In breast-conserving surgery, timely and accurate intraoperative margin assessment is crucial for ensuring surgical success and reducing local recurrence rates. This review first outlined the current methods for intraoperative margin evaluation, including rapid pathological examination and specimen imaging techniques. According to the technical classification, this review systematically introduced emerging technologies that have advanced significantly in recent years, encompassing advanced microscopy, advancements in conventional imaging technologies, novel imaging technologies, and techniques based on biochemical and electrical property contrasts of tissues. Finally, the review summarized and compared these technologies horizontally, and proposed several assessment dimensions aligned with surgical clinical needs, aiming to support the optimization and clinical translation of intraoperative margin assessment techniques. Despite the vigorous development of new technologies, further clinical research and technical refinement remain necessary to achieve continuous improvement and innovation, ultimately providing better options for the patients.

This article provided a systematic review of the current application and development prospect of minimally invasive surgery for breast cancer in China. Although application of endoscopic and robotic surgical procedures remain limited in breast surgery, they have shown advantages in cosmetic outcomes and postoperative recovery across various procedures, including axillary lymph node dissection, breast-conserving surgery, mastectomy, and breast reconstruction. Nonetheless, further high-quality clinical evidence is needed to confirm their long-term oncological safety. Despite current challenges of prolonged operation time and high medical cost, minimally invasive techniques are poised to become an integral component of breast cancer surgical care with continuous refinements of technology and accumulating clinical evidence.

Objective To develop a novel method for measuring the Hounsfield Unit(HU)value of the surface carbon fiber material of the Varian Exact IGRT Couch,and to establish a treatment couch model in the treatment planning system(TPS)for correcting the attenuation of radiation dose caused by the treatment couch.Methods Two different field combinations were used to measure the radiation dose attenuation at the thin end and the middle medium-thickness part of the Varian Exact IGRT Couch.Dose deviations were measured when radiation passed through the treatment couch or not.Multiple sets of different HU values for the couch surface materials were defined in the TPS,and the dose difference between with and without couch was calculated under the same conditions as the measurements.The HU value of the treatment couch material corresponding to the actual measurements was found by data comparison and analysis.Results The attenuation for two interpenetrating fields was-2.49%to-1.69%at the thin end,and-3.43%to-2.23%at the medium-thickness part.The attenuation for multiple oblique incident fields ranged from-3.12%to-2.17%at the thin end,and that was-3.59%to-2.86%at the medium-thickness part.When the HU values of the couch model's surface and internal materials in the TPS were defined as-500 and-960,for two interpenetrating fields,the attenuation was-2.57%to-1.53%at the thin end,and-3.28%to-2.18%at the medium-thickness part;while for multiple oblique incident fields,the attenuation was-3.12%to-2.21%at the thin ends,and-3.42%to-2.43%at the medium-thickness part.These calculated results were consistent with the actual measurement values.For 40 verification plans,the average point dose difference between measurement and calculation in TPS were 0.90%and 0.89%at the thin end and medium-thickness part,respectively.Conclusion This novel measurement method can measure the HU value of the surface carbon fiber material and internal foam material of Exact IGRT Couch.Defining the HU values of these two materials of the couch model in the TPS as-500 and-960 can correct the radiation dose attenuation caused by the treatment couch,thereby improving the dose accuracy of the target volume and organs-at-risk.

Objective To explore the trajectory of psychological symptom clusters in pregnant women with assisted reproductive technology(ART),and analyze the influencing factors of each trajectory subgroups,in order to provide a theoretical basis for the management of psychological health during pregnancy in pregnant women with ART.Methods A total of 205 pregnant women who had conceived using ART were sampled from the obstetrics clinic of a tertiary hospital in Nanjing from August 2023 to April 2024 using a convenient sampling method.The baseline data were assessed by general information questionnaire,Symptom Checklist-90,Distress Disclosure Index and Positive Psychological Capital Questionnaire at 10-14 weeks gestation,and the follow-up information was assessed by Symptom Checklist-90 at 22-26 weeks of gestation and 34-38 weeks of gestation.Exploratory factor analysis was used to extract symptom clusters;the latent class growth mixture model was used to identify the track categories;the multiple logistic regression analysis was used to analyze the influencing factors of the track.Results 180 cases were finally included.By exploratory factor analysis,5,4 and 5 factors were extracted at 3 time points respectively.Trajectories of psychological symptom clusters in pregnant women with ART is divided into 3 potential classes:low level-slow relieving group(28.89％),high level-significant increasing group(6.11％),medium level-slow increasing group(65.00％).Logistic regression analyses showed that duration of infertility,number of ART,literacy,pain self-expression and positive psychological capital were influential factors in the potential categories of psychological symptom clusters in pregnant women conceived with ART(all P＜0.05).Conclusion The trajectory of psychological symptom clusters in pregnant women with ART was divided into 3 potential classes.Medical workers could develop corresponding interventions based on the influencing factors and implement comprehensive and efficient symptom management.

