Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding: A series of six cases and literature review

ObjectivesTo present a case series of modified transjugular intrahepatic portosystemic shunts (TIPS) and percutaneous transhepatic intrahepatic portosystemic shunts (PTIPS) in cirrhotic patients with variceal bleeding (VB). In addition, the scientific literature pertaining to PTIPS was reviewed.MethodsThis retrospective clinical case series included six cirrhotic patients with VB who were treated with PTIPS after the failure of endoscopic band ligation or endoscopic injection sclerotherapy combined with vasoactive drugs. The treatment was conducted between January 2017 and June 2019 at a single institution. Three patients suffered from severe atrophy of the right or left lobar of the liver as well as the main right or left branch of the portal vein. The remaining three patients showed severe atrophy of the whole liver and portal vein, resulting in widening of the liver fissure. A paired t-test was used to compare the changes in portal pressure gradient between before and after the PTIPS operation. The rebleeding rate, treatment efficacy, complications, and technical success rate were all assessed during follow-up.ResultsAll six PTIPS procedures were performed successfully, with no severe procedural-related complications observed. None of the patients experienced VB during a mean follow-up of 22.8 (range, 18.0–28.0) months. The mean portosystemic pressure gradient decreased from 28.3 ​± ​4.3 ​mmHg pre-procedure to 12.3 ​± ​2.6 ​mmHg immediately post-procedure (P ​< ​0.001). At follow-up, one patient was found to have developed grade 2 hepatic encephalopathy thrice during the first year, according to the West Haven criteria. However, this was resolved following medical treatment.ConclusionsWhen the patient’s portal venous anatomy is unconducive to the performance of TIPS using the transjugular approach, PTIPS can be considered as a safe, effective complementary surgical approach for patients with VB.     

Gallbladder neuroendocrine carcinoma diagnosis,treatment and prognosis based on the SEER database: A literature review

BACKGROUNDGallbladder neuroendocrine carcinoma (GB-NEC) has a low incidence rate; therefore, its clinical characteristics, diagnosis, treatment and prognosis are not well explored. AIMTo review recent research and analyze corresponding data in the Surveillance Epidemiology and End Results (SEER) database. METHODSData of GB-NEC (n = 287) and gallbladder adenocarcinoma (GB-ADC) (n = 19 484) patients from 1975 to 2016 were extracted from the SEER database. Survival analysis was performed using Kaplan–Meier and Cox proportional hazards regression. P < 0.05 was considered statistically significant. We also reviewed 108 studies retrieved from PubMed and Reference Citation Analysis (https://www.referencecitationanalysis.com/). The keywords used for the search were: (Carcinoma, Neuroendocrine) AND (Gallbladder Neoplasms). RESULTSThe GB-NEC incidence rate was 1.6% (of all gallbladder carcinomas), male to female ratio was 1:2 and the median survival time was 7 mo. The 1-, 2-, 3- and 5-year overall survival (OS) was 36.6%, 17.8%, 13.2% and 7.3% respectively. Serum chromogranin A levels may be a specific tumor marker for the diagnosis of GB-NEC. Elevated carcinoembryonic antigen, carbohydrate antigen (CA)-19-9 and CA-125 levels were associated with poor prognosis. Age [hazard ratio (HR) = 1.027, 95% confidence interval (CI): 1.006–1.047, P = 0.01] and liver metastasis (HR = 3.055, 95% CI: 1.839–5.075, P < 0.001) are independent prognostic risk factors for OS. Patients with advanced GB-NEC treated with surgical resection combined with radiotherapy and/or chemotherapy may have a better prognosis than those treated with surgical resection alone. There was no significant difference in OS between GB-NEC and GB-ADC.CONCLUSIONThe clinical manifestations and prognosis of GB-NEC are similar to GB-ADC, but the treatment is completely different. Early diagnosis and treatment are the top priorities.     

儿童进行性家族性肝内胆汁淤积症3型一例并文献复习

目的 探讨进行性家族性肝内胆汁淤积症3型（PFIC3）的临床及遗传学特点。方法 报道1例PFIC3病例。以“儿童”“进行性家族性肝内胆汁淤积症3型”（包括中英文）为检索词,对以下数据库的相关论文进行检索：PubMed、中国生物医学文献服务系统（SinoMed）、CNKI、万方数据知识服务平台、维普中文科技期刊数据库,收...     

