The incidence and mortality rates of sepsis are high，but the specific pathogenesis of sepsis is still unclear. Due to the lack of accurate treatment targets，the diagnosis and treatment of sepsis in clinical practice is extremely difficult. Currently ，the significance of immune dysfunction in the pathophysiology of sepsis has become a research hotpot. This paper summarizes and reviews the advances in the changing mechanisms of immune function during sepsis.

Sepsis is one of the main causes of death in patients with acute and critical illness. Acute kidney injury（SA ⁃AKI）is associated with poor prognosis in sepsis patients，which is complex pathogenesis and currently believed to be mainly related to immune inflammatory response，coagulation cascade activation，renal cell apoptosis，and mitochondrial kinetics abnormities. Early diagnosis and treatment of SA ⁃AKI patients can reduce the mortality. Previous diagnostic criteria based on serum creatinine have limitations. Recent studies have found that a variety of novel biomarkers are involved in the occurrence and development of SA⁃AKI，which may be new targets for the early diagnosis and treatment of SA ⁃AKI. In this brief reviewed paper，the pathophysiological mechanism of SA⁃AKI and its related novel biomarkers are discussed.

Objective To investigate the expression of Calmodule⁃dependent Kinase Ⅱ in diaphragmatic muscle of rats with lipopolysps ⁃induced acute respiratory distress syndrome（ARDS）and the effection on ARDS with diaphragm dysfunction induced by LPS. Methods The rat model of ARDS was established by intraperitoneal injection of LPS. Real ⁃time PCR was used to study the expression of CaMKII mRNA in the diaphragm tissues of both the model group（rats with ARDS）and the normal one. Results （1）The three subtypes of CAMKII，2b， 2d，and 2g，were all expressed in diaphragm tissues of the normal rats，among which CAMKII 2b subtype was least expressed（P < 0.05）；（2）Compared with the normal rats，the expression of CAMKII 2b，2d，and 2g mRNA in the rats ARDS were all up⁃regulated（P < 0.05）；while other different subtypes of CAMKII mRNA expression were significantly up⁃regulated in the group with ARDS for 48hs（P < 0.05），and the mRNA expression of the CAMKII 2b subtype was among the top，compared with other subtypes（P < 0.05）. Conclusion CAMKII has been expressed in diaphragm tissues of rats and played an important role in ARDS with diaphragm dysfunction induced by LPS， and among them CAMKII 2b subtype may play a key role in this process.

Objective To study the expression of heme oxidase（HO⁃1）and HO⁃1 mRNA in the lung tissue of septic rats. Methods Forty rats were selected and randomly divided into a sham operation group of 20 rats and a sepsis group of 20 rats；the two groups were decapitated and sacrificed at 20 min before surgery and 2，6 h and 12 h after modeling. HE stained light microscope pathological sections；collected the detection results of HO1⁃1 protein activity level by Western blotting method and the detection results of HO⁃1 mRNA level by Realtime PCR method；constructed sepsis model by rat cecal ligation and perforation（CLP）method；immune group Observe the lung tissue morphology，HO⁃1mRNA and HO⁃1 protein expression at each time point；observe the lung injury tissue morphology and HO ⁃1 level changes in sepsis rats；analyze the corresponding indexes in HO ⁃1 and sepsis And lung function damage. Results The lung tissue morphology of the sham operation group was always in a com⁃ plete state，while the lung tissue morphology of the sepsis group had obvious pathological changes in the lung tissue；the color of HO⁃1 imprints in the sepsis group was very different at each time point. The color of the blot is darkest at 12 h，followed by the lightest color at 6，24 h；while the color of the HO⁃1 blot at the 3 time points of the sham operation group is very light，and the color of the blot at 12 h is the darkest at 12 h like the sepsis group. Followed by the lightest color at 6 and 24 h；the sham operation group has remained stable without significant changes，while the sepsis group has the lowest OD value at 2 h，and then gradually increases. The difference in OD at the 3 time points is statistically significant significance（P < 0.05）；the OD value of rats in the sepsis group was higher than that in the sham operation group at each time point（P < 0.05）. Conclusion The expression of HO⁃1 in the lung tissue of the sepsis group was significantly higher than that in the sham operation group，indicat⁃ ing that HO⁃1 has a significant effect on the pathomorphological changes of the lung tissue of patients with sepsis

lung tissue in the sepsis group The pathomorphological damage of the lung tissue gradually reduced with the increase of the expression of HO⁃1 in the lung tissue，indicating that HO⁃1 has a significant protective effect and improvement effect on the pathological morphology of the lung tissue of patients with sepsis.

