Objective  To analyze the clinical characteristics of elderly patients with COVID⁃19 receivinginvasive mechanical ventilation. Methods  In this retrospective，single⁃center cohort study，we included twocohorts of elderly（age ≥ 60 years）inpatients with laboratory confirmed COVID⁃19 from Wuhan NO.1 Hospital（Wuhan，China）. They were divided into two groups：20 patients received tracheal intubation and invasivemechanical ventilation，and 30 patients in the control group did not undergo invasive mechanical ventilation duringhospitalization，and finally recovered and discharged. Demographic，clinical，treatment，and laboratory data wereextracted from electronic medical records and compared between these two groups. Results The age range ofpatients in the invasive ventilation group ranged from 64 ~ 83 years，with a median age of 71.5 years（IQR 67.0，79.8），and a sex ratio of 13：7. More than half of the patients had underlying diseases，the most common of whichwas hypertension， Comorbidities were present in nearly half of patients in both groups，with hypertension beingthe most common comorbidity，followed by coronary heart disease and diabetes. The most common symptoms onadmission were fever and cough，followed by sputum and chest tightness. The critically ill patients in the invasiveventilation group accounted for 65% and 25% of the patients with severe disease，which were significantly higherthan the control group（P = 0.000）. Chest CT showed lung consolidation in the invasive ventilation group was 75%，which was significantly higher than that of the control group（47%）（P = 0.047）. The patients′ lymphocyte count （1.13 ± 0.63 ）× 10^9/L，lymphocyte percentage（4.16 ± 3.45）%，serum albumin（27.14 ± 4.42）g/L in the invasiveventilation group were significantly lower than the control group（all P = 0.000）；The concentrations of D⁃dimer，CRP，LDH，and BUN were significantly higher than those of the control group（all P = 0.000）. All patientsreceived antiviral treatment. In the invasive ventilation group，18 patients（90%）received glucocorticoids，signifi⁃cantly higher than the control group（27%）（P = 0.000）. Before invasive mechanical ventilation，17 patients（85%）were given noninvasive mechanical ventilation，and 2 patients（15%）were given high⁃flow nasal cannula oxygen.In the process of endotracheal intubation for patients in the invasive ventilation group，medical staff adopted threelevels of protection. After induction of anesthesia，the blood pressure and heart rate of the patients decreased signif⁃icantly（P < 0.05）. Conclusion The potential risk factors of heavier clinical typing on admission，lower peripheralblood lymphocyte counts，heavier inflammation，lower serum albumin levels can help clinicians to identify elderlypatients who needed invasive mechanical ventilation at an early stage. Anesthetic agents should be used carefullyduring tracheal intubation to ensure patients′ safety. The medical staff should have a high⁃evel protection duringthe intubation to maximally ensure their safety.

Objective  To investigate the clinical efficacy of chloroquine phosphate in accelerating thenegative conversion of nucleic acid in patients with common COVID⁃19. Methods  From February 21 to March 8，2020，88 patients with common COVID⁃19 in the Fourth People′s Hospital of Honghu City，Hubei Province，were included in the study. According to the principle of informed consent，they were divided into the treatmentgroup（n = 56）and the control group（n = 32）. We compared the time of first conversion to be negative of novelcoronavirus nucleic acid and the total duration of sickness，hospital stay and hospitalization expenses between thegroups. Within the treatment group we compared counts of white blood cells and lymphocytes，functions of liverand kidney before and after chloroquine phosphate treatment as well as the curative effect in patients of differentage groups. Results  Compared with the control group，the patients in the treatment group experienced signifi⁃cantly quicker negative conversion of COVID⁃19 nucleic acid，shorter hospital stay and less costs and the rate ofrecovered patients tested positive for the coronavirus was significantly lower（P < 0.05）. However，the counts ofwhite blood cells and lymphocytes，functions of liver and kidney showed no significant differences before andafter treatment with chloroquine phosphate. In the treatment group，the time when the nasopharyngeal swab nucleicacid test turned negative for the first time and the first time when the patients in the group aged between 18 to 35years and the group aged between 35 and 50 years were significantly shorter than that in the group aged between50 to 65（P < 0.05）. There was no significant difference between the groups aged 18 to 35 years and 35 ~ 50years（P > 0.05）. Conclusion  Chloroquine phosphate can significantly accelerate negative conversion of nucleic acid in patients with common COVID⁃19，reduce total duration of sickness and the length of hospital stay，lowerthe hospitalization expenses，reduce the rate of recovered patients tested positive again and drug adverse reac⁃tions，but the efficacy of chloroquine phosphate may be influenced by patients′ age.

