Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency

BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s.Although TIPS has good therapeutic effects on the formation of PVT,the effect of PVT on TIPS stenting has rarely been reported.Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT,which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIM To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODS Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis.Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197).The incidence of PVT before TIPS was compared between the two groups.After TIPS placement,primary patency rate was compared using Kaplan–Meier analysis at 3,6,9 and 12 mo,and 2 and 3 years.The clinical outcomes were analyzed.RESULTS Before TIPS procedure,the incidence of PVT in group A was lower than in group B (P = 0.003),and TIPS technical success rate in group A was higher than in group B (P = 0.016).The primary patency rate in group A tended to be higher than in group B at 3,6,9 and 12 mo,2 years and 3 years (P = 0.006,P = 0.011,P = 0.023,P = 0.032,P = 0.037 and P = 0.028,respectively).Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001),6 mo (P = 0.003 and P = 0.005),9 mo (P = 0.005 and P = 0.012),12 mo (P = 0.008 and P = 0.024),2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017),respectively.During 3-years follow-up,the 1-,2- and 3-year survival rate in group A were higher than in group B (P = 0.008,P = 0.021,P = 0.018,respectively),but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).CONCLUSION Patients with prior splenectomy have a high incidence of PVT,which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion.

Computer Assisted Assignments of Rotationally Resolved Molecular Spectra

A graphically oriented interactive program for assignments of rotationally resolved molecular spectra has been devised. The program functions by grouping spectral lines in term of the second difference principle. and graphing spectral intensity versus frequency in a bar graph of the selected groups, distinguished by color and/or line-type. This allows for easy detection of regular patterns buried in the observed spectrum. Furthermore, it includes a Loomis-Wood view for assisting in spectral assignments. As an example, the program was applied in assigning the molecular spectrum of the production in the discharge of PCl3 buffered by helium gas, which may belong to several species. The results suggest that the program is highly efficient and quite useful in the assignment and the analysis of molecular spectra, especially those of symmetric top, slightly asymmetric top and linear molecules. The accuracy and efficiency of this program will likely ensure its wide application in the processing of molecular spectra.

Comprehensive Bile Acid Profiling of ABCB4-mutated Patients and the Prognostic Role of Taurine-conjugated

Background and Aims:We asked if comprehensive bile acid profiling could provide insights into the physiopathology of ABCB4-mutated patients and evaluated the prognostic value of taurine-conjugated tetrahydroxylated bile acid(tauro-THBA)in cholestasis.Methods:Serum bile acid profiles were evaluated in 13 ABCB4-mutated patients with 65 healthy controls by ultra-high-performance liquid chromatography/multiple-reaction monitoring-mass spectrometry(UPLC/MRM-MS).The concentration of tauro-THBA was compared between ABCB4-mutated patients with different prognoses.The areas under the curve(AUCs)of tauro-THBA were compared between ABCB11-mutated patients with native liver survival and those who died or underwent liver transplantation before 3 years of age by receiver operating characteristic curve(ROC),with another patient cohort for further verification.Results:The overall hydrophobicity indices of bile acids in ABCB4-mutated patients(12.99±3.25 m)were significantly lower than those of healthy controls(14.02±1.74 m,p<0.000).That was due to markedly increased bile acid modifications including conjugation,sulfation,and ketonization.Differences in the tauro-THBA concentration in ABCB4-mutated patients with different prognoses were not significant.ROC analysis indicated that levels of tauro-THBA of<60 nM yielded an AUC of 0.900 with a sensitivity of 80%and specificity of 87.5%for ABCB11-mutated patients with different prognoses(p=0.0192).Of the 15 patients with good prognosis,14 were classified correctly and four of the five patients with a poor prognosis were classified correctly(14:15 vs.1:5,p=0.005)with tauro-THBA as a classifier.Conclusions:Tauro-THBA concentration may be a biomarker for predicting the clinical outcome in low gammaglutamyl transferase intrahepatic cholestasis patients.