Medical integration is an inevitable trend of medical development and medical educa-tion reform nowadays. Under the guidance of integration,medical colleges at home and abroad develop a series of exploration and practice of medical education reform. According to difficulties and problems of medical education reform,this article put forward:changing ideas to adapt to the transformation of medi-cal model,combining medical education reform and new medical reform,playing the main role of educa-tion administration department in the reform of medical course system,strengthening multi-dimensional integration of medical science.

Fierce earthquake could result in mass casualties. The patient is sent to the hospital after simple trauma management for further treatment. Emergency response to hospital infection management in station hospital can effectively prevent the occurrence and spreading of infectious diseases.

Objective To improve our understanding of localized Castleman's disease ( Localized Castleman's disease, LCD) ,and to improve its diagnosis and treatment. Methods Clinical characteristics and treatment of 26 LCD cases were retrospectively analyzed, and its clinical features and treatment strategies were reviewed. Results Among the 26 cases, there were 10 cases with clinical symptoms, which mainly showed local pain induced by the compression of the tumors, and 3 in the 10 cases associated with paraneoplastic pemphigus. The swollen lymph node was at a localized area, which was mostly at retroperitoneal (10 cases) and mediastinum (7 cases). The CT scan of LCD had its special characters including local calcification and necrosis. 22 cases were of hyaline vascular type, and the other 4 cases were of plasma type based on histopathologic examination. Twenty-five patients received complete tumor resection and 2 cases of them recurred after a follow-up of 5 to 206 months averaging at 48 ± 13 months. In one case the tumor adjoining vital organs deep in the mediastinum couldn't be completely resected. This patient and another with complete tumor resection recurred and received combined chemotherapy with complete tumor disappearance and were all alive without recurrence as found by follow up to May, 2010. The other patient with recurrent tumor after tumor resection didn't receive chemotherapy and died 11 years later. Conclusions LCD patients mainly have isolated lymphadenectasis, and some patients may have systemic symptom and show abnormal laboratory results. CT scan is helpful in establishing a diagnosis of LCD.Complete surgical resection offers a favorite result for this disease.

objective To understand the baseline data of mortality from malignant tumor from 2006 to 2009 around Hongyanhe Nuclear Power Plant in Wafangdian City,Liaoning Province,so as to provide scientific basis for evaluating the impact of normal operation of nuclear power plant on the health of the residents nearby.Methods Thirty small towns near Hongyanhe Nuclear Power Plant were divided into 5 investigated areas according to the distances away therefrom(0.,10.,20-,30-,and 40-km).The data about from malignant tumor were obtained from the Center for Disease Control and Prevention of Wafangdian.The mortality distribution of difierent malignant tumors was analyzed,including the radiosensitive malignant tumors,especially leukemia,breast cancer,and thyroid gland cancer in different area,gender,and age groups.Results The mortality from malignant tumor was 151.97/105,and the standardized mortality rate(SMR)was 97.76/105.The mortality from malignant tumor among the males was 188.28/105(with the SMR of 116.76/105),and that among the females was 113.47/105(with the SMR of 75.89/105).with a sex ratio of 1.71.The first five cancers in the rank of death causes were lung,liver,stomach,colorectal,and esophageal cancers with mortality of 46.19/105,23.51/105,20.30/105,8.06/105 and 5.45/105,respectively.The mortality from mal.ignant tumor in the areas around the nuclear power plant from the near to the distant were 99.85/105, 137.40/105,138.73/105,156.30/105,and 154.16/105,respectively.The mortality from radiosensitive malignant tumors,leukemia,breast cancer,and thyroid gland cancer were 4.57/105,4.06/105,and 0.26/105,respectively.Conclusions Lung cancer and digestive tract malignant tumors are the main causes of death from malignant tumors in Wafangdian area before the nuclear power plant began to operate.There are no significant differences in the mortality distribution of malignant tumors among different areas,genders,and age groups.There are not significant differences in the mortality distribution of leukemia and breast cancer among different areas and age groups.

