Corrigendum: Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax.

[This corrects the article DOI: 10.3389/fmed.2021.754781.].

Geometric features of middle cerebral artery are associated with spontaneous basal ganglia intracerebral haemorrhage.

BACKGROUND AND PURPOSE: Haemodynamics around the middle cerebral artery (MCA) and lenticulostriate arteries is believed to play important roles in the vascular rupture and local haemodynamics is subject to vascular geometry. Nonetheless, the relationship between the geometric features of MCA and spontaneous basal ganglia intracerebral haemorrhage (ICH) has not been investigated. To examine the relationship between the MCA geometric features and spontaneous basal ganglia ICH. METHODS: This study was of retrospective and observational nature. The study recruited 158 consecutive hospitalised patients with consecutive CT-confirmed unilateral spontaneous basal ganglia ICH. Clinical data were extracted from electronic medical records, and imaging data were evaluated by two trained radiologists. The MCA-related geometric features were examined and their relationship with spontaneous basal ganglia ICH was analysed. Haemodynamic analyses under different MCA structural features were conducted. RESULTS: Compared with the contralateral MCA, the ipsilateral MCA had greater M1 diameter ratio (proximal/distal) and a smaller M1/M2 angle and MCA bifurcation angle (p＜0.01). Imaging study showed differences in the MCA shape in both sides on coronal plane (p＜0.05). These MCA features were significantly correlated with the spontaneous ICH in basal ganglia. The greater M1 diameter ratio (proximal/distal), the inferior-oriented M1, the smaller M1/M2 angle and the superior-oriented M1 conditions increased the pressure, from high to low. The greater M1 diameter ratio (proximal/distal) and the inferior-oriented M1 increased the shear stress at the distal end of M1 segment. CONCLUSIONS: The geometric features of MCA were significantly related to the spontaneous ICH in basal ganglia. The risk of haemorrhage, from high to low, included the greater M1 diameter ratio (proximal/distal), the inferior-oriented M1 (distal end), the smaller M1/M2 angle and the superior-oriented M1. Mechanistically, these vascular structural features contribute to increased vascular wall pressure and shear stress, which eventually lead to haemorrhage.

C-Arm Cone-Beam CT Virtual Navigation versus Conventional CT Guidance in the Transthoracic Lung Biopsy: A Case-Control Study.

C-arm cone-beam computed tomography (CBCT) virtual navigation-guided lung biopsy has been developed in the last decade as an alternative to conventional CT-guided lung biopsy. This study aims to compare the biopsy accuracy and safety between these two techniques and explores the risk factors of biopsy-related complications. A total of 217 consecutive patients undergoing conventional CT- or C-arm CBCT virtual navigation-guided lung biopsy from 1 June 2018 to 31 December 2019 in this single-center were retrospectively reviewed. Multiple factors (e.g., prior emphysema, lesion size, etc.) were compared between two biopsy techniques. The risk factors of complications were explored by using logistic regression. The patients' median age and male-to-female ratio were 63 years and 2.1:1, respectively. Eighty-two (82) patients (37.8%) underwent conventional CT-guided biopsies, and the other 135 patients (62.2%) C-arm CBCT virtual navigation-guided biopsies. Compared with patients undergoing C-arm CBCT virtual navigation-guided lung biopsies, patients undergoing conventional CT-guided lung biopsies showed higher needle repositioning rate, longer operation time, and higher effective dose of X-ray (52.4% vs. 6.7%, 25 min vs. 15 min, and 13.4 mSv vs. 7.6 mSv, respectively; p < 0.001, each). In total, the accurate biopsy was achieved in 215 of 217 patients (99.1%), without a significant difference between the two biopsy techniques (p = 1.000). The overall complication rates, including pneumothorax and pulmonary hemorrhage/hemoptysis, are 26.3% (57/217), with most minor complications (56/57, 98.2%). The needle repositioning was the only independent risk factor of complications with an odds ratio of 6.169 (p < 0.001). In conclusion, the C-arm CBCT virtual navigation is better in percutaneous lung biopsy than conventional CT guidance, facilitating needle positioning and reducing radiation exposure. Needle repositioning should be avoided because it brings about more biopsy-related complications.

