Cirrhotic portal hypertension is a clinical syndrome caused by persistently elevated portal venous pressure due to liver cirrhosis and can lead to a series of complications， among which esophagogastric variceal bleeding has become one of the most severe complications due to sudden onset and a high mortality rate. Since the release of Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension （2019 edition）， significant advances have been achieved in this field in China and globally. In order to formulate an expert consensus aligned with the situation of China， Chinese Society of Surgery， Chinese Medical Association organized and compiled Expert Consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension （2025 edition）. This article elaborates on the key updates in the new edition and explores the major differences between the old and new editions， in order to enhance the understanding of the new edition among clinicians and provide a reference for clinicians in clinical work.

Objective:To propose a novel radiotherapy marking method-the"#"-character method,which aimed at improving the accuracy and repeatability of positioning during radiotherapy.Methods:A specially"cross-shaped"stamp was designed by this study,which consisted of a handheld square base with a"cross-shaped"protrusion.Using this stamp,the extreme positions of end-expiration and end-inspiration were marked respectively at the laser-guided regions on the directly above and bilateral sides of the patient's body,and each position was printed a"+"character.Finally,a"#-shaped"signal was formed,which represented the full range of respiratory motion of patients.The study included two parts:surface displacement caused by respiration was simulated through a three-dimensional(3D)motion platform,which was used to conduct a phantom experiment for anthropomorphic dummy,A randomized controlled study involving 40 patients,who were treated between January and June 2024 at the Department of Radiotherapy,Cancer Hospital,Chinese Academy of Medical Sciences,were conducted.The cohort included 20 patients with breast tumor(Positioning the outer contour by exposing the chest)and 20 patients with thoracic tumor(fixed position of using thermoplastic film).These patients were divided into two groups for comparison,which received respectively the"#-shaped"method and the conventional"+-shaped"method.The cone-beam computed tomography(CBCT)images before treatment were used to compare the influences of the two kinds of marking methods on the positioning errors of patients with breast tumor and patients with thoracic tumor.Then,the statistical analysis was used to assess precision and accuracy of positioning.Results:The result of phantom experiment indicated that the positioning error of the"#-shaped"method was significantly better than that of the"+-shaped"method under various parameters of respiratory movement.Under three kinds of different respiratory cycles(3,4,and 5 seconds)and amplitudes(8,12,and 15 mm),the positioning errors of the"#-shaped"method were respectively(0.15±0.04)cm,(0.19±0.05)cm and(0.35±0.14)cm,while the"+-shaped"method were respectively(0.42±0.16)cm,(0.64±0.28)cm and(0.88±0.37)cm,and the differences were statistically significant(t=8.347,3.416,2.901,P<0.05).The results of actual patients indicated the positioning error[(0.97±0.32)cm]of the"#-shaped"method was significantly lower than[(1.62±0.47)cm]of the"+-shaped"method for patients with breast tumor(Positioning the outer contour by exposing the chest),and the difference was significant(t=3.615,P<0.05).On the other hand,the positioning error[(0.69±0.24)cm]of the"#-shaped"method was significantly lower than[(0.97±0.39)cm]of the"+-shaped"method for patients with thoracic tumor(fixed position of using thermoplastic film),and the difference also was significant(t=1.934,P<0.05).Conclusion:Compared to the conventional"+-shaped"method,the"#-shaped"method appears higher accuracy and repeatability during the positioning process of radiotherapy,which especially is suitable to the treatment for breast tumor and thoracic tumor that need accurately control the influences of respiratory motion.

