简介：TheNewEnglishcurriculumcriteriasuggestteachingEnglishgrammarbasedonthestudents’cognitivecharacteristicsandemotionalneeds,helpingthemdiscovertherulesandencouragingthemtomasterthegrammarbyusingit.Butduetothelimitedtimeinalesson,manyEnglishteachersadoptasimpleapproachtoteachgrammar,inwhichstudentsarerequiredtomemorizetherulesfirstandthenpracticealot.Thisapproachiseffec-

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简介：基于盒子的推理是以前的答案在被存储为未来使用的一种AI技术。人们习惯于根据在他们的记忆被存储并且以前被他们使用了的那些线路指导自己。只基于人到熟悉的线路的偏爱，它通过认知活动的学习被获得。我们建议基于推理到路径计划的盒子使用聪明的方法。一个盒子底存储所有答案到所有最短的路径是不可能的；因此，他们的部分应该被存储。不管多么，线路哪个并且哪个应该被存储不应该是？我们怎么并且怎么改编已经被存储了的盒子我们基于他们获得最短的线路？所有这些问题需要被由于基于盒子的推理技术，集成网络的知识解释。这篇论文建议在另一个点的基于盒子的推理。根据问题空间的总分析发现一些不能替代的连接的这个工具，它被称为must_be_passed在来源和目的地之间连接。仅仅从格子的那些最好的出口/入口节点计算最短的路径盒子到不能替代的连接，然后增加他们进存储为未来使用的盒子底。这个方法基于基于盒子的推理技术并且完全考虑问题空间的性质。除了在线路网络的自然格子的知识的使用，这个方法是比计算效率上的存在算法更有效的。

简介：AbstractIntroduction:Basal cell carcinoma (BCC) is the most common human malignancy commonly in white people, but in less than 1% of cases it may appear on unexposed areas, like the perineal and anal regions. Vulvar BCC is often diagnosed late because it grows slowly and tends to be asymptomatic, with no specific physical findings. Here, we present a rare Latin patient with a 10-year history of vulvar BCC with dermatoscopic and histopathologic findings.Case report:A 65-year-old Latin woman presented with a nodule on her left labium majus, which she first noted 10 years ago, and that had grown slowly but constantly. She also reported a 20-year history of pruritus and occasional pain. Physical examination showed a 3.5 cm × 3.0 cm erythematous lesion with a central rough without inguinal lymphadenopathy. Contact dermatoscopy (Dermalite DL3 Gen.) showed one blurred cluster of arborising vessels in a pinkish background with white homogeneous areas and lines radial converging. An incisional biopsy was realized, and histopathology diagnosed BCC.Discussion:Vulvar BCC is a rare malignancy that affects mainly Caucasian women over 70 years of age. The most common etiology for BCC is ultraviolet radiation, but as the vulva is unexposed its cause is unclear. Mutations in tumor suppressor and regulatory genes such as p53 are present in 50% of cases. Gorlin syndrome, chronic radiation, chronic arsenic exposure, xeroderma pigmentosum, and immunosuppression have been considered as risk factors.Conclusion:Vulvar BCC characteristics are the same as other cutaneous forms, featuring blue ovoid nests and arborizing telangiectasia, confused with inflammatory diseases, such as eczema, psoriasis, and chronic infection (especially if it is accompanied by pruritus), this makes diagnosis complex, with a delay of 5 to 6 years on average, with an average size of 2.1 cm. Diagnosis is enhanced with dermatoscopy, as the preferred treatment for most BCC cases is wide surgical excision.

简介：AbstractIntroduction:Primary systemic amyloidosis is characterized by clonal plasma cell disorder, and its signs and symptoms are various and complex, damage to the skin and mucous membrane is often more likely to attract attention.Here we reported a case of a 61-year-old male patient who presented with topical mucocutaneous lesion, as well unusual skin vegetations.Case presentation:A 61-year-old man was hospitalized due to repeated burning sensation on his back, multiple ecchymosis, and skin vegetations. Through a series of examinations (mainly including skin histopathology, bone marrow cytology, bone marrow flow cytometry, immunofixation electrophoresis), Primary systemic amyloidosis was diagnosed, but multiple myeloma could not be diagnosed. Subsequently, he received chemotherapy. In the half-year follow-up, there was no significant change in his symptoms and signs.Discussion:In this case, in addition to the typical skin damage of primary amyloidosis, the multiple skin vegetations in the buttocks, abdomen, and arms are particularly noteworthy. According to the histopathology and Immunohistochemistry of the skin vegetation, we infer that the formation mechanism of these skin vegetation is lymphatic obstruction caused by amyloid, which leads to lymphatic dilatation, lymph leakage, and dermal edema.Conclusion:Primary systemic amyloidosis is a rare disease, which is often difficult to diagnose. We should be alert to those atypical skin features so as not to delay diagnosis.

