Objective To investigate the effects of Interleukin⁃17A on rat bronchial fibroblasts prolifera⁃ tion，autophagy and collagen degradation after autophagy. Methods Enzyme combined digestion method and tissue block adherence method was used to culture and identify BF. CCK⁃8 method was used to detect cell prolifera⁃ tion. Experimental groups：control group，rapamycin group，IL ⁃17A + rapamycin group，IL⁃17A group. The forma⁃ tion of autophagic vesicles was observed by transmission electron microscopy. The expression of autophagy marker proteins LC3 and p62 in BF were detected by Western blot. ELISA was used to detect matrix metalloproteinase⁃ 1 and matrix metalloproteinase inhibitor expression. Results The proliferation ability of BF cells was best when the IL⁃17A concentration was 20 ng/ml. The number of autophagic vesicles in the IL⁃17A group was significantly reduced， the ratio of LC3⁃II/LC3⁃I and the expression level of MMP⁃1 were significantly down⁃regulated，and the expression levels of p62 and TIMP⁃1 were significantly up⁃regulated（P < 0.05）. Rapamycin partially reversed the effects of IL⁃17A. Conclusion IL⁃17A can promote the proliferation of BF cells. IL⁃17A also can inhibit the degradation of collagen by inhibiting autophagy，and promote the occurrence and development of airway remodeling

Objective To investigate the function of RGFP966，a highly selective histone deacetylase 3 （HDAC3）inhibitor，in radiation ⁃induced neuroinflammation and neuronal injury. Methods Microglia cell line BV2 or hippocampal neuron cell line HT22 were radiated by a medical linear accelerator. The expression of microg⁃ lia activation indicator IBA⁃1 was observed by cellular immunofluorescence；the expression and secretion level of inflammatory cytokines in radiated microglia were detected by quantitative real ⁃ time reverse transcription polymerase chain reaction（qRT⁃PCR）or enzyme⁃linked immunosorbent assay（Elisa）；the activity of BV2 cells and HT22 cells were detected by cell counting kit⁃8 assay；neuronal apoptosis was identified using TUNEL staining. Results RGFP966 dramatically reduced the secretion of inflammatory cytokines brought about by ionizing radiation（IR）in BV2 cells，including tumor necrosis factor α（TNF⁃α），interleukin 6（IL⁃6），and interleukin 1β（IL⁃1β）. Pretreated with RGFP966 significantly reduced the number of apoptosis in radiated HT22 cells. Radia⁃ tion⁃induced impairment of the viability of BV2 cells and HT22 cells was also alleviated by RGFP966. In the mouse model of RBI，RGFP966 significantly reduced the number of neuronal apoptosis. Conclusion The selective HDAC3 inhibitor RGFP966 effectively alleviated microglial neuroinflammation and neuronal apoptosis caused by IR. Therefore，RGFP966 has the potential to treat radiation⁃induced brain injury.

Objective To investigate the expression and impact of the supraoptic hyperpolarization⁃activated cyclic nucleotide gated 2（HCN2）on chronic visceral hypersensitive（CVH）rats. Methods Neonatal male Sprague⁃ Dawley rats were randomly divided into sham operated（Sham）group，colorectal distention（CRD）group，Vehicle group，ZD7288 1 ng group，ZD7288 10 ng group and ZD7288 100 ng group. Neonatal CRD was enrolled to establish the rat models of CVH. ZD7288，the inhibitor HCN2，was stereotactically injected in supraoptic nuclei（SON）at the 8th postnatal week，and the effects of ZD7288 on visceral sensation were assessed via procedures of abdominal withdrawal reflex（AWR）score，visceral pain threshold and the electromyograph（EMG）of external oblique muscle discharge. All rats were sacrificed by 4% ⁃ paraformaldehyde perfusion or decapitation，and the brains and colons （between left curvature of colon and the pelvis）were collected for further detections. The hematoxylin⁃eosin（HE） staining of colon tissue was performed to avoid subjects with organic conditions. The supraoptic expression of HCN2 and c⁃Fos were detected by immunohistochemistry，immunofluorescence and Western blot. Results Morphological detection showed that there were no obvious morphological changes in rats with the use of colonic HE staining. Compared with Sham group，the expression of supraoptic HCN2 was significantly upregulated in CRD group by immunohistochemistry and Western Blot（P < 0.05）；the c⁃Fos positive cells in SON were significantly increased in CRD group by immunohistochemistry（P < 0.05）；the number of HCN2 and c⁃Fos co⁃labeled cells in SON were significantly increased by immunofluorescent（P < 0.05）. Behavioral and electrophysiological tests showed that the stereotactic injection of ZD7288 in SON dose⁃dependently increased the AWR scores and AUC，and decreased the visceral pain threshold compared with the Vehicle group（P < 0.05）. Conclusions SON inhibits the chronic visceral hypersensitivity via the upregulation of HCN2 in rats.

