The incidence of placenta accreta spectrum disorders is increasing， which is becoming a global issue impacting maternal and neonatal health. In order to better manage placenta accreta spectrum disorders， according to the latest international guidelines and evidence-based data， we have made a detailed summary to its clinical diagnostic criteria， early identification of high-risk groups， prenatal screening and diagnosis， imaging characteristics of ultrasound and MRI， timing of delivery and surgical management. The aim is to standardize the early diagnosis and management of placenta accreta spectrum disorders at an early stage and reduce maternal and fetal complications finally.

Placenta accreta spectrum is a prevalent cause of severe postpartum hemorrhage and emergency hysterectomy. In recent years， there has been an increasing incidence of placenta accreta spectrum. Besides traumatic uterine injury factors such as elevated cesarean section rates， other non-traumatic factors including uterine malformation， endometritis， uterine adenomyosis， in vitro fertilization-embryo transfer also warrant serious consideration. This article focuses on early disease detection， standardized diagnosis， prevention， and treatment of placental implantation disorders associated with non-traumatic factors to enhance the adverse outcomes for these parturients.

Placenta accreta spectrum （PAS） refers to a condition where placental villi abnormally adhere to or invade the uterine muscle layer to varying degrees. PAS can lead to severe obstetric complications， including postpartum hemorrhage， hysterectomy and even life-threatening situations. Nowadays， the diagnosis of PAS typically relies on imaging examinations such as ultrasound. Despite the widespread use of ultrasound， its accuracy is a subject of controversy， leading to the emergence of new imaging prenatal diagnostic indicators. This article aims to review prenatal diagnostic indicators of PAS， including ultrasound features and magnetic resonance imaging （MRI）. Additionally， we will discuss existing joint diagnostic methods and the latest research findings.

Objective To retrospectively analyze of factors influencing early preterm birth （EPB） and late preterm birth （LPB） in pregnancy women with placenta previa complicated by placenta accreta spectrum disorders （PAS）， and assess maternal and infant outcomes. Methods We included 590 cases of pregnancy women with placenta previa complicated by PAS who underwent cesarean sections at five hospitals in Wuhan and Xianning cities between January 2018 and June 2021. These patients were divided into three groups based on delivery gestational age ： EPB， LPB， and term birth （TB）. A multiple logistic regression model was employed to analyze the risk factors associated with EPB and LPB. Additionally， differences in early maternal and infant outcomes among these groups were examined. Results Among 590 pregnancy women with placenta previa complicated by PAS， the proportions of EPB and LPB were 9.7% and 54.4%. The use of uterine contraction inhibitors prior to cesarean section， vaginal bleeding， and previous cesarean sections history were identified as risk factors for both EPB and LPB. The proportion of severe postpartum hemorrhage was comparable between the EPB group and the LPB group； however， the incidence of neonatal asphyxia， low birth weight infants， and the rate of newborns transferred to the Neonatal Intensive Care Unit （NICU） within 24 hours after cesarean delivery were significantly higher in the EPB group compared to the LPB group. Conclusions Placenta previa complicated by PAS predominantly leads to LPB. The history of prior cesarean sections， uterine contractions， and vaginal bleeding prior to cesarean section， are significantly associated with both EPB and LPB. During the perinatal period， efforts should be made to extend gestational weeks under close monitoring to minimize the incidence of premature births and thereby improve early maternal and infant outcomes.

Objective To investigate the prenatal diagnosis and perinatal outcomes between anterior placenta accreta and non-anterior placenta. Methods A retrospective analysis was done for 560 pregnant women who were diagnosed with placenta accreta and delivered in the Third Affiliated Hospital of Guangzhou Medical University.According to the location of the placenta， the group was dividing into anterior placenta accreta group （319 cases） and non-anterior placenta accreta group （241 cases）. The general characteristics， maternal and infant outcomes of the two groups were analyzed. The non-anterior placenta accrete group （241 cases） then were dividing into two groups according to the time of clear diagnosis. Those who were firstly diagnosed with placenta accrete during or after the operation was the intrapartum diagnosis group （missed diagnosis） （70 cases）， and those who were diagnosed with clear placenta accreta before the delivery was prenatal diagnosis group （171 cases）. The general characteristics， maternal and infant outcomes of the two groups were also analyzed. Results There were statistically significant differences in the parity， history of cesarean section， delivery mode， degree of placenta accreta， missed diagnosis rate， neonatal birth weight， and hysterectomy rate between the non-anterior placenta accrete group and the anterior placenta accreta group. In the case of prenatal diagnosis of different degrees of placenta accreta， the prenatal diagnosis rate of placental adhesion in the non-anterior placenta accreta group was lower than that of the anterior placenta accreta group， which was statistically significant. In the non-anterior placenta accrete group， there were statistically significant differences in the age， cesarean section history， placenta previa status， mode of delivery， degree of implantation， 24-hour bleeding volume， blood transfusions， NICU transfer rate， uterine loss rate between the intrapartum diagnosis group （missed diagnosis） and the prenatal diagnosis group. Conclusions The high-risk factors of patients with non-anterior placenta accreta are different from those of patients with anterior placenta accreta. Multiple births and a history of cesarean section are high-risk factors for anterior placenta accreta patients. Non-anterior placenta accreta are more likely to be missed diagnosed， especially the placental adhesion. For pregnant women with non-anterior placenta accreta missed diagnosis， there is a high rate of adverse birth outcomes， especially in the rate of neonatal transfer to the NICU.

