducing visceral hypersensitivity, immune regulation and other effects, it can alleviate the symptoms of acid reflux, heartburn and pharyngeal discomfort, and help to improve the patients' anxiety, depression and other negative emotions. It has the characteristics of simplicity and fewer adverse reactions, at the same time, according to the patient's condition and compliance to choose the appropriate therapy. The mechanism of TCM non-drug therapy in the treatment of this disease needs to be further explored, so as to better guide clinical popularization and application.