Objective:To explore the risk factors for postoperative lower extremity lymphedema in patients with cervical cancer and construct a nomogram prediction model.Methods:A retrospective case-control study was conducted. Using convenience sampling method, 750 cervical cancer patients in Ziyang People's Hospital from May 2014 to May 2022 were selected. The included patients were divided into a modeling group (525 cases) and a validation group (225 cases) according to a ratio of 7∶3. In the modeling group, patients were divided into a developing group and a non-developing group according to the incidence of postoperative lower extremity lymphedema. Self-designed baseline data questionnaire was used to collect clinical data of patients. Logistic stepwise regression analysis was used to analyze the influencing factor for the incidence of postoperative lower extremity lymphedema in cervical cancer patients. R 4.0.2 software was used to construct a nomogram model for predicting the incidence risk of postoperative lower extremity lymphedema in cervical cancer patients based on the independent risk factors. Receiver operating characteristic (ROC) curve was used to evaluate the differentiation of the nomogram prediction model. Calibration curves were drawn to evaluate the consistency of the nomogram prediction model.Results:Among 525 cervical cancer patients in the modeling group, 109 (20.76%) had postoperative lower extremity lymphedema. There were statistically significant differences in the proportions of patients with different ages, tumor stages, surgical methods, postoperative drainage time, continuous standing time, number of lymph node dissection, and with or without diabetes mellitus, postoperative chemotherapy, postoperative radiotherapy, strenuous exercise or physical labor between the developing group and the non-developing group (all P < 0.05). Multivariate logistic regression analysis showed that age ≥ 60 years old( OR = 2.548, 95% CI: 1.253-5.181), postoperative radiotherapy ( OR = 8.048, 95% CI: 3.867-16.749), postoperative drainage time ≥5 d ( OR = 2.664, 95% CI: 1.043-6.803), continuous standing time ≥ 1 h ( OR = 3.024, 95% CI: 1.252-7.305), number of lymph node dissection > 20 ( OR = 7.063, 95% CI: 1.595-31.281), comorbid diabetes mellitus ( OR = 2.617, 95% CI: 1.200-5.711), and strenuous exercise or physical labor ( OR = 3.518, 95% CI: 1.841-6.721) were all independent risk factors affecting the incidence of postoperative lower extremity lymphedema in cervical cancer patients (all P < 0.05). Based on the above risk factors, a nomogram model was established to predict the incidence risk of postoperative lower extremity lymphedema in cervical cancer patients, and internal and external validation was performed. The results showed that the calibration curves of the modeling group and the validation group showed a good fit to the ideal curves (modeling group: χ2 = 7.87, P = 0.446; validation group: χ2 = 7.92, P = 0.441); the area under the ROC curve was 0.839 (95% CI: 0.795-0.883) and 0.834 (95% CI: 0.783-0.885), respectively, indicating that the prediction model had good predictive efficacy. Conclusions:Age, postoperative radiotherapy, postoperative drainage time, continuous standing time, number of lymph node dissection, whether combined with diabetes mellitus and strenuous exercise or physical labor may be the influencing factors for the incidence of postoperative lower extremity lymphedema in cervical cancer patients. The constructed nomogram model has high clinical value in evaluating the incidence risk of postoperative lower extremity lymphedema in cervical cancer patients.

