BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in ...BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.展开更多
Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, ...Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, stenosis incision, stentimplantation, stem cell flap transplantation, etc. However, there are currently nospecific clinical standards or guidelines to quantify a series of specific parametersin the treatment of benign esophageal stricture, such as the frequency of drugadministration, dosage, dilation inner diameter, and number of treatments. Thisleads to operator bias in clinical practice and inconsistent treatment outcomesamong patients. Therefore, this article reviews the current advances and existingchallenges in the endoscopic treatment of benign esophageal stricture, with theaim of exploring the possibility of achieving precision and standardization in theendoscopic treatment of this disease.展开更多
BACKGROUND It is critical to explore effective therapeutic targets for improving the survival rate of patients with hepatocellular carcinoma(HCC).Although many studies have focused on flotillin-1(FLOT1)as a lipid raft...BACKGROUND It is critical to explore effective therapeutic targets for improving the survival rate of patients with hepatocellular carcinoma(HCC).Although many studies have focused on flotillin-1(FLOT1)as a lipid raft-associated protein that regulates the activation of some proteins or kinases to promote tumor cell survival and proliferation,few studies have explored the regulation of Golgi apparatus function.AIM To investigate the molecular mechanism through which FLOT1 activates the Golgi stress response downstream of transcription factor E3(TFE3),thereby promoting the progression of HCC.METHODS FLOT1 expression in HCC tissue,HCC cell lines,and nude mouse tumor models was assessed.The impact of FLOT1 silencing or its overexpression on the proliferation of HCC cells was studied.CCK-8,flow cytometry,and transwell assays were used to assess the proliferation,cell cycle,migration,and invasion abilities of HCC cells.A dual-luciferase reporter assay was used to study the effect of FLOT1 on the transcriptional activity of the downstream Golgi apparatus stress element promoter of TFE3.Western blotting,co-immunoprecipitation,and immunofluorescence staining were employed to detect relevant proteins.RESULTS High FLOT1 expression was correlated with a poor prognosis in patients with HCC.The knockdown of FLOT1 suppressed the proliferation,migration,and invasion of HCC cells and promoted their apoptosis.Xenograft assays revealed that FLOT1 knockdown inhibited HCC tumorigenesis in vivo.Mechanistically,FLOT1 inhibited the expression of mechanistic target of rapamycin complex 1/2 proteins through ubiquitination and downstream effector p-S6 kinase-T389,leading to the dephosphorylation and nuclear translocation of TFE3 and promotion of Golgi stress-mediated responses,ultimately resulting in HCC progression.CONCLUSION FLOT1 recruits and inhibits mechanistic target of rapamycin complex 1/2,causing dephosphorylation and TFE3 nuclear translocation,thereby activating the Golgi stress response and further promoting the proliferation,migration,and invasion capabilities of HCC cells.These results underscore the potential of FLOT1 as a promising therapeutic target for HCC.展开更多
Conventional wisdom holds that progression from compensated cirrhosis to de-compensated cirrhosis is irreversible in the natural history of the disease.How-ever,in recent years,more and more clinical evidence suggests...Conventional wisdom holds that progression from compensated cirrhosis to de-compensated cirrhosis is irreversible in the natural history of the disease.How-ever,in recent years,more and more clinical evidence suggests that liver cirrhosis can achieve re-compensation,that is,after effective etiological treatment and complication management,the liver function of partially decompensated patients with cirrhosis has improved and gradually stabilized,and decompensation no longer occurs for a long time.Liver regeneration,as one of the powerful intrinsic abilities of the liver,is the key to the restoration of the structure and complex phy-siological functions of the damaged liver.Studies have shown that the restoration of liver regeneration in patients with cirrhosis can promote the occurrence of re-compensation,thereby improving the prognosis of patients.At the same time,monitoring liver regeneration indicators is helpful in assessing patients're-compensation potential for early selection of appropriate treatment options.Insufficient attention has been paid to the role of liver regeneration in the course of liver cirrhosis.Therefore,this article aims to review the value of liver regene-ration in the re-compensation of decompensated cirrhosis.展开更多
AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular imag...AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.展开更多
Gastric varices(GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has be...Gastric varices(GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has been confirmed to be highly effective for most patients in many studies. However, this treatment might be ineffective for some types of GV, such as splenic vein thrombosis-related localized portal hypertension(also called left-sided, sinistral, or regional portal hypertension). Herein, we report a case of repeated pancreatitis-induced complete splenic vein thrombosis that led to intractable gastric variceal bleeding, which was treated by splenectomy. We present detailed radiological and pathological data and blood rheology analysis(the splenic artery- after a short gastric vein or stomach vein- gastric coronary vein- portal vein). The pathophysiology can be explained by the abnormal direction of blood flow in this patient. To our knowledge, this is the first reported case for which detailed patho-logy and blood rheology data are available.展开更多
BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has ...BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.Since the Viatorr stent entered the Chinese market in 2015,it has not yet been widely used in clinical practice.Further,unlike other countries,the main cause of liver cirrhosis in China is viral hepatitis.Therefore,use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIM To investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODS Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively.The patients were divided into three groups(A-C),according to their disease etiology,with post-hepatitis,autoimmune,and alcoholic cirrhosis,respectively.Preoperative and postoperative liver and renal function and coagulation data,Child-Pugh grade,and model for end-stage liver disease(MELD)scores were collected.Statistical analyses were performed using the t-test or chi-square test.The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTS The surgical success rate was 100%,with mean portal pressure gradient(mmHg)decreasing from 25.5±5.22 to 10.04±2.76(t=45.80;P<0.001).After 24 mo,the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C,while the cumulative survival rate was significantly higher in group A than in group B/C(P<0.05 for both).The Child-Pugh score for group A was 6.96±1.21,which was significantly better than those of groups B(7.42±0.99;t=-2.44;P=0.016)and C(7.52±1.12;t=-2.67;P=0.009).Further,the MELD score for group A(9.62±2.19)was significantly better than those for groups B(10.64±1.90;t=-2.92;P=0.004)and C(10.82±2.01;t=-3.29;P=0.001).CONCLUSION Insertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function.Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.展开更多
BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-relat...BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.展开更多
BACKGROUND Intrahepatic portosystemic venous shunt(IPSVS)is a rare hepatic disease with different clinical manifestations.Most IPSVS patients with mild shunts are asymptomatic,while the patients with severe shunts pre...BACKGROUND Intrahepatic portosystemic venous shunt(IPSVS)is a rare hepatic disease with different clinical manifestations.Most IPSVS patients with mild shunts are asymptomatic,while the patients with severe shunts present complications such as hepatic encephalopathy.For patients with portal hypertension accompanied by intrahepatic shunt,portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt flow.CASE SUMMARY A 57-year-old man,with the medical history of chronic hepatitis B and liver cirrhosis,was admitted to our hospital with abnormal behavior for 10 mo.He had received the esophageal varices ligation and entecavir therapy 1 year ago.Comparing with former examination results,the degree of esophageal varices was significantly reduced,while the right branch of the portal vein was significantly expanded and tortuous.Meanwhile,abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena cava.The imaging findings indicated the diagnosis of IPSVS and hepatic encephalopathy.Instead of radiologic interventions or surgical therapies,this patient had only accepted symptomatic treatment.No recurrence of hepatic encephalopathy was observed during 1-year follow-up.CONCLUSION Hemodynamic changes may exacerbate intrahepatic portosystemic shunt.The intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage.展开更多
BACKGROUND While tuberculosis(TB)itself is a common disease,isolated TB of the liver is a rare entity.Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma.In ...BACKGROUND While tuberculosis(TB)itself is a common disease,isolated TB of the liver is a rare entity.Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma.In contrast,isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice,with only a few sporadic cases and short series available in the current literature.Vascular complications,such as portal vein thrombosis(PVT),have rarely been reported previously.CASE SUMMARY A 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg.He had a 10-year hepatitis B virus(HBV)infection in his medical history.Contrast-enhanced computed tomography(CECT)confirmed hepatosplenomegaly,with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein.A liver biopsy showed epithelioid granulomas with a background of caseating necrosis.ZiehlNelson staining showed acid-fast bacilli within the granulomas.The patient was diagnosed with isolated hepatic TB with PVT.Anti-TB therapy(ATT),including isoniazid,rifapentine,ethambutol,and pyrazinamide,was administered.Along with ATT,the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant.He remained asymptomatic,and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.CONCLUSION Upon diagnosis of hepatic TB associated with PVT and HBV coinfection,ATT and anticoagulants should be initiated to prevent subsequent portal hypertension.Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.展开更多
