Simultaneous portal vein thrombosis and splenic vein thrombosis in a COVID-19 patient:A case report and review of literature

BACKGROUND It is well-described that the coronavirus disease 2019(COVID-19)infection is associated with an increased risk of thrombotic complications.While there have been many cases of pulmonary emboli and deep vein thrombosis in these patients,reports of COVID-19 associated portal vein thrombosis(PVT)have been uncommon.We present a unique case of concomitant PVT and splenic artery thrombosis in a COVID-19 patient.CASE SUMMARY A 77-year-old-male with no history of liver disease presented with three days of left-sided abdominal pain.One week earlier,the patient was diagnosed with mildly symptomatic COVID-19 and was treated with nirmatrelvir/ritonavir.Physical exam revealed mild right and left lower quadrant tenderness,but was otherwise unremarkable.Significant laboratory findings included white blood cell count 12.5 K/μL,total bilirubin 1.6 mg/dL,aminoaspartate transferase 40 U/L,and alanine aminotransferase 61 U/L.Computed tomography of the abdomen and pelvis revealed acute PVT with thrombus extending from the distal portion of the main portal vein into the right and left branches.Also noted was a thrombus within the distal portion of the splenic artery with resulting splenic infarct.Hypercoagulable workup including prothrombin gene analysis,factor V Leiden,cardiolipin antibody,and JAK2 mutation were all negative.Anticoagulation with enoxaparin was initiated,and the patient’s pain improved.He was discharged on apixaban.CONCLUSION It is quite uncommon for PVT to present simultaneously with an arterial thrombotic occlusion,as in the case of our patient.Unusual thrombotic manifestations are classically linked to hypercoagulable states including malignancy and hereditary and autoimmune disorders.Viral infections such as Epstein-Barr virus,cytomegalovirus,viral hepatitis,and COVID-19 have all been found to increase the risk of splanchnic venous occlusions,including PVT.In our patient,prompt abdominal imaging led to early detection of thrombus,early treatment,and an excellent outcome.This case is unique in that it is the second known case within the literature of simultaneous PVT and splenic artery thrombosis in a COVID-19 patient.

Neutrophil extracellular traps mediate neuro-immunothrombosis

Neutrophil extracellular traps are primarily composed of DNA and histones and are released by neutrophils to promote inflammation and thrombosis when stimulated by various inflammato ry reactions.Neutrophil extracellular trap formation occurs through lytic and non-lytic pathways that can be further classified by formation mechanisms.Histones,von Willebrand factor,fibrin,and many other factors participate in the interplay between inflammation and thrombosis.Neuroimmunothrombosis summarizes the intricate interplay between inflammation and thrombosis during neural development and the pathogenesis of neurological diseases,providing cutting-edge insights into post-neurotrauma thrombotic events.The blood-brain barrier defends the brain and spinal cord against external assaults,and neutrophil extracellular trap involvement in blood-brain barrier disruption and immunothrombosis contributes substantially to secondary injuries in neurological diseases.Further research is needed to understand how neutrophil extracellular traps promote blood-brain barrier disruption and immunothrombosis,but recent studies have demonstrated that neutrophil extracellular traps play a crucial role in immunothrombosis,and identified modulators of neuro-immunothrombosis.However,these neurological diseases occur in blood vessels,and the mechanisms are unclear by which neutrophil extracellular traps penetrate the blood-brain barrier to participate in immunothrombosis in traumatic brain injury.This review discusses the role of neutrophil extracellular traps in neuro-immunothrombosis and explores potential therapeutic interventions to modulate neutrophil extracellular traps that may reduce immunothrombosis and improve traumatic brain injury outcomes.

Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer

BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression between the thrombosis group and the non-thrombosis group.Other aspects had no statistically significant differences(P>0.05).Multivariate regression analysis showed that age≥60 years,KPS score≤50 points,parenteral nutrition,stage III to IV,distant metastasis,bone marrow suppression,and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer(P<0.05).Catheter duration of 1-6 months and catheter duration>6 months were protective factors for PICC-related thrombosis(P<0.05).The predictive model for PICC-related thrombosis was obtained as follows:P predictive probability=[exp(Logit P)]/[1+exp(Logit P)],where Logit P=age×1.907+KPS score×2.045+parenteral nutrition×9.467+catheter duration×0.506+tumor-node-metastasis(TNM)staging×2.844+distant metastasis×2.065+bone marrow suppression×2.082+activities of daily living impairment×13.926.ROC curve analysis showed an area under the curve(AUC)of 0.827(95%CI:0.724-0.929,P<0.001),with a corresponding optimal cut-off value of 0.612,sensitivity of 0.755,and specificity of 0.857.Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence(P>0.05).ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets,respectively.CONCLUSION Age,KPS score,parenteral nutrition,TNM staging,distant metastasis,bone marrow suppression,and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer,while catheter duration is a protective factor for the disease.The predictive model has an AUC of 0.827,indicating high predictive accuracy and clinical value.

Current concepts in the management of non-cirrhotic non-malignant portal vein thrombosis

Non-cirrhotic non-malignant portal vein thrombosis(NCPVT)is an uncommon condition characterised by thrombosis of the portal vein,with or without extension into other mesenteric veins,in the absence of cirrhosis or intra-abdominal malignancy.Complications can include intestinal infarction,variceal bleeding and portal biliopathy.In this article,we address current concepts in the management of NCPVT including identification of risk factors,classification and treatment,and review the latest evidence on medical and interventional management options.

Advanced nanomedicines and immunotherapeutics to treat respiratory diseases especially COVID-19 induced thrombosis

Immunotherapy and associated immune regulation strategies gained huge attraction in order to be utilized for treatment and prevention of respiratory diseases.Engineering specifically nanomedicines can be used to regulate host immunity in lungs in the case of respiratory diseases including coronavirus disease 2019(COVID-19)infection.COVID-19 causes pulmonary embolisms,thus new therapeutic options are required to target thrombosis,as conventional treatment options are either not effective due to the complexity of the immunethrombosis pathophysiology.In this review,we discuss regulation of immune response in respiratory diseases especially COVID-19.We further discuss thrombosis and provide an overview of some antithrombotic nanoparticles,which can be used to develop nanomedicine against thrombo-inflammation induced by COVID-19 and other respiratory infectious diseases.We also elaborate the importance of immunomodulatory nanomedicines that can block pro-inflammatory signalling pathways,and thus can be recommended to treat respiratory infectious diseases.

Application of ultrasonography-elastography score to suspect porto-sinusoidal vascular disease in patients with portal vein thrombosis

Background:Porto-sinusoidal vascular disease(PSVD)and portal vein thrombosis(PVT)are causes of portal hypertension characterized respectively by an intrahepatic and a pre-hepatic obstacle to the flow in the portal system.As PVT may be a consequence of PSVD,in PVT patients at presentation,a pre-existing PSVD should be suspected.In these patients the identification of an underlying PSVD would have relevant implication regarding follow-up and therapeutic management,but it could be challenging.In this setting ultrasonography may be valuable in differential diagnosis.The aim of the study was to use ultrasonography to identify parameters to discriminate between PSVD and“pure”PVT and then to suspect PVT secondary to a pre-existing PSVD.Methods:Fifty-three patients with histologically proven PSVD and forty-eight patients affected by chronic PVT were enrolled and submitted to abdominal ultrasonography with elastography by acoustic radiation force impulse(ARFI).Results:ARFI was higher and superior mesenteric vein(SMV)diameter was wider in PSVD patients than in PVT patients.Thus,a prognostic score was obtained as linear combinations of the two parameters with a good discrimination capacity between PSVD and PVT(the area under the curve=0.780;95%confidence interval:0.690-0.869).Conclusions:A score based on ARFI and SMV diameter may be useful to suspect an underlying PSVD in patients with PVT and to identify a subgroup of patients to be submitted to liver biopsy.