Objective To analyze the pregnancy outcomes of combined B-Lynch suture and intrauterine packing with gauze versus combined B-Lynch suture and intrauterine balloon tamponade in the treatment of central placenta previa with abnormally adherent placenta. Methods A retrospective analysis was conducted on 48 patients with central type placenta previa combined with adhesive placental implantation at Nanfang Hospital of Southern Medical University from July 2021 to October 2023. Among them， 23 patients were treated with B-Lynch suture combined with uterine gauze tamponade （study group）， and 25 patients were treated with B-Lynch suture combined with uterine balloon tamponade （control group）. The intraoperative bleeding volume， postpartum 24-hour bleeding volume， postoperative intervention surgery rate， postoperative ICU transfer rate， and hospitalization costs were compared between the two groups. Results There was no statistically significant difference in intraoperative bleeding between the two groups （P > 0.05）. Compared with the control group， the study group showed a decrease in 24-hour postpartum hemorrhage， red blood cell infusion， surgical time， and hospitalization costs； The postoperative hospitalization days are shorter （P < 0.05）. Three patients in the control group underwent uterine artery embolization intervention surgery， and one patient was transferred to the ICU. There was no statistically significant difference in the ICU transfer rate and postoperative intervention surgery rate between the two groups （P > 0.05）. There was no difference in Apgar scores between the two groups of newborns. After discharge， patients were followed up until 42 days postpartum， and the results showed that all patients had no late postpartum hemorrhage， no poor healing of uterine incisions， no complications such as bladder ureteral injury and intestinal obstruction. Conclusion Combined B-Lynch suture and intrauterine gauze packing is a simple， feasible， safe， and reliable hemostatic method. It is suitable for primary healthcare institutions and worthy of promotion.

IgG4?related disease （IgG4?RD） is a chronic fibroinflammatory disorder with systemic involvement， predominantly affecting middle?aged and elderly males. Although the precise etiology and pathogenesis of the disease remain incompletely understood， its hallmark histopathological features include dense lymphoplasmacytic infiltration with IgG4?positive plasma cells， storiform fibrosis， obliterative phlebitis， and often increased numbers of eosinophils. While more than half of patients with IgG4?RD exhibit elevated serum IgG4 concentrations， this finding lacks specificity as it can also be observed in other conditions； furthermore， a subset of patients may present with normal serum IgG4 levels. Therefore， serum IgG4 elevation is not considered a definitive diagnostic criterion for this condition. The disease is characterized by its broad organ involvement frequently affecting the lymph nodes， salivary glands， lungs among others. The clinical and radiological manifestations of IgG4?RD exhibit a wide range of diversity， varying according to the specific organ involved. However， it generally demonstrates a favorable response to corticosteroid therapy while displaying a high propensity for relapse. Thoracic involvement in IgG4?RD presents an array of imaging findings encompassing abnormalities in the lungs， lymph nodes， pleura， chest wall， mediastinum， as well as large vessels such as the aorta and coronary arteries. Accurately differentiating IgG4?RD from malignancies， inflammatory conditions， and other autoimmune diseases poses a significant diagnostic challenge specifically for radiologists. This review aims to provide comprehensive insights into the pathophysiology， clinical characteristics， and thoracic imaging features of IgG4?RD with the ultimate goal of facilitating precise diagnosis and thorough evaluation of thoracic involvement。

Image-enhanced endoscopy （IEE） is an advanced endoscopic imaging technique utilized to enhance the visualization of mucosal surface patterns and microvascular system features of gastrointestinal lesions， playing a pivotal role in real-time diagnosis. Real-time optical diagnosis can be achieved through various tools and techniques， including narrow band imaging （NBI）， Pentax endoscopy （i-SCAN）， flexible spectral imaging color enhancement （FICE）， blue laser imaging （BLI）， and linked-color imaging （LCI）. This article provides a comprehensive review on the application progress of IEE in detecting colorectal lesions， aiming to establish a novel theoretical foundation for clinical detection of such lesions.

