This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the C...This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords:“liver cirrhosis,”“portal hypertension,”“ascites,”“pathogenesis,”“diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.展开更多
Background The resection and reconstruction of the hepatic artery is often required in radical surgery for hilar cholangiocarcinoma. In this study, we report our experience in performing arterioportal shunting as an a...Background The resection and reconstruction of the hepatic artery is often required in radical surgery for hilar cholangiocarcinoma. In this study, we report our experience in performing arterioportal shunting as an alternative for the arterial reconstruction. Methods Four patients with hilar cholangiocarcinoma underwent extended left hepatectomy and caudate Iobectomy combined with en bloc resection of the hepatic artery and arterioportal shunting with restriction of the arterial caliber. The efficacy of arterioportal shunting was assessed by computed tomography angiography （CTA）. Results All the four patients recovered uneventfully without any complications. CTA showed a patent shunt and normal liver regeneration. No signs of portal hypertension were found at one year of follow-up. Conclusions Arterioportal shunting with restriction of the arterial caliber appears to be a feasible and safe alternative for the microvascular reconstruction after hepatic artery resection in radical surgery for hilar cholangiocarcinoma.展开更多
Periodic arrays of hybrid-shunted piezoelectric patches are used to control the band-gaps of phononic metamaterial beams. Passive resistive-inductive （RL） shunting circuits can produce a narrow resonant band-gap （R...Periodic arrays of hybrid-shunted piezoelectric patches are used to control the band-gaps of phononic metamaterial beams. Passive resistive-inductive （RL） shunting circuits can produce a narrow resonant band-gap （RG）, and active negative capacitive （NC） shunting circuits can broaden the Bragg band-gaps （BGs）. In this article, active NC shunting circuits and passive resonant RL shunting circuits are connected to the same piezoelectric patches in parallel, which are usually called hybrid shunting circuits, to control the location and the extent of the band-gaps. A super-wide coupled band-gap is generated when the coupling between RG and the BG occurs. The attenuation constant of the infinite periodic structure is predicted by the transfer matrix method, which is compared with the vibration transmittance of a finite periodic structure calculated by the finite element method. Numerical results show that the hybrid-shunting circuits can make the band-gaps wider by appropriately selecting the inductances, negative capacitances, and resistances.展开更多
BACKGROUND: Portal hypertension is a common disease and its major surgical therapeutic approaches include devascularization and shunting. This study was undertaken to investigate the effects of combined splenocaval or...BACKGROUND: Portal hypertension is a common disease and its major surgical therapeutic approaches include devascularization and shunting. This study was undertaken to investigate the effects of combined splenocaval or mesocaval C shunt and portoazygous devascularization (combined procedures) on portal hypertension. METHODS: The clinical data of 150 patients with portal hypertension who had undergone combined procedures at the First Affiliated Hospital of Zhengzhou University from May1990 to May 2003 were analyzed retrospectively. RESULTS: The mean free portal pressure (FPP) was 25.6±1.83 mmHg, 18.0±2.07 mmHg and 18.4±2.19 mmHg before operation, after splenectomy plus splenocaval or mesocaval C shunt, and combined procedures, respectively. There was no operative death in all patients. The 1-7 year follow-up of 100 patients showed rebleeding in 3 patients, encephalopathy in 4, thrombosis of artificial vascular graft in 3, and dying from liver failure in 2. CONCLUSIONS: The combined procedures can not only decrease portal pressure but also preserve hepatic blood flow to some extent. It may be one of the best choices for treating portal hypertension in China.展开更多
文摘This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords:“liver cirrhosis,”“portal hypertension,”“ascites,”“pathogenesis,”“diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.
文摘Background The resection and reconstruction of the hepatic artery is often required in radical surgery for hilar cholangiocarcinoma. In this study, we report our experience in performing arterioportal shunting as an alternative for the arterial reconstruction. Methods Four patients with hilar cholangiocarcinoma underwent extended left hepatectomy and caudate Iobectomy combined with en bloc resection of the hepatic artery and arterioportal shunting with restriction of the arterial caliber. The efficacy of arterioportal shunting was assessed by computed tomography angiography （CTA）. Results All the four patients recovered uneventfully without any complications. CTA showed a patent shunt and normal liver regeneration. No signs of portal hypertension were found at one year of follow-up. Conclusions Arterioportal shunting with restriction of the arterial caliber appears to be a feasible and safe alternative for the microvascular reconstruction after hepatic artery resection in radical surgery for hilar cholangiocarcinoma.
基金supported by the National Natural Science Foundation of China(Grant Nos.51275519 and 51175501)
文摘Periodic arrays of hybrid-shunted piezoelectric patches are used to control the band-gaps of phononic metamaterial beams. Passive resistive-inductive （RL） shunting circuits can produce a narrow resonant band-gap （RG）, and active negative capacitive （NC） shunting circuits can broaden the Bragg band-gaps （BGs）. In this article, active NC shunting circuits and passive resonant RL shunting circuits are connected to the same piezoelectric patches in parallel, which are usually called hybrid shunting circuits, to control the location and the extent of the band-gaps. A super-wide coupled band-gap is generated when the coupling between RG and the BG occurs. The attenuation constant of the infinite periodic structure is predicted by the transfer matrix method, which is compared with the vibration transmittance of a finite periodic structure calculated by the finite element method. Numerical results show that the hybrid-shunting circuits can make the band-gaps wider by appropriately selecting the inductances, negative capacitances, and resistances.
文摘BACKGROUND: Portal hypertension is a common disease and its major surgical therapeutic approaches include devascularization and shunting. This study was undertaken to investigate the effects of combined splenocaval or mesocaval C shunt and portoazygous devascularization (combined procedures) on portal hypertension. METHODS: The clinical data of 150 patients with portal hypertension who had undergone combined procedures at the First Affiliated Hospital of Zhengzhou University from May1990 to May 2003 were analyzed retrospectively. RESULTS: The mean free portal pressure (FPP) was 25.6±1.83 mmHg, 18.0±2.07 mmHg and 18.4±2.19 mmHg before operation, after splenectomy plus splenocaval or mesocaval C shunt, and combined procedures, respectively. There was no operative death in all patients. The 1-7 year follow-up of 100 patients showed rebleeding in 3 patients, encephalopathy in 4, thrombosis of artificial vascular graft in 3, and dying from liver failure in 2. CONCLUSIONS: The combined procedures can not only decrease portal pressure but also preserve hepatic blood flow to some extent. It may be one of the best choices for treating portal hypertension in China.
