Analysis of three-dimensional visualization imaging of severe portal vein stenosis after liver transplantation and clinical efficacy of portal vein stent implantation / 器官移植

Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation, and to evaluate clinical efficacy of portal vein stent implantation. Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed. Imaging characteristics of severe portal vein stenosis, and advantages of three-dimensional reconstruction imaging and interventional treatment efficacy for severe portal vein stenosis were analyzed. Results Among 10 patients, 3 cases were diagnosed with centripetal stenosis, tortuosity angulation-induced stenosis in 2 cases, compression-induced stenosis in 2 cases, long-segment stenosis and/or vascular occlusion in 3 cases. Three-dimensional reconstruction images possessed advantages in accurate identification of stenosis, identification of stenosis types and measurement of stenosis length. All patients were successfully implanted with portal vein stents. After stent implantation, the diameter of the minimum diameter of portal vein was increased [(6.2±0.9) mm vs. (2.6±1.7) mm, P<0.05], the flow velocity at anastomotic site was decreased [(57±19) cm/s vs. (128±27) cm/s, P<0.05], and the flow velocity at the portal vein adjacent to the liver was increased [(41±6) cm/s vs. (18±6) cm/s, P<0.05]. One patient suffered from intrahepatic hematoma caused by interventional puncture, which was mitigated after conservative observation and treatment. The remaining patients did not experience relevant complications. Conclusions Three-dimensional visualization technique may visually display the location, characteristics and severity of stenosis, which is beneficial for clinicians to make treatment decisions and assist interventional procedures. Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow.

Diagnosis and treatment strategies for vascular complications after kidney transplantation / 器官移植

With persistent progress in donor-recipient evaluation criteria, organ procurement and preservation regimens and surgical techniques, the incidence of vascular complication after kidney transplantation has been declined, whereas it is still one of the most severe surgical complications of kidney transplantation, which may lead to graft loss and recipient death, and seriously affect the efficacy of kidney transplantation. Therefore, the occurrence, clinical manifestations, diagnosis and treatment strategies of common vascular complications after kidney transplantation, including vascular stenosis, arterial dissection, pseudoaneurysm, vascular rupture and thrombosis were reviewed in this article. In combination with the incidence, diagnosis and treatment of vascular complications after kidney transplantation in the First Affiliated Hospital of Xi'an Jiaotong University, diagnosis and treatment strategies for common vascular complications after kidney transplantation were summarized, aiming to provide reference for clinical diagnosis and treatment of vascular complications after kidney transplantation, lower the incidence of vascular complications, and improve clinical efficacy of kidney transplantation and survival rate of recipients.

Pathogenesis and Traditional Chinese Medicine Prevention and Treatment Strategy of Diabetic Vascular Calcification Based on Theory of Stasis-toxin-deficiency / 中国实验方剂学杂志

Vascular complications are the primary cause of the high disability and mortality in diabetic patients. Vascular calcification is a pathological basis of diabetic vascular complications and increases the risk of adverse cardiovascular events and the difficulty of revascularization in diabetic patients. It is of great clinical value to explore the measures for prevention and treatment of diabetic vascular calcification with integrated traditional Chinese and Western medicine. This paper explores the intrinsic association of stasis， toxin， and deficiency with diabetic vascular calcification to reveal the pathogenesis of diabetic vascular calcification. Stasis and toxin are causally affected by and combined with each other； deficiency refers to the deficiency of healthy Qi and the loss of Qi and blood. The three elements are associated with the occurrence and development of blood vessel diseases. This paper proposes the evolutional law of stasis， toxin， and deficiency in traditional Chinese medicine （TCM） for diabetic vascular calcification. Specifically， diabetic vascular calcification is rooted in the stasis of meridians and collaterals， develops due to the combination of stasis and toxin， and is aggravated by middle Qi deficiency. Furthermore， this paper proposes the TCM intervention principle of activating blood， removing toxin， tonifying deficiency， and dredging collaterals for the prevention and treatment of diabetic vascular calcification. The aim is to provide a theoretical basis for clinical and translational research on the prevention and treatment of diabetic vascular calcification with integrated Chinese and Western medicine.