Predictive model for non-malignant portal vein thrombosis associated with cirrhosis based on inflammatory biomarkers

BACKGROUND Portal vein thrombosis(PVT),a complication of liver cirrhosis,is a major public health concern.PVT prediction is the most effective method for PVT diagnosis and treatment.AIM To develop and validate a nomogram and network calculator based on clinical indicators to predict PVT in patients with cirrhosis.METHODS Patients with cirrhosis hospitalized between January 2016 and December 2021 at the First Hospital of Lanzhou University were screened and 643 patients with cirrhosis who met the eligibility criteria were retrieved.Following a 1:1 propensity score matching 572 patients with cirrhosis were screened,and relevant clinical data were collected.PVT risk factors were identified using the least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression analysis.Variance inflation factors and correlation matrix plots were used to analyze multicollinearity among the variables.A nomogram was constructed to predict the probability of PVT based on independent risk factors for PVT,and its predictive performance was verified using a receiver operating characteristic curve(ROC),calibration curves,and decision curve analysis(DCA).Finally,a network calculator was constructed based on the nomograms.RESULTS This study enrolled 286 cirrhosis patients with PVT and 286 without PVT.LASSO analysis revealed 13 variables as strongly associated with PVT occurrence.Multivariate logistic regression analysis revealed nine indicators as independent PVT risk factors,including etiology,ascites,gastroesophageal varices,platelet count,D-dimer,portal vein diameter,portal vein velocity,aspartate transaminase to neutrophil ratio index,and platelet-to-lymphocyte ratio.LASSO and correlation matrix plot results revealed no significant multicollinearity or correlation among the variables.A nomogram was constructed based on the screened independent risk factors.The nomogram had excellent predictive performance,with an area under the ROC curve of 0.821 and 0.829 in the training and testing groups,respectively.Calibration curves and DCA revealed its good clinical performance.Finally,the optimal cutoff value for the total nomogram score was 0.513.The sensitivity and specificity of the optimal cutoff values were 0.822 and 0.706,respectively.CONCLUSION A nomogram for predicting PVT occurrence was successfully developed and validated,and a network calculator was constructed.This can enable clinicians to rapidly and easily identify high PVT risk groups.

Analysis of The Effect of Bundled Nursing Intervention on Lung Cancer Patients with a High Risk of PICC-Related Thrombosis

Objective: To explore the effect of bundled nursing intervention on lung cancer patients with a high risk of PICC-related thrombosis. Methods: Eighty-six PICC patients were selected and randomly divided into a control group and an observation group of 43 patients each. The control group received general nursing care and the observation group received bundled nursing intervention based on the control group. The occurrence of venous thrombosis, quality of life score, Zung self-rating depression scale (SDS) score, self-rating anxiety (SAS) score, and nursing satisfaction after treatment were compared between the two groups. Results: The incidence rate of PICC-related venous thrombosis in the observation group (2/4.652%) was lower than that of the control group (13/30.231%) after nursing intervention (P < 0.05). After the intervention, the quality-of-life scores of the observation group were higher than those of the control group (P < 0.001). After the intervention, the SDS and SAS scores of the observation group were lower than those of the control group (P < 0.001). The nursing satisfaction rate of the observation group (41/ 4.652%) was higher than that of the control group (35/18.604%) (P < 0.05). The difference is statistically significant. Conclusion: In the care of lung cancer patients with a high risk of PICC-related thrombosis, bundled nursing care achieved better results.

Diagnostic Value of the Padua Score Combined with Thrombotic Biomarker Tissue Plasminogen Activator Inhibitor-1 (tPAI-1) Detection for the Risk of Deep Vein Thrombosis in Patients with Pulmonary Heart Disease

