Volume 105 · Issue 41 · 2025

Pituitary prolactinoma, the most prevalent functional pituitary adenomas, has witnessed significant advancements in diagnostic and therapeutic concepts with the advancement of surgical techniques and the update of more clinical evidence-based medical evidence. Based on the 2014 version of the "Chinese Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma", the China Pituitary Adenoma Specialist Council has revised this consensus, in accordance with the latest evidence-based medical evidence and clinical experience, aiming to provide standardized diagnosis and treatment suggestions for clinicians. The consensus systematically expounds the epidemiological characteristics, clinical manifestations, diagnostic criteria, differential diagnosis process and treatment strategies of prolactinomas, and puts forward individualized management suggestions for special populations (such as pregnant women, male patients and refractory prolactinomas). The treatment decision strongly advocates for multidisciplinary team evaluation involving specialists from neurosurgery, endocrinology, radiology, radiation oncology, pathology, ophthalmology, and obstetrics/gynecology, etc. Through the raising of recommendation questions, summary and evaluation of evidence, formation of recommendation opinions, expert discussions, and in combination with clinical practice, 36 recommendations have been formed in aspects such as screening, assessment, diagnosis, treatment, and monitoring. This consensus takes into account both clinical needs and international evidence-based standards, providing a highly reliable reference for diagnosis and treatment, and is expected to enhance the standardization and overall level of prolactinoma diagnosis and treatment in China.

The "Consensus on the diagnosis and treatment of pituitary prolactinoma (2025 edition)" is based on the latest evidence-based medicine evidence and has comprehensively refined the diagnosis and treatment strategies for prolactinoma. In terms of diagnosis, the consensus optimizes the imaging evaluation process and introduces innovative recommendations such as aneurysm screening. In terms of treatment, the consensus clarifies a step-by-step medication strategy, establishes the important position of neuroendoscopic surgery for well-defined adenomas with Knosp 0-1 grade, and refines the application details of radiotherapy. In terms of the management of special populations, the consensus significantly strengthens the refined and individualized management plans for refractory prolactinoma, male patients, pregnant patients, etc. The artical vertically compars the evolution of the 2025 edition consensus with the 2014 edition consensus, horizontally compars its similarities and differences with international consensus, and deeply explores the clinical value and current limitations of the new edition consensus, in order to provide references for clinical practice and jointly promote the improvement of the diagnosis and treatment level of prolactinoma in China.

Cardiac arrest (CA) is one of the leading causes of death worldwide. More than 90% of CA patients experience varying degrees of neurological impairment following the return of spontaneous circulation (ROSC), which significantly affects both survival rates and quality of life. In recent years, significant progress has been made in research focused on neuroprotection following CA. Various neuroprotective strategies have demonstrated positive effects in improving neurological outcomes in CA patients. However, the efficacy of certain key interventions, such as targeted temperature management, remains controversial, underscoring the complexity inherent in neuroprotective strategies. This review aims to summarize the latest advancements in neuroprotective strategies for post-resuscitation neurological injury, including target temperature management, oxygenation and ventilation management, pharmacological interventions, special gas therapy, and other treatment methods. Additionally, it explores the challenges faced in this field, providing a reference for future research directions and contributing to the improvement of neurological prognosis and long-term quality of life for CA patients.

With the widespread use of herbicides, the number of herbicide poisoning cases has been steadily increasing, particularly among agricultural workers, farmers, and non-target populations exposed to contaminated environments. How to achieve efficient and accurate early diagnosis of herbicide poisoning and implement effective treatment measures remains a significant challenge in the fields of medicine and agricultural science. This review systematically analyzes recent research hotspots related to herbicide poisoning through bibliometric and visualization methods. It summarizes advances in understanding the toxicological mechanisms, breakthroughs in diagnostic and therapeutic strategies, and the current status of clinical management. Furthermore, this article discusses the major challenges and unresolved issues that remain in clinical practice, identifies critical aspects that require urgent improvement, and proposes perspectives for future research and clinical applications. The aim is to provide a valuable reference for enhancing the treatment and management of herbicide poisoning.