Chest CT Patterns from Diagnosis to 1 Year of Follow-up in Patients with COVID-19.

Background The chest CT manifestations of COVID-19 from hospitalization to convalescence after 1 year are unknown. Purpose To assess chest CT manifestations of COVID-19 up to 1 year after symptom onset. Materials and Methods Patients were enrolled if they were admitted to the hospital because of COVID-19 and underwent CT during hospitalization at two isolation centers between January 27, 2020, and March 31, 2020. In a prospective study, three serial chest CT scans were obtained at approximately 3, 7, and 12 months after symptom onset and were longitudinally analyzed. The total CT score of pulmonary lobe involvement, ranging from 0 to 25, was assessed (score of 1-5 for each lobe). Univariable and multivariable logistic regression analyses were performed to explore independent risk factors for residual CT abnormalities after 1 year. Results A total of 209 study participants (mean age, 49 years ± 13 [standard deviation]; 116 women) were evaluated. CT abnormalities had resolved in 61% of participants (128 of 209) at 3 months and in 75% of participants (156 of 209) at 12 months. Among participants with chest CT abnormalities that had not resolved, there were residual linear opacities in 25 of the 209 participants (12%) and multifocal reticular or cystic lesions in 28 of the 209 participants (13%). Age 50 years or older, lymphopenia, and severe or aggravation of acute respiratory distress syndrome were independent risk factors for residual CT abnormalities at 1 year (odds ratios = 15.9, 18.9, and 43.9, respectively; P < .001 for each comparison). In 53 participants with residual CT abnormalities at 12 months, reticular lesions (41 of 53 participants [77%]) and bronchial dilation (39 of 53 participants [74%]) were observed at discharge and were persistent in 28 (53%) and 24 (45%) of the 53 participants, respectively. Conclusion One year after COVID-19 diagnosis, chest CT scans showed abnormal findings in 53 of the 209 study participants (25%), with 28 of the 209 participants (13%) showing subpleural reticular or cystic lesions. Older participants with severe COVID-19 or acute respiratory distress syndrome were more likely to develop lung sequelae that persisted at 1 year. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lee and Wi et al in this issue.

Evaluation of dangerous collateral vessels and thrombus in Budd-Chiari syndrome patients with inferior vena cava obstruction.

PURPOSE: To evaluate the diagnostic accuracy of preoperative imaging in defining inferior vena cava (IVC) obstruction characteristics, in identifying the presence of a thrombus and dangerous venous collateral. The other goal is to explore the clinical implication of these data in the designing the treatment strategy in Budd-Chiari patients. METHODS: This study included 112 patients with IVC obstruction who underwent endovascular treatment between July 2009 and June 2019. Two radiologists independently assessed MSCT and/or MRI imaging data with a 5-point scale to evaluate the diagnostic accuracies relating to obstructive characteristics, dangerous collateral vessels, and thrombus within IVC. RESULTS: The diagnostic sensitivities for obstructive characteristics, as determined by the two independent assessors, ranged from 81.25 to 100%. The areas under the receiver operating characteristic curve (ROC) for judging thrombus ranged from 0.87 to 0.975 for the two assessors. Inter-assessor agreement was substantial or excellent with regards to diagnostic accuracy (κ = 0.745-0.927). Twelve cases involving dangerous collateral vessels were identified in the MSCT group of 82 patients (κ = 1); six were identified by digital subtraction venography (DSV) imaging. Eight cases involving dangerous collateral vessels were reported in the MRI group of 32 patients (κ = 1); three were identified by DSV imaging. CONCLUSION: Preoperative MSCT and MRI can accurately reveal the obstructive characteristics and risk factors of patients with IVC obstruction and can therefore be used to guide interventional planning so as to minimize complications.

