A Large Portal Vein: A Rare Finding of Recent Portal Vein Thrombosis

Acute portal vein thrombosis (PVT) is rarely encountered by clinicians. The most common manifestation of acute PVT is sudden onset of abdominal pain. A computed tomography scan without contrast often shows a high-density material in the portal vein. After injection of contrast agents, absence of luminal enhancement and enlargement of the obstructed portal vein are shown. In this case report, we demonstrated a rare computed tomography finding in which the diameter of the main portal vein was enormously distended to 3-fold that of the aorta in a patient with recent PVT. Despite thrombolysis and anticoagulation were immediately given, portal venous recanalization was not achieved in the patient. After 5 years, variceal bleeding and ascites occurred and liver function had persistently deteriorated. Finally, he died of progressive liver failure. Considering this case, we suggest that an early decision for invasive interventional treatment might be necessary to both increase the rate of portal venous recanalization and improve prognosis, as anticoagulation and thrombolysis therapy failed to recanalize recent PVT

Curriculum learning for robotic peg-in-hole assembly

Robotic assembly is very essential in the smart industry. With the help of Deep Learning technology, the robots gain the ability to perform more complex tasks with less human involvement, and become more adaptive to the environmental changes, compared to the conventional ways of fine tuning the robot strategies and parameters. One of the most interesting and trending tasks is the peg-in-hole insertion tasks where the robot needs to insert a peg or pin into a hole. A lot of research has been done to increase the performance for high precision insertion tasks and deep reinforcement learning is a convincing method to realize the purpose. In this project, a curriculum learning methodology is proposed and applied to train the robot from easier tasks, such as larger clearances, and transfer the learned knowledge to train with more difficult tasks. The training algorithm in each curriculum followed is a deep reinforcement learning method. The results have shown the potential that the curriculum learning is capable for training the robot to perform much more difficult tasks that are failed by the direct training.Bachelor of Engineering (Mechanical Engineering

Child-Na score: a predictive model for survival in cirrhotic patients with symptomatic portal hypertension treated with TIPS.

BACKGROUND AND AIM: Several models have been developed to predict survival in patients with cirrhosis undergoing TIPS; however, few of these models have gained widespread acceptance, especially in the era of covered stents. The aim of this study was to establish an evidence-based model for predicting survival after TIPS procedures. METHODS: A total of 210 patients with cirrhosis treated with TIPS were considered in the study. We comprehensively investigated factors associated with one-year survival and developed a new predictive model using the Cox regression model. RESULTS: In the multivariate analysis, the Child-Pugh score and serum sodium levels were independent predictors of one-year survival. A new score incorporating serum sodium into the Child-Pugh score was developed: Child-Na score. We compared the predictive accuracy of Child-Na score with that of other scores; only the Child-Na and MELD-Na scores had adequate predictive ability in patients with serum Na levels <138 mmol/L. The best Child-Na cut-off score (15.5) differentiated two groups of patients with distinct prognoses (one-year cumulative survival rates of 80.6% and 45.5%); this finding was confirmed in a validation cohort (n = 86). In a subgroup analysis stratifying patients by indication for TIPS, the Child-Na score distinguished patients with different prognoses. CONCLUSIONS: Patients with variceal bleeding and a Child-Na score ≤15 had a better prognosis than patients with a score ≥16. Patients with refractory ascites and a Child-Na score ≥16 had a high risk of death after the TIPS procedures; caution should be used when treating these patients with TIPS

Imbalance of pro- vs. anti-coagulation factors in Chinese patients with Budd-Chiari syndrome and non-cirrhotic portal vein thrombosis.