Objective To compare the effects of different immunotherapy on mmunologic function and prognosis in elderly immunosuppressive patients with sepsis. Methods Ninety⁃one elderly patients with immuno⁃ suppressive of sepsis were randomly divided into control group（A group，n = 30）and thymalfasin treatment group （B group，n = 30）and thymalfasin combined with Xuebijing treatment group（C group，n = 31）. The changed of the mmunologic function such as CD3+ T cell count and CD4+ T cell count and the ratio of CD4+ /CD8+ T cell count and human leukocyte antigen DR expression rate，ICU length of hospital stay，total length of stay in hospital and 90⁃ day mortality were compared and analyzed. Results The CD3 + T cell count，CD4 + T cell count，the ratio of CD4+ /CD8+ T cell count and the expression rates of HLA⁃DR increased significantly after treatment and total length of stay in hospital and 90⁃day mortality rate were decreased significantly in group B and group C when compared with those in group A（P < 0.05）. The CD3+ T cell count，CD4+ T cell count，and the expression rates of HLA⁃DR increased significantly and the length of stay in ICU and total length of stay in hospital decreased significantly in group C when compared with those in group B after treatment（P < 0.05）. Conclusion In elderly immunosuppressive patients with sepsis，the use of thymalfasin or combined with Xuebijing injection can improve the mmunologic func⁃ tion and prognosis. Combination therapy has synergistic effect and is superior to single thymalfasin treatment.

Objective To understand the blood volume status and volume reactivity of patients with sepsis using bedside ultrasound under mechanical ventilation. Methods 136 cases of sepsis patients with breathing machine treatment were chosen at random from May 2017 to Sep 2020 in ICU 2 of the first Affiliated Hospital of Guangxi Medical University，and ICU 2 and 1 of Guangxi integrated traditional Chinese and western medicine hospital affiliated to Guangxi university of traditional Chinese medicine. The indicators of bedside ultrasound were recorded as the indicators of PICCO were obtained synchronously in ICUs，respectively. The indicators were end⁃ diastolic volume index，the variation rate of stroke，the minimum diameter of the inferior vena cava（IVC），inferior vena cava expansion index and NT ⁃ proBNP. Analysis were performed according to the data properties. Result Groups of End ⁃diastolic volume index of IVCDmin difference was statistically significant（P < 0.05），and value of End⁃diastolic volume index group in IVCDmin were（1.57 ± 0.32）cm. The optimal cut⁃off point for the smallest IVCDmin reflecting body volume deficiency was 1.35 cm，the sensitivity and specificity were 86.40% and 84.80%， respectively（P < 0.01），and the optimal cutoff point of the minimum IVCDmin reflecting the body volume overload was 1.81 cm，the sensitivity and specificity were 76.50% and 89.60%，respectively（P < 0.01）. The gold standard of cutoff point for effective volume reactivity of inferior vena cava expansion index was 14.47% ，sensitivity and specificity were 87.7%，81.0%（P < 0.01）. Conclusion In patients with sepsis under mechanical ventilation， when the IVCDmin was less than 1.35 cm，it should be paid to the state of insufficient blood volume. If the IVCDmin is greater than 1.81 cm，body volume overload should be early warned. And It should be evaluated timely of the body ± s blood volume status and volume reactivity in order to accurately guide the fluid management.

Objective To explore the role and mechanism of pharmacokinetics/pharmacokinetics（PK/ PD）in ICU elderly patients with sepsis. Methods Sixty elderly patients with sepsis in ICU from January 2019 to March 2020 were randomly divided into the Therapeutic Drug Monitoring（TDM）group and control group According to different methods of administration. The dose of meropenem was adjusted in TDM group. The control group was not adjusted. The treatment effect，microbial cure rate and case fatality rate were compared between the two groups. Results The clinical indexes of TDM group were significantly lower than those of control group（P < 0.05）. The clinical cure rate（90.00%）and microbial cure rate（93.33%）in TDM group were significantly higher than those in control group（70.00%），and the difference was statistically significant（P < 0.05）. The incidence of adverse side effects（10.00%）and case fatality（3.33%）in TDM group were significantly lower than those in control group （23.33%，10.00%），and the difference was statistically significant（P < 0.05）. The patients who achieved PK/PD goal in TDM group（93.33%）were significantly higher than those in control group（53.33%），and the difference was statistically significant（P < 0.05）. Conclusion PK/PD theory can optimize the treatment of meropenem in ICU elderly with sepsis，improve the effective rate of treatment and microbial cure rate，reduce the incidence of adverse reactions and mortality.

