Objective To investigate the expression of TLR9 mRNA of peripheral blood mononuclear cells (PBMCs) in patients with acute pancreatitis .Methods Fifty two AP patients with the disease duration in 24 h were collected ,peripheral EDTAK2 coag‐ulation vein blood were collected on the first ,third and fifth day ,then plasma were cryop reserved to detect pancreatic elastase , proinflammatory cytokines and anti‐inflammatory cytokines .Then the peripheral EDTAK2 coagulation vein blood two to three months after treatment were collected in the same method to undertake these tests ,and act as the reference level value .Peripheral blood was collected from 36 acute pancreatitis patients .Three months later ,peripheral blood was collected again from these 36 peo‐ple as controls .PBMCs were isolated by Ficoll‐Hypaque gradient centrifugation .RT‐PCR was adopted to determine the relative con‐tent of the expression of TLR9 mRNA of the PBMCs .Results The relative content of expression of TLR9 mRNA were significant‐ly up‐regulated in the patients with acute pancreatitis ,compared with that of controls (P<0 .05) .The up‐regulated expression of TLR9 mRNA was related to expression of TNF‐a and IL‐1 .Conclusion The up‐regulated expression of TLR9 mRNA in acute pan‐creatitis patients indicates that infective factors might be mediated by TLR 9 .

Objective To create the evaluation index system of rehabilitation service for all disabled in Shanghai.MethodsCompositive quantitative and qualitative research methods,such as literature review,focus-group discussion,questionnaire survey,specialist consultation were carried in the study.ResultsThe Evaluation Index System of Rehabilitation Service for All Disabled in Shanghai finally comes into being includes 8 first-degree index,32 second-degree indexes and 100 third-degree index.ConclusionThe evaluation index system would be provided with directive significance to the goal of 'rehabilitation service for all disabled persons'.

Laparoscopic radical resection of transverse colon cancer is a difficult operation, which is featured by large operation area, multiple steps, and many clinical anatomical variations. It requires the concept of complete mesocolic excision. Because of its absolute high-definition picture restoration, the 4K laparoscope can effectively assist in the identification, protection and severance of blood vessels during the operation, and assist in judging the fascia space of the operation. After entering Toldt fascial space through the intermediate approach guided by the superior mesenteric vein, the left, right transverse colon and lower area of mesangium are completely dissected, the upper area of colon, hepatic and splenic flexure are sepearted. The authors summarize practical experiences, investigate the extent of lymph node dissection in 4K laparoscopic radical resection of transverse colon cancer and share surgical experience.

Objective:To explore the application of 3D printing technology combined with CPBL teaching mode in the teaching of master's degree in spine surgery.Methods:42 postgraduates in our department were randomly divided into two groups: experimental group (21) and control group (21). The experimental group used 3D printing technology combined with CPBL teaching mode as teaching techniques. Before class, the teacher would select some typical cases and design related problems. During class, 3D models were used to guide students to think and solve related problems; The control group used traditional teaching mode. Students in the two groups were compared for the theoretical knowledge and operational techniques they have mastered, and the students' satisfaction and recognition towards different teaching modes were obtained through questionnaire survey. Independent sample t-test was performed using SPSS 25.0.Results:The scores of the theoretical knowledge, operational techniques, teaching satisfaction and recognition of postgraduates were (84.7±3.4), (87.1±3.7), (9.7±0.3), (9.3±0.4) in the experimental group, and (79.7±3.3), (80.4 ± 4.0), (8.4±0.7) and (8.3±0.6) in the control group. The difference between the two groups was statistically significant ( P<0.05). Conclusion:The new teaching mode of combining 3D printing technology with CPBL teaching mode is better than the traditional teaching mode, which is worth further promotion and application.

At present, there are a series of problems in the clinical teaching of postgraduates, such as insufficient integration of professional teaching and ideological and political education, insufficient understanding of teachers and students, insufficient exploration of ideological and political elements, and immature construction of teaching system. This paper mainly starts from three aspects: improving the teaching system and mechanism, building a disease-based curriculum ideological and political chain and teaching implementation strategies, organically combines different professional curriculum contents with ideological and political education, and carries out preliminary exploration and practice in the construction of ideological and political teaching system of orthopedic clinical curriculum, so as to guide students to establish correct values, outlook on life and world outlook. It provides useful practical experience for improving the quality of clinical teaching and promoting the reform and innovation of graduate teaching.

Inguinal hernia is a common surgical disease, and most patients need surgical treatment. In recent years, minimally invasive surgery based on laparoscopy has been popularized in hernia surgery. With the release of clinical guidelines, the progress of instruments and materials, the update of treatment concepts and anatomical knowledge, laparoscopic inguinal hernia repair, especially laparoscopic total extraperitoneal hernia repair (TEP), is developing towards a more accurate and minimally invasive direction. Based on literatures in recent years and combined with clinical practice, the authors explore the advances in clinical application of laparoscopic TEP.

Objective:To explore the feasibility and superiority of applying digital orthopedic technology of virtual human reconstruction and 3D printing to CBL teaching of kyphosis for clinical postgraduates.Methods:Thirty postgraduates of professional degree participated in the standardized training of resident doctors in our department were randomized into the experimental group (New CBL teaching mode group) and the control group (traditional teaching mode group) with 15 students in each group, and the two groups were taught differently (the teaching content was two typical cases of kyphosis). Among them, the experimental group adopted the new CBL teaching mode, and successively conducted small class theory teaching, model explanation, group discussion, preoperative design, surgery observation and specific questions and answers, etc. The control group only used the traditional method to teach theory in a large class. The teaching effect of the two groups was evaluated in t test by SPSS 25.0.Results:For the teaching of patients with ankylosing spondylitis and kyphosis, scores of the satisfaction with class interest, mastery of theoretical knowledge and understanding of operation plan in the experimental group were (9.4±0.2), (91.1±3.8), and (91.5±3.5) respectively, and those in the control group were (8.2±0.4), (82.1±3.5) and (83.1±4.7) respectively, with statistical significance ( P<0.05). Conclusion:In the teaching of kyphosis, the CBL teaching mode based on digital orthopedic technology is superior to the traditional teaching mode, which is conducive to improving clinical skills for students.

Cervical lymph node metastasis in thyroid cancer is closely related to the disease recurrence and prognosis of patients. Accurate judgment of lymph node metastasis is vital for tumor stage and treatment in patients with thyroid cancer, which can effectively improve the prognosis of patients. However, preoperative detection of cervical lymph node metastasis is the key points and difficulties in individualized treatment of thyroid cancer. Currently, fine needle aspiration washout fluid thyroglobulin is often used to assess cervical lymph node metastasis of differentiated thyroid cancer preoperatively, and it has a higher diagnostic efficacy. The continuous exploration and application of tumor markers and emerging biomarkers have provided new perspectives for the preoperative diagnosis of lymph node metastasis in thyroid cancer. As a new non-invasive detection technique, liquid biopsy is convenient to obtain samples and has broad clinical application in early diagnosis of cervical lymph node metastasis of thyroid cancer. In addition, the analysis and application of liquid biopsy biomarkers will help the development of clinical diagnosis and treatment strategies, and provide the possibility of early precision therapy for thyroid cancer patients. This review summarizes current research surrounding the molecular markers related to cervical lymph node metastasis of thyroid cancer.