In the past, aortic dissection, aortic aneurysm, and other aortic diseases, primarily rely on surgical intervention. In recent years, due to breakthroughs in materials science, endovascular therapy has become the first choice for the surgical treatment of most aortic diseases. However, traditional endovascular repair cannot fully meet the clinical needs for certain complex lesions involving the aortic arch and the originations of visceral arteries. The emergence of physician-modified stent technology has brought new hope for the treatment of complex aortic diseases. This article provides a detailed introduction to the concept, development, technical characteristics, and applications of physician-modified stents in the treatment of aortic diseases, analyzing their advantages and limitations. Physician-modified stents serve as a powerful complement to traditional endovascular interventions and commercial branched stents, yet further research and refinement are still required.

This article reports a case of peritoneal dialysis (PD)-associated peritonitis caused by Streptococcus dysgalactiae subspecies dysgalactiae. The patient was an elderly female with a previous diagnosis of anti-neutrophil cytoplasmic antibody-associated vasculitis with renal involvement and chronic kidney disease stage 5. She had been receiving regular PD therapy for 8 years. She was admitted to the hospital due to abdominal pain and cloudy peritoneal dialysate for 10 hours, and the peritoneal dialysate culture result was positive for Streptococcus dysgalactiae subspecies dysgalactiae. She was treated with intraperitoneal vancomycin and intravenous ampicillin for anti-infection, but the therapeutic effect was poor. Therefore, the PD catheter was removed and the patient was discharged after the condition was improved.

This article reports a case of peritoneal dialysis (PD)-associated peritonitis caused by Streptococcus dysgalactiae subspecies dysgalactiae. The patient was an elderly female with a previous diagnosis of anti-neutrophil cytoplasmic antibody-associated vasculitis with renal involvement and chronic kidney disease stage 5. She had been receiving regular PD therapy for 8 years. She was admitted to the hospital due to abdominal pain and cloudy peritoneal dialysate for 10 hours, and the peritoneal dialysate culture result was positive for Streptococcus dysgalactiae subspecies dysgalactiae. She was treated with intraperitoneal vancomycin and intravenous ampicillin for anti-infection, but the therapeutic effect was poor. Therefore, the PD catheter was removed and the patient was discharged after the condition was improved.

Objective:To summarise and analyse the experience in the diagnosis and management of abdominal aortic endograft infection in recent years.Methods:Retrospectively summarised and analysed the general data, clinical presentation, laboratory and imaging findings, causative organisms and treatment choices of 14 patients with abdominal aortic endograft infection treated in Beijing Friendship Hospital, Capital Medical University, from January 2018 to June 2024, and analysed the prognosis of the patients and the risk factors associated with prognosis.Results:Positive bacterial cultures were 10 out of 14 patients. One non-operatively treated patient died of infectious toxic shock. Thirteen surgically treated patients underwent axillary-bifemoral artery bypass, removal of the infected stent, and closure of the aortic stump. Four of the 13 cases had combined aortoenteric fistula, 3 cases underwent one-stage enterocutaneous fistula repair, 1 case only fistula drainage, 3 cases of gastrojejunal anastomosis, all of them underwent gastric or jejunal nutrient tube implantation. Two of the 13 patients had combined the infection foci spread to the renal artery openings. To save the kidney, intraoperative left kidney autologous renal transplantation was performed in 1 case, and autologous saphenous vein reconstruction from celiac trunk artery-left renal artery and superior mesenteric artery-right renal artery was performed in the other case. All 14 patients were retrospectively summarised and followed up in August 2024, with 5 deaths in the early postoperative period (< 3 months), 3 deaths in the mid- to long-term period (≥3 months), and 5 survivors, with a median follow-up time of 2 years (1-5 years) for surviving patients. Among the 13 operated patients, 4 cases were combined with aortoenteric fistula, and 3 cases died in the early postoperative period; 4 cases of abdominal aortic infection foci involving renal artery openings, 2 cases of early postoperative death; 4 cases with pleural effusion, 4 cases died in the early postoperative period; 2 cases of combined creatinine elevation, 2 cases of early postoperative death; 2 cases of postoperative infection of artificial blood vessels.Conclusions:Abdominal aortic endograft infection are aggressive. The risk of early death is increased in patients who are elderly, in poor general condition, with aortoenteric fistula or with pre-existing cardiac, pulmonary, hepatic and renal insufficiency, but surgery based on adequate anti-infective therapy remains an effective means of saving the patient′s life.