Chimeric antigen receptor-T cell (CAR-T) therapy has achieved remarkable efficacy, however, the complex process and high treatment costs largely limit the clinical application of conventional CAR-T therapy. With the advancement of biotechnology, in vivo CAR-T therapy is steadily moving from the laboratory into the clinical practice. This thesis systematically synthesizes the delivery vehicles for in vivo CAR-T therapy, including viral vector system [lentiviral vectors, adeno-associated virus (AAV) vectors] and non-viral vector system [polymeric nanoparticles, lipid nanoparticles (LNP), and other delivery vectors]. Meanwhile, focusing on the design strategies and clinical trials, it summarizes clinical practices of in vivo CAR-T therapy at home and abroad, and discuss the existing challenges and future prospects in combination with the latest data, aiming to facilitate its development and clinical translation in China.

Recently, the therapeutic paradigm for pituitary prolactinomas has shifted from a single-pathway of "drug priority" approach toward a multidisciplinary assessment and individualized treatment model. The "Consensus on the diagnosis and treatment of pituitary prolactinoma(2025 edition)" combines the latest evidence-based medicine and technological advances at home and abroad to expand the indications and clinical role of surgical intervention. This article systematically reviews the major differences between the two versions of consensus regarding surgical recommendations, highlighting that with the widespread adoption of endoscopic transnasal techniques, surgery is now recognized as a first-line or co-primary treatment option in selected patients, particularly for those with well-circumscribed microadenomas, macroadenomas, and women of reproductive age. In addition, the article further discusses the role of surgery in fertility management, long-term remission, and in cases with poor drug tolerance or adherence. It also emphasizes that the surgen′s experience, technical proficiency, and multidisciplinary collaboration are still the key prerequisites for ensuring the safety and effectiveness of treatment. The publication of the 2025 consensus marks a major conceptual shift in the management of prolactinomas, offering important guidance and practical paths for establishing a more precise, effective, and humanistic comprehensive diagnosis and treatment system.

Pituitary prolactinoma is the most common functioning pituitary adenoma in clinical practice. Hypogonadotropic hypogonadism secondary to hyperprolactinemia is the main clinical manifestation of patients. Most patients respond well to dopamine receptor agonists (DA). The patients with DA resistance and pituitary tumor apoplexy need neurosurgical treatment. Neurosurgery also increasingly applied to non-invasive microadenoma patients. Radiotherapy is an effective adjuvant treatment method. However, 10%-15% of prolactinoma patients develop refractory pituitary tumors and even progress to metastatic pituitary neuroendocrine tumors (pituitary cancer), seriously affecting the quality of life and even lifespan of patients. This article systematically reviews the definition evolution, molecular mechanism, early predictive markers, and the latest treatment progress of refractory pituitary prolactinoma. It is also suggested that the diagnosis and treatment level of refractory pituitary prolactinoma be gradually improved through the exploration and application of precision medicine and the promotion of standardized multidisciplinary collaborative diagnosis and treatment models.

Prolactinoma, the most common functional pituitary neuroendocrine tumor, belongs to Pit-1 lineage of pituitary neuroendocrine tumors. The treatment methods include surgery, medication, and radiation therapy, with drug therapy centered around dopamine receptor agonists. Cabergoline, a selective D2 receptor agonist with high receptor affinity and long-acting properties, is recommended as a first-line treatment in international guidelines for prolactinoma management.Based on the 2014 edition, the "Consensus on the diagnosis and treatment of pituitary prolactinoma (2025 edition)" has made important updates to the treatment recommendations for cabergoline, mainly including: For patients with bromocriptine resistance, if cabergoline is available, switching to cabergoline is recommended as the first choice; For patients receiving long-term, high-dose cabergoline treatment, regular echocardiogram monitoring is recommended to assess the condition of heart valves. Meanwhile, it also provides more detailed elaborations on cabergoline′s efficacy, adverse reactions (such as heart valve disease, impulse control disorders, etc.), and its application in drug-resistant prolactinomas. However, since cabergoline has not yet been marketed in Chinese mainland, the practical clinical experience with this drug in the domestic setting remains relatively limited, and there is a lack of systematic summary of local data. Endocrinologists need to pay special attention to the selection of its indications, efficacy evaluation, and safety monitoring during long-term medication.

