ObjectiveTo analyze the changes in the degree of coordination of China's major epidemic prevention and control efforts before and after the outbreak of the Corona Virus Disease 2019 (COVID-19), so as to explore the impact of epidemic prevention and control measures on coordination dynamics. MethodsA total of 3 864 policy documents related to epidemic prevention and control from January 2000 to December 2020 across 31 provinces (autonomous regions, and municipalities) in China were systematically collected. Contents specific to collaborative and cooperative efforts were extracted, and the extent of interdepartmental coordination were quantified to assess the effectiveness of epidemic prevention and control efforts. Wilcoxon signed-rank test was adopted to statistically analyze the differences between the indicators before and after the epidemic. ResultsThe average overall coordination level for major epidemic prevention and control in 31 provinces (autonomous regions, and municipalities) increased from 43.06% to 97.62%, and the average coordination levels in the eastern, central, and western China soared from 42.29%, 37.50%, and 47.46%, to 98.81%, 96.20%, and 97.46%, respectively, with statistically significant differences (all P<0.05). In terms of department categorization, coordination levels in the professional departments and the key support departments peaked at 100.00%, while other support departments rose to 95.43%, with an increase of 77.15%, 181.85%, and 139.89%, respectively, exhibiting noteworthy statistically significant differences (all P<0.001). ConclusionThe scope of coordination departments of China’s major epidemic prevention and control exists a remarkable surge following the COVID-19 outbreak, notable heightened coordination is particularly observed among the key support departments. Future endeavors should prioritize the roles played by diverse departments in epidemic prevention and control, enhancing both the clarity of departmental responsibilities and the effectiveness of interdepartmental coordination.

[Abstract] Objective: To explore the expression patterns of melanoma lineage antigens and nuclear antigen Ki-67 and their correlations with survival in melanoma patients. Methods: A retrospective analysis was conducted to analyze the pathological data of melanoma patients treated at the Department of Melanoma, Peking University Cancer Hospital from February 2008 to August 2020, mainly including the expression patterns of melanoma lineage antigens (S-100, HMB-45, Melan-A) and Ki-67, demographics, clinical features and survival. The correlation between expression patterns of melanoma lineage antigens, Ki-67 and melanoma-specific survival (MSS) was analyzed. Results: In total, 603 patients were included in this study. The median follow-up time was 47.4 months. The positive rates of S-100, HMB, and Melan-A were 92.8%, 92.1% and 90.0%, respectively. The percentages of patients with melanoma lineage antigen scores (S-100, HMB-45 and Melan-A was scored each, as 1 when positive and 0 when negative) of 0, 1, 2, and 3 were 0.5%, 5.0%, 15.6%, and 78.8%, respectively. The percentages of patients with Ki-67 scores of 0, 1, 2, and 3 were 43.0%, 36.3%, 16.3%, and 4.5%, respectively. Ki-67 was highly expressed in mucosal and progressive melanomas. In a multivariate analysis, Ki-67 expression was an independent prognostic factor for poorer MSS (HR=1.506, 95%CI: 1.248-1.818, P<0.001) as the incidence of MSS event increased by 50% per 25% increase in Ki-67 expression, whereas there was no statistical correlation between melanoma lineage antigen expression and MSS (HR=0.991, 95%CI: 0.759-1.293, P=0.94). Conclusion: High expressions melanoma lineage antigens are ubiquitous in melanoma tissues, and Ki-67 is an independent prognostic factor for MSS.

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.

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.

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 explore the prognostic value of PD-L1 expression level in patients with metastatic renal cell carcinoma (mRCC).Methods:The clinicopathological and survival data of patients with mRCC in our hospital from Jan 2014 to Apr 2016 were retrospectively analyzed including 46 males and 15 females. The median age of these patients was 56 years(range: 29-75 years), with 41 patients ≤60 years and 20 patients >60 years. The baseline data before the systemic therapy showed 36 patients(59.0%)had 1 metastatic organ and 25 patients (41.0%) had equal or more than 2 organs to be metastasized. Among them, 17 patients(27.9%)had lung metastasis and 54 patients(88.5%)had liver metastasis. Abnormal baseline LDH occurred in 4 patients and 52 patients had normal LDH. Favorite and intermediate risk patients categorized by MSKCC risk stratification accounted for 59.6%(34 patients)and 40.4%(23 patients), respectively. Six patients(9.8%)experienced distant metastasis at initial diagnosis, with 4 of them undergoing primary site resection, and the other 55 patients undergoing radical nephrectomy. PD-L1 expression was detected by the immunohistochemical staining method. PD-L1 staining rate ≥1% detected on the tumor cell membrane was defined as positive expression. The correlation between PD-L1 expression and clinicopathological characteristics were compared. Kaplan-Meier method and log-rank test were used to compare the differences about DFS and OS under different factors. Cox proportional hazards regression model is used for multivariable analysis of survival data.Results:The detailed pathological types of the 61 patients with renal cell carcinoma were classified as 53 clear cell carcinomas, 3 papillary carcinomas, 1 collecting duct carcinoma, 2 translocation renal cell carcinomas and 2 being unclassified. There were 4, 20, 19 and 9 patients categorized as WHO/ISUP nuclear grade 1, 2, 3 and 4, and 26, 12, 20 and 2 patients were categorized as T 1, T 2, T 3 and T 4 stage, respectively. Five patients had regional lymph node metastasis(N+), and the other 56 patients had no regional lymph node metastasis(N-). The numbers of patients categorized as stage Ⅰ, Ⅱ, Ⅲ and Ⅳ diseases according to TNM staging system were 20, 11, 21 and 8, respectively. The total PD-L1 positive rate was 24.6%(15/61). The corresponding PD-L1 expression rate of patients with WHO/ISUP nuclear grade 1-4 were 0(0 patient), 5.0%(1 patient), 31.6%(6 patients)and 44.4%(4 patients), respectively; With the increasing WHO/ISUP nuclear grade, the positive rate of PD-L1 gradually escalated with a linear correlation ( P=0.006). The PD-L1 expression of the normal and abnormal LDH group were 19.2%(10 patients)and 75.0%(3 patients), respectively, with significant difference( P=0.035). Univariate analysis of disease-free survival time(DFS)showed that the prognostic factors include PD-L1( P=0.045), age group( P=0.014), WHO/ISUP nuclear grade( P<0.001), T stage( P=0.015), N stage( P=0.026)and TNM stage( P=0.005). However multivariate analysis only suggested WHO/ISUP nuclear grade as the independent prognostic factors for DFS( HR=1.8, 95% CI 1.1-2.9, P=0.018). Either in univariate or multivariate analysis, PD-L1 was not a prognostic factor for overall survival (OS)of mRCC patients(univariate analysis: P=0.154; multivariate analysis: P=0.902). The independent prognostic factors of OS include WHO/ISUP nuclear grade( HR=3.0, 95% CI 1.1-8.0, P=0.033)and MSKCC risk stratification( HR=5.9, 95% CI 1.2-29.7, P=0.03). Conclusions:This study showed that the higher the WHO/ISUP nuclear grade of patients with mRCC, the higher the positive rate of PD-L1. PD-L1 expression was not the independent prognostic factor for DFS or OS of mRCC.

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.

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.

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.