Objective To assess the effect of ultrasonic thyroid artificial intelligence(AI)-assisted diagnostic system(AI-assisted diagnostic system)for diagnosing medullary thyroid carcinoma(MTC)compared with different physicians and taken papillary thyroid carcinoma(PTC)as the controls.Methods Totally 63 MTC,70 PTC and 62 benign thyroid nodules confirmed by pathology were enrolled.AI-assisted diagnostic system was utilized to analyze thyroid nodules and identify the likelihood of malignancy,and the probability value threshold was set at ≥0.40.All thyroid nodules were retrospectively reviewed and categorized by 3 physicians(1 senior physician,1 attending physician and 1 junior physician)according to Chinese thyroid imaging reporting and data system(C-TIRADS).The efficacy of AI-assisted diagnostic system and physicians for diagnosing MTC and PTC were evaluated.Results AI-assisted diagnostic system showed lower sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the curve(AUC)for diagnosing MTC and PTC compared with physicians.Significant differences of AUC were found between senior physician and AI-assisted diagnostic system,as well as between attending physician and AI-assisted diagnostic system for diagnosing MTC and PTC(all P＜0.01),while no significant difference of AUC was between junior physicians and AI-assisted diagnostic system(both P＞0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and AUC for AI-assisted diagnostic system for diagnosing MTC were all lower than those for diagnosing PTC,but the AUC was not significantly different(P＞0.05).Conclusion Ultrasonic thyroid AI-assisted diagnostic system had relatively high value for diagnosing MTC.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To identify the core genes related to the disease severity of respiratory syncytial virus (RSV) bronchiolitis in children using RNA sequencing (RNA-seq) and weighted gene co-expression network analysis (WGCNA), aiming to provide reference for predicting the condition of RSV infection.Methods:Twenty-two patients admitted to the Second Affiliated Hospital of Wenzhou Medical University with RSV bronchiolitis from October 1, 2019 to February 29, 2020 were enrolled as the case group. They were divided into three groups based on the severity of the disease: mild group, moderate group and severe group. Twenty-two healthy children were selected as the control group. Total RNA was extracted from whole blood leukocytes and analyzed by RNA-seq to compare the differentially expressed genes (DEGs) between children with RSV bronchiolitis and healthy children. The gene co-expression modules related to disease severity and biological indicators for disease severity assessment were identified.Results:The median age of the 22 patients (19 males and 3 females) was 3 months. The median age of the 22 healthy children (14 males and 8 females) was 4 months. There was no significant difference in age or gender between the two groups. There were 8 cases in the mild group, 7 cases in the moderate group and 7 cases in the severe group. Through significance analysis, 416 DEGs were found in the mild group, 586 in the moderate group and 846 in the severe group. According to WGCNA analysis, 10 co-expression modules were found, among which brown module ( r=0.62, P<0.001) was significantly correlated with disease severity. The protein-protein interaction network of DEGs in brown module was constructed and the top 30 core genes were selected according to the connectivity of gene nodes, among which the genes with high correlation were RBX1 and PSMA7. The expression of RBX1 and PSMA7 genes was up-regulated in the severe group, but their expression in the mild and moderate groups was not significantly different from that in the control group. Conclusions:RBX1 and PSMA7 genes might be biological predictors of disease severity in RSV bronchiolitis.

Objective:To systematically understand the reform progress of disease prevention and control system in China.Methods:The literature regarding the reform of China′s disease prevention and control system was searched by using the keywords including disease prevention and control, center for disease prevention and control (CDC), disease control, reform, and system from 2003 to 2020 in China CNKI, Wanfang Data knowledge service platform, VIP information and China biomedical literature database. The language is limited to Chinese. A total of 25 studies were included to analyze the information about the organizational structure, functional orientation, financing mechanism and personnel system of China′s disease prevention and control system.Results:The 25 studies described the specific changes and reform suggestions of China′s disease prevention and control system, including key policies (7 studies), organizational structure transformation (4 studies), institutional function transformation (7 studies), financing mechanism transformation (5 studies), personnel system reform (2 studies), and performance-based salary system reform (4 studies). Meanwhile, the reform suggestions were concluded at the top-level design system reform (two aspects), organization structure (three aspects), functioning (four aspects), and personnel guarantee mechanism (three aspects).Conclusions:This study indicates that there is a lack of empirical evidence regarding specific reform effects and content analysis at the micro level of disease prevention and control system in China. Future study should strengthen the rigorousness of study design and focus on the quantitative impacts of reform implementation in China.

