A qualitative research on dyadic experience of disease management in patients with decompensated cirrhosis and their spouses returning to the family / 中国实用护理杂志

Objective:To explore the real experience of decompensated cirrhosis patients and their spouses returning to family dual disease management and to provide a reference for the targeted intervention strategies.Methods:Totally 13 decompensated cirrhosis patients and their spouses admitted in Infectious Disease Department, the First Affiliated Hospital of Zhengzhou University from February 2022 to April 2022 were recruited for semi-structured interviews. Colaizzi 7-step analysis was used to summarize and extract the themes.Results:The final analysis yielded a total of 8 generic categories belonging to 3 categories based on the dyadic illness management theory. These were negative disease perception including disease cognitive bias, lack of complication awareness, negative family management including low self-worth, conflict management, poor management compliance, economic pressure, passive attitude, dyadic health needs to be improved including negative emotional dominance, self-perceived discrimination, communication disorders, intimacy decrease.Conclusions:Decompensated cirrhosis patients and their spouses have negative and resistant psychology in disease perception, management compliance, management attitude, behavior, and so on, clinical medical staff should be aimed at decompensated cirrhosis patients and their spouses on the health education to strengthen disease, guiding role transformation, gives targeted positive psychological intervention, to provide multi-dimensional social support, to improve the negative mood, reduce stigma and improve binary health.

Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy / 中华肝脏病杂志

Objective: To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Methods: Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student t-test or Mann-Whitney U test between groups. Categorical data were compared by the χ (2) test or Fisher's exact probability method between groups. Results: 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, t = 12.70, P < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, t = 5.963, P < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), χ (2) = 5.275, P = 0.029]. Conclusion: Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.

Efficacy of vitamin D adjuvant therapy for prevention of spontaneous bacterial peritonitis in patients with decompensated cirrhosis of hepatitis B / 中华临床感染病杂志

Objective:To evaluate the efficacy of vitamin D supplementation for prevention of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis of hepatitis B.Methods:A total of 172 patients with decompensated cirrhosis of hepatitis B admitted in Jinhua Hospital affiliated to Zhejiang University School of Medicine from January to December 2021 were randomly divided into two groups with 86 cases in each group. Patients in both groups received conventional antiviral and symptomatic treatment; while patients in the intervention group received additinal oral vitamin D drops (800 IU/d) for 6 months. After 6 months of treatment, the incidence of SBP and the serum biochemical indexes were compared between two groups. SPSS 21.0 statistical software was used for data analysis.Results:After 6 months of treatment, the incidence of SBP in the intervention group(5.81%, 5/86) was significantly lower than that in control group(30.23%, 26/86)( χ2=19.210, P<0.01). The serum 25-(OH)D level in intervention group was significantly higher than that in the control group ( t=13.425, P=0.018), while the levels of CRP, PCT and IL-6 in intervention group were significantly lower than those in control group ( t=17.312, 10.353 and 12.218, P<0.01 or <0.05). Conclusion:Vitamin D adjuvant therapy can increase serum 25-(OH)D level, decrease serum CRP, PCT and IL-6 levels, and effectively reduce the incidence of SBP in patients with decompensated cirrhosis of hepatitis B.

Assessment of efficacy and safety of daclatasvir, sofusbuvirand ribavirin regimen for 12 weeks as compared to daclatasvir and sofusbuvir combination regimen for 24 weeks in decompensated cirrhotic patients due to hepatitis C virus genotype 3 infection

Background: Assessment of efficacy and safety of daclatasvir+sofosbuvir+ribavirin (DCV+SOF+RBV) for 12 weeks as compare to daclatasvir and sofusbuvirfor 24 weeks in decompensated cirrhotic patients due to hepatitis C virus (HCV) genotype 3 infection. Methods: An observational, prospective, COHORTstudy over 1 year, in decompensated cirrhosis due to G3-HCV infected adult patients. Treatment was a combination of sofosbuvir 400 mg/day+daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacyendpoint was sustained virologic response rates 12 weeks after therapy (SVR 12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. Results: The32 patients were screened and 2 were excluded, one patient due toassociated HBV+, one patient due to severe anemia. 30 patients were randomized. All 30 randomized patients were divided into two groups. Group 1 was given SOF+DCV+RBV for 12 weeks while group 2 patients were given SOF+DCV for 24 weeks. 81.8% of the participants in the group1 achieved SVR 12. The 90.9% of the participants in the group 2 achieved SVR12 (p=1). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. Conclusions: Both the regimen SOF+DCV with or without RBV are highly efficacious and safe. Addition of RBV can reduce the treatment duration to 12 weeks, and it will further improve compliance and more convenient for the patients.

