Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.

Geology and Geochemistry of K-feldspar Veins in Lamprophyre at the Zhenyuan Gold Deposit,Yunnan,Southwest China:Implications for Gold Mineralization

Lamprophyres typically appear in hydrothermal gold deposits.The relationship between lamprophyres and gold deposits is investigated widely.Some researchers suggest that the emplacement of lamprophyres triggers gold mineralization,whereas others hypothesize that the formation of lamprophyres increases the fertility of mantle sources and ore-forming fluids.K-feldspar veins,with ages between those of lamprophyres and gold deposits,appear in lamprophyres in Zhenyuan.Therefore,K-feldspar veins are ideal for investigating the relationship between lamprophyres and gold deposits.Phlogopite in K-feldspar veins has lower Mg#,Ni,and Cr contents and higher TiO2,Li,Ba,Sr,Sc,Zr,Nb,and Cs contents than phlogopite in lamprophyres.The in-situ Sr isotopic values of apatites(0.7063–0.7066)in K-feldspar veins are within the range for apatites(0.7064–0.7078)from lamprophyres.High large-ion lithophile element concentrations and low Nb and Ta concentrations in phlogopite from lamprophyres,in addition to high(87Sr/86Sr)i values of apatite(0.7064–0.7078),indicate that the magma parental to these phlogopite and apatite crystals is derived from an enriched mantle.Kfeldspar veins are genetically correlated with lamprophyres,whereas sulfide mineral assemblage and trace element compositions of pyrite in K-feldspar veins suggest that K-feldspar veins in lamprophyres are not directly related to gold mineralization of the Zhenyuan deposit.

Further study on the genesis of lamellar calcite veins in lacustrine black shale--A case study of Paleogene in Dongying Depression, China

Lamellar calcite veins are prevalent in carbonate-rich,lacustrine dark shale.The formation mechanisms of these veins have been extensively debated,focusing on factors such as timing,depth,material source,and driving forces.This paper examines dark lacustrine shale lamellar calcite veins in the Paleogene strata of Dongying Depression,using various analytical techniques:petrography,isotope geochemistry,cathodoluminescence,inclusion thermometry,and electron probe micro-analysis.Two distinct types of calcite veins have been identified:granular calcite veins and sparry calcite veins.These two types differ significantly in color,grain structure,morphology,and inclusions.Through further investigation,it was observed that vein generation occurred from the shallow burial period to the maturation of organic matter,with a transition from granular calcite veins to sparry calcite veins.The granular calcite veins exhibit characteristics associated with the shallow burial period,including plastically deformed laminae and veins,the development of strawberry pyrite,the absence of oil and gas,weak fractionation in oxygen isotopes,and their contact relationship with sparry calcite veins.These granular calcite veins were likely influenced by the reduction of sulfate bacteria.On the other hand,sparry calcite veins with fibrous grains are antitaxial and closely linked to the evolution and maturation of organic matter.They contain oil and gas inclusions and show a distribution range of homogenization temperature between 90℃ and 120℃ and strong fractionation in oxygen isotopes,indicating formation during the hydrocarbon expulsion period.The carbon isotope analysis of the surrounding rocks and veins suggests that the material for vein formation originates from the shale itself,specifically authigenic micritic calcite modified by the action of methanogens.The opening of horizontal fractures and vein formation is likely driven by fluid overpressure resulting from undercompaction and hydrocarbon expulsion.Veins may form rapidly or through multi-stage composite processes.Early veins are predominantly formed in situ,while late veins are a result of continuous fluid migration and convergence.Furthermore,the veins continue to undergo modification even after formation.This study emphasizes that the formation of lamellar calcite veins in shale is a complex diagenetic process influenced by multiple factors:biology,organic matter,and inorganic processes,all operating at various stages throughout the shale's diagenetic history.

