Severe Pulmonary Hypertension Secondary to Concomitant Mitral Stenosis with Veno-occlusive Disease in the Context of Systemic Sclerosis: Importance of Careful and Comprehensive Assessment

Pulmonary Arterial Hypertension (PAH) is a clinical syndrome consisting of physiologic/ hemodynamic criteria that are a consequence of several etiologies. Confirmation of pulmonary hypertension is based on right heart catheterization. Pulmonary hypertension is a devastating condition that can lead to considerable morbidity and premature mortality. In the last few decades, significant advancement in the pharmacotherapy of pulmonary hypertension has resulted from better understanding of the complex pathogenesis and pathophysiology of this dreaded disease. Despite these accomplishments, pharmacotherapy of pulmonary hypertension is still far from perfect, and the mortality in this modern treatment era is still unacceptably high. We report a complex clinical presentation characterized by severe pulmonary hypertension secondary to concomitant mitral stenosis with veno-occlusive disease in the context of systemic sclerosis. Our case highlights the importance of a systematic and comprehensive diagnostic approach to avoid missing an underlying pathology.

Long-term results of stent graft in the treatment of TASC C, D femoropopliteal artery occlusive disease / 中华普通外科杂志

Objective:To evaluate the long-term outcome of Viabahn stent graft in the treatment of complex femoropopliteal occlusive lesions.Methods:From Sep 2013 to Mar 2020, clinical data of TASC C and D femoropopliteal lesions treated with Viabahn were retrospectively analyzed. Patency rates, the freedom rate from clinically-driven target lesion revascularization (F-TLR), limb salvage and survival after five years were calculated.Results:A total of 65 patients (67 lower limbs) were included. 20 limbs were TASC C lesions, 47 limbs were TASC D lesions. The mean lesion length was (29.1±9.4) cm, including 48 chronic total occlusion (CTO) lesions (71.6%) with mean lesion length of (26.1±10.4) cm. Technique success rate was 98.6%. Mean length of stent graft was (31.3±10.1) cm.Major amputation was performed in 4.2% cases within 5 years. All-cause mortality in 5 years was 23.1%. Primary patency rates at 1,3,and 5 years were 76.8%,59.4%,50.9%, Assisted primary patency rates were 88.4%, 83.4%, 83.4% and secondary patency rates were 88.4%, 85.8%, and 85.8% . F-TLR at 1, 3 and 5 year was 88.2%,76.9%,73.1% .Conclusion:Viabahn for complex and long femoropopliteal artery occlusions is an acceptable treatment with fair long-term outcome.

Stent implantation strategy of endovascular treatment in aortoiliac occlusive disease / 国际外科学杂志

Aortoiliac occlusive disease is a group of ischemic disease caused by stenosis or occlusion of infrarenal aorta and iliac artery. Gluteus or lower extremity intermittent claudication and even limb-threatening ischemia are most common symptoms. With the development of endovascular devices and techniques, therapeutic options of complex lesions have changed from open surgery to endovascular treatment, which have the advantages including satisfied patency rate, less perioperative complications and fast recovery. This article will review and summarize stent implantation choices and techniques for endovascular treatment in aortoiliac occlusive disease.

Anticoagulant therapy and transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid related hepatic sinusoidal obstruction syndrome / 临床肝胆病杂志

Hepatic sinusoidal obstruction syndrome (HSOS) is a vascular liver disease characterized by varying degrees of liver injury and portal hypertension. HSOS in China is mostly associated with the intake of pyrrolizidine alkaloids. The step-up approach with anticoagulant therapy and transjugular intrahepatic portosystemic shunt (TIPS) as the core treatment methods is the therapy currently recommended for this disease. Subcutaneous injection of low-molecular-weight heparin is the first choice for anticoagulant therapy, and oral warfarin can be used in combination or sequentially to enhance anticoagulation. Patients with no response to anticoagulant therapy can switch to TIPS. The Drum Tower Severity Score (DTSS) system can be used during treatment to evaluate the severity of the disease, in order to identify high-risk patients earlier and switch to TIPS in time, thereby improving the prognosis of patients.