Safety and efficacy of ARNI (valsartan/sacubitril) vs ACEI (enalapril) in acute heart failure – A prospective observational study

Objective: To compare the safety and efficacy of valsartan/sacubitril (angiotensin receptor neprilysin inhibitor [ARNI]) against enalapril (angiotensin-converting enzyme inhibitor [ACEI]) in patients with acute heart failure at 6-month follow-up. Methods: In this prospective, single centre, and observational study conducted between September 2017 and February 2020 in India, patients with acute decompensated heart failure with reduced ejection fraction (<40%) were included. Patients were divided in two groups: valsartan/sacubitril (ARNI) group and enalapril (ACEI). Patients were followed up for at least 6 months after administration of first dose and were evaluated for safety, efficacy, and tolerability of target drug. Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever appropriate, was applied for comparing categorical variables. Results: A total of 200 patients were included in the present study, 100 each in ARNI and ACEI group. The mean age of the population was 61.2 ± 8.4 years and 62.6 ± 8.6 years in ARNI group and ACEI group, respectively. The mean maximum tolerated dose by population in ARNI group was 203.6 mg and 8.9 mg in ACEI group. Readmission for heart failure were seen significantly higher in ACEI group than ARNI group (p value ¼ 0.001). Parameters like ejection fraction, left ventricular end diastolic and systolic dimensions, 6 min walk test and Kansas City Cardiomyopathy Questionnaires (KCCQ) showed p values < 0.05 between the groups. Conclusion: The ARNI study group showed better safety and efficacy outcomes at the end of 6 months follow-up compared to ACEI group

Estado del arte del síndrome cardiorrenal, ventajas y limitaciones de las terapias conocidas / State of the art of cardiorenal syndrome, advantages and limitations of known therapies

Resumen Las interacciones entre las enfermedades cardiacas y las renales se han clasificado como síndromes cardiorrenales. La clasificación actual incluye cinco subtipos: insuficiencia cardiaca aguda que conduce a insuficiencia renal aguda (tipo 1), insuficiencia cardiaca crónica que conduce a insuficiencia renal (tipo 2), lesión renal aguda que conduce a insuficiencia cardiaca (tipo 3), enfermedad renal crónica que conduce a insuficiencia cardiaca (tipo 4) y afecciones sistémicas que conducen a insuficiencia cardiaca y renal (tipo 5) (tabla 1)1,2. En esta revisión discutimos la definición, la clasificación y la fisiopatología del síndrome cardiorrenal, enfocándonos en el manejo en fases agudas y su recuperación, al exponer la evidencia actualmente disponible de los diuréticos y la ultrafiltración, con el objetivo de intervenir de manera oportuna a nuestros pacientes al conocer las ventajas y las limitaciones de cada una de las estrategias de manejo en aras de reducir el riesgo de eventos clínicos, rehospitalización y muerte.

Abstract Interactions between heart and kidney disease have been classified as cardiorenal syndromes. The current classification includes five subtypes, which are: acute heart failure leading to acute kidney failure (type 1), chronic heart failure leading to kidney failure (type 2), acute kidney injury leading to heart failure (type 3), chronic kidney disease leading to heart failure (type 4) and systemic conditions leading to heart and kidney failure (type 5) (table 1)1,2. In this review, we discuss the definition, classification, pathophysiology, focusing on acute phases treatment and its recovery, exposing the actual evidence for diuretics and ultrafiltration in order to intervene in a timely manner, pointing out the main advantages and limitations of each of the available strategies of treatment in order to reduce the risk of clinical events, re-hospitalization and death.

