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Objective:To summarize the experience and the clinical data of patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy.Methods:A total of 24 patients who underwent endoscopic parathyroidectomy for primary hyperparathyroidism in Peking Union Medical College Hospital during Feb. 2021 to May. 2022 were concluded in this study (20 cases of parathyroidectomy via axillary approach and 4 cases of parathyroidectomy via thoracic and breast approach) . The operation time, postoperative drainage, length of stay, level of parathyroid hormone and serum calcium of those patients were collected. Postoperative complications and recurrence of hyperparathyroidism were also observed.Results:The postoperative levels of serum parathyroid hormone and serum calcium were significantly reduced (over 50%) compared with preoperative level ( P<0.05) . The average operation time was (96±22) min (64-157 min) . The mean postoperative drainage volume was (47±16) ml on day 1, (46±11) ml on day 2, and (30±9) ml on day 3, respectively. The average length of postoperative hospital stay was (2.8±1.1) days (2-6 days) . In one case of parathyroidectomy via axillary approach, the operation was converted to open surgery because of the low position of lesion. Other cases completed endoscopic surgery and obtained satisfactory cosmetic results. There were no postoperative complications such as bleeding, permanent hoarseness, coughing while drinking water, or surgical site infection. The mean follow-up time was (7.4±4.2) months (1-16 months) . There was no obvious discomfort and no recurrence during follow-up. Conclusion:Endoscopic parathyroidectomy is safe and effective in the treatment of primary hyperparathyroidism, which can be used as a surgical option for patients with cosmetic requirements.
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Objective:We aimed to build a novel model with metastasis-related genes (MTGs) signature for predicting progression-free interval (PFI) of papillary thyroid carcinoma (PTC) .Methods:We integrated PTC datasets with the MTGs to identify differentially expressed MTGs (DE-MTGs), then we established a novel MTGs based signature and validated it in external datasets and cell lines. Finally, we established a signature and clinical parameters-based nomogram for predicting the PFI of PTC.Results:We identified 155 DE-MTGs related to PFI in PTC. The functional enrichment analysis showed that the DE-MTGs were associated with essential oncogenic processes. Consequently, we established and optimized a novel 10-gene signature. The novel signature had a C-index of 0.76 and the relevant nomogram had a C-index of 0.80. Also, it was closely related to pivotal clinical characters of multiple datasets and invasiveness of PTC cell lines. And the signature was an independent prognostic factor in PTC. Finally, we built a nomogram including the signature and relevant clinical factors. The efficacy was satisfying in predicting PTC’s PFI.Conclusions:The MTG signature and nomogram were closely associated with PTC prognosis and may help clinicians improve the individualized prediction of PFI.
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Objective:To explore whether deep learning could apply to recognize the recurrent laryngeal nerve (RLN) in videos of endoscopic thyroidectomy (ETE) via breast approach.Methods:Videos of ETE via breast approach in Peking Union Medical College Hospital from Feb. 2020 to Aug. 2021 were collected. Videos containing RLN were selected, and the outline of RLN was marked by two thyroid surgeons. Then data were divided into a training set and a test set in a ratio of 5:1 and classified into the high and low difficulty group according to a senior thyroid surgeon’s opinion. Those pictures were input to D-LinkNet model. Precision, sensitivity and mean dice index was calculated.Results:A total of 46 videos including 153, 520 frames of pictures were included in this study. 131,039 frames of 39 videos were in the training set and 22,481 frames of 7 videos were in the test set. When the intersection over union threshold was 0.1, the sensitivity and precision was 92.9%/72.8% and 47.6%/54.9% in high and low recognition group, respectively. When the intersection over union threshold was 0.5, the sensitivity and precision turned to 85.8%/67.2% and 37.6%/43.5% in high and low difficulty group, respectively. Mean Dice index was 0.781 and 0.663 in high and low difficulty group, respectively.Conclusions:RLN recognition based on deep learning is feasible and has potential application value in ETE, which may help surgeons reduce the risk of accidental injury of RLN and improve the safety of thyroidectomy.
