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Late polymicrobial transjugular intrahepatic portosystemic shunt infection in a liver transplant patient:A case report

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World Journal of Hepatology 2022年第4期14卷 846-853页

作者： Irene De La Caridad Perez Ziv J Haskal John I Hogan curtis k argo Department of Medicine University of Virginia Medical CenterCharlottesvilleVA 22903United States Department of Radiology and Medical Imaging Division of Vascular and Interventional RadiologyUniversity of Virginia Medical CenterCharlottesvilleVA 22903United States Department of Medicine Division of Infectious Diseases and International HealthUniversity of Virginia Medical CenterCharlottesvilleVA 22903United States Department of Medicine Division of Gastroenterology and HepatologyUniversity of Virginia Medical CenterCharlottesvilleVA 22903United States

BACkGROUND Infection of a transjugular intrahepatic portosystemic shunt(TIPS)stent is a rare and serious complication that most commonly occurs during TIPS creation and revision.Patients typically present with recurrent bacteremia due to shunt occlusion or vegetation.To date there are approximately 58 cases reported.We present a patient diagnosed with late polymicrobial TIPS infection five years following TIPS creation.CASE SUMMARY A 63-year-old female status-post liver transplant with recurrent cirrhosis and portal hypertension presented with sepsis and recurrent extended-spectrum betalactamase Escherichia coli bacteremia.Computed tomography of the abdomen revealed an occluded TIPS with thrombus extension into the distal right portal vein,and focal thickening of the cecum and ascending colon.Colonoscopy revealed patchy ulcers in these areas with histopathology demonstrating ulcerated colonic mucosa with fibrinopurulent exudate.Shunt thrombectomy and revision revealed infected-appearing thrombus.Patient initially cleared her infection with antibacterial therapy and TIPS revision;however,soon after,she developed Enterobacter cloacae bacteremia and Candida glabrata and C.albicans fungemia with recurrent TIPS thrombosis.She remained on antifungal therapy indefinitely and later developed vancomycin-resistant Enterococcus faecium with recurrent TIPS thrombosis.The option of liver re-transplant for removal of the infected TIPS was not offered given her critical illness and complex shunt anatomy.The patient became intolerant to linezolid and elected hospice care.CONCLUSION Clinicians should be aware that TIPS superinfection may occur as long as five years following TIPS creation in an immunocompromised patient.

关键词： Transjugular intrahepatic portosystemic shunt Endotipsitis Colitis Liver cirrhosis Liver transplantation Case report

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Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock: The CVICU cohort

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World Journal of Hepatology 2017年第2期9卷 106-113页

作者： Lukasz A Myc Jonathan G Stine Rinita Chakrapani Alexandra kadl curtis k argo Department of Medicine University of Virginia Division of Gastroenterology and Hepatology University of Virginia School of Medicine University of Virginia Division of Pulmonary and Critical Care Medicine University of Virginia

AIM To examine patient-centered outcomes with vasopressin(AVP) use in patients with cirrhosis with catecholaminerefractory septic shock. METHODS We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit(ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents. RESULTS Forty-five consecutive patients with cirrhosis were treated for catecholamine-resistant septic shock; 21 received AVP while the remaining 24 received another agent [phenylephrine(10), dopamine(6), norepinephrine(4), dobutamine(2), milrinone(2)]. In general,no significant differences in baseline demographics, etiology of cirrhosis, laboratory values, vital signs or ICU mortality/severity of illness scores were observed with the exception of higher MELD scores in the AVP group(32.4, 95%CI: 28.6-36.2 vs 27.1, 95%CI: 23.6-30.6, P = 0.041). No statistically significant difference was observed in unadjusted 7-d(52.4% AVP vs 58.3% and P = 0.408) or 28-d mortality(81.0% AVP vs 87.5% non-AVP, P = 0.371). Corticosteroid administration was associated with lower 28-d mortality(HR = 0.37, 95%CI: 0.16-0.86, P = 0.021) independent of AVP use. CONCLUSION AVP is similar in terms of patient centered outcomes of seven and 28-d mortality, in comparison to all other vasopressors when used as a second line vasoactive agent in catecholamine resistant septic shock. Large-scale prospective study would help to refine current consensus standards and provide further support to our findings.