Duration Of Diabetes Mellitus And Vascular Complications

Background:Type 2 diabetes mellitus (DM) is associated with disabling and potentially life-threatening micro-vascular and macro-vascular complications. Common risk factors for vascular complications in people with type 2 diabetes include hyperglycemia, insulin resistance, dyslipidemia, hypertension, tobacco use and obesity. This study aimed to determine the incidence of macro-and micro-vascular complications and risk factors among patients with type 2 diabetes mellitus.Material And Methods:100 Patients with type 2 DM attending the medicine opdatShardaben General Hospital,were included in this observational studywho fulfille d inclusion criteria. Detailed historyof all patients was recorded including the duration of DM, risk factors for DM and complications of DM.Result:Incidence of DM was higher in males (56%). Maximum patients with diabetes were between 51 -70 years. 31% patients were newly diagnosed having DM, 36% had DM of <5 years, 24% had DM duration of 5-10 years and 9% had DM duration of >10 years. Mean fasting Blood sugarwas 186mg/dL. 78% had one or more micro vascular complications. Retinopathy was the most common micro-vascular complication (35%). The most common macro-vascular complication was coronary artery disease (44%). Conclusion:Retinopathy was the most common micro-vascular and coronary artery disease is most common macro vascular complication. Incidence of micro-vascular complication increases with duration of diabetes, while macro-vascular complications doesn’t correlatewiththedurationof diabetes mellitus.

Perioperative management of split liver transplantation / 器官移植

In the context of shortage of donor livers, split liver transplantation has achieved the goal of "one donor liver for two recipients", which effectively alleviates the shortage of donor livers and has promising development prospect. With the advancement of liver transplant techniques, split liver transplantation may yield clinical prognosis equivalent to total liver transplantation. However, perioperative management of split liver transplantation still encounters multiple challenges, with demanding techniques requirement and high-risk postoperative complications. Besides, there is a possibility of dividing one high-quality donor liver into two marginal donor livers, which will affect the development of liver transplantation. In this article, perioperative management of split liver transplantation was discussed from the perspectives of preoperative evaluation, recipient management and postoperative complication management, aiming to provide reference for promoting the development of split liver transplantation and enhancing clinical prognosis of recipients after split liver transplantation.

Diagnosis and treatment of vascular complications after liver transplantation in adults / 器官移植

As an efficacious treatment for end-stage liver diseases and primary malignant liver tumors, liver transplantation has been widely applied worldwide, and gradually receives widespread recognition from patients. With the development of organ transplant technique, vascular complications have rarely occurred after adult liver transplantation. However, vascular complications, such as postoperative thrombosis and anastomotic stenosis, are still common in the recipients undergoing living donor liver transplantation and split liver transplantation. Inappropriate treatment may lead to the loss of grafts and death of recipients. The authors have been engaged in liver transplantation for many years, witnessing persistent development of diagnostic and therapeutic technologies for vascular complications after liver transplantation. In this article, current status and development trend of diagnosis and treatment of different vascular complications were illustrated from the etiology, clinical manifestations, diagnosis and treatment of hepatic artery complications, portal vein complications, inferior vena cava and hepatic vein complications, aiming to further improve the survival rate of grafts and recipients and provide reference for promoting the development of clinical liver transplantation.

Clinical application of split liver transplantation technique / 器官移植

Currently, multiple difficulties exist in clinical liver transplantation, such as shortage of donor liver, increasing quantity of patients waiting for liver transplantation and lack of matching donors, etc. Some children and adult patients have little chance of undergoing liver transplantation, which also limits the development of liver transplantation. In this context, split liver transplantation emerges, in which 1 donor liver can be applied to 2 or even more recipients. It may effectively increase the utilization rate of donor liver and alleviate the shortage of donor liver. With the development of split liver transplantation, the survival rate of split liver transplantation is comparable to that of total liver transplantation. Multiple transplantation centers have routinely adopted split liver transplantation. In this article, the development of split liver transplantation, the selection and matching of donors and recipients, the split and reconstruction techniques of donor liver and postoperative complications were reviewed, aiming to provide reference for subsequent development of split liver transplantation in clinical practice and increase the chance of liver transplantation for more patients diagnosed with end-stage liver diseases.