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Objective:To explore whether deep learning could apply to recognize the recurrent laryngeal nerve in the video of unilateral axillary approach endoscopic thyroidectomy.Methods:Videos of endoscopic thyroidectomy via unilateral axillary approach in Peking Union Medical College Hospital from Jul. 1st, 2020 to May. 1st, 2021 were collected. Videos containing the recurrent laryngeal nerve were selected, and the outline of recurrent laryngeal nerve were marked by two senior thyroid surgeons and staffs. Data were divided into training set and test set in a ratio of 5:1, and classified into high, medium and low recognition group according to difficulty of recognizing the outline of the nerve. The neuron network was based on PSPNet combined with Resnet50. All data were analyzed by R (ver. 4.0.2) .Results:A total of 38 videos including 35,501 frames of pictures were included in this study. 29, 704 frames of 32 videos were in our training set and 5797 frames of 6 videos were in the test set. When the intersection over union (IOU) threshold is 0.1, the sensitivity and precision is 100.0%/92.1%, 95.8%/80.2% and 81.0%/80.6% in high, medium and low recognition group respectively. When the IOU threshold is 0.5, the sensitivity and precision is 92.6%/85.3%, 71.7%/60.5% and 38.1%/37.9% in high, medium and low recognition group respectively, indicating that neuron network could located the outline of recurrent laryngeal nerve in high and medium recognition group. False negatives were often due to small targets and unclear boundaries.Conclusion:Recurrent laryngeal nerve recognition based on deep learning is feasible and has potential application value in endoscopic thyroidectomy, which may help surgeons reduce the risk of accidental injury of recurrent laryngeal nerve and improve the safety of thyroidectomy.
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The incidence of parathyroid carcinoma (PC) is low while the long-term outcome is poor in most cases. Most patients with PC suffered from relapse or metastasis, and the main reason of mortality is hypercalcemia and related complications. Surgery is the main therapy for PC. Local resection is suitable for benign lesion while radical resection including parathyroid lesion, ipsilateral thyroid lobe and surrounding soft tissue is suggested for parathyroid carcinoma. It is still difficult to identify the malignancy among parathyroid neoplasm before operation without distant metastasis. Parathyroid carcinoma was diagnosed after first surgery of local resection in most patients with histopathological evaluation. The significance of remedial surgery for this situation was still indeterminate. In this review, the different opinions about the management of PC were introduced and several suggestions were presented based on the literatures.
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Peking Union Medical College Hospital, as one of the most stressful medical institutions in China, is facing the problem of emergency department overcrowding. In order to effectively alleviate the emergency overcrowding, improve the medical quality and patients′ medical experience, the hospital firmly grasped the two incremental links of " throughput" and " output" factors, established a multidisciplinary and multi-department cooperation team, constructed a close medical alliance cooperation mode, and innovated and explored a harmonious emergency overcrowding relief mode with the goal of unblocking the " exit" of patients. The practice showed that the comprehensive measures could effectively alleviate the problem of emergency overcrowding, and improve the medical environment and medical quality.
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Objective:To investigate the application value of machine learning algorithms for gauze detection in laparoscopic pancreatic surgery.Methods:The retrospective and descriptive study was conducted. The 80 intact laparoscopic pancreatic surgery videos from Peking Union Medical College Hospital of Chinese Academy of Medical Sciences with timing of July 2017 to July 2020 were collected. The training set was used to train the neural network, and the test set was used to test the ability of neural network for gauze detection under different difficulties. Under the supervision of two superior doctors, videos that containing gauze were selected and classified according to recognition difficulty into three difficulty level including easy, normal and hard difficulty, and further divided based on random number method into training set with 61 videos and test set with 19 videos in a ratio of 3:1 roughly. The minimum enclosing rectangle of the gauze were marked frame by frame. All images were input to the neural network model for training after normalization and preprocessing. For every image, the output of neural network is the predicted minimum enclosing rectangle of gauze. The intersection over union >0.5 was identified as positive result. Observation indicators: (1) video annotation and classification; (2) test outcomes of neural network for test set.Count data were represented as absolute numbers or percentages.Results:(1) Video annotation and classification: a total of 26 893 frames of images form 80 videos were annotated, with 61 videos including 22 564 frames of images as the training set and 19 videos including 4 329 frames of images as the test set. Of the training set, 19 videos including 5 791 frames of images were classifed as easy difficulty, 38 videos including 15 771 frames of images were classifed as normal difficulty, 4 videos including 1 002 frames of images were classifed as hard difficulty, respectively. Of the test set, 4 videos including 1 684 frames of images were classifed as easy difficulty, 6 videos including 1 016 frames of images were classifed as normal difficulty, 9 videos including 1 629 frames of images were classifed as hard difficulty, respectively. (2) Test outcomes of neural network for test set: the overall sensitivity and accuracy of gauze detection by neural network in the test set were 78.471%(3 397/4 329) and 69.811%(3 397/4 866), respectively. The sensitivity and accuracy of gauze detection by neural network were 94.478%(1 591/1 684) and 83.168%(1 591/1 913) in easy difficulty test set. The sensitivity and accuracy of gauze detection by neural network were 80.413%(817/1 016) and 70.859%(817/1 153) in normal difficulty test set, 60.712%(989/1 629) and 54.944%(989/1 800)in hard difficulty test set. The frame rate reached more than or equally to 15 fps. The overall false negative rate and false positive rate of gauze detection by neural network in the test set were 21.529%(932/4 329) and 30.189%(1 469/4 866), respectively. The false negative was mainly due to the existence of blurred images, too small gauze exposure or blood immersion of gauze. The false positive was caused by the reflection of connective tissue or body fluids.Conclusion:The machine learning algorithms for gauze detection in laparoscopic pancreatic surgery is feasible, which could help medical staff identify gauze.
