Objective To develop a multivariate predictive nomogram to identify high-risk cohorts for sentinel lymph node(SLN)metastasis among cT 1-2N0 breast cancer patients with preoperatively normal axillary ultrasound(AUS),thereby providing a reference for personalized axillary management.Methods A retrospective analysis was conducted on the clinicopathological and ultrasonographic data of 427 patients diagnosed with invasive breast cancer who received treatment at Ward 4(Breast Unit),Department of General Surgery,Liuzhou Workers' Hospital,between January 2018 and December 2023.Univariate correlation analysis and multivariate logistic regression analysis were employed to identify independent risk factors associated with SLN metastasis.The accuracy and predictive performance of the nomogram were assessed using receiver operating characteristic(ROC)curve analysis.Results Our study enrolled 427 women diagnosed with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Among these patients,47 cases(11.0％)exhibited sonographically normal axillary lymph nodes,whereas 380 cases(89.0％)showed non-visualized lymph nodes.SLN metastasis,confirmed by postoperative pathological examination,was identified in 78 patients(18.3％).Univariate analysis revealed that estrogen receptor(ER)status,maximal tumor diameter,tumor location,lymphovascular invasion(LVI),and perineural invasion(PNI)were significantly associated with the presence of SLN metastasis(P＜0.05).Multivariate logistic regression analysis further identified the following independent high-risk factors for SLN metastasis:tumor location in the upper outer quadrant(OR=4.118,95％CI=1.349～12.571),tumor size greater than 2 cm(OR=2.246,95％CI=1.252～4.029),presence of LVI(OR=4.477,95％CI=2.207～9.081),and presence of PNI(OR=3.013,95％CI=1.573～5.771)(all P＜0.05).Ultrasonographic features of axillary lymph nodes—including their positivity status,short-axis diameter,and numerical count—did not show a statistically significant association with the SLN metastatic burden(P ≥ 0.05).However,these features demonstrated a statistically sig-nificant correlation with the pathological nodal stage(pN-stage)classification(P＜0.05).In patients with 1～2 positive sentinel lymph nodes,sonographic characteristics of axillary lymph nodes(including status,maximum diameter,minimum diameter,and numerical count)did not exhibit a significant association with either axillary lymph node metastatic burden or pN-stage classification(all P ≥ 0.05).The area under the receiver operating characteristic curve(AUC)for the predictive nomogram was 0.702(95％CI:0.651～0.749,P＜0.0001),with a sensitivity of 78.21％and specificity of 59.12％.Conclusions Tumor location in the upper outer quadrant,tumor size greater than 2 cm,LVI,and PNI were identified as significant independent risk factors for SLN metastasis among patients with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Further-more,from the perspective of pN-stage stratification,omission of axillary lymph node dissection(ALND)appears to be clinically feasible for the majority of cT1-2N0 patients with 1～2 metastatic SLNs.However,preoperative ultrasonographic characteristics of lymph nodes demonstrate limited predictive value for axillary lymph node(ALN)metastatic burden or pN-stage progression.

