Safety and efficacy of modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension

BACKGROUND Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension(LSPH).The hemorrhage is fatal and requires safe and effective interventions.AIM To evaluate the clinical safety and efficacy of modified endoscopic ultrasound(EUS)-guided selective N-butyl-2-cyanoacrylate(NBC)injections for gastric variceal hemorrhage in LSPH.METHODS A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted.Preoperative EUS evaluations were performed.Enrolled patients were divided into modified and conventional groups according to the NBC injection technique.The final selection of NBC injection technique depended on the patients’preferences and clinical status.The technical and clinical success rates,operation time,NBC doses,perioperative complications,postoperative hospital stay,and recurrent bleeding rates were analyzed,respectively.RESULTS A total of 27 patients were enrolled.No statistically significant differences were observed between the two groups regarding baseline characteristics.In comparison to patients in the conventional group,patients in the modified group demonstrated significantly reduced NBC doses(2.0±0.6 mL vs 3.1±1.0 mL;P=0.004)and increased endoscopic operation time(71.9±11.9 min vs 22.5±6.7 min;P<0.001).Meanwhile,the two groups had no significant difference in the technical and clinical success rates,perioperative complications,postoperative hospital stay,and recurrent bleeding rates.CONCLUSION Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage,with advantages of reduced injection dose and no radiation risk.Drawbacks were time consumption and technical challenge.

Brain region-specific roles of brain-derived neurotrophic factor in social stress-induced depressive-like behavior

Brain-derived neurotrophic factor is a key factor in stress adaptation and avoidance of a social stress behavioral response.Recent studies have shown that brain-derived neurotrophic factor expression in stressed mice is brain region–specific,particularly involving the corticolimbic system,including the ventral tegmental area,nucleus accumbens,prefrontal cortex,amygdala,and hippocampus.Determining how brain-derived neurotrophic factor participates in stress processing in different brain regions will deepen our understanding of social stress psychopathology.In this review,we discuss the expression and regulation of brain-derived neurotrophic factor in stress-sensitive brain regions closely related to the pathophysiology of depression.We focused on associated molecular pathways and neural circuits,with special attention to the brain-derived neurotrophic factor–tropomyosin receptor kinase B signaling pathway and the ventral tegmental area–nucleus accumbens dopamine circuit.We determined that stress-induced alterations in brain-derived neurotrophic factor levels are likely related to the nature,severity,and duration of stress,especially in the above-mentioned brain regions of the corticolimbic system.Therefore,BDNF might be a biological indicator regulating stress-related processes in various brain regions.

Glucocorticoid receptor signaling in the brain and its involvement in cognitive function

The hypothalamic-pituitary-adrenal axis regulates the secretion of glucoco rticoids in response to environmental challenges.In the brain,a nuclear receptor transcription fa ctor,the glucocorticoid recepto r,is an important component of the hypothalamicpituitary-a d renal axis's negative feedback loop and plays a key role in regulating cognitive equilibrium and neuroplasticity.The glucoco rticoid receptor influences cognitive processes,including glutamate neurotransmission,calcium signaling,and the activation of brain-derived neurotrophic factor-mediated pathways,through a combination of genomic and non-genomic mechanisms.Protein interactions within the central nervous system can alter the expression and activity of the glucocorticoid receptor,there by affecting the hypothalamic-pituitary-a d renal axis and stress-related cognitive functions.An appropriate level of glucocorticoid receptor expression can improve cognitive function,while excessive glucocorticoid receptors or long-term exposure to glucoco rticoids may lead to cognitive impairment.Patients with cognitive impairment-associated diseases,such as Alzheimer's disease,aging,depression,Parkinson's disease,Huntington's disease,stroke,and addiction,often present with dysregulation of the hypothalamic-pituitary-adrenal axis and glucocorticoid receptor expression.This review provides a comprehensive overview of the functions of the glucoco rticoid receptor in the hypothalamic-pituitary-a d renal axis and cognitive activities.It emphasizes that appropriate glucocorticoid receptor signaling fa cilitates learning and memory,while its dysregulation can lead to cognitive impairment.This provides clues about how glucocorticoid receptor signaling can be targeted to ove rcome cognitive disability-related disorders.

Modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension:A case report

BACKGROUND Left-sided portal hypertension(LSPH),also known as sinistral portal hypertension or regional portal hypertension,refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis.N-butyl-2-cyanoacrylate(NBC)has been widely used in the endoscopic hemostasis of portal hypertension,but adverse events including renal or pulmonary thromboembolism,mucosal necrosis and gastrointestinal(GI)bleeding may occur after treatment.Herein,we report successfully managing gastric variceal(GV)hemorrhage secondary to LSPH using modified endoscopic ultrasound(EUS)-guided selective NBC injections.CASE SUMMARY A 35-year-old man was referred to our hospital due to an upper GI hemorrhage.Gastroscopy revealed GV hemorrhage and computed tomography venography(CTV)confirmed LSPH.The patient requested endoscopic procedures and rejected surgical therapies including splenectomy.EUS-guided selective NBC injections were performed and confluences of gastric varices were selected as the injection sites to reduce the injection dose.The“sandwich”method using undiluted NBC and hypertonic glucose was applied.No complications occurred.The patient was followed up regularly after discharge.Three months later,the follow-up gastroscopy revealed firm gastric submucosa with no sign of NBC expulsion and the follow-up CTV showed improvements in LSPH.No recurrent GI hemorrhage was reported during this follow-up period.CONCLUSION EUS-guided selective NBC injection may represent an effective and economical treatment for GV hemorrhage in patients with LSPH.

水淹胁迫对美洲黑杨嫁接苗叶片色素及光合特性的影响

以‘全红杨’‘中红杨’和‘2025杨'3个品种嫁接苗为试验材料,采用随机区组设计,盆栽模拟水淹环境,以正常浇水条件为对照,研究不同胁迫处理时间下,3个杨树品种的叶片色素含量、光合特性的响应变化及各指标间的相关性。结果表明:水淹胁迫期间,3个杨树品种叶片色素含量及气孔导度(G_(s))、净光合速率(P_(n))、蒸腾速率(T_(r))和胞间CO_(2)浓度(C_(i))均极显著下降。胁迫后期,叶绿素a含量下降幅度大于叶绿素b,同时叶片C_(i)升高,羧化效率(CE)下降,C_(i)与P_(n)的相关性由正变为负,三者P_(n)的再次下降主要是由非气孔限制所致。对P_(n)的相关性分析表明,花色素苷含量与‘全红杨’叶片P_(n)呈正相关,而‘2025杨’花色素苷含量与P_(n)呈负相关。水淹胁迫70d,3个杨树品种叶片P_(n)均始终为正值,水分利用效率(WUE)大幅提高,表现出稳定的耐涝遗传特质,其中‘全红杨'耐水淹能力相对较弱。

RUSLE模型对黄土高原退耕植被恢复坡面土壤侵蚀的模拟效果分析

[目的]为了探究RUSLE模型对黄土高原退耕植被恢复坡面土壤侵蚀模拟的效果。[方法]基于陕北安塞区坊塌小流域内10个径流小区2016-2022年的降雨产流产沙监测资料,通过RUSLE模型中各因子在黄土高原的不同常用算法之间的变换组合,模拟144种因子组合下各退耕植被恢复坡面的土壤侵蚀量,采用纳什效率系数(NSE)和均方根误差(RMSE)评价模型模拟结果的有效性。[结果]利用RUSLE模型144种因子组合模拟的退耕植被恢复坡面土壤侵蚀量,NSE范围为-38.47~0.19,RMSE范围为1.92~12.65 t/(hm 2·a),模拟效果较差,所选各因子算法难以适应退耕植被恢复坡面上的土壤流失量的评估,还需要对RUSLE模型各因子进一步改进。运用RUSLE模型对黄土高原退耕植被恢复坡面土壤侵蚀模拟时,建议尽可能采用时间分辨率高的数据减小对R因子的计算误差,综合考虑土壤有机质含量、土壤粒径与团粒结构组成和容重等土壤理化性质对K因子的影响,以及植被覆盖度、植被高度、枯落物、生物结皮等对C因子的影响,充分考虑10°以上的坡度,细化其LS因子的算法。[结论]RUSLE模型无法很好地适用于黄土高原退耕植被恢复坡面土壤侵蚀的模拟。研究结果为土壤侵蚀模型的研发及RUSLE模型在黄土高原植被恢复坡面的应用提供一定参考依据。

Unloading and successful treatment with bioresorbable stents during percutaneous coronary intervention:A case report