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Pancreatic ductal adenocarcinoma (PDAC) has poor prognosis due to limited therapeutic options. This study examines the roles of genome-wide association study identified PDAC-associated genes as therapeutic targets. We have identified HNF4G gene whose silencing most effectively repressed PDAC cell invasiveness. HNF4G overexpression is induced by the deficiency of transcriptional factor and tumor suppressor SMAD4. Increased HNF4G are correlated with SMAD4 deficiency in PDAC tumor samples and associated with metastasis and poor survival time in xenograft animal model and in patients with PDAC (log-rank P = 0.036; HR = 1.60, 95% CI = 1.03-2.47). We have found that Metformin suppresses HNF4G activity via AMPK-mediated phosphorylation-coupled ubiquitination degradation and inhibits in vitro invasion and in vivo metastasis of PDAC cells with SMAD4 deficiency. Furthermore, Metformin treatment significantly improve clinical outcomes and survival in patients with SMAD4-deficient PDAC (log-rank P = 0.022; HR = 0.31, 95% CI = 0.14-0.68) but not in patients with SMAD4-normal PDAC. Pathway analysis shows that HNF4G may act in PDAC through the cell-cell junction pathway. These results indicate that SMAD4 deficiency-induced overexpression of HNF4G plays a critical oncogenic role in PDAC progression and metastasis but may form a druggable target for Metformin treatment.
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Objective To investigate the expression of Cripto-1 in pancreatic cancer and to analyze its clinical significance. Methods Cripto-1 expression in normal pancreas,pancreatic cancer and adjacent non-tumor tissues,chronic pancreatitis tissues and other related tissues was evaluated using immunohistochemistry.The association of Cripto-1 expression with the clinicopathological characteristics and the prognostic value of Cripto-1 in patients with pancreatic cancer were analyzed. Results The expression of Cripto-1 was higher in chronic pancreatitis tissues,pancreatic cancer and its metastases than in normal pancreas(P=0.019,P=0.025,and P=0.018,respectively).Cripto-1 overexpression was correlated with poorly differentiated pancreatic cancer.The patients with Cripto-1 upregulation had shorter median survival time(8 months vs.16 months,χ
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Humans , Biomarkers, Tumor , Carcinoma, Pancreatic Ductal , GPI-Linked Proteins , Intercellular Signaling Peptides and Proteins , Neoplasm Proteins/genetics , Pancreatic Neoplasms , PrognosisABSTRACT
Parathyroid carcinoma is an endocrine malignancy with poor outcomes. Its incidence is low and the molecular mechanisms related with carcinogenesis and development remains largely unknown. It is difficult to diagnose and manage parathyroid carcinoma. In this review, the recent advances in the molecular mechanism of parathyroid carcinoma are summarized, with emphasis on the prospects for future clinical applications.
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As one of the most lethal malignancies, pancreatic cancer and its therapy remains a big problem all around the world. With the few candidates for surgery and the poor outcome for chemotherapy, the immunotherapy becomes one important direction. Mesothelin, a membrane protein, expresses at low levels in normal tissues, but is re-expressed at a high frequency in pancreatic cancer, which makes mesothelin an ideal target for immunotherapy.This review summarizes the progression of mesothein-targeted immunotherapy for pancreatic cancer.