Objective The expression level of KLF14 in the neonatal rat cardiomyocytes（NRVM）of rats was detected under physiological and pathological hypertrophic conditions. To construct rat Kruppel⁃like factor 14 （KLF14）adenovirus vector and infect NRVM，and then to investigate its effect on cardiomyocyte hypertrophy. Methods pHBAd⁃MCMV⁃RFP⁃KLF14 recombinant plasmid was synthesized according to NCBI database sequence. The plasmid sequence was verified by PCR and sequencing，and then amplified using bacillus coli. Adenoviral vector was packaged in HEK 293 cell. NRVM were transfected with KLF14 adenovirus or negative control red fluorescent protein（RFP）adenovirus，then stimulated with isoprenaline（ISO）to induce myocytes hypertrophy. Real ⁃time PCR（RT ⁃PCR）was used to measure the expression of BNP and KLF14 expression. Results The KLF14 adenovirus plasmid was successfully constructed by PCR and sequencing. RT⁃PCR showed that the KLF14 expression in NRVM was significantly increased after KLF14 adenovirus transfection，and overexpression of KLF14 aggravated ISO⁃induced BNP expression. Conclusions KLF14 is expressed at low abundance in cardiomyocytes under physiological conditions，while upregulated in pathological hypertrophy. Over expression of KLF14 promotes ISO⁃induced cardiomyocytes hypertrophy.

Objective To explore the role of coenzyme Q10 in protection of traumatic brain injury（TBI） and its potential mechanism. Methods Adult male C57BL/6 mice were randomly selected and a controlled cortical impact（CCI）was used to establish a mouse model. The mice were randomly divided into Sham group，TBI group， CoQ10 low⁃dosage group（LDG）and high⁃dosage group（HDG）. Expression levels of inflammatory cytokines TNF⁃α， IL⁃6，and IL⁃1β were detected by real⁃time PCR. Apoptosis⁃related protein expression of Bcl⁃2，Bax and c⁃Caspase⁃3 were detected by Western blot. And the mRNA and protein levels of GAP43 were measured by both real⁃time PCR and Western blot. The injury degree and recovery of neural function in each group was assessed by using modified neurological severity scores（mNSS）and Rotarod test. Results As compared with TBI group，expression levels of TNF⁃α，IL⁃6，and IL⁃1β were significantly decreased in LDG and HDG（P < 0.05）；Bcl⁃2 expression was signifi⁃ cantly increased，while levels of Bax and c⁃Caspase3 markedly decreased and Bcl⁃2/Bax ratio declined（P < 0.05） in LDG and HDG. mRNA and protein levels of GAP43 were elevated after treatment with CoQ（P < 0.05）. As com⁃ pared with TBI group，the mNSS scores significantly decrease in LDG and HDG on days 7 and 14 after TBI（P < 0.05）； whereas，the Rotarod test time was prolonged（P < 0.05）. Conclusions Coenzyme Q10 may play a protective role for the mice with traumatic brain injury through decreasing cell apoptosis and levels of inflammatory factors.

