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.

Phosphatase and tensin-homolog deleted on chromosome 10 (PTEN) is an important cancer suppressor gene. Its pathogenic mutation leads to PTEN hamartoma tumor syndrome (PHTS), a rare syndrome also known as Cowden syndrome, which is relevant to early-onset hereditary breast cancer (BC). In this paper, we report three patients with unilateral multicentric BC and synchronous and metachronous bilateral BC who harbored PTEN gene mutations, and summarize the clinical manifestations, pathological characteristics, diagnosis, treatment and follow-up outcomes to provide reference for management of PTEN gene mutation-related BC among the Cowden syndrome population.

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.

Objective:To evaluate the efficacy of lumbar cisterna drainage(LCD) in treating paraplegia after thoracic endovascular aortic repair(TEVAR) for acute aortic dissection.Methods:A retrospective descriptive study was used to analyze 4 patients with aortic dissection who developed paraplegia after transthoracic aortic stent graft repair (TEVAR) admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from May 2015 to May 2022. There were 3 males and 1 females, aged between 38 and 65 years old. All patients with paraplegia after TEVAR were treated with LCD. Follow-up was carried out by outpatient and telephone for 12 months. The imaging indicators and clinical efficacy were observed.Results:Two patients were fully recovered before discharge, one patient was completely recovered by about 3 months after surgery, and one patient still had reduced sensation and grade 4 muscle strength at 12 months of follow-up. The CT angiography of all 4 patients did not show any evidence of endoleak, and there was no enlargement of the distal dissecting aneurysm.Conclusion:Lumbar cisterna drainage can alleviate or cure paraplegia caused by spinal cord ischemia after TEVAR for acute aortic dissection.

Objective:To construct the curriculum content system of Extreme Environmental medicine based on the trainees' competency.Methods:After analysis of Chinese doctors' post competency demand, and the characteristics of military students, qualitative and quantitative methods were used to construct the curriculum system. The consistency of expert opinions was represented by Kendall's W coefficient, using chi-square test. The hierarchy and weights of all items were analyzed by the analytic hierarchy process, using consistency ratio ( CR) , which was incorporated into this system after passing the test ( CR<0.1) . Results:The selective experts were all authoritative and positivity, the assessments were consistency. Finally, it formed 5 primary items, 15 secondary items, and 54 third items of educational materials and 13 knowledge modules and 1 comprehensive seminar.Conclusions:Based on the demand of Chinese doctors' post competency, a curriculum system of extreme environment medicine has been constructed, through combined application of qualitative and quantitative research methods.

Cellular mechanics, a major regulating factor of cellular architecture and biological functions, responds to intrinsic stresses and extrinsic forces exerted by other cells and the extracellular matrix in the microenvironment. Cellular mechanics also acts as a fundamental mediator in complicated immune responses, such as cell migration, immune cell activation, and pathogen clearance. The principle of atomic force microscopy (AFM) and its three running modes are introduced for the mechanical characterization of living cells. The peak force tapping mode provides the most delicate and desirable virtues to collect high-resolution images of morphology and force curves. For a concrete description of AFM capabilities, three AFM applications are discussed. These applications include the dynamic progress of a neutrophil-extracellular-trap release by neutrophils, the immunological functions of macrophages, and the membrane pore formation mediated by perforin, streptolysin O, gasdermin D, or membrane attack complex.
Microscopy, Atomic Force ; Neutrophils

Cryptorchidism is one of the most common congenital malformations in the urogenital system of boys.It can be an isolated disease,and may also be combined with other congenital malformations.It is a risk factor for testicular cancer and male infertility.Orchidopexy is the main treatment method.Although undergo early orchidopexy is becoming more common,there are still some infertility after adulthood.In this review,long-term appearance of the scrotum,fertility and malignancy after operation are reviewed.

