Female ; Humans ; Breast Neoplasms ; Testosterone ; Prolactin ; Estradiol ; Testosterone Congeners ; China

Objective:To investigate the stability and feasibility of using absorbable screws during Bernese periacetabular osteotomy.Methods:A retrospective analysis was conducted on a 36 year-old woman diagnosed with developmental dysplasia of the hip, who had undergone Bernese periacetabular osteotomy. Finite element analysis was used to simulate the stability of the acetabulum under loads of 10%, 20%, 50%, and 100% of the patient's weight. The structural stiffness of the pelvis and the maximum equivalent stress on the absorbable screws were observed under different conditions, including whether the acetabular bone block and the ilium were in contact, whether 3 or 4 screws were used, and whether a graft (including fibular cortical bone and PEEK grafts) was used.Results:The structural stiffness of the pelvis fixed with four screws increased by 67%-94% compared to that with three screws. After using a graft, the structural stiffness of the pelvis increased by 50%-83%. As the load increased, the maximum equivalent stress on the screws also increased. When the acetabular bone block and the ilium had no contact, no graft was used, and only three screws were used for fixation, the maximum equivalent stress could reach 518.9 MPa, while this value dropped to 61% when four screws were used (318.7 MPa). When the acetabular bone block and the ilium were in contact, the maximum equivalent stress was about 12% of that when there was no contact, regardless of the number of screws used. When a cortical bone graft or a PEEK graft was used, the maximum equivalent stress could drop to 21%-26% of that without a graft. When the screw strength was 130 MPa, a load of 20% of body weight was applied, and only three screws were used without a graft, the equivalent stress could exceed the strength of the screw; if four screws were used, the equivalent stress was slightly higher than the strength of the screw when a load of 50% of body weight was applied. However, when a graft was used (either cortical bone or PEEK), even when a load of 100% of body weight was applied, the equivalent stress was slightly lower than the strength of the screw.Conclusion:Absorbable screws can provide sufficient stability for Bernese periacetabular osteotomy. The contact between the acetabular bone block and the ilium, an increase in the number of screws, and the use of grafts (cortical bone and PEEK grafts) can further improve stability. Therefore, absorbable screws have broad application prospects in Bernese periacetabular osteotomy.

Objective:To systematically retrieve, analyze and evaluate risk prediction models of postoperative urinary retention, so as to provide a basis for the application and optimization of the model.Methods:The research on the risk prediction model of postoperative urinary retention was electronically retrieved in PubMed, Web of Science, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure, WanFang Data, VIP, China Biology Medicine disc and other databases. The language of the literature was Chinese or English. The search period was from database establishment to February 20, 2023. Two researchers independently conducted literature screening and data extraction, and independently evaluated the bias risk and applicability of the included literature using the Prediction Model Risk of Bias Assessment Tool.Results:A total of 10 articles were included, including 17 risk prediction models for postoperative urinary retention. The areas under the receiver operating characteristic curve of 17 models were 0.700 to 0.920. The five most common predictors included in the model were age, gender, postoperative analgesia, diabetes, and operation time. The applicability of the model was good among the 10 studies, but there was some bias, mainly due to insufficient sample size, neglect of missing data and processing methods, overfitting issues, conversion of continuous variables into binary variables, and use of single factor screening for predictive factors.Conclusions:The risk prediction model of postoperative urinary retention has good prediction performance, but there is a certain risk of bias. The clinical value of the model needs further verification. External validation and continuous optimization are required for existing prediction models. Prospective research should also be carried out to develop a universal prediction model with good prediction performance, so as to provide an accurate and practical tool for clinical evaluation of postoperative urinary retention.