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The comprehensive and multiple disciplinary team therapeutic strategies of pancreatic cancer have been accepted as a consensus. Immune checkpoint inhibitors have made great breakthroughs in the treatment of various solid tumors. However, immune checkpoint inhibitors failed to elicit efficacy in patients with pancreatic cancer and how to overcome the immunosuppressive tumor microenvironment may be the crucial event. Combination regimens of immune checkpoint inhibitors with chemotherapy, radiotherapy, and molecular targeted therapy have been underway, but the sample size of the clinical trial was still limited. Considering the current research status and progress of pancreatic cancer, this article further discusses the practical problems of immune checkpoint inhibitors and makes objective evaluation of its value.
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The diagnosis and treatment of thyroid cancer during pregnancy is one of the hot spots and difficult problems in the diagnosis and treatment of thyroid diseases.The detection of thyroid cancer during pregnancy has been a great challenge for both clinicians and pregnant women.It should be diagnosed as soon as possible through multidisciplinary collaboration. Comprehensive and reasonable assessment of the status of pregnant women and fetuses,selection of the most appropriate treatment and follow-up methods are needed to avoid iatrogenic side effects on pregnant women and fetuses,maintain normal pregnancy and obtain the best therapeutic effect.
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Objective To investigate the imaging anatomy and clinical significance of the inferior pancreaticoduodenal veins (IPDVs).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 42 patients with pancreatic head ductal adenocarcinoma who were admitted to Peking Union Medical College Hospital from January to June 2018 were collected.There were 24 males and 18 females,aged from 41 to 78 years,with an average age of 61 years.Patients received preoperative contrast-enhanced computed tomography (CT) examination with 1 mm slice thickness,and underwent corresponding surgery according to the preoperative evaluation.Observation indicators:(1) results of preoperative CT examination;(2) surgical situations.Normality of measurement data was analyzed using Shapiro-Wilk test.Measurement data with skewed distribution were described as M (QR) or M (range),and comparison between groups was analyzed by the Mann-Whitney U test.Count data were described as absolute number or percentage,and comparison between groups was analyzed by the chi-square test.Results (1) Results of preoperative CT examination:42 patients received preoperative contrast-enhanced CT examination with 1 mm slice thickness.① The first jejunal venous trunk was identified in all the 42 patients.The first jejunal venous trunk crossed dorsal to the superior mesenteric artery (SMA) in 34 patients and ventral to the SMA in 8 patients.② Of 42 patients,2 showed no IPDV,and 40 showed IPDV including 23 with 1 IPDV,13 with 2 IPDVs,3 with 3 IPDVs,and 1 with 4 IPDVs.A total of 62 IPDVs were identified in the 42 patients,with an average IPDV number of 1 (range,0-4).There were 43 IPDVs drained into first or second jejunal venous trunks and 19 IPDVs drained into superior mesenteric vein (SMV).③ Of 42 patients,type Ⅰ IPDV was identified in 32 patients including 20 with 1 IPDV drained into jejunal venous trunk at dorsal side of SMA,7 with 2 IPDVs drained into jejunal venous trunk at dorsal side of SMA,2 with 3 IPDVs drained into jejunal venous trunk at dorsal side of SMA,and 3 with 1 IPDV drained into jejunal venous trunk at ventral side of SMA,and non-type Ⅰ IPDV was identified in 10 patients;type Ⅱ IPDV was identified in 18 patients including 17 with 1 IPDV drained into SMV and 1 with 2 IPDVs drained into SMV,and non-type Ⅱ IPDV was identified in 24 patients.Some patients can simultaneously had type Ⅰ and type Ⅱ IPDV.(2) Surgical situations:42 patients underwent pancreatoduodenectomy,14 of which underwent laparoscopic surgery and 28 underwent open surgery.There were 5 cases with SMV or portal vein reconstruction,and 18 with intraoperative blood transfusion.All the 42 patients were diagnosed as pancreatic ductal adenocarcinoma by postoperative pathological examination,including 30 of R0 resection and 12 of R1 resection.The volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with R0 and R1 resection (situation of surgical margin),cases with SMV or portal vein reconstruction were 650 mL(853 mL),15,20,12,4 in the 32 patients with type Ⅰ IPDV,aod 475 mL (480 mL),3,10,0,1 in the 10 patients with non-type Ⅰ IPDV;there were significant differences in the volume of intraoperative blood loss and situation of surgical margin (Z=94.000,x2=5.250,P＜ 0.05).There was no significant difference in the cases with intraoperative blood transfusion,cases with SMV or portal vein reconstruction between patients with type Ⅰ and non-type Ⅰ IPDV (x2 =0.045,0.886,P＞0.05).Conclusions IPDVs can be distinguished on the contrast-enhanced CT with slice thickness,and classified as IPDVs drained into SMV or jejunal venous trunk.It is necessary to carefully deal with IPDVs drained into jejunal venous trunk in the pancreaticoduodenectomy due to its more volume of intraoperative blood loss and lower R0 resection rate.
