Anti⁃tuberculosis drug⁃induced liver injury（ATB⁃DILI）was the most common adverse drug reaction in anti⁃tuberculosis treatment，which was one of the reasons that caused patients to stop anti⁃tuberculosis treatment. It then affectes the therapeutic effect of tuberculosis. This article focuses on the pathogenesis，clinical diagnosis and treatment of ATB ⁃DILI，and the necessity of prevention and liver protection in anti ⁃tuberculosis treatment，

Objective To explore the relationship between the expression of miR⁃5088⁃5p in placenta and the clinical characteristics of patients with preeclampsia and its role in the pathogenesis of preeclampsia. Methods The expression of miR⁃5088⁃5p in placenta was measured by qRT⁃PCR and the correlation between the expression of miR⁃5088⁃5p and clinical features was analyzed，and the expression of LC3B and p62 in placental tissue was detected by immunofluorescence. At the same time，human placental trophoblast cell line（HTR8⁃S/Vneo）was cultured in vitro and divided into nomorxia group and hypoxia group. The expression of LC3B and p62 protein in placental trophoblasts of each group was detected by Western blot after transfection of miR⁃ 5088⁃5p mimics. Results The expression of miR⁃5088⁃5p in placenta of preeclampsia was significantly low（P < 0.01），and the expression level was negatively correlated with systolic blood pressure，diastolic blood pressure and platelet count， but positively correlated with neonatal weight（P < 0.05）. Immunofluorescence showed that LC3B increased and p62 decreased in placenta of preeclampsia group. In addition，compared with the nomorxia group，the expression of LC3BⅡ/Ⅰ protein in hypoxia group increased（P < 0.05），while the expression of p62 protein decreased（P < 0.05），and the expression of LC3BⅡ/Ⅰ decreased（P < 0.01）and p62 increased（P < 0.05）after transfection of miR⁃5088⁃5p mimics. Conclusion miR⁃5088⁃5p is significantly down⁃regulated in placental tissue of preeclamp⁃ sia，and its overexpression can significantly inhibit the occurrence of autophagy of placental trophoblasts，which is 

Objective Based on the success in preparation of vancomycin⁃incorporated PLGA/TCP scaf⁃ fold，its effect of repair infected femur defects in goats was evaluated. Methods A goat model of infected femur defects was established and the goats were randomly assigned to three groups. The experimental group 1 was implanted with vancomycin⁃incorporated PLGA/TCP scaffold，the control group 1 was implanted with antibiotic⁃PMMA（poly⁃ methyl methacrylate）and the control group 2 was served as a blank control group. White blood cells（WBC），erythro⁃ cyte sedimentation rate（ESR）and C⁃reactive protein（CRP）were detected at different time points. The content and antibacterial activity of vancomycin were detected in local tissues. X ⁃ ray and hematoxylin ⁃eosin（HE）stain were performed to assess biodegradation of the scaffold and bone reconstruction. Results All of the animals survived. The experimental group 1 and the control group 1 had better anti ⁃infective effect. As compared with the blank control group，ESR and CRP were significantly lower in the other two groups at weeks 4，8 and 12 after operation（P < 0.05）. Besides，the experimental group 1 showed more biodegradation and bone reconstruction than the control group （P < 0.05）. As compared with the control group，the degree of inflammatory reaction was less in the experimental group 1 and the control group 1. Conclusions The composite vancomycin⁃incorporated PLGA/TCP porous scaffold can not only be added anti⁃infective drugs，but also customize implant materials according to the shape of femur defects. The efficacy of anti⁃infection is hopefully achieved，

Objective To explore the possibility of improving anticancer effect of paclitaxel in VX2 brain tumor in rabbits by ultrasound irradiation mediated by microbubbles. Methods Brain tumor model was established， and 20 tumor ⁃bearing rabbits with tumor age of 14 days were randomly assigned to control group（CON），single taxol group（PTX）；ultrasound + paclitaxel group（US + PTX）；ultrasound + microbubble + paclitaxel group （PTX + MB + US），with different injections and treatments. The tumor volumes in each group were examined by ultrasound before and after the treatment and the volume inhibition rate（TIR）was calculated. The apoptosis of tumor cells in each group was observed under ，and the apoptosis index of tumor cells was calculated. Results The TIR of US + MB + PTX group was higher than that of control group，indicating significant difference（P < 0.05）. Conclusion In the case of intravenous infusion of ultrasound contrast agent，diagnostic ultrasound can significantly improve the chemotherapy effect of taxol on rabbit VX2 brain tumor.

