Mesenchymal stem cells（MSCs）have become a hot spot in the field of modern biology due totheir plasticity，low immunogenicity，immune regulation and self⁃renewal ability，and in numerous researches onbody injury repair，tissue function reconstruction，immune regulation and gene therapy. However，the problems ofstem cell therapy still exist，such as safety，low rate of survival，differentiation and less homing quantity，and thereis also a risk of tumorigenesis. Meanwhile，many studies have found that MSCs play their role of repair，regulationand treatment mainly through paracrine mechanism. Extracellular vesicles（EVs）secreted by MSCs not only retainthe biological activity of parental MSCs，and show similar therapeutic potential，but also compensate for someshortcomings in stem cell therapy. Therefore，MSCs⁃derived extracellular vesicles（MSC⁃EVs）have gained wideattention in many fields. In this article，the paracrine role of MSCs and its latest research progress and clinicalapplication in myocardial repair，respiratory system，immune regulation and other fields are reviewed.

Objective To explore the high risk factors associated with severe and critical patients withcoronavirus disease⁃2019（COVID⁃19）by propensity score matching analysis（PSM），and to improve the ability ofthe early recognition and intervention，and thus to realize higher survival rate of these patients. Methods 292 patientswith laboratory confirmed COVID⁃19 admitted to the Third Hospital of Wuhan from January 27，2020 to March 18，2020 were selected. According to the symptoms，the patients were divided into two groups：213 mild/moderatepatients and 79 severe/critical patients. By PSM，a total of 165 cases were included，of which 101 were mild/mod⁃erate patients and 65 were severe/critical patients. Baseline characteristics，laboratory findings，clinical outcomeand ECG data of these patients were collected，and the risk factors of severe/critical patients with COVID⁃19 andtheir outcome were explored by using a COX model. Results Before PSM，The difference of age，sex，hyperten⁃sion，coronary heart disease history and the ratio of cardiovascular diseases with or less than 2 types of cardiovascu⁃lar system was statistically significant between the two groups. However，after PSM，there were no significant differ⁃ences（P > 0.05）. There were significant differences in WBC count and lymphocyte count between the two groupsbefore PSM（P < 0.05），while only WBC count after PSM was statistically significant（P < 0.05）. CRP increased，blood calcium decreased and mortality was high in observation group before and after PSM，and the differenceswere statistically significant（P < 0.05）. There were significant differences in ECG changes between the two groupsbefore PSM in premature beat，concave ST segment elevation and T wave depression（P < 0.05），but only the con⁃cave ST segment elevation after PSM was statistically significant（P < 0.05） Cox regression analysis showed that SpO2，WBC count and CRP were risk factors of severe/critical COVID⁃19 patients after adjusting for age，gender，lymphocyte count，hs ⁃TnI and blood calcium，the odds ratios（OR）were respectively 1.059（95% CI：1.003 ~1.119，P < 0.05），0.938（95% CI：0.921 ~ 0.955，P < 0.05），1.004（95% CI：1.001 ~ 1.007，P < 0.05）. ConcaveST segment elevation was not a risk factor for severe covid⁃19 patients，but an independent risk factor for death inCOVID⁃19 patients，OR was 3.095（95% CI：1.657 ~ 5.782，P < 0.05）. Conclusion According to propensitymatching analysis，decreased SpO2，increased white blood cell count and CRP were risk factors for severe covid⁃19patients. In addition to older age and decreased SpO2，concave ST segment elevation was an independent risk factorfor death in severe/critical COVID⁃19 patients.

Objective To investigate the effect of pirinixic acid（WY⁃14643），the peroxidase proliferator⁃activated receptor⁃alpha agonist（PPAR⁃α agonist），on oxidative stress and apoptosis of parahepatic tissues in livercancer after transcatheter arterial embolization（TAE）. Methods VX2 liver cancer model with 60 rabbits weresuccessfully established，the rabbits randomly divided into three groups：the control，TAE and combined treatment（WT），20 in each. The TAE group was treated with TAE operation，the WT group with injection of WY⁃14643［3 mg/（kg·d）］through the ear vein for 3 consecutive days before TAE，and the control group did not receive anytreatment. After operation，4ml of peripheral blood was drawn from the ear vein for examinations of liver functionindicators ALT and AST，followed by detection of oxidative stress indicators SOD，GSH⁃Px，CAT and MDA usingchemiluminescence，detection of apoptosis of the liver cells and calculation of the apoptotic index （AI）usingTUNEL，and detection of the mRNA and protein expressions of SOD1，Bcl⁃2 and caspase⁃3 using RT⁃qPCR andWestern blot. Results The liver function indexes，MDA content and expressions of AI and Caspase⁃3 in the TAEgroup were significantly increased，and the SOD，GSH⁃Px，CAT activity and expressions of SOD1 and Bcl⁃2 inthe TAE group were significantly decreased. The data in the WT group were opposite the TAE group（P < 0.05）.Conclusion PPAR⁃ α agonist pirinixic acid can inhibit oxidative stress by enhancing the activity of antioxidantenzymes SOD，GSH ⁃Px and CAT and enhancing the expressions of SOD1，reduce cell apoptosis by upregulatingthe expression of Bcl⁃2 and downregulating the expression of Caspase⁃3，so that the damage to liver tissues adja⁃cent to cancer after TAE can be mitigated.

