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Background & Aims: Among individuals with Child-Pugh B cirrhosis and acute variceal bleeding (AVB), the Baveno VII workshop recommended pre-emptive TIPS in those with a Child-Pugh score of 8-9 and active bleeding at initial endoscopy (Child B8-9 + AB criteria). Nevertheless, whether this criterion is superior to the CLIF-Consortium acute decompensation score (CLIF-C ADs) remains unclear. Methods: Data on 1,021 consecutive individuals with Child-Pugh B cirrhosis and AVB from 13 university hospitals in China who were treated with pre-emptive TIPS (n = 297) or drug plus endoscopic treatment (n = 724) between 2010 to 2019 were retrospectively analysed. A competing risk regression model was used to compare the outcomes between the two groups after adjusting for confounders. The concordance-statistic for benefit (c-for-benefit) was used to evaluate a models’ ability to predict treatment benefit (risk difference between treatment groups). Results: Pre-emptive TIPS was associated with reduced mortality compared to drug plus endoscopic treatment (adjusted hazard ratio 0.62, 95% CI 0.44 to 0.88). A higher baseline CLIF-C AD score was associated with greater survival benefit (i.e., larger absolute mortality risk reduction). After adjusting for confounders, a survival benefit was observed in individuals with CLIF-C ADs ≥48 or Child-Pugh B8-9 with active bleeding, but not in those with CILF-C ADs

Background & Aims: Hepatic encephalopathy (HE) is a major complication after transjugular intrahepatic portosystemic shunt (TIPS) and is primarily influenced by the gut microbiota. We aimed to evaluate alterations in the microbiota after TIPS and the association between such alterations and HE. Methods: We conducted a prospective longitudinal study of 106 patients with cirrhosis receiving TIPS. Faecal samples were collected before and after TIPS, and the gut microbiota was analysed by 16S ribosomal RNA sequencing. Results: Among all patients, 33 developed HE (HE+ group) within 6 months after TIPS and 73 did not (HE- group), and 18 died during follow-up. After TIPS, the autochthonous taxa increased, whereas the potential pathogenic taxa decreased in the HE- group, and the autochthonous taxon Lachnospiraceae decreased in the HE+ group. Furthermore, synergism among harmful bacteria was observed in all patients, which was weakened in the HE- group (p

Introduction: Lenvatinib is the first-line treatment for advanced hepatocellular carcinoma (HCC). We aimed to compare the clinical outcomes of lenvatinib plus drug-eluting beads transarterial chemoembolization (DEB-TACE) versus lenvatinib alone in real-world practice. Methods: This retrospective analysis included 142 consecutive patients who received lenvatinib plus DEB-TACE and 69 patients who received lenvatinib alone as first-line treatment from 15 Chinese academic centers from Nov 2018 to Nov 2019. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR) evaluated by mRECIST criteria, and safety profiles were compared between the two groups. Results: The median OS and PFS were significantly longer in the combined therapy group than in the monotherapy group in whole cohort (median OS, 15.9 vs 8.6 months, p=0.0022; median PFS, 8.6 vs 4.4 months, p

Acute portal vein thrombosis (PVT) is rarely encountered by clinicians. The most common manifestation of acute PVT is sudden onset of abdominal pain. A computed tomography scan without contrast often shows a high-density material in the portal vein. After injection of contrast agents, absence of luminal enhancement and enlargement of the obstructed portal vein are shown. In this case report, we demonstrated a rare computed tomography finding in which the diameter of the main portal vein was enormously distended to 3-fold that of the aorta in a patient with recent PVT. Despite thrombolysis and anticoagulation were immediately given, portal venous recanalization was not achieved in the patient. After 5 years, variceal bleeding and ascites occurred and liver function had persistently deteriorated. Finally, he died of progressive liver failure. Considering this case, we suggest that an early decision for invasive interventional treatment might be necessary to both increase the rate of portal venous recanalization and improve prognosis, as anticoagulation and thrombolysis therapy failed to recanalize recent PVT.

The first enantioselective catalytic 1,2-hydroperoxidation has been achieved in the presence of PEG-600 using an acid-base bifunctional chiral squaramide as the organocatalyst, affording a range of enantioenriched α-N-substituted hydroperoxides bearing an oxindole moiety with excellent stereoselectivities (up to 99% ee). [ABSTRACT FROM AUTHOR]

The enantioselective conjugated addition of tritylthiol to in situ generated ortho-quinone methides (o-QMs) is catalyzed by an acid-base bifunctional squaramide organocatalyst. The transformation proceeds with high yield (up to 99%) and stereoselectivity (up to 97:3 e.r.) using water as solvent under mild conditions. The catalyst system provides a new strategy for the synthesis of optically active benzyl mercaptans. Control experiments suggested that o-QMs are generated by the tertiary amine moiety of the squaramide organocatalyst and that the water-oil biphase is crucial for achieving high reactivity and stereoselectivity. [ABSTRACT FROM AUTHOR]

A direct aldol reaction of free hydroxyacetone and activated ketone has been firstly achieved with a newly developed imidazole-based prolineamide catalyst. The adducts anti-1,2-diols bearing a chiral tertiary alcohol moiety were obtained in high yield (up to 92%) and stereoselectivity (up to 15:1 dr and 90% ee). [ABSTRACT FROM AUTHOR]

