Vitamin D deficiency in individuals with a spinal cord injury: a literature review.

STUDY DESIGN: Literature review of studies investigating vitamin D status in individuals with a spinal cord injury (SCI). OBJECTIVES: Prevalence of vitamin D deficiency seems to be high in the general population. Little is known regarding such a deficiency in individuals with a SCI. This review aimed to examine the literature that investigated vitamin D status in this population. SETTING: Switzerland. METHODS: A literature review was performed to investigate the prevalence of vitamin D deficiency in individuals with a SCI and to determine the factors leading to deficiency. RESULTS: Sixteen studies which met all the inclusion criteria were identified. All of these studies assessed total serum 25-hydroxy vitamin D status in individuals with an acute or chronic SCI. Overall, the prevalence of vitamin D deficiency or insufficiency seems to be high (range: 32-93%) in this population compared with that in able-bodied persons. The main factors are immobility, low physical activity and bedrest, and therefore not enough exposure to sunlight. In addition, age, skin pigmentation, lesion level, occurrence of pressure ulcers, body mass index, season and latitude appeared to be further determinants for vitamin D deficiency. In athletes, playing their sport indoors or outdoors may have an additional role in developing vitamin D deficiency. CONCLUSION: The available studies suggest that individuals with a SCI are at increased risk for vitamin D insufficiency/deficiency. Nutritional strategies and supplementation recommendations need to be developed to prevent these conditions in SCI. SPONSORSHIP: Not applicable.

Toxoplasma gondii infection in pork produced in France.

The aim of this study was to assess the seroprevalence of the Toxoplasma gondii parasite in pork produced in France, and to determine infection risk factors. An innovative survey was designed based on annual numbers of slaughtered pigs from intensive and outdoor farms in France. A total of 1549 samples of cardiac fluids were collected from pig hearts to determine seroprevalence using a Modified Agglutination Test. Of those, 160 hearts were bio-assayed in mice to isolate live parasites. The overall seroprevalence among fattening pigs was 2·9%. The adjusted seroprevalence in pigs from intensive farms was 3·0%; the highest in sows (13·4%); 2·9% in fattening pigs and 2·6% in piglets. Adjusted seroprevalence in fattening animals from outdoor farms was 6·3%. Strains were isolated from 41 animals and all were genotyped by Restriction Fragment Length Polymorphism as type II. Risk-factor analysis showed that the risk of infection was more than three times higher for outdoor pigs, and that sows' risk was almost five times higher than that of fattening animals. This study provides further evidence of extensive pork infection with T. gondii regardless of breeding systems, indicating that farm conditions are still insufficient to guarantee 'Toxoplasma-free pork'.

Early symptoms and long-term clinical outcomes of distal limb's cutaneous arterio-venous malformations: a retrospective multicentre study of 19 adult patients.

INTRODUCTION: Cutaneous arterio-venous malformations (AVM) are high-flow vascular malformations made up of a direct link between arteries and veins without intermediary capillary space. 'Distal limb's AVM', which mean involving hands or feet, are rare and their functional prognosis is often poor. Little is known about their early clinical symptoms. The objectives of this study were to identify early clinical symptoms of distal limb's cutaneous AVMs and to determine their long-term clinical outcome. METHODS: A retrospective study was carried out including adult patients who had distal limb's AVM, who were followed up between January 2000 and November 2013 in two regional tertiary care centres. The information was collected from patients' clinical records and completed by a structured telephone questionnaire. RESULTS: Nineteen patients were included in the study: four (21%) with foot AVM and 15 (79%) with hand AVM. The first clinical symptoms were as follows: swelling (47%), pain (47%), one or several venous dilatations (37%) and rarely abnormal skin colour, hyperthermia and pulsating sensation. The median diagnosis delay was 9 years after the onset of first manifestations. Amongst the 17 patients who underwent a treatment, 53% had embolotherapy session(s), 12% surgery and 35% had both. After an average follow-up of 57.6 months, 31% of the 13 patients contacted who were receiving treatment were in complete remission; 31% had partial remission; 15% had relapse after initial improvement and 23% had treatment failure. Overall, 74% of patients had a serious development of the AVM: 37% had digital or hand amputation, and 42% remained symptomatic and/or unstable. CONCLUSION: This study suggests that initial manifestations of distal limb's AVMs are discreet and non-specific, leading to a diagnosis delay of about 10 years, with poor prognosis. Doctors should evoke the diagnosis earlier, when these symptoms are shown: pain and/or swelling, sometimes with a large vein.

