乳腺良性肿瘤热消融中西医结合诊疗指南

上海市中西医结合学会甲乳外科专业委员会

中国中西医结合学会疡科专业委员会世界中医药学会联合会乳腺病专业委员会

中国医师协会介入医师分会超声介入专业委员会

中国抗癌协会肿瘤超声治疗专业委员会 中国超声医学工程学会超声治疗及生物效应专委会

国家卫生健康委继续教育与能力建设超声医学专家委员会治疗学组 上海市医师协会超声分会

上海市抗癌协会肿瘤消融治疗专业委员会

摘要 热消融术是一种针对乳腺良性病变的新型微创治疗方法，已证实其在乳腺良性肿瘤中的疗效。本指南综合分析

高质量临床证据，结合国内著名专家的临床经验与意见，经多次专家研讨达成共识。主要阐述乳腺良性肿瘤的热消融治

疗准则与操作规范，包括适应证、禁忌证、术前评估、麻醉方式、治疗类型及并发症处理等。同时，指南还强调了中医中药

在热消融诊治过程中的重要作用，提出了“中医五位一体”的综合治疗方案。本指南可为从事乳腺良性肿瘤治疗的医师

提供了重要的参考依据。

关键词 乳腺良性肿瘤; 热消融治疗; 中西医结合; 诊疗指南; 中医五位一体

Diagnosis and Treatment Guidelines for Benign Breast Tumors by Thermal Ablation with Integrated Traditional Chinese and Western Medicine Professional Committee of Thyroid and Breast Surgery，Shanghai Association of Chinese Integrative Medicine; Professional Committee of Ulcerology，Chinese Association of Integrative Medicine; Specialty Committee of Mammary Disease，World Federation of Chinese Medicine Societies; Committee of Interventional Ultrasound，Interventional Physician Branch，Chinese Medical Doctor Association; Tumor Ultrasound Therapy Committee，China Anti-Cancer Association; Special Committee of Ultrasound Therapy and Biological Effects，Chinese Association of Ultrasound in Medicine and Engineering; Treatment Group，Ultrasound Medical Expert Committee， National Health Commission Capacity Building and Continuing Education Center; Ultrasound Branch，Shanghai Medical Doctor Association; Tumor Ablation Therapy Committee，Shanghai Anti-Cancer Association

Abstract

Thermal ablation is a novel minimally invasive treatment for benign breast lesions，with confirmed efficacy in benign breast tumors． Based on a comprehensive analysis of high-quality clinical evidence，this guideline combines the clinical experience and opinions of renowned national experts，where consensus has been reached through multiple expert discussions． This guideline primarily outlines the treatment criteria and technical specifications of thermal ablation for benign breast tumors and related diseases，including indications，contraindications，preoperative assessment，anesthesia methods，treatment types，and complication management． Additionally，the guideline emphasizes the importance of traditional Chinese medicine( TCM) in thermal ablation，putting forward the comprehensive treatment plan of“TCM five-in-one”． This guideline provides an important reference for physicians engaged in benign breast tumor treatment．

Keywords

Benign breast tumor; Thermal ablation treatment; Integrated traditional Chinese and Western medicine; Diagnosis and treatment guideline; TCM five-in-one

中图分类号: Ｒ273

文献标识码: A

doi: 10． 3969 /j． issn． 1673 － 7202． 2025． 22． 002

Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults

Taynara Formagini1,2 *, Joanna Veazey Brooks2,3,4 , Andrew Roberts2,5 , Kai McKeever Bullard6 , Yan Zhang6 , Ryan Saelee6 and Matthew James O'Brien7

1 Department of Family Medicine, University of California San Diego, San Diego, CA, United States,

2 Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States, 3University of Kansas Cancer Center, Kansas City, KS, United States, 4Division of Palliative Medicine, University of Kansas School of Medicine, Kansas City, KS, United States, 5Aetion Inc., New York, NY, United States, 6Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States, 7 Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Introduction: Racial and ethnic minority groups and individuals with limited educational attainment experience a disproportionate burden of diabetes. Prediabetes represents a high-risk state for developing type 2 diabetes, but most adults with prediabetes are unaware of having the condition. Uncovering whether racial, ethnic, or educational disparities also occur in the prediabetes stage could help inform strategies to support health equity in preventing type 2 diabetes and its complications. We examined the prevalence of prediabetes and prediabetes awareness, with corresponding prevalence ratios according to race, ethnicity, and educational attainment.

