contrast enhanced computed tomography and reconstruction of hepatic vascular system for transjugular intrahepatic portal systemic shunt puncture path planning

AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.

Systemic lupus erythematosus complicated by noncirrhotic portal hypertension: A case report and review of literature

A 48 year-old Chinese woman suffering from polyarthritis,irregular fever and trichomadesis was admitted to the hospital.A diagnosis of systemic lupus erythematosus(SLE)was made based on polyarthritis,pancytopenia,reduced complement 3,multiple positive autoantibodies,a positive Coomb’s test and protein in her urine.In addition,splenomegaly was detected during physical examination and confirmed by abdominal ultrasonography and magnetic resonance imaging,indicating that the patient had SLE and portal hypertension.Further negative investigations ruled out the possibility of cirrhosis.The patient was diagnosed with active SLE complicated by noncirrhotic portal hypertension(NCPH)without liver histopathology,due to the patient’s refusal for liver biopsy.Portal vein diameter and splenomegaly decreased following treatment with methylprednisolone,hydroxychloroquine and metoprolol tartrate.To date,SLE complicated by NCPH has rarely been reported,as it is under-recognized clinically as well as pathologically.Here we describe a case of SLE complicated by NCPH and review the literature for its characteristics,which may contribute to improving the recognition of NCPH and reducing missed and delayed diagnosis of this disorder.

Transjugular intrahepatic porto-systemic shunt in the elderly:Palliation for complications of portal hypertension

AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population group.METHODS:A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010.Twentyfive patients were referred for TIPS.We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease.Of the 23 patients suitable for TIPS,the indications for TIPS placement was portal hypertension complicated by refractory ascites alone(n = 9),hepatic hydrothorax alone(n = 2),refractory ascites and hydrothorax(n = 1),gastrointestinal bleeding alone(n = 8),gastrointestinal bleeding and ascites(n = 3).RESULTS:Of these 23 attempted TIPS procedure patients,21 patients had technically successful TIPS procedures.A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years(range 65-82 years).Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS.Sixteen of 21 patients who underwent successful TIPS(excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo.Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients.Bleeding was controlled following technically successful procedures in 10 out of 11 patients.CONCLUSION:We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.

Systemic mastocytosis: A rare cause of non-cirrhotic portal hypertension

Mastocytosis is a clonal neoplastic disorder of the mast cells(MC) that can be limited to the skin(cutaneous mastocytosis) or involve one or more extracutaneous organs(systemic mastocytosis). The clinical manifestations of mastocytosis are heterogeneous ranging from indolent disease with a long-term survival to a highly aggressive neoplasm with survival of about 6 mo. Although liver involvement in aggressive systemic mastocytosis(ASM) is relatively common, the development of portal hypertension with or without cirrhosis is rare. We report a case of ASM without skin involvement in a 72-year-old caucasian male who presented with non-cirrhotic portal hypertension based on clinical, analytical, imagiological and endoscopic findings. Given the hematological picture, the correct diagnosis was established based on ancillary tests for MC using bone marrow aspirates and biopsy. Extensive involvement of the liver and gastrointestinal tract was histologically documented. The disease progressed rapidly and severe pancytopenia and recurrent upper gastrointestinal bleeding became the dominant problem. This case illustrates the challenge in establishing a diagnosis of ASM especially when the clinical picture is atypical and without skin involvement. Gastroenterologists should consider infiltrative disease, particularly systemic mastocytosis, as a differential diagnosis in a clinical case of portal hypertension of unknown etiology.

Duodenal variceal bleeding secondary to idiopathic portal hypertension treated with transjugular intra-hepatic portosystemic shunt plus embolization: A case report

BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension(IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt(TIPS) plus embolization. CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leadingto duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation. CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.

Reducing risk of transjugular intrahepatic portosystemic shunt using ultrasound guided single needle pass

Delayed liver laceration following transjugular intrahepatic portosystemic shunt (TIPS) is a serious and likely underdiagnosed complication. It is however an important complication following TIPS, which remains one of the most technically challenging interventional procedures performed. In addition to laceration, a number of complications regarding bleeding and perforation are well described following TIPS procedures. We feel the adoption of techniques such as ours and that of other authors described in the literature using an ultrasoundguided percutaneous transhepatic approach with a small caliber needle provides a safer and less traumatic procedure and should reduce complications of bleeding and almost completely eliminate the risk of liver laceration. Our procedure was successfully performed under conscious sedation rather than general anaesthesia further reducing the overall procedural risk to the patient.