Vitamin D deficiency in Swiss elite wheelchair athletes.

STUDY DESIGN: This is a retrospective analysis of total serum 25-hydroxyvitamin D (25[OH]D) in Swiss elite wheelchair athletes. OBJECTIVES: The aim was to investigate the occurrence of vitamin D deficiency in Swiss elite wheelchair athletes over the whole year and to detect differences between winter and summer months, and between indoor and outdoor athletes. SETTING: This study was conducted in Switzerland. METHODS: A total of 164 blood samples from 72 Swiss elite wheelchair athletes (mean±s.d.: age 32±13 years) were analyzed for total serum 25[OH]D. All participants were members of the national team in their discipline. The following disciplines have been included: rugby, athletics, cycling, tennis, ski alpine, curling and basketball. According to general guidelines, insufficient vitamin D status was defined between 50 and 75 nmol l-1, deficiency below 50 nmol l-1 and severe deficiency below 27.5 nmol l-1. RESULTS: In all, 73.2% of all samples showed an insufficiency/deficiency in vitamin D status. Total serum 25[OH]D was significantly higher during summer compared with winter months (69.5±21.4 nmol l-1 vs 51.5±21.9 nmol l-1; P<0.001). Indoor sports showed a higher amount of vitamin D insufficiency/deficiency (80.9%) than outdoor sports (70.1%), with a significantly higher 25[OH]D concentration in outdoor sports (P=0.042). CONCLUSION: A high percentage of vitamin D deficiency was found among Swiss elite wheelchair athletes. Conclusively, we recommend supplementation with vitamin D-especially during winter-to prevent a deficiency and an impairment of performance.

Many respiratory viruses have temporal association with meningococcal disease.

BACKGROUND: Previous ecological studies have shown a temporal and spatial association between influenza epidemics and meningococcal disease (MNG); however, none have examined more than two respiratory viruses. METHODS: Data were obtained in Chile between 2000 and 2005 on confirmed cases of MNG and all confirmed cases of respiratory viruses (influenza A and B; parainfluenza; adenovirus; and respiratory syncytial virus [RSV]). Both variables were divided by epidemiological weeks, age range, and regions. Models of transference functions were run for rates of MNG. RESULTS: In this period, 1022 reported cases of MNG and 34,737 cases of respiratory virus were identified (25,137 RSV; 4300 parainfluenza; 2527 influenza-A; 356 influenza-B; and 2417 adenovirus). RSV was the major independent virus temporally associated to MNG (it appears one week before MNG), followed by parainfluenza, influenza-B, adenovirus, and influenza-A. CONCLUSIONS: The rate of MNG in Chile is temporally associated to all of the respiratory viruses studied, but with variability according age range, and regions.

Reliability of a 3-min all-out Arm Crank Ergometer Exercise Test.

The 3-min all-out test is a well-established exercise test developed for cycling ergometry. However, no such test exists in arm cranking. Thus the aim of this study was to investigate the test-retest reliability of a 3-min all-out exercise test on an arm crank ergometer. 21 healthy participants (9 male and 12 female, age 34±11 years, body mass 69.6±11.1 kg and height 175.5±6.9 cm) twice performed a 3-min all-out exercise test on an arm crank ergometer separated by 7 days. Peak power (PP), mean power (MP), fatigue index (FI), time to peak (TTP) and total work (TW) were assessed to detect test-retest reliability. PP, MP, FI and TW showed an excellent intra-class correlation coefficient (ICC) ranging from 0.940 to 0.984. Only TTP showed very low reliability with an ICC of 0.379. The results from this test-retest analysis showed that all parameters except the TTP were highly reliable in a 3-min all-out exercise test on an arm crank ergometer in able-bodied participants.

[CLOVES syndrome: a malformational syndrome closely resembling Proteus syndrome]. / Syndrome CLOVES: un syndrome malformatif proche du syndrome de Protée.

