Volume 103 · Issue 38 · 2023

Endocrine therapy is the primary systemic therapy for hormone receptor-positive breast cancer, which runs through the whole process of treatment for early and metastatic breast cancer. The development of new endocrine agents and targeted drugs such as cyclin-dependent kinases 4/6(CDK4/6)inhibitors has improved outcome of patients with hormone receptor-positive breast cancer and changed the treatment landscape. The update of clinical research data provides more treatment options, calling for treatment optimization. Experts had a deep discussion around the hot topics on endocrine therapy of breast cancer, and formulated the'Expert consensus on endocrine therapy of breast cancer (2023 edition)'.This consensus is based on research data worldwide and clinical practice experience, with the aims of standardizing clinical diagnosis and optimizing treatment in neoadjuvant, adjuvant and metastatic setting of hormone receptor-positive breast cancer.

The effective implementation of myopia prevention and control interventions is the foundation of achieving the goal of myopia prevention and control in China. However, relevant guidance documents for the implementation and evaluation of myopia prevention and control interventions are still lacking. Therefore, after in-depth research and summarizing relevant practical experiences, the Vision Health Branch of Chinese Association for Student Nutrition and Health Promotion and the Public Health Ophthalmology Branch of Chinese Preventive Medicine Association discussed and proposed the Chinese expert consensus on comprehensive public health intervention for myopia prevention and control in children and adolescents. The consensus develops a theoretical framework of comprehensive intervention actions for myopia prevention and control from the perspective of public health, creates six comprehensive intervention actions, including the establishment of vision health records and myopia risk assessment, evaluation of vision care related behaviors and the development of proper eye-use behaviors, health education for teachers, students and parents, improvement of reading and writing environment at home and school, 2 hours of daytime outdoor activities, hierarchical management and medical orthosis of myopia, and proposes a system of indicators for the implementation and effectiveness evaluation of myopia intervention actions, so as to provide a cost-effective and universally appropriate public health prescription for myopia prevention and control in children and adolescents.

To analyze the effect and prognosis of infant kidney transplantation.

Clinical data of 37 cases of infant kidney transplantation under 3 years old in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 1, 2017 to July 31, 2022 were retrospectively collected. These 37 cases included 31 primary kidney transplantation and 6 secondary kidney transplantation. Kaplan-Meier method was used to draw the survival curve of the transplanted kidney and the recipient, and the prognosis and complications were analyzed. Median follow-up was 18 months (range: 6-66 months).

The recipients were 20 males and 17 females, with a median age of 16 months (range: 2 months, 26 days to 36 months) and a median weight of 8 kg (range: 3.2 to 14.0 kg). The youngest child was only 2 months, 26 days old, and weighed only 3.2 kg. The most common primary disease of recipients was congenital nephrotic syndrome (13 cases, 41.9%). Intra-abdominal transplantation occurred in 19 cases (51.3%) and intra-iliac fossa transplantation occurred in the remaining 18 cases (48.6%). Postoperative renal function recovery was delayed in 7 cases (18.9%), and thrombosis caused renal function loss in 5 cases (13.5%), of which 4 cases received second renal transplantation and were successful. During the follow-up period, there were 11 cases of acute rejection (29.7%) and 6 cases of CMV pneumonia (16.2%). The estimated glomerular filtration rate 1 year after transplantation was higher than that 1 month after surgery [(101.9±22.1) vs (71.1±25.6) ml/(min·1.73m²), P<0.001], and remained constant 2 years after transplantation. Both the 1-year and 2-year survival rates of the transplanted kidney were 85.3%, and both the 1-year and 2-year survival rates of the recipients were 96.8%.

Although the implementation of infant kidney transplantation is difficult, it can still achieve relatively satisfactory efficacy and prognosis.

To explore the correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with stable chronic obstructive pulmonary disease (COPD).

