Pathological diagnosis is the gold standard for confirming breast cancer. Traditional manual pathological diagnosis methods for breast cancer are time-consuming, labor-intensive, highly subjective, and exhibit poor diagnostic consistency. In recent years, artificial intelligence (AI) technology has rapidly advanced and is progressively being applied clinically as a promising early diagnostic tool. However, many existing AI models lack interpretability, which limits the trustworthiness of their clinical application. Khater et al, by combining a high-precision machine learning model with an explainable AI model, achieved highly accurate breast tumor diagnosis and provided explanations for key biological and pathological features influencing the diagnostic results. This points the way for the future application and development of AI in medical diagnosis and treatment. The article interprets the main content of that study, and analyzes the advantages and limitations of AI in medical diagnosis and treatment, with the aim of promoting its better application in clinical practice.

Breast cancer is one of the most common malignant tumors in women, and its treatment and management strategies are crucial for improving patients’ prognosis and quality of life. Early breast cancer refers to lesions confined to the breast and regional lymph nodes (N1 stage) without distant metastasis. Thanks to the improvement of screening techniques, the detection rate of early breast cancer has increased. The “early diagnosis and early treatment” model has led to a decrease in breast cancer mortality, especially among young women. The 2024 European Society for Medical Oncology (ESMO) clinical practice guideline for the diagnosis, treatment, and follow-up of early breast cancer aims to provide comprehensive and standardized recommendations for the diagnosis and treatment of early breast cancer, helping clinicians make optimal decisions. This article interprets the main content of the guideline in order to provide references and assistance for the current clinical diagnosis and treatment of early breast cancer in China.

Objective To compare the clinical efficacy of abdominal ultrasound-guided endoscopic retrograde appendicitis therapy(ERAT)with laparoscopic appendectomy(LA)for acute uncomplicated appendicitis using propensity score matching.Methods The clinical data of 441 patients with acute uncomplicated appendicitis admitted to the Third People's Hospital of Yunnan Province from March 2020 to April 2023 were collected.The cases were classified based on the differences in surgical method and divided into the ERAT group(n = 30)and LA group(n = 411).The clinical efficacy of patients was compared between the two groups after reducing confounding bias by propensity score matching(PSM).Results After PSM,a total of 30 pairs of patients in the two groups were successfully matched,and the baseline data of the two groups met the requirements for comparability.At 24 hours after the operation,the ERAT group exhibited lower white blood cells,neutrophil counts,and C-reactive protein levels compared to the LA group,and these differences were statistically significant(P<0.05).There was no significant difference in the operation time and total effective rate between the ERAT group and the LA group(P>0.05).However,the ERAT group had lower intraoperative blood loss and shorter pain relief time compared to the LA group,and these differences were statistically significant(P<0.05).Conclusion Abdominal ultrasound-guided endoscopic retrograde appendicitis treatment is an effective,safe,and feasible technique with good prospects for the treatment of acute uncomplicated appendicitis.

AIM:To investigate the role of phosphoenolpyruvate carboxykinase 1(PCK1)in the proliferation and migration of mouse vascular smooth muscle cells(VSMCs)and the underlying mechanism.METHODS:The prolif-eration and migration of mouse VSMCs were induced by platelet-derived growth factor(PDGF)-BB.The cells were divided into a vehicle group and a PDGF-BB group.The expression of PCK1 was detected by Western blot and immunofluores-cence staining.The mouse Pck1 siRNA(si Pck1)were transfected into mouse VSMCs to silence PCK1.The cells were di-vided into the vehicle,si Pck1+vehicle,PDGF-BB and si Pck1+PDGF-BB groups.The protein level of PCK1 was detected by Western blot.The proliferation was explored by Ki-67 immunofluorescence staining and the viability was detected by CCK-8 assay.The migration was determined by a scratch test.Mitochondrial dynamics were observed via transmission electron microscopy.A lentivirus carrying dynamin-related protein 1(Drp1)gene(lenti-Drp1)was transfected into VSMCs to induce them to overexpress DRP1.The cells were divided into the PDGF-BB,si Pck1+PDGF-BB,lenti-Drp1+PDGF-BB and lenti-Drp1+si Pck1+PDGF-BB groups.Proliferation,migration and mitochondrial dynamics were measured as described above.RESULTS:PDGF-BB increased the protein expression of PCK1 and DRP1,cell viability,the per-centage of Ki-67-positive cells,the wound healing rate and mitochondrial division in VSMCs.These effects were sup-pressed when PCK1 protein expression was silenced.After DRP1 was overexpressed,the inhibitory effects of PCK1 silenc-ing on cell viability,the percentage of Ki-67-positive cells,the wound healing rate and mitochondrial division were signifi-cantly reversed.CONCLUSION:PCK1 promotes the mitochondrial division,proliferation and migration of VSMCs in mice by upregulating the expression of DRP1.