Objective To investigate the impact of CCND1 on renal ischemia?reperfusion?induced acute kidney injury through the promotion of glycolysis and elucidate its underlying molecular mechanism， thereby offering a novel therapeutic target for acute kidney injury. Methods We selected 8?week?old male C57BL/6 mice to establish a model of renal ischemia?reperfusion injury (IRI). To investigate the role of CCND1 in acute kidney injury (AKI)， we employed a CCND1 overexpression plasmid and a CCND1 interference plasmid for both in vivo and in vitro experiments. Kidney function was evaluated using creatinine and urea nitrogen test kits， while glycolysis and indicators of renal tubule epithelial cell damage were assessed through quantitative real?time PCR， Western blotting， immunohistochemistry， and immunofluorescence techniques. Results In the model of renal ischemia?reperfusion?induced acute renal injury， down?regulation of CCND1 expression in renal tubular epithelial cells resulted in cellular and tissue damage. However， when an overexpression plasmid for CCND1 was administered in vivo， it significantly improved kidney function and reduced kidney injury in IRI mice. The overexpression of CCND1 promoted glycolysis， pyruvate production， and increased energy production. We further confirmed the role of CCND1 in vitro where its overexpression promoted glycolysis， enhanced energy production， and alleviated AKI. Conversely， knockdown of CCND1 inhibited glycolysis leading to severe impairment in cell energy production and exacerbation of injury. Conclusions In summary， down?regulation of CCND1 expression in renal tubular epithelial cells is observed in acute kidney injury， while overexpression of CCND1 can ameliorate acute kidney injury induced by renal ischemia?reperfusion. This mechanism may be attributed to the promotion of glycolysis and timely restoration of energy supply to cells and tissues facilitated by CCND1 overexpression.

Objective To investigate the microbiome composition of deep invasive endometriosis lesions， offering novel insights into its pathogenesis， diagnosis， and treatment strategies. Methods From May 2021 to May 2022， we collected samples of normal endometrium （normal group， n = 10）， endometrium from patients with deep infiltrating endometriosis （DIE endometrium group， n = 14）， and lesions from these patients （DIE lesion group， n = 10） for 16s rRNA sequencing analysis. We employed the bacterial community diversity algorithm （alpha diversity and beta diversity）， principal coordinate analysis （PCoA） distance matrix algorithms （Bray?Curtis and Unifrac matrices）， as well as the biological identification algorithm （LeFSe） to investigate microbiome differences between groups and identify differentially abundant bacteria and enriched KEGG functions. Results The diversity of the three groups did not show any significant difference， while the β diversity exhibited a statistically significant distinction （P = 0.005 5）. The focus group had a relatively low abundance of Firmicutes at the phylum level and a relatively increased abundance of Fusobacteria. At the genus level， there was an increased relative abundance of Enterococcus and Prevotella. LEFse analysis suggested that Proteobacteria and Gammaproteobacteria were the main dominant in the lesion group. Notably， Gamma proteobacteria emerged as a key differential species among the three groups' microbial flora with statistical significance （P = 0.021 2）. Conclusion Compared to the normal group and DIE group， there was a significant increase in the abundance of Fusobacteria， Proteobacteria， Gammaproteobacteria， Enterococcus， and Prevotella. These findings offer novel therapeutic targets for the prevention and intervention of deep infiltrating endometriosis.

Objective To observe the effect of preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer on lung function and mRNA expression of GATA-binding protein 3 （GATA3） and forkhead protein P3 （Foxp3） in peripheral blood. Methods Sixty esophageal cancer patients who underwent modified Ivor-Lewis surgery in our hospital from January 2022 to October 2023 were selected and divided into two groups by simple random method. The control group was given conventional diet before operation， and the observation group was given enteral nutrition support before operation. The two groups were compared in terms of nutritional support. Results Both groups showed significantly decreases in one-second exertion expiratory volume/exertion lung volume （FEV1/FVC） （P < 0.05）， FVC （P < 0.05）， FEV1 （P < 0.05） and the levels of peripheral blood GATA3 （P < 0.05）， Foxp3 mRNA （P < 0.05） expression compared with those at admission （P < 0.05）， but no significant differences in pulmonary function （P > 0.05）， peripheral blood GATA3 （P > 0.05）， and Foxp3 mRNA （P > 0.05） expression between them at 1 week postoperatively. Both groups exhibited significantly lower levels of albumin， prealbumin， haemoglobin， transferrin， PNI and body mass and body mass index at admission as compared to those at one week after surgery （P < 0.05）. The observation group showed significantly higher levels of albumin， prealbumin， haemoglobin， transferrin， and PNI at 1 week postoperatively （P < 0.05）， but no significant differences in ventilation time， defecation time， drain retention time， hospitalisation time， and complication rate as compared to the control group （P > 0.05）. Conclusion Preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer improves postoperative nutritional status， and renders less effect on postoperative lung function and peripheral blood GATA3 and Foxp3 mRNA expression.

