Objective:Analyze risk factors for unplanned removal of totally implantable venous access ports (TIVAP) in breast cancer patients and develop a machine learning prediction model. Methods:A single-center, retrospective study was conducted, including breast cancer patients(n=1,258) who underwent TIVAP removal at the Department of Breast and Thyroid Surgery of a tertiary hospital in Chongqing between October 2013 and March 2023.Variable screening was performed using univariate logistic regression and the Least Absolute Shrinkage and Selection Operator (LASSO) method to identify potential risk factors. The variables selected through this process were then incorporated into a multivariate logistic regression for further analysis. The dataset was randomly split into a training set (n=881) and a validation set (n=377) in a 7:3 ratio. Subsequently, four machine learning prediction models-random forest, decision tree, logistic regression, and XGBoost-were developed and evaluated. The model demonstrating the best performance was selected as the final predictive model. Results:The XGBoost model developed in this study demonstrated optimal performance in predicting the risk of unplanned removal of totally implantable venous access ports (TIVAP) in breast cancer patients. In the training set, the area under the receiver operating characteristic curve (AUC) was 0.826 (95% CI: 0.783-0.869), with a specificity of 0.829 and a sensitivity of 0.683. In the validation set, the AUC was 0.751 (95% CI: 0.704-0.839), with a specificity of 0.820 and a sensitivity of 0.636, indicating that the model possesses strong discriminative ability and robust predictive performance. Furthermore, the study identified independent risk factors for unplanned TIVAP removal, primarily including body mass index (BMI), TNM stage, implantation route, number of successful puncture attempts, coagulation function indices, neutropenia, and catheter indwelling time. The calibration curve shows that the XGBoost model is well calibrated and fitted, and DCA indicates that the model has good clinical net benefits. Conclusion:This study developed a machine learning prediction model for the risk of unplanned removal of totally implantable venous access ports (TIVAP) in breast cancer patients. The model demonstrated favorable discrimination and calibration, with robust predictive performance. It contributes to the early identification of high-risk patients in clinical practice, enabling targeted interventions and preventive measures to reduce the incidence of unplanned TIVAP removal.

BACKGROUND:Thyroid nodule ultrasound (US) images and their features are of great importance in thyroid nodule diagnosis and can be helpful for radiologists' clinical decision making. The aim was to evaluate whether an artificial intelligence (AI)-assisted system can accurately characterize thyroid nodule US features and assist radiologists in diagnosing thyroid cancer. METHODS:The AI-assisted system (MDT-TC) was trained and internally validated on B-mode US images from 7204 lesions in 6884 patients in Southwest Hospital. The model performance was validated using 3 independent external validation cohorts. RESULTS:Echogenicity (ECH) and shape (SHA) are features of high importance for model recognition, and these features lead to excellent model performance. The model achieved up to 87.56% accuracy in determining ECH attributes and 69.21% in identifying shape categories. The area under the receiver operating characteristic curve (AUC) of the internal validation cohort and 3 independent external validation cohorts for MDT-TC were 0.951, 0.837, 0.816, and 0.871, respectively. The sensitivity values were 98.7%, 91.2%, 90.3%, and 85.6%, respectively. The AUC for the accurate diagnosis of radiologists with MDT-TC assistance was significantly higher than that of radiologists without MDT-TC assistance (P < .001). In addition, the AUC for the accurate diagnosis of junior doctors with MDT-TC assistance was significantly higher than that for those without (P < .01). CONCLUSION:MDT-TC incorporates radiomic features extracted from thyroid lesion US images and can significantly improve the diagnostic performance of radiologists. This result was particularly strong for junior doctors. Therefore, our data support the idea that MDT-TC can help to identify patients with thyroid cancer and could greatly benefit clinical practice.

