Palliative and hospice care is an emerging medical care model for the development of modern medicine， and its emergence is not only a sign of social demand and the development of human civilization， but also an important manifestation of the change in the modern medical model. Hospice care is the final stage of palliative care， which is of great significance for the end?of?life treatment of incurable diseases. Palliative and hospice care has become an independent discipline in many countries， and its development has been rapid. However， the development of hospice and palliative care in China is not satisfactory， and the lack of money and human resources are the main reasons limiting its development. Many scholars have carried out a lot of useful practices in this regard. How to explore a road of hospice and palliative care development suitable for China's national conditions is an urgent problem to be solved. By reviewing domestic and foreign literature， this paper summarizes the development mode and payment method of palliative and hospice care abroad， identifies the challenges encountered in the practice of hospice care in China， and draws on the development experience of palliative and hospice care in foreign countries. We aimed to identify pain points and difficulties faced in developing palliative and hospice care in China， so as to better serve patients at the end of life， gradually promote the concept of palliative and hospice care， and contribute to the sustainable development of palliative and hospice care in China.

Cadmium is one of the heavy metals with severe reproductive toxicity， whose half-life lasts 20 to 40 years. Cadmium could induce dysfunction of testis and epididymis for its significant accumulation in human testis， and the amount， motility parameters and morphology of sperm change abnormally. The adverse change could also extend to male offspring and cause the impairment of their reproductive system. There has been no clear mechanism of how cadmium induces dysfunction of male reproductive system， and treatment for the adverse influence on male reproductive system by cadmium has not yet been found. Therefore， this problem has been discussed in reproductive and environmental field for a long time. A number of previous investigations showed that cadmium could damage male fertility by followed pathways， including interfering with hormone secretion， inducing oxidative stress， activating inflammation and apoptosis， and causing energy metabolism disorder， etc. In order to enlighten new ideas for therapeutic targets of male reproductive function damage induced by cadmium， we systematically reviewed and summarized the findings of previous publications in this paper.

Deep learning is a machine learning method in the field of artificial intelligence， which simulates the workings of the neural network of the human brain to solve complex problems， and has been used in many important researches and applications in the field of medicine， such as diagnostic imaging， biomedical data processing， drug research and development， personalized medicine， etc.， which improves the accuracy and efficiency of diagnosis and treatment. In the field of assisted reproduction， deep learning could efficiently identify well-grown embryos， suitable oocytes， or sperms during the intervention process， assisting medical staff to make more accurate choices to improve pregnancy rates and reduce the risk of multiple pregnancies. This paper summarizes the latest advances in the application of deep learning in the field of assisted reproduction technology in the past 5 years， and provides an outlook for future research.

An increasing number of studies in recent years have focused on the association between female endometrial microbiota and fertility. Once the endometrial microflora microecology is unbalanced， it will cause a series of endometrial lesions， thereby destroying endometrial receptivity， affecting embryo implantation， resulting in embryo implantation or implantation failure. Among them， the most concerned is the positive significance of lactobacillus-led microbiota on reproductive outcome. Although the relationship between endometrial microbiota and reproductive outcome has not reached a consensus， most studies recognize the positive impact of lactobacillus-led microbiota on reproductive outcome. In this review， the relationship between lactobacillus-dominated microbiota and reproductive outcome is reviewed.

Objective To investigate the protective effects of melatonin （MT） on early embryo in vitro development of mice after exposure to benzophenone-3 （BP-3）. Methods Fertilized mouse oocytes at the syngeneic stage were cultured in KSOM culture medium， 0.8 μmol/L BP-3 culture medium， and 1 × 10^-7 mol/L MT + 0.8 μmol/L BP-3 mixed culture medium， respectively. The rescue effect of MT on the early embryos developmental potential of BP-3-exposed mice in vitro was explored by detecting the blastocyst rate， gene transcription level， protein expression level， and the degree of DNA damage in the three groups of embryos. Results MT improved the developmental potential of mouse embryos exposed to BP-3 in vitro. Compared with the control group， MT treatment significantly increased the protein expression of ATP5A and ATP5B and decreased the DNA damage （P < 0.05）. Furthermore， the transcription levels of antioxidant gene Gpx1 and pluripotency related genes Pou5f1 and Cdx2 were significantly up-regulated in MT-treated blastocysts， and the expression of pro-apoptotic gene Bax was decreased. Compared with the control group， BP-3 treatment enhanced the signal intensity of γ-H2AX in blastocysts （P < 0.05）， while adding MT could effectively alleviate DSBs（P < 0.05）. Conclusion The physiological concentration of BP-3 exposure has reproductive toxicity， but the addition of appropriate concentration of MT could significantly improve the in vitro developmental potential and quality of BP-3-exposed early embryos.

