Objective To study the clinical outcomes of robotic extended thymectomy and thoracoscopic extended thymectomy for thymoma patients with myasthenia gravis compared with conventional median sternotomy extended thymectomy.Methods The clinical data of thymoma patients with myasthenia gravis treated by extended thymectomy between June 2013 and June 2016 were retrospectively reviewed.The clinical outcome parameters were compared according to surgical approach.Results 41 thymoma patients with myasthenia gravis,8 cases underwent robotic extended thymecotmy,11 cases underwent thoracoscopic extended thymectomy and 20 underwent median sternotomy extended thymectomy.The resected extension included tumor,thymus tissue and adipose tissue in anterior mediastinum.There were no significant differences between robotic group and thoracoscopic group regarding operative time,blood loss,chest tube duration,hospital stay,postoperative complications and postoperative myasthenic crisis (P ＞ 0.05).The blood loss of robotic group and thoracoscopic group was significantly lower than that in median sternotomy group(P ＜ 0.05).The chest tube duration of thoracoscopic group was significantly shorter than that in median sternotomy group(P ＜0.05).The effective rates of MG after extended thymectomy in robotic group,thoracoscopic group and sternotomy group was 65.0％ 、69.2％ 、62.5％ respectively and there was no significant difference (P ＜ 0.05).Conclusion Robotic thymectomy and thoracoscopic thymecotomy are both minimal invasive surgery approach with less bleeding for thymoma patients with myasthenia gravis.The clinical outcomes of robotic thymectomy and thoracoscopic thymecotomy are similar.

Objective To evaluate clinical therapeutic efficacy and adverse effecacy of transcatheter arterial chemoembolization(TACE)combined with radiofrequency capacitive heating(RCH) for metastatic hepatic carcinoma(MHC). Methods Thirty-nine cases of MHC were enrolled in this study and divided into two groups: study group(n = 19)and control group(n = 20). Before therapy, the Karnofsky's score of the patients was all beyond 60. Results The carcinoma growth rate of the study group was -(0.38 ? 0.22), while that of the control group was -(0.13 ? 0.25), showing significant statistical difference(P 0.05). Conclusion The therapeutic effect of MHC can be further improved by the treatment of TACE combined with radiofrequency capacitive heating without increase of adverse side effects.

Objective To investigate the role of pre-chemotherapy hemoglobin and platelet levels in the effect of chemotherapy and prognostic outcome in patients with International Federation of Gynecology and Obstetrics(FIGO) stage Ⅰ b2 - Ⅱb cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy.Methods From January 1999 to December 2010,111 patients with FIGO stage Ⅰ b2 - Ⅱ b who underwent chemosurgical treatment at the department of obstetrics and gynecology in Peking Union Medical College Hospital were reviewed.The median age of patients was 42 years (range:21 -68 years).The median level of prechemotherapy hemoglobin and platelet levels was 127 g/L and 266 ×109/L,respectively.Chemotherapy response was evaluated according to the WHO criteria,including complete response (CR),partial response (PR),arable disease (SD) and progressive disease (PD).Patients who achieved CR or PR were defined as responder.Rates of clinical response were compared with the clinicalpathological variables using chi-square test.Multiple logistic regression was carried out to evaluate the relationship among the probability of achieving an optimal clinical response and the variables.The log-rank test was used to compare the homogeneity of progression-free survival and overall survival functions across strata defined by categories of prognostic variables.The Cox proportional hazard model was used to assess the significance of potential prognostic factors for progression-free survival and overall survival.Results All patients received one to three cycles of chemotherapy.After the neoadjuvant chemotherapy,9 patients achieved CR,77 patients PR,23 patients SD, 2 patients PD.The overall response rate was 77.5％(86/111).By univariate analysis,the clinical response rate was associated with tumor grade( P =0.026),deep cervical stromal invasion ( P =0.029 ) and positive lymph nodes ( P =0.048 ).By multiple logistic regression,deep cervical stromal invasion ( P =0.015 ) and positive lymph nodes ( P =0.031 ) were independent predictors of optimal clinical response.By log-rank test,5-year overall survival rate and 5-year progression-free survival rate were associated with lymph nodes metastases status and lymphovascular invasion ( P =0.000),but not with hemoglobin and platelet levels( P ＞ 0.05 ).By Cox regression model,lymph nodes metastases status and lymph-vascular space involvement ( P ＜ 0.01 ) were independently prognostic factors of 5-year overall survival rate and 5-year progression-free survival rate.Conclusion Pretreatment hemoglobin and platelet levels were neither predictors of clinical response to chemotherapy nor prognostic factors.

