Portal pressure gradient and serum albumin: A simple combined parameter associated with the appearance of ascites in decompensated cirrhosis treated with transjugular intrahepatic portosystemic shunt

BACKGROUND/AIMS: In recent years, greater assessment accuracy after transjugular intrahepatic portosystemic shunt (TIPS) to ascertain prognosis has become important in decompensated cirrhosis due to portal hypertension. The aim of this study was to assess the ratio of the portal pressure gradient (PPG) pre-TIPS (pre-PPG) to albumin (PPA), which influence ascites formation in cirrhotic patients in the 6-months after TIPS placement, and is a metric introduced in our study. METHODS: This was a retrospective cohort study of 58 patients with decompensated cirrhosis admitted to an academic hospital for the purpose of TIPS placement. We collected the following data: demographics, laboratory measures, and PPG during the TIPS procedure. Then we analyzed the association between the above data and ascites formation post-TIPS in cirrhosis patients. RESULTS: Twenty-two patients with ascites and 28 without ascites were evaluated. Univariate and binary logistic regression analysis were adjusted for the following variables: to determine prognosis; Child-Pugh scores, lymphocyte count, platelet count, hemoglobin level, albumin level and pre-PPG or PPA. The outcome showed that PPA was better than pre-PPG and albumin for predicting ascites according to area under receiver operating characteristic curves and a statistical model that also showed PPA’s influence 6-months post-TIPS. CONCLUSIONS: The combined measurement of pre-PPG and albumin, defined as PPA, may provide a better way to predict post-TIPS ascites in decompensated cirrhosis, which underlines the need for a large clinical trial in the future.

Brain function changes of resting-state functional MRI in cirrhotic patients with hyperbilirubinemia / 中国医学影像技术

Objective To explore the brain function changes in cirrhotic patients with normal blood ammonia and high in direct bilirubin with regional homogeneity (ReHo) of resting-state functional MRI (rs-fMRI).Methods Fifty-three cirrhotic patients with normal blood ammonia and high indirect bilirubin (cirrhosis group) and 60 healthy volunteers (control group) performed rs-fMRI scans.ReHo values in different brain areas of the two groups were acquired and compared.The correlation between the ReHo values of different brain regions in both groups and the indirect bilirubin concentrations was analyzed.Results Compared with control group,cirrhosis group showed that ReHo values increased in left dorsal-lateral frontal gyrus,left orbital superior frontal gyrus,left top edge of angular gyrus,left precentral gyrus,right caudate,right putamen,right insula,right olfactory cortex (all P＜0.001),and decreased in left superior occipital gyrus,left middle occipital gyrus,left cuneus,left orbital inferior frontal gyrus,right paracentral lobule,right precuneus,right middle occipital gyrus,bilateral lingual gyrus and bilateral cerebellum (all P＜0.001).ReHo values in right insula and right putamen in cirrhotic patients positively correlated with indirect bilirubin (r=0.32,P=0.021).Conclusion The resting state brain function increases and decreases in some brain regions of cirrhotic patients with normal blood ammonia and high indirect bilirubin.Indirect bilirubin level correlates with function of some brain regions,which has certain effect on brain function of adult.

A clinical study of transjugular intrahepatic portosystemic shunt combined with stomach and esopha-geal variceal embolization for gastric varices bleeding / 中华消化内镜杂志

Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS)combined with stomach and esophageal variceal embolization(SEVE)for gastric variceal haem-orrhage,and the efficacy with or without a gastrorenal shunt. Methods A total of 52 patients with gastric variceal bleeding history and portal hypertension treated with TIPS combined with SEVE were included from October 2013 to March 2015.Patients were divided into two groups according to preoperateive CT angiogra-phy,27 cases with gastric variceal haemorrhage associated with a gastrorenal shunt in group A,and 25 gastric varices bleeding cases without gastrorenal shunt in group B. During the follow-up,the incidence of the total rates of rebleeding,TIPS primary patency and hepatic encephalopathy,and the survival rates were compared between group A and group B. Results In all patients,the average portal vein pressure decreased from 36. 50±7. 00 cmH2 O(1 cmH2 O= 0. 098 kPa)before operation to 28. 15±6. 27 cmH2 O after TIPS combined with SEVE,with significant difference(t= 10. 357,P= 0. 001). Fifty two patients were followed up for 1 to 18 months(1-18 months in group A;1-15 months in group B).The total rates of rebleeding,TIPS primary patency,hepatic encephalopathy and survival were 11. 54%(6/ 52),86. 54%(45/ 52),11. 54%(6/ 52) and 92. 31%(48/ 52),respectively. There were no significant differences between the two groups in the total rates of rebleeding[11. 11%(3/ 27)VS 12. 00%(3/ 25),P = 1. 000],TIPS primary patency[88. 89%(24/ 27)VS 84. 00%(21/ 25),P= 1. 000],hepatic encephalopathy[14. 81%(4/ 27)VS 8. 00%(2/ 25), P= 0. 738]or total survival rate[92. 59%(25/ 27)VS 92. 00%(23/ 25),P = 1. 000]after TIPS combined with SEVE. Conclusion TIPS combined with SEVE is effective for gastric varices,and equally effective in the treatment of both gastric variceal haemorrhage associated with a gastrorenal shunt and gastric varices bleeding without gastrorenal shunt.

Angiographic manifestations and embolization treatment of renal artery injury caused by percutaneous nephrolithotomy percutaneous nephrolithotomy / 介入放射学杂志

Objective To investigate the angiographic manifestations of renal artery injury caused by percutaneous nephrolithotomy, and to evaluate the therapeutic effect of super-selective renal arterial embolization in treating renal artery injury. Methods A total of 22 patients with persistent or intermittent gross hematuria that occurred after percutaneous nephrolithotomy, who were encountered at authors’ hospital during the period from Jan. 2010 to June 2014, were included in this study. The diagnosis was confirmed by renal angiography in all patients, and super-selective renal arterial embolization with steel micro-coils was carried out in all patients. The patients were followed up for three months. The results were analyzed. Results Of the 22 patients, DSA examination showed that renal artery pseudoaneurysm (RAP) was found in 14 (63.6%), renal arteriovenous fistula (RAVF) in 5 (22.7%) and RAP associated with RAVF in 3 (13.6%). Renal angiography performed after super-selective renal arterial embolization showed that complete obstruction of the bleeding arteries was achieved in all patients, and the active bleeding stopped. Both the technical success rate and the hemostasis rate were 100%. During the follow-up period lasting for three months, no recurrence of hematuria or severe complications occurred. In 20 patients, different degree of embolism syndrome was observed after the treatment. Conclusion Renal artery pseudoaneurysm and renal arteriovenous fistula are the main types of renal artery injury after percutaneous nephrolithotomy. Super-selective renal arterial embolization with micro-coils can be used as the treatment of choice for patients who has failed to respond to conservative therapy.

Efficacy of transjugular intrahepatic portosystemic shunt combined with gastroesophageal variceal embolization in the treatment of 18 cases of gastric fundal varices associated with a gastrorenal shunt / 中华消化杂志

Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastroesophageal variceal embolization (SEVE) in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm .Methods From October 2013 to December 2014 ,the clinical data of 18 patients with portal hypertension caused gastroesophageal variceal bleeding and treated by TIPS combined with SEVE were collected . The difference of portosystemic pressure gradient between before and after operation was observed ,and Child‐Pugh score before and after operation was also evaluated .The hemostasis in 24 hours ,TIPS patency ,the occurrence of hepatic encephalopathy(HE) ,rebleeding ,hepatic failure ,mortality and the change of liver function and thrombocytopenia were recorded after operation .Student′s t‐test or analysis of variance was performed for statistical analysis of measurement data .Results In the 18 patients ,the average portal vein pressure decreased from (34 .23 ± 6 .35) cmH2O (1 cmH2O= 0 .098 kPa) before operation to (25 .69 ± 6 .89) cmH2O after TIPS combined with SEVE ,and the difference was statistically significant (t=7 .572 , P0 .05) .Conclusion TIPS combined with SEVE in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm could effectively control bleeding ,and no ectopic embolism happened .

