Objective:To carry out the scoping review on the form, function and application effect of decision aids for breast reconstruction of breast cancer patients, so as to provide reference for domestic research on decision aids for breast reconstruction.Methods:According to the scoping review framework, literature was systematically searched on Web of Science, PubMed, Cochrane Library, Embase, Scopus, CINAHL, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc. The retrieval period was from the establishment of the database to January 19, 2024.Results:A total of 14 articles were included, including 8 randomized controlled trials (RCT), four quasi-experimental studies, one qualitative study, and one prospective cohort study. The main forms of decision aids included web-based software programs, mobile applications (APP), decision support groups, or decision support manuals. The evaluation of intervention effectiveness mainly involved indicators such as patient decision regret, decision conflict, satisfaction, acceptance, and patient-reported outcomes.Conclusions:Breast reconstruction decision aids have a certain positive impact on improving patient satisfaction, decision quality, and patient-reported outcomes, but most studies have not examined their long-term effects. The research on decision aids for breast reconstruction in China is still in its infancy. It is suggested that future research should draw on relevant foreign studies to develop and advance high quality and diversified decision aids, and promote their clinical applications.

Objective To explore the effects of military operation types on the mental health of Chinese veterans and the mediating role of psychological quality based on a dual-factor model of mental health.Methods Cross-sectional study design was adopted in this study.Self-designed demographic information questionnaire,patient health questionnaire depression module-9 item(PHQ-9),general anxiety disorder-7(GAD-7),satisfaction with life scale and psychological quality questionnaire were used to survey on 3 027 Chinese veterans.Results ① Compared to the one-factor model and the two-factor models with other indicators,the dual-factor model of mental health,with anxiety symptoms as a negative indicator and life satisfaction as a positive indicator,fitted better(Chi-square/df=8.927,GFI=0.974,AGFI=0.962,RMSEA=0.051,NNFI=0.985,IFI=0.988,CFI=0.988).②Taking the subjects who did not participate in war/non-war military operations as the reference,psychological quality showed significant relatively mediating effects between war and life satisfaction,and between war and anxiety symptoms(P＜0.05),while no such significances were observed in the corresponding ones for non-war military operations.③ War could decrease veterans'life satisfaction through full mediation of cognitive,adaptive and personality dimensions of psychological quality,and increase anxiety symptoms through partial mediation of the personality dimension of psychological quality.Conclusion The dual-factor model of mental health is applicable to Chinese veteran population,and psychological quality plays a mediating role between war and mental health.

Objective:To explore the effect of information-based health education on stress response and examination success rate of patients undergoing enhanced CT examination.Methods:A total of 1 064 patients who underwent enhanced CT examination in the First Affiliated Hospital of Zhengzhou University from March 2017 to February 2020 were selected as research objects by the convenient sampling method. A total of 554 patients who underwent enhanced CT examination from March 2017 to August 2018 were selected as the routine group and received routine health education. A total of 510 patients who underwent enhanced CT examination from September 2018 to February 2020 were selected as the information group to implement information-based health education. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to investigate patients in the two groups. The examination success rate, examination quality, physical and mental stress response and adverse reactions were compared between the two groups.Results:The success rate and quality of enhanced CT examination in the information group were higher than those in the routine group, and the differences were statistically significant ( P<0.05) . After intervention, the SAS score, SDS score, heart rate, systolic blood pressure, diastolic blood pressure in the information technology group were lower than those in the conventional group, and the differences were statistically significant ( P<0.05) . Conclusions:Information-based health education can improve the quality of enhanced CT examination, improve the success rate of examinations and reduce the incidence of physical and mental stress and adverse reactions in patients.

Chemical peeling is one of the three most common skin resurfacing techniques.Alphahydroxy acid,salicylic acid,trichloroacetic acid and Jessner's solution are common chemical peeling agents,and their action depths range from the stratum corneum to the reticular layer of the dermis.Chemical peeling has been widely applied to aesthetic dermatology,and this review mainly summarizes common chemical peeling agents and application of chemical peeling in discosmetic dermatoses,such as acne and melasma,and facial rejuvenation.