Tratamiento endovascular de la enfermedad obstructiva aortoilíaca / Endovascular management of aortoiliac occlusive disease

Resumen Introducción: La angioplastia transluminal percutánea (ATP), se ha convertido en una técnica aceptada, en el tratamiento de la enfermedad obstrutiva aortoilíaca, con tasas de éxito del 90-92% y permeabilidad primaria del 55-72% a 5 años. Objetivo: Evaluar los resultados del tratamiento endovascular del sector aortoilíaco. Material y Método: Estudio descriptivo, retrospectivo (revisión de serie de casos unicéntrica), de pacientes, sometidos consecutivamente al tratamiento endovascular (ATP simple y ATP con stent) de la patología obstructiva del sector aortoilíaco, durante un período de 7 años (2002-2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizaron 103 procedimientos en 94 pacientes, sexo masculino: 63,83%, femenino: 36,17%, edad promedio: 67,4 años (rango 47-96), distribución de las lesiones según la clasificación TASC II: A (46,24%), B (39,78%), C (8,60%), D (5,38%), remodelando la biburfaccción aórtica (kissing stent) en un 6,80%, procedimientos híbridos (12,62%), seguimiento promedio (47,13 meses), éxito clínico (90,29%), exito técnico (94,17%), permeabilidad primaria, primaria asistida y secundaria a 5 años del 68,09%, 75,53% y 81,91% respectivamente, tasa de salvación de la extremidad a 5 años del 84,04%, mortalidad < 30 días del 1,94%, supervivencia a 5 años del 90,42%. Discusión: Las técnicas endovasculares del sector aortoilíaco son fiables, sus resultados ténicos y permeabilidad, están influenciados por el estadio clínico del paciente y severidad de las lesiones tratadas. Conclusión: En pacientes adecuadamente seleccionados, el tratamiento endovascular del sector aortoilíaco presenta excelentes resultados, permitiendo aumentar la indicación de tratamiento en pacientes considerados de alto riesgo.

Introduction: Percutaneous transluminal angioplasty (PTA) has become an accepted technique in the treatment of aortoiliac occlusive disease, with success rates of 90-92%, and primary patency of 55-72% at 5 years. Aim: To evaluate the results of endovascular treatment (PTA or PTA with stents) of the aortoiliac sector. Material and Method: Descriptive, retrospective study (single-center case series) of patients, consecutively subjected to endovascular treatment (PTA or PTA with stents) of aortoiliac occlusive disease, during a period of 7 years (2002 - 2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: 103 procedures were performed in 94 patients, male: 63.83%, female: 36.17%, mean age: 67.4 years (range 47-96), distribution of the lesions according to the TASC II classification: A (46.24%), B (39.78%), C (8.60%), D (5.38%), remodeling the aortic bifaction (kissing stent) in 6.80%, hybrid procedures (12.62%), average follow-up (47.13 months), clinical success (90.29%), technical success (94.17%), primary patency, assisted primary and secondary at 5 years of 68.09%, 75, 53% and 81.91% respectively, 5-year limb salvage rate of 84.04%, mortality < 30 days of 1.94%, 5-year survival of 90.42%. Discussion: Endovascular techniques in the aortoiliac sector are reliable, their technical results and patency are influenced by the clinical stage of the patient and the severity of the lesions treated. Conclusion: In appropriately selected patients, endovascular treatment of the aortoiliac sector, presents excellent results, allowing an increase in the indication for treatment in patients considered to be at high risk.

