Association between postoperative pathological results and non-sentinel nodal metastasis in breast cancer patients with sentinel lymph node-positive breast cancer.

OBJECTIVE: For patients with 1-2 positive sentinel lymph nodes (SLN) identified by biopsy, the necessity of axillary lymph node dissection (ALND) remains a matter of debate. The primary aim of this study was to investigate the association between postoperative pathological factors and non-sentinel lymph node (NSLN) metastases in Chinese patients diagnosed with sentinel node-positive breast cancer. METHODS: This research involved a total of 280 individuals with SLN-positive breast cancer. The relationship between postoperative pathological variables and non-sentinel lymph node metastases was scrutinized using univariate, multivariate, and stratified analysis. RESULTS: Among the 280 patients with a complete count of SLN positives, 126 (45.0%) exhibited NSLN metastasis. Within this group, 45 cases (35.71%) had 1 SLN positive, while 81 cases (64.29%) demonstrated more than 1 SLN positive. Multivariate logistic regression analysis revealed that HER2 expression status (OR 2.25, 95% CI 1.10-4.60, P = 0.0269), LVI (OR 6.08, 95% CI 3.31-11.14, P < 0.0001), and the number of positive SLNs (OR 4.17, 95% CI 2.35-7.42, P < 0.0001) were positively correlated with NSLNM. CONCLUSION: In our investigation, the risk variables for NSLN metastasis included LVI, HER2 expression, and the quantity of positive sentinel lymph nodes. However, further validation is imperative, including this institution, distinct institutions, and diverse patient populations.

Effect of preoperative peripheral blood platelet volume index on prognosis in patients with invasive breast cancer.

Aim: This study was designed to investigate the prognostic value of the platelet volume index in patients with invasive breast cancer (IBC). Methods: A total of 524 patients with IBC were enrolled in this study, with a median follow-up time of 6.76 years. The relationship between platelet volume indices and breast cancer prognosis was analyzed. Results: There is a strong correlation between a higher platelet distribution width-to-platelet count ratio (PDW/P) and poorer disease-free survival (DFS) in patients with IBC. The DFS rate was significantly lower among individuals with elevated PDW/P ratios compared with those with lower ratios. Conclusion: The PDW/P ratio is an independent risk factor for predicting DFS in patients with IBC.

Lymphovascular invasion is a significant risk factor for non-sentinel nodal metastasis in breast cancer patients with sentinel lymph node (SLN)-positive breast cancer: a cross-sectional study.

BACKGROUND: A connection between lymphovascular invasion and axillary lymph node metastases in breast cancer has been observed, but the findings are inconsistent and primarily based on research in Western populations. We investigated the association between lymphovascular invasion and non-sentinel lymph node (non-SLN) metastasis in breast cancer patients with sentinel lymph node (SLN) metastasis in western China. METHODS: This study comprised 280 breast cancer patients who tested positive for SLN through biopsy and subsequently underwent axillary lymph node dissection (ALND) at The People's Hospital of Guangxi Zhuang Autonomous Region between March 2013 and July 2022. We used multivariate logistic regression analyses to assess the association between clinicopathological characteristics and non-SLN metastasis. Additionally, we conducted further stratified analysis. RESULTS: Among the 280 patients with positive SLN, only 126 (45%) exhibited non-SLN metastasis. Multivariate logistic regression demonstrated that lymphovascular invasion was an independent risk factor for non-SLN in breast cancer patients with SLN metastasis (OR = 6.11; 95% CI, 3.62-10.32, p < 0.05). The stratified analysis yielded similar results. CONCLUSIONS: In individuals with invasive breast cancer and 1-2 positive sentinel lymph nodes, lymphovascular invasion is the sole risk factor for non-SLN metastases. This finding aids surgeons and oncologists in devising a plan for local axillary treatment, preventing both over- and undertreatment.

How to establishing an indicators framework for evaluating the performances in primary TB control institutions under the new TB control model? Based on a Delphi study conducted in Guangxi, China.

