BACKGROUND A transjugular intrahepatic portosystemic shunt(TIPS)is widely placed to treat portal hypertension.Because the Viatorr®stent(W.L.Gore and Associates,Flagstaff,AZ,United States)is not available in all h...BACKGROUND A transjugular intrahepatic portosystemic shunt(TIPS)is widely placed to treat portal hypertension.Because the Viatorr®stent(W.L.Gore and Associates,Flagstaff,AZ,United States)is not available in all hospitals in China,the bare metal stent(BMS)/stent-graft combination technique is still popular for TIPS construction.Stent fracture is a complication after TIPS placement using this technique,with limited available literature focusing on it.AIM To assess the incidence of stent fracture after TIPS placement using the BMS/stent-graft combination technique and to identify the risk factors for stent fracture.We proposed technique modifications to improve the clinical results of TIPS placement with the BMS/stent-graft combination technique.METHODS We retrospectively analyzed the computed tomography(CT)data of all patients with portal hypertension who underwent the TIPS procedure between June 2011 and December 2021 in a single center.Patients implanted with the BMS/stent graft and had follow-up imaging data available were included.We identified patients with stent fracture and analyzed their characteristics.Multivariable logistic regression was applied to identify the potential predictors of stent fracture.RESULTS Of the 68 included patients,stent fracture occurred in seven(10.3%)patients.Based on CT images,the stent fractures were categorized into three types.Our study consisted of four(57.1%)type I fractures,one(14.3%)type II fracture,one(14.3%)type IIIa fracture,and one(14.3%)type IIIb fracture.After adjusting for covariates,multivariable logistic regression revealed that the risk factors for stent fracture were the implantation of a greater number of stents[adjusted odds ratio(aOR)=22.2,95%confidence interval(CI):1.2-415.4,P=0.038]and a larger proximal sagittal stent bending angle(aOR=1.1,95%CI:1.0-1.3,P=0.020).CONCLUSION Stent fracture occurred in approximately 10%of patients with portal hypertension who underwent TIPS with the BMS/stent-graft combination technique.The number of implanted stents and stent bending angle at the inferior vena cava end were predictors of stent fracture,which suggests that the incidence of stent fracture could potentially be reduced by procedural modifications.展开更多
公路工程BIM(building information modeling)设计与传统建筑工程相比体量大、施工路线长、易受周围地形影响,道路、桥梁和隧道作为公路工程的重要组成部分其结构具有较强的复杂性。为开展BIM技术在公路工程正向设计中的技术研究,弥补...公路工程BIM(building information modeling)设计与传统建筑工程相比体量大、施工路线长、易受周围地形影响,道路、桥梁和隧道作为公路工程的重要组成部分其结构具有较强的复杂性。为开展BIM技术在公路工程正向设计中的技术研究,弥补其应用不足,本文以Bentley三维协同设计管理平台为技术支持,基于BIM技术研究了公路工程正向设计的流程及方法,分析了基于BIM技术的道路、桥梁和隧道工程正向设计的关键技术,开展了基于Bentley平台公路工程量统计、模型优化出图和成果交付等功能应用。结果表明:通过开展公路工程BIM正向设计研究,提高了公路工程设计水平和信息化应用程度,为公路工程的三维可视化正向协同设计提供参考,对推进国内公路工程BIM正向设计的应用研究起到一定的指导作用。展开更多
文摘BACKGROUND A transjugular intrahepatic portosystemic shunt(TIPS)is widely placed to treat portal hypertension.Because the Viatorr®stent(W.L.Gore and Associates,Flagstaff,AZ,United States)is not available in all hospitals in China,the bare metal stent(BMS)/stent-graft combination technique is still popular for TIPS construction.Stent fracture is a complication after TIPS placement using this technique,with limited available literature focusing on it.AIM To assess the incidence of stent fracture after TIPS placement using the BMS/stent-graft combination technique and to identify the risk factors for stent fracture.We proposed technique modifications to improve the clinical results of TIPS placement with the BMS/stent-graft combination technique.METHODS We retrospectively analyzed the computed tomography(CT)data of all patients with portal hypertension who underwent the TIPS procedure between June 2011 and December 2021 in a single center.Patients implanted with the BMS/stent graft and had follow-up imaging data available were included.We identified patients with stent fracture and analyzed their characteristics.Multivariable logistic regression was applied to identify the potential predictors of stent fracture.RESULTS Of the 68 included patients,stent fracture occurred in seven(10.3%)patients.Based on CT images,the stent fractures were categorized into three types.Our study consisted of four(57.1%)type I fractures,one(14.3%)type II fracture,one(14.3%)type IIIa fracture,and one(14.3%)type IIIb fracture.After adjusting for covariates,multivariable logistic regression revealed that the risk factors for stent fracture were the implantation of a greater number of stents[adjusted odds ratio(aOR)=22.2,95%confidence interval(CI):1.2-415.4,P=0.038]and a larger proximal sagittal stent bending angle(aOR=1.1,95%CI:1.0-1.3,P=0.020).CONCLUSION Stent fracture occurred in approximately 10%of patients with portal hypertension who underwent TIPS with the BMS/stent-graft combination technique.The number of implanted stents and stent bending angle at the inferior vena cava end were predictors of stent fracture,which suggests that the incidence of stent fracture could potentially be reduced by procedural modifications.
文摘公路工程BIM(building information modeling)设计与传统建筑工程相比体量大、施工路线长、易受周围地形影响,道路、桥梁和隧道作为公路工程的重要组成部分其结构具有较强的复杂性。为开展BIM技术在公路工程正向设计中的技术研究,弥补其应用不足,本文以Bentley三维协同设计管理平台为技术支持,基于BIM技术研究了公路工程正向设计的流程及方法,分析了基于BIM技术的道路、桥梁和隧道工程正向设计的关键技术,开展了基于Bentley平台公路工程量统计、模型优化出图和成果交付等功能应用。结果表明:通过开展公路工程BIM正向设计研究,提高了公路工程设计水平和信息化应用程度,为公路工程的三维可视化正向协同设计提供参考,对推进国内公路工程BIM正向设计的应用研究起到一定的指导作用。