Objective To investigate the effect of microRNA⁃155⁃5p（miR⁃155⁃5p）on the pathogenesis of preeclampsia through targeted inhibition of silent information regulator 1（Sirt1）in patients with preeclampsia. Methods From January 2018 to December 2018，placental samples（n = 25）from patients with preeclampsia and normal pregnant women were selected from the obstetrics department of our hospital. RT⁃qPCR was used to detect miR⁃155⁃5p and Sirt1 expression in the placenta. In addition，over⁃expression of miR⁃155⁃5p and knock⁃ down of Sirt1 was performed to determine its effect on HTR⁃8/SVeno cells migration and invasion. Results The expression of miR⁃155⁃5p in the placenta of the preeclampsia group was higher than that of the control group（P < 0.01），and the expression levels of Sirt1 mRNA and protein were lower in the patients with preeclampsia than in the control group（P < 0.01）. There was a negative correlation between miR⁃155⁃5p expression and Sirt1 protein expression in preeclampsia patients（r = -0.636 6，P = 0.016 9）. Over⁃expression of miR⁃155⁃5p and knockdown of Sirt1 in HTR ⁃8/SVeno cells，respectively，inhibited invasion and migration of trophoblast cells（P < 0.01）. Conclusion miR⁃155⁃5p may regulate the migration and invasion of trophoblast cells by inhibiting Sirt1 expres⁃ sion，thus affecting the occurrence of preeclampsia.

Objective To study the prognostic value of serum markers and clinical features in chronic obstructive pulmonary disease（COPD）patients in acute exacerbation stage. Methods To compare the clinical data of COPD patients in acute exacerbation stage with different prognosis，and analyze the value of matrix metallopro⁃ teinase⁃12（MMP⁃12），fibrinogen（FIB）and Clara cell secretory protein⁃16（CC⁃16）in predicting the poor prog⁃ nosis by ROC analysis. Results The proportion of age ≥ 60 years，pulmonary function grade Ⅲ⁃Ⅳ，smoking， coronary heart disease，diabetes mellitus，gastrointestinal bleeding and the levels of MMP⁃12，FIB and CC⁃16 in patients with poor prognosis was significantly higher than that in patients with good prognosis（P < 0.05）. The area of lower curve for predicting poor prognosis of patients with different serum markers were 0.719，0.824 and 0.683 respectively. Logistic regression analysis confirmed that MMP ⁃ 12 ≥ 20.930 pg/mL，FIB ≥ 3.465 g/L，CC ⁃16 ≥ 0.405 pg/mL，age ≥ 60 years old，pulmonary function grade Ⅲ⁃Ⅳ，smoking and complications were risk factors for poor prognosis. Conclusion Age，pulmonary function classification，complications and serum levels of MMP⁃12，FIB and CC⁃16 are important predictors of prognosis in patients with acute exacerbation of COPD.

Objective To explore the safety and perioperative management of percutaneous nephrolithotomy in the treatment of complex renal calculi with HIV infection. Methods From January 2010 to March 2020，68 patients with complex nephrolithiasis and HIV infection underwent percutaneous nephrolithotomy，and their clinical data were analyzed retrospectively. Results 62 patients received primary lithotripsy，with a clearance rate of 91.17%（62/68）；and one of whom received secondary lithotripsy. The surgical duration was（93.62 ± 10.64）min， the intraoperative bleeding volume was（145.23 ± 21.32）ml，the length of hospital stay was（5.2 ± 2.7）d，and the total complication rate was 17.65%（12/68）. There was no significant difference in CD4 + T lymphocyte count between pre⁃operation and one day after surgery in 68 patients（P > 0.05）. There were no significant differences in inflammatory indexes（leukocyte，platelet，and CRP）before and after the procedure（P > 0.05）. Conclusions Sufficient preoperative assessment for immune function，full preparation for perioperative period，and strict intraop⁃ erative protection measure and abidance by the rules of surgical procedures can provide safety guarantee for doctors and the patients with complex nephrolithiasis and HIV infection undergoing percutaneous nephrolithotomy. Better efficacy will be achieved.

