Effect Of Shunt Research Articles

Hepatic encephalopathy in non-cirrhotic portal hypertension.

Hepatic encephalopathy (HE) is traditionally associated with hepatic parenchymal diseases, such as acute liver failure and cirrhosis. Its prevalence in non-cirrhotic portal hypertension (NCPH) patients, extrahepatic portal vein obstruction (EHPVO), and non-cirrhotic portal fibrosis (NCPF) is less well described. HE in NCPH allows one to study the effect of portosystemic shunting and ammonia without significant hepatic parenchymal injury. The current review narrates the spectrum and management of hepatic encephalopathy in NCPH patients. We synthesized data from various studies on the occurrence and management of HE in NCPH, mainly EHPVO, idiopathic non-cirrhotic portal hypertension (INCPH), and porto-sinusoidal vascular disease (PSVD). The prevalence of minimal hepatic encephalopathy (MHE) in NCPH is reported from 12 to 60%, depending on the condition and diagnostic criteria. MHE was reported in nearly a third of EHPVO patients. Studies show that venous ammonia levels are significantly elevated in patients with MHE and spontaneous shunts (82.4 ± 20.3 vs. 47.1 ± 16.7 µmol/L, P = 0.001). Large portosystemic shunts substantially increase the risk of HE, with 46-71% of patients with persistent or recurrent HE having identifiable shunts. Management of HE in NCPH primarily focuses on reducing ammonia levels through lactulose, which has shown improvement in 53% of patients with MHE after three months (P = 0.001). Shunt occlusion in patients with large portosystemic shunts is helpful in selected cases. HE in NCPH, particularly in EHPVO, is associated with elevated ammonia levels and spontaneous shunts. Despite the high prevalence of HE in NCPH, this is still a neglected aspect in the care of NCPH. A high index of suspicion and the application of appropriate screening tools are crucial for timely diagnosis and management. HE screening tools that are well-studied in cirrhosis, are also valid in NCPH. Effective management strategies include lactulose, rifaximin, dietary modifications, and shunt embolisation in some cases. Future research should focus on the long-term natural history and efficacy of treatment strategies in this population.

New Double Perovskite Solar Cell Containing Ba3PCl3 (A3BX3) and CsSnI3 (ABX3) Leading to an Improved Efficiency Above 30%

AbstractIn photovoltaic (PV) technology, halide perovskites stand out for their exceptional optical properties, improved performance, and cost‐effectiveness. This study utilized SCAPS‐1D to examine a novel dual absorber solar cell, using Ba3PCl3 as the top absorber and CsSnI3 as the bottom absorber, marking the first comprehensive analysis of this pairing. The research thoroughly investigated the thickness, doping concentrations, and defect densities of each absorber to evaluate their impact on electrical properties such as VOC, JSC, FF, and power conversion efficiency (PCE). Additionally, the study meticulously analyzed the effects of temperature, shunt, and series resistances. The results show that the first device (FTO/SnS2/Ba3PCl3/Au) achieved a PCE of 17.75%, while the second device (FTO/SnS2/CsSnI3/Au) reached a PCE of 20.63%. Optimized designs combining both absorbers (FTO/SnS2/Ba3PCl3/CsSnI3/Au) resulted in a PCE of 30.97%, with a JSC of 47.52 mA/cm2, FF of 80.42%, and VOC of 0.81 V. These promising findings offer valuable insights for the future development of experimental solar devices.

Predicting the long-term course: Shunt surgery results in idiopathic normal pressure hydrocephalus-a comprehensive study.

Idiopathic normal pressure hydrocephalus is a neurological disorder primarily affecting the elderly. Shunt surgery is the gold standard treatment, yet long-term outcome remains poorly investigated, especially concerning neuropsychological performance, motor skills and quality of life. This study aimed to evaluate the long-term effects of shunting in iNPH patients up to three years post-surgery. A cohort of 30 patients with iNPH who underwent shunt placement between January 2020 and February 2021 was followed up for three years. A standardized test battery assessed neuropsychological performance, quality of life, and motor skills. The patients were tested before and one, two and three years after surgery. Motor skills, particularly lower body function, significantly improved post-surgery and remained improved even after three years. Upper body motor skills exhibited mixed results, with improvement in manual dexterity but not in finger tapping tests. Neuropsychological assessments revealed sustained improvement in certain aspects up to three years post-surgery, while a various degree of deterioration was observed in others. Quality of life, as measured by the Rankin Scale as well as Stein and Langfitt Grading, showed initial improvement post-surgery but declined over time. iNPH patients demonstrate sustained improvements in motor skills, neuropsychological function and quality of life after shunt surgery. In long-term, motor skill and certain neuropsychological aspects remained improved, quality of life and some other neurocognitive aspects declined progressively over the follow up period.These findings underscore the importance of long-term follow-up and highlight the need for further research to better understand iNPH.

