We reported a case with huge mass in the anterior neck region, which pathological diagnosis was thyroid metastasis from hepatocellular carcinoma(HCC). A tracheotomy was performed, and a tracheostomy tube was placed because of postoperative dyspnea. Thyroid metastasis from HCC is very rare. The causes include hematogenous metastasis, lymphatic metastasis and other factors. Furthermore, Hepatitis B virus (HBV) infection also plays an important role in tumor progression. Combined with the literature review, surgical resection of thyroid in the treatment of metastatic thyroid malignant tumors can prolong the survival. In clinical work, it is still necessary to develop a reasonable, standardized and comprehensive diagnosis and treatment strategy to improve the quality of life of patients and the therapeutic efficacy.

Objective:To investigate the clinical manifestations, histological features, immunophenotype, molecular characteristics, and treatments of uterine inflammatory myofibroblastic tumor (UIMT).Methods:Clinical and pathological data of 4 UIMT cases diagnosed at the Peking Union Medical College Hospital, Beijing, China from 2020 to 2024 were collected. Their clinicopathological and genetic characteristics were analyzed.Results:The patients′ ages were 63, 42, 53 and 37 years, respectively. The tumors were located in the submucosa and intermuscular walls of the uterus, with a diameter ranging from 1.5 to 6.0 cm. All tumors were suspected by the clinician as leiomyosarcoma. Histologically, 3 of the 4 tumors showed spindle cells that appeared like leiomyoma. Prominent myxoid stroma and inflammatory cells infiltration were observed, with mitotic figures of 1-2 per 10 high-power fields. One case was primarily composed of spindle cells arranged in fascicles, with inflammatory cell infiltration, inconspicuous myxoid stroma and mitotic figures of 3 per 10 high-power fields. Two cases exhibited a pushing pattern of invasion and slightly unclear boundaries, while the other two showed infiltrative growth with unclear boundaries. The immunohistochemistry revealed diffuse and strong, cytoplasmic granular staining of ALK in all 4 cases. RNA sequencing was performed in 3 cases, of which 2 cases showed ALK gene rearrangements, and 1 case did not. One case underwent FISH testing and showed ALK gene translocation. Follow-up showed that no recurrence or metastasis was observed after surgery in all patients.Conclusions:UIMT is a rare mesenchymal tumor of the uterus and lacks specific clinical manifestations. When tumor cells exhibit mild atypia, indistinct borders, myxoid stroma, inflammatory cell infiltration, and decreased expression of ER and PR on immunohistochemistry, immunohistochemical staining of ALK is recommended to confirm the diagnosis of UIMT. This tumor shares many features with myogenic tumors and endometrial stromal sarcomas. Molecular testing may also be needed to assist in diagnosis when necessary. For patients who are not suitable for surgery or have recurrence and metastasis, targeted therapy with ALK inhibitors can be used.

F-FDG PET/CT is an ideal auxiliary tool for early and accurate diagnosis of malignant tumors in children.This guideline aimed to standardize 18F-FDG PET/CT examination process for malignant tumors in children,hence providing references for nuclear medicine professionals.

Objective To analyze the current situation of department configuration and discipline development of medical record management in China,identify existing problems and challenges,and provide a reference for medical record management.Methods Based on the functions of word frequency analysis,coding and statistics of Nvivo 20 software,the sample literature was comprehensively interpreted by the content analysis method.Results Currently in China,medical record departments are mainly established as secondary departments in healthcare institutions with generally insufficient staffing.The professional title distribution presents a"pyramid"structure with senior∶intermediate∶junior ratio at 1∶3∶4,showing complex professional backgrounds and low proportion of postgraduate degree holders.The informatization level varies significantly with hospital grades,with basic-level hospitals below secondary level demonstrating relatively low informatization.There exist substantial gaps in on-the-job training and continuing education,while scientific paper output and research project applications remain generally weak.Conclusion Under the new circumstances,it is necessary to improve the academic education and continuing education system for medical record management,strengthen discipline construction and informatization development,enhance selection and train-ing of inter-disciplinary talents in medical records,optimize professional title promotion channels,and continuously increase at-tention and investment in medical record departments to meet the needs of hospital modernization development.

Objective To analyze the current situation of department configuration and discipline development of medical record management in China,identify existing problems and challenges,and provide a reference for medical record management.Methods Based on the functions of word frequency analysis,coding and statistics of Nvivo 20 software,the sample literature was comprehensively interpreted by the content analysis method.Results Currently in China,medical record departments are mainly established as secondary departments in healthcare institutions with generally insufficient staffing.The professional title distribution presents a"pyramid"structure with senior∶intermediate∶junior ratio at 1∶3∶4,showing complex professional backgrounds and low proportion of postgraduate degree holders.The informatization level varies significantly with hospital grades,with basic-level hospitals below secondary level demonstrating relatively low informatization.There exist substantial gaps in on-the-job training and continuing education,while scientific paper output and research project applications remain generally weak.Conclusion Under the new circumstances,it is necessary to improve the academic education and continuing education system for medical record management,strengthen discipline construction and informatization development,enhance selection and train-ing of inter-disciplinary talents in medical records,optimize professional title promotion channels,and continuously increase at-tention and investment in medical record departments to meet the needs of hospital modernization development.

