Objective:To optimize the smart follow-up workflow for day-case breast surgery patients using an action research approach and evaluate its effectiveness.Methods:A total of 648 post-discharge patients who underwent day-case breast surgery at the Day Surgery Unit of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences between February and May 2024 were selected by convenience sampling. Patients who received routine smart follow-up (automated+telephone) from February to March 2024 served as the baseline group. Patients enrolled in April 2024 ( n=218) and May 2024 ( n=202) formed the first and second cycle groups, respectively, in which the smart follow-up workflow was optimized iteratively using action research. Outcome indicators included automated recovery rate and total recovery rate of follow-up forms, as well as the incidence of postoperative discomfort symptoms. Results:The automated and total recovery rates of follow-up forms in the first and second cycle groups were significantly higher than those in the baseline group, with statistically significant differences observed ( P<0.01). The proportion of patients experiencing persistent chest distress was significantly lower in the first and second cycle groups compared to the baseline group, and further reduced in the second cycle group compared to the first, with statistically significant differences observed ( P<0.01). Pain levels in the first and second cycle groups were also significantly lower than those in the baseline group, with statistically significant differences observed ( P<0.01) . Conclusions:Optimizing the smart follow-up workflow for day-case breast surgery patients based on an action research approach can significantly improve the automated and overall recovery rates of follow-up forms, reduce postoperative discomfort, and enhance both the efficiency and quality of follow-up care.

Objective:To optimize the smart follow-up workflow for day-case breast surgery patients using an action research approach and evaluate its effectiveness.Methods:A total of 648 post-discharge patients who underwent day-case breast surgery at the Day Surgery Unit of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences between February and May 2024 were selected by convenience sampling. Patients who received routine smart follow-up (automated+telephone) from February to March 2024 served as the baseline group. Patients enrolled in April 2024 ( n=218) and May 2024 ( n=202) formed the first and second cycle groups, respectively, in which the smart follow-up workflow was optimized iteratively using action research. Outcome indicators included automated recovery rate and total recovery rate of follow-up forms, as well as the incidence of postoperative discomfort symptoms. Results:The automated and total recovery rates of follow-up forms in the first and second cycle groups were significantly higher than those in the baseline group, with statistically significant differences observed ( P<0.01). The proportion of patients experiencing persistent chest distress was significantly lower in the first and second cycle groups compared to the baseline group, and further reduced in the second cycle group compared to the first, with statistically significant differences observed ( P<0.01). Pain levels in the first and second cycle groups were also significantly lower than those in the baseline group, with statistically significant differences observed ( P<0.01) . Conclusions:Optimizing the smart follow-up workflow for day-case breast surgery patients based on an action research approach can significantly improve the automated and overall recovery rates of follow-up forms, reduce postoperative discomfort, and enhance both the efficiency and quality of follow-up care.

AIM: To understand the visual acuity and spectacle usage among primary and secondary school students in Xi'an city, providing scientific evidence for making myopia prevention and control efforts.METHODS:Vision screening and spectacles usage survey was conducted on 38 226 students in 119 primary and secondary schools from 16 counties and districts in Xi'an city, and uncorrected visual acuity, refractive power, glasses wearing rate, full correction rate were statistically analyzed.RESULTS:The myopia rate among primary and secondary school students in Xi'an city is 61.53%, showing an increasing trend as the grade level goes up(χ2trend=5332.203, P<0.01). Among them, the proportion of mild myopia decreases with the increase of grade level, while the proportion of moderate and high myopia shows an upward trend with the increase of grade level(χ2trend=2671.562, P<0.01). The glasses wearing rate among myopic students is 51.69%, showing an upward trend as the grade level goes up(χ2trend=1486.941, P<0.01). The spectacle prescription rate for female students is higher than that for male students(χ2=23.659, P<0.01), and the rate in urban areas is higher than that in suburban counties(χ2=102.241, P<0.01). The full correction rate among students wearing glasses is 67.08%, and the rate for students wearing glasses in urban areas is higher than that in suburban counties(χ2=4.980, P<0.05). Among myopic students, 63.66% had undergone visual acuity checks more than or equal to twice in the past year, with vocational high school students having the lowest frequency of twice vision screenings, accounting for 58.06%. There is a negative correlation between myopic students residing in suburban counties and their glasses wearing rate, while a higher grade level and increased frequency of annual vision checks are positively correlated with the glasses wearing rate among myopic students(all P<0.01).CONCLUSION:The situation of students' myopia prevention and control is severe in Xi'an city, with low rates of spectacles usage, full correction, and frequency of visual checks. Special attention needs to be paid to the vision correction status of students in suburban counties, primary schools, and vocational high schools.

