The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Objective:To explore the relationship between residual collateral vessels in uterine arterial embolization (UAE) and the risk of bleeding during the operation of curettage for cesarean scar pregnancy.Methods:A total of 499 patients who underwent preventive UAE before curettage for scar pregnancy in Shandong Provincial Hospital from January 2012 to June 2019 were included. Clinical data of the patients were retrospectively collected and analyzed. In patients with uterine collateral circulation, collateral vessels were embolized as much as possible. Angiography was performed after UAE. All the cases were divided into 3 grades according to residual staining in middle and lower part of corpus uteri as follows, grade A: no or mild staining, grade B: moderate staining, grade C: intense staining. Blood loss of the patients during curettage was recorded, and the incidence rate of minor hemorrhage (<50 ml) and massive hemorrhage (>500 ml) of the 3 grades were calculated respectively. The results of three grades groups were compared with those of control group (patients without collateral circulation) by using Chi-square test or Fischer exact probability.Results:According to angiogram acquired after UAE, collateral vessels were found in 53 patients, with 25 cases in grade A group, 15 cases in grade B group, and 13 cases in grade C group, respectively. Thirty-six patients underwent transcatheter embolization of collateral vessels. The incidence rate of minor hemorrhage in type B and C [60.0% (9/15), 46.2% (6/13)] was lower than that in control group (87.9%, 392/446), with significant difference found (χ2=9.972, P=0.002, χ2=19.090, P<0.001). Significant difference was found in the incidence rate of massive haemorrhage between group C (23.1%, 3/13) and control group (2.2%, 9/446) (χ2=14.480, P=0.001). Conclusion:As for cesarean scar pregnancy cases with uterine collateral vessels, embolization of collateral vessels may reduce the amounts of bleeding during curettage. Residual staining of middle and lower part of corpus uteri may be helpful in predicting the risk of massive haemorrhage during curettage.

Objective To assess the diagnosis value of endorbronchial ultrasonography with a guide sheath combination with virtual bronchoscopic navigation at peripheral lung lesions. Methods 23 patients with lung peripheral lesions, 10 cases male, 13 cases female, age 29~78, the median age of 61, were retrospectively analyzed by diagnosised with EBUS-GS-TBLB combination VBN from March 2015 to December 2015. Results 23 cases of patients, 8 cases of adenocarcinoma, squamous carcinoma in 5 cases, mixed carcinoma in 1 case, 1 case of small cell carcinoma and lung metastatic carcinoma in 1 case, 2 cases were tuberculosis, 1 case of inflammation, 4 cases were negative. The total positive rate was 82.6%. Conclusion EBUS-GS-TBLB combination with VBN to the diagnosis of lung lesions with high positive rate, it is worthy of promoting clinically.

Objective To explore and summarize the choices of pedicle skin flaps in repairing cutaneous defect of foot and ankle.Methods Defects of forefoot,pedal dorsum,pedal plantar and ankle were repaired with pedicle skin flaps such as dorsal pedal flap,medial plantar flap,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal artery flap,anterior ankle artery flap peroneal artery flap etc.Results Except for necrosis of 2 cases of flap,the other 249 flaps all survived.Blood vessel crisis was induced in 5 patients on 1st postoperative day,and in 2 cases on 2nd postoperative day,by tight package of transplanted skin,which was treated by emergent explorative operation.Finally 135 cases got 3 to 96 months' followed up(average of 16 months).There were 4 cases of medial pedal flap and 3 cases of plantar metatarsal flap received secondary reshaping for treating skin wear out.Nine cases of posterior tibial artery flap,and 6 cases of sural nerve flap were reshaped secondarily to improve bulk shape.Other flaps did not need secondary reshaping.Among them,in medial pedal flap,fibular-side flap of hallux,and tibialside flap of 2nd toe,sensory nerve were all transferred together with the flap,and normal sensory was got,with 4-10 mm two point discrimination.Condusion In covering tissue defects on heel or plantar side of forefoot,medial plantar artery flap is ideal.For defects on plantar side of forefoot,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe have the advantages of wear resistance and nerve innervation.While dorsal pedal flap,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal flap,anterior ankle artery flap,and peroneal artery perforator flap have the advantages of large size,thinness,similar color with recipient site,and constant anatomical position,they are feasible for repairing defects on dorsum of foot or near ankle.