BACKGROUND: Adenocarcinoma is the most common type of lung cancer. It has been clinically evaluated that therapiestargeting against the epidermal growth factor receptor (EGFR) as the clinical standard first-line treatment. The response and outcome of EGFR-tyrosine kinase inhibitors (TKIs) in patients harboring common mutations in EGFR kinase domain (deletion in exon19 and L858R in exon 21) has been well demonstrated, but not in rare or complex mutations. METHODS: A total of 150 patients that harbored rare or complex mutations in EGFR diagnosed by histopathology were included in this retrospective study. The clinical-pathological characteristics of all 150 patients as well as the response and progression-free survival (PFS) in 48 patients that received EGFR-TKIs in first/second/third line treatments weredescribed and analyzed. RESULTS: Patients were divided into four groups based on the mutation types: single G719X point mutation in exon 18 (n=46, 30.7%), single L861Q point mutation in exon 21 (n=45, 30.0%), other single rare mutation (n=14, 9.3%) and complex mutations (n=45, 30.0%). The result indicated thatthere was no correlation of EGFR mutation typeswith other parameters such as gender, age, clinical stage, pathology and smoking history. For the 48 patients that received EGFR-TKIs treatment, there were no significant differencesamong 4 groups in terms of objective response rate (ORR) and disease control rate (DCR) (54.5% vs 30.0% vs 0.0% vs 35.7%, χ²=3.200, P=0.34; 90.9% vs 85.0% vs 66.7% vs 92.9%, χ²=2.162, P=0.59). The median progress-free survival (mPFS) was 11.0 months (95%CI: 4.4-17.6), and in each group of different EGFR mutation types are 15.8 months (95%CI: 9.5-22.2), 8.0 months (95%CI: 5.1-11.0), 4.9 months (95%CI: 1.4-8.4) and 23.1 months (95%CI: 15.8-30.4)(χ²=7.876, P=0.049). CONCLUSIONS The efficiency of targeting EGFR-TKIs on different types of rare or complex mutations was heterogeneous. The PFS may be better in patients that harbored complex mutations than those with single rare mutations. Further studies with larger sample size are necessary. Moreover, to discover novel therapeutic targets and develop new drugs are imminentfor those patientswith no response to the existing treatments.
Carcinoma, Non-Small-Cell Lung ; drug therapy ; genetics ; Disease-Free Survival ; ErbB Receptors ; antagonists & inhibitors ; genetics ; Exons ; genetics ; Female ; Humans ; Lung Neoplasms ; drug therapy ; genetics ; Male ; Middle Aged ; Mutation ; Protein Kinase Inhibitors ; pharmacology ; therapeutic use ; Retrospective Studies ; Treatment Outcome

BACKGROUND: Human epidermal growth factor receptor 2 (HER2) is one of the driver genes of non-small cell lung cancer (NSCLC). Several studies have shown that the efficacy of pemetrexed in HER2-mutant NSCLC is controversial. The aim of this study is to investigate the efficacy of pemetrexed combined with platinum chemotherapy in patients with HER2-mutant and HER2 wild-type lung adenocarcinoma. METHODS: The clinical data of 106 cases of EGFR, ALK, ROS-1, KRAS, BRAF, RET and MET-negative patients with advanced lung adenocarcinoma patients who diagnosed by histopathology in the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed. The relationships between HER2 gene status, clinical characteristics and response and progression-free survival (PFS) were analyzed. RESULTS: All of the 106 patients' HER2 status were determined. HER2 mutations occurred in 32 cases (30.2%), no mutations in 74 cases (69.8%). HER2 mutations were common in young, non-smoking and female patients. All patients received first-line pemetrexed and platinum-based chemotherapy. The objective response rate (ORR) and disease control rate (DCR) of patients with HER2-mutant lung adenocarcinoma were significantly higher than those without HER2 mutations (40.6% vs 14.9%, χ²=8.464, P=0.004; 93.8% vs 68.9%, χ²=6.327, P=0.012), and the difference was statistically significant. According to univariate analysis, the PFS was significantly associated with the brain metastases, maintenance chemotherapy and HER2 gene status (P<0.05), but not with age, gender, smoking history, oligometastases, liver metastases and type of platinum (P>0.05). Cox multivariate analysis indicated that HER2 mutation was an independent positive prognostic factor of PFS (P=0.038). CONCLUSIONS HER2-mutant lung adenocarcinoma patients with first-line pemetrexed combined with platinum chemotherapy have greater clinical benefit than HER2 wild-type patients.
Adenocarcinoma of Lung ; drug therapy ; genetics ; pathology ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Disease-Free Survival ; Female ; Genes, erbB-2 ; genetics ; Humans ; Male ; Middle Aged ; Mutation ; Pemetrexed ; therapeutic use ; Platinum ; therapeutic use ; Retrospective Studies ; Treatment Outcome

