Supraclavicular brachial plexus block is a commonly used technique for upper limb anesthesia and analgesia. Recently， ultrasound can visualize the trajectory of the brachial plexus， surrounding fascia and anatomical markers， among which standardized scanning and imaging， needle techniques and drug injection methods gradually formed a precise supraclavicular block technique system. However， the application and promotion of precise supraclavicular blocks are in their infancy， risk of intraneural injection， phrenic paralysis， and lack of block dynamics are still difficult and painful points in clinical anesthesia practice. To improve the anesthesiologists' understanding of these techniques and promote their clinical application， this paper focuses on its anatomical basis， approach， and technical characteristics as well as their application in arthroscopic shoulder surgery.

Podoplanin （PDPN） is a relatively conserved sialic acid transmembrane mucin， which is often expressed in different types of cell tissues such as fibroblasts， alveolar cells and glomerular podocytes in ontogenetic development， and participates in the embryonic development， immune response， and malignant progression of cancer. Acute inflammation is a series of red，swollen，hot，painful defense reactions when the body is stimulated，which has a certain protective effect on the body，but when acute inflammation gradually develops into chronic inflammation， it will have a certain harmful effect on the body and lead to disease. In recent years， studies have shown that when the body produces inflammation，the expression of PDPN in various cell tissues is upregulated，such as fibroblasts， T cells and macrophages， etc.， and is also expressed in inflammatory diseases， such as multiple sclerosis， rheumatoid arthritis and systemic sclerosis，and PDPN mainly interacts with adjacent cells or proteins to regulate cell proliferation，contraction，migration，colonization and other behaviors to participate in the occurrence and development of inflammatory diseases. This article will mainly review the structure， function， function and mechanism of PDPN in inflammation.

Objective To clarify the effect of gentiopicroside on alleviating nonalcoholic steatohepatitis （NASH） in rats， and to explore the role of LC3II gene and autophagy in this process. Methods Establishment of SD rat NASH model was established and assigned to normal control group， model control group， gentiopicroside group， gentiopicroside+autophagy inhibitor 3-methyladenine group， metformin positive control group， 8 rats in each group. After 4 weeks of treatment， mRNA and protein expression of LC3Ⅱ were detected， LC3Ⅰ in liver tissue was assessed by q-PCR and Western blot， HE staining was performed for liver histopathology， the therapeutic effect of gentiopicroside on NASH in rats was evaluated with serum lipids （CHOL and TG）， alanine aminotransferase and inflammatory factor （IL-1β and TNF-α） changes. Results （1）In the normal control group， the structure of hepatic lobule was normal， without fatty change and inflammatory damage； In the model control group， the structure of hepatocyte cord was disordered， with severe liver steatosis and inflammatory damage， and spot and flaky necrosis was observed； The liver steatosis and inflammatory damage were alleviated in gentiopicroside group and metformin positive control group； Compared with gentiopicroside group， liver steatosis and inflammatory damage in gentiopicroside+3?MA group were significantly aggravated， and the structure of hepatic lobule was disordered and necrosis was increased. （2）The ALT， CHOL， TG， IL-1β， TNF-α levels of NASH model control group were significantly higher than those in the normal control group， the ALT， CHOL， TG， IL-1β， TNF-α levels of gentiopicroside group， metformin positive control group were reversed to some extent， while gentiopicroside+3?MA group the level of ALT， CHOL， TG， IL-1β， TNF-α is higher than that of gentiopicroside group， the difference was statistically significant， all P < 0.05. （3）The expression of LC3Ⅱ mRNA and protein in the liver tissue of rats in the model control group was significantly lower than that in the normal control group. This trend was reversed in the gentiopicroside group and the metformin positive control group， while the expression of LC3ⅡmRNA and protein in the gentiopicroside+3-MA group was significantly lower， the difference was statistically significant， all P < 0.05. Conclusion Gentiopicroside could alleviate NASH-related liver injury in rats. Its mechanism may be related to GPS up-regulating the expression of LC3Ⅱ in liver tissue and promoting autophagy

