Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Material...Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.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
Objective:To systematically evaluate prediction models for postoperative deep vein thrombosis(DVT)in elderly hip fracture patients and assess their methodological quality and predictive performance.Methods:Following P...Objective:To systematically evaluate prediction models for postoperative deep vein thrombosis(DVT)in elderly hip fracture patients and assess their methodological quality and predictive performance.Methods:Following PRISMA guidelines,we searched eight databases(PubMed,Embase,Cochrane Library,Web of Science,CINAHL,CNKI,Wanfang,VIP)from inception to May 2025.Studies developing or validating DVT prediction models in elderly hip fracture patients were included.Two reviewers independently screened studies,extracted data,and assessed risk of bias and applicability using the PROBAST tool.Results:Eleven studies were included,all conducted in China between 2021 and 2025.Sample sizes ranged from 101 to 504 patients(total n=3,286).Models incorporated 3 to 9 predictors,with D-dimer,age,and time from injury to surgery being most common.All 11 studies(100%)were rated as high risk of bias,primarily due to small sample sizes,lack of validation,and inadequate missing data handling.Applicability concerns were low in 8 studies(72.7%).AUC values ranged from 0.648 to 0.967,with 10 studies(90.9%)reporting AUC>0.7.Meta-analysis identified time from injury to surgery(OR=4.63,95%CI:2.58–6.68),age(OR=1.99),D-dimer(OR=1.51),and Caprini score(OR=1.75)as significant predictors.Conclusion:Current DVT prediction models for elderly hip fracture patients demonstrate acceptable discrimination but are limited by high risk of bias and lack of external validation.Prospective,multicenter studies with rigorous validation are needed to develop clinically applicable models.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
AIM:To analyze the effect of conbercept treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME)using optical coherence tomography(OCT)images.METHODS:This retrospective study included ...AIM:To analyze the effect of conbercept treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME)using optical coherence tomography(OCT)images.METHODS:This retrospective study included patients who first received conbercept injections for RVO-ME at Yijishan Hospital of Wannan Medical College from December 1,2017,to March 31,2022.Data on disease duration,age,hypertension,OCT images,central macular thickness(CMT),and best-corrected visual acuity(BCVA)were collected before and at 4-6 wk after treatment.Patients were divided into 4 groups according to different types of macular edema:cystoid macular edema(CME),sponge-like diffuse retinal thickening(SDRT),serous retinal detachment(SRD),and mixed type(FULL).Changes in CMT and visual acuity before and after treatment were compared among the groups to analyze differences in the effect of conbercept treatment on different ME types,and the effect of baseline CMT and visual acuity on post-treatment visual acuity.RESULTS:Totally 139 patients(139 eyes)were classified as having macular edema,including 62 males(44.6%)and 77 females(55.4%),with a mean age of 58.9±10.9 years,and they were divided into 4 groups based on different types of macular edema,including 54 cases(54 eyes)(mean age 59.6±11.1 years)in the CME group,23 cases(23 eyes;mean age 56.6±10.2 years)in the SDRT group,22 cases(22 eyes;mean age 57.8±12.0 years)in the SDR group,and 40 cases(40 eyes;mean age 60.0±10.7 years)in the FULL group.There were no significant differences in the duration of disease or age between groups(P>0.05).There was a significant difference in preoperative CMT between groups(P=0.01,one-way ANOVA),with the CMT in the FULL group being significantly greater than that in the SDRT group(P=0.03).There were no significant differences in pre-treatment visual acuity between the four groups(P=0.26).After conbercept treatment,the macular central recess thickness was reduced and visual acuity was improved in all four groups,among which the CMT in the CME and FULL groups was reduced significantly compared with the other two groups(P<0.05),and the visual acuity in the CME and SRD groups was improved significantly compared with the other two groups(P<0.05).Postoperative visual acuity was negatively correlated with preoperative CMT(P=0.044)and positively correlated with preoperative visual acuity(P<0.01).CONCLUSION:The efficacy of intravitreal conbercept in the treatment of RVO and macular edema may be related to the type of edema observed on OCT images,in which the efficacy is best in patients with CME but poor in patients with SDRT.展开更多
