Abstract:Objective：To investigate the relationship between TLR2/NF-κB signaling pathway and the apoptosis and autophagy dysfunction of RSC96 cells induced by 1-methyl-4-phenyl-pyridinium（MPP⁺ ）. Methods：RSC96 cells were divided into the PBS group， MPP ⁺ group，and MPP ⁺ + CU-CPT22 group. Cell survival rate was detected using CCK-8 after treatment with different MPP ⁺ concentrations（0.1，0.3，0.5，0.7，0.9 mmol/L）. Cell apoptosis was detected by TUNEL staining. RT-qPCR was performed to detect the TLR2 mRNA level. Western blot was performed to detect the expression levels of apoptosis related indicators Bcl-2/Bax，cleaved caspase-3/caspase-3，autophagy-related indicators LC3II/LC3I and P62，as well as TLR2 and p-NF-κB/NF-κB. Results：Compared with the PBS group，the cell viability of the MPP ⁺ group decreased in a concentration-dependent manner，the number of TUNEL-staining positive cells increased，the ratio of Bcl-2/Bax decreased while cleaved caspase-3/caspase-3 ratio increased，as well as had a decrease in the ratio of LC3Ⅱ/LC3Ⅰ and an increase in P62 and p -NF -κB/NF -κB ratio elvel. RT -qPCR and Western blot results showed that MPP ⁺ upregulated the expression of TLR2. In addition，compared with the MPP ⁺ group，the MPP ⁺ + CU-CPT22 group showed a decrease in the number of TUNEL-staining positive cells，an increase in Bcl-2/Bax level，and a decrease in cleaved caspase-3/ caspase-3 ratio. Meanwhile，LC3 Ⅱ/LC3 Ⅰ ratio was increased，and the P62 expression level was decreased. Conclusion：MPP ⁺ stimulation induced apoptosis and the imbalance of autophagy in RSC96 cells，and the mechanism may be related to the activation of the TLR2/NF-κB signaling pathway.

Abstract:Objective：To explore the potential damage effects and related mechanisms of clozapine（CLP）on the heart development of zebrafish. Method：12.5 μmol/L CLP（L -CLP）and 25.0 μmol/L CLP（H -CLP）were used to culture zebrafish embryos for 72 hours， respectively. The heart morphology，heart rate，and the distance between venous sinus and arterial bulb（SV -BA）were observed under microscope；The expression of cardiac development-related genes NKX2.5，Hand2 and Cmlc2 were detected by fluorescence quantitative PCR；In addition，after 24 hours of culture，the endoplasmic reticulum inhibitor 4-phenylbutyric acid（4-PBA）or dopamine D2 receptor inhibitor bromocriptine（BRC）were added to the H-CLP group for 48 hours. Then，we counted the cardiac function indicators，and detected the expression of endoplasmic reticulum stress genes（Chop、Bip）and apoptosis-related genes（Caspase3，Bax/Bcl2）. Results： CLP induced damages of cardiac structure and function in a dose-dependent manner，induced the expression of Chop and Bip，and further increased the expression of Caspase3 and Bax/Bcl2. 4-PBA and BRC significantly alleviated CLP-induced cardiac injury and decreased the expression levels of Chop、Bip、Caspase -3 and Bax/Bcl2. Conclusion：CLP can damage the heart development of zebrafish，and the mechanism may be related to inhibiting dopamine D2 receptor and stimulating endoplasmic reticulum stress.

Abstract:Objective：To compare the effects of three main active components of cortex dictamni namely obacunone，dictamnine， and fraxinellone，in the treatment of atopic dermatitis（AD）and explore their mechanisms. Methods：The AD mouse model was established using 2，4-dinitrofluorobenzene（DNFB），and the effects of ethanol extract of cortex dictamni，obacunone，dictamnine， fraxinellone，and dexamethasone on chronic itch induced by AD in mice were observed. The severity degree of skin lesions in mice was evaluated using a skin lesion scoring system. Hematoxylin-eosin（HE）and toluidine blue staining were used to evaluate epidermal thickness and mast cell count in mice. Enzyme-linked immunosorbent assay（ELISA）was used to detect the levels of interleukin（IL）-4， IL -31，and IL -10 in mouse skin lesions. Western blot was used to detect the protein levels of Janus kinase（JAK1），phosphorylated JAK1（p-JAK1），signal transducer and activator of transcription（STAT）3，p-STAT3，STAT6 and p-STAT6. Results：Chronic itch induced by AD in mice was significantly inhibited by the ethanol extract of cortex dictamni. Compared with the model group，two of the three main active componentsof Cortex dictamni，namely dictamnine and fraxinellone，significantly inhibited the chronic itch induced by AD in mice，improved skin lesion symptoms and inflammatory cell infiltration，downregulated the levels of IL-4 and IL-31， upregulated the levels of IL-10，and inhibited the JAK1-STAT3/STAT6 signaling pathway. However，there was no significant difference between the obacunone group and the model group. Conclusion：Dictamnine and fraxinellone may be the main active components of cortex dictamnitoin exerting anti-dermatitis effect.