A total of 186 patients with COPD in stable stage who visited in the outpatient department of Beijing Hospital from March 2021 to February 2022 were prospectively included. Demographic data, respiratory symptoms and lung function were collected. The original DICOM data of high-resolution CT (HRCT) were processed using the FACT medical imaging information system and the pulmonary emphysema index pixel index-950 (PI-950) and the airway wall thickness (4-6 T) and the percentage of airway area (4-6 WA%) of the 4-6 generation bronchi which represent the segmental and subsegmental bronchi were measured automatically. According to the modified British medical research council dyspnea scale (mMRC, 0-1 point for low score group, 2-4 points for high score group), chronic obstructive pulmonary disease assessment test (CAT, score<10 points for low score group,≥10 points for high score group), cough, expectoration and wheezing (asymptomatic group and symptomatic group), they were divided into two groups as dependent variables. The relationship between imaging parameters and the above symptoms was evaluated using a logistic regression model.

The study ultimately included 186 patients who met the inclusion criteria, including 162 males and 24 females, aged (68.9±9.3) years old. There were 83 patients in the high mMRC group, 120 patients in the high CAT group, 146 patients in the cough group, 154 patients in the expectoration group, and 65 patients in the wheezing group. The age and emphysema parameter PI-950 in the high score group of mMRC were higher than those in the low score group, while the percentage of the forced expiratory volume in 1 second (FEV₁) predicted value (FEV₁ pred) after medication, the percentage of carbon monoxide diffusion volume (DLCO) predicted value (DLCO pred), and the percentage of the maximum midexpiratory flow (MMEF) predicted value (MMEF pred) after medication were lower than those in the low score group (all P<0.05). The age of the high CAT group was higher than that of the low score group, while FEV1 pred and MMEF pred after medication were lower than those of the low score group (all P<0.05). The proportion of males, patients with smoking history, and smoking index in the cough group were higher than those in the non cough group, while the 4 WA% was lower than that in the non cough group (all P<0.05). The proportion of males, patients with smoking history, smoking index, and PI-950 in the expectoration group were higher than those in the non expectoration group, while FEV1 pred after medication and 4 WA% were lower than those in the non expectoration group (all P<0.05). The 5 WA% and 6 WA% of the wheezing group were higher than those of the non wheezing group, while MMEF pred after medication was lower than that of the non wheezing group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for demographic characteristics, smoking, combined diseases, lung function and other confounding factors, for every 10% increase in PI-950, the likelihood of developing more severe dyspnea for the patients (high score group according to mMRC) increased by 67.3% (OR=1.673, 95%CI: 1.052-2.658); Every 10% increase in 6WA% increased the likelihood of wheezing by 3.189 times (OR=4.189, 95%CI: 1.070-16.395). No correlation was found between various imaging indicators and cough, expectoration, and CAT scores (P>0.05).

Quantitative CT measurement indicators in stable COPD patients can explain the presence and severity of respiratory symptoms, the pulmonary emphysema indicator is associated with dyspnea, and the percentage of proximal airway wall area is associated with wheezing.

To investigate the relationship between sarcopenia and abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients.

A cross-sectional study was conducted. MHD patients who underwent regular dialysis between January 2021 and January 2022 at hemodialysis center in Jiangdu People′s Hospital Affiliated to Yangzhou University were enrolled. The incidence of sarcopenia in these patients was examined by measuring handgrip strength, gait speed and appendicular skeletal muscle mass index (ASMI) using bioelectrical impedance analysis. AAC score was measured by a lateral lumbar spinal radiograph. The general information of the patients was collected and the blood biochemical indexes were detected. These patients were divided into non-calcification group (n=104) and calcification group (n=127) according to the score of AAC. Multivariate logistic regression was used to analyze the related factors of AAC.