We report a case of congenital accessory scrotum and pseudodiphallia with perineal lipoma. A 7-month-old boy was admitted to Xiamen Children's Hospital for a postnatal perineal mass. Physical examination found a mass of 4 cm×4 cm between the scrotum and anterior edge of the anus, with pigmented and wrinkled skin resembling the scrotum without a testicle. There was also a penis-like swelling on the surface of the mass without a urethral orifice. The penis and scrotum with bilateral testis were normal, as were the other organs. The patient's chromosome was 46,XY. Perineal ultrasound, MRI, and voiding cystourethrogram indicated no association between the mass and the penis, urethra, rectum, and anus. A resection of the mass and penis-like swelling and perineoplasty was performed because the normal penis was found to rotate clockwise about 90 degrees during the operation. The pathology showed that the masses were accessory scrotum and lipoma and the penile-like swelling was a pseudodiphallia without corpus cavernosum. Congenital accessory scrotum and pseudodiphallia with a perineal lipoma are rare. It is essential to clarify the anatomical relationship between the mass and genitourinary tract or anorectum before operation.

Objective:To investigate the effects of nicorandil combined with thrombus aspiration during percutaneous coronary intervention on reperfusion arrhythmia in patients with acute ST-elevation myocardial infarction.Methods:180 patients with acute ST-elevation myocardial infarction who received treatment in Yidu Central Hospital, Weifang Medical University, China between January 2019 and June 2020 were included in this study. They were randomly assigned to receive either nicorandil combined with thrombus aspiration during percutaneous coronary intervention (NPCI group, n = 90) or conventional PCI (PPCI group, n = 90). Myocardial perfusion (myocardial blush grade 3 blood flow) and the occurrence of reperfusion arrhythmia within 24 hours after treatment were compared between the NPCI and PPCI groups. Results:The incidence of myocardial blush grade 3 blood flow in the NPCI group was significantly higher than that in the PPCI group [84.44% (76/90) vs. 68.88% (62/90), χ2 = 6.01, P = 0.01]. There was no significant difference in the total incidence of reperfusion arrhythmia between NPCI and PPCI groups ( χ2 = 1.19, P = 0.27). The incidence of severe reperfusion arrhythmia in the NPCI group was significantly lower than that in the PPCI group [13.33% (12/90) vs. 27.77% (25/90), χ2 = 5.75, P = 0.02]. The influential factor of severe reperfusion arrhythmia was analyzed by logistic regression taking whether NPCI treatment was used as the variable ( OR = 0.40, 95% CI 0.18-0.89, P = 0.02). The other factors that affect severe reperfusion arrhythmia included age ( OR = 0.71, 95% CI 0.19-0.92, P = 0.04), time from onset to reperfusion of infarct related artery ( OR = 0.62, 95% CI 0.21-0.98, P = 0.02), dcuhistory of pre-infarct angina pectoris ( OR = 0.67, 95% CI 0.19-0.98, P = 0.03), admission blood glucose level ( OR = 1.96, 95% CI 1.05-5.78, P = 0.03), admission leukocyte count ( OR = 1.99, 95% CI 1.02-6.18, P = 0.03) and cardiac function ( OR = 1.71, 95% CI 1.06-6.91, P = 0.04). Conclusion:Nicorandil combined with thrombus aspiration during percutaneous coronary intervention for the treatment of acute ST-elevation myocardial infarction can not only improve myocardial perfusion, but also reduce the incidence of reperfusion arrhythmia. The combined therapy is superior to monotherapy, has certain clinical significance and is innovative.

During pandemic of corona virus disease 2019 (COVID-19), emergency orthopedic trauma is commonly seen. It is particularly important to ensure the emergency treatment quality of orthopedic trauma but avoid cross-infection between doctors and patients. The double-buffered diagnosis and treatment mode refers to the model of patients first undergoing medical observation in the comprehensive buffer ward and the inpatient buffer rooms of various disciplines after admission to confirm the exclusion of COVID-19 and then receiving specialist diagnosis and treatment. The authors summarize the experiences of using the double-buffered diagnosis and treatment model in the Department of Orthopedics, Renmin Hospital of Wuhan University during the prevention and control of COVID-19 pandemic so as to provide a reference for treatment of orthopedic patients.

