Vein Diameter Research Articles

The feasibility and efficiency for constructing arteriovenous fistula with

Autogenous arteriovenous fistula (AVF) is an efficient hemodialysis access for patients with end-stage kidney disease (ESKD). The specific threshold of vein diameter still not reached a consensus. We conducted a comprehensive search in PubMed, Embase, and Web of Science databases for articles which comparing the treatment outcomes of AVF with 2 mm as vein diameter threshold. Fixed and random effect model were used for synthesis of results. Subgroup analysis was designed to assess the risk of bias. Eight high-quality articles were included finally. Among a total of 1,075 patients (675 males and 400 females), 227 and 809 patients possessed <2 mm and ≥2 mm vein respectively. Apart from gender and coronary artery disease (P < 0.05), there was no significant difference in age, diabetes, hypertension or radial artery between maturation and non-maturation groups. The functional maturation rate was lower in patients with <2 mm vein according to fixed effect model [OR = 0.19, 95% CI (0.12, 0.30), P < 0.01]. There was no significant difference in primary [OR = 0.63, 95% CI (0.12, 3.25), P = 0.58] or cumulative patency rates [OR = 0.40, 95% CI (0.13, 1.19), P = 0.10]. Vein diameter less than 2 mm has a negative impact on the functional maturation rate of AVF, while it does not affect the primary and cumulative patency rates (12 months).

Predictive value of liver and spleen stiffness measurement based on two-dimensional shear wave elastography for the portal vein pressure in patients with compensatory viral cirrhosis.

This study aimed to explore the predictive value of liver and spleen stiffness measurement based on two-dimensional shear wave elastography for the portal vein pressure in patients with compensatory viral cirrhosis. From January 2017 to August 2019, 107 patients with compensatory viral cirrhosis and 76 patients with viral hepatitis were enrolled as cirrhosis group and hepatitis group, respectively. Patient data were obtained during admission, and this study was a review and analysis of patient data. Liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter and spleen thickness were compared between the two groups, and their diagnostic value for compensatory viral cirrhosis was analyzed. According to the hepatic vein pressure, the cirrhosis group patients were divided into non-hypertensive group (no portal hypertension, hepatic venous pressure gradient (HVPG) < 5 mmHg), mild group (mild portal hypertension, 5 mmHg ≤ HVPG ≤ 10 mmHg) and severe group (clinically significant portal hypertension group, HVPG > 10 mmHg). LSM, SSM, portal vein diameter and spleen thickness of the three groups were compared, and the correlation between SSM and hepatic vein pressure was analyzed. LSM, SSM, portal vein diameter and spleen thickness in the cirrhosis group were higher than those in hepatitis group (all P<0.05). The area under the curve (AUC) of combined detection was larger than that of LSM, SSM and spleen thickness detection alone in liver cirrhosis diagnosis (all P<0.05). LSM, SSM, portal vein diameter and spleen thickness increased with the increase of hepatic vein pressure in patients with liver cirrhosis (all P<0.05). LSM, SSM, portal vein diameter and spleen thickness were all positively correlated with hepatic vein pressure (P<0.05). ROC curve showed that AUC of combined detection was greater than that of LSM, SSM, portal vein diameter and spleen thickness alone detection in the diagnosis of clinically significant portal hypertension (all P<0.05). The increase of LSM, SSM, portal vein diameter and spleen thickness were the influencing factors for hepatic vein pressure rising (all P<0.05). There was an increase of LSM and SSM in patients with compensatory viral cirrhosis, which were positively correlated with hepatic venous pressure, and combined index detection has diagnostic and predictive value for the change of portal venous pressure.

Optimization of high-power short duration catheter radiofrequency ablation for pulmonary veins isolation in patients with artiral septial defect

