Esophagogastric variceal bleeding is a common complication and the leading cause of death in advanced liver cirrhosis， and endoscopic variceal ligation （EVL） and endoscopic cyanoacrylate injection （ECI） are commonly used treatment strategies. Thrombocytopenia is one of the most common hematological complications in liver cirrhosis， and patients with severe thrombocytopenia have the potential risk of bleeding， which may affect treatment decision-making by clinicians and endoscopists. This article reviews the evolution of guidelines and clinical research advances regarding EVL/ECI in China and globally， in order to provide a basis for decision making among clinicians.

The randomized controlled trials (RCTs) regarding acupuncture direction published from January 1st, 2013, to November 7th, 2023 were searched in China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Database. As a result, 21 RCTs were included. The problems identified included conceptual misunderstandings regarding acupuncture direction, incomplete selection strategies, confounding research factors, and inaccuracies in reporting. Based on the findings, four strategic approaches for enhancing therapeutic efficacy through acupuncture direction were summarized: aligning needle direction with the meridian pathway, directing the needle toward the lesion site, orienting the needle toward adjacent acupoints, and targeting special anatomical structures. Two additional strategies were proposed for optimizing the procedure: simplifying acupuncture operations and directing the needle toward safe anatomical sites. Recommendations were made to improve the rationality of research factor settings and the completeness of acupuncture operation reporting. Furthermore, three methods for reporting acupuncture direction were discussed: reporting the tip-pointed position, reporting the insertion angle and orientation, and reporting azimuth and polar angles, aiming to promote greater standardization and completeness in acupuncture practice and reporting.
Acupuncture Therapy/standards* ; Humans ; Acupuncture Points ; Randomized Controlled Trials as Topic ; Meridians

Objective To investigate the differences and the immunocompatibility of wild-type (WT), four-gene modified (TKO/hCD55) and six-gene modified (TKO/hCD55/hCD46/hTBM) pig erythrocytes with human serum. Methods The blood samples were collected from 20 volunteers with different blood groups. WT, TKO/hCD55, TKO/hCD55/hCD46/hTBM pig erythrocytes, ABO-compatible (ABO-C) and ABO-incompatible (ABO-I) human erythrocytes were exposed to human serum of different blood groups, respectively. The blood agglutination and antigen-antibody binding levels (IgG, IgM) and complement-dependent cytotoxicity were detected. The immunocompatibility of two types of genetically modified pig erythrocytes with human serum was evaluated. Results No significant blood agglutination was observed in the ABO-C group. The blood agglutination levels in the WT and ABO-I groups were higher than those in the TKO/hCD55 and TKO/hCD55/hCD46/hTBM groups (all P<0.001). The level of erythrocyte lysis in the WT group was higher than those in the ABO-C, TKO/hCD55 and TKO/hCD55/hCD46/hTBM groups. The level of erythrocyte lysis in the ABO-I group was higher than those in the TKO/hCD55 and TKO/hCD55/hCD46/hTBM groups (both P<0.01). The pig erythrocyte binding level with IgM and IgG in the TKO/hCD55 group was lower than those in the WT and ABO-I groups. The pig erythrocyte binding level with IgG and IgM in the TKO/hCD55/hCD46/hTBM group was lower than that in the WT group and pig erythrocyte binding level with IgG was lower than that in the ABO-I group (all P<0.05). Conclusions The immunocompatibility of genetically modified pig erythrocytes is better than that of wild-type pigs and close to that of ABO-C pigs. Humanized pig erythrocytes may be considered as a blood source when blood sources are extremely scarce.

China prospective multicenter birth cohort (Prospective Omics Health Atlas birth cohort, POHA birth cohort) study was officially launched in 2022. This study, in collaboration with 12 participating units, aims to establish a high-quality, multidimensional cohort comprising 20 000 naturally conceived families and assisted reproductive families. The study involves long-term follow-up of parents and offspring, with corresponding biological samples collected at key time points. Through multi-omics testing and analysis, the study aims to conduct multi-omics big data research across the entire maternal and infant life cycle. The goal is to identify new biomarkers for maternal and infant diseases and provide scientific evidence for risk prediction related to maternal diseases and neonatal health.