Objective:To systematically evaluate and integrate the exercise experience of overweight or obese pregnant women during pregnancy, in order to provide basis for the formulation of standardized exercise programs for this population.Methods:We searched databases including PubMed, Cochrane Library, Web of Science, CINAHL, Embase, Ovid, PsycINFO, Chinese Biomedical Literature Database, VIP, Wanfang and China National Knowledge Infrastructure, from their inception to August 16, 2023, to collect qualitative studies on the exercise experience of overweight or obese pregnant women during pregnancy. The quality of included studies was evaluated according to Joanna Briggs Institute Critical Appraisal Tool for qualitative studies in Australia. The results were integrated by integrating methods.Results:A total of 11 studies were included. Sixty-one complete findings were grouped according to similarities to form 9 new categories. These categories resulted in 3 synthesized findings. Pregnant women with overweight or obesity were affected by promoting and hindering factors; careful balance of exercise risk and benefit for overweight or obese pregnant women during pregnancy; expectations and needs of overweight or obese pregnant women for exercise during pregnancy.Conclusions:Overweight or obese pregnant women highly rated the benefits and importance of exercise, but their participation and adherence to exercise is challenging. Medical staff should pay attention to the exercise experience of overweight or obese pregnant women during pregnancy, understand the driving factors and obstacles of exercise for overweight or obese pregnant women, in order to provide standardized and personalized exercise guidance programs for overweight or obese pregnant women.

Objective:To retrieve, evaluate and summarize relevant evidence on communication strategies for families with perinatal loss, and to provide an evidence-based basis for communication practice among clinical health professionals.Methods:The system searches for evidence related to the loss of family doctor-patient communication strategies during the perinatal period in computer decision support systems such as UpToDate, BMJ Best Clinical Practice, International Guidelines Network, UK National Institute for Health and Clinical Excellence, PubMed, Web of Science, CINAHL, China National Knowledge Infrastructure, Wanfang Data, as well as in Chinese and English databases and related websites.The search was conducted between January 2012 and December 2022. The literature ′s quality and extracted evidence were independently evaluated by two researchers according to professional judgement. Results:A total of 13 articles were included, including 1 clinical decision, 2 guidelines, 4 national standards, 2 expert consensus, and 4 systematic reviews. 30 pieces of evidence have been summarized across five aspects, comprising communication environment, communication skills, timing and key points of communication, communication for special populations, and system-level communication support.Conclusions:This study summarizes the relevant evidence on communication strategies for family doctor-patient communication strategies for perinatal loss. Clinical professionals should carefully select and apply relevant evidence based on available medical resources and parental preferences, Develop and implement practical standards for family doctor-patient communication strategies for perinatal loss at the system level, further harmonize communication behaviors, and improve communication quality.

Objective:To investigate dietary patterns under social jet lag in pregnant women with gestational diabetes mellitus (GDM) and analyze its relationship with blood glucose control and delivery outcomes, to provide a reference for comprehensive management of pregnant women with GDM.Methods:A cross-sectional study method was used to select pregnant women with GDM during their stay in the obstetrics ward of the Obstetrics and Gynaecology Hospital of Nanjing Medical University from October 2022 to December 2023 as the study population. Social jet lag and dietary information were collected using Simplified Food Frequency Questionnaire and Self-assessment Questionnaire on Social Jet Lag. Spearman correlation analysis was used to analyze the correlation between dietary patterns and blood glucose control as well as delivery outcomes. Receiver operating characteristic curve was used to analyze the predictive performance of social jet lag, dietary patterns and fasting blood glucose for cesarean section.Results:A total of 350 pregnant women with GDM were included, 140 pregnant women with social time lag, aged (31.97 ± 3.88) years old; 210 pregnant women without social time lag, aged (32.32 ± 3.91) years old. The plant-based dietary pattern factor, fast food dietary pattern factor, and the intakes of protein, fat, and carbohydrates of pregnant women with social jet lag were -0.06 (-0.25, 0.32) and 0.08 (-0.43, 0.66), (119.57 ± 89.77) g, (82.69 ± 59.48) g, (228.77 ± 140.18) g, compared with pregnant women without social jet lag [-0.21 (-0.39, 0.08), -0.24 (-0.57, 0.07), (86.29 ± 47.75) g, (57.31 ± 37.86) g, (170.79 ± 85.56) g], the differences were statistically significant ( Z=-2.39, -2.86, t=81.43, 90.78, 88.34, all P<0.05). The social jet lag of GDM women was positively correlated with plant-based dietary patterns, fast food dietary patterns, fasting blood glucose, glycated hemoglobin and cesarean section ( r values were 0.19-0.24, all P<0.05). The plant-based dietary pattern of pregnant women with GDM was negatively correlated with fasting blood glucose and cesarean section ( r=-0.17, -0.24, both P<0.05), while the fast food dietary pattern was positively correlated with fasting blood glucose and cesarean section ( r=0.20, 0.19, both P<0.05). The area under the curve in the combined prediction of multiple factors such as social jet lag, plant-based dietary pattern, fast food dietary pattern and fasting blood glucose for the outcome of cesarean section during pregnancy was 0.742. Conclusions:The dietary structure of GDM women with social jet lag is unreasonable, consume more carbohydrates, sugar, and fats, which are associated with poor glycemic control and increased cesarean section rate. Medical staff should be alerted to social jet lag preferences and dietary intake of GDM and include them in the risk assessment of adverse outcomes of GDM, give timely correction and strengthen management, which can provide a reference for early preventive interventions for GDM with different risk stratification.

