The Influence of a Fermentation‐Resistant Glucose Diet on the Glucose Concentration and Other Metabolites in Portal and Jugular Blood in Cows

The goal of this study was to determine the effect of fermentation‐resistant glucose on the glucose concentration and other metabolites in portal and jugular blood in 15 non‐lactating cows. In all cows, an indwelling catheter was placed in the left jugular vein and the portal vein for collection of blood samples. Five control cows were fed hay as a normal diet, five control cows were fed straw to induce an energy deficit and five cows were fed hay and they received additionally 2000 g of a fermentation‐resistant d ‐glucose product. The glucose concentration in jugular and portal blood was not influenced by feeding. The concentration of urea and bile acids were significantly higher in portal blood than jugular blood. There was no difference between portal and jugular blood of glucose and total solids. Diet had a significant effect on the concentrations of ammonia, urea, free fatty acids and triglycerides. The concentrations of ammonia and urea were higher in blood of cows fed straw than in blood of cows fed either hay or a fermentation‐resistant glucose product. The concentration of urea remained constant in cows fed hay, but increased in cows fed straw and decreased in cows fed a fermentation‐resistant glucose product. The concentration of free fatty acids and triglycerides were significantly higher in cows fed a fermentation‐resistant glucose product than in cows fed hay. In the present study, a single administration of 300 g of fermentation‐resistant glucose did not affect the concentration of blood glucose. Therefore, despite ongoing promotion of such products, there is no indication at this time that administration of fermentation‐resistant glucose to cows at the start of lactation results in an increase in blood glucose concentration.     

经脾静脉置管预防脾切除断流术后早期门静脉血栓

目的 评价经脾静脉置管抗凝治疗对脾切除断流术后门静脉血栓形成的预防效果及安全性.方法 60例择期行脾切除断流术的门脉高压上消化道出血患者随机分为置管组和对照组,采用超声多普勒和（或）强化螺旋CT 扫描监测术后门静脉血栓形成情况.结果 60例患者全部随访3个月,对照组累计门静脉血栓发生率为56.7%,置管组为16.7%,两组比较,差异有统计学意义（P ＜0.05）.经脾静脉置管以200U/h的剂量输入肝素溶液对体循环静脉血凝血酶原时间和活化部分凝血活酶时间无影响.结论 断流术后经脾静脉置管抗凝治疗能有效降低门脉高压脾切除断流术后早期门静脉血栓形成,是安全可行的.     

脾切除断流术后经脾静脉抗凝治疗预防早期门静脉血栓的安全性分析

目的 评价经脾静脉置管抗凝治疗预防脾切除断流术后早期门静脉血栓(PVT)形成的安全性.方法 60例择期行脾切除断流术的门脉高压患者随机分为置管组和对照组,采用超声多普勒和(或)强化螺旋CT扫描监测术后门静脉血栓形成情况.结果 60例患者全部随访到3个月.对照组累计PVT发生率56.7%置管组为16.7%,两组有统计学差异(P<0.05).经脾静脉置管输入肝素溶液对体循环静脉血凝血酶原时间和活化部分凝血活酶时间无影响.结论 经脾静脉置管抗凝治疗预防脾切除断流术后早期门静脉血栓形成是安全可行的.     

Ultrasound‐Guided Catheterization of the Portal Vein in 11 Cows Using the Seldinger Technique