Objective To observe the effect of nicorandil，an ATP⁃sensitive potassium channel opener，on the expression of SYP and GAP43 in adult rats with cerebral ischemia⁃reperfusion，and to explore the mechanism of nicorandil in synaptic plasticity. Methods Rats were divided into Sham + Vehicle group（n = 34），MCAO + Vehicle group（n = 34）and MCAO + Nicorandil group（n = 34）according to the randomization principle. Middle cerebral artery occlusion（MCAO）model procedure was used by the intraluminal suture model. Nissl staining was used to assess the infarct volume，and modified neurological severity scores（mNSS）were calculated to assess the neurological function on the 1st，3rd，7th and 14th days after surgery. Morris Water Maze test was used to detect the learning and memory function. PCR and Western blot were used to detect the mRNA and protein levels of SYP and GAP43. Results Compared with those in MCAO + Vehicle group，the infarct volume of MCAO + Nicorandil group was significantly reduced；neurological impairment was significantly ameliorated；learning and memory disorders were improved；and the mRNA and protein levels of SYP and GAP43 were increased. The differences were statistically significant（P < 0.05）. Conclusion The treatment with Nicorandil can promote functional recovery of neurological deficits in MCAO rats. The possible mechanism is closely related to the up⁃regulation of expression of SYP and GAP43，thus to improve synaptic plasticity.

Objective To evaluate the effects of brevilin on HeLa cell proliferation，apoptosis，ROS production and mitochondrial dysfunction and its related mechanisms. Methods HeLa cell line was used as the study object. MTT method，flow cytometry，DCFH ⁃DA probe and mitochondrial swelling test were used to detect the effects of brevilin on HeLa cell proliferation，apoptosis，ROS production and mitochondrial function. Western blot was used to detect the specific protein expressions of mitochondrial dysfunction and PINK1/Parkin pathway. We constructed a small interfering RNA（siRNA）mediated low PINK1 expression cell line to verify the mechanism of brevilin. Results Brevilin inhibited cell viability，induced apoptosis and promoted the production of ROS in a dose⁃ dependent manner（P < 0.01）. Moreover，with the increase of brevilin concentration，the mitochondrial swelling of HeLa cells increased gradually（P < 0.001）. The ration of Bax/Bcl⁃2，Cyt C and cleaved caspase⁃3 upregulated in HeLa cells with the increasing concentration of brevilin（P < 0.01）. At the same time，the release of CytoCyt C were significantly enhanced（P < 0.01）and the level of Mito Cyt C clearly decreased（P < 0.01）after treatment with brevilin. Compared with the control group，the expression of PINK1 and Parkin protein in brevilin treated group was significantly lower（P < 0.01）. Further functional evaluation showed that PINK1 gene knockdown produced similar in vitro activity results as brevilin treatment，such as inhibiting HeLa cell activity，increasing the percentage of apoptotic cells and promoting ROS production. Conclusion Brevilin treatment activates the PINK1/Parkin pathway，and thereby inhibits HeLa cell viability，increases the percentage of apoptotic cells and promotes ROS production.

Objective To investigate the effect of miR⁃17⁃5p on the proliferation and metastasis of colorectal cancer（CRC）cells by regulating MYLIP. Methods The tissues adjacent to the CRCs as well the CRC cell lines SW620，Lovo，Caco⁃2，HT29 and normal colon epithelial cells FHC were collected from the CRC patients. miR⁃17⁃5p inhibitor（as experimental group）and miR ⁃NC（negative control group）were transfected into CRC cells by lipo⁃ some transfection technique. The expression of miR⁃17⁃5p in CRC tissues and cells was detected by RT⁃qPCR，the targeting relationship between MYLIP and miR⁃17⁃5p was detected by double luciferase reporter gene assay. MTT assay was used to detect the proliferation of colorectal cancer Lovo cells，Transwell chamber assay was used to detect the invasion and migration of colorectal cancer Lovo cells and Western blotting was used to detect the expression of MYLIP and EMT（epithelial ⁃mesenchymal transition）related proteins in CRC cells. Results The expression of miR⁃17⁃5p in CRC tissues was significantly higher than that in the adjacent tissues（P < 0.05），and the highest expression of miR⁃17⁃5p was found in Lovo cells of the colorectal cancers（P < 0.05）. Knocking down miR⁃17⁃5p inhibited the proliferation and metastasis of Lovo cells in the colorectal cancers. miR⁃17⁃5p was specifically bound to MYLIP′ s 3′ UTR，and mir ⁃ 17 ⁃ 5p targeted the expression of MYLIP′ s protein. Targeted down ⁃ regulation of MYLIP expression by miR⁃17⁃5p promoted the proliferation and metastasis of Lovo cells in the colorectal cancers. Conclusion miR⁃17⁃5p plays an important role in the occurrence and development of colorectal cancer. It can pro⁃ 

