The care of patients at the end of life is a hot issue at present，but the development of hospice care in China is not satisfactory. How to explore a way of hospice care suitable for China's national conditions is an urgent problem to be solved. In this paper，the problems encountered in the practice of hospice care in China are summarized and prospected. Combined with their own exploration，the idea of integrating hospice care is put for⁃ ward. Through the inclusive operation mode，the number of hospice care services is increased，and the concept of hospice care is gradually popularized in the service，at the same time，hospice care can develop sustainably.

Prostate cancer（PCa）is most common among American and European males. Advanced PCa patients are witnessed to be effectively treated with androgen deprivation therapy（ADT）at the preliminary stage and it eventually develops to the castration⁃resistant prostate cancer（CRPC），which results in poor prognosis. In recent years，immune checkpoint inhibitors（ICIs）have been successfully applied in the treatment of advanced PCa. In this paper，we have reviewed the literature on ICIs′ role in the treatment of advanced PCa，and discussed its development directions and application prospects.

Objective To investigate the differences and causes of glioblastoma cell linesof different geno⁃ typesin radiation resistance. Methods Three GBM cell lines with different genotypes （U87MG，U251MG， U118MG）were selected. P53 and PTEN gene mutations were detected by exon sequencing technology，and MGMT expression was detected by Western blotting. After irradiation withdifferent doses（2 Gy，5 Gy，10 Gy），flow cytometry was used to detect the levels of apoptosis，and plate clone formation to detect cell proliferations，so that the radia⁃ tion resistance was analyzed. Western blot was used to detect the activation of DNA damage marker protein （γH2AX），NF⁃κB effector molecule（RELA/p65）and EGFR within 48 hours after radiation，followed byanalyz⁃ ing the correlation between DNA damage and the activation of NF ⁃ κB and EGFR signaling pathways. Results U87MG，U251MG，and U118MG all hadmutation sites of P53 and PTEN. Among them，U87MG and U251MG low⁃expressed MGMT，and U118MG high⁃expressed MGMT. After 48 hradiation with the doses of 2 Gy，5 Gy，and 10 Gy，there was a change inthe apoptosis rate：U87MG > U118MG > U251MG，and at the survival score： U251MG > U118MG > U87MG across the four doses. There were differences in the activation time and dose of γH2AX，RELA/p65 and EGFR in the three cell lines after irradiation. Conclusion Radiation resistance：U251MG has the highest radiation resistance，followed by U118MG and U87MG in sequence，which suggests that the radia⁃ tion resistance of GBM cell line is related to its genotypes. There are differences in the activation of the NF ⁃ κB pathway and the EGFR pathway after irradiation to the three cell lines，which ultimately leads to differences in their radiation resistance. 

Objective To investigate the role of MIP⁃1ɑ antagonist combined with bortezomib in the facili⁃ tation of osteoblasts in myeloma bone disease（MBD）by inhibiting Erk1/2/Bax. Methods A MBD mouse model was constructed by subcutaneous injection of myeloma cell lines. The mice were divided into four groups ：the control group，Bortezomib（Bor）group，MIP ⁃ 1ɑ antagonist（Bx471）group，Bor combined with Bx471（Bor + Bx471）group. Enzyme linked immunosorbent assay（ELISA）was used to detect the expression levels of MIP ⁃1ɑ， SOST，IL⁃6，BALP，RANKL，and OPG and Western blotting the expression levels of Erk，Bax，Caspase 3， Caspase 9，and X⁃ray to assess the degree of bone destruction. Results X⁃ray tests showed that the tumor⁃bearing mice in the control group had pathological fractures. As compared with the control group，the bone destructions in the other three groups were at a lower level. In contrast，the levels of MIP⁃1α，SOST，RANKL，and IL⁃6 in the control group were significantly higher than in Bor group and Bx471 group（P < 0.05），especially than in Bor+ Bx471 group（P < 0.001），while the expressions of OPG and BALP were significantly lower than in the Bor com⁃ bined with Bx471 group（P < 0.001）. The protein expressions of Erkl/2，Bax，Caspase 3，Caspase 9 in the control group were higher than in Bor group and Bx471 group（P < 0.05），especially than in Bor + Bx471 group（P < 0.001）. Conclusions MIP⁃1ɑ antagonists combined with bortezomib may inhibit the Erk1/2/Bax signaling pathway and then promote MBD osteoblasts. 

