Objective To analyze the relationship between myocardial damage and death in critical coronavirus disease 2019（COVID⁃19）. Methods A total of 113 critical COVID⁃19 patients were selected in our hospital from February 1，2020 to March 25，2020. Univariate analyses were used to compare two groups（death group and survival group）. Then，the receiver operating characteristic curve（ROC）was performed to assess the predictive value of myocardial injury markers for death. Results A total of 113 critical patients with COVID ⁃19 were recruited，including 68 male and 45 female. The mean age was（67.25 ± 14.06）years，ranging from 29 to 95 years. In univariate analysis，the following factors had significant differences between death group and survival group（P < 0.05）：Age > 70 years，hypertension，coronary heart disease and body temperature > 39℃. Multivariate analysis showed hypersensitive troponin I（Hs⁃TnI）greater than 0.04 μg/L（HR = 2.10，95% CI：1.13 ~ 3.91）， myoglobin（MYO）greater than 100 μg/L（HR = 2.14，95% CI：1.15 ~ 3.97），and white blood cell count（WBC） greater than 9.5 × 109 /L（HR = 2.18，95% CI：1.20 ~ 3.98）were the independent predictors of mortality in COVID⁃19. ROC curve showed myocardial injury markers Hs⁃TnI，CK⁃MB，and MYO had excellent predictive significance for the risk of death in critical COVID ⁃ 19（P < 0.05）. Conclusions Critical COVID ⁃ 19 patients with myocardial damage had a high fatality. The myocardial injury markers Hs⁃TnI，CK⁃MB，and MYO had excellent predictive significance for the risk of death in critical COVID⁃19. It is of important significance in early discovering predictive information，assessing risks of death，

Objective To study the evaluation and prediction value of CT visual quantitative assessment combined with artificial intelligence（AI）for the severity of Coronavirus Disease 2019（COVID ⁃ 19）. Method The clinical and imaging data of 86 patients with COVID⁃19，including severe/critical cases（n = 31）and ordinary cases（n = 55），were studied retrospectively. The characteristic CT parameter variation of thetwo groups was analyzed and compared. The number of involved pulmonary segments was analyzed using the receiver operating characteristic curve（ROCcurve）. CTscores and two visual quantitative assessment methods were used to evaluate and predictthe ability ofordinary and severe⁃critical COVID⁃19. Moreover，the artificial intelligence software was utilized to predict the severity of COVID ⁃19 and calculatethe specificity and sensitivity of severe ⁃critical COVID ⁃ 19. Results The median CT score and the median number of involved pulmonary segments in thesevere ⁃critical groupwere signifi⁃ cantly higher than those in the ordinary group（P < 0.001）. The difference in ground⁃glass opacity（GGO），consoli⁃ dation，subpleural line，and“crazy⁃paving”sign between the two groupswas not statistically significant. The results of ROC curve analysis showed that the area under the curve（AUC）is 0.879 when the CT score was used for prediction of severe⁃critical COVID⁃19，and the sensitivity was 71.0%，and the specificity is 90.9% at the cutoff value of 8.5. The AUC was 0.883 when the number of involved pulmonary segments was used to predict the severe⁃ critical COVID ⁃ 19. When the cut ⁃ off value was 10.5，the sensitivity was 87.1% and the specificity was 81.8%. When AI was used for prediction of severe⁃critical COVID⁃19，the sensitivity was 77.4% and specificity was 92.7%. Conclusions CT visual quantitative assessment combined with artificial intelligence could be used to assess and predict theseverity of COVID⁃19，

