Objective To compare the clinical effects of laparoscopic Nissen fundoplication (LNF)combined with highly selective vagotomy(HSV)(LNFHSV)in treatment of gastroesophageal reflux disease(GERD),and to provide reference for the clinical application of LNFHSV.Methods 22 patients with a history of GERD unrelieved by medication and underwent LNFHSV were selected.At the same time ,36 patients with GERD underwent LNF were used as control.The mean operation time,hospital stay,incidence of main operative complications,HSS complete remission and Demeester scores of the patients in two groups were retrospectively analyzed.Results The Demeester scores,hospital stay, incidence of main operative complications of the patients in two groups before operation had no significant differences(P>0.05).The mean operation time in LNFHSV group (90 min±35 min) was longer than that in LNF group(65 min± 21 min).The Demeester scores of the patients in two groups after operation had significant difference(P<0.05).The HSS complete remission rate of the patients in LNFHSV group was 91.1%,the part remission rate was 8.9%,and no effectiveness was 0;they were 83.3%,13.8%,and 2.8% in LNF group;there were significant differences between two groups(P<0.05).Conclusion LNFHSV has better effectiveness in controlling GERD than LNF procedure.

Objective To investigate the clinical pathological characteristics and prognosis of primitive neuroectodermal tumor (PNET) of breast.Methods Patients with breast PNET were retrieved from CNKI,Pubmed,Europe PMC and other databases from Jan.1980 to Dec.2016.The clinical data of one patient with breast PNET in our hospital were analyzed retrospectively.Results 18 cases had painless,rapid growth mass as the main clinical features.The pathological morphology showed small round cell tumors,PAS staining positive.Immunohistochemistry CD99 and Fli-1 characteristic expression were the main indexes for the diagnosis of breast PNET.The positive expression of Vimentin,NSE,Syn and negative expression of CK,EMA,Desmin,CgA,LCA,S-100 also played an important role in the diagnosis of breast PNET.The positive expression of genetic marker EWSRI was the golden standard for diagnosis of breast PNET.The size of the tumor,surgical treatment,lymph node metastasis,distant metastasis and chemotherapy were the important factors that affect the prognosis of the PNET.The survival rates of 1 and 3 years were 71.4％ and 33.3％ respectively.Conclusions Breast PNET is a rare tumor with poor prognosis,and its diagnosis is highly dependent on pathology.Surgery can significantly improve the prognosis of the patients.Surgery should be the main treatment,combined with radiotherapy and chemotherapy.The current study does not show evidence of effectiveness in terms of endocrine or targeted drug therapy for breast PNET patients.

Based on the current situation and task of fighting COVID-19, and combined with emergency management mode of public health emergencies and participation of multi-times emergency rescue practices along with the case analysis and literature review and brain-storming, we constructed a basic framework of the emergency command system of public health emergencies in COVID-19 epidemic prevention and control background. The framework contained four modules: the response mechanism, the organizational structure, the emergency capacity, and the supervisory mechanism and the advantages and key points in implementing this emergency command system was discussed.