Nutritional status in non-alcoholic subclinical porto-systemic encephalopathy

AIM To understand the role of nutritional status in cirrhotic patients without clinical porto-systemic encephalopathy (PSE).METHODS Fifty-one non-alcoholic patients with cirrhosis without PSE were studied prospectively and compared with 20 healthy volunteers. The nutritional evaluation included serum prealbumin, albumin, transferrin, body mass index (BMI), mid-arm muscle circumference (MAMC), and grip power. The occurrence of subclinical PSE (SPSE) was defined when N20-N65 inter-peak latencies of median nerve-stimulated somatosensory evoked potentials were ＞2.5 standard deviations of control means. Blood chemistries were tested within 12h of somatosensory evoked potentials test and nutritional evaluation.RESULTS Twenty-five, 17 and 9 cirrhotic patients were graded as Child-Pugh class A, B, and C, respectively. Twenty-four (47.1%) patients developed SPSE. Cirrhotic patients with SPSE had lower serum albumin (2.8g/dL±0.5g/dL vs 3.1g/dL±0.7g/dL, P＜0.001) levels than those without SPSE. Prealbumin (10.6mg/dL±5.7mg/dL vs 12.5mg/dL±5.8mg/dL), transferrin (164mg/dL±46mg/dL vs 178mg/dL±58mg/dL), BMI (23.7kg/m2±2.7kg/m2 vs 25.3kg/m2±3.6kg/m2), MAMC (22.2cm±2.6cm vs 22.7cm±3.5cm), and grip power (26.3kg±6.4kg vs 26.9kg±6.8kg) were not different between cirrhotic patients with and without SPSE. N20-N65 inter-peak latencies were correlated with serum albumin levels (P=0.01) but not with prealbumin, transferrin, BMI, MAMC, or grip power. Serum albumin, prealbumin and transferrin levels were different among cirrhotic patients with Child-Pugh classes A, B, and C (P＜0.05). BMI, MAMC, and grip power were not different among Child-Pugh classes A, B and C.CONCLUSION Our data suggest that serum albumin level is a simple test in the evaluation of nutritional status in patients with cirrhosis.

Contrast-enhanced ultrasound in portal venous system aneurysms: A multi-center study

AIM: To investigate contrast-enhanced ultrasound (CEUS) findings in portal venous system aneurysms (PVSAs).

Body composition changes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis

AIM:To investigate the effect of transjugular intra-hepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients.METHODS: Twenty-one patients with liver cirrhosis and clinical indications for TIPS insertion were investigated before and 1, 4, 12, 52 wk after TIPS. For each patient we assayed body composition parameters [dry lean mass, fat mass, total body water (TBW)], routine liver and kidney function tests, and free fatty acids (FFA). Glucose and insulin were measured for the calculation of the homeostasis model assessment insulin resistance (HOMA-IR); liver function was measured by the galactose elimination capacity (GEC); the severity of liver disease was graded by model for end-stage liver disease (MELD).RESULTS: Porto-systemic gradient decreased after TIPS (6.0±2.1 mmHg vs 15.8±4.8 mmHg, P<0.001). Patients were divided in two groups according to initial body mass index. After TIPS, normal weight patients had an increase in dry lean mass (from 10.9±5.9 kg to 12.7±5.6 kg, P=0.031) and TBW (from 34.5±7.6 L to 40.2±10.8 L,P=0.007), as well as insulin (from 88.9±49.2 pmol/L to 164.7±107.0 pmol/L,P=0.009) and HOMA-IR (from 3.36%±2.18% to 6.18%±4.82%,P=0.023). In overweight patients only FFA increased significantly (from 0.59±0.24 mmol/L to 0.93±0.34 mmol/L, P=0.023).CONCLUSION: TIPS procedure is effective in lowering portal pressure in patients with portal hypertension and improves body composition without significant changes in metabolic parameters.

Construction of an evaluation system for the service capabilities of government to business (G2B) web portals

On the basis of analyzing both domestic and foreign evaluation systems for the e-government and also taking into account of the current situation of government portals in urban centers,the paper is aimed to construct an evaluation system primarily for the measurement of the service capability of business-oriented G2B portals of local governments in general and those G2B portals of the new development zones in particular.This system is composed of 6 first tier indicators,18 second tier indicators and 90 third tier indicators.And the weight of each indicator is determined by Delphi Method and Analytic Hierarchy Process(AHP) Method.Subsequently,we used this system to evaluate the government portals of Tianjin Binhai New Area and Shanghai Pudong New Area and proved to have the desired practicability.