Research progress on perioperative sarcopenia in liver transplantation / 中华临床营养杂志

Liver transplantation is the ultimate treatment for end-stage liver diseases such as decompensated cirrhosis and severe hepatitis, but with the sarcopenia incidence of up to 43.4%. Sarcopenia can significantly increase postoperative complications, prolong hospital stay, shorten postoperative survival and seriously affect patient prognosis. At present, sarcopenia is mainly evaluated by calculating the skeletal muscle measurement at the level of third lumbar vertebra on preoperative abdominal computed tomography images. Existing studies have demonstrated that the protein synthesis rate is reduced due to insufficient nutrient intake and metabolic disorder in liver transplantation patients. The identified liver-muscle axis mediators (e.g., hyperammonemia, low growth hormone and testosterone, endotoxemia), potential mediators (e.g., fibroblast growth factor 21) and gut microbiota play an important role in liver transplantation related sarcopenia. This paper reviewed the latest progress on the studies of perioperative sarcopenia in liver transplantation. Combining clinical practice, it is believed that combined therapy of rational nutrition and hormone supplementation, individualized resistance training and liver-muscle axis mediator pathway blockade, together with enhancement of clinicians' recognition of sarcopenia, may ameliorate or even reverse sarcopenia, effectively reduce perioperative complications and improve long-term prognosis of patients.

The intervention effect of transitional rehabilitation training on the clinical outcome of elderly patients with ADHF based on physical function evaluation / 中国实用护理杂志

Objective:To explore the effect of individual rehabilitation intervention on the clinical outcome of patients with acute decompensated heart failure.Methods:A total of 152 elderly patients with acute decompensated heart failure in a tertiary hospital from January 2017 to December 2018 were selected and randomly assigned to the test group and the control group. The test group developed individualized interim rehabilitation interventions based on the evaluation results of balance, mobility, muscle strength and endurance of patients. The control group only performed routine rehabilitation related health care and discharge follow up, the short physical performance battery and the rate of all-cause readmission 6 months after discharge were compared between the two groups.Results:Finally, 144 patients finished the reseach, 72 patients in each group. After 3 months of intervention, the total scores of balance test, 4-meter timed walking, time to complete 5 chair rise and SPPB in the test group were 3.05±1.01, 3.74±0.58, 2.75±0.76, 9.44±2.16, while those in the control group were 2.82±0.86, 3.30±1.02, 2.24±0.74, 8.33±2.46. There was significant difference between the two groups ( t value was from -5.287 to -2.001, P<0.01) . Six months after discharge, the all-cause readmission rate was 12.5% (9/72) in the test group and 23.6% (17/72) in the control group, the difference was statistically significant ( t value was -0.348, P<0.05). Conclusions:The individual rehabilitation exercise based on the results of physical function evaluation can effectively improve the patients' body function and quality of life. Besides this, it can reduce the rate of all-cause readmission 6 months after discharge, which can provide reference for the transitional rehabilitation training of the elderly patients with acute decompensated heart failure.

Analysis of quality of life and influencing factors of decompensated cirrhosis patients with intestinal obstruction / 国际外科学杂志

