Objective To analyze the association between plasma circulating tumor DNA(ctDNA)TP53 mutation status and survival outcomes in breast cancer patients.Methods PubMed,Embase,and the Cochrane Library were searched for relevant literature published between 2000 and 2025,examining the impact of plasma ctDNA TP53 mutations on survival outcomes in breast cancer patients,including overall survival(OS),progression-free survival(PFS),or disease-free survival(DFS).Two researchers independently screened the literature according to predefined inclusion and exclusion criteria and extracted relevant data.The Newcastle-Ottawa scale and Cochrane Risk of Bias Assessment Tool were used to evaluate study quality.Meta-analysis,publication bias assessment,and sensitivity analysis were performed using Review Manager 5.3 and STATA 18.0 software.Results A total of 14 studies(13 cohort studies and 1 randomized controlled trial)in-volving 3521 breast cancer patients were included,among whom 921 had TP53 mutations.All studies were as-sessed as high-quality or low-risk.The random-effects model demonstrated that TP53 mutations were significantly associated with poorer OS(I2=77%,HR=1.82,95%CI:1.15-2.88,P=0.010),PFS(I2=63%,HR=1.68,95%CI:1.30-2.17,P＜0.001),and DFS(I2=85%,HR=1.98,95%CI:1.05-3.75,P=0.040).Funnel plots indicated no significant publication bias,and sensitivity analysis confirmed the stabil-ity and reliability of the results.Subgroup analyses based on study design,breast cancer stage and molecular subtype revealed that TP53 mutations were associated with worse prognosis in prospective studies(OS:HR=2.32,95%CI:1.84-2.92,P＜0.001;PFS:HR=1.83,95%CI:1.47-2.27,P＜0.001),metastatic/ad-vanced breast cancer(OS:HR=2.03,95%CI:1.44-2.87,P＜0.001;PFS:HR=1.90,95%CI:1.57-2.31,P＜0.001),and hormone receptor-positive and human epidermal growth factor receptor 2-negative(HR+HER2-)patients(OS:HR=2.11,95%CI:1.56-2.85,P＜0.001;PFS:HR=1.94,95%CI:1.62-2.33,P＜0.001).Among different treatment regimens,patients with TP53 mutations receiving trastuzumab combined with paclitaxel exhibited relatively better prognosis(PFS:HR=0.08,95%CI:0.02-0.30,P＜0.001).Conclusion Plasma ctDNA TP53 mutations are closely associated with survival outcomes in breast cancer patients and may serve as a potential predictor of poor prognosis,providing support for clinical manage-ment and prognostic assessment.

Background::The prevalence of type 2 diabetes mellitus (T2DM) has been rapidly growing in Chinese populations in recent decades, and the shift in eating habits is a key contributing factor to this increase. Eating out of home (EOH) is one of the major shifts in eating habits during this period. However, the influence of EOH on the incidence of T2DM among Chinese urban workers is unknown.Methods::The cross-sectional study involved an analysis of 13,904 urban workers recruited from 11 health examination centers in the major cities of China to explore the relationship between EOH and T2DM between 2013 September and 2016 March.Results::Average weekly EOH frequency ≥10 times was positively associated with increased incidence of T2DM in the sampled population (OR: 1.31 [1.11-1.54], p < 0.01), most notably in participants ≤45 years old (OR: 1.41[1.11-1.80], p < 0.01]) and in males (OR:1.26 [1.06-1.51], p < 0.01). An EOH frequency of 5 times/week appears as a threshold for a significant increase in the odds of T2DM. Weekly EOH frequency ≥5 times was associated with increased odds of T2DM in a dose-response manner in the total population and almost all subgroups ( poverall association < 0.05 and pnonlinearity ≤ 0.05). Conclusion::This study showed that a frequency of EOH (≥5 times/week) was associated with a frequency-dependent increase in the odds of T2DM urban workers in China. More nutrition promotion is needed to improve the eating behavior of Chinese urban workers to reduce T2DM risk.

