Objective To understand the cognitive influencing factors affecting the use of epinephrine by medical staff for the treatment of serve allergic reactions and the current state of research at home and abroad. Methods Using searching terms such as “adrenaline” “anaphylactic shock”“severe anaphylactic reaction”“allergic reaction”“epinephine”“anaphylaxis”in Chinese and English. Literature review was performed from China National Knowledge Infrastructure （CNKI）， Wanfang Data， Chongqing VIP Database， PubMed， Web of Science. The retrieval time is from the inception of the databases to July 20， 2024. Literature contents were extracted and analyzed. Results A total of nine articles were retrieved， and eight international studies showed that there were differences in the correct use of adrenaline in patients with severe allergic reactions among medical staff of different professions， levels of hospitals， ages， and years of service. Through targeted training and education， the correct use rate of adrenaline by medical staff in the treatment of severe allergic reactions could be significantly improved. Only one Chinese study suggested that clinicians and nurses had severe cognitive deficiencies in the proper use of adrenaline. Conclusion Medical staff have varying degrees of cognitive insufficiency of correct use of adrenaline for the treatment of severe allergic reactions， which is influenced by multiple factors.

Objective To evaluate clinical efficacy of the combination of Vonoprazan and high-dose Amoxicillin in the initial eradication treatment of Helicobacter pylori （Hp）. Methods Select 200 patients with Hp infection who have not undergone Hp eradication treatment in the past as the research subjects. All patients were randomly divided into the observation group （n = 100） and control group （n = 100） using random number table method. In the observation group， a combination regimen of Vonoprazan （20 mg twice a day） and Amoxicillin （1 g three times a day） was given for 14 days. In the control group， a bismuth quadruple therapy was delivered for 14 days， which included Esomeprazole （20 mg twice a day）， Bismuth Potassium Citrate （220 mg twice a day）， Amoxicillin （1 g twice a day） and Clarithromycin （0.5 g twice a day）. The Hp eradication rate and incidence of adverse reactions after medication were compared between two groups. Results Of 200 patients， 11 patients were excluded from subsequent analysis， including 8 cases lost to follow-up and 3 cases with poor compliance of medication. The remaining 189 patients （96 in the observation group and 93 in the control group） completed the entire procedure. According to intention-to-treat （ITT） and per-protocol （PP） set analyses， the Hp eradication rate in the observation group was significantly higher than that in the control group （91.0% vs. 79.0%， P_ITT =0.017； 94.8% vs. 84.9%， P_PP= 0.024）. The incidence of adverse reactions did not significantly differ between two groups （4% vs. 5%，χ ² < 0.001，P > 0.999）. Conclusion The combination therapy of Vonoprazan and high-dose Amoxicillin is an efficacious and safe therapeutic option for patients with initial Hp infection， which is worthy of promotion in grassroot-level hospitals.

Cervical tumors may occur in a variety of benign and malignant tumors. It is difficult to make a correct diagnosis in the absence of other systemic symptoms and pathological biopsy， which is likely to delay the optimal treatment opportunity. Patients diagnosed with esophageal cancer presenting with extensive cervical lymph node metastasis accompanied by pain as the initial symptom have been rarely reported in clinical practice. In the present study， a case of esophageal cancer presenting with extensive cervical lymph node metastasis as the initial manifestation was reported. The patient received multi-line treatment. Despite repeated disease progression， the patient obtained 33-month survival. In this article，clinical manifestations， diagnosis and treatment process and prognosis of this patient were reported， aiming to deepen the understanding of lymph node metastasis of esophageal cancer， improve the first visit rate， deliver early treatment， thereby obtain higher quality of life and longer survival.

Objective To investigate the risk factors of acute kidney injury （AKI） in patients with severe acute pancreatitis （SAP）. Methods Clinical data of 66 patients with SAP were collected in this retrospective study. All patients were divided into the AKI and non-AKI groups according to whether they were complicated with AKI. The risk factors of AKI in patients with SAP were identified by using Logistic regression analysis and receiver operating characteristic （ROC） curve. Results The overall age and Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱscore of SAP patients complicated with AKI were higher than those without AKI， but diabetes mellitus was more common in non-AKI patients （all P < 0.05）. Patients in the AKI group had higher levels of hypersensitive C-reactive protein （CRP）， systemic inflammatory response index （SIRI）， creatinine （Scr）， CRP/Albumin （Alb） index and D-dimer （DDI） upon admission， whereas had lower fasting triglyceride and glucose simple index （TyG）， Alb， total cholesterol， high density lipoprotein cholesterol （HDL-C） and blood calcium levels compared with their counterparts without AKI， and the differences were statistically significant （all P < 0.05）. Stepwise regression analysis showed that increased APACHEⅡ score， increased SIRI index， increased PLR index， decreased SII index and decreased blood calcium were the independent risk factors for SAP patients complicated with AKI （all P < 0.05）. ROC curve results showed that in addition to Scr， APACHEⅡ score， SIRI index and blood calcium had certain diagnostic value in SAP patients complicated with AKI， among which the area under the ROC curve （AUC） of APACHEⅡ score was 0.880 （95% CI 0.787-0.974， optimal cutoff value 11.50）， 0.662 （95% CI 0.521-0.804， optimal cutoff value 10.89） for SIRI index， and 0.754 （95% CI 0.627-0.881， optimal cutoff value 2.07 mmol/L） for blood calcium level （all P < 0.05）. The combination of the above three indexes with Scr could further improve the diagnostic value for AKI in SAP patients， among which the AUC of Scr + blood calcium was the largest， reaching 0.969 （95% CI 0.929-1.000， P < 0.05）. Conclusions APACHEⅡ score， SIRI index， PLR index， SII index and blood calcium level are the independent risk factors of AKI in SAP patients. APACHEⅡ score， SIRI index and blood calcium have diagnostic value in SAP patients complicated with AKI. The combination of these three indexes with Scr can significantly improve the diagnostic efficiency for AKI， providing a novel diagnostic approach for AKI in SAP patients.

H-type hypertension is accompanied by elevated homocysteine （Hcy） （≥10 μmol/L） in the blood， which synergistically increases the risk of cardiovascular diseases with hypertension， especially stroke. Approximately 75% of hypertensive patients in China are H-type， which is closely associated with the characteristics of Chinese population. Early screening and diagnosis of H-type hypertension and accurate prevention and treatment are of significance. Folic acid supplementation based on blood pressure reduction can effectively reduce the risk of stroke in hypertensive patients. The effects of folic acid supplementation on stroke prevention vary among different populations. Screening patients with a higher cost-benefit ratio can significantly improve prevention and treatment efficiency. With the proposal of H-type hypertension concept， more and more related studies have been conducted， which provides valuable clues for elucidating relevant mechanisms. It is necessary to carry out further in-depth research to expand and supplement related theories of H-type hypertension.

Mycoplasma pneumoniae pneumonia （MPP） is a common cause of community-acquired pneumonia in children aged 5 and older in China. Although most affected children have favorable clinical prognosis， some cases can escalate into severe MPP due to risk factors such as pathogen resistance or co-infections， etc. These severe cases significantly jeopardize the lives of children and may lead to diverse long-term sequelae. In response to this challenge， the Children’s Medical Center of the Third Affiliated Hospital of Sun Yat-sen University， integrating current guidelines， expert consensus， and its extensive clinical experience， has devised the “412” cluster treatment strategy. This comprehensive approach encompasses treatments for anti-infection， anti-inflammatory storm， anticoagulation and antioxidant stress. Additionally， it seamlessly integrates traditional Chinese medicine with western therapies， featuring bundled respiratory management and follow-up care. This strategy provides a valuable reference for the diagnosis and treatment of severe MPP in children.