Effects of Transjugular Intrahepatic Portosystemic Shunt on Renal and Pulmonary Function in Hepatic Decompensation with and without Hepatorenal and Hepatopulmonary Syndromes: A Review.

Cirrhosis is often characterized by decreased liver function, ranging from a compensated, typically asymptomatic phase to a decompensated phase characterized by the appearance of ascites or variceal bleeding, and ultimately hepatorenal syndrome (HRS) or hepatopulmonary syndrome (HPS). The latter two complications are associated with a poor prognosis and limited treatment efficacy. In cases of ascites or variceal bleeding resistant to medical therapy, transjugular intrahepatic portosystemic shunt (TIPS) is effective and safe. Shunting blood by TIPS diverts portal blood to the systemic circulation, potentially increasing systemic blood volume and benefiting renal function. However, TIPS could also divert nitric oxide to the systemic circulation, potentially worsening systemic hypotension and perfusion, which could be detrimental to renal function. Available evidence indicates that TIPS often improves renal function in patients with portal hypertension, with or without HRS. No studies have shown persistently decreased renal function after TIPS. However, these data are insufficient to support a recommendation for the use of TIPS specifically for HRS. In patients without pre-existing HPS, TIPS does not appear to significantly affect pulmonary gas exchange. Results of TIPS in HPS have been inconsistent; some studies have shown improvement, but effects were transient. No studies have shown a persistent decline in pulmonary function after TIPS. The evidence supports the need for large randomized controlled trials to investigate the beneficial effects of TIPS for HRS. Similar pulmonary function data are less clear regarding TIPS for HPS. The aim of the current report was to review the literature regarding the effects of TIPS on renal and pulmonary function in hepatic decompensation, with or without the development of HRS or HPS.

Digestive dynamics: Unveiling interplay between the gut microbiota and the liver in macronutrient metabolism and hepatic metabolic health.

Although the liver is the largest metabolic organ in the body, it is not alone in functionality and is assisted by "an organ inside an organ," the gut microbiota. This review attempts to shed light on the partnership between the liver and the gut microbiota in the metabolism of macronutrients (i.e., proteins, carbohydrates, and lipids). All nutrients absorbed by the small intestines are delivered to the liver for further metabolism. Undigested food that enters the colon is metabolized further by the gut microbiota that produces secondary metabolites, which are absorbed into portal circulation and reach the liver. These microbiota-derived metabolites and co-metabolites include ammonia, hydrogen sulfide, short-chain fatty acids, secondary bile acids, and trimethylamine N-oxide. Further, the liver produces several compounds, such as bile acids that can alter the gut microbial composition, which can in turn influence liver health. This review focuses on the metabolism of these microbiota metabolites and their influence on host physiology. Furthermore, the review briefly delineates the effect of the portosystemic shunt on the gut microbiota-liver axis, and current understanding of the treatments to target the gut microbiota-liver axis.

Small Transjugular Intrahepatic Portosystemic Shunt Plus Variceal Embolization for Gastric Varices: A Multicenter Cohort Study

Background and AimsThe effect of transjugular intrahepatic portosystemic shunt (TIPS) plus variceal embolization for treating gastric varices (GVs) remains controversial. This nationwide multicenter cohort study aimed to evaluate whether adding variceal embolization to a small diameter (8-mm) TIPS could reduce the rebleeding incidence in patients with different types of GVs. MethodsThis retrospective cohort study involved 629 patients who underwent 8-mm TIPS for gastric varices at seven medical centers. The primary endpoint was all-cause rebleeding, and the secondary endpoints included overt hepatic encephalopathy (OHE) and all-cause mortality. ResultsA total of 629 patients were included. Among them, 429 (68.2%) had gastroesophageal varices type 1 (GOV1), 145 (23.1%) had gastroesophageal varices type 2 (GOV2), and 55 (8.7%) had isolated gastric varices type 1 (IGV1). In the entire cohort, adjunctive embolization reduced rebleeding (6.2% versus 13.6%, P=0.005) and OHE (31.0% versus 39.4%, P=0.02) compared with TIPS alone. However, no significant differences were found in mortality (12.0% versus 9.7%, P=0.42). In patients with GOV2 and IGV1, TIPS+E reduced both rebleeding (GOV2: 7.8% versus 25.1%, P=0.01; IGV1: 5.6% versus 30.8%, P=0.03) and OHE (GOV2: 31.8% versus 51.5%, P=0.008; IGV1: 11.6% versus 38.5%, P=0.04). However, in patients with GOV1, adjunctive embolization did not reduce rebleeding (5.9% versus 8.7%, P=0.37) or OHE (33.1% versus 35.3%, P=0.60). ConclusionsCompared with TIPS alone, 8-mm TIPS plus variceal embolization reduced rebleeding and OHE in patients with GOV2 and IGV1. These findings suggest that patients with GOV2 and IGV1, rather than GOV1, could benefit from embolization with TIPS.