Objective ‒ to perform the analysis and biophysical substantiation of a new technique of catheter radiofrequency ablation (RFA) with high power and short duration based on mathematical modeling of own clinical data of the electro-thermodynamic effect of RFA on the myocardium; to investigate the morphological characteristics of the myocardium in different areas of the atrium and to determine the morphometric parameters of the display on the electroanatomical model of the heart of the ablation zone in the EnSite Precision navigation system, necessary for effective and safe high-power and short-duration RFA.Materials and methods. Clinical studies were performed in Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine. Specialized high-tech medical equipment was used for the objectivity of clinical data obtained and used in the work. Morphological characteristics of the myocardium (thickness of the wall of the left atrium, distance from the back wall of the heart to the esophagus, diameters of the pulmonary veins) were evaluated on the computed tomography images of the heart of the patients, which were obtained in the radiology department on a Toshiba device (Japan) using a spiral scanning. The morphometric parameters of the ablation zone, which were later used to evaluate the effectiveness of RFA and which formed the basis of standardized protocols for the operation, were determined for display on the electro-anatomical maps of the patients' hearts in the EnSite Precision system (Abbott, USA). Biophysical substantiation of the RFA technique with high power and short duration was performed using mathematical modeling of the electro-thermodynamic effect of RFA on the myocardium and own clinical data in the Comsol Multiphysics automated simulation of biophysical processes.Results. It is proposed for a group of patients with combined atrial fibrillation with an atrial septal defect to perform RFA using a new ablation technique with high power and short duration at one point of application of radio frequency energy. Achieving transmurality of ablation in a shorter time makes it possible to hold the electrode more precisely and stably in this area when isolating the pulmonary veins in a complex geometry and without support for the electrode in case of a defect. The morphological characteristics of the myocardium were studied and the morphometric parameters of the display on the electroanatomical heart model of the ablation zone, necessary for effective and safe RFA, were determined. These include: the diameter of the point-label of radiofrequency ablation on the anatomical model of the heart, which must correspond to the real data of the size of the destruction; the percentage of overlap of RFA points for the formation of an effective transmural line; estimated number of ablation points to standardize the evaluation of the effectiveness of the procedure.Conclusions. The conducted research made it possible to solve the current problems of catheter radiofrequency ablation in patients with atrial fibrillation and atrial septal defect, namely to increase the efficiency and safety of pulmonary vein isolation. Transmurality and integrity of the isolating line was achieved due to the determined morphological characteristics of the myocardium and the calculated morphometric parameters of the ablation zone. The obtained data are adapted to a real display visible to the surgeon on the electro-anatomical map of the heart in the EnSite Precision navigation system. This system is actively used in clinical practice, but it was necessary to optimize the clinical protocols of RFA with high power and short duration, which was achieved as a result of this work.

An Approach to Investigations of Chronic Liver Disease.

Chronic liver disease (CLD) in children is more diverse compared to adults with respect to the etiology, progression and response to therapy. After history and clinical examination, the first step is to confirm the presence of CLD with basic blood investigations and ultrasonography. Markers of portal hypertension are splenomegaly, increased portal vein diameter, thrombocytopenia and presence of varices on endoscopy. The next step is to evaluate the etiology of CLD which will depend on the age of the child and needs targeted investigations as metabolic and inherited causes predominate in early childhood. CLD progression ought to be monitored regularly and several non-invasive markers are available but they have to be evaluated further in children. Since CLD progresses, complications have to be detected early not only to initiate appropriate treatment but also to prognosticate.

Bilaterality of varicocele: The overlooked culprit in male infertility. Case series study.

Varicocele is the most common correctable cause of male infertility that always has been a debatable subject as regards how it affects fertility and the best way to treat it. Proper assessment of the disease bilaterality is crucial not to miss one side and not to jeopardize treatment outcome. This study aimed to objectively assess varicocele bilaterality in infertile men aiming to improve treatment outcome in this cohort of patients. This prospective study was conducted between January 2019 and January 2022 including infertile males with varicoceles. Assessment of missed concomitant contralateral varicocele done pre-operatively by Color Doppler Ultrasound and intraoperatively by intraoperative Doppler device and measurement of maximal vein diameter of contralateral side. A total of 329 cases completed the study. A hundred cases (30.4%) were initially referred as unilateral varicoceles and 229 (69.6%) as bilateral varicoceles. After reassessment of the study population, bilaterality of varicocele was found to be as high as 98.5% (324/329). Repeat CDUS strongly correlated with the intraoperative measured varicocele diameter (r = 0.9, p < 0.001). Moreover, sperm parameters showed significant improvement 3 and 6 months post varicocelectomy. Normal pregnancy after 1 year of surgery occurred in 118 cases (35.9%). Varicocele bilaterality in infertile men is underreported. Thorough assessment by expert radiologists and andrologists is of paramount importance not to miss significant pathology or hazard treatment outcome.

Effect of far-infrared therapy device on arteriovenous fistula maturation and lifespan in hemodialysis patients: a randomized controlled clinical trial.

Arteriovenous fistula (AVF) is the first choice of vascular access for hemodialysis treatment, and its surgical maturity rate is not high, and its postoperative complications (mostly stenosis) significantly shorten its life. At present, there are few studies on treatment methods to improve the maturity and survival of AVF. In this study, the effect of far infrared therapy (FIR) on the maturity and longevity of arteriovenous fistula in hemodialysis patients was discussed, and the protective mechanism of AVF induced by FIR therapy was explored, aiming at exploring a new treatment method. The hemodialysis patients admitted to the 900th Hospital of the Chinese Joint Logistics Support Force of the People's Liberation Army from January 2021 to April 2023 were randomly divided into control group and intervention group, with 40 cases in each group. Among them, the control group was coated with mucopolysaccharide polysulfonate cream; Intervention group: The patients were treated with mucopolysaccharide polysulfonate cream and far infrared radiation at the same time. After 3 months' intervention, the arteriovenous fistula (vein diameter, mature time of arteriovenous fistula, blood flow controlled by pump during dialysis, blood flow of brachial artery during dialysis and the occurrence of complications of internal fistula (oozing, occlusion and infection) and the pain score (numerical rating scale, NRS) of the two groups were compared, and the curative effects were compared. There was no significant difference in general data between the two groups (P > 0.05), which indicated that the study was comparable. After 3 months' intervention, the vein diameter, pump-controlled blood flow and brachial artery blood flow in the intervention group were significantly higher than those in the control group (P < 0.05). And the maturity time, NRS score and complication rate of arteriovenous fistula were significantly lower than those of the control group (P < 0.05). The primary patency rate of AVF in the intervention group was higher than that in the control group, and the overall patency rate between the two groups was statistically significant (P < 0.05). As a promising new treatment method, far infrared therapy can effectively promote the maturity of AVF, increase venous diameter, pump controlled blood flow during dialysis, brachial artery blood flow during dialysis, and prolong the service life of AVF.

