ObjectiveTo compare the therapeutic effects of carvedilol alone and carvedilol combined with endoscopic variceal ligation （EVL） in the prevention of re-bleeding from gastroesophageal varices， and to provide strategies for clinical treatment. MethodsWe retrospectively included 178 patients who had received carvedilol alone or carvedilol plus EVL to prevent gastroesophageal variceal re-hemorrhage from October 2010 to June 2023. They were divided into carvedilol alone group （47 cases） and carvedilol+EVL group （131 cases）. Between-group comparisons were conducted using the paired t test for normally distributed continuous data， the Mann-Whitney U test for non-normally distributed continuous data， and the chi-square test for categorical data. A Cox proportional hazards model was employed for univariable and multi-variable analyses. The cumulative incidence rates of re-bleeding and mortality were estimated using the Kaplan-Meier method. The baseline characteristics of the two groups were matched through propensity score matching （PSM） to reduce selection bias and enhance the credibility of causal inference. ResultsThe re-bleeding rate of the carvedilol+EVL group was significantly lower than that of the carvedilol alone group （10-year cumulative incidence： 29.8% vs 36.2%， hazard ratio ［HR］=0.505， 95% confidence interval ［CI］： 0.292‍ ‍—‍ ‍0.847， P=0.015）. There was no significant difference in liver-related mortality （10-year cumulative incidence： 21.3% vs 21.4%， HR=0.799， 95%CI： 0.406‍ ‍—‍ ‍1.578， P=0.518）. The results were stable with PSM analysis. The Cox regression analysis revealed that creatinine was an independent risk factor affecting re-bleeding （HR=1.004， 95%CI： 1.001‍ ‍—‍ ‍1.008， P=0.011） and liver-related mortality （HR=1.004， 95%CI： 1.001‍ ‍—‍ ‍1.007， P=0.019）. ConclusionCarvedilol combined with EVL is better than carvedilol alone in the prevention of gastroesophageal variceal re-bleeding.

Asia-Pacific Association for the Study of the Liver published the guidelines on management of ascites in liver disease in May 2023， which introduces the diagnosis， differential diagnosis， and treatment of ascites， hyponatremia， hepatic hydrothorax， and hepatorenal syndrome in patients with liver cirrhosis and acute-on-chronic liver failure. This article summarizes the main recommendations in the guidelines， so as to provide a reference for the treatment of ascites in patients with liver diseases in China.

Objective To evaluate the value of intrathecal synthetic related markers in patients with mild cognitive impairment(MCI),Alzheimer's disease(AD),and other types of dementia.Methods Retrospec-tively collect the clinical data of 577 patients diagnosed with MCI(MCI group,178 cases),AD(AD group,131 cases),and other types of dementia(other types group,268 cases)from June 2019 to July 2023 in Beijing Tiantan Hospital,Capital Medical University.Oligoclonal zone electrophoresis(OCB)and 24 h intrathecal pro-tein synthesis rate(ISR)of each group were investigated,and the difference of different indexes among the groups was compared to evaluate the value of related indexes in the differential diagnosis of different diseases.Results Compared with AD group and other groups,AD group had a higher proportion of females,more patients were＞50-70 years old,and the incidence of abnormal lipid metabolism was higher,with statistical significance(P＜0.05).There were significant differences in OB(S),cerebrospinal fluid albumin,serum albumin and cerebrospinal flu-id IgG in different disease groups(P＜0.05).IgG index and ISR in patients with positive SOB(CSF)were higher than those in negative and weakly positive patients,and the differences were statistically significant(P＜0.001).IgG index was positively correlated with ISR(r=0.878,P＜0.001).Conclusion Intrathecal synthetic mark-ers such as IgG index,SOB(CSF)and 24 h ISR have synergistic effects in the diagnosis of cognitive dysfunction and various dementias,which can be collectively utilized in the diagnosis of diseases.

Objective To analyze the distribution characteristics and application value of liver,renal func-tion indexes and autoantibody-related indexes of neuromyelitis optica spectrum disorder(NMOSD).Methods The liver,renal function and autoantibody-related indexes data of patients diagnosed with NMOSD and multiple sclerosis(MS)in Beijing Tiantan Hospita,Capital Medical University from June 2015 to June 2023,as well as gender and age-matched controls underwent routine physical examination were retrospectively collected.A total of 95 patients with NMOSD(NMOSD group),230 patients with MS(MS group),and 244 healthy controls(routine physical examination group)were selected to evaluate the diagnostic value of each index for NMOSD.Results Compared with MS group,the levels of alanine aminotransferase,as well as the positive rates of α-hydroxybutyrate dehydrogenase,y-glutamyltransferase,anti-SS-A antibody,anti-SS-B anti-body,anti-ribosomal P protein antibody and Ro-52 antibody were significantly increased in NMOSD group,while the levels of albumin,indirect bilirubin and total bilirubin were significantly decreased,and the differ-ences were statistically significant(P＜0.05).The difference index between NMOSD and conventional physi-cal examination group was similar to that of MS group.The seven indexes,a-hydroxybutyrate dehydrogenase,albumin,globulin,direct bilirubin,indirect bilirubin,total bile acid and uric acid alkalinity could be used for the diagnosis of NMOSD.The area under the curve of combined diagnosis of NMOSD was 0.969,and the sensitiv-ity and specificity were 92.6％and 92.9％.Conclusion Multiple indexes of liver and kidney function in NMOSD patients are different from those in MS patients and healthy subjects underwent routine physical ex-amination,and the positive rate of some autoantibody indexes in NMOSD patients is higher than that in MS patients.Liver,renal function and autoantibody-related indexes can be used clinically to assist diagnosis,and the combined application of multiple indexes can further enhance its diagnostic value.

