Due to an aging population，the incidence of osteoporotic fractures is increasingly rapidly in China，and the demand for bone repair and regeneration is also growing rapidly. Osteoporosis，diabetes，inflamma⁃ tion and tumors，trauma，congenital skeletal malformations are directly or indirectly lead to bone defect，and greatly influence the life quality of patients. The treatment of bone defect is always a difficult point in clinic. Metformin has been widely used in type 2 diabetes mellitus（T2DM）. Recently，a large number of studies have shown that metfor⁃ min also plays an important role in repairing different types of bone defects. The application status and clinical trails of metformin in bone defect repair were emphatically reviewed in this article，as well as prospected the development.

In orthopedics，bone infection is a disease with a high treatment cost，a long cycle，and a high disability rate. The current treatment measures have drawbacks such as easy repetition and the requirement for secondary surgery to remove the internal implants. The development of biodegradable implant materials with anti⁃ bacterial properties has the potential to reduce patient suffering as well as the social burden. Mg⁃based metals have attracted extensive attention in the research field of bone infection repair materials with the advantages of degrad⁃ able in vivo，elastic modulus similar to bone tissue，as well as certain antibacterial properties. This article reviews the benefits of magnesium⁃based metals as a bone infection repair material，as well as existing issues，treatments for improving corrosion resistance and antimicrobial properties，and the clinical application of magnesium as an orthopedic implant. 

Objective To analyze the method，effect，bone metabolism and hemorheology of posterolateral minimally invasive total hip arthroplasty for femoral neck fracture in the elderly. Methods According to the random number table method，98 elderly patients with femoral neck fracture who underwent total hip arthroplasty in our hospital from January 2019 to July 2021 were divided into observation group and control group，with 49 cases in each group. Posterolateral conventional approach was used in the control group and posterolateral minimally invasive approach was used in the observation group. The clinical indexes，pain degree，hip function，bone metabolism， hemorheology，balance function and complication rate were compared between the two groups. Results Compared with the control group，the observation group had smaller incision，less intraoperative bleeding，shorter first time out of bed and shorter hospital stay（P < 0.05）；After treatment，compared with the control group，the observation group had lower pain and better hip function（P < 0.05）；After treatment，the improvement of bone metabolism and hemorheological indexes in the observation group were better than those in the control group（P < 0.05）；After treatment，the balance function of the observation group was higher than that of the control group（P < 0.05）；There was no significance between the two groups when compared the incidence of complication（P > 0.05）. Conclusion Total hip arthroplasty through posterolateral minimally invasive approach was effective for elderly femoral neck fractures. It could effectively alleviate the pain of patients，improve bone metabolism，promote blood circulation， facilitate the recovery of hip function and reduce the dysfunction of body balance. 

Objective To observe the clinical efficacy and safety of anterolateral acromion percutaneous minimally invasive internal fixation（Minimally invasive percutaneous plate osteosynthesis，MIPPO）technique in the treatment of elderly patients with osteoporotic fractures of the proximal humerus. Methods Elderly patients with proximal humeral osteoporotic fractures treated with the proximal humeral locking internal fixation system （PHILOS）in our hospital from January 2017 to December 2019 were randomly divided into MIPPO group（34 cases treated with anterolateral acromion MIPPO technique combined with PHILOS）and ORIF group（31 cases treated with transdeltoid pectoralis major open reduction and internal fixation combined with PHILOS treatment）. There was no statistical significance in the comparison of sex distribution，age，injured side，preoperative preparation time and other data between the two groups before operation（P > 0.05）. The intraoperative（operation time，surgi⁃ cal incision length，etc.），postoperative complications，and fracture healing time were observed in the two groups； the pain visual analog scale（VAS score）was used to evaluate the shoulder pain on the 1st and 3rd day after the operation；the Neer function score of the shoulder joint was used to evaluate the clinical treatment effect after 12 months. Results There were less blood loss，and shorter intraoperative time，surgical incision length，postopera⁃ tive hospital stay and fracture healing time in the MIPPO group（P < 0.05）. The VAS score of the MIPPO group was significantly lower than that of the ORIF group on the 1st and 3rd day after operation（P < 0.05）. The Neer score of shoulder joint in the MIPPO group was higher than that in the ORIF group in the follow⁃up after 12 months （P < 0.05）. Conclusion Anterolateral acromion percutaneous minimally invasive internal fixation is safe and effective in the treatment of senile osteoporotic fractures of proximal humerus. It has the advantages of small soft tissue injury and short hospital stay，and is suitable for popularization. 

