Abstract:Objective：To investigate the effects of venetoclax(ABT-199)combined with decitabine(DAC)and/or aclarubicin(ACM) on the proliferation and apoptosis of acute myeloid leukemia(AML)cell lines(HL60 and KG -1). Methods：HL60 and KG -1 were treated with different concentrations of ABT-199，DAC，ACM，ABT-199+DAC，ABT-199+ACM and ABT-199+ACM+DAC. The cell proliferation was determined by CCK-8 method. Compusyn software was used to analyze whether the drug combinations had synergistic effect. The apoptosis and cell cycle were detected by flow cytometry(FCM). Results：ABT-199，DAC and ACM inhibited the growth of HL60 and KG -1 respectively. The three ways of drug combinations significantly inhibited the cell proliferation of HL60 and KG -1， compared with ABT-199 alone，and all had synergistic effect. The combinations of ABT-199 significantly induced the apoptosis of HL60 and KG-1. The cell cycle was arrested at G2/S phase in HL60 and KG-1 cells treated by DAC，the combination of ABT-199 and DAC，or the combination of ABT-199，ACM and DAC. Conclusion：ABT-199 combinations significantly inhibited the proliferation of AML cell lines and had synergistic effect. ABT-199 combined with ACM and DAC promoted the apoptosis and arrested the cell cycle of AML cells.

Abstract:Objective：To investigate the potential association of 3-hydroxy-3-methylglutaryl-CoA synthase 1(HMGCS1)expression with the prognosis of patients with esophageal squamous cell carcinoma(ESCC)and to explore the biological effects of HMGCS1 on the metastatic ability of ESCL cells. Methods：Tissue samples from 6 patients who underwent ESCC surgeries in our hospital were collected and divided into non-metastatic and lung metastatic groups. Protein spectrum sequencing analysis together with GEPIA database was performed to screen differentially expressed proteins. Western blot and qPCR were used to determine HMGCS1 expression in esophageal epithelial cells and ESCC cells. Immunohistochemical staining was performed to determine HMGCS1 expression in tissue sections from 121 patients with ESCC. Cox proportional survival risk model was enrolled to analyze the survival risk factors of ESCC patients，and multivariate correlation analysis was used for the analysis of the association of HMGCS1 with the clinicopathology of ESCC patients. Furthermore，Kaplan-Meier analysis was employed to analyze the effect of HMGCS1 on the prognosis of ESCC patients. The migration and invasion ability of ESCC cells were detected by scratch and Transwell. Results：We identified 45 significantly up-regulated and 51 down-regulated(including HMGCS1)proteins in the tumor tissues of patients with lung metastasis，compared with those without metastasis. GEPIA verified that HMGCS1 was down-regulated in esophageal cancer. Western blot and qPCR results further validated that HMGCS1 expression in ESCC cells was significantly lower than that in normal esophageal epithelium. Immunohistochemical staining of 121 patients with ESCC confirmed that the expression of HMGCS1 in ESCC was significantly lower than that in normal esophageal tissues. Additionally，the expression of HMGCS1 in patients with lymph node metastasis was significantly lower than that in patients without lymph node metastasis(P ＜ 0.05). Cox survival risk analysis showed that T stage[HR：2.118(1.020~4.399)]，lymph node metastasis[HR：2.127(1.466~5.584)]and low HMGCS1 expression were risk factors[HR：0.413(0.211~0.807)]for survival of ESCC. Multivariate correlation analysis indicated that HMGCS1 expression was significantly correlated with lymph node metastasis. Kaplan-Meier survival analysis demonstrated that patients with low HMGCS1 expression had a poor prognosis. Furthermore，we found that overexpression of HMGCS1 markedly inhibited the migration and invasion ability of ESCC cells(P ＜ 0.05). Conclusion：HMGCS1 could suppress the metastasis of ESCC cells and its expression was positively correlated with the prognosis of ESCC patients.

