ObjectiveTo examine factors associated with breast cancer among adult women in suburban Shanghai and develop a risk stratification model, and to provide a basis for the identification of high-risk populations. MethodsA cross-sectional study was conducted using baseline data from the Shanghai Suburban Adult Cohort and Biobank. A total of 39 683 women aged 20-74 years, comprising 249 breast cancer cases and 39 434 non-breast cancer cases, were included. Information on demographic characteristics, reproductive health, lifestyle, chronic diseases, and psychological status was collected. Missing data were handled using multiple imputation. Multivariable Firth logistic regression analyses were used to identify factors associated with breast cancer, and restricted cubic spline analyses were performed to assess the dose-response relationship between glycated hemoglobin and breast cancer. With breast cancer as the outcome variable, the data were randomly split into a training set and a test set at a ratio of 7∶3. A logistic regression model was developed for risk stratification and further calibrated using Platt scaling. Model performance was evaluated using the area under receiver operating characteristic curve (ROC-AUC), area under the precision-recall curve (PR-AUC), Brier score, calibration intercept, and calibration slope, to assess discrimination, overall prediction error, and calibration. Given that breast cancer was a low-prevalence outcome, the model’s precision, recall, and lift for the top 5% and top 10% of high-risk individuals were further calculated, to evaluate the model’s ability to identify and stratify risk in high-risk screening scenarios. ResultsIn the fully adjusted multivariable Firth logistic regression model, increasing age was associated with a higher risk of breast cancer (OR=1.050, 95%CI: 1.033-1.067), whereas older age at menarche (OR=0.921, 95%CI: 0.859-0.987) and a greater number of pregnancies (OR=0.875, 95%CI: 0.770-0.986) were associated with a lower risk of breast cancer. Women with a history of estrogen use had a higher risk of breast cancer than those without such a history (OR=3.098, 95%CI: 1.481-5.728). Hyperglycemia was associated with an increased risk of breast cancer (OR=1.754, 95%CI: 1.305-2.334). Compared with women without anxiety or depression, those with mild (OR=2.239, 95%CI: 1.484-3.266) or severe (OR=10.104, 95%CI: 1.106-32.798) anxiety or depression had a higher risk of breast cancer. Restricted cubic spline analyses showed a nonlinear association between glycated hemoglobin and breast cancer (P=0.003). The logistic regression-based risk stratification model showed moderate discriminative ability (ROC-AUC=0.730, 95%CI: 0.673-0.784) and a low overall prediction error (Brier score=0.006, 95%CI: 0.006-0.006). The lift values were 4.261 for the top 5% high-risk group and 3.199 for the top 10% high-risk group, identifying 21.3% and 32.0% of breast cancer cases, respectively. ConclusionBreast cancer among adult women in suburban Shanghai is associated with older age, earlier age at menarche, fewer pregnancies, history of estrogen use, hyperglycemia, and mild and severe anxiety or depression, suggesting that greater attention should be paid to reproductive hormone-related factors, metabolic abnormalities, and psychological health in community-based women’s health management. The logistic regression-based model using routine epidemiological indicators shows moderate discriminative ability and potential for enriching high-risk populations and might help support initial screening and stratified management of women at high risk of breast cancer in resource-limited community settings.