Objective To provide support for the diagnosis and treatment of COVID⁃19 patientscomplicated with bacterial infectionin our hospital by retrospectively analyze inflammatory indicators，distribution ofinfection strains and antibiotic susceptibility test. Methods The data on 125 patients with COVID⁃19 who had been treated and received bacterial and fungal cultures in our hospital from January 23，2020 to April 22，2020. PCT，WBC，and CRP，positive strains and antimicrobial susceptibility results were analyzed in combination with the clinical treat⁃ ment. Results Of 125 patients，19 were positive for bacterial or fungal culture；bacterial infection occurred in 12 （63.2%）patients and candida infection occurred in 7（36.8%）patients. There were significant differences in mean age，presence of underlying diseases，and clinical typing of COVID⁃19 pneumonia between culture⁃positive and ⁃neg⁃ ative groups（P < 0.01）；The inflammatory indicators PCT，WBC and CRP were increased at different levels in cul⁃ ture⁃positive patients，and differed significantly between culture⁃negative and ⁃positive patients（P < 0.01）. Moxi⁃ floxacin and cefoperazone ⁃ sulbactam showed significant efficacy in the treatment of bacterial or fungal infection. Conclusions COVID⁃19 patients are at risk for nosocomial bacterial or fungal infection，and develop sepsis，re⁃ spiratory and genitourinary infections. WBC，PCT and CRP can be used as the differential indicators of bacterial or fungal infection in COVID⁃19 pneumonia patients. Timely bacterial or fungal culture and antibiotic susceptibility test 

Osteonecrosis of the femoral head is one of the common diseases in orthopedics. It is a progres⁃ sive disease. If it is not intervened in time in the early stage，it will lead to progressive destruction of the femoral head，and eventually result in the collapse of the structure of the femoral head，which is seriously affecting the quality of life. At present，the clinical treatment of osteonecrosis of the femoral head is mainly based on the ARCO stage and the condition of the patients. Hip arthroplasty is often used for advanced patients，but due to the limited life span of the prosthesis and the younger trend of the patient′s age，the effect of this treatment is not satisfactory. For early patients，a series of conservative treatment and hip preservation can be used，such as drug intervention， lifestyle improvement，core decompression，autogenous bone transplantation and so on，but the clinical effect is not satisfactory. With the continuous maturity of tissue engineering and regenerative medicine and the good character⁃ istics of bone marrow mesenchymal stem cells ，BMSCs has become a hot seed cell in clinical basic research. Researchers have observed a certain effect of BMSCs combined with other treatments in the treatment of osteonecro⁃ sis of the femoral head. With the continuous development of related research，the application of BMSCs in the treat⁃ ment of ONFHis expected to become a satisfactory treatment in the future.

Objective To investigate the effect of Deubiquitinase inhibitor Au（PPh3）PT on inducing gastric cancer cells cytotoxicity. Methods MTS assay was performed to test the cell viability of MGC⁃803 and SGC⁃ 7901 cancer cells. Apoptotic rates were assessed by microscopy and flow cytometry analysis using Annexin V/PI double staining. Apoptosis related proteins and ubiquitinated proteins were detected by western blot analysis. Results We found that Au（PPh3）PT significantly decreased the cell viability in a dose⁃ and time⁃dependent man⁃ ner. The cell apoptosis rate was obviously higher than that in control group after 24 h treatment with 1.0 μmol/L and 1.5 μmol/L of Au（PPh3）PT（P < 0.05）. It was confirmed that Au（PPh3）PT resulted in a reduction in precursor forms of caspase⁃3，⁃8，and ⁃9 with a concomitant increase in the cleaved forms of caspase⁃3，caspase⁃8，caspase⁃9， and PARP. Also，we found that a striking increase in total and K48⁃linked ubiquitinated proteins. Conclusion The results show that Au（PPh3）PT induced cytotoxicity and cell death in gastric cancer cells. This effect may be 

Objective To investigate the protection of ghrelin against doxorubicin ⁃induced heart failure and cardiac injury in rats and underlying mechanisms. Methods A total of 32 Sprague ⁃Dawley（SD）rats were randomized into control group，heart failure group and ghrelin group. Rat heart failure was induced by intraperitoneal injection of doxorubicin. The rats with heart failure in the ghrelin group and those in the heart failure and control groups were intraperitoneally injected with ghrelin and the same volume of saline twice per day，respectively. The changes in echocardiographic parameters，cardiac hemodynamics，myocardial histology，plasma levels of TNF⁃α， IL⁃10 and 15⁃F2t⁃isoprostane in the rats were analyzed. Results Compared with the heart failure group，the rats in the ghrelin group had significantly lower LVSD（P < 0.05），higher left ventricular ejection fraction（LVEF） （P < 0.05）and maximum rise speed of left ventricular pressure（+dP/dtmax）（P < 0.01）. Histological analysis revealed that the rats in the ghrelin group had lesser cardiomyocyte degeneration and necrosis than those in the heart failure group. Mechanistically，the rats in the ghrelin group had significantly lower plasma levels of TNF ⁃ α and 15⁃f2t ⁃isoprostane（P < 0.01），but higher plasma IL ⁃10 level（P < 0.05）. Conclusion Ghrelin improves cardiac function of doxorubicin⁃induced heart failure and ameliorates myocardial injury at least in part through regu⁃ 