Abstract:Objective：To explore the pulmonary microbiome characteristics of adolescent mice model of bronchopulmonary dysplasia（BPD）. Methods：Thirty-two C57BL/6J neonatal mice were divided into air female group，air male group，hyperoxic female group，and hyperoxic male group，with 8 mice in each group. The mice in the hyperoxic group were placed in the environment with FiO₂>95% for 7 days immediately after birth，and the mice in the air group were placed in the same indoor air with FiO₂=21%. All mice were then raised in indoor air environment until 6 weeks. The pathological changes of lung tissues were observed by hematoxylin-eosin staining（HE）. The characteristics of pulmonary microbiome were analyzed by 16S rDNA sequencing. Results：The alveolation degree of lung tissue decreased in early hyperoxygen exposure group（P < 0.01）. Two-factor ANOVA showed that radial alveolar count（RAC） had no significant difference between sex in mice（F=2.001，P > 0.05）. The results of Anosim similarity analysis showed that there was statistical significance in pulmonary microbiome of male mice in the air group and the high oxygen group（r=0.906，P=0.03），while there was no statistical significance in the female mice（r=- 0.0938，P=0.722）.Alpha diversity results showed that there was no statistical difference in the species richness of lung flora between the high oxygen group and the air group（P > 0.05），and in the analysis of Beta diversity，PCoA diagram showed that there were statistical differences in lung flora among the four groups（P < 0.05）. LEfSe analysis showed that the abundance of Corynebacterium in the high oxygen group decreased and Staphylococcus increased. Conclusion：The lung microbiota of adolescent mice in the BPD model are disregulated，with a decrease in the abundance of Corynebacterium，and an increase in Staphylococcus，and the microbiota imbalance might be related to gender.

Abstract:Objective：To explore the related risk factors and predictive value ofacute hydrogen sulfide（H₂S）poisoning combined withcentral nervous system（CNS）injury. Methods：Acute H₂S poisoning patients withmoderate to severe conditions who were treated in multiple hospitals from January 1，2018，to April 30，2023 were recruited. Based on whether CNS injury was present，the gender，age， laboratory test results，30- day mortality，and neurological function prognosis were analyzed to investigatethe relevant risk factors for acute H₂S poisoning combined withCNS injury. The receiver operating characteristic（ROC）curve was used to analyze the efficacy of Lactate（Lac）and neuron-specific enolase（NSE）in predicting acute H₂S poisoning combined with CNS injury. Results：Compared with the non-CNS injury group，the CNS group has higher H₂S exposure concentration，significantly decreased systolic blood pressure， median glascow score and oxygenation indexupon admission，and significantly increased heart rate. The CNS injury group had a significantly higher incidence of acute respiratory distress syndrome（ARDS）and myocardial injury after admission. The30-day mortality rate was 50%，and the number of patients with mRS score > 2 was significantly increased. In addition，the analysis found that the levels of Lac and NSE upon admission were significantly higher in the CNS group compared to the non-CNS injury group，and the differences were statistically significant. The ROC curve showed that the combination of Lac and NSE was more effective in predicting acute H₂S poisoning combined with CNS injurythan a single index，with an area under curve（AUC）of 0.948. Conclusion：Patients with acute H₂S poisoning combined with CNS injury have increased incidence of ARDS and myocardial damage，increased 30-day mortality rate，and poor neurological prognosis. In addition，the early elevation ofserum Lac and NSE levels has higher clinical value in evaluating acute H₂S poisoning combined with CNS injury.