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As one of the most lethal malignancies, pancreatic cancer and its therapy remains a big prob-lem all around the world. With the few candidates for surgery and the poor outcome for chemotherapy, the im-munotherapy becomes one important direction. Mesothelin, a membrane protein, expresses at low levels in normal tissues, but is re-expressed at a high frequency in pancreatic cancer, which makes mesothelin an ideal target for im-munotherapy.This review summarizes the progression of mesothein-targeted immunotherapy for pancreatic cancer.
ABSTRACT
The comprehensive and multiple disciplinary team therapeutic strategies of pancreatic cancer have been accepted as a consensus. Immune checkpoint inhibitors have made great breakthroughs in the treat-ment of various solid tumors. However, immune checkpoint inhibitors failed to elicit efficacy in patients with pan-creatic cancer and how to overcome the immunosuppressive tumor microenvironment may be the crucial event. Combination regimens of immune checkpoint inhibitors with chemotherapy, radiotherapy, and molecular targeted therapy have been underway, but the sample size of the clinical trial was still limited. Considering the current re-search status and progress of pancreatic cancer, this article further discusses the practical problems of immune checkpoint inhibitors and makes objective evaluation of its value.
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Objective To investigate the preoperative localizaion diagnosis and surgical strategies of primary hyperparathyroidism (pHPT).Methods The clinical data of pHPT patients who underwent initial parathyroid surgery at the Peking Union Medical College Hospital from Jan.2009 to Apr.2017 were retrospectively analyzed to explore preoperative localization and surgical options.Results There were a total of 902 surgical cases included in the study with 674 women and 228 men.All had preoperative parathyroid ultrasonography (US) (sensitivity 97.18％,positive predictive value (PPV) 98.40％) and 99Tcm-sestamibi (MIBI) scan (sensitivity 94.24％,PPV 98.00％).The combination of US and MIBI scan had a sensitivity of 92.39％ and PPV of 97.37％.MIBI scan showed negative results in 51 cases.We found that male patients with cystic lesions were more likely related to negative MIBI scan (P＜0.05).Among 89 patients with negative MIBI and/or US,39 received neck CT,17 received positron emission tomography (PET)/CT,and 9 received ultrasound-guided biopsy for further localization.800 patients (88.69％) underwent minimally invasive parathyroid surgery (MIP) with anesthesia of cervical plexus block.656 patients (72.72％) had normal parathyroid hormone (PTH) level on the first post-operative day,140 patients (15.52％) had postoperative hypocalcaemia and 234 patients (25.94％) presented hypocalcaemic symptoms within 3 days after operation,which could be relieved by intravenous calcium or continuous medicine taken by mouth.During the follow-up of the 800 MIP patients,4 had recurrence and one patient was not cured.Conclusions Parathyroid US and MIBI scan are of good value in localizaion diagnosis.Neck CT or PET/CT should be used as supplementary approaches in patients with negative US and/or MIBI scan.MIP with anesthesia of cervical plexus block is simple and feasiable for pHPT cases with accurate localization.