Objective To study the effect of silencing TIPE gene on Wnt/β⁃catenin signal on proliferation and apoptosis of NSCLC cells. Methods Human non ⁃small cell lung cancer cell line A549 was transfected with shRNA⁃TIPE by lentivirus vector. The expression levels of TIPE and β⁃catenin in A549 were detected by real time PCR and Western blot. Cell clone formation experiment，CCK8 and flow cytometry were used to detect cell prolifer⁃ ation and cell apoptosis. Results After transfection of shRNA⁃TIPE lentivirus was transfected into non⁃small cell lung cancer cell line A549，（1）The mRNA and protein expression levels of TIPE and β⁃catenin were lower than those of negative control group and blank control group；（2）The ability of clone formation of A549 cells decreased significantly after silencing of TIPE gene（F = 17.48，P = 0.000 3）；（3）After transfection of shRNA⁃TIPE lentivirus， the apoptotic rate（18.4 ± 4.5）% was significantly higher than that of negative control（12.7 ± 3.6）% and the blank control（11.5 ± 3.4）%，with statistical difference（F = 4.484 4，P = 0.035 1）. Conclusion TIPE gene can promote proliferation and inhibit apoptosis of non⁃small cell lung cancer cell line A549 by activating Wnt/β⁃catenin 

Objective To investigate the difference of lung function and serum cytokine levels in elderly patients diagnosed with COPD with different BMI with acute exacerbation. To analyze the relationship between BMI and lung function and the level of serum cytokine expression. Methods A total of 97 elderly patients with acute exacerbation of COPD admitted to our hospital from June 2018 to December 2019 were selected as the research objects. They were divided into three groups according to BMI：normal body reconstitution（31 cases），low body reconstitution（32 cases），and high body reorganization（34 cases）. The serum cytokine levels，blood gas indexes and lung function indexes of all subjects were determined. Pearson correlation was used to analyze the correlation between BMI and lung function and serum cytokine levels in elderly patients with acute exacerbation of COPD. Results BMI was negatively correlated with serum cytokine levels in elderly patients with acute exacerbation of COPD and positively correlated with lung function. Conclusion BMI is correlated with pulmonary function and inflammatory response index in elderly patients with acute exacerbation of COPD，which can evaluate the severity of the disease to a certain extent.

Objective To investigate the association of mean platelet volume to lymphocyte ratio（MPVLR） with long ⁃ term mortality in patients with coronary heart disease after percutaneous coronary intervention（PCI）. Methods From January 2013 to December 2017，3 472 patients with coronary heart disease undergoing PCI in our hospital were enrolled. Based on receiver operating characteristics curve analysis，the best threshold value for predicting long⁃term mortality in patients with coronary heart disease after PCI was 5.69. According to the threshold value，the patients were divided into the low MPVLR（MPVLR < 5.69，n = 2 433）and the high MPVLR group （MPVLR ≥ 5.69，n = 1 039）. Results Inunivariate analysis，there was a significant difference in all⁃cause death and cardiogenic death between the two groups（P < 0.05）；Cox multivariate regression analysis showed that higher MPVLR level in admission was an independent risk factor for long⁃term cardiogenic death（HR = 1.630，95%CI： 1.020 ~ 2.640，P < 0.05）and all⁃cause death（HR = 1.579，95%CI：1.093 ~ 2.281，P < 0.05）in patients with coronary heart disease after PCI. Conclusions MPVLR has certain predictive value for long⁃term death events in patients with coronary heart disease after PCI.

Objective To investigate the effect of symptom duration of rotator cuff tear with frozen shoulder on clinical efficacy of rotator cuff repair with manipulation release and to provide reference for operation timing. Methods eighty patients which rotator cuff repair under manual release were retrospectively analyzed. They were divided into A group（n = 40）the duration was less than or equal to 3 months）and B group（n = 40：the duration was more than 3 months and less than 6 months）. VAS，ASES and Constant⁃Murley scores were compared before operation and post operation to evaluate the efficacy. Results The two groups of patients successfully went through the operation. The VAS scores of patients in both groups at 6 weeks，3 months and 6 months after operation grew gradually lower than those before operation（P < 0.05），and ASES and Constant⁃Murley score increased gradually higher than those before operation（P < 0.05）. There was no statistical difference in VAS and ASES score between the two groups（P > 0.05）. The statistical difference of constant⁃Murley score was significant only at 6 weeks after operation（P < 0.05）. Conclusion The patients with the duration is less than or equal to 3 months can get the improvement of shoulder join activity earlier than the patients with the duration of more than 3 months and less than 6 months，but there is no significant difference concerning the long term curative effect.