Objective To investigate the activation of p38/p53 signaling pathway in hippocampal neuronsof rats with status epilepticus（SE）and its protective effect on neuron injury after epilepsy. Methods Forty ratswere randomly divided into normal control group，epilepsy group，inhibitor group and dimethylsulfoxide solventcontrol group. A lithium chloride ⁃ pilocarpine epileptic rat model was established. HE staining was used to detectthe pathological changes of neurons in hippocampal CA1 region of rats and immunohistochemical staining to observethe staining of p38/p⁃p38 and p53/p⁃p53 positive cells. Results Many degenerated and necrotic neuron cells werefound in hippocampal CA1 region of SE rats，and they were obviously decreased in number in the inhibition group.The number of p38/p ⁃p38 positive cells in the epilepsy group increased at each time point compared with thecontrol group，reaching the peak at hour 2 and beginning to decrease at hour 6. The number of positive cells in theinhibitor group was smaller than that in epilepsy group. Across the time points，the number of p53/p⁃p53 positivecells in the epilepsy group at each time point was larger than that in control group；The longer seizure lasted，thenumber of positive cells the larger；The number of positive cells in the inhibitor group was smaller than that in theepilepsy group. Conclusion P38 inhibitor has certain protective effect on SE rat neuron injury，probably becausethe p53 gene⁃mediated apoptosis pathway is blocked in mechanism.

Objective To investigate the effect of miR⁃209 down regulating the MEK/ERK signal pathway on the proliferation and radiosensitivity of glioma U87 cells. Methods The expressions of miR ⁃209，MEK and ERK mRNA in U87 cells before and after radiotherapy were detected by Real Time PCR. After miR⁃209 transfection， the expressions of miR⁃209，ERK and MEK were detected by Western blot and real time PCR. Results After radiotherapy，the relative expression of miR⁃209 in U87 cells decreased（t = 2.491，P = 0.0374），and there was no significant difference in ERK and ERK mRNA expressions between pre⁃ and post⁃radiotherapy. After the miR⁃209 was transfected to the U87 cells，the MEK mRNA expression decreased（0.11 ± 0.05），The ERK mRNA expression decreased（F = 9.891，P = 0.002 9），and the p⁃MEK and p⁃ERK expressions both decreased，and cell prolifera⁃ tion was inhibited. Conclusion miR⁃209 can inhibit cell proliferation and enhance radiosensitivity by down regu⁃ lating the expression of MEK⁃ERK in U87 cells.

Objective To explore the risk factors of heart failure（HF）in patients with ST⁃segment elevation myocardial infarction（STEMI）after primary percutaneous coronary intervention（PPCI）during hospitalization. Methods The medical data on 118 patients with STEMI who had undergone PPCI from June 2018 to May 2020 were collected in our hospital. The patients were divided into HF group（n = 58）and non⁃HF group（n = 60）. The relationship between the influencing factors and the occurrence of HF was analyzed. Results The percentage of diabetes and multi ⁃vessel lesions，and levels of HbA1c，fasting blood glucose，BNP and cTnI peak were signifi⁃ cantly higher in HF group than in non⁃HF group（P < 0.05）. The Syntax score was significantly higher and the total ischemic time（TIT）was markedly longer in HF group than in non⁃HF group（P < 0.05 for both comparisons）. The multivariate binary logistic regression analysis showed that Syntax score ，multi⁃vessel lesions ，and TIT were independent risk factors of HF in patients with STEMI during hospitalization after PPCI（P < 0.05），whereas hemo⁃ globin was a protective factor of HF. The ROC curve showed that Syntax score and TIT could be used as predictors of HF. The AUC were 0.877 and 0.786，the best cut⁃off point was 18.5 points and 221.5 min，the sensitivity was 89.7% and 91.4%，and the specificity was 68.3% and 55.0%. Syntax score combined with TIT was also used as pre⁃ dictor of HF，and the AUC was 0.922. Conclusions Patients with higher Syntax score，multi⁃vessel lesions，and longer TIT were more likely to develop HF during hospitalization after PPCI. Hemoglobin was a protective factor. Combination of Syntax score with TIT had higher predictive value for HF patients with STEMI after PPCI during hospitalization.

