Objective:To study the relationship between the expression of Fas,Fas Ligand and epidermal tumors' malignant degree.Methods:The immunohistochemical technique was employed to detect the expression of Fas and Fas Ligand in Bowens' disease,Squamous Cell Carcinoma(SCC)and Basal Cell Carcinoma(BCC).Results:The Fas and Fas Ligand could be detected in Bowens disease and SCC.The intensity of expression of Fas was downregulated and that of Fas Ligand was upregulated along with the maligant degree increasing of tumors.The expression of Fas,Fasl in BCC were lower than that in Bowens disease and SCC.Conclusion:The expression of Fas and Fas Ligand were correlated to malignant degree and clinical prognosis of some epidermal tumors,for abnormal apoptosis directed by contract of Fas and Fas Ligand may be one of the causes responsible to epidermal tumor's local immune escaping.

Shanghai East Hospital has built a general practice residency training information system based on "Internet +" technology since 2017. This training system effectively promoted the training quality, improved the clinical and research ability of general practitioners, and strengthened the supervision of the training. It has improved the training satisfaction, increased passing rate of national medical licensing examination and graduation comprehensive examination of trainees. This training system can largely break the time and space limitations, and has strong replicability. It may provide reference to optimize the general practice standardized residency training for other institutions.

rse effect when compared with tibolone.

Objective To investigate the occurrence of postoperative healthcare-associated infection(HAI)in pa-tients with hepatobiliary malignant tumor,explore the related risk factors,so as to provide the basis for taking ef-fective prevention and control measures.Methods The occurrence of postoperative HAI in patients with hepatobili-ary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed,risk factors for postoperative HAI were analyzed through reviewing and collecting patients’medical data.Results A total of 302 patients were investigated,42 (13.91 %)developed postoperative HAI,no multiple site infection occurred,the main infection site was deep surgical site (n=10,23.81 %),followed by lower respiratory tract (n=9,21 .43%) and digestive system (n=7,16.67%).Of 42 infection cases,38(90.48%)were sent specimens for pathogenic cul-ture,36 pathogenic strains were isolated,31 (86.11 %)of which were gram-negative bacteria,and 5 (13.89%) were gram-positive bacteria.Multivariate logistic analysis showed that operation duration≥2 hours (OR =1 .48), overweight (or obesity)(OR=1 .40),and preoperative radiotherapy (OR=2.98)were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P <0.05).Conclusion Incidence of postoper-ative HAI is high in patients with hepatobiliary malignant tumor,risk factors are long length of operation,over-weight (or obesity),and preoperative radiotherapy,effective prevention and control measures against risk factors should be taken.

Objective To evaluate the effectiveness and safety of percutaneous transhepatic balloon dilation for the removal of common bile duct stones.Methods 60 patients of common bile duct stone were divided into two groups:PTBD group (30 cases) and endoscopic sphicterotomy (EST) group (30 cases).Postoperatively biliary tract was drained for three days.Results All stones were removed in 28 patients (93％) in PTBD group and 29 cases (97％) in EST group.Early complications occurred in 13％ in PTBD patients and in 17％ in EST patients(x2 =0.35,x2 =0.13,P ＞0.05).There was no mortality in neither group.Long-term complications such as gallstone recurrence and cholangitis in PTBD group was significantly less than that in EST group (x2 =6.41,P ＜ 0.05).Conclusions The success rate of PTBD was similar to that of EST and while in PTBD the function of Oddi's sphincter was well reserved.PTBD procedure is a valuable alternative to EST in patients with bile duct stones,especially in patients who are not suitable for EST.

ObjectiveTo evaluate radio-frequency hemostasis in hepatectomy.MethodsFrom January 2009 to February 2011,the clinical data of 60 patients undergoing curative liver resection were divided into two groups using radio-frequency hemostasis (RFH) and clamp crushing method (CCM) respectively,RFH group (30 cases) and CCM group (30 cases).There was no difference between the 2 groups regarding the age,sex.hepatic function and tumor size.Data regarding the intra-operative and postoperative courses of the patients were analyzed.ResultsNo damage of hepatic vein occured in RFH group.Hepatic veins rupture occurred in 5 cases and massive bleeding occurred in 3 cases in CCM group.lntra-operative blood loss was significantly less in FRH group [ (219 ±62) ml] than in CCM group [ (416 ±96) ml ] (P ＜ 0.05 ).The postoperative drainage volume in RFH group was significantly less than that in CCM group on the third postoperative day.The serum ALT and T-BIL in RFH group was significantly lower than that in CCM group on postoperative day 1 and day 7 ( separately t =5.987,16.803,22.264,8.386,8.255,all P ＜0.05 ).Postoperative hepatic function in RFH group was significantly better than that in CCM group.ConclusionsThe use of radio-frequency hemostasis in hepatectomy is less traumatic,of less bleeding,faster recovery than clamp crashing method.