Atrial Shunt Device Effects on Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Although the results of A Study to Evaluate the Corvia Medical Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF II) trial were neutral overall, atrial shunt therapy demonstrated potential efficacy in responders (no latent pulmonary vascular disease and no cardiac rhythm management device). Post hoc analyses were conducted to evaluate the effect of shunt vs sham stratified by responder status. To evaluate the effect of atrial shunt vs sham control on cardiac structure/function in the overall study and stratified by responder status. This was a sham-controlled randomized clinical trial of an atrial shunt device in heart failure with preserved ejection fraction (HFpEF)/HF with mildly reduced EF (HFmrEF). Trial participants with evaluable echocardiography scans were recruited from 89 international medical centers. Data were analyzed from April 2023 to January 2024. Atrial shunt device or sham control. Changes in echocardiographic measures from baseline to 1, 6, 12, and 24 months after index procedure. The modified intention-to-treat analysis of the REDUCE LAP-HF II trial included 621 randomized patients (median [IQR] age, 72.0 [66.0-77.0] years; 382 female [61.5%]; shunt arm, 309 [49.8%]; sham control arm, 312 [50.2%]). Through 24 months, 212 of 217 patients (98%) in the shunt arm with evaluable echocardiograms had patent shunts. In the overall trial population, the shunt reduced left ventricular (LV) end-diastolic volume (mean difference, -5.65 mL; P <.001), left atrial (LA) minimal volume (mean difference, -2.8 mL; P =.01), and improved LV systolic tissue Doppler velocity (mean difference, 0.69 cm/s; P <.001) and LA emptying fraction (mean difference, 1.88 percentage units; P =.02) compared with sham. Shunt treatment also increased right ventricular (RV; mean difference, 9.58 mL; P <.001) and right atrial (RA; mean difference, 9.71 mL; P <.001) volumes but had no effect on RV systolic function, pulmonary artery pressure, or RA pressure compared with sham. In the shunt arm, responders had smaller increases in RV end-diastolic volume (mean difference, 5.71 mL vs 15.18 mL; interaction P =.01), RV end-systolic volume (mean difference, 1.58 mL vs 7.89 mL; interaction P =.002), and RV/LV ratio (mean difference, 0.07 vs 0.20; interaction P <.001) and larger increases in transmitral A wave velocity (mean difference, 5.08 cm/s vs -1.97 cm/s; interaction P =.02) compared with nonresponders randomized to the shunt, suggesting greater ability to accommodate shunted blood through the pulmonary circulation enabling LA unloading. In this post hoc analysis of the REDUCE LAP-HF II trial, over 2 years of follow-up, atrial shunting led to reverse remodeling of left-sided chambers and increases in volume of right-sided chambers consistent with the shunt flow but no change in RV systolic function compared with sham. Changes in cardiac structure/function were more favorable in responders compared with nonresponders treated with the shunt, supporting the previously identified responder group hypothesis and mechanism, although further evaluation with longer follow-up is needed. ClinicalTrials.gov Identifier: NCT03088033.

Transcranial ultrasonographic evaluation of effect of ventriculoperitoneal shunt on intracranial dynamics: A prospective observational study

BackgroundTranscranial sonographic (TCS) evaluation of optic nerve sheath diameter (ONSD), third ventricular diameter (TVD) and mean flow velocities (Vm) and pulsatility index (PI) of middle cerebral artery (MCA) can provide important insights to the change in intracranial dynamics following ventriculo-peritoneal (VP) shunt surgery. The primary objective of this study was to observe changes in ONSD values following VP shunt at 12 h, compared to pre-VP shunt values. MethodsAfter obtaining ethical approval, patients admitted with a diagnosis of hydrocephalus posted for a VP shunt surgery were prospectively enrolled. TCS evaluation was done before induction of anesthesia and 12-hour post-VP shunt surgery. We recorded the values of ONSD, TVD and Vm and PI MCA at both time points. ResultsThirty-four patients (19 male) were evaluated for ONSD and for the improvement of symptoms. Transtemporal window could not be obtained in six patients. At 12 h following VP shunt, bilateral median ONSD values reduced significantly from their pre-VP shunt values [right ONSD- 0.62 (0.59–0.64) to 0.53 (0.5–0.54) mm (p < 0.001); left ONSD- 0.62 (0.59–0.63) to 0.53 (0.5–0.54) mm (p < 0.001)]. Similarly, the median TVD at 12 h post-VP shunt reduced significantly from its pre-VP shunt measurements [0.97 (0.85–1.09) to 0.74 (0.7–0.84) cm]. PI MCA values reduced significantly, while Vm MCA values increased significantly from the pre-VP shunt values. ConclusionVP shunt reduced the ONSD, TVD, PI MCA and increased the Vm MCA after shunt surgery as early as 12hrs.