Macrophages exhibit extensive tumor infiltration capacity across diverse solid malignancies, establishing macrophage-targeted immunotherapies as an emerging frontier in oncology. Genetic engineering of macrophages using chimeric antigen receptor (CAR) technology - enabling recognition and phagocytosis of neoplastic cells - is emerging as a potential therapeutic strategy against solid tumors. Human induced pluripotent stem cells (iPSCs) provide a renewable platform for the efficient differentiation of functionally competent macrophages. In this study, we engineered human iPSC-derived CAR macrophages (iCAR-M) targeting interleukin-13 receptor subunit alpha 2 (IL-13Rα2). Pan-tumor transcriptomic and immunohistochemical analyses revealed that IL-13Rα2, a tumor-associated antigen, was overexpressed in human glioblastoma (GBM), uterine carcinosarcoma (UCS), and melanoma specimens. In vitro phagocytosis assays revealed target-specific clearance of IL-13Rα2-positive tumor cells by iCAR-M. Intracranial administration of iCAR-M potently suppressed tumor growth, enhanced intratumoral cytotoxic T-cell infiltration, and prolonged the survival of humanized, immunocompetent mice bearing GBM xenografts. The administered iCAR-M maintained phagocytic capacity in vivo and acquired an M1-like pro-inflammatory phenotype. Comprehensive safety assessment revealed no detectable evidence of systemic toxicity or treatment-related neurotoxicity. Collectively, these results demonstrate the potent efficacy and favorable safety profile of iPSC-derived, IL-13Rα2-targeted CAR macrophages, supporting their therapeutic potential against solid tumors. © 2026 The Pathological Society of Great Britain and Ireland.

Purpose To examine the mediating role of social support in the relationship between fear of cancer recurrence (FCR) and fertility intention among reproductive-aged women with breast cancer. Methods This study employed a cross-sectional design, utilising convenience sampling to select 231 women of reproductive-aged diagnosed with breast cancer and treated at a tertiary hospital in Chongqing between December 2023 and June 2024 as research subjects.Participants completed a demographic questionnaire, the Fertility Intention Scale, the Social Support Rating Scale, and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF).Pearson correlation analysis was conducted to examine the inter-variable correlations, followed by the construction of a structural equation model using AMOS 26 software, with bootstrap method applied to verify the mediation effects. Results Fertility intention was negatively correlated with FCR (r = -0.610, P < 0.001) and positively correlated with social support (r = 0.673, P < 0.001). Social support was also negatively correlated with FCR (r = -0.521, P < 0.001). Structural equation modeling revealed that social support partially mediated the relationship between FCR and fertility intention, accounting for 27.93% of the total effect. Conclusion Enhancing social support may help alleviate FCR and subsequently increase fertility intention among reproductive-aged women with breast cancer.

HER2 signaling is activated in response to somatic HER2 mutations, which are often found in invasive lobular breast cancer (ILC) and are associated with poor prognosis. Tyrosine kinase inhibitors (TKIs) have demonstrated considerable antitumor activity in patients with HER2-mutated advanced breast cancer (BC). Further, several clinical trials have indicated that HER2-targeted antibody-drug conjugates (ADCs) exhibit promising efficacy in lung cancer with HER2 mutations, and the efficacy of ADCs against HER2-mutated BC is currently being evaluated. Several preclinical studies have demonstrated that the therapeutic efficacy of ADCs in HER2-mutated cancer can be enhanced by the addition of irreversible TKIs, but the potential of such a combined treatment regimen for the treatment of HER2-mutated BC has not been reported. Herein, we describe a case in which a patient with estrogen receptor-positive/HER2-negative metastatic ILC with 2 activating HER2 mutations (D769H and V777L) exhibited a significant and durable response to anti-HER2 treatment with pyrotinib (an irreversible TKI) in combination with ado-trastuzumab emtansine, which was administered after multiple lines of therapy that had resulted in disease progression. Further, based on the evidence from the present case, TKI plus ADC seems to be a promising combination anti-HER2 regimen for patients with HER2-negative/HER2-mutated advanced BC, although further rigorous studies are warranted to confirm these findings.