Objective@#To explore the life quality of decompensated cirrhosis complicated with intestinal obstruction patients and analyze its influencing factors, and provide basis for clinical intervention.@*Methods@#In Affiliated People′s Hospital of Hubei University of Medicine, a retrospective collection of 39 patients with decompensated cirrhosis complicated with intestinal obstruction from August 2018 to August 2019 were included in the observation group, including 25 males and 14 females, aged (52.34±2.64) years old, ranging from 39 to 64 years old. A total of 42 patients with decompensated cirrhosis not complicated with intestinal obstruction were selected as the control group by random number table method in simple random sampling, including 30 males and 12 females, aged (51.34±3.45), ranging from 37 to 68 years old. The patients in the two groups were investigated by using the chronic liver disease patient quality of life scale- chronic liver disease questionnaire. The abdominal symptoms, fatigue, systemic symptoms, activity, emotion, anxiety, and the total score of quality of life of the patients in the two groups were compared, and the influencing factors were analyzed. Among them, measurement data of normal distribution were expressed as (Mean±SD), and comparison between groups was evaluated by t test; Comparison of count data was evaluated by chi- square test. Factors affecting quality of life were analyzed by multiple linear regression.@*Results@#The scores of abdominal symptoms, fatigue, systemic symptoms, activity, emotion, anxiety and the total score of the observation group were (5.58±1.79), (4.23±1.74), (4.93±1.39), (5.36±1.36), (4.74±1.05), (4.26±1.25), (31.06±6.53), respectively. The scores of the control group were(6.27±1.12), (5.47±1.26), (6.14±0.78), (5.88±0.93), (5.45±0.82), (4.96±0.94), (33.79±4.01), respectively. The difference between the two groups was statistically significant (P< 0.05). Multiple linear regression results showed that disease course, child-pugh classification of liver function, discomfort symptoms such as abdominal pain, abdominal distension and fatigue, nutrition status, gender, age, medical expenses payment method, family per capita monthly income and anxiety were influencing factors.@*Conclusions@#Decompensated cirrhosis complicated with intestinal obstruction patients life quality is lower than decompensated cirrhosis not complicated with intestinal obstruction patients, and the influencing factors include disease-related factors and non-disease-related factors. Medical staff should give patients corresponding intervention according to their conditions to improve the quality of life of patients as much as possible.

Analysis of Clinical Efficacy of Recombinant Human Brain Natriuretic Peptide Combined with Levosimendan in the Treatment of Acute Decompensated Heart Failure Complicated with Renal Insufficiency / 中国药房

OBJECTIVE：To observe the clinical effect and safety of recombinant human brain natriuretic peptide （rhBNP） combined with levosimendan in the treatment of acute decompensated heart failure （ADHF）complicated with renal insufficiency. METHODS：A total of 156 patients with ADHF complicated with renal insufficiency admitted to the Dept. of Cardiology in the Affiliated Hospital of Southwest Medical University during Jan.-Dec. 2019 were randomly divided into rhBNP group ，levosimendan group and combination group ，with 52 patients in each group. All patients received rountine treatment. On this basis ，rhBNP group was given rhBNP for injection [after 1.5 μg/kg intravenous pulse injection，intravenous dripping for 24 h with 0.007 5 μg（/ kg· min）]；leosimendan group was given Leosimendan injection 12.5 mg [intravenous dripping for 1 h with 6-12 μg（/ kg·min），then intravenous dripping for 23 h with 0.1 μg（/ kg·min）]. Combination group received drug combination according to the administration method of single drug group. Three groups received treatment for consecutive 7 d. Cardiac function indexes [heart rate （HR），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD）]，mean arterial pressure （MAP），pulmonary capillary pressure （PCWP），renal function indexes [estimated glomerular filtration rate （eGFR），serum creatinine （Scr）]，serum levels of cystatin C （Cys-c）and amino-terminal brain natriuretic peptide precursor （NT-proBNP）were observed in 3 groups before and after treatment. Clinical efficacy and the occurrence of ADR were recorded. RESULTS ：Three cases withdrew from the study in rhBNP group and 1 case in levosimendan group ；152 cases completed the study. Before treatment ，there was no statistical significance in cardiac function indexes ，MAP，PCMP，renal function indexes or serum levels of Cys-C and NT-proBNP among 3 groups（P＞0.05）. After treatment ，the HP ，MAP，PCWP and serum level of NT-proBNP in 3 group as well as serum level of Cys-C in combination group were decreased significantly （P＜0.05）；the LVEF in 3 group as well as the eGFR and Scr level in levosimendan group and combination group were significantly increased （P＜0.05），compared with before treatment ；above indexes of combination group were significantly better than those of rhBNP group and levosimendan group （P＜0.05）. Total effective rate of combination group was 94.23％ ，which was significantly higher than those of rhBNP group （77.55％）and levosimendan group （76.47％）（P＜0.05）. There was no significant difference in the incidence of ADR among 3 groups（P＞ 0.05）. CONCLUSIONS ：rhBNP combined with levosimendan in the treatment of ADHF complicated with renal insufficiency can significantly increase the clinical efficacy ，and improve cardiac and renal function but don ’t increase the incidence of ADR.