Wing design is a critical factor in the aerodynamic performance of flapping-wing(FW)robots.Inspired by the natural wing structures of insects,bats,and birds,we explored how bio-mimetic wing vein morphologies,combined ...Wing design is a critical factor in the aerodynamic performance of flapping-wing(FW)robots.Inspired by the natural wing structures of insects,bats,and birds,we explored how bio-mimetic wing vein morphologies,combined with a bio-inspired double wing clap-and-fling mechanism,affect thrust generation.This study focused on increasing vertical force and payload capacity.Through systematic experimentation with various vein configurations and structural designs,we developed innovative wings optimized for thrust production.Comprehensive tests were conducted to measure aerodynamic forces,power consumption,and wing kinematics across a range of flapping frequencies.Additionally,wings with different aspect ratios,a key factor in wing design,were fabricated and extensively evaluated.The study also examined the role of bio-inspired vein layouts on wing flexibility,a critical component in improving flight efficiency.Our findings demonstrate that the newly developed wing design led to a 20%increase in thrust,achieving up to 30 g-force(gf).This research sheds light on the clap-and-fling effect and establishes a promising framework for bio-inspired wing design,offering significant improvements in both performance and payload capacity for FW robots.展开更多
AIM:To evaluate the therapeutic effects of ranibizumab on optic disc and macular microvascular perfusion in central retinal vein occlusion(CRVO)with macular edema(ME).METHODS:Optical coherence tomography angiology(OCT...AIM:To evaluate the therapeutic effects of ranibizumab on optic disc and macular microvascular perfusion in central retinal vein occlusion(CRVO)with macular edema(ME).METHODS:Optical coherence tomography angiology(OCTA)parameters,including optic disc vessel density(VD;including whole-disc VD,intra-disc VD,and peripapillary VD),superficial/deep capillary plexus(SCP/DCP)VD,and central macular thickness(CMT)were analyzed.Additional assessments included best-corrected visual acuity(BCVA)via Early Treatment Diabetic Retinopathy Study(ETDRS)chart and hemorheological profiling.CRVO patients received monthly intravitreal ranibizumab injections for three consecutive months.Pre-and post-treatment parameters were statistically compared.RESULTS:The study comprised 60 CRVO-ME patients(28 males;32 females),aged 50-78y(mean 63.3±7.6y)and 60 age-/sex-matched healthy controls.As compared with participants exhibiting normal funduscopic findings,CRVO patients demonstrated significantly elevated levels of low-shear-rate whole blood viscosity(LSR-WBV),high-shearrate whole blood viscosity(HSR-WBV),and aggregation index(AI,all P<0.05).In CRVO-affected eyes,vertical cupto-disc(C/D)ratio and optic cup volume were significantly smaller,whereas retinal nerve fiber layer(RNFL)thickness was significantly greater,compared to both unaffected contralateral eyes and normal control eyes(all P<0.05).Following treatment,VD of the entire optic disc(P<0.05),intra-disc VD(P<0.05),and peripapillary VD(P<0.05)all increased significantly relative to baseline.CMT decreased significantly(P<0.05),whereas macular SCP-VD and macular DCP-VD showed non-significant slight reductions(P>0.05).At baseline,BCVA of CRVO eyes correlated with whole-disc VD(r=-0.276,P=0.033),intra-disc VD(r=-0.342,P=0.009),and peripapillary VD(r=-0.335,P=0.007),with intra-disc VD demonstrating the strongest association.Besides,BCVA improvement,after the treatment,correlated positively with whole-disc VD(r=0.342,P=0.008)and intradisc VD(r=0.396,P=0.002).CONCLUSION:Optic disc blood perfusion is more closely associated with visual acuity than macular perfusion,suggesting intra-disc VD may serve as a potential biomarker for monitoring visual acuity changes in CRVO.Multiple ranibizumab injections significantly improve optic disc perfusion but may have exerted detrimental effects on the macula.CRVO patients shows higher hemorheological parameters than those with normal fundi.Reduced vertical C/D ratio and optic cup volume may be linked to CRVO incidence,potentially acting as susceptibility factors.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy(HE) remains a problem in TIPS placeme...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy(HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.AIM To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.METHODS A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A(targeting left branch of portal vein, n = 937) and group B(targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed.RESULTS The symptoms of ascites and variceal bleeding disappeared within a short time.By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B(P = 0.278, P = 0.561, respectively).Incidence of HE differed significantly between groups A and B at 1 mo(14.94% vs36.80%, χ~2 = 4.839, P = 0.028), 3 mo(12.48% vs 34.20%, χ~2 = 5.054, P = 0.025), 6 mo(10.03% vs 32.24%, χ~2 = 6.560, P = 0.010), 9 mo(9.17% vs 31.27%, χ~2 = 5.357, P =0.021), and 12 mo(8.21% vs 28.01, χ~2 = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years(6.61% vs 7.16%, χ~2 = 1.204, P =0.272) and 5 years(5.01% vs 6.18%, χ~2 = 0.072, P = 0.562). The total survival rate did not differ between groups A and B(χ~2 = 0.226, P = 0.634, log-rank test).CONCLUSION Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portalhypertension-related complications.展开更多
AIM: To evaluate the effect of the shunting branch of the portal vein (PV) (left or right) and the initial stent position (optimal or suboptimal) of a transjugular intrahepatic portosystemic shunt (TIPS).