妊娠期肝内胆汁淤积症96例临床治疗体会

目的探讨妊娠期肝内胆汁淤积症(ICP)对母儿的影响。方法将2008年1月～2010年12月本院住院的96例ICP患者(观察组)与同期其他随机抽取的正常孕妇106名产妇(对照组)进行比较。结果 ICP早产儿(25%);胎儿宫内窘迫(31.58%);低体重儿(19.74%);围产儿死亡(3.95%);明显高于对照组(P<0.01)。剖宫产率(87.5%);产后出血(21.88%);明显高于对照组(P<0.01)。结论妊娠期肝内胆汁淤积症对母婴危害极大,应提高认识,加强孕期监护,提高围生儿生存率,降低产科并发症。     

Isolated scaphoid dislocation: A case report and review of literature

BACKGROUNDIsolated dislocations of the scaphoid are extremely rare types of injuries, commonly associated with severe ligament disruptions, and are occasionally misdiagnosed. Treatment options for dislocations of the scaphoid mainly include closed reduction, with or without internal fixation, and open reduction with ligament repair.CASE SUMMARYA 59-year-old male worker sustained a twisting trauma of his right wrist, caused by a moving belt while he was operating a machine. When he presented at our emergency department, the patient complained of swelling, tenderness, and restriction of movement of the right wrist. Radiographs confirmed a primary complex partial radial dislocation of the scaphoid and some chip fractures of the capitate and hamate. Closed reduction with K-wire internal fixation was performed with the assistance of arthroscopy, and an excellent prognosis was achieved.CONCLUSIONArthroscopy-assisted reduction is a minimally invasive method to reduce the dislocated scaphoid and maintain the blood supply.     

Molecular targeted therapy causes hepatic encephalopathy in patients after Transjugular intrahepatic portosystemic shunt (TIPS): A case report and literature review

We report two cases of hepatic encephalopathy caused by molecular targeted drugs after the Transjugular intrahepatic portosystemic shunt (TIPS) procedure in our center. The liver toxicities and anti-angiogenic effects induced by targeted drugs may generate an imbalance in ammonia metabolism, elevating blood ammonia levels. TIPS diverts partial blood supply from the liver, aggravates liver impairment, and shunts ammonia-rich blood from the intestine into the systemic circulation. These may be the mechanisms leading to hepatic encephalopathy caused by molecular targeted drugs following TIPS. When clinicians choose molecular targeted therapy as the second or third targeted therapy for patients who have undergone TIPS, the consequence of drug-induced hepatic encephalopathy should also be considered.     

Temporary pacemaker protected transjugular intrahepatic portosystemic shunt in a patient with acute variceal bleeding and bradyarrhythmia: A case report

BACKGROUNDEsophagogastric varices are a common complication of cirrhosis with portal hypertension and endoscopic treatment has been recognized as a primary preventive and therapeutic option for such patients; however, it should be noted that bradyarrhythmia is regarded as one of the contraindications to endoscopic examination. Meanwhile, acute variceal bleeding may result in a high mortality rate in cirrhotic patients with portal hypertension accompanied by bradyarrhythmia. At present, there is an absence of reports concerning the treatment of such group of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS). The present report details the case of a cirrhotic patient with acute variceal bleeding accompanied by bradyarrhythmia who underwent TIPS under temporary pacemaker protection.CASE SUMMARYWe report the case of a 64-year-old male patient who was confirmed with bradyarrhythmia by ambulatory electrocardiogram 24 h before the operation. The patient was successfully treated by TIPS under temporary pacemaker protection.CONCLUSIONIn terms of cirrhotic patients with abnormal cardiac electrophysiological conduction, TIPS may be effective in reducing the complications of portal hypertension following the exclusion of severe pulmonary hypertension and heart failure, showing moderate feasibility in clinical applications.     