Objective To compare the effect of transforaminal and straddling pedicle screw internal fixation in patients with thoracolumbar burst fractures. Methods A total of 86 patients with thoracolumbar burst fractures were randomly divided into traumatic vertebral group and straddling vertebra group and were treated with transpe⁃ dicular screw fixation and straddling vertebra pedicle screw internal fixation，respectively，and were followed up for 2 years. The pain，Oswestry dysfunction index（ODI），imaging index and postoperative complications，incision healing and fracture healing were compared. In addition，the biomechanical characteristics of the 2 groups were compared by biomechanical test. Results The scores of pain visual analogue scale（VAS）and ODI in the two groups were decreased successively at completion of operation，3 months after operation and the last follow ⁃ up （P < 0.05），and the compression rate of injured spine and Cobb angle of kyphosis at completion of operation，3 months after operation and the last follow⁃up were lower than before operation（P < 0.05）. However，except VAS， the above indexes in traumatic vertebra group at 3 months after operation and the last follow ⁃ up were lower than those in straddling vertebra group（P < 0.05）. There were no postoperative complications in both groups after operation，and the incision healed in Grade A and the fracture healed in both groups. The torsion angle，flexion displacement，flexion displacement and pullout strength in the traumatic vertebral group were lower than those in the straddling vertebral group（P < 0.05）. Conclusion For patients with thoracolumbar burst fractures，the strad⁃ dling screw fixation and transpedicular screw fixation all could obtain good clinical efficacy，while transpedicular screw fixation had better clinical application value.

Immune checkpoint inhibitors（ICIs）represented by programmed cell death receptor⁃1 and ligand inhibitors significantly improve the five⁃year overall survival rates of patients with advanced non⁃small cell lung cancer（NSCLC）. However，the objective response rate of ICIs treatment is about 20%，and only a small number of patients can benefit from it. Moreover，the response and efficacy of patients to ICIs cannot be accurately predicted by detecting the expression level of PD ⁃ L1. Therefore，more ideal biomarkers need to be identified to screen patients and predict the response to immunotherapy. In recent years，an increasing number of studies has focused on genetic polymorphisms at different sites of PD⁃1/PD⁃L1 in NSCLC. In this article，we reviewed the effects of PD⁃1/PD⁃L1 gene polymorphisms on susceptibility，prognosis and treatment effect of NSCLC patients，as well as the correlation with immune⁃related adverse events and hyper⁃progressive disease ，so as to explore thepotential predictive biomarkers of ICIs treatment and provide some reference for precision immunotherapy in patients with NSCLC.

Objective To study the effect of Mus81 gene silencing on the proliferation，apoptosis and chemosensitivity of MCF ⁃7 human breast cancer cell line，and to preliminarily explore its regulatory mechanism. Methods Mus81⁃silenced MCF ⁃7 breast cancer cell line was initially constructed. Cell growth and proliferation were detected by thiazolyl blue（MTT）method and plate cloning assay. Propidium iodide（PI）staining and Annexin V⁃APC staining were used to detect changes in cell cycle and apoptosis. qRT⁃PCR detected the expression of down⁃ stream genes after Mus81 was silenced，and MTT method detected the 50% inhibitory concentration（IC50）and reversal index（RI）of chemotherapy drugs. Results The MTT growth curve and plate cloning assay showed that the proliferation of MCF ⁃7 cell line was significantly retarded after Mus81 gene silencing（P < 0.001），and the number of cell clones was significantly decreased（P < 0.001）. Annexin V ⁃APC and PI staining showed that the apoptotic rate of MCF⁃7 cells increased（P < 0.001），and obvious G2/M phase arrest developed. MTT test results showed that the IC50 values of MCF ⁃7 cells to cisplatin，doxorubicin，epirubicin and 5⁃fluorouracil were signifi⁃ cantly reduced after Mus81 silencing，and the RI was 5.118，3.070，3.027 and 8.997 respectively. The results of qRT⁃PCR and Western blot for detecting the expression of downstream signaling pathways showed that the expres⁃ sions of APAF1，APC and PTEN genes in MCF⁃7 cells increased after Mus81 silencing，while the expressions of MAPK3 and MAPK1 genes decreased. Conclusions Mus81 gene silencing can significantly inhibit the growth and proliferation of the MCF⁃7 human breast cancer cell line and induce G2/M phase arrest and apoptosis. It can also increase the sensitivity of MCF ⁃ 7 cells to cisplatin，doxorubicin，epirubicin and 5⁃fluorouracil. The mechanismmay be related to the regulation of the expressions of downstream genes APAF1，APC，PTEN，MAPK1 and MAPK3， suggesting that Mus81 may be a potential therapeutic target of breast cancer.