AIM To compare the outcomes of transcatheter superior mesenteric artery(SMA) urokinase infusion and transjugular intrahepatic portosystemic shunt(TIPS) for acute portal vein thrombosis(PVT) in cirrhosis.METHODS From J...AIM To compare the outcomes of transcatheter superior mesenteric artery(SMA) urokinase infusion and transjugular intrahepatic portosystemic shunt(TIPS) for acute portal vein thrombosis(PVT) in cirrhosis.METHODS From January 2013 to December 2014, patients with liver cirrhosis and acute symptomatic PVT who met the inclusion criteria were randomly assigned to either an SMA group or a TIPS group. The two groups accepted transcatheter selective SMA urokinase infusion therapyand TIPS, respectively. The total follow-up time was24 mo. The primary outcome measure was the change in portal vein patency status which was evaluated by angio-computed tomography or Doppler ultrasound.Secondary outcomes were rebleeding and hepatic encephalopathy.RESULTS A total of 40 patients were enrolled, with 20 assigned to the SMA group and 20 to the TIPS group. The symptoms of all patients in the two groups improved within 48 h. PVT was improved in 17(85%) patients in the SMA group and 14(70%) patients in the TIPS group. The main portal vein(MPV) thrombosis was significantly reduced in both groups(P < 0.001), and there was no significant difference between them(P= 0.304). In the SMA group, superior mesenteric vein(SMV) thrombosis and splenic vein(SV) thrombosis were significantly reduced(P = 0.048 and P = 0.02),which did not occur in the TIPS group. At 6-, 12-,and 24-mo follow-up, in the SMA group and the TIPS group, the cumulative rates free of the first episode of rebleeding were 80%, 65%, and 45% vs 90%, 80%,and 60%, respectively(P = 0.320); the cumulative rates free of the first episode of hepatic encephalopathy were 85%, 80%, and 65% vs 50%, 40%, and 35%,respectively(P = 0.022).CONCLUSION Transcatheter selective SMA urokinase infusion and TIPS are safe and effective for acute symptomatic PVT in cirrhosis.展开更多
Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots.Lately,studies have shown that these patients may probably be at an increased risk of venous thrombotic comp...Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots.Lately,studies have shown that these patients may probably be at an increased risk of venous thrombotic complications.Although the hemostatic changes in the chronic liver disease patients and the factors that may predict bleeding vs thrombotic complications remains an area of active research,it is believed that the coagulation cascade is delicately balanced in these patients because of parallel reduced hepatic synthesis of pro and anticoagulant factors.Thrombotic state in cirrhotic patients is responsible for not only portal or non-portal thrombosis[deep vein thrombosis(DVT)and pulmonary embolism(PE)];it has also been associated with progression of liver fibrosis.The use of anticoagulants in cirrhosis patients is a challenging,and often a scary situation.This review summarizes the current literature on the prevalence of venous thrombosis(DVT and PE),risk factors and safety of prophylactic and therapeutic anticoagulation in patients with chronic liver disease.展开更多
Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is...Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.展开更多
Background:Treatment options for patients with cavernous transformation of portal vein(CTPV)are limited.This study aimed to evaluate the feasibility,efficacy and safety of transjugular intrahepatic portosystemic shunt...Background:Treatment options for patients with cavernous transformation of portal vein(CTPV)are limited.This study aimed to evaluate the feasibility,efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)to prevent recurrent esophageal variceal bleeding in patients with CTPV.Methods:We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016.All patients were diagnosed with CTPV.The indication for TIPS was a previous episode of variceal bleeding.The data on recurrent bleeding,stent patency,hepatic encephalopathy and survival were retrieved and analyzed.Results:TIPS procedure was successfully performed in 56 out of 67(83.6%)patients with CTPV.TIPS was performed via a transjugular approach alone(n=15),a combined transjugular/transhepatic approach(n=33)and a combined transjugular/transsplenic approach(n=8).Mean portosystemic pressure gradient(PSG)decreased from 28.09±7.28 mmHg to 17.53±6.12 mmHg after TIPS(P<0.01).The probability of the remaining free recurrent variceal bleeding was 87.0%.The probability of TIPS patency reached 81.5%.Hepatic encephalopathy occurrence was 27.8%,and survival rate was 88.9%until the end of follow-up.Four out of 11 patients who failed TIPS died,and 4 had recurrent bleeding.Conclusions:TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV,and to achieve clinical improvement.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis...BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s.Although TIPS has good therapeutic effects on the formation of PVT,the effect of PVT on TIPS stenting has rarely been reported.Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT,which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIM To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODS Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis.Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197).The incidence of PVT before TIPS was compared between the two groups.After TIPS placement,primary patency rate was compared using Kaplan–Meier analysis at 3,6,9 and 12 mo,and 2 and 3 years.The clinical outcomes were analyzed.RESULTS Before TIPS procedure,the incidence of PVT in group A was lower than in group B (P = 0.003),and TIPS technical success rate in group A was higher than in group B (P = 0.016).The primary patency rate in group A tended to be higher than in group B at 3,6,9 and 12 mo,2 years and 3 years (P = 0.006,P = 0.011,P = 0.023,P = 0.032,P = 0.037 and P = 0.028,respectively).Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001),6 mo (P = 0.003 and P = 0.005),9 mo (P = 0.005 and P = 0.012),12 mo (P = 0.008 and P = 0.024),2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017),respectively.During 3-years follow-up,the 1-,2- and 3-year survival rate in group A were higher than in group B (P = 0.008,P = 0.021,P = 0.018,respectively),but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).CONCLUSION Patients with prior splenectomy have a high incidence of PVT,which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion.展开更多
Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique.The aim of this study was to ...Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique.The aim of this study was to compare ALPPS,two-staged hepatectomy(TSH),and portal vein embolization(PVE)/ligation(PVL)using updated traditional meta-analysis and network meta-analysis(NMA).Data sources:Electronic databases were used in a systematic literature search.Updated traditional metaanalysis and NMA were performed and compared.Mortality and major morbidity were selected as primary outcomes.Results:Nineteen studies including 1200 patients were selected from the pool of 436 studies.Of these patients,315(31%)and 702(69%)underwent ALPPS and portal vein occlusion(PVO),respectively.Ninetyday mortality based on updated traditional meta-analysis,subgroup analysis of the randomized controlled trials(RCTs),and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE,PVL,and TSH cohorts.Moreover,analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts.The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters,time to operation,definitive hepatectomy,and R0 margins rates compared with the PVO cohort.In contrast,1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort.Conclusions:This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy approaches.Furthermore,two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.展开更多
AIM: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) with covered stents for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (PVTT).
