Esophagogastric variceal bleeding in cirrhotic patients is associated with high mortality if not adequately managed. Standardized treatment of esophagogastric variceal bleeding includes adequate resuscitation maneuvers, restrictive transfusion policy, antibiotic prophylaxis, pharmacologic therapy, and endoscopic therapy. After this initial treatment, the most appropriate therapy to prevent both early and late rebleeding must be instituted following a risk stratification strategy. Placing a preemptive transjugular intrahepatic portosystemic shunt in high-risk patients, as soon as possible after admission, to achieve early control of bleeding has proved to improve survival. The present review will focus on the initial management of patients with acute esophagogastric variceal bleeding, including general management and assessment, pharmacotherapy, as well as the available endoscopic, interventional and salvage treatments, trying to provide reference for standardizing the treatment process of such patients, in order to improve their survival rate.

Objective To observe the changes of motor function and brain tissue transcriptomic profiles in mice with traumatic brain inury (TBI) by seawater immersion, and to explore its potential mechanism. Methods A total of 51 male C57/BL adult mice were randomly divided into sham surgery group, TBI group and TBI+seawater group (17 mice in each group). Behavior tests (rotating bar and balance beam tests) were performed at 1 d, 3 d and 7 d after injury to detect the changes of endurance and motor coordination ability in mice. Blood-brain barrier permeability (Evans blue staining) and brain tissue pathological changes (HE staining) were detected at 12 h and 24 h after injury. The expression levels of apoptosis-related proteins BCL-2 and Bax in brain tissues were detected with Western blotting 24 h after injury, and carry out brain tissue transcriptomics detection and analyze the related differentially expressed genes and signal pathways. Results Behavior tests showed that compared with the sham surgery group and TBI group, mice in TBI+seawater group had a significantly shortened time on the rotating bar (P<0.001) and spend a significantly prolonged time to pass through the balance beam (P<0.001) on 1 d, 3 d, and 7 d after injury. Evans blue staining showed that the EB permeation area of TBI+seawater group was significantly larger than that of the TBI group (P<0.05), and the EB permeation area at 24 h after injury was significantly smaller than that at 12 h after injury in both groups (P<0.05). HE staining results showed that the pathological damage in TBI+seawater group was worsened compared with TBI group. Western blotting results showed that 24 h after injury, the expression of Bax in TBI+seawater group was significantly increased (P<0.05) while the expression of Bcl-2 was significantly decreased (P<0.05) in injured brain tissue compared with TBI group. Transcriptomic analysis showed that there were 625 differentially expressed genes in the injured brain tissue of TBI+seawater group compared with TBI group (P<0.05), and the expression levels of p53-related genes and natural killer cell-related genes were significantly increased (P<0.05). Pathway enrichment analysis showed that natural killer cell immune regulation, lymphocyte immune regulation, and cytokine-cytokine receptor binding pathways were significantly enriched (P<0.05). Conclusions Seawater immersion can promote apoptosis of damaged neural cells in TBI mice, leading to impaired motor coordination and endurance in mice. Endogenous apoptosis mediated by p53 and immune regulation mediated by natural killer cells may be associated with this phenomenon.

Objective To investigate the prevalence and risk factors of hypertension in young men first exposed to high altitude for half a year at 4500 m. Methods A total of 228 young men who firstly traveled from a plain area to an altitude of 4500 meters in northern Tibet and stayed there for six months were recruited in present study. They were divided into hypertension group (HTN, n=66) and non-hypertension group (NTN, n=162) based on their blood pressure status. A self-administered questionnaire, the Pittsburgh Sleep Quality Index (PSQI), physical examinations and laboratory tests were used to investigate the risk factors and clinical complications of hypertension. The general data and clinical complications of the two groups were compared, and multivariate logistic regression was used to analyze the risk factors of high-altitude hypertension and predisposition of clinical complications. Results Among the 228 individuals, 66 developed hypertension (incidence of 28.9%), including 52 cases of stage Ⅰ hypertension and 14 cases of stage Ⅱ hypertension. Fifty-eight individuals had isolated diastolic hypertension, and 8 individuals had combined systolic and diastolic hypertension. The proportions of obesity and overweight, central obesity, smoking over 10 cigarettes per day, family history of hypertension, dyslipidemia, and hyperuricemia were significantly higher in HTN group than those in NTN group (P<0.05). The PSQI score was also higher significantly in HTN group than that in NTN group (P<0.001). Multivariate logistic regression analysis showed that hyperuricemia (P=0.02), central obesity (P=0.04), family history of hypertension (P=0.03) and sleeping quality (P<0.001) were the independent risk factors for high-altitude hypertension. The proportion of clinical complications in the past month in HTN group was significantly higher than that in NTN group (P=0.001), and the proportion of three or more kinds of clinical complications was also higher in HTN group than that in NTN group (P=0.01). After adjusting for demographic differences, the risk of dizziness and headache in HTN group was higher than that in NTN group (P<0.05). Conclusions Young men firstly exposed to an altitude of 4500 meters still have a high incidence of hypertension after six months, mostly stage Ⅰ hypertension with diastolic pressure elevation; Hyperuricemia, central obesity, family history of hypertension, and poor sleep quality are the independent risk factors for high-altitude hypertension. High-altitude hypertension can cause various clinical complications, and the higher risk of accompanying dizziness and headache.

