Non-alcoholic fatty liver disease(NAFLD)has become the most important cause of chronic liver disease,and its pathogenic mechanism is very complex.microRNA(miRNA)are widely distributed non-cod-ing RNA.miRNA play an important regulatory role in the pathogenesis and progression of various chronic liv-er diseases,including NAFLD,and may even be used as diagnostic indicators or even therapeutic targets for liver diseases.As a non-invasive biological indicator,a large number of research data show that miRNA has important clinical value in the diagnosis and prognosis of NAFLD.This article provides a review of the re-search progress related to the pathogenic mechanism and clinical diagnostic value of miRNA in NAFLD.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Background: Xylazole (Xyl) is a veterinary anesthetic that is structurally and functionally similar to xylazine. However, the effects of Xyl in vitro remain unknown. Objectives: This study aimed to investigate the anesthetic mechanism of Xyl using fetal rat nerve cells treated with Xyl. Methods: Fetal rat nerve cells cultured for seven days were treated with 10, 20, 30, and 40 μg/ mL Xyl for 0, 5, 10, 15, 20, 25, 30, 45, 60, 90, and 120 min. Variations of amino acid neurotransmitters (AANTs), Nitric oxide-Cyclic GMP (NO-cGMP) signaling pathway, and ATPase were evaluated. Results: Xyl decreased the levels of cGMP and NO in nerve cells. Furthermore, Xyl affected the AANT content and Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase activity in nerve cells. These findings suggested that Xyl inhibited the NO-cGMP signaling pathway in nerve cells in vitro. Conclusions This study provided new evidence that the anesthetic and analgesic effects of Xyl are related to the inhibition of the NO-cGMP signaling pathway.

[摘 要] 目的： 探讨程序性死亡蛋白-配体1（programmed death ligand-1，PD-L1）和肿瘤浸润淋巴细胞（tumor-infiltrating lymphocyte, TIL）在三阴性乳腺癌（triple-negative breast cancer，TNBC）组织中的水平及其临床意义。方法：收集2015年1月至2019年1月福建医科大学附属第二医院手术切除的61例TNBC患者的癌及癌旁组织石蜡标本，用免疫组化法检测癌组织中PD-L1表达和CD8+ TIL的水平，用卡方检测方法分析TNBC组织中PD-L1和CD8+ TIL水平与患者临床病理特征及预后的关系。结果： PD-L1和CD8+ TIL在TNBC组织中的阳性率分别为63.9%（39/61）和32.8%（20/61）。PD-L1表达与TNBC患者的肿瘤大小、淋巴结转移、病理分期、复发与否有明显关联（均P<0.05），与患者的年龄、肿瘤分化程度、脉管侵犯以及Ki67表达水平无明显关联（均P>0.05）；CD8+ TIL水平与TNBC患者的肿瘤大小、肿瘤分化程度、淋巴结转移、病理分期、复发与否有明显关联（均P<0.05），与患者的年龄、脉管侵犯以及Ki67表达水平无明显关联（均P>0.05）。PD-L1和CD8+ TIL水平与患者的无进展生存期（PFS）及总生存期（OS）具有显著相关性（均P<0.05），PD-L1+或者缺乏CD8+ TIL与患者更差的PFS及OS相关（均P<0.05）。结论：TNBC组织中存在较高水平的PD-L1和CD8+ TIL，PD-L1阳性表达或缺乏CD8+ TIL与肿瘤侵袭性增加相关，也与患者更差的PFS及OS相关。

Objective To investigate the clinicopathological characteristics of colon cancer patients with different mismatch repair gene (MMR) status and evaluate the value of MMR status combined with preoperative blood neutrophil-lymphocyte ratio (NLR) in predicting postoperative recurrence of colon cancer. Methods We retrospectively analyzed the pathological MMR immunohistochemistry results of 125 colon cancer patients after radical resection. Patients were divided into deficient mismatch repair (dMMR) group (n=55) and proficient mismatch repair (pMMR) group (n=70), and further divided into four groups according to MMR status and NLR level. Results Compared with the pMMR group, the patients in the dMMR group had younger onset age, larger tumor size, lower differentiation and more nerve invasion, and were more likely to occur in the right hemicolon (P < 0.05). According to the ROC curve, the NLR threshold was determined as 3. The proportion of low NLR in dMMR group was significantly higher than that in pMMR group (P < 0.05). The 3-year recurrence-free survival rate of the dMMR with low NLR group was 85.0%, significantly higher than those of the other three groups (P < 0.05); Survival analysis showed a significant advantage of the dMMR with low NLR group comparing with the pMMR with high NLR group. Conclusion dMMR colon cancer has unique clinicopathological characteristics. MMR status combined with NLR value can be used to evaluate the postoperative recurrence risk of colon cancer patients.

Objective:To evaluate the clinical efficacy,toxicity,and prognostic factors of nab-paclitaxel as first-line treatment for elderly patients with advanced lung squamous carcinoma.Methods:This was a prospective study.Forty patients enrolled in the Second Affili-ated Hospital of Fujian Medical University were treated with nab-paclitaxel(260 mg/m2,ivggt d1),and a period of three weeks was considered as one session.The effects were evaluated after two cycles.Results:All 40 patients were followed up and appraised.Two patients achieved complete remission,13 achieved partial remission,13 achieved stable disease,and 12 achieved progressive disease. The objective response rate was 37.5% and the disease control rate was 70.0%.The progression-free survival(PFS),median overall sur-vival,and 1-year survival rate was 6.3 months,12.6 months,and 62.5%,respectively.The main hematologic toxicities were neutrope-nia and anemia,and the main non-hematologic adverse events were fatigue,constipation,nausea,vomiting,muscle aches,and hear-ing loss.Most patients could tolerate these toxic reactions.Moreover,Cox multivariate regression analysis showed that the neoplasm stage,Eastern Cooperative Oncology Group performance status,response rate,and PFS were independent factors for the survival rate (P<0.05),while age was not related to patient prognosis(P>0.05).Conclusions:Nab-paclitaxel as single drug and first-line therapy for elderly patients with advanced lung squamous carcinoma is effective and safe.