Objective To investigate the relationship between 9p21.3 non⁃coding RNA（LncRNA ANRIL） copy number variations（CNVs）and pulmonary hypertension（PAH），and provide a scientific theoretical basis for the pathogenesis of PAH. Methods Based on a case⁃control study of 587 PAH patients as the case group and 736 healthy adults as the control group in southern China，the genotype of ANRIL CNVs was detected by TaqMan meth⁃ od，and the correlation between ANRIL CNVs and PAH was analyzed. A series of biological experiments revealed that CNVs were the molecular mechanism affecting the occurrence of PAH. Results ANRIL CNV ⁃2738282 was significantly associated with the incidence of PAH in the population. Loss of copy number could reduce the risk of PAH（OR = 0.40，95% CI：0.31 ~ 0.53）. The deletion of CNV⁃2738282 copy number can decrease the expression of ANRIL，and then alter the transcriptional regulation of target gene CARD8 by ANRIL，thus affect the occur⁃ rence of PAH. Conclusion ANRIL CNV ⁃2738282 is associated with PAH and can be used as a biomarker for PAH susceptibility assessment.

Objective To study the feasibility and clinical efficacy of homemade device（calcaneal trac⁃ tion and reduction control）in the adjuvant calcaneal fracture therapy for surgical treatment. Methods 40 calcaneal fracture patients（41 feet）were collected from January 2014 to August 2016 in Changzhou first people′s hospital. 20 patients（21 feet）were treated with adjuvant homemade device（experiment group），and other patients were treated with traditional method（control group）. According to the radiographic criterion，the plantar imaging exami⁃ nation was followed up. Meanwhile，the postoperative function was evaluated by Maryland Foot Score system， AOFAS and VAS soccer. Results 39 patients（40 feet） were successfully followed up for five years. They all acquired almost normal calcaneus length，height，width，Bohler angle and Gissane angle one year after surgery. And they also have significantly improved Maryland Foot Score，AOFAS score and VAS score one year after surgery compared with pre ⁃ operation. The difference of calcaneus length，height，width，Bohler angle，Gissane angle， Maryland Foot Score，and AOFAS score were significance different between experimental group and control group after five years surgery（P < 0.05）. No patients had incision healing delay or wound infection after surgery. Conclusion The homemade device（calcaneal traction and reduction control）can restore bone length，height， width and calcaneal axis after calcaneal fracture surgery，which is worth popularizing in the clinical treatment.

Objective To explore the effect of progesterone（P4）level on hCG day on embryo quality， and cumulative live birth rate in freeze⁃all strategy patients. Methods From January 2016 to December 2018， patients under 36 years old with first IVF cycle，antagonist or agonist protocol in freeze⁃all strategy were retrospec⁃ tively analyzed and divided into four groups according to their hCG ⁃day P4 levels：group 1（< 0.50 ng/mL，n = 801），group 2（0.50 ~ 1.14 ng/mL，n = 1 626），group 3（1.15 ~ 1.49 ng/mL，n = 499）and group 4（≥ 1.50 ng/mL， n = 997）. The control group was group 2. Results Compared with the control group，the rate of high⁃quality em⁃ bryos and frozen embryos in group 1 increased significantly（P < 0.01），while that in group 4 decreased significantly （P < 0.01）. The cumulative live rate in group 4 were significantly lower than those in the control group（69.71% vs. 75.83%，P < 0.001）. Multivariate regression analysis showed that group 4 significantly reduced the cumulative live birth rate（AOR = 0.759，95%CI：0.63 ~ 0.91，P < 0.01）；group 1 did not affect the cumulative live birth rate（AOR = 0.901，95%CI：0.74 ~ 1.10，P > 0.05）. Conclusion P4 level ≥ 1.5 ng/mL on hCG day significantly reduced the cumulative live rate，which may relate to the decrease of the high ⁃quality embryo rate and frozen embryo rate；P4 level < 0.5 ng/mL did not affect embryo quality and cumulative live birth rate in freeze⁃all strategy cycles.

