Objective To study the survival rate,cause of death and the incidence of complications of extremely low birth weight (ELBW) infants.Method Clinical data of the ELBW infants admitted in our hospital between December 2013 and November 2016 were retrospectively analyzed.The cases were assigned into five groups based on gestational age (GA) or birth weight (BW) to further analyze the survival rates among each group.According to the time of death,the cases were assigned into two groups (death within 7 days or after 7 days) to analyze their direct death causes.ELBW infants were categorized into three groups according to GA (＜ 26 weeks,26-27 weeks and ≥ 28 weeks) or into two groups according to birth weight (＜ 750 g and ≥ 750 g) to analyze the incidence of complications within 14 days or after 14 days.Result A total of 122 ELBW infants were enrolled in this study.The mean GA was 27.6 ± 2.1 (range of 22-33) weeks,mean birth weight was 849 ± 112 (range of 525-995) g.GA and BW were both positively correlated with the survival rate.Among all the studied cases,43 were dead cases.Within these 43 cases,13 of them died within 7 days.The top 3 causes of death of them were neonatal respiratory distress syndrome (RDS),severe asphyxia and pulmonary hemorrhage of neonatal.The other 30 cases died after 7 days,while the top 3 causes of death of them were sepsis,bronchopulmonary dysplasia (BPD) combined with pneumonia and neonatal necrotizing enterocolitis (NEC).The incidences of complications of all 122 ELBW infants within 14 days of hospitalization were as follow:ELBW infants with BW ＜ 750 g had higher morbidity of neonatal severe asphyxia and neonatal blood glucose disorder than ELBW infants with BW ≥ 750 g (37.0％ vs.8.4％,51.9％ vs.24.2％,P ＜0.05);ELBW infants with GA ＜ 26 weeks and 26-27 weeks had higher morbidity of neonatal RDS than ELBW infants with GA≥28 weeks (86.5％ and 94.3％ vs.59.4％,P ＜ 0.05).99 cases of ELBW infants whose duration of hospitalization were more than 14 days were analyzed.The incidences of retinopathy of prematurity (ROP) in GA ＜ 26 weeks group was higher than that in GA between 26-27 weeks group and GA ≥ 28 weeks group (40.7％ vs.18.2％ and 14.3％,P ＜ 0.05).The incidences of BPD and anemia in GA ＜ 26 weeks group and GA between 26-27 weeks group were higher than that in GA≥28 weeks group (BPD:70.4％ and 68.2％ vs.35.7％;anemia:88.9％ and 84.1％ vs.57.1％;P ＜ 0.05).The incidence of sepsis in GA ＜ 26 weeks was higher than that in GA ≥ 28 weeks group (74.1％ vs.39.3％,P ＜0.05).The differences of the incidences of all the complications between BW ＜ 750 g group and BW ≥750 g showed no significance statistically (all P ＞ 0.05).Conclusion As the increasing of GA and BW,the survival rates of ELBW infants increase significantly,and the incidence of complications decline significantly.The complications related to ELBW infants during hospitalization should be prevented to improve the early survival quality of them.

Objective To investigate the clinical effect of hemorrhoid elimination agent made by our hospital for the treatment of constipation, blood in stool, pain in defecation, anal burning sensation and abdominal distension after hemorrhoids surgery. Methods A number of 120 patients from January 2017 to June 2019 undergo hemorrhoid surgery in the department of anorectal surgery in our hospital were enrolled in the study. The patients were divided into the experimental group and the control group by the random digit table. The experimental group took hemorrhoid elimination agent orally, and the control group took paraffin oil orally. The two groups were compared in terms of the clinical efficacy, symptom and sign scores before and after treatment and adverse reactions. Results The total clinical effective rate of patients in the experimental group was 95%，and the total effective rate in the control group was 81.6% . Compared withpre-treatment, the fecal character score in the experimental group was significantly improved after treatment, and the incidence of hematochezia was significantly reduced after treatment (P<0.05). There was no significant difference in fecal character score and incidence of hematochezia before and after treatment in the control group(P>0.05). After treatment, the score of symptoms and signs in the experimental group was significantly lower than that in the control group (P<0.05). The incidence of hematocele in the experimental group was 5 %，while that in the control group was 21.67%，with significant difference between them(P<0.05). Conclusion With obvious effect and high safety, hemorrhoid elimination agent can effectively relieve constipation and hemostasis after hemorrhoidectomy, which is worthy of promotion in clinic.