Ineffective peripheral tissue perfusion in patients with diabetic foot: a mid-range theory / Perfusión de tejido periférico ineficaz en pacientes con pie diabético: una teoría de rango medio / Perfusão tissular periférica ineficaz em pacientes com pé diabético: uma teoria de médio alcance

ABSTRACT Objective: to develop a mid-range theory for nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. Method: the theory construction was carried out in six stages: approach definition; theoretical-conceptual model definition; definition of the main concepts; pictogram development; construction of propositions and establishment of causal relationships evidence for practice. Results: twelve etiological factors and 22 clinical indicators were included in the theory, some of which were not listed in NANDA International (Inc.) and others were adapted to better characterize patients with diabetic foot. A pictogram was constructed and eight propositions were established to verify causal relationships and evidence for practice. Conclusion: medium-range theory made it possible to broaden the concepts and demonstrate the causal relationships between the elements of ineffective peripheral tissue perfusion, providing subsidies to minimize gaps in knowledge and assist clinical nursing practice.

RESUMEN Objetivo: desarrollar una teoría de rango medio para el diagnóstico de enfermería de la perfusión tisular periférica ineficaz en pacientes con pie diabético. Método: la construcción de la teoría se realizó en seis etapas: definición del enfoque; definición del modelo teórico-conceptual; definición de los principales conceptos; desarrollo de pictogramas; construcción de proposiciones y establecimiento de relaciones causales basadas en evidencia para la práctica. Resultados: se incluyeron en la teoría 12 factores etiológicos y 22 indicadores clínicos, algunos de los cuales no estaban incluidos en NANDA International (Inc.) y otros se adaptaron para caracterizar mejor a los pacientes con pie diabético. Se construyó un pictograma y se establecieron ocho proposiciones para verificar las relaciones causales y la evidencia de la práctica. Conclusión: la teoría de rango medio permitió ampliar los conceptos y demostrar las relaciones causales entre los elementos del diagnóstico de perfusión tisular periférica ineficaz, brindando subsidios para minimizar las brechas en el conocimiento y ayudar a la práctica clínica de la enfermería.

RESUMO Objetivo: desenvolver uma teoria de médio alcance para o diagnóstico de enfermagem perfusão tissular periférica ineficaz em pacientes com pé diabético. Método: a construção da teoria foi realizada em seis etapas: definição da abordagem; definição do modelo teórico-conceitual; definição dos conceitos principais; desenvolvimento de pictograma; construção das proposições e estabelecimento das relações de causalidade evidências para a prática. Resultados: foram incluídos na teoria 12 fatores etiológicos e 22 indicadores clínicos, alguns destes não estavam listados na NANDA Internacional (Inc.) e outros foram adaptados para melhor caracterização dos pacientes com pé diabético. Construiu-se um pictograma e foram estabelecidas oito proposições para verificar as relações causais e evidências para a prática. Conclusão: a teoria de médio alcance possibilitou ampliar os conceitos e demonstrar as relações causais entre os elementos do diagnóstico perfusão tissular periférica ineficaz, fornecendo subsídios para minimizar as lacunas no conhecimento e auxiliar a prática clínica da enfermagem.

