A teaching method called cross-disciplinary joint teaching,which integrated the neural system-based physiology,anatomy and histology from gross morphology to micmstructure,then to physiological function,was carried out on 2010 clinical eight-year program medical students.Jointteaching method was carried out throughout the whole courses.That means in three subjects related to the discipline,teachers compile the textbook,discuss teaching scheme,compile cases,collectively prepare lessons,and attend lectures and discussion together.Flexible teaching forms such as casebased teaching,problem-based teaching and bilingual teaching were also run through the whole processes of the teaching.Compared with the traditional teaching model,cross-disciplinary joint teaching not only achieves the integration of morphology,microstructure and functions of nervous system,but also has a priority of helping the students to develop a more efficient learning ability such as initiative study and thinking extension.

OBJECTIVETo compare the clinicopathological features and prognosis between left-sided colon cancer (LC) and right-sided colon cancer (RC).

METHODSClinicopathological and follow-up data of 2 174 colon carcinoma cases undergoing resection at Shanghai Changhai Hospital of The Second Military Medical University from January 2000 to December 2010 were retrospectively analyzed. Patients with transverse colon cancer, overlapping position, unknown location, recurrent cancer, multiple primary cancer, concomitant malignant tumors, preoperative chemotherapy, local resection, incomplete clinical data and missed follow up were excluded. Finally, a total of 1 036 patients, whose primary tumors were radically removed, were enrolled, with 563 patients in LC group (including carcinoma in cecum, ascending colon and hepatic flexure) and 473 in RC group (including carcinoma in splenic flexure, descending colon and sigmoid colon). The clinicopathological features and survival, including median overall survival, 5-year overall survival rate, tumor specific median overall survival, cancer specific 5-year overall survival rate, were compared between LC and RC groups. Tumor specific overall survival was defined as the period between operation date to the date of death caused by cancer progression. Multivariate Cox regression analysis was used to analyze the influencing factors of survival. Propensity score matching was carried out to balance the clinicopathological factors between the two groups with the SAS 9.3, taking the following parameters into consideration (age, gender, gross appearance, tumor diameter, invasion depth, lymph node metastasis, distant metastasis, TNM stages, differentiation, CEA and CA199-9). Patients in RC group and LC group were matched according to the propensity scores and the clinicopathological characteristics and prognosis of two groups were compared again.

RESULTSNo significant differences were identified between the two groups in age, distant metastasis and serum CEA level. Compared with RC group, LC group had more male patients [60.9%(343/563) vs. 51.0%(241/473), P=0.001], more ulcerative tumors [71.9% (405/563) vs. 65.3%(309/473), P=0.006], better differentiation [well/moderately differentiated: 87.5%(493/563) vs. 73.8%(349/473), P=0.000], lower infiltration depth [T1-2: 17.1%(96/563) vs. 10.1%(48/473), P=0.001], higher lymph node metastasis rate [N0: 53.3%(300/563) vs. 62.4%(295/473), P=0.013], lower TNM stage [stage I(: 13.3%(75/563) vs. 7.8%(37/473), P=0.000], lower serum CA199 level [<37 kU/L: 68.4% (385/563) vs. 62.6% (296/473), P=0.022] and smaller tumor diameter [<5.0 cm: 55.1%(310/563) vs. 38.3%(181/473), P=0.000]. The median overall survival was 82 months and 76 months in LC and RC groups, respectively, and the 5-year overall survival rate was 58.3% and 50.9%(P=0.038). The median tumor specific survival was 84 months and 78 months in LC and RC groups, respectively, and the 5-year tumor specific overall survival rate was 60.6% and 52.9% (P=0.031). Multivariate Cox regression analysis showed that tumor location (LC vs. RC) was not associated with overall survival (P=0.106) and tumor specific survival (P=0.091). After propensity score matching, no significant difference was found in clinicopathological factors and propensity score (0.458±0.129 vs. 0.459±0.129, P=0.622) between LC and RC group. After matching, there was no significant difference in overall survival rate (54.0% vs. 51.7%, P=0.982) and tumor specific overall survival rate(56.4% vs. 53.1%, P=0.819) between two groups.