Analysis of quality of life and influencing factors of decompensated cirrhosis patients with intestinal obstruction / 国际外科学杂志

Objective To explore the life quality of decompensated cirrhosis complicated with intestinal obstruction patients and analyze its influencing factors,and provide basis for clinical intervention.Methods In Affiliated People's Hospital of Hubei University of Medicine,a retrospective collection of 39 patients with decompensated cirrhosis complicated with intestinal obstruction from August 2018 to August 2019 were included in the observation group,including 25 males and 14 females,aged (52.34 ±2.64) years old,ranging from 39 to 64 years old.A total of 42 patients with decompensated cirrhosis not complicated with intestinal obstruction were selected as the control group by random number table method in simple random sampling,including 30 males and 12 females,aged (51.34 ± 3.45),ranging from 37 to 68 years old.The patients in the two groups were investigated by using the chronic liver disease patient quality of life scale-chronic liver disease questionnaire.The abdominal symptoms,fatigue,systemic symptoms,activity,emotion,anxiety,and the total score of quality of life of the patients in the two groups were compared,and the influencing factors were analyzed.Among them,measurement data of normal distribution were expressed as (Mean ± SD),and comparison between groups was evaluated by t test;Comparison of count data was evaluated by chi-square test.Factors affecting quality of life were analyzed by multiple linear regression.Results The scores of abdominal symptoms,fatigue,systemic symptoms,activity,emotion,anxiety and the total score of the observation group were (5.58 ± 1.79),(4.23 ± 1.74),(4.93 ± 1.39),(5.36 ± 1.36),(4.74 ± 1.05),(4.26 ± 1.25),(31.06 ± 6.53),respectively.The scores of the control group were(6.27 ± 1.12),(5.47 ± 1.26),(6.14 ± 0.78),(5.88 ± 0.93),(5.45 ± 0.82),(4.96 ± 0.94),(33.79 ± 4.01),respectively.The difference between the two groups was statistically significant (P ＜ 0.05).Multiple linear regression results showed that disease course,child-pugh classification of liver function,discomfort symptoms such as abdominal pain,abdominal distension and fatigue,nutrition status,gender,age,medical expenses payment method,family per capita monthly income and anxiety were influencing factors.Conclusions Decompensated cirrhosis complicated with intestinal obstruction patients life quality is lower than decompensated cirrhosis not complicated with intestinal obstruction patients,and the influencing factors include disease-related factors and non-disease-related factors.Medical staff should give patients corresponding intervention according to their conditions to improve the quality of life of patients as much as possible.

Ten-year survival and factors associated with increased mortality in patients admitted for acute decompensated heart failure in Thailand

INTRODUCTION@#Data on the long-term outcomes of Asian patients admitted for acute decompensated heart failure is scarce. The objectives of this study were to determine short-term, intermediate-term and long-term survival among patients admitted for acute decompensated heart failure in Thailand, and to identify factors independently associated with increased mortality.@*METHODS@#Patients who were admitted with a primary diagnosis of heart failure were enrolled in the Thai Acute Decompensated Heart Failure Registry (ADHERE) from 18 hospitals located across Thailand during 2006. Medical record data was collected according to ADHERE protocol. Mortality data was collected from death certificates on file at the Thailand Bureau of Registration Administration.@*RESULTS@#A total of 1,451 patients were included. The mean age of the patients was 63.7 ± 14.4 years, and 49.7% were male. One-year, five-year and ten-year mortality rates in Thai patients admitted for acute decompensated heart failure were 28.0%, 58.2% and 73.3%, respectively. Independent predictors of increased mortality were identified. There were more cardiovascular-related deaths than non-cardiovascular-related deaths (54.6% vs. 45.4%, respectively).@*CONCLUSIONS@#The ten-year mortality rate in Thai patients admitted for acute decompensated heart failure was 73.3%. Many factors were found to be independently associated with increased mortality, including left ventricular ejection fraction.

