Abstract:Objective：The study aims to investigate the different proportions of immune cells in visceral adipose tissue(VAT)among lean group，metabolically healthy obesity(MHO)group and metabolically unhealthy obesity(MUO)group. Methods：Samples of VAT came from 48 obese patients who received metabolic surgeries and 11 other patients who had non-inflammatory disease(such as hernia， cholecystolithiasis and renal cyst)and received laparoscopic surgery at the First Affiliated Hospital of Nanjing Medical University. After extracting RNA from VAT，we applied RNA-seq technology to count and analyze proportions of immune cells and differentially expressed genes in VAT among three groups. One - way ANOVA and Pearson correlation analysis were used for statistical analysis. Results：The proportion of regulatory T cells，natural killer cells，M0 macrophages，and M2 macrophages varied among three groups(P= 0.031；P=0.002；P=0.004；P=0.024). In MUO group，the proportion of M2 macrophages decreased compared with other two groups(P= 0.014). SPP1，CHIT1，ITGAX，CD300LB，IL1RN，DCSTAMP and some other genes had positive correlation with the proportion of M0 and M1 macrophages in two obese groups，but had negative correlation with the proportion of M2 macrophages. C5AR1 and GPR183 had positive correlation with the proportion of M0 and M1 macrophages in MHO group and had negative correlations with the proportion of M2 macrophages. However，the correlation between these two genes and macrophages is opposite in MUO group compared with MHO group. Conclusion：Compared with lean group，the infiltration status of immune cells in VAT is more severe in MHO and MUO group. Comparing between MHO and MUO group，the proportion of M1 macrophages in VAT lifted，indicating that higher level of inflammation in vivo connects with impaired metabolic ability. The differently expressed gene C5AR1 and GPR183 between two obese groups may play a role in predicting alterations in metabolic ability.

Abstract:Objective：The current study aims to investigate the possible mechanism of auditory nerve injury at the spiral ganglion of the cochlea induced by apolipoprotein E(ApoE)gene deficiency in mice. Methods：Auditory brainstem response(ABR)were measured in ApoE knockout(ApoE^-/-)mice，and the amplitude and latency of the wave groups were analyzed. Immunofluorescence and H&E staining were used to analyze the pathological damage of auditory nerve and ribbon synapsesin the spiral ganglion. Western blot and qRT - PCR were used to detect the protein expression and phosphorylation levels of LIM kinase 1(Limk1)and cofilin1，and to detect the phosphatidylinositide 3-kinases(PI3K)pathway activation. Results：The amplitude of wave Ⅰ in ApoE^-/- mice by ABR was shortened and the latency was prolonged. The spiral ganglion staining showed that the number of ribbon synapses and auditory nerve fibers were reduced in ApoE^-/- mice，accompanied by the structural damage. Western blotting，qRT - PCR and immunofluorescence staining revealed that Limk1 and cofilin1 showed a significant decrease in protein phosphorylation levels after ApoE knockdown，while the PI3K pathway activation was inhibited. Conclusion：ApoE gene deficiency could damage the ribbon synapse and auditory nerve at the spiral ganglion of the cochlea，which might be related to the actin cytoskeleton of theauditory nerve.