Objective To explore the effect of Helicobacter pylori（Hp）infection on pregnancy outcome in patients with GDM. Methods A total of 179 pregnant women having regular prenatal examinations in our hospital were randomly selected，then divided into GDM group（66 cases）and control group（113 cases）according to the screening results of OGTT. All pregnant women were tested for Hp serum antibodies by fasting venous blood in the next morning. The Hp infection rate of the two groups of patients was compared. GDM group was sub⁃divided into Hp positive group and Hp negative group. The pregnancy outcome of the Hp positive group and Hp negative group was compared. Results （1）Hp infection rate in GDM group was 57.57%，which was apparently higher than that in the control group of 33.62%（P = 0.002）.（2）In patients with GDM，gestational week of delivery，fetal head and abdominal circumference in pregnancy end，newborn weight and body length of Hp positive group were notably shorter or lower than these in Hp negative group（P＜0.05）. Incidence of hyperemesis gravidarum（HG），pre⁃ eclampsia（PE），preterm birth and abortion in Hp positive group was significantly higher than that in Hp negative group（P＜0.05）. Conclusion Hp infection is prevalent in GDM patients，and GDM patients are more susceptible to Hp infection than normal pregnant women，which affects the pregnancy outcome of GDM patients.

Objective To investigate the risk factors of acute kidney injury in patients with septic shock caused by intra⁃abdominal infection. Methods 129 patients were enrolled and then 56 cases were divided into in AKI group and 73 cases in non⁃AKI group. The clinical data of the two groups were compared by univariate analy⁃ sis. Multiple logistic regression analysis was used to analyze the risk factors of Septic acute kidney injury in ICU patients. Using ROC curve to evaluate the ability of APTT and PCT in diagnosing AKI. Results Compared with the non⁃AKI group，PCT，APTT，serum albumin（Alb）et.al were statistically significant in AKI group（all P < 0.05）. APTT，PCT were independent risk factors for S⁃AKI（P < 0.01），and Alb was known as an independent protective factor for Septic acute kidney injury（P < 0.05）；The area under the curve（AUC）of APTT and PCT was greater than 0.8，the sensitivity and specificity of APTT and PCT were 75.0% ，85.2% ，73.4% ，74.1% respectively. Conclusion APTT and PCT level on admission to the ICU are significantly associated with acute kidney injury in patients with septic shock caused by intra⁃abdominal infection，and Alb level is known as an independent protec⁃ tive factor；APTT and PCT have certain diagnostic efficacy in evaluating Septic acute kidney injury.

Objective To explore an accurate，economical and efficient intervention method for thalasse⁃ mia. Methods Blood samples were collected from 20，525 newlyweds for routine blood examination. In the study group，the people with positive result of screening for mean corpuscle volume received hemoglobin electrophoresis. After electrophoresis，some people were selected for α thalassemia gene detection，and all couples at risk of thalas⁃ semia were diagnosed. In the control group，hemoglobin electrophoresis was performed and 6 screening parameters were set to guide the couples with positive screening to take blood again for α and β gene detection，and all couples at risk of thalassemia were diagnosed. The couples at risk in both groups abandoned the affected fetus through prenatal diagnosis. Results 392 couples at risk were detected in 10，235 couples in the study group，the detection rate was 3.83%，and the average cost for each couples was 4，246 yuan. 392 couples was followed up；25 thalassemia fetuses were terminated within one year，with an average cost of 77，090 yuan per case. 207 couples at risk were detected in 10，290 couples in the control group，the detection rate was 2.01%，and the average cost for each pairs was 11，279 yuan；4，433 couples were followed up；7 thalassemia fetuses were terminated within one year，with an average cost of 34，5436 yuan per case. There were significant differences between the two groups in the detection rate of risk couples，the cost of intervention for each thalassemia fetus，and the number of people to be followed up. Conclusions Use of manpower and testing cost weremarkedly less in the study group than in the control group，but the rate of successful intervention of thalassemia fetuses was significantly higher. Reasonable selection of screening methods and process can significantly improve the efficiency.

