Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation.Traditional methods such as hepatic venous pressure gradient(HVPG...Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation.Traditional methods such as hepatic venous pressure gradient(HVPG)measurement have long been considered the gold standard for assessing portal pressure.However,these methods are invasive and carry procedural limitations.Recent advances in endoscopic ultrasound(EUS)-guided techniques have emerged as promising alternatives,offering direct and minimally invasive assessment of portal pressure.EUS-guided portal pressure gradient measurement enables real-time evaluation of haemodynamic through direct access to the portal system.This technique has shown to be as accurate as HVPG,and it has some extra benefits,like the ability to take liver biopsies and check collateral circulation all at the same time.Despite these benefits,the technique poses challenges such as operator dependence,proce-dural complexity,and limited standardization across centres.This minireview highlights the evolution of portal pressure measurement,focusing on the potential of EUS-guided techniques in pre-transplant assessment,risk strati-fication,and monitoring therapeutic outcomes.Furthermore,it discusses the technical challenges,clinical implications,and future directions for integrating these innovations into routine practice.Advances in portal pressure measurement hold significant promise for enhancing decision-making and outcomes in liver transplantation.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assiste...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.展开更多
Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,name...Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,namely,hepatic venous pressure gradient measurement,is invasive and not widely available.Transient elastography has emerged as a non-invasive alternative for assessing liver stiffness(LS),and recent studies have highlighted the potential role of splenic stiffness(SS)in evaluating PH severity.This narrative review summarizes the available evidence on the utility of splenic transient elastography in assessing PH.We evaluated its diagnostic accuracy,technical challenges,and clinical applications,particularly in distinguishing between cirrhotic PH(CPH)and noncirrhotic PH(NCPH).A comprehensive literature search was conducted using the PubMed database,focusing on studies that assess splenic elastography in the diagnosis and prognosis of PH.This review compares splenic elastography with other non-invasive imaging modalities,including MR elastography and shearwave elastography.Additionally,we examined the role of SS using elastography in predicting the presence of esophageal varices and its potential impact on reducing the need for endoscopic screening.Studies have demonstrated that splenic elastography correlates well with PH severity,with cut-off values ranging between 45 kPa and 50 kPa for significant PH detection.Splenic elastography,when combined with platelet count and LS measurements,improves diagnostic accuracy and risk stratification for the occurrence of variceal bleeding.Despite its clinical promise,technical challenges such as patient positioning,body habitus,and probe selection remain key limitations.Notably,splenic elastography may be particularly useful in diagnosing NCPH,where LS remains normal but PH is present.Splenic transient elastography is a valuable adjunct in the non-invasive assessment of PH.Its ability to predict varices,differentiate between CPH and NCPH,and reduce unnecessary endoscopies suggests that it should be incorporated into routine hepatology practice.Future research should focus on refining SS cut-offs,evaluating its cost-effectiveness,and integrating splenic elastography into clinical guidelines for PH management.展开更多
BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,t...BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.展开更多
Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity inc...Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.展开更多
Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,an...Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,and hepatic encephalopathy.This narrative review explores the pathophysiology of PH in cirrhosis,evaluates diagnostic methods for identifying clinically significant PH(CSPH),and discusses guideline-driven strategies to prevent initial and further decompensation.While HVPG remains the gold standard for diagnosing CSPH,non-invasive tools such as liver stiffness measurement and spleen stiffness measurement are increasingly used for initial risk stratification.The combined use of these tools reduces the proportion of patients in the diagnostic"grey zone".Endoscopic ultrasound-guided portal pressure gradient is an emerging diagnostic tool that requires further validation.Non-selective beta-blockers are the cornerstone of primary prophylaxis for decompensation,and their combination with endoscopic variceal ligation is the first-line therapy for secondary prophylaxis of recurrent esophageal variceal bleeding.Statins show promise in reducing PH and preventing decompensation while further studies are still needed.This review also discusses the indications for preemptive transjugular intrahepatic portosystemic shunt and its role in managing refractory ascites and variceal bleeding.展开更多
In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following tran...In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.展开更多
Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for...Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for portal hyper-tension and esophagogastric variceal bleeding,respectively.With advancements in artificial intelligence in medicine,non-invasive diagnostic methods are in-creasingly replacing traditional invasive procedures,permitting more rational and personalized patient care.This review summarizes the formation and diagnosis of portal hypertension,as well as the primary prophylaxis,secondary prophylaxis,and management of acute esophagogastric variceal bleeding.This study also highlights the latest progress in artificial intelligence in the diagnosis and treat-ment of portal hypertension and esophagogastric varices.展开更多
BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated ...BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.展开更多
BACKGROUND Liver cirrhosis and portal hypertension(PHT)can lead to lymphatic abnormalities and coagulation dysfunction.Because lymphangiogenesis may relieve liver cirrhosis and PHT,the present study investigated the g...BACKGROUND Liver cirrhosis and portal hypertension(PHT)can lead to lymphatic abnormalities and coagulation dysfunction.Because lymphangiogenesis may relieve liver cirrhosis and PHT,the present study investigated the gene expression alterations in the lymphatic system and the effectiveness of platelet-mediated lymphangiogenesis in improving liver cirrhosis and PHT.AIM To investigate the role of lymphangiogenesis in preclinical PHT models.METHODS Immunohistochemistry and transcriptome sequencing of bile duct ligation(BDL)and control lymphatic samples were conducted to reveal the indicated signaling pathways.Functional enrichment analyses were performed on the differentially expressed genes and hub genes.Adenoviral infection of vascular endothelial growth factor C(VEGF-C),plateletrich plasma(PRP),and VEGF3 receptor(VEGFR)inhibitor MAZ-51 was used as an intervention for the lymphatic system in PHT models.Histology,hemodynamic tests and western blot analyses were performed to demonstrate the effects of lymphatic intervention in PHT patients.RESULTS Lymphangiogenesis was increased in the BDL rat model.Transcriptome sequencing analysis of the extrahepatic lymphatic system revealed its close association with platelet adherence,aggregation,and activation.The role of PHT in the rat model was investigated by activating(PRP)and inhibiting(MAZ-51)the lymphatic system.PRP promoted lymphangiogenesis,which increased lymphatic drainage,alleviated portal pressure,reduced liver fibrosis,inhibited inflammation,inhibited angiogenesis,and suppressed mesenteric artery remodeling.MAZ-51 reversed the above improvements.CONCLUSION Via VEGF-C/VEGFR-3,platelets impede fibrosis,angiogenesis,and mesenteric artery remodeling,ultimately alleviating PHT.Thus,platelet intervention is a therapeutic approach for cirrhosis and PHT.展开更多
BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively ...BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.展开更多
This letter comments on the recently published article in the World Journal of Gastroenterology,in which the authors demonstrated a strong link between lymphangiogenesis and the process of platelet adherence,aggregati...This letter comments on the recently published article in the World Journal of Gastroenterology,in which the authors demonstrated a strong link between lymphangiogenesis and the process of platelet adherence,aggregation,and activation by employing a rat model of liver cirrhosis caused by bile duct ligation(BDL).The authors applied both gain and loss of function approach by using platelet-rich plasma and vascular endothelial growth factor 3 receptor inhibitor MAZ-51 to activate and inhibit angiogenetic signaling in BDL rat model,respectively,to verify the crucial function of lymphangiogenesis in the development of liver cirrhosis and portal hypertension(PHT).In clinical practice,platelet transfusion has been applied to improve liver function in patients suffering from chronic liver disease and cirrhosis.Therefore,this study provides support for the application of platelet transfusion or pharmacological intervention of lymphangiogenesis as novel therapeutic approaches for liver cirrhosis and PHT.展开更多
BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identif...BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.展开更多
BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,includin...BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.展开更多
BACKGROUND The portal vein thrombosis(PVT)can exacerbate portal hypertension and lead to complications,increasing the risk of mortality.AIM To evaluate the predictive capacity of artificial neural networks(ANNs)in qua...BACKGROUND The portal vein thrombosis(PVT)can exacerbate portal hypertension and lead to complications,increasing the risk of mortality.AIM To evaluate the predictive capacity of artificial neural networks(ANNs)in quan-tifying the likelihood of developing PVT in individuals afflicted with hepatitis B-induced cirrhosis.METHODS A retrospective study was conducted at Beijing Ditan Hospital,affiliated with Capital Medical University,including 986 hospitalized patients.Patients admitted between January 2011 and December 2014 were assigned to the training set(685 cases),while those hospitalized from January 2015 to December 2016 were divided into the validation cohort(301 cases).Independent