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"Westward Migration Spirit" is the precious spiritual wealth of Chinese Communist Party and the Chinese nation. The course teaching team takes the undergraduate students of clinical medicine as the teaching object, tries to integrate the "Westward Migration Spirit" into the cultivation of medical students’ medical professionalism, so as to endow new connotation of medical professionalism and promote the improvement of medical students’ professionalism. Through literature review, expert consultation and questionnaire survey, the paper sorted out the context of "Westward Migration Spirit" of Chongqing Medical University, and typical examples with the spirit of medical science and humanity were selected and integrated into the teaching. A questionnaire was designed to investigate the evaluation of 425 clinical medicine undergraduates and 5 teachers on the medical professionalism course integrated with "Westward Migration Spirit" . The results show that the students and teachers have good feedback to the medical professionalism courses integrated with the "Westward Migration Spirit" , and the course has a significant positive effect on the cultivation of medical students’ medical professionalism.
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With the development of various laboratory testing techniques such as serum calcium and parathyroid hormone (PTH) , a large number of asymptomatic or normocalcemic primary hyperparathyroidism (PHPT) can be diagnosed early. PHPT has become the third most common endocrine disease affecting human health. Currently, most PHPT, especially normocalcemic primary hyperparathyroidism, are not primary diseases and may be related to vitamin D deficiency/insufficiency and/or insufficient calcium supplementation. That is, the relative hypocalcemia caused by long-term vitamin D deficiency/insufficiency and/or insufficient calcium supplementation leads to parathyroid hyperfunction, stimulates parathyroid hyperplasia, and secretes excessive parathyroid hormone to compensate for the regulation of calcium and phosphorus balance. When it is in the initial reversible stage, it can be cured by internal medicine; if it progresses freely, long-term hypocalcemia stimulation will lead to excessive parathyroid hyperplasia and even tumor occurrence with the formation of so-called PHPT and parathyroidectomy has to be performed. Therefore, routine screening of bone mineral density, calcium, magnesium, phosphours, 25-hydroxyvitamin D, parathyroid hormone and other bone metabolism indicators in the physical examination of general population is beneficial to the prevention and treatment of bone metabolism diseases, urinary stones and hyperparathyroidism. At the same time, attention should be paid to identifying the stage of prehyperparathyroidism in which vitamin D deficiency/insufficiency and insufficient calcium supplementation will stimulate parathyroid hyperfunction. Active intervention on prehyperparathyroidism is an effective way to avoid the development of primary hyperparathyroidism.
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Objective:To study whether the "combination of medical care and pension" service model can effectively control the development of chronic disease in the elderly and reduce the direct economic burden caused by the disease.Methods:A total of 180 elderly participants who received the "combination of medical care and pension" service model for chronic disease management in Chongqing, China were investigated and analyzed statistically. Epidata 2.0 was used for data entry, SPSS 20.0 was used for data analysis, and paired sample t test was used for comparison between groups. Results:After 12 months of chronic disease management, hospitalization events and expenses of the elderly were reduced, among which the number of hospitalization was reduced by 0.24 timed on average, the length of hospitalization was reduced by 10.41 days on average, and the hospitalization expenses were reduced by 11 144 yuan on average. The direct economic burden due to chronic diseases was reduced by approximately 8 844.5 yuan, accounting for 33.8% of the average cost of hospitalization for the elderly without the application of the model.Conclusion:The chronic disease of the elderly is well controlled by chronic disease management through the "combination of medical care and pension" service model.
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Vitamin D deficiency can be a trigger factor for recurrent oral ulcers. This article combining two cases of recurrent oral ulcers in patients with vitamin D deficiency who were cured by active vitamin D supplementation emphasizes that 25-hydroxyvitamin D and other indicators should be screened in patients with recurrent oral ulcers, so as to improve the understanding of the disease and the ability of clinical diagnosis and treatment for it.
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Vitamin D deficiency/insufficiency has become a worldwide public health problem, especially in breast cancer patients. Vitamin D is a fat-soluble vitamin necessary for human body, which has important physiological functions such as regulating calcium and phosphorus metabolism and affecting cell proliferation and differentiation. Vitamin D deficiency/insufficiency is closely related to the occurrence of bone diseases and various extra-bone diseases, and is also a risk factor for the occurrence, development and poor prognosis of breast cancer. Vitamin D deficiency/insufficiency and low blood calcium are the main cause of enhanced parathyroid function or secondary hyperparathyroidism, but are often overlooked due to the absence of early clinical manifestations. Bone problems of breast cancer patients are more obvious than those of general population because of the systemic treatment such as chemotherapy and endocrine therapy and changes in menstrual state, and vitamin D deficiency and secondary hyperparathyroidism will further aggravate their bone health problems. Therefore, it is necessary to strengthen the monitoring of blood calcium, parathyroid hormone and bone metabolism indicators in breast cancer patients, so as to make targeted supplementation of vitamin D and calcium. We should pay attention to the prevention and treatment of vitamin D deficiency/insufficiency associated hyperparathyroidism and bone health problems to improve the quality of life and prognosis of patients.
