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.

Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.

Objective:To investigate the regulation of Parkin-dependent mitophagy mediated by calcyclin-binding protein and Siah-1 interacting protein (CacyBP/SIP) on apoptosis and cycle of dopaminergic (DA) neurons.Methods:SH-SY5Y cells were divided into model group, control group and CacyBP/SIP group; cells in the model group were treated with 1-methyl-4-phenylpyridine (MPP +, 0.5 mmol/L) for 24 h, and cells in the control group and CacyBP/SIP group were transfected with empty lentivirus or CacyBP/SIP-sgRNA lentivirus on the basis of MMP +(0.5 mmol/L) treatment for 24 h, respectively. Western blotting was used to detect the protein expression levels of CacyBP/SIP, microtubule-associated protein l light chain 3 (LC3), lysosome-associated membrane protein 2 (LAMP2), phosphatase and tensin homolog ten induced kinase 1 (Pink1), Parkin, P53, Bcl-2, and Bax; flow cytometry was used to detect the cell apoptosis and cycle; immunofluorescent single staining was used to detect the expressions of LC3 and LAMP2; immunofluorescent double staining was used to detect the coexpressions of CacyBP/SIP and Parkin. Results:As compared with the model group and control group, the CacyBP/SIP group had significant reduction in protein expressions of CacyBP/SIP, LAMP2, Pink1, and Parkin, LC3-II/I ratio, immunofluorescent staining intensities of LC3-II and LAMP2, and Bcl-2 protein expressions ( P<0.05). As compared with the model group and control group, the CacyBP/SIP group had significantly increased Bax protein expression, significantly decreased Bcl-2/Bax ratio, significantly increased apoptosis rate, significantly increased P53 protein expression, significantly increased proportion of cells at G1 phase, and significantly decreased immunofluorescent intensity of CacyBP/SIP and Parkin co-expressions ( P<0.05). Conclusion:After knocking out CacyBP/SIP gene, the decrease of Parkin protein leads to cell cycle being arrested at G1 stage, and mediates the decrease of Parkin-dependent mitochondrial autophagy, thereby leading to increased cell apoptosis.

Objective: To observe the treatment of inflammatory myopathy-associatied cardiomyopathy and its impact on prognosis of disease. Methods: In this single-center retrospective study, 29 cases of inflammatory myopathy-associated cardiomyopathy were collected in Peking Union Medical College Hospital from 1999 to 2016. The clinical data and adverse events during follow up were documented. Among 29 patients there were 11 cases of polymyositis, 8 cases of dermatomyositis, 8 cases of overlap syndrome and 2 cases of nonspecific myositis.All the patients started with sufficiene prednisone (1-2 mg·kg^-1·d^-1). 7 cases received intravenous immune globulin, while 12 cases were prescribed with steroid pulse therapy, 16 cases with methotrexate, 15 cases with cyclophosphamide, 6 cases with cyclosporine A, while 11 cases with combination of immune suppressors (methotrexate plus cyclophosphamide or cyclosporine A). After a median follow up of 4.8 years (2 month to 15 years), 14 cases died including 9 of cardiac death. Patients with cardiac deaths had lower usage percentages of intravenous gamma globulin (0 vs. 7/20, P=0.05) and steroid pulse therapy (1/9 vs. 11/20, P=0.043) than controls. Comparing with controls, patients in the group of adverse events were more prone to choose methotrexate alone rather than combination of immune suppressors (all-cause death: 1/14 vs. 8/15, P=0.014; cardiac death: 0 vs. 9/20, P=0.027). Kaplan-Meier survival analysis showed significant difference of survival rates between patients with combination of immune suppressors and controls (Log Rank χ²=6.001, HR=7.58, P=0.014), as well as between patients with β receptor blockers and controls (Log Rank χ²=4.589, HR=2.95, P=0.032). Conclusions We recommend a management strategy that emphasize both primary disease controlling and cardiac remodeling improvement in patients with inflammatory myopathy-associated cardiomyopathy. On the basis of sufficient glucocorticoids, intravenous gamma globulin, steroid pulse therapy, combination of methotrexate plus other immune suppressants, and β receptor blockers were worthy to be considered.

OBJECTIVETo compare the difference of serum sex hormone between female patients with post-adolescent acne and healthy women, and to explore the efficacy and action mechanism of acupoint catgut embedding, fire needle, auricular acupuncture on skin lesion in female patients of post-adolescent acne.