Objective To explore the relationship between CD40⁃ rs1883832 and CD40⁃ rs4810485 gene polymorphisms and the genetic susceptibility and prognosis of hepatitis B cirrhosis. Methods 480 patients with hepatitis B cirrhosis，480 patients with hepatitis B virus and 480 healthy medical examiners admitted to our hospital from February 2015 to January 2018 were selected as case group，hepatitis B group and healthy group，respectively. The polymorphisms of CD40⁃rs1883832 and CD40⁃rs4810485 were analyzed by polymerase chain reaction⁃restric⁃ tion fragment length polymorphism（PCR⁃RFLP）method，and the genotype distribution and allele frequency of the two loci were compared of the 3 groups. Follow⁃up the 2⁃year survival of the patients in the case group，the Cox regression analysis method was used to analyze the effect of CD40⁃rs1883832 and CD40⁃rs4810485 gene polymor⁃ phisms on the prognosis of patients with hepatitis B cirrhosis. The Kaplan⁃Meier method was used to analyze the survival of two patients with different genotypes，and log⁃rank test was performed. Results The frequency of CD40⁃ rs1883832 T allele in the case group was higher than that in the healthy group and hepatitis B group，and the hepa⁃ titis B group was higher than the healthy group（P < 0.05）. There was no significant difference in the frequency of CD40⁃ rs4810485 G allele between the 3 groups（P > 0.05）. Cox regression analysis showed that the CT and TT genotypes of CD40⁃rs1883832 were independent risk factors affecting the prognosis of hepatitis B cirrhosis（HR = 1.682，2.588，P < 0.05）with the prognosis of hepatitis B cirrhosis（P > 0.05）. The two⁃year mortality rate of 480 patients with hepatitis B cirrhosis was 16.55%（72/145）. Among them，thirty ⁃three patients with CD40⁃ rs1883832 gene carrying C allele （CC + CT）died，and patients without C allele（TT）died 39 cases. According to Kaplan⁃Meier survival curve anal⁃ ysis，the difference between the 2⁃year survival curves of patients with CC + CT genotype and TT genotype was statistically significant（P < 0.05）. Fifty⁃one patients with CD40⁃rs4810485 gene carrying C allele（CC+CG）died， and patients without C allele（GG）died 21 cases.. According to Kaplan⁃Meier survival curve analysis，there was no statistically significant difference between the CC + CG genotype patient and the GG genotype patient 2⁃year survival curve（P > 0.05）. Conclusion The CD40⁃rs1883832 gene polymorphism is closely related to the genetic susceptibility and prognosis of hepatitis B cirrhosis，and compared with the CC + CT genotype，patients with TT 

Objective To observe the clinical efficacy of extracorporeal shock wave（ESW）in treating epicondylitis of humerus through short⁃to⁃medium follow⁃up. Methods A total of 104 patients with epicondylitis humerus were randomly divided into ESW group（n = 50），and traditional treatment group（n = 54）for one course of treatment（once a week，4 weeks as a course of treatment）. The visual analogue scale（VAS）score，recurrence rate，and patient satisfaction of the two groups were compared before，at the end of，and 4，24 and 48 weeks after the treatment. Results There was no significant difference in terms of VAS score when at rest and making fist between the two groups at the end of and 4 weeks after the treatment（P > 0.05）but at the end of，24 and 48 weeks after the treatment，the ESW group had lower VAS score when at rest and making fist and difference was statistically significant（P < 0.05）. Short⁃to⁃medium follow⁃up showed recurrence rate and satisfaction rate in ESW group was 8.00% and 76.0%，respectively，and that was 29.63% and 55.56% in the traditional treatment group，indicating statistical significance（P < 0.05）. Conclusion Both ESW and local closure therapy are effective for epicondylitis of the humerus. Short ⁃to ⁃mid ⁃term follow ⁃up shows that ESW has a longer duration，lower recurrence rate，and 

Objective This study tried to analyze the clinical effect of double plastic biliary stent implan⁃ tation combined with ursodeoxycholic acid（UDCA）in the treatment of difficult large stone（≥ 15 mm）in common bile duct（CBD）. Methods Sixty⁃three patients with difficult CBD large stone from January 2018 to December 2019 in our hospital were enrolled，All the patients were placed double plastic biliary stents by endoscopic retrograde cholangiopancreatography（ERCP）. Thirty ⁃two patients in the observation group received oral administration of UDCA 15 mg/（kg · d）for 3 months after ERCP while the other 31 patients without UDCA were included in the control group. Stents in each patient were pulled out 3 months after the first ERCP. The incidence of abdominal pain or distention，abnormal liver function，cholangitis before second ERCP and stents obstruction，diameter change of the largest CBD stone and success rate of stone removal during second ERCP were compared between the two groups. Results ERCP was successful in all patients and no serious complications（such as gastrointestinal bleeding，perforation，and severe acute pancreatitis）occurred during two operations. The incidence of abdominal pain or distension，liver dysfunction，cholangitis before second ERCP and stents obstruction found in second ERCP in the observation group was 6.3%（2/32），18.8%（6/32），3.1%（1/32）and 15.6%（5/32）respectively， which was significantly lower than the according index of 25.8%（8/31），45.2%（14/31），22.6%（7/31）and 38.7% （12/31）in the control group. The difference between the two groups was statistically significant （χ2 = 4.510， 5.069，5.376，4.259；P = 0.043，0.024，0.026，0.039）. In the observation group，the median value of the diameter of the largest CBD stone was 17 mm and 12 mm respectively during two ERCP operations，while in the control group was 17 mm and 15 mm. The diameter of the largest CBD stone in both groups were significantly reduced in the second ERCP compared with first ERCP and the differences were statistically significant（Z = 4.659，4.736；P < 0.001）. The effect of the mean stone diameter reduction was more significant in the observation group（Z = 3.883，P < 0.001）. The success rate of stone removal in second ERCP was 90.6%（29/32）in the observation group and 71.0% （22/31）in the control group with statistically significant difference（χ2 = 3.946，P = 0.047）. Conclusions In patients with difficultly large CBD stone，double biliary plastic stents combined with UDCA could more effectively reduce the incidence of abdominal pain or distention，abnormal liver function，cholangitis and stents obstruction before secondary ERCP. It also could reduce the diameter of the largest CBD stone and thus improve the success rate of stone extraction.