Abstract:Objective：To study the therapeutic effect of emodin on inflammatory pain induced by complete Freund’s adjuvant (CFA)in mice and its possible molecular mechanism. Methods：CFA was injected subcutaneously on the dorsal side of the right hind paw of C57BL/6 to induce an inflammatory pain model，and emodin solution was injected intraperitoneally for intervention. The pain threshold was evaluated by the von Frey test and the hot plate test. qRT-PCR and ELISA measure the expression of inflammatory cytokines tumor necrosis factor α(TNF -α)，interleukin -1β(IL -1β)and interleukin -6(IL -6). Western blot was used to detect the expression of transient receptor potential vanillic acid 1(TRPV1)and transient receptor potential vanillic acid 4(TRPV4)in dorsal root ganglion(DRG). Results：The mechanical pain and thermal pain thresholds of mice in the CFA group were significantly lower than those of the control group(P ＜ 0.05). Emodin treatment significantly increased mechanical pain and thermal pain threshold in mice with induced inflammatory pain(P ＜ 0.05). Compared with the control group，emodin intervention can not only significantly reduce the inflammatory cytokines TNF-α，IL-1β and IL-6 in DRG and serum of mice with CFA inflammatory pain，but also reduce the expression levels of TRPV1 and TRPV4 in DRG(P ＜ 0.05). Conclusion：Emodin relieves CFA-induced inflammatory pain by reducing the content of inflammatory cytokines TNF-α，IL-1β and IL-6 in DRG and serum，and down-regulating the expression of pain- related ion channels TRPV1 and TRPV4 in DRG.

Abstract:Objective：To investigate the inhibitory effects of puerarin on airway inflammation and Th2 immunity in a murine model of chronic asthma. Methods：Thirty-two female BALB/c mice were randomly divided into four groups，including the control group，the ovabumin(OVA)group，the puerarin group，and the budesonide group，8 mice in each group. In the latter three groups，chronic asthmatic models were established by OVA allergy and activation for 12 weeks. Twenty -four hours after the last airway provocation， acetylcholine(Ach)was administered via caudalis vein to measure airway resistance by pulmonary function detector. The airway inflammation and hypersecretion in the lung were assessed by hematoxylin & eosin(HE)and periodic acid Schiff(PAS)staining， respectively. The levels of interleukin(IL)-4 and IL-13 in bronchoalveolar lavage fluid(BALF)and total immunoglobulin E(IgE)in serum were measured by ELISA. The protein expression of thymic stromal lymphopoietin(TSLP)was determined by Western blot. Results：As compared with the control group，the airway hyperreactivity，airway inflammation，cell count and eosinophil percentage in BALF，levels of total serum IgE and BALF IL-4 and IL-13，and TSLP expression in the lung were significantly increased in the asthma group(P ＜ 0.05). As compared with the asthma group，all the above indices mentioned in the puerarin group and the budesonide group were decreased significantly(P ＜ 0.05). Conclusion：Puerarin alleviates the airway inflammation，hyperresponsiveness，and Th2 immunity by down-regulating the expression levels of TSLP in a chronic experimental asthma.

Abstract:Objective：Screening individuals at high risk of renal cancer by miRNA prognostic model and performing early intervention treatment to improve patient survival. Methods：The models were evaluated by risk survival curve，receiver operating characteristic(ROC)curve and survival status plots based on the Cancer Genome Atlas(TCGA)database，and an independent prognostic analysis was performed to screen prognosis related miRNAs in clear cell renal cell carcinoma. Results：① Preliminary screening of 3613 differentially expressed mRNAs and 49 differentially expressed miRNAs. ②Three miRNAs related to prognosis were screened by univariate and multivariate Cox regression analysis to construct a risk prognostic model，and there were obvious survival differences in the high and low risk groups of the Train group，the Test group，and all samples. The areas under the ROC curve of the 1， 3 and 5-year survival analysis of the 3 groups were all close to or greater than 0.70，and the risk score can be used as an independent prognostic factor. ③In GO analysis，it is mainly concentrated in the development of nephron epithelium and nephron，postsynaptic density，metal ion transmembrane transporter activity，etc. In KEGG enrichment analysis，it is mainly involved in other types of O-glycan biosynthesis and N -glycan biosynthesis. Conclusion：Three miRNA risk prognostic models based on TCGA database can be used as prognostic biomarkers of renal clear cell carcinoma.

