Surgical resection in patients with advanced primary carcinoma of liver has high risks of early recurrence and incidence of portal vein tumor thrombus, caused by insufficient resi-dual liver volume after two-steps hepatotomy. At present, the treatment for patients with advanced primary carcinoma of liver is limited, thus can't satisfy the requirement of patient for treatment. The authors introduce the clinical experience of a patient with hepatocellular carcinoma and insufficient residual liver volume who underwent preventive immunotherapy plus target therapy after associa-ting liver partition and portal vein ligation for staged hepatectomy, in order to provide reference for relevant treatment.

Objective:To investigate the intention of medical students to be vaccinated against COVID-19 and to analyze the influencing factors.Methods:A self-filled electronic questionnaire survey was conducted among medical students from a medical school in Shanghai randomly selected from June 21 to 29, 2021. The questionnaire contained items of basic information, intention for COVID-19 vaccination, awareness of COVID-19 prevention measures and awareness of COVID-19 vaccine. Logistic regression was used to analyze the influencing factors.Results:The average age of the 966 respondents was (20.4±2.9) years, and 63.6% (614/966) of them were female;23.7% (229/966) of them had family members or relatives who had participated in anti-pandemic work or volunteer service;90.6% (875/966) of the respondents expressed they were very willing or willing to be vaccinated against COVID-19. The majority of the respondents thought that “COVID-19 infection is very serious” (94.3%, 911/966), “good protection can effectively prevent COVID-19 infection” (92.4%, 893/966), and “they can fully implement all kinds of protection measures” (73.5%, 710/966). About half of the respondents (51.8%, 501/966) knew about the adverse reactions and contraindications of COVID-19 vaccine. The low protected capability (47.4%, 458/966), short duration of protection (50.6%, 489/966), and many side effects (48.7%, 470/966) were the major concerns about COVID-19 vaccine. Logistic regression analysis showed that people thought that “COVID-19 infection is very serious” ( OR=5.30, 95 %CI:2.60-10.81, P<0.001), thought that “good protection can effectively prevent COVID-19 infection” ( OR=2.46, 95 %CI:1.26-4.81, P=0.009), thought that “they can fully implement all kinds of protection measures” ( OR=2.55, 95 %CI:1.53-4.25, P<0.001) were more willing to receive COVID-19 vaccination. While those concerned about vaccine quality did the opposite ( OR=0.29, 95 %CI:0.13-0.65, P=0.003). Conclusions:Medical students have a high intention of vaccination against COVID-19. The vaccine-related knowledge quality should be emphasized in future publicity to further enhance the intention of COVID-19 vaccination.

Objective:To investigate the nutritional risk and prevalence of malnutrition in patients with terminal stage gastrointestinal malignant tumors in a tertiary hospital in Changsha.Methods:Cluster sampling was used to conduct a cross-sectional survey of inpatients from Departments of Gastroenterology, Gastrointestinal Surgery, Hepatobiliary Surgery and Oncology in Hunan Provincial People's Hospital from January 2019 to July 2020. Nutritional Risk Screening 2002 (NRS 2002) was used to assess the prevalence of nutritional risk with malnutrition defined as concurrent presence of BMI < 18.5 kg/m 2, poor general condition and NRS 2002 nutritional impairment score of 3. Step 2 of Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria (without whole body muscle mass) was adopted to diagnose malnutrition. Step 3 of GLIM criteria was used to evaluate the prevalence of severe malnutrition. Results:A total of 802 patients registered in the 4 departments were selected for screening via cluster sampling and 514 were enrolled according to the inclusion/exclusion criteria. The prevalence of nutritional risk in patients with terminal stage gastrointestinal cancer was 49.8% (256/514). The prevalence of malnutrition and severe malnutrition per GLIM criteria were 41.6% (214/514) and 18.3% (94/514), respectively.Conclusions:Although nutritional support therapy is not recommended for patients with end-stage cancer. This paper suggests that the prevalence of nutritional risk and malnutrition in patients with end-stage gastrointestinal cancer is not as high as described in some articles.

