Feasibility and long-term outcomes of hepatic vein recanalization in Budd-Chiari syndrome through intrahepatic collateral pathways.

BACKGROUND AND AIMS: To investigate the feasibility and long-term outcomes of hepatic vein (HV) recanalization using intrahepatic collateral pathways in patients with Budd-Chiari syndrome (BCS) with HV obstruction. METHODS: Clinical data of 29 BCS patients with HV obstruction and intrahepatic collateral pathways were reviewed. All patients underwent HV recanalization through the intrahepatic collaterals. Follow-up was performed at 1, 3, 6, and 12 months after treatment and annually thereafter. Cumulative patency and survival rates were assessed using Kaplan-Meier curves. The independent predictors of patency were determined using a Cox regression model. RESULTS: HV recanalization was successful in 28 of the 29 patients (96.6%), with no complications. Of the 28 cases, simultaneous recanalization of the accessory HV and right HV was achieved in 11 patients, accessory HV and middle HV in six, accessory HV and left HV in three, right HV and middle HV in five, and left HV and middle HV in three. Twenty-eight patients were followed from 4 to 87 (mean, 53.6 ±â€…26.7) months after treatment, and six patients developed reocclusion. The overall cumulative 1-, 3-, 5-, and 7-year primary HV patency rates were 96.3, 82.9, 74.6, and 59.7%, respectively. The cumulative 1-, 3-, 5-, and 7-year survival rates were 100, 95.8, 95.8, and 86.3%, respectively. CONCLUSION: Interventional treatment of HV obstruction in BCS patients through intrahepatic collateral approaches is well tolerated and feasible and can result in excellent long-term patency and survival rates.

Mid- to long-term outcomes of initial transjugular intrahepatic portosystemic shunt versus anticoagulation for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome.

BACKGROUND: Anticoagulation therapy (AT) is often used as the initial treatment for pyrrolizidine alkaloid (PA)-induced hepatic sinusoidal obstruction syndrome (HSOS). However, transjugular intrahepatic portosystemic shunt (TIPS) is an alternative treatment. This study aimed to determine the mid- to long-term outcomes of TIPS versus AT as the initial treatment for PA-induced HSOS. METHODS: We retrospectively analyzed the clinical data of 61 patients with PA-induced HSOS that were collected between November 2015 and July 2021. The patients were allocated to the TIPS group ( n = 20) or the AT group ( n = 41). These two groups were divided into subgroups according to the severity grading. The clinical data of the patients in both groups were analyzed. Cumulative survival rates were calculated and compared between the two groups and among the subgroups. RESULTS: The clinical symptoms and signs improved or stabilized in 100% of the patients following TIPS and in 85% of the patients following AT at discharge ( P = 0.166). The mortality rate was 0.0% in the TIPS group and 34.1% in the AT group ( P = 0.005). The patients were followed up for 2-69 months (mean, 26.3 ± 20.5 months). In the mild- and moderate-grade subgroups, there was no difference in the cumulative survival rate between the TIPS and AT groups ( P = 0.589 and P = 0.364, respectively). In the severe and very severe-grade subgroups, the cumulative survival rate was higher in the TIPS group than in the AT group ( P = 0.018 and P = 0.025, respectively). CONCLUSION: AT is a suitable initial treatment for mild or moderate PA-induced HSOS, whereas TIPS should be considered the appropriate initial treatment for severe or very severe PA-induced HSOS.

Genetic origin and expression patterns of acetohydroxyacid synthase multigene family in Brassica juncea and B. carinata and their progenitors.

Acetohydroxyacid synthase (AHAS), the key enzyme in the branched-chain amino acids leucine, isoleucine, and valine biosynthesis pathway, has gained intensive investigation because it is the target of five different AHAS herbicides widely used to control weeds in farmland. In the present study, the AHAS gene family in Brassica juncea and B. carinata and their progenitor species was characterized in combination with bioinformatics, gene-specific PCR and qRT-PCR analyses. The results indicated that B. juncea contains four AHAS genes, of them, BjuAHAS3 and BjuAHAS4 originated from the A genome donor of B. rapa, whereas BjuAHAS6 and BjuAHAS7 from the B genome donor of B. nigra. BjuAHAS3 and BjuAHAS6 are predicted to be functional and constitutively expressed in all vegetative and reproductive tissues in the tested B. juncea accessions. B. carinata contains five AHAS genes, of them, BcaAHAS1, BcaAHAS2, and BcaAHAS5 originated from the C genome donor of B. oleracea, whereas BcaAHAS6 and BcaAHAS7 came from the B genome donor of B. nigra. BcaAHAS1, BcaAHAS2, and BcaAHAS6 are predicted to be functional. BcaAHAS1 and BcaAHAS6 are constitutively expressed in all vegetative and reproductive tissues in the tested B. carinata accessions, however, BcaAHAS2 is mainly expressed in siliques. In addition, translocation events for the AHAS1, AHAS2, and AHAS7 genes occurred when the three amphidiploids species B. napus, B. juncea, and B. carinata were formed by hybridization of their respective diploid species. The findings in this study will provide important basic information for the breeding of herbicide-resistant varieties in B. juncea and B. carinata.