This study explores the diagnostic value of combining the Padua score with the thrombotic biomarker tissue plasminogen activator inhibitor-1(tPAI-1)for assessing the risk of deep vein thrombosis(DVT)in patients with pulmonary heart disease.These patients often exhibit symptoms similar to venous thrombosis,such as dyspnea and bilateral lower limb swelling,complicating differential diagnosis.The Padua Prediction Score assesses the risk of venous thromboembolism(VTE)in hospitalized patients,while tPAI-1,a key fibrinolytic system inhibitor,indicates a hypercoagulable state.Clinical data from hospitalized patients with cor pulmonale were retrospectively analyzed.ROC curves compared the diagnostic value of the Padua score,tPAI-1 levels,and their combined model for predicting DVT risk.Results showed that tPAI-1 levels were significantly higher in DVT patients compared to non-DVT patients.The Padua score demonstrated a sensitivity of 82.61%and a specificity of 55.26%at a cutoff value of 3.The combined model had a significantly higher AUC than the Padua score alone,indicating better discriminatory ability in diagnosing DVT risk.The combination of the Padua score and tPAI-1 detection significantly improves the accuracy of diagnosing DVT risk in patients with pulmonary heart disease,reducing missed and incorrect diagnoses.This study provides a comprehensive assessment tool for clinicians,enhancing the diagnosis and treatment of patients with cor pulmonale complicated by DVT.Future research should validate these findings in larger samples and explore additional thrombotic biomarkers to optimize the predictive model.

Mechanism of anti-arterial thrombosis of Dahuangzhecong Fang screened by Ti-Al intermetallic compound porous material

The mechanism of antithrombotic of Dahuangzhechong Fang separated and purified by Ti-Al intermetallic compound porous material (TAICPM) was researched. Dahuangzhechong Fang, which was isolated and screened by TAICPM, was used to oral rats. At the end of study, their blood and thrombus were collected. The results show that TAICPM with the pore size of 1-5 μm can screen Dahuangzhechong Fang well. Dahuangzhechong Fang can increase 6-keto-PGF1α, lower content of TXD2 and platelet. Dahuangzhechong Fang has good effect to resist arterial thrombosis.

基于顶空-固相微萃取-气相色谱-质谱和顶空-气相色谱-离子迁移谱技术结合化学计量法分析芜菁冻干片挥发性成分

为探究不同品种芜菁冻干片中挥发性有机物(volatile organic compounds,VOCs)的差异,采用顶空-固相微萃取-气相色谱-质谱(headspace solid phase microextraction gas chromatography-mass spectrometry,HS-SPME-GC-MS)和顶空-气相色谱-离子迁移谱(headspace gas chromatography-ion mobility spectrometry,HS-GC-IMS)对紫色、黄色和白色3种芜菁冻干片的VOCs进行分析,并结合主成分分析(principal component analysis,PCA)和偏最小二乘判别法(partial least squares-discriminant analysis,PLS-DA)等化学计量法探究不同品种芜菁冻干片挥发性成分的差异。结果表明,通过HS-SPME-GC-MS共解析出96种VOCs,包括醛类、醇类、酮类、含硫化合物、酯类、酸类等化合物,其中含硫化合物和酯类为芜菁冻干片中相对含量最高的化合物种类;HS-GC-IMS共解析出94种VOCs,包括醛类、酯类、酮类及含硫化合物等挥发性成分。HS-SPME-GC-MS和HS-GC-IMS检出的挥发性物质种类和含量存在差异,共有VOCs有15种,二者结果互为补充,结合使用可以较全面系统地表征芜菁冻干片的挥发性成分。PCA和PLS-DA结果表明,2种方法均能够有效区分3种芜菁冻干片。通过变量投影重要度分别筛选了59种和23种差异VOCs,该结果可为芜菁冻干片VOCs的差异分析提供参考方法。

见光诱导催化合成3,4-二氢异喹啉-1(2H)-酮及其衍生物

建立了一种在温和条件下,用可见光催化合成一系列3,4-二氢异喹啉-1(2H)-酮及其衍生物的方法。该方法在室温条件下,以2-烯丙基-N-甲氧基苯甲酰胺为模板底物,以碘化钾作为光催化剂,25 W 460 nm的蓝色LED灯照射下,合成一系列3,4-二氢异喹啉-1(2H)-酮衍生物,最高产率可达到83%。该合成路径具有底物适用范围广、经济实用等特点,为3,4-二氢异喹啉-1(2H)-酮衍生物合成提供了一种经济简便的方法。