Objective To retrospectively summarize the diagnosis and treatment experience of acute renal failure caused by urinary calculi obstruction in infants under the age of 6 months in order to improve the level of treat-ment. Methods Between January 2010 and December 2014,15 infants under the age of 6 months with bilateral urinary tract calculi obstruction leading to acute renal failure were treated in West China Hospital,Sichuan University. All cases were Tibetan(10 males,5 females). The ages ranged from 1 month 15 days to 5 months 24 days. The weights ranged from 3. 5 to 7. 0 kg. The clinical characteristics,treatment and clinical outcome were analyzed. Results A total of 9 infants(5 males,4 females)were assessed to be able to tolerate general anesthesia surgery and received positive conservative treatment before operation,and obstruction relief within 6 hours of admission. Six infants (5 males, 1 female)with serious internal milieu disorder,pneumonia,and shock,were assessed as critical cases,who could not tolerate general anesthesia surgery temporarily. Under the emergency blood purification support,they received anti -infection,spasmolysis,rehydration,to correct the internal milieu disorder and obstruction relief within 12 hours of admis-sion. Serum potassium,creatinine returned to normal 12 - 48 hours after obstruction relief. Stone specimens were obtained from 5 cases,and the stone compositions were calcium oxalate stone in 3 cases,calcium oxalate and carbonate apatite mixed stone in 2 cases. A total of 13 cases need further urolithiasis treatment. Conclusions The infants under the age of 6 months with bilateral urinary tract calculi obstruction are more severe with more complications. The emergency treatment principle is to save lives,then relieve the obstruction;surgery should be as brief as possible,since removing the stones is not the primary purpose. If the infants are in critical,life - threatening circumstances,and cannot tolerate general anesthesia surgery,the blood purification will be helpful to gain time and create conditions for treatment.

Objective To summarize the experience of selection and maintainence for the lungs from donation. Methods From January 2015 to June 2016, 62 cases had been evaluated by Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University? All the clinic data had been collected to evaluate the donor lungs, including the basic information, physical examination, results of radiology and laboratory, the bronchoscope, etc? All the satisfactory donors had been harvested and transplanted to the receipient and then follow up? Results Forty cases of donor lung had been harvested from 62 cases? There were 31 male and 9 female cases with average age of 28?7 years? There were 34 cases form donation after brain death and 6 cases from donation after circulatory death? In addition, 8 cases which were considered to be the marginal donors became satisfied after the donor maintanence? The microbe in all 40 cases had been detected and the bacterial infection rate was 82?5% ( 33/40)? The microbe below could be detected in the bronchial stump or lung tissue, including Klebsiella Pneumonia, Baumanii, Staphylococcus Aureus, Enterococcus Faecium, etc? In the end, 22 bilateral lung transplantations, 17 single lung transplantations, 1 heart?lung transplantation had been implemented successfully and the survival rate in the perioperative period was 90?0%? Conclusions The utilization ratio of donation can be increased and the waste of medical resource in unacceptable donor can be reduced by the sufficient donor selection and maintanence? The participation of multi?department is needed in the process of donor selection and maintanence.

Objective To summarize the experience of selection and maintainence for the lungs from donation. Methods From January 2015 to June 2016, 62 cases had been evaluated by Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University? All the clinic data had been collected to evaluate the donor lungs, including the basic information, physical examination, results of radiology and laboratory, the bronchoscope, etc? All the satisfactory donors had been harvested and transplanted to the receipient and then follow up? Results Forty cases of donor lung had been harvested from 62 cases? There were 31 male and 9 female cases with average age of 28?7 years? There were 34 cases form donation after brain death and 6 cases from donation after circulatory death? In addition, 8 cases which were considered to be the marginal donors became satisfied after the donor maintanence? The microbe in all 40 cases had been detected and the bacterial infection rate was 82?5% ( 33/40)? The microbe below could be detected in the bronchial stump or lung tissue, including Klebsiella Pneumonia, Baumanii, Staphylococcus Aureus, Enterococcus Faecium, etc? In the end, 22 bilateral lung transplantations, 17 single lung transplantations, 1 heart?lung transplantation had been implemented successfully and the survival rate in the perioperative period was 90?0%? Conclusions The utilization ratio of donation can be increased and the waste of medical resource in unacceptable donor can be reduced by the sufficient donor selection and maintanence? The participation of multi?department is needed in the process of donor selection and maintanence.