On August 31， 2025， the Asian Pacific Association for the Study of the Liver （APASL） updated and released management of acute variceal bleeding： updated APASL guidelines （2025 edition）， which systematically elaborates on the definition， diagnosis， assessment， and treatment of acute variceal bleeding. This article gives an excerpt of the recommendations in this guideline.

Objective:To construct a performance management model based on comprehensive evaluation method with probability weight,and to explore its application value in management for emergency equipment.Methods:A performance evaluation system was formulated by performance management model from three dimensions included operation quality,cost investment and social benefit of emergency equipment.Probability weight method was used to assign the index weight,and management countermeasures included engineering technical support,expenditure control and improvement of social benefit were formulated according to the comprehensive evaluation results.A total of 109 emergency equipment in clinical use at Renji Hospital,Shanghai Jiao Tong University School of Medicine from March 2022 to February 2024 were selected.The management method with conventional evaluation model(conventional evaluation management method)was adopted to manage 103 equipment during March 2022 and February 2023,and the management method with performance management model based on comprehensive evaluation method with probability weight(comprehensive evaluation management method)was adopted to manage 104 equipment(included the used 98 equipment that were managed by conventional evaluation management method at the first stage,and 6 new equipment)during March 2023 and February 2024.The operation quality and management cost of the two kinds of management methods for equipment were compared.A self-made questionnaire survey was conducted to investigate the performance evaluation of operators,who used equipment,for the two kinds of management methods in using equipment.Results:The average use rate,data integrity rate and pass rate of quality inspection of clinical emergency equipment of adopting the comprehensive evaluation management method were respectively(96.61±1.52)%,(97.74±1.91)%and(95.96±1.19)%,all of which were higher than those of adopting conventional evaluation management method.The average values of the alarm rate and the damage rate of the component and accessories of the system were respectively(1.24±0.83)%and(1.08±0.56)%,both of which were lower than those of the conventional evaluation management method.The differences of the above indicators were statistically significant(t=3.410,3.292,3.848,2.967,2.825,P<0.05).The average amplification of the management investment of respiratory therapy,diagnosis and treatment of electrocardiogram,rescue treatment,basic treatment and other management investment of emergency equipment were lower than those of the conventional evaluation management method,and the differences were statistically significant(t=3.533,3.487,4.002,3.317,2.726,P<0.05).The scores of operators who used equipment for configurations quantity,configuration quality and management level that adopted comprehensive evaluation management method were all higher than those that adopted conventional evaluation management method,and the differences were statistically significant(t=3.183,3.934,2.363,P<0.05).Conclusion:The performance management model based on the comprehensive evaluation method with probability weight can enhance the operational quality of clinical emergency equipment,and control the management cost of equipment,and improve the service level of equipment.

Objective:To construct a performance management model based on comprehensive evaluation method with probability weight,and to explore its application value in management for emergency equipment.Methods:A performance evaluation system was formulated by performance management model from three dimensions included operation quality,cost investment and social benefit of emergency equipment.Probability weight method was used to assign the index weight,and management countermeasures included engineering technical support,expenditure control and improvement of social benefit were formulated according to the comprehensive evaluation results.A total of 109 emergency equipment in clinical use at Renji Hospital,Shanghai Jiao Tong University School of Medicine from March 2022 to February 2024 were selected.The management method with conventional evaluation model(conventional evaluation management method)was adopted to manage 103 equipment during March 2022 and February 2023,and the management method with performance management model based on comprehensive evaluation method with probability weight(comprehensive evaluation management method)was adopted to manage 104 equipment(included the used 98 equipment that were managed by conventional evaluation management method at the first stage,and 6 new equipment)during March 2023 and February 2024.The operation quality and management cost of the two kinds of management methods for equipment were compared.A self-made questionnaire survey was conducted to investigate the performance evaluation of operators,who used equipment,for the two kinds of management methods in using equipment.Results:The average use rate,data integrity rate and pass rate of quality inspection of clinical emergency equipment of adopting the comprehensive evaluation management method were respectively(96.61±1.52)%,(97.74±1.91)%and(95.96±1.19)%,all of which were higher than those of adopting conventional evaluation management method.The average values of the alarm rate and the damage rate of the component and accessories of the system were respectively(1.24±0.83)%and(1.08±0.56)%,both of which were lower than those of the conventional evaluation management method.The differences of the above indicators were statistically significant(t=3.410,3.292,3.848,2.967,2.825,P<0.05).The average amplification of the management investment of respiratory therapy,diagnosis and treatment of electrocardiogram,rescue treatment,basic treatment and other management investment of emergency equipment were lower than those of the conventional evaluation management method,and the differences were statistically significant(t=3.533,3.487,4.002,3.317,2.726,P<0.05).The scores of operators who used equipment for configurations quantity,configuration quality and management level that adopted comprehensive evaluation management method were all higher than those that adopted conventional evaluation management method,and the differences were statistically significant(t=3.183,3.934,2.363,P<0.05).Conclusion:The performance management model based on the comprehensive evaluation method with probability weight can enhance the operational quality of clinical emergency equipment,and control the management cost of equipment,and improve the service level of equipment.

