This paper analyzed the problems existing in China’s basic medical and health services from the perspective of fairness and efficiency, and the main restricting factors of balanced developmen. The main factors were: the far-reaching influence of "dual economic structure" between urban and rural areas, the government’s low-efficiency intervention in the allocation of health resources, the efficiency of hierarchical diagnosis and treatment system has not been fully released, the level of basic medical security needs to be improved, and the reform of the management and operation mechanism of medical institutions is lagging. It is proposed to adhere to the value concept of appropriate balance between fairness and efficiency, give full play to the functions of the government and the market, and take concrete measures to improve the financing mode, optimize the allocation of resources and improve the service system.

Myocardial fibrosis （MF） is a prevalent pathological process in a spectrum of cardiac conditions， including myocardial infarction， hypertensive heart disease， and dilated cardiomyopathy. It is marked by an overabundance of extracellular matrix deposition， diminished myocardial compliance， and impaired cardiac function， which can lead to arrhythmias and sudden cardiac death. The current therapeutic approach primarily aims to suppress the progression of fibrosis， yet the therapeutic outcomes are poor. The pathogenesis of MF involves multiple signaling pathways， including the transforming growth factor-beta （TGF-β）/Smads signaling pathway， nuclear factor-kappa B （NF-κB） signaling pathway， phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， and mitogen-activated protein kinase （MAPK） signaling pathway. Traditional Chinese medicine （TCM） boasts a rich history in the treatment of cardiovascular diseases， offering distinctive benefits such as minimal side effects and high safety， and it has demonstrated promising therapeutic effects in the treatment of MF. In recent years， research has turned its attention to the application of TCM in modulating the signaling pathways associated with MF. It has been demonstrated that TCM can modulate the MF-related signaling pathways to exert anti-inflammatory effects， regulate cellular autophagy， cell proliferation， and apoptosis， reduce myocardial oxidative stress and damage， and inhibit the activation of fibroblasts and collagen synthesis， thereby exhibiting the potential to mitigate or even reverse the progression of MF. Experimental research and clinical observations indicate that TCM formulas such as Yixin Futing decoction， Luhong prescription， Zhilong Huoxue Tongyu capsules， and Kangjian Yixin prescription can effectively ameliorate MF and enhance cardiac function through the multi-component regulation of multiple cellular pathways. Specific TCM constituents， including isoliquiritigenin and astragaloside， have been shown to inhibit the expression of TGF-β₁， thereby disrupting the Smad signaling pathway. Compounds like glycyrrhizic acid and allicin can suppress the NF-κB signaling pathway and curtail collagen synthesis in myocardial cells， and forsythoside can activate the PI3K/Akt signaling pathway， contributing to its anti-fibrotic effects.

Gastric cancer(GC)is one of the most common gastrointestinal tumors.As a newly discovered type of non-coding RNAs,transfer RNA(tRNA)-derived small RNAs(tsRNAs)play a dual biological role in cancer.Our previous studies have demonstrated the potential of tRF-23-Q99P9P9NDD as a diagnostic and prognostic biomarker for GC.In this work,we confirmed for the first time that tRF-23-Q99P9P9NDD can promote the proliferation,migration,and invasion of GC cells in vitro.The dual luciferase reporter gene assay confirmed that tRF-23-Q99P9P9NDD could bind to the 3'untranslated region(UTR)site of acyl-coenzyme A dehydrogenase short/branched chain(ACADSB).In addition,ACADSB could rescue the effect of tRF-23-Q99P9P9NDD on GC cells.Next,we used Gene Ontology(GO),the Kyoto Encyclopedia of Genes and Genomes(KEGG),and Gene Set Enrichment Analysis(GSEA)to find that downregulated ACADSB in GC may promote lipid accumulation by inhibiting fatty acid catabolism and ferroptosis.Finally,we verified the correlation between ACADSB and 12 ferroptosis genes at the transcriptional level,as well as the changes in reactive oxygen species(ROS)levels by flow cytometry.In summary,this study proposes that tRF-23-Q99P9P9NDD may affect GC lipid metabolism and ferroptosis by targeting ACADSB,thereby promoting GC progression.It provides a theoretical basis for the diagnostic and prognostic monitoring value of GC and opens up new possibilities for treatment.

