Objective To compare the efficacy and safety of different cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy (ET) for the treatment of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced or metastatic breast cancer. Methods Randomized controlled trials (RCTs) on CDK4/6i for the treatment of HR+/HER2− metastatic or advanced breast cancer were retrieved from databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP, and SinoMed, with the search period ranging from database inception to August 2023. Bayesian network meta-analysis was conducted using R 4.2.0 software. Results A total of 18 RCTs from 25 articles, involving 8 031 patients and 11 treatment regimens, were included. There was no significant difference in progression-free survival (PFS) or overall survival (OS) among different CDK4/6i+ET combinations. The highest cumulative probability for PFS was observed with dalpiciclib (DAL)+fulvestrant (FUL), while ribociclib (RIB)+FUL ranked first for OS. In terms of efficacy, abemaciclib (ABE)+aromatase inhibitors (AI) and ABE+FUL ranked first in objective response rate and clinical benefit rate, respectively. Regarding safety, statistically significant difference in grade 3-4 adverse events was observed among certain types of CDK4/6i (P<0.05). Conclusion Current evidence suggests that CDK4/6i+ET is superior to ET alone for the treatment of HR+/HER2− advanced/metastatic breast cancer. Different CDK4/6i+ET combinations demonstrate comparable or similar efficacy; however, the incidence of adverse reactions is higher with combination therapy. Treatment regimens should be selected based on individual conditions.

Obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) are linked to numerous chronic conditions, including cardiovascular disease, atherosclerosis, chronic kidney disease, and type II diabetes. Previous research identified the natural flavonoid diosmin, derived from Chrysanthemum morifolium, as a regulator of glucose metabolism. However, its effects on lipid metabolism and underlying mechanisms remained unexplored. The AMP-activated protein kinase (AMPK) pathway serves a critical function in glucose and lipid metabolism. The relationship between diosmin and the AMPK pathway has not been previously documented. This investigation examined diosmin's capacity to reduce lipid content through AMPK pathway activation in hepatoblastoma cell line G2 (HepG2) and 3T3-L1 cells. The study revealed that diosmin inhibits lipogenesis, indicating its potential as an anti-obesity agent in obese mice. Moreover, diosmin demonstrated effective MASLD alleviation in vivo. These findings suggest that diosmin may represent a promising therapeutic candidate for treating obesity and MASLD.
Diosmin/administration & dosage* ; Animals ; AMP-Activated Protein Kinases/genetics* ; Humans ; Non-alcoholic Fatty Liver Disease/enzymology* ; Mice ; Obesity/enzymology* ; Hep G2 Cells ; Male ; 3T3-L1 Cells ; Mice, Inbred C57BL ; Signal Transduction/drug effects* ; Lipid Metabolism/drug effects* ; Chrysanthemum/chemistry* ; Lipogenesis/drug effects*

Objective:To evaluate the diagnostic value of metagenomic next-generation sequencing（mNGS）in bone and joint infections caused by non-tuberculous mycobacteria（NTM）.Methods:Clinical data of 175 patients with suspected NTM bone and joint infections admitted in Beijing Chest Hospital，Capital Medical University from January 2019 to January 2023 were retrospectively analyzed. Mycobacterium growth indicator tube（MGIT）method was used for mycobacterial culture on the bone tissue or abscess samples and mNGS test was performed on bone tissue samples in all patients. Taking clinical diagnosis as the gold standard，the sensitivity，specificity，positive predictive value，negative predictive value，positive likelihood ratio，and negative likelihood ratio of the two methods were compared.Results:Twenty-six patients（14.9%）were clinically diagnosed as NTM bone and joint infections. The mNGS showed higher sensitivity（100.0% vs. 57.7%，），specificity（99.3% vs. 86.6%），positive predictive value（96.3% vs. 42.9%），and negative predictive value（100.0% vs. 92.1%），compared to MGIT culture（all P<0.001）. The positive likelihood ratio（149.00 vs. 4.31）and negative likelihood ratio（0 vs. 0.49）of mNGS were also superior to those of MGIT. Conclusion:Compared to MGIT culture，mNGS has high diagnostic value in NTM bone and joint infections and can serve as an efficient and reliable method for clinical diagnosis.