Objective To explore the relationship of glycated hemoglobin with organ dysfunction progres⁃ sion and ICU mortality in diabetes with sepsis. Methods 102 diabetes with sepsis admitted in the department of Intensive Care Unit of the First Aftiliated Hospital of Soochow University from May 2018 to June 2019 were divided into the two group according to the level of glycated hemoglobin：the abnormal glycated hemoglobin group （HbA1c ≥ 6.5%）and the normal glycated hemoglobin group（HbA1c < 6.5%）. Survival analysis was performed by kaplan⁃Meier method and log⁃rank test.Logistic regression analysis and Cox regression analysis were used to study the influencing factors of the progression of organ dysfunction and ICU mortality. Results Among the 102 patients， 39 were in the group with abnormal glycated hemoglobin and 63 were in the group with normal glycated hemoglo⁃ bin. The incidence of organ dysfunction progression in the abnormal group was significantly higher than that in the normal group（48.7% vs. 22.2%，P = 0.001）. The ICU mortality in the abnormal group was significantly higher than that in the normal group（38.5% vs. 7.9% ，P < 0.001）. Multivariate Logistic regression analysis showed that HbA1c ≥ 6.5%（OR = 1.070，95% CI：1.006 ~ 1.138，P = 0.031）and lactic acid level（OR = 1.557，95%CI：1.166 ~ 2.081，P = 0.003）were independent risk factors for the progression of organ dysfunction. Kaplan⁃Meier analysis along with the log⁃rank test showed that the survival period was significantly shorter in patients with an HbA1c level ≥ 6.5% than in those with an HbA1c level < 6.5%（P < 0.001）. Multivariable Cox proportional hazard analysis with backward elimination indicated that HbA1c ≥ 6.5%（HR = 1.394，95% CI：1.157 ~ 1.678，P < 0.001），high lactic acid level（HR = 1.555，95%CI：1.165 ~ 2.077，P = 0.003）and age（HR = 1.080，95%CI：1.004 ~ 1.162，P = 0.039） were significant，independent predictors of ICU mortality. Conclusions In diabetes with sepsis，higher glycated hemoglobin at ICU admission is associated with progression of organ dysfunction and ICU mortality.

Objective To observe the influences of Bacillus cereus on proliferation and migration of oral squamous cell carcinoma，and investigate the mechanism. Methods CCK8 detected the proliferation of SCC ⁃25 infected by Bacillus. The migration and invasion of SCC25 treated by Bacillus was detected by scratch experiment. The intracellular expression of NF⁃ κB signaling pathway was detected by western blot. Results Compared with control group，the proliferation，migration and invasion of SCC⁃25 were significant declined（P < 0.05）. And the activity of SCC⁃25 was increased when treated with NF⁃ κB inhibitor（P < 0.05）. The western blot showed that SCC⁃25 infected by Bacillus was contributed to the increasing expression of pP65、pIκBα and IKKγ，and the acti⁃ vation of NF⁃κB pathway. Conclusion Bacillus cereus may inhibit the proliferation，migration and invasion of oral squamous cell carcinoma through NF⁃κB signaling pathway.

Objective To elucidate whether MALAT1 regulates the growth，migration，and invasion of giant cell tumor stromal cells through miR⁃30. Methods Collect the samples of cancer and para⁃cancer in clinical patients with giant cell tumor of bone for fluorescence quantitative PCR，to detect the expression level of MALAT1 and miR⁃30；culture primary cells of giant cell tumor of bone to obtain purified primary stromal cell line；construct MALAT1 overexpression plasmid，synthesize miR ⁃30 mimic and inhibitor；overexpress MALAT1 plasmid and/or miR⁃30 related fragments in cells，observe cell growth by MTT experiment，observe migration and invasion by tran⁃ swell experiment. Results Compared with the adjacent tissues，the expression level of MALAT1 was significantly decreased in giant cell tumor of bone tissue，while the level of miR ⁃ 30 was increased；bioinformatics analysis found that MALAT1 showed matched sequence interacting with miR⁃30，and the luciferase reporter gene reporter showed that overexpression of miR ⁃30 can significantly inhibit the luciferase signal of MALAT1 WT，but not for MUT mutant plasmids；overexpression of MALAT1 or miR⁃30 inhibitor alone inhibited the growth，migration，and invasion of stromal cells；and downstream antagonism experiments showed that overexpression of MALAT1 counter⁃ acted the promotion effect induced by miR⁃30 mimic. Conclusion MALAT1 and miR⁃30 are involved in the devel⁃ opment and regulation of bone giant cell tumor stromal cells；MALAT1 inhibits the proliferation，migration，and invasion of bone giant cell tumor cells by regulating miR⁃30.