Objective To investigate the effects and related mechanisms of Tasquinimod （Tasq） on malignant phenotypes such as proliferation， migration， epithelial-mesenchymal transition （EMT）， stem cell characteristics in glioblastoma multiforme（GBM）cells， so as to provide reference for preliminary experiment of Tasq as a potential drug treating GBM. Methods The effects of Tasq on the proliferation， apoptosis， migration and colony formation of GBM cell lines （U87 and U251） were evaluated by CCK?8， apoptosis staining， transwell assay and colony formation assay. The expression of apoptosis?related proteins and EMT?related proteins were detected by western blot. The effect of Tasq on spheres formation of glioma stem cell （GSC） was detected by sphere formation assay， and the expression of stem cell?related proteins in GSC were detected by immunofluorescence staining and Western blot. Results Tasq inhibited the proliferation of U87 and U251 in concentration?dependent and time?dependent manner； Tasq also inhibited the migration and colony formation of U87 and U251， and promoted its apoptosis；Tasq promoted the expression of apoptotic protein Cleaved Caspase?3 and decreased the expression of anti?apoptotic protein BCL?2， EMT?related proteins （Snail，Vimentin）. Tasq also reduced the spheroid formation ability of GSC and the expression of stem cell?related proteins （SOX2，Nestin）， the differences were statistically significant while compared with that in the control group（P < 0.01）. Conclusion Tasq inhibits proliferation， migration， colony formation of GBM cells and promoted its apoptosis in vitro. Tasq may inhibit the malignant progression of GBM cells by inhibiting EMT and stem cell characteristics.

Objective To investigate the effect of hydrogen on myocardiumapoptosis after limb ischemia-reperfusion in rabbits through inhibition of the tumor necrosis factor-like cytokine 1A （TL1A）/death receptor 3 （DR3） pathway. Methods The gene expression omnibus （GEO） GSE160516 dataset was downloaded and the kyoto encyclopedia of genes and genomes （KEGG） pathway enrichment was performed. Eighteen male New Zealand large-eared white rabbits were randomly divided into control group （Group C）， limb ischemia-reperfusion group （Group R）， and hydrogen group （Group H） using the random number table method， with six rabbits in each group. The rabbit double hind limb ischemia-reperfusion model was established， and the animals in each group were centrifuged with venous blood to prepare serum， and the hearts were removed. Serum TL1A and DR3 levels were measured by enzyme-linked immunosorbent assay （ELISA）. The terminal deoxynucleotidyl transferase UTP mediated nicked end labeling （TUNEL） assay was performed to detect apoptosis rate in myocardium. The relative expression of TL1A， DR3 and cysteine aspartate protease 3 （Caspase3） proteins in myocardium was measured by western blotting （WB）. The real-time reverse transcription polymerase chain reaction （RT-qPCR） was performed to determine the relative expression of TL1A， DR3 and Caspase3 mRNA in myocardium. Results KEGG enrichment analysis revealed that gene expression was enriched to Apoptosis signaling pathway，TNF signaling pathway and MAPK signaling pathwayafter myocardium ischemia-reperfusion in mice. It was observed that the expression levels of serum TL1A and DR3 were significantly higher in group R compared with group C （P < 0.01）， while the expression levels of serum TL1A and DR3 were significantly lower in group H compared with group R （P < 0.01）. Compared with group C， the apoptosis rate of myocardium in group R was significantly higher （P < 0.01）；compared with group R， the apoptosis rate of myocardium in group H was significantly lower （P < 0.01）. The relative expressions of TL1A， DR3 and Caspase3 protein and mRNA in myocardium were significantly increased in group R compared with group C （all P<0.01）； the relative expressions of TL1A， DR3 and Caspase3 protein and mRNA in myocardium were significantly decreased in group H compared with group R （P < 0.05， P < 0.01）. Conclusion Hydrogen attenuates myocardium apoptosis after limb ischemia-reperfusion by inhibiting the TL1A/DR3 pathway.

Objective To analyze the role of peroxisome proliferator-activated receptors （PPAR-γ） expression in P. acnes-induced pyroptosis， cell proliferation and apoptosis in human keratinocytes （HaCaT） so as to provide a new theoretical basis for clinical treatment. Methods Expression patterns of PPAR-γ in acne and normal skin tissues were evaluated using IHC. By lentiviral transfection， PPAR-γ was upregulated in HaCaT cells， and the expression of PPAR-γ was verified by Western blot. ELISA was performed to analyze the levels of P. acnes-induced pyroptotic-associated inflammatory factors IL-1β and IL-18. EdU assay and flow cytometry were used to detect the cell proliferation and apoptosis ability. Western blot was used to determine the levels of NLR family pyrin domain containing 3 （NLRP3）， cysteinyl aspartate specific proteinase-1 （caspase-1）， Gasdermin D （GSDMD） and PPAR-γ expression． Results PPAR-γ expression was significantly decreased in acne （P < 0.05）. Compared with the control， the P. acnes-induced pyroptotic-associated inflammatory factors IL-1β and IL-18 were increased （P < 0.01）， the pyroptotic-associated proteins were increased significantly （P < 0.05）. After treatment with P. acnes， the up-regulated PPAR-γ reduced the expression of IL-1β and IL-18 and HaCaT cell apoptosis， promoted the cell proliferation， up-regulated the expression of NLRP3， Caspase-1 and GSDMD in human keratinocytes all in a statistically significant way （all P < 0.05）. Conclusion PPAR-γ can effectively regulate P. acnes-induced pyroptosis， cell proliferation and apoptosis in human keratinocytes.

