Transjugular intrahepatic portosystemic shunt(TIPS)is an important intervention for portal hypertension,and the degree of reduction in portal venous pressure is closely associated with the prognosis of patients.While a greater reduction in portal venous pressure may lead to more effective alleviation of portal hypertensive symptoms in cirrhotic patients,it also increases the risk of hepatic encephalopathy and liver failure.Therefore,appropriate control of the degree of reduction in portal venous pressure is essential for optimizing therapeutic outcomes.This article reviews the methods for measuring portal venous pressure,the factors affecting the reduction in portal venous pressure,the optimal range for reduction in different indications,and the impact of varying degrees of pressure reduction on complications,in order to provide guidance for improving the treatment outcome of TIPS and the prognosis of patients after surgery.

Objective To explore the effect of organizational climate on work alienation in psychiatric nurses,and the mediating role of psychological capital and positive coping styles between organizational climate and work alienation,in order to provide a reference for reducing work alienation among psychiatric nurses.Methods Convenience sampling method was used to select nurses working in 6 tertiary A psychiatric hospitals in Shandong Province from January to July 2024,and the general questionnaire,Nurses' Work Alienation Questionnaire,Organizational Climate Scale for Nursing,Psychological Capital Questionnaire,and Simple Coping Style Scale were used to conduct the survey and the mediation effect test.Results A total of 606 questionnaires were recovered,of which 572 were valid,and the validity rate of the questionnaires was 94.39％.Psychiatric nurses scored(89.58±13.69)for nursing organizational climate,(32.48±11.31)for work alienation,(97.28±19.12)for psychological capital,and(23.93±7.22)for positive coping styles.There was a direct effect of nursing organizational climate on work alienation(β=-0.681,95％CI=-0.824～-0.539).Psychological capital and positive coping styles acted as separate mediators and chain mediators in the effect of nursing organizational climate on work alienation(β=-0.116,-0.048,-0.019,95％CI=-0.182～-0.034,-0.086～-0.006,-0.042～-0.002).Conclusion There are multiple mediating effects of psychiatric nurses' psychological capital,positive coping styles between nursing organizational climate and work alienation.Nursing managers can enhance psychiatric nurses' psychological capital by creating a positive and healthy organizational climate,encouraging them to adopt positive coping styles to solve problems,and reducing work alienation.

Objective:To analyze the research hotspots and trends of non-pharmacological interventions for geriatric depression, to provide a reference for conducting relevant research in China.Methods:Literature on non-pharmacological interventions for geriatric depression was electronically searched in the China National Knowledge Infrastructure and Web of Science Core Collection databases. The search period was from database establishment to June 1, 2024. The authors, institutions, countries, and keywords of the published articles were visually analyzed based on CiteSpace 6.2.R7.Results:A total of 238 articles in Chinese and 342 articles in English were included. There was an overall fluctuating upward trend in the number of publications on non-pharmacological interventions for geriatric depression. Repetitive transcranial magnetic stimulation, electroconvulsive therapy, acupuncture therapy and psychotherapy, music therapy, and exercise therapy were the research hotspots. Repetitive transcranial magnetic stimulation and music therapy for the improvement of cognitive function and neurotransmitters in patients, and Meta-analysis and systematic review of related studies were the research trends.Conclusions:Non-pharmacological interventions for geriatric depression have attracted the attention of scholars at home and abroad. High-quality studies should be conducted in China to strengthen the cooperation among institutions and authors, and to explore non-pharmacological intervention programs suitable for our geriatric depression population.

Objective To explore the effect of organizational climate on work alienation in psychiatric nurses,and the mediating role of psychological capital and positive coping styles between organizational climate and work alienation,in order to provide a reference for reducing work alienation among psychiatric nurses.Methods Convenience sampling method was used to select nurses working in 6 tertiary A psychiatric hospitals in Shandong Province from January to July 2024,and the general questionnaire,Nurses' Work Alienation Questionnaire,Organizational Climate Scale for Nursing,Psychological Capital Questionnaire,and Simple Coping Style Scale were used to conduct the survey and the mediation effect test.Results A total of 606 questionnaires were recovered,of which 572 were valid,and the validity rate of the questionnaires was 94.39％.Psychiatric nurses scored(89.58±13.69)for nursing organizational climate,(32.48±11.31)for work alienation,(97.28±19.12)for psychological capital,and(23.93±7.22)for positive coping styles.There was a direct effect of nursing organizational climate on work alienation(β=-0.681,95％CI=-0.824～-0.539).Psychological capital and positive coping styles acted as separate mediators and chain mediators in the effect of nursing organizational climate on work alienation(β=-0.116,-0.048,-0.019,95％CI=-0.182～-0.034,-0.086～-0.006,-0.042～-0.002).Conclusion There are multiple mediating effects of psychiatric nurses' psychological capital,positive coping styles between nursing organizational climate and work alienation.Nursing managers can enhance psychiatric nurses' psychological capital by creating a positive and healthy organizational climate,encouraging them to adopt positive coping styles to solve problems,and reducing work alienation.