This article reviews the application and future prospects of complement component 5 (C5) inhibitors in kidney transplantation for sensitized recipients. Kidney transplantation significantly improves the survival and quality of life for patients with end-stage kidney disease. However, donor kidney shortages and human leukocyte antigen (HLA) sensitization are major obstacles. HLA-sensitized candidates, particularly highly sensitized ones, face a significantly elevated risk of post-transplant rejection due to pre-existing HLA antibodies. Eculizumab, a terminal complement inhibitor, inhibits rejection by preventing the cleavage of C5 into C5a and C5b, thus blocking the formation of the membrane attack complex and suppressing complement-dependent cytotoxicity.

Objective:To construct a risk prediction model for radiation dermatitis in the perineum of cervical cancer patients undergoing radiotherapy, and verify the predictive effect of the model, so as to provide theoretical basis for reducing the risk of perineal radiation dermatitis in clinical practice.Methods:A prospective study design was used to conveniently select 247 cervical cancer patients who received radiotherapy at Tianjin Medical University Cancer Institute & Hospital from January 2022 to March 2023 as the modeling group. They were divided into a group with perineal radiodermatitis ( n = 130) and a group without perineal radiodermatitis ( n = 117). The data of the two groups were compared, and a risk prediction model was constructed based on the results of logistic regression analysis. Used the area under the receiver operating characteristic (ROC) curve to test the predictive performance of the model. From May to November 2023, 109 patients were selected as the validation group to conduct external validation of the model. Results:Among the 247 patients in the modeling group, the age of the group with perineal radiodermatitis was (45.31 ± 7.25) years old, and the age of the group without perineal radiodermatitis was (46.70 ± 6.43) years old. The incidence of perineal radiation dermatitis during radiotherapy in the modeling group was 52.6% (130/247), while in the validation group it was 44.0% (48/109). The final predictive variables included in the model were high blood sugar or not ( OR = 0.304, 95% CI 0.174-0.530), vaginal bleeding/discharge or not ( OR = 4.338, 95% CI 2.397-7.854), involvement of 1/3 of the vagina or not ( OR = 0.497, 95% CI 0.281-0.879), whether topical skin protectants could be used( OR = 3.479, 95% CI 1.596-7.583), whether skin protectants could be used in a standardized manner ( OR = 2.399, 95% CI 1.201-4.789), whether the skin could be cleaned with the correct cleaning agent ( OR = 3.155, 95% CI 1.603-6.209), and whether the skin could be wiped with the correct method ( OR = 3.325, 95% CI 1.806-6.121), totaling 7 predictive factors (all P<0.05). The area under the ROC curve of the prediction model was 0.866, the sensitivity was 0.735, and the specificity was 0.852, the Youden index was 0.587. Model validation results showed the area under the ROC curve was 0.762, the sensitivity was 0.815, the specificity was 0.717, and the accuracy was 80.73%, indicating good predictive performance. Conclusions:The predictive model constructed in this study had good predictive performance and could provide reference for clinical nursing staff to screen high-risk patients with perineal radiation dermatitis.