To investigate the effects of Pithecellobium clypearia extract on the tissue structure,in-flammatory lesions as well as microbial diversity in the intestinal of yellow-feathered broilers.2401-day-old yellow-feathered broilers were randomly divided into four groups(groups A,B,C and D),groups A,B and C were supplemented with Pithecellobium clypearia extract in basal diets with concentrations of 0.5,1.0 and 2.0 g/kg,respectively.Group D served as the control group without adding Pithecellobium clypearia extract in diets,and the full trial period lasted for 70 d.Duodenum and jejunum samples were collected on the 20th,40th and 70th days of the test,the vil-lous/crypt ratio of duodenum and jejunum were calculated,and the mRNA expression level of in-flammatory cytokine as well as related pathways were detected in each group,respectively.In addition,the contents of cecum were collected at 70 th day of the experiment and the microbial di-versity in cecum were also analysed by 16S rDNA sequencing.The results showed that adding 0.5 and 1.0 g/kg of Pithecellobium clypearia extract in the diet could significantly increase the veloci-ty height/crypt depth ratio of duodenum and jejunum(P＜0.05)compared to control group,as well as the mRNA expression level of tight junction protein(CLDN1 and CLDN5)in jejunum,which further improved the structure of mucous of intestinal.Pithecellobium clypearia extract could significantly(P＜0.05)decrease the mRNA expression level of inflammatory cytokine inclu-ding IL-1β,IL-8 and TNF-α,as well as the related pathway genes such as TLR4,MyD88 and NF-κB in jejunum,thus reduced the inflammatory lesions in intestinal.Pithecellobium clypearia ex-tract also could significantly increase the abundance of beneficial microbial such as Parabacteroide and Prevotellaceae,while significantly decrease the abundance of pathogenic microbial such as Proteobacteria in cecum(P＜0.05)and improve the microbial diversity in intestinal.In summary,Pithecellobium clypearia extract could improve the structure of intestinal tissue and the gut barri-er function,as well as the microbial diversity in cecum,and also decrease the inflammatory lesions in jejunum,which is helpful to the intestinal health for yellow-feathered broilers.The present study provides scientific basis for the development of Pithecellobium clypearia as a safe feed additive in the future.

Objective:To explore the application effect of eyebrow lift combined with periorbital muscle manipulatation in the treatment of upper eyelid skin relaxation.Methods:From February 2017 to June 2022, a total of 52 female patients with upper eyelid skin laxity aged 38-64 (43.2±5.0) years, admitted to the Department of Plastic Surgery and Laser Medicine, Beijing Anzhen Hospital were selected for treatment in eyebrow lift with sub-brow excision, removed excess skin and orbicularis oculi muscle, and cut off part of periorbital muscle, and the orbicularis orbicularis muscle at the lower edge of the incision was suspend and fixed to the periosteum of supraorbital margin.Results:After following up from 6 months to 1 year after surgery, the upper eyelid slack and crow′s feet of 52 patients were improved significantly, no obvious downward movement appeared in the eyebrows, and the surgical effect was satisfied.Conclusions:The treatment of upper eyelid skin relaxation in eyebrow lift combined with periorbital muscle manipulatation can significantly improve the upper eyelid slack and crow′s feet, and it is worthy of clinical application.

With the deepening of research in oral microbiomics, an important relationship between changes in the oral microbiome and orthodontic treatment has been found. Orthodontic treatment will have an impact on the oral and systemic microbiome. The presence of oral appliances can change the quantity and quality of the oral microbiometo and increase the risk of oral and even systemic diseases in patients undergoing orthodontic treatment. Compared with fixed orthodontic treatment, clear aligners will not have a harmful impact on the structure of the oral microbiome, which is more conducive to maintain oral health during the orthodontic treatment process. In addition, different bracket types and materials can lead to different changes in the oral microbiome, and the occurrence and development of orthodontic-related diseases, such as white spot lesions, dental caries, gingivitis and periodontitis, are also related to changes in the oral microbiome. At present, the role of the oral microbiome in the process of orthodontic treatment needs to be further studied. Whether a change in the oral microbiome caused by orthodontic treatment can be restored after orthodontic treatment is still uncertain and needs more research. This paper reviews the research progress on the application of microbiomics in orthodontics, including the impact of fixed appliances and clear aligners on the microbiome and the relationship between orthodontic-related diseases and the oral microbiome.