Objective To investigate the role of 5 ⁃ HT7 receptors in dural plasma protein extravasation （PPE）induced by electrical stimulation of the trigeminal ganglion. Methods To construct migrainous rat model by means of electrical stimulation of the trigeminal ganglion. A total of 35 rats were randomly divided into 7 groups， sumatriptan（5⁃HT1B/1D receptor agonist ）positive control group，AS19（5⁃HT7 receptor agonist）5 and 10 mg/kg groups，SB269970（5⁃HT7 receptor antagonist）5 and 10 mg/kg groups，dimethyl sulfoxide and normal saline negative control groups. All drugs were administered 30 minutes before electrical stimulation. 2% Evans blue dye was injected intravenously as a marker of PPE 5 minutes before electrical stimulation. The assessment of PPE was measured using a fluorescence microscope equipped with a grating monochromator and a spectrophotometer. The ratio of the fluorescence intensity from the stimulated compared to the contralateral side was expressed as the PPE ratio. Results The PPE ratio of sumatriptan group was significantly lower than other groups（P < 0.005）. No significant differencewas discovered among AS19，SB269970 and negative control groups（P > 0.05）. Conclusions 5⁃HT7 receptors might not be involved in dural PPE induced by activation of the trigeminovascular system.

Objective To explore the risk of transmission of HIV through unprotected sexual intercourse for childbearing purpose in married or unmarried serodiscordant couples in which the male partner has tested posi⁃ tive for HIV. Methods The male partners of 58 couples had received antiretroviral therapy（ART）for more than one year. Under the condition of HIV⁃1 RNA being < 20 copies/mL and CD4+ T lymphocyte count > 250 cells/μL， the couples who desired to have children had vaginal intercourse without condoms. The female partners were informed in advance the risk of HIV infection and the prevention methods and did not take prophylactic medications before and after sexual contact. They had sex without condom use 2 to 3 times during the period of ovulation for less than 6 months，and HIV antibodies were tested 3，6，12，and 18 months after their last sexual intercourse. Results 58 HIV⁃positive male patient［ages from 23 to 45 years，an average age of（31.6 ± 4.9）years］received ART for 12 to 48 months（a median of 18 months）. HIV⁃1 RNA was less than 20 copies/mL in peripheral blood and in semen at least once. The average count of CD4 + T⁃lymphocyte（518.4 ± 167.4）cells/μL after the therapy was markedly greater than the baseline［（310.7 ± 130.6）cells/μL，t = 10.281，P＜0.001］. All the patients had unprotected sex with their partners for 3 to 6 months（median：6 months）. All the female partners were tested negative for HIV antibodies and 4 of them became pregnant. Two infants were tested negative for HIV antibodies. Conclusions Men who are successfully treated with ART have a relatively low risk of passing HIV to his hetero⁃ sexual partner by sex.

Objective The aim of this study was to investigate the expression of acid⁃sensing ion channels （ASICs）in gastric mucosa of patients infected with Helicobacter pylori（Hp）and its role in the gastrointestinal function of HP infected gastritis. Methods 22 patients with gastritis diagnosed via endoscopy were divided into 2 groups：the Hppositive group（Hp（+），n = 11）and the Hp negative group（Hp（-），n = 11）. The expression and⁃ localization of ASICs in gastric mucosa of patients with gastritis were detected by immunochemistry. Serum CCK， SP，GAS and MTL levels were measured with ELISA methods. The correlation between ASICs expression and gastrointestinal hormones was analyzed by Pearson′s analysis. Results The expression of ASIC3 in gastric mucosa and the levels of CCK，SP and MTL in serum were significantly increased in HP infected patients. Moreover the serum levels of CCK，SP and MTL were closely correlated to the expression of ASIC3. Conclusion Hp could induce the expression of ASIC3 in gastric mucosa，which can affect the secretion of gastrointestinal hormones and gastrointestinal function in patients with HP infection.

Objective To study the efficacy of sublingual desensitization therapy（SLIT）in children with allergic rhinitis. Methods 151 pediatric patients were selected in accordance with the guidelines for diagnosis and treatment of allergic rhinitis and divided into two groups according to the treatment wishes of the patients and their parents. The control group received a conventional therapy with cetirizine hydrochloride plus azelastine hydrochloride nasal spray，and the study group received the same conventional therapy in addition to sublingual desensitization. The efficacy was assessed by TMS and TNSS in both groups 3，6 and 12 months after treatment. Results After 3 months of treatment，there were no evident differences between the study group and the control group in symptom score，sign score，and drug score，while after six⁃month treatment，the symptom score，sign score，and drug score were significantly different between the study group and the control group（P < 0.05）. Conclusions Sublingual desensitization therapy is effective in the treatment of children with allergic rhinitis and has a lower recurrence rate and shows a better efficacy initially after 6⁃month treatment，providing different options for children with allergic rhinitis.

