At present，there is no specific drug for the radical treatment of myasthenia gravis. The thera⁃ pies vary with different etiology and population of patients as well，with discrepancies in long⁃term and short⁃term efficacy，prognosis and safety. In order to select a safe and effective medication regimen for the patients，this paper reviews the relevant domestic and foreign studies and compares the latest guidelines of myasthenia gravis issued by the Chinese Society for Immunology and the Myasthenia Gravis Foundation of America in 2020，aiming to provide surgeons with more references for the treatment of myasthenia gravis.

Acute myocardial infarction（AMI）is the major medical challenge in China and throughout the world. With the progress of percutaneous coronary intervention（PCI），the mortality rate of AMI is decreased. However，the incidence of heart failure（HF）after AMI increases and the risk of death is markedly increased. This paper reviews the latest progress of diagnosis and treatment of HF after AMI，and aims to promote and optimize the standardized clinical strategies and the standardized management of HF after AMI and to improve the outcome of these patients.

Objective To investigate the relationship of serum lipoprotein a（Lp（a））and S100 calcium binding protein A4（S100A4）expression level with platelet activation in patients with acute myocardial infarction （AMI）and its influence on major adverse cardiac events. Methods One hundred AMI patients and another 116 healthy individuals in our hospital were enrolled as study group and control group. LP（a），S100A4 and platelet activation related parameters were assessed，and all patients completed one ⁃year follow ⁃up. Risk factors affecting the occurrence of major adverse cardiac events in AMI patients were screened. Results Serum level of Lp（a）， S100A4 and platelet activation related parameters were significantly higher in study group than those in control group，showing statistical difference（all P < 0.05）. Major adverse cardiac events occurred in 42 AMI patients within 1 year. Serum Lp（A）and S100A4 level was abnormally elevated in patients with major adverse cardiac events. Unconditional logistic regression analysis showed that Lp（A）and S100A4 were risk factors affecting the occurrence of major adverse cardiac events in patients with AMI. Conclusion Serum Lp（a）and S100A4 expres⁃ sion level is positively correlated with platelet activation related parameters，indicating AMI patients with higher serum Lp（A）and S100A4 level suffer a greater risk of major adverse cardiac events.

Objective o investigate the relationship between high residual platelet activity and Ⅱb/Ⅲa receptor，P⁃selectin on platelet surface，prognosis in patients with non ST segment elevation acute myocardial infarction（NSTEMI）after percutaneous coronary intervention（PCI）. Methods A total of 214 patients with NSTEMI receiving PCI were selected. According to the platelet aggregation rate，they were divided into HRPR group and LRPR group. The level of Ⅱb/Ⅲa receptor（PAC⁃1）and P⁃selectin（CD62p）on the platelet surface were measured. All patients were followed up for one year to count the occurrence of ischemic events. Results The levels of PAC⁃ 1+ /CD62P+，PAC⁃1- /CD62P+，PAC⁃1+ /CD62P- platelets in HRPR group were higher than those in LRPR group，the difference was statistically significant（P < 0.05）. The platelet aggregation rate was positively correlated with the levels of PAC⁃1+ /CD62P+，PAC⁃1+ /CD62P-（P < 0.05）. When platelets were pre incubated with PAC⁃1，the platelet aggregation rate was decreased significantly（P < 0.05）. When platelets were pre incubated with anti⁃CD62p anti⁃ body，there was no significant change in platelet aggregation rate（P > 0.05）. The incidence of ischemic events in HRPR group was higher than that in LRPR group（P < 0.05）. Conclusion HRPR in NSTEMI patients after PCI was related to Ⅱb/Ⅲa receptor on platelet surface，but it′s not related to P⁃selectin. HRPR could increase the risk of ischemic events in patients.