Transjugular intrahepatic portosystemic shunt(TIPS)is an important intervention for portal hypertension,and the degree of reduction in portal venous pressure is closely associated with the prognosis of patients.While a greater reduction in portal venous pressure may lead to more effective alleviation of portal hypertensive symptoms in cirrhotic patients,it also increases the risk of hepatic encephalopathy and liver failure.Therefore,appropriate control of the degree of reduction in portal venous pressure is essential for optimizing therapeutic outcomes.This article reviews the methods for measuring portal venous pressure,the factors affecting the reduction in portal venous pressure,the optimal range for reduction in different indications,and the impact of varying degrees of pressure reduction on complications,in order to provide guidance for improving the treatment outcome of TIPS and the prognosis of patients after surgery.

Objective:To analyze the research hotspots and trends of non-pharmacological interventions for geriatric depression, to provide a reference for conducting relevant research in China.Methods:Literature on non-pharmacological interventions for geriatric depression was electronically searched in the China National Knowledge Infrastructure and Web of Science Core Collection databases. The search period was from database establishment to June 1, 2024. The authors, institutions, countries, and keywords of the published articles were visually analyzed based on CiteSpace 6.2.R7.Results:A total of 238 articles in Chinese and 342 articles in English were included. There was an overall fluctuating upward trend in the number of publications on non-pharmacological interventions for geriatric depression. Repetitive transcranial magnetic stimulation, electroconvulsive therapy, acupuncture therapy and psychotherapy, music therapy, and exercise therapy were the research hotspots. Repetitive transcranial magnetic stimulation and music therapy for the improvement of cognitive function and neurotransmitters in patients, and Meta-analysis and systematic review of related studies were the research trends.Conclusions:Non-pharmacological interventions for geriatric depression have attracted the attention of scholars at home and abroad. High-quality studies should be conducted in China to strengthen the cooperation among institutions and authors, and to explore non-pharmacological intervention programs suitable for our geriatric depression population.

Objective To investigate the association between metabolic associated fatty liver disease(MAFLD)and carotid atherosclerotic plaque.Methods A total of 1 107 patients who were hospitalized in The Second Affiliated Hospital of Kunming Medical University from July,2014 to December,2022 were enrolled,and all patients underwent abdominal ultrasound and CT angiography of the head and neck arteries.Baseline data and clinical diagnosis were collected,and the patients were divided into MAFLD group with 499 patients and non-MAFLD group with 608 patients based on medical history,clinical tests,and imaging findings.According to the CT value,carotid plaques were classified into calcified plaques,non-calcified plaques,and mixed plaques.According to the NASCET criteria,carotid stenosis was categorized as normal vessel,slight stenosis,mild stenosis,moderate stenosis,and severe stenosis/occlusion.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.Univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for carotid atherosclerosis.Results Compared with the non-MAFLD group,the MAFLD group had a significantly higher proportion of patients with calcified plaques(74.3%vs 63.3%,P<0.05),non-calcified plaques(27.1%vs 17.1%,P<0.05),or mixed plaques(27.3%vs 20.7%,P<0.05),as well as a significantly higher proportion of patients with mild stenosis(50.9%vs 44.9%,P<0.05),moderate stenosis(14.6%vs 8.4%,P<0.05),or severe stenosis/occlusion(6.6%vs 3.5%,P<0.05).The univariate logistic regression analysis showed that MAFLD was a risk factor for calcified carotid plaques,non-calcified plaques,and mixed plaques,and it was also a risk factor for mild stenosis,moderate stenosis,and severe stenosis/occlusion of the carotid artery(all P<0.05).After adjustment for confounding factors,the multivariate Logistic regression analysis showed that MAFLD was an independent risk factor for calcified plaque,non-calcified plaque,mixed plaque,and moderate stenosis of the carotid arteries(all P<0.05).Conclusion MAFLD is an independent risk factor for moderate stenosis,calcified plaques,non-calcified plaques,and mixed plaques of the carotid arteries.