Objective:To construct a risk prediction model for radiation dermatitis in the perineum of cervical cancer patients undergoing radiotherapy, and verify the predictive effect of the model, so as to provide theoretical basis for reducing the risk of perineal radiation dermatitis in clinical practice.Methods:A prospective study design was used to conveniently select 247 cervical cancer patients who received radiotherapy at Tianjin Medical University Cancer Institute & Hospital from January 2022 to March 2023 as the modeling group. They were divided into a group with perineal radiodermatitis ( n = 130) and a group without perineal radiodermatitis ( n = 117). The data of the two groups were compared, and a risk prediction model was constructed based on the results of logistic regression analysis. Used the area under the receiver operating characteristic (ROC) curve to test the predictive performance of the model. From May to November 2023, 109 patients were selected as the validation group to conduct external validation of the model. Results:Among the 247 patients in the modeling group, the age of the group with perineal radiodermatitis was (45.31 ± 7.25) years old, and the age of the group without perineal radiodermatitis was (46.70 ± 6.43) years old. The incidence of perineal radiation dermatitis during radiotherapy in the modeling group was 52.6% (130/247), while in the validation group it was 44.0% (48/109). The final predictive variables included in the model were high blood sugar or not ( OR = 0.304, 95% CI 0.174-0.530), vaginal bleeding/discharge or not ( OR = 4.338, 95% CI 2.397-7.854), involvement of 1/3 of the vagina or not ( OR = 0.497, 95% CI 0.281-0.879), whether topical skin protectants could be used( OR = 3.479, 95% CI 1.596-7.583), whether skin protectants could be used in a standardized manner ( OR = 2.399, 95% CI 1.201-4.789), whether the skin could be cleaned with the correct cleaning agent ( OR = 3.155, 95% CI 1.603-6.209), and whether the skin could be wiped with the correct method ( OR = 3.325, 95% CI 1.806-6.121), totaling 7 predictive factors (all P<0.05). The area under the ROC curve of the prediction model was 0.866, the sensitivity was 0.735, and the specificity was 0.852, the Youden index was 0.587. Model validation results showed the area under the ROC curve was 0.762, the sensitivity was 0.815, the specificity was 0.717, and the accuracy was 80.73%, indicating good predictive performance. Conclusions:The predictive model constructed in this study had good predictive performance and could provide reference for clinical nursing staff to screen high-risk patients with perineal radiation dermatitis.

Objective:To evaluate the diagnostic value of metagenomic next-generation sequencing（mNGS）in bone and joint infections caused by non-tuberculous mycobacteria（NTM）.Methods:Clinical data of 175 patients with suspected NTM bone and joint infections admitted in Beijing Chest Hospital，Capital Medical University from January 2019 to January 2023 were retrospectively analyzed. Mycobacterium growth indicator tube（MGIT）method was used for mycobacterial culture on the bone tissue or abscess samples and mNGS test was performed on bone tissue samples in all patients. Taking clinical diagnosis as the gold standard，the sensitivity，specificity，positive predictive value，negative predictive value，positive likelihood ratio，and negative likelihood ratio of the two methods were compared.Results:Twenty-six patients（14.9%）were clinically diagnosed as NTM bone and joint infections. The mNGS showed higher sensitivity（100.0% vs. 57.7%，），specificity（99.3% vs. 86.6%），positive predictive value（96.3% vs. 42.9%），and negative predictive value（100.0% vs. 92.1%），compared to MGIT culture（all P<0.001）. The positive likelihood ratio（149.00 vs. 4.31）and negative likelihood ratio（0 vs. 0.49）of mNGS were also superior to those of MGIT. Conclusion:Compared to MGIT culture，mNGS has high diagnostic value in NTM bone and joint infections and can serve as an efficient and reliable method for clinical diagnosis.

This article reviews the application and future prospects of complement component 5 (C5) inhibitors in kidney transplantation for sensitized recipients. Kidney transplantation significantly improves the survival and quality of life for patients with end-stage kidney disease. However, donor kidney shortages and human leukocyte antigen (HLA) sensitization are major obstacles. HLA-sensitized candidates, particularly highly sensitized ones, face a significantly elevated risk of post-transplant rejection due to pre-existing HLA antibodies. Eculizumab, a terminal complement inhibitor, inhibits rejection by preventing the cleavage of C5 into C5a and C5b, thus blocking the formation of the membrane attack complex and suppressing complement-dependent cytotoxicity.