Long-term outcomes of interventional treatment for Budd-Chiari syndrome with chronic accessory hepatic vein obstruction.

OBJECTIVE: Interventional treatment is the main therapy for Budd-Chiari syndrome (BCS) with hepatic vein obstruction. The aim of this study was to investigate the long-term outcomes of endovascular management for BCS with chronic accessory hepatic vein (AHV) obstruction. METHODS: In total, 68 patients with primary BCS who underwent AHV dilation with or without stenting from January 2008 to December 2018 were included in this retrospective study. The technical success rate and complications were recorded. Cumulative patency rates were estimated by the Kaplan-Meier curves and compared using the log-rank test. RESULTS: Technical success was achieved in all 68 patients, and AHV patency was confirmed by postoperative angiography. Fifty-two patients underwent balloon dilation alone and 16 underwent adjunctive stent implantation. During a mean follow-up period of 60.2 ± 30.5 months, AHV reocclusion occurred in 14 patients in the balloon group and four patients in the stent group (χ2 = 0.034, P = 0.855). The overall cumulative 1-, 3-, 5-, and 7-year primary and secondary AHV patency rates were 90.6, 76.6, 72.0, and 68.2% and 98.4, 91.4, 89.2, and 89.2%, respectively. The cumulative 1-, 3-, 5-, and 7-year primary patency rates of the AHV were 89.8, 73.8, 71.2, and 71.2% in the balloon group and 93.3, 86.2, 75.4, and 60.3% in the stent group, respectively. There was no statistically significant difference between the two groups (P = 0.934). CONCLUSION: Interventional treatment of BCS with chronic AHV obstruction has good long-term outcomes. Both balloon dilation alone and adjunctive stent implantation can be used for AHV recanalization.

Inheritance and Molecular Characterization of a Novel Mutated AHAS Gene Responsible for the Resistance of AHAS-Inhibiting Herbicides in Rapeseed (Brassica napus L.).

The use of herbicides is an effective and economic way to control weeds, but their availability for rapeseed is limited due to the shortage of herbicide-resistant cultivars in China. The single-point mutation in the acetohydroxyacid synthase (AHAS) gene can lead to AHAS-inhibiting herbicide resistance. In this study, the inheritance and molecular characterization of the tribenuron-methyl (TBM)-resistant rapeseed (Brassica napus L.) mutant, K5, are performed. Results indicated that TBM-resistance of K5 was controlled by one dominant allele at a single nuclear gene locus. The novel substitution of cytosine with thymine at position 544 in BnAHAS1 was identified in K5, leading to the alteration of proline with serine at position 182 in BnAHAS1. The TBM-resistance of K5 was approximately 100 times that of its wild-type ZS9, and K5 also showed cross-resistance to bensufuron-methyl and monosulfuron-ester sodium. The BnAHAS1544T transgenic Arabidopsis exhibited higher TBM-resistance than that of its wild-type, which confirmed that BnAHAS1544T was responsible for the herbicide resistance of K5. Simultaneously, an allele-specific marker was developed to quickly distinguish the heterozygous and homozygous mutated alleles BnAHAS1544T. In addition, a method for the fast screening of TBM-resistant plants at the cotyledon stage was developed. Our research identified and molecularly characterized one novel mutative AHAS allele in B. napus and laid a foundation for developing herbicide-resistant rapeseed cultivars.

Male Sterility of an AHAS-Mutant Induced by Tribenuron-Methyl Solution Correlated With the Decrease of AHAS Activity in Brassica napus L.

Tribenuron-methyl (TBM), an acetohydroxyacid synthase (AHAS)-inhibiting herbicide, can be used as an efficient chemical hybridization agent to induce male sterility for practical utilization of heterosis in rapeseed (Brassica napus L.). Utilization of rapeseed mutants harboring herbicide-resistant AHAS alleles as the male parent can simplify the hybrid seed production protocol. Here we characterized a novel TBM-resistant mutant K5 derived from an elite rapeseed variety, Zhongshuang No. 9 (ZS9), by ethyl methyl sulfonate mutagenesis. Comparative analysis of three BnAHAS genes (BnAHAS1, BnAHAS2, and BnAHAS3) between the mutant K5 and ZS9 identified a C-to-T transition at 544 from the translation start site in BnAHAS1 in K5 (This resistant allele is referred to as BnAHAS1544T ), which resulted in a substitution of proline with serine at 182 in BnAHAS1. Both ZS9 and K5 plants could be induced complete male sterility under TBM treatment (with 0.10 and 20 mg⋅L-1 of TBM, respectively). The relationship between TBM-induced male sterility (Y) and the relative AHAS activity of inflorescences (X) could be described as a modified logistic function, Y = 100-A/(1+Be(-KX)) for the both genotypes, although the obtained constants A, B, and K were different in the functions of ZS9 and K5. Transgenic Arabidopsis plants expressing BnAHAS1544T exhibited a higher TBM resistance of male reproductive organ than wild type, which confirmed that the Pro-182-Ser substitution in BnAHAS1 was responsible for higher TBM-resistance of male reproductive organs. Taken together, our findings provide a novel valuable rapeseed mutant for hybrid breeding by chemical hybridization agents and support the hypothesis that AHAS should be the target of the AHAS-inhibiting herbicide TBM when it is used as chemical hybridization agent in rapeseed.