Objective The research aimed to investigate the role of miRNA⁃330⁃3p/Ap2m1 axis in theeffects of reduction of myocardial cell apoptosisand improvement of myocardial function in myocardial infarctionby GATA⁃4 overexpressed⁃mouse bone marrow mesenchymal stem cell（BMSC）⁃secreted exosomes（BMSC^GATA⁃4⁃exosome）. Method Mouse myocardial infarction models were established and then divided into seven groups. Eachmouse was injected with BMSC^miRNA⁃330⁃3p⁃mimic⁃exosome，BMSC^miRNA⁃330⁃3p⁃inhibitor⁃exosome，BMSC^GATA⁃4⁃exosome，BMSC^empty carrier⁃exosome，and BMSCexosome through the caudal vein for 48 hours. The untreated myocardial infarction group andnormal mice were included in the control group. Cardiac color ultrasound was used to detect cardiac function ineach group. The expression of miRNA⁃330⁃3p in myocardial infarction was detected by RT⁃PCR. Tunel assay wasused to detect the number of apoptotic cells in myocardial tissue of myocardial infarction in each group. Westernblot was used to detect the expression of the corresponding target gene Ap2m1 of miRNA⁃330⁃3p and Cnot4 protein.Results The BMSC^miRNA⁃673⁃5p⁃mimic⁃exosome group showed the most significant improvement in myocardial function inmyocardial infarction（P < 0.05）and the highest expression of miRNA⁃330⁃3p in cardiomyocytes（P < 0.05）. Thecardiomyocytes in the BMSC^miRNA⁃330⁃3p⁃mimic⁃exosome group had the lowest apoptosis rate（P < 0.05），and Ap2m1 inthe BMSC^miRNA⁃330⁃3p⁃mimic⁃exosome+myocardial cell culture group had the lowest expression（P < 0.05）. Conclusion Overexpressed GATA⁃4 bone marrow⁃derived mesenchymal stem cell exosomes inhibit the expression of Ap2m1protein against myocyte apoptosis through miRNA⁃330⁃3p.

Objective The aim of this research was to investigate the effects of PTEN⁃induced kinas 1（PINK1）on the malignant biological behavior of gastric cancer（GC）. Methods PINK1 expression was downreg⁃ulated by small interfering RNA（siRNA）in GC cells. MTT assay，Wound healing assay and Transwell assay wereconducted to explore the role of PINK1 in GC cells′ proliferation and migration. Survival analysis and MTT experimentswere applied subsequently to find out the effect of PINK1 on chemosensitivity of oxaliplatin. Results Down⁃regulation of PINK1 significantly inhibited the proliferation，migration and invasion of gastric cancer cells. Inhibitionof PINK1 in GC cells could promote the production of reactive oxygen species（ROS）and induced apoptosis⁃related geen Bcl⁃2 upregulationand furtherly induce GC cells deaths. Finally，PINK1 downregulation effectivelyincreased the drug sensitivity of GC cells to oxaliplatin，which highly suggested a chemoresistance role of PINK1 inGC. Conclusion PINK1 may be a potential therapeutic target for GC；down⁃regulation of PINK1 could inhibit themalignant biological behavior of GC cells，enhance the sensitivity of oxaliplatin，and synergistic sensitization withchemotherapy.

Objective To investigate the effect of fasudil combined with methylprednisolone sodium succi⁃nate on pulmonary fibrosis induced by paraquat poisoning. Methods Seventy⁃five Wistar male rats were randomlydivided into 5 groups，15 rats in each group：normal control group（group Cont），paraquatposoning group（groupPQ），methylprednisolone sodium intervention group（group MSS），fasudil intervention group（group FAS），meth⁃ylprednisolone sodium + fasudil intervention group（group MSS + FAS）. The daily status of rats in each group wasobserved and recorded. Five rats in each group were anesthetized and sacrificed on the 7th，14th and 21st day，respectively. The lung tissue samples were obtained. The histopathological changes of rats on the 21st day wereobserved by hematoxylin⁃eosin and Masson staining. The positive expression of transforming growth factor⁃β1（TGF⁃β1）in the lung tissue of rats in each group on the 21st day was determined by immunohistochemistry. The meanoptical density was measured. The content of TGF⁃β1 in the lung homogenates of rats in each group at each timepoint was determined by enzyme⁃inked immunosorbent assay. Results FAS and MSS could reduce the degree ofpulmonary fibrosis，FAS combined with MSS had better effect. Conclusion Fasudil combined with methylprednis⁃olone sodium succinate can reduce the degree of lung fiber induced by paraquat poisoning in rats

Objective To investigate whether Ixazomib induces apoptosis of esophageal squamous carcino⁃ma cells through mTOR/p70S6K signaling pathway. Methods Esophageal squamous cell carcinoma cells KYSE⁃140 and KYSE⁃150 were treated by Ixazomib，followed by CCK⁃8 and Edu assays to examine the cell proliferation.Flow cytometry was used to detect apoptosis of KYSE⁃140 and KYSE⁃150 cells，and expressions of caspase⁃3 andother apoptotic factors. The mRNA and protein expression levels of mTOR，p70S6K and 4E⁃BP1 were examined byRT⁃qPCR and western blot. Expressions of p⁃p70S6KThr421/Ser424 and p⁃4E⁃BP1Thr36 were detected by westernblot. Results Proliferations of KYSE⁃140 and KYSE⁃150 cells were inhibited by Ixazomib treatment in a dose⁃dependent manner. After Ixazomib treatment ，apoptosis of KYSE⁃140 and KYSE⁃150 cells were significantlyinduced（P < 0.05）and the activity of caspase⁃3 was significantly increased（P < 0.05）. The PARP was cleaved inIxazomib treatment group，whereas there was no PARP cleavage in control group. Also，the expression of apoptosisactivator p⁃p38 was significantly increased in Ixazomib treatment group（P < 0.05）. Compared with the controlgroup，Ixazomib treatment caused inhibition of the mRNA and protein expression of mTOR（P < 0.05），decreasedexpression of p70S6K and 4E⁃BP1 mRNA expression（P < 0.05）. Western blot results showed that expressions ofp⁃p70S6KThr421/Ser424 and p⁃4E⁃BP1Thr36 were significantly decreased（P < 0.05）. Conclusion Ixazomibmay induce apoptosis of esophageal squamous carcinoma cells by inhibiting mTOR / p70S6K signaling pathway.

