Evidence serves as the driving force shifting medical practice from empirical medicine towards evidence-based medicine. In the current era of information explosion, it is challenging for clinical surgeons to extract evidence from the vast pool of primary research literature to address clinical issues. Literature reviews, as a form of synthesized evidence, are particularly crucial for precise and efficient evidence utilization. A new form of review within the framework of evidence-based medicine, systematic reviews, also has widespread application in the surgical domain. With the development of methodological approaches in evidence-based medicine, the types of systematic reviews continue to diversify. This paper outlines and summarizes the common types and methodologies of systematic reviews in the surgical field, aiming to provide a clear framework for surgical practitioners to select evidence for both confirming and innovating clinical practices in specific clinical challenges.

Clarifying the applicability （indications or contraindications） of traditional Chinese medicine （TCM） dietary regimens to different syndromes is a guarantee for the rational application and safety of TCM dietary therapy. By considering evidence from ancient literature， modern research and experts' experience， the Grading System for Syndrome Suitability of Dietary Therapy in TCM （GRADE-SSD） has been constructed. According to the currently available highest-quality evidence， GRADE-SSD classified the applicability of TCM dietary therapy to various TCM syndromes into 2 categories and 4 grades： "definitely" applicable/contradicted （Grade A）， "very likely" applicable/contradicted （Grade B）， "possibly" applicable/contradicted （Grade C）， and insufficient evidence to determine （Grade D）. When applying， first， systematically search the currently available ancient books and clinical research evidence. For different types of evidence （ancient TCM books， randomized controlled trials， observational studies， and meta-analyses）， use the prescribed tools to evaluate the quality of the evidence， and then determine the applicability level of TCM syndromes of dietary therapy based on the principle of "taking the highest" quality. If there is a lack of direct evidence， GRADE-SSD supports a downgraded evaluation based on indirect evidence of "similar prescriptions". When there is a lack of ancient books and clinical research， the GRADE-SSD plan can evaluate the quality of evidence from peer consensus or expert opinions for the applicability level of TCM syndromes of dietary therapy. Based on the requirements for the safety of TCM dietary therapy， when there is both "applicable" and "contradicted" evidence， it should be considered as "contradicted" evidence. GRADE-SSD also provides an evidence certainty update plan based on new evidence in the future. The evaluation results of GRADE-SSD can provide a basis for setting inclusion/exclusion criteria in clinical trials of TCM dietary therapy and stating the applicability of each syndrome in the labels of dietary therapy products.

Objective:To explore the curative efficacy of tandem autologous stem cell transplantation (ASCT) for high-risk multiple myeloma (HRMM).Methods:From January 2017 to December 2021, retrospective analysis was conducted for 240 initially diagnosed HRMM patients. According to different treatment protocols after induction chemotherapy, they were further assigned into three groups of tandem ASCT (n= 20) ,single ASCT (n=80) and non-transplantation (n= 140). Rates of deep response (very good partial response and above) before and after transplantation and differences in 2-year progression-free survival (PFS) and overall survival (OS) were compared among three groups. The prognostic factors of HRMM were examined by univariate and multivariate analyses.Results:In single ASCT group, the rates of deep responses were 67.50% (54/80) after induction chemotherapy and 80.00 % (64/80) post-ASCT ( P=0.072). There were no significant statistical differences. In tandem ASCT group, the rates of deep response were 65.00% (13/20) after induction chemotherapy and 95.00 % (19/20) post-ASCT ( P=0.018). There were significant statistical differences. The 2-year PFS of tandem ASCT, single ASCT and non-transplantation groups were (75.00±2.90) %, (71.25±3.00) % and (61.43±3.10) % respectively. No statistically significant difference existed in 2-year PFS rates between single ASCT and non-transplantation groups, as well as between tandem ASCT and single ASCT groups ( P=0.365 and P=0.052). Significant difference existed in 2-year PFS between tandem ASCT and non-transplantation groups ( P<0.032). Two-year OS rates of tandem ASCT, single ASCT and non-transplantation groups were (90.00±3.50) %, (78.75±2.70) % and (62.86±2.50) % respectively. No statistically significant difference existed in 2-year OS rate between single ASCT and non-transplantation groups, as well as between tandem ASCT and single ASCT groups ( P=0.071 and P=0.057). Significant difference existed in 2-year OS between tandem ASCT and non-transplantation groups ( P=0.003). Univariate and multivariate analyses indicated that the independent prognostic factors affecting PFS were multi-hit, stages RISS-Ⅲ and failure to achieve very good partial response (VGPR) after four cycles of induction therapy and non-tandem ASCT. The independent prognostic factors affecting OS were multi-hit, stages RISS-Ⅲ and non-tandem ASCT. Conclusion:Tandem ASCT not only significantly improves the depth of remission but also further enhances 2-year PFS/OS of HRMM patients. It is a recommended treatment for HRMM.