Objective To evaluate the defecation function of patients with low rectal cancer after laparoscopic-assisted transanal total mesorectal excision (TaTME),and analyze the influencing factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 55 patients with low rectal cancer who underwent laparoscopic-assisted TaTME in the First Hospital of Jilin University from May 2017 to December 2018 were collected.There were 39 males and 16 females,aged (60-± 11) years,with a range from 24 to 80 years.Among the 55 patients,21 were in TNM stage Ⅰ,14 were in TNM stage Ⅱ,and 20 were in TNM stage Ⅲ;24 were in pathological stage T1-2 and 31 were in pathological stage T3.Observation indicators:(1) surgical and postoperative conditions;(2) follow-up;(3) analysis of influencing factors for postoperative defecation function.Follow-up was performed using questionnaires by telephone interview to detect the complications at 3 and 6 months after surgery up to June 2019.The measurement data with normal distribution were expressed as Mean± SD,and comparison between groups was done using the t test.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Univariate and multivariate analyses were performed using logistic regression models.Results (1) Surgical and postoperative conditions:55 patients successfully underwent laparoscopic-assisted TaTME without conversion to open surgery.The operation time,volume of intraoperative blood loss,diameter of postoperative pathological specimen,time to urinary catheter removal,distance between the anastomostic stoma and anal verge,and tumor diameter were (246±62) minutes,(69±27) mL,(3.5±0.7) cm,(2.1±0.9) days,(2.4±0.5) cm,and (3.9-± 1.6)cm,respectively.(2) Follow-up:55 patients were followed up at 3 months and 6 months after surgery,and the low anterior resection syndrome questionnaires were completed.Among the 55 patients,35 had low anterior resection syndrome at 3 months after surgery,and 24 had low anterior resection syndrome at 6 months after surgery,showing a significant difference (x2 =4.42,P＜0.05).There was no new onset low anterior resection syndrome in 55 patients after 3 months.(3) Analysis of influencing factors for defecation function:univariate analysis showed that the distance between the anastomotic stoma and anal verge and tumor diameter were influencing factors affecting defecation function of patients at 3 months after surgery (x2 =19.075,8.185,P＜ 0.05).The distance between the anastomotic stoma and anal verge was a influencing factor affecting the defecation function of patients at 6 months after surgery (x2=9.183,P＜0.05).Multivariate analysis showed that the distance between the anastomotic stoma and anal verge ＜ 2 cm,and tumor diameter ＞5 cm were independent risk factors affecting the defecation function of patients at 3 months after surgery (odds ratio =1.135,6.057,95％ confidence interval:1.089-1.323,1.206-30.435,P＜0.05).The distance between the anastomotic stoma and anal verge ＜ 2 cm was an independent risk factor affecting the defecation function of patients at 6 months after surgery (odds ratio =2.724,95％ confidence interval:1.982-3.066,P＜0.05).Conclusions The incidence of low anterior resection syndrome after laparoscopic-assisted TaTME for low rectal cancer is high.Distance between the anastomotic stoma and anal verge and tumor diameter are independent risk factors for the postoperative defecation founction.

