Objective To explore the high-risk factors and prevention strategies for rebleeding in patients with upper gastrointestinal hemorrhage(UGIH)treated with endoscopy,and construct a predictive model.Methods 97 patients with UGIH who experienced rebleeding after endoscopic treatment from January 2020 to December 2023 were selected as the observation group,and another 178 patients with UGIH who did not experience rebleeding after endoscopic treatment admitted during the same period were selected as the control group,both groups were followed up for 1 year after endoscopic treatment.Clinical data of the two groups was compared,the high-risk factors for rebleeding after endoscopic treatment in patients with UGIH were analyzed by multivariate Logistic regression analysis,a predictive model was constructed,and the predictive value of the model for rebleeding after endoscopic treatment in patients with UGIH was analyzed by plotting a receiver operator characteristic curve(ROC curve)to analyze.Results The proportions of patients in the observation group with liver cirrhosis,shock,endoscopic active bleeding,Forrest classification of Ia to Ib,level of blood hemoglobin≤90 g/L,and level of blood platelet≤100×109/L were 55.67%,14.43%,37.11%,62.89%,23.71%,and 23.71%,respectively,which were higher than the control group's 41.57%,2.25%,18.54%,44.38%,3.37%,and 7.87%.The level of serum D-dimer(D-D)of the observation group was higher than that of the control group,and the bleeding volume of the observation group was more than that of the control group,the prothrombin time(PT)of the observation group was longer than that of the control group(P<0.05).Multivariate Logistic regression analysis showed that:cirrhosis((O＾R)=2.423,95%CI:1.124～5.224),shock((O＾R)=6.897,95%CI:1.487～31.995),endoscopic active bleeding((O＾R)=2.604,95%CI:1.109～6.118),Forrest grading of Ia to Ib((O＾R)=2.494,95%CI:1.162～5.354),level of blood hemoglobin≤90 g/L((O＾R)=5.270,95%CI:1.797～15.442),level of blood platelet≤100×109/L((O＾R)=5.018,95%CI:1.733～14.531),bleeding volume>189.61 mL((O＾R)=1.025,95%CI:1.016～1.034),PT>15.99 s((O＾R)=1.996,95%CI:1.618～2.460)were both risk factors for rebleeding in UGIH patients after endoscopic treatment(P<0.05).Regression equation model:logit(P)=-18.551+cirrhosis×0.885+shock×1.931+endoscopic active bleeding×0.957+Forrest grading×0.914+level of blood hemoglobin×1.662+level of blood platelet×1.613+bleeding volume×0.025+PT×0.691.The ROC curve for predicting rebleeding in UGIH patients after endoscopic treatment was plotted according to the diagnostic probability logit(P).When logit(P)>0.30,the 95%CI was 0.891～0.955,and the diagnostic sensitivity and specificity were 88.66%and 83.15%,respectively.The area under the curve(AUC)value was 0.923.Conclusion The cirrhosis,shock,endoscopic active bleeding,Forrest grade Ia to Ib,level of blood hemoglobin≤90 g/L,level of blood platelet≤100×109/L,bleeding volume>189.61 mL,and PT>15.99 s are independent risk factors for rebleeding after endoscopic treatment in patients with UGIH.The model constructed based on this has high predictive value,which can be used clinically to provide personalized intervention and treatment for high-risk patients to reduce or avoid the occurrence of rebleeding.

Objective:To investigate the autophagy level of CD8+T cells in rat model of chronic obstructive pulmonary disease(COPD)and correlation with its number,and to explore the role of autophagy in pathogenesis of COPD.Methods:Thirty-six 6-week-old male SD rats were divided into three groups,including normal control group,COPD group and COPD intervention group.COPD model was established by smoking,and intraperitoneal injection of 3-methyladenine(3-MA)was used for intervention.Lung function of rats was detected by small animal pulmonary function testing,and frequency of CD8+T cells,CD8+memory T cells,CD8+effector T cells in blood and lung of rats were detected by flow cytometry.CD8+T cells were sorted by immunomagnetic beads,and expressions of autophagy protein including LC3-Ⅱ/Ⅰ,Beclin-1 and p62 in CD8+T cells were detected by Western blot.The middle lobe of right lung was collected for histological observation.Results:Infiltration of inflammatory cells and the decline of lung function in COPD group were more obvious than those in normal group.Frequency of CD8+T cells,CD8+effector T cells and CD8+memory T cells in blood and lung of rats in COPD group were significantly higher than those in normal control group(all P<0.05).Level of autophagy protein,LC3-Ⅱ/Ⅰ and Beclin-1 of CD8+T cells in COPD group were significantly higher than that in normal control group,while level of p62 was lower than that in normal control group(P<0.01).CD8+T cells,CD8+effector T cells,CD8+memory T cells in COPD intervention group were significantly lower than those in COPD group(P<0.05).Correlation analysis showed that LC3-Ⅱ/Ⅰ expression level was positively correlated with frequency of CD8+T cells in blood(r=0.667,P<0.01).Expression level of Beclin-1 was positively correlated with frequency of CD8+T cells and CD8+effector T cells in blood(r=0.505,P=0.021;r=0.428,P=0.037).Expression of LC3-Ⅱ/Ⅰprotein was positively correlated with frequency of CD8+T cells and CD8+effector T cells in lung tissue(r=0.474,P=0.019;r=0.549,P=0.006).Expression of Beclin-1 was positively correlated with frequency of CD8+effector T cells in lung tissue(r=0.458,P=0.025).Conclusion:Level of CD8+T cell autophagy is correlated with its number.CD8+T cell autophagy may be involved in the chronic inflam-matory process of COPD,and 3-MA can inhibit COPD inflammation.

