Objective:To analyze the clinical features, treatment efficacy and prognosis of cavernous lymphangioma.Methods:The clinical manifestations, laboratory findings, imaging examinations and treatment of 8 patients with pathology-diagnosed cavernous lymphangioma admitted in Peking Union Medical College Hospital from January 1990 to July 2020 were retrospectively analyzed.Results:All the patients were female. The onset age ranged from 0 to 58 years, with a course of 24 (5,78) months. There were 2 cases of abdominal mass, 2 cases of axillary mass, 1 case of neck mass, 1 case of inguinal mass, 1 case of mandibular mass and 1 case of pleural and peritoneal effusion. Seven cases had adult onset and 1 case had congenital onset. Two patients had had history of surgery adjacent to lesion sites. Contrast-enhanced CT scan showed a low-density round mass with no significant enhancement in 5 patients. Seven patients underwent complete resection of the mass, 1 patient received partial resection and intervention with medium-chain fatty-acid diet. During the follow-up, 4 patients were stable after 3.5 (1.3-17.8) years, while 2 patients relapsed 1 and 13 year after surgery, respectively. Additionally, one patient was diagnosed with Bowen disease.Conclusion:Cavernous lymphangioma can be congenital or acquired and usually occurs in female. The body mass is the common clinical manifestation; and surgery is the most common treatment, but it is prone to relapse and requires long-term follow-up.

Objective To explore the roles of miR-10a in the cisplatin resistance in cervical cancer cell lines,and further study the mechanism.Methods The cells were transfected with the mimics of miR10a and its negative control RNA (NC).Methyl thiazolyl tetrazolium (MTF) assay and fluorescence activated cell sorter were used to analyze drug sensitivity and apoptosis after treating with cisplatin,luciferase reporter assay to identify that miR-10a directly targets phosphatase and tensin homologue deleted on chromosome ten (PTEN).The expression of PTEN gene and its protein levels after tansfection was measured,respectively.Results after transfected with miR-10a mimics:(1) The 50％ inhibition concentration of Hela cells (7.2 μg/ml) was more than in the NC group (5.6 μg/ml).The 50％ inhibition concentration of Siha cells (6.4 μg/ml) was significantly more than in the NC group (3.8 μg/ml) (P＜0.05).(2) The apoptosis rates of Hela cells and Siha cells were significantly lower compared to the NC group (P ＜ 0.05).(3)miR-10a might directly target the 3'-untranslated region (3'-UTR) of PTEN,which significantly changed the PTEN protein level (P ＜ 0.05).Conclusions miR-10a may modulate cisplatin-induced apoptosis in cervical cancer by inhibiting PTEN protein level.

Abstract: Objective　This article summarizes the clinical characteristics and diagnosis and treatment experience of an elderly patient infected with Omicron variant BA.5.1.3 of COVID-19 in Hainan Province. Methods　The clinical data and treatment of an elderly patient infected with Omicron variant BA.5.1.3 of COVID-19 admitted to Haikou designated hospital on August 15, 2022 were retrospectively analyzed. Results　A 107-year-old female patient was admitted to the hospital with "fever and cough for 1 day". Two of her family members have infected with COVID-19. The patient initially developed fever, accompanied by cough, expectoration, a little white sticky sputum, accompanied by sore throat, muscle pain, fatigue. Nucleic acid test was positive in throat swab, indicating Omicron variant BA.5.1.3 infection. The patient was diagnosed as mild COVID-19 and treated with antiviral therapy, Chinese medicine conditioning, anticoagulation, electrolyte disorder regulation and symptomatic treatment for 9 days. The patient's clinical symptoms were relieved, and she was cured and discharged after two negative nucleic acid tests. One week later, the patient recovered well. Conclusions　Omicron variant BA.5.1.3 is highly infectious, and comprehensive treatment such as antiviral treatment and traditional Chinese medicine treatment has achieved good efficacy. For elderly patients, attention should be paid to maintaining the stability of organ function and internal environment, which is helpful to improve the prognosis of patients.