AIM: To investigate the killing efficiency of a recombinant plasmid containing a thymidine kinase (TK) domain insert driven by the vascular endothelial growth factor receptor 2 (VEGFR2) promoter (KDR) on vascular endo...AIM: To investigate the killing efficiency of a recombinant plasmid containing a thymidine kinase (TK) domain insert driven by the vascular endothelial growth factor receptor 2 (VEGFR2) promoter (KDR) on vascular endothelial cells.METHODS: The KDR-TK fragment was extracted from pBluescript Ⅱ KDR-TK plasmid by enzymatic digestion with Xho I and Sal I. The enhanced green fluorescence protein (EGFP) carrier was extracted from pEGFP by the same procedure. The KDR-TK was inserted into the pEGFP carrier to construct pEGFP-KDR-TK. Using ultrasound irradiation and microbubble, pEGFP-KDR-TK was transferred into human umbilical vein endothelial cells (HUVECs). The transient infection rate was estimated by green fluorescent protein (GFP) expression. Transfected HUVECs, non-transfected HUVECs, and HepG2 cells were cultured in the presence of different concentrations of ganciclovir (GCV), and the killing efficacy of HSV-TK/GCV was analyzed by 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide (MTT) assay. RESULTS: The recombinant pEGFP-KDR-TK was successfully constructed by inserting the KDR-TK fragment into the pEGFP carrier. Transfected HUVECs showed cytoplasmic green fluorescence, and the transient transfection rate was about 20.3%. Pools of G418-resistant cells exhibited a higher sensitivity to theprodrug/GCV compared to non-transfected HUVECs or non-transfected HepG2 cells, respectively. CONCLUSION: KDR promoter and the suicide gene/prodrug system mediated by diagnostic ultrasound combined with microbubble can significantly kill HUVECs. Such therapy may present a novel and attractive approach to target gene therapy on tumor vessels.展开更多
BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepat...BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma(HCC).Therefore, attention should be paid to the treatment of MPVTT and its complications.AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization(TACE/TAE)+^(125)I seeds implantation with transjugular intrahepatic portosystemic shunt(TIPS) in treating MPVTT and its complications.METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and ^(125)I implantation(TIPS-^(125)I group) or TACE/TAE + TIPS only(TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-^(125)I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-^(125)I group,whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively(P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%,respectively, in the TIPS-^(125)I group, whereas those in the TIPS only group were31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%,27.5%, and 42.5%, respectively, in the TIPS-^(125)I group, and 42.2%, 68.9%, and84.4%, respectively, in the TIPS only group(P < 0.05). TIPS-^(125)I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.CONCLUSION TACE/TAE+^(125)I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.展开更多
Purpose:The aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-strippi...Purpose:The aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy(FS).Methods:A total of 64 patients(35 females,29 males;mean age,57?11 years[range,29–79 years])with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019.The maximum diameter of the vein branches was>20 mm,which appeared to be cystic dilatation and forms large-scale in the crus or the thigh.All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia.The surgical time,pain/phlebitis,number of incisions,amount of bleeding,recurrence of varicose vein,incidence of surgical site infections(SSIs),satisfaction score,and improvement in clinical symptoms were evaluated respectively with the patients in two groups:Group A,with patients who underwent treatment with the Trivex system,and Group B,patients who underwent treatment by point-form-stripping combined with FS.Results:All procedures were performed successfully.The average operative time in Group A was 56?11 min,whereas that of Group B was 90?33 min,which was a significant difference(p<0.05).Group A patients felt little pain after surgery,whereas in Group B the level of pain peaked on postoperative day 30,mostly due to thrombophlebitis after FS.There was no recurrence of varicose vein was observed in any patient,however,there were some residual effects in Group B,including the amount of bleeding volume,in-hospital stays,pain/phlebitis,and number of incisions(P<0.05).There were no significant differences with respect to SSIs,improvement in clinical symptoms,and satisfaction scores observed(p>0.05).Conclusions:This study shows that patients benefited from both treatment options.However,primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy(FS).In summary,the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy(FS)for those who demand a high level of appearance,and especially for young patients,the Trivex system is recommended.展开更多
BACKGROUND Portal vein thrombosis(PVT)was previously a contraindication for trans-jugular intrahepatic portosystemic shunt(TIPS).AIM To perform a systematic review and meta-analysis of the current available studies in...BACKGROUND Portal vein thrombosis(PVT)was previously a contraindication for trans-jugular intrahepatic portosystemic shunt(TIPS).AIM To perform a systematic review and meta-analysis of the current available studies investigating outcomes of TIPS for cirrhotic patient with PVT.METHODS Multiple databases were systematically searched to identify studies investigating the outcomes of TIPS for cirrhotic patients with PVT.The quality of studies was assessed by Cochrane Collaboration method and Methodological Index for Non-Randomized Studies.The demographic data,outcomes,combined treatment,and anticoagulation strategy were extracted.RESULTS Twelve studies were identified with 460 patients enrolled in the analysis.The technical success rate was 98.9%in patients without portal vein cavernous transformation and 92.3%in patients with portal vein cavernous transformation.One-year portal vein recanalization rate was 77.7%,and TIPS patency rate was 84.2%.The cumulative encephalopathy rate was 16.4%.One-year overall survival was 87.4%.CONCLUSION TIPS is indicated for portal hypertension related complications and the restoration of pre-transplantation portal vein patency in cirrhotic patients with PVT.Cavernous transfor-mation is an indicator for technical failure.Post-TIPS anticoagulation seems not mandatory.Simultaneous TIPS and percutaneous mechanical thrombectomy device could achieve accelerated portal vein recanalization and decreased thrombolysis-associated complications,but further investigation is still needed.展开更多
文摘Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.