Purpose To analyze the impact of clinicopatho-logical factors on residual tumor burden(RCB)grading system and Miller-Payne(MP)grading system in non-specific invasive breast cancer patients after neoadjuvant chemotherapy,and to explore the predictive value of the two grading systems for patient survival.Methods The clinical data of 177 patients with non-specific invasive breast cancer diagnosed by preoperative punc-ture and treated with neoadjuvant chemotherapy were retrospec-tively analyzed.The relationship of RCB grading system or MP grading system with disease free survival(DFS)and overall sur-vival(OS)was studied,and the value of the two systems in predicting prognosis was analyzed and compared.Results RCB grading was related to menstrual status,histological grading be-fore treatment,and lymph node metastasis after treatment;MP grading was related to pre-treatment histological grading,post-treatment lymph node metastasis,and pre-treatment molecular typing.By evaluating the ROC curve of recurrence and survival and comparing the area under curve(AUC),it was shown that RCB grading system was superior to MP grading system in pre-dicting recurrence and evaluating survival.Univariate and multi-variate survival analysis showed that pre-treatment clinical stag-ing,post-treatment lymph node metastasis,and RCB grading were independent factors for DFS.Pre-treatment clinical stag-ing,pre-treatment molecular typing,and RCB grading were in-dependent factors for OS,while MP grading was not an inde-pendent factor for DFS and OS.Conclusion RCB grading sys-tem has a higher predictive value for patient survival than MP grading system.RCB grading evaluation system is recommended as evaluation system for non-specific invasive breast cancer after neoadjuvant chemotherapy.

Objective:To investigate the application effect of WeChat group combined with case-based learning (CBL) in probation teaching of vascular surgery.Methods:A total of 128 intern doctors of the seven-year medical program in vascular surgery were selected and divided into experimental group (WeChat group combined with CBL teaching) and control group (CBL teaching alone), and a unified assessment method was used to evaluate the mastery degree of professional theories and clinical knowledge and assess the teaching effect of these two teaching modes in vascular surgery. SPSS 22.0 was used to perform the t-test. Results:Compared with the control group, the experimental group had significantly higher scores of theoretical examination [(86.36±7.42) vs. (84.71±6.72)] and clinical examination [(88.44±7.62) vs. (86.22±6.41)], as well as significantly higher degrees of satisfaction with learning interest, classroom climate, self-learning ability, clinical thinking ability, and teamwork spirit.Conclusion:The teaching mode of WeChat group combined with CBL can improve the effect of the probation teaching of vascular surgery and the self-learning and clinical thinking abilities of intern doctors.

Objective: To evaluate the therapeutic effect of dental autotransplantation with the application of digital design combined with 3D printing of donor tooth models and recipient alveolar fossa model preoperatively. Methods: Twelve cases that could not be retained due to tooth fracture or extensive absorption of alveolar bone were recruited in the study. Cone-beam computed tomography (CBCT) data were imported into Mimics software for digital design, and the best-matched third molar was selected as the donor tooth. Replicas of the donor teeth and the recipient socket were printed out with three-dimensional (3D) printing technologies as a simulation model for recipient tooth socket preparation. During tooth autotransplantation, preparation of the recipient tooth socket and the donor tooth were guided by the 3D-printed replicas sequentially. Then, the donor tooth was implanted into the recipient tooth pocket. Patients were followed up at 3, 6 and 12 months after the operation, with CBCT examination to evaluate the status of bone reconstruction and periodontal ligaments at each time point. Results: Twelve patients were transplanted with an autogenous third molar with the apical foramen completely closed. Among them, 7 patients had alveolar fossa infection before the operation, of which 1 had extensive resorption of the alveolar bone due to the infection. All 12 patients recovered well after the operation and were followed up for at least 12 months. In total, 11 caseswere successful in tooth autotransplantation with normal mastication, and 1 case had root resorption 14 months postoperation. Conclusion Digital design combined with 3D printing technology can assistin the selection of thebest-matched donor tooth and preparation of the recipient socket before tooth transplantation proceduresand reduce the extra-alveolar exposure time of the donor tooth and number of trial placementsintothe alveolar fossa. Thus, this combined strategy can effectively improve the outcome of dental autotransplantation.

