Objective To investigate the application value of clinical typing in the treatment of BuddChiari syndrome (BCS).Methods The retrospective corss-sectional study was adopted.The clinical data of 95 patients with BCS who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to September 2015 were collected.Based on patients' compensation and clinical symptoms,3 clinical typing and 8 subtypes of BCS were proposed,and each subtype was treated with corresponding strategies.Observation indices included (1) the clinical typing of BCS,(2) selection of treatment,(3) treatment effect,(4) follow-up situations.Follow-up using telephone interview and outpatient examination was performed once within 3 months after the first treatment and then once every 6 months up to December 2015 or death,loss to follow-up and experienced decompensation.During follow-up,color Doppler ultrasound and blood bio-chemistry test were performed regularly,and CT angiography was also conducted when necessary.Count data were presented as the case or percentage.The survival rate was calculated using Kaplan-Meier method and the survival curve was drawn.Results (1) BCS clinical typing of 95 patients:4 were detected in type Ⅰ (3 in type Ⅰ a and 1 in type Ⅰ b),7 in typeⅡ (4 in type Ⅱa and 3 in type Ⅱb),and 84 in type Ⅲ(43 in type Ⅲa,4 in type Ⅲb,32 in type Ⅲc,and 5 in type Ⅲd).(2) Selection of treatment in 95 patients:① among the 3 patients with type Ⅰ a,2 of them received inferior vena cava balloon angioplasty while 1 patient had to give up the operation due to failure in opening the occlusion.This patient underwent close observation and follow-up afterwards.② The patient with type Ⅰ b underwent cavity-antrum artificial blood vessel bypass operation due to failure in opening the occlusion.③Among the 4 patients with type Ⅱ a,one of them underwent hepatic vein balloon angioplasty.The other 3 patients underwent close observation and follow-up because of failure in intervention therapy,such as segmental occlusion of hepatic vein or difficulty in finding the hepatic vein.④ Among the 3 patients with type Ⅱ b,due to the history of upper gastrointestinal bleeding,2 patients received modified spleen-lung fixation and intestine-cavity blood vessels bypass,respectively,and 1 patient received intestine-cavity artificial blood vessels bypass due to severe peritoneal effusion.⑤ Among the 43 patients with type Ⅲ a,35 patients underwent inferior vena cava balloon angioplasty due to failure in hepatic vein intervention therapy (6 of them received firstly thrombolysis treatment due to combined thrombosis.Four patients received inferior vena cava and hepatic vein balloon angioplasties.Another 4 patients received close observation and follow-up due to failure in both inferior vena cava and hepatic vein intervention therapy.⑥Among the 4 patients with type Ⅲ b,2 underwent inferior vena cava balloon angioplasty and intestine-cavity artificial blood vessel bypass.The other 2 patients only received modified spleen-lung fixation because of failure in inferior vena cava intervention therapy.⑦ Among the 32 patients with type Ⅲ c,3 underwent inferior vena cava and hepatic vein balloon angioplasties,and 27 patients underwent only inferior vena cava balloon angioplasty due to failure in hepatic vein intervention therapy (7 of them received balloon angioplasty following thrombolysis treatment due to combined thrombosis).On account of failure in both inferior vena cava and hepatic vein intervention therapy,2 patients underwent resection of lesion membranes and cavity-antrum artificial blood vessel bypass,respectively.⑧ Among the 5 patients with type Ⅲ d,1 underwent inferior vena cava balloon angioplasty and intestine-cavity artificial blood vessel bypass,and 4 underwent only modified spleen-lung fixation due to failure ininferior vena cava intervention therapy.(3) Treatment efficacy:of 95 patients,8 received followup observation,and 87 patients recovered to varied extent after interventional therapies and operations,with symptomatic relief of leg edema,ulcer,peritoneal effusion and esophageal varicosity.Eighty-seven patients went through the perioperative period safely,and no death occurred.The incidence of postoperative complications was 10.3％ (9/87).The complications mainly include venous thrombosis in lower limbs during catheter-directed thrombolysis therapy,pleural effusion,pneumatosis,and peritoneal effusion after surgery,all of which were cured after symptomatic treatment.(4) Follow-up results:87 were followed up for 3-42 months with an average time of 19 months.During the follow-up,5 patients (1 in type Ⅰ a and 4 in type Ⅲa) received recanalization surgery because of the reocclusion after the inferior vena cava balloon angioplasty,and no decompensation occurred.However,decompensation was found in 11 patients (disease progression in 4 patients and symptom relapse in 7 patients).The survival rates of patients without decompensation at 0.5,1.0,2.0 and 3.0 years after the first treatment were 96.5％,95.0％,83.4％ and 80.5％,respectively.Conclusion According to patients' compensation and clinical symptoms,clinical typing of BCS and treatment strategiesis are determined,and it will provide a satisfactory clinical efficacy.