Objective:To explore the value of metanephrine, normetanephrine, and some steroid hormones in the assessment of adrenal venous sampling (AVS).Methods:This retrospective study enrolled 101 patients with primary aldosteronism who underwent AVS at Peking Union Medical College Hospital between June 1, 2021, and October 1, 2024. Multiple hormones, including aldosterone, cortisol, metanephrine, normetanephrine and steroid hormone profiles, were measured in samples from the inferior vena cava and bilateral adrenal veins during AVS. Selectivity index and lateralization index were calculated based on the levels of different hormones to determine successful AVS cannulation (selectivity index≥2) and aldosterone hypersecretion lateralization (lateralization index≥2). Patients who underwent unilateral adrenalectomy were followed for at least 6 months. Clinical and biochemical outcomes were assessed according to the Primary Aldosteronism Surgical Outcome (PASO) criteria, with biochemical remission defined as achieving complete or partial biochemical remission postoperatively. The efficacy of different hormones relative to cortisol for calculating selectivity index and lateralization index was evaluated for subtype classification.Results:The age at diagnosis of the enrolled patients was (50.5±9.6) years, including 77 males. Regarding the selectivity index, five hormones including metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone, and dehydroepiandrosterone demonstrated significantly higher selectivity index compared to cortisol (all P<0.05). Based on the cortisol-derived selectivity index, AVS cannulation was unsuccessful in 8 patients; using the five indices, unsuccessful cannulation occurred in 2, 2, 3, 4, and 5 patients, respectively. Based on postoperative follow-up, 55 patients were identified as having unilateral surgically relievable primary aldosteronism. In identifying these patients, the performance of metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone, and dehydroepiandrosterone was non-inferior to cortisol, correctly identifying 95% (52/55), 93% (51/55), 91% (50/55), 87% (48/55), and 89% (49/55) of cases, respectively. However, among these patients, there were no statistically significant differences in the success rate of intubation in AVS and the ability to identify patients with unilateral primary aldosteronism between the five indicators and cortisol (all P>0.05). Using cortisol-based lateralization as the reference standard, androstenedione and dehydroepiandrosterone both achieved an accuracy of 90% (84/93) for determining the lateralized side, while 17α-hydroxypregnenolone, normetanephrine, and metanephrine achieved accuracies of 89% (83/93), 81% (74/93), and 80% (73/93), respectively. Conclusion:Metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone and dehydroepiandrosterone could increase the success rate of intubation in AVS, with a high ability to identify patients with unilateral primary aldosteronism, and are expected to replace cortisol as new indicators of AVS.

Objective:To explore the risk factors for postoperative lower extremity lymphedema in patients with cervical cancer and construct a nomogram prediction model.Methods:A retrospective case-control study was conducted. Using convenience sampling method, 750 cervical cancer patients in Ziyang People's Hospital from May 2014 to May 2022 were selected. The included patients were divided into a modeling group (525 cases) and a validation group (225 cases) according to a ratio of 7∶3. In the modeling group, patients were divided into a developing group and a non-developing group according to the incidence of postoperative lower extremity lymphedema. Self-designed baseline data questionnaire was used to collect clinical data of patients. Logistic stepwise regression analysis was used to analyze the influencing factor for the incidence of postoperative lower extremity lymphedema in cervical cancer patients. R 4.0.2 software was used to construct a nomogram model for predicting the incidence risk of postoperative lower extremity lymphedema in cervical cancer patients based on the independent risk factors. Receiver operating characteristic (ROC) curve was used to evaluate the differentiation of the nomogram prediction model. Calibration curves were drawn to evaluate the consistency of the nomogram prediction model.Results:Among 525 cervical cancer patients in the modeling group, 109 (20.76%) had postoperative lower extremity lymphedema. There were statistically significant differences in the proportions of patients with different ages, tumor stages, surgical methods, postoperative drainage time, continuous standing time, number of lymph node dissection, and with or without diabetes mellitus, postoperative chemotherapy, postoperative radiotherapy, strenuous exercise or physical labor between the developing group and the non-developing group (all P < 0.05). Multivariate logistic regression analysis showed that age ≥ 60 years old( OR = 2.548, 95% CI: 1.253-5.181), postoperative radiotherapy ( OR = 8.048, 95% CI: 3.867-16.749), postoperative drainage time ≥5 d ( OR = 2.664, 95% CI: 1.043-6.803), continuous standing time ≥ 1 h ( OR = 3.024, 95% CI: 1.252-7.305), number of lymph node dissection > 20 ( OR = 7.063, 95% CI: 1.595-31.281), comorbid diabetes mellitus ( OR = 2.617, 95% CI: 1.200-5.711), and strenuous exercise or physical labor ( OR = 3.518, 95% CI: 1.841-6.721) were all independent risk factors affecting the incidence of postoperative lower extremity lymphedema in cervical cancer patients (all P < 0.05). Based on the above risk factors, a nomogram model was established to predict the incidence risk of postoperative lower extremity lymphedema in cervical cancer patients, and internal and external validation was performed. The results showed that the calibration curves of the modeling group and the validation group showed a good fit to the ideal curves (modeling group: χ2 = 7.87, P = 0.446; validation group: χ2 = 7.92, P = 0.441); the area under the ROC curve was 0.839 (95% CI: 0.795-0.883) and 0.834 (95% CI: 0.783-0.885), respectively, indicating that the prediction model had good predictive efficacy. Conclusions:Age, postoperative radiotherapy, postoperative drainage time, continuous standing time, number of lymph node dissection, whether combined with diabetes mellitus and strenuous exercise or physical labor may be the influencing factors for the incidence of postoperative lower extremity lymphedema in cervical cancer patients. The constructed nomogram model has high clinical value in evaluating the incidence risk of postoperative lower extremity lymphedema in cervical cancer patients.