BACKGROUND Esophagogastric varices are a common complication of cirrhosis with portal hypertension and endoscopic treatment has been recognized as a primary preventive and therapeutic option for such patients;however,...BACKGROUND Esophagogastric varices are a common complication of cirrhosis with portal hypertension and endoscopic treatment has been recognized as a primary preventive and therapeutic option for such patients;however,it should be noted that bradyarrhythmia is regarded as one of the contraindications to endoscopic examination.Meanwhile,acute variceal bleeding may result in a high mortality rate in cirrhotic patients with portal hypertension accompanied by bradyarrhythmia.At present,there is an absence of reports concerning the treatment of such group of patients who underwent transjugular intrahepatic portosystemic shunt(TIPS).The present report details the case of a cirrhotic patient with acute variceal bleeding accompanied by bradyarrhythmia who underwent TIPS under temporary pacemaker protection.CASE SUMMARY We report the case of a 64-year-old male patient who was confirmed with bradyarrhythmia by ambulatory electrocardiogram 24 h before the operation.The patient was successfully treated by TIPS under temporary pacemaker protection.CONCLUSION In terms of cirrhotic patients with abnormal cardiac electrophysiological conduction,TIPS may be effective in reducing the complications of portal hypertension following the exclusion of severe pulmonary hypertension and heart failure,showing moderate feasibility in clinical applications.展开更多
BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome a...BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome are diverse.Due to the insidious onset and lack of specific early-stage manifestations,POEMS syndrome is easily misdiagnosed or never diagnosed,leading to delayed treatment.Neurological symptoms are usually the first clinical manifestation,while ascites is a rare symptom in patients with POEMS syndrome.CASE SUMMARY A female patient presented with unexplained ascites as an initial symptom,which is a rare early-stage manifestation of the condition.After 1 year,the patient gradually developed progressive renal impairment,anemia,polyserosal effusion,edema,swollen lymph nodes on the neck,armpits,and groin,and decreased muscle strength of the lower extremities.The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion.Treatment comprised bortezomib+dexamethasone,continuous renal replacement therapy,chest and abdominal closed drainage,transfusions of erythrocytes and platelets,and other symptomatic and supportive treatments.The patient’s condition initially improved after treatment.However,then her symptoms worsened,and she succumbed to the illness and died.CONCLUSION Ascites is a potential early manifestation of POEMS syndrome,and this diagnosis should be considered for patients with unexplained ascites.Furthermore,multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.展开更多
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.
文摘Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, stenosis incision, stentimplantation, stem cell flap transplantation, etc. However, there are currently nospecific clinical standards or guidelines to quantify a series of specific parametersin the treatment of benign esophageal stricture, such as the frequency of drugadministration, dosage, dilation inner diameter, and number of treatments. Thisleads to operator bias in clinical practice and inconsistent treatment outcomesamong patients. Therefore, this article reviews the current advances and existingchallenges in the endoscopic treatment of benign esophageal stricture, with theaim of exploring the possibility of achieving precision and standardization in theendoscopic treatment of this disease.
基金Supported by the National Natural Science Foundation of China,No.82203806the General Hospital of Western Theater Command Project Funding,No.2024-YGJC-B10.
文摘BACKGROUND It is critical to explore effective therapeutic targets for improving the survival rate of patients with hepatocellular carcinoma(HCC).Although many studies have focused on flotillin-1(FLOT1)as a lipid raft-associated protein that regulates the activation of some proteins or kinases to promote tumor cell survival and proliferation,few studies have explored the regulation of Golgi apparatus function.AIM To investigate the molecular mechanism through which FLOT1 activates the Golgi stress response downstream of transcription factor E3(TFE3),thereby promoting the progression of HCC.METHODS FLOT1 expression in HCC tissue,HCC cell lines,and nude mouse tumor models was assessed.The impact of FLOT1 silencing or its overexpression on the proliferation of HCC cells was studied.CCK-8,flow cytometry,and transwell assays were used to assess the proliferation,cell cycle,migration,and invasion abilities of HCC cells.A dual-luciferase reporter assay was used to study the effect of FLOT1 on the transcriptional activity of the downstream Golgi apparatus stress element promoter of TFE3.Western blotting,co-immunoprecipitation,and immunofluorescence staining were employed to detect relevant proteins.RESULTS High FLOT1 expression was correlated with a poor prognosis in patients with HCC.The knockdown of FLOT1 suppressed the proliferation,migration,and invasion of HCC cells and promoted their apoptosis.Xenograft assays revealed that FLOT1 knockdown inhibited HCC tumorigenesis in vivo.Mechanistically,FLOT1 inhibited the expression of mechanistic target of rapamycin complex 1/2 proteins through ubiquitination and downstream effector p-S6 kinase-T389,leading to the dephosphorylation and nuclear translocation of TFE3 and promotion of Golgi stress-mediated responses,ultimately resulting in HCC progression.CONCLUSION FLOT1 recruits and inhibits mechanistic target of rapamycin complex 1/2,causing dephosphorylation and TFE3 nuclear translocation,thereby activating the Golgi stress response and further promoting the proliferation,migration,and invasion capabilities of HCC cells.These results underscore the potential of FLOT1 as a promising therapeutic target for HCC.