Quantitative anatomy of the large variant right hepatic vein: A systematic three-dimensional analysis.

Anatomical variations of the right hepatic vein, especially large variant right hepatic veins (≥5 mm), have important clinical implications in liver transplantation and resection. This study aimed to evaluate anatomical variations of the right hepatic vein using quantitative three-dimensional visualization analysis. Computed tomography images of 650 patients were retrospectively analyzed, and three-dimensional visualization was applied using the derived data to analyze large variant right hepatic veins. The proportion of the large variant right hepatic vein was 16.92% (110/650). According to the location and number of the variant right hepatic veins, the configuration of the right hepatic venous system was divided into seven subtypes. The length of the retrohepatic inferior vena cava had a positive correlation with the diameter of the right hepatic vein (rs = 0.266, p = 0.001) and the variant right hepatic veins (rs = 0.211, p = 0.027). The diameter of the right hepatic vein was positively correlated with that of the middle hepatic vein (rs = 0.361, p < 0.001), while it was inversely correlated with that of the variant right hepatic veins (rs = -0.267, p = 0.005). The right hepatic vein diameter was positively correlated with the drainage volume (rs = 0.489, p < 0.001), while the correlation with the variant right hepatic veins drainage volume was negative (rs = -0.460, p < 0.001). The number of the variant right hepatic veins and their relative diameters were positively correlated (p < 0.001). The volume and percentage of the drainage area of the right hepatic vein decreased significantly as the number of the variant right hepatic vein increased (p < 0.001). The findings of this study concerning the variations of the hepatic venous system may be useful for the surgical planning of liver resection or transplantation.

Reversion of liver cirrhosis after endovascular treatment in Chinese patients with Budd-Chiari syndrome.

To investigate the impact of endovascular (EV) treatment on liver cirrhosis in Chinese patients with Budd-Chiari syndrome (BCS). From September 2011 to March 2022, 97 patients from four hospitals in China who were diagnosed with primary BCS complicated with liver cirrhosis and received EV treatment were retrospectively enrolled in this study for clinical analysis. In addition, liver tissues for basic research were acquired from 25 patients between June 2022 and March 2023, including six with benign liver tumors, 11 with BCS before EV treatment, and eight with EV-treated BCS. Liver cirrhosis was assessed by clinical outcomes, histological studies, and the expression of related genes at the mRNA and protein levels. The patients with BCS had better liver function after EV treatment, evidenced by an increased albumin level and reduced total bilirubin, ALT, and AST. The imaging findings suggested an amelioration of liver cirrhosis and portal hypertension, including increased portal vein velocity (13.52±8.89cm/s vs. 17.51±6.67cm/s, p<0.001) and decreased liver stiffness (30.37±6.39kPa vs.23.70±7.99kPa, p<0.001), portal vein diameter (14.97±3.42mm vs. 13.36±2.89mm, p<0.001), and spleen volume (870.00±355.61cm3 vs. 771.36±277.45cm3 , p<0.001). Furthermore, histological studies revealed that EV treatment resulted in a restoration of liver architecture with reduced extracellular matrix deposition. Meanwhile, hepatic angiogenesis and inflammation, which have a close relationship with cirrhosis, were also inhibited. In addition, the state of hepatocytes switches from apoptosis to proliferation after EV treatment. BCS-induced liver cirrhosis could be reversed by EV treatment from macroscopic to microscopic dimensions. Our study may provide further insights into understanding BCS and treating cirrhosis.

