Abstract:β-arrestin is involved in multiple physiological and pathological processes，such as cardiovascular and gastrointestinal diseases，kidney and lung dysfunction，inflammation and metabolic disorders，bone mineral homeostasis maintenance，reproductive and central nervous system diseases. With the in-depth understanding of β-arrestin mediated pathways，G protein-coupled receptors（GPCR）biased signal transduction gives us an insight into the development of selective drugs with higher efficiency and fewer side effects. In recent years，G protein-biased or β-arrestin-biased ligands have continuously emerged. Especially，β-arrestin-biased ligands have shown great application prospects in treating neuropsychiatric diseases.

Abstract:Objective：This study aims to analyze and summarize the clinical characteristics of patients infected with corona virus disease 2019（COVID-19）in fever clinic，and compare the differences in clinical characteristics of patients with different length of stay. Methods：The clinical manifestations，laboratory examinations and imaging data of 11 patients with COVID-19，who were diagnosed in the fever clinic of the First Affiliated Hospital of Nanjing Medical University from January 2，2020 to February 29，2020，were analyzed and summarized，and the differences of clinical characteristics among patients with different length of stay were compared. Results：Among the 11 patients，6 patients with underlying diseases，and 1 patient with a history of chronic smoking. The symptoms of fever and dry cough were the most common symptom. The lymphocyte count was decreased in 7 patients. The most common chest CT abnormality is the ground-glass exudation of the lungs. Compared with the patients with hospitalization time＞ 14 days，the patients with hospitalization time ≤ 14 days had a lower average age，shorter symptom duration before the first visit，higher absolute neutrophil count and basal albumin level，and less infiltrated pulmonary lobes. Due to the small sample size，there was no statistically significant difference between the two groups. Conclusion：During the diagnosis and treatment of fever outpatients，it is necessary to pay attention to the patients’ epidemiological history and abnormal CT manifestations of the chest. At the same time，it is necessary to be aware that the risk factors of long-term hospitalization for patients with COVID-19 may be the elderly age and the large number of pneumonia infiltration

Abstract:Objective：This study aims to explore the value of general information and chest CT features in the differential diagnosis between mild and severe corona virus disease 2019（COVID-19）. Methods：The general information，chest CT features and CT image changes of follow-up of confirmed 127 patients with NCP from January 1 to February 20，2020，were retrospectively analyzed in Wuhan Central Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology，with 101 mild cases（79.53%）and 26 severe cases（20.47%）. The general information and chest CT features of different clinical subtypes were compared using χ2 test or Fisher’s exact probability，and the CT image changes of follow-up were summarized. Results：In 127 COVID-19 patients，73 males（57.48%）and 54 females（42.52%）. There was no significant difference in gender（χ2=1.847，P=0.174）. Compared with the mild cases，the average age of severe cases was older（χ2=4.547，P=0.033. Thirty-two（25.20%）patients had underlying disease，including 15 mild cases（14.85%）and 17 severe cases（65.38%），and there were significant differences in underlying disease between two groups（χ2=28.014，P＜0.001. In terms of CT features，mild cases mainly showed ground glass opacity（67 cases）and mixed ground glass opacity（45 cases），severe cases mainly showed mixed ground glass opacity（19 cases）and crazy paving（10 cases）. There were significant differences in chest CT features between two groups（χ2=11.330，P=0.010）. Mediastinal lymph node enlargement was found in 1 case（3.85%）（P=0.205）and pleural effusion in 4 cases（15.38%）（P=0.001）among severe cases. Compared with the mild cases，the CT grade of lesions in severe cases was generally higher，and the peak of lung involvement was later. Conclusion：There were different chest CT features and CT image changes in COVID-19 patients. Chest CT scan can not only evaluate its clinical course and severity，but also make early warning of severe COVID-19.

Abstract:Objective：This study aims to summarize the clinical characteristics of liver injury in patients with corona virus disease 2019（COVID-19）. Methods：The clinical data of 93 patients with COVID-19 who were hospitalized in Nanjing Public Health Medical Center were retrospectively analyzed. Results：Among the 93 patients，38（40.9%）had liver injury，including 27 males and 11 females，aged 26-87 years，with an average age of 48. Among these patients with liver injury，the abnormal liver function was manifested as increased total bilirubin（TBIL）and alanine aminotransferase（ALT）/aspartate transaminase（AST），9 patients with abnormal TBIL，25 patients with abnormal ALT/AST，and 4 patients with abnormal TBIL combined with ALT/AST. The increase of TBIL was within 3 times and the increase of ALT/AST within 5 times. Among the 38 patients with liver injury，19（50%）suffered liver injury when admission，and 19（50%）suffered liver injury after admission. The value of TBIL，ALT and AST in the two groups were（16.4±2.0）μmol/L vs.（17.8±2.4）μmol/L（P=0.43），（56.3±8.6）U/L vs.（52.02±6.3）U/L（P=0.69），and（42.8±4.7）U/L vs.（31.92±2.4）U/L（P=0.047），respectively. Conclusion：Among the patients diagnosed with COVID-19，the incidence of liver injury is high and the severity is relatively mild，and most of them can recover by themselves. However，the mechanism of liver injury is complex，and in addition to the liver injury caused by the virus，it may also be combined with drug-induced liver injury，which should be paid attention to in the process of diagnosis and treatment.