BACKGROUND: In China, the new TB control model of trinity form had been implemented in all parts, and the comprehensively evaluation to the performances in primary TB control institutions were closely related to the working capacity and quality of TB service, but there was still no an unified evaluation indicators framework in practice and few relevant studies. The purpose of this study was to establish an indicators framework for comprehensively evaluating the performances in primary TB control institutions under the new TB control model of trinity form in Guangxi, China. METHODS: The Delphi method was used to establish an indicators framework for comprehensively evaluating the performances in primary TB control institutions under the new TB control model of trinity form, and the analytic hierarchy process(AHP) was used to determine the weights of all levels of indicators, from September 2021 to December 2021 in Guangxi, China. RESULTS: A total of 14 experts who had at least 10 years working experience and engaged in TB prevention and control and public health management from health committee, CDC, TB designated hospitals and university of Guangxi were consulted in two rounds. The average age of the experts were (43.3 ± 7.549) years old, and the effective recovery rate of the questionnaire was 100.0%. The average value of authority coefficient of experts (Cr) in the two rounds of consultation was above 0.800. The Kendall's harmony coefficient (W) of experts' opinions on the first-level indicators, the second-level indicators and the third-level indicators were 0.786, 0.201 and 0.169, respectively, which were statistically significant (P < 0.05). Finally, an indicators framework was established, which included 2 first-level indicators, 10 second-level indicators and 37 third-level indicators. The results of analytic hierarchy process (AHP) showed that the consistency test of all levels of indicators were CI < 0.10, which indicating that the weight of each indicator was acceptable. CONCLUSION: The indicators framework established in this study was in line with the reality, had reasonable weights, and could provide a scientific evaluation tool for comprehensively evaluating the performances in primary TB control institutions under the new TB control model of trinity form in Guangxi, China.

Influence of a herbal preparation on the pharmacokinetics of highly active antiretroviral therapy drugs in rats.

Shenlin Fuzheng Capsule (SLFZC) is a herbal preparation used for HIV/AIDS in Guangxi, China. This study was designed to evaluate the influence of SLFZC on the pharmacokinetics of highly active antiretroviral therapy (HAART) drugs, zidovudine (3'-azido-3'-deoythymidine, AZT), 2',3'-dideoxy-3'-thiacytidine (3TC) and efavirenz (EFV). Thirty-six male SD rats were divided into three groups. Group A was given a combination of AZT, 3TC and EFV (AZT/3TC/EFV). Group B rats were given AZT/3TC/EFV simultaneously with SLFZC. Group C rats were given AZT/3TC/EFV 2h prior to SLFZC. Blood samples were collected at fixed time intervals. Plasma concentration of each antiretroviral drug was tested for calculation of pharmacokinetic parameters. There was significant difference among groups with respect to t1/2 for AZT (F=3.371, P<0.05), but the Student-Newman-Keuls (SNK) pairwise multiple comparison procedure showed no statistical differences in all pairwise comparisons (P>0.05). There were no significant differences among groups in terms of Cmax, T max, AUC0-12h and CL for AZT, and t1/2, Cmax, Tmax, AUC0-12h and CL for 3TC and EFV, respectively. The results indicate that SLFZC has little impact on pharmacokinetic properties of AZT, 3TC and EFV.

[A systematic evaluation on the quality of Meta-analysis in articles published in National Medical Journal of China from 1998 to 2014].

OBJECTIVE: To assess qualities on methodologies and reporting on Meta-analysis used in papers being published in National Medical Journal of China. METHODS: Computerized literature searching was performed in Wangfang Medical Online to collect articles that Meta-analysis was used in the National Medical Journal of China since January 1998 until October 2014. Manual retrieval was also conducted.Qualities on methodologies and reporting were evaluated by both Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scales. RESULTS: A total of 74 papers were included. The results on the qualities of methodology evaluation in these papers were 3 to 10 (median 7) scores, 10 articles (13.5%) were rated as high, 61 articles (82.4%) as moderate and 3 articles (4.1%) as low. No statistically significant difference existed in each year of AMSTAR score (χ(2) = 10.205, P = 0.423). The titles of AMSTAR scales with a lower coincidence rate were "Was a list of studies (included and excluded) provided?", "Was the conflict of interest stated?", "Was the status of publication (i.e.grey literature) used as an inclusion criterion?" and "Was the likelihood of publication bias assessed?". The results on the qualities of reporting evaluation in these papers were 5.5 to 26 (median 20) scores, 9 articles (12.2%) scored <15 points, 39 articles (52.7%) 15.5-21 points and 26 articles (35.1%) 21.5-27 points. There was statistically significant difference in each year of PRISMA score (F = 4.301, P = 0.000). And the year 2010 was the highest one. The titles of PRISMA scales with a lack of comprehensive reports were "Structured summary", "Objectives of introduction", "Protocol & registration", "Data collection process", "Data items", "Risk of bias in individual studies", "Risk of bias across studies", "Additional analyses", "Study selection","Risk of bias within studies", "Conclusion limitations", "Conclusions" and "Funding support" etc. CONCLUSIONS: Articles of Meta-analysis published in National Medical Journal of China have a high quality so as to provide rationales for clinical decision-making. However, both of qualities on methodology and reports sill call for continual improvements.