Quantitative analysis of the structure of the portal vein of the liver and splenic vein in people with different somatotypes in portal hypertension

BACKGROUND: HeathCarter somatotyping using bioimpedance analysis is one of the most common methods of somatotyping because of its non-invasiveness, portability, comparative reliability of the data, and ease of use. Knowledge of the relationship between portal hypertension and somatotype may lead to the development of effective approaches to the diagnosis, treatment, and prevention of this disease.&#x0D; AIM: To examine the frequency of various somatotypes in people with portal hypertension.&#x0D; MATERIALS AND METHODS: The study included 46 patients with cirrhosis of the liver who were treated at the University Clinical Hospital N 2 Sechenov University. The calculation of endo- (ENDO) and mesomorphy (MESO) scores, assessment of the somatotype by HeathCarter, and data visualization on the somatogram were carried out using the ABC-01 MEDASS software (STC MEDASS, Russia). Portal hypertension was diagnosed by ultrasonography of the abdominal cavity and retroperitoneal space.&#x0D; RESULTS: The diameter of the splenic vein was 7 mm in 17/18 men and 23/28 women. The diameter of the portal vein was 13 mm in 8/18 men and 12/28 women. The mesoendomorphic somatotype was the most common among women and endomesomorphic among men. More than half (n=9; 52.9%) of men had splenic vein diameter large than normal and the endomesomorphic somatotype, whereas the predominant part of women (n=18; 78.3%) had the mesoendomorphic somatotype. Similar results were obtained in patients with portal vein diameter larger than normal, and the endomesomorphic somatotype prevailed among men (n=5; 62.5%) and mesoendomorphic among women (n=10; 83.3%).&#x0D; CONCLUSIONS: The frequency of portal hypertension in patients with different somatotypes varied. It was higher in patients with a pronounced endomorphic component than in those with other somatotypes. In general, our results underline the complexity of the association of portal hypertension with somatotypes and indicate the need for a deeper analysis of this problem and further research. Future studies should include larger numbers of both healthy individuals and patients with chronic liver disease, different age groups, and a broader set of parameters for analysis. Understanding the relationship between portal hypertension and somatotypes can help develop more effective strategies for the prevention and treatment of this syndrome.

Correlation between preoperative Doppler ultrasonography-assessed specific accessory cephalic vein diameter-cephalic vein diameter ratio (r) and early dysfunction of Radial artery-Cephalic vein arteriovenous fistula: a single-center cross-sectional study.

Accessory cephalic vein (ACV) ligation can circumvent immature arteriovenous fistula (AVF). However, no consensus has been reached on the definite timing of ACV ligation. This study aimed to retrospectively analyze the correlation between preoperative Doppler ultrasonography (DUS)-assessed specific ACV diameter-cephalic vein diameter ratio (r) and early dysfunction of Radial artery-Cephalic vein (RC)-AVF in order to improve the early maturity rate of RC-AVF. A total of 258 patients who underwent RC-AVF at The Third Affiliated Hospital, Sun Yat-sen University from 1 June 2018 to 31 March 2022 were included in this study. The inclusion criteria were as follows: (I) cephalic vein ≥2.0 mm and radial artery ≥1.5 mm, suitable for RC-AVF establishment; (II) presence of an ACV. As per the specific r determined using preoperative DUS assessment, all patients were classified into two groups: Group A (r<0.8) and Group B (r≥0.8). Furthermore, patients in each group were divided into intervention and non-intervention subgroups based on the presence or absence of intraoperative ACV ligation, respectively. Patient data including age, sex, underlying disease, AVF side, and radial diameter were compared. The difference of maturity rate between participants in the intervention group and non-intervention group with different r values was analyzed, so as to obtain the relationship between different r values and maturity rate. No statistical differences were observed between the intervention and non-intervention subgroups in the two groups in terms of sex, age, comorbidities, complications, AVF side, radial artery, cephalic vein, and ACV diameters (P>0.05). When r<0.8, the maturity rates of the intervention group and the non-intervention group were 80% and 92.98%, respectively, χ2=4.561. The difference in maturation rate between the intervention and non-intervention subgroups was insignificant (P=0.075) when r<0.8. When r≥0.8, the maturity rates of the intervention group and the non-intervention group were 89.83% and 45.45%, respectively, χ2=25.943. The difference in maturation rates between the intervention and non-intervention subgroups was significant when r≥0.8 (P<0.001). Preoperative DUS suggested a correlation between r≥0.8 and early immaturity of RC-AVF. Therefore, concurrent intraoperative ACV ligation should be carried out when preoperative r is ≥0.8, as it may reduce the early power dysfunction of RC-AVF.

Varicocele Surgery: Three Years Experience

Despite available treatments like varicocelectomy, a standard therapy remains controversial. Varicocele repair has shown promise in improving sperm parameters, but further research is needed, especially in nonobstructive azoospermia cases. Techniques such as microscopic testicular sperm extraction and intracytoplasmic sperm injection have shown some success in achieving pregnancies. Objective: To articulate our hands-on experience and understanding pertaining to varicocele. Methods: This study included patients who presented to our clinic due to varicocele and underwent surgical procedures between November 2020 and January 2023. Results: This research involved 26 varicocele patients, primarily age rage was 27.5 years old. The majority (85%) had varicocele on the left side, and 15% had bilateral varicocele. The mean vein diameter was 3.58mm and 2.6mm for the left side and bilateral cases respectively, with a general average of 3.45mm. Analysis of sperm count, motility, and morphology reflected an average of 32.6 million/ml, 23.2%, and 5.23%, respectively. An average of 4.45 veins was ligated during surgery, with a slight variance based on the side. One patient lost approximately 85% of the testicular blood supply due to a complication during surgery, leading to testicle hardening without atrophy. Two patients experienced recurrence (7.6% recurrence rate). Negative and positive correlations were found between the number of ligated veins and preoperative sperm count (p=0.043, r=-0.408), and vein diameter and preoperative sperm morphology (p=0.004, r=0.544), respectively. Conclusions: Despite the limitations, our study provides valuable insights into the relationship between varicocele severity and sperm parameters.