Objective:To evaluate the efficacy and safety of cord blood stem cell transplantation (CBSCT) in pediatric recipients with mucopolysaccharidosis type Ⅱ (MPS Ⅱ, Hunter syndrome).Methods:Clinical data of five male children with MPS Ⅱ who underwent CBSCT at the Department of Hematology, Children's Hospital of Soochow University between March 2018 and July 2023 were retrospectively analyzed. Post-transplantation clinical outcomes and enzymatic activity were observed. Literature was searched in the China National Knowledge Infrastructure (CNKI), Wanfang, and PubMed databases using the keywords "mucopolysaccharidosis type Ⅱ" "MPS Ⅱ" "IDS gene" and "Hunter syndrome" in both English and Chinese. Articles describing clinical manifestations, genetic diagnosis, and hematopoietic stem cell transplantation (HSCT) in MPS II were screened.Results:All five patients were male, with a median age at diagnosis of 4.3(2.5-5.5) years and a median age at transplantation of 4.6(2.8-6.5) years. At diagnosis, all exhibited coarse facial features, hepatosplenomegaly, skeletal deformities or abnormalities, abnormal head MRI findings, and Mongolian spots; four had joint stiffness, three had valvular heart disease, and two had airway obstruction, short stature, and intellectual disability. Three recipients received single-unit cord blood, and two received double-unit cord blood. Myeloablative conditioning regimens consisted of busulfan, cyclophosphamide, anti-thymocyte globulin ± fludarabine. The median neutrophil engraftment and platelet engraftment times were 19(14-21) days and 26(15-44) days, respectively. Complete donor chimerism was achieved at 1 month post-transplantation. Complications included peri-engraftment syndrome in 5 cases, acute graft-versus-host disease (GVHD) in 2 cases (1 with grade Ⅳ skin and grade Ⅱ intestinal involvement; 1 with grade Ⅱ skin involvement), limited chronic GVHD in 1 case (moderate intestinal involvement), cytomegalovirus (CMV) infection in 3 cases, Epstein-Barr virus (EBV) infection in 1 case, and capillary leak syndrome in 1 case; all were successfully managed. At the last follow-up in December 2023, all patients were alive, and enzyme activity had normalized by 3 months post-transplantation. Most clinical symptoms and signs improved; however, neurocognitive function showed no significant improvement, and some recipients exhibited progressive brain parenchymal changes on MRI. Literature review included 7 English and 5 Chinese studies, indicating that CBSCT and other HSCT modalities can improve multi-system clinical manifestations in MPS Ⅱ children, including restoration of enzyme activity, organ function improvement (such as liver and spleen shrinkage, adenoid reduction), enhanced motor function, and stabilization of neurocognitive function. Some studies suggest superior efficacy compared with enzyme replacement therapy, particularly in delaying disease progression and improving daily living abilities.Conclusion:CBSCT effectively restores enzymatic activity and improves multi-system manifestations in children with MPS Ⅱ, although its effect on neurological symptoms remains controversial. It is a safe and feasible therapeutic option for this condition.

Objective:To evaluate the clinical efficacy of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in treating pediatric Diamond-Blackfan anemia (DBA).Method:Clinical data of five pediatric DBA recipients who underwent haplo-HSCT at the Children's Hospital of Soochow University between June 2018 and June 2023 were retrospectively analyzed. The conditioning regimen comprised a backbone protocol of fludarabine, busulfan, and rabbit anti-human thymocyte immunoglobulin (Bu+Flu+ATG), with optional cyclophosphamide, rituximab, or thiotepa. Post-transplant prophylaxis for graft-versus-host disease (GVHD) included cyclosporine A/tacrolimus combined with mycophenolate mofetil and methotrexate. Outcome measures included neutrophil and platelet engraftment times, hematopoietic reconstitution, incidence and severity of post-transplant complications, hemoglobin maintenance, and survival status. Literature was searched in CNKI, Wanfang, and PubMed using the keywords "Diamond-Blackfan anemia" "DBA" and "haplo-HSCT" in both English and Chinese.Result:The median age at transplantation was 61 months. Human leukocyte antigen (HLA) matching ranged from 5-8/10 loci. Stem cell sources included bone marrow alone (1 case), bone marrow plus peripheral blood stem cells (PBSCT, 2 cases), umbilical cord blood (CB-HSCT, 1 case), and PBSCT combined with CB-HSCT (1 case). All five recipients achieved successful engraftment with complete hematopoietic and immune reconstitution. Median neutrophil and platelet engraftment times were 11 days and 9 days, respectively, with erythroid reconstitution at 25 days post-transplant. Complications included grade IV acute GVHD (aGVHD) in one recipient, grade I aGVHD in two recipients, and chronic GVHD (cGVHD) in one recipient. Cytomegalovirus (CMV) infection occurred in three cases, and Epstein-Barr virus (EBV) infection in one case, all of which resolved with ganciclovir. No other transplant-related complications were reported. At a median follow-up of 44.8(4.8-59.2) months, all recipients were alive with sustained erythroid reconstitution and disease-free survival. Literature review (six studies) confirmed HSCT as an effective treatment for DBA, with prognosis closely related to age at transplantation, conditioning regimens, and donor selection.Conclusion:Haplo-HSCT can be considered as a viable treatment option for pediatric DBA recipients.