Gliomas are not only among the most vascular-rich solid tumors, but also the most common primary brain tumors. The vascular morphology and molecular characteristics of gliomas are heterogeneous. Pericytes are one of the important cell components in glioma vascular structure and are highly heterogenies. However, the heterogeneity of pericytes in gliomas is not clear, and the biological characteristics and clinical significance of different subpopulations of pericytes are still unknown. An in-depth understanding of pericyte characteristics based on gene expression profiling, as well as the correlation of pericytes and the clinical prognosis of glioma are important prerequisites for the development of follow-up targeted vascular therapy. In this study, the heterogeneity of pericytes in glioma was revealed by single-cell RNA sequencing technique, the relationship between pericyte subpopulations and patient survival, prognosis and treatment response were clarified, and the MMP9 + pericytes were identified as a unique pericyte subpopulation in the core area of glioma, providing theoretical basis for analyzing the characteristics of vascular microenvironment of glioma and new targets for anti-vascular therapy of glioma.

Aim To investigate the safety and feasibility of extending the flushing interval for the totally implantable venous access port (TIVAP) during the non-treatment stage in patients with breast cancer (BC) by retrospectively analyzing the patients’ clinical data, including the incidence of TIVAP-related complications. Methods This single-center retrospective study included patients with BC who underwent TIVAP implantation at our hospital between January 2018 and March 2021 during their non-treatment phase and visited the hospital regularly for TIVAP flushing. Among the 1013 patients with BC who received TIVAP implantation, 617 patients were finally included on the basis of the inclusion and exclusion criteria and divided into three groups according to the length of the flushing interval: group 1 (≤30 days, n = 79), group 2 (31–90 days, n = 66), and group 3 (91–120 days, n = 472). The basic characteristics of patients in each group and the incidence of TIVAP-related complications (catheter obstruction, infection, and thrombosis) were analyzed. Results No significant intergroup differences were observed in age, body mass index (BMI), tumor stage, pathological staging, implantation approach, chemotherapy regimen, duration of treatment, and TIVAP-related blood return rate (P > 0.05). Among patients from all three groups, 11 cases of catheter pump-back without blood and eight cases of TIVAP-related complications such as infection, thrombosis, and catheter obstruction were recorded. However, no significant differences in TIVAP-related complications were observed among the three groups (P > 0.05). Conclusion Extending the TIVAP flushing interval beyond three months during the non-treatment stage in BC patients is safe and feasible and did not increase the incidence of TIVAP-related complications.

Objective:To evaluate the clinical effect of comprehensive nursing intervention to promote postoperative functional rehabilitation of affected limbs in patients with breast cancer.Methods:A total of 336 patients with breast cancer in the Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University from September 2017 to September 2018 were involved in this retrospective study, including 168 patients from Unit A (intervention group) and 168 patients from Unit B (control group). The comparison of age, marital status, physical working and housing status was performed by χ2 test. The comparison of education, BMI, clinical stage of tumor, axillary lymph node dissection and patient satisfaction with nursing were performed by the Mann-Whitney U test. The evaluation results on motion range of the shoulder joints before surgery were compared by t test and the results at 2 months after operation were compared by analysis of covariance.Results:At 2 months after operation, there were significant differences in the degree of horizontal flexion, horizontal extension, abduction, anterior flexion, posterior extension, internal rotation, external rotation and wall climbing height between intervention group and control group (F=894.621, 655.310, 8 025.193, 10 779.431, 1 957.617, 3 525.204, 2 412.949, 7.629, all P<0.001). The satisfaction rate in the nursing satisfaction survey was 99.4%(167/168) in intervention group, significantly higher than 88.7%(149/168) in control group (Z=-3.808, P<0.001).Conclusion:Appropriate and targeted comprehensive nursing interventions should be given to breast cancer patients after operation, which can significantly improve the motion range of the affected shoulder joints and increase patient satisfaction with nursing, worthy of clinical application.

植入式静脉输液港( implantable venous access port, IVAP)简称输液港,是一种在人体内可长期留置的静脉输液装置,适用于完全胃肠营养、高浓度化疗药物等的输注,能减少患者因反复静脉穿刺带来的痛苦[1].与中心静脉导管( central venous catheter,CVC)和外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相比,IVAP具有留置时间长、维护周期长、美观舒适、提高患者生活质量等优点.因此,IVAP已成为国内多家医院乳腺癌患者化疗的首选静脉通道.