Abstract:Objective：Cardiac magnetic resonance imaging(CMR)was used to analyze the imaging features of the rat model of myocardial fibrosis，and to explore the correlation between MR T2WI findings and pathological changes of myocardial fibrosis. Methods：Fifty SD rats were randomly selected，forty mice were randomly selected and subcutaneously injected with five mg/kg isoproterenol for ten days to establish the myocardial fibrosis model，and ten rats were subcutaneously injected with the same dose of normal saline for ten days as the control group. The model group was divided into three subgroups，and in vivo imaging scan was performed on day five，seven，and nine with 7.0 T magnetic resonance equipment，respectively. The control group was scanned on day seven and the contrast noise ratio(CNR)was calculated. The HE and Masson staining were performed to observe the structural changes of myocardial tissues and calculate the collagen volume fraction(CVF). Results：36 rats in the model group and 10 rats in the control group were included in statistical analysis. The CNR of the model group(15.26 ± 1.93)and the control group(3.56 ± 0.93)showed statistically significant differences(P＜0.01). Compared with the control group，the left ventricular lumen of the model group was enlarged，the left ventricular wall showed T2WI hyposignal changes，and the thickness of the ventricular wall decreased and became thinner. The left ventricular wall thickness of the control group was(2.73±0.23)mm，which was statistically significant compared with that of the model group(1.19±0.29)mm(P ＜ 0.01). These indicated fibrotic changes in the ventricular wall.The CVF of the control group(6.18% ± 2.90%)was significantly different from that of the model group(43.06% ± 6.59%)(P ＜ 0.01). The value of phase relationship between CNR and CVF was 0.993，showing a significant positive correlation. Conclusion：The MR T2WI of the myocardial fibrosis model of rats is characterized by obvious pathological imaging characteristics，which could be used to carry out imaging and clinical research of myocardial fibrosis.

Abstract:Objective：To investigate the effect and mechanism of ticagrelor on endothelial injury induced by ox -LDL. Methods： ELISA method was used to detect the serum ET-1 and NO contents. Cell viability，proliferation and migration ability were determined by CCK-8，EdU kit and Transwell assay respectively. Annexin V-PI assay was used to detect cell apoptosis. The levels of DNMT1 and p16 were detected by Real-time PCR and Western blot. The lentiviral overexpression vector pLVX-puro-EGFP was used to construct the p16 overexpression system. The lentiviral knockout vector pLKO.1 was used to construct the DNMT1 and p16 knockout system. The methylation status of p16 promoter region was determined by the methylation-specific PCR method. Results：Ticagrelor promoted the viability，proliferation and migration ability of human umbilical endothelial cell(HUVEC)treated with ox-LDL，and significantly inhibited ox - LDL - induced apoptosis. Ticagrelor down - regulated the expression of p16 in HUVECs induced by ox - LDL，and overexpressed p16 could reverse the protective effect of ticagrelor on HUVECs induced by ox-LDL. DNMT1 inhibited the expression of p16 by affecting the methylation level of p16 promoter region. Conclusion：Ticagrelor could reduce the injury of HUVECs induced by ox-LDL and improve endothelial function. The mechanism might be related to the regulation of DNMT1/p16 signaling pathway.

Abstract:Objective：In this study，the conditions for the prokaryotic expression of mouse interleukin-3(IL-3)were screened and optimized，in order to lay the foundation for effective culture of mouse bone marrow -derived mast cells(BMMCs)in vitro. Methods： Nucleotide sequences of mouse IL -3 were optimized according to the commonly used codons in Escherichia coli(E. coli)and it were then synthesized and cloned into the pET -28a(+)vector. The mouse IL -3 plasmid was transformed into E. coli BL21(DE3)and the expression conditions was optimized. The recombinant mouse IL-3 was further purified and applied in the culture of mouse bone marrow -derived mast cells(BMMCs)in vitro to confirm its bioactivity. Results：The plasmid of pET-28a(+)-IL-3 was successfully constructed， and the recombinant mouse IL - 3 was expressed at approximately 16 kDa by SDS - PAGE analysis. The finally purified mouse IL - 3 combined with mouse stem cell factor could induce the differentiation of surface FcεRI and CD117 double positive BMMCs，which further exhibited the function of β-Hexosaminidase release. Conclusion：In this study，the recombinant plasmid for mouse IL -3 was constructed and the expression conditions in E.coli were optimized accordingly. The finally purified mouse IL-3 could be successfully utilized in the culture of BMMCs in vitro for the investigation of allergy.