Objective To investigate the clinicopathological characteristics and survival analysis of patients with gastric cancer with left supraclavicular lymph node metastasis. Methods The gastric cancer database entered from 2010 to 2019 in the Department of Surgery of the Third Hospital of Hebei Medical University from 2010 to 2019 was retrieved，and the ultrasound ⁃guided puncture pathology to confirm the left supraclavicular lymph node metastasis was screened out. The clinical pathological characteristics，survival and related prognostic factors were analyzed. Results A total of 286 cases of gastric cancer with left supraclavicular lymph node metastasis were retrieved，accounting for 2.62% of the total number of gastric cancer patients admitted during the same period. Among them，there were 157 males（54.90%）and 129 females（45.10%），and the median age was 59 years old. 79 cases（27.62%）were located in the cardia，69 cases（24.13%）in the gastric body，and 91 cases（31.82%）in the antrum，47 cases（16.43%）of whole stomach；192 cases（67.13%）with lesions ≥ 5 cm，94 cases（32.87%） with lesions less than 5 cm；103 cases（36.01%）with Borrmann classification of type Ⅰ to Ⅱ，and type Ⅲ to Ⅳ 183 cases（63.99%）；65 cases（22.73%）of high⁃medium differentiated adenocarcinoma，and 221 cases（77.27%） of low⁃undifferentiated adenocarcinoma. Of the 286 patients with gastric cancer with supraclavicular lymph node metastasis，277（96.85%）were followed up，with a 2⁃year overall survival（OS）of 51.26% and a 2⁃year progres⁃ sion⁃free survival（PFS）of 42.24%. COX multivariate analysis showed that the tumor tissue type was poorly differ⁃entiated⁃undifferentiated type（HR = 2.164，95%CI：1.085～8.316，P = 0.028），and the depth of invasion was cT4a～cT4b stage（P = 0.005），tumor marker CEA（P = 0.007），combined with positive abdominal exfoliation cytology and peritoneal metastasis（P = 0.001）is an independent risk factor affecting the prognosis of gastric cancer patients with left supraclavicular lymph node metastasis，and they received conversion therapy（including systemic chemotherapy or systemic chemotherapy + HIPEC chemotherapy）（P = 0.001）and R0 surgery treatment is a pro⁃ tective factor affecting the prognosis（P = 0.001）. Conclusion The prognosis of gastric cancer patients with left supraclavicular lymph node metastasis is poor，which is closely related to a variety of clinical factors，and active conversion therapy could improve the prognosis.

Objective To explore the correlation among BMI，serum adipocytokines and general clinical characteristics of colorectal cancer patients. Methods According to BMI，110 patients with colorectal cancer were divided into the normal weight group（control group，n = 62），and overweight and obese group（experimental group，n = 48）. Serum levels of adiponectin，leptin，TNF⁃α and VEGF in two groups were compared. The baseline characteristics of patients with colorectal cancer in different BMI groups were compared，and regression analysis was performed on their postoperative survival for five years. Results Serum levels of leptin，TNF⁃α and VEGF in the overweight and obese group were significantly lower than those in the control group，and adiponectin level was significantly higher than that in the control group（P < 0.05）. There were no significant differences in male ratio， age，tumor size，tumor location，tumor differentiation，lymph node metastasis and TNM stage between the two groups（P > 0.05）. A significant negative correlation was observed between BMI and adiponectin（P < 0.05），and a significant positive correlation was also found among leptin，TNF⁃α and VEGF（P < 0.05）. The results of the survival curve showed that the difference in survival time distribution was statistically significant between the two groups（χ2 = 4.976，P = 0.026）. Logistic regression analysis showed that tumor differentiation degree，lymph node metastasis and TNM stage were risk factors for 5⁃year survival（P < 0.05），while BMI was not an influential factor for 5⁃year survival（P > 0.05）. Conclusions Abnormal expression of serum adiponectin，leptin，TNF⁃α and VEGF in overweight colorectal cancer patients showed a certain correlation with BMI. The main factors influencing the long ⁃term prognosis were tumor differentiation，lymph node metastasis and TNM stage. Body mass index has a certain effect on five⁃year survival，and the mechanism involved needs to be further investigated. 

Objective As a primary solution to the adenomyosis，the levonorgestrel⁃releasing intrauterine system（LNG⁃IUS）is clinically vitiated for its high rate of expulsion/downward displacement. This study aimed to study the expulsion/malposition rate，effectiveness，and side effects by modifying the LNG ⁃ IUS and anchoring it into the myometrium. Methods A total of 41 patients with adenomyosis who had LNG⁃IUS downward displacement/ expulsed visiting our hospital January 2014 to March 2018 were enrolled as the experimental group and treated with the modified LNG⁃IUS，while another 41 patients during the same period，as the control group，were treated with LNG⁃IUS after GnRH⁃α treatment. Results Among the experiment group，the modified system in 2 patients were expulsed respectively at months 12 and 18 after anchoring，with a total expulsion rate of 4.9% in 36 months. In the control group the total expulsion rate was 19.5%，with significant difference between the groups（χ2 = 4.100， P = 0.043）. In the experiment group，the LNG ⁃ IUS positions in the 39 patients without expulsion were properly fixed in uterus without ectopic displacement and infection during observation period. As compared with pretreat⁃ ment，the differences of both groups were statistically significant within one year treatment in terms of the degree of dysmenorrhea（VRS score），menstrual volume（PBAC score），uterine volume and hemoglobin（all P > 0.05）. Conclusion The Modified LNG⁃IUS is safe，effective，economical and simple in reducing the rate of LNG⁃IUS expulsion/downward displacement in adenomyosis patients with expulsion or malposition of LNG⁃IUS