Pituitary prolactinoma is a common functional pituitary tumor with a high incidence in women of childbearing age, and its diagnosis and treatment are closely related to obstetrics and gynecology practice. "Consensus on the diagnosis and treatment of pituitary prolactinoma (2025 edition)" is based on evidence-based medicine and proposes systematic solutions to obstetrics and gynecology problems such as menstrual disorders, infertility, pregnancy safety, and lactation management. By constructing the path of abnormal menstruation-infertility assessment-pregnancy monitoring-postpartum management, a prolactinoma management model with obstetrics and gynecology needs as the main line is established. According to the high-quality evidence, it breaks through the traditional tumor-centered model and emphasizes the equal importance of reproductive health protection and tumor control. At the same time, the consensus clarifies the symptom-driven diagnostic pathway of obstetrics and gynecology (such as abnormal menstruation as an absolute indication for prolactin testing), the dynamic balance strategy of fertility management (such as microadenoma patients can try pregnancy during dopamine agonist therapy and stop the drug after pregnancy), a symptom-led monitoring system during pregnancy, postpartum management to support lactation, and a simplified long-term follow-up plan. It emphasizes the important role of obstetrics and gynecology in multidisciplinary diagnosis and treatment, providing a standardized and individualized decision-making framework for clinical practice.

To explore the application value of the "TINAVI" orthopedic surgical robot with screw placement in lumbar spondylolysis with spondylolisthesis.

A retrospective cohort study was conducted to analyze clinical data of the patients with spondylolytic spondylolisthesis who underwent surgery at Xi′an Honghui Hospital, Xi′an Jiaotong University, from January 2023 to January 2024. The patients were divided into a robot-assisted group and a freehand group based on pedicle screw placement technique. Intraoperative time was recorded, and postoperative lumbar CT scans were performed on day 3 to evaluate screw placement satisfaction, cortical penetration rate, and facet joint violation using the Neo classification criteria. Clinical outcomes, including visual analogue scale (VAS) for low back pain and Oswestry disability index (ODI), were assessed preoperatively, at 3 days, 3 months, 6 months and final follow-up.

A total of 208 patients were enrolled, including 77 males and 131 females with a mean age of (60.4±10.7) years; there were 65 cases in the robot-assisted group and 143 cases in the freehand group. All the patients were followed up for (15.7±3.1) months (12-24 months). The intraoperative time in the robot-assisted group was significantly shorter than that in the freehand group[(134.6±17.2) vs (148.0±20.7) min, P<0.001]. The screw placement satisfaction rate [96.9% (252/260) vs 87.1% (498/572)] and cortical penetration rate [8.1% (21/260) vs 28.7% (164/572)] were both superior in the robot-assisted group than those in the freehand group (both P<0.05). The proximal facet joint violation rate was lower in the robot-assisted group [7.7% (10/130) vs 22.4% (64/286), P<0.01]. The robot-assisted group and the freehand group both showed significant improvements in VAS and ODI scores from preoperative values [VAS: (5.22±0.74) vs (5.12±0.84)points; ODI: (36.32±3.82) vs (37.00±3.04) points] to all postoperative time points [3 months: VAS (2.20±0.78) vs (2.12±0.82) points; ODI (25.12±3.04) vs (25.70±3.44) points; 6 months: VAS (0.82±0.40) vs (0.70±0.62) points; ODI (14.31±3.20) vs (14.60±3.84) points; final follow-up: VAS (0.78±0.42) vs (0.68±0.30) points; ODI (13.20±3.20) vs (13.40±3.24) points, all P<0.05]. No significant intergroup differences were observed in VAS or ODI at any time point (all P>0.05). No major complications (e.g., neurovascular injury) occurred in either group.

The orthopedic surgical robot can significantly improve the accuracy of screw placement, reduce the inferior facet joint invasion rate and operation time in lumbar spondylolysis surgery, and has good application value for patients with lumbar spondylolysis with spondylolisthesis.

To compare the performance of four different cardiovascular risk models in predicting cardiovascular diseases (CVD) risk among Chinese patients with rheumatoid arthritis (RA).