Objective: To investigate the clinicopathological characteristics, therapy and prognosis of patients with pulmonary mucoepidermoid carcinoma. Methods: The clinical data of 87 patients diagnosed as pulmonary mucoepidermoid carcinoma at The First Affiliated Hospital of Zhengzhou University from April 2011 to May 2016 were retrospectively analyzed. The clinicopathological features were summarized and the prognoses were analyzed. Results: Among the 87 patients with lung mucoepidermoid carcinoma, 53 were male and 34 were female, the gender ratio between men and women was 1.56∶1.The ages of patients were from 16 to 79 years and the median age was 52.5 years. Seventeen cases were diagnosed as stage Ⅰ, 28 cases were stage Ⅱ, 26 cases were stage Ⅲ, 16 cases were stage Ⅳ.Thirty-six patients were examined by immunohistochemistry, of which 29 cases were cytokeratin (CK) 5/6 positive, 29 cases were CK7 positive, 10 cases were CK positive, 28 cases were p63 positive, 14 cases were p40 positive, 17 cases were thyroid transcription factor-1 (TTF-1) positive, 11 cases were NapsinA positive, 2 cases were epithelial membrane antigen (EMA) positive, 4 cases were CK8/18 positive, 3 cases were surfactant proteins A (SPA) positive, 1 case was CAM5.2 positive and 1 case was CK14 positive. Among the 87 patients, 34 cases were treated by operation alone, 23 cases were treated by operation combined with chemotherapy, 5 cases were treated by radiotherapy combined with chemotherapy, 14 cases were treated by chemotherapy alone, 2 cases were treated by particle implantation combined with chemotherapy, 2 cases were treated by local radiofrequency hyperthermia combined with chemotherapy, and 7 cases without special treatment.Five patients with brain metastasis were treated with cerebral radiotherapy combined with sequential chemotherapy. The 1-year, 2-year and 5-year survival rates of 87 patients were 90.7%, 81.6% and 46.3%, respectively. The median survival time was 60 months. The prognoses of patients with lung mucoepidermoid carcinoma were related with the clinical stage, smoking and operative therapy (all P<0.05). Conclusions The age distribution of patients with pulmonary mucoepidermoid is a wide range, the incidence of male is higher than that of female. The diagnosis of pulmonary mucoepidermoid carcinoma mainly relies on the morphological diagnosis and the immunohistochemical detection is non-specific. The prognoses of patients with lung mucoepidermoid carcinoma are related with clinical stage, smoking and operative therapy. For patients who are inoperable and with single distant metastasis, local radiotherapy, other local treatment and chemotherapy can significantly improve their prognoses.

Curriculum integration and problem based learning (PBL) is the development trend of medical education all over the world,and it is an effective mode to train high-quality medical talents to meet the needs of the times and national medical and health services.However,PBL is difficult to popularize in an all-round way at present due to the large enrollment of clinical medicine major in medical colleges and universities in China.Aiming at integrating knowledge and focusing on ability,Nanjing Medical University implemented a problem-based two-way integrated case teaching after top-level design,careful trial and steady promotion and has achieved initial results and improved the clinical competency of medical students.

