Transjugular intrahepatic portosystemic shunt combined with collateral vessel embolization in treatment of gastroesophageal variceal bleeding in liver cirrhosis： Research advances and controversies / 临床肝胆病杂志

Transjugular intrahepatic portosystemic shunt （TIPS） has been recommended as a treatment method for cirrhotic portal hypertension in domestic and foreign guidelines， but there is still uncertainty in its therapeutic efficacy. More and more studies have shown that TIPS combined with collateral vessel embolization （TIPS+E） has certain advantages in the treatment of gastroesophageal variceal bleeding in liver cirrhosis. This article reviews the major studies on TIPS+E in China and globally， summarizes related recommendations in guidelines and the current status of clinical application， and proposes the issues that need to be solved， such as indication， hemodynamic criteria， and selection of materials for embolization， and large－sample multicenter randomized controlled trials are needed for further clarification.

Features of acquired immune properties in innate immune cells and its roles in transplant rejection / 中华消化外科杂志

Transplant rejection involves natural immune cells and acquired immune cells. For decades, acquired immune cells have been dominating the study of transplant immunity. Researchers have found the surprising new features of innate immune cells, including immune memory, which may be of great significance to further improve graft survival. The short-term survival rate of grafts is very good, but the long-term graft outcomes are less so and most transplants are eventually lost to chronic rejection in the clinic. In animal models and clinical studies, innate immune cells, especially macrophages and natural killer cells, often predominate the chronic rejection process which lead grafts lost. Recent studies suggest that innate immune cells are capable of acquiring adaptive features in that they either directly recognize the allografts or become "trained" in the allogeneic milieu to further acquire features of memory and donor specificity. In selected transplant models, targeting the adaptive features of innate immune cells has been shown to promote long-term graft survival. Clearly, these findings highlight new therapeutic opportunities in further improvement of transplant outcomes as well as in treatment of cancers and autoimmune diseases in the clinic. The authors summarize the literature reports, introduce the recent acquired response characteristics of natural immune cells, and stimulate researchers to carry out more exploration in this field by fully discussing the heterogeneity and plasticity of natural immune cell types and the outstanding problems in related field.

Experimental study on α1 adrenergic receptor blocker in reducing portal hypertension in rats / 中华消化杂志

Objective:To observe whether α1 adrenergic receptor (α1AR) blocker can reduce and antagonize portal hypertension caused by α1AR activation in rats, and to provide a new approach for the clinical treatment of portal hypertension.Methods:Phenylephrine was chosen as α1AR agonist, and alfuzosin was used as α1AR blocker. The route of administration was portal vein injection, and the pressure was measured by trans-portal vein puncture. According to random number table, 32 male Sprague-Dawley rats were divided into 4 groups: control group, portal hypertension model group, alfuzosin treatment group and alfuzosin prevention group. The portal venous pressure (PVP) was measured in all rats before administration. The rats in the control group were injected with 0.9% sodium chloride solution (1 L/g), and the rats in portal hypertension model group were injected with phenylephrine(1.5 μg/g), and the PVP of the above two groups was measured again at 5 and 10 min after injection. The rats in alfuzosin treatment group were injected with phenylephrine(1.5 μg/g), PVP was measured again at 5 min after administration, and then the rats were given alfuzosin(0.9 μg/g), PVP was measured again at 5 min after administration. The rats in alfuzosin prevention group were injected with alfuzosin(0.9 μg/g), PVP was measured at 1 min after administration, and then the rats were given phenylephrine(1.5 μg/g), PVP was measured again at 1, 5 and 10 min after phenylephrine injection respectively. One way analysis of variance and Dunnett- t test were used for statistical analysis. Results:The portal vein puncture was successfully performed in 4, 6, 8 and 5 rats in the control group, portal hypertension model group, alfuzosin treatment group and alfuzosin prevention group, respectively. The PVP of rats in portal hypertension model group at 5 and 10 min after phenylephrine injection was (18.045±7.636) and (15.515±5.440) mmHg (1 mmHg = 0.133 kPa), respectively, which were both higher than that before administration ((8.452±2.830) mmHg), and the differences were statistically significant ( t=2.89 and 2.82, both P<0.05). At 5 min after alfuzosin injection, the PVP of rats in the alfuzosin treatment group was (10.088±3.743) mmHg, which was lower than that of rats at 5 min after phenylephrine injection ((16.146±4.324) mmHg) and that of portal hypertension model group at 10 min after phenylephrine injection, and the differences were statistically significant ( t=3.00 and 2.22, both P<0.05). There were no significant differences in PVP in the alfuzosin prevention group before administration, at 1 min after injection of alfuzosin, and at 1, 5 and 10 min after injection of phenylephrine (all P > 0.05). Conclusions:α1AR is an important factor involved in the regulation of PVP, and its blockers can reduce and antagonize the portal hypertension caused by α1AR activation, which is of great significance in the prevention and treatment of portal hypertension progression in liver cirrhosis.