Objective The aim of this study was to investigate whether the mechanism of high⁃salt diet in intestinal barrier function was related with the activation of the signaling pathway of Janus kinase 1⁃signal transducer and activator of transcription 3（JAK1⁃STAT3）. Methods SPF C57BL/6 mice weighing（20 ± 5）g were randomly divided into control group and high salt diet（HSD）group. There were 5 mice in each group. Control group was fed with standard chow ad libitum，while the high⁃salt diet was achieved by feeding a dietary chow consisting of 8% NaCl for 12 weeks. At the end of feeding，the intestinal tissue samples were collected to analyze the intestinal barrier function and the activity JAK1⁃STAT3 signaling pathway. Human normal colon epithelial cell line NCM ⁃ 460 was used for cell experiments：（1）Control group（Control）；（2）High salt treatment group（High NaCl，50 mmol/L） for 48 h；3）JAK1 inhibitor Ruxolitinib treatment group（High NaCl + Ruxolitinib），pretreatment with JAK1 inhibi⁃ tor Ruxolitinib（50 μmol/L）for 2 hours，then add high concentration NaCl（50 mmol/L）and incubate for 46 hours. After the cells were processed，the cells were collected to detect the intestinal epithelial barrier tight junc⁃ tion proteins and the changes of JAK1⁃STAT3 signaling pathway proteins by Western blot. Results High⁃salt diet could inhibit the expression of intestinal barrier protein and increase the permeability of intestinal barrier as well as activate the expression of JAK1⁃STAT3 signaling pathway protein in the intestinal tissue. JAK1 inhibitor Ruxolitinib resisted intestinal barrier dysfunction induced by high concentration of NaCl. Conclusion High ⁃salt diet may induce intestinal barrier dysfunction by activating JAK

Objective To investigate the effect of simvastatin combined with mechanical stretch on osteogenic differentiation of bone marrow mesenchymal stem cells（BMSCs）and explore its mechanisms. Methods simvastatin group，mechanical stretch group and simvastatin+mechanical stretch group in the study. ALP activity and RT ⁃ PCR were used to investigate the effect of simvastatin，mechanical stretch and simvastatin + mechanical stretch on osteogenic differentiation of BMSCs and RT⁃PCR and WB were used to investigate the expression of β ⁃catenin in each group. Results The level of osteogenic relative genes was up⁃regulated and the expression of β ⁃catenin protein was increased in each group when compared with those in the control group，especially in simvastatin+mechanical stretch group. DKK1 partly eliminated osteogenic differentiation of BMSCs in simvastatin+ mechanical stretch group. Conclusion Both simvastatin and mechanical stretch promote the osteogenic differentia⁃ tion of BMSCs. Simvastatin promotes the osteogenic differentiation of BMSCs induced by mechanical stretch via 