We integrate the precision medicine into the training process of breast surgery postgraduates. Besides the traditional training, we emphasize the idea of precision medicine and provide precision medicine lessons. We also carry out multidisciplinary precision-medicine teaching ward-rounds, and take use of AI system to assist clinical decision making, so as to stimulate the subjective initiative of the postgraduates, and strengthen the training of clinical practical capabilities. Our experience has showed that applying the precision medicine mode to the training of breast surgery postgraduates is more conducive to strengthening their clinical capabilities and overall quality.

目的 探讨乳腺癌术后疼痛综合征的临床特征及危险因素.方法 选取我院收治的乳腺癌患者240例,根据是否发生乳腺癌术后疼痛综合征将患者分为未发生组和发生组.采用单因素分析影响乳腺癌术后疼痛综合征的相关因素,采用多因素分析影响乳腺癌术后疼痛综合征的危险因素.结果 54例(22.50％)乳腺癌患者发生术后疼痛综合征,疼痛性质以麻木为主,最常见的疼痛部位为患侧腋窝.单因素分析结果显示,2组患者年龄、清扫腋窝淋巴结、术后放疗、慢性疼痛史和术前焦虑或抑郁比较,差异具有统计学意义(P<0.05).多因素分析结果显示,年龄≤50岁、清扫腋窝淋巴结、术后放疗、慢性疼痛史及术前焦虑或抑郁为乳腺癌术后疼痛综合征发生的危险因素.结论 乳腺癌术后疼痛综合征患者的疼痛性质以麻木为主,患侧腋窝是最常见的疼痛发生部位;年龄≤50岁、清扫腋窝淋巴结、术后放疗、慢性疼痛史及术前焦虑或抑郁为乳腺癌术后疼痛综合征发生的危险因素,临床应基于疼痛综合征的特点及危险因素,对乳腺癌患者进行个体化干预.

乳腺癌是全球女性发病率居第1位的疾病[1] ,其治疗措施是以手术为主的综合治疗.乳腺癌患者因为肥胖、慢性心脑血管疾病、肿瘤、化疗、手术、麻醉、术后肢体活动少等因素极易发生血栓.急性肺栓塞( acute pulmonary embolism, APE)指来自静脉系统或右心的血栓阻塞肺动脉及其分支所致疾病,以肺循环和呼吸功能障碍为主要病理生理特征,是乳腺癌患者术后最严重的并发症之一,也是乳腺癌本身常见的第2类致死原因[2].APE虽然发病率不高,但是病情凶险,病死率极高,抢救成功的概率很小[3].2019 年11 月陆军军医大学第一附属医院乳腺甲状腺外科成功救治1例乳腺癌改良根治术后并发急性肺栓塞的患者,现报道如下.

肉芽肿性乳腺炎是以乳腺小叶为中心、周边多灶性微脓肿的慢性炎症性疾病,以非干酪样坏死及坏死性肉芽肿为病理特征,其病因尚不明确,早期表现多为乳房肿块,随后可继发急性感染形成脓肿,破溃后形成瘘管、窦道或溃疡,且经久不愈或反复发作[1-2].近年来,肉芽肿性乳腺炎的发病率有增加的趋势,虽然新的治疗理念和方法取得了较好的效果,但仍有部分患者久治不愈,成为临床的一大难题.2018年10月,陆军军医大学第一附属医院乳腺甲状腺外科收治了1例皮肤坏死性肉芽肿性乳腺炎合并糖尿病患者,现报道如下,供同行参考.

自2019年12月在湖北省出现首例患者以来,新型冠状病毒肺炎(简称新冠肺炎)呈现爆发性流行趋势[1-2].WHO已将本次疫情认定为国际公共卫生紧急事件[3],中国也将新冠肺炎纳入《中华人民共和国传染病防治法》规定的乙类传染病,并采取甲类传染病的预防控制措施进行防控[4].鉴于新冠肺炎传染性很强,其主要传播途径为经呼吸道飞沫和密切接触传播,多地采取了包括“封城”、“封路”在内的多种方式减少人员聚集,以切断传播途径,但同时也对人民群众的正常生活和社会生产造成了极大影响.