Abstract:Objective：Our study aimed to probe the potential molecular mechanism of long non - coding RNA(lncRNA)VIM Antisense RNA 1(VIM-AS1)in diabetic retinopathy. Methods：LncRNA VIM-AS1，miR-497-5p and FBXW7 mRNA expressions were determined using qRT - PCR. The FBXW7 protein level was also detected using western blotting. The cell viability，migration and apoptosis were evaluated using CCK-8 assay，wound healing assay and flow cytometry analysis，respectively. Additionally，the binding relationships among lncRNA VIM-AS1，miR-497-5p and FBXW7 were verified by dual luciferase reporter assaies. Results：LncRNA VIM -AS1 and FBXW7 expressions were remarkably reduced in HG -treated ARPE - 19 cells，while miR - 497 - 5p was upregulated. LncRNA VIM - AS1 could upregulate the expression of FBXW7 by competitively binding to miR - 497 - 5p. LncRNA VIM - AS1 overexpression promoted cell proliferation and migration，and inhibited cell apoptosis in HG-induced ARPE-19 cells，while miR-497- 5p overexpression abolished the effects of lncRNA VIM -AS1 overexpression on HG -induced ARPE -19 cells. Furthermore，FBXW7 knockdown abrogated the effects of miR -497-5p inhibition on cell phenotypes of HG -treated ARPE -19 cells. Conclusion：LncRNA VIM-AS1 could promote the proliferation and migration，while inhibited cell apoptosis of HG-treated ARPE-19 cells by regulation of miR-497-5p/FBXW7 axis，suggesting that lncRNA VIM-AS1 might have great potential as therapeutic target for diabetic retinopathy

Abstract:Objective：To explore the role and mechanism of circular RNA FAT1(hsa_circ_0001461)-miR-181d-5p/miR-199a-5p axis in the biological functions of oral squamous cell carcinoma(OSCC)cells. Methods：The clinical tissues of 30 OSCC patients were collected，and the expressions of circFAT1，miR -181d -5p and miR -199a -5p in OSCC tissues and cells were detected by real -time quantitative PCR. starBase and dual luciferase reporter genes were used to verify the targeting relationship between miR-181d-5p/miR- 199a-5p and circFAT1. Functional experiments include CCK-8，Transwell，and flow cytometry to detect the effects of circFAT1-miR- 181d-5p/miR-199a-5p axis on OSCC cell viability，migration，invasion，apoptosis and cycle. Western blot combined with LY294002 treatment was used to detect the expression of PI3K/Akt/mTOR signaling pathway related proteins. Results：The circFAT1 expression increased，and miR-181d-5p and miR-199a-5p expressions decreased in OSCC(P ＜ 0.001). CircFAT1 could target miR-181d-5p and miR-199a-5p(P ＜ 0.01). Silencing circFAT1，miR-181d-5p mimic and miR-199a-5p mimic inhibited OSCC cell viability，migration， invasion and cycle progression，induced apoptosis，and inhibited the activation of PI3K/Akt/mTOR pathway；overexpressed circFAT1， miR-181d-5p inhibitor and miR-199a-5p inhibitor played the opposing roles(P ＜ 0.05). MiR-181d-5p and miR-199a-5p partially reversed the effect of circFAT1 on the biological functions of OSCC cells(P ＜ 0.05). LY294002 pretreatment reversed the effect of overexpression of circFAT1 on PI3K/Akt/mTOR pathway and cell viability(P ＜ 0.05). Conclusion：circFAT1 promotes the malignant progression of OSCC cells by miR-181d-5p/miR-199a-5p.