Objective To analyze the factors influencing poor recovery of renal function in patients with severe unilateral hydronephrosis after relief of obstruction， providing evidence for predicting the recovery of renal function. Methods Clinical data of 55 patients with severe unilateral hydronephrosis and glomerular filtration rate （GFR） < 10 mL/min admitted to Tungwah Hospital from 2015 to 2022 were retrospectively analyzed. All patients underwent percutaneous nephrostomy for temporary relief of the obstruction. Based on the recovery of renal function， all patients were divided into the recovery group and non-recovery group， and the factors influencing renal function recovery after nephrostomy were collected and analyzed. Results Among 55 patients treated with percutaneous nephrostomy for severe hydronephrosis， renal function was recovered in 30 cases （54.5%）， and poor recovery in 25 cases （45.5%）. Univariate analysis showed no significant differences in terms of gender， side， body mass index （BMI）， history of diabetes mellitus， history of hypertension， pre-nephrostomy GFR， and urinary pH of the affected kidney between the recovery and non-recovery groups （all P > 0.05）. However， there were significant differences in age， renal parenchymal thickness， ratio of GFR of the affected kidney to total GFR， presence of renal infection， and post-nephrostomy urinary output of the affected kidney between two groups （all P < 0.05）. Further multivariate logistic regression analysis showed that a pre-nephrostomy ratio of GFR of the affected kidney to total GFR （OR=0.24， 95%CI 0.06-0.98） and a post-nephrostomy urinary output of the affected kidney （OR=0.04， 95%CI 0.01-0.25） were the independent influencing factors of poor recovery of renal function after nephrostomy. Conclusions Partial patients with severe unilateral hydronephrosis and a GFR <10 mL/min can obtain renal function recovery after temporary relief of obstruction via percutaneous nephrostomy. The pre-nephrostomy ratio of GFR of the affected kidney to total GFR <10% and post-nephrostomy urinary output of the affected kidney <400 mL/day are the independent influencing factors for poor recovery of renal function， which can guide clinicians in predicting renal outcome.

Objective To identify hub genes associated with ferroptosis in the progression of diabetic nephropathy （DN） through bioinformatics analysis， offering novel insights into DN treatment. Methods Differentially expressed genes （DEGs） in DN were screened using RNA sequencing dataset GSE142025， and Gene Ontology （GO） and Gene Set Enrichment Analysis （GSEA） were utilized for functional annotation. Subsequently， the Weighted Gene Co-expression Network Analysis （WGCNA）was conducted to pinpoint key genes. Venn diagrams aided in identifying hub genes among ferroptosis-related genes （FRGs） common to DEGs and key genes. ROC curves were employed to assess the clinical diagnostic potential of these hub genes. Immunohistochemistry （IHC）was conducted to detect the expression levels of hub genes in DN patients and normal kidney tissues. Results 1 916 DEGs were identified between the DN and control （NC） groups. GO enrichment analysis revealed that DEGs were mainly involved in inflammation-related biological processes. GSEA analysis found significant enrichment in processes related to iron ion binding. Among 12 co-expression modules constructed by WGCNA， grey60， turquoise， and grey modules showed the highest correlation with DN. 188 key genes were selected from 3 modules based on the screening criteria， among which 2 were FRGs shared by DEGs， namely ceruloplasmin （CP） gene and lipocalin-2 （LCN2） gene. ROC curves confirmed high clinical diagnostic value of these two genes. IHC results showed upregulated expression of both two genes in DN patient samples （both P < 0.05）， consistent with the findings of bioinformatics analysis. Conclusion CP and LCN2 could be involved in the progression of DN by inhibiting ferroptosis， serving as promising biomarkers and treatment targets for DN.

Pancreatic cancer is a highly malignant tumor of the digestive tract， and its precision diagnosis and treatment is a major challenge in clinical practice. With the development of science and technology， artificial intelligence has been applied in the early diagnosis， treatment and prognosis prediction of some diseases， which has high clinical value. Medical imaging is a disciplie to evaluate human health， which consists of two relatively independent directions of medical imaging system and medical image processing. Artificial intelligence based on medical imaging plays an important role in the clinical diagnosis and treatment of pancreatic cancer. In this article， research progress in the application of artificial intelligence in precision diagnosis and treatment of pancreatic cancer was reviewed from the aspects of imaging diagnosis， efficacy evaluation， survival prediction and radiogenomics， etc.

Objective To investigate whether nitrazepam can increase the accuracy of RigiScan measurement of nocturnal penile tumescence and rigidity （NPTR） by improving the sleep quality of patients. Methods All participants received NPTR measurement for two consecutive nights. In Trial 1， 125 normal volunteers were randomly assigned into the control group （n = 68） and experimental group （n = 57）. They took either a placebo or 10 mg of nitrazepam before NPTR testing on the second night to observe the effect of nitrazepam on nocturnal penile erections in the normal population. In Trial 2， 128 patients with erectile dysfunction were randomly assigned into the control group （n = 64） and experimental group （n = 64）. They took either a placebo or 10 mg of nitrazepam before NPTR testing to observe the effect of nitrazepam on NPTR detection parameters including effective erection times （EEE）， total erection duration （TED）， erection duration with erection rigidity≥60% （D60）， average erection rigidity （AER）， average erection tumescence circumference （AET）， rigidity activity unit （RAU） and tumescence activity unit （TAU） at the tip and base of the penis and the normal erection rates. Results In Trial 1， there were no statistically significant differences in NPTR parameters and normal rates between two groups on the second night （all P > 0.05）. The Richards-Campbell Sleep Questionnaire （RCSQ） score in the experimental group was higher than that in the control group （P < 0.001）. In Trial 2， NPTR parameters （D60_tip， D60_base， AER_base， RAU_tip， TAU_tip） on the first night were lower compared to those on the second night in the control group （all P < 0.05）， and there were no significant differences in normal erection rates （67.2% vs. 78.1%， P = 0.065）. Except for AET_tip （7.85（6.83，8.98） cm vs. 8.10（7.50，8.90） cm， P = 0.014）， there were no statistically significant differences in NPTR parameters and normal erection rates between two nights in the experimental group （all P > 0.05）. In comparison between two groups， the parameters on the first night （EEE， D60_tip， RAU_tip and TAU_tip）and those on the second night （EEE， D60_tip， D60_base， TED， RAU_tip， RAU_base， TAU_tip and TAU_base） in the experimental group were lower than those in the control group （all P < 0.05）. No significant difference was observed in the normal erection rates on the first night between two groups （67.2% vs. 65.6%， P = 0.852）， and the normal erection rate on the second night in the experimental group was lower than that in the control group （78.1% vs. 57.8%， P = 0.014）. In the experimental group， the RCSQ scores on two nights were higher compared to those in the control group， and the RCSQ scores on the first night were lower than those on the second night in both groups （both P < 0.05）. Conclusions NPTR measurement yields the first night effect. Nitrazepam can significantly inhibit the nocturnal penile erection. Improving sleep quality cannot eliminate the first night effect， whereas increase the false negative rate of NPTR measurement. Nitrazepam should be avoided in the NPTR measurement for patients with normal sleep， whereas it can be given for patients with sleep disorders or sleep difficulty after full consideration of the advantages and disadvantages.

Osteoporosis （OP） is a bone disease characterized by systemic bone loss and destruction of bone microstructure. The fundamental cause is the imbalance between bone formation and bone resorption mediated by osteoblasts and osteoclasts，and bone resorption is greater than bone formation. Autophagy plays an important role in the occurrence and development of osteoporosis，and the change of autophagy level is a key factor affecting bone balance. Studies have confirmed that autophagy-related molecules of Beclin-1 and P62 directly regulate the formation of autophagosomes at different levels，thus affecting the occurrence and development of OP. In this article，the expression mechanism，functional characteristics and targeted therapy of Beclin-1 and P62 in OP were reviewed，aiming to provide a theoretical basis for the prevention，treatment and subsequent research of OP.

