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Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis-related complications has been recognized during recent years. This paper aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis-related complications. Hepatobiliary Study Group of Chinese Society of Gastroenterology and Hepatology Committee of Chinese Research Hospital Association invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts' clinical experiences. Overall, 10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis - related complications were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute gastroesophageal variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction and bacterial infections, as well as in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin - related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis-related complications.
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Inflammatory bowel disease (IBD) is a multisystem disease, and pancreatic diseases in patients with IBD should be taken seriously in clinical practice. This article systematically elaborates on the research status of acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, pancreatic exocrine dysfunction, pancreatic cancer, and asymptomatic laboratory examination and imaging abnormalities in IBD patients and analyzes the diagnosis and treatment strategies for these diseases, so as to provide an important reference for clinical identification and treatment of such diseases.
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Bacterial infection is frequently seen in patients with liver cirrhosis,and the most common type of bacterial infection is spontaneous bacterial peritonitis (SBP).In clinical practice,antibacterial agents are widely used in the treatment of SBP.In addition,antibacterial agents can reduce rebleeding and mortality rates in patients with upper gastrointestinal bleeding.However,in order to avoid bacterial resistance,the appropriate use of antibacterial agents is very important.This article reviews the indications and resistance of antibacterial agents in patients with liver cirrhosis.
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Pancreatic encephalopathy (PE)is a serious complication of pancreatitis,with difficulties in early diagnosis and poor prognosis. This article introduces the possible pathogenesis of PE involving pancreatin activation,cytokines,infection,water and electrolyte imbalance, and vitamin deficiency,summarizes the clinical manifestations and laboratory features of PE,and points out that the clinical manifestations of PE lack specificity and there are no reliable biochemical indices or diagnostic criteria.This article also elaborates on the diagnosis and treat-ment strategies for PE and points out that the key to PE treatment is active and effective treatment of the primary disease.Most PE patients are improved with the control of pancreatitis.
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Esophageal variceal bleeding is a major complication of liver cancer and a major cause of death in patients with liver cancer.This article summarizes the current status of the treatment of liver cancer complicated by esophageal variceal bleeding, including drugs and endoscopic and interventional treatment, with an emphasis on treatment options for liver cancer complicated by esophageal variceal bleeding.
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Objective To determine the prevalence and clinical features of peripancreatic vascular abnormalities in patients with pancreatitis.Methods The clinical data of 102 pancreatitis patients between January 2013 to December 2014 in the General Hospital of Shenyang Military Command who underwent contrast enhanced CT or contrast enhanced MRI scans were retrospectively analyzed.The radiological features of peripancreatic vascular abnormalities in such patients were examined, and the clinical features of pancreatitis patients with or without peripancreatic vascular abnormalities were investigated.Results Peripancreatic vascular abnormalities were found in 18 patients(17.6%), and vascular abnormalities were relatively common in portal vessels.No significant differences were observed on the age at onset, gender ratio, smoking status, alcohol consumption and length of stay between patients with and without peripancreatic vascular abnormalities.Compared with those without peripancreatic vascular abnormalities, patients with peripancreatic vascular abnormalities had a significantly higher incidence of peripancreatic fluid collection, pancreatic pseudocyst and gastric varices, and the differences were statistically significant(all P<0.05).Conclusions Peripancreatic vascular abnormalities can be complicated with pancreatitis.Enhanced CT or enhanced MRI were valuable in the diagnosis.Pancreatic pseudocyst, peripancreatic fluid collection and gastric varices were more common in pancreatitis complicated with peripancreatic vascular abnormalities.
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Peutz-Jeghers syndrome [PJS] is characterized by scattered black pigmentations on fingers and lips and multiple polyps in the gastrointestinal tract. Patients with PJS often have severe complications secondary to multiple large polyps. Herein, we present a young woman complicated with a large polyp in her colon without any clinical symptoms. We also emphasized the necessity of early diagnosis and treatment of multiple polyps in such patients
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Pancreatic cancer has a high degree of malignancy and a poor prognosis, and at present, early diagnosis of pancreatic cancer is very difficult. This article reviews the changes in molecular biological characteristics in the development, progression, and metastasis of pancreatic cancer and related mechanisms and determines the potential targets for clinical diagnosis of pancreatic cancer. This article also summarizes the clinical manifestations of pancreatic cancer, high-risk factors, tumor markers, and the role of combined determination and new equipment in early diagnosis, and points out that the application of serological and radiological examinations and identification of new tumor markers are important methods to improve the early diagnosis of pancreatic cancer in clinical practice.