Objective:To explore the diagnostic value of motion pain induction test for early knee osteoarthritis.Methods:A cross-sectional study was conducted and the data came from The Project of Health Management of Knee osteoarthritis in Community in Hangzhou in 2018, and a total number of 1 816 people were included which were divided into normal group ( n=530), early group ( n=534) and middle-late group ( n=752) by not sick, sick while Kellgren-Lawrence (KL) ≤Ⅱ and sick while KL>Ⅱ starting, squatting, walking up and down stairs and doing housework were included in the test, and the statistical indicators included age, gender and pain scores (visual analogue scale, VAS). Receiver operating characteristic (ROC) curves were mapped after the correlation analysis to obtain the cut-off points and compare their values of area under the curve (AUC). The confounders which included age and gender were corrected by propensity score matching (PSM) and the balance test is consistent with P>0.05 after the PSM. The Kappa analysis was used to verify the consistency of two diagnostic methods. Results:The age of normal, early and medial-late groupwas 67.39±7.43, 67.41±9.52, 71.55±9.87. And the gender distribution of three groups was (238 male, 292 female), (209 male, 325 female), (357 male, 395 female). There was no heterogeneitybetween the normal group and early group in distribution ( P>0.05) while there was heterogeneity between the early and medial-late group ( t=-0.034, P<0.05; χ2=8.80, P<0.05). The VAS scoresof starting pain in three groups was 0.16±0.37,2.70±1.69, 3.68±2.10. The VAS scoresof squatting pain was 0.42±0.49, 2.88±1.44, 4.01±2.08. The VAS scoresof up and down stair pain was 0.47±0.50, 2.87±1.38, 3.82±1.98. The VAS scoresof housework pain was 0.14±0.35, 2.15±1.40, 3.45±2.09. The VAS scoresofmaximum pain was 0.51±0.50, 3.59±1.48, 4.68±2.01. And there was significant difference between normal and early groupin all kinds of pain ( t=-33.81; t=-37.25; t=-37.66; t=-32.07; t=-45.41; P<0.05). The difference between early and medial-late group in all type of pain was significant ( t=-8.93; t=-10.84; t=-9.56; t=-12.52; t=-10.64; P<0.05). The results were similar after adjusting for confounders except for the pain of starting ( P>0.05). The results of ROC curve between normal and early group showed the maximum pain's AUC point was 0.98 and larger than others, and its cut-off point was 1. After adjusted, the results of ROC curve between early and medial-late group showed the maximum pain's AUC point was 0.72 which was larger than others and cut-off point was 4. For the AUC of ROC curve between early and medial-late groupwas lower, Kappa-test was used, and the Kappa point of two diagnostic methods was 0.41 ( P<0.05). Conclusion:The maximum of pain score in pain dimension>1 and ≤ 4 could be preliminarily diagnosed as early KOA. It had high value in separating early KOA from normal people and approximately similar to X-ray, and the value of identifying early and mid-late KOAwas moderateas well as the moderate consistency with KL stage. Comprehensive judgment of imaging examination should be improved when conditions are available.

The implementation of ideological and political education in medical colleges and universities should be combined with the talent cultivation goals of medical education,in line with the internal needs of medical career development and scientific research ethics construction,and enhance the pertinence and effectiveness of education.Medical students in the new era should be rich in"benevolence"and have firm political beliefs in their ideology,be full of"benevolent skills"and abide by professional ethics and morality.Therefore,it's an important measure for medical colleges and universities to carry out the innovations of ideological and political education in the integration of political beliefs and professional ethics that are guided by political beliefs and based on professional ethics.To enhance the effect of"integration",comprehensive policies need to be implemented from the aspects of educational content,educational field,educational form,and educational team,to achieve the"organic integration"and"mutual penetration"of political belief education and professional ethics education,as well as create a new model of ideological and political education in medical colleges and universities.

