Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Objective:To summarize the experience and outcomes of independent extracorporeal membrane oxygenation (ECMO) assistance for adult cardiac arrest patients conducted by a county-level hospital.Methods:Clinical data of 23 adult cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) at Tiantai County People's Hospital from January 2020 to October 2023 were retrospectively reviewed. Data, including initial cardiac rhythm, ECMO initiation time, cardiopulmonary resuscitation (CA)-Pump On time, ECMO initiation-Pump On time, ECMO cannulation-Pump On time, complications, neurological function prognosis, mortality rate, and survival rate, were collected and analyzed. Collect and analyze the mortality and survival rates of 33 adult cardiac arrest (CA) patients meeting the criteria for extracorporeal cardiopulmonary resuscitation (ECPR) but receiving only conventional cardiopulmonary resuscitation (CCPR) from January 2020 to October 2023, and compare these rates with those of patients who underwent CA-ECPR.Results:Among the 23 cardiac arrest patients, 16 patients achieved spontaneous heart rhythm recovery, 15 patients experienced death, and 8 patients showed improved conditions upon discharge, with 6 patients exhibiting good neurological function prognosis. Compared to CA-CCPR, patients who received CA-ECPR showed a significant decrease in mortality rate (65.21% vs. 90.91%, P=0.017) and a significant increase in survival rate (34.78% vs. 9.09%, P=0.017). After gradual optimization of the ECPR process, the 2022-2023 group showed a significantly increased survival rate compared to the 2020-2021 group(46% vs. 20%). ECMO initiation-Pump On time [41( IQR36.5-44.5)min vs.43( IQR32.75-58.5)min, P=0.709] and ECMO cannulation-Pump On time[30( IQR24.0-37.0)min vs. 33( IQR27.25-55.00)min, P=0.575] decreased, although the differences between the two groups were not statistically significant. In the comparison between survival and death groups, the proportion of initial shockable rhythm was significantly higher in the survival group (75% vs. 20%). CA-Pump On time [61( IQR49.25-69.25)min vs.69( IQR58.0-89.0)min, P=0.287]and ECMO initiation-Pump On time[39( IQR29.25-51.75)min vs.43( IQR34.0-52.0)min, P=0.539] were lower in the survival group, but the differences were not statistically significant. Conclusions:Independent implementation of ECPR for adult cardiac arrest at the county-level primary hospital improves the success rate of resuscitation and enhances patient prognosis. The promotion of ECPR rescue technology in county hospitals is feasible and significant, benefiting a larger population of cardiac arrest patients.

Objective To explore the risk factors for the returning of pediatric liver transplant recipi-ents to the intensive care unit(ICU)and provide reference for the clinical decision-making after surgery.Methods A retrospective analysis was conducted with the information of all the pediatric patients who underwent liver transplantation in Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine and were returned to the ICU from 2019 to 2021.The patients returned to the ICU during hospitalization and the reasons for the return were recorded.Each patient of ICU return was matched with three pediatric patients who did not return to the ICU during hospitalization.The basic information,the vital signs and laboratory indicators on the day of transfer from ICU,immunosuppressants and drug concentrations were compared between the two groups.Multivariate Logistic regression analysis was performed to explore the risk factors for the returning of pediatric liver transplant recipients to the ICU.Results The returning rate of pediatric liver transplant recipients to the ICU was 4.36％,and it was 16.00％within 48 h.The main reasons for the return included respiratory complications,abdominal infections,and hepatic vascular occlusion.Multivariate Logistic regression analysis showed that post-operative red blood cell transfusion(OR=4.554,95％CI=1.743-11.901,P=0.002)and high serum level of uric acid(OR=1.005,95％CI=1.001-1.009,P=0.014)were the risk factors for returning to the ICU.High diastolic blood pressure(OR=0.922,95％CI=0.885-0.960,P＜0.001)and high total protein level(OR=0.937,95％CI=0.891-0.986,P=0.012)were the protective factors for returning to the ICU.Conclusion Post-operative red blood cell transfusion and high serum level of uric acid are independent risk factors for the returning of pediatric liver transplant recipients to the ICU.