Objective:To explore the value of metanephrine, normetanephrine, and some steroid hormones in the assessment of adrenal venous sampling (AVS).Methods:This retrospective study enrolled 101 patients with primary aldosteronism who underwent AVS at Peking Union Medical College Hospital between June 1, 2021, and October 1, 2024. Multiple hormones, including aldosterone, cortisol, metanephrine, normetanephrine and steroid hormone profiles, were measured in samples from the inferior vena cava and bilateral adrenal veins during AVS. Selectivity index and lateralization index were calculated based on the levels of different hormones to determine successful AVS cannulation (selectivity index≥2) and aldosterone hypersecretion lateralization (lateralization index≥2). Patients who underwent unilateral adrenalectomy were followed for at least 6 months. Clinical and biochemical outcomes were assessed according to the Primary Aldosteronism Surgical Outcome (PASO) criteria, with biochemical remission defined as achieving complete or partial biochemical remission postoperatively. The efficacy of different hormones relative to cortisol for calculating selectivity index and lateralization index was evaluated for subtype classification.Results:The age at diagnosis of the enrolled patients was (50.5±9.6) years, including 77 males. Regarding the selectivity index, five hormones including metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone, and dehydroepiandrosterone demonstrated significantly higher selectivity index compared to cortisol (all P<0.05). Based on the cortisol-derived selectivity index, AVS cannulation was unsuccessful in 8 patients; using the five indices, unsuccessful cannulation occurred in 2, 2, 3, 4, and 5 patients, respectively. Based on postoperative follow-up, 55 patients were identified as having unilateral surgically relievable primary aldosteronism. In identifying these patients, the performance of metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone, and dehydroepiandrosterone was non-inferior to cortisol, correctly identifying 95% (52/55), 93% (51/55), 91% (50/55), 87% (48/55), and 89% (49/55) of cases, respectively. However, among these patients, there were no statistically significant differences in the success rate of intubation in AVS and the ability to identify patients with unilateral primary aldosteronism between the five indicators and cortisol (all P>0.05). Using cortisol-based lateralization as the reference standard, androstenedione and dehydroepiandrosterone both achieved an accuracy of 90% (84/93) for determining the lateralized side, while 17α-hydroxypregnenolone, normetanephrine, and metanephrine achieved accuracies of 89% (83/93), 81% (74/93), and 80% (73/93), respectively. Conclusion:Metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone and dehydroepiandrosterone could increase the success rate of intubation in AVS, with a high ability to identify patients with unilateral primary aldosteronism, and are expected to replace cortisol as new indicators of AVS.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

Purpose To explore the value of dual-layer spectral detector CT(DLSCT)in evaluating preoperative tumor staging in rectal adenocarcinoma(RA).Materials and Methods A total of 78 patients with pathologically confirmed RA in Guangdong Provincial Hospital of Chinese Medicine from May 2021 to March 2022 were involved in this retrospective study.All the patients underwent plain and dual-phase contrast-enhanced scans by DLSCT within one week before surgery.Taking pathological results as the golden standard,the accuracy rates of tumor staging were calculated and compared between the multiple-parameter maps derived from DLSCT and 120 kVp polyenergetic image.The effective atomic number(Z-eff)from plain scan,iodine concentration(IC)from arterial phase(AP)and venous phase(VP)were measured.The normalized iodine concentration(NIC)in AP and VP were calculated.The differences of Z-eff,NICAP and NICVP were compared among the pT1-2,pT3 and pT4 groups.The correlation between the pT stages and above values was assessed and the diagnostic efficiencies were analyzed.Results The overall accuracy rate(88.46%vs.67.95%;χ2=9.628,P=0.002),the pT1-2 staging accuracy rate(80.00%vs.40.00%;χ2=6.667,P=0.01),and the pT3 staging accuracy rate(88.10%vs.69.05%;χ2=4.525,P=0.033)of multiple-parameter maps derived from DLSCT were significantly higher than those of 120 kVp polyenergetic image,respectively.The Z-eff,NICAP and NICVP were significantly different among pT stage groups(F=6.456,11.029,12.698,all P<0.05)and exhibited a positive correlation with pT stages(r=0.371,0.367,0.363,all P<0.01).The areas under the curve of Z-eff,NICAP and NICVP to assess pT3-4 staging RA were 0.77,0.71 and 0.74,respectively.Conclusion The multiple-parameter maps derived from DLSCT can significantly improve the diagnostic accuracy of preoperative tumor staging of RA.Z-eff from plain scan and NIC from dual-phase helps differentiate pT1-2 from pT3-4 staging RA.

