Objective This study aims at establishing a teaching catalog and content for breast rare dis-eases and developing the syllabus for the breast rare disease using integrated multimodality of case-/problem-/resource-based learning(CBL+PBL+RBL).Methods By conducting bibliometrics co-occurrence analysis,we collected 6291 articles on breast rare disease published from January,1975 to June,2024.Additionally,we re-trieved the Textbook on Rare Diseases,the Catalog of Chinese Rare Disease,and Second Batch of Rare Dis-ease Catalog and then decided the teaching content.Results From 16,387 keywords,1000(6.1％)keywords were identified through co-occurrence analysis,including 50(0.3％)candidate diseases.These were classified into three categories:rare primary breast diseases,rare genetic mutation-related diseases associated with breast cancer,and rare systemic multi-system diseases involving the breast.From the candidate list,20(0.1％)rare primary breast diseases were further selected for their notable clinical teaching significance,and significant multi-systemic diseases affecting the breast,whether related to gene mutations or not.Teaching plans were draf-ted using a diversified parallel teaching approaches,taking into account the characteristics of different diseases and the focus of different teaching methods.Conclusions This study initiated the development of the teaching content for breast rare diseases and developed the teaching syllabus using the CBL+PBL+RBL integrated multi teaching model and targeting each rare breast disease for the critical point for teaching.

Objective:To observe the short-term efficacy of sub-Tenon’s triamcinolone acetonide (TA) in the treatment of cystoid macular edema (CME) after cataract surgery.Methods:A retrospective study. From October 1, 2013 to October 1, 2018, 21 patients (21 eyes) with CME after cataract surgery diagnosed at The Affiliated Eye Hospital of Wenzhou Medical University were included in this study. All eyes underwent BCVA, intraocular pressure, frequency domain OCT examination. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity when recorded. A frequency domain OCT instrument was used to measure the foveal retinal thickness (CRT). Among 21 eyes of 21 patients, 9 eyes were male and 12 eyes were female; the average age was 66.38±10.88 years. The average logMAR BCVA was 0.46±0.23; the average CRT was 519.90±131.59 μm; the average intraocular pressure was 11.01±3.97 mmHg (1 mmHg=0.133 kPa). All eyes underwent a single treatment of 100 mg/ml TA suspension 0.4 ml (containing TA 40 mg) under Tenon's capsule. The average follow-up time after treatment was 32.86±20.2 days. The changes of BCVA, CRT and intraocular pressure were observed 1 month after treatment. The BCVA, CRT and intraocular pressure before and after treatment were compared by paired t test. Results:One month after treatment, the average logMAR BCVA, CRT, and intraocular pressure of the CME eyes were 0.29±0.22, 307.71±35.82 μm and 14.19±6.30 mmHg, respectively. Compared with those before treatment, the differences were statistically significant ( t=5.252, 8.166, 4.128; P=0.000, 0.000, 0.001). Among 21 eyes, 13 eyes (61.90%) of the retinal cysts in the macular area completely disappeared; 8 eyes (38.1%) were still visible between the retinal layers. Three eyes with intraocular pressure over than 21 mmHg were treated with lowering intraocular pressure and returned to normal. Conclusion:Sub-Tenon’s capsular injection of TA to treat CME after cataract surgery can reduce CRT and improve vision in a short time.