Decompression of Axillary Vein: An Essential Adjunct for Advanced Lymphedema.

In advanced lymphedema, lymphovenous anastomosis (LVA) can be a solution based on using the pressure gradient between the high-pressure lymphatics and the low-pressure veins. If the vein pressure is high, the effect of surgery will be less optimal. This study evaluated the effect of axillary vein perivascular scar release on LVA. This is a retrospective study of 40 upper limb stage 2 and 3 lymphedema patients divided into 2 groups with an average follow-up of 33 months (minimum of at least 12 months): the scar release group ( n = 25) and the control group ( n = 15). All patients underwent LVA with or without lymph node transfer. Demographic data, outcome (volumetric change and bioimpedence analysis [BIA]), and major vein (axillary, basilic, and cephalic) diameter changes were evaluated. Both groups showed significant reduction in volume and BIA parameters after LVA. The scar release group (24 of 25 with lymph node transfer and 1 without) showed statistically higher reduction of BIA analysis compared with the control group at 1, 6, and 12 months after LVA. The changes in the major veins after axilla scar release showed significant changes in all 3 veins. There was a significant correlation between cephalic vein diameter reduction and BIA measurement. The release of perivascular scar in the axillary vein may result in better outcome after LVA. This is based on the finding that scar release shows correlation between cephalic vein diameter reduction and BIA measurement suggesting reduction of venous pressure in the peripheral vein increasing the pressure gradient between the lymphatic and venous system allowing better outflow after LVA. Therapeutic, III.

Is the multi-species variation in leaf anatomical traits along the environmental gradient modulated by herbaceous functional groups?

Grasses are widely distributed in various habitats with significantly different characteristics than non-grass species. However, an understanding of the multi-species differences in leaf anatomical traits variation and adaptive strategies between grass and non-grass species is limited. We measured leaf anatomical traits of 242 species from 10 sampling sites along an environmental gradient on the Loess Plateau (from east to west, environmental temperature, precipitation, and soil nutrients decreased, but radiation increased). Nine leaf anatomical traits were measured, and these traits related to the leaf physiological functions of photosynthesis (mesophyll thickness (MT), palisade tissue thickness (PT), spongy tissue thickness (ST)), defense (epidermal thickness (ET) and leaf thickness (LT)), and transport (xylem conduit diameter (CD) and major vein diameter (MVD)). Subsequently, we calculated the trait ratios, which reflect the proportion of investment in trait construction (epiderm-leaf thickness ratio (ET/LT) and mesophyll-leaf thickness ratio (MT/LT)). The results of linear regression analysis showed that non-grasses living under harsh environmental conditions have thicker leaf tissues responsible for photosynthesis and defense compared to grasses from the same environment. However, grasses and non-grasses living under stressful environmental conditions have higher MT/LT and lower ET/LT compared to species living in environments with a more proper resource supply, which indicated that both preferred to invest less in defense-related traits (e.g., epidermal thickness) while cost more in photosynthesis-related traits (e.g., mesophyll thickness) under the limited resource conditions. These findings highlight that grass and non-grass species have different trait characteristics and adaptive strategies in response to environmental changes. More importantly, a new inspiration is provided for exploring the plants’ general investment rule from the perspective of leaf anatomical trait-ratio values.

Investigation of the variation of vessels around the pancreatic head based on the first jejunal vein anatomy at pancreaticoduodenectomy.

Pancreaticoduodenectomy (PD) for pancreatic cancer carries a high risk of massive intraoperative blood loss. The artery first approach (AFA) prevents blood loss during PD, but the optimal approach is unclear. The first jejunal vein (FJV) often comprises multiple veins and broadly supports venous drainage of the proximal jejunum. Its ligation carries a risk of proximal jejunum congestion. Here we investigated the anatomical characteristics of PD-associated vessels and AFA approach selection based on FJV anatomy. This study included 148 Japanese living donors for liver transplantation. We reviewed their computed tomography images and assessed the anatomical pattern of PD-associated vessels in terms of FJV anatomy. The FJV traveled posterior to the superior mesenteric artery in 128 patients (86.5%, dorsal group) and anterior in 20 (13.5%, ventral group). The predominant draining vein of the inferior pancreaticoduodenal vein was the superior mesenteric vein in the ventral group (87.5%) and the FJV in the dorsal group (97.9%). Compared with the dorsal group, the ventral group had a significantly greater percentage with the superior mesenteric vein ventral to the superior mesenteric artery (30.0% versus 10.9%) and a significantly larger posterior superior pancreaticoduodenal vein diameter (3.2 ± 0.9 versus 2.7 ± 0.6mm, p = 0.0029). These results were validated in patients with pancreatic head cancer. The anatomical characteristics of PD-associated vessels differed significantly between groups defined by FJV anatomy. Understanding the venous anatomy, especially the FJV, could support selection of the best approach in AFA for PD.