Synbiotic regulates gut microbiota in patients with lupus nephritis: an analysis using metagenomic and metabolome sequencing.

Objective: To investigate the changes in gut microbes and their metabolites after administering synbiotics to patients with new-onset lupus nephritis (LN) treated using a conventional method and provide a theoretical basis for finding new targets for the diagnosis and treatment of LN. Methods: In this study, a total of 12 participants were divided into the lupus and synbiotic groups. Stool samples and clinical data were collected before and after treatment for metagenomic, nontargeted metabolomic, and statistical analyses. Results: The relative abundances of the pathogenic bacteria Prevotella, Bacteroides, and Enterobacteriaceae_unclassified decreased after synbiotic treatment, whereas the abundances of Actinobacteria and Firmicutes increased. Further, the Firmicutes to Bacteroidetes ratio increased; however, the difference was not statistically significant (p > 0.05). α diversity analysis showed no significant differences in the intestinal microbial richness and diversity index of patients with LN between the groups before and after treatment (p > 0.05). ß analysis showed the differences in the community structure between the samples of the two groups before and after treatment. Linear discriminant analysis effect size and receiver operating characteristic curve analyses revealed that Negativicutes (AUC = 0.9722) and Enterobacteriaceae_unclassified (AUC = 0.9722) were the best predictors of the lupus and synbiotic groups, respectively, before and after treatment. Joint analyses revealed that amino acid biosynthesis, aminoacyl-tRNA biosynthesis, purine metabolism, and other metabolic pathways may be involved in the changes in the metabolic function of patients with LN after the addition of synbiotics. Spearman's correlation analysis revealed the interaction between clinical features and flora, and flora exhibited a complex biological network regulatory relationship. Conclusion: Synbiotics regulate the metabolic functions of intestinal microorganisms in patients with LN and play a role in various biological functions. Synbiotic supplements may be safe and promising candidates for patients with LN.

Prognostic nomogram based on pre-treatment HALP score for patients with advanced non-small cell lung cancer.

BACKGROUND: To explore the correlation of pre-treatment Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score with the prognosis of patients with advanced Non-Small Cell Lung Cancer (NSCLC) undergoing first-line conventional platinum-based chemotherapy. METHODS: In this retrospective cohort study, 203 patients with advanced NSCLC were recruited from January 2017 to December 2021. The cut-off value for the HALP score was determined by Receiver Operating Characteristic (ROC) curve analysis. The baseline characteristics and blood parameters were recorded, and the Log-rank test and Kaplan-Meier curves were applied for the survival analysis. In the univariate and multivariate analyses, the Cox regression analysis was carried out. The predictive accuracy and discriminative ability of the nomogram were determined by the Concordance index (C-index) and calibration curve and compared with a single HALP score by ROC curve analysis. RESULTS: The optimal cut-off value for the HALP score was 28.02. The lower HALP score was closely associated with poorer Progression-Free Survival (PFS) and Overall Survival (OS). The male gender and other pathological types were associated with shorter OS. Disease progression and low HALP were correlated with shorter OS and PFS. In addition, nomograms were established based on HALP scores, gender, pathology type and efficacy rating, and used to predict OS. The C-index for OS prediction was 0.7036 (95% CI 0.643 to 0.7643), which was significantly higher than the C-index of HALP at 6-, 12-, and 24-months. CONCLUSION: The HALP score is associated with the prognosis of advanced NSCLC patients receiving conventional platinum-based chemotherapy, and the nomogram established based on the HALP score has a better predictive capability for OS.

