Neonatal respiratory distress syndrome （RDS） is a common cause of neonatal respiratory distress. Although intervention strategies such as prenatal corticosteroids（ACS）， neonatal pulmonary surfactant （PS） replacement therapy， and advanced neonatal respiratory management have improved the prognosis of neonates with RDS， it remains one of the leading causes of morbidity and mortality in premature infants. In order to facilitate the management of neonatal RDS， multiple countries around the world have issued clinical management guidelines and expert consensuses， but there has been no consensus on these guidelines or consensuses. By giving a brief review of Avery ME and others’ research results and introducing the long process of discovering and recognizing RDS as well as the gradual evolution of diagnosis and treatment of RDS， this article emphasizes the etiology，classification， evaluation， and diagnosis of RDS， highlights the latest evidence based on multinational guidelines/consensuses， and provides a brief introduction and evaluation of the consensus statement of the RDS-Neonatal Expert Taskforce （RDS-NExT） in the United States.
To identify the risk factors for acute kidney injury （AKI） in patients with infectious endocarditis （IE）， and to predict the risk of death during hospitalization in such patients with AKI，so as to provide help for clinical treatment of these patients.
Methods
Adult patients hospitalized at Peking University First Hospital from January 1， 2014 to December 31， 2019 who were diagnosed with IE were retrospectively collected and divided into either an AKI group or a non-AKI group according to whether AKI occurred or not. AKI cases clearly caused by cardiac surgery were excluded. The two groups were compared for potential variables to identify the risk factors for AKI. The patients with AKI were then divided into either a death group or a survival group based on the outcome， and the risk factors associated with death were identified and the risk of death was predicted.
Results
A total of 131 patients were included， including 56 patients in the AKI group （including 12 AKI cases clearly caused by cardiac surgery） and 75 in the non-AKI group， with the total incidence of AKI and non-surgical AKI being 42.7% and 33.6%， respectively. In the total AKI population， 12 people died and the case fatality rate was 21.4%. Diabetes （odds ratio ［OR］=4.69， 95%confidence interval ［CI］: 1.03～21.47）， abnormal urine test （OR=5.79， 95%CI: 1.67～20.08）， use of contrast medium （OR=5.68， 95%CI: 1.43～22.65）， and sepsis （OR=22.17， 95%CI: 4.75～103.53） were identified to be the risk factors for AKI in IE patients （P＜0.05）， while sepsis （OR=42.79， 95%CI: 1.64～1114.70） and the number of systems （or organs） involved （OR=4.44， 95%CI: 1.44～13.68） had an important effect on the risk of in-hospital death in IE patients with AKI （P＜0.05）.
Conclusion
Abnormal urine test， diabetes mellitus， contrast agent use， and sepsis are risk factors for AKI in IE patients. No matter when sepsis occurs，the number of affected systems （or organs） at 48 hours after AKI is significant in predicting the death of IE patients with AKI.
To explore the clinical utility of methylene blue combined with marker clip and hook-wire localization in evaluating axillary metastatic lymph nodes after neoadjuvant chemotherapy for breast cancer.
Methods
Patients with cN1 or cN2 breast cancer who underwent neoadjuvant chemotherapy from January 2019 to December 2023 at Peking University Shenzhen Hospital were enrolled. Axillary lymph node biopsy was performed and marker clips were placed before chemotherapy. After chemotherapy，methylene blue was used as a tracer to label axillary lymph nodes， and labeled lymph node biopsy was performed. Before axillary lymph node dissection was performed， the labeled lymph nodes were positioned with hook-wires under the guidance of color ultrasound.
