[Emphasis on the prevention and treatment of hepatic vascular diseases]

Portal hypertension, as a common and complex hepatic vascular disease, is a key pathophysiological link in many events of acute cirrhosis decompensation and the progression of multiple organ failure. The most effective measure to reduce portal hypertension is a transjugular intrahepatic portosystemic shunt (TIPS). Maintaining liver function, reducing complications, and improving patients' quality of life and survival time are positively impacted by early TIPS insertion. Patients with cirrhosis have a risk of portal vein thrombosis (PVT) that is 1 000 times higher than that of the normal population. Hepatic sinusoidal obstruction syndrome has a severe clinical course and a high mortality risk. The primary treatment approaches for PVT and HSOS are anticoagulation and TIPS. The innovative magnetic anastomosis vascular technique significantly shortens the anhepatic time and restores normal liver function in patients following liver transplantation.

[Expert consensus for diagnosis and treatment of thrombocytopenia in China]

Thrombocytopenia is the main clinical manifestation or common complication of multiple diseases, but there is still a lack of systematic understanding of pathogenesis, underlying diseases and treatment strategies of thrombocytopenia. Based on evidence-based medicine, this consensus summarizes seven aspects related to thrombocytopenia, including definition, epidemiology, pathogenesis, clinical manifestations, laboratory examination, diagnosis and treatment. This consensus provides an important reference for the diagnosis and treatment of thrombocytopenia.

Disturbances of mesenteric lymph flow and in vivo intestinal lymphocyte trafficking during early gut injury induced by ischemia-reperfusion in rats

We sought to define the role of mesenteric lymph in the generation of remote organ damage at the early stage of gut ischemia-reperfusion (I/R) injury. The measurement of mesenteric lymph flow was carried out by cannulation of mesenteric lymphatics. The distribution of in vivo intestinal lymphocyte trafficking was performed by 51Cr labeled lymphocyte and measurement of 51Cr-lymphocytes distribution by gamma-counter. Endotoxin concentration was assayed using the limulus test kit and TNF-alpha level was detected by ELISA. After gut I/R injury, the volumes of lymph flow in mesenteric lymphatics per hour were sharply decreased by 72% and the number of intestinal lymphocytes per milliliter was decreased by 61%, which led to the intestinal lymphocyte output per hour significantly decreased by 90% (predominantly T cells), while the population of 51Cr-lymphocytes in Peyer's patches, small intestine (except Peyer's patches), mesenteric nodes, large intestine, and stomach increased by 87%, 191%, 87%, 266%, 262%, respectively. Meanwhile, endotoxin and TNF-alpha levels in mesenteric lymph were significantly increased. These findings demonstrate the marked disorders of mesenteric lymph flow and in vivo intestinal lymphocytes migration and the accompanying increase of endotoxin and TNF-alpha levels in mesenteric lymph in the early stage of gut I/R injury.

Internal Field Distribution in Organic Light Emitting Diodes with Double Layer Structure

Double layer organic light emitting devices (OLED) are constructed by evaporating tris(8 -hydroxy) quinoline aluminum (Alq3) on a spin cast thin film of a methyl substituted ladder type poly -para -phenylene (m -LPPP). A thick layer of Mg:Ag is used as the cathode material. These organic materials are very suitable for application in OLEDs both, as transporting materials as well as active layers. Alq3 predominantly transports electrons while m - LPPP is a conjugated polymer having higher hole mobilities. Due to these transport properties the formation and radiative recombination of the excitons in ITO/m -LPPP/Alq3/Mg:Ag devices occur close to the m -LPPP/Alq3 interface. We compare the device performance of OLEDs with varying Alq3 layer thickness (0, 50, 150, 300, 500Å) and constant m -LPPP layer thickness (900Å). A difference in the device parameters and performance as a function of the Alq3 layer thickness is observed. We analyze these results with respect to the internal electric field distribution of the double layer devices derived from electroabsorption measurements.

Pediatric foot fractures: evaluation and treatment

Foot fractures account for 5% to 8% of all pediatric fractures and for approximately 7% of all physeal fractures. A thorough understanding of the anatomy of the child's foot is of central importance when treating these injuries. Due to the difficulties that may be encountered in obtaining an accurate physical examination of a child with a foot injury and the complexities of radiographic evaluation of the immature foot, a high index of suspicion for the presence of a fracture facilitates early and accurate diagnosis. Although the treatment results in pediatric foot trauma are generally good, potential pitfalls in the treatment of Lisfranc fractures, talar neck and body fractures, and lawn mower injuries to the foot must be anticipated and avoided if possible.

Elbow aspiration and arthrogram: an alternative method

We describe a posterior elbow-aspiration approach that is safe, easy, and effective in all settings, including trauma.

Use of P wave configuration during atrial tachycardia to predict site of origin

OBJECTIVES

This study sought to construct an algorithm to differentiate left atrial from right atrial tachycardia foci on the basis of surface electrocardiograms (ECGs).

BACKGROUND

Atrial tachycardia is an uncommon form of supraventricular tachycardia, often resistant to drug therapy.

METHODS

A total of 31 consecutive patients with atrial tachycardia due to either abnormal automaticity or triggered rhythm underwent detailed atrial endocardial mapping and successful radiofrequency catheter ablation of a single atrial focus. P wave configuration was analyzed from 12-lead ECGs during tachycardia during either spontaneous or pharmacologically induced atrioventricular block. P waves inscribed above the isoelectric line (TP interval) were classified as positive, below as negative, above and below (or conversely, below and above) as biphasic and flat P waves as isoelectric (0). In 17 patients the tachycardia was located in the right atrium: crista terminalis (n = 4); right atrial appendage (n = 4); lateral wall (n = 4); posteroinferior right atrium (n = 3); tricuspid annulus (n = 1); and near the coronary sinus (n = 1). In 14 patients, atrial tachycardia was located in the left atrium: at the entrance of the right (n = 6) or left (n = 4) superior pulmonary veins; left inferior pulmonary vein (n = 1); inferior left atrium (n = 1); base of left atrial appendage (n = 1); and high lateral left atrium (n = 1).

RESULTS

There were no differences in P wave vectors between sites at the right atrial lateral wall versus the right atrial appendage or between sites at the entrance of right versus left superior pulmonary veins. However, analysis of P wave configuration showed that leads aVL and V1 were most helpful in distinguishing right atrial from left atrial foci. The sensitivity and specificity of using a positive or biphasic P wave in lead aVL to predict a right atrial focus was 88% and 79%, respectively. The sensitivity and specificity of a positive P wave in lead V1 in predicting a left atrial focus was 93% and 88%, respectively.

CONCLUSIONS

1) Analyses of surface P wave configuration proved to be reasonably good in differentiating right atrial from left atrial tachycardia foci. 2) Leads II, III and aVF were helpful in providing clues for differentiating superior from inferior foci.

Elimination of sodium-24 and potassium-42 interferences in activation analysis of biological samples

We have developed a simple novel column technique for the removal of sodium-24 and potassium-42 based on a heterogeneous isotopic exchange reaction between an organic eluting solution (acetone-hydrochloric acid) and fine crystals of sodium chloride or potassium chloride or their analogs. The technique is fast, efficient, and highly selective; it has been successfully applied to irradiated human tissues prior to gamma-ray spectrometry with lithium-drifted germanium detectors.