Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Since 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has been widespread in the world, causing about 770 million infecting and 6.9 million deaths. Vaccines against SARS-CoV-2 infection have become the main way to prevent the severe SARS-CoV-2. The use of SARS-CoV-2 vaccine has substantial protection against the serious consequences of SARS-CoV-2 infection, but multiple systemic adverse reactions can occur after the use of SARS-CoV-2 vaccine. More and more studies have shown that SARS-CoV-2 vaccine caused lesions of ocular conjunctiva, cornea, sclera, uvea, retina and optic nerve tissue and resulted in damage to visual function. In this paper, the classification and characteristics of SARS-CoV-2 vaccines and related studies on ocular tissue lesions were reviewed, hoping to better understand the ocular adverse reactions of SARS-CoV-2 vaccine and provide some theoretical guidance for the prevention and treatment of ocular tissue damage caused by SARS-COV-2 vaccine.

Objective:To analyze the optical coherence tomography (OCT) imaging characteristics in patients with Coats disease and their value in predicting macular fibrosis.Methods:A nested case-control study was performed.A total of 43 patients (43 eyes) diagnosed with Coats disease through color fundus photography, ocular B-scan ultrasonography, fundus fluorescein angiography, and spectral-domain OCT examination were enrolled from January 2008 to October 2021 at the Xijing Hospital.Among them, there were 40 males and 3 females, aged from 2 to 60 years old, with a median age of 13 years.Macular fibrosis was used as an indicator of poor prognosis, and patients were divided into two groups based on whether macular fibrosis occurred at the end of follow-up.The differences in OCT characteristics between two groups were compared and logistic regression analysis was used to identify the risk factors for macular fibrosis.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Xijing Hospital of Fourth Military Medical University (No.KY20202009-C-1).Results:The OCT clinical features of 43 cases of Coats disease included intraretinal hard exudates in 43 eyes (100%), subretinal fluid in 21 eyes (48.8%), macular cysts in 17 eyes (27.9%), subretinal exudates in 9 eyes (20.9%), anterior retinal hyperreflective dots in 7 eyes (16.3%), epiretinal membrane in 21 eyes (48.8%), and intraretinal fluid in 22 eyes (51.2%).In color fundus photos of 41 eyes, 38 eyes (93.0%) had hard exudates distributed in the posterior pole and 27 eyes (65.9%) had the mid-peripheral region.OCT examination showed that hard exudates were distributed in the inner nuclear layer in 35 eyes (81.4%) and the outer nuclear layer in 33 eyes (76.7%).Among 21 eyes with exudative retinal detachment detected by OCT, 9 eyes (42.9%) were detected by fundus photography and 18 eyes (85.7%) were detected by B-scan ultrasonography.The proportions of eyes with subretinal fluid and subretinal exudates were higher in the macular fibrosis group than in the non-macular fibrosis group, and the differences were statistically significant ( χ2=20.755, P<0.001; χ2=6.133, P=0.013).Logistic regression analysis showed that the presence of subretinal fluid was a risk factor for macular fibrosis (odds ratio=48.345, 95% confidence interval: 4.272-547.066, P=0.002). Conclusions:OCT examination can detect subretinal fluid, subretinal exudates, macular cysts, macular exudates, and hyperreflective spots in the retina of patients with Coats disease.Subretinal fluid is a risk factor for macular fibrosis.