Objective:To systematically understand the reform progress of disease prevention and control system in China.Methods:The literature regarding the reform of China′s disease prevention and control system was searched by using the keywords including disease prevention and control, center for disease prevention and control (CDC), disease control, reform, and system from 2003 to 2020 in China CNKI, Wanfang Data knowledge service platform, VIP information and China biomedical literature database. The language is limited to Chinese. A total of 25 studies were included to analyze the information about the organizational structure, functional orientation, financing mechanism and personnel system of China′s disease prevention and control system.Results:The 25 studies described the specific changes and reform suggestions of China′s disease prevention and control system, including key policies (7 studies), organizational structure transformation (4 studies), institutional function transformation (7 studies), financing mechanism transformation (5 studies), personnel system reform (2 studies), and performance-based salary system reform (4 studies). Meanwhile, the reform suggestions were concluded at the top-level design system reform (two aspects), organization structure (three aspects), functioning (four aspects), and personnel guarantee mechanism (three aspects).Conclusions:This study indicates that there is a lack of empirical evidence regarding specific reform effects and content analysis at the micro level of disease prevention and control system in China. Future study should strengthen the rigorousness of study design and focus on the quantitative impacts of reform implementation in China.

Objective:To analyze the characteristics and citations of articles in Chinese Journal of Preventive Medicine from 2014 to 2017, and discuss the academic level and quality of the journal. Methods:All the literatures published in Chinese Journal of Preventive Medicine from 2014 to 2017 were retrieved through the Chinese Medical Citation index, and the citation frequency data in China′s core journals of science and technology from 2014 to 2018 was obtained through Institute of Scientific and Technical Information of China. The citation status of articles published in Chinese Journal of Preventive Medicine was statistically analyzed by the scientometric method. The main indicators included the citation rate of articles published in each year, the citation frequency of all articles, the citation status of individual papers and authors, the regional and high-yield institution distribution of cited authors, and the main citation journals. Results:From 2014 to 2017, a total of 929 articles were published in 19 columns of Chinese Journal of Preventive Medicine,and the number of each year was 253 (27.23%), 231 (24.87%), 224 (24.11%) and 221 (23.79%), respectively. The total number of published pages was 3 564, and the average number of articles was 3.45 pages. A total of 28 key topics have been published. The total citation was 3 861 times, with 4.16 times per paper. Among them, 161 papers were not cited，accounting for 17.33%. The maximum citation frequency of a single paper was 49 times. There were good citations in the columns of original article and methodology introduction. There was no correlation between fund project support and paper citation. But the cited rate (93.67%) and cited frequency of special issue ［ M ( P25, P75)=3 (1, 6)］ were higher compared with the cited rate (80.42%; χ 2=16.08, P<0.001) and cited frequency ［ M ( P25, P75)=2 (1, 6); Z=2.56, P=0.010] of free-lance articles. A total of 15 authors were cited more than 25 times, and 15 articles were cited more than 20 times. There were 213 institutions involved in the 768 cited papers, among which 12 institutions were cited more than 50 times. The authors of the cited papers were distributed in 28 provinces (autonomous regions, municipalities directly under the central government). From 2014 to 2018, a total of 281 journals cited the papers published in our journal, of which 12 journals cited more than 50 times. Conclusion:The quality of the literature in Chinese Journal of Preventive Medicine is high and the journal has a strong influence in the field of preventive medicine and public health in China. The editorial department should adjust the column setting timely, strengthen the planning of key topic selection and the solicitation and publicity of excellent papers, reduce the number of papers cited by zero, and further improve the influence of the magazine.

