Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding

BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive characteristics.However,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains controversial.METHODS A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022.Based on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were compared.RESULTS Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts.Notably,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST levels either preoperatively or postoperatively(P<0.05).Postoperative scores across all dimensions of life quality surpassed preoperative scores,with the study cohort achieving higher scores(P<0.05).At 22.00%,the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group(42.86%;P<0.05);conversely,no marked difference was obser-ved in the 1-year postoperative survival rate between the two cohorts(P>0.05).CONCLUSION TIPS,which has demonstrated robust efficacy in managing cirrhotic EGVB,remarkably alleviates varicosity and improves hemodynamics in patients.This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.

Correlation between serum markers and transjugular intrahepatic portosystemic shunt prognosis in patients with cirrhotic ascites

BACKGROUND Individuals with refractory ascites in the context of liver cirrhosis typically face an adverse prognosis.The transjugular intrahepatic portosystemic shunt(TIPS)is an efficacious intervention,but there is a lack of reliable tools for postoperative pro-gnosis assessment.Previously utilized clinical biochemical markers,such as the serum albumin concentration(Alb),sodium(Na+)concentration,and serum creatinine(Scr),have limited predictive value.Therefore,the quest for novel,specific biomarkers to evaluate the post-TIPS prognosis in patients with liver cirrhosis and refractory ascites holds significant practical importance.A retrospective analysis was conducted on 75 patients with liver cirrhosis and refractory ascites who underwent TIPS at our institution from August 2019 to August 2021.These patients were followed up regularly for two years,and the death toll was meticulously documented.The patients were allocated into a survival group(n=45 patients)or a deceased group(n=30 patients)based on their prognosis status.The clinical data of the two groups were collected,and Child-Pugh scores and MELD scores were calculated for analysis.Spearman correlation analysis was carried out to evaluate the correlation of prognosis with Child-Pugh grade,MELD score,and Cys C level.Additionally,a multiple-factor analysis utilizing the Cox proportional hazard model was used to identify independent risk factors affecting the post-TIPS prognosis of patients with liver cirrhosis and refractory ascites.The receiver operating characteristic curve(ROC)ascertained the predictive value of the Cys C concen-tration,Child-Pugh grade,and MELD score for the prognosis of liver cirrhosis with refractory ascites in post-TIPS patients.RESULTS During a 2-year follow-up period,among 75 patients with liver cirrhosis and refractory ascites who underwent TIPS treatment,30 patients(40.00%)passed away.The deceased cohort exhibited heightened aspartate aminotrans-ferase,alanine aminotransferase,total bilirubin,Scr,prothrombin time,Cys C,international normalized ratio,Child-Pugh,and MELD scores compared to those of the survival cohort,while Alb and Na+levels were attenuated in the deceased group(P<0.05).Spearman analysis revealed moderate to high positive correlations between prognosis and Child-Pugh score,MELD score,and Cys C level(r=0.709,0.749,0.671,P<0.05).Multivariate analysis using the Cox proportional hazard model demonstrated that the independent risk factors for post-TIPS prognosis in patients with liver cirrhosis and refractory ascites were Cys C(HR=3.802;95%CI:1.313-11.015),Child-Pugh(HR=3.030;95%CI:1.858-4.943),and MELD(HR=1.222;95%CI:1.073-1.393)scores.ROC analysis confirmed that,compared to those of the classic prognostic models for Child-Pugh and MELD scores,the predictive accuracy of Cys C for post-TIPS prognosis in patients with liver cirrhosis and refractory ascites was slightly lower.This analysis yielded sensitivity and specificity values of 83.33%and 82.22%,respectively.The area under the curve value at this juncture was 0.883,with an optimal cutoff value set at 1.95 mg/L.CONCLUSION Monitoring the serum Cys C concentration is valuable for assessing the post-TIPS prognosis in patients with liver cirrhosis and refractory ascites.Predictive models based on serum Cys C levels,as opposed to Scr levels,are more beneficial for evaluating the condition and prognosis of patients with ascites due to cirrhosis.

Effect of Gd on neutron absorption properties and electrochemical corrosion behavior of Zr-Gd alloy in boiling concentrated HNO3

A Zr-Gd alloy with neutron poisoning properties and resistance to boiling concentrated HNO3 corrosion was developed based on a corrosion-resistant Zr-702 alloy to meet the demand for neutron shielding in the closed-loop treatment of spent fuel and the nuclear chemical industry.In this study,1 wt.%,3 wt.%,5 wt.%,7 wt.%,and 9 wt.%Zr-Gd alloys were designed and fabricated with Zr-702 as the control element.The electrochemical behavior of the Zr-Gd alloys in boiling concentrated HNO3 was investigated,and the neutron shielding effect on plate thickness and Gd content was simulated.The experimental results demonstrate that the corrosion resistance of the alloy decreased slightly before~7-9 wt.%with increasing Gd content;this is the inflection point of its corrosion resistance.The alloy uniformly dissolved the Gd content that could not be dissolved in the Zr lattice,resulting in numerous micropores on the passivation coating,which deteriorated and accelerated the corrosion rate.The MCNP simulation demonstrated that when the Gd content was increased to 5 wt.%,a 2-mm-thick plate can shield 99.9%neutrons;an alloy with a Gd content≥7 wt.%required only a 1-mm-thick plate,thereby showing that the addition of Gd provides an excellent neutron poisoning effect.Thus,the corrosion resistance and neutron shielding performance of the Zr-Gd alloy can meet the harsh service requirements of the nuclear industry.

Semi-solid processing of aluminum and magnesium alloys:Status,opportunity,and challenge in China

Owing to its low cost,short process and low energy consumption,semi-solid processing(SSP)of aluminum(Al)and magnesium(Mg)alloys has been considered as a competitive approach to fabricate complicated components with excellent performance.Over the past decade,significant progress has been achieved in deeply understanding the SSP process,the microstructure and performance of the fabricated components in China.This paper starts with a retrospective overview of some common slurry preparation methods,followed by presenting the performance and the underlying mechanisms of SSP fabricated alloys.Then,the mainstream opinions on the microstructure evolution and rheological flow behavior of semi-solid slurry are discussed.Subsequently,the general situation and some recent examples of industrial applications of SSP are presented.Finally,special attention is paid to the unresolved issues and the future directions in SSP of Al and Mg alloys in China.

Anisotropy in tensile properties and fracture behaviour of 316L stainless steel parts manufactured by fused deposition modelling and sintering

Fused deposition modelling and sintering(FDMS)is a potential metal additive manufacturing technology due to its low cost and high efficiency.The mixture of metal powder and binder goes through heating,extrusion,debinding and sintering processes to produce the compact finished part.However,it is generally believed that parts produced by FDMS possess poor and anisotropic tensile properties,which always attributes to the weak interlayer combination.The current work aimed to enhance tensile properties and better understand the anisotropic fracture behavior of the 316L stainless steel prepared by FDMS.By process optimization,the yield strength and ultimate tensile strength obtained in this work are increased by 26.1%and 15.2%,based on the highest performance reported in previous studies.According to the ultimate tensile strength,the performance difference between the horizontal and vertical directions has been reduced to 27%.Furthermore,the experimental results indicated that the clustered irregular shape holes evolved from primitive voids prefer to distribute in the build direction,resulting in anisotropic tensile performance.It is suggested that the mechanical properties could be improved by applying a smaller extrusion diameter and rolling-assisted printing.In addition,the current FDMS parts show qualified performance for producing the customized and small batch components.