Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective:To identify risk factors for mucus plug formation and to construct a nomogram-based predictive model in children with adenovirus pneumonia.Methods:In this retrospective cohort study, 149 pediatric patients diagnosed with adenovirus pneumonia were included. All patients underwent bronchoscopy at the Department of Respiratory Tianjin Children′s Hospital Machang District, between January and December 2024. Their demographic characteristics, clinical manifestations, laboratory findings, imaging features, and treatment details were analyzed.The information of patients were collected about clinical manifestations, laboratory findings, imaging features, and treatment information. Patients were divided into a mucus plug group and a non-mucus plug group based on bronchoscopic findings. Independent risk factors were determined using multivariable Logistic regression. And a predictive nomogram was subsequently developed. Model performance was evaluated using the area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test.Results:Of the 149 enrolled patients (84 boys, 65 girls), 49 cases were classified into the mucus plug group and 100 cases into the non-mucus plug group. Compared with their counterparts, children in the mucus plug group were older on admission ( P<0.05), more likely to have a recent history of lower respiratory tract infection, and exhibited a higher prevalence of consolidation or bronchiolitis patterns on chest imaging (all P<0.05), while preoperative corticosteroid use was less frequent ( P<0.05). Multivariable Logistic regression identified age on admission ( OR=1.14, 95% CI 1.01-1.29, P=0.031), lower respiratory tract infection ( OR=5.23, 95% CI 2.15-13.56, P<0.001), radiographic consolidation ( OR=2.64, 95% CI 1.10-6.61, P=0.032), and bronchiolitis pattern ( OR=2.39, 95% CI 1.04-5.60, P=0.042) as independent risk factors, whereas pre-bronchoscopy corticosteroid use was a protective factor ( OR=0.26, 95% CI 0.10-0.63, P=0.004). The nomogram predictive model demonstrated strong discriminative ability (area under the curve=0.83) and good calibration (Hosmer-Lemeshow P=0.358). Conclusions:The independent risk factors for mucus plug formation include older age, a recent history of lower respiratory tract infection, and chest imaging features of consolidation or bronchiolitis in pediatric adenovirus pneumonia. Pre-bronchoscopy corticosteroid therapy is a protective effect. The developed nomogram demonstrates favorable predictive performance and may facilitate early identification and timely intervention.

Objective:To compare the mortality of patients with septic shock in the intensive care unit of the emergency department of Beijing Chaoyang Hospital in 2012 and 2022, and analyze the risk factors affecting the prognosis of patients in each year.Methods:According to the diagnostic criteria of septic shock, 82 patients with septic shock admitted to the ICU of the emergency department of Beijing Chaoyang Hospital in 2012 and 52 patients with septic shock admitted to the ICU in 2022 were included. The clinical data of patients in each year and the related indicators that may affect the prognosis were compared. The risk factors of death in patients with septic shock in each year were screened by multivariate logistic regression analysis, and the predictive value of risk factors on death was evaluated by receiver operating characteristic (ROC) curve.Results:In 2012, 30 patients with septic shock died and 52 survived. The fatality rate was 36.59%. In 2022, 16 patients with septic shock died and 36 survived, with a fatality rate of 30.77%. There was significant difference in mortality between 2012 and 2022 (χ 2=6.805, P=0.009). In 2012 and 2022, the mortality of septic shock patients with different gender, age and Sequential Organ failure assessment (SOFA) score had statistical significance ( P<0.05). Multivariate logistic regression analysis showed that gender ( OR=1.554, P=0.037), lactic acid ( OR=1.062, P=0.035) and SOFA score ( OR=1.199, P=0.028) were the risk factors affecting the prognosis of patients in 2012, gender ( OR=1.234, P=0.028), total cholesterol ( OR=1.358, P=0.028) and SOFA score ( OR=1.388, P=0.034) were the risk factors affecting the prognosis of patients in 2022. ROC curve analysis results showed that SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2012 (all P<0.05), and lactic acid, total cholesterol and SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2022 (all P<0.05). Conclusions:The case fatality rate of septic shock patients in 2022 is lower than that in 2012, the morbidity and mortality rate of male patients are still higher than that of female patients, and the case fatality rate of patients increases with age. SOFA score was an independent risk factor for the prognosis of septic shock patients in 2012 and 2022.