Objective:To investigate the risk factors of acute gastrointestinal failure in patients with traumatic brain injury(TBI).Methods:A retrospective analysis of 297 patients admitted to the Rugao Hospital Affiliated to Nantong University for traumatic brain injury from March 2018 to March 2020 was performed. Multivariate Logistic regression analysis was used to test the risk factors of acute gastrointestinal failure in patients with traumatic brain injury.Results:Of the 297 patients with TBI, 92 (30.98%) had acute gastrointestinal failure, of which 56 (18.86%) were acute gastrointestinal injury(AGI) Ⅲ and 36 (12.12%) were AGI Ⅳ. Multivariate Logistic regression analysis showed that female, low Glasgow Coma Scale (GCS) scores, frontal lobe injury, abnormal serum sodium, lung infection and intracranial infection were independent risk factors for acute gastrointestinal failure in TBI patients ( P<0.05). The length of ICU stay in the acute gastrointestinal failure group was significantly higher than that of the non-acute gastrointestinal failure group: (18.5 ± 2.6) d vs. (6.3 ± 1.2) d, and the incidence of good prognosis was significantly lower than that of the non-acute gastrointestinal failure group: 60.87%(56/92) vs. 80.49(165/205), the differences were statistically significant ( P<0.05). Conclusions:That female, low GCS scores, frontal lobe injury, abnormal serum sodium, lung infection and intracranial infection are independent risk factors for acute gastrointestinal failure in TBI patients

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.

Objective:To explore the application value of automated machine learning (autoML) model in predicting the risk of preeclampsia in the first trimester.Methods:From January 2017 to October 2020, 2 180 singleton pregnant women who were registered in Jinan Second Maternal and Child Health Hospital and underwent pregnancy examination at 12 weeks of gestation were selected. The pregnant women were divided into preeclampsia group (103 cases) and control group (2 077 cases) according to the occurrence of preeclampsia. The differences in clinical data and hematological indexes in the two groups were compared, and the correlation between each index and the risk of preeclampsia was analyzed too. All the pregnant women were randomly divided into training set and test set according to the ratio of 7∶3, and the autogluon autoML algorithm was used to build a variety of machine learning models, and training and cross-validation were performed in the training set to compare the accuracy of the different models. The importance of each index in the autoML model was analyzed, and the autoML model and the logistic regression model were used to predict the risk of preeclampsia in pregnant women in the test set respectively, and the receiver operating characteristic (ROC) curve was used to evaluate the prediction performance of the autoML and the logistic regression model.Results:The age, pre-pregnancy body mass index, body mass index at 12 weeks of gestation, waist circumference at 12 weeks of gestation, proportion of drinking history, high-sensitivity C-reactive protein (hs-CRP), triglyceride, low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), platelet distribution width (PDW), mean platelet volume, thyroid stimulating hormone (TSH) and β-human chorionic gonadotropin were all significantly higher than those in the control group (all P<0.05), and the free tri-iodothyronine (free T3), free thyroxine (free T4), placental growth factor (PIGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and pregnancy-associated plasma protein-A (PAPP-A) were all significantly lower than those in the control group (all P<0.05). Correlation analysis showed that the correlation between pre-pregnancy body mass index, body mass index at 12 weeks gestation, waist circumference at 12 weeks gestation, hs-CRP, triacylglycerol, AST, TSH, free T3, free T4, β-HCG, PIGF, sFlt-1, PAPP-A and preeclampsia risk were obviously higher; but the correlation between each index were lower. A total of 18 models in 8 categories were constructed with the autoML model algorithm, and the neural network _L2 based on FastAI had the highest accuracy in the training set (0.963) and the validation set (0.971). The TSH, LDL-C, PDW, waist circumference at 12 weeks of gestation, sFlt-1, AST were more important in the model, while the free T4, total cholesterol, pregnancy times, drinking history, parity and family history of hypertension were less important indicators. The area under the ROC curve of the autoML model for predicting the risk of preeclampsia in the first trimester was significantly higher than that of the logistic regression model (0.984 vs 0.765, P=0.002), while there was no statistical difference in the prediction accuracy of the two prediction models in the training set ( P>0.05). The prediction accuracy and sensitivity of the autoML model in the test set were both significantly higher than those of the logistic regression model (99.54% vs 98.32%, 93.75% vs 75.00%, both P<0.05). Conclusions:Factors such as TSH, LDL-C, PDW, waist circumference, sFlt-1 and AST in the first trimester of pregnancy have a certain correlation with the risk of preeclampsia. The autoML model based on the indicators of the first trimester has a high predictive value for the risk of preeclampsia.