Preoperative albumin-alkaline phosphatase ratio affects the prognosis of patients undergoing hepatocellular carcinoma surgery.

BACKGROUND: The correlation between the preoperative albuminalkaline phosphatase ratio (AAPR) and the prognosis of hepatocellular carcinoma (HCC) patients after radical resection is still not comprehensive. OBJECTIVE: This study aims to observe the correlation between preoperative AAPR and the prognosis of HCC patients after radical resection. METHODS: We constructed a retrospective cohort study and included 656 HCC patients who underwent radical resection. The patients were grouped after determining an optimum AAPR cut-off value. We used the Cox proportional regression model to assess the correlation between preoperative AAPR and the prognosis of HCC patients after radical resection. RESULTS: The optimal cut-off value of AAPR for assessing the prognosis of HCC patients after radical resection was 0.52 which was acquired by using X-tile software. Kaplan-Meier analysis curves showed that a low AAPR (⩽ 0.52) had a significantly lower rate of overall survival (OS) and recurrence-free survival (RFS) (P< 0.05). Multiple Cox proportional regression showed that an AAPR > 0.52 was a protective factor for OS (HR = 0.66, 95%CI 0.45-0.97, p= 0.036) and RFS (HR = 0.70, 95% CI 0.53-0.92, p= 0.011). CONCLUSIONS: The preoperative AAPR level was related to the prognosis of HCC patients after radical resection and can be used as a routine preoperative test, which is important for early detection of high-risk patients and taking personalized adjuvant treatment.

Correlation between the triglyceride-glucose index and chronic kidney disease among adults with metabolic-associated fatty liver disease: fourteen-year follow-up.

Background and aims: According to previous studies, triglyceride-glucose (TyG) is related to chronic kidney disease (CKD), but no studies have explored the correlation between TyG and CKD among adults with metabolic dysfunction-associated fatty liver disease (MAFLD). We aimed to explore the associations of the TyG index with CKD among adults with MAFLD. Methods: In this retrospective observational cohort study, data from 11,860 participants who underwent a minimum of three health assessments between 2008 and 2015 were retrospectively collected. Participants were followed up until the final medical visit or health examination. CKD refers to an eGFR < 60 mL/min per 1·73 m2 or the occurrence of two or more incidents of proteinuria. Results: Within a median 10·02-year follow-up period, 2005 (16·9%) participants reported developing CKD. Multivariate Cox regression models indicated a noticeable correlation between the TyG index and CKD incidence (HR per unit increase, 1.19; 95% CI: 1.09-1.29) and between the TyG index and CKD incidence (HR per SD increase, 1.12; 95% CI: 1.06-1.18). The CKD incidence increased by 1.8 times in participants in the highest TyG index quartile relative to patients in the lowest quartile of the TyG index quartile (HR 1·18, 95% CI: 1.01-1.38, P = 0.007). According to subgroup analysis, an elevated TyG index is likely to become more harmful to participants younger than 60 years (P for interaction = 0.035). Conclusion: An elevated TyG index may increase CKD incidence among MAFLD adults, particularly among younger people. Early intervention may help reduce the incidence of CKD.

[Relationship between pre-exposure prophylaxis and HIV infection: a meta-analysis].

OBJECTIVE: To evaluate the effect on pre-exposure prophylaxis (PrEP) to prevent HIV infection in high risk populations. METHODS: A computerized literature searching had been carried out in PubMed, EMbase, Ovid, Web of Science, Science Direct, Wanfang, Tsinghua Tongfang database and related websites to collect relevant papers (from establishment to June 2012) with the key words of pre-exposure prophylaxis, HIV, AIDS, high risk populations, relative risk, reduction. All randomized controlled trials (RCT) papers about using single or compound antiretroviral drugs (ARVs) orally or topically before HIV exposure or during HIV exposure in high risk populations were enrolled. Meta-analysis was conducted using Stata 10.0 to calculate the pooled RR value (95%CI). Consistency test was performed and publication bias was evaluated. RESULTS: Finally 5 RCT papers were enrolled, including 10 271 persons who were at high risk of HIV infection. The number of the experimental group was 5929, among which 116(1.96%) became infected. The number of the control group was 4342, among which 201(4.63%) became infected. Meta-analysis showed that the pooled relative risk (RR) and 95%CI was 0.49 (0.39 - 0.61), P < 0.05, indicating that the persons in experimental group had a 0.49 times lower risk of HIV infected, as compared with the control group. Publication bias analysis revealed a symmetry funnel plot. The fail-safe number was 825. CONCLUSION: PrEP was an effective and safe protection measure to reduce HIV infection in high risk populations.