Obesity in heart failure with preserved ejection fraction: Insights from the REDUCE LAP-HF II trial.

Obesity is causally related to the development of heart failure with preserved ejection fraction (HFpEF) but complicates the diagnosis and treatment of this disorder. We aimed to determine the relationship between severity of obesity and clinical, echocardiographic and haemodynamic parameters in a large cohort of patients with documented HFpEF. The REDUCE LAP-HF II trial randomized 626 patients with ejection fraction ≥40% and exercise pulmonary capillary wedge pressure (PCWP) ≥25 mmHg to atrial shunt or sham procedure. We tested for associations between body mass index (BMI), clinical characteristics, cardiac structural and functional abnormalities, physical limitations, quality of life and outcomes with atrial shunt therapy. Overall, 60.9% of patients had BMI ≥30 kg/m2 . As the severity of obesity increased, symptoms (Kansas City Cardiomyopathy Questionnaire score) and 6-min walk distance worsened. More severe obesity was associated with lower natriuretic peptide levels despite more cardiac remodelling, higher cardiac filling pressures, and higher cardiac output. Lower cut points for E/e' were needed to identify elevated PCWP in more obese patients. Strain measurements in all four chambers were maintained as BMI increased. Pulmonary vascular resistance at rest and exercise decreased with higher BMI. Obesity was associated with more first and recurrent heart failure events. However, there was no significant interaction between obesity and treatment effects of the atrial shunt. Increasing severity of obesity was associated with greater cardiac remodelling, higher right and left ventricular filling pressures, higher cardiac output and increased subsequent heart failure events. Despite significant obesity, many HFpEF patients have preserved right heart and pulmonary vascular function and thus, may be appropriate candidates for atrial shunt therapy.

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients of hydrocephalus in eastern India: A prospective observational study

Background: Hydrocephalus is a disorder of cerebrospinal fluid (CSF) physiology, resulting in an abnormal enlargement of the ventricles due to excessive accumulation of CSF. Although neurosurgical treatment has evolved over time with ventriculoperitoneal shunt (VPS) as the standard of care, procedure-related complications and poor long-term cognitive and motor milestone outcomes are still considerable, justifying the need for safer alternatives. Endoscopic third ventriculostomy (ETV) has emerged as a promising prospect especially in non-communicating hydrocephalus (NCH). Aims and Objectives: To compare the beneficial effects of ETV versus ventriculoperitoneal shunt in patients of NCH. Materials and Methods: The present prospective study was conducted at the Department of Neurosurgery, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata from July 2021 to December 2022 among 60 patients admitted with NCH. Out of 60 patients; 30 patients underwent ETV and the remaining 30 patients VP shunting. All included patients had their history taken and relevant clinical and radiological examination done pre-operatively. They were discharged on the third post-operative day or later depending on their clinical condition and recovery. Results: Aqueductal stenosis was the most common etiology for NCH in both the groups. Post-intervention, complications and reoperation rate were reported more in VP group as compared to ETV group. Overall 3 subjects died, out of which 2 belonged to VP group and 1 to ETV group. Success was found in 70% and 86.67% of the subjects in VP and ETV group respectively. Conclusion: In patients with non-communicating or obstructive hydrocephalus, ETV was reported to be superior to VPS in terms of reoperation and complication rate at 4th, 12th, and 24th weeks after the treatment.

Emergent TIPS for acute gastroesophageal variceal bleeding in cirrhotic patients with hepatocellular carcinoma.

To estimate the safety and effectiveness of emergent transjugular intrahepatic portosystemic shunt (TIPS) creation for acute variceal bleeding (AVB) in cirrhotic patients with hepatocellular carcinoma (HCC). Data of thirty-three patients with AVB and HCC undergoing emergent TIPS creation from January 2016 to January 2022 were enrolled and were retrospectively analyzed. The primary outcomes were the safety of emergent TIPS creation, the bleeding control rate, and the rebleeding rate. The secondary outcomes included overall survival (OS), liver function, overt hepatic encephalopathy (HE), and shunt dysfunction. Emergent TIPS creation was technically successful in 33 patients (100%) and one (3.0%) patient suffered a major procedure-related adverse event. The control rate of bleeding (within 5days) was 100%. During a median follow-up period of 26.3months, rebleeding occurred in 6 (18.2%) patients. The median OS was 20.0months. The 6-week and 1-year survival rates were 87% and 65%, respectively. Laboratory tests showed no significant impairment of liver function following TIPS creation. The incidences of overt HE and shunt dysfunction were 24.2% and 6.1%, respectively. Emergent TIPS creation is feasible and effective for treatment of AVB in cirrhotic patients with HCC.