Objective To investigate the biological changes of normal breast epithelial cells induced byestrogen through Nrf2/ROS signaling pathway. Methods Normal breast epithelial cell lines MCF⁃10A and MCF⁃12Awere selected and the control group and estrogen group（5 nmol/L）were established. MTT assay，LDH assay，enzyme⁃linked immunosorbent assay（ELISA），DCFH⁃DA fluorescence probe labeling assay，oxidase assay，wound⁃heal⁃ing assay，colony⁃forming assay and annexinV/PI double staining were used to detect the biological characteristicsof breast cells after intervention. Expression of Nrf2，HO⁃1，NQO1 protein and mRNA in breast cells were detect⁃ed by Western blot and PCR. Results Estrogen induced the enhancement of cell viability，migration and cloningability，and reduced cell apoptosis. Estrogen induced the accumulation of ROS and inhibited the activities of SOD，GPX，CAT and TAC in the cells，and then increased the level of LDH and 8⁃OHdG in the cells，leading to theincrease of cytotoxicity and oxidative damage of DNA. In addition，Western blot and RT⁃qPCR showed that estrogeninduced inhibition of Nrf2，HO⁃1 and NQO1 expression. Conclusion Estrogen can induce the proliferation andapoptosis of normal breast cells，and regulate Nrf2/ROS signal pathway to increase the oxidative damage of DNA，and then induce the biological changes of breast cells.

Objective To investigate the clinical efficacy of nasal intermittent positive pressure ventilation（NIPPV），bilevel positive airway pressure（BiPAP）and nasal continuous positive airway pressure（NCPAP）inpremature infants with respiratory distress syndrome（RDS）after extubation. Methods According to the respiratorysupport methods after extubation，70 premature infants with RDS were divided into NIPPV group（n = 20），BiPAPgroup（n = 24），and NCPAP（n = 26）. The indexes of blood gas analysis，success rate of extubation within one weekand complications before and after noninvasive ventilation were analyzed. Results There was no significant differ⁃ence in PaO2 and PaCO2 among the three groups before extubation（P > 0.05）. There was no statistically significantdifference between NIPPV group and BiPAP group in terms of 6 h PaO2 and 12 h PaO2 after non⁃invasive ventila⁃tion（P > 0.05），which were higher than those in NCPAP group（P < 0.05），indicating statistical significance. 6 hPaCO2 was the lowest in the NIPPV group，and the highest in the NCPAP group and pairwise comparison amongthe three groups was statistically significant（P < 0.05）. There was no significant difference in 12 h PaCO2 betweenthe NIPPV group and the BiPAP group（P > 0.05），which was lower than that in the NCPAP group（P < 0.05）. Theincidence of abdominal distension in the NIPPV group during noninvasive ventilation was significantly lower thanthat in the BiPAP group and the NCPAP group（P < 0.05）. The incidences of internal extubation failure within 7 days，pneumothorax，intracerebral hemorrhage，or bronchopulmonary dysplasia were not statistically significant in thethree groups（P > 0.05）. The incidence of abdominal distension in the NIPPV group was lower than that in theBiPAP group or the NCPAP group，and the difference was statistically significant（P < 0.05）. Conclusion As atransitional mode after the extubation in premature infants with RDS，both NIPPV and BiPAP can improve thepulmonary ventilation function. Attention should be paid to avoid low PaCO2 in the use of NIPPV.The use of BiPAPor NCPAP requires attention to the occurrence of abdominal distension.

Objective To compare the clinical characteristics and risk factors of hypertension with silentmyocardial infarction（HTN⁃SIM）. Methods 51 consecutive patients with HTN⁃SIM who were addressed in ourhospital from February 2016 to February 2019 were selected continuously，and 140 patients with hypertension（HTN）were selected during the same period. Their clinical characteristics were compared and their risk factorswere analyzed. Results Compared with HTN group，HTN⁃SIM group were older and had a longer course of hyper⁃tension. Compared with HTN group，HTN⁃SIM group had more dizziness，more dyspnea ，more oral ACEI/ARBdrug history，more coronary heart disease，and more hyperuricemia. Logistic regression analysis showed that thelong course of hypertension（OR = 1.092）and the history of coronary heart disease（OR = 3.107）was independentrisk factors for HTN⁃SIM. Conclusion Old age，long course of hypertension，and coexisting diseases are the clinicalfeatures of HTN⁃SIM. Dizziness and dyspnea are common clinical symptoms of HTN⁃SIM. In addition，we alsofound that the long course of hypertension and history of coronary heart disease are independent risk factors for thedevelopment of hypertension intoHTN⁃SIM.

