ObjectiveTo compare the therapeutic effects of carvedilol alone and carvedilol combined with endoscopic variceal ligation （EVL） in the prevention of re-bleeding from gastroesophageal varices， and to provide strategies for clinical treatment. MethodsWe retrospectively included 178 patients who had received carvedilol alone or carvedilol plus EVL to prevent gastroesophageal variceal re-hemorrhage from October 2010 to June 2023. They were divided into carvedilol alone group （47 cases） and carvedilol+EVL group （131 cases）. Between-group comparisons were conducted using the paired t test for normally distributed continuous data， the Mann-Whitney U test for non-normally distributed continuous data， and the chi-square test for categorical data. A Cox proportional hazards model was employed for univariable and multi-variable analyses. The cumulative incidence rates of re-bleeding and mortality were estimated using the Kaplan-Meier method. The baseline characteristics of the two groups were matched through propensity score matching （PSM） to reduce selection bias and enhance the credibility of causal inference. ResultsThe re-bleeding rate of the carvedilol+EVL group was significantly lower than that of the carvedilol alone group （10-year cumulative incidence： 29.8% vs 36.2%， hazard ratio ［HR］=0.505， 95% confidence interval ［CI］： 0.292‍ ‍—‍ ‍0.847， P=0.015）. There was no significant difference in liver-related mortality （10-year cumulative incidence： 21.3% vs 21.4%， HR=0.799， 95%CI： 0.406‍ ‍—‍ ‍1.578， P=0.518）. The results were stable with PSM analysis. The Cox regression analysis revealed that creatinine was an independent risk factor affecting re-bleeding （HR=1.004， 95%CI： 1.001‍ ‍—‍ ‍1.008， P=0.011） and liver-related mortality （HR=1.004， 95%CI： 1.001‍ ‍—‍ ‍1.007， P=0.019）. ConclusionCarvedilol combined with EVL is better than carvedilol alone in the prevention of gastroesophageal variceal re-bleeding.

Objective To compare the safety and efficacy of balloon-occluded retrograde transvenous obliteration(BRTO),endoscopic ultrasound(EUS)-guided coil embolization combined with endoscopic injection of cyanoacrylate,and titanium clip-assisted endoscopic cyanoacrylate injection(CLIP-ECI)in the treatment of gastric varices based on a network meta-analysis.Methods A computerized retrieval of randomized controlled trials(RCT)and retrospective studies concerning the"balloon-occluded retrograde transvenous obliteration""EUS-guided coil embolization combined with endoscopic injection of cyanoacrylate"and"titanium clip-assisted endoscopic cyanoacrylate injection"from the databases of PubMed,Web of Science,Cochrane Library,Embase,CNKI,Wanfang Medical Network,and CBM was conducted.The retrieval time period was from the establishment of the database to July 1,2024.Studies were selected based on inclusion and exclusion criteria,and data were processed using a random-effects model with STATA14.0 software for network meta-analysis.Results A total of 22 articles,including 7 RCTs and 15 retrospective studies,were included in this analysis,with a total sample size of 2 122 patients.The network meta-analysis showed that in terms of rebleeding prevention,the BRTO group(SUCRA 93.5)had the lowest rebleeding rate,followed by the EUS group(SUCRA 72.0);in terms of mortality,the CLIP-ECI group(SUCRA 82.1)had the lowest overall mortality,followed by the BRTO group(SUCRA 75.5);in terms of ectopic embolism rate,the BRTO group(SUCRA 68.7)had the smallest likelihood of ectopic embolism,while the ECI group(SUCRA 23.8)had the highest likelihood;in terms of gastric variceal eradication,the BRTO group(SUCRA 95.4)had the highest variceal eradication rate,followed by the EUS group(SUCRA 60.7).Conclusion Compared with endoscopic therapy,BRTOcan reduce the rebleeding rate of gastric varices and increase the eradication rate,with lower rates of ectopic embolization and mortality.Therefore,BRTO is an effective and safe means for the treatment of gastric varices.

