It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of “R0 resection” as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from “maximal resection” to “minimal effective treatment” de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China′s national conditions is the common goal of breast surgeons at this stage.

It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of “R0 resection” as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from “maximal resection” to “minimal effective treatment” de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China′s national conditions is the common goal of breast surgeons at this stage.

Objective:To construct a scientifically standardized and promotable pneumonia prevention and nursing plan for acute stroke patients to guide clinical nursing practice.Methods:According to the evidence-based retrieval strategy, we systematically searched the domestic and foreign clinical decision support system, guideline networks, professional association websites and relevant databases. All databases were searched from January 2012 to November 2022. A preliminary pneumonia prevention and nursing plan for acute stroke patients was formulated after literature quality evaluation, evidence extraction, evidence integration and evaluation. The plan was further revised and improved through three rounds of Delphi expert consultation.Results:In the three rounds of expert consultation, the enthusiasm of experts was 100.0%, 100.0%, 83.3%, the authority coefficient of experts were 0.967, 0.967, 0.937, the coefficient of variation were 0.048 to 0.363, 0 to 0.177, 0 to 0.144, and the Kendal harmony coefficient were 0.221, 0.139, 0.339 ( P<0.001) . The final nursing plan included 8 modules, including pneumonia risk prediction, general nursing, swallowing and dietary management, airway management, oral management, position and exercise, condition observation, and health education, with a total of 30 items. Conclusions:The evidence and Delphi method based pneumonia prevention and nursing plan for acute stroke patients is scientific, reliable and applicable, which can provide a basis for nursing practice.

Objective:To explore independent predictors of postoperative delirium in elderly patients by PRe-Operative Prediction of postoperative DElirium by appropriate SCreening (PROPDESC) and Mayo Delirium Prediction (MDP) , and analyze the predictive power of the two models.Methods:This study was a prospective Cohort study. Using the convenient sampling method, a total of 636 elderly surgical patients admitted to the Orthopedics, Gastroenterology, Cardiothoracic and Oncology Departments of Shantou Central Hospital from May to August 2022 were selected as the research objects. PROPDESC and MDP were used to predict postoperative delirium in elderly patients. The area under the receiver operating characteristic ( AUC) and diagnostic characteristics of the two predictive models were compared, and the single factor analysis and Logistic regression analysis were performed on 19 predictive factors of the two models to determine the independent influencing factors of postoperative delirium. Results:The AUC for external verification of the PROPDESC and MDP were 0.87 (95% CI: 0.84-0.90) and 0.89 (95% CI: 0.86-0.92) , respectively. The sensitivity of 71.79% and 80.34%, and specificity of 85.16% and 81.12%, respectively. Logistic regression analysis showed that emergency admission, age, sentence repetition and sequence subtraction in Montreal Cognitive Assessment (MoCA) were independent influencing factors for postoperative delirium ( P<0.05) . Conclusions:The predictive ability of PROPDESC and MDP models to predict postoperative delirium in elderly patients is satisfactory. On this basis, delirium risk assessment tools suitable for different surgical elderly populations in China can be constructed.

Objective:To systematically review the characteristics of sleep patterns in the elderly with subjective cognitive decline (SCD) and the relationship between subjective cognitive decline and sleep disorders.Methods:Observational studies on sleep patterns in the elderly with SCD were retrieved by computer in Chinese and English databases such as PubMed, Embase, Web of Science, ScienceDirect, China National Knowledge Infrastructure (CNKI) , WanFang Data and VIP, and the retrieval time was from the establishment of the database to March 31, 2020. Two researchers independently conducted article screening, data extraction and quality evaluation according to the standard. The random-effects model was used for Meta-synthesis of studies with data that could be pooled, and descriptive analysis for studies that could not be pooled.Results:A total of 12 articles were included, with a total sample size of 67 474 cases. The prevalence of SCD in the elderly was 25.9% (95% CI: 6.4%-52.5%) . The sleep patterns of the elderly with SCD were characterized by decreased total sleep time, prolonged wake-time after sleep onset, and frequent awakenings at night. Compared with the normal elderly, the elderly with SCD had a higher risk of poor sleep quality, insomnia and excessive daytime sleepiness ( OR=2.1, 1.15, 2.6) , and excessive daytime sleepiness (ESD) increased the risk of SCD in the elderly ( OR=6.06) . Conclusions:Compared with the normal elderly, the overall sleep quality of the elderly with SCD is poor, and sleep disorders can increase the risk of SCD in the elderly. Existing studies have differences in the diagnostic criteria of SCD, and future studies need to further confirm the causal relationship between SCD and sleep disorders in the elderly.

