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Percutaneous transhepatic intraportal biopsy using gastroscope biopsy forceps for diagnosis of a pancreatic neuroendocrine neoplasm:A case report

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World Journal of Gastroenterology 2023年第7期29卷 1235-1242页

作者： guang-chuan wang guang-Jun Huang Chun-Qing Zhang Qian Ding Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021Shandong ProvinceChina

BACKGROUND Pancreatic neuroendocrine neoplasms(PNENs)are a rare group of neoplasms originating from the islets of the Langerhans.Portal vein tumor thrombosis has been reported in 33%of patients with PNENs.While the histopathological diagnosis of PNENs is usually based on percutaneous biopsy or endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA),these approaches may be impeded by gastric varices,poor access windows,or anatomically contiguous critical structures.Obtaining a pathological diagnosis using a gastroscope biopsy forceps via percutaneous transhepatic intravascular pathway is an innovative method that has rarely been reported.CASE SUMMARY A 72-year-old man was referred to our hospital for abdominal pain and melena.Abdominal contrast-enhanced magnetic resonance imaging revealed a wellenhanced tumor(size:2.4 cm×1.2 cm×1.2 cm)in the pancreatic tail with portal vein invasion.Traditional pathological diagnosis via EUS-FNA was not possible because of diffuse gastric varices.We performed a percutaneous transportal biopsy of the portal vein tumor thrombus using a gastroscope biopsy forceps.Histopathologic examination revealed a pancreatic neuroendocrine neoplasm(G2)with somatostatin receptors 2(+),allowing systemic treatment.CONCLUSION Intravascular biopsy using gastroscope biopsy forceps appears to be a safe and effective method for obtaining a histopathological diagnosis.Although welldesigned clinic trials are required to obtain more definitive evidence,this procedure may help improve the diagnosis of portal vein thrombosis and related diseases.

关键词： Percutaneous transhepatic intravascular biopsy Portal vein tumor thrombosis Gastroscope biopsy forceps Pancreatic neuroendocrine neoplasms Case report

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Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding

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Hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 128-136页

作者： Xiao-Yan Sun guang-chuan wang Jing wang guang-Jun Huang Chun-Qing Zhang Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021China Department of Infectious Diseases Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021China

Background:Studies about treatment of patients with chronic portal vein thrombosis(CPVT)are still limited,especially in different types of CPVT.This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt(TIPS)in all types of CPVT with variceal bleeding.Methods:Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis.All patients had a history of variceal bleeding.The characteristics and clinical parameters were collected and recorded.Data on procedure success rate,variation in portal vein pressure,rebleeding,hepatic encephalopathy(HE),stent stenosis,and overall mortality were analyzed.Results:A total of 189 patients were included in this study(39 in type 1,84 in type 2,48 in type 3,18 in type 4).The TIPS procedure success rate was 86.2%.The success rate was significantly different among the four types(89.7%vs.88.1%vs.83.3%vs.77.8%,P=0.001).In the TIPS success group,portal vein pressure was significantly reduced from 27.15±6.59 to 19.74±6.73 mm Hg after the procedure(P<0.001)and the rebleeding rate was significantly lower than that of the fail group(14.7%vs.30.8%,P=0.017).In addition,there were no significant differences in HE rate(30.7%vs.26.9%,P=0.912)or overall mortality(12.9%vs.19.2%,P=0.403)between the TIPS success group and the fail group.In the TIPS success group,we found that the occurrence of HE was significantly different(P=0.020)among the four types,while there were no significant differences in rebleeding rate(P=0.669),stent stenosis rate(P=0.056),or overall mortality(P=0.690).Conclusions:TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.

关键词： Chronic portal vein thrombosis Transjugular intrahepatic portosystemic shunt Variceal bleeding Hepatic encephalopathy

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Transjugular intrahepatic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 517-523页

作者： Zhao-Peng Li Sui-Sui wang guang-chuan wang guang-Jun Huang Jing-Qin Cao Chun-Qing Zhang Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021China Department of Interventional Radiology Jining No.1 People’s HospitalJining 272011China Department of Pediatrics The Affiliated Hospital of Jining Medical CollegeJining 272000China

Background: Treatment options for patients with cavernous transformation of portal vein(CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV. Methods: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. All patients were diagnosed with CTPV. The indication for TIPS was a previous episode of variceal bleeding. The data on recurrent bleeding, stent patency, hepatic encephalopathy and survival were retrieved and analyzed. Results: TIPS procedure was successfully performed in 56 out of 67(83.6%) patients with CTPV. TIPS was performed via a transjugular approach alone( n = 15), a combined transjugular/transhepatic approach( n = 33) and a combined transjugular/transsplenic approach( n = 8). Mean portosystemic pressure gradient(PSG) decreased from 28.09 ± 7.28 mmHg to 17.53 ± 6.12 mmHg after TIPS( P < 0.01). The probability of the remaining free recurrent variceal bleeding was 87.0%. The probability of TIPS patency reached 81.5%. Hepatic encephalopathy occurrence was 27.8%, and survival rate was 88.9% until the end of follow-up. Four out of 11 patients who failed TIPS died, and 4 had recurrent bleeding. Conclusions: TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV, and to achieve clinical improvement.