Objective To develop a multivariate predictive nomogram to identify high-risk cohorts for sentinel lymph node(SLN)metastasis among cT 1-2N0 breast cancer patients with preoperatively normal axillary ultrasound(AUS),thereby providing a reference for personalized axillary management.Methods A retrospective analysis was conducted on the clinicopathological and ultrasonographic data of 427 patients diagnosed with invasive breast cancer who received treatment at Ward 4(Breast Unit),Department of General Surgery,Liuzhou Workers' Hospital,between January 2018 and December 2023.Univariate correlation analysis and multivariate logistic regression analysis were employed to identify independent risk factors associated with SLN metastasis.The accuracy and predictive performance of the nomogram were assessed using receiver operating characteristic(ROC)curve analysis.Results Our study enrolled 427 women diagnosed with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Among these patients,47 cases(11.0％)exhibited sonographically normal axillary lymph nodes,whereas 380 cases(89.0％)showed non-visualized lymph nodes.SLN metastasis,confirmed by postoperative pathological examination,was identified in 78 patients(18.3％).Univariate analysis revealed that estrogen receptor(ER)status,maximal tumor diameter,tumor location,lymphovascular invasion(LVI),and perineural invasion(PNI)were significantly associated with the presence of SLN metastasis(P＜0.05).Multivariate logistic regression analysis further identified the following independent high-risk factors for SLN metastasis:tumor location in the upper outer quadrant(OR=4.118,95％CI=1.349～12.571),tumor size greater than 2 cm(OR=2.246,95％CI=1.252～4.029),presence of LVI(OR=4.477,95％CI=2.207～9.081),and presence of PNI(OR=3.013,95％CI=1.573～5.771)(all P＜0.05).Ultrasonographic features of axillary lymph nodes—including their positivity status,short-axis diameter,and numerical count—did not show a statistically significant association with the SLN metastatic burden(P ≥ 0.05).However,these features demonstrated a statistically sig-nificant correlation with the pathological nodal stage(pN-stage)classification(P＜0.05).In patients with 1～2 positive sentinel lymph nodes,sonographic characteristics of axillary lymph nodes(including status,maximum diameter,minimum diameter,and numerical count)did not exhibit a significant association with either axillary lymph node metastatic burden or pN-stage classification(all P ≥ 0.05).The area under the receiver operating characteristic curve(AUC)for the predictive nomogram was 0.702(95％CI:0.651～0.749,P＜0.0001),with a sensitivity of 78.21％and specificity of 59.12％.Conclusions Tumor location in the upper outer quadrant,tumor size greater than 2 cm,LVI,and PNI were identified as significant independent risk factors for SLN metastasis among patients with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Further-more,from the perspective of pN-stage stratification,omission of axillary lymph node dissection(ALND)appears to be clinically feasible for the majority of cT1-2N0 patients with 1～2 metastatic SLNs.However,preoperative ultrasonographic characteristics of lymph nodes demonstrate limited predictive value for axillary lymph node(ALN)metastatic burden or pN-stage progression.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective:To compare the efficacy and safety of stone extraction with a single peroral choledochoscopy system under direct visualization and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) for non-difficult common bile duct stones.Methods:A total of 164 patients with common bile duct stones who underwent stone extraction by using the single peroral choledochoscopy system under direct visualization (the observation group, n=82) and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) (the control group, n=82) from January 2018 to April 2022 in Dongfang Hospital, Beijing University of Chinese Medicine were enrolled. The observation group was directly selected from the database, while the control group was randomly matched by age stratification with baseline data validated. The success rates of intubation, stone removal, postoperative complication incidence, and radiation exposure between the two groups were compared. Results:There was no significant difference between the baseline data of the observation group and the control group ( P>0.05). The number of patients with detected stones≥2 in the observation group and the control group were 59 (71.95%) and 37 (45.12%) respectively with significant difference ( χ 2=12.16, P=0.001). The success rates of bile duct intubation in the observation group and the control group were both 100.00% (82/82). The success rates of stone extraction were 98.78% (81/82) and 100.00% (82/82) respectively with no significant difference ( P>0.05). The one-time stone removal rates of the two groups were 93.90% (77/82) and 92.68% (76/82) respectively with no significant difference ( χ2=0.10, P=0.755). There was no significant difference in the incidence of postoperative complications between the observation group and the control group ( P>0.05). The amount of intraoperative ray exposure volume in the observation group was significantly lower than that of the control group [10.20 (6.69, 18.94) mGy VS 15.41 (10.70, 22.77) mGy, U=2 462.00, P=0.003]. Conclusion:The efficacy and safety of stone extraction with single peroral choledochoscopy system under direct visualization are comparable to those of traditional X-ray ERCP for non-difficult common bile duct stones, but it can significantly reduce the intraoperative ray exposure volume during therapeutic ERCP stone extraction.