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Objective:To systematically evaluate prediction models for postoperative deep vein thrombosis(DVT)in elderly hip fracture patients and assess their methodological quality and predictive performance.Methods:Following PRISMA guidelines,we searched eight databases(PubMed,Embase,Cochrane Library,Web of Science,CINAHL,CNKI,Wanfang,VIP)from inception to May 2025.Studies developing or validating DVT prediction models in elderly hip fracture patients were included.Two reviewers independently screened studies,extracted data,and assessed risk of bias and applicability using the PROBAST tool.Results:Eleven studies were included,all conducted in China between 2021 and 2025.Sample sizes ranged from 101 to 504 patients(total n=3,286).Models incorporated 3 to 9 predictors,with D-dimer,age,and time from injury to surgery being most common.All 11 studies(100%)were rated as high risk of bias,primarily due to small sample sizes,lack of validation,and inadequate missing data handling.Applicability concerns were low in 8 studies(72.7%).AUC values ranged from 0.648 to 0.967,with 10 studies(90.9%)reporting AUC>0.7.Meta-analysis identified time from injury to surgery(OR=4.63,95%CI:2.58–6.68),age(OR=1.99),D-dimer(OR=1.51),and Caprini score(OR=1.75)as significant predictors.Conclusion:Current DVT prediction models for elderly hip fracture patients demonstrate acceptable discrimination but are limited by high risk of bias and lack of external validation.Prospective,multicenter studies with rigorous validation are needed to develop clinically applicable models.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘AIM:To analyze the effect of conbercept treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME)using optical coherence tomography(OCT)images.METHODS:This retrospective study included patients who first received conbercept injections for RVO-ME at Yijishan Hospital of Wannan Medical College from December 1,2017,to March 31,2022.Data on disease duration,age,hypertension,OCT images,central macular thickness(CMT),and best-corrected visual acuity(BCVA)were collected before and at 4-6 wk after treatment.Patients were divided into 4 groups according to different types of macular edema:cystoid macular edema(CME),sponge-like diffuse retinal thickening(SDRT),serous retinal detachment(SRD),and mixed type(FULL).Changes in CMT and visual acuity before and after treatment were compared among the groups to analyze differences in the effect of conbercept treatment on different ME types,and the effect of baseline CMT and visual acuity on post-treatment visual acuity.RESULTS:Totally 139 patients(139 eyes)were classified as having macular edema,including 62 males(44.6%)and 77 females(55.4%),with a mean age of 58.9±10.9 years,and they were divided into 4 groups based on different types of macular edema,including 54 cases(54 eyes)(mean age 59.6±11.1 years)in the CME group,23 cases(23 eyes;mean age 56.6±10.2 years)in the SDRT group,22 cases(22 eyes;mean age 57.8±12.0 years)in the SDR group,and 40 cases(40 eyes;mean age 60.0±10.7 years)in the FULL group.There were no significant differences in the duration of disease or age between groups(P>0.05).There was a significant difference in preoperative CMT between groups(P=0.01,one-way ANOVA),with the CMT in the FULL group being significantly greater than that in the SDRT group(P=0.03).There were no significant differences in pre-treatment visual acuity between the four groups(P=0.26).After conbercept treatment,the macular central recess thickness was reduced and visual acuity was improved in all four groups,among which the CMT in the CME and FULL groups was reduced significantly compared with the other two groups(P<0.05),and the visual acuity in the CME and SRD groups was improved significantly compared with the other two groups(P<0.05).Postoperative visual acuity was negatively correlated with preoperative CMT(P=0.044)and positively correlated with preoperative visual acuity(P<0.01).CONCLUSION:The efficacy of intravitreal conbercept in the treatment of RVO and macular edema may be related to the type of edema observed on OCT images,in which the efficacy is best in patients with CME but poor in patients with SDRT.
基金Nguyen Tat Thanh University,Ho Chi Minh City,Vietnam for supporting this study。
文摘Wing design is a critical factor in the aerodynamic performance of flapping-wing(FW)robots.Inspired by the natural wing structures of insects,bats,and birds,we explored how bio-mimetic wing vein morphologies,combined with a bio-inspired double wing clap-and-fling mechanism,affect thrust generation.This study focused on increasing vertical force and payload capacity.Through systematic experimentation with various vein configurations and structural designs,we developed innovative wings optimized for thrust production.Comprehensive tests were conducted to measure aerodynamic forces,power consumption,and wing kinematics across a range of flapping frequencies.Additionally,wings with different aspect ratios,a key factor in wing design,were fabricated and extensively evaluated.The study also examined the role of bio-inspired vein layouts on wing flexibility,a critical component in improving flight efficiency.Our findings demonstrate that the newly developed wing design led to a 20%increase in thrust,achieving up to 30 g-force(gf).This research sheds light on the clap-and-fling effect and establishes a promising framework for bio-inspired wing design,offering significant improvements in both performance and payload capacity for FW robots.
基金Central High-Level Traditional Chinese Medicine Hospital Project of Eye Hospital China Academy of Chinese Medical Science(No.GSP5-83,No.GSP4-02No.GSP5-06)+1 种基金Supported by National Natural Science Foundation of China(General ProgramNo.82474582).