Abstract:Objective：To investigate the distribution characteristics of common human leukocyte antigen(HLA)haplotypes in Han population in Chinese Marrow Donor Program(CMDP)Jiangsu Branch from 7 prefecture-level cities in Jiangsu Province. Methods：In this study，11 889 volunteers from CMDP Jiangsu Branch were genotyped at HLA-A/B/DRB1/C/DQB1 loci using PCR-SBT method. HLA haplotypes frequencies of HLA-A-B-C，DRB1-DQB1，A-B-DRB1，A-B-DRB1-C-DQB1 were separately calculated using Arlequin 3.5 from 7 prefecture-level cities in Jiangsu Province，the common HLA haplotypes were statistically analyzed and compared with the published data of Han population in China. The clustering analysis between different populations was conducted by hierarchical clustering method with SPSS software. Results：In the HLA-A-B-C haplotypes，A*30∶01-B*13∶02-C*06∶02 and A*33∶03-B*58∶01- C*03∶02 were the top two common haplotypes in 7 prefecture -level cities of Jiangsu Province. The clustering analysis showed that Nanjing，Yangzhou，Changzhou and Zhenjiang were clustered，and Suqian，Huai’an and Xuzhou were clustered. The top two common haplotypes in HLA-DRB1-DQB1 haplotypes were DRB1*07∶01-DQB1*02∶02 DRB1*09∶01-DQB1*03∶03 in Suqian，Huai’an and Xuzhou，and DRB1*09∶01-DQB1*03∶03，DRB1*07∶01-DQB1*02∶02 were the top two common haplotypes in Changzhou，Yangzhou， Zhenjiang and Nanjing. The clustering analysis showed that 7 prefecture-level cities in Jiangsu Province were clustered into one group. Among the HLA-A-B-DRB1 haplotypes，A*30∶01-B*13∶02-DRB1*07∶01 was the most frequent haplotype in 7 prefecture-level cities of Jiangsu Province，and A*33∶03-B*58∶01-DRB1*03∶01 was the second frequent A-B-DRB1 haplotype in Nanjing，Yangzhou，Huai’ an and Changzhou. The clustering analysis showed that Nanjing，Yangzhou，Changzhou，Heilongjiang and Liaoning were clustered，and Huai’an，Suqian and Xuzhou were clustered. The most frequent HLA-A-B-DRB1-C-DQB1 haplotype was A*30∶01-B*13∶02-DRB1* 07∶01-C*06∶02-DQB1*02∶02 in 7 prefecture-level cities of Jiangsu Province，and the frequency of the haplotypes that containing A* 30∶01-B*13∶02-DRB1*07∶01 gradually decreased from north to south in Jiangsu Province. The clustering analysis showed that Changzhou，Xuzhou and Nanjing were clustered together，and then clustered with Zhenjiang. Huai’an and Suqian were clustered together，and then clustered with Xuzhou. Yueyang，Zhejiang and Guangdong were clustered together. Conclusion：On the whole，the three prefecture-level cities in Northern Jiangsu(Suqian，Huai’an and Xuzhou)are clustered together，and the other 4 cities are clustered together. The HLA haplotype polymorphism in Han population from 7 prefecture level cities of Jiangsu Province is more biased to the Northern China than the Southern China.

Abstract:Objective：To study the effects of surface property and corrosion behavior of pure titanium in a simulated peroxidation microenvironment. Methods：The pure titanium specimens were immersed in different simulated body fluids and divided into Hanks’ balanced salt solution(HBSS)group，HBSS+ bovine serum albumin(BSA)group，HBSS+hydrogen peroxide(H₂O₂)group and HBSS+ BSA+H₂O₂ group. The test samples and soaking solutions after 7 days of immersion were collected，and the titanium surface properties were analyzed by scanning electron microscopy(SEM)and X - ray photoelectron spectroscopy(XPS). An electrochemical potentiostat was used to investigate the corrosion behaviors of pure titanium specimens in different simulated body fluids. The quantities of titanium ion release in soaking solutions of different groups were detected by inductively coupled plasma optical emission spectrometer(ICP - OES). Results：SEM and XPS analysis results demonstrated that the micro - morphology of titanium surface in HBSS + H₂O₂ group changed obviously with significant increases in the contents of titanium and oxygen，whereas there were no remarkable differences in other groups. The Nyquist plots，Bode |Z| diagrams，Bode-phase diagrams and equivalent circuit fitting data obtained by electrochemical test showed that the corrosion resistance of titanium surface oxide film in HBSS+H₂O₂ group was the lowest，followed by HBSS+BSA+ H₂O₂ group，and HBSS+BSA group and HBSS group were the highest. ICP-OES revealed that the release of titanium ions in HBSS+ H₂O₂ group was significantly higher than those in other groups. Conclusion：In the simulated peroxidation microenvironment，H₂O₂ could destroy the oxide film on titanium surface，aggravate the corrosion behavior of titanium and trigger the release of titanium ions. When BSA and H₂O₂ act together，BSA could inhibit the corrosion of titanium surface by H₂O₂.