This retrospective cohort study included RA patients treated at Sun Yat-sen Memorial Hospital between January 2001 and July 2024. Clinical data were collected, and the main outcome was the events of CVD. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive performance of four CVD risk models in predicting CVD risk among Chinese patients with RA, including Framingham Risk Score (FRS), the Systematic Coronary Risk Evaluation 2 (SCORE2), the Prediction for Arteriosclerotic Cardiovascular Disease Risk in China (China-PAR) and the Expanded cardiovascular Risk Score for RA (ERS-RA).

A total of 1 334 RA patients were included in this study, 1 099 females (82.4%), with a mean age of (52.0±12.6) years. During a median follow-up of 6.16 (2.81, 9.07) years, 143(10.7%) patients developed CVD (incidence rate: 16.6 per 1 000 person-years). The ROC analysis revealed good discrimination across four models, with area under the curve (AUC) values ranging from 0.756 to 0.806. Among them, the China-PAR model showed the highest AUC (0.806, 95%CI: 0.760-0.852), which was significantly higher than SCORE2 (0.756, 95%CI: 0.704-0.808) and ERS-RA (0.763, 95%CI: 0.711-0.814), but was comparable to the FRS model (0.790, 95%CI: 0.743-0.838). The calibration curves revealed significant deviations between predicted risk and actual risk for all the four models (goodness-of-fit test, all P<0.05), all the standardized incidence ratios (SIR) were less than 1, indicating that all models underestimated the 10-year CVD risk in the RA patients. Based on the low-risk thresholds of the four models, 30.1% (China-PAR, 43/143) to 44.8% (ERS-RA, 64/143) of Chinese RA patients who experienced CVD events were misclassified as low-risk.

The China-PAR model may be currently more suitable for CVD risk assessment in Chinese RA patients with caution of underestimation.

To evaluate the efficacy and safety of orlistat, glucagon-like peptide-1 receptor agonists (GLP-1RA), and the combination of phentermine and topiramate in the treatment of childhood obesity.

Relevant literature on anti-obesity drug treatments for children was searched in databases including China National Knowledge Infrastructure, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, Embase, Web of Science, and Cochrane Library, with the search time frame spanning from the inception of each database to April 24, 2025. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. The quality of the included literature was evaluated using the Cochrane bias risk assessment tool, meta-analysis was conducted using Revman 5.3 software. Heterogeneity was assessed. The outcome indicators were the weight loss (body weight and body mass index) and improvement of metabolic indicators (low-density lipoprotein cholesterol and blood glucose) by anti-obesity medications, as well as related adverse events.

According to the inclusion and exclusion criteria, a total of 21 articles were included, involving 21 randomized controlled trials with a total of 2 186 patients. Orlistat treatment demonstrated lower body weight and body mass index compared to the control group after 6 months [SMD:-0.29 (-0.55--0.04) and -0.34 (-0.60--0.09), I²∶0 and 4%, both P<0.05]. After three months of treatment with orlistat, both low-density lipoprotein cholesterol and fasting blood glucose levels were lower than those in the control group (both P<0.05). Orlistat can increase the risk of oily bowel movements (RR=6.35, 95%CI: 4.02-10.05), fecal incontinence (RR=12.39, 95%CI: 2.29-66.89), abdominal bloating (RR=2.55, 95%CI: 1.42-4.58), and abdominal pain (RR=1.98, 95%CI: 1.25-3.13). GLP-1RA(liraglutide or semaglutide) showed lower body weight and body mass index compared to controls after 12 months of treatment [SMD:-0.41(-0.61--0.22) and -0.39(-0.62--0.16), both I² were 0, both P<0.05]. After 6 and 12 months of treatment with GLP-1RA, fasting blood glucose levels were lower than those in the control group (both P<0.05). GLP-1RA can increase the risk of constipation (RR=3.98, 95%CI: 1.05-15.09), nausea (RR=2.62, 95%CI: 1.92-3.58), vomiting (RR=4.19, 95%CI: 2.73-6.42), and abdominal pain (RR=1.65, 95%CI: 1.04-2.62). After 12 weeks of treatment, both phentermine monotherapy (mean difference=-1.4 kg) and phentermine combined with topiramate (mean difference=-3.9%) resulted in lower weight compared to the placebo group (both P<0.05), with a low incidence of serious adverse events.