Significance of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Portal Vein System of Pancreatic Cancer Patients

Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.

基于uPortal的数字化校园门户系统开发

数字化校园系统是高校信息化的重要基础设施,深刻改变了高校管理、教学和发展模式。uPortal作为开源企业级门框架台给数字化校园门户提供了高效安全、灵活统一的信息聚合机制。介绍了Portal及其开源产品uPortal的基本结构和工作流程,在对数字化校园门户系统需求及用例分析的基础上,基于uPortal开发了某高校数字化校园门户系统,主要实现了单点登录、用户权限控制、频道管理、界面与栏目的个性化定制等基本功能。应用测试表明,该门户系统运行平稳,具有良好的适应性、可访问性、可靠性和可扩展性。

四维血流磁共振成像在门静脉系统中的应用现状

磁共振成像在门静脉系统中的应用越来越受到重视,而四维血流磁共振成像作为一种新型磁共振技术,可以动态显示血管内血流动力学的变化。目前,该技术已广泛应用于全身各个血管系统检查中,其可以从形态学和血流动力学两方面对血流进行定性和定量分析,对疾病的诊断及其严重程度的判断具有重要意义。本文就四维血流磁共振成像在门静脉系统中的临床应用现状进行简要综述。

Portal技术在重庆城市一卡通系统的应用

介绍重庆城市一卡通系统多应用、多网络和多机具的业务特点,就现今面临的系统集成和业务扩展的难题,提出了基于Portal技术的解决方案,实现了一卡通系统的Portal的扩展模块——指令翻译机,建立起面向大多数知名厂商的"指令解析器"集合,并通过Portal技术在重庆城市一卡通系统的实际应用,缩短了新增业务的开发周期,降低了管理与维护的成本,展示了Portal技术的优越特性及其在这一领域的重要价值,为今后Portal技术在相似领域的应用奠定了基础。

大黄廑虫丸联合抗病毒治疗乙型肝炎肝硬化对凝血功能紊乱、肝硬化程度及门静脉系统相关参数的影响

目的探讨大黄廑虫丸联合抗病毒治疗乙型肝炎(HBV)肝硬化对病人凝血功能紊乱、肝硬化程度及门静脉系统相关参数的影响。方法选择2020年6月至2022年6月于无锡市中医医院接受治疗的100例HBV肝硬化病人,运用随机数字表法将其分为观察组与对照组,各50例。对照组采用常规抗病毒疗法,观察组基于对照组联合大黄廑虫丸,评估两组疗效并进行比较,对比两组凝血功能、HBV-DNA值、肝硬化程度、门静脉系统相关参数变化。结果观察组治疗显效病人占50.00%高于对照组26.00%,差异有统计学意义(P<0.05);治疗前两组病人的血小板计数(PLT)、凝血酶时间(TT)、纤维蛋白原(FIB)、HBVDNA水平比较差异无统计学意义(P>0.05),治疗后PLT[(125.42±24.57)×10^(9)/L比(116.12±21.38)×10^(9)/L]、FIB水平[(2.76±0.56)g/L比(1.80±0.63)g/L]高于对照组,TT[(14.18±4.28)s比(16.61±5.34)s]、HBV-DNA[(2.72±0.43)×10^(5) IU/L比(3.38±0.68)×10^(5) IU/L]小于对照组,差异有统计学意义(P<0.05);两组治疗前后的肝硬化程度和门静脉内径比较差异无统计学意义(P>0.05),治疗后观察组肝脏硬度数值(LSM)(15.32±2.27)kPa比(17.94±2.34)kPa、肝门静脉内径[(12.29±1.98)mm比(13.80±2.15)mm]低于对照组,差异有统计学意义(P<0.05);两组治疗前天冬氨酸氨基转移酶(AST)、丙氨酰氨基转移酶(ALT)水平比较差异无统计学意义(P>0.05),治疗后ALT、AST水平均下降,观察组下降幅度高于对照组,差异有统计学意义(P<0.05)。结论相较于单独抗病毒治疗,联合大黄廑虫丸治疗,疗效较好,改善肝功能,有助于凝血功能的恢复,缩小肝门静脉内径。

