Extramedullary plasmacytoma(EMP)is a malignant neoplasm characterized by monoclonal plasma cell proliferation originating outside the bone marrow and hematopoietic tissues.The co-occurrence of multiple myeloma(MM)with mammary EMP is clinically rare.This case report describes the diagnostic and therapeutic management of a middle-aged female patient with MM and mammary EMP,accompanied by a litera-ture review.The patient presented with persistent fever and was found to have a right breast mass via PET/CT during routine follow-up for MM.The lesion was biopsy-confirmed as mammary EMP,and the patient subse-quently underwent chemotherapy.This case highlights the critical importance of differential diagnosis between breast cancer and rare hematologic metastatic tumors in early prevention of disease progression.

Objective Pelvic fracture urethral distraction defect(PFUDD)is relatively rare among boys and difficult to manage.This study aims to explore the efficacy of progressive urethral anastomosis in the treatment of this disease.Methods A total of 34 male children with PFUDD who were admitted to our hospitals during Jan.2008 and Dec.2022 were collected.The therapeutic effects and the occurrence of postoperative complications were observed and analyzed.Results All cases were traumatic pelvic fractures,including fall injuries in 3 cases,traffic-related impact injuries in 21 cases,and pelvic crush injuries in 10 cases.Urethroplasty was performed at least 3 months after the initial trauma or after the failure of the last intervention.The mean length of the urethral defect was 3.0 cm,with a range of 1.5 to 5.5 cm.Three cases complicated with urethrorectal fistula underwent urethroplasty concomitant with fistula repair.All children were followed up for an average of 65.5 months,with a range of 5.0 to 155.0 months,with 32 cases(94.1％)achieving successful treatment.Two cases with stricture recurrence were cured by a second operation.Three cases with mild urinary incontinence were improved after half a year of pelvic floor muscle rehabilitation training.Conclusion The progressive urethral anastomosis strategy can yield a relatively high success rate.The trans-inferior-pubic resection or simpler approaches can be adopted for the treatment of PFUDD in over 90％of male children.

AIM:To investigate the impact of es-ketamine-mediated opioid-free anesthesia(OFA)on postoperative gastrointestinal function in patients undergoing laparoscopic distal gastrectomy for gas-tric cancer.METHODS:A total of 150 pa-tients,scheduled for elective laparoscopic distal gas-trectomy for gastric cancer and meeting the inclu-sion and exclusion criteria,were randomly assigned to either the OFA group or the opioid-based anes-thesia(OBA)group using a random number ta-ble,with 75 patients in each group.The OFA group was administered an anesthesia regimen pri-marily consisting of esketamine,while the OBA group received conventional opioid anesthesia,pri-marily consisting of sufentanil and remifentanil.The primary outcome measure was postoperative flatus time,defined as the interval from the end of sur-gery to the first passage of gas.RESULTS:The OFA group exhibited a shorter postoperative flatus time compared to the OBA group(P＜0.01).Intraopera-tive blood loss and norepinephrine consumption were significantly less in the OFA group compared to the OBA group(P＜0.05);the postoperative HADS-D score was better in the OFA group than in the OBA group,and both the OFA and OBA groups showed significantly lower postoperative HADS-A and HADS-D scores compared to their preoperative levels(P＜0.05);the incidence rate of abdominal distension was significantly lower in the OFA group compared to the OBA group(P＜0.05).CONCLUSION:The use of esketamine-mediated opioid-free anesthesia can expedite gastrointestinal function recovery,reduce hospital stay duration,and decrease postoperative adverse reactions in patients undergoing laparo-scopic distal gastrectomy for gastric cancer.

AIM:To investigate the impact of es-ketamine-mediated opioid-free anesthesia(OFA)on postoperative gastrointestinal function in patients undergoing laparoscopic distal gastrectomy for gas-tric cancer.METHODS:A total of 150 pa-tients,scheduled for elective laparoscopic distal gas-trectomy for gastric cancer and meeting the inclu-sion and exclusion criteria,were randomly assigned to either the OFA group or the opioid-based anes-thesia(OBA)group using a random number ta-ble,with 75 patients in each group.The OFA group was administered an anesthesia regimen pri-marily consisting of esketamine,while the OBA group received conventional opioid anesthesia,pri-marily consisting of sufentanil and remifentanil.The primary outcome measure was postoperative flatus time,defined as the interval from the end of sur-gery to the first passage of gas.RESULTS:The OFA group exhibited a shorter postoperative flatus time compared to the OBA group(P＜0.01).Intraopera-tive blood loss and norepinephrine consumption were significantly less in the OFA group compared to the OBA group(P＜0.05);the postoperative HADS-D score was better in the OFA group than in the OBA group,and both the OFA and OBA groups showed significantly lower postoperative HADS-A and HADS-D scores compared to their preoperative levels(P＜0.05);the incidence rate of abdominal distension was significantly lower in the OFA group compared to the OBA group(P＜0.05).CONCLUSION:The use of esketamine-mediated opioid-free anesthesia can expedite gastrointestinal function recovery,reduce hospital stay duration,and decrease postoperative adverse reactions in patients undergoing laparo-scopic distal gastrectomy for gastric cancer.