文摘AIM:To evaluate the therapeutic effects of ranibizumab on optic disc and macular microvascular perfusion in central retinal vein occlusion(CRVO)with macular edema(ME).METHODS:Optical coherence tomography angiology(OCTA)parameters,including optic disc vessel density(VD;including whole-disc VD,intra-disc VD,and peripapillary VD),superficial/deep capillary plexus(SCP/DCP)VD,and central macular thickness(CMT)were analyzed.Additional assessments included best-corrected visual acuity(BCVA)via Early Treatment Diabetic Retinopathy Study(ETDRS)chart and hemorheological profiling.CRVO patients received monthly intravitreal ranibizumab injections for three consecutive months.Pre-and post-treatment parameters were statistically compared.RESULTS:The study comprised 60 CRVO-ME patients(28 males;32 females),aged 50-78y(mean 63.3±7.6y)and 60 age-/sex-matched healthy controls.As compared with participants exhibiting normal funduscopic findings,CRVO patients demonstrated significantly elevated levels of low-shear-rate whole blood viscosity(LSR-WBV),high-shearrate whole blood viscosity(HSR-WBV),and aggregation index(AI,all P<0.05).In CRVO-affected eyes,vertical cupto-disc(C/D)ratio and optic cup volume were significantly smaller,whereas retinal nerve fiber layer(RNFL)thickness was significantly greater,compared to both unaffected contralateral eyes and normal control eyes(all P<0.05).Following treatment,VD of the entire optic disc(P<0.05),intra-disc VD(P<0.05),and peripapillary VD(P<0.05)all increased significantly relative to baseline.CMT decreased significantly(P<0.05),whereas macular SCP-VD and macular DCP-VD showed non-significant slight reductions(P>0.05).At baseline,BCVA of CRVO eyes correlated with whole-disc VD(r=-0.276,P=0.033),intra-disc VD(r=-0.342,P=0.009),and peripapillary VD(r=-0.335,P=0.007),with intra-disc VD demonstrating the strongest association.Besides,BCVA improvement,after the treatment,correlated positively with whole-disc VD(r=0.342,P=0.008)and intradisc VD(r=0.396,P=0.002).CONCLUSION:Optic disc blood perfusion is more closely associated with visual acuity than macular perfusion,suggesting intra-disc VD may serve as a potential biomarker for monitoring visual acuity changes in CRVO.Multiple ranibizumab injections significantly improve optic disc perfusion but may have exerted detrimental effects on the macula.CRVO patients shows higher hemorheological parameters than those with normal fundi.Reduced vertical C/D ratio and optic cup volume may be linked to CRVO incidence,potentially acting as susceptibility factors.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy(HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.AIM To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.METHODS A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A(targeting left branch of portal vein, n = 937) and group B(targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed.RESULTS The symptoms of ascites and variceal bleeding disappeared within a short time.By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B(P = 0.278, P = 0.561, respectively).Incidence of HE differed significantly between groups A and B at 1 mo(14.94% vs36.80%, χ~2 = 4.839, P = 0.028), 3 mo(12.48% vs 34.20%, χ~2 = 5.054, P = 0.025), 6 mo(10.03% vs 32.24%, χ~2 = 6.560, P = 0.010), 9 mo(9.17% vs 31.27%, χ~2 = 5.357, P =0.021), and 12 mo(8.21% vs 28.01, χ~2 = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years(6.61% vs 7.16%, χ~2 = 1.204, P =0.272) and 5 years(5.01% vs 6.18%, χ~2 = 0.072, P = 0.562). The total survival rate did not differ between groups A and B(χ~2 = 0.226, P = 0.634, log-rank test).CONCLUSION Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portalhypertension-related complications.
文摘AIM: To evaluate the effect of the shunting branch of the portal vein (PV) (left or right) and the initial stent position (optimal or suboptimal) of a transjugular intrahepatic portosystemic shunt (TIPS).
基金Supported by the National Natural Science Foundation of China,No.81572888
文摘AIM To compare the outcomes of transcatheter superior mesenteric artery(SMA) urokinase infusion and transjugular intrahepatic portosystemic shunt(TIPS) for acute portal vein thrombosis(PVT) in cirrhosis.METHODS From January 2013 to December 2014, patients with liver cirrhosis and acute symptomatic PVT who met the inclusion criteria were randomly assigned to either an SMA group or a TIPS group. The two groups accepted transcatheter selective SMA urokinase infusion therapyand TIPS, respectively. The total follow-up time was24 mo. The primary outcome measure was the change in portal vein patency status which was evaluated by angio-computed tomography or Doppler ultrasound.Secondary outcomes were rebleeding and hepatic encephalopathy.RESULTS A total of 40 patients were enrolled, with 20 assigned to the SMA group and 20 to the TIPS group. The symptoms of all patients in the two groups improved within 48 h. PVT was improved in 17(85%) patients in the SMA group and 14(70%) patients in the TIPS group. The main portal vein(MPV) thrombosis was significantly reduced in both groups(P < 0.001), and there was no significant difference between them(P= 0.304). In the SMA group, superior mesenteric vein(SMV) thrombosis and splenic vein(SV) thrombosis were significantly reduced(P = 0.048 and P = 0.02),which did not occur in the TIPS group. At 6-, 12-,and 24-mo follow-up, in the SMA group and the TIPS group, the cumulative rates free of the first episode of rebleeding were 80%, 65%, and 45% vs 90%, 80%,and 60%, respectively(P = 0.320); the cumulative rates free of the first episode of hepatic encephalopathy were 85%, 80%, and 65% vs 50%, 40%, and 35%,respectively(P = 0.022).CONCLUSION Transcatheter selective SMA urokinase infusion and TIPS are safe and effective for acute symptomatic PVT in cirrhosis.