Porto-sinusoidal vascular disease （PSVD） is a new disease nomenclature proposed in recent years， which is an important supplement to idiopathic non-cirrhotic portal hypertension. PSVD includes the patients with specific pathological conditions， but without portal hypertension symptoms， and the patients with portal vein thrombosis or viral hepatitis. This article elaborates on the naming， epidemiology， etiology， clinical manifestations， prognosis， and treatment of PSVD， in order to improve the understanding of this disease among clinicians.

Portal hypertension is a serious complication of liver cirrhosis resulting from the increases in portal vascular resistance and portal blood inflow. Both etiological and non-etiological therapies can effectively reduce portal venous pressure to a certain degree, but with an unsatisfactory effect in improving prognosis. New therapeutic drugs targeting the reduction in intrahepatic vascular resistance may help to achieve the reversal of portal hypertension. Based on the pathogenesis of cirrhotic portal hypertension, this article summarizes the current pharmacotherapies from the aspects of etiological and non-etiological therapies, so as to provide a comprehensive theoretical and evidence-based basis for clinical treatment options.

OBJECTIVES: Ultrasound is a safe and timely diagnosis method commonly used for breast lesion, however it depends on the operator to a certain degree. As an emerging technology, artificial intelligence can be combined with ultrasound in depth to improve the intelligence and precision of ultrasound diagnosis and avoid diagnostic errors caused by subjectivity of radiologists. This paper aims to investigate the value of artificial intelligence S-detect system combined with virtual touch imaging quantification (VTIQ) technique in the differential diagnosis of benign and malignant breast masses by conventional ultrasound (CUS). respectively, and AUCs for them were 0.74, 0.86, 0.79, and 0.94, respectively. The diagnostic accuracy of CUS+S-detect was higher than that of CUS (P<0.05). The diagnostic accuracy of CUS+S-detect was higher than that of CUS (P<0.05). The diagnostic specificity of CUS+VTIQ was higher than that of CUS (P<0.05). The diagnostic accuracy and AUC of CUS+S-detect+VTIQ were higher than those of S-detect or VTIQ applied to CUS alone (P<0.05). The sensitivities of CUS for senior radiologists, CUS for junior radiologists, CUS+S-detect+VTIQ for senior radiologists, and CUS+S-detect+VTIQ for junior radiologists were 60.00%, 80.00%, 72.73%, and 90.00%, respectively, when diagnosing benign and malignant breast masses in 50 randomly selected cases. The specificities for them was 66.67%, 76.67%, 80.00%, and 81.25%, respectively. The accuracies for them was 64.00%, 78.00%, 80.00%, and 88.00%, respectively. The AUCs for them were 0.63, 0.78, 0.88, and 0.80, respectively. Compared with the CUS for junior radiologists, the CUS+S-detect+VTIQ for junior radiologists had higher sensitivity, specificity, and accuracy (all P<0.05). The consistency of the combined application of S-detect and VTIQ for diagnosing breast masses at 2 different times was good among junior radiologists (Kappa=0.800). METHODS: CUS, S-detects, and VTIQ were used to differentially diagnose benign and malignant breast masses in 108 cases, and the final pathological results were referred to as the gold standard for classifying breast masses. The diagnostic efficacy were evaluated and compared, among the 3 methods and among S-detect applied to CUS (CUS+S-detect), VTIQ applied to CUS (CUS+VTIQ), and S-detect combined with VTIQ applied to CUS (CUS+S-detect+VTIQ). Fifty cases were acquired randomly from the collected breast masses, and 2 radiologists with different years of experience (2 and 8 years) used S-detect combined with VTIQ for the ultrasonic differential diagnosis of benign and malignant breast masses. RESULTS: The differences in sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC) of the 3 diagnostic methods of CUS, S-detect, and VTIQ were not statistically significant (all P>0.05). The sensitivities of CUS, CUS+Sdetect, CUS+VTIQ, and CUS+S-detect+VTIQ were 78.57%, 92.86%, 69.05%, and 95.24%, respectively, the specificities for them were 69.70%, 78.79%, 87.88%, and 92.42%, respectively, the accuracies for them were 73.15%, 84.26%, 80.56%, and 93.52%. CONCLUSIONS S-detect combined with VTIQ when applied to CUS can overcome the shortcomings of separate applications and complement each other, especially for junior radiologists, and can more effectively improve the diagnostic efficacy of ultrasound for benign and malignant breast masses.
Artificial Intelligence ; Breast/diagnostic imaging* ; Diagnosis, Differential ; Elasticity Imaging Techniques/methods* ; Humans ; Ultrasonography/methods*