Metabolic dysfunction-associated fatty liver disease can significantly increase the risk of chronic kidney disease in adults with type 2 diabetes.

AIMS: This study is to explore the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD) among populations with type 2 diabetes through longitudinal cohort study. METHODS: 3,627 subjects who had received at least three health examinations between 2008 and 2015 were included. CKD was stated as subjects with an eGFR < 60 mL/min per 1·73 m2 or the occurrence of 2 or more proteinuria during their follow-up. RESULTS: After median of 10·0 years follow up, 837 (23·1%) developed CKD (244·7 per 10,000 person-years; 95 % CI, 228.4 - 261·8). MAFLD ([HR] 1·46; 95 % CI 1·26-1·70, P < 0.001) acts as an important risk factor of developing CKD. After adjusting for confounding factors, this association was consistent (HR 1·30; 95 % CI 1·11-1·53, P < 0.001). In stratified analysis, subjects aged < 60 years were likely to have greater risk of MAFLD-related CKD (HR 1·58 and 1·03; 95 % CI 1·28-1·95 and 0·79-1·33, P < 0.001 in both cases, respectively). CONCLUSIONS: The risk of developing CKD in type 2 diabetes adults with MAFLD was higher, especially if they are below 60 years old. This study underscores the importance of early prevention strategies for MAFLD to reduce the occurrence of CKD in type 2 diabetes adults.

The Role of Metabolic Dysfunction-Associated Fatty Liver Disease in Developing Chronic Kidney Disease: Longitudinal Cohort Study.

BACKGROUND: The association between metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD) is unclear. OBJECTIVE: This longitudinal cohort study aimed to test whether MAFLD plays an important role in the development of CKD. METHODS: This cohort study included 41,246 participants who had undergone 3 or more health examinations from 2008 to 2015 at the People's Hospital of Guangxi Zhuang Autonomous Region, China. Participants were categorized into 2 groups according to whether they presented with or without MAFLD. The occurrence of new-onset CKD was stated as either an estimated glomerular filtration rate of <60 mL/min per 1.73 m2 or a higher level of albuminuria during their follow-up appointment. The association between MAFLD and CKD was evaluated using a Cox regression method. RESULTS: Of the 41,246 participants, 11,860 (28.8%) were diagnosed with MAFLD. Over the course of the 14-year follow-up (median 10.0 years), 5347 (13%) participants experienced a new incident of CKD (135.73 per 10,000 person-years). MAFLD was discovered as an important risk factor for new incidents of CKD (hazard ratio 1.18, 95% CI 1.11-1.26) by using the multivariable Cox proportional hazard regression model. When stratified by gender, the adjusted hazard ratio for the incidence of CKD in men and women with MAFLD were 1.16 (95% CI 1.07-1.26) and 1.32 (95% CI 1.18-1.48), respectively. According to the subgroup analysis results, after adjusting for confounding factors, the MAFLD-related CKD risk was greater in men aged <60 years (Pinteraction=.001) and in those with combined dyslipidemia (Pinteraction=.02), but this relationship was not found in women (all Pinteraction>.05). CONCLUSIONS: MAFLD plays an important role in the development of new incidents of CKD in the long run. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200058543; https://www.chictr.org.cn/showproj.html?proj=153109.

The relationship between metabolic dysfunction-associated fatty liver disease and the incidence rate of extrahepatic cancer.