Abstract:Objective：To summarize the major complications of acute promyelocytic leukemia in children and adolescents and to analyze the risk factors. Methods：Retrospective analysis was performed for children and adolescents with primary acute promyelocytic leukemia admitted to the First Affiliated Hospital of Nanjing Medical University from January 2010 to May 2021. The incidences of various complications were summarized. The risk factors for the occurrence of differentiation syndrome was evaluated with logistic multi- variate regression. Kaplan -Meier survival analysis was used to assesse the cumulative event -free survival(EFS)and overall survival (OS)of the patients. Results：In 43 patients with acute promyelocytic leukemia，the levels of serum ferritin，lactate dehydrogenase (LDH)，interleukin-6(IL-6)and albumin(ALB)in the differentiation syndrome group were significantly higher than those in the non-differentiation syndrome group(P ＜ 0.05). Multivariate logistic stepwise regression analysis showed that WBC_max，serum ferritin， LDH and IL-6 were significantly increased，which were independent risk factors for differentiation syndrome during induction treatment (P ＜ 0.01). There was no significant difference in cumulative OS rate and EFS rate between high - risk group and low - risk group. Conclusion：Various complications including bleeding and differentiation syndrome may be observed during the initial period and duration of therapy for acute promyelocytic leukemia in children and adolescents. Excessive increases of leukocyte count and inflammatory factors such as LDH，serum ferritin and IL-6 after retinoic acid induction therapy are the risk factors for the occurrence of differentiation syndrome.

Abstract:Objective：This study aims to observe the efficacy of dapagliflozin on patients with early diabetic kidney disease(DKD) and the influence on expression of regulatory T cells(Tregs)and inflammatory factors. Methods：Forty-seven patients who developed DKD between August 2019 and December 2019 in the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. On the basis of the original hypoglycemic therapy，all patients were prescribed dapagliflozin 10 mg，qd，orally，for 4 weeks and kept diet and exercise mode unchanged. Fasting plasma glucose(FBG)，glycated albumin(GA)，urinary albumin creatinine ratio(UACR)，24-hour urinary protein and estimated glomerular filtration rate(eGFR)were compared between baseline and 4-week after prescription. The level of Tregs in peripheral blood detected by flow cytometry，the levels of interleukin(IL)-6，IL-1β，tumor necrosis factor(TNF)-β and IL-10 measured by ELISA were also compared. Adverse drug reactions were recorded. Results：After 4 weeks of dapagliflozin treatment，FBG[(8.96 ± 0.83 mmol/L)^vs.(7.42 ± 0.67)mmol/L]，GA[(18.47 ± 3.32)% vs.(15.49 ± 2.62)%]，24 h urine protein quantification [1.14(0.29，2.08)g/24 h vs .0.28(0.15，0.83)g/24 h]，UACR[80(45，150)mg/g vs. 40(30，80)mg/g]and eGFR[(105.30 ± 36.01) mL/(min·1.73 m² )vs.(92.07 ± 35.26)mL/(min·1.73 m² )]were significantly lower than baseline(P ＜ 0.05). However，after 8 weeks of treatment，the eGFR could return to the level before treatment[(104.88 ± 36.86)mL/(min · 1.73 m² )vs.(105.30 ± 36.01) mL/(min·1.73 m² )，P ＞ 0.05]. Compared with baseline，the expression of Tregs was significantly up-regulated[(3.19 ± 0.74)% vs. (5.64 ± 0.93)%，P ＜ 0.05]，the pro-inflammatory factors IL-1β[(7.83 ± 1.39)ng/L vs.(4.57 ± 0.71)ng/L]，TNF-β[(372.85 ± 6.79) ng/L vs.(227.62 ± 7.29)ng/L]，IL-6[(3.99 ± 0.47)ng/L vs.(2.59 ± 1.01)ng/L]was significantly down-regulated(P ＜ 0.05)，and the expression of the anti-inflammatory factor IL-10 was up-regulated[(0.03 ± 0.01)ng/mL vs.(0.05 ± 0.01)ng/mL，P ＜ 0.05]. There were no adverse reactions such as hypoglycemia and ketosis，and 5 patients had asymptomatic urinary tract infection during the treatment period. Conclusion：Dapagliflozin may up-regulate the expression of Tregs to inhibit the inflammatory response and ultimately play a role in renal protection in DKD patients.