A novel deep learning-based quantification of serial chest computed tomography in Coronavirus Disease 2019 (COVID-19).

This study aims to explore and compare a novel deep learning-based quantification with the conventional semi-quantitative computed tomography (CT) scoring for the serial chest CT scans of COVID-19. 95 patients with confirmed COVID-19 and a total of 465 serial chest CT scans were involved, including 61 moderate patients (moderate group, 319 chest CT scans) and 34 severe patients (severe group, 146 chest CT scans). Conventional CT scoring and deep learning-based quantification were performed for all chest CT scans for two study goals: (1) Correlation between these two estimations; (2) Exploring the dynamic patterns using these two estimations between moderate and severe groups. The Spearman's correlation coefficient between these two estimation methods was 0.920 (p < 0.001). predicted pulmonary involvement (CT score and percent of pulmonary lesions calculated using deep learning-based quantification) increased more rapidly and reached a higher peak on 23rd days from symptom onset in severe group, which reached a peak on 18th days in moderate group with faster absorption of the lesions. The deep learning-based quantification for COVID-19 showed a good correlation with the conventional CT scoring and demonstrated a potential benefit in the estimation of disease severities of COVID-19.

Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax.

Objective: To preliminarily explore the safety and effectiveness of transpedal lymphangiography (TL) with high-dose ethiodized oil application (>20 ml) in the treatment of high-output postoperative chylothorax. Methods: From 1 July 2020 to 1 July 2021, a total of 7 patients with high-flow postoperative chylothorax (> 1,000 ml/d) were retrospectively reviewed in a single center. Clinical data, including surgery types, technical and treatment success of TL, and adverse events of TL, were collected and analyzed. Results: Seven patients (5 cases of non-small cell lung cancer; 2 cases of esophageal carcinoma) with a median age of 62 years (range: 30-70 years) occurred postoperative chylothorax after tumor resection with mediastinal lymphadenectomy. All patients received conservative treatment including total parenteral nutrition and somatostatin administration for a median of 20 days (range: 15-31 days) that failed to cure the chylothorax, so TL was performed as a salvage. Before TL, the median daily chyle output was 1,500 ml/day (range: 1,100-2,000 ml/day). The technical success rate of TL was 100% (7/7), with the median volume of ethiodized oil of 27.6 ml (range: 21.2-30.0 ml) injected in TL. Ruptured thoracic duct was identified in 5 patients (5/7, 71%) in fluoroscopy and chest CT after TL. The treatment success rate of TL was 86% (6/7). In 6 patients, the thoracic drainage was removed after a median of 7 days (range: 4-13 days) from TL performance. No adverse event of TL was reported. Conclusion: Transpedal lymphangiography with high-dose ethiodized oil application (>20 ml) is a feasible, safe, and effective modality for the treatment of high-flow (> 1,000 ml/day) postoperative chylothorax.

Management of isolated dissection of the abdominal aorta: a single-centre experience.

OBJECTIVES: Isolated abdominal aortic dissection (IAAD) is a rare disease. Currently, there is no consensus on the management of IAAD. Our goal was to report our experience with the management of IAAD. METHODS: A cohort of 45 consecutive patients with IAAD was treated between January 2010 and December 2018. We reviewed the demographics, clinical features, therapeutic modalities and follow-up results. RESULTS: A total of 33 patients had successful endovascular repair (EVAR) and 12 patients underwent conservative treatment initially. During a mean follow-up of 16.6 months, 2 of the patients in the EVAR group had endoleak; neither of them needed reintervention. Complete or partial thrombosis of the false lumens was seen in all patients (88% and 12%) on the latest computed tomographic angiography images, and a significant enlargement of the true lumen and regression of the false lumen and maximal abdominal aortic diameter were observed in all patients (P < 0.001). In the group receiving conservative treatment, 3 patients were lost to follow-up; 1 patient died; 2 patients had small re-entry sites, neither of which needed intervention; 1 patient had EVAR; and the others remain symptom-free. The latest computed tomographic angiography images showed that 1 patient had spontaneous healing with complete thrombosis of the false lumen, 7 patients had partial thrombosis and the diameter of the maximal abdominal aortic and false lumen remained stable or was less decreased. CONCLUSIONS: For patients with IAAD, close surveillance is necessary. In addition, EVAR is an effective therapeutic method with a high technical success rate and low complication rate for carefully selected patients.