Objective To explore the effect of mindfulness training on mental health of elite athletes and its possible mechanism.Methods Totally 462 Chinese elite athletes(Mage=18.16,SD=3.14,Range=12～28,44.8%female)were conducted a cross-sectional questionnaire survey.SPSS23 was employed for data statistical analysis,and the mediation model was tested through the Bootstrap program of the extension program PROCESS.Results Mindfulness significantly and negatively predicted anxiety(β=-0.386,P<0.001),depression(β=-0.342,P<0.001),and poor sleep quality(β=-0.324,P<0.001),but significantly and positively predicted training&competition satisfaction(β=0.432,P<0.001)and psychological well-being(β=0.399,P<0.001).Moreover,mindfulness showed significant effects on anxi-ety,poor sleep quality,and satisfaction to training and competition through experiential acceptance,cognitive defusion,and decentering.However,it performed significant impacts on their depression and psychological well-being only through experiential acceptance and cognitive defusion.Conclusion Mind-fulness directly predicts negative reactions such as anxiety,depression and poor sleep quality,as well as positive ones including training and competition satisfaction and psychological well-being in elite ath-letes.Moreover,it has indirect effects on anxiety,poor sleep and training and competition satisfaction through experiential acceptance,cognitive defusion and decentering,together with on depression and psychological well-being through the former two factors.

Here, we took base construction of neurosurgery as example to discuss and analyze according to requirements and evaluation indexes of base construction in Xinqiao Hospital, and put forward the specific objectives, measures and implementations of base construction. Foremost, we summarized experiences and overcame shortcomings through interpreting and implementing scheme of our base construction, which would help to improve the construction of standardized residency training base in China.

Objective:To investigate the risk factors for progression to castration-resistant prostate cancer (CRPC) in metastatic prostate cancer (mPCa) patients who underwent androgen deprivation therapy (ADT).Methods:One hunred mPCa patients underwent ADT were followed up from January 2014 to December 2020 in the Affiliated Central Hospital of Shenyang Medical University. Retrospective analyze the patient′s Gleason score, initial PSA value, minimum prostate specific antigen (nPSA) and time when PSA drops to the lowest point (TTN), and record the state of lymph node metastasis and bone metastasis. Single factor Kaplan-Meier analysis and multivariate Cox regression analysis were used to explore the related risk factors affecting the progress of CRPC.Results:A total of 82 cases (82%) of ADT patients progressed to CRPC. Univariate Kaplan-Meier analysis showed that Gleason score, PSA initial value, lowest nPSA and time to TTN, lymph node metastasis and bone metastasis are risk factors for CRPC ( P<0.01 or<0.05); Multivariate Cox regression analysis showed that Gleason score, initial PSA value, nPSA and TTN are independent risk factors for PCa patients to progress to CRPC ( P<0.01 or<0.05). Conclusions:This study demonstrated that Gleason score, lymph node metastasis, bone metastasis, initial PSA value, nPSA and TTN are risk factors for the progression of CRPC. Patients with higher Gleason grade, higher nPSA, shorter TTN, lymph node and bone metastasis have shorter PFS and higher risk of progression to CRPC.

Objective:To explore the efficacy of doctor-nurse co-led care involving education and engagement of patients on improving compliance of patients, and a treat-to-target urate-lowering rate for gout.Methods:Nurses were trained in practice management of gout. Patients diagnosed with gout in the departments of rheumatology and immunology of Anqing Municipal Hospital in Anhui Province were prospectively enrolled from January 1 to June 30, 2019. The patients were divided into the continuous-care group and the conventional management group by random number table method. The patients of continuous-care group received telephone follow-up, WeChat tracking and regular face-to-face communication. The patients of conventional management group were told to follow up regularly in the outpatient department, and the nurses did not follow up. Patients were evaluated before intervention and 12 months after intervention. The treat-to-target rate of blood uric acid and the frequency of gout flares were observed.Results:After 12 months of intervention, the patients of serum uric acid concentrations below 360 μmol/L were 92.39% (85/92) in the continuous-care group, and 26.74% (23/86) in the conventional management group. There was significant difference ( χ2 value was 80.282, P<0.001). After 12 months of intervention, the average serum uric acid concentration of patients in the continuous-care group was (301.6±61.4) μmol/L, and that in the conventional management group was (419.0±98.0) μmol/L, both of which were significantly lower than before intervention, continuous-care group (466.1±119.7) μmol/L, conventional management group (477.8±113.1) μmol/L. But the average serum uric acid concentration of patients in the continuous-care group was significantly lower than that in the conventional management group. There was significant difference between them ( t value was 96.678, P<0.001). At the end of 12 months, the patients of uric-acid-lowering therapy increased in both groups. The proportion of patients was 94.56% (87/92) in the continuous-care group, which was significantly higher than that in the conventional management group (58.14%, 50/86), there was significant difference ( χ2 value was 33.260, P<0.001). Conclusions:The mode of continuing nursing combined with specialized physician-led treatment can significantly improve the compliance and the control rate of treat-to-target for gout, and this management method is simple and feasible which provides a new management concept for clinical treatment of gout.

