A 61-year-old patient was admitted in November 2024 with the chief complaint of “marked enlargement of uterine myoma for 2 months after menopause”. This patient was diagnosed with uterine myoma 8 years ago and underwent modified radical mastectomy for right breast cancer in April 2023. Postoperative pathology revealed invasive carcinoma (SBR grade Ⅲ). Upon admission, examination results showed a cystic-solid mass in the posterior wall of the uterus and an elevated CA153 level of 273 U/mL. Transabdominal total hysterectomy and bilateral adnexectomy were performed. HE staining postoperatively indicated uterine myoma with involvement of invasive lobular carcinoma. Immunohistochemistry showed positivity for pan-cytokeratin (CKpan, ＋), GATA3 (＋), desmin (muscle＋), and estrogen receptor (ER, 90%＋ ＋ ＋), confirming the diagnosis of breast cancer metastasis to the uterine myometrium. CDK4/6 inhibitor, anastrozole, and zoledronic acid were used after surgery. Metastasis of invasive lobular carcinoma to the uterine myometrium is rare. Rapid enlargement of uterine myoma in breast cancer patients should alert clinicians to consider the possibility of metastasis, which must be confirmed by pathological examination.

Objective:Differences between randomized controlled trial (RCT) results and real world study (RWS) results may not represent a true efficacy-effectiveness gap because efficacy-effectiveness gap estimates may be biased when RWS and RCT differ significantly in study design or when there is bias in RWS result estimation. Secondly, when there is an efficacy- effectiveness gap, it should not treat every patient the same way but assess the real-world factors influencing the intervention's effectiveness and identify the subgroup likely to achieve the desired effect.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:Ten articles were included to discuss how to use the RCT research protocol as a template to develop the corresponding RWS research protocol. Moreover, based on correctly estimating the efficacy-effectiveness gap, evaluate the intervention effect in the patient subgroup to confirm the subgroup that can achieve the expected benefit-risk ratio to bridge the efficacy-effectiveness gap.Conclusion:Using real-world data to simulate key features of randomized controlled clinical trial study design can improve the authenticity and effectiveness of study results and bridge the efficacy-effectiveness gap.

Objective:Randomized controlled trials (RCT) usually have strict implementation criteria. The included subjects' characteristics of the conditions for the intervention implementation are quite different from the actual clinical environment, resulting in discrepancies between the risk-benefit of interventions in actual clinical use and the risk-benefit shown in RCT. Therefore, some methods are needed to enhance the extrapolation of RCT results to evaluate the real effects of drugs in real people and clinical practice settings.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:A total of 12 articles were included. Three methods in the included literature focused on: ①improving the design of traditional RCT to increase population representation; ②combining RCT Data with real-world data (RWD) for analysis;③calibrating RCT results according to real-world patient characteristics.Conclusions:Improving the design of RCT to enhance the population representation can improve the extrapolation of the results of RCT. Combining RCT data with RWD can give full play to the advantages of data from different sources; the results of the RCT were calibrated against real-world population characteristics so that the effects of interventions in real-world patient populations can be predicted.

Objective:To systematically summarize and assess risk prediction models for occurrence of cervical cancer and to provide evidence for selecting the most reliable model for practice, and guide cervical cancer screening.Methods:Two groups of keywords related to cervical cancer and risk prediction model were searched on Chinese databases (CNKI, and Wanfang) and English databases (PubMed, Embase, and Cochrane Library). Original articles that developed or validated risk prediction models and published before November 21, 2019, were selected. Information form was created based on the CHARMS checklist. The PROBAST was used to assess the risk of bias.Results:12 eligible articles were identified, describing 15 prediction models, of which five were established in China. The predicted outcomes included multiple stages from cervical precancerous lesions to cancer occurrence, i.e., abnormal Pap smear (1), occurrence or recurrence of CIN (9), and occurrence of cervical cancer (5), etc. The most frequently used predictors were HPV infection (12), age (7), smoking (5), and education (5). There were two models using machine learning to develop models. In terms of model performance, the discrimination ranged from 0.53 to 0.87, while only two models assessed the calibration correctly. Only two models were externally validated in Taiwan of China, using people in different periods. All of the models were at high risk of bias, especially in the analysis domain. The problems were concentrated in the improper handling of missing data (13), preliminary evaluation of model performance (13), improper use of internal validation (12), and insufficient sample size (11). In addition, the problems of inconsistency measurements of predictors and outcomes (8) and the flawed report of the use of blindness for outcome measures (8) were also severe. Compared with the other models, the Rothberg (2018) model had relatively high quality. Conclusions:There are a certain number of cervical cancer risk prediction models, but the quality is poor. It is urgent to improve the measurement of predictors and outcomes, the statistical analysis details such as handling missing data and evaluation of model performance and externally validate existing models to better guide screening.