Objective To develop a measuring tool for the elderly care service needs in the community.Methods Based on the literature search and Delphi expert consultation,a measuring tool for elderly care service needs was developed.The reliability (internal consistency coefficient) and validity (surface validity,content validity,criterion-related validity) of the developed measurement tool were evaluated with on-site expert consultation and the cross-sectional survey.Results A 11-dimension measurement tool was developed,which covered physical health,mental health and desires for old-age support assessment.The reliability evaluation showed that there was significant correlation (P＜0.05) among the measurement dimensions of the physical health and the mental health of the elderly in community.The validity evaluation showed that the measurement methods for the measurement dimensions of the elderly care needs,including the evaluation items,evaluation methods,and rating methods,all got below 2 scores in applicability assessment,and the measurement methods of the self-care ability,vision,the self-willingness/information expression of the elderly,the ability of the elderly to understand the willingness/information expressed by others,and the ability to provide family care were all supported by more than 50％ experts,which indicated that the surface validity and content validity were good.There was a significant positive correlation between the living places of the elderly and the needsof elderly care services (r=0.214,P＜0.01),and there were significant correlations between all measurement dimensions with the living place except anxiety (P＜0.05),which indicated that the measurement tool had an acceptable criterion-related validity.The consistency of self-supporting willingness,the family willingness to care for the elderly with the current old-age care place were relatively poor (Kappa=0.063,P=0.007;Kappa=0.051,P=0.006).Conclusion The overall performance of the measurement tool for the elderly care service needs developed in this study is acceptable.It has been approved by both the elderly care service suppliers and the elderly care service needs evaluators.It also shows some internal consistency in measurement results of the demanders,and is consistent with the actual living place.

Objective To survey on the elderly care needs in the community of Shanghai.Methods From February 2017 to May 2017,a survey on the elderly care needs was conducted using stratified sampling method among 4 312 residents aged ≥60 years in Malu township of Shanghai Jiading District.The survey involved physical health status (illness,self-care ability,vision,risk of falls),mental health status (expression ability in feelings of self-will/information,comprehension in others' willingness/information,depression,anxiety),social health status(family care ability),and willingness for elderly care method (self-desires for old-age support,family-desires for old-age support).The survey was implemented by family doctors.Results The total demand for elderly care services for the elderly in Malu Township was skewed,with a median score of 9.9 points (5.7,15.1).In terms of physical health status,72.7％(3 135) of the elderly suffered from one or more diseases,90.8％(3 915) of the elderly had good self-care ability,83.5％ (3 600) of the elderly had good eyesight,and 98.5％(4 247) of the elderly had only mild risk of falling;in terms of mental health status,81.8％(3 527) of the elderly had normal expression ability of self-willingness/information,and 98.3％(4 239) of the elderly had normal understanding ability of wishes/information expressed by others,87.5％(3 773) of elderly people did not have depression,97.0％(4 183) of the elderly had no anxiety;in terms of social health,58.7％(2 531) of elderly people had normal family care ability;58.7％(2 531) of elderly people were willing to get home-based care,and 53.0％(2 285) of their families also hoped that the elderly could get home-based care.Conclusion The needs of elderly care services is at a lower level among old-aged residents in Malu township,however,there is a relatively low social health status.This study provides an objective quantitative basis for the targeted development of medical care and support services for the elderlv in the communitv in the future.

Objective To develop and allocate regional elderly care resources based on local service needs.Methods From February 2016 to May 2016,a face-to-face questionnaire survey was conducted to measure the elderly care service needs among residents over 60 years of age in Malu Township of Shanghai Jiading District.A telephone survey on the old-age care resources in Malu Township was carried out in November 2016.The demarcation of the aged care service needs was considered according to the resource classification from supplier side and the needs scores from the demander side.Kappa consistency test was used to compare the current care setting and the care setting matched to the real needs on the basis of the demarcation criteria.Results The results of the demarcation showed that 8 old-aged with score ≥ 44.5 in the survey (0.2％) should have the skilled nursing facility-based care;218 with the score of 24.1 to 44.4 (5.1％) should have the welfare institution-based care;60 with score of 23.2 to 24.0 (1.4％) should have elderly home-based care;72 with scores of 22.1 to 23.1 (1.7％) should have the community-based care;3 954 with score ≤ 22.0 (91.6％) should have home-based care.The consistency between the status of current care setting and the care setting matched to the real needs based on the demarcation criteria was poor (Kappa=0.092,P＜0.01).Conclusions This study sets a grading criterion for the service objects of the various aged care services in Malu Township,and provides a basis for the orderly,rational and fair distribution of the regional old-age care service resources.However,the current resource allocation in the region is not accurately matched to the real needs,the problem should be solved with the application of the demarcation criterion.

Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.

Taking the curriculum "society, the individual & medicine" in university of Ottawa faculty of medicine as an example, the cultivation models for comprehensive quality of medical students in China and Canada was compared. In University of Ottawa faculty of medicine, the curriculum "society, the individual & medicine" is throughout the whole medical education, including three themes of statistics and epidemiology related knowledge, health related issues and professional development. The varied teaching modes are combined with electronic teaching equipment and students' subjectivity in learning is emphasized. Drawing insights from the medical education in Canada, we should focus on promoting early contact and lifelong study of medical humanities curriculum for medical students, enriching the curriculum content, enhancing the curriculum practicality, diversifying the teaching methods, strengthening the teachers' training, improving the assessment system and establishing the long-term mechanism.

