Objective: This study evaluated the efficacy of various local management strategies for diabetic foot ulcers (DFUs). Background: Several surgical and nonsurgical local interventional approaches are available for the treatment of DFUs. The comparative effectiveness of different treatments is unknown, and it remains unclear which approach is the optimal choice for DFU treatment due to limited direct comparisons. Methods: We did a systematic review and meta-analysis to select the optimal approach to DFU's local management. We searched Medline, Embase, Web of Science, and ClinicalTrials.gov from inception to September 1, 2023, to identify relevant randomized controlled trials. We analyzed data by pairwise meta-analyses with a random-effects model. A network meta-analysis using the surface under the cumulative ranking curve was performed to evaluate the comparative efficacy of different interventional approaches in the early (within 12 wk) and late stages (over 12 wk). Results: In all, 141 randomized controlled trials involving 14076 patients and exploring 14 interventional strategies were eligible for inclusion. Most studies (102/141) had at least 1 risk-of-bias dimension. Good consistency was observed during the analysis. Local pairwise comparisons demonstrated obvious differences in the early-stage healing rate and early-stage and late-stage healing times, while no significant difference in the late-stage healing rate or adverse events were noted. surface under the cumulative ranking curves identified the standard of care (SOC) + decellularized dressing (DD), off-loading (OL), and autogenous graft (AG) as the 3 most effective interventions within 12 weeks for both healing rate (97%, mean rank: 1.4; 90%, mean rank: 2.3; 80.8%, mean rank: 3.5, respectively) and healing time (96.7%, mean rank: 1.4; 83.0%, mean rank: 3.0; 76.8%, mean rank: 3.8, respectively). After 12 weeks, local drug therapy (LDT) (89.5%, mean rank: 2.4) and OL (82.4%, mean rank: 3.3) ranked the highest for healing rate, and OL (100.0%, mean rank: 1.0) for healing time. With respect to adverse events, moderate and high risks were detected in the SOC + DD (53.7%, mean rank: 7.0) and OL (24.4%, mean rank: 10.8) groups, respectively. Conclusion: The findings suggest that OL provided considerable benefits for DFU healing in both the early and late stages, but the high risk of adverse events warrants caution. SOC+DD may be the preferred option in the early stages, with an acceptable risk of adverse events.

Background: Pregnancy-associated breast cancer (PABC) occurs during the special physiological period of female pregnancy, requiring a clinical approach that considers both the effectiveness of maternal treatment and the safety of the baby, creating a clinical challenge. This article discusses the diagnosis and treatment of two PABC cases and provides a thorough review of existing literature to offer insights for clinical practice. Case Description: Patient A, a 41-year-old female at 30 weeks and 2 days of gestation, was diagnosed with left breast invasive carcinoma. Following one cycle of AC regimen chemotherapy, she successfully delivered a female infant at 35 weeks and 5 days of gestation. Subsequently, she received 5 cycles of THP regimen neoadjuvant therapy after childbirth. Then, she underwent left breast-conserving surgery and left axillary lymph node dissection. Postoperative pathology indicated pathologic complete response. Post-surgery, she received radiotherapy and targeted therapy. Patient B, a 33-year-old female at 27 weeks and 1 day of gestation, was diagnosed with left breast ductal carcinoma in situ (DCIS). She underwent left total mastectomy with left sentinel lymph node biopsy. Pathology post-surgery revealed intermediate-grade DCIS of the left breast concomitant with locally non-special type invasive carcinoma. No tumour metastasis was identified in the left sentinel lymph node. At 36 weeks of pregnancy, she delivered a male infant and subsequently received 4 cycles of AC regimen chemotherapy. After completing the chemotherapy, a newly formed mass was discovered in her right breast. Right breast mass mastectomy with vacuum assisted biopsy system was performed. Intraoperative pathology indicated intermediate-grade intraductal papillary carcinoma. During surgery, she underwent right total mastectomy and sentinel lymph node biopsy. Intraoperative frozen section analysis revealed the absence of tumour spread in the sentinel lymph nodes (0/8). Postoperatively, she received systematic endocrine therapy. Conclusions: Both patients had successful outcomes for the unborn babies following delivery. By prioritizing the safety of both the mother and the child, tailored breast cancer treatments were given to the two individuals, leading to effective therapy. Clinicians should increase their awareness and knowledge of PABC to avoid misdiagnosis or overlooking diagnoses.