Objective To observe the effects of electroacupuncture（EA）combined with repetitive tran⁃ scranial magnetic stimulation（rTMS）on spatial learning and memory ability，postsynaptic dense zone，microglia and neuroinflammatory factors in rats with Alzheimer′s disease（AD）. Methods SD rats were randomly divided into normal group，model group，electroacupuncture group，repetitive transcranial magnetic group and electroacu⁃ puncture + transcranial magnetic group. AD model rats were prepared by intraperitoneal injection of D ⁃galactose. The electroacupuncture（EA）group was given electroacupuncture stimulation for 20 min/times. The repetitive tran⁃ scranial magnetic（rTMS）group was given 10 pulses per string，10 strings of stimuli per day. The EA+rTMS group was given magnetic stimulation after electroacupuncture treatment，with the same methods and parameters as in the electroacupuncture and the repetitive transcranial magnetic groups. After 2 weeks of intervention，Morris water maze test，transmission electron microscope collection and analysis，immunohistochemical experiment，Western ⁃ blot test and data statistical analysis were carried out. Results Compared with the model group，the escape latency in each intervention group was shorter（P < 0.01），the time in the target quadrant was significantly prolonged （P < 0.01），the thickness of postsynaptic dense zone in each intervention group was significantly larger（P < 0.01）， the activated microglia and the expression of TNF⁃α，IL⁃6 and IL⁃1β protein in each intervention group were signif⁃ icantly decreased（P < 0.01）. Compared with the EA+rTMS group，was significantly longer and the time of target quadrant exploration was significantly shorter（P < 0.01），the thick⁃ ness of postsynaptic dense zone in the EA and rTMS groups was significantly decreased（P < 0.01），the activated microglia in the electroacupuncture group and repeated transcranial magnetic group was significantly increased （P < 0.05），and the protein expression of TNF⁃ α，IL⁃6 and IL⁃1 β were significantly increased（P < 0.01）. Conclusion EA combined with rTMS can effectively improve the learning and memory ability of AD ⁃like model rats，probably by inhibiting neuroinflammatory reaction and reducing synaptic injury of neurons in mechanism. 

Objective To investigate the mechanism by which deubiquitinase constitutive photomorpho⁃ genic⁃9 signalosome subunit 5（CSN5）regulates HCC growth. Methods Through Real⁃time PCR，Western blot and Immunohistochemical staining，the expression of CSN5 and MAT2A in HCC tissues and HCC cells was detect⁃ ed. EdU assay was used to examine the proliferation capability of HCC cells. Results CSN5 was found to be signif⁃ icantly upregulated in HCC tissues and cells. CSN5 downregulation in HCC cells contributed to the cells′ inability to grow. CSN5 inhibition reduced methionine adenosyltransferase 2A expression and inhibited HCC cell prolifera⁃ tion. Conclusion CSN5 regulates HCC cells proliferation through MAT2A. 

Objective To investigate the effect of circular RNA TCF25（circTCF25）on the proliferation and migration of vascular smooth muscle cells（A7r5）induced by tumor necrosis factor α（TNF⁃α）and explore its possible mechanism. Methods After TNF⁃ α（100 ng/mL）induced A7r5，RT⁃qPCR was used to detect the expression of circTCF25，mTOR mRNA and p70S6k mRNA. CCK⁃8 assay and colony formation assay were used to detect cell proliferation，and Transwell assay was used to detect cell migration. A7r5 were transfected with circTCF25 overexpression vector，and the effects of circTCF25 overexpression on the proliferation，migration， mTOR mRNA and p70S6k mRNA expression of TNF⁃α⁃treated A7r5 were detected by the above methods. Results After TNF⁃ α induction ，the proliferation ability of A7r5 and the number of migrated cells were significantly increased，the expression of circTCF25 was significantly reduced，and the expression of mTOR mRNA and p70S6k mRNA was significantly increased（P < 0.05）. After overexpression of circTCF25，the proliferation ability was significantly impaired and the number of migrating cells was significantly reduced，and the expressions of mTOR mRNA and p70S6k mRNA of A7r5 induced by TNF ⁃ α were significantly reduced（P < 0.05）. Inhibition of the mTOR signaling pathway could alleviate the effect of circTCF25 overexpression on the activity and migration of A7r5 induced by TNF⁃α（P < 0.05）. Conclusions circTCF25 can inhibit the proliferation and migration of vascu⁃ lar smooth muscle cells induced by TNF⁃α，for it may inhibit mTOR signaling pathway in mechanism. 