This paper analyzed the problems existing in China’s basic medical and health services from the perspective of fairness and efficiency, and the main restricting factors of balanced developmen. The main factors were: the far-reaching influence of "dual economic structure" between urban and rural areas, the government’s low-efficiency intervention in the allocation of health resources, the efficiency of hierarchical diagnosis and treatment system has not been fully released, the level of basic medical security needs to be improved, and the reform of the management and operation mechanism of medical institutions is lagging. It is proposed to adhere to the value concept of appropriate balance between fairness and efficiency, give full play to the functions of the government and the market, and take concrete measures to improve the financing mode, optimize the allocation of resources and improve the service system.

Objective:To analyze the risk factors of the number of central lymph node metastasis (CLNM) >5 in papillary thyroid microcarcinoma (PTMC) with clinical lymph node negative (cN0) .Methods:A total of 1567 cases of unilateral cN0 PTMC patients undergoing surgery at Endocrine and Breast Surgery Department of the First Affiliated Hospital of Chongqing Medical University from Jan. 2013 to Dec. 2018 were analyzed retrospectively. There were 405 cases of male and 1162 cases of female among them. According to the CLNM, they were divided into 0-5 and ≥5 groups. Clinicopathological characteristics of two groups were compared with Chi-square test and χ 2 test, et al. Results:The case of CLNM>5 involved was 4.1% (65/1567) .Univariate analysis showed that male, age ≤50 years old, tumor diameter> 8 mm, multifocal cancer all were related to CLNM>5 involved ( P<0.05) , multivariate logistic regression analysis found that male ( OR=1.886, P=0.017) , age ≤50 years ( OR=3.778, P=0.002) , tumor diameter>8 mm ( OR=2.483, P<0.001) and multifocal cancer ( OR=2.362, P=0.005) were independent risk factors for CLNM>5. Subgroup analysis showed that the number of Delphian lymph nodes metastasis≥1 ( OR=13.475, P<0.001) , pretracheal lymph nodes metastasis≥2 ( OR=41.695, P<0.001) , and Delphian+pretracheal lymph nodes metastasis≥2 ( OR=28.750, P<0.001) were also independent risk factors for CLNM>5. Conclusions:Unilateral PTMC patients who are male and age ≤50 years old with tumor diameter>8 mm, multifocal cancer have higher risk of central lymph nodes more than 5 involved, surgical treatment and prophylactic central neck dissection are recommended to such patients instead of long-term follow-up observation.Total thyroidectomy should be selected appropriately according to the intraoperative situation.

Objective    To study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time. Methods    From March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery. Results    There was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single- vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention. Conclusion    The learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.

Objective    To investigate the safety and effectiveness of minimally invasive coronary artery bypass grafting (MICABG) through comparing the perioperative clinical effects of conventional surgery and MICABG. Methods    A total of 543 patients in the single medical group of Beijing Anzhen Hospital who underwent beating coronary artery bypass grafting from January 2017 to September 2020 were collected, including 161 patients receiving MICABG (a minimally invasive group, 143 males and 18 females, aged 60.08±9.21 years), 382 patients receiving median thoracotomy (a conventional group, 284 males and 98 females, aged 61.68±8.81 years). The propensity score was used to match 143 patients in each of the two groups, and the perioperative data of the two groups were summarized and analyzed. Results    There was no death, perioperative myocardial infarction or stroke in the minimally invasive group. Compared with the conventional group, the minimally invasive group had longer operation time (296.36±89.4 min vs. 217.80±50.63 min, P=0.000), less number of bypass grafts (2.86±1.03 vs. 3.17±0.78, P=0.005), shorter postoperative hospital stay (6.29±1.46 d vs. 6.78±2.61 d, P=0.031), less drainage on postoperative day 1 (339.57±180.63 mL vs. 441.92±262.63 mL, P=0.001) and lower usage rate of inotropic drugs (9.09% vs. 26.57%, P=0.001). There was no statistical difference between the two groups in postoperative ICU stay ventilator assistance time, blood transfusion rate, secondary thoracotomy rate, or use of mechanical equipment. Conclusion    Reasonable clinical strategies can ensure the satisfactory overall safety of MICABG. In addition, it has the advantages of shorter postoperative hospital stay, less bleeding and smaller dosage of inotropic drugs.