文摘Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots.Lately,studies have shown that these patients may probably be at an increased risk of venous thrombotic complications.Although the hemostatic changes in the chronic liver disease patients and the factors that may predict bleeding vs thrombotic complications remains an area of active research,it is believed that the coagulation cascade is delicately balanced in these patients because of parallel reduced hepatic synthesis of pro and anticoagulant factors.Thrombotic state in cirrhotic patients is responsible for not only portal or non-portal thrombosis[deep vein thrombosis(DVT)and pulmonary embolism(PE)];it has also been associated with progression of liver fibrosis.The use of anticoagulants in cirrhosis patients is a challenging,and often a scary situation.This review summarizes the current literature on the prevalence of venous thrombosis(DVT and PE),risk factors and safety of prophylactic and therapeutic anticoagulation in patients with chronic liver disease.
文摘Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.
文摘Background:Treatment options for patients with cavernous transformation of portal vein(CTPV)are limited.This study aimed to evaluate the feasibility,efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)to prevent recurrent esophageal variceal bleeding in patients with CTPV.Methods:We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016.All patients were diagnosed with CTPV.The indication for TIPS was a previous episode of variceal bleeding.The data on recurrent bleeding,stent patency,hepatic encephalopathy and survival were retrieved and analyzed.Results:TIPS procedure was successfully performed in 56 out of 67(83.6%)patients with CTPV.TIPS was performed via a transjugular approach alone(n=15),a combined transjugular/transhepatic approach(n=33)and a combined transjugular/transsplenic approach(n=8).Mean portosystemic pressure gradient(PSG)decreased from 28.09±7.28 mmHg to 17.53±6.12 mmHg after TIPS(P<0.01).The probability of the remaining free recurrent variceal bleeding was 87.0%.The probability of TIPS patency reached 81.5%.Hepatic encephalopathy occurrence was 27.8%,and survival rate was 88.9%until the end of follow-up.Four out of 11 patients who failed TIPS died,and 4 had recurrent bleeding.Conclusions:TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV,and to achieve clinical improvement.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s.Although TIPS has good therapeutic effects on the formation of PVT,the effect of PVT on TIPS stenting has rarely been reported.Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT,which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIM To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODS Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis.Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197).The incidence of PVT before TIPS was compared between the two groups.After TIPS placement,primary patency rate was compared using Kaplan–Meier analysis at 3,6,9 and 12 mo,and 2 and 3 years.The clinical outcomes were analyzed.RESULTS Before TIPS procedure,the incidence of PVT in group A was lower than in group B (P = 0.003),and TIPS technical success rate in group A was higher than in group B (P = 0.016).The primary patency rate in group A tended to be higher than in group B at 3,6,9 and 12 mo,2 years and 3 years (P = 0.006,P = 0.011,P = 0.023,P = 0.032,P = 0.037 and P = 0.028,respectively).Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001),6 mo (P = 0.003 and P = 0.005),9 mo (P = 0.005 and P = 0.012),12 mo (P = 0.008 and P = 0.024),2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017),respectively.During 3-years follow-up,the 1-,2- and 3-year survival rate in group A were higher than in group B (P = 0.008,P = 0.021,P = 0.018,respectively),but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).CONCLUSION Patients with prior splenectomy have a high incidence of PVT,which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion.
文摘Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique.The aim of this study was to compare ALPPS,two-staged hepatectomy(TSH),and portal vein embolization(PVE)/ligation(PVL)using updated traditional meta-analysis and network meta-analysis(NMA).Data sources:Electronic databases were used in a systematic literature search.Updated traditional metaanalysis and NMA were performed and compared.Mortality and major morbidity were selected as primary outcomes.Results:Nineteen studies including 1200 patients were selected from the pool of 436 studies.Of these patients,315(31%)and 702(69%)underwent ALPPS and portal vein occlusion(PVO),respectively.Ninetyday mortality based on updated traditional meta-analysis,subgroup analysis of the randomized controlled trials(RCTs),and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE,PVL,and TSH cohorts.Moreover,analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts.The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters,time to operation,definitive hepatectomy,and R0 margins rates compared with the PVO cohort.In contrast,1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort.Conclusions:This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy approaches.Furthermore,two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.
基金Supported by Science and Technology Planning Project of Guangdong Province,China,No.2012B010200027The Key Technologies RD Program of Guangzhou,ChinaThe Presidential Foundation of the Nanfang Hospital,Southern Medical University,Guangzhou,China,No.2011B006
文摘AIM: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) with covered stents for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (PVTT).