肝硬化并发门静脉系统血栓形成风险和特征分析及列线图模型构建

目的 探讨肝硬化患者门静脉系统血栓形成(PVST)的危险因素和特征并进行列线图模型的构建及验证。方法 根据是否合并PVST将388例肝硬化患者分为血栓组(142例)与非血栓组(246例),再根据血栓类型将血栓组分为主干组(27例)、分支组(36例)和混合组(79例),比较各组患者一般临床资料及实验室检查结果。采用多因素logistic回归分析评估肝硬化患者PVST的危险因素并构建列线图预测模型,对模型的准确性进行内部验证。采用校准曲线和受试者工作特征(ROC)曲线评价模型的预测效果。结果 血栓组Hb、纤维蛋白原(FIB)均显著低于非血栓组,而D-二聚体(D-D)、门静脉主干(MPV)宽度、腹腔积液、消化道出血、脾脏切除史、内镜治疗史、Child-Pugh分级为B/C级患者病例均显著高于非血栓组(P<0.05)。主干组脾切除史占比高于分支组,白蛋白(Alb)低于分支组;主干组PT活动度(PTA)、Alb高于混合组,凝血酶原时间(PT)、国际正常化比值(INR)、D-D及腹腔积液占比均低于混合组;分支组PTA、Alb均高于混合组,PT、INR、D-D、MPV宽度及腹腔积液、消化道出血、脾脏切除史、内镜治疗史、Child-Pugh分级为B/C级患者比例均低于混合组(P<0.05)。多因素logistic回归分析结果显示,D-D、MPV宽度、脾脏切除史、内镜下治疗史均为肝硬化患者PVST的独立危险因素(P<0.05)。基于以上独立危险因素建立列线图预测模型,一致性指数为0.801,提示预测模型校准度良好。结论 D-D、MPV宽度、脾脏切除史和内镜下治疗史均为肝硬化患者并发PVST的独立危险因素,PVST患者中混合型血栓并发症更多,肝功能及凝血功能表现更差。根据以上因素建立的列线图预测模型,可对肝硬化患者PVST风险进行预测。

基于Portal的统一身份认证系统研究与开发

描述了基于Portal的统一身份认证系统的实现方法。整个系统主要由用户登录和注销管理、用户在不同应用系统中的操作权限管理和各个应用系统的信息管理三部分组成。文章详细介绍了采用"票证"技术解决用户对不同应用系统的持续访问,并给出了实现过程的主要数据结构。经过实际测试证明本系统有效地解决了用户重复登录和多点管理账号的问题,提高了用户的工作效率和应用系统的安全性。

基于Portal的装备保障信息系统设计与实现

装备保障信息系统是一个复杂的信息管理系统,业务覆盖面广,信息种类多,建立一个完善的装备保障信息系统需要多部门联合、多个开发团队共同完成;为了避免传统的WEB开发方式在系统整合和集成方面存在的操作繁琐、界面风格难以统一、维护升级困难等缺点,研究了Portal技术在装备保障信息系统建设领域中的应用,建立了5层体系结构和3层Portal结构,实现了可以灵活配置、支持多个团队开发的系统,验证了Portal技术是可以设计复杂系统的有效WEB开发方法。

基于Portal构架的企业门户系统设计与实现

随着互联网技术的快速发展,建设具有特色的企业门户系统成为一流企业的首要选择。目前,门户系统建设方案多种多样,主要针对Portal构架下企业门户系统进行了结构分析和设计,并对系统核心功能的实现进行了探讨。

一种网络安全数据库在植保机系统中的应用

针对我国现有植保机只能进行农药喷洒,并不能对病虫害进行预警而解决农作物病虫害的问题,对网络安全数据库在植保机系统的应用进行了研究。所设计的植保机DNN门户内容管理系统主要包括3层,分别为客户端、网络服务端和数据库端。为了使植保机系统可以根据数据库的数据对病虫害进行预警,同时保证数据库数据的安全,建立了粗糙集和BP神经网络的预警模型,包括采用粗糙集进行数据的预处理,并采用BP神经网络建立预警模型。为了验证植保机的DNN门户内容管理系统的有效性,利用采集到的样本对系统的运行进行了训练、验证和测试,结果表明:系统可以有效地对植物病虫害问题进行预警。