The integrated medical and elderly care model provides comprehensive medical and elderly care services by establishing medical facilities in elderly care institutions or forming close cooperative relationships with surrounding medical institutions. Currently， there are 87，000 paired partnerships established nationwide between medical and health institutions and elderly care service institutions， and more than 7，800 integrated medical and elderly care institutions have obtained the qualifications of medical and health institutions and completed elderly care service registration. This model not only meets the elderly’s healthcare needs but also provides life care， psychological support， and social activities， thereby improving their quality of life. However， the integrated medical and elderly care model also faces numerous ethical dilemmas in practice. This paper aimed to explore in depth the ethical dilemmas and countermeasures optimization in the work of elderly care institutions under this model， to promote the improvement of service quality， comprehensively guarantee the rights and interests of the elderly， and promote the healthy development of this model in practice. Under this model， the elderly care institutions not only bear the responsibility of providing long-term care and life services but also need to cooperate with medical institutions to provide healthcare and health management services for the elderly. By exploring the practical paths for elderly care institutions to address the ethical dilemmas faced with this model， feasible solutions were proposed to enhance the welfare of the elderly and promote the harmonious development of society.

Recurrent spontaneous abortion(RSA)has complex etiologies,including embryonic chromosomal abnormalities,maternal immune factors,prethrombotic states,and uterine anatomical a-nomalies.Currently,the pathogenesis of RSA remains incompletely elucidated,with placental tropho-blast dysfunction considered a key factor contributing to pregnancy failure.Recent studies have dem-onstrated that non-coding RNA(ncRNA)are stably expressed at the maternal-fetal interface and reg-ulate the proliferation,apoptosis,invasion,and metastasis of trophoblast immune cells.The ncRNA can directly modulate target gene expression or influence the occurrence and progression of RSA through competitive endogenous RNA(ceRNA)regulatory networks,providing novel targets for re-searchers exploring the pathogenesis of RSA.Additionally,ncRNA mediate intercellular interactions via vesicular transport,offering new insights into their regulatory mechanisms.Due to their tissue spe-cificity and expression stability,ncRNA are promising as novel biomarkers for RSA and other preg-nancy-related disorders.This review summarized the regulatory roles of ncRNA in the immune mecha-nisms underlying the occurrence and development of RSA based on multiple domestic and internation-al studies.

OBJECTIVE：To optimize the water extraction and ethanol precipitation technology of Zhuang medicine Baijin granules. METHODS ：HPLC method was adopted to determine the content of bergenin in Baijin granules extract. The extraction routes of Baijin granules （water decoction ，70％ ethanol reflux extraction ，water decoction combined with 70％ ethanol reflux extraction）was screened primarily with the yield of extract and the experiment of reducing uric acid of mice. The orthogonal test was adopted to optimize water extraction technology of Baijin granules with water multiple ，extraction time and extraction times as factors，taking the extraction yield and the bergenin content as index ，then the validation test was carried out. The orthogonal test was adopted to optimize the alcohol precipitation process of Baijin granules including the relative density of medicinal materials ， alcohol content and the alcohol precipitation time ，then the validation test was carried out. By the experiment of reducing uric acid ， the effects of medicinal materials extract of Baijin granules extract were compared before and after ethanol precipitation. RESLUTS：Established method for content determination of bergenin with linearity range of 0.007 2-0.288 mg/mL，had good precision，reproducibility，stability and accuracy. The initially chosen extraction process of Baijin granules was water decoction extraction. The optimal water extraction technology was soaked for 0.5 h，then decocted for 3 times with 14-fold water （mL/g）and 1.0 h each time. The optimal ethanol precipitation process was to concentrate the water extract to a relative density of 1.0 g/mL with alcohol content of liquid at 60％ and precipitated for 12 h. Validation tests showed that RSDs of extract yield and beragenin content were all lower than 2％（n＝3）. The experiment of pharmacodynamics showed that water extract （before ethanol precipitation ）and water extract after alcohol precipitation could significantly decrease the level of uric acid in hyperuricemia model mice （P＜0.01）. There was no statistical significance in the reduction of uric acid between 2 groups（P＞0.05）. CONCLUSIONS ：The optimized water extraction technology can obtain good extract yield and bergenin content ，and combined with ethanol precipitation technology for removing excess impurities would not affect the pharmacodynamics. The water extraction and ethanol precipitation technology is feasible，and can be used for extracting the medicinal materials of Baijin granules and its edulcoration.

Objective To evaluate the effects of intra-articular injection of tranexamic acid with different drainage tube clamping time on blood loss and complications after total knee arthroplasty. Methods A total of 93 patients undergoing total knee arthroplasty from Octorber 2016 to February 2017 in a Class 3 Grade A hospital in Beijing were selected by continuous sampling method. All the research subjects were divided according to the drainage tube clamping time into three groups: clamping 2 h group (n=33), 4 h group (n=29) and 6 h group (n=31). The 24 h postoperative wound drainage, hemoglobin decrease, knee girth, VAS and temperature postoperatively were observed. Results There were significant differences in the wound drainage among the three groups (P＜0.05). The knee girth and VAS of the 6 h group were higher than those of the 2 h and 4 h group, and the differences were statistically significant (P＜0.05). There were no significant differences among the three groups in hemoglobin decrease and temperature (P＞0.05). Conclusions Clamping drainage tube for 4 h after total knee arthroplasty can effectively reduce wound drainage, and will not increase the knee hematoma, pain and postoperative fever.

