Gastric variceal rupture and bleeding and hepatic encephalopathy are common and life-threatening complications in decompensated cirrhosis. As a minimally invasive interventional technique， balloon-occluded retrograde transvenous obliteration （BRTO） has made significant progress in the clinical management of gastric varices and hepatic encephalopathy in recent years. This article systematically reviews the technical principles， indications （e.g.， isolated gastric varices and refractory hepatic encephalopathy）， clinical efficacy （an acute hemostasis rate of 85% — 95%， a 1-year rebleeding rate of <15%， and an improvement rate of 60% — 80% for hepatic encephalopathy）， and safety （including complications such as renal impairment and elevated portal vein pressure） of BRTO. Meanwhile， this article discusses the advantages and disadvantages of BRTO and conventional treatment modalities （e.g.， transjugular intrahepatic portosystemic shunt and endoscopic treatment） and reviews the latest technological improvements in recent years， such as coil-assisted retrograde transvenous obliteration and plug-assisted retrograde transvenous obliteration. Future research should focus on the precision of patient selection （e.g.， stratification based on hemodynamic parameters）， the optimization of embolic materials （e.g.， application of new biodegradable embolic agents）， and the development of individualized treatment regimens， so as to improve efficacy and reduce the risk of complications.

In December 2025， American Gastroenterological Association released the expert review of clinical practice update on the management of ascites， volume overload， and hyponatremia in cirrhosis. The expert review proposes 13 best practice recommendations based on available evidence. This article gives an excerpt of the main recommendations from the expert review.

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 clarify the effect of methotrexate on blood uric acid levels and the incidence of hyperuricemia in patients with rheumatic and musculoskeletal diseases (RMDs).Methods:The clinical data were collected from 349 patients with RMDs who took methotrexate for more than 52 weeks and 429 patients with RMDs who did not take methotrexate, who were treated at Anqing Medical Center of Auhui Medical University from June 1, 2022 to June 30, 2024, to compare the differences in serum uric acid concentration and the incidence of hyperuricemia before and after 24 weeks of methotrexate administration in the two groups of patients with RMDs. The changes in serum uric acid concentration and serum creatinine value in the MTX na?ve patients who had taking MTX for 0, 24 and 52 weeks were compared. The relationship between serum uric acid concentration and methotrexate dosage was analyzed. Measurement data were compared using t-test or ANOVA, repeated measures analysis of variance, and count data were compared using χ2 test. Results:①At week 0, there was no significant difference in serum uric acid concentration [(300±63)μmol/L vs. (306±64)μmol/L, t=-1.416, P=0.157] and the incidence of hyperuricemia [9.3%(40/429) vs. 10.3%(36/349) , χ2=0.215, P=0.643] between the two groups. At week24, the serum uric acid concentration (307±70)μmol/L vs. (246±89)μmol/L was statistically significantly ( t=10.909, P<0.001) different. The incidence of hyperuricemia (11.0%, 47/429) vs. (4.6%, 16/349), was statistically significantly different ( χ2=10.497, P<0.001). There was a statistically significant difference in serum uric acid concentration between week 0 and week 24 in the methotrexate group ( t=10.237, P<0.001), and there was a statistically significant difference in the incidence of hyperuricemia ( χ2=8.312, P=0.004). ②The overall serum uric acid concentrations at week 0, weeks 24, and weeks 52 were (306±64)μmol/L, (246±89)μmol/L, and (247±66)μmol/L, respectively. The difference in overall serum uric acid concentration was statistically significant ( F= 29.506, P<0.001). There was no significant difference in serum uric acid concentration between weeks 24 and 52 ( P=1.000). There were significant differences in serum creatinine levels between weeks 0, 24 and 52 ( P<0.001). There was no significant difference in serum creatinine levels between weeks 0 ,52, weeks 24 and 52 ( P=0.077, P=1.000). There were statistically significant differences in the overall serum uric acid concentration and serum creatinine value at weeks 0, 24 and 52 of medication ( P<0.001).③ There was no significant difference in serum uric acid concentration before and after taking hydroxychloroquine, cyclosporine, tripterygium wilfordii, mycophenolate mofetil, tofacitinib, etanercept and adalimumab alone for weeks 0 and 24(all P>0.05). ④There was no significant difference in serum uric acid concentration between patients taking different doses of methotrexate (7.5 mg once weekly, 10 mg once weekly, 12.5 mg once weekly, 15 mg once weekly) at weeks 0 and 24 weeks(all P>0.05). Conclusion:MTX, as an anti-rheumatic drug, reduces the serum uric acid level and the incidence of hyperuricemia in patients with RMDs during the treatment.

Objective To 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.Methods We 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.Results The 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).Conclusion Carvedilol 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.

