Multidrug⁃resistant tuberculosis（MDR⁃TB）which characterized by high morbidity，high mor⁃ tality，high treatment cost and low cure rate is a huge obstacle to the WHO goal of ending TB globally by 2035. As the the second country with a high burden of MDR⁃TB ，the situation of prevention and control is even more severe. This paper tries to discuss the problems and confusions in the control of MDR ⁃TB from the aspects of diagnosis， treatment，prevention and control strategies，as well as the focus of our desire to make breakthroughs.

The COVID⁃19 pandemic was raging，brought a huge challenge to tuberculosis and other infec⁃ tious disease. Overwhelmed medical resource，interaction between difference disease，changes of social support and family care bring shocks to the implementation on tuberculosis prevention and control strategy. This article reviews the similarities and differences of disease control between COVID⁃19 and tuberculosis，as well as the im⁃ pact and implications of COVID⁃19 epidemic on tuberculosis. 

Objective To investigate the variation characteristics of rpoB gene of clinical isolates of Myco⁃ bacterium tuberculosis with different drug resistance phenotypes in Guangdong，so as to provide a research basis for the development of more accurate and rapid molecular detection technology. Methods 373 clinical isolates of Mycobacterium tuberculosis which had known their sensitivity to rifampicin（R），isoniazid（H），ethambutol（E） and streptomycin（S）were screened from the Mycobacterium collection. RpoB gene fragments including rifampin resistance determination region（RRDR）were amplified and sequenced from 373 clinical isolates by polymerase chain reaction. Results Firstly，among the 373 strains，192 strains were detected with rpoB gene variation，and a total of 225 mutations occurred in 40 types of mutation including base replacement，insertion and deletion. The mutations at 531，526，511，516，533 and 515 were the most common，accounting for 43.11%（97/225），20.89% （47/225），10.22%（23/225），8%（18/225），4.44%（10/225）and 4%（9/225）respectively. Secondly，among 192 rpoB mutants，159 had only unit point mutation and 33 had double site mutation. Among them，14 mutation types such as D516V，H526L，H526D，H526R and S531W only appeared in unit point mutation，which was unit point specific variation. 21 mutation types such as M515T，H526Q，D516G，M515V and E541A only appeared in double site mutation，which was double site specific. Five mutation types，including S531L，L511P，H526Y…etc.are single⁃ and double⁃site common mutations. There is no simultaneous variation of three loci. Thirdly，the mutation rates of the rpoB gene for the four first⁃line drug fully susceptible strains（Q），R⁃sensitive and H⁃resistant strains （RSHR ），R ⁃ resistant and H ⁃ susceptible strains（RRHS）and HR ⁃ resistant strains（MDR）were 4.67%（5/107）， 28.42%（27/95），90.62（29/32），94.24%（131/139），except that the mutation rate between RRHS and MDR strains was not statistically different（P > 0.05），Q/RSHR，Q/RRHS，Q/MDR，RSHR /RRHS，RSHR /MDR strains were significantly different in rpoB gene mutation rate（P = 0.000）. Conclusions RpoB gene mutation of Mycobacterium tuberculosis in Guangdong has diversity and regional characteristics. Different drug resistance phenotypes may have a far⁃reaching impact on rpoB gene mutation.

Objective To establish a risk model for tuberculosis patients with MDRO infection so as to predict the risk probability of nosocomial infection caused by MDRO in tuberculosis patients. Methods A retrospec⁃ tive analysis was performed on 125 tuberculosis patients hospitalized for more than 48 hours in ICU from January 2020 to March 2021. Patients were divided into MDRO group（n = 65）and non⁃MDRO group（n = 60）Through single factor analysis combined with ICU characteristics，factors that may contribute to the risk of MDRO infection were analyzed. Logistic regression analysis was used to construct the risk model of MDRO infection ，then the predictive diagnostic value of different indexes was compared by receiver operating characteristic. Results Single⁃ factor analysis showed that eight factors such as invasive mechanical ventilation，indwelling urinary tube，indwelling nasal gastrointestinal tube showed statistical significance（P < 0.05）. Logistic regression analysis showed that the misjudgment rate of the risk model was 21.6% for the three variables including placement of nasal gastrointestinal tube，bronchoscopic alveolar lavage and length of ICU stay，which indicated good prediction effect of the risk mode. By comparing the effect of the number of days of indwelling catheters for different types of invasive proce⁃ dures on whether patients developed multidrug⁃resistant bacterial colonization/infection，it was concluded that the operations except placement of thoracic and abdominal drainage tubes were significantly correlated with the occur⁃ rence of multidrug⁃resistant bacteria in tuberculosis patients（P < 0.01）. For the area under ROC curve of MDRO colonization/infection risk prediction of tuberculosis patients based on the placement of nasal gastrointestinal tube， bronchoscopic alveolar lavage，ICU stay and the combined factor. The combined factor is most effective in determin⁃ ing whether a tuberculosis patient has colonization/infection MDRO. Conclusion Indwelling nasal gastrointestinal catheter，bronchoscopic alveolar lavage，length of ICU stay and the combined factor are significant for risk predic⁃tion of MDRO colonization/infection in tuberculosis patients. The prediction probability of combined factors is better than that of single factor.