Objective:To investigate the efficacy and safety of autologous hematopoietic stem cell transplantation (ASCT) in the treatment of multiple myeloma (MM).Methods:The clinical data of 64 MM patients who received ASCT in the Second Affiliated Hospital of Xi'an Jiaotong University from October 2015 to March 2022 were retrospectively analyzed. The clinical characteristics, therapeutic effects and adverse reactions of the patients were summarized.Results:Of the 64 patients, 42 were male and 22 were female; the median age was 54 years old (37-69 years old). The median number of CD34 + cells collected from 46 patients in the CE (cyclophosphamide, etoposide) regimen mobilization group and 17 patients in the plerixafor mobilization group were 7.50×10 6/kg [(1.15-24.73)×10 6/kg] and 4.54×10 6/kg [(0.75-10.40)×10 6/kg], and the difference was statistically significant ( Z = 3.02, P = 0.024). Hematopoietic reconstitution was successful in all 64 patients, and the median time for white blood cell and platelet engraftment was 11 d (8-13 d) and 11 d (8-15 d), respectively. The patients' pretreatment regimens were all high-dose melphalan, the median white blood cell and platelet engraftment time of 29 patients in the oral group were 11 d (8-13 d) and 11 d (8-15 d), respectively, the median white blood cell and platelet engraftment time of 35 patients in the intravenous infusion group were 11 d (8-12 d) and 11 d (8-15 d), respectively, and there were no statistical differences (both P > 0.05). The ≥CR rate was 48.4% (31/64) before transplantation and 70.3% (45/64) three months after transplantation, and the difference was statistically significant ( χ2 = 6.35, P = 0.012). The median follow-up time of all patients was 27 months (2-67 months). The 3-year OS and PFS rates were 77.6% and 54.9%, and the median OS and PFS time were 67 and 52 months. The median hospitalization time was 20 d (15-37 d). There was no transplantation-related mortality, and the main adverse reactions were gastrointestinal reactions (100.0%, 64/64), grade 4 thrombocytopenia (98.4%, 63/64), grade 4 neutropenia, and agranulocytosis with fever (40.6%, 26/64). Conclusions:ASCT is effective for MM patients suitable for transplantation, which can further improve the remission rate and remission depth, prolong the PFS and OS time of patients, and the adverse reactions are controllable.

Objective:To evaluate and summarize the relevant evidence of comprehensive detumescence treatment of lower limb lymphedema in patients with gynecological malignant tumors, and to provide evidence-based basis for clinical intervention of comprehensive detumescence treatment of lymphedema.Methods:This study was an evidence - based nursing research. Databases such as BMJ Best Practice, UpToDate, PubMed, CNKI, Wanfang and other domestic and foreign databases, as well as websites such as the Australian Lymphology Society, the International Lymphedema, and the European Clinical Oncology Association were searched for relevant evidence and evaluation of comprehensive treatment of gynecological malignant tumor-related lower limb lymphedema. The search time was from the establishment of the database to April 1, 2022.Results:A total of 18 articles were included, including 2 guidelines, 5 systematic reviews, 4 expert consensus, 2 evidence summaries, 4 randomized controlled trials and 1 best practice. Twenty-eight evidence were summarized from 7 aspects : treatment cycle and edema stage, free-hand lymphatic drainage, graduated compression stockings, skin care, elastic socks, functional exercise and health education.Conclusions:The evidence summarized in this study can provide reference for clinical medical staff to formulate comprehensive treatment plans for lower limb lymphedema. Evidence-based practice should consider the individual status of patients and clinical scenarios, and provide personalized comprehensive treatment plans for patients with lower limb lymphedema of gynecological malignant tumors as soon as possible to improve the quality of life of patients.

Objective:To retrieve, obtain and summarize the best evidence for the prevention of recurrence in patients with diabetic foot, and to provide reference for clinical practice.Methods:According to the "6S" model of evidence-based resources, JBI, UpToDate, BMJ Best Practice, Cochrane Library, International Working Group on the Diabetic Foot, International Diabetes Federation, National Istitute for Health and Clinical Excellence, PubMed, EmBase, China National Knowledge Internet, Wanfang and China Biology Medicine disc were searched by computer for the prevention of recurrence of diabetic foot patients. The retrieval time limit was from the establishment of the database to April 2022. Two researchers independently evaluated the included literature and extracted the literature that met the quality standards.Results:Totally 12 articles were included at last, including 5 guidelines, 3 expert consensus and 4 Meta-analysis. From the six dimensions of the necessity and risk factors of recurrence prevention in diabetic foot patients, decompression brace prevention, surgery and wound management prevention, nutritional therapy prevention, health education and lifestyle prevention, monitoring and analysis, 18 pieces of best evidence were summarized.Conclusions:The best evidence for the prevention of recurrence of diabetic foot patients was summarized to provide evidence-based basis for management decision makers and decision implementers to prevent recurrence of diabetic foot. In the process of practice, medical workers should also fully evaluate the promoting factors and hindering factors in order to ensure that evidence can be better applied to clinical practice and serve patients.