Objective To analyze the correlation between the expression levels of carbonic anhydrase Ⅸ （CAⅨ）and CD8+ tumor infiltrating lymphocytes（TIL）and lymph node metastasis（LNM）in cervical cancer（CC）， and evaluate the clinical predictive value of CAIX combined with CD8 + TIL for LNM. Methods The expression levels and distribution patterns of CAIX and CD8 + TIL in 75 samples of CC by surgical resection were detected by immunohistochemical staining. The correlation between the two parameters and clinicopathological features of patients was statistically analyzed. The predictive efficacy of them for LNM was also assessed. Results The expres⁃ sion of CAⅨ was negatively correlated with the number of intraepithelial CD8+ TIL（P < 0.001），whereas positively correlated with the number of stromal CD8 + TIL（P < 0.001）.The expression of CAⅨ was significantly correlated with LNM（P = 0.002）. The expression of CAⅨ was significantly up⁃regulated with LNM（P = 0.001），whereas the number of intraepithelial CD8+ TIL was significantly decreased with LNM（P < 0.001）. The area under curve of CA Ⅸ combined with intraepithelial CD8+ TIL for predicting LNM（0.837，P < 0.001），specificity（100%），positive pre⁃ dictive value（100%）and accuracy（85.3%）were higher compared with those of CAⅨ combined with stromal CD8+ TIL and CAⅨ alone. Conclusion Hypoxia is probably involved in the regulation of CD8 + TIL. Hypoxia and in⁃ traepithelial CD8+ TIL may be closely associated with LNM is in CC. Combined detection of CAⅨ and intraepithelial CD8+ TIL could serve as a predictor for LNM in CC and reduce the misdiagnosis of LNM. 

Objective To observe the correlation between serum microRNA⁃146a（miR⁃146a）and miR⁃ 195 levels and the effect of laser treatment in patients with diabetic retinopathy（DR）. Methods 111 patients with DR admitted to our hospital from January 2018 to January 2020 were selected as the research subjects. The serum levels of miR⁃146a and miR⁃195 were detected before treatment，and laser treatment was performed. Evaluated the effect of laser treatment，analyzed the correlation between serum miR⁃146a and miR⁃195 levels and the effect of laser treatment in DR patients. Results Among 223 DR patients after laser treatment，181 cases were effective and 42 cases were ineffective；after preliminary comparing the data of the ineffective group and the effective group by Logistic regression analysis，the results showed that hypertension，pre⁃treatment serum miR⁃146a and miR⁃195 levels in DR patients were the influencing factors of laser treatment ineffectiveness（OR > 1，P < 0.05）；the receiver operating characteristic curve（ROC）was drawn and found that the pre⁃treatment serum miR⁃146a and miR⁃195 levels single predicted and combined predicted area under the curve（AUC）of laser treatment failure were both > 0.80，with certain predictive performance. Conclusion Serum miR⁃146a and miR⁃195 can be used as predictive indexes of ineffective laser treatment in DR patients. 

Objective To compare the treatment effectiveness of different chest pain practice patterns for patients with ST⁃segment elevation myocardial infarction（STEMI）during emergency care at the medical agencies in Xinhui district of Jiangmen City. Methods The clinical date on 266 patients who had been transferred from other medical agencies to our hospital in which diagnosed as STEMI and received primary percutaneous coronary interven⁃ tion（PCI）from August 2017 to July 2020 were collected. The patients were divided into the group of integrated health care system（n = 45），the cooperative hospital group（n = 134）and the non ⁃ cooperative hospital group （n = 87）. Results There were no significant differences in demographic data，Killip pump function classification and basic medical history among the three groups（P > 0.05）. Time to FMC⁃ECG completion，Time to diagnostic confirm on ECG，Time to troponin blood collection ⁃ report，Time to activation of intervention therapy room，and time to door to wire were shorter in the group of integrated health care system than in the other two groups（P < 0.001），the rate of clinical visit within two hours of onset was higher（P = 0.0259），and the hospitalization cost was lower（P < 0.001）. However，there were no significant differences in the rates of hospitalization mortality and heart failure among the three groups（P > 0.05）. Conclusions The construction of chest pain practice patterns based on integrated health care system can significantly shorten time to emergency care for patients with acute chest pain in counties and districts. 

