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

Multi-Gbps LDPC Decoder on GPU Devices

To meet the high throughput requirement of communication systems, the design of high-throughput low-density parity-check (LDPC) decoders has attracted significant attention. This paper proposes a high-throughput GPU-based LDPC decoder, aiming at the large-scale data process scenario, which optimizes the decoder from the perspectives of the decoding parallelism and data scheduling strategy, respectively. For decoding parallelism, the intra-codeword parallelism is fully exploited by combining the characteristics of the flooding-based decoding algorithm and GPU programming model, and the inter-codeword parallelism is improved using the single-instruction multiple-data (SIMD) instructions. For the data scheduling strategy, the utilization of off-chip memory is optimized to satisfy the demands of large-scale data processing. The experimental results demonstrate that the decoder achieves 10 Gbps throughput by incorporating the early termination mechanism on general-purpose GPU (GPGPU) devices and can also achieve a high-throughput and high-power-efficiency performance on low-power embedded GPU (EGPU) devices. Compared with the state-of-the-art work, the proposed decoder had a ×1.787 normalized throughput speedup at the same error correcting performance

Experimental Study on the Durability of Fly Ash-Based Filling Paste in Environments with Different Concentrations of Sulfates

In order to study the effects of different concentrations of sulfate on the strength of fly ash-based coal mine filling paste, using variable control, mechanical analysis, and other means, the changes in the uniaxial compressive strengths of filling paste blocks soaked in different concentrations of sodium sulfate solution for different durations are studied, and their stress-strain curves are discussed. The hydrated products of each block are analyzed at different stages by XRD, and the results indicate that different concentrations of sodium sulfate solution have different effects on the strength of the filling paste after soaking for different durations. A sodium sulfate solution with a concentration of 5% had an activator effect on the fly ash-based filling paste and enhanced the strength of the filling paste. A sodium sulfate solution with a concentration of 10% and 15% increased the early strength of the paste test block faster, but after 60 d, the strength decreased. The stress-strain curves for these blocks show that the elastic moduli of the filling paste test blocks change irregularly, and it was found that with the increase in soaking time, the blocks soaked in the 10% and 15% sodium sulfate solutions developed fissures in the later stage that adversely affected the strength of the filling paste. The XRD results show that the filling paste test block hydration products are hydrated calcium silicate (C-S-H) based and that ettringite (AFt), beneficial to strength of the filling paste in proper quantities, appeared in the main product of the filling paste test blocks that were soaked in the sodium sulfate solution. With the increase in the concentration of the sodium sulfate solution, the AFt is generated in larger quantities, and gypsum crystals begin to appear, which is not conducive to the filling paste block strength

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

Spleen Stiffness Performance in the Noninvasive Assessment of Gastroesophageal Varices after Transjugular Intrahepatic Portosystemic Shunts

Objectives. To investigate the performance of spleen stiffness (SS) by using two-dimensional shear-wave elastography (2D-SWE) for assessing the severity of gastroesophageal varices (GEVs) after transjugular intrahepatic portosystemic shunt (TIPS). Methods. 102 eligible patients were categorized as in the post-TIPS short-term (n=69) and long-term (n=38) follow-up groups. The performance of SS by using 2D-SWE for evaluating the severity of GEVs was compared with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), liver stiffness spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension (PH) risk score, platelet count-to-spleen diameter ratio (PSR), and varices risk score by using receiver operating characteristic (ROC) curve and DeLong test. Results. In the post-TIPS short-term follow-up group, area under the receiver operating characteristic curves (AUCs) of SS were 0.585 for mild (cutoff value=30.3 kPa), 0.655 for moderate (cutoff value=30.6 kPa), and 0.739 for severe (cutoff value=31.9 kPa) GEVs, which were higher than other parameters for severe GEVs. AUCs of SS were lower than other parameters for mild and moderate GEVs, but no difference was found (p>0.05). In the post-TIPS long-term follow-up group, AUCs of SS were 0.778 for mild (cutoff value=28.9 kPa), 0.82 for moderate (cutoff value=29.9 kPa), and 0.824 for severe (cutoff value=37.7 kPa) GEVs, which were higher than other parameters except for severe GEVs. AUC of SS was lower than other parameters for severe GEVs, but no significant difference was found (p>0.05). Conclusion. SS is an effective noninvasive tool to predict GEV severity during the post-TIPS follow-up

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