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Liver cirrhosis is a common gastrointestinal disease. Portal vein thrombosis( PVT ) can increase the mortality of patients with liver cirrhosis. Studies showed that increased D-dimer level,spleen thickness and Child-Pugh score are independent risk factors of PVT in liver cirrhosis. In addition,increased portal vein diameter,reduced portal vein blood velocity,elevated P-selectin level can predict the development of PVT after portal hypertension surgery. This article reviewed the advances in study on risk factors of PVT in liver cirrhosis.
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ObjectiveTo systematically evaluate the efficacy of mirabilite umbilical compress in the treatment of ascites in liver cirrhosis. MethodsThe literature on the treatment of cirrhotic ascites with mirabilite umbilical compress was searched in CNKI, VIP, Wanfang Data, and PubMed databases. A meta-analysis was carried out using the random effect model. The continuous and categorical data were expressed as aas standard mean difference (SMD) and odds ratio (OR), respectively. ResultsA total of 11 randomized controlled trials were included. The mirabilite umbilical compress treatment group showed a significantly higher response rate of ascites (OR=3.19, P＜0.0001) and significantly reduced abdominal circumference (SMD=1.69, P＜0.0001) and body weight (SMD=2.77, P＜0.0001) compared with the control group. After mirabilite umbilical compress treatment, alanine transaminase level was significantly decreased (SMD=1.92, P=00009), albumin level was significantly increased (SMD=-1.78, P=0.0006), while aspartate aminotransferase and total bilirubin levels showed no significant changes (SMD=3.39, P=0.25). ConclusionMirabilite umbilical compress is effective in the treatment of ascites in liver cirrhosis, yet its efficacy in improving liver function remains uncertain.
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Budd-Chiari syndrome (BCS) is characterized by the hepatic outflow obstruction from the small hepatic vein to the superior hepatic inferior vena cava. Portal vein thrombosis (PVT) refers to the development of thrombosis in the main portal vein, with or without thrombosis in the superior mesenteric or splenic vein. A large number of studies have shown that prothrombin (factor II, F2) G20210A mutation is related to BCS and PVT. F2 and its G20210A mutation are introduced, the effect of F2 G20210A mutation on thrombosis is reviewed, and the prevalence of F2 G20210A mutation in China is analyzed. An attempt is made to focus on the association of F2 G20210A mutation with PVT and BCS. It is believed that F2 G20210A mutation to some extent increases the risk for PVT and BCS. However, the prevalence of F2 G20210A mutation is extremely low in the Chinese population. Thus, this mutation may not be regarded as the cause of PVT and BCS in China.
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Objective To investigate the effect of gemcitabine on the cell cycle and apoptosis of the human pancreatic cancer cell line MiaPaCa-2 with Beclinl gene silencing.Methods siRNA targeting at Beclinl gene was constructed,then it was inserted into an expression vector and transfected into MiaPaCa-2 cells.The Beclinl mRNA and protein expression were detected by RT-PCR and Western blot.Gemcitabine was used to treat MiaPaCa-2 with Beclinl gene silencing,then the cell cycle and apoptosis were detected by flow cytometry.Results The MiaPaCa-2 cells with Beclinl gene silencing were successfully constructed,and the expression of Beclin1 mRNA was decreased from 1.0 in control group to 0.295,and number of cells in S and G2 phase was decreased,but number of cells in G1 phase was increased,and there was no change in apoptosis.After gemcitabine treatment,number of cells in S phase was further decreased,but number of cells in G1,G2 phase was increased,and apoptosis was inhibited.Conclusions Beclinl gene silencing can change the cell cycle of pancreatic cancer cells MiaPaCa-2,and influence the effects of gemcitabine on cell cycle and apoptosis.