Drug-induced hyperglycemia/diabetes is a global issue. Some drugs induce hyperglycemia by activating the pregnane X receptor (PXR), but the mechanism is unclear. Here, we report that PXR activation induces hyperglycemia by impairing hepatic glucose metabolism due to inhibition of the hepatocyte nuclear factor 4-alpha (HNF4α)‒glucose transporter 2 (GLUT2) pathway. The PXR agonists atorvastatin and rifampicin significantly downregulated GLUT2 and HNF4α expression, and impaired glucose uptake and utilization in HepG2 cells. Overexpression of PXR downregulated GLUT2 and HNF4α expression, while silencing PXR upregulated HNF4α and GLUT2 expression. Silencing HNF4α decreased GLUT2 expression, while overexpressing HNF4α increased GLUT2 expression and glucose uptake. Silencing PXR or overexpressing HNF4α reversed the atorvastatin-induced decrease in GLUT2 expression and glucose uptake. In human primary hepatocytes, atorvastatin downregulated GLUT2 and HNF4α mRNA expression, which could be attenuated by silencing PXR. Silencing HNF4α downregulated GLUT2 mRNA expression. These findings were reproduced with mouse primary hepatocytes. Hnf4α plasmid increased Slc2a2 promoter activity. Hnf4α silencing or pregnenolone-16α-carbonitrile (PCN) suppressed the Slc2a2 promoter activity by decreasing HNF4α recruitment to the Slc2a2 promoter. Liver-specific Hnf4α deletion and PCN impaired glucose tolerance and hepatic glucose uptake, and decreased the expression of hepatic HNF4α and GLUT2. In conclusion, PXR activation impaired hepatic glucose metabolism partly by inhibiting the HNF4α‒GLUT2 pathway. These results highlight the molecular mechanisms by which PXR activators induce hyperglycemia/diabetes.

Asbestos is harmful to human, and populations with occupational and environmental exposure to respirable asbestos fibers have higher risk of cancers like malignant mesothelioma and lung cancer. At present, patient with asbestos-induced malignant peritoneal mesothelioma and lung cancer is rare. In this study, we analyzed the clinical data of a case of asbestos-induced malignant peritoneal mesothelioma complicated with lung cancer to investigate the diagnosis and treatment of this disease.

Asbestos is harmful to human, and populations with occupational and environmental exposure to respirable asbestos fibers have higher risk of cancers like malignant mesothelioma and lung cancer. At present, patient with asbestos-induced malignant peritoneal mesothelioma and lung cancer is rare. In this study, we analyzed the clinical data of a case of asbestos-induced malignant peritoneal mesothelioma complicated with lung cancer to investigate the diagnosis and treatment of this disease.

Objective:To investigate the effects of cattle encephalon glycoside and ignotin(CEGI)on the expression of glial fibrillary acidic protein(GFAP)and neuronal nuclear antigen(NeuN)in the brain of APP/PS1 model mice of Alzheimer's disease.Methods:A total of 36 5-month-old APP/PS1 dual-transgenic model mice were randomly divided into 3 groups: the model group(normal saline 6.6 ml·kg -1·d -1), CEGI group(CEGI 6.6 ml·kg -1·d -1)and donepezil group(donepezil 2 mg·kg -1·d -1), with 12 in each group.Twelve C57BL/6J mice of the same age were used as the normal control group.All mice were given drugs for 6 weeks consecutively.Brain tissue was collected for immunohistochemical staining to detect the expression of amyloid β-protein(Aβ), GFAP and NeuN, which were then analyzed quantitatively. Results:The results of immunohistochemical staining indicated that levels of Aβ and GFAP were higher and levels of NeuN were lower in the model group than in the normal control group(0.147±0.068% vs.0%, 61.750±22.020 vs.26.000±4.598, 0.021±0.002 vs.0.032±0.003, P<0.05). Levels of Aβ and GFAP were lower and levels of NeuN were higher in the CEGI group and the donepezil group than in the model group(0.058±0.055 % vs.0.057±0.045 %, 38.250±5.418 vs.36.130±5.963, 0.029±0.004 vs.0.027±0.003, P<0.05). There was no significant difference in the expression of Aβ, GFAP and NeuN between the CEGI group and the donepezil group( P>0.05). Conclusions:CEGI has multi-target neuroprotective effects via down-regulating the expression of Aβ and GFAP and up-regulating the expression of NeuN.