Abstract:Objective：To study the effect of functional deletion of quinoline phosphoribosyltransferase(QPRT)gene on fetal kidney development. Methods：The expression of QPRT in fetal mouse kidney tissue was located by immunohistochemistry. The QPRT gene- deficient mouse model was constructed，and the serum of QPRT ^+/+(WT)and QPRT^-/-(KO)mice were collected for renal function detection. The body weight，kidney weight and kidney coefficient of KO and WT mice were calculated by weighing method，and the histopathological changes of kidney of mice and their offspring were observed by HE staining. Results：QPRT was strongly expressed in developing ureteral buds in fetal mouse kidney at 13 days of gestation. The kidney coefficient(kidney weight/body weight)of QPRT^-/- mice was significantly lower than that of wild-type mice，and the levels of urea nitrogen，serum creatinine and uric acid of QPRT^-/- mice were higher than those of wild-type mice(P ＜ 0.05). HE staining of kidney tissue showed cellular cystic dilatation in renal parenchyma of QPRT^-/- offspring mice，QPRT^+/- mice showed focal loose edema of renal cortex and interstitium；QPRT^+/+ mice showed no obvious histopathological changes in the kidneys. Conclusion：The loss of QPRT gene function may affect fetal kidney development.

Abstract:Objective：To investigate the feasibility of secondary superovulation scheme in improving the superovulation effect and embryonic development potential of adult mice. Methods：Firstly，the difference of total egg number among the conventional double ovulation scheme，the natural ovulation and random superovulation experimental schemes was compared，and then the conventional double ovulation experimental scheme was further optimized on the basis of the preliminary study of the effect of exogenous pregnant mare serum gonadotropin(PMSG)on the development of naturally conceived embryos. Results：The average total number of eggs in the optimized double ovulation experimental group was 61.7，which was significantly different from the natural ovulation group，the random superovulation group and the conventional double ovulation group，and improved the superovulation effect of adult mice. Conclusion： The optimized double superovulation scheme provides a new and efficient technical method for obtaining a large number of mouse multi -cell embryos and fertilized eggs.

Abstract:Objective：To retrospectively analyze the clinical characteristics，treatment and prognosis of intermediate-high risk acute pulmonary thromboembolism(APTE)patients，and to further provide basis for the selection of treatment strategies for intermediate-high risk APTE patients. Methods：A total of 55 hospitalized intermediate-high risk APTE patients who met the criteria from January 2016 to June 2019 in the First Affiliated Hospital of Nanjing Medical University were divided into the thrombolytic group(n=27)and the non- thrombolytic group(n=28)according to whether thrombolytic therapy was performed. The clinical data of the thrombolytic group and the non-thrombolytic group were compared，and the causes of thrombolytic therapy in the thrombolytic group were analyzed. Logistic regression was used to analyze the factors related to thrombolytic therapy in the intermediate-high risk APTE patients，and to compare the prognosis and incidence of adverse events in patients with different treatment regimens. Results：The proportion of first emergency visit，bilateral APTE and central APTE in the thrombolytic group was higher than that in the non-thrombolytic group，but the proportion of right ventricular enlargement/systolic dysfunction was lower than that in the non-thrombolytic group，the difference was statistically significant(P ＜ 0.05). Gender，lower extremity deep venous thrombosis，moderate to severe pulmonary hypertension，underlying diseases(including chronic pulmonary disease，hypertension，diabetes，coronary heart disease，cerebrovascular history，and malignant tumor)had no significant influence on whether thrombolytic therapy was performed. The percentage of D-dimer and peripheral blood neutrophil count in thrombolytic group was higher than that in non - thrombolytic group，peripheral oxygen saturation(SpO₂)was significantly decreased(P＜0.05)，arterial partial pressure of oxygen(PaO₂)had a downward trend.cardiac troponin T and N-terminal pro - B - type natriuretic peptidewere increased in the thrombolytic group，but the difference was not statistically significant. Logistic regression and receiver operating characteristic(ROC)curve analysis showed that SpO₂ was a factor related to thrombolytic therapy(P ＜ 0.05). The optimal cut-off value of SpO₂ was 91.5%. The nosocomial mortality of thrombolytic therapy and anticoagulant therapy was 0，but the incidence of bleeding of systemic thrombolytic therapy was higher than that of catheter - directed thrombolysis or anticoagulant therapy alone(P＜0.05). Conclusions：The reasons for thrombolytic therapy in intermediate - high risk APTE patients include low SpO₂，severe clinical symptoms，large emboli blocking pulmonary vessels，and heavy cardiac load. Low peripheral oxygen saturation is a factor associated with thrombolytic therapy. Compared with catheter - directed thrombolysis and anticoagulant therapy alone，systemic thrombolytic therapy has an increased risk of bleeding in intermediate -high risk APTE patients. Therefore，attention should be paid to the changes of the disease and appropriate treatment plan should be adopted，which may have positive significance for the diagnosis and treatment of intermediate-high risk APTE.