Objective  This study aimed to reveal the clinical features of cases，and provide evidence andsupport for the active treatment of neonates with homologous Echovirus type 11（ECHO11）infection under modernmedical conditions. Methods  Clinical features and treatment experience of ECHO11⁃infected newborns trans⁃ferred from the same ward of a subordinate hospital to the neonatal intensive care unit of Guangzhou Women andChildren′s Medical Center in June 2019 were recorded. Results  The age related to infection onset is 1 ~ 16 d.The primary symptoms related to viral infection were vomiting（50%）and fever（50%）. Thrombocytopenia andautoimmune hemolytic disease（100%）appeared in the early stage of the disease. After plasmapheresis，glutamic⁃pyruvic transaminase level，total bilirubin level，and thrombin time were decreased significantly. Conclusions This study showed that all cases had thrombocytopenia and autoimmune hemolytic disease，and early repeated useof blood purification treatment might improve the prognosis. The autoimmune response of premature infants may bethe reasons for the rapid progression of severe cases，which need immediate attention.

Objective Cervical cancer is one of the most common malignancies in women worldwide.Concurrent chemoradiotherapy followed by high⁃dose⁃rate brachytherapyis the standard treatment for locallyadvanced cervical cancer（LACC）. We aimed to investigate the treatment outcomes and toxicities of these patientswho underwent definitive intensity⁃modulated radiotherapy（IMRT）. Methods A total of 97 patients who receiveddefinitive IMRT for LACC between July 2012 and December 2015 were studied retrospectively. Overall survival（OS），disease⁃free survival（DFS），distant metastasis⁃free survival（DMFS），and local recurrence⁃free survival（LRFS）rates were calculated，and survival hazard ratios（HR）for different demographic and clinicopathologicalvariables，were also calculated to determine their prognostic significance. Patients were assessed and recorded foracute toxicities and late toxicities. Results Mean follow⁃up was 65.0（range 2.2～86.7）months. The 5⁃year OS，DFS，DMFS，and LRFS rates were 76.0%，65.7%，75.5% and 81.4%，respectively. The only negative indepen⁃dent risk factor for OS is histological type（squamous cell carcinoma vs. adenocarcinoma/adenosquamous carcinoma（HR = 4.932，95% CI：1.446～16.820，P = 0.011）. A total of 17（17.5%）patients developed grade 3 or greateracute toxicities，and 36（37.1%）patients developed late toxicities. Conclusion Patients with LACC who underwentdefinitive IMRT have achieved good outcomes，and tolerated associated toxicities.

Objective To compare the effectiveness of long⁃effect and short⁃effect granulocyte colonystimulating factor（G⁃CSF）in treatment of bone marrow suppression induced by multi⁃cycle chemotherapy for malig⁃nancies. Methods A retrospective analysis was conducted for 117 cases who used granulocyte colony stimulatingfactor to prevent and treat bone marrow suppression induced by chemotherapy for advanced malignancies in theThird Affiliated Hospital of Zunyi Medical University during Jul. 2019 to Feb. 2020. Among them，54 cases weretreated with Recombinant human granulocyte colony stimulating factor injection（short⁃effect，rhG⁃CSF group），and 63 cases were treated with Polyethylene glycol recombinant human granulocyte stimulating factor injection（long⁃effect，PEG⁃rhG⁃CSF group）. Clinical efficacies，the occurrence of bone marrow suppression and ADR werecompared between 2 groups. Results Patients in both groups showed different degrees of bone marrow suppressionafter chemotherapy，the time of WBC/ANC return to the normal range in the PEG⁃rhG⁃CSF group was（3.53 ±1.38）days，which was shorter than that in the rhG⁃CSF group（4.52 ± 1.78） days（P < 0.05）. And the maintenancetime after WBC/ANC rose to the normal range was（11.07 ± 2.98）days in the PEG⁃rhG⁃CSF group and（6.04 ±2.43）days in the rhG⁃CSF group respectively，which has a statistical difference between the two groups（P < 0.01）.After 3 days of G⁃CSF treatment，59.20% of patients in the rhG⁃CSF group returned to the normal range in WBC/ANC counts，compared with 69.80% in the PEG⁃rhG⁃CSF group. Conclusions Both rhG⁃CSF and PEG⁃rhG⁃CSFhad beneficial therapeutic effects on bone marrow suppression caused by multiple cycles of chemotherapy inpatients with malignant tumors，and the recovery of WBC/ANC in the PEG⁃rhG⁃CSF group was superior to that in the rhG⁃CSF group.

Objective To detect the clinical efficacy and safety of erlotinib combined with simultaneouswhole brain radiotherapy with simultaneous integrated boost（WBRT⁃SIB）in patients with lung adenocarcinomawith multiple cerebral metastases with EGFR mutation. Methods 45 pulmonary adenocarcinoma patients withbrain metastases，treated with erlotinib combined with WBRT⁃SIB were in combination therapy group（n = 22）andpatients treated with WBRT⁃SIB only were in radiotherapy group（n = 23）. The short⁃term effects，long⁃term effectsand adverse reactions of these two groups were compared. Results The short⁃term effective response rate（RR）ofthe combination therapy group was 77.72% ，which was significantly higher than that of the radiotherapy group（47.82%）（P < 0.05）. The one⁃year survival rate of the combination therapy group was 59.09%（13/22），whichwas significantly higher than that of the radiotherapy group 43.47%（10/23）（P < 0.05）. The main adverse reactionsin the two groups were fatigue and rash，most of which were mild，improved after symptomatic treatment，and noⅣadverse reactions. Conclusion Pulmonary adenocarcinoma patients with multiple brain metastases，have anideal clinical effect with WBRT⁃SIB combined with erlotinib. It prolongs the survival time of patients and reducesthe incidence of adverse reactions. It is worthy of promotion.