Abstract:Objective：To retrospectively analyzethe incidence，risk factors，and prognosis of ventricular fibrillation/ventricular tachycardia（VF/VT）within 72 hours of extracorporeal cardiopulmonary resuscitation（ECPR）in patients supported by extracorporeal membrane oxygenation（ECMO）. Methods：ECPR patients admitted to the Emergency Center of the First Affiliated Hospital of Nanjing Medical University from January 2017 to March 2023 were included. Patientswere divided into VF/VT group and nVF/VT group according to the occurrence of VF/VT within 72 hours of ECMO support. risk factors for VF/VT during ECMO support were analyzed through regression analysis，and the impact of VF/VT on clinical prognosis was explored. Results：A total of 95 patients with a mean age of（50.02±15.93）years were enrolled，with males accounting for 66.32%. The 28-day survival rate was 51.58%，and the incidence of VF/VT was 33.33%. Comparison among groups showed that the nVF/VT group had a higher rates of continuous renal replacement therapy，longer ECMO initiation time，and higher lactic acidlevels compared tothe VF/VT group.Troponin T（TnT）levels showed a trend of being higher in the VF/VT group，while the pH value was significantly lower in the VF/VT group compared to the nVF/VT group. Stepwise multivariable logistic regression analysis showed that the risk of maintaining high TNT levels significantly increased after VF/ VToccurrence，with an odds ratio（OR）of 18.156（95%CI：3.620-91.059）. Prolonged ECMO initiation time（OR=1.118，95%CI：1.060- 1.180）and decreased pH value（OR=0.005，95%CI：0.000-0.953）were identified as independent risk factors for VF/VT occurrence. Conclusion：In patients with ECPR，the risk of VF/VT occurring within 72 hours of ECMO support issignificantly increased in patients with severe acidosis or prolonged ECMO initiation time. The onset of VF/VT does not affect the clinical prognosis but may exacerbate myocardial injury.

Abstract:Objective：To evaluate the volume status and its impact on prognosis in heart failure patients with reduced ejection fraction（HFrEF）. Methods：Prospective and consecutive patients hospitalized in Department of Cardiology of the First Affiliated Hospital of Nanjing Medical hospital due to the diagnosis of HFrEF from 2017 to 2022 were enrolled. Estimated plasma volume（PV） was used to assess the patient’s volume load status，and divide the patients into low，medium，and high-volume load groups based on tertiles methods. Correlation analysis was used to evaluate the correlation between PV and classic volume load markers；Kaplan-Meier method was used to plot survival curves，and both univariate and multivariable COX regression analysis were performed to evaluate the correlation between volume load status and prognosis of HFrEF. Results：This study included 233 patients with an estimated PV of （4.26 ± 1.08）L. There is a clear correlation between PV and pro B-type natriuretic peptide（proBNP）. After a median follow-up of 25 months，90 patients experienced cardiovascular death and worsening heart failure requiring readmission. After adjusting for multiple factors including age，systolic blood pressure，proBNP，renal function，and New York Heart Association（NYHA）grading，compared to the low -volume load group，the medium and high volume load groupshad a hazard ratio of 1.78（0.94-3.36）and 2.74（1.45-5.16）， respectively，for cardiovascular death and worsening heart failure. Conclusion：The assessment of volume load status in patients with HFrEF shows that high-volume load is an independent risk factor for the prognosis of HFrEF patients.

Abstract:Objective：To investigate the safety and efficacy of immune checkpoint inhibitors（ICIs）received by real-world lung cancer patients. Methods：In this multi-center retrospective study，the clinical data of 1 022 lung cancer patients treated with ICIs from January 1，2018，to September 31，2022，in four hospitals were analyzed. Results：Among the included population，577 patients （56.5%）experienced varying degrees of immune-related adverse events（irAEs）. The most common systems affected were the endocrine system（41.4%），lungs（14.5%），and heart（13.5%）. Comparing the clinical characteristics between the two groups， significant differences were observed in Eastern Cooperative Oncology Group（ECOG）performance status，PD-L1 expression，lung cancer pathology type，history of epidermal growth factor receptor tyrosine kinase inhibitor therapy，tobacco and alcohol habits，and previous chronic diseases（all P < 0.05）. Patients who experience irAEs had a higher disease control rate（95.8% vs. 89.6%，P < 0.001） and longer median progression-free survival（11.1 months vs. 9.4 months，log-rank P < 0.001）compared to those who did not experience irAEs. Conclusion：In the real world，the incidence of irAEs in lung cancer patients treated with ICIs is relative high，with extensive involvement and many influencing factors，but most cases are mild. The incidence of irAEs may be associated with better disease control rates and progression-free survival.