Catheterization of the portal vein using the Seldinger technique [Acta Radiol. (1958) 38 , 368] was performed in 11 cows. Ultrasound‐guided percutaneous portocentesis, using a 25‐cm, 14‐gauge steel cannula, was performed from the 10th, 11th or 12th intercostal space on the right side. A stylet was placed through the cannula, which was then removed, and a polyurethane balloon‐tipped catheter was advanced over the stylet into the portal vein and sutured to the skin ( Seldinger, 1952 ). Blood samples were collected from the catheter at least once daily. The catheter was removed 9–15 days later when blood could no longer be aspirated. The cows were then slaughtered and a post‐mortem examination was performed. During the study, appetite remained normal in nine of 11 cows. In three cows, the general behaviour and demeanour were mildly, but transiently, abnormal. Four cows had leucopoenia. The most frequently encountered problem was occlusion of the catheter, which usually was resolved by flushing with heparinized saline. The most common post‐mortem lesion observed was an increase in fibrous connective tissue at the site of cannulation. In nine of 11 cows, there was a thrombus in the portal vein at the site of catheterization. Generally, the severity of the lesions was mild. The results of this study demonstrated that ultrasound‐guided percutaneous catheterization of the portal vein, using the Seldinger technique, is possible in cows. The catheter may be left in place for collection of blood samples for up to 15 days.     

Thrombolysis via an Operatively Placed Mesenteric Catheter for Portal and Superior Mesenteric Vein Thrombosis: Report of a Case

Mesenteric venous thrombosis (MVT) is a catastrophic form of mesenteric vascular occlusion. In the absence of peritoneal signs, anticoagulation therapy should be started immediately. For selected patients, thrombolysis through the superior mesenteric artery (SMA), jugular vein, or portal vein via a transhepatic route might be successful; however, exploratory laparotomy is mandatory when peritoneal signs develop. We report a case of acute MVT associated with protein C and S deficiency, treated successfully by limited bowel resection and simultaneous thrombolytic infusion, given via an operatively placed mesenteric vein catheter.     

Glucose or Essential Amino Acid Infusions in Late Pregnant and Early Lactating Simmenthal Cows Failed to Induce a Leptin Response

To assess the leptin response to metabolic challenges, three Italian Simmental cows were infused for 6 h: with (a) saline (control); (b) glucose; and (c) amino acid solutions according to a 3 × 3 Latin square experiment. The infusions were carried out at the 36th week of pregnancy, and the second and 12th week of the following lactation. At each of the three infusion periods, blood samples were collected from the jugular vein before and 15, 30, 120, 180, 240, 300 and 360 min after the beginning of each infusion. All samples were analysed for leptin, insulin, glucagon, growth hormone (GH), glucose, non‐esterified fatty acids (NEFA) and urea. The physiological phase of the cows significantly affected the basal concentrations of insulin, glucagon, urea and NEFA. The infusion of both glucose and the amino acid solutions did not affect leptin concentrations. Insulin response was significantly increased when animals were infused with the glucose solution and, within treatment, the greatest response was observed at the 12th week of lactation. The greatest glucagon response was observed when infusing the amino acid solution. Urea response to all treatments increased from the dry period to the 12th week of lactation. The GH and NEFA responses were not affected by treatments. The Multi Species radio‐immunoassay used in this study showed a lower sensitivity for ruminant leptin which may partially explain the lack of significant leptin variations. However, it can be hypothesized that leptin variations around parturition can be affected by the negative energy balance, and leptin release is not acutely affected by glucose and amino acid availability. In addition, no short‐term relationship were found between insulin, glucagon and GH and leptin release in Italian Simmental cows during the dry period and early lactation.     

浅静脉穿刺留置套管针在FOLFOX4方案化疗中的应用和护理

为观察浅静脉穿刺留置套管针在FOLFOX4方案化疗中的应用效果,回顾分析于我科接受FOLFOX4方案化疗的180例结直肠癌患者病例资料,根据持续静脉滴注的方式,分为浅静脉留置针组（试验组,128例）、颈内静脉置管组（对照I组,32例）和经外周静脉穿刺中心静脉置管（PICC）组（对照Ⅱ组,20例）。对各组穿刺时间、一次穿刺成功率及不良反应发生率进行统计比较。结果显示,180例患者中,试验组穿刺明显快于对照组,且一次穿刺成功率明显高于对照组,各组间不良反应发生率无明显差异。结果表明,浅静脉穿刺留置套管针安全、有效,操作简单、快捷,穿刺点选取方便,对静脉损伤小,避免了颈内静脉置管和PICC的不足,降低了静脉感染的发生率,是一种经济、简单易行的方法。     