Objective To explore the clinical effect of pegylated recombinant human granulocyte stimulat⁃ing factor（PEG⁃rhG⁃CSF）in the prevention of neutropenia after chemotherapy in elderly patients with gastrointesti⁃nal cancer. Methods A total of 47 patients with digestive tract tumors were included in this study. They weregiven a subcutaneous injection of 6 mg PEG⁃rhG⁃CSF on the third day of the first cycle of chemotherapy. If ANCdecreased，they were given subcutaneous injection of 6 mg PEG⁃rhG⁃CSF on the second cycle of chemotherapy. IfANC did not decrease，they were given a subcutaneous injection of 3 mg PEG⁃rhG⁃CSF on the second cycle of che⁃motherapy. Results In the first cycle of chemotherapy，the second cycles of chemotherapy with 3 mg PEG⁃rhG⁃CSFand the second cycles of chemotherapy with 6 mg PEG⁃rhG⁃CSF，the incidence of FN was 19.1%，31.6% and 55.6%（P＜0.05）. There was no significant difference in duration of ANC reduction in the three groups（P > 0.05）. In thefirst cycle of chemotherapy，the second cycles of chemotherapy with 3 mg PEG⁃rhG⁃CSF and the second cycles ofchemotherapy with 6 mg PEG⁃rhG⁃CSF，the incidence of FN was 4.3%，7.9% and 11.1%，which was no significantdifference（P > 0.05）. During the study period，there were 2 cases with bone pain，1 case with asthenia and 1 casewith muscle pain. The total incidence of adverse reactions was 8.5%. Conclusion PEG⁃rhG⁃CSF can effectivelyprevent neutropenia in elderly patients with gastrointestinal cancer，and it has high safety.

Objective  To observe the effects of camrelizumab monoclonal antibody combined with chemo⁃therapy on the expressions of cytokeratin 19 fragment antigen 21⁃1（CY211），matrix metalloproteinase⁃9（MMP⁃9）and tumor growth and metastasis in elderly patients with non⁃small cell lung cancer（NSCLC）. Methods  FromJanuary 2017 to October 2019，120 elderly NSCLC patients were randomly divided into observation group andcontrol group，with 60 cases in each group. The control group was treated with chemotherapy，while the observationgroup was treated with camrelizumab monoclonal antibody combined with chemotherapy. The therapeutic effect wasevaluated after 3 cycles，and the changes of serum CY211，MMP⁃9 expressions and tumor growth and metastasiswere compared before and after treatment. Results  After treatment，the total effective rate of the observationgroup was significantly higher than that of the control group（P < 0.05）. The levels of serum CY211，MMP⁃9 andvascular endothelial growth factor（VEGF）in the two groups were lower than those before treatment，and the obser⁃vation group was lower than the control group（P < 0.05）. The Karnofsky Performance Scale（KPS）score of bothgroups was higher than that before treatment，and the observation group was higher than the control group（P <0.05）. Conclusions Camrelizumab monoclonal antibody combined with chemotherapy has a significant effect onelderly NSCLC patients，which can significantly reduce the levels of serum CY211，MMP⁃9 and VEGF，reduceneovascularization，inhibit tumor growth and metastasis，and improve the quality of life of the patients.

Objective To investigate the effect of different doses of metformin on the incidence of contrast⁃induced nephropathy（CIN）after primary percutaneous coronary intervention（PCI）in patients with acute myocardialinfarction（AMI）complicated and type 2 diabetes mellitus（T2DM）. Methods To select 95 patients between January2017 to December 2019 in The First People′s Hospital of Nanning diagnosis of AMI with T2DM，and all of themwere treated primary PCI. They were divided into low⁃dose group（metformin ≤ 1 000 mg/d），the high dose group（metformin > 1 000 mg/d）and the control group（non⁃metformin）according preoperatively. To compare threegroups of patients with clinical data and analyze the risk factors for CIN production by Logistic regression. Results There were no statistically significant differences among the three groups in age，sex，BMI，cardiovascular riskfactors，coronary angiography，cardiovascular medication，hemoglobin a1c（HbA1c），baseline and postoperativecreatinine，estimated glomerular filtration rate（eGFR）（all P > 0.05）. CIN occurred in 7 cases（21.9%）of the low⁃dose group，8 cases（26.7%）of the high⁃dose group，and 7 cases（20.6%）of the control group. The incidencewas slightly higher in the high⁃dose group，but there was no statistically significant difference among three groups（P > 0.05）. Logistic regression analysis showed that age of > 75 years old，preoperative eGFR < 60 mL/min，andcontrast media volum of ≥ 150 mL were risk factors of CIN. Conclusion Patients with AMI and T2DM were treatedprimary PCI，continuous use of metformin by therapeutic doses in preoperative did not increase the incidence ofCIN. The incidence of CIN was not related to the dose of metformin，but to age，eGFR，and contrast media volume.

