To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To explore the clinical efficacy of the Bakri intrauterine balloon (BIUB) in preventing and treating postpartum hemorrhage(PPH) caused by different etiologies.

A retrospective study was conducted on 724 postpartum hemorrhage patients treated at 31 hospitals across 9 provinces in China from November 2018 to September 2019. Clinical data included age, height, pre-pregnancy weight, parity, gestational age at delivery, pregnancy complications and comorbidities was collected. Patients were divided into three groups based on PPH etiology: (1) Group A, with 308 cases of PPH caused by uterine atony; (2) Group B, 211 cases of PPH caused by placental factors; (3) Group C, 205 cases of PPH caused by coagulation dysfunction. General situation, bleeding volume before and after balloon placement, changes in related indicators of blood routine examination, and hemostatic efficacy of Bakri balloon were compared among groups.

(1) General situation: There were statistically significant differences in the average age [(31.43±4.95)years vs(32.27±4.82)years vs(33.17±5.07)years, P<0.001)], twin pregnancy [62 (20.13%) vs 11 (5.21%) vs 21 (10.24%), P<0.001], gestational weeks of delivery [(37.39±2.75)weeks vs (36.13±2.56)weeks vs (36.62±2.56) weeks, P<0.001], preterm delivery [76 (24.68%) vs 83 (39.34%) vs 79 (38.54%), P<0.001], cesarean delivery [215 (69.81%) vs 178 (84.36%) vs 150 (73.17%), P<0.001], prenatal red blood cell count [(3.92±0.63)×10¹²/L vs (3.74±0.69)×10¹²/L vs (3.79±0.67)×10¹²/L, P=0.007], hemoglobin [(111.98±16.18)g/L vs (108.66±15.92)g/L vs (107.00±19.76)g/L, P=0.006], hematocrit [(0.35±0.09)%vs (0.34±0.07)% vs(0.33±0.06)%, P=0.033], and mean corpuscular volume(MCV) levels [(86.46±11.20)fl vs (89.04±7.21)fl vs (85.55±11.97)fl, P=0.002] among the three groups of patients. No statistically significant difference were found in pre-pregnancy weight, parity, prenatal mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), and pre-balloon hemorrhage (P>0.05). (2) Changes in blood routine related indicators: There were no statistically significant changes in red blood cell count, hemoglobin, hematocrit, average red blood cell volume, and average red blood cell hemoglobin concentration among the three groups of patients before and after balloon placement (P>0.05). (3) Hemostatic effect: hemostatic success rates after balloon placement were 98.05%, 97.63%, and 96.59%, respectively. There was no significant difference in the success rate and incidence of complications of Bakri balloon hemostasis among the three groups of patients (P>0.05).

The Bakri balloon effectively achieves rapid hemostasis for PPH caused by uterine atony, placental factors, and coagulation dysfunction, demonstrating particular suitability for uterine atony. However, its efficacy is limited in cases of severe PPH.

To compare the differences in risk factors of postpartum hemorrhage (PPH) between patients conceiving via assisted reproductive technology (ART) and spontaneous conception, and to explore whether ART conception is an independent risk factor for PPH.

A retrospective cohort study was conducted involving 25 035 women aged 18-49 years with singleton vaginal deliveries at Peking University Third Hospital from January 2012 to December 2020. They were divided into ART group (2 003 cases, accounting for 8.0%) and natural pregnancy group (23 032 cases, accounting for 92.0%) based on whether ART conception occurred. The maternal age, gestational age at delivery, primiparous status, body mass index (BMI), pregnancy complications (pregnancy anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, macrosomia and placenta accreta spectrum) of the two groups were analyzed respectively. Chi-square and Mann-Whitney U tests were used to verify the correlation between ART and the incidence of PPH and blood loss. Furthermore, multivariate logistic regression was conducted.