Objective To explore the influence of external fixator combined with antibiotic-impregnated calcium sulfate on postoperative infection and bone healing in patients with open tibia and fibula fractures. Methods A total of 83 patients with open tibia and fibula fractures admitted to the First Affiliated Hospital of Hainan Medical College from June 2017 to June 2020 were selected, and according to the throwing method randomly divided into observation group (n=41) and control group (n=42). Patients in the control group were treated with external fixator, and those in the observation group were treated with external fixator combined with antibiotic-impregnated calcium sulfate. The bone healing (including complete weight bearing time, swelling elimination time, external fixator removal time, bone healing time), knee function (HSS score), ankle function (AOFAS score), quality of life, and incidence of complications were compared between the two groups. Results There was no statistically significant difference in the general data between the two groups (P>0.05). The complete weight bearing time, swelling elimination time, external fixator removal time, and bone healing time in observation group were shorter than in control group (P<0.05). There was no statistically significant difference in HSS score, AOFAS score and SF-36 score between the two groups before treatment (P>0.05). After treatment, the HSS scores and AOFAS scores of the two groups increased, and the observation group had higher scores than the control group (P<0.05). The SF-36 scores of the two groups increased, and the scores for energy, general health and physiological function in observation group were higher than in control group (P<0.05). There was no statistically significant difference in the incidence of malunion, nonunion and decreased muscle strength between the two groups (P>0.05), but the incidence of wound infection was lower in observation group than in control group (P<0.05). Conclusion External fixator combined with antibiotic-impregnated calcium sulfate is effective in treatment of patients with open tibia and fibula fractures, which can significantly reduce the postoperative infection rate and accelerate bone healing.

The special environment of low oxygen in the plateau area will have a significant impact on human physiology and psychology, especially in a short period of time to reach the plateau, which can lead to the impairment of attention, memory, executive function, information processing and other types of cognitive functions, and directly affect health and working ability of people in the plateau. To correctly recognize and avoid the damage has become an urgent problem for researchers and clinicians. This paper summarizes the research status of the impact of acute high altitude hypoxia on human cognitive function in recent years, and summarizes the mechanism of high altitude hypoxia affecting brain physiological function, the damage characteristics of acute hypoxia on different types of cognitive function and hypoxia acclimatization strategies, in order to more clearly explain the relationship between high altitude hypoxia and cognitive changes, and better ensure the health and safety of people entering the plateau and Tibet.

Advances in the treatment of haematological malignancies have improved the long-term prognosis of patients to some extent, but have also highlighted the importance of tumour progression and cardiovascular events caused by anti-tumour therapy. A significant proportion of patients with haematological malignancies receiving existing and emerging oncological treatment regimens such as anthracyclines, proteasome inhibitors, targeted therapies and immunotherapy experience cardiovascular events at some point after disease remission, which seriously affects the survival and quality of life of the patients. This article reviews the mechanisms, clinical manifestations and interventions of cardiotoxicity induced by therapeutic agents for haematological malignancies, with the aim of providing a reference to protect patients with haematological malignancies from cardiovascular complications.

Objective To investigate hepatitis B virus (HBV) reactivation in patients with diffuse large B-cell lymphoma (DLBCL) who were hepatitis B surface antigen negative/antibody to hepatitis B core antigen positive (HBsAg negative/anti-HBc positive) and received rituximab combined with CHOP (R-CHOP) chemotherapy regimen. Methods In this retrospective study, clinical data of 187 HBsAg negative/anti-HBc positive patients with DLBCL were collated and analyzed respectively from Hematology Department of Peking University Third Hospital from 2010 to 2018. All the patients received R-CHOP chemotherapy and did not receive prophylactic antiviral therapy. According to whether HBV was reactivated or not, these patients were divided into non-HBV reactivation group (174 cases) and HBV reactivation group (13 cases). Results The age of the patients in HBV reactivation group was significantly higher than that in non-HBV reactivation group [71(66, 80) years vs. 65(54, 75) years, P<0.05]. HBV DNA changed from undetectable baseline to detectable level in 13 patients (13/13, 100.0%). The time when HBsAg or HBeAg became positive in 2 patients was earlier than the time when HBV DNA could be detected. In 13 patients with HBV reactivation, 2 patients developed hepatitis related to HBV reactivation, and there was no fulminant hepatitis related to HBV reactivation. Serum HBsAg became positive in 7 of the 13 patients (7/13, 53.8%) with HBV reactivation, whereas serum HBeAg became positive in 3 patients (3/13, 23.1%). After HBV reactivation, HBV DNA reached an undetectable level again in 10 patients during follow-up, of which 7 patients received antiviral treatment. HBsAg became negative again in 2 HBsAg positive patients during follow-up. Conclusion DLBCL patients who were HBsAg negative/anti-HBc positive and treated with R-CHOP chemotherapy had a moderate risk of HBV reactivation. Close monitoring of HBV DNA levels and HBV serological markers should be performed in lymphoma patients who received R-CHOP chemotherapy.