Abstract:Objective：This study aims to investigate the effect of rat nuclear factor-κB（NF-κB）p65 subunit over-expression and its activity changes on the gene promoter activity of interferon regulatory factor-8（IRF-8），and initially screen the possible p65-binding elements within IRF-8 promoter. Methods：To construct the rat wild type p65 over-expression plasmid（pIRES2-p65 WT），complete sequence coding（CDS）of rat p65 was amplified by polymerase chain reaction（PCR） and cloned into pIRES2-EGFP. Then，S535D and S535A mutation was done respectively based on the wild type p65 over-expression plasmid to construct p65 constitutively active mutant（pIRES2-p65 S535D）and p65 dominant negative mutant（pIRES2-p65 S535A）. The potential p65-binding elements within IRF-8 promoter were predicted by using bioinformatics software. Based on the predicted results，luciferase reporter plasmids of full-length（FL）and three truncated IRF-8 gene promoter were constructed，namely pGL3-IRF-8-FL（-1 892~+174 nt），pGL3-IRF-8-1（-1 360~+174 nt），pGL3-IRF-8-2（-752~+174 nt），pGL3-IRF-8-3（-68~+174 nt）. The above-mentioned plasmids were co-transfected into human embryonic kidney 293T（HEK-293T）cells in different groups. Then，the expression level of p65 was detected by Western blot，and the promoter activity of IRF-8 was detected by luciferase experiment to screen the p65-binding elements. Results：It was verified that above-mentioned plasmid was constructed correctly by PCR analysis and nucleotide sequencing. The plasmids of pIRES2-p65 WT，pIRES2-p65 S535D，pIRES2-p65 S535A were respectively transfected into HEK-293T cells together with pGL3-IRF-8-FL. The luciferase results showed that the activity of IRF-8 promoter was markedly increased in response to pIRES2-p65 WT and pIRES2-p65 S535D，especially the later. However，there was no significant change of IRF-8 promoter activity after over-expression of pIRES2-p65 S535A. The plasmids of pGL3-IRF-8-FL or pGL3-IRF-8-1~3 and pIRES2-p65 were co-transfected into HEK-293T cells，and the result displayed that the activity of pGL3-IRF-8-3 was much lower than that of pGL3-IRF-8-FL，pGL3-IRF-8-1 and pGL3-IRF-8-2，indicating that the region of rat IRF-8 promoter（-752~-68 nt） might contain p65-binding elements. Conclusion：Over-expression of wild-type or continuously activated mutant p65 in HEK-293T cells can significantly promote the activity of IRF-8 promoter，and the p65-binding elements in IRF-8 promoter might be located in the -752~-68 nt region.

Abstract:Objective：This study aims to ohserve the protective effect of human-TLR4 IgG2（hTLR4 IgG2）on acetaminophen（APAP） induced liver injury，and to investigate the protective mechanism of hTLR4 IgG2 in drug induced liver injury. Methods：The hTLR4 Fab plasmid in our laboratory were used as templates to amplify the variable region genes，and the hTLR4 IgG2 eukaryotic expression vector was constructed and transfected into CHO-S cells. The stable transfectants strains and culture supernatants were collected. Finally，hTLR4 IgG2 was purifieded using a protein G column. Total 18 C57BL/6J mice were randomly divided into three groups：saline group，APAP（600 mg/kg）and the APAP+hTLR4 IgG2（5 mg/kg）group. The survival rate of mice after 24 hours intraperitoneal injection with APAP was compared. Repeat the above experimental grouping and modeling methods were repeated. Aspartate transaminase（AST），alanine aminotransferase（ALT），interleukin-1（IL-1），interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） in serum were also qualified，the liver was taken for pathological section and the expression of hepatic apoptosis protein was analyzed by Western blot after 8 hours intraperitoneal injection with APAP. Results：The hTLR4 IgG2 was successfully constructed and purified，and the results of ELISA showed that the antibody titer was 1∶204 800. Compared with the APAP group，the 24-hour survival rate of mice in the APAP+hTLR4 IgG2 group was significantly increased（P < 0.05）；the expression levels of AST，ALT and inflammatory cytokines in serum were significantly decreased（P < 0.05）；pathological detection results showed that the inflammatory cell infiltration，hyperemia and necrosis of liver tissue were significantly improved in APAP+hTLR4 IgG2 group，and the expression of apoptotic protein was decreased in the APAP+hTLR4 IgG2 group by Western blot. Conclusion：hTLR4 IgG2 can effectively inhibit the expression of inflammatory factors and apoptosis，and protect liver against APAP-induced injury in mice.