Objective To study the clinicopathologic features,diagnosis and differential diagnosis of tumors of haematopoietic and lymphoid tissue in the female productive tract. Methods Eleven cases of myeloid sarcoma and leukemia, 9 of non Hodgkin lymphoma(NHL),13 of cervical lymphoma-like lesions were selected from Peking University People′s Hospital from January 2006 to August 2017. According to WHO classification of tumors of haematopoietic and lymphoid tissues(2008)and updated classification(2016),the cases were studied by microscopy,immunohistochemistry and in situ hybridization.Results In 20 cases of tumors of haematopoietic and lymphoid tissue,the mean and median age was 48.5 and 56 years old(range:16-77 years old).In cases of lymphoma-like lesion of uterine cervix,the mean and median age was 45.9 and 48 years old(range:23-62 years old).The patients with neoplasm present as fever,fatigue, hypogastralgia, colporrhagia and mass etc. Eight cases had history of acute myeloid leukemia, and 3 had myeloid leukemia while pregnancy. One case of chronic lymphocytic leukaemia/small lymphocytic lymphoma(CLL/SLL)had history of ovary small cell carcinoma and high grade serous carcinoma resected with chemotherapy.One case of diffuse large B cell lymphoma(DLBCL)had history of renal transplantation. Lactic dehydrogenase(LDH)was elevated in 9 cases(9/18).The cases of lymphoma-like lesion present as contact bleeding in most cases and all located in cervix. Four cases of neoplasm located in vulva, 1 in vagina,4 in cervix, 4 in uterine corpus, 8 in ovary and 2 in placenta.Clinical staging of NHL: 4 case was stageⅠ,1 case of stageⅢ,and 4 cases of stageⅣ.Pathological morphology:9 cases were myeloid sarcoma, 2 cases were placenta invaded by myeloid leukemia. Six cases were DLBCL, and 1 case was CLL/SLL, 1 case was mucosa associated lymphoid tissuse lymphoma(MALToma), and 1 case was anaplastic large cell lymphoma. Resected mass, chemotherapy was performed in tumors of haematopoietic and lymphoid tissue. Five cases of myeloid sarcoma and 2 of NHL died. In 13 cases of lymphoma-like lesion of uterine cervix, the general condition was good as following up. Conclusions The clinical history, pathological morphology and immunohistochemistry are very important for diagnosing tumors of haematopoietic and lymphoid tissue in the female productive tract.Resection with chemotherapy is recommended in treatment. The prognosis of lymphoma-like lesion of uterine cervix is good,and should be differentiated from lymphoma.

OBJECTIVETo observe the differences in the clinical therapeutic effects on insomnia of spleen and stomach disharmony pattern in comparison of the combination of acupoint catgut-embedding therapy and auricular point pressure with the simple application of auricular point pressure.

METHODSOne hundred and eighty patients of insomnia of spleen and stomach disharmony pattern were randomized into an observation group (93 cases) and a control group (87 cases). In the observation group, the combination of acupoint catgut-embedding therapy and auricular point pressure was adopted. The acupoint catgut-embedding therapy was applied at Zhongwan (CV 12), Anmian (Extra), Xinshu (BL 15), Pishu (BL 20), Weishu (BL 21), Zusanli (ST 36), Yinlingquan (SP 9) and Sanyinjiao (SP 6), once every two weeks. The auricular point pressure was applied to Shenmen (TF), Pizhixia (AT), Xin (CO), Pi (CO), Wei (CO) on both sides alternatively, twice a week. The duration of treatment was 2 months for the two groups. In the control group, the auricular point pressure was simply used with the same points, manipulation and treatment duration as the observation group. After treatment, the clinical therapeutic effects were observed in the patients of the two groups. The Pittsburgh sleep quality index (PSQI) score was compared before and after treatment in the two groups. The recurrence was followed up in 3 months after the end of treatment.

RESULTSIt was observed that 2 cases were dropped out in the observation group, 4 cases in the control group. The dropped out cases were considered to be ineffective. After treatment, the total effective rate was 92.5% (86/93) in the observation group and was 80.5% (70/87) in the control group. The result in the observation group was better than that in the control group (<0.05). After treatment, PSQI scores were all reduced apparently in the two groups as compared with those before treatment (both<0.05). The score after treatment and the different value before and after treatment in the observation group were lower than those in the control group (both<0.05). In 3-month follow-up after treatment, the recurrence rate was 3.2% (3/93) in the observation group, which was lower than 13.8% (12/87) in the control group (<0.05).

CONCLUSIONIn the treatment of insomnia of spleen and stomach disharmony pattern, the acupoint catgut-embedding therapy combined with auricular point pressure are superior to the simple application of auricular point pressure in the clinical therapeutic effects, improving sleep quality and reducing the recurrence rate.