Objective To investigate the clinical effect of ultrasound ⁃guided“bow tie”fascia iliac plus sacral plexus block in hip arthroplasty. Methods A number of 66 patients aged 18⁃65 to undergo unilateral hip replacement were selected in our hospital from September 2019 to January 2020. They were randomly divided into 2 groups：ultrasound⁃guided iliac fascia plus sacral plexus block（group F，n = 33），ultrasound⁃guided lumbosacral plexus block（group C，n = 33）. The two groups were compared in terms of the ultrasound imaging and puncture injection time，the times of repeated punctures，heart rate（HR）and mean arterial pressure（MAP）at different time points，resting VAS score，Lovett muscle strength score，and nerve block ⁃ related complications at different time points after surgery. Results Compared with group C，group F had no significant differences in HR and MAP（P > 0.05）and in VAS scores 1，4，8，24 and 48 h after surgery（P > 0.05）. The time of ultrasound imaging and puncture injection in group F was significantly shorter than group C （P < 0.05）. The times of repeated puncture in group F were significantly less than group C（P < 0.05）. There was no significant difference in 24 and 48 h Lovett muscle strength score postoperatively（P > 0.05）. No nerve block⁃related complications were observed in both groups. Conclusion The ultrasound⁃guided“bow tie”fascia iliac plus sacral plexus block has a good analgesic effect in hip replacement surgery. The method is simple and effective，and it can be applied and promot-ed clinically.

Objective To explore the short and medium⁃term efficacy of biomimetic collagen⁃modified PM⁃ MA bone cement in the treatment of single segment osteoporotic thoracolumbar compression fractures（OVCF）. Methods 120 patients with single vertebral osteoporotic thoracolumbar compression fractures admitted to our hospital from May 2017 to June 2019 were randomly divided into control group and treatment group，60 for each group. PMMA bone cement was used for percutaneous kyphoplasty in the control group，while biomimetic mineralized collagen ⁃modified PMMA bone cement was used for percutaneous kyphoplasty in the treatment group. VAS score and oswestry disability index scale（ODI）were recorded presurgically and at postsurgical day 2 and months 3 and 6，and sagittal plane index，Cobb Angle and bone cement distribution in the vertebra were measured. Results There were statistical significant differences in VAS score ，ODI score，sagittal plane index and Cobb Angle between the two groups at preoperative and postoperative day 2 and months 3 and 6，while there were no statistical significant differences between the two groups in the postoperative observation time points，and there were no statis⁃ tical significant differences between the two groups in the same postoperative observation time points. 13 patients were in the control group and 10 in the treatment group. Recurrent low back pain occurred in two patients in the control group 6 months after surgery，but not in the treatment group. Conclusions The short and medium⁃term efficacy of biomimetic mineralized collagen ⁃ modified PMMA bone cement is equivalent to that of single PMMA bone cement in the treatment of single segment osteoporotic thoracolumbar compression fracture. The number of complications was less in the treatment group than in the control group，but the difference was not statistically significant，requiring larger sample size and long⁃term observation.

Objective To study the risk factors of recurrence of primary membranous nephropathy （PMN），and to reduce the possibility of progression to end⁃stage renal disease. Method PMN patients diagnosed by renal biopsy in our hospital from January 2012 to May 2020 were selected as study subjects，and were divided into recurrent group and non⁃recurrent group. The clinical data of the two groups were analyzed and compared. Results Multivariate COX regression analysis showed that hypertension and high uric acid were independent risk factors for the recurrence of PMN. Conclusion The main risk factors of the recurrence of PMN are hypertension and hyperuricemia. Relapses occur in the context of drug reduction，withdrawal，and infection.

Objective To explore the effect of crownless sinus patch in Standford type A dissection root plasty. Methods A total of 86 cases of Stanford type A aortic dissection from March 2008 to May 2018 were selected as Group A and another 66 cases with the same conditions from June 2018 to October 2020 were selected as group B. The patients of the two groups underwent Sun′s operation in our hospital. During the operation，the aortic wall and right atrial appendage were used for internal drainage at the aortic root in group A. In group B，the aortic root was repaired with non⁃coronary sinus patch，the vascular wall of aortic root was sutured with“Sandwich” method and the right valueless junction was suspended and shaped. The two groups were compared in terms of operation time，intraoperative blood loss，cardiopulmonary bypass time，intraoperative red blood cell transfusion， number of homeostasis cases after thoracotomy，total drainage volume 24 hours after operation，number of postopera⁃ tive pulmonary complications and mortality rate. The data were analyzed by SPSS10.0. Group t test and χ2 test were used for statistical analysis of measurement data and count data between groups. Results As compared with group A，the operation time and cardiopulmonary bypass time were both significantly shorter，the volume of transfused intraoperative red blood cells，the number of homeostasis cases after thoracotomy，the total drainage volume in 24 hours after operation，the amount of red blood cell transfusion，and the number of cases with pulmonary complications were significantly smaller，and the postoperative mortality was significantly lower in group B. Conclusion During Stanford type A aortic dissection，aortic root plasty with non ⁃coronary sinus patch，with its vascular wall sutured and reinforced with“Sandwich”method，is effective in reducing postoperative complications and improve the success rate of operation.