OBJECTIVE To construct an evaluation index system for the core competencies of ethics committee members of drug clinical trial institution,providing a basis for optimizing the training system for committee members,improving the quality of ethical review,and fully safeguarding the safety and rights of subjects.METHODS Using methods such as literature research and expert consultation,a preliminary core competency evaluation index system was constructed.The Delphi method was employed to revise and validate it,ultimately forming an evaluation index system for the core competencies of ethics committee members.Based on this system,a questionnaire survey was conducted among 90 ethics committee members from 29 drug clinical trial institutions nationwide,comparing their importance rating and self-assessment scores of the core competency indexes.RESULTS The evaluation system constructed included 4 primary indicators(ethics and professional knowledge,ethics review ability,communication and expression ability,moral integrity and work style)and 39 secondary indicators(familiarity with the content of clinical trial-related laws and regulations,ability to complete project ethics review and identify ethical defects in research protocols within a short period of time,ability to judge the scientific value of clinical research,etc.).The results of questionnaire survey showed that the interviewed ethics committee members had significant capability gaps in dimensions such as regulatory knowledge,ethical norms,review efficiency,risk judgment,and problem analysis.The differences between the importance rating scores of corresponding secondary indicators and the self-assessment scores were all no less than 0.38.CONCLUSIONS This study has developed a quantifiable and stratified core competency assessment tool for ethics committee members.It can provide a scientific framework for committee member training,qualification certification,and standardized management of ethics committees.

F-FDG PET/CT is an ideal auxiliary tool for early and accurate diagnosis of malignant tumors in children.This guideline aimed to standardize 18F-FDG PET/CT examination process for malignant tumors in children,hence providing references for nuclear medicine professionals.

Objective:To investigate the clinical manifestations, histological features, immunophenotype, molecular characteristics, and treatments of uterine inflammatory myofibroblastic tumor (UIMT).Methods:Clinical and pathological data of 4 UIMT cases diagnosed at the Peking Union Medical College Hospital, Beijing, China from 2020 to 2024 were collected. Their clinicopathological and genetic characteristics were analyzed.Results:The patients′ ages were 63, 42, 53 and 37 years, respectively. The tumors were located in the submucosa and intermuscular walls of the uterus, with a diameter ranging from 1.5 to 6.0 cm. All tumors were suspected by the clinician as leiomyosarcoma. Histologically, 3 of the 4 tumors showed spindle cells that appeared like leiomyoma. Prominent myxoid stroma and inflammatory cells infiltration were observed, with mitotic figures of 1-2 per 10 high-power fields. One case was primarily composed of spindle cells arranged in fascicles, with inflammatory cell infiltration, inconspicuous myxoid stroma and mitotic figures of 3 per 10 high-power fields. Two cases exhibited a pushing pattern of invasion and slightly unclear boundaries, while the other two showed infiltrative growth with unclear boundaries. The immunohistochemistry revealed diffuse and strong, cytoplasmic granular staining of ALK in all 4 cases. RNA sequencing was performed in 3 cases, of which 2 cases showed ALK gene rearrangements, and 1 case did not. One case underwent FISH testing and showed ALK gene translocation. Follow-up showed that no recurrence or metastasis was observed after surgery in all patients.Conclusions:UIMT is a rare mesenchymal tumor of the uterus and lacks specific clinical manifestations. When tumor cells exhibit mild atypia, indistinct borders, myxoid stroma, inflammatory cell infiltration, and decreased expression of ER and PR on immunohistochemistry, immunohistochemical staining of ALK is recommended to confirm the diagnosis of UIMT. This tumor shares many features with myogenic tumors and endometrial stromal sarcomas. Molecular testing may also be needed to assist in diagnosis when necessary. For patients who are not suitable for surgery or have recurrence and metastasis, targeted therapy with ALK inhibitors can be used.

