Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

With the increasing burden of hypertension in Chinese adults， the detection rate of hypertension among children and adolescents continued to rise， drawing increasing attention to the impact of pubertal timing on blood pressure. In recent years， many scholars have evaluated the association between pubertal development and blood pressure at different stages using various methods of assessing pubertal timing. To understand the correlation between pubertal timing and blood pressure in adolescents， this study reviews the associations between pubertal timing and blood pressure and their underlying mechanisms. The relationship between earlier female pubertal development and the risk of hypertension in adulthood shows positive， negative， and U-shaped correlations， with varying results. Earlier female pubertal development may lead to a higher detection rate of hypertension during adolescence. Most of the studies focus on the correlation between pubertal timing and adult blood pressure， with less research on adolescent blood pressure， indicating a need for further research to reveal underlying patterns.

Abstract Cardiovascular disease is the leading cause of death and disease burden in China and worldwide. The state of cardiovascular health in childhood and adolescence has been shown to be a strong predictor of cardiovascular health in adulthood. The study summarizes current state of cardiovascular health evaluation methods in children and adolescents, including Life s Simple 7, Life s Essential 8, and the aggregation of cardiovascular risk factors; and relevant indicators include diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood pressure, blood glucose, and the application of evaluation methods, so as to provide insights for the development of cardiovascular health evaluation methods applicable to children and adolescents in China.

Objective:To summarize the relevant evidence of perioperative nutritional management for elderly patients with hip fractures, so as to provide scientific guidance for clinical nursing staff to implement nutritional management.Methods:Literature related to perioperative nutrition management of elderly patients with hip fracture were systematically searched from domestic and foreign guide websites, professional association websites, as well as UpToDate, PubMed, BMJ, Web of Science, Cochrane Library, Embase, CINAHL, Chinese Medical Journal Network, Wanfang Database, CNKI and other databases. The search period was from the establishment of the databases to February 15, 2023. Three researchers conducted quality evaluation and data extraction on the literature.Results:A total of 20 articles were included, including one clinical decision, six guidelines, seven expert consensus and six systematic reviews. After extracting and integrating the evidence included in the literature, a total of 29 best pieces of evidence were finally summarized from eight aspects, such as establishing a multidisciplinary nutrition support team, nutrition risk screening, nutrition assessment and content, nutrition support goals, nutrition support methods, preoperative and postoperative nutrition support, health education and follow-up.Conclusions:This study summarizes 29 best evidence for perioperative nutrition management in elderly patients with hip fractures. Nursing staff can develop scientific and standardized perioperative nutrition management plans for elderly patients with hip fracture based on clinical conditions, improving their nutritional status and clinical prognosis.

Objective To investigate the correlation between sex hormone-binding globulin(SHBG)and lipid metabolism and visceral fat area(VFA)in male adults with different glucose tolerance.Methods A total of 473 male subjects were enrolled from the outpatient clinic and ward in PLA NO.903 Hospital from January 2018 to December 2020.All the subjects were divided into three groups according to OGTT results:normal glucose tolerance group(NGT,n=179),impaired glucose regulation group(IGR,n=90)and newly diagnosed type 2 diabetes mellitus group(T2DM,n=204).Serum SHBG level,abdominal visceral fat area(VFA)and biochemical indexes were compared among the three groups.Results Compared with NGT group,WC,WHR,BMI,HbA1c,FPG,2 hPG,2 hIns,TG and VFA were increased(P＜0.05),while SHBG was decreased(P＜0.05)in IGR group.WC,SBP,DBP,HbA1c,FPG,2 hPG,2 hIns,HOMA-IR,TG,FFA,VFA and VFA/SFA were increased,while HOMA-β,SHBG were decreased(P＜0.05)in T2DM group.Compared with IGR group,SBP,HbA1c,FPG,2 hPG,2 hIns and HOMA-IR were increased,HOMA-β was decreased in T2DM group(P＜0.05).Pearson correlation analysis showed that SHBG was positively correlated with HDL-C(P＜0.01),but was negatively correlated with WC,WHR,BMI,2 hIns,SUA,TG,VFA and SFA(P＜0.05 or P＜0.01).Multivariable linear regression analysis showed that HDL-C,TG and VFA were the influencing factors for SHBG.Conclusion Serum SHBG is closely related to abdominal obesity and lipid metabolism.Increasing the level of SHBG can reduce visceral fat accumulation and improve IR.