Superficial-Temporal-Artery-To-Middle-Cerebral-Artery Bypass in Cerebrovascular Occlusive Disease and Hemodynamic-Related Ischemia: Illustrative Case and Literature Review

Stroke is the third most common cause of death worldwide. About 10% to 15% of strokes related to the territory of the carotid artery are associated with its complete occlusion. There is an important subgroup of patients with cerebrovascular occlusive diseases who might benefit from an external-carotid-to-internal-carotid bypass. In the present study, we report a case of a 53-year-old male patient with stenosis of the M2 branch of themiddle cerebral artery (MCA), with a history of 20 episodes of transient ischemic accidents (TIA)s, in whom an anastomosis of the M4 branch of the superficial temporal artery-MCA was performed. The patient was discharged in three days, and in the two years of follow-up, they were no more TIAs.We also conducted a review of the literature on cerebrovascular occlusive disease and extracranial-intracranial bypass surgery. New methods to evaluate cerebral hemodynamics made it possible to classify a new subgroup of patients with symptomatic cerebrovascular disease and documented cerebrovascular compromise in whom the drug therapy fails, who can benefit from the extracranial-intracranial bypass. Our case report illustrates the advantages of revascularization in these selected patients.

Gynura segetum induces hepatic sinusoidal obstruction syndrome in mice by impairing autophagy

ABSTRACT Purpose: To investigate the underlying mechanism of hepatic sinusoidal obstruction syndrome (HSOS) induced by Gynura segetum by measuring autophagy in mouse models. Methods: The model group was administered G. segetum (30 g/kg/d) by gavage, while the normal control group was administered an equal volume of saline daily for five weeks. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic histopathological examinations, and Masson staining were performed to evaluate liver injury. Liver intercellular adhesion molecule-1 (ICAM-1) and P-selectin were evaluated by immunohistochemistry. Hepatocellular apoptosis was assessed using the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. Protein expression levels of autophagy markers were measured using Western blot analysis. Results: Gynura segetum was found to significantly induce liver injury compared with control mice, as evidenced by the increase of serum transaminases, a decrease in triglyceride levels, and histopathological changes in mice. Gynura segetum remarkably induced hepatocellular apoptosis and upregulated the expressions of ICAM-1 and P-selectin and also downregulated the protein expression levels of LC3, Atg12 and cytoplasmic polyadenylation element binding protein. Conclusions: Our results suggested that G. segetum induced liver injury with HSOS, and it was partly due to its ability to impair the autophagy pathway.

Treatment Strategy for Leriche Syndrome Complicated with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

Leriche syndrome is often complicated with ischemic heart disease (IHD). In such cases, as the internal mammary artery (IMA) supplies blood to the lower-limbs through a collateral network, coronary artery bypass grafting (CABG) using IMA is considered to worsen the lower-limb ischemia and use of intra-aortic balloon pumping prior to lower limb revascularization is not possible. Recent advances in endovascular technology enable us to perform endovascular treatment (EVT) even in Leriche syndrome. In 3 patients diagnosed with Leriche syndrome associated with IHD, tailor-made treatments were performed as one-stage or two-stage surgeries. Various techniques such as percutaneous coronary intervention (PCI), CABG, and open surgical revascularization or EVT of lower limbs were employed. EVT is a less invasive and more attractive alternative to open surgical revascularization, it led to new treatment options in patients with this particular circumstance. Considering the severity of pathophysiology, treatment strategy should be determined on a case-by-case basis.

Research advances in the pathogenesis of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome / 临床肝胆病杂志

Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is a type of hepatic sinusoidal obstruction syndrome mainly caused by the intake of Chinese herbal medicine or food containing pyrrolizidine alkaloids. This article reviews the recent research advances in the mechanism of action of pyrrolizidine alkaloids and their metabolites in disease development and progression from the aspects of drug factors, host factors, and influencing factors. It is pointed out that PA-HSOS has complex pathogenesis and various influencing factors, and some patients tend to have a poor prognosis; its pathogenesis remains unclear and needs further in-depth studies.