Objective To explore comparison between methotrexate and uterine arterial embolization in β-HCG, bleeding volume and success rate of women with cesarean scar pregnancy after cesarean section.Methods 42 patients who were diagnosed with cesarean scar pregnancy after cesarean section were collected.All patients were randomly divided into uterine arterial embolization group and methotrexate group,21 cases in each group corresponding treatment were given respectively, after the treatment, the serum levels of β-HCG, bleeding volume and success rate were detected in all patients.Results After treatment, compared with methotrexate group, the serum level ofβ-HCG was lower in the uterine arterial embolization group,and the difference was statistically significant(P<0.05); the bleeding volume was lower in the uterine arterial embolization group(P<0.05); the success rate was higher in the uterine arterial embolization group(P <0.05).Conclusion Compared with methotrexate,the uterine arterial embolization can significantly reduce the serum level ofβ-HCG in patients with cesarean scar pregnancy after cesarean section,reduce the amount of bleeding, improve the success rate of treatment.

Objective To evaluate the value of postoperative prophylactic radiotherapy for N0 e-sophageal squamous carcinoma. Methods From January 1993 to December 2006,859 patients with patho-logically staged N0 and M0 esophageal squamous cell carcinoma were included in this study. Among them, 760 received surgery alone, and 99 received surgery followed by postoperative radiotherapy. Radiotherapy started within 3 to 4 weeks after surgery. The median total dose was 50 Gy(2 Gy/F,5 F/w). Results In surgery alone group and postoperative radiotherapy group,the 5-yeur overall survival rotes were 72.2% vs 77.4% (X2 =0. 13,P >0.05) for all patients,34.6% vs67.1% (X2 =7.72,P <0.05) forpT4 disease,and 70.2% vs 81.3% (X2 =4.01 ,P <0.05) for tumor length >5 cm. Postoperative radiotherapy could lower the recurrence rate for pT4 patients. Conclusions For patients with NO esophageal squamous carcinoma, postoperative radiotherapy can significantly improve the survival for pT4 and tumor length > 5 cm,and also re-duce the recurrence for pT4 patients.

Objective To survey the situation of spinal cord injuries (SCI) in Beijing.Methods China Rehabilitation Research Center and Information Center of Beijing Health Bureau sponsored the surveillance of 86 hospitals in Beijing which had hospitalized SCI patients in 2002. The faculty of surveillance was composed of trained professionals. The number of registered SCI patients in 2002 was 1077, and 264 patients in 11 hospitals were chosen to be investigated in detail according to stratified sampling result.Results There were 1077 registered patients with a neurological deficit and the annual SCI incidence was 60 per million. The ratio of male to female was 3:1 and the ratio of cervical, thoracic, lumbar injuries and others is 4.9%, 28%, 66.7%, 0.4% respectively. The mean age at the time of injury was 41 years. The causes most frequently seen were falls from a height and traffic accidents. The mean time of hospitalization was 18.9 days and the mean expenditure of hospitalization was 27819.3 RMB. Four patients were transferred to rehabilitation hospitals, and others went homes directly after discharge.Conclusion There are many reasons for the high annual SCI incidence in Beijing and the first SCI cause was falling from a height, which should be pay special attention when the prevention measures are taken into account. The rate of SCI patients who received systemic medical rehabilitation was low.