Research progress on the relationship of mitochondrial dysfunction to diabetic vascular complications / 解放军医学杂志

Diabetes is an endocrine disease characterized by long-term hyperglycemia with or without progressive vascular disease, involving systemic complications, mainly reflected in macroangiopathy and microangiopathy, which are the leading cause of death and disability of diabetes. However, its pathogenesis has not yet been fully clarified. Endothelial cells are an important part of maintaining vascular homeostasis, and endothelial dysfunction is the initiator or promoter of diabetic vascular complications. Mitochondrial dysfunction also plays an important role in the pathological process of vascular endothelial cell dysfunction. In recent years, researches of the mechanism of mitochondria-vascular endothelial function and the drug development have become a hot topic in prevention and treatment of diabetes. The present paper mainly expounds the relationship of mitochondrial dysfunction to vascular complications of diabetes, aiming to provide the basis for drug development and clinical diagnosis and treatment.

Clinical analysis of hepatic arterial thrombolysis combined with splenic arterial embolization in treatment of hepatic arterial thrombosis after liver transplantation / 器官移植

Objective To analyze the clinical efficacy of transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in the treatment of hepatic artery thrombosis (HAT) after liver transplantation. Methods Clinical data of 9 patients diagnosed with HAT after liver transplantation undergoing transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization were retrospectively analyzed. The incidence of HAT and clinical efficacy of thrombolytic therapy were summarized. The incidence of thrombolysis related complications and clinical prognosis were evaluated. The thrombolytic therapy procedures of typical cases were analyzed. Results HAT was diagnosed at 1-66 d after liver transplantation with a median time of 10 d. The formation site of HAT was found at the anastomosis of the main hepatic artery in 8 cases and at the right branch in 1 case. Upon diagnosis, 9 patients received transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in emergency. The hepatic artery was open during operation in 4 cases and treated with postoperative thrombolytic therapy with indwelling catheter in 3 cases. The opening time for inwelling catheter was 72-96 h. The total successful rate was 7/9. The thrombolysis related complication of abdominal hemorrhage occurred in 1 case after surgery. Three cases died, including 2 cases of liver failure and infection, and 1 case of biliary ischemia and systemic infection at 70 d after interventional therapy. Conclusions Hepatic arterial thrombolysis combined with splenic arterial embolization is an efficacious treatment for HAT after liver transplantation, which can serve as the optimal therapy for patients who are unable to undergo secondary liver transplantation.

A study on clinical profile of acute coronary syndrome in type 2 diabetes mellitus patients with relevance to HbA1c

Background: Cardiovascular disease (CVD) has emerged as the dominant chronic disease in many parts of the world. At the beginning of the twenty-first century, CVD accounts for nearly half of all deaths in the developed world and 25% in the developing world. Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Vascular diseases account for most morbidity and mortality in patients with DM. Aim and objectives: To study the clinical profile of type 2 diabetic patients presenting with Acute Coronary Syndrome (ACS) with reference to HbAlc level. Materials and methods: After selecting appropriate samples for the study based on the inclusion criteria, a detailed history was elicited and clinical examination was done as per the proforma. The necessary investigations were done as per the proforma. The clinical profile of these patients was then analyzed and correlated with reference to HbAlc level and statistical analysis performed using paired’ test. Results: The prevalence of microvascular diabetic complications was high with nephropathy amounting to 62% and retinopathy amounting to 58%. Neuropathy was not documented. About 32% of patients were free of microvascular complications. Other macrovascular diabetic complications were not documented. Among complications of ACS, 24% developed hypotension and no other complication was noted. Remaining 76% did not suffer any complications. No mortality was documented. Patients with systolic dysfunction constituted 82% and diastolic dysfunction 66%. The percentage of patients with HbA1c >7% constituted 62% which was very high and only 32% of patients had their HbA1c level in the control range. K. Babu Raj, G. Sivachandran. A study on clinical profile of acute coronary syndrome in type 2 diabetes mellitus patients with relevance to HbA1c. IAIM, 2018; 5(8): 1-8. Page 2 Conclusion: A majority of diabetic patients developing acute coronary syndrome have poor glycaemic control as reflected by their HbAlc levels. The coronary event is likely to occur sooner after the detection of diabetes if good glycaemic control is not achieved. Exercise, in the form of regular day to day activities, does not achieve satisfactory glycaemic control and cannot prevent the development of adverse complications of diabetes.