Efficacy and safety of transesophageal ultrasound-guided patent foramen ovale closure for migraine in adolescents.

This retrospective analysis aims to assess the efficacy of transesophageal ultrasound-guided patent foramen ovale (PFO) closure in treating migraine in adolescents and compare the therapeutic outcomes of PFO closure for migraine with and without aura. We conducted a retrospective analysis of 86 cases of adolescents (12-20 years old) who underwent PFO closure for migraine at our institution over the past 3 years. The efficacy was evaluated using the visual analogue scale (VAS), headache impact test (HIT)-6, and pediatric migraine disability assessment (PedMIDAS) scores, as well as by assessing the monthly frequency of migraine attacks, duration of each attack, and overall migraine burden. The patients were divided into two groups: an aura group (55 cases) and a non-aura group (31 cases) to investigate difference in therapeutic efficacy between the groups. The effect of residual shunt on migraine burden was assessed. Among the 86 patients, 46 (54%) experienced complete remission of migraine, while 71 (83%) achieved a >50% reduction in migraine burden during the one-year follow-up period. Patients in the aura group showed more significant improvements in VAS, HIT-6, and PedMIDAS scores, as well as in monthly migraine attack frequency, duration of each attack, and overall migraine burden, than patients in the non-aura group. Moreover, patients with residual shunt did not exhibit statistically significant differences in therapeutic efficacy compared to patients with complete closure. PFO closure can effectively alleviate migraine symptoms in adolescents with migraine with concomitant PFO. The therapeutic efficacy is particularly pronounced for migraine with aura. Furthermore, minor levels of residual shunt have no effect on the improvement in migraine symptoms.

Qp/Qs in ostium secundum atrial septal defect mitigates right ventricular dysfunction in patients with secondary pulmonary hypertension

Abstract Background Ostium-secundum atrial septal defect (OS-ASD) can potentially lead to pulmonary hypertension (PH) and associated right ventricle (RV) - pulmonary artery (PA) uncoupling. This, in turn, may eventually result in RV systolic dysfunction. Notwithstanding, whether the characteristics of the OS-ASD could mitigate this relationship is unclear. Purpose To evaluate a potential interaction of the OS-ASD shunt (Qp/Qs ratio) on the relationship with RV–PA coupling and RV systolic function in patients with secondary PH. Methods We designed a cross-sectional study of 63 adult patients with OS-ASD in which we performed a conventional transthoracic echocardiogram using Vivid 9X-clear equipment (GE Vingmed Ultrasound, Horten, Norway). We evaluated the OS-ASD shunt and other echocardiographic parameters, including the tricuspid annular plane systolic excursion (TAPSE), the systolic pulmonary artery pressure (sPAP) ratio and the right ventricular free wall longitudinal strain (RVFWLS). Polynomic adjusted correlations were performed to model the relationship between the TAPSE/sPAP ratio and the RVFWLS, then we evaluated an interaction effect of the OS-ASD shunt (Qp/Qs ratio), respectively adjusted for age, sex, body mass index, body surface area and right atrial area. Results In our study, 49 (78%) subjects were male, with a mean age of 41.8 (±15) years; 7.94% (n=5) had mild PH, 42.9% (n=27) had moderate PH and 49.2% (n=31) had severe PH. Mean echocardiographic parameters were: TAPSE 24.5 (±5.1) mm , sPAP of 55.9 (±20.7) mmHg, TAPSE/sPAP 0.49 (±0.2) mm/mmHg, RVFWLS -25.6 (±6.6) % and Qp/Qs 2.9 (±0.9). We observed a quadratic relationship between the TAPSE/sPAP ratio and the RVFWLS (r=0.691, p &amp;lt; 0.001; Figure 1). OS-ASD shunt had a positive interaction effect (β=10.9, 95% CI: 2.09-19.6, p=0.018) on the relationship between TAPSE/sPAP and RVFWLS after adjusting for covariates (Figure 2). Conclusions In conclusion, in patients with OS-ASD, the RV systolic function decreases as the RV-PA uncoupling increases, as reflected in the quadratic regression between the TAPSE/sPAP and the RVFWLS. Moreover, the increase in OS-ASD shunt decreases RVFWLS values in relationship to the TAPSE/sPAP ratio as observed in the interaction model. These results could suggest that the OS-ASD characteristics could potentially mitigate RV dysfunction in patients with secondary PH.Figure 1.Quadratic regressionFigure 2.Interaction model

Comparative efficacy of early TIPS, Non-early TIPS, and Standard treatment in patients with cirrhosis and acute variceal bleeding: a network meta-analysis.

