Objective To analyze the efficacy of the"sandwich"technique for treating varicocele(VC).Methods A total of 310 patients with VC(365 affected veins)were selected and divided into interventional treatment group and non-interventional treatment group.The baseline data,hospitalization data,and 6-month follow-up data of the two groups were analyzed.Results The age of patients in the interventional treatment group was significantly lower than that in the non-interventional treatment group(P＜0.05).The surgical time and hospital stay in the interventional treatment group were significantly lower than those in the non-interventional treatment group(P＜0.05).In the non-interventional treatment group,two patients experienced surgical site infections,and one patient opted for interventional treatment due to recurrence after non-interventional treatment.After surgery,the diameter of the spermatic vein significantly decreased in both the interventional and non-interventional treatment(P＜0.05).Conclusion The"sandwich"technique(embolization coil combined with foam sclerotherapy)is an effective treatment for VC.

Objective To report a case of Elizabethkingia anopheles(E.anopheles)-associated sepsis and menin-gitis,review the relevant literatures,and provide reference for the diagnosis and treatment of this infection.Methods Treatment process of a pediatric patient aged 11-year-7-month old who developed post-neurosurgery E.anophe-les-associated sepsis and meningitis was analyzed retrospectively.Relevant literature was reviewed to summarize clinical characteristics of patients with E.anopheles-associated sepsis or meningitis.Results The main clinical manifestations of this pediatric patient were fever and abnormal cerebrospinal fluid routine.The cerebrospinal fluid and blood cultures showed E.anopheles.Patient recovered after vancomycin treatment.Including this case,a total of 33 cases were analyzed,with 16 males and 1 unreported gender.The median age of patients was 49 years old(range:1 day-84 years).Most cases were healthcare-associated infections(62.5％,n=20)with underlying disea-ses,and 24 cases were cured.Conclusion E.anopheles-associated infections are rare in clinic,but can cause severe infections such as sepsis and meningitis,warranting clinical attention.

Objective To report a case of Elizabethkingia anopheles(E.anopheles)-associated sepsis and menin-gitis,review the relevant literatures,and provide reference for the diagnosis and treatment of this infection.Methods Treatment process of a pediatric patient aged 11-year-7-month old who developed post-neurosurgery E.anophe-les-associated sepsis and meningitis was analyzed retrospectively.Relevant literature was reviewed to summarize clinical characteristics of patients with E.anopheles-associated sepsis or meningitis.Results The main clinical manifestations of this pediatric patient were fever and abnormal cerebrospinal fluid routine.The cerebrospinal fluid and blood cultures showed E.anopheles.Patient recovered after vancomycin treatment.Including this case,a total of 33 cases were analyzed,with 16 males and 1 unreported gender.The median age of patients was 49 years old(range:1 day-84 years).Most cases were healthcare-associated infections(62.5％,n=20)with underlying disea-ses,and 24 cases were cured.Conclusion E.anopheles-associated infections are rare in clinic,but can cause severe infections such as sepsis and meningitis,warranting clinical attention.

Objective To analyze the efficacy of the"sandwich"technique for treating varicocele(VC).Methods A total of 310 patients with VC(365 affected veins)were selected and divided into interventional treatment group and non-interventional treatment group.The baseline data,hospitalization data,and 6-month follow-up data of the two groups were analyzed.Results The age of patients in the interventional treatment group was significantly lower than that in the non-interventional treatment group(P＜0.05).The surgical time and hospital stay in the interventional treatment group were significantly lower than those in the non-interventional treatment group(P＜0.05).In the non-interventional treatment group,two patients experienced surgical site infections,and one patient opted for interventional treatment due to recurrence after non-interventional treatment.After surgery,the diameter of the spermatic vein significantly decreased in both the interventional and non-interventional treatment(P＜0.05).Conclusion The"sandwich"technique(embolization coil combined with foam sclerotherapy)is an effective treatment for VC.