Causes of death after transjugular intrahepatic portosystemic shunt in patients with hepatic sinusoidal obstruction syndrome / 临床肝胆病杂志

ObjectiveTo investigate the clinical features and causes of death after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatic sinus obstruction syndrome (HSOS), as well as the prevention and treatment measures to further improve the survival rate of such patients. MethodsA retrospective analysis was performed for 293 patients with HSOS who were admitted to Nanjing Drum Tower Hospital from January 2013 to December 2019, among whom 20 patients died after TIPS. General information, laboratory examination, and clinical treatment regimen were analyzed, and clinical indices and complications were compared at different stages of the disease. The paired t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups. ResultsThe mean survival time was 15.15±4.21 weeks for the 20 patients who died, among whom there were 15 male patients and 5 female patients, with a mean age of 67.60±7.01 years; there were 17 patients (85%) aged ≥60 years, and more than 90% of the patients had abdominal distention and oliguria. Among the 20 patients who died, 9 (45%) had chronic underlying diseases, and 5 (25%) had more than two underlying diseases. Portal venous pressure decreased from 21.67±5.15 mm Hg before surgery to 8.17±4.98 mm Hg after surgery (t=10.318,P＜0.05). The levels of total bilirubin, direct bilirubin, and D-dimer were significantly higher than the normal values before surgery, and there were significant increases in these levels on day 5 after surgery (Z=3.823,3.823,2.756, all P＜0.05); the hemoglobin level, platelet count, and creatinine level tended to decrease on day 5 after surgery (t=4.979,t=2.147,Z=-3.125, all P＜005). Three patients had hepatic encephalopathy before surgery, while 10 patients (50%) had hepatic encephalopathy after surgery. Causes of death included acute liver failure, infectious shock, and multiple organ failure syndrome (MODS). ConclusionThe possible risk factors for death after TIPS in HSOS patients include underlying diseases, high bilirubin, and complications such as hepatic encephalopathy and renal dysfunction. Causes of death mainly include acute liver failure and MODS. Ultrasound and laboratory markers should be reexamined during anticoagulation therapy to identify the patients with progression to severe diseases as early as possible, and in case of progressive deterioration of indices, TIPS should be selected as early as possible to improve the survival rate and prognosis of such patients. In addition, hemobilia should be observed during and after surgery, and intervention measures should be adopted in time to further reduce mortality rate.

Value of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score in predicting the prognosis of patients with hepatic sinus obstruction syndrome associated with Gynura segetum (Lour.) Merr / 临床肝胆病杂志

ObjectiveTo investigate the value of Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) score in predicting the prognosis of patients with hepatic sinusoidal obstruction syndrome (HSOS) associated with Gynura segetum (Lour.) Merr. MethodsA total of 49 patients with HSOS associated with Gynura segetum (Lour.) Merr. who were admitted to Beijing YouAn Hospital, Beijing Ditan Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Tianjin Third Central Hospital, and The First Affiliated Hospital of Xinxiang Medical University from January 2012 to July 2018 were enrolled and followed up for three years, with death as the outcome event. MELD and CTP scores were calculated according to the laboratory examination and clinical data on admission, and according to CTP score, the patients were divided into CTP class A (CTP score 5-6) group(n=8), CTP class B (CTP score 7-9) group(n=23), and CTP class C (CTP score ≥10) group(n=18). The patients were divided into death group(n=12) and survival group(n=37) according to the clinical outcome during follow-up. The Mann-Whitney U test was used for comparison of continuous data between groups, and the Kruskal-Wallis H test was used for ranked data. The area under the receiver operator characteristic (ROC) curve (AUC) was used to investigate the ability of CTP and MELD scores in predicting death. The Kaplan-Meier survival curves were used to determine the long-term prognosis of patients with different CTP and MELD scores, and the log-rank test was used for comparison. The ROC curve was used to evaluate the performance of these two scoring systems in predicting death. ResultsA total of 12 patients died during the 3-year follow-up period. The patients with HSOS had a median MELD score of 13.443 (8.792-18.379), and the death group had a significantly higher MELD score than the survival group ［19.84 (15.49-25.41) vs 11.58 (8.60-15.79), Z=-3.511, P＜0.001］. The patients with HSOS had a CTP score of 6-12, and of all 49 patients, 8 (16.3%) had CTP class A HSOS, 23 (46.9%) had CTP class B HSOS, and 18 (36.7%) had CTP class C HSOS. The mortality rate of the patients increased significantly with the increase in CTP score (χ2=16.078, P＜0.05). The mortality rates of the patients with CTP class A, B, and C HSOS were 0.0%, 13.0%, and 50.0%, respectively (χ2=10343, P＜0.05). The Kaplan-Meier analysis showed that the patients with a MELD score of ＜14.294 4 had a significantly better 3-year prognosis than those with a MELD score of ≥14.294 4 (χ2=14.893, P＜0.001). The higher the CTP score, the poorer the 3-year prognosis of patients (χ2=11.083, P＜0.05). CTP class had an AUC of 0.780 (95% confidence interval ［CI］: 0.639-0.922) in predicting the prognosis of HSOS patients, while MELD score had an AUC of 0.840 (95%CI: 0.722-0.958), and there was no significant difference between the two scores (Z=2.63, P＞0.05). ConclusionBoth MELD and CTP scores can predict the risk of death in patients with HSOS, with similar performance in predicting the prognosis of patients, and further studies are needed to validate their clinical value.