Cirrhosis is a chronic disease characterized by chronic liver inflammation and diffuse fibrosis. A combination of vasoactive drugs, preventive antibiotics, and endoscopy is the recommended standard treatment for patients with acute variceal bleeding; however, this has been challenged. We compared the effects of early transjugular intrahepatic portosystemic shunt (TIPS), non-early TIPS, and standard treatment in patients with cirrhosis and acute variceal bleeding. The present network meta-analysis was conducted in accordance with the criteria outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Assessing the methodological quality of systematic reviews guidelines. The review has been registered with the International Prospective Register of Systematic Reviews. The PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and World Health Organization-approved trial registry databases were searched for randomized controlled trials (RCTs) evaluating early TIPS, non-early TIPS, and standard treatment in patients with cirrhosis and acute variceal bleeding. Twenty-four RCTs (1894 patients) were included in the review. Compared with standard treatment, early TIPS [odds ratio (OR), 0.53; 95% credible interval (Cr), 0.30-0.94; surface under the cumulative ranking curve (SUCRA), 98.3] had a lower risk of all-cause mortality (moderate-to-high-quality evidence), and early TIPS (OR, 0.19; 95% CrI, 0.11-0.28; SUCRA, 98.2) and non-early TIPS (OR, 0.30; 95% CrI, 0.23-0.42; SUCRA, 1.8) were associated with a lower risk of rebleeding (moderate-to-high-quality evidence). Early TIPS was not associated with a reduced risk of hepatic encephalopathy, and non-early TIPS (OR, 2.78; 95% CrI, 1.89-4.23, SUCRA, 0) was associated with an increased incidence of hepatic encephalopathy (moderate-to-high-quality evidence). There was no difference in the incidence of new or worsening ascites (moderate-to-high-quality evidence) among the three interventions. Based on the moderate-to-high quality evidence presented in this study, early TIPS placement was associated with reduced all-cause mortality [with a median follow-up of 1.9 years (25th-75th percentile range 1.9-2.3 years)] and rebleeding compared to standard treatment and non-early TIPS. Although early TIPS and standard treatment had a comparable incidence of hepatic encephalopathy, early TIPS showed superiority over non-early TIPS in this aspect. Recent studies have also shown promising results in controlling TIPS-related hepatic encephalopathy. However, it is important to consider individual patient characteristics and weigh the potential benefits against the risks associated with early TIPS. Therefore, we recommend that clinicians carefully evaluate the patient's condition, considering factors such as severity of variceal bleeding, underlying liver disease, and overall clinical status, before making a treatment decision. Further well-designed RCTs comparing early TIPS with non-early TIPS are needed to validate these findings and provide more definitive guidance.

Effects of biventricular shunt on pump characteristics in a maglev total artificial heart.

Severe left ventricular failure can progress to right ventricular failure, necessitating alternatives to heart transplantation, such as total artificial heart (TAH) treatment. Conventional TAHs encounter challenges associated with miniaturization and hemocompatibility owing to their reliance on mechanical valves and bearings. A magnetically levitated TAH (IB-Heart) was developed, utilizing a magnetic bearing. The IB-Heart features a distinctive biventricular shunt channel situated between the flow paths of the left and right centrifugal blood pumps, simplifying and miniaturizing its control system. However, the impact of these shunt channels remains underexplored. This study aimed to investigate the effects of shunt flow on pump characteristics and assess the IB-Heart's potential to regulate flow balance between systemic and pulmonary circulation. At a rotational speed of 2000 rpm and flow rate range of 0-10 L/min, shunt flow exhibited a minor impact, with a 1.4 mmHg (1.3%) effect on pump characteristics. Shunt flow variation of about 0.13 L/min correlated with a 10 mmHg pressure difference between the pumps' afterload and preload conditions. This variance was linked to changes in the inlet flow rates of the left and right pumps, signifying the ventricular shunt structure's capacity to mirror the function of an atrial shunt in alleviating pulmonary congestion. The IB-Heart's ventricular shunt structure enables passive regulation of left-right flow balance. The findings establish a fundamental technical groundwork for the development of IB-Hearts and TAHs with similar shunt structures. The innovative coupling of centrifugal pumps and the resultant effects on flow dynamics contribute to the advancement of TAH technology.