Objective:To analyze the characteristics and citations of articles in Chinese Journal of Preventive Medicine from 2014 to 2017, and discuss the academic level and quality of the journal. Methods:All the literatures published in Chinese Journal of Preventive Medicine from 2014 to 2017 were retrieved through the Chinese Medical Citation index, and the citation frequency data in China′s core journals of science and technology from 2014 to 2018 was obtained through Institute of Scientific and Technical Information of China. The citation status of articles published in Chinese Journal of Preventive Medicine was statistically analyzed by the scientometric method. The main indicators included the citation rate of articles published in each year, the citation frequency of all articles, the citation status of individual papers and authors, the regional and high-yield institution distribution of cited authors, and the main citation journals. Results:From 2014 to 2017, a total of 929 articles were published in 19 columns of Chinese Journal of Preventive Medicine,and the number of each year was 253 (27.23%), 231 (24.87%), 224 (24.11%) and 221 (23.79%), respectively. The total number of published pages was 3 564, and the average number of articles was 3.45 pages. A total of 28 key topics have been published. The total citation was 3 861 times, with 4.16 times per paper. Among them, 161 papers were not cited，accounting for 17.33%. The maximum citation frequency of a single paper was 49 times. There were good citations in the columns of original article and methodology introduction. There was no correlation between fund project support and paper citation. But the cited rate (93.67%) and cited frequency of special issue ［ M ( P25, P75)=3 (1, 6)］ were higher compared with the cited rate (80.42%; χ 2=16.08, P<0.001) and cited frequency ［ M ( P25, P75)=2 (1, 6); Z=2.56, P=0.010] of free-lance articles. A total of 15 authors were cited more than 25 times, and 15 articles were cited more than 20 times. There were 213 institutions involved in the 768 cited papers, among which 12 institutions were cited more than 50 times. The authors of the cited papers were distributed in 28 provinces (autonomous regions, municipalities directly under the central government). From 2014 to 2018, a total of 281 journals cited the papers published in our journal, of which 12 journals cited more than 50 times. Conclusion:The quality of the literature in Chinese Journal of Preventive Medicine is high and the journal has a strong influence in the field of preventive medicine and public health in China. The editorial department should adjust the column setting timely, strengthen the planning of key topic selection and the solicitation and publicity of excellent papers, reduce the number of papers cited by zero, and further improve the influence of the magazine.

Objective To explore the value of 2017 thyroid imaging reporting and data system (TI-RADS) suggested by American College of Radiology in diagnosis of benign and malignant thyroid nodules. Methods According to 2017 TI-RADS, the sonographic features of 1 109 pathologically diagnosed thyroid nodules in 1 039 patients were retrospectively analyzed. Taken coarse needle biopsy or surgical pathology as the gold standards, the diagnostic efficacy of 2017 TI-RADS for different types of nodules was analyzed. Results Of 1 109 nodules, 551 were benign and 558 were malignant. The composition, echogenicity, aspect ratio, boundary and calcification were statistically different between benign and malignant nodules (all P<0.05). The probability of malignancy in nodules with a classification of TI-RADS 2, 3, 4 and 5 was 0, 5.45% (3/55), 22.29% (39/175) and 58.84% (516/877), respectively, which had statistical difference (P<0.001). When TI-RADS classification were larger than 4, the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value was 99.46% (555/558), 9.80% (54/551), 54.91% (609/1 109), 52.76% (555/1 052) and 94.74% (54/57), respectively. Conclusion 2017 TI-RADS classification is based on the morphology and maximum diameter management of thyroid nodules, demonstrating clinical application value in evaluating malignant nodules, but the specificity is low, therefore needing further improvement.