International medical community has seen the prevail of outpatient teaching for medical students in recent years. A student-centered and faculty-run teaching clinic was set up based on current outpatient resources in 2008 by Division of General Internal Medicine (DGIM) in Peking Union Medical College Hospital (PUMCH). We concluded that teaching clinic was an effective teaching mode for medical students to improve clinical skills, diagnostic proficiency and health-care professionalism in internal medicine.

Objective To review the feedback from trainees and trainers of interactive clinical skill training workshop for general practice.Methods An interactive clinical training workshop was held on October,2014,medical staff from 17 provinces or municipalities attended the workshop.Feedback from 86 trainees was collected by questionnaire survey,while the feedback from 12 trainers was collected by focus group.Results Total 86 questionnaires were collected from trainees with a response rate of 100％.The average working year of trainees was 15.6 ; 38.4％ of them were general practitioners in community health centers; and most of them had no similar trainings before.Among 86 trainees,70 (81.4％) thought that the training contents were relevant to their daily work,76 (88.4％) thought that workshop was good method for the training.More than 55.0％ trainees told that the training contents met their expectation ; 76 (88.4％) thought that the workshop was well conducted in general,68 (79.1％) were willing to participate similar training workshops in the future.However,the contents probably need similar training advised by the trainers in the questionnaire were not agreed by trainees.The trainers thought the width and depth of training contents should be modified according to the trainees' level.Basic knowledge,basic clinical skill and common diseases should be emphasized ; and the concept of general practice and indications of referral were among the important but difficult parts in the training.For an interactive clinical skill training,teaching materials preparation,lacale control and local teaching facilities were all important.Conclusions Clinical skill training is an important part of general practitioners' training,and workshop is an effective way for training.The training contentd should be more closer to the daily work of general practitioners.

Objective To discuss the reasons for and preventive methods of acute encephalocele during traumatic cerebral operation.Methods Retrospective analysis of 38 patients with acute encephalocele was made.Results The main cause of acute encephalocele were delayed intracranial hematomas,acute diffuse brain swelling,cerebral contusion and laceration in Sylvain tissue and ischemic anoxia.Conclusion Complete removal of hematoma and delayed hematoma,sufficient decompression and decrease of ICP are effective methods for prevention and treatment of acute encephalocele.

Objectives To explore the correlation of level of serum 25-hydroxyvitamin D with pulmonary function in adult with asthma. Methods Patients were divided into Asthmatic group(n=62)and Control group (n=28). The Asthmatic group was further divided into Mild Group (n=6), Moderate Group (n=13) and Severe Group (n=43). Serum levels of 25-hy?droxyvitamin D [25(OH)D], denoted as 25(OH) Vit D was detected by ELISA. Pulmonary function indicators,including FVC (forced vital capacity) , FEV1 (forced expiratory volume in 1 second) , FEV1%predicted , and FEV1/FVC%were deter?mined by a pulmonary function testing device. General profiles such as medical history, age and height as well as serum VitD levels were compared between subgroups of the asthmatic groups and between two genders. Serum levels of 25 (OH) VitD were compared between asthmatic group and control group while its correlation with FEV1%predicted were calculated in all three sub asthmatic groups. Results There was no significant difference in medical history, age, height and the 25(OH) VitD levels between male and female participants. Serum 25(OH) Vit D level was significantly lower in the asthmatic patient group [(29.69±20.45) nmol/L] compared to that in control group [(75.16±4.06) nmol/L] (P<0.05). It was significantly lower in severe sub group than those in the mild and moderate sub groups. The differences were both statistically significant ( P<0.05). There were positive correlations between serum 25(OH) Vit D levels and FEV1%predicted ( P<0.05) in all sub asth?matic groups. Conclusion Vitamin D deficiency is highly prevalent in asthmatic patients, and there is a strong correlation between 25(OH) Vit D asthma severity as well as between lung function.