Objective To investigate the effects of metoprolol succinate sustained-release tablets on acute phase ventricular pacing threshold and intracardiac electrical signal amplitude in a leadless pacemaker （Micra）. Methods A total of 100 patients implanted with a leadless pacemaker were selected and divided into a study group （n = 43） and a control group （n = 57） according to whether oral metoprolol succinate sustained release tablets were postoperatively administered. The patients with underlying diseases including hypertension， coronary heart disease， or diabetes were treated with antihypertensive drugs， hypoglycemic drugs， or anti-platelet aggregation drugs. The study group received oral metoprolol succinate sustained release tablets within one to three days after implantation of a leadless pacemaker； while the control group received no metoprolol succinate sustained release tablets. Changes in ventricular pacing threshold and intracardiac electrical signal amplitude were observed in two groups one week， one month and three months after implantation. Results No serious complications occurred in the patients at the three time points after implantation. Ventricular pacing thresholds were stable in both groups， and there was no statistical significance between the two groups as compared with the same time period （P > 0.05）. In terms of amplitude of ventricular intracardiac electrical signal， theamplitude of ventricular R-wave did not differ significantly between the two groups at the three time points after implantation（P > 0.05）. Conclusions Oral administration of metoprolol succinate sustained release tablets had no significant effects on acute phase ventricular pacing threshold and intracardiac electrical signal amplitude in a leadless pacemaker （Micra）.

Objective To explore the predictive value of novel anthropometric indicators for the long-term prognosis in patients with acute myocardial infarction （AMI）. Methods A total of 712 patients diagnosed with AMI in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were selected as research subjects， and divided into an event group and a non-event group according to whether major cardiovascular adverse events （MACEs） occurred during the period of follow-up. Gensini score was used to quantitatively assess the degree of coronary artery stenosis. Spearman correlation analysis was used to explore the correlation between the new anthropometric indicators and Gensini score. Receiver operating characteristic （ROC） curve was used to evaluate the ability of new anthropometric indicators to predict MACEs， and the patients were grouped according to the optimal cut-off value. Kaplan-Meier curve was used to analyze the survival difference between the groups. Multivariate Cox regression was used to analyze the independent risk factors of MACEs. Results During a median follow-up of 27（20，39）months， a total of 125 patients developed MACEs. As compared with those in the non-event group， the patients in the event group had a higher proportion of hypertension， diabetes and abdominal obesity， higher HbA1c and FBG levels， and longer body weight and waist circumference. The LAP index， CMI index， BRI index and Gensini score were significantly increased， and the differences were statistically significant （P ? 0.05）. Spearman correlation analysis showed that LAP index， CMI index and BRI index were positively correlated with Gensini score （r = 0.233， 0.126， 0.272， P < 0.001）. ROC curve analysis showed that the AUC of LAP index， CMI index， VAI index， BRI index and ABSI index were 0.745， 0.640， 0.490， 0.874 and 0.506 respectively； Kaplan-Meier curve analysis showed that the cumulative incidence of MACEs in LAP index， CMI index and BRI index was significantly increased in the high-value group （Log-rank test， P ? 0.05）. The results of multivariate Cox regression analysis after adjusting confounding showed that CMI index （HR = 1.430， 95%CI： 1.049 ~ 1.952， P = 0.024） and BRI index （HR = 1.332， 95%CI： 1.234 ~ 1.439， P ? 0.001）were independent risk factors for MACEs. Conclusions CMI index and BRI index of new anthropometric indicators are independent risk factors for long-term prognosis in patients with AMI.

Objective To investigate the therapeutic efficacy of combining fractional CO₂ laser with triamcinolone acetonide and econazole nitrate cream for the treatment of vulvar lichen sclerosus （VLS）. Methods The clinical data of 113 patients with vulvar lichen sclerosus （VLS） were retrospectively analyzed. The patients were divided into an observation group and a control group based on different treatments received. Clinical symptoms （vulvar itching， painful intercourse） and signs （vulvar skin color， vulvar skin elasticity， range of vulvar lesions） were scored using the Cattaneo scoring criteria. The Cattaneo scores before and after treatment were recorded for each patient， and comparisons were made between groups in terms of Cattaneo scores and occurrence of adverse reactions. The therapeutic efficacy of fractional CO₂ laser combined with triamcinolone acetonide and econazole nitrate cream was evaluated. Results After three treatments， both groups exhibited a significant decrease in Cattaneo scores， with a statistically significant difference （P < 0.05）. The study group demonstrated a significantly greater reduction in Cattaneo scores compared to the control group （P < 0.05）. Furthermore， the cure rate of VSL was higher in the study group than in the control group （25.86% vs. 10.91%， P < 0.05）. Regarding adverse effects， there was no statistically significant difference between the two groups （P > 0.05）. Conclusions Compared to the single application of fractional CO₂ laser， the combination of fractional CO₂ laser with triamcinolone acetonide and econazole nitrate cream demonstrates enhanced efficacy in alleviating signs and symptoms among patients with vulvar sclerosing tundra， while minimizing adverse reactions. This approach holds significant potential for clinical implementation.