Objective To analyze the independent risk factors and complications for perioperative hyperbilirubinemia in Stanford type A aortic dissection undergoing operation and investigate the management strategy of perioperative hyperbilirubi-nemia. Methods Between January 2013 and January 2018 from the department of great vessel surgery of heart centre of,290 cases of patients with Stanford type A aortic dissection undergoing operation were collected consecutively,male 210 cases,fe-male 80 cases. The related data and perioperative peak hyperbilirubinemia were recorded. According to the perioperative peak hyperbilirubinemia,patients were divided into 2 groups:≥51. 3 μmol/ L group and < 51. 3 μmol/ L group. Univariate and lo-gistic regression analysis were used to identify the independent risk factors. The perioperative complications were also recorded. Results Preoperative total bilirubin ≥ 17. 1 μmol/ L(OR = 2. 105,95％ CI: 1. 153 - 3. 125,P = 0. 016),cardiopulmonary bypass time > 3. 5 h(OR = 1. 103,95％ CI: 1. 316 - 6. 151,P = 0. 031),a large number of hemolysis(OR = 1. 503,95％CI: 1. 506 - 6. 651,P = 0. 029),the input amount of 24 h allogeneic red blood cell > 2000 ml(OR = 1. 381,95％ CI:0. 956 - 2. 552,P = 0. 036)were the independent risk factors for perioperative hyperbilirubinemia. The incidence rate of post-operative acute hepatic failure(2. 5％ vs. 0,P = 0. 021)and artificial liver therapy(2. 5％ vs. 0,P = 0. 021)in≥51. 3μmol/ L group were significantly increased. The incidence rate of postoperative acute lung injury(37. 5％ vs. 25. 2％,P =0. 039)and acute kidney injury(38. 7％ vs. 19. 5％,P = 0. 035)in 51. 3 μmol/ L group were also significantly increased. The duration of mechanical ventilation[(4. 1 ± 1. 6)days vs. (2. 8 ± 1. 3)days,P < 0. 05]and ICU stay time[(5. 1 ± 2. 3)days vs. (3. 9 ± 1. 8)days,P = 0. 035]and hospitalization time[( 19. 3 ± 3. 1)days vs. ( 17. 3 ± 2. 5)days,P = 0. 035]were sig-nificantly prolonged. Temporary nerve dysfunction(52. 5％ vs. 32. 6％,P = 0. 002)and in-hospital mortality( 17. 5％ vs. 8. 1％,P = 0. 037)were significantly increased. Conclusion Preoperative total bilirubin ≥ 17. 1 μmol/ L,cardiopulmonary bypass time > 3. 5 h,a large number of hemolysis,the input amount of 24 h allogeneic red blood cell > 2000 ml were the in-dependent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection. The perioperative complications in≥51. 3 μmol/ L group were significantly increased. Therefore,more attention should be paid to the independent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection,hyperbilirubinemia and its clearance should be moni-tored more actively and dynamically,the cause should be found more precisely,the treatment be more comprehensive to achieve to control the level of bilirubinemia and improve the prognosis.

Objective To evaluate the clinical efficacy of extraperitoneal laparoscopic radical prostatectomy(ELRP)for prostate cancer patients, and to summarize the experience of surgical treatment. Methods The clinical data of 50 prostate cancer patients who underwent ELRP by the same performer from January 2010 to June 2015 were retrospectively reviewed. Results All cases were all successfully completed ,no case was converted to open surgery. The average operation time was 238.8 min,average operative blood loss was 409.1 mL,and intraoperative or postopera?tive blood transfusion was 6(12%). The mean postoperative catheterization time was 23.7(17?38)d. The mean postoperative hospital stay was 15 (10?34)d. The postoperative recovery time of eating was 2?4 d,and the ambulation time was 1?3 d. Totally 3 cases(6%)had lymph node metasta?sis,and 7 cases(14%)had positive surgical margin. Totally 9 cases(18%)had surgery?related complication. Patients were followed up for 6 to 58 months,with an average of 12.5 months. One case(2%)had biochemical recurrence,and the tumor?free survival rate was 84%. At the end of fol?low?up,all of the patients were continent. Conclusion ELRP is safe and effective for the treatment of prostate cancer. With the development of minimally invasive techniques,the applications of RP are increasingly widespread. However,large?scale and long?term follow?up studies are still needed for high?risk prostate cancer patients.