Objective To evaluate the rehabilitation effect of innovative mirror therapy （MT） on the upper limb function and daily living activity ability of stroke patients. Methods Sixty patients with impaired hand function after stroke were enrolled and divided into the intervention （n = 30） and control groups （n = 30） according to the random number table method. Patients in the intervention group received conventional rehabilitation training combined with innovative MT， and those in the control group received conventional rehabilitation training and conventional MT. Before treatment and 4 weeks after treatment， the Fugl-Meyer Assessment Scale for the upper limb （FMA-UE）， the Fugl-Meyer Assessment Scale for the wrist and fingers （FMA-WH）， and the modified Barthel Index （MBI） were evaluated to compare the rehabilitation effects between two groups. Results After 4 weeks of treatment， the FMA-UE， FMA-WH， and MBI scores of patients in two groups were higher than those before treatment （all P < 0.05）. The FMA-UE， FMA-WH， and MBI scores in the intervention group were higher than those in the control group （50.00 （25.75， 57.25） vs.24.00 （9.75， 51.50）， 12.00（1.75， 14.75） vs. 0（0， 12.50）， 24.50（13.00， 28.75） vs.13.00（4.75， 21.00）， all P < 0.05）. The differences before and after treatment of FMA-UE， FMA-WH and MBI scores in the intervention group were all higher than those in the control group （all P < 0.05）. Conclusion Compared with traditional MT， innovative MT yields higher efficacy in improving the upper limb function and enhancing daily living capability of patients with impaired hand function after stroke.

Objective To investigate the key issues of clinical diagnosis and treatment of Zinner syndrome and reduce the misdiagnosis rate. Methods Clinical data of 1 case of Zinner syndrome were retrospectively analyzed. Zinner syndrome cases presenting hematuria， frequent urination and dysuria as initial manifestations were retrieved from PubMed， CNKI， Wanfang Data and Chongqing VIP until November 2022 by using the searching words of Zinner syndrome， renal agenesis and seminal vesicle cyst. Clinical characteristics， developmental characteristics and treatment methods were summarized. Results The 46-year-old male patient was admitted to the hospital because of “bladder space-occupying lesion for more than 8 years， hematuria with dysuria for 1 week”， and was diagnosed with Zinner syndrome by imaging examination. He successfully underwent “transurethral cystoscopy + transrectal pelvic mass puncture biopsy”， and was discharged from the hospital at postoperative 2 d. The patient was advised to continually receive anti-infection treatment after discharge. According to literature review， 16 cases of Zinner syndrome presenting with hematuria， dysuria and other urinary symptoms as the first manifestations were collected. All patients developed abnormalities in the urinary system by imaging examination. Surgical resection and puncture biopsy were the main treatment methods. Among 8 patients receiving follow-up， 7 cases did not recur， and 1 suspected recurrent case underwent puncture biopsy. Conclusions Zinner syndrome is mainly manifested with imaging characteristics of unilateral seminal vesicle cyst， ipsilateral renal agenesis and ipsilateral ejaculatory duct obstruction triad. Ultrasound， CT scan， and MRI are important diagnostic tools for Zinner syndrome. Laparoscopic seminal vesicle cystectomy can reduce the risk of recurrence.

Objective To analyze the albuminocytologic dissociation in cerebrospinal fluid （CSF） and differences in CSF protein levels in Guillain-Barré syndrome （GBS）patients with various types of antecedent infections and investigate the correlation between antecedent infections and increased CSF protein levels in GBS patients. Methods Clinical data and CSF analysis results of 198 GBS patients were collected. Enzyme-linked immunosorbent assay （ELISA） was employed to detect 14 types of infectious pathogens in the serum of GBS patients. The proportion of albuminocytologic dissociation and the differences in CSF protein levels were analyzed in GBS patients with different antecedent infections. Results In total，55.1% （109/198） of GBS patients had serological positivity for infectious pathogens，23.7% （47/198） for Campylobacter jejuni，20.7% （41/198） for Influenza A virus，15.2% （30/198） for Influenza B virus. Among them，18.7% （37/198） of GBS patients had serological positivity for two or more pathogens. In total，73.7% （146/198） of GBS patients had albuminocytologic dissociation in CSF. Among single pathogen-positive patients，83.3% （25/30） of Campylobacter jejuni positive patients showed albuminocytologic dissociation in CSF，100% （18/18） of Influenza A virus patients，6/7 of influenza B virus patients，4/5 of Hepatitis A virus patients，4/5 of Dengue virus patients，4/4 of Mycoplasma pneumoniae patients，1/1 of Epstein-Barr virus patients，1/1 of herpes simplex virus patients，and 1/1 of Varicella-zoster virus patients had albuminocytologic dissociation in CSF. Among patients infected with two or more pathogens，62.2% （23/37） showed albuminocytologic dissociation in CSF，while 66.3% （59/89） of GSB patients without antecedent infection had albuminocytologic dissociation in CSF. The positive rates of albuminocytologic dissociation in CSF exhibited significant differences among patients without and with various types of antecedent infections （P = 0.007），whereas no significant difference was noted in CSF protein levels （P > 0.05）. Conclusion The albuminocytologic dissociation in CSF of GBS patients is correlated with the type of antecedent infection. The highest proportion of albuminocytologic dissociation in CSF is observed in patients with Influenza A virus infections.

Low triiodothyronine syndrome （LT₃S） refers to the abnormal metabolism of thyroid hormones associated with critical illness， but without obvious symptoms of hypothyroidism. LT₃S is closely associated with many critical diseases， such as severe burns， etc. During the occurrence and development of critical illness， many factors can induce LT₃S by affecting the secretion， transfer and metabolism of thyroid hormones. LT₃S is a risk factor for the development of critical illness and the occurrence of complications. It is a good indicator for evaluating the severity and prognosis of critical diseases. In this article， the pathogenesis， relationship with critical illness and treatment progress of LT₃S were reviewed.

Hypertension is a serious public health problem worldwide and a major risk factor for cardiovascular disease. Hypertensive patients are constantly complicated with cardiovascular disease. Effective blood pressure control could improve clinical prognosis of these patients. In June 2023， 2023 ESH Guidelines for the management of arterial hypertension were released with updated recommendations for the timing of starting antihypertensive therapy. For patients with normal high-value blood pressure with prior cardiovascular disease， the guidelines recommend initiating antihypertensive therapy from 130/80 mmHg. The 2023 edition of the Chinese Guidelines for the Prevention and Control of Hypertension also recommends that the target blood pressure for those with high and very high cardiovascular risk can be further reduced to less than 130/80 mmHg. This suggests that greater clinical benefit can be achieved from intensive blood pressure control in hypertensive patients with comorbid cardiovascular disease. In recent years， multiple studies have shown the advantages of intensive blood pressure management in hypertensive patients. In this article， the progress in clinical studies related to intensive blood pressure control in hypertensive populations complicated with different cardiovascular diseases was reviewed， aiming to provide insight and evidence for intensive antihypertensive treatment in these patients.

Isthmin-1 （ISM1） belongs to the Isthmin gene family. It is expressed in various tissues and has multiple biological functions. ISM1 is involved in growth and development， metabolism， immunity， tumorigenesis and other physiological and pathological processes， which is associated with a variety of lung diseases， including acute respiratory distress syndrome， chronic obstructive pulmonary disease and pulmonary fibrosis， etc. In this article， the structure， biological function of ISM1 and its role in pulmonary diseases were reviewed， aiming to provide a theoretical basis for the diagnosis and treatment of ISM1-related diseases.