Objective To investigate the correlations between pathological changes and helicobacter pyloriinfection，serum pepsinogen and gastrin⁃17 of chronic atrophic gastritis（CAG）. Methods 127 patients with CAGwere enrolled in the study. Their serum levels of PGI，PGII，G ⁃17 and Hp were detected by 14C⁃UBT test andELISA. ROC curve was drawn to evaluate its diagnostic value. Results The infection rate of Hp was higher，andthe serum levels of PGI，PGII，PGR and G⁃17 decreased in the CAG group. The more severe the gastric mucosa at⁃rophy was，the more remarkably the serum levels of PGI，PGII，PGR and G⁃17 decreased. Moderate inflammationand moderate atrophy were predominant in the Hp ⁃infected patients. The area under the ROC curve of CAG was0.981，0.795，0.800 and 0.661 by PGI，PGII，PGR and G⁃17，respectively. Conclusion The combined test ofHp，PG and G⁃17 can improve the affirmative diagnose of atrophic gastritis，and it helps to stratify the atrophy riskand make early diagnosis of gastric mucosa atrophy.

Objective To investigate the clinical value of circulating tumor cells（CTCs）in the diagnosisand treatment of prostate cancer patients. Methods From September 2016 to September 2019，78 patients withprostate cancer who were treated in the urology department of the Second Affiliated Hospital of Zhengzhou Universitywere selected as the research group and 35 healthy subjects were used as the control group. The amount of 7.5 mLvenous blood was collected from each subject of both groups. CanPatrolTM technology was used to enrich，isolate，and count CTCs. According to CTCs count，prostate cancer patients were sub⁃divided into CTCs positive group andCTCs negative group，and their age，blood routine，biochemical indicators，prostate specific antigen（PSA），abdominal CT，prostate nuclear magnetic resonance（MRI），bone scan，Gleason were recorded at the same time.The correlations between the above indicators and the number of CTCs were analyzed. The diagnostic value of PSAlevel and CTCs level in prostate cancer was evaluated by the four⁃grid. Results The positive rate of CTCs in thepatients with metastatic prostate cancer was significantly higher than that in the patients without metastasis（P<；0.05）. The diagnostic sensitivity of CTCs and PSA for prostate cancer was 88.46% and 85.89%，respectively，thespecificity was 74.28% and 65.71%，respectively，and the accuracy was 84.07% and 79.64%，respectively. Thelevels of HB and ALB in the CTCs⁃positive group were significantly lower than those in the CTCs⁃negative group（P < 0.05），and the levels of PLT，FIB，DD，AKP，and LDH were significantly higher than those in CTCs⁃negativegroup（P < 0.05）. Pearson analysis showed that the CTCs were significantly positively correlated with PSA andGleason scores（r = 0.601，P < 0.05；r = 0.316，P < 0.05）. The PSA levels increased with the worsening stages，with significant differences at stage Ⅱ，stage Ⅲ，stage Ⅳ as compared with stage I，and between stage Ⅳ andstage Ⅱ（P < 0.05）. The number of CTCs also increased with the worsening pathological stages，with statisticaldifferences between stage Ⅳ and stage Ⅱ（P < 0.05）. Conclusion The CTCs levels are correlated with tumorigenesisand metastasis，related serological indicators，Gleason score of prostate cancer，and tumor pathological stage，andthey are of clinical significance in predicting the development of prostate cancer.

Objective To investigate the effect of serum lactate dehydrogenase（LDH）combined withinterleukin⁃18（IL⁃18）in early predicting refractory mycoplasma pneumoniae pneumonia（RMPP）in children.Methods A total of 144 cases diagnosed with mycoplasma pneumoniae pneumonia in the hospital during December2018 to November 2019 were involved in the study，including 48 cases of RMPP and 96 cases of general Mycoplasmapneumoniae（GMPP）. Another group of 40 healthy children who came for health examination in our hospitalduring the same period were assigned as the control group. The levels of LDH and IL⁃18 in the three groups werecompared. ROC curve was used to predict the incidence of RMPP，and the critical value of specific index wasdetermined. Results There were significant differences in the LDH level among the three groups（P < 0.001）andthe level of IL⁃18 in the RMPP group was significantly different as compared to the levels of RMPP and controlgroups，but there was no significant difference between the GMPP and control groups. When LDH was 306.05 U/L，AUC（area under the curve）was 0.95，with the RMPP sensitivity and specificity of 95.8% and 85.4%，respectively；When the level of IL⁃18 was 416.95pg/ml，AUC was 0.99，with the RMPP sensitivity and specificity of 97.9% and99.0%，respectively. Conclusion Early and timely detection of LDH and IL⁃18 levels is of great clinical signifi⁃cance in the early prediction of severe RMPP，early intervention and evaluation of prognosis.