关键词： Cavernous transformation Portal vein Transjugular intrahepatic portosystemic shunt Variceal rebleeding Portal hypertension

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Risk factors for early rebleeding and mortality in acute variceal hemorrhage

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World Journal of Gastroenterology 2014年第47期20卷 17941-17948页

作者： Jing-Run Zhao guang-chuan wang Jin-Hua Hu Chun-Qing Zhang Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong University Department of Gastroenterology Liaocheng People’s Hospital

AIM:To investigate the risk factors for 6-wk rebleeding and mortality in acute variceal hemorrhage(AVH)patients treated by percutaneous transhepatic variceal embolization(PTVE).METHODS:A retrospective cohort study of AVH patients who had undergone PTVE treatment was conducted between January 2010 and December 2012.Demographic information,medical histories,physical examination findings,and laboratory test results were collected.The PTVE procedure was performed as a rescue therapy for patients who failed endoscopic and pharmacologic treatment.Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test.The multivariate analysis was performed using the Cox regression test to identify independent risk factors for rebleeding and mortality.RESULTS:One hundred and one patients were included;71 were males and the average age was 51 years.Twenty-one patients rebled within 6 wk.Patients with high-risk stigmata,PTVE with trunk obliteration,and a hepatic vein pressure gradient(HVPG)≥20 mm Hg were at increased risk for rebleeding(OR=5.279,95%CI:2.782-38.454,P=0.003;OR=4.309,95%CI:=2.144-11.793,P<0.001;and OR=1.534,95%CI:1.062-2.216,P=0.022,respectively).Thirteen patients died within 6 wk.A model for end-stage liver disease(MELD)score≥18 and an HVPG≥20 mm Hg were associated with 6-wk mortality(OR=2.162,95%CI:1.145-4.084,P=0.017 and OR=1.423,95%CI:1.222-1.657,P<0.001,respectively).CONCLUSION:MELD score and HVPG in combination allow for early identification of patients with AVH who are at substantially increased risk of death over the short term.

关键词： Acute variceal hemorrhage Percutaneous transhepati

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Unexpected difficult airway due to severe upper tracheal distortion:A case report

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World Journal of Clinical Cases 2022年第26期10卷 9348-9353页

作者： Jian-Wei Zhou chuan-guang wang Gang Chen You-Fa Zhou Jia-Feng Ding Jia-Wei Zhang Department of Anesthesia The Fifth Affiliated Hospital of Wenzhou Medical UniversityLishui Municipal Central HospitalLishui 323000Zhejiang ProvinceChina Department of Anesthesia Sir Run Run Shaw HospitalHangzhou 310016Zhejiang ProvinceChina Department of Urology The Fifth Affiliated Hospital of Wenzhou Medical UniversityLishui Municipal Central HospitalLishui 323000Zhejiang ProvinceChina

BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult airways.However,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed preoperatively.Such patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction.Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/L.Due to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult airway.CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such patients.It is recommended to complete preoperative imaging examinations of the airway.For life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.

关键词： Tracheal distortion Difficult airway Management Imaging examination Emergency

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MDCT angiography to evaluate the therapeutic effect of PTVE for esophageal varices

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World Journal of Gastroenterology 2013年第10期19卷 1563-1571页

作者： Aitao Sun Yong-Jun Shi Zhuo-Dong Xu Xiang-Guo Tian Jin-Hua Hu guang-chuan wang Chun-Qing Zhang Department of Gastroenterology Provincial Hospital Affiliated with Shandong University Department of Radiology Provincial Hospital Affiliated with Shandong UniversityJinan 250021Shandong ProvinceChina