Objective To explore the clinical efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy（HIPEC）combined with apatinib and tigio chemotherapy for conversion therapy of patients with sim⁃ ple exfoliative cytology⁃positive gastric cancer（P0CY1）. Methods Prospective study included patients with P0CY1 gastric cancer confirmed by laparoscopic exploration. All patients were treated with HIPEC combined with apatinib and tigio. The specific drugs were as follows ：three cycles of HIPEC chemotherapy were given to the patients after laparoscopic exploration（paclitaxel 75 mg/m2 ），HIPEC began to take apatinib 500 mg daily for 21 days after 14 days of paclitaxel 75 mg/m2 ），HIPEC treatment，and oral tigio 80 mg/m2 . for 14 days after laparoscopic exploration. D），was stopped for 7 days，and every 3 weeks was a course of treatment. Laparoscopic exploration was performed again after 3 cycles of conversion therapy. the main end points were the negative conversion rate of intraperitoneal free cancer cells and the resection rate of R0，while the secondary end points were total survival time（OS），progression⁃free survival time（PFS），objective remission rate（ORR），disease control rate（DCR） and safety indicators. Results From 2018⁃02⁃05 to 2018⁃12⁃31，277 patients with advanced gastric cancer were enrolled in a total of 38 patients（13.72%）with P0CY1 after laparoscopic exploration，with a median age of 54 years. After 3 cycles of conversion therapy，the ORR was 52.63%（20/38），DCR was 89.47%（34/38）. All patients underwent secondary laparoscopic exploration，and the negative conversion rate of free cancer cells in the abdominal cavity was 42.11%. All patients were resected by R0 operation. The median follow⁃up time was 16.4 months，the median survival time（mOS）was 14.9 months，the 1⁃year OS was 65.79%，the median progression ⁃free survival time（mPFS）was 11.7 months，and the 1⁃year PFS was 50.00%. The main adverse reactions of chemotherapy were Ⅰ ~Ⅱ grade hematotoxicity and digestive tract reactions，and there was no death related to conversion therapy and surgical treatment in all cases. Conclusion HIPEC chemotherapy combined with apatinib and tigio can be used as a choice of conversion therapy for patients with P0CY1 gastric cancer ，which can significantly prolong the progression⁃free survival time，and the adverse reactions of chemotherapy can be controlled. It is a safe and effec⁃ tive conversion therapy，which is worthy of further study.

Objective To investigate the effect of expanding midpalatal suture in adults by personalized miniscrew⁃assisted rapid palatal expander on condylar position. Methods Ten adult patients with maxillary trans⁃ verse deficiency were expanded using a personalized miniscrew⁃assisted rapid palatal expander. The relative posi⁃ tion parameters of temple mandible joint were measured and contrasted before expansion（T0），after expansion （T1）and after retention for three months（T2）on CBCT. A statistical analysis was completed with the SPSS 21.0 software. Results The superior space（SS），posterior space（PS）and lateral space（LS）of temple mandible joint became wider and the medial space（MS）became smaller after rapid expanding of midpalatal suture，suggesting there were statistic differences（P < 0.05），which maintained the same changes after expansion for three months， whereas there were no statistical significances in radius of temple mandible joint and horizontal angle of condyle on both sides（P > 0.05）. Conclusions Expanding midpalatal suture in adults by personalized miniscrew ⁃assisted rapid palatal expander can cause bilateral condyle position an appropriate antero⁃inferior change，which is benefi⁃cial to the stability of correction results.