Objective To investigate the kinetic changes of myoglobin（Mb）levels in serum and evaluate its prognostic implication in patients who received liver transplantation and suffered from new acute renal injury （AKI）. Methods A total of 191 hospitalized patients after liver transplantation from July 2018 to June 2020 were recruited in this retrospective study.（1）The important clinical indexes related to liver and kidney function and related score results were recorded before，during and after operation；（2）Serum Mb levels of patients were deter⁃ mined on post⁃operation hrs 0，24，48，72，respectively；（3）These patients were divided into AKI group（n = 80） and non ⁃AKI group（n = 111）according to the clinical outcomes at 72h after operation. Data were processed by Student′s t⁃test，analysis of variance of repeated measurement design and χ2 ⁃test. Logistic regression was used to screen out risk factors related to AKI. The validity of predicting patients′ AKI within the 72 h period with some selected variables was verified by receiver operating characteristic （ROC）curves. Results （1）Among these patients，the mean levels of serum Mb in AKI group were significantly higher than those in non⁃AKI group on post operation hrs 0，24，48，and 72（P < 0.001）；（2）Logistic regression analysis showed that the level of preoperative MELD score（OR = 1.083，95%CI：1.022 ~ 1.147，P = 0.007），intraoperative amount of bleeding（OR = 1.001， 95%CI：1.000 ~ 1.002，P = 0.003），intraoperative total fluid output（OR = 1.015，95%CI：1.010 ~ 1.032，P = 0.008） and serum Mb level at 72 h after operation（OR = 1.038，95%CI：1.026 ~ 1.050，P < 0.001）were the independent risk factors related to AKI outcome in patients；（3）The total areas under ROC curve of preoperative MELD score， intraoperative amount of bleeding，intraoperative total fluid output andserum Mb level at 72 h after operation for predicting AKI for 80 patients with liver transplantation were respectively 0.655（95%CI：3.55 ~ 15.84，P < 0.01， 0.672），（95% CI：4.83 ~ 17.17，P < 0.01），0.532（95%CI：2.52 ~ 12.88，P < 0.01），0.861（95%CI：5.17 ~ 19.42， P < 0.01）. The optimal threshold values were respectively 16.7 points，0.8 L，2.9 L，150 ng/mL. The sensitivities were respectively 58% ，56% ，46% ，84% ，and the specificities were respectively 69% ，70% ，69% ，82%. Conclusion The increase ⁃ inserum Mb levels in liver transplantation patients are significantly correlated with their AKI outcome. Monitoring the dynamic changes inserum Mblevels during the early stage may be useful to predict the outcome of liver transplantation patients with new renal complications.

Objective To evaluate the effect of paclitaxel combined with carboplatin on left ventricular systolic function and motor synchrony in patients with ovarian cancer using two ⁃ dimensional speckle tracking imaging（2D⁃STI）technique. Methods A total of 30 patients with ovarian cancer were collected after surgery and received paclitaxel combined with carboplatin，and they were examined before chemotherapy，3⁃cycle，and 6⁃cycle， and 30 healthy subjects were selected forthe control group. After routine ultrasound examination，the layered strain technique was used to detect the longitudinal and circumferential strains of the whole left ventricle . The three layers of myocardium（GLS，GLS⁃endo，GLS⁃mid，GLS⁃epi，GCS，GCS⁃endo，CS⁃mid，CS⁃epi），the standard deviation of the time to peak（Tssl⁃SD，Tssc⁃SD）and the maximum difference（Tssl⁃dif，Tssc⁃dif）and the delay index （LSDI，CSDI）were obtained. The difference of parameters in each groupwere compared，and the ROC curve was used to evaluate the clinical value of various parameters in monitoring cardiac toxicity. The association between the parameters and the cumulative dose was analyzed. Results No significant difference was found between the pre⁃ chemotherapy group and the control group，while the conventional parameters（LVEDV，LVEF，e′）of the 3⁃cycle chemotherapy group and the 6⁃cycle chemotherapy group decreased，and the E/e′ value increased. The GLS，GLS⁃ endo，GLS⁃mid，GCS，GCS⁃endo，group were significantly reduced（P < 0.05），with a decreasing trend. At the same time，GLS⁃epi and GCS⁃epi decreased during 6⁃cycle of chemotherapy. The delay of Tssl ⁃ SD and LSDI in the 3⁃cycle chemotherapy group， while the delay of Tssl⁃SD in the 6⁃cycle chemotherapy group was more obvious. The ROC curve showed that AUC （0.922）and specificity（90.00%）of GLS⁃endo were the highest，the GLS sensitivity was the highest（86.67%）， GLS⁃endo was negatively correlated with drug dose（r = -0.732，P < 0.01）. Conclusion 2D⁃STI technique should be used in the early assessment of paclitaxel combined with carboplatin on left ventricular systolic function and 

