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 explore the application effects of the mode of "Multidisciplinary integration, Doctors & patients co-teaching, Simulated practice" in the teaching of spinal surgery.Methods:A total of 64 eight-year program clinical medical students who practiced in Peking Union Medical College Hospital in 2021 were taken as research objects and randomly divided into experimental group ( n=33) and control group ( n=31). The experimental group received the new teaching mode of "Multidisciplinary integration, Doctors & patients co-teaching, Simulated practice", and the control group received regular teaching mode. At the end of teaching, the teaching effects were evaluated from several aspects, including the scores of theoretical examinations, anatomical marks identification tests, and anonymous questionnaires. SPSS 22.0 software was used for paired t-test and two independent-samples t-test. Results:The theoretical test scores [(51.25±6.99) points] and anatomical structure identification scores [(37.56±1.83) points] of the experimental group were higher than those of the control group [(42.46±6.13) points and (30.37±3.46) points], and the differences were statistically significant ( P<0.001). The effective recovery rate of the questionnaire was 100%. The results of the questionnaire showed that the experimental group was significantly higher than the control group in terms of teaching attractiveness, attention, learning interest, learning efficiency, anatomical identification ability, problem-finding and problem-solving ability and overall teaching method satisfaction ( P<0.05). Conclusion:The teaching mode of "Multidisciplinary integration, Doctors & patients co-teaching, Simulated practice" can effectively improve students' theoretical knowledge, learning interest, learning efficiency, operation proficiency and problem-finding and problem-solving ability, which is worth promoting.

ObjectiveTo compare the differences in resistance and structure of skin between acupoints and non-acupoints， and to study the difference in skin permeability characteristics of Corydalis Rhizoma total alkaloid patches （CTTP） after administration at Shenque acupoint and non-acupoint， so as to provide experimental support for its clinical acupoint application to prevent and treat chronic pain. MethodTaking corydaline （CD）， tetrahydropalmatine （THP） and corydalis L （CDL） as evaluation indexes， and the quantitative analysis was carried out by high performance liquid chromatography （HPLC）. The mobile phase was methanol-0.04 mol·L^-1 phosphoric acid aqueous solution （70∶30， pH 6.0 adjusted with triethylamine）， the detection wavelength was 281 nm. In vitro transdermal test in Franz diffusion cell and in vivo transdermal test were used to study the skin permeability characteristics of CTTP through Shenque acupoint and non-acupoint administration. At the same time， the skin resistance between Shenque acupoint and non-acupoint was measured before and after the administration， and the distribution of the drug in each layer of the skin was compared by freezing sectioning， and visual verification was performed with fluorescence inverted microscope. ResultAfter 24 h of administration， the results of in vivo and in vitro experiments showed that the cumulative permeation and retention of CD， THP and CDL at Shenque acupoint skin were higher than those at non-acupoint skin （P<0.05， P<0.01）， the skin resistance of Shenque acupoint was lower than that of non-acupoint at all time points. The fluorescence microscopic observation results showed that the drug content of each layer of the skin was all Shenque acupoint>non-acupoint， indicating that the skin of Shenque acupoint had better effect on drug penetration and storage than non-acupoint. ConclusionThe 24 h cumulative permeation and retention of CTTP in Shenque acupoint skin are higher than those in non-acupoint skin， and the mechanism may be related to the thin skin， low electrical resistance and large number of hair follicle bodies at Shenque acupoint.

Objective:To compare the clinical efficacy of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 71 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from May 2018 to May 2020. There were 52 males and 19 females, with age range of 22-54 years［(41.0±7.8)years］. Of all, 33 patients were treated with robot-assisted percutaneous screw implantation (Group A) and 38 patients were treated with free-hand open screw implantation by Wiltse approach (Group B). Following parameters were measured, including frequency of radiation exposure, operation time, intraoperative blood loss, length of hospital stay, incidence of complications, rate of fracture healing at 3 months and 6 months postoperatively, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at 3 days, 3 months, 6 months postoperatively and at the last follow-up, anterior vertebral body height ratio and sagittal Cobb angle preoperatively, at 3 days postoperatively and at the last follow-up, and rate of screw implantation of grade A and B and rate of facet joint violation at 3 days postoperatively.Results:All patients were followed up for 10-24 months［(15.2±4.4)months］. Frequency of radiation exposure and operation time showed no statistical differences between the two groups (both P>0.05). Intraoperative blood loss was 100(100, 135)ml in Group A, less than 160(120, 200)ml in Group B ( P<0.01). Length of hospital stay was 8(7, 11) days in Group A, shorter than 12(10, 16)days in Group B ( P<0.01). There were no complications such as infection, spinal nerve injury or cerebrospinal fluid leakage in both group. There were no significant differences between the two groups in the rate of fracture healing at 3 and 6 months postoperatively (all P>0.05). VAS and ODI in Group A was 3(2, 4)points and 21(18, 23)points at 3 days postoperatively, lower than 4 (3, 5)points and 27(20, 32)points in Group B ( P<0.05 or 0.01), and the two groups showed no significant differences in VAS and ODI at other time points (all P>0.05). There were no significant difference in the anterior vertebral body height ratio or sagittal Cobb angle between the two groups at 3 days postoperatively and at the last follow-up (all P>0.05). Rate of screw implantation of grade A and B was 96.5% (191/198) in Group A, higher than 90.4% (206/228) in Group B ( P<0.05). Rate of facet joint violation was 4.0%(8/198) in Group A, lower than 11.8% (27/228) in Group B ( P<0.01). Conclusion:For thoracolumbar fracture, robot-assisted percutaneous screw implantation is superior to free-hand open screw implantation by Wiltse approach in terms of less bleeding, shorter hospitalization, earlier pain alleviation, higher accuracy of screw implantation and lower risk of facet joint violation.