The hypoxic microenvironment and inflammatory state of residual tumors caused by insufficient radio-frequency ablation(iRFA)are major reasons for rapid tumor progression and pose challenges for immu-notherapy.We retrospectively analyzed the clinical data of patients with hepatocellular carcinoma(HCC)treated with RFA and observed that iRFA was associated with poor survival outcomes and progression-free survival.Using an orthotopic HCC mouse model and a colorectal liver metastasis model,we observed that treatment with melatonin after iRFA reduced tumor growth and metastasis and achieved the best out-comes when combined with anti-programmed death-ligand 1(anti-PD-L1)therapy.In mechanism,melatonin inhibited the expression of epithelial-mesenchymal transitions,hypoxia-inducible factor(HIF)-1 α,and PD-L1 in tumor cells after iRFA.Flow cytometry revealed that melatonin reduced the proportion of myeloid-derived suppressor cells and increased the proportion of CD8+T cells.Transcriptomic analysis revealed an upregulation of immune-activated function-related genes in residual tumors.These findings demonstrated that melatonin can reverse hypoxia and iRFA-induced inflammation,thereby overcoming the immunosuppressive tumor microenvironment(TME)and enhancing the efficacy of immunotherapy.

The main clinical manifestation of dyslipidemia is hyperlipidemia， which is an important risk factor leading to the occurrence of cardiovascular and cerebrovascular diseases such as atherosclerosis， coronary heart disease and stroke. In clinical practice， lipid-lowering drugs are mainly used for treatment， but there are issues such as individual differences and genetic effects. Therefore， it is necessary to perform gene detection on patients， so as to guide individualized application of lipid-lowering drugs. This review mainly previews the definition of gene detection and the individualized treatment of lipid-lowering drugs， and introduces the application of gene detection in the individualized treatment of lipid-lowering drugs （statins， fibrates， nicotinic acid and ezetimibe）. Among them， the gene polymorphisms of APOE， SLCO1B1 and CYP450 family play a key role in the efficacy and safety of statins； the gene polymorphisms of APOA/B/C family have a significant impact on the efficacy of fenofibrate； the gene polymorphisms of HCAR2 and DGAT2 have an important impact on the efficacy of niacin； the gene polymorphisms of NPC1L1 have a significant impact on the efficacy of ezetimibe. It is suggested to conduct genotype detection for patients with dyslipidemia to select appropriate treatment strategies， so as to provide individualized medication guidance.

Objective:To explore the treatment efficacy of neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle in patients with Chiari malformation type I.Methods:Ninety-five patients with Chiari malformation type I, admitted to our hospital from January 2016 to January 2020, were chosen in our study. Patients from observation group ( n=57) were treated with posterior cranial fossa decompression+subdural tonsillectomy+endoscope-assisted exploration and release of the outflow tract of the fourth ventricle+enlarged reconstruction of the occipital cistern. Patients from control group ( n=38) were treated with posterior fossa decompression+subdural tonsillectomy+enlarged reconstruction of the occipital cistern. All patients were followed up for one year. Data of surgical duration, intraoperative blood loss, postoperative length of hospital stay, and incidence of complications were retrospectively analyzed in patients from the two groups, and the imaging changes of spinal cavity were observed before surgery and during postoperative follow-up. Chicago Chiari Outcome Scale (CCOS) was used to evaluate the prognoses of all patients (scores of 11-16 were defined as good prognosis). The differences of good prognosis rate among patients with different gender, age, degrees of tonsillar herniation and distributions of spinal cavity segments were analyzed. Results:There was no significant difference in surgical duration, intraoperative blood loss, postoperative length of hospital stay or incidence of complications between the two groups ( P>0.05). As compared with the control group (65.5%), the observation group had higher syringomyelia minification (75.5%) during postoperative follow-up, without significant difference ( P>0.05). The good prognosis rate of the observation group during postoperative follow-up (91.2%) was significantly higher than that of the control group (78.9%, P<0.05). Female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas had significantly higher good prognosis rate than male patients, patients with age>45 years, and patients with tonsillar herniation level between the foramen magnum and the atlas during postoperative follow-up, respectively ( P<0.05). Conclusion:As compared with conventional surgery, neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle is more effective in patients with Chiari malformation type I, and the good prognosis rate is likely higher in female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas.

