Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ2=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ2=0.139, P=0.709; χ2=0.578, P=0.447; χ2=2.617, P=0.106; χ2=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.
There are a great number of uncertainties in medical practice, causing considerable difficulties in medical activities such as diagnosis and prognostic prediction. Neural-fuzzy system (NFS) combines the advantages of artificial neural networks and fuzzy logic very well, and has become a new type of artificial intelligence model which is capable of acquiring knowledge from data and expressing it in the form of fuzzy rules. Because of its strong capability of classification and processing fuzzy information, NFS is more and more used in medical practice. Adaptive neural-fuzzy inference system (ANFIS) is one of the most popular forms of NFS. This review focuses on the use of ANFIS in medical practice.
ObjectiveTo construct a prediction model for the postoperative recurrence risk of granulomatous lobular mastitis (GM) based on multiple systemic inflammatory indicators and clinicopathologic characteristics, with the aim of guiding clinical treatment. MethodsThe GM patients who underwent lesion resection at Sichuan Provincial Hospital for Women and Children from January 2017 to March 2024 were retrospectively collected. The univariate and multivariate logistic regression analyses were used to screen the risk factors for recurrence after GM lesion resection, and a nomogram prediction model was constructed based on the risk factors. The test level was set at α=0.05. ResultsA total of 533 patients with GM were included in this study, of whom 118 cases (22.1%) developed postoperative recurrence. The results of multivariate analysis showed that the not taking oral bromocriptine, having microabscess formation in postoperative pathological examination, systemic immune inflammation index (SII) >789.0×109/L, and immunoglobulin E (IgE) >64.4 U/mL were the independent risk factors for recurrence after GM lesion resection. Based on the risk factors, the nomogram predicting recurrence risk was constructed. The area under the receiver operating characteristic curve (95%CI) was 0.913 (0.895, 0.932), and its sensitivity and specificity were 90.5% and 88.9%, respectively. The calibration curve showed that the probability of recurrence after GM lesion resection predicted by using the nomogram was highly consistent with the actual recurrence probability. The decision curve analysis showed that the nomogram had a good clinical net benefit. ConclusionsThe findings of this study suggest that close postoperative monitoring for recurrence is warranted in patients who did not receive oral bromocriptine treatment, presented with microabscess formation on pathological examination, and exhibited elevated SII and IgE level. The postoperative GM recurrence prediction nomogram model constructed based on risk factors demonstrates a good predictive performance, providing a valuable reference for early treatment and management strategies of GM.
With clinical medicine science transforming from traditional medicine to evidence-based medicine, how to practice evidence-based medicine has become a new challenge to clinical doctors. Therapy studies play an important part in clinical studies and how to practice evidence-based medicine in the therapy of diseases is an important question that doctors are concerned. This paper will introduce as on how to practice evidence-based medicine in the therapy of diseases.
Objective To evaluate the effectiveness of teaching evidence-based medicine (EBM). Methods 1. Introducing EBM teaching material in Chinese. 2. Offering EBM course in medical college of Sichuan University. 3. Problem-based,self-directed teaching methods. 4. A variety of test method. Results 36 Cochrane systematic review titles were registered, 17 Cochrane systematic review protocols were published in Cochrane Library, 6 Cochrane systematic reviews were published in Cochrane Library. 62 EBM research papers were published on Chinese Journal of EBM. Feedback of teaching EBM from postgraduates: 77.6%, 22.4% postgraduates consider this EBM course is very helpful and helpful for them respectively; 14.3%, 80% postgraduates achieve completely the goal and achieve the goal in greater part by this EBM course respectively; the reason of not achieving the goal is a lack of time to read and attend the course. 61.2%-80% and 16.3%-32.7% postgraduates consider the teaching contents is very good and good respectively; 61.2%-75.5% and 12.3%-28.6% postgraduates consider this teaching model is very good and good respectively; 44.9% postgraduates hope to increase hours of EBM course, increase discusses, increase EBM practice in future; 10.2% postgraduates consider the questions of test are hard to solve. Conclusion This EBM course is effective.
Objective To assess the effectiveness of evidence-based medicine for improving core competencies of undergraduate medical students. Methods MEDLINE, ERIC, Academic Source Premier, Campbell Library databases and three Chinese Databases (CBM, CNKI, VIP) were searched from January 1992 to May 2009.We also used Google to searching related literature. The design is a systematic review of randomized, non-randomized, and before-after studies. Two reviewers did study selection, quality assessment, and data abstraction independently. Different opinions were resolved by consensus. We used an adaptation of the quality measure from Gemma Flores-Mateo et al to assess the quality of selected studies. And descriptive analysis was conducted. Results A total of 17 studies met the selection criteria, 2 of them were of high quality, the others were of moderate quality. Studies involved Competencies of Scientific Foundation of Medicine, Clinical Skills, and Management of Information. Conclusion Competencies of Scientific Foundation of Medicine, Clinical Skills, and Management of Information are improved by evidence-based medicine teaching. No study on professional values, attitudes, behavior and ethics, population health and health systems, management of information, critical thinking and research is available. It is impossible to assess the four domains above.