Objective To explore the effect of andrographolide on proliferation， migration， stem cell properties and epithelial-mesenchymal transition process of triple negative breast cancer cells and its mechanism through in vivo and in vitro experiments. Methods Sulforhodamine B method was used to detect the Cell viability.Migration，the proportions of CD44⁺/CD24^-/low and the proliferation level of cancer stem cells were detected by wound healing assay， flow cytometry andmanmospheres assay，respectively.Western blot was used to detect the effects of andrographolide on the expression levels of YAP， ANKRD1， NESTIN， NANOG， E-cadherin， Vimentin， N-cadherin， Fibrone-Ctin YAP，ANKRD1， NESTIN， NANOG， E-cadherin， Vimentin， N-cadherin，Fibronectin and p-YAPin MDA-MB-231 and 4T1 cells. The effect of andrographolide on proliferation of breast cancer cells in vivo and the tumorigenicity of mice were examined through tumor transplantation experiment in mice.The expressions of YAP and ANKRD1 of tumor in mice was detected by immunohistochemistry. Results In vitro experiment results showed that cell viability of MDA-MB-231 and 4T1 cellstreated with andrographolide was decreased.in a dose-dependent manner.Compared with the control group， the healing rate of cells， the proportions of CD44⁺/CD24^-/low andthe volume and the number of stem cell microspheres in MDA-MB-231 and 4T1 cells were reduced（P < 0.05）.After andrographolide treatment，the expressions of YAP， ANKRD1， NESTIN， NANOG，Vimentin，N-cadherin and Fibronectin in MDA-MB-231 and 4T1 cells were down-regulated. Meanwhile， while the expression of E-cadherin andp-YAP were increased.In vivo experiment results showed that Compared with the control group， tumor volume and weight decreased and tumor inhibitory rate increased significantly after Andrographolide intervention （P < 0.01）. And the expression of YAP andANKRD1 of tumor in mice decreased. Conclusion Andrographolide may play a role against triple-negative breast cancer by regulating the Hippo/YAP pathway.

Objective To evaluate the role of left ventricular morphology combined with ST segment depression in predicting cardiac dysfunction in infants after patent ductus arteriosus （PDA）. Methods This study is designed as a retrospective study. From January 2016 to December 2022， 445 infants with PDA were treated in our hospital. Preoperative electrocardiogram examination and echocardiographic measurements were performed for recording the ST segment depression， left atrial diameter （LAD）， left ventricular end diastolic diameter （LVEDD）， left ventricular end systolic diameter （LVESD）， aortic diameter （AOD）， pulmonary artery diameter （PAD）， pulmonary artery systolic pressure （PASP）， left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS）. According to the postoperative left ventricular function， the above indexes were divided into groups and compared. Binary logistic regression analysis was done to investigate potential influences on cardiac function， and a ROC curve was plotted to assess the predictive significance of combining left ventricular morphology with ST segment depression. Results The left ventricular dysfunction occurred in 42 cases （9.23%）， with an average LVEF of （54.83 ± 3.37）%. Compared with the children with normal LVEF， there was no significant difference in age， weight， BSA， PDA diameter， LAD， AOD， PAD， LVEF and PASP （P > 0.05）. The preoperative levels of LVEDD， LVESD and ST segment depression were significantly higher in the children with left ventricular dysfunction （P < 0.05）. Binary logistic regression analysis showed that ST depression was an independent risk factor for predicting postoperative cardiac insufficiency in the children with PDA. The area under the curve of ROC analysis was 0.785， the sensitivity was 85.4%， and the specificity was 54.0%. Compared with pre-operative conditions， the levels of LAD， LVEDD， LVESD， AOD， PAD and LVFS were significantly decreased 6 months after operation （P < 0.05）. Conclusion Attention should be paid to left ventricular systolic dysfunction after closure of different PDA procedures， which is related to the rapid decrease of left ventricular preload and increase of after load. Preoperative left ventricular morphology combined with ST segment depression can be used as an important index to predict postoperative cardiac insufficiency in children with PDA.