Objective To investigate the efficacy and safety of sacubatrovalsartan sodium combined with emergency percutaneous coronary intervention（PCI）in patients with acute myocardial infarction（AMI）. Methods A total of 348 AMI patients，who had hospitalized in TEDA International Cardiovascular Hospital and had received emergency percutaneous coronary intervention from January 2020 to December 2020 were chosen. According to the postprocedural uses of different medications，the patients were assigned to a study group（n = 165，oral sacubatro⁃ valsartan sodium tablets）or a control group（n = 183，oral ramipril）. The changes in left ventricular end systolic diameter（LVESD），left ventricular end diastolic diameter（LVEDD）and left ventricular ejection fraction（LVEF）， and the rates of adverse cardiovascular events and adverse reactions were observed and compared between the two groups. Results All the patients were follow up for an average of（20.46 ± 3.58）weeks. LVESD and LVEDD sig⁃ nificantly shortened and LVEF significantly increased in both groups as compared with the baselines（P < 0.05）. LVESD and LVEDD were significantly lower and LVEF was evidently higher in the study group than in the control group（P < 0.05 for all comparisons）. The incidence of adverse events in the study group was significantly lower than that in the control group（8.49% vs. 16.94%，P < 0.05）. No adverse reactions were occurred in both groups. Conclusions Sacubatrovalsartan sodium combined with emergency percutaneous coronary intervention can improve the clinical efficacy and left ventricular remodeling in AMI patients.

Objective To investigate the myocardial protective effect of L⁃carnitine in acute ST⁃segment elevation myocardial infarction（STEMI）after percutaneous coronary intervention（PCI）. Methods 96 patients with STEMI after PCI who had been treated during the period of March 2018 to March 2019 were selected. They were randomly assigned to receive either routine prognostic improvement therapies with anticoagulation and lipid regulation（basic group，48 patients），or the routine therapies plus levocarnitine（study group，48 patients）for 14 days. Cardiac troponin I（cTnI），creatine kinase isoenzyme（CK⁃MB），serum superoxide dismutase（SOD）， total antioxidant capacity（T ⁃AOC），left ventricular ejection fraction（LVEF），and 6 ⁃ minute walking distance were compared between the two groups before and after treatment，so was the major adverse cardiovascular events （MACE）within 3 months after PCI between the two groups. Results There were no significant differences in cTnI， CK ⁃MB，SOD，T ⁃AOC，LVEF value，and 6⁃minute walking distance between the two groups before treatment （P > 0.05）. After treatment，the contents of cTnI and CK ⁃MB declined in both groups，and the content of cTnI was lower in the study group than in the basic group（P < 0.05），while that of CK⁃MB was similar（P > 0.05）；the contents of SOD，T ⁃AOC，LVEF and 6min walking distance increased and they were higher in the study group than in the basic group（P < 0.05）. The total incidence of MACE within 3 months after PCI was lower in the study group than in the basic group（P < 0.05）. Conclusions Levocarnitine can reduce the contents of cTnI and CK⁃MB， increase the contents of SOD and T ⁃AOC，improve myocardial damage，increase the LVEF value and 6⁃minute walking distance，and lower the incidence of MACE in STEMI patients after PCI.

Objective To investigate the effects of survivin inhibitor YM155 on the expression of angio⁃ genesis ⁃ related genes and microvessel density in cerebral infarction rats. Methods A total of 120 SD male rats were randomly divided into a sham group，a model group，a survivin inhibitor YM155 group（YM group），and a normal saline group（NS group），with 30 in each group. A cerebral ischemia model was established by middle cere⁃ bral artery occlusion. From day one after the model establishment，the rats in YM group received abdominal injec⁃ tion subcutaneously at a dose of YM155 of 6.5 mg/kg，while those in NS group received the same amount of normal saline. Immunohistochemistry was applied to detect changes in microvessel density（MVD）in the brain tissues of rats in each group，so were RT⁃PCR and Western blotting to detect expressions of survivin，VEGF，ES，and TSP⁃1 mRNA and protein. Results As compared with sham group，MVD in model group and NS group was significantly elevated；while compared with model group，MVD in YM group decreased significantly，and the difference was statistically significant（P < 0.01）. As compared with sham group，the expressions of survivin，VEGF mRNA and protein in model group and NS group increased significantly，while the expressions of ES，tsp⁃1 mRNA and protein decreased significantly，and the difference was statistically significant（P < 0.01）. As compared with model group， the expressions of survivin，VEGF mRNA and protein in YM group decreased significantly，while the expressions of ES，TSP⁃1 mRNA and protein increased significantly，and the difference was statistically significant（P < 0.01）. Conclusions Ym155 can reduce MVD，which is related to the down⁃regulation of survivin and VEGF expressions and the up⁃regulation of ES and TSP⁃1 expressions，suggesting that the interaction of these factors may be one of the important mechanisms for the formation and establishment of cerebral collateral circulation.