简介：AbstractIntroduction:Basal cell carcinoma (BCC) is the most common skin cancer which mainly affects the population over 50 years of age. In addition to surgical treatment, nonsurgical treatment is also an attractive option for some patients.We herein report a case of an 82-year-old man with BCC successfully treated with acitretin.Case presentation:An 82-year-old man presented with BCC on his left nose wing more than 2 years ago. Due to his unwillingness to accept treatment that may lead to pain, discomfort, or trauma, the patient was prescribed oral acitretin 25 mg twice daily [0.8 mg/(kg·d)] and was instructed to apply 2% fusidic acid cream topically once daily for trauma protection. The lesion progressively shrank in size after 4 weeks of treatment, and was almost completely resolved after 28 weeks of follow-up. The patient reported mild adverse effects, such as mild skin fragility and cheilitis, and apparent scaling skin, which caused minor discomfort but did not affect the continuation of treatment.Discussion:The pathogenesis of BCC is still unclear, but it has been demonstrated to be linked to overactive hedgehog signaling and its crosstalk with other pathways such as phosphoinositide 3-kinase and mammalian target of rapamycin. Acitretin could obviously inhibit cell growth and proliferation and down-regulate AMP-dependent protein kinases that plays critical role in the blocking of malignant progression of several tumors including BCC.Conclusion:We provide an effective alternative for the patients with BCC who are unwilling to receive surgical therapy.

简介：AbstractIntroduction:Malignant syphilis (MS) is a rare and severe variant of secondary syphilis that is frequently associated with HIV infection. The clinical impact of HIV and syphilis co-infection is bidirectional, and the presence of MS is associated with acute HIV infection. Clinically, MS is characterized by nodular and ulcerative lesions affecting the trunk and extremities, which are covered with thick crusts. The treatment of choice for MS remains benzathine penicillin G. Herein, we report a case in which MS was the initial presentation of HIV infection.Case presentation:A 35-year-old male patient came with the chief complaint of extensive erythematous nodular rash for the past one month, with notable ulceration on some lesions with annular configuration along with fever and malaise. Based on the abovementioned clinical, laboratory, and histopathologic findings, the patient was diagnosed with MS and HIV. The diagnosis was established based on histopathological examination and syphilis serological testing.Discussion:Cutaneous disorders are a frequent presenting feature of HIV infection. The clinical manifestations of syphilis in immunosuppressed patients are often severe and/or atypical. The patient was then treated with weekly intramuscular administration of 2.4 million units of benzathine penicillin G for 3 weeks and achieved rapid and significant clinical improvement, with no Jarisch-Herxheimer reaction.Conclusion:Co-infection with syphilis and HIV alters the course of both diseases, and most HIV-infected patients with syphilis have typical disease manifestations associated with decreased CD4+ T-cell counts.

简介：AbstractWe describe the case of a nine-month-old patient with a nasopharyngeal choristoma. The case presented includes the retrospective review of the historical, radiological, surgical and histological assessment of this pathology as well as a literature review of this entity. This case was presented in an infant with difficulty feeding, nasal obstruction and failure to thrive, evaluated with flexible nasal endoscopy, CT and MRI. The lesion was then surgically removed without complications. Nasopharyngeal choristoma is a rare congenital non-malignant mass, which may present within a range of symptoms and severity according to its size, growth and location.

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简介：Accordingtodifferencesinvegetationtypesandtheircoverage,combiningthelatestresearch,usingtheoryandmethodonthevalueofvegetationecosystemservices,thispapernotonlycalculatedgoodsproducedbydifferenttypesofvegetationbutalsoestimatedthevalueofvariousvegetationecosystemservicesandsetupdatabase,GISandeco-accountofvegetationecosystem.Theresultwasasfollows:thevalueofvegetation''sprimaryproductivity,soilandfertilityconservation,waterconservation.CO2fixationandO2releasewas199.6billionyuan/a22.64billionyuan/a22.6billionyuan/a,352.24billionyuan/aand374.19billionyuan/a,respectively.Thetotalvalueofecosystemserviceswas968.33billionyuan/a.Thetemperatedeciduousbroad-leavedforesthadthehighestcontributionrate,accountingfor16.42%,Theresultofvaluecanreflectregionalrealitymoreexactly.

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简介：Facialparalysiscanbeclassifiedascentralorperipheralfacialparalysisbasedonthelocationoftheunderlyinglesion,bothofwhichdemonstratefacialmotordysfunction.Inthecurrentlyreport,apatientadmittedtothedepartmentofotology,FirstPeople’sHospitalofQinhuangdao,presentedwithfacialasymmetryastheinitialsymptomofacerebralinfarctionandwasfirstmisdiagnosedasperipheralfacialparalysis.Thecaseisreportedasfollows.