Abstract:Objective：To evaluate the clinical efficacy and safety of inetetamab-based therapy in patients with human epidermal growth factor receptor 2（HER2）positive metastatic breast cancer（MBC）. Methods：A retrospective analysis of the clinical data of 60 patients with HER2 positive MBC who received inetetamab-based therapy in Jiangsu Provin Hospital from July 2020 to December 2022 was conducted. The progression-free survival（PFS），overall survival（OS），objective response rate（ORR）and disease control rate （DCR）of patients treated with inetetamab therapy were analyzed. Results：A total of 60 patients with HER2 positive MBC over all lines of treatment with inetetamab were enrolled（one，n=9；two，n=14；three，n=13；four or higher，n=24），in cluding 24 cases of inetetamab combined with chemotherap 32 cases of inetetamab plus pyrotinib and chemotherapy，and 4 cases of inetetamab combined with other drug regimens. At the end of follow up，the median PFS of the 60 patients was 6.23 months. The median PFS of patients who received inetetamab-based therapy as a first-or second -line therapy was significantly longer than third or later line，12.27 vs. 5.63 months. Compared with treatment in combination with chemotherapy，combination with pyrotinib and chemotherapy provided a better PFS（7.73 vs. 4.60 months）. The ORR and DCR were 35.0% and 81.7%，respectively. The most common adverse events were anemia， leucopenia and neutrocytopenia. Conclusion：Inetetamab，especially in combination with pyrotinib and chemotherapy，has a significant efficacy and good safety in patients with HER2 positive MBC.

Abstract:Objective：To evaluate and analyze the risk factors associated with tracheal lymph node metastasis in patients with papillary thyroid carcinoma（PTC），as well as the predictive ability of pretracheal lymph node involvement for tracheal lymph node metastasis. Methods：A retrospective analysis was conducted on the data of 645 patients who underwent surgical treatment for PTC in our hospital. According to the surgical indications and resection scope recommended in the Chinese Thyroid Cancer Diagnosis and Treatment Guidelines（2022 edition），thyroidectomy and lymph node dissection were performed based on preoperative palpation， ultrasound examination，and fine-needle aspiration biopsy results. Results：Among the 645 cases，215 cases（33.3%）were pathologically confirmed to have tracheal lymph node metastasis after surgery. Univariate analysis suggested that tracheal lymph node metastasis was associated with age <45 years，maximum tumor diameter ≥1 cm，intraglandular spread，extraglandular invasion， multifocal lesions，involvement of both lobes，and pretracheal lymph node metastasis. Multivariate analysis indicated that age <45 years and pretracheal lymph node metastasis were independent risk factors for tracheal lymph node metastasis. The sensitivity，specificity， positive predictive value，negative predictive value，and accuracy of pretracheal lymph node involvement in predicting tracheal lymph node metastasis were 21.4%，93.7%，63.0%，70.5%，and 69.6%，respectively. Conclusion：In young patients with PTC and pretracheal lymph node metastasis，careful evaluation of tracheal lymph node status is necessary. Pretracheal lymph node involvement has a certain predictive role in tracheal lymph node metastasis. Assessing pretracheal lymph nodes can help formulate strategies for managing tracheal lymph nodes，but more evidence from evidence-based medicine is still needed to facilitate better decision-making.

