Background and Aims:Tumor deposits(TDs)may influence prognosis beyond the current 8th edition AJCC pTNM nodal classification in gastric cancer(GC).This study investigates the prognostic value of TD number and proposes an improved pN staging(mpN)that classifies patients with TD number>1 as pN3b.We validated the mpN staging against the 8th AJCC pN staging.Methods:A dual-center retrospective cohort study was performed,including 1 327 patients who underwent radical gastrectomy at Sun Yat-sen University Cancer Center(2011-2015;test cohort)and 340 patients from Guangdong Provincial People's Hospital(2015-2022;validation cohort).Patients were dichotomized into low-TD(≤1)and high-TD(>1)groups.Outcomes were overall survival(OS)and disease-free survival(DFS).Survival analyses used Kaplan-Meier curves,IPTW,and Cox regression.Predictive performance of staging systems was assessed by time-dependent ROC(tROC)/tAUC,concordance index(C-index)and Akaike information criterion(AIC).Results:TDs were present in 435/1 327(32.7%)in the test cohort.Presence of TD was associated with worse OS(IPTW-adjusted HR=2.69,95%CI=2.18-3.31,P<0.01)and DFS(HR=2.82,95%CI=2.32-3.42,P<0.01).In multivariable models,TD remained an independent adverse factor for OS(HR=1.65,95%CI=1.34-2.05;P<0.01)and DFS(HR=1.74,95%CI=1.43-2.11,P<0.01).Increasing TD number correlated with progressively poorer survival;X-tile identified>1 as an optimal cutoff,with high-TD patients showing markedly worse outcomes(OS:adjusted HR=3.65,95%CI=2.74-4.88;DFS:adjusted HR=3.74,95%CI=2.85-4.91;both P<0.01).Incorporation of TD number into the mpN staging(assigning TD>1 to pN3b)improved prognostic discrimination:in the test cohort 5-year OS tAUC was 0.746 for mpN vs.0.703 for AJCC pN(C-index 0.738 vs.0.721,AIC 5 805.27 vs.5 849.30);similar improvements were observed in the validation cohort.Conclusion:TD presence and number exert significant negative prognostic impact in GC.Classifying patients with TD number>1 as pN3b enhances prognostic accuracy.Routine reporting of TD counts and further prospective multicenter validation of mpN staging are warranted.

Background and Aims:Tumor deposits(TDs)may influence prognosis beyond the current 8th edition AJCC pTNM nodal classification in gastric cancer(GC).This study investigates the prognostic value of TD number and proposes an improved pN staging(mpN)that classifies patients with TD number>1 as pN3b.We validated the mpN staging against the 8th AJCC pN staging.Methods:A dual-center retrospective cohort study was performed,including 1 327 patients who underwent radical gastrectomy at Sun Yat-sen University Cancer Center(2011-2015;test cohort)and 340 patients from Guangdong Provincial People's Hospital(2015-2022;validation cohort).Patients were dichotomized into low-TD(≤1)and high-TD(>1)groups.Outcomes were overall survival(OS)and disease-free survival(DFS).Survival analyses used Kaplan-Meier curves,IPTW,and Cox regression.Predictive performance of staging systems was assessed by time-dependent ROC(tROC)/tAUC,concordance index(C-index)and Akaike information criterion(AIC).Results:TDs were present in 435/1 327(32.7%)in the test cohort.Presence of TD was associated with worse OS(IPTW-adjusted HR=2.69,95%CI=2.18-3.31,P<0.01)and DFS(HR=2.82,95%CI=2.32-3.42,P<0.01).In multivariable models,TD remained an independent adverse factor for OS(HR=1.65,95%CI=1.34-2.05;P<0.01)and DFS(HR=1.74,95%CI=1.43-2.11,P<0.01).Increasing TD number correlated with progressively poorer survival;X-tile identified>1 as an optimal cutoff,with high-TD patients showing markedly worse outcomes(OS:adjusted HR=3.65,95%CI=2.74-4.88;DFS:adjusted HR=3.74,95%CI=2.85-4.91;both P<0.01).Incorporation of TD number into the mpN staging(assigning TD>1 to pN3b)improved prognostic discrimination:in the test cohort 5-year OS tAUC was 0.746 for mpN vs.0.703 for AJCC pN(C-index 0.738 vs.0.721,AIC 5 805.27 vs.5 849.30);similar improvements were observed in the validation cohort.Conclusion:TD presence and number exert significant negative prognostic impact in GC.Classifying patients with TD number>1 as pN3b enhances prognostic accuracy.Routine reporting of TD counts and further prospective multicenter validation of mpN staging are warranted.

