Cirrhotic portal hypertension is a clinical syndrome caused by persistently elevated portal venous pressure due to liver cirrhosis and can lead to a series of complications， among which esophagogastric variceal bleeding has become one of the most severe complications due to sudden onset and a high mortality rate. Since the release of Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension （2019 edition）， significant advances have been achieved in this field in China and globally. In order to formulate an expert consensus aligned with the situation of China， Chinese Society of Surgery， Chinese Medical Association organized and compiled Expert Consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension （2025 edition）. This article elaborates on the key updates in the new edition and explores the major differences between the old and new editions， in order to enhance the understanding of the new edition among clinicians and provide a reference for clinicians in clinical work.

The compilation instructions for the Expert Consensus on Clinical Application of Yifei Zhike Capsules systematically expound the development background， methodological framework， and core achievements of this consensus. In view of the problems existing in the clinical application of Yifei Zhike Capsules， such as insufficient efficacy evidence and lack of standardized syndrome differentiation， the Institute of Basic Research in Clinical Medicine， China Academy of Chinese Medical Sciences took the lead and collaborated with 21 tertiary grade-A hospitals and research institutions across China to form a multidisciplinary expert group （comprising 30 experts in clinical medicine， pharmacy， and methodology）. The compilation work was carried out in strict accordance with the World Health Organization （WHO） guidelines， the GB/T 1.1-2020 standard， and the writing specifications for the explanatory notes of expert consensus on clinical application of Chinese patent medicines. Through systematic literature retrieval （including 32 studies， with 24 clinical studies）， Grading of Recommendations Assessment， Development and Evaluations （GRADE）-based evidence grading， and multiple rounds of discussions using the nominal group method （25 experts voted to determine 17 clinical questions）， 5 evidence-based recommendations and 11 expert consensus suggestions were formed. It is clarified that this medicine （Yifei Zhike Capsules） is applicable to the treatment of expectoration/hemoptysis in acute and chronic bronchitis and the adjuvant treatment of pulmonary tuberculosis. It is recommended that it can be used alone or in combination with anti-tuberculosis drugs. The safety evaluation shows that this medicine mainly induces the following adverse reactions： mild gastrointestinal reactions （such as nausea and abdominal pain） and rashes. The contraindicated populations include pregnant women and women during menstruation. The compilation process of the consensus underwent three rounds of expert letter reviews， two rounds of peer reviews， and quality control assessments to ensure methodological rigor and clinical applicability. In addition， through policy alignment， academic promotion， and a dynamic revision mechanism， the standardization of clinical application was promoted， providing a demonstration for the evidence-based transformation of characteristic therapies of Miao medicine.

Objective To explore the value of oral contrast-enhanced ultrasonography (OCEUS) combined with contrast-enhanced CT in predicting preoperative T staging in patients with gastric cancer. Methods A retrospective analysis was conducted on 80 patients with gastric cancer confirmed via endoscopic biopsy or postoperative pathology at the First People’s Hospital of Jining from January 2021 to November 2024. The cohort included 56 males and 24 females, aged 38-79 years, with a median age of 55.9 years. All patients underwent both OCEUS and contrast-enhanced CT within one week prior to surgery. T staging of gastric cancer was determined using OCEUS, contrast-enhanced CT, or their combination. The results were compared with pathological T staging, and statistical differences in accuracy were analyzed. Results Pathological T staging identified T1 in 9 cases, T2 in 16 cases, T3 in 42 cases, and T4 in 13 cases. OCEUS indicated T1 in 6 cases, T2 in 14 cases, T3 in 50 cases, and T4 in 10 cases, with an accuracy rate of 80.0%. Contrast-enhanced CT indicated T1 in 4 cases, T2 in 12 cases, T3 in 52 cases, and T4 in 12 cases, with an accuracy rate of 75.0%. The combination of OCEUS and contrast-enhanced CT indicated T1 in 6 cases, T2 in 15 cases, T3 in 47 cases, and T4 in 12 cases, with an accuracy rate of 87.5%. The combined approach demonstrated significantly higher accuracy in preoperative T staging compared to either method alone (P < 0.05). Conclusion The combination of OCEUS and contrast-enhanced CT improves the accuracy of preoperative T staging in gastric cancer patients, providing valuable support for their diagnosis and treatment.