Background: The associations between metabolic dysfunction-associated fatty liver disease (MAFLD) and cancer development, especially extrahepatic cancers, are unknown. The aims of the current study were to investigate the cancer incidence rates of MAFLD and analyze the associations between MAFLD and the development of cancers. Methods: This historical cohort study included participants who underwent ultrasonographic detection of hepatic steatosis at a tertiary hospital in China from January 2013 to October 2021. MAFLD was diagnosed in accordance with The International Expert Consensus Statement. Cox proportional hazards regression modeling was used to assess the associations between MAFLD and the development of cancers. Results: Of the 47,801 participants, 16,093 (33.7%) had MAFLD. During the total follow-up of 175,137 person-years (median 3.3 years), the cancer incidence rate in the MAFLD group was higher than that in the non-MAFLD group [473.5 vs. 255.1 per 100,000 person-years; incidence rate ratio 1.86; 95% confidence interval (CI) 1.57-2.19]. After adjustment for age, gender, smoking status, and alcohol status, MAFLD was moderately associated with cancers of the female reproductive system/organs (labium, uterus, cervix, and ovary) [hazard ratio (HR) 2.24; 95% CI 1.09-4.60], thyroid (HR 3.64; 95% CI 1.82-7.30), and bladder (HR 4.19; 95% CI 1.15-15.27) in the total study cohort. Conclusion: MAFLD was associated with the development of cancers of the female reproductive system/organs (labium, uterus, cervix, and ovary), thyroid, and bladder in the total study cohort.

Sex Differences in the Impact of Metabolic Dysfunction-associated Fatty Liver Disease on the of Patients with Hepatocellular Carcinoma After Radical Resection.

Background: International experts have put forward a new definition for metabolic dysfunction-associated fatty liver disease (MAFLD). Nonetheless, sex differences in MAFLD function in hepatocellular carcinoma (HCC) survival is still unknown. Therefore, the current work focused on exploring the gender-specific association of MAFLD effect on prognosis after radical resection of liver cancer. Methods: The long-term prognostic outcomes of 642 HCC patients undergoing hepatectomy were analyzed retrospectively. To calculate overall survival (OS) and recurrence-free survival (RFS), Kaplan-Meier (KM) curve was plotted. Further, using Cox proportional model to explore the prognostic factors. Sensitivity analysis was performed using propensity score matching (PSM) to balance the confounding bias. Results: For MAFLD patients, median OS and RFS times were 6.8 years and 6.1 years, respectively, compared to 8.5 years and 2.9 years in non-MAFLD patients. KM curve shown that compare with non-MAFLD patients, MAFLD patients had a higher survival rate in men, but had a lower survival rate in women (P<0.05). Multivariate analysis showed that MAFLD was significantly risk factor with mortality in the female (HR = 5.177, 95%CI: 1.475-18.193). However, MAFLD was not related to RFS This correlation was consistent after PSM analysis. Conclusions: MAFLD can improve the mortality of women undergoing radical resection for liver cancer, which independently estimate disease prognosis but is not related to recurrence-free survival.

The relationship between women's body mass index and breast cancer outcomes was U-shaped.

Background: Several studies have analyzed the relationship between body mass index (BMI) and the prognosis of breast cancer (BC). However, whether their relationship is linear or curvilinear remains unclear. This cohort study examined the specific relationship between BMI and BC outcomes. Methods: This retrospective cohort study included 1049 BC patients from March 7, 2013 through December 31, 2019 in a hospital. Kaplan-Meier curves, multivariate Cox proportional models, and restricted cubic spline (RCS) was used to analysis the relationship between BMI and overall survival (OS) and breast cancer-specific survival (BCSS) was analyzed. Results: During a median of 4.87 (IQR:3.26-6.84) years of follow-up period, 71 patients (6.77%) died, of which 50 (70.42%) were attributed to BC. RCS analysis revealed a U- shaped relationship between BMI levels and OS and BCSS after adjusting for other variables. The turning points of the U-shaped curves were 23 kg/m2. On the left side of the turning point, the risk of OS (HR, 0.83; 95% CI, 0.70, 0.98) and BCSS (HR, 0.80; 95% CI, 0.65, 0.98) were adversely correlated with BMI. In contrast, to the right of the turning point, the risk of OS (HR, 1.22; 95% CI, 1.10, 1.37) and BCSS (HR, 1.28; 95% CI, 1.13, 1.46) was positively related to BMI. Kaplan-Meier curves and multivariate Cox regression analyses shown consistent results with RCS analyses. Conclusion: BMI was an independent prognostic factor for BC, and had a U-shaped relationship with OS and BCSS. Interventions should be designed to improve patient outcomes based on BMI.