Background::The prevalence of type 2 diabetes mellitus (T2DM) has been rapidly growing in Chinese populations in recent decades, and the shift in eating habits is a key contributing factor to this increase. Eating out of home (EOH) is one of the major shifts in eating habits during this period. However, the influence of EOH on the incidence of T2DM among Chinese urban workers is unknown.Methods::The cross-sectional study involved an analysis of 13,904 urban workers recruited from 11 health examination centers in the major cities of China to explore the relationship between EOH and T2DM between 2013 September and 2016 March.Results::Average weekly EOH frequency ≥10 times was positively associated with increased incidence of T2DM in the sampled population (OR: 1.31 [1.11-1.54], p < 0.01), most notably in participants ≤45 years old (OR: 1.41[1.11-1.80], p < 0.01]) and in males (OR:1.26 [1.06-1.51], p < 0.01). An EOH frequency of 5 times/week appears as a threshold for a significant increase in the odds of T2DM. Weekly EOH frequency ≥5 times was associated with increased odds of T2DM in a dose-response manner in the total population and almost all subgroups ( poverall association < 0.05 and pnonlinearity ≤ 0.05). Conclusion::This study showed that a frequency of EOH (≥5 times/week) was associated with a frequency-dependent increase in the odds of T2DM urban workers in China. More nutrition promotion is needed to improve the eating behavior of Chinese urban workers to reduce T2DM risk.

Objective To analyze the association between plasma circulating tumor DNA(ctDNA)TP53 mutation status and survival outcomes in breast cancer patients.Methods PubMed,Embase,and the Cochrane Library were searched for relevant literature published between 2000 and 2025,examining the impact of plasma ctDNA TP53 mutations on survival outcomes in breast cancer patients,including overall survival(OS),progression-free survival(PFS),or disease-free survival(DFS).Two researchers independently screened the literature according to predefined inclusion and exclusion criteria and extracted relevant data.The Newcastle-Ottawa scale and Cochrane Risk of Bias Assessment Tool were used to evaluate study quality.Meta-analysis,publication bias assessment,and sensitivity analysis were performed using Review Manager 5.3 and STATA 18.0 software.Results A total of 14 studies(13 cohort studies and 1 randomized controlled trial)in-volving 3521 breast cancer patients were included,among whom 921 had TP53 mutations.All studies were as-sessed as high-quality or low-risk.The random-effects model demonstrated that TP53 mutations were significantly associated with poorer OS(I2=77%,HR=1.82,95%CI:1.15-2.88,P=0.010),PFS(I2=63%,HR=1.68,95%CI:1.30-2.17,P＜0.001),and DFS(I2=85%,HR=1.98,95%CI:1.05-3.75,P=0.040).Funnel plots indicated no significant publication bias,and sensitivity analysis confirmed the stabil-ity and reliability of the results.Subgroup analyses based on study design,breast cancer stage and molecular subtype revealed that TP53 mutations were associated with worse prognosis in prospective studies(OS:HR=2.32,95%CI:1.84-2.92,P＜0.001;PFS:HR=1.83,95%CI:1.47-2.27,P＜0.001),metastatic/ad-vanced breast cancer(OS:HR=2.03,95%CI:1.44-2.87,P＜0.001;PFS:HR=1.90,95%CI:1.57-2.31,P＜0.001),and hormone receptor-positive and human epidermal growth factor receptor 2-negative(HR+HER2-)patients(OS:HR=2.11,95%CI:1.56-2.85,P＜0.001;PFS:HR=1.94,95%CI:1.62-2.33,P＜0.001).Among different treatment regimens,patients with TP53 mutations receiving trastuzumab combined with paclitaxel exhibited relatively better prognosis(PFS:HR=0.08,95%CI:0.02-0.30,P＜0.001).Conclusion Plasma ctDNA TP53 mutations are closely associated with survival outcomes in breast cancer patients and may serve as a potential predictor of poor prognosis,providing support for clinical manage-ment and prognostic assessment.