Objective To investigate the effect of BET protein inhibitor JQ⁃1 on the differentiation of peripheral blood B cells in systemic lupus erythematosus（SLE）. Methods We collected the peripheral blood from 46 SLE patients，from which B cells were isolated，purified and cultured in vitro. Flow cytometry was used to detect the proportion of apoptosis，survival and proliferation of peripheral blood B cells，the proportion of subpopu⁃ lation cells and the proportion of B cells differentiation into plasmablasts in vitro. Results Compared with the con⁃ trol group，the BET protein inhibitor JQ1 had little effect on the early apoptosis，survival and proliferation of the peripheral blood B cells，but it significantly reduced the rates of plasmablasts and plasma cells so as to reduce the proportion of B cells differentiation into plasmablasts in vitro. Conclusion BET protein inhibitor JQ⁃1 can regu⁃ late the differentiation of peripheral plasma blasts into plasma cells in SLE patients，indicating that it may have potential therapeutic effect on SLE.

Objective To explore the regulation mechanism of lnc⁃MEG3 on the proliferation and invasion of pituitary tumor cells. Methods The purchased pituitary tumor HP75 cells were divided into control group，si⁃NC group，si⁃MEG3 silence group，pcDNA3.1⁃NC group，oe⁃MEG3 group，oe⁃MEG3+mimic⁃NC group and oe⁃MEG3+ miR⁃10b⁃5p mimic group. After transfection，RT⁃qPCR was used to detect the expression levels of lnc⁃MEG3，miR⁃ 10b⁃5p and CD82 mRNA of cells in each group. CCK⁃8 method，scratch test and Transwell test were used to detect cell proliferation，migration and invasion abilities. Western blot was used to detect the protein expression of CD82， PCNA，E⁃cadherin，N⁃cadherin，MMP⁃9 of cells. Dual luciferase reporter gene was used to detect the targeting relationship between miR⁃10b⁃5p and lnc⁃MEG3，CD82. Results Overexpression of lnc⁃MEG3 significantly reduced the expression of miR⁃10b⁃5p，up⁃regulated CD82 and E⁃cadherin levels in cells，decreased PCNA，N⁃cadherin， and MMP⁃9 levels，and inhibited the proliferation and migration of pituitary tumor cells and invasion（P < 0.05）. Op⁃regulation of miR⁃10b⁃5p inhibited the expression of CD82，and weakened the inhibitory effect of lnc⁃MEG3 overexpression on the proliferation，invasion and migration of pituitary tumor cells. The results of dual luciferase reporter gene detection showed that after transfection of miR⁃10b⁃5p mimic，the luciferase activities of MEG3⁃WT and CD82⁃WT in the cells were significantly reduced（P < 0.05）. Conclusion The overexpression of lnc⁃MEG3 may inhibit the proliferation，migration and invasion of pituitary tumor cells by targeting to down⁃regulate miR⁃10b⁃ 5p and then up⁃regulating the expression of CD82.

Objective To explore the effect and mechanism of hypoxia in regulating macrophage polariza⁃ tion through upregulating hypoxia inducible factor⁃1α（HIF⁃1α）in endometriosis. Methods The ectopic endome⁃ triotic lesions of patients with endometriosis（endometriosis group，n = 17）and normal endometrium of patients without endometriosis（control group，n = 20）from January 2021 to December 2021 were collected. The distribu⁃ tions of macrophages in ectopic lesions and normal endometrium were detected by double immunofluorescence，and the hypoxic conditions were detected by immunohistochemistry. After treated with hypoxia，we detected the level of HIF⁃1α and the expression of specific markers of M1 and M2 macrophages by RT⁃qPCR in THP⁃1 cells. Results The density of macrophages in ectopic lesions of endometriosis was higher than that of normal endometrium. The density of both M1 and M2 macrophages are increased in endometriosis，but M2 macrophages are the mainly type macrophages in the lesions（P < 0.05）. The degree of hypoxia in ectopic lesions was higher than that of normal eutopic endometrium（P < 0.05）. Hypoxia could induce macrophages to transform into M2 macrophages through upregulating HIF⁃1α（P < 0.05）. Conclusions Hypoxia regulates the polarization of macrophages in endometriosis through upregulating HIF⁃1α.