Objective:To explore the application effects of mind map-based health education in improving rehabilitation of patients with traumatic cervical spinal cord injury after surgery.Methods:A retrospective cohort study was conducted to analyze the clinical data of 64 patients with traumatic cervical spinal cord injury admitted to Zhengzhou Orthopedic Hospital from August 2019 to September 2023, including 51 males and 13 females, aged 20-75 years [(52.7±12.5)years]. The injured segments were located at C 3/4 in 8 patients, at C 4/5 in 18, at C 5/6 in 22, and at C 6/7 in 16. The American Spinal Injury Association (ASIA) Scale was grade A in 3 patieats, grade B in 15, grade C in 18, and grade D in 28. All the patients underwent cervical decompression and fusion with internal fixation. Thirty-two patients received conventional nursing health education after surgery (conventional education group), while the other 32 patients received mind map-based nursing health education (mind map education group). Readiness for hospital discharge scale (RHDS) and quality of discharge teaching scale (QDTS) were used to compare the discharge readiness and quality of discharge instruction between the two groups at 4 hours before discharge. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and post-traumatic growth inventory (PTGI) were used to compare the anxiety, depression, and post-traumatic growth levels between the two groups before the health education, at discharge, and at 6 months after discharge. The incidence of complications was also compared between the two groups at 6 months after discharge. Results:All the patients were followed up for 6 months. At 4 hours before discharge, the total scores of RHDS and QDTS were (86.5±7.8)points and (142.9±2.7)points in the mind map education group, which were higher than (75.2±5.3)points and (125.3±2.3)points in the conventional education group ( P<0.01). Before the health education, no statistically significant differences were found in SAS scores, SDS scores, or PTGI total scores between the two groups ( P>0.05). At discharge, the SAS and SDS scores were (41.6±0.9)points and (41.4±1.1)points in the mind map education group, which were lower than (47.2±0.8)points and (47.0±0.7)points in the conventional education group ( P<0.01); the PTGI total score was (72.4±4.3)points, which was higher than (53.8±2.3)points in the conventional education group ( P<0.01). At 6 months after discharge, the SAS and SDS scores were (31.2±0.8)points and (31.0±1.0)points in the mind map education group, which were lower than (44.6±1.1)points and (42.4±0.9)points in the conventional education group ( P<0.01); the PTGI total score was (85.8±1.9)points, which was higher than (68.0±1.6)points in the conventional education group ( P<0.01); the complication rate was 6% (2/32) in the mind map education group, which was lower than 34% (11/32) in the conventional education group ( P<0.05). Conclusion:Compared with conventional nursing health education, mind map-based nursing health education can improve the discharge readiness and quality of discharge instruction for patients with traumatic cervical spinal cord injury after surgery, alleviate negative emotions such as anxiety and depression, improve their psychological status, promote post-traumatic growth, and reduce the incidence of complications.

Cutibacterium avidum(C.avidum)is a Gram-positive bacterium belonging to Corynebacterium cutis,which mainly exists on the surface of human skin and rarely causes invasive infection of superficial or deep skin.At present,there is no unified expert consensus on the diagnosis,treatment and prognosis of C.avidum.This paper reports a patient with epidermoid cyst caused by C.avidum who recovered and was discharged after neurosurgical resection of superficial mass and antimicrobial treatment,aiming to enhance the clinical recognition on C.avidum infection and provide reference for the diagnosis and treatment of the disease.

ObjectiveTo analyze the influencing factors for recurrence in successfully treated pulmonary tuberculosis patients with isoniazid-resistant and rifampicin-sensitive in Shaoxing City, Zhejiang Province. MethodsData on general demographic information, treatment information and drug susceptibility test results for pulmonary tuberculosis patients admitted to the designated tuberculosis medical institutions and registered in the tuberculosis information management system was collected in Shaoxing City from January 2011 to August 2024. A total of 428 patients with isoniazid resistance (including isoniazid single resistance and multiple resistance) but who were successfully treated were included in the study. Information for the recurrence after successful treatment of the patients was analyzed. The Cox proportional hazards models were used to analyze the influencing factors of recurrence in patients. ResultsAmong the 428 successfully treated patients included in the study, 31 cases (accounting for 7.24%) had recurrence by the end of the observation period, with a recurrence rate density of 1.31 per 100 person-years and a median recurrence time of 0.99 (0.08, 8.27) years. Among the relapsed population, 51.61% of the patients relapsed within one year after successful treatment. 77.42% of the patients relapsed within two years after successful treatment. Multivariate Cox regression analysis showed that when isoniazid resistance was discovered, the diagnosis classification of relapse (HR=4.115, 95%CI: 1.734‒9.767) and positive 0-month sequence smear (HR=4.457, 95%CI: 1.053‒18.866) were risk factors for recurrence after successful treatment in patients. ConclusionRegular follow-up should be strengthened for at least two years after the successful treatment of isoniazid-resistant pulmonary tuberculosis patients. Special attention should be paid to the treatment effect and regular re-examination and monitoring after the end of the treatment course of isoniazid-resistant pulmonary tuberculosis patients who have been re-treated and were sputum smear positive at baseline, so as to prevent recurrence and disease progression in high-risk populations.