Diabetes mellitus is one of the most common complications after liver transplantation. The survival rate of recipients after liver transplantation with diabetes mellitus and the long-term survival rate of grafts are significantly lower than those of their counterparts without diabetes mellitus. In recent years, diabetes mellitus after liver transplantation has attracted widespread attention along with the rapid development of liver transplantation in China. Although post-transplantation diabetes mellitus (PTDM) has been extensively investigated in the past two decades, multiple problems remain to be further resolved. The study was designed to review the latest research progress upon diabetes mellitus after liver transplantation, covering the definition and diagnostic criteria of PTDM, risk factors, prevention and treatment of diabetes mellitus after liver transplantation, aiming to deepen the understanding of diabetes mellitus following liver transplantation, deliver effective prevention and management, improve the long-term survival rate and enhance the quality of life of the recipients.

Objective To explore the correlation between childhood obesity and adult metabolic diseases. Methods A total of 3 542 people who underwent physical examination in the General Hospital of Fuming from January 2018 to January 2019 were selected as research subjects. They were divided into childhood obesity group and control group according to the childhood body mass index (BMI). Single factor and multivariate logistic regression analysis were performed on relevant factors that may affect adult metabolic diseases by comparing clinical data with laboratory parameters. Results A total of 113 adult patients with metabolic diseases were found in the control group, with an incidence rate of 4.56%. In the childhood obesity group, 322 adult patients with metabolic diseases were found, with an incidence rate of 30.32%. The incidence of adult metabolic diseases in the childhood obesity group was significantly higher than that of the control group, while the HDL-C level in the childhood obesity group was significantly lower than that in the control group. The differences were statistically significant (P<0.05). Univariate analysis showed that the gender and childhood obesity were significantly correlated to adult metabolic diseases (P<0.05). Multivariate logistic regression analysis showed that the childhood obesity was an independent risk factor for adult metabolic diseases (P<0.05). Conclusion There was a difference in the incidence of adult metabolic diseases and laboratory indicators in the adulthood between childhood obese patients and childhood non-obese patients. Childhood obesity is an independent risk factor for adult metabolic diseases.

Objective To explore the feasibility and guiding value of point-of-care ultrasound (PoCUS) in evaluating gastric residual volume (GRV) in the course of implementing enteral nutrition (EN) in patients with neurological critical illness. Methods Ninety patients with critical neurological diseases necessary for EN were admitted to the Department of Intensive Care Unit (ICU) of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine from March 1, 2017 to September 30, 2018 were selected, and they were randomly divided into a GRV extraction group (control group) and a PoCUS GRV group (study group), 45 patients in each group. Both groups were fed with Ruidai nutrient solution by nasogastric pump at a rate of 18 hours per day to persistently administer the target feeding volume for consecutive 7 days. The differences in tolerance of EN, the incidence of feeding interruption, the daily volume of EN fluid, the ratio of reaching total enteral nutrition (TEN) and the levels of serum albumin (Alb), prealbumin (PA) and prognosis were compared between the two groups. Results The incidences of reflux and wrong aspiration in the study group were significantly lower than those in the control group [8.9% (4/45) vs. 24.4% (11/45) and 4.4% (2/45) vs. 17.8% (8/45), both P < 0.05]. The EN liquid volume, ratio of reaching TEN, Alb and PA levels in the study group were significantly higher than those in the control group [EN liquid volume (mL/d): 944.6±277.1 vs. 783.7±230.5, the ratio of TEN: 86.7% (39/45) vs. 68.9% (31/45), Alb (g/L): 30.6±3.0 vs. 29.4±2.4, PA (g/L): 280.5±31.8 vs. 267.7±28.4, all P < 0.05]. The incidence of diarrhea [15.6% (7/45) vs. 13.3% (6/45)], the incidence of feeding interruption [8.9% (4/45) vs. 13.3% (6/45)], the length of stay in ICU (days: 10.4±6.2 vs. 8.3 ±5.4), the mortality [8.9% (4/45) vs. 13.3% (6/45)] had no significant differences between the two groups (all P > 0.05). Conclusion Evaluating GRV by PoCUS to adjust EN implementation plan can reduce the incidences of reflux and wrong aspiration and increase the EN intake.