Objective To evaluate the performance of prediction models for acute penetrating artery territory occlusive cerebral infarction based on machine learning algorithms and select the optimal model， aiming to provide evidence for clinical management of acute penetrating artery territory infarction. Methods A total of 441 patients diagnosed with acute perforator artery territory infarction were enrolled in this study. Patients with incomplete clinical information （n = 10） and multiple cerebral infarctions （n = 28） were excluded， resulting in a final sample size of 403 patients. The outcome variables were divided into two groups： good prognosis （mRS scores of 0-2） and poor prognosis （mRS scores>2）. Univariate and multi-variate Logistic regression （LR） using the stepwise regression method were employed to identify prediction variables. LR， random forest （RF） and support vector machine （SVM） models were utilized to develop a prognostic prediction model. The dataset was further divided randomly into a training set and a test set in a 7：3 ratio. In the test set， the predictive performance of the model for 90-day functional prognosis in patients with BAD （with poor prognosis defined as mRS scores > 2） was evaluated using metric such as the area under the receiver operating characteristic （ROC） curve （AUC）， accuracy， sensitivity and specificity， etc. Results Among 403 patients with BAD， 68.73% of them were male， with an average age of （60.4±11.4） years. Using the stepwise regression method， 7 prediction variables were selected from a pool of 44 variables： white blood cell count， platelet count， blood glucose， cholesterol， history of diabetes mellitus， history of taking hypoglycemic drugs， and history of smoking （all P < 0.05）. The AUC of LR， RF and SVN for predicting clinical prognosis was 0.610， 0.690， and 0.780， respectively. Conclusions Machine learning algorithms have demonstrated certain predictive ability for acute penetrating artery territory infarction. The performance of RF and SVM models （nonlinear models） is superior to traditional logistic regression model （linear model）.

Objective To evaluate the effect and safety of carbomer gel on reducing urinary retention of primiparous women after natural vaginal delivery. Methods Clinical data of 139 women with natural vaginal delivery were collected. Among them，68 cases who voluntarily participated in carbomer gel test were assigned in the study group，and 71 counterparts without use of carbomer gel were allocated in the observation group. In the study group，carbomer gel was applied on the birth canal in vaginal examination from the opening of cervix at 1.0-3.0 cm to the delivery of newborns. Baseline data，labor process，number of catheterization during labor，intrapartum fever，perineal injury，incidence of urinary retention from postpartum to discharge and Apgar score of the newborns were compared between two groups. Results Compared with the control group，the latency and active periods of the first stage of labor in the study group were prolonged，the number of catheterization during labor was less，the incidence of intrapartum fever was lower，and the perineal injury was slighter（all P < 0.05）. The incidence of urinary retention in the study group was 7.35%，significantly lower than 20% in the control group（P < 0.05）. No neonatal asphyxia occurred in two groups. There were no significant differences in Apgar score at 1 minute and 5 minutes after birth（both P > 0.05）. Conclusion Application of carbomer gel in the birth canal can lubricate the birth canal，increase the ductility of soft birth canal，promote fetal head descent，protect the perineum，shorten the first stage of labor，reduce the incidence of urinary retention，and cause no adverse effects on newborns.

Obesity， as a global health issue， presents significant challenges in its treatment and management， particularly the phenomenon of weight regain. This not only undermines the effectiveness of weight loss efforts but may also have further impacts on the physical and mental health of patients. This article delves into the issue of weight regain during the treatment of obesity， analyzing its definition， prevalence， and health implications. It elucidates the biological mechanisms of weight regain from aspects such as the body weight set-point theory， metabolic adaptation， immune cell phenotypic changes， lipid metabolism， and appetite regulation. A comprehensive management strategy is proposed， including lifestyle adjustments， continuous pharmacological treatment， surgical intervention， and multidisciplinary collaboration， aiming to achieve long-term weight control in obese patients. The study emphasizes the continuity and individualization of weight management， providing scientific guidance for clinical practice.

The incidence of allergic diseases is gradually increasing， and multi-system allergic diseases often co-occur in the same patient. It is very important to conduct comprehensive diagnosis and treatment with high quality， high efficiency， reasonable and standardized. The multi-disciplinary diagnosis and treatment provides a new way to solve the complicated and difficult comorbidities of allergic comorbidity and multimorbidity， which is an effective supplement to the traditional diagnosis and treatment mode， and is also the development trend of the diagnosis and treatment of allergic diseases. At present， the multi-disciplinary treatment of allergic comorbidity and multimorbidity is still in the exploratory stage at home and abroad， and has not yet formed a mature system or a operation mode. Based on the clinical exploration and practical experience of allergic disease expert team of the Third Affiliated Hospital of Sun Yat-sen University， this paper expounds the construction and implementation of the multi-disciplinary treatment system for allergic comorbidity and multimorbidity from the aspects of implementation objectives， organizational structure， basic requirements， operation mode， procedure， system guarantee， quality control and so on. Establishing a standardized， mature and perfect multi-disciplinary treatment system for allergic comorbidity and multimorbidity and ensuring its effective operation and implementation will help to improve the level of multi-disciplinary diagnosis and treatment for allergic comorbidity and multimorbidity.

Condyloma latum is a typical lesion of secondary syphilis，which usually appears in the vicinity of the initial chancre. It is found that treponema pallidum load in condyloma latum is significantly higher than that in other secondary syphilis. We report a case of mesosyphilis presented as giant flat condyloma latum in vulvar and perianal areas. A 17-year female patient came to our clinic，complaining of plaques in vulvar and perianal areas more than 2 months. Physical examination showed giant red moist plaques in vulvar and perianal areas. The titer of non-specific antibody for syphilis was 1∶64 and the specific antibody test for syphilis showed a value of 189.000 COI. The patient was diagnosed as secondary syphilis and treate with benzathine penicillin. The rash subsided after 3-week treatment. This case of condyloma latum with giant red plaques was easily misdiagnosed as condyloma acuminatum.

Bronchial asthma is a common chronic inflammatory disease of the lung， which can cause great health problems and socioeconomic burden. In recent decades， the prevalence of asthma in China has been increasing， and multiple factors have synergistically affected the progress of asthma. More and more studies have found that lipid metabolism disorders play an important role in the development of asthma. High density lipoprotein （HDL） has the functions of reverse cholesterol transport （RCT）， regulation of inflammation and anti-oxidation， and is also involved in the regulation of the immune system and lipid metabolism. Previous studies have shown that serum HDL is associated with the occurrence of asthma. The level of HDL in patients with severe asthma and acute exacerbation of asthma is low.

Tic disorder is a common neurodevelopmental disorder disease in children， with a high prevalence and different clinical manifestations among individuals. It is frequently complicated with other neuropsychiatric diseases， which brings significant burden to psychological and physical health of patients. At present， the etiology of tic disorder remains unclear， which is probably associated with genetic， immune， environmental and psychological factors， etc. The pathological mechanism involves cortico-striatum-thalamic-cortical pathway disorders and neurotransmitter abnormalities. Iron has an extremely important biological function in the developmental process of nervous system. Studies have found that iron deficiency may lead to brain development disorder and dopaminergic dysfunction， thereby causing the incidence and progression of tic disorder. Improving the nutritional status of iron through iron supplementation may become a new idea for the prevention and treatment of children with tic disorder.