Number and function of circulating endothelial progenitor cells in patients with primary Budd-Chiari syndrome.

BACKGROUND AND AIM: Primary Budd-Chiari syndrome (BCS) is associated with vascular endothelial injury. Circulating endothelial progenitor cells (EPCs) provide an endogenous mechanism to repair endothelial injury. This study investigated the levels and functionality of EPCs in patients with primary BCS. METHODS: EPCs (CD34+/CD133+/KDR+) were quantified in 82 patients with primary BCS (inferior vena cava type: n=19; hepatic vein type: n=22; and mixed type: n=41), 10 cirrhosis controls (CC group) and 10 age-matched healthy controls (HC group), using flow cytometry. EPCs proliferation was detected by MTT assay, adhesion by adhesion activity assay, and migration capacity by Transwell assay. RESULTS: EPCs levels were significantly lower in the BCS group (0.020±0.005%) than in the CC and HC groups (0.260±0.201%, 0.038±0.007%; P<0.001 for each). EPCs cultured in vitro from BCS and CC groups had, respectively, lower proliferation activity (0.20±0.04, 0.23±0.06 vs 0.58±0.07, each P<0.001), adhesion activity (15.8±1.7, 18.2±4.3 vs 35.0±2.5 cells/random microscopic field (RMF), each P<0.001) and migration activity (16.1±1.5, 16.7±3.0 vs 23.9±2.0 cells/RMF, each P<0.001) than in the HC group. EPCs functionality did not significantly differ between the BCS and CC groups. The numbers and functions of EPCs did not significantly differ among patients with inferior vena cava type, hepatic vein type and mixed type of BCS. CONCLUSION: Patients with primary BCS had lower EPCs levels, with less proliferation, adhesion and migration activities. These findings suggest that lower levels of less functional EPCs may be associated with venous occlusion in primary BCS patients.

Catheter-Directed Thrombolysis for Massive Pulmonary Embolism Resulting from Thrombosis in a Duplicated Inferior Vena Cava: A Case Report.

Pulmonary embolism (PE) associated with duplicated inferior vena cava (IVC) is rare, and there are no reports of this condition treated with catheter-directed thrombolysis. We present the case of a 54-year-old man who developed massive PE caused by thrombi in a duplicated IVC that detached during transcatheter angiography. After implantation of a retrievable filter in the common IVC, the patient underwent catheter-directed thrombolysis. He was asymptomatic at discharge, with complete resolution of thrombosis and successful retrieval of the filter. The patient had an uneventful 9-month follow-up with no further complications.

Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd-Chiari Syndrome.

BACKGROUND: Endovascular management is important for the treatment of primary Budd-Chiari syndrome, which is caused by inferior vena cava (IVC) obstruction. The aims of this study were to compare long-term outcomes of endovascular management for primary Budd-Chiari syndrome patients with membranous obstruction of IVC (MOVC) and segmental obstruction of IVC (SOVC) and explore the optimal endovascular strategy for these conditions. METHODS AND RESULTS: Clinical data of 265 patients with Budd-Chiari syndrome who received endovascular management (MOVC group, n=136; SOVC group, n = 129) were retrospectively reviewed. Cumulative IVC patency rates were generated by the Kaplan-Meier method and compared by log-rank test. In total, 245 patients were followed up from 3 to 72 months after treatment. The difference of long-term outcomes of balloon dilation alone versus stent placement was not significant in each group. The overall cumulative 1-, 3-, and 5-year primary IVC patency rates were 98.3%, 90.7%, and 83.8% in the MOVC group and 88.3%, 79.1%, and 67.9% in the SOVC group (P=0.007), respectively. The long-term IVC patency rates were lower in the SOVC group than in the MOVC group for patients who underwent balloon dilation alone (P=0.001) and did not significantly differ for patients who underwent stent placement between both the groups (P=0.687). CONCLUSIONS: The long-term treatment outcome of endovascular management was better for primary Budd-Chiari syndrome patients with MOVC than for those with SOVC. Balloon dilation alone could be the optimal treatment for patients with MOVC. However, stent placement should be more strongly recommended for patients with SOVC.