Objective To explore the relationship between the expression levels of STT3A and STT3B in Epithelial Ovarian Cancer （EOC） and the clinicopathological features and prognosis of the patients. Methods The clinical information of 88 patients with EOC who underwent surgical treatment and 22 patients with normal tubal epithelium and normal ovarian tissue in our department from 2010 to 2019 were collected and followed up. The expressions of STT3A and STT3B in EOC and control groups were detected by immunohistochemistry， and their relationships with clinicopathological features and prognosis of patients were analyzed. Results The expression of STT3A and STT3B in EOC patients was significantly higher than that of control group （P < 0.05）， and the expression of STT3A was related to tumor differentiation degree and lymph node metastasis （P < 0.05）. The expression of STT3B was significantly correlated with FIGO staging， serum CA125 level， Lymph?vascular space invasion， degree of tumor differentiation and lymph node metastasis （P < 0.05）. Kaplan?Meier survival analysis showed that the higher expressions of STT3A and STT3B were associated with poor prognosis （P < 0.05）. Multivariate Cox regression analysis revealed that the high expressions of STT3A and STT3B were independent risk factors for the prognosis of EOC patients （P < 0.05）. Western Blot results showed that STT3A and STT3B were significantly expressed in ovarian cancer （P < 0.05）. Conclusion STT3A and STT3B are extremely expressed in EOC tissues and are associated with poor prognosis of EOC patients， and may be potential markers for the prognosis of EOC patients.

Objective To investigate the correlation of serum autophagy-related protein 9a（ATG9a） and galectin-3 （Gal-3）with left ventricular hypertrophy （LVH） in essential hypertension （EH） patients. Methods A total of 84 patients with EH （NLVH group） and 69 patients with EH combined with LVH （LVH group） who underwent physical examination at the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical Universityfrom July 2020 to December 2022 were recruited prospectively，and another 115 healthy individuals who taking physical examination during the same period were included as the control group. The correlation of serum ATG9a and Gal-3 levels with LVH was analyzed in the patients with EH. Results Compared with the control group， the NLVH group and LVH group had significantly higher proportion of combined coronary heart disease and proportion of combined dyslipidemia， abnormal body mass index， increased systolic and diastolic blood pressure and homocysteine， alanine aminotransferase， triglycerides， total cholesterol， fasting blood glucose， LVPWTD， IVSTD， LVMI， and elevated ATG9a and Cal-3 level， but lower HDL-C level（P < 0.05）. Obviously longer course of hypertension， increased systolic and diastolic blood pressure， LVPWTD， LVEDD， IVSTD， LVMI， ATG9a， and Cal-3 in the LVH group were observed when compared with those in the NLVH group（P < 0.05）. ROC curve analysis showed that the areas under the curve for serum ATG9a and Cal-3 level was 0.829 （95% CI： 0.765 ~ 0.893） and 0.819 （95% CI： 0.753 ~ 0.884）， respectively， with significant differences （P < 0.001）. Conclusion Serum ATG9a and Cal-3 are correlated with LVH in patients with EH， and they can be regarded as clinical indicators in the auxiliary diagnosis and prognostic assessment for patients with EH with LVH.

Objective To investigate the expression of lamin B1（LMNB1） in ovarian cancer and its effect on the proliferation， migration and invasion of ovarian cancer cells and mechanism. Methods Expression of LMNB1 in ovarian cancer tissues and normal ovarian tissues was analyzed by TCGA database and GEO database； Kaplan-Meier plotter was used to analyze the effect of LMNB1 mRNA expression on the prognosis of patients with ovarian cancer. Sixty-eight ovarian cancer specimens and twenty-seven normal ovarian tissues were selected. The level of LMNB1 was detected in ovarian cancer tissues and normal tissues by immunohistochemistry， and the relationship between LMNB1 and clinicopathological features was analysed. LMNB1-knockdowned SKOV3 ovarian cancer cell lines were constructed， then the effects of down-expression of LMNB1 on proliferation， migration， and invasion of ovarian cancer cells were detected by CCK-8， colony formation assay， scratch wound healing assay， transwell assay and Edu assay. The expression of MMP2， MMP9， TIMP1 were detected by Western blot after the LMNB1 expression level was knockdowned. Gene Ontology （GO） and Kyoto Encyelopedia of Gene and Genomes（KEGG）were used to enrich the biological functions and signaling pathways of LMNB1 and related proteins. Results The expression of LMNB1 gene in human ovarian cancer tissues was significantly higher than that in normal ovarian tissues（P < 0.05）. Patients with high LMNB1 expression had poorer overall survival（P < 0.05）. Immunohistochemistry show that the expression level of LMNB1 was significantly upregulated in ovarian cancer tissues（P < 0.05）， and was correlated with pathological differentiation and Pathological stage. Silencing LMNB1 expression in SKOV3 cells significantly inhibited its proliferation， migration and invasion ability（P < 0.05）. LMNB1 and its co-expressed genes are mainly involved in PI3K-AKT pathway， P53 signaling pathway， cell cycle signaling pathway and cell apoptosis pathway. Conclusion The expression of LMNB1 in ovarian cancer tissues was significantly higher than in normal tissues， and strengthened the proliferation，invasion and migration ability of ovarian cancer cells. The mechanism of LMNB1 in ovarian cancer may be to regulate the activities of PI3K-AKT pathway， P53 signaling pathway， cell cycle signaling pathway and cell apoptosis pathway.