Objective To evaluate the outcome of surgical resection and rituximab for treatment of primary gastric diffuse large B cell lymphoma (PGDLBCL).Methods Data of 83 patients with primary gastric diffuse large B cell lymphoma were reviewed retrospectively.40 patients received surgical resection followed by chemotherapy,and the other 43 patients chemotherapy alone.The two groups were further divided into four sub-groups according to chemotherapy regimens (CHOP or R-CHOP).Overall survival (OS) and progression free survival (PFS) as two prognostic indexes were analyzed.Results The median age of these 83 cases at diagnosis was 52 years (range,20-76 years) with a male-to-female ratio of 43 to 40.And the follow-up duration ranged from 4-59 months (mean 36 months).The 5-year PFS for the patients received surgery and chemotherapy was 66.7％.PFS for the patients received chemotherapy alone was 82.6％.And 5-year OS for these two groups was 68.4％ and 85.9％,respectively.OS and PFS of chemotherapy alone group were better than the other one without statistically significance.In the combined group,the 5-year OS were 73.6％ for patients received R-CHOP and 64.2％ for patients received CHOP;the 5-year-PFS were 71.2％ and 62.5％,respectively.Meanwhile,the 5-year OS for patients received R-CHOP and CHOP were 85.7％ and 83.5％;the 5-year-PFS were 83.4％ and 81.8％,respectively.The OS and PFS did not differ significantly (P＞0.05) between two chemotherapy regimens.According to the Lugano stage,those who received chemotherapy alone for the patients with advanced stage (Ⅱ 2,Ⅱ E or Ⅳ) had better OS compared with received surgery and chemotherapy.A significant difference was found between the two groups (P＜0.05).However for the patients with early stage (Ⅰ or Ⅱ 2),there was no statistically significance between the two groups (P＞0.05).Univariate analysis showed that age,ECOG,Lugano stage,level of LDH and IPI score (P＜0.05) were factors of survival in patients with PGDLBCL.And multivariate analysis showed that IPI score was an independent prognostic factor for OS.Conclusion The survival of the patients received combined surgery and chemotherapy was not superior to those received chemotherapy alone.There was no statistically significance between two different regimens for prognosis of PGDLBCL.Because of poor quality of life caused by surgery,surgery shouldn't now been recommended for the patients with PGDLBCL without operative indication.Rituximab had no positive influence on OS and PFS in most patients with PGDLBCL,but this result should be confirmed by further large sample and multi-center study.

Objective:To compare the clinical efficacy of oxycodone hydrochloride controlled-release tablets (OHCT) and pa-tient-controlled intravenous analgesia (PCIA) in the treatment of intractable cancer pain. Methods:Retrospective analysis was conduct-ed to evaluate the intractable cancer pain of 89 elderly patients who were admitted to the medical oncology departments of The Second Affiliated Hospital of Fujian Medical University and the Fuzhou General Hospital of Nanjing Military Command between September 2012 and March 2014. Among the 89 patients, 47 were treated with OHCT, and 42 received PCIA. The total dosage ranged from 60 mg/d to 400 mg/d PO q12h for patients in the OHCT group, whereas abackground dose+patient-controlled dosemode was adopted for patients in the PCIA group. The therapeutic efficacy, presence of adverse reactions, cost of treatment, and degree of patient satisfaction were compared between the two groups. Results:The average dosages of analgesics in the two groups were almost the same (P>0.05). Visual analogue scale (VAS) values and daily average VAS values were both lower in the PCIA group than in the OHCT group at 24 h after analgesia (P<0.05). The incidence of adverse reactions, such as nausea and vomiting, was also lower in the PCIA group than in the OHCT group (P<0.05). The cost of treatment and degree of patient satisfaction were the same in both groups (P>0.05). Conclusion:Pa-tients who received PCIA attained better analgesia and exhibited less adverse reactions than those who received OHCT whereas the treatment cost and patient satisfaction did not differ in both groups.

Kallistatin, which protects organs and cells against inflammation, fibrosis and oxidative stress, is mainly synthesized and secreted in liver. However, its relationship to human liver disease remains unclear. The purpose of this study was to explore the relationship between serum kallistatin and clinical evidence of both cirrhosis and hepatocellular carcinoma (HCC), and to determine if serum kallistatin levels could be used as a diagnostic indicator of hepatic health status, especially human liver cirrhosis (LC). Our cohort consisted of 115 patients with clinically proven liver fibrosis (LF), LC, or HCC by liver biopsies, and 31 healthy controls (CON). Serum kallistatin levels were quantified by ELISA. Results of the present study demonstrated that irrespective of the underlying etiology, serum kallistatin levels were significantly lower in the LF/LC group when compared with the CON group. A decrease in serum kallistatin levels appeared to reflect the extent of cirrhosis, with the lowest levels associated with higher grades of cirrhosis. Patients with LC had a noticeable correlation between serum kallistatin levels and other serum biochemical indicators. The area under the curve (AUC) for LC, viral liver cirrhosis (VLC) and alcoholic liver cirrhosis (ALC) was 0.845, 0.757 and 0.931, respectively. In conclusion, our findings demonstrated that kallistatin, a plasma protein produced by the liver, can be a useful and reliable diagnostic indicator of hepatic health status, especially for LC.