Breast cancer remains a leading cause of mortality in women worldwide.Triple-negative breast cancer(TNBC)is a particularly aggressive subtype characterized by rapid progression,poor prognosis,and lack of clear therapeutic targets.In the clinic,delineation of tumor heterogeneity and development of effective drugs continue to pose considerable challenges.Within the scope of our study,high hetero-geneity inherent to breast cancer was uncovered based on the landscape constructed from both tumor and healthy breast tissue samples.Notably,TNBC exhibited significant specificity regarding cell prolif-eration,differentiation,and disease progression.Significant associations between tumor grade,prog-nosis,and TNBC oncogenes were established via pseudotime trajectory analysis.Consequently,we further performed comprehensive characterization of the TNBC microenvironment.A crucial epithelial subcluster,E8,was identified as highly malignant and strongly associated with tumor cell proliferation in TNBC.Additionally,epithelial-mesenchymal transition(EMT)-associated fibroblast and M2 macrophage subclusters exerted an influence on E8 through cellular interactions,contributing to tumor growth.Characteristic genes in these three cluster cells could therefore serve as potential therapeutic targets for TNBC.The collective findings provided valuable insights that assisted in the screening of a series of therapeutic drugs,such as pelitinib.We further confirmed the anti-cancer effect of pelitinib in an orthotopic 4T1 tumor-bearing mouse model.Overall,our study sheds light on the unique characteristics of TNBC at single-cell resolution and the crucial cell types associated with tumor cell proliferation that may serve as potent tools in the development of effective anti-cancer drugs.

Objective To investigate the application value of extracellular volume fraction(ECV)obtained from enhanced CT in diagnosis and classification of acute pancreatitis.Methods The clinical data from patients with acute pancreatitis(acute pancreatitis group)and normal controls(control group)underwent enhanced CT were analyzed retrospectively.The CT values of pancreas and abdominal aorta in the same sclice on precontrast and equilibrium-phase images were measured,and then pancreatic ECV was calcu-lated.The measured parameters were compared between the groups of control and acute pancreatitis,and subgroups of non-severe and severe pancreatitis.The logistic regression analysis was used to identify the risk factors for acute pancreatitis and severe pancrea-titis,and the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency in diagnosis and classifica-tion of acute pancreatitis.Results The pancreatic CT value and ECV were independent risk factors for acute pancreatitis(P＜0.05),and the ECV was an independent risk factor for severe pancreatitis(P＜0.05).The area under the curve(AUC)of ECV was higher in acute pancreatitis group(0.81)and severe pancreatitis subgroup(0.68).Conclusion As a quantitative parameter,the ECV obtained from enhanced CT has higher clinical application value and higher popularity in the diagnosis and classification of acute pancreatitis.

The precise assessment and management of the axillary lymph nodes in breast cancer is crucial for regional control, disease staging, selection of adjuvant chemotherapy strategies, and prediction of prognosis, with a general downward trend in surgical management. For early breast cancer with negative axillary lymph node metastases, sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as the criterion for axillary status measurement. Patients can be exempted from ALND if they have negative SLNB results. However, it remains to be carefully decided in China whether patients with one or two positive nodes in SLNB can be spared from ALND. However, consensus has been met that patients who meet the criteria of the Z0011 study can be exempted from ALND. For breast cancer patients with positive axillary lymph nodes metastases at the beginning of treatment, the clearance of lymph node disease can be achieved by neoadjuvant therapy, with a reduced rate of complications related to ALND. In particular, there are still many debates associated with SLNB after neoadjuvant therapy, such as whether patients who remain axillary lymph node positive can be spared from ALND. Exploratory and validation studies related to the SLNB avoidance criteria are still controversial. In the future, clinicians should consider the characteristics of patients, the risk of recurrence, and adjuvant treatment regimens to develop individualized axillary lymph node management.