[Application of suprarenal inferior vena cava filter placement in patients with venous thromboembolism].

OBJECTIVE: To evaluate the safety and efficacy of suprarenal inferior vena cava (IVC) filter implantation in patients with venous thromboembolism (VTE). METHODS: Between May 2006 and December 2014, 28 patients with VTE underwent suprarenal IVC filter implantation, anticoagulant treatment and/or catheter-directed thrombolysis at the affiliated hospital of Xuzhou medical college. Follow up examination with color Doppler ultrasound was taken after treatment to eassess the patency of IVC. RESULTS: One filter was successfully implanted in suprarenal IVC in each patient intraoperatively. The filter was retrieved in 26 patients after indwelling of 5 to 17 (mean 11 ± 3) days. The filter was permanently indwelled in 2 patients. There were no complications of filter tilt and migration in all cases. Twenty eight patients were followed up for 2 to 104 (mean 34 ± 34) months. None of the 2 patients whose filters were permanently indwelled presented complications of recurrent pulmonary embolism and IVC occlusion due to the filter. Among 26 patients whose filters were retrieved, the IVC was patent. CONCLUSION: Suprarenal IVC filter placement is a safe and effective method in the treatment of VTE.

Efficacy and safety of endovascular intervention for the management of primary entire-inferior vena cava occlusion.

PURPOSE: This study was designed to investigate the safety and efficacy of endovascular intervention for the treatment of primary entire-inferior vena cava (IVC) occlusion. METHODS: Endovascular interventions were performed in six patients for the treatment of primary entire-IVC occlusion. IVC and hepatic venography were performed via the jugular and femoral veins. Balloon angioplasty was used to revascularize the hepatic vein and IVC and a stent was placed in the IVC to maintain patency. Postoperative color Doppler ultrasonography was performed at 1, 3, 6, and 12 months, and then annually, to monitor the patency of the hepatic vein and IVC. RESULTS: The IVC and one or two hepatic veins were successfully revascularized in five patients. Revascularization was successful in the right and left hepatic veins in one patient; however, IVC patency could not be established in this patient. Eleven Z-type, self-expanding stents were placed into the IVCs of five patients (three stents in two patients, two stents in two patients, and one stent in one patient). There were no instances of postoperative bleeding or mortality. Follow-up was conducted for 18-90 months (42.8 ± 26.5 months). None of the five patients suffered restenosis of the IVC or hepatic veins. However, there was one of the six cases of right hepatic vein restenosis at 18 months postprocedure that was revascularized after a second balloon dilatation. CONCLUSIONS: Endovascular intervention is safe and efficacious for the treatment of primary entire-IVC occlusion.

Clinical outcomes of warfarin anticoagulation after balloon dilation alone for the treatment of Budd-Chiari syndrome complicated by old inferior vena cava thrombosis.

BACKGROUND: To evaluate the safety and clinical efficacy of warfarin anticoagulation after balloon dilation alone for the treatment of Budd-Chiari syndrome (BCS) complicated by old inferior vena cava (IVC) thrombosis. METHODS: From January 2008 to November 2013, 19 BCS patients complicated with old IVC thrombosis were treated with balloon dilation followed by oral administration of anticoagulant warfarin. Follow-up was performed at 1 week, then 1, 2, 3, 6, and 12 months after balloon dilation, and then annually thereafter. IVC patency and morphologic changes of the old thrombus were examined by ultrasound, and clinical symptoms and signs were determined by clinical examinations during follow-up. RESULTS: Successful IVC balloon dilation was achieved in the 19 patients (100%). Inferior vena cavography demonstrated the patency of IVC lumen, and the size of the old thrombus was not altered. The mean pressure gradient between IVC and the right atrium was reduced from 27.5 ± 3.0 cm H2O (range, 22-35) before treatment to 5.4 ± 1.3 cm H2O (range: 2-7) after treatment (t = 41.6, P < 0.05; 1 cm H2O = 0.098 kPa). Patients were followed up as outpatients for an average of 15.9 ± 14.4 months (range, 3-66). Anticoagulation with warfarin was well tolerated in all patients after balloon dilation alone. Of the 19 patients, complete resolution of the old thrombus was achieved in 12 patients and partial resolution was achieved in 7 patients. Color Doppler ultrasound showed that 17 patients had IVC lumen patency, and 2 patients had IVC reocclusion. None of the patients had recurrence of thrombosis, symptomatic pulmonary embolism, and bleeding complications throughout the follow-up period. CONCLUSIONS: Our results indicate that warfarin anticoagulation after balloon dilation alone is a safe and effective therapy for BCS patients with old IVC thrombosis.