BACKGROUND: CLOVES syndrome (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal nevi, Skeletal anomalies) is a sporadic malformational syndrome that has recently been described (mutation of PIK3CA), with asymmetric body hypertrophy, lipomatous hamartoma of the trunk and numerous malformations. PATIENTS AND METHODS: We report a case of CLOVES syndrome initially diagnosed as Proteus syndrome, revealed by infection of a dorsal lipomatous hamartoma. The patient presented with both right lower limb hypertrophy and capillary and venous-lymphatic malformations, associated with dorsal capillary malformations, left cervico-facial hypertrophy, and cervical epidermal hamartoma, all of which are consistent with Proteus syndrome. Imaging of the dorsal lipomatous hamartoma associated with capillary as well as underlying venous-lymphatic malformations and syringomyelia resulted in subsequent correction of the earlier diagnosis of Proteus syndrome to that of CLOVES syndrome. DISCUSSION: Several malformational syndromes are associated with tissue hypertrophy, hamartoma and vascular malformations. Diagnosis of CLOVES syndrome may be delayed due to its fairly close phenotypic similarity to Proteus syndrome. Nevertheless, the prognosis and complications differ. Our case underlines the importance of considering a diagnosis of CLOVES syndrome in the presence of lipomatous hamartoma with hemi-hypertrophy and epidermal hamartoma, in order to enable adequate follow-up with specific monitoring for the possible complications associated with this disease.

Evolution of anaesthesia care and related events between 1996 and 2010 in Switzerland.

BACKGROUND: Anaesthesia Databank Switzerland (ADS) is a voluntary data registry introduced in 1996. Its ultimate goal is to promote quality in anaesthesiology. METHODS: The ADS registry analyses routinely recorded adverse events and provides benchmark comparisons between anaesthesia departments. Data collection comprises a set of 31 variables organised into three modules, one mandatory and two optional. RESULTS: In 2010, the database included 2,158,735 anaesthetic procedures. Over time, the proportions of older patients have increased, the largest group being aged 50-64 years. The percentage of patients with American Society of Anesthesiologists (ASA) status 1 has decreased while the percentage of ASA status 2 or 3 patients has increased. The most frequent comorbidities recorded were hypertension (21%), smoking (16%), allergy (15%) and obesity (12%). Between 1996 and 2010, 125,579 adverse events were recorded, of which 34% were cardiovascular, 7% respiratory, 39% technical and 20% non-specific. The most severe events were resuscitation (50%), oliguria (22%), myocardial ischaemia (17%) and haemorrhage (10%). CONCLUSION: Routine ADS data collection contributes to the monitoring of trends in anaesthesia care in Switzerland. The ADS system has proved to be usable in daily practice, although this remains a constant challenge that is highly dependent on local quality management and quality culture. Nevertheless, success in developing routine regular feedback to users to initiate discussions about anaesthetic events would most likely help strengthen departmental culture regarding safety and quality of care.

Mutation analysis of the BRCA2 gene in 49 site-specific breast cancer families.

The hereditary breast cancer gene BRCA2 was recently cloned and is believed to account for almost half of site-specific breast cancer families and the majority of male breast cancer families. We screened 49 site-specific breast cancer families for mutations in the BRCA2 gene using single strand conformation analysis (SSCA) followed by direct sequencing. We found mutations in eight families, including all four families with male breast cancer. The eight mutations were small deletions with the exception of a single nonsense mutation, an all were predicted to interrupt the BRCA2 coding sequence and to lead to a truncated protein product. Other factors which predicted the presence of a BRCA2 mutation included a case of breast cancer diagnosed at age 35 or below (P = 0.01) and a family history of pancreatic cancer (P = 0.03). Two mutations were seen twice, including a 8535delAG, which was detected in two French Canadian families. Our results suggest the possibility that the proportion of site-specific breast cancer families attributable to BRCA2 may be overestimated.

Mapping of Dietary Interventions Beneficial in the Prevention of Secondary Health Conditions in Spinal Cord Injured Population: A Systematic Review.