Abstract:Objective：The current study aimed to compare and analyze the pulmonary function and eosinophil inflammation parameters between patients with chest tightness variant asthma(CTVA)and those with typical classical(CA)for further recognition about the atypical bronchial asthma with chest tightness as the main manifestation. Methods：A total of 55 patients with CTVA and 94 patients with CA who were diagnosed and treated in the Outpatient Department between October 2019 and October 2021 were retrospectively analyzed(the airway provocation test was positive in both groups，and the medical history and clinical characteristics met the diagnostic criteria of asthma). The pulmonary function test，exhaled nitric oxide，blood eosinophils，specific and total IgE levels were analyzed and compared between the two groups. Results：There was no significant difference in age，sex ratio，allergic history， allergic rhinitis，nasal polyps，eczema and chronic urticarial between the CTVA and CA groups(P ＞ 0.05). The patients with mild impairment of the small airway function in the CTVA group(CTVA group：CA group=27.27%：43.62%)were less than those of the CA group(P=0.047). There was no significant in the moderate to severe impairment of small airway function，the percentage of increased airway resistance，and RV/TLC between the two groups(P ＞ 0.05). There was no significant difference in ventilatory function[forced vital capacity(FVC)、forced expiratory volume in one second/forced vital capacity(FEV1/FVC)、peak expiratory flow(PEF)]or pulmonary reserve[maximal voluntary ventilation(MVV)]between the two groups(P ＞ 0.05). Peripheral blood eosinophils were significantly lower in the CTVA group[absolute：(0.16 ± 0.15)×109 /L，percentage：(2.50 ± 2.25)%]than in the CA group[absolute： (0.27 ± 0.25)×10⁹ /L，percentage(4.0 ± 3.8)%，with a significant difference[P=0.017(absolute)，P=0.031(percentage)]. The positive rate of specific IgE in the CTVA group(23.8%)was lower than that in the CA group(48.5%)(P=0.043)，and the total IgE level in peripheral blood in the CTVA group[86.7(24.7，172.9)kU/L]was significantly lower than that in the CA group[181.2(97.25， 454.8)kU/L]，with a significant difference(P=0.009). The mean concentration of exhaled nitric oxide in the CTVA group(29 ppb)was significantly lower than that in the CA group(79 ppb)，with a significant difference(P=0.027). Conclusion：The rate of mild obstruction of the small airway in CTVA patients was smaller than that in CA patients，the rate of moderate and severe obstruction of the small airway was equal to that in CA patients，and peripheral blood eosinophil levels were lower than in those with CA.