Abstract AIM:To evaluate the role of multi-detector row computed tomography(MDCT) angiography for assessing the therapeutic effects of percutaneous transhepatic variceal embolization(PTVE) for esophageal varices(EVs).METHODS:The subjects of this prospective study were 156 patients who underwent PTVE with cyanoacrylate for EVs.Patients were divided into three groups according to the filling range of cyanoacrylate in EVs and their feeding vessels:(1) group A,complete obliteration,with at least 3 cm of the lower EVs and peri-/EVs,as well as the adventitial plexus of the gastric cardia and fundus filled with cyanoacrylate;(2) group B,partial obliteration of varices surrounding the gastric cardia and fundus,with their feeding vessels being obliterated with cyanoacrylate,but without reaching lower EVs;and(3) group C,trunk obliteration,with the main branch of the left gastric vein being filled with cyanoacrylate,but without reaching varices surrounding the gastric cardia or fundus.We performed chart reviews and a prospective follow-up using MDCT images,angiography,and gastrointestinal endoscopy.RESULTS:The median follow-up period was 34 mo.The rate of eradication of varices for all patients was 56.4%(88/156) and the rate of relapse was 31.3%(41/131).The rates of variceal eradication at 1,3,and 5 years after PTVE were 90.2%,84.1% and 81.7%,respectively,for the complete group;61.2%,49% and 42.9%,respectively,for the partial group;with no varices disappearing in the trunk group.The relapsefree rates at 1,3 and 5 years after PTVE were 91.5%,86.6% and 81.7%,respectively,for the complete group;71.1%,55.6% and 51.1%,respectively,for the partial group;and all EVs recurred in the trunk group.Kaplan-Meier analysis showed P values of 0.000 and 0.000,and odds ratios of 3.824 and 3.603 for the rates of variceal eradication and relapse free rates,respectively.Cyanoacrylate in EVs disappeared with time,but those in the EVs and other feeding vessels remained permanently in the vessels without a decrease with time,which is important for

关键词： Multi-detector row computed tomography Percutaneous transhepatic variceal embolization Cyanoacrylate Esophageal varices Therapeutic effect

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A Novel Method for Forecasting Freak Wave Occurrence in A Short Crested Coastal Sea

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China Ocean Engineering 2024年第1期38卷 104-116页

作者： wang Ying-guang State Key Laboratory of Ocean Engineering Shanghai Jiao Tong UniversityShanghai 200240China School of Ocean and Civil Engineering Shanghai Jiao Tong UniversityShanghai 200240China

In order to forecast the distribution of crest amplitudes and the occurrence of freak waves in a short crested coastal sea,a novel transformed linear simulation method is initially proposed in this paper.A Hermite transformation model expressed as a monotonic cubic polynomial serves as the foundation for the novel simulation technique.The wave crest amplitude exceedance probabilities of two sea states-one with a directional wave spectrum based on the measured wave elevation data at the Yura coast and the other with a typical directional JONSWAP wave spectrum-have been predicted using the novel simulation method that has been proposed.The likelihood that a particular critical wave crest amplitude will be exceeded is directly correlated with the probability that freak waves will occur.It is shown that the novel simulation approach suggested can provide predictions that are more precise than those obtained from the Rayleigh crest amplitude distribution model,the Jahns and Wheeler crest amplitude distribution model,or the conventional linear simulation method.This study also demonstrated that the nonlinear simulation method is less effective than the novel simulation method in terms of efficiency.

关键词： wave crest amplitude freak waves short crested sea transformed linear simulation

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Jianpi Qinghua Formula Alleviates Diabetic Myocardial Injury Through Inhibiting JunB/c-Fos Expression

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Current Medical Science 2024年第1期44卷 144-155页

作者： Lin wang Qing-guang CHEN Hao LU Department of Endocrinology Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai 201203China Department of Traditional Chinese Medicine Naval Medical UniversityShanghai 200433China

Objective Diabetic cardiomyopathy(DCM)represents a substantial risk factor for heart failure and increased mortality in individuals afflicted with diabetes mellitus(DM).DCM typically manifests as myocardial fibrosis,myocardial hypertrophy,and impaired left ventricular diastolic function.While the clinical utility of the Jianpi Qinghua(JPQH)formula has been established in treating diabetes and insulin resistance,its potential efficacy in alleviating diabetic cardiomyopathy remains uncertain.This study aims to investigate the impact and underlying molecular mechanisms of the JPQH formula(JPQHF)in ameliorating myocardial injury in nonobese diabetic rats,specifically focusing on apoptosis and inflammation.Methods Wistar rats were assigned as the normal control group(CON),while Goto-Kakizaki(GK)rats were randomly divided into three groups:DM,DM treated with the JPQHF,and DM treated with metformin(MET).Following a 4-week treatment regimen,various biochemical markers related to glucose metabolism,cardiac function,cardiac morphology,and myocardial ultrastructure in GK rats were assessed.RNA sequencing was utilized to analyze differential gene expression and identify potential therapeutic targets.In vitro experiments involved high glucose to induce apoptosis and inflammation in H9c2 cells.Cell viability was evaluated using CCK-8 assay,apoptosis was monitored via flow cytometry,and the production of inflammatory cytokines was measured using quantitative real-time PCR(qPCR)and ELISA.Protein expression levels were determined by Western blotting analysis.The investigation also incorporated the use of MAPK inhibitors to further elucidate the mechanism at both the transcriptional and protein levels.Results The JPQHF group exhibited significant reductions in interventricular septal thickness at end-systole(IVSs)and left ventricular internal diameter at end-systole and end-diastole(LVIDs and LVIDd).JPQHF effectively suppressed high glucose-induced activation of IL-1βand caspase 3 in cardiomyocytes.Furthermore,JPQHF downregulated