Objective To investigate the awareness, implementation, and application of the Radiation Shielding Specification for Radiotherapy Room, Part 3: Radiotherapy Room of γ-Ray Sources (GBZ/T201.3—2014) by medical institution personnel, to collect problems and recommendations, and to provide a scientific basis for further amendments and implementation of the standard. Methods A questionnaire survey about the awareness, training and application situation and the modification advices of the standard was conducted among practitioners engaged in the production, use, and machine room design related to γ-ray source radiotherapy equipment (collectively referred to as medical institution personnel) in 12 provinces and direct-administered municipalities in China. The questionnaires were collected and a special Excel database was set up for statistical analysis using SPSS 22.0. Results A total of 126 practitioners responded and completed the questionnaire. Approximately 75.4% of respondents indicated that they either “understood” or “understood well” the standard; 42.86% received relevant training; 45.24% and 54.76% indicated that the standard “met” or “basically met” the requirements of detection of γ-ray radiotherapy equipment shielding or design of shielding room. The standard was highly evaluated for suitability. However, the awareness of the standard was inadequate, the rate of training participation was low, and its practical application was limited. Conclusion The standard generally aligns with the requirements for shielding room design in γ-ray radiotherapy. Some revisions should be done according to the current situation of γ-ray radiotherapy.

【Objective】 To observe the clinical effect of combination therapy of sacubitril valsartan and dapagliflozin in heart failure with reduced ejection fraction (HFrEF) and non-diabetes patients. 【Methods】 This study involved 96 patients with HFrEF and non-diabetes. The patients were randomly divided into control group (50 cases) and observation group (46 cases). On the basis of routine treatment, the control group was treated with sacubitril valsartan, while the observation group was treated with sacubitril valsartan and dapagliflozin. After 1-month and 6-month treatment, we monitored blood pressure, N-terminal pro brain natriuretic peptide (NT-proBNP), high sensitivity troponin T (cTnT), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left atrial diameter (LAD), left ventricular posterior wall thickness (LVPW), Minnesota soda heart failure life quality score (MLHFQ), the incidence of rehospitalization and death, and major adverse cardiovascular events (MACE) in the two groups. 【Results】 After 6 months, systolic blood pressure, cTnT, NT-proBNP, LVEDd, LVPW, and LAD of the observation group were significantly decreased compared with the control group (P<0.05), the LVEF value was significantly increased (P<0.05), and the MLHFQ and MACE incidence were significantly decreased (P<0.05). However, the two groups did not significantly differ in FBG or HbA1c (P>0.05). 【Conclusion】 The combination treatment of sacubitril valsartan and dapagliflozin on HFrEF and non-diabetes patients can significantly improve cardiac function, inhibit myocardial remodeling, reduce the incidence of MACE, and improve the prognosis.