Abstract:Objective：This study explores the effects and mechanisms of miR-1254 on liver cancer cells. Methods：①RT-qPCR was used to detect the expression of miR-1254 in liver cancer and adjacent tissues or cell lines. ②HUVEC tube -formation assays and transwell assays were used to demonstrate effects of miR-1254 on migration，invasion and vascular formation of liver cancer cells. ③Target Scan was used to predict the target gene of miR-1254. RT-qPCR and western blot were used to measure the expression of the target gene. Dual luciferase reporter assay was used to confirm the target gene. Results：①miR-1254 was up-regulated in liver cancer tissues and cell lines. ② miR-1254 promoted migration，invasion and vascular formation of liver cancer cells. ③The paired box gene 5（PAX5）was down-regulated in liver cancer tissues and miR-1254 negatively regulated the expression of PAX5，which was confirmed to be the direct target of miR-1254. ④Over-expressing PAX5 could reverse the promotive effects on HCC cells caused by the over-expresssion of miR-1254. Conclusion：miR-1254 promoted migration，invasion and vascular formation of liver cancer cells through targeting PAX5. So miR-1254 might have the value of target therapy in liver cancer.

Abstract:Objective：The aim of this study is to clarify ERS and the expression level of WFS1 in IUGR newborn rats，further exploring the molecular basis related to T2DM，which may provide a new therapy for preventing IUGR from leading to T2DM. Methods：The pregnant rats in the IUGR group were fed 50% calorie restriction from gestational day 14 until term. Immunohistochemistry，RT-PCR，transmission electron microscope and western blot were applied. Results：①The expressions of WFS1 and GRP78 in the pancreas and islets of IUGR rats were increased（P < 0.05，n=10）. ② Electron microscope showed that the endoplasmic reticulums in the pancreas of newborn IUGR rats were swollen and fused. ③Glucose-regulated protein 78（GRP78/Bip）and CHOP were significantly elevated in the pancreas and islets of IUGR. Conclusion：This study demonstrated that WFS1 might play roles in maintaining islet structure and function in IUGR rats，maybe partly via UPR.

Abstract:Objective：To investigate the effect of bisphenol S（BPS）exposure on the homeostasis of neurotransmitter metabolism in the mice brain-gut-microbiota axis. Methods：A subchronic BPS exposure model using male C57BL/6J mice was established. The neurotransmitters in tryptophan and tyrosine pathways in the prefrontal cortex，serum and intestine were detected with UHPLC-MS/MS. The gut microbiota analysis was detected based on 16S rRNA gene sequencing. Results：BPS exposure resulted in neurotransmitter metabolism disorders of tryptophan and tyrosine pathways in the mice prefrontal cortex，serum and intestine. In the tryptophan pathway，when compared with the control group，5-HT was decreased in the prefrontal cortex（PFC），serum and intestine of the BPS-exposed group，while 3-HK was greatly increased in the PFC and serum. In the tyrosine pathway，BPS exposure significantly increased L-dopa and DA levels in the PFC，but decreased the counterparts in the intestine. Additionally，BPS exposure led to a differential distribution of gut microbiota in BPS-exposure mice. In the genus level，the Acinetobacter，Lactobacillus and an unclassified_Clostridiales exerted great differences between the two groups. Conclusion：BPS exposure can affect central and peripheral neurotransmitter metabolism in tryptophan pathway and tyrosine pathway through the brain-gut axis. Additionally，BPS exposure caused gut microbiota disturbance.

Abstract:Objective：This study aims to evaluate the effect of muscone on the cardiotoxicity induced by doxorubicin（DOX） and explore its possible mechanism. Methods：Total 24 adult male C57BL/6 mice were randomly divided into 4 groups：normal saline group（control group，n=4），normal saline + muscone group（muscone group，n=4），doxorubicin + normal saline group（DOX group，n=8）and doxorubicin + muscone group（DOX + muscone group，n=8），reared for 5 weeks after drug treatment. Left ventricular ejection fraction（LVEF）was detected by cardiac ultrasonography before drug treatment，2 weeks after drug treatment and 5 weeks after drug treatment. Mouse was executed 6 weeks after drug treatment，and the isolated heart tissue was collected to detect the expression levels of Bax，Bcl-2，and cleaved-caspase-3 by immunohistochemical staining and quantitative real time polymerase chain reaction. H9C2 cells were divided into 4 groups（control group，muscone group，DOX group，DOX + muscone group） according to drug treatment for 24 hours，and the expression levels of Bax，Bcl-2，caspase-3，and cleaved-caspase-3 were assessed by Western blot. Results：Compared with the control group. The muscone group had no significant changes in cardiac function and apoptotic indicators. The cardiac function of the mice in the DOX group decreased. The expressions of Bax，cleaved-caspase-3 increased significantly（P　<　0.05），and the expression of Bcl-2 decreased significantly（P＜0.05）in mouse cardiomyocytes and H9C2 cells. Compared with the DOX group，the heart function of the mice in the DOX + muscone group was not significantly reduced，the upward trend of Bax and cleaved-caspase-3 expression was reversed（P＜0.05），and Bcl-2 expression was increased（P＜0.05）in mouse cardiomyocytes and H9C2 cells. Conclusion：Muscone plays a protective role in myocardial damage induced by doxorubicin，and can reduce myocardial cell apoptosis induced by doxorubicin.

