Objective:To obtain recombinant Profilin of silkworm,identify its immunogenicity,predict its B cell epitopes and construct the evolutionary trees. Methods: The nucleotide sequence of Profilin was acquired from NCBI,synthesized it and cloned it into pET-28 vector. Then,the recombinant plasimids were transformed to E. coli BL21. After induced by IPTG,recombinant protein was purified by Affinity chromatography. Furtherly,its allergenicity was identified by Western blot,the potential B cell epitopes was analyzed through DNAStar and build the evolutionary trees by MEGA5. 05. Results: The recombinant protein of Profilin was successfully expressed and purified by affinity chromatography. Besides,the protein contains a high IgE-binding activity with IgE existing in serum of patients allergic to silkworm. Conclusion: The recombinant proflilin has IgE-binding activity, and it is meaningful for fundamental research and specific diagnosis studies of allergic diseases caused by silkworm.

OBJECTIVE:To evaluate the effects of PDCA cycle management on perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department. METHODS:In retrospective analysis,512 discharge medical records, 861 ones and 1 070 ones were selected from our hospital before PDCA cycle management(Jan.-Dec. 2013,before intervention group), after first cycle of PDCA cycle management (Jan.-Dec. 2014,first intervention group) and after second cycle of PDCA cycle management(Jan.-Dec. 2015,second intervention group),respectively. The perioperative prophylactic application of antibiotics was analyzed comparatively before and after continuous intervention. RESULTS:After 2 cycles of PDCA cycle management intervention, the constituent ratio of internal fixation in orthopedics department increased significantly;utilization ratio of antibiotics,the rate of rational type,medication ratio 0.5-1 h before surgery,the rate of rational treatment course,the proportion of antibiotics use in accordance with indications increased from 50.20%,98.08%,93.77%,6.61%,82.10% to 58.41%,100%,99.04%,52.00%, 99.04%,respectively. The number of antibiotics type decreased from 4 to 2;the proportion of cephazolin increased significantly while that of clindamycin decreased significantly compared to before intervention. Postoperative prophylactic medication course decreased from(4.63 ± 2.42)d to(1.61 ± 0.75)d;the proportion of patients with medication course <24 h or ranged 24-48 h increased significantly, while those with medication course>72 h decreased significantly, with statistical significance (P<0.05). CONCLUSIONS:PDCA cycle management improves the rational rate of perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department in our hospital. The prophylactic medication course of our hospital is not yet fully controlled within 24 h so it should be further intervened.

Objective To investigate clinical and pathological features of pseudoepitheliomatous keratotic and micaceous balanitis (PKMB).Methods The clinical and pathological features as well as treatment of PKMB were retrospectively analyzed in 5 male patients collected from Janumy 2008 to December 2013.Results The age at onset of PKMB varied from 56 to 67 years in these 5 patients,and none of the patients had received prepucectomy.Indurated keratotic plaques were observed in the glans of penis and inner lamina of the prepuce with no tenderness on palpation,whose surfaces were covered with grayish yellow,adherent and hard micaceous crusts.Histopathological study revealed obvious hyperkeratosis complicated by parakeratosis,epidermal pseudoepitheliomatous hyperplasia,thickened spinous layer,and normal cell polarity in the epidermis,as well as telangiectasis and mild to moderate lymphocytic infiltration in the upper dermis.Immunohistochemical examination showed positive nuclear staining of epidermal cells for human papillomavirus (HPV) in 2 cases.Two patients took small doses of prednisone,but achieved no obvious improvement.Oral isotretinoin had resulted in a favorable outcome in another two cases,but relapse occurred after dose reduction,and thick crusts still appeared after topical application of glucocorticoid cream and tacrolimus cream,or carbon dioxide laser treatment and photodynamic therapy.Conclusions PKMB is a chronic and obstinate disease,and should be diagnosed based on pathological findings.Its treatment is difficult,and tretinoin has some effects,but relapse often occurs after drug withdrawal and maintenance treatment is needed.

Objective:On the basis of introducing and piloting long-term care insurance services and providing home care for older adults with disabilities in Suzhou, this paper aims to explore the working experience of home caregivers in the caring environment, understand their difficulties and issues, explore their true feelings and the relevant causes, and to draw lessons from their experience, providing constructive suggestions for the establishment of caregivers as well as policy recommendations for the government.Methods:The qualitative research method was used to collect the field experience data of 9 home caregivers in the caring environemnt through observation and semi-structured interview. Colaizzi phenomenological analysis was used to process and analyze the data.Result:1. Heavy workload and lack of incentive mechanism; 2. Care experience is diverse, with a sense of achievement and happiness, but lack of family′s trust and identification; 3. Professional trainings and peer support are needed.Conclusion:1. Improving the working environment of caregivers and reducing the burden of care; 2.Improve the employment treatment of home care workers, and actively improve the relevant incentive mechanism;3. Paying attention to the emotional experience of caregivers and helping them adapt to their role; 4.Standardize professional knowledge and skills training, provide risk assessment tools, and improve the quality of care.

The apoptosis-inducing factor, mitochondrion-associated 1(AIFM1)gene encodes an apoptosis-inducing factor(AIF)protein with apoptosis and redox function.AIF is widely expressed within cells in human tissues, and playing an important role in the mitochondria.Mutations in the AIFM1 gene are associated with severe X-linked mitochondrial encephalomyopathy, Cowchock syndrome, X-linked spondyloepimeta-physeal dysplasia with hypomyelinating leukodystrophy, auditory neuropathy and other diseases.AIFM1 gene mutations exhibit a wide range of clinical phenotypes, but the pathogenesis between mutations and phenotypes and phenotypic severity remains unclear.This paper summarizes the reported AIFM1 mutation-related loci, phenotypes, and possible pathogenesis mechanisms, and provide a brief review of AIFM1 mutation-related diseases and their progression.