Abstract:Objective：This study aims to investigate the effects of intraoperative neuromonitoring（IONM）on postoperative voice outcomes of by differentiated thyroid cancer（DTC）. Methods：We assessed patients with DTC underwent thyroid surgery in the First Affiliated Hospital of Sun Yat-sen University from September 2018 to March 2019. According to whether IONM was used or not，the patients were divided into IONM group and non-IONM group. Clinicopathological characteristics and voice outcomes between IONM and non-IONM patients with DTC were compared using propensity score matching（PSM）. Results：In the whole population and the subgroup of lymph node dissection in the prevention center，there was no statistical difference between the two groups in the total score of the voice handicap index-10（VHI-10）and the voice field of the thyroid cancer specific quality of life（THYCA-QoL）questionnaire 1 and 6 months after surgery（P>0.05）. In the subgroup of approaching or invading the posterior capsule，the median（quartile）THYCA- QoL voice score in the IONM group at 1 month and 6 months after surgery was 0.00（0.00，0.00）lower than in the non-IONM group 0.00 （0.00，33.33），（P=0.034）. The score of THYCA-QoL in the IONM group was 5.73 lower than that in the non-IONM group 15.66（P= 0.029）. There was no statistical difference in the VHI-10 questionnaire. Conclusion：IONM has no significant effect on subjective phonation disorder in patients with DTC and subgroup patients with preventive central lymphadenectomy. However，it can significantly improve the subjective voice abnormalities of patients in the approaching or invading the posterior capsule subgroup after surgery.

Abstract:Objective：To establish an effective method for predicting intracranial pressure（ICP）by measuring optic sheath diameter （ONSD）using ultrasonography. Methods：52 patients with severe neurological conditions were continuously monitored for postoperative invasive ICP. The mean diameter of the optic nerve sheath in vertical and horizontal directions was measured by transorbital ultrasound. The diagnostic efficacy of ONSD in intracranial hypertension was analyzed by receiver operating characteristic （ROC）curve，and the sensitivity and specificity of the method were evaluated. Results：The mean binocular ONSD（5.27±0.47）mm was well correlated with invasive ICP（11.77±6.18）mmHg in all patients（r=0.79，P < 0.01）. ROC curve showed that the ONSD cutoff for detecting intracranial hypertension（ICP≥20 mmHg）was 5.625 mm，with a sensitivity of 74.3% and a specificity of 90.4% . Meanwhile，the ONSD cutoff corresponding to ICP 5，10，15 and 25 mmHg were 5.175，5.325，5.375 and 5.825 mm. Conclusions： Bedside ultrasound measurements of ONSD through orbit can determine changes of ICP，especially in the case of invasive ICP or limited imaging examinatior in patients with severe neurological conditions . The ICP can be evaluated dynamically，quickly and non- invasively，which has significant clinical application value and is worthy of promotion.

Abstract:Objective：To analyze the urinary tract infection situation，pathogens，and drug resistance characteristics in male urethral stricture patients. Methods：Male patients with urethral stricture admitted to our hospital from January 2021 to August 2022 were enrolled. Clinical data and laboratory test results were collected to analyze the urinary tract infection，pathogen distribution，and drug resistance situation in the patients. Results：A total of 187 male urethral stricture patients were included，with132 cases（70.6%） experiencing urinary tract infections. Microbiological testing revealed positive urine cultures in 106 cases（56.7%）. A total of 111 strains of isolated pathogens were cultured，including 42 strains of Gram-positive bacteria，accounting for 37.8% ，mainly Staphylococcus epidermidis and Enterococcus faecalis，with resistance rate to levofloxacin exceeding 70% and sensitivity rates to vancomycin，tigecycline and nitrofurantoin all at 100%；63 strains of Gram-negative bacteria，accounting for 56.8%，mainly Escherichia coli and Klebsiella pneumoniae，with resistance rate to cefotetan，tobramycin，meropenem，piperacillin/tazobactam，imipenem，and amikacin all below 30%；and 6 strains of fungi，accounting for 5.4%，mainly Candida glabrata. The proportion of patients aged 40-65 years and those with suprapubic catheter in the urinary tract infection group was significantly higher than that in the non-infection group （P < 0.05）.Conclusion：The incidence of urinary tract infection is high in male urethral stricture patients，with the main pathogens being E.coli and S.epidermidis. The drug resistance of the pathogens is relatively strong. Antimicrobial agents should be used rationally according to drug sensitivity before surgery.