Abstract:Objective：This study aims to analyze the characteristics of EGFR and ALK oncogenic drivers in 2 394 patients with lung adenocarcinoma，improving clinicians’ understanding of the oncogenic drivers characteristics of patients with lung adenocarcinoma in this study. Methods：From January 2014 to April 2019，2 394 patients with lung adenocarcinoma diagnosed in our hospital with concurrent EGFR and ALK detection were collected，the characteristics of EGFR and ALK oncogenic drivers were analyzed，and the correlation between EGFR/ALK status and lung adenocarcinoma subtypes was discussed. Results：59.7%（1 429/2 394）patients with lung adenocarcinoma had EGFR mutation，which was higher than the national average（51.8%）and southeast Asia（51.4%）. The mutation rate of 21L858R（48.01%）was the highest，followed by the mutation rate of 19Del（43.32%）. About 10% had rare mutations，including 18G719X，20ins and 21L861Q. The incidence of ALK rearrangement was 4.4%，lower than the national average（6.0%），and EML4-ALK fusion was the most common. The EGFR mutation rates of different types of specimens were different. The EGFR mutation rates of tissue specimens，cytology specimens and peripheral blood specimens were 60.60%，51.20% and 46.48%，respectively. Among the primary tissue specimens，the EGFR mutation rates of surgical excision specimens，percutaneous lung puncture specimens and bronchoscopy specimens were 64.50%，59.25% and 45.45%，respectively. EGFR mutations were more likely to be expressed in lepidic adenocarcinoma（79.7%），papillary adenocarcinoma（74.9%）and acinar adenocarcinoma（74.4%），and were less common in solid adenocarcinoma（58.9%）and invasive mucinous adenocarcinoma（28.9%）. ALK rearrangement rates were higher in solid adenocarcinoma（8.6%） and invasive mucinous adenocarcinoma（13.3%） than in other subtypes. Conclusion：EGFR mutation rate was higher in this study，21L858R and 19Del were the most common. The highest rate of EGFR mutation was found in the surgical excision specimens，and both EGFR mutation and ALK fusion were associated with lung adenocarcinoma subtypes.

Abstract:Objective：To explore the relationship between lipoprotein-associated phospholipase A2（Lp-PLA2）and insulin resistance in newly diagnosed type 2 diabetes mellitus. Methods：A total of 219 newly diagnosed T2DM patients were selected. Lp-PLA2 levels，total cholesterol（TC），triacyl glycerin（TG），high-density lipoprotein cholesterol（HDL-C），low density lipoprotein cholesterol（LDL-C），glycosylated hemoglobin（HbA1c），fasting plasma glucose and fasting plasma insulin were measured，respectively．Postprandial venous blood samples were collected at 30 and 120minutes after OGTT to test glucose and insulin levels. The patients were divided into normal group（＜200 ng/mL）and high group（≥200 ng/mL）according to Lp-PLA2 level，to analyze the level of insulin resistance between the two groups and their correlation. Results：HOMA-IR in T2DM patients with high Lp-PLA2 level was significantly higher than those with normal Lp-PLA2（P＜0.05），while Matsuda ISI was significantly lower（P＜0.05）.With the increase of Lp-PLA2 level in newly diagnosed T2DM patients，HOMA-IR significantly increased（P＜0.05）and Matsuda ISI significantly decreased（P＜0.05）. Correlation analysis showed that the Lp-PLA2 levels were positively correlated with HOMA-IR（P＜0.05）and negatively correlated with Matsuda ISI（P＜0.05）． Regression analysis showed that Lp-PLA2 was an important predictor for HOMA-IR and Matsuda ISI（P＜0.05）. Conclusion：Lp-PLA2 level is closely related to T2DM insulin resistance. Lp-PLA2，as a simple and feasible indicator，can be useful for evaluating both cardiovascular risk and insulin sensitivity in T2DM.