Methods: This study was a pooled cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to March 2020. The final sample comprised 10,262 U.S. adults who self-reported being Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Those with prediabetes were classified as “aware” or “unaware” based on survey responses. We calculated prevalence ratios (PR) to assess the relationship between race, ethnicity, and educational attainment with prediabetes and prediabetes awareness, controlling for sociodemographic, health and healthcare-related, and clinical characteristics.

Results: In fully adjusted logistic regression models, Asian, Black, and Hispanic adults had a statistically significant higher risk of prediabetes than White adults (PR:1.26 [1.18,1.35], PR:1.17 [1.08,1.25], and PR:1.10 [1.02,1.19], respectively). Adults completing less than high school and high school had a significantly higher risk of prediabetes compared to those with a college degree (PR:1.14 [1.02,1.26] and PR:1.12 [1.01,1.23], respectively). We also found that Black and Hispanic adults had higher rates of prediabetes awareness in the fully adjusted model than White adults (PR:1.27 [1.07,1.50] and PR:1.33 [1.02,1.72], respectively). The rates of prediabetes awareness were consistently lower among those with less than a high school education relative to individuals who completed college (fully-adjusted model PR:0.66 [0.47,0.92]).

Discussion: Disparities in prediabetes among racial and ethnic minority groups and adults with low educational attainment suggest challenges and opportunities for promoting health equity in high-risk groups and expanding awareness of prediabetes in the United States.

KEYWORDS

prediabetes, prediabetes awareness, diabetes-related disparities, race and ethnicity, educational attainment

The frequency of polycystic ovary syndrome in women with prediabetes compared with normoglycemic women

Cem Sulu1 , Ipek Pervaz 2 , Turgut Gurer 3 , Dogan Yildiz 2 , Arzu Tas 3 , Ahmet Numan Demir 1 , Serdar Sahin1 , Hande Mefkure Ozkaya1 , Dildar Konukoglu 4 , Abdullah Tuten5 , Taner Damci 1 , Fahrettin Kelestimur 6 and Mustafa Sait Gonen 1*

1 Division of Endocrinology-Metabolism and Diabetes - Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

2Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

3Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

4Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

5 Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Türkiye,

6Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Faculty of Medicine, Yeditepe University, Istanbul, Türkiye

Objective: To determine rate of polycystic ovary syndrome (PCOS) and its related features in women with prediabetes.

Methods: Of 3465 consecutive women applied between 2021 and 2023, 3218   women with diabetes mellitus or conditions affecting gonadal functions were excluded through digital screening and tele-interviews. Remaining 247 women underwent clinical assessments, excluding another 49 due to other endocrine diseases. The diagnosis of PCOS and prediabetes were based on Rotterdam and American Diabetes Association criteria, respectively.

Results: 100 women had prediabetes and 98 women had normoglycemia. The frequency of PCOS were 17% and 19.4% in prediabetes and control groups, respectively (p=0.715). The frequency of PCOS was 24% (6/25) in women with impaired glucose tolerance (IGT) only, 22.2% (2/9) in women with impaired fasting glucose only, and 15.5% (9/58) in women who met the HbA1C criterion only. Prediabetes group had higher insulin-like growth factor-1 (IGF–1) levels and lower anti-Müllerian hormone (AMH) levels (p<0.05). Insulin was correlated with testosterone, antral follicle count, and ovarian volume only in prediabetes group (p<0.05). Mediation models showed that insulin increased testosterone both directly and indirectly through increasing IGF-1 (b=0.4, p=0.0006).