Objective To investigate the feasibility and safety of using diaphragmatic ultrasound to guide timing of laryngeal mask extraction during anaesthesia for laparoscopic inguinal hernia surgery in children. Methods A total of 140 children undergoing laparoscopic inguinal hernia repair surgery were selected， and the children were randomly divided into two groups： the group with laryngeal mask extraction guided by diaphragmatic ultrasound （Group D） and the group with laryngeal mask extraction guided by awake （group A）. The two groups were instructed on the timing of laryngeal mask extraction according to different ways， and the incidence of adverse events， such as difficulty in pulling out， cough， laryngospasm， bronchospasm， and pharyngeal pain， were compared between the two groups during and after the extraction， the analysis compared the incidence and management of peripheral oxygen desaturation between the two groups. Results The rates of difficulty in pullout and laryngospasm in group D were both lower than those in group A， and the number of cases of adverse events in group D was lower than that in group A， the difference was statistically significant. The incidence of oxygen desaturation after removal of the laryngeal mask was lower in group D than in group A， and the difference was statistically significant.The time from the end of surgery to removal of the laryngeal mask and the steward awakening score up to 4 points in group D were shorter than those in group A， and the differences were statistically significant. Conclusion During awakening from anaesthesia for laparoscopic inguinal hernia surgery in children， monitoring the rate of change in diaphragmatic thickness with ultrasound can lead to better guidance in the extraction of laryngeal mask with a lower incidence of adverse effects and greater safety.

Objective To investigate the relationships of prognosis of schizophrenic patients with their serum prolactin （PRL）， glial fibrillary acid protein （GFAP）. Methods A total of 128 schizophrenic patients admitted to the hospital from January 2020 to January 2022 were admitted and treated with risperidone in our hospital. The prognostic status of the patients after 12 months of treatment was analyzed， the prognostic factors were explored and the prognostic value of PRL and GFAP were investigated. Results Forty-one patients had poor prognoses. By Logistic multivariate regression analysis， the prognostic factors in the schizophrenic patients were found to include brain-derived neurotrophic factor （BDNF） （OR = 3.931， 95%CI： 1.618 ~ 9.555）， nerve growth factor （NGF） （OR = 3.861， 95%CI：1.589 ~ 9.384）， PRL （OR = 3.666， 95%CI： 1.508 ~ 8.909） and GFAP （OR = 4.297， 95%CI： 1.768 ~ 10.444） were （P < 0.05）. By receiver operating characteristic （ROC） curve analysis， the sensitivities of PRL， GFAP and their combination in predicting the prognoses of the patients were 70.73% （95%CI： 54.26% ~ 83.35%）， 73.17% （95%CI： 56.79% ~ 85.25%）， and 80.49% （95%CI： 64.63% ~ 90.63%）， respectively； the specificities were 75.86% （95%CI： 65.28% ~ 84.12%）， 73.56% （95%CI： 62.83% ~ 82.18%）， and 87.36% （95%CI： 78.09% ~ 93.22%）， respectively； and the AUCs were 0.743 （95%CI： 0.643 ~ 0.843）， 0.739 （95%CI： 0.633 ~ 0.845） and 0.884 （95%CI： 0.816 ~ 0.952）， respectively. Conclusion PRL combined with GFAP is effective in predicting the prognoses of patients with schizophrenia.

Objective To investigate the clinical effectiveness of modified ulnar artery perforator flap to repair large skin defect of hand. Methods From September 2012 to August 2021， the clinical data of 56 patients with large skin defect of hand who met the selection criteria in hand surgery department of the Second Hospital of Tangshan were retrospectively analyzed. According to whether the vein of the flap is anastomosed during the operation， they were divided into modified group （30 cases， from February 2017 to August 2021） and traditional group （26 cases， from September 2012 to January 2017）. The operation time， follow?up time， hospital stay， tension blister rate， survival rate of the flaps and patient satisfaction with flap appearance at final follow-up were compared between the two groups. Results All operations were successfully completed in both groups. There was no significant difference of follow?up time in both groups （P > 0.05）. The operation time of the modified group was longer than that of the traditional group， but the hospital stay was shorter than that of the traditional group， the incidence of tension blisters of the flaps were lower than that of the traditional group， the survival rate of the flaps were higher than that in traditional group， and patient satisfaction with flap appearance at final follow-up was better than that of the traditional group. There were statistically significant differences in terms of the operation time， hospital stay， tension blister rate， survival rate and appearance satisfaction of the flaps （P < 0.05）. Conclusion Compared with the traditional ulnar artery perforator flap， the modified ulnar artery perforator flap with vein anastomosis has lower incidence of tension blisters， higher survival rate， shorter hospital stay and better appearance.