The extraction of fetal electrocardiogram singal based on improved ICA algorithm / 生物医学工程学杂志

The present paper is a research on independent component analysis (ICA) method in the fetal electrocardiogram (FECG) extraction. Based on the fundamental model for the ICA and the fixed-point FastICA algorithm using negentropy, damped Newton iteration was used in place of Newton iteration. The algorithm was improved in order to overcome the drawbacks where it is more sensitive to choosing the initial value. The improved algorithm was used to extract the FECG. A synthetic ECG was used in the experiments, and three simulation signal sources were selected, including two sources of ECG and one Gaussian noise source. The experimental results were satisfactory, The convergence rate was faster and the error was smaller.

A clinical analysis 30 cases of lupus mesenteric vasculitis / 中华内科杂志

Objective To characterize the clinical characteristics of lupus mesenteric vasculitis (LMV). Methods Analyzing the clinical, laboratory and treatment data of LMV patients hospitalized from 2002. 1.1 to 2007. 12. 31 retrospectively. Results (1) The three common manifestations were abdominal pain, diarrhea and vomit with the prevalence rate of 77%, 70% and 67% respectively. (2)The majority of LMV cases were active vital organ (28/30), kidney (24/30) and hematological system (18/30) were the main organs of involvement. Ten patients had hydroureteronephrosis, and 8 patients had intestinal pseudo-obstruction at the same time. (3) Systemic lupus erythematosus disease activity index (SLEDAI) score was ≥10 in 80% (24/30) of patients. The progression of LMV was accompanied with new-onset ieucopenia or worsening leucopenia or hypocomplementemia in 10 cases. (4) Blood antinuclear antibodies were positive in 27 patients detected, and anti-SSA antibody was positive in 15 (56%), anti-U1RNP antibody was positive in 14 (52%). (5) Fourteen cases had bowel wall thickening with target sign or mesenteric vessels with palisade or comb sign in contrast CT scan of abdomen. (6)Twenty-seven cases were treated with orally or intravenous medium to high dose steroid therapy and recovered from LMV. Conclusions (1) Abdominal pain, diarrhea and vomit were frequent manifestations of LMV patients. (2) LMV was one of the serious complications of systemic lupus erythematosus(SLE), and usually accompanied by active SLE in other organs. (3) A drop in the white blood cell count or complement C3 titer might be correlate with the occurrence of LMV. It needs to further investigate the relationship between LMV and the high positive rate of anti-SSA and anti-U1RNP antibody. (4) LMV patients responded well to intravenous high dose methylprednisolone.

Clinical Application and Comparative Study of Aortic Dissection with MRI and Spiral CT / 实用放射学杂志

Objective To compare imaging features and to evaluate clinical values of aortic dissection(AD) with MRI and spiral CT.Methods MRI and spiral CT findings of AD in 18 cases confirmed by clinical or surgical pathology were analysed retrospectively.Results The sensitivity and specificity of two advanced techniques in diagnosis of AD were high.MRI and CT showed the dimension,true or false lumen,intimal flap,intimal tear,thrombus and intramural hematoma of AD,aortic dilatation or stenosis and the major aortic branches.Conclusion The two techniques are important for the suspect AD,two techniques are similar to display the features of dimension,classification,true or false lumen and aortic dilatation or stenosis,MRI plays an important role in diagnosis of AD and is better than CT in demonstrating the intimal flap,intimal tear,thrombus,intramural hematoma and the involvement of the major aortic branches,there were limitation in demonstrating calcification of intimal flap or vascular wall and emergency patients.