Cirrhosis is a severe disease caused by chronic inflammatory damage to the liver due to various factors,often complicated by portal hypertension.The primary causes of portal hypertension include increased intrahepatic vascular resistance and increased portal venous blood flow.Carvedilol,a third-generation non-selective beta-blocker(NSBB)with alpha-1 receptor-blocking role,is superior to traditional NSBBs in reducing portal pressure.It is believed that carvedilol significantly reduces hepatic venous pressure gradient(HVPG)through multiple mechanisms,prevents variceal bleeding,and extends patient survival.This paper reviews the mechanisms and clinical applications of carvedilol in the treatment of portal hypertension,focusing on its efficacy in the primary and secondary prevention of varices and its impact on the survival of cirrhotic patients with refractory ascites.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Asia-Pacific Association for the Study of the Liver published the guidelines on management of ascites in liver disease in May 2023， which introduces the diagnosis， differential diagnosis， and treatment of ascites， hyponatremia， hepatic hydrothorax， and hepatorenal syndrome in patients with liver cirrhosis and acute-on-chronic liver failure. This article summarizes the main recommendations in the guidelines， so as to provide a reference for the treatment of ascites in patients with liver diseases in China.

ObjectiveTo investigate the efficacy of percutaneous transhepatic variceal embolization （PTVE） alone or in combination with partial splenic embolization （PSE） in the treatment of portal hypertensive hemorrhage in liver cirrhosis through a meta-analysis. MethodsThis study was conducted according to PRISMA guideline， with a PROSPERO registration number of CRD42023396690. Wanfang Med Online， CNKI， CBM， VIP Databases， PubMed， Embase， the Cochrane Library， and Web of Science databases were searched for articles on PTVE alone or in combination with PSE in the treatment of portal hypertensive hemorrhage in liver cirrhosis published up to December 23， 2022. The articles were selected based on inclusion and exclusion criteria， and related data were extracted. The RevMan 5.4.1 statistical analysis software was used to perform the meta-analysis. ResultsEight articles were finally included， with a total sample size of 592 cases， among which there were 316 cases in the PTVE+PSE group and 276 cases in the PTVE group. The meta-analysis showed that compared with the PTVE group， the PTVE+PSE group had significantly lower postoperative portal vein pressure （standardized mean difference ［SMD］=-1.75， 95% confidence interval ［CI］： -2.33 to -1.16， P<0.05）， postoperative diameter of the portal vein （SMD=-0.87， 95%CI： -1.64 to -0.10， P<0.05）， postoperative rebleeding rate （odds ratio ［OR］=0.17， 95%CI： 0.11 — 0.28， P<0.05）， mortality rate （OR=0.13， 95%CI： 0.04 — 0.37， P<0.05）， and incidence rate of postoperative portal hypertensive gastrointestinal disease （OR=0.17， 95%CI： 0.07 — 0.45， P<0.05］， as well as a significantly higher postoperative platelet level （SMD=0.79， 95%CI： 0.52 — 1.06， P<0.05）， while there were no significant differences between the two groups in the incidence rates of postoperative ascites. ConclusionCompared with PTVE alone， PTVE combined with PSE can effectively reduce the rebleeding rate and mortality rate of portal hypertensive hemorrhage in liver cirrhosis， the incidence rate of portal hypertensive gastrointestinal disease， and portal vein pressure， and it can also shorten the diameter of the portal vein and increase platelet level. Therefore， it is an effective interventional method for the treatment of portal hypertension hemorrhage in liver cirrhosis.

Objective To explore the effect of mindfulness training on mental health of elite athletes and its possible mechanism.Methods Totally 462 Chinese elite athletes(Mage=18.16,SD=3.14,Range=12～28,44.8%female)were conducted a cross-sectional questionnaire survey.SPSS23 was employed for data statistical analysis,and the mediation model was tested through the Bootstrap program of the extension program PROCESS.Results Mindfulness significantly and negatively predicted anxiety(β=-0.386,P<0.001),depression(β=-0.342,P<0.001),and poor sleep quality(β=-0.324,P<0.001),but significantly and positively predicted training&competition satisfaction(β=0.432,P<0.001)and psychological well-being(β=0.399,P<0.001).Moreover,mindfulness showed significant effects on anxi-ety,poor sleep quality,and satisfaction to training and competition through experiential acceptance,cognitive defusion,and decentering.However,it performed significant impacts on their depression and psychological well-being only through experiential acceptance and cognitive defusion.Conclusion Mind-fulness directly predicts negative reactions such as anxiety,depression and poor sleep quality,as well as positive ones including training and competition satisfaction and psychological well-being in elite ath-letes.Moreover,it has indirect effects on anxiety,poor sleep and training and competition satisfaction through experiential acceptance,cognitive defusion and decentering,together with on depression and psychological well-being through the former two factors.