Objective:To evaluate preoperative serum ferritin (SF) in predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC).Methods:A retrospective analysis was conducted on 280 ESCC patients undergoing radical resection of esophageal cancer at Zhejiang Cancer Hospital from Jan 2008 to Dec 2013. Univariate and multivariate analysis were used to investigate the relationship between preoperative SF level and patients′ clinicopathologic characteristics. Kaplain-Meier method was used to analyze the relationship between preoperative SF level and the prognosis.Results:There were 183 cases (65.4%) with low SF level and 97cases (34.6%) with high SF level. The 1-, 3-and 5-year survival rates in low SF patients were 78.7%, 50.3%, 43.2% and that in high SF were 69.1%, 35.1%, 32.0%, respectively (χ 2=4.697, P=0.031). Univariate analysis demonstrated that intravascular cancer embolus, nerve infiltration and the level of preoperative SF were related to ESCC patients prognosis (all P<0.05). The multivariate analysis showed that carcinoma cell embolus ( OR=1.662, 95% CI: 1.239-2.229, P=0.001), nerve infiltration ( OR=1.823, 95% CI: 1.361-2.443, P<0.001) and the level of preoperative SF ( OR=1.504, 95% CI: 1.113-2.032, P=0.008) were independent risk factors for ESCC patients prognosis. Conclusion:Preoperative SF level closely associates with the prognosis of ESCC patients.

Objective To analyze the infectious status and genotype characteristics of group A rotavirus (RV) in children with diarrhea in Hangzhou city in 2017, and to provide information for the disease surveillance, epidemic control as well as vaccine development.Methods Fecal samples from children with acute diarrhea at Children's Hospital of Zhejiang University were collected from Jan to Dec in 2017. All samples were tested for RV antigen by emulsion technique. The antigen-positive samples were further detected by reverse transcription polymerase chain reaction (RT-PCR) and sequencing to determine the G and P genotypes. The RV positive rates in different genders, ages and months were compared by chi-square test. Results A total of 20895 fecal samples were collected from 12389 male patients and 8506 female patients. The gender ratio was 1.46:1. In 5012 (23.99％) RV antigen positive samples, 2964 (23.92％) were from male patients and 2048 (24.08％) were from female patients. There was no gender difference in RV positive rate (χ2=0.049, P>0.05). In the study, RV could be detected in the whole year. January, February and December were peak months, and the RV positive rates were significantly different in different months (χ2=2654.681, P<0.05). The highest RV positive rate was in 18-24 months age group and the lowest in<6 months age group, respectively. Children under 2 years old accounted for 76.56％RV positive cases, and those under 5 years old accounted for 98.72％ RV positive cases. The RV positive rates were also significantly different in all age groups (χ2=1013.832, P<0.05). A total of 116 samples were selected from each month, following the random stratified sampling principle, for PCR amplification, sequencing, and genotyping according to VP7 (G genotype) and VP4 (P genotype). A total of 4 G genotypes were detected and G9 (85.3％) was the predominant one. In the two detected P genotypes, P[8] (96.6％) was predominant. The 4 G/P combination genotypes were G9P[8] (85.3％), G3P[8] (9.5％), G2P[4] (3.5％), and G1P[8] (1.7％). Conclusions RV was a common pathogen in pediatric patients with acute diarrhea in Hangzhou city in 2017. Children under 5 years old, especially 18 months to 2 years old infants was the main infected population. The study showed RV infection had obvious seasonality and winter was the peak period. The G9 genotype was predominant in G genotypes, P[8] genotype was predominant in P genotypes, and G9P[8] genotype was predominant in G/P combination genotypes, respectively.