Objective To explore the interactive effect of vitamin D and triglyceride （TG）/high-density lipoprotein cholesterol （HDL-C） on the time to achieve glycemic control in hospitalized patients with type 2 diabetes mellitus （T2DM）. Methods A retrospective cohort study was conducted on 82 T2DM patients admitted to Henan Hongli Hospital from March 2021 to December 2023. Patients were categorized into two groups based on the time it took for their blood glucose to reach target levels during their hospitalization： the ≤ 7 d group and the > 7 d group. The baseline data， vitamin D levels， and TG/HDL-C ratios of both groups were compared. The relationship between vitamin D， TG/HDL-C levels， and the time it took for blood glucose to reach target levels was analyzed. Furthermore， the TG/HDL-C levels of patients with varying vitamin D levels were compared， and the relative risk （RR） and receiver operating characteristic （ROC） curve were used to analyze the interactive effect and predictive value of vitamin D and TG/HDL-C levels on the time it took for hospitalized T2DM patients to achieve target blood glucose levels. Results The hospitalization duration of the group with a duration of > 7 days was longer than that of the group with a duration of ≤ 7 days. The fasting blood glucose， glycosylated hemoglobin， and TG/HDL-c levels were higher in the former group， while the vitamin D level was lower. The proportion of patients with vitamin D deficiency and severe deficiency was higher in the former group compared to the latter group （P < 0.05）. Pearson correlation analysis revealed that vitamin D level was negatively correlated with the time to achieve glycemic control （r = -0.733， P < 0.001）， while TG/HDL-C level was positively correlated with the time to achieve glycemic control （r = 0.830， P < 0.001）. After adjustment， logistic regression analysis indicated that vitamin D （95%CI： 0.482 ~ 0.694） and TG/HDL-C level （95%CI： 1.053 ~ 1.392） remained independent factors influencing the time to achieve glycemic control in hospitalized T2DM patients （P < 0.05）. Patients with insufficient， deficient， and severely deficient vitamin D had higher TG/HDL-C levels compared to those with sufficient vitamin D （P < 0.05）. The relative risk （RR） of patients with vitamin D deficiency and elevated TG/HDL-C coexisting resulting in a hospitalization duration of > 7 days for T2DM patients was 15.867， indicating a synergistic effect. The area under the receiver operating characteristic （AUC） curve for predicting the time to achieve glycemic control in hospitalized T2DM patients using a combination of vitamin D and TG/HDL-C was 0.929， which was greater than that of vitamin D and TG/HDL-C alone （Z = 3.849， 3.526， P < 0.05）. Conclusion The vitamin D and TG/HDL-C levels in hospitalized T2DM patients are closely related to the time of reaching glycemic targets. The simultaneous exposure of both factors can affect the time of achieving glycemic targets， and the combined prediction of vitamin D and TG/HDL-C has good reference value for predicting the time of achieving glycemic targets in hospitalized T2DM patients.

Objective To investigate the efficacy of bevacizumab combined with raltitrexed in the treatment of unresectable hepatocellular carcinoma （HCC） and its effect on adverse reactions and survival rate. Methods A retrospective analysis was performed on 71 patients with unresectable hepatocellular carcinoma admitted to the oncology department of our hospital from February 2020 to June 2022. Among them， 35 cases were treated with raltitrexed as control group， and 36 cases were treated with bevacizumab combined with raltitrexed as observation group. All patients received transcatheter arterial chemoembolization （TACE）. After 1 month of treatment， the short-term treatment effect of the two groups was evaluated. The adverse reactions of the two groups were observed. Follow-up review was performed to record progression free survival （PFS） and overall survival（OS） in both groups. Results After 1 month of treatment， the disease control rate（DCR） and objective response rate（ORR） of control group were 74.29% and 45.71% respectively. The DCR and ORR of observation group were 83.33% and 55.56% respectively. There was no significant difference in short-term efficacy between the two groups （P > 0.05）. Following treatment， the vascular endothelial growth factor （VEGF）level in the observation group was considerably lower than in the control group （P < 0.05）. After treatment， 18 months of follow-up， OS curve showed： observation group OS was 50.00%， control group OS was 31.40%； PFS curve showed： observation group PFS was 43.33%， control group PFS was 26.92%. Using the Log-rank test， between the two groups， there was a statistically significant difference in OS （χ ² = 4.381， P = 0.036）， although there was no statistically significant difference in PFS between the two groups （χ ² = 3.264， P = 0.071）. There was no significant difference in adverse reactions between the two groups （P > 0.05）. Conclusion Bevacizumab combined with raltitrexed can reduce tumor neovascularization， inhibit tumor growth and spread， prolong the survival time of patients， and do not increase adverse drug reactions.