The precise assessment and management of the axillary lymph nodes in breast cancer is crucial for regional control, disease staging, selection of adjuvant chemotherapy strategies, and prediction of prognosis, with a general downward trend in surgical management. For early breast cancer with negative axillary lymph node metastases, sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as the criterion for axillary status measurement. Patients can be exempted from ALND if they have negative SLNB results. However, it remains to be carefully decided in China whether patients with one or two positive nodes in SLNB can be spared from ALND. However, consensus has been met that patients who meet the criteria of the Z0011 study can be exempted from ALND. For breast cancer patients with positive axillary lymph nodes metastases at the beginning of treatment, the clearance of lymph node disease can be achieved by neoadjuvant therapy, with a reduced rate of complications related to ALND. In particular, there are still many debates associated with SLNB after neoadjuvant therapy, such as whether patients who remain axillary lymph node positive can be spared from ALND. Exploratory and validation studies related to the SLNB avoidance criteria are still controversial. In the future, clinicians should consider the characteristics of patients, the risk of recurrence, and adjuvant treatment regimens to develop individualized axillary lymph node management.

Objective:To investigate the correlation between 25 hydroxyvitamin D[25 (OH) D] level and sleep monitoring index in patients with severe altitude obstructive sleep apnea hypopnea syndrome (OSAHS).Methods:Sixty-six patients with severe OSAHS (AHI≥30 times/hour) diagnosed by apnea hypopnea index (AHI) who had lived at high altitude (1 800-4 193 m) for≥1 year were included in the experimental group. The patients underwent polysomnography monitoring in Sleep Medicine Center of Qinghai Red Cross Hospital from June to December 2021. In addition, healthy volunteers matched the experimental group by gender, age, ethnicity and living altitude during the same period were selected for polysomnography monitoring. Finally, 48 healthy volunteers with AHI<5 times/hour were included as the control group. 25(OH)D level and its deficiency were compared between the two groups. The experimental group was further divided into severe deficiency group [25(OH)D≤10 μg/L], the deficiency group [10 μg/L<25(OH)D≤20 μg/L] and the non-deficiency group [25(OH)D>20 μg/L] according to 25(OH)D level, and the differences of sleep parameters among the three groups were compared. Correlation analysis and multifactor linear regression analysis were performed on the factors that may affect the level of 25(OH)D in patients with severe OSAHS.Results:A total of 114 adults living on the plateau for at least one year were enrolled, including 66 in the experimental group and 48 in the control group. 25(OH)D deficiency (≤30 μg/L) was found in all the individuals included in the experimental group and the control group, and the 25(OH)D level of the two groups was [(13.13±4.05) vs (13.68±4.60) μg/L, P=0.507] and there was no significant difference in deficiency degree (all P>0.05). Within the experimental group, rapid eye movement (REM) sleep time and proportion (REM%) and sleep awakening time of 25(OH)D non-deficiency group, were significantly lower than those in severe deficiency group (all P<0.05), and sleep efficiency in 25(OH)D non-deficiency group was significantly higher than that in severe deficiency group and deficiency group (all P<0.05). Spearman correlation analysis showed that the level of 25 (OH) D in experimental group were positively correlated with serum calcium ion level ( r=0.293, P=0.017) and sleep efficiency ( r=0.309, P=0.011), and were negatively correlated with age ( r=-0.298, P=0.015), REM sleep time ( r=-0.401, P=0.001), REM% ( r=-0.421, P<0.001) and awakening time ( r=-0.362, P=0.003). Multifactor linear regression analysis suggested that serum calcium, REM sleep time and history of hypertension were the predictors of 25(OH)D level in severe OSAHS at high altitude. Conclusions:There is a correlation between sleep monitoring indexes and serum 25(OH)D level in patients with severe OSAHS at high altitude. The longer the REM sleep time, the lower the 25(OH)D level. Meanwhile, there is a certain relationship between co-morbidity hypertension and 25(OH)D level in patients with severe OSAHS at high altitude.

