Master-apprentice education in traditional Chinese medicine （TCM） is an important approach for training TCM professionals. It compensates for the shortcomings of formal education， serves as a vivid practice of integrating Chinese traditional culture into TCM education， and is an effective pathway for cultivating high-level TCM talent. The implementation pathways for the innovative development of TCM master-apprentice education are as follows： fully utilizing the initiative of mentors and academic successors， innovating learning models that connect famous doctors and teachers， expanding master-apprentice model-based medical services to grassroots levels， integrating interdisciplinary， cross-border fields， and modern information technology with master-apprentice education， as well as promoting regular， systematic， and diversified theoretical learning. This approach aims to achieve innovative development of master-apprentice education in TCM under the background of the new era.

AIM: To analyze the reasons and clinical outcomes of intraocular lens(IOL)exchange.METHODS:This retrospective case series study included 47 patients(53 eyes)who underwent IOL exchange surgery at the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, between April 2020 and May 2024, aged from 5 to 87(44.8±3.6)years old. Patients' demographics, surgical indications, surgical techniques, preoperative and postoperative uncorrected visual acuity(UCVA)and best-corrected visual acuity(BCVA), as well as postoperative complications were recorded.RESULTS:The reasons for IOL exchange included refractive error(18 cases, 23 eyes, 43%), IOL dislocation(12 cases, 13 eyes, 25%), IOL opacification(12 cases, 12 eyes, 23%), neuroadaptation failure(3 cases, 3 eyes, 6%), and patient dissatisfaction with visual quality(2 cases, 2 eyes, 4%). The surgical techniques for IOL exchange included in-the-bag IOL fixation(16 eyes, 30%), ciliary sulcus fixation(27 eyes, 51%), and scleral suture fixation(10 eyes, 19%). There was statistical significant difference between preoperative UCVA(LogMAR)and UCVA(LogMAR)at 1 d postoperatively(1.03±0.64 vs 0.50±0.46, P<0.05), and there was statistical significant difference between preoperative BCVA(LogMAR)and BCVA(LogMAR)at 1 mo postoperatively(0.41±0.37 vs 0.17±0.21, P<0.05). Postoperative complications included posterior capsule opacification in 2 eyes and IOL dislocation in 1 eye.CONCLUSION:Refractive error, IOL dislocation, and IOL opacification were the three most common reasons for IOL exchange. Although less frequent, factors such as neuroadaptation issues associated with multifocal IOLs and patient-reported visual quality dissatisfaction reflect growing expectations for improved visual outcomes. IOL exchange surgery, though technically challenging, demonstrates favorable clinical efficacy and a low complication rate, representing an effective intervention for managing postoperative IOL-related issues following cataract surgery.

Objective:To compare and explore the clinical efficacy and safety of endoscopic thyroidectomy by gasless unilateral axillary approach for the treatment of papillary thyroid microcar cinoma (PTMC) .Methods:One hundred and ten patients with unilateral PTMC admitted to the Department of Thyroid and Breast Surgery, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, from Jan.3 2019 to Mar. 2022 were used as clinical study subjects, and according to the patients' choice of surgical modality, they were divided into 30 cases in the endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) group and 80 cases in the minimally invasive video-assisted thyroidectomy (MIVAT) group. We retrospectively compared and analyzed the differences in the surgery-related indexes, aesthetic satisfaction rate at 3 months postoperatively and functional status of the anterior cervical region between the 2 groups. SPSS 26.0 statistical software was used to process the data, analyze and draw conclusions. P<0.05 was considered a statistically significant difference. Results:The number of lymph nodes cleared in the study group (6.60±4.41) was less than that in the control group (9.63±6.25) ( P<0.05) ; the total operative time (169.83±28.76) min, postoperative drainage (173.60±94.33) ml, and time to remove drainage tubes after surgery (5.73±1.86 ) d was significantly higher than the total operative time (145.56±33.89) min, postoperative drainage (107.28±53.82) ml, and time to remove drainage tubes after surgery (2.88±1.07) d in the control group ( P<0.01) ;the intraoperative bleeding, number of positive lymph nodes, and postoperative hospital stay were not statistically significant between the two groups ( P>0.05) .The aesthetic satisfaction rate of the study group had a significant advantage over the control group (90% vs 70%) ( P<0.01) .Comparing the functional status of the anterior cervical region between the two groups after surgery,the occurrence of swallowing discomfort or with pulling sensation was better in the study group than in the control group 1 week after surgery ( P<0.05), and there was no statistically significant difference between the two groups in the occurrence of neck pain score, abnormal sensory function (neck pressure, foreign body sensation, numbness and pins and needles) and vocal difficulty ( P>0.05) ; 3 months after surgery, abnormal sensory function of the neck in the study group (at 3 months postoperatively, the occurrence of abnormal neck sensory function (neck pressure, foreign body sensation, numbness and pins and needles sensation) and swallowing discomfort or pulling sensation were better in the study group than those in the control group ( P<0.05). There were no signs of local recurrence or distant metastasis in both groups at follow-up to date. Conclusions:Both minimally endoscopic thyroidectomy procedures were safe, feasible, and effective in the treatment of unilateral PTMC. Among them, the ETGUA is more suitable for patients with strong cosmetic needs within the indications because of its concealed incision and its ability to protect the function of the anterior cervical region, and can be the preferred option.

