Psoas Muscle Density Predicts Occurrences of Hepatic Encephalopathy in Patients Receiving Transjugular Intrahepatic Portosystemic Shunts within 1 year.

PURPOSE: We aimed to assess the efficacy of psoas density (PD) for predicting hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) procedures. METHODS: Data were collected from patients who underwent TIPS procedures at a single institution between 2013 and 2019. PD was manually measured using software on unenhanced CT scans at the level of third lumbar vertebra. Laboratory and physical examination data were collected within 24 h after admission in order to compare the differences between patients with and without post-TIPS HE. RESULTS: A total of 251 patients were included in this study. Among these patients, 77 (30.7%) developed post-TIPS HE within one year after TIPS creation. The threshold of PD for predicting HE was 51.24 Hounsfield unit (HU). PD values less than this threshold were correlated with an increased risk of HE (hazard ratio 0.92; 95% CI 0.89-0.95, P < 0.001). The area under the receiver operating characteristic curve (AUROC) of PD was 0.743 (95% CI 0.685-0.796), which was superior to Model for End-stage Liver Disease (MELD) (0.569, P = 0.007), albumin-bilirubin score (ALBI) (0.641, P = 0.018), and Child-Pugh score (0.583, P = 0.003). CONCLUSION: PD measurement showed good HE predictive value in cirrhotic patients who underwent TIPS. This measure also performed better than MELD, ALBI and Child-Pugh.

Adenosine A(2A) receptor activation reverses hypoxia­induced rat pulmonary artery smooth muscle cell proliferation via cyclic AMP­mediated inhibition of the SDF1­CXC4 signaling pathway.

The occurrence and the subsequent development of pulmonary arterial hypertension (PAH) involve complicated mechanisms. Of these, the proliferation of pulmonary artery smooth muscle cells (PASMCs) has been indicated to be closely associated with its progression. Therefore, therapeutic methods targeting PASMCs to inhibit proliferation is an effective method for alleviating PAH. The present study was designed to determine the role of the adenosine A(2A) receptor (A2A receptor) in hypoxia­induced rat PASMC (RPASMC) proliferation. Primary RPASMCs were isolated from the pulmonary artery of adult male SD rats, cultured and used for the following experiments. The mRNA level and protein expression of CXCR4 were measured by reverse transcription­quantitative polymerase chain reaction and western blot analysis, respectively. The cell proliferation of RPASMCs was measured using a cell proliferation assay kit. In the present study, it was demonstrated that the proliferation of RPASMCs was partially mediated by activation of the stromal cell­derived factor 1 (SDF1)­CXC chemokine receptor 4 (CXCR4) axis under hypoxic conditions. In addition, SDF1­α alone upregulated the mRNA and protein expression levels of CXCR4, and stimulated the proliferation of RPASMCs. The protein expression of CXCR4 and the cell proliferation were markedly inhibited by application of A2A receptor agonist CGS21680 or cyclic adenosine monophosphate (cAMP) under hypoxic conditions or treatment with SDF1­α and was reversed by the A2A receptor antagonist SCH58261 or 8­bromoadenosine­3',5'­cyclic monophosphorothioate. These results demonstrated that the inhibition of SDF1­CXC4 signaling by the activation of A2A receptor and subsequent increase in the level of cAMP may be a potential method to ameliorate PAH.

Structural Novelties in Anionic Cluster Halide Phases. Discrete Tetrahedral A(4)Br(+) Ions in Two New Zirconium Bromide Structures (A = Na-Cs).

Suitable reactions of ABr, Zr, ZrBr(4), and an interstitial Z element in Ta containers at 850 degrees C afford two series of quaternary cluster phases containing A(4)Br(3+) ions. Cubic (A(4)Br)(2)Zr(6)(Z)Br(18) phases occur for various combinations of A = Na-Cs, Z = Be, B, H, Mn. The combination with A = K, Z = B was structurally characterized (inverse fluorite, Fm&thremacr;m, Z = 4, a = 16.191(2) Å). The 15-e cluster exhibits the appropriate magnetic moment, and this decreases toward the diamagnetic 14-electron limit in products with potassium deficiencies, (K(4)(-)(x)())(2)Zr(6)Br(18)B, x

The First Mixed-Halide Zirconium Cluster Compounds: Zr(6)Cl(1.6)I(10.4)Be, Zr(6)Cl(1.3)I(10.7)B, and Zr(6)Cl(11.5)I(1.5)B. Matrix Effects and Halogen Substitution in Compact Network Structures.

Investigations of the effect of halogen size on structure stability have been conducted in well-reduced and heavily interbridged zirconium chloride-iodide cluster systems. The title compounds are obtained in good yields from reactions of Zr, ZrCl(4), ZrI(4), and B or Be in sealed Ta tubes for approximately 4 weeks at 850 degrees C. Single-crystal diffraction at room temperature established these as Zr(6)Cl(1.65(4))I(10.35(4))Be and Zr(6)Cl(1.27(3))I(10.73(3))B [R&thremacr;, Z = 3, a = 14.3508(8), 14.389(1) Å, c = 9.8777(9), 9.915(2) Å, respectively] and Zr(6)Cl(11.47(2))I(1.53(2))B [P4(2)/mnm, Z = 2, a = 12.030(1) Å, c = 7.4991(8) Å]. These are derivatives of the Zr(6)I(12)C and orthorhombic Zr(6)Cl(13)B structures, respectively, the latter containing unusual linear chains of clusters interbridged by Cl(i-i) that are in turn interconnected by three-bonded Cl(a-a-a) atoms. The random substitution of fractional Cl at specific I sites in the first two, and I for certain Cl in the third, was positionally resolved in all cases. The replacement always occurs at two-bonded X(i), so that single types of halogen are left in sites that interconnect clusters and generate the three-dimensional array. Structural changes seen in both structures are specifically related to relief of X.X crowding in the parent structure (matrix effects). Substitution of Cl for I(i) in the Zr(6)I(12)C type greatly reduces intercluster I.I repulsions and allows, among other things, a 0.20 Å (5.8%) reduction in Zr-I(a-i) intercluster bond lengths. Increased Cl.I repulsions caused by I substitution in orthorhombic Zr(6)Cl(13)B (Pnnm) convert the twisted chains and angular Cl(a-a-a) interchain bridges to planarity in tetragonal Zr(6)Cl(11.5)I(1.5)B. Phase widths found are 0