Modeling Blood Flow in Veins of Uniform Properties (Giraffe Jugular Vein)

This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The effects of inertial and inclination angles that have not been discussed previously have been included. It has been shown that different flows for a uniform tube (vein) are possible. However, this flow matches that of a jugular vein which is supercritical, and the steady solution has been given by the balance between the driving forces of gravity and the viscous resistance to the flow at the right atrium of the heart must be sub-critical for a fixed right-atrium pressure which means that an elastic jump is required to return the flow to sub-critical from the supercritical flow upstream this type of relationship gives rise to flow limitation at the same time given any right atrium fixed pressure there exists a maximum flow rate which when exceeded the boundary conditions of the flow do not hold boundary conditions at the right atrium are not satisfied hence making the steady flow impossible this mechanism of flow limitation is slightly different from the other one in that causes airways through forced expiration from the observation made it is clearly shown that there is an intravascular pressure difference with a change in height.

Sclerotherapy as the Only Treatment for Varicose Veins

Background: Chronic venous insufficiency (CVI) is a widespread and underdiagnosed condition that affects more than 20% of the general population. The most prevalent manifestation of CVI is varicose veins (VVs), which affect up to 25% of women and 15% of males. Sclerotherapy is a minimally invasive procedure used primarily in treating telangiectasias, reticular veins, and small varicose veins. Objectives: This study aims to evaluate the efficacy and safety of various sclerotherapy techniques in treating varicose veins-related complications. Methods: We conducted a cross-sectional observational interventional study at Jordan University Hospital (JUH) from September 2022 to January 2023. The study involved patients with lower limb varicose veins, assessing their clinical response and monitoring potential treatment complications. Statistical analyses were performed using SPSS software version 21.0. Results: Of 567 patients with diagnosed VVs, 544 were female (95.94%), and 23 were male (4.06%). The primary complaints were pain and cosmetic concerns. Treatments included Foam Aethoxysklerol® 3% (polidocanol) and Micro-foam Aethoxysklerol® 1%. Improvement in symptoms was reported by 538 patients (94.89%). The most common adverse event was hyperpigmentation, reported in 120 patients (21.16%), followed by post-procedural pain in 104 patients (18.34%). Notably, one patient (0.18%) experienced deep vein thrombosis (DVT), one (0.18%) reported telangiectatic matting, and there were two cases (0.36%) of visual disturbances and one allergic reaction. Conclusion: Sclerotherapy is effective and safe for treating VVs with minimal adverse events. It is a viable standalone treatment, reducing complications linked to other methods like radiofrequency ablation and surgery.

Benefit in physical function and quality of life to nonsurgical treatment of varicose veins: Pilot study

BACKGROUND Studies on varicose veins have focused its effects on physical function;however,whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear.Moreover,the differences in such functions between individuals with varicose veins and healthy individuals remain unclear.AIM To investigate changes in physical function and the quality of life(QOL)following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity.METHODS We enrolled 37 participants(those with varicose veins,n=17;healthy individuals,n=20).We performed the following measurements pre-and post-nonsurgical treatment in the varicose vein patients and healthy individuals:Calf muscle oxygenation during the two-minute step test,open eyes one-leg stance,30 s sit-to-stand test,visual analog scale(VAS)for pain,Pittsburgh sleep quality index,physical activity assessment,and QOL assessment.RESULTS Varicose veins patients and healthy individuals differ in most variables(physical function,sleep quality,and QOL).Varicose veins patients showed significant differences between pre-and post-nonsurgical treatment—results in the 30 sit-to-stand test[14.41(2.45)to 16.35(4.11),P=0.018],two-minute step test[162.29(25.98)to 170.65(23.80),P=0.037],VAS for pain[5.35(1.90)to 3.88(1.73),P=0.004],and QOL[39.34(19.98)to 26.69(17.02),P=0.005];however,no significant difference was observed for muscle oxygenation.CONCLUSION Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients,bringing their condition close to that of healthy individuals.Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.

Multidetector computer tomography and magnetic resonance imaging of double superior mesenteric veins:A case report

BACKGROUND This study aimed to describe the findings of double superior mesenteric veins(SMVs),a rare anatomical variation,on multidetector computer tomography(MDCT)and magnetic resonance imaging(MRI)images.CASE SUMMARY We describe the case of a 34-year-old male,who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis.MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein(SMV),the double SMVs.CONCLUSION The double SMVs are a congenital abnormality without potential clinical manifestation.Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.