Objective:To evaluate the efficacy and safety of rituximab in the treatment of adult primary focal segmental glomerulosclerosis (FSGS).Methods:Adult FSGS patients treated with rituximab in the First Affiliated Hospital of Zhejiang University College of Medicine were retrospectively enrolled. One or two doses of rituximab (375 mg/m 2) were used aiming to achieve B cell depletion (defined as<5 B cells per microliter in peripheral blood) and the interval between the two doses was 2 weeks. The evaluated major outcomes were remission and relapse of nephropathy, and the secondary outcome measures were adverse events and renal outcomes. Results:A total of 14 patients (9 males) were enrolled, among whom 7 cases were steroid-dependent nephrotic syndrome (SDNS) or frequently relapsing nephrotic syndrome (FRNS), 6 cases were steroid-resistant nephrotic syndrome (SRNS) and one patient was new onset FSGS with contraindication to steroid. After treatment with rituximab, 7 patients with SDNS/FRNS achieved complete remission. At 6 months, the daily oral steroid dose reduced significantly compared with the baseline [(33.3±5.2) mg/d vs (6.7±6.6) mg/d, P<0.01]; while one patient still received tacrolimus 1.0 mg/d, the other 6 patients stopped using immunosuppressants; and the total number of relapse/total follow-up months decreased from 0.257 times/month to 0.058 times/month after the use of rituximab. For the other 6 SRNS patients and one patient with contraindication to steroid, three SRNS patients achieved partial remission and one patient with contraindication to steroid achieved complete remission at 34.50(20.25, 95.25) days after use of rituximab, and the other 3 SRNS patients failed to achieve remission, of whom one patient developed end stage renal disease at 23 months. Conclusions:Rituximab may reduce the risk of relapse and help steroid or immunosuppressant-tapering in adult steroid-dependent/frequently relapsing idiopathic FSGS. However, it is not effective in SRNS patients.

Objective:To investigate the efficacy and safety of individualized rituximab rescue therapy for active lupus nephritis with acute kidney injury (AKI).Methods:The clinical data of lupus nephritis patients with AKI treated with rituximab at the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University School of Medicine from April 2017 to June 2020 were collected, and the renal remission rate and adverse events after rituximab treatment were analyzed retrospectively. The Kaplan-Meier method was used to calculate the cumulative incidence of patients' remission.Results:There were 13 patients enrolled, including 8 females, and aged (35.23±15.92) years old. The urinary protein/creatinine ratio was (5.22±1.57) g/g before rituximab treatment. Four patients were on dialysis at admission, and 9 patients without dialysis had serum creatinine of (223.22±85.73) μmol/L. Eight patients were confirmed as proliferative lupus nephritis by renal biopsies, including 7 cases with crescent formation and 1 case with thrombotic microangiopathy (TMA), and the other 5 cases without renal biopsies were clinically diagnosed as TMA. The dose of rituximab was (815±516) mg (200-2 100 mg), and all the patients reached the state of peripheral blood B cells clearance (CD19 + B cell count was<5/μl). After the first treatment of rituximab, the median time to B-cell clearance was 21(15, 35) days, and 8 patients reached B-cell depletion (CD19 + B cell count was 0). The remission rate was 12/13 (two cases reached complete remission, and 10 cases reached partial remission). Three cases stopped dialysis, and 1 case (with glomerulosclerosis of 52.94%) entered maintaining dialysis. The relapse times in the maintenance remission period of 7 patients with refractory lupus nephritis declined significantly from (1.57±0.53) times in a median history of 60(20, 109) months to (0.43±0.79) times in a median history of 18(10, 23) months after the use of rituximab ( P=0.015). After using rituximab, the incidence of infection was 7/13. The median time from the use of rituximab to infection was 26(4, 44) days. Pulmonary infection (5/13) was the most common type and all infected patients recovered after anti-infection treatment. Conclusions:Rituximab can be used in the treatment of active lupus nephritis with AKI, especially in patients with crescent formation and TMA, but the infection should be paid close attention to and prevented.