Abstract With the increasing prevalence of overweight and obesity in children, the influence of overweight and obesity on pubertal timing has attracted the attention of scholars. This paper reviewed the correlation and mechanism between childhood obesity and pubertal timing, especially for earlier pubertal timing, and found that the regulation of hypothalamic-pituitary-gonadal axis function by nutrition and metabolic signals might under lie those associations. Obesity in girls was positively correlated with early pubertal timing, while the conclusions in boys were inconsistent. Overweight in boys was related to early pubertal timing, obesity in boys could lead to both earlier and later onset of puberty, which warrents further investigation.

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with rare type heart disease. METHODS: A pedigree identified at Shenzhen Maternity and Child Health Care Hospital Affiliated to Southern Medical University on July 9, 2021 was selected as the study subject. Clinical data were collected. Trio-whole exome sequencing (WES) was carried out for the proband and his parents. Candidate variants were validated by Sanger sequencing of his family members and bioinformatic analysis. RESULTS: The proband, a 5-month-old male, was found to have Barth syndrome (dilated myocardiopathy and left ventricular non-compaction). Trio-WES revealed that he has harbored a hemizygous c.542G>A (p.G181A) variant of the TAZ gene, which was inherited from his mother. In addition, his mother, aunt and maternal grandmother were also found to harbor a c.557G>A (p.R186Q) variant of the TNNI3 gene. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.542G>A (p.G181A) variant of the TAZ gene was classified as likely pathogenic (PS2_Strong+PM2_Supporting+PP3), whilst the c.557G>A (p.R186Q) variant of the TNNI3 gene was classified as pathogenic (PP1_Strong+PS4_Strong+PP3+PP4+PM2_Supporting). CONCLUSION The c.542G>A (p.G181A) variant of the TAZ gene probably underlay the Barth syndrome in the proband, and the c.557G>A (p.R186Q) variant of the TNNI3 gene may be responsible for the hypertrophic cardiomyopathy in his mother, aunt and maternal grandmother. Above finding has expanded the mutational spectrum of the TAZ gene and facilitated the diagnosis of this pedigree.
Female ; Humans ; Infant ; Male ; Pregnancy ; Barth Syndrome ; Cardiomyopathy, Hypertrophic ; East Asian People ; Heart Diseases ; Pedigree

Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.

A total of 360 patients with prostate hyperplasia underwent transurethral holmium laser enucleation of the prostate in Department of Urology of Jinhua People′s Hospital from July 2019 to December 2022. Among 360 patients, lower urinary tract symptoms occurred one month after operation in 40 cases with an incidence rate of 11.11%. The age, body mass index (BMI), course of disease, nature of disease, preoperative prostate volume, postoperative prostate volume, preoperative IPSS score, postoperative IPSS score, preoperative maximum urine flow rate, postoperative maximum urine flow rate, preoperative residual urine volume, postoperative residual urine volume, postoperative urinary tract infection, operative time, postoperative catheter retention time were compared between patients with lower urinary tract symptoms (study group) and those without (control group). There were significant differences in the course of disease, preoperative prostate volume, preoperative IPSS score, preoperative maximum urine flow rate, preoperative residual urine volume, postoperative urinary tract infection and postoperative catheter retention time between two groups ( t=28.01, 6.35, 8.79, 17.92, 34.84, 11.45;all P<0.05). Multivariate logistic analysis showed that the course of disease, preoperative prostate volume, preoperative IPSS score, postoperative urinary tract infection, and postoperative catheter retention time were independent risk factors for postoperative lower urinary tract symptoms ( OR=6.964, 3.442, 1.944, 4.836, 4.225, 4.894; all P<0.05); while the preoperative maximum urinary flow rate was the protective factor( OR=0.043, P<0.05). The incidence of postoperative lower urinary tract symptoms in patients undergoing transurethral holmium laser enucleation of prostate is high. Effective protective measures should be taken based on the risk factors to reduce the incidence of postoperative lower urinary tract symptoms and to promote the early recovery of patients.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.