Objective To investigate the efficacy and safety of erythropoietin（EPO）combined with mild hypothermia in the treatment of moderate to severe neonatal hypoxic⁃ischemic encephalopathy（HIE）. Methods A randomized controlled study was conducted on 92 children with moderate to severe HIE who met the mild hypothermia criteria from March 2017 to June 2019 in our hospital，and they were grouped according to the random number table method，46 cases each. The experimental group was treated with mild hypothermia for 72 hours combined with EPO intravenous infusion（once every other day for 14 days），and the control group was given mild hypother⁃ mia for 72 hours and normal saline at the same dose and same method as EPO. Statistics compared the safety and routine biochemical indicators of the two groups during treatment，and compared the prognosis of the two groups， such as the efficacy，newborn behavior scale（NBNA），intelligent development（CDCC）score，and the incidence of sequelae. Results （1）the NBNA scores of 7 days，14 days，and 28 days after birth in the experimental group showed an increasing trend，and were all greater than those in the control group（P < 0.05）；the MDI and PDI scores of the 3⁃month⁃old，6⁃month⁃old and 12⁃month⁃old in the experimental group were larger than those in the control group（P < 0.05）；the incidence of sequelae in the experimental group was 8.70% compared with 13.04% in the control group，the difference was not statistically significant（P > 0.05）；（2）Conventional biochemical indicators：at the end of mild hypothermia treatment，after the end of EPO treatment，the two groups of Hb，RBC， HcT，PLT，alanine aminotransferase，myocardial enzymes，creatinine，CR were compared，the difference was not statistically significant（P > 0.05）；（3）Safety during treatment：there were no serious adverse events，treatment abandonment events，and death events during treatment between the two groups. There was no statistically signifi⁃ cant difference in the incidence of general adverse events between the two groups（P > 0.05）. Conclusion EPO combined with mild hypothermia in the treatment of moderate to severe HIE can further reduce early stress injury reduce intelligence and nerve injury of children，improve prognosis，and do not increase the risk of adverse events during treatment.

Objective To explore the effect of metabolic syndrome and its components on short ⁃term survival of patients with severe trauma after first aid. Methods Patients with severe trauma were divided into metabolic syndrome group and non⁃metabolic syndrome group according to their disease status. Patients with severe trauma combined with metabolic syndrome in metabolic syndrome group and patients without metabolic syndrome in non⁃metabolic syndrome group. The prognosis of patients in metabolic syndrome group and non⁃metabolic syndrome group was compared and analyzed. Results The prevalence rate of metabolic syndrome in patients with severe trauma was 5.09%. The mortality rate of severe trauma patients 3 months after first aid was 7.46%. Body Mass Index ≥ 28（OR = 2.012，P = 0.006）is the only metabolic syndrome component that affects the death of patients. Conclusion Metabolic syndrome will affect the first aid effect and clinical outcome of patients with severe trauma. Obesity is the direct cause of death of trauma patients.

Objective Early predictors of trastuzumab ⁃ related cardiotoxicity are urgently needed. There⁃ fore，we investigated the clinical value of the deceleration capacity of the heart rate（DC）in predicting trastuzumab⁃ related cardiotoxicity in the treatment of human epidermal growth factor receptor 2（HER2）⁃positive breast cancer. Methods Patients with HER2⁃positive breast cancer treated with trastuzumab at our hospital from June 2015 to June 2017 were retrospectively observed. DC was assessed before treatment ，and the left ventricular ejection fraction（LVEF）was regularly monitored for 2 years（before，during，and after treatment）to evaluate the develop⁃ ment of cardiotoxicity. Results Among 150 eligible patients with complete datasets，28（18.7%）developed cardiotoxicity. The age of patients with cardiotoxicity were older（P = 0.018），the anthracycline dose they received was higher（P < 0.001），and DC and baseline LVEF they had were lower（P < 0.001），compared with those in patients without cardiotoxicity. Logistic regression revealed that lower DC，lower baseline LVEF，and higher anthra⁃ cycline dose were independent risk factors of trastuzumab ⁃ related cardiotoxicity. Receiver operating characteristic curve analysis revealed a greater area under the curve for DC than for the baseline LVEF in predicting cardiotoxicity （0.875 vs. 0.768，P = 0.032）. Conclusion DC should be an early predictor of trastuzuma⁃related cardiotoxicity