Objective The aim of this study is to complete a network meta⁃analysis to clarify the best epidural analgesia methods among five popular methods（CEI，PCEA，PIEB，CEI + PCEA，PIEB + PCEA）. Methods This network meta⁃analysis was conducted using the PubMed，EMBASE，Web of Science with the aim of identifying those randomized controlled trials（RCTs）that performed a comparison among five epidural analgesia methods in healthy primiparas. We searched from inception to 3 February 2020.The data were analyzed using ADDIS 1.16.8. Results 34 eligible trials were included，the results of network meta⁃analysis showed that there was no significant difference among the five administration techniques for the incidence of instrumental delivery，VAS score，the risk of hypotension and shivering，and newborns′ Apgar score. For the incidence of cesarean section， CEI + PCEA，PIEB，PIEB + PCEA were outweighed CEI. For the duration of 2nd stage，PCEA was shorter than CEI + PCEA；4. PCEA，PIEB + PCEA had less motor block than CEI，PIEB + PCEA had less motor block than CEI + PCEA，PCEA，PIEB. Conclusions The results of the present study suggest that the 5 epidural analgesia methods are safe and effective. On the basis of current evidence，we considered that CEI may be the least，PIEB + PCEA may be the best.

Objective To explore the influential factors of pregnancy after myomectomy，and to analyze the relationship between the clinical features of fibroids and the incidence of postoperative adverse pregnancy outcomes. Methods The clinical data on 286 patients who had undergone myomectomy in our hospital from October 2009 to December 2017 and stopped contraception after operation were analyzed retrospectively，including general information，clinical characteristics of fibroids ，delivery patterns and postoperative pregnancy outcomes. The factors affecting postoperative pregnancy were analyzed ；and the relationships between the characteristics of hysteromyoma and the incidence of postoperative adverse pregnancy outcomes was explored. Results Multi⁃factor unconditional logistic regression analysis found that age≥35 and infertility were independent risk factors for affect⁃ ing pregnancy in patients after myomectomy. There were no significant differences in the amount of fibroid removal， presence or absence of fibroid penetration to the uterine cavity，size of fibroid，and rates of postoperative Cesarean section and adverse pregnancy outcomes（P > 0.05 for all comparisons）. There were statistical differences in types of forbids and different surgical procedures（P < 0.05 for both comparisons）. Conclusions Myomectomy is a safe and effective treatment for women who have fertility requirements，but infertility and age of these women should be carefully considered for this procedure.

Objective To investigate the effects of stellate ganglion block on the intrapulmonary shunt， oxygenation，and early postoperative cognitive function in elderly patients during the period of one⁃lung ventilation. Methods Sixty patients，aged 65 to 80 years，who underwent thoracic surgery under general anesthesia，were randomly divided into two groups：group SGB and C（n = 30 in each group）. In group SGB，the ventilation side of one lung was injected with 0.25% ropivacaine 3ml SGB under ultrasound guided treatment before surgery. In contrast，patients in group C was not given SGB. BIS and rScO2 were recorded during general anesthesia. Blood samples from artery and internal jugular vein were taken before SGB（T0），15 min（T1）after two lung ventilation， 15 min（T2），30 min（T3），60 min（T4）after one ⁃lung ventilation and 15 min（T5）after the restoration of two lung ventilation. A formula calculated the intrapulmonary shunt（Qs/Qt）. Mini⁃mental state examination（MMSE） and Montreal Cognitive Assessment Scale（MoCA）evaluated the cognitive function at one day before and after the operation，and seven days after the operation. Postoperative cognitive dysfunction（POCD）was recorded. Results Qs/Qt was increased and PaO2 was decreased in both groups，rScO2 decreased in C group during single lung ventila⁃ tion（P < 0.05）；Qs/Qt of T2，T3，T4 in SGB group was lower than that in C group. PaO2 and rScO2 of T2 and T3 in SGB group was higher than that in C group（P < 0.05）；The MMSE and MoCA scores of SGB group were higher than those of C group 1 d and 7 d after surgery. The total incidence of POCD in SGB group was lower than that in C group（P < 0.05）. Conclusion Stellate ganglion block does not increase intrapulmonary shunt during one lung ventilation，which is beneficial to improve oxygenation and early postoperative cognitive function.