Retinal vein changes in patients with high-risk proliferative diabetic retinopathy treated with conbercept and panretinal photocoagulation co-therapy: a cohort study.

This study aimed to observe and compare retinal vein diameter changes and other essential indicators in patients with high-risk proliferative diabetic retinopathy (PDR) treated with intravitreal injection of conbercept (IVC) combined with panretinal photocoagulation (PRP) versus PRP monotherapy. A retrospective analysis was conducted on data from patients with high-risk PDR who received specific treatment and were followed up for 24 months. Among 82 patients with high-risk PDR, 50 eyes received PRP combined with IVC, whereas 32 eyes received PRP alone. During the 24-month follow-up period, changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT), retinal vein diameter, number of microaneurysms (MA), neovascularization (NV) area, hard exudate (HE) area, size of the foveal avascular zone (FAZ), superficial capillary plexus (SCP) blood flow density, and adverse effects were recorded and compared between the two groups at baseline and at 6, 12, 18, and 24 months after treatment. The relationship between each observation index and vein diameter was also analyzed. During the 24-month follow up, significant improvements in the BCVA, CFT, retinal vein diameter, number of MAs, NV area, HE area, FAZ, and SCP were observed in the IVC+PRP group after treatment. The PRP group only showed significant reductions in NV and HE areas. The IVC+PRP group showed significant superiority over the PRP group in improving the vein diameter, number of MA, and HE area. However, no statistically significant difference in NV area reduction was found between the groups. In the treatment of high-risk PDR, IVC+PRP therapy has a significant advantage over PRP monotherapy. IVC+PRP therapy may reverse diabetes-induced retinal vein changes, restoring morphology and function.

Effectiveness of Duplex Doppler Sonography of Portal Vein as a Supplementary Tool in Diagnosis of Pediatric Appendicitis

Background Acute appendicitis is the most common surgical emergency in pediatric patients. Ultrasound is the preferred initial imaging modality to evaluate children with clinically- suspected appendicitis. whether by directly visualizing the inflamed appendix or by using secondary signs. However. rate of falsely negative or equivocal exams is still high, leading to a risk of complications from negative appendectomies as well as delayed diagnosis. Objective To evaluate the diagnostic accuracy of portal vein flow velocity and diameter in diagnosis of pediatric acute appendicitis Patients and Methods A cross-sectional study over the course of 6 months from June until November 2021. Portal vein diameter and peak systolic flow velocity were measured for 75 pediatric patients with clinically suspected appendicitis referred to radiodiagnosis department at Ain Shams University Hospitals for a pelvi-abdominal ultrasound examination. The largest appendix diameter secondary sonographic signs, and total leucocytic count were recorded if available. Results The mean age of the population was 112 ± 4.12 years (range. 3-18 years). Mean portal vein flow velocity was 38.94 ± 9.59 cm/s in the appendicitis group and 27.96 ± 6.98 cites in the non-appendicitis group. Median portal vein flow velocity was significantly higher in the appendicitis group (p &amp;lt; 0.001 with an overall diagnostic accuracy 82.1% at cut-off value of &amp;gt; 33.3 cm/sec. Mean portal vein diameter was 9.37±2.01 mm in the appendicitis group and 8.84 ± 2.19 mm in the non-appendicitis group, showing no statistically significant difference (P = 0.27). The presence of right iliac fossa echogenic fat was highly significant (P &amp;lt; 0.001) in predicting acute appendicitis. Conclusion The use of portal vein velocity as a supplementary tool improved the diagnostic performance and increased the sensitivity of ultrasound in diagnosing acute appendicitis. thus, decreasing the incidence of delayed appendectomies that have an increased risk of complications as well as decreasing the incidence of unnecessary appendectomies. Further studies are required to establish a comprehensive guideline to use it as a tool in ultrasound examinations of these patients.