Conclusion: While the rate of PCOS was not increased in overall prediabetes group, a trend for an increased risk in IGT subgroup only was noteworthy. Positive correlation of insulin with testosterone, antral follicle count, and ovarian volume being only found in prediabetes group suggested that prediabetes might render ovaries susceptible to the PCOS-like changes. The lower AMH in prediabetes implied the toxic effects of even mild hyperglycemia on ovaries.

KEYWORDS

hyperandrogenism, impaired fasting glucose, impaired glucose tolerance, insulin resistance, polycystic ovary syndrome, prediabetes

Diabetes, biochemical markers of bone turnover, diabetes control, and bone

 Jakob Starup-Linde1,2*

1 Faculty of Health, Aalborg University, Aalborg, Denmark

2 Department of Endocrinology and Internal Medicine, Aarhus University Hospital THG, Aarhus, Denmark

Diabetes mellitus is known to have late complications including micro vascular and macro vascular disease. This review focuses on another possible area of complication regarding diabetes; bone. Diabetes may affect bone via bone structure, bone density, and biochemical markers of bone turnover.The aim of the present review is to examine in vivo from humans on biochemical markers of bone turnover in diabetics compared to non-diabetics. Further more, the effect of glycemic control on bone markers and the similarities and differences of type 1- and type 2-diabetics regarding bone markers will be evaluated. A systematic literature search was conducted using PubMed, Embase, Cinahl, and SveMed+ with the search terms: “Diabetes mellitus,” “Diabetes mellitus type 1,” “Insulin dependent diabetes mellitus,” “Diabetes mellitus type 2,” “Non-insulin dependent diabetes mellitus,” “Bone,” “Bone and Bones,” “Bone diseases,” “Bone turnover,” “Hemoglobin A Glycosylated,” and “HbA1C.” After removing duplicates from this search 1,188 records were screened by title and abstract and 75 records were assessed by full text for inclusion in the review. In the end 43 records were chosen. Bone formation and resorption markers are investigated as well as bone regulating systems. T1D is found to have lower osteocalcin and CTX, while osteo calcin and tartrate-resistant acid are found to be lower in T2D, and sclerostin is increased and collagen turnover markers altered. Other bone turnover markers do not seem to be altered in T1D or T2D. A major problem is the lack of histomorphometric studies in humans linking changes in turnover markers to actual changes in bone turnover and further research is needed to strengthen this link.

Keywords: diabetes mellitus, bone, bone turnover, markers of bone turnover, biochemical markers, glycemic contro

Cluster analysis for the overall health status of elderly, multimorbid patients with diabetes

Yan Bing† , Lei Yuan† , Ji Liu† , Zezhong Wang, Lifu Chen*, Jinhai Sun* and Lijuan Liu*

Department of Health Management, Naval Medical University, Shanghai, China

Purpose: To evaluate the overall health status and health-related abilities and problems of elderly patients with diabetes and multimorbidity compared with those with diabetes only. Additionally, we aimed to identify different subgroups of elderly, multimorbid patients with diabetes.

Methods: This cross-sectional study included 538 elderly patients with diabetes. The participants completed a series of questionnaires on self-rated health (SRH), diabetes self-management, self-efficacy, health literacy, depression, and diabetes distress. Differences in health-related abilities and problems were compared between elderly patients with diabetes and multimorbidity and those with diabetes only, with adjustments for covariates using propensity score matching. A cluster analysis was also performed to identify the overall health status subgroups of elderly, multimorbid patients with diabetes. Additionally, we  conducted a multinomial logistic regression analysis to examine the predictors of health related abilities and problem-cluster group membership.

Results: Elderly patients with diabetes and multimorbidity experienced more health-related abilities and problems than those with diabetes only, particularly within the domains of depression (p < 0.001), and diabetes distress. The level of health literacy (p < 0.001) and self-management (p = 0.013) in elderly, multimorbid patients with diabetes was also significantly higher than that in elderly patients with diabetes only. Cluster analysis of elderly, multimorbid patients with diabetes revealed three distinct overall health status clusters. Multinomial logistic regression analysis indicated that age (OR = 1.090, p = 0.043), sex (OR = 0.503, p = 0.024), living situation (OR = 2.769, p = 0.011), BMI (OR = 0.838, p = 0.034), regular exercise (OR = 2.912, p = 0.041 in poor vs. good; OR = 3.510, p < 0.001 in intermediate vs. good), and cerebral infarction (OR = 26.280, p < 0.001) independently and significantly predicted cluster membership.

