Trombosis venosa portal extrahepática, manejo quirúrgico con derivación meso-Rex. Serie de 3 casos / Extrahepatic portal vein thrombosis, surgical management with meso-Rex shunt. Series of 3 cases

La vena porta es un conducto que drena el flujo esplácnico al hígado y se puede ocluir por diferentes patologías, variando su presentación clínica de acuerdo con la causa de la obstrucción. Es muy importante diferenciar la trombosis portal asociada o no a la cirrosis, ya que su tratamiento y pronóstico es diferente. La trombosis venosa portal extrahepática es una condición netamente de origen vascular, y es la principal causa de trombosis portal en niños y adultos. Presentamos tres casos tratados con derivación meso-Rex, con seguimiento a 6 meses

The portal vein is a conduit that drains splanchnic flow to the liver, it can be occluded by different pathologies and its clinical presentation varies according to the cause of the obstruction. It is very important to differentiate portal thrombosis associated or not with cirrhosis, since its treatment and prognosis is different. Extrahepatic portal vein thrombosis (PEVT) is a condition of purely vascular origin, being the main cause of portal thrombosis in children and adults. We present three cases with meso-Rex shunt, with a 6-month follow-up

Clinical Value of Ultrasound in Evaluating Stent Placement for Managing Graft Stenosis after Meso-rex Bypass / 中国医学科学院学报

Objective To explore the feasibility of using ultrasound to evaluate stent placement for managing graft stenosis after Meso-rex bypass for cavernous transformation of the portal vein in adults. Methods This study enrolled the patients who underwent Meso-rex bypass due to cavernous transformation of the portal vein,were diagnosed graft stenosis by postoperative ultrasound,and then underwent percutaneous portal vein puncture portography and stent placement.We then compared the ultrasonic measurement indicators and sonographic manifestations before and after stent placement,and evaluated the alleviation of portal hypertension symptoms after stent placement and related clinical indexes. Results Finally,8 patients were enrolled in this study,including 5 males and 3 females,with an average age of(32.4±14.7)years.The median duration of follow-up was 26 months after stent placement.The mean diameter of graft stenosis was(2.74±0.23)mm after Meso-rex bypass and became wider[(7.23±0.68)mm]after stent placement(

Preoperative retrograde portography for children with cavernous transformation of the portal vein: clinical application in 8 cases / 浙江大学学报·医学版

OBJECTIVE@#To assess the clinical application of preoperative retrograde portal venography for children with cavernous transformation of the portal vein (CTPV).@*METHODS@#The clinical data of 8 cases of CTPV admitted in the Children's Hospital of Zhejiang University from January 2018 to September 2019 were retrospectively analyzed. Preoperative retrograde portography was performed to determine the corresponding vascular morphology and size of portal vein system. If the retrograde portography showed that the left branch of the shadow portal vein was unobstructed and its diameter was greater than 3 mm, Rex shunt would be performed after anatomic exploration of Rex recess; if retrograde portography showed that the diameter of left portal vein was less than 3 mm, but the diameter of left renal vein dissected during shunt operation was greater than 5 mm, Warren operation was selected. The patients were followed up for 1, 3 and 6 months after discharge, and then were followed up every 6 months.@*RESULTS@#Retrograde portal venography was successfully performed in 8 child patients.The anatomical position and size of main portal vein and its left and right branches, left renal vein and other important vessels were determined. Among them, there was the well-developed left and right branches of portal vein in 4 child patients, in which the left and right branches of portal vein converged together, but did not communicate with the main portal vein. In addition, the left branch diameter of the portal vein was greater than 3 mm, and the anatomical exploration results during shunt were consistent with it, so Rex shunt was performed. In the other 4 cases, the left branch diameter of the portal vein was small (less than 3 mm) in 3 cases, and the right branch was not clearly developed. Moreover, the left branch of the portal vein was poorly developed and almost occluded in 1 case. However, the left renal vein in these 4 child patients was well developed, the blood flow was unobstructed and the diameter was greater than 5 mm, so Warren operation was performed. Seven patients recovered well after the operation, and the other one had digestive tract rudimentary one year after operation, and the condition was stable after conservative treatment.@*CONCLUSIONS@#The preoperative retrograde portal venography can be used to evaluate the portal vein system in children with CTPV, which provides important clinical basis for making appropriate treatment plan before surgery.