Objective:To compare the mortality of patients with septic shock in the intensive care unit of the emergency department of Beijing Chaoyang Hospital in 2012 and 2022, and analyze the risk factors affecting the prognosis of patients in each year.Methods:According to the diagnostic criteria of septic shock, 82 patients with septic shock admitted to the ICU of the emergency department of Beijing Chaoyang Hospital in 2012 and 52 patients with septic shock admitted to the ICU in 2022 were included. The clinical data of patients in each year and the related indicators that may affect the prognosis were compared. The risk factors of death in patients with septic shock in each year were screened by multivariate logistic regression analysis, and the predictive value of risk factors on death was evaluated by receiver operating characteristic (ROC) curve.Results:In 2012, 30 patients with septic shock died and 52 survived. The fatality rate was 36.59%. In 2022, 16 patients with septic shock died and 36 survived, with a fatality rate of 30.77%. There was significant difference in mortality between 2012 and 2022 (χ 2=6.805, P=0.009). In 2012 and 2022, the mortality of septic shock patients with different gender, age and Sequential Organ failure assessment (SOFA) score had statistical significance ( P<0.05). Multivariate logistic regression analysis showed that gender ( OR=1.554, P=0.037), lactic acid ( OR=1.062, P=0.035) and SOFA score ( OR=1.199, P=0.028) were the risk factors affecting the prognosis of patients in 2012, gender ( OR=1.234, P=0.028), total cholesterol ( OR=1.358, P=0.028) and SOFA score ( OR=1.388, P=0.034) were the risk factors affecting the prognosis of patients in 2022. ROC curve analysis results showed that SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2012 (all P<0.05), and lactic acid, total cholesterol and SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2022 (all P<0.05). Conclusions:The case fatality rate of septic shock patients in 2022 is lower than that in 2012, the morbidity and mortality rate of male patients are still higher than that of female patients, and the case fatality rate of patients increases with age. SOFA score was an independent risk factor for the prognosis of septic shock patients in 2012 and 2022.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective:To identify risk factors for mucus plug formation and to construct a nomogram-based predictive model in children with adenovirus pneumonia.Methods:In this retrospective cohort study, 149 pediatric patients diagnosed with adenovirus pneumonia were included. All patients underwent bronchoscopy at the Department of Respiratory Tianjin Children′s Hospital Machang District, between January and December 2024. Their demographic characteristics, clinical manifestations, laboratory findings, imaging features, and treatment details were analyzed.The information of patients were collected about clinical manifestations, laboratory findings, imaging features, and treatment information. Patients were divided into a mucus plug group and a non-mucus plug group based on bronchoscopic findings. Independent risk factors were determined using multivariable Logistic regression. And a predictive nomogram was subsequently developed. Model performance was evaluated using the area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test.Results:Of the 149 enrolled patients (84 boys, 65 girls), 49 cases were classified into the mucus plug group and 100 cases into the non-mucus plug group. Compared with their counterparts, children in the mucus plug group were older on admission ( P<0.05), more likely to have a recent history of lower respiratory tract infection, and exhibited a higher prevalence of consolidation or bronchiolitis patterns on chest imaging (all P<0.05), while preoperative corticosteroid use was less frequent ( P<0.05). Multivariable Logistic regression identified age on admission ( OR=1.14, 95% CI 1.01-1.29, P=0.031), lower respiratory tract infection ( OR=5.23, 95% CI 2.15-13.56, P<0.001), radiographic consolidation ( OR=2.64, 95% CI 1.10-6.61, P=0.032), and bronchiolitis pattern ( OR=2.39, 95% CI 1.04-5.60, P=0.042) as independent risk factors, whereas pre-bronchoscopy corticosteroid use was a protective factor ( OR=0.26, 95% CI 0.10-0.63, P=0.004). The nomogram predictive model demonstrated strong discriminative ability (area under the curve=0.83) and good calibration (Hosmer-Lemeshow P=0.358). Conclusions:The independent risk factors for mucus plug formation include older age, a recent history of lower respiratory tract infection, and chest imaging features of consolidation or bronchiolitis in pediatric adenovirus pneumonia. Pre-bronchoscopy corticosteroid therapy is a protective effect. The developed nomogram demonstrates favorable predictive performance and may facilitate early identification and timely intervention.