可视化超声用于输液港植入全流程医护一体化管理

目的 观察可视化超声用于输液港植入前、中、后全流程医护一体化管理的价值。方法 选取133例于化学治疗前接受输液港植入的恶性肿瘤患者,其中106例经颈内静脉、27例经腋静脉植入;并观察植入前、中、后的临床及超声资料,分析超声对其全流程医护一体化管理的价值。结果 133例患者中,术前超声发现一侧颈内静脉狭窄4例,一侧颈内静脉先天走行变异2例,一侧颈内静脉血栓2例。133例均成功一次性穿刺植入输液港。术后发现27例经腋静脉植入输液港中,导管异位于右侧颈内静脉1例;106例经颈内静脉植入输液港中,导管附壁血栓13例,导管折断并异位3例,注射座周围皮下软组织感染2例,注射座翻转1例;以相应措施干预后,患者一般情况均良好。结论 可视化超声可于植入输液港前评估拟穿刺血管、于植入中实时引导穿刺、于植入后密切监控,实现输液港植入全流程医护一体化管理。     

右美托咪定经门静脉预处理对肝部分切除术患者术中炎症反应和氧化应激的影响

目的探讨右美托咪定经门静脉预处理对肝部分切除术患者术中肝脏缺血-再灌注损伤中炎症反应和氧化应激的影响。方法拟在全麻下行肝部分切除术患者60例,男34例,女26例,年龄25~64岁,体重55~70 kg,ASAⅡ级,肝功能Child-Pugh A级。采用随机数字表法将患者分为三组,每组20例。DP组在游离出门静脉后经门静脉输注右美托咪定1.0μg/kg,DJ组在游离出门静脉后经颈内静脉输注右美托咪定1.0μg/kg,C组给予等容量生理盐水。分别于肝门阻断前10 min、肝门开放后1、6、12、24 h经颈内静脉采血检测血清ALT、AST、TNF-α、IL-33、高迁移率族蛋白1(HMGB1)、血红素氧合酶-1(HO-1)浓度和超氧化物歧化酶(SOD)活性。结果与肝门阻断前10 min比较,肝门开放后1、6、12、24 h三组血清ALT、AST、TNF-α、IL-33、HMGB1和HO-1浓度明显升高,SOD活性明显降低(P<0.05)。与C组比较,肝门开放后1、6、12、24 h DP组和DJ组血清ALT、AST、TNF-α、IL-33、HMGB1浓度明显降低,HO-1浓度和SOD活性明显升高(P<0.05)。与DJ组比较,肝门开放后1、6、12、24 h DP组血清ALT、AST、TNF-α、IL-33、HMGB1浓度明显降低,HO-1浓度和SOD活性明显升高(P<0.05)。结论经门静脉输注右美托咪定能更有效抑制炎症反应和氧化应激,增强机体抗炎抗氧化能力,减轻肝部分切除术患者肝缺血-再灌注损伤。     

Thromboelastographic evaluation of mini-dose heparin in minor surgical procedures

Five dogs weighing approximately 10 kg were anesthetized with pentobarbital sodium 30 mg/kg intravenously (IV) and an initial sample of blood was drawn by jugular venipuncture for control values of thromboelastography (TEG). Immediately after venipuncture, mini-dose heparin (80 units/kg) was administered subcutaneously. One hour later, 0.5 ml blood was obtained by (A) jugular venipuncture for TEG, and an indwelling catheter immediately introduced into a femoral vein by cut-down. Blood samples for TEG were obtained via cut-down at (B) 15 min (C) 30 min, and (D) 60 min after cut-down. Low-dose heparin had no effect on the hemostatic parameters as measured by TEG and did not prevent the accelerated coagulation associated with surgery.     