Objective The diagnosis of tuberculosis is still the focus and difficulty of tuberculosis control. The differentially expressed genes of human beings are expected to become new diagnostic targets for tuberculosis. This study detected the mRNA expression of PR/SET domain 1（PRDM1）and GATA binding protein 2（GATA2） in human peripheral blood under different infection states of Mycobacterium tuberculosis，and analyzed their ability as diagnostic biomarkers. Methods The peripheral blood from patients with active tuberculosis，individual with latent tuberculosis infection and healthy controls was collected. The mRNA levels of PRDM1 and GATA2 in peripheral blood were detected by fluorescence quantitative PCR. The different expression and diagnostic value of PRDM1 and GATA2 were analyzed by the statistic software. Results The expression of PRDM1 and GATA2 in patients with active tuberculosis was significantly lower than those of latent tuberculosis infection and healthy controls（H = 69.27，P < 0.000 1；H = 37.97，P < 0.0001）. The area under curve of PRDM1 in differential diagnosis of active tuberculosis and latent tuberculosis infection was 0.8967，with sensitivity of 80.22% and specificity of 87.1%，the area under curve of GATA2 was 0.8061，the sensitivity and specificity was 82.35% and 70.97% respectively. When these two genes together was used to distinguish active tuberculosis from latent tuberculosis infection，the area under curve was 0.935，the sensitivity and specificity was 76.9% and 100% respectively. Conclusion The mRNA expression of PRDM1 and GATA2 in peripheral blood were potential biomarkers fordiagnosis of tuberculosis，and may assist diagnosis of active tuberculosis.

Objective To investigate the efficacy of matrix assisted laser desorption/Ionization ⁃ time of flight mass spectrometry（MALDI⁃TOF MS）for the diagnosis of smear⁃negative or sputum⁃scarce pulmonary tuber⁃ culosis（PTB）by testing bronchoalveolar lavage fluid（BALF）. Methods BALF of 87 patients with suspected smear⁃negative or sputum⁃scarce tuberculosis were tested by MALDI⁃TOF MS，SAT⁃TB，Gene⁃Xpert and BD960 from January 2020 to December 2021 in Anhui Chest Hospital. The results from those methods were compared. Results The sensitivity of MALDI⁃TOF MS for diagnosing smear⁃negative or sputum⁃scarce PTB was 68.5%（37/ 54），which was better than that of SAT⁃TB 13.0%（7/54），or Gene⁃Xpert 40.7%（22/54），or BD960 27.8%（15/54） （all P < 0.01）. The AUC value of MALDI⁃TOF MS was 0.827，which was better than that of SAT⁃TB 0.550，or Gene ⁃Xpert 0.704，or BD960 0.639（all P < 0.01）. Combining MALDI ⁃TOF MS with any one of the other three methods did not produce a better AUC value than using it alone. Conclusion MALDI⁃TOF MS appears to be a more accurate method in assisting the diagnosis of smear⁃negative or sputum⁃scarce PTB.

Objective To investigate the characteristics of the patients with multidrug⁃resistant pulmonary tuberculosis（MDR ⁃ PTB）and analyze the risk factors for developing the resistance of fluoroquinolones（FQs）. Methods A total of 230 MDR ⁃PTB patients admitted to Anhui Chest Hospital from April 2019 to March 2021 were collected and divided into the FQs sensitive group and the FQs resistant group according to the type of drug resistance. The chi ⁃ square test was used for comparative analysis of the factors related to FQs resistance，and multivariate logistic regression analysis was conducted to screen out independent risk factors. Results The chi ⁃ square test showed the risk factors related to FQs resistance were the type of treatment，the use of second⁃line anti⁃ tuberculosis drugs previously，comorbidities，chest CT findings，body mass index（BMI）and age（P < 0.05 for all）. Multivariate logistic regression analysis showed the use of second⁃line anti⁃tuberculosis drugs previously and BMI < 18.5 kg/m2 were independent risk factors（P < 0.05 for both）. Conclusion The use of second⁃line anti⁃tuberculosis drugs previously and BMI < 18.5 kg/m2 are independent risk factors for developing FQs drug resistance in MDR ⁃ PTB patients，which has certain reference value for clinical rapid diagnosis and differential diagnosis of FQs resis⁃ tant tuberculosis.