Objective To investigate the predictive value of remnant cholesterol（RC）level in patients with acute cerebral infarction（ACI）. Methods A total of 120 patients with ACI who were first diagnosed in our hospital from January 2020 to December 2020 in Ruyuan County People′s Hospital were selected as the research group. 120 healthy subjects during the same period were selected as the control group. The levels of RC，total cho⁃ lesterol（TC），low⁃density lipoprotein cholesterol（LDL⁃C），high⁃density lipoprotein cholesterol（HDL⁃C）and non⁃ high density lipoprotein cholesterol（non⁃HDL⁃C）were analyzed by correlation analysis and ROC curve to evaluate the predictive value on the incidence of ACI. Results The levels of LDL⁃C，HDL⁃C，RC，and non⁃HDL⁃C in the research group were significantly higher than those in the healthy control group，and the difference was statistically significant（P < 0.05）. Between the two groups，there is no significant statistical difference in TC levels（P > 0.05）. Logistic multivariate regression analysis showed that TC，LDL⁃C，HDL⁃C，RC and non⁃HDL⁃C are all risk factors for ACI. Compared with other indicators，further ROC analysis showed that the level of RC has a better predictive value for the occurrence of ACI. Conclusion RC has certain predictive and diagnostic value for the onset of ACI. 

Objective To study the immunoregulatory mechanism of interleukin ⁃6（IL ⁃6）/IL ⁃6 receptor axis and its correlation with hepatitis B virus（HBV）genotype in patients with HBV infection. Methods 96 patients with HBV infection treated in our hospital from June 2017 to December 2019 were selected into the study group， and some healthy people in our hospital during the same period were selected into the control group. The serum levels of IL⁃6 and sIL⁃6R were compared. According to the genotype，the infected patients were mainly divided into B genotype and C genotype，while a few A genotype and A/C mixed genotype were not included in the study. The levels of IL ⁃6/IL ⁃6 receptor axis and HBV DNA were compared between the two groups. Pearson correlation was used to analyze the correlation between IL⁃6，sIL⁃6R and HBV genotypes，and partial correlation was used to analyze the correlation between serum IL⁃6，sIL⁃6R and HBV DNA level. Results The serum levels of IL⁃6 and sIL⁃6R in the study group were significantly higher than those in the control group（P < 0.05）. Serum HBV DNA and IL⁃6/IL⁃6 receptor axis levels of C genotype were significantly higher than those of B genotype patients（P < 0.05）. Pearson correlation analysis showed IL⁃6 and sIL⁃6R were correlated with HBV genotype（r = 0.543，0.513）. Partial correlation analysis showed that log HBV DNA was positively correlated with IL⁃6 and sIL⁃6R（partial correlation coefficient were 0.501，0.459），（P < 0.05）. Conclusion The immunomodulation of IL ⁃6/IL ⁃6 receptor axis is closely related to HBV infection. Among them，the IL⁃6/IL⁃6 receptor axis of C genotype infection is in a state of high expression，which is positively related to HBV⁃DNA load. 

Objective To explore the different applications of anesthesia for hematologic diseases⁃induced thrombocytopenia in cesarean section. Methods A total of 297 cases with hematologic diseases⁃induced thrombo⁃ cytopenia who underwent cesarean section in the past 12 years were analyzed retrospectively. Patients were divided into general anesthesia（GA）and local anesthesia（LA）groups. General data of patients，blood routine indexes and coagulation function indexes before surgery and obstetric data were acquired. The pregnancy history and pres⁃ ent outcome of puerperas and children were collected by phone call. Results The account of planet before surgery of group GA were significantly lower than that of group LA（P < 0.05）. The Apgar scores at 5 min after delivery and the rate of postoperative analgesia were higher in group LA（P < 0.05）. There were no significant differences in the present outcome of puerperal physical conditions and fetal growth（P > 0.05）. Conclusions For puerperas with serious hematologic conditions（thrombocytopenia，a series of abnormal blood indexes，ASA physical status Ⅳ or Ⅴ and so on），general anesthesia was recommended. Intravertebral anesthesia could be the best choice if there were no contraindications in patients. There was no significant difference in the prognosis of mothers and children between general anesthesia and local anesthesia.

Objective To investigate the reproducibility and consistency of five⁃repetitionsit⁃to⁃stand test in patients with lumbar degenerative diseases. Methods From January 2019 to May 2020，a total of 63 patients with definite diagnosis of lumbar degenerative disease were selected according to inclusion and exclusion criteria. 5R⁃STS，VAS and ODI were carried out. Paired T⁃test was used to analyze the differences of the two measurements. Interclass correlation coefficients（ICC）were used to analyze the reproducibility of the 5R⁃STS test，and Bland⁃ Altman plot was used to analyze the range of consistency.Pearson correlation was used to analyze the correlation between 5R⁃STS and VAS low back pain，VAS leg pain and ODI score. Results Paired t test showed that the difference between the two repeated measurements was not statistically significant（t = -1.776，P = 0.080 6）. The two repeated measurements showed good consistency，with the correlation coefficient ICC value 0.978 2（95% CI： 0.964 2 ~ 0.986 8，P < 0.05）. 5R⁃STS was positively correlated with VAS low back pain（r = 0.443 8）and ODI （r = 0.660 8）. However，5R⁃STS had no significant correlation with VAS leg pain. Conclusion The 5R⁃STS test could be used as a supplementary measure for functional evaluation in lumbar degenerative diseases，which provides high reproducibility and is consistent with VAS low back pain and ODI score to some extent