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Objective To investigate the ability of induction of specific cytotoxic T lymphocytes (CTL) stimulated by dendritic cells (DCs) co-transfected with MUC1 and survivin mRNA of human pancreatic cancer,and to provide the experimental basis for the treatment of human pancreatic cancer with multi-epitope DC vaccine.Methods DCs were isolated and cultured from peripheral blood mononuclear cells (PBMCs) of 6 patients with pancreatic cancer.Human pancreatic cancer cell line MiaPaCa-2 was routinely cultured,after being transcripted and amplified by RT-PCR,MUC1 and survivin mRNA were co-transfected or individually transfected into DCs by electroporation,and they were named as DC-MUC1,DC-survivin,DC-MUC1 + survivin.The expression of MUC1 and survivin mRNA in DCs were detected by real-time PCR.The survival rate of transfected DCs were determined by MTT method.The lymphocyte proliferation ability was evaluated by mixed cell culture method.The Th1 cytokine releasing of antigen-specific CTLs were measured by ELISA assay.Results Mature DCs were obtained,the positive expression rates of surface markers CD40,HLA-DR,CD83 and CD86 were 34.31％,50.21％,89.17％ and 73.62％,respectively.The expression amount of MUC1 mRNA of DC-MUC1 was 36.24 ± 5.17,and the expression amount of survivin mRNA of DC-survivin was 34.53 ± 4.02,while the expression amounts of MUC1,survivin mRNA of DC-MUC1 + surviving were 31.79 ±4.26 and 14.67 ± 2.96,which were significantly lower than that in individual transfection group (P ＜ 0.05).The survival rate of DC-MUC1 + surviving was decreased in a time dependent manner,which was significantly lower than that in individual transfection group (about 50.21％ vs 80％ at 24 h,P ＜0.05).When DC/T cells ratio was 1∶ 10,1∶ 20,the autologous T cell proliferation index of MUC1 and survivin mRNA in co-transfection DC group was significantly higher than that in individual transfection group (P ＜ 0.05) ;when DC/T cells ratio was 1∶ 40,1∶ 80,the difference of proliferation index was not statistically significant.When DC/T cells ratio was 1∶ 10,after 14 d culture,the expressions of IL-2 in DC-MUC1,DC-survivin,DC-MUC1 + surviving were (892.73 ± 32.9),(713.62 ± 56.37),(1884.37 ± 95.21) pg/ml,and the expressions of granzyme B were (501.62 ± 12.30),(203.84 ± 12.55),(1193.15 ± 86.04) pg/ml ; and the expressions of IFN-γ were (981.50 ± 47.82),(696.05 ± 41.66),(2237.94 ± 189.55) pg/mL.The corresponding values in DC-MUC1 + surviving group were significantly higher than those in individual transfection group (P ＜ 0.05) ; while the difference of IL-10 was not statistically significant.Conclusions DCs co-transfected with MUC1 and survivin mRNA have a stronger ability to stimulate specific CTL in vitro than individual antigen loaded DCs.
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Objective To understand the characteristics of common causes of acute pancreatitis (AP) in China and evaluate the association of the aetiology with gender and mortality.Methods The relevant literature was searched by the China journal full-text database (CNKI),Wanfang database,Weipu database and other databases and proceeding.Based on collecting data retrieval strategy,according to the inclusion criteria selection literature,Meta analysis was performed mainly for gallstone,hyperlipidemia,alcohol and other AP from the aspects of gender and case fatality rate.Results The Meta analysis included 11 articles which were accordance with the criteria,involving 13 601 patients,including 6 732 cases of biliary AP,1 372 cases of hyperlipidemia AP and 1 169 cases of alcohol AP.The Meta analysis showed that biliary AP male to female ratio was 0.79 ∶ 1,hyperlipidemic AP male to female ratio was 1.54 ∶ 1,alcoholic AP male to female ratio was 10.47 ∶ 1,overeating AP male to female ratio was 1.29 ∶ 1,and there was significant difference (P ＜ 0.05).Alcoholic AP mortality rate was the highest,which was 2.81 times than the biliary AP and 2.46 times than the hyperlipemic AP,and there was significant difference (P ＜0.05).Conclusions Biliary tract disease is the main etiologic cause of AP in China,and there are more females than males.The mortality rate of alcoholic pancreatitis is the highest,and there are more males.But we should investigate further high-quality,large-scale trails in patients with AP.