Application Areas of Intermittent Pneumatic Compression in the Prevention of Deep Vein Thrombosis During Dixon Surgery: A Randomized, Controlled Trial

PurposeDeep vein thrombosis (DVT) is common in the lithotomy position after laparoscopic surgery. Intermittent pneumatic compression (IPC) plays an important role in DVT prevention. However, few studies have compared the different compression areas of IPC application. It was hypothesized that the location of the compression sleeves could have an impact on the effects of thromboprophylaxis. MethodsIn this randomized, controlled trial performed from August 2020 to March 2021, 164 patients scheduled to undergo laparoscopic Dixon surgery were randomly assigned to one of four groups, based on the bilateral placement of compression sleeves during surgery: feet, calves, thighs, or control (no IPC). Both lower extremities were monitored for DVT on days 1 and 7 after surgery, using ultrasonographic assessment of mean blood velocity, blood flow volume, and diameter of the common femoral veins. Thrombosis-related hematologic analysis was performed. FindingsOn day 1 after surgery, IPC of the feet or calves was associated with a reduced prevalence of DVT compared with controls (both: P = 0.024; OR = 0.09; 95% CI, 0.01–0.72), while IPC of the thighs had no significant benefit (P = 0.781; OR = 0.86; 95% CI, 0.29–2.55). The prevalence of DVT in the left extremity was lower with IPC of the feet and calves compared with controls (both, P = 0.048). The mean blood velocity in the common femoral vein was significantly increased after surgery with IPC of the left and right feet (P = 0.006 and 0.007, respectively) and calves (P = 0.011 and P = 0.026, respectively) compared with controls. Similarly, the volume of blood flow in the left common femoral vein was greater with IPC of the feet and calves (P = 0.03 and 0.027, respectively). However, on day 7 after surgery, the between-group differences in the prevalences of DVT and hematologic indicators of thrombosis were not significant. ImplicationsOn day 1 after surgery, IPC application at the feet or calves facilitated venous return and, hence, reduced the prevalence of DVT, especially in the left extremities. However, there were no significant differences in the prevalences of DVT or thrombosis-related hematologic indicators among the four groups on the day 7 after surgery. Chinese Clinical Trial Registration identifier: ChiCTR2000035325.

Angiopoietin-2 as a Predictor of Fibrosis Regression in Hepatitis C Virus-Patients after Direct Acting Antiviral Drugs

Abstract Background Hepatitis C virus (HCV) infection is the major cause of liver cirrhosis and hepatocellular carcinoma (HCC); thus, effective and safe treatment is crucial. Aim of the Work to evaluate the serum angiopoietin-2 as non-invasive marker of fibrosis regression in patients with Hepatitis C Virus receiving DAA drugs. Patients and Methods This study was conducted on 40 chronic HCV-patients who received DAA therapy in the Hepatic Virology Unit and the gastroenterology department of Ain Shams University hospitals. All patients were subjected to the following: Full history taking with stress concerning the hepatology system, clinical evaluation, laboratory investigations, Routine investigations: Abdominal and Pelvic ultrasonography and Transient elastography (Fibroscan) to measure liver stiffness measurement (LSM) for detection the degree of liver fibrosis in the chronic HCV-patients. Results Hematological findings, biochemical liver profile and liver fibrosis indices except hemoglobin level and platelets counts were significantly improved after DAA therapy. There was a significant improvement concerning the fibrosis stage after the treatment fibrosis staging at SVR12. The liver size, the spleen size and portal vein diameter were also significant after DAA therapy. There was improvement in the Child-Pugh score after successful HCV eradication by DAAs but the difference was no statistically significant. There was a statistically significant higher mean of Ang-2 levels in higher stages of liver fibrosis stages. Overall, serum Ang-2 levels significantly decrease after DAA therapy. In F0, F1, F2 &amp; F3 fibrosis stage; the mean Ang2 levels decrease after DAA therapy but in F4 fibrosis stage; the mean Ang2 levels did not change almost. Baseline Ang-2 and WBCs, AST, ALT, total bilirubin, INR, serum albumin, alpha-fetoprotein, serum creatinine, LSM, FIB-4 index, APRI score, liver size and portal vein diameter were significantly correlated. There were also a significant correlation between Ang-2 and all the fibrosis stages (from F0 to F4) before DAA treatment. Ang-2 levels were significantly associated with LSM based liver fibrosis stage regression after successful DAA therapy. Ang-2 levels did not correlate with hemoglobin, platelets and spleen size at baseline. Ang-2 levels did not correlate with hemoglobin, platelets, WBCs, INR, spleen size and portal vein diameter after DAA therapy. Ang-2 levels did not show significant correlation with the Child-Pugh score after DAA therapy. Conclusion Liver fibrosis stage after successful HCV eradication by DAAs. But in stage F4 (cirrhosis), mean Ang-2 remained almost unchanged after DAA therapy. Significant decrease of Serum Ang-2 could suggest its use as a predictor of liver fibrosis regression in Hepatitis C Virus-patients after Direct Acting Antiviral drugs after DAA therapy.