Objective To compare the effect of aerobic and resistance exercise on brown adipose tissues in rats.Methods Sprague-Dawley rats were randomly assigned to a control(C)group,an aerobic exercise (T) group and a resistance exercise(L)group.The rats of group T performed treadmill exercise 5 days per week for 8 weeks,while those of group L climbed vertical ladders with progressively increased weights once in 3 days for 8 weeks.All rats were weighed before and after the intervention.Then the bilateral interscapular brown adipose tissue was isolated and weighed at 48h after the last exercise.The hematoxylin-eosin staining was used to observe the morphology of adipocytes,and the quantitative real-time PCR and Western blotting were employed to detect the mRNA and protein expression of browning genes [PR-domain-containing 16 (PRDM 16),PPAR gamma coactivator-1α (PGC-1 α) and uncoupling protein 1(UCP1)] respectively.Results After the intervention,the increment of weight of group T and group L were only 52％ and 70％ of group C(P＜0.01 and P＜0.05).The weight of BAT in both group T and L was lower than group C,but without significance(P＞0.05).The average size of lipid droplets in group T decreased significantly(P＜0.01) and slightly in group L(P＞0.05) compared with group C.The PRDM16,PGC-1α and UCP1 mRNA expression of group T was 1.78(P＜0.01),2.2(P＜ 0.01) and 1.3(P＞0.05) times of group C,while that of group L was 1.30(P＞0.05),1.25(P＞0.05) and 1.21(P＞0.05) times of group C.The PRDM16,PGC-1α and UCP1 protein level in group T was 1.46-fold(P＜0.05),1.56-fold(P＞0.05)and 1.20-fold(P＞0.05),while that of group L was 1.08-fold(P＞0.05),0.94-fold(P＞0.05) and 1.20-fold(P＞0.05) of group C.Conclusion Eight weeks of aerobic exercise can significantly make the lipid droplets of adipocyte smaller,increase the differentiation and metabolic activity of BAT,and weakly stimulate BAT thermogenesis.However,8 weeks of resistance exercise has no significant effect on BAT.

Objective To investigate the effects of aerobic exercise on tau phosphorylation and PI3K/ Akt pathway in the hippocampus of obese rats,and provide some theoretical basis for physical activity improving obesity-related neurological disorders.Methods Male Sprague-Dawley rats aged 3 weeks were randomly assigned to either a high-fat or a normal diet protocol for 12 weeks.Animals submitted to the high-fat diet were further divided into two groups:a sedentary group (HF-Sed) and an exercise group (HF-Ex).The rats fed the normal diet were also divided into a sedentary group (ND-Sed)and an exercise group (ND-Ex).The rats in the HF-Ex and ND-Ex groups underwent a treadmill training for 8 weeks.Then the hippocampus was isolated at 48h after the last exercise.The protein and phosphorylation levels of tau,glycogen synthase kinase 3β (GSK3β),phosphoinositide 3-kinase (PI3K) and Akt were assayed using Western blotting.Results After 12 weeks of feeding,55％ of rats in the high-fat diet group reached the conditions for the obesity model.After 8 weeks of treadmill exercises,in the HF-Sed group the phosphorylation level of tau was significanlty higher than that in the ND-Sed group,while in the HF-Ex group that was significantly lower than the HF-Sed group.Moreover,in the HF-Sed group the phosphorylation level of GSK3β Ser9 was significantly lower,and the phosphorylation level of GSK3β Tyr216 was significantly higher than the ND-Sed group,indicating the activity of GSK3β was significantly higher than the ND-Sed group.However,after 8 weeks of treadmill exercise,in the HF-Ex group the phosphorylation level of GSK3β Ser9 was signfiicantly higher,and the phosphorylation level of GSK3β Tyr216 was signficanlty lower than the HF-Sed group,indicating significantly lower activity of GSK3β than the HF-Sed group.Then,in the HF-Sed group the protein levels of PI3K p110 and p85 subunits,and the phosphorylation levels of Akt Thr308 and Ser473 were significantly lower than those in the ND-Sed group,indicating inhibited activity of the PI3K/Akt pathway.However,in the HF-Ex group the protein levels of PI3K p110 and p85 subunits and the phosphorylation levels of Akt Thr308 and Ser473 were significanlty higher than those in the HF-Sed group,showing the activity of PI3K/Akt pathway was enhanced.Conclusion Obesity induces tau hyperphosphorylation in the rats hippocampus and long-term aerobic exercises can reduce tau hyperphosphorylation by increasing PI3K/Akt pathway activity and inhibiting GSK3β activity.It has a positive effect on delaying the formation of neurofibrillary tangles and improving obesity-related neurological disorders.