Objective To investigate the influence of collateral circulation on curative effects and progno⁃ sis of patients with acute cerebral infarction treated with mechanical thrombectomy. Methods A total of 470 patients （322 with collateral circulation and 148 without collateral circulation）with acute cerebral infarction treated with mechanical thrombectomy between January 1，2015 and November 12，2019 were included in this study. All variables，including admission，14⁃day and 90⁃day NIHSS（National Institutes of Health Stroke Scale）scores， incidence of symptomatic cerebral hemorrhage（sICH），30⁃day mortality，hemodynamic index after operation， peripheral blood HIF ⁃ 1α，VEGF and miRNAs were collected and compared between the groups. Results The scores of admission NIHSS in the collateral circulation group were significantly lower than the non⁃collateral circula⁃ tion group（P＜0.05），but they were not significantly different among the patients with different levels of collateral circulation（P＞0.05）. After treatment，the NIHSS scores of the two groups were significantly lower than at admis⁃ sion（P＜0.05）. The 14⁃day and 90⁃day NIHSS scores of the collateral circulation group were significantly lower than the non⁃collacteral group（P < 0.05），and so it was with the incidence of sICH and 30⁃day mortality（P＜ 0.05）. The average blood flow velocity and average blood flow in the collateral circulation group were significantly higher than the non⁃collateral circulation group（P < 0.05），while the peripheral blood flow resistance was signifi⁃ cantly lower（P < 0.05）. The serum HIF ⁃1α and VEGF in the collateral circulation were significantly lower than the non⁃collateral circulation（P < 0.05）. Peripheral blood mRNA⁃210，mRNA⁃126 and mRNA⁃132 in the collateral circulation were significantly higher than non ⁃collateral circulation，while mRNA ⁃92a was significantly lower（P < 0.05）. Multivariate logistic regression analysis showed mRNA ⁃ 210（OR = 1.452，95% CI：0.949 ~ 2.222，P = 0.025），mRNA⁃126（OR = 2.277，95%CI：1.086 ~ 4.777，P = 0.002），mRNA⁃132（OR = 3.550，95%CI：1.666 ~ 7.565，P = 0.025），mRNA⁃92a（OR = 0.017，95%CI：0.001 ~ 0.325，P = 0.007）were the factors influencing the formation of cerebral collateral circulation in the patients with acute ischemic stroke（P < 0.05）. Conclusions Among patients with acute cerebral infarction treated with mechanical thrombectomy，those with collateral circula⁃ tion have less neurological deficits and better prognosis than those without collateral circulation，and the specific miRNAs in the peripheral blood in the early stage of the disease are important influencing factors for the formation of cerebral collateral circulation.

Objective To explore the clinical value of three⁃dimensional external fixation combined with inducing membrane technology for tibial infectious nonunion. Methods Retrospectively analyzed the clinical data of 68 patients with nonunion of tibal infection in our hospital from January 2015 to January 2017，32 cases receiving induced membrane technology and fixed treatment in phase Ⅱ were assigned to the control group，and 36 cases undergoing three⁃dimensional external fixation combined with inducing membrane technology were assigned to the treatment group. The postoperative bone defect healing and secondary recurrence of infection were compared between the two groups of patients，and Johner⁃Wruhs lower limb function scores were compared between the two groups of patients before and last follow⁃up. Results 88.9% of the patients in the treatment group had good bone repair after the second stage operation，and the imaging and clinical healing time were（6.58 ± 1.06）months and （8.32±1.14）months，respectively；87.5% in the control group had bone defects that were well repaired（P > 0.05）， but the imaging and clinical healing time（7.10 ± 1.02）months，（8.96 ± 1.25）months were longer than the treat⁃ ment group（t = 2.055，P = 0.044；t = 2.208，P = 0.031）；The postoperative knee flexion activity and ankle back extension of the treatment group were better than those of the control group（P < 0.05），and the proportion of sec⁃ ondary relapse infection in the treatment group was lower than that of the control group，the difference was statisti⁃ cally significant（P < 0.05）. At the last follow ⁃up，the excellent rate of the lower extremity function score of the treatment group was higher than that of the control group（P < 0.05）. Conclusion The three⁃dimensional external fixation stent combined with the inducing membrane technology has high clinical application value for tibial infec⁃ tious nonunion. The procedure is simple and has strong stability，which can not only ensure the blood supply of the periosteum to the greatest extent，but also promote the formation of the inducing membrane and reduce postopera⁃ tive complications. 

Objective To compare the efficacy and safety of two approaches：laparoscopic cholecystectomy （LC）+ laparoscopiccommon bile duct exploration（LCBDE）single⁃stage bile duct suture andendoscopic retrograde cholangiopancreatography（ERCP）+ LC. Methods A total of 275 patients with cholecystolithiasis complicated with choledocholithiasis admitted to our hospital from September 2018 to September 2020 were selected and divided into control and observation groups in the study. LC + ERCP was performed in the control group，and LC + LCBDE was performed in the observation group. The clinical efficacy and safety of the two groups were compared. Results The amount of intraoperative bleeding in the control group was lower than that in the observation group（P < 0.001）. As compared with the observation group，the hospitalization time was significantly longer，the hospitalization cost significantly larger and the rates of stone residue and abnormality of liver function were significantly higherin the control group（P < 0.05）. Logistic regression analysis showed that the factors affecting the prognosis were postopera⁃ tive blood loss，length of stay，cost and abnormal liver function indexes（P < 0.05）. The lithotomy rate of the observa⁃ tion group was significantly higher than that of the control group（P < 0.05）. There was no significant difference in the incidence of complications between the two groups（P > 0.05）. Conclusion LC + LCBDE primary bile duct suture has higher efficacy and safety，which is beneficial for the improvement of clinical liver function indexes， reduction of hospital stay and lowering of cost. It is of high value clinically，worthy of promotion and application.