CONCLUSIONSignificant difference exists between RC and LC in clinicopathological factors, but not in survival.

Pneumonia caused by 2019-nCoV infection has been reported in Wuhan since December 2019, and spread rapidly across the country. The radical operation of colorectal cancer is semi-elective operation. Patients with colorectal cancer should receive operation as soon as possible after elective operation is resumed in each hospital. 2019-nCoV virus can be transmitted by asymptomatic infectors, and it has been confirmed to be transmitted by droplets and contact. However, fecal-oral transmission and aerosol transmission have not been excluded. Based on our experience with laparoscopic colorectal operation, we propose some surgery strategies for colorectal cancer patients under the corona virus disease 2019(COVID-19) situation: the screening process should be strictly carried out before surgery to reduce the risk of nosocomial infection in the later stage; laparoscopic-assisted surgery is recommended for radical surgery for patients with colorectal cancer; strict aerosol management must be made during the operation; natural orifice specimen extraction surgery and transanal total mesorectal excision are should be performed prudently; scientific and reasonable prophylactic stoma should be done; personnel protection in surgical ward and operation room must be strengthened.

Since the establishment of eight-year clinical medicine specialty, in line with the princi-ple of "eight-year consistency and fusion of the bachelor and doctor degree", the training mode of "strength-ening the foundation, focusing on quality, overall optimization, facing the clinical" has been implemented. In order to reach the standard of professional doctorate, a series of courses of professional doctorate need to be fused in limited time and designed carefully by medical schools. However, grasping proper teaching time and opportunity is particularly important for students' learning and development. By collecting the courses information of 11 medical colleges and universities offering eight-year clinical medicine specialty, we have analyzed the teaching time, methods and course categories of scientific research training courses and graduate degree courses, aiming to find the appropriate teaching program.

Pneumonia caused by 2019-nCoV infection has been reported in Wuhan since December 2019, and spread rapidly across the country. The radical operation of colorectal cancer is semi-elective operation. Patients with colorectal cancer should receive operation as soon as possible after elective operation is resumed in each hospital. 2019-nCoV virus can be transmitted by asymptomatic infectors, and it has been confirmed to be transmitted by droplets and contact. However, fecal-oral transmission and aerosol transmission have not been excluded. Based on our experience with laparoscopic colorectal operation, we propose some surgery strategies for colorectal cancer patients under the corona virus disease 2019(COVID-19) situation: the screening process should be strictly carried out before surgery to reduce the risk of nosocomial infection in the later stage; laparoscopic-assisted surgery is recommended for radical surgery for patients with colorectal cancer; strict aerosol management must be made during the operation; natural orifice specimen extraction surgery and transanal total mesorectal excision are should be performed prudently; scientific and reasonable prophylactic stoma should be done; personnel protection in surgical ward and operation room must be strengthened.

Objective To investigate the incidence rate, pathologic changes, mechanisms and diagnostic methods in renal bone disease.Methods The blood levels of carboxyterminal parpthyriod hormone (C-PTH), 1,25(OH)2D3, calcium and phosphate, aluminum in serum and bone tissue were measured. The bone biopsy and bone scan with 99m technetium methylene diphosphonate (99m TC-MDP) were performed in 51 uremic patients.Results One hundred per cent of the patients had varying degree of pathologic changes in bone, in which 50.9% of the patients presented high-turnover bone disease, 7.8% of the patients presented lowe-turnover bone disease and 41.8% of the patients had mixed-type bone disease. The levels of serum C-PTH were predominently high in high-turnover bone disease while the levels of serum 1,25(OH)2D3 were significantly decreased in low-turnover bone disease. There was a high positive rate for the diagnosis of renal bone disease by bone scan with 99m TC-MDP.Conclusions The examination of bone pathology is the most valuable method for the diagnosis of renal bone disease. Bone scan with 99m TC-MDP has reference value when clinical conditions do not allow to make bone biopsy.