Pituitary metastasis(PM), a rare metastatic complication of malignant tumors most commonly seen in lung and breast cancers, exhibits subtle and nonspecific clinical manifestations that complicate its differentiation from other sellar lesions. Symptom development correlates with anatomical involvement: tumors often initially destroy the posterior pituitary, causing diabetes insipidus; subsequently, pituitary stalk compression may trigger hyperprolactinemia, while progressive anterior pituitary destruction ultimately leads to hormonal deficiencies. Additionally, mass effects from the tumor can result in optic chiasm compression, with specific neurological manifestations dependent on the invasion site. Nonspecific symptoms such as fatigue and headache are frequently observed. Pituitary MRI serves as a critical diagnostic tool for distinguishing sellar pathologies. As a distant metastatic event, PM portends a poor overall prognosis. This study presents two cases of lung adenocarcinoma with PM, supplemented by a comprehensive literature review, to summarize clinical characteristics and diagnostic/therapeutic strategies.

Pituitary metastasis(PM), a rare metastatic complication of malignant tumors most commonly seen in lung and breast cancers, exhibits subtle and nonspecific clinical manifestations that complicate its differentiation from other sellar lesions. Symptom development correlates with anatomical involvement: tumors often initially destroy the posterior pituitary, causing diabetes insipidus; subsequently, pituitary stalk compression may trigger hyperprolactinemia, while progressive anterior pituitary destruction ultimately leads to hormonal deficiencies. Additionally, mass effects from the tumor can result in optic chiasm compression, with specific neurological manifestations dependent on the invasion site. Nonspecific symptoms such as fatigue and headache are frequently observed. Pituitary MRI serves as a critical diagnostic tool for distinguishing sellar pathologies. As a distant metastatic event, PM portends a poor overall prognosis. This study presents two cases of lung adenocarcinoma with PM, supplemented by a comprehensive literature review, to summarize clinical characteristics and diagnostic/therapeutic strategies.

Objective:To clarify the effect of methotrexate on blood uric acid levels and the incidence of hyperuricemia in patients with rheumatic and musculoskeletal diseases (RMDs).Methods:The clinical data were collected from 349 patients with RMDs who took methotrexate for more than 52 weeks and 429 patients with RMDs who did not take methotrexate, who were treated at Anqing Medical Center of Auhui Medical University from June 1, 2022 to June 30, 2024, to compare the differences in serum uric acid concentration and the incidence of hyperuricemia before and after 24 weeks of methotrexate administration in the two groups of patients with RMDs. The changes in serum uric acid concentration and serum creatinine value in the MTX na?ve patients who had taking MTX for 0, 24 and 52 weeks were compared. The relationship between serum uric acid concentration and methotrexate dosage was analyzed. Measurement data were compared using t-test or ANOVA, repeated measures analysis of variance, and count data were compared using χ2 test. Results:①At week 0, there was no significant difference in serum uric acid concentration [(300±63)μmol/L vs. (306±64)μmol/L, t=-1.416, P=0.157] and the incidence of hyperuricemia [9.3%(40/429) vs. 10.3%(36/349) , χ2=0.215, P=0.643] between the two groups. At week24, the serum uric acid concentration (307±70)μmol/L vs. (246±89)μmol/L was statistically significantly ( t=10.909, P<0.001) different. The incidence of hyperuricemia (11.0%, 47/429) vs. (4.6%, 16/349), was statistically significantly different ( χ2=10.497, P<0.001). There was a statistically significant difference in serum uric acid concentration between week 0 and week 24 in the methotrexate group ( t=10.237, P<0.001), and there was a statistically significant difference in the incidence of hyperuricemia ( χ2=8.312, P=0.004). ②The overall serum uric acid concentrations at week 0, weeks 24, and weeks 52 were (306±64)μmol/L, (246±89)μmol/L, and (247±66)μmol/L, respectively. The difference in overall serum uric acid concentration was statistically significant ( F= 29.506, P<0.001). There was no significant difference in serum uric acid concentration between weeks 24 and 52 ( P=1.000). There were significant differences in serum creatinine levels between weeks 0, 24 and 52 ( P<0.001). There was no significant difference in serum creatinine levels between weeks 0 ,52, weeks 24 and 52 ( P=0.077, P=1.000). There were statistically significant differences in the overall serum uric acid concentration and serum creatinine value at weeks 0, 24 and 52 of medication ( P<0.001).③ There was no significant difference in serum uric acid concentration before and after taking hydroxychloroquine, cyclosporine, tripterygium wilfordii, mycophenolate mofetil, tofacitinib, etanercept and adalimumab alone for weeks 0 and 24(all P>0.05). ④There was no significant difference in serum uric acid concentration between patients taking different doses of methotrexate (7.5 mg once weekly, 10 mg once weekly, 12.5 mg once weekly, 15 mg once weekly) at weeks 0 and 24 weeks(all P>0.05). Conclusion:MTX, as an anti-rheumatic drug, reduces the serum uric acid level and the incidence of hyperuricemia in patients with RMDs during the treatment.

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.