Objective To explore and analyze the colonization and drug resistance of carbapenem⁃resistant enterobacter（CRE）in patients in internal medicine ICUand to provide guidance for infection control management in ICU. Methods Active anal swab screening for CRE was performed in 394 newly admitted patients in internal medicine ICUfrom March 2017 to December 2018. The isolation and identification of pathogenic bacteria and anti⁃ microbial sensitivity testwere performed in 760 samples. Results Eighty ⁃four positive specimens were detected from 760 samples with a positive rate of 11.05%（84/760）. Furthermore，101 strains of CRE were detected with a total detection rate of 15.63%（101/646）. The detection rate of carbapenem⁃resistant Klebsiellapneumoniae was the highest，accounting for 43.18%（76/176）；followed by Citrobacterfreundii，21.43%（3/14），Enterobacter cloacae， 20.00%（2/10）；Enterobacter aerogenes，16.67%（1/6），Escherichia coli，4.79%（18/376），Proteus mirabilis 2.33%（1/43）. Antimicrobial sensitivity test showed that the drug resistance rate of different carbapenems was varied as follows：etapenem（99.01%），imipenem（81.19%）and meropenem（80.20%）. Conclusion There is high positive value of CRE in active screening，and high drug resistance rate of ertapenem，imipenem and meropenemin ICU of department of internal medicine. Therefore，cluster management of CRE is needed to prevent the outbreak of CRE and provide reference for preventing infection of CRE in hospital.

Objective To further evaluate the efficacy of foraminal lens combined with posterior percuta⁃ neous pedicle screw and streptomycin calcium sulfate artificial bone in the treatment of lumbar tuberculosis in the 1⁃year follow⁃up. Methods Data of fifty⁃two patients with lumbar tuberculosis who received surgical treatment in the First Affiliated Hospital of Guangxi University of Chinese Medicine from July 2016 to June 2020 were retrospec⁃ tively analyzed. The follow ⁃ up time ranged from 12 months to 20 months，with an average of（14.08 ± 1.27） months，and 50 effective cases were finally included. According to the method of operation，the patients were divided into group A（32 cases treated with foraminal lens combined with posterior percutaneous pedicle screw and streptomycin calcium sulfate artificial bone）and group B（18 cases treated with）A comparative study was conducted in terms of related indicators in the two groups. Results In the follow⁃up of 52 cases，2 cases were shed（1 case died，1 withdrew automatically），and 50 effective cases were eventually included. Comparison of age，sex，ESR， CRP，Cobb Angle，VAS，JOA，ODI score and ASIA grade between the two groups at the end of follow⁃up（P > 0.05） indicated no significant difference but comparison of operative time，intraoperative blood loss，time out of bed and length of stay between the two groups（P < 0.05）indicated statistical significance. Conclusion Compared to traditional anterior，posterior or combined anterior and posterior surgery for lumbar spinal tuberculosis，foraminal lens combined with posterior percutaneous pedicle screw and streptomycin calcium sulfate artificial bone in the treatment of lumbar tuberculosis，can also achieve satisfactory clinical effect. Streptomycin sulfate artificial bone helps to slowly release drugs and improve local drug concentration streptomycin lesions for a strong bactericidal effect. It also has the advantages of small trauma and quick recovery. In addition，it achieves the purpose of decom⁃ pression，removal of lesion tissue and reconstruction of spinal stability by bony fusion.