Different computed tomography patterns of Coronavirus Disease 2019 (COVID-19) between survivors and non-survivors.

This study aimed to compare the chest computed tomography (CT) findings between survivors and non-survivors with Coronavirus Disease 2019 (COVID-19). Between 12 January 2020 and 20 February 2020, the records of 124 consecutive patients diagnosed with COVID-19 were retrospectively reviewed and divided into survivor (83/124) and non-survivor (41/124) groups. Chest CT findings were qualitatively compared on admission and serial chest CT scans were semi-quantitively evaluated between two groups using curve estimations. On admission, significantly more bilateral (97.6% vs. 73.5%, p = 0.001) and diffuse lesions (39.0% vs. 8.4%, p < 0.001) with higher total CT score (median 10 vs. 4, p < 0.001) were observed in non-survivor group compared with survivor group. Besides, crazy-paving pattern was more predominant in non-survivor group than survivor group (39.0% vs. 12.0%, p < 0.001). From the prediction of curve estimation, in survivor group total CT score increased in the first 20 days reaching a peak of 6 points and then gradually decreased for more than other 40 days (R2 = 0.545, p < 0.001). In non-survivor group, total CT score rapidly increased over 10 points in the first 10 days and gradually increased afterwards until ARDS occurred with following death events (R2 = 0.711, p < 0.001). In conclusion, persistent progression with predominant crazy-paving pattern was the major manifestation of COVID-19 in non-survivors. Understanding this CT feature could help the clinical physician to predict the prognosis of the patients.

Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study.

Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20µg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.

The pulmonary sequalae in discharged patients with COVID-19: a short-term observational study.

BACKGROUND: A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia were discharged from hospitals in Wuhan, China. We aimed to determine the cumulative percentage of complete radiological resolution at each time point, to explore the relevant affecting factors, and to describe the chest CT findings at different time points after hospital discharge. METHODS: Patients with COVID-19 pneumonia confirmed by RT-PCR who were discharged consecutively from the hospital between 5 February 2020 and 10 March 2020 and who underwent serial chest CT scans on schedule were enrolled. The radiological characteristics of all patients were collected and analysed. The total CT score was the sum of non-GGO involvement determined at discharge. Afterwards, all patients underwent chest CT scans during the 1st, 2nd, and 3rd weeks after discharge. Imaging features and distributions were analysed across different time points. RESULTS: A total of 149 patients who completed all CT scans were evaluated; there were 67 (45.0%) men and 82 (55.0%) women, with a median age of 43 years old (IQR 36-56). The cumulative percentage of complete radiological resolution was 8.1% (12 patients), 41.6% (62), 50.3% (75), and 53.0% (79) at discharge and during the 1st, 2nd, and 3rd weeks after discharge, respectively. Patients ≤44 years old showed a significantly higher cumulative percentage of complete radiological resolution than patients > 44 years old at the 3-week follow-up. The predominant patterns of abnormalities observed at discharge were ground-glass opacity (GGO) (125 [83.9%]), fibrous stripe (81 [54.4%]), and thickening of the adjacent pleura (33 [22.1%]). The positive count of GGO, fibrous stripe and thickening of the adjacent pleura gradually decreased, while GGO and fibrous stripe showed obvious resolution during the first week and the third week after discharge, respectively. "Tinted" sign and bronchovascular bundle distortion as two special features were discovered during the evolution. CONCLUSION: Lung lesions in COVID-19 pneumonia patients can be absorbed completely during short-term follow-up with no sequelae. Two weeks after discharge might be the optimal time point for early radiological estimation.

