Portal Fibrotic Cord is Associated with Transjugular Intrahepatic Portosystemic Shunt Failure and Death in Cirrhotic Patients

Background and Aims:Occlusive portal vein thrombosis(PVT)often causes portal hypertension-related complications in cirrhotic patients.Transjugular intrahepatic portosystemic shunt(TIPS)is an effective treatment for this difficult problem.However,the factors influencing TIPS success and overall survival in patients with occlusive PVT are unknown.This study investigated the factors influencing TIPS success and overall survival in cirrhotic patients with occlusive PVT.Methods:Cirrhotic patients with occlusive PVT were selected from a prospective database of consecutive patients treated with TIPS in Xijing Hospital between January 2015 and May 2021.Baseline characteristics,TIPS success rate,complications,and survival were collected,and the factors associated with the TIPS success rate and transplant-free survival were analyzed.Results:A total of 155 cirrhotic patients with occlusive PVT were enrolled.TIPS succeeded in 126(81.29%)cases.The 1-year survival rate was 74%.Compared with those without,patients with portal fibrotic cord had a lower TIPS success rate(39.02%vs.96.49%,p<0.001),shorter median overall survival(300 vs.1,730 days,p<0.001)and more operation-related complications(12.20%vs.1.75%,p<0.01).Logistic regression analysis found that portal fibrotic cord(odds ratio 0.024)was a risk factor for TIPS failure.Univariate and multivariate analysis showed that portal fibrotic cord was an independent predictor of death(hazard ratio 2.111;95%CI:1.094-4.071,p=0.026).Conclusions:Portal fibrotic cord increased the TIPS failure rate and is a risk factor for poor prognosis in cirrhotic patients.

Starch-based adhesive hydrogel with gel-point viscoelastic behavior and its application in wound sealing and hemostasis

Hydrogels with tissue adhesiveness have demonstrated great promise for wearable electronics,artificial skin,soft robotics,and tissue repair.Nevertheless,adhesive hydrogels that are capable of sealing and hemostasis of wound with severe hemorrhage still lack.For this purpose,a series of ionically crosslinked starch hydrogels were developed here.The viscoelastic properties and tissue adhesiveness of the starch hydrogels were investigated.It is shown that the starch and cross linkers had significant influence on the viscoelastic properties of the starch hydrogels,which further resulted in varied tissue adhesiveness.Among the starch gels,there was one exhibiting a unique and stable"Gel Point"viscoelastic characteristic and it was named as gel-point adhesive hydrogel(GPAH).GPAH showed electrical conductivity,high tissue adhesiveness,high stretch-ability,self-healing capability,injectability,and degradability.The GPAH also exhibited high cytocompatibility,low hemolysis risk,and strong antibacterial effect.The wound sealing and hemostatic performance of GPAH was further evaluated by a rat femoral artery injury model.The blood loss after the sealing of GPAH(2.4±1.3 g)was significantly decreased compared to the group using gauze for sealing(6.3±1.5 g).Meanwhile,GPAH did not cause pathological changes of the soft tissues surrounding the wound.The above results indicate that GPAH,with high tissue adhesiveness,suitable viscoelastic property,strong antibacterial capacity,as well as electro-conductivity,bears great potential for the applications in smart wound management.

Injectable hydrogel wound dressing based on strontium ion cross-linked starch

Severe skin wounds cause great problems and sufferings to patients.In this study,an injectable wound dressing based on strontium ion cross-linked starch hydrogel(SSH)was developed and evaluated.The good inject-ability of SSH made it easy to be delivered onto the wound surface.The good tissue adhesiveness of SSH ensured a firm protection of the wound.Besides,SSH supported the proliferation of NIH/3T3 fibroblasts and facilitated the migration of human umbilical vein endothelial cells(HUVECs).Importantly,SSH exhibited strong antibacterial effects on Staphylococcus aiireiis(S.ai/rec/s),which could prevent wound infection.These results demonstrate that SSH is a promising wound dressing material for promoting wound healing.

Characteristics of novel Ti-10Mo-xCu alloy by powder metallurgy for potential biomedical implant applications

When biomaterials are implanted in the human body,the surfaces of the implants become favorable sites for microbial adhesion and biofilm formation,causing peri-implant infection which frequently results in the failure of prosthetics and revision surgery.Ti-Mo alloy is one of the commonly used implant materials for load-bearing bone replacement,and the prevention of infection of Ti-Mo implants is therefore crucial.In this study,bacterial inhibitory copper(Cu)was added to Ti-Mo matrix to develop a novel Ti-Mo-Cu alloy with bacterial inhibitory property.The effects of Cu content on microstructure,tensile properties,cytocompatibility,and bacterial inhibitory ability of Ti-Mo-Cu alloy were systematically investigated.Results revealed that Ti-10Mo-1Cu alloy consisted ofαandβphases,while there were a few Ti2Cu intermetallic compounds existed for Ti-10Mo-3Cu and Ti-10Mo-5Cu alloys,in addition toαandβphases.The tensile strength of Ti-10Mo-xCu alloy increased with Cu content while elongation decreased.Ti-10Mo-3Cu alloy exhibited an optimal tensile strength of 1098.1 MPa and elongation of 5.2%.Cytocompatibility study indicated that none of the Ti-10Mo-xCu alloys had a negative effect on MC3T3-E1 cell proliferation.Bacterial inhibitory rates against S.aureus and E.coli increased with the increase in Cu content of Ti-10Mo-xCu alloy,within the ranges of 20-60%and 15-50%,respectively.Taken together,this study suggests that Ti-10Mo-3Cu alloy with high strength,acceptable elongation,excellent cytocompatibility,and the bacterial inhibitory property is a promising candidate for biomedical implant applications.

Physical dosimetric reconstruction of a case of large area back skin injury due to overexposure in an interventional procedure

To estimate the physical dose of skin and key organs in a case of overexposure during a cardiac interventional procedure.Methods The female patient aged 50 suffered from owerexposure during ardiac interventional therapy in a hospital,Xinxiang city,Henan province,China in January 2020.The mesh-type phantom for the patient was constructed based on the adult mesh-type reference computational phantoms(MRCPs)released by the International Comission on Radiological Protection Publication 145 (ICRP145)and phantom deformation technology.Models of exposure scenario were constructed and simulated with particle and heavy ion transport code system(PHTTS)according to exposure conditions.Resuts:The maximum absorbed dose of key organs/tissues under iradiation in posteroanterior(PA)and 30°left anterior oblique directions(LOA)was 632.4 and 305.6 mGy,respectively.The let lung,heart,and left mammary gland received a larger dose under both iradiation conditions.The ratio of the absorbed dose with and without shielding was a lculated,and the relative difference in most organs was<1%between two directions.The iso-dose curve of the back skin revealed the ditribution of the absorbed dose(0.1-5.2 Gy).The dose estimate of key tssues/organs was higher than the conventional level,especially the local skin,up to 5.2 Gy.Concusions The interventional procedure in this ase resulted in a higher dose.Monte Carlo codes combined with the MRCPs can be employed to estimate physical dose to individuals in concrete irradia tion scenarios.