Objective To investigate the expression of circRAF1 in primary ovarian insufficiency （POI） and explore its effect on cell proliferation and apoptosis of human ovarian granulosa cells （GCs） line （KGN cells）. Methods The expression of circRAF1 in GCs and serum of patients with normal ovarian reserve function （n = 50） and patients with POI （n = 50） were detected with RT-qPCR. The correlation of circRAF1 with ovarian reserve function indexes was analyzed. Small interfering RNA （siRNA） targeting circRAF1 was constructed and transfected into KGN cells， with the cell proliferation detected by CCK-8 and EdU assay， and the cell apoptosis detected by JC-1 and Tunel assay. The mRNA and protein levels of genes related to cell proliferation and apoptosis （FSHR， PCNA， Bcl-2， Casp-9， Bax） were detected by RT-qPCR and WB. Results The expression of circRAF1 decreased in GCs and serum of POI patients. The expression of circRAF1 was positively correlated with serum E₂ and AMH levels （P < 0.001）， but negatively correlated with serum FSH and LH levels （P < 0.001）. At the same time， the expression of circRAF1 was positively correlated with AFC （P < 0.001）. Interfering with the expression of circRAF1 could inhibit the proliferation of KGN cells and promote their apoptosis. Conclusion The expression of circRAF1 in the GCs and serum of POI patients is down-regulated， which is correlated with the decline of ovarian reserve function. Interfering with circRAF1 can inhibit the proliferation of GCs and promote their apoptosis.

Objective To explore the effects of Jinghou Zengzhi Granules（JHZZG）， on ovarian GDF9 secretion and granulosa cells（GCs） apoptosis in controlled ovarian hyperstimulation（COH） rats through p38MAPK/CK2/IκBα/NF-κB pathway. Methods A model of COH rats was prepared and 18 rats were randomly divided into 3 groups， including natural ovulation group（NO group）， COH group， and COH+JHZZG group. The expression of p38MAPK， CK2， IκBα， NF-κB， GDF9 mRNA and protein were detected by qRT-PCR and Western blot， and the apoptosis rate of ovarian GCs by TUNEL. Results Compared with the NO group， the expression of p38MAPK and NF-κB in the ovarian tissue of rats in the COH group increased， while the expression of CK2， IκBα and GDF9 decreased， and the apoptosis rate of ovarian GCs increased （all P < 0.01）. Compared with the COH group， the expression of p38MAPK and NF-κB in the ovarian tissue of rats in the COH+JHZZG group decreased， while the expression of CK2， IκBα and GDF9 increased （all P < 0.01）， and the apoptosis rate of ovarian GCs decreased （P < 0.05）. Conclusion Jinghou Zengzhi Granules could promote the secretion of ovarian GDF9 and inhibit the apoptosis of ovarian GCs of COH rats through p38MAPK/CK2/IκBα/NF-κB signaling pathway， which thereby improve the quality of COH oocytes.

Objective To investigate the role of complement C3 in early predicting pregnancy outcomes of frozen-thawed embryo transfer （F-ET）. Methods A total of 378 F-ET cycles were prospectively collected and divided into group A （complement C3 ≤ 1.05， 120 cycles） and group B （complement C3 > 1.05， 258 cycles） based on the best cutoff value of complement C3 for predicting F-ET pregnancy outcomes. The outcomes of the two groups were compared， and the best cutoff value of complement C3 for predicting F-ET spontaneous abortion was analyzed in group B. Results Age was a risk factor for successful F-ET pregnancy （P < 0.05）， and complement C3 and embryo type were protective factors for successful F-ET pregnancy （P < 0.05）. The area under the receiver-operating characteristic curve （ROC） of complement C3 for predicting F-ET pregnancy outcome was 0.702， and the best cutoff value was 1.05 g/L， with a clinical pregnancy sensitivity of 87.60% and a specificity of 52.00%. The clinical pregnancy rate and embryo implantation rate in group B were both significantly higher than those in group A （67.05% vs. 52.75%， P < 0.05）. The best cutoff value of complement C3 for predicting spontaneous abortion after F-ET was 1.32 g/L， with an area under the ROC curve of 0.760， a sensitivity of 69.00%， and a specificity of 81.20%. Conclusions Complement C3 is of significance in the early prediction of F-ET pregnancy outcome. When complement C3 exceeds the level of 1.32 g/L， it may lead to an increase in the rate of spontaneous abortion.