Conclusion: Compared with elderly patients with diabetes only, those with diabetes and multimorbidity experienced more health-related abilities and problems within the domains of depression, and diabetes distress. Additionally, the level of health literacy and self-management in elderly, multimorbid patients with diabetes was significantly higher than that in those with diabetes only. Among the multimorbid diabetes group, old age, male sex, living without a partner, slightly lower BMIs, not exercising regularly, and experiencing cerebral infarctions were all positively correlated with worse overall health status.

KEYWORDS

multimorbidity, elderly, type 2 diabetes mellitus, overall health status, cluster group predictor

Pre- and Post-diagnosis Diabetes as a Risk Factor for All-Cause and Cancer-Specific Mortality in Breast, Prostate, and Colorectal Cancer Survivors: a Prospective Cohort Study

Huan Tao1 , Adrienne O’Neil 2,3, Yunseon Choi 4 , Wei Wang5 , Junfeng Wang6 , Yafeng Wang7 *, Yongqian Jia1 * and Xiong Chen8 *

1 Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, China, 2 The Centre for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, VIC, Australia, 3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia, 4 Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea, 5 School of Mathematical Sciences, Shanghai Jiao Tong University, Shanghai, China, 6 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, 7 Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China, 8 Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

Objective: The relationship between diabetes and all- and cause-specific mortality in individuals with common cancers (breast, colorectal, and prostate) remains both under-researched and poorly understood.

Methods: Cancer survivors (N = 37,993) from the National Health Interview Survey with linked data retrieved from the National Death Index served as our study participants. Cox proportional-hazards models were used to assess associations between pre- and post-diabetes and all-cause and cause-specific mortality.

Results: Over a median follow-up period of 13 years, 2,350 all-cause, 698 cancer, and 506 CVD deaths occurred. Among all cancer survivors, patients with diabetes had greater risk of: all-cause mortality [hazard ratio (HR) 1.35, 95% CI = 1.27–1.43], cancer-specific mortality (HR: 1.14, 95% CI = 1.03–1.27), CVD mortality (HR: 1.36, 95% CI = 1.18–1.55), diabetes related mortality (HR: 17.18, 95% CI = 11.51–25.64), and kidney disease mortality (HR: 2.51, 95% CI = 1.65–3.82), compared with individuals without diabetes. The risk of all-cause mortality was also higher amongst those with diabetes and specific types of cancer: breast cancer (HR: 1.28, 95% CI = 1.12–1.48), prostate cancer (HR: 1.20, 95% CI = 1.03–1.39), and colorectal cancer (HR: 1.29, 95% CI = 1.10–1.50). Diabetes increased the risk of cancer-specific mortality among colorectal cancer survivors (HR: 1.36, 95% CI = 1.04–1.78) compared to those without diabetes. Diabetes was associated with higher risk of diabetes-related mortality when compared to non-diabetic breast (HR: 9.20, 95% CI = 3.60–23.53), prostate (HR: 18.36, 95% CI = 6.01–56.11), and colorectal cancer survivors (HR: 12.18, 95% CI = 4.17–35.58). Both pre- and post-diagnosis diabetes increased the risk of all-cause mortality among all cancer survivors. Cancer survivors with diabetes had similar risk of all-cause and CVD mortality during the second 5 years of diabetes and above 10 years of diabetes as compared to non-diabetic patients.

Conclusions: Diabetes increased the risk of all-cause mortality among breast, prostate, and colorectal cancer survivors, not for pre- or post-diagnosis diabetes. Greater attention on diabetes management is warranted in cancer survivors with diabetes.

Keywords: diabetes, all-cause, cancer, cardiovascular disease, mortality, cohort study