Abstract:Objective：This study aims to investigate the variations of urinary iodine concentration(UIC)and urinary creatinine (UCr)in the second and third trimester of pregnancy in Nanjing establish the reference range of UIC/UCr，in order to explore the relationship between UIC/UCr and different degrees of hypothyroidism，and study the feasibility of using UIC/UCr to assess the iodine nutritional status in pregnant women. Methods：A total of 301 pregnant women at 20~28 weeks of gestation in the First Affiliated Hospital of Nanjing Medical University from 2018 to 2020 were recruited，and their thyroid stimulating hormone(TSH)，free triiodothyroxine(FT3)，free thyroxine(FT4)，anti-thyroglobulin antibody(TgAb)，anti-thyroperoxidase antibody(TPOAb)，and anti- thyroxine receptor antibody(TRAb)were detected. UIC and UCr were measured in morning urine. The normal reference range for UIC/ UCr was determined in 137 pregnant women with normal thyroid function and antibody. The iodine nutritional status of pregnant women with hypothyroidism of different degrees was analyzed. Results：①The UIC/UCr reference interval was 106.14~269.75 μg/g in middle and late pregnancy. ②According to our UIC/UCr reference interval，iodine deficiency accounted for 22.59%，iodine adequacy accounted for 48.17%，and iodine excess accounted for 29.24%. ③FT4 decreased with the increase of UIC/UCr，and TSH increased significantly when UIC/UCr exceeded the limit. ④ The proportions of iodine excess in subclinical hypothyroidism and isolated hypothyroxinemia were higher than that of iodine deficiency. Conclusion：Using UIC/UCr instead of UIC to evaluate iodine nutritional status during pregnancy，the iodine deficiency proportion is significantly reduced. UIC/UCr is correlated with TSH and FT4. Iodine should be supplemented carefully according to the UIC/UCr value in subclinical hypothyroidism and isolated hypothyroxinemia.

Abstract:Objective：To explore the relationship between the levels of S100 calcium binding protein，homocysteine(homocysteine， Hcy)and neuron specific enolase(neuronspecificenolase，NSE)in peripheral blood and the absorption of intracranial hematoma and cognitive function in patients with traumatic craniocerebral injury. Methods：A retrospective analysis was made on 74 patients with traumatic craniocerebral injury treated in our hospital from January 2018 to December 2020 as the observation group，and 75 healthy persons who underwent physical examination in our hospital in the same period were selected as the control group. The levels of S100 calcium binding protein，Hcy and NSE in peripheral blood of the two groups were compared. According to the absorption of hematoma and the occurrence of cognitive impairment，the observation group was divided into good absorption group，poor absorption group or cognitive impairment group and non - cognitive impairment group. The levels of S100 calcium binding protein，Hcy and NSE were compared among the groups. The correlation of hematoma absorption and cognitive function with the levels of S100 calcium binding protein，Hcy and NSE in peripheral blood was analyzed. Results：The levels of S100 calcium binding protein，Hcy and NSE in the observation group were significantly higher than those in the control group，the serum levels of S100 calcium binding protein，Hcy and NSE in the good absorption group were significantly lower than those in the malabsorption group，and the serum levels of S100 calcium binding protein，Hcy and NSE were positively correlated and negatively correlated with the absorption level of hematoma，that is，the better the absorption of hematoma，the lower the serum index. The levels of serum S100 calcium binding protein，Hcy and NSE in patients with cognitive impairment were significantly higher than those without cognitive impairment，and there was a positive correlation between cognitive impairment and serum levels of S100 calcium binding protein，Hcy and NSE(P ＜ 0.05). Conclusion： The hematoma absorption and cognitive function of patients with traumatic craniocerebral injury are significantly correlated with the levels of S100 calcium binding protein，Hcy and NSE in peripheral blood，which is helpful for the clinical diagnosis and treatment of the disease.