Results
A total of 22 patients with breast cancer was included in the study， with a median age of 42 years （range， 32～66 years）. All patients， including 18 stage II patients and 4 stage III patients， received chemotherapy with the EC-T （n=6） or TCbHP （n=16） regimen.Sixeen （16/22） patients were evaluated by PCR after chemotherapy. Lymph nodes localized with marker clips were identified in all patients during the operation. The number of lymph node biopsies during the operation was 3-5， and the total number of lymph nodes dissected was 9-38. Among the enrolled patients， 18 were detected with marker clips and stained lymph nodes， and 19 were detected with stained lymph nodes. The average detection time of the marker clip combined with methylene blue group was （13.27±1.87） min， which was longer than that of the methylene blue only group （8.89±2.28 min， P＜0.05）. However， the false negative rate of lymph nodes in the combination group （5.56%） was significantly lower than that of the methylene blue only group （31.58%， P＜0.05）. The accuracy of marker clip localization combined with methylene blue staining （77.27%） was higher than that of the methylene blue only group （59.09%）， and none of the patients had recurrence or metastasis during the postoperative follow-up period.
Conclusion
For early-stage breast cancer patients with positive lymph nodes and receiving neoadjuvant chemotherapy， ultrasonic-guided marker clip and methylene blue dual positioning combined with preoperative hook-wire positioning of axillary lymph nodes is a feasible method， which contributes to more reliable lymph node evaluation after chemotherapy with less trauma.
To investigate the association between serum vitamin levels and differentiated thyroid cancer （DTC）.
Methods
We retrospectively analyzed 50 patients with differentiated thyroid cancer admitted to the Fourth Hospital of Hebei Medical University from January 2021 to December 2022. Fifty patients with nodular goiter who underwent thyroidectomy were included as controls. The levels of vitamins A， E， and D in serum， as well as the concentration of methylmalonic acid （MMA）， were by high performance liquid chromatography-tandem mass spectrometry （LC-MS/MS）.
Results
The serum concentrations of vitamin A and E in patients with DTC were significantly lower than those of controls（P＜0.05）. Patients with BRAF-positive DTC had significantly serum vitamin D concentrations than those with BRAF-negative DTC （P＜0.05）. As the clinical stage of DTC patients increased， vitamin D concentrations decreased significantly （P＜0.05）， indicating an increase in disease severity.
Conclusion
Serum vitamin levels are associated with the occurrence and disease progression of DTC， especially vitamin D. This finding provides new ideas for future prevention and treatment of DTC， including monitoring and possible supplementation of vitamins to improve patients’ quality of life and prognosis.
To identify the predictive factors for pathological complete response （pCR）in elderly patients with breast cancer undergoing neoadjuvant therapy （NAT）.
Methods
A retrospective analysis was conducted on elderly patients with breast cancer （≥65 years） who received NAT at the Department of Breast of Sichuan Cancer Hospital from October 2014 to December 2023. The correlation between clinicopathological characteristics and pCR was analyzed. Univariate analysis was performed using the chi-square test or Fisher’s exact test， while multivariate analysis was conducted by binary logistic regression.
Results
A total of 132 older patients were included in this study， of whom 22 achieved a pCR，with an overall pCR rate of 16.7%. Univariate analysis showed statistically significant associations of higher pCR rates with hormone receptor （HR） negativity （P=0.004）， human epidermal growth factor receptor 2（HER2） positivity （P＜0.001）， and high Ki67 expression （P=0.013）. Multivariate analysis revealed that HR negativity （odds ratio ［OR］=3.244； 95% confidence interval ［CI］: 1.010～10.421； P=0.048） and HER2 positivity （OR=17.907； 95%CI: 5.180～61.908； P＜0.001） were independent predictive factors for pCR in elderly patients with breast cancer undergoing NAT. Subgroup analysis suggested a significant correlation of pCR rate with molecular subtypes based on HR and HER2 status （P＜0.001）. In HER2-positive breast cancer，the pCR rate was significantly higher in patients who received anti-HER2 therapy than in those who did not（60.0% vs 23.1%， P=0.031）.
Conclusion
HR negativity and HER2 positivity are independent predictive factors for pCR in elderly patients with breast cancer receiving neoadjuvant therapy.
To investigate the effect of left colic artery （LCA）-preserving lymph node dissection at the root of the inferior mesenteric artery （IMA） on the efficacy of laparoscopic radical resection of rectal cancer.