关键词：门高血压 Vasopressor 肝特别护理联合起来 Hepatology

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Spontaneous bacterial peritonitis prevalence in pretransplant patients and its effect on survival and graft loss post-transplant

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World Journal of Hepatology 2016年第36期8卷 1617-1622页

作者： Neeral L Shah Nicolas M Intagliata Zachary H Henry curtis k argo Patrick G Northup Division of Gastroenterology and Hepatology Department of Medicine University of Virginia

AIM To investigate the incidence of spontaneous bacterial peritonitis(SBP) in pre-transplant patients and its effect on post transplant mortality and graft failure. METHODS We conducted a retrospective cohort study of patient records from the organ procurement and transplant network data set. Patients were identified by the presence of SBP pre-transplant. Univariate post-transplant survival models were constructed using the kaplan-Meier technique and multivariate models were constructed using the Cox proportional hazards model. Variables that affected post-transplant graft survival were identified in the SBP population. RESULTS Forty-seven thousand eight hundred and eighty patient records were included in the analysis for both groups, and 1966(4.11%) patients were identified in the data set as having pre-transplant SBP. Patients that had pre-transplant SBP had higher rates of graft loss from recurrent hepatitis C virus(HCV)(3.6% vs 2.0%, P kaplan-Meier survival analysis showed a statistically significant difference in all-cause survival in patients with a history of SBP vs those without(P < 0.0001). Pretransplant history of SBP was independently predictiveof mortality due to recurrent HCV(HR = 1.11, 95%CI: 1.02-1.21, P < 0.017) after liver transplantation.CONCLUSION HCV patients prior to the advent of directing acting anti-viral agents had a higher incidence of pre-transplant SBP than other patients on the liver transplant wait list. SBP history pre-transplant resulted in a higher rate of graft loss due to recurrent HCV infection and chronic rejection.

关键词：自发的细菌的腹膜炎肝移植接枝失败丙肝

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Advanced non-alcoholic steatohepatitis cirrhosis: A high-risk population for pre-liver transplant portal vein thrombosis

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World Journal of Hepatology 2017年第3期9卷 139-146页

作者： Jonathan G Stine curtis k argo Shawn J Pelletier Daniel G Maluf Stephen H Caldwell Patrick G Northup Division of Gastroenterology and Hepatology Department of Medicine Center for the Study of Coagulation Disorders in Liver Disease University of Virginia Division of Transplant Department of Surgery University of Virginia

AIM To examine if liver transplant recipients with high-risk non-alcoholic steatohepatitis(NASH) are at increased risk for pre-transplant portal venous thrombosis.METHODS Data on all liver transplants in the United States from February 2002 through September 2014 were analyzed. Recipients were sorted into three distinct groups: High-risk(age > 60, body mass index > 30 kg/m2, hypertension and diabetes), low-risk and non-NASH cirrhosis. Multivariable logistic regression models were constructed.RESULTS Thirty-five thousand and seventy-two candidates underwent liver transplantation and of those organ recipients, 465 were transplanted for high-risk and 2775 for lowrisk NASH. Two thousand six hundred and twentysix(7.5%) recipients had pre-transplant portal vein thrombosis; 66(14.2%) of the high-risk NASH group had portal vein thrombosis vs 328(11.8%) of the lowrisk NASH group. In general, all NASH recipients were less likely to be male or African American and more likely to be obese. In adjusted multivariable regression analyses, high-risk recipients had the greatest risk ofpre-transplant portal vein thrombosis with OR = 2.11(95%CI: 1.60-2.76, P k NASH are at the greatest risk for portal vein thrombosis development prior to transplantation. These candidates may benefit from interventions to decrease their likelihood of clot formation and resultant downstream hepatic decompensating events. Prospective study is needed.

关键词：肝移植非酒精的脂肪肝疾病门高血压 Hepatology Coagulopathy

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精氨霉素的生产,分离,特性与结构

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国外生物科技 1989年第3期 56-62页

作者： argo.,AD 章练红

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The adjoint-based Two Oceans One Sea State Estimate(TOOSSE)

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Journal of Oceanology and Limnology 2022年第1期40卷 1-21页

