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Objective To compare the short term and long term efficacy of drugs combined with endoscopic therapy (ET) and transjugular intrahepatic portosystemic shunt (TIPS) in treatment of esophageal and gastric variceal bleeding (EGVB) in cirrhotic patients. Methods We reviewed 120 cases of patients admitted for acute esophageal and gastric variceal bleeding from January 2010 to December 2014, treated with drugs combined with endoscopy (n = 77) or TIPS (n = 43). The incidence of failure to control bleeding, long term rebleeding, mortality and complications were compared. Results Patients treated with TIPS had a higher probability of remaining free of bleeding or rebleeding than patients receving drugs+ET (59.7％ vs. 81.4％, P < 0.05). The incidence of hepatic encephalopathy in the drugs + ET group was lower than that in the TIPS group (13.2％ vs 27.9％, P < 0.05). There was no significant difference in the control of acute bleeding (96.1％ vs 97.7％, P > 0.05) and mortality (10.4％ vs. 4.7％, P > 0.05) between the two groups. Conclusions Both drugs+ET and TIPS surgery can control EGVB well, TIPS can better prevent the occurrence of rebleeding but will lead to a higher incidence of hepatic encephalopathy.
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<p><b>OBJECTIVE</b>To explore the effect of Salvianolate on myosin heavy chain (MHC) in cardiomyocytes of congestive heart failure (CHF) rats.</p><p><b>METHODS</b>Sixty male SD rats were divided into 6 groups according to random digit table, i.e., the normal control group (NCG), the model group, the Captopril group (CAG), the low dose Salvianolate group (LSG), the high dose Salvianolate group (HSG), the Captopril and high dose Salvianolate group (CSG), 10 in each group. CHF rat model was established with peritoneal injection of adriamycin in all rats except those in the NCG. Equal volume of normal saline was peritoneally injected to rats in the NCG, once per week for 6 successive weeks. Corresponding medication was started from the 5th week of injecting adriamycin. Rats in the CAG were administered with Captopril solution at the daily dose of 10 mg/kg by gastrogavage. Rats in the LSG and the HSG were administered with Salvianolate solution at the daily dose of 24.219 mg/kg and 48.438 mg/kg respectively by gastrogavage. Salvianolate was dissolved in 2 mL 5% glucose solution and administered by peritoneal injection. Rats in the CSG were peritoneally injected with high dose Salvianolate solution and administered with Captopril solution by gastrogavage. Two mL normal saline was peritoneally injected to rats in the model group, once per day for 8 successive weeks. Eight weeks later, the cardiac function and myocardial hypertrophy indices were detected by biological signal collecting and processing system. mRNA expression levels of alpha-MHC and beta-MHC in cardiac muscle were detected by fluorescence quantitative PCR. Expressions of protein kinase C (PKC) in cardiac muscle were detected by Western blot.</p><p><b>RESULTS</b>Compared with the normal control group, heart mass index (HMI) and left ventricular mass index (LVMI) obviously increased in the model group (P < 0.01). Compared with the model group, HMI and LVMI decreased in HSG, CAG, and CSG groups (P < 0.05, P < 0.01). It was more obviously lowered in the CSG group than in the CAG group (P < 0.05). Compared with the NCG, the mRNA expression level of alpha-MHC in cardiac muscle decreased, the mRNA expression level of p-MHC and the expression of PKC in cardiac muscle increased in the model group (P < 0.01). Compared with the model group, the mRNA expression level of alpha-MHC in cardiac muscle was increased, and the mRNA expression level of beta-MHC and the expression of PKC in cardiac muscle were decreased in HSG, CAG, and CSG groups (P < 0.05, P < 0.01). There was statistical difference between the CSG group and the CAG group (P < 0.05).</p><p><b>CONCLUSIONS</b>Salvianolate could up-regulate the mRNA expression level of alpha-MHC, and down-regulate the mRNA expression level of beta-MHC in cardiac muscle. Its mechanism might be related to decreasing the expression of PKC.</p>