Objective This article systematically evaluates and compares the clinical effects of Polyether⁃ ether ketone（PEEK）rods and titanium rods in lumbar fusion surgery. Methods A computer search of the Chinese Biomedical Literature Database，CNKI，VIP Database，Wanfang Database，PubMed，Embase and Cochrane Library for clinical trials on the use of PEEK rod in lumbar spine fusion for lumbar degenerative lesions，dated all databases will be built until November 2020. Data extraction and quality evaluation of all the included literatures were carried out，and the NOS scale was used to evaluate the methodological quality of 10 studies. Using RevMan5.3 software to conduct meta⁃analysis on JOA score，ODI score，VAS score，fusion rate，intervertebral space height， and operation time. Results A total of 10 studies were included，of which 8 were high quality and 2 were medium quality. Meta⁃analysis showed that there was no significant difference between the two groups in the JOA improve⁃ ment rate in the middle postoperative period（P＞0.05）. In the VAS score of low back pain，the VAS score of low back pain in the titanium rod group was significantly lower at 1 month after surgery（P＜0.05），and there was no significant difference at 6 months（P＞0.05）and 12 months after surgery（P＞0.05）. In the lower limb pain VAS score，there was no significant difference in 1 month（P＞0.05），6 months（P＞0.05）and 12 months（P＞0.05）. The fusion rate in the PEEK rod group was significantly higher than that of the titanium rod group（P＜0.05）. There was no significant difference in the height of the posterior intervertebral space between the two groups at 6 months after surgery（P＞0.05）. Conclusion In lumbar fusion surgery，the use of PEEK rod system could promote verte⁃ bral body fusion，obtain similar therapeutic effects as titanium rod system，and has better lumbar function perfor⁃ mance in the middle postoperative period.

Objective To study the risk factors of cervical lymph nodule metastasis（CLNM）on papillary thyroid carcinoma（PTC）based on Chinese thyroid imaging report and data system（C⁃TIRADS）. Methods A total of 194 patients diagnosed as PTC by surgery and pathological indication were included in the research. All selected participants were divided into lymph nodule metastasis group and lymph nodule negative group respectively accord⁃ ing to the presence of CLNM. Then，the relationship between C⁃TIRADS score of PTC and CLNM was analyzed by univariate and multivariate logistic regression analysis. Results The score of C ⁃TIRADS was 4.0（2.0，and 5.0） among the patients with CLNM，higher than those without cervical lymph nodule metastasis（P < 0.01）. Multivariate logistic regression analysis indicated that sex（OR = 0.288，95%CI：0.12～0.689，P = 0.005），age（OR = 0.964， 95%CI：0.936～0.992，P = 0.011），size（OR = 4.506，95%CI：2.275～8.922，P < 0.01）and number（OR = 3.502，95% CI：1.681～7.296，P = 0.001）of the nodule and C ⁃ TIRADS score（OR = 1.948，95% CI：1.227～ 3.091，P = 0.005）were risk factors for CLNM. Conclusion C ⁃ TIRADS score of PTC combined with patients′ sex，age and size and number of the nodule is of great significance in predicting CLNM of PTC. 

Objective To explore the value of ultrasonic measurement of diaphragm thickening fraction combined with diaphragm displacement in predicting successful weaning of patients with mechanical ventilation. Methods One hundred and fourteen patients who received mechanical ventilation were divided into successful weaning group（n = 87）and failed weaning group（n = 27）. The changed of the diaphragm function such as dia⁃ phragmatic thickness at the end of expiration（DTee），diaphragm thickening fraction（DTF）and diaphragmatic displacement were compared and analyzed. Multivariate logistic regression was used to analyze the influencing factors affecting the success of weaning. The ROC curve was used to analyze the potential indicators in predicting the accuracy of weaning outcome. Results The initial diaphragm thickening fraction in the successful weaning group was significantly higher than that in the failed weaning group（P < 0.05）. The diaphragmatic thickness at the end of expiration，diaphragm thickening fraction and diaphragmatic displacement during initial spontaneous breathing trial（SBT）in the successful weaning group were significantly higher than those in the failed weaning group（P < 0.05）. Multivariate logistic regression analysis showed the diaphragm thickening fraction and the diaphragm displacement during SBT were independent risk factors for weaning failure. The accuracy of diaphragm thickening fraction（AUC = 0.895，95%CI：0.832 ~ 0.957）and diaphragm displacement（AUC = 0.887，95%CI：0.821 ~ 0.954） in predicting weaning success was higher than the rapid shallow breathing index（AUC = 0.790，95%CI：0.687 ~ 0.892）. The prediction accuracy of diaphragm thickening fraction combined with diaphragm displacement（AUC = 0.966，95%CI：0.932 ~ 1.000）is higher than the single parameter. Conclusion Diaphragm thickening fraction and diaphragm displacement during SBT are independent risk factors of weaning failure in patients with mechanical ventilation. Diaphragm thickening fraction and diaphragm displacement are effective predictors of successful wean⁃ ing of mechanical ventilation and the combination of the two has higher value than the single parameter.