Umbilical vein recanalization with one stage stent placement as modified Meso-rex bypass for portal vein cavernous transformation / 中国实用外科杂志

OBJECTIVE:To study the effect of modified meso-rex surgery combined with umbilical vein recanalization and primary stent implantation in the treatment of portal vein portal vein cavernous transformation.METHODS:A retrospective study was conducted in Beijing Tsinghua Changgung Hospital. A patient underwent classic or thotopic total liver transplantation for more than 9 years, admitted in February 2018 was selected.Her main portal vein occlusion and portal vein cavernous transformation were followed by portal hypertension, esophageal and gastric varices, and gastrointestinal bleeding. Surgical treatment of Meso-rex bypass were performed. During operation, hyperplasia of the left liver was noted. After wedge resection of part of the left liver parenchyma, the stump of ligamentum teres hepatis was exposed. Left portal vein was difficult to be dissected and exposed. After the umbilical vein was recanalized to the left branch of the portal vein, vascular anastomosis and stent implantation were completed. Postoperative anticoagulant therapy was given,and the blood flow was monitored.RESULTS:The shunt procedure was successful. The bypass patent, and blood flow was unobstructed 1-year post-operation. No gastrointestinal bleeding occurred ever.CONCLUSION:Meso-rex bypass combined with umbilical vein recanalization and primary stent implantation can be used to treat patients with portal vein cavernous transformation whose left portal vein is patent but difficult to be exposed.The long-term effect is worth expecting and more cases are needed for further verification.

P-Rex1 Overexpression Results in Aberrant Neuronal Polarity and Psychosis-Related Behaviors / 神经科学通报·英文版

Neuronal polarity is involved in multiple developmental stages, including cortical neuron migration, multipolar-to-bipolar transition, axon initiation, apical/basal dendrite differentiation, and spine formation. All of these processes are associated with the cytoskeleton and are regulated by precise timing and by controlling gene expression. The P-Rex1 (phosphatidylinositol-3,4,5-trisphosphate dependent Rac exchange factor 1) gene for example, is known to be important for cytoskeletal reorganization, cell motility, and migration. Deficiency of P-Rex1 protein leads to abnormal neuronal migration and synaptic plasticity, as well as autism-related behaviors. Nonetheless, the effects of P-Rex1 overexpression on neuronal development and higher brain functions remain unclear. In the present study, we explored the effect of P-Rex1 overexpression on cerebral development and psychosis-related behaviors in mice. In utero electroporation at embryonic day 14.5 was used to assess the influence of P-Rex1 overexpression on cell polarity and migration. Primary neuron culture was used to explore the effects of P-Rex1 overexpression on neuritogenesis and spine morphology. In addition, P-Rex1 overexpression in the medial prefrontal cortex (mPFC) of mice was used to assess psychosis-related behaviors. We found that P-Rex1 overexpression led to aberrant polarity and inhibited the multipolar-to-bipolar transition, leading to abnormal neuronal migration. In addition, P-Rex1 overexpression affected the early development of neurons, manifested as abnormal neurite initiation with cytoskeleton change, reduced the axon length and dendritic complexity, and caused excessive lamellipodia in primary neuronal culture. Moreover, P-Rex1 overexpression decreased the density of spines with increased height, width, and head area in vitro and in vivo. Behavioral tests showed that P-Rex1 overexpression in the mouse mPFC caused anxiety-like behaviors and a sensorimotor gating deficit. The appropriate P-Rex1 level plays a critical role in the developing cerebral cortex and excessive P-Rex1 might be related to psychosis-related behaviors.

