Objective To discuss the indication and efficacy for treating hypospadias with ure-throplasty of Pedicled preputial double-faced island flap(PPDIF). Methods Records of 99 children (mean age, 5.1 years; age range, 4 months-12 years)with hypospadias who underwent PPDIF oper-ation were reviewed. Of them, 56 cases were penile type of hypospadias, 24 cases of penile root type, 13 cases of scrotal type and 6 cases of perineal type according to Barcat classification. Based on Duck-ett technique, the partial preputial cortical plate remained and was displaced to gastr-penis with ure-thra. , and finally the new urethra would be covered by the cortical plate. Results During follow-up of average 2 years, 8 patients(8. 1%) developed urethral fistula, 1 (1.0 %) developed mild meatal ste-nosis, and 1(1.0 %) developed flap necrosis. The success rate for total PPDIF procedure was 89.90 % (89/99). And the success rate of simple PPDIF for cases with penile and penile root hypospadias, and PPDIF+Duplay for cases with serotal and perineal hypospadias were respectively 91.25 % (73/80) and 84.21%(16/19). respectively. Conclusions PPDIF is good for treating most hypospadias. Furth-more it make penis better shape. In the severe cases, PPDIF+Duplay prededure is recommended and the effect was affirmative.

Objective:To explore the application effects of case-based learning (CBL) based on Rain Classroom in surgical nursing teaching of large class.Methods:A total of 357 nursing undergraduates of Batch 2017 in Fenyang College of Shanxi Medical University were selected as the research objects and randomly divided into experimental group (176 cases) and control group (181 cases). The experimental group adopted the CBL based on Rain Classroom, while the control group adopted the traditional multimedia classroom CBL mode. After the teaching, the teaching effect was evaluated by interviewing, comparing the scores of theoretical examination and questionnaire survey. SPSS 19.0 was performed for t test. Results:The scores of memory type, comprehension type and comprehensive application type questions in the experimental group were significantly higher than those in the control group ( P<0.01). The scores of the experimental group were significantly higher than those of the control group in stimulating thirst for knowledge, learning initiative, classroom learning efficiency, memory of knowledge points, problem analysis, clinical thinking and team cooperation ability ( P<0.01). The interview information suggested that the interest of pre-study materials, the control of discussion links and the network effect were the problems affecting the classroom effect of the experimental group, while the control group had the problems of poor learning autonomy and enthusiasm. Conclusion:The CBL based on Rain Classroom can mobilize the initiative and participation of students in large class teaching, improve the learning effect and cultivate comprehensive ability, which is worthy of promotion.