Objective: To analyze the correlation of growth differentiation factor-15(GDF-15)level with the severity of coronary artery disease and prognosis and in elderly patients with acute coronary syndrome. Methods: A total of 168 elderly patients with acute coronary syndrome admitted into Hangzhou Xixi Hospital and Shaoyifu Hospital Affiliated to Medical College of Zhejiang University from March 2017 to April 2018 were enrolled in the study.Patients were divided into three groups: GDF-15>1 800 μmol/L(n=28), GDF-15 between 1 200-1 800 μmol/L(n=45), and GDF-15<1 200 μmol/L(n=95). Plasma levels of high-sensitivity C-reactive protein(hs-CRP)and GDF-15, and SYNTAX score, single-vessel-, double-vessel, multi-vessel coronary disease and major adverse cardiovascular events(MACE)were analyzed and compared between groups. Results: Plasma levels of hs-CRP and GDF-15 had significant differences among the three groups(P<0.05). There were significant statistically differences in SYNTAX score, single-vessel, double-vessel and multi-vessel coronary disease and MACE among the three groups(P<0.05). Logistic regression analysis showed that the levels of GDF-15(OR=2.092, 95%CI: 1.585~2.687), SYNTAX score(OR=1.948, 95%CI: 1.097~2.098), double-vessel lesions(OR=1.124, 95%CI: 1.006~1.251)and multi-vessel lesions(OR=1.744, 95%CI: 1.149~2.642)(all P<0.05)were statistically significant influencing factors for the prognosis. Conclusions GDF-15 level is correlated with SYNTAX score, double-vessel lesions and multi-vessel lesions, and could predict the severity of coronary artery lesions and prognosis in patients with acute coronary syndrome.

OBJECTIVE: To establish a digital subtraction angiography (DSA) information management and image analysis system to realize scientific management of DSA image information and efficient processing of image data. METHODS: Based on Java Web under Windows 7 environment, a dynamic Browser/Server mode system was constructed by JSP and Servlet on the network. Eclipse and MySQL were used as development tool and database development platform. Tomcat network information service was used as application server. Matlab codes were embedded to analyze DSA image. RESULTS: The system consists of five modules:image information management, image processing, image analysis, advanced retrieval and clinical data management. It may complete such process as storing, deleting, saving, analyzing of DSA image and basic information of patients. CONCLUSIONS The main interface of the system is user-friendly and easy to operate. The system will be helpful to the clinical, teaching and scientific research work related to DSA.
Angiography, Digital Subtraction ; statistics & numerical data ; Databases, Factual ; Humans ; Indonesia ; Information Management ; Internet ; Software ; User-Computer Interface

Objective To investigate the mechanism of renal injury induced by changes in flow shear stress (FSS) during renal ischemia/reperfusion (I/R).Methods 1.In vitro,HUVECs were divided into 4 groups:(1) HUVECs were loaded with 12 dyn/cm2 force for 30,45,and 90 min by using plate fluid chamber system.(2) Cells were loaded with FSS for 2 h,and then cultured for 1,3,8 and 12 h respectively;(3) HUVECs were pretreated with 0,1,2,4 and 8 mmol metformin and cultured for 24 h.(4) HUVECs in control group were cultured normally.The expression of p-AMPK/AMPK protein was detected by Western blotting in each group.2.In vivo,16 SD rats with successful establishment of IR model were randomly divided into 4 groups (n =4 in each group):(1) static cold storage (CS) group:isolated kidneys were stored for 4 h;(2) hypothermia machine perfusion (HMP) group:isolated kidneys were continuously perfused with 0 ℃ lactated Ringer's solution for 4 h;(3)metformin treatment group (Met-CS):metformin was intraperitoneally injected 3 days before surgery,and the isolated kidneys were obtained after cold preservation for 4 h;(4)rat kidneys of control group were just subjected to thermal ischemia for 30 min.The injury of renal tissue in each group was observed by TUNEL and HE staining.The expression and distribution of p-AMPK protein in renal tissues were detected by immunohistochemistry.The correlation between FSS loss and AMPK expression in kidney tissue was analyzed.Results The expression of p-AMPK in HUVECs could be up-regulated by FSS,and the expression of p-AMPK protein increased with the prolongation of time.After stopping FSS,the expression of p-AMPK protein in HUVECs gradually decreased with time (P＜0.05).Metformin could activate AMPK activity in a concentration-dependent manner (P＜0.05).The content of p-AMPK in renal tissue of HMP group was significantly higher than that of CS group (P＜0.05).The expression of p-AMPK in renal tissue of HMP group mainly distributed in the renal tubules,and few in glomerular endothelial cells and blood vessels.The apoptosis rate of renal tissue in HMP group was significantly lower than that in CS group (P＜0.05).In the HMP group,the damage of the renal tissue was mild,there was no swelling,and the renal tubules were slightly expanded.In the CS group,the renal tissue was severely damaged and the renal tubules were markedly swollen.Conclusion During the course of renal IR in rats,changes in FSS may affect renal tissue damage through the AMPK pathway.