作者： Xiaowei WANG Chuanyu LIU Armin kÖHL Wu GENG Fan WANG Detlef STAMMER CAS key Laboratory of Ocean Circulation and Waves Institute of OceanologyChinese Academy of SciencesQingdao 266071China Center for Ocean Mega-Science Chinese Academy of SciencesQingdao 266071China Laboratory for Ocean Dynamics and Climate Pilot National Laboratory for Marine Science and Technology(Qingdao)Qingdao 266237China University of Chinese Academy of Sciences Beijing 100049China Institut für Meereskunde Universität HamburgHamburg D20146Germany State key Laboratory of Tropical Oceanography South China Sea Institute of OceanologyChinese Academy of SciencesGuangzhou 510301China

An eddy-resolving four-dimensional variational(adjoint)data assimilation and state estimate was constructed for the low-to mid-latitude Pacifi c,Indian Oceans,and South China Sea based on the framework of“Estimating the Circulation and Climate of the Oceans(ECCO)”.It is named as the Two Oceans One Sea State Estimate(TOOSSE).It fi ts a model to a number of modern observations of 2015-2016,including the argo fl oat temperature and salinity,satellite altimetric sea surface anomalies,by adjusting initial temperature and salinity,sea surface boundary conditions,and background diapycnal diff usivities.In total,~50%of the original model-data misfi ts have been eliminated,and the estimated state agreed well with a variety of independent observations at meso-to large scales,and on the intra-seasonal to interannual timescales.Mesoscale variability is systematically strengthened in TOOSSE and closer to observations than that without data assimilation,which is especially evidenced by the improved simulation of the mesoscale tropical instability waves(TIWs).Adjustments to ocean surface forcing parameters exhibit both large and frontal/mesoscale structures,and the magnitude reach 20%-100%of the fi rst guesses;the adjustments to diapycnal diff usivity exhibit an obvious elevation(decrement)in(below)the thermocline in the equatorial band.The results indicate that TOOSSE represents a dynamically and thermodynamically consistent ocean state estimate of the 2015-2016 Indo-Pacifi c Ocean,and can be widely utilized for regional process studies.

关键词： Pacifi c Ocean Indian Ocean South China Sea adjoint four-dimensional variational data assimilation

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Spatiotemporal variation and mechanisms of temperature inversion in the Bay of Bengal and the eastern equatorial Indian Ocean

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Acta Oceanologica Sinica 2022年第4期41卷 23-39页

作者： k M Azam Chowdhury Wensheng Jiang Guimei Liu Md kawser Ahmed Shaila Akhter College of Oceanic and Atmospheric Sciences Ocean University of ChinaQingdao 266100China keyLab of Marine Environment and Ecology of Ministry of Education Ocean University of ChinaQingdao 266100China Department of Oceanography&International Centre for Ocean Governance(ICOG) University of DhakaDhaka 1000Bangladesh National Marine Environmental Forecasting Center Beijing 100081China

In the northern Bay of Bengal,the existence of intense temperature inversion during winter is a widely accepted phenomenon.However,occurrences of temperature inversion during other seasons and the spatial distribution within and adjacent to the Bay of Bengal are not well understood.In this study,a higher resolution spatiotemporal variation of temperature inversion and its mechanisms are examined with mixed layer heat and salt budget analysis utilizing long-term argo(2004 to 2020)and RAMA(2007 to 2020)profiles data in the Bay of Bengal and eastern equatorial Indian Ocean(EEIO).Temperature inversion exists(17.5%of the total 39293 argo and 51.6%of the 28894 RAMA profiles)throughout the year in the entire study area.It shows strong seasonal variation,with the highest occurrences in winter and the lowest in spring.Besides winter inversion in the northern Bay of Bengal,two other regions with frequent temperature inversion are identified in this study for the first time:the northeastern part of the Bay of Bengal and the eastern part of the EEIO during summer and autumn.Driving processes of temperature inversion for different subregions are revealed in the current study.Penetration of heat(mean~25 W/m;)below the haline-stratified shallow mixed layer leads to a relatively warmer subsurface layer along with the simultaneous cooling tendency in mixed layer,which controls more occurrence of temperature inversion in the northern Bay of Bengal throughout the year.Comparatively lower cooling tendency due to net surface heat loss and higher mixed layer salinity leaves the southern part of the bay less supportive to the formation of temperature inversion than the northern bay.In the EEIO,slightly cooling tendency in the mixed layer along with the subduction of warm-salty Arabian Sea water beneath the cold-fresher Bay of Bengal water,and downwelling of thermocline creates a favorable environment for forming temperature inversion mainly during summer and autumn.Deeper isothermal layer depth,and thicker barrier layer thickness inten