Objective:To explore the value of coronary artery plaque progression parameters based on coronary CT angiography (CCTA) in predicting the occurrence of major adverse cardiovascular events (MACE) in patients with non-obstructive coronary artery disease.Methods:The study included clinical, imaging, and prognosis (MACE) parameters of non-obstructive coronary artery disease patients who underwent CCTA at the First Affiliated Hospital of Nanjing Medical University from September 2010 to December 2022. Patients were grouped based on the occurrence of MACE, and differences in clinical data, plaque baseline, and progression parameters between the two groups were compared. Univariate and multivariate Cox regression analyses were employed to identify factors that could effectively predict the occurrence of MACE in patients. Models were constructed using plaque baseline parameters, plaque progression parameters, and a combination of both. The concordance index-time curve, net reclassification improvement and integrated discrimination improvement were used to evaluate the risk stratification ability of the models.Results:A total of 258 patients were included, of whom 62 cases experienced MACE during the follow-up period. In comparison to the MACE(-) group, patients in the MACE(+) group exhibited longer lesion length, greater degree of stenosis, larger plaque total volume, calcified plaque volume, non-calcified plaque volume, fibrous plaque volume, total plaque burden, lipid-rich plaque burden, higher peri-coronary adipose tissue attenuation index (FAI), and annual change of diameter stenosis(ΔDS/y). There were also more cases of coronary artery disease reporting and data system upgrades and non-obstructive progression to obstructive status ( P<0.05). Multivariate Cox analysis revealed that FAI, ΔDS/y, and non-obstructive progression to obstructive status were independent predictors of MACE occurrence. Concordance index-time curve results indicated that the combined model had a better predictive efficacy for MACE in patients with non-obstructive coronary artery disease compared to models based on plaque baseline parameters and plaque progression parameters. Conclusion:The plaque progression parameters and FAI based on CCTA have the potential to predict the high-risk population for MACE in patients with non-obstructive coronary artery disease, demonstrating good risk stratification value.

ObjectiveTo explore the clinical efficacy of Gouteng prescription in treating the patients with primary hypertension with anxiety disorder due to yang hyperactivity and heat toxin and the impact of the formula on the balance of inflammatory cytokines. MethodA total of 98 patients diagnosed with primary hypertension and anxiety disorder were randomized into control and observation groups. On the basis of conventional western medicine treatment for hypertension， the control group （47 patients） was treated with Shugan Jieyu capsules for 8 weeks， while the treatment group （51 patients） with Gouteng prescription for 8 weeks. The two groups were compared in terms of the blood pressure level， 24-hour blood pressure variability， Hamilton anxiety scale （HAMA） score， Pittsburgh sleep quality index （PSQI） score， quality of life （SF-36 scale） score， traditional Chinese medicine （TCM） syndrome score and efficacy， incidence of adverse reactions， and the levels of interleukin （IL）-1β， IL-6， IL-10， and IL-4 in the serum of peripheral blood. ResultThe final trial was completed with 95 patients， including 46 in the control group and 49 in the observation group. The treatment in both groups lowered the blood pressure and blood pressure variability （P<0.05， P<0.01）. The observation group outperformed the control group in recovering the systolic blood pressure （SBP）， 24-hour mean systolic blood pressure （24 h SBP）， 24-hour systolic blood pressure variability （24 h SBPV）， and 24-hour diastolic blood pressure variability （24 h DBPV） （P<0.05）. After treatment， the HAMA and PSQI scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower HAMA and PSQI scores than the control group （P<0.05）. Compared with those before treatment， the SF-36 scores in both groups increased （P<0.05， P<0.01）. After treatment， the observation group had higher scores of physiological function （PF）， bodily pain （BP）， social function （SF）， role-emotional （RE）， and mental health （MH） indicators than the control group （P<0.05）. After treatment， the TCM syndrome scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower score than the control group （P<0.05）. The total response rate regarding TCM syndrome in the observation group was 85.71% （42/49）， which was higher than that （63.04%， 29/46） in the control group （χ²=6.621， P<0.05）. The treatment in both groups lowered the levels of pro-inflammatory cytokines （IL-1β， IL-6） and elevated the levels of anti-inflammatory cytokines （IL-10， IL-4） （P<0.05， P<0.01）， and the changes were more obvious in the observation group than in the control group （P<0.05）. There were no adverse events during the research process. ConclusionGouteng prescription can recover the blood pressure level， reduce blood pressure variability， suppress anxiety state， improve sleep and quality of life， decrease TCM syndrome score， increase total response rate， lower serum IL-1β and IL-6 levels， and elevate serum IL-10 and IL-4 levels in the patients with primary hypertension complicated with anxiety disorder due to yang hyperactivity and heat toxin. It may exert the effects by regulating the balance of pro-inflammatory and anti-inflammatory cytokines.