Background::Cancer immunotherapy has emerged as a promising strategy against triple-negative breast cancer (TNBC). One of the immunosuppressive pathways involves programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1), but many patients derived little benefit from PD-1/PD-L1 checkpoint blockades treatment. Prior research has shown that MYC, a master transcription amplifier highly expressed in TNBC cells, can regulate the tumor immune microenvironment and constrain the efficacy of immunotherapy. This study aims to investigate the regulatory relationship between MYC and PD-L1, and whether a cyclin-dependent kinase (CDK) inhibitor that inhibits MYC expression in combination with anti-PD-L1 antibodies can enhance the response to immunotherapy. Methods::Public databases and TNBC tissue microarrays were used to study the correlation between MYC and PD-L1. The expression of MYC and PD-L1 in TNBCs was examined by quantitative real-time polymerase chain reaction and Western blotting. A patient-derived tumor xenograft (PDTX) model was used to evaluate the influence of a CDK7 inhibitor THZ1 on PD-L1 expression. Cell proliferation and migration were detected by 5-ethynyl-2′-deoxyuridine (EdU) cell proliferation and cell migration assays. Tumor xenograft models were established for in vivo verification. Results::A high MYC expression level was associated with a poor prognosis and could alter the proportion of tumor-infiltrating immune cells (TIICs). The positive correlation between MYC and PD-L1 was confirmed by immunostaining samples from 165 TNBC patients. Suppression of MYC in TNBC caused a reduction in the levels of both PD-L1 messenger RNA and protein. In addition, antitumor immune response was enhanced in the TNBC cancer xenograft mouse model with suppression of MYC by CDK7 inhibitor THZ1. Conclusions::The combined therapy of CDK7 inhibitor THZ1 and anti-PD-L1 antibody appeared to have a synergistic effect, which might offer new insight for enhancing immunotherapy in TNBC.

Objective To assess the effects of low-dose esketamine on the median effective dose(ED50)of ciprofol for anesthesia induction in painless gastrointestinal endoscopy.Methods Fifty-nine pa-tients underwent elective painless gastrointestinal endoscopy,26 males and 33 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups by random number table method:esketamine combined with ciprofol group(group EC,n = 29)and ciprofol group(group C,n = 30).Group EC received intravenous injection of esketamine 0.3 mg/kg and group C received the same amount of normal saline 2 minutes before administration of ciprofol.The initial anesthesia induction dose of ciprofol was 0.4 mg/kg.If a positive reaction occurs during the examination,the next patient will receive an increase dose of propofol 0.04 mg/kg,otherwise will decrease by propofol 0.04 mg/kg.The positive reaction was defined that the patient's BIS can not be decreased to 60 2 minutes after anesthesia induction,or the cough or body movement reaction occur at level 2 or above when entering the mirror.The dosage of ciprofol,recovery time,discharge time,the occurrence of intraoperative and postoperative adverse reactions were recorded.The ED50,95%effective dose(ED95)and 95%confidence interval(CI)of the two groups were calculated by Probit probability regression analysis.Results Compared with group C,the dosage of ciprofol,the incidence of hypotension and frequency of administration of vasoactive drugs during the exami-nation process in group EC were significantly reduced(P＜0.05).The ED50 of ciprofol for anesthesia in-duction in painless gastrointestinal endoscopy in group EC was 0.21 mg/kg(95%CI 0.12-0.25 mg/kg)and the ED95 was 0.32 mg/kg(95%CI 0.26-0.39 mg/kg).The ED50 of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group C was 0.37 mg/kg(95%CI 0.32-0.40 mg/kg)and the ED95 was 0.48 mg/kg(95%CI 0.43-0.54 mg/kg).The ED50 and ED95 of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group EC was significantly lower than that in group C(P＜0.05).There was no significant difference in other frequency of adverse events between the two groups.Conclusion Esketamine 0.3 mg/kg can reduce the ED50 of ciprofol in painless gastrointestinal endoscopy and reduce the dosage of ciprofol during the examination process,which is safe for painless gastrointestinal endoscopy with stable intraoperative circulation.