Objective To explore the high-risk factors and prevention strategies for rebleeding in patients with upper gastrointestinal hemorrhage(UGIH)treated with endoscopy,and construct a predictive model.Methods 97 patients with UGIH who experienced rebleeding after endoscopic treatment from January 2020 to December 2023 were selected as the observation group,and another 178 patients with UGIH who did not experience rebleeding after endoscopic treatment admitted during the same period were selected as the control group,both groups were followed up for 1 year after endoscopic treatment.Clinical data of the two groups was compared,the high-risk factors for rebleeding after endoscopic treatment in patients with UGIH were analyzed by multivariate Logistic regression analysis,a predictive model was constructed,and the predictive value of the model for rebleeding after endoscopic treatment in patients with UGIH was analyzed by plotting a receiver operator characteristic curve(ROC curve)to analyze.Results The proportions of patients in the observation group with liver cirrhosis,shock,endoscopic active bleeding,Forrest classification of Ia to Ib,level of blood hemoglobin≤90 g/L,and level of blood platelet≤100×109/L were 55.67%,14.43%,37.11%,62.89%,23.71%,and 23.71%,respectively,which were higher than the control group's 41.57%,2.25%,18.54%,44.38%,3.37%,and 7.87%.The level of serum D-dimer(D-D)of the observation group was higher than that of the control group,and the bleeding volume of the observation group was more than that of the control group,the prothrombin time(PT)of the observation group was longer than that of the control group(P<0.05).Multivariate Logistic regression analysis showed that:cirrhosis((O＾R)=2.423,95%CI:1.124～5.224),shock((O＾R)=6.897,95%CI:1.487～31.995),endoscopic active bleeding((O＾R)=2.604,95%CI:1.109～6.118),Forrest grading of Ia to Ib((O＾R)=2.494,95%CI:1.162～5.354),level of blood hemoglobin≤90 g/L((O＾R)=5.270,95%CI:1.797～15.442),level of blood platelet≤100×109/L((O＾R)=5.018,95%CI:1.733～14.531),bleeding volume>189.61 mL((O＾R)=1.025,95%CI:1.016～1.034),PT>15.99 s((O＾R)=1.996,95%CI:1.618～2.460)were both risk factors for rebleeding in UGIH patients after endoscopic treatment(P<0.05).Regression equation model:logit(P)=-18.551+cirrhosis×0.885+shock×1.931+endoscopic active bleeding×0.957+Forrest grading×0.914+level of blood hemoglobin×1.662+level of blood platelet×1.613+bleeding volume×0.025+PT×0.691.The ROC curve for predicting rebleeding in UGIH patients after endoscopic treatment was plotted according to the diagnostic probability logit(P).When logit(P)>0.30,the 95%CI was 0.891～0.955,and the diagnostic sensitivity and specificity were 88.66%and 83.15%,respectively.The area under the curve(AUC)value was 0.923.Conclusion The cirrhosis,shock,endoscopic active bleeding,Forrest grade Ia to Ib,level of blood hemoglobin≤90 g/L,level of blood platelet≤100×109/L,bleeding volume>189.61 mL,and PT>15.99 s are independent risk factors for rebleeding after endoscopic treatment in patients with UGIH.The model constructed based on this has high predictive value,which can be used clinically to provide personalized intervention and treatment for high-risk patients to reduce or avoid the occurrence of rebleeding.