A total of 231 MHD patients (134 males and 97 females) were enrolled in the study, with the mean age of (57.1±11.4) years. Among 231 hemodialysis patients, the incidence of sarcopenia and AAC were 46.3% (107 cases) and 55.0% (127 cases), respectively. The age [(60.2±11.1) vs (53.4±12.2) years, P<0.001] and dialysis vintage [86 (46, 135) vs 57 (27, 109) months, P=0.005] in calcification group were longer than these in the non-calcification group. The level of 25(OH)D₃ [17.7 (13.5, 24.3) vs 20.5 (15.1, 28.1) μg/L, P=0.008] and gait speed [(0.88±0.23) vs (1.01±0.20) m/s, P=0.024], handgrip strength [(17.9±9.1) vs (20.7±9.9) kg, P=0.013], ASMI [(6.65±2.24) vs (7.83±2.46) kg/m², P<0.001] were lower. While, AAC score [12 (9, 19) vs 0 (0, 3), P<0.001] and the incidence of sarcopenia [58.3% (74/127) vs 31.7% (33/104), P<0.001] were higher in the calcification group than these in the non-calcification group. Multivariate logistic regression analysis indicated that sarcopenia (OR=1.928, 95%CI: 1.302-2.855, P=0.001), decrease of 25(OH)D₃ level (OR=0.969, 95%CI: 0.940-1.000, P=0.047), age (OR=1.043, 95%CI: 1.015-1.072, P=0.002), and dialysis vintage (OR=1.009, 95%CI: 1.004-1.015, P=0.001) were related factors of AAC.

Sarcopenia is associated with AAC in MHD patients. In clinical practice, attention should be paid to sarcopenia in MHD patients.

To explore the difference of peripheral blood mononuclear cells (PBMC) transcripts between atopic dermatitis (AD) and healthy controls, and to screen and preliminarily validate potential biomarkers of AD.

From January 2021 to May 2022, blood samples from 9 AD patients and 10 healthy controls were collected from the Dermatology and Cosmetic Center of the Third Affiliated Hospital of Chongqing Medical University, ribonucleic acid-sequencing (RNA-seq) was used to determine the transcriptome and relative expression of PBMC, the differentially expressed genes (DEGs) were analyzed by gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and protein-protein interaction networks (PPI) analysis, and the potential biomarkers were identified by quantitative real-time PCR (qRT-PCR).

The age of patients in the AD group [M (Q₁, Q₃)] was 26.50 (22.75, 30.50) years old, and the course of disease [M (Q₁, Q₃)] was 15 (10, 20) years,and the age of the healthy control group [M (Q₁, Q₃)] was 37.00 (27.75, 40.25) years old. Compared with healthy controls, 1 044 DEGs were detected in PBMC samples in AD group, including 668 up-regulated genes and 376 down-regulated genes. Differential variable splicing (AS) showed that mutually exclusive exons (46.74%) and skipped exon (31.01%) accounted for a large proportion. GO and KEGG enrichment analysis revealed that AD is closely linked to DEGs implicated in the inflammatory response and cytokine interaction and signal pathway. Comprehensive enrichment analysis and PPI analysis selected the expression of 8 candidate genes (CCL4, CCR3, CXCR5, NFKBIA, CXCL1, IL-1B, CCL20, LY96), which was confirmed by qRT-PCR and were consistent with that of RNA-seq.

CCL4, CCR3, CXCR5, NFKBIA, CXCL1, IL-1B, CCL20 and LY96 might be potential biomarkers of AD, participating in the occurrence and development of AD.

To explore the role of Langerin in mediating epicutaneous sensitization of atopic dermatitis (AD) in mouse model.

Mice were topically treated with calcipotriol (MC903) plus ovalbumin (OVA) on the ears to establish AD mouse models, and mice were divided into wild-type control group, wild-type AD group, Langerin knockout control group, and Langerin knockout AD group. Changes of lesion were daily observed. Infiltration of inflammatory cells, mRNA expression of Tslp, Il4, Il13, Il17a, and Il22, levels of serum total IgE, OVA-specific IgE (sIgE), OVA sIgG1 and OVA sIgG2a, proportion of regulatory T (Treg) cells in cervical draining lymph nodes were evaluated at the end of model preparation.