Orlistat, GLP-1RA (liraglutide and semaglutide), fenfluramine combined with topiramate demonstrate favorable efficacy and safety profiles in the treatment of childhood obesity.

A retrospective analysis was conducted on the clinical characteristics and imaging manifestations of 6 patients diagnosed with Trousseau′s syndrome accompanied by central nervous system (CNS) thrombotic events at Beijing Tongren Hospital between December 2015 and December 2022. Additionally, a literature review was performed summarizing 86 cases of Trousseau syndrome retrieved from PubMed and CNKI from January 1, 2020 to January 1, 2025. Among the 6 included patients, 2 were male and 4 were female, with a median age [M (Q₁, Q₃)] of 69 (58, 76) years. Four patients presented with cerebral infarction, while 2 exhibited cerebral venous thrombosis. Primary tumors included endometrial adenocarcinoma, ovarian cancer, lung cancer, and pancreatic cancer. All 4 patients with cerebral infarction showed significantly elevated D-dimer levels, decreased platelet counts, imaging findings consistent with the "three territory sign" and had poor prognosis after treatment. The 2 patients with cerebral venous thrombosis showed no obvious focal neurological signs and remained stable following treatment. All 4 cerebral infarction patients experienced systemic bleeding events. Those with systemic bleeding demonstrated abnormalities in coagulation parameters: platelet count decreased to [79 (29, 133)]×10⁹/L, prothrombin time (PT) prolonged to 16.8 (10.0, 51.6) s, activated partial thromboplastin time (APTT) prolonged to 53.8 (32.8, 78.3) s, fibrinogen decreased to 1.21 (0.47, 2.52) g/L, fibrin degradation products (FDP) increased to 128.2 (36.1, 316.4) mg/L, and D-dimer levels elevated. In the 2 patients without systemic hemorrhage, the average values of the above parameters were 123.5×10⁹/L, 14.4 s, 32.8 s, 2.14 g/L, 24.9 mg/L, and 9.21 mg/L, respectively. The literature review indicated that among the 86 Trousseau′s syndrome patients, 80 presented with CNS thrombotic events. Of these, 78 had cerebral infarction and/or hemorrhage, 1 had cerebral infarction combined with venous sinus thrombosis, and 1 presented with superior sagittal sinus thrombosis. The three most common tumor types were lung cancer (n=24, 30%), uterine/ovarian cancer (n=16, 20%), and pancreatic cancer (n=10, 12.5%). Trousseau′s syndrome can cause CNS thrombotic events, with intracranial venous system thrombosis being relatively rare. For cancer patients presenting with peripheral deep vein thrombosis, screening for intracranial venous thrombosis should be considered. Early anticoagulation may improve prognosis, but the risk of bleeding must be carefully weighed. Anticoagulant therapy should balance the benefits against the systemic bleeding risk, with particular vigilance for coagulation abnormalities.

The clinical data of patients with acute myeloid leukemia (AML) treated at Hebei Yanda Lu Daopei Hospital between August 1, 2024, and March 1, 2025 were retrospectively included, to differentiate AML with the same recurrent t(11;12)(p15;q13) karyotype but harboring distinct rare fusion genes, namely NUP98::RARG::LINE-L2a and NUP98::HOXC13. Two patients were included: Patient 1, a 12-year-old male, visited Hebei Yanda Lu Daopei Hospital on August 8, 2024, due to "fever for 4 days accompanied by sore throat"; Patient 2, a 33-year-old female, visited the hospital on September 22, 2024, due to "recurrent fatigue and cough for over one month". Case 1 and Case 2 carried the NUP98::RARG::LINE-L2a and NUP98::HOXC13 fusion genes, respectively. The patient with NUP98::RARG::LINE-L2a fusion genes exhibited bone marrow morphology and immunophenotypic features resembling acute promyelocytic leukemia (APL) but was resistant to all-trans retinoic acid. Although initial treatment achieved remission, early relapse occurred. The patient with NUP98::HOXC13 fusion genes showed increased myeloblasts, the presence of Auer rods, and an elevated proportion of promyelocytes, along with mutations in FLT3-TKD gene, RUNX1 gene and, WT1 gene, demonstrating resistance to multiple chemotherapy regimens. Both patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) without achieving complete remission. After transplantation, they were followed for 8 and 9 months, respectively, with quantitative monitoring of fusion genes showing negative results. Although the patients with NUP98::RARG::LINE-L2a and NUP98::HOXC13 fusion genes have completely identical chromosomal abnormalities, but they are different rare molecular subtypes. Both involve the NUP98 gene. The former partner gene is RARG, with clinical manifestations, bone marrow morphology, and immunophenotype similar to APL. The latter partner gene is HOXC13, with the characteristics of NUP98-AML patients.