The incidence of PPH in the ART group and non-ART group was 19.4% and 11.9%, respectively (P<0.001). After removing the confounding factors such as maternal age (34 years vs 31 years, P<0.001), gestational age (39 weeks vs 39 weeks, P=0.924), primiparous status (91.4% vs 76.7%, P<0.001), body mass index (BMI) (21.631 kg/m² vs 21.077 kg/m^2, P<0.001), pregnancy complications [pregnancy anemia (5.5% vs 6.0%, P=0.410), hypertensive disorders in pregnancy (8.0% vs 5.9%, P<0.001), gestational diabetes mellitus (33.5% vs 21.9%, P<0.001), macrosomia (3.1% vs 3.4%, P=0.482) and placenta accreta spectrum (4.0% vs 2.4%, P<0.001)], the incidence of PPH (OR=1.580, 95%CI: 1.382~1.806, P<0.001) and blood loss (β=47.526, 95%CI: 7.051~88.001, P=0.021) in the ART group was significantly higher than that in the non-ART group.

Compared with spontaneous conception, ART conception is associated with an increased risk of PPH during vaginal delivery, highlighting the need for enhanced risk management in ART pregnancies.

To investigate the predictive value of placental volume, placental area and cervical length for placenta accreta (PAS) in patients with complete placenta previa.

A retrospective study was conducted on 926 patients with complete placenta previa who received regular antenatal examination and delivered in the Affiliated Suzhou Hospital of Nanjing Medical University from January 2016 to December 2023. Among them, 90 patients meeting inclusion criteria with complete placenta previa and PAS were enrolled as the study group, and 90 patients with complete placenta previa without PAS were selected as controls. Maternal age, body mass index (BMI), gravidity and parity, placental area and volume measured by magnetic resonance imaging (MRI), cervical length, gestational age at delivery, intraoperative blood loss, and transfusion volume were compared between groups.

(1) The gravidity [3(3, 4) vs 3(2, 4), Z=2.13] and parity [2(1, 2) vs 2(1, 2), Z=3.06] in the study group was higher than that in the control group, and the difference was statistically significant (P<0.05). The gestational age of delivery in the study group was smaller than that in the control group [(35.51±1.45) weeks vs (36.35±1.77) weeks, t=3.48], and the difference was statistically significant (P<0.05). (2)The operation time [(94.27±33.57) min vs (63.04±27.58) min, t=6.82], blood loss [(2 358.46±537.29)ml vs(1 350.27±364.22)ml, t=14.74] and blood transfusion [(1 725.27±410.55)ml vs (836.58±357.29)ml, t=15.49] in the study group were higher than those in the control group, and the differences were statistically significant(P<0.01). (3)The uterine artery embolization rate (23.22% vs 3.33%, χ²=4.96) in the study group was higher than those in the control group, the difference was statistically significant (P<0.05). The neonatal weight of the study group was lower than that of the control group [(2 419.52±410.27)g vs (2 715.26±385.17) g, t=4.99], and the difference was statistically significant (P<0.05). (4) The placental area [(82.52±12.95) cm² vs (63.50±13.55)cm², t=9.63] and placental volume [(1 003.68±211.52)cm³ vs (812.66±219.50)cm^3, t=5.95] of the study group were higher than those of the control group, and the difference was statistically significant (P<0.05). The cervical length of the study group was smaller than that of the control group [(1.89±0.49) cm vs (2.76±0.54) cm, t=11.32], and the difference was statistically significant (P<0.05). (5) The MRI features of placenta volume, placenta area and cervical length included in this study have certain predictive value for whether patients with placenta accreta, and the AUC of the three MRI features were all >0.80, and the diagnostic value of placenta volume was the largest (AUC=0.88). The combination of three MRI features had high value in the prediction of placenta accreta in placenta previa (AUC=0.93).

The placental volume, placental area and cervical length are effective predictors of PAS in patients with complete placenta previa, aiding obstetricians in preoperative preparation and improve maternal outcomes.

To investigate the effect of a Macy model-based communication training program on doctor-patient communication in critically ill pregnant women.

A prospective study was conducted, involving 198 critically ill pregnant women and 32 healthcare providers admitted to the Intensive Care Unit (ICU) of our hospital from January 2023 to June 2024. Participants were divided into two groups based on different training periods: a control group (16 healthcare providers and 102 pregnant women, trained from January 2023 to September 2023) and an observation group (16 healthcare providers and 96 pregnant women, trained from October 2023 to June 2024). Medical staff in the control group received conventional doctor-patient communication training, while those in the observation group underwent Macy model-based communication training, focusing on ″eliciting patient perspectives, patient education, and treatment plan negotiation.″ The training outcomes of medical staff in both groups were compared before and after training. Additionally, the satisfaction feedback from the 198 critically ill pregnant women regarding the communication with medical staff after training was compared between the two groups after training.