Objective This study discussed the application value of preoperative clock positioning ultrasonic exploration in cardiac radio frequency ablation femoral venocentesis. Methods A total of 229 consecutive patients undergoing radiofrequency ablation were randomly divided into two groups： ultrasound group （n = 112） and control group （n = 117）. The patient's arteriovenous clock relationship in the inguinal ligament area， the number of femoral vein catheterization， the number of puncture and the puncture time， the number of accidental artery puncture and vascular complications were recorded. Results Compared with the control group， the total number of punctures and the number of punctures per single catheterization in the ultrasound group were significantly reduced， the puncture time and the single catheterization time were significantly shortened（P < 0.05）. The number of accidental arterial punctures and the puncture related hematoma in the ultrasound group was significantly less than that in the control group （P <0.05）. In subgroup analyses， the puncture time and the average placement time of a single catheter were shorter in the inner-superior group than in the inner-inferior group， and the number of mispunctured arteries was less than in the inner-inferior group （P < 0.05）. Conclusion Preoperative clock positioning ultrasound exploration can effectively reduce the puncture time， improve the success rate of puncture and reduce the complications of puncture， which has certain clinical application value.

Objective To investigate the clinical characteristics and disease activity as well as their correlations with cytokine of patients with primary Sjogren syndrome （pSS）. Methods The clinical data of pSS patients hospitalized in our department were retrospectively analyzed. The patients were divided into different groups according to age， gender， pathology of labial gland and disease activity. The differences in clinical characteristics， cytokine and the relations between them were analyzed retrospectively. Results Totally， 91 cases were included in the study. Among them， the ratio between male and female was about 1∶17.2 and 74.73% of the patients were elderly （≥ 50 years） and 25.27% were young and middle-aged （< 50 years）. The labial gland biopsy revealed Chsholm grade I or above in 57.14% of patients. 93.41% of the patients developed extraglandular involvement. Lymphadenopathy was the most common （50.55%） in extraglandular manifestations， followed by pancytopenia （45.05%） and elevated immunoglobulin （40.66%）. The main manifestations of the male pSS patients were arthritis/arthralgia， interstitial pneumonia disease， pancytopenia and elevated immunoglobulin. The young and middle-aged group had higher rates of fever and hypocomplementemia than the elderly group， while the latter had a higher rate of pancytopenia （especially granulocytopenia） than the young and middle-aged group （P < 0.01）. The group with focal lymphocytic sialadenitis had higher rater of globulin elevation than the group without focal lymphocytic sialadenitis. EULAR Sjogren′s syndrome disease activity index （ESSDAI） and FS were negatively correlated with age. The increase rates of serum IL-2R， IL-8， TNFa in the group of moderate and high disease activity were significantly higher than those in the group with low disease activity. Conclusion The elderly pSS patients are more susceptible for pancytopenia， but their disease activity and extraglandular manifestations are less patent and serious， as compared to young and middle-aged patients. The patients with focal lymphocytic sialadenitis are more likely to be affected with salivary gland enlargement and elevated globulin. The increases of serum IL-2R， IL-8 and TNFa are more commonly seen in those patients with moderate and high disease activity.

Objective To investigate the efficacy and safety of chemotherapy plus immunotherapy and recombinant human endostatin in treating patients with advanced non-small cell lung cancer （NSCLC）. Methods We retrospectively reviewed and analyzed the medical records of 24 patients with advanced NSCLC treated with chemotherapy plus immunotherapy and recombinant human endostatin in Guangzhou Chest Hospital from June 2020 to December 2022. We focused on analyses of progression-free survival （PFS） and objective response rate （ORR） as well as disease control rate （DCR） and adverse events （AEs）. Results At 19.2 months′ median follow-up， the median PFS （mPFS） was 11 months （95%CI：8.722 ~ 13.278）. Among them， 11 patients received first-line treatment with an mPFS of 11 months （95%CI：9.782 ~ 12.218）. The 6-month and 12-month PFS rates were 82.4% and 52.9%， respectively. The first-line treatment elicited an ORR of 58.8%， and a DCR of 94.1%. Among the 17 cases， 2 came out with grade 3 - 4 AEs， taking up 11.8%， among which hematotoxicity was the most common， and 8 with grade 1 - 2 AEs， taking up 47.1%， among which hematotoxicity accounted for 17.6%， pruritus for 17.6% and hepatic toxicity for 5.9%. Conclusion Chemotherapy plus immunotherapy and endostatin promises good efficacy and safety in treating patients with advanced NSCLC.