Objective To study the etiology,relevant factors and endoscopic characteristics of acute lower gastrointestinal tract hemorrhage.Methods A total of 938 patients receiving emergency colonoscopy for acute lower gastrointestinal tract hemorrhage were collected to study the etiological profiles.Different causes between young group and elderly group were also recorded.Results The total detectable rate of acute lower gastrointestinal tract hemorrhage in respect of causes was 96.16％ (902/938).The five leading causes were colorectal malignancy (41.26％),erosive colorectal polypus (12.37％),inflammatory bowel disease (9.59％),erosive and ulcer colitis (10.34％) and hemorrhoids (8.64％).Compared with youth and middle age patients,the incidence of colorectal malignancy (x2 =68.116,df =2,P =0.000) and colorectal polyps (x2 =9.101,df =2,P =0.011) were significantly increased in elderly patients,while incidence of inflammatory bowel disease (x2 =62.150,df=2,P =0.000) and erosive and ulcer colitis (x2 =20.292,df =2,P =0.000) were significantly decreased in those patients.Conclusions Emergency colonoscopy for diagnosis of acute lower gastrointestinal tract hemorrhage is an important measure.The major manifestation is bleeding resulting from colorectal malignancy,erosive colorectal polypus,inflammatory bowel disease,erosive and ulcer colitis and anal hemorrhoid.Age is associated with the cause of lower gastrointestinal tract bleeding induced by different kinds of lesions at the colorectum.

Objective To clone the human Islet neogenesis associated protein(rhINGAP)gene,express the gene extraeellulary in Pichia yeast for.further study on biological function and animal test on INGAP.Methods INGAP gene Was amplified with PCR and inserted into the recombinant plasmidα/pUC18.Then,the fusion gene of α and INGAP was digested and inserted into the expression plasmid pPIC9K.The positive recombinant plasmid which integrated INGAP Was confirmed by restriction enzyme digestion and sequencing,and it Was linearized with Sal Ⅰ digestion and transfered into the yeast host strain GS115 through electroporation.The yeast transformants that harbor the desired gene INGAP with high copy were selected by the auxotroph mediam G418,and verified by PCR.The condition of hake-flask culture was optimized,and the recombinant human INGAP Was induced expression with methanol as the only Carbone source.The antigen activity of the desired protein Was detected by Western blotting and ELISA method.Results Recombinant plasmid αINGAP/pPIC9K were successfully constructed and three positive Pichia yeast transformants were obtained.The expressed protein had satisfactory antigen activity,which Was confirmed by the Western blotting and ELISA method.Conclusions Pichia yeast expressing human Islet neogenesis associated protein (rhINGAP)gene was successfully constructed.

Objective To evaluate the current situation of two-way referral system by qualitative study.Methods The qualitative study was carried out in Department of General Internal Medicine of Peking Union Hospital and 4 clinics under Beijing Gaobeidian Community Health Center from June to December 2009.In-depth interview was conducted on 6 patients,who were referring from community health center to tertiary hospital and 16 general practitioners in the community.The method of thematic framework was used for data analysis.Results Only 1 of the 6 patients,who made the appointment,completed the two-way referral.From the view of the patients,the interrupt of the two-way referral was due to long-time waiting,inconvenient transportation to the hospital,availability of specialists,unsmooth process of referral and unsatisfied doctors.However,the community health service staff thought that difficulties of the two-way referral originated from the system,doctors,patients,and doctor-patient relationship.Sometimes patients distrusted doctors both in hospital and in community; communications between doctors or between doctors and patients were less efficient; patients had multiple choice for their primary care and they may go to any hospital freely bypass community-based referral system; patients had excessive expectation for medicine and doctors; some patients paid less attention to their own health,and so on.For improvement of the two-way referral system,the community health service staff proposed concrete measures in terms of relevant policy,the hospital,community health service,the doctors and patients; they emphasized the importance of upgrading their own communication ability and professional skills for primary care.Conclusions Many factors may influence successful implement of two-way referral,so it is necessary to improve the relevant policy and procedures and to upgrade medical staff in community.