Abstract:Objective：To investigate the immediate effects of vagal nerve stimulation（VNS）on the brain functional connectivity of patients with drug-resistant epilepsy（DRE）and explore the mechanism by whichVNS inhibits epileptic seizures. Methods： Magnetoencephalography（MEG）data were collected from 14 healthy subjects in a resting state and from 14 DRE patients in both resting and stimulated states. The changes in brain functional connectivity induced by immediate VNS were analyzed in six frequency bands. Results：In the resting state，DRE patients showed significantly enhanced functional connectivity compared to healthy subjects. When VNS occurred，DRE patients exhibited significantly reduced functional connectivity，including the connections between the left middle frontal gyrus and the right olfactory cortex and the connections between the left thalamus and the surrounding cortex of the right calcarine fissure in the theta frequency band，and the connections between the left thalamus and the left temporal polar middle temporal gyrus in the alpha frequency band. Conclusion：Immediate VNS can reduce the brain functional connectivity of DRE patients，thereby reducing the vulnerability of the brain network to seizures. This might be an important mechanism by which VNS modulates the inhibition of epileptic seizures in DRE patients.

Abstract:Objective：To retrospectively analyze the difference of clinical outcomes related indicators between patients with polycystic ovary syndrome（PCOS）and non -PCOS after assisted pregnancy by in vitro fertilization embryo transfer（IVF -ET），and to clarify the risk of miscarriage in the infertile population with PCOS after receiving IVF-ET treatment. Methods：A retrospective analysis was conducted on 655 PCOS patients with clinical single pregnancy after the first IVF-ET assisted pregnancy at the Reproductive Medical Center of Nanjing Drum Tower Hospital，affiliated with Nanjing University Medical College from April 2016 to April 2021.Clinical data of patients with infertility due to tubal factors during the same period were also analyzed. Propensity score matching（PSM）was used to performed a 1∶1 matching based on age and body mass index（BMI）. The assisted reproduction outcomes and miscarriage rates were compared between the two groups，and a subgroup analysis based on BMI was conducted within the included population. Results：Compared to the non-PCOS group，the PCOS group required higer doses and a longer duration of gonadotropins Gn during IVF cycles. The levels of serum follicle-stimulating hormone（FSH），luteinizing hormone（LH），and progesterone（P）on the day of human chorionic gonadotropin（hCG）trigger were lower than in the non-PCOS group（P < 0.05）. However，there was no significant difference in early and late miscarriage rates between the two groups（P > 0.05）. Subgroup analysis based on different BMI ranges showed that different BMI levels did not have an impact on the miscarriage rates of the patients. The miscarriage rates were similar in each BMI subgroup of the two groups，and the difference was not statistically significant（P > 0.05）.Conclusion：PCOS has no effect on the miscarriage of patients who received IVF-ET assisted reproductive therapy for the first time and got single pregnancy infertility；PCOS patients who first received IVF-ET assisted pregnancy treatment tend to receive single blastocyst transfer，which can obtain a relatively stable pregnancy outcome.

Abstract:Objective：To observe the effects of sustained inhalation of low concentrations of oxygen and pure oxygen on perioperative myocardial injury in patients undergoing off-pump coronary artery bypass grafting（OPCABG），it is proposed to investigate the optimal fraction of inspired oxygen（FiO₂）in patient undergoing OPCABG. Methods：A total of 100 patients with OPCABG that are aged 48 to 78 years，body mass index（BMI）of 21.7 to 33.9 kg/m² ，and American society of anesthesiologists physical status classification system（ASA) grade Ⅲ~Ⅳ were selected. They were divided into 2 groups：low-concentration oxygen group（L group，n=49）and pure oxygen group（H group，n=51）using random number table. After the routine anesthesia induction of propofol and fentanyl combined with cis-atricuronium and mechanical ventilation after endotracheal intubation，the inhaled oxygen concentrations of the two groups were adjusted to 40% and 100%，respectively，and maintained until the end of the operation. Volume controlled ventilation mode was used during the operation，with a tidal volume of 6~8 mL/kg and an I/E ratio of 1∶2. Two groups of patients were given total intravenous anesthesia：continuous infusion of propofol，dexmedetomidine，and cis-atriammonium，intermittent infusion of fentanyl，to maintenance the BIS values of 40~60 during the operation. Blood samples were collected from the upper limb of patients on the day before surgery（T₁），after induction of anesthesia（T₂），at the end of surgery（T₃），the first day after surgery（T₄），and the third day after surgery（T₅）. The concentration of serum creatine kinase-MB（CK-MB）and pro brain natriuretic peptide（proBNP） were measured. Transthoracic echocardiography（TTE）or transesophageal echocardiography（TEE) examination was performed at each time point. The left ventricular ejection fraction（LVEF）value and cardiac output（CO）value were measured by Simpson method. The duration of postoperative mechanical ventilation，ICU stay and total hospital stay were recorded. Results：Compared with T₁，the concentration of serum CK-MB in group L and group H was increased at T_3-5，and the concentration of serum proBNP was increased at T_{2 -5}. Compared with group L，the concentration of CK-MB was increased at T_3-5，and the concentration of proBNP was increased at T_2-5 in group H（P < 0.05）. Compared with T₁，LVEF value and CO value decreased at T₂ in group L and H，LVEF value and CO value increased at T_4-5 in group L，LVEF value and CO value increased at T₅ in group H，LVEF value and CO value decreased at T_4-5 in group H（P < 0.05）. Compared with group L，the mechanical ventilation time of patients in group H was prolonged（P < 0.05），and there was no significant difference in the length of ICU stay and total hospital stay between the two groups（P > 0.05）. Conclusion：Continuous inhalation of 40% oxygen during OPCABG in patients can help reduce myocardial injury within 3 days after surgery and improve left heart function.