Objective To evaluate the factors influencing the quality of anesthesia recovery after robot assisted laparoscopic radical prostatectomy. Methods Sixty patients having undergone radical prostatectomy were divided into two groups：L Group（operation time ≤ 2 h）and S group（operation time > 2 h）. The degree of anes⁃ thesia in both groups was assessed after extubation in the postanesthesia care unit（PACU）. The time of awake extu⁃ bation，time of discharge out of PACU，scores by visual analogue scale（VAS）and frequency of nausea and vomit⁃ ing were recorded and analyzed to look into the correlations of the influencing factors of anesthesia recovery quality with the operation duration，age，body mass index（BMI）. Results The awake extubation time ofthe S groupwas shorter than that of the L group（P < 0.05），and the time of discharge out of PACU in the S group was shorter than that of the L group（P < 0.01）. The awake extubation time was significantly correlated with the operation duration， time of discharge out of PACU and age（P < 0.01），but insignificantly with VAS and BMI（P > 0.05）. Conclusion The robot assisted minimally invasive surgery is optional for patients with prostate cancer upon the characteristics of patients and the experience of surgeons. Before operation，it is suggested to predict those influencing factors such as operation time and age and even make precautious measures for those patients with high risks so as to promote their rehabilitation and reduce the incidences of complications.

Objective To explore the effects of hypothermia therapy combined with oxiracetam on the expression of MBP and GFAP in patients with severe traumatic brain injury. Methods A total of 106 cases of severe traumatic brain injury patients treated in our hospital from May 2017 to June 2019 were selected and divided into control group and observation group with 53 cases in each group. The patients in the control group were given oxirace⁃ tam injection，and those in the observation group were treated with hypothermia therapy in addition to oxiracetam injection. Intracranial pressure，clinical efficacy，serum MBP and GFAP and adverse reactions were compared and analyzed. Results After the treatment，intracranial pressure decreased significantly in both groups，and that in the observation group was higher（P < 0.05）. Coma score was significantly improved；neurological function score was significantly decreased in the two groups，and the degree of change in the observation group was higher than that in the control group（P < 0.05）. The levels of serum MBP and GFAP in the two groups were significantly decreased， especially in the observation group（P < 0.05）. Six months after the treatment，the total clinical effective rate in the observation group was 71.70%，significantly higher than that of 52.83% in the control group（χ2 = 4.015，P = 0.045）. During the treatment，adverse reactions such as rash，diarrhea，dizziness and fever occurred in both groups，but there was no significant difference between the two groups（P < 0.05）. Conclusion Hypothermia combined with oxiracetam can effectively optimize coma and neurological function of patients，improve clinical efficacy and down⁃ regulate serum MBP and GFAP. It is safe and effective and worthy of further clinical research and promotion.

Objective To explore the clinical value of cattle encephalon glycoside and ignotin combined with meclofenoxate in the treatment of acute cerebral hemorrhage（ACH）. Methods A total of 123 ACH patients in our hospital were selected and divided into 3 groups according to the random number table method，41 cases in each group. The control group A was given cattle encephalon glycoside and ignotin，the control group B was given meclofenoxate，and the observation group was given the combined treatment of cattle encephalon glycoside and ignotin and meclofenoxate. The clinical efficacy，the volume of brain edema，the expression levels of serum MMP⁃2/ 9，TSP⁃1/2，neural related factors，neurological deficit（NIHSS）score，and modified Rankin scale（mRS）score before and after treatment were compared among the three groups. Results The total effective rate of in the obser⁃ vation group was higher than and in the control groups A and B（95.12% vs. 75.61%、78.05%，P＜0.05）. After treatment，the volume of brain edema in the observation group was lower than that in the control groups A and B， the serum levels of MMP⁃2/9，TSP⁃1/2，NSE，NGF，and GFAP were lower than those in control groups A and B， and BDNF levels were higher than those in control groups A and B（P < 0.05）. The NIHSS and mRS of the obser⁃ vation group after treatment were lower than those of the control groups A and B（P < 0.05）. Conclusion The combination of cattle encephalon glycoside and ignotin and meclofenoxate is effective in the treatment of ACH， which can reduce serum MMP ⁃ 2/9 and TSP ⁃ 1/2 levels，regulate nerve ⁃ related factors，promote the recovery of nerve function，and improve the prognosis.