Objective The current status and differences of pelvic floor function and pelvic floor organ prolapse（POP）in women at different physiological stages have still been unclear. This study is to compare and analyze the current status of premenopausal nullipara and parturients and postmenopausal women. Methods 366 female patients who had visited the perinatal center of our hospital from May 2018 to May 2020 were enrolled in this study，including 120 premenopausal nullipara，126 premenopausal parturients，and 120 postmenopausal women. The modified oxford staging（MOS），levator ani testing（LAT），pelvic floor electrophysiological indexes and POP index were collected in all the women. Results Chi⁃square test showed that the percentage of abnormality in MOS， LAT and type Ⅱ muscle fiber strength was significantly higher in postmenopausal women than in premenopausal nullipara and parturients（P < 0.01）. The proportion of postmenopausal women whose vaginal pressure and POP staging were zero was significantly lower than that of premenopausal nullipara（P < 0.01）. Multiple Logistic regres⁃ sion analysis showed that self⁃pelvic floor rehabilitation exercise was the protective factor of MOS and LAT，while childbirth and menopause were the risk factors of MOS，LAT and type Ⅱ muscle fiber strength abnormalities. Childbirth was the risk factor for POP. Conclusions The incidence of abnormal pelvic floor muscle strength and POP increased in postmenopausal women. Pelvic floor rehabilitation exercise can reduce the occurrence of this disorder.

Objective To compare the safety of median specimen extraction incision and traditional new right lower abdominal incision for prophylactic ileostomy in radical resection of rectal cancer. Methods The data of 61 patients with rectal cancer who underwent laparoscopic anterior resection and prophylactic ileostomy in the first affiliated hospital of Nanchang University from April 2019 to February 2021 were collected and reviewed retrospectively. They were divided into two groups：the median incision group（IMI group）and the new right lower abdominal incision（INI group）. The two groups were compared in terms of baseline data，intraoperative and post⁃ operative conditions of ileostomy and ileostomy closure. Results There was no significant difference between the IMI group and the INI group in terms of baseline data，operation time，blood loss，postoperative pain score，first exhaust time，feeding time，catheter removal time，drainage tube removal time，postoperative hospital stay，total cost and postoperative pathological results. There was no significant difference either in the incidence of stoma⁃ related complications between them（26.7% vs. 29.0%，P = 0.698）. The non ⁃stoma ⁃ related complications in the IMI group was significantly lower than the INI group（6.7% vs. 29.0%，P = 0.023）. For the operation of ileostomy closure，the average interval from the first operation to ileostomy closure in the IMI group was significantly shorter than that in the IMI group［（110.0 ± 32.0）d vs.（159.4 ± 73.4）d，P < 0.001）］，the first exhaust time of the IMI group was significantly shorter than that of the INI group［（2.5 ± 0.5）d vs.（2.9 ± 0.7）d，P = 0.010］，and the first feeding time of the IMI group was significantly shorter as well［（2.7 ± 0.5）d vs.（3.0 ± 0.5）d，P = 0.04］. There was no significant difference in the incidence of incisional hernia between the two groups. Conclusion Both the new right lower abdominal incision and the median incision for prophylactic ileostomy are safe in radical resec⁃ tion of rectal cancer. Comparatively，the former approach is advantageous for its less damage to the abdominal wall as well as less abdominal scarring. It can be used as a new option for prophylactic ileostomy.

Objective To explore the clinical value of Mg2+ transporter 1（MagT1）expression in peripheral blood CD8 + T lymphocytes in patients with acute myeloid leukemia（AML）. Methods One hundred and nighty⁃ seven new⁃onset AML patients admitted to our hospital from March 2014 to December 2018 and 60 physical exam⁃ iners in the same period were enrolled in the study. Peripheral blood monocytes cells（PBMCs）and CD8 + T cells were isolated. The concentration of serum Mg2+ was detected by automatic biochemical analyzer，and the expression of MagT1 mRNA in PBMCs was detected by RT⁃qPCR. AML patients were divided into low，medium and high risk groups according to NCCN AML guidelines. The expression of MagT1 mRNA and protein in CD8+ T cells were detected by RT⁃qPCR and Western blot. The expression of PD⁃1 and Tim⁃3 was detected by flow cytometry. The correlation between MagT1 protein and the expression of PD⁃1 and Tim⁃3 was analyzed by Spearson correlation assay. The relationship between MagT1 protein expression in CD8+ T cells and event free survival（EFS）and overall survival（OS）were analyzed by Kaplan ⁃Meier curve. Receiver operating characteristic（ROC）curve was used to evaluate the predictive value of MagT1 protein expression level in risk stratification and prognosis of AML patients. Results Compared with the control group，the Mg2+ concentration in peripheral blood of AML patients decreased， and the relative expression of MagT1 mRNA in PBMCs decreased. Compared with the low⁃risk group，the relative expression of MagT1 mRNA and protein in CD8+ T cells in the medium and high⁃risk groups decreased，while the levels of PD⁃1 and Tim⁃3 increased. The expression of MagT1 protein in CD8+ T cells was negatively correlated with the expression levels of PD⁃1 and Tim⁃3. The EFS and OS of patients with high expression of MagT1 protein were higher than those with low expression of MagT1 protein. The expression level of MagT1 has evaluation value for prognosis（AUC = 0.866，95%CI：0.817 ~ 0.915）and risk stratification（AUC = 0.724，95%CI：0.642 ~ 0.806） of AML patients. Conclusion The decreased expression of MagT1 in peripheral blood CD8+ T cells in patients with AML is associated with adverse risk stratification，CD8 + T lymphocyte depletion and adverse survival. It has important value in evaluating the risk and predicting the prognosis of patients with AML.