Abstract:Objective：To describe the intra-individual variation of plasma aldosterone concentration(PAC)and aldosterone to renin ratio(ARR)，and to investigate the current situation where positive rate of primary aldosteronism(PA)is based on cut - off values guideline recommended. Methods：Eighty PA patients diagnosed in the Department of Endocrinology，the First Affiliated Hospital of Nanjing Medical University from April 2017 to March 2021 who have 2~4 separated PAC and ARR results on different date were enrolled to calculate the intra-individual coefficient of variation(CV)and percentage difference of PAC and ARR. The percentage of PA patients with single average PAC and ARR below the recommended{PAC＜10，15，20 ng/dL；ARR＜20，25，30(ng/dL)[/ ng/(mL·h)]} were analyzed. Results：Totally 182 plasma rennin activity(PRA)and PAC measurements from 80 subjects were collected. CV of PAC and ARR was 19.74% and 26.11% respectively，the percentage difference was 41.78% and 52.22%. 35.0%，75.0%，93.7% subjects had at least one measurement of PAC lower than 10，15，20 ng/dL respectively；10.0%，37.5% and 72.6% subjects had at least twice PAC lower than 10，15，20 ng/dL respectively. 17.5%，26.3%，36.3% subjects had at least one ARR lower than 20，25，30(ng/dL)[/ ng/(mL·h)] respectively；5.0% ，6.3% ，6.3% subjects had at least twice ARR lower than 20，25，30(ng/dL)[/ ng/(mL · h)]respectively. Conclusion：The PAC and ARR in PA vary greatly in individuals on account of multiple factors. The proportion of single screening values below the positive cut - off values guideline recommended is relatively high，which may lead to false negative rate of PA screening. For suspected patients，screening repeatedly，recalibrating PA screening cut - off point and bringing wider PAC and ARR screening thresholds can improve PA diagnosis rates significantly.

Abstract:Objective：To investigate the distribution characteristics of oropharyngeal microbiota and the effects of different feeding methods on oropharyngeal microbiota colonization of healthy full term newborns in early -life. Methods：A total of 20 healthy term infants delivered between September 2021 and February 2022 at Shanghai Pudong New Area Health Care Hospital for Women and Children were recruited. According to feeding methods，infants were respectively divided into two groups，which were exclusively breastfeeding(n=8)and mixed-feeding(n=12). Oropharyngeal swab samples of all subjects were collected on the first day and day 5-7 after birth. The V3~V4 region of 16S rRNA gene was sequenced on Illumina Miseq^TM/Hiseq^TM platform，and the results were analyzed by bioinformatics. Results：①36 phylum，84 class，144 order，292 family and 736 genus were identified in the 40 oropharyngeal swab samples. ②From day 1 to day 5~7 after birth，the relative abundance and diversity of oropharyngeal microbiota decreased gradually， and the differences between individuals decreased significantly. The α diversity of oropharyngeal microbiota in the exclusive breastfeeding group was lower than that in the mixed-feeding group. ③At the phylum level，Proteobacteria，Firmicutes，Actinobacteria and Bacteroidetes were the main phyla in different feeding groups. However，there was no significant difference in the four dominant phyla between two groups(P ＞ 0.05). Compared with day 1，the relative abundance of Firmicutes(P=0.008)，Actinobacteria(P=0.844)and Bacteroidetes(P=0.250)increased，but Proteobacteria decreased(P=0.055)on day 5~7 in the exclusive breastfeeding group；while Firmicutes(P ＜ 0.001)and Actinobacteria(P=0.733)increased，but Proteobacteria(P＜0.001)and Bacteroidetes(P=0.027)decreased in the mixed-feeding group. ④At the genus level，Bradyrhizobium，Staphylococcus，Acinetobacter，Burkholderia and Streptococcus were the main genera on day 1，while with the passage of birth time，Streptococcus，Staphylococcus，Bacteroides，Rothia and Bifidobacterium became the main genera at day 5~7. Streptococcus and Staphylococcus were the dominant genera in different feeding groups，and the abundance of Bacteroides，Rothia，Bifidobacterium and other anaerobes in exclusive breastfeeding group was higher than that in mixed- feeding group. Conclusion：The diversitly of oropharyngeal microbiota decrease gradually and the stability increased gradually in the early life of newborns. Different feeding methods have certain effects on the colonization and distribution of oropharyngeal microbiota in early life. Exclusive breastfeeding is helpful for the early colonization of anaerobes in the oropharynx of newborns.