Effects of preemptive analgesia by nalbuphine combined with flurbiprofen on pain and platelet activity in patients with decompensated cirrhosis / 吉林大学学报(医学版)

Objective: To observe the influence of preemptive analgesia by nalbuphine combined with flurbiprofen in the platelet activity indexes of the patients with decompensated cirrhosis, and to explore its quality of analgesia in the patients with decompensated cirrhosis. Methods: A total of 120 patients with decompensated cirrhosis were randomly divided into combination group (40 cases, given nalbuphine combined with flurbiprofen before anesthesia), nalbuphine group (40 cases, given nalbuphine before anesthesia) and flurbiprofen group (40 cases, given flurbiprofen before anesthesia). The postoperative patient-controlled intravenous analgesia (PCIA) was carried out with sufentanil in all the patients. The indexes of visual analog score (VAS), PCIA compression number, sufentanil consumption, Ramsay score, thrombelastogram (TEG) indexes (R value, K value, a angle, MA value and CI value) and the maximum aggregation rate by arachidonic acid (MARAA) and β-endorphin (β-EP) level, recovery time, and agitation occurrence rate of the patients in various groups were recorded 12 h and 24 h after operation. Results: The indexes of VAS, PCIA compression number, sufentanil consumption and 3-EP level of the patients in combination group were lower than those in the other groups 12 and 24 h after operation (P0. 05). The Ramsay scores of the patients in three groups had no differences at 12 and 24 h after operation (P>0. 05). Compared with nalbuphine group, the R values and K values of the patients in combination group and flurbiprofen group at 12 and 24 h after operation were increased (P 0. 05). The recovery time of the patients among three groups had no significant difference (F=2. 054, P=0. 102). The agitation occurrence rate during recovery period of the patients in case group was the highest (F=5. 624, P= 0. 001), and there was no significant difference in the agitation occurrence rate during recovery period of the patiens between nalbuphine group and flurbiprofen group (χ2 =3. 020, P=0. 091). Conclusion: Combination of nalbuphine and flurbiprofen in the patients with decompensated cirrhosis before analgesia can improve the quality of postoperative analgesia and can' t inhibit the activity of platelet obviously.

Observation on portosystemic collateral vessels with catheterizing in portal vein directly through TIPS in decompensated cirrhotic portal hypertension patients / 中国介入影像与治疗学

Objective: To investigate the DSA manifestations of the portosystemic collateral vessels (PSCV) in the patients with decompensated cirrhotic portal hypertension (DCPH) and the feasibility of portovenography performed with catheterizing in the portal vein directly through TIPS. Methods: Totally 274 patients with DCPH who were treated with TIPS were enrolled and retrospectively analyzed. DSA was directly performed with catheterizing in the superior mesenteric vein and splenic vein through TIPS, respectively. DSA manifestations of PSCV were observed and described. And PSCV were classified based on the manifestations. Results: All 274 patients were successfully treated with portal vein angiography and TIPS, and no postoperative complications occurred. According to the origin, PSCV could be classified into four types, including branch of portal vein type (2.55% [7/274]), which were blood to hepatic and mainly by shunt; main portal vein type (23.36% [64/274]), which were blood leaving hepatic with large blood flow; tributaries of the portal vein type (12.77% [35/274]), which were blood leaving hepatic with various ways to systemic circulation; multi-sources type (61.31% [168/274]), which were supplied by multiple origins. Conclusion: Direct portovenography through TIPS is safe and feasible,which can display classification of PSCV, including branch of portal vein type, main portal vein type, tributaries of portal vein type and multi-sources type, all having different hemodynamic characteristics.

Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

BACKGROUND: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. RESULTS: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.95), mortality (HR, 0.41; 95% CI, 0.24–0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36–0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41–0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47–0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. CONCLUSION: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.