Eligibility of the movement-based classification systems in the diagnosis of patients with low back pain: A systematic review

ObjectiveTo evaluate the eligibility of the movement-based classification systems in the diagnosis of patients with low back pain.MethodsThe present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta -Analysis guidelines. Different databases including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest and Google Scholar were searched from January 1990 to December 2017. All studies assessed the reliability and validity of the movement-based classification systems to diagnose patients with low back pain were included. The keywords used to search the studies were: “reliability”, “validity”, “classification”, “movement impairment” and “low back pain”. Study selection and data extraction were performed by two independent reviewers.ResultsSixteen articles were met the inclusion criteria. Of these articles, 13 studies assessed the reliability and validity of movement-based classification systems to categorize patients with low back pain. Two out of 16 articles compared patients with low back pain and healthy subjects and one article had no control group.ConclusionsThe results of the reviewed studies demonstrated that movement-based classification systems are valid and reliable enough to categorize patients with low back pain.     

Endoscopic diagnosis and treatment of an appendiceal mucocele: A case report

BACKGROUNDAppendiceal mucocele is a rare disease that causes obstructive dilatation of the appendix due to the intraluminal accumulation of mucin. We report a case of endoscopic diagnosis and treatment of an appendiceal mucocele.CASE SUMMARYA 47-year-old man presented with a protrusion around the orifice of the appendix discovered by colonoscopy incidentally. He was admitted to our hospital for a routine checkup without any symptoms. Abdominal computed tomography showed a cystic mass approximately 3 cm in diameter with fat stranding. The preoperative diagnosis was non-neoplastic appendiceal mucocele, and endoscopic treatment was performed. The endoscopic findings and pathological results supported our preoperative diagnosis. The endoscopic treatment of appendiceal mucocele was feasible and effective, which was confirmed by repeated endoscopy and post-operative computed tomography after 7 mo. CONCLUSIONEndoscopic therapy provides a new method for the treatment of appendiceal mucocele.     

ABCB4基因外显子12和23突变与妊娠期肝内胆汁淤积症的关系

目的：探讨ABCB4基因外显子12和23的突变与妊娠期肝内胆汁淤积症（ICP）发病的关系。方法：从31例ICP患者外周血标本中提取出基因组DNA，聚合酶链反应（PCR）扩增ABCB4基因外显子12和23，PCR产物经DNA序列测定检测突变情况。结果：31例ICP患者均扩增出ABCB4基因外显子12和23的靶基因片段，未见外显子12和23的缺失,DNA测序分析31例ICP患者ABCB4基因外显子12和23，未发现点突变。结论：ABCB4基因外显子12和23的突变与中国皖南地区的ICP发生无关或关联很小，皖南地区ICP患者中可能存在其他ABCB4基因突变热点。ABCB4基因的突变与中国人ICP发病的相关性仍应进行更大样本的研究和其他外显子的筛查。     

A psychotechnological review on eye-tracking systems: towards user experience

Purpose: The aim of the present work is to show a critical review of the international literature on eye-tracking technologies by focusing on those features that characterize them as ‘psychotechnologies’. Method: A critical literature review was conducted through the main psychology, engineering, and computer sciences databases by following specific inclusion and exclusion criteria. A total of 46 matches from 1998 to 2010 were selected for content analysis. Results have been divided into four broad thematic areas. Results: We found that, although there is a growing attention to end-users, most of the studies reviewed in this work are far from being considered as adopting holistic human-computer interaction models that include both individual differences and needs of users. User is often considered only as a measurement object of the functioning of the technological system and not as a real alter-ego of the intrasystemic interaction. Conclusion: In order to fully benefit from the communicative functions of gaze, the research on eye-tracking must emphasize user experience. Eye-tracking systems would become an effective assistive technology for integration, adaptation and neutralization of the environmental barrier only when a holistic model can be applied for both design processes and assessment of the functional components of the interaction.

Implications for Rehabilitation

• Eye-tracking methodologies facilitates communicative functions of gaze favoring a successful outcome in many areas of rehabilitation.

• Eye-tracking systems would be an effective assistive technology for integration, adaptation and neutralization of the environmental barrier.

• Successful rehabilitation outcomes are improved when a holistic and interactive model is applied for both design processes and assessment of the functional components of the interaction.

     

基于护理依赖的患者分类系统在国内外的应用进展

基于护理依赖的患者分类系统可以使得护理资源配置优化,可以促进护理质量提高.重点就患者分类系统的概念、类型以及国内外应用现状进行综述,以期为我国的护理资源配置提供参考与借鉴.