After the training, the scores of the observation group in ″eliciting and understanding the patient′s perspective, ″ ″shared decision-making, ″ and ″patient education″ were (3.50±0.42), (3.49±0.42), and (3.30±0.56) points, respectively. In comparison, the control group scored (3.11±0.64), (3.02±0.62), and (2.90±0.52) points in the corresponding domains. The post-training scores in these three aspects were significantly higher in the observation group than in the control group, with statistically significant differences (t=2.038, 2.094, 2.511; P<0.05). However, no statistically significant differences were found between the two groups after training in the domains of preparation and assessment, information gathering, patient evaluation, communication during physical examination, and closing the consultation (P>0.05). Moreover, the satisfaction rate of critically ill obstetric patients in the observation group was 93.80%, significantly higher than that in the control group (75.5%), with a statistically significant difference ( χ²=11.245, P<0.05).

The communication training program based on the Macy model effectively enhances the communication skills of healthcare providers, and critically ill pregnant women showed high satisfaction with this communication approach.

报告1例妊娠中期自发性羊膜下血肿病例和文献复习，探讨其对妊娠结局的潜在影响及管理策略，提升临床医生对该疾病的认识。

回顾性分析佛山市第一人民医院于2024年2月1日收治的1例妊娠中期羊膜下血肿患者的临床资料，包括影像学评估、治疗经过及妊娠结局，并结合相关文献进行分析。

患者孕16周超声检查提示单脐动脉；孕27^＋周因下腹痛及早产征象入院，超声检查发现脐旁不规则稍强回声区，考虑血肿可能；严密监护下予地塞米松促胎肺成熟、硫酸镁保护胎儿脑神经治疗；动态复查胎儿超声示羊膜下血肿增大，靠近脐带根部，疑活动性出血。因血肿增大进展快且合并单脐动脉，围产风险高，遂行剖宫产终止妊娠。新生儿Apgar评分6-8-9分，转新生儿科治疗；产妇术后恢复良好，第4天出院。

羊膜下血肿虽罕见，但可导致严重不良围产结局；临床应重视早期识别、动态监测及个体化处理，以保障母胎安全。

探讨多胎妊娠合并葡萄胎的基本特征、遗传机制、诊断与治疗、孕期管理与妊娠结局。

回顾分析广州医科大学附属第三医院收治的2例多胎妊娠合并葡萄胎患者的临床资料，并结合文献对其基本特征、遗传机制、诊断、治疗、孕期管理与妊娠结局进行分析。

(1)例1患者孕32^＋3周以"双胎、子痫前期、胎盘增厚"收入院，入院后查血常规、凝血功能及肝肾功能均无明显异常，超声检查时胸腔少量积液，予解痉、控制血压等对症治疗；孕33^＋2周行胸部X光片及超声检查，均提示胸腔积液；孕33^＋4周剖宫产娩出两活婴，术中见胎盘大量成串状水泡样组织，送病理检查示双胎妊娠合并完全性葡萄胎。(2)例2患者以"胎之一完全性葡萄胎、胎儿生长受限、孕38^＋1周单胎妊娠状态"收入院，经会诊于38^＋3周行剖宫产娩出一活女婴，将胎盘及钳刮的陈旧性凝血块、大小不一的葡萄样组织及糟脆样组织送病理检查，病理回报"符合完全性葡萄胎表现"。

了解多胎妊娠合并完全性葡萄胎的临床特征、诊断与治疗要点，在严密监测和多学科共同管理下可以获得良好的母婴结局。

To explore the relationship between long non-coding RNA colon cancer related transcript 1 （lncRNA CCAT1），microRNA-152 （miR-152） expression and proliferation/invasion genes expression and clinicopathological characteristics in triple negative breast cancer （TNBC）.