Objective To analyze the clinicopathological features and prognosis of patients in endometrial cancer with bone metastases. Methods A retrospective review of medical records was performed to analyze patients with endometrial cancer who developed bone metastases at Peking Union Medical College Hospital (PUMCH) from January 2004 to December 2017, including patients with bone metastases at the diagnosis of endometrial cancer and at recurrence of endometrial cancer. The patient′s clinicopathological features, bone metastasis characteristics, treatment process and prognoses were also analyzed. Results The incidence of bone metastasis of endometrial cancer in PUMCH from 2004 to 2017 was 0.57% (14/2 458). (1) General clinical pathological features: the median age of the 7 patients with bone metastases diagnosed at the time of initial diagnosis was 50 years old, and the main pathological type was endometrioid carcinoma (n=5). The median age of the other 7 patients was 57 years old, with no significant difference comparing to the former groups (P=0.559). (2) The majority site of bone metastasis in endometrial cancer were discovered in pelvic bones, followed by the tibia. (3) Treatment: according to the staging of endometrial cancer, a comprehensive treatment based on surgery was performed, and one patient with isolated bone metastases underwent resection of bone metastasis. (4) Prognosis: nine out of the 14 patients died during the follow-up period. The median over all survival time was 25.5 months (range: 7.7-258.0 months). The median survival of population after diagnosis of bone metastases was 15.0 months (range: 3.0-51.0 months). The survival rate of endometrial cancer at 1-year after diagnosis of bone metastasis was 71.4%. The 2-year survival rate was 40.8%. (5) No independent prognostic factors affecting survival was found (P>0.05). Conclusions The incidence of bone metastasis in endometrial cancer is less than 1%. Bone metastasis could occur at the diagnosis of endometrial cancer or recurrence of endometrial cancer. Bone metastasis suggests a poor prognosis. There is no standard follow-up and treatment protocols so that individualized treatment is needed.

The great anti-epidemic spirit formed in the practice of fighting against the COVID-19 epidemic is a vivid embodiment of the national spirit and zeitgeist, an important part of the spiritual spectrum of the Communist Party of China, and an important content of professional ethics education for medical students in the new era. In the context of the new era, it is of great significance to integrate the great anti-epidemic spirit into the professional ethics education of medical students and explore its theoretical basis and existing problems. Based on the empirical investigation, this paper proposed the practical path of integrating the great anti-epidemic spirit into medical students’ professional ethics education from three dimensions:subject’s cognitive consciousness, school education practice, and hospital clinical training, to effectively exert the nurturing function of the great anti-epidemic spirit and improve the timeliness of professional ethics education for medical students.

Objective:To investigate the efficiency of biochemical screening and hotspot gene screening in the detection of neonatal inherited metabolic diseases.Methods:This was a prospective multi-center study.The study was carried out on 21 442 neonatal samples collected from 12 hospitals in 10 provinces from November 2020 to November 2021.The results of biochemical screening and hotspot gene screening were analyzed jointly.Biochemical screening methods included glucose-6-phosphate dehydrogenase deficiency enzyme activity assay and neonatal tandem mass spectrometry.Genetic screening analysis involved 135 genes associated with 75 neonatal diseases.Results:Of all the 21 442 neonates enrolled in the study, 21 205 were subject to biochemical screening.A total of 813 cases were positive in the initial screening, and 0.45% of them (95 cases) were diagnosed after recall.All the 21 442 neonates underwent gene screening.About 168 positive cases were detected in the initial screening, and 0.73% (156 cases) of them were confirmed finally.Biochemical and genetic screening improved the detection sensitivity of such diseases as primary carnitine deficiency, neonatal intrahepatic cholestasis caused by citrin deficiency, and 2-methylbutyrylglycinemia.Moreover, biochemical and genetic screening enabled the detection of more diseases, including the common single-gene genetic diseases such as thalassemia and Wilson disease.Conclusions:In neonatal screening, the combination of biochemical screening and gene screening expands the number of diseases detected and improve screening efficiency.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.