Objective To evaluate the teaching performance of the traditional Chinese medicine(TCM)course for the first three grades of the"4+4"reform pilot class in clinical medicine at Peking Union Medical College.Methods An anonymous survey was conducted using Questionnaire Star and the responses from TCM Teaching Questionnaire completed by students were statistically analyzed and summarized.Results Most students expressed interest in TCM and deemed it necessary to study TCM course.They believed that teachers well prepared for teach-ing performance and the teaching content was well-aligned with the textbooks,syllabus,and lecture slides.The teaching content was closely integrated with clinical practice,and students were satisfied with the teaching methods and approaches.Conclusions Teaching evaluations help teachers to summarize their teaching experiences and im-prove the teaching quality of the TCM course.

Objective:To explore the treatment of thoracoabdominal combined injury in a child with heart rupture caused by sheep horns under limited medical conditions.Methods:To summarize the diagnosis and treatment of a child with thoracoabdominal combined injury and cardiac rupture who were treated with epidural anesthesia and having spontaneous breath, and even more there was no oxygen supply and perioperative monitoring during operation.Results:After the complete of thoracoabdominal exploration, the repair of heart, stomach and diaphragm, postoperative anti-infection, nutritional support and symptomatic treatment, the little patient recovered successfully.Conclusions:Thoracoabdominal injuries combined cardiac rupture requires rapid judgment of the patient’s condition, control of bleeding, discharge cardiac tamponade and cardiac repair as soon as possible. In order to save life, unconventional measures can be used when it is necessary.

Objective To determine the reference red blood cells with weak agglutination intensity of low positive quali-ty control products by comparing RhD antigen expression intensity difference according to the serological results.Methods The RhD(+)red blood cells were detected by microcolumn gel method with 1 500 times diluted anti-D typing reagent.The samples with weak and strong RhD antigen expression intensity were selected as the reference red blood cells for weak agglu-tination intensity of low positive quality control products,and verification was performed.Results Ten RhD(+)red blood cells were detected with diluted anti-D typing reagent,of which 8 were 1+and 2 were±.Red blood cells with agglutination intensity of 1+were used as the benchmark to determine the maximum dilution ratio of anti-D typing reagent when their ag-glutination intensity was 1+.As the preparation standard of low positive quality control products,the agglutination intensity of red blood cells with low RhD antigen expression intensity was extremely weak±,which was difficult to ensure the stability of its control limit properties.Based on red blood cells with agglutination intensity of±,the maximum dilution ratio of anti-D typing reagent with agglutination intensity of 1+was re-determined as the preparation standard of low positive quality con-trol products,and the results met the requirements of quality control product setting.Conclusion Using red blood cells with low RhD antigen expression intensity as the benchmark to set the weak agglutination intensity of the low positive quality control products can avoid the loss of control due to the low target value.

【Objective】 To monitor the effectiveness and accuracy of the blood transfusion compatibility test system by self-made weakly positive internal quality control products. 【Methods】 Red blood cells from DAT(-) healthy subjects were selected, and B/RhD(-)E(-) red blood cells were selected as tube 1. A/RhD(+ )E(+ ) was selected as tube 2 to prepare blood group quality control products according to the principle of blood group antigen compatibility, and red blood cell preservation solution and corresponding ABO blood group reagent antibody were added to make the agglutination intensity of microcolumn gel method in reverse blood typing reach a low positive value (1+ ). Tube 3 and tube 4 were prepared with five different preservation media: plasma, serum, antibody diluent, mixture of equal plasma and antibody diluent, and mixture of equal serum and antibody diluent, respectively. IgM anti-E antibody was added to tube 3, and IgG anti-D antibody was added to tube 4, so that the agglutination intensity of microcolumn gel method reached a low positive value (1+ ). 【Results】 Comparison between the 5 different preservation media showed that the preservation medium of antibody diluent was the most stable for weakly positive antibody (F=11.35, P<0.05), Agglutination intensity 1+ is assigned 5 points by AABB Technical Manual, and its score was 5.25±1.75 points. 【Conclusion】 The use of self-made weakly positive quality control products can improve the effectiveness, accuracy and sensitivity of the monitoring system, thus achieving internal quality control and ensuring the safety of clinical blood use.

TGF-β1 is considered a key mediator in the formation of hepatic fibrosis and mainly acts by activating the downstream Smad signaling pathway.Smad2 and Smad3 are two major downstream regulators that promote TGF-β1-mediated tissue fibrosis,while Smad7 is a negative-feedback regulator of the TGF-β1/Smad pathway and inhibits TGF-β1-mediated hepatic fibrosis.A growing number of studies are showing that natural products can delay the progression of hepatic fibrosis by regulating the TGF-β1/Smad pathway,inhibiting HSC activation,and reducing ECM deposition.This article reviews the molecular mechanism of the TGF-β1/Smad signaling pathway in hepatic fibrosis,and summarizes the natural products that target the regulation of this pathway,providing a reference for research into the treatment of hepatic fibrosis.