Objective To evaluate the 5⁃year efficacy and safety of transurethral plasmakinetic enucleation of the prostate（PKEP）with anterior lobe preservation in the treatment of benign prostatic hyperplasia（BPH）. Methods 100 patients with BPH were divided into two groups：transurethral plasmakinetic resection of prostate （PKRP group，n = 50）and PKEP preserving anterior lobe（PKEP group，n = 50）. The operation time，intraopera⁃ tive blood loss，resected tissue weight，international prostate symptom score （I ⁃ PSS），quality of life score （QOL），residual urine volume（RUV）and maximum urinary flow rate（Qmax）3 months to 5 years after opera⁃ tion were compared between the two groups. Results compared with PKRP group，the operation time of PKEP group was shorter，the amount of intraoperative blood loss was less，and the weight of resected tissue was larger（all P < 0.001）. There was no significant difference in IPSS，RUV and QOL between the two groups at 3 months，half a year and 1 year after operation，but 3 and 5 years after operation，the IPSS，RUV and QOL in the PKEP group were better than those in the PKRP group. The Qmax of PKEP group was better than that of PKRP group in all postoperative periods. There was no significant difference in IPSS，RUV，QOL and Qmax in each period in PKEP group（P > 0.05）. There was no significant difference in PKRP group at 1 year after operation，but there was signifi⁃ cant difference in 3 years and 5 years after operation（P < 0.05）. Conclusion Anterior lobe preserved PKEP is an effective treatment for BPH，with shorter operation time，less intraoperative blood loss and complications，and obvious and stable efficacy in relieving voiding obstruction and lower urinary tract symptoms.

Objective To investigate the changes in episodic memory encoding（EME）and retrieval per⁃ formance（RP），and correlation of these changes withApoE，MTHFR gene C677T polymorphism in the patients with Mild Cognition Impairment（MCI）. Methods 227 subjects were enrolled in this study，including 109 patients with MCI（MCI group）and 118 patients with normal control group（NC group）. Employing EME and RP test，The scores of EME，RP and reaction time were inspected in all the subjects. Applying restriction fragment length polymorphism detected，the ApoE，MTHFR gene C677T polymorphism were detected，and its feature of its associ⁃ ation with the scores of episodic memory were analyzed. Results （1）The accuracy rate of encoding，retrieval accuracy in MCI group were lower than that in NC group，the differences were statistically significant（P < 0.05）. The reaction time of encoding and retrieval in MCI were obviously extended compared with that in NC group，the results were significantly different（P < 0.05）.（2）The difference in distribution frequency of ApoEε3/ε4、ε4/ε4、 MTHFR gene C677T TT genotype in MCI group were higher than that of NC group，the results were different （P＜0.05）.（3）The differences in score of EME and RP in different ApoE，MTHFR C677T genotypes among the two groups were statistically significant（P < 0.05）. Conclusions （1）The ability of encoding and retrieval of episodic memory in the elderly MCI patients of Han nationality in Guangzhou were decreased.（2）Polymorphism of ApoE gene and MTHFR gene were important risk factors of MCI in the elderly of Han nationality in Guangzhou， the gene polymorphism has an effect on encoding and retrieval of episodic memory in MCI patients.

Objective To explore the effect of extracapsular nodal extension（ENE）on axillary nodal metastasis burden and survival in breast cancer patients with 1 or 2 positive sentinel lymph nodes（SLNs）. Methods A total of 85 T1⁃2 breast cancer patients with 1 or 2 positive SLNs having undergone axillary lymph nodes dissec⁃ tion were divided into three groups：non⁃ENE，micro⁃ENE（≤ 2 mm）and macro⁃ENE（> 2 mm）. Correlations of extents of ENE with axillary nodal metastasis burden and prognosis of these patients were explored. Results The total number of metastatic lymph nodes significantly elevated（P < 0.05）and the number of non⁃SLSs was significantly higher than that of the non⁃ENE group（P < 0.05）. By Unadjusted Kaplan⁃Meier analysis the prognosis of patients with ENE ≤ 2 mm or > 2 mm was significantly poorer than that of the patients without ENE（P < 0.05， respectively）. Multivariate analysis showed that nodal metastasis on more than 3 LNs and the size of ENE > 2 mm were both the independent predictors for overall survival（P < 0.05）. Conclusion Presence of ENE on SLN is associated with increased nodal burden. Extranodal extension on sentinel lymph nodes to different extents renders dif⁃ ferent influences on the prognosis of patients with 1 or 2 ENE⁃positive SLNs. Therefore，it is needed to standardize 