risk factors for PVT were identified using COX univariate analysis and used to construct an ANN model.Model performance was evaluated through metrics such as the area under the receiver operating characteristic curve(AUC)and concordance index.RESULTS In the training set,PVT occurred in 19.0%of patients within three years and 23.7%within five years.In the validation cohort,PVT developed in 16.7%of patients within three years and 24.0%within five years.The ANN model incorporated nine independent risk factors:Age,ascites,hepatic encephalopathy,gastrointestinal varices with bleeding,Child-Pugh classification,alanine aminotransferase levels,albumin levels,neutrophil-to-lymphocyte ratio,and platelet.The model achieved an AUC of 0.967(95%CI:0.960–0.974)at three years and 0.975(95%CI:0.955–0.992)at five years,significantly outperforming existing models such as model for end-stage liver disease and Child-Pugh-Turcotte(all P<0.001).CONCLUSION The ANN model demonstrated effective stratification of patients into high-and low-risk groups for PVT deve-lopment over three and five years.Validation in an independent cohort confirmed the model's predictive accuracy.展开更多
Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to corre...Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.展开更多
Portal vein stenosis is one of the common complications after liver transplantation in children.Accurate hemodynamic assessment is crucial for predicting the risk of complications after liver transplantation.In order ...Portal vein stenosis is one of the common complications after liver transplantation in children.Accurate hemodynamic assessment is crucial for predicting the risk of complications after liver transplantation.In order to predict the location of portal vein thrombosis after liver transplantation surgery,single-outlet and three-outlet vascular models were reconstructed from computed tomography images by commercial software MIMICS.The velocity field was measured using a 9.4 T magnetic resonance imaging scanner.Based on the experiment data of magnetic resonance velocimetry,computational fluid dynamics was verified,validated and then used to study the pressure and shear stresses on the wall of the two portal vein models.The simulation results can serve for the clinical prediction of early thrombosis after liver transplantation in portal vein.展开更多
BACKGROUND Idiopathic portal hypertension(IPH)is a subtype of portal hypertension that arises in the absence of cirrhosis.IPH frequently manifests with clinical features typical of portal hypertension,including spleno...BACKGROUND Idiopathic portal hypertension(IPH)is a subtype of portal hypertension that arises in the absence of cirrhosis.IPH frequently manifests with clinical features typical of portal hypertension,including splenomegaly and esophagogastric fundal varices,along with other associated symptoms.Imaging studies may indicate portal hypertension;however,they typically do not provide evidence of cirrhosis.There are no standardized diagnostic criteria for IPH,and diagnosis is often established by excluding other hepatic diseases.Liver biopsy remains the most reliable approach to verify the diagnosis of IPH.CASE SUMMARY A patient previously diagnosed with“hepatitis B cirrhosis”at an external hospital presented to our facility with gastrointestinal bleeding.Initial assessment revealed minor liver injury,splenomegaly,esophagogastric varices,and portal hypertension.Imaging studies did not indicate cirrhosis and repeated hepatitis B serology tests yielded negative results.After excluding various causes of cirrhosis and other non-cirrhotic etiologies of portal hypertension,liver biopsy confirmed the diagnosis of IPH.The patient was managed with regular endoscopic therapy and long-term carvedilol administration.CONCLUSION Currently,there are no standardized diagnostic criteria for IPH,and its diagnosis is generally established by excluding other conditions.Liver biopsy remains the most reliable method for IPH diagnosis.展开更多
文摘Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation.Traditional methods such as hepatic venous pressure gradient(HVPG)measurement have long been considered the gold standard for assessing portal pressure.However,these methods are invasive and carry procedural limitations.Recent advances in endoscopic ultrasound(EUS)-guided techniques have emerged as promising alternatives,offering direct and minimally invasive assessment of portal pressure.EUS-guided portal pressure gradient measurement enables real-time evaluation of haemodynamic through direct access to the portal system.This technique has shown to be as accurate as HVPG,and it has some extra benefits,like the ability to take liver biopsies and check collateral circulation all at the same time.Despite these benefits,the technique poses challenges such as operator dependence,proce-dural complexity,and limited standardization across centres.This minireview highlights the evolution of portal pressure measurement,focusing on the potential of EUS-guided techniques in pre-transplant assessment,risk strati-fication,and monitoring therapeutic outcomes.Furthermore,it discusses the technical challenges,clinical implications,and future directions for integrating these innovations into routine practice.Advances in portal pressure measurement hold significant promise for enhancing decision-making and outcomes in liver transplantation.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.