Objective To develop a novel method for measuring the Hounsfield Unit(HU)value of the surface carbon fiber material of the Varian Exact IGRT Couch,and to establish a treatment couch model in the treatment planning system(TPS)for correcting the attenuation of radiation dose caused by the treatment couch.Methods Two different field combinations were used to measure the radiation dose attenuation at the thin end and the middle medium-thickness part of the Varian Exact IGRT Couch.Dose deviations were measured when radiation passed through the treatment couch or not.Multiple sets of different HU values for the couch surface materials were defined in the TPS,and the dose difference between with and without couch was calculated under the same conditions as the measurements.The HU value of the treatment couch material corresponding to the actual measurements was found by data comparison and analysis.Results The attenuation for two interpenetrating fields was-2.49%to-1.69%at the thin end,and-3.43%to-2.23%at the medium-thickness part.The attenuation for multiple oblique incident fields ranged from-3.12%to-2.17%at the thin end,and that was-3.59%to-2.86%at the medium-thickness part.When the HU values of the couch model's surface and internal materials in the TPS were defined as-500 and-960,for two interpenetrating fields,the attenuation was-2.57%to-1.53%at the thin end,and-3.28%to-2.18%at the medium-thickness part;while for multiple oblique incident fields,the attenuation was-3.12%to-2.21%at the thin ends,and-3.42%to-2.43%at the medium-thickness part.These calculated results were consistent with the actual measurement values.For 40 verification plans,the average point dose difference between measurement and calculation in TPS were 0.90%and 0.89%at the thin end and medium-thickness part,respectively.Conclusion This novel measurement method can measure the HU value of the surface carbon fiber material and internal foam material of Exact IGRT Couch.Defining the HU values of these two materials of the couch model in the TPS as-500 and-960 can correct the radiation dose attenuation caused by the treatment couch,thereby improving the dose accuracy of the target volume and organs-at-risk.

Objective:To systematically evaluate and integrate the exercise experience of overweight or obese pregnant women during pregnancy, in order to provide basis for the formulation of standardized exercise programs for this population.Methods:We searched databases including PubMed, Cochrane Library, Web of Science, CINAHL, Embase, Ovid, PsycINFO, Chinese Biomedical Literature Database, VIP, Wanfang and China National Knowledge Infrastructure, from their inception to August 16, 2023, to collect qualitative studies on the exercise experience of overweight or obese pregnant women during pregnancy. The quality of included studies was evaluated according to Joanna Briggs Institute Critical Appraisal Tool for qualitative studies in Australia. The results were integrated by integrating methods.Results:A total of 11 studies were included. Sixty-one complete findings were grouped according to similarities to form 9 new categories. These categories resulted in 3 synthesized findings. Pregnant women with overweight or obesity were affected by promoting and hindering factors; careful balance of exercise risk and benefit for overweight or obese pregnant women during pregnancy; expectations and needs of overweight or obese pregnant women for exercise during pregnancy.Conclusions:Overweight or obese pregnant women highly rated the benefits and importance of exercise, but their participation and adherence to exercise is challenging. Medical staff should pay attention to the exercise experience of overweight or obese pregnant women during pregnancy, understand the driving factors and obstacles of exercise for overweight or obese pregnant women, in order to provide standardized and personalized exercise guidance programs for overweight or obese pregnant women.

Objective:To retrieve, evaluate and summarize relevant evidence on communication strategies for families with perinatal loss, and to provide an evidence-based basis for communication practice among clinical health professionals.Methods:The system searches for evidence related to the loss of family doctor-patient communication strategies during the perinatal period in computer decision support systems such as UpToDate, BMJ Best Clinical Practice, International Guidelines Network, UK National Institute for Health and Clinical Excellence, PubMed, Web of Science, CINAHL, China National Knowledge Infrastructure, Wanfang Data, as well as in Chinese and English databases and related websites.The search was conducted between January 2012 and December 2022. The literature ′s quality and extracted evidence were independently evaluated by two researchers according to professional judgement. Results:A total of 13 articles were included, including 1 clinical decision, 2 guidelines, 4 national standards, 2 expert consensus, and 4 systematic reviews. 30 pieces of evidence have been summarized across five aspects, comprising communication environment, communication skills, timing and key points of communication, communication for special populations, and system-level communication support.Conclusions:This study summarizes the relevant evidence on communication strategies for family doctor-patient communication strategies for perinatal loss. Clinical professionals should carefully select and apply relevant evidence based on available medical resources and parental preferences, Develop and implement practical standards for family doctor-patient communication strategies for perinatal loss at the system level, further harmonize communication behaviors, and improve communication quality.