Chimeric antigen receptor T(CAR-T)cell therapy is a new method of immunotherapy for cancer that has achieved remarkable results in treating blood tumors.However,colorectal cancer(CRC),as a solid tumor,has different characteristics from hematological tumors,which impose certain constraints on the selection of its therapeutic targets and the effectiveness of treatment of CAR-T therapy.Therefore,it is necessary to select therapeutic targets with high specificity and effectiveness according to the characteristics of CRC,as well as to break through the constraints such as adverse effects caused by the treatment and the solid tumor microenvironment,to make CAR-T therapy applicable in the treatment of CRC.This article aimed to summarize the strategy of selecting therapeutic targets for CAR-T cell immunotherapy for CRC,analyze the restrictive factors of this therapy in the treatment of CRC,and forecast the prospect of CAR-T cell immunotherapy for CRC.

High quality bowel preparation is a necessary part of preoperative preparation for colorectal surgery and one of the keys to the success of surgery, which directly affects the quality of intraoperative procedures and postoperative recovery of patients. Conventional intestinal preparation mainly includes three aspects: preoperative dietary control, intestinal cleansing and prophylactic use of antibiotics. With the development of evidence-based medicine, the concepts and methods of bowel preparation have also changed. Long fasting is no longer advocated before surgery, and the traditional mechanical bowel preparation are also challenged. This article summarizes the application and research progress of different intestinal preparation methods before colorectal surgery, aiming to provide reference for clinical work of colorectal surgeons.

Objective:This study aims to analyze the prognosis of patients who underwent a simultaneous operations for colorectal cancer and liver metastases, and to establish a prognostic scoring system for these patients.Methods:From January 2010 to March 2019, the clinicopathological data of patients with colorectal cancer and liver metastases simultaneously operated at Shanghai Changhai Hospital were collected. The clinicopathological prognostic factors on tumor recurrence and survival outcomes on follow-up were analyzed. Single and multiple factors Cox regression analyses were used to determine the risk factors which affected the prognosis of patients. Using the risk factors of poor prognosis on Cox analysis, 1 point was given to each risk factor. Patients were then divided into different groups according to the different total scores. The median overall survival and disease-free survival of each group were analyzed.Results:Of 234 patients included in this study, there were 126 males and 108 females. The average age was (57.4±10.8) years. The median survival was 44.85 months. The 1-, 3-, and 5-year survival rates of the whole group were 87.3%, 55.2%, and 22.9%, respectively. Primary tumor in right colon, preoperative carcinoembryonic antigen ≥200 ng/ml, multiple liver metastases, and poorly differentiated adenocarcinoma/mucinous adenocarcinoma were independent risk factors of poor prognosis. After 1 point was given to each of the above 4 items, patients were then divided into the low-risk (0-1) and high-risk (2-4) groups. The median survivals of patients in the low-risk group ( n=174) and high-risk group ( n=60) were 53 months and 29 months, respectively. The corresponding median disease-free survivals were 21.34 months and 8.48 months, respectively. The differences between the 2 groups were significant ( P<0.05). Conclusion:The results of this study preliminary established a predictive scoring system for patients with simultaneous colorectal cancer and liver which can play a role in selecting treatment options for these patients.

Pneumonia caused by SARS-Cov-2 infection has been reported in Wuhan since December 2019, and spread rapidly across the country. The radical operation of colorectal cancer is confine operation. Patients with colorectal cancer should receive operation as soon as possible after elective operation is resumed in each hospital. SARS-Cov-2 virus can be transmitted by asymptomatic infectors, and it has been confirmed to be transmitted by droplets and contact. However, fecal-oral transmission and aerosol transmission have not been excluded. Based onLaparoscopic colorectal operation experiences, the author suggests that the surgery strategy for colorectal cancer patients under the COVID-19 situation. Recommending laparoscopy-assisted radical surgery for colorectal cancer patients. The aerosols need to be strictly managed during operation. NOSES and TaTME should be carried out with cautious during the epidemic period. Protective stoma should be carried out scientifically and reasonably, and the protection of operating room personnel should be strengthened.