The history,hardware,imaging principle and technical characteristics of dual-energy CT machine were described.The causes,clinical diagnosis and treatment of urinary calculi were analyzed.Dual-energy CT had its technical characteristics,clinical significance,advantages and practicality expounded in detail when used to determine the components of urinary calculi.

We obtained recombinant ferritin from Dermatophagoides f arinae ,and analyzed the characterization of the pro‐tein .A pair of primers was designed according to the known sequence of ferritin gene .The live mites identified and cultured lo‐cally were picked and the total RNA was extracted .The ferritin gene fragment was amplified by RT‐PCR ,and cloned into pET32a vector ,and then transferred into E .coli Top10 .The target gene obtained from the recombinant plasmid by digestion with Bam HⅠand Hind Ⅲ was connected to the prokaryotic expression vector pET‐32a .The expressed recombinant plasmid containing ferritin gene was constructed by cloning target gene into pET‐32a and transferred into E .coli Bl21 (DE3) .The ex‐pressed recombinant protein was analyzed by SDS‐PAGE ,and was purified by immobilized metal ion affinity chromatography (IMAC) .The ferritin expressed by dust mite was analyzed by the method of bioinformatics .The recombinant plasmid pET32a‐ferritin was constructed .SDS‐PAGE showed a correct molecular weight of the recombinant ferritin protein .After purification by affinity chromatography ,the protein showed only one strip on SDS‐PAGE gel .SDS‐PAGE showed a band at 20 kD .Dust mite ferritin contains 8 serine kinase ,7 threonine kinase ,7 tyrosine kinase ,and 0 histidine kinase phosphorylation sites .Hy‐drophilic region is larger than the hydrophobic region and it is an unstable protein .In conclusion ,the ferritin gene has been cloned and expressed .The purified ferritin has high purity . The study provides a basis for further study of composition and physicochemical properties of house dust mite allergen .

Objective:To evaluate and summarize the relevant evidence of comprehensive detumescence treatment of lower limb lymphedema in patients with gynecological malignant tumors, and to provide evidence-based basis for clinical intervention of comprehensive detumescence treatment of lymphedema.Methods:This study was an evidence - based nursing research. Databases such as BMJ Best Practice, UpToDate, PubMed, CNKI, Wanfang and other domestic and foreign databases, as well as websites such as the Australian Lymphology Society, the International Lymphedema, and the European Clinical Oncology Association were searched for relevant evidence and evaluation of comprehensive treatment of gynecological malignant tumor-related lower limb lymphedema. The search time was from the establishment of the database to April 1, 2022.Results:A total of 18 articles were included, including 2 guidelines, 5 systematic reviews, 4 expert consensus, 2 evidence summaries, 4 randomized controlled trials and 1 best practice. Twenty-eight evidence were summarized from 7 aspects : treatment cycle and edema stage, free-hand lymphatic drainage, graduated compression stockings, skin care, elastic socks, functional exercise and health education.Conclusions:The evidence summarized in this study can provide reference for clinical medical staff to formulate comprehensive treatment plans for lower limb lymphedema. Evidence-based practice should consider the individual status of patients and clinical scenarios, and provide personalized comprehensive treatment plans for patients with lower limb lymphedema of gynecological malignant tumors as soon as possible to improve the quality of life of patients.

Objective:To retrieve, obtain and summarize the best evidence for the prevention of recurrence in patients with diabetic foot, and to provide reference for clinical practice.Methods:According to the "6S" model of evidence-based resources, JBI, UpToDate, BMJ Best Practice, Cochrane Library, International Working Group on the Diabetic Foot, International Diabetes Federation, National Istitute for Health and Clinical Excellence, PubMed, EmBase, China National Knowledge Internet, Wanfang and China Biology Medicine disc were searched by computer for the prevention of recurrence of diabetic foot patients. The retrieval time limit was from the establishment of the database to April 2022. Two researchers independently evaluated the included literature and extracted the literature that met the quality standards.Results:Totally 12 articles were included at last, including 5 guidelines, 3 expert consensus and 4 Meta-analysis. From the six dimensions of the necessity and risk factors of recurrence prevention in diabetic foot patients, decompression brace prevention, surgery and wound management prevention, nutritional therapy prevention, health education and lifestyle prevention, monitoring and analysis, 18 pieces of best evidence were summarized.Conclusions:The best evidence for the prevention of recurrence of diabetic foot patients was summarized to provide evidence-based basis for management decision makers and decision implementers to prevent recurrence of diabetic foot. In the process of practice, medical workers should also fully evaluate the promoting factors and hindering factors in order to ensure that evidence can be better applied to clinical practice and serve patients.