Objective:To investigate the autophagy level of CD8+T cells in rat model of chronic obstructive pulmonary disease(COPD)and correlation with its number,and to explore the role of autophagy in pathogenesis of COPD.Methods:Thirty-six 6-week-old male SD rats were divided into three groups,including normal control group,COPD group and COPD intervention group.COPD model was established by smoking,and intraperitoneal injection of 3-methyladenine(3-MA)was used for intervention.Lung function of rats was detected by small animal pulmonary function testing,and frequency of CD8+T cells,CD8+memory T cells,CD8+effector T cells in blood and lung of rats were detected by flow cytometry.CD8+T cells were sorted by immunomagnetic beads,and expressions of autophagy protein including LC3-Ⅱ/Ⅰ,Beclin-1 and p62 in CD8+T cells were detected by Western blot.The middle lobe of right lung was collected for histological observation.Results:Infiltration of inflammatory cells and the decline of lung function in COPD group were more obvious than those in normal group.Frequency of CD8+T cells,CD8+effector T cells and CD8+memory T cells in blood and lung of rats in COPD group were significantly higher than those in normal control group(all P<0.05).Level of autophagy protein,LC3-Ⅱ/Ⅰ and Beclin-1 of CD8+T cells in COPD group were significantly higher than that in normal control group,while level of p62 was lower than that in normal control group(P<0.01).CD8+T cells,CD8+effector T cells,CD8+memory T cells in COPD intervention group were significantly lower than those in COPD group(P<0.05).Correlation analysis showed that LC3-Ⅱ/Ⅰ expression level was positively correlated with frequency of CD8+T cells in blood(r=0.667,P<0.01).Expression level of Beclin-1 was positively correlated with frequency of CD8+T cells and CD8+effector T cells in blood(r=0.505,P=0.021;r=0.428,P=0.037).Expression of LC3-Ⅱ/Ⅰprotein was positively correlated with frequency of CD8+T cells and CD8+effector T cells in lung tissue(r=0.474,P=0.019;r=0.549,P=0.006).Expression of Beclin-1 was positively correlated with frequency of CD8+effector T cells in lung tissue(r=0.458,P=0.025).Conclusion:Level of CD8+T cell autophagy is correlated with its number.CD8+T cell autophagy may be involved in the chronic inflam-matory process of COPD,and 3-MA can inhibit COPD inflammation.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objectives To explore and compare the clinical characteristics and risk factors for mortality between patients with artificial quartz stone silicosis and those with classic silicosis. Methods A total of 48 patients with artificial quartz stone silicosis (experiment group) and 98 patients with classic silicosis (control group) were recruited as the research subjects using the convenience sampling method. Data of clinical symptoms, laboratory tests, high-resolution computed tomography (HRCT), and pulmonary pathology of the research subjects were retrospectively analyzed. The Cox proportional hazards regression model was used to analyze the influencing factors on the survival time of silicosis patients. Results Patients in the experiment group had shorter years of dust exposure, latency period and time since last exposure than those in the control group (all P<0.01). The positive rate of anti-nuclear antibodies and the expression of neuron-specific enolase in the experiment group were higher than those in the control group (39.6% vs 10.2%, median： 28.44 vs 16.25, both P<0.01). The PaO₂ levels in the experiment group were lower than those in the control group (median： 66.0 vs 89.0, P<0.01). The patients in the experiment group had lower vital capacity, inspiratory reserve volume, forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and carbon monoxide diffusion capacity compared to the control group (all P<0.05), but the maximal expiratory flow in 75% vital capacity was higher than the control group (P<0.05). Compared with the control group, patients in the experiment group had the presence of ground-glass opacity (GGO) in both lungs, aggregation and fusion of subpleural nodules, and gradual formation of progressive massive fibrosis (PMF), with higher potential of pneumothorax. Within 5 years after diagnosis, the mortality of patients in the experiment group was higher than that in the control group (27.1% vs 4.1%, P<0.01). The Cox regression model analysis results showed that patients with nodule aggregation on lung HRCT images had a higher risk of mortality than those without nodule aggregation, and lower lung function including vital capacity, FVC, FEV₁ and maximum expiratory flow in 25% vital capacity had higher risk of reduced survival time (all P<0.05). Conclusion Compared with patients with classic silicosis, patients with artificial quartz stone silicosis have higher level of serum neuron-specific enolase, increasing the risk of autoimmune diseases. Pulmonary imaging features in patients with artificial quartz stone silicosis include GGO, PMF and susceptibility to pneumothorax, and rare calcification of mediastinal lymph nodes, leading to a higher mortality rate within 5 years after diagnosis.