Objective:To retrospectively analyze the prognosis and related risk factors of lymph node metastasis in early-stage (Ⅰ B-Ⅱ A) cervical cancer patients with postoperative positive lymph nodes who were treated with intensity modulated radiotherapy (IMRT). Methods:A retrospective analysis was conducted for 292 early-stage cervical cancer patients with postoperative high and/or moderate risk factors who were treated with pelvic-abdominal IMRT with/without concurrent chemotherapy in Ningxia Medical University General Hospital from January 2016 to December 2018. These patients included 239 with negative pelvic lymph nodes and 53 with positive lymph nodes, who were incorporated into the negative group and the positive group, respectively. Multivariate and univariate analyses of the risk factors of lymph node metastasis and prognosis were performed for both groups.Results:The univariate and multivariate analyses showed that the lesion ≥4 cm, deep interstitial invasion, and the number of risk factors were independent factors influencing pelvic lymph node metastasis ( χ2 = 7.11, 9.05, 90.08, P < 0.05). There was no statistically significant difference in the 3- and 5-year OS ( P>0.05) between both groups. The 3-year disease-free survival (DFS) and 5-year DFS of the negative group were 87.6% and 84.5%, respectively, and those of the positive group were 72.5% and 69.3%, respectively ( χ2=8.59, P=0.003). Regarding failure modes, distant metastasis mainly occurred in the positive group, while local recurrence was dominant in the negative group ( χ2=9.40, P<0.05). The univariate analysis of the DFS in 53 patients with postoperative positive lymph nodes showed that deep interstitial invasion affected DFS, with statistically significant differences ( χ2 = 7.25, P < 0.05). The result of the multivariate analysis showed that the lesion size >4 cm, positive residual, and deep interstitial invasion significantly influenced the DFS ( χ2 = 4.37, 4.69, 4.39, P < 0.05). Conclusions:The lesion size, deep interstitial invasion, and risk factor number were independent factors influencing lymph node metastasis, and the DFS after radiotherapy of patients with pelvic lymph node metastasis was significantly lower than the patients with negative lymph nodes. The main recurrence type of patients with lymph node metastasis was distant metastasis. Moreover, the deep interstitial invasion was independent factor affecting the DFS of early-stage cervical cancer patients with postoperative positive lymph nodes.

Objective:To retrospectively analyze the differences of survival, recurrence, acute side effects and prognostic factors between early stage (stage ⅠB-ⅡA) cervical cancer patients with intermediate risk factors receiving postoperative concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone.Methods:Clinical data of 211 patients with intermediate risk factors after early stage cervical cancer surgery admitted to Department of Radiation Oncology of General Hospital of Ningxia Medical University from January 2016 to December 2018, were retrospectively analyzed. Among them, 91 cases were assigned in the RT group and 120 cases in CCRT group. The 3- and 5-year overall survival (OS), progression-free survival (PFS), recurrence and acute side effects were compared between two groups by Chi-square test. Univariate analysis of OS and PFS was performed by Kaplan-Meier method and log-rank test was performed. Multivariate prognostic analysis was conducted by using Cox model. Results:The 3- and 5-year OS of 211 patients were 95.0% and 93.8%, respectively. The 3- and 5-year PFS were 86.8% and 83.2%, respectively. The OS of CCRT and RT group were 93.9%, 96.5% (3-year), 91.8%, 96.5% (5-year) respectively ( χ2=1.763, P=0.184), and the PFS were 84.4%, 89.9% (3-year), 79.3%, 88.3% (5-year) ( χ2=2.619 ,P=0.106), with no difference between the two groups. The total recurrence rate was 15.64%, and there was no significant difference in the recurrence rate and recurrence area between two groups ( χ2=2.623 ,P=0.105; χ2=6.745 ,P=0.080). Locoregional recurrence and lung metastasis were the main patterns of failure. Multivariate prognostic analysis showed that pathological type might significantly affect the OS ( χ2=3.849, P=0.05), and depth of invasion significantly affected the PFS ( χ2=4.095, P=0.043). The incidence of acute gastrointestinal side effect and bone marrow suppression in the CCRT group was significantly higher than that in the RT group ( χ2=56.425, 27.833; both P<0.001). Conclusions:Patients with intermediate risk factors after early cervical cancer surgery obtain high efficacy after radiotherapy. The main patterns of failure are locoregional recurrence and lung metastasis. The pathological type may be an independent prognostic factor of OS and the depth of invasion is an independent prognostic factor of PFS. Compared with RT, CCRT increases the risk of acute gastrointestinal side effects and myelosuppression, which can be tolerated. There is no significant difference in the clinical efficacy between RT and CCRT, which remains to be validated by large sample size studies.