This article discussed on the continuing medical education for general practitioners within a nonprofit multihospital system.Literature review,statistical analysis and survey results were employed.Training situation for general practitioner at home and aboard was reviewed.Statistics on population,disease spectrum,present situation of community doctors in Luwan branch of Ruijin hospital was also analyzed.Results showed that current education system for general practitioners cannot catch up the increasing demand yet.Meanwhile patients expected well qualified and skillful physicians in the community healthcare centers.Reinforcement of continuing medical education for general practitioners was the stepping stone of a nonprofit multihospital system.Improving skills and qualifications of physician played an essential role in the urban network of medical services.

Aim Toestablishanexcellentratasthmamodel from using OVA+pertussis sensitized, OVA sensitized and per-tussissensitizedrats.Methods Thethreemethodswereusedto sensitize rats;methacholine bronchial provocation tests were per-formed to determine airway hyperresponsiveness;bronchoalveolar lavage fluid ( BALF) was prepared after the animals were chal-lenged by nebulized antigen. The differential white cell count in BALF was performed, and lung tissue was detected by morpho-logicalanalysis.Results AllofOVA+pertussissensitization,OVA sensitization and pertussis sensitization could deteriorate lung function, increase inflammatory cells and cause pathological change, and OVA + pertussis sensitized rat model had better effect than OVA sensitized and pertussis sensitized rat models. Conclusion OVA+pertussissensitizationandOVAaerosolisa successful rat asthma model.

Objective: To investigate the correlation between body composition and eating habits among medical students, and to provide evidence for health promotion. Methods: In December 2021, stratified cluster random sampling method was used to conduct a questionnaire survey and body composition assessment among 445 students in grade one to grade four in Jining Medical University. Results: There were 152 girls (53.3%) and 45 boys (28.1%) with low skeletal muscle mass. Totally 167 students ( 37.5% ) had lower muscle mass, including 115 females (40.4%) and 49 males (30.6%). High body fat percentage was found in 259 (58.2%) students, including 179 females (62.8%) and 80 males (50.0%). There were 192 students (43.1%) with abnormal waist to hip ratio, with 139 females (48.8%) and 53 males (33.1%). In addition, emotional eating score of female students was significantly higher than that of male students(6.85±2.24, 6.11±2.69, t =2.96, P <0.05). Cognitive restricted eating was positively correlated with skeletal muscle mass and musde mass( r=0.13, 0.13, P <0.05). Emotional eating was positively correlated with body fat percentage, body fat and waist hip ratio( r =0.20, 0.20, 0.16, P <0.05). Unrestricted eating was positively correlated with body fat percentage, body fat and waist hip ratio( r =0.15, 0.18, 0.15, P <0.05). Multiple linear regression analysis showed that gender, family residence, physical activity and cognitive eating were associated with skeletal muscle mass and muscle mass of medical students( P <0.05). Conclusion With low skeletal muscle mass, low muscle mass, body fat percentage and waist and hip high ratio, reasonable eating habits combined with resistance exercise should be adopted to improve their physical health.

In recent years, organ transplantation has developed rapidly in China, whereas the proportion of supply and demand of organs for donation is severely unbalanced. To resolve the shortage of donor livers, repairing extended criteria donor liver and improving the quality of donor liver are critical research directions. Mesenchymal stem cell (MSC) is a category of stem cells with self-renewal and differentiation potential, which possess the functions of immunomodulation and tissue repair. The derivatives of MSC have the advantages of low immunogenicity and high biocompatibility, which have been widely applied in the treatment of multiple diseases. In this article, research progress on the role of MSC, exosomes and extracellular vesicles in alleviating liver steatosis, repairing ischemia-reperfusion injury and promoting the regeneration of small-for-size liver allograft was reviewed, and the feasibility and safety of MSC and the derivatives in repairing donor liver were summarized, aiming provide novel ideas for repairing marginal donor liver and enhancing the quality of liver allograft.

Although it is widely believed that abnormal energy metabolism exists in cancer cells and affects the biological behavior of cancers, the exact mechanism of energy metabolic reprogramming and specific mechanism of its effect on proliferation, invasion and metastasis of cancer cells have not been clarified. In recent years, studies have shown that long non-coding RNA (lncRNA) can affect energy metabolism, development and progression of cancer cells through binding to specific nucleic acids and proteins at the transcriptional and post-transcriptional stages, and specifically through transcriptional interference, epigenetic regulation of genes, changes in protein activity, competitive binding to microRNA (miRNA) and other related mechanisms. The further study on the mechanism of lncRNA regulating energy metabolism reprogramming of cancer cells is expected to find new markers and targets for diagnosis and treatment of cancer. This paper reviews the current research progress of the mechanism of lncRNA regulating metabolic reprogramming of glucose, fatty acid, protein and nucleotide in cancer, and provides a new idea of lncRNA's regulation of energy metabolism pathways for targeted anticancer therapy.