Objective To observe the value of pseudo-continuous arterial spin labeling(PCASL)MRI for evaluating renal function in patients with renal occupying lesions.Methods Totally 56 patients with single renal occupying lesion were retrospectively enrolled.The left and right side kidneys were divided into normal renal function group(normal group,30 ml/min)and damaged renal function group(damaged group,＜30 ml/min)according to glomerular filtration rate(GFR)measured with 99Tcm-DTPA dynamic renal imaging,respectively.The total renal blood flow(tRBF)and cortical renal blood flow(cRBF)were calculated using total nephrometry and cortical nephrometry based on PCASL MRI,respectively,then GFR,tRBF and cRBF were compared between groups on the same side.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of tRBF and cRBF for assessing unilateral renal injury.Pearson correlation analysis was performed to observe the correlations of tRBF and cRBF with GFR.Results GFR,tRBF and cRBF in left/right damaged group were all significantly lower than those in ipsilateral normal group(all P＜0.05).AUC of tRBF and cRBF for assessing left renal injury was 0.823 and 0.813,respectively,being not significantly different(P＞0.05).AUC of tRBF and cRBF for assessing right renal injury was 0.940 and 0.922,respectively,being not significantly different(P＞0.05).No obvious correlation of bilateral tRBF nor cRBF with GFR was found(all P＞0.05).Conclusion PCASL MRI could effectively evaluate renal function in patients with renal occupying lesion,and the efficacy of total nephrometry was comparable to that of cortical nephrometry.

Objective: To understand the prevalence and influencing factors of scoliosis among primary and middle school students in Shanghai, so as to provide reference for the prevention and control strategies of scoliosis in children and adolescents. Methods: From September to December 2021, a total of 4 531 students from grade four of primary school to grade three of junior high school from 16 primary and middle schools in 4 districts of Shanghai were selected by multi stage stratified cluster sampling to carry out scoliosis screening and questionnaire survey. Independent sample t-test, Chi-squared test, Fisher s exact probability method and nonparametric Mann Whitney U-test were used for statistical analysis, and multivariate Logistic regression was used to analyze the influencing factors of scoliosis. Results: The on the spot detection rate of scoliosis abnormality was 7.4% and the prevalence was 2.2%, mainly for thoracolumbar scoliosis (60.4%) and the scoliosis angle of 10° -<20°(88.1%). The results showed that the detection rate of scoliosis in boys was 1.6% and in girls was 3.3%, with a statistically significant difference ( χ 2=11.84, P < 0.01). There were significant differences in weight and BMI between scoliosis students and students with negative initial screening( t = -3.77, -5.30, P <0.01). And there was a statistically significant difference in the detection rate of scoliosis with different frequency of classroom seating arrangements ( Z =2.02, P <0.05). The results of multivariate Logistic regression showed that the risk of scoliosis in girls was higher than that in boys ( OR =1.87, 95% CI =1.21-2.88). BMI ( OR =0.89, 95% CI =0.83-0.95) and frequency of classroom seating arrangements ( OR =0.49, 95% CI =0.25-0.93) were correlated with lower rate of scoliosis. After stratification by sex, the frequency of classroom seating arrangements ( OR =0.26, 95% CI =0.10-0.67) in boys and the educational stage ( OR =2.35, 95% CI =1.26-4.41) in girls ( P <0.05) was correlated with higher rate of scoliosis, while BMI ( OR =0.86, 95% CI =0.79-0.94) in girls were correlated with lower rate of scoliosis. Conclusion Regular screening of scoliosis is an effective method for early detection of scoliosis. Girls in junior high school and low BMI should be paid close attention to. According to the occurrence and influencing factors of scoliosis, comprehensive prevention and control based on family, school, society, and other aspects can be carried out.