Objective To observe and compare the clinical efficacy of fire needling versus electroacupuncture in treating knee osteoarthritis of kidney and marrow deficiency type.Methods One hundred and ten patients with knee osteoarthritis of kidney and marrow deficiency type were randomly allocated to two groups, a fire needling group of 56 cases and an electroacupuncture group of 54 cases. The fire needling group received filiform needle acupuncture and fire needle pricking and the electroacupuncture group, electroacupuncture. Treatment was given once every other day, for a total of four weeks as one course. The Visual Analogue Scale (VAS) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were recorded in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Results The VAS score and the WOMAC subscores significantly decreased in both groups after treatment compared with those before treatment (P<0.01). There were no statistically significant post-treatment differences in the VAS score and the WOMAC subscores between the two groups (P>0.05). The VAS score and the WOMAC subscores decreased further in both groups at four weeks after treatment compared with those at the end of treatment (P<0.01). In the electroacupuncture group, there were statistically significant differences in the VAS score and the WOMAC pain and stiffness subscores between eight weeks and four weeks after treatment (P<0.01) and in the WOMAC pain, stiffness and joint function subscores between at eight weeks after treatment and at the end of treatment (P<0.01). In the fire needling group, there were statistically significant differences in the VAS score and the WOMAC pain, stiffness and joint function subscores between at eight weeks after treatment and at the end of treatment (P<0.01). At four weeks after treatment, the VAS score and the WOMAC pain, stiffness and joint function subscores were significantly lower in the fire needling group than in the electroacupuncture group (P<0.05,P<0.01). At eight weeks after treatment, the VAS score and the WOMAC pain and stiffness subscores were still significantly lower in the fire needling group than in the electroacupuncture group (P<0.01). The total efficacy rate was 94.6% in the fire needling group and 90.7% in the electroacupuncture group; there was no statistically significant difference between the two groups (P>0.05).Conclusions Both filiform needle acupuncture plus fire needle pricking and electroacupuncture can markedly relieve the pain and stiffness and improve joint function in knee osteoarthritis of kidney and marrow deficiency type. Both have an equivalent short-term therapeutic effect. Filiform needle acupuncture plus fire needle pricking has a better long-term therapeutic effect than electroacupuncture.

Objective To identify distinct subgroups of military personnel from Paracel Islands based on mental status for providing basis to intervention measures.Methods 174 enlisted military personnel were interviewed by symptom checklist-90 (SCL-90).The factor scores of SCL-90 were compared with army man norm and control group,then the cluster analysis was conducted.Results Interpersonal sensitivity,phobic and psychoticism of military personnel on Paracel Islands((1.65±0.56),(1.24±0.33),(1.44±0.46)) scored lower than those of army man norm (P＜0.05).Interpersonal sensitivity of military personnel on Paracel Islands scored lower than those of control (P＜0.05),depression and anxiety of them had no difference to control (P＞0.05),while other factors of them scored higher than control.According to cluster analysis,174 military personnel were divided into three subgroups.The first subgroup with high scores for all nine SCL-90-R dimensions,the second cluster showed moderate scores and the third cluster had lowest scores.Statistically significant sociodemographic differences could be found between the cluster groups (P＜0.05).Conclusion The mental health status of military personnel stationed in Paracel Islands is good on the whole,and can be divided into three clusters with different demographic and service characteristics.

ObjectiveTo investigate the clinical efficacy of fire needling plus filiform needles in treating knee osteoarthritis and its effect on the patients’ quality of life.MethodOne hundred and one patients with knee osteoarthritis were randomly allocated to fire needling, filiform needle and combination groups. They were treated with fire needling, filiform needles and fire needling plus filiform needles, respectively. An assessment was made using the WOMAC Osteoarthritis Index and the 36-item Short Form Health Survey (SF-36) in the 101 patients with knee osteoarthritis before and after treatment.ResultFire needling, filiform needles and fire needling plus filiform needles all had a marked therapeutic effect on knee osteoarthritis. The effect of fire needling plus filiform needles was better than those of fire needling and filiform needles (P<0.05,P<0.01). After four weeks of treatment, SF-36 quality of life item sub-scores increased in all the three groups of patients compared with before treatment (P<0.01); SF-36 role physical and general health scores were higher in the combination group than in the fire needling group (P<0.05, P<0.01); SF-36 physical functioning, role physical, general health, social functioning and mental health scores were higher in the combination group than in the filiform needle group (P<0.01).ConclusionFire needling plus filiform needles can effectively treat knee osteoarthritis and improve the patients’ quality of life. Its effects are superior to those of fire needling and filiform needles.