As the need for antibody production rises, there is an urgent need to lower the costs and enhance the efficiency of the separation process. Currently, the chromatographic media used for antibody separation and purification often focus on individual properties of antibodies, such as affinity, hydrophobicity, and charge, leading to issues like low purification efficiency or inadequate adsorption capacity. To address this, an electrostatically coupled polypeptide affinity medium (FD7-3, 5-diaminobenzoic acid n-sepharose, FD7-DA-Sepharose) was developed for rapid purification of antibodies from cell culture supernatant. This medium utilized 3, 5-diaminobenzoic acid as a spacer to attach the heptapeptide-affinity ligand (FYEILHD, FD7) to agarose microspheres. Antibodies could be adsorbed through charge interactions with the carboxyl functional group of the FD7-DA-Sepharose spacer, while FD7 enhanced electrostatic coupling and affinity adsorption through synergistic effects, significantly increasing the adsorption capacity while maintaining the affinity and specificity. The influences of pH and ionic strength on adsorption capacity were investigated with human immunoglobulin as a model protein. The static adsorption capacity (Q_m) of FD7-DA-Sepharose in the solution of pH 6.0 reached 67.73 mg/mL, representing a 52.68% increase compared with that (44.36 mg/mL) of the commercial Protein A affinity medium. Furthermore, the elution conditions for FD7-DA- Sepharose were mild (20 mmol/L PB, 0.5 mol/L NaCl, pH 6.0), in contrast to the harsh acidic elution (pH 2.7-3.6) typically associated with Protein A, which can damage antibody integrity. The FD7-DA-Sepharose medium was then employed to purify antibodies from cell culture supernatant, achieving the yield of 94.8% and the purity of 98.4%. The secondary structure of the purified antibody was determined by circular dichroism spectroscopy. The results demonstrated that FD7-DA-Sepharose enabled efficient purification of antibodies from cell culture supernatant, which provided a cost-effective solution (approximately one-third the price of commercial Protein A affinity medium) with gentle elution conditions that preserve the natural conformation of antibodies. This approach paves a novel, economical, and efficient way for the separation and purification of antibodies from cell culture supernatant.
Chromatography, Affinity/methods* ; Static Electricity ; Humans ; Sepharose/analogs & derivatives* ; Peptides/chemistry* ; Adsorption ; Antibodies/isolation & purification*

Objective To investigate the predictive ability of cyst fluid characteristics for malignant intraductal papillary mucinous neoplasms (IPMNs). Methods We prospectively collected fresh cyst fluid from patients undergoing pancreatic resection at the Department of Hepatobiliary Pancreatic Spleen Surgery, Changhai Hospital, Shanghai, from September 2023 to December 2024, who were ultimately pathologically confirmed with IPMN. We assessed the characteristics of cyst fluid, including viscosity, clarity, and color, and explored its predictive performance for benign or malignant. Results A total of 40 patients with IPMN were included. The sensitivity of the string sign （+） for diagnosing high-grade dysplasia/ invasive carcinoma （HGD/IC） was 90.9%, specificity was 92.9%, and accuracy was 76.0%. The cyst fluid of intestinal-type IPMN often exhibited a gelatinous consistency, and there was no significant difference in the distribution of gelatinous consistency between the HGD/IC group and the low-grade dysplasia （LGD） group. There were no significant differences in CEA, glucose, and amylase levels in the cyst fluid between the HGD/IC group and the LGD group. Conclusions The characteristics of pancreatic cyst fluid, especially viscosity, can effectively predict the benign or malignant nature of IPMN.

Objective:To compare the accuracy of two-dimensional (2D) ultrasound with three-dimensional (3D) reconstruction and conventional 2D ultrasound in measuring bladder volume in pelvic tumor patients, using computed tomography (CT) as the reference.Methods:A set of bladder phantoms were constructed to compare CT and ultrasound measurements with actual injected volumes. Clinical data of 104 pelvic tumor patients who received radiotherapy at the Cancer Hospital, Chinese Academy of Medical Sciences between August and December 2023 were retrospectively analyzed. Portable transabdominal ultrasound was used to obtain the largest bladder cross-section, and the maximum diameters in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions (D LR, D AP, D SI) were measured. The 2D ultrasound volume was calculated as V=0.523 × D LR × D AP × D SI. Full-bladder transverse videos were recorded and processed in Matlab R2016a through frame extraction(60 images), followed by contrast enhancement, edge detection segmentation, cubic spline interpolation, and image smoothing to achieve 3D reconstruction. Paired t-tests, intraclass correlation coefficients (ICC), and Bland-Altman analyses were performed to assess systematic bias and consistency between ultrasound methods and CT. Multivariate linear regression was applied to evaluate the effects of slice thickness, posture, age, and other factors on CT measurements. Results:In the phantom study, deviations of 2D ultrasound and CT from actual injected volumes were (0.73±3.05) ml ( t=-0.48, P=0.667) and (1.52±11.27) ml ( t=0.17, P=0.875), with ICC values>0.999. In the clinical study, mean bladder volumes measured by 3D-reconstructed ultrasound, conventional 2D ultrasound, and CT were (373.5±153.31), (314.89±135.28), (382.82±157.57) ml, respectively. The 3D-reconstructed method showed excellent agreement with CT (ICC=0.98; Bland-Altman mean bias=-9.32 ml, P=0.096), while 2D ultrasound also showed good consistency (ICC=0.91), but significantly underestimated bladder volume (mean bias=-67.93 ml, P<0.001). Subgroup analysis revealed that 2D ultrasound had the best agreement with CT in the medium-volume group (200-500 ml, ICC=0.902), whereas agreement decreased in the small-volume (<200 ml, ICC=0.884) and large-volume (>500 ml, ICC=0.840) groups (all P<0.001). The 3D-reconstructed ultrasound maintained excellent consistency with CT across all subgroups (all ICC>0.95), and the measured bladder volume was not statistically significant. Multivariate regression showed that slice thickness, posture, age, sex, and surgical status had no significant effects on CT measurements. Conclusions:Ultrasound with 3D reconstruction enables accurate bladder volume monitoring through true 3D contour reconstruction, while conventional 2D ultrasound systematically underestimates bladder volume and requires correction.