AIM:To observe the anti-scarring effects and safety of triamcinolone acetonide(TA)-loaded hydrogel sustained-release sheeting on stab incision glaucoma surgery(SIGS)with “one-step tunnel method” in rabbit eyes.METHODS:A total of 48 healthy New Zealand white rabbits were randomly selected and divided into 4 groups(12 rabbits in each group), trabeculectomy(Trab)group, SIGS group, polyvinyl alcohol hydrogel(PVAH)sheeting was implanted under the conjunctiva flap during SIGS(PVAH group), and hydrogel sustained-release sheeting loaded with TA was implanted under the conjunctiva flap during SIGS(TA/PVAH group). On the 1, 2, 3, and 4 wk after surgery, the intraocular pressure, filtering bubble morphology, anterior chamber reaction, and other complications were observed and recorded in each group. Then animals were euthanized, and the surgery area tissues of right eye were taken for pathological tissue paraffin section. Masson staining, picric acid-Sirius rose red staining, as well as α-smooth muscle actin(α-SMA)and fibroblast growth factor 2(FGF2)immunohistochemistry staining was performed on every section. The infiltration of inflammatory cells, proliferation of fibroblasts and synthesis of type I and type III collagen fibers in local tissues were observed. The average positive area ratio of α-SMA and FGF2 antibody immunohistochemical staining in each group was calculated and compared.RESULTS: The TA/PVAH group maintained diffuse and elevated functional filtering blebs, while flat filtering blebs appeared in Trab, SIGS and PVAH groups at 2 wk after surgery. Functional filtering blebs were present in 1 eye(33%), 2 eyes(67%)in the PVAH and TA/PVAH group at 4 wk after surgery, respectively, while the other filtering blebs were flattened. Masson staining showed that the hydrogels in PVAH and TA/PVAH groups did not degrade at 4 wk after surgery. Compared with the Trab and SIGS groups, the filtration passages were more obvious, with less collagen fiber proliferation. Sirius red staining showed that the expression of type I collagen and type III collagen in the TA/PVAH group was less than that in the Trab group, SIGS group and PVAH group at 4 wk after surgery. Immunohistochemical staining showed that the α-SMA expression in the TA/PVAH group was significantly lower than that in the Trab and SIGS groups at 1 wk after surgery(P<0.01). The α-SMA expression was the highest in the Trab and SIGS groups at 2 wk after surgery, while the α-SMA expression in the PHAP and TA/PVAH groups was significantly lower than that in the first two groups(P<0.01). Compared with the Trab group, the expression of FGF2 in the PVAH and TA/PVAH group was significantly increased at 1, 2, 3 and 4 wk after surgery(P<0.05). Compared with the SIGS group, FGF2 expression in the TA/PVAH group was significantly increased at 4 wk after surgery(P<0.05).CONCLUSION:In SIGS surgery of rabbit eyes, implanting hydrogel sustained-release sheeting loaded with TA under conjunctival flap can effectively inhibit the scarring of the filtering bleb, which may be the interaction of the anti-scar effect of TA and the stent function of hydrogel.