BACKGROUND With the development of percutaneous coronary intervention(PCI),the number of interventional procedures without implantation,such as bioresorbable stents(BRS)and drug-coated balloons,has increased annually.Metal drug-eluting stent unloading is one of the most common clinical complications.Comparatively,BRS detachment is more concealed and harmful,but has yet to be reported in clinical research.In this study,we report a case of BRS unloading and successful rescue.This is a case of a 59-year-old male with the following medical history:“Type 2 diabetes mellitus”for 2 years,maintained with metformin extended-release tablets,1 g PO BID;“hypertension”for 20 years,with long-term use of metoprolol sustained-release tablets,47.5 mg PO QD;“hyperlipidemia”for 20 years,without regular medication.He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours,on February 20,2022 at 15:35.Electrocardiogram results showed sinus rhythm,ST-segment elevation in leads I and avL,and poor R-wave progression in leads V1–3.High-sensitivity troponin I level was 4.59 ng/mL,indicating an acute high lateral wall myocardial infarction.The patient’s family requested treatment with BRS,without implanta-tion.During PCI,the BRS became unloaded but was successfully rescued.The patient was followed up for 2 years;he had no episodes of angina pectoris and was in generally good condition.CONCLUSION We describe a case of a 59-year-old male experienced BRS unloading and successful rescue.By analyzing images,the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations.We discuss preventive measures for BRS unloading.

黄土丘陵沟壑区坡沟系统产流产沙对源-汇-路径格局的响应

坡沟系统是流域水土流失与治理的基本单元,掌握其产流产沙规律是有效解决水土流失区生态环境恢复重建的核心问题之一。该研究利用无人机遥感与地理信息系统技术对流域的土地利用进行识别,再确定5个不同坡沟系统(2个无人为干扰的退耕植被恢复+自然植被坡沟系统SG1和SG2、2个人为扰动的退耕植被恢复+自然植被坡沟系统SG3和SG4、1个果园+坡耕地的坡沟系统SG5)内泥沙源、汇及其输移路径分布特征,并在量化指标的基础上,结合2016—2022年坊塌小流域5个坡沟系统的降雨和产流产沙的监测数据,研究了不同坡沟系统的产流产沙特征及其对源-汇-路径格局的响应。结果表明:次降雨条件下,SG1和SG2的产沙模数显著低于其他坡沟系统(P<0.05),且SG3径流深和产沙模数均较大;SG2的年平均径流深显著低于SG5(P<0.05)。坡沟系统径流深分别与总坡沟系统、沟间地、沟谷地的泥沙源和汇最大斑块面积比显著正相关(P<0.05),且与沟间地泥沙源、汇指数的相关系数均要大于沟谷地,径流深与总坡沟系统路径的分岔比、沟间地与沟谷地的路径比降均呈现出显著负相关(P<0.05);产沙模数与各源汇指数之间均无显著的相关性,但与路径数量密度、长度密度、沟间地的路径分岔比呈显著正相关(P<0.05);径流深和产沙模数均与路径复杂度呈显著负相关(P<0.05)。可见,降低源/汇比例大小,适当增加泥沙输移路径的复杂度和输移距离,可有效减少坡沟系统的水土流失。研究可为坡沟系统土壤侵蚀防控以及流域生态保护和修复提供科学支撑。

Mutual feedback between algal blooming and global warming

Global warming and algal blooms have been two of the most pressing problems faced by the world today.In recent decades,numerous studies indicated that global warming promoted the expansion of algal blooms.However,research on how algal blooms respond to global warming is scant.Global warming coupled with eutrophication promoted the rapid growth of phytoplankton,which resulted in an expansion of algal blooms.Algal blooms are affected by the combined effects of global warming,including increases in temperatures,CO_(2)concentration,and nutrient input to aquatic systems by extreme weather events.Since the growth of phytoplankton requires CO_(2),they appear to act as a carbon sink.Unfortunately,algal blooms will release CH4,CO_(2),and inorganic nitrogen when they die and decompose.As substrate nitrogen increases from decompose algal biomass,more N2O will be released by nitrification and denitrification.In comparison to CO_(2),CH4has 28-fold and N2O has 265-fold greenhouse effect.Moreover,algal blooms in the polar regions may contribute to melting glaciers and sea ice(will release greenhouse gas,which contribute to global warming)by reducing surface albedo,which consequently would accelerate global warming.Thus,algal blooms and global warming could form feedback loops which prevent human survival and development.Future researches shall examine the mechanism,trend,strength,and control strategies involved in this mutual feedback.Additionally,it will promote global projects of environmental protection combining governance greenhouse gas emissions and algal blooms,to form a geoengineering for regulating the cycles of carbon,nitrogen,and phosphorus.

Physician-dependent diagnosis delay in Crohn's disease:A pseudoproposition or not?

