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BACKGROUND: Endometrial cancer (EC) is a common gynecological malignancy that typically requires prompt surgical intervention; however, the advantage of surgical management is limited by the high postoperative recurrence rates and adverse outcomes. Previous studies have highlighted the prognostic potential of circulating tumor DNA (ctDNA) monitoring for minimal residual disease in patients with EC. AIM: To develop and validate an optimized ctDNA-based model for predicting short-term postoperative EC recurrence. METHODS: We retrospectively analyzed 294 EC patients treated surgically from 2015-2019 to devise a short-term recurrence prediction model, which was validated on 143 EC patients operated between 2020 and 2021. Prognostic factors were identified using univariate Cox, Lasso, and multivariate Cox regressions. A nomogram was created to predict the 1, 1.5, and 2-year recurrence-free survival (RFS). Model performance was assessed via receiver operating characteristic (ROC), calibration, and decision curve analyses (DCA), leading to a recurrence risk stratification system. RESULTS: Based on the regression analysis and the nomogram created, patients with postoperative ctDNA-negativity, postoperative carcinoembryonic antigen 125 (CA125) levels of < 19 U/mL, and grade G1 tumors had improved RFS after surgery. The nomogram's efficacy for recurrence prediction was confirmed through ROC analysis, calibration curves, and DCA methods, highlighting its high accuracy and clinical utility. Furthermore, using the nomogram, the patients were successfully classified into three risk subgroups. CONCLUSION: The nomogram accurately predicted RFS after EC surgery at 1, 1.5, and 2 years. This model will help clinicians personalize treatments, stratify risks, and enhance clinical outcomes for patients with EC.
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ObjectiveTo evaluate the clinical efficacy of sequential syndrome differentiation of Yiqi Huayu Qingre prescription （YHQ） in the treatment of refractory nephrotic syndrome in children. MethodA total of 112 children with refractory nephrotic syndrome were randomly divided into an observation group （57 cases） and a control group（55 cases）. The children in the control group were treated with prednisone tablets combined with tacrolimus，and those in the observation group were treated with YHQ by sequential syndrome differentiation on the basis of the control group. The total effective rates of the two groups after treatment were observed. The 24-hour urinary total protein（24 h UTP），plasma albumin（ALB），cholesterol（CHO），triglycerides（TG）， and traditional Chinese medicine quality of life scale scores before treatment and after four weeks，eight weeks，16 weeks，24 weeks，32 weeks，40 weeks，and 52 weeks in the two groups were recorded. The total course of treatment and the total accumulation of hormones were compared among the children with reduced or no hormone treatment till 52 weeks during treatment. ResultThe total effective rate in the observation group was higher （Z=-2.052，P<0.05）. The observation group had lower 24 h UTP and higher ALB at each follow-up time point than the control group（P<0.05，P<0.01）. At four weeks，eight weeks，and 16 weeks of treatment，there was no statistically significant difference in CHO between the observation group and the control group，and the observation group was lower than the control group in CHO at the rest of the time points （P<0.05，P<0.01）. For TG， the observation group was not significantly different from the control group at four weeks，eight weeks，16 weeks，and 40 weeks of treatment，but lower at 24，32，and 52 weeks （P<0.05，P<0.01）. The total treatment course of hormones in the observation group was shorter（P<0.01）， with less total accumulation（P<0.01）. At different follow-up time points，the total score of traditional Chinese medicine quality of life scale in the observation group was superior to that in the control group（P<0.05，P<0.01），and the scores of the observation group in the four dimensions （physiological function，independent factor，social factor，and psychological factor） after treatment were higher than those in the control group（P<0.05，P<0.01）. ConclusionYHQ under sequential syndrome differentiation has a definite clinical effect in treating children with refractory nephrotic syndrome. It has advantages in shortening the total course of hormone treatment and reducing the total accumulation of hormones，and can improve the quality of life of children with refractory nephrotic syndrome.
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BACKGROUND: Yunnan has one of the oldest and the most severe human immunodeficiency virus (HIV) epidemics in China. We conducted an observational study to evaluate the human papillomavirus (HPV) genotype distribution in relation to cervical neoplastic disease risk among HIV-infected women in Yunnan. METHODS: We screened 301 HIV-infected non-pregnant women in Mangshi prefecture in Yunnan province. All consenting participants underwent simultaneous and independent assessment by cervical cytology, colposcopy-histopathology, and HPV genotyping. Unadjusted and multivariable-adjusted multinomial logistic regression analysis was conducted to evaluate factors associated with single or multiple carcinogenic HPV genotypes. RESULTS: HPV genotypes were present in 43.5% (131/301) overall, and carcinogenic HPV genotypes were present in 37.5% (113/301) women. Among women with carcinogenic HPV genotypes, 80 (70.8% of 113) had a single carcinogenic HPV type, while 33 (29.2%) women had multiple (2 or more) carcinogenic HPV types. Overall, the most common carcinogenic HPV types were HPV52 (7.3%), HPV58 (6.6%), HPV18 (6.3%), HPV16 (6.0%), and HPV33 (5.3%). In women with cervical precancerous lesions (i.e., high-grade squamous intraepithelial lesions [HSIL] on cytology or cervical intraepithelial neoplasia grade 2 or worse [CIN2+] detected on colposcopy-histology), the most commonly detected genotypes were HPV16 (28.6%), HPV52 (25.0%), HPV58 (17.9%), HPV18 (10.7%) and HPV31 (10.7%). Increasing age was an independent risk factor associated with presence of single carcinogenic HPV types (adjusted odds ratio: 1.04, 95%CI: 1.01-1.07, p = 0.012) but not with the presence of multiple carcinogenic types in the multivariable-adjusted models. CONCLUSIONS: As HIV-infected women continue to live longer on antiretroviral therapy in China, it will be increasingly important to screen for, and prevent, HPV-associated cervical cancer in this population, especially given the wide diversity and multiplicity of HPV genotypes.