Objective:To introduce an innovative simulation training system of liposuction and compare the effect of the traditional training method with this system in the liposuction training for medical students.Methods:Thirty medical postgraduates (18 males and 12 females, aged 22 to 30 years) at Peking Union Medical College without liposuction experiences were selected. All the participants were randomly divided into two groups. In the traditional training group, the trainees were trained on the phantom, while the teachers gave explanations and demonstrations. In the simulation training system group, the trainees were trained by themselves on the simulation training system. Before and after the training, the two groups were required to perform a liposuction simulation test on the simulated training system. The resistance of liposuction cannula, the acceleration of liposuction cannula and the uniformity degree of operation of the two groups were recorded, and the differences in the training effects between the two groups were compared. R 3.5 and Python 3.7 were used for analysis. Application of the t test for measurement data was in accordance with normal distribution, and the results were expressed as Mean±SD deviation. Application of Wilcoxon signed-rank test or Wilcoxon rank sum test for the measurement data did not conform to the normal distribution. The results were expressed as M( P25, P75). P< 0.05 indicated statistical differences. Results:After the training, the area of liposuction in the traditional training group was more moderate than that before the training [skewness: -0.22(-0.38, -0.14) vs. -0.07(-0.24, 0.02)( V=20, P=0.022); kurtosis: 2.32(2.09, 2.58) vs. 1.96(1.90, 2.00)( V=112, P=0.002)]. After training, the number of times of lateral resistance[7.0(3.5, 13.5) vs. 0(0, 0)( V=111.5, P=0.004)] and acceleration [7.0(5.0, 17.5) vs. 3.0(2.0, 12.5)( V=102, P=0.002)] over-threshold were significantly reduced, the angle of liposuction coverage [131.18°(117.71°, 137.88°) vs. 169.89°(162.96°, 180.00°)( V=0, P<0.001)] was significantly improved, and the area of liposuction [skewness: -0.17(-0.33, 0.03) vs. -0.01(-0.13, 0.06)( V=21, P=0.026); kurtosis: 2.35(2.08, 2.50) vs. 1.94(1.83, 2.00)( V=118, P<0.001)] was more evenly distributed. The differences before and after training were analyzed between the simulation training system group and the traditional training group. The simulation training system group was superior to the traditional training group in the number of times of lateral resistance[-7.5±7.4 vs.-1.4±9.0 ( t=111.5, P=0.026)], the number of times of acceleration [-3.0(-6.5, -2.0) vs. -1.0(-4.0, 2.0)( W=156.5, P=0.035)] and the angle of coverage[(-40.24±18.88)° vs. (-11.10±25.54)° ( t=3.553, P<0.001)]. Conclusions:Simulation training system is an effective method in liposuction training to enhance the skills of trainees.

Objective:To introduce an innovative simulation training system of liposuction and compare the effect of the traditional training method with this system in the liposuction training for medical students.Methods:Thirty medical postgraduates (18 males and 12 females, aged 22 to 30 years) at Peking Union Medical College without liposuction experiences were selected. All the participants were randomly divided into two groups. In the traditional training group, the trainees were trained on the phantom, while the teachers gave explanations and demonstrations. In the simulation training system group, the trainees were trained by themselves on the simulation training system. Before and after the training, the two groups were required to perform a liposuction simulation test on the simulated training system. The resistance of liposuction cannula, the acceleration of liposuction cannula and the uniformity degree of operation of the two groups were recorded, and the differences in the training effects between the two groups were compared. R 3.5 and Python 3.7 were used for analysis. Application of the t test for measurement data was in accordance with normal distribution, and the results were expressed as Mean±SD deviation. Application of Wilcoxon signed-rank test or Wilcoxon rank sum test for the measurement data did not conform to the normal distribution. The results were expressed as M( P25, P75). P< 0.05 indicated statistical differences. Results:After the training, the area of liposuction in the traditional training group was more moderate than that before the training [skewness: -0.22(-0.38, -0.14) vs. -0.07(-0.24, 0.02)( V=20, P=0.022); kurtosis: 2.32(2.09, 2.58) vs. 1.96(1.90, 2.00)( V=112, P=0.002)]. After training, the number of times of lateral resistance[7.0(3.5, 13.5) vs. 0(0, 0)( V=111.5, P=0.004)] and acceleration [7.0(5.0, 17.5) vs. 3.0(2.0, 12.5)( V=102, P=0.002)] over-threshold were significantly reduced, the angle of liposuction coverage [131.18°(117.71°, 137.88°) vs. 169.89°(162.96°, 180.00°)( V=0, P<0.001)] was significantly improved, and the area of liposuction [skewness: -0.17(-0.33, 0.03) vs. -0.01(-0.13, 0.06)( V=21, P=0.026); kurtosis: 2.35(2.08, 2.50) vs. 1.94(1.83, 2.00)( V=118, P<0.001)] was more evenly distributed. The differences before and after training were analyzed between the simulation training system group and the traditional training group. The simulation training system group was superior to the traditional training group in the number of times of lateral resistance[-7.5±7.4 vs.-1.4±9.0 ( t=111.5, P=0.026)], the number of times of acceleration [-3.0(-6.5, -2.0) vs. -1.0(-4.0, 2.0)( W=156.5, P=0.035)] and the angle of coverage[(-40.24±18.88)° vs. (-11.10±25.54)° ( t=3.553, P<0.001)]. Conclusions:Simulation training system is an effective method in liposuction training to enhance the skills of trainees.