Objective To investigate the effect and mechanism of melatonin in alleviating hypoxia-induced apoptosis in ovarian gra-nulosa cells.Methods Rat ovarian granulosa cells were isolated and divided into normoxic,hypoxic,and melatonin groups.Hypoxia-induced injury models were established in the hypoxic and melatonin groups,and granulosa cells in the melatonin group were treated with melatonin.A total of 24 rats were randomized into the control,model,and intervention groups(n=8 per group).Rat models of declining ovarian function induced by long-term hypoxia were established in the model and intervention groups.The rats in the intervention group were intraperitoneally injected with melatonin.Cell proliferation was measured using a CCK-8 assay,and lactate secretion and HIF-1αprotein with a specific kit,respectively.The levels of estradiol and progesterone in the cell supernatant and rat serum were detected using ELISA.Granulosa cell apoptosis was detected by flow cytometry,ovarian morphology by HE staining,and Bax and caspase-3 expression by Western blotting.Results Compared with the normoxic group,the hypoxic group exhibited decreased granulosa cell proliferation,increased apoptosis,elevated lactate and HIF-1α levels,and reduced estradiol and progesterone levels(P＜0.05).Compared with hypoxic group,these changes were significantly reversed in the molatonin group(P＜0.05).Compared with the control group,the model group showed increased lactate,HIF-1α,Bax,and caspase-3 levels,decreased estradiol and progesterone levels,and reduced follicles.Compared with the model group,all the indicators were ameliorated in the intervention group(P＜0.05).Conclusion Melatonin alleviated hypoxia-induced granulosa cell apoptosis and promoted the recovery of ovarian function.

Objective:To understand the current status, research hotspots, and future trends in the field of retinoblastoma (RB).Methods:Using the Web of Science Core Collection SSCI and SCI-Expanded as data sources, relevant RB literature from January 2015 to November 2024 was retrieved. The bibliometric analysis software CiteSpace 6.2.R6 was employed to perform visual analyses of countries/regions, institutions, journals, authors, co-cited references, and keywords.Results:A total of 5 042 relevant publications were identified. Annual publication numbers in this field consistently exceeded 400, peaking at 565 in 2021. The United States contributed the highest number of publications, with 1 600 articles (31.73%). Among institutions, Harvard University ranked first with 167 publications (3.31%). Abramson DH of Memorial Sloan Kettering Cancer Center published the most papers (75). Nature (United Kingdom) received the highest citation count (2 349). The highest betweenness centrality was observed for the United States (0.14) among countries/regions, Shanghai Jiao Tong University (0.21) among institutions, and Berry JL of Children’s Hospital Los Angeles (0.21) at the author level. Co-citation and keyword analyses revealed that RB research hotspots are shifting from a focus on basic molecular mechanisms, such as the cell cycle and RB protein, toward advanced therapeutic strategies, such as intra-arterial chemotherapy and nanoparticle-based drug delivery. Emerging keywords such as complexity, chemoresistance and carboplatin indicate that future studies will focus on optimising diagnosis and treatment. Conclusions:From 2015 to 2024, RB research displayed a sustained growth trend, with the United States and its institutions and scholars contributing the most publications. The research focus has shifted from the exploration of molecular mechanisms to the optimization of precise treatment strategies, among which the application of nanotechnology and the resolution of drug resistance mechanisms will become key breakthrough directions.