Prokaryotic expression of Rex transcription regulator in Streptococcus suis 2 and in vitro binding assay / 中国人兽共患病学报

We cloned and prokaryoticly expressed the gene encoding Redox regulator(Rex)of Streptococcus suis serotype 2 and analyzed biological information and in vitro binding activity.The encoding Rex gene of SS2-1 strain was amplified by PCR with the designed primers,and then cloned into prokaryotic expression plasmid pET28a.The recombinant plasmid pET28a-Rex was transformed into E.coli BL21.After induced expression by IPTG,the Rex protein was obtained.The binding activity of Rex protein and DNA was analyzed by gel mobility shift assay (EMSA) in vitro.Purification of recombinant protein Rex was successfully expressed.The presence of NAD+ did not have major effect on mobility shift,but addition of NADH almost abolished such a binding activity.By in vitro binding assay,Rex was found to regulate the expression of Prex in response to NADH/NAD+ equilibrium.

Rex shunt in pediatric prehepatic portal hypertension: a clinical analysis of 5 cases / 中华肝胆外科杂志

Objective To study the therapeutic efficacy of Rex shunt in treating pediatric patients with prehepatic portal hypertension (PHPH).Methods Five children with PHPH who were admitted from October 2014 to May 2015 were reviewed.There were three boys and two girls,with age ranging from 50 to 95.5 months [(75.8 ± 1.9) months].They all suffered from recurrent upper gastrointestinal (GI) bleeding.Their red blood cell (RBC),white blood cell (WBC) and platelet (PLT) counts were decreased,but laboratory findings revealed no liver dysfunction.Ultrasound and CT scan diagnosed cavernous transformation of portal vein (CTPV) and splenomegaly.The mean splenic length was (42.8 ± 8.2) cm.Indirect portal venography revealed patent left portal vein.All patients underwent Rex shunt and were followed up for 3 ～ 7 months.Results The mean duration of operation was (566.0 ± 39.7) min.Intraoperative bleeding varied from 10 to 50 ml.The portal pressure significantly decreased after surgery from [(25.6 ± 1.5) mmHg,1 mmHg =0.133 kPa] preoperatively to (19.2 ± 3.3) mmHg postoperatively (P ＜ 0.05).Portal venography indicated patent left portal vein after the Rex shunt.The postoperative course was uneventful in the five patients with a mean hospital stay of (26 ± 9.3) days.There was no further GI bleeding.The RBC,WBC and PLT counts increased.Ultrasound indicated patent anastomotic stomas and decreased splenic size.Conclusion A Rex shunt in treating patients with PHPH is safe,feasible and efficacious.

Rex shunt: a new treatment for non-cirrhotic portal hypertension / 中华肝胆外科杂志

Objective The Rex shunt has been used to treat children with extrahepatic portal hypertension by creating a venous bypass between the superior mesenteric vein and the left portal vein to circumvent the extrahepatic portal venous obstruction.This retrospective study aimed to analyse our results in the use of this novel approach.Methods 52 patients with cavernous transformation and obstructed main portal veins were treated by Rex shunts.Results The age of children was 1.4 ～ 12 year,the mean age was 3.7 years.The patients were followed up from 1.5 to 5 years.In 48 patients,there was no recurrence of gastrointestinal bleeding after surgery making an efficacy rate of 92.3％.In the recurrence group,the postoperative venous pressure in the superior mesenteric vein was (27.6 ± 3.2) cmH2O (1 cmH2O =0.098kPa) which was significantly higher than the non-recurrence group (23.5 ± 3.1)cmH2O.The difference between the pre-and post-Rex shunting was significantly lower in the recurrence group (5.7 ± 1.8)cmH2O than the non-recurrence group (11.7 ± 3.3) cmH2 O,P ＜ 0.05.Thus,a low reduction in postoperative pressure was an early manifestation of poor prognosis.Conclusions The Rex shunt was safe and efficacious.The degree of reduction in postoperative venous pressure in the superior mesenteric vein could be used to predict recurrence of gastrointestinal bleeding.

Use of meso-Rex shunt with transposition of the coronary vein for the management of extrahepatic portal vein obstruction

The meso-Rex shunt is used to safely and effectively treat patients with portal hypertension due to extrahepatic portal vein obstruction. In the standard meso-Rex shunt technique, the patient's own internal jugular vein is used as a vascular autograft. Inevitably, such a procedure requires neck exploration and sacrifice of the internal jugular vein. Here, we present a case of a 20-year-old man with idiopathic extrahepatic portal vein obstruction, who was treated with a new technique of transposition of the coronary vein, which is enlarged in most cases of portal hypertension, as an alternative to the standard meso-Rex shunt technique. The transposition of the coronary vein into the Rex recessus is more efficient and less invasive than harvesting an autologous vein graft. Therefore, this technique simplifies the procedure and should be used when possible.