目的 分析乳腺癌术后上肢淋巴水肿经综合消肿疗法(CDT)治疗的临床效果.方法 选择2017年1月至2018年12月收治的乳腺癌术后上肢淋巴水肿患者97例,按随机数字表法分为观察组(n=50)和对照组(n=47).对照组患者接受压力波治疗,观察组患者接受CDT治疗,治疗14 d后评估2组疼痛、患肢周径及患肢功能改善情况,并比较2组治疗后临床疗效.结果 治疗前,2组VAS评分差异无统计学意义(P>0.05),治疗后,2组VAS评分较治疗前明显下降,且观察组VAS评分明显低于对照组(P<0.05).治疗前,2组腋窝、肘横纹向上10 cm、肘横纹向下10 cm、腕横纹向上5 cm及手虎口等患肢周径差异无统计学意义(P>0.05);治疗后,2组患肢周径较治疗前明显缩小,且观察组患肢周径明显小于对照组(P<0.05).治疗前,2组DASH评分差异无统计学意义(P>0.05);治疗后,2组DASH评分较治疗前明显下降,且观察组DASH评分明显低于对照组(P<0.05).观察组治疗总有效率为96.00％明显高于对照组的48.94％(P<0.05).结论 对乳腺癌术后上肢淋巴水肿患肢实施CDT治疗,可明显减轻患者疼痛,促进其水肿症状消退、患肢功能改善,临床疗效确切,值得推广.

2019年12月以来,湖北省武汉市部分医院陆续发现了多例有华南海鲜市场暴露史的不明原因肺炎病例,现已证实为一种新型冠状病毒感染引起的急性呼吸道传染病,被命名为新型冠状病毒肺炎(简称新冠肺炎).国家卫生健康委员会发布1号公告,将新冠肺炎纳入《中华人民共和国传染病防治法》规定的乙类传染病,采取甲类传染病防控[1].中国多省市均启动了重大突发公共卫生事件Ⅰ级响应,限制人员流动,同时全国各大医院也面临收治或筛查新冠肺炎患者的艰巨任务,这给需要及时到医院救治的其他疾病患者带来了诸多的不便.在疫情之下,如何解决这部分患者的诊治,也成为当前医务工作者亟待解决的关键问题.

2019年12月以来,湖北省武汉市陆续发现了多例新型冠状病毒肺炎(简称新冠肺炎)患者.随着疫情的蔓延,国内各省、自治区、直辖市、新疆生产建设兵团及境外也相继发现了此类病例.该病毒潜伏期长,传染性强.2020年1月20日,中华人民共和国国家卫生健康委员会将新冠肺炎纳入《中华人民共和国传染病防治法》规定的乙类传染病,并采取甲类传染病的预防、控制措施[1].截止2020年2月5日24时,全国累计确诊病例28 018例,累计死亡病例563例,疑似病例24 702例[2].

目的 探讨输液港植入后导管异位对乳腺癌患者治疗的影响.方法 对2017年11月至2018年11月在陆军军医大学第一附属医院乳腺甲状腺外科植入输液港后发生导管异位的9例乳腺癌患者进行跟踪随访,观察患者输液港植入术后1周有无早期并发症,如术区青紫或疼痛、伤口感染或/和裂开、局部肿胀及血肿;植港后3、6个月随访患者有无远期并发症,如输液不畅、夹闭综合征、血栓形成情况等.结果 本研究中9例输液港导管异位患者均完成既定的6～8个周期化疗,其中3例患者化疗周期结束后拔除输液港;6例患者化疗周期结束后继续使用输液港进行后续分子靶向治疗,随访期间均未出现明显不良反应.结论 输液港植入后发生导管异位,只要患者无自觉症状,在确认回抽见血、输注液体通畅后可正常使用,但要对患者进行6个月至1年的随访,密切观察有无并发症.