Objective The quantitative level of serum hepatitis B surface antigen（qHBsAg）has been evaluated as a marker of liver histological fibrosis in the chronic hepatitis B patient group. However ，few study focuses on HBeAg ⁃negative chronic HBV patients. The purpose of this study is to assess whether the quantitative level of qHBsAg has diagnostic value in staging of liver fibrosis in untreated HBeAg⁃negative chronic HBV patients. Methods The relationships between the quantitative levels of HBsAg and HBV DNA，alanine aminotransferase （ALT），aspartate aminotransferase（AST），liver fibrosis and other indicators were retrospectively analyzed. The HBsAg levels were measured at baseline as a single point of quantification and the cut⁃off point for the evaluated qHBsAg was 1 000 IU/mL. It was used to prove whether it could distinguish patients with mild fibrosis（S0⁃1）from significant fibrosis（S2⁃4）. Results Compared with patients with qHBsAg level < 1 000 IU/mL，patients with qHBsAg level > 1 000 IU/mL are more likely to develop S2⁃4 fibrosis（P = 0.029）and the difference is statistically significant. However，there was no significant difference in qHBsAg in patients with S0⁃1（3.53 ± 0.15）and S2⁃4 fibrosis（3.62 ± 0.16，P = 0.07）in different fibrosis stages. When HBV DNA（> 2 000 IU/mL）combined with HBsAg cut⁃off valueto evaluate different liver fibrosis stages，the incidence of significant fibrosis（S2⁃4）has no obvious correlation with qHBsAg level. qHBsAg could not accurately identify the stage of fibrosis（AUROC，0.62， cut ⁃ off value of 3 758 IU/mL，sensitivity of 73.1% ，specificity of 54.2%）. Conclusion Serum HBsAg levels could not distinguish patients with significant fibrosis（S2⁃4）. In addition，more than half of patients with no signif⁃ 

Objective To explore the effects of lanthanum carbonate combined with cinacalcet and calcitriol on thyroid hormone ，phosphorus ⁃ calcium metabolism and clinical symptoms in hyperparathyroidism patients undergoing maintenance hemodialysis（MHD）. Methods The clinical data of 90 patients with secondary hyperparathyroidism（SHPT）who underwent MHD in outpatient of the hospital from January 2017 to April 2020 were retrospectively analyzed. According to different administration methods，the 16 patients who were treated with calcitriol were included in group C，36 patients who treated with cinacalcet and calcitriol were included in group B，and 38 patients who treated with lanthanum carbonate combined with calcitriol and cinacalcet were included in group A. The clinical symptoms，levels of serum intact parathyroid hormone（iPHT）and phosphorus ⁃calcium metabolism，and occurrence of adverse reactions were compared among the three groups. Results At 1 month，3 months and 6 months after treatment，level of serum iPHT was the highest in group C，followed by group B and group A（P < 0.05）. At 6 months after treatment，controls rates of iPTH in groups A and B were 94.74% and 83.33%，which were higher than that in group C（56.25%）（P < 0.05）. After treatment，skin itching and bone joint pain in the three groups were improved（P < 0.05）. There was no significant difference in the proportion of patients with skin itching and bone joint pain among the three groups（P > 0.05）. At 1 month，3 months and 6 months after treatment，serum calcium，serum phosphorus and calcium phosphorus product in group A and B were lower than those in group C. The serum phosphorus and calcium phosphorus product in group A were lower than those in group B（P < 0.05）. There was no significant difference in the incidence of adverse reactions during treat⁃ ment among the three groups（P > 0.05）. Conclusion Lanthanum carbonate combined with cinacalcet and cal⁃citriol can effectively improve clinical symptoms of SHPT patients undergoing MHD，reduce iPHT level，and im⁃ prove calcium⁃phosphorus metabolism，with relatively higher medication safety.

Objective To explore the effect of levetiracetam combined with oxcarbazepine in the treatment of cognitive dysfunction in adult patients with temporal lobe epilepsy. Methods A total of 62 patients were enrolled randomly divided into control group（n = 31）and observation group（n = 31）. The control group was treated with levetiracetam and the observation group with oxcarbazepine on the basis of the control group. Both groups of patients received treatment for 3 months. All patients were tested for event⁃related potential P300，Wechsler Intelli⁃ gence Scale for Adult⁃Chinese Revised（WAIS⁃RC）and Clinical Memory Scale（CMS）before and after taking the drug. Results Compared with that before treatment，the score of CMS，WAIS⁃RC and memory quotient（MQ）of the two groups of patients increased；the P300 latency was shortened，and the volatility increased（P < 0.05）. Compared with the control group，the P2 and N2 wave latency of the observation group was significantly shortened after treatment，and the total intelligence quotient（FIQ），pointing memory and image free recall were significantly increased（P < 0.05）. Conclusion Levetiracetam combined with oxcarbazepine can improve the cognitive dys⁃ function of adult patients with temporal lobe epilepsy，and the effect is better than that of levetiracetam alone.

