Liver diseases cannot be easily detected in the early stage， and although invasive diagnostic methods， such as liver biopsy， are relatively accurate， they tend to have a low degree of acceptance， which greatly limits the improvement in diagnosis and treatment techniques for liver diseases. Therefore， it is of great importance to search for new biomarkers and therapeutic targets. As an emerging biomarker for liquid biopsy， tRNA-derived small RNA （tsRNA） is abnormally expressed in various liver diseases including viral hepatitis， fatty liver disease， liver injury， and liver cancer， and it can affect the development and progression of liver diseases by regulating the biological functions such as gene expression， epigenetic regulation， and protein translation. This article reviews the origin， classification， and biological function of tsRNA， as well as the research advances in tsRNA as biomarkers and potential therapeutic targets for liver diseases， so as to provide ideas for the early diagnosis and treatment of liver diseases.

Objective To study the relationship between serum visfatin, neutrophil-to-lymphocyte ratio (NLR) and disease severity of coronary heart disease (CHD) in elderly patients (≥90 years old). Methods One hundred and two elderly patients (≥90 years old) with CHD who received coronary CT angiography (CTA) were selected from January 2020 to June 2024. In addition, thirty-five elderly patients (≥90 years old) without CHD who underwent coronary CTA during the same period were included in the control group. The CHD patients were divided into mild group, moderate group and severe group by CT-SYNTAX score. The clinical data and levels of serum visfatin and NLR were compared, and the correlation and diagnostic value of the above levels with disease severity of CHD in elderly patients were analyzed. Results Serum visfatin and NLR were manifested as severe group>moderate group>mild group>control group (P<0.05). Pearson correlation analysis found that serum visfatin and NLR were moderately positively correlated with CT-SYNTAX score (r=0.574, 0.482, P<0.001). Receiver operating characteristics (ROC) curve indicated that the area under the curve (AUC) of combination of serum visfatin and NLR in diagnosing severe lesion in elderly patients (≥90 years old) with CHD was 0.882, which was higher than that of visfatin or NLR alone, and its 95%CI was 0.803-0.938. Conclusion There is a certain correlation between serum visfatin, NLR and disease severity of CHD in elderly patients. The combination of the above indicators has a higher predictive value on severe lesion.

Objective To study the relationship between serum visfatin, neutrophil-to-lymphocyte ratio (NLR) and disease severity of coronary heart disease (CHD) in elderly patients (≥90 years old). Methods One hundred and two elderly patients (≥90 years old) with CHD who received coronary CT angiography (CTA) were selected from January 2020 to June 2024. In addition, thirty-five elderly patients (≥90 years old) without CHD who underwent coronary CTA during the same period were included in the control group. The CHD patients were divided into mild group, moderate group and severe group by CT-SYNTAX score. The clinical data and levels of serum visfatin and NLR were compared, and the correlation and diagnostic value of the above levels with disease severity of CHD in elderly patients were analyzed. Results Serum visfatin and NLR were manifested as severe group>moderate group>mild group>control group (P<0.05). Pearson correlation analysis found that serum visfatin and NLR were moderately positively correlated with CT-SYNTAX score (r=0.574, 0.482, P<0.001). Receiver operating characteristics (ROC) curve indicated that the area under the curve (AUC) of combination of serum visfatin and NLR in diagnosing severe lesion in elderly patients (≥90 years old) with CHD was 0.882, which was higher than that of visfatin or NLR alone, and its 95%CI was 0.803-0.938. Conclusion There is a certain correlation between serum visfatin, NLR and disease severity of CHD in elderly patients. The combination of the above indicators has a higher predictive value on severe lesion.