Objective To evaluate the risk factors of treatment outcomes in MDR-PTB patients with long-term treatment regimen in China. Methods 332 patients with MDR-PTB were recruited from 22 sentinel hospitals and 1 tertiary general hospital in 23 Provinces in China from January 2013 to December 2017. The treatment outcomes were investigated retrospectively, and the influencing factors of treatment outcomes were collected and analyzed. Results For the 332 patients, 196 cases were successful (59.04%), 76 cases failed (22.89%), 33 cases lost follow-up (9.94%), 12 cases died (3.61%), and 15 cases were transferred out (4.52%). The main factors affecting the outcome of treatment included age ≥50 years (OR=0.342, 95%CI 0.169-0.690), course of MDR-PTB ≥1 year (OR=0.297, 95%CI 0.108-0.815), irregular treatment (OR=0.429, 95%CI 0.197-0.934), cavities before treatment (OR=0.073, 95%CI 0.026-0.207) and positive sputum culture month 3 (OR=0.161, 95%CI 0.072-0.358), and cavity closure month 6 (OR=15.723, 95%CI 5.690-43.444) is predictor of success. Conclusions The result of this study indicated that age, course of MDR-PTB, irregular treatment, sputum culture in month 3, cavity before treatment and cavity closure in month 6 were the influencing factors of MDR-PTB outcome. In the initial stage of treatment of MDR-PTB patients, sputum culture results in month 3 and CT images have important predictive value for the treatment results of MDR-PTB patients.

Objective To investigate the risk factors for concomitant pulmonary thromboembolism (PTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to construct a line graph prediction model accordingly and validate it. Methods 426 patients with AECOPD who attended the Affiliated hospital of North Sichuan Medical College from January 2019 to December 2021 were selected for retrospective analysis. The patients were divided into 256 cases in model group and 170 cases in validation group in a ratio of 6∶4. Indicators that may affect AECOPD patients with concurrent PTE were collected, and patients in model group were divided into PTE subgroup and non-PTE subgroup according to the presence or absence of concurrent PTE, and the above-mentioned indicators in the 2 subgroups were compared, and the independent influencing factors of AECOPD patients with concurrent PTE were screened by multifactorial logistic regression analysis, which was used to construct a column line graph prediction model. The prediction model was internally validated by Bootstrap method, and then externally validated by using the validation group data. Results A total of 39 (15.2%) of 256 AECOPD patients in model group were complicated by PTE. Multifactorial logistic regression analysis showed that Barthel index score, bed rest time, deep vein thrombosis of lower extremity, right heart insufficiency, PaO₂, fibrinogen, and C-reactive protein were independent influencing factors for complicated PTE in AECOPD patients (P<0.05). According to the results of multi-factor regression analysis, the column line graph prediction model was constructed using R4.1.3 software, and the internal validation area under ROC curve (AUC) of the model was 0.863, 95%CI was 0.798-0.927, sensitivity was 82.94%, and specificity was 74.36%; the internal validation results of the column line graph model by Bootstrap method showed that the mean absolute error was 0.02, and the prediction model was basically fitted with the ideal model; the external validation results showed that the AUC of the column line graph model constructed by the validation group was 0.892 with 95%CI of 0.803-0.942. Conclusions The major risk factors for concomitant PTE in patients with AECOPD include Barthel index score, bed rest time, deep vein thrombosis of lower extremity, right heart insufficiency, PaO₂, fibrinogen, and C-reactive protein, and the column line graph prediction model constructed from this has a high sensitivity and specificity.

With the improvement of people's health awareness and the popularization of low-dose spiral CT (LDCT) screening, more and more pulmonary nodules have been found. Pulmonary nodules gradually become a common and frequently occurring disease. The diagnosis and treatment of pulmonary nodules has also become a clinical problem. The rise of transbronchial pulmonary nodule diagnosis and treatment technology guided by various navigation technologies provides possibility for more minimally invasive diagnosis and treatment of pulmonary nodules. Navigation guided bronchoscopy is in a rapid development stage both at home and abroad. In order to standardize and promote the development of navigation bronchoscopy technology in China, Committee for the Prevention and Treatment of Senile Tumors of the CSCO organized domestic experts with rich experience in this field to jointly agree and write the consensus.