Age has a U-shaped relationship with breast cancer outcomes in women: a cohort study.

Background and Objectives: Age is a significant determinant of susceptibility to breast cancer. Currently, the available evidence regarding the non-linear correlation between the age of diagnosis and the prognosis of breast cancer patients is contradictory. Insufficient data currently exist regarding the influence of age at diagnosis on the prognosis of breast cancer. The objective of our investigation was to examine the relationship between age at diagnosis and overall survival (OS), breast cancer-specific survival (BCSS), and disease-free survival (DFS). Methods: This retrospective cohort study included 1054 patients diagnosed with breast cancer between March 7, 2013 and December 31, 2019. The hazard ratios (HRs) and 95% confidence interval (CI) for OS, BCSS, DFS were assessed using Cox proportional hazard ratio models and restricted cubic splines (RCS). Results: The study included 1054 breast cancer patients who met the criteria. With a median follow-up of 4.86 years, 71 patients (6.74%) died and 144 patients (13.66%) relapsed. After multivariable adjustment, age showed a U-shaped association with OS, BCSS, and DFS, with significantly higher risk at two ends, with age inflection points of 44, 44, and 41 years for OS, BCSS, and DFS, respectively. For OS, Quartile 1 (HR, 2.09; 95% CI: 0.90-4.84), Quartile 3 (HR, 2.44; 95% CI: 1.05-5.65) and Quartile 4 (HR, 3.38; 95% CI: 1.51-7.54) had poorer OS compared with Quartile 2. Similar results were found for BCSS and DFS. Conclusions: This study confirmed a U-shaped association between age at diagnosis and breast cancer outcome.

[Benefits of promoting male circumcision among the general population in the high HIV prevalence areas of Guangxi Province].

OBJECTIVE: To evaluate the effect of promoting male circumcision among the general population in the high HIV prevalence areas of Guangxi Province. METHODS: We interviewed 590 male residents from Hezhou and Qinzhou areas of Guangxi Province and conducted intervention using male circumcision promotion materials and various methods. If the subjects were willing and had no contraindication, they were referred to the appointed hospitals to receive circumcision. We conducted follow-up visits at 6 and 9 months after intervention for the changes in the subjects' knowledge, attitude and practice related to male circumcision. RESULTS: The male circumcision knowledge, willingness and operation rate were significantly improved after intervention (P < 0.05), but with no significant difference between the two follow-up visits (P > 0.05). The number of those who knew that phimosis and redundant prepuce were the reasons for circumcision increased from 66.1% at baseline to 81.9% and 79.8% at the two follow-up visits; those who knew that circumcision could prevent AIDS and sexually transmitted diseases increased from 28.0% to 77.4% and 78.6%; those who knew that surgical complications could be pain, bleeding and infection increased from 29.5%, 19.3% and 39.3% to 72.5%, 58.2% and 59.4% at the first follow-up and 75.0%, 57.0% and 63.0% at the second; those who were willing to receive circumcision increased from 35.3% at baseline to 59.6% and 61.3% at the two follow-up visits; and the rate of surgery increased from zero to 12.7% and 16.1%. CONCLUSION: The promotion of male circumcision among the general population in the high HIV prevalence areas of Guangxi Province significantly improved their knowledge, attitude and practice related to AIDS prevention. And the promotion activities should focus on the publicity of AIDS knowledge, risks of phimosis and redundant prepuce, and safety of circumcision.

How to Optimize Tuberculosis Health Education in College Under the New Situation? Based on a Cross-Sectional Study Among Freshmen of a Medical College in Guangxi, China.