Objective Explore the relationship between semen quality and trace element levels in seminal plasma， as well as miR-184 levels in exosomes of male infertility patients. Methods 155 male infertility patients in our hospital from January 2022 to July 2023 were selected as the infertility group， and another 155 male patients with normal physical examination during the same period were selected as the normal group. Compare the general information， semen quality parameters， trace elements， and miR-184 levels in exosomes between two groups， and analyze the correlation between male infertility patients and the above laboratory indicators through Spearman rank correlation analysis. Results The sperm concentration， total sperm motility （PR + NP）， forward motility sperm （PR）， average curve velocity， average linear velocity， average path velocity， and average lateral amplitude of sperm head （ALH） in the infertile group were lower than those in the normal group （P < 0.05）； The levels of Zn， Mg， and Ca in the infertile group were lower than those in the normal group， while the levels of Cu， Pb， and relative expression of miR-184 were higher than those in the normal group （P < 0.05）； The levels of Zn and Cu elements in male infertility patients are positively and negatively correlated with sperm concentration， total sperm motility （PR+NP）， and forward motility sperm （PR）， respectively. The levels of Pb elements are negatively correlated with the average lateral amplitude of sperm head （ALH）， and P < 0.05. The relative expression level of miR-184 in male infertility patients is negatively correlated with sperm concentration， total sperm motility （PR + NP）， forward motility sperm （PR）， and average sperm curve velocity， with P < 0.05. Conclusion The quality of semen in male infertility patients is closely related to the levels of trace elements in semen and miR-184 levels in exosomes.

Asthma is a chronic inflammatory airway disease， and airway inflammation， airway hyper?responsiveness and airway remodeling are the major pathological alterations in asthma. Numerous studies have demonstrated sphingosine metabolism disorders exist in asthma patients， and sphingosine?1?phosphate （S1P） is the end product of sphingolipid metabolism， which has become the focus of research as an important mediator of immune and inflammatory diseases， and is closely related to the development of asthma. In this paper， we summarize the role of S1P in the pathological changes of asthma from the relationship between S1P and asthma as well as its application in the clinical diagnosis， treatment and efficacy assessment of asthma， with a view to exploring more directions in the diagnosis and treatment of asthma。

Objective This study aims to investigate the impact of cultivation time on dendritic cells （DCs） and their derived exosomes' expression of immune?related membrane proteins （CD80， MHC?Ⅰ， MHC?Ⅱ） and provides experimental evidence for future research. Methods Mouse bone marrow cells were induced to differentiate into DCs using GM?CSF and IL?4， followed by maturation stimulation withTNF?α. Exosomes were extracted using ultracentrifugation.Western blot and Amnis image flow cytometry were used to identify exosomes derived from mouse DCs. Amnis image flow cytometry was used to detect the expression of immune?related proteins CD80， CD11c， MHC?Ⅰ， and MHC?Ⅱ in mouse DCs and their exosomes. Results After 5 days of in vitro cultivation， more than 50% of dendritic cells expressed CD80， CD11c， MHC?Ⅰ， and MHC?Ⅱ， reaching the highest level on day 13. The positivity rates were as follows： CD80 （97.29 ± 0.63） %， CD11c （92.31 ± 1.18） %， MHC?Ⅰ（97.91 ± 0.49） %， and MHC?Ⅱ（97.91 ± 0.49） %. The differences were statistically significant （P < 0.001）. The expression gradually decreased after day 13， but approximately 80% of DC cells still expressed MHC?Ⅰ and MHC?Ⅱ immune molecules on day 30. The expression levels of CD80， CD11c， and MHC?Ⅱ on the exosome membrane were highest on day 5 and then decreased overall with prolonged cultivation time， except for MHC?Ⅰ molecules. The differences were statistically significant （P < 0.01）. Conclusions In vitro?cultured mouse dendritic cells express high levels of immune?related membrane proteins and can be stably maintained for a long time under suitable culture conditions. The secreted exosomes also carry abundant immune?related membrane proteins， but no significant correlation was found between the immune?related proteins on the dendritic cell surface and the exosome membrane surface.