Clinical characteristics and outcomes of patients with hepatic veno-occlusive disease induced by Gynura segetum: A retrospective study / 中西医结合学报

OBJECTIVE@#Hepatic veno-occlusive disease (HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.@*METHODS@#This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.@*RESULTS@#Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen (P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived (both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels. Unexpectedly, we found that hydrothorax was detected in 21 (65.63%) patients in the death group and 19 (59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio (INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.@*CONCLUSION@#HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.

Clinical characteristics and outcomes of patients with hepatic veno-occlusive disease induced by Gynura segetum: A retrospective study / 中西医结合学报

OBJECTIVE@#Hepatic veno-occlusive disease (HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.@*METHODS@#This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.@*RESULTS@#Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen (P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived (both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels. Unexpectedly, we found that hydrothorax was detected in 21 (65.63%) patients in the death group and 19 (59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio (INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.@*CONCLUSION@#HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.

Application of angioplasty in non-acute stage of intracranial large artery occlusion guided by highresolution magnetic resonance imaging / 中国脑血管病杂志

Objective To evaluate the feasibility, safety and clinical efficacy of endovascular angioplasty for symptomatic, non-acute occlusion of the large intracranial artery under the guidance of highresolution magnetic resonance imaging (HR-MRI). Methods A total of 31 patients with symptomatic and subacute or chronic occlusion of the large intracranial artery in the Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University from June 2017 to December 2019 was analyzed retrospectively. The location of luminal and plaque at the occlusion segment were evaluated by HR-MRI to determine the characteristic of the occlusion (thrombosis or substantial occlusion of the wall), and obtain the relationship between the plaque distribution of intracranial artery and the opening location of perforating artery. According to the evaluation results, 26 patients were screened for recanalization with angioplasty. The success rate of surgical technique, perioperative complications, and the outcomes of postoperative clinical and imaging follow-up were evaluated. The modified Rankin scale (mRS) was used to assess the patient's prognosis. Results Of the 26 patients undergoing surgery, 22 cases were successful in recanalizing the occlusion vessel; 4 cases were failed to open due to the guidewire was difficult to pass through the occlusion segment, of which one case was occluded at the C6 segment of the internal carotid artery, two cases were occluded at the segment of the intracranial vertebral artery, and one case was occluded at the basilar artery. There were 2 cases with complications during the operation, both of which were asymptomatic peripheral embolism, and there were no complications of bleeding and death during the perioperative period. The median follow-up time in 22 successful patients was 12 (3, 21) months. There were no deaths or losses to follow-up. The median mRS score was 1 (1,3). There were no recurrent stroke or transient ischemic attacks. Two cases of asymptomatic in-stent restenosis occurred without adverse reactions and adverse consequences. Four failed patients had a median follow-up time of 11 (3, 18) months. There were no deaths or losses to follow-up. The median mRS score was 2(2, 3). There were 1 case of recurrent stroke and 2 cases of transient ischemic attacks, respectively. Conclusions For patients with symptomatic occlusion of the large intracranial artery in non-acute stage, It is safe and feasible with angioplasty for selected patients guided by HR-MRI to evaluate the occlusion length, pathological nature and latent space of the occlusion segment, and combined with other clinical conditions, which can improve the short-term outcomes of patients' ischemic symptoms and reduce the rate of recurrent stroke. However, the long-term efficacy needs to be confirmed with long-term follow-up.