Objective To investigate the efficacy of isoniazid in preventing tuberculosis in kidney trans⁃ plant recipients with high risk of LTBI，and to identify the risk factors for tuberculosis in all kidney transplant recipients. Methods The clinical data of 592 renal transplant recipients were retrospectively analyzed. According to LTBI risk stratification and prevention program，592 recipients were divided into high ⁃ risk LTBI prevention group（n = 53），high⁃risk non⁃prevention group（n = 74），and low⁃risk group（n = 465）. The incidence of postop⁃ erative tuberculosis in each group was compared. Cox regression analysis was performed on the clinical data of 592 recipients to compare the results. Results 29 patients developed tuberculosis infection after transplantation in 592 recipients. There were 25 cases of tuberculosis infection in the high⁃risk group without prevention of LTBI ，no tuberculosis occurred in the high⁃risk prevention group（33.8% vs. 0，P < 0.05），and 4 cases of tuberculosis occurred in the low ⁃ risk group（33.8% vs. 0.9%，P < 0.05）. In Cox regression analysis，abnormal preoperative chest imaging（OR = 8.607，95%CI：3.202 ~ 23.134，P < 0.001）was an independent risk factor for tuberculosis after transplantation. Conclusions Renal transplant recipients should be screened for LTBI before transplantation， especially for patients with abnormal chest imaging examinations. Postoperative isoniazid prophylaxis in high ⁃ risk LTBI patients can significantly reduce the incidence of tuberculosis.

Objective To understand the improvement of respiratory and systemic symptoms and signs of pulmonary tuberculosis patients treated with modified Baihe Gujin decoction，and to provide evidence ⁃ based evidence for multidisciplinary treatment of tuberculosis. Methods A total of 92 patients with newly diagnosed pulmonary tuberculosis who came to our hospital from June 2018 to December 2021 were selected as the research objects. 50 patients in the observation group and 42 patients in the control group were treated for 4 weeks with anti ⁃tuberculosis treatment and anti ⁃tuberculosis combined with modified Baihe Gujin decoction. The changes of symptoms and signs such as cough，expectoration，sore throat，chest tightness，shortness of breath，thirst，mental fatigue，fatigue and anorexia were observed before and after 4 weeks treatment，and the severity was recorded as none，mild，moderate and severe. Changes were analyzed，and the c2 test was used to compare and analyze the difference in improvement rate between the observation group and the control group，as well as between male and female in the observation group. Results The rates of cough，expectoration，sore throat，chest tightness，shortness of breath，thirst，mental fatigue，fatigue，anorexia and overall improvement in the observation group were 100%， 100%，92.00%，90.00%，78.00%，96.00%，84.00%，76.00%，96.00%，and 90.22%，respectively. The control group were 83.33%，90.48%，76.19%，45.24%，69.05%，71.43%，59.52%，64.29%，64.29%，69.31%，respectively. Except for expectoration，shortness of breath and fatigue，the comparison of the rates between the observation group and the control group was statistically significant（P < 0.05）. Comparing 24 males and 26 females in the observation group，the improvement rates for males were 100% ，100% ，95.83% ，91.67% ，75.00% ，100% ， 91.67%，83.33%，91.67%，and 92.13%，respectively. For females，the rates were 100%，100%，88.46%，88.46%， 80.77%，92.31%，76.92%，69.23%，100%，and 88.46%，respectively. The difference in rates between the two sexes was not statistically significant（P > 0.05）. Conclusion Modified Baihe Gujin Decoction can significantlyimprove the respiratory and systemic symptoms and signs of pulmonary tuberculosis patients，and it is suitable for both men and women. 

