Objective To investigate the impact of two different algorithms, AAA and AXB, on the dose distribution of postoperative radiotherapy for left-sided breast cancer after breast-conserving surgery. Methods A total of 96 target volumes from patients who underwent breast-conserving surgery for left-sided breast cancer were selected for dose verification using a two-dimensional matrix system. The planned dose distributions were simulated using both AAA and AXB algorithms. Dosimetric differences in organs at risk and the target volumes were then compared to identify the algorithm that could reduce the radiation dose to organs at risk without compromising the dose distribution to the target volume. Dose verification was performed on the plans generated by both algorithms, and the pass rates of plans for each target volume using both algorithms were compared to provide a quantitative basis for the precise selection of subsequent radiotherapy plans. Results Both AAA and AXB plans met the radiotherapy requirements. The AXB algorithm demonstrated significant advantages in the D₉₈, D₂, homogeneity index, and conformity index for the planning target volume, as well as in the V₅ and V₂₀ for the left lung. The AXB algorithm showed advantages in the V₃₀ for the heart and the maximum and mean doses for the skin. With the 2 mm/2% criterion in dose verification, the gamma pass rate was higher for the AXB algorithm. Conclusion Through a comparative analysis of the two algorithms, this study revealed that the AXB algorithm offers certain advantages in the dose distribution of radiotherapy after breast-conserving surgery for left-sided breast cancer. These findings provide an important reference for the rational selection of algorithms in clinical practice and are expected to improve radiotherapy efficacy and patient prognosis.

To investigate the positivity rates of specific antibodies, including parietal cell antibody (PCA) and anti-inner factor antibody (IFA), in a community population in Xinjiang for autoimmune gastritis (AIG), determine the prevalence of AIG, and analyze the correlations of PCA and IFA with clinical characteristics, pepsinogen (PG), gastrin 17 (G17), and Helicobacter pylori antibody (Hp-Ab).

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.

Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.

Humans ; Consensus ; Immunoglobulin Light-chain Amyloidosis/therapy* ; Heart ; Immunoglobulin Light Chains ; China

Objective:To analyze the influence mechanism of primary physicians'salary satisfaction on the turnover tendency,explore the moderating role of professional identity,and to provide a basis for enhancing the stability of the primary care physician workforce.Methods:The questionnaire survey method was used to study the salary satisfaction,professional identity and turnover ten-dency among 298 primary care doctors in the main urban area of Wuhan,and 284 valid questionnaires were obtained.The data were statistically analyzed.Results:The propensity to leave scores of primary care physicians aged 40 to 50 years,with bachelor's de-gree and 11 to 15 years of work were(3.01±0.87),(3.02±0.90),and(3.03±0.86),respectively,with high were high turnover tendency;primary care physicians'salary satisfaction and professional identity had a negative effect on the propensity to leave(P＜0.001);and professional identity had a negative effect on the salary satisfaction and turnover tendency(P＜0.001).Conclusion:Primary physicians'propensity to leave is more pronounced in the high-quality human capital group,with moderate security but in-sufficient incentives for pay;higher levels of professional identity reduce the relationship between pay satisfaction and propensity to leave.

Objective:To analyze the influence mechanism of primary physicians'salary satisfaction on the turnover tendency,explore the moderating role of professional identity,and to provide a basis for enhancing the stability of the primary care physician workforce.Methods:The questionnaire survey method was used to study the salary satisfaction,professional identity and turnover ten-dency among 298 primary care doctors in the main urban area of Wuhan,and 284 valid questionnaires were obtained.The data were statistically analyzed.Results:The propensity to leave scores of primary care physicians aged 40 to 50 years,with bachelor's de-gree and 11 to 15 years of work were(3.01±0.87),(3.02±0.90),and(3.03±0.86),respectively,with high were high turnover tendency;primary care physicians'salary satisfaction and professional identity had a negative effect on the propensity to leave(P＜0.001);and professional identity had a negative effect on the salary satisfaction and turnover tendency(P＜0.001).Conclusion:Primary physicians'propensity to leave is more pronounced in the high-quality human capital group,with moderate security but in-sufficient incentives for pay;higher levels of professional identity reduce the relationship between pay satisfaction and propensity to leave.

Objective:To analyze the influence mechanism of primary physicians'salary satisfaction on the turnover tendency,explore the moderating role of professional identity,and to provide a basis for enhancing the stability of the primary care physician workforce.Methods:The questionnaire survey method was used to study the salary satisfaction,professional identity and turnover ten-dency among 298 primary care doctors in the main urban area of Wuhan,and 284 valid questionnaires were obtained.The data were statistically analyzed.Results:The propensity to leave scores of primary care physicians aged 40 to 50 years,with bachelor's de-gree and 11 to 15 years of work were(3.01±0.87),(3.02±0.90),and(3.03±0.86),respectively,with high were high turnover tendency;primary care physicians'salary satisfaction and professional identity had a negative effect on the propensity to leave(P＜0.001);and professional identity had a negative effect on the salary satisfaction and turnover tendency(P＜0.001).Conclusion:Primary physicians'propensity to leave is more pronounced in the high-quality human capital group,with moderate security but in-sufficient incentives for pay;higher levels of professional identity reduce the relationship between pay satisfaction and propensity to leave.

Objective:To analyze the influence mechanism of primary physicians'salary satisfaction on the turnover tendency,explore the moderating role of professional identity,and to provide a basis for enhancing the stability of the primary care physician workforce.Methods:The questionnaire survey method was used to study the salary satisfaction,professional identity and turnover ten-dency among 298 primary care doctors in the main urban area of Wuhan,and 284 valid questionnaires were obtained.The data were statistically analyzed.Results:The propensity to leave scores of primary care physicians aged 40 to 50 years,with bachelor's de-gree and 11 to 15 years of work were(3.01±0.87),(3.02±0.90),and(3.03±0.86),respectively,with high were high turnover tendency;primary care physicians'salary satisfaction and professional identity had a negative effect on the propensity to leave(P＜0.001);and professional identity had a negative effect on the salary satisfaction and turnover tendency(P＜0.001).Conclusion:Primary physicians'propensity to leave is more pronounced in the high-quality human capital group,with moderate security but in-sufficient incentives for pay;higher levels of professional identity reduce the relationship between pay satisfaction and propensity to leave.