Objective To observe the protective effects of codonopsis pilosulae polysaccharide on lung tissues in mice with acute lung injury （ALI） induced by lipopolysaccharide （LPS） and its mechanism. Methods Fifty male Kunming mice were randomly divided into control group， model group， dexamethasone group， codonopsis polysaccharide high-dose group （300 mg/kg） and codonopsis polysaccharide low-dose group （150 mg/kg）. The ALI model was established by intraperitoneal injection of LPS. All mice were given gavage administration according to the grouping except for the control group. 0.3 s force expiratory volume （FEV 0.3） and force spirometry （FVC） and their ratios were measured using multiparametric lung function test system. The histopathology change of mouse lung was detected by hematoxylin-eosin （HE） staining， and the classification and count of inflammatory cells in alveolar lavage fluid （BALF） was detected by Richter-Giemsa staining. Levels of IL-1β， IL-6， MPO and TNF-α were measured by ELISA in BALF， and Western blot was used to detect the protein expression level of p-p38， p-IκB-α and p-p65. Results Compared with those in the control group， lung histopathological damage was more pronounced in the model mice， with significantly lower FEV 0.3， FVC， FEV0.3/FVC assay value， but significantly higher lung tissue wet mass/dry mass （W/D）， neutrophils， lymphocytes， IL-1β， IL-6， MPO， TNF-α， p-p38 MAPK， p-IκB-α， and p-p65 （P < 0.05）； while codonopsis pilosulae polysaccharide could significantly reverse these effects. Conclusion Codonopsis pilosulae polysaccharide plays a protective role against LPS-induced ALI via inhibiting MAPK/NF-κB pathway to reduce the pathological damage of lung tissue， and the level of inflammatory factors， thus to improve lung function in ALI model mice.

Objective To evaluate the clinical efficacy of plasma exchange （PE） and double plasma molecular absorption system （DPMAS） in the treatment of primary biliary cholangitis （PBC） and the effect of this therapy on prognosis. Methods The clinical data on 526 PBC patients in our hospital from December 2013 to January 2022 were retrospectively analyzed. The patients were divided into different groups according to different therapies and then matched with propensity. The changes in symptoms， laboratory indexes and MELD scores were compared between two groups before and after treatment， and the clinical efficacy of artificial liver treatment for PBC patients was assessed. The effect of this treatment on the survival outcomes in these patients via comparing the cumulative survival rates at 3， 6 and 12 months between the two groups. Results The efficiency was better in the group with artificial liver treatment in addition medical therapy than the group with medical treatment alone， the difference was statistically significant （76.7% vs. 55.8%， χ² = 4.214， and P = 0.040）. Cox proportional risk regression showed that TBIL was an independent risk factor affecting the 3?， 6?， or 12?month survival in PBC patients. Conclusions Artificial liver support system can effectively relieve symptoms， reduce levels of ALT， AST and TBIL， improve blood coagulation function， and lower MELD scores in PBC patients. This therapy revealed a trend of improvement in 3?， 6?， or 12?month survival outcomes.

Objective To investigate the effect of age on the incidence of cirrhosis and liver cancer in patients with chronic hepatitis B. Methods 279 patients with chronic hepatitis B were divided into the senior group and the younger group according to the age of the patients. The cumulative incidence of cirrhosis and liver cancer during 25 years of follow-up was calculated by using SPSS and R language through the long-term follow-up of HIS system， and the risk factors were analyzed by multivariate logistic regression. Results During follow-up， 24 cases developed cirrhosis and 12 cases developed liver cancer. The cumulative incidence of liver cirrhosis was 1.5%， 2.1%， 5.4%， 11.6% and 15.5% in the 5-year， 10-year， 15-year， 20-year and 25-year group， and 5.5%， 9.8%， 22.9%， 29.0% and 52.1% in the elderly， respectively. The difference between the younger age group and senior age group was statistically significant （P < 0.001）. A total of 2 risk factors （age and follow-up time） were included in the regression model. Two cases in the younger group developed into liver cancer after 17 and 21 years of follow-up， respectively. The cumulative incidence rates at 5， 10， 15， 20 and 25 years were 1.8%， 3.8%， 18.5%， 21.8% and 26.7%. A total of five factors （initial age， HBV-DNA load， HBV-DNA turned negative before the endpoint， follow-up time， and sex） were included in the regression model. Conclusions The incidence of cirrhosis and liver cancer in CHB patients aged ≥ 40 years， especially in male patients， is significantly higher than younger CHB patients. Timely initiation of antiviral therapy can delay disease progression and reduce the incidence of terminal liver disease.Whether antiviral therapy should be initiated for people aged 30 to 40 years remains to be studied.