Percutaneous coronary intervention in octogenarian patients / Intervención coronaria percutánea en pacientes octogenarios

Abstract: Introduction: Octogenarian patients are usually excluded from studies in which the effectiveness of percutaneous coronary intervention (PCI) is compared. Objective: Our aim is to compare this procedure among octogenarians and those younger; in addition to comparing the radial access (RA) and femoral access (FA) in patients older than 80 years. Material and methods: This is a retrospective, observational, comparative, longitudinal, single-center study. Patients who have been referred for PCI, from 2010 to 2016 in Monterrey, Nuevo Leon, Mexico were included. The groups were divided into the octogenarians group (OG) and a group of younger than 80 years (YG). Results: A total of 1,282 patients were collected, of whom 92 were of the OG and 1,190 were of the YG. The FA was the most used. Similar levels of radiation time (RT), radiation dose (DR), and amount of administered contrast medium (CM), vascular complications (VC) and mortality between the two groups were found. However, the OG had more length of hospital stay (LHS). Comparing the FA against RA in the OG there were no differences in RT, RD, amount of CM, VC, death and LHS. Conclusion: The results are similar between the two groups, with a greater tendency to more LHS in the OG. There were not significant differences between the RA and FA in the OG, except that LHS in the FA.

Resumen: Introducción: Los pacientes octogenarios son usualmente excluidos de los estudios en los cuales se compara la efectividad de las intervenciones coronarias percutáneas. Objetivo: Nuestro objetivo es comparar este procedimiento entre los pacientes octogenarios y aquéllos más jóvenes; además se compara el abordaje radial y el abordaje femoral en los pacientes octogenarios. Material y métodos: Éste es un estudio retrospectivo, observacional, comparativo, longitudinal, unicéntrico. Se realizó con aquellos pacientes que se refirieron para realización de un intervencionismo coronario percutáneo, en Monterrey, Nuevo León, México del 2010 al 2016. Los grupos se dividieron en el grupo de pacientes octogenarios y el grupo de pacientes menores de 80 años. Resultados: Se recabó un total de 1,282 pacientes, de los cuales 92 eran pacientes octogenarios, mientras que 1,190 fueron más jóvenes. En ambos el abordaje femoral fue el más utilizado. Se encontraron valores similares de dosis de radiación, tiempo de radiación, cantidad de contraste administrado, complicaciones vasculares y mortalidad entre los dos grupos. Sin embargo, los pacientes octogenarios tuvieron más días de estancia hospitalaria. Al comparar el abordaje femoral y el radial en octogenarios no se encontraron diferencias en dosis de radiación, tiempo de radiación, cantidad de medio de contraste, complicaciones vasculares, muerte y días de estancia hospitalaria. Conclusiones: Los resultados fueron similares entre ambos grupos de edad, con una mayor tendencia de estancia hospitalaria en octogenarios. No se encontraron diferencias significativas entre ambos abordajes en pacientes octogenarios, a excepción de mayores días de estancia hospitalaria en el abordaje femoral.

Role of advanced glycation end products in the onset of diabetic kidney disease complications

Advanced glycation end products are known to play an important role in diabetes complications, such as diabetic nephropathy. Most known pathways of diabetic complications involve oxidative stress, that have pivotal role in cell dysfunction onset and progression of angiopathies. This review will explore how AGEs cause endothelial dysfunction in diabetes and what current biochemical mechanisms have been proposed as an explanation for the development of diabetic nephropathy (AU)

Indicating value of lower extremity atherosclerotic disease ultrasound screening for cardiovascular diseases in type 2 diabetes patients / 上海交通大学学报（医学版）