Abstract:Objective：To explore the expression of microRNA let - 7 in the serum of stable male COPD patients and its clinical significance. Methods：One hundred and sixty COPD patients in stable period and 100 healthy volunteers were selected to collect clinical data and plasma samples. Serum samples were extracted by centrifugation at 4 ℃. The relative expression levels of let-7a，let- 7c and let -7d in serum of each group were detected by qPCR. Correlation analysis was conducted between let - 7 and lung function indexes. The ROC curve was used to analyze the diagnostic value of let-7 for COPD. Results：qPCR results showed that the serum let- 7a，let-7c and let-7d levels in COPD patients were significantly lower than the control and smoking groups(P ＜ 0.05). The expression of let-7 in GOLD groups had no significant difference(P ＞ 0.05). The expression levels of let-7 in the serum of the smoking group were lower than those of the control group，but the differences were not statistically significant(P ＞ 0.05). Pearson analysis showed that the serum let-7 expression had positively correlation with lung function(FEV1/FVC，MEF75%pred，MEF50%pred，MEF25%pred，MMEF75/25% pred)(P ＜ 0.05)，among which let-7 had the strongest correlation with MMEF75/25%pred；let-7c was positively correlated with FEV1% pred(P ＜ 0.05)，while let-7a and let-7d were not significantly correlated with FEV1%pred(P ＞ 0.05). ROC curve analysis showed that the area under the ROC curve of let-7a，let-7c，let-7d and combined index were 0.808，0.708，0.761，0.828，respectively，the diagnostic efficiency of combined indexes was better，and its sensitivity and specificity were 83.51% and 70.51%，respectively. Conclusion：The decrease of the serum let -7 expression level was related to the incidence of COPD. Let -7 has diagnostic value in patients with mild COPD，which could provide reference for timely clinical diagnosis and standardized treatment.

Abstract:Objective：To observe the efficacy and safety of Eribulin - based regimen in patients with HER2 negative metastatic breast cancer in the real world. Methods：We retrospectively analyzed clinical data of 60 patients with HER2 - negative metastatic breast cancer who received Eribulin-based therapy in Jiangsu Province Hospital between January 2020 and November 2021. Results： 30% of patients received Eribulin monotherapy while 70% of patients received Eribulin - based combination therapy. After a median follow-up of 5 months，the median progression-free survival(PFS)was 4.30 months(95%CI：3.86-5.69 months)，Median overall survival (OS)was not reached. The overall response rate(ORR)was 25.00%，and disease control rate(DCR)was 76.67%. Log-rank univariate analysis showed that there was a statistically significant difference between Eribulin monotherapy versus Eribulin-based combination regimen(2.93 months vs. 4.7 months，P=0.042). Multivariate analysis indicated that age and chemotherapy lines were independent risk factors for PFS in patients with HER2- negative metastatic breast cancer treated with Eribulin(P=0.022，0.048). The most common grade Ⅲ-Ⅳ adverse events(AE)associated with Eribulin include neutropenia，leukopenia，anemia，and lymphopenia，and no treatment- related severe adverse event(SAE)or deaths were observed. Conclusion：Our research indicated that Eribulin - based regimen can effectively treat HER2-negative metastatic breast cancer with controllable side effects.

Abstract:Objective：We aimed to evaluate myocardial systolic function and synchrony in the patients with permanent left bundle branch pacing(LBBP)and His bundle pacing(HBP)one year after operation by ultrasound speckle tracking imaging. Methods： Myocardial imaging of 40 patients with LBBP，40 patients with HBP and 40 control subjects were collected. Regional peak systolic strain in longitudinal，radial，circumferential motion，time to peak circumferential strain，time to peak radial strain，peak strain dispersion(PSD)，twist，and interventricular mechanical delay time(IVMD)were measured respectively. Standard deviation of time to peak circumferential strain(T - sd -CS)and standard deviation of time to peak radial strain(T - sd -RS)were calculated. The data was compared and analyzed among three groups. Results：The T-sd-CS of the HBP group in apical plane was larger than that of the control group，there were no significant differences between the HBP and control groups in other parameters. The QRS width of the LBBP group was longer than those of the HBP and control groups(P ＜ 0.05). The T-sd-CS of the LBBP group in the apical plane was larger than that of the HBP and control groups(P ＜ 0.05). The PSD of the LBBP group was larger than that of the HBP and control groups (P ＜ 0.05). There were no significantly differences in radial strain，T -sd -RS，longitudinal strain，twist and IVMD among all groups.Conclusion：Compared with the HBP and control groups，the LBBP group had slightly delayed left ventricular synchronization，and myocardial systolic functions were basically similar in the three groups.