Objective:To analyze the current status of salary system reform in public hospitals in Mianyang City, Sichuan Province, and provide reference for the deepening of salary system reform in public hospitals.Methods:From April to May 2023, a self-designed survey questionnaire was used to conduct a survey of medical staff in five municipal tertiary public hospitals through the Wenjuanxing platform. The survey questionnaire mainly included the basic information of the survey subjects, the implementation status of the salary system, and employee satisfaction with salary. In May 2023, semi-structured interviews were conducted with relevant personnel from government departments and public hospitals involved in the reform. The interview content included the reform measures taken and their impact, changes in medical staff salaries after the reform, and the current difficulties faced by the reform. Descriptive analysis was conducted on the data, and Chi-square test was used to compare the count data. Kendall′s tau-b test was used to analyze the correlation between salary level and basic information of the survey subjects.Results:In the reform of the salary system in public hospitals in Mianyang City, measures such as system construction, total salary quota determination and dynamic control, and salary management for non-establishment employees have been mainly adopted. 826 valid questionnaires were collected, with an effective response rate of 94.5%. The annual income level was positively correlated with age, education level, years of work experience, and professional title level ( r=0.420, P<0.001; r=0.245, P<0.001; r=0.364, P<0.001; r=0.504, P<0.001). Compared with the personnel in the same positions at the same level of hospitals in other cities and states in Sichuan Province, 274 people (33.2%) were quite satisfied or very satisfied with the current salary level; 350 people (42.3%) were quite satisfied or very satisfied with the salary distribution mechanism, and 441 people (53.4%) were quite satisfied or very satisfied with non-economic salaries. The proportion of survey respondents who believe that the existing salary structure and performance evaluation methods could reflect their actual work value was 464 people (56.2%) and 423 people (51.2%), respectively. A total of 10 people were interviewed, with 4 individuals believing that the salary level has increased after the reform, but the change was not significant compared to before the reform; 8 individuals believed that the current reform does not involve the reform of the salary structure; 6 individuals believed that the internal performance based salary distribution mechanism in hospitals was not sound; 3 individuals believed that there was insufficient attention to the reform of non-economic compensation; 7 individuals believe that the difficulties in the salary system reform were mainly concentrated on the unified understanding of policies, how to determine the increase in the total salary quota, and how to reasonably distribute it internally. Conclusions:Mianyang City has scientifically determined the total salary and implemented dynamic control, enhancing the public welfare nature of public hospitals, while also taking into account the salary management of employees both inside and outside the establishment, promoting equal pay for equal work. However, there were also issues such as disagreements on the dynamic adjustment of the total salary, an imperfect internal distribution mechanism within hospitals, and an incomplete salary system reform. It is necessary to further strengthen top-level design, reasonably increase salary levels, improve the internal distribution mechanism, and optimize the salary structure to continue deepening the reform of the salary system in public hospital.

Objective:To explore the predictive value of the neutrophil-to-lymphocyte ratio (NLR) and soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) for the risk of severe community-acquired pneumonia (CAP) in elderly patients.Methods:A total of 109 elderly CAP patients admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2023 to May 2024 were included. The patients were classified into severe group and non-severe group according to the severity of the disease. Inflammatory markers including NLR, sTREM-1, platelet-to-lymphocyte ratio (PLR), procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) were compared between severe group and non-severe group. Levels of NLR, sTREM-1, and PLR on days one, four and seven after admission in 27 elderly patients with severe CAP were dynamically monitored. Statistical analyses were performed using two independent sample t-test and Mann-Whitney U test. The predictive factors for severe CAP in elderly patients were analyzed by multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each indicator for predicting severe CAP in elderly patients. Results:There were 36 cases in severe group, and 73 cases in non-severe group. The levels of NLR, sTREM-1, PLR, PCT, CRP and IL-6 were significantly higher in the severe group than those in the non-severe group ( Z=-5.77, -3.48, -2.84, -3.94, -3.36 and -3.25, respectively; all P<0.01). Multivariate logistic regression analysis revealed that NLR and sTREM-1 were independent predictive factors for severe CAP in elderly patients (odds ratio ( OR) =1.112, 95% confidence interval ( CI) 1.000 to 1.235, P=0.049; OR=1.006, 95% CI 1.000 to 1.012, P=0.034). The ROC curve showed that the optimal cut-off value was 5.679 for NLR, and the area under the curve (AUC) was 0.841, with the sensitivity and specificity of 0.833 and 0.753, respectively. The optimal cut-off value of sTREM-1 was 151.275 ng/L (AUC was 0.731), with the sensitivity and specificity of 0.639 and 0.639, respectively. The AUC of the combined detection of NLR and sTREM-1 was 0.839, with the sensitivity and specificity of 0.944 and 0.630, respectively. The levels of sTREM-1 ((121.84±75.04) ng/L vs (179.06±85.44) ng/L), NLR (6.74±4.40 vs 11.87±7.78), and PLR (210.07±129.93 vs 294.91±187.61) on the 7th day of admission in 27 elderly patients with severe CAP were significantly lower than those on the 1st day ( t=-3.396, -3.492 and -3.396, respectively, P=0.005, 0.004 and 0.005, respectively). Conclusions:NLR and sTREM-1 have certain predictive value for the risk of severe CAP in elderly patients.