Objective To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions.Methods A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed.All the patients underwent embolization from October 1998 to June 2010,including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years.Only lesions were occlued in 12 cases without involving the internal carotid artery,while occlusions of internal carotid artery were performed in the rest 25 cases.Results Thirty-six patients were cured without recurrent hemorrhage after embolization.Only 1 patient with carotid artery occlusion died 48 hours after operation.Conclusion For patients with carotid arterial intractable epistaxis,if the elimanation of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation,the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives.

ObjectiveTo provide anatomy information for harvesting a pedicle or free posterior interosseous artery cutaneous branches-chain flaps. MethodsFourteen forearms from fresh human cadaver were used to study the anatomy characteristics of the posterior interosseous artery cutaneous branches-chain flaps with the following three methods:latex perfusion for microanatomy,denture materials and vinyl chloride mixed packing for cast,and PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography.The cutaneous perforator with a diameter ≥ 0.2 mm were included for statistical analysis.Results① There were 6.2 cutaneous branches raised from posterior interosseous artery. Measuring from the radial edge of ulnar head to the lateral epicondyle of humerus as the standard distance, the distal cutaneous branch clusters located at 21.24％ relative to the standard distance,while the proximal clusters located at 47.86％.② There were two large cutaneous perforators from the posterior interosseous artery at(5.82 ± 1.22)cm proximal to the ulnar styloid and (10.34 ±0.98)cm distal to the epicondyle of humerus.The diameter and pedicle length of the distal perforators were(0.50± 0.04)mm and (16.79 ± 5.12)mm respectively,while the proximal perforator were (0.60 ± 0.08 )mm in diameter with a pedicle (21.20 ± 12.28)mm in length.③ The vascular chains parallel to the posterior interosseous artery were formed via anastomosis of the adjacent cutaneous perforators. ConclusionThere is clinical significance to use pedicle or free posterior interosseous artery cutaneous branches-chain flaps.

Traditional Chinese medicine (TCM) has its own system of diagnosis and treatment theory, and its methods for evaluating clinical efficacy are different from those of Western medicine. Applying evaluation techniques and methods that are used in Western medicine mechanically to TCM will not work. So building evaluation techniques, which adhere to regulations and characteristics of TCM, is necessary and imperative. As the quality of life and patient-reported outcome instruments were brought into practice and developed, clinical evaluation ideas and methods for TCM are provided with an opportunity for development. This article puts forward the concept of subjective complex outcomes (SCOs), which constitutes subjective feelings gained from the patient, doctor and caregiver, different from laboratory parameters. SCOs provide a multidimensional and complex health-related quality of life (HRQL) assessment and focus on the source of assessment information of diseases. This article also introduces a case study building SCO methods of TCM treatment for chronic obstructive pulmonary diseases, in order to promote discussion and provide a platform for future research.

Objective To report our usage of a combined flap which is constituted of bilateral hallux nails, skins, bones to reconstruct a finger, and to introduce the method and outcome of this way. Methods Combine two halves of halluxes harvested from both feet to reform a fabricated finger and then transplant it to the finger stump to reconstruct the defect part of the finger. Plantar flaps or some other flaps near the donor sites were transposed to cover them. From June 2003 to June 2009, a total of 20 fingers (20 cases) which had defect degrees range from I to Ⅲunderwent reconstruction surgeries in this way. Results All the 20 fingers transplanted survived completely. Follow-ups 1 to 5 years after each surgery: all the fabricated fingers had very realistic configurations. The MP joints of the reconstructed thrumbs got to the normal range of motion, and the other reconstructed fingers' total ROM were 203 degree on average. All the reconstructed fingers had the sensation function above S3,and their two-point discriminations ranged from 6mm to 10mm. Both halluxes of each case were conserved major parts of nails and had nice, symmetric appearances. All the flaps for the donor halluxes survived completely, and none of the cases showed pains, ulcers or abrasions of their feet. All the cases showed normal gaits during follow-ups. Conclusion The combined flap by bilateral hallux nails, skins, bones is an ideal alteration for finger defect reconstruction for the important advantages of realistic configuration as well as minor destructions to donor sites.