Objective To evaluate the clinical value of low⁃dose dexmedetomidine（DEX）in alcoholic patients undergoing painless gastrointestinal endoscopy. Methods A total of 154 alcoholism who underwent painless gastroenteroscopy in the Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2020 who met the inclusion criteria were selected. All patients were randomly divided into dexmedetomidine + propofol group（trial group）and placebo+propofol group（control group）with 77 patients in each group. Patients in the trial group were given dexmedetomidine with 0.3 μg/kg，injected through micro⁃infusion pump 10 min before anesthesia，and then given intravenous propofol with 1.5 mg/kg. The patients in the control group were given the same amount of 0.9 % sodium chloride，and the injection method of propofol was the same as that in the trial group. During the operation， the bispectral index（BIS）of the two groups was maintained between 50 to 60. The mean pulse oxygen saturation （SpO2），mean arterial pressure（MAP），heart rate（HR），respiratory rate（RR），end ⁃expiratory carbon dioxide partial pressure（PETCO2），propofol dosage，induction time，examination time，recovery time，discharge time， incidence of body movement，the satisfaction of endoscopic physicians，the satisfaction of patients and adverse reac⁃ tions were recorded. Results The mean SpO2 and the satisfaction of endoscopic physicians in the trial group were significantly higher than those in the control group，while the dosage of propofol，induction time，awakening time， discharge time and the incidence of physical reaction in the trial group were significantly lower than those in the control group（P＜0.05）. There was no significant difference in examination time and patient satisfaction between the two groups. Discussion Low⁃dose dexmetomidine is safe and effective in painless gastroenteroscopy in patients with alcoholism，which can improve the sedative effect and reduce the occurrence of adverse events.

Objective To investigate the diagnostic value of cerebrospinal fluid GeneXpert MTB/RIF and cerebrospinal fluid LAMP for tuberculous meningitis. Methods Selected 110 cases of tuberculous meningitis in patients who were diagnosed and treated，60 patients were treated as tuberculous meningitis group A randomly，50 patients were used as tuberculous meningitis group B，in addition，20 patients with another central nervous system infection were collected as control group，Group A were extracted cerebrospinal fluid in order to send cerebrospinal fluid routine，biochemical，tuberculous smear，GeneXpert MTB/RIF，Group B take cerebrospinal fluid routine， biochemical，tuberculous smear，tuberculous culture and LAMP，and cerebrospinal fluid routine，biochemical， tuberculous smear，tuberculous culture，GeneXpert MTB/RIF and LAMP were taken from control group. Results In the group A，32 patients were positive in cerebrospinal GeneXpert MTB/RIF，the cerebrospinal fluid GeneXpert MTB/RIF lifampin resistance gene was positive in 3 patients，5 patients were positive in cerebrospinal tuberculous smear with positive rate was 8.3%，10 patients were positive in cerebrospinal fluid tuberculous culture，and the posi⁃ tive rate was 16.7%，32 patients were diagnosed with cerebrospinal fluid GeneXpert MTB/RIF lead to 53.0% posi⁃ tive rate，In the group B，the positive rates of cerebrospinal fluid tuberculous smear，tuberculous culture and LAMP were 8.0%，18.0% and 58.0%，respectively. In the control group，patients had negative result in cerebrospi⁃ nal fluid tuberculous smear，tuberculous culture，GeneXpert MTB/RIF and LAMP. Conclusions Cerebrospinal fluid GeneXpert MTB/RIF and LAMP are good methods for early diagnosis of tuberculous meningitis. 

Objective To investigate the values of ultrasound（US），fine ⁃ needle aspiration cytology （FNAC）and BRAFV600E mutation detection alone or combined in the diagnosis of thyroid nodules. Methods A total of 512 cases of thyroid nodules in the first affiliated hospital of Nanjing Medical University from January 2015 to December 2018 were reviewed and all the cases were received US，FNAC and BRAFV600E mutation detection and pathological diagnosis after surgery. The receiver operating characteristic curve（ROC）was draw with pathological diagnosis after surgery being the gold standard. The sensitivity，specificity，positive predictive values，negative predictive values，the optimum cutoff values and the area under curve（AUC）of each diagnostic method were calculated and compared. The diagnostic values of each method alone or combined were analyzed. Results Among the 512 cases of thyroid nodules，61 were confirmed benign nodules after surgery and 451 malignant. The sensitivity and specificity of US were 83.59% and 80.33%. The corresponding data for FNAC were 91.13% and 98.36%. The corresponding data for BRAFV600E were 95.79% and 96.72% . The corresponding data for FNAC combined with BRAFV600E were 98.45% and 96.72%. FNAC combined with BRAFV600E had a statistically different diagnostic efficiency from that of both US（χ2 = 21.081，P＜0.001）and FNAC（χ2 = 8.311，P = 0.004）alone. Conclusion FNAC com⁃ bined with BRAFV600E mutation detection can improve the diagnosis of thyroid nodules before surgery.

