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.

Objective To describe the epidemiological characteristics, investigation and treatment process of the first monkeypox cluster outbreak in Wuhan, and to provide reference for the prevention and control of monkeypox cluster outbreak in the future. Methods Field epidemiological investigation was conducted on the cases, and throat swabs, anal swabs, shingles fluid, whole blood, and serum samples were collected from the cases. Subsequently, real-time fluorescence quantitative polymerase chain reaction was employed for the detection of monkeypox virus nucleic acid and subsequent gene sequencing. Results Two cases had a high-risk exposure behavior in a hotel in Wuhan on June 2, 2023. The first case exhibited the emergence of beige papules on June 5 and sought medical treatment at a tertiary hospital in Wuhan on June 11. The Chinese Center for Disease Control and Prevention conducted tests on herpes fluid samples, which yielded positive results for the presence of monkeypox virus nucleic acid. Genetic sequencing analysis revealed that the infecting strain of the monkeypox virus in this case belonged to the West African clade B.1. Conclusion Based on epidemiological investigation and laboratory results, this monkeypox cluster outbreak may be caused by latent men with men sexual transmission. Monkeypox has the risk of both overseas importation and local transmission in our country. It is very necessary to detect, report and deal with monkeypox outbreak early.

In recent years， the potential anti-tumor effects of metformin have attracted widespread attention in the field of cancer treatment. This article summarizes the research progress of metformin in the treatment of malignant tumors，finding its potential application in the treatment of malignant tumors in the digestive system （biliary tract cancer，gastric cancer，esophagus cancer，colorectal cancer，pancreatic cancer，liver cancer） and reproductive system （prostate cancer，ovarian cancer，breast cancer， cervical cancer），non-small cell lung cancer，renal cell carcinoma，and melanoma. Metformin can inhibit the proliferation of tumor cells and extend the overall survival of patients. Its mechanisms of action include，but are not limited to，inhibiting the activity of mitochondrial complex Ⅰ，activating adenosine monophosphate-activated protein kinase/p53 signaling pathway，and blocking the cell cycle. Additionally，the combined use of metformin with chemotherapy drugs has shown potential for reducing toxicity and enhancing efficacy. It can enhance the sensitivity of biliary tract cancer，ovarian cancer，and melanoma cells to chemotherapy drugs， improve the drug resistance of gastric and colorectal cancer cells to chemotherapy，and reduce the toxic reactions of breast cancer patients during chemotherapy. Metformin is also used as an immunomodulator，applied in the immunotherapy of patients with esophagus cancer，colorectal cancer，cervical cancer，non-small cell lung cancer，and melanoma.

Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.

Objective:To investigate the related factors of pleasure loss in patients with human immunodefi-ciency virus(HIV)/acquired immune deficiency syndrome(AIDS).Methods:Totally 237 patients with HIV/AIDS from a certain infectious disease hospital were selected and surveyed with a self-designed general information ques-tionnaire,the Temporal Pleasure Experience Scale(TEPS),Self Acceptance Scale(SAQ),Discrimination Percep-tion Scale(SIS),and Perceived Social Support Scale(PSSS).Results:The patient's TEPS score was(73.4±16.1).Stepwise linear regression analysis showed that the PSSS total scores,education level,and personal monthly income were positively correlated with the TEPS total scores(β=0.41,5.17,4.63),and age was negatively corre-lated with the TEPS total scores(β=-0.30).Conclusion:It suggests that more attention should be paid to the lack of pleasure in patients with HIV/AIDS,and the lack of pleasure is related to personal monthly income,educa-tion level,age and perceived social support.