Objective To study the clinical efficacy of transumbilical single⁃port laparoscopic ovarian cyst excision and its application value in overweight and obese patients. Methods Patients undergone ovarian cyst exci⁃ sion in our hospital in January 2019 to March 2021 were selected and divided into umbilical single⁃port laparoscopic surgery group and multiport laparoscopic surgery group according to operation，or normal weight group and overweight and obese group according to body mass index. The various operation indicators were analyzed. Results Compared with the multiport laparoscopy group，the single⁃port group had longer operation time，shorter time to get out of bed， and higher hospitalization expense（P < 0.01）. There were no significant differences in intraoperative bleeding， exhaust time and postoperative hospital stay（P > 0.05）. In comparison of overweight patients and normal weight patients undergoing single ⁃port surgery，there were no differences in incision size，operation time，intraoperative bleeding，exhaust time，out⁃of⁃bed time，postoperative hospital stay and total hospitalization expense（P > 0.05）. Conclusion Transumbilical single ⁃ port laparoscopy has similar therapeutic effect in ovarian cyst excision com⁃ pared to multiport laparoscopy，but single⁃port laparoscopy is better in promoting recovery. Increased body mass index has no effect on the application of single⁃port laparoscopic ovarian cyst excision. 

Objective To investigate the predictive value of vascular endothelial growth factor（VEGF） level in patients with type 2 diabetes mellitus（T2DM）complicated with retinal microangiopathy. Methods A total of 146 patients with T2DM treated in our hospital from July 2018 to March 2021 were selected and were divided into DR group（n = 67）and non⁃DR group（n = 79）. Univariate and multivariate Cox regression analysis of the factors affecting T2DM patients with DR；The nomogram prediction model is constructed according to the independent influencing factors，and its prediction efficiency is evaluated. Results The course of T2DM in DR group was significantly longer than that in non ⁃DR group（P < 0.05）. In terms of biochemical indexes，FPG，HbA1c，GA， SCR，UA，bun，UACR and VEGF in DR group were significantly higher than those in non DR group（P < 0.05）， while ALB and RBC were significantly lower than those in non DR group（P < 0.05）. The course of T2DM， HbA1c，UA and VEGF were independent risk factors for DR in T2DM patients（P < 0.05），ALB and RBC were protective factors（P < 0.05）. The area under ROC curve（AUC）of the prediction model constructed according to risk factors was 0.874（95%CI：0.825 ~ 0.928，P < 0.001），which had high prediction value. Conclusion The level of VEGF was significantly increased in the serum of DR patients，which could be an independent risk factor for T2DM patients with DR and has a high predictive value for DR. 