Objective To assess the effectiveness and safety of combining methylprednisolone with mycophenolate mofetil in managing moderate to severe active Graves' ophthalmopathy （GO）， and to compare its efficacy against methylprednisolone monotherapy. Methods A retrospective study was conducted to select patients with moderate to severe active GO who received treatment at the Department of Endocrinology and Metabolism， Guizhou Medical University Affiliated Hospital， from January 2019 to January 2024. The patients were divided into two groups： a combination group receiving methylprednisolone combined with mycophenolate mofetil， and a monotherapy group receiving methylprednisolone alone. The objective was to compare changes in visual score， appearance score， clinical activity score （CAS）， eye protrusion， eye fissure width， and eye movement between the two groups of patients while documenting any adverse events. Results A total of 98 patients were enrolled in the study， comprising 32 patients in the combination group and 61 patients in the monotherapy group. Both groups exhibited improvements in quality of life scores， CAS， and degree of protrusion following treatment compared to baseline. However， at the end of the 12?week treatment period， there was no statistically significant difference （P > 0.05） observed between the two groups regarding changes in visual scores， appearance scores， CAS， protrusion degree， fissure width， and proportion of reduced eye movement before and after treatment. Notably though， the combined therapy group demonstrated a significantly higher improvement rate for pain relief and reduction of eyelid congestion during eye movement when compared to the monotherapy group （P < 0.001）. At the endpoint of treatment， there were no statistically significant differences in appearance score， protrusion degree， tear width， and reduction in eye movement between the two groups before and after treatment （P > 0.05）. The combination group exhibited higher visual scores and greater improvement in CAS compared to the monotherapy group （P < 0.05）， along with a higher rate of eyelid edema improvement （P < 0.05）. At 12 weeks， the monotherapy group had an effective rate of 65.0%， while the combination group had an effective rate of 66.7%. By week 24， the combined group achieved an effective rate of 80.0%. The overall effectiveness at week 12 and treatment endpoints did not show any statistically significant differences between the two groups （P > 0.05）. No cases of leukopenia or severe infection occurred in the combination group. Conclusions The combination therapy of methylprednisolone and mycophenolate mofetil demonstrates efficacy， tolerability， and safety in the treatment of moderate to severe active GO. While the overall effectiveness of this combination may not surpass that of hormone therapy alone， it exhibits potential superiority in improving visual scores， eyelid congestion， eyelid edema， and eye movement pain when compared to hormone therapy alone.

Objective To investigate the effect of compound Xueshuantong combined with viaminate of oral lichen planus （OLP） complicated with chronic periodontitis （CP）. Methods This study collected 305 patients with OLP and CP and randomly divided them into two groups. There were 156 patients in the observation group and 149 patients in the control group. All patients receive systemic treatment for CP. The control group was treated with viaminate capsules， and the observation group was treated with compound Xueshuantong Capsules combined with viaminate capsules. Both groups were treated for 4 weeks. Clinical efficacy， serum inflammatory factors ［matrix metalloproteinase-3 （MMP-3）， IFN-gamma （IFN-γ）， interleukin 6 （IL-6） and IL-35］， oral mucosal pain Visual Analogue Score （VAS）， lesion area of OLP， periodontal condition， and adverse reactions were detected. Results Compared to the control group， the total effective rate in the observation group was higher （P < 0.05）. After treatment， serum MMP-3 and IL-6 levels， oral mucosal VAS score， lesion area of OLP， gingival index and probing depth all decreased in the two groups （P < 0.05）. The changes of above indicators were more significant in the observation group （P < 0.05）. There was no difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusion Compound Xueshuantong combined with viaminate can effectively improve the symptoms of OLP complicated with CP， and alleviate inflammatory reactions， with good therapeutic effects.