The challenge of diagnosis delay in inflammatory bowel disease(IBD)has emerged as a significant concern for both patients and healthcare professionals.The widely accepted notion that there is an extended time frame from the onset of symptoms to the definitive diagnosis is often attributed to the heterogeneity of IBD and the non-specificity of clinical manifestations.Specific to patients with Crohn’s disease,the issue of delayed diagnosis appears to be more pronounced across different regions globally.The intricate interplay of real-world factors has led to debates regarding the primary contributors to these diagnostic delays.Drawing a comparison solely between patients and physicians and implicating the latter as the predominant influence factor may fall into a simplistic either-or logical trap that may obscure the truth.This letter,grounded in published evidence,explores areas for improvement in a forthcoming paper within the field,hoping to pinpoint the culprit behind the diagnosis delay issue for IBD patients rather than simply attributing it to so-called“physician-dependent factors”.Our objective is to motivate healthcare providers and policymakers in relevant fields to reflect on strategies for addressing this problem to reduce diagnostic delays and enhance patient outcomes.

Early gastric cancer recurrence after endoscopic submucosal dissection:Not to be ignored!

This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.

Neonatal tachypnea caused by diaphragmatic paralysis:A case report

BACKGROUND Diaphragmatic paralysis is typically associated with phrenic nerve injury.Neonatal diaphragmatic paralysis diagnosis is easily missed because its manifestations are variable and usually nonspecific.CASE SUMMARY We report a 39-week-old newborn delivered via vaginal forceps who presented with tachypnea but without showing other birth-trauma-related manifestations.The infant was initially diagnosed with pneumonia.However,the newborn still exhibited tachypnea despite effective antibiotic treatment.Chest radiography revealed right diaphragmatic elevation.M-mode ultrasonography revealed decreased movement of the right diaphragm.The infant was subsequently diagnosed with diaphragmatic paralysis.After 4 weeks,tachypnea improved.Upon re-examination using M-mode ultrasonography,the difference in bilateral diaphragmatic muscle movement was smaller than before.CONCLUSION Appropriate use of M-mode ultrasound to quantify diaphragmatic excursions could facilitate timely diagnosis and provide objective evaluation.

Flexner's legacy and the future of medical education:Embracing challenge and opportunity

This editorial comments on the article by Alzerwi.We focus on the development course,present challenges,and future perspectives of medical education.Modern medical education is gradually undergoing significant and profound changes worldwide.The emergence of new ideas,methodologies,and techniques has created opportunities for medical education developments and brought new concerns and challenges,ultimately promoting virtuous progress in medical education reform.The sustainable development of medical education needs joint efforts and support from governments,medical colleges,hospitals,researchers,administrators,and educators.

Post competency training in standardized training of resident physicians and integrated postgraduates

We focus on the importance and necessity of post-competency-based training in medical education alongside its current challenges and opportunities.Integrating post competency training into standardized educational frameworks is increasingly recognized as a critical component of preparing residents and postgraduates for real-world clinical practice.Post competency training represents a commitment to excellence in medical education,striving to produce competent,skilled practitioners to meet the challenges of modern healthcare.

Optimal traditional Chinese medicine formulas in treating ulcerative colitis:Choose one or take it all?

Ulcerative colitis(UC)is a chronic inflammatory bowel disease that presents significant treatment challenges due to its complexity,especially in terms of the various side effects that traditional medications may bring during the chronic course of the disease.Traditional Chinese medicine(TCM)has emerged as a promising complementary therapy for UC.Based on the latest research,our editorial explored the current issues and potential essential research directions for TCM in treating UC.We anticipate that future high-quality research will pave the way for the optimization of TCM formulas for UC and their broader global application.

Mindfulness and mindful parenting:Strategies for preschoolers with behavioral issues

The behavior issues of preschoolers are closely related to their parents'parenting styles.This editorial discusses the value and strategies for solving behavior issues in preschoolers from the perspectives of mindfulness and mindful parenting.We expect that upcoming studies will place greater emphasis on the behavioral concerns of preschoolers and the parenting practices that shape them,particularly focusing on proactive interventions for preschoolers'behavioral issues.

Multimodal emotion recognition in the metaverse era:New needs and transformation in mental health work

This editorial comments on an article recently published by López del Hoyo et al.The metaverse,hailed as"the successor to the mobile Internet",is undoubtedly one of the most fashionable terms in recent years.Although metaverse development is a complex and multifaceted evolutionary process influenced by many factors,it is almost certain that it will significantly impact our lives,including mental health services.Like any other technological advancements,the metaverse era presents a double-edged sword for mental health work,which must clearly understand the needs and transformations of its target audience.In this editorial,our primary focus is to contemplate potential new needs and transformation in mental health work during the metaverse era from the pers-pective of multimodal emotion recognition.