Aparelho T-Hyrax: um bem necessário / T-Hyrax appliance: a necessary change

Os aparelhos dentomucossuportados fazem parte do arsenal ortodôntico e/ou ortopédico para o tratamento da atresia maxilar (Haas) e podem estar associados às molas de TMA para correção da relação molar de Classe II por meio de distalização dos dentes superiores, sem depender da cooperação do paciente (Pêndulo, Pendex, T-Rex). Esses aparelhos têm a sua higiene dificultada e, ocasionalmente, promovem lesões à mucosa palatina. O presente artigo tem como objetivo expor uma discussão concernente às intercorrências clínicas relacionadas com a utilização de aparelhos que exibem apoio mucoso e apresentar uma associação do T-Rex ao Hyrax — o aparelho T-Hyrax — como uma alternativa para os casos que requerem a expansão rápida da maxila e a distalização de molares superiores, viabilizando, devido ao arquétipo do aparelho, uma condição de higiene mais favorável e com menores riscos de danos ao palato.

Current status of diagnosis and therapy for children's cavernous transformation of portal vein / 国际外科学杂志

The main clinical symptoms of the patients are upper gastrointestinal tract haematemesis,hypersplenotrophy and hypersplenia.Most cases can be detected by ultrasonography,digital subtraction angiography(DSA),multislice CT(MSCT) or magnetic resonance angiography(MRA).Rex surgery,Hassab surgery or combination the shunt and disconnection combined operation et al are the preferred operation,therapy for children's cavernous transformation of portal vein will be further developed.The relevant literatures were collected in recent years to review the advancement of surgical therapy for children's cavernous transformation of portal vein.

Current research of cavernous transformation of portal vein for children / 国际外科学杂志

Cavernous transformation of portal vein accounts for about 40％ in children portal hypertension.Compared with other causes of portal hypertension disease cavernous transformation of portal vein presents early age of disease onset,high risk of bleeding and normal liver function.Because the pathology is relatively simple and most children have no other diseases,so a reasonable treatment of the disease has decisive significance.The current concept for diagnosis and treatment of the disease is different between home and abroad,Controlling upper gastrointestinal bleeding is the main purpose in out country.Reliving hypersplenism,improving liver blood supply and quality of life are much important abroad,The article aims to summarize latest foreign literature to introduce latest research for the disease abroad.

Synergistic induction of cancer cell migration regulated by Gbetagamma and phosphatidylinositol 3-kinase

Phosphatidylinositol 3-kinase (PI3K) is essential for both G protein-coupled receptor (GPCR)- and receptor tyrosine kinase (RTK)-mediated cancer cell migration. Here, we have shown that maximum migration is achieved by full activation of phosphatidylinositol 3,4,5-trisphosphate-dependent Rac exchanger 1 (P-Rex1) in the presence of Gbetagamma and PI3K signaling pathways. Lysophosphatidic acid (LPA)-induced migration was higher than that of epidermal growth factor (EGF)-induced migration; however, LPA-induced activation of Akt was lower than that stimulated by EGF. LPA-induced migration was partially blocked by either Gbetagamma or RTK inhibitor and completely blocked by both inhibitors. LPA-induced migration was synergistically increased in the presence of EGF and vice versa. In correlation with these results, sphingosine-1-phosphate (S1P)-induced migration was also synergistically induced in the presence of insulin-like growth factor-1 (IGF-1). Finally, silencing of P-Rex1 abolished the synergism in migration as well as in Rac activation. Moreover, synergistic activation of MMP-2 and cancer cell invasion was attenuated by silencing of P-Rex1. Given these results, we suggest that P-Rex1 requires both Gbetagamma and PI3K signaling pathways for synergistic activation of Rac, thereby inducing maximum cancer cell migration and invasion.

