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Background:Gastrointestinal bleeding is caused by factors such as poor platelet and coagulation function,and damage to varicose veins during endoscopic secondary preventive treatment in cirrhosis patients with gastroesophageal varices.At present,there is no clear standard for the use of somatostatin and its analogues after endoscopic secondary preventive treatment.Aims:To investigate the clinical value of somatostatin in preventing rebleeding after endoscopic secondary prophylaxis in patients with gastroesophageal varices.Methods:Clinical data of cirrhotic patients with gastroesophageal varices underwent endoscopic secondary prevention(endoscopic variceal ligation,endoscopic injection sclerotherapy,endoscopic cyanoacrylate injection)from Sept.2020 to Aug.2023 in this region were retrospectively analyzed.And patients were divided into group A(conventional therapy)and group B(conventional therapy+somatostatin).The prognosis(rebleeding rate,mortality rate),treatment benefit(length of stay,hospitalization cost)and blood indicators of the two groups were compared.Results:There was no significant difference in bleeding rate 3 days and 6 weeks after surgery between group A and Group B(P>0.05),and no death occurred after surgery.Hospital stay and hospitalization cost in group A were significantly decreased than in group B(P<0.05).No significant difference in incidence of adverse reaction was found between the two groups(χ2=3.21,P>0.05).No significant differences in hemoglobin,platelets,creatinine and liver function Child grade 6 weeks after surgery in group A and group B were found when compared with before surgery(P>0.05),while D-Dimer level was significantly decreased(P<0.05).Conclusions:For patients with gastroesophageal varices,endoscopic secondary preventive surgery can be performed according to the characteristics of blood flow after preoperative CT examination,and somatostatin can be unnecessary after surgery to improve treatment compliance and reduce the economic burden of patients.
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Objective:To investigate the factors that affect the therapeutic effects of endoscopic radiofrequency ablation (Stretta procedure) on gastroesophageal reflux disease (GERD).Methods:Seventy patients with gastroesophageal reflux disease who received endoscopic radiofrequency ablation (Stretta procedure) treatment in Jinhua Hospital of Traditional Chinese Medicine from January 2016 to January 2019 were included in this study. They were divided into good prognosis group ( n = 57) and poor prognosis group ( n = 13) according to prognostic effects. The clinical data of all patients were collected, including gender, age, body mass index (BMI), course of disease, complications (hypertension, coronary heart disease, diabetes), smoking, drinking, Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores. Unconditional stepwise logistic regression was performed to analyze the factors that affect the therapeutic effects of Stretta procedure on GERD. Results:Univariate analysis results revealed that the proportion of patients aged ≥ 60 years with BMI ≥ 25 kg/m 2, alcohol abuse, HAMD score ≥ 8, HAMD score ≥ 7 was significantly higher in the poor prognosis group than in the good prognosis group ( χ2 = 9.574, 10.821, 22.575, 8.653, 10.586, 4.070, 8.653, all P < 0.05). Logistic regression analysis confirmed that female gender, age ≥ 60 years, BMI ≥ 25 kg/m 2, course of disease ≥ 5 years, alcohol abuse, HAMD score ≥ 8 and HAMA score ≥ 7 were the risk factors for poor prognosis of gastroesophageal reflux disease ( χ2 = 11.174, 6.023, 8.698, 5.972, 5.821, 7.485, 5.443, all P < 0.05). Consistency analysis revealed that gender, age, BMI, course of disease, alcohol abuse, HAMD score and HAMA score could be used to predict the therapeutic effects of endoscopic radiofrequency ablation (Stretta procedure) on GERD. Combined application of gender, age, BMI, course of disease, alcohol abuse, HAMD score and HAMA score exhibited higher consistency than a single application, 0.827 > 0.577, 0.533, 0.795, 0.547, 0.606, 0.434 and 0.547. Conclusion:There are many factors that affect the therapeutic effects of endoscopic radiofrequency ablation (Stretta procedure) on GERD, including gender, age, BMI, course of disease, alcohol abuse, HAMD score and HAMA score. This is of certain reference value for clinical treatment of GERD, and combined application of these influential factors has a high accuracy in the prediction of the therapeutic effects of Stretta procedure on GERD.
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Liver cirrhosis is the most common cause of portal hypertension. Portal hypertension can cause complications such as esophageal and gastric varices, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. For the standardized diagnosis and treatment of portal hypertension, we should pay attention to primary diseases and whole-course treatment, emphasize whole-course chain management including early screening and early diagnosis, active prevention, and reasonable emergency treatment, and formulate individualized and precise prevention and treatment plans for patients.