Identification and validation of stromal-tumor microenvironment-based subtypes tightly associated with PD-1/PD-L1 immunotherapy and outcomes in patients with gastric cancer.

BACKGROUND: Immunotherapies targeting programmed cell death 1 (PD-1) and programmed death-ligand 1 (PD-L1) have been approved for gastric cancer (GC) patients. However, a large proportion of patients with T-cell-inflamed tumor microenvironment do not respond to the PD-1/PD-L1 blockade. The stromal component of the tumor microenvironment has been associated with immunotherapy. This study aims to explore the clinical significance of the non-immune cells in the tumor microenvironment and their potential as biomarkers for immunotherapy. METHODS: A total of 383 patients with GC from the Cancer Genome Atlas (TCGA) cohort, 300 patients with GC from the GSE62254 cohort in Gene Expression Omnibus (GEO) were included in the study. A stromal score was generated using the ESTIMATE algorithm, and the likelihood of response to PD-1/PD-L1 immunotherapy of GC patients was predicted using the TIDE algorithm. The prognostic value of the stromal score from GC cases was evaluated by the Kaplan-Meier method and Cox regression analysis. Gene set enrichment analysis (GSEA) was also conducted. RESULTS: The stromal score showed significant differences in different molecular subtypes and T stages. Multivariate analyses further confirmed that the stromal score was an independent indicator of overall survival (OS) in the two cohorts. The low stromal score group showed higher tumor mutation burden (TMB) and micro-satellite instability (MSI), and was more sensitive to immune checkpoint inhibitor according to the TIDE algorithm. Activation of the transforming growth factor and epithelial-mesenchymal transition were observed in the high stromal score subtype, which is associated with T-cell suppression, and may be responsible for resistance to PD-1/PD-L1 therapy. BPIFB2 was confirmed as a hub gene relevant to immunotherapy. CONCLUSION: The stromal score was associated with cancer progression and molecular subtypes, and may serve as a novel biomarker for predicting the prognosis and response to immunotherapy in patients with GC.

Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis.

OBJECTIVE. The purpose of this study was to describe the clinical manifestations and CT features of coronavirus disease (COVID-19) pneumonia in 15 pregnant women and to provide some initial evidence that can be used for guiding treatment of pregnant women with COVID-19 pneumonia. MATERIALS AND METHODS. We reviewed the clinical data and CT examinations of 15 consecutive pregnant women with COVID-19 pneumonia in our hospital from January 20, 2020, to February 10, 2020. A semiquantitative CT scoring system was used to estimate pulmonary involvement and the time course of changes on chest CT. Symptoms and laboratory results were analyzed, treatment experiences were summarized, and clinical outcomes were tracked. RESULTS. Eleven patients had successful delivery (10 cesarean deliveries and one vaginal delivery) during the study period, and four patients were still pregnant (three in the second trimester and one in the third trimester) at the end of the study period. No cases of neonatal asphyxia, neonatal death, stillbirth, or abortion were reported. The most common early finding on chest CT was ground-glass opacity (GGO). With disease progression, crazy paving pattern and consolidations were seen on CT. The abnormalities showed absorptive changes at the end of the study period for all patients. The most common onset symptoms of COVID-19 pneumonia in pregnant women were fever (13/15 patients) and cough (9/15 patients). The most common abnormal laboratory finding was lymphocytopenia (12/15 patients). CT images obtained before and after delivery showed no signs of pneumonia aggravation after delivery. The four patients who were still pregnant at the end of the study period were not treated with antiviral drugs but had achieved good recovery. CONCLUSION. Pregnancy and childbirth did not aggravate the course of symptoms or CT features of COVID-19 pneumonia. All the cases of COVID-19 pneumonia in the pregnant women in our study were the mild type. All the women in this study-some of whom did not receive antiviral drugs-achieved good recovery from COVID-19 pneumonia.