OBJECTIVES: To investigate the role of DTX2 in regulating biological behaviors of oxaliplatin-resistant colorectal cancer cells (CRC/OXA cells). METHODS: CCK8 assay was used to determine the inhibition rate of oxaliplatin-treated CRC cells. A CRC/OXA cell line was constructed, in which DTX2 expression level was detected. The cells were transfected with a DTX2-shRNA plasmid or co-transfected with DTX2-shRNA and pcDNA-Notch2, and the changes in cell proliferation, migration and invasion ability were evaluated using plate cloning assay, scratch assay and Transwell invasion assay. The expression levels of Notch2, NICD and epithelial-mesenchymal transition (EMT) proteins of the transfected cells were detected with Western blotting. In a nude mouse model bearing SW620/OXA cell xenografts, the effects of DTX2 knockdown and Notch2 overexpression in the implanted cells on tumor growth and protein expressions were tested. RESULTS: The IC₅₀ of oxaliplatin was 6.00 μmol/L in SW620 cells and 8.00 μmol/L in LoVo cells. CRC/OXA cells showed a significantly increased expression of DTX2. DTX2 knockdown in CRC/OXA cells significantly inhibited cell proliferation, migration and invasion, and these effects were reversed by co-transfection of the cells with pcDNA-Notch2. DTX2 knockdown significantly reduced the expression levels of Notch2, NICD and vimentin proteins and increased E-cadherin expression in CRC/OXA cells, and co-transfection with pcDNA-Notch2 potently attenuated the changes in these proteins. In the tumor-bearing mice, DTX2 overexpression obviously promoted the growth of SW620/OXA cell xenograft, enhanced the protein expressions of Notch2, NICD and vimentin, and lowered the expression of E-cadherin. CONCLUSIONS High expression of DTX2 promotes proliferation, migration, invasion and EMT of CRC/OXA cells through the Notch2 signaling pathway, suggesting the potential of DTX2 as a target to improve the efficacy of oxaliplatin.
Epithelial-Mesenchymal Transition ; Humans ; Cell Proliferation ; Oxaliplatin ; Colorectal Neoplasms/metabolism* ; Animals ; Drug Resistance, Neoplasm ; Receptor, Notch2/metabolism* ; Cell Line, Tumor ; Mice, Nude ; Cell Movement ; Organoplatinum Compounds/pharmacology* ; Neoplasm Invasiveness ; Mice

OBJECTIVES: To explore the molecular mechanism of Jiangzhi Huaban Decoction (JZHBD) for improving atherosclerosis through the "qi meridian-blood channels" pathway. METHODS: ApoE^-/- mouse models of atherosclerosis were established by high-fat diet feeding for 8 weeks, with C57BL/6 mice on a normal diet as the controls. Forty ApoE^-/- mouse models were randomized into model group, low-, medium-, and high-dose JZHBD treatment groups, and atorvastatin treatment group (n=8) for their respective treatments for 8 weeks. The changes in body weight and overall condition of the mice were monitored weekly. After the treatments, serum levels of TC, TG, HDL-C, LDL-C, TBA, ALT, and AST of the mice were measured, pathological changes in the liver and aortic root plaques were examined with HE staining, and lipid accumulation in the liver and aortic wall was assessed using Oil Red O staining. The core molecular mechanism was studied through transcriptomics, and the expressions of the key pathway proteins were confirmed using Western blotting and immunohistochemistry. RESULTS: Treatment with JZHBD significantly reduced blood lipid and total bile acid levels, improved liver function and hepatic steatosis, and decreased aortic lipid deposition and plaque area in the mouse models of atherosclerosis. Transcriptomic analysis suggested that the therapeutic mechanism of JZHBD involved reverse cholesterol transport, PPAR signaling, and the inflammatory pathways. In atherosclerotic mice, JZHBD treatment obviously up-regulated hepatic expressions of PPARγ, LXRα, ABCA1, ABCG1, and CYP7A1, down-regulated hepatic expressions of p-p65/p65, IL-6, IL1β in the liver, increased ABCG5 and ABCG8 expressions in the intestines, and decreased ICAM-1 and VCAM-1 expressions in the aortic plaques. CONCLUSIONS JZHBD improves atherosclerotic vascular damage and plaque formation possibly by regulating hepatic reverse cholesterol transport and inflammation via modulating the hepatic PPARγ/LXRα/NF-κB signaling pathway.
Animals ; Drugs, Chinese Herbal/therapeutic use* ; Mice, Inbred C57BL ; Plaque, Atherosclerotic/metabolism* ; Liver/metabolism* ; Mice ; Atherosclerosis/metabolism* ; Cholesterol/metabolism* ; PPAR gamma/metabolism* ; Male ; Diet, High-Fat ; Biological Transport