Objective To explore the safety，feasibility and clinical value of No.253 lymph node dissection in indocyanine green（ICG）fluorescence⁃guided laparoscopic colorectal cancer surgery. Methods Clinical data of 145 patients with colorectal cancer in our department from Jun. 2019 to Jan. 2021 were retrospectively analyzed. Of the total，68 patients（ICG group）received submucosal injection of ICG via colonoscopy 1 to 3 days before surgery，followed by fluorescence imaging laparoscopic radical colorectal cancer surgery and 77 patients（control group）underwent routine laparoscopic radical resection of colorectal cancer at the same time. Whether ICG fluores⁃ cence navigation had advantages in No.253 lymph node dissection，and whether there were differences between the two groups in terms of operation time，estimated blood loss，postoperative recovery and short ⁃term complications were analyzed. Results The comparison of lymph node development and dissection between the two groups showed that there were 68 cases of successful lymph node fluorescence development in ICG group，with success development rate of 100%；60 cases in the control group，with a success rate of 88.2% in. The total number of lymph nodes detected in ICG group，the total number of positive lymph nodes and the total number of No.253 lymph nodes were significantly higher than those in the control group（P < 0.05）. The number of positiveNo.253 lymph nodes detected in ICG group had no statistical difference when compared with that in the control group（P > 0.05）. There was no significant difference between ICG group and the control group in terms of operation time，estimated blood loss，time of first ambulation after operation，time of first anal exhaust after operation，time of first liquid food intake after operation，postoperative hospital stay and short ⁃ term complications （P > 0.05）. Conclusion No.253 lymph node dissection in ICG fluorescence ⁃guided colorectal cancer surgery is safe and feasible. It has certain clinical application value. 

Objective To explore the efficacy of sublingual immunotherapy（SLIT）with dermatophagoi⁃ des farinae drops in the treatment of mite allergen⁃induced allergic rhinitis（AR）at different treatment courses in children. Methods The data on 120 pediatric patients with mite allergen⁃induced AR，who had been treatment in the ENT department of Huazhong University of Science and Technology Union Shenzhen Hospital since 2013，were reviewed. Integral follow⁃up data was collected and a four⁃year course of treatment with SLIT was completed. A follow⁃up was started before therapy and every three months during the treatment. After therapy，total nasal symptom score（TNSS），total rhinitis medication scores（TRMS），visual analogue scale（VAS），and rhinoconjunctivitis quality of life questionnaire（RQLQ）scores were assessed；and adverse reactions were recorded. Results After one⁃year SLIT，TNSS，TRMS，VAS and RQLQ scores were significantly improved than the baselines（P < 0.05）； TNSS，TRMS，VAS and RQLQ scores，as compared with the one ⁃year therapy，were significantly improved two years after SLIT（P < 0.05）. VAS and RQLQ scores on the three⁃year therapy with SLIT were significantly improved than those on the two⁃year treatment with SLIT（P < 0.05）. TNSS，TRMS，VAS and RQLQ scores did not differ significantly between the three⁃year and the four⁃year therapies（P > 0.05）. There were no significant differences in the rate of adverse events among the one⁃year，two⁃year，three⁃year and four⁃year therapies（P > 0.05）. All the pediatric patients had no serious adverse reactions. Conclusions More than two years of SLIT，as compared with one year of therapy，has better effects for mite allergen⁃induced AR in children. VAS and RQLQ scores on the three⁃ year therapy with SLIT improve more markedly than those on the two⁃year therapy. Therefore，children should be treated for at least two years，and the 3⁃year therapy is the optimal course.