Reversal of hepatic steatosis in rats by addition of glucagon to total parenteral nutrition (TPN)

Infusion of total parenteral nutrition (TPN) with excess carbohydrate calories leads to hepatic steatosis in rats that is associated with an elevated portal insulin/glucagon molar ratio. Previously we have shown that adding glucagon to TPN prevents hepatic steatosis in rats. In this study we attempted to reverse the steatosis by adding glucagon to TPN after 1 week of TPN alone. Adult rats (n = 28) received internal jugular catheters: Group 1 (n = 7), saline (3 cc/h) and chow ad libitum; Group 2 (n = 7), 25% dextrose base TPN solution for 1 week; Group 3 (n = 7), 25% dextrose base TPN for 2 weeks; Group 4 (n = 7), 25% dextrose base TPN for 1 week and then glucagon (15 micrograms/100 g/day) added to TPN for the second week. The infusion rate of TPN was 1.2 ml/100 g/hr (40% kcal greater than control). At 7 days (Group 2) and 14 days (Groups 1, 3, and 4) portal and peripheral venous blood levels were drawn for insulin and glucagon radioimmunoassay, blood glucose determination, and liver function tests; livers were removed for histology and lipid content determination. Blood glucose was equivalent among all groups. Liver function tests were within normal limits. Panlobular vacuolization of the hepatocytes was noted on histology in Groups 2 and 3. Hepatic lipid content was significantly elevated in Group 3. The portal insulin/glucagon molar ratio was increased because of excessive portal venous insulin in Groups 2 and 3 (P less than 0.05 by ANOVA). In contrast, portal venous insulin and the insulin/glucagon molar ratio did not increase in Group 4 and hepatic lipid infiltration was absent when glucagon was added to the TPN solution after 1 week of TPN solution alone. The results suggest that the addition of glucagon to hypertonic dextrose TPN is not only protective in preventing hepatic steatosis, but may reverse steatosis, possibly by increasing hepatic lipid export.     

Portal vein afferents are critical for the sympathoadrenal response to hypoglycemia

We sought to elucidate the role of the portal vein afferents in the sympathetic response to hypoglycemia. Laparotomy was performed on 27 male Wistar rats. Portal veins were painted with either 90% phenol (denervation group [PDN]) or 0.9% saline solution (sham-operated group [SHAM]). Rats were chronically cannulated in the carotid artery (sampling), jugular vein (infusion), and portal vein (infusion). After a recovery period of 5 days, animals were exposed to a hyperinsulinemic-hypoglycemic clamp, with glucose infused either portally (POR) or peripherally (PER). In all animals, systemic hypoglycemia (2.48+/-0.09 mmol/l) was induced via jugular vein insulin infusion (50 mU x kg(-1) x min(-1)). Arterial plasma catecholamines were assessed at basal (-30 and 0 min) and during sustained hypoglycemia (60, 75, 90, and 105 min). By design, portal vein glucose concentrations were significantly elevated during POR versus PER (4.4+/-0.14 vs. 2.5+/-0.07 mmol/l; P<0.01, respectively) for both PDN and SHAM. There were no significant differences in arterial glucose or insulin concentration between the four experimental conditions at any point in time. When portal glycemia and systemic glycemia fell concomitantly (SHAM-PER), epinephrine increased 12-fold above basal (3.75+/-0.34 and 44.56+/-6.1 nmol/l; P<0.001). However, maintenance of portal normoglycemia (SHAM-POR) caused a 50% suppression of the epinephrine response, despite cerebral hypoglycemia (22.2+/-3.1 nmol/l, P<0.001). Portal denervation resulted in a significant blunting of the sympathoadrenal response to whole-body hypoglycemia (PDN-PER 27.6+/-3.8 nmol/l vs. SHAM-PER; P<0.002). In contrast to the sham experiments, there was no further suppression in arterial epinephrine concentrations observed during PDN-POR versus PDN-PER (P = 0.8). These findings indicate that portal vein afferent innervation is critical for hypoglycemic detection and normal sympathoadrenal counterregulation.     