关键词： Jianpi Qinghua formula diabetic cardiomyopathy AP-1 transcription factor apoptosis inflammation

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Differentially private SGD with random features

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Applied Mathematics(A Journal of Chinese Universities) 2024年第1期39卷 1-23页

作者： wang Yi-guang GUO Zheng-chu Polytechnic Institute of Zhejiang University Zhejiang UniversityHangzhou 310015China School of Mathematical Sciences Zhejiang UniversityHangzhou 310058China

In the realm of large-scale machine learning,it is crucial to explore methods for reducing computational complexity and memory demands while maintaining generalization performance.Additionally,since the collected data may contain some sensitive information,it is also of great significance to study privacy-preserving machine learning algorithms.This paper focuses on the performance of the differentially private stochastic gradient descent(SGD)algorithm based on random features.To begin,the algorithm maps the original data into a lowdimensional space,thereby avoiding the traditional kernel method for large-scale data storage requirement.Subsequently,the algorithm iteratively optimizes parameters using the stochastic gradient descent approach.Lastly,the output perturbation mechanism is employed to introduce random noise,ensuring algorithmic privacy.We prove that the proposed algorithm satisfies the differential privacy while achieving fast convergence rates under some mild conditions.

关键词： learning theory differential privacy stochastic gradient descent random features reproducing kernel Hilbert spaces

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Clinical and molecular characterization of 10 Chinese children with congenital adrenal hyperplasia due to 11beta‑hydroxylase deficiency

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World Journal of Pediatrics 2024年第4期20卷 422-433页

作者： Wen‑Li Lu Xiao‑Yu Ma Jiao Zhang Jun‑Qi wang Ting‑Ting Zhang Lei Ye Yuan Xiao Zhi‑Ya Dong Wei wang Shou‑Yue Sun chuan‑Yin Li Rong‑Gui Hu guang Ning Li‑Dan Zhang Department of Pediatrics Ruijin HospitalShanghai Jiao Tong University School of MedicineNo.197Ruijin 2nd RdHuangpu DistrictShanghai 200025China Department of Pediatric Genetic and Metabolic Endocrinology West China Second University HospitalSichuan UniversityNo.20Section 3Renmin South RoadSichuan 610041China Department of Endocrine and Metabolic Diseases Shanghai Clinical Center for Endocrine and Metabolic DiseasesRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Cancer Center School of MedicineShanghai Tenth People’s HospitalTongji UniversityYanchang Zhong Lu 301St RdJing’an DistrictShanghai 200031China

Background The clinical manifestations of nonclassical 11beta-hydroxylase deficiency are very similar to those of nonclassical 21-hydroxylase deficiency.For this study,we investigated the relationship between the clinical and molecular features of congenital adrenal hyperplasia caused by 11beta-hydroxylase deficiency and reviewed the related literature,which are expected to provide assistance for the clinical diagnosis and analysis of congenital adrenal hyperplasia.Methods Clinical data for 10 Chinese patients diagnosed with congenital adrenal hyperplasia in our hospital from 2018 to 2022 were retrospectively analyzed.We examined the effects of gene mutations on protease activity and constructed threedimensional structure prediction models of proteins.Results We describe 10 patients with 11beta-hydroxylase gene mutations(n=5,46,XY;n=5,46,XX),with 10 novel mutations were reported.Female patients received treatment at an early stage,with an average age of 2.08±1.66 years,whereas male patients received treatment significantly later,at an average age of 9.77±3.62 years.The most common CYP11B1 pathogenic variant in the Chinese population was found to be c.1360C>T.All mutations lead to spatial conformational changes that affect protein stability.Conclusions Our study found that there was no significant correlation between each specific mutation and the severity of clinical manifestations.Different patients with the same gene pathogenic variant may have mild or severe clinical manifestations.The correlation between genotype and phenotype needs further study.Three-dimensional protein simulations may provide additional support for the physiopathological mechanism of genetic mutations.

关键词： 11β-hydroxylase deficiency CYP11B1 Enzymatic activity Phenotype-genotype correlation Threedimensional protein simulations

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