Encapsulating peritoneal sclerosis（EPS）is a rare and serious complication in patients with long-term peritoneal dialysis and a history of recurrent and severe peritoneal dialysis-associated peritonitis（PDAP）. Early diagnosis of EPS is difficult，clinical prognosis is poor，and the fatality rate is high. The pathogenesis of EPS is still not fully understood，and ideal prevention and treatment regimens are still lacking. Tamoxifen，a selective estrogen receptor modulator，is currently used in the treatment of breast cancer，ovarian cancer and some diseases characterized by fibrotic lesions. Studies have shown that tamoxifen can also be used to treat EPS. In this article，research progress in EPS and tamoxifen in the treatment of EPS was systematically reviewed.

Cytokines are small molecular proteins released by activated immune cells or non-immune cells. Cytokines can play a wide range of biological roles in immune regulation and the incidence and progression of immune diseases by selectively binding with specific signals and activating the downstream immune signal transduction pathway. Encouraging efficacy has been achieved in the application of antibody-based cytokines or cytokine receptor monoclonal antibodies in the treatment of related immune diseases. Nevertheless， the high cost of administration based on monoclonal antibodies makes it unaffordable for patients. Aptamers， also known as chemical antibodies， are oligonucleotide fragments synthesized in vitro and obtained by artificial screening， which can specifically bind to multiple target molecules with high affinity. Compared with antibodies， aptamers have the advantages of low cost， low immunogenicity and convenient modification. Hence， the potential application prospect of functionalized aptamers in targeted therapy of immune diseases has attracted more and more attention from researchers. In this article， chemical modification of specific aptamers related to 8 types of cytokine aptamers （IL-1α， IL-6， IL-17， TNF-α， TGF-β， IFN-γ， MCP-1 and IP-10） which play critical roles in immune regulation was reviewed， the research progress in their application in the treatment for immune and immune-related diseases was summarized， and the potential application of aptamer drugs in precise targeted therapy for specific immune diseases was briefly predicted.

Objective To investigate the median effective dose （ED₅₀） of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine under opioid-free anesthesia （OFA）. Methods Adult patients aged 18-59 years with body mass index （BMI）<30 kg/m² and ASA grade Ⅰ or Ⅱ were selected for endotracheal intubation general anesthesia. Dixon sequential method was adopted. The initial dose of esketamine was 0.5 mg/kg， and the dose of the next patient was determined according to the tracheal intubation response. The ratio of adjacent doses was 1:1.1. The ED₅₀ and 95% confidence interval （CI） of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA were calculated. Results A total of 29 patients were included for statistical analysis. Tracheal intubation reaction was positive in 15 cases （positive group） and negative in 14 cases （negative group）. In the positive group， 3 cases had cough reaction during tracheal intubation. The ED₅₀ of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA was 0.448 mg/kg， and the corresponding 95%CI was 0.421-0.476 mg/kg. Conclusion In the OFA of esketamine combined with dexmedetomidine and lidocaine， 0.448 mg/kg of esketamine results in 50% of the maximum response intensity for inhibiting tracheal intubation response.

The severe acute respiratory syndrome coronavirus 2 （SARS-CoV-2） is still spreading widely around the world， and it is estimated that there are more than 760 million confirmed cases of SARS-CoV-2 infection （COVID-19）. Although most of the infected patients can be cured， there are still many patients who experience persistent clinical symptoms such as dizziness， fatigue， weakness， coughing and chest pain， etc. at two to three months or even longer after being infected with SARS-CoV-2. Internationally， this type of discomforts is referred to as long COVID. The emergence of long COVID has brought a new crisis to people’s health， which not only affects the quality of life and work of patients， but also brings great pressure on the health care of the society. Continuously exploring the impact of long COVID and its underlying mechanism， developing health management strategies for long COVID， and better prevention and treatment of long COVID are still the focus of research worldwide. The article introduces the definition of long COVID and reviews recent research progress in its underlying mechanism， common systemic clinical manifestations， risk factors， and health management of long COVID， aiming to provide more ideas for deepening clinicians’ understanding of long COVID.

Ischemic stroke is a common acute cerebrovascular disease in clinical practice， which poses a severe threat to human health. In recent years， with deepening understanding of ischemic stroke， significant progress has been made in the diagnosis and treatment. However， current treatments for ischemic stroke are partially limited due to extremely complex pathological mechanisms. Studies have shown that mitochondrial dysfunction plays an important role in the pathogenesis of ischemic stroke. Therefore， modulation of mitochondrial function through mitochondrial dynamics is essential to ameliorate the damage of cerebral ischemic neuronal cells. In this article， the molecular mechanism of mitochondrial dynamics and its role in ischemic stroke were reviewed， aiming to provide useful reference for the treatment of ischemic stroke.

Adequate bowel preparation is a prerequisite for colonoscopy， and chronic constipation （CC） is one of the important influencing factors. In recent years， scholars have paid more and more attention to bowel preparation for CC. In this article， the selection of intestinal detergents before colonoscopy for CC was summarized according to literature review. The effectiveness and safety of each protocol were assessed to provide reference for clinical practice， improve the quality of bowel preparation for CC and deliver timely tertiary prevention for colorectal cancer.

Subdural abscesses are located between the dura mater and the subarachnoid space， which are primarily caused by Staphylococci and Streptococci， etc. Subdural abscesses caused by Salmonella Typhi are extremely rare. In this article， a patient with acquired immunodeficiency syndrome （AIDS） presented with a subdural abscess with fever and headache. Blood culture and next-generation sequencing （NGS） of cerebrospinal fluid were indicative of Salmonella Typhi infection. He was treated with sensitive antibiotics based on drug sensitivity testing combined with surgical drainage， and Salmonella Typhi was cultured in the drainage sample. During 4-month postoperative follow-up， relevant symptoms were mitigated and imaging examination results were normal. This case prompts that intracranial infection caused by Salmonella Typhi is extremely rare， which can occur in immunocompromised population. Blood culture， pus culture and NGS are of significant value in differential diagnosis of Salmonella Typhi infection. After the diagnosis is confirmed， sensitive antibiotics combined with surgical treatment can achieve high efficacy.

Gastroesophageal reflux disease （GERD） is a common recurrent disease and the treatment of GERD is challenging. Chronic heartburn and/or reflux symptoms seriously affect the quality of daily life of patients. Studies have shown that GERD is closely associated with the impairment of anti-reflux barrier of the esophagus，of which mucin （MUC） is the main component. The role of MUC in the pathogenesis of GERD and influencing factors were reviewed in this article.

Objective To evaluate the prognostic value of early blood inflammatory indicators in patients with respiratory failure caused by severe community-acquired pneumonia. Methods A total of 186 patients diagnosed with respiratory failure due to severe pneumonia on admission were recruited in this study. According to clinical prognosis， they were divided into the death group （n = 42） and improvement group （n = 144）. Twelve cytokines， ferritin， C-reactive protein， procalcitonin， blood routine examination and blood gas analysis results of the patients within two days after admission were analyzed. Pneumonia severity index （PSI） and APACHE Ⅱ scores of the patients were collected. The correlation between the above indicators and prognosis was explored. Results Compared with the improvement group， the levels of IFN-γ， IL-10， IL-6， IL-8， C-reactive protein （CRP）， procalcitonin and ferritin were significantly higher in the death group （all P < 0.05）. Upon admission， the hemoglobin level and platelet count in the death group were significantly lower than those in the improvement group （both P < 0.05）. The PSI and APACHE Ⅱ scores on admission in the death group were significantly higher compared with those in the improvement group （both P < 0.05）. Patients in the death group had higher lactic acid level and lower oxygenation index （OI） compared with their counterparts in the improvement group （both P < 0.05）. Multivariate Logistic regression analysis revealed that IL-6， ferritin， PSI and APACHE Ⅱ scores and lactic acid level were the risk factors for poor prognosis， whereas platelet count was the protective factor for poor prognosis （all P < 0.05）. The receiver operating characteristic （ROC） curve indicated that IL-6，procalcitonin and ferritin were favorable predictors for clinical prognosis of patients. When IL-6 and ferritin levels exceed 11.41 ng/L and 659 μg/L， and platelet count was less than 148.5×10⁹/L， patients were at risk of death. Conclusions In patients with respiratory failure caused by severe community-acquired pneumonia， the increase of blood inflammatory indicators， such as IL-6， ferritin and procalcitonin， suggests high risk death in patients， especially for patients with IL-6 >11.41 ng/L， ferritin>659 μg/L， and platelet count<148.5×10⁹/L. Extensive attention should be paid to lowering the risk of death in these patients.