Objective:To clarify the effect and related factors of antiviral therapy on the change of esophageal varices in patients with hepatitis B virus-related cirrhosis.Methods:Fifty-two cases with hepatitis B virus-related cirrhosis who underwent endoscopy before and after antiviral therapy were selected from prospective cohorts. Patients were divided into three groups: no, mild, and moderate-severe based on the degree of esophageal varices. The changes in the severity of esophageal varices in each group were compared after antiviral therapy. Clinical characteristics (platelet, liver and kidney function, liver stiffness, and virological response) of patients with different regressions were analyzed. Measurement data were analyzed by independent sample t-test, one-way ANOVA, Mann-Whitney U test and Kruskal-Wallis H test, and Chi-Square test was used for count data.Results:All patients received entecavir-based antiviral therapy. The median treatment time was 3.1 (2.5-4.4) years. The proportion of patients without esophageal varices increased from 30.8% to 51.9%, the proportion of mild esophageal varices decreased from 40.4% to 30.8%, and the proportion of patients with moderate-to-severe esophageal varices decreased from 28.8% to 17.3% ( χ2=14.067, P=0.001). A total of 40.4% of patients had esophageal varices regression, and 13.5% had esophageal varices progression. The progression rate was significantly higher in patients with moderate-severe esophageal varices than patients with mild and no esophageal varices ( χ2=28.126, P<0.001), and 60.0% of patients with moderate-severe esophageal varices still remained in moderate-severe state after antiviral treatment. Baseline platelet count and 5-year mean change rates were significantly lower in patients with progressive moderate-to-severe esophageal varices than in those without progression (+3.3% vs. +34.1%, Z=7.00, P=0.027). Conclusion:After effective antiviral treatment, 40.4% of patients with hepatitis B virus-related cirrhosis combined with esophageal varices has obtained esophageal varices regression, but those with moderate to severe esophageal varices still have a considerable risk of progression while receiving mono antiviral treatment only. Thrombocytopenia and without significant improving are the clinical signs of progression risk after receiving antiviral treatment.

Objective This study aimed to examine and propagate the medication experience and group formula of traditional Chinese medicine (TCM) Master XIONG Jibo in diagnosing and treating arthralgia syndrome (AS) through data mining. Methods Data of outpatient cases of Professor XIONG Jibo were collected from January 1, 2014 to December 31, 2018, along with cases recorded in A Real Famous Traditional Chinese Medicine Doctor: XIONG Jibo's Clinical Medical Record 1, which was published in December 2019. The five variables collected from the patients’ data were TCM diagnostic information, TCM and western medicine diagnoses, syndrome, treatment, and prescription. A database was established for the collected data with Excel. Using the Python environment, a customized modified natural language processing (NLP) model for the diagnosis and treatment of AS by Professor XIONG Jibo was established to preprocess the data and to analyze the word cloud. Frequency analysis, association rule analysis, cluster analysis, and visual analysis of AS cases were performed based on the Traditional Chinese Medicine Inheritance Computing Platform (V3.0) and RStudio (V4.0.3). Results A total of 610 medical records of Professor XIONG Jibo were collected from the case database. A total of 103 medical records were included after data screening criteria, which comprised 187 times (45 kinds) of prescriptions and 1 506 times (125 kinds) of Chinese herbs. The main related meridians were the liver, spleen, and kidney meridians. The properties of Chinese herbs used most were mainly warm, flat, and cold, while the flavors of herbs were mainly bitter, pungent, and sweet. The main patterns of AS included the damp heat, phlegm stasis, and neck arthralgia. The most commonly used herbs for AS were Chuanniuxi (Cyathulae Radix), Huangbo (Phellodendri Chinensis Cortex), Cangzhu (Atractylodis Rhizoma), Qinjiao (Gentianae Macrophyllae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqi (Astragali Radix), and Chuanxiong (Chuanxiong Rhizoma). The most common effect of the herbs was “promoting blood circulation and removing blood stasis”, followed by “supplementing deficiency (Qi supplementing, blood supplementing, and Yang supplementing)”, and “dispelling wind and dampness”. The data were analyzed with the support ≥ 15% and confidence = 100%, and after de-duplication, five second-order association rules, 39 third-order association rules, 39 fourth-order association rules, and two fifth-order association rules were identified. The top-ranking association rules of each were “Cangzhu (Atractylodis Rhizoma) → Huangbo (Phellodendri Chinensis Cortex)” “Cangzhu (Atractylodis Rhizoma) + Chuanniuxi (Cyathulae Radix) → Huangbo (Phellodendri Chinensis Cortex)” “Chuanniuxi (Cyathulae Radix) + Danggui (Angelicae Sinensis Radix) + Gancao (Glycyrrhizae Radix et Rhizoma) → Qinjiao (Gentianae Macrophyllae Radix)” and “Chuanniuxi (Cyathulae Radix) + Danggui (Angelicae Sinensis Radix) +Gancao (Glycyrrhizae Radix et Rhizoma) + Huangbo (Phellodendri Chinensis Cortex) → Qinjiao (Gentianae Macrophyllae Radix)”, respectively. Five clusters were obtained using cluster analysis of the top 30 herbs. The herbs were mainly drying dampness, supplementing Qi, and promoting blood circulation. The main prescriptions of AS were Ermiao San (二妙散), Gegen Jianghuang San (葛根姜黄散), and Huangqi Chongteng Yin (黄芪虫藤饮). The herbs of core prescription included Cangzhu (Atractylodis Rhizoma), Chuanniuxi (Cyathulae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Huangbo (Phellodendri Chinensis Cortex), Mugua (Chaenomelis Fructus), Qinjiao (Gentianae Macrophyllae Radix), Danggui (Angelicae Sinensis Radix), and Yiyiren (Coicis Semen). Conclusion Clearing heat and dampness, relieving collaterals and pain, and invigorating Qi and blood are the most commonly used therapies for the treatment of AS by Professor XIONG Jibo. Additionally, customized NLP model could improve the efficiency of data mining in TCM.