Objective:To explore the chain mediating effect of subjective well-being and coping style between disease cognition and self care in elderly patients with major depression. To provide suggestions for establishing nursing plans for elderly patients with major depression.Methods:This was a cross-sectional study. Two hundred and fourteen elderly patients with major depression admitted to the Department of Psychiatry of the General Hospital of the Northern Theater Command of the People ′s Liberation Army of China between February 2020 and December 2021 were selected as study subjects by convenience sampling. The patients were tested with Self-rating Depression Scale, the Brief Illness Perception Questionnaire, Appraisal of Self-care Agency Scale-revised, General Well-being, and Trait Coping Style Questionnaire. Correlation tests were performed with Pearson's correlation analysis; the median effect test was performed with the bias-corrected percentile Bootstrap method. Results:Disease cognition scores were negatively correlated with subjective well-being, positive coping, and self care scores ( r=-0.25, -0.34, -0.51, all P<0.05), but positively correlated with negative coping scores ( r=0.28, P<0.05). Disease cognition had a significant direct predictive effect on self care ( β=-0.12, P<0.05); disease cognition directly predicted subjective well-being, positive coping and negative coping ( β=-0.42, -0.15, 0.16, all P<0.05); subjective well-being directly predicted positive coping, negative coping and self care ( β=0.23, -0.19, 0.26, all P<0.05); positive coping and negative coping directly predicted self care ( β=0.40, -0.32, both P<0.05). The mediating effect value of subjective well-being accounted for 33.12% of the total effect. The mediating effect of positive coping accounted for 14.09% of the total effect. The mediating effect of negative coping accounted for 13.35% of the total effect. The mediating effect between subjective well-being and positive coping accounted for 10.12% of the total effect.The mediating effect between subjective well-being and negative coping accounted for 8.37% of the total effect. Conclusions:The disease cognition of elderly patients with major depression can not only directly affect self-care, but also indirectly affect self care through the mediating effect of subjective well-being, coping style, and the chain mediating effect of subjective well-being→coping style.

Objective:To study the early use of inhaled nitric oxide (iNO) as a rescue therapy in extremely premature infants (EPIs) with refractory hypoxic respiratory failure (HRF).Methods:Between January 2021 and December 2021, EPIs with refractory HRF receiving iNO within the first week of life in our NICU were enrolled. Their clinical characteristics and outcomes were retrospectively analyzed.Results:A total of 11 EPIs were included with 5 males and 6 females. The median gestational age (GA) was 24(22.6, 25.2) weeks. The median birth weight (BW) was 580(490, 770) g. The most common primary diagnoses were moderate/severe respiratory distress syndrome (RDS) (5/11) and early-onset sepsis (3/11). The median age starting iNO therapy was 6.5(4.5, 34.0)h and the median duration of iNO was 24(12, 36)h. The median iNO starting dose was 5(5, 8) ppm and the therapeutic range was 5-20 ppm. Therapeutic efficacy was defined as ≥30% FiO 2 reduction after 6 h of iNO treatment. The treatment was effective in 8 cases. The oxygenation index (OI) decreased more than 10% from baseline 1 h after initiation in 9 patients and in all 11 patients after 12 h of iNO. The reduction of OI was more prominent in EPIs with a higher OI at baseline. Of the 11 patients, 8 survived, 1 died and 2 abandoned further treatments. Conclusions:As an early rescue therapy for EPIs with refractory HRF, iNO can improve oxygenation without obvious short-term adverse effects.

Objective:To study the epidemiological characteristics and pathogen status of infection of patients with herpetic pharyngitis in eastern region of Chengdu in 2022, in order to provide experimental basis for scientific prevention and control of herpetic pharyngitis.Methods:Information and fecal specimens were collected from patients diagnosed with herpetic angina at sentinel monitoring hospitals in eastern region of Chengdu from January to December 2022, their epidemiological characteristics were analyzed, real-time fluorescence quantitative PCR (RT-PCR) and semi nested RT-PCR (RT-snPCR) were used to detect and identify enterovirus subtypes.Results:Among the 236 cases of herpetic angina, the age of the affected children was mainly 0-9 years (99.15%), with children aged below 3 years accounting for 75.85% of the total cases, children in the 1-year-old group had the highest constituent ratio, accounting for 47.88% of the total cases; The virus detection rate in the 2-year-old group was higher than that in the 0-year-old group ( χ2=5.945, P=0.015). There were 142 male infected cases (60.17%) and 94 female cases (39.83%); there was a statistically significant difference in the virus detection rate between the male group (91.55%) and the female group (78.72%) ( χ2=7.938, P=0.005). In the seasonal distribution, the summer group had the highest constituent ratio (40.25%), while the winter group had the lowest constituent ratio (11.86%), The composition ratio of the summer group was significantly higher than that of the other groups, and the differences were statistically significant ( χ2=10.393, 19.199, 49.358, all P<0.001). The virus detection rate in the summer group was significantly higher than that in the spring group and the winter group ( χ2=16.951, 4.592, both P<0.05). The RT-PCR result showed that a total of 204 out of 236 children with herpetic angina were virus positive, with a detection rate of 86.44% (204/236), including coxsackievirus A (CV-A) 6 (22.55%), CV-A16 (5.88%), CV-A2 (2.94%), enterovirus type A71 (EV-A71) (2.94%), and other enteroviruses (65.69%). The RT-snPCR result showed that five viruses were identified from other enteroviruses, including CV-A4 (8.33%), CV-A5 (6.86%), CV-A10 (12.25%), CV-A12 (24.02%), and coxsackievirus B3 (CV-B3) (6.86%); another 15 positive samples of enterovirus were not successfully classified. We selected 9 strains of the virus in this study and 30 reference sequences from the NCBI database to. Conclusions:Herpetic angina in eastern region of Chengdu in 2022 is mainly found in male children under 3 years of age, and was concentrated between April and June. It has been confirmed that CV-A12 and CV-A6 were more common in intestinal viruses, and the 9 strains isolated in this study were homologous to multiple isolates.