Objective Hospital acquired pneumonia（HAP）is one of the most common nosocomial infec⁃ tions and often causes prolonged hospital stay and increased mortality. The elderly population is a high proportion of HAP，which needs more attention from clinicians. The purpose of this study is to analyze the clinical characteristics and risk factors of elderly HAP，in order to provide evidence for early clinical intervention and decision making，to improve prognosis and reduce mortality. Methods The patients with HAP diagnosed in our hospital from January 1，2014 to January 1，2018 were included，and their medical records were retrospectively analyzed. The patients were divided into a survival group and a death group，and their clinical characteristics and death ⁃ related risk factors were analyzed. Results Of 497 enrolled patients with HAP，50% ~ 60% had symptoms of fever，cough and purulent sputum，9.7% had dyspnea symptom and often accompanied by cerebrovascular disease and diabetes. The average blood urea nitrogen/albumin ratio was（0.224 ± 0.157）mmol/g，21.5% had multidrug⁃resistant bacterial infection，and 48.9% had a history of antibiotic use within 90 days before onset. The death toll was 76（15.3%）. According to COX regression analysis，purulent sputum，dyspnea，history of antibiotic use 90 days before onset， history of chemoradiotherapy，multidrug ⁃ resistant bacterial infection，and increased blood urea nitrogen/albumin levels were the risk factors for death of elderly patients with HAP. The area under the ROC curve of blood urea nitrogen/albumin level was 0.703. The survival time of HAP with high blood urea nitrogen/albumin ratio was signifi⁃ cantly lower than that of the control group. Conclusions Symptoms were atypical in the elderly patients with HAP，who had many complications，multiple drug⁃resistant bacteria infection and high mortality. Blood urea nitrogen/ albumin ratio is a simple and valuable risk factor for death，which deserves clinicians′ attention.

Objective Due to fatigue of rescuer，quality of chest compressions（CCs）declines over time. In the present study，we investigated the relationship among the quality of CCs，objective and subjective fatigue in a manikin study of teenagers. Methods Total 130 volunteers aged at 16⁃18 yrs were recruited to participate in this study. After thetraining course and theoretical examination of basic life support，6⁃min of compression ⁃only CPR performance was assessed. The quality of CCs including rate and depth of compression was analyzed. The rescuer fatigue was evaluated by the changes of heart rate（HR）and blood lactate（LAC），and rating of perceived exertion （PRE）. Results Total 120 participants completed this study. The decreases in quality of CCs and increases of PRE were observed over time in all participants. Spearman analysis confirmed that PRE was closely negatively with depth of CCs（P < 0.01）. Significantly positively relationship were found among PRE and changes in HR and LAC （P < 0.01）. Conclusion The quality of CCs declines and fatigue of rescuers increases overtime. PRE significantly negatively correlated with depth of CCs. Closely positive relationship were among PRE，HR and LAC

Objective To observe the effect of low frequency treatment of midnight ⁃noon ebb ⁃flow acu⁃ puncture on ovarian reserve function and pregnancy outcome in patients with poor ovarian response treated with vitro fertilization⁃embryo transfer. Methods 70 patients who were to undergo in vitro fertilization（IVF）were randomly divided into the observation group and the control group，the former treated with low⁃frequency treatment of midnight⁃noon ebb⁃flow acupuncture for 2 menstrual cycles before IVF and the latter only with IVF. The changes of ovarian function before and after treatment were compared within the observation group and the data of basic clinical information，exogenous administration，oocyte，embryo information and pregnant outcome between the two groups were compared. Result After the low frequency treatment of midnight⁃noon ebb⁃flow acupuncture，the basic AFC was significantly higher than before the treatment（P = 0.002），the basic FSH was lower significantly （P = 0.011）. The numbers of oocytes retrieved and embryos available in the observation group were significantly higher than those of the control group（P < 0.05）. The clinical pregnant rate and live birth rate were higher than those of the control group（44.4% vs. 29.2%），（29.6% vs. 12.5%）. Conclusion The low⁃frequency treatment of midnight⁃noon ebb⁃flow acupuncture before IVF can significantly improve the ovarian reserve function，increase the number of oocytes and embryos available，

Objective To observe the effect of Yishen Jianpi Huayu Decoction on serum IgGand IgM level of Meniere patients and its clinical effect. Methods Ninety Meniere patients were divided into observation group and control group，with 45 cases in each one. Patients in the control group were given Betahistine Mesylate tablets orally，and those in the observation group had Yishen Jianpi Huayu Decoction for 7 days as a course of treatment. After continuous treatment for 28 days（4 courses），vertigo，tinnitus and hearing loss in the two groups were compared and serum IgG and IgM were tested by enzyme⁃linkedimmunosorbent assay（ELISA）. Results Vertigo， tinnitus and hearing loss in the two groups were all improved and the effective rate in the observation group was higher than that in the control group（P < 0.05）. Serum IgGand IgM level in the observation group was lower than that in the control group（P < 0.5）. Conclusion Yishen Jianpi Huayu Decoction is effective in the treatment of Meniere and can reduce serum IgG and IgM level of patients.

As an important part of cellular immunity，T lymphocytes play a key role in tumor immunotherapy. In the past，chemoradiotherapy and/or surgical treatment had limited effects on overall survival of patients with esophageal squamous cell carcinoma，and immunotherapy that brought survival benefits to tumor patients began to be applied for the treatment of esophageal squamous cell carcinoma. The mechanism of T lymphocytes′ effects on esophageal squamous cell carcinoma has not been fully elucidated yet. Thus exploring the role of T lymphocytes in esophageal squamous cell carcinoma may be helpful for finding new therapeutic approaches. This article reviews the role of T lymphocytes in the development of esophageal squamous cell carcinoma.