Objective To explore the application effect of"three-station"teaching rounds in standardized training teach-ing rounds of general surgery residents.Methods 50 trained doctors from the general surgical base from July 2022 to July 2023 were randomly selected and divided into two groups,with 25 patients in each.The observation group used a"three-station"teaching ward round,while the control group used a traditional teaching ward round mode.The exam scores,ward round effects,satisfaction,and experience were compared.Results The total scores of the observation group were significantly higher than those of the control group(P＜0.05),and the scores of the medical history collection and physical examination in the case anal-ysis test and skill test were significantly higher than those of the control group(P＜0.05).There was no significant difference in the theoretical test scores between the two groups(P＞0.05).The proportion of"Yes"in the questionnaire of the observation group was higher than that of the control group in the aspects of improving the diagnosis and treatment of diseases,clinical think-ing,doctor-patient communication ability and increasing learning interest(P＜0.05).The satisfaction of questionnaire teaching round in the observation group was 84.0％,significantly higher than that in the control group(60.0％)(P＜0.05).In the observation group,the percentages of the attending physicians and the teaching rounds were 64.0％and 68.0％,respectively,which were significantly higher than those of the control group(28.0％and 32.0％,P＜0.05).Conclusion The"three-sta-tion"teaching ward round can improve the exam scores,ward round effectiveness and satisfaction,improve the experience of attending physicians and teaching ward round subjects,and is worth promoting in various resident training bases.

[Objective]To establish the reference intervals of thyroid hormones in pregnant women from Sanming city and compare them with those from other areas in China.[Methods]The study recruited 605 pregnant women and 229 non-pregnant healthy women who visited Sanming First Hospital between March 29 and June 28,2023.Blood samples were se-quentially collected from the participants to determine the serum levels of thyroid stimulating hormone(TSH),free triiodo-thyronine(FT3)and free thyroxine(FT4).The reference intervals of thyroid hormones were established by using a percen-tile range of P2.5 to P97.5 and their changes in different periods of pregnancy were analyzed and compared with those from oth-er areas in China.[Results]There were significant differences in levels of TSH,FT4 and FT3 at different periods of pregnan-cy(all P<0.05).Compared with non-pregnant women,women in first trimester had significantly decreased levels of TSH and FT4,but similar level of FT3.Since the second trimester,TSH level displayed rising tendency,while FT3 and FT4 lev-els showed gradual decrease.The reference intervals of thyroid hormones in the first,second and third trimester of pregnan-cy in Sanming city were TSH(0.068,2.943)μU/mL,FT3(4.302,6.888)pmol/L,FT4(8.240,14.719)pmol/L;TSH(0.419,3.274)μU/mL,FT3(4.074,6.629)pmol/L,FT4(6.726,11.980)pmol/L;TSH(0.422,3.570)μU/mL,FT3(3.741,5.850)pmol/L,FT4(6.103,10.347)pmol/L,respectively.Significant differences were found in the reference in-tervals of thyroid hormones during pregnancy among different areas in China.[Conclusions]The levels of TSH,FT3,FT4 during pregnancy are different from those during non-pregnancy,and also significantly differ in different periods of preg-nancy.Reference intervals of thyroid hormones in pregnant women are affected by various factors such as geographic loca-tion,ethnicity and laboratory test method,etc.Therefore,establishing the population-specific reference intervals of thy-roid hormones will benefit for the diagnosis and treatment of thyroid disease in pregnant women from Sanming city.