Objective:To analyze the clinical characteristics of hospitalized premenopausal patients with hyperuricemia.Methods:The medical records of premenopausal women with hyperuricemia (serum uric acid ≥360 μmol/L during hospitalization) admitted in Peking Union Medical College Hospital from 2013 to 2018 were reviewed and the clinical data were analyzed.Results:A total of 2 099 patients were enrolled. Only 14.01% (294 cases) of the patients were concerned about hyperuricemia by physicians. Autoimmune diseases (32.11%, 674 cases), nephrotic disease (19.29%, 405 cases) and endocrine system diseases (9.72%, 204 cases) are the main reasons for hospitalization, while 6.34%(133 cases) of patients were in gestation. In terms of the etiology, renal diseases (49.35%, 1 035 cases), specific drug use (49.26%, 1 034 cases) were the main causes of secondary hyperuricemia in premenopausal women, followed by metabolic diseases (10.62%, 233 cases). There was no significant difference in serum uric acid level among premenopausal women of different ages ( H=4.47, P=0.107), but the etiology of hyperuricemia among patients of different ages had significant differences. The proportion of hyperuricemia in patients with cancer and metabolic syndrome,secondary to use of diuretics and anti-tuberculosis drugs had differences among different age groups ( χ2=90.96,52.89,19.26 and 6.41, P<0.05). Conclusion:Hyperuricemia is not uncommon in premenopausal women. There are many secondary factors leading to hyperuricemia in premenopausal women, among which drugs and renal lesions are the main causes. In addition, the secondary factors in women with hyperuricemia has differences among different age groups.

Objective:To investigate the clinical effect of stage treatment for long-standing facial paralysis with free functional gracilis transfer innervated by cross-face nerve grafting(CFNG).Methods:A retrospective study was carried out focusing on the case data of patients with long-standing facial paralysis who were treated by the free functional gracilis transfer innervated by CFNG in the Second Department of Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2014 to December 2020. CFNG was performed in the first stage approach and free functional gracilis transfer in the second stage approach. Auther utilized the modified House-Brackmann grading scale to record the patients’ lip angle movements postoperatively and measured the static and dynamic angle formed between the horizontal line of both lip corners and the vertical midline before and after surgery objectively. Paired t-test was utilized to evaluate the bilateral middle and lower facial symmetry changes, so as to estimate the surgical effect. The significance level was set at 0.05. Results:A total of 26 patients with long-standing facial paralysis were enrolled in this study, including 10 males and 16 females, aged from 16 to 28 years, with an average age of (24.8±3.5) years. The interval of staging operation was 6 to 12 months. The postoperative follow-up was 1-3 years, with an average of (34.9±11.7) months. All grafts survived well. No major complication occurred. 2 patients underwent gracilis muscle debulking due to the paralysis side facial bulking one year after the second stage operation. 1 patient underwent muscle fixation position adjustment due to the poor position of gracilis muscle fixation one year after the second stage operation. 1 patient underwent masseter nerve-CFNG end-to-side anastomosis 2 years after the second stage operation due to insufficient movement of the mouth. The facial symmetry of all patients was improved after the two-staged operations. The movement of lip corners was classified as excellent in 15 cases, good in 9 cases, and fair in 2 cases in terms of the modified House-Brackmann grading scale. According to the objective evaluation of oral angle movement, the static lip angle after surgery was higher than that before surgery (86.4°±3.3° vs. 82.3°±2.7°) and the difference was statistically significant ( t=5.27, P=0.017); the dynamic lip angle after surgery was higher than that before surgery (86.9°±2.8° vs. 80.1°±3.3°), and the difference was statistically significant ( t=7.55, P<0.001). Conclusion:Free functional gracilis transfer innervated by CFNG is an ideal technique for long-standing facial paralysis. It can effectively improve the facial dynamic of the affected side.

Objective:To investigate the clinical effect of stage treatment for long-standing facial paralysis with free functional gracilis transfer innervated by cross-face nerve grafting(CFNG).Methods:A retrospective study was carried out focusing on the case data of patients with long-standing facial paralysis who were treated by the free functional gracilis transfer innervated by CFNG in the Second Department of Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2014 to December 2020. CFNG was performed in the first stage approach and free functional gracilis transfer in the second stage approach. Auther utilized the modified House-Brackmann grading scale to record the patients’ lip angle movements postoperatively and measured the static and dynamic angle formed between the horizontal line of both lip corners and the vertical midline before and after surgery objectively. Paired t-test was utilized to evaluate the bilateral middle and lower facial symmetry changes, so as to estimate the surgical effect. The significance level was set at 0.05. Results:A total of 26 patients with long-standing facial paralysis were enrolled in this study, including 10 males and 16 females, aged from 16 to 28 years, with an average age of (24.8±3.5) years. The interval of staging operation was 6 to 12 months. The postoperative follow-up was 1-3 years, with an average of (34.9±11.7) months. All grafts survived well. No major complication occurred. 2 patients underwent gracilis muscle debulking due to the paralysis side facial bulking one year after the second stage operation. 1 patient underwent muscle fixation position adjustment due to the poor position of gracilis muscle fixation one year after the second stage operation. 1 patient underwent masseter nerve-CFNG end-to-side anastomosis 2 years after the second stage operation due to insufficient movement of the mouth. The facial symmetry of all patients was improved after the two-staged operations. The movement of lip corners was classified as excellent in 15 cases, good in 9 cases, and fair in 2 cases in terms of the modified House-Brackmann grading scale. According to the objective evaluation of oral angle movement, the static lip angle after surgery was higher than that before surgery (86.4°±3.3° vs. 82.3°±2.7°) and the difference was statistically significant ( t=5.27, P=0.017); the dynamic lip angle after surgery was higher than that before surgery (86.9°±2.8° vs. 80.1°±3.3°), and the difference was statistically significant ( t=7.55, P<0.001). Conclusion:Free functional gracilis transfer innervated by CFNG is an ideal technique for long-standing facial paralysis. It can effectively improve the facial dynamic of the affected side.