Methods
Clinical data of patients undergoing laparoscopic radical resection for rectal cancer at the Department of General Surgery of Beijing Fengtai Hospital from February 2017 to February 2019 were retrospectively analyzed. According to the location where the IMA was ligated， 23 cases were included in a high ligation group （Group H， IMA root ligation） and 74 were included in a low ligation group（group L， LCA preserved）. Operation parameters （operation time， intraoperative blood loss， number of lymph nodes dissected， number of metastatic lymph nodes， postoperative hospital stay， and time to postoperative intestinal function recovery）， postoperative complications， and postoperative 2-year recurrence rate and 5-year survival rate were compared between the two groups.
Results
There was no statistical difference between the two groups in preoperative TNM stage. The time to postoperative intestinal function recovery was shorter in group L than in group H （P＜0.05）， but there was no statistical difference in the rest operation parameters. The incidence of postoperative anastomotic leakage and urinary dysfunction in group L was lower than that of group H （P＜0.05）. The postoperative 2-year recurrence rate and 5-year survival rate were not statistically different between the two groups.
Conclusion
LCA-preserving lymph node dissection at the root of the IMA can not only shorten the time to postoperative intestinal function recovery but also reduce the incidence of postoperative anastomotic leakage and urinary dysfunction without affecting the curative effect of laparoscopic radical resection for rectal cancer .
To investigate the awareness， demand， intention， and preference for digital therapeutics （DTx） in orthopedic rehabilitation patients， so as to better promote the application of DTx in orthopedic rehabilitation in the future.
Methods
An observational cross-sectional study was conducted to investigate the awareness， demand， intention， and preference for DTx among orthopedic rehabilitation outpatients and inpatients in four public medical institutions in Beijing， including rehabilitation medicine department in Grade Ⅲ Level A hospital， rehabilitation specialist hospital， and community rehabilitation center. A self-designed electronic questionnaire was used for survery， and the results were statistically analyzed.
Results
A total of 928 valid questionnaires were obtained. Statistical analysis of the degree of awareness of DTx showed that 80.28% of patients “did not know”； the proportion of patients with “no awareness at all” in people over 50 years old was significantly higher than that of other age groups （P=0.036 ），but the degree of understanding of DTx among people with master’s degree or above was significantly higher than that of other education groups （ P=0.011 ）. Of the 693 patients who had never used DTx， 75.61% were willing to try to use DTx to manage their own health problems， and if used together with medical staff，the percentage of patients willing to use DTx increased to 86.00%. Compared with patients who had not used DTx， the proportion of patients who were willing to spend more than one hour per day on orthopedic rehabilitation training and the proportion of patients who were willing to attend the hospital more than twice a week for rehabilitation treatment were significantly higher in those who had used DTx （P＜0.001）.However， patients who had used DTx were more worried about personal privacy or other security issues（P=0.003） and believed that DTx would weaken their interpersonal relationships with medical staff （P＜0.001）.
Conclusion
Although the awareness of DTx in orthopedic rehabilitation patients needs to be improved，they have high confidence and more expectations for the new mode of DTx than traditional rehabilitation methods. In the future， we should continue to increase the popularization and education of DTx in orthopedic rehabilitation， and improve the DTx products of orthopedic rehabilitation with regard to product design，performance modules， usage methods， and safety guarantees
To investigate the sleep quality， depressive status， and occupational burnout among neurosurgery residents and analyze the influencing factors of occupational burnout， in order to provide a scientific basis for improving the occupational burnout of neurosurgery residents.
Methods
A cluster sampling method was used to conduct a questionnaire survey on occupational burnout， self-assessment of depression， and sleep quality among neurosurgery residents in training in Beijing. Univariate analysis，Pearson correlation analysis， and multivariate analysis were conducted to identify the influencing factors of occupational burnout among neurosurgery residents.
Results
A total of 210 valid questionnaires were collected， in which 141 individuals （67.1%） reported experiencing occupational burnout. Poor health，smoking， poor sleep quality， and depressive state were risk factors for emotional exhaustion. Drinking alcohol， long working hours， poor sleep quality， and moderate to severe depressive state were risk factors for depersonalization. Having parents working in the medical field and personal income satisfaction for daily expenses were protective factors for low personal accomplishment， while smoking， long working hours， poor sleep quality， and mild depressive state were risk factors for the same. Smoking， alcohol consumption， and long working hours were identified as risk factors for occupational burnout among neurosurgery residents.