Achieving above 25 % efficiency from FA0.85Cs0.15Pb(I0.85Br0.15)3 perovskite solar cell through harnessing the potential of absorber and charge transport layers

In the present article, better stability and enhanced optical behavior have been reported by using mixed -cation lead mixed - halide perovskites, [FAxCs1−xPb(IxBr1−x)3]x=0.85 as the active layer while SnO2 as electron transport layer and Spiro-OMeTAD has been chosen as hole transport layer. The design of the cell configuration FTO/SnO2/[FAxCs1−xPb(IxBr1−x)3]x=0.85/Spiro-OMeTAD/Au has been developed with the help of SCAPS-1D software. In this work,15.86 % power conversion efficiency has been attained which is approximately equal to experimentally reported result. Further we have analyzed the comparative investigation of various HTL layers in place of Spiro-OMeTAD. Further MoO3 based device parameters like thickness, bandgap and defect density of absorber layer, effect of interface, shunt and series resistance and temperature were tuned and calculated to get their optimum values. Finally, PCE of 25.85 % was attained for the optimized device structure FTO/SnO2/[FAxCs1−xPb(IxBr1−x)3]x=0.85/MoO3/Au. These outcomes could provide an idea for highly efficient solar cell device fabrication.

Safety and Effectiveness of a Novel Tips Access Set with Steerable Cannula in a Swine Model

PurposeThis study aimed to assess the safety, effectiveness, and feasibility of the Liverty™ transjugular intrahepatic portosystemic shunt (TIPS) access set, which has an ergonomic handle that allows for in situ cannula tip deflection and a distal steerable cannula angle, versus the COOK® Rosch-Uchida Transjugular Liver Access Set (RUPS-100) in healthy pigs.MethodsTwelve pigs randomly underwent TIPS with the Liverty™ set or the RUPS-100 set. Three interventionalists performed 4 TIPS procedures, 2 with each set. The primary outcome was procedural success, defined as successful establishment of the intrahepatic portosystemic shunt and stent placement.ResultsThe shunt was successfully established in 11 pigs. The procedural success was achieved in all 6 pigs in the Liverty™ group and 5 out of 6 pigs for the RUPS-100 group (Fisher exact test, P > 0.999). The mean duration of puncture was shorter in the Liverty™ group versus the RUPS-100 group (12.3 ± 4.5 min vs. 16.2 ± 8.5 min), but without significant statistical difference (two sample t test, P = 0.359). The cannula angle was adjusted 69% of passes in the Liverty™ group, which was significantly higher than that in the RUPS-100 group (12%, P = 0.004). Overall, the TIPS procedural performance was comparable between the groups. Both sets were safe. No intraabdominal hemorrhage, vascular injuries, tissue or organ injuries, porto-biliary fistula, biliary peritonitis, and infection or abscess occurred in either group.ConclusionThe Liverty™ set is safe and has similar procedural metrics to the COOK® RUPS-100 set. It allows in situ adjustment of the angle of the stiffening cannula without increasing procedure time and lessens the occurrences of periprocedural complications.Graphical

The effectiveness of splenorenal shunt in the correction of portal hypertension and hypersplenism in the long-term period

The aim is to evaluate the long-term results of splenorenal anastomosis (SRA) in the treatment of portal hypertension a year or more after surgery. Materials and methods. The long-term results of the imposition of CPA after one to ten years have been studied. Life expectancy, the number of bleeding recurrences, and the severity of thrombocytopenia were assessed based on the results of fibrogastroscopy, duplex scanning (DS), and computed tomography with bolus enhancement. Results. One-year survival rate was 96.77%, three-year - 87.09%, five-year - 74.19%, ten-year - 22.58%. Within three years after bypass surgery, no recurrence of bleeding was observed, while in half of the patients (54.28%) the varicose veins of the esophagus disappeared, in the rest (45.72%) they decreased to grade I. Recurrence of bleeding occurred in six patients (17.14%) after 5-13 years, in one case massive, which was accompanied by shunt thrombosis (2.85%) according to the results of DS. For the rest, its function was preserved. The median platelet count one year and three after CP did not differ and was 110 x109 and 105 x109. It was found that the larger the diameter of the portal vein and the lower the volume velocity of blood flow in it, the smaller was the increase in platelets in the long-term period (r=0.90, p=0.037; r=0.87, p=0.01). Conclusions. After performing splenorenal bypass surgery for portal hypertension for the purpose of primary and secondary prevention of gastric bleeding, its recurrence occurred in 17.14% 5-13 years after surgery. After the correction of portal hypertension, there was a tendency to increase the number of platelets in the long-term postoperative period, which was dependent on the volume velocity of blood flow in the portal vein and the degree of its expansion before surgical treatment.