Objective:To investigate an association between glycosylated hemoglobin(HbA1c)level and non-alcoholic fatty liver(NAFL)in the elderly.Methods:In this retrospective case-control study, 5 186 elderly individuals aged 65 years and over meeting the inclusion conditions via health physical examination were successively selected from January to December 2018.They were divided into NAFL group(n=1 731)and non-NAFL group(n=3 455). Waist circumference, body mass index, smoking history, diastolic blood pressure, glomerular filtration rate, serum levels of triglyceride, low density lipoprotein cholesterol, alanine aminotransferase, aspartic aminotransferase, fasting blood glucose and HbA1c were compared between the two groups, and their correlations with NAFL were analyzed.Results:The prevalence of NAFL was 33.4%(1, 731/5, 186). The values of waistline, body mass index, smoking history, diastolic blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol, glomerular filtration rate, alanine aminotransferase, aspartate aminotransferase, fasting glucose and HbA1c were higher in the NAFL group than in non-NAFL group(all P<0.05). While levels of creatinine, urea nitrogen and age were lower in the NAFL group than in non-NAFL group( P<0.05). According to the quartile of HbA1c level, these subjects were divided into Q1 to Q4 groups(HbA1c<5.7%, 5.7≤HbA1c<6.0%, 6.0%≤HbA1c<6.5%, HbA1c≥6.5%), and the prevalence of NAFL in the Q1 to Q4 were 22.8%(225/1 120), 27.9%(398/1 429), 36.5%(514/1 409), 45.9%(564/1 228)respectively.The prevalence of NAFL was increased along with the increase in the level of HbA1c( P<0.01). Multivariate Logistic regression analysis showed that after adjusting for age, gender and metabolic components, the risk for developing NAFL was gradually increased in Q2 group, Q3 group, Q4 group versus Q1 group as the following OR value: OR=1.274, 95% CI: 1.004-1.616; OR=1.639, 95% CI: 1.294-2.077; OR=1.787, 95% CI: 1.337-2.389, respectively, all P<0.01. Conclusions:The prevalence of NAFL is positively associated with HbA1c levels in the elderly and HbA1c is an independent risk factor for NAFL disease.

The introduction of evidence-based medicine in general practice teaching can effectively improve the clinical decision-making ability of general practitioners, promote the transformation of general practice service mode, and enrich the connotation of general practice. The ways to implement the idea of evidence-based medicine into general practice education include strengthening the teaching staff of evidence-based medicine in general practice, innovating the teaching methods of evidence-based medicine in general practice, and introducing the evaluation and examination of evidence-based medicine skills into the assessment system of general practitioners. Evidence-based medicine education in general practice teaching still faces many problems. It is necessary to continuously strengthen the connotation construction of evidence-based medicine teaching for general practitioners, continuously improve the teaching methods of evidence-based medicine for general practitioners, and scientifically carry out assessment of evidence-based medicine teaching for general practitioners.

Total 732 subjects aged 30-60 years undergoing health check-up at Beijing Hospital Medical Examination Center in 2009,who had no history of non-alcoholic fatty liver disease (NAFLD) were recruited in the study.According to the quartile of hemoglobin (HGB) level,the subjects were divided into 4 groups:Q1:HGB ≤ 131 g/L (n =192),Q2:HGB ＞ 131 g/L and ≤ 140 g/L (n =178),Q3:HGB ＞ 140 g/L and ≤152 g/L (n =184),Q4:HGB ＞ 152 g/L (n =178).All participants were followed up for 4 years,the prevalence rates of NAFLD in groups Q1,Q2,Q3 and Q4 were 8.3％ (16/192),17.4％ (31/178),23.4％ (43/184) and 25.3％ (45/178),respectively (P ＜0.05).Logistic regression showed that the rates of NAFLD in groups Q2,Q3 and Q4 were 2.32 (1.22-4.41),3.36 (1.81-6.21) and 3.72(2.02-6.87) times higher as group Q1 (P ＜ 0.05).Multiple logistic regression analysis showed that the hemoglobin level,TG and BMI were the independent risk factors of NAFLD.