Objective:To evaluate the effect of anti-vascular endothelial growth factor (VEGF) in patients with wet age-related macular degeneration (wAMD) and investigate the recurrence factors.Methods:In this case-control study, 40 eyes of 38 patients with wAMD treated by anti-VEGF therapy in Xijing Hospital from October 2015 to April 2017 were included.Ranibizumab or conbercept was consecutively intravitreally injected monthly under 3+ pro re nata (PRN) regimen.All included patients were followed-up at least 12 months.The best corrected visual acuity (BCVA) was expressed in logarithm of the minimum angle of resolution (LogMAR) units.Optical coherence tomography (OCT) was used to observe the morphologic characteristics of macula and measure the central retina thickness (CRT). Patients were divided into recurrence and recurrence-free group based on whether recurrence occurred during follow-up.Potential associated factors with recurrence after treatment were analyzed by multivariate logistic regression analysis.Meanwhile, the morphological and functional response were identified at 1 month after loading phase as well as at last follow-up visit.This study protocol was approved by the Ethics Committee of Shanghai General Hospital (No.2016KY243) and written informed consent was obtained from each patient prior to receiving injection.Results:All the operative eyes showed retinal effusion absorption at least once, and 21 (52.5%) eyes had relapse during follow-up.The patients with lower BCVA (LogMAR) value at the first absorption time had higher risk of recurrence ( OR=16.7, 95% CI=1.22-100, P<0.05). The eyes in the recurrence group received more times of treatment than eyes in the recurrence-free group (5.8±2.3 vs 3.5±1.4, t=3.64, P<0.05). However, there was no significance between the two groups in BCVA change before and after treatment ( t=-1.52, P>0.05). In the recurrence group, the BCVA (LogMAR) and CRT at last visit were 0.73±0.34 and (187.2±81.7)μm respectively, while were significantly improved in comparison with 0.81±0.37 and (234.2±74.5)μm at the relapse time ( t=2.14, 2.62; both at P<0.05). There were 87.5% (35/40) eyes showed good morphological responses at 1 month after the loading phase while 12.5% (5/40) eyes presented poor morphological responses, the retinal effusion was absorbed after additional (3.2±2.2) times of injections.The BCVA of eyes with a good morphological response at 1 month following loading phase was better than that at the first retinal effusion absorption time ( t=-2.23, P<0.05). Average CRT at last visit was significantly decreased in comparison with the baseline CRT ( Z=-4.62, P<0.01). Conclusions:For wet AMD patients, the anti-VEGF treatment is safe and effective in the short term, while there is still a high rate of recurrence.More attention should be paid to eyes with better vision at the first time of retinal effusion absorption which may have more chance to experience recurrence.Patients need long-term follow-up after treatment to prevent recurrence.In addition, the complete loading treatment is needed for patients who have a good morphological response after the first retinal effusion absorbed.