A total of 120 TNBC tissue samples and paired adjacent normal tissue samples were collected from surgical resections performed in the Baoding Second Central Hospital from July 2021 to June 2024. The expression levels of lncRNA CCAT1，miR-152 and proliferation-related genes （EZH2，PIWIL2，YAP1），as well as invasion-related genes （GLI1，TUG1，RAB11），were detected using real-time quantitative PCR. Binding sites between lncRNA CCAT1 and miR-152 were predicted using the StarBase database. Pearson correlation was used to analyze correlations between the expression levels of lncRNA CCAT1，miR-152 and the expression levels of proliferation and invasion related genes in TNBC tissues. For normally distributed measurement data, an independent samples t-test was used for comparisons between two groups, analysis of variance for comparisons among multiple groups and paired t-test was used for comparisons with adjacent non-tumor tissues. The relationship between the expression of lncRNA CCAT1 and miR-152 in TNBC tissue and proliferation genes，invasion genes and clinical pathological characteristics were analyzed by stepwise multiple linear regression.

Compared with adjacent normal tissues，TNBC tissues exhibited significantly higher expression levels of lncRNA CCAT1，EZH2 mRNA，PIWIL2 mRNA，YAP1 mRNA，GLI1 mRNA，TUG1 mRNA，and RAB11 mRNA，while miR-152 expression was significantly decreased （all P<0.001）. Binding sites between lncRNA CCAT1 and miR-152 were identified，and their expression levels in TNBC tissues showed a negative correlation （r=-0.761，P<0.001）. Pearson correlation analysis revealed that lncRNA CCAT1 expression was positively correlated with the mRNA expression of EZH2，PIWIL2，YAP1，GLI1，TUG1，and RAB11 （r=0.716，0.685，0.702，0.734，0.726，0.688； all P<0.001），whereas miR-152 expression was negatively correlated with the mRNA expression of these genes （r=-0.713，-0.702，-0.698，-0.721，-0.716，-0.703； all P<0.001）. The expression levels of lncRNA CCAT1 in TNBC tissues with tumor diameter >2 cm，histological grade 3，TNM stage Ⅲ and lymph node metastasis were significantly higher than that with tumor diameter ≤2 cm，histological grade 1–2，TNM stage Ⅰ–Ⅱ and no lymph node metastasis （t=2.529，F=20.827，t=2.944，t=3.172； P=0.013，<0.001，0.004，0.002），the expression levels of miR-152 were significantly lower than that with tumor diameter ≤2 cm，histological grade Ⅰ/Ⅱ，TNM stage Ⅰ–Ⅱ and no lymph node metastasis （t=-2.481，F=-10.611，t=-2.936，t=-3.160； P=0.015，<0.001，0.005，0.002）. The expression level of lncRNA CCAT1 in TNBC tissue were positively correlated with the mRNA expression of EZH2，PIWIL2，YAP1，GLI1，TUG1，RAB11，as well as tumor diameter，histological grade，TNM staging and lymph node metastasis status （OR=3.203，2.807，2.034，4.425，4.476，2.185，2.074，3.127，2.255，4.972； P=0.002，0.006，0.044，<0.001，<0.001，0.031，0.040，0.002，0.026，<0.001）. The expression level of miR-152 were negatively correlated with the gene expression and clinical pathological indicators mentioned above （OR=-2.543，-2.787，-2.120，-2.856，-3.498，-2.403，-2.225，-3.200，-2.819，-4.284； P=0.012，0.006，0.036，0.005，0.001，0.018，0.028，0.002，0.006，<0.001）.

lncRNA CCAT1 is highly expressed and miR-152 is lowly expressed in TNBC tissues，which are closely related to the enhanced proliferation，invasion ability of TNBC cells and poor clinicopathological characteristics of patients，and may become a biomarker for evaluating the malignant progression of TNBC.

To investigate the clinical application and outcomes of endoscopic nipple-sparing mastectomy （NSM） and immediate reconstruction in early breast cancer.

The clinical data of 38 patients with early breast cancer who underwent surgery in the Women and Children's Hospital of Chongqing Medical University from June 2020 to June 2024 were retrospectively analyzed. According to the type of surgery，patients were divided into the endoscopic surgery group （n=25） and the open surgery group （n=13）. Operation time，intraoperative blood loss were compared between two groups using independent sample t test； hospital stay，preoperative and postoperative patient satisfaction with breast appearance were compared between two groups using the nonparametric Mann–Whitney test，and pre- and postoperative patient satisfaction within-group was compared by paired rank-sum test.