Objective To explore the role of glucocorticoid receptors（GRs）in the depressive⁃like behaviors of offspring of perinatally depressed mice（PND）. Methods Western blot was applied to detect the expression of GRs in PND mice generated with wild⁃type mice. Twenty mice with the placenta GR knocked down were generated using transgenic mice. Then western blot was used to verify the knockdown of the GRs in the mice，and the mor⁃ phology of the mice was analyzed. Pregnant GRs knocked down mice were stimulated continuously to be used to compare the growth and development of offspring of the GRs knockdown group（KD）and the GRs non⁃knockdown group（N⁃KD）；The locomotion behaviors and depressive⁃like behaviors of each group′s offspring were detected by open field test（OFT）and the forced swimming test（FST）. Results Compared with the control group，the level of GRs was increased in the placenta of female offspring of PND mice（P < 0.05）；The expression of GRs in placenta of KD decreased significantly（P < 0.05）；We observed no significant differences between the KD and N⁃KD in placental morphology（P > 0.05）；The growth and development and the exercise capacity of the KD and N⁃KD showed no significant differences（P > 0.05）；However，the female offspring of KD had more depressive tendencies than the male offspring（P < 0.05）. Conclusion A decrease in placental GRs augments the tendency of female offspring of PND mice to depression.

Objective By detecting the expression of long⁃chain non⁃coding RNA LINC00467 in ovarian cancer tissues and ovarian cancer cell lines，to preliminarily explore its relationship with the clinicopathological characteristics of ovarian cancer and its biological characteristics in ovarian cancer，and the possible regulatory mechanism of LINC00467 was preliminarily explored. Methods Firstly，based on the gene expression profile interactive analysis database of Cancer Genome Atlas（TCGA），the expression level of LINC00467 in ovarian cancer tissue（Ovarian cancer，OC）was evaluated through bioinformatics analysis；then the possible miRNA targets of LINC00467 were predicted using the Starbase database. Then quantitative real ⁃time PCR（qPCR）was used to detect the expression of LINC00467 in 66 pairs of ovarian cancer tissues and normal ovarian tissues，and analyze its relationship with the clinicopathological characteristics of ovarian cancer. Furthermore，after reducing the expres⁃ sion of LINC00467 through gene silencing technology，CCK⁃8 experiment，colony formation experiment，Transwell migration and invasion experiment were used to determine the effect of LINC00467 on the biological characteristics of ovarian cancer cells. The binding relationship between LINC00467 and miR⁃302a⁃3p was detected by dual⁃lucif⁃erase reporter gene，and the expression of miR⁃302a⁃3p was detected after reducing the expression of LINC00467. Results The bioinformatics analysis showed that the expression of LINC00467 in ovarian cancer tissue（OC）in the Cancer Genome Atlas（TCGA）database was significantly higher than that of the normal control group；quantitative real⁃time PCR（qPCR）indicated that the expression of LINC00467and miR⁃302a⁃3p in 66 cases of OC group was significantly higher than that of the normal ovarian group. The expression of LINC00467in ovarian cancer cell lines was also significantly higher than that in human ovarian epithelial cell lines（HOSEpiC），which verified the results revealed by bioinformatics analysis. Further analysis showed that the expression level of LINC00467 was positively correlated with the pathological grade of ovarian cancer，lymph node metastasis and FIGO staging. The results of survival analysis showed that the overall survival of OC patients with low expression of LINC00467 was better than that of OC patients with high expression of LINC00467. After silencing the expression of LINC00467，the proliferation activity，colony forming ability，migration and invasion ability of ovarian cancer cells were significantly inhibited. Conclusion The long⁃chain non⁃coding RNA LINC00467 is highly expressed in ovarian cancer tissues and cells， which is related to the proliferation and metastasis of ovarian cancer cells，and positively related to the poor prognosis of patients with ovarian cancer. Its mechanism may be that LINC00467 targets and regulates miR⁃302a⁃3p.