This paper reports the diagnosis and treatment of a patient with hereditary aceruloplasminemia (ACP). The 51-year-old male went to the Department of Rare Diseases Medicine of Peking Union Medical College Hospital on October 27, 2024 due to "dysarthria for 7 years and unstable gait for 2 years". Laboratory tests showed blood ceruloplasmin (CP)<0.02 g/L, ferritin 1 516 μ g/L, imaging examination showed multiple organ iron deposition, single human whole exon sequencing (WES) showed homozygous mutation of CP gene, diagnosis of ACP, oral administration of deferoxone tablets, deferoxamine and frozen plasma transfusion, reexamination on Nov. 8, 2024, blood CP increased to 0.06 g/L.

A 63-year-old male was seen in Guangxi Zhuang Autonomous Region Workers' Hospital on March 12, 2025 due to "cough after aspiration and dyspnea for 5 h". The patient underwent esophageal barium meal angiography due to choking and cough after eating after comprehensive treatment of esophageal cancer. During the process, he experienced choking and cough, and then felt dyspnea and frequent cough. Chest X-ray examination showed high-density shadows of the two lungs, so barium sulfate aspiration was considered. After admission, large-volume lung lavage was given, and the barium residue was reduced after reexamination of chest X-ray. The patient was discharged in stable condition. Follow-up until September 2025, the patient was not hospitalized and continued lavage treatment, and there was frequent cough discomfort. There was no significant change in the reexamination of chest X-ray compared with the time of discharge.

The child, 10 months old and 23 days old, was seen at the Capital Children's Medical Center affiliated to Capital Medical University in August 2020 because of "loose stools for 10 months and perineal purulent exudation for 8 months". The child has loose defecation, blood in the stool, perianal abscess and anal fistula, accompanied by malnutrition; Colonoscopy showed neoplasms and ulcers; Biopsy pathology showed diffuse chronic inflammatory cell infiltration, accompanied by cryptitis and crypt abscess. Other causes were excluded, and the diagnosis was very early-onset inflammatory bowel disease (VEO-IBD). Gene detection revealed a complex heterozygous mutation of interleukin 10 receptor A (IL-10RA) gene. He was given enteral nutrition, anti-infection and thalidomide treatment with protective enterostomy, and performed hematopoietic stem cell transplantation (HSCT) in the Department of Hematology of our hospital on September 7, 2021; Guan fistula surgery was performed on August 2, 2022. After discharge, the patient was followed up until June 30, 2025 (a total follow-up of 34 months). The clinical symptoms of the child were relieved after transplantation, the intestinal ulcer healed, and there were no transplant-related complications.

Pulmonary fibrosis is a progressive and fatal interstitial lung disease, and the global incidence is on the rise. Although the existing therapeutic drugs pirfenidone and nintedanib can delay the progression of the disease, they have limited efficacy and cannot reverse fibrosis and off-target effects. In recent years, the delivery technology of targeted pulmonary fibrosis treatment has shown a trend of diversification and precision. Although small molecule drugs are easy to penetrate biofilms, they have off-target effects and gastrointestinal adverse reactions, and nanocarrier encapsulation can partially solve these problems; Oligonucleotides, small interfering RNAs and microRNAs have accuracy in gene regulation, but they face the challenges of low endosomal escape efficiency and poor stability, and need to rely on chemical modification or composite carriers to enhance delivery efficiency; Although mRNA therapy can encode therapeutic proteins, its immunogenicity and large-scale production process are still the main obstacles to clinical translation. The short peptide delivery system has the advantage of low immunogenicity, but is less stable in vivo and easily degraded by proteases. Although each delivery route has both advantages and disadvantages, targeted delivery technology is gradually breaking through the limitations of traditional therapies, and continuous innovation in accuracy, safety and clinical translation efficiency is needed in the future. Therefore, this article aims to summarize the research progress made in drug delivery technology targeted for pulmonary fibrosis treatment in recent years, and to look forward to the opportunities and challenges in this field in the future.