OBJECTIVES: Individuals with spinal cord injury are at risk of secondary health conditions (SHC) that develop as a consequence of autonomic dysfunction, prolonged oxidative stress and inflammation, and physical inactivity coupled with inadequate energy and nutritional intake. SHC can be debilitating and even life-threatening, and its prevention remains one of the major challenges in the continuum of medical care of aging SCI population. An unhealthy diet is a major driver of inflammation, oxidative stress, and unfavourable metabolic status and may be a practical preventive target to tackle increased SHC risk post-injury. AIMS: To provide a catalogue of dietary interventions beneficial in prevention of SHC among individuals with SCI by conducting a systematic review of the literature on dietary interventions and dietary supplementation in promoting health and well-being after the injury. In addition, we aimed to provide a summary of observational studies exploring the association between habitual diet (macro- and micronutrients intake and dietary patterns) and health patterns following the injury. METHOD: This review was registered at PROSPERO (University of York) with registration number CRD42022373773. Four medical databases (EMBASE.com, MEDLINE [Ovid], Cochrane CENTRAL, and Web of Science Core Collection) and Google Scholar were searched from inception until 11th July 2022. Studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. Based on strength of the study design and risk of bias assessment (using the NIH tool), we classified studies from Level 1 (most reliable studies) to Level 4 (least reliable studies). RESULTS: Of 12,313 unique citations, 47 articles (based on 43 original studies) comprising 32 interventional (22 RCTs, 3 NRCT, and 7 pre-post studies) and 11 observational studies (2 cohort studies, 2 case-control, 1 post-intervention follow-up study, and 6 cross-sectional studies) were included in the present systematic review. Twenty studies (46.5%) were classified as Level 1 or 2, indicating high/moderate methodological quality. Based on those studies, dietary strategies including high protein diet, intermittent fasting, balanced diet in combination with physical conditioning and electrical stimulation, and dietary supplementation including alpha-lipoic acid, creatine, vitamin D, and cranberry-derived supplements and probiotics were mapped as the most promising in prevention of SHC among individuals with SCI. CONCLUSIONS: To develop timely and effective preventive strategies targeting major SHC (e.g., cardiometabolic diseases, urinary tract infections) in SCI, further research is warranted to confirm the effectiveness of dietary strategies/interventions identified through the current systematic review of the literature.

Correlation of heart rate at lactate minimum and maximal lactate steady state in wheelchair-racing athletes.

STUDY DESIGN: Prospective, experimental study. OBJECTIVE: To investigate whether the heart rate (HR) at lactate minimum (LMHR)determined by means of a HR-guided lactate minimum test (LMT) corresponds to the HR at maximal lactate steady state (MLSS) in wheelchair-racing athletes. SETTING: Institute of Sports Medicine. METHODS: Eight well-trained wheelchair-racing athletes (mean age: 33±12 years; height: 169±12 cm; body mass: 59±11 kg; VO(2peak): 2.76±0.73 l min(-1)) completed a HR-guided LMT on a treadmill in their own racing wheelchair. Subsequently, exercise intensity at MLSS and corresponding HR were determined by means of several endurance tests on different days. RESULTS: All measured parameters (HR, speed, blood lactate, oxygen consumption and rating of perceived exertion) revealed significantly higher values at MLSS compared with values at lactate minimum (LM). However, there were highly significant correlations (r=0.914, P=0.002) between LMHR and HR at MLSS (163±6 versus 172±7 b.p.m.) as well as for speed (r=0.935, P=0.001) and blood lactate (r=0.944, P<0.001) at LM versus MLSS. The correlation for oxygen consumption (r=0.798, P=0.018) at LM versus MLSS was lower yet significant. CONCLUSIONS: There exists a close relationship between LMHR and HR at MLSS in wheelchair racing. This allows the prediction of MLSS based on a single exercise test in this special group of athletes. For practical use during daily training, routine HR at MLSS can be assumed to be 8-9 b.p.m. above the LMHRin wheelchair-racing athletes.

The level of lactic acidosis affects lactate minimum in a heart rate-based lactate minimum test.

The aim was to investigate whether the level of lactic acidosis in the first part of a heart rate-based lactate minimum test affects the lactate minimum heart rate and performance. We tested 15 men (age: 31 ± 6 years, height: 179 ± 6 cm, body mass: 75.6 ± 7.6 kg and V˙O(2peak) 50.3 ± 10.0 ml · min (- 1) · kg( - 1)). They all completed 2 lactate minimum tests following 2 different protocols during the first part of the test, i. e., i) a maximal test until exhaustion to provoke extensive lactacidaemia and ii) a submaximal test abandoned 3 stages earlier than the maximal test to provoke significantly lower but still considerable lactacidaemia. The second part of the lactate minimum test was identical for both runs. It consisted of a heart rate-based incremental test to determine the lactate minimum and the corresponding lactate minimum heart rate and performance. Results showed a significantly higher maximal blood lactate concentration at the end of the maximal test compared to the submaximal test (9.7 ± 2.7 vs. 6.0 ± 2.0 mmol · l( - 1), P<0.001). Also mean lactate minimum heart rate (160 ± 12 vs. 144 ± 13 bpm, P<0.001) and performance (200 ± 40 vs. 170 ± 35 W, P<0.001) were significantly higher after the maximal test compared to the submaximal test. We conclude that the first part of the heart rate-based lactate minimum test needs to be performed until exhaustion to receive reliable and meaningful results.

