Objective:To analyze the multimodal ultrasound characteristics of primary breast cancer and sentinel lymph node (SLN) and to establish a nomogram model for predicting SLN metastasis in invasive breast cancer, thereby providing reference for precise clinical diagnosis and treatment.Methods:A total of 329 patients diagnosed with invasive breast cancer and admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from June 2018 to October 2023 were retrospectively enrolled. They were randomly divided into a training cohort ( n=230) and a validation cohort ( n=99) in a ratio of 7 to 3. In the training cohort, ultrasound findings and clinical parameters were analyzed, univariate and multivariate Logistic regression analyses were used to identify independent predictive factors for SLN metastasis, and a nomogram model was constructed based on these factors. The ROC curve, calibration curve, and decision curve analysis (DCA) were plotted between the training and validation cohorts to assess the discrimination, calibration, and clinical applicability of the nomogram model. Results:Regression analysis identified 3 independent risk factors for establishing the nomogram prediction model: ratio of the long diameter to the short diameter of SLN ( P=0.020), lymphatic contrast-enhanced ultrasound (LCEUS) enhancement pattern ( P<0.001) and intravenous contrast-enhanced ultrasound (ICEUS) enhancement mode ( P=0.002). The area under the curve (AUC) of the training cohort was 0.888, the accuracy was 0.865; the AUC of the validation cohort was 0.870, the accuracy was 0.859, demonstrating good predictive performance of the model in both cohorts. The calibration curve demonstrated that the nomogram has a strong concordance between predicted and actual probability. DCA demonstrated that the nomogram could increase net benefit within a certain probability threshold range. Conclusions:The nomogram based on ratio of the long diameter to the short diameter of SLN, LCEUS enhancement pattern and ICEUS enhancement mode can effectively predict SLN status in patients with invasive breast cancer, facilitating precise diagnosis and treatment.

Objective: Based on physical activity (PA) and sedentary behavior (SB) variables on weekdays and weekends, the study aims to cluster the physical activities inside and outside kindergartens and to explore the cluster characteristics of different children using physical fitness indicators, so as to provide new strategies and methods for early childhood education and health. Methods: From March to June 2019, 291 children aged 3-6 years from 6 kindergartens in Nanchang were recruited by a stratified cluster random sampling method. The ActiGraph GT3X-BT triaxial accelerometer was used to measure and analyze the PA and SB levels inside and outside the kindergarten. A twostep clustering algorithm model was employed for cluster analysis. Physical fitness were measured and evaluated according to the "National Physical Fitness Measurement Standard Manual (Preschool Section)". Differences in physical fitness among different clusters of children were compared, and the cluster characteristics of different children were analyzed. Results: The clustering algorithm model indicated that based on six indicators, including PA and SB inside the kindergarten on weekdays, and PA and SB outside the kindergarten on both weekdays and weekends, children could be divided into three categories:active inside (high PA, low SB inside), active outside (high PA outside), and inactive (low PA, high SB both inside and outside). The average silhouette coefficient of the model was 0.3, indicating good clustering results. Both the active inside and active outside children showed significantly higher PA inside on weekdays, PA outside on weekdays and weekends, daily low intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) than the inactive children ( F=157.91, 80.79 , 95.86, 95.52, 124.74, P <0.05). After adjusting for gender and age, the physical fitness scores of both active outside ( 19.03 ±0.47) and active inside (19.11±0.40) were significantly higher than those of the inactive children (17.94±0.31). Additionally, active inside children (3.91±0.14) also showed significantly better performance in continuous double-leg jumps, compared to inactive children (3.45±0.11) ( P <0.05). Conclusion Children active inside and those active outside perform well in PA. Future research should focus on the proportion of structured and unstructured PA time to enhance the overall physical fitness of children.