Objective To explore the feasibility of intelligent spatiotemporal image correlation-fetal heart navigator(iSTIC-FHN) in the display of the ductal arch view in normal fetuses ,and to compare two-dimensional echocardiography( 2DE) and iSTIC-FHN based measures of ductus arteriosus( DA ) in normal fetuses . Methods Two hundred and eleven normal fetuses with gestational age of 22 - 32 weeks were enrolled . Each fetus had undergone conventional 2DE examination and the iSTIC fetal cardiac volumes were obtained .The volume datasets were analyzed offline using new automatic software ( the Fetal Heart Navigator ,FHN ) . The diameter of DA were measured by 2DE and iSTIC based FHN ,respectively . Pearson's correlation analysis was used to examine the relation between gestational age and diameter of DA for both 2DE and iSTIC-FHN . The measurement of the diameters of ductus arteriosus by two methods were compared . Results The ductal arch view using FHN was successfully obtained in 165(78 .2％ ) cases among 211 normal cases . The comparison of 2DE and iSTIC-FHN in the measurement of the DA was made in 131(62 .1％ ) normal fetuses . Mean 2DE DA increased from ( 3 .00 ± 0 .23) mm at 22 weeks to ( 5 .42 ± 0 .26) mm at 32 weeks . Mean iSTIC-FHN DA increased from ( 2 .96 ± 0 .21) mm at 22 weeks to ( 5 .36 ± 0 .17) mm at 32 weeks . There was a good correlation between the two methods ( Pearson's R 2 = 0 .942 ,P =0 .539) . Bland-Altman plot showed the 95％ limits of agreement was ( - 0 .3287 ,0 .3111) . Conclusions iSTIC-FHN is the potential tool for the evaluation of the ductal arch view .

Objective To improve the imaging diagnostic performance by analyzing US and CT findings of pancreatoblastoma in children. Methods From January 2000 to December 2016, 9 patients with pancreatoblastoma proven pathologically were enrolled in the study. The clinical and imaging features in 9 cases were analyzed retrospectively, the tumor parameters compared with intraoperative and postoperative pathology were location, size, texture, capsule, calcification, adjacent organs invasion and lymph node metastasis. The parameter of tumor size was evaluated by intraclass correlation coefficient. Results The tumor diameter ranged from 30-95 mm (median diameter 40 mm). Six tumors located in the head of the pancreas, 3 tumors located in the body and tail of the pancreas. One tumor was pure cystic, 2 tumors were solid and cystic mixed, 5 tumors were solid. Calcification was seen in 5 cases. Capsule was seen in 5 cases. Blood vessels, biliary tract and bowel around tumors were infiltrated by tumors in 3 cases proven by the pathology. Lymphadenectasis was seen in 2 cases, in which 1 case was metastasis. There were no significant differences in location, nature, calcification on US and CT. The largest diameter measured by CT and US was consistent with the tumor''s actual size, ICC=0.90.Capsule was shown by US in 5 cases and CT in 3 cases. CT showed the morphology of calcification in 5 cases, lymphadenectasis in 2 cases, abdominal effusion in 2 cases, cavernous transformation of the portal vein with the extensive collaterals in 1 case, which were not shown by US. Both US and CT dit not show the surrounding tissue infiltrated by tumors in 3 cases,but showed biliary system expansion. Conclusions The typical pancreatoblastoma manifested as encapsulated solid tumor originated in the pancreas with necrosis and calcification. US examination took a slight advantage on displaying capsule of tumor than CT. CT was more clear and intuitive in showing calcification and relationship between tumor with surrounding tissues and lymph node, and no operator dependent.

Objective To evaluate the effects of intra-aortic balloon counterpulsation (IABP) on mortality of patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI).Methods Randomized controlled trials (RCTs) of IABP compared with non-IABP control in AMI patients, from January 1970 to May 2015, were searched from MEDLINE, Embase and Web of Science.The data were analyzed with software RevMan 5.0.Results Five RCTs involving 1 450 AMI patients, including 722 treated with IABP (IABP group) and 728 without IABP (non-IABP group), were included for analysis.Compared with non-IABP group, IABP did not significantly decrease the hospital mortality or 30-day mortality (OR=0.92, 95%CI: 0.69-1.25,P=0.61).According to the timing of IABP before or after PCI, it was further divided into IABP-before-PCI subgroup and IABP-after-PCI subgroup.Compared with non-IABP group, the 30-day mortality was not decreased in IABP-before-PCI subgroup or in IABP-after-PCI subgroup (OR=0.64, 95%CI: 0.23-1.78,P=0.39;OR=1.25, 95%CI: 0.42-3.77,P=0.69, respectively).According to complicating with cardiogenic shock (CS) or not, patients were divided to AMI with CS subgroup and AMI with no-CS subgroup;the hospital or 30-day mortality were not significantly decreased in both subgroups (OR=0.96, 95%CI: 0.70-1.32,P=0.80;OR=0.68, 95%CI: 0.28-1.70,P=0.27, respectively).Conclusion IABP does not decrease the 30-day mortality of AMI patients treated with PCI.