文摘Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,namely,hepatic venous pressure gradient measurement,is invasive and not widely available.Transient elastography has emerged as a non-invasive alternative for assessing liver stiffness(LS),and recent studies have highlighted the potential role of splenic stiffness(SS)in evaluating PH severity.This narrative review summarizes the available evidence on the utility of splenic transient elastography in assessing PH.We evaluated its diagnostic accuracy,technical challenges,and clinical applications,particularly in distinguishing between cirrhotic PH(CPH)and noncirrhotic PH(NCPH).A comprehensive literature search was conducted using the PubMed database,focusing on studies that assess splenic elastography in the diagnosis and prognosis of PH.This review compares splenic elastography with other non-invasive imaging modalities,including MR elastography and shearwave elastography.Additionally,we examined the role of SS using elastography in predicting the presence of esophageal varices and its potential impact on reducing the need for endoscopic screening.Studies have demonstrated that splenic elastography correlates well with PH severity,with cut-off values ranging between 45 kPa and 50 kPa for significant PH detection.Splenic elastography,when combined with platelet count and LS measurements,improves diagnostic accuracy and risk stratification for the occurrence of variceal bleeding.Despite its clinical promise,technical challenges such as patient positioning,body habitus,and probe selection remain key limitations.Notably,splenic elastography may be particularly useful in diagnosing NCPH,where LS remains normal but PH is present.Splenic transient elastography is a valuable adjunct in the non-invasive assessment of PH.Its ability to predict varices,differentiate between CPH and NCPH,and reduce unnecessary endoscopies suggests that it should be incorporated into routine hepatology practice.Future research should focus on refining SS cut-offs,evaluating its cost-effectiveness,and integrating splenic elastography into clinical guidelines for PH management.
文摘BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.
文摘Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.
基金Supported by Quebec Health Research Fund Clinician Research Scholars Junior 1,No.350546.
文摘Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,and hepatic encephalopathy.This narrative review explores the pathophysiology of PH in cirrhosis,evaluates diagnostic methods for identifying clinically significant PH(CSPH),and discusses guideline-driven strategies to prevent initial and further decompensation.While HVPG remains the gold standard for diagnosing CSPH,non-invasive tools such as liver stiffness measurement and spleen stiffness measurement are increasingly used for initial risk stratification.The combined use of these tools reduces the proportion of patients in the diagnostic"grey zone".Endoscopic ultrasound-guided portal pressure gradient is an emerging diagnostic tool that requires further validation.Non-selective beta-blockers are the cornerstone of primary prophylaxis for decompensation,and their combination with endoscopic variceal ligation is the first-line therapy for secondary prophylaxis of recurrent esophageal variceal bleeding.Statins show promise in reducing PH and preventing decompensation while further studies are still needed.This review also discusses the indications for preemptive transjugular intrahepatic portosystemic shunt and its role in managing refractory ascites and variceal bleeding.
基金Supported by Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province,No.2023GBYJ-YL-1.
文摘In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.
基金Supported by the National Natural Science Foundation of China,No.81970533the Natural Science Foundation of Shandong Province,No.ZR2022ZD21.