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Objective To investigate the clinical effect of ambroxol hydrochloride combined with cough syrupintegrated traditional Chinese and Western Medicine on infantile cough.Methods Selected 200 cases of patients with cough who were treated in our hospital from January 2012 to December 2015,divided into two groups randomly,100 cases in observation group,100 cases in control group.The observation group was treated with ambroxol hydrochloride combined with cough syrup,the control group were treated with ambroxol hydrochloride.To observe the clinical symptoms and clinical manifestations of the patients after treatment,recorded the time of cough and the disappearance of cough,and to determine the effect of treatment.The lung function indexes of the two groups were detected:peak expiratory flow,forced vital capacity,forced expiratory volume in one second,maximal expiratory flow rate of 50％ vital capacity and maximal expiratory flow rate of 25％ vital capacity.All the patients were followed up for 6 months by telephone or clinic,the recurrence rate of the two groups was observed,and the number of children with asthma were recorded.Results The time of cough and the disappearance time of cough in observation group were significantly shorter than that of the control group (P ＜ 0.05);the total effective rate of observation group was 93.00％ (93/100),significantly higher than that of the control group 74.00％ (74/100) (P ＜ 0.05).After treatment,expiratory flow peak,forced vital capacity,one second forced expiratory volume,vital capacity 50％ of maximum expiratory flow and 25％ of vital capacity maximal expiratory flow of two groups were significantly increased (P ＜ 0.05) and the observation group increased more significantly than the control group (P ＜0.05).After 6 months of follow-up,the control group had 22 cases of recurrence,the recurrence rate was 22.00％;the observation group had 6 cases of recurrence,the recurrence rate was 6.00％,the recurrence rate of the observation group was significantly lower than that of the control group (P ＜ 0.05);the control group had 14 cases of children with asthma,the change rate was 14％;the observation group had 2 cases of children with asthma,the change rate was 2％,the change rate of the observation group was significantly lower than that of the control group (P ＜ 0.05).Conclusion Ambroxol hydrochloride combined with cough syrup has better curative effect on infantile cough,can effectively improve children's lung function,reduce the rate of recurrence and change of asthma,which has high clinical application value.
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Objective To investigate the clinical effect of ambroxol hydrochloride combined with cough syrupintegrated traditional Chinese and Western Medicine on infantile cough.Methods Selected 200 cases of patients with cough who were treated in our hospital from January 2012 to December 2015,divided into two groups randomly,100 cases in observation group,100 cases in control group.The observation group was treated with ambroxol hydrochloride combined with cough syrup,the control group were treated with ambroxol hydrochloride.To observe the clinical symptoms and clinical manifestations of the patients after treatment,recorded the time of cough and the disappearance of cough,and to determine the effect of treatment.The lung function indexes of the two groups were detected:peak expiratory flow,forced vital capacity,forced expiratory volume in one second,maximal expiratory flow rate of 50％ vital capacity and maximal expiratory flow rate of 25％ vital capacity.All the patients were followed up for 6 months by telephone or clinic,the recurrence rate of the two groups was observed,and the number of children with asthma were recorded.Results The time of cough and the disappearance time of cough in observation group were significantly shorter than that of the control group (P ＜ 0.05);the total effective rate of observation group was 93.00％ (93/100),significantly higher than that of the control group 74.00％ (74/100) (P ＜ 0.05).After treatment,expiratory flow peak,forced vital capacity,one second forced expiratory volume,vital capacity 50％ of maximum expiratory flow and 25％ of vital capacity maximal expiratory flow of two groups were significantly increased (P ＜ 0.05) and the observation group increased more significantly than the control group (P ＜0.05).After 6 months of follow-up,the control group had 22 cases of recurrence,the recurrence rate was 22.00％;the observation group had 6 cases of recurrence,the recurrence rate was 6.00％,the recurrence rate of the observation group was significantly lower than that of the control group (P ＜ 0.05);the control group had 14 cases of children with asthma,the change rate was 14％;the observation group had 2 cases of children with asthma,the change rate was 2％,the change rate of the observation group was significantly lower than that of the control group (P ＜ 0.05).Conclusion Ambroxol hydrochloride combined with cough syrup has better curative effect on infantile cough,can effectively improve children's lung function,reduce the rate of recurrence and change of asthma,which has high clinical application value.
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Feedback for teaching refers to the mutual transmission and interaction of various information between teaching and learning in teaching process,and is an inevitable result and objective existence of teaching in which teachers and students participate.Effective feedback for teaching is characterized by timely,comprehensive and authentic.Teachers can continuously modify teaching per formance through the feedback of students;the feedback of teaching by students is reflected in examination performance,which really reflects the idea that teaching benefits teachers as well as students.Clinical comprehensive course of eight-year program students is an important bridge between basic medicine and clinical medicine,and the foundation of teaching clinical medicine.Feedback for teaching was applied in students of academic year 2011 from the Department of Surgery of Clinical College in Pekjing Union Medical College,and teaching approach was adjusted in time,contributing to good teaching effectiveness.