Metabolic Profiles and Bile Acid Extraction Rate in the Liver of Cows with Fasting‐induced Hepatic Lipidosis

This study was designed to monitor lipid profile in the portal and hepatic blood of cows with fasting‐induced hepatic lipidosis, and to compare the results with those in the jugular blood. The work was also carried out to investigate bile acid (BA) in these vessels, and further to investigate BA extraction rate in the liver. Five cows were equipped with catheters in the portal, hepatic and jugular veins (day 0), fasted for 4 days (day 1–day 4) and then refed (day 5–day 11). Before morning feeding, blood was sampled before, during and after fasting from the catheterized vessels. In the portal blood, the concentration of non‐esterified fatty acids (NEFA) showed a progressive increase and at day 5 there was an approximate twofold rise. Increased NEFA concentrations were also found similarly in the other two veins. At day 5, β‐hydroxybutyrate (BHBA) in the portal, hepatic and jugular blood rose to 197, 190 and 186% of the pre‐fasting value, respectively. However, the concentrations of NEFA and BHBA in the three veins gradually returned to pre‐fasting concentration during the refeeding period. Compared with the pre‐fasting value at day 0, the content of liver triglyceride (TG) increased significantly at day 5 (P < 0.01). In the liver, the hepatic extraction rate of BA dropped from 3.1 times pre‐fasting to 2.2 times during fasting. There were no significant differences in the concentrations of glucose, TG, total cholesterol, cholesterol esters, free cholesterol and phospholipids. The results of the current study show that metabolic alterations occur in the portal, hepatic and jugular veins during induction of hepatic lipidosis in cows, and mostly metabolites, with exception of BA concentration, run parallel. The decreased BA extraction rate in the liver of fasted cows was considered to reflect hepatic cell impairment caused by TG accumulation. Hopefully, the findings, at least in part, contribute to the explanation of the pathophysiology of hepatic lipidosis in dairy cows.     

Analysis of potential predictors of internal jugular vein stenosis and the anatomic position in hemodialysis patients

Objective To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients. Methods A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy. Results Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23%, 36.52%, 41.11% and 3.14% respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P﹤0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1%. The right internal jugular vein stenosis rate was 66.4% and 44.1% in the age﹤65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0% and 32.8% (P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95% CI 1.083-2.568, P=0.020). Conclusions There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.     

1500例临时静脉留置导管透析的临床分析

目的探讨临时静脉内留置导管透析的血管选择、透析效果、并发症、影响因素及处理。方法静脉置管后观察导管血流量、留置时间、尿素清除指数（Kt／V）、再循环、血液流变学指标、并发症及其影响因素。结果颈内静脉、锁骨下静脉、股静脉是留置导管静脉常选静脉。1500例静脉留置导管总体使用良好，透析充分，Kt／V平均1．20±0．35；导管再循环率低为（10．5±2．5）％；留置导管常见的并发症依次为血流量不足、栓塞、感染、导管脱落等。大多数能通过调整导管位置、导管内溶栓及抗感染等处理改善；5例反复发生栓塞者血纤维蛋白原显著升高；导管尖端位于右心房者与上腔静脉者比较，前者具有更好的血流量、再循环率低[（285±50．5）ml／minVS（205±45．5）ml／mim（8±3．5）％VS（12±4．5）％，（P〈0．05）]；导管腔内高浓度肝素与低浓度肝素比较，前者导管留置时间明显延长（P〈0．05），检塞发生率减少（P〈0．05）。结论临时静脉内留置导管透析血流量充分，透析疗效确切。留置导管常见的并发症有血流量不足、栓塞、感染等，绝大多数能通过处理矫正。导管尖端位置、导管腔肝素浓度、血液粘度等对导管成活、血流量不足、栓塞有重要影响。     