The coagulation abnormalities in non-cirrhotic Budd-Chiari syndrome (NC-BCS) and non-cirrhotic portal vein thrombosis (NC-PVT) are unclear. We conducted this case-control study to investigate the coagulation profile of NC-BCS and NC-PVT in Chinese patients.We measured the levels of factors II, V, VII, VIII, IX, X, XI, XII, protein C (PC), protein S (PS) and antithrombin (AT) in blood samples from 37 NC-BCS patients, 74 NC-PVT patients, and 100 healthy controls. The levels and ratios of pro- and anti-coagulation factors were compared between patients with NC-BCS and healthy controls, between different types of NC-BCS and between NC-PVT and healthy controls.In patients with NC-BCS, factor VIII (P<0.001) was significantly elevated; factor V (P<0.001), VII (P<0.001), IX (P = 0.003), X (P<0.001), XI (P<0.001), XII (P<0.001), PC (P<0.001) and AT (P<0.001) were significantly decreased; and no difference was observed for factor II (P = 0.088) and PS (P = 0.199) compared with healthy controls. Factor VIII-to-PC (P = 0.008), factor VIII-to-PS (P = 0.037) and factor VIII-to-AT (P = 0.001) were significantly increased; other ratios were significantly reduced or did not show any difference. No differences were observed between different types of NC-BCS for individual pro- and anti-coagulation factors or the ratios between them. Among patients with NC-PVT, factor VIII (P<0.001) was significantly elevated and other factors were significantly decreased. Factor II-to-PC (P<0.001), factor VIII-to-PC (P<0.001), factor IX-to-PC (P<0.001), factor VIII-to-PS (P<0.001), factor II-to-AT (P<0.001), factor VIII-to-AT (P<0.001) and factor IX-to-AT (P<0.001) were significantly increased; all other ratios for NC-PVT were significantly reduced or did not show any significant difference.NC-BCS and NC-PVT are associated with elevated levels of factor VIII and the decreased levels of PC and AT were probably the most significant features of coagulation imbalance. Additionally, NC-PVT was associated with decreased levels of PS

Transarterial Chemoembolization for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Prognostic Factors in a Single-Center Study of 188 Patients

Transarterial chemoembolization (TACE) could achieve a better survival benefit than conservative treatment for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). In this retrospective study, all HCC patients with Child-Pugh score <7 and PVTT who were consecutively admitted to our center between January 2006 and June 2012 and underwent TACE were enrolled. The efficacy and safety of TACE were analyzed. Prognostic factors were determined by Cox regression analysis. Of the 188 patients included, 89% had hepatitis B virus infection, 100% were at Barcelona Clinic Liver Cancer stage C, and 81% (n=152) and 19% (n=36) were at Child-Pugh classes A and B, respectively. The incidence of procedure-related complications was 88%. No procedure-related death was found. The median overall survival was 6.1 months. Type of PVTT (hazard ratio [HR] = 2.806), number of tumor lesions (HR = 2.288), Child-Pugh class (HR = 2.981), and presence of metastasis (HR = 1.909) were the independent predictors of survival. In conclusion, TACE could be selectively used for the treatment of advanced HCC with PVTT. But a high rate of postoperative adverse events should not be undermined in spite of no procedure-related death. Preoperative type of PVTT, number of tumor lesions, Child-Pugh class, and metastasis could predict the prognosis of these patients

Ratios between pro- and anti-coagulant factors for patients with NC-BCS, NC-PVT and healthy controls.

<p><b>NOTE.</b> Values are expressed as median (range).</p><p>* indicates P < 0.05 when compared with the healthy controls.</p><p><b>Abbreviations:</b> AT, antithrombin; NC-BCS, non-cirrhotic non-tumoral Budd-Chiari syndrome; NC-PVT, non-cirrhotic non-tumoral portal vein thrombosis; PC, protein C; PS, protein S.</p><p>Ratios between pro- and anti-coagulant factors for patients with NC-BCS, NC-PVT and healthy controls.</p

Demographic characteristics of patients with NC-BCS and NC-PVT.

<p><b>NOTE.</b> Values are expressed as mean ± SD; n indicates number of cases. <b>Abbreviations:</b> HV, hepatic vein; IHPV, intrahepatic portal vein; INR, international normalized ratio; IVC, inferior vena cava; MELD, Model for End-stage Liver Disease; MPV, main portal vein; NC-BCS, non-cirrhotic non-tumoral Budd-Chiari Syndrome; NC-PVT, non-cirrhotic non-tumoral portal vein thrombosis; PT, prothrombin time; SMV, superior mesenteric vein; SV, splenic vein.</p><p>Demographic characteristics of patients with NC-BCS and NC-PVT.</p

Univariate and multivariate analyses of pre-TIPS prognostic factors associated with one-year survival in patients in the training cohort with covered stents.

<p><b>NOTE</b>. Bold values indicate P-values <0.05; —: not included in the multivariate analysis. <b>Abbreviations</b>: INR, international normalized ratio; ALP, alkaline phosphatase.</p

Subgroup analysis of one-year cumulative survival in patients pooled from the training cohort and validation cohort undergoing TIPS with variceal bleeding.

<p>Subgroup analysis of one-year cumulative survival in patients pooled from the training cohort and validation cohort undergoing TIPS with variceal bleeding.</p