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective:To investigate the incidence and influencing factors of parastomal hernia in patients with permanent colostomy.Methods:The retrospective cohort study was conduc-ted. The clinicopathological data of 72 patients with permanent colostomy in the Beijing Friendship Hospital of Capital Medical University from January 2016 to June 2020 were collected. There were 50 males and 22 females, aged (66±12)years. Observations indicators: (1) follow-up; (2) analysis of factors affecting the incidence of parastomal hernia; (3) comparison of the incidence of parastomal hernia in patients with different age. Follow-up was conducted using outpatient examination. Patients were followed up once every 12 months after surgery to detect the incidence of parastomal hernia up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers and percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model. Kaplan-Meier method was used to draw the parastomal hernia occurrence curve and calculate the incidence rate of parastomal hernia and Log-rank test was used to analyze the incidence of parastomal hernia. Results:(1) Follow-up. All 72 patients were followed up for 23(range, 12?76)months. During the follow-up, there were 31 patients developed parastomal hernia, with the incidence as 20.8%(15/72), 36.1%(26/72) and 43.1%(31/72) at postoperative 1 year, postoperative 2 year and postoperative 5 year, respectively. Of the 31 patients with parastomal hernia, there were 21 cases of type Ⅰ, 3 cases of type Ⅱ and 7 cases of type Ⅲ. Patients with parastomal hernia recovered with conservative treatment. (2) Analysis of factors affecting the incidence of parastomal hernia. Results of univariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were related factors affecting the incidence of parastomal hernia ( χ2=7.98, t=?2.95, 2.02, P<0.05). Results of multivariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were independent factors affecting the incidence of parastomal hernia ( odds ratio=4.07, 3.19, 0.07, 95% confidence interval as 1.46?11.32, 1.43?7.09, 0.01?0.84, P<0.05). (3) Comparison of the incidence of parastomal hernia in patients with different age. Of the 72 patients, there were 37 cases with age <65 years and 35 cases with age >65 years. Of the 31 patients with parastomal hernia, there were 10 cases with age<65 years and all of them with type Ⅰ parastomal hernia, and the incidence of parastomal hernia in postoperative 1 year and postoperative 2 year was 13.5%(5/37) and 27.0%(10/37), respectively. There were 21 cases with age ≥65 years and cases with type Ⅰ, type Ⅱ and type Ⅲ parastomal hernia were 11, 3 and 7, respectively. The postoperative 1 year and postoperative 2 year incidence of parastomal hernia in the 21 cases was 28.6%(10/35) and 45.7%(16/35), respectively. There was a significant difference in the incidence of parastomal hernia between patients<65 years and ≥65 years ( χ2=9.28, P<0.05). Conclusion:Age, subcutaneous fat thickness and rectus abdominis thickness are independent factors affecting the incidence of parastomal hernia.

Objective:To investigate the clinical features and prognosis of extranodal nasal-type NK/T-cell lymphoma of the extra-upper aerodigestive tract (extra-UADT NKTCL).Methods:The clinical data of 159 patients with extra-UADT NKTCL from the China Lymphoma Collaborative Group (CLCG) database between November 2001 and December 2015 were retrospectively analyzed. Kaplan-Meier survival analysis and Log-rank test were used to evaluate the prognosis. The Cox regression model is used for multi-factor analysis.Results:Extra-UADT NKTCL commonly occurs in skin and soft tissues (106/159, 66.7%) and gastrointestinal tract (31/159, 19.5%). The incidences of elevated lactate dehydrogenase (LDH) and Ann Arbor Ⅲ~Ⅳ stage were 47.8% (76/159) and 64.2% (102/159), respectively. The 3-year overall survival (OS) and progression-free survival (PFS) rates were 43.6% and 27.9%, respectively. The corresponding OS rates of primary skin/soft tissue site and gastrointestinal tract site were 41.0% and 59.4% ( P=0.281), while the PFS rates were 24.8% and 48.3%, respectively ( P=0.109). Combined modality treatment improved the 3-year OS of all the patients (58.4% vs 33.9%, P=0.001) and 3-year PFS (40.7% vs 20.7%, P=0.008) when compared with chemotherapy alone. LDH elevation, Ann Arbor synthesising and ≥2 junction external bits were intrusive as independent risk factors for total survival ( P<0.05), LDH elevation and ≥2 junction outer bits were intrusive as independent risk factors for progressionless survival( P<0.05). The distant extranodal dissemination was the primary failure patterns. Conclusions:Extra-UADT NKTCL appears to have distinct clinical characteristics and poor outcome. Compared with chemotherapy alone, combined modality treatment may improve the prognosis of patients with extra-UADT NKTCL.