Objective To investigate the value of serum γ⁃glutamyl transpeptidase（GGT），direct biliru⁃ bin（DB），total bile acid（TBA）and alanine amino transferase（ALT）in the diagnosis of biliary atresia（BA）. Methods A total of 544 infants with cholestasis who were hospitalized and received treatment from January 2013 to January 2020 were enrolled in this study. According to the results of intraoperative cholangiography，they were divided into BA group with 268 infants and non⁃BA cholestasis group with 276 infants. Serum levels of GGT，DB， TBA and ALT were compared between the two groups. According to the age，infants were divided into 1 ~ 2 month group，2 ~ 3 month group and over 3 month group，and the four indexes were also analyzed among 3 group. A receiver operating characteristic（ROC）curve analysis was performed for indexes with statistical significance，and the area under the ROC curve（AUC）and the optimal cut ⁃off value for diagnosis were calculated. Results The BA group had a younger age of onset than that in the non⁃BA cholestasis group（P＜0.05）. There was no signifi⁃ cant difference in sex between the two groups，while the BA group had significantly higher serum levels of GGT， DB，TBA and ALT than those in the non⁃BA cholestasis group（P＜0.001）. GGT had the highest AUC of 0.828 （95% CI：0.794 ~ 0.863）in the diagnosis of BA，and at the optimal cut⁃off value of 276U/L it had a sensitivity of 70.8% and a specificity of 80.1%. GGT also had the highest AUC in the 1 ~ 2 month group（AUC = 0.857，95% CI： 0.804 ~ 0.910）and 2 ~ 3 month group（AUC = 0.883，95% CI：0.828 ~ 0.939）with the cut⁃off values of 194 U/L， 340 U/L. DB had the highest AUC of 0.758（95% CI：0.674 ~ 0.841）in the over 3 month group，and at the opti⁃ mal cut⁃off value of 112.45 μmmol/L，it had a sensitivity of 81.3% and a specificity of 64.8%. Conclusions Both GGT and DB had good diagnostic value for BA. GGT had good diagnostic value for children aged 1~3⁃month partic⁃ ularly，while DB had better diagnostic value for children aged over 3 months. 

Objective To investigate the epidemiological characteristics of meningococcal meningitis （MM）in children aged 0 ~ 2 years among Anhui province from 2004 to 2019，to evaluate the effect of immunization strategy，and to provide evidence for the control and prevention of MM. Methods The descriptive epidemiological methods were used to analyze data from China information system for disease control and prevention during 2004- 2019. Results from 2004 to 2019，124 MM cases were reported totally，and the average annual incidence rate of MM among children aged 0 ~ 2 years in Anhui was 0.33/100 000，the average annual death rate was 0.10/100 000， the average annual fatality rate was 29.84%. Most MM cases among children aged 0 ~ 2 years occurred during winter⁃ spring. The case number and annual incidence rate of Hefei were highest. Serogroup A ，serogroup B and serogroup C were detected in cases，moreover，Serogroup A and serogroup C cases occurred before 2009，Serogroup B cases occurred after 2012. Antibody level against serogroup A and serogroup C declined among 69 children aged 0 ~ 2 years after primary vaccination，positive rates of antibodies against serogroup A and serogroup C were 84.06% and 47.83% in children when they were three years old. Conclusion The reported incidence of MM cases in children aged 0 ~ 2 years declined from the peak and remained at a low and sporadic level in recent years in Anhui during 2004-2019. The adjustment of primary immunization strategy in Anhui Province was targeted. Serogroup B cases occurred in recent years. Antibody level against serogroup A and serogroup C declined among children declined after primary immunization. Booster immunity in time was required. Strengthening immunization and enhancing surveillance were recommended.