Objective:To learn about the characteristics of natural foci and the spatial distribution of mosquitoes and ticks in Yadong County, Tibet Autonomous Region (Tibet for short).Methods:The eco-geographical characteristics, demographic information, agricultural and animal husbandry data of the natural foci in Yadong County, Tibet were collected from the Yadong County 2020 statistical yearbook, vector data were collected from the Yadong County Center for Disease Control and Prevention, and the data of the meteorological station in Yadong County from 2010 to 2021 were collected from the World Weather Network. In July 2021, a total of 20 mosquito and tick sampling points were selected for field investigation according to the distribution characteristics of vegetation and animal husbandry of Yadong County. The light trap method was used to trap mosquitoes, and the manual inspection and flag dragging method were used to catch ticks. The spatial distribution characteristics of mosquitoes and ticks were analyzed.Results:The natural epidemic foci in Yadong County, Tibet, were high in the north and low in the south, with an elevation difference of about 5 000 m. It was rich in water resources, and the average runoff of Yadong River was 20.1 m 3/s. The climate in the north was cold and dry, and the south was mild and humid. From 2010 to 2021, the annual average station air pressure in Yadong County was 452.8 mmHg (1 mmHg = 0.133 kPa), the maximum monthly average temperature, precipitation and relative humidity of air were 8.7 ℃, 134.5 mm and 81.3%, respectively, all in July. A total of 6 897 diptera insects were attracted by the light trap method, all of which were non-blood-sucking mosquitoes. The total density was 163.77 pieces/(lamp·h), the dominant population was Muscaridae, accounting for 89.69% (6 186/6 897). In different sampling areas, Xiayadong Township collected the most mosquitoes, accounting for 67.17% (4 633/6 897); the others were Yadong County and Shangyadong Township, accounting for 27.36% (1 887/6 897) and 5.47% (377/6 897), respectively. A total 2 014 host animals were examined, and 23 parasitic ticks were caught, of which 20 were of the genus Ixodes and 3 were of the genus Haemophilus. No free ticks were caught in all ticks sampling points. Conclusions:The climate and ecological environment of the natural foci in Yadong County, Tibet have obvious vertical gradient. Mosquitoes and ticks are active, but the density is not high, the density of mosquitoes is generally high in the south and low in the north.

To establish rat model of lung ischemia/reperfusion (IR) in vivo, and to explore the effects of acidification pretreatment for respiratory acidosis on the expression of matrix metalloproteinase-9 (MMP-9) and the possible mechanisms.
 Methods: A total of 36 male Sprague-Dawley rats were divided into a sham group (S group), a IR group, and an experiment group (RA group) (n=12 in each group). The rat left lung hilum in the S group was dissociated, followed by perfusion without ischemia. After the left lung hilum in the IR group was blocked for 45 min, the rats were followed by reperfusion for 180 min. After left lung hilum in the RA group was dissociated, the respiratory parameters were adjusted so that pressure of end tidal carbon dioxide (PETCO2) reached 56-65 mmHg (1 mmHg=0.133 kPa) for 5 min, then the rats was subjected to IR. Lung tissue wet/dry (W/D) and lung permeability index (LPI) were calculated, while the lung histopathology was observed and the MMP-9 protein expression were measured.
 Results: Compared with the control group, the W/D and LPI in the IR group and the RA group increased after reperfusion (both P<0.05), and the levels of W/D and LPI in the group RA were lower than that in the IR group (P<0.05). LPI and pathology scores were significantly lower in the RA group than those in the IR group (both P<0.01). After IR, the expression of MMP9 in the lung tissues in the IR group and the RA group increased significantly (both P<0.01). The expression of MMP-9 protein in the RA group was significantly lower than that in the IR group (P<0.01).
 Conclusion: After lung IR injury, the expression of MMP-9 protein, vascular permeability and inflammatory exudation is increased. The acidification pretreatment for respiratory acidosis can inhibit the expression of MMP-9 protein and reduce inflammatory exudation after lung IR, showing a protective effect on lung IR injury.
Acidosis, Respiratory ; drug therapy ; prevention & control ; Animals ; Gene Expression Regulation, Enzymologic ; drug effects ; Lung ; enzymology ; Lung Injury ; enzymology ; Male ; Matrix Metalloproteinase 9 ; genetics ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; drug therapy ; prevention & control