Objective To explore the clinical efficacy and safety of tofacitinib in the treatment of difficult⁃ to ⁃treat rheumatoid arthritis（D2T ⁃RA）. Methods Fifty ⁃one patients with D2T ⁃RA who had received therapies with tofacitinib for 24 weeks were included into this study. Disease activity indicators including disease activity score 28 joint count⁃C⁃reactive protein（DAS28CRP），disease activity score 28 joint count⁃erythrocyte sedimentation rate （DAS28ESR），erythrocyte sedimentation rate（ESR），C⁃reactive protein（CRP），swollen joints count，tender joints count，visual analogue score（VAS）and safety indicators were observed prior to treatment initiation and at weeks 4，12，and 24 after Tofacitinib treatment. Results As compared with the baselines，DAS28CRP，DAS28ESR，CRP， ESR，swollen joints count，tender joints count and VAS were all significantly decreased at weeks 4，12 and 24 after tofacitinib treatment（P < 0.05）. As compared with 4 weeks of treatment，DAS28CRP，DAS28ESR，swollen joints count，tender joints count and VAS were all significantly decreased at weeks 12 and 24（P < 0.05）. The patients with no previous therapies with biologic DMARDs were more likely to achieve the RDA of DAS28CRP than those with prior uses of DMARDs（82.35% vs. 76.47%）. No adverse events including thrombosis，severe infection，and ane⁃ mia occurred. Conclusions Tofacitinib can effectively improve symptoms，signs，and inflammatory indexes， and rapidly reduce the disease activity of D2T RA in the short term. It also has a better safety.

Objective To explore the effect of helicobacter pylori（Hp）on carotid elasticity in patients with chronic obstructive pulmonary disease（COPD）by ultrafast pulse wave velocity（UFPWV）. Methods A total of 80 patients with COPD were selected as a COPD group and then divided into a Hp（-）and a Hp（+）subgroup based on 14C urea breath test（14C⁃UBT），while 40 individuals receiving physical examination during the same period were selected as a control group. The clinical data and pulse wave velocity（PWV⁃BS and PWV⁃ES）at the beginning and the end of contraction were compared. Results High sensitivity C⁃reactive protein（Hs⁃CRP），BS and ES were higher in the Hp（+）subgroup than in the Hp（-）subgroup（P < 0.05）；while high density lipoprotein （HDL⁃C），oxygen partial pressure（PaO2），oxygen saturation（SaO2）and forced expiratory volume in the first second（FEV1）were lower（P < 0.05）. BS was（5.47 ± 1.02）in the control group，（5.97 ± 1.06）in the Hp（-） subgroup，and（6.87 ± 1.03）m/s in the Hp（+）subgroup；whereas ES was（6.98 ± 1.44），（7.95 ± 1.05），and （9.59 ± 1.44）m/s respectively. BS and ES were positively correlated with 14C ⁃ UBT，systolic blood pressure （SBP）and Hs⁃CRP（P < 0.05），but negatively correlated with HDL⁃C，PaO2，SaO2 and FEV1（P < 0.05）. Hs⁃CRP， SBP and HDL⁃C were the influencing factors of BS；while Hs⁃CRP，Hp14C⁃UBT，SBP and PaO2 were the influenc⁃ ing factors of ES（P < 0.05）. Conclusions BS and ES significantly increase in patients with COPD complicated by HP infection. Hp may be a risk factor of carotid atherosclerosis in COPD patients，indicating that clinical atten⁃ tion is needed. UFPWV can detect the early changes in carotid elasticity，and early intervention is beneficial to the prevention and treatment of related complications.

Objective To evaluate the clinical effect of high⁃frequency ultrasound in the diagnosis and rehabilitation of Achilles tendon injury and predict the recovery process of Achilles tendon by using share wave elastography（SWE）. Methods A total of 54 patients with suspected Achilles tendon injury were examined by high ⁃frequency ultrasonography and SWE. Forty patients with postoperative Achilles tendon injury were examined by high ⁃frequency ultrasonography and SWE at months 1 ，3 and 6 postoperatively. The thickness，echo，blood flow and shear wave velocity（SWV）of the affected Achilles tendons were observed and compared with those of the healthy Achilles tendon. Results For all the 54 patients，the sensitivity，specificity and accuracy rates of high⁃ frequency ultrasonography were 97.6%（40/41），76.9%（10/13）and 92.6%（50/54），respectively. After surgery， the thickness of the Achilles tendons decreased with time，the internal echo was gradually uniform，and the blood flow and adhesion decreased，which was consistent with the clinical symptoms. The shear wave velocity increased with time. Conclusion High⁃frequency ultrasound and shear wave velocity can determine the type and degree of Achilles tendon injury，and contribute to its diagnosis and rehabilitation prediction as well.