Objective:To explore the efficacy and feasibility of hypomethylating agent (HMA) as preventive therapy in children with high-risk acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:A retrospective cohort study. Data from 173 children who underwent allo-HSCT for high-risk AML at Children′s Hospital of Soochow University between August 2019 and April 2023 were analyzed. Participants were categorized into a trial group receiving HMA and a control group. Further classification was based on HMA courses:≥4 and <4 courses. The efficacy and safety of HMA preventive treatment after allo-HSCT were evaluated. Survival analysis was performed using the Kaplan-Meier method with Log-Rank testing, the Fine-Gray model was used to assess cumulative relapse rates and Cox regression was used to identify prognostic factors. Adverse events during HMA were descriptively analyzed.Results:Among 173 patients, there were 100 males (57.8%) and 73 females (42.2%), with the age of 81 (34,127) months. The starting time of HMA was 123 (91, 191) d post-transplant, continuing 4.0 (3.0, 6.5) courses and the follow-up period was 24 (13, 32) months. The trial group (53 cases) showed better 2-year overall survival (OS) rate ((88.6±5.6)% vs. (76.6±4.3)%, χ 2=5.00, P=0.025) and relapse-free survival (RFS) rate ((89.2±4.7)% vs. (56.2±4.8)%, χ 2=15.75, P<0.001) than control group (120 cases). The 2-year OS rates and RFS rates were similar between ≥4 courses group (31 cases) and <4 courses group (22 cases)(both P>0.05). The cumulative relapse rate in the trial group was significantly lower ((10.8±0.2)% vs. (35.2±0.2)%, χ 2=10.84, P=0.001) than control group. Among children with molecular relapse, 8 cases (8/30, 26.7%) in the control group had hematological relapse compared to 1 case (1/2) in the trial group ( χ 2=0.81, P=0.369). The differences in incidence of acute and chronic graft-versus-host disease (GVHD) were not statistically significant (all P>0.05). Cox regression analysis revealed that minimal residual disease (MRD) positivity detected by flow cytometry before allo-HSCT and chronic GVHD were independent risk factors for OS (both P<0.05).The HMA preventive treatment was an independent protective factor for RFS, while age ≥10 years and MRD positivity detected by PCR before allo-HSCT were independent risk factors for RFS (all P<0.05). In trial group, 38 cases experienced grade 3 to 4 adverse events (71.7%). Conclusion:HMA is safe as preventive treatment in post-transplant children with high-risk AML, which can reduce the relapse risk and doesn't increase the risk of GVHD.

Objective:To explore the efficacy and feasibility of hypomethylating agent (HMA) as preventive therapy in children with high-risk acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:A retrospective cohort study. Data from 173 children who underwent allo-HSCT for high-risk AML at Children′s Hospital of Soochow University between August 2019 and April 2023 were analyzed. Participants were categorized into a trial group receiving HMA and a control group. Further classification was based on HMA courses:≥4 and <4 courses. The efficacy and safety of HMA preventive treatment after allo-HSCT were evaluated. Survival analysis was performed using the Kaplan-Meier method with Log-Rank testing, the Fine-Gray model was used to assess cumulative relapse rates and Cox regression was used to identify prognostic factors. Adverse events during HMA were descriptively analyzed.Results:Among 173 patients, there were 100 males (57.8%) and 73 females (42.2%), with the age of 81 (34,127) months. The starting time of HMA was 123 (91, 191) d post-transplant, continuing 4.0 (3.0, 6.5) courses and the follow-up period was 24 (13, 32) months. The trial group (53 cases) showed better 2-year overall survival (OS) rate ((88.6±5.6)% vs. (76.6±4.3)%, χ 2=5.00, P=0.025) and relapse-free survival (RFS) rate ((89.2±4.7)% vs. (56.2±4.8)%, χ 2=15.75, P<0.001) than control group (120 cases). The 2-year OS rates and RFS rates were similar between ≥4 courses group (31 cases) and <4 courses group (22 cases)(both P>0.05). The cumulative relapse rate in the trial group was significantly lower ((10.8±0.2)% vs. (35.2±0.2)%, χ 2=10.84, P=0.001) than control group. Among children with molecular relapse, 8 cases (8/30, 26.7%) in the control group had hematological relapse compared to 1 case (1/2) in the trial group ( χ 2=0.81, P=0.369). The differences in incidence of acute and chronic graft-versus-host disease (GVHD) were not statistically significant (all P>0.05). Cox regression analysis revealed that minimal residual disease (MRD) positivity detected by flow cytometry before allo-HSCT and chronic GVHD were independent risk factors for OS (both P<0.05).The HMA preventive treatment was an independent protective factor for RFS, while age ≥10 years and MRD positivity detected by PCR before allo-HSCT were independent risk factors for RFS (all P<0.05). In trial group, 38 cases experienced grade 3 to 4 adverse events (71.7%). Conclusion:HMA is safe as preventive treatment in post-transplant children with high-risk AML, which can reduce the relapse risk and doesn't increase the risk of GVHD.