Objective To analyze vacA dominant genotypes of Helicobacter pylori（H.pylori）in gastric can⁃ cer patients in Liaoning and its association with NF⁃κB expression and provide laboratory basis for the mechanism and clinical treatment of gastric cancer. Methods A total of 140 cases of gastric cancer tissue samples with positive H. pylori were determined by surgical resection from 2010 to 2014. DNA was extracted from gastric cancer tissues according to the kit instructions，and the expression of different vacA genotypes of H. pylori was detected by PCR technology. The expression of NF⁃κB protein in gastric cancer tissues was detected by immunohistochemistry. Results The distribution of vacAs1，vacAm1，and vacAs1m1 subtypes in gastric cancer was higher than that of other subtypes（P < 0.05）. Among them，the proportion of vacAm1 and vacAs1m1 genotypes in diffuse gastric cancer is higher than that of intestinal gastric cancer，and the difference is statistically significant（P < 0.01）. NF⁃ κB expression is closely related to gender and lymphatic metastasis and the expression of NF⁃ κB in male patients was significantly higher than that in female patients，indicating statistical significance（P < 0.05）. The expression of NF⁃ κ B was significantly higher in patients with lymphatic metastasis than in those ，and the difference was statistically significant（P < 0.01）. NF⁃κB expression was closely related to H.pylori vacAs1，vacAm1，and vacAs1m1 subtypes，and the differences were statistically significant（P < 0.05）. When these three genotypes were positive， the positive expression rate of NF ⁃ κB was significantly increased. Conclusion H. pylori vacAm1，vacAs1，and vacAs1m1 are the dominant genotypes of gastric cancer in Liaoning. Patients carrying vacAs1m1 gene subtype may be a high⁃incidence population of diffuse gastric cancer，and vacAs1m1 gene subtype may promote the expression of NF⁃κB and cause gastric cancer.

Objective To assess the effectiveness and safety of mecapegfilgrastimas（HHPG ⁃ 19K）in preventing neutropenia after chemotherapy in cancer patients systematically，aiming to provide evidence ⁃ based reference for clinical treatment. Methods The original research on mecapegfilgrastimas in the database from Cochrane Library，PubMed，EMBase，ClinicalTrials.gov，CBM，CNKI，VIP，Wanfang and ChiCTR was retrieved. The studies on mecapegfilgrastimas forprophylaxis of chemotherapy⁃induced neutropenia were collected. Literature screening and methodological quality assessment were completed by two reviewers independently. Meta ⁃ analysis was performed using the RevMan 5.3 software. Results Four RCTs were included，involving 671 patients whowere finally enrolled in this study.The Meta analysis revealedmecapegfilgrastimas significantly decreased the incidence of grade ≥ 4 neutropenia at cycle two（RR = 0.37，95%CI：0.21 ~ 0.65）and there was no significant differences at cycle one（RR = 0.56，95%CI：0.31 ~ 1.00）. There were no significant differences in the incidence rate of FN （RR = 0.42，95%CI：0.15 ~ 1.19）andbone pain（RR = 1.10，95%CI：0.48 ~ 2.51）between mecapegfilgrastimas group and the control group. The descriptive analysis showed that mecapegfilgrastimas markedly shortenedin the mean duration of grade ≥ 3 neutropenia at cycle one（P < 0.000 1）as compared with placebo. The efficacy of mecapegfilgrastim was equivalent to that of rhG⁃CSF. Conclusions Mecapegfilgrastim is superior to placebo in preventing chemotherapy⁃induced neutropenia. The efficacy of mecapegfilgrastim is better than that of rhG⁃CSF in prevention of the incidence of grade ≥ 4 neutropenia atchemotherapy cycletwo.Mecapegfilgrastim has the similar efficacy torhG ⁃CSF in prophylaxis ofthe incidence of grade ≥ 4 neutropenia at cycle one or theoccurrence of FN. The safety of mecapegfilgrastim is similar to that of rhG⁃CSF.