Objective To study the effect of Qinggan Huashi Huoxue decoction combined with silybin capsule on the clinical efficacy and liver fibrosis index of patients with alcoholic liver disease. Methods A total of 112 patients with alcoholic liver disease treated in our hospital from July 2019 to July 2021 were randomly divided into observation group and control group，with 56 cases in each group. The control group was treated with silybin capsule，and the observation group was treated with Qinggan Huashi Huoxue decoction. The clinical efficacy，liver function index，liver fibrosis index，quality of life score and treatment safety of the two groups were comprehensively evaluated. Results The total effective rate in the observation group was 91.07%（51/56），which was higher than 75.00%（42/56）in the control group（P < 0.05）. After treatment，the levels of total bilirubin（TBIL），alanine aminotransferase（ALT）and aspartate aminotransferase（AST）in the observation group were lower than those in the control group（P < 0.05）. After treatment，the levels of type Ⅲ procollagen peptide（iii⁃pc），laminin（LN） and hyaluronic acid（HA）in the observation group were lower than those in the control group（P < 0.05）. After treatment，the scores of quality of life in the observation group were higher than those in the control group（P < 0.05）. The incidence of adverse reactions in the observation group and the control group were 14.29%（8/56）and 8.93%（5/56）respectively（P > 0.05）. Conclusion Qinggan Huashi Huoxue decoction combined with silybin capsule had a significant therapeutic effect on patients with alcoholic liver disease，improved the indexes of liver function and liver fibrosis，improved the quality of life，and had good therapeutic safety.

Colorectal cancer is the most common malignant tumor of the digestive system. The survival rate of patients with the cancer is negatively correlated with the stage of cancer at the time of diagnosis. If it is detected early，up to 90% of deaths can be avoided. So far，many miRNAs have been confirmed to be tumor suppressor genes or oncogenes，which have a good prospect of clinical application. However，the current research is mainly focused on the miRNA of peripheral blood and tissue samples of patients with the cancer，few studies pay attention to the role of fecal miRNAs，and systematically uncover the significance of fecal miRNA in the diagnosis and prog⁃ nostic assessment of the cancer. Therefore，this article reviews the latest research advances in the role of fecal miR⁃ NAs in the diagnosis and prognostic assessment of colorectal cancer，expounding its potential value as a biomarker of colorectal cancer.

In recent years，the incidence of thyroid tumors has increased year by year，and surgery is one of the effective approaches for thyroid tumors. With the standardization of thyroid disease treatment and the im⁃ provement of patients′ cosmetic needs，lumpectomy thyroid surgery has rapidly developed and derived a variety of accesses. However，no matter what kind of procedure is used，it can cause hypoparathyroidism，which seriously affects the quality of life of patients after surgery. In order to reduce the incidence of permanent hypoparathyroidism， endoscopic thyroidectomy combined with parathyroid auto ⁃ transplantation came into being，but the conventional transplantation of parathyroid glands and the evaluation of the effect after transplantation are still controversial. This paper reviews the current situation of endoscopic thyroidectomy and parathyroid transplantation and the evaluation of the effects of various surgical methods needs to be confirmed by prospective randomized controlled studies.

As a major difficulty in the field of wound repair，chronic wounds greatly lower the quality of life of patients. In recent years ，adipose⁃derived mesenchymal stem cells（ADSCs）have become a research hotspot in the field of wound repair，with clear efficacy but limitations. Recent studies have indicated that the com⁃ bination of ADSCs and negative pressure wound therapy（NPWT）has a better effect，but there is still no systematic description of it in relevant literature. At present，a large number of studies have shown that NPWT can improve the survival rate of ADSCs，and promote vascular formation and adipose tissue regeneration. The combined applica⁃ tion of ADSCs and NPWT has better efficacy in wound repair and can effectively improve the wound healing rate. This article reviews the mechanism of ADSCs and NPWT on chronic wounds respectively and their combined appli⁃ cation in chronic wounds.