Objective:To evaluate the efficacy and safety of cord blood stem cell transplantation (CBSCT) in pediatric recipients with mucopolysaccharidosis type Ⅱ (MPS Ⅱ, Hunter syndrome).Methods:Clinical data of five male children with MPS Ⅱ who underwent CBSCT at the Department of Hematology, Children's Hospital of Soochow University between March 2018 and July 2023 were retrospectively analyzed. Post-transplantation clinical outcomes and enzymatic activity were observed. Literature was searched in the China National Knowledge Infrastructure (CNKI), Wanfang, and PubMed databases using the keywords "mucopolysaccharidosis type Ⅱ" "MPS Ⅱ" "IDS gene" and "Hunter syndrome" in both English and Chinese. Articles describing clinical manifestations, genetic diagnosis, and hematopoietic stem cell transplantation (HSCT) in MPS II were screened.Results:All five patients were male, with a median age at diagnosis of 4.3(2.5-5.5) years and a median age at transplantation of 4.6(2.8-6.5) years. At diagnosis, all exhibited coarse facial features, hepatosplenomegaly, skeletal deformities or abnormalities, abnormal head MRI findings, and Mongolian spots; four had joint stiffness, three had valvular heart disease, and two had airway obstruction, short stature, and intellectual disability. Three recipients received single-unit cord blood, and two received double-unit cord blood. Myeloablative conditioning regimens consisted of busulfan, cyclophosphamide, anti-thymocyte globulin ± fludarabine. The median neutrophil engraftment and platelet engraftment times were 19(14-21) days and 26(15-44) days, respectively. Complete donor chimerism was achieved at 1 month post-transplantation. Complications included peri-engraftment syndrome in 5 cases, acute graft-versus-host disease (GVHD) in 2 cases (1 with grade Ⅳ skin and grade Ⅱ intestinal involvement; 1 with grade Ⅱ skin involvement), limited chronic GVHD in 1 case (moderate intestinal involvement), cytomegalovirus (CMV) infection in 3 cases, Epstein-Barr virus (EBV) infection in 1 case, and capillary leak syndrome in 1 case; all were successfully managed. At the last follow-up in December 2023, all patients were alive, and enzyme activity had normalized by 3 months post-transplantation. Most clinical symptoms and signs improved; however, neurocognitive function showed no significant improvement, and some recipients exhibited progressive brain parenchymal changes on MRI. Literature review included 7 English and 5 Chinese studies, indicating that CBSCT and other HSCT modalities can improve multi-system clinical manifestations in MPS Ⅱ children, including restoration of enzyme activity, organ function improvement (such as liver and spleen shrinkage, adenoid reduction), enhanced motor function, and stabilization of neurocognitive function. Some studies suggest superior efficacy compared with enzyme replacement therapy, particularly in delaying disease progression and improving daily living abilities.Conclusion:CBSCT effectively restores enzymatic activity and improves multi-system manifestations in children with MPS Ⅱ, although its effect on neurological symptoms remains controversial. It is a safe and feasible therapeutic option for this condition.