Objective To explore the expression level and diagnostic value of plasma exosomal miR⁃221 for non⁃small cell lung cancer（NSCLC）. Methods Sera of 72 NSCLC patients（NSCLC group）and 52 healthy controls（healthygroup），there are from December 2018 to December 2019，Dongfeng General Hospital of Sino⁃ pharm，Hubei Shiyan. After centrifugation of whole blood，the exosomes and their RNA were extracted by kit， identification of plasma exosomal by transmission electron microscopy，Western blotting and nanoparticle tracking analysis. The expression of miR⁃221 in lung cancer group and control group was detected by real⁃time quantitative polymerase chain reaction，a comparative analysis of the relationship between them and clinicopathological parame⁃ ters of lung cancer patients. The diagnostic value of exosomal miR⁃221 was evaluated with receiver operating charac⁃ teristic（ROC）curve. Results The plasma exosomes were successfully isolated and identified according to the recognized exosomes characteristics. The expression of miR⁃221 was significantly higher in the NSCLC group than in the healthy control group（P < 0.001）. The area under the ROC curve（AUC）was 0.758（95% CI：0.672～0.844， P < 0.001）. The diagnostic sensitivity was 86%，and the specificity was 66%. Conclusion Plasma exosomal miR⁃ 221 may be a potential biomarker for diagnosis of NSCLC，

Objective To investigate the clinical value of procalcitonin （PCT），C ⁃ reactive protein （CRP），interleukin⁃6（IL⁃6）combined with（1，3）⁃D⁃glucan（BDG）and galactomanannan（GM）in early differ⁃ ential diagnosis of bloodstream infections. Methods We retrospectively involved 124 hospitalized patients with positive blood cultures from January to December 2019. The levels of PCT，CRP，IL⁃6，BDG and GM test indexes were compared between bacteria group and fungus group，and the receiver operating curve（ROC）was used to evaluate the diagnostic value of each index and the combined detection in fungal bloodstream infections. Results The level of PCT，CRP and IL⁃6 in the fungus group was significantly lower than those in the bacteria group（P < 0.05）；while that of BDG in the fungus group was significantly higher than that in the bacterial group（P < 0.05）. The area under the ROC curve（AUC）of PCT，CRP，IL⁃6，and BDG alone for the diagnosis of fungal bloodstream infections was 0.859，0.718，0.8 and 0.843 respectively（P < 0.05）but that of the combined diagnosis of the four indicators was 0.914. The comparison of AUC of CRP，IL⁃6，and BDG and that of the diagnosis value of the com⁃ bined indicated statistical significance（P < 0.05）. Conclusion The level of PCT，CRP，IL⁃6 and BDG can be used as reference indicator to distinguish fungal and bacterial bloodstream infections，and the differential diagnosis value of PCT and BDG is higher. The combined detection of four indicators has certain clinical value in the early 

Objective To investigate the incidence of malignant tumor and evaluate the potential risk factors in DM patients. Methods A retrospective case analysis was conducted on patients with dermatomyositis from 2006 to 2015 in Guangzhou First People′s Hospital，including general information，clinical symptoms，labo⁃ ratory examination results，and drug records. The end point of the study was defined as the occurrence or death of a malignant tumor. Results In this study，59 of the 238 patients with dermatomyositis had a 24.8% overall incidence of malignant tumors.Nasopharyngeal cancerand lung cancerare the most common malignant diseases. Among the 59 patients with malignant tumor，35（59.3%）developed dermatomyositis within 1 year after diagnosis. In subsequent years，and only 1 patient had tumor after the third year.multivariate Logistic regression analysis showed that the male gender，dyspneaand high level of CRP for the risk factors，Interstitial Lung Disease（ILD）was a protective factor for malignant tumor. Conclusion Due to the high incidence of Chinese patients with dermatomyositis malig⁃ nant tumor，We should be on high alert for the presence of malignant tumors in these patients. Nasopharyngeal car⁃ cinoma and lung cancer is the most common malignant disease. The risk of malignant tumor in dermatomyositis is the highest rates in the first year after diagnosis. After systemic malignant tumor screening work shall be carried out in the first year. Male gender，dyspnea，high level of CRP is risk factosr for malignant tumors occur. The presence of pulmonary interstitial disease reduces the risk of malignant tumors of coexist.