Abstract:Objective：To analyze and summarize the treatment status and the incidence of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI)and extremely preterm infants(EPI)in the latest 3 years. Methods：A retrospective analysis was performed in 547 premature infants，with gestational age less than 32 weeks and survival time≥28 days，who were admitted to Neonatal Medical Center of Children’s Hospital of Nanjing Medical University from January 2018 to December 2020. According to clinical diagnosis， they were divided into BPD group(n=126)and non -BPD group(n=421). The two groups were compared comprehensively，and the clinical data and incidence of BPD among the latest 3 years were compared and summarized. Results：The gestational age of the BPD group was 28.57±1.49 weeks，and the EPI with gestational age less than 28 weeks accounted for 31.7%，while that of the non -BPD group was 30.05±1.39 weeks，and the EPI was only 8.1%(P ＜ 0.05). The birth weight of BPD group was 1132.18±251.25 g，and the extremely low birth weight(ELBW)infants with birth weight ＜ 1 000 g accounted for 28.6% ，while that of non-BPD group was 1384.47±267.44 g，and ELBW infants only accounted for 6.4%(P ＜ 0.05). The proportion of 5 min Apgar score ≤ 7 and resuscitation in the delivery room were significantly higher in BPD group(P ＜ 0.05). The first dose of the pulmonary surfactant was significantly higher(P ＜ 0.05)and the rate of usage times ≥ 2 times was lower(P ＜ 0.01)in the non -BPD group. The the proportion of invasive mechanical ventilation and non-invasive ventilation，duration of ventilation and incidence of pulmonary hemorrhage were significantly increased in BPD group(P ＜ 0.001). The length of hospitalization was significantly longer and total cost was higher in BPD group (P ＜ 0.05). Longitudinal analysis showed the total incidence of BPD was 23.0% in three years，while it was 28.8% in 2019 and 15.3% in 2018(P ＜ 0.05)，there were no significant differences in the proportion of invasive mechanical ventilation，EPI and ELBW(P ＞ 0.05)， but the ELBW in 2018 was significantly higher than other years(P ＜ 0.05). Conclusion：It is necessary to monitor and track the early situation of EPI and ELBW，and pay more attention to the standardized application of PS in the early stage，to further reduce BPD and improve the prognosis greatly.

Abstract:Objective：To investigate what factors could affect the accuracy of preoperative ^99m Tc-methoxy isobutylisonitrile(^99m Tc-MIBI) imaging in patients with secondary hyperparathyroidism(SHPT). Methods：The clinical characteristics of 482 renal SHPT patients undergoing surgical treatment in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Postoperative pathology was used as control，different imaging schemes(Group A：only ^99m Tc-MIBI dual-phase plane imaging；Group B： group A plus early phase SPECT/CT)were compared. In addition，patients in group B were divided into completely identified group and partly identified group，and the effects of clinical characteristics on MIBI imaging were analyzed. Results：In general，the sensitivity，specificity and diagnostic consistency of group B were higher than that of group A(81.9% vs. 70.3%；97.1% vs. 60.0%； 82.2% vs. 69.9%；99.9% vs. 97.9%，P ＜ 0.01 respectively). However，there was no significant difference in negative predictive value (6.8% vs. 10.2%，P ＞ 0.05). Serum phosphorus ion level was an independent risk factor for predicting false negative MIBI imaging (OR=0.57，95% CI：0.372~0.866，P=0.007). The risk of misdiagnosing on ^99m Tc - MIBI dual - phase plane imaging plus early phase SPECT/CT was increased when the level of serum phosphorus ion was lower than 1.97 mmol/L. Conclusion：^99m Tc -MIBI dual -phase plane imaging plus early phase SPECT/CT can improve the sensitivity and accuracy of hyperfunctional parathyroid tissue detection in SHPT patients. The judgment of imaging results should be combined with the level of serum phosphorus ion. When the level of serum phosphorus ion is lower than 1.97 mmol/L，imaging doctors and clinicians should concentrate on the possibility of misdiagnosing hyperfunctional parathyroid.