Objective:To verify Baveno VI criteria, Expanded-Baveno VI criteria, liver stiffness×spleen diameter-to-platelet ratio risk score (LSPS), and platelet count/spleen diameter ratio (PSR) in evaluating the severity value of esophageal varices (EV) in patients with non-cirrhotic portal hypertension (NCPH).Methods:111 cases of NCPH and 204 cases of hepatitis B cirrhosis who met the diagnostic criteria were included in the study. NCPH included 70 cases of idiopathic non-cirrhotic portal hypertension (INCPH) and 41 cases of nontumoral portal vein thrombosis (PVT). According to the severity of EV on endoscopy, they were divided into the low-bleeding-risk group (no/mild EV) and the high-bleeding-risk group (moderate/severe EV). The diagnostic value of Baveno VI and Expanded-Baveno VI criteria was verified to evaluate the value of LSPS and PSR for EV bleeding risk severity in NCPH patients. The t-test or Mann-Whitney U test was used to compare the measurement data between groups. Comparisons between counting data groups were performed using either the χ2 test or the Fisher exact probability method. Results:Considering endoscopy was the gold standard for diagnosis, the missed diagnosis rates of low/high bleeding risk EVs in INCPH/PVT patients with Baveno VI and Expanded-Baveno VI criteria were 50.0%/30.0% and 53.8%/50.0%, respectively. There were no statistically significant differences in platelet count (PLT), spleen diameter, liver stiffness (LSM), LSPS, and PSR between low-bleeding-risk and high-bleeding-risk groups in INCPH patients, and the area under the receiver operating characteristic curve (AUC) of LSPS and PSR was 0.564 and 0.592, respectively ( P=0.372 and 0.202, respectively). There were statistically significant differences in PLT, spleen diameter, LSPS, and PSR between the low and high-bleeding risk groups in PVT patients, and the AUCs of LSPS and PSR were 0.796 and 0.833 ( P=0.003 and 0.001, respectively). In patients with hepatitis B cirrhosis, the Baveno VI and Expanded-Baveno VI criteria were used to verify the low bleeding risk EV, and the missed diagnosis rates were 0 and 5.4%, respectively. There were statistically significant differences in PLT, spleen diameter, LSM, LSPS and PSR between the low-bleeding-risk and high-bleeding-risk groups ( P<0.001). LSPS and PSR AUC were 0.867 and 0.789, respectively ( P<0.05). Conclusion:Baveno VI and Expanded-Baveno VI criteria have a high missed diagnosis rate for EVs with low bleeding risk in patients with INPCH and PVT, while LSPS and PSR have certain value in evaluating EV bleeding risk in PVT patients, which requires further clinical research.