文摘Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for portal hyper-tension and esophagogastric variceal bleeding,respectively.With advancements in artificial intelligence in medicine,non-invasive diagnostic methods are in-creasingly replacing traditional invasive procedures,permitting more rational and personalized patient care.This review summarizes the formation and diagnosis of portal hypertension,as well as the primary prophylaxis,secondary prophylaxis,and management of acute esophagogastric variceal bleeding.This study also highlights the latest progress in artificial intelligence in the diagnosis and treat-ment of portal hypertension and esophagogastric varices.
文摘BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.
基金Supported by the National Natural Science Foundation of China,No.82100639,No.82200630,and No.81970526Postdoctoral Scientific Research Foundation of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,No.202401023+3 种基金Clinical Research Program of Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,No.JYLJ202124Shanghai Municipal Commission of Health and Family Planning,No.20244Y0195 and No.20234Y0132the Fundamental Research Program Funding of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.JYZZ162Science Foundation of Xinjiang Uygur Natural Autonomous Region,No.2022D01F17.
文摘BACKGROUND Liver cirrhosis and portal hypertension(PHT)can lead to lymphatic abnormalities and coagulation dysfunction.Because lymphangiogenesis may relieve liver cirrhosis and PHT,the present study investigated the gene expression alterations in the lymphatic system and the effectiveness of platelet-mediated lymphangiogenesis in improving liver cirrhosis and PHT.AIM To investigate the role of lymphangiogenesis in preclinical PHT models.METHODS Immunohistochemistry and transcriptome sequencing of bile duct ligation(BDL)and control lymphatic samples were conducted to reveal the indicated signaling pathways.Functional enrichment analyses were performed on the differentially expressed genes and hub genes.Adenoviral infection of vascular endothelial growth factor C(VEGF-C),plateletrich plasma(PRP),and VEGF3 receptor(VEGFR)inhibitor MAZ-51 was used as an intervention for the lymphatic system in PHT models.Histology,hemodynamic tests and western blot analyses were performed to demonstrate the effects of lymphatic intervention in PHT patients.RESULTS Lymphangiogenesis was increased in the BDL rat model.Transcriptome sequencing analysis of the extrahepatic lymphatic system revealed its close association with platelet adherence,aggregation,and activation.The role of PHT in the rat model was investigated by activating(PRP)and inhibiting(MAZ-51)the lymphatic system.PRP promoted lymphangiogenesis,which increased lymphatic drainage,alleviated portal pressure,reduced liver fibrosis,inhibited inflammation,inhibited angiogenesis,and suppressed mesenteric artery remodeling.MAZ-51 reversed the above improvements.CONCLUSION Via VEGF-C/VEGFR-3,platelets impede fibrosis,angiogenesis,and mesenteric artery remodeling,ultimately alleviating PHT.Thus,platelet intervention is a therapeutic approach for cirrhosis and PHT.
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.
基金Supported by National Natural Science Foundation of China,No.82460461Medical Subject Leader of Yunnan Province(General Surgery),No.D-2024029+2 种基金Yunnan Fundamental Research Project for Excellent Young Scholars,No.202401AW070003The Young and Mid-aged Academic and Technical Leader Reserve Talent Program of Yunnan Province,No.202205AC160063Beijing Bethune Charitable Foundation,No.STLKY0089.
文摘This letter comments on the recently published article in the World Journal of Gastroenterology,in which the authors demonstrated a strong link between lymphangiogenesis and the process of platelet adherence,aggregation,and activation by employing a rat model of liver cirrhosis caused by bile duct ligation(BDL).The authors applied both gain and loss of function approach by using platelet-rich plasma and vascular endothelial growth factor 3 receptor inhibitor MAZ-51 to activate and inhibit angiogenetic signaling in BDL rat model,respectively,to verify the crucial function of lymphangiogenesis in the development of liver cirrhosis and portal hypertension(PHT).In clinical practice,platelet transfusion has been applied to improve liver function in patients suffering from chronic liver disease and cirrhosis.Therefore,this study provides support for the application of platelet transfusion or pharmacological intervention of lymphangiogenesis as novel therapeutic approaches for liver cirrhosis and PHT.