Objective To investigate hematopoietic reconstruction of nonmyeloablative receptors after a new strategy of bone marrow transplantation ⁃ vascularized bone marrow transplantation（VBMT）containing both bone marrow cells and its own stromal microenvironment. Methods Vascularized femur as a carrier of BMCs was transplanted into irradiated（5 Gy）syngeneic Lewis rats. Routine blood tests，spleen index measurement，bone marrow count，flow cytometry and histopathological examination were used to assess hematopoietic potentialof the receptor. The same amount of BMCs suspensionor saline was injected intravenouslyto use as a positive or negative control group. Results Ascompared with the negative control group，both VBMT and intravenous BMT accelerated the recovery of leukocytes and platelets and had a higher spleen index（P < 0.05）. Numerous lymphocytes and lymphatic nodule were seen in the spleen section in spite of obscure boundary betweenthe white and the red pulp. Histological appearances of bone marrow also showed scattered BMCs，but the bone marrow was almostreplaced by vacuolar tissuesin the control group. The number of BMCs was a magnitude lower in the control group than in the VBMT and intravenous BMT groups. However there were no significant differences between VBMT and intravenous BMT in the above results. Conclusions Vascularized bone marrow transplantation accelerates reconstruction of partialhematopoietic systeminnonmyeloablative receptors andcan be used as a new transplantation of bone marrow.

Objective To investigate the changes in the expression of intrahepatic glycoprotein 130 （gp130）in acute liver injury and its effect on hepatocyte apoptosis and its mechanism. Method First，carbon tetrachloride（CCl4）was used to induce acute liver injury in mice to detect changes in the expression of gp130 in the liver，endoplasmic reticulum stress（ERS；labeled with caspase⁃12），and apoptosis（with cleaved caspase⁃3 expression and TUNEL comprehensive evaluation）；Secondly，4⁃phenylbutyric acid（PBA；ERS inhibitor）was used to intervene in mice to explore the effect of ERS on the expression of gp130 in the liver；Finally，the expression of gp130 in the liver of the model mice was knocked down，and the effect and mechanism of gp130 on liver injury and hepatocyte apoptosis were explored. Result The expression of gp130 in the liver of model mice is up⁃regulated， and ERS and apoptosis signals are significantly activated（P < 0.05）；PBA reduces the expression of gp130 in the liver and reduces the apoptotic response of hepatocytes（P < 0.05）；the down⁃regulation of gp130 aggravated the CCl4⁃induced liver injury，ERS，and hepatocyte apoptosis in mice（P < 0.05）. Conclusion ERS promotes the up⁃ regulation of gp130 expression in acute liver injury；up⁃regulation of gp130 is beneficial to alleviate liver injury， and the mechanism may be related to negative regulation of ERS⁃mediated hepatocyte apoptosis.

Objective To investigate the expression level of interleukin ⁃38（IL ⁃38）in serum and renal cancer tissues of patients with renal cell carcinoma and its clinical significance. Methods ELISA was used to detect the expression level of IL ⁃38 in serum of renal carcinoma group and healthy control group. The expression levels of Th17 cells and Treg cells in peripheral blood of the two groups were detected by flow cytometry. The expression level of IL⁃38 mRNA in tumor and adjacent tissues of patients with renal carcinoma was detected by real⁃time fluorescence quantitative PCR. Results The serum IL⁃38 level in renal carcinoma group was lower than that in control group，and correlated with tumor stage，lymph node metastasis，Fuhrman grade and tumor size，the difference was statistically significant（P < 0.001）. ROC curve analysis showed that when serum IL⁃38 was 150.65 pg/mL，the area under the curve was 0.863，the sensitivity was 71.7%，and the specificity was 87.2%. Il⁃38 mRNA expression in renal carcinoma tissues of different stages was lower than that in adjacent tissues，the difference was statistically significant（P < 0.001）. The expression level of Treg cells in peripheral blood of renal carcinoma group was lower than that of control group，and Th17 cells were higher than that of control group，the differences were statistically significant（P < 0.001）. The expression levels of serum IL⁃38 and peripheral blood Treg cells in patients with renal cancer were higher than those before surgery，and the expression levels of peripheral blood Th17 cells were lower after surgery，with statistical significance（P < 0.05）. Conclusion IL⁃38 is low expression in renal carcinoma，and its expression level is closely related to clinical stage and pathological grade，which is expected to be a new biomarker for predicting the occurrence and prognosis of renal carcinoma. 