HGG-11. APPLICATION OF SHUNT IN PEDIATRIC DIFFUSE INTRINSIC PONTINE GLIOMA COMPLICATED WITH HYDROCEPHALUS: A 10-YEAR EXPERIENCE FROM A SINGLE CENTER

Abstract OBJECTIVE Currently, there is no unified treatment protocol for pediatric diffuse intrinsic pontine glioma with hydrocephalus. The present study aims to explore the clinical characteristics and the best intervention modality for pediatric diffuse intrinsic pontine glioma with hydrocephalus. METHODS The detailed data of children with diffuse intrinsic pontine glioma admitted to the Department of Pediatrics of Guangdong Sanjiu Brain Hospital from January 2010 to December 2021 were retrospectively analyzed. The effect of radiotherapy and shunt on the prognosis of pediatric diffuse intrinsic pontine glioma complicated with hydrocephalus was evaluated. RESULTS 165 children with DIPG aged ≤18 years were included in the analysis, of whom 9 (5.5%) had mild ventricular dilatation, 48 (35%) had hydrocephalus, and 11 (22.9%) underwent cerebrospinal fluid shunting, of whom 10 (90.9%) underwent ventriculoperitoneal shunt and 1 (9.1%) underwent endoscopic third ventriculostomy. After shunt and radiotherapy, 53 cases of hydrocephalus could be evaluated, of which 37 patients (69.8%) were significantly relieved, and 16 (30.2%) were not. 99 children had tumor progression after treatment, including 41 cases (41.4%) with hydrocephalus and 5 cases (12.2%) with ventriculoperitoneal shunt. A total of 138 children were included in the survival analysis, which revealed that hydrocephalus, mild ventricular dilatation, and no ventricular abnormality had no effect on the prognosis (p=0.944). The treatment of hydrocephalus at the initial diagnosis did not affect the prognosis, p=0.405. The median survival of the hydrocephalus remission group post-radiotherapy was 12 months, and 8 months for the non-remission group, p=0.042. The median survival was 20 months in the shunt group and 8 months in the untreated group (p=0.005). CONCLUSIONS Asymptomatic ventricular enlargement in pediatric diffuse intrinsic pontine gliomas does not require surgical intervention. Hydrocephalus remission post-radiotherapy is a favorable prognostic indicator. Cerebrospinal fluid shunt could improve the prognosis of children with hydrocephalus when the tumor progresses post-radiotherapy.

Transjugular Intrahepatic Portosystemic Shunt and Thrombectomy (TIPS-Thrombectomy) for Symptomatic Acute Noncirrhotic Portal Vein Thrombosis

PurposeTo report the safety and effectiveness of transjugular intrahepatic portosystemic shunt and mechanical thrombectomy (TIPS-thrombectomy) for symptomatic acute noncirrhotic portal vein thrombosis (NC-PVT). Materials and MethodsPatients with acute NC-PVT who underwent TIPS-thrombectomy between 2014 and 2021 at a single academic medical center were retrospectively reviewed. Thirty-two patients were included (men, 56%; median age, 51 years [range, 39–62 years]). The causes for PVT included idiopathic (n = 12), prothrombotic disorders (n = 11), postsurgical sequelae (n = 6), pancreatitis (n = 2), and Budd-Chiari syndrome (n = 1). The indications for TIPS-thrombectomy included refractory abdominal pain (n = 14), intestinal venous ischemia (n = 9), ascites (n = 4), high-risk varices (n = 3), and variceal bleeding (n = 2). Variables studied included patient, disease, and procedure characteristics. Patients were monitored over the course of 1-year follow-up. ResultsSuccessful recanalization of occluded portal venous vessels occurred in all 32 patients (100%). Compared with pretreatment patency, recanalization with TIPS-thrombectomy resulted in an increase in patent veins (main portal vein [28% vs 97%, P < .001], superior mesenteric vein [13% vs 94%, P < .001], and splenic vein [66% vs 91%, P < .001]). Three procedure-related adverse events occurred (Society of Interventional Radiology grade 2 moderate). Hepatic encephalopathy developed in 1 (3%) of 32 patients after TIPS placement. At 1-year follow-up, return of symptoms occurred in 3 (9%) of 32 patients: (a) ascites (n = 1), (b) variceal bleeding (n = 1), and (c) intestinal venous ischemia (n = 1). The intention-to-treat 1-year portal vein and TIPS primary and secondary patency rates were 78% (25/32) and 100% (32/32), respectively. Seven patients required additional procedures, and the 1-year mortality rate was 3% (1/32). ConclusionsTIPS-thrombectomy is a safe and effective method for treating patients with symptomatic acute NC-PVT.