基金Supported by Shaanxi Provincial Social Development Fund,No.2024SF-YBXM-140.
文摘BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.
基金Supported by The Beijing Hospitals Authority Youth Programme,No.QMl220201802.
文摘BACKGROUND The portal vein thrombosis(PVT)can exacerbate portal hypertension and lead to complications,increasing the risk of mortality.AIM To evaluate the predictive capacity of artificial neural networks(ANNs)in quan-tifying the likelihood of developing PVT in individuals afflicted with hepatitis B-induced cirrhosis.METHODS A retrospective study was conducted at Beijing Ditan Hospital,affiliated with Capital Medical University,including 986 hospitalized patients.Patients admitted between January 2011 and December 2014 were assigned to the training set(685 cases),while those hospitalized from January 2015 to December 2016 were divided into the validation cohort(301 cases).Independent risk factors for PVT were identified using COX univariate analysis and used to construct an ANN model.Model performance was evaluated through metrics such as the area under the receiver operating characteristic curve(AUC)and concordance index.RESULTS In the training set,PVT occurred in 19.0%of patients within three years and 23.7%within five years.In the validation cohort,PVT developed in 16.7%of patients within three years and 24.0%within five years.The ANN model incorporated nine independent risk factors:Age,ascites,hepatic encephalopathy,gastrointestinal varices with bleeding,Child-Pugh classification,alanine aminotransferase levels,albumin levels,neutrophil-to-lymphocyte ratio,and platelet.The model achieved an AUC of 0.967(95%CI:0.960–0.974)at three years and 0.975(95%CI:0.955–0.992)at five years,significantly outperforming existing models such as model for end-stage liver disease and Child-Pugh-Turcotte(all P<0.001).CONCLUSION The ANN model demonstrated effective stratification of patients into high-and low-risk groups for PVT deve-lopment over three and five years.Validation in an independent cohort confirmed the model's predictive accuracy.
文摘Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.
基金the Interdisciplinary Program of Shanghai Jiao Tong University(No.YG2021QN36)the National Natural Science Foundation of China(Nos.82000615 and 52106050)the Natural Science Foundation of Shanghai(No.21ZR1431800)。
文摘Portal vein stenosis is one of the common complications after liver transplantation in children.Accurate hemodynamic assessment is crucial for predicting the risk of complications after liver transplantation.In order to predict the location of portal vein thrombosis after liver transplantation surgery,single-outlet and three-outlet vascular models were reconstructed from computed tomography images by commercial software MIMICS.The velocity field was measured using a 9.4 T magnetic resonance imaging scanner.Based on the experiment data of magnetic resonance velocimetry,computational fluid dynamics was verified,validated and then used to study the pressure and shear stresses on the wall of the two portal vein models.The simulation results can serve for the clinical prediction of early thrombosis after liver transplantation in portal vein.
文摘BACKGROUND Idiopathic portal hypertension(IPH)is a subtype of portal hypertension that arises in the absence of cirrhosis.IPH frequently manifests with clinical features typical of portal hypertension,including splenomegaly and esophagogastric fundal varices,along with other associated symptoms.Imaging studies may indicate portal hypertension;however,they typically do not provide evidence of cirrhosis.There are no standardized diagnostic criteria for IPH,and diagnosis is often established by excluding other hepatic diseases.Liver biopsy remains the most reliable approach to verify the diagnosis of IPH.CASE SUMMARY A patient previously diagnosed with“hepatitis B cirrhosis”at an external hospital presented to our facility with gastrointestinal bleeding.Initial assessment revealed minor liver injury,splenomegaly,esophagogastric varices,and portal hypertension.Imaging studies did not indicate cirrhosis and repeated hepatitis B serology tests yielded negative results.After excluding various causes of cirrhosis and other non-cirrhotic etiologies of portal hypertension,liver biopsy confirmed the diagnosis of IPH.The patient was managed with regular endoscopic therapy and long-term carvedilol administration.CONCLUSION Currently,there are no standardized diagnostic criteria for IPH,and its diagnosis is generally established by excluding other conditions.Liver biopsy remains the most reliable method for IPH diagnosis.