Objective·To verify the indicating value of the simple screening of lower extremity atherosclerosis artery disease (LEAD) by lower extremity arterial ultrasound examination for coronary atherosclerotic heart disease (CAD) in patients with type 2 diabetes. Methods·A total of 606 type 2 diabetes patients were enrolled. Their clinical data and biochemical parameters (hepatorenal function, glycometabolism, tumor markers) were collected. All patients were undertaken lower extremity vascular ultrasound and CT angiography (CTA) scan for coronary artery disease. According to the results of lower extremity ultrasound, patients were divided into two groups, patients with LEAD group (n=318) and patients without LEAD group (n=288). According to the history of coronary CTA or percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA), the patients were divided into CAD group (n=280) and non-combined CAD group (n=326). The prevalence of CAD in different LEAD groups was compared and their relationship was analyzed. Results·The degree of LEAD was proportional to the prevalence of CAD. Both of the prevalences of CAD in group with arterial stenosis >50% (81%) and group with plaque and stenosis<50% (63%) were significantly higher than that in group without plaque (29%) (P=0.021,P=0.015, respectively). Spearman analysis found that age, sex, duration of diabetes, systolic blood pressure, total cholesterol, LEAD, femoral artery intima-media thickness were positively correlated with CAD. However, high density lipoprotein cholesterol and glomerular filtration rate were negatively associated with CAD. Logistic regression analysis revealed that duration of diabetes, existence of LEAD were independent associated factors of CAD. After adjusting the confounding factors, odds ratio risk analysis showed the risk increased 4.818 times in patients with LEAD (OR=5.818, 95% CI 2.627-12.888, P=0.000). Conclusion·The evaluation of LEAD by ultrasound has an indicating value for CAD in type 2 diabetes patients.

Indicating value of lower extremity atherosclerotic disease ultrasound screening for cardiovascular diseases in type 2 diabetes patients / 上海交通大学学报（医学版）

Objective·To verify the indicating value of the simple screening of lower extremity atherosclerosis artery disease (LEAD) by lower extremity arterial ultrasound examination for coronary atherosclerotic heart disease (CAD) in patients with type 2 diabetes. Methods·A total of 606 type 2 diabetes patients were enrolled. Their clinical data and biochemical parameters (hepatorenal function, glycometabolism, tumor markers) were collected. All patients were undertaken lower extremity vascular ultrasound and CT angiography (CTA) scan for coronary artery disease. According to the results of lower extremity ultrasound, patients were divided into two groups, patients with LEAD group (n=318) and patients without LEAD group (n=288). According to the history of coronary CTA or percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA), the patients were divided into CAD group (n=280) and non-combined CAD group (n=326). The prevalence of CAD in different LEAD groups was compared and their relationship was analyzed. Results·The degree of LEAD was proportional to the prevalence of CAD. Both of the prevalences of CAD in group with arterial stenosis >50% (81%) and group with plaque and stenosis<50% (63%) were significantly higher than that in group without plaque (29%) (P=0.021,P=0.015, respectively). Spearman analysis found that age, sex, duration of diabetes, systolic blood pressure, total cholesterol, LEAD, femoral artery intima-media thickness were positively correlated with CAD. However, high density lipoprotein cholesterol and glomerular filtration rate were negatively associated with CAD. Logistic regression analysis revealed that duration of diabetes, existence of LEAD were independent associated factors of CAD. After adjusting the confounding factors, odds ratio risk analysis showed the risk increased 4.818 times in patients with LEAD (OR=5.818, 95% CI 2.627-12.888, P=0.000). Conclusion·The evaluation of LEAD by ultrasound has an indicating value for CAD in type 2 diabetes patients.