Objective To explore the impact of total endoscopic thyroid surgery via air⁃free transaxillary approach on function of recurrent laryngeal nerve（RLN）. Methods A total of 300 patients met the criteria for inclusion and exclusion were divided into endoscopy group（n = 150）and open group（n = 150）. The patients in the endoscopy group were treated with total endoscopic thyroidectomy via air⁃free transaxillary approach，while those in the open group received open surgery through anterior cervical incision. The surgical situation and postoperative recovery in the two groups were compared. Cox proportional hazard regression model was used to analyze the influ⁃ encing factors of occurring intraoperative RLN injury. Results As compared with the open group，the endoscopy group had longer surgical duration，less intraoperative blood loss，more postoperative drainage and shorter postop⁃ erative hospital stay，and it had lower VAS score and higher satisfaction score on the cosmetic incision 24 and 48 hours after operation. One week after operation，the incidences of vocal cord lesions（χ2 = 15.153，P < 0.001）， dysphonia and dysphagia（χ2 = 12.837，P < 0.001）in the endoscope group were significantly lower than those in the control group（P < 0.05）. Total endoscopic thyroid surgery via air⁃free transaxillary approach and malignant tumors were the key risk factors for intraoperative RLN injury. Conclusions Total endoscopic thyroid surgery via air⁃free transaxillary approach can effectively improve the postoperative quality of life in patients and is worthy of clinical application.

Objective To observe the effects of dexmedetomidine on pharmacokinetics and hemodynamics of sufentanil in children with congenital heart disease. Methods A total of 167 children，ASA class Ⅱ，aged 3 to 36 months，receiving general anesthesia for cardiac interventional surgery were enrolled. All the subjects received propofol of 2 mg/kg，sufentanil of 0.3 μg/kg，and cisatracurium besilate of 0.2 mg/kg during anesthesia induction. In anesthesia maintenance ，group D was intravenously given dexmedetomidine with the first dose of 1 μ g/kg followed by a maintenance dose of 0.7 μg/（kg·h），and group P was given propofol of 8 mg/（kg·h）. The intraoper⁃ ative hemodynamic parameters and adverse reactions were recorded. Blood samples were collected at 5，10，20， 30，45，60，75，and 90 min after SUF administration by dilution sampling method. Plasma concentration of SUF was determined by UHPLC ⁃ MS/MS method，and pharmacokinetic parameters were calculated by the Phoenix WinNonlinTM software. Results The plasma concentration at 20，60，or 120 min was significantly higher in group P than in group D（P < 0.05）. The clearance rate was（28.59 ± 10.23）mL/（kg·min）in group D，which was signifi⁃ cantly higher than that in group P（20.78 ± 10.45）mL/（kg·min）（P < 0.05）. There were no significant differences between the two groups in the elimination half⁃life，area under curve，apparent volume of distribution，and mean residence time of sufentanil（P > 0.05）. The incidence of intraoperative adverse hemodynamic reactions were 23.8% in group D and 19.2% in group P（P > 0.05）. Conclusions Dexmedetomidine accelerates the clearance rate of sufentanil but does not increase the incidence of adverse reactions in children with congenital heart disease.

Objective To explore the effects of personalized antiplatelet therapy on the 90⁃day prognosis and safety in acute ischemic stroke（AIS）. Methods Participants were recruited in 14 hospitals. The study group received personalizedantiplatelet therapy，while the control group received conventional medications based on the clinical guideline.The rate of recurrence，mRS scores and bleeding events were recorded on day 90 and then com⁃ pared between the two groups. Results 1472 patients were recruited. In the study group，the patients with clopido⁃ grel resistance accounted for 61% and those with aspirin resistance was 9.4%. The rate of recurrence was 4.1% in the study group and 4.5% in the control group（P = 0.75）. The incidence of poor prognosis was 17.7% in the study group but 23.6% in the control group（P = 0.007）. The rate of bleeding events was 2.4% in the study group and 2.8% in the control group（P = 0.67）. Conclusions Personalized antiplatelet therapy can improve the short⁃term prognosis in patients with AIS and has no marked impacts on its safety. It provides evidence⁃based supports for clin⁃ ical precision medications.