AIM:Bone morphogenetic protein 7(BMP7)reduces the expression of Yes-related protein 1(YAP1)by down-regulating Ajuba level and decreasing extracellular matrix(ECM)deposition.This study aimed to inves-tigate the influence of these factors on modifying the degree of renal fibrosis in rats with diabetic nephropathy.METH-ODS:Eighteen Sprague-Dawley(SD)rats were randomly divided into three groups:the normal control(NC)group,the diabetes mellitus(DM)group,and the DM group treated with BMP7 overexpressing adeno-associated virus(DM+rAAV-BMP7).Each group consisted of six rats.Diabetic kidney disease(DKD)was established in the DM and DM+rAAV-BMP7 groups by injecting 55 mg/kg streptozotocin(STZ)via the tail vein.NRK-52E cells were divided into three groups:the normal glucose(NG)group,the high glucose(HG)group,and the high glucose group treated with recombinant hu-man BMP7(HG+rhBMP7)group.Pathological changes in renal tissues were observed using hematoxylin and eosin(HE)and Sirius red staining.Immunohistochemical staining was performed to examine the expression sites of Ajuba and YAP1 in the renal cortex.Western blot analysis was conducted to determine the expression levels of BMP7,Ajuba,YAP1,colla-gen type Ⅲ(Col-Ⅲ),and fibronectin(FN)in the rat renal cortex and NRK-52E cells.RT-qPCR was used to measure the mRNA levels of Ajuba and YAP1 in the rat renal cortex.RESULTS:Biochemical indices revealed significantly ele-vated levels of blood glucose,serum creatinine,triglycerides,total cholesterol,and 24-hour urinary protein in the DM group compared to the NC group(P<0.05).In the DM+rAAV-BMP7 group,the levels of serum creatinine,24-hour uri-nary protein,triglycerides,and total cholesterol were lower than those in the DM group(P<0.05).Pathological staining demonstrated that the renal interstitium of the DM group exhibited inflammatory cell infiltration,fibrous tissue,collagen fi-ber deposition,disordered renal tubule arrangement,atrophy,and vacuolar degeneration,which were ameliorated in the DM+rAAV-BMP7 group.Immunohistochemistry revealed that Ajuba and YAP1 were mainly expressed in the cytoplasm and nucleus,with high expression in the cytoplasm of the DM group,which was significantly decreased in the DM+rAAV-BMP7 group.Western blot results indicated that the protein levels of FN,Col-Ⅲ,Ajuba,and YAP1 were up-regulated in the DM and the HG groups(P<0.05),but significantly down-regulated in the DM+rAAV-BMP7 group(P<0.05).RT-qP-CR results demonstrated that the mRNA levels of Ajuba and YAP1 were higher in the DM group and significantly lower in the DM+rAAV-BMP7 group(P<0.05).CONCLUSION:The overexpression of BMP7 can ameliorate renal fibrosis in rats with DKD.This effect is likely mediated by the down-regulation of Ajuba,reduction of YAP1 expression,and subse-quent inhibition of ECM deposition.

Objective To investigate the serum levels of peroxisome proliferator-activated receptor-γ coactivator-1α(PGC-1α)and fibronectin type Ⅲ domain-containing protein 5(FNDC5)in patients with hypertensive cerebral hemor-rhage and their association with disease severity and prognosis.Methods A total of 80 patients with hypertensive cere-bral hemorrhage who were diagnosed and treated in our hospital from July 2019 to February 2022 were enrolled as case group,and 80 individuals undergoing physical examination were enrolled as control group.ELISA was used to measure the serum levels of PGC-1α and FNDC5,and the receiver operating characteristic(ROC)curve was used to investigate their value in predicting the prognosis of patients with hypertensive cerebral hemorrhage.The logistic regression analysis was used to investigate the influencing factors for poor prognosis in patients with hypertensive cerebral hemorrhage.Results The case group had significantly lower serum levels of PGC-1α and FNDC5 than the control group(P<0.05),and the good prognosis group also had significantly higher serum levels of PGC-1α and FNDC5 than the poor prognosis group.Disease severity,PGC-1α,and FNDC5 were influencing factors for poor prognosis in patients(P<0.05).Serum PGC-1α and FNDC5 alone or in combination had an area under the ROC curve of 0.957,0.937,and 0.985,respec-tively,in predicting poor prognosis in patients with hypertensive cerebral hemorrhage.Conclusion There are low expres-sion levels of PGC-1α and FNDC5 in patients with hypertensive cerebral hemorrhage,which are associated with the sever-ity and prognosis of patients.Both of them are independent protective factors for prognosis and have a certain application value in evaluating prognosis in clinical practice.