目的 探讨以外科方法 处理乳腺癌合并糖尿病患者术后皮下积液的临床应用效果.方法 选取2017年1月至2018年12月本科室收治的女性乳腺癌合并糖尿病患者60例,均接受改良根治术,符合ⅡA～ⅢA期(T2 K-3 N0-1 M0),根据所住院的区域分为干预组和对照组,各30例.对照组在接受改良根治术后,伤口加压包扎,肩部制动,常规糖尿病饮食指导并控制血糖.干预组在对照组的基础上,于术后2d应用外科方法及早干预处理局部积液腔;比较2组患者术后5d引流液量、拔管时间、术后接受辅助化疗的最佳时间、是否因皮下积液再次手术引流.结果 通过外科方法处理的干预组患者术后5d引流液量、拔管时间、术后接受辅助化疗最佳时间、再次手术引流例数比较,差异均具有统计学意义(P<0.05).结论 对于乳腺癌合并糖尿病患者应用外科方法将铜绿假单胞菌注射液通过引流管通道注入术后创面腔隙内,使手术后的局部创面产生良性的无菌性炎症,可促进术后创面快速愈合,同时缩短拔管时间,患者术后接受辅助化疗的最佳时间得以保证,减轻患者的精神心理压力.

Objective To investigate the application of fast track surgery in early functional recovery of affected limbs after breast cancer surgery.Methods According to the inclusion and exclusion criteria,124 patients with breast cancer in the Southwest Hospital,Army Medical University from May 2016 to May 2017 were enrolled for a prospective study.The patients were divided into control group and intervention group by random number table,62 cases in each group.In control group,conventional nursing methods were used for functional exercises of limbs.In intervention group,fast-track surgery was applied,i.e.,preoperative and postoperative guidance on functional exercises of the affected limbs was given;after discharge,clinical nursing specialists made an individualized exercise program for each patient after evaluation in clinic and provided guidance and supervision by WeChat.The postoperative wound recovery time,duration of drainage and length of hospital stay were compared between two groups by t test.At postoperative 10 days,1 and 3 months,the Constant-Murley shoulder assessment was used to evaluate the functional recovery of the affected limbs and the WHOQOL-BREF quality of life assessment was used to evaluate the quality of life of breast cancer patients.The scores were compared between two groups using repeated measures analysis of variance.Results The recovery time of wound,duration of drainage and length of hospital stay were (7.5±2.1) d,(6.3±2.4) d and (7.6±2.4) d in intervention group,which were significantly lower than those in control group[(10.3±3.2) d,(10.2±3.7) d,(10.2±4.2) d;t =5.762,6.963,4.232,all P＜0.001).The scores on postoperative limb function recovery in intervention group were superior to those in control group (pain:comparison between groups,F=94.553,P＜0.001;time point comparison,F=723.882,P＜0.001;interaction,F=21.356,P=0.169;daily mobility:comparison between groups,F=351.725,P＜0.001;time point comparison,F=1 681.920,P＜0.001;interaction,F=20.623,P＜0.001;range of motion of the joints:comparison between groups,F=441.381,P＜0.001;time point comparison,F=2 458.887,P＜0.001;interaction,F=28.420,P＜0.001;muscle strength:comparison between groups,F=84.571,P＜0.001;time point comparison,F=1 474.775,P＜0.001;interaction,F=13.862,P＜0.001).The scores on postoperative quality of life in intervention group were also significantly better than those in control group (subjective feeling on quality of life:comparison between groups,F =235.607,P ＜ 0.001;time point comparison,F =607.245,P ＜ 0.001;interaction,F =1.913 P =0.169;subjective feeling on health status:comparison between groups,F =140.170,P＜0.001;time point comparison,F =618.834,P＜0.001;interaction,F =1.533,P =0.218;physical health:comparison between groups,F =72.713,P ＜ 0.001;time point comparison,F =2 324.181,P＜0.001;interaction,F =18.296,P＜0.001;mental health:comparison between groups,F =64.987,P＜ 0.001;time point comparison,F =2 613.833,P ＜ 0.001;interaction,F =16.158,P ＜ 0.001;social relationship:comparison between groups,F=58.654,P＜0.001;time point comparison,F=2 775.791,P＜ 0.001;interaction F=16.710,P＜0.001;environment:comparison between groups,F=59.818,P＜0.001;time point comparison,F =2 638.321,P＜0.001;interaction,F =22.660,P＜0.001).Conclusion The mode of fast track surgery can significantly improve early functional exercises of affected limbs in breast cancer patients after surgery,increase their compliance and ameliorate their quality of life.