Um lugar para o sintoma na clínica psicanalítica / Un lugar para el síntoma en la clínica psicoanalítica / A place for the symptom in the psychoanalytic work

Este trabalho contém uma reflexão a respeito da função do sintoma na dinâmica do psiquismo, a partir da intersecção entre o campo da psicanálise e o de narrativas com valor de metáfora. O sintoma configura-se como uma porta de entrada para o encontro do indivíduo consigo mesmo. São também apresentados, como ilustração, alguns recortes extraídos da clínica.

This paper contains a reflection on the function of symptom in the psyche’s dynamic, through an intersection of the field of psychoanalysis and the one of narratives with metaphorical value. Symptom is regarded as a front door for the individual to encounter himself. Clinical vignettes are also presented as illustration.

Este trabajo presenta una reflexión sobre la función del síntoma en la dinámica del psiquismo, considerando la intersección entre el campo del psicoanálisis y el de las narrativas con valor de metáforas. El síntoma es considerado como una puerta de entrada al encuentro del indivíduo consigo mismo. Son presentadas algunas ilustraciones clínicas.

Expressão imunohistoquímica do marcador tumoral CD34 e P27 como fator prognóstico em adenocarcinoma de próstata clinicamente localizado após prostatectomia radical / Immunohistochemistry expression of tumor markers CD34 and P27 as a prognostic factor of clinically localized prostate adenocarcinoma after radical prostatectomy

OBJETIVO: Analisar a expressão imunoistoquímica do marcador CD34 e p27, como fator prognóstico em pacientes com neoplasia de próstata localizada. MÉTODOS: Análise de 100 casos de pacientes portadores de neoplasia prostática localizada submetida à cirurgia curativa. Realizou-se o preparo histológico habitual, seguido da reação imunoistoquímica para a detecção do acúmulo da proteína CD34 e p27 seguida de análise estatística. RESULTADOS: Na avaliação do marcador P27 e na correlação com as variáveis, observou-se diferença significativa no escore de Gleason com expressão positiva (P27 positivo) relacionada com PSA médio mais baixo (p=0,091), escore de Gleason mais baixo (p<0,0001) e menor área de tumor no CD34 (p=0,036). Correlacionando-se o marcador CD34 na área tumoral observou-se quanto menor o CD34 positivo menor é o valor do PSA (p<0,0001), e menor é o escore de Gleason (r=0,5726 ; p<0,0001) e quanto maior o CD34 positivo maior é o estadiamento (r=0,3305 ; p<0,0001) e a chance de recidiva (p=0,002). Os pacientes com estadiamento mais alto, também tinham maior área CD34 positivo (p<0,0001). CONCLUSÃO: Os marcadores P27 e CD34 estão associados com os eventos próprios ao câncer de próstata; contudo, apenas o CD34 foi capaz de determinar a possibilidade de recidiva bioquímica.

OBJECTIVE: to analyze the immunohistochemical expression of P27 and CD34 markers as prognostic factors in patients with localized prostate cancer. METHODS: analysis of 100 patients with localized prostate cancer submitted to curative surgery. We carried out the usual histological preparation, followed by immunohistochemistry to detect the accumulation of P27 and CD34 protein followed by statistical analysis. RESULTS: in the evaluation of P27 marker and on the correlation with the variables we found significant difference in Gleason score with positive expression (positive P27) related to lower mean PSA (p = 0.091), lower Gleason score (p < 0.0001) and smaller tumor area in CD34 (p = 0.036). Regarding the CD34 marker at the tumor area, it was observed that the smaller the positive CD34, the lower the PSA value (p < 0.0001) and lower the Gleason score (r = 0.5726, p < 0.0001), and the higher the positive CD34, the higher the staging (r = 0.3305, p <0.0001) and the chance of recurrence (p = 0.002). Patients with higher stage also displayed larger positive CD34 areas (p < 0.0001). CONCLUSION: the markers CD34 and P27 are associated with events specific to prostate cancer, however, only CD34 was able to determine the possibility of biochemical recurrence.