Metabolic sensors mediate hypoglycemic detection at the portal vein

The current study sought to ascertain whether portal vein glucose sensing is mediated by a metabolic fuel sensor analogous to other metabolic sensors presumed to mediate hypoglycemic detection (e.g., hypothalamic metabosensors). We examined the impact of selectively elevating portal vein concentrations of lactate, pyruvate, or beta-hydroxybutyrate (BHB) on the sympathoadrenal response to insulin-induced hypoglycemia. Male Wistar rats (n = 36), chronically cannulated in the carotid artery (sampling), jugular vein (infusion), and portal vein (infusion), underwent hyperinsulinemic-hypoglycemic ( approximately 2.5 mmol/l) clamps with either portal or jugular vein infusions of lactate, pyruvate, or BHB. By design, arterial concentrations of glucose and the selected metabolite were matched between portal and jugular (NS). Portal vein concentrations were significantly elevated in portal versus jugular (P < 0.0001) for lactate (5.03 +/- 0.2 vs. 0.84 +/- 0.08 mmol/l), pyruvate (1.81 +/- 0.21 vs. 0.42 +/- 0.03 mmol/l), or BHB (2.02 +/- 0.1 vs. 0.16 +/- 0.03 mmol/l). Elevating portal lactate or pyruvate suppressed both the epinephrine (64% decrease; P < 0.01) and norepinephrine (75% decrease; P < 0.05) responses to hypoglycemia. In contrast, elevating portal BHB levels failed to impact epinephrine (P = 0.51) or norepinephrine (P = 0.47) levels during hypoglycemia. These findings indicate that hypoglycemic detection at the portal vein is mediated by a sensor responding to some metabolic event(s) subsequent to the uptake and oxidation of glucose.     

Computed Tomography (CT) Venography Using a Multidetector CT Prior to the Percutaneous External Jugular Vein Approach for an Implantable Venous-Access Port

Background and Purpose

The objective of this study was to determine the success rate and complications of using the percutaneous approach of the external jugular vein (EJV) for placement of a totally implantable venous-access port (TIVAP) with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V).

Methods

A prospective cohort study of 45 patients in whom placement of a TIVAP was attempted via the right EJV was conducted. The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using a Multidetector Helical 16-section CT. The angulation between the right EJV and the right subclavian vein, anterior jugular vein, transverse cervical vein, and suprascapular vein was estimated.

Results

CT-V success was achieved in 45 of 45 patients (100 %). A plexus of veins under the clavicle was most commonly responsible for the insertion of the central venous catheter. The EJV approach resulted in a successful cannulation rate of 93 %. No initial complications of pneumothorax or carotid artery puncture occurred during insertion procedures. Late complications occurred in three patients. These included one port erosion (2 %), one catheter occlusion (2 %), and one wound hematoma (2 %). Catheter-related infections were observed in one patient (2 %).

Conclusions

The percutaneous EJV approach with CT-V guidance is an optional method for patients with multiple central venous cannulations, those in hemodialysis, or those with long catheter indwelling periods.     

Glucose sensing by the hepatoportal sensor is GLUT2-dependent: in vivo analysis in GLUT2-null mice