Objective To establish a line chart prediction model of incision complications after traditional open lumbar interbody fusion（lumbar interbody fusion，LIF），in order to provide reference for clinical periopera⁃ tive management. Methods The clinical data of patients with traditional open LIF hospitalized in our hospital from September 2015 to August 2020 were analyzed retrospectively，and the related risk factors were analyzed. The line chart prediction model was established by the results of univariate and multivariate logistic regression analysis. the prediction efficiency，specificity and sensitivity of the prediction model are evaluated. Results In this study， 65 cases of postoperative incision complications occurred in 426 patients，with an incidence of 15.26%. The results of univariate analysis and multivariate unconditional Logistic regression analysis showed that age，BMI，preoperative albumin，operation time and the number of operative segments were independent risk factors for incisional compli⁃ cations after traditional open LIF，and their odds ratios were 2.290，2.679，3.524，2.740 and 3.330，respectively （P＜0.05）. The prediction model of line chart was established，and the area under ROC curve was calculated （AUC=0.809，95% CI：0.768 ~ 0.845，P＜0.001）. The Jordan index，specificity and sensitivity were 0.549， 0.795 and 0.754 respectively. Conclusions The prediction efficiency of the line chart model established in this study is good，which provides an effective reference for early clinical identification of high⁃risk groups and early intervention.

Objective To investigate the prevalence of multi ⁃morbidity and related functional limitation among middle⁃aged and senior population in China，and analyze the related influencing factors. Methods The data from China Health and Retirement Longitudinal Study 2018（CHARLS 2018）were used，covering population over 45 years old in 28 provinces across China. The study included 14 types of chronic diseases and the participant who was confirmed with two or more types was defined as the one with multi⁃morbidity. Activity Daily Living，（ADL）， Instrumental Activity Daily Living（IADL）and the degree of depression were used to evaluate health outcomes. Results Patients with multi ⁃ morbidity accounted for 53.8% ；the proportions of two，three，and four or more chronic diseases were 19.7%，14.2% and 20.0%，respectively. ADL loss，IADL loss，and depression accounted for 26.7%，26.6%，and 38.5%，respectively. Age，female sex，poor marital status，living environment were risk factors for comorbidity. Conclusion Multi⁃morbidity has become one of the most serious public health concerns in China. The government should increase resources and policy input，as well as adjust the focus of health system services in order to improve the effectiveness of multi⁃morbidity management.

Objective To investigate the clinical efficacy of Huaiqihuang granule in the treatment of recur⁃ rent systemic lupus erythematosus. Methods 152 cases of recurrent SLE were divided into two groups. The control group was given routine treatment of SLE，and the observation group was treated with Huaiqihuang granule. After 12 weeks of treatment，clinical efficacy，the positive rate of ANA titer，24 h Upro level，serum inflammatory factors，cellular immune function and SLEDAI score were compared. The recurrence rate of SLE in two groups was compared after 6 months of follow ⁃up. Results The total effective rate of the observation group was significantly higher than that of the control group（P < 0.05）；After treatment，the positive rate of ANA titer，24 h Upro and serum IL⁃10 level in the observation groupwere significantly lower than the control group；The IL⁃2 level in the observation group was significantly higher than that of the control group（all P < 0.05）. After treatment，CD3+，CD4+ and CD4+ /CD8+ in the observation group were higher than before treatment and control group（all P < 0.05）. After treatment，SLEDAI scores of the two groups were decreased，and the observation group was significantly lower than control group（all P < 0.05）. After 6 months of follow⁃up，the recurrence rate of SLE in the observation group was lower than control group（P < 0.05）. Conclusion Huaiqihuang granule adjuvant therapy can effectively improve the clinical efficacy，reduce systemic inflammatory response，improve immune function，reduce SLE activity，and have low recurrence rate，which is worthy of clinical promotion.