Objective To investigate the effect of long non⁃coding RNA FTX（LncFTX）on the proliferation， migration and glycolysis of colorectal cancer cells. Methods The background expression of LncFTX in different colorectal cancer cell lines was detected by RT⁃qPCR. Small interfering RNA was used to down⁃regulate LncFTX expression in HT ⁃ 29 cells；CCK8 and Transwell assay were used to verify cell proliferation and migration，and western blot was used to evaluate the expression of PPARγ and downstream Leptin，TNFα and glycolytic related proteins. The changes of enzymes involved in glucose metabolism in HT⁃29 cells were analyzed by ELISA. Results LncFTX was highly expressed in different colorectal cancer cells. Down⁃regulating LncFTX expression in HT⁃29 cells significantly inhibited cell proliferation and migration，and the expression of PPARγ and Glut4 was significantly decreased，while PDHA1，Leptin and TNFα were significantly increased. The intracellular PFK and LDH levels in HT⁃29 cells after LncFTX down⁃regulation were（0.14 ± 0.02）U/mg and（72.03 ± 14.64）U/L，respectively， which were lower than those in control group（P < 0.05）. CS content increased to（8.07 ± 0.50）U/mg（P < 0.05）. After activation of PPARγ in LncFTX⁃reduced HT⁃29 cells，the corresponding proteins expression and the changes of PFK，LDH and CS contents were reversed to a certain extent. Conclusion LncFTX can affect the proliferation， migration，as well as aerobic glycolysis in HT⁃29 cells，via regulating the expression of PPARγ.

Objective To investigate the effects of Lactobacillus rhamnosus and curcumin on liver patho⁃ logical changes，liver index，liver function，serum inflammatory factors and liver tissue TLR4，MyD88，NF ⁃κB expression in MAFLD model rats and its possible mechanism. Methods After 1 week of adaptive feeding，40 SD male rats were randomly divided into normal control group（MCS），model control group（MCD），Lactobacillus rhamnoides intervention group（LGG），curcumin intervention group（CUR）and Lactobacillus rhamnoides plus curcumin intervention group（LGG + CUR）with 8 rats in each group.At the end of the 4th week，the rats were killed，and the liver index，pathological changes and fat content of liver tissue were compared，and the levels of serum transaminase，inflammatory factors and the expression of TLR4，NF⁃κBp65 and MyD88 in liver tissue were detected. Results Compared with MCS group，the general condition of MCD group was worse，large area steatosis and lipid infiltration of liver tissue，serum transaminase and inflammatory factors were significantly increased， which confirmed that the rat model of MAFLD was successfully established by methionine choline deficiency diet for 4 weeks. The liver index，liver pathological changes，liver fat level，serum transaminase，inflammatory factors， and the expression of TLR4，NF⁃κBp65 and MyD88 in each intervention group were significantly lower than those in MCD group，and the decrease was the most significant in LGG+CUR group. Conclusion Both Lactobacillus rhamnosus and curcumin can significantly improve liver lipid deposition，liver function and reduce the expression of liver index and inflammatory factors in MAFLD rats，which may be related to the regulation of TLR4 signal path⁃ way and the decrease of the expression of TLR4，MyD88 and NF⁃κB in liver. 

Objective To understand the effect of human umbilical cord mesenchymal stem cells（hUC⁃ MSCs） on myofibroblasts and to explore the effect of artesunate combined with hUCMSCs on myofibroblasts. Methods hUC⁃MSCs were isolated from umbilical cord by type Ⅱ collagenase digestion and adherence method. Human embryonic lung fibroblasts（MRC⁃5）were induced by TGF⁃β1 for 48 h，then added to MSCs and or ART for 24 h. Besides，after removal of the MSCs，TGF⁃β1 was readded into the MSC⁃deMFB system. The apoptosis level and the proliferation of cells were detected by flow cytometry and CCK8，respectively. The mRNA and protein expression levels of α ⁃ SMA，collagen and fibronectin were detected by qPCR and WB，respectively. Results hUCMSCs used in the experiment met the ISCT MSC criteria. After TGF⁃β1 pretreatment of MRC⁃5（MFB），cells were co ⁃cultured with MSCs for 24 h and the CCK8 increased compared with the control group（P < 0.01）. The mRNA and protein expression of α⁃SMA，COL1A1 and Fibronectin were significantly lower and close to the initial level of fibroblasts. When TGF ⁃ β1 was re ⁃added to the MSC ⁃ deMFB system，the cells recovered myofibroblasts characteristics，suggesting that MSC⁃induced myofibroblasts dedifferentiation was reversible. When myofibroblasts were stimulated by artesunate and MSCs simultaneously ，the cell apoptosis rate increased compared with the control group and it further inhibited the mRNA and protein expressions of α ⁃ SMA and COL1A1（P < 0.01）. Conclusions hUCMSCs can induce proliferation，dedifferentiation and inhibit extracellular matrix synthesis oflung myofibroblasts. Artesunate can induce the apoptosis of MSC⁃deMFB and overcome the effects of MSC⁃induced proliferation of myofibroblasts. Artesunate in conjunction with hUCMSCs may be a novel anti⁃fibrosis strategy.