Objective To study the impact of laparoscopic radical resection and open radical resection on immune function in patients with colon cancer. Methods 110 cases received complete mesocolic excision surgery of the right colon cancer patients, according to the different surgical methods divided into observation group and control group, the observation group adopted laparoscopic surgery while the control group treated with open surgery, then compared the inflammatory stress response and related immunology index changes before and after operation. Results After op-eration, inflammatory stress indicators such as MCP-1, HMGB-1, Glucagon, BG in observation group were signifi-cantly better than that in control group. After operation, WBC, CRP, IL-6 index in the two groups were significantly improved. CRP, IL-6, CD4+, CD8+, NK cell index in observation group was significantly better than that in control group. There were significant differences between the two groups, < 0.05. Conclusion Laparoscopic CME surgery can help to relieve inflammatory stress response, and the immune function is less affected, it is worthy of promoting clinical application.

Objective Few researches are reported on the association of integrinαvβ6 with vaginal mucous infection and de-fense.This study aimed to investigate the effects of IL-6, TGF-β, and IFN-γon the expression of integrinαvβ6 in the vaginal epithelial cell line VK2/E6E7. Methods Immortalized human vaginal epi-thelial cells (VK2/E6E7) were cultured in vitro and treated with gra-dient concentrations of IL-6 (1, 10, 50, and 100 ng/mL), TGF-β(0.1, 1, 10, and 100 ng/mL), and IFN-γ(50, 500, 2500, and 5000 U/L) , respectively.After 48 hours, the cells were collected and total RNA extracted by the Trizol method to be reversely tran-scribed to cDNA. The expressions of integrin αand β6 subunit mRNA were detected by real-time quantitative PCR. Results In the IL-6-treated VK2/E6E7 cells, the integrin αand β6 subunit mRNA expressions were significantly lower in the 1 ng/mL and 10 ng/mL groups but remarkably higher in the 100 ng/mL group (1.14 ±0.12 and 1.37 ±0.25) than in the blank control (1.00 ±0.09) (P<0.05), and only the expression ofβ6 subunit mRNA was elevated in the 50 ng/mL group (P<0.05), with the expressions increased in a concentration-dependent manner.In the TGF-βtreated VK2/E6E7 cells, the expressions of integrinαandβ6 subunit mRNA were significantly lower in the 0.1 ng/mL and 1 ng/mL groups but remarkably higher in the 100 ng/mL group than in the blank control (1.00 ±0.09) (P<0.01), and only the expression ofβ6 subunit mRNA was elevated in the 10 ng/mL group (4.31 ±0.78, P<0.01), with the expressions increased in a concentration-dependent manner.In the IFN-γtreated VK2/E6E7 cells, the expressions of both integrinαandβ6 subunit mRNA were significantly lower in the 50 U/L, 500 U/L, 2500 U/L, and 5000 U/L groups than in the blank control (all P<0.01). Conclusion IL-6 and TGF-βhave an inhibitory effect the expression ofαvβ6 in VK2/E6E7 cells at low concentrations, which gradually diminishes with the increased concentration of inflammatory factors.In the early stage of inflammation, IFN-γcan effectively suppress the expression ofαvβ6 at a high concentration.However, with the progression of inflammation and decrease of its concentration, IFN-γloses its inhibi-tory effect and therefore does not help inflammation control.

Objective: To select anti-HAb18G (hepatoma associated antigen) human Fd fragments with guided selection of L chain of chimeric Fab-HAb18. Methods: The human Fd repertories genes were amplified by RT-PCR from PBMC of hepatoma patients, and cloned into the vector pComb3X with chimeric L chain to construct the human-mouse hybrid Fab phage library. HAblSGE, extracellular region of HAblSG, was used as antigen to screen. The positive clones was obtained by ELISA and FCM with p Ⅲ-fusion Fab antibody. The DNA sequences were analyzed. Results: A human-mouse Fab antibody library were constructed with 2?107 PFU. After 6 rounds panning, 7 positive clones were obtained with ELISA and FCM. And sequences of 2 clones with better affinity were same. The CHI belonged to the IgG2 class as the parent Fd, and the variable region belonged to VH3 family. Conclusions: Through the construction of the HuMFab phage antibody library and chemeric L chain-guided selection, we get the available human Fd fragments for subsequent research.

Objective: To investigate the characteristic of nasal mucosa absorption in vivo of tetramethylpyrazine hydrochloride (TMP HCl) in rats. Methods: The nasal circulatory perfusion test of TMP HCl was performed in rats.Results: The absorption rate constants was increased with the increasing of the concentration of TMP HCl; The absorption rate constants was increased with the elevating of pH values at the pH value range of 4.70～7.00. Conclusion:When the pH value of nasal circulatory perfusion liquid of TMP HCl is 7.00, the nasal mucosa absorption is optimal.