Bi-monthly hepatic arterial infusion chemotherapy as a novel strategy for advanced hepatocellular carcinoma in decompensated cirrhotic patients

BACKGROUND AND AIMS: We previously reported the comparable efficacy of bi-monthly hepatic arterial infusion chemotherapy (B-HAIC) to that of sorafenib chemotherapy for the treatment of advanced hepatocellular carcinoma (aHCC) in patients with compensated cirrhosis. In this study, we demonstrate the efficacy of B-HAIC in patients with decompensated cirrhosis.METHODS: Forty-five patients with aHCC refractory to transcatheter arterial chemo-embolization (TACE) were treated with B-HAIC and were divided into two groups according to hepatic functional reserve (Child-Pugh grade). Overall survival period, treatment response, and adverse events in each group were analyzed.RESULTS: Efficacy and disease control rates in the Child-Pugh B group (n=24; 21% and 71%, respectively) were not significantly impaired compared the Child-Pugh A group (n=21; 38% and 67%, respectively). Median survival time and survival rate at 12 months in the Child-Pugh B group were 422 days and 58.3%, respectively, whereas those in the Child-Pugh A group were 567 days and 70.8%, respectively. Importantly, the hepatic functional reserve of patients did not worsen in either group during the treatment period. Furthermore, the occurrence rate of adverse events leading to discontinuation of anti-tumor treatment was not significantly increased in the Child-Pugh B group.CONCLUSIONS: Given the preservation of hepatic functional reserve afforded by B-HAIC chemotherapy in patients with decompensated cirrhosis, B-HAIC might be an acceptable alternative strategy for aHCC patients who do not respond to TACE.

A study of serum ferritin as a prognostic marker in patients with decompensated liver disease

Introduction: Decompensated liver disease caused by various modifiable and non-modifiable factors leads to the progression of cirrhosis, jaundice, bleeding varies and other complications which leads to high complications and mortality. This study was carried out to predict whether serum ferritin a marker of body iron stores and inflammation is a valid prognostic marker in advanced liver disease. Aim of the study: To study whether serum ferritin levels as an independent prognostic marker to predict the mortality of patients with decompensated liver disease. Materials and methods: It was a prospective and analytical study of 100 patients admitted to our hospital with DCLD and its complications. The study period was from August 2017 to July 2018. After informed consent patients were evaluated with laboratory investigations, clinical examination. Results: It was found that among enrolled 100 patients after getting informed consent, the majority were male patients but sex wise both female and male patients that P- the value of the comparison non-significant. This indicated that there was a low correlation between, LFT values with SF values. This also proved that high SF values were having a low association with LFT values which needs more investigation. Conclusion: Serum ferritin is one of the surrogate markers to predict prognosis in the patients of DCLD. Compared with a well established prognostic model like MELD score, to assess the mortality with SF level is statistically valid one. So, in future SF levels will be a one of the best screening independent prognostic markers in people with liver disease

Algoritmo de insuficiencia cardíaca aguda Manejo inicial:: etapa prehospitalaria, departamento de emergencias, internación en unidad coronaria

Con la finalidad de "saber qué hacer" en el ámbito de la urgencia de una insuficiencia cardíaca aguda y con el objetivo de optimizar las estrategias de diagnóstico y tratamiento en el primer contacto con un paciente que podría estar cursando esta patología, se presentan en este artículo, conceptos fundamentales sobre definiciones de esta patología, clasificaciones clínicas y hemodinámicas, manejos iniciales en diferentes escenarios (etapa pre hospitalaria, departamento de emergencia, ingreso a unidad coronaria) y finalmente, un algoritmo diagnóstico y terapéutico para la rápida toma de decisiones. Es nuestro objetivo que médicos generalistas, clínicos, internistas y/o cardiólogos, puedan en una forma organizada y eficiente optimizar el diagnóstico y manejo precoz de esta condición clínica que amenaza la calidad de vida y supervivencia.

Algorithm of acute heart failure Initial management: prehospital stage, emergency department, admission to coronary unit In order to "know what to do" in the area of acute heart failure and with the objective of optimizing diagnostic and treatment strategies in the first contact with a patient who might be attending this pathology, article, fundamental concepts on definitions of this pathology, clinical and hemodynamic classifications, initial management in different scenarios (prehospital stage, emergency department, coronary unit admission) and, finally, a diagnostic and therapeutic algorithm for rapid decision making. It is our goal that general practitioners, clinicians, internists and / or cardiologists, in an organized and efficient way, can optimize the diagnosis and early management of this life-threatening clinical condition.