Extramedullary plasmacytoma(EMP)is a malignant neoplasm characterized by monoclonal plasma cell proliferation originating outside the bone marrow and hematopoietic tissues.The co-occurrence of multiple myeloma(MM)with mammary EMP is clinically rare.This case report describes the diagnostic and therapeutic management of a middle-aged female patient with MM and mammary EMP,accompanied by a litera-ture review.The patient presented with persistent fever and was found to have a right breast mass via PET/CT during routine follow-up for MM.The lesion was biopsy-confirmed as mammary EMP,and the patient subse-quently underwent chemotherapy.This case highlights the critical importance of differential diagnosis between breast cancer and rare hematologic metastatic tumors in early prevention of disease progression.

Objective Pelvic fracture urethral distraction defect(PFUDD)is relatively rare among boys and difficult to manage.This study aims to explore the efficacy of progressive urethral anastomosis in the treatment of this disease.Methods A total of 34 male children with PFUDD who were admitted to our hospitals during Jan.2008 and Dec.2022 were collected.The therapeutic effects and the occurrence of postoperative complications were observed and analyzed.Results All cases were traumatic pelvic fractures,including fall injuries in 3 cases,traffic-related impact injuries in 21 cases,and pelvic crush injuries in 10 cases.Urethroplasty was performed at least 3 months after the initial trauma or after the failure of the last intervention.The mean length of the urethral defect was 3.0 cm,with a range of 1.5 to 5.5 cm.Three cases complicated with urethrorectal fistula underwent urethroplasty concomitant with fistula repair.All children were followed up for an average of 65.5 months,with a range of 5.0 to 155.0 months,with 32 cases(94.1％)achieving successful treatment.Two cases with stricture recurrence were cured by a second operation.Three cases with mild urinary incontinence were improved after half a year of pelvic floor muscle rehabilitation training.Conclusion The progressive urethral anastomosis strategy can yield a relatively high success rate.The trans-inferior-pubic resection or simpler approaches can be adopted for the treatment of PFUDD in over 90％of male children.

Objective:To explore the factors influencing lymph node metastasis and prognosis in patients with Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods:A retrospective analysis was conducted on clinical data of 239 patients with Siewert Type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction who underwent surgical treatment at Beijing Friendship Hospital, Capital Medical University, from July 2013 to December 2022. Among them, there were 204 males and 35 females. The patients′ ages ranged from 27 to 83 years, with a mean age of 63.1 years. Statistical analysis was performed using SPSS 26.0 software, with categorical data presented as n(%) and compared using χ2 tests, corrected χ2 tests, or Fisher′s exact tests. Ordinal data were expressed as frequencies and percentages and compared using rank-sum tests. Multivariate analysis was conducted using Logistic regression, and survival analysis was performed using the Cox regression model. Follow-up was conducted every 6 months, with the last follow-up conducted in November 2023. Results:Multivariate analysis identified infiltration depth ( OR=0.038, 95% CI: 0.011-0.139, P<0.001), tumor deposit ( OR=0.101, 95% CI: 0.011-0.904, P=0.040) and intravascular cancer embolus ( OR=0.234, 95% CI: 0.108-0.507, P<0.001) as independent predictors of LNM. Lymph nodes No. 1, 2, 3, 4, 7, 10, and 11 were more prone to metastasis in the abdominal cavity. Notably, Siewert Ⅲ AEG patients showed a higher metastatic rate in nodes No. 5 and No. 6 compared to Siewert Ⅱ. Mediastinal LNM was predominantly found in nodes No. 110 and No. 111 for Siewert Ⅱ AEG, with rates of 5.45% and 3.64%, respectively. A three-year survival analysis underscored LNM as a significant prognostic factor ( P=0.001). Conclusions:Siewert Ⅱ AEG patients should undergo removal of both celiac and mediastinal lymph nodes, specifically nodes No. 1, 2, 3, 4, 7, 10, 11, 110, and 111. Dissection of nodes No. 5 and No. 6 is not indicated for these patients. In contrast, Siewert Ⅲ AEG patients do not require mediastinal LND, but pyloric lymphadenectomy for nodes No.5 and No.6 is essential. The presence of LNM is associated with poorer long-term prognosis. Perioperative chemotherapy may offer a survival advantage for AEG patients.