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Objective To investigate the specific anti-tumor immune response induced by dendritic cells (DCs) transfected with total RNA of human pancreatic cancer Capan-2 cells.Methods DCs were isolated and cultured from peripheral blood mononuclear cells (PBMCs) derived from six patients with pancreatic cancer.Total RNA of Capan-2 cells and MUC4 mRNA were transfected into DCs by electroporation.The survival rate of transfected DCs was determined by MTT method and the expression of MUC4 mRNA in DCs was detected by Western blotting.The activity of cytotoxic T lymphocyte cells (CTLs) induced by DCs transfected with total RNA of Capan-2 cells were evaluated by IFN-γ ELISA and the induction of specific CTL response to the killing effect on pancreatic cancer cell in vitro were measured by 51 Cr standard cytotoxicity test.Results The survival rate of DCs transfected with total RNA of Capan-2 cells (DC-Capan-2-total RNA) showed a decrease in a time dependent manner and the survival rate was reduced to 60.81％ after transfection for 96 h.The survival rate of MUC4 mRNA transfection DCs (DC-MUC4 mRNA) was stable at around 80％.The difference of DCs surviral rate between the two groups was statistically significant (P ＜ 0.05).The amount of MUC4 protein expression of DC-Capan-2-total RNA was significantly lower than that of DC-MUC4 mRNA (P ＜0.05).The quantity of CTL IFN-γ release induced by DC-Capan-2-total RNA was (89.34 ± 3.85)U/mL and the quantity of DC-MUC4 mRNA induced CTL IFN-γ release was (21.77 ± 21.77)U/ml There was statistically significant between the two groups (P ＜0.05).In addition,the specific CTLs induced by DC-Capan-2-total RNA could effectively identify and kill the HLA-A2+/MUC4+ Capan-2 and the HLA-A2+/MUC4-PANC 1 cells,and could not effectively identify and kill the HLA-A2 /MUC4-MiaPaCa-2 cells and the HLA-A2-/MUC4 + AsPC-1 cells.Conclusions A more pronounced CTL anti-tumor immune response can be induced by DCs transfected with total RNA of Capan-2 cells compared with a single tumor associated antigen,but it is limited by MHC class Ⅰ antigen presented.
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Objective To observe the inhibitory effect on lymph node metastasis of pancreatic cancer and lymphangiogenesis in mice by injection of KAll gene within xenograft tumor.Methods Pancreatic cancer cell line MiaPaCa-2 wag used to construct the nude mice models bearing tumors,then the mice were divided into normal saline group,Ad group and Ad-KAI1 group.Since the successful model construction,normal saline,Ad,Ad-KAI1 was injected every week for 3 times,respectively in the three groups,then the tumor size was documented.50 d after model construction,the tumor and enlarged lymph nodes were collected and subjected to pathological exam,and the expression of LYVE-1 and the MLVD in xenograft tumor was detected by immunohistochemistry.Results Two weeks after MiaPaCa-2 implantation,the model was 100％ successfully constructed.The growth curve of subcutaneous tumor among 3 groups was not statistically significant (P＞0.05) ; the weights of subcutaneous tumor in the 3 groups were (2514.4 ±351.3),(2466.1 ± 295.5),(2294.4±255.4) mg after 50 d,and the difference among the 3 groups was not statistically significant (P ＞0.05).Enlarged lymph nodes metastasis was observed in 8 mice (80％) in normal saline group,and 20 lymph nodes were collected,with 2.0 lymph nodes per mice; and enlarged lymph nodes metastasis was observed in 7 mice (70％) in Ad group,and 15 lymph nodes were collected,with 1.5 lymph nodes per mice; while enlarged lymph nodes metastasis was observed in 4 mice (40％) in Ad-KAI1 group,and 6 lymph nodes were collected,with 0.6 lymph nodes per mice.All the lymph nodes were confirmed to be metastasis of the primary tumor after pathologic exam.The difference of lymph nodes metastasis,number of lymph nodes metastasis per mice among the 3 groups was statistically significant (F =3.14,3.35,P ＜ 0.05).The MLVD of subcutaneous tumor among the 3 groups was (18.70 ± 5.60),(19.40 ± 4.58),(9.80 ±4.10)/400 times magnification,the MLVD of Ad-KAI1 group was significantly lower than those in normal saline group and Ad group (F10.76,11.36,P ＜ 0.05),but the difference between normal saline group and Ad group was not statistically significant.Conclusions KAI1 can inhibit the lymph node metastasis of pancreatic cancer,and the mechanism may be related with decreased lymphangiogenesis and reduced lymphatic vessel density.