Objective To investigate the potential causal relationships between coronavirus disease-2019(COVID-19)susceptibility,hospitalization and severe case with late-onset myasthenia gravis(LOMG)based on Mendelian randomization(MR).Methods The public data from non-overlapping genome-wide association studies were screened,COVID-19 susceptibility,hospitalization and severe case served as the exposure data,and LOMG as the outcome data.The inverse-variance weighted(IVW)method was mainly adopted to evalu-ate the causal effect,which was supplemented by the methods such as MR-Egger method,weighted median method,weighted model and simple model.The sensitivity analysis was performed.Results The genetically predicted severe case of COVID-19 had the positively causal relationship with LOMG(OR=1.01,95％CI:1.00-1.03,P=0.046).The sensitivity analysis results revealed the study results were steady(P＞0.05).No heterogeneity or horizontal pleiotropy was found.Conclusion Severe case of COVID-19 may be associated with an increased risk of LOMG.

Objective To explore the causal relationship between ischemic stroke and different types of epilepsy so as to provide genetic evidence for the risk of epilepsy after ischemic stroke.Methods Based on the summary data of genome-wide association study,Mendelian randomization (MR ) analysis was performed with MR-Egger regression,weighted median and inverse-variance weighting.Sensitivity analysis was conducted by using MR-Egger regression test,MR-PRESSO test and leave-one-out method.Results Two-sample MR analysis showed that there was a causal relationship between ischemic stroke and the risk of epilepsy (OR=1.10,P=0.036)and generalized epilepsy (OR=1.25,P=0.001 ),but no such relationship was observed with the risk of focal epilepsy (OR=1.06,P=0.360).In addition,diastolic blood pressure (OR=1.12,P=0.002)and BMI (OR=1.08,P=0.015)also had a causal relationship with the risk of epilepsy. After adjusting confounding factors,multivariate MR analysis revealed that only ischemic stroke (OR=1.18,P=3.770×10-6)and epilepsy risk had a causal relationship.Conclusion There is a causal relationship between ischemic stroke and the risk of generalized epilepsy,which can be used to stratify the risk of post-stroke epilepsy.

Objective To evaluate the value of intrathecal synthetic related markers in patients with mild cognitive impairment(MCI),Alzheimer's disease(AD),and other types of dementia.Methods Retrospec-tively collect the clinical data of 577 patients diagnosed with MCI(MCI group,178 cases),AD(AD group,131 cases),and other types of dementia(other types group,268 cases)from June 2019 to July 2023 in Beijing Tiantan Hospital,Capital Medical University.Oligoclonal zone electrophoresis(OCB)and 24 h intrathecal pro-tein synthesis rate(ISR)of each group were investigated,and the difference of different indexes among the groups was compared to evaluate the value of related indexes in the differential diagnosis of different diseases.Results Compared with AD group and other groups,AD group had a higher proportion of females,more patients were＞50-70 years old,and the incidence of abnormal lipid metabolism was higher,with statistical significance(P＜0.05).There were significant differences in OB(S),cerebrospinal fluid albumin,serum albumin and cerebrospinal flu-id IgG in different disease groups(P＜0.05).IgG index and ISR in patients with positive SOB(CSF)were higher than those in negative and weakly positive patients,and the differences were statistically significant(P＜0.001).IgG index was positively correlated with ISR(r=0.878,P＜0.001).Conclusion Intrathecal synthetic mark-ers such as IgG index,SOB(CSF)and 24 h ISR have synergistic effects in the diagnosis of cognitive dysfunction and various dementias,which can be collectively utilized in the diagnosis of diseases.