Objective:To systematically evaluate the impact of internet-based patient decision aid (PtDA) on decision-making for prenatal screening and diagnosis among pregnant women.Methods:Randomized controlled trials (RCTs) on the application of internet-based PtDA for prenatal screening and diagnosis among pregnant women were searched in PubMed, Embase, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Date, VIP, and China Biology Medicine disc. The search period was from inception to August 11, 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Meta-analysis was performed using RevMan 5.4 software.Results:A total of 10 studies involving 3 838 pregnant women were included. The meta-analysis showed that internet-based PtDA significantly reduced decision conflict ( P<0.05), improved decision knowledge ( P<0.01), and decreased decision anxiety ( P<0.05) among pregnant women but had no significant impact on decision regret ( P>0.05) . Conclusions:Internet-based PtDA effectively reduce decision conflict and anxiety while improving decision knowledge during prenatal screening and diagnostic decision-making. Future studies should focus on developing culturally appropriate decision aids tailored to the Chinese context and explore the enhanced role of nurses in prenatal screening counseling.

Objective:To systematically analyze the reasons for delayed medical consultation in cervical cancer patients, providing a reference basis for promoting timely medical consultation and early treatment for cervical cancer patients.Methods:A computer-based search was conducted across various databases, including China National Knowledge Infrastructure, Wanfang Data, VIP, China Biology Medicine disc, PubMed, Web of Science, Embase, CINAHL, and Cochrane Library, for qualitative studies on delayed medical consultation in cervical cancer patients. The search covered all available records up to June 30, 2024. The Joanna Briggs Institute centre for evidence-based health care qualitative research quality assessment criteria was used to assess the quality of the included studies, and an integrative synthesis method was applied to combine the findings.Results:A total of 11 studies were included, with 36 individual findings. These findings were grouped into 13 new categories. A total of three major synthesized results were identified: insufficient awareness of cervical cancer, barriers to medical consultation behavior, and the influence of social factors.Conclusions:Strengthening the promotion of cervical cancer health knowledge, providing psychosocial support for patients, and establishing robust social support systems are essential strategies to facilitate timely medical consultation and early treatment for cervical cancer patients.

Objective:To systematically evaluate and integrate qualitative research on the experiences of patients with premature ovarian insufficiency (POI) , so as to provide a basis for developing targeted interventions.Methods:The qualitative research on the experiences of patients with POI was electronically searched in Wanfang Data, VIP, China National Knowledge Infrastructure, China Biology Medicine disc, PubMed, Cochrane Library, Embase, CINAHL, and Web of Science. The search period was from database establishment to July 19, 2024. The included articles were evaluated with the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. Aggregative synthesis was used to integrate the literature.Results:A total of 11 articles were included. The 38 themes were distilled and summarized into 12 new categories, culminating in four integrated outcomes of unfamiliar bodies, psychological shock and calming, the double-edged sword of family and society, and hormone therapy.Conclusions:Patients with POI face multiple pressures from illness, psychology, family and society. Improving the experience of patients with POI requires a concerted effort by healthcare professionals, families, and even society.

Objective:To systematically evaluate the impact of internet-based patient decision aid (PtDA) on decision-making for prenatal screening and diagnosis among pregnant women.Methods:Randomized controlled trials (RCTs) on the application of internet-based PtDA for prenatal screening and diagnosis among pregnant women were searched in PubMed, Embase, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Date, VIP, and China Biology Medicine disc. The search period was from inception to August 11, 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Meta-analysis was performed using RevMan 5.4 software.Results:A total of 10 studies involving 3 838 pregnant women were included. The meta-analysis showed that internet-based PtDA significantly reduced decision conflict ( P<0.05), improved decision knowledge ( P<0.01), and decreased decision anxiety ( P<0.05) among pregnant women but had no significant impact on decision regret ( P>0.05) . Conclusions:Internet-based PtDA effectively reduce decision conflict and anxiety while improving decision knowledge during prenatal screening and diagnostic decision-making. Future studies should focus on developing culturally appropriate decision aids tailored to the Chinese context and explore the enhanced role of nurses in prenatal screening counseling.

Objective:To systematically analyze the reasons for delayed medical consultation in cervical cancer patients, providing a reference basis for promoting timely medical consultation and early treatment for cervical cancer patients.Methods:A computer-based search was conducted across various databases, including China National Knowledge Infrastructure, Wanfang Data, VIP, China Biology Medicine disc, PubMed, Web of Science, Embase, CINAHL, and Cochrane Library, for qualitative studies on delayed medical consultation in cervical cancer patients. The search covered all available records up to June 30, 2024. The Joanna Briggs Institute centre for evidence-based health care qualitative research quality assessment criteria was used to assess the quality of the included studies, and an integrative synthesis method was applied to combine the findings.Results:A total of 11 studies were included, with 36 individual findings. These findings were grouped into 13 new categories. A total of three major synthesized results were identified: insufficient awareness of cervical cancer, barriers to medical consultation behavior, and the influence of social factors.Conclusions:Strengthening the promotion of cervical cancer health knowledge, providing psychosocial support for patients, and establishing robust social support systems are essential strategies to facilitate timely medical consultation and early treatment for cervical cancer patients.