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.

Objective:To explore the effects of Pender's health promotion model in nursing interventions for patients undergoing hematopoietic stem cell transplantation.Methods:Totally 92 patients who underwent hematopoietic stem cell transplantation at the Department of Hematology, Ningbo First Hospital from January 2018 to December 2020 were selected by convenient sampling, and divided into a control group and an intervention group according to the random number table, with 46 patients in each group. Patients in the control group received routine care, while patients in the intervention group were treated with Pender's health promotion model. The general information questionnaire, Self-Perceived Burden Scale (SPBS) , Adult Health Self-management Ability Assessment Scale, and Functional Assessment of Cancer Therapy-Bone Marrow Transplantation Scale (FACT-BMT) were used to investigate the patients and compare the differences in self-perceived burden, self-management ability, and quality of life of the two groups of patients before and after the intervention.Results:The total scores of physical burden, emotional burden, and self-perceived burden in the intervention group were lower than those in the control group; the scores of core management ability, disease-related knowledge, and self-monitoring in the intervention group were higher than those in the control group; the scores and total score of the quality of life in the intervention group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of Pender's health promotion model in patients receiving hematopoietic stem cell transplantation can reduce the patient's self-perceived burden and improve their self-management ability and quality of life, which is worth promoting in clinical practice.

Objective:To explore the effect of acceptance and commitment nursing therapy on the psychological resilience and post-traumatic growth of patients with hematopoietic stem cell transplantation.Methods:From January 2018 to December 2019, convenience sampling method was used to select 88 patients who underwent hematopoietic stem cell transplantation in Ningbo First Hospital as the research object. All patients were divided into control group and intervention group with the method of random number table, with 44 cases in each group. Control group was treated with conventional nursing care and medication, and intervention group received acceptance and commitment nursing therapy on this basis. We compared the scores of psychological resilience, post-traumatic growth and quality of life of patients between two groups before and after intervention.Results:Before intervention, there was no statistically significant difference in the total scores of psychological resilience, post-traumatic growth, quality of life and scores in each dimension between two groups ( P>0.05) . After intervention, the total scores of psychological resilience, post-traumatic growth and quality of life of intervention group were higher than those of control group, and the differences were statistically significant ( P<0.05) . Conclusions:Acceptance and commitment nursing therapy can improve the psychological resilience, post-traumatic growth and quality of life of patients with hematopoietic stem cell transplantation, which is worthy of clinical promotion.

OBJECTIVE: To explore the correlation of genetic mutations and clinical features of myelodysplastic syndromes (MDS) with scores of Revised International Prognostic Scoring System (IPSS-R). METHODS: Eighty-seven patients with de novo MDS were enrolled. Mutations of MDS-related genes and clinical features were used to determine the incidence and subtype of mutations. Clinical features and IPSS-R scores of the patients with high frequency mutations involving TET2, TP53, ASXL1, RUNX1 and SF3B1 genes were compared. RESULTS: Fifty-four patients (62.1%) harbored at least one point mutation. The incidences of various mutations were significantly different, with the incidence of MDS-EB-2 being 100% and MDS-SLD being only 38.9%. Compared with the wild types, patients harboring mutations had higher lactate dehydrogenase, higher β2 microglobulin, higher percentage of bone marrow blast cells and lower hemoglobin levels (P=0.027, <0.01, <0.01, 0.046, respectively). The IPSS-R scores of MDS patients with mutations were significantly higher than the wild types (P<0.01). The IPSS-R scores of the TP53 mutation groups were 7.82±1.83, which was significantly higher than the control group (3.77±1.66, P<0.01). No difference was found between the IPSS-R between patients carrying TET2, ASXL1, RUNX1, and SF3B1 mutations or the wild types (P>0.05). CONCLUSION Genetic mutations are commonly found in MDS. MDS patients with mutations have unique clinical laboratory characteristics. Although the prognostic value of most genes is controversial, TP53 is an definite indicator of poor prognosis.
DNA Mutational Analysis ; Humans ; Incidence ; Mutation ; Myelodysplastic Syndromes ; genetics ; Prognosis ; Tumor Suppressor Protein p53 ; genetics

The molecular mechanism of diffuse large B cell lymphoma (DLBCL) has not been fully elucidated, and epigenetics plays an important role in its development. MicroRNAs (miRNAs) are important parts of epigenetics, which are involved in the occurrence and development of DLBCL. Relevant studies have found that miRNAs can not only be used as molecular diagnostic markers of DLBCL, but also be used to judge the prognosis and treatment effect of DLBCL.

