The treatment of breast cancer has fully entered the era of precision therapy. Sentinel lymph node biopsy (SLNB) first replaced axillary lymph node dissection (ALND) in breast cancer patients with negative clinical lymph nodes. Subsequent clinical studies have confirmed the feasibility of using SLNB alone in selected patients with limited lymph node metastasis, which has changed clinical practice. For even lower-risk patients, there is growing evidence supporting the complete omission of axillary surgery. Furthermore, with the emerging evidence from studies on axillary preservation after neoadjuvant therapy in patients from cN+ to cN0 status, it has become possible for these patients to avoid ALND. Even for those with persistent node-positive disease after neoadjuvant therapy, the possibility of avoiding ALND is under clinical investigation. However, it is important to acknowledge the remaining uncertainties in clinical practice. These include the challenges to the conventional concept of radical resection, the balance between axillary surgery and radiotherapy, the implications of de-escalated axillary staging on systemic therapy decisions. Careful evaluation and a balanced integration of surgery, radiotherapy, and systemic therapy are crucial to achieving truly precise de-escalation in axillary management.
Objective To explore the current status of nutritional literacy in maintenance hemodialysis (MHD) patients and analyze its influencing factors. Methods MHD patients in Wenjiang Hemodialysis Center of West China Hospital, Sichuan University between January and April 2022 were selected by convenient sampling method. A questionnaire survey was conducted using the Nutrition Literacy Evaluation Scale for end-stage renal disease dialysis patients, and the current status and influencing factors of nutritional literacy in MHD patients were analyzed. Results A total of 214 patients were included, with an average nutritional literacy score of 19.14±5.78 for MHD patients. Among them, there were 60 cases (28.04%) of highly likely low nutritional literacy, 124 cases (57.94%) of moderate nutritional literacy, and 30 cases (14.02%) of highly likely high nutritional literacy. The correlation test results showed that hemoglobin, albumin, cholesterol, triglyceride, calcium, phosphorus, potassium, creatinine, estimated glomerular filtration rate, and nutritional literacy scores were not correlated. The results of multiple linear stepwise regression analysis showed that education level [non-standardized partial regression coefficient (b)=1.821, 95% confidence interval (CI) (1.143, 2.498), P<0.001], age [b=−2.460, 95%CI (−4.247, −0.672), P=0.007], hypertensive kidney damage [b=2.233, 95%CI (0.428, 4.039), P=0.016] were all factors affecting the nutritional literacy of MHD patients. Conclusions In clinical work, more attention should be paid to MHD patients with low educational level, older age, and more primary diseases. And targeted interventions should be adopted to improve the level of nutritional literacy in order to improve the quality of life of MHD patients.