Abstract:Objective：The aim of this study was to investigate the prognostic role of baseline metabolic parameters of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography(¹⁸F-FDG PET/ CT)imaging in patients with extranodal natural killer/T-cell lymphoma(ENKTL). Methods：Eighty-three patients newly diagnosed with ENKTL who underwent pretreatment ¹⁸F-FDG PET/CT scans were enrolled in this study. The baseline maximum standardized uptake value(SUVmax)，total metabolic tumor volume (TMTV)，total lesion glycolysis(TLG)，and clinical characteristics were collected for the retrospective analysis. TMTV was defined using the 41% SUVmax threshold. Kaplan-Meier curve(Log-rank test)was used for survival analysis. The statistically significant factors in the univariate analysis were incorporated into the Cox proportional hazards model for multivariate survival analysis. Results： Thirty-seven(44.6%)patients progressed and 32(38.6%)patients died within a median follow-up time of 21.6(8.9，38.3)months. The receiver operating curve(ROC)analysis indicated that the optimal cut-off values of SUVmax，TMTV and TLG were 16.7，64.9 cm³ and 490.4，respectively.Patients with higher SUVmax，TMTV and TLG had worse prognosis. In multivariate analysis，TMTV，TLG and prognostic index of natural killer lymphoma(PINK)were independent prognostic factors of both PFS(HR 5.411，P=0.001；HR 7.905， P ＜ 0.001；HR 2.858，P=0.011)and OS(HR 6.137，P=0.002；HR 8.014，P ＜ 0.001；HR 2.666，P=0.023)，treatment mode and β2- microglobulin(β2-MG)were independent prognostic predictors of PFS and OS，respectively(HR 2.323，P=0.021；HR 2.627，P=0.021）. TMTV，together with PINK，may have better risk stratification performance in ENKTL patients. Conclusion：Baseline high SUVmax，TMTV and TLG can predict a relatively poor prognosis in patients with ENKTL，TMTV，TLG and PINK are independent predictors for survival outcomes. Moreover，the combination of TMTV and PINK may provide better risk substratification in PFS and OS.

Abstract:Objective：To evaluate the effects of dexmedetomidine mixed with ropivacaine for programmed intermittent epidural bolus technique on labor analgesia and intrapartum maternal hyperthermia. Methods：A total of 104 singleton full-term parturients，of American Society of Anesthesiologists physical status Ⅰ or Ⅱ，aged 20~35 years，weighing 60~85 kg，scheduled for elective labor analgesia，were divided into 0.1% ropivacaine mixed with 0.5 μg/ml dexmedetomidine(group RD，n=52)and 0.1% ropivacaine mixed with 1 μg/mL fentanyl(group RF，n=52)by a random number table method. Both groups received programmed intermittent epidural bolus technique in labor analgesia. The visual analogue scale(VAS)score and the maternal temperature were measured before anesthesia(T₀)，at 30 min(T₁)，1 h(T₂)，2 h(T₃)，4 h(T₄)，6 h(T₅)post analgesia，10 cm cervical dilatation(T₆)and 2 h after delivery (T₇). Recording the incidence of breakthrough pain and the adverse effects，the Apgar scores were evaluated at 1 min and 5 min after the delivery. Venous blood samples were collected in non-infusion sides at T₀ and T₇ to detect the maternal white blood cell count and serum C-reactive protein. Results：Compared with group RF，the onset time of analgesia was significantly shortened，the VAS scores at T₂~6 and the incidence of breakthrough pain(4.1% vs. 20.0%)were lower in group RD(P ＜ 0.05). The incidence of intrapartum fever was lower in group RD(8.2% vs. 38.0%)，and also the maternal temperature at T_4~7 than those in group RF. Compared with T₀，the maternal white blood cell count and C - reactive protein at T₇ were significantly higher in both groups（P < 0.01），but there were no significant differences between the two groups at T0 and T（7 P > 0.05）. The incidence of pruritus was lower in the group RD compared to group RF（P < 0.05）. Conclusion：Dexmedetomidine may enhance the efficacy of epidural labor analgesia with ropivacaine and reduce the rate and degree of intrapartum maternal hyperthermia associated with epidural labor analgesia without increasing adverse effects on mother and infant.