Objective To explore the preoperative application of 3D ⁃ SLicer software in the resection of cerebellopontine Angle tumor，so as to provide a better auxiliary means for precise surgery. Methods From 2018 to 2019，20 patients with pontine Angle tumors were collected from the Neurosurgery Department of the Second Affiliated Hospital of Zhengzhou University. Before surgery，3D⁃SLicer software was used to reconstruct the sinus， skull and skin，and design skin incisions and bone flaps. Results According to the results of 3 d reconstruction， all the surgical approaches were successfully designed to find the tumor in the best position and to protect the venous sinus and brain tissue. All the 20 cases were successfully completed，and the 3D reconstructed images were basically consistent with the actual intraoperative findings. Conclusions 3D⁃SLicer software can provide objective and accurate positioning for the resection of tumors in the cerebellopontal Angle area，help understand the location of blood vessels and nerves，avoid the yaw of the surgical path，and improve the success rate of the operation.

Objective To study the clinical application of the position，named“looking at the moon”，in laparoscopic axillary surgery in breast cancer. Methods A total of 283 patients undergoing laparoscopic axillary surgery for breast cancer in our hospital were selected. The observation group adopted the position of“looking at the moon”（142 cases），which was designed through relevant data. In the control group，the supine position that shoulder and back were higher on the operative side was adopted in 141 patients. The indexes of position placement，perioperative characteristics，patient comfort and doctor satisfaction were compared between the two groups. Results All patients completed laparoscopic axillary surgery for breast cancer successfully，without trans⁃ ferring to open surgery. It took less time in the observation group than in the control group in time⁃consuming of position placement. Moreover，there was shorter operation time，less postoperative complications but higher doctor satisfaction（P < 0.05）. Conclusion The application of the position“looking at the moon”in laparoscopic axillary surgery for breast cancer can improve the efficiency and reduce complications，which not only expose operative field effectively ，but also shorten the time of operation.

Femoro ⁃popliteal artery（FPA） calcification is a common disease in vascular surgery. Its incidence and diagnostic rate are increasing year by year，and it has become an important disease that endangers the mobility and life health of patients. Due to the special anatomical structure and complex mechanical characteristics of FPA，the lesions are often manifested as long segment，diffuse and severe calcification occlusion of the tube wall，which is often difficult to deal with，and the rate of postoperative reintervention is high. The severity of wall calcification is an important factor affecting the therapeutic effect. In recent years，new ideas and technologies for endovascular treatment of FPA calcification have emerged in an endless stream，which have deeply influenced the selection of clinical treatment strategies and will also determine the development direction of endovascular treatment for a long time to come. This article would briefly state some new treatment concepts on the FPA calcified lesions such as“leave nothing behind”or“vessel preparation”，“classification of dissection after balloon dilation and the new dealing strategies”，and emphatically summarized some commonly clinical used new technologies such as the emergence of some new guide wires and stents，new technology for volume reduction in cavity，special balloons，“composite”technology and“Pave⁃and⁃Crack”technology. In order to provide some references for the selection of equipment and future research ideas，and further improve the success rate of endovascular opening and postoperative patency rate of FPA with severe calcification lesions.

At present，ischemic preconditioning（IPC）is the classic method to reduce ischemia reperfu⁃ sion injury（IRI），by repeating short⁃term ischemic stimulation of the heart，the myocardium itself could improve the tolerance of the subsequent long ⁃term ischemia ⁃ reperfusion injury. IPC has been used in some clinical practices such as coronary balloon angioplasty and coronary artery bypass grafting，etc. Multiple short balloon undulations or coronary artery ligation are used to achieve ischemic preconditioning. However，these ischemic preconditioning are invasive and having high risks，so its clinical application is limited. In 1993，Przyklenk et al. proposed the concept of remote ischemic preconditioning（RIPC），that is，after a transient non⁃lethal ischemic preconditioning of an organ，it could produce a protective effect on the remote organs that subsequently undergo an ischemic event. Compared with IPC，RIPC has advantages of convenience and safety，simple and easy clinical applica⁃ tion，low economic cost and small damage to target organs ，etc. ，and has a wide application prospect in clin⁃