Clinical analysis of 18 patients with portal vein stenosis after liver transplantation / 器官移植

Objective To summarize the experience of clinical diagnosis and treatment of portal vein stenosis after liver transplantation. Methods Clinical data of 18 patients presenting with portal vein stenosis after undergoing liver transplantation were retrospectively analyzed. The incidence, treatment and prognosis of portal vein stenosis were summarized. Results Seventeen patients had a medical history of liver cirrhosis before liver transplantation, 7 cases with a medical history of portal vein thrombosis and 8 cases with a medical history of devascularization or shunt with splenectomy. Three cases received the pediatric liver grafts. Eighteen patients suffered from portal vein stenosis from postoperative 23 d to 24 months with a median time of 2.2 months, which was detected by color Doppler ultrasound (CDU) and diagnosed by CT angiography (CTA) of the portal vein or interventional therapy. After the diagnosis was confirmed,all cases received anticoagulant treatment by warfarin. Five patients with portal hypertension underwent balloon dilatation,and one of them received endovascular stent implantation simultaneously. The remaining 13 patients received conservative therapy. After corresponding treatment, 9 cases were mitigated, 7 patients remained unchanged and 2 cases were aggravated. Conclusions For the recipients with a medical history of liver cirrhosis before liver transplantation, portal vein stenosis should be monitored by conventional CDU and diagnosed by CTA or interventional therapy after transplantation. Patients without clinical symptoms can receive conservative treatment. Those complicated with portal hypertension can undergo interventional therapy. Favorable clinical prognosis is obtained in most cases.

Application value of contrast-enhanced ultrasound in vascular complications of transplanted kidney / 器官移植

Objective To evaluate the application value of contrast-enhanced ultrasound (CEUS) in the diagnosis of vascular complication (VC) of transplanted kidney. Methods Imaging data of conventional ultrasound and CEUS in 28 patients suspected with VC of transplanted kidney were analyzed retrospectively.The results of computed tomography angiography (CTA)or digital subtraction angiography (DSA)were served as the diagnostic standard. The value of CEUS in diagnosing VC of transplanted kidney was analyzed. Results No adverse reaction related to contrast agent was observed in 28 patients during the CEUS examination. And 22 cases with VC were confirmed. VCs were detected correctly by CEUS in 17 cases,but 5 cases with transplant renal artery stenosis (TRAS ) were missed and 1 case with focal infarction in transplanted kidney was misdiagnosed. The diagnostic sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV)and accuracy of CEUS for VC of transplanted kidney were 0.77,1.00,1.00,0.55 and 0.82, respectively. The diagnostic sensitivity,specificity,PPV,NPV and accuracy of conventional ultrasound and CEUS for TRAS were 0.37 and 0.74,0.89 and 1.00,0.88 and 1.00,0.40 and 0.64,0.54 and 0.82, respectively. There were significant differences in the sensitivity and accuracy between conventional ultrasound and CEUS (both in P<0.05 ). Conclusions CEUS is an effective method for detecting VC of transplanted kidney.

Diagnosis, prophylaxis and treatment of splenic arterial steal syndrome after orthotopic liver transplantation / 中华肝胆外科杂志

Objective To study the diagnosis,prophylaxis and treatment of splenic artery steal syndrome (SASS),and to evaluate their clinical outcomes in recipients who underwent orthotopic liver transplantation (OLT).Methods 1 385 consecutive patients who suffered from liver cirrhosis and had undergone OLT in our hospital between Jan,2004 and Dec,2013 were studied.We hypothesized that patients were at risk of SASS when the calibre of the splenic artery (SA) was 1.5 times larger than the common hepatic artery (CHA) together with splenomegaly (318 patients,23.0％).Further surveillance with Doppler ultrasound (DUS) was carried out immediately at CHA reperfusion during operation.When a sluggish peak systolic velocity (PSV) ＜ 30 cm/s or no flow was detected in a patent hepatic artery,prophylactic SA banding (SAB) was considered.127 patients (39.9％) who fulfilled these criteria were recruited to the intervention group to undergo SAB.Eventually,patients who developed SASS were treated with coil-embolization of the SA (SAE),re-anastomosis of the HA to aorta (HTA),ligation of SA (SAL) or splenectomy (SPT),or retransplantation.Results SAB resulted in immediately increase in the mean PSV of the HA from 19.3 ±5.5 cm/s to 45.9 ± 9.1 cm/s (P ＜ 0.05),and resistance index (RI) of the HA rehabilitated to reasonable levels (0.5 ～0.8),without any HA or biliary related complication in all the 127 patients.17 patients in the control group were identified to have SASS (8.9％).5 of these 17 patients required emergency treatment by coil-embolization.Of the remaining 12 patients,11 who developed hepatic artery thrombosis secondary to SASS required to undergo embolectomy or thrombolysis followed by HTA (4 patients),SAL (3 patients),SPT (5 patients).Three of these patients finally required re-OLT.All these patients obtained acceptable results by these salvage strategies,except 2 out of the 12 patients who died from liver failure.Conclusions SASS is an important but it is often and under-diagnosed cause of graft ischemia after OLT.Prophylactic SAB should be introduced to patients at risk of developing SASS in order to obtain satisfactory results.Coil-embolization of SA shortly after diagnosis is an effective salvage intervention to prevent further progression to develop devastating consequences.