Objective:To evaluate the clinical efficacy of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in treating pediatric Diamond-Blackfan anemia (DBA).Method:Clinical data of five pediatric DBA recipients who underwent haplo-HSCT at the Children's Hospital of Soochow University between June 2018 and June 2023 were retrospectively analyzed. The conditioning regimen comprised a backbone protocol of fludarabine, busulfan, and rabbit anti-human thymocyte immunoglobulin (Bu+Flu+ATG), with optional cyclophosphamide, rituximab, or thiotepa. Post-transplant prophylaxis for graft-versus-host disease (GVHD) included cyclosporine A/tacrolimus combined with mycophenolate mofetil and methotrexate. Outcome measures included neutrophil and platelet engraftment times, hematopoietic reconstitution, incidence and severity of post-transplant complications, hemoglobin maintenance, and survival status. Literature was searched in CNKI, Wanfang, and PubMed using the keywords "Diamond-Blackfan anemia" "DBA" and "haplo-HSCT" in both English and Chinese.Result:The median age at transplantation was 61 months. Human leukocyte antigen (HLA) matching ranged from 5-8/10 loci. Stem cell sources included bone marrow alone (1 case), bone marrow plus peripheral blood stem cells (PBSCT, 2 cases), umbilical cord blood (CB-HSCT, 1 case), and PBSCT combined with CB-HSCT (1 case). All five recipients achieved successful engraftment with complete hematopoietic and immune reconstitution. Median neutrophil and platelet engraftment times were 11 days and 9 days, respectively, with erythroid reconstitution at 25 days post-transplant. Complications included grade IV acute GVHD (aGVHD) in one recipient, grade I aGVHD in two recipients, and chronic GVHD (cGVHD) in one recipient. Cytomegalovirus (CMV) infection occurred in three cases, and Epstein-Barr virus (EBV) infection in one case, all of which resolved with ganciclovir. No other transplant-related complications were reported. At a median follow-up of 44.8(4.8-59.2) months, all recipients were alive with sustained erythroid reconstitution and disease-free survival. Literature review (six studies) confirmed HSCT as an effective treatment for DBA, with prognosis closely related to age at transplantation, conditioning regimens, and donor selection.Conclusion:Haplo-HSCT can be considered as a viable treatment option for pediatric DBA recipients.

【Objective】 To investigate the efficacy and surgical technique of total laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion, so as to provide reference for the selection of surgery for patients with bladder cancer. 【Methods】 Clinical data of 48 patients with bladder cancer who underwent laparoscopic radical cystectomy during Mar.2017 and Aug.2022 in our hospital were retrospectively analyzed, including 23 cases who received traditional laparoscopic radical cystectomy combined with extracorporeal ileal conduit, and 25 who received total laparoscopic radical cystectomy with intracorporeal ileal conduit.The operation time, blood loss, postoperative intestinal function recovery time, drainage tube removal time and hospital stay were compared between the two groups. 【Results】 All procedures were successfully performed, and no Clavien-Dindo>grade 3 complications were observed.The operation time, and amount of estimated blood loss of the traditional group and total laparoscopic radical group were (227.0±46.4) min vs. (253.6±58.9) min, and (131.7±79.8) mL vs. (154.0±93.0) mL, respectively.There were no differences in postoperative intestinal function recovery time and drainage tube removal time (P>0.05).The hospital stay was shorter in the total laparoscopic radical group than in the traditional group (P=0.035). 【Conclusion】 Total laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion is safe and feasible.which is comparable to the traditional laparoscopic surgery, while the hospital stay in the total laparoscopic group is shorter, which is conducive to rapid postoperative recovery.