文摘Conventional wisdom holds that progression from compensated cirrhosis to de-compensated cirrhosis is irreversible in the natural history of the disease.How-ever,in recent years,more and more clinical evidence suggests that liver cirrhosis can achieve re-compensation,that is,after effective etiological treatment and complication management,the liver function of partially decompensated patients with cirrhosis has improved and gradually stabilized,and decompensation no longer occurs for a long time.Liver regeneration,as one of the powerful intrinsic abilities of the liver,is the key to the restoration of the structure and complex phy-siological functions of the damaged liver.Studies have shown that the restoration of liver regeneration in patients with cirrhosis can promote the occurrence of re-compensation,thereby improving the prognosis of patients.At the same time,monitoring liver regeneration indicators is helpful in assessing patients're-compensation potential for early selection of appropriate treatment options.Insufficient attention has been paid to the role of liver regeneration in the course of liver cirrhosis.Therefore,this article aims to review the value of liver regene-ration in the re-compensation of decompensated cirrhosis.
基金Supported by General Hospital of Chengdu Military Command,No.2013YG-B009
文摘AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.
基金Supported by National Natural Science Foundation of China,No.81401993(to Tang SH)
文摘Gastric varices(GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has been confirmed to be highly effective for most patients in many studies. However, this treatment might be ineffective for some types of GV, such as splenic vein thrombosis-related localized portal hypertension(also called left-sided, sinistral, or regional portal hypertension). Herein, we report a case of repeated pancreatitis-induced complete splenic vein thrombosis that led to intractable gastric variceal bleeding, which was treated by splenectomy. We present detailed radiological and pathological data and blood rheology analysis(the splenic artery- after a short gastric vein or stomach vein- gastric coronary vein- portal vein). The pathophysiology can be explained by the abnormal direction of blood flow in this patient. To our knowledge, this is the first reported case for which detailed patho-logy and blood rheology data are available.
文摘BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.Since the Viatorr stent entered the Chinese market in 2015,it has not yet been widely used in clinical practice.Further,unlike other countries,the main cause of liver cirrhosis in China is viral hepatitis.Therefore,use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIM To investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODS Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively.The patients were divided into three groups(A-C),according to their disease etiology,with post-hepatitis,autoimmune,and alcoholic cirrhosis,respectively.Preoperative and postoperative liver and renal function and coagulation data,Child-Pugh grade,and model for end-stage liver disease(MELD)scores were collected.Statistical analyses were performed using the t-test or chi-square test.The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTS The surgical success rate was 100%,with mean portal pressure gradient(mmHg)decreasing from 25.5±5.22 to 10.04±2.76(t=45.80;P<0.001).After 24 mo,the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C,while the cumulative survival rate was significantly higher in group A than in group B/C(P<0.05 for both).The Child-Pugh score for group A was 6.96±1.21,which was significantly better than those of groups B(7.42±0.99;t=-2.44;P=0.016)and C(7.52±1.12;t=-2.67;P=0.009).Further,the MELD score for group A(9.62±2.19)was significantly better than those for groups B(10.64±1.90;t=-2.92;P=0.004)and C(10.82±2.01;t=-3.29;P=0.001).CONCLUSION Insertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function.Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.
文摘BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.