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In Oct. 2016, the Central Committee of the Communist Party of China and the State Council issued the "Outline for Healthy China 2030" , which planned to achieve chronic disease management for the entire population and the overall 5-year survival rate of cancer increasing by 15% by 2030. In Jan. 2019, the "2618 Glycolipid Project" was launched, which promoted the comprehensive management of blood glucose, blood pressure and blood lipids in the grassroots. Breast cancer is the most common malignant tumor in women. With the improvement of its diagnosis and treatment, most of the patients survive for a long time in a state of chronic disease. Diabetes, dyslipidemia, and hypertension have a higher prevalence in breast cancer patients, and are most common concomitant diseases of breast cancer. Breast cancer patients also have a higher proportion of carotid plaques and carotid intima thickening. However, there is no obvious symptoms, and there is a lack of clinical understanding of its harm, which will inevitably affect the treatment and prognosis of breast cancer patients. This article will explore the significance and implementation of "2618 Glycolipid Project" in the management of patients with breast cancer, in order to further improve the life quality and the prognosis of breast cancer patients.
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Objective To evaluate the clinical feasibility and advantages of ultrasound guided mammo-tome biopsy for micro-calcifications visible in mammography. Methods A total of 12 patients with mammogra-phy-revealed micro-calcifications examined by ultrasound guided vacuum-assisted biopsy in our hospital from Jun. 2017 to Dec. 2018 were enrolled in this study and their medical records data were analyzed. Results All 12 patients had accepted pre-biopsy ultrasound localization and all micro-calcifications were successfully excised. A-mong 12 cases, 4 were revealed as benign breast diseases and 8 were diagnosed as breast cancer. Conclusions Ul-trasound guided mammotome biopsy is found to be an alternative method to stereotactic biopsy in patients with US-detectable micro-calcifications, and re-scan ultrasonography focusing on the specific microcalcification area may be helpful for improving the ultrasound detection rate of micro-calcifications.
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Objective@#To evaluate the clinical feasibility and advantages of ultrasound guided mammotome biopsy for micro-calcifications visible in mammography.@*Methods@#A total of 12 patients with mammography-revealed micro-calcifications examined by ultrasound guided vacuum-assisted biopsy in our hospital from Jun. 2017 to Dec. 2018 were enrolled in this study and their medical records data were analyzed.@*Results@#All 12 patients had accepted pre-biopsy ultrasound localization and all micro-calcifications were successfully excised. Among 12 cases, 4 were revealed as benign breast diseases and 8 were diagnosed as breast cancer.@*Conclusions@#Ultrasound guided mammotome biopsy is found to be an alternative method to stereotactic biopsy in patients with US-detectable micro-calcifications, and re-scan ultrasonography focusing on the specific microcalcification area may be helpful for improving the ultrasound detection rate of micro-calcifications.
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Genitourinary syndrome of menopause (GSM),is a common disease in postmenopausal women.It is reported that the incidence of GSM in breast cancer patients (79％-95％) was higher than that in normal counterparts (more than 50％).GSM significantly reduced the quality of life in breast cancer patients,but was not given enough attention,and most of breast cancer patients with GSM were not diagnosed and treated.In addition,chemotherapy and endocrine therapy for breast cancer may increase the incidence and severity of GSM.Hence,prevention and treatment of GSM should be strengthened in breast cancer patients.
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Chronic kidney disease,especially in patients with end-stage renal disease (ESRD),is prone to causing secondary hyperparathyroidism,and part of refractory secondary hyperparathyroidism patients require treatment with parathyroidectomy.Parathyroidectomy makes the thyroid inevitably subject to mechanical stimulation,leading to transient mechanical thyroiditis,hyperthyroxinemia and postoperative transient thyrotoxicosis,causing dysfunction in multiple systems of the body,and even inducing or aggravating water and electrolyte disorders (such as hyperkalemia),arrhythmia and cardiovascular events.However,this complication has not yet received sufficient clinical attention.This article will discuss the prevention and treatment of thyrotoxicosis or hyperthyroidism,one of the postoperative complications,in secondary hyperparathyroidism patients with ESRD,based on the relevant documents and our own clinical practice.
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We report one case of unilateral breast cancer treated with contralateral prophylactic mastectomy simultaneously and confirmed pathologically as synchronous bilateral primary breast carcinoma.The clinical characterization and diagnosis of bilateral primary breast cancer combined with a review of literature were discussed to serve as a reference for early diagnosis and treatment of the disease.