基金New Century Distinguished Scholar Supporting Program of Ministry of Education (80000-3171404) The National Natural Science Foundation of China, No. 30300082, No. 30470467
文摘AIM: To investigate the killing efficiency of a recombinant plasmid containing a thymidine kinase (TK) domain insert driven by the vascular endothelial growth factor receptor 2 (VEGFR2) promoter (KDR) on vascular endothelial cells.METHODS: The KDR-TK fragment was extracted from pBluescript Ⅱ KDR-TK plasmid by enzymatic digestion with Xho I and Sal I. The enhanced green fluorescence protein (EGFP) carrier was extracted from pEGFP by the same procedure. The KDR-TK was inserted into the pEGFP carrier to construct pEGFP-KDR-TK. Using ultrasound irradiation and microbubble, pEGFP-KDR-TK was transferred into human umbilical vein endothelial cells (HUVECs). The transient infection rate was estimated by green fluorescent protein (GFP) expression. Transfected HUVECs, non-transfected HUVECs, and HepG2 cells were cultured in the presence of different concentrations of ganciclovir (GCV), and the killing efficacy of HSV-TK/GCV was analyzed by 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide (MTT) assay. RESULTS: The recombinant pEGFP-KDR-TK was successfully constructed by inserting the KDR-TK fragment into the pEGFP carrier. Transfected HUVECs showed cytoplasmic green fluorescence, and the transient transfection rate was about 20.3%. Pools of G418-resistant cells exhibited a higher sensitivity to theprodrug/GCV compared to non-transfected HUVECs or non-transfected HepG2 cells, respectively. CONCLUSION: KDR promoter and the suicide gene/prodrug system mediated by diagnostic ultrasound combined with microbubble can significantly kill HUVECs. Such therapy may present a novel and attractive approach to target gene therapy on tumor vessels.
基金the Beijing Municipal Science and Technology Commission project,the Capital of the Public Health Cultivation-Transcatheter Implantation combined with TACE/TAE in the treatment of portal vein tumor thrombus in clinical research,No.Z171100000417031
文摘BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma(HCC).Therefore, attention should be paid to the treatment of MPVTT and its complications.AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization(TACE/TAE)+^(125)I seeds implantation with transjugular intrahepatic portosystemic shunt(TIPS) in treating MPVTT and its complications.METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and ^(125)I implantation(TIPS-^(125)I group) or TACE/TAE + TIPS only(TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-^(125)I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-^(125)I group,whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively(P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%,respectively, in the TIPS-^(125)I group, whereas those in the TIPS only group were31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%,27.5%, and 42.5%, respectively, in the TIPS-^(125)I group, and 42.2%, 68.9%, and84.4%, respectively, in the TIPS only group(P < 0.05). TIPS-^(125)I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.CONCLUSION TACE/TAE+^(125)I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.
基金supported by a grant from the“Famous doctors,Famous hospital,Famous clinic”project of the SHENZHEN municipal government[SZSM201512013].
文摘Purpose:The aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy(FS).Methods:A total of 64 patients(35 females,29 males;mean age,57?11 years[range,29–79 years])with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019.The maximum diameter of the vein branches was>20 mm,which appeared to be cystic dilatation and forms large-scale in the crus or the thigh.All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia.The surgical time,pain/phlebitis,number of incisions,amount of bleeding,recurrence of varicose vein,incidence of surgical site infections(SSIs),satisfaction score,and improvement in clinical symptoms were evaluated respectively with the patients in two groups:Group A,with patients who underwent treatment with the Trivex system,and Group B,patients who underwent treatment by point-form-stripping combined with FS.Results:All procedures were performed successfully.The average operative time in Group A was 56?11 min,whereas that of Group B was 90?33 min,which was a significant difference(p<0.05).Group A patients felt little pain after surgery,whereas in Group B the level of pain peaked on postoperative day 30,mostly due to thrombophlebitis after FS.There was no recurrence of varicose vein was observed in any patient,however,there were some residual effects in Group B,including the amount of bleeding volume,in-hospital stays,pain/phlebitis,and number of incisions(P<0.05).There were no significant differences with respect to SSIs,improvement in clinical symptoms,and satisfaction scores observed(p>0.05).Conclusions:This study shows that patients benefited from both treatment options.However,primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy(FS).In summary,the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy(FS)for those who demand a high level of appearance,and especially for young patients,the Trivex system is recommended.
文摘BACKGROUND Portal vein thrombosis(PVT)was previously a contraindication for trans-jugular intrahepatic portosystemic shunt(TIPS).AIM To perform a systematic review and meta-analysis of the current available studies investigating outcomes of TIPS for cirrhotic patient with PVT.METHODS Multiple databases were systematically searched to identify studies investigating the outcomes of TIPS for cirrhotic patients with PVT.The quality of studies was assessed by Cochrane Collaboration method and Methodological Index for Non-Randomized Studies.The demographic data,outcomes,combined treatment,and anticoagulation strategy were extracted.RESULTS Twelve studies were identified with 460 patients enrolled in the analysis.The technical success rate was 98.9%in patients without portal vein cavernous transformation and 92.3%in patients with portal vein cavernous transformation.One-year portal vein recanalization rate was 77.7%,and TIPS patency rate was 84.2%.The cumulative encephalopathy rate was 16.4%.One-year overall survival was 87.4%.CONCLUSION TIPS is indicated for portal hypertension related complications and the restoration of pre-transplantation portal vein patency in cirrhotic patients with PVT.Cavernous transfor-mation is an indicator for technical failure.Post-TIPS anticoagulation seems not mandatory.Simultaneous TIPS and percutaneous mechanical thrombectomy device could achieve accelerated portal vein recanalization and decreased thrombolysis-associated complications,but further investigation is still needed.