Skin tumidness and thickness, dermal inflammatory cells infiltration, the mRNA expression levels of Tslp, Il4, Il13, Il17a and Il22 in wild-type AD groups were higher than those in wild-type control groups, with (1.80±0.66, 1.64±0.25, 1.71±0.54, 2.41±0.23, 2.49±0.32) and (0.53±0.45, 0.85±0.29, 0.73±0.50, 0.72±0.25, 0.56±0.29), respectively (all P<0.05). In addition, the levels of serum total IgE, OVA sIgE and OVA sIgG1 in wild-type AD groups were higher than those in wild-type control groups, with [(1 216.00±572.70) ng/ml, (597.00±538.30) ng/ml, 1.59±0.09] and [(24.22±35.04) ng/ml, (20.01±41.71) ng/ml, 1.16±0.03], respectively (all P<0.05). In Langerin knockout mice, compared to wild-type mice, skin erythema, skin tumidness, epidermal thickening, inflammatory cell infiltration were more obvious; the mRNA expression levels of Tslp, Il4, Il13, Il17a and Il22 were upregulated with (8.19±6.44, 2.53±0.69, 2.82±0.73, 3.94±1.32, 3.80±1.43) (all P<0.05); the levels of serum total IgE, OVA sIgE and OVA sIgG1 were significantly increased with (2 508.00±657.10) ng/ml, (1 808.00±470.70) ng/ml, (1.73±0.09) (all P<0.05); the number of CD4⁺CD25⁺CD127^-Treg cells were decreased significantly with (13.25±0.96)% and (15.31±1.47)%, respectively (P<0.05).

Langerin is involved in mediating epicutaneous sensitization of the AD mouse model and plays a negative immunoregulatory role.

To investigate the value of 3D visualization reconstruction technology in pheochromocytoma/paraganglioma surgery.The clinical data of 87 patients with pheochromocytoma/paraganglioma admitted to the Department of Urology of Peking Union Medical College Hospital between January 2019 and December 2022 were retrospectively analyzed, and 3D visualization model reconstruction was performed preoperatively in 47 patients [Group A:males was 24 cases,the age M(Q₁, Q₃)42.00(30.00, 54.00)]. while the remaining 40 patients [Group B: males was 23 cases,the age M(Q₁, Q₃) 44.00(30.25, 53.75)] was not. The maximum tumor diameter, operation time, intraoperative bleeding, drain retention time and postoperative hospital stay were compared between the two groups. Surgery was successfully completed in both groups. 37 (78.7%) patients in group A underwent laparoscopic surgery, 7 (14.9%) patients underwent open surgery, and 3 (6.4%) patients underwent laparoscopic-to-open surgery. Thirty-one (77.5%) patients in group B underwent laparoscopic surgery, 5 (12.5%) patients underwent open surgery, and 4 (10.0%) patients underwent laparoscopic to open surgery. There was a difference in the maximum diameter of the tumor between the two groups [(6.09±3.02) cm vs (5.32±1.76) cm, P<0.05], the retention time of the drainage tube was significantly shorter in group A compared with group B [(3.20±1.38) d vs (4.02±1.98) d, P<0.05], and the length of the hospital stay after surgery was significantly shorter [(5.75±2.12) d vs (6.49±3.37) d, P<0.05]. Comparison of operation time and intraoperative bleeding between the two groups showed no statistically significant difference (P>0.05).Two cases of postoperative anemia and one case of pulmonary atelectasis in group B patients improved before discharge. Conclusion when the tumor diameter is>6 cm or has a close relationship with the surrounding organs and blood vessels, the use of 3D visual reconstruction technology can formulate and implement a more accurate and safe surgical plan, shorten the retention time of the drainage tube and postoperative hospitalization time, which is conducive to the patient′s postoperative recovery and reduce postoperative complications.

Transient smartphone "blindness" is a physiological phenomenon related to differences in retinal photosensitivity, and its mechanism was first elucidated in 2016. This article reports a case of a healthy young woman who had a transient and transient loss of vision in her left eye after lying on her side and watching her mobile phone for a long time at night. After detailed medical history inquiry, specialist examination and consultation with relevant departments, organic changes were ruled out, and she was diagnosed with transient "blindness" of smartphone. The significance of this example is to remind both physicians and patients that detailed medical history inquiry and knowledge of retinal physiology can avoid unnecessary anxiety and overexamination.