Automatic Detection and Characterization of Human Veins Using Infra-Red Image Processing

The detection and characterization of human veins using infrared (IR) image processing have gained significant attention due to its potential applications in biometric identification, medical diagnostics, and vein-based authentication systems. This paper presents a low-cost approach for automatic detection and characterization of human veins from IR images. The proposed method uses image processing techniques including segmentation, feature extraction, and, pattern recognition algorithms. Initially, the IR images are preprocessed to enhance vein structures and reduce noise. Subsequently, a CLAHE algorithm is employed to extract vein regions based on their unique IR absorption properties. Features such as vein thickness, orientation, and branching patterns are extracted using mathematical morphology and directional filters. Finally, a classification framework is implemented to categorize veins and distinguish them from surrounding tissues or artifacts. A setup based on Raspberry Pi was used. Experimental results of IR images demonstrate the effectiveness and robustness of the proposed approach in accurately detecting and characterizing human. The developed system shows promising for integration into applications requiring reliable and secure identification based on vein patterns. Our work provides an effective and low-cost solution for nursing staff in low and middle-income countries to perform a safe and accurate venipuncture.

In vivo quantification of human aqueous veins by enhanced depth imaging optical coherence tomography and optical coherence tomography angiography images

AIM:To investigate the aqueous vein in vivo by using enhanced depth imaging optical coherence tomography(EDI-OCT)and optical coherence tomography angiography(OCTA).METHODS:In this cross-sectional comparative study,30 healthy participants were enrolled.Images of the aqueous and conjunctival veins were captured by EDI-OCT and OCTA before and after water loading.The area,height,width,location depth and blood flow of the aqueous vein and conjunctival vein were measured by Image J software.RESULTS:In the static state,the area of the aqueous vein was 8166.7±3272.7μm^(2),which was smaller than that of the conjunctival vein(13690±7457μm^(2),P<0.001).The mean blood flow density of the aqueous vein was 35.3%±12.6%,which was significantly less than that of the conjunctival vein(51.5%±10.6%,P<0.001).After water loading,the area of the aqueous vein decreased significantly from 8725.8±779.4μm^(2)(baseline)to 7005.2±566.2μm^(2)at 45min but rose to 7863.0±703.2μm^(2)at 60min(P=0.032).The blood flow density of the aqueous vein decreased significantly from 41.2%±4.5%(baseline)to 35.4%±3.2%at 30min but returned to 45.6%±3.6%at 60min(P=0.021).CONCLUSION:The structure and blood flow density of the aqueous vein can be effectively evaluated by OCT and OCTA.These may become biological indicators to evaluate aqueous vein changes and aqueous outflow resistance under different interventions in glaucoma patients.

Comprehensive review of hepatocellular carcinoma with portal vein tumor thrombus:State of art and future perspectives

Background:Despite advances in the diagnosis of patients with hepatocellular carcinoma(HCC),70%-80%of patients are diagnosed with advanced stage disease.Portal vein tumor thrombus(PVTT)is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated.Data sources:A systematic search of MEDLINE(PubMed),Embase,Cochrane Library and Database for Systematic Reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases until December 2022 was conducted using free text and MeSH terms:hepatocellular carcinoma,portal vein tumor thrombus,portal vein thrombosis,vascular invasion,liver and/or hepatic resection,liver transplantation,and systematic review.Results:Centers of surgical excellence have reported promising results related to the individualized surgical management of portal thrombus versus arterial chemoembolization or systemic chemotherapy.Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus,accurate identification of the subgroups of patients who may benefit from resection,as well as meticulous surgical technique.This review addressed five specific areas:(a)formation of PVTT;(b)classifications of PVTT;(c)controversies related to clinical guidelines;(d)surgical treatments versus non-surgical approaches;and(e)characterization of surgical techniques correlated with classifications of PVTT.Conclusions:Current evidence from Chinese and Japanese high-volume centers demonstrated that patients with HCC and associated PVTT can be managed with surgical resection with acceptable results.

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.