Objective:To investigate the application value of different types of acellular matrix graft biological meshes in inguinal hernia repair of adolescents.Methods:The retrospective cohort study was conducted. The clinical data of 159 adolescent patients with inguinal hernia who were admitted to Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2013 to June 2018 were collected. There were 155 males and 4 females, aged from 13.0 to 18.0 years, with a median age of 15.0 years. Of the 159 patients, 42 undergoing traditional high ligation of hernia sac were divided into traditional operation group, 61 undergoing Lichtenstein hernia repair using domestic cross-linked acellular matrix graft biological meshes were divided into domestic biological mesh group, and 56 undergoing Lichtenstein hernia repair using imported non cross-linked acellular matrix graft biological meshes were divided into imported biological mesh group. Observation indicators: (1) surgical situations; (2) postoperative recovery; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detected postoperative recovery and complications of patients up to June 2019. Measurement data with skewed distribution were represented as M (range), comparison between multiple groups was analyzed using the Kruskal-Wallis H test, and paired comparison between groups was analyzed using the Nemenyi test. Count data were described as absolute numbers, comparison between multiple groups was analyzed using the chi-square test or Fisher exact probability, and paired comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison between groups was corrected using the Bonferroni method. Results:(1) Surgical situations: all the 3 groups underwent inguinal hernia repair successfully. The operation time of the traditional operation group, domestic biological mesh group and imported biological mesh group was 20 minutes(range, 10-25 minutes), 35 minutes (range, 30-40 minutes) and 35 minutes (range, 30-40 minutes), respectively, showing a significant difference among the three groups ( χ2=91.640, P<0.05). There were significant differences in the operation time between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group ( P<0.016 7). There was no significant difference in the operation time between the domestic biological mesh group and the imported biological mesh group( P>0.05). (2) Postoperative recovery: the postoperative recurrence rate of hernia of the traditional operation group, domestic biological mesh group and imported biological mesh group was 7.1%(3/42), 0, 0, respectively, showing a significant difference among the three groups ( χ2=8.150, P<0.05). There were significant differences in the postoperative recurrence rate of hernia between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group ( P<0.016 7). There was no significant difference in the postoperative recurrence rate of hernia between the domestic biological mesh group and the imported biological mesh group( P>0.05). The incidence of seroma of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3%(2/61), 17.9%(10/56), respectively, showing a significant difference among the three groups ( χ2=14.929, P<0.05). There were significant differences in the incidence of seroma between the imported biological mesh group and the traditional operation group or between the imported biological mesh group and the domestic biological mesh group ( χ2=6.517, 6.741, P<0.016 7). There was no significant difference in the incidence of seroma between the traditional operation group and the domestic biological mesh group ( P>0.05). The incidence of fat liquefaction of incision of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3%(2/61), 1.8%(1/56), respectively, showing no significant difference among the three groups ( P>0.05). Patients with fat liquefaction of incision were cured after the treatment of dressing change. The duration of hospital stay of the traditional operation group, domestic biological mesh group and imported biological mesh group were 3.0 days(range, 2.0-5.0 days), 3.0 days(range, 1.0-5.0 days), 2.5 days(range, 1.0-5.0 days), respectively, showing no significant difference among the three groups ( χ2=0.907, P>0.05). (3) Follow-up: all the 155 patients were followed up for 12-77 months, with a median time of 41 months. None of patients was observed with chronic pain, foreign body sensation or infection during the follow-up. Conclusions:It is safe and effective to repair adolescent inguinal hernia with biological mesh. There was no significant difference in the clinical efficacy between the two different types of acellular matrix graft biological meshes, both of which can be used in repair of adolescent inguinal hernia.

The incidence of stroke increases year by year.It seriously affects the quality of life in patients.The pathogenesis of stroke is related to a variety of factors,involving genetic polymorphisms,biochemical mechanisms,and inflammatory effect.Among them,vascular endothelial growth factor (VEGF) has become one of the hotspots of research on the pathogenesis of stroke in recent years.This article reviews the correlation between VEGF gene polymorphism and stroke.

Objective To estimate the absorbed dose and effective dose to the examined adult patients during digital tomosynthesis and to provide reference data for radiation dosimetry.Methods The phantom experiments were grouped according to the examined site(main beam scanned site),and the data displayed in real time during digital tomosynthesis are used as conditions for the phantom experiments.The effective doses to the examined patients were estimated on the basis of phantom scanning and tissue-absorbed dose calculation.Results During digital tomosynthesis,the effective doses to the examined patients of various groups were 0.524 mSv for head,0.736 mSv for cervical spine,2.719 mSv for thoracic vertebra,1.810 mSv for chest,1.240 mSv for lumbar spine,2.317 mSv for abdomen and 2.316 mSv for pelvis,respectively.Conclusions During digital tomography,the highest value of effective doses was estimated to be 2.719 mSv in thoracic vertebra group,followed by abdominal group 2.317 mSv and pelvic group 2.316 mS,with the lowest 0.524 mSv in head group.The main factors influencing the effective dose include tube voltage,total mAs,irradiation field size,main beam irradiation range,and the number of tissues or organs in scanned range.