Objective To observe the effect of a comprehensive program based on the theory of multi⁃ sensory stimulation on the sleep function in elderly patients with post ⁃ischemic stroke insomnia（PSI）. Methods A total of 72 PSI patients were selected from our hospital and randomly divided into observation group and control group. The observation group adopted a comprehensive plan based on the multi⁃sensory stimulation theory，that is， a variety of interventions were creatively compressed in a sleeping house within one hour at one location；the con⁃ trol group was treated with conventional western medicine，and both groups were intervened for 4 weeks. Pittsburgh Sleep Quality Index（PSQI），Athens Insomnia Scale（AIS），Anxiety Self⁃Rating Scale（SAS），serum tumor necrosis factor alpha（TNF⁃α），interleukin 6（IL⁃6），serotonin（5⁃HT），sleep chart were used to monitor sleep efficiency，total sleep time，number of night awakening before intervention，4 weeks after intervention，and 3 months after intervention；The sleep efficacy was determined 3 months after the intervention. Results In terms of PSQI score，the two groups after 4 weeks of intervention were lower than those before the intervention，and there was no significant difference between the two groups（P > 0.05）；3 months after the intervention，the observation group was lower than the control group（P < 0.05）. In terms of AIS scores，the two groups were lower than before the intervention for 4 weeks，and the control group was lower than the observation group（P < 0.05）；the observation group was higher than the control group 3 months after the intervention，the difference was statistically significant Meaning（P < 0.05）. In terms of SAS scores，the two groups were lower than before the intervention for 4 weeks， and the observation group was lower than the control group（P < 0.05）；the observation group was lower than the control group 3 months after the intervention，the difference was statistically significant Meaning（P < 0.05）. In terms of TNF⁃α and IL⁃6，the two indicators of the two groups were lower than before the intervention for 4 weeks and 3 months after the intervention. The comparison between the two groups was lower than the control group at both time points，and the difference was statistically significant（P < 0.05）. In terms of 5⁃HT，the two groups were higher than before the intervention 4 weeks after the intervention，while the observation group was higher than before the intervention 3 months after the intervention（P < 0.05），while the control group was not different from before the intervention（P > 0.05），the observation group was higher than the control group，the difference was statistically significant（P < 0.05）. In terms of sleep efficiency in sleep patterns，the two time nodes of the two groups were higher than before the intervention for 4 weeks and 3 months after the intervention，and the observation group was higher than the control group in comparison between the groups，and the difference was statistically significant （P < 0.05）. In terms of total sleep time，after 4 weeks of intervention，both groups were higher than before inter⁃ vention，and the comparison between the two groups was higher than the observation group in the control group， the difference was statistically significant（P < 0.05）；only the observation group was higher in the 3 months after intervention Before the intervention，there was no statistical difference in the control group（P > 0.05），and the observation group was higher than the control group in comparison between the groups，and the difference was statistically significant（P < 0.05）. In terms of the number of night awakening，the two time points of the two groups were lower than those before the intervention for 4 weeks and 3 months after the intervention，and the difference was statistically significant（P < 0.05）；and the comparison between the groups was two weeks after the intervention. There was no difference between the two groups，the observation group was lower than the control group 3 months after intervention，and the difference was statistically significant（P < 0.05）. In terms of curative effect，3 months after the intervention，the marked efficiency of the observation group was 83.33% and that of the control group was 30.56%，the difference was statistically significant（P < 0.05）. Conclusion A comprehensive program based on the multi⁃sensory stimulation theory could not only effectively relieve sleep disorders and anxiety symptoms ，but also integrate multiple treatments with high efficiency to fully utilize the treatment time. It is worthy of further clinical study and promotion. 

Objective To explore the effect and influence of comprehensive rehabilitation model on stable schizophrenia inpatients under closed management. Methods 100 cases of stable schizophrenia inpatients treated in a tertiary grade A psychiatric hospital were randomly assigned to study group and control group，with 50 cases in each group. The control group was given routine rehabilitation activities ，and the intervention group was added in ⁃ward comprehensive rehabilitation mode. Negative symptom scale，social function rating scale for inpatients with mental illness and anxiety self ⁃ rating scale were used for evaluation before and after the intervention，and body mass index was recorded also. Results Covariance analysis showed that the differences between the two groups before and after intervention were statistically significant in body mass index，negative symptoms and their dimensions，inpatient psychiatric patients′ social function and their ability to live a daily life ，initiation and communication（P < 0.05）. Conclusion In ⁃ ward comprehensive rehabilitation training can effectively relieve those inpatients′ anxiety，improve negative symptoms，and promote social functions，in conclusion，it provides an new way of rehabilitation for the closed management of psychiatric department.

Cerebral ischemia/reperfusion（I/R）injury secondary to ischemic stroke is associated with a high mortality and disability. Long non⁃coding RNAs（lncRNAs），one of non⁃coding RNAs，can regulate gene expression at the epigenetic ，transcriptional and post ⁃transcriptional levels. Acting as endogenous sponges of microRNAs（miRNAs），it can inhibit the negative regulation of miRNAs on mRNAs by suppressing the expression of miRNAs，which functions as a regulatory axis in mechanism. Numerous studies have found that the lncRNAs ⁃ miRNAs ⁃mRNAs regulatory axis is involved in the pathological process of cerebral I/R injury. This paper reviews the research advances in the role of the axis in cerebral I/R，and looks into the mechanism of lncRNAs and miR⁃ NAs in the treatment of ischemic cerebrovascular diseases. 

Membranous nephropathy （MN）is the most common pathological type of adult nephrotic syndrome. At present，the diagnosis mainly depends on renal biopsy. Recent studies have found that the specific biomarkers phospholipase A2 receptors and thrombospondin type 1 domain ⁃ containing 7A have importantsignifi⁃ cance as a non⁃invasive procedure in diagnosis of MN，detection of disease changes，and assessment of prognosis， which can partly replace renal biopsy. Thanks to the discovery of these biomarkers，the pathogenic effect of immune⁃ related factors in MN has been further confirmed. Therefore ，targeted therapeutic drugs led by rituximab have become a new choice for the treatment of MN.In addition，other types of anti ⁃CD20 monoclonal antibodies have been found to be an alternative for rituximab⁃resistant patients. This article reviews the research progress in the diagnosis and treatment of MN.