Objective To investigate the effect of Ruin nutrient solution combined with dietary education on the postoperative patients with gastrointestinal neoplasms.Methods 88 patients with gastrointestinal neoplasms in Hangzhou tumor hospital from January 2016 to January 2017 were randomly divided into the control group(44 cases) and the observation group(44 cases).The control group were given the early stage total parenteral nutrition.The observation group were received the early stage enteral nutrition and dietary education.The recovery time, the occurrence of complications and the hospitalization time and hospitalization expenses were compared in the two groups.Results After the intervention, the recovery time of bowel sounds and recovery time of anal in the observation group were less than those in the control group, the difference was statistically significant(P<0.05);the incidence of complications in the observation group was lower than that in the control group(P<0.05).The hospitalization time and hospitalization cost in the observation group were better than those in the control group, the difference was statistically significant(P<0.05).Conclusion The combination of Ruin nutrient solution and dietary education is effective on the treatment of the postoperative patients with gastrointestinal neoplasms, which can effectively promote the recovery of intestinal function and reduce the incidence of complications, accelerate the rehabilitation of patients and deserve to be further promoted in clinic application.

Objective To evaluate the effect of conversion from mycophenolic acid (MPA) to mizoribine (MZR) in renal transplant recipients with gastrointestinal tract (GI) symptoms.Methods A total of 355 renal transplant recipients with GI symptoms caused by MPA administration were enrolled from April 2015 to March 2017 in 25 different renal transplant centers in China.The symptomatic improvement of GI before (baseline) and after conversion to MZR (1,2,4 weeks) was assessed by each item of GI symptoms indication.In addition,the efficacy and safety of the conversion therapy during 12 months were determined.Results Patients showed improvement in GI symptoms including diarrhea,abdominal pain,abdominal distention and stomachache after conversion to MZR 1,2,4 weeks (P＜0.05).In patients with different severity of diarrhea,conversion to MZR therapy significantly improved diarrhea (P＜0.05).During 12 months,no patient experienced clinical immune rejection.We did not observe any infections,leucopenia and other serious side effects.Conclusion MZR could markedly improve GI symptoms caused by MPA administration in renal transplant recipients.

Objective To investigate the effects of salinomycin on the cell proliferation and epithelial-mesenchymal transition (EMT) of MCF-7 mammosphere (MCF-7 MS). Methods Breast cancer MCF-7 cells were cultured in suspension in serum-free medium to obtain MCF-7 MS. The cell viability of MCF-7 MS cells treated with serial concentrations of 0, 10, 30, 100, 300, 1 000, 3 000 and 10 000 nmol/L of salinomycin for 24 hours were detected by CCK-8 assay. The half maximal inhibitory concentration (IC50) was calculated. Western blot analysis was performed to detect the expression levels of E-cadherin and Snail in MCF-7 MS cells treated with 30 nmol/L and 60 nmol/L salinomycin. The same capacity of DMSO was added to MCF-7 MS as control group. The xenograft tumors from MCF-7 MS transplant mice were divided into control group (the same capacity of normal saline) and salinomycin group (5 mg/kg salinomycin), then the expressions of E-cadherin and Snail were dectected by immunohistochemical staining. Results With the increased concentration of salinomycin, the cell survival rate of MCF-7 MS cells decreased (P<0.05). The IC50 after 24 h-treatment was 989 nmol/L. Both 30 and 60 nmol/L of salinomycin increased the expression of E-cadherin and decreased the expression of Snail compared with control group. In addition, 60 nmol/L treatment group showed more significant effect (P<0.05). In xenograft tumors from MCF-7 MS transplant mice, the expression of Snail decreased, and E-cadherin increased in salinomycin treatment group compared with control group (P<0.01). Conclusion Salinomycin can inhibit the cell proliferation and EMT in MCF-7 MS cells, which is a potential drug to target cancer stem cells.