Abstract:Objective：To explore the risk factors of sentinel lymph node（SLN）and non-sentinel lymph node（NSLN）metastases in patients with invasive breast cancer. Methods：We retrospectively analyzed the clinical-pathologic characteristics of 845 patients with invasive breast cancer who underwent Sentinel Lymph Node Biopsy（SLNB）in the First Affiliated Hospital of Nanjing Medical University from August 2016 to February 2019. Univariate logistics regression and multivariate logistics regression methods were used to explore the relationship between clinical-pathological parameters and the metastasis of SLN and NSLN. Results：A total of 845 patients were recruited in this study，of which 160 were SLN positive（18.9%）and 685 were negative（81.1%）. Results：of univariate logistic regression analysis：Tumor size，ER status，PR status，lymphovascular invasion，Ki-67，and p53 were risk factors for SLN metastasis. Multivariate Logistic regression analysis results：Tumor size，PR status，lymphovascular invasion were independent risk factors for SLN metastasis. 160 patients with SLN positive patients were further received ALND，among which，NSLN turned out to be negative in 130 cases（81.3%），and positive in 30 cases（18.7%）. Univariate logistic regression showed that PR status and the number of positive SLNs were the risk factors for NSLN metastasis. Multivariate Logistic regression analysis indicated the number of positive SLNs was an independent risk factor for NSLN metastasis. Conclusion：Tumor size，PR status，lymphovascular invasion were independent risk factors for SLN metastases；the number of positive SLNs was an independent risk factor for NSLN metastases.

Abstract:Objective：This study aims to analyze the effect and duration of pegylated recombinant human granulocyte colony-stimulating factor（PEG-rhG-CSF）by studying the dynamic changes of blood routine in breast cancer patients after chemotherapy. Methods：A total of 65 breast cancer patients who needed adjuvant chemotherapy were included. Patients were injected with PEG-rhG-CSF at different time period after the first and subsequent chemotherapy，and the patient’s blood routine results were dynamically monitored. Results：The lowest point in the white blood cell（WBC）count and neutrophil count（NC）occurred around the 10 th day after the first chemotherapy. After the injection of PEG-rhG-CSF，WBC and NC mostly returned to normal levels within 3-5 days. Prophylactic injection of PEG-rhG-CSF in subsequent chemotherapy significantly reduced the incidence of Ⅲ/Ⅳ myelosuppression. Conclusion：Myelosuppression will be the most severe in breast cancer patients on the 10 th day after chemotherapy. Therefore，it is rational to test blood routine on the 10 th day after chemotherapy. Prophylactic injection of PEG-rhG-CSF can reduce the incidence of myelosuppression. PEG-rhG-CSF can still be used in patients with Ⅲ and Ⅳ myelosuppression，and most patients will be cured within 3-5 days.

Abstract:Objective：This study aims to investigate the clinical effect of sacubitri/valsartan in treating heart failure patients with reduced ejection fraction and to explore the clinical factors of poor treatment of Sacubitri/Valsartan. Methods：A retrospective study of 104 heart failure patients with reduced ejection fraction in the Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University was conducted from December 2017 to December 2018. All patients were treated with sacubitri/valsartan basing on their conventional anti-heart failure drugs for （3.9±2.2） months，6 patients were excluded for withdrawal or death. Baseline population characteristics including sex，age，primary diseases and other basic diseases were described，we also observed the catagories of conventional anti-heart failure drugs and doses of Sacubitri/Valsartan before and after the treatment. NYHA classification，the index of normal vatal signs（HR，SBP），laboratory examinaiton（NT-proBNP），cardiac structure（LVEF，LVDd，LVDs）were compared before and after treatment. The incidence of drug related adverse reactions was recorded. Univarite and multivariate Logistic regression model were applied to analyze the revelant clinical factors influencing the treatment of Sacubitril/Valsartan. Results：①There were statisitcally significant differences in NYHA classification before and after the treatment（P＜0.05）. ② HR and SBP after treatment were statisitcally significant lower than those before the treatment（P＜0.05）；③After treatment，NT-proBNP was significanly less than before（P＜0.05）. ④There were statisitcally significant differences in LVEF，LVDd before and after treatment（P＜0.05），while LVDs did not show the difference（P＞0.05）. ⑤During the treatment of sacubitri/valsartan，three patients withdrew because of severe cough，as well one patient with the increase of serum creatinine；One patient died because of severe valvular heart disease during the treatment，another patient was diagnosed Hodgkins lymphoma and then dead during the follow-up. No one left experienced any obvious hypotension，angioedema or hyperpotassemia.⑥Univariate and mutivariate Logistic regression analysis showed that the length of medical history（OR=4.952）and baseline LVDd（OR=1.124）were related with the poor treatment of sacubitri/valsartan. Conclusion：Sacubitri/valsartan can validly improve NYHA classification，LVEF and decrease NT-proBNP，HR，SBP，LVDd in patients with reduced ejection fraction basing on their conventional anti-heart failure therapy. Clinical factors including the length of medical history and LVDd can influence the treatment of sacubitri/valsartan. With advanced clinical effect and mild adverse reactions，sacubitri/valsartan is recommended for heart failure patients with reduced ejection fraction as early as possible.

