Quantitative Assessment of the Portal Pressure for the Liver Surgery Using Serological Tests.

OBJECTIVE: To establish a reliable equation to predict hepatic venous pressure gradient (HVPG) using serological tests for surgical patients with hepatocellular carcinoma (HCC). BACKGROUND: Accurate assessment of portal pressure for surgical patients with HCC is important for safe hepatic resection (HR). The HVPG is regarded as the most reliable method to detect portal hypertension. However, HVPG is not utilized in many medical centers due to invasiveness of procedure. METHODS: Between 2006 and 2008, 171 patients (Correlation cohort), who underwent liver surgery in a tertiary hospital, were enrolled. Preoperative measurements of the HVPG and serological tests were performed simultaneously. Correlation between the HVPG and serological tests were analyzed to establish an equation for calculated HVPG (cHVPG). Between 2008 and 2013, 510 surgical patients (Application cohort) were evaluated, and HR recommended when cHVPG < 10 mm Hg. The outcomes of HR were analyzed to evaluate reliability of the cHVPG for HR. RESULTS: In the correlation cohort, the equation for cHVPG was established using multivariate linear regression analysis; cHVPG (mm Hg) = 0.209 × [ICG-R15 (%)] - 1.646 × [albumin (g/dL)] - 0.01×[platelet count (10)] + 1.669 × [PT-INR] + 8.911. In the application cohort, 425 patients with cHVPG < 10 mm Hg underwent HR. Among them, 357 had favorable value of ICG-R15 < 20% (group A), and 68 had unfavorable value of ICG-R15 ≥ 20% (group B). There was no significant difference in patient demographics, tumor characteristics, operative outcome, and survival rates between group A and B. CONCLUSIONS: The equation for cHVPG of this study was established on statistical reliability. The cHVPG could be useful to predict portal pressure quantitatively for surgical patients with HCC using serological tests.

Comparison of Prenatal Health Management State and Educational Needs for Pregnant Women with Advanced Maternal Age and Under the Age of 35.

PURPOSE: This study was done to confirm prenatal health management and educational needs for pregnant women with advanced maternal age (AMA) and pregnant women under 35 years of age. METHODS: This study was a descriptive research in which self-report questionnaires were used. Participants were 279 pregnant women (83 AMA and 196 less than 35). RESULTS: Only 32.5% of AMA women had received prenatal education and 51.8% reported wanting internet education. AMA women, compared to the under 35 women, had higher levels of self-awareness of health problems and possibility of health problems but lower levels of alcohol experience before pregnancy. For prenatal health management, scores were low for prenatal exercise, prenatal education and nutrition. For prenatal health management education, AMA women reported high levels of need for education on health problems. CONCLUSION: The results indicate that prenatal health management education must be given considering differences in age-related requirements by emphasizing health care and obstetric complications during pregnancy for AMA womenand anemia and information on substance use during pregnancy for women under 35. Reliable internet-based education programs need to be developed using available information and communication technology for the increasing number of employed pregnant women.