Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: Acute variceal bleeding (AVB) is life-threatening. We aimed to systematically review the current evidence regarding the efficacy and safety of terlipressin for AVB in liver cirrhosis. METHODS: We searched the PubMed, EMBASE, and Cochrane Library databases. The reference list was also hand-searched. Using a random-effect model, we combined the data obtained according to the different time points when the events developed. Odds ratio (OR) and weighted mean difference (WMD) were calculated. Quality of evidence was evaluated by the GRADE methodology. RESULTS: Thirty randomized controlled trials with 3344 patients were included. Compared with no vasoactive drug, terlipressin significantly improved the control of bleeding within 48 hours (OR = 2.94, P = .0008) and decreased the in-hospital mortality (OR = 0.31, P = .008). Compared with somatostatin, terlipressin had a significantly higher risk of complications (OR = 2.44, P = .04). Compared with octreotide, terlipressin had a significantly inferior control of bleeding within 24 hours (OR = 0.37, P = .007). Compared with vasopressin, terlipressin had a significantly lower risk of complications (OR = 0.15, P = .02). Compared with terlipressin combined with endoscopic variceal ligation, terlipressin alone had significantly higher 5-day treatment failure (OR = 14.46, P = .01) and transfusion requirements within 49 to 120 hours (WMD = 1.20, P = .002). No outcome was significantly different between terlipressin and sclerotherapy. Compared with balloon tamponade, terlipressin significantly decreased the 30-day rebleeding (OR = 0.05, P = .001) and transfusion requirements (WMD = -2.70, P = .02). Quality of evidence was very low to moderate. CONCLUSION: Our findings were in accordance with the current recommendations regarding terlipressin for the treatment of AVB in cirrhosis. However, due to low quality of evidence, further studies are recommended.

ABO blood type and risk of hepatocellular carcinoma: a meta-analysis.

BACKGROUND: ABO blood type is an invariant factor. There is a link between ABO blood type and some malignancies, such as gastric, pancreatic, and skin cancer. The role of ABO blood type in the pathogenesis of hepatocellular carcinoma (HCC) remains controversial. We performed a meta-analysis to explore the relationship between ABO blood type and risk of HCC. METHODS: Literature search was conducted among the PubMed, EMBASE, and Cochrane Library databases. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Seven papers were included. They included 92,847 healthy subjects, 5,463 patients with hepatitis, 294 cirrhotic patients, and 3,322 HCC patients. The proportion of blood type O was significantly lower in HCC patients than healthy subjects (OR = 0.76, 95%CI = 0.66-0.87, P < 0.0001) without any significant heterogeneity (P = 0.55, I2 = 0%). The proportions of blood types A, B, and AB were not significantly different between HCC patients and healthy subjects. The proportion of ABO blood type was not significantly different between patients with HCC and those with hepatitis or cirrhosis. CONCLUSION: HCC patients might have a lower proportion of blood type O than healthy subjects. Among the patients with chronic liver diseases, ABO blood type might not be associated with the risk of HCC.

[Gas chromatographic determination of micro organic impurities in 3-chloro-2-hydroxypropyl trimethyl ammonium chloride].

A simple, rapid and reliable method for the determination of micro organic impurities, epichlorohydrin and 1,3-dichloropropanol, in 3-chloro-2-hydroxypropyl trimethyl ammonium chloride (CHPTMA) by gas chromatography is reported. 2-Ethylhexanol was the internal standard. Epichlorohydrin and 1,3-dichloropropanol in CHPTMA were extracted by chloroform. The gas chromatographic separation was achieved on a stainless steel column packed with 10% PEG 20M/Chromosorb W/AW and with a flame ionization detector. The ranges of recovery were 97.5%-105.0% and 93.3%-98.8%, the RSDs were 11.5% and 13.1% and the mininum detectable concentrations were 5.0 micrograms/g and 10 micrograms/g for epichlorohydrin and 1,3-dichloropropanol respectively.