Objective To investigate the value of the apparent diffusion coefficient (ADC)measurement in assessment of tumor grade and myometrial invasion of endometrial carcinoma (EC).Methods 80 EC patients and 28 cervical cancer patients with normal endometrium were studied retrospectively.1.5T conventional MRI and DWI (b=0,1 000 s/mm2)were performed,and ADC values were calculated by two radiologists.Statistical analyses were performed by using SPSS 19.0 and Medcalc software.Results The mean ADC values (×10-3mm2/s)were 0.851±0.131,0.752±0.099,0.681±0.089 for G1,G2 and G3 EC,respectively.Significant statistical differences were achieved for the three groups (G1 vs G2:P=0.005;G2 vs G3:P=0.03;G1 vs G3:P< 0.000 1).For the prediction of G3,the area under the curve (AUC)of 0.851 and the cut-off value of ≤0.742×10-3mm2/s were identified,with the sensitivity, specificity and accuracy of 88.24%,76.19% and 85%,respectively.Conclusion There are significant statistical differences between histologic grades of EC.ADC measurement may have the potential to select G3 EC patients.

Objective To evaluate the prognostic value of blood lactate (Lac) level in sepsis patients with or without diabetes.Methods 106 patients admitted to intensive care unit (ICU) of Zhongshan Hospital Affiliated to Fudan University from April 2015 to November 2016 were enrolled. The patients with age > 18 years and the length of hospital stay > 24 hours were included. Records including blood Lac, serum creatinine (SCr), white blood cell count (WBC), platelet count (PLT), sequential organ failure assessment (SOFA) on the first day of admission; minimum oxygen index (PaO2/FiO2) in 3 days after admission; mechanical ventilation, whether there was a history of diabetes, usage of biguanides, etiology control treatment, usage of continuous renal replacement therapy (CRRT) were collected. According to the level of blood Lac patients were divided into high Lac group (Lac > 2 mmol/L) and low Lac group (Lac ≤ 2 mmol/L);based on their diabetic history, sepsis patients were divided into the diabetes group and non-diabetes group. The survival curve of each group was analyzed by Kaplan-Meier regression analysis, and the factors influencing the prognosis were analyzed by multivariate Cox regression analysis.Results There were 76 males and 30 females sepsis patients, with an average age of (68.1±14.7) years old. In the 51 patients of low Lac group, there were 7 patients who suffered from diabetes. While in the 55 patients of high Lac group, there were 12 patients who suffered from diabetes. Compared with low Lac group, high Lac group had a higher age, higher SOFA score, and a lower proportion of patients who had the treatment of etiology control (allP < 0.05). There was no significant difference of blood Lac in sepsis patients with diabetes and those without diabetes (mmol/L: 3.03±2.73 vs. 2.81±2.40,P > 0.05). Kaplan-Meier survival curve analysis showed that the 90-day survival rate in the high Lac group was significantly lower than that in the low Lac group (56.36% vs. 90.20%,χ2 = 0.697,P = 0.008). The high Lac group without diabetes had lower survival rate, and the 90-day survival rate was significantly lower than that of the low Lac group without diabetes (58.14% vs. 90.90%,χ2 = 7.152,P = 0.007); there was no significant difference in 90-day survival rate between the high Lac group and the low Lac group with diabetes (50.00% vs. 85.71%,χ2 = 0.012,P = 0.914). Multivariate Cox regression analysis showed that blood Lac was an independent risk factor for the prognosis of sepsis patients [odds ratio (OR) = 3.863, 95% confidence interval (95%CI) = 1.237-12.060,P = 0.020]. After stratification according to their diabetic history, the blood Lac was an independent risk factor for the prognosis of sepsis patients without diabetes (OR = 4.816, 95%CI = 1.407-15.824, P = 0.010), but the blood Lac had no effect on the prognosis of sepsis patients with diabetes (OR = 0.000, 95%CI =0.000-1.103,P = 0.270).Conclusions The predictive value of blood Lac on sepsis patients with or without diabetes was different. The blood Lac was related with the prognosis of sepsis patients without diabetes, while further study should be conducted for the prognostic value of blood Lac in sepsis patients with diabetes, and it's possible to increase the cut-off-point of Lac level in these patients.