“五闭-五到-心力”教学路径改革探索——以汽车类材料科学基础课程为例

针对学生学情与教材传统内容兼容度低、“五闭”与学习效率低、脆弱知识多与学科思维少的三大教学难点,通过“一体两翼与思政”螯合提出重组教学内容,三大教学理念引领课堂升级,三大教学目标重在因材施教等创新举措;通过信息技术与传统教学深度融合,强化师生互动,优化教学活动,完善考核机制,获得教学目标达成度良好、学生发展态势凸显、教学模式辐射、跟踪学生学习的教改效果。课程构建并实施了打开学生“五闭”,达成“五到-心力”转变,实现沉浸式教学模式,这不仅提升了教学广度与深度,还展示出良好的教学效果,同时还具有迁移应用。

基于CNCSCOLOR的色相-色调感性模型构建

中国应用色彩体系(CNCSCOLOR)基于中国人眼视觉实验所开发,但在国外色彩体系的早期市场占有下没有得到广泛应用。本研究尝试开发一套易于学习推广的模型,以促进其普及和应用。首先通过对三维色彩体系的研究分析,借鉴日本PCCS色彩体系,构建了简化的二维色相-色调基本模型,其中色调融合了色彩属性明度和彩度。模型用直角坐标定位,水平轴为彩度,垂直轴为明度,5种无彩色将明度轴分为四段,12个20色色相环即12种有彩色色调,按照明度与彩度的大小有序分布于平面内。确定构成基本模型的240种有彩色和5种无彩色的选色规则,选出色彩,组合完善基本模型。其次,研究确定12种有彩色色调的感性,得到色相-色调感性模型。通过主观调查初步分析得到有彩色色调的感性,再实施客观眼动实验进一步验证调查结果,最终确定12个有彩色色调的感性分别是鲜明的、明快的、强烈的、浑厚的、清新的、淡雅的、浑浊的、厚重的、浅淡的、暗淡的、灰暗的、黑暗的。研究得到的色相-色调模型包含的色彩数量少,采用二维的平面布局,使初学者易懂易记,便于普及应用;且色调命名符合中国人的情感特征,将用于后续的感性配色模型构建,便于设计师和消费者快速进行精准的产品色彩搭配,对中国本土色彩体系的发展和色彩设计水平的提升具有实际的应用价值。

现代医院管理制度下激励-协调-监督机制应用于医护人员培训管理中的效果分析

目的研究现代医院管理制度下激励-协调-监督机制应用于医护人员培训管理中的效果并进行分析。方法选取2022年2月—2024年2月于医院工作的84例医护人员开展研究。将其按照时间点分作参考组(n=42,2022年2月—2023年2月)及研究组(n=42,2023年3月—2024年2月)。参考组开展常规管理,研究组则开展基于激励-协调-监督机制的管理。对比两组管理质量,不良事件发生情况,管理满意度,核心能力。结果研究组文化建设、奖惩机制、上报制度及沟通协调机制评分均高于参考组(均P<0.05)。研究组不良事件发生率低于参考组(7.14%vs 23.81%)(P<0.05)。研究组管理方式、管理内容、管理形式及沟通技巧满意度分别为95.24%、92.86%、97.62%、95.24%,均高于参考组的78.57%、73.81%、76.19%、73.81%(均P<0.05)。研究组各项核心能力评分均高于参考组(均P<0.05)。结论激励-协调-监督机制应用于医护人员培训管理中的效果较佳,可提高管理质量、管理满意度及核心能力,且能减少不良事件的发生。

Liver transplantation and resection in patients with hepatocellular cancer and portal vein tumor thrombosis: Feasible and effective?

Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy,have given some hope to prolong survival in them.This review summarized recent evidence in literature regarding the possible role of liver resection(LR)and liver transplantation(LT)in patients with locally advanced HCC and PVTT with no extrahepatic disease.Downstaging therapies have helped make curative resection or LT a reality in selected patients.This review emphasizes on the key points to focus on when considering surgery in these patients,who are usually relegated to palliative systemic therapy alone.Meticulous patient selection based on tumor biology,documented downstaging based on imaging and decrease in tumor marker levels,and an adequate waiting period to demonstrate stable disease,may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.