Objective To investigate the effects of dexmedetomidine on renal function in patients with hemorrhagic shock undergoing emergency surgery.Methods Sixty patients (27 males, 33 females) with hemorrhagic shock, aged 18-69 years, ASA physical status Ⅲ or Ⅳ, required emergency surgery under general anesthesia, were randomized into two groups (n=30 each): dexmedetomidine group (group D) and control group (group C).The patients in group D receiving a loading dose of dexmedetomidine (0.5 μg/kg within 10 min) after the induction of anesthesia followed by a continuous infusion rate of 0.4 μg·kg-1·h-1 till 30 min before the end of surgery, while those in group C received equal volume of normal saline.Venous blood were obtained immediately before beginning of surgery (T1), immediately after surgery (T2), 24 h after surgery (T3) and 72 h after surgery (T4) for detecting the concentrations of the serum creatinine (Scr) and blood urea nitrogen (BUN), the contents of neutrophil gelatinase-associated lipocalin (NGAL) and high mobility group box-1 (HMGB1).The range ability of the concentration of the serum Scr from T4 to T1 (ΔScr) and the content of the serum HMGB1 from T4 to T1 (ΔHMGB1) were also calculated and recorded.Hemodynamic index (including MAP, HR) and arterial blood gas results were recorded during surgery.Results Compared with T1, MAP, CVP and BE were increased, meanwhile, HR and Lac were decreased at T2, but there was no statistically significant difference between the two groups.No statistical difference was found in BUN at any time point between group D and group C.Compared with T1, Scr decreased in both groups at T2-T4.The ΔScr in group D was higher than that in group C at T4 (P＜0.05).The content of serum NGAL at T4 in group D was significantly dropped when compared with T1 (P＜0.01) and was lower than that in group C (P＜0.05).Compared with T1, the content of serum HMGB1 was significantly decreased in both groups at T2 (P＜0.05);the content of serum HMGB1 at T3 in group C was significantly increased and was higher than that in group D;the ΔHMGB1 in group C was higher than that in group D.Conclusion Hemorrhagic shock could induce acute kidney injury.Perioperative continuous infusion of dexmedetomidine facilitated renal function recovery after ischemia-reperfusion injury in patients with hemorrhagic shock through inhibiting the elevation of serum HMGB1.

Objective To evaluate the effects of prolonged anesthesia with propofol during the early pregnancy on cognitive function of offspring rats.Methods One hundred and twenty female Sprague-Dawley rats at 5-7 days of gestation,weighing 280-320 g,were randomly divided into 4 groups (n =30 each) using a random number table:control group (group C),and propofol 2,4 and 8 h groups (P2,P4,P8 groups).In P2,P4,P8 groups,after propofol 20 mg/kg was injected intravenously,propofol was infused at 20 mg· kg-1 · h-1 for 2,4 and 8 h,respectively.In group C,normal saline 2 ml/kg was infused intravenously.At 30,31,32,33,34,35 and 36 days after birth,Morris Water maze was performed to evaluate the learning and memory abilities of offspring rats.At the end of Morris water maze test,the hippocampus of offspring rats was removed for microscopic examination of pathological changes with light and electron microscope.Results Compared with group C,the escape latencywas significantly prolonged,the frequency of crossing the original platform was decreased,and the time of staying at the original platform quadrant was shortened in p4 and P8 groups,and no significant changes were found in the indices mentioned above in group P2.The pathological changes of hippocampi were not found in C and P2 groups,while the pathological changes were obvious in P4 and P8 groups.Conclusion Prolonged anesthesia with propofol during the early pregnancy can induce cognitive dysfunction of offspring rats and the mechanism is related to the damage to hippocampal tissues.

Objective To investigate the effect of isoflurane anesthesia during early pregnancy on the cognitive function of offspring rats.Methods Thirty SD rats at 5-7 day gestation were randomly divided into 3 groups ( n =10 each):control group (group C) and 2 isoflurane groups (groups Ⅰ1,Ⅰ2).Groups Ⅰ1 and Ⅰ2 inhaled 1.4％ isoflurane in O2 for 4 and 8 h respectively while group C inhaled 95 ％ O2 for 8 h.At 20 and 30 days after birth,offspring rats from 5 pregnant rats were tested for learning and memory abilities using Morris water maze.The offsprings were sacrificed at 7 days after test and their hippocampi were isolated for determination of N-methyl-D-aspartate receptor subunit 2B (NR2B) mRNA and protein expression.Results There were no significant differences in the results of Morris water maze test and NR2B mRNA and protein expression among the three groups.Conclusion Isoflurane anesthesia during early pregnancy has no effect on the cognitive function of the offspring rats.