CT and MRI features of hepatic sinusoidal obstruction syndrome / 中国介入影像与治疗学

Objective: To observe CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS). Methods: Clinical and imaging data of 45 HSOS patients were retrospectively analyzed. Results: Forty-one patients underwent CT examination. Plain CT showed liver enlargement in 20 cases, including enlargement of left lobe and caudate lobe in 7 cases. Decreased density of liver parenchyma was observed in 21 cases, different degrees abdominal effusion in 36 cases, and pleural effusion in 2 cases. Contrast-enhanced CT scan showed uneven enhancement of liver parenchyma in 31 cases, map-like enhancement in 21 cases, patchy uneven enhancement in 9 cases and minor enhancement in 1 case. Patchy map-like enhancement of the portal venous phase was detected in all patients, and the enhancement range further expanded during delayed phase. No bile duct dilatation nor angiogenesis of the medial and lateral hepatic branches was observed. Twelve patients underwent MR examination. Plain MRI showed uneven liver signals, the liver enlargement in 10 cases, and compressed and tapered posterior segment of inferior vena cava in 5 cases. No morphologic abnormality of gallbladder was found in 12 cases. Enhanced MRI showed uneven enhancement of liver parenchyma, and the reduced area of lamellar enhancement and abnormal enhancement foci were all map-shaped. Conclusion: CT and MRI manifestations of HSOS have certain characteristics, which are helpful for clinical diagnosis.

Pulmonary capillary hemangiomatosis: a lesson learned

Pulmonary capillary hemangiomatosis (PCH) is a rare and controversial entity that is known to be a cause of pulmonary hypertension and is microscopically characterized by proliferation of dilated capillary-sized channels along and in the alveolar walls. Clinically, it is mostly seen in adults. Clinical features are characterized by nonspecific findings such as shortness of breath, cough, chest pain, and fatigue. It can be clinically indistinguishable from pre-capillary pulmonary arterial hypertension disorders such as primary pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension. However, the diagnostic distinction, which usually requires a multidisciplinary approach, is crucial in order to avoid inappropriate treatment with vasodilator medications usually used for PAH treatment. Prognosis of PCH remains poor with lung transplant being the only definitive treatment. We report an autopsy case of pulmonary capillary hemangiomatosis unmasked at autopsy that was treated with a prostacyclin analog, usually contraindicated in such patients. We emphasize that this entity should always be on the differential diagnosis in a patient with pulmonary hypertension and requires great vigilance on the part of the clinician, radiologist and pathologist to make the diagnosis and guide appropriate management.