Objective To study the effects of ShenhongTongluo Granules on blood lipids, inflammatory related factors and oxidative stress-related indexes in rabbit atherosclerosis model, and to explore the mechanism of Shenhongtongluo Granules on atherosclerosis. Methods 70 healthy male New Zealand white rabbits were randomly divided into blank control group, model group, aspirin combined with simvastatin group, aspirin group, simvastatin group, Shenhongtongluo Granule prevention group, and Shenhongtongluo Granule treatment group. The rabbit atherosclerosis model was established by lipidforage diet combined with immune stimulation, and the blank group was fed with commonforage. The Shenhongtongluo Granule prevention group was given Shenhongtongluo Granule at the beginning of modeling, and the other intervention groups were given the corresponding drugs after the successful modeling. Before and after modeling, lipid changes were checked in each group, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), superoxide dismutase activity (SOD) and malondialde-hyde (MDA) in the serum. The aorta of the model group was separated and oil red O staining was performed to observe the pathological and morphological changes of the aorta. Western blotting and reverse transcription polymerase chain reaction (RT-PCR) were used to detect the expression of Nox4 and p22phox. Western blotting was used to detect the expression of TLR4 and NF-κB protein in aorta. Results Twelve weeks after modeling, atheromatous plaques were obviously observed on the aorta stained with oil red O, indicating successful atherosclerosis modeling. Compared with the blank control group, TC, TG, and LDL-C in the serum of the atherosclerosis model group were significantly increased (all P<0.05). Compared with the model group, the atherosclerotic plaques in the Shenhongtongluo Granule prevention and the treatment groups were significantly reduced , the levels of TC , TG , LDL-C in serum were decreased, and the levels of SOD were increased, and MDA levels were reduced (all P<0.05). The expressions of TLR4, NF-κB, Nox4, and p22phox in the aorta of Shenhongtongluo Granule prevention group were significantly reduced (all P<0.05). Conclusions Shenhongtongluo Granules can inhibit the formation of atheromatous plaques, have a good effect on regulating blood lipids, and can improve the ability of anti-oxidative stress, and have a good preventive and therapeutic effect.

Heparinases can produce biologically active oligosaccharides by specifically cleaving the α-(1,4) glycosidic linkages of heparin and heparan sulphate. Heparinases are divided into heparinase and heparanase. Because heparinase is an effective biocatalyst, more and more researchers pay attention to the application of heparinase in medical field in the recent years. Combined with the related research work in our group, the application value of heparinase in the medical field was summarized, such as the determination of the structure of heparin, the preparation of low-molecular-weight heparin and ultra-low-molecular-weight heparin, tumor therapy and as a heparin antagonist. In addition, we summarized the definition, source of heparinase and its application in the medicine field. Heparinases have a great application prospect in the field of medicine.
Heparin ; Heparin Lyase ; metabolism ; Heparitin Sulfate ; Oligosaccharides ; Polysaccharide-Lyases

Objective To evaluate the clinical effectiveness of 5-aminolaevulinic acid (ALA)-based photodynamic therapy (PDT) for the treatment of moderate to severe acne vulgaris.Methods From January to June 2013,a total of 43 patients with moderate to severe acne vulgaris were treated by 5 aminolaevulinic acid based PDT with red light.All patients were received three times of treatment at 2-week intervals.Clinical assessment was conducted before and at 2,4,6 and 8 weeks after treatment.Results The lesion counts of both inflammatory and non-inflammatory lesions were reduced significantly after treatment.The mean percentage reduction in inflammatory lesions was 88.9 ％ at 8 weeks after the treatment,meanwhile that in non-inflammatory lesions was 73.4％.After 8 weeks of treatment,55.8％ patients (24/43)showed clinical cure,and 41.9％ patients (18/43)showed excellent response and 2.3％ patient (1/43) showed good response.Only 4.7％ patients (2/43)showed signs of recurrence after 4 months after ALA-PDT.After one course of ALA-PDT,the symptoms in this recurrent case were significant improvement.The common adverse effects included pain,edema and transient hyperpigmentation.They could gradually disappear without a need of special intervention.Conclusions ALA-PDT is a safe and effective therapeutic option for the treatment of moderate to severe acne vulgaris.