ObjectiveTo investigate whether there is a causal relationship between reproductive history (number of children, age at first birth) and the risk of hormone-related cancers (breast, endometrial, and ovarian) in women. MethodsUnivariate and multivariate Mendelian randomization (MR) methods were used to investigate the causal effects of the number of children (childlessness in infertile women and number of children ever born in fertile women) and age at first birth on three hormone-related cancers. The inverse variance weighting method was used for the primary analysis, and sensitivity analyses and reliability tests were used to ensure the reliability of the results. ResultsUnivariate MR showed that infertile women had a higher risk of breast cancer compared with fertile women (OR=1.07, 95%CI 1.05 to 1.09, P<0.001). Multivariate MR showed that among fertile women, after accounting for the effect of age at first birth, higher number of children ever born may be associated with lower risk of breast cancer (OR=0.61, 95%CI 0.43 to 0.85, P<0.01). Neither univariate nor multivariate MR found a causal relationship between age at first birth and hormone-related cancers, and no causal relationship was found between the number of children ever born and endometrial and ovarian cancers; sensitivity analyses and reliability tests demonstrated that the results were unlikely to be affected by heterogeneity and horizontal pleiotropy. ConclusionThe more children a normal woman has, the lower her risk of breast cancer. Infertile women face a higher risk of breast cancer.
The implantation of a left ventricular assist device (LVAD) is an important therapeutic tool for patients with end-stage heart failure, which can either help patients transit to the heart transplantation stage or serve as destination therapy until the end of their lives. In recent years, the third generation of LVAD has evolved rapidly and several brands have been marketed both domestically and internationally. The number of LVAD implantations has been increasing and the long-term survival rate of implanted patients has improved, so this device has a broad development perspective. This article summarizes the current status, usage standards and precautions, and common complications after implantation of LVAD, as well as looks forward to the future development of LVAD, hoping to be helpful for researchers who are new to this field.
Lumbar disc herniation (LDH) is one of the most important causes of back and leg pain, which seriously affects the quality of life of patients. As the first-line treatment for LDH, non-operative treatment can relieve 80% to 90% of symptoms among the patients with LDH. This guideline followed Guidelines for the Formulation/Revision of Clinical Treatment Guidelines in China (2022 edition) and WHO handbook for guideline development (2014 edition) to set up guideline working group. This guideline identified fourteen clinical questions through the literature review and clinical experts’ consensus. We drafted the recommendations after systematically searching and evaluating the evidence; delphi method was adopted for expert consensus on the preliminary recommendations, finally, 19 recommendations were made to guide non-operative treatments for LDH. This guideline can provide guidance for the clinical practice of Chinese and western orthopedics practitioners.