In the preceding article, we demonstrated that activation of the hepatoportal glucose sensor led to a paradoxical development of hypoglycemia that was associated with increased glucose utilization by a subset of tissues. In this study, we tested whether GLUT2 plays a role in the portal glucose-sensing system that is similar to its involvement in pancreatic beta-cells. Awake RIPGLUT1 x GLUT2-/- and control mice were infused with glucose through the portal (Po-) or the femoral (Fe-) vein for 3 h at a rate equivalent to the endogenous glucose production rate. Blood glucose and plasma insulin concentrations were continuously monitored. Glucose turnover, glycolysis, and glycogen synthesis rates were determined by the 3H-glucose infusion technique. We showed that portal glucose infusion in RIPGLUT1 x GLUT24-/- mice did not induce the hypoglycemia observed in control mice but, in contrast, led to a transient hyperglycemic state followed by a return to normoglycemia; this glycemic pattern was similar to that observed in control Fe-mice and RIPGLUT1 x GLUT2-/- Fe-mice. Plasma insulin profiles during the infusion period were similar in control and RIPGLUT1 x GLUT2-/- Po- and Fe-mice. The lack of hypoglycemia development in RIPGLUT1 x GLUT2-/- mice was not due to the absence of GLUT2 in the liver. Indeed, reexpression by transgenesis of this transporter in hepatocytes did not restore the development of hypoglycemia after initiating portal vein glucose infusion. In the absence of GLUT2, glucose turnover increased in Po-mice to the same extent as that in RIPGLUT1 x GLUT2-/- or control Fe-mice. Finally, co-infusion of somatostatin with glucose prevented development of hypoglycemia in control Po-mice, but it did not affect the glycemia or insulinemia of RIPGLUT1 x GLUT2-/- Po-mice. Together, our data demonstrate that GLUT2 is required for the function of the hepatoportal glucose sensor and that somatostatin could inhibit the glucose signal by interfering with GLUT2-expressing sensing units.     

体位改变时经颈内静脉植入胸壁式输液港导管头端位置变化及影响因素

目的观察由卧位至立位经颈内静脉植入胸壁式输液港导管头端位置变化,并分析其影响因素。方法回顾性分析171例接受颈内静脉植入胸壁港患者,均于术后拍摄卧位和立位X线胸片,测量由卧位至立位时导管头端移动距离,采用Pearson相关分析及多元回归分析观察导管头端移动距离的影响因素。结果由卧位至立位时导管头端呈向头侧移位倾向,平均移动距离(15.82±16.87)mm。导管头端移动距离与性别(P=0.039)及皮脂厚度(P=0.011)呈正相关,与留置导管长度(P=0.039)呈负相关。结论由卧位至立位时,经颈内静脉植入胸壁式输液港导管头端倾向于向头侧移位,移动距离与患者性别、皮脂厚度及留置导管长度相关。     

Intrahepatic Segmental Portal Vein Thrombosis After Living-Related Donor Liver Transplantation

Background

Intrahepatic segmental portal vein thrombosis after living-related liver transplantation (LRLT) is uncommon. The cause remains unclear.

Methods

After providing written informed consent, 25 recipients receiving LRLT at our institution from January 2011 to September 2013 were enrolled in this study. We performed triphase computerized tomographic (CT) study of the liver graft of each recipient 1 month after LRLT. The patencies of hepatic artery, portal vein, and hepatic vein were evaluated in detail. The triphase CT scans of the liver of each donor before transplantation also were reviewed. Thrombosis of the intrahepatic segmental portal vein was defined as the occlusion site of the portal vein being intrahepatic. Extrahepatic portal vein thrombosis was excluded in this study.

Results

Among the 25 patients, 2 (8%) developed thrombosis of intrahepatic segmental portal vein. One 47-year-old man received LRLT for hepatitis B viral infection–related liver cirrhosis (Child-Pugh class C) with 3 hepatocellular carcinomas (total tumor volume <8 cm). Another 53-year-old man received LRLT for alcoholic liver cirrhosis (Child-Pugh class C). Both had developed progressive jaundice and cholangitis 1 month after surgery. Intrahepatic biliary stricture was found on the follow-up magnetic resonance images. However, liver triphase CT study demonstrated occlusion of intrahepatic portal vein of segment 8 in each patient. Radiologic interventions and balloon dilatation therapy via percutaneous transhepatic biliary drainage route improved the symptoms and signs of cholangitis and obstructive jaundice for both.

Conclusions

Thrombosis of intrahepatic segmental portal vein is not common but is usually associated with complications of intrahepatic bile duct. Early detection is important, and follow-up CT study of liver is suggested.