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Background: Liver cirrhosis complicated with esophageal and gastric variceal bleeding is a commonly seen critical illness. Gastrointestinal endoscopy is widely applied for bleeding control and prevention of rebleeding. Aims: To investigate the timing of re-treatment of endoscopic selective varices devascularization (ESVD) for treatment of esophageal and gastric varices presenting as Sarin type GOV1 and GOV2. Methods: Forty-eight cirrhotic patients with GOV1 or GOV2 varices and a history of bleeding admitted from October 2018 to September 2019 at Jinhua Municipal Central Hospital were enrolled and underwent ESVD therapy for secondary prevention. After the first ESVD procedure, patients were randomly allocated into two groups, and received the re-treatment 2 weeks (Group A) and 4 weeks (Group B) later, respectively. All patients were followed up for 6 months and the efficacy of ESVD, as well as the rebleeding rate and the mortality rate were compared between the two groups. Results: There was no significant difference in devascularization of varicose veins between Group A and Group B (76.9% vs. 81.8%, P>0.05). The incidence of rebleeding in Group A was significantly lower than that in Group B during the 6-month follow-up (11.5% vs. 36.4%, P<0.05). No death occurred in both groups. Conclusions: ESVD is effective for secondary prevention of GOV1 and GOV2 variceal bleeding. With regard to the timing of re-treatment, short-term (2 weeks postoperatively) re-treatment might reduce the probability of rebleeding because it could deal with the high risk and vulnerable bleeding vessels earlier.
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Background: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common critical illness in clinical practice. Early gastroscopic intervention may detect the bleeding lesion, and endoscopic treatment can be performed if necessary. Aims: To explore the value of ultra-early emergency gastroscopy (performed within 4 hours of bleeding) in patients with ANVUGIB. Methods: A total of 120 patients with ANVUGIB admitted from December 2019 to October 2020 at the Jinhua Hospital were recruited in this retrospective study. All patients received an emergency gastroscopy after admission. According to the timing of emergency gastroscopy, they were divided into three groups: ultra-early group (gastroscopy performed within 4 hours of bleeding), early group (gastroscopy performed within 4-24 hours of bleeding), and routine group (gastroscopy performed within 24-48 hours of bleeding). The detection rate of bleeding lesion and efficacy of endoscopic intervention were compared between the three groups. Results: The detection rate of bleeding lesion in ultra-early group was moderately higher than that in early group and routine group with no significant difference (94.6% vs. 89.7% and 86.4%, P>0.05). There were no significant differences in immediate hemostasis rate, rebleeding rate and mortality rate between the three groups (P>0.05). But the time of oral feeding, amount of blood transfusion, as well as the length and cost of hospital stay in ultra-early group were superior to those in early group and routine group (P<0.05). Conclusions: Ultra-early emergency gastroscopy within 4 hours of bleeding can increase the detection rate of bleeding lesion, accelerate the time of oral feeding, and reduce the amount of blood transfusion. It is beneficial for establishing definite diagnosis and may guide the treatment regimen in patients with ANVUGIB.
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Objective To construct sigF deletion mutant of Bacillus anthracis and the complementary strain of sigF deletion mutant in order to analyze the effect of losing sigF on formation of spores.Methods The spectinomycinadenyltransferase gene(spc) was inserted to replace sigF of B.anthracis by homologous recombination.A plasmid which contained sigF and sigF promotor was constructed and then transferred to the mutant to get a complementary strain of sigF deletion mutant.The characters of the mutant were analyzed by measuring growth curves, the ability of carbohydrate metabolism was compared, and spore formation was observed under a microscope.Results The sigF deletion strain A16D2△sigF was constructed from A16D2,which had a similar growth rate to the wild type A16D2 in logarithmic phase, but was not significantly different from the initial strain in the ability to use carbohydrates,although unable to form spores.The strain was found to maintain the state of asymmetric division by microfluidics experiment.Conclusion It is showed by this study that sigF is the essential gene of B.anthracis for spore formation, but not essential for vegetative growth.
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Objective To evaluate surgical treatment of severe liver injury.Methods Retrospective analysis on 52 patients with severe liver injury from October 2002 to April 2015 was made in accordance with liver damage by the American Institute of Traumatic Surgery (AAST),incorporated with imaging examinations and intraoperative findings.There were 19 cases of grade Ⅲ,27 of grade Ⅳ,6 cases of grade V.All patients were treated by surgery:simple suture in 4 cases,omentum tamponade in 16 cases,debridement hepatectomy was performed on 24 cases,hepatic segment resection in 2 cases,right liver resection in 1 case,peripheral hepatic gauze packing in 5 cases.Results 48 cases were cured,4 cases died.The cure rate was 92.3％ (48/52),mortality was 7.7％ (4/52),with one dying of right portal vein rupture and bleeding,3 of multiple organ failure.28 patients had one or more complications including postoperative hemorrhage in 3 cases,bile leakage in 6 cases,liver abscess in 5 cases,pleural effusion in 6,incision infection in 3 cases,and deep vein thrombosis of lower limbs in 2.Conclusions CT examination can identify type and degree of liver injury.Level Ⅰ-Ⅱ liver injury are recommended to nonoperative treatment,while level Ⅲ-V liver injury especially with hemodynamic instability or combined with other internal organs injury should be managed surgically.