Objective This study aimed to explore the prognostic value of ¹⁸F?FDG PET/CT Metabolic and Heterogeneity Parameters Combined with Clinical Features Before Definitive Chemoradiotherapy （D?CRT） in predicting the prognosis of esophageal squamous cell carcinoma （ESCC） Patients. Methods A retrospective analysis was conducted on clinical data from 106 patients with ESCC who received D?CRT at the first affiliated Hospital of University of Science and Technology of China between January 2017 and December 2021. All patients underwent ¹⁸F?FDG PET/CT examination before the treatment. The primary tumor's metabolic and heterogeneity parameters were obtained through data processing. All patients were followed up for overall survival. The Kaplan?Meier method and Cox proportional hazards models were used to analyze the association between clinical features， tumor metabolism and heterogeneity parameters and patient prognosis. Results The 1? and 1.5?year overall survival rates of all patients were 77.4%and 51.9%. The median survival time was 20 months. Univariate analysis showed that N stage， M stage， metabolic tumor volume， total lesion glycolysis， heterogeneity index?2 （HI?2）， and coefficient of variation with a threshold of 40% maximum standard uptake value （CV40%） were correlated with the prognosis of ESCC （all P< 0.05）. Multivariate analysis showed that N stage and CV40% were independent predictors of prognosis in patients with ESCC （P = 0.039 and P < 0.001， respectively）. Conclusion N stage and tumor metabolic heterogeneity parameter CV40%， which offering a degree of predictive value， are closely related to the prognosis of patients with ESCC treated with D?CRT.

Objective To investigate the risk factors of postoperative complications in patients with spinal tuberculosis and analyze the value of prognostic nutritional index （PNI） in predicting these complications. Methods The clinical data of 156 patients with spinal tuberculosis who underwent surgery in the Affiliated Hospital of Zunyi Medical University from January 2018 to July 2022 were retrospectively analyzed. The patients were divided into a complication group and a non-complication group based on the presence or absence of postoperative complications. Baseline data， laboratory indicators， and surgery-related indicators were compared between the two groups. The risk factors for postoperative complications in spinal tuberculosis were analyzed， and receiver operating characteristic （ROC） curves were plotted to evaluate the predictive value of PNI for postoperative complications in the patients. Results Among all of 156 patients， 68 contracted a total of 82 instances of postoperative complications， with an incidence of 43.59%. Coinfection with pulmonary tuberculosis， preoperative anti-tuberculosis treatment duration more than 4 weeks， surgical operation duration， and drainage days were identified as independent risk factors for postoperative complications in spinal tuberculosis （P < 0.05）. On the other hand， a higher PNI was found to be a protective factor against postoperative complications of the spinal tuberculosis （P < 0.05）. The area under the ROC curve for PNI predicting postoperative complications ofthe spinal tuberculosis was 0.805. Conclusion The risk of postoperative complications in patients with spinal tuberculosis is subject to such factors ascoexistence of pulmonary tuberculosis，preoperative anti-tuberculosis treatment duration， surgery duration， drainage duration， and preoperative PNI. Preoperative PNI has a certain value for predicting the postoperative complications in the patients.