ObjectiveTo improve the quality standard of Yuanhu Zhitong oral liquid in order to strengthen the quality control of this oral liquid. MethodThin layer chromatography（TLC） was used for the qualitative identification of Corydalis Rhizoma and Angelicae Dahuricae Radix in Yuanhu Zhitong oral liquid by taking tetrahydropalmatine， corydaline reference substances and Corydalis Rhizoma reference medicinal materials as reference， and cyclohexane-trichloromethane-methanol（5∶3∶0.5） as developing solvent， Corydalis Rhizoma was identified using GF254 glass thin layer plate under ultraviolet light（365 nm）. And taking petroleum ether（60-90 ℃） -ether-formic acid（10∶10∶1） as developing solvent， Angelicae Dahuricae Radix was identified using a silica gel G TLC plate under ultraviolet light（305 nm）. High performance liquid chromatography（HPLC） was performed on a Waters XSelect HSS T3 column（4.6 mm×250 mm， 5 μm） with acetonitrile（A）-0.1% glacial acetic acid solution（adjusted pH to 6.1 by triethylamine）（B） as the mobile phase for gradient elution（0-10 min， 20%-30%A； 10-25 min， 30%-40%A； 25-40 min， 40%-50%A； 40-60 min， 50%-60%A）， the detection wavelength was set at 280 nm， then the fingerprint of Yuanhu Zhitong oral liquid was established， and the contents of tetrahydropalmatine and corydaline were determined. ResultIn the thin layer chromatograms， the corresponding spots of Yuanhu Zhitong oral liquid， the reference substances and reference medicinal materials were clear， with good separation and strong specificity. A total of 12 common peaks were identified in 10 batches of Yuanhu Zhitong oral liquid samples， and the peaks of berberine hydrochloride， dehydrocorydaline， glaucine， tetrahydropalmatine and corydaline. The similarities between the 10 batches of samples and the control fingerprint were all >0.90. The results of determination showed that the concentrations of corydaline and tetrahydropalmatine had good linearity with paek area in the range of 0.038 6-0.193 0， 0.034 0-0.170 0 g·L^-1， respectively. The methodological investigation was qualified， and the contents of corydaline and tetrahydropalmatine in 10 batches of Yuanhu Zhitong oral liquid samples were 0.077 5-0.142 9、0.126 1-0.178 2 g·L^-1， respectively. ConclusionThe established TLC， fingerprint and determination are simple， specific and reproducible， which can be used to improve the quality control standard of Yuanhu Zhitong oral liquid.

Objective To explore the effects of permissive hypercapnia on postoperative cognitive function in elderly patients with diabetes mellitus.Methods Sixty elderly patients with diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia,were randomly divided into two groups:the permissive hypercapnia ventilation diabetes mellitus group(group DH)and the routine ven-tilation diabetes mellitus group(group DR),30 patients in each group.Another sixty elderly patients with non-diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia,were randomly divided into two groups:the permissive hypercapnia ventilation non-diabetes mellitus group(group NH)and the routine ventilation group(group NR),30 patients in each group.All patients in four groups were performed with tracheal intubation and mechanical ventilation after anesthesia induction.The respiratory parameters were adjusted to maintain PaCO2 in a range of 45-65 mmHg in groups DH and NH,and PaCO2 in a range of 35-45 mmHg in groups DR and NR.PETCO2 was recorded 5 minutes before pneu-moperitoneum,5,15,and 30 minutes after pneumoperitoneum.Blood samples were taken from the radial artery and jugular bulb for blood gas analysis 5 minutes before pneumoperitoneum,5,15,and 30 minutes after pneumoperitoneum.pH value and PaCO2 were recorded and arterial internal jugular vein bulbar oxygen difference(Da-jvO2)and cerebral oxygen extraction rate(CERO2)were calculated at the same time.The serum S100β protein concentration were detected before anesthesia induction and 3 days after operation.Montreal cognitive assessment(MoCA)scores and occurrence of postoperative cognitive dysfunction were recorded 1 day before operation,and 1 day,3 days and 7 days after operation.Results Compared with the baseline value 5 minutes before pneumoperitoneum,PETCO2 and PaCO2 were significantly increased,pH value,Da-jvO2 and CERO2 were significantly decreased 5,15,and 30 minutes after pneumoperitoneum in the four groups(P＜0.05).Compared with before anesthesia induction,the serum S100β protein concen-tration were significantly increased 3 days after operation in the four groups(P＜0.05).Compared with the last day before operation,MoCA scores were significantly decreased 1 day and 3 days after operation in the four groups(P＜0.05).Compared with group DR,PETCO2 was significantly increased,pH value,Da-jvO2,and CERO2 were significantly decreased 5 minutes before pneumoperitoneum,5,15,and 30 mi-nutes after pneumoperitoneum,the serum S100β protein concentration was significantly decreased 3 days af-ter operation,MoCA scores were significantly increased 1 day and 3 days after operation,the incidence rate of POCD was significantly decreased in group DH(P＜0.05).Compared with group NR,PETCO2 was sig-nificantly increased,pH value,Da-jvO2,and CERO2 were significantly decreased 5 minutes before pneu-moperitoneum,5,15,and 30 minutes after pneumoperitoneum,the serum S100β protein concentration was significantly decreased 3 days after operation,MoCA scores were significantly increased 1 day and 3 days af-ter operation,the incidence rate of POCD was significantly decreased in group NH(P＜0.05).Compared with group NH,Da-jvO2 and CERO2 were significantly increased 5 minutes before pneumoperitoneum,5,15,and 30 minutes after pneumoperitoneum,the serum S100β protein concentration was significantly in-creased 3 days after operation,MoCA scores were significantly decreased 1 day and 3 days after operation in group DH(P＜0.05).Conclusion Permissive hypercapnia can improve the cerebral oxygen metabolism during operation,reduce postoperative serum S100β protein concentration and reduce the incidence rate of POCD in the elderly patients with diabetes mellitus.