Objective To analyze the effect of Chinese diabetes risk score in health checkup of elderly population and to explore the risk factors of abnormal glucose metabolism in the elderly patients.Methods Chinese diabetes risk score(C-DRs)screening,glucose tolerance test(OGTT),blood biochemical parameters and history collection were performed in 1 181 elderly people participating the health checkup.The area under the ROC curve(AUC)was used to evaluate the accuracy of the screening method.The effect of different cumulative C-DRs on screening target population was reflected by the Gordon index.Multivariate logistic regression analysis was used to analyze relevant risk factors for the glucose metabolic abnormalities.Results The AUC of screening for diabetes was 0.749(95%CI:0.715-0.782),and the best cut-point value was 32.5 points.The sensitivity was 86.50%,the specificity was 60.84%,and the Gordon index was 0.47(P=0.000).The AUC of screening for the pre-diabetes was 0.760(95%CI:0.733-0.787),and the best cut-point was 33.5 points.The sensitivity was 70.89%,the specificity was 68.72%,and the Gordon index was 0.40(P=0.000).The AUC of screening for MS was 0.797(95% CI:0.772-0.823),and the best cut-point value was 32.5 points.The sensitivity was 83.62%,the specificity was 64.90%,and the Gordon index was 0.49(P=0.000).The AUC of screening for insulin resistance was 0.609(95%CI:0.645-0.734),and the best cut-point value was 30.5 points.The sensitivity was 81.25%,the specificity was 44.81%,and the Gordon index was 0.26(P=0.000).Multiple logistic regression analysis showed that age over 80 years,abdominal obesity(waist circumference,male ≥ 90 cm,female ≥ 85 cm),hypertension,hypertriglyceridemia,family history of diabetes were risk factors for abnormality of glucose metabolism in the elderly.The odd ratio values of the above were 1.557,1.543,1.495,1.569,1.625,1.715(all P<0.05).Conclusions Chinese diabetes risk score may be used to screen for diabetes,metabolic syndrome and insulin resistance in the elderly population.Old age,abdominal obesity,hypertension,hypertriglyceridemia and family history of diabetes are independent risk factors for abnormal glucose metabolism in the elderly population.

Objective To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study.Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI).Subjects were divided into three groups according to diagnostic threshold of liver fibrosis:APRI ＜0.43 group,APRI 0.43-0.53 group and APRI ≥ 0.54 group.The correlation between APRI and biochemical variables was analyzed,and the risk factors of progressive fibrosis were also analyzed.Results Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI ≥ 0.98 (2.97％,progressive fibrosis),318 with APRI ≥0.54 (15.48％),1 475 with APRI ＜ 0.43 (71.81％),261 with APRI 0.43-0.53 (12.71％).Logistic stepwise regression analysis showed that TG (P =0.002,OR =1.095,95％CI:1.033-1.161),2 hPG(P =0.000,OR =1.103,95％ CI:1.058-1.151,BUN(P =0.034,OR =1.215,95 ％ CI:1.014-1.454) were risk factors,and H DL-C (P =0.034,OR =0.353,95 ％ CI:O.135-0.924) was a protective factor for the progression of fibrosis.Conclusion The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.

Objective To investigate the relationship between serum uric acid and the risk of nonalcoholic fatty liver disease.Methods A cohort study was performed among individuals who had physical examination at Beijing Hospital medical examination center during 2009.A total of 732 subjects without nonalcoholic fatty liver disease,30-60 years old,were selected.Subjects were divided into 4 groups (Q1,Q2,Q3,Q4) according to serum uric acid level.Theincidence of NAFLD in each group in 2013 were observed.Serum alanine aminotransferase,aspartate aminotransferase,triglycerides,total cholesterol,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,fasting plasma glucose,and imaging examinations were determined.Cumulative incidence ofNAFLD was compared between each group and effect of baseline serum uric acid on new-onset NAFLI was assessed by logistic regression analysis.Results The cumulative incidence of NAFLD increased irconjunction with the increase of baseline serum uric acid in 4 groups (Q1 8.70％,Q2 13.04％,Q3 19.23％,Q4 32.97％,x2=37.865,P＜0.05).Logistic regression showed that the incidence of nonalcoholic fattyliver disease was increased along with elevated levels of serum uric acid.Subjects in the Q2,Q3,Q4 groups showed an increased risk of NAFLD,relative risks were 1.575 (0.807-3.074);2.580 (1.329-54.701);5.164 (2.838-9.397),compared to those in Q1 group.Moreover,after adjustment for baseline factors (e.g.Age,sex),risk of NAFLD remained higher,with odds ratio at 1.234,and the difference was statistically significant.Conclusions Serum uric acid was found to be correlated with the prevalence of nonalcoholic fatty liver disease.Serum uric acid appeared to be an independent risk factor for NAFLD.