Objective:To analyze the MRI findings of tendinopathy of the common extensor tendon (CET) and common flexor tendon (CFT) and to explore its application for injury classification.Methods:Sixty-two patients with elbow tendinopathy of CET and/or CFT who were examined in the Radiology Department of Beijing Jishuitan Hospital from August 2019 to April 2022 were enrolled as the case group, and 20 healthy subjects (40 elbows) were recruited as the control group. The clinical data of patients and MRI findings of elbow joint of all subjects were reviewed. The MRI of tendinopathy of CFT and CET were read by 2 senior radiologists independently, and the consistency was tested by the κ test. The MRI manifestations for injury classification were discussed. Results:The κ values of CFT, CET, medial collateral ligament complex and lateral collateral ligament complex were 0.645, 0.657, 0.615 and 0.653 respectively. MRI clearly showed the anatomical structure of CFT, CET and surrounding soft tissue. The CFT and CET of the elbow of 20 normal volunteers (40 sides) in the control group showed thin line or banded low signal in each MRI sequence, and the muscle fibers were continuous. In 27 patients with classification Ⅰ injury of CFT and/or CET of elbow joint, MRI showed thickening or thinning of tendons and increased signal intensity on fat suppression T2-weighted imaging. In 27 cases of classification Ⅱ injury, MRI showed that the fluid signal involved 20% to 80% of the tendon thickness. In 8 cases of classification Ⅲ injury, MRI showed that the fluid signal involved more than 80% of the tendon thickness. Conclusions:Tendinopathy of CFT and CET of elbow joint has its characteristic MRI manifestations, indicating that MRI can be used for the diagnosis of tendinopathy. In addition, MRI can also be used for the injury classification.

Objective:To study the relationship between distal radioulnar joint (DRUJ) effusion and the integrity of triangular fibrcarotilage (TFC) in asymptomatic young adults.Methods:Thirty two asymptomatic young adults, 22 males and 10 females with a mean age of 25 year(20-30) were recruited in the study between September 2014 and October 2019. All subjects had no wrist pain, no wrist deformity or wrist mass, and had no history of wrist trauma or surgery. The DRUJ effusion was definedasfluid-like high signal intensityon fatsuppression proton density-weighted MRI.The presence of distal radioulnar joint effusion, the shape of the effusion, and the presence of triangular fibrocartilage abnormalities were documented.Results:Among 32 subjects, 25(78.1%, 15 males and 10 females) presented with distal radioulnar joint effusion on wrist MR images, including linear/tubular in 21 cases(84.0%) and saccular in 4 cases(16.0%).Twenty cases (62.5%) had distal radioulnar joint effusion while the TFC was intact, among whom, the effusion was confined to the proximal side of distal radioulnar jointin 17 cases, and reached the lower surface of TFC in 3 cases. In 5 cases (15.6%) with TFC tear, the effusion reached the lower surface of TFC in 4 cases. There were neutral, positive and negative variations of the ulna in 23, 6 and 3 cases, respectively, among whomthe distal radioulnar effusion was presented in 17, 5, 3 cases, and TFC tear in 1, 4 and 0 cases, respectively.The presence of distal radioulnar effusion was not significantly correlated with genders( P=0.069) or types of ulna variance( P=0.702). Conclusion:The distal radioulnar joint effusion maybe resent in asymptomatic young adults, and it maybe complicated with TFC tear.

Objective:To explore the anatomy and injuries features of the thumb extensor and flexor mechanism with MRI.Methods:Ten healthy subjects without thumb injury and 20 patients with thumb extensor or flexor mechanism injuries were recruited in the study between September 2013 and September 2021. All subjects underwent MRI examination, the MRI features of thumb extensor or flexor mechanism in healthy subjects and patients were analyzed. The imaging findings were compared with the surgical results and confirmed by followed up in patients.Results:The healthy subjects showed homogeneous low-signal-intensity on T1-weighted and proton-fat saturation sequence(PD FS) images. Twenty patients with thumb extensor or flexor mechanism injures(including 8 cases of extensor pollicislongusinjury,1 case of extensor pollicisbrevis injury, 4 cases of flexor pollicislongus injury, 2 cases offlexor pollicis brevis injury and 5casesofpulley injury) demonstrated poor definition in T1WI, and heterogeneously increased signal intensity in PD-FS. Depending on the degree of injury, the fibers may be partially or completely discontinuity of the involved tendons. There was edema in the soft tissues surrounding the injured sites.Conclusion:MRI is an accurate method for evaluation of the anatomy and pathological conditions of the thumb extensor and flexor mechanism.