Objective To study the body function and its influencing factors of maintenance hemodialysispatients. Methods A total of 224 patients with end⁃stage renal disease（ESRD）undergoing maintenance hemodi⁃alysis in our hospital from August 2016 to August 2019 were selected. The KDQOL scale was used for physicalfunction survey，and the general data including age，gender，work status，place of residence，cultural educationlevel，medical background，etc. were surveyed through the self⁃made social demographic data questionnaire，andperform correlation analysis and multiple regression analysis to detect factors that affect body function. Results The total body function score of 220 patients in this study was（55.72 ± 7.31），which was in the middle and low level.Among them，the body function score was（13.19 ± 3.71）points，the body role score was（12.78 ± 1.87）points，and the body discomfort score was（9.79 ± 1.72）points，general health score of（9.87 ± 2.53）points，symptom anddiscomfort score of（10.09 ± 1.38）points；Correlation analysis showed that female were more likely to have physicalhealth problems. Dialysis time，age，history of diabetes and hypertension were all negatively correlated withphysical function or physical role. Marital status was positively correlated with physical function and physical role.Family months total income was positively correlated with physical function，physical role，and general health.Educational level was positively correlated with physical role，general health. Multiple linear regression analysisshowed that age，history of diabetes，and family income were the main factors affecting the physical function ofpatients with maintenance hemodialysis. Conclusion Age，history of diabetes and family income are the mainfactors affecting the body function of maintenance hemodialysis patients.

Objective Observing clinical efficacy and the changes in inflammatory response mediatorswith idiopathic pulmonary fibross（IPF）after treating with pulmonary rehabilitation combined with N⁃acetyl cysteine（Nac）and low dose of glucocorticoid. Methods 72 IPF patients were randomly divided into two groups. 36 patientsin conventional therapy group was given symbicort turbuhaler combined with low dose of glucocorticoid and Nac as thebasic treatment. 36 patients in treating group was treated with pulmonary rehabilitation on the basis of conventionaltherapy. The clinical efficacy，the influence on pulmonary function and quality of life，and the inflammatory responsemediators of these two groups were observed. Results The clinic effective rates of conventional therapy group，treating group were 77.8% and 94.4% individually，which had a statistical significance（P < 0.05）. Symptom scor⁃ing，quality of living evaluation，pulmonary function index（FEV1、FVC）and changes of inflammatory factorswere improved in treating group compared with that in conventional therapy group（P < 0.05）. Conclusion IPFpatients treating with pulmonary rehabilitation combined with Nac showed significantly improvement in clinical effi⁃cacy，pulmonary function and quality of life，which also decreasing inflammatory factors expression and restorescorticosteroid responses in IPF.

Objective to evaluate the effect of Fisher grading endplate fistulation combined with lumbarcistern drainage on chronic hydrocephalus after aneurysm clipping. Methods According to the difference of opera⁃tion methods，205 patients with aSAH were divided into three groups：group A：22 patients with simple actionaneurysm clipping；group B：104 patients with endplate fistula during the operation of craniotomy clipping；groupC：79 patients with endplate fistula during the operation of craniotomy clipping，combined with lumbar cisterndrainage after the operation. Six months after SAH，the incidence of chronic hydrocephalus was compared amongthe three groups based on Fisher′s classification. The three groups were followed up for 12 months，and the survivalcurve was drawn by Kaplan⁃Meier survival analysis method，and the single factor survival analysis was conductedby log rank method. The prognosis of the patients was evaluated by modified Rankin Scale（mRS）. Results Theincidence of chronic hydrocephalus in group A，B and C was 33.33%，13.16% and 8.07%，respectively（P > 0.05）.The incidence of chronic hydrocephalus in group A，B and C was 38.46%，31.11% and 8.82%，respectively，withstatistical significance（P < 0.05）. The incidence of chronic hydrocephalus in three groups was statistically signifi⁃cant（P < 0.05），33.33% in group A，38.10% in group B and 9.09% in group C），The Bonferroni method wasfurther used to correct the test level，in which the difference between the groups B and C was statistically significant（χ2 = 8.679，P = 0.003）. Kaplan⁃Meier survival analysis method was used to draw the survival curve，and logrank method was used for single factor survival analysis. There was a significant difference in survival status amongthe three groups（P < 0.001）. After 12 months of follow⁃up，mRS scores of patients with Aash after aneurysmclipping showed that there was a significant difference in mRS scores between group A，group B and group Crespectively（P < 0.05），and there was no significant difference in mRS scores between group B and group CSignificance（P > 0.05）. Conclusion endplate fistulation combined with lumbar cistern drainage can not onlyreduce the incidence of chronic hydrocephalus in Fisher Ⅲ⁃Ⅳ grade aSAH patients

Objective The present study tried to investigate the clinical effects of orthopedic tractioncombined with Sanchi spinal surgery in the treatment of lumbar disc herniation. Methods A total of 100 patientswith lumbar disc herniation treated in our hospital（January 2019 to March 2020）were selected and diagnosed byMRI and CT. They were divided into two groups according to therapeutic methods. The control group（n = 50）re⁃ceived conventional traction combined with manual guidance and the observation group（n = 50）received orthostat⁃ic traction combined with Sanchi spinal surgery. Before and after treatment，lumbar spine physiological curvature，pain，lumbar spine function，spinal nerve function，and clinical efficacy were compared. Results After treat⁃ment，the lumbar spine physiological curvature values of both groups were significantly increased and the VASscores were significantly reduced. The improvement of the observation group was significantly better than controlgroup（P < 0.05）. After treatment，the ODI scores of both groups were significantly reduced and the JOA scoreswere obviously improved. The improvement of the observation group was significantly better than that of controlgroup（P < 0.05）. After 1 month and 3 months of treatment，the clinical efficacy of the two groups was significantlydifferent（P < 0.05）. Conclusion Lumbar intervertebral disc herniation could be adopted to treat lumbar vertebracurvature with reduce pain and promoting lumbar spine function recovery.