Abstract:Objective：The current study aims to explore the risk factors for the cervical anastomotic leakage after esophagectomy， establish a nomogram prediction model，and test its predictive ability. Methods：A retrospective analysis was performed on clinical data of 362 patients undergoing radical resection of esophageal carcinoma in Nanjing medical university affiliated cancer hospital between January 2019 and May 2022. The independent risk factors for postoperative cervical anastomotic leakage were analyzed by univariate analysis and multivariable logistic regression analysis. Based on these factors，a nomogram model was established to predict the risk of the cervical anastomotic leakage. The predictive performance of the nomogram was verified by receiver operating characteristic curve(ROC)and calibration curve. Results：The incidence of the postoperative cervical anastomotic leakage was 11.88% (43/362). The multivariable logistic regression analysis showed that diabetes，chronic bronchitis，the history of thoracic or abdominal surgery，neoadjuvant therapy and postoperative pulmonary infection were the independent high risk factors for cervical anastomotic leakage after esophagectomy(P＜0.05). A nomogram prediction model was established based on these factors. The area under the receiver operator characteristic curve achieved 0.844(95% CI 0.771~0.918).The calibration curve displayed a general consistency between the prediction and ideal curves. Conclusion：Diabetes，chronic bronchitis，the history of thoracic or abdominal surgery， neoadjuvant therapy and postoperative pulmonary infection are the independent high risk factors for the cervical anastomotic leakage after esophagectomy，and clinical prediction model shows good evaluation efficacy and provides a reference for the assessment and early intervention of the cervical anastomotic leakage.

Abstract:Obesity is a chronic metabolic disease characterized by abnormal or excessive accumulation of adipose tissue，which is caused by an increase in adipocyte volume(hypertrophy)and number(hyperplasia). It is determined by environmental factors and genetic factors. In recent years，the roles of autophagy in regulating adipocyte number，adipogenesis，and white fat browning process have attracted extensive attention. This article systematically reviewed the effects of three different types of autophagy in adipose tissue on processes such as adipogenesis，white fat browning，and fat metabolism，aiming to clarify the effect of autophagy on adipose tissue function and obesity，and then provide potential targets for obesity prevention and treatment.

Abstract:Diffuse hemispheric glioma，H3 G34-mutant is a high -grade glioma，which is newly defined by WHO in 2021，and its hallmark is the H3F3A gene mutation by exchanging glycine at position 34 of histone H3.3 for arginine or valine. This subtype occurs primarily in children and young adults and is clinically rare，of which the pathogenesis remains unclear. Imaging manifestations are not typical，and it is easy to be misdiagnosed and missed in the early stage. The diagnosis depends on immunohistochemistry and molecular pathology. Surgery is essential when it comes to treatment，supplemented by the postoperative radiotherapy and chemotherapy. Unfortunately，the prognosis remains poor. Here we reviewed the related research progress of this subtype in order to improve clinicians’understanding of the disease.

Abstract:Studies reveal that the gut microbiota and its metabolites play an important role in the pathogenesis and progression of various cardiovascular diseases，and are inseparably related to the prognosis of the disease.In patients with heart failure，splanchnic hypoperfusion leads to intestinal ischemia and alters intestinal permeability，and then translocates bacteria and their toxins into the blood circulation，triggering local orsystemic inflammatory responses. Trimethylamine N - oxide(TMAO)，as a metabolite of gut microbiota，is involved in the pathological process of heart failure，such as exacerbating cardiac hypertrophy and fibrosis，inducing inflammatory responses，and worsening heart failure by affecting renal function. This article reviews trimethylamine N-oxideas as the therapeutic target of heart failure and as a prognostic marker of heart failure.