Pre-hospital rescue is key to the emergency medical system. Based on the current pre-hospital emergency standardized system construction in China, the authors explored the standardization of pre-hospital emergency system construction, command dispatch and emergency service quality control standardization, pre-hospital classification standardization, pre-hospital emergency service capacity standardization, pre-hospital emergency and intra-hospital emergency connection standardization, standardized training for pre-hospital emergency doctors and nurses. These efforts aim to achieve such rescue and transfer criteria for patients, as " vicinity, urgency, professional needs, and intension of both patients and their families" . Such criteria if met can further reduce emergency response time and shorten the emergency radius, hence improving emergency medical services.

Objective:To investigate the clinicopathological features of pulmonary epithelioid hemangioendothelioma (PEHE).Methods:Eighteen cases of PEHE were collected from August 2011 to December 2018 at the First Affiliated Hospital of Zhengzhou University. All cases were retrospectively studied by hematoxylin and eosin staining and immunohistochemistry (IHC). The clinicopathological features were reviewed; the status of CAMTA1 and TFE3 gene was analyzed and patients′ outcome was followed up.Results:Of the 18 cases, there were 11 males and 7 females with a male to female ratio of 1.6 to 1.0. The patients′ age ranged from 36 to 68 years (mean 52 years). Twelve cases (12/18) showed a single nodule and six cases (6/18) showed multiple bilateral nodules. Seven cases (7/18) involved other organs besides lung. Seventeen (17/18) patients presented with respiratory symptoms and one patient (1/18) presented with abdominal pain. Grossly, the tumors were greyish-white nodules with indistinct borders. Microscopically the tumor cells were epithelioid and arranged in strands and nests, and cytoplasmic vacuoles were commonly noted. The stroma was myxochondroid or hyaline. By IHC, the tumor cells were positive for CD31(18/18), CD34 (16/18), ERG (18/18) and Fli-1 (18/18); CKpan was focally positive in 5 cases (5/18). TFE3 was positive in 3 cases (3/18), and Ki-67 index ranged from 5% to 30%. FISH analysis showed seventeen cases (17/18) had CAMAT1 rearrangement, one case had TFE3 rearrangement displaying a split signal. Eight patients (8/18) had surgical excision, three patients (3/18) had surgery and chemotherapy, and seven patients (7/18) had chemotherapy only. Four patients (4/18) died of the disease.Conclusions:Patients with PEHE have non-specific symptoms, and correct diagnosis depends on pathologic biopsy and the exclusion of other tumors with epithelioid morphology. Some patients with PEHE have poor prognosis, particularly in those who have multiple nodules, peripheral invasion or metastasis.

Objective: To evaluate the efficacy and safety of steroids-free immunosuppressive therapy including tacrolimus, cyclosporin A, tripterygium glycosides or intravenous cyclophosphamide in membranous nephropathy (MN) patients combined with type 2 diabetes mellitus (T2DM). Methods: This study was a retrospective analysis of patients with T2DM complicated with biopsy proved MN in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 2009 to January 2017. The patients were divided into steroids-free group and control group. The patients in steroids-free group were treated with one or two immunosuppressive agents except glucocorticoids. The patients in control group were treated with glucocorticoid combining with immunosuppressive agents. Results: A total of 64 patients were enrolled in this study. There were 26 cases in steroids-free group and 38 cases in control group. The total remission rate was 69.24% in steroids-free group and 73.68% in control group at 12 months. In a median follow up of 33(12-106) months, two patients in control group entered hemodialysis and one of them died after 1 year of dialysis. One patient in steroids-free group died of accidental death and no patient entered dialysis. All patients in control group had elevated blood glucose level, whereas only 5 patients in steroids-free group had elevated blood glucose and all these 5 patients used tacrolimus. Conclusion Immunosuppressive regimen without glucocorticoid treatment can reduce side effects on blood glucose level in MN patients with type 2 diabetes, with a certain rate of treatment response.