Objective To assess the effect of lidocaine，administrated at the beginning of cardiopulmo⁃ nary bypass（CPB）and rewarming，on postoperative delirium after cardiac valve replacement；to explore the rela⁃ tionship between the effect and regional cerebral oxygen saturation（rSO2）. Methods 60 patients aged 34 ~ 75 years old，males or femals，scheduled for mitral valve replacement，with American Society of Anesthesiologists（ASA） physical status Ⅱ or Ⅲ，were enrolled in the current study. Participants were randomized assigned into 2 groups （n = 30 each）：2% lidocaine 4mg/kg was administrated to participants of group A at the beginning and rewarming of CPB，while same amount of normal saline was administrated to participants of group B. The incidence of postop⁃ erative delirium was assessed by Confusion Assessment Method for Intensive Care Unit（CAM⁃ICU）. Bilateral rSO2 was collected consecutively throughout the course of the operation，the baseline，mean，minimum of rSO2 and the percentage of rSO2 decrease from baseline to minimum were calculated. The extubation time，the adverse reactions， the durations of ICU stay ，the dosage of sedative and analgesic drugs and hospitalization were recorded. Results Compared with group B，the percentage of rSO2 decrease from baseline to minimum was significantly decreased， the minimal rSO2 was significantly increased，the incidence of postoperative delirium was significantly decreased， the extubation time and duration of ICU stay were significantly shortened，and the dosage of sufentanil was signifi⁃ cantly decreased after operation in group A（P < 0.05）. There were no significant difference in other results（P > 0.05）. Conclusions Administrating lidocaine at the beginning and rewarming of CPB can reduce the incidence of delirium after mitral valve replacement，shorten the extubation time and duration of ICU stay，and decrease the dosage of sufentainil after operation，which may be related to the improvement of intraoperative rSO2.

Objective To explore the predictive value of IGF⁃1 for ovarian response and ooctye quality in Mid⁃luteal phase GnRHa protocol. Methods Serum at the day of starting Gn therapy（Gn starting Day）and the day of HCG use（Day HCG）were collected from patients in our center taking Mid ⁃luteal phase GnRHa protocol and following Donor ⁃sperm IVF（D ⁃ IVF）. And then analyzing the relationship of IGF ⁃1 and clinical outcomes. Results There was no difference of IGF⁃1 in Gn starting Day in high response and normal response Groups. IGF⁃1 in Gn starting Day was significant higher in clinical pregnant group than in nonpregnant group. IGF⁃1 in Gn starting Day was an important factor affecting clinical outcome（OR = 0.987，95%CI：0.977 ~ 0.998，P = 0.021）. Receiver operator curve（ROC）for IGF⁃1 in Gn starting Day to predict clinical outcome of one transfer cycle showed that area under the curve（AUC）was 0.669（P = 0.029）. Conclusions When taking Mid⁃luteal phase GnRHa protocol， IGF⁃1 in Gn Starting Day cannot predict ovarian response but has predictive values for clinical pregnancy.

Objective To explore the risk factors of BPD in extremely premature and preterm infants with gestational age less than 32 weeks. Methods A total of 171 premature infants with gestational age < 32 weeks who were hospitalized in the neonatal intensive care unit of our hospital from January 1，2019 to April 30，2021 were selected and divided into BPD group and non⁃BPD group according to the clinical diagnosis. The general infor⁃ mation of children in the two groups at birth，the main diseases and treatment measures after admission，complica⁃ tions，and the general information of mother before delivery were analyzed retrospectively. Multivariate logistic regression was used to analyze the risk factors of BPD. Results The incidence of BPD in 171 children was 38.5% （66/171），including 34 males and 32 females. By univariate analysis，there were statistical significant differences between the two groups in birth weight，gestational age，multiple fetuses，5⁃minute Apgar score，rescue tracheal intubation in delivery room，first arterial blood gas after admission：PH，PaO2 and PaCO2，oxygen concentration at admission，number of blood transfusions during hospitalization，time to use antibiotics（days），re⁃intubation after admission，use of pulmonary surfactant（PS），use of invasive mechanical ventilation，invasive ventilation time ≥ 7 days，neonatal respiratory distress syndrome（RDS）and patent ductus arteriosus（PDA）（P < 0.05）. By multi⁃ variate Logistic regression analysis，gestational age（OR = 2.033，95%CI：1.161 ~ 3.559，P = 0.013），mechanical ventilation（OR = 0.165，95%CI：0.031 ~ 0.883，P = 0.035），and PaO2 at admission PaO（2 OR = 1.025，95%CI： 1.002 ~ 1.049，P = 0.033）were the independent risk factors for BPD in premature infants. Conclusion The occurrence of BPD is closely related to gestational age. The smaller the gestational age is，the higher the incidence of BPD. On the other hand，premature infants with low PaO2 at admission and receiving invasive mechanical venti⁃ lation are more likely to develop BPD.

