Epigenetics refers to steady phenotypic changes in gene expression without modifications in the genetic nucleotide sequence.Disorder of epigenetic mechanisms plays an important role in the occurrence and development of human malignant tumors including hepatocellular carcinoma.A large number of gene targets and pathways related to epigenetics were discovered.For instance,DNA methylation,histone modification and RNA regulator gene silencing were associated with the development of hepatocellular carcinoma.Exploring the abnormal epigenetics is of great significance for prevention and treatment of hepatocellular carcinoma.

A co-words network for high frequency words was established using the title information of papers pub-lished in 22 medical journals from 2005 to 2013.The evolution of medical scientific research topics was analyzed with the visual analysis software NEViewer, which showed that medical research in China was focused on basic and application studies with the prevention and treatment of frequently encountered diseases and the associated technical methods as the two main directions, and that medical scientific research topics would remain their stable status in a rather long period.The hot medical topics were explained.

Objective To investigate the expression of Toll like receptor 2 (TLR2) in glioma and its relationship with the malignant biological behavior of glioma, so as to provide a new therapeutic target for glioma immunotherapy. Methods The tumor tissues of 90 glioma patients undergoing surgical excision were collected, of which WHO gradingⅠ-Ⅱgrade 39 cases,Ⅲgrade 24 cases,Ⅳgrade 24 cases. In addition, the normal brain tissues of 12 patients undergoing routine intracranial decompression were selected. The human glioma cell lines U87-MG, U251-MG and human astrocyte cell line HA were cultured. The expression levels of TLR2 mRNA and protein were detected by reverse transcriptase polymerase chain reaction (RT-PCR) and Western Blot test. The correlation between TLR2 protein and different clinical pathological parameters was analyzed. Results The expression levels of TLR2 mRNA and protein in the glioma tissuesⅠ-Ⅱgrade,Ⅲgrade andⅣgrade were significantly higher than those in normal brain tissues (0.27 ± 0.09, 0.57 ± 0.12 and 0.96 ± 0.18 vs. 0.11 ± 0.05; 0.31 ± 0.05, 0.44 ± 0.05 and 0.71 ± 0.09 vs. 0.02 ± 0.01), there were statistical differences (P<0.05). In different grades of glioma tissues, there were statistical differences in the expression levels of TLR2 mRNA and protein (F = 205.9 and 194.9, P<0.05). The expression levels of TLR2 mRNA and protein in human malignant glioma cell lines U87-MG and U251-MG were significantly higher than those in human astrocyte cell line HA (1.000 ± 0.100 and 0.356 ± 0.060 vs. 0.245 ± 0.030, 0.720 ± 0.100 and 1.800 ± 0.150 vs. 0.004 ± 0.000), there were statistical differences (P<0.05). The expression of TLR2 protein was independent of age, sex and location(P>0.05), but was related to tumor diameter and WHO grading (P < 0.01). Conclusions TLR2 in different grade glioma tissues and glioma cell lines are expressed, and its expression level is associated with the malignant degree of glioma; TLR2 protein not only can be used as a biomarker of gliomas and prognosis, but also provide a new target for the treatment of glioma.

Objective To study the effect of the intervention mode of MTP on use of antibacterials in upper respiratory infection.Methods Adopt retrospective method to select randomly prescriptions of upper respiratory infection from July to September in 2006 for baseline investigation in Outpatient Clinic of Respiratory Department of the First People's Hospital of the city of Zhuhai in Guangdong province.Then aim physicians was interfered by MTP and investigation of post-interference was carried out after a month.The process of intervention and investigation was carried out repeatedly until June in 2007.The ratio of antibacterials use,injection use percentage and average drug fee was observed in pre/post-interference.Results The ratio of antibacterials use in upper respiratory infection in our hospital was decreased from 81.33% to 0,and the ratio percentage of injection use and average drug fee decreased by 81.69% and 35.47% respectively after four MTP circulations.Conclusion The intervention mode of MTP is feasible and effective on promoting the rational use of antibacterials on upper respiratory infection in Outpatient Clinic of Respiratory Department of our hospital.

Myeloproliferative neoplasms (MPN) are a group of clonal disorders of hematopoietic stem cells, and JAK2 V617F gene mutation is the main basis for the diagnosis of MPN. Previous studies have shown that BCR-ABL fusion gene and JAK2 V617F gene mutation are mutually exclusive in MPN patients, but in recent years, patients with a double mutation of both genes are often reported. The article synthesizes the relevant domestic and foreign literature in recent years, and reviews the BCR-ABL fusion gene and JAK2 V617F mutation double-positive MPN.

Objective To explore the application effect of cross-team scenario simulation exercise in the training of fire emergency plan in operating room.Methods Totally 48 nurses,16 anesthetists and 16 workmates in operating room of Zhejiang Provincial People′s Hospital from January 2015 to March 2016 were selected and divided into eight groups. The training of fire emergency plan in operating room was carried out with the method of scenario simulation exercise. The system of exercise contained three phases. The first phase was the theoretical study;the second phase was a teaching of centralized operation exercise;the third phase was the exercise in groups according to the design of simulation scenarios. The score was evaluated according to the method of subjective comment with over 80 points as the qualified,and below 79 points as the unqualified. At the same time,the time of completing the process before and after the exercise was recorded.Results The mean score of exercise examination was (88.75±4.23) points among eight groups with six groups whose scores were more than 90 points. When the small fire in operating room could be put out within three minutes by themselves,the time from the occurrence of fire to the restart of surgery after training (428.8±19.1) s was less than that (605.0±17.9) s before training with a significant difference (P<0.05). When the big fire in operating room could not be put out within three minutes by themselves,the time of retreat after training (44.6±4.2) s was less than that (71.0±6.4) s before training with a significant difference (P<0.05).Conclusions The cross-team scenario simulation exercise can improve the mastery level of fire emergency plan in operating room of operating room members. It is worthy of popularization and application in clinic.

Langerhans cell histiocytosis (LCH) is a rare disease characterized by the proliferation of Langerhans cells and the destruction of local tissue. LCH large occurs in children, whilst incidence of the elderly population is extremely low, and there are few related studies. LCH lesions can involve multiple organs and systems, including bone tissue, lymph nodes, skin, liver, and spleen. However, it is rare that multiple soft tissues are implicated for eldly patients with LCH and present with soft tissue mass as the main manifestation. Here is a report on the clinical features, treatment and prognosis of an elderly LCH with multiple soft tissue masses as the main manifestation, in order to provide clinical reference.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.