Objective:To investigate the imaging features of pancreatic hypervascular tumors in computed tomography (CT) and magnetic resonance imaging (MRI) examinations.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 53 patients with pancreatic hypervascular tumors who were admitted to two medical centers, including 32 cases in the Affiliated Hospital of Medical School, Ningbo University and 21 cases in the First Affiliated Hospital of Naval Medical University, from March 2007 to February 2021 were collected. There were 21 males and 32 females, aged (48±23)years. Of the 53 patients, there were 19 cases with pancreatic neuroendocrine tumor (PNET), 9 cases with pancreatic metastasis from renal cell carcinoma (PRCC), 8 cases with solid pseudopapillary tumors of pancreas (SPTP), 7 cases with intrapancreatic accessory spleen (IPAS), 6 cases with serous cystadenoma of pancreas (SCP) and 4 cases with aneurysms. All the 53 patients underwent CT and MRI. Observation indicators: (1) imaging feature of PNET; (2) imaging feature of PRCC; (3) imaging feature of SPTP; (4) imaging feature of IPAS; (5) imaging feature of SCP; (6) imaging feature of aneurysms. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging feature of PNET: of the 19 cases with PNET, there were 1 case with Von Hippel-Lindau disease (VHLD), 8 cases with multiple endocrine neoplasia type 1 (MEN1) and 10 cases with neuroendocrine tumor (NET). Of the 19 cases, 16 cases had single tumor and 3 cases had 2 tumors, 9 cases had tumor located at head of pancreas and 10 cases had tumor located at body and tail of pancreas. Morphology of tumors in the 19 cases were mostly round or elliptical, with some shallow lobes and clear boundary. There were 4 cases with cluster-like calcifications in the center of tumors and 15 cases with no cluster-like calcification in the center of tumors. The tumor diameter of 19 cases was (26.7±10.3)mm. Of the 19 cases, 1 case underwent pancreatic atrophy and segmental expansion of the main pancreatic duct and 18 cases underwent no pancreatic atrophy or segmental expansion of the main pancreatic duct, 2 cases underwent dilated bile ducts and 17 cases underwent no dilated bile ducts. The enhance-ment mode of imaging examination of PNET was wash in and wash out. (2) Imaging feature of PRCC: Of the 9 cases with PRCC, 2 cases had single tumor and 7 cases had multiple tumors. Of the 2 cases with single tumor, 1 case had tumor located at neck of pancreas and 1 case had tumor located at body and tail of pancreas. All the 7 cases with multiple tumors had tumor located at head, neck, body and tail of pancreas. Morphology of tumors in the 9 cases were round or quasi-circular, with clear boundary. The tumor diameter were (18.0±5.0)mm of the 2 cases with single tumor and 2.0-50.0 mm of the 7 cases with multiple tumors, respectively. Of the 9 cases, 2 cases underwent pancreatic ducts dilatation and 7 cases underwent no pancreatic ducts dilatation. The enhancement mode of imaging examination of PRCC was wash in and wash out. (3) Imaging feature of SPTP: all 8 cases with SPTP had single tumor, including 4 cases with tumor located at head of pancreas and 4 cases with tumor located at body and tail of pancreas. Morphology of tumors in the 8 cases were lobulated with clear boundary. Of the 8 cases, there were 2 cases with no calcifications of tumors and 6 cases with calcification of tumors, 2 cases with no cystic necrosis of tumors and 6 cases with cystic necrosis of tumors, 3 cases with no bleeding in the tumors and 5 cases with bleeding in the tumors. The tumor diameter of 8 cases was (51.6±11.8)mm. All the 8 cases were negative for pancreatic ducts dilatation, but the adjacent organs were compressed and moved. The enhancement mode of imaging examination of SPTP was asymptotic enhancement. (4) Imaging feature of IPAS: all the 7 cases with IPAS had single tumor located at tail of pancreas. Morphology of tumors in the 7 cases were round or quasi-circular shape with clear boundary. Of the 7 cases, 1 case with solid-cystic and uneven density tumor was epidermoid cyst in the accessory spleen of the tail of the pancreas, and 6 cases had solid and uniform density tumors. The tumor diameter of 7 cases was (25.5±8.5)mm. All the 7 cases were negative for pancreatic ducts dilatation and the surrounding structures of pancreatic ducts were clear. The enhancement mode of imaging examination of IPAS was asymptotic enhancement. (5) Imaging feature of SCP: all 6 cases with SCP had single tumor, including 1 case with tumor located at neck of pancreas and 5 cases with tumor located at body and tail of pancreas. Morphology of tumors in the 6 cases were round or quasi-circular, with clear boundary. Of the 6 cases, 2 cases had cystic tumors and 4 cases had solid tumors. The tumor diameter of 6 cases was (35.5±15.4)mm. Of the 6 cases, 2 cases were positive for pancreatic ducts dilatation and 4 cases were negative for pancreatic ducts dilatation. The enhancement mode of imaging examination of SCP was wash in and wash out. (6) Imaging feature of aneurysms: all the 4 cases with aneurysms had single tumor, including 1 case with tumor located at body of pancreas and 3 cases with tumor located at tail of pancreas. One case with tumor located at body of pancreas was superior duodenal aneurysm and 3 cases with tumor located at tail of pancreas were splenic aneurysms. Morphology of tumors in the 4 cases were round, with clear boundary. Of the 4 cases, 1 case was negative for tumor marginal calcification and 3 cases were positive for tumor marginal calcification. The tumor diameter of 4 cases was (11.3±2.5)mm. All the 4 cases were negative for pancreatic ducts dilatation. The enhance-ment mode of imaging examination of aneurysms was wash in and wash out.Conclusions:The imaging features of pancreatic hypervascular tumors in CT and MRI examinations show diversity. The enhancement mode of imaging examination of PNET, PRCC, SCP and aneurysms is wash in and wash out. The enhancement mode of imaging examination of SPTP and IPAS is asymptotic enhancement.