Objective To investigate the development and influence factors of collateral circulation between spleen and lung in patients with portal hypertension after modified splenopneumopexy.Methods Data of 59 patients from January 2009 to December 2014 were analyzed,and the development of collateral circulation between spleen and lung after surgery were evaluated with ultrasound.Patients were divided into obvious collaterals group (maximum collateral diameter ≥ 2 mm,n =43) and non-obvious collaterals group (maximum collateral diameter ＜ 2 mm,n =16) according to ultrasound examination 3 months after surgery.Gender,age,type of disease,Child-Pugh classification,free portal pressure,portal vein diameter,splenic vein diameter,splenic artery diameter,splenic length,ejection fraction,forced vital capacity rate of one second (FEV1％),whether partial splenectomy was performed,and management of splenic upper pole were recorded and analyzed between the two groups.Results 3 months after surgery obvious collateral circulation could be observed in 43 patients,6 months after surgery the number increased to 53 (x2 =4.526,P ＜ 0.05).Splenic length (t =2.092) and FEV1％ (t =2.233) were significantly higher in obvious collaterals group (all P ＜ 0.05),and there were no statistical differences in gender (x2 =0.092),age (t =-1.254),type of disease (x2 =1.565),Child-Pugh classification (Z =-1.821),free portal pressur (t =0.912),portal vein diameter (t =0.008),splenic vein diameter (t =-0.485),splenic artery diameter (t =0.397),ejection fraction (t =-0.852),whether partial splenectomy was performed (x2 =0.002),and management of splenic upper pole (x2 =1.731) between the two groups (all P ＞ 0.05).Conclusions Obvious collateral circulation can develop between spleen and lung in patients with portal hypertension after modified splenopneumopexy,and the development of collateral circulation is associated with splenic length and FEV1％.

Background PM_2.5 pollution has become a widely concerned environmental health problem. Polycyclic aromatic hydrocarbons(PAHs) are the main harmful components of PM_2.5, and their sources and carcinogenic risk deserve attention. Objective To analyze the source apportionment of PAHs in ambient PM_2.5 in Fuzhou, and to evaluate the potential carcinogenic risk through inhalation due to exposure to PAHs. Methods In this study, two sampling sites were set up in Cangshan (industrial area) and Taijiang (commercial and residential area) districts in Fuzhou City. PM_2.5 was collected from 10th to 16th of each month from 2017 to 2020 by membrane filtration method. The concentrations of ambient PM_2.5 were measured by weighing, and the concentrations of 16 PAHs, including naphthalene(NAP), acenaphthylene(ACY), acenaphthene(ACE), fluorene(FLU), phenanthrene(PHE), anthracene(ANT), fluoranthene(FLT), pyrene(PYR), benzo[a]anthracene(BaA), chrysene(CHR), benzo[b]fluoranthene(BbF), benzo[k]fluoranthene(BkF), benzo[a]pyrene(BaP), indeno[1,2,3-cd]pyrene(IcdP), dibenzo[a,h]anthracene(DahA), and benzo[g,h,i]perylene(BghiP), were determined by ultra-high performance liquid chromatography coupled with diode array detector and fluorescence detector. The concentrations of PM_2.5 and PAHs were compared in the two districts and the concentrations of PAHs were also compared in different seasons. The diagnostic ratio [FLT/(FLT+PYR), IcdP/(IcdP+BghiP), BaA/(BaA+CHR), and BaP/BghiP] method and positive matrix factorization (PMF) analysis were used to determine the sources of PAHs in PM_2.5 in Fuzhou. The excess carcinogenic risk (ECR) model was used to assess the potential health risk of inhalation exposure to PAHs. Results During 2017–2020, the M (P₂₅, P₇₅) concentration of ambient PM_2.5 in Cangshan and Taijiang districts of Fuzhou were 35.0 (25.0, 47.5) and 34.0 (25.5, 46.0) μg·m⁻³ respectively, and the percentages of PM_2.5 exceeding the national standard in Cangshan and Taijiang were 2.68% and 4.17%, respectively, without significant differences (P＞0.05). The M (P₂₅, P₇₅) concentrations of ΣPAHs in Cangshan was 5.03 (3.07, 7.67) ng·m⁻³, higher than that in Taijiang, 3.20 (2.05, 5.59) ng·m⁻³ (P＜0.05). The M (P₂₅, P₇₅) concentrations of PAHs monomers except ACY, FLU, and ACE in Cangshan were higher than those in Taijiang (P＜0.05). The concentrations of ΣPAHs in PM_2.5 in four seasons in Cangshan were higher than those in Taijiang (P＜0.05). In both districts, the concentration of ΣPAHs in winter was higher than those in spring, summer, and autumn (P＜0.05). According to the diagnostic ratio method, the median ratios of FLT/(FLT+PYR) in the two districts ranged from 0.4 to 0.5, and those of IcdP/(IcdP+BghiP), BaA/(BaA+CHR), and BaP/BghiP were from 0.2 to 0.5, from 0.2 to 0.35, and less than 0.6, respectively. The results of PMF analysis showed the proportions of four factors in Cangshan were 37.9%, 13.2%, 24.0%, and 24.9%, respectively. The major load contributors to factor 1 included FLT, PHE, and PYR; to factor 2, FLU, ACY, and ACE; to factor 3, DahA; to factor 4, BghiP, IcdP, and BaP. The proportions of four factors in Taijiang were 23.6%, 19.3%, 22.0%, and 35.1%, respectively. The main load contributor to factor 1 was DahA; to factor 2, BghiP; to factor 3, FLT, PHE, and PYR; to factor 4, IcdP, BaP, BbF, BkF, CHR, and BaA. The benzo[a]pyrene equivalences (BEQ) in Cangshan and Taijiang districts were 1.87 ng·m⁻³ and 1.61 ng·m⁻³, respectively. The excess carcinogenic risks of PAHs through inhalation exposure was 3.83×10⁻⁶ and 3.30×10⁻⁶, respectively. Conclusion The complex sources of PAHs in ambient PM_2.5 include dust, vehicle emissions, industrial emissions in Fuzhou, and are different in selected two districts. The level of PAHs in ambient PM_2.5 may pose a potential carcinogenic risk to local population.