Conclusion
Smoking， alcohol consumption， and long working hours are important risk factors for occupational burnout， while poor sleep quality and depressive state are common risk factors for emotional exhaustion， depersonalization， and low personal accomplishment. Effective and timely interventions， such as reasonable work schedule arrangements and psychological support， should be implemented by managers to reduce occupational burnout among healthcare professionals， ensuring both the quality of medical care and the physical and mental well-being of physicians.
Mendelian randomization is a causal inference method using genetic variants as instrumental variables， which utilizes the assignment randomness of genetic variants to achieve the effect similar to that of a randomized controlled trial， and can overcome the confounding bias in traditional observational studies. By virtue of the temporal precedence of the genetic variants， Mendelian randomization can also overcome the reverse causality interference in traditional observational studies. Mendelian randomization has been widely used in recent years for causal inference in the medical field. In this paper，we will review the Mendelian randomization method and its application in the field of breast cancer research，aiming to provide new ideas for the causal association study of breast cancer， as well as to provide a basis for the prevention and treatment of this malignancy.
Hepatocellular carcinoma is currently the fourth most common malignant tumor and the second leading cause of cancer-related deaths in China， posing a serious threat to people's lives and health. Early diagnosis and treatment can significantly improve the survival rate and prognosis of liver cancer patients. The detection of serum biomarkers has significant clinical application value in early screening and diagnosis of liver cancer due to its simple operation. Alpha-fetoprotein is a highly specific serum biomarker for clinical diagnosis of hepatocellular carcinoma. However， in China， about 30%～40% of hepatocellular carcinoma patients test negative for alpha-fetoprotein， which greatly limits its role in the diagnosis of hepatocellular carcinoma. In recent years， the serum markers discovered by researchers， including protein markers， enzyme markers， cytokine markers， gene markers， and antigen/antibody markers， can compensate for the insufficiency of alpha-fetoprotein in hepatocellular carcinoma diagnosis. Therefore， the discovery and application of novel serum biomarkers has become an urgent need in clinical medicine in order to improve the early diagnosis rate of alpha-fetoprotein negative hepatocellular carcinoma.
Pyroptosis is a recently discovered form of inflammasome dependent programmed cell death mediated by caspase-1/4/5/11 and gasdermin family proteins. Many studies have shown that pyroptosis is a double-edged sword， which is closely related to the occurrence and treatment of diseases. With the deepening of research， the relationship between pyroptosis and disease is becoming more and more clear， and pyroptosis is becoming a new hot topic in disease research. In this paper， we review the pathological features of pyroptosis and its relationship with related diseases， in order to provide new ideas and methods for the study of pyroptosis.
Coronary heart disease remains one of the leading causes of cardiovascular mortality.With the in-depth understanding of the pathogenesis of coronary heart disease， it is now widely believed that vulnerable plaques within the coronary arteries are associated with the occurrence of future acute coronary syndromes. The vulnerability of plaques is mainly assessed using intravascular imaging techniques such as Intravascular Ultrasound （IVUS） and Optical Coherence Tomography （OCT）. However， these methods require the use of additional interventional consumables， and the analysis is relatively time-consuming，which limits their application in the interventional diagnosis and treatment of coronary heart disease. Recent studies have shown that radial wall strain （RWS） analysis has a high consistency with traditional intravascular imaging techniques in assessing vulnerable plaques， and it can avoid additional interventional costs. RWS is expected to become a routine method for assessing plaque vulnerability and optimizing strategies for coronary intervention. This article provides a review of the principles， workflow， clinical research， and current limitations of RWS.
Erythematous lesions on the scalp are common clinical manifestations that can be caused by a variety of diseases， including psoriasis， seborrheic dermatitis， contact dermatitis， lichen planopilaris， actinic keratosis， etc. As a non-invasive imaging technique， dermoscopy can assist in the diagnosis and differential diagnosis of scalp erythema. By reviewing the relevant literature in recent years，this article summarizes the dermoscopic characteristics of the above diseases and the key points for their differential diagnosis.