Objective Ischemic stroke is one of the most important causes of neurological diseases and death in the world，but the current treatment scheme is limited. Methods Patients with ischemic stroke treated in our hospital from 2019 to 2021 were divided into control group and observation group，which were treated with trox⁃ erutin and troxerutin combined with high ⁃frequency electrotherapy respectively. The expression levels of miR ⁃ 137 and miR⁃155 were detected by RT⁃PCR in venous blood samples from patients before and after treatment. National Institutes of Health Stroke Scale（NIHSS）score and Barthel index（BI）statistics were performed in patients，and the Pearson correlation between the two was analyzed. Results After treatment，the expression level of miR⁃137 in peripheral blood of patients in the two groups increased，and the expression level of miR⁃155 decreased，while the change in observation group is significantly greater than that of controls. After treatment，the NIHSS score of the observation group was significantly lower than that of the control group，and the BI index was significantly higher than that of the control group（P < 0.05）. The results of correlation analysis showed that miR⁃137 expression level was negatively correlated with NIHSS score and positively correlated with BI index. MiR⁃155 expression levels were positively correlated with NIHSS score and negatively correlated with BI index. The effective rate of the observation group was higher than that of the control group，and the incidence of adverse reactions was lower than that in the control group. Conclusion Troxerutin combined with high frequency electrotherapy can improve nerve injury in patients with ischemic stroke.

Objective To explore the relationship between suicidal/self⁃injury behaviors and the levels of inflammatory cytokines in adolescents with affective disorder. Methods Seventy ⁃eight adolescents with affective disorder aged 15 ~ 24，who met the current diagnostic criteria of major depressive episode and major depressive episode of DSM⁃5 bipolar disorder were included in the study，26 of them in the non⁃suicidal/self⁃injury group and 52 in the suicidal/self ⁃ injury group. Their clinical symptoms were assessed by the Hamilton Depression Scale （HAMD），Hamilton Anxiety Scale（HAHA）and 32⁃item hypomania symptom Checklist（HCL⁃32）. Fasting venous blood was collected in the next morning following admission，and the levels of inflammatory cytokines in the samples were determined by ELISA. Results In the suicidal/self ⁃injury behavior group，the number of female （75.00%）was significantly higher than the number of male（25.00%）（χ2 = 4.875；P = 0.027）. The mean age in the suicidal/self⁃injury behavior group was significantly lower than that in the non⁃suicidal/self⁃injury behavior group ［（16.73 ± 2.09）vs.（18.69 ± 2.46），t = 3.683；P < 0.001］. The expression levels of IL⁃4 and IL⁃13 in the anti⁃ inflammatory cytokines in the former were significantly lower than those in the latter（F = 9.261，P = 0.003；F = 4.462，P = 0.038，respectively）. By binomial logistic regression analysis，the risk factors for the patients with suicidal/self⁃injury behavior were age（OR = 0.504），female（OR = 9.141），bipolar Ⅱ（OR = 3.235），IL⁃4（OR = 0.964），and IL⁃13（OR = 0.952）. Conclusion Bipolar Ⅱ ，female，younger age and significantly decreased expression of IL⁃4 and IL⁃13 are independent risk factors for suicidal/self⁃injury behavior in adolescents with affec⁃ tive disorder. 