Objective To investigate the impact of esketamine hydrochloride in combination with ultrasound? guided transverse thoracic muscle plane block on stress response and inflammatory levels in patients undergoing cardiac valve replacement under general anesthesia. Methods A total of 120 patients who underwent elective extracorporeal circulation?supported median open heart valve replacement were selected and randomly assigned into four groups using the random number table method： general anesthesia alone （Group G）， general anesthesia with intravenous administration of esketamine （Group E）， general anesthesia with transverse thoracic plane block （Group T）， and esketamine combined with transverse thoracic muscle plane block （Group ET）； each group consisted of 30 cases. Patients in group E and group ET received a continuous infusion of esketamine hydrochloride injection at a rate of 0.2 mg/kg^-1?h^-1 until the completion of the surgical procedure， while patients in group G and group T received an equivalent volume of saline solution until the completion of the surgical procedure. After the induction of general anesthesia， patients in group T and group ET underwent ultrasound?guided bilateral transverse thoracic muscle plane block， while patients in group G and group E did not receive any specific intervention. All four groups received identical protocols for anesthesia induction and maintenance， with self?controlled intravenous analgesic pumps administered to all patients postoperatively. The following time points were recorded： 1 day prior to surgery （T0）， pre?induction of anesthesia （T1）， 1 minute post?tracheal intubation （T2）， 1 minute post?median sternotomy （T3）， 1 minute prior to initiation of cardiopulmonary circulation （T4）， 1 minute after cessation of cardiopulmonary circulation （T5）， 1 minute after completion of surgery （T6）， 1 day post?surgery （T7）， 2 days post?surgery （T8）， and 3 days post?surgery（T9）. Mean Arterial Pressure （MAP） and Heart Rate （HR） were continuously monitored from T1 to T6. The levels of blood glucose and lactate were measured and recorded at T1， T4 to T6. The levels of White Blood Cells （WBC） and C?Reactive Protein （CRP） were assessed at T0， as well as at T7 to T9. The occurrence of postoperative adverse reactions was documented in all four groups. Results （1） Comparison of hemodynamics among the four groups： Compared with group G， there was a significant decrease in MAP and HR at T3 in group T （P < 0.05）. At the T5 time point， MAP was lower in group ET compared to group E， while HR was higher in group ET compared to group T （P < 0.05）. （2） The lactate and blood glucose levels of the four patient groups after extracorporeal circulation transfer were higher than those at the T1 time point （P < 0.05）. Patients in group E had lower lactate values at the T5 time point and lower blood glucose values at the T6 time point compared to group G （P < 0.05）. Additionally， patients in group E exhibited lower lactate and blood glucose values at both the T5 and T6 time points compared to those in group T （P < 0.05）. （3） Compared to T0， the levels of white blood cells （WBC） and C?reactive protein （CRP） were increased in all four groups after surgery （P < 0.05）. At the T7 time point， the WBC levels in group E and group T were significantly lower than those in group G （P < 0.05）. Furthermore， compared to group E and group T， the level of WBC in group ET was significantly lower at T7， while the level of CRP was significantly lower at T8 （P < 0.05）. （4） There were no significant differences observed in postoperative adverse reactions among the four groups （P > 0.05）. Conclusion Combining low?dose esketamine hydrochloride with transverse thoracic muscle plane block under general anesthesia during open heart valve replacement surgery can effectively stabilize the patient's hemodynamics， mitigate perioperative stress response and postoperative inflammation levels， thereby demonstrating significant clinical utility.

Objective To investigate the clinical efficacy and safety of combined administration of Wuling capsule and citicoline sodium capsule in managing sudden sensorineural hearing loss among elderly patients. Methods The patients were randomly assigned to the control group （n = 72） and treatment group （n = 71） using a random number table method. Both groups received oral administration of mecobalamin at a dosage of 0.5mg three times daily， as well as oral intake of ginkgo biloba leaves at a dosage of 2 g three times daily. In addition， the control group also took citicoline sodium capsules orally at a dosage of 0.1 g three times daily. On the basis of the control group， the treatment group was additionally administered Wuling capsules orally at a dosage of 0.99 g three times daily. Both groups underwent one month of treatment for observation purposes， during which their hearing condition， blood viscosity， inner ear microcirculation， peripheral blood cytokines， clinical efficacy and adverse drug reactions were compared. Results The total effective rate of the treatment group and control group was 84.51% （60/71） and 68.06% （49/72）， respectively， with a significant difference observed （P < 0.05）. Following treatment， the pure tone hearing thresholds in the treatment group were measured at （40.03 ± 5.04） dB， while those in the control group were recorded as （45.25 ± 6.21） dB； for high frequency region listening levels， values of （45.27 ± 6.05） dB and （50.01 ± 7.69） dB were obtained for the treatment and control groups respectively； similarly， low frequency region listening levels were found to be （44.21 ± 5.47） dB for the treatment group and （49.32 ± 6.24） dB for the control group. Following treatment， the plasma viscosity was （1.21 ± 0.19） and （1.58 ± 0.24） mPa·s， the high tangential viscosity of whole blood was （3.59 ± 0.52） and （4.12 ± 0.61） mPa·s， the low tangential viscosity of whole blood was （5.83 ± 0.84） and （6.52 ± 0.91） mPa·s， the diameter of the internal auditory artery was （1.12 ± 0.15） and （0.96 ± 0.11） mm， the diameter of anterior inferior cerebellar artery was（1.35 ± 0.18）and（1.19 ± 0.15）mm， calcitonin gene?related peptide concentration in plasma was（386.92 ± 40.02）and（354.21 ± 36.47）ng/mL， soluble vascular intercellular adhesion factor?1 concentration in plasma was（132.14 ± 18.96）and（156.34 ± 21.32） ng/mL， with statistically significant differences observed （P < 0.05）. There were no adverse reactions in both groups during treatment. Conclusion The combination of Wuling capsule and citicoline sodium capsule exhibits a significant therapeutic effect in the management of senile sudden deafness， leading to improvements in hearing ability， blood viscosity， inner ear microcirculation， and peripheral blood cytokine secretion.