ObjectiveTo investigate the influence of different diagnostic criteria on the short-term prognosis of patients with acute-on-chronic liver failure （ACLF）. MethodsA total of 115 ACLF patients who were hospitalized in Department of Gastroenterology， The Second Affiliated Hospital of Kunming Medical University， from January 2018 to January 2022 were enrolled， and all patients received internal medical treatment combined with artificial liver therapy. According to the guidelines， the patients were divided into CMA guideline group （Diagnostic and treatment guidelines for liver failure by Chinese Medical Association）（n=100）， APASL guideline group （Consensus statements of Asian Pacific Association for the Study of the Liver）（n=94）， and EASL guideline group （Criteria proposed by European Association for the Study of the Liver）（n=36）. The above three guidelines were compared in terms of 90-day mortality rate. A one-way analysis of variance was used for comprision of continuous date between groups； the chi-square test was used for comprision of categorical date between groups. The receiver operating characteristic （ROC） curve of related variables. ResultsThe 90-day mortality rate was 50.0% in the CMA guideline group， 51.1% in the APASL guideline group， and 77.8% in the EASL guideline group， and the EASL guideline group had a significantly higher 90-day mortality rate than the CMA guideline group （χ²=8.351， P=0.004） and the APASL guideline group （χ²=7.650， P=0.006）. EASL guideline had a sensitivity of 22.2% and a specificity of 92.3% in predicting the risk of short-term mortality， with an area under the ROC curve was 0.576. ConclusionACLF patients who meet EASL guideline tend to have a worse short-term prognosis， and this guideline may help to identify patients at a relatively high risk of short-term death.

Objective:To evaluate the effect of paravertebral nerve block (PVNB) combined with general anesthesia on intraoperative regional cerebral oxygen saturation (rScO 2) in elderly patients undergoing thoracoscopic lobectomy. Methods:Seventy American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 60-85 yr, with body mass index of 18-25 kg/m 2, were divided into 2 groups ( n=35 each) using a random number table method: general anesthesia group (group G) and PVNB combined with general anesthesia group (group PG). PVNB was performed at T 4 and T 6 with 0.5% ropivocaine 10 ml for each site under ultrasound guidance before induction of anesthesia in group PG.After induction of anesthesia, anesthesia was maintained with IV propofol and remifentanil, and a patient-controlled intravenous analgesia pump was connected at the end of operation.The maximum and minimum rScO 2 and cumulative time of rScO 2 below the baseline value were recorded.The rScO 2 was recorded before anesthesia (T 0), at 5 min before one-lung ventilation (T 1), at 5 min after one-lung ventilation (T 2) and at tracheal extubation (T 3). The length of postoperative hospital stay and complications within 30 days after operation were recorded. Results:Compared with group G, the minimum rScO 2 and rScO 2 at T 2 and T 3 were significantly increased, the incidence of postoperative cognitive dysfunction was reduced ( P<0.05), and no significant change was found in the other parameters mentioned above in group PG ( P>0.05). Conclusion:PVNB combined with general anesthesia can improve intraoperative rScO 2 and reduce the development of postoperative cognitive dysfunction in elderly patients undergoing thoracoscopic lobectomy.

Objective:To identify the risk factors for decrease in regional cerebral oxygen saturation (rScO 2) during one-lung ventilation (OLV) in the patients undergoing thoracic surgery. Methods:A total of 175 patients of both sexes, aged ≥55 yr, with expected operation time≥2 h, scheduled for elective thoracic surgery with OLV, were selected in the Fourth Hospital of Hebei Medical University from August 2017 to September 2018.The rScO 2 was continuously monitored from the beginning of anesthesia induction until removal of tracheal intubation.General anesthesia, general anesthesia combined with epidural block or general anesthesia combined with local nerve block were used.The baseline characteristics, previous medical history and history of anesthesia surgery, type of surgery, method of anesthesia, duration of anesthesia, duration of OLV, duration of surgery, and intraoperative adverse events (hypoxemia, hypotension, bradycardia, etc.) were recorded.According to whether a decrease in rScO 2 occurred during OLV (absolute value of rScO 2 was less than 65% or a decrease of more than 20% of the baseline value), the patients were divided into 2 groups: low rScO 2 group and normal rScO 2 group.Multivariate logistic regression analysis was used to identify the risk factors for decrease in rScO 2 during OLV. Results:One hundred and seven patients developed decrease in rScO 2 during OLV, with an incidence of 61.1%.The results of logistic regression analysis showed that hypoxemia was an independent risk factor for decrease in rScO 2, and general anesthesia combined with epidural block was a protective factor for decrease in rScO 2 during OLV. Conclusion:Hypoxemia is an independent risk factor for decrease in rScO 2 during OLV, while general anesthesia combined with epidural block is a protective factor for decrease in rScO 2 in the patients undergoing thoracic surgery.