Operation time was significantly longer in the endoscopic surgery group than in the open surgery group ［（165.84±16.30） min vs （99.69±12.35） min，t=12.813，P<0.001］. Intraoperative blood loss and postoperative hospital stay showed no statistically significant difference（t=1.456，P=0.154；Z=-0.135，P=0.199）. The patient satisfaction with breast appearance showed no significant differences between two groups before operation［48.00（39.00，55.50） vs 53.00（44.00，58.00），Z=-0.856，P＝0.392）］，while postoperative satisfaction was significantly higher in the endoscopic surgery group ［42.00（40.00，45.50） vs 38.00（33.00，43.00），Z=-2.501，P=0.012］. The patient satisfaction with breast appearance after surgery was significantly better than that before surgery （Z=-2.432，-2.906，P=0.015，0.004）.

The endoscope-assisted NSM and immediate reconstruction in early breast cancer has the advantages of good aesthetic effect，safety and operability，and high postoperative patient satisfaction worthy of clinical application.

To analyze the influencing factors of the efficacy of neoadjuvant chemotherapy （NAC） in young patients with HER-2 low-expression breast cancer.

According to the inclusion and exclusion criteria，this retrospective study collected the clinical data of 68 young breast cancer patients with HER-2 low-expression （<40 years old） who received preoperative NAC in the Department of Oncology Surgery，Department of Breast Surgery of the First Hospital of Lanzhou University and Department of Breast Surgery of Gansu Provincial Cancer Hospital from December 2017 to July 2022. The pathological efficacy of NAC was evaluated by the Miller-Payne grading system. According to the grading results，the patients were divided into the poor pathological response group （grade 1-3，n=33） and the good pathological response group （grade 4-5，n=35）. The clinicopathological characteristics and hematological indexes were compared between two groups by chi-square test/Fisher's exact test and Mann-Whitney U test. Factors with statistically significant differences were included in multivariate logistic regression analysis to screen out the independent predictors of NAC efficacy in young patients with HER-2 low-expression，and accordingly a nomogram model was constructed and evaluated.

Among young breast cancer patients with HER-2 low-expression，there was no statistically significant difference in clinicopathological characteristics between two groups （all P<0.050）. Compared with the poor response group，the good response group had higher absolute lymphocyte count after NAC （post-Lym），platelet count after NAC （post-Plt），albumin after NAC （post-Alb），random venous plasma glucose before and after NAC （pre-RVPG，post-RVPG），and change value （ΔRVPG） （χ²=5.858，4.788，4.637，7.428，4.839，5.316； P=0.016，0.029，0.031，0.006，0.028，0.021）. Multivariate analysis showed that post-Alb （OR=7.713，95%CI： 1.620-36.716，P=0.010），post-RVPG （OR=14.612，95%CI： 2.225-95.939，P=0.005） and ΔRVPG （OR=9.639，95%CI： 2.511-36.997，P<0.001） were independent predictors of NAC efficacy in young breast cancer patients with HER-2 low-expression. Based on the results of multivariate logistic regression analysis，the nomogram model for predicting NAC efficacy in young patients with HER-2 low-expression was constructed. The area under the receiver operating characteristic curve was 0.797 （95%CI： 0.693-0.900）. The mean absolute error of the calibration curve was 0.042 （<0.050），indicating that the model had good calibration.

The efficacy of NAC in young breast cancer patients with HER-2 low-expression may be closely related to metabolism-nutrition status. Albumin，random venous plasma glucose and blood glucose fluctuation before and after NAC may become predictors of efficacy in this population，providing a basis for precise treatment.

To investigate the risk factors for nipple-areolar complex （NAC） ischemia and necrosis following nipple-sparing mastectomy （NSM）.

The clinical data of 150 patients who underwent NSM in the Affiliated Hospital of Putian University from May 2019 to September 2023 were retrospectively analyzed. Patients were divided into the non-necrosis group （with no significant necrosis） and the necrosis group （with significant necrosis） based on the degree of NAC ischemia and necrosis. Chi-square test or t test was used to compare clinical and surgical parameters between two groups. The variables with significant difference in univariate analysis were processed into a multivariate logistic regression model to identify independent risk factors for significant NAC ischemia and necrosis after NSM，and then a predictive model was constructed. At 6 months after surgery，the BREAST-Q questionnaire was used to evaluate breast satisfaction，psychosocial well-being，sexual well-being and physical well-being in both groups.