Abstract:Objective：This study aims to compare the early results of total hip arthroplasty（THA）by direct anterior approach（DAA），lateral approach（DLA） and posterior approach（PA）. Methods：A total of 22 patients（8 males and 14 females）who underwent total hip arthroplasty using DAA from September 2018 to September 2019 were retrospectively analyzed. Of the patients who underwent total hip arthroplasty using DLA and PA during the same period，22 were matched according to age，BMI，etiology，and severity. The operation time，incision length，postoperative 3-day continuous pain score（VAS），phosphokinase（CK），C-reactive protein（CRP），hemoglobin，blood loss，postoperative 1-month and 3-month Harris scores，prosthesis position and postoperative complications in the three groups were statistically analyzed. Results：The VAS on the first and second day after operation in DAA group was lower than that in DLA group，and the difference had statistical significance. The Harris score at 1 month after operation in DAA group was higher than that in DLA and PA groups（P < 0.05）. The operation time DAA was（90.91 ± 18.55）min，the difference was statistically significant compared with the other two groups（P < 0.05）. Conclusion：Compared with the traditional direct lateral approach and posterior approach，the direct anterior approach has the advantages of less postoperative pain and faster short-term rehabilitation.

Abstract:Objective：This study aims to investigate the prognostic significance of the clinical，pathological and treatment factors on the thymoma patients accepted surgical treatment. Methods：Retrospective analysis was performed on 354 patients with thymoma undergoing surgical treatment between January 2008 and June 2018. The association between the prognostic factors and survival was assessed using the Kaplan-Meier method. Results：Kaplan-Meier analysis showed that age（P=0.002），tumor size（P=0.045），pathological type（P=0.051），TMN stage（P=0.004），Masaoka-Koga stage（P < 0.001），radical resection（P < 0.001）were related to the prognosis of patients with thymoma. Age（P=0.003，hazard ratio：10.151，95% CI：2.239~46.02），pathological type（P=0.045，hazard ratio：3.376，95% CI：1.030~11.064），Masaoka-Koga stage（P=0.009，hazard ratio：5.621，95% CI：1.552~20.352）was also validated as an independent prognostic factor in multivariate Cox analysis. Conclusion：The early detection of thymoma can effectively improve the overall survival of the thymoma patients after surgical treatment. Radical resection is an important factor to improve the prognosis of patients with thymoma. Accurate pathological analysis after surgery can help analyze the prognosis of patients with thymoma.

Abstract:Objective：This study aims to evaluate the efficiencies of modified 308 nm monochromatic excimer light（MEL）and fractional CO2 laser respectively combining with topical calcipotriol treatments for refractory vitiligo with leukotrichia，and to search for factors associated with the treatment response. Methods：A prospective research was performed in 60 patients of refractory vitiligo with leukotrichia treated in the Department of Dermatology，The First Affiliated Hospital of Nanjing Medical University from May 2019 to August 2019，they were divided into group A and group B according to the random number table. Group A was treated with modified 308-nm MEL，a black opaque cloth with the same shape as the lesion is closely attached to the lesion surface，and the edge of the cloth is 1mm from the inner side of the lesion edge，the light focuses on the edge of the lesion，three times a week，36 times a course，combined with topical calcipotriol. Group B was treated with fractional CO2 laser once a month，3 times a course，combined with topical calcipotriol. The treatment time of both groups lasts for 3 months. The clinical efficacy and repigmentation pattern of both groups were assessed. We also assessed the factors associated with the clinical efficacy. Results：After treatment，the effective rate and markedly effective rate of group A（89.5%，50.9%）were significantly higher than group B（67.6%，22.1%）（P < 0.01）. In group A，39（68.4%）lesions showed marginal repigmentation，10（17.8%）lesions showed mixed repigmentation，6（10.5%）lesions showed perifollicular repigmentation，2（3.5%）lesions showed diffuse repigmentation. In group B，49（72.1%）lesions showed marginal repigmentation，9（13.2%）lesions showed perifollicular repigmentation，6（8.8%）lesions showed diffuse repigmentation，4（5.9%）lesions showed mixed repigmentation. Multivariable analysis showed the following to be independent factors with markedly effect：disease duration≤2 years，duration with no repigmentation≤1 year，without elevated serum thyroid antibody，face and neck site，and nonsegmental subtype. Conclusions：Both combinations of modified 308 nm MEL and topical calcipotriol，and fractional CO2 laser and topical calcipotriol in the treatment of refractory vitiligo with leukotrichia have good clinical effect. The combination of modified 308-nm MEL and topical calcipotriol showed better therapeutic effect than the combination of fractional CO2 laser and topical calcipotriol. Marginal repigmentation pattern occurred most frequently in refractory vitiligo with leukotrichia. Disease duration，duration with no repigmentation，serum thyroid antibody，lesion site and subtype were shown to be independent prognostic factors of markedly effect in patients of refractory vitiligo with leukotrichia.