Objective:To systematically evaluate and integrate qualitative research on the experiences of patients with premature ovarian insufficiency (POI) , so as to provide a basis for developing targeted interventions.Methods:The qualitative research on the experiences of patients with POI was electronically searched in Wanfang Data, VIP, China National Knowledge Infrastructure, China Biology Medicine disc, PubMed, Cochrane Library, Embase, CINAHL, and Web of Science. The search period was from database establishment to July 19, 2024. The included articles were evaluated with the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. Aggregative synthesis was used to integrate the literature.Results:A total of 11 articles were included. The 38 themes were distilled and summarized into 12 new categories, culminating in four integrated outcomes of unfamiliar bodies, psychological shock and calming, the double-edged sword of family and society, and hormone therapy.Conclusions:Patients with POI face multiple pressures from illness, psychology, family and society. Improving the experience of patients with POI requires a concerted effort by healthcare professionals, families, and even society.

Objective:Based on the specific cleavage and non-specific "trans-cleavage" activities of the clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein(CRISPR/Cas13), we established a visually amplification-free rapid detection technique of 2019-nCoV nucleic acid. This technique is easily processed with a low detection limit and good specificity.Methods:According to the 2019-nCoV gene sequence, specific CRISPR RNAs were screened and designed by bioinformatics analysis, and then synthesized as universal signal-strained RNA transcription targets in vitro to establish and optimize the reaction system. Moreover, the 2019-nCoV pseudoviral nucleic acid was used as a standard substance to evaluate the detection limit. A total of 65 positive samples were collected from various 2019-nCoV variants, while 48 negative samples included other clinically common respiratory pathogens, such as influenza A virus, influenza B virus, human parainfluenza virus, Klebsiella pneumonia, etc. All samples were tested by quantitative PCR (qPCR), digital PCR, and the method established in this study. The sensitivity and specificity of the newly established method were analyzed and evaluated. Results:With the newly established technique, the detection time for 2019-nCoV nucleic acid could be minimized to 6 minutes. In addition, the detection limit was 14 copies/μl when assisted by the displaying instrument, whereas it increased to 28 copies/μl with the naked eye. This technique had a sensitivity and specificity of 98.5% (66/67) and 100% (46/46) respectively, showing no statistically significant difference compared to the gold standard qPCR( P=1). Conclusions:This study has successfully established a CRISPR/Cas13a-based visually rapid detection technique for 2019-nCoV nucleic acid. This technique offers the advantages of a simple process, convenient operation, low environmental operating requirements, a detection limit close to qPCR, and a strong potential for on-site testing applications.

Objective:Currently,traditional cervical cancer screening methods,such as high-risk human papillomavirus testing and liquid based cytology(LBC),still possess limitations.This study aims to identify new diagnostic biomarkers to achieve the goal of"precision screening"via exploring the clinical value of DNA methylation[ΔCtP:paired box gene 1(PAX1)and ΔCtJ:junctional adhesion molecule 3(JAM3)]detection in cervical exfoliated cells for the diagnosis of high-grade cervical lesions. Methods:A total of 136 patients who underwent gynecological examinations in the vaginal room of the Department of Gynecology at the Third Xiangya Hospital of Central South University from June 2021 to June 2022 were retrospectively studied.Among them,122 patients had non-high-grade cervical lesions,and 14 patients had high-grade cervical lesions.The variables included general information(age,body mass index,and menopause status),LBC,high-risk human papillomavirus,cervical tissue pathology,vaginal examination results,and the ΔCt values of JAM3 and PAX1 gene methylation.Logistic regression analysis was used to identify the factors affecting the diagnosis of high-grade cervical lesions,followed by correlation analysis and construction of a conditional inference tree model. Results:Logistic regression analysis showed that the methylation ΔCt values of PAX1 and JAM3 genes and LBC detection results were statistically significant between the high-grade cervical lesions group and the non-high-grade cervical lesions group(all P<0.05).Correlation analysis revealed a negative correlation between cervical pathological changes and ΔCtP(r=-0.36,P<0.001),ΔCtJ(r=-0.448,P<0.001),LBC(r=-0.305,P<0.001),or bacterial diversity(r=-0.183,P=0.037).The conditional inference tree showed that when ΔCtJ>10.13,all of patients had non-high-grade cervical lesions,while ΔCtP>6.22,the number of non-high-grade lesions accounted for 97.5%(117/120),and high-grade lesions accounted for only 2.5%(3/120).When ΔCtJ>8.61 and LBC were atypical squamous cell of undetermined significance or negative for intraepithelial lesions or malignancy(NILM),105(99.1%)patients were non-high-grade cervical lesions,only 1(0.9%)patient was high-grade lesion.When the results of LBC were high-grade lesions,only 9 patients'histopathological examination was the high-grade lesions and 3 non-high-grade lesions.When LBC indicated low-grade lesions,atypical squamous cell of undetermined significance,no intraepithelial lesions,and ΔCtP>6.22,117(97.5%)of patients'histopathological examination was the non-high-grade lesions. Conclusion:The JAM3/PAX1 gene methylation test can be used independently for the stratified diagnosis of high-grade/non-high-grade cervical lesions in women with high-risk human papillomavirus infection,independent of the cytological results of cervical excision.The JAM3/PAX1 gene methylation test can also be used in combination with LBC to make up for the shortcomings of low sensitivity of LBC.In addition,the application of methylation kit in large-scale cervical cancer screening in the future will be good to the detection of more patients with high-grade cervical lesions,and achieve early screening and early treatment for cervical lesions/cancer.