Objective:To preliminarily evaluate the safety and efficacy of shunt-related interventional therapy accompanied with spontaneous portosystemic shunts (SPSS) in patients with hepatic encephalopathy (HE).Methods:Case data on six patients who underwent interventional therapy accompanied by SPSS for HE from January 2017 to March 2021 were collected to evaluate the efficacy and postoperative complications.Results:All six patients underwent SPSS. Four patients had hepatitis B cirrhosis; one had alcoholic cirrhosis; and one had hepatic arterioportal fistula-induced portal hypertension. Child-Pugh liver function scores were C and B in three and three cases, respectively. The SPSS type was gastrorenal shunt in two cases; portal-thoracic-azygos venous in two cases; portal-umbilical-iliac venous in one case; and portal-splenic venous - inferior vena cava in one case. Two of them had previously had a transjugular intrahepatic portosystemic shunt (TIPS), and there were SPSS prior to TIPS. Five cases (5/6) successfully underwent shunt embolization, and one case (1/6) underwent stent implantation for flow restriction (portal-umbilical-iliac vein). The technical success rate was 100%. HE did not recur during hospitalization or the three-month follow-up period. However, one case had a recurrence of HE within a year after surgery and was treated symptomatically, while another experienced gastrointestinal bleeding a year after surgery..Conclusion:SPSS embolization or flow restriction is effective and safe for improving HE patients' symptoms.

Objective To explore the current status,hotspots and trends of research on the TCM regulation of cellular autophagy;To provide reference for related research.Methods The literature related to the TCM regulation of cellular autophagy was retrieved from CNKI,Wanfang Data,VIP and CBM from the establishment of the databases to December 31,2022.Authors and institutional collaboration networks were drawn using CiteSpace 5.7.R5.keywords emergence analysis and timeline view were drawn.VOSviewer 1.6.18 software was used to draw keyword co-occurrence mapping.Results A total of 2 001 articles were included,with a general upward trend in the number of publications.The cooperation teams were mainly represented by Jia Lianqun,Yang Guanlin,Song Nan and others.Research institutions with more publications included Hunan University of Chinese Medicine,Liaoning University of Chinese Medicine,and Guangzhou University of Chinese Medicine.The keywords of the literature formed 9 meaningful clusters,showing that the research hotspots in this field mainly focused on apoptosis,mitochondrial autophagy,experimental studies,signaling pathways,and herbal monomers,etc.TCM interventions that attracted much attention included electroacupuncture,moxibustion,resveratrol,curcumin,etc,mainly involving PI3K/Akt,AMPK/mTOR and other signaling pathways.Conclusion The research on cellular autophagy in the field of TCM has been highly popular in recent years.Experimental studies,molecular mechanisms,related diseases,and TCM intervention are the research hotspots in this field.The research trend is dominated by TCM monomer,TCM theory research and other directions,mainly focusing on apoptosis,oxidative stress and other pathways to carry out extensive research.

Objective:To retrospectively analyze the gender differences in the clinical characteristics and perioperative outcomes of patients with type A aortic dissection in our institution.Methods:From January 2019 to January 2020, total 405 patients underwent surgical treatment for type A aortic dissection at Beijing Anzhen Hospital, including extensive aortic repair (total aortic arch replacement combined with stenting elephant trunk implantation) and limited aortic repair. In the entire cohort, male 295 cases, female 110 cases. All measures in this study were expressed as ± s or median(quartiles) and analyzed by Student t test for variables or non- parametric tests; count data were expressed as frequencies and percentages and analyzed by χ2 test and Fisher exact probability test. Independent risk factors were analyzed by logistic multivariate regression. Results:Females were older than males[(53.3 ± 12.4)years old vs. (47.1 ± 11.0)years old, P<0.001] and had significantly higher proportion of diabetes(9.1% vs. 4.1%, P=0.047) and previous cerebrovascular disease (11.8% vs. 5.8%, P=0.038). Females had a lower proportion of total aortic arch replacement combined with elephant trunk implantation (64.5% vs. 82.7%, P<0.001), while aortic cross-clamp time[168.0(144.8, 201.5) minutes vs. 190.0 (163.0, 217.0) minutes, P<0.001] and CPB time[99.0 (79.8, 118.0) min vs. 107.0 (91.0, 126.0) min, P=0.006] were significantly shorter than males. Females had significantly higher rates of pulmonary infection (14.5% vs. 5.8%, P=0.004) and stroke than males (15.5% vs. 8.1%, P=0.030). The difference in the proportion of postoperative deaths between female and male TAAD patients was not statistically significant (3.6% vs. 7.8%). Logistics multivariable regression analysis found that female was an independent risk factor for postoperative stroke ( OR=2.574, 95% CI: 1.198-5.531, P=0.015) and pulmonary infection ( OR=2.610, 95% CI: 1.180-5.772, P=0.018). Conclusion:Gender did not affect mortality after TAAD repair significantly, but females increased the risk of stroke and pulmonary infection after TAAD surgery.

Objective:To investigate the differences in outcomes of surgical strategies and prognosis of patients with acute type A aortic dissection(ATAAD) during the period of COVID-19 Omicron variant epidemic compared with the non-epidemic period.Methods:Clinical data were retrospectively collected from ATAAD patients during the COVID-19 Omicron variant epidemic(December 7, 2022 to January 10, 2023) and during the non-epidemic period(December 7, 2019 to January 10, 2020) to compare the differences in surgical strategies, perioperative mortality, and perioperative complication rates in ATAAD patients during the two different periods.Results:There were 14 patients in the COVID-19 infected group and 43 patients in the control group. Patients in the infected group had a shorter mean aortic clamp time[(89.71±16.27)min vs.(110.09±28.99)min, P<0.01], a significantly higher postoperative mortality rate relative to the control group(21.43% vs. 2.33%, P=0.02), a significantly longer length of stay in the ICU(3 days vs. 2 days, P=0.04) and the duration of intubation time(34 h vs. 14 h, P<0.01), and the incidence of adverse events, mainly cerebral infarction, was higher in infected group(28.57% vs. 6.98%, P=0.03). Conclusion:During the COVID-19 Omicron variant strain epidemic, our center preferred a more conservative surgical strategy in COVID-19 infected patients. Although the COVID-19 infection increased the postoperative mortality and complication rate of ATAAD, patients still achieve a more satisfactory outcome. Therefore, surgical treatment should be timely performed for ATAAD patients.