Objective To explore the values of real⁃time shear wave elastography（SWE）and/or contrast⁃ enhanced ultrasound（CEUS）techniques in the diagnosis of breast cancer. Methods One hundred and twelve breast tumor patients with a total of 112 breast masses hospitalized in our hospital from April 2015 to December 2018 were divided into benign mass group（n = 65）and malignant mass group（n = 47）according to the pathological examination results. SWE and CEUS were performed in both groups. The area under curve（AUC）of the receiver operating characteristic（ROC）was used to analyze the diagnostic values of SWE and/or CEUS for the breast masses. Results The average elasticity，maximum elasticity，peak intensity，and time of significant decline in the malig⁃ nant mass group were significantly higher than those in the benign mass group（P < 0.05），and the peak time was significantly lower than that of the benign mass group（P < 0.05）. There was no statistically significant difference in the minimum elasticity value between the two groups（P > 0.05）. The AUC of SWE and CEUS for breast cancer diagnosis were 0.766，0.818，0.896，respectively. Conclusion Both SWE and CEUS have certain diagnostic value when used alone in the diagnosis of breast cancer，and their combined application is conducive to improving the accuracy of diagnosis.

Objective To compare the diagnostic value of computer aided diagnosis（CAD）system，TI⁃RADS classification and ultrasound scoring in the diagnosis of benign and malignant thyroid nodules. Methods Retro⁃ spective analysis was performed in 672 thyroid nodules confirmed by surgery and fine needle aspiration pathology. The ROC curve was constructed with pathological results as the gold standard，and the diagnostic value of CAD system，TI ⁃RADS classification and ultrasound scoring method for benign and malignant thyroid nodules was compared. Results The area under the ROC curve of thyroid nodules diagnosed by CAD system，TI⁃RADS classi⁃ fication and ultrasound scoring method was 0.889，0.848 and 0.844，respectively. The sensitivity，specificity，posi⁃ tive predictive value，negative predictive value and accuracy of CAD system were all higher than those of TI⁃RADS classification and ultrasound scoring method（P < 0.05）. Conclusion CAD system is an objective，accurate and rapid evaluation method，which is beneficial to improving the diagnostic efficiency of thyroid nodule，and is worthy of promotion.

Objective To investigate the genotypes and hematological manifestions of HbH patients among child⁃bearing adults in Jiangxi province，and to provide guidence for prenatal diagnosis and genetic counsel⁃ ing. Methods Routine blood test，hemoglobin electrophoresis，and thalassemia genetic testing were performed on 9883 child ⁃bearing adults admitted to Jiangxi Maternal and Child Health Hospital. Information of genotypes and hematological parameters of these HbH patients was collected and analyzed，and 5 HbH families in need of thalas⁃ semia prenatal diagnosis received further detection at the appropriate gestational ages. Thalassemia genetic testing was performed by Gap⁃PCR，Dot⁃RDB and Sanger sequencing，respectively. Results Thirty⁃four cases with HbH disease（0.34%）were detected among 9883 subjects，with nineteen cases as ⁃3.7α /⁃SEA（57.58%），nine cases as ⁃4.2α/⁃SEA（27.27%），one case as αWSα/⁃SEA，one case as αCSα/⁃SEA，one case as αCD61（AAG>TAG）α/⁃⁃SEA，and three cases as compound β⁃thalassemia and deletional HbH. Routine blood test revealed that all 34 cases showed microcytic hypochromic hematological features. The HbH⁃WS case showed normal hemoglobin（Hb），while the other 33 cases with HbH disease demonstrated mild or moderate anemia. Hemoglobin electrophoresis analysis revealed the decreased HbA2 level in 31 patients with HbH disease and the increased HbA2 level in 3 patients with com⁃ pound HbH disease and β⁃thalassemia. A total of 30 cases with HbH disease showed the presence of HbH and 19 cases of Hb Bart′s via hemoglobin separation. Conclusion Deletional HbH disease is more common than the non⁃ deletional among child⁃bearing adults in Jiangxi Province，with ⁃3.7α/⁃⁃SEA as the most prevalent genotype. The clinical manifestions of HbH disease vary with individuals，most of which are mild or moderate microcytic hypo⁃ chromic anemia. Genetic testing is nessesary for the diagnosis of HbH patients and prenatal diagnosis is an effective method for these HbH patients at risk of offspring birth with clinically affected thalassemia

