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ObjectiveTo investigate the effect of probiotics on the risk of esophagogastric variceal bleeding (EVB) within 1 year in cirrhotic patients with gastroesophageal varices. MethodsA retrospective analysis was performed for the clinical data of 692 cirrhotic patients with gastroesophageal varices who were hospitalized in Beijing Ditan Hospital, Capital Medical University, from February 2008 to February 2017 and were followed up for more than 1 year. Among these patients, 346 patients who received probiotics during the 1-year follow-up were enrolled as probiotics cohort (probiotics group), and then, by using the 1∶1 propensity score method, 346 patients who did not receive probiotics treatment were enrolled as non-probiotics group after adjustment for Child-Pugh class, degree of varices, and red color sign. All patients were managed according to the primary prevention strategy recommended by related guidelines, and in addition, the patients in the probiotics group were given probiotic therapy. The incidence rate of EVB within 1 year was compared between the two groups. The t-test or the Mann-Whitney U 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. Univariate and multivariate backward Cox regression analyses were used to screen out the influencing factors for EVB. The Kaplan-Meier analysis was used to investigate the cumulative incidence rate of EVB in both groups, and the log-rank test was used for comparison. ResultsProbiotic therapy was an independent protective factor against EVB in cirrhotic patients (adjusted hazard ratio=0.510, 95% confidence interval: 0.299-0.870, P=0.013). A total of 61 patients experienced EVB during the 1-year follow-up, with 23 patients in the probiotics group and 38 in the non-probiotics group, and the probiotics group had a significantly lower cumulative incidence rate of EVB within 1 year than the non-probiotics group (6.6% vs 11.0%, χ2=4.045, P=0.042). The probiotics group had a significantly longer median time from baseline to the occurrence of EVB than the non-probiotics group ［137.0 (85.0-258.0) days vs 123.0(72.5-206.5) days, Z=-1.101, P=0.271］. ConclusionProbiotics can effectively reduce the incidence rate of EVB within 1 year in cirrhotic patients with gastroesophageal varices, with a tendency to delay the occurrence of bleeding events.
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BACKGROUND:Periprosthetic joint infection is a complication that is difficult to deal with after joint arthroplasty. Early diagnosis is the key to treatment. To find a fast response, high-sensitivity and high-specificity molecular biomarker can significantly optimize the diagnosis process of periprosthetic joint infection. OBJECTIVE:To monitor blood procalcitonin, interleukin-6 and lipopolysaccharide binding protein levels, to compare with blood leukocyte count and C-reactive protein levels, to identify above indexes, and to distinguish sensitivity and specificity of periprosthetic joint infection. METHODS: A total of 81 patients with pain after arthroplasty who were treated in Affiliated Hospital of Jining Medical Colege from January 2008 to December 2013 were enroled in this study. The repair surgery of al patients was divided into two stages. In the first stage, complete debridement and the instalation of temporary occupancy device were conducted. After 3 months averagely, two-phase reconstruction was performed. At 1 day before surgery, venous blood was colected. Calcitonin, interleukin 6, lipopolysaccharide binding protein, leukocyte count and C- reactive protein levels were detected. During the operation, synovial membrane and sample of false envelope around the prosthesis were colected. Bacterial and histological examinations were performed. The sensitivity and specificity were calculated using receiver operating characteristic curve. RESULTS AND CONCLUSION: One-way analysis of variance results showed that the receiver operating characteristic curve of lipopolysaccharide binding protein was bigger, 0.962; 95 confidence interval 0.924-1.000. Diagnostic value was optimal, and the critical value was 23.5 μg/L. These data suggested that when lipopolysaccharide binding protein exceeded 23.5 μg/L before surgery, periprosthetic joint infection would be identified. The receiver operating characteristic curve of C-reactive protein was 0.871. The receiver operating characteristic curve of leukocytes was close to 0.5. The diagnostic value of leukocyte count on periprosthetic joint infection was not great. These findings indicate that lipopolysaccharide binding protein has good application prospect in the diagnosis of periprosthetic joint infection after joint replacement, and shows high positive predictive rate and negative predictive rate of periprosthetic joint infection.