Objective To explore the effects of multidisciplinary clinical nursing pathway combined with psychology and rehabilitation for the management of ankle fractures in the elderly. Methods From June 2018 to December 2019，65 cases of geriatric ankle fractures who accepted surgery in our hospital，were randomly divided， with 30 cases in the conventional nursing group and 35 cases in the nursing pathway group.All patients received routine nursing care，as to the nursing pathway group，procedural nursing program carried out according to the newly designed nursing pathway for ankle fractures in the elderly. Results The nursing pathway group proved significantly superior to the conventional group with regard to the average length of stay，interval between trauma and surgery， as well as the average hospital expenses（P < 0.05）. The nursing pathway group had better SAS scores than the conventional nursing group，with significant difference（P < 0.05）. With respect to nursing satisfaction survey of inpatients，the nursing pathway group demonstrated significantly better scores than the conventional nursing group in terms of health education，service initiative and timeliness，as well as service humanization（P < 0.05）. At the last follow ⁃up，the function scores of the nursing pathway group were better than that of the conventional nursing group，which did not reach significant difference（P > 0.05）. Conclusion The multi⁃disciplinary clinical nursing pathway model combined with psychology and rehabilitation，along with the development of surgical techniques， may improve the treatment effect of traumatic ankle fractures in the elderly，which is worthy of clinical promotion.

Objective To explore the effect of comprehensive nursing in hospital combined with WeChat continuous intervention in the prevention of neonatal umbilical infection. Methods From January 2019 to January 2020，640 newborns under full menstrual vaginal delivery in our hospital were selected as the research objects，and 320 cases were divided into observation group and control group by random digital table method. The control group was given routine nursing，and the observation group carried out in⁃hospital comprehensive nursing combined with WeChat continuous intervention to compare the effects of umbilical infection，umbilical cord shedding time，umbilical healing time and nursing satisfaction after neonatal nursing in the two groups. Results After the implementation of extended nursing intervention based on WeChat platform，the neonatal umbilical infection rate in the observation group was significantly lower than that in the control group（P < 0.05）. The umbilical cord shedding time and umbilical healing time in the observation group were significantly lower than those in the control group（P < 0.05）. The satisfaction rate of newborn parents in the observation group was significantly higher than that in the control group（P < 0.05）. Conclusion After comprehensive nursing in hospital combined with WeChat continuous inter⁃ vention，the infection rate of umbilical cord could be significantly reduced，the time of umbilical cord shedding and umbilical healing could be shortened ，and the satisfaction rate of newborn parents to nursing could be improved.

Pathological scar includes hypertrophic scar and keloid，which is the result of poor healing of deep tissue injury.In recent years，it has been found that Botulinum toxin Type A plays an important role in the process of pathological scar formation，such as the tension around the scar，the proliferation of fibroblasts，the release of inflammatory factors，the formation of blood vessels and scar pain. In addition，it has been found that Botulinum toxin Type A has A good therapeutic effect on pathological scars. Compared with the use of botulinum toxin Type A alone，combined use with other methods is more effective in preventing and treating pathological scars. In this paper，the mechanism and clinical application of Botulinum toxin type A on pathological scar are reviewed to provide new ideas for the treatment of pathological scar.

Type Ⅳ cardiorenal syndrome plays an important role in the mortality and prognosis of patients with chronic kidney disease（CKD）. At present，the understanding of the pathogenesis of type Ⅳ cardiorenal syndrome is not comprehensive，and current treatment methods cannot effectively control the life threat of type Ⅳ cardiorenal syndrome to CKD patients. Therefore，it is necessary to further explore the pathogenesis of type Ⅳ cardiorenal syndrome and develop new effective therapy methods. This article attempts to review the recent progress in the pathogenesis of type Ⅳ cardiorenal syndrome，which might provide the basis for medicine design and guide clinical diagnosis and treatment.

Lymphocyte ⁃activation gene 3（LAG ⁃3），also known as CD223，is a transmembrane protein found on activated T cells. It can be found on the activated CD4 + T and CD8 +T，as well as on Treg，NK cells，B cells and DC. LAG ⁃3 consists of three parts：the extracellular region，penetrating region and intracellular region. Fibrinogen like protein 1，FGL⁃1，as a newly discovered ligand of LAG⁃3，which can inhibit T cell function in a receptor⁃ligand interdependent manner in vitro and in vivo. We review the role of FGL⁃1⁃LAG⁃3 pathway in tumor immunity，and aim to reveal the role of LAG⁃3⁃FGL⁃1 pathway in tumor immunity and to provide new ideas for tumor immunotherapy.