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Phlebosclerosis: An overlooked complication of varicose veins that affects clinical outcome: A case report

BACKGROUND Phlebosclerosis is a common age-related fibrotic degeneration of the venous wall.It is a disorder rather than a disease,which may cause venous dysfunction and even venous thrombosis.It is rarely reported in patients with varicose veins.CASE SUMMARY The present report describes the case of a 70-year-old man with varicose veins,vitiligo,and phlebosclerosis.Venous angiography revealed blood reflux in the superficial and deep veins.The patient underwent surgery to remove the saphe-nous veins.During the operation,a calcified vein resembling a wooden stick was found,which was surprisingly extracted from the thickened venous wall.A cross-section of this wooden stick-like vein revealed venous fibrosis and calcification,obvious thickening of the venous wall,extensive collagen deposition on the venous wall,hyaline degeneration,and venous sclerosis causing closure of the venous lumen.CONCLUSION This is probably the first report of a wooden stick-like structure being found in the venous wall in patients with varicose veins and venous ulcers.Phlebosclerosis can be observed in the late stage of varicose veins complicated by frequent infections and worse clinical outcomes.Therefore,it is important to be aware of this condition and address it rather than overlook it.

Conversion therapy of a giant hepatocellular carcinoma with portal vein thrombus and inferior vena cava thrombus:A case report and review of literature

BACKGROUND The prognosis of hepatocellular carcinoma(HCC)combined with portal and hepatic vein cancerous thrombosis is poor,for unresectable patients the combination of targeted therapy and immune therapy was the first-line recommended treatment for advanced HCC,with a median survival time of only about 2.7-6 months.In this case report,we present the case of a patient with portal and hepatic vein cancerous thrombosis who achieved pathologic complete response after conversion therapy.CASE SUMMARY In our center,a patient with giant HCC combined with portal vein tumor thrombus and hepatic vein tumor thrombus was treated with transcatheter arterial chemoembolization(TACE),radiotherapy,targeted therapy and immunotherapy,and was continuously given icaritin soft capsules for oral regulation.After 7 months of conversion therapy,the patient's tumor shrank and the tumor thrombus subsided significantly.The pathology of surgical resection was in complete remission,and there was no progression in the postoperative follow-up for 7 months,which provided a basis for the future strategy of combined conversion therapy.CONCLUSION In this case,atezolizumab,bevacizumab,icaritin soft capsules combined with radiotherapy and TACE had a good effect.For patients with hepatocellular carcinoma combined with hepatic vein/inferior vena cava tumor thrombus,adopting a high-intensity,multimodal proactive strategy under the guidance of multidisciplinary team(MDT)is an important attempt to break through the current treatment dilemma.

Intrahepatic portal venous systems in adult patients with cavernous transformation of portal vein: Imaging features and a new classification

Background: Cavernous transformation of the portal vein(CTPV) due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in the hepatic hilum. This study aimed to investigate the imaging features of intrahepatic portal vein in adult patients with CTPV and establish the relationship between the manifestations of intrahepatic portal vein and the progression of CTPV. Methods: We retrospectively analyzed 14 CTPV patients in Beijing Tsinghua Changgung Hospital. All patients underwent both direct portal venography(DPV) and computed tomography angiography(CTA) to reveal the manifestations of the portal venous system. The vessels measured included the left portal vein(LPV), right portal vein(RPV), main portal vein(MPV) and the portal vein bifurcation(PVB). Results: Nine males and 5 females, with a median age of 40.5 years, were included in the study. No significant difference was found in the diameters of the LPV or RPV measured by DPV and CTA. The visualization in terms of LPV, RPV and PVB measured by DPV was higher than that by CTA. There was a significant association between LPV/RPV and PVB/MPV in term of visibility revealed with DPV( P = 0.01), while this association was not observed with CTA. According to the imaging features of the portal vein measured by DPV, CTPV was classified into three categories to facilitate the diagnosis and treatment. Conclusions: DPV was more accurate than CTA for revealing the course of the intrahepatic portal vein in patients with CTPV. The classification of CTPV, that originated from the imaging features of the portal vein revealed by DPV, may provide a new perspective for the diagnosis and treatment of CTPV.