Objective:To investigate the attributes and influencing factors of care needs for maternal after perinatal loss, and to provide a reference for promoting maternal physical and mental health and improving the quality of care.Methods:From February to June of 2023, a cross-sectional study was used, 222 maternal after perinatal loss were selected by the convenience sampling method and completed a battery of questionnaires, including a general information questionnaire, the Distress Thermometer (DT), the Perceived Social Support Scale (PSSS), the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF) and Kano Model-based Questionnaire on Care Needs for Maternal after Perinatal Loss.Results:A total of 207 maternal after perinatal loss were included in the complete data, (31.12±4.55) years old, (68.64 ± 10.70) of PSSS, (16.10 ± 3.43) of ATSPPH-SF. The care needs for maternal after perinatal loss included 4 must-be quality, 8 one-dimensional quality and 13 attractive quality. Multiple linear regression analysis showed that education level ( t=2.28), the PSSS score ( t=2.15) and the ATSPPH-SF score ( t=3.94) were the main influencing factors of care needs for maternal after perinatal loss (all P<0.05). Conclusions:Health care professionals should gradually improve the nursing service system according to the priority division of care needs attributes of maternal after perinatal loss, and develop personalized care according to different influencing factors.

Objective:To construct a prognostic risk model for hepatocellular carcinoma(HCC),and elucidate the immune characteristics and immunotherapy response in patients with different prognostic stratification.Methods:RNA-seq data of TCGA-LIHC and ICGC(LIRI-JP),and gene microarray data of GSE14520 and GSE54236 in hepatocellular carcinoma,as well as clinical informa-tion of the corresponding samples were downloaded.First,screening of differentially expressed genes in tumor and non-tumor tissue samples from TCGA-LIHC,GSE14520 and GSE54236.For the common differential genes,univariate cox regression analysis was per-formed using TCGA-LIHC data to obtain HCC prognosis-related genes.Five genes were randomly selected as a panel,and the optimal prognostic marker panel was screened among 10 000 panels using Lasso-cox regression analysis combined with a five-fold cross-valida-tion method.TCGA-LIHC data were used as training set to construct the prognostic risk model,and ICGC data were used as validation set to test the model performance.Tumor immune dysfunction and exclusion(TIDE)algorithm and Immunophenotypic score(IPS)were used to predict immunotherapy efficacy in patients in different prognostic groups.Results:Overall survival was significantly lon-ger in low-risk group of HCC patients compared with high-risk group.Tumor proliferation rate,Treg and Th2 cell chemotaxis,stromal remodeling,and pro-tumor cytokines were significantly increased in high-risk patients,while NK cells,Th1 cells,effector cells and endothelial cells were significantly increased in low-risk patients.Immune checkpoint analysis showed that PDCD1,CTLA4 and CD276 were up-regulated in high-risk patients,while PDCD1LG2 was upregulated in low-risk patients.TIDE score and IPS results predicted that patients in low-risk group had better efficacy to immunotherapy.Conclusion:This study constructed a prognostic risk model containing three genes,DNASE1L3,RDH16 and DLGAP5,which can effectively predict the prognosis of HCC patients and assist in clinical decision making for individualized immunotherapy.

Objective To Analyze tislelizumab(TIS)combined with sorafenib(SRF)as the first-line treatment regimen for unresectable hepatocellular carcinoma(HCC).Methods Clinical data of patients with unresectable HCC treated in Jinhua Hospital and Shulan(Hangzhou)Hospital affiliated to Zhejiang University School of Medicine from January 2020 to January 2023 were retrospectively analyzed.They were divided into a combined group(TIS combined with SRF)and a control group(SRF)according to the diagnosis and treatment protocol.The main observational indexes of the study were objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS)and overall survival(OS).In addition,attention was paid to the occurrence of adverse reactions during the treatment to assess safety.Results A total of 61 patients were included in the study,with 31 in the combined group and 30 in the control group.The difference in ORR between the two groups was not statistically significant(P＞0.05),while DCR was significantly higher in the combined group than in the control group(P＜0.05).Survival analysis showed that the median PFS and median OS of the combined group were significantly higher than those of the control group(P＜0.05).In terms of safety,there was no statistically significant difference in the incidence of hand-foot syndrome,transaminase elevation,loss of appetite,proteinuria,rash,diarrhea,thrombocytopenia,and malaise between the two groups(P＞0.05);whereas 8 cases of hypothyroidism(25.81％)and 4 cases of capillary hyperplasia(12.90％)occurred in the combined group,and no hypothyroidism or capillary hyperplasia occurred in the control group.In addition,no patients died or discontinued treatment due to adverse effects.Conclusion Compared to single drug SRF,the combination of TIS and SRF first-line treatment for unresectable HCC can improve DCR,prolong median PFS and OS,and the safety is controllable.