Objective:To explore the clinical characteristics and appropriate treatment of occult pneumococcal bacteremia (OPB) in children.Methods:The clinical characteristics, drug sensitivity and antibiotic use of 39 children with OPB who met the inclusion criteria in the Pediatric Internal Medicine Ward of Shenzhen Children′s Hospital from January 2013 to December 2018 were retrospectively analyzed.Results:The median age of onset in OPB in children was 2 years and 4 months, and 74.4% of children(29/39 cases) were between 6 months and 3 years.The average total fever duration was 3.69 days (1-14 days), and the average hospital stay was 6.74 days.Peripheral blood white blood cell count was >15×10 9/L in 89.7% (35/39 cases) of the children, C-reactive protein was increased in 76.9% (30/39 cases) of the children, and procalcitonin > 2 mg/L in 38.9% (14/36 cases) of the children.During hospita-lization, all the children received the treatment of intravenous antibiotics.The antibiotics used initially included Cefuroxime in 11 cases (28.2%), Amoxicillin sulbactam sodium in 10 cases (25.6%), Ceftriaxone sodium in 7 cases (17.9%) and Meloxicillin sulbactam in 6 cases (15.4%). The average fever clearance time after the antibiotic therapy was 1.4 days, and the average intravenous antibiotics treatment time was 6.2 days.The results indicated that the insensitivity rate of Penicillin was 46.2%, the insensitivity rate of Amoxicillin, Ceftriaxone and Cefotaxime were 22.2%, 10.3% and 17.9%, respectively, Erythromycin resistant rate was 100.0%, and no patient was resistant to Vancomycin and Linezolid. Conclusions:OPB occurs most frequently in infants aged from 6 months to 3 years old, with low drug resistance to Amoxicillin, Ceftriaxone and Cefotaxime.Children with complete immunity have shorter fever duration and good prognosis after antibiotic treatment.

Objective To compare the clinical effect of laparoscopic and open umbilical hernia repair for adult umbilicalhernia.Methods Eighty-threepatients with adult umbilical hernia admitted to People's Hospital of Beijing Daxing District from Feb.2008 to Jan.2017 were randomly divided into laparoscopic umbilical hernia repair group (n =38) and open umbilical hernia repair group (n =45).Patients in laparoscopic umbilical hernia repair group accepted laparoscopic umbilical hernia repair with intraperitoneal onlay mesh (n =38),while patients in open umbilical hernia repair group accepted traditional umbilical hernia repairtreatment.Operation time,hospital stay,blood loss,seroma/hematoma formation,wound infection,incomplete bowel obstruction and recurrence were compared between the two groups with the software of SPSS 22.0.The outpatient consultation was performed at 2 weeks,1 month,3 months,and 6 months after operation.The follow-up contents were wound condition,pain,and whether there were any masses in the umbilicus.After every 3 months of telephone follow-up or outpatient review,whether there were any masses in the umbilicus,the average follow-up time was 14 months.Results All operations were successfully completed.The operation time of laparoscopic umbilical hernia repair group was shorter than open umbilical hernia repair group [(31 ± 8) min vs (48 ± 10) min,P ＜ 0.01],and hospital stay were significantly shortened in laparoscopic umbilical hernia repair group (P ＜ 0.05).The amount of bleeding of the laparoscopic umbilical hernia repair group decreased significantly than open umbilical hernia repair group [(40 ± 18) ml vs (62 ± 25) ml,P ＜ 0.01].The postoperative painof the laparoscopic umbilical hernia repair group was mild than open umbilical hernia repair group (P ＜ 0.05).The postoperative complications include seroma,wound infection and incomplete bowel obstruction.There were no significant differences between the two groups of seroma,incision infection and recurrence (P ＞ 0.05).The difference of the incidence of incomplete bowel obstruction between the two groups was statistically significant (P =0.019) . The total postoperative complication rate was significantly lower in laparoscopic umbilical hernia repair group than in open umbilical hernia repair group(x2 =5.328,P =0.021).Conclusions Laparoscopic umbilical hernia repair has short operation time,less bleeding,and satisfactory postoperative pain.It is worthy of advocacy for umbilical hernia patients who can tolerate general anesthesia.