METHODSA total of 107 female patients of post-adolescent acne were divided into an integrated acupuncture group (54 cases, 4 cases were excluded) and a medication group (53 cases, 5 cases were excluded). The patients in the integrated acupuncture group were treated with comprehensive treatment of acupoint catgut embedding, fire needle, auricular acupuncture; the acupoint catgut embedding was applied at Dazhui (GV 14), Yintang (GV 29), Yangbai (GB 14) through Yuyao (EX-HN 4) and other acupoints based on syndrome differentiation; the fire needle was applied at skin lesion; the auricular acupuncture was applied at erjian (HX), e (AT), kou (CO), etc. The patients in the medication group were treated with oral administration of tanshinone capsules (4 capsules each time, 3 times a day) and external use of adapalene gel (one treatment per day at night). Patients in the two groups were treated for 8 weeks. The skin lesion of acne was evaluated before treatment as well as 4 weeks and 8 weeks after treatment in the two groups; the serum levels of testosterone (T) and estradiol (E) were tested 24 hours before menstruation in the integrated acupuncture group (50 cases) and healthy control group (46 cases), and the change of serum sex hormone after treatment was observed in 21 patients with sex hormone disorder in the integrated acupuncture group.

RESULTSBefore treatment, the level of E in the integrated acupuncture group was significantly lower than that in the healthy control group (<0.01), but T/E in the integrated acupuncture group was significantly higher than that in the healthy control group (<0.01). After treatment, the level of E was significantly increased (<0.01) and T/E was reduced (<0.01) in the 21 patients with sex hormone disorder in the integrated acupuncture group. The skin lesion scale of acne was significantly reduced in the two groups after 4-week and 8-week treatment (all <0.01); the difference between the two groups was not significant after 4-week treatment (>0.05); the skin lesion scale of acne in the integrated acupuncture group was significantly lower than that in the medication group after 8-week treatment (<0.01). The efficacy between the two groups was not significant after 4-week the treatment (>0.05); after 8-week treatment, the cured and effective rate was 66.0% (33/50) in the integrated acupuncture group, which was superior to 45.8% (22/48) in the medication group (<0.05).

CONCLUSIONCompared with healthy women, the level of serum sex hormone of E is reduced in the female patients of post-adolescent acne, resulting in relative increased level of T; the acupoint catgut embedding, fire needle, auricular acupuncture have better efficacy than medication for post-adolescent acne, which have regulation effects on sex hormone disorder.

Objective To investigate the safety and efficacy of LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase.Methods From May 2014 to August 2017,the clinical and imaging data of 56 patients with ruptured wide-necked intracranial aneurysm treated with LVIS stents for acute phase assisted embolization at the Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.All patients were treated with LVIS stent combined with coil embolization.Immediate postoperative angiography,six months after procedure,and follow-up imaging were evaluated by Raymond grade (RS grade).The clinical follow-up results were evaluated by the modified Rankin Scale (mRS) score.Results LVIS stent combined with coil embolization was performed in 56 patients with 60 aneurysms in this group.The success rate of stent release was 100％.Immediate angiography after procedure showed that the complete embolization rate of aneurysms was 80.0％ (48/60),the near complete embolization rate was 13.3 ％ (8/60),and the incomplete embolization rate was 6.7％ (4/60).Postoperative follow-up angiography at 6 monthrevealed that the complete embolization rate of aneurysms was 87.8％ (36/41),nearly complete embolization rate was 7.3％ (3/41),incomplete embolization rate was 4.9％ (2/41).Postoperative follow-up angiography at 12 months revealed that the complete embolization rate of aneurysms was 83.0％ (39/47),and near complete embolization rate was 12.8％ (6/47),and incomplete embolization rate was 4.3％ (2/47).Of the 56 patients,49 were followed up clinically and 7 were lost to follow up.The average follow-up time was 13 ± 4 months.The clinical follow-up showed that the good prognosis (mRS score 0-2) rate was 87.8％ (43/49).Intraoperative complications occurred in 7 cases,5 were intraoperative parent artery thrombosis and 2 were intraoperative aneurysm rupture.Conclusions LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase has good efficacy and safety.Its long-term efficacy remains to be confirmed by long-term follow-up.

Objective To explore the significance of combined detection of tumor markers cancer embryo antigen (CEA) ,alpha fetoprotein (AFP ) ,carbohydrate antigen 19-9 (CA19-9 ) and carbohydrate antigen 72-4 (CA72-4 ) in digestive tract tumors . Methods The electrochemical luminescence method was adopted to detected the CEA ,AFP ,CA19-9 and CA72-4 levels in 106 cases of digestive tract malignant tumor confirmed by pathological examination (malignant tumor group) ,110 cases of digestive tract be-nign diseases (benign disease group) and 60 persons undergoing the healthy physical examination (control group) in our hospital from January to December 2015 .The differences were compared among various groups and the positive detection rates of 4 markers in the patients with digestive tract tumors were compared .Results The serum levels of CEA ,AFP ,CA19-9 and CA72-4 levels in the malignant tumor group were significantly higher than those in the benign disease group and control group(P<0 .05);the benign disease group and normal control group had no statistically significant difference (P>0 .05) .In the single indicator detection of ser-um CEA ,AFP ,CA19-9 and CA72-4 ,AFP had the highest detection rate in hepatocellular carcinoma (HCC) ,which was 74 .19% ;the positive detection rate of CA 72-4 in gastric cancer was highest ,which was 60 .71% ;the positive detection rate of CA 19-9 in pan-creatic cancer was highest ,which was 75 .00% ;the positive detection rate of CEA was not high without specificity in various tumor diseases .The positive detection rate of 4-item combined detection was significantly higher than that of single item detection (P<0 .05) .Conclusion The detection of tumor markers CEA ,AFP ,CA19-9 and CA72-4 is conducive to the identification of tumor types ,meanwhile they can improve the detection rate of gastrointestinal cancer and conduces to early diagnosis and early treatment for the patients .