Objective To investigate the value of cerebral state index (CSI) in monitoring the consciousness state of patients with brain trauma.Methods The consciousness sates of 218 patients with craniocerebral trauma were assessed by three experienced specialists by Glasgow Coma Scale (GCS),and the CSI of the patients were measured by Cerebral State Monitor.Correlation between GCS and CSI as well as the distribution of CSI in various consciousness defined by GCS were discussed.The predictive value of CSI in discriminating different conscious states of the patients was also analyzed.Results The Cochran Q test showed that there was a consistency of the GCS judged by three specialists (P ＞ 0.05),and the CSI of the patients was positively correlated with the GCS (r=0.819,P＜0.001).A gradual decrease in the CSI was found across categories of the various consciousness states,including sobriety,somnolence,confusion,light coma,coma in moderate depth and deep coma.The receiver operating characteristic curve (ROC) analysis showed that CSI could significantly discriminate the different consciousness states of the patients (P ＜0.001).The area under the curve (AUC) for the consciousness was 0.995 for deep coma,0.984 for sobriety,0.815 for coma in moderate depth,0.769 for somnolence,0.768 for light coma and 0.695 for confusion,respectively.Conclusion CSI can be used to monitor the severity of craniocerebral trauma.

Objective To investigate the value of cerebral state index (CSI) in monitoring the consciousness state of patients with brain trauma.Methods The consciousness sates of 218 patients with craniocerebral trauma were assessed by three experienced specialists by Glasgow Coma Scale (GCS),and the CSI of the patients were measured by Cerebral State Monitor.Correlation between GCS and CSI as well as the distribution of CSI in various consciousness defined by GCS were discussed.The predictive value of CSI in discriminating different conscious states of the patients was also analyzed.Results The Cochran Q test showed that there was a consistency of the GCS judged by three specialists (P ＞ 0.05),and the CSI of the patients was positively correlated with the GCS (r=0.819,P＜0.001).A gradual decrease in the CSI was found across categories of the various consciousness states,including sobriety,somnolence,confusion,light coma,coma in moderate depth and deep coma.The receiver operating characteristic curve (ROC) analysis showed that CSI could significantly discriminate the different consciousness states of the patients (P ＜0.001).The area under the curve (AUC) for the consciousness was 0.995 for deep coma,0.984 for sobriety,0.815 for coma in moderate depth,0.769 for somnolence,0.768 for light coma and 0.695 for confusion,respectively.Conclusion CSI can be used to monitor the severity of craniocerebral trauma.

Objective To investigate the prenatal diagnosis and genetic counseling of fetal nuchal fold (NF) thickening.Methods This study retrospectively analyzed 17 fetuses with increased NF detected by prenatal ultrasound examination in Peking Union Medical College Hospital,Peking Union Medical College & Chinese Academy of Medical Sciences from December 1,2016 to December 1,2017.All cases were divided into isolated (isolated group) or non-isolated increased NF group (non-isolated group) according to whether the fetus had concomitant ultrasonographic abnormalities or not.Karyotype and chromosomal microarray analysis (CMA) were performed on all cases.Clinical data,prenatal genetic testing results and pregnancy outcomes were analyzed.Results Of those twelve cases in the isolated group,two were terminated due to the identification of chromosomal abnormalities and pathogenic copy number variations (CNVs) and the fetal autopsy results were consistent with the prenatal diagnosis.The rest 10 pregnancies were all continued including one fetus carrying a variant of unknown significance,which was proved to be a paternal heredity by CMA,and nine without genetic abnormalities and all-these infants were healthy during follow-up.Among the five non-isolated cases,one was diagnosed as trisomy 21 by karyotyping and CMA,and the other four were found to have structural abnormalities under ultrasound scan,but without genetic abnormalities in karyotyping and CMA.And all the five pregnancies were terminated after genetic counseling and three of them chose whole exome sequencing (WES) for further test.One homozygous mutation in CHRNA 1 gene and one de novo mutation in SETD2 gene were found in two cases,respectively,while no abnormality was identified in the other one case.Conclusions Once increased NF were indicated by ultrasound examination,prenatal genetic testing should be offered to the patients,including CMA,regardless of other ultrasonographic abnormalities,and WES should also be offered when necessary.Considering a thickened NF is associated with increased risks of structural defects,a close follow-up with fetal echocardiography and ultrasound is required even the prenatal tests are normal.