Objective To investigate the role of electrochemical detection of circulating free DNA in the diagnosis of thyroid cancer and its correlation with TI ⁃ RADS grading and clinicopathological features. Methods Circulating free DNA was extracted from plasma of 114 patients with thyroid cancer，35 patients with benign thyroid disease and 35 normal people. The current adsorption rate（ir%）of plasma free DNA（cfDNA）was detected by electrochemical method. The differences of current adsorption rate between patients with thyroid cancer，benign thyroid disease and normal people，as well as the relationship between adsorption rate and clinicopathological features and thyroid shadow were analyzed The relationship between response reporting and data system classifica⁃ tion（TI⁃RADS classification）. Results The ir value of thyroid cancer patients was higher than that of benign lesions patients（P < 0.05），AUC=0.778. The IR value of patients with thyroid cancer was higher than that of patients with benign lesions（P < 0.05），AUC = 0.778. There was no significant difference in ir between patients with benign thyroid lesions and normal controls（P = 0.094）. The sensitivity，specificity and accuracy were 61.4% ， 68.6% and 64.1%，with statistically significant differences（P < 0.05）. There was no statistically significant difference in tumor size，lymph node metastasis，local invasion and multi ⁃centrality between the ir value < 29 group and the ir value ≥ 29 group（P > 0.05）. ir value ≥ 29 was an independent risk factor for thyroid cancer OR = 1.244 （P < 0.01）. Conclusion Plasma cfDNA current adsorption rate（ir value）has certain significance in the diagnosis of thyroid cancer. The index of ir ≥ 29 is an independent risk factor of thyroid cancer. Plasma cfDNA current adsorption rate（ir value）sis correlated with TI⁃RADs grading.

Objective The aim of this study was to retrospectively analyze the consistency of imaging staging of pneumoconiosis diagnosed by imaging physicians and the reliability of original report diagnosis according to the latest international standard“diagnosis of Occupational Pneumoconiosis”（GBZ70⁃2015），so as to provide basis for improving the accuracy of imaging staging diagnosis of pneumoconiosis. Methods three pneumoconiosis imaging diagnostic physicians with different seniority，R1，R2，R3（low，medium and high）were invited to read the films independently and double blindly on the special workstation for pneumoconiosis diagnosis，and the stages were recorded as stage 0，stageⅠ，stageⅡ and stageⅢ. The three physicians read the films together to reach the relative gold standard，which was recorded as Major，to collect the original report classification of each case and recorded as Report. According to the diagnosis of Occupational Pneumoconiosis（GBZ70⁃2015）implemented on May 1，2016，the imaging stages of pneumoconiosis were diagnosed，the results of film reading were recorded， and the data were collated and statistically analyzed. Results The results of imaging staging of pneumoconiosis by different seniority doctors showed that the consistency between low seniority physicians and relative gold standard was moderate（Kappa = 0.745），and that between middle and senior seniority doctors and relative gold standard was better（Kappa = 0.836，0.896），but the accuracy of original report was low，the consistency was poor（Kappa = 0.583），and the consistency of three doctors was good（overall Kappa=0.765）. Conclusion there are some differ⁃ ences in imaging staging of pneumoconiosis among different seniority doctors. The diagnostic consistency of middle and senior doctors is better than that of low seniority doctors ，and the staging is different. In this study ，after excluding the interference of external factors，it was found that the difference among film ⁃ reading doctors mainly came from the difference between stage Ⅰ and stage Ⅱ judgment，and the accuracy of the original report on the classification and evaluation of pneumoconiosis was limited.

Objective The aim of this study was toinvestigate the diagnostic value of four⁃dimensional hysterosalpingo⁃contrast sonography（4D⁃HyCoSy）combined with saline infusion sonography（SIS）for uterine cavity lesions in infertile women. Methods The clinical data of 244 infertile women detected by transvaginal 4D⁃HyCoSy were analyzed. All the patients were performed with SIS guided by ultrasound after 4D ⁃HyCoSy. The sensitivity， specificityand accuracy of HyCoSy and 4D⁃HyCoSy combined SIS for uterine cavity lesions in the diagnosis of uter⁃ ine lesions were compared and analyzed. Results The sensitivity，specificityand accuracy of uterine cavity lesions diagnosed byHyCoSy were 68.8% ，69.2% and 68.8% ，respectively. While those by HyCoSy combined with SIS were 92.2%，84.6% and 91.8%，respectively. The difference in specificity was not statistically significant（P > 0.05）， while the difference in sensitivity and accuracy was statistically significant（P < 0.001）. Conclusions HyCoSy combined with SIS can clearly show uterine cavity lesions，and its diagnosis of small endometrial polyps，endome⁃ trialhyperplasia and intrauterine adhesions are better than HyCoSy alone. HyCoSy combined with SIS canimprove diagnostic accuracy of uterine cavity lesions.