Objective: To study the expression and clinical significance of Vimentin and E-cadherin in human breast cancer tissues. Methods: : The clinical data of 56 cases of breast cancer patients, who underwent radical mastectomy in Chaohu Hospital Affiliated to Anhui Medical University from January 2014 to January 2016, were retrospectively analyzed. The protein and mRNAexpressions of Vimentin and E-cadherin in breast cancer tissues were detected by immunohistochemistry and qPCR, respectively; and the relationship between the expression of Vimentin and E-cadherin in breast cancer tissues and the clinicopathological characteristics was analyzed. Logistic multivariate regression was used to analyze the independent factors affecting the protein expressions of Vimentin and E-cadherin. Spearman was used to analyze the correlation between Vimentin and E-cadherin. Kaplan-Meier was used to analyze the relationship between protein expressions of Vimentin, E-cadherin and prognosis. ROC curve was used to analyze the diagnostic value of Vimentin and E-cadherin on prognosis. Results: The rates of breast cancer tissues with high positive expression of Vimentin and E-cadherin were 76.79% and 19.64%, respectively.Among them, 47 cases (47/56, 83.93%) of breast cancer tissues showed significantly higher Vimentin mRNA expression than adjacent tissues (P<0.05), and 46 cases (46/56, 82.14%) of breast cancer tissues showed significantly lower Ecadherin mRNA expression than adjacent tissues (P<0.05). Vimentin protein expression was associated with tumor size, lymph node metastasis, vascular invasion, histological grade, clinical stage, molecular typing, Ki67+, ER-, PR- and HER2- expression (P<0.05). And E-cadherin protein expression was associated with lymph node metastasis, vascular invasion, histological grade, clinical stage, molecular typing, Ki67+, ER-, PR- and HER2- expression (P<0.05). Tumor size, lymph node metastasis, vascular invasion, histological grading, clinical staging, molecular typing, Ki67+, ER-, PR- and HER2- expression were all independent factors affecting the expression of Vimentin and E-cadherin (P<0.05). There was a negative correlation between Vimentin and E-cadherin expression (P<0.05). The 3-year survival rate of patients with high expression of Vimentin protein was 67.44%, while that of patients with low expression of E-cadherin protein was 68.89%. Conclusion: The high expression of Vimentin and low expression of E-cadherin in breast cancer tissues may be related to the occurrence, development, invasion and metastasis of breast cancer. It can be used as a reliable indicator of clinical diagnosis and prognosis.

Objective: To explore the correlation of genetic mutations and clinical features of myelodysplastic syndromes (MDS) with scores of Revised International Prognostic Scoring System (IPSS-R). Methods: Eighty-seven patients with de novo MDS were enrolled. Mutations of MDS-related genes and clinical features were used to determine the incidence and subtype of mutations. Clinical features and IPSS-R scores of the patients with high frequency mutations involving TET2, TP53, ASXL1, RUNX1 and SF3B1 genes were compared. Results: Fifty-four patients (62.1%) harbored at least one point mutation. The incidences of various mutations were significantly different, with the incidence of MDS-EB-2 being 100% and MDS-SLD being only 38.9%. Compared with the wild types, patients harboring mutations had higher lactate dehydrogenase, higher β2 microglobulin, higher percentage of bone marrow blast cells and lower hemoglobin levels (P=0.027, <0.01, <0.01, 0.046, respectively). The IPSS-R scores of MDS patients with mutations were significantly higher than the wild types (P<0.01). The IPSS-R scores of the TP53 mutation groups were 7.82±1.83, which was significantly higher than the control group (3.77±1.66, P<0.01). No difference was found between the IPSS-R between patients carrying TET2, ASXL1, RUNX1, and SF3B1 mutations or the wild types (P>0.05). Conclusion Genetic mutations are commonly found in MDS. MDS patients with mutations have unique clinical laboratory characteristics. Although the prognostic value of most genes is controversial, TP53 is an definite indicator of poor prognosis.