Objective To observe the changes in serum a proliferation inducing ligand(a proliferation inducing ligand,APRIL)and N-myc downstream regulated gene 1(N-myc downstream regulated gene 1,NDRG1)levels,and analyze their diagnostic value for ovarian endometrioma(OEM).Methods From July 2021 to July 2022,132 patients with OEM who visited Zigong First People's Hospital were regarded as the observation group,and regular follow-up was conducted.According to the prognosis of these patients,they were grouped into the recurrence group(n=50)and the non recurrence group(n=82).Meanwhile,78 healthy individuals who had their medical checkups at the hospital during the same period were the control group.Enzyme linked immunosorbent assay(ELISA)was applied to detect serum APRIL and NDRG1 levels,and the general data of the recurrent and non recurrent groups were compared.Logistic regression analysis was applied to analyze the relevant factors affecting the prognosis of OEM.Pearson analysis was applied to explore the correlation between serum APRIL and NDRG1 levels in patients with OEM.Receiver operating characteristic(ROC)curve was applied to evaluate the diagnostic value of serum APRIL,NDRG1 levels and their combination for OEM.Results Compared with the control group,APRIL level(35.28±6.81ng/ml vs 26.37±3.19ng/ml)and NDRG1 level(124.39±15.67μg/L vs 9.67±10.82μg/L)in observation group were increased,and the differences were significant(t=10.864,17.278,all P<0.05).Compared with the non recurrence group,the serum levels of APRIL(40.38±7.88ng/ml vs 32.16±6.18ng/ml)and NDRG1(132.04±19.83μg/L vs 119.73±13.16μg/L)in the recurrence group were increased,and the differences were significant(t=6.668,4.287,all P<0.05).Logistic regression analysis showed that serum APRIL and NDRG1 levels were risk factors for the prognosis of patients with OEM(Waldχ2=11.839,28.437,all P＜0.001).Pearson method analysis results showed a positive correlation between serum APRIL level and NDRG1 level in patients with OEM(r=0.439,P<0.001).The area under the curve(AUC)of combined diagnosis of serum APRIL and NDRG1 levels in patients with OEM was 0.849,with a sensitivity and specificity of 73.95%and 85.37%,respectively,which was better than the single prediction of APRIL and NDRG1(Z =2.644,2.094,P=0.008,0.036).Conclusion The serum levels of APRIL and NDRG1 were increased in patients with OEM.The combination of the two has high clinical value in the diagnosis of OEM,which may be closely related to the prognosis of patients with OEM.