关键词： temperature inversion Bay of Bengal argo and RAMA data intrusion of the Arabian Sea water eastern equatorial Indian Ocean penetrative heat below mixed layer depth

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西番莲果的成长及成份

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热带作物科技 1992年第2期 75-76页

作者： argo.,HE 余天一

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不同制备方法对甘薯果胶化学组成和凝胶特性的影响

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食品科技 2011年第8期36卷 225-230,235页

作者：张春蓬木泰华中国农业科学院农产品加工研究所农业部农产品加工与质量控制重点开放实验室北京100193

以甘薯渣为原料,采用酸法和磷酸氢二钠法提取果胶,超滤、酒精沉淀和离子交换法纯化果胶,研究不同提取和纯化方法对甘薯果胶得率、基本化学组成、中性糖组成和凝胶性的影响。采用磷酸氢二钠法制备果胶得率高于酸法制备果胶,但半乳糖醛酸... 详细信息

以甘薯渣为原料,采用酸法和磷酸氢二钠法提取果胶,超滤、酒精沉淀和离子交换法纯化果胶,研究不同提取和纯化方法对甘薯果胶得率、基本化学组成、中性糖组成和凝胶性的影响。采用磷酸氢二钠法制备果胶得率高于酸法制备果胶,但半乳糖醛酸含量较低,且淀粉、灰分含量较高。采用酸法提取果胶,超滤法所得果胶半乳糖醛酸含量最高(63.1%),中性糖含量最低(16.3%),凝胶强度最高(278.1g/cm2),相比于其他两种纯化方法(57.1%～58.5%,20.2%～22.6%61.9～65.7g/cm2)。采用磷酸氢二钠法提取果胶,离子交换法所得果胶半乳糖醛酸含量(65.0%)显著(P<0.05)高于其他两种纯化方法(45.0%～51.5%),灰分含量(3.2%)显著(P<0.05)低于其他两种纯化方法(9.6%～10.6%),具有最高的凝胶强度(534.0g/cm2)。结果表明提取和纯化方法对甘薯果胶得率、基本化学组成、中性糖组成和凝胶性有显著影响。

关键词：甘薯果胶提取纯化中性糖组成凝胶性

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The response of the upper ocean to tropical cyclone Viyaru over the Bay of Bengal

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Acta Oceanologica Sinica 2019年第1期38卷 61-70页

作者： Mir kashem Md kawser Ahmed Fangli Qiao M A E Akhter k M Azam Chowdhury Department of Oceanography University of Dhaka First Institute of Oceanography Ministry of Natural Resources Department of Physics Khulna University of Engineering & Technology

Better forecast of tropical cyclone(TC) can help to reduce risk and enhance management. The TC forecast depends on the scientific understanding of oceanic processes, air-sea interaction and finally, the atmospheric process. The TC Viyaru is taken as an example, which is formed at the end of 11 May 2013 and sustains up to 17 May 2013 during pre-monsoon season. argo data are used to investigate ocean response processes by comparing pre-and post-conditions of the TC. Eight oceanic parameters including the sea surface temperature(SST), the sea surface salinity(SSS), and the barrier layer thickness(BLT), the 26°C isotherm depth in the ocean(D26), the isothermal layer depth(ILD), the mixed layer depth(MLD), the tropical cyclone heat potential(TCHP) and the effective oceanic layer for cyclogenesis(EOLC) are chosen to evaluate the pre-and post-conditions of the TC along the track of Viyaru. The values of the SST, D26, BLT, TCHP and EOLC in the pre-cyclonic condition are higher than the post-cyclonic condition, while the SSS, ILD and MLD in the post-cyclonic condition are higher than the pre-cyclonic condition of the ocean due to strong cyclonic winds and subsurface upwelling. It is interesting that the strong intensity of the TC reduces less SST and vice versa. The satisfied real time argo data is not available in the northern Bay of Bengal especially in the coastal region. A weather research and forecasting model is employed to hindcast the track of Viyaru, and the satellite data from the National Center Environmental Prediction are used to assess the hindcast.

关键词： effective oceanic layer for cyclogenesis, sea surface temperature tropical cyclone tropical cyclone heat potential tropical cyclone viyaru weather research and forecasting model

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