Objective To investigate the effect of enteral nutrition at different time points on the recoveryof patients with gastrointestinal fistula after emergency operation. Methods We retrospectively reviewed the clinicaldata of patients undergoing emergency operation for gastrointestinal fistula in the People′s Hospital of GuangxiZhuang Autonomous Region from January 1，2008 to December 31，2018. 62 patients were divided into 2 groups，the observation group treated with enteral nutrition less than 48h after operation and the control group with enteralnutrition when gastrointestinal function recovered after operation，respectively. Nutrient indexes（albumin，pre⁃al⁃bumin，hemoglobin，transferrin，weight，triceps skinfold and urinary trimethylhistidine） and infection index（WBC，c⁃reactive protein and procaicltonin）were recorded on the 3rd，7th and 14th day after operation in the twogroups. Postoperative complications were retrospectively analyzed in terms of incision infection，bleeding，ventosity，diarrhea and intestinal obstruction. The exsufflation time of anus or stoma，primary healing rate of gastrointestinalfistula，mortality and the hospital length of stay were also compared between these two groups. Results Therewere no significant differences in nutrient index and infection index at the 3rd，7th and 14th day after operationbetween the observation group and control group（P > 0.05）. In terms of postoperative complications，the morbidityof ventosity，diarrhea and intestinal obstruction in the observation group was significantly higher than in the controlgroup（P < 0.05），while it had no significant difference in the rate of incision infection and bleeding between thegroups（P > 0.05）. Otherwise，the longer exsufflation time of anus or stoma and hospital length of stay wereshowed in the observation group（P < 0.05），whereas there was not significant difference in primary healing rate ofgastrointestinal fistula and mortality（P > 0.05）. Conclusion The patients with gastrointestinal fistula have morecomplications such as ventosity，diarrhea and intestinal obstruction when treated enteral nutrition less than 48 hafter emergency operation，and consequently prolong the hospital stay. Thus，enteral nutrition should be appliedduring the recovery of intestinal function.

Spinal cord injury（SCI）is a highly disabling disease，which will seriously reduce the patients′mobility，disability adjusted life expectancy，cause huge losses to patients′ families and society. Even the discussionabout whether glial scarsexerteda positive or negative effect not stopped，previous studies showed that glial scars had agreat impact on SCI. In any case，mastering the method of reducing glial scar formation after SCI would provide achoice for further treatment of SCI，helping neuron regeneration and restoring movement and sensation. Therefore，we reviewed the methods of reducing glial scar formation after SCI in the past three years. In future research，researchers could work harder to achieve more precise，effective，accessible，and safe applications based on exist⁃ing research. Carrying out combination therapy would reduce irritation and risk. It would also promote more safe andeffective methods into the clinic and thus relieve the pain of patients with SCI.

Bone metabolism⁃related diseases have become an increasing health burden worldwide and fur⁃ther basic research is still needed for a better understanding of the pathogenesis of these diseases and improvingand expanding existing prevention and treatment methods. Circadian circadian clock can regulate the physiologyand pathology of many organisms. In bones，circadian rhythms help coordinate bone formation and absorption.Bmal1 is the core biological clock gene，which plays an important role in the regulation of circadian rhythm，partic⁃ipates in the rhythm oscillation of bone formation and the expression of extracellular matrix. Chondrocytes，osteo⁃blasts and osteoclasts play an important role in the integrity and function of bone. The abnormal expression ofBmal1 would affect bone metabolism，and vice versa，bone metabolism would also affect the expression of Bmal1.

Objective To investigate the effects of Scarf combined with Akin osteotomy on hallux valgus.Methods 53 patients（60 feet）of hallux valgus who were operated from June 2015 to May 2016 with Scarf osteot⁃omy combined with Akin osteotomy. The preoperative HVA was（37.2 ± 7.5）° and（16.9 ± 2.7）°；DMAA is（13.5± 3.5）°. The preoperative AOFAS score was（67.1 ± 2.9）points. Results 53 patients（60 feet）were followed up for36 months after operation. None of them developed bone nonunion. There is one patient（1 foot）with metatarsalgia，one patient（1 foot）with deep infection，one patient（1 foot）with necrosis of head of first metatarsus. Postopera⁃tive parameters were：HVA（12.9 ± 1.4）°，IMA（9.5 ± 1.3）°，DMAA（10.5 ± 2.5）°，and AOFAS score（95.3± 7.3）points. There parameters were all improved compared with those before operation（P < 0.01）. Conclusion Scarf osteotomy combined with Akin osteotomy can correct deformity and improve symptoms. Therefore，it is aneffective method for the treatment of hallux valgus.