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Breast cancer (BC) and cardiovascular diseases (CVD) are two important “killers” threatening women's life and health.There are several overlapping risk factors and interactive control measures between BC and CVD.BC patients have a higher rate of mental and psychological problems,which may lead to behavior degeneration and treatment interruption,or even affect the body status of and rehabilitation progress,finally result in a bad effect on the life quality and prognosis of breast patients.Crossing field between cardiovasology and psychology has formed a new discipline named psychocardiology,which emphasizes the treatment of CVD while paying great attention to patients' mental-psychological problems.Long-term pain and stress caused by breast cancer and cardiovascular disease can affect patients' psychological state and even lead to anxiety and depression.CVD and mental disorders often coexist in breast cancer patients.Therefore,the clinical practice of breast cancer should strengthen the construction of “double heart medicine”,that is,the construction of breast cancer psychological cardiology and multidisciplinary collaboration.
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The outline of "Healthy China 2030 Program" has put forward a "double-aspect" health management policy of " all-around and all-cycle protection of peoples' health".Therefore,Chinese experts started to draw up the "comprehensive management guidelines of following-up and concomitant diseases of breast cancer patients" which begins to focus on the concomitant diseases of breast cancer caused by the untoward effects of acute therapy and chronic treatment,and aims at providing integrated health care strategy in the convalescence period for clinicians and breast cancer patients.This is the first time to standardize the principles of preventing and managing concomitant diseases of breast cancer during cancer therapy and follow-ups.Currently,three kinds of disease entities regarding bone,cardiovascular and dyslipidemia,mental and psychiatric disorders were defined as concomitant diseases of breast cancer.Besides,authors have found higher prevalence of sleep disorder,cognitive dysfunction,diabetes and prediabetes,thyroid diseases and metabolic syndrome,in which these diseases should also be considered as concomitant diseases of breast cancer.We'll discuss these diseases in this paper to increase the consciousness in prevention and management of them,and improve the life quality and prognosis of breast cancer patients.
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Male breast cancer is a rare disease with an incidence of about 1％ of breast cancers in USA,and about 1.4％ in China.Male breast cancer accounts for 1.9％ to 6.5％(with the mean value of 2.9％) of breast cancers in southwest of China.In China,male breast cancer is usually with poor prognosis caused by delayed diagnosis and treatment,because of being ignored by the community.It is important to strengthen the popular science propaganda,diagnosis and treatment of male breast cancer in China.
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Breast cancer and thyroid diseases are common diseases in women.It is reported that breast cancer and thyroid diseases have some relevance.Breast cancer patients have relatively high incidence of thyroid dysfunction,thyroid node and thyroid cancer,which are easily misdiagnosed for lacking of obvious clinical manifestations and will affect the treatment and prognosis of breast cancer.In breast cancer patients,screening and diagnosis of thyroid function and disease through thyroid function detection and ultrasound examination should be strengthened.
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Breast cancer and dyslipidemia are common diseases in women.It is reported that breast cancer and dyslipidemia have some relevance.Breast cancer patients have a relatively high incidence of dyslipidemia,which is easily undiagnosed for lacking of obvious clinical manifestations and will affect the treatment and prognosis of breast cancer.In breast cancer patients,screening and diagnosis of dyslipidemia through blood lipid detection should be strengthened.
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Chemotherapy plays an important role in the comprehensive treatment of breast cancer,and chemotherapy related fatty liver disease (CRFLD) and hepatitis B virus (HBV) reactivation were still ignored at present.It would cause great influence on the patient's outcome.Preventive measures on them will be discussed in this paper.
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Postoperative adjuvant therapy for primary invasive breast cancer patients with synchronous ax-illary metastases is mainly based on the characteristics of biomarker of the primary tumor. Recently, some studies have showed the discordance and clinical significance of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancer and synchronous axillary lymph node metastases. As local metastasis, the synchronous axillary metastases may represent the potentially metastatic breast cancer cells much better than the primary tumor. Hence, determination of biomarkers status should be performed in synchronous axillary metastasis, together with primary tumor, to guide therapy management and evaluate the prognosis of primary invasive breast cancer patients with synchronous axillary metastases.
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Granular cell tumor of the breast (GCTB) is a rare tumor which stems from Schwann cells.It is a largely benign tumor,but in the literature extremely infrequent cases can exhibit malignant characteristics.It tends to a particular problem as its characteristics are similar with breast carcinoma macroscopically,clinically,and radiologically.Typically,GCTB is benign and solitary lesion,yet including atypical GCTB and malignant GCTB,they can co-localize with breast malignancies multicentricity.The histopathological and immunohistochemical detection is the gold standard for diagnosis of GCTB up to now.And local expanded resection is the main treatment method at present.