Seventy-one patients were in the non-necrosis group，and 79 were in the necrosis group. Compared with the non-necrosis group，patients in the necrosis group had a higher BMI，a higher proportion of diabetes history and neoadjuvant chemotherapy，and more excised breast tissue，more the surgeries with an upper quadrant periareolar incision，more breast implant reconstructions，and more frequent thermal dissection of sub-NAC tissue （P<0.050）. Multivariate logistic regression analysis showed that BMI>24 kg/m² （OR=3.371，95%CI： 1.243-9.144，P=0.017），history of diabetes （OR=6.003，95%CI： 1.234-29.203，P=0.026），preoperative neoadjuvant chemotherapy （OR=7.153，95%CI： 1.590-32.184，P=0.010），excised breast tissue volume>240 g （OR=9.923，95%CI： 3.511-28.041，P=0.001），upper quadrant periareolar incision （OR=7.173，95%CI： 2.247–22.894，P=0.001），and thermal dissection of sub-NAC tissue （OR=6.084，95%CI： 2.148-17.232，P=0.001） were independent risk factors for NAC ischemia and necrosis after NSM. The constructed prediction model showed good performance with a C-index of 0.754 and an area under the receiver operating characteristic curve of 0.885 （95%CI： 0.832-0.938）. Postoperative BREAST-Q scores indicated that the non-necrosis group was significantly superior to the necrosis group in breast satisfaction ［74 （68，89） vs 71 （57，89），P<0.001］，psychosocial well-being ［75 （69，93） vs 69 （56，84），P<0.001］，sexual well-being ［71 （53，100） vs 71 （56，90），P<0.001］，and physical well-being ［77 （62，90） vs 72 （59，90），P=0.013］.

The established prediction model provides a quantitative basis for preoperative risk assessment in NSM. Strict preoperative patient selection and optimized intraoperative procedures helps to reduce NAC ischemia and necrosis，thereby improving patient satisfaction and quality of life.

To examine the relationships between coping mode，fear of cancer recurrence （FCR），and hope level in patients with triple negative breast cancer （TNBC），and further analyze the mediating effect of coping styles on the relationship between hope level and FCR.

According to the inclusion and exclusion criteria, a convenience sampling method was adopted to enroll 289 patients with triple-negative breast cancer (TNBC) who received treatment in the Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Army Medical University, from January to September 2024 for a cross-sectional study. The patients with TNBC were surveyed using the Fear of Progression Questionnaire-Short Form （FoP-Q-SF），the Herth Hope Index （HHI），the Medical Coping Modes Questionnaire （MCMQ），and a general information questionnaire. The correlation between coping mode, hope level, and FCR was analyzed using the Pearson correlation analysis. The PROCESS 4.3 macro program was applied to verify the mediating effect of coping mode on the relationship between hope levels and FCR, and the Bootstrap method (with 1 000 repeated samplings) was used to test this mediating effect.

A total of 270 valid questionnaires were recovered, with an effective rate of 93.43% (270/289). The total scores were as follows： FCR total score （42.49±8.22），hope level （30.72±8.30），and coping mode （68.40±11.48）. FCR showed a significant negative correlation with the total hope score and its subscales （r=-0.632 to -0.515，all P<0.001）. FCR was negatively correlated with the "Confrontation" coping subscale （r=-0.440，P<0.001） and positively correlated with the "Avoidance" and "Resignation" subscales （r=0.391 to 0.541，all P<0.001）. Hope level was positively correlated with "Confrontation" （r=0.309，P<0.001） and negatively correlated with "Avoidance" and "Resignation" （r=-0.294 to -0.247，all P<0.001）. The mediating effect of the "Resignation" coping mode on the relationship between hope level and FCR was -0.156 0，accounting for 22.43% of the total effect.

Hope level in TNBC patients is a negative predictor of FCR and the "Resignation" coping mode partially mediates the relationship between hope level and FCR，suggesting that enhancing hope levels and encouraging active coping strategies （such as confrontation） may help to reduce FCR in TNBC patients.