Abstract:Objective：This study aims to provide basis for prevention and control of myopia by analyzing the prevalence of myopia and refraction-related ocular biological parameters of teenagers in 4 primary schools in Nanjing. Methods：By using random cluster sampling method，217 first-grade students from 4 primary schools in Nanjing were selected to carry out a follow-up study for 6 consecutive years. Results：After 6 years of follow-up，the prevalence rate of myopia increased from 6.70% to 72.63%. The number of moderate myopia increased gradually. The proportion of moderate myopia increased from 8.33% to 52.31%. there were 124 of 167 non-myopia students at baseline developing into myopia during the 6 years，and students in grade 3 to 4 or grade 5 to 6 have a higher incidence rate. AL/CRC increased from 2.89±0.08 to 3.13±0.14（P＜0.05）. SER was correlated with logMAR，AL and AL/CRC（Except for grade 1）（P＜0.05）. Conclusion：The prevalence rate of myopia increases gradually in 4 primary schools in Nanjing，and the moderate myopia increases dramatically. Grade 3 to 4 and grade 5 to 6 are the peak stages of myopia. SER correlates with logMAR，AL and AL/CRC. AL/CRC can acts as an evaluation index for myopia screening.

Abstract:Objective：This study aims to investigate the clinical features，laboratory examinations，imaging characteristics，diagnosis and treatment of pulmonary cryptococcosis. Methods：The clinical data of 75 patients with pulmonary cryptococcosis，diagnosed from June 2009 to June 2019 in the First Affiliated Hospital of Nanjing Medical University，were retrospectively analyzed. According to the immune status，the enrolled patients were divided into an immunocompetent group with 43 cases and an immunocompromised group with 32 cases. Results：The patients consisted of 50 males and 25 females，with a mean age of（48.2±12.35）years（range，17 to 80 years）. The main symptoms were cough，expectoration and fever. Twenty-seven patients were asymptomatic. There were differences in lymphocyte count，fibrinogen，carcinoembryonic antigen，cytokeratin 19 fragment and erythrocyte sedimentation rate in the two groups（P＜0.05）. Pulmonary cryptococcosis imaging showed no specificity，nodular or mass-like shadows in 33，patchy infiltrates or consolidation in 25 and mixed lesions in 17 cases，there were no statistically significant differences between the two groups（P＞0.05）. Up to September 30，2019，except for 4 cases of lost follow-up，59 cases received antifungal drug therapy alone and 12 cases received surgery combined with antifungal drug therapy. Forty-eight cases were cured，18 cases were improved and 5 cases died. The effective rate of fluconazole alone was 53/55（96.4%）. Conclusion：Pulmonary cryptococcosis is commonly seen in immunocompetent patients and it has no specific clinical and imaging manifestations. The diagnosis mainly relies on pathological examination. The commonly used of antifungal drugs have better effect on pulmonary cryptococcosis. Most patients with pulmonary cryptococcosis have a good prognosis.

Abstract:Objective：This study aims to evaluate the construct validity of the Alzheimer’s disease assessment scale - cognitive subscale（ADAS-Cog）among Chinese older people population. Methods：A total of 628 normal controls，572 patients with mild cognitive impairment（MCI） and 76 patients with Alzheimer’s disease（AD） were collected to assess the construct validity of ADAS-Cog. Results：In general，the correlation coefficients between the scale and the total scores of ADAS-Cog in AD and MCI groups were between 0.51-0.83 and 0.27-0.69. The construct validity of AD group was better than that of MCI group，but all of them were not good enough. In the factor analysis of the AD group，two factors were analyzed：memory（including word recall and word recognition）and cognitive function（all other scales），which accounted for 63.23% of total variance. Four factors were extracted from the MCI group：memory（including word recall and word recognition），language（including recall of test instructions，spoken language ability，word-finding difficulty and comprehension of spoken language），ideation（including naming objects and fingers and ideational praxis）and commands，with a cumulative variance interpretation rate of 68.02%. Conclusion：This study confirmed that ADAS-Cog had good item correlation and structural validity in evaluating AD population，but was poor in MCI population.