Resistance of tomato genotypes to the greenhouse whitefly Trialeurodes vaporariorum (West.) (Hemiptera: Aleyrodidae)

The greenhouse whitefly, Trialeurodes vaporariorum Westwood, is the most common and abundant whitefly in Argentine horticultural greenhouse crops, especially in tomato (Solanum lycopersicum). Resistance in some wild tomato relatives, such as S. peruvianum, S. habrochaites and S. pennellii to the greenhouse whitefly has been described. The Mi gene confers effective resistance against several species of insects, among them the sweet potato whitefly, Bemisia tabaci Gennadius. Resistance to T. vaporariorum was found in the prebreeding line FCN 93-6-2, derived from a cross between S. lycopersicum cultivar Uco Plata INTA (MiMi) and the wild line FCN 3-5 S. habrochaites. The purpose of this study was to evaluate resistance to T. vaporariorum in tomato genotypes and to study the relationship between this resistance and the presence of the REX-1 marker, which is linked to the Mi gene. In a free-choice assay, the average number of adults per leaf and the number of immatures on the middle and basal plant parts were analyzed. In a no-choice assay, the oviposition rate and adult survival rate were calculated. For all variables analyzed, FCN 3-5 was the most resistant strain. Variations were found in the F2 progeny between the prebreeding line FCN 13-1-6-1 and cv. Uco Plata INTA. Results from the F2 progeny indicate that resistance to T. vaporariorum may be polygenic with transgressive segregation. Whitefly resistance was found to be independent of the REX-1 marker.

Derivação meso-porta (shunt Rex): tratamento atual da obstrução extra-hepática da veia porta / Meso-portal bypass (Rex shunt): current treatment of extrahepatic portal vein obstruction

Objetivo: Apresentar a caso de uma criança brasileira, provavelmente a primeira, portadora de obstrução extra-hepática da veia porta (OEHVP), submetida ao shunt Rex (derivação cirúrgica meso-porta) para tratamento da hipertensão porta pré-hepatica. Descrição: Menino de um ano e nove meses, 11 kg, previamente hígido, apresentou hematemese e melena. Foi realizada endoscopia digestiva alta, que demonstrou varizes de esôfago sangrantes grau III. Foi iniciado tratamento com propranolol e escleroterapia. Apresentou mais três episódios de sangramento importante e sinais laboratoriais de hiperesplenismo e aumento da amônia sérica. Realizado diagnóstico de cavernoma da veia porta. Foi indicado tratamento cirúrgico, após avaliação da coagulação e biopsia hepática normais. Foi feita opção pela derivação meso-porta ou shunt Rex, que consiste na colocação de um enxerto de veia jugular entre a veia mesentérica superior e o ramo esquerdo intra-hepatico da veia porta, restaurando o fluxo sanguíneo portal para o fígado. O paciente foi submetido com dois anos e seis meses, em março de 2004, à cirurgia no Children's Hospital de Chicago, sem intercorrências, tendo recebido alta no quinto dia pós-operatório. Retornou após um mês da cirurgia ao Brasil, onde seguiu fazendo controles periódicos. Atualmente, quase três anos apos o shunt Rex, o menino tem vida normal, com provas de função hepática normais, sem esplenomegalia, sem varizes e nem sinais de hipertensão porta. O shunt encontra-se pérvio e com bom fluxo pela ultra-sonografia. Conclusões: A cirurgia de derivação mesoporta e uma opção terapêutica recente e, muito provavelmente, tornar-se-á o método de escolha no manejo da hipertensão porta pré-hepática, por OEHVP. É superior aos outros procedimentos cirúrgicos, já que elimina totalmente a hipertensão porta e suas seqüelas.

EFFECTS OF IL-1 AND IL-4 ON THE EXPRESSION OF p27 AND CDK_2 IN RAT GLOMERULAR MESANGIAL CELLS IN VITRO / 解放军医学杂志

To evaluate the effects of interleukin-1 and interleukin-4 on the expression of p27 (one of the negative cell-cycle proteins) and CDK 2 (cell-cycle depending kinase, one of the positive cell-cycle proteins) on renal mesangial cells of rat in vitro, and to analyze their significance. The results showed that the proliferation of mesangial cells was induced markedly by interleukin-1, while the expression of p27 was down-regulated and that of CDK 2 was up-regulated. All of above changes were prevented by interleukin-4. The results suggested that the responses of rat renal mesangial cells to interleukin-1 and interleukin-4 were closely related to the changes in the expression of p27 and CDK 2.