BACKGROUND:Rapid developments in the field of bioinformatics have provided new methods for the diagnosis of osteoarthritis.Artificial neural networks have powerful data computing and classification capabilities,which have shown better performance in disease diagnosis. OBJECTIVE:To establish a new diagnostic predictive model of osteoarthritis based on artificial neural network and to verify the diagnostic value of the model in osteoarthritis with an external dataset. METHODS:The eligible osteoarthritis-related data sets were downloaded through GEO database search and divided into Train group and Test group.The gene expression matrix of the Train group was analyzed to screen the differentially expressed genes.GO and KEGG enrichment analyses were performed on the differentially expressed genes.Through Lasso regression model,support vector machine model and random forest tree model,the key genes of osteoarthritis were further identified from the differentially expressed genes.The R software"Neuralnet"package was then used to construct the osteoarthritis diagnosis model based on artificial neural network,and the model performance was evaluated by the five-fold cross-validation.Two independent data sets in the Test group were used to verify their diagnostic results. RESULTS AND CONCLUSION:A total of 90 differentially expressed genes related to osteoarthritis were obtained by differential analysis,of which 33 were down-regulated and 57 were up-regulated.GO enrichment analysis showed that the differentially expressed genes were mainly involved in the following biological processes,including leukocyte-mediated immunity,leukocyte migration in bone marrow and chemokine production.KEGG enrichment analysis showed that these genes were mainly enriched in rheumatoid arthritis,interleukin-17 signaling pathway and osteoclast differentiation pathway.Five key genes for the diagnosis of osteoarthritis,HMGB2,GADD45A,SLC19A2,TPPP3 and FOLR2,were identified by three machine learning methods.The artificial neural network model of five key genes in the Train group showed that the accuracy was 96.36%and the area under the curve was 0.997.The five-fold cross validation of the neural network model showed that the average area under the curve was greater than 0.9 and the model was of robustness.Two independent data sets in the Test group showed its area under the curve was 0.814 and 0.788 respectively.Therefore,the establishment of an artificial neural network model for the diagnosis of osteoarthritis has a certain diagnostic value.

As a male sexual organ, the penis can not only meet the requirements for sexual life between sexual partners, but also increase and improve sexual satisfaction and enhance male self-confidence.The treatment of micropenis is a high-frequency trending topic.This paper reviews the different causes of micropenis, the treatment methods and progress of "penile elongation, " aiming to improve the understanding and provide solutions.

Anlotinib has strong antiangiogenic effects and leads to vessel normalization.However,the"window period"characteristic in regulating vessel normalization by anlotinib cannot fully explain the long-term survival benefits achieved through combining it with other drugs.In this study,through RNA sequencing(RNA-seq)and label-free quantitative proteomics analysis,we discovered that anlotinib regulated the expression of components of the extracellular matrix(ECM),leading to a significant reduction in ECM stiffness.Our bioinformatic analysis revealed a potential positive relationship between the ECM pathway and gefitinib resistance,poor treatment outcomes for programmed death 1(PD-1)targeting,and unfavourable prognosis following chemotherapy in lung cancer patients.We administered anlotinib in combination with these antitumour drugs and visualized their distribution using fluorescent labelling in various tumour types.Notably,our results demonstrated that anlotinib prolonged the retention time and distribution of antitumour drugs at the tumour site.Moreover,the combination therapy induced notable loosening of the tumour tissue structure.This reduction was associated with decreased interstitial fluid pressure and tumour solid pressure.Additionally,we observed that anlotinib effectively suppressed the Ras homologue family member A(RhoA)/Rho-associated protein kinase(ROCK)signalling pathway.These findings suggest that,in addition to its antiangiogenic and vessel normalization effects,anlotinib can increase the distribution and retention of antitumour drugs in tumours by modulating ECM expression and physical properties through the RhoA/ROCK signalling pathway.These valuable insights contribute to the development of combination therapies aimed at improving tumour targeting in cancer treatment.