Analysis of safety and efficacy of intravenous thrombolysis combined with emergent carotid artery stenting in patients with acute anterior circulation stroke with tandem lesion treated with mechanical thrombectomy / 中国脑血管病杂志

Objective: To analyze the safety and efficacy of intravenous thrombolysis(IVT) combined with emergency carotid artery stenting (eCAS) in acute ischemic stroke (AIS) patients with anterior circulation tandem occlusion and treated with mechanical thrombectomy. Methods: From January 2014 to September 2018, a total of 124 consecutive patients diagnosed with AIS with anterior circulation tandem occlusion and treated with mechanical thrombectomy were retrospectively enrolled from Department of Neurology in 5 comprehensive stroke centers. Patients were divided into 4groups according to IVT and eCAS:group A was without IVT and eCAS; group B was eCAS without IVT; group C was IVT without eCAS; group D was IVT combined with eCAS. Baseline and clinical characteristics were documented and compared among the 4 groups. Baseline characteristics included age, gender, risk factors for stroke, good collateral circulation ratio, National Institutes of Health Stroke Scale(NIHSS) score and Alberta stroke program early CT(ASPECT) score, etc. Clinical characteristics included occlusion site of intracranial artery, the degree of extracranial stenosis, etiology of extracranial stenosis, surgical strategy, femoral artery puncture to recanalization time (PTR).medication during hospitalization, etc. The safety and clinical outcomes of the 4 groups were evaluated, including recanalization, symptomatic intracranial hemorrhage, and prognosis. The modified thrombolysis in cerebral infarction score(mTICI) 2b or 3 was considered as successful recanalization. The modified Rankin scale (MRS) score 0-2 at 90 days was considered as favorable functional outcome and MRS score 0-1 was excellent functional outcome. Results: (1) There were no statistically significant differences in age, blood glucose level at admission, onset to femoral artery puncture time, gender, hypertension, diabetes, atrial fibrillation, smoking, good collateral circulation ratio, NIHSS score and ASPECT score among the 4 groups (all P >0. 05). (2) There were no statistically significant differences in occlusion site of intracranial artery, the degree of extracranial stenosis, extracranial stenosis etiology, priority treatment of distal or proximal lesion and PTR time among the 4 groups (all P > 0. 05). (3) In the total of 124 stroke patients with anterior circulation tandem occlusion and treated with mechanical thrombectomy, the rate of successful reperfusion (mTICI class 2b-3) was 75. 8% (94 cases);symptomatic intracranial hemorrhage was 15. 3% (19 cases); favorable functional outcome at 90 days was 48. 4% (60 cases) and excellent functional outcome was 29. 0% (36 cases);the overall mortality rate was 22. 6% (28 cases). The successful recanalization rate of group A, B, and C was 67.4% (31/46), 75. 8% (25/33), and 75. 0% (21/28), respectively. All patients in group D achieved recanalization (17/17). Compared to the group D, the difference was statistically significant in each group(X2 = 6. 831, P = 0. 009; X2 =4. 906, P = 0. 027; X2 =7. 410, P = 0. 006). The excellent functional outcome of group A.B.and C were 21.7% (10/46), 18.2% (6/33) and 35.7% (10/28).respectively. Compared with group D(10/17), the difference of group A or group B was statistically significant (X2 =7. 878, P = 0.005;X2 =8.517, P = 0.004). However.there was no significant difference between group C and group D(X2 =2.288, P=0. 130). There was no significant difference in symptomatic intracranial hemorrhage, favorable functional outcome and overall mortality rate among the 4 groups (all P > 0. 05). Conclusion: For patients with tandem lesion of the anterior circulation and treated with mechanical thrombectomy, IVT combined with eCAS appears to be feasible and safety.

Efficacy of transjugular intrahepatic portosystemic shunt in the treatment of 21 patients with gynura segetum-related hepatic sinusoidal obstruction syndrome / 中华消化杂志

Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS)in the treatment of patients with hepatic sinusoidal obstruction syndrome (HSOS).Methods From April 2015 to August 2018,at The First Affiliated Hospital of University of Science and Technology of China,21 patients with gynura segetum caused HSOS were selected.All the patients received TIPS treatment because of unresponsiveness to anticoagulant therapy for at least two weeks.After operation patients were followed up with liver and portal vein Doppler ultrasonography examination,liver and kidney function tests,and survival observation.T test,logistic univariate regression analysis and Cox regression analysis were performed for statistical analysis.Results Among the 21 patients with gynura segetum-related HSOS,18 patients were in the subacute phase and three patients in the chronic phase.All of them were moderate or severe patients and all successfully underwent TIPS.The postoperative portal vein pressure was (16.71 ± 4.68) cmH2O (1 cmH2O =0.098 kPa),which was lower than that before operation ((41.52 ±6.27) cmH2O),and the difference was statistically significant (t =16.936,P ＜ 0.01).The postoperation portal vein blood flow velocity was (41.52 ±7.70) cm/s,which was higher than before operation ((11.19 ± 3.29) cm/s),and the difference was statistically significant (t =-15.191,P ＜0.01).At one month after operation,15 of 21 patients were clinically cured;among the remaining six patients,four patients were improved and two patients were ineffective (including one patient died).At four months after operation,two patients died,and the remaining 19 patients were clinically cured.At one month after operation,the levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and serum creatinine were (23.7 ± 16.8) U/L,(33.9 ±7.4) U/L,(52.7 ± 38.2) μmol/L and (62.7 ± 12.6) μmol/L,respectively,which were lower than those before operation ((60.5 ± 42.4) U/L,(78.4 ± 42.4) U/L,(74.9 ± 38.2) μmol/L and (82.4 ± 19.6) μmol/L,respectively),and the differences were statistically significant (t =3.193,3.493,2.378 and 4.519;all P ＜ 0.05).The level of albumin was (39.0 ±3.1) g/L,which was higher than that before operation ((30.9 ± 3.8) g/L),and the difference was statistically significant (t =-10.283,P ＜ 0.01).Portal vein thrombosis and preoperative TBil level had predictive value for therapeutic efficacy (both P ＜0.05).The one-year cumulative survival rate of patients was 90.5％.Preoperative TBil level and hepatic encephalopathy had effects on the prognosis of patients (both P ＜ 0.05).Conclusion TIPS is a safe,reliable and effective treatment for patients with subacute and chronic gynura segetum-related HSOS who are not responding to ineffective anticoagulant therapy,which can improve the prognosis and survival rate of the patients.

Comparison of clinical effects of bare stent and covered metal stent graft in the treatment of complete occlusion of central venography in hemodialysis patients / 中华肾脏病杂志

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients.Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study.According to the type of stent,the patients were divided into two groups,BMS group (n=46)and CS group (n=20).The demographic data,clinical signs and symptoms,and pre-procedure and post-procedure imaging data were followed up and recorded.The primary patency rates were calculated at 1,3,6,9,and 12 months.Results The related symptoms were improved within 2 day post-procedure.The primary patency rates of BMS group in 1,3,6,9 and 12 months were 97.83％,95.65％,69.56％,41.3％,and 34.78％ respectively.The rates of CS group were 100％,100％,95％,65％,and 60％respectively.They did not reached statistical significance for primary patency rates between two groups in 1,3,and 6 months (P ＞ 0.05 respectively).However,from 9 months after procedure,it began to show the significant difference between two groups (P ＜ 0.05).The median patency time of the CS group was (10.30±5.32) months,while BMS group was (8.52±0.49) months.The difference between the two groups was statistically significant (P=0.046).Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect.The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.

Progress in endovascular therapies of TASC Ⅱ D aortoiliac occlusive disease / 国际外科学杂志

Aortoiliac occlusive disease is a common and frequently-occurring disease of vascular surgery,and atherosclerosis is the main cause of its disease.Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC Ⅱ) D type of aortoiliac occlusive disease due to complex lesions,the preferred treatment method is aortobifemoral bypass.With the change of treatment concept,in-depth study of kiss stent,and the introduction of reconstruction of aortic bifurcation and integrated stent technology,endovascular therapies has achieved satisfactory short-term and long-term patency rates.At present,endovascular therapies has become the preferred treatment for TASC Ⅱ D aortoiliac occlusive disease.This article reviews the recent advances in endovascular therapies of TASC ⅡD aortoiliac occlusive disease.