Atherosclerosis is a common vascular disease， which is characterized by lipid deposition and related inflammatory reactions. Vulnerable atherosclerotic plaque is the main pathological cause of acute cardiovascular events. Therefore， early detection and timely interventional treatment of vulnerable plaques are of clinical significance. Although a variety of clinical methods have been developed for the diagnosis and treatment of vulnerable plaques， the acute clinical events caused by vulnerable plaques frequently occur. Nanoparticles have shown huge potential in this regard. Nanoparticles are widely applied in imaging because their unique optical properties can efficiently label tissues and cells to detect the state of disease. Metal nanoparticles can achieve high-resolution imaging， which can also be used as drug delivery carriers to improve therapeutic effect. In this article， recent research progress in the use of nanoparticles in targeted diagnosis of vulnerable atherosclerotic plaques was reviewed， and the future development of nanoparticles in related fields and the challenges and opportunities for clinical transformation were also illustrated.

Pancreatic schwannoma is an extremely rare neurogenic tumor， lacking of specific clinical manifestations and imaging signs. It is difficult to make a definite diagnosis before operation， and it is frequently misdiagnosed with other benign and malignant tumors of the pancreas. In this article， the diagnosis and treatment of a patient with pancreatic schwannoma were reported. The 44-year-old female patient was admitted to the hospital because of pancreatic mass found by physical examination for 5 days. Abdominal enhanced CT scan showed pancreatic body mass， approximately 6.4 cm×5.4 cm in size. The patient underwent middle pancreatectomy and distal pancreatic stump jejunum Roux-en-Y anastomosis. Postoperative pathological report was consistent with pancreatic epithelioid schwannoma. During the follow-up of 2 years， no tumor recurrence or metastasis was found. This case provides clinical reference for clinicians to diagnose and treat pancreatic schwannoma.

Adult-onset latent autoimmune diabetes （LADA） represents an autoimmune form of diabetes that emerges in the adult population. Frequently， individuals with LADA are initially misdiagnosed as type 1 or type 2 diabetes mellitus. Nonstandard management of LADA patients can impede efforts to preserve the remaining functionality of pancreatic islet beta-cells，elevate the risk of early complications of diabetes and increase the mortality rate. This review offers a comprehensive examination of various biomarkers， encompassing genetic factors， transcriptional profiles， proteins， metabolomic markers， and inflammatory indices， which may be employed to forecast the onset of LADA， aiming to facilitate prompt recognition and diagnosis of LADA， thereby retarding the progressive deterioration of pancreatic islet beta-cell function.

Genetic variation is one of the important factors leading to the incidence and development of cancer. Copy number variation is an important source of genetic diversity， which can be expressed as gene amplification or deletion in structure， and is related to the occurrence and development of different tumors. High-throughput sequencing and gene chip technology can be adopted to detect the variation of copy number， and provide relevant information about tumor molecular characteristics， prognosis and treatment， which is conducive to more accurate diagnosis and treatment decisions for patients in clinical practice. Ovarian cancer is one of the female reproductive system diseases with the highest mortality rate. Understanding its pathogenesis is of significance for improving the survival rate of ovarian cancer. At present， the specific role and mechanism of copy number variation in ovarian cancer are still unclear. In this article， relevant copy number variation in ovarian cancer was reviewed based on the existing research results， aiming to provide novel ideas and methods for the prevention， diagnosis and treatment of ovarian cancer.

Objective To analyze the correlation between hypertension，abnormal blood glucose and lipid metabolism and the site and frequency of gout attack. Methods Clinical data of 84 primary gout patients were collected. Gender，age，height，body weight，body mass index （BMI），complicated diseases，site and frequency of gout attack were recorded. The differences of clinical parameters at different sites of gout attack were compared. The differences of frequency of gout attack in patients complicated with diabetes mellitus，hypertension and hyperlipidemia at different time points were also compared. The relationship between age and BMI，and frequency of gout attack was assessed by Spearman’s rank correlation analysis. Results Among 84 patients with primary gout，82 patients were male and 2 female，aged （37.95±10.16） years on average，with a mean height of 170 （165，175） cm，mean weight of 76 （70，83） kg，mean BMI of 26.5 （24.6，29.3） kg/m². Among them，7 patients （8%） were complicated with diabetes mellitus，18 cases （21%） of hypertension and 16 cases （19%） of hyperlipidemia. the most common site of gout attack was the lower limb，especially the metatarsophalangeal joint （38.10%） and knee joint （35.71%）. The frequency of gout attack within 1，6 and 12 months in gout patients complicated with hypertension was higher compared with that in those without hypertension （all P<0.05）. The frequency of gout attack in gout patients complicated with hypertension was increased over time （all P < 0.05/6 between any two consecutive time points）. BMI of gout patients was positively correlated with 1-year cumulative frequency of gout attack （r_s=0.28，P<0.05）. Conclusions The frequency of gout attack in patients complicated with hypertension is higher compared with that of their counterparts without hypertension. The frequency of gout attack is increased over time. Extensive attention should be diverted to blood pressure and BMI in gout patients，thereby reducing the frequency of gout attack.

The long-term survival rate of patients with hepatocellular carcinoma （HCC） is poor， and drug efficacy is an important factor affecting clinical prognosis. N6-methyladenosine （m⁶A） modification is the most abundant modification in eukaryotic RNA， which can affect the occurrence and development of HCC and drug efficacy by regulating cancer-related biological functions. However， the role of m⁶A modification in HCC drug treatment has not been fully elucidated. Therefore， the biological functions of different regulatory members of the m⁶A modification process （methyltransferase， demethyltransferase and binding protein） in HCC drug treatment were illustrated， proposing that regulatory members of the m⁶A modification process can be used as biomarkers for HCC prognosis evaluation and have the potential to become therapeutic targets and providing novel insights for HCC precision medicine.

Diabetic cardiomyopathy （DCM） refers to myocardial cell or cardiac microvascular injury and metabolic disorder caused by hyperglycemia alone. Studies have shown that DCM is closely associated with abnormal mitochondrial fusion. Optic atrophy 1 （Opa1） is one of the main proteins of mitochondrial fusion. Under hyperglycemia environment，the expression level of Opa1-1 is down-regulated，resulting in mitochondrial fusion disorder，which thereby leads to energy metabolism disorder，oxidative stress，increased insulin resistance，lipotoxicity and apoptosis，and finally causes DCM. Up-regulating the expression level of Opa1 can mitigate the symptoms of DCM. In this article，research progress in the correlation between Opa1 and DCM was reviewed，aiming to provide novel ideas for DCM research.