Assessment of Right Lobe Size/Serum Albumin Ratio as a Non-Invasive Marker for Esophageal Varices in HCV Patients

Abstract Background Viral hepatitis was estimated to be the 7th leading cause of mortality globally. HCVassociated disease is one of the leading causes of HCC and the main indications for liver transplantation. Approximately 71 million people are chronically infected worldwide, with a total global HCV prevalence estimated at 2.5%. Egypt has the highest world prevalence of hepatitis C virus (HCV) infection, which is associated with substantial disease and economic burden. Chronic HCV infection can result in hepatic fibrosis, cirrhosis, HCC and death. One of the major complications of cirrhosis is gastroesophageal varices, the incidence of which ranges from 35% to 80%). Current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. Noninvasive identification of patients at highest risk for esophageal varices would limit investigation to those most likely to benefit. Aim of the Work The aim of our study is to determine the predictive value of noninvasive parameters (Rt. lobe diameter/ serum albumin ratio) in the prediction of esophageal varices. Patients and Methods It is a cross-sectional study carried on 100 patients collected from the Hepatology outpatient clinics and from Hepatology and Gastroenterology unit, Internal medicine department at Ain Shams University Hospital over 6-month period, with inclusion and exclusion criteria aiming at the elimination of other factors that might affect the study results. All patients were divided into 3 groups: 30 patients with Child-Pugh A, 30 patients with Child-Pugh B, and 40 patients with Child-Pugh C. patients were subjected to the following: Clinical assessment: including; Full medical history and clinical examination, laboratory investigations: (AST, ALT, Bilirubin, Albumin, INR, Alpha feto-protein, CBC), abdominal ultrasonography and doppler ultrasonography: performed after overnight fasting and the patient in supine position with emphasis on the liver right lobe diameter (cm), splenic bi-polar diameter (long axis) (cm), ascites, presence of periportal thickening, portal vein diameter (mm) and patency, upper GI endoscopy. Results Our study showed that regarding platelet count, INR, serum albumin, Liver size, liver size / serum albumin ratio there was a significant difference among esophageal varices grades. Liver size / serum albumin ratio had non-significant diagnostic performance in differentiating esophageal varices grade-I from grade-0, had significant moderate diagnostic performance in differentiating other esophageal varices grades from each other. Liver size / serum albumin ratio cutoff points had high specificity &amp; PPV but low sensitivity&amp; NPV in differentiating grade-I from grade-0, had high sensitivity&amp; NPV but moderate specificity &amp; PPV in differentiating other grades from each other. Conclusion Our study showed that there was significant moderate agreement between endoscopy and liver size / serum albumin ratio regarding esophageal varices grades. Our study stresses on the use of some of the non-invasive parameters in predicting the grade of esophageal varices in cirrhotic patients without submitting them to the invasive, time consuming and expensive procedure of endoscopy.

Serum Kallistatin Level as a Predictor of Esophageal Varices in Patients of Liver Cirrhosis

Abstract Background Esophageal varices are porto-systemic collaterals resulting from portal hypertension, and considered the most lethal complication of liver cirrhosis so early diagnosis of varices can improve prognosis of liver cirrhosis. Kallistatin a tissue kallikrein-binding protein and a serine proteinase inhibitor (serpin) is mainly formed and secreted in liver and its serum level diminished in liver cirrhosis. It has anti-angiogenic, anti-oxidant, anti-inflammatory and anti-tumor effects. Kallistatin level is believed by many literature to be related to the severity of liver disease. Aim of the Work The aim of this study was to assess the relation between serum kallistatin level and presence of OVs. This study also aimed to evaluate serum kallistatin level as a non-invasive predictor of OVs. Patients and Methods This study was conducted in the Gastro-enterology unit, Internal medicine department, Ain Shams University hospitals &amp;Theodor Bilharz Institute. This is a case control study including 60 cirrhotic patients and 20 healthy. Results There was no significant differences between the studied groups regarding demographic data. There was no significant differences between the studied groups as regards Hb, WBCs, ALT, AST, creatinine and, urea but there was highly significant differences between cirrhotic groups and healthy group in the means of platelet count, serum albumin, serum sodium, total and direct bilirubin but no significant difference between groups I and II. Regarding to prothrombin time, there was highly significant differences between the 3 groups as it was higher in group I more than II more than III. There was also no significant difference between the cirrhotic groups regarding to Child Pugh score, MELD score and portal hypertensive gastropathy (PHG). There were significant differences between the 3 studied groups regarding to the means of splenic diameter and portal vein diameter. Kallistatin level showed significant decrease in both patients with OVs and patients without OVs vs. healthy individuals and there was highly significant difference between patients with OVs and patients without OVs. The level of Kallistatin concentration is not correlated with size of varices or risky signs suggesting that Kallistatin level can predict presence of O.V but it can’t reflect the size and severity of varices. There was no significant correlation between serum level of Kallistatin and age, gender and smoking. There was positive correlation to hemoglobin, platelet count, albumin level and negative correlation with PT, INR and urea. There was positive correlation to portal hypertensive gastropathy (PHG) and negative correlation with MELD score and portal vein diameter. Conclusion Serum level of Kallistatin level may express the degree of liver dysfunction. It is correlated with presence of O.V but not correlate to size or risky signs of OVs suggesting that Kallistatin level can’t reflect the presence of O.V. It can predict the presence of severe PHG.