Objective:To analyze the radiographic parameters of shoulder balance that affect the postoperative satisfaction of Lenke type 1 adolescent idiopathic scoliosis (AIS).Methods:A total of 98 patients with AIS who underwent posterior pedicle screw fusion in Xijing Hospital of Air Force Medical University from August 2017 to July 2020 were retrospectively analyzed. There were 26 males and 72 females, aged 15.2±5.3 years (range, 10-24 years). Distribution of upper instrumented vertebrae: T 2 58 cases (59%), T 3 25 cases (26%), T 4 15 cases (15%); Distribution of lower instrumented vertebrae: T 12 63 cases (64%), L 1 28 cases (29%), L 2 4 cases (4%), L 3 3 cases (3%). Clavicle angle (CA), radiographic shoulder height (RSH), and coracoid height difference (CHD), clavicle-rib cage intersection difference (CRID), T 1 tilt angle, first rib tilt angle, clavicle chest angle difference(CCAD) and Scoliosis Research Society-22 (SRS-22) scale were compared before and after operation. Binary logistic regression was used to analyze the radiographic indicators of shoulder balance that affected the postoperative satisfaction of Lenke type 1 AIS. The receiver operating characteristic (ROC) curve was drawn to determine the threshold value of the imaging index. Results:All operations were successfully completed. The operation time was 260±80 min (range, 220-320 min), and the intraoperative blood loss was 360±110 ml (range, 300-700 ml). There was no nerve, dural or vascular injury during operation. RSH, CHD, CRID, T 1 tilt angle, first rib tilt angle, and CCAD at the final follow-up were 4.0 (0, 13.9) mm, 7.0 (0, 12.9) mm, 4.0 (0, 10.0) mm, 4.8° (3.3°, 8.2°), 5.3°±3.9°, and 5.5° (3.0°, 8.9°), respectively, which were less than the preoperative 10.6 (2.0, 20.3) mm, 10.3 (2.5, 15.9) mm, 8.0 (1.0, 15.2) mm, 7.6° (3.5°, 12.2°), 7.5°±6.9°, 8.5° (3.6°, 18.3°), and the difference was statistically significant ( P<0.05). The SRS-22 function, pain, appearance, and psychological scores at the final follow-up were 4.6 (4.0, 4.9), 4.1±0.5, 4.1±0.7, and 4.2 (3.9, 4.8) points, respectively, which were greater than the preoperative scores of 4.2 (3.8, 4.6), 4.0±0.7, 3.5±0.7, and 4.0 (3.5, 4.4) points, the difference was statistically significant ( P<0.05). Binary logistic regression showed that CCAD was an independent radiographic indicator of shoulder balance that affected the satisfaction of AIS patients after orthopaedic surgery ( OR=0.826, P=0.040). ROC curve showed that the area under the curve and 95% CI was 0.726 (0.572, 0.865), and the threshold was 6.6°. Conclusion:CCAD is an independent radiographic parameter of shoulder balance that affects the postoperative satisfaction of AIS. Patients are more likely to achieve a satisfactory outcome when their postoperative CCAD is ≤6.6°, which can be used clinically as a radiographic parameter to assess the efficacy of orthopaedic spine surgery.

Objective:To summarize the best evidence of prevention strategies for non-ventilator associated hospital-acquired pneumonia (NV-HAP) .Methods:The literature on the prevention and control of NV-HAP was searched on UpToDate, BMJ Best Practice, Agency for Healthcare Research and Quality, Guidelines International Network, Medlive, PubMed, Web of Science, Cochrane Library, WanFang Data, China Biology Medicine disc, and other databases and websites. The search period was from November 1, 2013, to November 1, 2023. Two researchers conducted a literature quality evaluation and extracted evidence.Results:A total of ten articles were included, including six guidelines, two systematic reviews, and two randomized controlled trials. Twenty-six pieces of evidence were summarized from seven aspects of oral hygiene, prevention of aspiration, nutrition and activity, airway management, hand hygiene, cleaning, disinfection and isolation, and antibiotic management.Conclusions:The best evidence of NV-HAP prevention strategies summarized provides a reference for medical and nursing staff to prevent and control NV-HAP.