Objective To analyze the type and incidence of abnormal chromosome karyotype in peripheral blood of infertile patients with different semen quality.Methods Selectet 292 infertility patients who came to our hospital from January 2018 to December 2021 for G-banding karyotyping and semen analysis.According to the semen analysis results,the patients were divided into abnormal semen quality group and normal control group.We made statistics and analysis on the abnormal karyotypes.Results In the group with abnormal semen quality,20 cases(18.87%)of abnormal karyotypes were found.In the normal control group,9 cases(4.84%)had abnormal karyotypes were found.The comparison of the abnormal rates of peripheral blood chromosome karyotypes between the two groups showed statistical significance(P<0.05).The detection rate of chromosomal abnormalities in patients with Azoospermia was 50%,and sex chromosome abnormalities were the main types of abnormalities in this group.Conclusion Karyotype analysis of infertile patients can effectively analyze the causes of infertility,and has important clinical significance for assisted reproduction and primary prevention of birth defects.

Continuing medical education for general practitioners is an important measure to upgrade the quality of primary health care services in China, which is still facing various challenges and need to be further developed and improved. This article analyzes the status quo and existing problems of continuing medical education for general practitioners in China, and proposes suggestions based on the concept of people centered and integrated health care (PCIC), including faculty development, training contents, assessment methods, and experience learning, to provide references for the improvement of continuing medical education for general practitioners.

Based on the theoretical reflection on the reflective function of medical records,the important findings in the practice of medical records writing in the field of palliative care,and conceptual analysis of narrative medicine tools,combined with empirical investigation materials and analysis,this paper focused on the practice of medical records writing for reflection and research.The main contents include defining the concept of narrative medical records,which are medical records used in clinical practice that incorporate narrative content;clarifying their characteristics and functions at different levels;and exploring practical paths for their application in clinical practice.Based on an in-depth exploration of the uniqueness of narrative medicine practice at Peking Union Medical College,it also emphasized the necessity of writing medical records with narrative thinking.Specifically,it focused on using narrative thinking and forms to enhance the improvement of current medical records writing,and further sought a general framework and multiple possibilities for narrative medicine clinical pathways.

Objective:To investigate the stability and feasibility of using absorbable screws during Bernese periacetabular osteotomy.Methods:A retrospective analysis was conducted on a 36 year-old woman diagnosed with developmental dysplasia of the hip, who had undergone Bernese periacetabular osteotomy. Finite element analysis was used to simulate the stability of the acetabulum under loads of 10%, 20%, 50%, and 100% of the patient's weight. The structural stiffness of the pelvis and the maximum equivalent stress on the absorbable screws were observed under different conditions, including whether the acetabular bone block and the ilium were in contact, whether 3 or 4 screws were used, and whether a graft (including fibular cortical bone and PEEK grafts) was used.Results:The structural stiffness of the pelvis fixed with four screws increased by 67%-94% compared to that with three screws. After using a graft, the structural stiffness of the pelvis increased by 50%-83%. As the load increased, the maximum equivalent stress on the screws also increased. When the acetabular bone block and the ilium had no contact, no graft was used, and only three screws were used for fixation, the maximum equivalent stress could reach 518.9 MPa, while this value dropped to 61% when four screws were used (318.7 MPa). When the acetabular bone block and the ilium were in contact, the maximum equivalent stress was about 12% of that when there was no contact, regardless of the number of screws used. When a cortical bone graft or a PEEK graft was used, the maximum equivalent stress could drop to 21%-26% of that without a graft. When the screw strength was 130 MPa, a load of 20% of body weight was applied, and only three screws were used without a graft, the equivalent stress could exceed the strength of the screw; if four screws were used, the equivalent stress was slightly higher than the strength of the screw when a load of 50% of body weight was applied. However, when a graft was used (either cortical bone or PEEK), even when a load of 100% of body weight was applied, the equivalent stress was slightly lower than the strength of the screw.Conclusion:Absorbable screws can provide sufficient stability for Bernese periacetabular osteotomy. The contact between the acetabular bone block and the ilium, an increase in the number of screws, and the use of grafts (cortical bone and PEEK grafts) can further improve stability. Therefore, absorbable screws have broad application prospects in Bernese periacetabular osteotomy.