OBJECTIVE：To systematically evaluate the efficacy and safety of pe ficitinib for treating rheumatoid arthritis （RA），and to provide evidence-based reference for the clinical treatment of RA. METHODS ：Retrieved from PubMed ，Embase， The Cochrane Library ，CJFD，VIP and Wanfang database during from their establishment to September 2019，randomized controlled trials （RCTs）about the efficacy and safety of Peficitinib （trial group ）versus placebo （control group ）in the treatment of RA were collected. The risk of bias assessment tool provided in Cochrane System Evaluator Manual 5.1.0 was used to evaluate the quality after data extracted from clinical studies which met the inclusion criteria. Meta-analysis of the efficacy [the proportion of patients who met the American College of Rheumatology 20％ improvement criteria （ACR20），ACR50，ACR70，the proportion of the patients with 28 joint disease activity index ＜2.6 calculated by erythrocyte sedimentation rate （DAS28-ESR＜2.6），the proportion of patients with 28 joint disease activity index ＜2.6 calculated by C-reactive protein （DAS28-CRP＜2.6），etc.] and safety（incidence of total ADR ）was performed by using Stata 16 statistical software. RESULTS ：Totally 5 RCTs were included ， 药学。E-mail：hyl3160131@163.com 5.11），P＜0.001]，150 mg[RR＝3.52，95％CI（1.78，6.96），P＜ 0.001]}，ACR70{total [RR ＝2.51，95％CI（1.52，4.14），P＜0.001]，100 mg[RR＝3.50，95％CI（1.62，7.58），P＝0.001]，150 mg [RR＝4.59，95％CI（1.47，14.30），P＝0.009]}，DAS28-ESR＜2.6{total [RR ＝4.83，95％CI（3.20，7.28），P＜0.001]，100 mg[RR＝ 5.37，95％CI（2.68，10.77），P＜0.001]，150 mg[RR＝7.44，95％CI（3.78，14.65），P＜0.001]} and DAS 28-CRP＜2.6{total [RR ＝3.41， 95％CI（2.65，4.39），P＜0.001]，100 mg[RR＝4.00，95％CI（2.67，5.99），P＜0.001]，150 mg[RR＝4.45，95％CI（2.99，6.63），P＜ 0.001]} in trial group were significantly higher than control group ，with statistical significance. In term of safety ，there was no statistical significance in the incidence of total ADR [RR ＝1.05，95％ CI（0.94，1.16），P＝0.395] between 2 groups. CONCLUSIONS：For the treatment of RA ，100 mg or 150 mg peficitinib once per day is superior to placebo in terms of ACR 20， ACR50 and ACR 70，DAS28-ESR＜2.6，DAS28-CRP＜2.6； the adverse events are mild and tolerable and it may be a new treatment option for RA.