BACKGROUND:As a dominant breed pig in southwest China,the southern Yunnan small-ear pig has been widely used as an experimental animal in the basic research of other disciplines,but there are still no reports on its application in anterior cruciate ligament reconstruction. OBJECTIVE:To establish a large animal model of the southern Yunnan small-ear pig with anterior cruciate ligament with autologous Achilles tendon was established. METHODS:Twenty adult female Yunnan small-ear pigs were equally randomized into two groups.In the autologous Achilles tendon group,the right knee anterior cruciate ligament was reconstructed with autologous Achilles tendon as a graft,while in the sham-operated group,a similar operation was performed on the right knee without any treatment of the anterior cruciate ligament.General conditions of each pig were observed and recorded before and 12 months after surgery.Ligaments and grafts were taken for gross observation and MAS scoring.Hematoxylin-eosin staining was performed to observe morphological characteristics of ligaments.The staining and arrangement of type I and type Ⅲ collagen were evaluated by immunohistochemistry.Transmission electron microscopy was used to observe the type,size,diameter,ratio,and distribution of collagen fibers in ligaments. RESULTS AND CONCLUSION:All animals had normal diet and activity,good wound healing,no obvious inflammatory reaction,no local purulent infection,and no significant changes in mental and urinary conditions compared with those before surgery.The reconstructed cruciate ligament of the knee was intact,with no stiffness and normal range of motion.Both the anterior drawer and Lachman tests were negative.Gross observation of the graft:12 months after surgery,the grafts was in good position,with good integrity,obvious tension,ligament color close to the original anterior cruciate ligament,and complete surface synovial coverage.Most of the intraarticular ligaments in the autologous Achilles tendon group were defined as MAS I type and a few were defined as MAS Ⅱ type.In the sham-operated group,the intraarticular ligament was defined as MAS I type.Hematoxylin-eosin staining indicated that,12 months after surgery,collagen fibers in the autologous Achilles tendon group began to appear bundled,isotropic,and uniformly arranged,with more obvious isotropic corrugations,and the nuclei were mainly linear or spindle-shaped,which were similar to those in normal anterior cruciate ligament tissue of the sham-operated group.Immunohistochemistry results indicated that,12 months after surgery,there was a higher expression of type I collagen and significantly less expression of type Ⅲ collagen in the reconstructed anterior cruciate ligament in the autologous Achilles tendon group.The degree of type I and type Ⅲ staining was similar in the two groups.Under the transmission electron microscope,the diameter,arrangement and density of collagen fibers in the reconstructed anterior cruciate ligament of the autologous Achilles tendon group were similar to those of the original anterior cruciate ligament at 12 months after surgery,indicating that the ligament remodeling process had been basically completed in the autologous Achilles tendon group at 12 months after surgery.Through a comprehensive evaluation of animal general conditions,ligament general view,MAS score,hematoxylin-eosin staining,immunohistochemistry,and transmission electron microscopy observation,we successfully established a large animal model of anterior cruciate ligament reconstruction using autogenous Achilles tendon in southern Yunnan small-ear pigs,with good morphological,histological and ultrastructural results.

Objective:To explore how electrical stimulation of the sciatic nerve affects learning and memory in cases of chronic cerebral hypoperfusion and its mechanism.Methods:Thirty-two Sprague-Dawley rats were randomly divided into a normal group, a sham-operation group, a model group and a stimulation group, each of 8. In the model and stimulation groups a chronic cerebral hypoperfusion model was established using the modified 2-VO method. The stimulation group then received electrical stimulation of the sciatic nerve for 4 weeks. Afterward all of the rats′ learning and memory were tested using the Morris water maze. HE staining and immunohistochemistry were used to observe any morphological change in the hippocampus and the expression of neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF).Results:The model and stimulation groups demonstrated significantly longer escape latency, fewer platform crossing times and shorter target quadrant times than the normal and sham-ope-ration groups before the intervention. All of these indicators had improved after the intervention. According to the HE staining, neuronal damage in the hippocampus was aggravated significantly in the model group compared with the normal and sham-operation groups, while the degree of damage was reduced in the stimulation group. Moreover, the immunohistochemistry results suggested that the expressions of NSE and VEGF were reduced significantly in the model group compared with the normal and sham-operation groups, while in the stimulation group they had increased significantly compared with the model group.Conclusions:Electrical stimulation of the sciatic nerve can improve learning and memory in cases of chronic cerebral hypoperfusion, at least in rats. It is probably related to the increased expression of VEGF in the hippocampus.