Objective To investigate the neurotoxic effects of different concentrations of tetracaine and ropivacaine on the brachial plexus nerve in rats.Methods Forty-eight male Sprague-Dawley rats,weighing 410-430 g,were randomly divided into 8 groups (n =6 each):normal saline group (group NS),0.25％,0.50％ and 1.00％ tetracaine groups (groups T1-3 ),and 0.25％,0.50％,1.00％ and 2.00％ ropivacaine groups (groups R1-4 ).The rats received injection of normal saline 1.0 ml,0.25％,0.50％ and 1.00％ tetracaine 0.5 ml,0.25％,0.50％,and 1.00％ ropivacaine 1.0 ml and 2.00％ ropivacaine 0.5 ml in groups NS,T1-3 and R1-4 respectively through one side of the axillary sheath.The other side of the axillary sheath served as control side.Five days later,compound action potential and nerve conduction velocity (NCV) of the brachial plexus nerve were measured.Tne brachial plexus nerve was obtained as the specimen for microscopic examination with light and transmission electron microscope.Results Compared with the control side and group NS,the compound action potential and NCV of the brachial plexus nerve were significantly decreased in groups T2,3 and R3,4 ( P ＜ 0.05 ).The compound action potential and NCV of the brachial plexus nerve were gradually decreased with the increasing concentrations of tetracaine in groups T1 3 ( P ＜ 0.05 ).The compound action potential and NCV of the brachial plexus nerve were significantly decreased in group R4 as compared with groups R1-3 (P ＜ 0.05).The microscopic examination showed that the pathologic changes were more severe in groups T2,3 and R3,4 than those on the control side and than in group NS.Conclusion 0.50％ and 1.00％ tetracaine,and 1.00％ and 2.00％ ropivacaine can result in pathologic damage to the brachial plexus nerve in rats and the degree of damage is related to the concentration.

Objective To investigate the effect of ketamine anesthesia in early pregnancy on expression of hippyragranin (HGN) mRNA in hippocampus in offsprings of rats.Methods One hundred and twenty pregnant Sprague-Dawley rats at 5-7 days of gestation,aged 7 weeks,weighing 270-300 g,were randomly divided into 4 groups (n =30 each):2 h anesthesia with ketamine group (group K1),4 h anesthesia with ketamine group (group K2),8 h anesthesia with ketamine group (group K3) and control group (group C).Ketamine 20 mg/kg was injected via the caudal vein,followed by continuous intravenous infusion at 130 mg· kg-1 · h-1 after loss of righting reflex,and the infusion lasted for 2,4 and 8 h in groups K1-K3,respectively.The equal volume of normal saline was given instead of ketamine in group C.The learning ability and memory of the offsprings were tested by Morris water maze test on postnatal day 30.The offsprings were sacrificed on 2nd day after the end of Morris water maze test,their brains were removed and hippocampi were isolated for determination of the expression of HGN mRNA by RT-PCR.Results Compared with group C,the escape latency was significantly prolonged,the frequency of crossing the original platform was decreased,the time of staying at the original platform quadrant was shortened,and the expression of HGN mRNA was up-regulated in groups K1-K3 (P ＜ 0.05).There was no significant difference in the escape latency,frequency of crossing the original platform and time of staying at the original platform quadrant among groups K1-K3 (P ＞ 0.05).The expression of HGN mRNA was significantly higher in group K3 that in group K1 (P ＜ 0.05).There was no significant difference in the expression of HGN mRNA between group K2 and group K3 (P ＞ 0.05).Conclusion The mechanism by which ketamine anesthesia in the early pregnancy induces impairment of learning ability and memory of the offsprings is related to up-regulation of HGN mRNA expression in hippocampus in offsprings of rats.

Objective To investigate the effect of inhalation of enflurane on the expression of N-methyl-D-aspartate receptor subunit 2B (NR2B) in the hippocampus of the offsprings of rats.Methods Thirty SD rats pregnancy 8-10 day weighing 200-250 g were randomly divided into 3 groups ( n =10 each):control group (Group C),4 h inhalation of enflurane group ( group E1 ) and 8 h inhalation of enflurane group ( group E2 ).Group E1 and E2inhaled 1.7 ％ enflurane (in O2 2 L/min) for 4 and 8 h respectively,while group C inhaled oxygen 2 L/rin for 8 h.The learning and memory functions of the offsprings were assessed at 20 and 30 days after birth by Morris maze test.The expression of the NR2B mRNA were examined by RT-PCR,NR2B protein were examined by mmunohistochemistry.Results Compared with group C,the escape latency was significantly prolonged,the frequency of crossing the original platform was significantly decreased,the staying time at the original platform quadrant was significantly shortened at 3-5 days after the test in group E1 and E2 (.P ＜ 0.05 ),the expression levels of NR2B mRNA and protein were significantly decreased at 20 and 30 days after birth in group E1 and E2 ( P ＜ 0.05).There were no significant differences in the indexes mentioned above between groups E1 and F2 ( P ＞ 0.05).Conclusion Inhalation enflurane in the early pregnancy can result in cognition dysfunction through inhibiting NR2B expression in the hippocampus of the offsprings of the rats.