Objective To assess the efficacy and safety of Excimer laser coronary atherectomy（ELCA）in the treatment of resistant chronic total occlusion（CTO）lesions. Methods Fifty⁃one patients with severe resistant CTO lesions in Fuwai Yunnan Cardiovascular Hospital during May 2020 and August 2021 were included in the study，22 of them treated with ELCA and 29 with routine PCI. The plaque characters were analyzed and the final treatment effects were optimized by intravascular ultrasound（IVUS）after the successful procedures by which the balloons as well as the follow⁃up stents successfully went through the lesions and the residual stenosis was less than 20%. Results The total success rate of the two groups were 90.2%（46/51），that of the ELCA group reached 100% （22/22）and that of the non⁃ELCA group 82.7%（24/29）. Neither coronary perforation nor acute cardiac tamponade occurred during the operation in both the groups. Conclusion ELCA is a valuable tool for the treatment of resistant CTO lesions. It helps to achieve optimal outcomes for the patients with severe resistant CTO lesions.

Objective To preliminary explore the clinical value of three⁃dimensional visualization technol⁃ ogy for the laparoscopic D3 radical resection of colorectal cancer. Methods The clinical data of forty patients with colorectal cancer undergoing laparoscopic D3 radical operation in Dongguan Municipal People′s Hospital from May 2019 to December March 2021 were analyzed retrospectively. Before the operation，all patients underwent enhanced CT examination and then used commercial reconstruction software to perform 3D visualization reconstruction and guide the actual operation. Results The three⁃dimensional visualization model clearly showed the shape and direction of the colon，the location of the tumor，the anatomy and variation of the main blood vessels and the blood vessels supplying the cancer，and showing a coincidence rate of 100% with the actual surgical exploration. The D3 radical resection of colorectal cancer is formulated based on the three⁃dimensional model before the operation. The coincidence rate with the actual surgical plan was 100%. All the 40 patients completed operations successfully， and no patient was converted to open surgery. The unexpected injury of blood vessel did not happen. The mean operative time was（162.1 ± 51.7）min with a mean estimated blood loss of（58.6 ± 46.3）mL. The mean time of first flatus was（51.7 ± 36.7）h and the postoperative hospital stay was（8.2 ± 6.5）d. The postoperative complications appeared in 4 patients，including one of inflammatory bowel obstruction，one of anastomotic leakage and two of lymphatic fistula，the complication rate was 10.0% ，and they were all cured with conservative treatments. The mean number of harvested lymph node was（28.8 ± 39.1），among which（3.9 ± 2.5）was positive. TNM staging：Stage Ⅰ4 cases，Stage Ⅱa 8 cases，Stage Ⅱb 5 cases，Stage Ⅲa 15 cases，Stage Ⅲb 5 cases，Stage Ⅲc 3 cases. Conclusions On the basis of clarifying tumor blood supply arteries and their vascular variations，3D visualization technology can not only improve the efficiency and safety of surgery，but also perform accurate laparoscopic D3 radical resection of colorectal cancer on the basis of oncology.

Objective The evaluation criteria for the rational use of vonoprazan is established，in order to provide a reference for clinical rational drug use. Methods Based on the drug instructions of vonoprazan，clinical guidelines，and expert consensus，the evaluation standards for vonoprazan are formulated.AHP method was used to assign weights to various indexes of evaluation criteria. TOPSIS method was used to analyze the use of vonoprazan of 236 cases in the hospital from January 2021 to January 2022 and evaluate rational drug use. Logistic binary regression model was constructed to explore the influencing factors of irrational drug use，and through the OpenVigiL database to mine the adverse reactions of the drug after the market. Results Among 236 cases，there were 71 rea⁃ sonable cases（30.1%），1 basic reasonable case（0.4%），and 164 unreasonable cases（69.5%）.Logistic regression analysis found that concomitant use of antiplatelet drugs was the main reason for the increase in irrational drug use. In addition，a total of 88 adverse reactions of the drug were discovered. Conclusion The AHP ⁃TOPSIS method can be used to evaluate the rationality of vonorasen. The research results show that the drug has unreasonable phe⁃ nomena such as unsuitable indications，no economic considerations，and no patient education. At the same time， attention should also be paid to the adverse reactions of the drug. Intensify management efforts to promote clinical rational drug use.