Abstract:Objective：To evaluate the effects of combined use of oxycodone and propofol for total intravenous anesthesia in patients with breast cancer undergoing breast-conserving surgery，on the intraoperative anesthesia，perioperative adverse reactions and analgesic effects. Methods：Eighty patients elective undergoing breast-conserving surgery for breast cancer，with American Society of Anesthesiologists（ASA）physical status classification Ⅰ or Ⅱ，aged 26-61 year，and body mass index（BMI）of 19~28 kg/m² ，were randomly divided into oxycodone group（n=40）and fentanyl group（n=40）. The systolic blood pressure（SBP），diastolic blood pressure （DBP），and heart rate（HR）were recorded at the following time points：before anesthesia induction（T₀），immediately before tracheal intubation（T₁），at the start of surgery（T₂），during resection of the breast specimen（T₃），and at the end of surgery（T₄）. The numerical rating scale（NRS）for pain were recorded at rest and during movement at 2 h，6 h，24 h and 48 h after surgery. The time to awakening， extubation time，and propofol consumption were also recorded. The incidence of cough reflex during induction，intraoperative awareness，intraoperative hypotension，postoperative agitation，nausea and vomiting，and skin itching were observed in both groups. Results：At T₂ and T₃，the SBP，DBP and HR in the oxycodone group were significantly higher than those in the fentanyl group（P < 0.05）. The NRS scores for resting pain and movement pain at 2 h after surgery were significantly lower in the oxycodone group than the fentanyl group（P < 0.05）. The incidence of cough reflex during induction was significantly lower in the oxycodone group than in the fentanyl group（P < 0.05）. Conclusion：Oxycodone combined with propofol for total intravenous anesthesia can be safely used in breast- conserving surgery for breast cancer. It provides satisfactory anesthesia induction and maintenance，has minimal impact on circulation during surgery，and has effective postoperative analgesic effects.

Abstract:Objective：Based on genomics，this study aims to investigate the distribution of drug-resistant genes，virulence factors， and homology analysis of the hospital isolated carbapenem resistant Klebislla. pneumoniae strains. The molecular mechanisms of nosocomial infections will be elucidated to provide laboratory evidence for the clinical treatment and prevention of multidrug-resistant strains. Methods：A clinical isolate of carbapenem-resistant pan-drug-resistant Klebislla. pneumoniae（KPX）was collected，cultured， and identified. The minimum inhibitory concentrations（MICs）of commonly used antibiotics were determined，and multilocus sequence typing（MLST）was performed for genetic typing，followed by whole-genome sequencing. Based on the results of the genetic sequencing，selected relevant resistance genes for amplification detection in an additional 50 clinical isolates of carbapenem-resistant KPX，verified their carriage status，and further elaborate on the sequencing results. Results：The drug sensitivity test showed that the KPX strain was resistant to all antibiotics except colistin and tigecycline. The sequencing results relevant that the chromosomal gene sequence of this bacterium is 5 468 925 bp in length and contains four plasmids（179 972 bp，141 377 bp，85 181 bp，and 20 247 bp）. It had a total of 5 984 protein-coding genes，85 tRNA genes，and 25 rRNA operons. Additionally，this bacterium carried a large number of resistant genes involved in encoding multiple antibiotics. MLST results indicated that the genetic type of this bacterium is ST11，and most of its sequences are similar to previously reported strains in Sichuan and Hangzhou. The closest match was a strain with the code SCKP020029（NCBI accession number：CP029384）of Klebislla. pneumoniae. The additional 50 carbapenem-resistant Klebislla. pneumoniae collected were confirmed to produce extended-spectrum beta-lactamases（ESBLs），with 97% being of ST11. Pulsed-field gel electrophoresis（PFGE）results showed that they belonged to three different clones. Among these strains，the detection rates of resistance genes were as follows：KPC-2（98%），SHV-11（98%），TEM-1（76%），CTX -M（76%），Oqxb1（66%），qnrS（70%），Int1 （42%），sul1（82%），sul2（96%），iutA（88%），iucABCD（10%），and rmpA2（100%）. Conclusion：The experimental results revealed that a high degree of genomic similarity among nosocomial carbapenem resistant Klebislla. Pneumoniae strains，with epidemiological characteristics of both clustering and sporadic cross -infection. Antimicrobial-resistance profiles suggested the presence of significant selective antibiotic pressure. Furthermore，the dissemination of plasmid -mediated resistance genes among bacteria indicates that the spread of these resistant strains within the hospital is primarily through plasmid transfer. Effective monitoring，isolation，and control of these plasmids are essential measures to reduce the spread of bacterial resistance in nosocomial infections.