Objective Hemodynamic instability is the main factor in the development of intraventricular hemorrhage （IVH） in preterm infants. The purpose of this study is to evaluate the predictive value of blood pressure variability （BPV） and anterior cerebral artery （ACA） blood flow parameters in IVH in preterm infants with gestational age ≤ 32 weeks and birth weight ≤ 1 500 g. Methods Preterm infants with gestational age ≤32 weeks and birth weight ≤ 1500 g admitted to the neonatal intensive care unit （NICU） were selected as the research subjects. All preterm infants were admitted within 1 hour after birth， and systolic blood pressure （SBP）， diastolic blood pressure （DBP）， and mean arterial blood pressure （MABP） were monitored every 1 hour interval. The difference between maximum and minimum values （max?min）， standard deviation （SD）， coefficient of variation （CV）， and successive variation （SV） were used as BPV indicators. On the 1st， 3rd， and 7th day of admission， transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 1st day， systolic velocity （Vs）， diastolic velocity （Vd）， and resistance index （RI） of ACA were measured simultaneously. Preterm infants were divided into IVH group and non IVH group based on the results of transcranial ultrasound examination， and the correlation between BPV indicators， ACA blood flow parameters， and the development of IVH was analyzed. Results A total of 92 preterm infants met the inclusion criteria， including 49 in the IVH group and 43 in the non IVH group. There was no statistically significant difference in baseline characteristics such as gestational age， birth weight， gender， and perinatal medical history between the two groups of preterm infants （P > 0.05）. SBP SD （OR = 1.480 95% CI：1.020 ~ 2.147）， and ACA?RI （OR = 3.027 95% CI： 2.769 ~ 3.591） are independent risk factors for IVH in preterm infants. The sensitivity and specificity of combined detection of SBP SD， and ACA?RI in predicting IVH were 61.2% and 79.1%， respectively. Conclusion High BPV and ACA?RI are related to IVH in preterm infants with gestational age ≤ 32 weeks and birth weight ≤ 1 500 g. Combined detection of SBP SD， and ACA?RI has a certain predictive effect on early identification of IVH.

Objective To analyze the sensitivity of Acinetobacter baumannii （A. baumannii） to common antibiotics， and to detect the expression level of efflux pump genes and outer membrane protein （OMP） genes and to explore the relationship between the expression of these genes and antibiotic resistance. Methods A total of 213 isolates of multidrug?resistant A. baumannii from the lower respiratory tract of inpatients from our hospital were collected. Susceptibility testing was conducted by K?B disk diffusion method. According to the drug sensitivity test， they were divided into non?sensitive groups （NS groups） and sensitive groups （S groups）. The expression level of efflux pump genes （adeB， adeJ， adeG， craA， abeM， amvA） and OMP genes （omp25， omp33?36， carO） were detected by fluorescence quantitative PCR， and the differences of these genes between NS groups and S groups were compared. Results The insensitive rates of A. baumannii to amikacin and imipenem were 89.2% and 81.2% respectively， and the insensitive rates to piperacillin/tazobactam， cefoperazone/ sulbactam and gentamicin were more than 92%. The distribution of increased relative expression of adeB gene （RE≥1） in NS and S groups of antibiotics （AMK， IPM， CFP， FEP， TZP， CAZ， SXT， CIP， SCF， CN） was analyzed respectively. The results showed that the proportion of RE ≥ 1 in most antibiotic NS groups was significantly higher than that in S groups， suggesting that the overexpression of adeB was closely related to the above?mentioned antibiotic resistance. The RE values of adeB gene mRNA of efflux pump were significantly different in the following antibiotics （AMK， IPM， CFP， FEP， TZP， CAZ， CIP， SCF， CN） between NS groups and S groups respectively. The RE values of efflux pump genes （adeJ， adeG， craA， abeM and amvA） in the two groups had no elevation， and there was no statistical difference between the two groups by comparative analysis. The average RE values of OMP genes （omp25， omp33?36， carO） were all more than 1.0， indicating an increasing of relative expression. Conclusion The A. baumannii is highly resistant to many kinds of antibiotics. The overexpression of efflux pump gene adeB plays an important role in drug resistance of A. baumannii in our hospital， while other efflux pump genes （adeJ、adeG、craA、abeM、amvA） and OMP genes （omp25， omp33?36， carO） may not effect in most isolates of the drug resistance mechanism in this study.