Intelligent diagnosis of retinal vein occlusion based on color fundus photographs

AIM:To develop an artificial intelligence(AI)diagnosis model based on deep learning(DL)algorithm to diagnose different types of retinal vein occlusion(RVO)by recognizing color fundus photographs(CFPs).METHODS:Totally 914 CFPs of healthy people and patients with RVO were collected as experimental data sets,and used to train,verify and test the diagnostic model of RVO.All the images were divided into four categories[normal,central retinal vein occlusion(CRVO),branch retinal vein occlusion(BRVO),and macular retinal vein occlusion(MRVO)]by three fundus disease experts.Swin Transformer was used to build the RVO diagnosis model,and different types of RVO diagnosis experiments were conducted.The model’s performance was compared to that of the experts.RESULTS:The accuracy of the model in the diagnosis of normal,CRVO,BRVO,and MRVO reached 1.000,0.978,0.957,and 0.978;the specificity reached 1.000,0.986,0.982,and 0.976;the sensitivity reached 1.000,0.955,0.917,and 1.000;the F1-Sore reached 1.000,0.9550.943,and 0.887 respectively.In addition,the area under curve of normal,CRVO,BRVO,and MRVO diagnosed by the diagnostic model were 1.000,0.900,0.959 and 0.970,respectively.The diagnostic results were highly consistent with those of fundus disease experts,and the diagnostic performance was superior.CONCLUSION:The diagnostic model developed in this study can well diagnose different types of RVO,effectively relieve the work pressure of clinicians,and provide help for the follow-up clinical diagnosis and treatment of RVO patients.

Transcatheter arterial chemoembolization combined with PD-1 inhibitors and Lenvatinib for hepatocellular carcinoma with portal vein tumor thrombus

BACKGROUND Hepatocellular carcinoma(HCC)patients complicated with portal vein tumor thrombus(PVTT)exhibit poor prognoses and treatment responses.AIM To investigate efficacies and safety of the combination of PD-1 inhibitor,transcatheter arterial chemoembolization(TACE)and Lenvatinib in HCC subjects comorbid with PVTT.METHODS From January 2019 to December 2020,HCC patients with PVTT types Ⅰ-Ⅳ were retrospectively enrolled at Beijing Ditan Hospital.They were distributed to either the PTL or TACE/Lenvatinib(TL)group.The median progression-free survival(mPFS)was set as the primary endpoint,while parameters like median overall survival,objective response rate,disease control rate(DCR),and toxicity level served as secondary endpoints.RESULTS Forty-one eligible patients were finally recruited for this study and divided into the PTL(n=18)and TL(n=23)groups.For a median follow-up of 21.8 months,the DCRs were 88.9%and 60.9%in the PTL and TL groups(P=0.046),res-pectively.Moreover,mPFS indicated significant improvement(HR=0.25;P<0.001)in PTL-treated patients(5.4 months)compared to TL-treated(2.7 months)patients.There were no treatment-related deaths or differences in adverse events in either group.CONCLUSION A triplet regimen of PTL was safe and well-tolerated as well as exhibited favorable efficacy over the TL regimen for advanced-stage HCC patients with PVTT types Ⅰ-Ⅳ.

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.

Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein:A case report

BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.

Enlightenment of calcite veins in deep Ordovician Wufeng-Silurian Longmaxi shales fractures to migration and enrichment of shale gas in southern Sichuan Basin, SW China

The relationship between fracture calcite veins and shale gas enrichment in the deep Ordovician Wufeng Formation-Silurian Longmaxi Formation (Wufeng-Longmaxi) shales in southern Sichuan Basin was investigated through core and thin section observations, cathodoluminescence analysis, isotopic geochemistry analysis, fluid inclusion testing, and basin simulation. Tectonic fracture calcite veins mainly in the undulating part of the structure and non-tectonic fracture calcite veins are mainly formed in the gentle part of the structure. The latter, mainly induced by hydrocarbon generation, occurred at the stage of peak oil and gas generation, while the former turned up with the formation of Luzhou paleouplift during the Indosinian. Under the influence of hydrocarbon generation pressurization process, fractures were opened and closed frequently, and oil and gas episodic activities are recorded by veins. The formation pressure coefficient at the maximum paleodepth exceeds 2.0. The formation uplift stage after the Late Yanshanian is the key period for shale gas migration. Shale gas migrates along the bedding to the high part of the structure. The greater the structural fluctuation is, the more intense the shale gas migration activity is, and the loss is more. The gentler the formation is, the weaker the shale gas migration activity is, and the loss is less. The shale gas enrichment in the core of gentle anticlines and gentle synclines is relatively higher.