NRF2/ABCB1-mediated efflux and PARP1-mediated dampening of DNA damage contribute to doxorubicin resistance in chronic hypoxic HepG2 cells.

Transarterial chemoembolization (TACE)-induced hypoxia can trigger residual liver cancer cells to present a more aggressive phenotype associated with chemoresistance, but the underlying mechanisms are still unknown. In this study, the human liver cancer cell line HepG2 was pre-cultured in different oxygen environments to examine the possible mechanisms of hypoxia-induced doxorubicin resistance. Our study showed that HepG2 cells pre-cultured in a chronic intermittent hypoxic environment exhibited significant resistance to doxorubicin, evidenced by increased intracellular doxorubicin efflux, relatively higher cell proliferation, lower apoptosis, and decreased DNA damage. These changes were accompanied by high levels of NRF2 and ABCB1 under conditions of both chronic and acute hypoxia and PARP1 gene expression only under conditions of chronic hypoxia. SiRNA-mediated silencing of NRF2 gene expression downregulated the expression of ABCB1 and increased the intracellular doxorubicin accumulation and cell apoptosis both in acute and chronic hypoxic HepG2 cells. Moreover, silencing of PARP1 gene expression increased the doxorubicin-induced DNA damage and cell apoptosis in chronic hypoxic cells. On the basis of these findings, we concluded that NRF2/ABCB1-mediated efflux and PARP1-mediated DNA repair contribute to doxorubicin resistance in chronic hypoxic HepG2 cells.

Endovascular Treatment of Subclavian Artery Pseudoaneurysm.

BACKGROUND: In recent years, endovascular treatment of subclavian artery pseudoaneurysm (SAP) has been recommended by many experts. The aim of this study is to evaluate the safety and efficacy of the endovascular treatment of SAP, and to introduce our experience in the diagnosis and treatment of SAP. METHODS: A total of 8 consecutive patients with SAP were treated with endovascular treatment in our hospital between 2010 and 2018. We retrospectively reviewed the patients' clinical characteristics, physical examinations findings, diagnostic imaging results, endovascular treatment, clinical outcome, and follow-up results. RESULTS: All the 8 patients received endovascular treatment with covered stents initially. The technical success rate was 87.5% (7/8). In 1 patient with severe tortuosity of the proximal subclavian artery, the stent could not be released through the femoral artery approach in the primary operation but was successfully released via the brachial artery approach in the secondary operation. No complications occurred in the perioperative period. All the symptoms and signs were significantly relieved. During a follow-up of 4.5-84.5 months (average 31.5 months), 1 patient developed an endoleak 4 months after operation and reintervention was attempted but failed. No adverse events occurred in other patients during the follow-up period. CONCLUSIONS: Endovascular treatment of SAP is safe and effective, and should be used as a first-line treatment. Stent placement through the brachial artery approach is recommended for SAP with severe proximal vascular tortuosity.

A single-center retrospective study: Clinical features of different types of Budd-Chiari syndrome in Chinese patients in the Hubei area.