OBJECTIVE：To systematically evaluate the efficacy and safety of guselkumab in the treatment of moderate-to- severe plaque psoriasis ，and to provide evidence-based reference for the clinical treatment. METHODS ：Retrieved from PubMed ， Embase，Cochrane Library ，CNKI，VIP，Wanfang database during inception to Oct. 2019，randomized controlled trials （RCTs） about guselkumab versus placebo/positive control in the treatment of moderate-to-severe plaque psoriasis were collected. After literature screening and data extraction ，quality evaluation was performed by using the bias risk evaluation tool recommended by the Cochrane System evaluator manual 5.1.0. Meta-analysis was performed by using Stata 16.0 software. RESULTS ：Eight RCTs with a total of 3 488 patients were included. The results of Meta-analysis indicated that the proportion of patients who achieved 90％ reduction or more from baseline of psoriasis area and severity index （PASI）in guselkumab group was significantly higher than that placebo group [RR ＝26.72，95％CI（15.98，44.70），P＜0.001]，adaliumumab group [RR ＝1.45，95％CI（1.32，1.59）， P＜0.001] and secukinumab group （P＜0.000 1）. The proportion of patients with Investigator ’s Global Assessment （IGA）score of 0 or 1 in guselkumab group was significantly better than placebo group [RR ＝11.15，95％ CI（8.22，15.14），P＜0.001] and adaliumumab group [RR ＝1.27，95％CI（1.19，1.35），P＜0.001]. The proportion of patients with IGA score of 0，the proportion of patients who achieved 75％ reduction or more from baseline of PASI ，dermatology life qu ality index score of 0 or 1 in guselkumab group were signifi cantly superior than placebo group and adaliumumab gr oup，the proportion of patients who achieved 100％ reduction from baseline of PASI in guselkumab group Lewx- was significantly superior than placebo group （P＜0.05）， inn@outlook.com there was no significant difference compared with adaliumumab group （P＞0.05）. There was no statistical significance in the proportion of patients with IGA score of and other secondary outcome indicators between guselkumab and secukinumab group （P＞0.05）. In the safety indicators as total incidence rate of ADR ，rate of withdrawl due to ADR ，etc. ，there was no statistical significance between guselkumab and placebo/ adalimumab groups （P＞0.05）. CONCLUSIONS ：Guselkumab is superior to placebo ，adaliumumab and secukinumab in improving the symptoms of moderate-to-severe plaque psoriasis with good safety .

OBJECTIVE：To systemat ically evaluate the efficacy and safety of Ubrogepant and Rimegepant in the treatment of acute migraine ，and to provide evidence-based reference for the clinical treatment. METHODS ：Retrieved from PubMed ，Embase， Cochrane Library ，CNKI，VIP，Wanfang database and Clinicaltrials. gov ，randomized controlled trials （RCTs） about the Ubrogepant and Rimegepant （trial group ）versus placebo （control group ）in the treatment of acute migraine were collected during the inception to Jan. 2020. After literature screening and data extraction ，quality assessment was performed using the bias risk assessment tool provided by the Cochrane system evaluator manual 5.1.0. Meta-analysis was performed by using Stata 16.0 software. RESULTS ：Eight RCTs with a total of 7 989 patients were included. The results of Meta-analysis showed that the proportion of patients who were free from pain at 2 h postdose in Ubrogepant group [RR ＝1.65，95％CI（1.38，1.98），P＜0.001] and Rimegepant group [RR ＝1.69，95％CI（1.46，1.95），P＜0.001]，the proportion of patients who were free from the most bothersome symptom at 2 h postdose in Ubrogepant group [RR ＝1.35，95％ CI（1.20，1.53），P＜0.001] and Rimegepant group [RR ＝1.37，95％CI（1.24，1.51），P＜0.001]，and other secondary outcome indicators （ i.e. the proportion of patients with pain relief at 2 h postdose ，the proportion of patients with sustained freedom from pain from 2-24 h postdose ，the proportion of patients with sustained pain relief from 2-24 h postdose ，the proportion of patients without photophobia at 2 h postdose ，the proportion of patients without phonophobia at 2 h postdose ，the proportion of patients without nausea at 2 h postdose ）were all significantly better than control group （P＜0.05）. In terms of safety ，there was no statistical significance in the incidence of total ADR between Ubrogepant group and control group [RR ＝1.04，95％CI（0.87，1.25），P＝0.646]，but the incidence of total ADR in Rimegepant group were significantly higher than control group [RR ＝1.23，95％ CI（1.01，1.50），P＝0.043]. There was no statistical significance in other security indicators （i.e. incidence of nausea ，dizziness，dry mouth ，somnolence，urinary tract infection）in 2 groups（P＞0.05）. CONCLUSIONS ：Ubrogepant and Rimegepant are effective in the treatment of acute migraine. Ubrogepant is safe ，while Rimegepant may increase the incidence of ADR.