Objective To investigate the risk factors of perioperative blood transfusion in patients undergoing hip revision，and to provide guidance for early screening the patients at high risks of postoperative blood transfusion. Methods A total of 162 patients who had undergone hip revision surgery during the period from August 2012 to March 2021 were included in this study. They were divided into a transfusion group（88 patients）and a non⁃trans⁃ fusion group（74 patients）according to whether they received blood transfusion，with a transfusion rate of 54.32%. The data on age，gender，BMI，hypertension，diabetes，osteoporosis，preoperative red blood cells，preoperative hemoglobin，preoperative platelets，preoperative PT，preoperative APTT，preoperative INR，preoperative TT， preoperative blood calcium，preoperative albumin，ASA score and postoperative allogeneic blood transfusion were collected from both groups. The SPSS software was used to analyze the risk factors of postoperative blood transfusion in patients with hip revision. The R software（4.1.1）was used to build a nomogram prediction model，and the ROC curve and calibration curve were drawn to evaluate the differentiation and standard degree of the model. Results Multivariate binary logistic regression analysis showed that hypertension（OR = 2.249，P = 0.037），osteoporosis （OR = 3.927，P = 0.001），preoperative hemoglobin（OR = 0.255，P = 0.026）and preoperative blood calcium levels （OR = 0.338，P = 0.038）were risk factors for postoperative blood transfusion in hip revision patients. R software was used to construct a nomogram prediction model and draw a ROC curve and a calibration curve. The area under the curve（AUC）was 0.751，and the slope of the calibration curve was close to 1，indicating that the prediction model had good differentiation and accuracy in predicting the risks of postoperative blood transfusion. Conclusions The nomogram has better differentiation and accuracy in predicting the risks of postoperative blood transfusion in hip revision patients，which is established based on five independent risk factors including hypertension，osteoporosis， preoperative hemoglobin and preoperative blood calcium.

Objective To retrospectively analyze the clinical characteristics and risk factors of critically ill obstetric patients with acute myocardial injury. Methods We conducted a single center，retrospective，cohort study. It enrolled 143 critically ill obstetric patients who received mechanical ventilation，from Jan 1st 2009 to Dec 31th 2019，in Peking University People′s Hospital. Patients′ clinical variables，obstetric variables，outcomes and prognostic variables were collected. According to the diagnostic criteria of myocardial injury ，the patients were assigned to myocardial injury group and non⁃myocardial injury group. Independent risk factors of acute myocardial injury were analyzed by univariate analysis and multivariate logistic regression respectively，and the predicting value of independent risk factors for myocardial injury was estimated by the receiver operating characteristic curve. Results Acute myocardial injury was found in 61 patients（42.7%）. In myocardial injury group，patients′ aspartate aminotransferase（AST），creatinine，albumin，hemoglobulin，lactate，temperature，the incidence of hypotension， time of surgery and the volume of blood loss during operation were increased significantly，when compared with that in non ⁃myocardial injury group（P < 0.05）. After including former variables into multivariate logistic regres⁃ sion，we discovered that early creatinine level（OR = 1.016，95%CI：1.004 ~ 1.027，P = 0.008），lactate level （OR = 1.492，95%CI：1.053 ~ 2.115，P = 0.025）and the volume of blood loss during operation（OR = 1.000 2， 95%CI：1.000 1 ~ 1.000 4，P = 0.011）were independent risk factors of myocardial injury. The area under ROC curve（0.853），standard error（0.033）and 95% confidence intervals（0.789 ~ 0.917）of the receiver operating characteristic curve，indicating a good predicting value. Conclusion Early creatinine level，lactate level and the volume of blood loss during operation are independent risk factors of myocardial injury in critically ill obstetric patients，and play a crucial role in predicting the development of myocardial injury.