Value of transjugular intrahepatic portosystemic shunt in the prevention of esophageal variceal rebleeding in patients with portal vein thrombosis after splenectomy / 临床肝胆病杂志

ObjectiveTo investigate the technical success rate and outcome of transjugular intrahepatic portosystemic shunt (TIPS) in preventing esophageal variceal rebleeding in patients with portal vein thrombosis (PVT) after splenectomy. MethodsA retrospective analysis was performed for the clinical data of 46 patients with PVT after splenectomy who were admitted to Shandong Provincial Hospital from December 2009 to January 2017 and underwent TIPS to prevent esophageal variceal rebleeding. According to the success or failure of TIPS, the patients were divided into TIPS success group with 38 patients and TIPS failure group with 8 patients. The two groups were compared in terms of postoperative variceal rebleeding, stent dysfunction, hepatic encephalopathy (HE), and survival. The paired t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier curve was used to analyze variceal rebleeding-free rate, stent patency rate, HE-free rate, and survival rate, and the log-rank test was used for comparison of cumulative rebleeding-free rate and cumulative survival rate. ResultsThe technical success rate of TIPS was 82.6%. There were significant differences in 6-, 12-, and 24-month cumulative rebleeding-free rates between the TIPS success group and the TIPS failure group (94.3%/89.8%/89.8% vs 85.7%/85.7%/28.6%, χ2=4.563, P=0.033). In the TIPS success group, the 6-, 12-, and 24-month cumulative stent patency rates were 79.3%, 74.3%, and 69.0%, respectively, and the 6-, 12-, and 24-month cumulative HE-free rates after TIPS were 72.1%, 55.5%, and 55.5%, respectively. There were significant differences in 6-, 12-, and 24-month cumulative survival rates between the TIPS success group and the TIPS failure group (94.0%/94.0%/86.2% vs 714%/71.4%/71.4%, χ2=4.988, P=0.026). ConclusionTIPS is a safe and feasible method for preventing esophageal variceal rebleeding in patients with PVT after splenectomy, and TIPS combined with a percutaneous transhepatic approach may promote technical success.

Clinical value of X-ray guided endoscopic gastrojejunostomy using stent ( with video) / 中华消化内镜杂志

Objective To evaluate the efficacy and safety of X-ray guided endoscopic gastrojejunostomy using stent in treatment of malignant gastric outlet obstruction ( GOO ) . Methods Six hospitalized patients with malignant GOO underwent X-ray guided endoscopic gastrojejunostomy using stent in the department of gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University between March 2017 and June 2017. The technical success rate, clinical success rate, procedure time, adverse events and follow-up were recorded and analyzed in this retrospective study. Results The stent was successfully placed in the 6 patients with 100％ ( 6/6) technical success rate. The mean procedure time was 91. 7±51. 8 min. After the procedure, all patients were fed liquid or semi-liquid diet, and the GOO score system was increased from 0-1 before operation to 2-3 after operation. The clinical success rate was 100％(6/6). Peritonitis was observed in 2 patients during operation, and resolved by abdominal drainage. Gastrointestinal bleeding occurred in 1 patient after operation, which was resolved with conservative treatment. During a mean follow-up period of 78. 6 days (range 32-100 days), there was no recurrence of obstruction symptoms except that 1 patient died because of tumor progress 60 days after procedure. Conclusion The X-ray guided endoscopic gastrojejunostomy using stent is feasible and safe to treat malignant GOO with a reliable short-term efficacy.

Analysis of 833 times measured hepatic venous pressure gradient / 中华肝脏病杂志

Objective@#To summarize and analyze the clinical data of hepatic venous pressure gradient (HVPG) and to explore the application value of HVPG in the diagnosis, evaluation and clinical treatment of portal hypertension in cirrhosis.@*Methods@#The patient data of HVPG measurement performed in Shandong Provincial Hospital from April 2010 to November 2017 were collected.@*Results@#A total of 633 patients with 833 times of HVPG measurements were included. There was significant difference in HVPG between patients with different etiologies, different Child-pugh grades and different degrees of decompensated cirrhosis.@*Conclusion@#The HVPG test is suitable for the diagnosis and evaluation of portal hypertension. The HVPG of patients with different severity of liver cirrhosis can guide the choice of the treatment plan, and the HVPG measurement should also be strictly standardized and quality control.