OBJECTIVE:To study the effects and mechanism of rapamycin on invasion and metastasis of cervical cancer HeLa cell. METHODS:HeLa cells were divided into control group and rapamycin low-dose,medium-dose and high-dose groups (10, 30,100 nmol/L). After treated for 48 h,cell viability was measured by MTT assay,and inhibitory rate was calculated;migration and invasion of cell was tested by Transwell assay. The expression of matrix metalloproteinase 2(MMP-2),MMP-9,Vimentin and E-cadherin,and phosphorylation of protein kinase B (Akt),mammalian target of rapamycin (mTOR) were detected by Western blot. RESULTS:Compared with control group,the inhibition rate of cell viability was increased in rapamycin groups(P<0.01);the number of invasion and metastasis cells decreased(P<0.01);the expression of MMP-2,MMP-9 and Vimentin were decreased (P<0.01 or P<0.05);the expression of E-cadherin was enhanced(P<0.01 or P<0.05);the phosphorylation of Akt and mTOR were reduced (P<0.01). CONCLUSIONS:Rapamycin could inhibit invasion and metastasis of HeLa cell via Akt/mTOR signal pathway.

Objective To investigate the serum levels of uric acid (UA) in bipolar disorder patients and their clini?cal significance. Methods Serum levels of UA was measured in 126 bipolar disorder patients including 77 mania pa?tients and 49 depression patients, 69 first-episode schizophrenic patients and 126 healthy controls (control group). Bipo?lar disorder patients was assessed by using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAMD). Results The serum UA levels were significantly higher in bipolar group [(349.34 ± 107.21) μmol/L] than in schizophrenic group [(319.71±84.48)μmol/L] and in control group [(280.94±71.90)μmol/L] (P<0.01). There were signifi?cant differences in serum UA levels between manic episode and depressive episode [(366.45 ± 104.01) μmol/L vs. (322.45±107.69)μmol/L]. The serum UA levels were higher in both manic episode and depressive episode groups than in control group (P<0.01). The serum UA levels was not significantly different between patients with and without medication (P>0.05). Correlation analysis indicated that the correlation of serum UA levels with YMRS scores and HAMD scores was not significant in bipolar disorder patients (P>0.05). Conclusions Patients with bipolar disorder has elevated serum uric acid levels which may be a biomarkers of bipolar disorder.

Objective To investigate the effectiveness and safety of dexmedetomidine combining with sufentanyl in controlling PCIA after laryngeal carcinoma surgery. Methods One hundred laryngeal carcinoma patients (ASAⅠorⅡ) were randomly assigned into 2 groups (n = 50, in each group). Group SF: sufentanil 0.04 mg/(kg·h)+dolasetron 12.5 mg; Group DE: dexmedetomidine 0.1 mg/(kg·h) +sufentani 0.02 mg/(kg· h) +dolasetron 12.5 mg, in which all drugs were dissolved in 100 mL 0.9% normal saline. Parameters: Infusion speed 2 mL/h; PCIA dosage 0.5 mL each time; monitor time: 15 min. PCIA were administrated after anesthesia recovery; BP, HR, SpO2, RR, RPP, pain and sedation score, side effect formation rate at 4、12、24、48 h after surgery were also recorded. Results MAP, RPP and HR in group DE were significant decreased compared with group SF at each time point,(P < 0.05); VAS scores had no significant difference between the two groups(P >0.05); Ramsay calm scores in group DE were significant better than that in group SF at each time point after surgery (P < 0.05); Frequency of nausea,vomiting and chills in group DE were significant lower than those in group SF (P < 0.05). Conclusion Small dose dexmedetomidine combination with sufentanil administration in PCIA after laryngeal carcinoma surgery could acquire satisfied analgesic effect , also could eliminate the patient anxious mood , enhance the security in the perioperative period and improve the patients' satisfaction degree , whichis very suitable for multi mode analgesia acquirement.