[Effect of thrombolytic therapy and influencing factors of Budd-Chiari syndrome with inferior vena cava thrombosis].

Objective: To examine the effect of thrombolytic therapy of Budd-Chiari syndrome (B-CS) with inferior vena cava (IVC) thrombosis, and the prognosis factors of it. Methods: The clinical data of 67 patients of B-CS with IVC thrombosis treated in the Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2020 were analyzed retrospectively. There were 30 males and 37 females. The age was (47.7±11.1) years(range: 18 to 72 years). All patients received catheter directed thrombolysis, and the thrombolysis process, complications and outcomes were analyzed. All patients received IVC balloon angioplasty after thrombolytic therapy. The t test, χ2 test, Mann-Whitney U test were used for univariate analysis of the prognosis factors of thrombolysis effects, while unconditional Logistic regression model were used for multivariate analysis. Results: In the 67 patients, 47 cases succerssed in thrombolytic therapy. The successful rates of thrombolysis at 1-, 2-, 3- and 4-week were 9.0%, 29.9%, 64.2% and 70.1%, respectively. The rates of thrombolytic catheter-related infection at 1-, 2-, 3- and 4-week were 1.5%, 4.5%, 14.9% and 31.3%, respectively. No serious complications such as symptomatic and acute pulmonary embolism occurred during perioperative period of IVC balloon angioplasty. Univariate analysis showed that differences in thrombus length ((36.7±18.1) mm vs. (52.0±16.4) mm, t=-3.234, P=0.002), Child-Pugh classification (class A/B/C: 37/8/2 vs. 10/8/2, Z=-2.310, P=0.021) and pre-opening IVC proportion (68.1% (32/47) vs. 35.0% (7/20), χ²=6.313, P=0.012) were statistically significant. The thrombus length (OR=0.948, 95%CI: 0.913 to 0.984, P=0.005), pre-opening IVC (OR=5.451, 95%CI: 1.469 to 20.228, P=0.011) were independent prognosis factors of thrombolytic effect. Conclusions: Thrombolytic therapy for B-CS with IVC thrombosis were satisfactory, and the thrombolysis duration should be confined within 3 weeks. IVC balloon angioplasty is safe and effective for patients failing in thrombolysis, and pre-opening IVC is an important method to improve the thrombolytic effect.

Meta-analysis indicates that resistant starch lowers serum total cholesterol and low-density cholesterol.

The effects of resistant starch (RS) on serum cholesterol levels have been previously investigated. However, the results of those studies are inconsistent. The purpose of our meta-analysis was to determine if RS affects blood lipids based on the current literature. The methods included searching databases (PubMed, Embase, Scopus, and Cochrane Library) up to September 2017, as well as hand-searching reference lists of articles published in English. The initial search yielded 1228 articles. Of these, 14 articles (20 trials) were included in our investigation focusing on the effects of RS on total cholesterol (TC; 19 trials), triglycerides (TG; 19 trials), low-density lipoprotein cholesterol (LDL-C; 16 trials), and high-density lipoprotein cholesterol (17 trials). Methodological quality was assessed using TC, LDL-C, TGs, and high-density lipoprotein cholesterol. Pooled effects were calculated using a random-effects model. The meta-analysis of these data showed that RS supplementation has an effect on lowering TC and LDL-C (TC: mean difference, -7.33mg/dL [95% confidence interval -12.15 to -2.52mg/dL]; LDL-C: mean difference: -3.40mg/dL [95% confidence interval, -6.74 to -0.07mg/dL]). Subgroup meta-analysis revealed that a longer time (>4weeks) of RS supplementation can generate more obvious effects on TC and LDL-C levels, and higher dose (>20 g/d) of RS also had a lowering effect on TG level. Future research should focus on the relationship between RS type and cholesterol-lowering effects, and the effects on subjects of different health status or those with different baseline levels of serum lipids. Moreover, the mechanism for the cholesterol-lowering effects of RS should be further explored. In conclusion, RS can reduce serum TC and LDL-C levels, particularly when administered for a duration longer than 4 weeks.