Objective To evaluate the alleviating effect of berberine（BBR）on hepatic inflammation in nonalcoholic steatohepatitis（NASH）mice from the perspectives of oxidative stress and endoplasmic reticulum stress. Methods A total of 24 C57BL/6J mice were randomly divided into 4 groups. Mice in the NASH and NASH+BBR groups were fed with high-fat，high-fructose，and high-cholesterol diets for 28 weeks to induce the NASH disease models，whereas mice in the CD and CD+BBR groups were given with normal diets，and mice in the CD+BBR and NASH+BBR groups were given with 200 mg/（kg·d）of BBR by gavage once a day starting from the 25^th week for 4 consecutive weeks. The body weight of mice was recorded weekly. Glucose tolerance test and insulin resistance test were performed at the 3^rd week of administration. Serum alanine aminotransferase，aspartate aminotransferase，triglyceride，total cholesterol，LDL cholesterol，and HDL cholesterol levels，and hepatic triglyceride and total cholesterol levels were measured at the end of treatment. Liver samples were treated with HE，Oil-Red O and Masson staining. The expression levels of liver inflammatory factors of TNF-α and IL-1β mRNA were detected by qPCR. The levels of malondialdehyde，total superoxide dismutase activity and total antioxidant capacity，indicators of oxidative stress in liver tissues were assessed by colorimetric assay. The expression levels of proteins in the endoplasmic reticulum stress-related pathways in liver tissues were detected by Western blot. Results NASH mouse models were successfully established. Compared with the mice in the NASH group，weight gain was inhibited，glucose tolerance abnormality was mitigated，insulin sensitivity was increased and liver function and hyperlipidemia were improved after treatment with BBR in the NASH+BBR group（all P < 0.05）. Hepatic pathological slices showed a reduction in steatosis ，and a decrease in inflammatory cell infiltration，but there was no significant alleviation in fibrosis. The mRNA expression levels of liver inflammatory factors were down-regulated（all P < 0.05）. The levels of hepatic tissue oxidative stress factor of malondialdehyde were decreased，whereas those of antioxidant factors of total superoxide dismutase activity and total antioxidant capacity were increased（all P < 0.05）. The expression levels of endoplasmic reticulum stress marker of GRP78 protein and PERK/eIF2α/ATF4/CHOP endoplasmic reticulum stress signaling pathway were significantly down-regulated（all P < 0.05）. Conclusions BBR can alleviate overweight，glycolipid metabolism disorder and liver function abnormality in NASH mice. Besides，it can also mitigate hepatic steatosis and inflammation，but it has no significant effect on the alleviation of fibrosis. BBR mitigates inflammatory response in NASH mice probably by suppressing oxidative stress and endoplasmic reticulum stress in the liver.

Cardia cancer patients complicated with cirrhosis，hypersplenism，and portal hypertension constantly have contraindications to systemic drugs such as chemotherapy due to poor liver function，and surgery has become the preferred treatment for patients with such cardia tumors. Evaluation of surgical indications，optimization of surgical regimen，and perioperative management strategy are key factors for safe and successful implementation of these surgeries. Here，we reported a 65-year-old male patient undergoing laparoscopic splenectomy plus pericardiac vascularization combined with radical resection of cardiac carcinoma. Satisfactory clinical efficacy was obtained. He could eat semi-liquid diet at 2 weeks after surgery. During over 1-year follow-up，the patient was generally in good condition，could eat normal diet，and the white blood cell，red blood cell and platelet were restored normal. Liver function was normal，and no thrombosis was seen on portal ultrasound. This case prompts that for cardia cancer patients complicated with cirrhosis，hypersplenism，esophago-gas-tric fundal varices，esophageal stricture，this surgical regimen provides novel therapeutic ideas，which can be utilized as a safe and effective treatment option.

Objective To investigate the effect of high keratin 23 （KRT23） expression promoting cell proliferation on liver cancer. Methods The expression of KRT23 in liver cancer was analyzed by bioinformatics. After overexpression and inhibition of KRT23， the effect of KRT23 on the proliferation of liver cancer cells was analyzed by MTT and clone formation assay. The regulatory relationship between KRT23 and AKT signaling pathway was analyzed by software prediction， qPCRand Western blot. Results The expression level of KRT23 in liver cancer was significantly higher than that in normal control tissues. MTT and clone formation assay showed that overexpression of KRT23 promoted cell proliferation， while downregulation of KRT23 inhibited cell proliferation. GSEA analysis， qPCR and Western blot showed that KRT23 could activate the AKT signaling pathway and promote cell proliferation. Meanwhile， inhibition of AKT signaling pathway in overexpressing KRT23 cells significantly reduced cell proliferation. Conclusions KRT23 affects the proliferation of liver cancer cells by regulating the AKT signaling pathway. These results suggest that KRT23 exerts significant effects upon the malignant procession of liver cancer and may play an important role in the occurrence and development of liver cancer.

Fractional exhaled nitric oxide （FeNO） is a biomarker of type 2 inflammation， and produced by nitric oxide synthase （NOS） expressed on the airway epithelial cells， with the substrates of L-arginine and oxygen. Type 2 cytokines such as interleukin （IL）-4 and IL-13 can up-regulate inducible NOS， which results in the abundant production of NO. NO plays an important role in the pathogenesis of bronchial asthma， and is closely associated with the airway inflammation and remodeling， reduction of lung function and eosinophil infiltration， etc. The technique of FeNO test is applied in the clinical diagnosis of asthma， predicting the response to steroids and evaluating the compliance of asthmatic patients. In recent years， it also plays a guiding role in choosing the optimal biologics for individual therapy for patients of asthma. As a non-invasive， convenient， and economical method， the role of FeNO in the diagnosis and treatment of asthma will be better understood and applied.

Objective To investigate the relationship between the expression of Zeste White 10 interactor（ZWINT）and Cyclin-dependent kinase 2（CDK2）and clinicopathological features in breast cancer，and evaluate their pathological diagnostic values in breast cancer. Methods GEPIA database was utilized to analyze the difference in the expression of ZWINT between breast cancer and normal breast tissues and assess the correlation between ZWINT and CDK2 expression in breast cancer. Kaplan-Meier Plotter database was employed to predict the relationship between ZWINT expression and clinical prognosis of breast cancer patients. Paraffin-embedded pathological specimens of 84 cases of breast cancer and paired paracancerous tissues and fresh specimens of 20 cases of breast cancer and paired paracancerous tissues were collected. Quantitative real-time polymerase chain reaction（RT-qPCR）and immunohistochemical staining were used to detect the expression levels of ZWINT and CDK2 mRNA and protein in breast cancer and paracancerous normal breast tissues，to analyze the relationship between ZWINT and CDK2 expression levels and clinicopathological features of breast cancer. Association analysis was used to analyze the correlation between ZWINT and CDK2. Receiver operating characteristic（ROC）curve was delineated to evaluate the values of ZWINT and CDK2 in the pathological diagnosis of breast cancer. Results The results of database analysis showed that ZWINT was highly expressed in breast cancer tissues and there was a positive correlation between the expression of ZWINT and CDK2 in breast cancer（r_s = 0.600，P < 0.001）. The expression of ZWINT was closely correlated with clinical prognosis of breast cancer patients（all P < 0.05）. The test results of 84 cases showed that the expression levels of ZWINT and CDK2 mRNA and protein in breast cancer tissues were higher than those in para-carcinoma tissues（both P < 0.05），and high expression was closely correlated with tumor size，tumor stage and lymph node metastasis（all P < 0.05）. Association analysis revealed that the degree of association of Φ and Cramer V coefficient test under symmetric measurements was the same as 0.322（P = 0.003），while the column linkage number was 0.306（P = 0.003）. The expression levels of ZWINT and CDK2 proteins were closely correlated. The areas under the ROC curve of ZWINT and CDK2 were 0.886 and 0.818，which yielded high diagnostic values for breast cancer. Conclusions ZWINT and CDK2 expression levels are closely correlated the occurrence，development and prognosis of breast cancer. Detection of ZWINT and CDK2 contributes to pathological diagnosis of breast cancer.