Objective:To review the clinical effect of oral mucosa prefabricated urethra in the treatment of complicated hypospadias in adult patients.Methods:A retrospective analysis was performed on adult patients with complicated hypospadias who underwent two-stage surgical repair in the Second Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2011 to December 2020. In the first stage, the urethra was prefabricated with oral mucosa, which was 5.0-6.0 cm in length and 1.0-1.2 cm in width. The second stage was urethral anastomosis, in which scrotal flap was applied to cover the wound. Postoperative follow-up was conducted by telephone or WeChat, including penile appearance and the situation of urination.Results:A total of 114 patients were enrolled, age raging from 18 to 63 years old, with an average age of 28 years. There were 22 cases who had underwent one previous repair operation, 69 cases had two repair operations, and 23 cases had three repair operations. The time from the last operation was 6 months to 60 months, with an average of 25 months. Postoperative complications included urinary fistula in 36 cases, urethral orifice stenosis in 52 cases and penile scar in 58 cases. The scrotal septal skin flap was used in 46 cases and scrotal fascia flap was used in 68 cases. The flaps size ranged from 1.2 cm×3.0 cm to 3.0 cm×5.5 cm. Among the 114 patients, 6 patients were complicated with urinary extravasation, which healed spontaneously in 2-4 weeks; 2 patients developed urinary fistula due to blood supply disorder at the distal end of the scrotal flap, which was repaired half a year later. Other patients healed well. 94 patients were followed up for 6-84 months, with an average of 37 months. All patients had no chordee, smooth urination, no urethral stricture and fistula. All patients were satisfied with the appearance of the penis. Urethral ultrasound and magnetic resonance hydrography were performed in 18 patients. The results showed that the reconstructed urethra was smooth, the mucosa graft had good extension, and there was no residual urine in the urethra.Conclusions:Oral mucosa prefabricated urethra could be used for repair hypospadias in adult patients who failed in repair surgeries, and could obtain good clinical effect.

Objective:To review the clinical effect of oral mucosa prefabricated urethra in the treatment of complicated hypospadias in adult patients.Methods:A retrospective analysis was performed on adult patients with complicated hypospadias who underwent two-stage surgical repair in the Second Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2011 to December 2020. In the first stage, the urethra was prefabricated with oral mucosa, which was 5.0-6.0 cm in length and 1.0-1.2 cm in width. The second stage was urethral anastomosis, in which scrotal flap was applied to cover the wound. Postoperative follow-up was conducted by telephone or WeChat, including penile appearance and the situation of urination.Results:A total of 114 patients were enrolled, age raging from 18 to 63 years old, with an average age of 28 years. There were 22 cases who had underwent one previous repair operation, 69 cases had two repair operations, and 23 cases had three repair operations. The time from the last operation was 6 months to 60 months, with an average of 25 months. Postoperative complications included urinary fistula in 36 cases, urethral orifice stenosis in 52 cases and penile scar in 58 cases. The scrotal septal skin flap was used in 46 cases and scrotal fascia flap was used in 68 cases. The flaps size ranged from 1.2 cm×3.0 cm to 3.0 cm×5.5 cm. Among the 114 patients, 6 patients were complicated with urinary extravasation, which healed spontaneously in 2-4 weeks; 2 patients developed urinary fistula due to blood supply disorder at the distal end of the scrotal flap, which was repaired half a year later. Other patients healed well. 94 patients were followed up for 6-84 months, with an average of 37 months. All patients had no chordee, smooth urination, no urethral stricture and fistula. All patients were satisfied with the appearance of the penis. Urethral ultrasound and magnetic resonance hydrography were performed in 18 patients. The results showed that the reconstructed urethra was smooth, the mucosa graft had good extension, and there was no residual urine in the urethra.Conclusions:Oral mucosa prefabricated urethra could be used for repair hypospadias in adult patients who failed in repair surgeries, and could obtain good clinical effect.