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.

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.

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 systematically evaluate the effect of different traditional Chinese medicine(TCM)appropriate techniques on patients with knee osteoarthritis of cold-dampness obstruction type,so as to provide evidence-based clinical practice.[Methods]Databases including PubMed,Web of Science Core Collection,CINAHL Complete,Embase,Science Direct,Cochrane Library,CNKI,Wanfang,VIP and SinoMed were searched for literature on the intervention effect of TCM appropriate techniques on patients with knee osteoarthritis of cold-dampness obstruction type.The retrieval time was from January 1,2019 to July 18,2024.Two researchers independently screened the literature,extracted the data and evaluated the quality of the literature.RevMan 5.4 software was used for traditional Meta-analysis,and Stata 17.0 software was used for network Meta-analysis.[Results]A total of 33 studies were included,involving 3 154 patients and 13 TCM appropriate techniques.Network Meta-analysis showed that acupoint application combined with Chinese medicine fumigation and washing had the best effect in relieving knee joint symptoms,and the surface under the cumulative ranking(SUCRA)was 92.7%,moxibustion combined with Chinese medicine iontophoresis had the best effect in improving clinical efficacy,and the SUCRA was 86.8%.[Conclusion]The existing research shows that acupoint application combined with Chinese medicine fumigation and washing can effectively relieve the knee joint symptoms of patients with knee osteoarthritis of cold-dampness obstruction type,and moxibustion combined with Chinese medicine iontophoresis can effectively improve the clinical efficacy.The combined use of different TCM appropriate techniques is better than the single use.It is suggested that the clinical medical staff can implement comprehensive TCM appropriate techniques based on TCM syndrome differentiation,so as to improve the clinical efficacy and nursing quality of patients with cold-dampness obstruction type knee osteoarthritis.

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 systematically evaluate the effect of different traditional Chinese medicine(TCM)appropriate techniques on patients with knee osteoarthritis of cold-dampness obstruction type,so as to provide evidence-based clinical practice.[Methods]Databases including PubMed,Web of Science Core Collection,CINAHL Complete,Embase,Science Direct,Cochrane Library,CNKI,Wanfang,VIP and SinoMed were searched for literature on the intervention effect of TCM appropriate techniques on patients with knee osteoarthritis of cold-dampness obstruction type.The retrieval time was from January 1,2019 to July 18,2024.Two researchers independently screened the literature,extracted the data and evaluated the quality of the literature.RevMan 5.4 software was used for traditional Meta-analysis,and Stata 17.0 software was used for network Meta-analysis.[Results]A total of 33 studies were included,involving 3 154 patients and 13 TCM appropriate techniques.Network Meta-analysis showed that acupoint application combined with Chinese medicine fumigation and washing had the best effect in relieving knee joint symptoms,and the surface under the cumulative ranking(SUCRA)was 92.7%,moxibustion combined with Chinese medicine iontophoresis had the best effect in improving clinical efficacy,and the SUCRA was 86.8%.[Conclusion]The existing research shows that acupoint application combined with Chinese medicine fumigation and washing can effectively relieve the knee joint symptoms of patients with knee osteoarthritis of cold-dampness obstruction type,and moxibustion combined with Chinese medicine iontophoresis can effectively improve the clinical efficacy.The combined use of different TCM appropriate techniques is better than the single use.It is suggested that the clinical medical staff can implement comprehensive TCM appropriate techniques based on TCM syndrome differentiation,so as to improve the clinical efficacy and nursing quality of patients with cold-dampness obstruction type knee osteoarthritis.

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.

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.

Objective To analyze the distribution characteristics and application value of liver,renal func-tion indexes and autoantibody-related indexes of neuromyelitis optica spectrum disorder(NMOSD).Methods The liver,renal function and autoantibody-related indexes data of patients diagnosed with NMOSD and multiple sclerosis(MS)in Beijing Tiantan Hospita,Capital Medical University from June 2015 to June 2023,as well as gender and age-matched controls underwent routine physical examination were retrospectively collected.A total of 95 patients with NMOSD(NMOSD group),230 patients with MS(MS group),and 244 healthy controls(routine physical examination group)were selected to evaluate the diagnostic value of each index for NMOSD.Results Compared with MS group,the levels of alanine aminotransferase,as well as the positive rates of α-hydroxybutyrate dehydrogenase,y-glutamyltransferase,anti-SS-A antibody,anti-SS-B anti-body,anti-ribosomal P protein antibody and Ro-52 antibody were significantly increased in NMOSD group,while the levels of albumin,indirect bilirubin and total bilirubin were significantly decreased,and the differ-ences were statistically significant(P＜0.05).The difference index between NMOSD and conventional physi-cal examination group was similar to that of MS group.The seven indexes,a-hydroxybutyrate dehydrogenase,albumin,globulin,direct bilirubin,indirect bilirubin,total bile acid and uric acid alkalinity could be used for the diagnosis of NMOSD.The area under the curve of combined diagnosis of NMOSD was 0.969,and the sensitiv-ity and specificity were 92.6％and 92.9％.Conclusion Multiple indexes of liver and kidney function in NMOSD patients are different from those in MS patients and healthy subjects underwent routine physical ex-amination,and the positive rate of some autoantibody indexes in NMOSD patients is higher than that in MS patients.Liver,renal function and autoantibody-related indexes can be used clinically to assist diagnosis,and the combined application of multiple indexes can further enhance its diagnostic value.