Algoritmo de insuficiência cardíaca aguda Manejo inicial: estágio pré-hospitalar, departamento de emergências, admissão à unidade coronária Para "saber o que fazer" na área de insuficiência cardíaca aguda e com o objetivo de otimizar estratégias de diagnóstico e tratamento no primeiro contato com um paciente que possa estar atendendo a esta patologia, artigo, conceitos fundamentais sobre definições desta patologia, classificações clínicas e hemodinâmicas, gerenciamento inicial em diferentes cenários (estágio pré-hospitalar, departamento de emergência, admissão da unidade coronária) e, finalmente, um algoritmo diagnóstico e terapêutico para a tomada de decisões rápidas. Nosso objetivo é que clínicos gerais, clínicos, internistas e / ou cardiologistas, de forma organizada e eficiente, possam otimizar o diagnóstico e o gerenciamento precoce desta condição clínica que ameaça a vida.

Value of hypoxia-inducible factor 1α in diagnosis and prognosis of acute decompensated chronic heart failure / 上海交通大学学报（医学版）

Objective: To investigate the value of hypoxia-inducible factor 1α (HIF-1α) in diagnosis and prognosis of acute decompensated chronic heart failure (CHF). Methods: 32 patients with acute decompensated CHF (Group A), 33 patients with stable CHF (Group B) and 30 controls (Group C) were included. HIF-1α, B-type natriuretic peptide (BNP) and other biochemical indicators in blood were detected. Length of stay and readmission frequency within 3 months of Group A were recorded. Correlations between HIF-1α and other indicators were analyzed. ROC curves of HIF-1α and BNP were developed to compare their diagnostic values. Results: The HIF-1α and BNP levels of Group A were both significantly higher than those of Group B and Group C (P0.05). Conclusion: HIF-1α has a certain value in diagnosis and prognosis of acute decompensated CHF.

Effects of Entecavir Combined with Silymarin on Inflammatory Markers and Oxidative Stress Level in Patients with Hepatitis B Virus-related Decompensated Liver Cirrhosis / 中国药房

OBJECTIVE:To prospectively study the effects of entecavir combined with Silymarin on the inflammatory markers and oxidative stress level in patients with hepatitis B virus-related decompensated liver cirrhosis (HBV-DLC).METHODS:A total of 85 HBV-DLC patients in Hospital of Wuhan Technology University during Jan.2015-Aug.2016 were divided into control group (42 cases) and observation group (43 cases) according to the single and double number random.Control group was given entecavir 0.5 mg,qd.Observation group was additionally given Silymarin capsules 140 mg,tid,on the basis of control group.Both groups were treated for 48 weeks.After treatment,HBV DNA and HBeAg negative conversion rate were observed.The levels of liver function indexes (TBil,AST,ALT),the Child-pugh score and levels of inflammatory indexes (IL-18,IL-8,TNF-α),the levels of oxidative stress indexes (MDA,SOD,NO) were compared between 2 groups before and after treatment.The occurrence of ADR was recorded.RESULTS:Before treatment,there was no statistical significance in liver function indexes,inflammatory factors or oxidative stress indexes of 2 groups (P＞0.05).After treatment for 48 weeks,serum HBV DNA and HBeAg negative conversion rate of observation group were higher than those of control group,but without statistical significance (P＞0.05).Compared with before treatment,liver function indexes levels,Child-pugh score,inflammatory indexes,MDA and NO levels of 2 groups were decreased significantly after treatment for 48 weeks (P＜0.05),while SOD level was decreased significantly (P＜0.05);the degree of improvement of above indexes in observation group was higher than control group (P＜0.05).There was no statistical significance in the incidence of ADR between control group and observation group (P＞0.05),and both were improved after drug withdrawal.CONCLUSIONS:Entecavir combined with Silymarin can inhibit inflammatory reaction and relieve oxidative stress reaction to improve the liver function of HBV-DLC patients;drug combination better than entecavir alone.