Objective To investigate the prevalence and influencing factors of chronic kidney disease （CKD）among older adults participated in health check⁃up in a community of Tianjin in tests of urinary albumin， urine creatinine and serum uric acid，so as to for early prevention，control and management of CKD. Methods A total of 6685 elderly residents aged 60 and above who underwent free health examination carried out by Junlia⁃ ngcheng Hospital of Dongli District in Tianjin from April to July 2019 were selected. The health examination data were collected，and the detection of urinary albumin，urine creatinine and serum uric acid was included. The albu⁃ min to creatinine ratio（ACR）was calculated. The count data were statistically analyzed by chi ⁃square test，and the unconditional logistic regression model was used to analyze the influencing factors of CKD. Results Among 5288 subjects with complete data，the total prevalence of CKD was 32.68%. Application of ACR was able to detect 26.88% of CKD patients at the early stage of renal dysfunction in the elderly. Multivariate logistic regression analysis showed that the influencing factors of CKD including females，age，SBP ≥ 140 mmHg，FPG ≥ 6.1 mmol/L，hyper⁃ uricemia and low HDL ⁃Cemia. Conclusion The prevalence of CKD in community ⁃dwelling elderly in Tianjin is relatively high. The detection rate of CKD in the early stage of renal dysfunction can be improved by the tests of urinary albumin and creatinine in health check⁃up for the elderly. Adding serum uric acid test will contribute to the prevention and control of CKD. The early prevention and control of CKD should be strengthened when people with abnormal levels of SBP，FPG，SUA and HDL⁃C. 

Objective To identify the pathogenic mutation in a Chinese family with autosomal dominant spastic paraplegia. Methods The clinical data of a family with hereditary spastic paraplegia was collected. The genomic DNA of the proband and his family members was extracted. The whole exon sequencing was performed to detect the proband and identify the candidate gene pathogenic sites. Sanger sequencing technology was used to identify the candidate gene pathogenic sites. Results Results of the whole exome sequencing showed that there was a heterozygous mutation c.715 C > T（p. R239C）in exon 10 of ATL1 gene in the proband，which was reported to cause hereditary spastic paraplegia. Sanger sequencing revealed the same mutation existed in other patients in this family，but this mutation was not detected in the normal members in this family. Conclusion The c.715C > T heterozygous mutation of ATL1 gene is the pathogenic mutation of hereditary spastic paraplegia in this family，and identification of this pathogenic mutation will be helpful for genetic counseling and prenatal diagnosis of this family.

Objective To evaluate the clinical effect of press needle embedded in back⁃shu points of five zang and Geshu（BL 17）in the treatment of insomnia. Methods A total of 66 patients with insomnia were randomized into press needle group and drug group. The press needle group was treated with press needles at back⁃ shu points of five zang and Geshu（BL 17）. The needle was embedded for 1 day，and the treatment was per⁃ formed 3 times per week. The drug group took 1 mg Estazolam tablet orally every night. Both groups were treated for 4 weeks. Pittsburgh Sleep Quality Index（PSQI）was used before and after the treatment. The adverse reactions were recorded in the two groups. Results After the treatment，the total score of PSQI and the score of each factor of the two groups were lower than those before the treatment（P < 0.05）. The score reduction of sleep latency in the drug group was greater than that in the press needle group（P < 0.05），and the daytime dysfunction score reduction in the press needle group was greater than that of the drug group（P < 0.05）. The total effective rate of the needle group was 80.00%，and that of the drug group was 72.41%，showing no statistical significance（P > 0.05）. During the treatment，there were less adverse reactions in the press needle group. Conclusions Pressing needle embed⁃ ded in back ⁃ shu points of five zang and Geshu（BL 17）can improve the sleep of insomniacs，and its efficacy is equivalent to that of estazolam. Eestazolam may be more helpful with sleep latency but pressing needles may be more effective in improving daytime function. 

Breast cancer is one of the most common and frequently⁃occurring malignant tumors in women all over the world，and it is one of the most important causes of female death. Related tumor markers and therapeu⁃ tic targets have become research hotspots. Postmenopausal hormone therapy（MHT）is the most effective approach to prevent and treat menopausal⁃related symptoms and chronic diseases. However，it may increase the risk of breast cancer，and its mechanism is still unclear. The 10⁃year follow⁃up results of the Women′s Health Initiative（WHI） study showed that the breast cancer risk of women in the estrogen alone treatment group was not increased，but decreased ，while the risk of breast cancer in the estrogen and progesterone combined treatment group was increased. Our previous studies have found that certain synthetic progesterone could significantly promote the prolif⁃ eration of human breast cancer cells with positive expression of PGRMC1. Recent studies have also found that blood PGRMC1 concentration was increased in breast cancer patients. If PGRMC1 can be developed into a breast cancer risk marker for routine screening before hormone therapy，it will be of great significance. Whether pGRMC1 can be used as a potential marker of patients susceptible to breast cancer during hormone therapy is reviewed in this paper.

Colorectal cancer（CRC）is the most common carcinoma in gut. The incidence and mortality of CRC are increasing gradually every year with the changes of people′s life style，but the underlying mechanism is still not completely elucidated. The poor prognosis is due to its high rates of recurrence and metastasis. miR ⁃ 124 has been confirmed to play a vital role in the pathogenesis of CRC. In this review，we summarize the upstream mol⁃ ecules and downstream target genes of miR⁃124，and we also discuss the potential target therapy for miR⁃124