Objective:To investigate the differences in cell-free DNA (cfDNA) concentrations between the inflammatory bowel disease (IBD) patients with different disease severities and the significance.Methods:Cross-sectional study was conducted. Ninety-one patients with IBD were included in the Second Affiliated Hospital of Zhengzhou Univesity from April 2021 to May 2022, including 48 patients with ulcerative colitis (UC) and 43 patients with Crohn′s disease (CD). Fifteen healthy people were assigned as healthy control group. The differences in cfDNA concentration between IBD group and healthy control group and between IBD patients with different disease severities were compared. The correlations between cfDNA concentration and laboratory indicators of IBD patients were analyzed.Results:The cfDNA concentration of IBD patients was higher than that of healthy control group [ (86.7±22.6) ng/ml vs. (52.6±15.8) ng/ml, P<0.001], and the cfDNA concentrations of UC and CD patients were higher than that of healthy control group (both P<0.001), the differences were statistically significant. The cfDNA concentration of mild, moderate and severe UC patients increased successively, and the differences were statistically significant [ (62.9±11.1) ng/ml vs. (83.6±17.1) ng/ml vs. (103.9±19.1) ng/ml, all P<0.01]. cfDNA concentration of UC patients was positively correlated with disease activity ( r = 0.74, P<0.001). cfDNA concentration of active CD patients was significantly higher than that in remission stage [ (104.2±17.2) ng/ml vs. (78.6±18.6) ng/ml, P<0.001]. cfDNA concentration in CD patients was positively correlated with disease activity ( r = 0.58, P<0.001). cfDNA concentration in UC patients was positively correlated with C-reactive protein (CRP) ( r = 0.4, P<0.01) and erythrocyte sedimentation rate (ESR) ( r = 0.37, P<0.01), and negatively correlated with hemoglobin ( r = -0.46, P<0.01) and albumin ( r = -0.51, P<0.01). cfDNA concentration in CD patients was positively correlated with CRP ( r = 0.48, P<0.01) and ESR ( r = 0.38, P<0.05), and negatively correlated with hemoglobin ( r = -0.45, P<0.01) and albumin ( r = -0.32, P<0.05) . Conclusion:cfDNA concentration closely correlates with disease severity of IBD patients and is a new indicator to evaluate disease severity of IBD patients.

Objective:To investigate the differences in cell-free DNA (cfDNA) concentrations between the inflammatory bowel disease (IBD) patients with different disease severities and the significance.Methods:Cross-sectional study was conducted. Ninety-one patients with IBD were included in the Second Affiliated Hospital of Zhengzhou Univesity from April 2021 to May 2022, including 48 patients with ulcerative colitis (UC) and 43 patients with Crohn′s disease (CD). Fifteen healthy people were assigned as healthy control group. The differences in cfDNA concentration between IBD group and healthy control group and between IBD patients with different disease severities were compared. The correlations between cfDNA concentration and laboratory indicators of IBD patients were analyzed.Results:The cfDNA concentration of IBD patients was higher than that of healthy control group [ (86.7±22.6) ng/ml vs. (52.6±15.8) ng/ml, P<0.001], and the cfDNA concentrations of UC and CD patients were higher than that of healthy control group (both P<0.001), the differences were statistically significant. The cfDNA concentration of mild, moderate and severe UC patients increased successively, and the differences were statistically significant [ (62.9±11.1) ng/ml vs. (83.6±17.1) ng/ml vs. (103.9±19.1) ng/ml, all P<0.01]. cfDNA concentration of UC patients was positively correlated with disease activity ( r = 0.74, P<0.001). cfDNA concentration of active CD patients was significantly higher than that in remission stage [ (104.2±17.2) ng/ml vs. (78.6±18.6) ng/ml, P<0.001]. cfDNA concentration in CD patients was positively correlated with disease activity ( r = 0.58, P<0.001). cfDNA concentration in UC patients was positively correlated with C-reactive protein (CRP) ( r = 0.4, P<0.01) and erythrocyte sedimentation rate (ESR) ( r = 0.37, P<0.01), and negatively correlated with hemoglobin ( r = -0.46, P<0.01) and albumin ( r = -0.51, P<0.01). cfDNA concentration in CD patients was positively correlated with CRP ( r = 0.48, P<0.01) and ESR ( r = 0.38, P<0.05), and negatively correlated with hemoglobin ( r = -0.45, P<0.01) and albumin ( r = -0.32, P<0.05) . Conclusion:cfDNA concentration closely correlates with disease severity of IBD patients and is a new indicator to evaluate disease severity of IBD patients.