Objective To observe the effect of Qichang Xuexheng decoction retention enema combined with heat-sensitive moxibustion after radical gastrectomy. Methods Eighty-three cases of gastric cancer admitted to our hospital from January 2019 to January 2022 were divided into two groups by envelope random method. The control group was given normal saline enema after operation for gastric cancer， and the observation group was given Qichang Xuexheng Decoction retention enema combined with heat-sensitive moxibustion after operation for gastric cancer. Results The indexes of gastrointestinal function recovery in observation group were better than those in control group （P < 0.05）. There was no significant difference between the observation group and the control group （P > 0.05）， and the other intestinal flora in the observation group was better than that in the control group （P < 0.05） at 3 and 7 days after surgery. Shannon index， Chaol index， gastrin （GAS） and motilin （MTL） in observation group were higher than those in control group at 3 and 7 days after operation， vasoactive peptide （VIP） and TCM syndrome score were lower than those in control group （P < 0.05）. There was no significant difference in CD8⁺ between the observation group and the control group at 7 days after surgery （P > 0.05）， and the immune function indexes of the observation group were better than those of the control group at 3 and 7 days after surgery （P < 0.05）. Conclusion Qi Chang Xue Xing Tang retention enema combined with heat sensitive moxibustion is beneficial to the recovery of gastrointestinal function and immune function in patients after radical gastrectomy， which may be related to the regulation of intestinal flora diversity.

Objective To explore the curative effect of Quick needling combined with Jingshu Granule on cervical vertigo in patients with blood stasis and qi stagnation pattern. Methods A total of 106 cervical vertigo patients with blood stasis and qi stagnation pattern admitted to the hospital from November 2019 to August 2022 were selected and divided into observation group （n = 53） and control group （n = 53） by random number table method. The control group was treated with Jingshu granule， and the observation group was treated with Quick needling combined with Jingshu granule. The effects of continuous treatment for 8 weeks in both groups were observed. TCM syndrome score， vertigo improvement and clinical efficacy were compared between the two groups. The improvement of inflammatory factors， vasomotor factors and vertebrobasilar hemodynamics in peripheral blood was compared between the two groups. The occurrence of adverse reactions during treatment was recorded and compared between the two groups. Results The TCM syndrome scores of the main and secondary symptoms of the two groups after treatment were lower than before treatment （P < 0.05）， and the TCM syndrome scores of the main and secondary symptoms of the observation group after treatment were lower than those of the control group （P < 0.05）. Dizziness handicap inventory （DHI） scores of both groups after treatment were lower than before treatment （P < 0.05）， DHI scores of the observation group were lower than that of the control group after treatment（P < 0.05）. The total effective rate of the observation group was higher than that of the control group （P < 0.05）. After treatment， the tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and C-reactive protein （CRP） in both groups were lower than before treatment （P < 0.05）， and the TNF-α， IL-6 and CRP in the observation group were lower than that of the control group （P < 0.05）. Endothelin-1 （ET-1） and 5-hydroxytryptamine （5-HT） after treatment were lower than before treatment， nitric oxide （NO） was higher than before treatment （P < 0.05）， ET-1 and 5-HT in observation group after treatment were lower than those of the control group， and NO was higher than that of the control group （P < 0.05）. The blood flow velocity of left vertebral artery， right vertebral artery and basilar artery in both groups after treatment was higher than before treatment （P < 0.05）， and the blood flow velocity of left vertebral artery， right vertebral artery and basilar artery in the observation group after treatment was higher than those of the control group （P < 0.05）. There was no obvious adverse reaction in both groups during treatment. Conclusion For the treatment of cervical vertigo patients with blood stasis and qi-stagnation pattern， the combination of Quick needling and Jingshu Granule could enhance clinical efficacy， inhibit the synthesis of inflammatory factors in peripheral blood， improve vasomotor factors and vertebrobasilar hemodynamics， with good safety. It has certain clinical application value.

Urothelial bladder cancer （UBC） is one of the most common malignant tumors in urology， and its occurrence and progression are closely related to the tumor microenvironment （TME）. Tumor-associated neutrophils （TAN）， as an important type of immune cells in TME， have been proven to have anti-tumor or pro-tumor regulatory effects on various tumors， which are related to their heterogeneity and plasticity. The study on TAN′s bidirectional regulation may provide new targets for tumor treatment. This article reviews the current status of TAN′s bidirectional regulation research by searching recent literature， and summarizes its research progress in UBC.

Primary biliary cholangitis （PBC） is a chronically progressive autoimmune liver disease. At present， There are limited drugs to treat PBC， and some patients eventually progress to end-stage liver disease due to poor response to drugs. The pathogenesis of PBC is not fully understood， but there is increasing evidence that apoptosis of bile duct epithelial cell （BEC） plays an important role in the pathogenesis of PBC. This article reviewed the main factors and related mechanisms affecting BEC apoptosis in PBC， aiming to provide a theoretical basis for developing new therapeutic targets， developing new drugs or proposing new therapeutic schemes for PBC patients.