Objective Discuss the safety and effectiveness of flow diverter device and traditional stent inthetreatment of unruptured ophthalmic segment aneurysms. Methods A retrospective analysis from January 2017 to January 2023 was performed on the clinical data of 70 cases of unruptured aneurysms in the Department of Neurosurgery of Southern Theater General Hospital treated with stent-assisted embolization. According to the type of implanted stents， theywere divided into flow diverter device group （n = 21） and traditional stent group （n = 49）， and the postoperative clinical effects and complications of the two groups were compared. Results The two groups of patients followed 3 to 24 months， with an average of （14.4 ± 1.82） months. The results of perioperative and follow-up showed that the inclusion rate was higher in the flow diverter device group and the traditional stent group （93.3% vs. 87.9%）， with no significant difference（P > 0.05）， and the incidence of perioperative and short-term complications was lower（0 vs. 6.1%） in the flow diverter device group than in the traditional stent group，and there currencies rate in the flow diverter device group was lower than that in the traditional stent group（0 vs. 6.1%）， but the difference was not significant （P > 0.05）. Conclusion Flow diverter devices and traditional stents in the treatment of unruptured ophthalmic segment aneurysmsare feasible， safe and effective. Preliminary results suggest that the incidence of short-term complications and retreatment is lower after treatment with flow diverter devices， and the operation time is short， but further studies are needed to validate long-term complications in patients.

Objective To investigate the expression of lymphoid enhancer binding factor 1 （LEF1） in B cell chronic lymphoproliferative disorders （B?CLPD） and estimate its value in the differential diagnosis of the subtype of B?CLPD. Methods A retrospective study was conducted on 58 patients diagnosed with B?CLPD by using bone marrow biopsy samples or lymphnode biopsy samples from Hematology Department of The Second People's Hospital of Wuhu from September 2018 to June 2023， as well as 20 bone marrow biopsy samples which were diagnosis as non?hematologic malignancy in the control group. Immunohistochemical method was used to detect the expression of LEF1 in 78 samples， and statistical analysis was conducted. Results In all 78 cases， 16 of 20 chronic lymphocytic leukemia （CLL） patients were LEF1 positive， the positive rate was 80%； mantle cell lymphoma 1/12； Follicular lymphoma 1/5； marginal zone cell lymphoma 0/11； Lymphoplasmacyticlymphom 0/8； hairy cell leukemia 0/2； in Control group no patient was LEF1 positive（P = 0.000）. The expression of LEF1 is correlated with CD200 and CLL score（P < 0.05）. In the LEF1 negative group with 4 CLL patients， 2 were detected with +12 chromosomal abnormality， the detective rate was higher than that of the LEF1 positive group（P > 0.05）. Conclusion LEF1 was a sensitive and specific diagnosis marker in CLL and B?CLPD subtype.

Objective To analyze the short?term clinical efficacy and influencing factors of ustekinumab monoclonal antibody （UST） in the treatment of Crohn's disease （CD）. Methods Retrospective cohort study was used to collect the clinical data of CD patients treated with UST in the 10th People's Hospital affiliated to Tongji University from December 2020 to October 2022. The main analysis is the short?term clinical efficacy and influencing factors of UST treatment for CD at weeks 8 and 16， And analyze the endoscopic response rate of some patients. Results A total of 91 CD patients who first used UST were included. The 8?week clinical response rate of UST treatment for CD was 61.5%， and the clinical response rate was 45%； The clinical response rate at 16 weeks was 71.4%， and the clinical response rate was 54.9%. 56 cases underwent endoscopic re?examination in our hospital， and the endoscopic response rate at 16 weeks was 41.1%. Univariate analysis showed that fistula （including anal fistula， personal history of anal fistula， and intestinal skin fistula） is associated with clinical remission in Crohn's disease patients at 8/16 weeks. Further multivariate COX regression analysis showed that the presence of a history of anal fistula surgery was an independent protective factor affecting clinical remission in CD patients treated with UST at 8 weeks （HR = 0.04，95% CI： 0.00 ~ 0.38； P = 0.005） and 16 weeks （HR = 0.04，95% CI： 0.01 ~ 0.34； P = 0.003） compared to those without fistula； Narrow lesions are an independent risk factor for 16 week clinical remission in CD patients compared to non?narrow and non?penetrating lesions （HR = 1.75， 95% CI： 1.08 ~ 2.84； P = 0.023）. No patients were found to have stopped medication due to serious adverse reactions. Conclusions UST can improve the clinical remission and response of CD patients at 8/16 weeks， and has good short?term clinical efficacy. CD patients with a personal history of anal fistula are recommended to use UST monoclonal antibodies， while patients with stenotic lesions should be cautious in using UST monoclonal antibodies. Whether the patient has undergone surgical treatment in the past， as well as whether UST has been used on the first or non?first line， has no significant impact on clinical remission.