Seroprevalence and factors associated with Toxoplasma gondii infection in wild boar ( Sus scrofa) in a Mediterranean island.

Knowledge of the factors affecting the presence of Toxoplasma gondii in wildlife is limited. Here we analyse which local landscape characteristics are associated with the presence of toxoplasmosis in wild boar, Sus scrofa, on the island of Corsica, France. Meat juice samples from 1399 wild boars collected during two hunting seasons were tested for T. gondii antibodies using the modified agglutination test (titre 1:4). The overall seroprevalence was 0.55 (95% CI 0.50-0.59) for the first year and 0.33 (95% CI 0.29-0.35) for the second year. Seroprevalence varied according to age and county. At the county level, seropositivity in adults was related to farm density during year 1, and to habitat fragmentation, farm density and altitude during year 2. The exposure of wild boar to T. gondii is thus variable according to landscape characteristics and probably results in a variable risk of transmission of toxoplasmosis to humans.

Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players.

BACKGROUND: There is considerable evidence that respiratory muscle training improves pulmonary function, quality of life and exercise performance in healthy athletic populations. The benefits for wheelchair athletes are less well understood. Therefore, in the present study, influence of inspiratory muscle training (IMT) on respiratory function and repetitive propulsive sprint performance in wheelchair basketball players was examined. METHODS: Using a placebo-controlled design, 16 wheelchair athletes were divided to an experimental (IMT; n=8) or placebo (sham-IMT; n=8) group based on selective grouping criteria. 30 dynamic breaths were performed by the IMT group twice daily at a resistance equivalent to 50% maximum inspiratory pressure (MIP), and 60 slow breaths were performed by the sham-IMT group once a day at 15% MIP for a period of 6 weeks. RESULTS: In the IMT group, both MIP and maximum expiratory pressure (17% and 23%, respectively; p< or =0.03) were improved. Similar improvements were noted for the sham-IMT group with 23% and 33% from baseline for MIP and maximum expiratory pressure, respectively (p< or =0.03). There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test (sprint and recovery times, peak heart rate and peak blood lactate concentration). Reported experiences of using the IMT training device suggested "less breathlessness" and "less tightness in the chest during the training". CONCLUSIONS: Although there was no improvement in sprint performance, an improved respiratory muscle function and quality of life were reported by participants in both the IMT and sham-IMT groups.

Management of vascular and nonvascular complications following pancreas transplantation with interventional radiology.

Pancreas transplantation exposes to high rates of complications, either vascular (thrombosis, stenosis, pseudoaneurysm, arteriovenous fistula) or nonvascular (fluid collection, graft rejection). With advances in percutaneous and endovascular techniques, interventional radiologists are increasingly involved in the management of these complications. In this article, we review the anatomical considerations relevant to pancreas transplantation, the techniques used for image-guided interventions for vascular and nonvascular complications, and the expected outcomes of these interventions.

Heart rate-based lactate minimum test: a reproducible method.

OBJECTIVE: To find the individual intensity for aerobic endurance training, the lactate minimum test (LMT) seems to be a promising method. LMTs described in the literature consist of speed or work rate-based protocols, but for training prescription in daily practice mostly heart rate is used. The aim of the present study was to investigate the reproducibility of a new heart rate-based LMT protocol. DESIGN: 20 subjects each underwent four LMTs on a cycle ergometer. The LMT consisted of a first part (Conconi test) to induce lactate accumulation and a second part (incremental protocol) with stages of 5 min starting beyond the aerobic threshold. During these stages work rate was adjusted to reach predetermined heart rates, which were calculated for every single test from heart rate (HR) at rest and maximum HR. Lactate was measured after each stage to define the lactate minimum (LM) and the corresponding HR. SETTING: Institute of Sports Medicine. PARTICIPANTS: 20 healthy and endurance-trained individuals (13 men, seven women). MAIN OUTCOME MEASURES: Reproducibility of heart rate at LM. RESULTS: The reproducibility of heart rate at LM was high (coefficient of variation (CV) = 2.1%). The reproducibility of work rate at LM was good (CV = 6.7%). CV for lactate concentrations at LM was 17.4%. High interindividual differences at LM were found in heart rate (range 149-178 beats/min) and lactate levels (range 1.2-6.8 mmol/l). CONCLUSION: The LMT using a heart rate-based protocol is a reproducible method of assessing HR at an exercise intensity where an equilibrium exists between blood lactate accumulation and elimination.

Determination and possible application of the aerobic gas exchange threshold in aerobically untrained paraplegic subjects based on stimulated cycle ergometry.

