Juan Gu

Time since last birth and the risk of endometrial cancer: A meta-analysis of observational studies

Introduction Endometrial cancer, an adenocarcinoma originating from the uterine lining, is the most prevalent cancer of the female genital tract globally.Identifying early risk factors for endometrial cancer is crucial for prevention.Prior research suggests that pregnancy may lower endometrial cancer risk by reducing estrogen exposure.This meta-analysis aims to delve into the existing population-based longitudinal studies to evaluate the association between the time elapsed since the last birth and the risk of endometrial cancer. Methods and analysis We searched PubMed, Cochrane Library, Embase, and Web of Science for cohort studies published up to June 21, 2024, using relevant medical subject headings (MeSH) and keywords. Statistical analyses were conducted using Stata version 14.0. A fixed-effects model was applied if P > 0.1 and I 2  ≤ 50%; otherwise, a random-effects model was used to account for significant heterogeneity Publication bias was assessed using funnel plots and Egger’s test. Our meta-analysis included 3 cohort studies and 5 case-control studies with a total of 3,310,734 participants, published between 1994 and 2024. The analysis revealed that time since last birth is associated with endometrial cancer risk. Specifically, a period of 0–10 years since the last birth was linked to a reduced risk of endometrial cancer (OR= 0.431; 95% CI: 0.351–0.530). A period of 10–20 years since the last birth also showed a decreased risk (OR=0.867; 95% CI:0.747–1.007), whereas more than 20 years since the last birth was associated with an increased risk (OR = 1.304; 95% CI: 1.111–1.530). Conclusions Our meta-analysis indicates that a shorter time since the last birth is protective against endometrial cancer, whereas a longer interval increases risk. Further research is needed to clarify the underlying mechanisms of this association. These findings are crucial for developing new strategies for endometrial cancer prevention and treatment.

Diagnosis and rescue of malignant hyperthermia induced by anesthesia during radical surgery in a cervical cancer patient using the National Remote Emergency System: A case report

Rationale: Malignant hyperthermia (MH) is a rare yet serious medical complication that typically arises following general anesthesia or the administration of specific anesthetics. Due to the infrequency of MH, anesthesiologists often lack sufficient expertise in identifying and managing it, leading to misdiagnosis and inappropriate treatment. There is an urgent need to enhance the diagnosis and management of MH through the utilization of relevant tools. Patient concerns: In this case, a 52-year-old woman underwent radical cervical cancer surgery under general anesthesia, with no family or significant medical history. She experienced a gradual increase in end-tidal carbon dioxide (ETCO2) to a maximum of 75 mm Hg and a rise in body temperature from 36.5 to 37.5 °C in a very short period, as well as a blood gas analysis showing a pH of 7.217. Diagnosis: The anesthesiologist immediately used The WeChat applet-based National Remote Emergency System for Malignant Hyperthermia (MH-NRES), and the score was 40, which indicated that the patient was very likely to have MH. Interventions: We immediately discontinued sevoflurane and switched total intravenous anesthesia to maintain general anesthesia, with a rapid intravenous infusion of dantrolene sodium. Outcomes: The ETCO2 and the temperature quickly dropped to normal, followed by successful completion of the surgery, and the patient was discharged 8 days after surgery. Lessons: The experience can provide a basis use of MH-NRES and improve the ability of anesthesiologists to deal with intraoperative MH as well as increase the survival probability of patients.