Objective To investigate the effects of nalbuphine combined with dexmedetomidine on postoperative recovery quality and pain in patients who undergoing laparoscopic bariatric surgery. Methods A total of 169 patients who underwent laparoscopic bariatric surgery at our hospital were included and divided into control group （group C）， nalbuphine group （group N）， dexmedetomidine group （group D）， and nalbuphine combined with dexmedetomidine group （group ND） using randomised numerical table method. Group C received intravenous injection of saline， group N and group ND received intravenous injection of nalbuphine before the end of the surgery， and group D and group ND received pumping of dexmedetomidine before anesthesia induction and during surgery. Compare the postoperative recovery quality score （QoR?40）， hemodynamics at different time points， visual analogue scale score （VAS）， sedation?agitation scale （SAS）， first time out of bed activity and exhaust time， and incidence of nausea and vomiting among four groups. Results The postoperative QoR?40 scores of patients in group ND were better than those in group C and group N （P < 0.05）， and the QoR?40 scores in group D were better than those in group C （P < 0.05）. MAP and HR were more stable during the awakening period in group ND and group D （P < 0.05）. Compared with group C， patients in all three groups had lower VAS scores and SAS scores （P < 0.05） and consumed less remedial analgesic medication（P < 0.05）. In terms of adverse reactions， the incidence of postoperative nausea， vomiting and coughing in the group ND was lower than that in the group C （P < 0.05）. Conclusion The combination of nalbuphine and dexmedetomidine could improve the quality of postoperative recovery and pain in patients undergoing laparoscopic bariatric surgery， reduce hemodynamic fluctuations during the patients′ recovery period， reduce the incidence of nausea and vomiting， and improve the patients′ prognosis.

Objective The study aimed to compare the diagnostic efficacy of QuantiFERON?TB Gold （QFT?TB） detection of specific cellular immune IGRAs in tuberculosis diagnostic laboratory for pulmonary tuberculosis， extrapulmonary tuberculosis and special population samples in vitro， which may provide evidence for clinical diagnosis and treatment. Methods A total of 546 patients with tuberculosis （AFB + 146 cases， AFB?247 cases）， 117 patients with molecular biology positive tuberculosis （Xpert 69 cases， TB?DNA 48 cases） and 36 patients with histopathological positive were collected from January to July 2023. There were 72 cases of extrapulmonary tuberculosis， 276 cases of pleural effusion and 25 cases of ascites. QFT?TB method was used for detection， chi?square test was applied for comparison between groups， and the methodological evaluation of positive rate and coincidence rate were all compared. Results The positive rates of QFT?TB in pulmonary tuberculosis， extrapulmonary tuberculosis and close contacts were 83.69 %， 69.44 %， and 32.41 %， respectively. The coincidence rates of QFT?TB in AFB +， GeneXpert， TB?DNA and pathological confirmed tuberculosis patients were 91.09%， 88.40%， 81.25%， and 72.22%， respectively. The positive rate of pleural effusion in patients with tuberculous pleurisy was 60.50 %， and the uncertainty rate was 29.71%. The positive rate of ascites was 44.00 % and the uncertainty was 36.00%. Conclusion QFT?TB test has good value in the auxiliary diagnosis of pulmonary tuberculosis， and has certain reference significance for the diagnosis of extrapulmonary tuberculosis based on the detection of pleural fluids and ascites.

Objective To investigate the application value of single nucleotide polymorphism （SNP） linkage analysis based on next-generation sequencing （NGS） technology in preimplantation genetic testing （PGT） of families with autosomal recessive polycystic kidney disease （ARPKD）. Methods A family with ARPKD was selected， where the female member had a pregnancy ultrasound revealing polycystic kidney in the fetus. Genetic testing showed compound heterozygous mutations of the polycystic kidney/polycystic liver disease 1 gene （PKHD1）， c.10444C > T （paternal） and c.4303del （maternal）， with the c.4303del mutation being reported for the first time. Targeting the coding region of the PKHD1 gene， 335 high-density tightly linked SNP sites were selected in the upstream and downstream 2M regions using multiplex polymerase chain reaction （PCR） and NGS. The couple's SNP risk haplotypes carrying gene mutations were constructed. After in vitro fertilization， blastocyst culture was performed. Trophoblastic cells obtained from the biopsy were subjected to whole-genome amplification， and NGS was used for linkage analysis and low-depth chromosomal aneuploidy screening of the embryos. Sanger sequencing was used to verify the results of embryo linkage analysis. Results Among the 6 biopsied embryos， 4 were mutation-free and euploid， 1 exhibited heterozygous for the mutation and mosaic while another unstable sequencing data， making it impossible to judge. One of the mutation-free and developmentally healthy euploid embryos was implanted into the maternal uterus， resulting in the full-term delivery of a healthy baby. Conclusion Application of NGS-based SNP linkage analysis in PGT can effectively blocking the vertical transmission of ARPKD within families， while avoiding abortion issues caused by aneuploid embryos. This study is also the first PGT report targeting the PKHD1 gene c.4303del mutation.