Objective:To investigate the treatment approaches and outcomes of early hepatic artery thrombosis (E-HAT) in adult recipients following orthotopic liver transplantation (OLT).Methods:A retrospective analysis was conducted on clinical data of E-HAT cases after adult OLT at the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to June 2022. Clinical characteristics, treatment methods, therapeutic outcomes, long-term survival of recipients and grafts, and the incidence of long-term complications were summarized. The Kaplan-Meier method was utilized to calculate recipient survival rates.Results:Among 1 016 OLT recipients, 22 cases (2.2%) developed postoperative E-HAT. There were 19 males and 3 females, with a age of 44.81±9.98 years. E-HAT was diagnosed via angiography at a median of 3.5 (1.0, 7.0) days post-OLT. Twenty recipients underwent vascular intervention therapy, achieving clinical success in 14 cases (70.0%) with a mean thrombolysis duration of 5.1±3.2 days. Twelve cases (60.0%) experienced complications, including abdominal bleeding (10 cases), gastrointestinal bleeding (1 case), catheter-related infection (1 case), subcutaneous bleeding (1 case), and hepatic artery dissection (1 case). Five recipients underwent hepatic artery re-anastomosis, including two initial cases and three following failed interventional therapy. Surgery was performed at a median of 5.0 (1.0, 15.3) days post OLT, with 4 successful cases. Through combined interventional and surgical treatment, 81.8% (18/22) of grafts were salvaged. However, the success rate was significantly lower in cases with marked transaminase (AST, ALT) and total bilirubin elevation (16/18 vs 2/4). Nineteen E-HAT survivors were followed for a median of 22 (5, 52) months. During follow-up, 2 cases experienced thrombus recurrence, and 12 cases developed biliary complications, including ischemic biliary stenosis (11 cases), extensive liver necrosis (1 case), localized liver abscess (1 case), and biliary anastomotic stenosis (1 case). Seven recipients died due to graft failure. The 1-year, 3-year and 5-year cumulative survival rates were 67.2%, 60.5% and 34.5%, respectively.Conclusions:Combined interventional and surgical treatment demonstrates a high success rate for managing E-HAT, particularly when addressed before significant graft damage. Ischemic biliary stenosis remains the most common long-term complication.

Objective To explore the role and possible mechanism of adenosine monophosphate(AMP)-dependent protein kinase(AMPK)/insulin receptor(IR)/insulin receptor substrate(IRS1)pathway in myocardial insulin resistance in diabetic mice.Methods Thirty C57BL/6J mice were randomly divided into control group,diabetes group and AMPK-activated group according to the experimental design,with 10 mice in each group.Fasting blood glucose(FBG)was detected by a dynamic blood glucose detector detected.Glycosylated hemoglobin kit(HbA1c)was used to detect the level of HbA1c in mice.Fasting insulin(FINS)was detected by insulin detection kit in mice.Heart rate(HR),left ventricular end-systolic diameter(LVIDd),left ventricular end-diastolic diameter(LVIDs),ejection fraction(EF)and left ventricular fractional shortening(LVFS)were measured by echocardiography.Masson staining was used to detect myocardial collagen deposition in mice.The levels of total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),glutathione(GSH),malondialdehyde(MDA)and reactive oxygen species(ROS)were detected by ELISA kit.The protein levels of AMPK,IR and IRS1 in myocardial tissue were detected by Western blotting(WB).RT-qPCR detected the mRNA levels of AMPK,IR and IRS1 in myocardial tissue.Results Compared with the control group,the levels of FBG,HbA1c,FINS,TC,TG and LDL-C in diabetic group were increased(t=14.94～63.46),the cardiac function indexes HR,EF and LVFS decreased(t=56.62,199.00,42.50),LVIDd increased(t=176.80),and the differences were statistically significant(all P<0.05),and there was no significant difference in LVIDs(t=3.46,P>0.05).The collagen deposition around small blood vessels in myocardial interstitial was increased,and the serum GSH level was decreased(t=5.75),ROS and MDA levels increased(t=22.60,15.18),the expression levels of AMPK,IR,IRS1 protein(t=7.00,4.33,3.66)and mRNA(t=2.61,5.17,6.79)in myocardial tissue decreased,and the differences were statistically significant(all P<0.05).Compared with diabetic group,the levels of FBG,HbA1c,FINS,TC,TG and LDL-C in AMPK activated group were decreased(t=9.14～56.34),the cardiac function indexes HR,EF and LVFS increased(t=135.90,152.00,41.99),LVIDd decreased(t=203.20),and the differences were statistically significant(all P<0.05),and there was no significant difference in LVIDs(t=1.58,P>0.05).Perivascular collagen deposition decreased and serum GSH level increased(t=19.60),ROS and MDA levels decreased(t=32.90,23.44),the expression levels of AMPK,IR,IRS1 protein(t=15.14,29.44,17.15)and mRNA(t=11.52,9.67,8.49)in myocardial tissue increased,and the differences were statistically significant(all P<0.05).Conclusion Activation of AMPK can improve the cardiac function structure,reduce blood glucose and lipid levels and reduce oxidative stress levels in diabetic mice.The mechanism of action may be related to insulin resistance mediated by AMPK/IR/IRS1 pathway.