Objective: To explore the clinical characteristics of drug-resistant tuberculosis (TB) in children and to study the effectiveness of second-line anti-TB therapy for children and to examine the incidence of adverse drug reactions. Method: Retrospective research was conducted. The clinical records of children in West China Second Hospital diagnosed as drug-resistant TB from January 2010 to June 2014 were investigated.The clinical characteristics and risk factors were analyzed retrospectively. Treatment effect at discharge was examined as a short-term outcome indicator to evaluate the effectiveness of second-line anti-TB therapy and the incidence of adverse drug reactions. χ² test was used. Result: Forty-six patients were diagnosed as drug-resistant TB in 443 children infected with TB, with a 10.4% resistance rate. The 46 children included 26 male and 20 female patients, aged from one month and 28 days to 17 years and 5 months, with the average age (8.4±4.5) years, >7 to 14 years old patients as the biggest part(25 patients, 54.3%). Among the 46 children, 20 patients(43.5%)had close contact with TB patients, of whom 12 patients (60.0%) contacted with family members (including parents, brothers and sisters and grandparents living together) and 8 patients(40.0%) contacted with patients from outside family (such as relatives or neighbors). Moreover, 11 cases (23.9%) were under initial treatment and 35 cases (76.1%) were retreated.From 2010 to 2014, the number of cases of initial and retreated patients had no significant difference(0 and 1, 1 and 13, 4 and 7, 4 and 11, 2 and 3 cases, χ²=3.255, P=0.196). Among retreated patients, 31.4% (11/35) had irregular treatment before.Until discharge, the effective rate was 87.0% (40/46), while the incidence rate of adverse drug reaction was 10.9%(5/46). Conclusion The therapy for drug-resistant TB is effective and the incidence of adverse drug reaction is relatively low.

Objective To explore the clinical characteristics of drug-resistant tuberculosis ( TB) in children and to study the effectiveness of second-line anti-TB therapy for children and to examine the incidence of adverse drug reactions .Method Retrospective research was conducted .The clinical records of children in West China Second Hospital diagnosed as drug-resistant TB from January 2010 to June 2014 were investigated.The clinical characteristics and risk factors were analyzed retrospectively .Treatment effect at discharge was examined as a short-term outcome indicator to evaluate the effectiveness of second-line anti-TB therapy and the incidence of adverse drug reactions .χ2 test was used.Result Forty-six patients were diagnosed as drug-resistant TB in 443 children infected with TB, with a 10.4% resistance rate.The 46 children included 26 male and 20 female patients , aged from one month and 28 days to 17 years and 5 months,with the average age ( 8.4 ±4.5 ) years, >7 to 14 years old patients as the biggest part (25 patients, 54.3%).Among the 46 children, 20 patients(43.5%)had close contact with TB patients, of whom 12 patients (60.0%) contacted with family members (including parents, brothers and sisters and grandparents living together) and 8 patients(40.0%) contacted with patients from outside family (such as relatives or neighbors).Moreover, 11 cases (23.9%) were under initial treatment and 35 cases (76.1%) were retreated.From 2010 to 2014, the number of cases of initial and retreated patients had no significant difference(0 and 1, 1 and 13, 4 and 7, 4 and 11, 2 and 3 cases,χ2 =3.255,P=0.196).Among retreated patients, 31.4% (11/35) had irregular treatment before.Until discharge, the effective rate was 87.0%(40/46), while the incidence rate of adverse drug reaction was 10.9%(5/46).Conclusion The therapy for drug-resistant TB is effective and the incidence of adverse drug reaction is relatively low .

Aim To investigate anti-hepatic fibrotic mechanism of Acanthus ilicifolius alkaloid A ( HBOA ) involved in high mobility group box 1 ( HMGB1 ) . Methods A hepatic fibrosis model of rat was estab-lished by the olive oil of CCl4 for 12 weeks. Then, at the 8th week,the successful model rats were randomly divided into model control group, colchicine group, HBOA high-dose group and HBOA low-dose group. From the 9th week,the rats in each group were treated with the drugs daily for 4 weeks respectively. The changes of liver histopathology and collagen were ob-served by HE staining and Masson staining, and the serum indicators including aspartate aminotransferase (AST),alanine aminotransferase(ALT) , total biliru-bin ( T-BIL ) , HMGB1 , interleukin-1β( IL-1β) and tumor necrosis factor-α( TNF-α) were determined. Moreover , the protein of HMGB1 in liver was examined by immunohistochemistry, and the expression of HMGB1 mRNA was measured by real-time fluores-cence quantitative PCR. Results Compared with the model control group,HBOA high-dose and HBOA low-dose groups significantly attenuated the fibrotic degree induced by CCl4 , markedly decreased the levels of ALT, AST, T-BIL, HMGB1, IL-1β, TNF-α. Moreo-ver, the expression of HMGB1 protein and mRNA in liver was decreased. And furthermore, serum HMGB1 level had significant positive correlation with IL-1β, TNF-α,ALT,AST and T-BIL. Conclusion HBOA has beneficial effects against liver fibrosis in rat which is induced by CCl4 , the mechanisms may be related to the inhibition of inflammatory response to HMGB1 .