Objective To analyze the values of renal resistance index （RRI）， cystatin C （CysC）， blood β2?microglobulin （β2?MG） and urinary N?acetyl?β?glucosamine glycosidase （NAG） in early prediction of contrast?induced acute kidney injury （CI?AKI）. Methods A retrospective cohort analysis on 207 postoperative patients after intervention therapy was conducted. The patients were divided into AKI group （18 patients） and non?AKI group （189 patients） based on whether CI?AKI occurred. General and clinical data were collected and compared. According to the time of diagnosis of AKI （D0 on the day of surgery or D1 on the first day after surgery）， the AKI group was divided into AKI （D0） group and AKI （D1） group. Indicators RRI， CysC， and blood β2?MG， serum creatinine （sCr）， and urinary NAG were compared between the two groups. The risk factors of CI?AKI were explored using logistic regression and linear regression. Results In the AKI group， males， preoperative sCr， acute physiological and chronic health （APACHⅡ） score and sequential organ failure （SOFA） score， surgical duratrion， sCr， CysC， blood β2?MG， urinary NAG on the day of surgery and the first day after surgery， and RRI were higher than those in the non?AKI group； Higher APACHEⅡ and SOFA scores and higher CysC level on D1 were independent risk factors for the occurrence of CI?AKI （P < 0.05）. Levels of CysC and urinay NAG on D0 were higher in the AKI （D0） group than in the AKI （D1） group （P < 0.05）. RRI， urinary NAG and blood β2?MG were not independent risk factors for CI?AKI. Conclusions CysC and urinary NAG are powerful predictors for the prediction of CI?AKI， and RRI and blood β2?MG cannot predict the occurrence of CI?AKI early.

Objective To investigate the effects of perineal massage combined with hip joint exercise on the outcome of delivery and mental resilience of primipara. Methods 90 pregnant women in the third trimester （after 36 weeks） who obtained the knowledge about perineal massage from midwife clinic were randomly divided into two groups with 45 cases each. The control group received regular antenatal examination and family self-exercise； the experimental group received perineal massage and hip joint training combined treatment. The delivery outcome，birth experience and maternal mental resilience of the two groups were compared. Results the number of vaginal delivery in the experimental group were higher than that in the control group （P < 0.05）； the second stage of labor was significantly shorter than that of the control group （P < 0.05）； the perineal integrity rate was higher than that of the control group （P < 0.05）； the scores of all dimensions in delivery experience questionnaire were higher than that of the control group （P < 0.05）； the scores of all dimensions in maternal mental resilience were higher than those of the control group （P < 0.05） after intervention. Conclusion The perineal massage which conducted by midwives combined with hip movement can effectively improve the quality of delivery，relieve the negative emotions of pregnant women，improve the psychological elasticity level of pregnant women，and improve the delivery outcomes.

Post-stroke cognitive impairment （PSCI），refers to a range of clinical syndromes of cognitive impairment caused by stroke. Although its specific pathogenesis is still unclear，many studies have confirmed that endoplasmic reticulum-mitochondria interaction has become a key hub for intracellular signal transduction and substance metabolism， and its regulation of various biological processes，such as Ca²⁺ balance，lipid metabolism，mitochondrial dynamics，autophagy， and neuroinflammation，is closely related to the development of PSCI. Therefore，in this paper，we will review the various functions of endoplasmic reticulum-mitochondrial interactions and explore their specific roles in PSCI，in order to discover new therapeutic targets and provide new theoretical basis and references for the development of PSCI-targeted drugs in the future.