Objective:To investigate the influencing factors and clinical effect analysis of the choice of treatment method for spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 35 patients with SISMAD admitted to Beijing Friendship Hospital, Capital Medical University from December 2015 to November 2021 were retrospectively analyzed. They were divided into conservative group ( n=24) and surgical group (endoluminal stent group + open surgery group, n=11). The conservative group was treated with conservative methods, the endoluminal stent group ( n=10) was treated with endoluminal stent placement, and the open surgery group ( n=1) was treated with superior mesenteric artery endarterectomy + angioplasty + ileal resection. The white blood cell (WBC) count on admission, the time of abdominal pain, YOO classification, aorta mesenteric angle(AMA), and the length of hospital stay between the two groups were analyzed. All patients were followed up for more than 24 months, at the end of which the vascular remodeling rate of superior mesenteric artery (SMA) between the two groups was studied. In addition, the primary patency rate and secondary patency rate of intracavitary stents were analyzed. Measurement data that conform to normal distribution were expressed as mean ± standard deviation ( ± s), and independent samples t-test was used for comparison between groups; measurement data that do not conform to normal distribution were expressed as median (interquartile range) [ M( Q1,Q3)], the nonparametric test was used for comparison between groups. Enumeration data were compared between groups using the Chi-square test. Results:Univariate analysis showed that compared with the conservative group, the IVS type in YOO classificationin of surgical group was significantly more than the conservative group. There was no significant difference in WBC, duration of abdominal pain, or AMA at admission ( P>0.05). In addition, the length of hospital stay in the conservative group was significantly shorter than that in the surgical group. No intestinal necrosis occurred in endoluminal stent group. After 24 months of follow-up, the remodeling rate of SMA in the surgical group was higher than that in the conservative group; the primary patency rate of the endoluminal stent group was 87.5%, and the secondary patency rate was 100%. One patient in the conservative group developed SMA dissection aneurysm during 12 months of follow-up and received endovascular treatment. Conclusions:For the treatment of SISMAD, most patients can be cured by conservative treatment. However, for patients with consistent abdominal pain and IVS type in YOO classification, if there is no severe manifestation of peritonitis, it is recommended to perform endovascular stent placement as soon as possible to open the blood supply. Meanwhile, the SMA stenting has an ideal long-term patency rate and vascular remodeling rate.

Technical framework is centered on top-level design of smart hospitals. Guangdong Second Provincial General Hospital adopted hospital intelligent twins as its technical framework of the all-scenario intelligent construction. Its construction practices covered four layers of intelligent interaction, intelligent connection, intelligent hub and intelligent application. These practices can advance the construction of smart hospitals into the all-scenario intelligent stage, featuring intelligent medical treatment, intelligent service and intelligent management, thus providing reference for promoting the construction of smart hospitals and realizing the digital transformation of medical industry.

Objective To preliminarily explore the clinical features,treatment,and outcomes of moyamoya disease in the elderly.Methods The clinical data of the elderly patients with moyamoya disease (aged ＞ 60 years) admitted to the Department of Neurosurgery,the 307th Hospital of PLA from May 2007 to July 2016 were collected retrospectively.Their clinical features,imaging features,and surgical outcomes were analyzed.Results A total of 68 patients were enrolled,including 35 females (51.47％) and 33 males (48.53％).The ratio of male to female was 1:1.06.The age at the time of diagnosis of moyamoya disease was 62.82 ±3.08 years.Fifty-two patients (76.5％) had vascular risk factors.The most common clinical manifestation was cerebral ischemia (n =61,89.7％).Thirty of them (44.1％) presented as transient ischemic attack.The Suzuki staging of most patients was 4-6 (71.6％),12 patients (17.6％) complicated with posterior cerebral artery stenosis or occlusion.Thirty-one patients were treated with encephalo-duroarterio-synangiosis (EDAS).Among them,17 patients underwent bilateral surgery and 14 underwent unilateral surgery.The incidence of perioperative infarction or hemorrhage was 5.6％ (2 patients developed cerebral infarction and 1 patient developed cerebral hemorrhage);37 patients received conservative treatment.During the follow-up period,5 patients developed cerebral infarction (1 in the surgical treatment group and 4 in the conservative treatment group);there was no significant difference between the 2 groups.There were no significant differences in age,sex,vascular risk factor,clinical symptoms,and preoperative modified Rankin Scale (mRS) scores between the 2 groups.Cerebral angiography was performed 6-9 months after operation in the surgical treatment group.A total of 24 cerebral hemispheres were evaluated by Matsushima typing,of which 17 (70.8％) were excellent.During the follow-up period,the proportion of patients with clinical outcome excellent (the mRS score was 0) (Z =-5.268,P ＜ 0.00l) and clinical improvement (the mRS score was improved ≥ 1 compared to the baseline) (Z =-3.780,P ＜ 0.001) were significantly higher than the conservative treatment group.Conclusions The clinical symptoms of old patients with moyamoya disease were mainly cerebral ischemia.Most of them had vascular risk factors,and the imaging manifestations showed higher Suzuki staging.The perioperative risk of EDAS in the old patients with moyamoya disease was lower.It might be an effective method to prevent clinical symptoms progress and improve the outcomes.