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Objective To observe the expression of forkhead or winged helix transcription 3 (Foxp3) in colon cancer tissue and paracancerous tissue,and detect the level of serum interleukin (IL)-17 in colon cancer patients and healthy human,to explore the changes of regulatory T cell (Treg cell) and Th17 cell in the process of occurrence and development of colon cancer.Methods The expression of Foxp3 in 56 patients with colon cancer and paracancerous tissue and 15 cases with normal colon tissue was measured by immunohistochemical SP method and the level of serum IL-17 was determined by enzyme-linked immunosorbent method.Results The level of serum IL-17 in colon cancer tissue was higher than that in normal colon tissue [(9.1 ± 2.3) ng/L vs.(6.2 ± 1.5) ng/L],and there was significant difference (P =0.007).Foxp3 positive cell number in colon cancer tissue was more than that in normal colon tissue and paracancerous tissue (24.1 ± 6.4 vs.2.7 ± 1.1 and 8.7 ± 2.3),paracancerous tissue was more than normal colon tissue,and there was significant difference (P ＜ 0.01).The level of serum IL-17 in colon cancer tissue with TNM Ⅲ was higher than that in TNM Ⅰ-Ⅱ [(8.5 ± 2.1) ng/L vs.(5.4 ± 0.9) ng/L],Foxp3 was more than that in TNM Ⅰ-Ⅱ (25.8 ± 6.2 vs.18.2 ± 4.4),and there was significant difference (P＜ 0.01).There was no significant difference in the level of serum IL-17 between middle-high differentiated adenocarcinoma and low differentiated adenocarcinoma [(9.4 ± 1.1) ng/L vs.(8.9 ± 1.8) ng/L] (P ＞ 0.05).Foxp3 in middlehigh differentiated adenocarcinoma was more than that in low differentiated adenocarcinoma (26.8 ± 5.5 vs.17.2 ± 3.2),and there was significant difference (P ＜ 0.01).Conclusions Detection of IL-17 and Foxp3 can provide a new way of targeting therapy for colon cancer.IL-17 levels and Foxp3 expression are closely related to the immune status of local tumor tissues,the joint detection is benefitial to the further understanding of the patients with tumor immune state,provide basic information for tumor immunotherapy.
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Pancreatic cancer is a common malignant neoplasm of the pancreas with an extremely high mortality.Currently,the early diagno-sis of pancreatic cancer is still not ideal.Attention should be paid to some clinical warning symptoms,such as unexplained abdominal and back pain,jaundice,and unexpected diabetes.Additionally,the combined use of CA19-9,CEA,and other tumor markers,the attention to biochemical indicators,the detection of mutation in KAI1 or p53 gene,and the exploration of the value of miRNA in clinical diagnosis are of great significance.On the other hand,ultrasound,CT,MRCP,ERCP,PET-CT,and other imaging methods,as well as effective col-lection of cytology specimens,should be performed.Thus,there is hope for the early diagnosis of pancreatic cancer.
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Objective To compare the clinical efficacy of endoscopic variceal ligation versus pericardial devascularization in the treatment of portal hypertension.Methods The clinical data of 101 cirrhotic patients with gastroesophageal varices and variceal hemorrhage from January 2010 to January 2012 were analyzed.Fifty-three patients received endoscopic variceal ligation,and forty-eight patients received pericardial devascularization.Postoperative changes in liver function and hypersplenism were compared between the two groups.The rate of rehaemorrhagia and incidence of postoperative complications after surgery were compared as well.Continuous data were expressed as mean ±SD,and categori-cal data were expressed as number of cases or percentage.Comparison of continuous data between the two groups was made by independent-samples t test,and comparison of categorical data was made by chi-square test.Results After surgery,the variceal ligation group showed no significant changes in liver reserve function,while the albumin level was significantly decreased in the pericardial devascularization group (t=2.512,P0.05),but significant increases in the counts of white blood cells and platelets were detected in the pericardial devascular-ization group (P0.05), 6 months,7.5%vs 8.3%(χ2 =0.021,P>0.05),and 1 year,9.4%vs 8.3%(χ2 =0.038,P>0.05).The incidence rates of postopera-tive complications in the two groups were 24.5%and 50%,respectively (χ2 =7.040,P<0.05).Conclusion Compared with pericardial devascularization,endoscopic variceal ligation causes fewer microlesions,preserves liver function,and leads to a lower incidence of postopera-tive complications.However,if hypersplenism is observed in the cirrhotic patients with gastroesophageal varices and variceal hemorrhage,peri-cardial devascularization can be used to control the hypersplenism and prevent esophageal hemorrhage.