Objective:To analyze the cases referred to a higher-level hospital from the Department of Neonatology in a primary hospital, and evaluate the efficiency of clinical works related to the referrals.Methods:Data of neonates admitted to the Department of Neonatology at Maternal and Child Health Hospital of Dabu County from January 2018 to December 2020 and referred to the superior hospital were retrospectively analyzed.Results:A total of 1 670 neonates were included and 128 neonates were referred.The median age of the neonates referred was 0.5 hours(0 hours, 25 days), the median gestational age was 38 + 3(29 + 1, 42 + 4) weeks, the median weight was 3 000(1 250, 4 800) g, and the transport distance was 78 km.Twenty-four cases were assessed as critical cases before the referral, 125 cases were improved and discharged after treatment in the superior hospital, and three cases died.The referral rate in 2018, 2019 and 2020 showed a downward trend year by year (10.3%, 7.6% and 4.0%, respectively), and the difference was statistically significant( χ2=14.362, P=0.001). The proportion of critical cases in referral cases increased year by year (9.4%, 23.9% and 38.9%, respectively), and the difference was statistically significant( χ2=9.289, P=0.010). The incidence of critical case was higher in those whose mothers didn′t have regular prenatal examination during pregnancy( χ2=5.129, P=0.032). Conclusion:The ability of neonatal treatment in primary hospitals has been improved.The neonates need to be referred and critical cases are not rare in primary hospitals.More attention should be paid to the safety and effectiveness of the regional transport network.Also, enhancing the health awareness of residents and improving the primary medical technics are important to maximize the life safety and optimal transition of newborns.

Objective:To study the effects of breastfeeding within 2 weeks after birth on late-onset sepsis in very low birth weight infants (VLBWI).Methods:From July 2018 to June 2019, clinical data of VLBWI (birth weight <1 500 g) born in our hospital were retrospectively reviewed. According to the proportion of breastfeeding volume in total feeding volume within 2 weeks after birth, the infants were assigned into high-proportion breastfeeding group (breastfeeding >50%), low-proportion breastfeeding group (breastfeeding ≤50%) and formula group. The incidences of late-onset sepsis among the three groups were compared using the chi-square test or Fisher's exact probability method. Logistic regression was used to analyze the effects of breastfeeding within 2 weeks after birth on late-onset sepsis.Results:The incidences of late sepsis in high-proportion breastfeeding group, low-proportion breastfeeding group and formula group were 0.4% (1/216), 8.1% (5/62) and 8.0% (2/25), respectively ( P<0.001). Logistic regression analysis showed that compared with the high-proportion breastfeeding group, the low-proportion breastfeeding group ( OR=17.844, 95% CI 2.005~158.775) and the formula group ( OR=23.261, 95% CI 1.916~282.350) had increased risks of late-onset sepsis. Conclusions:For VLBWI, high proportion breastfeeding (breastfeeding >50%) within 2 weeks after birth may reduce the risk of late-onset sepsis.