Abstract:Objective：To compare the clinical outcome and literature review of laparoscopic microwave ablation and laparoscopic hepatectomy for the treatment of giant hepatic hemangioma，and explore the treatment strategiesgiant hepatic hemangioma. Method： From January 2020 to December 2022，a total of 18 patientsdiagnosed with giant hepatic hemangiomaunderwent laparoscopic vascular tumor microwave ablation at the First Affiliated Hospital of Nanjing Medical University. Based on the size，location，and body mass index of the hemangioma，18 patients who underwent laparoscopic hemangioma resection duringthe same period were selected for a 1∶ 1 matched case-control study. The surgical duration，intraoperative blood loss，postoperative complications，postoperative hospital stay， andpostoperative liver function［alanine transaminase（ALT），aspartate transaminase（AST），and total bilirubin（TBIL）］on the first day were compared between two groups of patients，as well as the short -term and long -term complicationsand prognosis. Results：The surgical duration in the laparoscopic microwave ablation group was shorter than that in the laparoscopic surgery group（P < 0.001），the intraoperative blood loss was lower than that in the laparoscopic surgery group（P < 0.001），and the postoperative hospital stay was shorter than that in the laparoscopic surgery group（P < 0.001）. There were no significant difference in the incidence of postoperative adverse reaction（P > 0.05），postoperative liver function on the first day after surgery（ALT，AST，TBIL，P > 0.05）between the two groups. No midium-term or long-term complications were observedduring the follow-up period after surgery in both groups. Conclusion：Laparoscopic microwave ablation is an effective and safe treatment for giant liverhemangioma，and it can significantly reduce intraoperative blood loss，surgical duration，and postoperative hospital stay.

Abstract:Myeloperoxidase（MPO）is an important member of the haemoglobin peroxidase-cyclooxygenase superfamily. It is expressed in a variety of inflammatory cells，including neutrophils，activated microglia，monocytes/macrophages，as well as astrocytes and neurons，and plays an important role in immune surveillance and host defense mechanisms. However，studies have found that the increased expression and activity of MPO is associated with the development and progression of several major diseases，including Parkinson’s disease，Alzheimer’s disease，stroke，and cardiovascular disease. Over the years，several pharmaceutical companies and research institutes have made a lot of progress in the development of MPO inhibitors. This review mainly summrizes the structure of MPO protein，its catalytic mechanism and the progress of inhibitor development，aiming to provide a reference for the development of this enzyme inhibitors.

Abstract:Red blood cell distribution width（RDW）is a simple and cheap parameter to reflect the heterogeneity of red blood cell volume in peripheral blood. In recent years，as a new inflammatory marker，or combined with other laboratory indexes，it shows unique advantages in clinical outcome evaluation，diagnosis，treatment and prognosis of various pathological conditions. This article reviews research progress of RDW and its derivatives in the relationship between digestive system inflammation and tumor diseases and their possible pathophysiological mechanisms.