Objective:To investigate the therapeutic effect of reverse proximal segment dorsal flap of radial digital artery of the thumb in repairing thumb tip defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with thumb tip defects admitted to Renqiu People 's Hospital from February 2010 to October 2020. There were 37 males and 19 females，aged 17-66 years［（37.8±12.2）years］. The injury on the right side was observed in 35 patients and on the left side in 21 patients. All of them were thumb tip defects with exposed distal phalanx. Dimension of skin defects was 2.9 cm×1.8 cm-3.3 cm×2.6 cm.The reverse proximal segment dorsal flap of thumb radial digital artery was used，with the dorsal digital nerve sutured with the proper digital nerve. The donor site was repaired with free skin graft from the ulnar side of the affected forearm. The time of flap harvesting，operation time and healing of the flap were measured. At the last follow-up，the shape，texture，sensory recovery and complications of the flap were observed. One month after operation and at the latest follow-up，the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association and Vancouver Scar Scale（VSS）score were used to evaluate the recovery of sensory function of the flap and scar formation of the donor sites，respectively. Results:All patients were followed up for 6-26 months［（13.2±6.4）months］. The time of flap harvesting ranged from 20 to 35 minutes［（26.0±5.3）minutes］. The operation time was 1-2 hours［（1.3±0.3）hours］. Blisters appeared at the distal end of the flap in 2 patients after operation，but they were not treated. After 7 days，the blisters subsided and the flaps survived. The other flaps survived successfully. The donor sites healed by first intention. At the last follow-up，the flaps showed relatively cosmetic appearance，similarities in texture，elasticity and color to the surrounding area and good sensory recovery，without scar contracture and dystrophy of interphalangeal joint. According to the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association，56 patients exceeded S3 grade compared to none at postoperative 1 month（ P<0.01），and the VSS score was 3-7 points［（5.0±1.4）points］compared to 6-12 points［（8.8±1.5）points］at postoperative 1 month（ P<0.01）. The donor site left a linear scar，which had no significant effect on its shape and function. Conclusion:The reverse proximal segment dorsal flap of the radial digital artery of the thumb can be used to repair thumb tip defects，for it has advantages of easy operation，a high survival rate as well as good appearance and sensory function recovery，with less damage to the donor area.

Objective:To report our clinical efficacy of pedicled transplantation of proximal thumb dorsal transverse flap to repair tissue defects at thumb pulp and fingertip.Methods:From February 2010 to November 2020, 97 patients with tissue defects at thumb pulp and fingertip were treated by pedicled transplantation of proximal thumb dorsal transverse flap at Department of Orthopedics, People's Hospital of Renqiu. They were 55 men and 42 women, aged from 17 to 66 years (average, 41.3 years). Altogether 55 right and 42 left sides were affected. The size of soft tissue defects ranged from 2.8 cm×1.8 cm to 3.9 cm×2.8 cm. Postoperatively, flap survival, shape, color and sensory recovery at the recipient area were observed; wound healing, function and complications at the donor site were also observed.Results:All the 97 flaps survived and all the wounds healed at the first stage. Blisters appeared at the distal end of the flap in only 2 cases but subsided 7 days after operation with no special treatment and the flaps survived smoothly. All the skin grafts at the donor site survived uneventfully. The 97 patients were followed up for 6 to 26 months (average, 10.7 months). Their flaps were not swollen, finger abdomen was full, finger appearance satisfactory, and finger feeling recovered well. The two-point discrimination at the last follow-up ranged from 4 to 11 mm (average, 7.6 mm). By the trial criteria for assessment of upper limb function suggested by Hand Surgery Society of Chinese Medical Association, sensory function of the affected finger was assessed as S 4 in 21 cases and as S 3+ in 76 cases at the last follow-up. No scar contracture was observed at the donor site and no movement restriction at the interphalangeal joint. Conclusion:Proximal thumb dorsal transverse flap is a reliable choice for reconstruction of complex tissue defects at thumb pulp and fingertip because of the advantages of easy harvest, constant vascular anatomy, full appearance and good sensory function at the recipient site, and limited damage to the donor site.