ε-聚赖氨酸对苹果灰霉病菌的抑菌机制

为研究ε-聚赖氨酸(ε-PL)对苹果灰霉病菌Botrytis cinerea的抑制效果及其机制。用不同浓度的ε-PL处理B.cinerea,研究其对B.cinerea的菌落直径、孢子萌发、菌丝生长及对苹果灰霉病防治效果的影响,同时考察B.cinerea细胞通透性、抗氧化酶活性、细胞可溶性蛋白与核酸的泄漏、丙二醛含量及活性氧的变化规律。结果表明:ε-PL对B.cinerea的最小抑菌浓度为400 mg/L,该浓度的ε-PL能有效控制苹果灰霉病;100 mg/L以上的ε-PL能显著抑制B.cinerea孢子萌发和菌丝生长(P<0.05),破坏孢子膜结构,增大孢子细胞的通透性,造成可溶性蛋白与核酸发生泄漏,使孢子形态呈现萎缩干瘪、甚至溶解现象;此外,100 mg/L以上的ε-PL能显著降低B.cinerea的超氧化物歧化酶、多酚氧化酶和过氧化氢酶的活性,升高丙二醛含量(P<0.05)。综上,ε-PL能通过破坏B.cinerea孢子细胞膜结构、增大细胞通透性、抑制抗氧化酶活性、促进活性氧的积累,进而增大孢子膜的脂质过氧化程度,损伤孢子结构,最终抑制苹果灰霉病菌的生长。此项研究可为ε-PL在苹果采后病害防治中的应用打下基础,具有较高的应用价值。

基于KY3H中医体质辨识-评估-干预系统辨证治疗先兆流产临床研究

目的:观察在常规治疗基础上基于KY3H中医体质辨识-评估-干预系统辨证治疗先兆流产的临床疗效。方法:选取2022年7月—2023年6月在浙江中医药大学附属温州市中医院治疗的600例先兆流产患者,以随机数字表法分为对照组与观察组各300例。对照组予以常规治疗,观察组在对照组基础上根据体质类型针对性给予中药汤剂治疗。2组均治疗2周。比较2组临床疗效、性激素水平及保胎成功率。结果:治疗2周后,总有效率观察组93.00%(279/300),高于对照组87.67%(263/300),差异有统计学意义(P<0.05)。2组血清孕酮(P)、雌二醇(E2)、人绒毛膜促性腺激素(HCG)水平均较治疗前升高,观察组血清P、E2、HCG水平均高于对照组,差异均有统计学意义(P<0.05)。保胎成功率观察组90.67%(272/300),高于对照组83.67%(251/300),差异有统计学意义(P<0.05)。结论:在常规治疗基础上基于KY3H中医体质辨识-评估-干预系统辨证治疗先兆流产能提高P、E2、HCG水平,改善妊娠结局。

基于船舶-流场运动耦合的内河航道设计方法

航道一般指江河及运河内可供船舶通航的水域,目前大多采用流场演化规律分析结合工程人员经验的方法开展规划设计,对通行船舶这一因素考虑不够全面.拟从河道中船舶与流场直接作用的角度提出一种内河航道设计方法.首先,基于Fluent二次开发,突破了船舶-流场相互作用的水动力响应解耦算法,对内河航段中船舶自由漂流运动进行模拟,其中,流场使用有限体积法进行求解,船舶运动控制方程通过用户自定义模块(UDF)输入并采用四阶Runge-Kutta法求解,动网格技术用于更新计算域;然后,考虑航行频率,给予通行船型不同权重,使用加权最小二乘法对漂流轨迹进行曲线拟合,得到航道边界线.选取了长江东流(从天生洲起)这一具有典型碍航结构物(弯道、分汊)航段开展航道设计验证.研究结果表明:设计的航道与现行规划航道趋势一致;同时,结合流场细节云图对船舶运动响应过程进行分析,发现设计的航道可使船舶有效规避风险急流、斜流,合理利用水流动能,提升航行安全性和经济性.

Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate

Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic decompensation.Portal flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT development.However,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still elusive.In particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as yet.Moreover,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction progression.Anticoagulation and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still unknown.Nevertheless,their impact on mortality rates should be addressed more extensively.In this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.