Background The characteristics and prevalence of Budd-Chiari syndrome in China remain unclear. This study aimed to analyze the clinical features of Budd-Chiari syndrome in Chinese patients in the Hubei area. Methods One-hundred and thirty patients with Budd-Chiari syndrome, admitted to Union Hospital from January 2002 to January 2011, were included in this retrospective study. Clinical features, laboratory data, imaging characteristics, and cumulative patency rates were analyzed. Results Of the 130 patients with Budd-Chiari syndrome, 77 were men (59.2%) and 53 women (40.8%). Budd-Chiari syndrome was more commonly associated with inferior vena cava block (56.9%, 74/130) than hepatic vein block (19.2%, 25/130) and combined inferior vena cava/hepatic vein block (23.9%, 31/130). The clinical features of Budd-Chiari syndrome varied based on the location of the obstruction. The incidence of bilirubin abnormality, elevated alkaline phosphatase, and γ-glutamyl peptide transferase levels was common in patients with Budd-Chiari syndrome. Liver injury was more severe in cases with combined inferior vena cava/hepatic vein block than in the other two types of Budd-Chiari syndrome. Color Doppler ultrasound imaging was better for the diagnosis of hepatic vein obstruction, while computed tomography and magnetic resonance imaging were superior in diagnosing inferior vena cava obstruction. The cumulative 1-, 5-, and 10-year patency rates were 97%, 69%, and 59%, respectively. Univariate analysis indicated that liver cirrhosis was an independent risk factor of recurrence. Conclusion The most prevalent type of Budd-Chiari syndrome is inferior vena cava obstruction in Chinese patients in the Hubei area. Different types of Budd-Chiari syndrome have diverse clinical and biochemical features, which may assist clinicians in diagnosing Budd-Chiari syndrome. Liver cirrhosis was found as an independent risk factor of recurrence.

Kerogen in aquifer material and its strong sorption for nonionic organic pollutants.

Sorption of organic pollutants by subsurface materials has been found to not only correlate with the total organic carbon (TOC) content, but also depend on the types of soil and sediment organic matter (SOM). Characterization of geochemically heterogeneous SOM is key to elucidating sorption mechanisms and predicting pollutant transport in ground water systems. In this study, kerogen, a nonextractable organic material, was isolated with an acid demineralization procedure from a sandy aquifer material (Borden, Ontario, Canada) having a TOC content of approximately 0.021% (w/w). Petrographical examinations reveal that the kerogen has three major types of macerals including bituminite (Kerogen Type I and II), vitrinite (Type III), and fusinite (Type IV or charred kerogen). The solid-state 13C nuclear magnetic resonance (NMR) spectrum shows two dominant peaks, aliphatic and aromatic carbons, for the isolated material. Sorption isotherms measured using phenanthrene, naphthalene, 1,3,5-trichlorobenzene (TCB), and 1,2-dichlorobenzene (DCB) as sorbates showed that both the isolated kerogen and the original sand exhibited nonlinear sorption and that the phenanthrene and TCB isotherms measured for the kerogen material are more nonlinear than the respective isotherms for the original sand. The single-point organic carbon--normalized sorption capacity measured for the isolated kerogen can be several times greater than that measured for the original sand for a given sorbate. The study suggests that kerogen plays a major role in overall sorption isotherm nonlinearity and could yield higher-than-predicted sorption capacities for the subsurface material even though the content of this organic material is very low.

The role of condensed organic matter in the nonlinear sorption of hydrophobic organic contaminants by a peat and sediments.

This study examines the effect of soil organic matter heterogeneity on equilibrium sorption and desorption of phenanthrene, naphthalene, 1,3,5-trichlorobenzene (1,3,5-TCB), and 1,2-dichlorobenzene (1,2-DCB) by soils and sediments. Two estuary sediments, a Pahokee peat (PP; Euic, hyperthermic Lithic Haplosaprist), and two subsamples (base- and acid-treated peat [TP] and acid-treated peat [FP]) of the peat were used as the sorbents. The contents of black carbon particles were quantified with a chemical extraction method. Petrographical examinations revealed the presence of the condensed soil and sediment organic matter (SOM) in Pahokee peat. The Freundlich isotherm model in two different forms was used to fit both sorption and desorption data. The results show that the sorption and desorption isotherms are generally nonlinear and that the apparent sorption-desorption hysteresis is present for phenanthrene and TCB. Detailed analysis of sorption data for the tested sorbent-sorbate systems indicates that black carbon is probably responsible for sorption isotherm nonlinearity for the two sediments, whereas the humic substances and kerogen may play the dominant role in nonlinear sorption by the peat. This investigation suggests that the microporosity of SOM is important for the hydrophobic organic contaminant (HOC) sorption capacity on the peat.