Transarterial chemoembolization (TACE) could achieve a better survival benefit than conservative treatment for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). In this retrospective study, all HCC patients with Child-Pugh score <7 and PVTT who were consecutively admitted to our center between January 2006 and June 2012 and underwent TACE were enrolled. The efficacy and safety of TACE were analyzed. Prognostic factors were determined by Cox regression analysis. Of the 188 patients included, 89% had hepatitis B virus infection, 100% were at Barcelona Clinic Liver Cancer stage C, and 81% (n = 152) and 19% (n = 36) were at Child-Pugh classes A and B, respectively. The incidence of procedure-related complications was 88%. No procedure-related death was found. The median overall survival was 6.1 months. Type of PVTT (hazard ratio [HR] = 2.806), number of tumor lesions (HR = 2.288), Child-Pugh class (HR = 2.981), and presence of metastasis (HR = 1.909) were the independent predictors of survival. In conclusion, TACE could be selectively used for the treatment of advanced HCC with PVTT. But a high rate of postoperative adverse events should not be undermined in spite of no procedure-related death. Preoperative type of PVTT, number of tumor lesions, Child-Pugh class, and metastasis could predict the prognosis of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Portal vein thrombosis (PVT) increases the risk of variceal rebleeding in liver cirrhosis. However, the strategy for preventing variceal rebleeding in cirrhotic patients with PVT has not been explored. This study aims to evaluate whether the transjugular intrahepatic portosystemic shunt (TIPS) or conventional therapy is preferable for the prevention of variceal rebleeding in liver cirrhosis patients with PVT. Methods and analysis: This is a randomised controlled trial comparing the safety and efficacy of TIPS versus conventional therapy (ie, endoscopic therapy combined with non-selective β-blockers and anticoagulants) for the prevention of variceal rebleeding in cirrhotic patients with non-tumoral PVT. A total of 50 cirrhotic patients with PVT (thrombus >50% of portal vein lumen occupancy) and a history of variceal bleeding will be stratified according to the Child-Pugh class and degree of PVT, and randomised into the TIPS and conventional therapy groups. The primary objective was to compare the incidence of variceal rebleeding between the two groups. The secondary objectives were to compare the overall mortality, variceal rebleeding-related mortality, portal vein recanalisation and complications between the two groups, and to observe the progression of PVT in patients without portal vein recanalisation. Ethics and dissemination: This study was approved by the ethics committee of Xijing hospital (No. 20110224-5), and was registered at ClinicalTrials.gov (NCT01326949). All participants give written informed consent. The first patient was recruited into our study on 4 June 2011. A total of 29 patients were recruited through 5 March 2013 (14 and 15 patients assigned to the TIPS and conventional therapy groups, respectively). If TIPS is superior to conventional therapy for the prevention of variceal rebleeding in cirrhotic patients with PVT, TIPS might be recommended as the first-line therapy in such patients. But a small sample size potentially limits the generalisation of our conclusions. Trial registration: This study was registered at ClinicalTrials.gov on 29 March 2011. The trial registration number is NCT01326949. Trial status: The first patient was recruited into our study on 4 June 2011. A total of 29 patients were recruited through 5 March 2013 (14 and 15 patients assigned to the TIPS and conventional therapy groups, respectively). [ABSTRACT FROM AUTHOR]

A novel interrogation of fiber Bragg grating (FBG) in a strain sensor, which is based on Er-doped fiber laser's transient regime, is reported. The applied strain on FBG changes the laser cavity loss, which in turn modifies the laser's transient regime. The strain value can be obtained by measuring the build-up time of the laser. This method translates wavelength shift information into time domain that can be accurately measured with low-cost electronic devices. In the experiment, the strain sensitivity can be adjusted by simply controlling the pumping level of the laser, a sensitivity of 1.66 μℇ/μs is achieved under fitful pumping level. © 2006 Wiley Periodicals, Inc. Microwave Opt Technol Lett 48:1904–1904, 2006; Published online in Wiley InterScience (www.interscience.wiley.com(. DOI 10.1002/mop.21773 [ABSTRACT FROM AUTHOR]

We proposed and demonstrated a room-temperature multiwavelength Yb-doped fiber ring laser with high stability based on a Mach-Zehnder interferometer by exploiting spatial hole burning and polarization hole burning effects, from which stable eight lasing wavelengths is obtained. The number of the lasing wavelengths (eight) is the most to our knowledge, and the wavelength spacing is 1.1 nm. Triple-, and dual-wavelength operation with the wavelength spacing of 1.1 nm or its integral multiples have been obtained by adjusting the intracavity polarization controllers. © 2008 Wiley Periodicals, Inc. Microwave Opt Technol Lett 50: 723–725, 2008; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.23206 [ABSTRACT FROM AUTHOR]

A letter to the editor about the case of 76-year-old male patient with hepatic hydatidosis who was diagnosed with cholangitis.

We present experiments of line and parallel configurations of hybrid erbium-doped fiber amplifiers/fiber Raman amplifiers (EDFAs/FRAs). For the line structure, a gain flatness of ±1.15 dB over a range of 47 nm (1483 to 1530 nm) is obtained. In the parallel configuration, the gain flatness is below ±2 dB for 1487 to 1507 nm and 1520 to 1550 nm. Using a high-birefringence fiber loop mirror as a signal reflector, a noise figure is less than 6 dB in the gain bandwidth. Then performances of different hybrid configurations are compared. [ABSTRACT FROM AUTHOR]