Objective To understand current status of occupational protection awareness and behavior among dif-ferent professional medical interns,and provide basis for strengthening the education about occupational protection among medical interns .Methods Questionnaire survey was used to survey medical interns at the end of their clini-cal internship.Results A total of 385 cases of occupational exposure occurred during internship period,occupation-al exposure rate was 42.31 % (385/910),occupational exposure mainly occurred in nursing interns (n =190).358 (39.34%)medical interns understood self-protective antibody (hepatitis B surface antibody);difference in occupa-tional exposure rates and awareness of self-protective antibody among different professional medical interns was sta-tistically significant (all P <0.05);222 (57.66%)medical interns sustained occupational exposure more than once, 45.45% of occupational exposure occurred during the process of diagnostic and therapeutic procedure,exposure mainly occurred in the wards (32.21 %).After occupational exposure,46.75% of medical interns felt nervous, 35.06% were worried,18.18% appeared serious psychological reaction,only 14.03% sought support and help from others.Conclusion Awareness of occupational protection among medical interns is insufficient,education and awareness of occupational protection should be intensified,psychological behavioral after occupational exposure should be paid attention among medical students.

Objective:To describe the clinical characteristics , overall survival as well as to evaluate the prognostic factors in Chinese diffuse large B cell lymphoma ( DLBCL) patients.Methods: DLBCL pa-tients who were initially diagnosed and treated in Peking University Cancer Hospital from January 1995 to December 2008 were identified and analyzed ,retrospectively .The 5-year OS rates were estimated with Ka-plan-Meier.Log-rank test was used to compare the survival curves of the different groups .The multivari-ate analysis of prognostic factors was conducted with Cox regression model , which included all statistically significant prognostic factors in the univariate analyses .Results:A total of 525 DLBCL patients were in-cluded in this retrospective analysis , of whom , 294 were male and 231 female ( male∶female=1 .27∶1 ) . The median age at the initial diagnosis was 55 (range 16-90) years, and 37.0% (n=194) were 60 years and above .Regarding the clinical staging at the initial diagnosis , 54 patients (10.3%) were diag-nosed as Stage Ⅰ of the disease, 152 (28.9%) as Stage Ⅱ, 117 (22.3%) as Stage Ⅲ and 202 (38.5%) as Stage Ⅳ.The ‘B symptoms’ and increased serum LDH were presented in 206 (39.2%) and 192 (36.6%) patients, respectively.A total of 197 (37.5%) patients were treated with rituximab (R).The survival follow-up continued till 31 January 2014 with a median follow-up time of 77.5 ( range:0-205) months.A total of 267 patients (50.9%) died during the follow-up period.The medi-al overall survival ( OS) time was 84 months, and 5-year OS rate was 52.3%.There were six statistically significant prognostic factors that were identified in both univariate and multivariate analyses : gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .The relative risk ( RR) of these prognostic factors in the multivariate analyses were: age >60 years /≤60 years=1.380 (95%CI 1.078 -1.765), male /female =1.315 (95%CI 1.025 -1.687), stage Ⅲ/stageⅠ=3.034(95%CI 1.667-5.522), stage Ⅳ/Ⅰ=3.748(95%CI 2.102 -6.681), with B symp-toms/without B symptoms=1.278(95%CI 0.999-1.636),serum LDH increased/LDH not increased=1.351(95%CI 1.057 -1.726), without R treatment /with R treatment =1.543(95%CI 1.182 -2 .015 ) .Compared with the IPI , age >50 years/≤50 years was a statistically significant factor in both univariate and multivariate analyses RR =1.478 (95%CI 1.148-1.902), P=0.002.Conclusion:Six factors were related to DLBCL survival:gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .Compared with the IPI , several specific factors may predict a poor prognosis in Chinese DLBCL patients:male , age>50 years and the presence of ‘B symptoms ’ .But this result is not conclusive until these factors are further tested .

OBJECTIVETo investigate the prevalence and relevant factors on the echocardiographic left ventricular hypertrophy (LVH).

METHODA cross-sectional study was conducted among the hypertensive patients in an urban community.

RESULTSThe prevalence of LVH was 29.2% in 1 686 hypertensive patients, with 25.4% in males and 34.5% in females, respectively. The prevalence was significantly higher in females than in males (chi(2) = 16.17, P < 0.01). The rate was increasing with age and significantly higher prevalence was observed in 45-, 55-, 65- age groups of females (P < 0.05). Moreover, elevated systolic blood pressure and higher BMI were related to the LVH in hypertensive patients, while higher education level seemed a protective factor.

CONCLUSIONThese results implied that a comprehensive intervention should be taken in the prevention of LVH.

Adult ; Age Factors ; Aged ; Blood Pressure ; Body Mass Index ; China ; epidemiology ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Cross-Sectional Studies ; Echocardiography ; methods ; Female ; Humans ; Hypertension ; blood ; physiopathology ; Hypertrophy, Left Ventricular ; blood ; epidemiology ; physiopathology ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Sex Factors ; Smoking ; Triglycerides ; blood ; Urban Population