Birth cohort is an important platform to study the effect of early-life exposure on health outcome, but large cohorts to investigate the effect of preconception exposure, especially paternal exposure, on reproductive health and birth outcome are limited. The Preconception Reproductive Health and Birth Outcome Cohort (PREBIC) is a prospective birth cohort study which pays equal attention to the contribution of environmental, psychological, behavioral as well as other factors to reproductive health and adverse birth outcomes in both men and women in Chongqing, China. PREBIC started in 2019 and plans to recruit 20 800 reproductive-age couples with child-bearing willingness. Followed up was conducted to understand the conception status of the women within two years. Women in pregnancy would be visited at first, second, third trimesters and after delivery. The offspring would be monitored until 2 years old to understand the incidences of preterm birth, low birth weight, birth defects, neurodevelopmental disorders and other outcomes. Related information and biospecimen collections (including semen, peripheral blood, urine, placenta, umbilical cord, cord blood and oral swab) were scheduled in each period. By January 2022, PREBIC had recruited 8 698 participants from all 38 districts in Chongqing. The goal of PREBIC is to establish one of the largest prospective preconception birth cohorts covering both men and women, which might provide a unique insight to understand the effects of the full reproductive cycle on reproductive health and adverse outcomes, with especial emphasis on preconception exposures.

Objective:To explore the safety and efficacy of serial expansion without delay for the treatment of giant congenital melanocytic nevi (GCMN) on the back.Methods:The clinical date of children with GCMN on the back admitted to the Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from February 2017 to March 2019 were retrospectively analyzed. In stage Ⅰ, an expander was placed on each side of the back to laterally expand the skin on the back, as a whole. In stage Ⅱ, after the expanders were removed and part of the nevus was removed, the expanded flaps were advanced integrally across the back with additional incisions on both sides of the trunk. The new expanders were then placed under the expanded flaps simultaneously for serial expansion. In stage Ⅲ, the expanded flaps were used to reconstruct the wound after resection of GCMN. The color, texture of the flaps and the postoperative scar on the back were observed.Results:Ten patients were enrolled, including 4 males and 6 females, with an average age of 3.4 years (ranged between 2-6 years). All patients completed three stages of treatment. In the second stage, new expanders were placed under the expanded flap for serial expansion simultaneously. The three-stage operation took a total of 6.80 to 11.77 months, and all the nevus on the back were removed. The mean follow-up time was 16.6 months (ranged between 12-24 months). In one case, the skin flap necrosis (1.5 cm × 1.2 cm) was caused by abrasion at the end of stage Ⅱ when the inflation of the expander was nearly completed, without exposure of the dilator. After the expanders were removed in stage Ⅲ, the flap survived well. In the other children, no wound dehiscence, infection, dilator exposure and other complications occurred. The back was maintained as a whole aesthetic unit without conspicuous scars and the postoperative scars were located on the sides of the trunk. The color and texture of the flap were similar to its surrounding tissue.Conclusions:Serial expansion without delay is safe and efficient in the treatment of GCMN on the back. It not only eliminates the need to wait 4 to 15 months for the expander implantation, but also saves one operation and anesthesia. During the treatment, additional incisions are only made on both sides of the trunk, which could maintain the back as a whole aesthetic unit and obtain a better postoperative appearance.

Objective:To explore the safety and efficacy of serial expansion without delay for the treatment of giant congenital melanocytic nevi (GCMN) on the back.Methods:The clinical date of children with GCMN on the back admitted to the Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from February 2017 to March 2019 were retrospectively analyzed. In stage Ⅰ, an expander was placed on each side of the back to laterally expand the skin on the back, as a whole. In stage Ⅱ, after the expanders were removed and part of the nevus was removed, the expanded flaps were advanced integrally across the back with additional incisions on both sides of the trunk. The new expanders were then placed under the expanded flaps simultaneously for serial expansion. In stage Ⅲ, the expanded flaps were used to reconstruct the wound after resection of GCMN. The color, texture of the flaps and the postoperative scar on the back were observed.Results:Ten patients were enrolled, including 4 males and 6 females, with an average age of 3.4 years (ranged between 2-6 years). All patients completed three stages of treatment. In the second stage, new expanders were placed under the expanded flap for serial expansion simultaneously. The three-stage operation took a total of 6.80 to 11.77 months, and all the nevus on the back were removed. The mean follow-up time was 16.6 months (ranged between 12-24 months). In one case, the skin flap necrosis (1.5 cm × 1.2 cm) was caused by abrasion at the end of stage Ⅱ when the inflation of the expander was nearly completed, without exposure of the dilator. After the expanders were removed in stage Ⅲ, the flap survived well. In the other children, no wound dehiscence, infection, dilator exposure and other complications occurred. The back was maintained as a whole aesthetic unit without conspicuous scars and the postoperative scars were located on the sides of the trunk. The color and texture of the flap were similar to its surrounding tissue.Conclusions:Serial expansion without delay is safe and efficient in the treatment of GCMN on the back. It not only eliminates the need to wait 4 to 15 months for the expander implantation, but also saves one operation and anesthesia. During the treatment, additional incisions are only made on both sides of the trunk, which could maintain the back as a whole aesthetic unit and obtain a better postoperative appearance.