Caracterización de pacientes diabéticos de tipo 2 con complicaciones vasculares y riesgo de ateroesclerosi / Characterization of diabetic patients type 2 with vascular complications and atherosclerosis risk

Se realizó un estudio observacional, descriptivo y prospectivo para caracterizar a 200 pacientes diabéticos de tipo 2, diagnosticados con complicaciones vasculares y riesgo de ateroesclerosis, los cuales fueron ingresados en el Servicio de Medicina Interna del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde junio del 2010 hasta igual mes del 2011. Entre las complicaciones más frecuentes figuraron: enfermedades cardiovasculares (29,5 %), neuropatía (21,5 %) y retinopatía (19,5 %). Prevalecieron los afectados con 3 complicaciones (40,5 %), los que tenían un tiempo de evolución de la enfermedad de 11-15 años (38,0 %); además de la hiperlipidemia (35,0 %), la hipertensión arterial (32,0 %) y el tabaquismo (26,5 %) como factores de riesgo. Se concluye que con un enfoque multidisciplinario en el tratamiento y control de esta enfermedad se logra mejorar el pronóstico de los afectados.

An observational, descriptive and prospective study was carried out to characterize 200 diabetic patients type 2, diagnosed with vascular complications and atherosclerosis risk, who were admitted in the Internal Medicine Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba from June, 2010 to the same month of 2011. Among the most frequent complications there were: cardiovascular (29.5%), neuropathy (21.5%) and retinopathy (19.5%). The affected patients with 3 complications prevailed (40.5%), those who had a clinical course of 11-15 years (38.0%); besides the hyperlipidemia (35.0%), hypertension (32.0%) and tabaquism (26.5%) as risk factors. It is concluded that with a multidisciplinary approach in the treatment and control of this disease, it is possible to improve the prognosis of the affected patients.

Relationship of HS-CRP level in diabetic persons free from micro and macrovascular disease.

C-reactive protein is considered as one of the most sensitive markers of systemic inflammation. Studies have found that increase in the levels of Creactive protein is associated with the vascular complications. Hence we aimed in finding the correlation of hs-crp with other risk factors like BMI, FBS and HbA1c in diabetic subjects who have still not developed any micro and macrovascular complications. 229 cases of type 2 diabetics and 205 healthy individuals were selected as per the criteria. BMI was calculated, FBS was estimated by glucose-oxidase peroxidase method. Hs-crp was estimated by immunoturbidometric technique. The group was divided into low risk and high risk group as per their hs-crp level. Correlation was seen with other factors like BMI, FBS and HbA1c. The level of Hs-crp was high in diabetic subjects when compared to normal individuals. Further when the diabetic subjects were divided into high risk and low risk groups, the difference between the groups were statistically significant. Hs-crp failed to show any correlation with BMI, FBS and HbA1c. Diabetes is considered as an inflammatory disease hence we observed an increase in the hs-crp level in diabetes than in the normal. Since the vascular complication was totally absent hs-crp failed to show any correlation with BMI, FBS and HbA1c.