文摘BACKGROUND Intrahepatic portosystemic venous shunt(IPSVS)is a rare hepatic disease with different clinical manifestations.Most IPSVS patients with mild shunts are asymptomatic,while the patients with severe shunts present complications such as hepatic encephalopathy.For patients with portal hypertension accompanied by intrahepatic shunt,portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt flow.CASE SUMMARY A 57-year-old man,with the medical history of chronic hepatitis B and liver cirrhosis,was admitted to our hospital with abnormal behavior for 10 mo.He had received the esophageal varices ligation and entecavir therapy 1 year ago.Comparing with former examination results,the degree of esophageal varices was significantly reduced,while the right branch of the portal vein was significantly expanded and tortuous.Meanwhile,abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena cava.The imaging findings indicated the diagnosis of IPSVS and hepatic encephalopathy.Instead of radiologic interventions or surgical therapies,this patient had only accepted symptomatic treatment.No recurrence of hepatic encephalopathy was observed during 1-year follow-up.CONCLUSION Hemodynamic changes may exacerbate intrahepatic portosystemic shunt.The intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage.
文摘BACKGROUND While tuberculosis(TB)itself is a common disease,isolated TB of the liver is a rare entity.Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma.In contrast,isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice,with only a few sporadic cases and short series available in the current literature.Vascular complications,such as portal vein thrombosis(PVT),have rarely been reported previously.CASE SUMMARY A 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg.He had a 10-year hepatitis B virus(HBV)infection in his medical history.Contrast-enhanced computed tomography(CECT)confirmed hepatosplenomegaly,with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein.A liver biopsy showed epithelioid granulomas with a background of caseating necrosis.ZiehlNelson staining showed acid-fast bacilli within the granulomas.The patient was diagnosed with isolated hepatic TB with PVT.Anti-TB therapy(ATT),including isoniazid,rifapentine,ethambutol,and pyrazinamide,was administered.Along with ATT,the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant.He remained asymptomatic,and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.CONCLUSION Upon diagnosis of hepatic TB associated with PVT and HBV coinfection,ATT and anticoagulants should be initiated to prevent subsequent portal hypertension.Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.
文摘BACKGROUND Esophagogastric varices are a common complication of cirrhosis with portal hypertension and endoscopic treatment has been recognized as a primary preventive and therapeutic option for such patients;however,it should be noted that bradyarrhythmia is regarded as one of the contraindications to endoscopic examination.Meanwhile,acute variceal bleeding may result in a high mortality rate in cirrhotic patients with portal hypertension accompanied by bradyarrhythmia.At present,there is an absence of reports concerning the treatment of such group of patients who underwent transjugular intrahepatic portosystemic shunt(TIPS).The present report details the case of a cirrhotic patient with acute variceal bleeding accompanied by bradyarrhythmia who underwent TIPS under temporary pacemaker protection.CASE SUMMARY We report the case of a 64-year-old male patient who was confirmed with bradyarrhythmia by ambulatory electrocardiogram 24 h before the operation.The patient was successfully treated by TIPS under temporary pacemaker protection.CONCLUSION In terms of cirrhotic patients with abnormal cardiac electrophysiological conduction,TIPS may be effective in reducing the complications of portal hypertension following the exclusion of severe pulmonary hypertension and heart failure,showing moderate feasibility in clinical applications.
文摘BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome are diverse.Due to the insidious onset and lack of specific early-stage manifestations,POEMS syndrome is easily misdiagnosed or never diagnosed,leading to delayed treatment.Neurological symptoms are usually the first clinical manifestation,while ascites is a rare symptom in patients with POEMS syndrome.CASE SUMMARY A female patient presented with unexplained ascites as an initial symptom,which is a rare early-stage manifestation of the condition.After 1 year,the patient gradually developed progressive renal impairment,anemia,polyserosal effusion,edema,swollen lymph nodes on the neck,armpits,and groin,and decreased muscle strength of the lower extremities.The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion.Treatment comprised bortezomib+dexamethasone,continuous renal replacement therapy,chest and abdominal closed drainage,transfusions of erythrocytes and platelets,and other symptomatic and supportive treatments.The patient’s condition initially improved after treatment.However,then her symptoms worsened,and she succumbed to the illness and died.CONCLUSION Ascites is a potential early manifestation of POEMS syndrome,and this diagnosis should be considered for patients with unexplained ascites.Furthermore,multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.