This article reports a case of a 33-year-old male patient who was seen for "progressive protrusion of the left eye for 1 month". The examination found a solid mass in the left orbit, and the clinical diagnosis was "space-occupying lesion of the left orbit". Subsequently, the tumor was partially resected in the neurosurgery department of an external hospital, and the diagnosis of low-grade osteosarcoma was confirmed by histopathology. Recurrence occurred 4 months later, with decreased vision in the left eye and limited upward turning of the eyeball. After re-operation by ophthalmology combined with neurosurgery, the patient's visual acuity recovered after operation, and no other treatment was performed.

Cognitive decline and cognitive impairment are a major challenge in today's aging society. Circulating low-density lipoprotein cholesterol (LDL-C) has been shown to be associated with the risk of cardiovascular events, and clinical and experimental evidence suggests that circulating LDL-C is related or causally related to neurocognitive function. During physiological and pathological cognitive decline, circulating LDL-C acts on cerebrovascular related structures, initiating or accelerating cognitive related brain molecules and pathways, resulting in changes in the structure and function of the central nervous system. This review summarizes recent studies on the correlation between LDL-C and cognitive function, clinical trials focusing on the effects of circulating extremely low LDL-C on cognitive function, and discusses the possible risks of LDL-C-lowering treatment on cognitive function in elderly people in clinical practice; In addition, the research progress of LDL-C on neurocognitive function was briefly described from the perspectives of blood-brain barrier damage, neuroinflammation, and the correlation with pathological changes related to Alzmer's disease (AD).

Extracellular matrix is an important part of tumor microenvironment, and hardness is one of the most important mechanical properties of extracellular matrix. The change of hardness can affect the biological behavior of tumor. This paper mainly introduces the microscopic basis of extracellular matrix, the regulatory mechanism of extracellular matrix hardness, the influence of extracellular matrix hardness on tumor drug resistance and its mechanism. A better understanding of these characteristics will help to further study the regulatory mechanism of extracellular matrix hardness on tumor drug resistance.

In recent years, artificial intelligence technology based on machine learning has been gradually applied to the diagnosis, treatment, prognosis and prediction of pituitary adenoma, demonstrating the great development potential of machine learning in the diagnosis and treatment of pituitary adenoma. By summarizing the relevant literature, this paper systematically expounds the application status of artificial intelligence in the diagnosis and treatment of pituitary adenoma, and introduces its application progress in the diagnosis, surgical treatment, prediction of disease progression and postoperative rehabilitation of pituitary adenoma. In the early screening of pituitary adenomas, the application of artificial intelligence technology has greatly improved the efficiency and accuracy of diagnosis. In terms of auxiliary diagnosis, the classification of pituitary adenoma, the identification of dopamine agonist drug-tolerant individuals, and the diagnosis of pituitary growth hormone adenoma have shown high performance. In terms of treatment, combined with artificial intelligence technology, it can realize accurate judgment of characteristics such as pituitary adenoma texture and infiltration degree, helping clinicians to better formulate surgical plans to achieve personalized treatment. In terms of prognosis prediction, many scholars have developed different machine models for attempt, and all have achieved ideal results. Of course, due to the small sample size of most research models, it is very difficult to cover all possible cases; In addition, in some complex cases, the accuracy of machine learning models is low, which needs further research and development.

Hepatic stellate cells (HSC) are key effector cells that mediate the development of liver fibrosis, and aerobic glycolysis is an important metabolic feature of HSC activation. Transforming growth factor-β 1 (TGF-β 1) induces aerobic glycolysis, and glucose transporter 1 (GLUT1) is the most widely distributed glucose transporter and is involved in the regulation of sugar metabolism, thus affecting cell proliferation and growth. However, the relationship between TGF-β 1 and GLUT1 in the process of liver fibrosis and the specific molecular mechanism are still unclear. Therefore, this paper investigates the molecular mechanism of GLUT1 and TGF-β 1 in the process of liver fibrosis.

A stable state of skin immune balance ensures the body's tolerance to harmless environmental damage and microbial biofilms, while in inflammatory skin diseases such as atopic dermatitis (AD), the regulation of skin immune balance is seriously impaired, resulting in an uncontrolled immune response of the skin to allergens.