PURPOSE: To accurately characterise cardiopulmonary baseline performance in aerobically untrained paraplegic subjects by means of an incremental exercise test (IET) and to derive possible training recommendations based on these measurements. METHODS: Twelve motor complete paraplegic subjects with no previous experience in stimulated leg-cycling participated in the study. Exercise testing was performed on a recumbent FES-tricycle by means of a work rate and cadence controlled IET until maximal work rate was reached. Heart rate (HR) and respiratory parameters were recorded continuously. RESULTS: Peak oxygen uptake was 671 +/- 192 mL min(-1) (mean + standard deviation), peak HR 90 +/- 12 beats min(-1), net peak power 8.4 +/- 3.3 W and peak minute ventilation 23.6 +/- 7.5 L min(-1). Aerobic gas exchange threshold (GET) was found to be 51% +/- 10% of peak oxygen uptake and corresponded to 41% +/- 13% of peak power. CONCLUSIONS: A cadence and work rate controlled exercise test allows the determination of cardiopulmonary parameters during stimulated cycle ergometry even in aerobically untrained paraplegic subjects. The precise determination of GET allows an appropriate exercise intensity to be prescribed and thus provides a suitable method for exercise intensity calculation in the spinal cord injured population in the future.

[Toxoplasmosis: a survey on meat products in Côte d'Ivoire]. / Toxoplasmose: à propos d'une enquête sur la viande en Côte d'Ivoire.

Toxoplasmosis is a worldwide parasitic zoonosis that can cause severe problems under certain circumstances. Before the advent of the last-generation anti-retroviral drugs, estimation predicted that 50% of HIV-infected patients would develop toxoplasmosis (mainly central nervous system forms). It is the first clinical manifestation of AIDS in 20% of patients. This report describes an epidemiological survey on the seroprevalence of Toxoplasma antibodies in bushmeat and pork in the Côte d'Ivoire. The purpose was to determine how the parasite circulates among wild and domestic animals and to evaluate the risk of transmission to humans after ingestion of these meats. Fifteen samples of bushmeat were purchased on markets in 6 different cities. A total of 91 single samples of fresh pork raised at three different modern breeding facilities were collected from a slaughterhouse in Abidjan. Serological testing was performed on muscle fluid using an ELISA test (Pourquier Toxoplasma kit). No bushmeat sample was positive. Global seroprevalence in pork samples was 8.8% [range, 8.2-9.37]. The seroprevalence of toxoplasmosis measured in pork samples produced at modern livestock breeding facilities was lower than values reported in samples produced by traditional breeding in Africa. This finding suggests that the use of modern techniques excluding rodents (good hygiene) can reduce animal contamination. Curing (heat and smoking) may account for the absence of Toxoplasma antibodies in bushmeat. Public information campaigns concerning the risk of consuming meat containing cysts as well as raw vegetables contaminated with oocysts are needed to prevent transmission of toxoplasmosis.

Ultrasonographic guidance for portal vein access during transjugular intrahepatic portosystemic shunt (TIPS) placement.

PURPOSE: The purpose of our study was to retrospectively assess the safety and efficacy of percutaneous real-time ultrasound guidance for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Between January 2011 and November 2018, procedure details and outcome were retrospectively analyzed for 224 patients who underwent TIPS placement using real-time ultrasound guidance for portal vein puncture. There were 175 men and 49 women with a mean age of 52.7±10.6 (SD) years (range: 22-82 years). For each procedure, technical success, primary ultrasound guidance success, portosystemic pressure gradient, duration of the intervention, procedural complications, radiation exposure, mortality and morbidity rates at day 30 post-procedure were recorded for data analysis. RESULTS: Technical success rate was 100.0% with a success rate of the primary ultrasound guidance of 97.8% (219/224; 95% CI: 95.8-99.7). Mean duration of the procedure was 86.2±41.7 (SD) min (range: 22.0-267.0min). Mean dose-area product was 62.0±50.2 (SD) Gy.cm2 (range: 3.7-306.5Gy.cm2). Twelve complications (12/224; 5.4%) occurred in ten patients during TIPS procedures including 8 arterial punctures (3.6%) and 4 biliary punctures (1.8%). Four complications (4/224; 1.8%) were clinically significant. Mortality rate at day 30 after the procedure was 9.8% (22/224), without any patient dying from technical complications. CONCLUSION: Real-time ultrasound guidance is a safe technique to assist in the creation of TIPS and may allow for lower radiation exposure.