Objective To evaluate the efficacy of soybean powder in improving perimenopausal symptoms. Methods 97 perimenopausal patients were randomly selected from July 2016 to December 2019 to complete the perimenopausal symptom score. With the consent of the patients and the ethical approval of the hospital，they were allowed to take 50 grams of soybean powder a day for 90 days，and then complete the score again. The positive rate and score of perimenopausal symptoms before and after taking soybean powder were compared. The contents of urine metabolites estrol，dihydrodaidzein and o ⁃ demethylated Angolan red sandalwood were measured，and the correlation between metabolites and perimenopausal symptoms was analyzed. Result （1）the positive rate of perimenopausal symptoms after taking soybean powder was lower than that before taking soybean powder，and the difference was statistically significant（χ2 = 53.41，P < 0.001）.（2）The comprehensive score of perimenopausal symptoms after taking soybean powder was lower than that before taking soybean powder，and the difference was statistically significant（H = -8.52，P < 0.001）.（3）The dose of urinary metabolite estrol was negatively correlated with perimenopausal symptom weighted total score and insomnia（r = -0.23，P = 0.02）. Dihydrodaidzein was negatively correlated with palpitation（r = -0.27，P = 0.007）. O ⁃demethyl angola nobilin was negatively correlated with hot flashes，sweating，mood swings，and palpitations（r1 = -0.22，P1 = 0.03；r2 = -0.21，P2 = 0.04；r3 = -0.21，P3 = 0.04）. Conclusion Taking soybean powder is beneficial to reduce the occurrence and severity of perimenopausal symp⁃ toms. The content of estrol is related to perimenopausal symptoms and sleep quality. Dihydrodaidzein content is related to palpitation in patients. The content of o⁃demethylated Angolan rosewood is related to the symptoms of hot flashes，sweating，mood swings and palpitations.

Objective To compare the diagnostic performances of high performance liquid chromatogra⁃ phy and capillary zone electrophoresis in the determination of HbA2 in α ⁃thalassemia. Methods The patients underwent α ⁃thalassemia screening in the Guangdong Second Provincial General Hospital from January 2019 to December 2021 were engaged in this study for the gathering of their clinical data such as HbA2 and thalassemia gene test results. The patients were divided into control group and α⁃thalassemia group according to the results of thalassemia gene detection. The indexes of the two groups were analyzed. The ROC was used to evaluate and com⁃ pare the diagnostic performances and cut⁃off point of HbA2 in α⁃thalassemia detected by high performance liquid chromatography and capillary zone electrophoresis. Results HbA2 in the α⁃thalassemia group was both significantly decreased when detected by both high performance liquid chromatography，as compared to the control group ［（2.78 ± 0.39）% vs.（2.57 ± 0.21）%，P < 0.001）］or capillary zone electrophoresis［（2.62 ± 0.46）% vs.（2.34 ± 0.31）%，P < 0.001）］. When detected by high performance liquid chromatography，the AUC of the HbA2 of ROC was 0.715（95%CI：0.682 ~ 0.747，P < 0.001）and the cut⁃off point was 2.8%，with sensitivity and specificity of 82.6% and 55.7%，respectively，while detected by capillary zone electrophoresis，the AUC of the HbA2 of ROC was 0.786（95%CI：0.751 ~ 0.821，P < 0.001）and the cut⁃off point was 2.6%，with sensitivity and specificity of 91.1% and 57.4%，respectively. Conclusions The capillary zone electrophoresis is better than the high perfor⁃ mance liquid chromatography when used for diagnosing α⁃thalassemia.

Objective To explore the relationship between early spontaneous abortion and chromosome variation by analyzing the types，incidence and the distribution between males and females of chromosome variation in couples with spontaneous abortion in Jiangxi province. Methods 997 couples（1 994 cases）with spontaneous abortion were divided into 4 groups：1 abortion，2 abortions，3 abortions and ≥ 4 abortions. Chromosome karyotype was detected and statistically analyzed. Results （1）The chromosome variation rate was 13.94%（139/997）， including 83 cases of chromosome polymorphism and 56 cases of chromosome aberration，of which balanced trans⁃ location accounted for 55.36%（31/56）of the total aberration.（2）There was no significant difference in chromosomal variation types between male and female with one abortion（P > 0.05）. But there was a significant difference in abnormal chromosome structure between couples who miscarried ≥ 2 times and those who miscarried once（P < 0.05）. The chromosomal polymorphism of couples with ≥ 4 abortions was significantly different from that of other groups （P < 0.05）.（3）The chromosomal aberration rate was increased with the abortion times within 3 times，and the correlation between the two was statistically significant（OR = 1.648，95%CI：1.163 ~ 2.334，P < 0.05）. Conclusion Chromo⁃ some translocation is the main genetic factor causing recurrent abortion. The chromosomal aberration rate is positively correlated with the abortion times within 3 times. For couples with recurrent abortion，routine chromosome examina⁃ tion shall be carried out，and couples with abortion ≥ 4 times shall pay attention to the genetic effect of chromo⁃ some polymorphism to assess the risk of reproduction.