Sudden cardiac arrest is a major public health problem with sudden onset and high fatality and disability rate. As a key drug in the treatment of cardiac arrest, epinephrine usually needs to be administered repeatedly. Although the dosing interval of 3 to 5 min has been widely used in clinical practice for many years, there is a lack of sufficient evidence-based evidence. The purpose of this review is to summarize the pharmacological basis and evidence-based progress of adrenaline dosing interval in the treatment of sudden cardiac arrest, and the importance of exploring the ideal adrenaline dosing interval under the current background, analyze the relevant progress in this field, and look forward to future research directions, so as to provide reference for clinical practice and scientific research.

A 61-year-old male was seen in Liaocheng People's Hospital of Shandong Province on February 13, 2025 due to "dull abdominal pain for 2 months". The patient had a 20-year history of hepatitis B and underwent partial hepatectomy for hepatocellular carcinoma 10 years ago (23 Jan 2015). In order to regulate liver function after operation, Chinese medicine containing gardenia was taken for 9 years. Abdominal physical examination and laboratory examination showed no abnormalities. The abdominal plain CT scan (Figures 1 and 2, shown by arrows) and the enhanced portal vein phase maximum density projection images (Figures 3 and 4, shown by arrows) showed thickening and edema of the ascending and transverse colon walls, and linear calcification of the mesenteric vein. Colonoscopy revealed that the mucosa of the right colon was congested with a dark purple appearance. Combined with medical history, imaging and endoscopic findings, the diagnosis of idiopathic mesenteric venous sclerosis was confirmed. Because the patient's symptoms are mild, symptomatic treatment is given, and it is recommended to stop the use of traditional Chinese medicine immediately. After 5 months of follow-up (25 Jul 2025), the patient's abdominal symptoms were significantly relieved, and there was no abdominal pain, diarrhea or other gastrointestinal discomfort, and no progression of the lesions was found in the re-imaging examination.

A 61-year-old woman developed joint deformation 20 years ago and intermittent proximal limb muscle pain with squat difficulty for the past 10 years. For the past 5 to 6 years, I have regularly taken prednisone acetate 10 mg once a day. The main symptoms include dry mouth, scrubbing sensation in the eyes and chest tightness. Physical examination showed multiple joint deformations of both hands and feet, and negative tenderness. X-ray examination showed poor alignment and flexion deformity of the distal interphalangeal joints of both hands, and patchy high-density shadows could be seen around some joints, accompanied by local joint space stenosis (Figures 1 and 2). Laboratory tests showed anti-nuclear antibody (ANA) 1:160 (cytoplasmic granular type), anti-SCL70 antibody 45.03 RU/ml, anti-Jo-1 antibody>800 RU/ml, anti-SSA antibody 71.72 RU/ml, anti-U1RNP antibody, anti-dsDNA antibody, anti-SM antibody, rheumatoid factor (RF) and anti-CCP antibody were all negative, anti-mutant citrulline vimentin antibody 27.68 U/ml, serum protein electrophoresis: gamma globulin 22.2%. Chest CT showed interstitial changes in lower lobes of both lungs. Diagnosis: Scleroderma with pulmonary interstitial fibrosis, calcium deposits in the fingers. Prednisone 10 mg once daily +5 mg once nightly, cyclophosphamide 50 mg once every other day and nintedanib 150 mg once daily were given. Patients with scleroderma can develop erosive arthritis, often accompanied by calcium deposits. Unlike diffuse calcium deposits in patients with myositis, calcium deposits in patients with scleroderma tend to be confined to periarticular or trauma sites.