Abstract:Objective：This study aims to prepare bionic bone scaffolds using 10 times simulated body fluid（10×SBF）mineralized silk fibroin/chitosan（SF/CS）electrospun scaffolds，and to compare the physical properties and the ability of inducing osteogenic differentiation of cells before and after mineralization. Methods：The compositions and properties of the scaffolds before and after mineralization were compared by scanning electron microscopy（SEM），Fourier transform infrared spectroscopy（FT-IR），water absorption and mechanical properties. The effects of biomimetic mineralization on the adhesion and proliferation of human bone marrow mesenchymal stem cells（HBMSC）on scaffolds were compared by living cell staining and Cell Counting Kit-8（CCK-8）. Alkaline phosphatase（ALP）staining and alizarin red staining（ARS）were used to compare the osteoinductive ability of the scaffolds before and after mineralization. Results：SEM，FT-IR，water absorption and mechanical properties confirmed the success of mineralization and the improvement of physical properties. Live cell staining and CCK-8 showed that biomimetic mineralization did not increase the cytotoxicity of the scaffolds. ALP and ARS showed that the scaffolds after mineralization were more likely to induce osteogenic differentiation of HBMSC. Conclusion：SBF biomimetic mineralized scaffolds are more suitable for bone tissue engineering.

Abstract:Objective：This study aims to evaluate the instant and after thermocycling micro-tensile bond strength（μTBS） of three universal dentin adhesives and one 7th generation dentin adhesive under etch-rinse and self-etch strategies. Methods：Total 128 non-carious human third molars were randomly divided into 4 equal groups based on the dentin adhesives（Optibond Versa（OV），All-bond Universal（AU），Single Bond Universal（SU），Adper Easy One（AEO））. Two bonding modes（etch-rinse and self-etch）were employed for each half of each adhesive group. After bounding with resin，half of the specimens were stored in distilled water at 37 ℃ for 24 h and the other half were underwent a 5 000-cycle thermocycling ageing process. Along the long axis，the dentin-resin bonded teeth were sectioned into approximately 0.9 mm×0.9 mm specimens for the micro-tensile bond strength（μTBS） test. Statistical analyses were computed using three-way ANOVA. The resin-dentin interfaces of non-thermocycled specimens were observed by scanning electron microscopy（SEM）. Results：There were 2-factors interactions between thermocycling and adhesives，etch modes and adhesives. After thermocycling or under self-etch strategie，3 universal adhesives had higher μTBS than AEO（P <0.001）. While without thermocycling，the μTBS of OV and AU were higher than AEO，and the μTBS of OV were higher than SU. The μTBS of AU were higher than AEO and SU when under the etch-rinse strategy. Conclusion：Universal adhesives in this study had higher μTBS than the 7th generation adhesive，especially after thermocycling or under self-etch strategy.

Abstract:Objective：This study aims to investigate effects of short-term training on accuracy and precision of jaw and finger movement in healthy Chinese. Methods：Twenty healthy volunteers were recruited in this study. We recorded 10 consecutive jaw and finger movements separately before and after a 30-minute motor training and then calculated and compared their accuracy and precision. Results：Accuracy and precision of jaw and finger movements were significantly improved after short-term training（P＜0.05），and finger movement improved more than jaw movement（P＜0.05）. Conclusion：Short-term training can improve the performance of jaw and finger movement，which demonstrates that neuroplasticity occurs in motor control. Spinally innervated finger movement differs from trigeminally innervated jaw movement in motor learning. Short-term motor training helps to improve finger movement.

Abstract:Retinoblastoma（RB）is the most common ocular malignancy in children. Despite a recently enhanced understanding of the etiology of RB，the mortality associated with it remains high worldwide. Hence，it's urgent to find better treatments. Autophagy is a highly conserved catabolism process in eukaryotes. Studies have shown that autophagy plays a crucial role in the progression of RB，and it is expected to become a new target for RB treatment. This article reviews the role of autophagy in the development and treatment of retinoblastoma，and provides new ideals for clinical treatment of RB.

Abstract:Effectiveness of mesenchymal stem cells in treating osteoarthritis have been proven in animal experiments and clinical studies. More and more evidence indicate that mesenchymal stem cells works primarily through paracrine mechanisms and exosomes play an important role in this process. Exosomes are extracellular vesicles containing a variety of active substances and play a key role in intercellular and intracellular communication. This article reviews the research on the treatment of osteoarthritis by exosomes derived from different mesenchymal stem cells and discusses the future direction. This may provide new ideas for the treatment of osteoarthritis.

Abstract:Diabetes mellitus is a chronic metabolic disease associated with high cardiovascular risk. Sodium glucose transporter 2 inhibitors（SGLT2i）are a new type of hypoglycemic drugs that can inhibit the absorption of glucose from the proximal tubule of the kidney，and then decrease blood sugar. SGLT2i can reduce HbA1c and have good effects on blood pressure，blood lipid，body weight and uric acid. Importantly，numerous clinical trials have demonstrated the cardioprotective effect of SGLT2i in patients with diabetes. The main mechanism is to affect cardiac remodeling，reduce ventricular load，improve cardiomyocyte metabolism and change adipokine production. This article reviews the effect of SGLT2i on the prognosis of cardiovascular disease in patients with diabetes mellitus.