Atrial fibrillation （AF） is a type of supraventricular arrhythmia characterized by uncoordinated atrial activation， ineffective atrial contraction. It has a high incidence rate and is often complicated by stroke， heart failure， and myocardial disease induced by tachycardia， causing a significant burden on patients and their families. Comprehensive management of AF is crucial for effectively reducing mortality， disability， and improving prognosis. However， traditional electrocardiogram （ECG） monitoring often misses asymptomatic and paroxysmal AF at a higher possibility. In recent years， a new device for monitoring AF， insertable cardiac monitor （ICM）， has emerged to overcome the limitations of traditional arrhythmia monitoring， for it provides real-time ECG monitoring and alerts for users. ICMs have been widely used in multiple medical senarios， primarily for patients with unexplained syncope， and recently they are adopted to monitor AF However， its role in AF monitoring has not received significant attention in clinical practice.Based on relevant literature， this article reviews the application effect of ICM in monitoring AF and the latest research progress in the field and evaluates its advantages and disadvantages to provide some references for AF management.

Pancreatic cancer （PC） is one of the deadliest malignant tumors worldwide，known as the ‘king of cancers’ due to its insidious onset， high malignancy， and high mortality rate. PC is highly malignant and progresses rapidly， but its onset is insidious with atypical early symptoms， making it difficult to detect early lesions through conventional imaging studies. It is usually only discovered when symptoms like jaundice， abdominal and back pain occur. Surgical resection is currently the only curative option for PC. However， due to the difficulty in early diagnosis， the majority of patients are already in the middle to late stages at the time of diagnosis， missing the opportunity for surgery. Studies have confirmed that the progression of pancreatic cancer is relatively slow， with the initial tumor cells requiring at least 15 years to gain metastatic ability. Therefore， timely detection of pancreatic cancer through tumor markers could significantly improve the survival rate of patients. The most widely used and diagnostically valuable tumor marker in clinical practice is Carbohydrate antigen 199 （CA199）. However， due to about 3% ~ 7% of pancreatic cancer patients being Lewis antigen-negative blood types and not expressing CA19-9， its sensitivity is only 79% ~ 81%， which does not provide good efficacy for the diagnosis of pancreatic cancer. Pancreatic juice， as a fluid near the tumor， has attracted much attention as a good source of tumor-related biomarkers. Many studies have confirmed the accuracy of using proteins， DNA， and exosomes in pancreatic juice for the diagnosis of pancreatic cancer， showing great prospects for pancreatic juice as a source of tumor markers for the diagnosis of pancreatic cancer. Therefore， this thesis reviews the efficacy of pancreatic juice as a specimen for the diagnosis of pancreatic cancer.

Chronic cough （CC） is a common respiratory disorders， with prevalence rates as high as 10% ~ 20%. The burden of CC can be severe， as patients with CC experience substantial physical effects （e.g.， stress urinary incontinence， sleep disturbance， and chest pain）， psychological consequences （e.g.， frustration， anxiety， and depression）， and social impairments （e.g.， social distress/isolation and reduced quality of life）. As a result， CC is a frustrating conundrum for patients and clinicians. In this paper， combined with the new concepts of domestic and foreign literature， we expound the concept of CC， epidemiology， pathogenesis， etiological structure， clinical manifestations and auxiliary examination， diagnosis and differential diagnosis， treatment， and future prospects， etc.， for peer reference and learn from， so as to promote more in-depth related clinical research.

A 36-year-old male patient was hospitalized due to persistent chest tightness and dyspnea lasting over 10 days. An echocardiogram revealed significant aortic valve regurgitation， the presence of vegetation on the aortic valve， severe mitral valve regurgitation， and enlargement of both the left atrium and left ventricle. Following a comprehensive multidisciplinary consultation， the focus was directed towards the aortic valve vegetation as the primary concern， with particular attention given to the potential diagnosis of blood culture-negative infective endocarditis （IE） and non-bacterial thrombotic endocarditis， while differentiating it from rheumatic heart disease. Ultimately， the vegetation was excised during a surgical aortic valve replacement procedure， which facilitated histopathological examination， biological culture， and high-throughput metagenomic sequencing of pathogenic microorganisms. The definitive diagnosis was established as aortic valve infective endocarditis （Q fever IE） leading by infection of Coxiella burnetii.