Objective To evaluate the short-term efficacy and safety of percutaneous liver puncture for local management of portal vein thrombosis(PVT).Methods Variations in thrombus,blood flow,and laboratory examination results were observed before and after percutaneous liver puncture in 197 patients with PVT,and the occurrence of comorbidities was recorded and followed up for one year after treatment.Results After treatment,the thrombus in the main portal vein vessels almostly disappeared in 119 patients(60.41％)with PVT,the thrombus had a significant reduction in 57 patients(28.93％),and the thrombus had a smaller change or an increase in 21 patients(10.66％);146 patients(74.11％)had smooth blood flow in the main portal vein vessels,29 patients(14.72％)showed significant improvement in blood flow,and 22 patients(11.17％)showed no significant improvement or worsening of blockage.The mean portal venous pressure was significantly lower than that before treatment(P＜0.001);thrombin time,activated partial thromboplastin time,and prothrombin time were prolonged compared to those before thrombolysis(P＜0.001),and fibrinogen were reduced compared to those before thrombolysis(P＜0.001).A total of 35 patients(17.77％)occured comorbidities during treatment.One year after treatment,196 patients(99.49％)with PVT survived,of which thrombus essentially disappeared in 141(71.94％),thrombus stabilized(or decreased)in 42(21.43％),and thrombus increased in 13(6.63％).Conclusion percutaneous liver puncture for local management of PVT is effective and reliable in the short-term and requires standardized management of the entire process.

OBJECTIVE To study the pharmacological basis of Schisandra chinensis in the treatment of allergic asthma. METHODS The common components of 10 batches of S. chinensis from different habitats were analyzed by UPLC-Q-TOF-MS/MS. Furthermore， the allergic asthma model was established by intraperitoneal injection of ovalbumin （OVA） and aluminum hydroxide for stimulation combined with atomization exitation； general behavioral observation and the contents of interferon γ （IFN-γ）， interleukin-4 （IL-4） and immunoglobulin E （IgE） in serum were taken as criteria for evaluating the therapeutic effect of S. chinensis from different habitats in the treatment of allergic asthma. Correlation coefficients between common peak area and efficacy evaluation index of each batch of medicinal material were analyzed through grey correlation degree and Pearson correlation analysis. RESULTS A total of 21 common components were identified in 10 batches of S. chinensis from different habitats. After administration of S. chinensis， symptoms such as shortness of breath， sneezing and curling of rats were alleviated. In addition， the content of IFN-γ was significantly increased while the contents of IL-4 and IgE in serum were distinctly decreased （P＜0.01）. Grey correlation analysis showed that 11 common components had high correlation coefficients with IFN-γ， IL-4 and IgE （rˉ＞0.8）. Pearson correlation analysis showed that 8 components were significantly positively correlated with the content of IFN-γ （P＜ 0.05）， and 9， 8 components were significantly negatively correlated with the content of IL-4 and IgE （P＜0.05）. Based on the results of grey correlation degree and Pearson correlation analysis， 7 components such as peak 3， 4， 6， 7， 9， 19 and 20， were highly related to S. chinensis in the treatment of allergic asthma. CONCLUSIONS Schisandrol A， schisandrin B， schisandrin C， gomisin M2， gomisin J， pregomisin and angeloylgomisin H are the potential pharmacodynamic substance basis of S. chinensis in the treatment of allergic asthma.