Percutaneous vertebral augmentation, including percutaneous vertebroplasty and percutaneous kyphoplasty, has been considered as an effective and safe option in treating osteoporotic vertebral compression fractures. The fractured vertebrae were strengthened by the bone cement injected, thus reducing the symptoms related to fracture. Bone cement injected intraoperatively can be divided into extraspinal (leakage) and intraspinal part, depending on its final location. The former may lead to pulmonary embolism, spinal cord or nerve injury, or some other sequelae; the latter may closely relate to the clinical outcome, radiological outcomes, surgical complications and biomechanical properties. To date, there were a large number of studies on term of the distribution type of bone cement. However, the classification criteria varied and there was lack of literature review on this issue. According to the literature reviewed, the distribution type of bone cement was a critical parameter in percutaneous vertebral augmentation; most classification systems were based on the postoperative X-ray, some based on the postoperative CT, and only a few based on postoperative MRI; in different classification systems, criteria on bone cement morphology tends to be consistent, however, criteria on bone cement range tends to be inconsistent, consistency, similarity and controversy all exited among conclusions between various studies on the morphology and range of bone cement; any single classification system can not describe the distribution of bone cement thoroughly. In this study, classification systems were reviewed, clinical significance and biomechanical conclusions of different classification systems were documented, and the reliability and limitations of classification systems were summarized, hence providing an insight for further research on classifications of the bone cement distribution.

Objective:To compare the population characteristics, the positive rate of screening, the detection rate of breast cancer, early diagnosis rate and the cost between the mass screening group and opportunistic screening group of breast cancer.Methods:This study is a prospective multicenter cohort study conducted from January 1, 2014 to December 31, 2016. The participants were enrolled for mass screening or opportunistic screening of breast cancer. After completing the questionnaire, all the participants received breast physical examination and breast ultrasound examination every year for 3 rounds by year. The participants′ characteristics and screening results of the two groups were compared by χ 2 test, Fisher exact test or Wilcoxon rank-sum test. Results:A total of 20 080 subjects were enrolled. In the mass screening group, 9 434 (100%), 8 111 (85.98%) and 3 940 (41.76%) cases completed the 3 rounds of screening, and 10 646 (100%), 6 209 (58.32%) and 2 988 (28.07%) cases in the opportunistic screening group, respectively. In the opportunistic screening group, the proportions of less than 3 months lactation (1 275/9 796 vs. 1 061/8 860, χ2=4.597, P=0.032), non-fertility (850/10 646 vs. 574/9 434, χ2=27.400, P<0.01), abortion history (6 384/10 646 vs. 5 062/9 434, χ2=81.232, P<0.01), postmenopausal (2 776/10 646 vs. 2 217/9 434, χ2=17.757, P<0.01), long-term oral contraceptives(>6 months) (171/10 646 vs. 77/9 434, χ2=25.593, P<0.01) and family history of breast cancer in first-degree relatives (464/10 646 vs. 236/9 434, χ2=51.257, P<0.01) were significantly higher than those in mass screening group. The positive rate of screening (514/10 646 vs. 128/9 434, χ2=194.736, P<0.01), the detection rate of breast cancer (158/10 646 vs. 13/9 434, χ2=107.374, P<0.01), and positive rate of biopsy (158/452 vs. 13/87, χ2=13.491, P<0.01) in the opportunistic screening group were significantly higher than those of the mass screening group. The early diagnosis rate of the mass screening group was significantly higher than the opportunistic screening group (10/12 vs. 66/141, χ2=5.902, P=0.015). The average cost for detecting each breast cancer case of the mass screening group was 215 038 CNY, which was 13.6 times of the opportunistic screening group (15 799 CNY/case). In the opportunistic screening group, the positive rate of biopsy in primary hospitals was significantly lower than that in large-volume hospitals (79/267 vs. 79/185, χ2=8.267, P=0.004), but there was no significant difference in the mass screening group (6/37 vs. 7/50, χ2=0.082, P=0.774). Conclusions:Breast cancer screening can improve early detection rate. Compared with the mass screening mode, the opportunistic screening mode has the advantages of higher proportion of high-risk factors, higher positive rate of screening, higher detection rate of breast cancer, higher positive rate of biopsy, and lower cost of screening. However, the early diagnosis rate of breast cancer of opportunistic screening is lower than that of mass screening. The positive rate of opportunistic screening in primary hospitals is lower than that of large-volume hospitals. The two screening modes have their own advantages and should be chosen according to local conditions of different regions in China.