Objective The aim of this study was to understand HIV infection status and influencing factors among drug users in Guigang City from 2009 to 2019. Methods A unified questionnaire was used to collect demographic，behavioral，and serological information of the research subjects. Results A total of 10，001 people were monitored from 2009 to 2019，and 685 people were HIV positive. Overall HIV antibody ⁃ positive rate was 6.85%，and the annual HIV infection rate showed a downward trend year by year. Drug users are mainly 31 to 40 years old，male，junior high school education，and married. The proportion of drug users aged 21 to 30 has a decreasing trend year by year，while the proportion of drug users aged over 40 had an upward trend year by year. the awareness rate of AIDS prevention and control knowledge was 91.4% ，with an upward trend. Multivariate Logistic regression showed that the risk factors of HIV infection were drug injection，sharing needles with others and positive hepatitis C antibody，while high school and above education were protective factors. Conclusion HIV infection is affected by many factors，and targeted health education and behavioral interventions should be carried out to prevent further spread of HIV.

Objective Observation on the clinical efficacy of staged comprehensive therapy for patients with refractory Helicobacter pylori infection（RHPI）. Methods A total of 88 patients with refractory Hp infection who had repeated failures of ≥ 3 times with triple therapy were included from 2018 to 2020 according to the consen⁃ sus recommendation. They were randomly divided into treatment group（45 cases）and control group（43 cases）， of which the treatment group adopt staged comprehensive therapy，namely：early stage（Chinese medicine Banxia Xiexin Decoction plus or minus symptomatic treatment）×7 days；standard triple antibacterial treatment（esomepra⁃ zole + amoxicillin + clarithromycin）+Chinese medicine Sanyu ×10 Days；late stage（Chinese medicine Xiangsha Liujunzi Decoction plus or minus treatment）×7 days The control group received standard quadruple antibacterial treatment（esomeprazole + amoxicillin + clarithromycin + colloidal bismuth tartrate）×14 days. Both groups of patients were rechecked for 13C or 14C breath test after stopping the drug for 1 month. The differences in the efficacy of Hp eradication rate，TCM symptom score before and after treatment，and Hp resuscitation rate after 1 year were compared between the two groups，and adverse reactions were recorded. Results In the treatment group and the control group，the eradication rate of Hp was 93.33% and 81.40%，respectively，and the Hp relapse rate after 1 year was 13.33% and 25.58%，respectively.The Hp eradication rate in the treatment group was significantly higher than that in the control group，the Hp relapse rate after 1 year was significantly lower than that in the control group， and the difference was statistically significant（P < 0.05）；the scores of TCM symptoms in the two groups were improved before and after treatment，and the treatment group had a significant rate of 62.22%. The efficiency was 37.21%，and the treatment group was significantly higher than that in the control group（P < 0.05）；no serious adverse events occurred during the treatment period，and the adverse reactions in the treatment group during the radical cure of Hp were significantly less than those in the control group（P < 0.05）. Conclusion Early Banxia Xiexin Decoction and later stage Xiangsha Liujunzi Decoction combined with Chinese medicine Diyu and triple therapy can significantly increase the eradication rate of RHPI，reduce the relapse rate，relieve symptoms obviously， have definite curative effect and have fewer adverse reactions.

β⁃thalassemia，the most common form of thalassemia，is a monogenic inherited disease caused by the abnormality of β⁃globin gene. Although there are currently many treatments for thalassemia，such as blood transfusion，iron chelation，splenectomy，and allogeneic hematopoietic stem cell transplantation（HSCT），the pathway to cure thalassemia still faces great challenges. In this paper，the current clinical treatment strategies of β⁃thalassemia were systematically described based on the pathogenesis of the disease，and the research progress of how to cure β⁃thalassemia by gene therapy was emphatically described.

Hepatocellular carcinoma （HCC）is a malignant tumor with high morbidity and mortality， which has no obvious symptoms in the early stage. At the time of diagnosis ，most patients are already in the advanced stage and cannot receive radical surgery. Molecular targeted drugs represented by sorafenib are the stan⁃ dard treatment for advanced HCCbut the efficacy is still not ideal. In recent years，immunotherapy represented by immune checkpoint inhibitors （ICIs）achieved remarkable results in advanced HCC. This article wouldbriefly review the clinical research status of ICIs in advanced HCC.

As a new type of immunotherapy，Chimeric antigen receptor T cell therapy has become a hot spot in tumor field in recent years. The CD19 CAR ⁃T cell therapy achieved significant results particularly in the treatment of refractory and recurrent hematologic malignancies. However，the treatment is accompanied by signifi⁃ cant toxicities，the most widely reported being cytokine release syndrome（CRS）and neurotoxicity. While the true characteristics and mechanisms of cardiotoxicity remain unclear. This article summarizes the current acquaintance with cardiotoxicity of CD19 CAR⁃T cell therapy by introducing its mechanisms，clinical manifestation，prevention and treatment advances，aiming to minimize the risk of cardioascular complications，make more cancer patients benefit from the potential life⁃saving treatment.