Objective To explore the related influencing factors of sub⁃delirium syndrome in patients with severe tumor，and to construct a drug⁃free therapy and then to analyze its application value. Methods A total of 286 patients with severe tumor who were hospitalized from September 2020 to March 2021 were used as study subjects. They were screened for sub ⁃ delirium and divided into a sub ⁃ delirium group（SSD group，n = 172）and a group without sub⁃delirium（non⁃SSD，n = 114）. The general data onthe patients were collected，and the univariate and multivariate analysis were applied to analyze the related risk factors. Based onthe analysis results，a drug ⁃free treatment plan for sub ⁃delirium syndrome was constructed. The sub ⁃delirium group weresubdivided into a routine plan intervention group（control group）and a drug⁃free treatment plan intervention group（study group）by using a random number table The incidence of delirium，total dailyhours ofsleep after intervention，hospital stay，sleep quality score，cognitive function score，VAS score，HAMA score，APACHEⅡscore and PPI score were compared between the two groups. The application value was analyzed. Results The rate of sub⁃delirium was 60.13% in 286 patients. The scores on ECOG，APACHEⅡ，and PPI were higher in the SSD group than in the non ⁃SSD group （P < 0.05）. Opioids，sleep disorder，infection，PPI score and APACHEⅡscore were the independent risk factors for sub⁃delirium in patients with severe tumor（P < 0.05）. After drug⁃freetreatment，thescores oncognitive function and sleep quality and the total daily hours ofsleep were significantly higherin the study groupthan inthe control group， whilehospital stay was shorter（P < 0.05）. Thescores on VAS，HAMA，APACHEⅡand PPI were significantly lower in the study group than in the control group（P < 0.05）. The incidence rate of deliriumwas significantly lowerin the study group than in the control group（15.12% vs. 31.40%，P < 0.05）. Conclusions Opioid drugs，sleep disorder，infection，PPI score and APACHE score are independent predictors of sub⁃delirium syndrome in patients with severe tumor. The drug⁃freetreatment protocol constructed based on the results of risk analysis can significantly improve cognitive function，sleep quality，VAS score，PPI score and APACHE score，shorten hospital stay，and reduce the incidence of sub⁃delirium. It shows higher clinical application value.

Lung ischemia reperfusion injury（LIRI）refers to the aggravation of lung tissue injury after lung perfusion is restored on the basis of lung ischemia caused by various reasons，with high morbidity and mortality. In the inflammatory response of lung tissue caused by LIRI，there are changes in autophagy activity according to the different characteristics and development stages of the disease. Therefore，in⁃depth study of the relationship between autophagy and inflammation is of great significance for maintaining autophagy homeostasis and improving lung injury caused by ischemia⁃reperfusion. This paper reviews the regulatory mechanisms of inflammation，autoph⁃ agy and their interaction on LIRI，aiming to provide reference for the diagnosis，treatment and prognosis of LIRI.

Objective To analyze the effect of integrated medical management on patients with type 1 diabetes mellitus（T1DM）. Methods A total of287 T1DM patients were enrolled in this study，and integrated medical management was implemented for them for three years. Through special government funds，a treatment center was established to provide patients with therapeutic intervention and standardized chronic disease management in the outpatient department. Interventions included insulin therapy，injection needles，blood glucose self ⁃ monitoring （SMBG）devices，regular diabetes education，and observation indicator monitoring.The management effect was evaluated by comparing the observation indicators before and after the management for three years. Results SMBG frequency and intensive insulin therapy rate of T1DM patients in children and adolescents，adults and the elderly increased after the management（all P < 0.01），but the ketosis incidence and hospitalization frequency decreased （all P < 0.05），and daily insulin dose of T1DM patients in children and adolescents increased（P < 0.01）. Compared with those before the management，the 2 h postprandial c ⁃ peptide level，HbA1c compliance rate and exercise compliance rate of T1DM patients in children and adolescents and adults decreased（all P < 0.05），and dietary control rate of adult T1DM patients increased（P < 0.01）. Conclusion Integrated medical management is effective for improving self ⁃management awareness and skills of T1DM patients，reducing the occurrence of complications and medical cost. However，it is still necessary for patients to have exercise and diet control to strengthen the management effect.