Objective:To compare the population characteristics, the positive rate of screening, the detection rate of breast cancer, early diagnosis rate and the cost between the mass screening group and opportunistic screening group of breast cancer.Methods:This study is a prospective multicenter cohort study conducted from January 1, 2014 to December 31, 2016. The participants were enrolled for mass screening or opportunistic screening of breast cancer. After completing the questionnaire, all the participants received breast physical examination and breast ultrasound examination every year for 3 rounds by year. The participants′ characteristics and screening results of the two groups were compared by χ 2 test, Fisher exact test or Wilcoxon rank-sum test. Results:A total of 20 080 subjects were enrolled. In the mass screening group, 9 434 (100%), 8 111 (85.98%) and 3 940 (41.76%) cases completed the 3 rounds of screening, and 10 646 (100%), 6 209 (58.32%) and 2 988 (28.07%) cases in the opportunistic screening group, respectively. In the opportunistic screening group, the proportions of less than 3 months lactation (1 275/9 796 vs. 1 061/8 860, χ2=4.597, P=0.032), non-fertility (850/10 646 vs. 574/9 434, χ2=27.400, P<0.01), abortion history (6 384/10 646 vs. 5 062/9 434, χ2=81.232, P<0.01), postmenopausal (2 776/10 646 vs. 2 217/9 434, χ2=17.757, P<0.01), long-term oral contraceptives(>6 months) (171/10 646 vs. 77/9 434, χ2=25.593, P<0.01) and family history of breast cancer in first-degree relatives (464/10 646 vs. 236/9 434, χ2=51.257, P<0.01) were significantly higher than those in mass screening group. The positive rate of screening (514/10 646 vs. 128/9 434, χ2=194.736, P<0.01), the detection rate of breast cancer (158/10 646 vs. 13/9 434, χ2=107.374, P<0.01), and positive rate of biopsy (158/452 vs. 13/87, χ2=13.491, P<0.01) in the opportunistic screening group were significantly higher than those of the mass screening group. The early diagnosis rate of the mass screening group was significantly higher than the opportunistic screening group (10/12 vs. 66/141, χ2=5.902, P=0.015). The average cost for detecting each breast cancer case of the mass screening group was 215 038 CNY, which was 13.6 times of the opportunistic screening group (15 799 CNY/case). In the opportunistic screening group, the positive rate of biopsy in primary hospitals was significantly lower than that in large-volume hospitals (79/267 vs. 79/185, χ2=8.267, P=0.004), but there was no significant difference in the mass screening group (6/37 vs. 7/50, χ2=0.082, P=0.774). Conclusions:Breast cancer screening can improve early detection rate. Compared with the mass screening mode, the opportunistic screening mode has the advantages of higher proportion of high-risk factors, higher positive rate of screening, higher detection rate of breast cancer, higher positive rate of biopsy, and lower cost of screening. However, the early diagnosis rate of breast cancer of opportunistic screening is lower than that of mass screening. The positive rate of opportunistic screening in primary hospitals is lower than that of large-volume hospitals. The two screening modes have their own advantages and should be chosen according to local conditions of different regions in China.

Objective:To investigate the clinical characteristics and imaging manifestations of primary bone lymphoma (PBL) located in the jaw.Methods:Clinical data of 14 PBL patients admitted to The First Affiliated Hospital of Zhengzhou University from January 2014 to April 2019 were retrospectively analyzed, which including age, gender, location, chief complaint, laboratory test, imaging manifestations and so on.Results:Among the 14 PBL patients, 10 were male and 4 were female. Age range from 4 to 79 years, median age was 56 years old. There were 6 cases involved maxillary, 7 cases involved mandible and 1 case involved mandible and maxillary simultaneously. Twelve patients were admitted with local mass as the chief complaint, 3 had a history of toothache, 4 had loosen tooth and 2 had numbness of lips and cheeks. Two cases of oral mass with mucosal surface ulcer or abscess formation. One case complained of fever, night sweats and other systemic symptoms. The imaging findings showed 8 cases of osteolytic lesions, 1 case of sclerosis, 4 cases of mixed lesions and 1 case of cystic lesions. One case had periosteum reaction. In 12 cases, there was an obvious mass, which was characterized by the large soft-tissue mass and marrow changes were associated with surprisingly little cortical destruction.Conclusions:PBL is more common in middle aged male. The upper and lower jaw bones can be involved. Clinical and imaging manifestations lack characteristics, and common dental or periodontal symptoms such as toothache, tooth loosening, and paresthesia may occur. However, the imaging characteristics of large soft tissue masses with small degree of bone destruction can be used as an important basis for the differential diagnosis of osteomyelitis, squamous cell carcinoma, osteosarcoma and other diseases.