This report describes a 72-year-old male patient with occipitotemporal cavernous hemangioma(CCH).The patient presented with persistent pain in the right occipital and retro auricular areas for over one year.Physical examination detected a tender mass in the right occipital region.Imaging studies showed destruction of the right occipitotemporal bone with a heterogeneous signal mass and irregular enhancement on magnetic resonance imaging(MRI).Positron emission tomography/computed tomography(PET/CT)examination revealed increased fluorodeoxyglucose(FDG)uptake(SUVmax=5.9),suggesting a benign lesion.Complete surgical excision of the tumor and involved skull was performed,with pathological diagnosis confirming cavernous hemangioma.The patient's symptoms completely resolved with no recurrence during three months of follow-up.This case represents the first report of PET/CT application in diagnosing occipitotemporal CCH,providing valuable reference for improving diagnostic accuracy and reducing misdiagnosis rates for this rare condition.

Objective To explore the mechanism of acupuncture protection of quadriceps muscle cells in knee osteoarthritis model rats based on Piezo1/YAP/Caspase3 axis.Methods 40 SPF grade Wistar rats were selected and adaptively fed for 7 days before being divided into three groups:sham surgery group,model group,western medicine group,and acupuncture group,with 10 rats in each group,according to a random control table.The model group,Western medicine group,and acupuncture group used the modified Hulth method to construct knee osteoarthritis models,while the sham surgery group only cut open the joint cavity and sutured it.After successful model replication,the sham surgery group was given physiological saline by gavage,the western medicine group was given celecoxib solution by gavage,and the acupuncture group was given acupuncture at the infrapatellar,crane top,and blood sea levels.Each group was intervened once a day for 14 consecutive days.During the treatment period,the rats continued to undergo treadmill training.After the intervention,the hematoxylin eosin staining method(HE)was used to detect the morphological changes of various rat quadriceps muscle tissues and articular cartilage;TUNEL method was used to detect apoptosis of quadriceps muscle cells,immunofluorescence method was used to detect the protein expression of Piezo1,YAP,and p-YAP in quadriceps muscle cells,Western blot method was used to detect the expression of anti apoptotic proteins CTGF,AREG,Gli2,AFP in quadriceps muscle tissue,as well as the protein expression levels of apoptosis related proteins Bcl-2,Bcl-xl,Bax,cytc,and Caspase3.Results Compared with the model group,the western medicine group and the acupuncture group had higher thigh circumference,quadriceps wet weight,wet weight maintenance rate,and wet weight to body weight ratio(P<0.05).Compared with the western medicine group,the acupuncture group had higher thigh circumference,quadriceps wet weight,wet weight maintenance rate,and wet weight to body weight ratio(P<0.05).Compared with the model group,the apoptosis index of the quadriceps muscle in the Western medicine group and acupuncture group rats was lower,and the apoptosis index of the quadriceps muscle in the acupuncture group was lower(P<0.05).Compared with the model group,the Western medicine group and acupuncture group showed higher expression of Piezo1 and p-YAP proteins in the quadriceps femoris muscle tissue,lower expression of YAP protein,higher expression of CTGF,AREG,Gli2,AFP proteins,higher expression of Bcl-2 and Bcl-xl proteins,and lower expression of Bax,cytc,and Caspase3 proteins(P<0.05).Compared with the Western medicine group,the acupuncture group showed higher expression of Piezo1 and p-YAP proteins in the quadriceps muscle tissue,lower expression of YAP protein,higher expression of CTGF,AREG,Gli2,AFP proteins,higher expression of Bcl-2 and Bcl-xl proteins,and lower expression of Bax,cytc,and Caspase3 proteins(P<0.05).Conclusion Acupuncture increases the expression of Piezo1 protein in the quadriceps femoris muscle of knee osteoarthritis model rats,promotes the phosphorylation of YAP into the nucleus,thereby promoting proliferation,anti apoptotic proteins CTGF,AREG,Gli2,and AFP protein expression,inhibiting Caspase3-dependent mitochondrial apoptosis,and protecting muscle cells.