持续淹水胁迫对美洲黑杨幼苗生长及生理生化的影响

比较‘2025’杨及其2个芽变红叶品种(‘全红杨’‘中红杨’)的耐涝能力,以3个品种嫁接苗为试验材料,采用随机区组设计,盆栽模拟淹水环境,以正常浇水样本为对照。研究不同胁迫处理时间下,3个杨树品种植株表型、光合特性的响应变化及对叶片部分生理指标的影响,并采用隶属函数和灰色关联分析法对抗涝能力和指标进行评价,为新品种的选育及推广提供理论依据。结果表明:通过84 d的模拟试验,3个杨树品种的叶片始终保持有净光合速率,表现出稳定的耐涝遗传特质。淹水28 d,胁迫引起的叶片气孔限制因素使Pn快速下降,高生长均略高于对照(P>0.05);淹水42 d,MDA含量、SOD和CAT酶活性升高,茎基部产生不定根,叶绿素降解减缓,Pn回升;淹水56~70 d,3个杨树品种高生长量分别较CK下降了53.33%、42.79%和49.96%。SOD、CAT活性下降,膜透性增大,叶片叶绿素加速降解,Pn再次下降。通过各生理指标隶属函数进行综合评价,‘全红杨’的抗淹水能力较弱(P<0.05),‘中红杨’与‘2025’杨差别不大(P>0.05)。关联分析表明,质膜相对透性、抗氧化CAT和SOD酶活性是影响3个杨树品种抗涝性的主要指标。

冬季郑州市12个常绿树种的光合特性及滞尘能力

为筛选出北方城市冬季生态效益突出的常绿树种,以缓解大气CO_(2)和粉尘颗粒物污染,并为这些树种的园林应用提供科学支持,该文选取郑州市园林绿化应用广泛的12个常绿树种,利用LI-6400便携式光合测定仪和洗脱-质量差值法,并对其光合特性及滞尘能力进行测定,计算出其光合参数[叶片的净光合速率(P_(n))、蒸腾速率(T_(r))、气孔导度(G_(s))、胞间CO_(2)浓度(C_(i))]和滞尘参数(单位叶面积滞尘量、单叶滞尘量、单位面积树冠滞尘量),并分别进行聚类分析。结果表明:(1)大叶女贞、黄杨、海桐、枇杷叶片P_(n)、T_(r)、G_(s)值均极显著高于其他树种(P<0.01);香樟、银木、黄杨、枇杷叶片C_(i)值极显著高于其他树种(P<0.01)。大叶女贞、海桐、石楠叶肉细胞保持着较高的光合活性,而香樟、银木叶片光合活性较弱,低温抑制明显。(2)洗淋后7 d和14 d,枇杷、广玉兰、桂花各滞尘参数均极显著高于其他树种(P<0.01)。洗淋后14 d,枇杷、广玉兰、桂花单位面积树冠的滞尘量累积在6.65 g·m^(-2)·crown^(-1)以上,滞尘能力强;石楠、银木、大叶女贞、法国冬青、黄杨单位面积树冠的滞尘量在3.99 g·m^(-2)·crown^(-1)以上。(3)聚类分析结果表明,黄杨、大叶女贞和海桐光合特性优势明显,其次为法国冬青、广玉兰、枇杷、石楠和乐东拟单性木兰;广玉兰、桂花、枇杷滞尘能力最强,其次为大叶女贞、法国冬青、石楠和银木。综上所述,大叶女贞、广玉兰、枇杷、法国冬青、黄杨、石楠对改善北方城市冬季空气质量及滞尘均有重要贡献,生态调节能力强,可作为园林绿化优先选用树种。

有机化学专业课中开展课程思政的探索与实践

在有机化学专业课程中挖掘思政资源进行课程思政的探索与实践,进而达到传授专业知识并育人的目的。有机化学中的课程思政资源非常丰富,融入点也很多,作者概括为以下四个主要方面,并探索将其应用于有机化学专业教学中课程思政工作的途径:1)辩证唯物主义的呈现和深化;2)爱国情怀的激发和责任担当意识的培养;3)科学素养和创新意识的培养;4)科学发展与社会生活的结合和渗透。