Abstract:Objective：To investigate the value of the texture analysis based on preoperative enhanced CT in predicting the histopathological differentiation of pancreatic ductal adenocarcinoma(PDAC). Methods：Pathological data of 66 patients with PDAC from January 2017 to October 2020 were retrospectively collected，other 34 PDAC patients from other hospital were used for external validation cohort，and they were divided into two groups according to postoperative pathological results：high differentiation and moderately - poorly differentiation. The clinical and conventional imaging characteristics such as gender，age，tumor site，maximum tumor diameter，tumor enhancement and vascular invasion were recorded for univariate regression analysis. ROI based on both arterial phase and venous phase of the preoperative enhanced CT was automatically drawn by ITK -SNAP software and texture features were extracted. Univariate analysis was used to compare the texture features between the two groups，and the texture features with statistical difference were included in binary logistic regression model，and the prediction model of arterial phase and venous phase were established respectively. The prediction model established by the training group is directly applied to the external validation group. The AUC values of ROC were used to evaluate the diagnostic value of prediction model. Results：One and two texture features were selected to construct prediction model respectively based on the CT arterial and venous phase，including run entropy，zone percentage and size-zone non-uniformity. The AUC，sensitivity and specificity were 0.716，0.581，0.824，0.722，0.600，and 0.765 in the training group and the validation group based on the CT arterial texture feature model respectively. The AUC，sensitivity and specificity of the CT venous texture feature model in the training group and the validation group were 0.895，0.781，0.882，0.873，0.722，0.929， respectively. Conclusion：There are differences in the characteristic parameters of texture analysis of CT enhanced images between highly and moderately-poorly differentiated pancreatic ductal adenocarcinoma，providing a new method for preoperative evaluation of the malignant degree of pancreatic ductal adenocarcinoma carcinoma.

Abstract:Gastric cancer is one of the most common malignant tumor in the world. The prognosis is relatively poor due to the lack of early diagnostic markers and drug resistance to existing treatment options. The study of novel methods of cell death is expected to provide new targets for the diagnosis and treatment of gastric cancer. At present，novel cell death methods in gastric cancer include ferroptosis，pyroptosis，necroptosis，autophagy，lysosome - dependent cell death and NETosis，all of which belong to programmed cell death. In order to provide theoretical bases and research directions for the diagnosis and targeted therapy of gastric cancer，this article reviews the relationships between gastric cancer and cell death methods.

Abstract:Obesity is increasing rapidly among children and adolescents in China，which is associated with multiple obesity complications，the risk of obesity and related complications in adulthood，and reduction of life expectancy. Nowadays，no medication is approved for weight loss in children and adolescents in China. Metabolic surgery has been considered as weight loss treatment for children and adolescents with moderate to severe obesity when lifestyle interventions are ineffective. Studies in China and other countries have shown that children and adolescents with moderate and severe obesity achieved substantial weight loss after metabolic surgery，accompanied with improvement，even reversal of obesity - related complications such as type 2 diabetes，dyslipidemia and hypertension，etc. and similar perioperative complication as adults. Postoperative appropriate nutrient supplement and monitoring are beneficial to reduce the long - term malnutrition complications，and patients’mental health also need to be monitored. This article reviewed the development of metabolic surgery in children and adolescents in China and abroad，and also indications， contraindications，surgical procedures and follow-up requirements.

Abstract:Malnutrition is an independent risk factor affecting the outcome of patients with liver cancer. The key to improve malnutrition in patients with liver cancer is to take effective assessment tools as early as possible to detect and timely intervene. This article reviews the clinical application of commonly used nutrition assessment tools and methods in the treatment of liver cancer patients to provide reference for the selection of nutrition assessment for such patients.