Objective:To analyze the association between the perioperative amplitude-integrated electroencephalogram(aEEG)of neonates with congenital heart disease(CHD) and their neurodevelopmental outcome at 2 years of age.Methods:Neonates with CHD ( n=32) who were admitted to the neonatal intensive care unit at our hospital were included.All patients had undergone cardiac surgery during the neonatal period and preoperative and postoperative aEEG monitoring.The background pattern, sleep-wake cycle(SWC) pattern and seizure activity (including electrographic seizure activity) were used to quantify cerebral activity related to brain function.Infants with CHD were enrolled prospectively to follow up at 2 years old.Participants were assessed at 2 years old via the Bayley Scale of Infant Development. Results:A total of 32 neonates were enrolled in the study.Compared with average of normal population, psychomotor development index(PDI) of participants decreased significantly ( P<0.05). The mental development index(MDI) of patients with abnormal behavior was significantly lower.The longer length of ICU, longer time of ventilation, and the older age of father were risk factors of lower PDI.The MDI (76.29±23.38) of cases with mild abnormal preoperative background pattern were significantly lower than that with normal background pattern (97.37±22.65)( P=0.039). The PDI (74.00±20.09) of cases with abnormal preoperative background pattern was significantly lower than that (92.12±20.42) with normal preoperative background pattern ( P=0.046). The PDI (85.04±20.384) of cases with immature preoperative SWC were significantly lower than that with the normal preoperative SWC(110.00±16.55) ( P=0.027). Conclusion:Abnormal perioperative background pattern and SWC are markers for neurodevelopment disorder.The perioperative aEEG is a useful bedside tool that helps predict outcomes in infants underwent heart surgery.

Objective To determine the long term outcomes of laryngomalacia infants with anomalies and to determine the clinical practice guideline for these infants.Methods The charts of infants with moderate to severe laryngomalacia,who were admitted to our hospital between January 2013 and December 2015,were retrospectively reviewed.These infants were divided into two groups,anomaly(A) group(n=37) and non-anomaly (NA) group(n=19).Results Fifty-six cases were enrolled.Infants in A group were older at symptom relief than those in NA group[(10.00±3.56) months vs.(7.89±3.03) months,P＜0.05],and the weight percentiles of infants in A group were lower at 3,6 and 12 months than those in NA group(P＜0.05).There was no statistically significant difference between the two groups on the weights percentiles in infants at 24 months after diagnosis.Five of 37 cases in A group and 3 of 19 cases in NA group had supraglottoplasty.One infant in A group had tracheotomy.Conclusion Both breathing difficulty and development retardations of infants with moderate or severe laryngomalacia could gradually improved with age.There is not enough evidence to support the aggressive supraglottoplasty for infants with anomalies and laryngomalacia.

Objective To study insulin sensitivity and first-phase insulin secretion in obese subjects with impaired glucose regulation (ICR) in Shanghai. Methods A total of 129 subjects [38 lean controls and 91 obese subjects with ICR including 64 isolated impaired glucose tolerance (IGT) ,8 isolated impaired fasting glucose (IFC) and 19 IFC + ICT] underwent 75 g oral glucose tolerance test and insulin-modified reduced sample number (n = 12) of Bergman's minimal model method with frequently sampled intravenous glucose tolerance test (FSIGTT). Insulin resistance was determined from the insulin sensitivity index (S1) of the FSIGTT. Insulin secretion was determined during the FSIGTT by the acute insulin response to glucose (AIRg). The disposition index (DI) , the product of AIRg and S1, was used to determine whether AIRg was adequate to compensate for insulin resistance. Results (1) Compared with normal controls, the value of S1 was significantly decreased in 3 groups with ICR (all P

Objective To evaluate the difference of carotid intimal medial thickness (IMT) among different glucose tolerance status and to investigate the association of IMT with different glucose levels of 4 time points during oral glucose tolerance test (OGTT) and the lipid metabolic indices in non-diabetic subjects. Methods Eleven normal control subjects, 69 subjects with impaired glucose regulation (IGR) newly diagnosed by OGTT (including 28 patients with non-elevated OGTT 30 min and 60 min glucose values (