Clinical application of hepatic venous pressure gradient to predict early bleeding after esophageal variceal ligation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the predictive value of hepatic venous pressure gradient (HVPG) for early bleeding after esophageal variceal ligation (EVL) by analyzing the differences in HVPG in patients with and without post-EVL bleeding.</p><p><b>METHODS</b>The medical records of patients who had been diagnosed with cirrhosis and esophageal varices and who had pre-EVL HVPG measurement data were surveyed. The study population included 105 patients from October 2010 to March 2014. Data of HVPG value, previous treatment history, endoscopic manifestation, and whether bleeding and serious complications occurred within 2 weeks after the ligation procedure were investigated as independent risk factors.</p><p><b>STATISTICAL METHODS</b>included the chi-square test and Wilcoxon test, logistic regression modeling and receiver operating characteristic (ROC) analysis using the SPSS software version 16.</p><p><b>RESULTS</b>Only HVPG value was identified as an independent risk factor of early bleeding after EVL.According to the ROC analysis, the area under the curve (AUC) of HVPG for early bleeding after EVL was 0.866; when HVPG was more than or equal to 16 mmHg, AUC was 0.838. The sensitivity was 90.9% and the specificity was 76.4%.</p><p><b>CONCLUSION</b>HVPG is an independent factor of early bleeding after EVL and when HVPG cut-off value of more than or equal to 16 mmHg is used the predictive ability has certain accuracy and high sensitivity and specificity.</p>

Percutaneous transhepatic variceal embolization with 2-Octyl-Cyanoacrylate versus endoscopic cyanoacrylate injection for treatment of gastric variceal bleeding / 中华消化内镜杂志

Objective To compare the efficacy of a modified percutaneous transhepatic variceal embolization (PTVE) with 2-Octyl-Cyanoacrylate (2-OCA) and endoscopic variceal obturation (EVO) in preventing gastric variceal bleeding.Methods Seventy-seven patients with history of gastric variceal bleeding who underwent either EVO or PTVE were retrospectively reviewed.The rebleeding rate,survival rate and complications were compared between the two groups.Results EVO was performed in 45 patients; PTVE was performed in 32 patients.During the follow-up (19.78 ± 7.70 months in EVO group,vs.21.53 ± 8.56 months in PTVE group),rebleeding occurred in 17 patients (37.78％) of EVO group,and in 4 patients (12.5％) of PTVE group (P =0.028).The cumulative rebleeding free rate for EVO was 75％,59％,and 49％ in 1,2,and 3 years,respectively; 93％,84％,84％ for PTVE (P =0.011).There is no significant different in survival rate and the incidence of complications was similar in two groups.Conclusion Compared with EVO,PTVE with 2-OCA demonstrates advantage as an effective and safe method for gastric varices.

Efficacy of percutaneous transhepatic variceal embolization with TH glue for large gastric fundal variceal bleeding / 中华消化内镜杂志

Objective To investigate the efficacy of percutaneous transhepatic variceal embolization (PTVE) with Cyanoacrylate (TH glue) in treating large gastric fundal variceal bleeding.Methods PTVE was performed on 24 patients with TH glue injected into the main stem of left gastric vein and its fundic branches.The degree of varices in gastric fundus,rebleeding rate and survival rate after the procedure were compared with those before.Results Varices in gastric fundus were all embolized successfully with TH glue.The diameter of varices was reduced to below 5mm or disappeared in 20 patients (83.3％),and reduced to 5-10mm in the other 4 ( 16.7％ ) During the follow-up period of 3-36 months(mean 16.6 months),the rebleeding rate and mortality were 12.5 ％ ( 3/24 ),and 12.5 ％ (3/24),respectively.One patient died of liver cancer,and two others died of chronic liver failure.Conclusion PTVE with TH glue is of ideal therapeutic effect to block the feeding veins of large gastric fundal varices.

An immunohistochemical study of bFGF and COX2 after human brain contusion / 中国法医学杂志

Objective Study the changes of bFGF, COX2 after human severe brain injury and find an effective method for estimating time interval after brain injury.Method 35 brain tissue samples of severe brain injury were examined using immunohistochemical staining and image analysis technique to evaluate the expression of bFGF and COX2.Results Maximal bFGF expression was found at 0h after brain contusion. The intensity of bFGF staining decreased remarkably 12h after brain contusion and descended gradually to the minimum on the 11th day. Expression of COX2 positive cells increased significantly 12h after brain contusion and reached the maximum level one day after brain contusion. Then the expression decreased gradually from the 2nd day to almost aero on the 11th day.Conclusion The changes of bFGF and COX2 were regular along with various survival time after brain contusion so that bFGF and COX2 immunohistochemical staining can be used as a referential data for estimating time interval after human brain contusion.