Objective To study and analyze the CT and MRI findings of hepatic eosinophilic infiltration. Methods Twenty nine patients of hepatic eosinophilic infiltration who were confirmed by biopsy or clinical diagnosis were retrospectively analyzed. All the patients underwent CT and/or MRI scan. Twenty seven cases underwent upper abdominal CT plain scan and three phase enhanced scan, and 5 cases underwent upper abdominal MR plain scan and three phase enhanced scan, of which 3 cases underwent CT and MRI scan. Evaluations were made regarding to the numbers of lesion, distribution, size, shape, margin, density or signal characteristic, enhancement parttern and other special features. Pearson correlation analysis was used to analyze the correlation between the number of hepatic lesions and the number of eosinophils in peripheral blood. Results A total of 108 lesions of eosinophilic hepatic infiltration were observed in 29 cases, including 2 cases with single lesion and 27 cases with multiple lesions. Ninety five of the lesions were located in subcapsular parenchyma or surrounding the portal vein. Most subcapsular lesions were wedge-shaped(n=28). Lesions surrounding portal vein were round-shaped(n=32), while the hepatic parenchymal lesions were irregular or round-shaped(n=13). The mean size of lesion was 34 mm, ranging from 3 to 61 mm. The margin of all the lesions were obscure. The lesions showed slightly low density or isodensity on CT pre-contrast images. On MR pre-contrast images, lesions showed slightly low signal or isointense on T1WI, and hyperintense on T2WI. Branches of portal vein were found infilrated by all lesions. Tueleve cases showed“stripe sign”along the portal vein branches, 16 cases showed“halo ring sign”around the portal vein. Pearson analysis indicated a significant correlation between the number of eosinophilic hepatic infiltrated lesions and the increase of eosinophils in peripheral blood (r=0.783, P<0.05). Conclusion The imaging features of EHI had certain characteristics, especially in the three phase dynamic enhanced scanning, from which we can mainly find“progressive enhancement”,“portal vein sign”,“stripe sign”and“halo ring sign”.

Objective To establish a preprocedure nomogram for predicting contrast-induced acute kidney injury (CI-AKI) after coronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods Clinical data of 245 patients underwent CAG or PCI were collected.CI-AKI prediction nomogram integrated preprocedural predictors was established with clinical characteristics associated with CI-AKI which were selected with the LASSO regression model,and CI-AKI risk scores were calculated.The ROC curve was constructed to calculate the risk score cutoff.Results The occurrency of CI-AKI was 13.88％ (34/245).Sex,diabetes mellitus,lactate dehydrogenase level,high-sensitivity C-reactive protein,drinking years,chronic kidney disease (CKD),stage of CKD,stroke,acute myocardial infarction as well as systolic blood pressure were significant risk factors.The efficiency of CI-AKI nomogram was good,and the cutoff value of risk score was-1.953.Conclusion The novel nomogram can be used to preprocedurally predict the risk of CI-AKI after CAG or PCI treatment.