Objective To evaluate clinical efficacy of chiropractic combined with core muscle strength training in patients with chronic non-specific low back pain. Methods One hundred and twenty patients with chronic non-specific low back pain were randomly divided into chiropractic group （n = 40），combined group （n=39） and conventional group （n=41）. Patients in each group were treated with short wave and ultrasound. Chiropractic therapy was added in chiropractic group，and chiropractic combined with core muscle strength training was supplemented in combined group. The changes of numerical rating scale （NRS） score，Oswestry disability index （ODI），Roland-Morris Disability Questionnaire （RMDQ） of low back pain and temperature difference between two sides of spinous process before and after corresponding treatment were compared among three groups. Results After treatment，NRS score，ODI index，RMDQ evaluation of low back pain and temperature difference in combined group were improved up to 2.06±0.63，13.00±3.53 and 6.25±1.20，significantly better than 2.44±0.84，17.11±4.41 and 9.42±2.49 in chiropractic group，4.03±0.82，21.31±5.68 and 11.09±2.78 in conventional group，and the differences were statistically significant （all P<0.05）. Conclusion On the basis of routine treatment，chiropractic combined with core muscle strength training can mitigate relevant symptoms and improve the quality of life of patients with chronic non-specific low back pain，which can be further promoted and applied in clinical treatment.

Lipid-rich carcinoma（LRC）of the breast was first described in 1963，and is now considered an invasive breast carcinoma of no special type（IBC-NST）. Some researchers believe that the lipid content of cancer cells in LRC is secreted by ductal epithelial cells of the breast. The pathological features of LRC include hard texture，light yellow sections，unclear boundaries with surrounding tissues. LRC is generally considered an invasive phenotype of breast cancer，no consensus has been reached regarding treatment regimen and standard for LRC. Further follow-up studies will help to develop comprehensive treatment plans. In this article，the research process and development status of LRC were reviewed.

Objective To evaluate the application value of the MRI-based three-dimensional （3D） reconstruction of pelvic autonomous nerves and surrounding organs in laparoscopic D3 radical resection for rectal cancer. Methods Fifty-six patients with rectal cancer were randomly divided into the reconstruction and control groups. In the reconstruction group， surgical plans were formulated based on preoperative MRI 3D reconstruction. In the control group， conventional surgical plans were formulated. Intraoperative and postoperative functional recovery-related indicators were compared between two groups. Results The 3D reconstruction model provided individualized visualization of the distribution relationship between the pelvic autonomous nerves and surrounding organs. Compared to the control group， patients in the reconstruction group had significantly shorter operation time （（143.7±13.3）min vs. （151.5±12.1） min， P = 0.040）， less blood loss （（31.3±12.1） mL vs. （39.4±11.6） mL， P = 0.024））， improved IPSS score （（6.0±1.3） vs. （7.9±2.6）， P = 0.003）， and shorter duration of urinary catheter removal （2.0（2.0， 2.0）d vs. 3.5（3.0， 4.0）d， P < 0.001）. Conclusions MRI-based 3D reconstruction of pelvic autonomous nerves provides a more precise visualization of the anatomical position of the pelvic autonomous nerves and surrounding organs， ultimately improving the efficiency and safety of D3 resection. It offers important reference for surgeons in formulating precise and individualized surgical plans.

Objective To investigate the role of ultrasound-guided volume resuscitation in the treatment of severe trauma. Methods Sixty patients with severe trauma requiring surgical intervention were included and randomly assigned into the ultrasound-guided volume resuscitation group （group U， n = 30） and the empirical treatment group （group C， n = 30） using the random number table method. All patients underwent general anesthesia induction， central venous catheterization and subsequent surgery. In group U， ultrasound examination was conducted for assessing the inferior vena cava （IVC）， aortic root peak velocity variation （ΔV_peak） and time integral variation of aortic root velocity （ΔVTI） upon arrival at the operating room， after general anesthesia induction， at the end of operation and upon resuscitation， respectively. Fluid resuscitation therapy in group U was guided based on these results. In group C， patients were subjected to fluid resuscitation based on heart rate （HR）， mean arterial pressure （MAP）， central venous pressure （CVP）， fluid load test and blood gas analysis results， etc. Radial artery blood samples were collected from all patients immediately upon arrival at the OR （T₀）， at 1 h （T₁）， 2 h （T₂）， 4 h （T₃）， 6 h （T₄）， and 24 h （T₅） post-arrival， and lactate levels along with other blood gas analysis results were recorded accordingly. Additionally， the total amount of crystalloids and colloids administered from 0-<1 h，1-<2 h， 2-<4 h， 4-6 h， and 0-6 h since arrival were documented. The operation time， anesthesia duration， postoperative recovery time， extubation time， blood loss volume， urine output， duration of hypotension， duration of elevated lactate levels， length of hospital stay， ICU transfer rate， 28-d mortality rate， and the total amount of norepinephrine use were recorded. Results Compared with T₀， lactate levels in group U exhibited an increase at T₁ and T₂， and followed by a return to normal levels at T₄. In group C， an elevation in lactate levels was demonstrated at T_1~T₃， which subsequently decreased to normal levels at T₅. Patients in group U displayed lower lactate levels at both T₂ and T₃ than those in group C. Additionally， patients in group U exhibited reduced overall usage of norepinephrine and a shorter duration of elevated lactate levels. Moreover， patients in group U received a higher volume of crystalloid fluids during the initial hour （0-<1 h）， and lesser amounts during 2-<4 h and 4-6 h as well as overall within 0-6 h， respectively. Furthermore， compared to the group C， there was less administration of colloid fluids during 2-<4 h and overall within 0-6 h in group U （all P < 0.05）. However， no statistically significant differences were observed in the operation time， anesthesia duration， postoperative recovery time， extubation time， length of hospital stay， intraoperative blood loss， transfusion volume， oxygenation index， urine output or duration of hypotension between two groups （all P > 0.05）. Conclusion Ultrasound-guided volume resuscitation can be safely employed in severe trauma patients， which can reduce the total amount of transfusion， decrease the total dosage of vasoactive medications， and shorten the duration of elevated lactate levels.

Objective To evaluate the effect of intrauterine hyperglycemia exposure on inflammatory cytokine levels in neonatal umbilical cord blood and the incidence of allergic diseases in infants. Methods 112 pregnant women and their infants were enrolled. According to the glucose levels during pregnancy， all women were divided into the intrauterine hyperglycemia exposure （n = 55） and non-intrauterine hyperglycemia exposure groups （n = 57）. The levels of inflammatory cytokines in the umbilical cord blood were compared between two groups. During 1-year follow-up， the incidence of allergic diseases such as atopic dermatitis and wheezing in infants was compared between two groups. The impact of intrauterine hyperglycemia on neonatal immunity and infant allergic diseases was evaluated. Results There were no significant differences in the levels of IL-1β， IL-2， IL-6， IL-8， IL-10， IL-12 and TNF-α between two groups （all P > 0.05）. In the intrauterine hyperglycemia exposure group， the IL-4 level in the umbilical cord blood was （30.180±8.648） pg/mL， significantly higher than （22.500±10.100） in the non-intrauterine hyperglycemia exposure group （P < 0.05）. In the intrauterine hyperglycemia exposure group， the incidence of allergic diseases was 34.7%， higher compared with 24.0% in the non-intrauterine hyperglycemia exposure group during 1-year follow-up. However， there was no significant difference between two groups （P > 0.05）. Conclusion Intrauterine hyperglycemia exposure exerts certain effect on the IL-4 level in the neonatal cord blood， which may provide evidence for early intervention of allergic diseases.