BACKGROUND This study aims to evaluate radiation exposure in patients with complete portal vein thrombosis (CPVT) or portal cavernoma (PC) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation using real-time ultrasound guidance for portal vein targeting. MATERIALS AND METHODS This is a single institution retrospective analysis. Between August 2009 and September 2018, TIPS was attempted in 49 patients with CPVT or PC. Radiation exposure (dose area product [DAP], air KERMA (AK) and fluoroscopy time [FT]), technical success, clinical success, complications and survival were analyzed. RESULTS In total, 29 patients had CPVT and 20 patients had PC. 41/49 patients had cirrhosis. TIPS indications were refractory ascites (n =  25), variceal bleeding (n = 16) and other (n = 8).  https://www.selleckchem.com/products/triparanol-mer-29.html  TIPS was successfully placed in 94% (46/49) of patients via a transjugular approach alone (n = 40), a transjugular/transhepatic approach (n = 5) and a transjugular/transsplenic approach (n = 1). Median DAP was 261 Gy * cm2 (range 29-950), median AK was 0.2 Gy (range 0.05-0.5), and median FT was 28.2 min (range 7.7-93.7). Mean portosystemic pressure gradient decreased from 16.8  ±  5.1 mmHg to 7.5  ±  3.3 mmHg (P  less then   0.01). There were no major procedural complications. Overall clinical success was achieved in 77% of patients (mean follow-up of 21.1 months). Encephalopathy was observed in 16 patients (34%), grade II-III encephalopathy in 7 patients (15%). TIPS revision was performed in 15 patients (32%). Overall survival rate was 75%. CONCLUSION In our experience, the use of real-time ultrasound guidance allowed the majority of the TIPS to be performed via a transjugular approach alone with a reasonably low radiation exposure considering the high technical difficulties of the selected cohort of patients with CVPT or PC.INTRODUCTION Erectile dysfunction (ED) was established to be linked to the risk factors of coronary artery disease such as metabolic syndrome, hypertension, diabetes, smoking, obesity and dyslipidemia. OBJECTIVE To study the influence of smoking and obesity on penile hemodynamics in patients with erectile dysfunction. PATIENTS AND METHODS This prospective study was carried out on 130 patients above 40 years and suffering from ED for more than 6 months. Selected patients were divided into four groups group 1 (nonsmokers/non-obese) N = 36, group 2 (nonsmokers/obese) N = 30, group 3 (smokers/non-obese) N = 34, group 4 (smokers and obese) N = 30. Other risk factors for ED were excluded except dyslipidemia. All patients were subjected to personal history, sexual history, history of medical disorders or operations, evaluation of erectile function using an abridged IIEF-5. Measuring of BMI, fasting lipid profile, blood sugar, TT, prolactin, and PSA was performed. Penile hemodynamics was evaluated using intracavernoscerning patient's response to ICI (p value 0.000). A significant negative correlation between BMI and total testosterone was recorded (p = 0.001). Regarding the mean value of testosterone, a significant difference was observed between the different four groups (p = 0.002). And a statistically significant difference was reported between group 1 and group 2 (p = 0.004) and group 2 and group 3 (p = 0.007). CONCLUSION Both smoking and BMI are strong risk factors for ED and affect response to ICI and penile duplex parameters (PSV, EDV, RI). Smoking and BMI together cause more deterioration of penile duplex parameters and response to ICI. The effect of smoking on EDV and RI was more than BMI. The effect of BMI on PSV, response to ICI and testosterone levels was more than smoking.BACKGROUND Predicting the prognosis of patients with adrenocortical carcinoma (ACC) is difficult, due to its unpredictable behavior. The aim of this study is to develop and validate a nomogram to predict survival outcomes in patients with ACC. METHODS Nomograms were established using the data collected from the Surveillance, Epidemiology, and End Results (SEER) database. Based on univariate and multivariate Cox regression analyses, we identified independent risk factors for overall survival (OS) and cancer-specific survival (CSS). Concordance indexes (c-indexes), the area under the receiver operating characteristics curve (AUC) and calibration curve were used to evaluate predictive performance of these models. The clinical use of nomogram was measured by decision curve analysis (DCA) and clinical impact curves. RESULTS A total of 855 eligible patients, randomly divided into training (n = 600) and validation cohorts (n = 255), were included in this study. Based on the independent predictors, the nomograms were established and demonstrated good discriminative abilities, with C-indexes for OS and CSS were 0.762 and 0.765 in training cohorts and 0.738 and 0.758 in validation cohorts, respectively. The AUC and calibration plots also demonstrated a good performance for both nomograms. DCA indicated that the two nomograms provide clinical net benefits. CONCLUSION We unveiled the prognostic factors of ACC and developed novel nomograms that predict OS and CSS more accurately and comprehensively, which can help clinicians improve individual treatment, making proper clinical decisions and adjusting follow-up management strategies.BACKGROUND The clinical values of inflammatory and nutritional markers remained unclear for gastric cancer with neoadjuvant chemotherapy (NACT). METHODS The inflammatory, nutritional markers and their changes were analyzed for locally advanced gastric cancer with NACT. The predictive value was evaluated by the Cox proportional hazards regressions under three hypothesized scenarios. The nomograms including independent prognostic factors were plotted for survival prediction. RESULTS A total of 225 patients were included in the study. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index, and hemoglobin (Hgb) were significantly reduced, and the body mass index was significantly increased after NACT (all P  less then  0.05). The pre-NACT NLR [hazard ratio (HR) = 1.176, P = 0.059] showed a trend to correlate with the overall survival (OS) when only pre-NACT markers available; The post-NACT Hgb (HR = 0.982, P = 0.015) was the independent prognostic factor when only post-NACT markers available; The post-NACT Hgb (HR = 0.