Objective To evaluate the concordance of two-dimensional echocardiography (2DE) and intelligent spatiotemporal image correlation (iSTIC) in measuring fetal aortic and aortic arch diameters during the second and third trimesters.Methods Data were collected by a prospective cross-sectional study of 140 normal singleton fetuses with the gestational age from 22 to 32 weeks.A total of 6 dimensions of the fetal aortic and aortic arch,including aortic annular diameter (AO),ascending aorta diameter (AAO),aortic arch diameter [AO Arch (INA to LCCA)],aortic arch diameter [AO Arch (LCCA to LSA)],aortic isthmus diameter and descending aorta diameter (DAO),were measured by two different methods.Concordance was assessed by comparing the measurements acquired by iSTIC with those determined by 2DE and depicted by Bland-Altman plots.Inter-and intra-observer variability was evaluated by the intraclass correlation coefficient (ICC) test.Results A total of 137 iSTIC volumes in 140 cases were found to be suitable for further analysis.Good correlation was observed in the measurements that determined by 2D or iSTIC (Pearson's R2 =0.977-0.983).There was no significant difference in the mean values of all the parameters that measured by two methods.Bland-Altman plot showed that the 95％ limits of agreement (LOA) in AO,AAO,AO Arch (INA to LCCA),AO Arch (LCCA to LSA),aortic isthmus diameter and DAO were (-0.1260/+ 0.2299),(-0.1707/+ 0.2241),(-0.1547/+ 0.2190),(-0.1736/+ 0.2024),(-0.1514/+ 0.2039) and (-0.1485/+ 0.2228),respectively.The points in the outside of LOA were 5.11％ (7/137),4.38％ (6/137),5.11％ (7/137),5.84％ (8/137),4.38％ (6/137)and 4.38％ (6/137),respectively.Conclusions iSTIC has a good agreement with 2DE in measuring fetal aortic and aortic arch dimensions during the second and third trimesters.

Objective To evaluate the effects of intra-aortic balloon counterpulsation (IABP) on mortality in patients with acute myocardial infarction according to the type of revascularization.Methods Recruited randomized controlled trials of IABP compared with no-IABP controls in acute myocardial infarction patients from January 1970 to May 2015 were searched from Medline,Embase and Cochrane Library,according to inclusion criteria and exclusion criteria.These data were analyzed using the methods recommended by the Cochrane Collaboration's software RevMan 5.0.Revascularization included thrombolytic therapy,percutaneous coronary intervention (PCI),or coronary artery bypass grafting.Results (1) Eleven randomized controlled trials were enrolled for analysis with 1 102 patients in IABP group,1 123 in no-IABP control group.(2) Compared with no-IABP control group,IABP could not significantly decrease the in-hospital or 30 day mortality (OR =0.84,95％ CI 0.65-1.09,P =0.20).(3) Compared with no-IABP control group,IABP could not significantly decrease the in-hospital or 30 day mortality in thrombolytic patients(OR =0.64,95％ CI 0.25-1.61,P =0.34),in PCI patients (OR =0.89,95％ CI 0.68-1.18,P =0.42),and in coronary artery bypass grafting patients (OR =0.46,95％ CI 0.13-1.63,P =0.23).(4) The difference reached borderline signiicance between no-IABP control group and IABP group in patients using IABP before PCI(OR =0.47,95％ CI 0.22-1.00,P =0.05),but not in case of after PCI(OR =1.33,95％ CI 0.63-2.79,P =0.45).Conclusions IABP does not decrease the in-hospital or 30 day mortality of acute myocardial infarction patients who received thrombolytic therapy,PCI,or coronary artery bypass grafting.But IABP might decreases the in-hospital or 30 day mortality in patients when used before PCI.