Background: China is a country with a high burden of tuberculosis (TB), and students are the high-risk group for TB. The enrollment scale of colleges has increased dramatically due to the advancement of the enrollment expansion system of Chinese colleges. Consequently, this has brought severe challenges to TB prevention and control in colleges. In 2017, a new TB control guide for schools was issued in China, which included the 8 core knowledge of TB. The target of the overall awareness rate on TB among population was "≥85%," which was proposed by the "13th Five-Year" National TB Control Plan in China. The cognition of the 8 core knowledge of TB in the new guide among college students is crucial to achieve this target, but few studies on this have been reported. Based on the abovementioned new situation and the new guide, this study aimed to investigate and analyze the cognition, attitudes, and health education needs on TB among freshmen of a medical college in Guangxi province, and discuss how to optimize TB health education in colleges in China. Methods: A cross-sectional study was conducted among freshmen of a medical college in Guangxi, China. A self-designed questionnaire was used to conduct an on-site questionnaire survey. The data was entered in Epidata 4.4.2.1 and was analyzed using SPSS version 25.0. Including descriptive statistics and t-test, and the criterion for statistically significant difference was p < 0.05. Results: A total of 583 freshmen responded to the survey questionnaires. Regarding cognition about the 5 related knowledge of TB, 551 (94.5%) freshmen knew about the predilection site of TB, while 333 (57.1%), 328 (56.4%), 257 (44.1%), and 201 (34.5%) freshmen knew about the pathogen, the policies about free treatment, the designated hospitals, and the World TB Day, respectively. Regarding cognition on the 8 core knowledge of TB, the overall awareness rate among the freshmen is 73.3%(3,420/4,664); the awareness rate of the knowledge that "guarantee adequate sleep, reasonable diet, and strengthen physical exercise can reduce the incidence of TB" among them was the highest at 88.7% (517/583); and the awareness rate of the knowledge that "coughing or sputum expectoration occurred for more than 2 weeks should be suspected of infecting TB and seeking medical treatment in time" among them was the lowest at 47.5% (277/583). Whether students received health education on TB (T = 4.267, p = 0.000) and whether students heard of TB (T = 3.739, p = 0.000) are the main factors of cognition. Five hundred sixty-two (96.4%) and 565 (96.9%) freshmen were willing to learn and tell others about the knowledge of TB, respectively. Three hundred seventy (63.5%.) freshmen, the highest amount, were willing to accept TB health education in the forms of "website, Weibo, and WeChat." Conclusion: The cognition on the 5 related knowledge of TB among freshmen is unbalanced, and the overall awareness rate of the 8 core knowledge of TB among freshmen still needs to be improved. Freshmen who have not heard of TB and have not received TB health education before enrollment are the key intervention groups. It is recommended that institutions make full use of modern multimedia technology, continuously optimize the health education forms, implement precise policies, and strengthen the theoretical and practical health education on TB from the initial entry of freshmen into colleges.

Associations of Estimated Glomerular Filtration Rate with All-Cause Mortality and Cardiovascular Mortality in Patients with Diabetic Foot Osteomyelitis.

AIM: The purpose of this study was to explore the association between estimated glomerular filtration rate (eGFR) and clinical outcomes in patients with diabetic foot osteomyelitis (DFO). METHODS: This was a retrospective observational study. A total of 199 patients with DFO were recruited and divided into three groups by eGFR: normal kidney function group (eGFR ≥ 90), mildly decreased kidney function group (eGFR 60-89) and moderately to severely decreased kidney function group (eGFR < 60). The patients were followed-up for a median of 36 months, and the study outcomes were all-cause mortality and major cardiovascular adverse events (MACE). Cox proportional hazard models were used to assess the association between eGFR and the outcomes, and a stratified analysis by sex was conducted. RESULTS: During follow-up, all-cause mortality occurred in 51 (25.63%) patients among 199 participants, 54 (28.72%) had MACE in 188 participants and 26 (48.15%) of them died. After fully adjusting for potential confounders, compared to eGFR < 90 mL/min/1.73 m2, eGFR ≥ 90 mL/min/1.73 m2 had lower incidence of all-cause mortality (HR = 0.43, 95% CI: 0.22-0.85; P = 0.015) and MACE (HR = 0.51, 95% CI: 0.27-0.96; P = 0.038). Additionally, compared to eGFR < 90 mL/min/1.73 m2, eGFR ≥ 90 mL/min/1.73 m2 was independently associated with decreased risk of all-cause mortality (HR = 0.33; 95% CI 0.14-0.76, P = 0.010) and MACE (HR = 0.27; 95% CI 0.11-0.65, P = 0.004) in male, but not in female. CONCLUSION: In conclusion, decreased eGFR is a risk factor for all-cause mortality and MACE in individuals with DFO. Additionally, male with decreased eGFR had a higher risk of all-cause mortality and MACE, but female did not.