Objective To understand the epidemiological characteristics of syphilis in Zhaoqing City in the past ten years（2011⁃2020），and provide a scientific basis for preventive interventions. Methods We retro⁃ spectively collected the syphilis registry data in Zhaoqing from 2011 to 2020. Results From 2011 to 2020，a total of 13，119 cases of syphilis were reported in Zhaoqing City，and the incidence of syphilis from 39.18/100 000 to 41.87/100 000 had shown an upward trend，（χ2 = 242.909，P < 0.05）. The staging of syphilis is dominated by latent syphilis，accounting for 86.31%；in the past 10 years，latent syphilis has shown an upward trend，while primary syphilis，secondary syphilis and fetal syphilis have all shown a downward trend，especially with fetal syphilis. Most significantly，the incidence rate decreased from 1.2129/100 000 live births to 1.46/100 000 live births（χ2 = 239.912，P < 0.05）. Moreover，Syphilis is concentrated in the urban region of Zhaoqing city. Both males and females showed a fluctuating upward trend（χ2 = 98.697，161.313，P < 0.05），and the incidence of males was more than that of females，with a sex ratio of 1.19（χ2 = 17.620，P < 0.05）. The incidence tends to increase with age，and the incidence is highest in people over 50 years old，and the incidence in the 10 to 19⁃year⁃old group has an increasing trend in 10 years. Of the total cases，farmers accounted for the highest proportion of occupational distribution，followed by housework and unemployed. Conclusions From 2011 to 2020，the incidence of syphilis in Zhaoqing City showed a slight upward trend，Men，teenagers，and the elderly are the key management targets.

Objective To study the correlation between the effect of Zhibaidihuang pills on central preco⁃ cious puberty in girls and the polymorphism of estrogen receptor（ER）α and β genes. Methods A total of 60 girls with central precocious puberty were selected from the outpatient department of traditional Chinese medicine of Guangdong Province Hospital for Women and Children Healthcare from July 2017 to January 2020. The patients were divided into effective group（n = 60）and ineffective group（n = 20）according to the effect of modified Zhibaidi⁃ huang pills. Polymerise chain reaction⁃restriction fragment length polymorphism（PCR⁃RFLP）was used to analyze the restriction fragment length. Genetic polymorphisms of estrogen receptor α genes Pvu Ⅱ and Xba I and receptor β genes RsaI and AluI were detected in the two groups of girls. Results There was no significant difference in ERα⁃Pvu II and ERα⁃XbaI gene polymorphisms between the effective group and the ineffective group（P > 0.05）. There were significant differences in ERβ RsaI and ERβ Alui gene polymorphisms between the effective group and the invalid group（P < 0.05）. Conclusion The genetic polymorphisms of ERα⁃PvuII and ERα⁃Xba I do not affect the efficacy of the treatment of girls with precocious puberty by modified Zhibaidihuang pills，but the different gene polymorphisms of Erβ⁃RsaI and Erβ⁃AluI do.

Objective To study the correlation between the effect of Zhibaidihuang pills on central preco⁃ cious puberty in girls and the polymorphism of estrogen receptor（ER）α and β genes. Methods A total of 60 girls with central precocious puberty were selected from the outpatient department of traditional Chinese medicine of Guangdong Province Hospital for Women and Children Healthcare from July 2017 to January 2020. The patients were divided into effective group（n = 60）and ineffective group（n = 20）according to the effect of modified Zhibaidi⁃ huang pills. Polymerise chain reaction⁃restriction fragment length polymorphism（PCR⁃RFLP）was used to analyze the restriction fragment length. Genetic polymorphisms of estrogen receptor α genes Pvu Ⅱ and Xba I and receptor β genes RsaI and AluI were detected in the two groups of girls. Results There was no significant difference in ERα⁃Pvu II and ERα⁃XbaI gene polymorphisms between the effective group and the ineffective group（P > 0.05）. There were significant differences in ERβ RsaI and ERβ Alui gene polymorphisms between the effective group and the invalid group（P < 0.05）. Conclusion The genetic polymorphisms of ERα⁃PvuII and ERα⁃Xba I do not affect the efficacy of the treatment of girls with precocious puberty by modified Zhibaidihuang pills，but the different gene polymorphisms of Erβ⁃RsaI and Erβ⁃AluI do.