ObjectiveTo introduce the clinical application of full reconstruction for 72 cases of Ⅳ to Ⅵ-degree finger defect.MethodsFrom December 1998 to December 2010, sixty-three cases (85 fingets) of Ⅳ-degree finger defect, thirty-three cases (49 fingers) of Ⅴ-degree finger defect and 17 cases (23fingers) with Ⅵ-degree finger defect were applied full reconstruction. The procedures of full reconstruction of Ⅳ to Ⅴ-degree finger defect were as follows:Harvest part of nail, skin which includes some skin harvested from dorsal and palmar metatarsal to ensure the length of the reconstructed finger,and dorsal part of distal phalanx from hallux to form a composite flap, which constitute the contour of a finger, and harvesting interphaalangeal joint from the second toes to reconstruct the proximal interphalangeal (PIP) joint. Bone transplantation from the iliac bone to the distal (for Ⅳ-degree and light Ⅴ-degree defect) or both proximal and distal (for severe Ⅴ-degree defect) stump of the reconstructed PIP joint was needed to get to an appropriate length.On the basis of the treatment of Ⅴ-degree defect, reconstruction of Ⅵ-degree finger defect was to harvest one more joint: the metatarsophalangeal joint of the second toe, and connect it with the proximal iliac bone rod.ResultsAbout half of the cases were conserved of 4 toes, and the donor wound of halluxes were covered with the composite flaps (composed of nail, skin) harvested from the second toes which had been sacrificed.The other cases were conserved of all the 5 toes,and the donor wound of halluxes were covered by free flap transplantation.The second toes were reconstituted by bone transplantation from the iliac bones.All of the 157 fingers survived completely, and 75 fingers underwent second-stage plastic surgeries. Sixty-seven fingers underwent second-stage tenolysis surgeries.Follow-ups 7 months to 11 years after surgery, and all the reconstructed fingers had realistic configurations, and the two-point discrimination of the finger pulps ranges from 5 mm to 12 mm. Dorsal extension of the PIP joints were -10°～10°, flexion of the PIP joints range from 55° to 85°,and the average was 76°. ConclusionThe full reconstruction is an ideal alteration for Ⅳ to Ⅵ-degree finger defect reconstruction for the realistic configuration and ideal function of the reconstructed fingers.The one disadvantage of the full reconstruction is that the surgery is much more complex.

ObjectiveTo introduce the new method of full reconstruction for Ⅰ to Ⅲ-degree finger defect.MethodsFor reconstruction of Ⅰ to Ⅱ-degree finger defect, the surgery procedure was as follows:Harvest part of nail,skin and dorsal part of distal phalanx from hallux to form a composite flap,and then the flap was transplanted to the finger stump to reconstruct the defect part of the finger.The design of the composite flap was according to the recipient part. For reconstruction of Ⅲ-degree finger defect, the skin included in the flap could be designed according to the recipient part, but the bone can only be harvested from the fibulodoral part of the hallux and far from the insertion of the extensor hallucis longus tendon, which means the length was limited.If the bone length was not enough,one bone mass with appropriate size and shape was harvested from the iliac bone and connected with the bone of the composite flap. Some cases of Ⅲ-degree finger defect were reconstructed by harvesting interphalangeal joints from the second toes to reconstruct distal interphalangeal joints(DIP). The bone defect was reconstituted by bone mass from the iliac bone to conserve the contour of the second toe.The hallux wound was covered by a local flap or free flap transplantation.ResultsOne hundred and eighteen cases (126 fingers) of Ⅰ-degree defect, one hundred and eighty-seven cases (201 fingers) of Ⅱ-degree defect and 90 cases (111 fingers) of Ⅲ-degree finger defect were applied full reconstruction. All the reconstructed fingers survived completely and the configurations were similar to real fingers. Followed up our work on 150 fingers from a number of patients, between 1 and 11 years after the original surgery.Total ranges of motion of the reconstructed fingers got to over 180°.The reconstructed DIP joints had the range of motion of 15°-40°. The donor halluxes and toes were conserved with the normal length,relatively primary appearance and full function. ConclusionFull reconstruction for Ⅰ to Ⅲ-degree finger defect has great advantages in that the reconstructed finger has very realistic configuration as well as ideal function and the donor hallux is conserve well.